突发公共卫生事件与政府应急能力建设

政府如何加强应急体系建设,提升应对突发公共卫生事件的能力,是关系社会秩序能否稳定和谐的重大问题。为此应在坚持行政应急性原则的基础上,从公共卫生应急资源的准备供给、管理供给和补偿供给三方面形成实现应急能力的支持系统,以消解突发公共卫生事件所引发的社会影响或动荡。     

突发公共卫生事件与政府应急能力建设

政府如何加强应急体系建设,提升应对突发公共卫生事件的能力,是关系社会秩序能否稳定和谐的重大问题.为此应在坚持行政应急性原则的基础上,从公共卫生应急资源的准备供给、管理供给和补偿供给三方面形成实现应急能力的支持系统,以消解突发公共卫生事件所引发的社会影响或动荡.     

“新冠肺炎”疫情中的思考:心理干预的“危”与“机”

一场突如其来的新型冠状病毒感染的肺炎(以下简称“新冠肺炎”)疫情,既是对中国社会治理体系、应急管理体系、公共卫生体系、临床医疗体系的一次重大挑战,也是对这些体系多年来建设成效的一次考验。站在本专业角度来看,当然也是对我国心理危机干预体系建设与发展的一次检验。     

“新冠肺炎”疫情中的思考:心理干预的“危”与“机”

一场突如其来的新型冠状病毒感染的肺炎(以下简称“新冠肺炎”)疫情,既是对中国社会治理体系、应急管理体系、公共卫生体系、临床医疗体系的一次重大挑战,也是对这些体系多年来建设成效的一次考验。站在本专业角度来看,当然也是对我国心理危机干预体系建设与发展的一次检验。     

构建21世纪美国公共卫生体系的原则

美国卫生与福利部长沙拉拉博士在一次演讲中提出了构建２１世纪美国公共卫生体系的十大原则,这些原则包括公共卫生与信息革命;大力发展预防医学;医学研究;消除卫生保健的悬殊状况;新世纪卫生人卫生人培养;保护大学生卫生中心以及医学伦理学等主要内容。这些原则对我们思考规划２１世纪的医疗卫生体系及医学教育系不无借鉴启迪意义。     

"非典"重大突发公共卫生事件的思考

“非典”属于重大突发公共卫生事件,它不仅是卫生部门的事情,而且环保、公安等部门都兼负有责任。在抗击“非典”的过程中,我国政府在各方面都做出很大的努力,也取得了明显的效果。《突发公共卫生事件应急条例》的颁布,标志着我国进一步将突发公共卫生事件应急处理工作纳入法制的轨道,将促使我国突发事件应急处理机制的建立和完善。     

中国健康城市建设的进展及理论思考

中国健康城市的建设走过了探索和实质性发展两个阶段.它以健康促进的理念为指导,以"健康社会、健康环境、健康人群"为主线,成为了当前开展健康促进的典范.健康城市能呈现实质且快速发展的势头,政府主导是其重要的特点.它既符合中国社会文化背景和现状,也是以"上游策略"来解决全人群健康问题创新性举措.中国健康城市推行的深远意义在于,它为当前公共卫生体系建设赋予了先进的内涵,与世界卫生组织倡导的"健康促进曼谷宪章"的核心精神是完全相符的,成为了引领中国公共卫生汇入国际现代公共卫生运动的领头兵.但是,它的茁壮成长仍需要有远见的政治家的呵护和支持.     

公共卫生领域非传统安全威胁及应对

医学公共卫生领域非传统安全威胁历来是而且当今仍然是威胁人类自身生存的重大社会安全问题.重大传染病的暴发、自杀、现代医学高科技等现象动辄呈现出全球化趋势,尤其是SARS的爆发,突出了公共卫生的重要性,给我国公共卫生的管理及政策制定提出了更高要求:应真正建立起以"预防为主"的公共卫生体系,加强中国与国际的安全合作,加强公民的医学和健康教育.这是由公共卫生本身的性质和时代的发展共同决定的.     

临床医学生公共卫生教育的现状与对策

公共卫生是我国医疗卫生体系的重要组成部分.从医学教育的源头上加强临床与公共卫生的联系,通过宣扬"大卫生观"、改组教学计划、注重教师资质、调整配套教材、改进教育方法等对策,有助于培养具有足够公共卫生意识和群防群治能力的临床医生,促进医疗事业的良性发展.     

传染病管理策略的转变

SARS暴发结束以来,人们在流行病学、临床上、疾病预防和控制、传染病应急机制建立和完善等诸多方面进行总结、反思、探索和研究,带来了许多积极的转变和进步,表现在:(1)公共卫生基础建设和突发公共卫生应急系统建设受到重视和加强,国家制定了相应法律法规,提供了依法预防和处理突发公共卫生事件法律保证,同时从国家到地方都把公共卫生建设放在优先的位置…;(2)对突发性公共卫生事件反应、处理更加科学化和规范化[2],表现在SARS后出现的一些突发公共卫生事件,信息灵敏、各方联动、反应迅速、效果显著;(3)各级医疗机构和医务人员对诸如新发和再现传染病意识、预警水平和处理能力明显提高,一方面继续保持对SARS重现的高度警惕,同时跟踪各种传染病流行的新趋势和特点,临床上对各种传染病早期识别和管理水平大大提高;(4)加强了国际间合作,分享信息和联合攻关,提高了对传染病认识和控制水平.     

Who is my neighbor? A communitarian analysis of access to health care for immigrants

Immigrants lacking health insurance access the health care system through the emergency departments of non-profit hospitals. Because these persons lack health insurance, continued care can pose challenges to those institutions. I analyze the values of our health care institutions, utilizing a Walzerian approach that describes its appropriate sphere of justice. This particular sphere is dominated by a caring response to need. I suggest that the logic of this sphere would be best preserved by providing increased access to health insurance to this population. This access would marry the rights of these members of our community to access care to our responsibility to contribute to financing of the system. I close with some considerations on what it means to be a member of the community.     

正视公共卫生,建立有效的疾病控制体系--SARS疫情后的反思

SARS是由一种变异的冠状病毒(Corona-virus)所致的极为危险的传染病,给我们这个世界带来了一次严峻的考验,从政府到社会的方方面面都全力投身于这一次疫情抗击活动。疫情暴露了我们在卫生改革与发展过程中战略与战术上的缺陷与失误,也使我们清楚地认识到,政府必须正视公共卫生,必须建立一个拥有处理公共卫生突发事件能力的疾病控制系统,为居民健康服务;尽管这次SARS危机挑战的是国家的公共卫生系统,但是对我国卫生事业的改革与发展已经产生了巨大而深远的影响。     

The analytic decision‐making preference model to evaluate the disaster readiness in emergency departments: The A.D.T. model

In recent years, a series of important emergencies have been taken place worldwide in industrial plants. After the occurrence of a disaster, it is essential to activate the correct emergency procedures. Particularly, it is important to direct people injured in hospitals which are able to handle emergencies. Thus, nowadays, the emergency services require a management process starting from the disaster moment to the involvement of all actors participating in the process to provide integral, safe, and quality attention. The aim of this study is to help hospitals become better prepared for major disasters and public health emergencies and to evaluate the readiness of emergency departments for a disaster situation. A hybrid model called the “analytic decision‐making preference model” based on analytic hierarchy process, decision‐making trial and evaluation laboratory, and technique for order of preference by similarity to ideal solution methods is proposed. Analytic hierarchy process is used to determine the criteria and subcriteria weights. Then, decision‐making trial and evaluation laboratory is used to evaluate interdependence between criteria and subcriteria. After this, technique for order of preference by similarity to ideal solution is applied to rank the emergency departments from highest to lowest according to their closeness coefficient. A real‐life application in Colombia is presented.     

Public mistrust: the unrecognized risk of the CDC Smallpox Vaccination Program

Phase 1 of the CDC's Smallpox Vaccination Program has foundered because of a lack of volunteers. However, despite the enrollment of fewer than 10% of the projected number of hospital employees in Phase 1, and recent recommendations of two advisory groups, CDC and DHHS officials recently announced plans to expand this vaccination program. During Phase 2 of the Smallpox Vaccination Program, an additional 10 million health care and emergency workers are scheduled to receive vaccination. This paper reviews reasons why state health departments and hospitals rejected participation in Phase 1. It urges the federal government to take account of these problems before proceeding to Phase 2 and argues that the flaws in this program not only threaten bioterrorism preparedness efforts but, more importantly, might endanger trust in public health initiatives.     

Nonfatal and fatal self-harm injuries among children aged 10-14 years--United States and Oregon, 2001-2003

Fatal and nonfatal injuries due to suicidal behavior among younger adolescents are of growing concern for many communities. We examined the incidence and patterns of these injuries among persons aged 10-14 years using three databases, two national and a third from Oregon. Suffocation and firearm gunshot were the leading external causes of suicide; poisoning and cutting/piercing were the leading causes of nonfatal self-harm injuries. The most common psychosocial factors associated with those treated in emergency departments for self-harm injuries were psychological conditions; drug/alcohol involvement; and adverse circumstances, including family discord, school problems, and physical/sexual abuse. Analysis of population-based data from these databases are part of the public health approach and can help direct much needed research and prevention efforts that address self-harming behavior in these younger adolescents.     

Interest in smoking cessation among emergency department patients.

The authors interviewed adult patients presenting to 4 Boston emergency departments (EDs) about their smoking, quit attempts, and interest in an outpatient referral. Of the 539 patients enrolled, 26% were current smokers. Of the current smokers, 72% had tried to quit in the past year, and 34% wanted an outpatient referral. Current smokers were younger than nonsmokers and were less likely to have a high school education, primary care provider, and private insurance. The findings of this study reinforce the potential benefit of routine screening for smoking and interest in quitting in the ED. Because many underinsured Americans use the ED as a source of regular health care, the public health implications of increasing screening, counseling, and referral for smokers are substantial.     

Transnational Quarantine Rhetorics: Public Mobilization in SARS and in H1N1 Flu

This essay examines how Chinese governments, local communities, and overseas Chinese in North America responded to the perceived health risks of Severe Acute Respiratory Syndrome (SARS) and H1N1 flu through the use of public and participatory rhetoric about risk and quarantines. Focusing on modes of security and quarantine practices, I examine how globalization and the social crises surrounding SARS and H1N1 flu operated to regulate differently certain bodies and areas. I identify three types of quarantines (mandatory, voluntary, and coerced) and conduct a transnational comparative analysis to investigate the relationships among quarantines, rhetoric, and public communication. I argue that health authorities must openly acknowledge the legitimacy of public input and actively seek public support regarding health crises. Only by collaborating with concerned communities and citizens and by providing careful guidance for public participation can health institutions ensure the efficacy of quarantine orders during emerging epidemics.     

进展期胃癌术后生存质量影响因素探讨

胃癌是我国发病率和病死率较高的恶性肿瘤,且住院病例90％以上为中晚期。因此预后不佳。近年来在进展期胃癌诊断和治疗方面有较大进展,尤其是人们对术后生存质量的重视。本文初步探讨了进展期胃癌术后生存质量的影响因素：如患者一般状况、手术方式、术后辅助放化疗和中医药治疗等。     

拉丁美洲国家医疗保障制度探析

拉丁美洲国家的经济发展水平较高,公共健康开支和私人健康开支也比较高,医疗保障制度覆盖面较大,财政的健康开支公平性较高。但是国别之间,健康开支水平与经济发展水平之间以及健康开支水平与财政负担的公平性之间缺乏紧密的联系。这说明,社会医疗保险制度模式、收入差距等因素制约了医疗保障制度的作用的发挥和财政负担公平性的实现。