Quality design: a planning methodology for the integration of refugee and local health services,West Nile,Uganda

In an emergency, the international community responds to the immediate health needs of refugees through the establishment of action-oriented, life-saving services. Healthcare delivery is often managed with limited, if any, coordination with local health management structures. In situations where refugees remain in the host country for many years, sustainability issues inevitably arise. Refugee-hosting governments may ultimately be called upon to assume the management and funding of refugee services. Planning for service integration, while protecting against declines in service quality, is a challenge in the typically resource-poor host environments. This paper discusses these issues by presenting the experience of the West Nile districts in northern Uganda, and describes quality design as a relevant planning methodology. Quality design is a systematic planning approach that documents and directly incorporates the service users' self-defined expectations and needs.     

Rebuilding and strengthening health systems and providing basic health services in fragile states

The international community has compelling humanitarian, political, security and economic reasons to engage in rebuilding and strengthening health systems in fragile states. Improvements in health services and systems help to strengthen civil society and to restore legitimacy to governments. Effective engagement with fragile states to inform the design of health programmes and selection of interventions depends on donor coordination and an understanding of health system challenges. Planning requires consideration of allocation (services to be delivered), production (organisation of services), distribution (beneficiaries of services) and financing. The criteria for selecting interventions are: their impact on major health problems; effectiveness; the possibility of scale-up; equity; and sustainability. There are various options for financing and models of engagement, but support should always combine short-term relief with longer-term development. Stakeholders should aim not only to save lives and protect health but also to bolster nations' ability to deliver good-quality services in the long run.     

A multiple additive regression tree analysis of three exposure measures during Hurricane Katrina

This paper analyses structural and personal exposure to Hurricane Katrina. Structural exposure is measured by flood height and building damage; personal exposure is measured by the locations of 911 calls made during the response. Using these variables, this paper characterises the geography of exposure and also demonstrates the utility of a robust analytical approach in understanding health‐related challenges to disadvantaged populations during recovery. Analysis is conducted using a contemporary statistical approach, a multiple additive regression tree (MART), which displays considerable improvement over traditional regression analysis. By using MART, the percentage of improvement in R‐squares over standard multiple linear regression ranges from about 62 to more than 100 per cent. The most revealing finding is the modelled verification that African Americans experienced disproportionate exposure in both structural and personal contexts. Given the impact of exposure to health outcomes, this finding has implications for understanding the long‐term health challenges facing this population.     

PM2.5的健康危害、毒理效应与作用机制的研究

大气颗粒物对人体健康的影响在世界范围内引起关注,尤其是细粒子（PM_2.5,fine particulate matter）因粒径小、成分复杂,对人体健康的影响尤为突出。PM_2.5的毒理效应与作用机制是当前研究的热点,分析其研究现状与存在问题能更好地把握其核心领域并开展更进一步的研究。基于文献检索与分析,系统梳理了PM_2.5危害导致的疾病类型;介绍了PM_2.5毒理研究的主要实验手段;讨论当前认知的PM_2.5毒理效应（包括PM_2.5不同组分、不同来源、不同季节的影响）;汇总PM_2.5毒理作用机制研究方法的原理、特点、检测指标与测定方法,解析目前研究认为的五种主要的PM_2.5毒理作用机制。在分析已有研究成果的基础之上,就PM_2.5毒理实验、方法和研究内容方面存在的不足进行讨论,并提出今后需要重点开展的研究方向,以期为PM_2.5健康危害的准确评估和有效防治提供科学依据。     

土木工程结构健康监测研究进展

阐述了实施土木工程结构健康监测的必要性和迫切性,介绍了结构健康监测系统的概念、组成及其应用,信号采集与处理以及损伤检测的方法和研究现状,重点讨论了神经网络法在损伤诊断中的应用。介绍了利用小波神经网络和概率神经网络等新型网络的损伤诊断方法,最后指出了需要进一步研究的重点和难点问题。     

一种城市生态系统健康评价方法及其应用

利用集对分析方法,将评价城市生态系统健康状况的多个指标系统合成一个与最优评价集的相对贴近度,用来描述城市生态系统健康状况.运用集对分析方法,以北京、大连、上海、武汉、厦门、广州等城市为例,对1995～2003年间的城市生态系统健康进行了评价.结果表明,不同时期各城市生态系统健康状况排序有所变化,但厦门和广州一直名列前茅.此外,对北京1992～2003年间城市生态系统健康状况的变化情况进行了具体分析,结果显示,北京城市生态系统健康状况随着时间的推移而不断改善.     

有机氯农药污染场地挖掘过程中污染物的分布及健康风险

分析了某污染场地挖掘过程中场地内及其周边空气中HCHs和DDTs的污染物分布特征;应用健康风险评价模型研究了挖掘场地附近居民区经呼吸暴露途径的致癌和非致癌风险.结果表明,挖掘区附近居民区空气中HCHs和DDTs呈现出明显的季节分布特征,秋冬季节浓度高,春夏季节浓度较低.ΣHCHs冬季浓度在5.65~133 ng·m-3之间,均值为28.6 ng·m-3;ΣDDTs冬季浓度在4.48~2 800 ng·m-3之间,均值为457.3 ng·m-3.ΣHCHs春季浓度在6.23~26.4 ng·m-3之间,均值为15.1 ng·m-3;ΣDDTs夏季浓度在3.17~8.1 ng·m-3之间,均值为6.1 ng·m-3,春夏季节施工可减少二次污染产生.居民区空气中HCHs和DDTs浓度与离地面高度呈显著负相关(P0.05,n=33).挖掘区附近成人居民经呼吸暴露产生的致癌风险及非致癌风险在可接受风险范围内,但挖掘过程对幼年居民产生一定的致癌及非致癌风险.因此,该类污染场地挖掘过程中应采取措施抑制挖掘区污染物向空气扩散,以降低风险.     

职业健康安全管理体系的持续改进要求

在分析职业健康安全管理体系主要要素的基础上,阐明了主要要素对持续改进的要求和组织进行持续改进的思路。     

Injury surveillance trends in career–technical education: New Jersey 1999–2018

Introduction: Adolescents engaging in school-sponsored work experiences may be at risk of injury due to factors such as inexperience. This article examines trends in 20 years of reported injuries among New Jersey (NJ) adolescents engaging in school-sponsored work experiences, and compares a transition from paper to online reporting format. Methods: New Jersey requires reporting of injuries occurring during school-sponsored work experiences to the NJ Department of Education. Injuries reported by NJ schools from 1999 to 2018 (n = 2,119) were examined; incidence rates for 2008 to 2018 (n = 743) were calculated using publicly available NJ Department of Education enrollment data for the denominator, including for specific groups of students: career and technical education; special healthcare needs. Results: A downward trend in reported injuries in NJ schools was observed. However, the year online reporting became required by code (2013), an increase of nearly 50% was seen from 2012 (59–89), followed by a decline in reported incidents 2014 to 2018 (mean = 65, range 76 down to 47). Injury rate trends over time paralleled those of reported incidents. Conclusions: This study suggested worker safety and public health benefits of improvements from State of NJ code required training programs and online injury surveillance report form. Practical Applications: One potential method to address the safety and health of adolescents engaging in work experiences is the use of online reporting forms, to aid in surveillance efforts, coupled with occupational safety and health training specifically geared toward teachers and administrators who both supervise young, relatively inexperienced and vulnerable workers and who make relatively frequent worksite visits. Incorporation of specific details of the instructions on the use of a reporting form into required trainings, in addition to providing a clear, accessible guidance manual online, could further help improve youth worker safety surveillance efforts.     

Efficacy of text messaging apprentices to reinforce ergonomics and safety voice training

Introduction: Injuries and work-related musculoskeletal disorders (MSDs) are common among masons. SAfety Voice for Ergonomics (SAVE) integrates training in ergonomic and safety problem-solving skills into masonry apprenticeship training. The purpose of this study was to assess the efficacy of text messaging to reinforce SAVE program content. Method: SAVE effectiveness was evaluated at masonry apprenticeship training centers across the United States by comparing three experimental groups: (1) Ergonomics training, (2) Ergonomics and Safety Voice training, and a (3) Control. Apprentices received SAVE training with their standard instruction. To reinforce classroom training, refresher training was implemented by sending weekly text messages for six months. Half of the text messages required a response, which tested knowledge or assessed behavior, while the remaining reiterated knowledge. Apprentices (n = 119) received SAVE text messages. Response rates and percentage of correct responses were compared with chi-square tests and independent group t-tests. Multivariable logistic regression analysis predicted apprentice response with selected demographic and work experience variables. Finally, feedback on of the use of text messaging was obtained. Result: Of 119 participants, 61% (n = 72) responded to at least one text message. Logistic regression revealed that being a high school graduate and a brick and block mason significantly affected the odds of responding. Sixty-nine percent of apprentices agreed that text messages reinforced SAVE content. Conclusion: Even though there was no training center requirement to respond, the high response rate suggests that text messaging can effectively be used to reinforce ergonomics and safety voice training for both knowledge and behavior. Practical Application: The prevalent use of text messaging creates opportunities to reinforce health and safety training and engage workers, especially for populations that may be at various locations over time such as construction sites. Instructors and practitioners should consider the utility of text messaging for supporting their training and safety programs.