上海市医疗废物控制系统建设设想

根据上海的实际情况，借鉴国内外先进的医疗废物管理、处置经验，从控制的角度全面阐述了上海市医疗废物控制系统的目标、集中处置系统以及配套系统等各个方面建设的具体设想。     

疫情下医疗废物的处置现状分析

2019年新冠疫情席卷全球,在疫情环境下,医疗废物大幅增多,全国各大城市纷纷出现医疗废物处置不当的现象。本文对国内外现状分析,在认知、设施、管理和监督四个方面发现存在一定的问题,通过加强教育、加大储备、完善机制和改善监管的建议,为提升医疗废物应急处置能力提供参考。     

Organizational policy and other factors associated with emergency medical technician seat belt use

INTRODUCTION: The purpose of this study was to determine factors associated with seat belt usage among Emergency Medical Technicians (EMTs). METHODS: As part of biennial re-registration paperwork, nationally registered EMTs completed a survey on the safety and health risks facing Emergency Medical Services (EMS) providers. Respondents were asked to describe their seat belt use while in the front seats of an ambulance. They were categorized as "high" in seat belt use if it had been more than a year since they had not worn their seat belt or "low" in seat belt use if they had not worn their seat belt at least once within the past 12 months. A logistic regression model was fit to estimate the association between seat belt use, organizational seat belt policy, type of EMS organization worked for, EMT certification level, and the size of community where EMS work is performed. RESULTS: Of the 41,823 EMTs that re-registered in 2003, surveys were received from 29,575 (70.7%). A significant interaction between organizational seat belt policy and type of EMS organization was found to exist. Participants reporting no organizational seat belt policy had lower odds of seat belt usage when compared to individuals that do have a seat belt policy. Odds Ratios ranged from 0.20 (95% CI 0.10-0.40) for military organizations to 0.59 (95% CI 0.38-0.93) for private EMS organizations. Paramedics and those working in rural areas also had lower odds of seat belt use. CONCLUSION: Several factors were found to be associated with seat belt usage among EMTs while in the front compartment of an ambulance. However, it appears that only one, organizational policy, is a modifiable characteristic.     

The 2004 Madrid train bombings: an analysis of pre-hospital management

The terrorist train bombings in Madrid, Spain, on 11 March 2004 triggered a swift and massive medical response. This paper analyses the pre-hospital response to the attacks to gain insight into current trends in disaster management among Madrid's Emergency Medical Services (EMSs). To this end, the existing emergency planning framework is described, the basic structures of the different EMSs are presented, and the attacks are briefly depicted before consideration is given to pre-hospital management. Finally, an explanation of the main underlying misconceptions in emergency planning and management in Madrid is provided to aid understanding of the origins of some of the problems detected during the response. These are attributable mainly to inappropriate planning rather than to mistakes in field-level decision-making. By contrast, many of the successes are attributable to individual initiatives by frontline medics who compensated for the lack of clear command by senior managers by making adaptive and flexible decisions.     

医疗废物焚烧中二恶英的产生及控制

医疗废物的安全处置一直被世界各国所重视,我国自SARS灾难后,强化了医疗废物的治理力度。本文针对目前主要采用焚烧法处置医疗废物过程中二恶英的生成途径进行了论述,并结合二恶英的分子结构、毒性及危害提出了控制对策与建议。     

The relationship of occupational injury and use of mental health care

Introduction: Symptoms of depression and anxiety are a common consequence of occupational injury regardless of its cause and type. Nevertheless, mental health care is rarely covered by workers’ compensation systems. The aim of this study was to assess the use of mental health care post-injury. Methods: We used a subsample of patient-care workers from the Boston Hospital Workers Health Study (BHWHS). We matched one injured worker with three uninjured workers during the period of 2012–2014 based on age and job title (nurse or patient-care associate) and looked at their mental health care use pre- and post-injury using medical claims data from the employer sponsored health plan. We used logistic regression analysis to assess the likelihood of mental health care use three and six months post-injury controlling for any pre-injury visits. Analyses were repeated separately by job title. Results: There were 556 injured workers between 2012 and 2014 that were matched with three uninjured workers at the time of injury (n = 1,649). Injured workers had a higher likelihood of seeking mental health care services than their uninjured counterparts during the six months after injury (OR = 1.646, 95% CI: 1.23–2.20), but not three months post-injury (OR = 0.825, 95% CI: 0.57–1.19). Patient-care associates had a higher likelihood to seek mental health care post-injury, than nurses (OR: 2.133 vs OR: 1.556) during the six months period. Conclusions: Injured workers have a higher likelihood to experience symptoms of depression and anxiety based on their use of mental health care post-injury and use is more predominant among patient-care associates; however, our sample has a small number of patient-care associates. Practical Applications: Treating depression and anxiety as part of the workers’ compensation system has the potential of preventing further physical ailment and improving the return to work process regardless of nature of injury.     

Using data linkage to assess the impact of motorized recreational vehicle-related injuries in Ohio

Problem

Motorized recreational vehicle (MRV)-related injuries can result in severe medical and financial consequences. The objective of this study was to describe the epidemiology, and clinical and financial impact of MRV-related injuries in Ohio.

Method

Probabilistically linked statewide Emergency Medical Services (EMS) and hospital (inpatient and emergency department) data for 2003 and 2004 were examined. Record pairs with a MRV-related E-code (E821-E823, E825) were included in this study.

Results

There were 2,893 patients with MRV-related injuries, who had linked EMS and hospital records, resulting in more than $15 million in hospital charges and 1,921 inpatient days of hospitalization. The male-to-female ratio was nearly 4:1, and 19% were younger than 16. Almost 82% of cases were not wearing a helmet; there was a trend of decreasing helmet use with increasing age. Mean (SE) inpatient hospital charges and length of stay (LOS) were $22,218 ($1,290) and 3.8 (0.2) days, respectively. The mean (SE) Injury Severity Score (ISS) for inpatients was 9.2 (0.4). Individuals injured on a street/highway were 3.20 times more likely to sustain an ISS ≥ 16 (95% CI: 1.03, 9.88; p = 0.044) and 3.05 times more likely to sustain a traumatic brain injury (TBI) (95% CI: 1.17, 7.94; p = 0.024) than those who were injured at a place designated for sport or recreation. Children aged 12 to 15 and young adults aged 16 to 25 were 2.47 and 2.14 times more likely, respectively, to sustain a TBI than adults aged 36 or older (aged 12 to 15: 95% CI: 1.13, 5.38; p = 0.024; aged 16 to 25: 95% CI: 1.26, 3.64; p = 0.005). Higher ISS was associated with both higher total charges (p < 0.001) and longer LOS (p < 0.001).

Discussion

This study demonstrates that MRV-related injuries are an important public health problem in Ohio, with a substantial clinical and financial impact.

Impact on Industry

Enactment and enforcement of statewide MRV safety legislation and training of MRV users offer valuable opportunities to prevent these costly injuries.     

Assessment of older drivers: relationships among on-road errors, medical conditions and test outcome

PROBLEM: It is essential that driver licensing authorities have a valid and reliable system for evaluating older drivers' continuing competency; road tests are usually required as part of such a system. This study sought to find information about the nature of driving errors made during license review tests, and about relationships between error type and test outcome for older drivers. METHOD: Data from licensing authority files from 533 road tests during a 12-month period were analyzed; medical and other referral information was included. Average driver age was 76 years. Performance scores were generated for intersection negotiation, lane changing, low speed manoeuvres, positioning and speed control, safety margin, and car control. RESULTS: Logistic regression analysis showed that test outcome was well predicted by a subset of driving performance scores; adding driver age to the model explained very little variance. Age alone was strongly associated with outcome. Relationships between referral information and test outcome are also reported. IMPACT: Results highlight several factors relevant to the development of more valid and reliable road tests for older drivers.     

Changes in excretion rates of stress hormones in medical staff exposed to electromagnetic radiation

The aim of this paper is to study the effect of electromagnetic radiation (EMR) on the excretion rates of stress hormones of medical staff in physiotherapy. The excretion rates of stress hormones cortisol, adrenaline and noradrenaline were followed during morning shift in 15 female physiotherapists using RIA kits and a spectrofluorimetric method. The mean number of treatments with EMR emitting devices per month and the emission of each device was assessed. A control group of nurses, matched by age, sex and work task was used. The psychosocial factors were evaluated and no differences between the two groups was found. Calculations of the individual EMR exposure show levels above the ICNIRP guidelines. Significantly higher excretion rates of cortisol, adrenaline and noradrenaline among the studied physiotherapists in comparison with the control group of nurses were found. In conclusion, our data showed that EMR influenced the excretion rates of stress hormones of medical staff in physiotherapy.     

冀南野生药用资源植物研究

常用中药中以药用植物占多数，几乎凡具有特殊化学成分及生理作用的植物均可以作为药用植物利用。统计表明，冀南野生药用植物资源丰富，约170种。主要分布在西部山区。本文对其中部分重要药用资源植物的成分、功效作较详细介绍，其它只作一般性介绍：一、冀南重要野生药用植物