疾病预防控制机构应急能力评价及发展对策研究
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摘要
研究目的
1.阐明疾病预防控制机构应急能力现状及存在的问题,为我国疾病预防控制机构应急体系建设提供客观依据。
2.完善提高疾病预防控制机构应急能力的应对策略和措施,为我国疾病预防控制事业的可持续发展提供政策建议。
3.制定培训方案,评价培训效果,探索出一套科学可行的培训模式,为我国应急培训的顺利实施提供理论和技术支持。
研究方法
1.采用文献回顾法对国内外关于突发公共卫生事件的研究现状及存在的问题进行回顾性调查分析。
2.采用定性和定量相结合的“双轨”研究方法,对湖北省疾病预防控制中心、13个市/州和84个县/区,共98个疾病预防控制机构应急建设情况进行普查;采用分层随机抽样的方法,对湖北省疾病预防控制中心、3个市/州和6个县/区,共10个疾病预防控制中心应急人员的应急能力进行半结构式访谈和问卷调查,并对相关因素进行多因素Logistic回归分析。
3.采用实证研究的方法,对来自湖北省各级疾病预防控制机构的315名学员开展三期“提高应急能力”的应急培训;对来自湖北省17个市/州卫生局及河南、安徽、湖南、江西等省卫生厅应急办的负责人共21名卫生行政人员开展“提高卫生行政领导应急能力”的应急培训,通过半结构式访谈和问卷调查评价培训效果。
研究结果
1.湖北省三级疾病预防控制机构现有工作人员8371人,其中应急人员2729人,占32.60%;年龄构成呈纺锤型分布,以35～44岁龄组为主,占34.33%;学历以大中专为主,占80.57%;职称以中级为主,占44.86%;预防医学专业的人员比例不足1/5(19.44%);不同单位之间人员素质得分不均衡,省级人员平均素质得分是市/州级的1.12倍,县/区级的1.39倍;同时,最近三年流入人员的素质得分低于流出人员的素质得分。
2.对突发公共卫生事件应急能力的调查结果显示,虽然100%的单位制定了突发公共卫生事件的监测方案,但由于缺乏有效的宣传学习手段,应急人员对预案的掌握理解程度较低;虽然所有的单位均能开展传染病疫情的分析,但分析手段和能力不能满足预测预警工作的需要;对实验室的调查结果显示,实验室的仪器设备严重缺乏,管理工作落后,检验检测能力不能满足突发公共卫生事件应急处理工作的需要;对应急物质储备的调查结果显示,各级政府高度重视突发公共卫生事件工作,但是应急资金和应急物质的储备等后勤保障方面还明显滞后于实际工作的需要,如仅80.61%的单位指定了专门机构负责突发公共卫生事件应急物资的储备、管理和调配;绝大多数疾病预防控制机构认为当前的应急处理工作的费用完全不能满足实际工作的需要(74.49%)或者是勉强能够满足实际工作的需要(24.49%)。
3.对培训和继续教育情况的调查结果显示,仅25.51%的单位开展了应急人员的培训需求调查,仅52.04%的单位制定了应急人员的培训规划,仅60.20%的单位制定了应急培训效果的评价办法等。同时,绝大多数调查对象认为通过培训和应急演练是迅速提高各级CDC应急能力较为可行的途径。
4.疾病预防控制机构专业人员的应急能力虽然较SARS暴发前有了一定程度的提高,但应对突发公共卫生事件的能力不能满足实际工作的需要,尤其是对疾病监测数据的利用、分析能力明显不足。多因素Logistic回归分析显示,影响疾病预防控制人员应急能力的因素主要有:工作单位(OR=3.61)、文化程度(OR=2.69)、所学专业(OR=2.90)、从事业务(OR=2.07)、培训时间(OR=2.16)及培训层次(OR=4.12)等。
5.实证研究的结果显示,应急培训更新了学员的应急知识,增强了应对突发公共卫生事件的信心,提高了应急处置能力。统计分析显示,培训后的应急知识和自评价得分与培训前相比均有统计学意义(P<0.05)。随访结果显示,12个月后的应急知识和自评价得分与培训后相比出现轻微的下降,但是差异均无统计学意义(P>0.05),而与培训前的应急知识和自评价得分相比,差异均有统计学意义(P<0.05)。同时,超过80%的学员对培训效果和培训资源感到满意。
研究结论
1.政府对疾病预防控制机构应急工作投入不足,经费得不到保障。
2.疾病预防控制机构专业人员的应急能力不能满足实际工作需求,人员配置难以适应当前工作需要;同时,现阶段人员的流动对于CDC而言意味着人才流失。
3.监测体系不健全,监测数据利用能力低下,不能满足预测预警的需要。
4.疾病预防控制机构仪器设备缺乏,检验检测能力较差,影响了工作的正常开展。
5.后勤保障能力较弱,应急资金和应急物质的储备和管理滞后于实际工作需要。
6.通过应急培训能显著提高疾病预防控制机构分析决策及应急处置能力,本研究开发的培训方案和培训模式是科学可行的。
政策建议
1.落实政府及相关部门的疾病预防控制职责,建立健全各项保障机制。
2.优化人事制度改革,完善人员配置,提高疾病预防控制机构人员的综合素质。
3.完善疫情监测体系,健全应急预案,增强预测预警能力。
4.更新实验仪器设备,优化人力资源配置,提高检验检测能力。
5.加强应急物质储备,完善应急物质管理制度,提高应急保障能力。
6.完善应急培训机制,加大培训力度,提高CDC专业人员的综合素质。
创新和应用
本研究不但开展了相关的现况研究,而且针对提出的策略和建议进行了实证研究,根据研究结果开发了相应的突发公共卫生事件应急能力培训模式,并在全国部分地区进行推广。国务院应急办与卫生部在研究制定《2006年～2010年应急管理培训工作总体实施方案》时,参考了该课题的研究成果。
Objectives
1. To explore the current situation and problems of response capacity of Center for Disease Prevention and Control (CDC) and public health staff, and then provide some related evidences for the construction of emergency system in China.
2. To improve the strategies and measures of increasing the capacity of emergency response to CDC and public health staff, and then provide some policy suggestions for CDC’s sustainable development in China.
3. To provide technical support for emergency preparedness training project’s successfully implementation through develop training program, evaluate training effectiveness, and then explore a feasible and effective training mode in China.
Methods
Literature reviewing, census, semi-structured interview, questionnaire and empirical study were used to assess preparedness and response capacity for public health emergency in Hubei province.
1. The current situation and problems of public health emergency were analyzed by literature reviewing and retrospective investigation.
2. The 98 CDC participated in this census in Hubei province. The response capacity of personnel from 10 CDC was investigated by questionnaire and semi-structured interview, and the related factors were analyzed by Logistic regression. The qualitation and quantitation study methods were applied including questionnaire and semi-structured interview.
3. The empirical study was used in this research. 315 public health staff from 98 CDC of Hubei province participated in the emergency training in 2005. There were 78 participants from the class June, 119 from the class of August, and 118 from the class of October. Thirteen participants did not complete their training because of some unrelated factors with the training, and were not part of the evaluation (N=302, 95.87% response rate). Twenty-one public health leaders from Health department of Hubei, Henan, Hunan, Jiangxi, and Anhui, participated in the leadership training program in 2006, and the response rate was 100%. The training programs were evaluated by anonymous questionnaire and semi-structured interviews at pre-training, immediately post-training and 12-month after training (Follow-up).
Results
1. There were 8371 staff in 98 CDC of Hubei Province, and 2729 staff were emergency personnel with 32.60%. The age structure was fusiform, and most of personnel belong to 35~44 age group (34.33%). A majority of personnel qualification were associate degree or secondary school diploma with 80.57%. People with middle-level professional title were 44.86%, and preventative medicine personnel were only one-fifth (19.44%). Distribution of average quality score of personnel were imbalance in different CDC, and the average quality score of personnel in province CDC are 1.12 times than that in city CDC and 1.39 times than that in county CDC. At the same time, the average quality score of personnel of enrolling in CDC was lower than the average quality score of resignation’s personnel within last three years.
2. The survey results of response capacity of public health emergency indicated that 100% agency developed the monitoring scheme, but there had a low level of understanding due to lack of effective methods to promote learning. Although all of CDC could carry out the analysis of monitoring data, the capacity and methods were not satisfied to the demand of prediction and precaution. The results of research about laboratory showed that the performance of detection could not fit with the actual requirement of public health emergency response because of the deficiency of instrumentation and management. According to the research results of emergency material and fund, we found the every government gave great importance to public health emergencies after SARS, but there were not enough response material and fund which could not satisfy the practical work needs. For example, only eighty percent CDC designated the specialized department in charge of emergency material and emergency fund, and the majority of CDC (74.49%) had not enough fund to response to the public health emergency.
3. The results of investigation about training and continuing education showed that only twenty-five percent of CDC carried out the requirement research to emergency training, and sixty percent of CDC developed the measures about training effectiveness evaluation. Meanwhile, the majority of public health personnel indicated that emergency training and emergency drilling were scientific and feasible way to improve the response capacity.
4. The response capacity of personnel has been promoted after crisis of SARS in CDC. However, the disposition of personnel and response capacity regarding public health emergency did not always satisfy with the requirement of current situation. Factors influencing on the response capacity regarding public health emergency might include: levels of work (OR=3.61), standard of culture (OR=2.69), major of graduation (OR=2.90), department of work (OR=2.07), length of training's time (OR=2.16) and levels of training (OR=4.12).
5. The emergency training improved the knowledge levels and increased attitudinal and behavioral intentions scores regarding emergency preparedness. The results of post-test showed that the emergency knowledge and self-assessment scores of participants increased significantly as compared with pre-test(P<0.05), The results of the follow-up measure showed that the emergency knowledge and self-assessment scores of participants declined slightly as compared with post-test levels (P>0.05). However, there was a significant increase as compared with pre-test (P<0.05). Moreover, more than eighty percent of participants reported that the training process and resources were scientific and feasible.
Conclusions
1. Public health emergency has not obtained enough support from government, especially fund investment.
2. The response capacity regarding public health emergency was difficult to adapt to the current needs for disease prevention and control. For example, personnel composition, professional title, educational background and major of graduation did not always satisfy with the requirement of current situation. At the same time, there was a brain drain for personnel movement at this stage for center of disease prevention and control.
3. The monitoring system regarding public health emergency is not perfect, and the analysis capacity of monitoring data did not always satisfy with the requirement of predict and precaution.
4. There had no enough instrumentation in CDC, and the performance of disease control and public health emergency response were restricted by the poor detectivity.
5. The capacity of logistical support was poor. The reserve, management and dispatching regarding emergency material and fund did not satisfy with the need of practical work.
6. The emergency preparedness capability could be improved by emergency training, and the emergency training model was effective and feasible in improving the emergency preparedness capability of public health personnel.
Suggestions
1. Government and relevant departments should implement the responsibilities of disease prevention and control, and perfect the ensure mechanism of emergency material and fund.
2. Center of disease prevention and control should improve the personnel system reform and improve human resources allocation, and then increase the capacity of public health emergency response.
3. Disease surveillance system and emergency plans should be improved to strengthen the performance of prediction and precaution.
4. Government and relevant departments should purchase laboratory apparatus and equipment, and optimize human resources allocation, and then improve the performance of measure and analysis.
5. The emergency material and fund should be reserved, and the regulatory regime should be improved at present in order to enhance the emergency ensure capacity.
6. Develop and improve the emergency training model, and strengthen emergency preparedness training for public health staff, and then increase the performance of public health emergency response.
Innovation and Application
This research not only carried out the present study, but also developed the empirical study according to the related strategies and suggestions. The emergency preparedness training model for public health staff in CDC was developed according to the research results, and it was spread in China. Meanwhile, the study and research results were referenced by State Council and the Ministry of Health when they developed the project of emergency management training from 2006 to 2010.
1.阐明疾病预防控制机构应急能力现状及存在的问题,为我国疾病预防控制机构应急体系建设提供客观依据。
2.完善提高疾病预防控制机构应急能力的应对策略和措施,为我国疾病预防控制事业的可持续发展提供政策建议。
3.制定培训方案,评价培训效果,探索出一套科学可行的培训模式,为我国应急培训的顺利实施提供理论和技术支持。
研究方法
1.采用文献回顾法对国内外关于突发公共卫生事件的研究现状及存在的问题进行回顾性调查分析。
2.采用定性和定量相结合的“双轨”研究方法,对湖北省疾病预防控制中心、13个市/州和84个县/区,共98个疾病预防控制机构应急建设情况进行普查;采用分层随机抽样的方法,对湖北省疾病预防控制中心、3个市/州和6个县/区,共10个疾病预防控制中心应急人员的应急能力进行半结构式访谈和问卷调查,并对相关因素进行多因素Logistic回归分析。
3.采用实证研究的方法,对来自湖北省各级疾病预防控制机构的315名学员开展三期“提高应急能力”的应急培训;对来自湖北省17个市/州卫生局及河南、安徽、湖南、江西等省卫生厅应急办的负责人共21名卫生行政人员开展“提高卫生行政领导应急能力”的应急培训,通过半结构式访谈和问卷调查评价培训效果。
研究结果
1.湖北省三级疾病预防控制机构现有工作人员8371人,其中应急人员2729人,占32.60%;年龄构成呈纺锤型分布,以35～44岁龄组为主,占34.33%;学历以大中专为主,占80.57%;职称以中级为主,占44.86%;预防医学专业的人员比例不足1/5(19.44%);不同单位之间人员素质得分不均衡,省级人员平均素质得分是市/州级的1.12倍,县/区级的1.39倍;同时,最近三年流入人员的素质得分低于流出人员的素质得分。
2.对突发公共卫生事件应急能力的调查结果显示,虽然100%的单位制定了突发公共卫生事件的监测方案,但由于缺乏有效的宣传学习手段,应急人员对预案的掌握理解程度较低;虽然所有的单位均能开展传染病疫情的分析,但分析手段和能力不能满足预测预警工作的需要;对实验室的调查结果显示,实验室的仪器设备严重缺乏,管理工作落后,检验检测能力不能满足突发公共卫生事件应急处理工作的需要;对应急物质储备的调查结果显示,各级政府高度重视突发公共卫生事件工作,但是应急资金和应急物质的储备等后勤保障方面还明显滞后于实际工作的需要,如仅80.61%的单位指定了专门机构负责突发公共卫生事件应急物资的储备、管理和调配;绝大多数疾病预防控制机构认为当前的应急处理工作的费用完全不能满足实际工作的需要(74.49%)或者是勉强能够满足实际工作的需要(24.49%)。
3.对培训和继续教育情况的调查结果显示,仅25.51%的单位开展了应急人员的培训需求调查,仅52.04%的单位制定了应急人员的培训规划,仅60.20%的单位制定了应急培训效果的评价办法等。同时,绝大多数调查对象认为通过培训和应急演练是迅速提高各级CDC应急能力较为可行的途径。
4.疾病预防控制机构专业人员的应急能力虽然较SARS暴发前有了一定程度的提高,但应对突发公共卫生事件的能力不能满足实际工作的需要,尤其是对疾病监测数据的利用、分析能力明显不足。多因素Logistic回归分析显示,影响疾病预防控制人员应急能力的因素主要有:工作单位(OR=3.61)、文化程度(OR=2.69)、所学专业(OR=2.90)、从事业务(OR=2.07)、培训时间(OR=2.16)及培训层次(OR=4.12)等。
5.实证研究的结果显示,应急培训更新了学员的应急知识,增强了应对突发公共卫生事件的信心,提高了应急处置能力。统计分析显示,培训后的应急知识和自评价得分与培训前相比均有统计学意义(P<0.05)。随访结果显示,12个月后的应急知识和自评价得分与培训后相比出现轻微的下降,但是差异均无统计学意义(P>0.05),而与培训前的应急知识和自评价得分相比,差异均有统计学意义(P<0.05)。同时,超过80%的学员对培训效果和培训资源感到满意。
研究结论
1.政府对疾病预防控制机构应急工作投入不足,经费得不到保障。
2.疾病预防控制机构专业人员的应急能力不能满足实际工作需求,人员配置难以适应当前工作需要;同时,现阶段人员的流动对于CDC而言意味着人才流失。
3.监测体系不健全,监测数据利用能力低下,不能满足预测预警的需要。
4.疾病预防控制机构仪器设备缺乏,检验检测能力较差,影响了工作的正常开展。
5.后勤保障能力较弱,应急资金和应急物质的储备和管理滞后于实际工作需要。
6.通过应急培训能显著提高疾病预防控制机构分析决策及应急处置能力,本研究开发的培训方案和培训模式是科学可行的。
政策建议
1.落实政府及相关部门的疾病预防控制职责,建立健全各项保障机制。
2.优化人事制度改革,完善人员配置,提高疾病预防控制机构人员的综合素质。
3.完善疫情监测体系,健全应急预案,增强预测预警能力。
4.更新实验仪器设备,优化人力资源配置,提高检验检测能力。
5.加强应急物质储备,完善应急物质管理制度,提高应急保障能力。
6.完善应急培训机制,加大培训力度,提高CDC专业人员的综合素质。
创新和应用
本研究不但开展了相关的现况研究,而且针对提出的策略和建议进行了实证研究,根据研究结果开发了相应的突发公共卫生事件应急能力培训模式,并在全国部分地区进行推广。国务院应急办与卫生部在研究制定《2006年～2010年应急管理培训工作总体实施方案》时,参考了该课题的研究成果。
Objectives
1. To explore the current situation and problems of response capacity of Center for Disease Prevention and Control (CDC) and public health staff, and then provide some related evidences for the construction of emergency system in China.
2. To improve the strategies and measures of increasing the capacity of emergency response to CDC and public health staff, and then provide some policy suggestions for CDC’s sustainable development in China.
3. To provide technical support for emergency preparedness training project’s successfully implementation through develop training program, evaluate training effectiveness, and then explore a feasible and effective training mode in China.
Methods
Literature reviewing, census, semi-structured interview, questionnaire and empirical study were used to assess preparedness and response capacity for public health emergency in Hubei province.
1. The current situation and problems of public health emergency were analyzed by literature reviewing and retrospective investigation.
2. The 98 CDC participated in this census in Hubei province. The response capacity of personnel from 10 CDC was investigated by questionnaire and semi-structured interview, and the related factors were analyzed by Logistic regression. The qualitation and quantitation study methods were applied including questionnaire and semi-structured interview.
3. The empirical study was used in this research. 315 public health staff from 98 CDC of Hubei province participated in the emergency training in 2005. There were 78 participants from the class June, 119 from the class of August, and 118 from the class of October. Thirteen participants did not complete their training because of some unrelated factors with the training, and were not part of the evaluation (N=302, 95.87% response rate). Twenty-one public health leaders from Health department of Hubei, Henan, Hunan, Jiangxi, and Anhui, participated in the leadership training program in 2006, and the response rate was 100%. The training programs were evaluated by anonymous questionnaire and semi-structured interviews at pre-training, immediately post-training and 12-month after training (Follow-up).
Results
1. There were 8371 staff in 98 CDC of Hubei Province, and 2729 staff were emergency personnel with 32.60%. The age structure was fusiform, and most of personnel belong to 35~44 age group (34.33%). A majority of personnel qualification were associate degree or secondary school diploma with 80.57%. People with middle-level professional title were 44.86%, and preventative medicine personnel were only one-fifth (19.44%). Distribution of average quality score of personnel were imbalance in different CDC, and the average quality score of personnel in province CDC are 1.12 times than that in city CDC and 1.39 times than that in county CDC. At the same time, the average quality score of personnel of enrolling in CDC was lower than the average quality score of resignation’s personnel within last three years.
2. The survey results of response capacity of public health emergency indicated that 100% agency developed the monitoring scheme, but there had a low level of understanding due to lack of effective methods to promote learning. Although all of CDC could carry out the analysis of monitoring data, the capacity and methods were not satisfied to the demand of prediction and precaution. The results of research about laboratory showed that the performance of detection could not fit with the actual requirement of public health emergency response because of the deficiency of instrumentation and management. According to the research results of emergency material and fund, we found the every government gave great importance to public health emergencies after SARS, but there were not enough response material and fund which could not satisfy the practical work needs. For example, only eighty percent CDC designated the specialized department in charge of emergency material and emergency fund, and the majority of CDC (74.49%) had not enough fund to response to the public health emergency.
3. The results of investigation about training and continuing education showed that only twenty-five percent of CDC carried out the requirement research to emergency training, and sixty percent of CDC developed the measures about training effectiveness evaluation. Meanwhile, the majority of public health personnel indicated that emergency training and emergency drilling were scientific and feasible way to improve the response capacity.
4. The response capacity of personnel has been promoted after crisis of SARS in CDC. However, the disposition of personnel and response capacity regarding public health emergency did not always satisfy with the requirement of current situation. Factors influencing on the response capacity regarding public health emergency might include: levels of work (OR=3.61), standard of culture (OR=2.69), major of graduation (OR=2.90), department of work (OR=2.07), length of training's time (OR=2.16) and levels of training (OR=4.12).
5. The emergency training improved the knowledge levels and increased attitudinal and behavioral intentions scores regarding emergency preparedness. The results of post-test showed that the emergency knowledge and self-assessment scores of participants increased significantly as compared with pre-test(P<0.05), The results of the follow-up measure showed that the emergency knowledge and self-assessment scores of participants declined slightly as compared with post-test levels (P>0.05). However, there was a significant increase as compared with pre-test (P<0.05). Moreover, more than eighty percent of participants reported that the training process and resources were scientific and feasible.
Conclusions
1. Public health emergency has not obtained enough support from government, especially fund investment.
2. The response capacity regarding public health emergency was difficult to adapt to the current needs for disease prevention and control. For example, personnel composition, professional title, educational background and major of graduation did not always satisfy with the requirement of current situation. At the same time, there was a brain drain for personnel movement at this stage for center of disease prevention and control.
3. The monitoring system regarding public health emergency is not perfect, and the analysis capacity of monitoring data did not always satisfy with the requirement of predict and precaution.
4. There had no enough instrumentation in CDC, and the performance of disease control and public health emergency response were restricted by the poor detectivity.
5. The capacity of logistical support was poor. The reserve, management and dispatching regarding emergency material and fund did not satisfy with the need of practical work.
6. The emergency preparedness capability could be improved by emergency training, and the emergency training model was effective and feasible in improving the emergency preparedness capability of public health personnel.
Suggestions
1. Government and relevant departments should implement the responsibilities of disease prevention and control, and perfect the ensure mechanism of emergency material and fund.
2. Center of disease prevention and control should improve the personnel system reform and improve human resources allocation, and then increase the capacity of public health emergency response.
3. Disease surveillance system and emergency plans should be improved to strengthen the performance of prediction and precaution.
4. Government and relevant departments should purchase laboratory apparatus and equipment, and optimize human resources allocation, and then improve the performance of measure and analysis.
5. The emergency material and fund should be reserved, and the regulatory regime should be improved at present in order to enhance the emergency ensure capacity.
6. Develop and improve the emergency training model, and strengthen emergency preparedness training for public health staff, and then increase the performance of public health emergency response.
Innovation and Application
This research not only carried out the present study, but also developed the empirical study according to the related strategies and suggestions. The emergency preparedness training model for public health staff in CDC was developed according to the research results, and it was spread in China. Meanwhile, the study and research results were referenced by State Council and the Ministry of Health when they developed the project of emergency management training from 2006 to 2010.
引文
1. Marmagas SW, King LR, Chuk MG. Public health's response to a changed world: September 11, biological terrorism, and the development of an environmental health tracking network [J]. Am J Public Health. 2003, 93(8):1226-1230.
2. Mathew D. Information technology and public health management of disasters--a model for South Asian countries [J]. Prehosp Disaster Med. 2005, 20(1):54-60.
3. Wen-kui G, Jia-tong Z, De-cheng L, et al. The three networks framework to deal with public health emergencies in Guangxi, China [J]. Can J Public Health. 2006, 97(5):398-401.
4.王颖.培养有中国特色的应急管理人才——访中国行政管理学会副秘书长张学栋[J].国际人才交流, 2004, 4:8-9.
5.应桂英,苏维,栾荣生.影响突发公共卫生事件决策的因素分析[J].中华医学杂志, 2006, 86(17):1161-1164.
6.舒彬,廖巧红,聂绍发.我国突发公共卫生事件预警机制建设现状[J].疾病控制杂志, 2005, 9(6):623-626.
7. Barnett DJ, Everly GS, Parker CL, et al. Applying educational gaming to public health workforce emergency preparedness[J]. Am J Prev Med. 2005, 28(4):390-395.
8. Watson-Alván S, Alves-Dunkerson J. The importance of a shared vision in emergency preparedness: engaging partners in a home-rule state [J]. Dent Clin North Am. 2007, 51(4):785-803.
9. Qureshi KA, Merrill JA, Gershon RR, et al. Emergency preparedness training for public health nurses: a pilot study [J]. J Urban Health. 2002, 79(3):413-416.
10. Chant AD. A confusion of roles: manpower in the National Health Service [J]. J R Soc Med. 1998, 91:63-65.
12.王重建,魏晟,刘建平,等.湖北省疾病预防控制人员应急能力评价及影响因素分析.中国公共卫生, 2007, 23(6):731-733.
13.突发公共卫生事件应急条例, 2003年5月.
14.刑力新(硕士),韩文秀(导师).天津大学05届硕士论文:突发公共卫生事件应对研究.
15.王陇德.现场流行病学,北京:人民卫生出版社, 2004, 19-21.
16. Moye PK, Pesik N, Terndrup T, et al. Bioterrorism training in U.S. emergency medicine residencies: has it changed since 9/11[J]? Acad Emerg Med. 2007, 14(3):221-227.
17. Brolén P, Ortenwall P, Osterhed H, et al. KAMEDO Report 89: terrorist attack in Bali, 2002[J]. Prehosp Disaster Med. 2007, 22(3):246-250.
18. Choi N. Narrative analysis on survivor's experience of Daegu subway fire disaster--the hypothetical suggestions for disaster nursing practice [J]. Taehan Kanho Hakhoe Chi. 2005, 35(2):407-418.
19. Hu YY, Adams RE, Boscarino JA, et al. Training needs of pediatricians facing the environmental health and bioterrorism consequences of September 11th[J]. Mt Sinai J Med. 2006, 73(8):1156-1164.
20. Murphy FA. Emerging zoonoses: The challenge for public health and biodefense [J]. Prev Vet Med. 2008 Mar 29. [Epub ahead of print].
21. Perrone LA, Tumpey TM. Reconstruction of the 1918 pandemic influenza virus: how revealing the molecular secrets of the virus responsible for the worst pandemic in recorded history can guide our response to future influenza pandemics [J]. Infect Disord Drug Targets. 2007, 7(4):294-303.
22. Hoang VM, Dao LH, Wall S, et al. Cardiovascular disease mortality and its association with socioeconomic status: findings from a population-based cohort study in rural Vietnam, 1999-2003[J]. Prev Chronic Dis. 2006, 3(3):A89.
23. Omar S, Alieldin NH, Khatib OM. Cancer magnitude, challenges and control in the Eastern Mediterranean region[J]. East Mediterr Health J. 2007, 13(6):1486-1496.
24. Zindah M, Belbeisi A, Walke H, et al. Obesity and diabetes in Jordan: findings from the behavioral risk factor surveillance system, 2004 [J]. Prev Chronic Dis. 2008, 5(1):A17.
25. Petersen PE, Bourgeois D, Ogawa H, et al. The global burden of oral diseases and risks to oral health [J]. Bull World Health Organ. 2005, 83(9):661-669.
26. Ng N, Stenlund H, Bonita R, et al. Preventable risk factors for noncommunicable diseases in rural Indonesia: prevalence study using WHO STEPS approach [J]. Bull World Health Organ. 2006, 84(4):305-313.
27. Rhodes KV, Kushner HM, Bisgaier J, et al. Characterizing emergency department discussions about depression[J]. Acad Emerg Med. 2007, 14(10):908-911.
28. Gibson S, Lemyre L, Clément M, et al. Terrorism threats and preparedness in Canada: the perspective of the Canadian public[J]. Biosecur Bioterror. 2007, 5(2):134-144.
29. Williams K, Prevost AT, Griffin S, et al. The ProActive trial protocol - a randomised controlled trial of the efficacy of a family-based, domiciliary intervention programme to increase physical activity among individuals at high risk of diabetes [J]. BMC Public Health. 2004, 4:48.
30.贾红,李丽,刘毅.适应公共卫生事业发展,培养预防医学实用性人才[J].医学教育探索, 2005, 4(2):110-112.
31.胡银生.重人才,加快提高疾病预防控制水平[J].中国公共卫生管理, 2004, 20(4):298-299.
32.孙树丰.新发传染病的出现及应对措施[J],中华临床与卫生2004 3(2):126-127
33. Hattori T. Newly emerging infections[J], Nippon Naika Gakkai Zasshi. 2005, 94(9):568-576.
34.王彬.突发公共卫生事件法制管理的探讨[J].中国卫生质量管理, 2005, 12(3):54-56.
35. Reischl TM, Buss AN. Responsive evaluation of competency-based public health preparedness training programs [J]. J Public Health Manag Pract. 2005, S100-5.
36.向浩,王重建,许奕华,等.中国突发公共卫生事件应急人才培养现状与分析[J].中华预防医学杂志, 2007, 41(6):9-11.
37.人才仍缺乏素质待提高——公共卫生教育呼唤改革.公共卫生教育改革论坛. 2005年9月.
38.袁重胜,方传龙,程秋,等.积极开展MPH教育,培养高素质高层次公共卫生应用型人才[J].中国公共卫生管理, 2002, 18(6):553-554.
39.徐建国.传染病突发公共卫生事件的技术管理[J].中华流行病学杂志, 2006, 27(12):1013-1016.
40.刘玲玲,刘学在,唐学锋,等.四川省疾病预防控制机构人力资源现状分析[J].中国卫生事业管理. 2006, 12:740-742.
41.杨峰,谢洪彬,王伟成,等.我国疾病预防控制中心人才流失情况分析.卫生研究, 2005, 34(5):516-517.
42.万成松,郑莉,卫秦芝,等.应急型公共卫生人才培养模式的探索与实践[J].医学教育探索, 2007,6(8):683-685.
43.王重建,许奕华,魏晟,等.分析决策能力试点研究培训效果评价[J].中国公共卫生, 2006, 22(5):605-606.
44. Petrakova A, Sadana R. Problems and progress in public health education [J]. Bull World Health Organ. 2007, 85(12):963-970.
45. Hu GQ, Rao KQ, Sun ZQ. A preliminary framework to measure public health emergency response capacity [J]. J Public Health. 2005, 12:66-72.
46.郑金成.提高基层疾病预防控制机构应急能力的对策探讨[J].国际医药卫生导报, 2007, 13(2):114-115.
47. Olson D, Leitheiser A, Atchison C, et al. Public health and terrorism preparedness: cross-border issues[J]. Public Health Rep. 2005, 120 S1:76-83.
48. Bioterrorism & Emergency Readiness. Competencies for All Public Health Workers. Columbia University School of Nursing Center for Health Policy. 2002.
49.唐星明,黎介寿.高层次医学创新人才培养的实践与成效[J].中华医学杂志. 2005, 85(14):944-945.
50.樊立华,陈莉,李莉.疾病预防控制中心人力资源现况分析与管理对策的探讨[J].疾病控制杂志, 2005, 9(5):481-482.
51.魏晟,廖巧红,聂绍发,等.突发公共卫生事件预警决策分析能力现状调查[J].中国公共卫生, 2007, 23(3):347-348.
52.王凤兰,张占伟,毛滢.加强人才培养开发人力资源[J].中华医院管理杂志, 2004, 20(9):221-222.
53. Sadana R, Mushtaque A, Chowdhury R, et al. Strengthening public health education and training to improve global health[J]. Bull World Health Organ. 2007, 85(3):163-164.
54. Matthews AK, Sprague K, Girling E, et al. Emergency preparedness volunteer training program [J]. J Public Health Manag Pract. 2005, 11:S63-67.
55. Harrison LM, Davis MV, MacDonald PD, et al. Development and Implementation of a Public Health Workforce Training Needs Assessment Survey in North Carolina[J]. Public Health Rep. 2005, 120(1):S28-34.
56. Wang J, Wang GG.. Participation in management training in a transitioning context: a case of China [J]. Human Res Develop Quarterly. 2006, 17(4):443-473.
57. Porter J, Johnson J, Upshaw VM, et al. The Management Academy for Public Health: a new paradigm for public health management development [J]. J Public Health Manag Pract. 2002, 8:66-78.
58. Lowrey W, Evans W, Gower KK, et al, Abdolrasulnia M. Effective media communication of disasters: pressing problems and recommendations [J]. BMC Public Health. 2007, 7:97.
2. Mathew D. Information technology and public health management of disasters--a model for South Asian countries [J]. Prehosp Disaster Med. 2005, 20(1):54-60.
3. Wen-kui G, Jia-tong Z, De-cheng L, et al. The three networks framework to deal with public health emergencies in Guangxi, China [J]. Can J Public Health. 2006, 97(5):398-401.
4.王颖.培养有中国特色的应急管理人才——访中国行政管理学会副秘书长张学栋[J].国际人才交流, 2004, 4:8-9.
5.应桂英,苏维,栾荣生.影响突发公共卫生事件决策的因素分析[J].中华医学杂志, 2006, 86(17):1161-1164.
6.舒彬,廖巧红,聂绍发.我国突发公共卫生事件预警机制建设现状[J].疾病控制杂志, 2005, 9(6):623-626.
7. Barnett DJ, Everly GS, Parker CL, et al. Applying educational gaming to public health workforce emergency preparedness[J]. Am J Prev Med. 2005, 28(4):390-395.
8. Watson-Alván S, Alves-Dunkerson J. The importance of a shared vision in emergency preparedness: engaging partners in a home-rule state [J]. Dent Clin North Am. 2007, 51(4):785-803.
9. Qureshi KA, Merrill JA, Gershon RR, et al. Emergency preparedness training for public health nurses: a pilot study [J]. J Urban Health. 2002, 79(3):413-416.
10. Chant AD. A confusion of roles: manpower in the National Health Service [J]. J R Soc Med. 1998, 91:63-65.
12.王重建,魏晟,刘建平,等.湖北省疾病预防控制人员应急能力评价及影响因素分析.中国公共卫生, 2007, 23(6):731-733.
13.突发公共卫生事件应急条例, 2003年5月.
14.刑力新(硕士),韩文秀(导师).天津大学05届硕士论文:突发公共卫生事件应对研究.
15.王陇德.现场流行病学,北京:人民卫生出版社, 2004, 19-21.
16. Moye PK, Pesik N, Terndrup T, et al. Bioterrorism training in U.S. emergency medicine residencies: has it changed since 9/11[J]? Acad Emerg Med. 2007, 14(3):221-227.
17. Brolén P, Ortenwall P, Osterhed H, et al. KAMEDO Report 89: terrorist attack in Bali, 2002[J]. Prehosp Disaster Med. 2007, 22(3):246-250.
18. Choi N. Narrative analysis on survivor's experience of Daegu subway fire disaster--the hypothetical suggestions for disaster nursing practice [J]. Taehan Kanho Hakhoe Chi. 2005, 35(2):407-418.
19. Hu YY, Adams RE, Boscarino JA, et al. Training needs of pediatricians facing the environmental health and bioterrorism consequences of September 11th[J]. Mt Sinai J Med. 2006, 73(8):1156-1164.
20. Murphy FA. Emerging zoonoses: The challenge for public health and biodefense [J]. Prev Vet Med. 2008 Mar 29. [Epub ahead of print].
21. Perrone LA, Tumpey TM. Reconstruction of the 1918 pandemic influenza virus: how revealing the molecular secrets of the virus responsible for the worst pandemic in recorded history can guide our response to future influenza pandemics [J]. Infect Disord Drug Targets. 2007, 7(4):294-303.
22. Hoang VM, Dao LH, Wall S, et al. Cardiovascular disease mortality and its association with socioeconomic status: findings from a population-based cohort study in rural Vietnam, 1999-2003[J]. Prev Chronic Dis. 2006, 3(3):A89.
23. Omar S, Alieldin NH, Khatib OM. Cancer magnitude, challenges and control in the Eastern Mediterranean region[J]. East Mediterr Health J. 2007, 13(6):1486-1496.
24. Zindah M, Belbeisi A, Walke H, et al. Obesity and diabetes in Jordan: findings from the behavioral risk factor surveillance system, 2004 [J]. Prev Chronic Dis. 2008, 5(1):A17.
25. Petersen PE, Bourgeois D, Ogawa H, et al. The global burden of oral diseases and risks to oral health [J]. Bull World Health Organ. 2005, 83(9):661-669.
26. Ng N, Stenlund H, Bonita R, et al. Preventable risk factors for noncommunicable diseases in rural Indonesia: prevalence study using WHO STEPS approach [J]. Bull World Health Organ. 2006, 84(4):305-313.
27. Rhodes KV, Kushner HM, Bisgaier J, et al. Characterizing emergency department discussions about depression[J]. Acad Emerg Med. 2007, 14(10):908-911.
28. Gibson S, Lemyre L, Clément M, et al. Terrorism threats and preparedness in Canada: the perspective of the Canadian public[J]. Biosecur Bioterror. 2007, 5(2):134-144.
29. Williams K, Prevost AT, Griffin S, et al. The ProActive trial protocol - a randomised controlled trial of the efficacy of a family-based, domiciliary intervention programme to increase physical activity among individuals at high risk of diabetes [J]. BMC Public Health. 2004, 4:48.
30.贾红,李丽,刘毅.适应公共卫生事业发展,培养预防医学实用性人才[J].医学教育探索, 2005, 4(2):110-112.
31.胡银生.重人才,加快提高疾病预防控制水平[J].中国公共卫生管理, 2004, 20(4):298-299.
32.孙树丰.新发传染病的出现及应对措施[J],中华临床与卫生2004 3(2):126-127
33. Hattori T. Newly emerging infections[J], Nippon Naika Gakkai Zasshi. 2005, 94(9):568-576.
34.王彬.突发公共卫生事件法制管理的探讨[J].中国卫生质量管理, 2005, 12(3):54-56.
35. Reischl TM, Buss AN. Responsive evaluation of competency-based public health preparedness training programs [J]. J Public Health Manag Pract. 2005, S100-5.
36.向浩,王重建,许奕华,等.中国突发公共卫生事件应急人才培养现状与分析[J].中华预防医学杂志, 2007, 41(6):9-11.
37.人才仍缺乏素质待提高——公共卫生教育呼唤改革.公共卫生教育改革论坛. 2005年9月.
38.袁重胜,方传龙,程秋,等.积极开展MPH教育,培养高素质高层次公共卫生应用型人才[J].中国公共卫生管理, 2002, 18(6):553-554.
39.徐建国.传染病突发公共卫生事件的技术管理[J].中华流行病学杂志, 2006, 27(12):1013-1016.
40.刘玲玲,刘学在,唐学锋,等.四川省疾病预防控制机构人力资源现状分析[J].中国卫生事业管理. 2006, 12:740-742.
41.杨峰,谢洪彬,王伟成,等.我国疾病预防控制中心人才流失情况分析.卫生研究, 2005, 34(5):516-517.
42.万成松,郑莉,卫秦芝,等.应急型公共卫生人才培养模式的探索与实践[J].医学教育探索, 2007,6(8):683-685.
43.王重建,许奕华,魏晟,等.分析决策能力试点研究培训效果评价[J].中国公共卫生, 2006, 22(5):605-606.
44. Petrakova A, Sadana R. Problems and progress in public health education [J]. Bull World Health Organ. 2007, 85(12):963-970.
45. Hu GQ, Rao KQ, Sun ZQ. A preliminary framework to measure public health emergency response capacity [J]. J Public Health. 2005, 12:66-72.
46.郑金成.提高基层疾病预防控制机构应急能力的对策探讨[J].国际医药卫生导报, 2007, 13(2):114-115.
47. Olson D, Leitheiser A, Atchison C, et al. Public health and terrorism preparedness: cross-border issues[J]. Public Health Rep. 2005, 120 S1:76-83.
48. Bioterrorism & Emergency Readiness. Competencies for All Public Health Workers. Columbia University School of Nursing Center for Health Policy. 2002.
49.唐星明,黎介寿.高层次医学创新人才培养的实践与成效[J].中华医学杂志. 2005, 85(14):944-945.
50.樊立华,陈莉,李莉.疾病预防控制中心人力资源现况分析与管理对策的探讨[J].疾病控制杂志, 2005, 9(5):481-482.
51.魏晟,廖巧红,聂绍发,等.突发公共卫生事件预警决策分析能力现状调查[J].中国公共卫生, 2007, 23(3):347-348.
52.王凤兰,张占伟,毛滢.加强人才培养开发人力资源[J].中华医院管理杂志, 2004, 20(9):221-222.
53. Sadana R, Mushtaque A, Chowdhury R, et al. Strengthening public health education and training to improve global health[J]. Bull World Health Organ. 2007, 85(3):163-164.
54. Matthews AK, Sprague K, Girling E, et al. Emergency preparedness volunteer training program [J]. J Public Health Manag Pract. 2005, 11:S63-67.
55. Harrison LM, Davis MV, MacDonald PD, et al. Development and Implementation of a Public Health Workforce Training Needs Assessment Survey in North Carolina[J]. Public Health Rep. 2005, 120(1):S28-34.
56. Wang J, Wang GG.. Participation in management training in a transitioning context: a case of China [J]. Human Res Develop Quarterly. 2006, 17(4):443-473.
57. Porter J, Johnson J, Upshaw VM, et al. The Management Academy for Public Health: a new paradigm for public health management development [J]. J Public Health Manag Pract. 2002, 8:66-78.
58. Lowrey W, Evans W, Gower KK, et al, Abdolrasulnia M. Effective media communication of disasters: pressing problems and recommendations [J]. BMC Public Health. 2007, 7:97.