Hệ thống y tế cơ sở sẽ đi theo mô hình của Hoa Kỳ từ tháng Một

Khám, chữa bệnh cho nhân dân tại Trung tâm Y tế Dự phòng tỉnh Phú Thọ. (Ảnh: Trung Kiên/TTXVN)

Ông Phạm Văn Tác, Vụ trưởng Vụ Tổ chức cán bộ (Bộ Y tế) cho biết, sắp tới Bộ Y tế sẽ tiến hành sáp nhập các trung tâm y tế dự phòng, trung tâm phòng chống HIV/AIDS, trung tâm phòng chống bệnh xã hội… thành một đơn vị thống nhất.

Ngày 30/12, tại hội nghị đổi mới hệ thống y tế địa phương, ông Tác cho hay, việc cải cách hành chính ở tuyến tỉnh sẽ được thực hiện ngay từ tháng 1/2016 theo mô hình CDC Hoa Kỳ (kiểm soát dịch bệnh) theo tinh thần của thông tư số 51/2015/TTLT-BYT-BNV.

Theo thông tin từ Bộ Y tế, hiện nay ở nhiều địa phương tồn tại trung bình 5-7 trung tâm, cá biệt có địa phương lên đến 12 trung tâm..

Cũng theo thông tư 51, cấp sở sẽ khống chế đội ngũ lãnh đạo không quá 3 cấp phó; tại cấp tổng cục lãnh đạo có không quá 4 cấp phó.

Như vậy việc sáp nhập các trung tâm này sẽ giúp tinh giảm rất nhiều về nhân lực. Điển hình như riêng đội ngũ giám đốc các trung tâm sẽ giảm 5-12 người xuống còn 1 giám đốc duy nhất. Như vậy, tính chung trên toàn quốc sẽ giảm hàng trăm xe công phục vụ riêng các giám đốc; giảm xây dựng mới hàng trăm trụ sở công…

Cũng theo ông Tác, với quy định mới tiêu chuẩn chức danh lãnh đạo yêu cầu lãnh đạo phải có trình độ sau đại học và thêm một quy định buộc phải có đó là chứng chỉ về đào tạo quản lý ngành y tế.

"Bởi lâu nay người quản lý trong ngành thường có bằng cấp về chuyên môn, chuyên ngành liên quan đến điều trị, dự phòng trong khi việc quản lý phải có kỹ năng, nghiệp vụ về điều hành nhân sự, tài chính," ông Tác nhấn mạnh.

Theo quy định mới, đối với tiêu chuẩn về trình độ chuyên môn, do đặc thù của ngành y tế là ngành chuyên môn kỹ thuật cao, Giám đốc Sở Y tế phải có trình độ chuyên môn sau đại học về y, dược, y tế công cộng, hoặc quản lý y tế.

Đối với Phó Giám đốc Sở Y tế phải có trình độ chuyên môn sau đại học một trong các chuyên ngành y, dược hoặc chuyên ngành khác phù hợp với lĩnh vực công tác đảm nhiệm.

Đối với tiêu chuẩn về ngạch, yêu cầu Giám đốc và Phó giám đốc Sở y tế giữ ngạch chuyên viên chính hoặc các ngạch tương đương trở lên.

Cũng trong thời gian tới, tại cấp xã phường cũng sẽ thành lập trung tâm hai chức năng trên cơ sở sáp nhập trung tâm y tế dự phòng, trung tâm y tế và bệnh viện tuyến huyện. Việc này đảm bảo thống nhất điều hành trong việc phòng chống và điều trị cho người dân đạt kết quả tốt nhất ngay tại tuyến cơ sở, nguồn lực đầu tư tập trung.

Báo cáo của Bộ Y tế cho thấy thực tế thời gian qua, một số địa phương còn xem nhẹ đầu tư cho y tế dự phòng, khiến dịch bệnh lây lan, chỉ tập trung cho các cơ sở điều trị vì đây là cơ sở có nguồn thu./.

• Trung tâm y tế dự phòng Hà Nội bắt đầu tiêm vắcxin 5 trong 1
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Skin Diseases with an Immune Component, Part I: Allergic and Hypersensitivity-Related Conditions

Skin Diseases with an Immune Component, Part I: Allergic and Hypersensitivity-Related Conditions

Editor-in-Chief: Nikki A. Levin, MD, PhD
Editor-in-Chief: Cathleen K. Case, MS, ANP-BC, DCNP
Medical Writer for original manuscript: Nancy J. Nordenson, MT (ASCP), MFA
Medical Writer for updates to manuscript: Joshua F. Kilbridge

Contact Dermatitis (Irritant and Allergic)

Contact dermatitis presents as an itchy erythematous or vesicular rash when acute, and as dry, lichenified, fissured skin when chronic.⁷ Irritant contact dermatitis is a nonimmunologic condition caused by exposure to an irritant, such as a caustic agent.⁷ In contrast, allergic contact dermatitis is a T-cell–mediated (ie, type IV) hypersensitivity reaction caused by sensitization to an allergen.⁷

Allergic and irritant contact dermatitis often cannot be differentiated by clinical presentation alone.⁷Patch testing using one or more screening series should be performed to identify a cause.⁷ The relevance of patch test results should be determined within the context of the patient’s current and past exposures.⁷

Management includes avoidance of and/or protection from (eg, gloves for hand dermatitis) the triggering irritant or allergen.⁷ Topical corticosteroids are first-line treatment; second-line treatments include psoralen plus ultraviolet A light, azathioprine, and cyclosporine.⁷

Case example

A 24-year-old hairdresser presents with a 6-month history of itchy red skin on her hands and wrists. She admits to having direct exposure to multiple chemicals, including hair dye, relaxers, and cleaning products. She has been using triamcinolone 0.1% cream on the rash without much improvement.

On examination, the patient has erythematous, fissured, oozing plaques on her dorsal hands and wrists and some small vesicles between her fingers. The palms are erythematous and scaly. A potassium hydroxide preparation of scale from her hands is negative for fungal hyphae.

Given that the differential diagnosis of the patient’s eruption includes allergic contact dermatitis (as well as atopic dermatitis, psoriasis, tinea manuum, and irritant contact dermatitis), she is scheduled for evaluation by patch testing. Nursing staff apply the patches of a standard series of allergens to the patient’s back, in addition to supplementary allergens associated with hairdressing. The patches on the back are secured with surgical tape and carefully marked with surgical marker for future reference. The patient returns at 48 hours to have the patches removed and the early reading performed. She returns at 96 hours for a late reading of the patch tests. She is found to be markedly allergic to glutaraldehyde, a sterilizing agent, as well as to Group B corticosteroids, which include triamcinolone.

Based on these results, the patient is advised to wear protective gloves when handling chemicals at work and to discontinue triamcinolone. She is prescribed twice-daily hand soaks in a coal tar solution, application of a non–cross-reacting corticosteroid ointment twice daily, and oral antibiotics for presumed secondary infection. She is asked to use petrolatum on her skin after hand washing.

This case demonstrates that workers in certain occupations, such as hair dressing and cosmetology, are at high risk for allergic contact dermatitis due to frequent exposure to chemicals. Patients with dermatitis of any etiology may then become allergic to topical corticosteroids, as happened to this patient. Patch testing is the gold standard evaluation for determining specific allergens causing dermatitis. Counseling patients by providing them with detailed information regarding products to avoid is essential to prevent recurrence or persistence of contact dermatitis.

Skin Diseases with an Immune Component, Part I: Allergic and Hypersensitivity-Related Conditions

Editor-in-Chief: Nikki A. Levin, MD, PhD
Editor-in-Chief: Cathleen K. Case, MS, ANP-BC, DCNP
Medical Writer for original manuscript: Nancy J. Nordenson, MT (ASCP), MFA
Medical Writer for updates to manuscript: Joshua F. Kilbridge

 Click the supportive multimedia hyperlinks throughout this activity to access illustrations, videos, journal articles, glossary terms, online textbooks, and other resources to enhance understanding of relevant issues.

Introduction

A hypersensitivity reaction is an exaggerated and pathologic response by the immune system to a self- or foreign antigen.^1,2 Four types of hypersensitivity reactions are recognized², which differ in mediators involved, mechanisms, timing, and clinical manifestations (Table).^2-4

Table. Four Types of Hypersensitivity Reactions^2-4

Type	Mediators	Mechanism	Timing*	Examples of Conditions
Type I (immediate/ anaphylactic)	IgE, histamine, tryptase, leukotrienes	IgE, produced in excessive amounts, interacts with mast cells to cause release of histamine and other inflammatory compounds	15–30 min, usually; 10–12 h for some delayed reactions	Anaphylaxis, asthma, urticaria, angioedema
Type II (cytotoxic)	IgG or IgM, complement	Antibody is bound to antigen on cell surface, triggering complement activation, phagocytosis, and cytotoxicity	Minutes to hours	Some drug reactions, transfusion reactions
Type III (immune complex)	IgG or IgM immune complexes	Antigen-antibody immune complexes are deposited in tissue, activating mast cells, neutrophils, and phagocytes and triggering complement cascade	3–10 h	Serum sickness, arthus reaction, vasculitis, systemic lupus erythematosus
Type IV (delayed/ cell-mediated)	Antigen-specific T-cells; monocyte chemotactic factor, interleukin-2, interferon-gamma, TNF alpha and beta	Activated antigen-specific helper T-cells stimulate release of cytokines and chemokines, which attract and activate macrophages, eosinophils, and neutrophils; cytotoxic T-cells cause damage directly	1–3 d; up to 4 wk for some reactions	Allergic contact dermatitis, tuberculin reaction, granuloma formation

*Timing from exposure to antigen.

Cancer ISN'T all in your genes

Cancer ISN'T all in your genes: Up to 90% of cases 'could be wiped out by avoiding triggers caused by our unhealthy lifestyles'

Monday, December 28, 2015 by: Jennifer Lea Reynolds
Tags: cancer prevention, weight control, lifestyle choices

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(NaturalNews) A study published in the journal Nature reinforces what health-minded people have long-known: lifestyle plays a huge role in whether or not a person develops cancer; it's not solely relegated to their genes. As such, behaviors like eating healthy foods and not smoking are key factors in cancer prevention. In fact, upwards of 90 percent of cases could be "wiped out," by swapping unhealthy lifestyle choices for healthier ones.^(1,2)

The information stems from researchers who set out to assess – and ultimately debunk – the ongoing "bad luck" cancer debate. Many experts maintain that cancer development is mostly linked with chance mutations involving a "... strong correlation between tissue-specific cancer risk and the lifetime number of tissue-specific stem-cell divisions." However, there's much more to it, as the study published inNature points out.⁽²⁾

The study, entitled, Substantial contribution of extrinsic risk factors to cancer development, notes that "...the rates of endogenous mutation accumulation by intrinsic processes are not sufficient to account for the observed cancer risks." It concluded that "... cancer risk is heavily influenced by extrinsic factors. These results are important for strategizing cancer prevention, research and public health."⁽²⁾

'Cancer isn't just all about genes'

Dr. Emma Smith of Cancer Research UK says in a video that while a few cancers exist "by chance in our DNA," many are bought on by external factors. This, she says, is "good news" because it means many cancers are preventable. She goes on to explain that the study builds a strong, scientifically-backed "wall of evidence" demonstrating that "cancer isn't just down to genes." She says that four in ten cancers in the UK could be preventable – if people were to make significant lifestyle changes including eating healthier foods, maintaining a proper weight and quitting smoking.⁽¹⁾

Other factors identified as ways to help wipe out cancer cases included reducing alcohol consumption and avoiding pollution. While one can't help where they're born or how they're raised, or avoid certain environmental circumstances brought about by job and family situations, there are many ways a person can – as the study makes clear – reduce their risk of developing cancer.⁽¹⁾

How you can reduce your cancer risk

Avoid processed foods

So while you may not easily be able to pack your bags and move your entire family to a new state or country where air pollution isn't problematic, you can engage in other healthy behaviors.

For example, diet plays a significant role in keeping cancer at bay. A division of the World Health Organization (WHO), the International Agency for Research on Cancer, released information earlier this year stating that red meat is "probably carcinogenic to humans" and that processed meats are "carcinogenic to humans." The likes of bacon and hot dogs are made using all kinds of health-harming methods designed to preserve the food and enhance flavors.⁽³⁾

Exercise more

As far as keeping your weight in check, eating healthy foods is only part of the equation. Proper amounts of exercise also matter in the fight to keep weight down. In fact, some medical professionals are even involved in writing their overweight patients "park prescriptions," in which they're encouraged to obtain healthier weights – not by popping pills or resorting to the latest silly diet, but by walking more. Many doctors even map out a person's work or school commute, providing options whereby they walk through trails and parks in lieu of sitting on a bus or in a car for hours.⁽⁴⁾

It's been found that excess weight is associated with the development of at least 10 cancers, including breast, bowel, esophagus, ovary and liver cancer. It's estimated that one in six of these cancers could be prevented by – you guessed it – maintaining a healthy weight.⁽⁵⁾

Stop smoking

When it comes to smoking, it's no secret that quitting (or never taking it up in the first place), greatly lessens the chances of developing cancer. The National Cancer Institute explains that more than 250 cancer-causing chemicals – ranging from arsenic and vinyl chloride to nickel and formaldehyde – lurk in tobacco smoke. In addition to causing stroke and heart disease, puffing away on cigarettes is also associated with causing a variety of cancers such as cancer of the mouth, throat, stomach, liver and rectum.⁽⁶⁾

Do your best to improve your diet, watch your weight and stop smoking. By taking charge of that which you can easily control, you'll be well on your way to keeping cancers at bay.

Sources for this article include:

(1) DailyMail.co.uk

(2) Nature.com

(3) NaturalNews.com

(4) Blogs.NaturalNews.com

(5) NaturalNews.com

(6) Cancer.gov

Learn more: http://www.naturalnews.com/052452_cancer_prevention_weight_control_lifestyle_choices.html#ixzz3viqlhndr

Drug resistance deadlier than cancer by 2050

Drug resistance deadlier than cancer by 2050: Study

Catherine Boyle | @cboylecnbc

Thursday, 11 Dec 2014 | 4:01 AM ET

Media for Medical | Universal Images Group | Getty Images

Infections resistant to medicines will kill more people per year than cancer by 2050, and cost the world $100 trillion annually, according to a U.K. government-backed report led by Jim O'Neill, the well-known former Goldman Sachs economist.

The wide-ranging study, called the Review on Antimicrobial Resistance, was commissioned by the U.K. government earlier this year amid growing concerns about drug-resistant "superbugs", including new strains of E. coli, malaria and tuberculosis.

Its forecasts, based on research by RAND Europe and KPMG, suggest that drug resistance, which is estimated to have caused around 700,000 deaths globally this year, will cause 10 million by 2050 if further action is not taken.

Antibiotic use is rising around the world, while at the same time the number of new antibiotics is falling. If these medicines become ineffectual, there could be a huge economic ramifications, as people of working age are affected, and once treatable diseases become incurable again.

Read MoreWhite House escalates fight against antibiotic resistance

New antibiotics take time and money to develop, and by their nature are less effective the more they are used. As such, many pharmaceutical companies have slowed development of these kinds of drugs.