我国省级区域医疗卫生与经济协调发展的时空演变研究

目的:探索我国省级区域医疗卫生与经济协调发展状况及其时空演变,为医疗卫生与经济增长关系研究提供新思路。方法:借鉴物理学概念及有关成果,构建协调发展评价模型,对我国省级区域医疗卫生与经济协调发展状况进行分析,并运用探索性空间数据分析方法分析其时空演变。结果:我国省级区域医疗卫生与经济协调发展取得了一定进展,各省级区域呈现出"中间重(过渡类较多)、两头轻(协调类、失衡类较少)"的状态,和"东高西低"的阶梯特征;在空间上集聚,高值集聚和低值集聚均比较明显,热点和次热点区域主要集中在东、中部地区,而冷点和次冷点区域主要集中在西部地区。结论:协调发展评价模型适用于区域医疗卫生与经济协调发展研究,为医疗卫生与经济增长协调关系研究提供了新基础。     

口腔金属材料磁共振成像伪影的实验研究

研究3种口腔常用金属材料在l3种不同头颈部扫描序列中的伪影。测量伪影大小，并进行统计学分析。得出3种金属在相同序列成像中，纯钛伪影最小，硬质钴铬合金伪影最大；相同金属材料，6种自旋回波及快速自旋回波序列产生伪影最小，3种梯度回波序列产生伪影较大，4种平面回波序列伪影最大且使图像变形。口腔金属材料产生伪影与材料类型及成像技术密切相关，通过合理选择金属材料及成像技术得到最佳MR成像。     

医学女生社会支持状况及其影响因素的调查研究

目的:了解医学院女生社会支持状况,为女大学生心理保健提供依据。方法:采用整群随机抽样的方法,对184名医学女生运用《社会支持评定量表》进行测试。结果:城市女生在邻居支持项目上得分均值低于农村女生,在参加活动项目上得分均值高于农村女生;独生女生在家人支持、主观支持因子及总分得分均值低于非独生女生;朋友支持以及同学支持项目得分均值大一高于大二,家人支持项目四年级高于其它年级,参加活动项目得分均值大二高于大四,主观支持因子得分均值大一高于大二,大二低于大四,差异均具有显著性意义。结论:医学女生社会支持呈现一定的特点,受其年级、生源地、是否为独生子女等因素的影响。对女大学生心理保健时,应鼓励其积极建立与主动获取社会支持。     

The vaccination coverage rate: why is it so low?

The problems hampering vaccination programs in Zaire include the inaccessibility of vaccination posts, the deplorable condition of vaccines and supplies, transport difficulties, and community disinterest. Most vaccination posts in Zaire are physically inaccessible and poorly stocked. They lack skilled staff and are unable to provide quality care. They do not have the means of providing themselves with vaccine; shortages are so common that vaccination schedules are difficult to follow. Refrigerators are usually not available in vaccination centers and are often diverted to other uses if they are available. The instructions for storing vaccines are often incorrectly followed. Single-use needles and syringes continue to be reused. Vehicles assigned to vaccination programs are often used for the private benefit of program officials or their families. Misuse of vehicles contributes to their short life expectancy. Local communities are disinterested in vaccination programs because they do not contribute to immediate survival. Moreover, the population regularly experiences the death of correctly vaccinated children. Some persons distrust vaccination as a trick to render women sterile or cause fever and convulsions in children. Mass vaccination programs are so poorly organized that their failure is predictable. The officials in charge spend most of their time in their offices rather than getting to know the target populations, and are often more interested in publicity for themselves than in the program. Press coverage is indispensable, but it should be devoted to furthering the program and not the careers of the officials in charge. Training of vaccinators, stocking of vaccination posts, and other essential tasks are often left until the last minute and improvised rather than carefully planned and implemented. The vaccinators are often unemployed persons who have little knowledge of correct techniques. Vaccination coverage could be improved if planners and health officials would acquaint themselves with the target communities, their health problems, and their perceptions of the vaccination program. Vaccination posts, hours of operation, and date of vaccination programs should be carefully planned to ensure that they are accessible to the population. The community should be informed about the program and motivated to participate. The logistics should be carefully worked out, and the vaccinators should be trained well in advance of the campaign.     

新疆阿拉山口口岸2012年入境集装箱空箱卫生状况调查

目的对阿拉山口口岸2012年入境1514个需进行卫生处理集装箱空箱卫生状况和携带微生物情况进行调查分析,为加强入境集装箱空箱卫生检疫及卫生处理工作提供依据。方法对箱内携带垃圾进行分类分析,随机抽取集装箱,对其箱内表面采样,参考国家有关标准,采用显色培养基和生化培养试剂盒做微生物培养、鉴定菌种。结果处理集装箱空箱中,检查结果如下：携带动物尸体集装箱3个;携带动植物残留物集装箱101个;携带生活垃圾集装箱1373个;携带人类或动物传染病病原体集装箱48个;携带病媒生物集装箱37个。微生物检测情况如下：随机抽取处理集装箱空箱采集412份样品,检出金黄色葡萄球菌225株;沙门氏茵20株;大肠埃希氏菌61株;蜡样芽孢杆菌199株;链球菌31株等病原微生物。结论入境集装箱空箱携带垃圾、病原微生物为国际间疫病的传播提供了便利通道,给各国的卫生安全及人体健康带来威胁。应加强阿拉山口口岸入境集装箱空箱的卫生检疫及卫生处理工作。     

Grandparents raising grandchildren:kinship care in Baltimore public housing

Life circumstances and threatening ecologies disenfranchise families living in public housing development. Many are children who live with their grandparents in housing units, but are not on the lease. The grandparents and grandchildren experience health problems, are in poverty, and are not served by the child welfare system. Frequently, the children are forced to sleep in bedrooms with other individuals who may be inappropriate, subjecting them to potential sexual child abuse and other circumstances. Housing officials are compelled to remedy this problem and ensure that all residents of public housing are on the lease and are properly housed consistent with the U.S. Housing Act of 1932. National housing policy needs to be reformed to accommodate the needs of children who for a range of circumstances cannot live with their parents. doi:10.1300/J045v22n03_11.     

Unequal cluster sizes for trials in English and Welsh general practice: implications for sample size calculations

Cluster randomized trials are often used in primary care settings. In the U.K., general practices are usually the unit of allocation. The effect of variability in practice list size on sample size calculations is demonstrated using the General Medical Services Statistics for England and Wales, 1997. Summary statistics and tables are given to help design such trials assuming that a fixed proportion of patients are to be recruited from each cluster. Three different weightings of the cluster means are compared: uniform, cluster size and minimum variance weights. Minimum variance weights are shown to be superior to uniform, particularly when clusters are small, and to cluster size weights, particularly when clusters are large. Where there are large numbers of participants per cluster and cluster size weights are used, the power actually falls as more patients are recruited to large clusters. When minimum variance weights are used the increase in the design effect due to variation in list size is small, regardless of the size of intracluster correlation coefficient or the number of participants per cluster, provided there is no loss of randomized units. When the expected number of participants per practice is low a greater loss in power comes from practices which fail to recruit patients. A method to estimate the likely effect and allow for it is presented.     

Tissue gas exchange models and decompression computations: a review

Mathematical models for inert gas transport and decompression are summarized. Both semi-infinite and finite media are treated, and resulting analytic expressions are obtained and compared against each other. One-dimensional plane and cylindrical geometries are considered, and limiting forms are explicitly detailed. Models are placed into three categories for discussion--bounded, bulk, and perfusion-diffusion. The intent is to collect treatments and techniques into one source for reference. Staging criteria, where appropriate to a model, are also included in the development. Bounded, bulk, and perfusion-diffusion models are described in supersaturation, statistical, and thermodynamic frameworks. Some strengths and weaknesses of deterministic and statistical models are noted. Today, models can be nested in hi-tech decomputers utilizing precision depth sensors and elapsed timers. The ability to solve equations and check criteria in an essentially continuous time mode imparts new dimensionality, enhancing capability and optimizing performance. However, there are limits on all computational models, both in theory and application, and herein we review range, physical correctness, and history of the algorithm.     

Host range and emerging and reemerging pathogens

An updated literature survey identified 1,407 recognized species of human pathogen, 58% of which are zoonotic. Of the total, 177 are regarded as emerging or reemerging. Zoonotic pathogens are twice as likely to be in this category as are nonzoonotic pathogens. Emerging and reemerging pathogens are not strongly associated with particular types of nonhuman hosts, but they are most likely to have the broadest host ranges. Emerging and reemerging zoonoses are associated with a wide range of drivers, but changes in land use and agriculture and demographic and societal changes are most commonly cited. However, although zoonotic pathogens do represent the most likely source of emerging and reemerging infectious disease, only a small minority have proved capable of causing major epidemics in the human population.     

Nutritional factors and visual function in premature infants.

Approximately 5-7% of all infants are born prematurely, and birth before 37 weeks is the most common cause of neonatal mortality, morbidity and long-term disability. Premature infants are poorly equipped for life outside the womb, and oxidant stress has been implicated in the aetiology of visual impairment in these infants, who are often exposed to increased O2 concentrations and high light intensity in neonatal units. The carotenoids lutein and zeaxanthin, which give the macular area of the eye its yellow colour, are located in the retinal pigment epithelium of the eye, and are believed to play a role in protecting it against oxidative and light damage. The macular pigments are of dietary origin, and green leafy vegetables are the primary source of lutein and zeaxanthin. Lutein is one of the five most common carotenoids found in the diet. There is current interest in the macular pigment in relation to age-related macular degeneration, but these pigments may also have a protective role in the retinal pigment epithelium of the newborn infant. Little information is available on blood lutein and zeaxanthin levels in neonates. Levels of lutein in human milk are two to three times higher than those of beta-carotene, whereas their concentrations in the mothers' blood are approximately the same. Human milk is the main dietary source of lutein and zeaxanthin for infants until weaning occurs. The biochemical mechanisms which mediate the transport of the macular carotenoids into the eye are not known, but tubulin has been identified as the major carotenoid-binding protein, and may play a role in the physiology of the macula.     

An epidemiological study of human filariasis : loaiasis, dipetalonemiasis, tetrapetalonemiasis, in Douala fisherman of the river Wouri estuary (Cameroon) (author's transl)

The aim of the study is to establish the prevalence of loaiasis, dipetalonemiasis, tetrapetalonemiasis, with particular emphasis on T. streptocerca infection. Eight small villages located close to Douala in the mangrove area of the Wouri estuary are visited and 788 dermic scarification prints stained with B?hmer hematoxylin are examined. Microfilariae belonging to the species L. loa are found in 11,2 p. 100 of the prints, D. perstans mirofilariae are found in 23,2 p. 100 and T. streptocerca in 6,9 p. 100. The prevalence of filariasis and the parasitic load are higher in male than in female. The older the inhabitants are, the more heavily infected they are found. Except for pruritus and craw-craw associating a filarial infection with characteristic symptoms seems to be difficult in this study.     

Bone transplant

We describe the methodology of the Bone and Soft Tissue Bank, from extraction and storage until use. Since the year 1986, with the creation of the Bone Bank in the University Clinic of Navarra, more than 3,000 grafts have been used for very different types of surgery. Bone grafts can be classified into cortical and spongy; the former are principally used in surgery to save tumour patients, in large post-traumatic reconstructions and in replacement surgery where there are massive bone defects and a structural support is required. The spongy grafts are the most used due to their numerous indications; they are especially useful in filling cavities that require a significant quantity of graft when the autograft is insufficient, or as a complement. They are also of special help in treating fractures when there is bone loss and in the treatment of delays in consolidation and pseudoarthrosis in little vascularized and atrophic zones. They are also used in prosthetic surgery against the presence of cavity type defects. Allografts of soft tissues are specially recognised in multiple ligament injuries that require reconstructions. Nowadays, the most utilised are those employed in surgery of the anterior cruciate ligament although they can be used for filling any ligament or tendon defect. The principal difficulties of the cortical allografts are in the consolidation of the ends with the bone itself and in tumour surgery, given that these are patients immunodepressed by the treatment, the incidence of infection is increased with respect to spongy grafts and soft tissues, which is irrelevant. In short, the increasingly widespread use of allografts is an essential therapeutic weapon in orthopaedic surgery and traumatology. It must be used by expert hands.     

Changes in Elderly Household Participation in the Food Stamp Program

Participation of the elderly in the food stamp program in 1977-78 and 1979-80 are studied using nationally representative and comparable samples. The impact of the elimination of the purchase requirements for the Food Stamp program and changes in other eligibility requirements are studied. Large increases in FSP participation are documented as are some of the factors, particularly social isolation, which are still associated with lowered participation.     

漫漫长路 中文走近DICOM

医学数字影像设备CT、MR等已经在各级医院广泛应用。当初，各厂商生产的这些设备由于采用不同的协议，只能在系统内部传输图像，难以实现更大范围的信息共享。为了解决这一问题，制定了通用协议DICOM。近年来，越来越多的各种影像设备遵从这一协议，成为事实上的国际标准。中国的医疗机构总数和大型医疗设备总数均居世界前列。DICOM在定义了日文和韩文后即将完成对中文的定义。笔者希望通过披露鲜为人知的过程，介绍相关的背景知识，能让大家开阔视野并从中得到一些启迪。     

Socio-demographic characteristics of the physically disabled in Canada.

The major purpose of this paper is to compare a large sample of physically disabled Canadians (N = 1,692) with a similar group of able-bodied persons on a set of socio-demographic characteristics. The data are obtained from the General Social Survey of 1985, and the findings are placed within a minority group status framework. A series of demographic, personal adjustment and economic variables are analyzed using both cross-tabular and logit statistical techniques. In general, the data show that the physically disabled are older, female, and more likely to be divorced, separated or widowed. Relative to the able-bodied, they are not satisfied with their health, jobs, economic circumstances, personal relationships, and life in general. The factors associated with dissatisfaction are likely to be primarily economic and personal. The data developed in this study provide evidence that the physically disabled in Canada are in fact a minority group who are disadvantaged and do not participate fully in the structure of Canadian society.     

Tuberculosis in Peru: identification,treatment

The incidence of tuberculosis in Peru is estimated at 171.3 per 100,000, but regional differentials are significant. The government has administered a decentralized tuberculosis control program for the past several years. Diagnosis, follow-up, and treatment are free. Vaccinations are provided for newborns and at the age of six. Health promoters at the health posts are responsible for screening individuals with coughs lasting longer than two weeks. Sputum samples are analyzed, with the test repeated as necessary. Chest X-rays and tuberculin tests are sometimes useful for diagnosis of tuberculosis, but are difficult to use in many areas of Peru. Cases are treated with a combination of four drugs for the first two months, after which two of the drugs are continued for another four months. The protocol is for most patients regardless of whether the tuberculosis is pulmonary or extrapulmonary. A second and more difficult protocol is used for patients with positive sputum tests after six months of treatment. Hospitalization is reserved for very serious forms of tuberculosis or for complications. Patients receive their medications daily at the health post in the first treatment phase and twice weekly in the second. Tolerance has been good and no routine laboratory tests are performed. Possible side effects are diagnosed clinically. Chemoprophylaxis with isoniazide is provided for children under five years of age who are in contact with tuberculosis carriers. Educational talks are given to patients and their families to impress upon them the importance of proper treatment and follow-up.     

超声成像质量的评价因素及其改善方法

空间分辨率和对比度分辨率是评价超声成像质量的两个关键因素。本文首先详细介绍了这两个关键因素;然后,深入分析了改善超声成像质量的幅度变迹、编码激励和谐波成像方法的工作原理和对图像的改善程度;最后,讨论了超声成像方法的发展趋势。     

HIV/AIDS and young age widowhood in sub-Saharan Africa

This article investigates a probable hidden consequence of high rates of HIV infection and AIDS deaths-an apparently rising proportion of women aged below 50 years who are widowed. It is assumed that young widows who remain unmarried and are sexually active may widely disseminate HIV infection if they are seropositive and do not use condoms. Data from eight nationally representative social surveys in sub-Saharan Africa are analyzed. Four of the surveys are from countries with high HIV prevalence rates (about 10% of adults are HIV positive) and the other four surveys are from countries with relatively low prevalence rates (about 2% of adults are HIV positive). The proportion of young widows in six countries with relevant data are calculated and compared over time. The results show that the proportion of young widows is higher in countries with high HIV prevalence rates than in countries with low prevalence rates. Moreover, while the proportion of young widows decreased in countries with low HIV prevalence rates, the proportion increased in high-prevalence countries. The implications of these results for research policy in Sub-Saharan Africa are discussed.     

Endophenotypes in psychiatry: an interim evaluation

Inheritance plays an undisputedly important role in the development of most psychiatric disorders. However, the genes involved have mostly not yet been identified. In all probability, not a single gene but a large number of genes are involved in each disorder. In psychiatry, a lot is expected from research into the relationship between so-called endophenotypes and genotypes because endophenotypes are more closely related to the genotype and are better defined and quantifiable than the phenotype. Endophenotypes are biological or neuropsychological markers which are (a) associated with the disorder in the population, (b) are themselves heritable, (c) are manifest in the absence of the disorder, (d) cosegregate with the illness in the families and (e) are more prevalent in relatives of people suffering from the disease than in the general population. To date only a few markers have been examined in sufficient detail to know whether they fulfil these criteria. Therefore it is still too early to evaluate the significance ofendophenotypes in psychiatry.     

Sozialstruktur und Krankheit

Data from statutory health insurance companies are rarely used for studies in social epidemiology. Nevertheless it has been shown that health insurance data are suitable for studying social inequalities in health, social inequalities in health care utilization and for considering the healthrelated effects of unemployment. If analyses are confined to diseases that are well-documented and that are routinely treated in hospital settings, biases can be kept within acceptable boundaries. This applies particularly to malignant and cardiovascular diseases, diabetes, and accidents. Since the most frequently used indicators of social differentiation (income, education, and occupational position) are routinely recorded, social inequalities in health care can be examined, and unemployment periods of up to 24 months are well documented. The analyses have revealed considerable health inequalities. These may even be underestimated since the higher income groups are usually privately insured. Inpatient treatment in an unemployed compared to an employed insured is lower. Myocardial infarction is an exception since risks increase with increasing length of unemployment.