Ships in Distress,Environmental Threats to Coastal States,and Places of Refuge: New Directions for an Ancien Regime ?

Places of refuge for ships in distress is a topic before the International Maritime Organization as a result of several recent well-publicized refusals by maritime authorities of coastal states to allow such ships to enter sheltered waters within national jurisdiction. The traditional right of refuge of the crew, ship, and cargo is pitted against threat perceptions held by coastal states resulting in a "not in my backyard" syndrome. Instances of modern state practice seem to restrict the right of refuge to a purely humanitarian dimension. There is a need to reevaluate the right of refuge and to establish a system of places of refuge on the basis of regional cooperation to counter the potential threat of stricken ships that are unable to effect necessary repairs in sheltered areas within national jurisdiction.     

健康教育对心脑血管疾病终点事件发生的干预效应

通过健康教育干预探讨对心脑血管疾病发生之影响,为心脑血管疾病的防治工作提供理论依据。方法：从2000年到我院集中体检的大于50岁以上的在职和离退休干部4000人中,抽出资料完整并符合本次研究纳入标准者2000人,随机分为健康干预组和一般治疗对照组各1000人。其中干预组1000人中,高血压480人,高脂血症413人,高血压合并高脂血症107人;对照组1000人中,高血压478人,高脂血症423人．高血压合并高脂血症100人。两组均以高血压、高脂血症作为最主要的危险因素进行健康教育干预。健康教育干预组患者分别建立健康档案,制定系统的健康教育干预措施并组织实施,定期随访：一般治疗对照组患者将体检结果通知本人后,由其在门诊接受健康教育和治疗,对健康教育和治疗方法不作强制性规定。连续观察五年,比较两组五年间心脑血管疾病的发生情况（即以发生AMI／心绞痛、脑出血、脑血栓形成等心脑血管疾病的终点事件为评价标准）。结果：健康教育干预组病情控制良好,发生上述心脑血管疾病终点事件比危险因素对照组明显减少（急性心肌梗塞发生率为2．0％比3．4％,脑血栓发生率为4．3％比7．5％,TIA为2．1％比2．9％）,P〈0．01。结论：对存在心脑血管疾病危险因素者积极开展健康教育干预,可起到控制疾病进一步发展,减少心脑血管疾病终点事件的发生。     

Network theory and SARS: predicting outbreak diversity

Many infectious diseases spread through populations via the networks formed by physical contacts among individuals. The patterns of these contacts tend to be highly heterogeneous. Traditional "compartmental" modeling in epidemiology, however, assumes that population groups are fully mixed, that is, every individual has an equal chance of spreading the disease to every other. Applications of compartmental models to Severe Acute Respiratory Syndrome (SARS) resulted in estimates of the fundamental quantity called the basic reproductive number R0--the number of new cases of SARS resulting from a single initial case--above one, implying that, without public health intervention, most outbreaks should spark large-scale epidemics. Here we compare these predictions to the early epidemiology of SARS. We apply the methods of contact network epidemiology to illustrate that for a single value of R0, any two outbreaks, even in the same setting, may have very different epidemiological outcomes. We offer quantitative insight into the heterogeneity of SARS outbreaks worldwide, and illustrate the utility of this approach for assessing public health strategies.     

Modelling parasite aggregation: disentangling statistical and ecological approaches

The overdispersion in macroparasite infection intensity among host populations is commonly simulated using a constant negative binomial aggregation parameter. We describe an alternative to utilising the negative binomial approach and demonstrate important disparities in intervention efficacy projections that can come about from opting for pattern-fitting models that are not process-explicit. We present model output in the context of the epidemiology and control of soil-transmitted helminths due to the significant public health burden imposed by these parasites, but our methods are applicable to other infections with demonstrable aggregation in parasite numbers among hosts.     

Would SYNTAX have been a positive trial if XIENCE V had been used instead of TAXUS?: A meta-analysis of a first-generation vs. a second-generation drug-eluting stent system

Treatment options for coronary revascularisation include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). In the ‘synergy between PCI with TAXUS and cardiac surgery (SYNTAX)’ trial, PCI and CABG using state-of-the-art techniques (using paclitaxel-eluting stents and arterial grafts, respectively) were compared in the treatment of complex coronary artery disease. In Syntax, PCI was inferior to CABG at one year, entirely due to an increased repeat intervention rate. We hypothesised that the use of a superior drug-eluting stent system could reduce the need for repeat intervention. (Neth Heart J 2010;18:451-3.)     

‘Ins’ and ‘outs’ of triple therapy

Chronic oral anticoagulant treatment is obligatory in patients (class I) with mechanical heart valves and in patients with atrial fibrillation with CHADS2 score >1. When these patients undergo percutaneous coronary intervention with placement of a stent, there is also an indication for treatment with aspirin and clopidogrel. Unfortunately, triple therapy is known to increase the bleeding risk. For this group of patients, the bottom line is to find the ideal therapy in patients with indications for both chronic anticoagulation therapy and percutaneous intervention to prevent thromboembolic complications such as stent thrombosis without increasing the risk of bleeding. (Neth Heart J 2010;18:444-50.)     

乳果糖对肝癌TACE后肠黏膜损伤的保护作用研究

目的了解乳果糖对肝癌TACE后患者肠黏膜损伤的保护作用。方法将54例患者随机分为2组,治疗组按常规治疗加服乳果糖,对照组按常规治疗,服药后观察全身和肠道情况并检测二胺氧化酶(DAO)的内毒素水平。结果治疗组血二胺氧化酶水平与术前相比差异无显著性(P>0.05),未应用乳果糖组血内毒素水平比术前降低(P<0.05);治疗组血内毒素水平与术前相比差异无显著性(P>0.05),而未应用乳果糖组血内毒素水平比术前升高(P<0.05)。结论乳果糖增强了肠道黏膜的屏障作用,在避免肝癌TACE后的肠道细菌易位,内毒素血症起到积极作用。     

围产儿出生缺陷分析及干预措施

摘要目的：掌握围产儿出生缺陷的发生情况,探讨引起围产儿出生缺陷的相关因素,为制订及完善出生缺陷预防对策及干预措施提供科学依据。方法：按照全国出生缺陷监测中心制定的监测方案,对2010年10月1日～2011年9月30日在湘潭市县级及以上医疗保健机构住院分娩的围生儿出生缺陷监测资料进行分析。结果：5年出生缺陷的平均发生率为93．30／万,出生缺陷的发生率无明显趋势（x2=0．114,P=0．736）乡村的出生缺陷发生率明显高于城镇（X2=24．638,P〈O．001）,男性围产儿的出生缺陷发生率显著高于女性（XZ=6．693,P=0．010）,出生缺陷的发生率与季节无关（x2=3．852,P=0．278）,出生缺陷的围产儿死亡率大大高于非出生缺陷）L（X2=2904．583,P〈0．001）,先天性心脏病、肢体畸形（并指／趾、多指／趾、肢体短缩、马蹄内翻足）、唇裂及唇腭裂是高发的出生缺陷。结论：减少出生缺陷的发生是一项长期工程,需要采取综合措施,从各个环节入手,以预防为主,加强优生优育健康教育,落实婚前及围产期保健,推行新生儿疾病筛查,可有效降低出生缺陷的发病率,提高出生人口素质。     

营养保健知识宣教对妇女产褥期知识、行为干预效果研究

目的:评价营养保健知识宣教对妇女产褥期营养保健知识认知、饮食行为的效果。方法:选择青岛市孕晚期妇女作为研究对象,随机分为干预组和对照组,对干预组对象进行营养保健知识宣教。结果:干预组对象大部分营养保健知识的知晓率显著高于对照组,干预组对象从医务人员、书刊杂志获得营养保健知识的发生率(83.1%、72.3%)显著高于对照组对象(65.2%、56.0%);干预组对象薯类、鱼类、豆制品、绿叶蔬菜、坚果,膳食纤维、烟酸、钙、维生素C的每日摄入量显著高于对照组,蛋类,胆固醇的摄入量显著低于对照组。结论:针对性强的营养保健知识教育能明显提高产褥期妇女知识水平,促进健康的饮食行为,因此应推广有针对性的营养保健知识宣教。