武汉农村某社区高血压患者用药及血压状况

目的调查武汉市农村某社区高血压患者用药情况及血压达标状况。方法采用问卷调查结合现场体格检查的方法,对武汉市某乡镇社区346例高血压患者的药物使用情况和血压控制情况进行调查。结果武汉市农村社区高血压患者用药率为98.27%,常用药物包括CCB、ACEI、利尿剂、β-阻滞剂、ARB、α-阻滞剂和复方降压制剂;二联用药患者占23.12%,其中以CCB+ACEI应用最多(12.14%);三联用药患者占4.62%,其中以CCB+β-阻滞剂+利尿剂应用最多(1.73%)。二联、三联用药患者血压达标率明显好于单一用药及不用药患者(P0.05)。结论武汉市农村社区高血压患者药物应用种类基本符合国内外高血压防治指南,但也存在利尿剂使用较少和降压药用量不足现象。     

珍菊降压片治疗轻中度高血压

目的观察珍菊降压片治疗轻中度高血压的有效性和安全性。方法门诊轻中度高血压患者196例,随机分为珍菊降压片单用组和珍菊降压片与赖诺普利片合用组。两组疗程均为12周。结果单用组总有效率89．42％,合用组总有效率98．91％（P〉0．05）,不良反应轻微。结论单用或合用珍菊降压片治疗轻中度高血压病均安全有效。     

使用高血压药物需要注意的三个问题

使用高血压药物要注意什么 目前根据我国的高血压指南，我们常用的高血压药物种类有五大类：利尿剂，简单说就是通过利尿减少血容量达到降压的目的：第二类是D受体阻滞剂；第三类是血管紧张素转化酶抑制剂（ACEI）；还有一种降压药血管紧张受体拮抗剂（ARB）；还有一大类是钙拮抗剂（CCB），这五大类都可以作为降压的及时用药和维持用药。     

辽宁省农村高血压患者用药状况调查

目的了解辽宁省农村地区高血压患者用药情况。方法采取随机抽样和入户调查方法，对辽宁省庄河和本溪县4397户的14802人进行高血压患病及用药情况调查。结果共查出高血压患者444人，患病率为3．0％，其中76．8％的高血压患者采用单一降压药治疗，68．4％的患者服用复方制剂。服用最多的降压药为复方降压片（56.9％），北京降压0号（14．9％）和卡拖普利（10．2％）。钙通道阻滞剂（3．4％）和利尿剂（0．8％）使用率明显低于其他地区。结论农村大多数高血压患者服用价格低廉的复方制剂，联合用药水平及药物使用结构与《中国高血压防治指南》要求存在巨大差距。     

社区门诊抗高血压药物使用情况调查分析

目的：了解社区门诊病人应用高血压药物的现状和合理性。方法：对2009年10月1日-2009年12月31日杭州市企业退休人员门诊医疗服务中心定海路门诊部接诊的门诊病历作回顾性调查分析,共收集到高血压病例540例。调查内容包括：用药种类、用药方式、用药频度（DDD s）、日均费用（DDD c）。结果：社区高血压病人用药方式以单独用药为主占74.26%（401/540）,其中单独应用钙离子拮抗剂类（CCB）药物的有37.96%（205/540）。用药频度（DDD s）较高的前3位药物分别为珍菊降压片、非洛地平、氨氯地平。日均费用（DDD c）较高的前3位药物分别是氯沙坦、雷米普利、缬沙坦。药品消耗金额前3位的是非洛地平、厄贝沙坦、氨氯地平。结论：CCB在社区门诊高血压病人的用药中占主导地位;复方制剂由于费用较低,在社区有一定需求。     

60例高血压病应用珍菊降压片和替米沙坦片疗效及药物经济学分析

目的比较珍菊降压片和替米沙坦片疗效及对两药进行药物经济学分析。方法选取门诊高血压病人60例随机分成两组,分别给予珍菊降压片或替米沙坦片口服6个月,对两组的降压幅度、降压疗效、副作用和成本-效果进行比较分析。结果两组的降压幅度、降压疗效、副作用差异均无统计学意义（P〉0．05）,成本-效果比：使用珍菊降压片平均费用为368．84元．而使用替米沙坦平均为704．54元,为珍菊降压片的1．91倍。结论珍菊降压片降压效果确切,费用低廉,副作用较少,值得临床推广。     

沈阳市青年高血压住院患者药物流行病学调查

目的了解辽宁省沈阳市青年高血压住院患者的药物流行病学特征,为评估青年高血压患者的合理用药提供参考依据。方法采用方便抽样方法随机抽取2013年1月—2017年1月沈阳市某3所三级甲等医院心血管内科住院的3 000例青年高血压患者的病历资料,分析其药物流行病学特征。结果沈阳市3 000例青年高血压住院患者中,1级高血压患者541例(18.03%),2级高血压患者1 104例(36.80%),3级高血压患者1 355例(45.17%);伴发疾病包括左心室肥厚774例(25.80%),颈动脉硬化252例(8.40%),冠心病452例(15.07%),心力衰竭184例(6.1%),缺血性脑卒中408例(13.60%),出血性脑卒中204例(6.80%),慢性肾脏病160例(5.33%);抗高血压药物单药治疗888例(29.60%),联合用药2 112例(70.40%);单药治疗中,血管紧张素转化酶抑制剂(ACEI)184例(20.72%),血管紧张素受体阻断剂(ARB)152例(17.12%),β–受体阻滞剂176例(19.82%),钙通道阻滞剂(CCB)300例(33.78%),利尿剂76例(8.56%),1、2和3级高血压患者降压药物单药使用情况差异有统计学意义(χ~2=44.87,P 0.001);联合用药治疗中,ACEI/ARB+CCB 344例(16.29%),ACEI/ARB+利尿剂196例(9.28%),CCB+β–受体阻滞剂352例(16.67%),ACEI/ARB+CCB+利尿剂416例(19.70%),ACEI/ARB+β–受体阻滞剂+CCB556例(26.33%),ACEI/ARB+β–受体阻滞剂+利尿剂248例(11.74%),2和3级高血压患者降压药物使用情况差异有统计学意义(χ~2=138.45,P 0.001)。结论沈阳市不同级别青年高血压住院患者的用药类别不同,应针对不同级别高血压患者合理应用降压药物。     

2011—2013年口服抗高血压西药应用分析

目的：分析我院口服降压药的应用情况,为临床合理用药提供参考。方法：对2011年至2013年我院口服降压药的种类、用量、销售金额、用药频度（DDDs）、日均费用等进行统计、分析。结果：口服抗高血压药物主要为血管紧张素转化酶抑制剂（ACEI）、血管紧张素Ⅱ受体阻断药（ARB）、钙通道阻滞剂（CCB）类药物为临床一线用药,其中最为常用的有复方卡托普利,复方利血平氨苯堞啶,非洛地平等,其每年平均增长率为15．26％,13．35％,18．56％。结论：抗高血压药使用基本合理,口服类抗高血压药应依照高血压防治指南配备,降低药品的不合使用。     

济南市某社区高血压患者立体化管理的模式探讨

目的通过分析社区常驻高血压患者的用药情况，探索高血压患者立体化管理模式。方法以济南某社区483例高血压患者为研究对象，通过高血压分级、分类和分期管理，评价社区高血压患者的用药情况。结果本次调查发现高血压1—3级患者中有90人（34．09％）未常规服用降压药物，导致血压控制未达标；不符合《中国高血压防治指南》（以下简称“指南”）推荐首选的降压药物人数为49人（18．08％）；联合用药中不符合“指南”推荐的人数为22人（42．31％）；有441人（9i．30％）不能每天监测血压，有447人（92．55％）不能一日三次监测血压；合并脑卒中的高血压患者优先选择ARB或CCB的人数为14人（70％），合并冠心病／稳定性心绞痛的高血压患者优先选择长效CCB或ACEI的人数为14人（25．93％），合并糖尿病的高血压患者优先选择ACEI或ARB的人数为11人（13．92％）。结论社区高血压患者存在不合理用药的情况，血压监测不能实现动态监测，需要进一步优化高血压管理。     

2007～2009年广州市老城区社区高血压患者用药统计分析

目的通过2007～2009年广州市老城区社区高血压患者用药情况统计分析,了解高血压患者用药现象及其趋势,促进社区抗高血压药物的合理应用,并探讨社区高血压综合防治模式。方法利用2007年以来构建的社区健康管理平台,对2007年～2009年的广州市老城区社区管理的高血压患者的用药情况进行统计、分析。结果社区管理的2298例高血压患者中,服降压药物者1922人,服药率为83．63％;其中二联用药率为68．31％,三联用药率为2．89％。任用药类别方面,使用频率由高至低依次是钙离子拮抗剂占51．60％,p受体阻滞剂占25．37％,ARB类占16．39％,利尿剂占13．74％,ACEI类占9．91％,中成药类占5．31％,复方制剂占3．43％。单个药物用药频度前几位的分别是美托洛尔、氨氯地平、硝苯地平和厄贝沙坦片。结论广州市老城区社区高血压患者抗高血压药物的使用基本合理,且已从短效制剂向长效制剂方向发展,加强对社区高血压患者的管理,可促进其坚持服药、合理用药和有效、平稳控制血压。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.