慢性收缩性心力衰竭患者药物治疗情况调查及相关因素分析

目的 分析湖北省慢性收缩性心力衰竭(心衰)患者药物治疗分布及其影响因素。方法 回顾性调查和分析2000—2010年湖北省8市12家三级甲等医院心衰住院患者资料, 根据年龄、性别和随访结果分组, 分析不同组间药物治疗种类和药费的分布差异。对药物治疗年费用进行log1()对数转换。结果 (1)共16681例心衰患者纳人研究, 随访期间有6453例死亡。死亡组药物治疗年费用低于存活组(3.19±0.65*?. 血管紧张素受体阻滞剂使用率随年龄增加而增加;而地高辛、利尿剂、p受体阻滞剂、血管紧张素转化酶抑制剂使用率随年龄增加呈倒“U”形分布。不同年龄组药物治疗存在性别差异。(3)随着患者年龄增加药物治疗费用有增加趋势(<30, 30~、40~、50~、60~和70~79岁组分别为2.96±0.70、3.09±0.62、3.15±0.58、3.30±0.59、3.25±0.58和3.35±0.60, 尸<0.01), 而年龄彡80岁组减低至50~岁组水平。男性患者药物治疗费的分布与全部患者水平相似, 而女性患者在<30、30~和40~岁组间无差异, 在其他年龄组的分布与全部患者水平相似。结论 湖北省心衰患者药物治疗有待改善, 药物治疗受年龄、性别影响, 其中女性患者药物治疗情况较男性差。     

慢性心力衰竭住院病例药物治疗的回顾性调查

目的了解慢性心力衰竭(心衰)住院病例治疗药物在30年来的应用情况。方法采用两中心、回顾性研究。对药物治疗在年代、性别、年龄、心功能和病因等的分布进行分析。结果入选5189例次,男女比为1∶1.02(P>0.05)。平均年龄(62.93±13.49)岁。临床诊断依次是冠心病(44.2%)、风湿性心脏病(24.1%)、肺心病(19.0%)、扩张型心肌病(4.8%)等。入院时心功能以纽约心功能分级(NYHA)Ⅲ级、Ⅳ级为主,分别为40.6%和44.5%。治疗药物总体应用比例为硝酸酯类80.0%、利尿剂71.8%、洋地黄制剂68.1%、血管紧张素转换酶抑制剂(ACEI)52.2%和β-受体阻滞剂19.5%,上述药物的应用逐年代增加。肺心病心衰病例的主要治疗药物也是硝酸酯类、利尿剂、洋地黄制剂。男性应用ACEI多于女性,≥60岁患者应用ACEI和血管紧张素受体拮抗剂(ARB)的比例多于<60岁年龄组,β-受体阻滞剂的应用则无性别和年龄差异。结论慢性心衰住院病例的治疗药物以利尿剂、硝酸酯制剂和洋地黄制剂等为主;ACEI和β-受体阻滞剂的应用增加迅速,虽未达到"指南"的要求,但显示了治疗观念的变化。     

高龄慢性心力衰竭患者病因及药物治疗现状分析

目的 分析≥80岁慢性心力衰竭(CHF)住院患者病因分布和药物治疗现状,为CHF的防治提供参考.方法 回顾分析2007年7月1日～2011年6月31日住院CHF患者224例的临床资料.结果 CHF病因分布前3位为冠心病、老年性瓣膜病、高血压性心脏病.药物应用情况为利尿药76.8％、硝酸酯类70.5％、β受体阻滞剂67.9％、血管紧张素转换酶抑制剂(ACEI)30.4％、血管紧张素Ⅱ受体拮抗剂(ARB)37.5％、醛固酮受体阻滞剂18.8％、洋地黄类0.9％.结论 CHF病因变化与生活水平、医疗条件的改善有关.在CHF治疗指南指导下,β受体阻滞剂、ACEI、ARB应用比例明显增加.     

高血压患者合理用药之四β受体阻滞剂在临床上的应用(下)

β受体阻滞剂与其他降压药物的联合 β受体阻滞剂与利尿剂联合:单用β-受体阻滞剂抑制交感神经和肾素血管紧张素系统的活性,因此,合并心力衰竭的高血压患者,用β阻滞剂可使心衰加重;单用利尿剂会减少血容量,增加心率,增加交感神经冲动外传,激活肾素血管紧张     

上海市奉贤东部地区心力衰竭患者β受体阻滞剂应用情况调查及分析

目的调查上海市奉贤东部地区β受体阻滞剂在慢性心力衰竭患者中的使用现状,为本地区进一步规范合理使用β受体阻滞剂提供参考依据。方法收集在本院住院的CHF患者,并调查其β受体阻滞剂的使用情况。结果完成此次调查共136个病例,其中低年龄组（〈70岁）的β受体阻滞剂使用率为14.3%,高年龄组（≥70岁）的使用率为11.1%。结论上海市奉贤东部地区CHF患者β受体阻滞剂使用严重不足,亟需一步改善。     

南京地区高尿酸血症患者性别与年龄特征分析

目的 探索南京地区高尿酸血症(HUA)患者的性别与年龄特征。方法 以13 924名体检人员为研究对象,其中男性7 280人,女性6 644人,采用酶比色法检测尿酸(UA)。统计UA频数分布,比较不同年龄组男女HUA检出率。结果 男性、女性UA值分布均符合正态分布;在≤ 29、30～39、40～49、50～59岁年龄组中,男性HUA检出率明显高于女性(P＜0.01);在70～79、 ≥80岁年龄组中,女性HUA检出率明显高于男性(P＜0.05)。男性各相邻年龄组HUA检出率变化不明显,仅≥80岁组显著高于70～79岁组(P＜0.05)。女性从≤ 29岁组至30～39岁组,HUA检出率明显下降(P＜0.05);40～49岁组至60～69岁组以及70～79岁组至 ≥80岁组,HUA检出率均明显升高(P＜0.05)。结论 男性总体HUA检出率高于女性;男性在80岁之前HUA检出率随年龄增加而降低,女性50岁之后HUA检出率随年龄增加而升高。     

高龄老年住院冠心病患者二级预防抗血小板治疗现况10年对比

目的了解高龄老年冠心病患者抗血小板药物治疗现况,并与10年间结果对比,为改进冠心病二级预防工作提供依据。方法选择2014年1月~5月在解放军总医院心内科就诊≥80岁冠心病患者,调查抗血小板药物的使用率、种类及联合用药等情况。结果共收集447例患者,男性420例(94.0%),女性27例(6.0%),年龄(88.5±4.8)岁,体质量指数(23.5±4.0)kg/m2,≥24 kg/m2者占47.4%。(1)抗血小板药物总使用率为75.4%,与2005年、2012年相比均有明显提高(P0.05);(2)危险因素抗血小板药物使用率:高血压77.6%,脑卒中/短暂性脑缺血78.4%,糖尿病83.4%,血脂紊乱14.3%,吸烟72.3%;各危险因素抗血小板药物使用率均有明显提高(P0.01);(3)危险因素达标率:血压42.2%,血糖47.3%,总胆固醇37.5%,低密度脂蛋白胆固醇40.6%。与2012年比较,各危险因素治疗率及血压达标率明显偏低(P0.01),血脂达标率明显升高(P0.05);(4)二级预防药物使用率:硝酸酯类66.2%,β受体阻滞剂32.0%,调脂药60.0%,血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻断剂25.5%/31.3%,除β受体阻滞剂外均高于2012年。结论高龄老年冠心病患者抗血小板药物使用率较10年前有所提高,二级预防药物使用率及危险因素控制达标率均有所改善,但依指南推荐目标仍需加强。     

阿托伐他汀钙治疗扩张型心肌病合并蛋白尿的研究

目的 观察使用阿托伐他汀钙治疗扩张型心肌病患者合并蛋白尿的疗效、安全性.方法 将60例扩张型心肌病合并蛋白尿患者随机分为观察组和对照组各30例,2组均常规给予洋地黄强心,血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、β受体阻滞剂、醛固酮类等药物逆转心室重构等标准治疗,观察组在此治疗基础上加用阿托伐他汀钙,观察2组疗效及安全性,检测治疗前后尿蛋白减少情况.结果 观察组治疗后3个月、6个月、12个月24h尿蛋白减少有效率(20.00％、56.67％、76.67％)与对照组同期(3.33％、20.00％、20.00％)比较,差异有统计学意义(P＜0.05),且无明显不良反应.结论 阿托伐他汀钙可以明显降低扩张型心肌病患者合并出现的蛋白尿.     

卡维地洛治疗慢性心力衰竭对外周血中血浆肾素活性及利钠肽水平的影响

目的：探讨β受体阻滞剂卡维地洛治疗慢性心力衰竭时对外周血中血浆肾素活性(DRA)、心钠肽(ANP)及脑钠肽(N-BNP)水平的影响。方法：60例慢性心衰患者随机分为常规治疗组(血管紧张素转换酶抑制 利尿剂 地高辛)和卡维地洛组(常规治疗药物 卡维地洛)，随访12周，采用放射免疫法测定2组治疗前后和30例健康体检者(正常对照组)外周血中PRA、ANP及N-BNP水平。同时使用核素心室显像测定心衰患者左心室射血分数(LVEF)。结果：心衰患者外周血中PRA、ANP及N-BNP水平较正常对照组显著升高，其中ANP及N-BNP水平在卡维地洛治疗前与INEF负相关，在卡维地洛治疗后与LVEF密切相关，但PRA水平与L,VEF无关。治疗后卡维地洛组外周血中PRA、ANF及N-BNP水平较常规治疗组下降更明显。结论：外周血中ANP及N-BNP水平在慢性心衰的病理生理机制中起着重要作用，甚至在β受体阻滞剂治疗后仍可用于指导心衰患者的治疗。β受体阻滞剂能抑制心衰患者神经分泌的过度激活。     

常规药物加小剂量β受体阻滞剂治疗老年慢性充血性心衰临床观察

目的观察小剂量β-受体阻滞剂治疗老年慢性充血性心衰患者的疗效。方法选择45例老年慢性充血性心衰患者,随机分成两组用不同方法治疗观察,观察组23例在常规应用强心、利尿、扩血管药物治疗的基础上加用小剂量β受体阻滞剂治疗,并与常规用药组22例对照;比较两组治疗前后患者临床症状、心功能、左室射血分数、心率和血压变化、药物副作用。结果观察组治疗后心率明显下降,LVEF明显上升,治疗的总有效率为91.3%(对照组为61.1%),与对照组比较均有非常显著差异(P<0.01);用药过程无严重副作用发生。结论在常规抗心衰药物治疗的基础上加用小剂量β受体阻滞剂可明显改善患者的心功能,提高临床疗效,改善生活质量,延长寿命。     

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.     

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.     

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.