某部新兵军事训练伤原因调查分析及对策

目的了解某部新兵基础训练期间军事训练伤的发生规律及影响因素,为科学施训和减少军事训练伤的发生提供预防对策。方法采用回顾性调查和医学鉴定相结合的方法。收集训练伤登记数据,分析训练伤发生原因,提供预防策略。结果参加全训新兵1 250人,发生训练伤263人次,发生率为21.04%;训练伤发生部位主要包括踝关节、小腿、膝关节、上肢等,其中下肢训练伤发生较频繁,膝关节以下部位训练伤发生181人,占68.82%;在各种训练科目中,致伤课目分别为5 km越野、器械训练、投弹训练、体育锻炼等;在全训的第1-12周中,训练伤的发生高峰出现在第4-6周,共发生训练伤126人次。结论军事训练伤的发生存在着主客观因素,某部训练伤的发生与个体因素、训练强度、训练环境以及训练管理等多种因素有关,建议部队预防训练伤在组织领导、科学训练、综合保障、健康教育等方面加强工作力度。     

上海地区细菌性食物中毒季节和气候特征分析

[目的]从历年细菌性食物中毒发生的长期趋势中探讨其发生规律,为开展细菌性食物中毒的预警研究提供基础资料。[方法]分析1992—2006年上海地区细菌性食物中毒发生的基本特征(包括地区和行业分布、食品和致病菌种类)、季节特征(包括中毒年均月度和累年逐日的分布,五一、十一黄金周发生情况)和气候特征(包括中毒月均、逐日发生情况与气象因素的关系,中毒的发生与中毒前3天气象因素的关系)。[结果]细菌性食物中毒的发生无城乡差异,发生中毒的行业、食品和致病菌较为集中。5—10月是上海地区细菌性食物中毒的高发季节,五一和十一黄金周、6月下旬到7月上旬是其中的3个高发时段。月均中毒发生起数与月均气温、相对湿度相关;除五一和十一黄金周外的其他时段,平均气温低于19.2℃或相对湿度低于60.3%的条件下,发生细菌性食物中毒的概率很小;中毒发生日概率与中毒发生前1天的平均气温(5—6月、9—10月)和相对湿度(5—6月)有关。[结论]上海地区细菌性食物中毒的发生具有较明显的季节和气候特点。     

河南省1996～2000年食物中毒分析

目的 研究河南省食物中毒发生的规律及趋势,探讨预防措施,以减少食物中毒的发生。方法 对河南省1996～2000年全省各地市食品卫生监督机构食物中毒个案报表汇总统计,根据其发生中毒的种类、场所、致病因素等进行归类,食物中毒的诊断按国家标准进行。结果 食物中毒的发生在河南省种类多是植物性食品、场所以农村乡镇家庭聚餐为最多。致病因素多是农药和化学物。结论 针对食物中毒发生的种类、场所及致病因素,加强预防性卫生监督,减少食物中毒的发生。     

开放性胫骨骨折手术患者术中发生切口感染的危险因素

目的 探究开放性胫骨骨折手术患者术中发生切口感染的相关危险因素。方法 选取2019年6月至2022年1月医院收治的术中发生切口感染的开放性胫骨骨折手术患者30例,纳入发生组;另选取医院同期收治的术中未发生切口感染的开放性胫骨骨折手术患者30例,纳入未发生组;查阅并记录患者相关资料,经Logistics回归分析患者术中发生切口感染的相关危险因素。结果 发生组术前肥胖、合并糖尿病、血清白蛋白<30 g/L的占比均高于未发生组,手术时间长于未发生组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,术前肥胖、手术时间长、合并糖尿病、血清白蛋白<30 g/L均为切口感染发生的危险因素(P<0.05)。结论 术前肥胖、手术时间长、合并糖尿病、血清白蛋白低均为开放性胫骨骨折手术患者术中发生切口感染的危险因素。     

2010年宜都市学校和托幼机构传染病聚集性疫情分析

目的 了解宜都市学校和托幼机构传染病聚集性疫情发生情况及特征,为制定学校和托幼机构聚集性疫情防治对策提供理论依据.方法 对全市2010年学校和托幼机构聚集性疫情资料进行描述流行病学分析.结果 2010年宜都市学校和托幼机构共发生手足口病、水痘、流行性腮腺炎、上呼吸道感染、急性出血性结膜炎、病毒性脑炎聚集性疫情41起,共发病244例,平均为6例.手足口病聚集性疫情最多,占总事件数的56.10％ (23/41),上呼吸道感染、急性出血性结膜炎、病毒性脑炎聚集性疫情发生最少,均占总事件数的2.44％(1/41).托幼机构发生聚集性疫情最多,占65.85％ (27/41).除学校假期和12月外,其余月份均有聚集性疫情发生,发病高峰在3、4月.托幼机构、小学、中学发生聚集性疫情最多的乡镇分别为陆城城区、高坝洲镇、姚店镇.结论 2010年,宜都市学校和托幼机构发生传染病聚集性疫情多,但疫情涉及病例数少,手足口病发生聚集性疫情最多,托幼机构是发生聚集性疫情的主要场所.     

100例糖尿病患者发生低血糖的原因分析及预防

目的分析糖尿病患者发生低血糖症的原因,预防低血糖发生。方法回顾性分析我院2006年1月至2009年1月期间收治的100例糖尿病患者的,临床资料,研究与患者低血糖发生相关的危险因素,并采取预防措施。结果药源性、年龄因素、饮食及运动、夜间低血糖、未察觉低血糖、相关知识缺乏等都是糖尿病患者发生低血糖的危险原因;结论良好的预防对糖尿病患者发生低血糖有着积极的作用。     

老年糖尿病并发低血糖症的临床特点及预防保健措施探讨

目的 分析老年糖尿病并发低血糖的原因及临床特点,制定低血糖预防保健措施。方法 选取广饶县广饶经济开发区卫生院2017年3月—2018年3月收治的200例老年糖尿病患者为研究对象,依据是否发生低血糖分为未发生组91例和低血糖发生组109例。采取单因素/多因素logistic回归分析,探讨低血糖发生的危险因素,并结合低血糖发生的原因制定预防保健措施。结果 单因素分析发现：低血糖发生组和未发生组患者饮食情况、用药频次、健康教育情况、对疾病的重视程度、对药物的认识程度、血糖监测频次和运动情况等因素比较,差异有统计学意义(P＜0.05);多因素logistic回归分析显示：每天多次用药、对疾病不重视和对药物完全不了解是低血糖发生的独立危险因素(P＜0.05)。结论 老年糖尿病患者低血糖发生与诸多因素有关,其中每天监测多次血糖、经常接受健康教育是低血糖发生的保护因素;每天多次用药、对疾病不重视和对药物完全不了解是低血糖发生的独立危险因素。结合低血糖发生因素的特点制定并实施预防保健措施,有助于降低低血糖的发生。     

带状疱疹后遗神经痛相关因素Spearman分析

目的通过调查带状疱疹流行病学因素,探讨影响后遗神经痛发生的各种相关因素。方法选择150例带状疱疹患者,设定年龄、性别、发病诱因、伴随发热、合并基础疾病、有无前驱痛、皮损的面积及临床类型、急性期疼痛程度、早期使用小剂量激素和初治时间等为相关因素,根据患者是否发生带状疱疹后遗神经痛(Postherpetic Neuralgia,PHN)分为发生组和未发生组,将可能影响PHN发生的相关因素进行Spearman分析。结果 PHN组和未发生PHN组比较,在年龄、合并基础疾病、前驱痛、皮损面积、类型、急性期疼痛程度和初治时间等方面差异有统计学意义;将以上影响因素采用Spearman等级分析,PHN的发生与年龄和初治时间呈负相关,其它因素呈正相关,置信度0.05时,有显著的相关性。结论带状疱疹患者的年龄越大、合并有基础疾病、有前驱痛、皮损面积越大、程度越严重和急性期神经疼痛越重,发生PHN的风险越大;从出现皮疹到治疗间隔时间越短,发生PHN的风险就越小,说明及时诊治对预防PHN发生非常重要。     

十二指肠急诊手术后并发肠瘘的高危因素分析

目的 探讨十二指肠急诊手术后并发肠瘘的高危因素,为预防并发症的产生提供指导.方法 入选2009年7月～2011年12月在某院进行十二指肠急诊手术患者72例,根据患者术后是否发生肠瘘将所有患者分为发生肠瘘组和未发生肠瘘组,收集两组患者所有临床资料,比较两组患者危险因素.结果 十二指肠急诊术后肠瘘发生率为19.4％；发生肠瘘组患者就诊时间长于未发生组,胰腺损伤率以及术前发生休克比例均显著高于未发生肠瘘组,差异均具有统计学意义(P＜0.05)；就诊时间、合并胰腺损伤、术前发生休克与十二指肠术后发生肠瘘存在密切关系.结论 十二指肠急诊手术后并发肠瘘发生率高,其主要的危险因素主要包括就诊时间延长、合并胰腺损伤、术前发生休克.     

神经外科患者医院感染的危险因素分析与防治措施

目的探讨神经外科患者发生医院感染的相关因素及防治措施,为预防神经外科患者医院感染提供参考依据。方法选择2012年3月-2014年3月神经外科收治的1 094例住院患者,回顾性分析发生医院感染患者的临床资料,探讨其发生医院感染相关因素,所有数据采用SPSS17.0软件进行统计分析。结果 1 094例患者发生医院感染78例,感染率7.13%;发生医院感染部位依次为呼吸道、泌尿道、胃肠道及创口等,分别占48.72%、26.92%、15.38%及2.56%;神经外科患者发生医院感染危险因素为高龄、住院时间长、合并基础疾病、有吸烟与饮酒史、存在意识障碍、长期应用抗菌药物及进行侵入性操作。结论神经外科患者发生感染有多种危险因素,应制定相应的预防措施,以降低神经外科患者发生医院感染的概率。     

基于结构方程模型探讨哮喘患者治疗依从性影响因素

目的 探讨结构方程模型在哮喘患者治疗依从性影响因素分析中的应用,为哮喘患者治疗依从性的改善提供依据。方法 应用哮喘患者报告临床结局量表,对太原市366位哮喘患者进行调查。采用结构方程模型分析调查结果。结果 结构方程模型分析:生理领域中,生理机能的改善,使治疗依从性提高。治疗满意度又是生理机能与治疗依从性的中间调节作用。心理领域中,恐怖、抑郁等不良心理状态的缓解,可引起患者治疗依从性提高。社会领域中,参与社会活动越多,获得社会支持越丰富,患者治疗依从性就越高。结论 哮喘患者的生理机能、心理状况、社会活动、社会支持、治疗满意度均与治疗依从性有密切关系。关注哮喘患者,改善其生理机能,给予心理干预,创造活动交流机会,增加人文关怀,有助于治疗依从性的提高。     

基于新冠肺炎疫情防控的医联体上下联动机制运行实践与思考

建立医联体上下联动机制,其目的在于推进分级诊疗制度,构建分工协作的医疗服务体系。针对新冠肺炎疫情防控工作特点,从发挥医联体“龙头效应”、实施互联网远程医疗和推行规范性诊疗方案等方面,对医联体上下联动机制进行了新的探索与实践;认为应该建立健全医联体体制机制、统一线上诊疗方案及检测技术标准、建立院感防护长效管理机制、完善应急物资储备预案和构建医联体应急物资保障体系,以提高疫情中的医疗救治工作效率。     

Negotiating access to medical treatment and the making of patient citizenship: the case of hepatitis C treatment

Drawing on qualitative interview accounts with people who have injected drugs, we deploy ideas of biological and therapeutic citizenship to explore how the negotiation of access to hepatitis C treatment enacts patient citizenship potential. We find that the patient citizenship made through hepatitis C treatment divides those who are deserving from those who are not, largely in relation to their presentations of self‐control, responsibility and recovery regarding drug use. Accessing treatment requires that patients negotiate their entitlement by reflexively producing the patient citizen role expected of them. In this context of rationed treatment expectation, access to treatment is constructed in relation to gratitude rather than entitlement. Rationed treatment expectation also interplays with a utilitarian approach to hepatitis C expertise. Accounts of the bio‐effects of hepatitis C and its treatment as uncertain further weaken the potential for shared illness identity and biosocial membership as well as contributing to treatment delay. We conclude that the construction of hepatitis C treatment as a negotiation of ‘recovery towards normality’ positions people who continue to use or inject drugs as beyond patient citizenship. Our findings underscore the situated limits of therapeutic and biological citizenship, emphasising that these processes are unavoidably forces of governance.     

Users of a Psychosocial Care Center: a study of their social outcomes about psychiatric treatment

The purpose of this study is to identify and analyze representations users of a psychosocial care center construct about psychiatric treatment. Interviews were held with 11 individuals at a Psychosocial Care Center. Data were analyzed through content analysis, according to Bardin, using the Moscovician social representation theory as a methodological-theoretical reference framework. Data analysis allowed us to define three categories. The first category--treatment is to be medicated--contains issues like medication as psychiatric treatment, the effects of treatment, various professionals involved and their participation in treatment. The second category--treatment is to be cared for (or not)--was outlined as: care in psychiatric treatment, violence and closed institutions. The third category--treatment is to be active--was based on: treatment and occupational therapy, psychiatric treatment and work. We concluded that the representations about psychiatric treatment are closely linked to the use of medication and to the physician as the precursor of the treatment.     

The economics of public health: financing drug abuse treatment services

Drug abuse treatment financing exhibits a heterogeneous set of sources from federal, state, and local governments, as well as private sources from insurance, patient out-of-pocket, and charity. A public health model of drug abuse treatment is presented for a market that can be characterized by excess demand in many communities and an implied policy of rationing. According to best estimates, as many as 6.7 million individuals may need treatment, but only an estimated 1.5 million individuals actually participated in treatment episodes. Since, as demonstrated empirically, drug abuse treatment has a robust and positive social net benefit to society, it is perplexing that treatment financing stops with a rationing outcome that inhibits social welfare. The justification for public financing is centered on the external costs of drug addiction, but subsidization is grounded in the reality that a large number of addicted individuals do not have sufficient resources to pay for treatment out-of-pocket, nor do they have private insurance coverage. Social welfare losses are generated by financial arrangements that are inconsistent with rational budgeting theory and as such would lead to non-optimal organization and management of the drug abuse treatment system.     

辅助生殖前子宫腺肌病合并不孕的治疗策略

目前已明确辅助生殖技术（assisted reproductive technology,ART）可以改善子宫腺肌病合并不孕患者的妊娠结局,但对于ART前需要采取何种治疗,尚无统一意见。从子宫腺肌病对ART妊娠结局影响的原因入手,重点综述能够改善子宫腺肌病ART结局的治疗措施,包括激素治疗,如促性腺激素释放激素激动剂（gonadotropin releasing hormone agonist,GnRHa）、米非司酮和孕三烯酮等,保守性手术治疗以及一些新手段,如子宫动脉栓塞术和高强度超声聚焦消融（high intensity focused ultrasound,HIFU）等。并针对目前存在的争议,如对药物治疗的具体用法、ART前是否需要腹腔镜手术切除病灶及手术的适应证和局限性、子宫动脉栓塞及HIFU等新手段对妊娠及新生儿有无影响、药物治疗或手术后ART方式及时机的选择等进行阐述。     

肺结核合并糖尿病临床特征和疗效分析

目的对肺结核合并糖尿病的临床特征及其治疗方法进行研究。方法随机选择我院45名肺结核合并糖尿病患者,形成A组治疗组;选择32名肺结核患者,形成B组对照组。将A、B组患者临床病症和治疗效果资料进行对比分析。结果 A组咳嗽咯痰、咯血、结核中毒以及胸闷等症状高于B组,经治疗,B组痰菌转阴率、结核病灶吸收率以及空洞闭合率高于A组,疗效较A组较好。结论肺结核合并糖尿病患者临床症状相比于肺结核患者更为明显,治疗后效果较低,应尽早接受诊断和医治。     

Patient resistance as agency in treatment decisions

Medication is critical to the management of medical problems, however relatively little attention has been paid to the treatment recommendation process where a new medication is first prescribed. This article argues that how and when a patient agrees to a physician's treatment demonstrates a patient's active involvement in decisions about treatment. Using 100 video recorded primary care visits across 10 internal medicine clinics in the Western United States, this paper uses conversation analysis to document the delivery and reception of treatment recommendations in acute medical visits with adult patients. Specifically, this article analyzes patients demonstrating active participation regarding treatment decisions as a limited form of agency. Starting from the premise that participants orient to physicians' treatment recommendations as normatively requiring patient acceptance before moving to a next activity, this article argues that when patients resist a recommendation, they actively participate in how the treatment recommendation emerges as acceptable. This article argues that through resistance to a treatment recommendation, patients work to negotiate and collaboratively co-construct what counts as an acceptable recommendation. Overall, this article argues that patient resistance is an interactional resource for patients to assert their agency by ensuring the ensuing recommendation is acceptable and in accord with their treatment preferences and concerns.     

Chronic recurrent headache without neurological abnormalities. Practice guidelines of the Netherlands Society of Neurology

The diagnosis of chronic recurrent headache without neurological abnormalities is based on the anamnesis and physical examination; EEG or other supplementary examinations as a rule are not indicated. Regarding treatment of migraine, a distinction is made between attack treatment, preferably with non-specific drugs (analgetics and non-steroid anti-inflammatory agents (NSAIDs)) after aural symptoms if any, and prophylactic treatment (agents of choice: beta-receptor blockers). Cluster headache requires adequate treatment as soon as possible after the diagnosis, usually with attack treatment (sumatriptan s.c. or oxygen) as well as prophylactic treatment (agent of choice: verapamil). In the treatment of tension headache, a non-pharmaceutical treatment (relaxation) is to be preferred to pharmacotherapy (tricyclic antidepressants). Patients with chronic recurrent headache should be asked about excessive use of analgetics and caffeine-containing beverages, because these (or abstinence from them) may be the cause of the symptoms.     

杀虫剂处理衣服对伊蚊和蚋防护效果观察

目的研究氯菊酯以及氯菊酯与避蚊胺复配的杀虫剂处理衣服对刺扰伊蚊和班布蚋的防护效果。方法用2种剂量的药物浸泡迷彩服,通过强迫接触法进行击倒时间的观察;用2种剂量的药物浸泡蚊帐,并设空白对照,在野外通过人帐诱法,观察其防护效果;在野外穿着药物处理过的服装观察对蚊、蚋的防护效果。结果强迫接触试验中对班布蚋的击倒时间剂量1的KT50为2.110 min,剂量2的KT50为2.760min,对刺扰伊蚊的击倒时间,剂量1的KT50为6.826 min,剂量2的KT50为7.757 min;人帐诱试验剂量1对蚊蚋的防护效果为88.17%～88.64%,剂量2对蚊蚋的防护效果为92.90%～93.26%;在野外防护效果试验中,穿着实验室浸泡的衣服,剂量1对蚊、蚋的保护率为84.51%～92.19%,剂量2对蚊、蚋的保护率为90.14%～95.31%,现场对衣服进行喷雾,剂量1对蚊、蚋的保护率为91.55%～95.31%,剂量2为94.37%～96.89%。结论用0.80%的氯菊酯以及0.50%氯菊酯和5.21%避蚊胺复配药物2种剂量浸泡衣服或使用前对衣服进行喷雾,在野外活动时都能有效地防护刺扰伊蚊和班布蚋的叮咬。