我国罕见药物现状分析及对策探讨

目的:完善国家基本罕见药物目录,保证群众对罕见药物的可获得性;方法:通过基本药物目录中的罕见病用药,分析我国罕见药的现状及其原因.结果:国家基本药物目录中罕见药种类极少,与基本药物的"可获得性"相差甚远.结论:我国急需从罕见药的法律地位、研究生产流通和费用支付机制政策方面入手,建立具有中国特色的罕见药制度.     

基本药物制度实施效果评价研究综述

按照世界卫生组织对基本药物的定义,从可获得性、可负担性和合理用药三个方面,对国内外相关评估方法及指标进行综述,为基本药物制度效果评价研究提供方法学参考。世界卫生组织等国际机构对基本药物制度的效果评价提出了多维度的评价指南,为我国进行该方面研究提供了借鉴。目前我国基本药物可获得性研究多停留在描述性统计分析,可负担性研究较少涉及地域间的横向对比,对合理用药的评价尚不规范,基本药物制度效果评价亟需与国际多维度的分析框架和关键评价指标接轨,并关注政策执行过程与效果的结合,以展开系统而有效的政策评估。     

基于熵权灰色关联法的乡镇卫生院基本药物可获得性研究

目的:评价基本药物制度实施之后乡镇卫生院的基本药物可获得性情况。方法:运用熵权灰色关联法对山东省11个县(区)的基本药物可获得性进行综合评价,同时结合重要性推导模型,对各县(区)基本药物的可获得性与需求情况进行分析。结果:基本药物制度实施之后,乡镇卫生院药品配送及时性较差,基本药物使用情况不容乐观,仍有部分地区存在资源浪费与资源严重不足的现象。结论:政府支持对于基本药物政策的实施起到重要的作用,资源配置不合理将形成新一轮的"看病难"现象,因此,为进一步规范乡镇卫生院基本药物可获得性,各相关部门应积极采取措施完善基本药物招标采购机制,加强监管与检查的力度,完善考核机制,保证基本药物制度在乡镇卫生院的顺利实施。     

金砖五国药物政策比较及对我国的启示

目的:比较巴西、俄罗斯、印度、中国和南非五个金砖国家的药物政策,为进一步完善我国的基本药物制度提供借鉴.方法:采用系统评价的方法,对比研究和系统总结这些国家药物政策及部分国家实施基本药物制度的经验.结果:巴西实施基本药物制度,并开办大众药店;俄罗斯实施医药分离制度;印度德里的基本药物制度模式具有典型代表性;南非政府集中采购与配送等.这些金砖国家的药物政策各有其特点,但目的一致,即增加大众对低价、高质量药品的可获得性.结论:金砖国家药物政策改革成效显著,但各国政府在深化医药改革中依然面临着严峻的挑战,还需要根据本国国情不断地探索,同时借鉴发达国家的经验,进一步巩固与完善本国的药物政策.     

江西省农村地区基本药物可获得性情况分析

为掌握江西省农村地区基本药物可获得性情况,采用分层随机抽样调查,结合检查档案、实地查看等多种方法获取资料并进行统计分析。结果显示:基本药物品规配置率较高,药品安全监管有力,质量可靠;农民获取方便,满意度较高。结论:江西省农村地区基本药物可获得性较好。     

提高社区基本药物的可获得性以促进双向转诊制建立

双向转诊制能促进病人分流、降低医疗费用和加强上下级医疗机构的合作。本文分析了基本药物制度和配套政策现行的实施状况,以及基本药物可获得性的提高来求解决双向转诊目前存在的部分问题,并提出了对提高社区基本药物可获得性的建议,为双向转诊顺利进行提供政策性的保障。     

我国儿童基本药物的可获得性研究——基于全国19省份的调查分析

目的:分析我国儿童基本药物的可获得性现状,为进一步保障我国儿童用药需求提供参考和建议。方法:利用国家卫健委与课题组合作调研获取的全国19个省份的调查数据,从药品配备率和可获得率两方面分析我国儿童基本药物的可获得性,并分析影响可获得性的因素。结果:我国儿童基本药物的可获得性整体较低,儿童基本药物的短缺现象并非发生在个别地区、个别医疗机构或个别治疗领域,而是普遍性的短缺;我国儿童基本药物短缺的源头问题在于儿童专用品种研发成本过高和儿童适宜品种定价机制失当,致使企业研产动力不足。结论:建议尽快将已有的国家儿童用药扶持政策细则落实到位,并进一步发挥卫生、药监、招标、定价、医保等多部门的协同合作,制定更多的优惠政策,帮扶企业研制儿童专用药品,以进一步促进我国儿童用药的供应保障。     

陕西省公立医院基本药物制度实施状况评估

目的 评估陕西省公立医院国家基本药物制度的实施状况.方法 利用2008年版WHO-Health Action International(HAI)标准化调查方法,于2012年3～5月间对陕西省10个城市120家一级、二级和三级公立医院的38种基本药物价格和可获得性状况进行调查.结果 陕西省公立医院基本药物的可获得性整体水平较低,原研药的平均可获得性仅为5.9％,最低价格仿制药的平均可获得性为23.9％;三级医院的可获得性高于其他等级医院.基本药物原研药的采购价明显高于国际参考价,仿制药的采购价略高于国际参考价;一级医院基本药物的采购价低于二级医院和三级医院.经济发展水平不同的地区,基本药物的零售价差异不大.基本药物原研药的可支付性较差,仿制药的可支付性较好.结论 建议完善国家基本药物目录,适度扩充基本药物品种;完善药品定价机制,深入推进公立医院改革.     

我国基本药物生产流通使用中存在问题和成因分析

描述我国药品生产、流通和使用等各个环节中存在的问题，从政策层面上揭示了基本药物可获得性低的原因，提出政府应系统考虑基本药物目录范围、基本药物生产、供应、使用和价格等各个方面，形成国家基本药物政策，从制度上确保公众对基本药物的可获得性。     

广州市社区卫生服务机构基本药物可获得性调查

目的:了解城市社区卫生服务机构基本药物的可获得性,为促进基本药物制度的实施提供实证依据和政策建议。方法:选取广州市28个医疗机构进行数据收集,采用国际关于基本药物可获得性的标准方法进行分析和研究。结果:调查的40种药品中,社区卫生服务中心专利品牌药和最低价等效仿制药的可获得性中位数分别是13.16%和42.11%;26个专利药采购价格的中位数是国际参考价格的5.14倍,基本药物的零售价比其采购价高出15%～20%;少数常见病的药品费用超出了大多数人群的经济承受能力。结论:在广州,社区卫生服务中心的基本药物可获得性比较低;药品价格水平高于国际水平;调查涉及的大部分药物可负担性较好。     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.