Europe and hospitals--strengths and requirements

Hospitals all over Europe must get ready to face the important challenge of 1993 at all levels: micro-economic, macro-economic, local, regional and European. Despite the liberalization trends which will inevitably appear with the increased freedom of exchange and movement, hospitals must strive to remain havens of peace to patients.     

Self-Esteem and Fruit and Vegetable Intake in Women and Men

Influences on food choices are multifactorial, and limited research has been reported on the role of social-psychological variables. Earlier studies have linked self-esteem with a variety of health behaviors. The purpose of this study was to extend the research to examine the relationship of self-esteem to dietary behaviors, specifically the intake of fruits and vegetables and their key nutrients. Subjects were 155 married couples in a stratified random sample of households in one mid-western state. Husbands and wives were interviewed separately in their own homes. Independent variables were age, education, income, body mass index, and self-esteem.The dependent variables were number of servings and variety of vegetables and fruits per week and energy-adjusted intakes of fiber, folate, and vitamins A and C. Self-esteem was measured by the Rosenberg questionnaire, while dietary intake was assessed by a semiquantitative food frequency questionnaire. Women reported significantly more servings of fruits per week, greater variety in both fruit and vegetable choices, and higher energy-adjusted nutrient intakes than did their husbands. Women met Food Guide Pyramid (FGP) recommendations for fruit intake and approached the recommendation for vegetable servings. Men fell short of FGP recommendations for both fruit and vegetables. After adjustment for age, education, income, and body mass index, self-esteem was a significant predictor of vitamin C and folate intake among women and folate intake among men. No other dietary variables were associated with self-esteem, although for men there was a trend for increased weekly servings of vegetables and increased variety in vegetable choices with higher self-esteem. One implication for practice is that age and education appear to be far stronger factors contributing to fruit and vegetable intake than is self-esteem. Additional research is needed to clarify the strength of self-esteem as a factor in specific food choices, especially among subpopulations.     

企业职工高尿酸血症与血压、血脂、血糖的相关性研究

目的探讨企业职工高尿酸血症（HUA）与血压、血脂、血糖的相关性,为企业进行健康管理提供依据。方法以中国石油长庆油田公司各下属企业为抽样单位,整群随机抽取2个单位,每个单位中所有的HUA者作为HUA组,共720人;同时在尿酸水平正常者中随机选取620人为正常组。通过Logistic回归分析HUA与年龄、性别、血压、血脂、血糖的关系。结果HUA合并高血压、高血脂、空腹m糖受损任意一项、两项、三项的比例均远高于正常组（OR值分别为：4．036,2．562,4．174）。多因素Logistic回归发现：男性、收缩压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇是HUA的危险因素（OR值分别为7．736,2．309,1．721,2．761,1．411）;高密度脂蛋白胆固醇为HUA的保护因素（OR值为0．211）。结论HUA存在性别差异,且与血压、血脂密切相关。企业对职工的健康管理应充分考虑多危险因素的综合作用,全面的进行健康教育及干预。     

护士职业礼仪与整体护理研究

整体护理强调的是以病人为中心，以护理程序为核心，有系统的对病人进行身心整体护理。整体护理是否见效，在很大程度上取决于护士的职业素质。从我院开展的整体护理模式病房工作成效分析，在学习新模式，转变传统护理观念的同时，同样要重视护士职业礼仪的教育，这样既提高整体护理的理论知识，     

Overweight and obesity in children and adolescents and preventative measures

The prevalence of overweight and obesity in children is increasing rapidly. This is alarming because obesity is associated with severe chronic diseases, such as type 2 diabetes mellitus. Obesity at young age is related to obesity at adult age. Consequently, the prevention of overweight from childhood onwards is an important issue. Apart from diabetes mellitus type 2 there is an increased risk of orthopaedic complications, respiratory problems, fertility problems, cardiovascular diseases and psychosocial consequences in the form of a negative self-image, emotional and behavioural problems and depression. Environmental and behavioural factors are regarded as the most important causes of the rapid increase in the prevalence of overweight and as the most important starting points for prevention. Most prevention programmes are still in the initial stages. Prevention programmes aimed at stimulating breast feeding and daily physical activity (playing outside) and the restriction of sweetened drinks and watching TV are very promising. With such preventive measures the involvement of both the school and the parents is important.     

Environmental and occupational medicine and injury prevention: education and impact,classroom and community

The core value guiding the work of physicians and health workers, including those in Environmental and Occupational Epidemiology and Medicine and Injury Prevention, is to protect the health of the public, especially its most vulnerable individuals. In these fields, we emphasize teaching the use of epidemiology, the core discipline of public health, as a tool for early detection and prevention of disease and injury, as well as an instrument for hypothesis testing. The classic core topics are toxic and physical exposures and their effects, and strategies for their prevention; emerging issues are child labor, mass violence, and democide. In environmental health, students need to be prepared for the reality that the most important and severe problems are often the most difficult to investigate, solve, and evaluate. The following are some recommendations for producing graduates who are effective in protecting communities from environmental hazards and risks: (1) Teach the precautionary principle and its application; (2) Evaluate programs for teaching environmental and occupational health, medicine and epidemiology in schools of public health by their impact on the WHO health indicators and their impact on measures of ecosystem sustainability; (3) Develop problem-oriented projects and give academic credit for projects with definable public health impact and redefine the role of the health officer as the chief resident for Schools of Public Health and Community Medicine; (4) Teach the abuses of child labor and working conditions of women in the workplace and how to prevent the hazards and risks from the more common types of child work; (5) Upgrade teaching of injury prevention and prevention of deaths from external causes; (6) Teach students to recognize the insensitivity of epidemiology as a tool for early detection of true risk; (7) Teach the importance of context in the use of tests of statistical significance; (8) Teach the epidemiologic importance of short latency periods from high exposures as sentinel events for later group risk for cancer and stating the case for action; (9) Protect students and colleagues who are whistleblowers in environmental health from harassment and punishment; (10) Develop curricula and workshops that promote the use of epidemiologic tools for preventing genocide, democide, and their precursors. Schools of Public Health and Community Medicine are at the interface between the resources of academic power and the major problems of community health. Implementing the above recommendations will strengthen academic investigation and impact.     

Adenocarcinoma of the stomach and esophagus and drinking water and dietary sources of nitrate and nitrite

We conducted a population-based case-control study of adenocarcinoma of the stomach and esophagus in Nebraska, U.S.A. Nitrate concentrations in public drinking water supplies were linked to residential water source histories. Among those using private wells at the time of the interview, we measured nitrate levels in water samples from wells. Dietary nitrate and nitrite were estimated from a food-frequency questionnaire. Among those who primarily used public water supplies (79 distal stomach, 84 esophagus, 321 controls), average nitrate levels were not associated with risk (highest versus lowest quartile: stomach OR=1.2, 95% CI [0.5-2.7]; esophagus OR=1.3, 95% CI [0.6-3.1]). We observed the highest ORs for distal stomach cancer among those with higher water nitrate ingestion and higher intake of processed meat compared with low intakes of both; however, the test for positive interaction was not significant (p=0.213). We did not observe this pattern for esophagus cancer. Increasing intake of nitrate and nitrite from animal sources was associated with elevated ORs for stomach cancer and with a significant positive trend in risk of esophagus cancer (P-trend=0.325 and 0.015, respectively). Larger studies with higher exposures to drinking water sources of nitrate are warranted to further evaluate N-nitroso compound precursors as risk factors for these cancers.     

Cultural and historical trends and influences of food, nutrition and cuisine on health and development

The distinctive qualities of the cuisine of Hangzhou are the result of its geographical situation, which provided good soils, reliable rainfall, a lake that has been a water source and renowned beauty spot for centuries. The rich water-sources facilitated the development of gastronomy, agriculture, trade and administration, especially after it became the capital of the Southern Sung Dynasty. Hangzhou's food sources are especially diverse, notably for fish, green vegetables, fungi, and tofu, and have been since early records. As capital, it became a leader in cuisine, and in the development of the restaurant industry. The strength of food traditions has been reinforced constantly by the cultural, medicinal, nutritional, and social values of food and cooking, by the interest of Chinese scholars in food and wine, and by the narrative that accompanies specific dishes.     

支原体、衣原体感染与不孕症的关系及耐药性分析

目的 探讨解脲脲支原体(Uu)、人支原体(Mh)、沙眼衣原体(Ct)与不孕症的关系,并对支原体药敏结果进行分析,以期更好地指导临床治疗,提高不孕症的治愈率.方法 选择不孕妇女320例,其中原发不孕132例,继发不孕188例,并选择120例正常生育妇女做对照,取宫颈分泌物做Uu、Mh、Ct检测,并对支原体感染者做药敏试验.结果 不孕组Uu、Ct、Uu+Ct、Uu+Mh阳性率与对照组比较均差异有统计学意义(P<0.05);继发不孕组与原发不孕组相比,Uu、Ct、Uu+Ct、Uu+Mh阳性率差异无统计学意义(P>0.05);Uu对米诺环素、多西环素、交沙霉素、环酯红霉素较敏感,Uu+Mh对米诺环素、多西环素较敏感;Uu+Mh感染的耐药率升高,多药耐药现象严重.结论 Uu、Mh、Ct感染是引起不孕症的重要因素,把其列为不孕妇女的常规检测项目,同时结合药敏试验进行治疗,有利于不孕症的诊治,提高不孕症的治愈率.     

Self-perception and malocclusion and their relation to oral appearance and function

The aim of this study was to evaluate the relationship between malocclusion and self-perception of oral appearance/function, in 12/15-year-old Brazilian adolescents. The cluster sample consisted of 717 teenagers attending 24 urban public (n=611) and 5 rural public (n=107) schools in Maringá/PR. Malocclusion was measured using the Dental Aesthetic Index (DAI), in accordance with WHO recommendations. A parental questionnaire was applied to collect information on esthetic perception level and oral variables related to oral health. Univariate and multiple logistic regression analyses were performed. Multiple logistic regression confirmed that for 12-year-old, missing teeth (OR=2.865) and presence of openbite (open occlusal relationship) (OR=2.865) were risk indicators for speech capability. With regard to 15-year-old, presence of mandibular overjet (horizontal overlap) (OR=4.016) was a risk indicator for speech capability and molar relationship (OR=1.661) was a risk indicator for chewing capability. The impact of malocclusion on adolescents' life was confirmed in this study. Speech and chewing capability were associated with orthodontic deviations, which should be taken into consideration in oral health planning, to identify risk groups and improve community health services.     

药品使用和费用问题及国内外控制措施

目前,无论是城市还是农村,无论是国内还是国外,无论是发达国家还是发展中国家,较高的药品费用是医疗卫生事业中出现的较为严重的问题。它直接阻碍了人群对于医院卫生服务的合理利用,致使因病致贫,因病返贫的人口增大。面对挑战,国内外专家提出了各种方案,以控制药品费用的过度增长。本文简要介绍了10种国内外控制药品费用的较为有效的方法。但是,这些方法只能提供一些参考,只有根据当地具体情况有选择吸收,科学地“扬弃”才可能取得较好的效果。     

Studies of vitamins and minerals and HIV transmission and disease progression

HIV-1 infection is having a devastating impact on people in developing countries. Poor nutrition and HIV-related adverse health outcomes contribute to a vicious cycle that may be slowed down by using nutritional interventions, including vitamins and minerals. Among children, periodic supplementation with vitamin A starting at 6 mo of age has been shown to be beneficial in reducing mortality and morbidity among both HIV-infected and uninfected children. Limited data exist on the role of other nutrient supplements among children. Among HIV-infected adults, the safety and the efficacy of vitamin A supplements need further study, although adequate dietary intake of this essential nutrient is recommended. Multivitamin supplements were efficacious in reducing adverse pregnancy outcomes and early childhood infections, and is currently provided to pregnant HIV-infected pregnant women in many programs. The efficacy of such supplements among HIV-negative pregnant women needs further study. Daily multivitamin supplements were found to reduce HIV disease progression among men and women in several observational studies and randomized trials, and to provide an important low-cost intervention that could be provided to adults in early stages of HIV disease to prolong the time before antiretroviral therapy is recommended. Next, research priorities include examining the roles of minerals, including selenium, in HIV infection, as well as determining the safety and the efficacy of micronutrient supplements among individuals who are advanced in their disease and who are receiving antiretroviral therapy.