基于扎根理论的农村地区基本药物可获得性影响因素研究

运用扎根理论研究法,对农村地区基本药物可获得性影响因素及其作用机制进行系统梳理与分析.总结出影响基本药物可获得性的四大因素:基本药物制度顶层设计存在缺陷、多项政策间相互影响、政府部门政策执行出现偏差、基本药物制度相关配套政策不到位.农村地区基本药物可获得性受到多方面因素综合影响,扎根理论的思路与方法为该领域研究提供了有力支撑.在未来的研究中,需结合定性与定量研究结果,完善该理论形成的理论模型,进一步识别模型中的关键问题及其根源,为改善农村地区基本药物可获得性提供政策依据.     

医院与社区获得性耐甲氧西林金黄色葡萄球菌耐药性的研究

目的为比较医院获得性耐甲氧西林金黄色葡萄球菌(MRSA)与社区获得性MRSA的耐药性,以期为临床有效防治MRSA提供科学依据. 方法收集2002～2004年从各临床标本中分离出的不重复MRSA菌株, 参照卫生部医政司医院感染监控小组制定的诊断标准,将其分为社区获得性MRSA组与医院获得性MRSA两组,各组随机各取20株作为本试验的试验对象;对两组的耐药率进行配对t检验,并就其耐药性及原因进行分析. 结果社区获得性MRSA、医院获得性MRSA耐药性存在差异,医院获得性MRSA较社区获得性MRSA耐药性高. 结论 MRSA的出现是高抗生素选择压力的结果;医院获得性MRSA较社区获得性MRSA耐药性差异确实存在统计学的显著性,尤其对阿莫西林/克拉维酸、氨苄西林/舒巴坦、头孢唑林、克林霉素的耐药性差异明显; MRSA菌株多具有多重耐药性.     

复发性流产与止血功能异常研究进展

复发性流产相关的止血功能异常包括遗传性、获得性以及联合功能异常.止血功能异常的类型与复发性流产的发生具有时段及频率的关联性.迄今为止,止血功能异常作为不明原因流产的重要危险因素仍存在争议,需要循证医学的研究进一步证实.预防性抗凝仅可用于有止血功能异常和不明原因流产的妇女,而抗凝治疗对预防复发性流产发生的益处还需要随机对照研究进一步证实.     

应用ROC曲线探讨心脏术后获得性吞咽障碍相关因素的临界值

目的应用ROC曲线探讨心脏术后获得性吞咽障碍发生相关因素的临界值,为预测心脏术后获得性吞咽障碍的发生提供更准确的依据。方法采用便利抽样的方法选取中国医学科学院阜外医院2017年3—10月进行择期心脏手术的患者578例。采用洼田饮水试验对心脏手术患者进行吞咽功能的筛查;采用二元logistic回归分析来确定获得性吞咽障碍的危险因素后,绘制ROC曲线,确定影响心脏术后获得性吞咽困难发生的界值点。结果本研究中578例患者心脏术后发生获得性吞咽障碍(3~5级)的47例(8.1%);在47例阳性患者中吞咽功能5级的16例(2.8%),4级的16例(2.8%),3级的15例(2.6%);插管时长、心功能分级、Euroscore评分对是否发生心脏术后获得性吞咽障碍的ROC曲线下有效面积分别为0.728、0.651、0.673,插管时长对心脏术后发生获得性吞咽障碍的最佳临界值为24 h(P<0.05)。结论气管插管时间>24 h对于心脏术后获得性吞咽障碍有一定预测意义。     

外科重症疾病获得性生长激素抵抗的研究进展

危重症疾病获得性生长激素抵抗,表现为血清生长激素浓度升高,胰岛素样生长因子-Ⅰ浓度减低,以及对外源性生长激素的促合成作用减弱.危重症病人外源性生长激素的使用可增加病死率.因此,深入理解获得性生长激素抵抗的机制具有理论意义和临床价值.该文作者对获得性生长激素抵抗的机制及其防治作如下综述.     

早期强化语言训练对儿童获得性失语的康复作用1例报道

目的探讨儿童获得性失语早期康复的方法和疗效。方法报道1例因病毒性脑炎导致儿童获得性失语的临床康复过程。结果经1个月语言康复治疗后,患儿可以进行简短的日常交流。结论早期语言康复训练对儿童获得性失语患儿的语言功能恢复有显效。     

艾滋病流行对社会经济发展的影响

艾滋病的全称为获得性免疫缺陷综合征(acquired immtme deficiency syndrome，AIDS)，是一种由逆转录病毒引起的，以人体免疫系统受损为主要特征的全身性疫病。人体一旦受到艾滋病病毒的感染，其免疫系统将受到严重损伤，机体抵抗力下降，以至诱发严重感染和一些少见的肿瘤。艾滋病已经成为全球危害公众生命健康、甚至危及社会稳定的重要的传染性疾病。     

获得性再生障碍性贫血的免疫发病机制

再生障碍性贫血（aplastic anemia,AA）,简称再障,是由多种原因引起的骨髓造血功能减低或衰竭,导致周围血全血细胞减少的综合征,临床上常表现为较严重的贫血、出血和感染。有关获得性再障的机制研究主要经历3个阶段。最初人们认为,获得性再障的发生是各种诱发因素（尤其药物及化学物质）对骨髓细胞的直接毒性作用的结果。     

四川省获得性耐药结核病患者社会行为危险因素的研究

目的了解获得性耐药结核病（ADR-TB）患者产生的主要社会行为危险因素。方法选取2002年6月至2005年6月在四川省结核病防治所就诊的949例ADR-TB患者，采用随机系统抽样的方法获得316例作为病例组，按年龄和性别1：1配对同期治疗后仍然对抗结核药敏感患者作为对照。采用问卷调查患者可能导致获得性耐药的社会行为危险因素，并对其危险因素进行条件logistic回归分析，用比值比和可信区间评价它们之间的联系。结果四川省ADR-TB产生的主要社会行为危险因素为经济状况差，DOTS不彻底，患者在治疗中依从性差和治疗过程有中断，其调整的OR值及可信区间分别为5．623（3．462～9、386），8.875（6．136～15．442），6．467（3．942～10．622）和4．906（2．477～10．654）。结论加强对ADR-TB的社会行为危险因素的发现，并有针对性地采取有效的措施，对降低ADR-TB的产生具有重要意义。     

社区获得性与医院获得性儿童肺炎病原菌及耐药分析

目的 探讨广西南宁市社区获得性儿童肺炎与医院获得性儿童肺炎的病原菌分布及耐药情况,以指导儿科合理用药.方法 对广西南宁市第八人民医院儿科2005年1月-2009年12月收治的205例社区获得性肺炎与58例医院获得性肺炎患儿进行回顾性分析.结果 社区获得性肺炎病原菌以革兰阳性菌(52.7%)为主,以肺炎链球菌(23.5%)最常见;医院获得性肺炎以革兰阴性菌为主,大肠埃希菌(36.2%)最常见,产β-内酰胺酶菌明显增多;病原菌耐药率普遍增高,真菌感染所占比率上升较快.结论 社区获得性与医院获得性儿童肺炎的病原菌耐药率不断升高,应加强监测,合理使用抗菌药物,减少医院感染.     

Mothers' Experience with Household Roles and Social Support During the First Postpartum Year

This prospective, longitudinal study was conducted to investigate the changes ig the division of household labor, and in the emotional and practical support received by new mothers during the first postpartum year. Questionnaires were completed by 436 married, recently employed mothers at l, 3, 6, 9, and 12 months after they had delivered their Fist child. Results showed that women assumed primary responsibility for the majority of household tasks studied, and that they perceived declines over time in their husbands' participation in household chores, their husbands' and others' expressions of caring, and in the frequency with which friends and relatives "helped out" during the year. Women who had had cesarean sections (versus those with vaginal deliveries) and who returned to work (versus those who stayed home) believed their husbands participated more in traditionally feminine household chores. Women's satisfaction with their husbands' contribution to household activities was significantly related to their own mental health, delivery type (cesarean section), job status (being at home vs. back at work), and family income; and to their husbands' occupation, expressions of caring, and participation in child care and certain household chores (house cleaning, grocery shopping, cooking, washing clolhes and dishes, household repairs, car maintenance, and garbage removal). Overall, these findings showed diminishing levels of emotional and practical support for women at a time when the need for support was likely greater: following the birth of their fist child.     

Social structure and nursing research

The concept of social structure is ill defined in the literature despite the perennial problem and ongoing discussion about the relationship between agency and structure. In this paper I will provide an outline of what the term social structure means, but my main focus will be on emphasizing the value of the concept for nursing research and demonstrate how its erasure in some research negatively effects on our understanding of the nurses' role in clinical practice. For example, qualitative research in nursing has largely focused on agency through such theories as phenomenology, hermeneutics, and symbolic interactionism. The result is that social structure may be erased or seen as epiphenomena of agency. My purpose is to provide a theoretical discussion of social structure and how such a discussion can help us to understand how nurses live and experience clinical practice. While not denying the importance of agency, I will argue that the thinned out approach to social structure places limits on our understanding of the constraints nurses experience in their working lives. The result is that nurses' attitudes and clinical failings are individualized, resulting in ever more calls for improved education, when a more thorough examination of structural issues may elucidate more fundamental problems.     

A Cross-cultural Perspective on Children's Theories of Mind and Social Interaction

This study incorporated two cross-cultural dimensions using both Singaporean and UK subjects as well as expert raters from both cultures to investigate links between children's “theories of minds” (ToM) and their social interactive behaviour. This trian-gulation procedure examined 12 dyads paired on equal and unequal ToM status and were videotaped at social pretend play. The two-fold aim of this procedure was (a) to obtain observers' judgements of the dyads at play and check for agreement of views, and (b) to predict the theory of mind status of the dyads from these judgements. Videotaped segments of the 12 dyads were rated independently by 6 Singaporean and 5 UK pre-school teachers. These ratings produced three sets of measures of facilitation, shared meaning and thematic maintenance of interactive play. Agreement among raters and group differences between these scores were analysed using non-parametric statistics. Results indicated a link between theory of mind ability and quality of social interaction.     

对中国社会保障立法的展望——建立农村社会医疗保障制度的构想

立法先行是现代社会保障制度作为国家制度安排特征的具体体现，只有通过法律的形式，社会保障才能制度化，普及所有公民。然而中国并没有统一的社会保障法律制度，农村社会保障法律制度的缺失，使农民被排斥于社会保障所构建的安全网之外。展望中国社会保障制度的构建过程，认为农村社会保障体系的建设将是工作的重点。文章试从农村社会医疗保障的视角，略论农村社会保障制度的构建问题。     

How Goal Orientation Match Between Social Workers and Their Supervisors Impacts Social Workers' Job Satisfaction

Abstract

Social workers' perceptions of their supervisors' dispositional goal orientations towards learning and performing act as powerful situational influences—in interaction with their own goal orientations— to affect social workers' job satisfaction. Social workers perceiving their supervisors' goal orientation to align with their own will experience greater job satisfaction. Supervisors cognizant of supervisees' goal orientations are more able to provide individually motivating tasks, support, and rewards. Such inquiry offers a promising direction for improving the work conditions of social workers. An increase in job satisfaction should be correlated with an increase in improved client outcomes and reduction in social worker turnover.     

Social marketing: a critical appraisal

This article provides a critical analysis of the growing useof social marketing in the field of health promotion. In responseto a recent article by A. Hastings and G. Haywood (Health PromotionInternational, 6, 135–134), three questions are askedabout each of the proposed tenets of social marketing: are theseideas new? are they more effective than current health promotionpractices? and do they raise any particular ethical concerns?On each of these counts, the analysis suggests that the purportedbenefits of social marketing might not be as great as proponentsclaim. There are also some problematic unintended consequencesthat arise from the use of social marketing methods. The narrowfocus on individual behavior change and the potentially manipulativetechniques for inducing behavior change are of particular concern.The paper concludes with a call for further discussion aboutthe limits and potential iatrogenic side-effects of using socialmarketing strategies for health promotion.     

Preventing Racism and Promoting Social Justice: Person-Centered and Environment-Centered Interventions

This paper proposes that prevention of racism is a social justice issue in light of the pervasively detrimental effects of racism on all members of our society and the especially traumatizing effects for people of color. Review of contact theory and its extensions provides the theoretical background for person-focused prevention strategies. Specifically, the paper describes a model primary prevention program to address the development of racist attitudes and beliefs in White children as a way of stopping future racist traumatization of people of color. Advocating for public policy changes is discussed as a valuable environment-centered prevention tool in working toward social justice. Implications for training incorporating multicultural counseling competencies, critical psychology, prevention science, and advocacy are discussed.     

基层医疗卫生机构发展困境及其对策研究——基于扎根理论

目的:研究分析基层医疗卫生机构的发展困境,并提出相应对策。方法:对武汉市某区7家基层医疗卫生机构以及该区卫生健康委负责人进行访谈,运用扎根理论,对原始访谈资料逐级分类、归纳和提炼。结果:提炼出18个初始范畴、9个主范畴以及3个核心范畴,获得样本地区基层医疗卫生机构在运营管理、政策障碍、资源配置三个维度的发展情况。结论:通过全面提升服务能力、健全保障机制、加强人力资源管理等,促进基层医疗卫生机构的发展,实现"强基层"的目标。