Comparison of Di-n-methyl Phthalate Biodegradation by Free and Immobilized Microbial Cells

Objective To compare the biodegradation of di-n-methyl pathalate by free and immobilized microbial cells. Methods The enrichment and isolation technique was used to isolate the microorganism. The PAV-entrapment method was utilized to immobilize the microorganisms. The scanning electron microscophy (SEM) was used to observe the growth and distribution of microbial cells immobilized inside the PVA bead gels. The GC/MS method was used to identify the main intermediates of DMP degradation. Results The microbial cells could grow quite well in PVA gel.The metabolic pathway did not change before and after immobilization of the microbial cells. The degradation rate of immobilized cells was higher than that of flee cells. Conclusion The immobilized microbial cells possess advantages than free cells when applied to the biodegradation of toxic organic pollutants.     

合同购买重点卫生服务试点研究

目的探讨合同购买重点卫生服务的适宜技术。方法应用社会学评估方法,对试行合同购买卫生Ⅷ项目重点卫生服务1年以上的某项目县运行情况进行现场调查分析。结果合同购买重点卫生服务在试点县3所县级卫生机构和11所乡镇卫生院得到有效实施；合同任务基本实现；合同购买方式不但可以规范直接面向需方提供服务的财务行为,而且是社区落实卫生干预活动行之有效的管理手段；基层实施合同购买重点卫生服务操作程序应简便,监管指导要到位。结论合同购买重点卫生服务试点是成功的,项目推行的购买程序和管理技术对于政府改变公共卫生的直接财政投入方式可提供借鉴。     

Priority-setting and rationing in healthcare: Evidence from the English experience

In a context of ever increasing demand, the recent economic downturn has placed further pressure on decision-makers to effectively target healthcare resources. Over recent years there has been a push to develop more explicit evidence-based priority-setting processes, which aim to be transparent and inclusive in their approach and a number of analytical tools and sources of evidence have been developed and utilised at national and local levels. This paper reports findings from a qualitative research study which investigated local priority-setting activity across five English Primary Care Trusts, between March and November 2012. Findings demonstrate the dual aims of local decision-making processes: to improve the overall effectiveness of priority-setting (i.e. reaching ‘correct’ resource allocation decisions); and to increase the acceptability of priority-setting processes for those involved in both decision-making and implementation. Respondents considered priority-setting processes to be compartmentalised and peripheral to resource planning and allocation. Further progress was required with regard to disinvestment and service redesign with respondents noting difficulty in implementing decisions. While local priority-setters had begun to develop more explicit processes, public awareness and input remained limited. The leadership behaviours required to navigate the political complexities of working within and across organisations with differing incentives systems and cultures remained similarly underdeveloped.     

2009-2010 novel influenza A (H1N1) vaccination coverage in the Republic of Korea

This study aimed to assess vaccination coverage for novel influenza A (H1N1) in Korea using a immunization registry system as the data source. Vaccination coverage was found to be 26.1% for the total population and 54.4% for priority groups targeted by a national vaccination campaign between October 27, 2009, to March 31, 2010. The factors associated with increased coverage were rapid vaccination and free vaccination; these factors may need to be considered in future pandemics.     

The Safe Care Framework™: A practical tool for critical thinking

Safe, effective and ethical clinical decision-making in nursing depends on critical thinking, yet there is no consensus on the educational strategies that are most effective in developing and refining this foundational skill. A qualitative inquiry among graduating Bachelor of Science in Nursing students sought to determine whether one such educational strategy, an operationalized critical thinking framework, would assist nursing students to better understand acute care patients' complex profiles. The Safe Care Framework™, consisting of the ‘Concept Map Template’ and the ‘Priority Setting Tool Template’, was developed using a constructivist pedagogical approach. The framework illustrates and operationalizes the systematic critical thinking processes that expert nurses use to provide safe, comprehensive care. Thematic analysis of qualitative survey results revealed the following three main themes; (1) greater organization and understanding of patient data; (2) guiding of assessments and priorities of care; (3) better communication with others, and several subthemes. Thus, the Safe Care Framework™ may be a practical operational tool that can support novice nurses in developing critical thinking skills. This framework adds to the literature on innovative pedagogy for nurse educators.     

Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products

While the health risks associated with adult cigarette smoking have been well described, effects of nicotine exposure during periods of developmental vulnerability are often overlooked. Using MEDLINE and PubMed literature searches, books, reports and expert opinion, a transdisciplinary group of scientists reviewed human and animal research on the health effects of exposure to nicotine during pregnancy and adolescence. A synthesis of this research supports that nicotine contributes critically to adverse effects of gestational tobacco exposure, including reduced pulmonary function, auditory processing defects, impaired infant cardiorespiratory function, and may contribute to cognitive and behavioral deficits in later life. Nicotine exposure during adolescence is associated with deficits in working memory, attention, and auditory processing, as well as increased impulsivity and anxiety. Finally, recent animal studies suggest that nicotine has a priming effect that increases addiction liability for other drugs. The evidence that nicotine adversely affects fetal and adolescent development is sufficient to warrant public health measures to protect pregnant women, children, and adolescents from nicotine exposure.     

The Pyhäjärvi Cataract Study. I. Study design,baseline characteristics and the demand for cataract surgery

Purpose: The Pyhäjärvi Cataract Study aims to study demand for cataract surgery in the population of a rural town in Finland. Methods: A random, population‐based sample of 881 persons aged ≥ 60 years were interviewed by telephone to obtain a Visual Function‐14 (VF‐14) score. A total of 294 persons were invited for an ophthalmic examination based on three categories of VF‐14 score. Of these, 230 (78%) responded, 10 of whom were excluded as a result of prior bilateral surgery. The New Zealand Priority Criteria (NZPC) and the 15‐Dimension Quality of Life (15‐D) instruments were administered. In addition, another group of 96 patients waiting for cataract surgery were examined and scored using the VF‐14, NZPC and 15‐D instruments. A modified Lens Opacities Classification System (LOCS) III classification was used for grading the cataract. Results: Only one (0.5%) of the 220 examined subjects was referred for cataract surgery. Many patients with relatively good visual acuity (VA), including six people with a 100‐point VF‐14 score suggesting no visual symptoms, were waiting for surgery. Demographic factors were not associated with access to cataract surgery. The patients examined from the waiting list for cataract surgery had more cataractous changes in the lens(es), poorer VA, were older, and scored higher on the NZPC instrument than the population sample examined. Conclusions: Practically no hidden demand for cataract surgery was found in the study population as defined by the national criteria for cataract surgery in Finland. This reflects the fact that the current Finnish health care system appears to recognize and treat cataract patients very well, even in rural areas. Although VA tests may not be sufficient for evaluating need for cataract surgery, the role of questionnaires is not clear either.     

Healthy young and middle age adults: What will it take to vaccinate them for influenza?

Starting in 2010, healthy adults age 19–49 will be recommended for annual influenza vaccination. Because they were not previously targeted, little is known about their vaccine-related attitudes and behaviors. Using nationally representative survey data from 2009 to 2010, we found that adults newly recommended for influenza vaccination (as compared to previously recommended groups) are less likely to believe flu vaccines are safe (44% vs. 63%), to have ever been vaccinated (36% vs. 64%), to be vaccinated following a healthcare provider recommendation (44% vs. 52%), and to visit a doctor's office during vaccination season (41% vs. 69%). To boost rates of influenza vaccination in this population, new and untraditional strategies aimed at encouraging first-time vaccination are needed.     

Using a stated preference discrete choice experiment to assess societal value from the perspective of decision-makers in Europe. Does it work for rare diseases?

Objectives: To pilot the feasibility of using a discrete choice experiment (DCE) design to investigate individual preferences from the decision-maker perspective regarding the use of public funding for orphan drugs and generate prior information for future experimental designs.Methods: A DCE was used on a convenience sample of participants from five European countries (England, France, Germany, Italy and Spain), exploring their preferences in distinct healthcare scenarios involving orphan drugs. A preliminary review of the empirical literature on distributive preferences informed the selection of attributes and their levels in the design. An online questionnaire was used to conduct the DCE survey.Results: A total of 199 questionnaires were completed. The five country model showed relative preference for some attributes over others: cost of treatment, improvement in health, value for money and availability of treatment alternatives received the greatest attention. However, disease severity, beginning of life, waiting times and side effects were also shown to be important social values that should not be ignored.Conclusions: The ?ndings presented in this study provide insight about the preferences that can influence decisions on orphan drugs in different countries. This study also provides valuable prior information that could inform future DCE designs in this area.     

The impact of COVID-19 pandemic on the urgency of patients admitted to the emergency department

BackgroundThe COVID-19 pandemic brought important changes in access to the Emergency Department (ED). At present, an analysis of how the COVID-19 pandemic has changed not only the number but also the nature of the urgency of ED access is not available. This study aimed to verify the effect of the COVID-19 pandemic on the urgency of patients admitted to the ED utilizing timebased analyses.MethodsA quasi-experimental interrupted time series analysis based on a retrospective review of data from all ED admissions occurring at the Merano Hospital (Italy) from 1 January 2015 to 30 June 2021 was conducted.ResultsFrom January 2015 to June 2021, 416,560 patients were admitted to the ED. Since the pandemic outbreak, the trend of urgent patients (classified as orange and red by triage) remained unchanged compared to the pre-pandemic period (p = 0.095, p = 0.155). In contrast, patients classified as blue (non-urgent) increased exponentially since the outbreak of the pandemic (p < 0.001).ConclusionThe present study reported stability in urgent codes (orange and red) since the pandemic outbreak while a dramatic increase in non-urgent codes (blue and green) is reported. The results of the study may indicate the need to find health policy solutions to manage this large increase in nonurgent patients requiring assessment in EDs since the outbreak of the pandemic.