妊娠期肝内胆汁淤积症对早产发生率的影响

目的 探讨妊娠期肝内胆汁淤积症（ICP）对早产发生率的影响。方法 采用前瞻性队列研究,以2014年1月1日至2015年3月31日安庆市立医院所有住院分娩的单胎活产孕妇为研究对象。通过调查问卷和医院电子病历系统,收集孕妇人口学信息等资料,采用单因素和多因素统计方法分析ICP对早产发生率的影响。结果 2 758例孕妇ICP发生率为7.25%,早产发生率为16.28%。ICP增加早产和医源性早产的风险,分别为RR=2.33,95% CI：1.67~3.25和RR=8.46,95% CI：5.45~13.12,但对自发性早产的发生无影响（RR=0.94,95% CI：0.57~1.54）。结论 ICP增加医源性早产的发生风险,与自发性早产的发生无明显相关。     

非政府组织与全球健康:国际经验与借鉴

非政府组织(Non-governmental organization,NGO)在全球健康领域发挥着重要作用。本专题集中研究NGO在全球健康领域的作用、治理工具、在政府全球健康战略中的地位、项目管理经验、中国NGO的发展状况等五个方面。研究认为,全球健康已初步形成大国、国际政府间组织和大型NGO主导的治理格局,中国仅靠政府力量并不能满足日益增长的全球健康需求。建议中国应将NGO纳入全球健康战略,建立NGO管理和合作机制,使其成为实施全球健康项目的重要补充力量;对中国非政府组织采取"重点扶持、整体改善"策略。     

国际非政府组织参与全球健康治理的工具研究

非政府组织在全球健康治理中发挥着日益重要的作用。本研究筛选了10家在全球健康事务中有重要作用的关键非政府组织,总结非政府组织参与全球健康治理的工具,包括:"产生知识和证据"、"合作"、"参与"、"协商一致"、"透明性"、"组织建设"、"制定政策或战略方向"、"责任"和"规制"九个维度。实施型、倡导型、支持型和综合型非政府组织在参与全球健康治理的工具选择上具有共性和各自侧重点。中国应努力培育本土非政府组织,同时应注重其"透明性"、"参与"与"合作"。     

社区卫生服务举办主体多元化与政府主导权被迫让渡的关系

目的:社区卫生服务机构中约有半数不属于政府直接举办,形成了多元化的举办主体格局。本文用定性研究的方法审视"举办主体多元化"对社区卫生发展的影响,并探讨监管权解决方案。方法:在陕西省T区和山东省X区,用最大差异抽样法选取不同专业的卫生技术人员以及卫生行政人员进行访谈。采用归纳式的主题分析方法,解释举办主体多元化格局形成的前因后果,并提炼出实务理论。结果:选择举办主体多元化是财力不足、体制约束和卫生资源多样化基础上的适应性策略。这一方面促进了服务网络的建立,另一方面政府被迫让渡主导权给举办主体,社区卫生服务机构缺乏自主管理,监管碎片化、监管弱化,最终社区卫生发展出现偏差。结论:多元举办主体格局的问题实质是治理权划分的问题。解决发展偏差、收回政府主导权的方法应是强化服务监管,放弃对机构的人、财、物等具体事务的管理,同时调整价格、医保等财务相关政策,使社区卫生服务机构具有独立经营能力。     

Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States

BackgroundSexual minority (lesbian, bisexual, mostly heterosexual) young women face many sexual and reproductive health disparities, but there is scant information on their experiences of chronic pelvic pain, including an absence of information on prevalence, treatment, and outcomes.AimThe purpose of this study was to describe the characteristics of chronic pelvic pain experiences of young women by sexual orientation identity and gender of sexual partners.MethodsThe analytical sample consisted of a nationwide sample of 6,150 U.S. young women (mean age = 23 years) from the Growing Up Today Study who completed cross-sectional questionnaires from 1996 to 2007.OutcomesAge-adjusted regression analyses were used to examine groups categorized by sexual orientation identity (completely heterosexual [ref.], mostly heterosexual, bisexual, lesbian) and gender of sexual partner (only men [ref.], no partners, both men, and women). We examined differences in lifetime and past-year chronic pelvic pain symptoms, diagnosis, treatment, and quality of life outcomes. Sensitivity analyses also examined the role of pelvic/gynecologic exam history and hormonal contraceptive use as potential effect modifiers.ResultsAround half of all women reported ever experiencing chronic pelvic pain, among whom nearly 90% had past-year chronic pelvic pain. Compared to completely heterosexual women, there was greater risk of lifetime chronic pelvic pain among mostly heterosexual (risk ratio [RR] = 1.30, 95% confidence interval [CI]: 1.22–1.38), bisexual (RR = 1.30, 95% CI: 1.10–1.52), and lesbian (RR = 1.23, 95% CI: 1.00–1.52) young women. Additionally, compared to young women with only past male sexual partners, young women who had both men and women as past sexual partners were more likely to report chronic pelvic pain interfered with their social activities (b = 0.63, 95% CI: 0.25–1.02), work/school (b = 0.55, 95% CI: 0.17–0.93), and sex (b = 0.53, 95% CI: 0.05–1.00).Clinical ImplicationsHealthcare providers, medical education, and field-wide standards of care should be attentive to the way sexual orientation-based healthcare disparities can manifest into differential prognosis and quality of life outcomes for women with chronic pelvic pain (particularly bisexual women).Strengths & LimitationsOur study is the first to examine a variety of chronic pelvic pain outcomes in a nationwide U.S. sample across different outcomes (ie, past-year and lifetime). Though limited by sample homogeneity in terms of age, race, ethnicity, and gender, findings from this article provide foundational insights about chronic pelvic pain experiences of sexual minority young women.ConclusionOur key finding is that sexual minority women were commonly affected by chronic pelvic pain, and bisexual women face pain-related quality of life disparities.Tabaac AR, Chwa C, Sutter ME, et al. Prevalence of Chronic Pelvic Pain by Sexual Orientation in a Large Cohort of Young Women in the United States. J Sex Med 2022;19:1012–1023.     

中日两国水痘及其疫苗接种管理的比较与启示

水痘对儿童生命安全影响巨大,有关水痘疫苗的相关管理尤为重要。当前中国水痘疫苗作为非免疫规划疫苗,实行自愿接种,相关管理较为落后。本文通过查阅国内外知名的文献数据库及国内外政府部门相关网站,获取相关资料进行整理。选取2014年从自愿接种转变为常规接种的日本作为参考,对中日两国的水痘疫情监测系统、发病水平、接种策略、接种率等方面进行对比分析。本文发现国内水痘监测报告信息系统建设较日本好,但是监测策略有待完善,水痘流行病学研究相对落后;日本将水痘疫苗接种纳入常规免疫后发病水平显著下降,而国内水痘疫苗接种策略落后,接种水平低,发病水平高,亟待改善疫苗接种策略。     

Analyzing the efficacy of a new natural compound made of the alga Ecklonia bicyclis,Tribulus terrestris and BIOVIS® in order to improve male sexual function

BackgroundWe investigated the therapeutic efficacy of a new composite natural drug based on Tribulus terrestris, BIOVIS^® and the alga Ecklonia bicyclis in order to improve male sexual function, selecting patients using the International Index of Erectile Function (IIEF), Nocturnal Penile Tumescence and Rigidity Testing (NPTR) using the RigiScan^® device and hormonal levels.Materials and methodsA total of 164 patients with erectile dysfunction (ED) were enrolled between September 2009 and January 2010. Patients were classified as having mild (n = 64), moderate (n = 62) or severe (I = 38) ED. Mean age was 53.1 years. A new compound (150 mg of the alga Ecklonia bicyclis, 396 mg of Tribulus terrestris and 144 mg of BIOVIS^®) was administered to all patients twice a day for 60 days. The IIEF questionnaire was administered and NPTR testing was carried out using the Rigiscan^® device both pre and post-treatment with all patients.Results150 patients were evaluable, and their IIEF scores were all significantly improved, with an increase of 78% in the mild ED group, an 80% improvement in the moderate ED group, and an improvement of 108% in the severe ED group compared with the baseline. The mean IIEF scores for all the patients showed significant improvement after 8 weeks of treatment with this new composite drug (baseline 14.3 ± 1.5 to 26.2 ± 3.2; P = 0.01). Among other parameters penile rigidity and tumescence, as tested using the RigiScan^® showed significant improvement for treated patients. Furthermore, no significant side effects were claimed.ConclusionThe active components of these three natural compounds (namely protodioscin, a steroidal saponin, contained in Tribulus terrestris; the polyphenols, dieckol, florofucofuroeckol and bieckol, contained in the alga Ecklonia bicyclis; and the polymers of d-glucosamine and n-acetyl-d-glucosamine contained in BIOVIS^®) when combined, seem to work in synergy not only improving erectile function but also stimulating testosterone-dependent sexual desire. Protodioscin is able to stimulate testosterone production and it also has an androgen-mimetic action, binding and activating the testosterone receptors. Polyphenols play an anti-nflammatory role, modulating the cytokines (lipopolisaccarids, TNF-alpha, IFN-gamma) with a potent antioxidant and antifibrotic effect. BIOVIS^® acts on both the non-adrenergic and non-cholinergic system (NANC) and on the endothelial cell system as a strong nitric oxide synthetase (NOS) stimulator. Our study demonstrated that this new composite drug was effective in the oral treatment of ED.     

Halsted of the Halsted suture

GASTROENTEROLOGY 2001;120:386-386     

Undergraduate education about cancer

The quality, quantity and balance of undergraduate cancer teaching in Australian Medical Schools were investigated by a survey, using a self-administered questionnaire, of recent graduates from all Australian medical schools. Stratified random cluster sampling was used and a response rate of 84% (389 respondents) was achieved. The results revealed substantial differences in knowledge, experience in, and rating of teaching between the medical, surgical, radiotherapeutic and palliative components of cancer management. The proportions of graduates who had never attended radiotherapy and palliative care clinics or units (42.3% and 49.9%, respectively) were more than double the proportion who had never attended medical and surgical cancer clinics or units (17.5% and 10.9%, respectively). More than twice as many graduates rated their instruction in the palliative management of cancer as poor or very poor (29.4%) compared with those rating their instruction as poor or very poor in both cancer prevention (8.4%) and treatment for cure (14.6%). The respondents displayed a considerable lack of knowledge about radiotherapy treatment options, and reported a lack of perceived competence in doing cervical smears. Their answers to questions about 5-year survival of selected cancers, about the existence of screening tests validly shown to reduce mortality, and the ages at which breast and cervical cancers are likely to develop all revealed worrying levels of incorrect knowledge. There was some important disturbing variation in levels of knowledge, experience and rating of cancer instruction between states and between universities.     

Contact inhibition of growth cone motility during neural development and regeneration

The potential importance of contact inhibition for neural development and regeneration has only recently been recognised. Growth cones have been shown to undergo abrupt collapse following contact with various cell types in vitro, including other neurons, and the collapse phenomenon is now being exploited to isolate and characterise the relevant molecules. Identifying the underlying mechanisms, which may involve ligand-receptor interactions, will be necessary for a full understanding of both axon guidance and the failure of axons to regenerate in the CNS of higher vertebrates.