“精准医学”理念下康复治疗人才培养的思考与实践

随着精准医学理念不断深入人心和"健康中国"国家战略的深入实施,患者对医疗水平的要求越来越高,康复医疗已向"精准康复"方向发展。作为人才培养的高等医学教育也必须顺应这种新的医学模式。我国康复治疗人才培养起步较晚,目前仍以"综合"康复治疗师培养为主,这种"庞杂"的康复治疗人才培养模式,与国际上专业分化培养的现状不接轨,导致培养的人才不精不专,甚至无法与国际专业组织及人员进行对话。这就要求我们要逐步改革目前康复治疗专业教育模式,构建与国际接轨、符合精准医学理念的人才培养模式。文章立足于国内康复治疗人才培养现状,从专业设置分化、课程体系和教学内容设立、教学师资队伍建设、教育教学模式和教学手段改革、临床实习带教队伍建设等5个方面,阐述了如何开展分方向培养康复治疗人才,培养符合精准医学理念的、满足国际国内需求的高、精、专高水平合格人才,以迎接精准医学教育时代的到来。     

Relevance of food‐based dietary guidelines to food and nutrition security: A South African perspective

Food‐based dietary guidelines are often developed at country level to assist in bringing dietary intakes closer to nutrient intake goals and, ultimately, to prevent nutrition‐related diseases. However, high food prices, alongside growing inflation, increasingly restrict food choices. This can leave those who are already vulnerable and less well off more exposed to the associated health implications of a nutrient deficient diet. With food and nutrition security being a high priority on the global nutrition agenda, this paper explores the feasibility of food‐based dietary guidelines to assist in improving food and nutrition security, focusing on nutritionally vulnerable groups in South Africa. It is argued that increased food prices, together with population growth, urbanisation and inflation, constrain everyday healthy food choices of a large proportion of South Africans. The South African food‐based dietary guidelines released in 2012 advocate the consumption of a daily diet containing a variety of foods. Unfortunately, even when the most basic and low‐cost food items are selected to make up a recommended daily diet, the associated costs are well out of reach of poor individuals residing in South Africa. The average household income of the poor in South Africa equips many households to procure mainly low‐cost staple foods such as maize meal porridge, with limited added variety. Although the ability to procure enough food to maintain satiety of all family members might categorise them as being food secure, the nutritional limitations of such monotonous diets may have severe implications in terms of their health, development and quality of life. Food‐based dietary guidelines alone have little relevance in such circumstances where financial means limit food choice. Alternative interventions are therefore required to equip the poor to follow recommended healthy diets and to improve individual food intake and nutrition security.     

唐山市某医院医护人员对HPV及其疫苗认知和接受度调查

目的:调查河北省唐山某医院医护人员对HPV及其疫苗的认知、态度和接受性,探究全科医师和护士对HPV疫苗接种的看法,为HPV疫苗的推广提供一定的基础。方法:采用自行设计的调查问卷,以自填式匿名方式调查唐山市某医院200名医护人员对HPV病毒及其疫苗的认知态度。结果:198名医护人员中,91.5%的医师和75.0%的护士曾经听说过HPV,53.2%的医师和47.7%的护士曾经听说过HPV疫苗,超过半数的医师和护士担心HPV疫苗的安全性(61.2%vs 65.8%)和有效性(59.6%vs 65.1),仅有23.4%医师和34.8%护士愿意接受该疫苗,53.1%医师和30.9%护士建议患者使用HPV疫苗,仅有30.0%左右医师和护士赞同让自己的子女接受HPV疫苗,65.3%医师和55.7%的护士建议满18周岁接种HPV疫苗。结论:医师和护士关于HPV病毒的认知水平较高,但不够全面,对HPV疫苗认知不足,多数医师和护士对HPV疫苗持观望态度。     

加强医疗设备安全使用管理应把握的几个环节

针对临床科室人员在使用仪器设备时普遍存在的重使用、轻管理的现象,阐述了应从建立健全组织机构、明确安全管理重点以及严格落实制度措施等方面加强医疗设备安全使用管理,切实提高医疗设备安全使用管理水平,促进医院综合水平和社会效益的双提高。     

Iron Deficiency Is Associated with Food Insecurity in Pregnant Females in the United States: National Health and Nutrition Examination Survey 1999-2010

Food-insecure pregnant females may be at greater risk of iron deficiency (ID) because nutrition needs increase and more resources are needed to secure food during pregnancy. This may result in a higher risk of infant low birth weight and possibly cognitive impairment in the neonate. The relationships of food insecurity and poverty income ratio (PIR) with iron intake and ID among pregnant females in the United States were investigated using National Health and Nutrition Examination Survey 1999-2010 data (n=1,045). Food security status was classified using the US Food Security Survey Module. One 24-hour dietary recall and a 30-day supplement recall were used to assess iron intake. Ferritin, soluble transferrin receptor, or total body iron classified ID. Difference of supplement intake prevalence, difference in mean iron intake, and association of ID and food security status or PIR were assessed using χ² analysis, Student t test, and logistic regression analysis (adjusted for age, race, survey year, PIR/food security status, education, parity, trimester, smoking, C-reactive protein level, and health insurance coverage), respectively. Mean dietary iron intake was similar among groups. Mean supplemental and total iron intake were lower, whereas odds of ID, classified by ferritin status, were 2.90 times higher for food-insecure pregnant females compared with food-secure pregnant females. Other indicators of ID were not associated with food security status. PIR was not associated with iron intake or ID. Food insecurity status may be a better indicator compared with income status to identify populations at whom to direct interventions aimed at improving access and education regarding iron-rich foods and supplements.     

Beliefs about back pain: The confluence of client,clinician and community

Patient beliefs play an important role in the development of back pain and disability, as well as subsequent recovery. Community beliefs about the back and back pain which are inconsistent with current research evidence have been found in a number of developed countries. These beliefs negatively influence people's back-related behaviour in general, and these effects may be amplified when someone experiences an episode of back pain.In-depth qualitative research has helped to shed light on why people hold the beliefs which they do about the back, and how these have been influenced. Clinicians appear to have a strong influence on patients' beliefs. These data may be used by clinicians to inform exploration of unhelpful beliefs which patients hold, mitigate potential negative influences as a result of receiving health care, and subsequently influence beliefs in a positive manner.     

灵宝市餐饮业人员艾滋病干预措施评价

目的评价不同健康教育模式对宾馆,职工食堂,饭店等餐饮业单位外来务工人员艾滋病知识和态度的干预效果。方法将在灵宝市疾病预防控制中心参加健康体检的外来务工人员随机分为4组,其中3个干预组,1个空白组。结果集中宣教、集中宣教和观看VCD、观看VCD和空白对照4种方法有统计学意义(P<0.05),进行两两比较集中宣教,观看VCD和集中宣教比较无统计学意义(P>0.05),观看VCD和空白对照比较无统计学意义,其他两两比较均有统计学意义。外来务工人员对艾滋病态度4组之间有统计学意义(P<0.001),两两比较只有集中宣教,观看VCD和空白组有统计学意义(P<0.05)。结论不同干预措施有不同的干预效果,其中集中宣教和发放宣传资料,观看VCD效果最好。     

Physician Training:

The authors surveyed former medical resident physicians who participated in long-term home health care program services during training. Forty-four physicians who had served in a home visit program were surveyed after an average of ten years since completion of medical training (range: 1 to 18 years). The majority of the 43 respondents (56%) make house calls in their current medical practices and most of the 36 now involved in medical house staff training (83%) incorporate their home care experience into their teaching today. Working at a home health care program can have educational value for medical residents, influence later practice, and result in personal and professional rewards.     

腺相关病毒载体优化的研究进展

 腺相关病毒（adeno-associated viruses，AAV）是用于基因传递与表达的常用载体，具有安全性好、免疫原性低、表达稳定等优点，在基因治疗中逐步得到应用。但是AAV载体在基因治疗中仍面临着转导效率低、载体容量小、靶向性弱以及宿主的免疫反应等限制，影响了AAV载体的广泛应用。因此，AAV载体技术的优化研究在持续推进，优化策略能够提高AAV转导效率，降低机体免疫反应，调高靶向性，扩展载体容量，优化调控。本文对相关研究进展进行综述，为AAV载体在临床应用提供一定的参考。