经皮椎体成形术治疗跳跃性多节段脊柱骨折的手术效果评价

目的探讨经皮椎体成形术治疗跳跃性多节段脊柱骨折的手术效果。方法113例跳跃性多节段脊柱骨折患者,依据手术方式不同分为观察组(60例)与对照组(53例)。观察组行经皮椎体成形术治疗,对照组行常规手术治疗。比较两组术中出血量及住院时间,手术前后视觉模拟评分法(VAS)、日本矫形外科协会(JOA)评分。结果观察组术中出血量少于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。手术后,观察组VAS、JOA评分分别为(3.2±0.6)、(20.1±6.2)分,均优于对照组的(4.4±1.1)、(15.3±5.7)分,差异有统计学意义(P<0.05)。结论跳跃性多节段脊柱骨折患者应用经皮椎体成形术治疗,患者损伤小,术中出血量减少,住院时间缩短,较常规手术减轻患者疼痛,脊柱功能显著改善。     

多层次医疗保障体系中我国职工医疗互助保险的发展现状分析

目的 分析我国职工医疗互助保险的发展现状及问题,为多层次医疗保障体系中职工医疗互助保险的完善提供借鉴。方法 采取24个省级行政区（除港澳台和7个未检索到省级层面相关文件的省份）发布的省级职工医疗互助保险政策为研究样本,从统筹层次、经办形式、缴费标准、保障人群以及补偿待遇五个方面进行分析。结果 省级职工医疗互助保险均由省级总工会主管,经办形式以工会自主经办为主,部分地区（37.5%）委托第三方经办。年缴费标准主要集中在51～100元/年,占到样本总量的31.8%。部分地区（54.2%）的职工医疗互助保险中,对女职工、退休职工及职工家人设计了针对性保障政策。绝大多数地区（70.8%）在职工医疗互助保险的补偿范围上与基本医疗保险保持一致,近一半的地区（54.2%）采取按医疗费用分段或按住院次数浮动比例报销政策。结论 建议职工医疗互助保险在“省级主管”的基础上,尝试“购买服务”的方式委托第三方机构进行专业经办。在“现收现付”向“部分累积”转变的背景下,探索考虑参保人员类型、疾病风险等因素的筹资标准精算模型,探索建立不同人群的“梯度化”的保险计划,在保障范围上适当增加基本医保目录外部分。     

Patterns over time in quality of life, coping and psychological adjustment in late stage melanoma patients: An application of multilevel models

Background: Quality of life (QOL) assessment is an important component within cancer research. There is often variability in QOL scores both between patients and across time. Understanding this variability in terms of personal characteristics and psychosocial factors would be useful but is often obstructed by the types of analyses that are applied to longitudinal data sets. Improved understanding can be gained with the application of multi-level or hierarchical models that allow for greater flexibility for modelling individual patterns of change over time. Methods and patients: Questionnaires were sent to a cohort of stage IV melanoma patients seen at the Sydney Melanoma Unit between 1991 and 1996, approximately every 3 months for up to 2 years. The data reported here are from a sub-sample of 44 patients who each completed between 3 and 8 questionnaires. Three aspects of QOL were measured (effort to cope, mood and physical well-being), each with a single LASA line. Multilevel techniques were used to model the patterns of QOL over time. Covariates were added to explain variation between patients in their average QOL and change in QOL over time. Results: The scores of each of the three QOL measures showed marked fluctuations over time. However, there was little systematic change during the study in either effort to cope ( p = 0.32) or mood ( p = 0.06). In contrast, the physical well-being scores of some patients improved while others deteriorated ( p < 0.001). On average, physical well-being deteriorated ( p < 0.001). Variability between patients accounted for 60% (effort to cope), 45% (mood) and 44% (physical well-being) of the total variance of each scale. A range of psycho-social factors including active and avoidant coping styles and psychological adjustment accounted for significant amounts of the variability between patients in each QOL measure. Conclusion: Individual coping and psychological adjustment are related to individual changes in QOL and to differences among patients' QOL. The study illustrates the use of multi-level techniques to further our understanding of differences between patients in their QOL and how it changes over time.     

肺结核患者治疗结局影响因素多水平模型分析

目的 分析北京地区肺结核患者治疗结局的影响因素.方法 以2016-2018年北京市登记的肺结核患者为研究对象,通过构建两水平回归模型分析影响肺结核患者治疗结局的相关因素.结果 在研究范围内影响肺结核患者治疗结局的因素包括年龄和职业.年龄在40～59岁组和60岁及以上组肺结核患者治疗不成功的风险分别是0～19岁组的1.8...     

Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany

Health workforce needs have moved up on the reform agendas, but policymaking often remains ‘piece-meal work’ and does not respond to the complexity of health workforce challenges. This article argues for innovation in healthcare governance as a key to greater sustainability of health human resources. The aim is to develop a multi-level approach that helps to identify gaps in governance and improve policy interventions. Pilot research into nursing and medicine in Germany, carried out between 2013 and 2015 using a qualitative methodology, serves to illustrate systems-based governance weaknesses. Three explorative cases address major responses to health workforce shortages, comprising migration/mobility of nurses, reform of nursing education, and gender-sensitive work management of hospital doctors. The findings illustrate a lack of connections between transnational/EU and organizational governance, between national and local levels, occupational and sector governance, and organizations/hospital management and professional development. Consequently, innovations in the health workforce need a multi-level governance approach to get transformative potential and help closing the existing gaps in governance.     

经皮椎体成形术治疗多节段陈旧性胸腰椎骨质疏松压缩骨折的临床研究

目的探讨经皮椎体成形术（PVP）治疗多节段陈旧性胸腰椎骨质疏松压缩骨折的临床疗效及安全性。方法应用PVP治疗42例共151节胸腰椎多节段陈旧性骨质疏松性椎体压缩骨折,术前分析患者影像学资料,结合患者症状、体征,明确责任椎及数量,采用功能障碍（ODI）及模拟视觉评分（VAS）评价术后患者疼痛缓解及日常活动功能恢复情况。结果 27例完成3节椎体,8例完成4节椎体,3例完成5节椎体,2例完成6节椎体,2例完成7节椎体。术前ODI平均值和VAS评分分别为79.3±11.85、47.25±1.09,术后1 d平均34.26±9.38、3.65±0.53;术后1 d疼痛缓解及日常活动功能恢复明显（P〈0.05）,随访1年时间内总体效果稳定。8节椎间盘漏,3节椎体旁软组织漏,2节椎体周围静脉引流。2例术中出现轻微骨水泥反应,舌下含服硝酸甘油,片刻缓解,继续完成手术。结论经皮椎体成形术治疗多节段陈旧性胸腰椎骨质疏松压缩骨折临床疗效显著,安全性高。术中须注意骨水泥反应和骨水泥外漏并发症。     

Estimating and testing variance components in a multi-level GLM

Most analysis of multi-subject fMRI data is concerned with determining whether there exists a significant population-wide ‘activation’ in a comparison between two or more conditions. This is typically assessed by testing the average value of a contrast of parameter estimates (COPE) against zero in a general linear model (GLM) analysis. However, important information can also be obtained by testing whether there exist significant individual differences in effect magnitude between subjects, i.e. whether the variance of a COPE is significantly different from zero. Intuitively, such a test amounts to testing whether inter-individual differences are larger than would be expected given the within-subject error variance. We compare several methods for estimating variance components, including a) a naïve estimate using ordinary least squares (OLS); b) linear mixed effects in R (LMER); c) a novel Matlab implementation of iterative generalized least squares (IGLS) and its restricted maximum likelihood variant (RIGLS). All methods produced reasonable estimates of within- and between-subject variance components, with IGLS providing an attractive balance between sensitivity and appropriate control of false positives. Finally, we use the IGLS method to estimate inter-subject variance in a perfusion fMRI study (N = 18) of social evaluative threat, and show evidence for significant inter-individual differences in ventromedial prefrontal cortex (VMPFC), amygdala, hippocampus and medial temporal lobes, insula, and brainstem, with predicted inverse coupling between VMPFC and the midbrain periaqueductal gray only when high inter-individual variance was used to define the seed for functional connectivity analyses. In sum, tests of variance provides a way of selecting regions that show significant inter-individual variability for subsequent analyses that attempt to explain those individual differences.     

图书馆过刊阅览室工作探析

从过刊阅览室的基本要素、工作人员的基本能力、多元化的服务等方面,分析探讨过刊阅览室工作的理论问题,并对过刊阅览室的实际工作予以总结。     

Effect of aluminum hydroxide adjuvant on the immunogenicity of the 2009 pandemic influenza A/H1N1 vaccine: multi-level modeling of data with repeated measures

Objective To evaluate the effect of the aluminum hydroxide (AI-OH) adjuvant on the 2009 pandemic influenza A/H1N1 (pH1N1) vaccine.Methods In a multicenter,double-blind,randomized,placebo-controlled trial,participants received two doses of split-virion formulation containing 15 μg hemagglutinin antigen,with or without aluminum hydroxide (AI-OH).We classified the participants into six age categories (＞61 years,41-60 years,19-40 years,13-18 years,8-12 years,and 3-7 years) and obtained four blood samples from each participant on days O,21,35,and 42 following the first dose of immunization.We assessed vaccine immunogenicity by measuring the geometric mean titer (GMT) of hemagglutination inhibiting antibody.We used a two-level model to evaluate the fixed effect of aluminum AI-OH and other factors,accounting for repeated measures.Results The predictions of repeated measurement on GMTs of formulations with or without AI-OH,were 80.35 and 112.72,respectively.AI-OH significantly reduced immunogenicity after controlling for time post immunization,age-group and gender.Conclusion The AI-OH adjuvant does not increase but actually reduces the immunogenicity of the split-virion pH1N1 vaccine.     

The interplay of structure and agency in health promotion: integrating a concept of structural change and the policy dimension into a multi-level model and applying it to health promotion principles and practice

The recent debate in public health about the "inequality paradox" mirrors a long-standing dispute between proponents of structuralist approaches and advocates of action theory. Both views are genuine perspectives of health promotion, but so far they have not been adequately linked by health promotion theory. Using Anthony Giddens's concepts of structure and agency seems promising, but his theory has a number of shortcomings that need to be amended if it is to be applied successfully to health promotion. After briefly assessing Giddens's theory of structuration, this paper proposes to add to it both the concept of structural change as proposed by William Sewell and the policy dimension as described by Elinor Ostrom in her distinction between "operational" and "collective choice" level. On this basis, a multi-level model of the interaction of structure and agency in health promotion is proposed. This model is then connected to central claims of the Ottawa Charter, i.e. "build healthy public policy", "create supportive environments", "strengthen community actions", and "develop personal skills". A case study from a local-level health promotion project in Germany is used to illustrate the explanatory power of the model, showing how interaction between structure and agency on the operational and on the collective choice level led to the establishment of women-only hours at the municipal indoor swimming pool as well as to increased physical activity levels and improved general self-efficacy among members of the target group.