Richmond-Kotelchuck健康政策模式图的启示──我国预防医学模式转变中的三个关键问题

Richmond－Kotelchuck的健康政策模式图由科学知识基础、政治意愿和社会行为措施三部分组成。该模式图充分体现了三者对整个健康政策模式图的作用及其相互联系。随着社会的发展,我国当前正面临着转变预防医学模式的任务,借助于该模式图,本文论述了我国预防医学模式转变中值得注意的三个关键问题：科学研究、健康教育和举措设计。     

预防医学在医院管理中的应用

本文针对目前一些医院在发挥预防功能方面存在“预防为主”意识不强、预防专业人员匮乏、管理不力和投入少等不足之处,进而从增强“预防为主”的意识、健全预防管理组织、搞好三级预防等方面提出了自已的做法和建议。     

山东莒南HFRSⅡ型灭活疫苗效果观察

报告了ＨＦＲＳ地鼠肾细胞Ⅱ型灭活疫苗,自１９９４年以来,在莒南县高发疫区５个乡镇１７个村,对１６～６０岁的１１５１０人,全程免疫后４年的观察结果。疫苗初免３针后１４天、１年,血清中和抗体阳性率分别为６８９７％、１８５２％。加强１针后１４天达到１００％,加强后１年、２年、３年,中和抗体阳性率分别为６０００％、５３３３％、５０００％。几何平均滴度依次为８４、３２、１７０５、５７５、５３９、３６９。荧光抗体阳性率依次分别为９２００％、６２０７％、１００００％、５６００％、３２００％、２５００％。基础免疫后４年内,接种组发病１人,发病率为２１７／１０万;对照组发病６１人,发病率为１２８９１／１０万。疫苗保护率４年年均为９８３２％,安全性较好。疫苗接种者在流行高峰期后,荧光抗体滴度增高６人,均无临床表现。结论：ＨＦＲＳⅡ型灭活疫苗接种４年内,预防效果良好;接种人群未出现免疫增强反应病例。     

国内关于缩短平均住院日的影响因素及对策研究

平均住院日是衡量医院医疗质量与管理水平的综合指标。医院合理提速运行的基础是控制平均住院日的影响因素,这些因素可分为可控因素和不可控因素。相应可通过宏观协调转化不可控因素,引入的新的管理思想,制定适宜的平均住院日标准,配以微观措施以降低医院的平均住院日。     

Dietary salt and blood pressure

Research evidence on the role of dietary sodium in the etiology and pathogenesis of hypertension is briefly reviewed. This matter is assuming new importance at present, given new data on the efficacy of normalization of blood pressure for adults with so-called "mild" hypertension (average diastolic 90-104 mm Hg), hence the need for safe nutritional-hygienic alternatives to years-long drug treatment for millions of people with such hypertension. Two trials by the authors deal with some unresolved questions in this area. The first, a preliminary study, involved 21 lacto-ovo-vegetarian high school students living in a boarding school. With decrease in daily Na intake from 216 to 72 meq for the experimental compared with the control group, red blood cell Na concentration was significantly lower in the former; systolic pressure was slightly but not significantly lower. The second trial, the Primary Prevention of Hypertension, involves over 200 hypertension-prone persons aged 30-44, and explores the ability in the experimental group to reduce blood pressure and prevent development of hypertension by safe nutritional-hygienic means (weight reduction, dietary Na decrease, avoidance of excess alcohol, rhythmic exercise). Initial results at 6 months are presented. Trials on the prevention and control of hypertension by nonpharmacologic means, including reduced Na intake, and involving analyses of the inter-relationships among dietary Na, other dietary factors, Na metabolism, and blood pressure in samples from different population strata, are an important present-day research need.     

龙胆斑枯病有效调控及其与药材产量和质量的相关性研究

龙胆斑枯病是龙胆栽培过程中的主要病害。本文通过田间试验及实验室研究,探讨了龙胆斑枯病的发病规律及病害对产量和质量的影响,并从农业措施、土壤与种苗处理、化学农药防治和中药防治等角度提出了有效防治措施。研究表明:黑龙江龙胆斑枯病的病原菌为Septoria mi- crospora speg．和Septoria gentianae Thum．;农学措施防治研究表明优质健壮种苗、较高的栽培密度、与高杆作物间作可有效缓解龙胆斑枯病;就有效成分而言,獐牙菜苦苷含量与病情之间无明显规律性,但龙胆苦苷含量随病情指数增加而呈现下降趋势;植物新农药防治龙胆斑枯病药效试验表明,9种中药乙醇提取物对龙胆斑枯病病菌（Septoria microspora Speg．）均有不同程度的抑制作用。     

河南省1963～2002年百日咳流行动态及控制策略分析

目的掌握河南省40年来百日咳的流行病学特征及其影响因素,为制定免疫策略和预测疫情趋势提供依据。方法对河南省不同免疫阶段的百日咳流行病学特征进行分析。结果河南省40年来共报告百日咳3 065 075例,死亡572例。大致可分4个阶段:1963~1978年,年平均发病率为293.47/10万,死亡43例;1979~1983年,年发病率为87.70/10万~17.78/10万,呈逐年下降趋势,死亡6例;1984~1990年,发病率为1.28/10万~6.73/10万,死亡1例;1990年以后发病率为0.25/10万~1.00/10万,连续10年无死亡病例。表明随着百日咳疫苗接种率的不断提高,不但大大降低了百日咳的发病率和死亡率,也改变了其流行周期。结论目前的免疫策略首先应继续做好儿童常规免疫,其次应加强百日咳疫情管理,提高疫情报告的及时性、准确性。     

试论健康价值观

健康是人类最宝贵的财富。健康价值观是指个体对健康各方面(包括生理功能、心理功能和社会功能等)的价值进行评价的稳定的内部标准和主观看法。健康价值观及其对它的测评研究有着不断完善和进取的发展过程,其结构也有着不同的划分。健康价值观受父母教养方式、文化环境、社会科技的进步、受教育程度及重大生活事件等因素的影响。对健康价值观的研究在理论上和实践应用中都有着重要的意义。     

Outcome from Complex Neurosurgery: An Evidence Based Approach

Summary ? Background. The aim of this study was to determine outcome, including quality of life, after surgery for petroclival meningioma using a standard skull base approach and to carry out an evidence based appraisal of the relevant literature.  Method. Pre- and post-operative data including adverse events were prospectively recorded in 19 patients (15 females, age range 29–63) undergoing a transpetrous approach for a petroclival meningioma. Patients were assessed using the GOS and SF-36 post operatively.  Findings. 24 operations were done. 6 patients developed a new permanent neurological deficit and 10 experienced a temporary deficit or exacerbation of existing deficits. At 1 year 15 patients had made a good/moderate recovery, 3 were severely disabled and 1 died – in keeping with other studies. By contrast the SF-36 showed that in all 8 categories of the SF-36 between 39–72% of surviving patients were functioning below the accepted norms.  Interpretation. After transpetrous excision of a petroclival meningioma the quality of life for the patient is worse than that indicated in surgeons' reported results. This paper represents an attempt to address the issue of evidence-based medicine and finds that such an approach is not apparent in the medical literature on this pathology. While we argue that methods for measuring outcome should be refined and carers input recognised it does raise certain philosophical considerations. It is the counsel of perfection and if achieved may lead to surgeons operating on fewer patients, more petroclival cases being viewed as inoperable because of the higher morbidity, despite there being an inescapable pathway to surgical intervention.     

加强预防医学研究生分会工作的分析与建议

对公卫研究生分会的工作进行调查与分析 ,结果学院领导和研究生管理部门对分会工作比较关心和支持 ;分会工作计划切实可行 ;分会干部的积极性、表率作用及组织的学术活动较好。但对分会组织的文体活动不够满意。建议 :增设公卫研究生分会活动基金 ;举办人文知识讲座 ;邀请知名的研究生导师作专题学术报告 ;增加活动场地和改善体育设施 ;组织活泼多样的文体活动 ,尤其是英语口语活动