精神分裂症病人大脑两半球功能整合的实验研究

目的：检查精神分裂症患者可能存在的大脑两半球功能整合缺陷。方法：对20名精神分裂症患者和20名正常对照者进行不同复杂度汉字“同-异”判断的半视野速示实验。结果：①“同”判断的正确反应时（895．4毫秒）显著长于“异”判断（767．0毫秒）（F=87．44，P〈0．001），“同”判断的正确反应百分数（62．70）也显著低于“异”判断（95．30）（F=74．32，P〈0．001），表明“同”判断明显难于“异”判断；②患者和正常者一样，“异”判断的正确反应时和正确反应百分数在左视野（右半球）呈现、右视野（左半球）呈现和两视野（两半球）同时呈现三种条件之问均未出现显著差异；③正常人的“同”判断在两视野（两半球）同时呈现条件的正确反应时（674．8～743．4毫秒）明显快于左视野（右半球）（795．4—820．5毫秒）（t=2．89～4．57，均P〈0．001）和右视野（左半球）（798．6—857．1毫秒）（t=2．99—4．51，均P〈0．001），而病人没有出现两视野（两半球）对“同”判断的这种优势效应；④两视野（两半球）同时呈现条件下正常人“同”判断的正确反应百分数（88．3～89．5）与“异”判断（94．5—95．4）没有显著差异，而病人“同”判断的正确反应百分数（69．4—74．1）仍明显低于“异”判断（94．4—96．5）（t=2．39—2．60，均P〈0．05）。结论：精神分裂症患者仅在相对较难的“同”判断任务加工中表现出大脑两半球的功能整合缺陷。     

Hemispheric control of unilateral and bilateral responses to lateralized light stimuli after callosotomy and in callosal agenesis

Normally, simple digital or manual responses to a light stimulus in the right or left visual hemifields are performed faster with uncrossed hand-field combinations than with crossed hand-field combinations. Because of the organization of visual and motor pathways, the integration of uncrossed responses is assumed to occur within a single hemisphere, whereas a time-consuming inter-hemispheric transfer via the corpus callosum is considered to be necessary for the integration of crossed responses. However, callosal transfer may be dispensable for those crossed responses which can be controlled through ipsilaterally descending motor pathways by the hemisphere receiving the visual stimulus. We investigated crossed-uncrossed differences (CUDs) in speed of simple visuomotor responses to lateralized flashes in one subject with total section of the corpus callosum and two subjects with complete callosal agenesis. We recorded the reaction times as well as the premotor times, as indicated by the electromyographic latencies of the prime movers, of three types of responses: a distal response involving a thumb flexion, a proximal response chiefly involving a forearm flexion and an axial response involving a shoulder elevation. Further, the three types of responses to a single lateralised flash were performed both unilaterally and bilaterally. The three acallosal subjects showed CUDs greatly exceeding normal values on distal responses, either unilateral or bilateral, and on unilateral proximal responses. These abnormally long CUDs stood in sharp contrast to the insignificant CUDs exhibited by the same subjects on bilateral proximal responses and on unilateral and bilateral axial responses in agreement with correspondingly insignificant CUDs reported for normal subjects. These results confirm that a callosal contribution is important for the execution of fast distal and unilateral proximal responses to a visual stimulus directed to the hemisphere ipsilateral to the responding hand. By contrast, the other types of crossed responses appear to be efficiently coordinated across the midline without the aid of the corpus callosum. This is in keeping with the hypothesis that they are governed by a bilaterally distributed motor system which is preferentially activated for the execution of symmetrical bilateral movements, employing axial and proximal limb muscles.     

The role of anterior ectosylvian cortex in cross-modality orientation and approach behavior

Physiological and behavioral studies in cat have shown that corticotectal influences play important roles in the information-processing capabilities of superior colliculus (SC) neurons. While corticotectal inputs from the anterior ectosylvian sulcus (AES) play a comparatively small role in the unimodal responses of SC neurons, they are particularly important in rendering these neurons capable of integrating information from different sensory modalities (e.g., visual and auditory). The present experiments examined the behavioral consequences of depriving SC neurons of AES inputs, and thereby compromising their ability to integrate visual and auditory information. Selective deactivation of a variety of other cortical areas (posterolateral lateral suprasylvian cortex, PLLS; primary auditory cortex, AI; or primary visual cortex, 17/18) served as controls. Cats were trained in a perimetry device to ignore a brief, low-intensity auditory stimulus but to orient toward and approach a nearthreshold visual stimulus (a light-emitting diode, LED) to obtain food. The LED was presented at different eccentricities either alone (unimodal) or combined with the auditory stimulus (multisensory). Subsequent deactivation of the AES, with focal injections of a local anesthetic, had no effect on responses to unimodal cues regardless of their location. However, it profoundly, though reversibly, altered orientation and approach to multisensory stimuli in contralateral space. The characteristic enhancement of these responses observed when an auditory cue was presented in spatial correspondence with the visual stimulus was significantly degraded. Similarly, the inhibitory effect of a spatially disparate auditory cue was significantly ameliorated. The observed effects were specific to AES deactivation, as similar effects were not obtained with deactivation of PLLS, AI or 17/18, or saline injections into the AES. These observations are consistent with postulates that specific cortical-midbrain interactions are essential for the synthesis of multisensory information in the SC, and for the orientation and localization behaviors that depend on this synthesis.     

Converging patterns of inputs from oral structures in the postcentral somatosensory cortex of conscious macaque monkeys

Single neuronal activities were recorded in the oral region of the postcentral gyrus in conscious Japanese monkeys. Among 5,756 neurons isolated, receptive fields (RFs) and submodalities were identified in 1,502 neurons in area 3b, 970 in area 1, and 1,461 in area 2. The relative incidence of neurons that had bilateral RFs increased gradually upon moving caudally from area 3b to area 2 (bilateral integration). A total of 276 neurons had bimaxillary RFs covering both the maxillary and mandibular divisions of the trigeminal nerve, such as the upper and lower lips, upper and lower teeth, palate and tongue, or combinations thereof. There was also a tendency for the relative incidence of neurons with bimaxillary RFs to increase across the postcentral gyrus but with an abrupt change in area 2 (bimaxillary integration). A total of 382 neurons had composite RFs covering more than one of five oral structures: lip, cheek mucosa, teeth/gingiva, tongue, and palate. The relative incidence of neurons with composite RFs was significantly higher in area 2 than in areas 3b and 1 (interstructural integration). These results indicate that the convergence of inputs from oral structures proceeds in a hierarchical manner across the postcentral gyrus, but chiefly in area 2 for the bimaxillary and interstructural integrations. The relative incidence of neurons with composite RFs was higher among neurons associated with the teeth/gingiva or palate than among neurons associated with the tongue or lip in all three areas. We interpret this to mean that anatomical or functional differences between oral structures might be reflected in the converging patterns in the oral representation.     

福建三明医防融合实践:局限与对策

三明市医防融合改革源于医疗集团重医轻防以及三明市疾病预防需求增加的现状,通过预防与卫生健康网络的纵向融合、医疗与预防体系的横向融合、完善医疗与预防融合的政策支持三举并行,三明市已初步搭建起医防融合的桥梁。但改革面临着监督考核“缺位”、政府管控“越位”与协同机制“错位”的三重悖论,通过构建利益共同体能够有效化解悖论,可通过强化政策执行监督、放权与赋权并举以及完善医防协同机制的路径实现优化。     

医防融合背景下基层卫生技术人员的培训现状和相关知识需求调查

目的 调查5省基层卫生技术人员医防融合相关培训状况以及相关知识能力的需求状况,为完善我国基层医防融合建设,提高基层卫生服务机构防病治病能力提供参考建议。方法 对五个省15个区县的乡镇卫生院和社区卫生服务中心（站）的卫生技术人员进行分层抽样问卷调查,对调查数据进行描述并对各种医防融合相关知识能力需求进行单因素χ²检验和多因素logistic分析。结果 76.0%的基层卫生技术人员近一年参加过培训,乡镇卫生院卫生技术人员培训参与率（73.2%）低于社区卫生服务中心（站）（84.3%）（χ²= 83.812,P＜0.001）,不同特征基层卫生技术人员培训参与率不同（P＜0.01）。各类培训参与率均低于相关知识技能的需求率,公共卫生相关知识技能的需求率最高。χ²检验和多因素logistic分析显示不同特征基层卫生技术人员对各类知识技能的需求率不同:相对于社区卫生服务中心（站）,乡镇卫生院人员对传染病防控技能（OR = 0.756,95%CI:0.666～0.858）和一般病与常见病诊疗技能（OR = 0.860,95%CI:0.762～0.971）的需求程度更高;临床医疗岗位人员对传染病防控技能及一般病与常见病诊疗技能、的需求程度更高（P＜0.001）;年轻人员对慢病管理与病因监测技能的需求更高（OR = 0.937,95%CI:0.885～0.992）;公共卫生岗位人员（OR = 1.346,95%CI:1.114～1.626）和专职管理岗位人员（OR = 2.334,95%CI:1.707～3.191）对信息化技能的需求程度更高。结论 应以需求为导向,加强基层卫生技术人员的培训强度,提升培训内容和知识技能需求的匹配程度,建立完善医防交叉培训机制和医防能力兼备的复合型人才培养供给体系。     

医防融合背景下我国基层医疗卫生机构医防工作现状及认知调查

目的 通过调查我国5省基层卫生人员医防工作的参与情况与对开展医防融合工作的认知现状, 探讨目前基层医防融合工作存在的问题,为促进基层医疗卫生机构医防融合工作提供参考依据。方法 采用多阶段分层抽样,根据地域方位差异分别抽取四川、贵州、江西、江苏和广东5个省,再依据经济状况每省选取3个区县,共15个区县的乡镇卫生院和社区卫生服务中心(站)的卫生人员(6 439名)进行问卷调查与访谈, 对调查数据进行描述并对医防融合工作参与情况与认知现状进行检验。结果 从事公共卫生工作的958名卫生人员中,仅有292人(30.5%)同时参与公共卫生服务与医疗服务,有615人(64.2%)只参与公共卫生服务; 51.7%的公共卫生工作人员以独立公共卫生服务的方式参与基本卫生服务。从事公共卫生工作的卫生人员主要以护理学和临床医学专业为主,仅15.6%的人员具有预防医学专业背景。从事临床医疗工作的1 964名人员中,1 464人(74.5%)医疗服务与公卫服务均参与,但对基本公共卫生服务的投入时间相对较少。不同岗位的卫生人员参与医防工作的情况不同(=2 208.874,P<0.001)。结论 基层临床医疗工作与公共卫生工作机制相对独立。公共卫生工作人员因缺乏疾病诊断治疗能力或无处方权而不能很好地参与到临床医疗工作中; 临床医疗工作人员因缺乏公共卫生知识和技能对公共卫生服务的参与受限。 建议整合医防融合服务机制,打造基层整合型服务; 培养基层医防复合型人才,加大全科医生培养力度。     

社会融合对流动老人基本公共卫生服务利用的影响研究

目的 了解流动老人基本公共卫生服务利用情况,以及社会融合对基本公共卫生服务利用的影响。方法 于2021年7—12月,采用方便抽样的方法,抽取广州市、深圳市、江门市452名流动老人进行问卷调查。采用二元logistic回归模型分析流动老人社会融合对建立健康档案、接受健康教育和老年人健康管理之间的影响。结果 在452名流动老人中,60.8%建立了居民健康档案,接受过健康教育和老年人健康管理的分别有64.4%和60.0%。Logistic分析结果显示,流动老人的居民健康档案行为受到月消费水平（B = 0.368,P＜0.05）、社区文体活动参与程度（B = 0.362,P＜0.01）、居留意愿（B = 0.408,P＜0.001）、年龄（B = - 0. 513,P＜0.01）、户籍类型（B = 0.742,P＜0.01）、流动类型（B = - 0.539,P＜0.05）等变量的影响;健康教育服务利用行为受到社区文体活动参与程度（B = 0.354,P＜0.01）、年龄（B = - 0.411,P＜0.05）、户籍类型（B = 0.561,P＜0.05）的影响;老年人健康管理服务利用行为受到社区文体活动参与程度（B = 0.291,P＜0.01）、居留意愿（B = 0.239,P＜0.05）、年龄（B = - 0.474,P＜0.05）、流动类型（B = - 0.471,P＜0.05）、流动时间（B = 0.225,P＜0.05）、流动目的（B = 0.328,P＜0.01）的影响。结论 流动老人基本公共卫生服务利用率较低,社会融合会对流动老人的基本公共卫生服务利用产生积极影响。可以通过提高流动老人获得基本公共卫生服务的能力和社会融合水平来促进流动老人的基本公共卫生服务利用,从而实现基本公共服务均等化。