腹腔镜下可调节胃束带术及多学科综合治疗重度肥胖症及其合并症

目的 评估腹腔镜下可调节胃束带术(LAGB)及多学科(MDT)综合治疗重度肥胖症及其合并症的效果.方法 回顾性分析2009年10月至2011年2月在北京协和医院接受LAGB及MDT综合治疗的16例重度肥胖症患者的临床资料,总结减重及合并症改善情况.结果 16例患者中,15例完成术后3个月回访,平均体重(P=0.000)和BMI(P=0.000)均明显低于术前,额外体重减轻百分比(%EWL)为(25.7±7.4)%.13例完成术后6个月回访,术后6个月平均体重(P=0.001)和BMI(P=0.001)明显低于术前,与术后3个月差异无统计学意义(P=0.103,P=0.053);术后6个月的%EWL为(37.0±14.7)%,明显高于术后3个月的(29.1±6.8)%(P=0.042).6例完成术后12个月回访,术后3个月平均体重明显低于术前(P=0.007),术后6个月与术后3个月差异无统计学意义(P=0.065),术后12个月明显低于术后6个月(P=0.007);术后3个月的平均BMI明显低于术前(P=0.005),术后6个月明显低于术后3个月(P=0.045),术后12个月明显低于术后6个月(P=0.013);术后3、6、12个月的%EWL分别为(29.6±6.8)%、(42.4±14.0)%、(60.4±12.6)%,术后6个月明显低于术后3个月(P=0.028),术后12个月明显低于术后6个月(P=0.001).9例术前合并阻塞性睡眠呼吸暂停低通气综合征的患者,术后自觉症状均明显缓解.16例术前合并代谢综合征的患者中,10例术后病情得到明显改善.9例术前合并高血压的患者中,7例术后停用降压药物,血压恢复正常;1例减少药量,1例改用更缓和的降压药物.8例术前合并2型糖尿病的患者中,7例术后停用降糖药物,血糖恢复正常;1例降糖药物剂量减少.结论 LAGB及MDT综合治疗病态肥胖及其合并症安全有效、切实可行.     

《突发公共卫生事件应急条例》修订必要性、可行性分析

文章通过结合实际工作和文献研究的方法,分析得出随着社会的发展,《突发公共卫生事件应急条例》已经难以发挥其指导和规范作用,缺乏和相关法律、法规的衔接,在实际工作中也凸现不足,因此有必要进行修订.在国家政府重视下,上位法的出台及相关法律法规的修订,应急管理人员经验逐步丰富的背景下,能够完成《突发公共卫生事件应急条例》的修订工作.     

安徽某县村级门诊糖尿病筛检结果分析与评价

目的:探讨在村级门诊中进行糖尿病筛查的可行性,加强糖尿病患者预防的积极性.方法:通过随机抽样和现场调查收集资料,对安徽省某县村级门诊的1248条有效血糖检测信息进行记录并做统计分析.结果:糖尿病患者112人(2型糖尿病),其中包括以往已确诊糖尿病患者25人,糖尿病总体患病率为9.0%;随着年龄增加,患病率升高(P<0.05);男性组糖尿病患病率高于女性组(P<0.05);肥胖人群组糖尿病发病率高于非肥胖组(P<0.05).结论:村级门诊开展糖尿病筛检有利于糖尿病早发现、早诊断、早治疗,有利于加强糖尿病患者自我保健积极性和减轻农村居民经济负担,可行性较高.     

军队医院主渠道药品社会化保障可行性

随着军队后勤保障社会化改革的深入和药品品种多样化的发展,军队医院主渠道药品必然要向社会化保障发展。本文依据对军队医院主渠道药品供应保障模式的学习和认识,就现行保障模式的弊端,以及社会化保障的可能性进行分析。     

‘It felt like there was always someone there for us’: Supporting children affected by domestic violence and abuse who are identified by general practice

One in five children in the UK are affected by domestic violence and abuse. However, primary care clinicians (GPs and nurses) struggle to effectively identify and support children and young people living in homes where it is present. The IRIS+ (Enhanced Identification and Referral to Improve Safety) training and advocacy support intervention aimed to improve how clinicians respond to children and young people affected by domestic violence and abuse. IRIS+ training was delivered as part of a feasibility study to four general practices in an urban area in England (UK). Our mixed method design included interviews and questionnaires about the IRIS+ intervention with general practice patients, including children and young people as well as with clinicians and advocacy service providers. We collected the number of identifications and referrals by clinicians of children experiencing domestic violence and abuse through a retrospective search of medical and agency records 10 months after the intervention. Forty-nine children exposed to domestic violence and abuse were recorded in medical records. Thirty-five children were referred to a specialist domestic violence and abuse support service over a period of 10 months. Of these, 22 received direct or indirect support. The qualitative findings indicated that children benefitted from being referred by clinicians to the service. However, several barriers at the patient and professional level prevented children and young people from being identified and supported. Some of these barriers can be addressed through modifications to professional training and guidance, but others require systematic and structural changes to the way health and social care services work with children affected by domestic violence and abuse.