The incorporation of activities to control dengue by community health agents

OBJECTIVE

To evaluate the performance of Community Health Agents when dengue control activities were added to their tasks.

METHODS

Performance was measured comparing the evolution of selected indicators from the Brazilian National Dengue Control Program and the Family Health Strategy for 2002 to 2008 in the municipality of Sao Gabriel do Oeste, MS, Central Western Brazil, with those of Rio Verde de Mato Grosso, neighboring municipality with demographic, socioeconomic and health services similarities. Data were collected from municipal databases of the Information System for Yellow Fever and Dengue and the Information System for Primary Healthcare of the Mato Grosso do Sul State Health Office. The variables selected for the family health strategy activities were: monthly home visits, pregnant women whose antenatal care began in the first trimester, children under one with up-to-date vaccinations and hypertensive patients. Those selected for the Brazilian National Dengue Control Program were: properties inspected with Aedes aegypti and properties not inspected.

RESULTS

The two municipalities maintained a similar trend in dengue control indicators in the period studied. With regard to the Family Health Strategy, in 2002 Sao Gabriel do Oeste was better off in three of the four indicators studied, however, this situation was reversed at the end of the period when the county was overtaken by Rio Verde de Mato Grosso in three of the four indicators analyzed, including, the monthly average community health worker visits per registered family, the main activity of a Family Health Strategy agent. CONCLUSIONS: Incorporating the National Dengue Control Program into the Family Health Strategy is viable and developed without prejudice to dengue control activities, however, the same did not occur with the activities of family health in Sao Gabriel do Oeste. The additional workload of the community health workers is the most likely hypothesis for the declining performance of these agents in the Family Health Strategy activities.     

6县(市)基本公共卫生服务绩效考核实施现状研究

目的了解6个县(市)实施基本公共卫生服务绩效考核现状并发现存在的问题,进而提出可行建议,为政府部门制定政策提供参考。方法查阅文献资料、开展定量调查收集数据,对相关部门管理人员、乡镇卫生院院长、乡村两级医务人员和农村居民进行定性访谈。结果 6个县(市)制定了对乡镇卫生院基本公共卫生服务的绩效考核办法,其中2个县(市)制定了对村卫生室的考核办法。6个县(市)中有4个县(市)绩效考核包括了效率指标和效果指标。6个县(市)对乡镇卫生院开展基本公共卫生服务实行专项绩效考核,频率主要为1年2次;调查的15个乡镇卫生院中8个乡镇卫生院制定了基本公共卫生服务专项考核方案,7个乡镇卫生院制定了综合考核方案,但5个乡镇卫生院绩效考核未落实到位。7个乡镇卫生院制定了对村医的绩效考核办法。结论 6个县(市)实施基本公共卫生服务绩效考核取得一定成效,但绩效考核办法仍不完善,需要进一步改进。     

重组L-天冬酰胺酶的鉴定

目的 :对重组L 天冬酰胺酶进行鉴定。方法 :用基因测序、氨基酸组成分析、N 末端氨基酸测序、胰肽图谱、IEF、分子量、紫外扫描等各种实验手段对重组L 天冬酰胺酶及其天然品进行了全面比较。结果 :重组产品与天然品具有同质性。结论 :重组L 天冬酰胺酶具有较好的应用前景。     

论医德的评判

医德评羊是医学伦理原则和规范赖以发生作用的“杠杆”。在医疗活动中具有调节、规范、激励医务人员言行的作用。文章着重论述了医德评判的客观标准并对其进行了客观分析,认为从历史发展趋势和社会转型期的整体高度评判,当前医德水准在向更高的目标迈进。还指出,新的医德价值体系必须以市场关系为基础,同时不能忽略思想教育和宣传,使物质文明和精神文明有机结合,构建良好的医德价值体系基础。     

The stresses of rheumatoid arthritis: Appraisals of perceived impact and coping efficacy

Objective. This study examined appraisals of the impact of 7 stressors associated with rheumatoid arthritis (RA) and the perceived ability to cope With those stressors. Methods. Subjects were 446 participants in a panel study of persons with RA. Data were derived from the 1994 annual interview. Results. There were significant differences among mean ratings of the stressors. Taking care of RA, fatigue, pain, and functional impairment were rated as having the greatest impact; perceived coping efficacy was highest for medication side effects and taking care of RA. Appraisals of impact and coping efficacy were negatively correlated. Clinical factors were the strongest predictors of both appraisals. Depressive symptoms and instrumental support were also independently associated with both appraisals for most stressors. Conclusions. All of the stressors were problematic to some degree, suggesting that coping research should include stressors other than pain and function. Most subjects rated the effects of these stressors as moderate, however. Future examination of the coping responses of these individuals may shed light on adaptation to RA.     

Appraisal of and coping with arthritis-related problems in household activities,leisure activities,and pain management

Purpose. We examined whether or not there are systematic differences in how people appraise different types of illness-related problems and in how they cope with these problems. Methods. Two hundred thirty-five adults with recently diagnosed rheumatoid arthritis completed a mailed questionnaire followed by a telephone interview. A series of stress appraisal and coping variables were assessed in relation to three areas: household activities, leisure activities, and pain management. Results. Pain Differed significantly from household and leisure activities with regard to several appraisal and coping variables. Participants reported the least control over problems with pain, while attaching the most importance to pain control. Leisure activities also stood out as unique on several variables. Participants perceived greater ability and were more satisfied with their ability in relation to leisure activities. Conclusion. These findings show that, at least early in the disease, appraisal and coping strategies differ across the areas of household activities, leisure activities, and pain management.     

Cost-effectiveness of sub-national geographically targeted vaccination programs: A systematic review

Immunization is an essential component of national health plans. However, the growing number of new vaccine introductions, vaccination campaigns and increasing administrative costs create logistic and financial challenges, especially in resource-limited settings. Sub-national geographic targeting of vaccination programs is a potential strategy for governments to reduce the impact of infectious disease outbreaks while optimizing resource allocation and reducing costs, promoting sustainability of critically important national immunization plans. We conducted a systematic review of peer-reviewed literature to identify studies that investigated the cost-effectiveness of geographically targeted sub-national vaccination programs, either through routine immunization or supplementary immunization activities. A total of 16 studies were included in our review, covering nine diseases of interest: cholera, dengue, enterotoxigenic Escherichia coli (ETEC), hepatitis A, Japanese encephalitis, measles, rotavirus, Shigella and typhoid fever. All studies modelled cost-effectiveness of geographically targeted vaccination. Despite the variation in study design, disease focus and country context, studies generally found that in countries where a heterogenous burden of disease exists, sub-national geographic targeting of vaccination programs in areas of high disease burden was more cost-effective than a non-targeted strategy. Sensitivity analysis revealed that cost-effectiveness was most sensitive to variations in vaccine price, vaccine efficacy, mortality rate, administrative and operational costs, discount rate, and treatment costs. This systematic review identified several key characteristics related to geographic targeting of vaccination, including the vaccination strategy used, variations in modelling parameters and their impact on cost-effectiveness. Additional research and guidance is needed to support the appropriateness and feasibility of geographically targeted vaccination and to determine what country context would make this a viable complement to routine immunization programs.     

Scholarship in anesthesiology: the role of critical appraisal,literature review,quality improvement,journal club,and presentation skills

If asked to describe the term “anesthesiologist scholar”, one may receive a variety of definitions depending on the individual’s area of practice, location in the world, and the generation in which they trained. In this article, we review the roles of five core elements that make an anesthesiologist a “scholar”: skills in critical appraisal, literature review, quality improvement, journal club participation, and presentation delivery. Although this list of scholarly components is not comprehensive, review of each element’s role in the everyday practice and training of physicians will offer insight into their evolution and may offer a glimpse into the future of anesthesiologist scholars. Overall, through the dissemination, recognition, and support of scholarship through these practices, we will continue to achieve meaningful outcomes for our patients and promote a culture of collaboration worldwide. We should ensure that these topic areas become a bedrock of medical education globally, and we must foster opportunities for those who have already completed training to develop and master these skills as a part of their clinical and academic practice.     

上海市级医院安防监控系统集成平台构建与应用

目的 构建上海市级医院安防监控系统集成平台，保障医院安防监控系统正常运行。方法 利用边缘计算与多码流处理等信息技术，集成多家市级医院安防监控系统，搭建了包括医院边缘物联网、医院数据分平台、申康中心数据总平台的医院安防监控系统集成平台。结果 平台运行一段时间后，大多数医院的数字监控设备在线率和录像平均缺失时长均有了不同程度的改善。在纳入集成平台的23家上海市级医院中，数字监控设备在线率增幅最大值为33.29%,录像平均缺失时长降幅最大值为100%。结论 集成平台采用数字监控设备在线率和监控录像平均缺失时长两项指标，对市级医院的安防监控系统运行绩效进行评价，为创造安全稳定的就医环境发挥了重要作用。