对县级疾病预防控制机构学科建设问题的思考

目的对县级疾病预防控制机构学科发展水平滞后问题提出若干思考与建议。方法回顾本地疾控机构学科建设面临的困难和问题,探讨其中的症结,分析事物的成因。结果县级疾控机构学科建设未引起足够的重视,学科发展受非预防医学类专业人员比例显著增加和在岗专业人员学历偏低以及职称晋升限制政策等多种因素的制约,影响各项疾控职能的发挥及国家基本公共卫生服务项目的实施效果。结论县级疾控机构学科建设必须列入优先领域、着力构建学科建设体系、加强应用研究和优化学科发展环境。     

Trends in Risk-Adjusted Initiation and Reduction of Opioid Use among Veterans With Dementia in US Department of Veterans Affairs Community Living Centers

ObjectiveProper initiation and reduction of opioids is important in providing effective and safe pain relief to Veterans with dementia, including in Community Living Centers (CLCs). We examined the trends in aggregated monthly risk-adjusted opioid administration days and dosage over 3 opioid safety regulatory periods: pre–Opioid Safety Initiative period (October 1, 2012–June 30, 2013; period 1), pre–CDC Clinical Practice Guideline period (January 1, 2014–November 30, 2015, period 2) and post–Veterans Affairs Clinical Practice Guideline period (March 1, 2017–September 30, 2018; period 3).DesignA retrospective study between October 1, 2012, and September 30, 2018.Settings and participants4995 long-stay CLC residents with dementia who had incident (incident cohort, n = 2609) or continued (continued opioid cohort, n = 2386) opioid administration in CLCs.MethodsCLC Minimum Data Set (MDS) assessments data and bar-code medication administration data were used. Opioid initiation was examined for incident opioid cohort and reduction was examined using continued opioid cohort. We first computed aggregated monthly risk-adjusted opioid administration days, opioid with benzodiazepine administration days and opioid dosage, and then examined risk-adjusted incident and continued opioid administration trends over the regulatory periods controlling for facility-level characteristics.ResultsAmong the incident opioid cohort, compared to period 1, there were 1.9 and 2.1 fewer risk-adjusted opioid administration days per month in periods 2 and 3, respectively; 1.5 fewer risk-adjusted days per month with opioid and benzodiazepine administration in both periods 2 and 3; and 2.2 and 3.7 morphine milligrams equivalent per day (MMED) lower risk-adjusted dosage in periods 2 and 3, respectively. Among the continued opioid cohort, compared to period 1, there were 1.6 and 2.9 fewer risk-adjusted days with opioid and benzodiazepine administration days per month in periods 2 and 3, respectively, and 5.3 MMED lower risk-adjusted dosage per month in period 3.Conclusions and implicationsCLC providers initiated and reduced opioid administration in fewer days and at lower dosage among Veterans with dementia across the regulatory periods. The result was likely due to systemic efforts from health care professionals, CLC administrators, and policy makers or VA central office, aiming to reduce opioid misuse and improve quality of care in nursing home residents with dementia. What is still unknown is whether pain was well controlled or nonpharmacologic treatments were utilized.     

CDC20在子宫内膜癌中的表达及其对RL95-2细胞增殖和凋亡的影响

目的：评估细胞分裂周期蛋白20（CDC20）在子宫内膜癌（EC）中的表达，探讨其对EC细胞RL95-2周期和凋亡的影响及可能的机制。方法：从癌症基因组图谱（TCGA）数据库获取EC 的mRNA 表达矩阵以及患者的临床信息，通过R 语言分析CDC20 mRNA的差异表达情况及其与肿瘤分期的相关性，qPCR及WB法检测CDC20在RL95-2细胞中的表达；向RL95-2细胞转染sh-CDC20以敲减CDC20的表达，采用CCK-8法和流式细胞术检测敲减CDC20对RL95-2细胞增殖活力、细胞周期分布和凋亡的影响，WB法分析对Mcl-1/p-Chk1信号活性的影响；建立RL95-2细胞裸鼠移植瘤模型，评估敲减CDC20 对肿瘤生长的抑制作用及对移植瘤组织中Mcl-1/p-Chk1信号轴和细胞凋亡的影响。结果：CDC20在EC组织及RL95-2细胞中呈高表达（均P<0.01），且CDC20的高表达与EC 的分期有关联。敲减CDC20可显著降低RL95-2 细胞增殖活力（P<0.01），阻滞细胞周期于G1期（P<0.01），促进细胞凋亡（P<0.01），抑制细胞中Mcl-1和p-Chk1的表达（P<0.05 或P<0.01）。敲减CDC20 可显著抑制RL95-2细胞裸鼠移植瘤的生长（P<0.01），降低移植瘤组织内Mcl-1 和p-Chk1 的表达（P<0.01），促进移植瘤细胞凋亡（P<0.01）。结论：CDC20在EC组织中呈高表达且与肿瘤分期有关联，敲减CDC20 能够抑制RL95-2细胞及其裸鼠移植瘤的生长而促进凋亡，这可能与Mcl-1/p-Chk1信号轴有关。     

新疆生产建设兵团农二师农牧团场厕所卫生状况调查分析

目的了解农二师农牧团场厕所卫生状况，为今后改厕提供依据。方法采取整群随机抽样，调查公厕454个．户厕6132个，结论卫生公厕合格率为15．64％，卫生户厕合格率为12．46％。     

Needlestick injuries in dentistry: Time to revisit

BackgroundBlood-borne pathogens (BBPs) are infectious microorganisms that are found in human blood and can cause diseases in humans. Health care workers such as physicians, surgeons, nurses, dentists, dental students, dental assistants, laboratory technicians, personnel handling infectious waste, and other health care employees are at increased risk of exposure to these pathogens. Percutaneous injuries from needles or other sharp objects are the major sources of BBPs in the workplace. Needlestick injuries (NSIs) have the most potential to transmit and have the easiest mode of transmission of BBPs.Types of Studies ReviewedThe authors searched electronic databases (PubMed, Web of Science, Google Scholar, Scopus, Embase, MEDLINE-Ovid) for studies and articles focused on the various aspects of NSIs, their possible causes, prevention, and management protocols.ResultsThere is a lack of literature on the global prevalence of NSIs among dental practitioners and underreporting of NSIs by clinicians. The authors also found that dental students and inexperienced practitioners were the most vulnerable. They found apparent inconsistencies in guidelines and recommendations from various regulatory and statutory agencies in charge of limiting and managing NSIs.ConclusionThe most significant occupational risks for health care workers globally are NSIs. Dentists are recognized as one of the high-risk groups for exposure to NSIs. Although the reporting rate was noticeably low, the frequency of NSIs among dental students was alarmingly high.Practical ImplicationsAppropriate and succinct training of dental health care workers is crucial for prevention and management of NSIs. It is recommended that dentists familiarize themselves with recommendations from such agencies and organizations as the Center for Disease Control and Prevention, Occupational Safety and Health Administration, and American Dental Association.     

Geographic Density of Gastroenterologists Is Associated With Decreased Mortality From Alcohol-Associated Liver Disease

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