Un sistema de vigilancia de salud pública para el cambio climático en las ciudades

This paper makes a first proposal for a public health surveillance system for climate change in cities, and describes the process that led to its definition. After several years of monitoring different aspects related to climate change and its impact, the public health services of Barcelona made a preliminary proposal and gathered a working group of experts to discuss and review it. Four categories of components were defined: climate data, health impacts of climate change and its determinants, contributions of the city to mitigation (especially those with health co-benefits), and actions to reduce vulnerability to extreme events. They were broken in twelve components, with indicators for each. The proposal was further refined with subsequent reviews, and is being used by the city public health services involved in this field.     

Functional transition: Inconsistently parallel to the increase in future liver remnant volume after preoperative portal vein embolization

BACKGROUNDPreoperative portal vein embolization (PVE) is a widely used strategy to enable major hepatectomy in patients with insufficient liver remnant. PVE induces hypertrophy of the future liver remnant (FLR) and a shift of the functional reserve to the FLR. However, whether the increase of the FLR volume (FLRV) corresponds to the functional transition after PVE remains unclear.AIMTo investigate the sequential relationship between the increase in FLRV and functional transition after preoperative PVE using 3-dimensional (3D) computed tomography (CT) and ^99mTc-galactosyl-human serum albumin (^99mTc-GSA) single-photon emission computed tomography (SPECT) fusion images. METHODSThirty-three patients who underwent major hepatectomy following PVE at the Department of Gastroenterological Surgery I, Hokkaido University Hospital between October 2013 and March 2018 were enrolled. Three-phase dynamic multidetector CT and ^99mTc-GSA SPECT scintigraphy were performed at pre-PVE, and at 1 and 2 wk after PVE; 3D ^99mTc-GSA SPECT CT-fused images were constructed from the Digital Imaging and Communications in Medicine data using 3D image analysis system. Functional FLRV (FFLRV) was defined as the total liver volume × (FLR volume counts/total liver volume counts) on the 3D ^99mTc-GSA SPECT CT-fused images. The calculated FFLRV was compared with FLRV.RESULTSFFLRV increased by a significantly larger extent than FLRV at 1 and 2 wk after PVE (P < 0.01). The increase in FFLRV and FLRV was 55.1% ± 41.6% and 26.7% ± 17.8% (P < 0.001), respectively, at 1 wk after PVE, and 64.2% ± 33.3% and 36.8% ± 18.9% (P < 0.001), respectively, at 2 wk after PVE. In 3 of the 33 patients, FFLRV levels decreased below FLRV at 2 wk. One of the three patients showed rapidly progressive fatty changes in FLR. The biopsy at 4 wk after PVE showed macro- and micro-vesicular steatosis of more than 40%, which improved to 10%. Radical resection was performed at 13 wk after PVE. The patient recovered uneventfully without any symptoms of pos-toperative liver failure.CONCLUSIONThe functional transition lagged behind the increase in FLRV after PVE in some cases. Evaluating both volume and function is needed to determine the optimal timing of hepatectomy after PVE.     

Improving community health and social care practitioners’ confidence,perceived competence and intention to use behaviour change techniques in health behaviour change conversations

Community health and social care practitioners play an increasingly important role in the health promotion agenda, but lack confidence in having effective health behaviour change (HBC) conversations with members of the public. This study reports the development and evaluation of a training intervention based on health psychology to improve health and social care practitioner self-rated confidence, competence and intention to use five behaviour change techniques (BCTs) in their HBC conversations. A 2-day behavioural science interprofessional skills training course plus online learning module was designed for health and social care staff across North East Scotland, teaching five evidence-based BCTs (e.g. Action Planning), plus person-centred communication skills. Participants rated confidence, competence and future intention to use the BCTs on likert scales (1–10) pre-course and post-course, and provided acceptability data. 177 participants aged 20–64 took part, qualitative and quantitative data suggested that the course had high acceptability. Paired samples t tests (n = 120 with complete data) showed significant improvements in confidence, competence and intention following the course, which remained significant with a conservative analysis (n = 174) assuming no change for missing data. Perceived competence in Action Planning increased most during the course (mean change 3.09). In conclusion, health psychology-based skills training can improve practitioner confidence, competence and intention to use evidence-based BCTs; further evaluation is needed to assess practice change.     

四川省卫生总费用的结构变动及预测研究

目的 分析2008—2019年四川省卫生总费用结构变动及影响因素和预测研究,为助力“健康四川”建言献策。方法 使用四川省卫生统计年鉴的相关卫生总费用数据,在描述性分析的基础上,使用结构变动度分析卫生总费用的结构变动,灰色关联法研究卫生总费用的影响因素并进行GM(1,1)预测。结果 2008—2019年卫生总费用持续增加,政府、社会和个人卫生支出结构逐步合理;人均卫生费用水平排名靠后,社会卫生支出成为卫生总费用的主要构成单元;千人口床位、常住人口和农村居民人均可支配收入是影响卫生总费用的主要因素;预测发现,2020—2025年卫生总费用仍呈增加趋势,个人卫生支出占比进一步下降。结论 四川省卫生总费用结构渐趋合理,医疗服务水平得到大幅度改善;但仍需重点关注人均卫生费用等相对性指标。     

团块状灰度变化减轻子宫良性疾病聚焦超声消融术中的远场不良反应

目的：评估团块状灰度变化能否减轻子宫良性疾病聚焦超声消融术中的远场不良反应。方法：开展单中心回顾性临床观察研究,纳入重庆医科大学附属第二医院行聚焦超声消融术的40例子宫良性疾病。比较团块状灰度变化出现前后,在相同能量水平（最小不可耐受能量）下,术中即刻骶尾部或臀部疼痛、放射痛、会阴部痛、肛门胀痛的发生率及不良反应程度。结果：在相同能量水平（最小不可耐受能量）下,团块状灰度变化出现后术中即刻骶尾部或臀部疼痛、放射痛、会阴部痛、肛门胀痛的发生率及不良反应程度明显低于团块状灰度变化出现前（P<0.05）。结论：团块状灰度变化能减轻子宫良性疾病聚焦超声消融术中的远场不良反应。     

Oral senile amyloidosis in senescence accelerated mouse (SAM)

Oral senile amyloidosis in senescence accelerated mouse (SAM) was examined for two SAM sublines (P/2/Iw and R/1/Iw) and for various ages by light microscopy, immunohistochemistry, and electron microscopy. The amyloid deposition, identified by green birefrigence following Congo red stain, was observed only in P/2/Iw. In P/2/Iw, no amyloid deposition was found at age 6 months; however, frequency and extent of such deposits increased with advancing age. Distribution of amyloid deposition was as follows: along papillary layers of mucous epithelium in the tongue, the gingiva, the palate, and the buccal mucosa; foci in connective tissues; along vessels, muscles, and minor salivary glands. Immunohistochemically, the amyloid deposition was positive with anti-ASSAM serum being raised against a unique amyloid protein ASSAM which probably induced "senile systemic amyloidosis". P/2/Iw is useful as an animal model of oral senile amyloidosis.     

仁术健胃颗粒逆转胃癌前期病变的临床研究

目的观察仁术健胃颗粒对胃癌前病变的逆转作用。方法将１２０例符合诊断标准的胃癌前期病变患者,随机分为仁术健胃颗粒治疗组８０例和胃复春对照组４０例进行临床疗效观察。结果①综合疗效：治疗组总有效率为９１．２５％,对照组为７５．００％,经统计学处理,差异有显著性（Ｐ〈０．０５）;②治疗组胃镜及对萎缩、肠化、异型增生的疗效分别为７１．２５％、７７．５０％、７９．４９％、８８．４６％,对照组为５２．５０％、６     

树立新观念 搞好高校教材工作改革

社会主义市场经济必然要求高校教材走向市场。教材管理者、学校领导和师生都必须树立新观念。坚持社会效益首位前提下的双重效益观念是搞好主校教材工作改革的关键     

肾小球轻微病变型肾病综合征并发特发性急性肾衰临床分析

目的 :探讨肾小球轻微病变 NS并发 IARF的病理特征、治疗效果及预后。方法 :回顾性分析 12例肾小球轻微病变 NS并发 IARF患者的临床特征、病理结果、治疗及预后情况。结果 :本组 12例病理示肾小球病变轻微 ,肾小管间质病变较广泛。 10例肾功能恢复正常、2例好转 ,肾衰恢复或好转的平均时间为 2 2 .4± 15.3d;8例 NS缓解 ,时间为 4 0 .5± 2 0 .7d。结论 :肾小球轻微病变 NS并发 IARF可能为肾小管间质的亚致死性损伤所致 ,兼顾 PNS和 ARF两个环节的治疗 ,预后良好。     

生前与死后伤的区别——用免疫组化法检测损伤组织中的免疫球蛋白G

目的 :研究损伤组织中的免疫球蛋白 G(Ig G)的分布以区别生前与死后伤。方法 :卵白素—生物素过氧化物酶复合物技术 (ABC法 ) ,直接用辣根过氧化物酶标记单一特异性抗体 (直接法 )检测人体生前与死后损伤皮肤组织中的 Ig G。结果 :生前损伤标本均阳性 ,死后损伤标本均阴性。应用本方法可以检测极短时间 (<1 0 min)内死亡的生前伤。钝器伤 Ig G阳性反应分布范围比锐器伤广。结论 :应用 ABC法、直接法的免疫组化技术检测人体损伤皮肤组织中的 Ig G比较简便 ,该方法适用基层推广应用。