Decentralisation and convergence in health among the provinces of Spain (1980-2001)

This study measures the process of convergence in the state of health among the provinces and regions of Spain during 1980-2001 in order to analyse the possible influence of the decentralisation of healthcare management to the regions in this period. Sigma and beta convergence models, traditionally employed in macroeconomics, have been used, taking Life Expectancy at Birth (LEB) and Infant Mortality (IM) as health indicators. The analysis was carried out at two territorial levels: provinces and regions. The results reveal that the process of decentralisation either does not affect convergence or leads to divergence in health. Indeed, in the case of IM the so-called change of role scenario seems to have occurred. Thus, certain provinces with initially poor indicators have improved, overtaking those that were originally in a better position. The final result, however, is of greater dispersion than initially.     

厦门市综合性医院结核病人发现报告与转诊情况分析

目的评价厦门市综合性医院结核病人发现和网络报告水平,为进一步完善结核病归口管理提供依据。方法通过收集2004～2008年厦门市结核病控制工作季报表、督导报告等相关信息,比较福建省和厦门市综合性医院对肺结核病人发现水平,并进行评价。结果2004～2008年厦门市综合性医院结核病转诊到位率为43.6%,高于福建省转诊到位率40.1%(P<0.01);登记活动性肺结核病人发现率历年保持在94.5/万以上;活动性肺结核病人初治涂阳率只有34.6%,低于全省水平(P<0.01)。结论厦门市各级综合性医院积极落实结核病归口管理办法,于2004年提前实现新涂阳肺结核病人发现率达到70%要求,有效提高了厦门市综合性医院对肺结核病人发现水平。但有少部分综合性医院还存在对结核病疫情漏报现象,今后要进一步完善结核病归口管理操作规程,建立责任考核制度,提高结核病归口管理工作质量。     

肺结核患者生存质量评价在结核病归口管理中的临床应用

目的应用肺结核患者生命质量评价,对影响生命质量的不利因素实施干预,促进结核患者的归口管理。方法根据结核病生存质量测定专用量表的测评结果,针对影响肺结核患者生存质量的不利因素,对2008年新发现的386例疑似肺结核患者,运用自制的“流动人口肺结核患者转诊须知”与传统转诊口头讲解的方法相结合,追踪时继续围绕“转诊须知”进行健康教育等干预措施;并将干预后与干预前的转诊到位率相比较。结果2008年转诊的386例疑似肺结核患者,转诊到位286例,转诊到位率74．1％,比2007年同期相比提高20．1％,到位率提高具有统计学意义（P〈0．001）。结论应用肺结核患者生命质量评价,指导临床结核患者转诊工作,对实现（DOTS）战略和结核病“高发现率、高治愈率”起着重要的作用。     

The Convergence Insufficiency Treatment Trial: Design,Methods, and Baseline Data

Objective: This report describes the design and methodology of the Convergence Insufficiency Treatment Trial (CITT), the first large-scale, placebo-controlled, randomized clinical trial evaluating treatments for convergence insufficiency (CI) in children. We also report the clinical and demographic characteristics of patients. Methods: We prospectively randomized children 9 to 17 years of age to one of four treatment groups: 1) home-based pencil push-ups, 2) home-based computer vergence/accommodative therapy and pencil push-ups, 3) office-based vergence/accommodative therapy with home reinforcement, 4) office-based placebo therapy. Outcome data on the Convergence Insufficiency Symptom Survey (CISS) score (primary outcome), near point of convergence (NPC), and positive fusional vergence were collected after 12 weeks of active treatment and again at 6 and 12 months posttreatment. Results: The CITT enrolled 221 children with symptomatic CI with a mean age of 12.0 years (SD = +2.3). The clinical profile of the cohort at baseline was 9Δ exophoria at near (+/? 4.4) and 2Δ exophoria (+/?2.8) at distance, CISS score = 30 (+/?9.0), NPC = 14 cm (+/? 7.5), and near positive fusional vergence break = 13 Δ (+/? 4.6). There were no statistically significant nor clinically relevant differences between treatment groups with respect to baseline characteristics (p > 0.05).Conclusion: Hallmark features of the study design include formal definitions of conditions and outcomes, standardized diagnostic and treatment protocols, a placebo treatment arm, masked outcome examinations, and the CISS score outcome measure. The baseline data reported herein define the clinical profile of those enrolled into the CITT.     

前牙牙体聚合度的测量研究

目的通过测量60付自然恒牙列模型,获取自然前牙牙体聚合度的正常值,补充国人牙体测量方面的数据并为临床应用提供参考。方法选取山东大学在校生及青年员工的60付正常牙合牙列模型,以精细藻酸盐印模材取模,超硬石膏灌注,对模型各前牙进行定点,转移模型各定点至坐标纸,测量、计算颊舌向聚合度,统计分析所得数据。结果得出各牙位牙体颊舌向聚合度。结论本研究的前牙牙体聚合度测量补充了牙体测量方面的科学数据。对较大聚合度牙齿牙体预备时,先预备牙合面可减少磨切量,对保护牙体有重要意义。     

Dependence of short-latency ocular following and associated activity in the medial superior temporal area (MST) on ocular vergence

Motion of a large-field pattern elicits short-latency ocular following responses (OFR) in the monkey, which are mediated at least in part by the medial superior temporal area of the cortex (MST). The magnitude of the OFR is known to be inversely related to viewing distance, and we investigated the dependence of OFR and the associated neuronal activity in the MST on a major cue to viewing distance, ocular vergence, in alert monkeys (Macaca fuscata). The vergence angle, expressed in terms of the apparent viewing distance, ranged from infinity to 16.6 cm (0–6 m⁻¹). The magnitude of the initial OFR increased monotonically with increases in convergence at a mean (±SD) rate of 19.6±4.5%/m⁻¹ in four monkeys (over the range 0–4 m⁻¹). In two monkeys, we recorded the single unit activity of 160 MST neurons that responded to motion of a large-field pattern with directional selectivity. The mean latency (±SD) of the MST discharges elicited by large-field motion was 50±7.5 ms (n=115), which preceded the onset of OFR by an average of 10±9.9 ms. The discharge modulation elicited by large-field motion showed a significant dependence on vergence in 91/160 neurons (57%), 72 of which (79%) increased their firing rate with increasing convergence (“near” neurons), and the remainder increasing their firing rate with decreasing convergence (“far” neurons). However, on average, the sensivity of these MST neurons to vergence was only about 30% of that shown by the OFR. It could be that only those neurons that are very sensitive to vergence angle contribute to the OFR, but it is also possible that much of the modulation of OFR with vergence occurs downstream from the MST or in alternative pathways (yet to be discovered) that contribute to OFR. Received: 11 October 1997 / Accepted: 21 January 1998     

Otolith and canal integration on single vestibular neurons in cats

In this review, based primarily on work from our laboratory, but related to previous studies, we summarize what is known about the convergence of vestibular afferent inputs onto single vestibular neurons activated by selective stimulation of individual vestibular nerve branches. Horizontal semicircular canal (HC), anterior semicircular canal (AC), posterior semicircular canal (PC), utricular (UT), and saccular (SAC) nerves were selectively stimulated in decerebrate cats. All recorded neurons were classified as either projection neurons, which consisted of vestibulospinal (VS), vestibulo-oculospinal (VOS), vestibulo-ocular (VO) neurons, or non-projection neurons, which we simply term vestibular (V) neurons. The first three types could be successfully activated antidromically from oculomotor/trochlear nuclei and/or spinal cord, and the last type could not be activated antidromically from either site. A total of 1228 neurons were activated by stimulation of various nerve pair combinations. Convergent neurons were located in the caudoventral part of the lateral, the rostral part of the descending, and the medial vestibular nuclei. Otolith-activated vestibular neurons in the superior vestibular nucleus were extremely rare. A high percentage of neurons received excitatory inputs from two nerve pairs, a small percentage received reciprocal convergent inputs and even fewer received inhibitory inputs from both nerves. More than 30% of vestibular neurons received convergent inputs from vertical semicircular canal/otolith nerve pairs. In contrast, only half as many received convergent inputs from HC/otolith-nerve pairs, implying that convergent input from vertical semicircular canal and otolith-nerve pairs may play a more important role than that played by inputs from horizontal semicircular canal and otolith-nerve pairs. Convergent VS neurons projected through the ipsilateral lateral vestibulospinal tract (i-LVST) and the medial vestibulospinal tract (MVST). Almost all the VOS neurons projected through the MVST. Convergent neurons projecting to the oculomotor/trochlear nuclei were much fewer in number than those projecting to the spinal cord. Some of the convergent neurons that receive both canal and otolith input may contribute to the short-latency pathway of the vestibulocollic reflex. The functional significance of these convergences is discussed.     

Synaptic input to cells of the rabbit superior cervical ganglion

Orthodromic responses in rabbit superior cervical ganglion (s.c.g.) cells were investigated in vitro with intracellular electrodes. Mean RMP was-55.4±0.8 mV, mean input resistance 39.7±1.9 M and membrane time constant 10.8±0.7 ms.Several distinct patterns of orthodromic response consisting of synaptic potentials of different latencies and the generation of 1–3 orthodromic action potentials were observed. In one of these, stimulation of higher threshold preganglionic fibres evoked an orthodronic action potential of longer latency, in another of shorter latency. Marked convergence of preganglionic fibres onto ganglion cells occurred; on average a minimum of 7.5±0.4 fibres converged on each cell. Of 29 cells, 24 (i.e. 83%) received an input from both low threshold (B) and high threshold (C) fibres. In 15 of these cells a single action potential was generated, in 14 of these cells 2 or more action potentials were generated during the orthodromic response. The physiological significance of this convergence and its implications for the extent of divergence at this synapse are discussed; on average each preganglionic axon must synapse 240 ganglion cells.Some observations on the occurrence of IS action potentials on direct stimulation of the cell and on the conductance change during the after-hyperpolarization following the action potential are also reported.     

Organization of geniculate inputs to visual cortical cells in the cat

Neuronal connectivity between a geniculate cell and a striate cortical cell was examined by cross-correlograms between their impulse activities. Delayed positive correlations were found in 82 pairs, and the onset delay of the positivity was short enough in 65 pairs to infer that the geniculate cell monosynaptically excited the cortical cell. These monosynaptic excitations were found in both simple and complex cells. By determining connectivity of a cortical cell with multiple geniculate cells, the convergence of X and Y geniculate cells and that of on-center and off-center geniculate cells was demonstrated in several striate cells.     

88-A型牙体聚合度测量仪的研制

目的介绍口内牙体聚合度测量仪器的研制及试用以提高牙体预备质量。方法运用几何方法,设计88-A型牙体聚合度测量仪,通过运算得出牙体聚合度。结果88-A型牙体聚合度测量仪可以在口内直接测量基牙牙体聚合度,满足了设计要求。结论88-A型牙体聚合度测量仪的研制为提高牙体预备质量提供了有用的方法和工具。