21所医院微生物室感染控制支持能力现状调查

目的 了解德州市二级及二级以上医院微生物室对感染管理工作的专业支持能力.方法 对德州市11个县市区,21所二级及二级以上医院进行现场检查及问卷调查.结果 全市17所医院设立了微生物室,12所医院参加了省级室间质量控制,5所医院既未参加室内质控也未开展室间质控；近95.0％的医院未落实三级报告等检验规程.结论 微生物室基本专业水平较低下,感染控制支持能力较差,制约了感染控制工作的深入开展；微生物室人员知识理念陈旧,亟待提高微生物学及医院感染管理知识技能.     

Measures of initiation and progression to increased smoking among current menthol compared to non-menthol cigarette smokers based on data from four U.S. government surveys

There are no large-scale, carefully designed cohort studies that provide evidence on whether menthol cigarette use is associated with a differential risk of initiating and/or progressing to increased smoking. However, questions of whether current menthol cigarette smokers initiated smoking at a younger age or are more likely to have transitioned from non-daily to daily cigarette use compared to non-menthol smokers can be addressed using cross-sectional data from U.S. government surveys. Analyses of nationally representative samples of adult and youth smokers indicate that current menthol cigarette use is not associated with an earlier age of having initiated smoking or greater likelihood of being a daily versus non-daily smoker. Some surveys likewise provide information on cigarette type preference (menthol versus non-menthol) among youth at different stages or trajectories of smoking, based on number of days smoked during the past month and/or cigarettes smoked per day. Prevalence of menthol cigarette use does not appear to differ among new, less experienced youth smokers compared to established youth smokers. While there are limitations with regard to inferences that can be drawn from cross-sectional analyses, these data do not suggest any adverse effects for menthol cigarettes on measures of initiation and progression to increased smoking.     

深圳市现制现售饮用水卫生监督管理的探讨

探讨现制现售饮用水的卫生监督管理方式。通过对深圳市现制现售饮用水卫生状况的调研情况以及存在的卫生问题探讨，提出一些相应的对策，以期为法律制定者提供建议和参考，确保消费者的饮用水安全。     

泉州市心脑血管疾病患病现状及卫生需求调查研究

目的调查泉州市心脑血管疾病患病现状及卫生需求,为临床防控、健康教育干预等工作提供参考。方法选择泉州市第一医院2012—1013年收治的心脑血管疾病患者736例,于首次就诊时采用自行设计的患病现状和卫生需求调查表及诺丁汉健康调查问卷(NHP)进行调查。根据卫生需求调查结果对患者进行有针对性的健康指导和干预,并于3个月后评估其生活质量。结果 736例患者中心血管疾病、脑血管疾病分别为368例(占50.0%),267例(占36.3%);患者对发病原因、治疗措施及疾病预后的需求较高,分别为98.9%、97.7%、94.7%;就诊3个月后患者精力、疼痛、情感、睡眠、社会活动及身体活动方面评分均低于首次就诊(P0.05)。结论卫生工作者了解心脑血管疾病患病现状及卫生需求并进行有针对性的临床防控、健康教育干预,有利于心脑血管疾病的诊治、保健和康复,提高患者生活质量。     

Changes in the National Endovascular Management of Femoropopliteal Arterial Disease: An Analysis of the 2011–2019 Medicare Data

PurposeTo describe national trends in the utilization of endovascular approaches (including balloon angioplasty, atherectomy, and stent placement) for the management of femoropopliteal peripheral arterial disease (PAD).Materials and MethodsThe Medicare Physician/Supplier Procedure Summary dataset containing 100% of Part B claims was interrogated for years 2011–2019. The Current Procedural Terminology codes specific for femoropopliteal angioplasty, stent placement, and atherectomy were used to create summary statistics for utilization by year, place of service (hospital inpatient, hospital outpatient, and office-based laboratory), and provider specialty (cardiology, radiology, and surgery).ResultsThe use of atherectomy increased from 34,732 (33%) procedures in 2011 to 75,435 (53%) procedures in 2019, and atherectomy became the dominant treatment strategy for femoropopliteal PAD. The relative utilization of stent placement (36,793 [35%] to 28,899 [20%]) and angioplasty only (34,398 [32%] to 38,228 [27%]) decreased concomitantly from 2011 to 2019. By 2019, the use of atherectomy was twofold higher in office-based laboratories than in the outpatient hospital setting (44,767 and 20,901, respectively). Treatment strategy varied by provider specialty in 2011 when cardiologists used atherectomy most frequently (17,925 [43%]), whereas radiologists used angioplasty alone (5,928 [6%]) and surgeons stented (18,009 [37%]) most frequently. By 2019, all specialties utilized atherectomy most frequently (29,564 [59%] for cardiology, 10,912 [58%] radiology, and 33,649 [47%] surgery).ConclusionsThe national approach to endovascular management of femoropopliteal PAD has changed since 2011 toward an implant-free strategy, including a multifold increase in the use of atherectomy. Discordant rates of atherectomy use between the ambulatory hospital and office-based settings highlight the need for comparative effectiveness studies to guide management.     

Association between first oral examination characteristics and dental treatment needs in privately insured children: A claims data analysis

BackgroundEarly childhood caries (ECC) remains the most common, preventable infectious disease among children in the United States. Screening is recommended after the eruption of the first tooth, but it is unclear how the age at first dental examination is associated with eventual restorative treatment needs. The authors of this study sought to determine how provider type and age at first dental examination are associated longitudinally with caries experience among children in the United States.MethodsDeidentified claims data were included for 706,636 privately insured children aged 0 through 6 years as part of the nationwide IBM Watson Health Market Scan (2012-2017). The authors used Kaplan-Meier survival analysis to describe the association between the age of first visit and restorative treatment needs.ResultsA total of 21% of this population required restorative treatment, and the average age at first dental examination was 3.6 years. A multivariable Cox proportional hazards model showed increased hazard for restorative treatment with age at first dental visit at 3 years (hazard ratio, 2.05; 95% CI, 1.97 to 2.13) and 4 years (hazard ratio, 3.99; 95% CI, 3.84 to 4.16).ConclusionThe high proportion of children requiring restorative treatment and late age at first dental screening show needed investments in educating general dentists, medical students, and pediatricians about oral health guidelines for pediatric patients.Practical ImplicationsCommunicating the importance of children establishing a dental home by age 1 year to parents and health care professionals may help reduce disease burden in children younger than 6 years.     

大学生的人工流产现状、认知与态度调查分析

目的:了解大学生的人工流产现状、认知与态度。方法:采用随机抽样,对福建924名在校大学生进行无记名问卷调查。结果:有人工流产经历的占有过性经历的10.3%,其中有7人(25.9%)不是在正规医疗场所进行人工流产。大学生对负压吸引术(17.8%)、钳刮术(38.3%)的知晓率较低,知道人工流产可能引起宫颈和宫腔粘连、盆腔感染、宫外孕等疾病的人不到一半。有250人(27.0%)对朋友的人工流产经历表示不同程度的介意,对伴侣的人流经历有表示介意多达880人(95.2%),显示出大学生在思想上比较介意人流经历,并且对不同对象双重标准的矛盾心理。男生对人工流产的认知度和宽容度均低于女生,有性经历者对人工流产的认知度低于无性经历者,而宽容度却高于无性经历者。大学生渴望通过学校生殖健康课和社区教育得到相关知识。结论:大学生在人工流产方面的认知有较大欠缺,需要学校、社区、家庭进行系统科学的教育以降低大学生人工流产发生率。     

Effect of transspinal direct current stimulation on afferent pain signalling in humans

Anodal transspinal Direct Current Stimulation (tsDCS) has been suggested as a means to treat neuropathic pain by reducing pain signalling/processing and Laser Evoked Potentials (LEPs) likewise as a method to evaluate such reduction. However, results in previous studies are disagreeing. To evaluate these claims using rigorous methodology, LEPs were evoked from hands and feet in healthy volunteers. The N2 potential and three psychophysic parameters (general- and pinprick pain, warmth) were used to evaluate the signalling and appreciation of pain respectively. This was made at three time points; at baseline, directly- and 30 min after low thoracic tsDCS (20 min, 2.5 mA, cathode on shoulder). The study was randomized, cross over, double blinded and placebo controlled.At the group level, low thoracic anodal tsDCS produced reduced perceptions of all three tested pain qualities from the foot (p < 0.05 – p < 0.001). These reductions began during stimulation and became more pronounced during the 30 min after its cessation (p < 0.05 – p < 0.01). The LEP parameter alteration mirroring these changes was latency prolongation (p < 0.05 – p < 0.001) whereas amplitude reductions were in par with placebo stimulation. Similar but less pronounced and only transient (during stimulation, p < 0.05 – p < 0.001) changes, were seen for hand stimulation. The interindividual variation was large.The findings indicate that anodal tsDCS may become a technique to treat neuropathic pain by reducing pain signalling/processing and LEPs likewise a method to evaluate such reduction.