21世纪卫生系统改革对卫生经济学发展的影响

该文介绍了发达国家和发展中国家在卫生改革中遇到的问题。前者有：组建医院间“战略联盟”,管理保健市场发展,卫生服务效率、公平性和可及性等。后者有：减少政府的作用,改变公共部门的组织及管理,增加卫生资金的来源及数量。这些问题引起卫生经济学界关注。第二次国际卫生经济学会会议将讨论以下专题：信息不对称及卫生保健组织间关系、卫生保健的选择,卫生及卫生服务的需求,健康及卫生服务的分布,卫生保健的经济学评价,卫生保健市场分析,健康保险,管理保健,卫生服务的产出等18个主题。     

Creative versus repetitive dance therapies to reduce the impact of fibromyalgia and pain: A systematic review and meta-analysis

Background and purposePhysical exercise is one of the most effective interventions to reduce fibromyalgia symptoms. Previous studies have reported benefits of dance-based intervention on the fibromyalgia impact, health-related quality of life and pain, regardless the interventions were based on creative- or repetitive dance. This study aimed to compare the effectiveness of creative and repetitive dance interventions.MethodsPRISMA guidelines were followed in this systematic review. The Cochrane Library, PubMed, Trip, Google Scholar, Web of Science (WOS), Embase and Scopus databases were selected to identify potential articles. Studies were included if they met the following inclusion criteria: to be a clinical trial or a randomized controlled trial, include people with fibromyalgia, have a comparison group and evaluate the impact of the disease, pain or quality of life. Fifteen articles fulfilled the inclusion criteria. The methodological quality of the studies was assessed using the Cochrane Collaboration's tool.ResultsDance-based interventions significantly reduced fibromyalgia impact (standardized mean difference = −0.69), pain (standardized mean difference = −0.70 and increased quality of life (standardized mean difference = 0.43) of people with fibromyalgia. The effectiveness of dance interventions is increased when a creative component is added, since it can lead to higher improvements in pain, impact of the disease and improving quality of life.ConclusionDance-based interventions are significantly effective in reducing the impact of fibromyalgia, pain as well as increasing health-related quality of life. Subgroup analyses suggest that creative dance-based interventions could be more effective than repetitive dance-based interventions to reduce pain and fibromyalgia impact. However, results must be taken with caution due to the large heterogeneity and the small number of articles.     

Relationship between lower limb dynamics and knee joint pain

To test the hypothesis that appropriate and timely neuromuscular control of limb motions plays an important role in the preservation of joint health, we kinematically and kinetically examined the behavior of the legs of young adult subjects at heel strike during natural walking. We compared a group of 18 volunteers, who, we presumed, were preosteoarthrotic because of mild, intermittent, activity-related knee joint pain, with 14 age-matched asymptomatic normal subjects. The two groups of subjects exhibited similar gait patterns with equivalent cadences, walking speeds, terminal stance phase knee flexion, maximum (peak) swing angular velocity, and overall shape of the vertical ground reaction. However, our instrumentation detected statistically significant differences between the two groups within a few milliseconds of heel strike. In the knee pain group, the heel hit the floor with a stronger impact in this brief interval. Just before heel strike, there was a faster downward velocity of the ankle with a larger angular velocity of the shank. The follow-through of the leg immediately after heel strike was more violent with larger peak axial and angular accelerations of the leg echoed by a more rapid rise of the ground reaction force. This sequence of events represents repetitive impulsive loading, which consistently provoked osteoarthrosis in animal experiments. We refer to this micro-incoordination of neuromuscular control not visible to the naked eye as "microklutziness."     

Comparing the Discriminative Validity of Two Generic and One Disease-Specific Health-Related Quality of Life Measures in a Sample of Patients with Dry Eye

OBJECTIVE: The purpose of this study was to compare the discriminative properties of two generic health-related quality of life (QoL) instruments (SF-36 and EQ-5D) and a newly developed disease-specific patient-reported outcomes instrument (Impact of Dry Eye on Everyday Life (IDEEL)) to distinguish between different levels of dry eye severity. METHODS: Assessment of 210 people: 130 with non-Sjogren's Keratoconjunctivitis Sicca (non-SS KCS), 32 with Sj?gren's Syndrome (SS) and 48 controls; comparison of SF-36, EQ-5D, and IDEEL age-adjusted data by dry eye severity levels. Severity was assessed based on diagnosis (non-SS KCS, SS, control), patient-report (none, very mild, mild, moderate, severe, extremely severe) and clinician-report (none, mild, moderate, severe). RESULTS: Discriminative validity results were consistent for all instruments. Significant differences between severity levels were found with most SF-36 scales (P < 0.05), all EQ-5D scales (P < 0.05), and all IDEEL scales (P < 0.0001), except for Treatment Satisfaction. IDEEL scales consistently outperformed the generic QoL measures regardless of the severity criterion used. Most SF-36 scales outperformed the EQ-5D QoL scale, but the EQ-5D visual analog scale outperformed the SF-36 scales, except for General Health Perceptions. CONCLUSIONS: The disease-specific IDEEL scales are better able to discriminate between severity levels than the majority of the generic QoL scales. Preliminary evidence demonstrates that the IDEEL will be sensitive to QoL changes over time, although further testing in controlled longitudinal studies is needed.     

The impact of a single seizure on health status and health care utilization

PURPOSE: To assess the health status of patients after a single seizure. METHODS: We compared single-seizure patients (SS) with patients who had well-controlled epilepsy (WC), and uncomplicated hypertension (HT). Patients were adults screened from emergency and outpatient units of two urban teaching hospitals using predefined criteria. The 83 patients (SS, 30; WC, 29; HT, 24) were interviewed by phone about functional status (SF-36), comorbid illness, cause of illness, number of visits to health providers, and drug side effects. RESULTS: No significant differences were found among groups for health status, SF-36 domain, or occurrence of drug side effects. SS patients had significantly lower scores on vitality (p < 0.03) and a trend toward lower role physical function (p < 0.07) compared with age-adjusted population norms. SS reported more visits to health providers than WC or HT, and the number of visits remained high at interview 1 year later. Patient knowledge of the "reason" for the seizure was not associated with health status or number of visits. CONCLUSIONS: Health status of patients within 1 year of a single seizure is similar to that of patients with well-controlled epilepsy or hypertension, but SS patients have greater health care utilization.     

Most cited papers in Toxicon.

Citation of a published work is one of the parameters considered in the analysis of relevance and importance of scientific contributions. In 2002, for the first time the Impact Factor of Toxicon has risen above 2.0, placing it at the 17th position among 76 journals in the 'toxicology' field. The aim of this article was to identify the most cited articles in Toxicon, that have contributed to the steady increase of its Impact Factor. The number of citations, complete reference and type of all documents appearing in Toxicon in the period 1963-2003 were retrieved from the ISI Web-of-Science homepage. The documents retrieved were sorted by the number of citations received. A 'citation index', defined as the number of citations divided by the number of years since publication, was calculated for each document. It was clearly seen that reviews in Toxicon received 4.4-fold more citations than articles. Unexpectedly, it was found that recent papers were proportionally more cited than old ones. A decrease in the proportion of papers dealing on 'snake*' through out the period and the broadened range of subjects of the most cited papers recently published in Toxicon reflects an increased 'visibility' in other fields of toxinology. Research on plant toxins gained its own space in Toxicon with newer publications showing high citation indexes. It can be postulated that these facts helped to increase Toxicon's Impact Factor from 1.248 in 1999 to 2.003 in 2002. With the increased number of issues in Toxicon as well as publications of subject-dedicated volumes containing mostly reviews, the Impact Factor of Toxicon is expected to keep rising in the near future.     

冲击载荷作用下蛋白质水溶液润滑吸附膜的生长特性

目的研究蛋白质水溶液挤压润滑条件下材料表面蛋白质吸附膜的动态生长特性及其影响因素。方法利用光干涉技术测量球盘点接触在循环冲击条件下BSA蛋白质水溶液的吸附膜厚的生长过程,并研究冲击载荷、冲击次数、材料表面性质对BSA水溶液的吸附成膜特性的影响。结果动态条件下蛋白质润滑吸附膜要比静态工况下的升高很多,冲击条件下蛋白质吸附膜不断生长,并最终达到稳定厚度。小载荷和疏水材料表面有利于蛋白质润滑吸附膜的生长。钢表面极易形成较厚吸附膜,而陶瓷表面吸附膜厚较低。结论针对冲击载荷作用下蛋白质水溶液润滑吸附膜的生长特性研究对人工关节磨损、松动等的治疗、预防具有一定的临床指导意义。     

Impact of Guidelines for Antihypertensive Treatment on Clinical Practice

Many Guidelines and Consensus Statements were published in 1993 and 1994. The pressure to produce these guidelines comes from clinicians faced with rapid change, from a wish to provide an independent authoritative view rather than rely on commercial promotion of particular treatments, and from governments seeking assistance with the allocation of scarce resources.

Evaluation of the impact that guidelines exert on clinical practice is notoriously difficult, but has been attempted using the self-report questionnaire, or the more reliable but expensive analysis of actual practice data, before and after publication of the guidelines.     

中国地理资源期刊集群平台期刊特约专栏实施成效分析与启示

【目的】 依据中国地理资源期刊集群平台期刊特约专栏出版实践,分析实施成效,总结出版经验,为同行组织特约专栏提供借鉴。【方法】 采用中国知网的统计数据,分析中国地理资源期刊集群7种平台期刊在2016—2017年刊发的特约专栏的表现。【结果】 特约专栏整体上能够提高期刊影响力,推广学术传播,但不同类型的特约专栏的表现存在差别。【结论】 内容型专栏是提升期刊影响力的有效措施,双盲评审、相似主题的间隔时间及同一作者的出现频次是特约专栏成效的重要影响因素。特约专栏的组织需要与科技创新一致,落实“四个面向”的战略部署。