Visual Inspection with Acetic Acid (VIA) Screening Program: 7 Years Experience in Early Detection of Cervical Cancer and Pre-Cancers in Rural South India

Cervical cancer continues to be a major public health problem in India in the absence of wide spread organised cervical screening programs. Visual inspection of the cervix with acetic acid (VIA) is an effective, inexpensive screening test that can be combined with simple treatment procedures for early cervical lesions, provided by trained health workers. We report 7 years experience in early detection of cervical cancer and pre-cancers using the VIA test in a community-based program in rural Andhra Pradesh, India where there are no existing organised cervical screening programs.

Materials and Methods:

Eligible women aged between 26 and 60 were opportunistically screened by trained health wor kers using the VIA test. Women who tested positive were further evaluated and those with cervical lesions were treated either by cryotherapy in the screening clinic or referred to a higher center.

Results:

A total of 18,869 women were screened by a single round of VIA testing with a positive rate of 10.75%. Biopsy proven high-grade squamous intraepithelials (HSILs) were 90 (0.48%) and low-grade squamous intraepithelials (LSILs) were 43 (0.28%). The overall prevalence of cervical intraepithelial neoplasia (CIN) 2+ lesion rate is 1.05%. A total of 312 (1.65%) cryotherapies were done and 49 women underwent hysterectomy.

Conclusions:

VIA by trained female health workers is a safe, acceptable, and effective test that can save lives from cervical cancer even in remote areas with few resources. These results have important implications for efficient service delivery in cervical screening programs in low-resourced settings.     

建立“全院共享、流程自动”的人力资源信息系统

信息化是医院人力资源管理发展的一种趋势。本文以某县级医院人力资源管理信息化实践为基础,提出借助商品化软件、内外网结合、全院共享的信息化思路,通过细致筛选软件产品、医院主导软件实施、运行中持续改进等具体做法,实现实施技术向医院的成功转移,捋顺薪酬管理流程,建立全院共享的人力资源信息系统。人事信息系统的建立提高人事信息的利用效率,为医院的管理决策提供有效支撑。本文总结建设思路和做法,为其他县级医院人力资源信息化建设提供借鉴。     

实验动物品系数据库的建立

目的基于国内外部分实验动物数据库和文献,收集整理世界上现有的200多种共计26 000多个品系的实验动物数据,建立关系型检索数据库,使其成为世界上最大最全的实验动物品系数据库。方法构建基于My SQL数据库软件的中小型数据库,建立检索界面、录入界面和数据库接口。结果本文建立了实验动物品系数据库,已经收录小鼠品系数据21 596条;大鼠品系数据2062条;猴品系数据13条;地鼠品系数据2条;犬品系数据5条;兔品系数据5条。以后会逐步完善数据,实现实验动物品系数据库的定期更新。讨论该数据库的建立方便我国科研人员查阅和使用国内外实验动物品系资源,为引进欧美日等发达国家的实验动物品系资源提供链接。     

地方高校图书馆特色资源建设分析*

本文以广西中医药大学图书馆近几年来建设特色资源库情况为例,分析建库内容、建库层次,指出存在的问题及应对对策,提出深化建库内容、深化层次建设是特色资源建设的发展趋势。     

Economic Burden of Opioid-Induced Constipation Among Long-Term Opioid Users with Noncancer Pain

Background

Opioid-induced constipation (OIC) can be a debilitating side effect of opioid therapy and may result in increased medical costs. The published data on the economic burden of OIC among long-term opioid users are limited.

Objective

To assess the economic burden of OIC in patients with noncancer pain in a managed care population in the United States.

Methods

This retrospective study used 2007–2011 data from the Truven Health MarketScan Commercial and Medicare databases. The study included adults with ≥12 months of insurance enrollment before and after starting long-term (≥90 days) use of opioids. Patients were excluded if they had cancer or a diagnosis of drug abuse or drug dependence during the study period, or if they had constipation or bowel obstruction within 90 days before starting opioid therapy during the study period. OIC was identified by International Classification of Diseases, Ninth Edition codes for constipation (564.0) or bowel obstruction (560.x) within 12 months of the initiation of an opioid. Patients with OIC were identified in the nonelderly, elderly (age ≥65 years), and long-term care populations. Differences in costs and healthcare resource utilization were calculated using propensity scoring.

Results

A total of 13,808 nonelderly (age, 48.6 ± 10.4 years; female, 50%) and 2958 elderly patients (age, 78.7 ± 8.1 years; female, 70%) met the study inclusion criteria. Of 401 nonelderly and 194 elderly patients with OIC, 85 patients initiated opioid therapy in a long-term care facility (age, 80.7 ± 11.6 years; female, 77%). After matching by key covariates, patients with OIC had significantly more hospital admissions than patients without OIC (nonelderly, 33% vs 22%, respectively; P <.001; elderly, 51% vs 31%, respectively; P <.001) and longer inpatient stays (nonelderly, 3.0 ± 8.4 days vs 1.0 ± 3.0 days, respectively; P <.001; elderly, 5.2 ± 12.2 days vs 2.1 ± 4.0 days, respectively; P <.001). The group with OIC had significantly higher total healthcare costs than the group without OIC in all 3 study cohorts (nonelderly, $23,631 ± $67,209 vs $12,652 ± $19,717, respectively; elderly, $16,923 ± $38,191 vs $11,117 ± $19,525, respectively; long-term care, $16,000 ± $22,897 vs $14,437 ± $25,690, respectively; all P <.05).

Conclusion

To the best of our knowledge, this is the first study to analyze the economic impact of long-term use of opioids among patients with OIC, using real-world data. The findings underscore the significant economic burden associated with long-term opioid use for noncancer pain in a managed care population. Effective therapies for OIC may reduce the associated economic burden and improve quality of life for long-term opioid users.     

焚烧飞灰处理技术与资源化利用研究进展

焚烧飞灰中含有可溶盐、重金属、痕量有机物及二恶英等物质,对环境和人体健康造成极大的危害。介绍了目前熔融处理、水泥固化、化学药剂稳定化等处理技术的研究进展,总结了飞灰资源化利用途径,提出了未来研究方向的建议。     

基于地理信息系统的卫勤资源管理方案设计

目的:设计一种基于地理信息系统(geographic information system,GIS)的数据管理方案,用于卫勤部门管理下属医疗卫生机构的卫生资源.方法:按照数据服务层、应用服务层、表现层的逻辑功能设计总体方案,利用关系数据库统一管理空间数据和卫勤资源数据的存储、转换和关联.结果:该系统可实现地理空间信息和卫勤专题信息的导入、导出、维护、汇总、查询分析等功能.结论:该系统为提高卫勤保障能力和卫勤管理效率提供了新途径.