A commitment to marginalized children in the European Union: The hope and challenges of the EU Child Guarantee

While children in general are usually seen as a societal priority, many children are disadvantaged by marginalization, with adverse effects on health and development. Following feasibility studies, the European Commission has now adopted a formal Child Guarantee of service access. This paper links the Feasibility Studies to other reports on the need to address marginalized and institutionalized children. The problems in identifying and quantifying such children are outlined, as are the challenges of planning for these groups of children and the difficulty of finding universal definitions and data. This European Union initiative is timely, given that around a quarter of European children are marginalized, while the effects of Covid-19 will add to this marginalization.     

Development and validation of standardized severity rating scale to assess the consistency of drug-drug interaction severity among various drug information resources

BackgroundThe consistency in reporting the severity of drug interactions across the drug information resources is important in guiding the appropriate clinical use of drug-pairs, to minimize the associated adverse events. This necessitates the need of a standardized severity rating scale, that can accommodate the different severity ratings of the same interacting drug-pair into a reasonable severity category, that can ease the consistency assessment among different drug information resources.ObjectiveTo develop and validate a standardized severity rating scale that can ease the consistency assessment among the various drug information resources.MethodsThe definitions of various severity rating categories as documented in the eight drug information resources was consolidated to develop a standardized severity rating scale. Thus developed rating scale was validated using twenty commonly used drug-pairs. Fleiss' kappa score was used as an indicator for assessing overall consistency among various drug information resources, whereas, Cohen's kappa was used as an indicator of level of consistency between two drug information resources and between individual drug information resource and newly developed standardized severity rating scale.ResultsThe newly developed standardized severity rating scale classifies the severity of drug-drug interactions into three categories namely mild, moderate and major. The Fleiss' kappa score was improved from 0.047 to 0.176, indicating improved strength of agreement [Average pairwise agreement: 16% Vs 36.7%] among various drug information resources. The average pairwise Cohen's kappa was 0.082 [Strength of agreement: poor] in original severity ratings whereas it was improved to 0.198 [Strength of agreement: almost equal to fair] in standardized severity rating scale.ConclusionThe newly developed standardized severity rating scale can be used as a tool to assess the consistency of severity rating categories among the various drug information resources.     

日本汉方药企业近十年申请专利的分析及思考——以津村制药和Kracie为例＊

目的 对日本医疗用汉方医药品和一般用汉方医药品市场占有率最大的企业日本津村制药公司和Kracie制药公司2008-2020年间申请的专利内容进行综述，为国内中药经典名方和保健食品研发、知识产权保护提供参考。方法 通过日本专利局的官方检索渠道J-PlatPat平台，检索日本津村制药公司和Kracie制药公司在2008年至2020年间申请的专利，并进行专利布局和技术内容分析。结果 共收集43项日本津村制药公司特许和实用新案专利，其围绕汉方制剂产品全过程质量控制构建了坚实的专利技术体系；共收集52项Kracie制药公司特许和实用新案专利，其致力于功能性制剂和组合物的开发，重点在生活改善、老龄化和癌症等领域进行专利布局，还创建了多种产品功效和功能的客观评价方法。结论 津村制药近十年专利布局提示在中药现代化制造和走向国际的过程中，应把提高品质作为主攻方向，树立持续质量改进理念，完善产品有效性证据链。Kracie制药公司践行的以人为中心的汉方药设计理念，以及精准满足消费者健康需求的研发模式值得借鉴。     

医学信息工程专业导论课程设计与实施

为了提高学生对医学信息工程专业的专业定位、培养目标及专业发展方向等的认知程度。结合教学改革的需要,从教学目标、教学内容、教学策略和方法以及形成性评价等方面探讨了专业导论课的课程设计、实施和课程评价。结果显示,医学信息工程专业导论课受到了学生的高度认可,开设导论课是非常有必要的。     

注射剂说明书中儿童用药信息标注情况与儿童用药风险分析

目的：调查注射剂药品说明书中关于儿童用药安全信息的标注情况，分析儿童用药风险。方法：统计我院141份常用注射剂说明书，分析儿童用药安全信息标注情况。结果：儿童专用药品说明书4份，占2.8%。国产药和外资药儿童临床试验数据和儿童药代动力学的数据标注率分别为4.7%、40.0%和11.3%、34.3%，儿童用法用量标注率分别为51.9%、68.6%，外资药高于国产药；抗感染类药物说明书儿童临床试验项、儿童药代动力学项标注率分别为29.4%、37.3%，明显高于其他类别。限制级抗菌药物的儿童临床试验项、儿童药代动力学项标注率分别为77.8%、77.8%，明显高于其他类别。外资西药和国产西药的儿童临床试验项、儿童药代动力学项标注率分别为40.0%、34.3%和4.9%、11.8%，西药高于中成药。儿童专用药品未出现儿童用药安全信息的标注缺失情况；非儿童专用药品的儿童用法用量项、儿童药代动力学项标注率分别为54.7%和17.5%，非儿童专用药品标注率低于儿童专用药品。部分国产西药与外资西药说明书儿童用药项存在差异。结论：注射剂中儿童专用药品较少，非儿童专用药品中儿童用药安全信息标注不充分，儿童用药存在风险隐患     

沉默信息调节因子过表达或谷氨酰胺剥夺对肾透明细胞癌细胞凋亡、增殖的影响

背景与目的：肾透明细胞癌（clear cell renal cell carcinoma，ccRCC）是最常见的肾癌类型，它与代谢密切相关。探讨沉默信息调节因子4（silent information regulator 4，SIRT4）过表达或谷氨酰胺（glutamine，Gln）剥夺对ccRCC细胞增殖、凋亡的影响。方法：慢病毒构建SIRT4和突变体H161Y过表达的Caki-2细胞株，利用无Gln的培养基来构建Gln剥夺模型，并通过体外增殖活力实验［细胞计数试剂盒-8（cell counting kit-8，CCK-8）］和克隆形成实验来分析两者对Caki-2细胞增殖和生长能力的影响；利用DCFH-DA荧光探针检测细胞内活性氧自由基（reactive oxygen species，ROS）水平进而评估Gln代谢对细胞ROS含量的影响；进一步通过线粒体膜电位检测、凋亡检测和蛋白质印迹法（Western blot）检测凋亡相关分子，分析SIRT4过表达以及Gln剥夺对Caki-2细胞凋亡的影响。结果：过表达SIRT4可抑制Gln代谢从而抑制Caki-2细胞增殖，另外还原性物质还原型烟酰胺腺嘌呤二核苷酸磷酸（reduced nicotinamide adenine dinucleotide phostate，NADPH）的生成减少能够增加细胞内ROS含量，促进细胞凋亡。而Gln剥夺抑制细胞增殖和促进细胞凋亡的效果均比过表达SIRT4明显，但长期缺乏Gln将导致细胞无法生长。结论：无论是过表达SIRT4还是Gln剥夺均能抑制ccRCC细胞增殖，促进凋亡。     

Barriers to vaccination service delivery within general practice: opportunity to make a sustainable difference in Aboriginal child health?

Objective: To identify behavioural barriers of service provision within general practice that may be impacting the vaccination coverage rates of Aboriginal children in Perth, Western Australia (WA). Methods: A purposive developed survey was distributed to 316 general practices across Perth and three key informant interviews were conducted using a mixed‐methods approach. Results: Of the surveyed participants (n=101), 67.4% were unaware of the low vaccination coverage in Aboriginal children; 64.8% had not received cultural sensitivity training in their workplace and 46.8% reported having inadequate time to follow up overdue child vaccinations. Opportunistic vaccination was not routinely performed by 30.8% of participants. Key themes identified in the interviews were awareness, inclusion and cultural safety. Conclusion: Inadequate awareness of the current rates, in association with a lack of cultural safety training, follow‐up and opportunistic practice, may be preventing greater vaccination uptake in Aboriginal children in Perth. Cultural safety is a critical component of the acceptability and accessibility of services; lack of awareness may restrict the development of strategies designed to equitably address low coverage. Implications: The findings of this study provide an opportunity to raise awareness among clinicians in general practice and inform future strategies to equitably deliver targeted vaccination services to Aboriginal children.     

我国城镇脑卒中患者住院卫生服务利用情况及住院费用的影响因素研究

背景　作为全球第二大常见致死病因，脑卒中给患者带来了极大的经济负担和家庭负担。患者的卫生服务利用状况会影响其医疗费用的支出，但目前关于我国城镇脑卒中患者住院卫生服务利用情况的研究较少。目的　了解我国城镇脑卒中患者的住院服务利用情况，并探讨住院费用的影响因素，为降低患者疾病经济负担、加强患者经济保护、控制医疗费用过快增长提供理论支持和现实依据。方法　数据来源于“全国基本医疗保险卫生服务利用调查数据库”（2010-2015年），于2018年10月采用机械抽样法在数据库中抽取城镇缺血性脑卒中患者56 485例，收集其基本情况和住院服务利用情况（住院次数、住院天数、住院费用）。采用单因素分析比较不同基本情况脑卒中患者的住院服务利用差异，采用多元线性回归分析脑卒中患者住院费用的影响因素。结果　我国城镇脑卒中患者的年均住院次数为1（0）次，次均住院天数为11.0（6.0）d，次均住院费用为6 070.06（8 289.87）元。不同性别、年龄、险种类型、卒中类型、医院级别、地区、城市类别的患者，年均住院次数、次均住院天数、次均住院费用比较，差异有统计学意义（P<0.05）。多元线性回归分析结果显示：性别、年龄、险种类型、卒中类型、医院级别、地区、城市类别、次均住院天数是患者住院费用的影响因素，其中男性患者住院费用较女性高1.8%，年龄每增长1岁患者住院费用上升0.07%，职工医疗保险患者住院费用较居民医疗保险患者高20.1%，卒中类型为入脑前动脉未特指的闭塞或狭窄引起的脑梗死（I63.2）、大脑动脉血栓形成引起的脑梗死（I63.3）患者住院费用分别较脑梗死（I63）患者高40.8%、38.8%，二级、三级医院就诊患者住院费用分别较基层医院就诊患者高72.1%、121.1%，东部地区患者住院费用分别较中部、西部地区高23.5%、34.0%（P<0.05）；住院次数也是患者住院费用的影响因素，住院次数每增加1次患者住院费用上升57.7%（P<0.05）。结论　不同特征脑卒中患者的住院卫生服务利用状况存在差异，住院费用与多种因素有关；应通过提高医院诊疗技术、缩短住院天数、加强对患者的健康教育等方式来实现费用控制，降低患者负担。     

Objective and subjective measures of the neighbourhood environment: Associations with frailty levels

ObjectivesThe aim of this study was to investigate whether perceptions of the neighbourhood environment (NE) and objective measures of the NE were associated with frailty in older adults.MethodsA cross-sectional study in Adelaide, Australia, recruited a sample of 115 community-dwelling adults aged ≥60 years. Respondents’ perceptions of their NEs were assessed using the Neighbourhood Environment Walkability Scale (NEWS). An objective assessment of these NEWS survey questions was conducted using seven variables: residential density, land use mix diversity, street connectivity, accessibility, seasonal persistent green cover, road crash density and crime rate. Frailty was evaluated using the FRAIL (fatigue, resistance, ambulation, illnesses and loss of weight) scale. Multivariable linear regression analyses were employed to assess the associations between NEWS and frailty, and to assess the associations between objective neighbourhood variables and frailty.ResultsFrail and pre-frail older adults were more likely to live in areas with lower residential density, lower density of road crashes, and higher accessibility than robust participants. Additionally, a poorer perception of the overall environment, worse land-use mix and accessibility and worse crime safety were associated with frailty and pre-frailty after adjustment of covariates and objective GIS variables.DiscussionNeighbourhood characteristics, both objective and perceived, are associated with frailty levels in older adults, and that strategies to tackle frailty must consider the impact of the neighbourhood environment.