远红外线治疗仪照射对血液透析患者新建动静脉内瘘成熟的影响

目的探讨远红外线治疗仪照射在血液透析患者新建动静脉内瘘成熟的影响。方法选取我院2016年3月～2018年3月期间治疗的维持性血液透析并培养动静脉内瘘患者60例作为研究对象,根据单双数将其随机分为研究组(单数)与对照组(双数),各30例,所有患者术后3个月均由同一组护士进行穿刺,首次使用内瘘时间均为50 d,使用内瘘2个月为观察期,在此基础上,对照组患者给予健康教育,同时在2周拆线后采用握力器锻炼手臂肌肉功能,研究组患者于术后3 d采用远红外线治疗仪照射内瘘侧手臂。观察两组患者的治疗情况。结果研究组患者术后第1天内瘘成熟度评分比较差异无统计学意义(P0.05),研究组患者术后40 d、术后110 d内瘘成熟度评分高于对照组,差异有统计学意义(P0.05)。研究组患者血肿、渗血及栓塞等并发症发生率低于对照组,且第1针成功率高于对照组,差异有统计学意义(P0.05)。研究组患者疼痛评分低于对照组,内瘘内径评分高于对照组,差异有统计学意义(P0.05)。结论采用远红外线治疗仪照射能促进血液透析患者新建动静脉内瘘的成熟,以增强治疗效果,提高患者生命质量。     

Patient perceptions of ambulatory blood pressure monitoring testing,tolerability, accessibility,and expense

Use of 24‐hour ambulatory blood pressure monitoring is strongly endorsed by contemporary hypertension guidelines. The objective of this study was to assess patient perceptions of ambulatory blood pressure testing, tolerability, accessibility, and expense. A convenience sample of 50, consenting patients undergoing ambulatory blood pressure monitoring at the University of Alberta Hypertension Clinic in Edmonton, Canada was studied. A 16‐item structured questionnaire was administered in person or electronically. Questions regarding the tolerability of ambulatory monitoring were evaluated using a 5‐point Likert scale and wait times, expenditures, and willingness to pay were evaluated by direct questioning. Mean age was 53.1 ± 15.4 years, 32 (64%) were female, and 23 (46%) were employed. Mean 24‐hour ambulatory BP was 134 ± 12/79 ± 8 mmHg. Ambulatory monitoring caused discomfort in 40 (80%) patients and disturbed sleep in 39 (78%). Forty‐one (82%) patients perceived that the home (vs pharmacy, primary care clinic, and speciality care clinic) would be the easiest venue to access future testing. On average, patients waited 27.3 ± 23.7 days for testing; they felt that a wait time of 21.3 ± 12.3 days was appropriate. Mean time taken off work was 8.6 ± 10.8 hours. Twelve (24%) patients indicated that they would be willing to pay out‐of‐pocket to undergo testing sooner, at a mean expenditure of $120 ± 69. Nineteen (62%) patients were willing to buy a monitor and felt that a mean purchase cost of $125 ± 89 was appropriate. These findings extend current knowledge of patient perceptions of ambulatory monitoring and may help to refine and optimize future delivery of this essential test.     

Increased killer cell activity in insulin dependent (Type 1) diabetes mellitus

Summary Antibody dependent cell mediated cytotoxicity in relation to the levels of circulating killer cells was investigated in 16 newly diagnosed classical insulin dependent (Type 1) diabetics, 11 islet cell antibody positive non diabetic children with at least one HLA haplotype in common with their diabetic sibling, and in 15 normal controls. Antibody dependent cell mediated cytotoxicity was evaluated using, as target, ⁵¹Cr labelled human 0⁺ erythrocytes sensitised with an anti-CD antiserum. Killer cells were measured by the low affinity E-rosetting cell technique. Increased killer cell levels (>normal mean + 2SD) were accompanied by a significant enhancement in antibody dependent cell mediated cytotoxicity both in newly diagnosed diabetics (p < 0.05) and in unaffected siblings (p < 0.01). These preliminary results indicate that raised antibody dependent cell mediated cytotoxicity is a feature of insulin dependent diabetes at diagnosis and suggest that active B cell damage might be occurring some time before the onset of clinical symptoms.     

浙江省湖州市2008—2012年职业病报告病例分析

[目的]分析浙江省湖州市近5年职业病发病规律和特征,为制定职业病防治政策提供科学依据。[方法]根据2008年1月1日至2012年12月31日职业病信息网络报告和职业病报告卡数据,以浙江省湖州市确诊的职业病报告病例为分析对象,将数据库的数据逐年导入Excel 2003软件进行汇总统计与分析。[结果]2008至2012年全市共报告职业病5大类10种共计301例,其中尘肺病282例,位居职业病首位。矽肺、煤工尘肺、电焊工尘肺位居尘肺病的前三位,分别为84.0%、10.3%、3.5%;分布在10个行业,其中建材、煤炭行业位居前两位,分别为72.0%和12.8%,其他行业均在5.0%以下。急、慢性中毒的毒物主要为铅及其化合物和苯。其他职业病主要为职业性皮肤病（10例）、噪声聋（3例）和职业性中暑（1例）。[结论]浙江省湖州市2008—2012年职业病报告病例数呈逐年上升趋势,其中尘肺病为主要职业病危害。有关部门应加强监管,特别是对小型私营企业进行监管,以有效预防和控制职业病的发生。     

REGIONAL DISPARITIES IN SELF‐REPORTED HEALTH: EVIDENCE FROM CHINESE OLDER ADULTS

Despite the subjectivity inherent in individuals' interpretation of good health, self‐reported health is widely used in health‐related studies. With data from the pilot survey of the new China Health and Retirement Longitudinal Study, this paper applies the vignette method to control for differences in individual response scales and examines regional differences in self‐reported health among the elderly in China. The results show that people in different provinces seem to use different criteria when assessing their health conditions. Regional health disparities are underestimated if differentials in response scales are not accounted for. A substantial share of the disparities cannot be explained by the observed differences in respondents' chronic health condition, demographic characteristics, and household wealth, a finding confirmed by a test based on inpatient‐care information. Copyright © 2013 John Wiley & Sons, Ltd.     

ARE HEALTH SHOCKS DIFFERENT? EVIDENCE FROM A MULTISHOCK SURVEY IN LAOS

Using primary data from Laos, we compare a broad range of different types of shocks in terms of their incidence, distribution between the poor and the better off, idiosyncrasy, costs, coping responses, and self‐reported impacts on well‐being. Health shocks are more common than most other shocks, more concentrated among the poor, more idiosyncratic, more costly, trigger more coping strategies, and highly likely to lead to a cut in consumption. Household members experiencing a health shock lost, on average, 0.6 point on a five‐point health scale; the wealthier are better able to limit the health impacts of a health shock. Copyright © 2013 The World Bank Group.     

Risk factors for patient‐reported medical errors in eleven countries

Objectives The aim of this study was to identify common risk factors for patient‐reported medical errors across countries. In country‐level analyses, differences in risks associated with error between health care systems were investigated. The joint effects of risks on error‐reporting probability were modelled for hypothetical patients with different health care utilization patterns. Design Data from the Commonwealth Fund’s 2010 lnternational Survey of the General Public’s Views of their Health Care System’s Performance in 11 Countries. Setting Representative population samples of 11 countries were surveyed (total sample = 19 738 adults). Utilization of health care, coordination of care problems and reported errors were assessed. Regression analyses were conducted to identify risk factors for patients’ reports of medical, medication and laboratory errors across countries and in country‐specific models. Results Error was reported by 11.2% of patients but with marked differences between countries (range: 5.4–17.0%). Poor coordination of care was reported by 27.3%. The risk of patient‐reported error was determined mainly by health care utilization: Emergency care (OR = 1.7, P < 0.001), hospitalization (OR = 1.6, P < 0.001) and the number of providers involved (OR three doctors = 2.0, P < 0.001) are important predictors. Poor care coordination is the single most important risk factor for reporting error (OR = 3.9, P < 0.001). Country‐specific models yielded common and country‐specific predictors for self‐reported error. For high utilizers of care, the probability that errors are reported rises up to P = 0.68. Conclusions Safety remains a global challenge affecting many patients throughout the world. Large variability exists in the frequency of patient‐reported error across countries. To learn from others’ errors is not only essential within countries but may also prove a promising strategy internationally.