朱启勇辨治复发性口疮思路

本文主要总结朱启勇教授诊治复发性口疮的思路与经验,认为复发性口疮与脏腑的虚、实、寒、热密切相关,并将复发性口疮分为胃热证、肺阴虚证、脾虚证3种证型,分别给予清降胃热、养阴清热、健脾益气治疗。     

家庭医生政策执行方式的行为逻辑

本文采用扎根理论,利用2017—2018年上海3家社区卫生服务中心的访谈材料,从执行者行为的微观角度归纳并构建家庭医生如何选择政策执行方式的理论解释。研究归纳了家庭医生相关政策的执行中存在的三类政策执行方式:忠实执行、积极变通和消极变通。这三类政策执行方式因政策与情境契合度(简称契合度)的不同而区分。其中契合度较高时,容易发生忠实执行,即完全忠实于政策设计的执行方式;当政策与情境有不契合时,执行成本升高,出于职责观念和行政压力,执行者首先使用积极变通来降低执行成本,用自由裁量权在操作中对政策作修补和本土化,从而实现政策初衷;消极变通因任务契合度过低且具有强制性而产生,消极变通中出现了目标替代,仅表面应付上级考核指标,降低了执行成本、维护了岗位利益。结论:政策执行方式的行为逻辑可以通过契合度、职责观念、执行成本三个因素得到解释。本文整体、平衡地关注了消极与积极的政策变通,弥补以往研究只关注消极变通的不足;建议应完善决策制度保证基层执行者的决策参与,从而提升决策质量。     

Family nurture intervention alters relationships between preterm infant EEG delta brush characteristics and term age EEG power

ObjectiveFamily Nurture Intervention (FNI) facilitates mother/infant emotional connection, improves neurodevelopmental outcomes and increases electroencephalogram (EEG) power at term age. Here we explored whether delta brushes (DB), early EEG bursts that shape brain development, are altered by FNI and mediate later effects of FNI on EEG.MethodsWe assessed DB characteristics in EEG data from a randomized controlled trial comparing infants with standard care (SC, n = 31) versus SC + FNI (n = 33) at ~35 and ~40 weeks GA.ResultsCompared to SC infants, FNI infant DB amplitude increased more from ~35 to ~40 weeks, and FNI infants had longer duration DBs. DB parameters (rate, amplitude, brush frequency) at ~35 weeks were correlated with power at ~40 weeks, but only in SC infants. FNI effects on DB parameters do not mediate FNI effects on EEG power or coherence at term.ConclusionsDBs are related to subsequent brain activity and FNI alters DB parameters. However, FNI’s effects on electrocortical activity at term age are not dependent on its earlier effects on DBs.SignificanceWhile early DBs can have important effects on later brain activity in preterm infants, facilitating emotional connection with FNI may allow brain maturation to be less dependent on early bursts.     

Subregistro de los suicidios en el Boletín Estadístico de Defunción Judicial en Málaga

The objective of this study is to confirm from Deaths with Judicial Intervention (DIJ), whether cause of death was suicide, through family information and to establish the percentage of those identified as such in the Statistical Death Bulletin of Judicial Court (BEDJ). For this purpose, the DIJ were selected from the database of the Cementary Park of Málaga in 2017. Information was collected from the family of the deceased, through the Cementary's Psychological Cabinet to confirm or rule out suicide and the BEDJ was subsequently consulted to confirm whether these cases were identified as such. Relatives confirmed 65 suicides, of which only 27% are identified as such in the relevant section of the BEDJ, a document that serves as a source of information for official suicide statistics. From this study we concluded that the family can offer complementary information that would help improve suicide statistics.     

广东省家庭医生式服务试点地区居民健康行为及影响因素分析

目的了解广东省家庭医生式服务试点地区居民健康行为及影响因素,为开展健康教育提供依据。方法2015年7—10月抽样选取1010名家庭医生式服务试点地区居民进行问卷调查,以吸烟、饮酒、早餐、吃水果、锻炼及睡眠等6项行为为调查内容,同时选用P-CAT量表测量基层医疗服务质量。结果 6项行为方式共赋值12分,被调查者平均得分(8.72?0.65)分,得分从高到低依次为吃早餐、限酒、不吸烟、体育锻炼、吃水果和睡眠。多重线性回归分析结果显示:女性、已婚或慢性病患者的健康行为优于各对应组;收入对健康行为有正面影响;基层医疗服务可及性、服务提供综合性对健康行为有正向影响。结论试点地区居民整体健康行为较好。健康教育和健康促进应聚焦于合理膳食、锻炼及睡眠等健康行为;男性、单身或离异及低收入群体是重点关注的对象;提高基层医疗服务可及性和服务提供综合性有利于促进居民的健康行为。     

3种现代医院图书馆服务平台功能比较

探讨目前流行的3种网络信息交流工具——博客、微博和微信,比较分析其在医院图书馆发展中的作用及其特征。指出医院图书馆应根据自身需要应用这些交流工具开展相应服务,为用户搭建互动交流平台,促进服务质量的提高。     

Migrant Workers in Agriculture: A View from Thailand

There has been a dramatic increase in the global movement of workers during the last few decades. As Thailand has developed rapidly over the past 20 years, it has attracted laborers (both authorized and unauthorized) from the neighboring countries of Myanmar, People’s Democratic Republic of Lao (Lao PDR), and Cambodia. Given that agriculture has been Thailand’s most important industry, its continued growth has been dependent on migrant workers. Both crop agriculture and animal-production agriculture have employed migrant labor. Migrants have been hired to plant, weed, fertilize, spray pesticides, and harvest crops such as rice, corn, sugar cane, and cassava. They have worked at rubber and coffee plantations, as well as in the production of ornamental crops. Also, migrants have labored on pig, beef, and duck farms. There have been numerous documented health problems among migrant workers, including acute diarrhea, malaria, and fever of unknown causes. Occupational illness and injury have been a significant concern, and there has been limited health and safety training. This article reviewed the demographic changes in Thailand, studied the agricultural crops and animal production that are dependent on migrant labor, discussed the health status and safety challenges pertaining to migrant workers in agriculture, and described several recommendations. Among the recommendations, the conclusions of this study have suggested that addressing the cost for health care and solutions to health care access for migrant labor are needed.     

Comparison of Families with and without a Suicide Prevention Plan Following a Suicidal Attempt by a Family Member

The frequency and extent of the existence of a familial suicide prevention plan may differ across cultures. The aim of this work was, therefore, to determine how common it was for families to develop a suicide prevention plan and to compare the main measures used by families with and without such a plan, after an attempt to commit suicide was made by a member of a family living in a rural area of Korea. On the basis of the presence or absence of a familial suicide prevention plan, we compared 50 recruited families that were divided into 2 groups, with Group A (31 families) employing a familial suicide prevention plan after a suicide attempt by a family member, and Group B (19 families) not doing so. The strategy that was employed most frequently to prevent a reoccurrence among both populations was promoting communication among family members, followed by seeking psychological counseling and/or psychiatric treatment. Contrary to our expectation, the economic burden from medical treatment after a suicide attempt did not influence the establishment of a familial suicide prevention plan. It is a pressing social issue that 38% (19 of 50) of families in this study did not employ a familial suicide prevention plan, even after a family member had attempted suicide. Regional suicide prevention centers and/or health authorities should pay particular attention to these patients and their families.