卫生法学专业法律诊所教学体系的构建

起源于美国的法律诊所教育以对学生进行法学实践技能教育为目的,在全面培养学生理论联系实际的能力和锻炼各项实用的职业技能方面具有积极作用。我国目前的卫生法学专业在培养学生的实务能力方面存在不足,法律诊所教育对此有较好的弥补作用。因此,本文借鉴美国高校在开展法律诊所教育中积累的专业划分细致、开展校外诊所、注重先期培训、评价机制独特等实践经验,从法律诊所的定位、校内校外双培制、师资队伍的建设、评价机制的确定等方面探讨构建一套科学合理的卫生法学专业法律诊所教学体系。     

助产士产前门诊对初产妇情绪及满意度的影响

目的探讨助产土产前门诊对初产妇焦虑抑郁情绪和初产妇对门诊助产士提供护理服务态度和方式的满意度的影响。方法应用随机数字表法将2011年12月～2012年12月在本院产科建卡并定期产检的106例正常初产妇分为对照组和观察组，对照组给予常规产前门诊，观察组在对照组基础上给予助产士产前门诊，观察并比较两组初产妇焦虑、抑郁情绪和初产妇对门诊助产士提供护理的服务态度和方式的满意度。结果观察组焦虑、抑郁标准分均明显低于对照组，且观察组初产妇对门诊助产士提供护理的服务态度和方式的满意度明显高于对照组，差异均有统计学意义（P〈0．05）。结论助产土产前门诊能够有效减少初产妇的焦虑及抑郁程度，提高初产妇对门诊助产士提供护理服务态度和方式的满意度。     

改良早期预警评分在心脏科门诊预检分诊中的应用

目的评估改良早期预警评分系统（MEWS评分）在心脏科门诊识别危重患者的应用效果。方法将2012年10～12月来我院就诊的心内科门诊19971例患者进行MEWS评分，据此安排就诊先后顺序，并根据病情危重程度实施必要的处置，将MEWS评分与病情转归进行比较和分析。结果MEWSO～4分患者18634例随诊，5～8分患者1063例，与专科病房及CCU／ICU做好无缝隙连接；≥9分患者274例，死亡危险性明显增加，立即进行紧急医疗干预，实施特别护理。结论简便的MEWS将心脏科患者病情分值化，使医护人员对就诊患者分诊依据更充分，具有识别潜在危重病的作用。     

我国全科诊所发展影响因素的鱼骨图分析

通过文献检索,运用鱼骨图法对当前影响我国全科诊所发展的因素归纳为4个方面:政策因素、组织因素、供方因素和需方因素。对照国外全科诊所发展经验,结合我国全科诊所发展的实际情况,对4个方面的影响因素进行分析和总结,为促进全科诊所发展提供参考。     

Results of offering oral rapid HIV screening within a dental school clinic

To broaden the availability of human immunodeficiency virus (HIV) testing, we offered rapid HIV screening tests to 811 patients attending a dental school for routine dental hygiene care. Study design is a prospective cross‐sectional study. The 319 (39.3%) agreeing to test, self‐identified as: Hispanic (34.4%), White (25.8%), African American (13.1%), Asian (8.3%), Native American/Pacific Islander (0.9%), more than one race/ethnicity (1.1%) or declining to state (16.5%). Over 35% (n = 113) were first time HIV test takers, with another 2.2% (n = 7) unaware of their testing history. Approximately 60% of the decliners choose “just don't want test today” as the reason. Following a strictly structured algorithm, four possible undiagnosed infections were initially identified, with one completing the algorithm to case confirmation. In conclusion, the confirmed incidence rate finding of HIV seropositivity of 0.31% found through initial screening at the dental clinic, compared with the 0.018% incidence rate of HIV with confirmed diagnosis in Los Angeles County, indicates that a rapid HIV screening test offered in a dental school clinic can potentially play an important role in discovering undiagnosed HIV individuals.     

Assessing Retention in a Free Diabetes Clinic

The PATH Clinic in Birmingham, Alabama, is a free clinic for uninsured patients with uncontrolled diabetes. In its first 22 months, more than 25% of patients were lost to follow-up. This report shares reasons for patients becoming lost to follow-up. Investigators used patient records for quantitative analyses and phone interviews for qualitative analysis. Sociodemographic factors were not associated with patients’ likelihood of becoming lost to follow-up. Qualitative results show that these patients had uncertainty regarding appointment dates, complicated life circumstances, and transportation barriers. Results indicate that social interventions may improve patient compliance and retention and should be tested.     

Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan,China

Setting: Thirteen methadone maintenance treatment (MMT) clinics across Yunnan, the province with the highest human immunodeficiency virus (HIV) burden in China.Objectives: To determine, among HIV-negative participants on MMT, the proportion lost to follow-up (defined as those who missed the 6-monthly follow-up examination), factors associated with loss to follow-up (LFU), HIV seroconversion rate and factors associated with seroconversion.Design: Prospective cohort study from October 2008 to April 2011. All participants were administered a pre-tested structured questionnaire to capture associated factors and offered HIV testing every 6 months. χ² test and log-binomial regression were used for data analysis.Results: Of 1146 participants, 541 (47%) were lost to follow-up in 2.5 years. Factors associated with higher LFU proportion include <6 months of previous MMT, inconvenient location of the MMT clinic and average methadone dose ⩽60 mg/day, with adjusted relative risks (RRs) of respectively 1.4 (95%CI 1.2–1.5), 1.2 (95%CI 1.0–1.4) and 1.1 (95%CI 1.0–1.3). The overall HIV seroconversion rate was 6.6 (95%CI 3.7–11.0) per 1000 person-years. Not living with a partner contributed to higher HIV rates, with an adjusted RR of 3.6 (95%CI 1.0–12.8).Conclusion: The retention rate of MMT participants in Yunnan was not satisfactory. Decentralising service delivery in the community and making directly observed treatment more convenient has the potential to improve retention.     

2~6岁儿童牙科诊室行为影响因素研究

目的探寻2~6岁儿童牙科诊室行为的影响因素,建立简便易行的低龄儿童牙科诊室行为预测模型。方法对96例接受牙科治疗的2~6岁儿童的牙科诊室行为评估分为配合组与不配合组;问卷调查获取家长口腔健康意识、母亲牙科焦虑、儿童日常行为特点及情绪类型等资料;使用SPSS11.5软件分析组间各因素差异及与牙科诊室行为的相关程度。结果两组患儿年龄(4.35±0.83 vs 3.85±1.07)和情绪应激性(17.77±4.88 vs 23.23±4.76)之间差异有统计学意义(P0.05);治疗持续时间、幼儿园入园表现、家长对儿童口腔疾患的责任承担度与儿童口腔诊室行为均存在显著相关性(P0.05)。结论通过治疗前与家长的针对性沟通可有效预测低龄儿童牙科诊室行为。