浙江省宁波市手足口病经济负担调查研究

目的 评估宁波市手足口病经济负担。 方法 选取国家疾病监测信息报告管理系统中2011年宁波市报告的手足口病例,进行问卷调查和病历回顾,收集病例就医过程、相关费用和医疗保险等信息,估算手足口病例经济负担。 结果 共调查手足口病轻症病例106例,重症病例58例,死亡病例6例。2011年宁波市手足口病总体经济负担为3635.1万元,其中直接经济负担2181.2万元,间接经济损失1453.9万元。轻症、重症、死亡病例直接费用的中位数分别为1581、7419和21 533元,直接医疗费用的中位数分别为1431、6977和17 224元。参加至少一种医疗保险的病例占32.9%,医疗保险可为轻症、重症病例分别减轻38.2%和29.1%的直接医疗费用。 结论 手足口病给患者和社会均造成了较重的经济负担。提高医疗保险覆盖率、减少轻症病例住院比例将有助于减轻患者经济负担;控制和降低发病率,才能有效减轻手足口病对社会的经济负担。     

A brief intervention to improve food allergy knowledge among US pediatricians: lessons learned

Objective: To evaluate a brief educational tool for pediatricians developed to address known gaps in food allergy knowledge. Study Design: Pre‐ and post‐assessments were administered to a convenience sample of 61 US pediatricians completing the Food Allergy Comprehension Tool between February and March of 2010. McNemar’s and Wilcoxon signed rank tests were used to determine whether clinical knowledge of food allergy and level of comfort in caring for food‐allergic children increased significantly after reviewing the tool. Logistic regression models were used to measure the association of participant characteristics with increased knowledge and comfort. Results: Sixty‐one percent of surveyed physicians answered more knowledge questions correctly after reviewing the tool. Significantly more participants correctly indicated that anaphylaxis poses the greatest threat to teenagers rather than young children, and correctly rejected chronic nasal problems as a symptom of food allergy (p < 0.05). Comfort in caring for food‐allergic children increased significantly on all items post‐intervention (p < 0.05). Odds of increased knowledge and comfort were significantly higher among pediatricians without previous training in food allergy. Conclusion: The Food Allergy Comprehension Tool is a rapid way to address known knowledge gaps among pediatricians and to identify areas in need of further intervention. We recommend integration of the tool with current food allergy guidelines.     

医学物理界科研滞后原因探讨

研究目的在于推动医学物理界科研发展。通过对医学物理界历史和现实的科研状况回顾与分析，揭示影响医学物理界开展科研的主要原因：缺乏科研带头人的传帮带，缺乏科研设备，教师的科研要求太低动力不足，知识面太窄，没有明确的研究方向。强调指出科研能否开展起来，贡献大小关键在于主观能动性的发挥，在端正科研态度的基础上，应遵循“一综述、二对比、三确定”的三个步骤，认真选定有发展前景的研究方向，掌握研究该方向课题的相关理论和技能；最后部分阐明了选题常用的四种方法：（1）顺藤摸瓜找题，（2）到相关社会实践中找题，（3）阅读文献找题，（4）学术交流找题。     

Use of emergency medical identification in the paediatric haemophilia population: a national study

Summary. The use of emergency medical identification (EMI) such as MedicAlert^® has been recommended for use in a variety of medical conditions; however, there is no consensus as to what form should be used and where they should be placed. There are also no uniform guidelines to direct first responders to where they should look for EMI in an emergency. The aim of this study was to identify current paediatric haemophilia nursing practice in educating families about EMI and their perceptions of patient/family adherence to using EMI. US haemophilia nurses listed on the Center for Disease Control’s website received an email invitation to participate in a 30‐item questionnaire posted on SurveyMonkey. Survey responses showed a wide variety of responses concerning recommendations about the form and location of EMI, particularly in the infant population. Nurses also reported that EMI was often not worn on the body and had low overall adherence. In the infant and preschool population, this was due to safety concerns, sizing, cost and parents not seeing the need for EMI. In school age and adolescents, the barrier to wearing EMI included stigma, cost and sizing. Collaboration is needed among nursing and medical staff, first responders, emergency room staff and manufacturers of EMI to develop standardized EMI which address these issues. Standard educational guidelines are needed to teach nurses and patient/families about the forms and location of EMI. Additionally, national guidelines are needed for the identification of paediatric EMI by first responders and emergency room staff.     

Potential health risks to adults and children in the UK from exposure to dietary lead in gamebirds shot with lead ammunition

We estimate potential risks to human health in the UK from dietary exposure to lead from wild gamebirds killed by shooting. The main source of exposure to lead in Europe is now dietary. We used data on lead concentrations in UK gamebirds, from which gunshot had been removed following cooking to simulate human exposure to lead. We used UK food consumption and lead concentration data to evaluate the number of gamebird meals consumed weekly that would be expected, based upon published studies, to result in changes, over and above those resulting from exposure to lead in the base diet, in intelligence quotient (IQ), Systolic Blood Pressure and chronic kidney disease (CKD) considered in a recent opinion of the European Food Safety Authority (EFSA) to be significant at a population level and also in SAT test scores and in rates of spontaneous abortion. We found the consumption of <1 meal of game a week may be associated with a one point reduction in IQ in children and 1.2–6.5 gamebird meals per week may be associated with the other effects. These results should help to inform the development of appropriate responses to the risks from ingesting lead from ammunition in game in the UK and European Union (EU).     

两种HBV DNA定量试剂在慢性乙型肝炎医疗决策点的比较研究

目的比较两种实时荧光定量HBV-DNA检测试剂对慢性乙型肝炎（CHB）患者管理的一致性。方法选取某国产试剂H和Roche公司COBAS AmpliPrep/COBAS TaqMan（CAP/CTM）高灵敏核酸检测系统作为比较对象,分别检测133例CHB患者血清HBV-DNA。选择HBV-DNA〈500 IU/mL、500～2000 IU/mL、〉2000 IU/mL等三个浓度进行两检测系统的一致性监测。结果 （1）两系统检测结果比较,试剂H组HBV-DNA浓度为500～2000 IU/mL时,其结果的Log值为2.84±0.27,相应标本在CAP/CTM组的检测结果为3.48±0.54,两种系统检测结果差异有统计学意义（P=0.000）。试剂H组HBV-DNA浓度为〉2000 IU/mL时,其结果的Log值为4.74±1.06,相应标本在CAP/CTM组的检测结果为5.32±1.01,两种系统检测结果差异有统计学意义（P=0.000）。（2）以CAP/CTM为标准,试剂H在HBV-DNA〈500 IU/mL、500～2000 IU/mL、〉2000 IU/mL时的敏感度分别为100%、81.5%和75.9%;特异度分别为87.5%、95.3%和100%。结论国产试剂H系统和CAP/CTM系统在对CHB患者的抗病毒治疗筛选上以及停药的关键医疗决策浓度监测上有较大差异。     

两种磁共振血管成像序列对脑静脉畸形的比较影像学研究

目的探讨磁共振静脉血氧水平依赖成像（VEN-BOLD）和时间飞跃法血管成像（TOF-MRA）对静脉畸形（CVM）的诊断价值。方法采用1.5T超导磁共振扫描仪对我院收治的13例CVM患者进行TOF-MRA和VEN-BOLD对比成像分析。结果 TOF-MRA原始轴位图像可显示全部13例CVM的引流静脉,并可进行最大密度投影重建（MIP）3D图像观察,但仅6例原始图像可显示稀少的髓静脉;而VEN-BOLD可清晰显示全部13例CVM的引流静脉及更多的髓静脉。结论 TOF-MRA可对CVM的引流静脉进行3D直观显示;而VEN-BOLD可清晰准确地显示CVM的引流静脉及髓静脉,二者结合可作为CVM诊断必要的补充序列。     

基于网络用户搜索行为的医疗器械关键词分析

基于百度指数关键词检索频度分析，选取9个医疗器械相关关键词，分析关键词的大众关注度与媒体关注度，以及关键词检索人群属性，如性别、年龄、职业和地区等的分布情况，并据此提出具有针对性的意见。     

探析制约医学院校思想政治教育队伍素质提高的因素

近年来,医学院校思想政治教育队伍的素质有了很大提高,但仍存在着许多不尽如人意的地方。文章探析了制约医学院校思想政治教育队伍素质提高的因素,提出了相应的对策与建议。     

医学生实习带教体会

实习是这些医学生迈向医师岗位所必需经历的阶段和重要环节。更好地安排、组织好实习带教工作,具有重要的现实意义和需求。本文就长期实习带教的经历,分享体会,以期对医学生实习带教具有帮助。