两种杀灭鼠体蚤方法的效果及其评价

为有效控制黄胸鼠体表印鼠蚤的数量,作者于1997年10月13日至11月9日,在龙陵县腊勐乡以沿鼠通道和鼠洞撒灌5/万溴氰菊酯粉剂和用8/万的溴氰菊酯水剂普通滞留喷洒,做了现场设对照区的试验。结果表明:前一种方法的灭鼠率高为95.35％,所用经费为后者的1/5,后者灭蚤率为82.18％。前一种方法比后者经济有效,建议推广应用。     

运用DEA模型分析武进区县域医共体模式下公立医疗机构运行效率△

目的:基于DEA-BCC模型,评价常州市武进区公立医疗机构运行效率,为县区级医院医共体优化资源配置提供参考。方法:选取该区18家公立医疗机构2018-2020年的全国卫生健康财务年报数据,从中筛选出投入产出指标,采用DEA数据分析方法,评价其运行效率。结果:18家公立医疗机构综合运行效率均有所提升,不同层级的医疗机构、乡镇卫生院存在差异,乡镇卫生院的综合运行效率偏低。三年间,乡镇卫生院的总体综合效率值均小于1,DEA均为无效;2018-2020年乡镇卫生院的规模报酬均为不同程度的递减状态;仍有部分医院存在资源利用不充分或过剩等问题。结论:政府应将医疗卫生资源改革的重点放在建立多专业的质控中心,不断提升基层医疗机构服务能力;合理控制各级医疗机构发展规模,促进基层医疗卫生资源的有效整合;明确医共体单位功能定位,实现错位发展。     

Spatial Modeling and Analysis of Heat-Related Morbidity in Maricopa County,Arizona

The objective of the present study was to examine the effects of a confluence of demographic, socioeconomic, housing, and environmental factors that systematically contribute to heat-related morbidity in Maricopa County, Arizona, from theoretical, empirical, and spatial perspectives. The present study utilized ordinary least squares (OLS) regression and multiscale geographically weighted regression (MGWR) to analyze health data, U.S. census data, and remotely sensed data. The results suggested that the MGWR model showed a significant improvement in goodness of fit over the OLS regression model, which implies that spatial heterogeneity is an essential factor that influences the relationship between these factors. Populations of people aged 65+, Hispanic people, disabled people, people who do not own vehicles, and housing occupancy rate have much stronger local effects than other variables. These findings can be used to inform and educate local residents, communities, stakeholders, city managers, and urban planners in their ongoing and extensive efforts to mitigate the negative impacts of extreme heat on human health in Maricopa County.     

全面质量管理在县域医共体中的应用探索:以庐江县人民医院医疗集团为例

目的研究全面质量管理在县域医共体中的应用效果。方法建立健全覆盖全员、全方位、全过程的医疗质量与安全管理共同体,实行集团内人、财、物共享,实施以质量控制为核心的持续改进,对比实施前后基层医疗服务能力、管理水平及患者满意度。结果改革后医共体内基本形成有序的就医格局,医疗卫生服务能力持续提升,医院的业务量、门诊服务人次、住院服务人次、手术总服务台次、收支结余实现了“四增长一下降”,提高了医疗质量同质化水平,患者满意度高于改革前。     

永靖县农村育龄妇女妊娠结局调查分析

目的:通过对永靖县育龄妇女妊娠结局的调查,了解农村妇女的生殖健康现状及其影响因素,为进一步搞好计划生育工作和妇女保健工作提供科学依据。方法:整群抽取甘肃省永靖县6个乡(镇)、6个村的育龄妇女作为调查对象,于2004年7月采用统一制定的调查问卷对其进行入户调查,同时组织育龄妇女到县(乡)计划生育服务站(所)进行妇科检查。结果:1 268名育龄妇女,总妊娠次数3 034次,人均妊娠2.39次。妊娠结局中死胎死产91次,占3.00%;自然流产198次,占6.53%;人工流产241次,占7.94%;活产2 504次,占82.53%。死胎死产率3.51%,自然流产率7.09%。死胎死产发生率和自然流产发生率随妊娠次数增加而增加;文化程度较低或者收入较低者发生率较高。结论:甘肃省农村地区育龄妇女妊娠结局中死胎死产率、自然流产率与全国或者国内其他地区调查结果相比,发生率比较高,其相关影响因素有不同之处。应进一步加强对农村育龄妇女生殖健康知识的普及教育,提高育龄妇女产前保健水平和入院分娩率,降低不良妊娠结局发生率。     

Caries decline before fluoride toothpaste was available: earlier and greater decline in the rural north than in southwestern Norway

The purpose of this study was to evaluate factors related to caries in 6–17-year-olds in 2 groups of Norwegian counties between 1966 and 1983. The average number of surfaces filled and permanent teeth extracted due to caries declined in the 4 northern counties from 1967. An increase was recorded in the 7 southwestern counties until 1971, then a decline. In the 1960s significantly more surfaces were filled and teeth extracted in the north compared to the southwest. Based on intra-county comparisons, the decline in surfaces treated was greater in the north between 1967 and 1983; 5.4 ± 0.4 vs 3.7 ± 0.7, P < 0.01. The averages were 1.9 surfaces treated in the north and the southwest in 1983. Higher infant mortality, lower percentage of people with completed senior secondary education, and more inhabitants per doctor and per dentist in the north indicate a less favorable situation than in the southwest. School-based fluoride programs had been implemented in both groups from the mid-1960s and around 60% participated when fluoride toothpaste became freely marketed in 1971. More fluoride programs and more fluoride tablets were available to children in the north; this may indicate a preventive attitude among dentists. The decline of caries started at different times in different parts of Norway. In the rural north with the most unfavorable situation, the decline was greater and started years before fluoride toothpaste came on to the market. The early decline may partly be ascribed to the school-based fluoride programs, the continued decline to several factors.     

A benchmark dose study of prenatal exposure to di(2-ethylhexyl) phthalate and behavioral problems in children

IntroductionPrenatal exposure to di(2-ethylhexyl) phthalate (DEHP) has been reported to be associated with adverse effects on neurodevelopment that yield behavior syndromes in young children with an estimated median exposure lower than the currently recommended tolerable daily intake (TDI) and reference dose (RfD).ObjectivesOur aim was to derive the benchmark dose for prenatal exposure to DEHP for the neurodevelopmental health in children.MethodsA total of 122 mother-child pairs from the Taiwan Maternal and Infant Cohort Study were analyzed for the dose-response relationship between maternal exposure to DEHP and children's behavioral syndromes evaluated at 8 years (n = 122, 2009), 11 years (n = 96, 2012), and 14 years (n = 78, 2015) of age. We employed a multivariate regression model to assess the statistical associations between the estimated maternal average daily intake of DEHP and child's individual CBCL scores for boys and girls at each separate age, followed by a mixed model for all the children across three ages accounting for individual variations. We then employed structural equation models by combining the children's specific behavioral problem scores at different ages and obtained a simulated overall latent score in relation to maternal exposure. Based on the established dose-response relationship, we derived the benchmark dose (BMD) and the lower limit (BMDL).ResultsAssociations of maternal DEHP exposure (median 4.54$\mu g/kg\_bw/day$) with the Child Behavior Checklist (CBCL) scores were all significant, except for somatic complaints, adjusting for child's age, gender, IQ, and family income. The BMDL, given a benchmark response of 0.10 (0.05) and a background response of 0.05, was 6.01 (2.16) $\mu g/kg\_bw/day$for an integrated CBCL score.ConclusionsThe current TDI (RfD) of 50 (20) $\mu g/kg\_bw/day$ for DEHP might not protect pregnant women for their children from behavioral problems. There remains the lack of comparable toxicological data. Further investigations are needed.     

基于清晰集定性比较分析的地方政府县域医共体创新实践影响因素及其组合路径分析

背景地方政府创新的影响因素分析一直是地方治理创新研究的重要议题。目的探究影响地方政府县域医共体创新实践的因素，并分析其组合路径。方法于2021年3月，以中国医院协会医共体分会举办的第二届"寻找县域医共体实践价值案例"评选活动的初选结果为案例源，将"政策创新类型"作为结果变量（中央主导型创新/地方回应型创新=0，地方自发型创新=1），以经济发展水平、行政层级、地理区位、问题属性及平台作为条件变量，采用清晰集定性比较分析（csQCA）法，通过必要条件分析、充分条件组合分析，探究影响地方政府县域医共体创新实践的因素并构建地方政府县域医共体创新实践的影响路径模型。结果5个条件变量一致性均<0.9，即经济发展水平、行政层级、地理区位、问题属性及平台均不是地方自发型创新的必要条件。条件变量组合分析（基于中间解）结果显示，共得到5组前因条件组合，分别为：经济发展水平*~地理区位*平台，行政层级*~地理区位*平台，经济发展水平*问题属性*平台，~经济发展水平*地理区位*~问题属性*平台，经济发展水平*行政层级*地理区位*问题属性（*表示"且"，~表示"非"）。5组前因条件组合一致性指标均为1，原始覆盖率为0.14~0.43，净覆盖率为0.14~0.43，总体覆盖率为1。地方政府县域医共体创新实践主要呈现出两类模式，即平台型创新模式和动机型创新模式。结论若要实现高水平的医共体创新实践，应该关注政策与当地经济发展水平之间的强相关性，激活地方政府的主动创新意愿，以及加强对县域医共体的平台支持。本研究对于理解地方政府县域医共体创新实践的机理乃至地方政府创新都具有一定价值。     

Spurious scintiphotographic recurrence of pulmonary emboli

Pulmonary perfusion scintiphotographs in patients with acute, extensive pulmonary embolism have disclosed instances in which Scintiphotographic changes thought to indicate embolic recurrence were not substantiated by clinical-angiographic observations. These spurious Scintiphotographic recurrences reflected changes in the regional distribution of pulmonary vascular resistance secondary to different rates of embolic resolution or distal migration of emboli. To document the influence of changes in vascular resistance upon perfusion scintiphotographs, studies were performed in animals subjected to various sequences of pulmonary arterial obstruction by balloon catheters. Scintiphotographic changes mimicking, but not representing, recurrence of embolism were produced. Observations in both animals and man indicate that the diagnosis of embolic recurrence based on Scintiphotographic changes alone should be made with caution, particularly in patients with multiple emboli and pulmonary hypertension.