小剂量布地奈德吸入联合扎鲁司特与大剂量布地奈德吸入治疗轻中度支气管哮喘的对比研究

目的比较小剂量布地奈德吸入联合扎鲁司特与大剂量布地奈德吸入治疗轻中度支气管哮喘的疗效。方法40例18~70岁轻中度哮喘患者随机分为扎鲁司特组(20例,布地奈德干粉600μg/d吸入;扎鲁司特20mg口服,每天2次)和对照组(20例,布地奈德干粉1200μg/d吸入),持续治疗6周。于治疗前和治疗6周后进行临床评估和肺功能检查。结果扎鲁司特组与对照组治疗后哮喘发作天数百分数及日间和夜间哮喘症状评分较治疗前显著降低,沙丁胺醇用量较治疗前显著减少,肺功能指标较治疗前显著改善,扎鲁司特组与对照组之间疗效比较,差异无统计学意义。结论小剂量布地奈德吸入联合扎鲁司特与大剂量布地奈德吸入在改善哮喘症状上差异无统计学意义。     

贫困地区农民合作医疗支付能力研究

贫困地区合作医疗筹资的可行性,在很大程度上受到农民对合作医疗的支付能力和意愿支付水平的影响。但目前国内对农民支付能力的研究较少,本文利用扩展线性支出系统来研究农民的客观支付能力。研究结果表明:在农村贫困地区,一般人群的合作医疗筹资应以个人投入为主,而特困和贫困人群的合作医疗筹资应以政府和集体支持为主。     

麝香保心丸治疗冠心病心绞痛的疗效观察

目的观察麝香保心丸治疗冠心病心绞痛的疗效。方法将84例冠心病心绞痛患者随机分成两组,治疗组44例在常规治疗的基础上加用麝香保心丸,对照组40例仅用常规治疗,用药过程中严密观察心绞痛发作次数及心电图变化。结果治疗组治疗后心绞痛发作次数少于对照组,差异有统计学意义(P<0.01),治疗组的心电图好转总有效率高于对照组,差异有统计学意义(P<0.01)。结论心绞痛病人早期使用麝香保心丸,能有效预防和治疗心绞痛,减少心血管事件发生。     

铸造核桩金属烤瓷冠修复的临床研究

目的:对核桩金属烤瓷冠进行临床研究.方法:随机抽取门诊的烤瓷桩冠修复病例,随访观察(2个月～4年)35例,64颗牙.结果:松动3颗,龈炎5颗,无根折.结论:应尽量保存牙体组织,其不足部分用核桩恢复.     

Immunisation - to be or not to be?

This paper seeks to explore some of the issues surrounding the use of immunisation as a public health strategy. As a health visitor I began to question the issue of informed consent which I found may compromise immunisation targets and related financial incentives. The measles and rubella campaign in the Autumn, 1994 is the focus of discussion although the general issues can be generalised to all childhood immunisation programmes. The evidence shows many discrepancies. Vaccination can be seen as the major contributor to the reduction of many potentially harmful diseases. However in developed industrialised countries it can be argued that the diseases should not be avoided and that, in seeking to avoid them, we may cause more damage both short term and long tenn than just leaving alone.     

Public - private 'partnerships' in health - a global call to action

The need for public-private partnerships arose against the backdrop of inadequacies on the part of the public sector to provide public good on their own, in an efficient and effective manner, owing to lack of resources and management issues. These considerations led to the evolution of a range of interface arrangements that brought together organizations with the mandate to offer public good on one hand, and those that could facilitate this goal though the provision of resources, technical expertise or outreach, on the other. The former category includes of governments and intergovernmental agencies and the latter, the non-profit and for-profit private sector. Though such partnerships create a powerful mechanism for addressing difficult problems by leveraging on the strengths of different partners, they also package complex ethical and process-related challenges. The complex transnational nature of some of these partnership arrangements necessitates that they be guided by a set of global principles and norms. Participation of international agencies warrants that they be set within a comprehensive policy and operational framework within the organizational mandate and involvement of countries requires legislative authorization, within the framework of which, procedural and process related guidelines need to be developed. This paper outlines key ethical and procedural issues inherent to different types of public-private arrangements and issues a Global Call to Action.     

上海市闵行区结核病患者隐瞒病情行为调查

目的描述和分析上海市闵行区结核病患者患病后的隐瞒病情行为及其对结核病控制的影响,并提出相应的对策。方法对上海市闵行区186名新诊断的流动人口及本地人口结核病人进行问卷调查;对闵行区疾病预防控制中心、七宝社区卫生服务中心的工作人员进行访谈。结果上海市流动人口结核病人患病后,50%左右的病人会对邻居、同事和朋友隐瞒病情。流动人口怕失去工作,怕房东拒绝其继续租用临时住房。隐瞒病情行为是目前城市防治工作中必须面对的一个问题。结论病人隐瞒病情的行为,给结核病防治工作增加了难度。做好对病人隐私权的保护工作和加强对居民的卫生宣传教育工作非常重要。     

深圳市预防与控制梅毒母婴传播实施策略初探

目的探讨阻断梅毒母婴传播和降低新生儿先天梅毒发病的策略,最大限度地控制和降低先天梅毒的发生.方法设立专项防治经费,启动深圳市预防与控制梅毒母婴传播项目,开展妊娠梅毒免费普查及综合干预工作,及时发现孕产妇人群中的梅毒感染者,阻断或降低梅毒母婴传播及新生儿先天梅毒的发生,并对其进行效果评估及成本效益分析.结果深圳市预防与控制梅毒母婴传播项目实施以来,共检测孕妇186 517例,检出梅毒阳性777例,阳性率4.16‰.对555例孕产妇梅毒患者进行追踪随访,选择继续妊娠330例,终止妊娠181例,失访44例.检测孕产妇梅毒患者所生婴儿126例,快速血浆反应素环状卡片试验(RPR)初筛阳性109例,最终确诊先天梅毒24例.项目的实施成功阻断了87.30%产妇梅毒可能造成的母婴传播.2003年深圳市先天梅毒报告24例,比2002年同期减少39例,下降61.90%.结论实施预防与控制梅毒母婴传播项目适合深圳市情,将为广东省乃至全国探索梅毒防治提供行之有效的策略和经验.     

IT管理——从被动到主动管理

随着医院信息系统规模的扩大,建设高可靠性系统就成了医院信息化中重中之重的任务.本文研究了医院IT系统现在存在的问题,着眼于如何提高IT服务水平、提高系统可用性、降低成本,提出IT主动管理方法,并在北京医院组织了实施.