广东省民营医院可持续发展的现状、问题及对策

在《广东省民营医院可持续发展力综合评价研究报告》的基础上，对广东省民营医院可持续发展力的现状、问题及对策进行扼要的分析和探讨。     

健康促进可持续发展路径和策略探讨

<正>健康促进(health promotion)是指运用行政的或组织的手段,广泛协调社会各相关部门以及社区、家庭和个人,使其履行各自对健康的主体责任,共同维护和促进健康的一种社会行为和社会可持续发展大智慧、大战略。本文就健康促进与教育可持续发展路径及相关对策作简要阐述。1建立完善4项体系建设为根本保障1.1加强健康促进法律法规体系建设依法治国是我国的基本国策,依法治教是做好健康促进与     

杭州市生活垃圾处理现状与管理对策

介绍了杭州市生活垃圾处理现状,分析了杭州市可持续发展的垃圾处理管理对策。     

郑州市垃圾处理现状与对策

针对郑州市垃圾处理现状，提出了郑州市可持续发展的垃圾处理对策。     

浅议新型农村合作医疗制度可持续发展的对策

文章旨在通过对影响新型农村合作医疗制度可持续发展制约因素的分析，从供给方的政府、结报中心或保险公司、医院以及需求方的农村居民出发，提出了实现新型农村合作医疗制度可持续发展的一系列对策措施。     

南宁市免疫规划现状分析与建设思路

开展南宁市免疫规划现状调研,通过对全市免疫规划工作取得的进展以及存在问题进行剖析,提出解决存在问题的对策和下一步扩大免疫规划建设思路,为免疫规划工作长期可持续发展献策。     

济南市实行“厕所开放联盟”发展现状与对策

介绍了济南市城管局以“厕所开放联盟”的形式呼吁沿街单位对外开放内部厕所,以缓解城市公厕“如厕难”的问题;调查分析了其在协作运行过程中出现的问题,提出了这一可持续发展对策。     

可持续发展与医疗卫生工作的新思维

可持续发展是一种新的经济，社会发展观，从可持续发展的视角研究人类健康问题，可以为我们提供有益的启示。可持续发展拓宽了医疗卫生工作的视野；可持续发展更新了医疗卫生工作的内容：可持续发展开辟了医疗卫生工作的新途径。     

成都市生活垃圾现状与处理对策

分析了成都市生活垃圾现状及存在的问题,提出了成都市可持续发展的生活垃圾处理对策.     

重大危险源控制与管理对策

就近年来我国重大危险源的评价，重大危险源控制技术现状以及应对策略等方面作一系统综述，找出其中的薄弱环节及与发达国家的差距并提出建议与对策，减少由突发事件造成的经济损失，促进城市健康、可持续发展。     

足月新生儿贫血发生时间及影响因素的研究

目的:探讨足月新生儿贫血发生时间及其影响因素。方法:对收治的287例发生贫血的足月新生儿进行回顾性研究,分析足月新生儿贫血发生时间与性别、胎龄、出生体质量、溶血、失血等多种因素的相关性。结果:47%足月新生儿贫血发生在生后1周内,32%发生在生后第2周,13%发生在生后第3周,8%发生在生后第4周。早期贫血足月新生儿中溶血及宫内窘迫、生后窒息发生率较晚期贫血足月新生儿高,差异有统计学意义(P<0.01)。早期贫血足月新生儿的出生体质量较晚期贫血足月新生儿大(P<0.05),初始出现贫血时平均红细胞体积(MCV)较晚期贫血足月新生儿高(P<0.05),但感染发生率却较晚期贫血足月新生儿低(P<0.01)。结论:足月新生儿贫血多发生在生后3周内,且溶血及围产期缺氧与足月新生儿早期贫血密切相关,感染与足月新生儿晚期贫血密切相关。     

Increasing seroprevalence but waning herd immunity against measles after elimination: Longitudinal seroepidemiology of measles in Osaka Prefecture,Japan, 2003–2020

Japan is one of the countries conducting longitudinal serosurveillance of vaccine-preventable diseases. We conducted surveillance of the local measles-specific antibody titer, calculated the effective reproduction number (R_e), and compared data of four terms: term 1, 2003–2006 (before the introduction of the second shot of measles-containing vaccine); term 2, 2007–2010 (early term toward measles elimination); term 3, 2011–2014 (later term toward measles elimination); and term 4, 2015–2020 (after elimination of measles in Japan). Approximately 250 sera from volunteers aged 0 to ≥ 40 years were collected and examined for measles-specific IgG using the gelatin particle agglutination (PA) method annually from 2003 to 2020. Seroprevalence and the geometric mean of the PA antibody titer were examined by term. R_e was calculated using the age-dependent proportion immune and contact matrix for each term. Of the 4,716 sera, 886 in term 1, 1,217 in term 2, 1,069 in term 3, and 1,544 in term 4 were collected. The seroprevalence gradually increased from term 1 (88.3% CI 86.0–90.3) to term 4 (95.7% CI 94.6–96.7), and the seroprevalence of term 1 was significantly lower than those of other terms (Fisher’s exact test, p < 0.001), with PA titer ≥ 16 as positive. By contrast, PA antibody titers significantly decreased from term 1 (median 1,024) to term 4 (median 256) (Mann–Whitney U test, p < 0.001). With the protection level (PA titer ≥ 128 and ≥ 256) as positive, R_e gradually increased from term 1 (1.8 and 2.3) to term 4 (2.5 and 4.8, respectively). Waning levels of measles antibodies potentially increase the measles susceptibility in Osaka, Japan. This trend might imply a limitation of vaccine-induced immunity in the absence of a natural booster for wild strains after measles elimination. This study provides a cue for maintaining continuous measles elimination status in the future.     

Return of premium term life: is it for real?

Physicians who feel they are wasting their money in paying premiums for a typical 30-year-level term life insurance policy may find help in a return-of-premium term life insurance policy. Premiums are higher, but all the money is refunded at the end of the term if the policyholder has not died. Estimates are that 93 percent of policyholders outlive the term of their life insurance.     

Using short‐term response information to facilitate adaptive randomization for survival clinical trials

Increased survival is a common goal of cancer clinical trials. Owing to the long periods of observation and follow‐up to assess patient survival outcome, it is difficult to use outcome‐adaptive randomization in these trials. In practice, often information about a short‐term response is quickly available during or shortly after treatment, and this short‐term response is a good predictor for long‐term survival. For example, complete remission of leukemia can be achieved and measured after a few cycles of treatment. It is a short‐term response that is desirable for prolonging survival. We propose a new design for survival trials when such short‐term response information is available. We use the short‐term information to ‘speed up’ the adaptation of the randomization procedure. We establish a connection between the short‐term response and the long‐term survival through a Bayesian model, first by using prior clinical information, and then by dynamically updating the model according to information accumulated in the ongoing trial. Interim monitoring and final decision making are based upon inference on the primary outcome of survival. The new design uses fewer patients, and can more effectively assign patients to the better treatment arms. We demonstrate these properties through simulation studies. Copyright © 2009 John Wiley & Sons, Ltd.     

Risk factors for preterm and term low birthweight in Ahmedabad, India.

To identify and quantify risk factors for preterm and term low birthweight (LBW) we conducted a hospital-based case-control study, linked with a population survey in Ahmedabad, India. The case-control study of 673 term LBW, 644 preterm LBW cases and 1465 controls showed that low maternal weight, poor obstetric history, lack of antenatal care, clinical anaemia and hypertension were significant independent risk factors for both term and preterm LBW. Short interpregnancy interval was associated with an increased risk of preterm LBW birth while primiparous women had increased risk of term LBW. Muslim women were at a reduced risk of term LBW, but other socioeconomic factors did not remain significant after adjusting for these more proximate factors. Estimates of the prevalence of risk factors from the population survey was used to calculate attributable risk. This analysis suggested that a substantial proportion of term and preterm LBW births may be averted by improving maternal nutritional status, anaemia and antenatal care.     

Some thoughts on the "unattached" fraction of radon decay products.

A problem exists in the meaning and use of the term "unattached fraction" to describe the highly diffusive portion of the airborne radon progeny. The term was originally developed to aid in lung dosimetry but now that more detailed size measurements can be made, there are ambiguities in its definition between a physical size basis and a dosimetric definition. Some possible ways to resolve these ambiguities are presented and discussed. It is suggested that the term only be used in the context of complete size information rather than as the conventional operationally defined term.     

Water disinfection by-products and pre-labor rupture of membranes

The causes of term pre labor rupture of membranes (term PROM) remain poorly defined. The authors conducted a record-based prevalence study to explore a possible relation between disinfection by-products in drinking water and term PROM in an Australian community with spatially variable trihalomethane and nitrate levels. A multilevel statistical model was used to examine the relation between factors operating at the levels of the individual, district, and water distribution zone and the prevalence of PROM at term among 16,229 women in Perth, Western Australia (2002-2004). Adjusted odds ratios for term PROM increased with increasing tertiles of nitrate exposure (moderate exposure: odds ratio = 1.23, 95% confidence interval: 1.03, 1.52; high exposure: odds ratio = 1.47, 95% confidence interval: 1.20, 1.79), but there was no significant relation with exposure to trihalomethanes. This study raises the possibility that water contaminants may promote the development of PROM at term.     

Rural case management: a pilot study

The long term goal of this research is to improve the quality, effectiveness and efficiency of home and community-based services for rural long term care clients. Case management has been espoused as one method to improve services. Long term care case management models have been tested in urban areas with good results, but it is not known to what extent these models are applicable to the special circumstances of rural home and community-based care. The purposes of this pilot study are: 1. To describe case management in long term home health care as practiced in rural Kentucky. 2. To analyze case management for factors that promote or impede effective and efficient delivery of long term home health care for older rural Kentuckians. 3. To propose a model appropriate to case management in long term home health care for older rural Americans.     

早产儿婴儿期神经行为发育随访结果分析

目的:探讨早产儿婴儿期神经行为发育情况,为临床早期干预提供理论依据。方法:2008年4月～2009年3月在烟台毓璜顶医院儿童保健中心接受保健服务的381例早产儿作为研究组,随机抽取同时期在毓璜顶医院儿童保健中心体检的足月儿350例作为对照组,进行前瞻性队列研究。早产儿于纠正胎龄40周、足月儿于出生后2～3天进行NBNA评分;在早产儿纠正年龄/足月儿生后年龄为3、6、9月及1岁时采用首都儿科研究所修订的《0～6岁小儿神经心理发育量表》测查发育商(DQ)。结果:早产儿与足月儿NBNA评分差别有统计学意义(t'=-13.4496,P0.0500)。早产儿组NBNA评分≤35分者22例,与对照组(6例)相比差别有统计学意义(χ2=8.163,P=0.043)。早产儿组在3、6月及1岁时的发育商低于足月儿,早产儿大运动、精细动作、语言落后于足月儿。早产儿组智力低下发生率高于对照组。结论:早产儿的智力发育水平低于足月儿,尤其是大运动、精细动作、语言落后于足月儿。应进行系统的早期干预,促进早产儿潜在能力得到最大程度的发挥。     

Maternal, Care Provider, and Institutional-Level Risk Factors for Early Term Elective Repeat Cesarean Delivery: A Population-Based Cohort Study

To identify maternal, care provider, and institutional-level risk factors for early term (37–38 weeks) elective repeat cesarean delivery in a population-based cohort. Retrospective cohort study of women in the British Columbia (BC) Perinatal Data Registry, BC, Canada, 2008–2011, with an elective repeat cesarean delivery at term. Absolute percent differences (risk differences) in early term delivery rates were calculated according to maternal characteristics, type of care provider, calendar time (day of the week, time of year), and annual institutional obstetrical volume. Of the 7,687 elective repeat cesareans at term in BC, 55 % occurred before 39 + 0 weeks. Early term delivery was significantly more common with multiple previous cesareans [8.2 percentage points (95 % CI 5.5, 10.9) for 2 previous cesareans, 11.3 (95 % CI 5.1, 17.4) for 3 or more previous cesareans], obesity [6.7 percentage points (95 % CI 1.6, 11.7)], and a hospital obstetrical volume <2,500 deliveries per year. Type of care provider and calendar time were not significant risk factors for early term delivery. Early term elective repeat cesarean was common across a wide range of maternal, care provider, and institutional characteristics, suggesting that most obstetrical care settings would benefit from quality-improvement programs to reduce elective repeat cesarean deliveries before 39 weeks. A better understanding of the risks and benefits of early term delivery among obese women and women with multiple previous cesareans is needed given the higher rates of early term delivery observed in these women.