北京市托幼机构消毒卫生标准方案研究

目的为更好地监督指导和评价托幼机构消毒卫生工作,探讨托幼机构日常消毒方案和消毒卫生指标。方法采用问卷调查和采样监测方法,对北京市托幼机构消毒卫生状况进行了调查,提出制定托幼机构消毒卫生标准建议案。结果北京市托幼机构餐具消毒主要采用煮沸消毒与远红外线加热消毒;室内空气消毒主要采用自然通风、紫外线照射和化学消毒剂等综合处理方法;普通物体表面采用含氯消毒剂作擦拭消毒;保教人员和儿童手大多数用肥皂及流动水清洗。所有检测对象上均未检出致病菌,检测细菌总数以中位数表示,室内空气、物体表面、教师和儿童手的细菌总数中位数依次为907、3和228。结论北京市托幼机构室内空气、物体表面、教师和儿童手细菌总数均呈偏态分布,根据分析结果提出制定托幼机构消毒卫生标准建议。     

合编医疗单位技术建设双向互动模式的构建与实践

作者结合本单位管辖2个医院、4个疗养院的实际情况，以及承担医疗、疗养、特勤保障等特点，提出并实践了“疗治双向互动、疗疗双向互动、资源双向互动”的“双向互动”技术建设新模式，深化了疗治结合内涵，加快了重点学科建设，促进了人才队伍成长，提高了科研工作能力，在研究探索联勤体制下“多军兵种结合、疗医结合、疗疗结合、医医结合”的技术建设方面进行了有益尝试。     

Methodological bases for prognosis in medicine]

Current status of prognosis in clinical, experimental and prophylactic medicine is delineated with formulation of the purposes and feasibility of therapeutic and preventive realization of the disease onset and run prediction. Literature and first-hand experience provided the basis for grounding medical prognosis theory. Basic points in the theory are the following: utilization in the prognosis of only a complex of the most significant clinical signs of the disease, the patient's record, social and household, ecological and occupational aspects of the patient's life; comparison of the latter with leading pathogenetic mechanisms underlying the emergence and progression of the pathology; consideration of the relationships between dysfunction and morphology of the organs and systems; simultaneous analysis of the aggression factors, systemic reactivity and resistance of tissue; scrutiny of predisposition to pathological reactions. An essential aspect of medical prediction is a valid choice of mathematical methods of analysis and processing of the clinical information.     

Hand and wrist injuries: Part I. Nonemergent evaluation

Diagnosis of upper extremity injuries depends on knowledge of basic anatomy and biomechanics of the hand and wrist. The wrist is composed of two rows of carpal bones. Flexor and extensor tendons cross the wrist to allow function of the hand and digits. The ulnar, median, and radial nerves provide innervation of the hand and wrist. A systematic primary and secondary examination of the hand and wrist includes assessment of active and passive range of motion of the wrist and digits, and dynamic stability testing. The most commonly fractured bone of the wrist is the scaphoid, and the most common ligamentous instability involves the scaphoid and lunate.     

上海市高校结核防控体系执行现状与分析

目的 了解本市高校结核病防控工作的执行情况,并分析执行现状,为本市结核病预防与控制的顶层设计提供决策依据。方法 选择2018年4月至8月我院诊治的本市高校大学生结核病患者14例作为研究对象,采用现象学研究方法和半结构式访谈方式进行深入访谈,对获得的访谈资料进行进一步整理分析,并将主题进行提炼。结果 14例患者均完成访谈,共提炼出4个主题,分别是高校师生对结核病认识不足、高校对结核病防控工作重视度不够、高校缺乏结核病防控措施及方案、缺乏医教协同的结核病防控。结论 高校师生对结核病的认识不足以及高校对结核病防控工作的不重视,是导致本市高校结核防控体系执行现状有不足的重要原因,对缺乏结核病防控的措施及方案的高校,应根据其学校特点,医教协同参与,制定相应的结核病防控的措施及方案,并完善本市高校结核病预防与控制体系,从而有效控制高校结核病的发生。     

基于WHO-FICs架构智力残疾儿童青少年身体活动与运动康复的健康结局：系统综述的系统综述

目的 基于世界卫生组织国际分类家族(WHO-FICs)构建智力残疾儿童青少年参与身体活动和运动康复的健康和功能结局的研究架构,系统分析智力残疾儿童青少年的主要健康与功能障碍表现、参与身体活动的方案以及健康和功能结局。 方法 运用《国际疾病分类第十一次修订本》(ICD-11)和《国际功能、残疾和健康分类》(ICF),对智力残疾儿童青少年身体活动干预方案以及健康与功能结局进行系统分析,构建智力残疾儿童青少年健康与功能状况、身体活动干预方案以及健康与功能结局架构。检索Scopus、PubMed、Embase、Web of Science、中国知网、维普、万方数据,收集建库至2022年8月18日公开发表的智力残疾儿童青少年参与身体活动与运动康复的健康及功能结局的系统综述,进行系统综述。 结果 最终纳入系统综述8篇,来自5个国家,包括190项随机对照试验和7 011例参与者,研究领域主要涉及智力障碍、儿童神经病学、康复科学、残疾与健康、适应性体育、特殊教育等,发表时间集中在2018年至2022年。常见的健康状况主要有唐氏综合征、孤独症谱系障碍、脆性X综合征、Prade-Willi综合征、智力障碍、认知障碍;身体活动干预形式分为体适能类、技能类和活动类3类,活动频率每周1~5次,活动强度为中-高强度,持续时间1周~1.5年;健康结局体现在智力功能和适应性行为、身体活动、心理行为健康与社会适应、整体生活质量和福祉方面。 结论 基于WHO-FICs构建了智力残疾儿童青少年参与身体活动和运动康复的健康效果的理论架构。智力残疾儿童青少年主要功能障碍表现为智力功能和适应性行为、活动和心理健康、生活质量和福祉3个层面。其中智力功能和适应性行为层面涉及概念性技能、社交性技能和实践性技能,活动和参与层面表现为低体育活动参与度、久坐和肥胖,活动能力低,没有发展基本运动能力和身体素质。生活质量和福祉层面涉及情绪和情感、自尊、一般自我概念、幸福感、友谊、与他人的关系或社会成熟度、生活质量和福祉等。身体活动方式可以分为体适能类、技能类和运动项目类。主要健康和功能结局主要表现在三个领域：智力功能与适应性行为,活动和参与以及心理行为健康与社会适应、生活质量和福祉。在智力功能和适应性行为领域,主要健康结局涉及认知功能(执行功能、认知可塑性、工作记忆等)、心理功能(情绪自我控制、自我价值和自尊)。在活动和参与领域,主要健康结局涉及体适能(肌力和肌耐力、速度、灵敏性)和动作技能(基本动作技能、平衡、核心稳定性),提高体育活动参与度,促进其更好地适应与赋能(社交、亲社会行为等),达成健康目标(降低疾病风险、缓解焦虑和抑郁、肥胖管理)。在心理行为健康与社会适应、生活质量和福祉领域,参与身体活动与运动康复可以提升儿童青少年整体的生活质量和福祉。     

和谐沟通法在临床护理中的应用

通过对沟通有关的4个基本要素(护士、病人及家属、沟通方法、内容)所构成的6种关系(护士与病人、护士与沟通内容、护士与沟通方法、病人与沟通方法、病人与沟通内容、沟通内容与沟通方法)的运筹和把握,阐明了和谐沟通法的重要性,提出了和谐沟通法是优化护患关系、减少医疗纠纷发生必不可少的重要手段。     

吸毒人群孤独感及相关分析

目的探讨吸毒人群的孤独感水平。方法采用感情与社会孤独量表、幸福感指数量表和自尊量表,对109名吸毒人员和119名正常人员进行调查。结果⑴吸毒人群的情感孤独、社会孤独和孤独指数均显著性高于正常人群;⑵在女性水平、24岁及以下水平、未婚水平、农民水平、城镇水平以及文化因素、父母文化因素和父母婚姻因素的所有水平上,吸毒人群的孤独感显著性高于正常人群;⑶吸毒人群的孤独感与情感指数、生活满意度和幸福指数倾向于零相关,与自尊呈显著性负相关。结论吸毒人群的孤独感显著高于正常人群,降低吸毒人群的孤独感有助于提高心理健康水平。     

关节镜手术室器械与设备的管理与维护

目的探讨关节镜专科手术器械与设备的管理与维护方法。方法制定关节镜手术器械及设备的管理制度,规范关节镜器械的清洗、消毒和保养的流程和相关方法,严格相关人员的培训计划。结果自2003年1月—2008年6月,共完成关节镜手术3235例,无一例因器械与设备故障而影响工作,保证了关节镜专科手术器械和设备的正常运行。结论健全的管理制度,对器械与设备的精心管理与养护,减少了器械与设备的损耗,保证了手术的顺利进行。     

肺栓塞误诊及漏诊26例临床分析

目的 探讨肺栓塞误漏诊常见原因,提高对肺栓塞的认识和诊断,以降低误、漏诊率、病死率.方法 回顾性分析26例诊断明确的肺栓塞的临床资料及误诊情况,就误、漏诊原因加以分析.结果 肺栓塞常见误漏诊原因为临床医生对肺栓塞的不认识或重视不够;肺栓塞起病隐匿,症状多样,缺乏特异性;合并心、肺慢性疾病掩盖了肺栓塞的临床表现.结论 加强对肺栓塞的认识,对疑似肺栓塞症状患者,特别对有肺栓塞高危因素的人群,应尽早行特异性检查,以提高确诊率和早期抢救成功率.     

某市餐饮业餐饮具消毒效果监测

目的了解某市各类餐饮单位餐饮具的消毒状况,为改进餐具消毒质量提供依据。方法以回顾性调查资料的方法对某市各类餐饮单位连续4年餐饮具消毒效果检测数据进行分析。结果学生及职工食堂餐具消毒质量合格率为74.70%,小型餐馆餐具消毒质量合格率为52.89%。每年不同季节中以第1、4季度消毒合格率较高,第2、3季度消毒合格率较低,存在显著差异(P<0.01)。不同规模餐饮单位餐具消毒质量,以星级宾馆合格率最高为99.82%,大中型餐饮单位合格率为82.87%,小型餐馆合格率仅为52.89%。高温蒸汽消毒合格率为97.50%,用化学消毒剂消毒合格率为64.51%。结论某市各餐饮单位餐饮具消毒效果随季节、餐饮单位规模和消毒方法不同而变化,规模档次越低消毒合格率越低,以热力消毒方法消毒效果最好。     

基于ICF-CY儿童青少年身体活动指南的内容分析与比较

目的 比较国内外儿童青少年身体活动指南的政策背景和理论依据、活动方式和活动量、收益以及影响因素,为相关指南的制定和实施提供理论依据和方法指导。 方法 运用《国际功能、残疾和健康分类(儿童和青少年版)》(ICF-CY)的分类架构对世界卫生组织、中国、美国、澳大利亚、加拿大(2套)等颁布的6套儿童青少年身体活动指南进行内容解析和编码。对指南的政策背景、理论依据、循证方法、推荐活动方式、活动量、收益以及影响因素进行内容分析。 结果 6套指南均依据相关国家的健康政策和身体活动与健康的理论;推荐的主要活动方式包括体适能、技能和运动项目三大类,推荐的活动量为每天至少60 min中等强度或高强度活动,每周至少3次高强度或增强骨骼肌肉功能的活动。身体活动有助于发展和改善身体功能,提升活动和参与水平,同时有助于形成良好的生活习惯,建立健康的生活方式,并改善相关环境因素。 结论 ICF-CY的理论架构、术语和编码是儿童青少年身体活动指南内容分析的有效工具。国内外儿童青少年身体活动指南均有其健康发展的政策背景和健康相关的理论依据。儿童青少年的身体活动有体适能、技能和运动项目三大类,且各指南推荐了中、高强度的活动量。身体活动有助于形成良好的运动习惯,形成积极的生活方式。为了促进儿童青少年的身体活动,需要建立适宜的环境,包括：产品和技术;自然环境和对环境的人为改变;支持和相互联系;态度;服务、体制和政策。     

Quality of STIs and HIV/AIDS care as perceived by biomedical and traditional health care providers in Zambia: are there common grounds for collaboration?

OBJECTIVE: To explore biomedical and traditional health care providers' (BHPs and THPs, respectively) perceptions of good quality of care and opinions on weaknesses in the services they provide to patients with STIs and HIV/AIDS. METHODS: Using data from a cross-sectional survey, we post-coded two open-ended questions related to THPs' and BHPs' perceptions on good quality of care and on provided care. The post-coding was done following Donabedian's framework of assessment of quality of care, and allowed transformation of qualitative data into quantitative. The analysis is based on comparison of frequencies, proportions and subsequent chi-square tests and odds ratios. SETTING: Ndola and Kabwe, Zambia Main measures: Proportions of responses from 152 BHPs and 144 THPs. RESULTS: Substantial proportions of providers from both sectors perceived drugs availability (63% of BHPs and 70% of THPs) and welcoming attitude (73% of BHPs and 64% of THPs) as important components of good quality care. BHPs were more likely than THPs to mention proper examination, medical management (provider's technical ability) and explanation of causes and prognosis of the disease as important. More THPs than BHPs cited short waiting time and cost of care. A majority of BHPs (87%) and of THPs (80%) reported deficiencies in their STIs and HIV/AIDS-related services. Both groups regarded training of providers and nutritional support and health education to patients as lacking. None of the THPs alluded to voluntary counselling and testing (VCT) or supportive/home-based care as aspects needing improvement. CONCLUSION: Drugs availability and welcoming attitude were two aspects of quality highly valued by THPs and BHPs. Future collaborative interventions need to respond to aspects of joint concern including training of providers, nutritional support and health education to patients. Further, there is an imperative of expanding and adapting VCT, home-based care and palliative care to THPs for better care of STIs and HIV/AIDS.     

The patient's perceived caring needs as a message of suffering

The patient's perceived caring needs as a message of suffering ¶The aim of the study was to arrive at a deeper understanding of the patient's experience of caring needs, that is, of problems, needs and desires, by investigating and explaining how these will be expressed and shaped in the caring relation and to illuminate its implications for caring. The target population consisted of 38 patients in a medical ward and 37 patients in a surgical ward in a central hospital in Western Finland. The patients were interviewed in the wards and asked about perceived caring needs. By means of a hermeneutical process of interpretation a pattern emerged which was interpreted as pictures of themselves and of the nurses. These types of patients fell into three groups: the satisfied, the complaining and satisfied, and the complaining and dissatisfied patients. The types of nurses were divided into the competent and friendly, the competent and contact-creating and the competent and courageous. The patients' caring needs can be interpreted and understood from the standpoint of their experience of suffering, but also in relation to their experience of pleasure and comfort. The most conspicuous caring needs were experiencing confidence in the competence of the nurses, comfort, guidance, dialogue and closeness, which the patients expressed as problems, needs and desires. The patients' caring needs can contain new possibilities of growth and development. The nurse can relieve patients' suffering by promoting their experience of comfort. If the nurses' view of the limits of reality are extended to comprise the existential/spiritual dimension of human beings as well, new possibilities will emerge of interpreting and understanding patients' caring needs as a message of suffering.     

基于世界卫生组织国际健康分类家族康复指南研究:理论架构和方法体系

目的 基于世界卫生组织国际健康分类家族(WHO-FICs)研究康复指南的理论架构和方法体系。方法 运用国际康复政策文件和分类标准研究康复指南内容,工具包括《联合国残疾人权利公约》、《世界残疾报告》、《社区康复指南》、《健康服务体系中的康复》以及《国际疾病分类》(ICD)-11、《国际功能、残疾和健康分类》(ICF)和《国际健康干预分类》(ICHI) β-2。 结果 本研究系统论述WHO-FICs (ICD-11、ICF和ICHI)的理论架构、分类系统、疾病诊断与功能描述、编码、干预和评定方法,提出了在康复循证研究和康复指南制定中运用国际分类家族的理论与方法。结论 构建康复指南的理论架构和方法体系,涉及康复本体、术语和编码、疾病诊断和功能描述以及干预和功能评定标准方法。     

Cytokine production in patients with chronic viral hepatitis C during treatment with interferon-alpha

Serum content of proinflammatory cytokines (IL-1 beta, IL-6, TNF-alpha) and growth factors (GM-CSF, TGF-1 beta) and expression of CD14 and CD95 antigens on peripheral blood monocytes before and after 12-day therapy with alpha-interferon were studied in 25 patients with chronic viral hepatitis C (VHC). The concentrations of TNF alpha, GM-CSF, and TGF-1 beta were significantly increased (p < 0.05) and coexpression of CD14+ and CD95+ antigens on monocytes was increased by 61% in VHC patients in comparison with the control. After 3 months of therapy with alpha-interferon, the content of TNF alpha, GM-CSF, and TGF-1 beta essentially decreased and that of IL-6 increased; this was paralleled by improvement of clinical and laboratory parameters and decrease of coexpression of CD14+ and CD95+ antigens on blood monocytes. Modulation of the functions of immunocompetent cells and changed production of cytokines are apparently one of the mechanisms of inhibitory effect of alpha-interferon on HCV infection. Study of proinflammatory cytokines and growth factors in the serum and expression of CD14 and CD 95 antigens on monocytes can serve as additional tests for evaluating the efficiency of interferon therapy in patients with VHC.     

Correlative imaging of the spatio-angular dynamics of biological systems with multimodal instant polarization microscope

The spatial and angular organization of biological macromolecules is a key determinant, as well as informative readout, of their function. Correlative imaging of the dynamic spatio-angular architecture of cells and organelles is valuable, but remains challenging with current methods. Correlative imaging of spatio-angular dynamics requires fast polarization-, depth-, and wavelength-diverse measurement of intrinsic optical properties and fluorescent labels. We report a multimodal instant polarization microscope (miPolScope) that combines a broadband polarization-resolved detector, automation, and reconstruction algorithms to enable label-free imaging of phase, retardance, and orientation, multiplexed with fluorescence imaging of concentration, anisotropy, and orientation of molecules at diffraction-limited resolution and high speed. miPolScope enabled multimodal imaging of myofibril architecture and contractile activity of beating cardiomyocytes, cell and organelle architecture of live HEK293T and U2OS cells, and density and anisotropy of white and grey matter of mouse brain tissue across the visible spectrum. We anticipate these developments in joint quantitative imaging of density and anisotropy to enable new studies in tissue pathology, mechanobiology, and imaging-based screens.     

综合性心理干预对外伤性截瘫病人负性情绪的影响

[目的]探讨综合性心理干预对外伤性截瘫病人负性情绪的影响。[方法]将48例外伤性截瘫病人随机分为干预组实验组和对照组,对照组给予常规心理护理,干预组在常规护理基础上进行综合性心理干预,比较干预前后两组病人焦虑、抑郁评分以及出院时生活质量情况。[结果]干预组病人及家属理解并配合,对疾病的认知程度以及配合锻炼明显优于对照组,焦虑和抑郁评分均明显低于对照组。[结论]对外伤性截瘫病人进行综合性心理干预,能够提高病人对治疗康复的积极性,有效改善外伤性截瘫病人的信心和生活质量。     

High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain

Background: Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with consequent difficulty in diagnosis and treatment. Patients with CPP have high levels of anxiety and depression, with a consequent impairment of their quality of life. Aims: The objective of this study was to determine the prevalence of anxiety and depression and their impact on the quality of life of women with CPP. Materials and methods: A cross‐sectional controlled study was conducted on 52 patients with CPP and 54 women without pain. Depression and anxiety were evaluated by the Hospital Anxiety and Depression Scale, and quality of life was evaluated by the World Health Organization Quality of life Whoqol‐bref questionnaire. Data were analysed statistically by the Mann‐Whitney U‐test, the Fisher exact test, chi‐square test and Spearman correlation test. Results: The prevalence of anxiety was 73% and 37% in the CPP and control groups, respectively, and the prevalence of depression was 40% and 30% respectively. Significant differences between groups were observed in the physical, psychological and social domains. Patients with higher anxiety and depression scores present lower quality of life scores. Discussion: The fact that DPC is a syndromic complex, many patients enter a chronic cycle of search for improvement of medical symptoms. The constant presence of pain may be responsible for affective changes in dynamics, family, social and sexual. Initially the person is facing the loss of a healthy body and active, to a state of dependence and limitations. In this study, patients with higher scores of anxiety and depression scores had lower quality of life and patients with lower scores of anxiety and depression had scores of quality of life. These results show that perhaps the depression and anxiety may be related to the negative impact on quality of life of these patients. Conclusion: In view of this association, we emphasise the importance of a specific approach to the treatment of anxiety and depression together with clinical treatment to improve the quality of life of these patients.