临床治疗的疗效与危险性关系评价的数学方程

目的:在生物和化学药物治疗效果提高的同时,对人体的毒性也有可能同时增大。本研究提出了更好的监测和反馈新方法。方法:本文提出用数学手段来评价和检测治疗中的疗效与危险性的关系包括4个数学方程和医学环境。结果:四个方程来源于三类数学体系(统计,量效关系和极值),它们能有效的帮助我们评价药物等的临床作用和毒性情况。结论:本文阐述的方程中各参数的范围和特点是未来临床上可行的途径和研究方向。     

Screening in health fairs. A critical review of benefits, risks, and costs

Health fairs provide multiphasic screening to more than 2 million Americans each year, and the number is growing rapidly. Nearly 40 different tests are in use, commonly including the measurement of up to 30 different blood chemistry levels. This report reviews the activities in a sample of 940 health fair sites and examines the experience regarding six specific screening procedures (blood pressure, anemia, blood chemistries, glaucoma, hearing, and fecal occult blood testing). Widespread use of these and other tests raises complex issues of cost, risk, and benefit. Rates of false alarm of healthy people and false reassurance of those at risk may be high for some tests, and the benefits of detecting new disease are easily overestimated. Detailed data collection and evaluation could help health fair sponsors to identify more rational screening strategies.     

HRT: a reappraisal of the risks and benefits

In 2002, when results of the Women's Health Initiative (WHI) randomised controlled trial of hormone replacement therapy (HRT) showed an increased occurrence of breast cancer and thromboembolism, up to two-thirds of women taking HRT stopped the therapy, often without medical consultation. Recent analyses of the WHI data and other randomised controlled trials suggest that, although there are potential side effects and risks involved in taking HRT, these may be reduced by: using lower HRT doses; minimising or eliminating systemic progestogens; using non-oral routes in some women; and initiating HRT in symptomatic women near menopause. When HRT is initiated near menopause for symptom control, there may be additional benefits (reduced fracture and cardiovascular risk) that outweigh the risks (which are not significantly raised in women under age 60 years). Older women with continuing symptoms should not be denied HRT if their therapy and risks are assessed on an individual basis and each patient is aware of the risks.     

胃内水球的理性认识与合理选择

肥胖是一种全球性的慢性疾病,严重影响着肥胖个体的身心健康,给家庭和社会带来沉重的负担。减重手段从传统内科→内镜→外科手术呈梯次发展,不同人群根据自身需求可以选择不同的减重方式。胃内水球（IGB）是一种内镜下无创的减肥方法,通过在胃内放置占位性球囊,实现优于药物治疗的减重效果。本文简述了IGB的发展史,综述其减重效果及机制,探讨了适用人群,强调了IGB联合高强度的术后管理对维持长期减重的重要性以及未来发展趋势,旨在引导患者理性认识：IGB较高的安全性、减重效果的有限性和对术后管理的依赖性。患者可以根据身体状况、经济条件、心理状态及生活工作性质结合IGB的适应证进行合理选择。在IGB放置后结合高强度的术后管理,积极干预患者的生活方式和饮食习惯,才有可能实现长期减重及改善肥胖相关伴发病。     

Health benefits and risks of the Internet

The linking of the Internet with health and medicine involves all levels of society, including individuals, health care providers, professional organizations, communities, and local and federal governments. A growing body of evidence suggests that despite the benefits of the Internet, this means of communication also figures into the creation of new forms of health risk for some users. This paper examines the effects of the Internet on the promotion of both health and illness. The discussion focuses on those factors of online communication that produce positive health outcomes and also the potential for health risk. Implications for health providers and for better serving patients are analyzed together with recommendations for improving services for those who go online to access health information.     

Pertussis and pertussis vaccine. Reanalysis of benefits, risks, and costs

Using recently published information, we examined the experience of a hypothetical cohort of 1 million children followed up from birth to 6 years of age without and with a pertussis vaccination program. Costs associated with death or lost wages were not estimated. A vaccination program reaching 90% of children would reduce disease incidence and disease-related costs by 90%. Taking into account costs associated with vaccine and vaccine reactions, the costs are reduced 82%. The ratio of overall costs without a program to those with a program is 5.7:1. The benefit-cost ratio is 11.1:1. Because we did not include indirect costs, this is a conservative estimate. Until improved vaccines are available, continued use of our present vaccines, with careful attention to possible contraindications, seems the only prudent course to follow.