广州市41例HIV感染孕产妇干预情况分析

目的了解广州市孕产妇艾滋病病毒（HIV）感染的特征及母婴阻断情况,为进一步做好艾滋病母婴阻断提供依据。方法 2009年10月至2010年9月,对接受婚检、产检及助产服务的孕产妇进行HIV筛查,阳性个案进行确诊试验。对HIV感染孕产妇及其新生儿的一般情况、干预效果进行分析。结果广州市全人口孕产妇HIV抗体阳性检出率为0.02%（41/178 029）。HIV感染孕产妇平均年龄27岁,绝大多数为汉族,受教育程度偏低,大部分无业或农民;最可能的感染途径是性传播。76.9%（30/39,2例失访）的孕产妇顺利分娩;分娩产妇中母亲用药率为56.7%（17/30）,婴儿用药率为60.0%（18/30）;46.7%（14/30）的婴儿成功随访至结案,未检出HIV感染个案。结论母婴阻断效果明显。在母婴阻断干预过程中,HIV感染孕产妇及其婴儿的随访工作难度较大,要根据孕产妇人群的特点有针对性地开展工作。     

Joint liaison psychiatry-diabetes clinic: a new specialist service.

AIMS: Specialist diabetes clinics have an established role in prevention and management of complications. As psychological problems are usually treated separately from diabetes centres, the role of a specialist psychiatrist within a teaching hospital was assessed. The aims of the study were to describe referral patterns, specific psychiatric conditions and treatments offered. RESULTS: During weekly outpatient sessions over a 12-month period, 31 patients were referred with a wide range of psychiatric diagnoses. One-third of patients were seen on the day and two-thirds within 2 weeks of referral. Treatments included anti-depressant medication, counselling and cognitive behaviour therapy. Successful discharge was obtained in 10 subjects and eight were undergoing continued treatment. CONCLUSIONS: The range of specific diagnoses requiring psychiatric supervision supported the role of specifically trained personnel as seen in a joint liaison psychiatry-diabetes service.     

大庆地区469例妊娠期妇女甲状腺功能参考区间的建立

目的建立不同妊娠期妇女甲状腺功能的参考区间。方法收集469例不同妊娠期妇女的血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)数据,采用中位数(M)及百分位数(P2.5～P97.5)建立95%参考区间。结果孕早期1组:FT33.98～7.49 pmol/L、FT48.04～20.32 pmol/L、TSH0.14～3.65 m IU/L;孕早期2组:FT33.91～6.43 pmol/L、FT48.1～15.42 pmol/L、TSH 0.06～5.12 m IU/L;孕中期:FT34.03～5.96 pmol/L、FT46.71～14.12 pmol/L、TSH 0.18～4.72 m IU/L;孕晚期:FT33.96～6.08 pmol/L、FT46.74～14.26 pmol/L、TSH 0.84～4.98 m IU/L。采用本标准和美国甲状腺协会指南标准筛查临床甲减的检出率分别是0%(0/469)和1.1%(5/469),指南标准检出率高于本标准的检出率(P=0.025)。本标准和指南标准筛查亚临床甲减的检出率分别是1.7%(8/469)和10.0%(47/469),指南标准检出率高于本标准的检出率(P=0.000)。结论建立妊娠期特异性参考值区间,可准确、及时诊断妊娠期甲状腺功能异常。     

Cardiac angiosarcoma in a pregnant women

We present a case of cardiac angiosarcoma in a pregnant women. Clinical manifestations of angiosarcoma were unspecific and progressed rapidly as hemopericardium, cardiac tamponade, heart failure, fever, chest pain. Pregnancy was interrupted at 22-nd week. The patient died in 6 months after appearance of first symptoms.     

Screening for brucellosis in pregnant women

During a period of 6 months, 537 pregnant women from a rural area in Saudi Arabia were tested serologically for brucellosis. Of the 513 women who were tested routinely, 18 were found to have a positive titre (3.5%). Of 24 patients in whom the test was carried out because of symptoms suggestive of brucellosis, all were positive. Thirty of the 42 positive cases had titres exceeding 1:160. The incidence of abortion among pregnant women with Brucella titres less than 1:160 was 7.7% contrasting with 17.6% among those with titres above 1:160 (P less than 0.04). This observation calls for further study of the incidence of brucellosis in pregnant women in infected areas, and the connection between elevated Brucella titre and abortion.     

Framework for counseling pregnant women presented

At a recent conference, the Health Resources and Services Administration (HRSA) presented guidelines on how health care providers can implement guidelines for counseling and testing of all pregnant women. At the February, 1995, national meeting in Washington, D.C. on women and HIV, sponsored by the National Institutes of Health, HRSA officials told providers: all settings that provide care to pregnant women should provide voluntary HIV counseling and testing on site; follow-up care for all people with HIV should be provided at counseling and testing sites or by referral; all pregnant women with HIV should be given information on the benefits and potential risks of zidovudine (AZT, Retrovir); AZT should be made available either on site or by referral; follow-up care should be included; caregivers must be sensitive to the high level of distrust and fear that many racial/ethnic-minority people have toward health care providers and experimental protocols; training should be provided for health care workers in HIV counseling and testing, and diagnosis and management of HIV in women. HRSA will provide technical assistance, training materials, and other resources to assist providers with implementation of the counseling and testing guidelines.     

The exclusion of pregnant women from NHS health care: a cross-sectional,humanitarian, health service evaluation

BackgroundRecent UK immigration policy, including obligatory charging and data sharing between the NHS and the Home Office, has created an atmosphere of fear and increased the barriers to health-care faced by highly marginalised and vulnerable individuals. Charging for maternity care (often incorrectly) leads to avoidance or delayed presentation for antenatal care and increased maternal and neonatal morbidity, mortality, and associated costs.MethodsThis cross-sectional health service evaluation used data collected from patients during medical consultations at Doctors of the World (DOTW) clinics in the UK. DOTW is a humanitarian organisation, providing care to those excluded from NHS health care. We describe patient characteristics with a particular focus on pregnant women presenting to DOTW for antenatal care instead of NHS care.Findings980 adults had a medical consultation at DOTW between Jan 1, 2016 and Dec 31, 2016. Of these 945 (96%) of 980 people were non-EU or EEA nationals, 518 (53%) of 980 were women, and 104 (20%) of 518 were pregnant. Among pregnant women, 18 (17%) of 104 had a experienced a history of violence and 36 (34%) of 104 had an urgent medical need. 86 (83%) of 104 pregnant women were presenting for their first antenatal visit; 50 (58%) of these 86 women were attending after 10 weeks gestation.InterpretationAttendance at DOTW clinics is evidence of exclusion from mainstream health-care provision. A fifth of women attending medical consultations at DOTW in 2016 were pregnant, with a third having an urgent medical need. Most were attending for their first antenatal visit, with over half attending after 10 weeks gestation; NICE recommend first antenatal visit by 10 weeks. These results are of great concern, particularly given the refusal of the government to publish its review of the public health impact of the NHS overseas visitor charging regulations.FundingWellcome Trust, European Union; European Programme for Integration and Migration, European Commission: DG Health and Food Safety/Consumers, Health, Agriculture and Food Executive Agency.     

社区健康服务中心孕产妇保健服务效果分析

目的分析该社区健康服务中心孕产妇保健服务效果,找出薄弱环节,为社区健康服务中心孕产妇保健工作提供参考。方法选取2010~2012年该社区健康服务中心孕产妇系统管理报表数据进行回顾性分析。结果常住人口平均产后访视率为98.33%,流动人口平均产后访视率为96.23%,均已达到深圳市社康服务中心妇女保健指标要求（产后访视率90.00%以上）;2012年的常住人口早孕建卡率（97.18%）、孕妇健康管理率（94.92%）、系统管理率（93.79%）较2010、2011年有大幅度提高,而2012年流动人口的早孕建卡率（47.83%）,孕妇健康管理率（43.48%）,系统管理率（41.30%）仍然相对较低。结论该社区常住人口孕产妇管理工作指标完成情况较好,流动人口孕产妇的管理工作需要加强。     

The first year of a geriatric-orthopaedic liaison service: an alternative to 'orthogeriatric' units?

The use of orthopaedic beds by large numbers of elderly patients with multiple pathology will increase and already exceeds the provision of orthopaedic-geriatric rehabilitation units. A cross-specialty multidisciplinary ward round improved the quality of care of orthopaedic patients without requiring expenditure on equipment, facilities or staff, and abolished the need to transfer patients to geriatric beds for rehabilitation, this being achieved on the orthopaedic unit. The liaison service provided excellent medical training in acute and rehabilitative aspects of geriatric medicine, enhanced the role of other disciplines in the care of the elderly orthopaedic patient and facilitated communication between departments.     

Screening pregnant women for genital herpes.

In a prospective study to identify the viral type isolated from women undergoing screening for herpes simplex virus (HSV) during pregnancy using fluoroscine-labelled monoclonal antibodies to HSV-1 and HSV-2, HSV-2 was more likely to be isolated during the third trimester and was the only viral type isolated at term. As the severity of neonatal central nervous system disease is greater with HSV-2 than HSV-1 we recommended that all women with a history of genital herpes should be screened during pregnancy.     

Anesthesia for pregnant women with Mitral stenosis

Background Rheumatic heart disease is still a major heart problem associated with pregnancy in south China, despite its declining trend. The mortality and morbidity are considerably reduced1 by better perinatal care, where the anesthesiologist plays a major role in the multidisciplinary approach. Nevertheless, in wealthy nation, rheumatic disease has become uncommon and complex congenital heart disease is increasing in the recent decades. With the advent of intensive obstetric and anesthetic care, the death rate of pregnant women with heart disease is lower in mitral stenosis compared with other congenital heart diseases like Eisenmenger＇s syndrome, pulmonary vascular obstructive disease and Marfan＇s syndrome with aortopathy2. Although mitral stenosis is often associated with mitral regurgitation, morbidity is usually related to mitral stenosis3.