养生之道——访著名老中医宋祚

祚民教授，国家级名老中医，1944年毕业于孔伯华北京国医学院后，自开诊所，解放后创办联合诊所，又转至公立医院工作，在医疗岗位上，已辛勤耕耘60余载，治病救人无数，桃李遍布京城。如今，以八旬之躯，应诊不疲，毫无倦意，精神矍铄，思路清晰，举止谈吐优雅，无一丝耄耋之象。为此，本刊特作专访，整理如下。     

巧用茅根治肾炎

茅根味甘，性寒，无毒。有凉血，止血，清热，利尿等功效。传统上以其治热病烦渴，吐血，鼻血，肺热，喘急，淋病，小便不利，水肿黄疸等。用茅根治急性肾炎，经济，简便，而且效果好。     

糖尿病并发周围神经病变误诊为冠心病1例

患者，男，51岁，主因“左后背疼痛2d”入院，该患者无明显诱因出现左后背伴左上肢疼痛，伴胸闷，心前区不适，无胸痛，无发热，无恶心呕吐，无大汗淋漓，既往冠心病，糖尿病病史，血糖控制不理想，BP：120／70mmHg，双肺（一），HR70次／min，率齐，低钝，未闻及杂音，心电图显示心肌缺血，诊断为冠心病，急性冠脉综合征。给予扩张血管，营养心肌，活血化瘀等药物治疗，胸闷症状好转，仍后背疼痛，     

预激综合征引起室上性心动过速1例

患儿，男性，8岁，因心悸1d入院。就诊时胸闷、心悸、乏力、精神差，少言懒动，汗出。体格检查：T36．5℃，P232次／min，R32次／min，血压测不到，神志清楚，面色无华，瞳孔等大等圆，对光反射存在，唇淡，咽不充血，颈软，颈静脉搏动明显急促，双肺呼吸音清，心率232次／min，律齐，心音弱，各瓣膜听诊区未闻及病理性杂音，腹平软，上腹部压痛明显，无反跳痛，肝脾未及，余无异常。实验室检查，血常规：     

夏季除湿有良方

进入夏季，环境温度升高，湿度变大，天气闷热。特别是梅雨季节，湿热熏蒸，更是导致各种疾病的常见原因。湿邪侵犯人体，容易导致腹部胀满，食欲不振，大便溏泄，小便混浊，头重如裹，身体沉重困乏，     

支气管哮喘食疗方三款

芝麻杏仁糊 处方：黑芝麻1000g，甜杏仁200g，白糖250g，蜂蜜250g。 制法与服法：芝麻洗净，滤干，入铁锅内，用旺火不停翻炒，炒至水汽蒸发，不断发出噼啪声，离火，盛碗，冷却后研碎，备用；杏仁快速洗净，打碎成泥，备用。将熟芝麻、杏仁泥倒入大磁盆内，加白糖、蜂蜜拌匀，磁盆不盖，让水蒸汽进入，隔水用旺火蒸3小时，离火、冷却。     

改造你 还是改造我？

对婚姻过于理想化 因爱，一切皆对，因恨，一切皆错，恋爱时，浪漫的感情充斥了整个心房，“情人眼里出西施”，总是自觉，不自觉地把对方理想化，偶像化，对方的优点就是优点，缺点也是优点，婚后，由浪漫走入了现实，过起了实实在在的生活，两个各自生活了二十几年的人组成了一个新家庭，即使再相似，也会有生活习惯，价值观念不相同的地方。     

子宫切除手术前后健康教育的作用

例1：患者，女，43岁，因更年期子宫功能性出血，重度贫血而入院，经病理切片证实为子宫内膜腺瘤型增生，行全子宫切除手术，当其得知需要手术治疗便出现心理紧张，有恐惧感，心跳加快，血压上升至21．3／12．6kPa，伴头昏，面色苍白，四肢发冷，出冷汗，针对患者的心理状态，入院后，责任护士热情接待，亲切交谈，常规介绍了病区环境，管理制度，该患者的主治医生。     

顼教授咨询信箱

我今年75岁，患高血压10余年，刚开始服卡托普利，血压控制还可以。由于服药时间长，引发咳嗽不止，停药后就好了。后换为硝苯地平，尼群地平片，波依定，蒙诺等药物，低压正常，高压居高不下，脉差一直较大。现在服络活喜，每天早晚各一片，寿比山隔天服，血压有所好转，但高压还是没有恢复正常，一直在150～140毫米汞柱之间。我想知道用什么办法能使高压降下来？有医生讲，年纪大，动脉硬化，高压能控制在140～150毫米汞柱就可以，这种说法是否对？     

脑萎缩专业药物研制成功

脑萎缩是一种脑组织细胞相对减少而引起脑神经功能失调的疾病。发病缓慢，早期症状为头痛，头晕，健忘，失眠，腰膝酸软，手足麻木，尿频，尿急，行为异常，多疑，自私，说话不利索，行动迟缓等。     

挪威卫生服务体系概况及对我国的启示

本文通过对挪威卫生服务体系的发展脉络进行追溯,了解到挪威政府对初级卫生保健体系和专科卫生服务体系一直采取不同的管理模式,并随着人口结构、卫生服务需求的变化将初级卫生保健逐步交由自治市政府管理,而专科卫生服务则采取了市场化较强的半政府、半市场的组织管理模式,并由中央政府进行统筹。这样的管理结构从目前来看较好的解决了初级卫生服务供给不足和专科卫生服务效率低下的问题。     

郴州农村妇女卫生保健意识及健康教育需求调查

目的:了解湖南省郴州市农村妇女卫生保健意识及其健康教育需求,为进一步提高健康教育质量提供依据。方法:结合预防医学本科生社会实践,组织大学生对郴州市保和乡326名农村妇女进行问卷调查。结果:大部分调查对象的卫生保健意识较差,近1年来,40.5%的妇女出现过生殖道感染症状;卫生保健意识主要与年龄、文化程度有关(P0.05);调查对象对健康教育的需求主要是儿童保健、常见妇科疾病预防和孕产期保健等方面的知识。结论:应针对不同年龄、不同文化层次的农村妇女进行相应的健康教育,健康教育的方式应多种多样。大学生组织的社会实践活动在农村妇女的健康促进工作中有着重要的作用。     

21世纪全面开展初级卫生保健的思考与建议

从我国当前的国力和国际经验来看,我国在21世纪仍然特别需要采取低成本、广覆盖与高产出的卫生发展战略,需要富有远见和创新精神的卫生制度设计。通过立法保障和普及初级卫生保健,保证城乡居民公平享有基本卫生服务,保障全体公民的基本健康权利,是解决当前广大群众“看病难、看病贵”问题的可行策略,是符合我国国情、尽快改善卫生公平性、控制医疗费用过快上涨和提高人民健康水平的最佳制度选择,也是推动卫生改革和体制创新的关键举措。建议通过立法构建我国21世纪初级卫生保健体系,将卫生工作的重点从医疗服务转到疾病预防,将卫生资源从过度的医院服务转向普及基层的初级卫生保健服务,并对相关的社会、环境、行为和心理等健康危险因素进行干预。在大力控制传染病、地方病的同时,尽快建立控制慢性非传染性疾病的能力,防止国家、社会和家庭在未来付出更高的健康损失和经济代价;建议我国未来的卫生服务大体上由“两层服务体系”提供,即初级卫生保健层次和转诊服务层次,逐步实现居民人人享有的“双重健康保障”,即:所有公民享有基本卫生服务和基本医疗保险。     

日本预防保健体系对我国构建家庭保健体系的启示

日本的医疗卫生保健体系从广义上讲以预防保健、医疗和照护为三大支柱,并针对儿童、残疾人、老年人等弱势群体通过社会福利政策给予支持,从而打造了全方位的预防保健、医疗、照护、福利网络。随着医疗费用在国民收入中所占比例的不断增加和人口老龄化的不断加剧,日本逐步深化预防保健的重要性,积极促进以治疗为重点的医疗体制向重视疾病预防、健康促进的预防保健医疗体制转变。同时,加强保健、医疗、照护、福利在社区层面的联合。本文重点分析日本预防保健体系的构成及特点,总结其经验,以期为中国强化预防保健意识,促进人口计生系统转型,构建全面深入的家庭预防保健体系提供借鉴和参考。     

The demand for private health care in the UK

Policy change has eroded the entitlement of UK residents to free state-provided health care, with a resulting rise in the use of the private sector. This paper examines the choice between public and private health care. It models the use of private health care as a function of its costs and benefits relative to state care and no care. The results indicate a difference between users of private care and other care, and the importance of past use as a predictor of current use. But they also show considerable movement between the public and private sectors, indicating a complex relationship in public and private sector use.     

Have out‐of‐pocket health care payments risen under free health care policy? The case of Sri Lanka

Compared to its neighbors, Sri Lanka performs well in terms of health. Health care is provided for free in the public sector, yet households' out‐of‐pocket health expenditures are steadily increasing. We explore whether this increase can be explained by supply shortages and insufficient public health care financing or whether it is rather the result of an income‐induced demand for supplementary and higher quality services from the private sector. We focus on total health care expenditures and health care expenditures for specific services such as expenses on private outpatient treatments and expenses on laboratory and other diagnostic services. Overall, we find little indication that limited supply of public health care per se pushes patients into the private sector. Yet income is identified as one key driver of rising health care expenditures, ie, as households get richer, they spend an increasing amount on private services suggesting a dissatisfaction with the quality offered by the public sector. Hence, quality improvements in the public sector seem to be necessary to ensure sustainability of the public health care sector. If the rich and the middle class increasingly opt out of public health care, the willingness to pay taxes to finance the free health care policy will certainly shrink.     

军队保健医师能力素质建设

干部保健工作不仅是医疗服务,也是政治任务,事关党、国家和军队的安定和稳定,其发展过程经历萌芽、发展、曲折中前进、壮大等几个过程,逐步形成一套科学的体系.保健医师是干部保健工作的主体,军队保健医师因保健对象的特殊性与临床医师相比有很大区别.但绝大多数由临床医师转来,与实际保健需求有一定差距.重视和开展军队保健医师的能力素质建设和模块化层级式培训,以符合新时期强军保健任务的需要,有利于保健医师能力的提高和技术的进步,为保健政策的制定提供科学的数据支撑.     

徐州市市区社区卫生服务现状和对策研究

目的：通过了解社区居民卫生服务需求及徐州市市区卫生资源的基本现状，为上级有关部门在制定徐州市社区卫生服务区域规划、领导决策提供科学依据。方法：对居民卫生服务需求调查采用分层整体抽样和系统分析。市区卫生资源现况来源于1999年徐州市卫生统计资料的汇总、整理、分析。结果：社区居民老龄化程度较高，≥60岁老龄人口构成为24．6％。主要病种为慢性病，患病率为355．0‰，两周患病率为212．25；市区卫生资源较丰富但布局不尽合理，医护人员比例失调、护理人员相对短缺,目前为止我市无六位一体的社区卫生服务点。结论：我们应该合理利用现有的卫生资源，尽快建立适合于我市经济发展的新的集预防、治疗、保健、康复、健教及计划生育指导于一体的综合性、可持续的社区卫生服务体系。     

Is Home Health Care a Substitute for Hospital Care?

A previous study used aggregate (region-level) data to investigate whether home health care serves as a substitute for inpatient hospital care and concluded that “there is no evidence that services provided at home replace hospital services.” However, that study was based on a cross-section of regions observed at a single point of time and did not control for unobserved regional heterogeneity. In this article, state-level employment data are used to reexamine whether home health care serves as a substitute for inpatient hospital care. This analysis is based on longitudinal (panel) data—observations on states in two time periods—which enable the reduction or elimination of biases that arise from use of cross-sectional data. This study finds that states that had higher home health care employment growth during the period 1998–2008 tended to have lower hospital employment growth, controlling for changes in population. Moreover, states that had higher home health care payroll growth tended to have lower hospital payroll growth. The estimates indicate that the reduction in hospital payroll associated with a $1,000 increase in home health payroll is not less than $1,542, and may be as high as $2,315. This study does not find a significant relationship between growth in utilization of home health care and growth in utilization of nursing and residential care facilities. An important reason why home health care may serve as a substitute for hospital care is that the availability of home health care may allow patients to be discharged from the hospital earlier. Hospital discharge data from the Healthcare Cost and Utilization Project are used to test the hypothesis that use of home health care reduces the length of hospital stays. Major Diagnostic Categories with larger increases in the fraction of patients discharged to home health care tended to have larger declines in mean length of stay (LOS). Between 1998 and 2008, mean LOS declined by 4.1%, from 4.78 to 4.59 days. The estimates are consistent with the hypothesis that this was entirely due to the increase in the fraction of hospital patients discharged to home health care, from 6.4% in 1998 to 9.9% in 2008. The estimated reduction in 2008 hospital costs resulting from the rise in the fraction of hospital patients discharged to home health care may have been 36% larger than the increase in the payroll of the home health care industry.