迟发性性腺功能减退症,要重视,但不要过度——专访解放军总医院李江源教授

近些年来,越来越多的普通人开始熟悉迟发性性腺功能减退症。在专家看来,我们应该怎样对待迟发性性腺功能减退症呢?为此,我们采访了知名的内分泌专家,解放军总医院(301医院)的李江源教授。     

迟发性性腺功能减退症的“前世今生”

在弟弟的劝说下．费青松终于意识到,人到中年、事业辉煌的男士们更应该更新健康理念,重视疾病的预防。为此,哥俩专门拜访了秦医生,希望能解答自己关于迟发性性腺功能减退症的种种疑惑。     

2018年上半年某城区中老年男性迟发性性腺功能减退症的流行病学调查

目的对南充市城区中老年男性迟发性性腺功能减退症(LOH)的流行病学进行调查。方法 2018年1月—7月在南充市城区中随机选取的9个社区为研究区域,采用年龄分层抽样选取40～80岁的中老年男性为调查对象,应用中老年男子雄激素缺乏(ADAM)问卷、老年男子症状(AMS)问卷和性腺激素水平测定方法来调查南充城区LOH患病率,同时对比不同年龄组中老年男性性腺激素水平和LOH的患病率。结果 729名中老年男性完成调查,量表筛查LOH阳性率:ADAM量表阳性率为74.49%,而AMS量表阳性率为36.76%。不同年龄组的睾酮(TT)和游离睾酮(FT)水平存在统计学差异,随着年龄的增加,TT和FT水平有明显下降趋势,LH和FSH水平在不同年龄组中并无明显差异;196例TT<300 ng/dl(26.89%),105例TT<300 ng/dl且FT<50 pg/ml(14.4%),以量表结果阳性结合TT<300 ng/dl为LOH诊断标准,筛查LOH患病率分别是23.46%(ADAM)和20.71%(AMS),不同年龄分组之间比较LOH阳性率均存在统计学差异(P<0.05),随年龄增加LOH发病率有明显上升趋势。结论南充城区中老年男性LOH的患病率相比国内大型城市调查结果偏低,但高于一些农村地区调查结果,可能与城市经济发展水平、人群生活习惯、地域有一定的相关性,其深层次原因仍待进一步研究和讨论。     

萧瑟的秋天：男性更年期那些事儿——最熟悉的陌生人：迟发性性腺功能减退症

很多人把中老年比作人生的秋天。 秋天,本该是一年四季中色彩最丰富的季节。遗憾的是．很多中老年男性拥有的却是一个“万里悲秋常作客,百年多病独登台”的秋天。     

最熟悉的陌生人:迟发性性腺功能减退症

年逾古稀的费家老爷子,近些年来脾气变得有点古怪。他的家人原本没有在意。直到费家长子费青松发现,人到中年的自己,也出现了一些"微妙"的变化。发生在费家父子身上的变化,究竟是什么呢?     

浅析小儿体虚感冒重视顾护脾胃

小儿感冒病变部位主要在肺,与脾胃关系非常密切.肺主一身之气,而肺之气又依赖于脾运化精微以充养.脾为肺之母脏,子能令母虚,母病亦及子,即肺虚能导致脾虚,脾虚亦可致肺虚.所以在治疗小儿体虚感冒时要重视调理脾胃,处处顾护脾胃之气,使肺气充实而感冒愈.     

临床药师要关注药物的代谢转化

药物进入体内后，经有关酶的催化，进行化学变化，称代谢转化。药物经转化后水溶性增高，有利于排泄体外。多数情况代谢产物的活性或毒性降低，但也有不少实例经代谢转化后代谢产物药理活性或毒性增高。药物的酶促代谢不只通过单一途径，产生的也不仅单一产物，每个代谢产物的药理活性或毒性不同，而每个病人的酶活性有所不同，对通过这些途径的速率相异，可表现为药物效应或毒性的个体差异。临床药师观察到病人所表现的不同反应往往可用代谢转化的观点解释，因而临床药师要关注药物的代谢转化，以便协助医师更适当、更安全有效地用药。     

中、小型医药企业应关注通用名药品

由于近年的医疗制度改革的深入及零售药店的红火、医疗保险制度的实施,消费者普遍选择价格较低但疗效确切的通用名药品,这为我国众多的中、小型制药企业带来了无限商机。不少国内制药企业已普遍尝到这类药品为其带来的甜头,有不少药厂靠此还获得了生存和发展的机遇,如上市公司西南药业在1987年底开始生产散利痛,现已成为其拳头产品,多年来一直占据着大西南医药市场,在零售药店和中、小型医院走势较好,年销售额已近8000万元(尽管使用这个品名与上海一家制药企业的同名产品一直有些纠纷,但这并不是关键性的市场因素)。又如重庆的一家小型药厂…     

Why we should still estimate the costs of substance abuse even if we needn't pay undue attention to the bottom line

A coalition of provincial, national and international addictions agencies has sponsored a series of symposia leading to the developing of international guidelines for estimating the costs of substance abuse. These guidelines have now been used in national studies in four continents, with more consistent and comparable results than in previous studies. Although the bottom‐line results have been used to argue for alcohol and drug issues having a higher place on the public policy agenda, the real value in such studies lies in the detailed results regarding mortality and morbidity attributable to substance abuse, the relative contribution of acute versus chronic conditions to overall problem levels and the role of substance misuse in adverse social consequences, such as crime and economic productivity. There is a variety of factors which undermine the robustness of the findings, including lack of data, layering of assumptions and changes in the epidemiological knowledge base. It is argued that economic cost estimates should nonetheless be conducted and continually refined, as the detailed findings are of great utility to the design and targeting of prevention programming and policy. The presentation concludes on a personal note of farewell, as this is the author's final conference presentation.[Single E. Why we should still estimate the costs of substance abuse even if we needn't pay undue attention to the bottom line. Drug Alcohol Rev 2009;28:117–121]     

医学教育应注重人文精神的培养

随着社会的进步,科学的发展,医学模式发生很大的转变,使得社会因素、心理因素对人体的健康和疾病发生着重要的影响,也使得医学需要关注人精神。人素质的提高,人精神的培养对医学生教育显得尤为重要。该针对目前医学教育中人精神的缺失,从科学精神与社会精神相统一的角度,提出培养人精神的建议。     

Pharmacists need to participate and pay closer attention to the Medicare for All discussion

It has been a decade since the Patient Protection and Affordable Care Act (ACA) was signed into law. The ACA’s reception remains mixed, despite its moderate success in increasing insurance coverage, and discussions of health care reform have not abated. Among ongoing efforts to reform or repeal the ACA, “Medicare for All” appears in several prominent policy proposals. Public opinion polls from across the United States have demonstrated the growing popularity of reform proposals, which has encouraged legislators to be stronger advocates for such changes. Between 2017 and 2020, the 115th and 116th U.S. Congress introduced more than a dozen legislative proposals aimed at health care reform. Unfortunately, the variety and nuance of these legislative proposals have resulted in considerable confusion and division across the nation among health care providers and patients regarding definitions and implications of Medicare for All. This commentary aims to improve pharmacists’ understanding of Medicare for All, discuss the possible impact of Medicare for All on pharmacy practice, and serve as a call for U.S. pharmacists to participate in advocacy and reform of the health care system in which they practice. We argue that only through proactive participation in legislative advocacy will the pharmacists’ role in patient care continue to evolve. This brief commentary is divided into 5 major sections: (1) support for Medicare for All, (2) definitions of existing Medicare for All policy proposals, (3) estimation of the impact of Medicare for All proposals on the health care system, (4) the pharmacist perspective on the impact of Medicare for All, and (5) recommendations for pharmacy practice and advocacy.