关于区域卫生规划的若干思考

该文认为,目前区域卫生规划执行中遇到的障碍包括:目标认识模糊,制度基础缺乏,实施手段不足,政府引导不力,规划技术不成熟等。     

The effect of non-differential exposure misclassification on estimates of the attributable and prevented fraction

This paper considers the effect of non-differential exposure misclassification on the population attributable fraction and the population prevented fraction as a function of the sensitivity and specificity of the exposure classification, the true relative risk, and the true prevalence of the exposure. Given a certain set of sensitivity, specificity, and prevalence of the exposure, the apparent attributable fraction is a constant proportion of the true attributable fraction regardless of the true relative risk. This observation does not hold for the apparent prevented fraction and the apparent relative risk, both of which vary with the true relative risk. For both the attributable and the prevented fraction, the sensitivity of the exposure classification has a greater influence on the magnitude of the bias than the specificity; also, the higher the prevalence of the exposure, the larger is the bias caused by the imperfect exposure classification.     

提高认识 突破难点 为实现妇女儿童纲要目标而奋斗

在国务院领导同志的直接关心下 ,经过近一年的筹备 ,由卫生部、国务院妇儿工委、财政部共同组织实施的“降低孕产妇死亡率和消除新生儿破伤风项目”正式启动了。我受国务院领导同志委托 ,对这一项目的启动表示热烈的祝贺 ,并向为妇女儿童发展作出贡献的同志们致以崇高的敬意 !1　突破难点 ,确保基本实现两个《纲要》的目标我们党和政府一贯重视妇女儿童工作。江泽民总书记指出 ,“全党全社会都要树立马克思主义妇女观”,“把男女平等作为促进我国社会发展的一项基本国策”。各级党委和政府从促进经济、社会发展的战略高度和全党全国的工作大…     

人工耳蜗植入体刺激器外壳气密性检测方法

在人工耳蜗植入系统中,刺激器是接收、处理电信号、保证刺激电极正确刺激人体耳蜗神经的核心部件。刺激器外壳的密封性保证了刺激器内部电路与人体之间的有效隔离,既可以防止内部电路所含的有害成分渗入到人体,又可以保证体液不会腐蚀内部电路,对患者的生命安全及患者感知声音的效果有着重要影响。YY0989.7-2017是针对人工耳蜗植入系统的专用要求,现分析影响该标准规定整体泄漏检测的准确性因素,阐述整体泄漏检测过程中所遇到的问题,并给予解决方法和注意事项。     

固定矫治中影响前牙转矩控制的因素

正确的牙齿转矩是牙合平面、整个牙弓形态及面部美学表达的关键.上前牙的转矩可进一步影响鼻唇角、笑线、笑弧,而下前牙的转矩关系到颏唇沟深度等重要的面部美学指标,故而在矫治中建立正确的前牙转矩,有助于在三维方向上完成矫治目标.影响唇侧固定矫治中前牙转矩控制的因素包括牙齿本身的解剖形态、不同的矫治体系及托槽、弓丝及控制转矩的不...     

新时期军队医院建设面临的形势及对策

为探讨新时期军队医院建设的新问题,本阐述了军队医院建设面临的新的形势是：国家医药管理体制改革的影响;卫生系统的集团化运作的影响;精简整编的影响;医疗安全问题的影响;同时,也提出一些对策,即：积极参与竞争,主动开辟市场;调整发展战略,加强内涵建设;硬件软件并举,提高服务质量,顺应发展趋势,加大改革力度。     

机械误差对相邻野衔接处的剂量影响

目的：定性的探讨放射治疗机的机械误差对相邻野衔接处剂量的影响。方法：假定患者的相邻野设计采用半野衔接技术,相邻野相交方向的实际位置与数字指示之间有±1．0mm的误差,利用三维治疗计划系统和胶片剂量仪模拟分析这种误差对实际剂量分布的影响。结果：理论上,用半野衔接技术可以非常好的解决相邻野的剂量衔接问题。而在实际放疗中,如果由于机械误差造成相邻野在衔接部分有重叠区,在辐射野的重叠区,剂量分布会比治疗计划预期高出约10％之多;如果由于机械误差造成相邻野在衔接部分有留空区,在辐射野的留空区,剂量分布会比治疗计划预期低约10％。结论：本研究表明尽管在物理技术方面做了很好的质量保证,但体外照射治疗机很小的机械误差（±1．0mm）也会造成相邻野衔接处的剂量分布与治疗计划有很大的差异。而且机械误差是系统误差,影响疗程总量,对靶区和危及器官的累积物理剂量和生物等效剂量有很大的影响,而这种剂量分布的改变很难为医技人员所掌握控制。因此,在设计治疗计划时,应该尽量避免使用相邻野。     

Distribution of selenium and glutathione peroxidase in the rat

The selenium content was determined in the adrenals, brain, erythrocytes, femur, hair, heart, kidneys, lungs, muscle, pancreas, plasma, spleen, testes, and thymus of rats, which had been fed a commercial rat diet containing 0.3 mg Se/kg diet. In the plasma, the erythrocytes, and the soluble fraction of the tissues (with the exception of femur and hair) the activity of the glutathione peroxidase (GSH-Px) was measured, using both hydrogen peroxide and t-butyl hydroperoxide as substrates. From the masses of the tissues and the values for the selenium content and the GSH-Px activity, the distribution of the element and the enzyme in the body was calculated. For selenium the main pools were the muscle and the liver, and for the GSH-Px, the liver and the erythrocytes. By comparing the selenium content and the GSH-Px activity the percentage of the tissue selenium, which was bound to the enzyme in the soluble tissue fraction, was estimated. This percentage differed considerably from tissue to tissue, the highest value being found in the erythrocytes and the smallest in the testes. According to this estimation the majority of the selenium in the rat is not contained in the GSH-Px but in other compounds.     

强化政府社会职能解决看病难看病贵

形成"看病难、看病贵"有多种因素,解决这一问题必须找准钥匙投对锁。通过对公共医疗卫生内涵的分析、对不同经济体制下医疗卫生体制实行政府主导与市场主导不同模式的回顾,以及对政府社会职能缺失原因的探讨,进一步明确解决老百姓"看病难、看病贵"问题,不仅取决于医疗卫生体制改革的成效,而且取决于政府社会职能的发挥。因此,适应构建和谐社会的要求,转变政府职能,强化社会管理,建设公共服务型政府是深化医疗卫生体制改革,提高医疗卫生服务质量,解决"看病难、看病贵"的有效途径。     

浅谈半导体激光治疗下肢静脉曲张的工程技术

下肢静脉曲张是周围血管常见疾病，传统手术方式是采用大隐静脉高位结扎抽剥术或曲张静脉剥脱术去除曲张静脉为主。近年来随着科技的不断进步，越来越多的先进技术被应用到医学领域中，用来提高高疗质量，减轻病人痛苦。其中就包括开展微创治疗下肢静脉曲张，治疗方法有腔内激光治疗、腔内射频治疗、曲张静脉旋切治疗、电凝疗法等。 半导体激光器体积小、重量轻、可靠性高、转换效率高、功耗低、驱动电源简单、能直接调制、使用安全、其应用领域非常广泛。     

Research with families of people with mental disorder

The purpose of this paper is to present a critical reflection on the knowledge produced on the topics: the impact of the mental illness in the family, the impact of the family environment in the evolution of the eating and the experience family with the mental illness. The measures of overload and express emotion are useful to guide public politics and the practice professional, however in they do not give a multidimensional picture to them of the experience of the care. Research on the familiar experience contribute to the understanding of the present suffering in this experience and of the forms of confrontation adopted by the families, also contributing to perceive the differences of the cultural contexts in the confrontation of the families.     

钴-60放射源货包运输跌落事故的辐射影响分析

目的 探讨B（U）型钴-60运输货包发生严重跌落事故后,对事故处理人员、公众,以及事故处理后重新启动运输的相关工作人员及公众的辐射影响。方法 选取国内一条贯穿南北的典型运输路线,对B（U）型钴-60运输货包发生严重跌落事故的辐射影响进行分析。结果 B（U）型钴-60运输货包发生跌落事故后,事故处理人员所致最大剂量为3.2 mSv;距离事故10m处的公众所致最大剂量为5.6×10^-2 mSv;事故货包重新启运后对运输工作人员所致最大剂量为9.6 mSv,对运输沿线公众所致最大剂量为5.2×10^-2 mSv。结论 B（U）型钴-60运输货包发生严重跌落事故后,对事故处理人员以及事故处理后重新启动运输的相关工作人员所致剂量最大为载货司机,低于事故处理人员剂量控制值10 mSv;对事故点公众及事故处理后重新启动运输后运输沿线公众所致剂量低于事故公众剂量控制值1 mSv。     

转型期医院可持续发展机制实证研究

为转型期医院可持续发展的实现提供理论依据，本文对某区域医院的可持续发展机制进行了较为系统的经济学实证研究，阐述了转型期医院可持续发展的特征；提出了转型期医院可持续发展模式是医院集约型发展模式，能力是医院临床学科综合发展能力，基础是医院医生人力资源配置的合理性，核心是医院科技进步水平，标志是医院综合竞争力。     

医疗技术发展的伦理监督和法律调控——兼对《医疗技术临床应用管理办法》的解读

医疗技术的违规使用问题日趋严重,对医疗技术的发展进行监管有其必要性;通过医疗技术发展实现目的·陛与规律性的统一、动机与效果的统一,达到技术发展与社会的协调。主张对医疗技术的发展、使用、推广进行监管：对医疗技术的发展进行伦理监督和法律监管;对医疗技术及其使用主体即医生、医疗机构实行准入制度。     

Effects of a standing aid on loads on low back and legs during dishwashing

In order to prevent low back pain during dishwashing, we developed a standing aid for supporting the forward bending posture, and then evaluated the effects of the standing aid on decreasing load on the low back and legs. Eight female volunteers were asked to wash plates for 60 minutes in each of three working postures: (a) without the standing aid, (b) with the standing aid under the thighs, and (c) with the standing aid under the shins. The following were measured: electromyogram (EMG), electrocardiogram (ECG), the force applied to the standing aid, the ground reaction force, the bending angle of the trunk, the bending angle of the knee, and local discomfort in body regions. While using the standing aid under the shins, the muscle load decreased in the low back and legs. While using the standing aid under the thighs, the muscle loads decreased in the low back but increased in the legs. It was suggested that the standing aid under the shins was more effective in decreasing the load on the low back and legs than the standing aid under the thighs.     

Surgical management of inflammatory bowel diseases

The development of the medical management of the inflammatory bowel disease (IBD-ulcerative colitis, Crohn's disease) has reduced the number of the acute surgical interventions. Beyond the medical treatment the surgical management, the operative modalities, the pre and postoperative care has gone through a lot of changes. They review the different types of surgical alternatives and debating on the advantages and disadvantages, they put emphasis on the different surgical solutions of the Crohn's disease and that of the ulcerative colitis. Among the applied surgical alternatives to the ulcerative colitis they discuss the traditional proctocolectomy with end-ileostomy, the Kock-reservoir (as continent stoma), as well as the restorative proctocolectomy which is sufficient to preserve the anal continence. Principles of the surgery of the Crohn's disease are discussed according to the localisation of the inflammatory process (small bowel, colonic, rectal, anal channel). Because of the predisposition of relapses and the necessity of the successive surgical therapy, the extensive resections should be avoided.     

医疗帐篷升温、降温实验研究

目的:研究医疗帐篷依托升降温设备在低温、高温环境下内部温度的变化规律.方法:在帐篷四角的0.1、1.0、1.6 m高度和医疗帐篷中央0.1、0.5、1.0、1.3、1.6 m高度安装传感器,共计设置17个点位,在风机的出风口、进风口和室外分别设置3个点位作为参照.升温测试选择在1月份的辽宁省沈阳市,降温测试选择在8月份...     

The impact of the NHS internal market on the merger of colleges of midwifery and nursing. Not just a case of putting the cart before the horse

Presents and discusses the findings from a research project into the impact of the NHS internal market on the merger of colleges of midwifery and nursing. Begins by briefly describing the major changes which have been introduced in the NHS since 1979 and sets these within the context of the charging nature of the public sector in the UK. Second, describes the background to the research and the methods employed. Continues with a brief review of the approaches to the change management process, which in particular draws attention to the importance of the environment in which the organization operates, and of the relationship between management styles and the different approaches to organizational change. Presents a case study of the merger of five colleges of nursing and midwifery. Follows with a discussion of the case study and the conclusions drawn from it for the process of change within the NHS.     

风雨三十年思路大转变——对卫生改革的几点感受

我国卫生改革走过了30个春秋。通过卫生改革,公共卫生体系逐步健全;农村和基层医疗服务体系逐步健全;居民医疗保健体系逐步健全。在科学发展观的指导下,卫生改革的思路越来越清晰,目标越来越明确。分析了卫生改革思路实现的"六个转变":一是从零打碎敲的改革转到整体系统的改革;二是从照搬企业的改革转到按自身特点的改革;三是从依靠精英的改革转到全民参与的改革;四是从重轻失衡的改革转到统筹协调的改革;五是从经济利益的改革转到"以人为本"的改革;六是从各自为政的改革转到政府主导的改革。     

2012年中国地级城市医院竞争力100强排行榜分析

为探究新医改下我国地级城市医院的竞争力发展状况,对2012年中国百强地级城市医院竞争力进行描述性统计分析和独立样本t检验,并与2011年数据进行比较,研究发现100强地级城市医院竞争力继续增强;强地级城市医院东部地区竞争力最强,苏粤鲁占据半壁江山;指标分析显示,东部地区年门诊量优势明显,高级人才比例普遍下降,东部十强领先,西部十强增速迅猛,而中部十强发展滞后,组间首尾差距大,相邻差距小;中医院式微。由此为地级城市医院如何增强竞争力,摆脱尴尬境地指出解决方向。