European training in public health: A practical experience

Development of public health in Europe requires the human resourcesnecessary for planning and managing programmes with a European,intersectoral and multidisciplinary approach, based on the ‘healthfor all’ strategy. In this paper the European TrainingConsortium in Public Health (ETC-PH) presents the experienceof 4 years of developing educational activities and materialwith these approaches. Participants from different countriesand 5 institutions concerned with training in public healthhave been involved. Evaluation is positive both for studentsand teachers and an ETC network and project register have beencreated as a way for communication to continue and for the consortiumto offer ongoing support to all participants.     

急性心肌梗死患者健康教育效果评价

目的评价健康教育模式对急性心肌梗死（AMI）患者健康知识水平和不良健康习惯改善的效果。方法对42例在首都医科大学宣武医院心脏中心已确诊的AMI患者实施健康教育,采用自身对照的方法,应用自设的知识和行为问卷,分别于健康教育前、健康教育后（出院日、出院1周）进行3次问卷调查。结果健康教育后较健康教育前知识水平、不良健康习惯均有显著提高。出院日较入院前比较,差异有统计学意义（P〈0.05）;出院1周较入院前比较,差异有统计学意义（P〈0.05）;健康教育后出院1周较出院日知识水平、不良健康习惯均有所下降,两组比较,差异具有统计学意义（P〈0.05）。结论健康教育模式在AMI患者预防和治疗中具有显著的效果和意义。     

Scientific information activity in practical public health

The article examined the need for improving scientific information activity in the system of applied public health. Barriers were revealed which constrained the optimization of information supply for physicians. The findings of the study were provided which confirmed the low level of scientific information culture of professionals in the applied public health. Possible ways of improving scientific information activity were presented. Emphasis was made on the need for introducing the course of "The fundamentals of scientific health information" into the curricula of state institutes of advanced training for physicians. The data on the information needs of physicians and their information culture were given.     

急性心肌梗死住院患者健康教育需求调查

目的调查分析急性心肌梗死住院患者的健康教育需求,为医院针对性地进行健康教育提供依据。方法采用问卷调查方式,对随机抽取的2006年1月至2009年1月的186例急性心肌梗死住院患者健康教育需求进行问卷调查。结果急性心肌梗死住院患者对健康教育有普遍需求,90%以上患者需要了解自己的病情、治疗方法及效果,而对环境介绍、心理指导、康复训练等不重视;最受欢迎的健康教育方式是医护人员面对面的讲解,选择的人达到98.38%;40~49岁年龄组患者健康教育的需求人数占98.11%,对接受健康教育持积极态度的人占96.23%,明显高于其他年龄组(P0.05或P0.01)。大专以上文化程度患者对健康教育需求人数占96.67%,对接受健康教育持积极态度的人占93.33%,明显高于其他受教育程度人员(P0.01)。结论患者对健康教育内容需求程度有差异,不同特征人员对健康教育需求程度也不同,应根据患者的实际有的放矢、因人而异、形式多样的开展健康教育。     

The health and activities limitation index in patients with acute myocardial infarction

Utility assessment is required to estimate quality-adjusted life years, but is often avoided due to the cumbersome nature of elicitation techniques. The Health Activities and Limitations Index (HALex) offers a method of utility assessment using existing values from the National Health Interview Survey (NHIS) and a utility algorithm to derive preferences. The authors assessed the construct validity of the HALex by comparing derived values with directly assessed HALex utilities in patients post acute myocardial infarction (AMI). OLS regression was used to model the relationship between utilities and patient demographics, comorbidities, and treatment. The mean and median utility for patients (n = 160) was.57 (SD = 22) and.55 respectively, and was not statistically different from the mean [.57 (SD =.30)] and median (.58) for similar NHIS respondents (n = 46). Patients with a comorbidity index of three or less had mean utilities.13 higher than the mean utility for patients with an index of four or more. No relationship was found between patients' age, race, and income and their utilities. The HALex scoring algorithm is a promising means to obtain utilities, and provides a methodology to easily estimate utilities for patients, but is not without limitations.     

Quality of life after acute myocardial infarction: A comparison of diabetic versus non-diabetic acute myocardial infarction patients in Quebec acute care hospitals

Background  

Previous studies have evaluated the individual effects of acute myocardial infarction (AMI) and diabetes mellitus on health-related quality of life outcomes (QOL). Due to the rising incidence of these comorbid conditions, it is important to examine the synergistic impact of diabetes mellitus and AMI on QOL.     

急性心肌梗死的护理

目的:探讨急性心肌梗死病人的护理。方法:密切观察病情变化,及时、准确、有效的护理,可防止病情恶化,改善预后。结果:50例患者中,痊愈42例,好转6例,死亡2例,总有效率占96%,病死率占4%。结论:心肌梗死是一种常见的内科心血管疾病,急性期病死率高,严重危害患者的生命,精心护理在心肌梗死中占有重要地位,对病人进行全身心护理可以提高病人生存率。     

Repeat thrombolysis in acute myocardial infarction

During two years period (Jul. 97-Aug. 99) data of patients suffering from recurrent acute myocardial infarct within 6 days were compared by retrospective analysis. In this interval authors treated 58 patients with recurrent myocardial infarct. 22 patients were transmitted to a catheterisation lab, data of the other 36 patients were compared. There were two treatment groups: 18 patients received repeated thrombolysis (IT group), and 18 patients got conventional therapy (HT group). In the thrombolytic group 15 patients received streptokinase infusion again, and urokinase infusion was administred in 3 patients at second time. The patients were not transferred to a cath lab, because of their older ages (10 patients), or capacity problems (13 patients), or in absence of their signed consent (13 patients). Comparisons were made on the basis of non invasive diagnostic procedures (reperfusion signs suggested by ECGs and enzymatic changes, and left ventricular ejection fraction at discharge), bleeding rate, and frequency of recurring angina at the 3 months visit, and on the basis of mortality. Ejection fractions and reperfusion signs were better in the repeated thrombolytic group (time of maximal level ST elevation: IT 19.70 +/- 6.00 min, HT 23.17 +/- 5.15 min, p = 0.26 NS; T wave inversion time within six hours: IT 168 +/- 45.17 min, HT 170 +/- 58.99 min, p = 0.94; reperfusion arrhythmia: IT 7, HT 3, p = 0.15; CK peak time: IT 16.89 +/- 6.94 hour, HT 20.00 +/- 6.72 hour, p = 0.18 NS; CK-MB peak time: IT 12.22 +/- 7.19 hour, HT 16.67 +/- 6.17, hour, p = 0.55; > 3 x CK peak time: IT 14.18 +/- 6.03 hour, HT 20.00 +/- 7.37 hour, p = 0.06, > 3 x CK-MB peak time: IT 8.80 +/- 4.54 hour, HT 15.20 +/- 6.19 hour, p = 0.02, ECHO EF: IT 48.53 +/- 6.81%, HT 43.14 +/- 4.90%, p = 0.02, Isotope ventriculography EF: IT 50.87 +/- 5.45%, HT 44.57 +/- 4.89%, p = 0.003), however the bleeding rate was moderately higher (minor bleeding: IT 7, HT 3, p = 0.15, major bleeding: IT 3, HT 1). The frequency of ischemic episodes at 3-month visit, and 3-month mortality were similar in the two groups (episodes of angina: IT 2.00 +/- 1.57, HT 2.42 +/- 1.88, p = 0.55; mortality: IT 4, HT 6, p = 0.46). Repeated thrombolysis is an effective therapeutical tool in centres without cath lab--according to the risk-benefit ratio too--in the case of early repeated myocardial infarct.     

Thrombolysis in acute myocardial infarction.

Reperfusion of ischaemic myocardium with thrombolytic agents during the early stages of acute myocardial infarction reduces the mortality rate and can limit infarct size with associated sparing of left ventricular function. Effective and safe regimens are now available and in the absence of contraindications thrombolysis should now form part of the standard management acute myocardial infarction.     

急性心肌梗死的溶栓治疗

自从 1 979年心肌梗死溶栓治疗获得成功以来 ,各地相继开展了急性心肌梗死的溶栓治疗研究 ,不但挽救了数以百万计人口的生命 ,同时也积累了大量的临床经验。在我国溶栓治疗已日益完善 ,成为治疗急性心肌梗死的一项有效措施。1　常用溶栓药物的分类及现状1 .1　非纤维蛋白特异性溶栓剂　在激活血栓处的纤溶酶原的同时 ,也激活全身血液系统中的纤溶酶原。1 1 1　尿激酶 (UK)　可以直接激活纤溶酶原成纤溶酶 ,无抗原性 ,不产生过敏 ,近期内可重复使用 ,是当前国内应用最广的溶栓剂。一般 70kg体重者 ,用量约 1 5 0万U ,30min内输注 ,梗死…     

急性一氧化碳中毒致急性心肌梗死一例

正急性一氧化碳中毒病例临床常见,但中毒后引起急性心肌梗死少见报道。山东省立医院急救中心于2016年1月成功救治1例急性一氧化碳中毒致急性心肌梗死的患者,并行冠状动脉介入治疗手术,成功放入支架1枚,患者预后良好。现报告如下。1临床资料患者男性,55岁,于2016年1月24日18:00在家中出现头痛、头晕,随后意识不清,呼之不应,无恶心、呕吐,无大小便失禁。室内有取暖用蜂     

Hemodynamic complications of acute myocardial infarction

These complications can be broken down into three major categories: the direct effects of ischemia, the effects of myocardial rupture or similar structural loss secondary to ischemic insult, and the effects of inhibitory autonomic reflexes triggered by infarction. It is critical to correlate the hemodynamic problem with its etiology in order to choose the appropriate treatment.     

Early management of acute myocardial infarction

Management of acute myocardial infarction (AMI) has changed dramatically since 1962, when the world's first operating coronary care unit opened in our hospital. Recently, thrombolytic agents, aspirin and beta-blockers have been shown to reduce the mortality of patients with AMI if given early. This article reviews management strategies and therapeutic options currently available during the first 24 hours of the hospital phase of AMI.