Comments on the care provided at the Santa Clara Heart Center

The essential objective of this work is the care provided at Santa Clara Heart Center to a total of 170 patients who underwent Cardiovascular surgery from October 1986 to December 1987. Data were collected from the record book of the Surgical Intensive Care Unit of the Heart Center, taking into account the following variables: sex, age, place of residence, frequency of extracorporeal and closed surgery applied, as well as the causes of the repeated surgery performed. It was found that extracorporeal surgery was performed in 82.2% of patients, who underwent mostly elective cardiovascular surgery. There was a prevalence of acquired diseases. The most frequent causes for repeated surgery were mediastinitis (wound sepsis) and postoperative bleeding. Surgical mortality was 5.8% (112 patients).     

Some Comments Regarding the Allergic State

Areas within which ragweed (Ambrosia) pollen concentrations equaled or exceeded selected values were determined from measurements around ten experimental ragweed sources. These areas were related to source size, surrounding vegetative cover, and meteorological conditions. Areas from 6 to 100 times the source area had mean concentrations above 100 grains/cu m while concentrations above 10 grains/cu m were found over areas from 11 to 300 times the source area. The size of the polluted area was related directly to source size and inversely to wind speed and the removal efficiency of surrounding vegetation.     

农村孕产妇住院分娩保障效果评价*

目的分析调研地区农村孕产妇住院分娩保障采取措施、效果及存在的问题,并提出建议。方法通过文献研究和现场调研收集资料,采用定性和定量分析软件进行数据分析。结果调研地区通过出台配套政策、统筹城乡医保和多元化筹资渠道等措施实现了农村孕产妇住院分娩政策的平稳过渡,如孕产妇保健服务利用、住院分娩率等较为稳定,但也存在顺产和剖腹产总费用上涨,报销比例较低的情况。结论调研地区农村孕产妇住院分娩保障政策过渡较为平稳,但仍存在一些问题,因此本研究提出如下建议:住院分娩顺产费用纳入基本医疗保障,逐步实现产妇零承担;合理制定住院分娩费用支付方式,促进孕产妇自然分娩;促进城乡孕产妇生育受益公平化,建立农村生育保险制度。     

国际旅行卫生保健中心发展的几点思考

〔目的〕探讨入世后新形势、新任务下我国国际旅行卫生保健中心的工作对策。〔方法〕笔者结合工作实践,从体制创新和制度创新的角度对国际旅行卫生保健中心在改革发展过程中如何加强自身体系建设进行探讨。〔结果〕各级国际旅行卫生保健中心应明确各自职责,切实落实“垂直体制,双重管理”模式,大力推行保健中心品牌建设,完善保健中心分级管理办法并加强与出入境管理部门的横向联系,加快保健中心信息化建设步伐。〔结论〕我国国际旅行卫生保健中心作为检验检疫工作技术保障机构及具有医疗行业特色的医疗保健机构应以“服务经济,促进发展”为中心,大力推进事业单位机构改革进程,努力开拓国际旅行卫生保健事业的新局面。     

婚前健康教育工作实施体会

婚前健康教育已成为婚前保健技术服务的法定内容和重要策略。婚前健康教育对于提高婚检质量、保障母婴健康、提高出生人口素质具有积极作用。广州市番禺区妇幼保健院在实施围婚保健系列服务过程中 ,着重加强了健康教育工作 ,收到较好的效果。1 按标准创设健康教育环境　我院按《母婴保健专项技术服务基本标准》设立宣教室 ,环境温馨、优美 ,配置录像、影碟、录音、男女生殖系统解剖模具等宣教设备 ,墙面布置有婚育指导及避孕知识宣传栏 ,图文并茂 ,通俗易懂。还设有“悄悄话”咨询室 ,便于一对一、面对面交流 ,满足前来婚前检查者的心理需…     

Association of West Nile virus illness and urban landscapes in Chicago and Detroit

Background  

West Nile virus infection in humans in urban areas of the Midwestern United States has exhibited strong spatial clustering during epidemic years. We derived urban landscape classes from the physical and socio-economic factors hypothesized to be associated with West Nile Virus (WNV) transmission and compared those to human cases of illness in 2002 in Chicago and Detroit. The objectives were to improve understanding of human exposure to virus-infected mosquitoes in the urban context, and to assess the degree to which environmental factors found to be important in Chicago were also found in Detroit.     

Midwifery Care at a Freestanding Birth Center: A Safe and Effective Alternative to Conventional Maternity Care

Objective

To estimate the effect of a midwifery model of care delivered in a freestanding birth center on maternal and infant outcomes when compared with conventional care.

Data Sources/Study Setting

Birth certificate data for women who gave birth in Washington D.C. and D.C. residents who gave birth in other jurisdictions.

Study Design

Using propensity score modeling and instrumental variable analysis, we compare maternal and infant outcomes among women who receive prenatal care from birth center midwives and women who receive usual care. We match on observable characteristics available on the birth certificate, and we use distance to the birth center as an instrument.

Data Collection/Extraction Methods

Birth certificate data from 2005 to 2008.

Principal Findings

Women who receive birth center care are less likely to have a C-section, more likely to carry to term, and are more likely to deliver on a weekend, suggesting less intervention overall. While less consistent, findings also suggest improved infant outcomes.

Conclusions

For women without medical complications who are able to be served in either setting, our findings suggest that midwife-directed prenatal and labor care results in equal or improved maternal and infant outcomes.     

Some Comments on Mapping from Disease-Specific to Generic Health-Related Quality-of-Life Scales

An article by Lu et al. in this issue of Value in Health addresses the mapping of treatment or group differences in disease-specific measures (DSMs) of health-related quality of life onto differences in generic health-related quality-of-life scores, with special emphasis on how the mapping is affected by the reliability of the DSM. In the proposed mapping, a factor analytic model defines a conversion factor between the scores as the ratio of factor loadings. Hence, the mapping applies to convert true underlying scales and has desirable properties facilitating the alignment of instruments and understanding their relationship in a coherent manner. It is important to note, however, that when DSM means or differences in mean DSMs are estimated, their mapping is still of a measurement error–prone predictor, and the correct conversion coefficient is the true mapping multiplied by the reliability of the DSM in the relevant sample. In addition, the proposed strategy for estimating the factor analytic mapping in practice requires assumptions that may not hold. We discuss these assumptions and how they may be the reason we obtain disparate estimates of the mapping factor in an application of the proposed methods to groups of patients.