544名实习护生艾滋病知识及态度的调查

目的了解实习护生对艾滋病相关知识、态度及相关影响因素,为有针对性地在实习护生中开展健康教育,进行艾滋病流行的干预提供依据。方法用整群抽样法,以班级为单位抽取共计558例实习护生,采取不记名自填问卷的方式进行艾滋病认知、态度问卷调查。结果实习护生对艾滋病知识处于中等水平,得分（9.49±3.16）分;对传播途径认识错误方面,62.5%认为感染HIV的孕妇分娩的婴儿也是HIV感染者、55.3%认为共用浴盆、游泳池传染HIV;在对高危行为认识错误中,44.3%认为肛交不传播,40%认为多个性伴侣不易传播;实习护生对待艾滋病的态度不容乐观,呈中等水平,得分（172.11±14.37）分。结论实习护生对艾滋病知识掌握不够,态度有待提高。对实习护生开展健康教育不仅要注重知识水平的提高,态度及高危行为的教育也很重要。     

实习护生对艾滋病相关知识掌握情况的调查分析

目的 了解实习护生对艾滋病相关知识掌握情况及影响因素,为有针对性开展健康教育提供依据.方法 用整群抽样法,以班级为单位抽取共计544例实习护生,采取不记名独立填写的方式进行艾滋病认知、态度问卷调查.结果 实习护生对艾滋病知识处于中等水平,平均得分(9.49±3.16)分,对主要传播途径认识正确率为81.40%;对高危行为和安全套等知识掌握仅有42.28%.实习护生对待艾滋病的态度呈中等水平,平均得分(172.11±14.37)分.艾滋病知识水平、态度水平的影响因素为学历、民族以及知识得分.结论 实习护生对艾滋病知识掌握不够,态度有待提高.对实习护生开展健康教育不仅要注重提高知识水平,更要加大对艾滋病的态度及高危行为的教育力度.     

护士对HIV感染者/AIDS病人歧视与其护理行为的相关性研究

[目的]了解护士对人类免疫缺陷病毒(HIV)感染者/艾滋病(AIDS)病人的歧视和护理行为现状,探讨二者之间的关系。[方法]2011年4月—5月采用分层配额的方法对北京协和医院300名护士进行问卷调查,以测量护士对艾滋病歧视水平和对HIV感染者/AIDS病人的护理行为。[结果]护士艾滋病歧视水平总体得分为(49.22±8.92)分,其中偏见维度得分最高为(3.67±0.89)分,工作中的歧视维度得分最低为(2.27±0.74)分。护士对HIV感染者/AIDS病人的护理行为总体得分为(102.88±17.77)分,其中健康教育得分最高为(3.57±0.54)分,生活护理得分最低为(3.26±0.62)分。护士艾滋病歧视水平与护理行为之间存在负相关(r=-0.518,P0.01)。[结论]护理行为与对艾滋病歧视水平呈负相关;降低护士艾滋病歧视水平,有利于提高护士对HIV感染者/AIDS病人的护理服务质量。     

对手术室护士无瘤技术知信行的调查

目的：了解目前手术室护士对无瘤技术的认知、态度和行为及其相关的影响因素,为进一步提高手术室的护理质量提供参考依据。方法采用自行设计的无瘤技术问卷对北京市某2所三级甲等肿瘤医院和2所三级甲等综合医院的158名手术室护士进行调查。结果男护士无瘤技术知信行（KAP）知识得分为（53．91±23．61）分,态度得分为100分,行为得分为（83．33±22．22）分,女性护士得分分别为（72．38±14．95）,（96．50±9．62）,（86．37±17．13）分,女性护士在知识和态度方面的得分与男性护士比较,差异无统计学意义（t值分别为-1．189,-0．481;P＞0．05）;而行为方面得分比较,差异有统计学意义（t＝4．456,P＜0．01）。相关分析发现,知识与操作得分呈正相关（r＝0．348,P＜0．01）;态度与行为得分呈正相关（r＝0．242,P＜0．01）;年龄、工龄与无瘤技术知识得分呈正相关（r值分别为0．329,0．326;P＜0．01）。肿瘤医院手术室护士的无瘤技术知识、态度和行为得分均高于综合医院手术室护士,差异有统计学意义（t值分别为-5．065,-2．648,-4．738;P＜0．05）。结论手术室护士对无瘤技术的知识掌握不理想,无瘤技术的相关操作有待统一化和规范化。工龄、年龄以及工作的手术室类型均为相关影响因素。     

护理本科生对艾滋病相关知识及态度的调查分析

目的了解护理本科生(护生)对艾滋病(AIDS)相关知识了解情况及对人类免疫缺陷病毒(HIV)感染者/AIDS患者的态度,为学校开展相关健康教育提供参考依据。方法 2011年2月采用问卷调查法,对285名护生进行调查,收回问卷276份,有效问卷257份。结果护生对HIV/AIDS相关知识平均得分为(21.2±3.8)分,对正确使用安全套知识平均得分为(3.7±1.6)分,各年级掌握情况有差异(P<0.001)。257名护生中,82.5%对因输血或注射感染HIV者持同情态度,33.9%和32.3%的护生对因婚前或婚外性行为、性服务者而感染HIV者持歧视态度。结论学校应对护生进行系统正确的HIV/AIDS相关知识的教育,培养护生正确对待HIV感染者/AIDS患者的态度。     

大学生艾滋病知识、态度、行为和感染危险性的调查分析

目的:了解湖南高校大学生对艾滋病知识、态度、行为和感染的危险性自我评估的现状,为制定相应对策提供科学依据。方法:采用现状调查,对1326名大学生艾滋病知识、态度、行为和感染危险性进行匿名问卷调查。结果:1326名调查对象中,有关AIDS知识得分为12.36±2.97(0～20),22.2％的大学生对HIV感染者持不能容忍和消极的态度,29％的大学生有饮酒行为,2.6％的大学生服用过带麻醉性质的药品,14.1％的大学生有过性行为,仅4.1％的认为目前有很大的危险性感染艾滋病。结论:在大学生中进一步加大力度开展控制和预防艾滋病的健康教育势在必行。     

青岛市高等学校大学生对肺结核防治认知及行为调查

目的了解青岛市高等学校大学生对肺结核防治认知及行为的状况,为高等学校结核病防治健康教育提供客观依据。方法采用自行编制的肺结核知识、态度、行为问卷,对1070名青岛市高等学校大学生进行调查。采用SPSS17．0统计软件进行数据分析。结果大学生肺结核知识平均得分为（4．09±1．59）分,全部知识知晓率为23．8％,单一知识知晓率为53．7％～85．5％;态度平均得分为（43．96±4．03）分;行为平均得分为（4．20±0．99）分。不同专业的大学生在肺结核知识和态度方面得分比较差异有显著性（F=57．56、8．08,P〈0．05）,而行为方面得分比较差异无显著性iF=1．89,P〉0．05）。结论大学生对肺结核的认知还不全面,态度还需要改善,健康行为有待强化。高等学校应加强对大学生结核病防治的健康教育。     

健康教育对贫困地区农村流动人口艾滋病知识、态度及行为干预效果的研究

[目的]探讨综合健康教育对贫困地区农村流动人口艾滋病知识、态度及行为的干预效果.[方法]以陕西省蓝田县为本研究的项目县,采用随机抽样方法抽取2个乡8个村,并将8个村随机分为干预组和对照组.对干预组进行为期4个月的综合性健康教育.应用艾滋病(AIDS)知识、态度及行为调查问卷进行干预效果评估.[结果]贫困地区农村流动人口艾滋病知识问卷总分为24.66分±4.69分(0分～36分),态度问卷总分为45.43分±11.23分(0分～75分),安全套使用率低,目的主要为避孕,非婚性行为者两组分别占2.6%、4.0%.实施综合健康教育后,干预组艾滋病知识得分明显提高(P<0.05),对伦理道德方面的态度、对艾滋病的态度和对艾滋病感染者/病人的态度得分和总分均有明显提高(P<0.05),非婚性行为安全套使用率100.0%,目的主要为预防性传播疾病,非婚性行为明显减少,与对照组比较差异均有统计学意义(P<0.05).[结论]贫困地区农村流动人口艾滋病知识总体认知水平不高,对艾滋病态度的正向倾向性较差,并存在高危行为.综合健康教育对提高贫困地区农村流动人口艾滋病知识、转变其态度及行为具有较好的干预效果.     

性传播疾病就诊患者艾滋病相关知识行为态度调查

目的调查和分析性传播疾病（STD）门诊患者艾滋病（AIDS）相关知识、行为和态度，为介入STD人群开展AIDS相关的防治干预提供依据。方法采用自制STD就诊患者情况调查表对280例STD就诊患者进行人口学特征、AIDS相关知识、行为和态度等的问卷调查，用SPSS13．0进行统计描述分析。结果STD就诊患者对AIDS相关知识认识不足；STD就诊患者存在感染人体免疫缺陷病毒（HIV）的高危行为。结论STD患者是HIV感染的高危人群，做好STD患者的健康教育和行为干预对预防STD／AIDS具有特殊重要的意义。     

脑卒中患者疾病防治知识与健康行为的现状调查及相关性研究

目的：描述脑卒中患者的疾病防治知识与健康行为水平,分析其相关性,为提高和改善其健康行为提供理论依据。方法便利抽取北京市某社区卫生服务站脑卒中患者106例,应用一般情况调查表评估患者的一般资料,应用脑卒中患者疾病防治知识问卷评估患者的疾病防治知识,应用健康促进生活方式量表II（HPLPII）评估患者的健康行为。结果脑卒中患者疾病防治知识得分为（23．25±3.15）分,总正确率77．51％,处于中等水平,脑卒中患者健康行为总体得分（131．57±19．71）分,脑卒中患者疾病防治知识得分和健康行为得分呈正相关（r＝0．41,P＜0．05）。结论在护理工作中,应重视提高脑卒中患者的疾病防治知识,有效地提高其健康行为水平。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.