山东省卫生监督人力资源配置现状及其公平性分析

目的了解2014—2016年山东省卫生监督人力资源配置现状及其公平性。方法采用描述性分析、洛伦兹曲线、基尼系数及卫生资源密度指数(HRDI)进行公平性分析与评价。结果山东省卫生监督人力资源总量呈上升趋势,但配置数量仍然不足;除其他技术人员外,以45～54岁年龄段人员为主;专科及以上学历占比较高,机构基本合理;各类卫生监督人力资源按人口分布的洛伦兹曲线优于按地理分布,其他技术人员配置公平性最差;卫生监督人力资源按人口分布和按地理分布的基尼系数,除其他技术人员外,均处于配置基本公平状态;卫生监督人力资源配置地域间差异明显。结论山东省卫生监督人力资源总量呈上升趋势,但配置数量不足,公平性有待提高,卫生监督人员结构需要进一步优化,各类型人员按人口分布优于按地理分布。     

健康人力资本与个人收入经济发展的关系

论述了健康影响经济的相关理论，从健康与经济发展、健康与个人收入、健康与经济增长3个方面对健康对经济影响进行实证分析。从历史经济发展及近年来在微观经济学领域和宏观经济学领域关于健康人力资本、个人收入、经济发展三者关系研究，证实了健康人力资本通过改善个体在劳动市场的表现，提高了个人收入，并且作为一种投资直接促进了经济增长。     

rhEPO、rhG-CSF对芥子气全身吸收中毒犬疗效观察

目的　评价重组人红细胞生成素 (rhEPO)、重组人粒细胞集落刺激因子 (rhG CSF)对芥子气全身吸收中毒犬的治疗效果。方法　以成年家犬为中毒模型 ,共 10条 ,中毒剂量为 12mg kg,皮下注射。随机分为中毒对照组 4条 ,治疗组 6条 ,治疗组动物在中毒后 30min即进行相应的药物治疗。中毒前所有犬各测一次血常规的基础值 ,中毒后每日监测血常规的动态变化 ,持续 1周。结果　对照组犬于 3天内死亡 3条 ,治疗组犬全部成活。对照组白细胞计数 (WBC)在中毒后第 3开始剧烈下降 ,红细胞计数 (RBC)在中毒后即有轻度上升 ,之后回落 ;而治疗组WBC、RBC在中毒后 1周内均无显著变化。两组的淋巴细胞计数 (LYM)在中毒后都有显著下降 ,治疗组稍好于对照组。治疗组的网织红细胞计数 (RC)于中毒后第 2天开始显著增长 ,之后维持在高水平 1周左右。治疗组的RC变化不明显。结论　犬芥子气中毒后 ,应用rhEPO、rhG CSF能明显改善中毒犬的部分血常规指标     

“八位一体”的农村卫生人力资源开发与管理新机制

卫生人力资源是卫生资源中最主要的资源[1].农村卫生人力资源的开发与管理能力决定着农村医疗工作的诊疗质量和公共卫生服务水平;整体人力资源的素质则决定着农村卫生事业的兴衰.做好农村基层卫生服务,人才是关键[2].建立一支训练有素、适应性强的医疗卫生专业人才队伍和畅通农村分享城市优良卫生人力资源的渠道是我们亟待解决的问题.自2009年实施卫Ⅺ项目以来,实施“公开招录、竞争上岗、拜师带徒、强化培训、借力助教、鼓励进修、创新平台、严格考核”的“八位一体”的人才系统工程,探索出一条全面提升农村卫生人力资源素质的新路子.     

Changing medical doctor productivity and its affecting factors in rural China

Using the data collected from the health facility-based survey, part of the national health service survey conducted in 1993 and 1998, this paper tries to examine changes in labour productivity among the county-level hospitals and township health centres in rural China, and to analyse factors affecting the changes. The results presented in the paper show that the average number of outpatient visits per doctor per day and the average number of inpatient days per doctor per day declined significantly over the period from 1986 to 1997. The main factors resulting in the reduction of productivity are associated with the increase of inappropriate staff recruitment in these health facilities, the significant decline of rural population covered by health insurance, particularly rural cooperative medical schemes (CMS), and the rapid rise of health care costs. The latter two factors also have brought about a reduction in the use of these health facilities by the rural population. The paper suggests that the government should tighten up the entrance of health and non-health staff into the rural health sector and develop effective measures aimed to avoid providing pervasive financial incentives to the over-provision of services and over-use of drugs. In addition, other measures that help to increase the demand for health services, such as the establishment of rural health insurance, should be considered seriously.     

基于分级诊疗的广西卫生人力资源配置分析

目的:从推进实施分级诊疗的视角,对比分析广西的医院和基层医疗卫生机构卫生人力资源配置状况与存在问题,并有针对性地提出政策建议。方法:对广西相关年份的医院及基层医疗卫生机构的卫生人力资源配置状况进行分析和讨论。结果:广西医院及基层医疗卫生机构卫生人力资源均呈增长趋势,但医院与基层医疗机构之间在人员数量、学历及职称构成等人员质量方面仍有较大差距,优势资源仍有向医院汇集的态势。结论:广西的卫生人力资源配置与分级诊疗的需要仍不相适应,建议政府加大基层卫生人力供给、改革基层医务人员薪酬制度、加快推进医联体改革,引导卫生人力资源向基层流动。     

重组人促红素联合蔗糖铁治疗妇科恶性肿瘤相关性贫血的疗效及不良反应观察

目的观察重组人促红素联合蔗糖铁治疗妇科肿瘤相关性贫血的临床效果及不良反应。方法选取2014年1月至2016年4月在中国医科大学附属盛京医院就诊的妇科肿瘤相关性贫血患者82例,其中观察组42例,对照组40例。观察组给予重组人促红素注射液联合蔗糖铁注射液治疗及预防贫血,重组人促红素注射液150 IU/kg/次皮下注射,每周3次。蔗糖铁注射液200 mg静脉注射,每周3次,连续8周。对照组血红蛋白(hemoglobin,HB)80g/L时,未予升血治疗而仅行化疗。观察两组治疗前及治疗后的红细胞(red blood cell,RBC)计数,HB、红细胞比容(hematocrit,HCT)及不良反应。结果观察组治疗后RBC、HB、HCT均高于治疗前,且均高于对照组,差异有统计学意义(P0.05);对照组8周后RBC、HB、HCT均低于化疗前,差异有统计学意义(P0.05)。观察组无血栓等不良反应发生。结论化疗可加重妇科肿瘤相关性贫血,而重组人促红素联合蔗糖铁治疗妇科肿瘤相关性贫血,临床效果显著。     

2011-2017年四川省市、县级疾控检验人员结构动态分析

目的分析2011-2017年四川省市、县区级疾控机构卫生检验技术人员数据,通过人员结构变化以得到近期发展动态特点。方法从中国疾控基本信息系统获得人员结构数据并进行分析。结果2011-2017年,检验人员年平均数量1372人,市、县级年平均数量为339人、1033人,构成比平均值分别为15.97%(13.09%~19.17%)、11.69%(10.95%~12.99%),2012年的下降趋势和2017年的上升趋势较为明显。地区疾控机构检验人员数量构成比年度均值区间为7.28%~17.41%,其中,一类地区区间为:攀枝花(13.96%)~成都市(17.41%);二类地区区间为7.28%(雅安市)~15.64%(德阳市);三类地区区间为:7.88%(阿坝州)~10.75%(甘孜州)。检验人员性别比从73.19下降至61.12,其中县级性别比例从67.82降至54.16。部分年份检验人员中、高级职称构成比均出现年度下降趋势,初级及以下职称构成比2013年后开始明显上升,2017年较2011上升8.6%(市26.24%、县3.56%)。研究生和本科人员构成比均增加,其中本科学历增幅为50.73%(市42.07%、县62.75%)。结论2011-2017年,市、县级疾控检验人员数量和构成比年份趋势明显,男女性别比呈现下降趋势;地区人员构成比差异较大,三州地区检验人员构成比水平仍需提高;研究生和本科人员构成比增加;市级疾控检验人员指标机构优于县级,县级检验人员配置建设应该得到重视。     

Nutraceuticals and skin appearance: Is there any evidence to support this growing trend?

The rise of the nutraceutical market, specifically oral nutrition supplements claiming to improve skin appearance, is striking. This paper aims to examine the published scientific evidence for beneficial effects of nutraceuticals on skin appearance. An overview of skin physiology and intrinsic and extrinsic ageing is provided which underlies the potential physiological processes nutraceuticals purport to counter. Common ingredients used are explored. Some of these (vitamins A, C, B₂, B₃, B₇, copper, iodine, zinc) have authorised skin‐related health claims, but many do not. Current evidence for those without existing authorised claims (e.g. green tea extract, pomegranate extract, carotenoids, evening primrose oil, borage oil, fish oil, collagen and co‐enzyme Q10) is reviewed, focussing primarily on evidence from randomised controlled trials where available, in relation to skin parameters including wrinkles and hydration. Issues of safety are also considered, and the postulated mechanisms for some emerging ingredients, such as cocoa flavanols and probiotics, are explored. Evidence from high quality human trials demonstrating clear benefit is required by regulatory authorities in order for foods and nutrition supplements to carry a health or beauty claim. To date, the evidence for many ingredients in relation to skin appearance is limited, not sufficiently robust and/or inconsistent. Although there are a small number of human studies suggesting a potential benefit and some plausible biological mechanisms, much of the evidence to date comes from animal and in vitro studies. There are simply not enough good quality randomised controlled trials in this area to draw firm conclusions about the benefit of nutraceuticals to skin appearance.     

The temporal relation between cigarette smoking and pancreatic cancer

Temporal trends in US cigarette smoking prevalence rates 1920 to 1978, were related to temporal trends in US pancreatic cancer mortality rates in both sexes. In males, the rise and fall in smoking prevalence was followed by a rise and recent fall in cancer rates. In females, the later rise in smoking prevalence has been accompanied by a rise in cancer rate, and a recent slight decline in smoking rate has been associated with a slowing of the rise in cancer rate.     

Overview of Beneficial Effects of (Poly)phenol Metabolites in the Context of Neurodegenerative Diseases on Model Organisms

The rise of neurodegenerative diseases in an aging population is an increasing problem of health, social and economic consequences. Epidemiological and intervention studies have demonstrated that diets rich in (poly)phenols can have potent health benefits on cognitive decline and neurodegenerative diseases. Meanwhile, the role of gut microbiota is ever more evident in modulating the catabolism of (poly)phenols to dozens of low molecular weight (poly)phenol metabolites that have been identified in plasma and urine. These metabolites can reach circulation in higher concentrations than parent (poly)phenols and persist for longer periods of time. However, studies addressing their potential brain effects are still lacking. In this review, we will discuss different model organisms that have been used to study how low molecular weight (poly)phenol metabolites affect neuronal related mechanisms gathering critical insight on their potential to tackle the major hallmarks of neurodegeneration.     

HIV risk and testing behaviors among pregnant women tested for HIV in Florida by site type, 2012

The numbers of perinatal human immunodeficiency virus (HIV) infections in the United States have continued to decline, but the prevalence of female adults and adolescents living with diagnosed HIV infection continues to rise. Opportunities still exist to prevent mother-to child HIV transmission. The objective of this study was to identify demographics, HIV risk, and testing behaviors among pregnant women and to compare these characteristics by HIV testing site type. Multivariable analyses were conducted to examine demographics, HIV risk, and testing behaviors among 24,836 records of pregnant women publicly tested for HIV in the state of Florida in 2012. The testing records indicated that Latina and non-Hispanic black (NHB) women had decreased odds of reporting partner risk compared to those from non-Hispanic white women (Latina: adjusted odds ratio [AOR] 0.20, 95 percent confidence interval [CI]: 0.14–0.28; and NHB AOR 0.14, 95 percent CI: 0.10–0.21), and women tested in prisons/jails had higher odds of reporting previous HIV testing compared to those tested in prenatal care sites (AOR 1.86, 95 percent CI: 1.03–3.39). An understanding of HIV risk and testing behaviors among pregnant women by site type may enhance current targeted testing and prevention strategies for pregnant women and facilitate timely linkage to care.     

基于集聚度和集中指数的山东省护理人力资源配置现状及公平性分析

目的 对山东省护理人力资源的配置现状及公平性进行分析,为优化山东省护理人力资源配置提供依据。方法 描述性分析2015—2019年山东省注册护士现状,利用集聚度与集中指数评价山东省护理人力资源配置的公平性。结果 山东省注册护士数、每千人口注册护士数以及床护比等均呈上升趋势,但2019年护士占卫技人员比例与医护比有所下降。中部地区护理人力资源集聚度大于1,差值大于0;西南部地区集聚度小于1,差值均小于0。山东省护理人力资源集中指数均大于0。结论 山东省护理人力资源总量稳步提高,但医护比例倒置问题未得到解决。山东省护理人力资源按地理和人口分布存在差异,存在向经济水平较高地区集中的倾向。医疗卫生主管部门应合理规划不同地市护理人员的配置,引导护理人力资源配置向欠发达地区倾斜,以保证山东省护理人力资源平衡。     

1985-2016年温州市HIV感染者和病人死亡情况分析

目的 了解1985-2016年温州市新报告艾滋病病毒(human immunodeficiency virus, HIV)感染者和病人死亡状况,为制定防控措施提供科学依据。 方法 以1985-2016年报告的所有现住址为温州市的HIV感染者和病人死亡病例为研究对象,对其一般人口学特征、存活时间、死亡原因、抗病毒治疗等情况进行统计分析。 结果 1985-2016年累计报告现住址为温州市的HIV/AIDS病例3 512例,其中死亡516例,病死率为14.69%。在所有死亡病例中男性占83.72%, 50岁及以上年龄组占56.01%,已婚有配偶占57.75%,小学及以下占54.85%,农民占35.85%,医疗机构发现占79.46%,异性传播占80.62%。死于艾滋病及其相关疾病者占51.74%,2010-2016年历年因艾滋病及其相关疾病死亡的比例呈下降趋势,非艾滋病相关死亡的比例呈上升趋势(χ²_趋势=5.81,P=0.016)。死亡病例确诊阳性后中位存活时间为173 d,1年内死亡的占60.66%。接受过艾滋病抗病毒治疗者占33.53%,随着存活时间的延长艾滋病及其相关疾病死亡者中接受抗病毒治疗所占比例整体呈上升趋势(χ²_趋势=29.43,P=0.000)。死前做过CD4⁺T淋巴细胞检测者占56.01%,最近一次CD4⁺T淋巴细胞＜200/μl者占58.82%。 结论 最近几年温州市非艾滋病相关死亡成为HIV/AIDS病例的主要死因,死亡病例的晚发现比例高,CD4⁺T淋巴细胞检测和抗病毒治疗比例低,今后需扩大检测覆盖面,及时发现HIV感染者,加强随访管理,以减少HIV感染者死亡,延长患者存活时间。     

Glycoprotein B (gB) vaccines adjuvanted with AS01 or AS02 protect female guinea pigs against cytomegalovirus (CMV) viremia and offspring mortality in a CMV-challenge model

The transmission of cytomegalovirus (CMV) from mother to fetus can give rise to severe neurodevelopment defects in newborns. One strategy to prevent these congenital defects is prophylactic vaccination in young women. A candidate vaccine antigen is glycoprotein B (gB). This antigen is abundant on the virion surface and is a major target of neutralization responses in human infections. Here, we have evaluated in a challenge model of congenital guinea pig CMV (GPCMV) infection, GPCMV-gB vaccines formulated with the clinically relevant Adjuvant Systems AS01_B and AS02_V, or with Freund's adjuvant (FA). Fifty-two GPCMV-seronegative female guinea pigs were administered three vaccine doses before being mated. GPCMV-challenge was performed at Day 45 of pregnancy (of an estimated 65 day gestation). Pup mortality rates in the gB/AS01_B, gB/AS02_V, and gB/FA groups were 24% (8/34), 10% (4/39) and 36% (12/33), respectively, and in the unvaccinated control group was 65% (37/57). Hence, efficacies against pup mortality were estimated at 64%, 84% and 44% for gB/AS01_B (p < 0.001), gB/AS02_V (p < 0.001) and gB/FA (p = 0.014), respectively. Efficacies against GPCMV viremia (i.e. DNAemia, detected by PCR) were estimated at 88%, 68% and 25% for the same vaccines, respectively, but were only significant for gB/AS01_B (p < 0.001), and gB/AS02_V (p = 0.002). In dams with viremia, viral load was approximately 6-fold lower with vaccination than without. All vaccines were highly immunogenic after two and three doses. In light of these results and of other results of AS01-adjuvanted vaccines in clinical development, vaccine immunogenicity was further explored using human CMV-derived gB antigen adjuvanted with either AS01_B or the related formulation AS01_E. Both adjuvanted vaccines were highly immunogenic after two doses, in contrast to the lower immunogenicity of the unadjuvanted vaccine. In conclusion, the protective efficacy and immunogenicity of adjuvanted vaccines in this guinea pig model are supportive of investigating gB/AS01 and gB/AS02 in the clinic.     

Blood glucose rise after lactose tolerance testing in infants

Lactose tolerance tests are used clinically to screen children and infants. It is assumed that absorption of a lactose challenge in infants would occur in a predictable pattern prior to weaning. Twenty-one infants from 3 to 12 months of age were studied. The maximum blood glucose rise over fasting levels ranged from 11.0 to 62.0 mg/100 ml; the mean was 32.6 mg/100 ml. Six infants had a maximum rise of less than 20 mg/100 ml. Eleven infants (52%) had a maximum rise of greater than 30 mg/100 ml. Signs of intolerance were not noted in any subject. Weight and length were normally disturbed. Results indicate the variance in glucose rise existing within a population of infants growing normally and consuming milk. Gastric emptying, digestion, and absorption may influence the blood glucose rise after a lactose test. Established glucose levels used as an index to lactose absorption in older children and adults may not accurately reflect lactase activity in infants.     

山东省疾病预防控制机构人力资源配置现状与公平性分析

[目的]了解山东省疾控机构人力资源配置状况,针对其存在的问题提出相应的对策建议,为优化疾控人力资源配置和政府决策提供参考依据。[方法]依托统计年鉴相关数据,对山东省2012-2017年疾控机构人力资源配置现状进行描述性分析,并运用基尼系数和卫生资源密度指数分析其按人口和地理分布的公平性。[结果]山东省疾控机构人力资源总量呈下降趋势,各类人员配置比例均未达到国家标准;按人口分布的公平性优于按地理分布,区域间差异明显;女性逐渐多于男性,年龄结构仍不合理,老龄化趋势明显,学历水平呈上升趋势,但大专及以下学历人员比重仍较大,职称总体水平偏低,高级职称人员缺乏。[结论]山东省疾控机构人力资源总量不足,区域间配置差异明显,人员结构不合理。为此,应充分发挥政府职能作用,通过建立健全人才准入、培养和激励机制,建设“互联网+公共卫生”平台,完善公共卫生服务体系,提升人员素质,优化资源配置。     

Transhepatic hormone levels in the portacaval shunted pig--the effects of arginine upon gastrin and glucagon release.

Hypergastrinemia and hyperglucagonemia follow portacaval shunt (PCS) or cirrhosis in man and experimental animals. The cause is unknown although portal diversion and hepatic dysfunction are suggested. In these studies transhepatic techniques were used to define the hepatic handling of basal and arginine-stimulated gastrin and glucagon levels in sham-operated and portacaval-shunted pigs and in a group of pair-fed sham-operated pigs. After PCS, basal gastrin levels were lower than those in sham-operated animals but were also lower in the pair-fed group, suggesting that the change resulted from partial starvation. Arginine-stimulation caused a rise in hepatic venous levels in PCS and in pair-fed pigs and in portal venous levels in sham-operated pigs. These data also suggested a response to diminished intake in PCS pigs. There was an immediate transitory rise in portal immunoreactive glucagon (Unger 30K) after PCS and a subsequent rise from the 4th postoperative day in all circulations. Arginine stimulation caused in sham-operated and PCS pigs a biphasic rise in the portal circulation and a later rise in the arterial circulation in PCS pigs. These data suggest that the effect of PCS upon gastrin levels is associated with the impaired appetite while the effect upon glucagon is the result of diversion past the liver.