Effect of defocusing and of distracted attention upon recordings of the visual evoked potential

Pattern reversal visual stimuli are used to evoke potentials (VEPs) for assessment of visual acuity and for localizing defects along the visual pathways. Our goal was to assess the importance of attention and defocusing to the recordings of pattern VEP. Forty-one volunteers with normal (6/6) corrected visual acuity participated in this study. Twenty-one were asked to defocus intentionally the visual stimulus (located 200cm away) by fixating at a target 25 or 50cm from the eye. Twenty other subjects performed auditory tasks to distract their attention from the visual stimulus. Pattern VEPs were elicited by different check sizes. The amplitude and time-to-peak of the P₁₀₀ wave were measured. Intentional defocusing caused amplitude reduction and prolongation of the time-to-peak in young subjects (20–34years old). With the smallest checks used (7.5) we could not record a reliable response from 43 of the young subjects (6 out of 14). In older patients (35–61years old), intentional defocusing induced negligible effects on pattern VEPs regardless of check size. There were no effects of auditory distraction upon the pattern VEPs. Our data suggest that intentional defocusing can produce false positive results (reduced VEP with prolonged time-to-peak) only when small checks are used in young subjects. Divided attention has negligible effect on the recordings of pattern VEPs. With proper controls, the pattern VEP test can be used for objective assessment of visual function.     

Psychiatric services and training for children and adolescents in Europe: Results of a country survey

Mental health budgets, services and programs are seldom commensurate with mental health needs in the countries, particularly of population groups whose voice in advocacy is weak. In this inquiry we explored the adequacy of mental health care resources available for the young in Europe. To achieve this objective this survey investigated a few variables (e. g., number of services, degree of coverage, trained personnel) that were used as gross indicators of the discrimination suffered by this health sector. We sent a short postal questionnaire to the mental health focal points of the 51 countries included in the World Health Organization European Region. Thirty six countries (70.5 %) responded. The results showed that the degree of coverage and quality of services for the young were generally worse in comparison with those for adults, including for serious disorders. A lack of both specialized and in-training personnel was identified. The exposure of general practitioners and pediatricians to psychiatry for the young was limited. Generally, the lower the income level of the country the worse the situation. Our mapping confirmed findings of previous inquiries. European child psychiatry leaders had raised a set of recommendations to improve the current situation; their implementation can now benefit from novel strategies adopted by the World Health Organization to advance mental health worldwide.     

Diagnostic laparoscopy for penetrating injuries in the thoracoabdominal region

Background The role of laparoscopy in diagnosis of penetrating abdominal injuries is still controversial. In the present investigation diagnostic laparoscopy was studied in penetrating injuries of the thoracoabdominal region.Methods Between March 1998 and June 2003, 43 patients with penetrating thoracoabdominal injuries underwent diagnostic laparoscopy at the Rambam Medical Center. There were 41 males and two females; the average age was 30 years (range, 16–54 years). Thirty-one patients had a lower chest injury, eight patients had an upper abdomen and flank injury, and four patients had combined chest and abdomen injuries. In 11 patients intraperitoneal penetration was diagnosed. In 10 patients the procedure was converted to open laparotomy, and one patient with a small laceration of the right diaphragm opposite the liver was observed without laparotomy.Results The average operating time for the laparoscopy was 25 min (10–45 min), and 85 min (40–175 min) for laparotomy. Patients who underwent laparoscopy were discharged after an average of 1.6 (1–3) days, while those who underwent laparotomy were discharged after an average of 7.6 (2–15) days.Conclusions Laparoscopy is a useful diagnostic tool in penetrating injuries of the chest, thoracoabdominal region, and flank. This procedure is particularly reliable in diaphragmatic tears. Laparoscopy should be considered the procedure of choice for the evaluation of penetrating injuries of the lower chest and upper abdomen for diagnosis of peritoneal penetration.     

论“三项改革”及其对医疗机构发展的影响

本文通过分析城镇职工基本医疗保险制度、医疗机构和药品生产流通体制"三项改革"实施的背景、目的、内容,阐明 改革的必然性和重要性;论述了安徽省"三项改革"实践对医疗机构产生的积极影响及医疗机构在改革中取得的初 步成效.文中涉及值得注意的几个观点和内容,在实际中具有一定的意义:一是将"三项改革"的目标体系表述为三 个,即比较低廉的费用,比较优质的服务和提供医疗服务的主体医疗机构的健康发展,让群众享有价格合理、质量 优良的医疗服务,提高人民的健康水平;二是以安徽省改革成果为例,选择适宜的指标体系,如单病种医疗效果和 费用分析,医疗业务收入构成等,初步数量化地表述"三项改革 "给医疗机构降低费用、提高质量、机构健康发展方面带来的影响和成效;三是提出医疗服务质量是医疗机构健康发展永恒的主题和生命线.     

分类树中QUEST算法与多水平logistic模型的联合应用与比较

目的探讨分类树中的QUEST算法和多水平logistic模型联合应用于分析层次资料的可行性.方法首先介绍模型的原理,据此提出联合应用的具体思路,然后采用分析实例进行深入探讨,并用预测准确率和ROC曲线对模型拟合效果加以比较.结果QUEST算法能非常准确地搜索出主要影响因素,并能更加深入地刻画因变量、自变量间的复杂联系,在此基础上再进行多水平logistic模型会更加高效、准确.结论QUEST算法和多水平logistic模型各有优势,将它们联合用于层次资料的分析将更能保证分析的正确性和完善性.     

湖南省不同管电压胸部X射线摄影所致受检者入射体表剂量比较

目的:比较在胸部X射线摄影中不同管电压对受检者入射体表剂量(ESD)的影响。材料与方法:在湖南省范围内,按不同级别的医院和疾病预防控制中心进行抽样,对抽样单位的每台胸部摄影设备抽取10例成年病人,采用热释光计量计(LiF,Mg,Cu,P)对接受临床胸部后前位(PA)和侧位(LAT)摄影检查病人的ESD进行测量,按不同的摄影管电压进行分类统计分析。结果:抽取了31家卫生医疗机构共35台放射诊断设备,获得胸部PA摄影110～150kVp的高仟伏模式和低于110kVp的常规仟伏模式病人数分别为88例和138例,平均每次放射摄影所致病人ESD分别为0.2874mGy/次和0.4523mGy/次,LAT高仟伏模式和常规仟伏模式摄影病人分别为23例和50例,平均每次放射摄影所致病人ESD分别为0.9976mGy/次和0.7016mGy/次。除直接数字摄影(DR)系统外,屏片系统和计算机摄影(CR)系统使用高仟伏模式进行胸部PA摄影时,ESD均较低,胸部LAT摄影时,无论何种系统,两种管电压模式所致病人的ESD影响无差异。结论:在湖南省抽样单位,在屏片系统和CR系统胸部PA摄影中使用高仟伏可降低病人的ESD。     

2008年卫生应急工作要点

2008年卫生应急工作总的指导思想是：认真学习贯彻党的十七大精神，以邓小平理论、“三个代表”重要思想为指导，深入贯彻落实科学发展观，全面实施《中华人民共和国突发事件应对法》（以下简称《突发事件应对法》）、《突发公共卫生事件应急条例》、《国家突发公共事件总体应急预案》、《国家突发公共卫生事件应急预案》、《国家突发公共事件医疗卫生救援应急预案》，贯彻落实《国务院关于全面加强应急管理工作的意见》、《卫生部关于加强领导完善机制全面推进卫生应急工作的通知》和《全国卫生部门卫生应急管理工作规范》，进一步完善卫生应急机制、体制和法制，加强卫生应急管理体系、预案体系建设，切实落实卫生应急工作总体部署和各项措施，积极推进卫生应急工作全面展开，不断提高应对突发公共卫生事件的能力。     

Positive serology for<Emphasis Type="Italic"> Helicobacter pylori</Emphasis> and vomiting in the pregnancy

Introduction. Recently, several investigators have suggested that H. pylori may be a contributory factor in hyperemesis gravidarum. The purpose of this study was to evaluate whether seropositivity for IgG antibodies to H. pylori may also be related to nausea, vomiting, heartburn and epigastric pain in pregnancy. Materials and methods. One hundred and eighty-five women, at term pregnancy, were included in the study. All women completed a questionnaire regarding information on the number of pregnancies and deliveries, weight gain, smoking and gastrointestinal complaints before and during pregnancy. The presence of H. pylori infection was determined by serology. Results. The overall prevalence rate of H. pylori seropositivity was 45.9%. Women positive for H. pylori IgG were older (28.7±4.5 vs. 27.0±4.5, p=0.02), had more prior pregnancies (3.2±2.1 vs. 2.6±1.6, p=0.02) and deliveries (2.6±1.6 vs. 2.0±1.1, p=0.006) and reported vomiting in the first trimester more frequently than H. pylori negative patients (81.2% vs. 65%, p=0.004). On the other hand vomiting in the second trimester was reported more frequently among smokers during pregnancy compared to non-smokers. Conclusions. H. pylori seropositivity is significantly associated with emesis gravidarum but not with gastro-intestinal symptoms later in pregnancy. First trimester vomiting more than doubles the likelihood that the gravida is H. pylori IgG positive.     

Retinal and extraocular cytomegalovirus end-organ disease in HIV-infected patients in Europe: a EuroSIDA study, 1994–2001

This multicentre prospective cohort study by the EuroSIDA study group was designed to determine the factors affecting the incidence of cytomegalovirus (CMV) end-organ disease (CMVD) and the rate of survival after diagnosis in patients with AIDS during the years 1994–2001. This period includes two eras, the pre-HAART era and the HAART era, because HAART affects the natural history of HIV infection, especially with respect to opportunistic infections, including CMV infection. Clinical and laboratory data were collected from the charts of 8,556 patients in 63 AIDS clinics in Europe. A total of 707 patients had CMVD at recruitment and at follow-up: 449 with retinitis (CMVR), 190 with extraocular CMV disease (EOCMVD), and 58 with both. Of the cases of EOCMVD, 66% involved the gastrointestinal tract and 17% the central nervous system. Of patients with a CD4+ count of 200 mm^–3 initially, 1.8% on HAART developed CMVD within a 24-month period, as compared to 11.1% on dual therapy and 14.3% without treatment (P<0.0001). There were highly significant differences in survival according to the calendar year (P<0.0001), with mortality declining from 79% during the years 1994–1995 to 42% in 2000–2001. The incidence of death after any CMVD was 28.4 per 100 patient-years of follow-up. Median survival of CMVR patients and EOCMVD patients was 11 and 7 months, respectively, the prognosis being better among patients with gastrointestinal rather than neurological CMVD. The initiation of HAART was associated with a 37% decrease in mortality (P<0.05). Eighteen percent of all deaths were caused by EOCMVD itself. This study describes a decline in the incidence and mortality of CMVR and EOCMVD during the HAART era of the HIV epidemic. It furthermore serves as a reminder of the importance of EOCMVD as a cause of morbidity and mortality in AIDS in the pre-HAART era.