Delivery Complications Associated With Prenatal Care Access for Medicaid-Insured Mothers in Rural and Urban Hospitals

CONTEXT: Pregnancy complications affect many women. It is likely that some complications can be avoided through routine primary and prenatal care of reasonable quality. PURPOSE: The authors examined access to health care during pregnancy for mothers insured by Medicaid. The access indicator is potentially avoidable maternity complications (PAMCs). Potentially avoidable maternity complications are often preventable through routine prenatal care, such as infection screening and treatment. The authors examined the risks of potentially avoidable maternity complications among rural and urban hospital deliveries for groups of mothers defined by race or ethnicity. METHODS: Data are from the year 2000 Nationwide Inpatient Sample (NIS). The stratified sample represents all discharges from 20.5% of community hospitals in the United States. The Nationwide Inpatient Sample identifies hospital locations, but not patients' areas of residence. Analyses, which accounted for the sample design, included calculation of potentially avoidable maternity complication rates by race or ethnicity, chi2, t tests, and multivariate logistic regression. FINDINGS: Within groups defined by race or ethnicity, unadjusted rates for potentially avoidable maternity complications did not differ significantly by hospital location. Holding other factors constant, potentially avoidable maternity complications were less common in rural hospitals than in urban hospitals (odds ratio, 0.78; CI, 0.62 to 0.99). In rural hospitals, African Americans had notably higher risk for potentially avoidable maternity complications than did non-Hispanic whites (odds ratio, 1.72; CI, 1.26 to 2.36). In urban hospitals, risk of potentially avoidable maternity complications was not significantly higher for African Americans. Hispanics and Asians had notably lower risks of potentially avoidable maternity complications in urban hospitals than did non-Hispanic whites. CONCLUSIONS: Providers and policymakers should work to reduce the risks of potentially avoidable maternity complications for African American women in rural areas who are insured by Medicaid.     

女性吸毒人员的吸毒因素、社会化状况及应对措施

目的:了解女性吸毒人员社会化基本状况,并对其应对方式进行分析。方法:问卷调查、个案访谈及对在册病案进行回顾性分析及采用单因素Logistic回归分析。结果:诱发女性吸毒的因素众多,采用单因素Logistic回归分析OR值2 0以上,并有显著性意义的因素有:受教育程度、职业状况、婚姻状况、好奇、同伴影响、感情受挫、寻求刺激和减肥。结论:社会化不足是导致女性吸毒、影响其戒毒和保持戒毒后操守的重要因素,有针对性地对女性吸毒人员实施有效的社会化治疗是必要和有效的。     

Auditory brainstem implantation: The first Indian experience

Multichannel auditory brainstem implants (ABI) are currently indicated for patients with neurofibromatosis type II (NF2) involving both vestibulocochlear nerves. The ABI helps bypass the damaged cochlear nerves and restores a level of auditory sensation via the electrical stimulation of the cochlear nucleus. The implant is usually placed in the lateral recess of the fourth ventricle at the time of tumor resection to stimulate the cochlear nucleus. We report a case of ABI done on a 15-year-old girl with bilateral vestibular schwannomas.     

Tear of the distal biceps branchii tendon: A new method of ultrasound evaluation

Tear of the distal biceps brachii tendon is an uncommon injury. Ultrasound evaluation of the distal tendon using an anterior approach is often difficult because of technical factors. We describe a new method of ultrasound evaluation of the distal biceps tendon insertion. This involves a posterior approach with the forearm pronated. With pronation of the forearm, the radial tuberosity faces posteriorly, bringing the distal biceps tendon insertion into view. A surgically proven case of distal biceps tendon tear is presented to illustrate our technique.     

Nephrin、podocin在V型狼疮性肾炎肾组织中的表达

目的 探讨肾小球足细胞相关蛋白nephrin和podocin在V型狼疮性肾炎(V-LN)发病中的作用.方法 检测V-LN组11例和特发性膜性肾病(IMN)组8例患者的尿常规、24-h尿蛋白定量、尿补体C3及纤维蛋白原降解产物(FDP)、血脂、血清补体及肝肾功能,并行肾组织活检间接免疫荧光染色,激光共聚焦显微镜观察nephrin、podocin表达的变化.结果 24-h尿蛋白定量、血清白蛋白、肌酐、尿补体C3两组间无统计学差异;V-LN组血脂、血清补体C3、C4及尿FDP均低于IMN组;nephrin、podocin表达两组均减弱,但IMN组更明显.结论 Nephrin、podocin表达减弱可能参与V-LN蛋白尿的发生,但V-LN表达减弱不及IMN明显,推测V-LN蛋白尿的发生可能还有其他机制参与.     

参麦注射液联合川芎嗪对脓毒症小鼠肝脏的保护作用

目的探讨参麦联合川芎嗪注射液对脓毒症小鼠肝脏的保护作用。方法采用盲肠结扎穿孔(Cecal ligation and puncture,CLP)方法诱导形成脓毒症。将雄性成年的昆明小鼠随机分为5组,分别是假手术组、模型组、参麦注射液治疗组、川芎嗪注射液治疗组和参麦联合川芎嗪注射液治疗组。CLP术前24,12,1 h各组小鼠分别腹腔注射参麦注射液和川芎嗪注射液或者等计量的生理盐水。观察CLP造模后24 h各组小鼠血清中肿瘤坏死因子α(TNF-α)、白介素6(IL-6)含量、谷丙转氨酶(ALT)、谷草转氨酶(AST)活性以及肝脏组织中丙二醛(MDA)、髓过氧化物酶(MPO)水平,并观察各组小鼠的存活率及其肝脏组织的病理变化。结果参麦、川芎嗪及参麦联合川芎嗪三组药物治疗组的脓毒症小鼠其死亡率、血清中炎症因子(TNF-α、IL-6)含量、肝脂质过氧化(MDA、MPO)水平、ALT/AST及其肝脏病理损伤程度均较模型组明显减轻,尤以参麦联合川芎嗪给药治疗组疗效最为显著。此外,联合给药治疗组血清中的炎症因子(TNF-α、IL-6)水平较单一用药组显著降低。结论参麦联合川芎嗪注射液较单一用药能够更有效地抑制炎症反应,提高脓毒症小鼠的存活率、减轻肝脏损伤。     

痔瘘熏洗凝胶剂药效学初步研究

目的:观察痔瘘熏洗凝胶剂的抗炎、镇痛效果.方法:选取雌性大鼠分组后通过建立角叉菜胶肛周肿胀模型,观察痔瘘熏洗凝胶剂对实验性痔疮的抗炎作用;选取雌性小鼠分组后通过热板法观察痔瘘熏洗凝胶剂的镇痛作用.结果:痔瘘熏洗剂及其改进剂型--痔瘘熏洗凝胶剂对角叉菜胶所致大鼠肛周肿胀均有显著的抑制作用,对热传导引起的疼痛有确切的镇痛作...     

生长抑素联合清营汤治疗重症急性胰腺炎临床疗效

目的探讨早期应用生长抑素联合清营汤治疗重症急性胰腺炎患者的近期疗效。方法68例重症急性胰腺炎患者,随机分成两组。治疗组(n=34),对照组(n=34),并观察两组患者的近期疗效。结果重症急性胰腺炎早期联用清营汤组治疗1周后,患者APACHEⅡ评分明显下降,两周复查CT显示联用清营汤组,患者急性胰腺炎的CT严重度指数(CT severity index,CTSI)评分明显下降。而单纯施他宁组患者治疗一周后APACHEⅡ评分略有下降,两周复查CT显示患者急性胰腺炎的CTSI评分略下降。两组结果相比差异显著(P<0.05)。结论早期应用生长抑素联合清营汤治疗重症急性胰腺炎可改善临床症状,提高疗效,减少并发症,降低死亡率。     

乳腺癌患者保乳术联合腔镜腋窝淋巴结清扫术的临床研究

目的 探讨保乳手术联合腔镜腋窝淋巴结清扫术(MALND)对乳腺癌患者上肢功能、应激反应及血管细胞黏附分子-1 (VCAM-1)、细胞间黏附分子-1(ICAM-1)水平的影响。方法 回顾性分析98例乳腺癌患者的临床资料,依据手术方式的不同分为研究组53例和对照组45例。对照组行保乳手术联合传统腋窝淋巴结清扫术(CALND),研究组行保乳手术联合MALND。比较2组术前、术后6个月上肢功能;收集2组患者术前、术后12 h焦虑自评量表(SAS)、抑郁自评量表(SDS)评分以及心率(HR)、平均动脉压(MAP)水平,并对比2组应激反应程度;比较2组患者术前、术后5 d VCAM-1、ICAM-1水平。结果 术后6个月,研究组前屈、后伸、内收、外展、内旋、外旋活动角度大于对照组,差异有统计学意义(P<0.05);术后12 h,研究组SAS、SDS评分及HR、MAP水平低于对照组,差异有统计学意义(P<0.05);术后5 d,研究组VCAM-1、ICAM-1水平低于对照组,差异有统计学意义(P<0.05)。结论 保乳手术联合MALND对乳腺癌患者上肢功能影响小,术后应激反应程度轻...