新生儿缺氧缺血性脑病心肌酶谱测定的临床意义

目的：观察新生儿缺氧缺血性脑病（ＨＩＥ）心肌酶活性化及心脏受损的情况,方法：采用连续监测法等方法检测了１１０例新生儿ＨＩＥ与４５例正常新生儿脐血心肌酶谱测定值比较。结果：血清心肌酶谱ＨＩＥ新生儿组明显高于新生儿正常对照组（Ｐ〈０．０１）,而重度ＨＩＥ组显高于轻、中度ＨＩＥ组（Ｐ〈０．０１）。结论：新生儿ＨＩＥ做心肌产谱测定是诊断其心肌损害、损害程度和估计预后的临床指标之一,有助于临床早期预测新生儿ＨＩＥ心肌损害有给予早期治疗。     

To Stay or Not to Stay: Issues in Rural Primary Care Physician Retention in Eastern Kentucky

An important aspect of primary care physician availability is the retention of physicians once they have located. While retention has been under-researched compared to recruitment, it is especially important in rural areas where physician shortages already exist. This study reports the results of a retention survey completed by 132 primary care physicians in rural eastern Kentucky. The survey sets up an objective, hypothetical retention scenario and asks physicians to respond to structured questions and to an open-ended question about factors not appearing in the survey. In response to the structured portion of the survey, physicians indicate that relief coverage is the most important factor in rural physician retention. A content analysis of 75 open-ended responses reveals that besides the other factors in the survey, "sociocultural integration" is the pre-eminent retention issue for rural practitioners. This article concludes that the role of the local rural community may be more important in retention than in recruitment. Finally, it is suggested that additional in-depth qualitative research be conducted within the local contexts to enhance the understanding of rural physician retention processes.     

血源乙型肝炎疫苗免疫持久性观察

为了解血源乙型肝炎（乙肝）疫苗的免疫持久性,对澄江县1991～1995年按照0、1、6个月免疫程序完成血源乙肝疫苗接种的人群,按接种后间隔1～5年分组,每组随机抽取100名儿童,采末梢血,共得517份免疫者的血清样品．用酶联免疫吸附试验（ELISA）检测抗-HBs、HBsAg。结果表明,接种乙肝疫苗2年内抗-HBs阳性率在90％以上,以后随间隔年眼的延长而明显下降,间隔5年降至60％,人群平均保护率达78.57％．     

流行性乙型脑炎减毒活疫苗免疫学效果观察

1998年5月,我们在江苏省新沂市选择1～1．5岁健康儿童进行流行性乙型脑炎（乙脑）减毒活疫苗免疫学效果观察．免疫前和免疫后1个月各采血检测乙脑反向被动血凝（RPHI）抗体．检测到合格双份血清87人,抗体测定免疫前阴性44人．其免疫后抗体阳转率为93．18％,免疫前阳性43人,其免疫后抗体≥4倍增长率为34．88％,表明乙脑减毒活疫苗的免疫成功率是较高的．     

Estrogen replacement therapy among elderly women: results from the 1995 medicare current beneficiary survey

Research Objectives: To develop population-based estimates of estrogen replacement therapy use rates in 1995 among women over age 65 living in the community; to estimate the impact of socioeconomic and health characteristics on estrogen use. Method: Estimates are based on a large, nationally representative sample of Medicare beneficiaries; detailed self-report data were merged with Medicare claims. Results: Overall, 13.1% of women reported use of estrogen replacement therapy in 1995. Estrogen users were more likely to be white, age 65–74, with private insurance, high income, history of osteoporosis and heart problems, no history of breast cancer, and a patient of gynecologists. Conclusions: Estrogen use was substantially lower among the socioeconomically disadvantaged, controlling for medical history variables, suggesting considerable inequity in access to estrogen replacement therapy treatment.     

Public involvement in health care priority setting: an economic perspective

Background  Public involvement in health care decision making and priority setting in the UK is being promoted by recent policy initiatives. In 1993, the British Medical Association called for public consultation where rationing of services was to be undertaken. The approach to priority setting advocated by many health economists is the maximization of quality adjusted life years (QALYs). Typically, for a particular health care programme, the QALY calculation takes account of four features: (1) the number of patients receiving the programme, (2) the survival gain, (3) the gain in quality of life and, (4) the probability of treatment success. Only one feature, that relating to quality of life, is based upon public preferences. If the QALY is to be used as a tool for health care resource allocation at a societal level then it should incorporate broader societal preferences.
Methods  This study used an interview-based survey of 91 members of the general public to explore whether the traditional QALY maximization model is a good predictor of public responses to health care priority setting choices.
Results and conclusions  Many respondents did not choose consistently in line with a QALY maximization objective and were most influenced by quality of life concerns. There was little support for health care programmes that provided a prognostic improvement but left patients in relatively poor states of health. The level of respondent engagement in the survey exercise was not sensitive to the provision of supporting clinical information.     

视细胞移植术后视网膜色素上皮的结构变化

获得纯化的由大肠杆菌表达的小鼠 Ｆａｓ配体（Ｆａｓ ｌｉｇａｎｄ,ＦａｓＬ）。方法：以质粒 ｐＥＴ－１５ｂ为载体,在大肠杆菌ＢＬ２１（ＤＥ３）中表达小鼠的ＦａｓＬ,用金属螫合亲和层析法纯化。结果：转化菌中,重组质粒是稳定的,异丙基－β－Ｄ硫代半乳糖苷可诱导小鼠ＦａｓＬ的表达 ,金属螫合亲和层析法可以初步纯化此蛋白。结论：在大肠杆菌中表达出小鼠的ＦａｓＬ,并得到初步纯化。     

增免灵对活动性肺结核患者的疗效及外周血T淋巴细胞亚群的影响

目的　比较常规疗法伍用增免灵与单用常规疗法对活动性肺结核的疗效及外周血Ｔ 淋巴细胞亚群的影响。方法　抽取常规化疗组（６１ 例）、常规化疗加增免灵组（７２ 例） 及健康对照组（３５ 例） 患者外周血,用ＡＰＡＡＰ法测定外周血淋巴细胞亚群。结果　活动性肺结核患者外周血ＣＤ＋３ 及ＣＤ＋４ 百分率及ＣＤ＋４ ／ＣＤ＋８ 比值显著低于健康对照组（ Ｐ＜ ０．０５） ,ＣＤ＋８ 高于健康对照组。结论　短程化疗伍用增免灵可显著改善活动性肺结核的疗效及细胞免疫状况。     

尾部悬吊及恢复过程中大鼠动脉血管收缩反应的变化

目的 探讨模拟失重下动脉收缩反应变化的时程特征及其可逆性。方法 采用尾部悬吊大鼠模型模拟失重,利用离休动脉环测定血管收缩反应的变化。结果 尾部悬吊２ｗｋ后,大鼠的腹主动脉、肠系膜动脉和股动脉收缩反应明显降低,而颈总动脉无明显改变;悬吊４ｗｋ后,肠系膜动脉和股动脉的收缩反应与悬吊２ｗｋ相比有进一步的降低;悬吊８ｗｋ大鼠的动脉血管收缩反应性与悬吊４ｗｋ相比无明显差异;４ｗｋ尾部悬吊大鼠解除悬吊后５ｗｋ