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     

模拟失重大鼠比目鱼肌小动脉风各级血管内径的变化

目的 探讨模拟失重是否可引起后肢肌肉小动脉网各级血管内径发生改变及其可逆性。方法 采用墨汁灌注法观察尾部悬吊４ｗｋ（ＳＵＳ－４）,悬吊４ｗｋ后恢复１ｗｋ（ＲＥＣ－１）、恢复５ｗｋ（ＲＥＣ－５）,以及对照（ＣＯＮ）大鼠比目鱼肌小动脉网各组血管内径的变化。结果 在ＳＵＳ－４组,比目鱼肌的营养动脉、弓状小动脉及Ｖ、Ⅱ级模行小动脉的内径,较ＣＯＮ组分别减小了３１％、２９％、２８％及４１％（均为Ｐ〈０．０１     

轻、中度缺氧对事件相关电位的影响及不同刺激模式的比较

目的 观察轻、中度缺氧对脑事件相关电位（ＥＲＰ）的影响,比较不同刺激模式发的ＥＲＰ对缺氧的敏感性,方法１２名受试者在地面、２５００ｍ和４３００ｍ匠心同度（吸放低氧混合气）分别进行视觉Ｏｃｄｄｂａｌｌ、Ｓｔｅｒｎｂｅｒｇ记忆量（ＭＳＥＴ）为１ 和ＭＳＥＴ为３的任务测试,记录ＥＲＰ的Ｐ３潜伏期、波幅和反应时（ＲＴ）及反应错误率（ＥＲ）。结果 ４３００ｍ高度缺氧时Ｐ３潜伏期显著延长,任务难度较大时ＥＲ增     

Cerebrospinal fluid isoprostane shows oxidative stress in patients with multiple sclerosis

The CSF level of the isoprostane 8-epi-prostaglandin (PG)-F2alpha (a reliable marker of oxidative stress in vivo) was three times higher in subjects with definite MS than in a benchmark group of subjects with other neurologic diseases. This increase was not correlated with that of PGE2 levels, measured as an index of cyclooxygenase activity, and was much lower in steroid-treated patients. The levels of 8-epi-PGF2alpha were moderately correlated with the degree of disability.     

Phospholipase A2 enzymes regulate alpha IIb beta3-mediated, but not Fc gammaRII receptor-mediated, pp125FAK phosphorylation in platelets

The alphaII(b)beta3 integrin and FcgammaRII receptors mediate, respectively, platelet adhesion and spreading on fibrinogen and immunoglobulin (IgG) coated surfaces. Platelet adhesion to fibrinogen resulted in a partial conversion of the faster to the slower migrating (phosphorylated) form of Ca(+2)-sensitive cytosolic phospholipase A2(cPLA2) but failed to trigger arachidonic acid (AA) release. Full mobility shift of cPLA2 and a massive release of AA release were stimulated by platelet adhesion to IgG or addition of thrombin to the fibrinogen adherent platelets. IgG and thrombin induced AA production were blocked by methyl arachidonyl fluorophosphonate (MAFP), an irreversible inhibitor of cPLA2 and the Ca(+2)-independent phospholipase A2 (iPLA2). In contrast, bromoenol lactone (BEL), a specific inhibitor of iPLA2 had no effect on the release of AA. MAFP and BEL prevented pp125FAK phosphorylation and platelet spreading on fibrinogen having no effect on pp125FAK phosphorylation or platelet spreading on immobilized IgG. We conclude that alpha(IIb)beta3-mediated pp125FAK phosphorylation and platelet spreading on fibrinogen are regulated by PLA2 enzymes.     

Book reviews

Health Matters A. PETERSEN & C. WADDELL, EDITORS Buckingham, Open University Press, 1998, IBSN 0 335 20261 6 (hbk), 0 335 20260 8 (pbk)

Madness in its Place: Narratives of Severalls Hospital, 1913–1997 DIANA GITTINS London, Routledge, ISBN 0 415 183888-X

Introduction to Social Research: Quantitative and Qualitative Approaches KEITH PUNCH London, Sage, 1998, 319 pp., price not stated, ISBN 0 7619 5812 6 (hbk), 0 7619 5813 4 (pbk)