Making use of a natural stress test: pregnancy and cardiovascular risk

The gestational period serves as a natural stress test that can be used to predict future cardiovascular health risks of female patients. Recent evidence confirms that mothers with hypertensive pregnancies have higher cardiovascular disease (CVD) risks compared to other women of similar age. In women with preeclampsia, those delivering before 37 weeks of gestation and mothers with recurring preeclampsia in subsequent pregnancies carry the greater risks. These sex-specific risks are of similar magnitude to traditional CVD risk factors, such as smoking and obesity. Unfortunately, none of the commonly used CVD risk stratification models make use of these sex-specific markers, which can powerfully predict future CVD outcomes. Because women have historically posed a greater diagnostic challenge than men in assessing CVD risks, better models for risk stratification in this sex group are needed. A history of hypertension in pregnancy should be included as a variable in cardiovascular risk stratification. In addition, screening women for a history of preeclampsia should become routine practice, with greater emphasis placed on therapies to modify adverse outcomes for these higher-risk women.     

2008—2009年我国食品出口美国、日本和欧盟的安全问题分析

食品安全已成为全球关注的焦点问题之一。为建立和完善我国食品出口安全制度,保障我国食品出口安全,本文对2008、2009年我国食品出口美国、日本、欧盟受阻的种类和问题进行了分析,归纳出制约我国食品出口的四个原因,即贸易保护日益加剧、质量监控管理落后、检疫技术标准滞后、食品消费理念转变,并提出了完善食品标准,适应贸易需求;提升企业素质,增强社会责任;加强政府监管,保护消费者利益;实施绿色营销,开拓产品市场的针对性建议和对策。     

农村低保边缘群体医疗救助研究

农村低保边缘群体迫切需要医疗救助,但将农村低保边缘群体纳入医疗救助制度当中,还存在财政资金投入不足,边缘群体愿望得不到体现,民政部门负担重,家庭收入核算操作难等问题。针对这些问题,提出相应的对策建议。     

The Influence of Personality and Coping on Female Sexual Function: A Population Survey

IntroductionFemale sexual dysfunction (FSD) is a common disorder with limited data investigating relationships with psychological influences, such as personality traits and coping mechanisms.AimTo investigate the relationship and impact of personality traits and coping strategies on female sexual function.MethodsA web‐based survey was distributed to a sample of women representative of the area's demographic distribution.Main Outcome MeasuresParticipants completed the Female Sexual Function Index (FSFI), the Ten Item Personality Index (TIPI), and the Brief COPE.ResultsFive hundred twenty‐six females responded. The mean total FSFI score was 24.56 (SD 6.77) with lowest scores in the desire domain. Personality scores were similar to published normative values. Subjects displaying stronger tendencies for introversion (r = 0.246, P < 0.001), not being open to new experiences (r = 0.159, P = 0.008), and emotional instability (r = 0.244, P < 0.001) were found to have significantly worse sexual function. Conscientiousness was significantly associated with better desire, orgasm, satisfaction, and total FSFI score (P = 0.029, P = 0.002, P = 0.005, P = 0.003). Moreover, the utilization of negative coping strategies such as self‐blame, self‐distraction, and behavioral disengagement, significantly correlated with poor sexual function (r = −0.298, P < 0.001, r = −0.360, P < 0.001, r = −0.398, P < 0.001, respectively).ConclusionPersonality and coping are linked to sexual function with introversion, not being open to new experiences, emotional instability, and the utilization of negative coping strategies being significantly associated with poor sexual function. Women presenting with sexual function complaints may need further evaluation of their personality and coping strategies in order to mitigate any negative impact of these tendencies. Crisp C, Vaccaro C, Fellner A, Kleeman S, and Pauls R. The influence of personality and coping on female sexual function: A population survey. J Sex Med 2015;12:109–115.     

Reliability of temporal bone high-resolution CT in patients with facial paralysis in temporal bone fracture

Objective

This study aimed to investigate the reliability of temporal bone high-resolution CT (HRCT) in patients with traumatic facial paralysis.

浙江省省级公立医院门诊患者自我感知满意度的影响因素研究

目的 旨在探索公立医院门诊患者自我感知满意度现状及影响因素,为公立医院提升患者满意度,改善服务质量提供科学参考。方法 采用自行设计的调查问卷对浙江省16家省级公立医院的6 477名门诊患者进行问卷调查。在对门诊患者满意度现状数据分析的基础上,将患者的社会人口学和医疗机构服务质量两大类因素分别进行单因素和两分类logistic回归分析,进一步筛选患者满意度的影响因素及影响程度大小。结果 所调查的6 477例门诊患者满意率为91.14%,影响满意率的因素有性别OR = 1.22（1.02～1.45）、收入OR = 0.60(0.43,0.84)、自助系统便捷性OR = 0.70（0.56,0.89）、收费透明性OR = 0.71（0.55,0.91）、治疗中医生治疗态度OR = 0.70（0.53,0.91）、检查化验项目合理性OR = 0.74（0.56,0.99）、门诊治疗效果自我感知OR = 0.68（0.50,0.93）、化验取单取药便捷程度OR = 0.59（0.47,0.74）以及环境整体卫生及舒适度OR = 0.42(0.33,0.54)。结论 浙江省省级医院门诊患者满意度较高,医院应当继续改善信息化便民服务设施、建立公众监督平台、提高收费透明度、优化就诊流程、改善医疗服务环境,逐步提升患者满意度。     

Cancer care for people with dementia: Literature overview and recommendations for practice and research

As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.     

Neighborhood heterogeneity in health and well-being among the elderly in India – Evidence from Study on global AGEing and adult health (SAGE)

We establish a rationale for a multilevel approach in examining health among older adults. Using data on a nationally representative sample of 6560 Indian adults aged 50 years and older, we examine the extent of contextual variation between neighborhoods, after accounting for the compositional effect of individuals’ background characteristics, across multiple dimensions of elderly health. The variance apportioned to neighborhoods in null intercept-only models varied widely across different health outcomes examined in the elderly – while neighborhoods accounted for only 4% of the total variation in high blood pressure at exam, 23% of the total variation in self-rated poor quality of life could be attributed to neighborhood-level differences. In models that accounted for state, place of residence, and demographic and socioeconomic characteristics of individuals, the contribution of neighborhood to the total variation for most health outcomes was attenuated (2–11%) but persisted to exist. Our findings underscore the importance of neighborhoods in studying the health and well-being of the elderly in India.     

大数据理念下居民医疗服务利用监测研究

居民医疗服务利用监测是卫生政策管理与研究的重要内容之一。国家卫生服务调查、居民医保就诊数据等传统的服务利用监测存在成本高、偏倚大,监测指标更新缓慢,无法满足新时期的卫生管理决策等问题。多数据源的数据衔接与再构架为居民服务利用监测提供了新的思路,通过Access数据库管理与Excel的编程技术能够实现不同数据源的对接,同时构架出居民年度医疗服务利用等具体问题的新数据库,从而反映居民的年度服务利用、居民就诊偏好、不合理的服务利用行为等,推动居民医疗服务利用监测研究的发展。