A bill of rights for patients with obstetric fistula

According to the seven categories of vulnerability proposed by Kipnis (cognitive, juridical, deferential, medical, allocational, social, and infrastructural), and the four generally accepted principles of biomedical ethics (respect, beneficence, non-maleficence, and fairness), women with obstetric fistulas are an exceptionally vulnerable population. Therefore, they merit special consideration in both clinical care and research settings. Adoption of a formal bill of rights for patients with fistula similar to the one proposed in the present report should be encouraged at all facilities where these women are treated. Acknowledgment of their rights would help to improve their care and end the abuses they are exposed to in institutional settings.     

Sex,drugs and prisons: HIV prevention strategies for over 190 000 clients in Ukraine

Setting: One hundred and forty non-governmental organisations implementing human immunodeficiency virus (HIV) prevention programmes among clients, including people who inject drugs, prisoners, female sex workers, men who have sex with men and street children in Ukraine, 2010–2011.Objective: Among enrolled clients, to assess factors associated with HIV testing, HIV retesting within a year of initial testing and HIV seroconversion.Design: Retrospective cohort study involving record reviews.Results: Of 192 487 clients, 42 109 (22%) underwent an initial HIV test (22% were positive). Among HIV-negative clients at baseline, 10 858 (27%) were retested within a year: 317 (3%) of these were HIV-positive. HIV testing and retesting rates were lower among prisoners (0.3%) and others (street children and partners of those in risk groups, 6%), and those who did not receive counselling or services such as condom and needle distribution. Individuals who were not counselled were more likely to seroconvert.Conclusions: In this large cohort of high-risk groups from Eastern Europe, HIV testing was low and HIV sero-conversion was high. This is of public health concern, bringing into question the overall quality of counselling and how well it is tailored to the specific needs of various risk groups. Qualitative studies to understand the reasons for non-testing are urgently required for designing client-specific interventions.     

Development of Press-Coated,Floating-Pulsatile Drug Delivery of Lisinopril

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor, primarily used for the treatment of hypertension, congestive heart failure, and heart attack. It belongs to BCS class III having a half-life of 12 hrs and 25% bioavailability. The purpose of the present work was to develop a press-coated, floating-pulsatile drug delivery system. The core tablet was formulated using the super-disintegrants crosprovidone and croscarmellose sodium. A press-coated tablet (barrier layer) contained the polymer carrageenan, xanthan gum, HPMC K4M, and HPMC K15M. The buoyant layer was optimized with HPMC K100M, sodium bicarbonate, and citric acid. The tablets were evaluated for physical characteristics, floating lag time, swelling index, FTIR, DSC, and in vitro and in vivo behavior. The 5% superdisintgrant showed good results. The FTIR and DSC study predicted no chemical interactions between the drug and excipients. The formulation containing xanthan gum showed drug retaining abilities, but failed to float. The tablet containing HPMC K15M showed a high swelling index. The lag time for the tablet coated with 200 mg carrageenan was 3±0.1 hrs with 99.99±1.5% drug release; with 140 mg HPMC K4M, the lag time was 3±0.1 hrs with 99.71±1.2% drug release; and with 120 mg HPMC K15M, the lag time was 3±0.2 hrs with 99.98±1.7% drug release. The release mechanism of the tablet followed the Korsmeyer-Peppas equation and a first-order release pattern. Floating and lag time behavior have shown good in vitro and in vivo correlations.     

漂浮导管技术在急性心衰患者中的临床应用

目的探讨漂浮导管技术应用于急性心功能衰竭患者的临床效果、指导意义。方法 2007年5月～2010年12月入住我科ICU的75例急性心衰患者中35例患者在漂浮导管监测下给予常规心衰治疗,另40例患者未予漂浮导管监测下给予经验性常规心衰治疗,比较两组患者治疗前后的病情缓解时间。结果 35例在漂浮导管监测指导下治疗的患者较未予漂浮导管监测治疗的患者病情缓解时间短、心衰并发症发生率低（P〈0.05）。结论漂浮导管技术对于血流动力学不稳定的急性心力衰竭患者的临床治疗有重要的指导价值。     

广州市番禺区流动人口性病干预情况分析

目的 了解对番禺区流动人口实施性病行为干预的效果,为性病防治工作提供理论依据.方法 随机调查番禺区超过100人的大型工厂5个、建筑工地5个的流动人口作为研究对象,对调查对象开展健康教育和安全套推广,比较干预前后流动人口的性病相关知识知晓率、安全套使用率和4种性病(淋病、沙眼衣原体、尖锐湿疣和梅毒)的感染率.结果 干预后的流动人口性病相关知识知晓率有明显升高,从干预前的51.68％上升到干预后的91.24％;淋病感染率从干预前的2.40％下降到干预后的1.90％,沙眼衣原体感染率从干预前的9.76％下降到干预后的6.65％,尖锐湿疣感染率从干预前的7.99％下降到干预后的5.06％,梅毒感染率从干预前的3.55％下降到干预后的2.22％.结论 对番禺区流动人口进行性病的健康教育和行为干预成效显著.     

流动已婚育龄妇女社会支持状况及影响因素调查

目的:了解流动已婚育龄妇女的社会支持的情况及其影响因素.方法:采用整群抽样方法随机抽取佛山市西樵镇一个社区的流动已婚育龄妇女进行面对面问卷调查.结果:在遇到急难情况时,流动已婚育龄妇女曾得到的经济支持和精神支持中来源于配偶的支持最多,分别为76.12％和78.65％;客观支持、主观支持、支持利用度得分和社会支持总分平均分分别为(9.19±3.09)、(26.54±4.06)、(7.59±2.21)和(43.61±6.71)分;Logistic回归分析显示和谁来打工影响客观支持得分,和丈夫、亲戚/同乡/朋友来打工的OR值分别为3.487和3.187;年龄影响主观支持得分,30岁～和40～49岁年龄组的OR值分别为2.484和2.340;职业以及和谁来打工影响社会支持总分,职业为干部/职员/专业技术人员以及和丈夫来打工的OR值分别为2.162和2.541.结论:西樵镇流动已婚育龄妇女的社会支持情况较好,但其社会支持主要来源于配偶,其他途径获取支持较少,提示相关部门和家庭外的其他社会组织应拓宽流动已婚育龄妇女获得支持的途径,并加大对她们的支持力度,特别是单独来工作、职业社会保障不完善和年龄较低的流动已婚育龄妇女.     

Cluster Analysis of Vulnerable Groups in Acute Traumatic Brain Injury Rehabilitation

Objective

To analyze the complex relation between various social indicators that contribute to socioeconomic status and health care barriers.

骨科患者漂浮血栓危险因素分析

目的:探讨骨科患者漂浮血栓(FFT)的发生率及危险因素。方法:以2009年1月至2013年11月因骨科疾病致深静脉血栓(DVT)患者855例为研究对象,对年龄、就诊原因、发现时间、骨折部位、发生血栓部位等方面的资料进行统计分析。结果:855例患者发生漂浮血栓70例,发生率8.2%,平均年龄51.34岁,因摔伤及车祸、工伤而入院的患者最多,伤后发现血栓时间平均4.77d,以股骨远端及髁间,胫骨近端及胫骨平台骨折发生漂浮血栓最多,达31例,占44.3%,70例漂浮血栓中,腘静脉漂浮血栓最常见,占82.9%。FFT较普通血栓(OT)风险度更高,其发生与患者年龄、病史、骨折部位及血栓发生部位均具有相关性,对于高危患者,临床医生要引起高度重视,积极采取预防措施降低FTT及肺栓塞的发生。