妇幼卫生专业毕业生的追踪调查

20 0 2年 9～ 1 2月对中山大学公共卫生学院妇幼卫生专业的毕业生及用人单位进行了信函追踪调查。结果表明 :总体而言 ,该系学生思想素质、业务水平、工作能力均较强 ,受到用人单位的一致好评。该系学生保健服务能力是强项 ,体现了“以保健为中心”的办学思想。但同时也发现妇幼系的培养模式、课程设置、教学方法均存在一定问题 ,最突出的是临床动手能力较差 ,其次为社区工作能力、组织管理能力、社交能力相对不足 ,创新能力较差 ,所以教学改革势在必行     

化学染发剂和冷烫精的毒性及对人体健康影响的调查研究

本文通过化学染发剂和冷烫精对大白鼠骨髓多染红细胞，毛囊细胞的微核实验及人群健康影响调查，结果表明化学染发剂，冷烫清具有较强致突变作用，两者同时使用致突变明显增强，并提出研制高效无毒染发剂和加强防护的重要性。     

Medical management of chronic pancreatitis

慢性胰腺炎的临床表现包括疼痛、脂肪泻和糖尿病。在西方国家，慢性胰腺炎最常见的病因是酗酒。70％以上的病人在就诊时有疼痛的临床表现，而且，这些患者中又有75％以上会在几年之后出现疼痛减轻或完全消失。对于所有的慢性胰腺炎的病人来说，均应排除非胰源性疼痛和胆道梗阻、胰腺假性囊肿等胰腺局部并发症。应建议所有慢性胰腺炎病人戒烟、戒酒。阿片类镇痛剂仅应用于治疗疼痛严重的病人。尽管有报道认为胰酶替代治疗有助于止痛，但是，对于已经确诊的慢性胰腺炎病人来说，该疗法无效。激素类药物进行腹腔神经丛阻滞术可能有助于病人度过剧烈疼痛期。顽固性疼痛是进行胰液引流或胰腺切除的适应证。建议应用适量胰酶替代联合(或不联合)制酸剂治疗营养不良。慢性胰腺炎导致的糖尿病与原发性糖尿病的治疗原则相似。     

Are chronic wheezing and asthma-like attacks related to FEV1 decline? The Cracow study

Analysis is presented of the relationship between decline in ventilatory function and possible symptoms of bronchial hypereactivity. Data comes from three consecutive surveys within a 13-year follow-up study of a population sample of 1747 persons (718 males and 1029 females) who completed spirometric testing and interviews. Chest symptoms recorded in the two initial surveys were used as baselines for the prognostic study on FEV₁ change. To evaluate changes in lung function the FEV₁ decline index, expressed as percentage of FEV₁ loss during the study period, was calculated. Chronic wheezing and asthma-like attacks were very strongly related to FEV₁ baseline level. Multiple linear regression analysis for each separate symptom including age and smoking habits as confounders and showed that the FEV₁ decline index was higher and more significant when wheezing and asthma-like attacks or chronic cough were present. When the combination of symptoms were introduced into the regression model, the effect of wheezing became insignificant. Only attacks of shortness of breath in both sexes and chronic cough in women were significantly associated with more rapid FEV₁ decline. However, the effect of persistent wheezing in men had a rather substantial impact on FEV₁ change. Comparing the effect of the number of cigarettes smoked with the effect of symptoms, one can see that FEV₁ decline due to attacks of shortness of breath is comparable to that seen with heavy smoking. There was no strong evidence that the symptoms under study precede the more rapid FEV₁ decline.     

Health insurance and private providers: A study of the civil servants' medical benefit scheme in bangkok,Thailand

Compulsory health insurance schemes have received attention recently as a means of creating a reliable extra-budgetary source of health care funding. Yet, the full implications of such schemes in a developing country context are unclear; in particular, the impact on and relationship with private sector providers has infrequently been explored. This study examines patterns of public and private sector utilization under the Civil Servants' Medical Benefit Scheme (CSMBS) in Bangkok, Thailand. The CSMBS currently provides limited reimbursement for private inpatient care, but recent proposals suggest increasing benefit levels for care sought in the private sector. The study shows that despite high level of cost recovery in the public sector, charges were much lower than those in the private sector. Different patterns of diagnosis in the two sectors were found with private hospitals tending to treat a less complex case mix. Within the private sector, there was a limited tendency to specialize in certain types of care. It is concluded that under the current payment mechanism of fee-for-service reimbursement, measures to enhance access to private sector care should be approached with caution. In the long run, the scheme should merge with the recently established social security scheme.     

Computed tomography features immediately after replacement of haematoma with oxygen through percutaneous subdural tapping for the treatment of chronic subdural haematoma in adults

Summary In an effort to achieve a simple and less invasive method for the treatment of chronic subdural haematoma, replacement of the haematoma with oxygen by percutaneous subdural tapping was employed in 36 patients. This study was conducted on 23 haematomas in 20 patients, whose computed tomography (CT) scans immediately following the treatment were available for evaluation, with particular regard to distinguishing between their findings and those seen with tension pneumocephalus. The CT features werde divided into two patterns according to the location of oxygen; a convexity type (19 haematomas) and an interhemispheric type (4 haematomas). Analysis of the CT appearances revealed the oxygen was exclusively confined to the haematoma cavity, distinguishing it from the findings in tension pneumocephalus. This observation indicates the safety of replacement of the haematoma with oxygen when combined with our percutaneuous subdural tapping technique which prevents lesions of the inner haematoma membrane.     

慢性活动性肝炎中单核性细胞超微形态研究

经电镜观察,慢活肝中主要为淋巴细胞及单核巨噬细胞浸润。淋巴细胞分3型,通过4种方式与肝细胞接触,可能代表杀伤肝细胞的动态过程。与肝细胞接触的主要为起细胞毒作用的T_8~+Ⅱ型淋巴细胞及单核巨噬细胞。多数T_4~+淋巴细胞为Ⅰ型淋巴细胞,可能为T辅助细胞。在肝细胞损伤中,淋巴细胞及单核巨噬细胞均起重要作用。     

强化政府行为促进妇幼卫生事业发展

中山市各级政府切实加强妇幼卫生工作的领导，卫生部门主动开展工作，有关部门紧密配合，以提高人口素质为宗旨，抓重点、攻难点，始终把妇幼卫生工作的主要目标纳入各级政府社会经济发展目标管理，作为考核干部和政府工作的重要内容，使各项指标如期圆满完成。     

鸟氨酸-天门冬氨酸联合乳果糖治疗肝性脑病疗效观察

目的探讨鸟氨酸-天门冬氨酸(雅博司)联合乳果糖治疗肝性脑病的疗效.方法选择56例肝性脑病患者,在综合性治疗的基础上,给鸟氨酸-天门冬氨酸20g/d静脉滴注;乳果糖20ml口服或鼻饲,每日三次.另选36例患者作为对照组,给一般综合性治疗,同时给乙酰谷酰胺1.0g/d静脉滴注,分别治疗20天.结果治疗组病死率明显下降,与对照组相比,有显著性差异(x2=4.02,P＜0.05),在降低血氨及促进脑电图改善方面,两组也存在显著性差异.结论雅博司联合乳果糖治疗慢性重型肝炎合并的肝性脑病,疗效显著,值得研究和应用.     

医疗卫生服务价格改革方向初探

医疗卫生服务价格改革是要理顺价格构成成份之间量的关系，使每个构成成份的价格值都在供求关系的约束中，在政府的有效管制中，从而成为医疗卫生资源合理配置的有效工具。为此：①对生产要素分别定价；②对劳动定价；③对资本和自然资源定价；④确定医疗卫生机构内部管理时劳动价格；⑤价格中的所有构成成份价格都置于供给和需求关系约束下；⑥确定医疗卫生服务价格的理想传递方式。