Hepatitis B in the family

During a 3-year period (1992–1995), 239 index cases of hepatitis B virus (HBV) infection and 459 members of their households from the Osijek-Baranja county were examined. The aim of the study was to determine the spread of HBV infection in the families with a member verified as a virus carrier, and to identify the family members with the highest risk of infection according to kinship degrees. The retrospective and prospective methods were used in the study. The probable route of infection was assessed by the use of an epidemiologic questionnaire, and the serologic status of the study subjects concerning infection with HBV was determined by enzyme immunoassays (HBsAg, anti-HBs, anti-HBe and anti-HBc). The first member of a family identified as a virus carrier was considered an index case. HBV infection was demonstrated in 334 (47.85%) out of a total of 698 subjects. Only 21 (6.28%) of the 334 subjects with verified HBV infection developed the clinical picture of acute hepatitis B. The ratio of clinically manifest vs inapparent infection was 1:16. Serologic traces of infection were detected in 95 of the 459 family members of the index cases, yielding a mean rate of the infection among the virus carrier family members of 20.70%.     

Using Adapted Short MASTs for Assessing Parental Alcoholism: Reliability and Validity

In previous research adapted versions of the Short Michigan Alcoholism Screening Test (SMAST) have been employed to assess an individual's father's (F-SMAST) and mother's alcohol abuse (M-SMAST). However, to date psychometric information on these forms has been limited. In order to more broadly assess the psychometric properties of these forms, several critical issues in five related studies were addressed. The samples for the five studies were drawn from a college population at a large midwestern university. Overall, the reliability and validity of the adapted SMASTs appears to be quite good. The F-SMAST demonstrated high reliability (from the standpoint of internal consistency, temporal stability, and reliability across siblings) as well as validity (both in respect to convergence with an interview measure and with father's own report on a parallel instrument). Furthermore, shortening both of these instruments to nine-item versions appears to improve their reliability and validity. For researchers and clinicians interested in assessing parental history of alcoholism, the F-SMAST and M-SMAST would appear to be a reliable and valid paper-and-pencil measure.     

以需求为导向的全科医师师资培训方法探索--模块教学的应用

目的 探讨规范、有效、可行、实用的全科医师师资培训的内容与方法。方法 采用实地考察、专业人员研讨会、文献法等多种方法相结合的研究方法。结果 全科医师师资应具备医生和教师的双重条件，并积极提供相应的培训课程；当前及今后一段时期我国师资团队仍将由高校理论师资、专科医生和全科医生3类人员组成；全科医师师资培训内容应以需求为导向、自下而上地确定，总体涵盖“一理论四技能”，但可依据师资类别选用；模块教学使培训更具针对性和灵活性，便于培训的组织与实施。结论 模块教学是适应我国当前全科医师师资培训现状的、具有较大实用价值的培训策略和方法。     

用广义估计方程估计数量性状的家庭相关

目的 研究数量性状家庭相关的测量方法，并对身高家系资料进行分析。方法 应用广义估计方程2(GEE2)估计数量性状的均数结构和关联结构的边际回归模型。所有估计都可在软件MAREG中实现。并用身高家系实例说明方法的应用。结果 GEE2可同时考虑协变量对性状的影响和性状的内部相关，得到回归系数和相关系数的稳健估计。对身高家系资料分析，调整性别、18岁前主要居住地和出生年代后，亲子相关(r=0．459)和同胞相关(r=0．671)高于配偶相关(r=0．184)，有统计学意义。同一类型亲属对中，同性别相关(如父子r=0．603，母女r=0．456，兄弟r=0．947，姐妹r=0．681)大于异性别相关(如父女r=0．431，母子r=0．364，兄妹或姐弟r=0．530)。结论 GEE2可灵活的估计各种家庭相关系数和协变量对性状均数的影响，且参数估计稳健，因此可作为评价数量性状家庭聚集性的标准方法之一。     

The social worker's role in the hospital: seen through the eyes of other healthcare professionals

Social workers in hospitals necessarily work alongside other healthcare professionals, and the perspectives on social work held by doctors and senior nurses are relevant both to their relationship with social workers and to the smooth running of the hospital. An exploratory investigation in the East Anglian Region has produced profiles of perceived social work practice in six different patient-care categories: surgical and orthopaedic, accident and emergency, medicine for the elderly, psychogeriatric medicine, psychiatry and paediatrics. The social worker's functions are recognized as including statutory responsibilities in child protection and mental health, and there are some secondary roles that often reflect a social worker's personal interest or sphere of expertise. The social worker's primary role, however, is deemed to be that of discharge planning - a task which has been given statutory force under the National Health Service (NHS) and Community Care Act 1990. The nurses and doctors interviewed rated the quality of social work practice predominantly by the extent to which the social worker was seen to identify unambiguously with the hospital and its ethos; but they also set great store by the presence and easy accessibility of a social worker, and they preferred regular contact with the same person. They saw the social worker as a key agent within the health care framework, and acknowledged that the social care role and the social worker's link with the community were crucial components of good hospital practice.     

城区实行妇幼保健与计划生育技术服务一体化管理初探

四方区政府从妇幼保健与计划生育技术服务工作即有联系又有区别的实际出发，为能更好地实现卫生资源的统筹调配、充分利用、优势互补，依托现有的妇幼保健机构成立了区计划生育服务中心，实行了妇幼保健与计划生育技术服务的一体化管理，减少了机构重叠，避免了工作交叉，充分利用了现有的区域卫生资源，取得了良好的社会效益与经济效益     

Marie Unna hypotrichosis: an autosomal dominant hair disorder

Hereditary hypotrichosis of Marie Unna type is a rare distinctive syndrome of hair loss which is inherited with an autosomal dominant gene. We report a family with more than half affected individuals in 4 subsequent generations which supports the very strong autosomal dominant pattern of inheritance.     

Social support,family variables,and complicance in renal transplant children

The relationship between family functioning, social support, and medication compliance in 32 renal transplant children and their parents was examined. Results indicated that children whose fathers gave more emotional support or were more informative were less compliant with azathioprine and cyclosporine (P<0.05 for both). Children from families experiencing numerous stresses were also found to be less compliant with azathioprine (P<0.05). Finally, compared with older children, younger children were found to be less compliant with cyclosporine (P<0.005). Implications for predicting child adherence and for future research relating to compliance with multidrug regimens are discussed.     

Treatment of metabolic alkalosis with intravenous infusion of concentrated hydrochloric acid

A concentrated hydrochloric acid (1 N) infusion was utilized for treatment on 35 occasions of metabolic alkalosis in 24 patients. The amount of hydrochloric acid to be infused was calculated from total base excess. To avoid over-correction, two thirds of the calculated dosage of hydrochloric acid only was infused. 1 N hydrochloric acid solution was infused at a speed of 1 mEq/min through a roentgenographically confirmed central venous line. Metabolic alkalosis was successfully treated in all instances without any complication. However, increased respiratory stimulation was not demonstrated in these observations. Concentrated hydrochloric acid infusion is a safe, reliable, and effective method of rapid correction of metabolic alkalosis. Because only small volumes are needed, this method is especially useful when fluid intake must be restricted.     

Analysis of the differential diagnosis and assessment of pleuritic chest pain in young adults

The most important problem in the approach to young patients with acute pleurisy is distinguishing those with idiopathic or viral pleurisy from patients with pulmonary embolism. Three clinical features are helpful in making this distinction: (1) pleural effusion(s) present on chest roentgenography, (2) history of predisposing factors for or past history of veno-occlusive disease, and (3) physical signs indicative of phlebitis. Lung scanning should be performed in patients with these findings. If results of scanning are highly characteristic of pulmonary embolism (segmental or lobar defect with ventilation/perfusion mismatch) in such a patient, anticoagulation may be considered immediately. Patients in whom scanning reveals indeterminate characteristics or abnormalities not characteristic of pulmonary embolism should undergo pulmonary angiography if other clinical features suggest that the probability of pulmonary embolism remains at least moderately high.