简论我国当前医务社会工作的境地与如何开展医务社会工作

我国当前的医务社会工作正处于萌芽阶段,其理论基础、价值观、伦理观都未充实,亟待医务工作者、众多学科学者、政策制定者进行深入研究,并建立健全医务社会工作的各项制度,使此工作有据可依。其中还对医务社会工作的功能、职能和工作方式进行了叙述。     

产妇分娩方式的变化与新生儿转归的关系

目的探讨分娩方式变化及其与新生儿死亡率、重度窒息率的相关性。方法对我院近10年来产妇的分娩方式、剖宫产指征、新生儿结局进行回顾性分析,比较不同阶段阴道分娩率、剖宫产率、新生儿死亡率和新生儿重度窒息率间的差异。结果产妇的分娩方式呈现剖宫产率逐年增高、经阴分娩率逐年降低的趋势,而新生儿死亡率及重度窒息率未出现明显下降。剖宫产指征变化以社会因素所占比例逐年增高为主。结论提高剖宫产率不能显著降低新生儿死亡率及重度窒息率。     

在传承中超越 努力探索新时期中医人才培养新模式

首都医科大学附属北京中医医院是一所临床优势突出的大型综合中医院,名医荟萃,专科特色突出,形成了北京中医医院的服务品牌。近年来在工作中院党委发现随着名老中医的故去,医院原有的一些特色优势有弱化的趋势。2007年医院党委确定了由党委书记为第一责任人,组织实施"新名中医培养战略工程"。采用"团队带团队"的方式,发挥第一、二、三批全国老中医药专家学术经验继承工作的滚动效应,集中医院内可以利用的中医药资源,通过多种形式的培养方法,利用三年的时间,在教学相长的过程中打造一批具有中医临床特长的中青年名医队伍。新的人才培养模式有力地促进了我院中医人才队伍建设。本项目同时获得北京市委组织部、北京市人事局的资助。     

高血压社区综合防治三级管理模式的实践效果评价

目的探讨高血压社区综合防治三级管理模式的效果。方法将204例社区高血压患者分为试验组和对照组。试验组给予高血压综合防治三级管理的干预;对照组给予原高血压社区防治模式进行管理。随访1年后,比较管理前后患者高血压防治知识知晓率、血压控制率、社区医生业务水平、医学生临床技能成绩,调查社区居民的满意度。结果管理后试验组患者高血压防治知识知晓率、血压控制率均高于对照组,差异有统计学意义(P<0.05);社区医生业务水平、医学生临床技能成绩较前提高;社区居民对医疗服务总体评价的满意度达85.3%。结论高血压社区综合防治三级管理模式在高血压社区防治中取得良好效果,值得推广。     

Preliminary evaluation of the human relevance of respiratory tumors observed in rodents exposed to naphthalene

Inhalation bioassays in mice and rats exposed to naphthalene (NA) show incidences of lung and nasal cancer, respectively. This paper describes a preliminary mode of action (MOA)/human relevance (HR) framework for NA. Species differences in both carcinogenic and cytotoxic responses between the rodent and human have been noted based on qualitative and quantitative differences in metabolism. Some occur at the initial oxidation of NA in the rat through CYP2F, versus CYP2A13 metabolism in the human respiratory system and which results in a difference in the specific naphthoquinone formed. Normally, subsequent reactive metabolites are then conjugated through glutathione, but high dose exposures, as in the rat bioassay, result in glutathione depletion, and the availability of 1,2-naphthoquinone for other conjugation. In the rat nose, it is proposed that a naphthoquinone imine is formed via a species and site-specific aryl amidase acting on an amino acid conjugate of the quinone. Such a quinone imine is believed to be the active agent in Alachlor and phenacetin, resulting in the same profile of respiratory tumors in the rat as NA. Based on the MOA and the limited epidemiological data indicating no human evidence of nasal or lung tumor risk, the carcinogenic response observed in rats does not appear relevant to the human.     

Reproducibility and robustness of metabolome analysis in rat plasma of 28-day repeated dose toxicity studies

BASF has developed a rat plasma metabolomics database (MetaMap^®Tox) containing the metabolome of more than 500 chemicals, agrochemicals and drugs, for which the toxicity is well known, derived from 28-day repeated dose toxicity studies in rats. The quality/reproducibility of data was assessed by comparing the metabolome of 16 reference compounds tested at least twice under identical experimental conditions at three time points (day 7, day 14 and day 28). Statistical correlation analysis showed that the repeated treatment induced very similar changes to the metabolome. For all repetitions the modes of action of the compounds were always correctly identified. Moreover, when compared against the metabolome of all compounds available in the MetaMap^®Tox database, the repetitions showed in most cases the highest degree of overall similarity with the metabolome of the original study. In addition, we also evaluated the robustness of our metabolomics technique, displayed by constancy of variability in control groups over time. Based on these results, it can be concluded, that metabolomics can reproducibly be applied during toxicological in vivo testing in rats under the conditions applied here.     

Mode of delivery after previous obstetric anal sphincter injuries (OASIS)—a reappraisal?

Introduction and hypothesis  To prospectively evaluate anorectal symptoms, quality of life (QoL), sphincter integrity and function after subsequent childbirth following previous obstetric anal sphincter injuries (OASIS). Methods  A validated Manchester Health Questionnaire, endoanal sonography and manometry were performed during the third trimester and 13 weeks postpartum. Women without objective compromise of anal function were recommended a vaginal delivery and the others a caesarean section. Results  Seventy-three consecutive women with previous OASIS were seen during a subsequent pregnancy of whom 59 were reviewed 13 weeks following delivery. Anal manometry findings did not change significantly following a subsequent vaginal delivery or caesarean section. Only one new defect (internal sphincter) occurred after a vaginal delivery. There was no significant change in symptoms or QoL. Three (6.8%) sustained repeat OASIS. Conclusions  Women who have no antenatal evidence of objective compromise of anal sphincter function can be reassured that a vaginal delivery is not associated with any significant deterioration in function or QoL. This paper was presented at the 36th Annual meeting of the International Continence Society in Christchurch, New Zealand and a preliminary abstract is published in: Neurourology Urodynamics 2006;25(6):512–513.     

Stress urinary incontinence 3 years after pregnancy: correlation to mode of delivery and parity

The aim was to estimate the incidence of stress urinary incontinence 3 years after delivery and its correlation to mode of delivery and parity. A longitudinal cohort study was conducted with 120 women at the Antenatal Clinic at the State University of Campinas. There was a significant difference in the incidence of postpartum stress urinary incontinence (SUI) among patients with SUI during pregnancy (p > 0.0001). Women that were asymptomatic during pregnancy and had vaginal delivery developed SUI 2.4 times more frequently than after c-section (19.2% and 8.0%, respectively). The incidence of SUI after delivery dropped significantly in the primiparous (p = 0.0073) and multiparous 2–3 (p < 0.0001), but not in the multiparous with four or more deliveries (66.7% to 60.0%) (p = 0.5637). A significant correlation has been observed between parity and SUI (p = 0.0299). Pregnancy possibly predisposes to SUI 3 years after delivery as well as parity. No significant correlation has been demonstrated between mode of delivery and SUI.     

0～3岁儿童口腔保健模式的建立

目的探讨0～3岁儿童口腔保健模式建立的可行方案。方法试验组60例从母亲妊娠期开始实施口腔健康教育,孩子出生后定期口腔检查并进行个体化健康教育,采取相应的预防干预措施;对照组60例则未采取上述措施。试验组儿童3岁左右与对照组的3岁儿童进行口腔检查,并对两组幼儿的母亲问卷调查结果予以评估。数据采用EpiData3．0录入,应用SPSS12．0完成数据分析。结果两组幼儿母亲口腔保健知识知晓情况比较,试验组正确率为66．3％,对照组正确率为48．9％,13项目知识指标中有9项（P〈0．05）,两组差异有统计学意义;幼儿龋患情况比较,试验组幼儿龋患率为10％,龋均为0．45;对照组幼儿龋患率为25％,龋均为1．217,两组龋患率比较,差异有统计学意义（P〈0．05）。结论该项目健康教育与行为干预模式效果明显,具有可行性,值得推广应用。