利用信息技术提高河南省出生缺陷防治管理水平

目的 总结通过信息平台,提高出生缺陷防控水平的经验和挑战.方法 回顾性总结系统中出生缺陷三级预防措施落实,沿胎儿生命周期获取功能和代谢障碍缺陷个案的数据并进行总结分析.结果 平台促进了出生缺陷三级预防措施落实.系统包括11 912例有遗传病或缺陷儿家族史的孕妇信息,433例染色体和基因异常胎儿产前诊断记录,7977例结...     

实行医疗器械不良事件监测管理的探索与思考

本文介绍了如何在医院内部建立医疗器械不良事件监测管理体系,以及该管理体系起到的巨大作用。     

Factors Contributing to Delay in Driving Licensure Among U.S. High School Students and Young Adults

PurposeMore teens delay in driving licensure (DDL). It is conceivable they miss Graduated Driver Licensing (GDL) safety benefits. We assessed prevalence, disparities, and factors associated with DDL among emerging adults.MethodsData used were from all seven waves (W1–7) of the NEXT Generation Health Study (W1 in 10th grade [2009–2010]). The outcome variable was DDL (long-DDL [delayed >2 years], intermediate-DDL [delayed 1–2 years] versus no-DDL), defined as participants receiving driver licensure ≥1 year after initial eligibility. Independent variables included sex, urbanicity, race/ethnicity, family structure, parental education, family affluence, parental monitoring knowledge, parent perceived importance of alcohol nonuse, and social media use. Logistic regressions were conducted.ResultsOf 2,525 participants eligible for licensure, 887 (38.9%) reported intermediate-DDL and 1,078 (30.1%) long-DDL. Latinos (adjusted odds ratio [AOR] = 2.5 vs. whites) and those with lower affluence (AOR = 2.5 vs. high) had higher odds of intermediate-DDL. Latinos (AOR = 4.5 vs. whites), blacks (AOR = 2.3 vs. whites), those with single parent (AOR = 1.7 vs. both biological parents), whose parents’ education was high school or less (AOR = 3.7 vs. bachelor+) and some college (AOR = 2.0 vs. bachelor+) levels, and those with lower affluence (AOR = 4.4 vs. high) had higher odds of long-DDL. Higher mother’s monitoring knowledge (AOR = .6) was associated with lower odds of long-DDL, but not intermediate-DDL.ConclusionsSome teens that DDL “age out” of protections afforded to them by GDL driver restrictions. Minority race/ethnicity, socioeconomic status, urbanicity, and parenting factors contribute to DDL. Further study of these factors and their individual/collective contributions to DDL is needed to understand potential unintended consequences of GDL, particularly in more vulnerable youth.     

动态血糖与微量血糖安静和运动时的相关性分析

目的：将安静状态和运动应激后动态血糖值（continuous glucose monitoring system blood glucose, CGMSBG）与相对应的微量血糖值（self monitoring blood glucose, SMBG）进行相关性分析,以评价两种血糖值的一致性,分析在运动应激情况下动态血糖仪的准确性。方法：以在山东大学齐鲁医院内分泌科住院并行动态血糖仪(CGMS)检查的13例2型糖尿患者为研究对象,采用Person相关法分别分析所测安静状态和运动后相对应的CGMSBG与SMBG的相关性。结果：13例患者安静状态下所测的223次SMBG与相应CGMSBG的相关系数r为0.939（P＜0.01）。血糖在较低范围时（＜4.4mmol/L）相关系数r为0.524（P＜0.05）,血糖在中等范围时(4.4～10mmol/L)相关系数r为0.811（P＜0.01）。运动后CGMSBG与SMBG相关系数r为0.960（P＜0.01）,且二者差值的中位数为0.10mmol/L。结论：动态血糖与微量血糖有良好的相关性,这种相关性在血糖中等范围时最好,较高范围时次之,较低范围时最差。运动后CGMSBG较SMBG偏高,但二者之间仍然有良好的相关性。     

深圳市龙岗区2009-2014年围产儿出生缺陷监测资料分析

目的 了解深圳市龙岗地区围产儿出生缺陷的发生情况及影响因素,为制定针对性干预措施、降低出生缺陷提供依据.方法 依照《中国出生缺陷监测方案》,将深圳市龙岗区妇幼保健信息系统中监测的2009至2014年围产儿出生缺陷资料导出后进行回顾性分析.结果 深圳市2009-2014年围产儿出生缺陷总的发生率为15.12‰,发生率呈逐年上升趋势(趋势x2=114.23,P＜0.001),其中产前确诊占10.39％,产后确诊占89.02％.6年间出生缺陷发生率前5位依次为:先天性心脏病、多指(趾)、马蹄内翻足、外耳其他畸形、唇裂合并腭裂.男婴和女婴出生缺陷发生率有显著性差异(x2=57.914,P＜0.001),不同户籍类型的产妇出生缺陷发生率也有显著性差异(x2=8.518,P=0.014).开展免费筛查和诊断前后引产孕周的差异有统计学意义(t=4.127,P＜0.001).结论 龙岗区近几年出生缺陷发生率逐年增多,尤其以先天性心脏病增长比例最高,因此应制定一、二级预防措施,加强宣传教育,加强婚前、孕前保健,重视产前筛查和产前诊断,降低出生缺陷率.     

Trams,trains, planes and automobiles: logistics of conducting a statewide audit of medical records

Objective: This paper reports on the logistics of conducting a validation study of a routinely collected dataset against medical records at hospitals to inform planning of similar studies. Method: A stratified random sample of 15 hospitals and two homebirth practitioners was included. Site visits were arranged following consent. In addition to the validation of perinatal data, information was collected regarding logistics. Results: Records at 14 metropolitan and rural hospitals up to 500 km from the research centre, and two homebirth practitioners, were audited. Obtaining consent to participate took between 5 days and 10 months. Auditors visited sites on 101 days, auditing 737 medical record pairs at 16 sites. Median audit time per record was 51.3 minutes; electronic records each took 36 minutes longer than paper. Travel time accounted for nearly one‐quarter of audit time. Conclusions: Delays obtaining consents, long travel times and electronic records prolonged audit duration and expense. Employment of experts maximised use of available audit time. Conducting a validation study is a time‐consuming and expensive exercise; however, confidence in the accuracy of public health data is vital. Implications: Validation studies are unquestionably important. Three alternative strategies have been proposed to make future studies viable.     

中俄双边口岸地区鼠形动物监测名录

目的于2006至2009年间对中俄黑龙江、内蒙古双边11个口岸地区的鼠形动物进行本底调查。方法 5 m夹夜法、弓形夹法及电弧捕鼠器捕捉法。结果编著中俄双边11个口岸鼠形动物名录。结论该名录为中俄口岸公共卫生及鼠传疾病的防治提供本底资料。     

熵指数在临床麻醉中的应用

以脑电为基础的分析监测技术已用于临床麻醉深度的监测。随着频谱熵指数的出现并应用于临床,熵指数正受到越来越多的关注。该方法将脑电图信号定量后产生两个相应的参数:状态熵(SE)和反应熵(RE)。熵指数和脑电双频指数(BIS)均可用于监测麻醉药对中枢神经系统的影响。与BIS一样,RE仍难以反映疼痛刺激程度。     

术中多普勒监护在鞍旁肿瘤手术中的应用

目的探讨术中多普勒监护(IDM)在鞍旁肿瘤手术中的意义。方法对45例鞍旁肿瘤手术中应用IDM的病例资料进行回顾性分析。结果术后无死亡病例,3例出现暂时的肢体偏瘫。结论在鞍旁肿瘤手术过程中合理应用IDM,有助于最大程度避免术中血管的损伤及减轻血管的受损伤程度,可减少术后并发症。     

Cardiac arrhythmias six months following traumatic spinal cord injury

ObjectiveTo investigate the incidence of cardiac arrhythmias at six months following traumatic spinal cord injury (SCI) and to compare the prevalence of arrhythmias between participants with cervical and thoracic SCI.DesignA prospective observational study using continuous twenty-four-hour Holter monitoring.SettingInpatient rehabilitation unit of a university research hospital and patient home setting.ParticipantsFifty-five participants with acute traumatic SCI were prospectively included. For each participant, the SCI was characterized according to the International Standards for Neurological Classification of SCI by the neurological level and severity according to the American Spinal Injury Association Impairment Scale.Outcome measuresComparisons between demographic characteristics and arrhythmogenic occurrences as early as possible after SCI (4 ± 2 days) followed by 1, 2, 3, 4 weeks and 6 month time points of Holter monitoring.ResultsBradycardia (heart rate [HR] <50 bpm) was present in 29% and 33% of the participants with cervical (C1–C8) and thoracic (T1–T12) SCI six months after SCI, respectively. The differences in episodes of bradycardia between the two groups were not significant (P < 0.54). The mean maximum HR increased significantly from 4 weeks to 6 months post-SCI (P < 0.001), however mean minimum and maximum HR were not significantly different between the groups at the six-month time point. There were no differences in many arrhythmias between recording periods or between groups at six months.ConclusionsAt the six-month timepoint following traumatic SCI, there were no significant differences in occurrences of arrhythmias between participants with cervical and thoracic SCI compared to the findings observed in the first month following SCI.