海事立法与相关涉海立法的边界及协调研究

海事管理涉及面广,与一些涉海管理部门存在管理交叉。海事立法是一个系统工程,进一步明晰海事立法和其他涉海立法的边界,深入分析海事立法与其他涉海立法之间的交叉领域,着力加强海事立法与其他涉海立法的协调,对于加强海事立法和海事管理具有重要意义,有必要对我国海事立法与相关涉海立法的边界和协调加以深入研究。     

460例犯罪少年流行病学调查初报

460例犯罪少年有关因素进行流行病学调查结果表明:13～17岁是少年初次违法犯罪的年龄高峰期。各类罪行比率,城市高于农村(P<0.05),夏季多于其他季节(P<0.05)。两组少年犯家庭相比较,不和谐、缺陷家庭、中低生活水平及受父母不良教育方法的比率明显高于和谐、非缺陷家庭(P<0.05,P<0.01)。少年犯六种气质类型以多血质与胆汁混合型比率为高(P<0.01)。     

医保支付和经济激励：整合的医疗服务系统形成的“引擎”

整合的医疗服务系统的基本内涵是在合适的费用激励约束下促成组织结构整合、服务合作机制建立及其医务人员行为互动而形成的一种动态均衡状态。本文在揭示目前我国医疗服务主体存在非整合行为主要问题的基础上,通过美英澳等国案例分别从组织结构整合、医师行为转变和病人就诊规制3个方面梳理了促进医疗服务系统整合的循证依据。最后还指出要保证这项措施的成功应注意其本身的科学设计与共享的保健路径、有效的评估机制以及其他措施有机结合,实施系统的政策安排。     

Environmental risk factors in outpatient recovery from malnutrition

Studies evaluating Nutrition Rehabilitation Centres indicate that they hold several advantages over alternative methods of care for malnourished children. Nonetheless, an important minority of outpatient cases attending such centres does not make adequate progress, and this has been attributed to shortcomings in their home environment.

A survey in Uganda showed that different features of the home environment affected progress for urban and rural outpatients. The findings also suggest that for both groups the child's home situation can indeed be used to explain his progress, with eight variables explaining around 70 percent of the variance in recovery scores. These variables describe the size of the child's family, the level of food resources available, and the amount of help his mother can martial in caring for him.

Information on these predictors of recovery could be recorded in the case notes on the child's first attendance at the clinic, thereby providing an initial estimate of the risk that he will not respond adequately to the outpatient treatment, requiring, instead, more intensive care.     

The changing cultural and economic dynamics of polygyny and concurrent sexual partnerships in Iringa,Tanzania

Polygyny has been identified both as a ‘benign’ form of concurrency and as the cultural basis of concurrent partnerships that are considered important drivers of the HIV epidemic in sub-Saharan Africa. This paper investigates the changing cultural and economic dynamics of polygyny in concurrency in Iringa, Tanzania, a region with traditions of polygyny and high prevalence of HIV. Our analysis of focus group discussions, in-depth interviews and key informant interviews indicate that contemporary concurrent partnerships differ from regional traditions of polygyny. Whereas in the past, polygyny reflected men's and their kin group's wealth and garnered additional prestige, polygyny today is increasingly seen as a threat to health, and as leading to poverty. Nevertheless, participants evoked the social prestige of polygyny to explain men's present-day concurrency, even outside the bounds of marriage, and despite continued social prohibitions against extramarital affairs. Difficult economic conditions, combined with this prestige, made it easier for men to engage in concurrency without the considerable obligations to wives and children in polygyny. Local economic conditions also compelled women to seek concurrent partners to meet basic needs and to access consumer goods, but risked greater moral judgement than men, especially if deemed to have excessive ‘desire’ for money.     

The American Physician in Occupational Medicine and Hygiene

The satisfactory quality of the practice of occupational medicine in industry is essential to the safety and health of employees. Measures of environmental control are not, in themselves, a satisfactory means of protecting workmen against many common hazards of industrial operations. Careful surveillance of workmen by trained, experienced, and competent occupational physicians is essential in the prevention of illness and disability induced by occupational operations, materials, and types of energy. The professional responsibilities of the occupational physician extend beyond the industrial facility into the general environment where the escaping production materials, by-products, and wastes may penetrate, and also into the larger community where its products may be distributed. The gross inadequacy in the number of trained physicians in the professional field must be met before this urgent problem of national health can be solved.     

Law Enforcement-applied Tourniquets: A Case Series of Life-saving Interventions

Abstract

Although the epidemiology of civilian trauma is distinct from that encountered in combat, in both settings, extremity hemorrhage remains a major preventable cause of potential mortality. The current paper describes the largest case series in the literature in which police officers arriving prior to emergency medical services applied commercially available field tourniquets to civilian victims of violent trauma. Although all 3 patients with vascular injury arrived at the receiving emergency department in extremis, they were successfully resuscitated and survived to discharge without major morbidity. While this outcome is likely multifactorial and highlights the exceptional care delivered by the modern trauma system, tourniquet application appears to have kept critically injured patients alive long enough to reach definitive trauma care. No patient had a tourniquet-related complication. This case series suggests that law enforcement officers can effectively identify indications for tourniquets and rapidly apply such life-saving interventions.     

基于文献数据挖掘中药复方治疗支气管扩张伴感染的用药规律*

目的基于文献数据挖掘的方式,收集近20年文献中治疗支气管扩张伴感染的中药复方,探讨支气管扩张伴感染的中医用药规律。方法 将收集所得83个处方,运用频数分析、聚类分析、关联规则进行数据挖掘,探讨其潜在的用药规律。结果 频数分析显示共涉及药物140味,使用频次≥10次的中药有29味;聚类分析反映了清肺祛痰消痈、祛瘀止血、益气养阴的治疗方法;关联规则体现清热补虚为本病的基本方法,重视消痈排脓。结论 支气管扩张的基本病机为本虚标实,在清热祛痰排脓的同时,要兼顾益气养阴、活血化瘀。     

慢性阻塞性肺疾病住院患者医院感染的卫生经济学评价

目的 研究医院感染(NI)对慢性阻塞性肺疾病患者住院费用的影响。方法 选取某三级甲等医院呼吸内科病区118例发生NI的慢性阻塞性肺疾病住院患者作为病例组,采用1∶1条件配比非感染病例作为对照组,比较两组患者的一般情况,慢性阻塞性肺疾病对两组患者的住院天数及住院费用的影响。结果 慢性阻塞性肺疾病发生NI患者住院天数延长,住院费用增加,P<0.01;各分项费用中除其他费用外,两组患者花费差异均具有统计学意义P<0.01。结论 慢性阻塞性肺疾病患者NI延长住院时间,增加住院费用。采取有效措施控制NI将会产生良好的经济效益和社会效益。     

穴位敏化规律及相关机制的系统科学解析

穴位敏化规律包括基于过程的穴位敏化规律和基于空间的敏化穴位的分布规律,应当从动态过程去认识穴位敏化。试举例说明关于穴位"静息态"与"敏化态"的分界标准,以及穴位敏化的演化过程与对应器官功能变化的演化过程之间的响应关系,但仍需深入研究。穴位敏化是开放的人体自组织系统的一个主动过程,这一主动性使敏化穴位成为了实现"小刺激大效应"的一个基础性的本能环节。以针灸为代表的穴位刺激疗法所具备的双向良性调节、饱和调节、多靶点调节的特征是由人体自组织系统的一系列内在特性所决定的。