A Multidisciplinary Approach to Treating Obesity in a Community Health Centre

Objectives

The aim of the study is to assess the weight loss programme with regards to the long-term effectiveness of weight reduction and weight maintenance, using completion rate and BMI, blood sugar, cholesterol and blood pressure levels as outcomes. The aim of the study also includes identifying the factors associated with adherence to the programme.

Methods

The programme was developed by a multidisciplinary team. It included 6 months of introduction and another 18 months of maintenance. The data for 397 participants was collected after 24 months.

Results

346 participants have completed the introduction and 123 have completed the programme. In the introduction, the average weight loss was 12% of the initial weight. The participants, who completed the full programme, lost 9.4% of their initial weight. The participants also significantly (p<0.05) reduced their blood sugar and cholesterol levels, as well as their blood pressure. The factors associated with adherence to the programme are: age over 50, lower educational levels, lower initial weight and higher weight loss in the introduction.

Conclusions

The multi-disciplinary approach to obesity treatment was effective for a selected group of people. The proportion of dropouts was relatively high, but still low compared to similar programmes. Group treatment and mutual support are of a great importance in bringing about and maintaining the changes.     

Key Determinants Influencing the Health Literacy of Pregnant Women in the Czech Republic

Background

Health literacy is a critical determinant of women’s and children’s health and therefore has immense consequences for the health of society as well. Evidence from epidemiological, clinical and experimental studies indicates that unhealthy lifestyles and risky behavioural habits of parents before conception and during pregnancy influence the etiology of various health defects. Decreasing primary risk factors, practicing physical wellness, monitoring physiological markers and preparing for labour, breastfeeding and newborn care should be the main parental responsibilities during the prenatal period.

Methods

Our study focused on specifying the main determinants of health literacy among 360 pregnant Czech women by using an anonymous questionnaire and selected anthropometric data of mothers. The criteria for study participation produced a sample representing 1.41% of Czech women in labour during a given 2012 reference period.

Results

Despite quite adequate knowledge of both risks and supporting factors for pregnancy and foetal development, the lifestyles of a majority of the women surveyed were far from optimum: only 30% reported good dietary and physical activity habits, 24% were active or passive smokers and one third of the women occasionally drank alcohol, more often among those who were university educated.

Conclusion

Our results have confirmed previously published data noting that health literacy and a healthier lifestyle of pregnant women are associated with a higher level of education (except for alcohol drinking) and with contact with a midwife (in some examined parameters) in prenatal courses.     

Essential Medicines: An Indian Perspective

The concept of defining essential medicines and establishing a list of them was aimed to improve the availability of affordable medicines for the world''s poor. Access to essential medicines is a major determinant of health outcomes. Several countries have made substantial progress towards increasing access to essential medicines, but access to essential medicines in developing countries like India is not adequate. In this review we have tried to present the Indian scenario in respect to availability and accessibility of essential medicines over last one decade. To enhance the credibility of Indian healthcare system, procurement and delivery systems of essential medicines have to be strengthened through government commitment, careful selection, adequate public sector financing, efficient distribution systems, control on taxes and duties, and inculcating a culture of rational use of medicines in current and future prescribers.     

英国初级卫生保健质量与结果框架解析

目的 了解英国初级卫生保键质量与结果框架,为改善我国全科服务质量提供经验借鉴.方法 文献综述与定性访谈.结果 质量与结果框架作为全科服务合同的一部分,目的是通过引进激励机制改进服务质量,制定一套反映全科医疗服务质量的指标和评分体系,通过综合打分对全科医生的服务进行衡量.结论 在完善的组织管理、疾病登记体系和信息系统的支撑下,质量与结果框架有利于对全科服务进行标准化评估,统一的定价和支付体系有利于减少不同地区初级卫生保健的服务差异,激励了全科诊所服务的积极性.但也有专家学者指出了其中的一些弊端,有待进一步修正和完善.     

同时性多原发大肠癌治疗

目的：探讨同时性多原发大肠癌诊断和治疗效果。方法：对28例同时性多原发大肠癌患者的临床资料进行了回顾分析。结果：全部病例均行同期手术切除,根治性切除22例（78.57%）。5年生存率为57.1%,10年分别为35.7%,与同期大肠单癌病例根治性切除相比差异无统计学意义。结论：同时性多原发大肠癌根治性手术的效果与大肠单癌行根治性手术的效果相似,治疗原则是根治性切除手术。     

肝硬化食管胃底静脉曲张及出血的非侵入性临床检查研究

目的 研究分析非侵入性临床检查在肝硬化食管胃底静脉曲张及出血的应用,为临床诊断提供参考意见.方法 选取肝硬化食管胃底静脉曲张及出血患者作为观察组(n=20),并选取同期住院患者中明确诊断为肝硬化合并食管胃底静脉曲张未破裂出血的病例作为对照组(n=20)进行研究,对比分析2组患者血小板计数(PLT)、血小板压积(PCT)、血小板平均体积(MPV)、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT),腹部超声及CT相关指标即门静脉直径(PV)及脾静脉直径(SV)等.结果 观察组患者PLT、PCT、MPV较对照组明显降低(P相似文献   

加味赤石脂禹余粮汤联合热敏灸治疗肝硬化腹水并顽固性腹泻疗效观察

【目的】观察加味赤石脂禹余粮汤联合热敏灸对肝硬化腹水并顽固性腹泻的临床疗效。【方法】选择肝硬化腹水并顽固性腹泻患者60例,随机分为治疗组与对照组各30例,对照组采用西医常规疗法加中药加味赤石脂禹余粮汤治疗,治疗组在对照组治疗基础上加用热敏灸疗法,观察2组患者腹泻、腹水及肝功能指标[总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、白蛋白(ALB)、前白蛋白(PA)]改善情况。【结果】(1)腹泻疗效:治疗组总有效率为100.00%,优于对照组的86.67%(P<0.05)。(2)腹水疗效:经彩超检查,治疗后2组的肝硬化腹水均有显著改善(P<0.05),且治疗组疗效优于对照组(P<0.05)。(3)肝功能作用:治疗后,2组TBIL、ALT、AST、ALB、PA指标均显著改善(P<0.05),且治疗组的改善作用均优于对照组(P<0.05)。(4)不良反应及随访情况:治疗过程中,治疗组与对照组均未发生明显不良反应。3个月后随访,对照组腹泻治愈患者中复发5例,治疗组无复发病例。【结论】加味赤石脂禹余粮汤联合热敏灸对肝硬化腹水并顽固性腹泻患者疗效显著,具有止泻迅速、应用方便、安全可靠等优点,并且有加速腹水消退、促进肝功能恢复的作用。     

自拟青附柴金丹联合药物敷贴治疗原发性痛经

目的 观察北京市第四批名老中医于增瑞自拟经验方青附柴金丹联合自拟穴位敷贴治疗原发性痛经的临床疗效.方法 39例原发性痛经患者采用自拟经验方青附柴金丹联合药物敷贴治疗,与39例单纯应用氨酚待因片治疗的患者进行分析比较,观察疗效.结果 自拟青附柴金丹联合药物敷贴治疗组总有效率为94.87％,对照组总有效率为53.85％,2组比较,P＜0.05.结论 自拟经验方青附柴金丹联合药物敷贴治疗原发性痛经,可使瘀祛滞通,气顺血和,冲任充盈,经行畅达平和,疼痛自除.     

河南省中小学教师职业倦怠的现状及成因分析

目的:探讨河南省中小学教师职业倦怠现状、成因及对策。方法:采用教师职业倦怠量表、社会支持评定量表、总体幸福感量表和教师职业压力源问卷,于2013年采用分层随机整群的抽样方法,对560名中小学教师进行调查。结果:男性教师情感衰竭和去人格化程度高于女性(t=2.132和2.293,P<0.05);不同年龄段的教师情感衰竭和去人格化得分差异有统计学意义(F=15.722和5.573,P<0.05);不同教龄教师在情感衰竭和去人格化得分上差异有统计学意义(F=11.048和3.930,P<0.05);不同职称的教师在情感衰竭的得分上差异有统计学意义(F=11.751,P<0.001);中学老师的情感衰竭和去人格化得分高于小学教师(t=6.333和3.220,P<0.05);城市(县市)地区教师的情感衰竭和去人格化得分高于农村地区(t=5.124和2.315,P<0.05)。社会支持3个因子与去人格化呈负相关,与成就感低落呈正相关(P<0.05);除松弛与紧张因子外,总体幸福感的其他5个因子与情感衰竭、去人格化呈负相关,与成就感低落呈正相关(P<0.05);职业压力的6个因子与情感衰竭和去人格化呈正相关(P<0.05)。结论:中小学教师的社会支持度、总体幸福感和职业压力对中小学教师职业倦怠产生影响。