茂名市无偿献血者HCV感染人群特征分析

目的：了解茂名市无偿献血者 HCV 感染人群特征,为无偿献血者招募和 HCV 感染防控提供依据。方法选取茂名市中心血站无偿献血者标本,采用不同厂家试剂、不同操作人员进行 HCV 抗体检测。对初次检测具反应性标本采用双孔进行复试确认,对检测结果进行统计分析。结果茂名地区无偿献血者 HCV 感染率为0．74％;女性感染率略高于男性,但差异无统计学意义（P ＞0．05）;公务员及医务人员感染率相对较低;重复献血者 HCV 感染率明显低于首次献血者,差异有统计学意义（P ＜0．05）。结论茂名地区无偿献血人群 HCV 感染率处于较低水平,符合献血条件的小于35岁人群 HCV 感染风险较低,建立一支固定的无偿血者队伍,有利于保障临床用血安全。宜加强对于公务员和医务人员之外的群体进行 HCV 知识的宣教和防控,有效控制人群 HCV 感染。     

Periostin as a predictor of prognosis in chronic bird-related hypersensitivity pneumonitis

BackgroundPeriostin is an established biomarker of Th2 immune response and fibrogenesis. Recent research has indicated that periostin plays an important role in the pathogenesis of idiopathic interstitial pneumonias. To clarify the relationship between periostin and pathogenesis in chronic bird-related hypersensitivity pneumonitis (HP) and to reveal the usefulness of serum periostin levels in diagnosing and managing chronic bird-related HP.MethodsWe measured serum periostin in 63 patients with chronic bird-related HP, 13 patients with idiopathic pulmonary fibrosis, and 113 healthy volunteers. We investigated the relationship between serum periostin and clinical parameters, and evaluated if the baseline serum periostin could predict the prognosis.ResultsSerum periostin was significantly higher in patients with chronic bird-related HP compared to the healthy volunteers. In chronic bird-related HP, serum periostin had significant positive correlations with serum KL-6 levels, the CD4/CD8 ratio in bronchoalveolar lavage fluid, and fibrosis score on HRCT, and a significant negative correlation with the diffusing capacity of the lungs for carbon monoxide. Chronic bird-related HP patients with serum periostin levels exceeding ≥92.5 ng/mL and ≥89.5 ng/mL had a significantly worse prognosis and significantly higher frequency of acute exacerbation, respectively. Higher serum periostin (92.5 ng/mL or higher; binary response for serum periostin) was an independent prognostic factor in multivariate analysis.ConclusionsSerum periostin may reflect the extent of lung fibrosis and play an important role in pathogenesis of chronic bird-related HP. Elevated serum periostin could be a predictor of prognosis in patients with chronic bird-related HP.     

Hepatitis C virus infection in asymptomatic male volunteer blood donors in Karachi, Pakistan

The objectives of this study were to assess the proportion of hepatitis C virus (HCV) reactors and to identify risk factors associated with HCV infection in volunteer blood donors in Karachi, Pakistan. Between 1 January 1998 and 31 December 2002, consecutive blood donations tested at two blood banks were used to assess the proportion of HCV sero-reactors donors. To evaluate the potential risk factors, a case-control study design was implemented to select cases and controls between 15 October 2001 and 15 March 2002. The overall seroprevalence of HCV in these blood donors was 1.8% (6349/35 1309). Trend analysis revealed a significant (P < 0.001) linear increase in proportions of HCV-seropositive donors from 1998 to 2002. Final multivariate logistic regression model showed that the cases were more likely than controls to have reported past hospitalization or to have received multiple injections. When a glass syringe was used to give therapeutic injections, it increased the adjusted odds of being HCV seropositive significantly more among cases than in controls and this relationship was stronger when injection was given by general medical practitioner than if the injection was given in hospital setting. Cases were more likely than controls to have reported sexual contact with multiple sexual partners. Primary prevention programmes focused on identified risk factors might help to curtail the spread of HCV infection in this community and in other similar settings in developing countries.     

Sex and Body Mass Index but Not CXCL12 801 G/A Polymorphism Determine the Efficacy of Hematopoietic Cell Mobilization: A Study in Healthy Volunteer Donors

Analyses of healthy donors of granulocyte colony-stimulating factor (G-CSF) mobilized hematopoietic stem and progenitor cells (HSPCs) and of patients undergoing autologous stem cell transplantation have suggested that individuals harboring the CXCL12-A allele mobilize a higher number of CD34 + HSPCs after G-CSF administration. We typed 463 healthy unrelated donors (376 men and 87 women) who had received daily subcutaneous injections at a mean dose of 7.36 ± 1.71 μg/kg G-CSF for 5 days for CXCL12 801 G/A using a real-time PCR assay. Interestingly, the median concentration of mobilized CD34 + cells on day 5 was almost identical in donors with the A-allele (79/μL; range, 11 to 249/μL) and the G/G-group (82/μL; range, 15 to 268/μL). In addition, the allelic distribution was not different in donors (n = 11) who mobilized less than 20/μL CD34 + cells. No difference in the overall yield of CD34 + cells in the apheresis product and in the number of CD34 + cells/kg recipient could be detected between both groups. In a multivariate regression model for the endpoint CD34 + cells/μL at day 5, only male sex (regression coefficient, 11.5; 95% confidence interval, 1.7 to 21.2, P = .021) and body mass index as continuous variables (regression coefficient, 3.5; 95% confidence interval, 2.5 to 4.5, P = .0001) but not age, smoking status, or CXCL12 allelic status represented independent variables. Our data derived from a large well-controlled cohort contradict previous analyses suggesting an association between CXCL12 allelic status and the yield of CD34 + HSPC after G-CSF mobilization. Concentration of CD34 + cells in the peripheral blood, the most objective parameter, could not be predicted by CXCL12 genotype.     

泰国农村卫生人力扶持政策对我国的启示

目前我国农村卫生人力资源不足的问题严重制约了农村卫生服务工作的开展.泰国在农村卫生人力扶持政策方面积累了较多先进经验,其中比较有代表性的是强制性农村服务政策和健康促进志愿者制度.我国也有类似的、正在发展的农村订单定向免费医学生培养项目和健康志愿者制度,泰国农村卫生人力扶持政策在政策引导、建立体系、奖惩措施等方面对我国有一定的启发和借鉴意义.     

医务社工与志愿者在医院服务管理中作用的评价

目的 通过实证调查采集患者、医务工作者和志愿者对医务社工及志愿者工作的评价,解析医务社工及志愿者在医院服务管理中的作用.方法 采用问卷调查、文献查阅、深度访谈法,调研上海市3家三级甲等公立医院获取第一手资料.结果 调查结果显示,患者、医务人员及医务管理人员高度认可医务社工与志愿者在医院服务管理的作用.结论 医务社工和志愿者在医院服务管理中能发挥独特的作用,可以增进医患沟通,缓解或预防医患矛盾,给患者更多人文关怀和增值服务,一定程度上解决了医患之间的诊治经费问题,提升服务品质,降低人力成本,应当得到全社会更多的重视.     

The prevalence and incidence of medical conditions in healthy pharmaceutical company employees who volunteer to participate in medical research

AIMS: Although clinical research in healthy volunteers is commonly performed there have been few studies of the value of the medical screening of subjects. The aim of this study was to investigate the prevalence and incidence of medical conditions found during the medical screening of 'healthy' subjects employed in a pharmaceutical company who volunteered to participate in medical research. METHODS: This was a retrospective study of the medical notes of all the subjects who volunteered for membership of the Zeneca Clinical Pharmacology Unit's healthy volunteer panel over a 4 year period from 1990 to 1994. The prevalence of medical conditions found at presentation was determined. The incidence of medical conditions during the 4 year observation period was also ascertained. Medical screening included a full medical history and examination, clinical chemistry, haematology and urinalysis screens, pulmonary function tests, ECGs, 24 h ambulatory cardiac monitoring and a request for information from the volunteer's General Practitioner. RESULTS: Prevalence-1293 subjects volunteered to join the panel of which 156 subjects (12%) were not accepted at presentation including 141 (10. 9%) for medical reasons. The most medical common reasons were; previously diagnosed medical conditions (3.3%), cardiovascular abnormalities (1.9%), abnormal liver function tests (1.9%), anaemia (1.2%), hyperlipidaemia (1.1%), excess alcohol intake (0.6%) and thyroid disease (0.5%). Incidence-36 of the 1137 volunteers (0.8% per year) accepted onto the panel subsequently developed medical conditions of which the most common were; anaemia (0.29% per year), cardiovascular abnormalities (0.13% per year) and vasovagal syncope (0.13% per year). CONCLUSIONS: This study demonstrates the importance of medical screening before healthy volunteers participate in clinical research.     

Mentoring Children With Incarcerated Parents: Implications for Research,Practice, and Policy

We investigated children and families who were participating in a mentoring program targeting children with incarcerated parents. Using multiple methods and informants, we explored the development of the mentoring relationship, challenges and benefits of mentoring children with incarcerated parents, and match termination in 57 mentor‐child dyads. More than one‐third of matches terminated during the first 6 months of participation. For those matches that continued to meet, however, children who saw their mentors more frequently exhibited fewer internalizing and externalizing symptoms. In monthly interviews with participants, themes emerged about challenges associated with mentoring and reasons for match termination. Implications for researchers, practitioners, and policymakers are discussed.     

Ambulatory Urodynamics in Asymptomatic,Young, Healthy Male Volunteers

Objectives: To assess the incidence of detrusor overactivity and reproducibility of data from ambulatory urodynamic monitoring (AUM) in male volunteers. Methods: Sixteen asymptomatic healthy male volunteers with a mean age of 26.3 years (range: 22–30) underwent AUM by natural filling cystometry followed by a pressure/flow study. The studies were repeated three times. Results: Detrusor overactivity (DO) was detected in six subjects (37.5%), but clinically significant detrusor overactivity was noted only in three (18.8%). Q_max, detrusor opening pressure, and P_detQ_max were similar among the three measurements. The bladder outlet obstruction index (BOOI) varied, and there was a significant difference between the first and third measurements (P = 0.0371). Obstruction grade was ranked as unobstructed in all studies for 13 subjects, equivocal (BOOI 45 and 46) in one subject, and both unobstructed and equivocal (BOOI 30, 43 and 30) in one subject. There was a significant difference in bladder contractility index (BCI) between the first and third studies (P = 0.0186). The BCI was always strong in five subjects, always normal in eight subjects, and strong to normal in three subjects. Conclusion: DO was found in 37.5% of male volunteers. BOOI and BCI may not be highly reproducible, and the third study may provide the best result if the first and second studies differ. However, 87.5% of subjects were rated as unobstructed and all subjects were rated as normal or strong, with the categories of obstruction and bladder contractility showing no change in most subjects. AUM with three studies seem adequate for the evaluation of lower urinary tract dysfunction in males.     

美国普及病人安全知识的分析与思考

普及和提高全民病人安全知识,是美国政府减少可预防的医疗差错的重要措施之一。为此,美国政府大量投资,建立两个报告系统,规范相关操作制度,取得一定效果。本文就这一措施的国家行动、建立监察系统、保护性措施及规范操作制度进行分析与思考。