冰雪来袭天寒心暖

“危机时刻见真情”，面对中国南方各省罕见雪灾，中国政府和居民展开大规模的自助自救行动。[编者按]     

Dreams that lie in tatters: the changing fortunes of nurses who left the British NHS to own and run residential homes for elderly people

During the 1980s many nurses left the British National Health Service to own and run private residential care homes for elderly people. At the time, a public policy of guaranteed financial support for residents underpinned the rapid expansion in the sector and residential homes were considered as profitable low-risk business ventures. However, since the introduction of the 1990 National Health Service and Care in the Community Act, this automatic funding has been withdrawn and residential homes have had to compete amongst each other for a finite number of clients funded by limited local budgets. The withdrawal of guaranteed state support and the introduction of social care markets have had negative impacts on many residential home businesses. Indeed, many homes are facing financial difficulties. This paper considers the actions and attitudes of former nurse proprietors under the new conditions based on a three-stage survey in Devon, England. Proprietors are experiencing increased levels of stress and many are unhappy with their current work experiences. The paper concludes that although the small business private sector may seem attractive to nurses, any move into private sector ownership has an associated risk. Social policy conditions may change with concurrent consequences for businesses and business owners.     

当归四逆汤加味治疗肩周炎56例

[目的]探讨当归四逆汤对肩周炎的治疗效果。[方法]56例门诊患者,均予以当归四逆汤加味治疗,辅助治疗,嘱患者每天进行肩关节功能锻炼3～5次,如爬墙等,并用红外线或热水袋温熨患肩。[结果]临床治愈31例占55.4%,显效13例占23.3%,好转8例占14.3%,总有效率为92.9%。[结论]当归四逆汤加味治疗肩周炎有较好疗效。     

甘温除热法管见

金·李东垣针对当时的外感热病气虚毒强发热证,提出了甘温除热法,体现了扶正灭毒的治疗原则,创立了补中益气汤、当归补血汤等一系列名方和补中升阳泻火的用药法度,示人根据正邪斗争的具体情况来辨证施治,切不可一见发热便滥用攻伐,至今仍有现实指导意义。     

Skeletal muscle function and hypertrophy are diminished in old age

Muscle loss occurs during aging. To investigate whether the hypertrophic response is attenuated at old age, we used male Fischer 344 (26 months old; n = 5) and Fischer 344 x Brown Norway rats (6, 9, and 33 months old; n = 8, 10, and 6, respectively). Hypertrophy of the left plantaris muscle was induced by surgical denervation of its agonists. The right leg served as control. The mass and maximal tetanic force (P(0)) of control muscles declined by approximately 30% between 9 and 26 months (P < 0.05). Fatigue resistance during intermittent isometric contractions was reduced by approximately 60% at 33 months. At 33 months, the attenuated hypertrophy was accompanied by a decrease rather than an increase in P(0). Yet, hypertrophy was accompanied by a 25% rise in fatigue resistance at all ages (P = 0.001). Thus, aging is associated with a decline in muscle mass and function. In addition, at advanced age, the hypertrophic response is reduced and a hypertrophic stimulus even aggravates the age-associated muscle weakening.     

Observations on metal concentrations in tilapia (Oreochromis mossambicus) in reservoirs of south Sri Lanka

Samples of the muscle and liver of tilapia (Oreochromis mossambicus) obtained from the five reservoirs in four catchments in southern Sri Lanka in 1998 were analyzed for 16 elements: As, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb, Sr, and Zn by inductively coupled plasma emission spectrophotometry, and Hg by atomic absorption spectrophotometry. The concentrations of Cr, Ni, and Pb were below the detection limits of the instrumental techniques employed in all samples. The elements As, Ca, Co, Cu, Fe, Hg, K, Mg, Mn, Na, Sr, and Zn were detected in the muscle and liver tissue, with Cd detected in some liver samples. There were no statistically significant differences between the individual concentrations of any of the metals and the site from which the tilapia were collected (P>0.05). Furthermore, no statistically significant correlations were found between total length of fish and metal concentration. No elements were found at concentrations of toxicological concern. However, a principal component analysis suggests that the populations of tilapia in the reservoirs may be exposed to different regimes of metals, possibly associated with different catchment land-use patterns.     

Training and education needs of consumers,families, and front-line staff in behavioral health practice

Much of the behavioral health care delivered to people with serious mental illnesses and chronic addictive disorders is provided by front-line or direct service mental health workers. Issues related to the qualifications, training, and ongoing evaluation of the competencies of this important provider group have received scant attention in the behavioral health field. This paper explores the educational needs and best practices of the consumers and families who carry much of the burden of caring for disabled populations, as well as the front-line staff, many of whom are employed in state psychiatric hospitals and community mental health or addiction treatment systems. Within the overall context of culturally competent behavioral health care, specific recommendations are proposed in an attempt to move the field forward.     

乌龙茶叶及茶汤中菊酯类农药和重金属的残留情况

目的探讨乌龙茶叶及茶汤中菊酯类农药和重金属的残留情况.方法于2004年采集3个茶叶生产基地的5种春季乌龙茶样品,进行常规的泡茶,测定干茶叶中的氯氰菊酯和氰戊菊酯农药以及Cu、Zn、As、Cd、Pb等重金属残留情况.干茶叶和茶汤中的菊酯类农药分别采用超声波萃取和振荡萃取,浓缩净化后用气相色谱-电子捕获检测器测定,干茶叶及茶汤分别经消解,用电感耦合等离子体-质谱及原子荧光光度法检测其中的重金属含量.结果干茶叶样品中氯氰菊酯和氰戊菊酯的含量分别为0.200～0.585和0.335～0.780 mg/kg,而其相应的茶汤样品中这2种菊酯类农药均未检出.各个干茶叶样品中均未检出Hg.故未做茶汤样品中Hg的残留分析,茶汤样品中Cu、Zn、As、Cd、Pb的含量分别为0.440～1.663μg/ml,1.590～3.509μg/ml,未检出～0.389μg/ml,未检出～14.220ng/ml,0.759～1.462 μg/ml.结论菊酯类农药残留不会因冲泡茶叶进入茶汤,冲泡过程能溶出茶叶中部分重金属,但其含量基本在国家标准范围内.     

江苏栽培明党参及其土壤中微量元素及重金属的含量测定

目的探讨江苏栽培明党参及其土壤中微量元素与重金属的含量及两者间的累积规律。方法采用原子吸收、原子荧光法及电感耦合等离子体发射光谱法对明党参及土壤中的微量元素进行测量。结果明党参中含有多种对人体有益或必需的微量元素，且含量与土壤中相应元素的含量呈正相关，重金属含量均低于药用植物及制剂进出口绿色行业标准。结论江苏栽培明党参药材是安全的。     

Financing health care in Egypt: current issues and options for reform

Aim The Government of Egypt has embarked on a process of reforming health care financing in the country. Under the influence of external advisers it, has so far focused on social health insurance as the main funding mechanism. Other options, in particular tax-based financing, have hardly been considered. In this article, social health insurance and taxation-based financing are analysed on their ability to meet Egypt's stated health policy goals and their viability. Subjects and methods Review of current health care financing arrangements in Egypt, of potential areas for improvement, and of stated health policy goals. Analysis of social health insurance and taxation-based financing on their ability to meet the stated policy goals and their viability. Results Although both funding mechanisms have distinct advantages and disadvantages when applied to the Egyptian health system, tax-based financing seems better able to meet the official policy goals of the Government of Egypt than social health insurance on grounds of efficiency, equity and technical feasibility. Conclusions The Government of Egypt will have to raise public health expenditure substantially to finance care at an adequate level. Expanding and refining the present tax-based financing scheme, rather than switching to an insurance-based scheme seems the technically superior strategy. Other measures to improve the coordination of financing, such as the creation of a single fundholding agency, are needed as well as tighter regulation of private providers and the pharmaceutical market.