对围绝经期妇女激素补充治疗的认知度调查

目的探讨医护人员和妇女主任对激素补充治疗(HRT)的知晓率及培训需求情况。方法采用自行设计的调查问卷,对桐乡市医护人员和妇女主任进行问卷调查,调查表的主要内容分为一般情况、对HRT的利弊认知度、推荐与否、培训需求等方面。结果共调查医护人员430人、妇女主任206人,两组人员在平均年龄、工作年限、文化程度等基本特征方面无统计学差异。68.9%的妇女主任认为围绝经期妇女有必要应用HRT,明显高于医护人员。只有8.6%的医护人员表示一定会推荐患者使用HRT,明显低于妇女主任。医护人员不推荐使用HRT的原因主要是对副作用的担心。医务人员组更倾向于从相关书籍、期刊获得信息,而妇女主任组更倾向于从医生及媒体获得相关信息。结论桐乡市部分医护人员对HRT的相关知识了解不够,担心HRT发生不良反应,HRT的推荐率低。医护人员和妇女主任在HRT的认知上存在差异。针对不同人群,开展形式多样的HRT知识宣教及培养妇女主任成为HRT知识的传播者是提高HRT应用的关键措施。     

Granger因果分析1型糖尿病患儿静息态fMRI数据

目的 观察1型糖尿病（T1DM）患儿静息态fMRI双侧海马效应连接的变化。方法 对1型T1DM患儿（n=18,T1DM组）和健康儿童（n=13,对照组）行静息态fMRI数据采集,以双侧海马为ROI进行Granger因果分析。结果 与对照组比较,以左侧海马为种子点,T1DM组左侧海马对双侧额中回、岛盖部额下回、三角部额下回、中央后回、辅助运动区、脑岛、前扣带和旁扣带脑回、内侧扣带和旁扣带脑回、缘上回,左侧内侧额上回、中央前回,右侧背外侧额上回的外向流显著减弱;以右侧海马为种子点,T1DM组右侧海马对双侧辅助运动区、内侧扣带和旁扣带脑回,左侧的额中回、岛盖部额下回、三角部额下回、内侧额上回、中央后回、前扣带和旁扣带脑回、缘上回外向流显著减弱。结论 T1DM患儿海马功能可能受到损伤,导致额叶、辅助运动皮层、扣带皮层对海马信息的提取能力减弱;与右侧海马相比,左侧海马可能对认知处理的参与度更高;海马外向流减弱对T1DM相关认知损害具有早期警示作用。     

基于智库理念的基层医生信息需求调查

以济宁市5所医院近300名临床医生为研究对象,通过问卷调查,了解其获取专业信息的动力因素、渠道、障碍及满意度,分析其信息需求及存在问题,指出医学院校图书馆应以提高专业信息资源的权威性、时效性和检索的全面性为着力点,向当地医院开展智库服务。     

社区药学服务调查报告Ⅱ

目的调查分析社区老年人群用药常识及对社区药学服务的需求情况,为社区开展老年人药学服务提供理论依据。方法对温州12个社区的居民进行问卷调查,选取60岁以上老年人与60以下的成年人进行对比分析。结果社区老年人健康问题以高血压、糖尿病等慢性病为主;社区老年人与非老年人在社区卫生服务中心购药的比例分别为58.25%与42.42%;79.80%老年人有家中备药习惯,但仅13.13%老年人按说明书中贮存要求存放药品;老年组与非老年组相比,用药误区存在显著性差异,老年组用药问题相对较多,在合理用药知识宣传、指导家庭备用药的选用及上门服务等药学服务方面存在更大的需求。结论社区老年人用药存在诸多问题,对社区药学服务的需求非常迫切。老年人社区药学服务目前还处于初级探索阶段,还需要社区药师发挥专业特长不断探索,不断实践,不断创新,让药学服务模式融入到社区卫生服务。     

囊性纤维化跨膜传导调节因子抑制药在分泌性腹泻中的应用研究进展

摘 要 分泌性腹泻威胁着全球健康,是儿童发病和死亡的主要原因之一。肠上皮细胞腔内Cl-通道激活导致肠道液体过度分泌是肠毒素引起腹泻的主要原因。在霍乱及其他细菌肠毒素引发的腹泻中,囊性纤维化跨膜传导调节因子（cystic fibrosis transmembrane conductance regulator, CFTR）是主要的cAMP-调节Cl 通道,其主要功能是促进上皮细胞液体分泌。利用肠上皮细胞CFTR抑制药抗分泌性腹泻是一种新途径。已有的CFTR抑制药有噻唑啉酮类、甘氨酸酰肼类和喹喔啉二酮等。同时,从天然植物中提取分离的一些成分也具有CFTR抑制作用,但研究还不够深入。因此,对CFTR抑制药的研究进展进行了综述。     

Strategies adopted to manage physical and psychosocial challenges after returning home among people with stroke: A qualitative study

Stroke survivors encounter various physical and psychosocial challenges after hospital discharge. Systematic reviews consistently suggest the importance of self-management in promoting post-stroke recovery. However, stroke survivors’ performance of self-management behaviors after returning home is poorly understood. This study was conducted to explore how stroke survivors manage their life after returning home from the hospital. This was a qualitative study with individual, semi-structured interviews. We recruited a purposive sample of adults who had a first or recurrent ischemic or hemorrhagic stroke and currently lived at home. Participants were asked about their post-stroke experiences, challenges encountered, and strategies adopted for managing post-stroke conditions. Data were transcribed verbatim and analyzed using thematic analysis. A total of 30 stroke survivors (mean age = 61.97 years, SD = 10.20) were interviewed. Most were men (n = 18), married (n = 25), and retired (n = 21). Two-thirds had experienced an ischemic stroke. Five key themes emerged: pursuing lifelong learning to live well after a stroke; reinterpreting unpleasant experiences as new learning opportunities; engaging in life activities to better adapt to post-stroke challenges; being confident in oneself to persevere in self-management behaviors; and continuing to accept the current self and explore the new self. Participants regarded learning as a prerequisite for improving their affected functions and managing uncertainties in recovery. Learning requires self-participation, building self-efficacy and positive outcome expectations, testing and adapting strategies to one''s own health conditions, and engaging in leisure or social activities. These findings will guide future development of interventions for enhancing stroke survivors’ recovery outcomes.     

感染HIV的孕产妇预防艾滋病母婴传播服务需求与障碍分析

目的了解艾滋病病毒(HIV)感染孕产妇的预防艾滋病母婴传播服务需求与服务利用障碍。方法对某艾滋病高发地区,自2003年以来截至2004年10月发现并分娩的HIV感染孕产妇进行问卷调查。结果13.79%的孕产妇不愿意接受产前检查,5.17%的孕产妇不愿意住院分娩,怕歧视、担心检查和住院分娩费用高等是孕产妇不接受孕产期保健的主要原因;96.43%的孕产妇愿意本人和给孩子服用抗逆转录病毒药物预防艾滋病母婴传播,但只有87.50%的孕产妇服用了抗HIV药物,未服药的原因为临产急诊分娩,未得到检测结果,延误了孕产妇和婴儿的服药时机;89.29%的孕产妇希望其所生婴幼儿获得随访服务,但只有58.93%的婴幼儿得到过随访服务,其中51.52%的婴幼儿在出生后3个月内得到首次随访;怕别人知道自己的感染情况是不愿意接受随访的主要原因;近7%的孕产妇不愿意或不知道要给所生的婴幼儿进行HIV抗体检测。结论育龄妇女和孕产妇艾滋病检测不及时、非住院分娩、婴幼儿随访服务薄弱、经济负担、社会歧视等问题,是预防艾滋病母婴传播服务利用的主要障碍,预防艾滋病母婴传播综合能力亟待加强。     

Comparison of two methods of determining renal perfusion with and without captopril pretreatment in groups of patients with left ventricular dysfunction

Methods of effective renal plasma flow measurement by ¹²⁵I-orthoiodohippurateelimination and para-aminohippurate clearance were comparedwith and without captopril pretreatment in 10 chronic heartfailure patients and in 20 patients after transmural myocardialinfarction. In the chronic heart failure group measurements of effectiverenal plasma flow by the two techniques were strongly correlated(r=0·92, P<0·00001), as was the captopril-mediatedchange in effective renal plasma flow by the two methods (r=0·85,P=0·002). However, in absolute terms para-aminohippurateclearance significantly exceeded ¹²⁵I-orthoiodohippurate clearanceby a mean (± SD) of 24·8 ± 43·7ml. min^–1 (P<0·05) so that only using the formertechnique was a signifincant in renal perfusion observed inresponse to converting enzyme inhibition. In the post-myocardial infarction group, correlations betweenthe two methods were variable and much poorer than in the chronicheart failure group (r=0·54, P=0·01 and r=0·74,P=0·002 on consecutive days). Furthermore, captoprilmediatedincrements in effective renal plasma flow by the two techniqueswere unrelated (r= – 0·19, P=0·59). In thisgroup ¹²⁵I-orthoiodohippurate elimination significantly exceededpara-aminohippurate clearance (P<0·05). This reversedassociation and the weaker relationships between methods inpost-infarction as compared to chronic heart failure patientsmay be related to interference by thrombolytic or aspirin treatments.