以症状为主线的教学模式在耳鼻咽喉头颈外科规范化培训教学中的应用

耳鼻咽喉头颈外科住院医师规范化培训教学对临床思维的要求日益提高,传统以理论授课为主的教学模式难以使学生对耳鼻咽喉头颈外科形成系统的临床思维,本文探讨了“以症状为主线,充分培养临床思维”的教学模式在耳鼻咽喉头颈外科基地住院医师规范化培训培养中的应用及心得体会.     

Supplementation with macular carotenoids reduces psychological stress,serum cortisol,and sub-optimal symptoms of physical and emotional health in young adults

Purpose: Oxidative stress and systemic inflammation are the root cause of several deleterious effects of chronic psychological stress. We hypothesize that the antioxidant and anti-inflammatory capabilities of the macular carotenoids (MCs) lutein, zeaxanthin, and meso-zeaxanthin could, via daily supplementation, provide a dietary means of benefit.

Methods: A total of 59 young healthy subjects participated in a 12-month, double-blind, placebo-controlled trial to evaluate the effects of MC supplementation on blood cortisol, psychological stress ratings, behavioural measures of mood, and symptoms of sub-optimal health. Subjects were randomly assigned to one of three groups: placebo, 13?mg, or 27?mg / day total MCs. All parameters were assessed at baseline, 6 months, and 12 months. Serum MCs were determined via HPLC, serum cortisol via ELISA, and macular pigment optical density (MPOD) via customized heterochromatic flicker photometry. Behavioural data were obtained via questionnaire.

Results: Significant baseline correlations were found between MPOD and Beck anxiety scores (r?=??0.28; P?=?0.032), MPOD and Brief Symptom Inventory scores (r?=?0.27; P?=?0.037), and serum cortisol and psychological stress scores (r?=?0.46; P?P?Conclusions: Supplementation with the MCs significantly reduces stress, cortisol, and symptoms of sub-optimal emotional and physical health. Determining the basis for these effects, whether systemic or a more central (i.e. brain) is a question that warrants further study.     

2020—2021年芜湖市主城区大气PM2.5中多环芳烃污染特征及健康风险评估

目的 调查芜湖市主城区大气 PM2.5中多环芳烃（PAHs）污染特征及其人群健康风险。方法 2020年6月至2021年5月，每月10至16日采集芜湖市主城区大气PM2.5样品，检测和分析其中16种优先控制PAHs浓度及组成特征，并利用特征比值法和物质结构判断PM2.5中PAHs来源，采用US EPA健康风险模型评估其人群健康风险。结果 大气PM2.5浓度均值为49.2μg/m³，范围为7~151μg/m³；16种PAHs均有不同程度检出，总浓度均值为6.85ng/m³，范围为0.13~31.62ng/m³；PM2.5与16种PAHs各月份日均浓度变化存在相关性（R=0.867，P<0.001）；16种PAHs季节变化为冬季＞秋季＞春季＞夏季，构成均以4~6 环为主；大气PM2.5中PAHs主要来源为机动车排放和燃煤。PM2.5中16种PAHs的总致癌风险值（Risk）为2.20×10^-7，低于1×10^-6，致癌风险可忽略；非致癌风险危害商值（HQ）为0.49，小于1，非致癌健康风险低。结论 芜湖市主城区大气PM2.5中PAHs污染较轻，无明显健康风险。     

Relationship between unhealthy sleep status and dry eye symptoms in a Japanese population: The JPHC-NEXT study

PurposeTo investigate whether and how unhealthy sleep habits (i.e., the frequency of difficulty falling or staying asleep, and the frequency of waking up tired) and the duration of sleep are related to the prevalence of dry eye disease (DED) in a general population.MethodsThis study included a total of 106,282 subjects aged 40–74 years who participated in a baseline survey of the Japan Public Health Center-based Prospective Study for the Next Generation. DED was defined as the presence of clinically diagnosed DED or severe symptoms. Multivariable-adjusted logistic regression models were used to assess the relationships of various components of sleep status with DED.ResultsHigher frequencies of having difficulty falling or staying asleep, and waking up tired were significantly related to increased DED in both sexes (P_trend<0.001). Compared with those with 8 h/day of sleep, shorter sleepers had an increased prevalence of DED in both sexes, although DED was increased among men who slept ≥10 h/day. By comparing participants with the greatest vs. the least difficulty of falling asleep, the multivariable-adjusted odds ratios (95% confidence interval [CI]) were 2.23 (95% CI, 1.99–2.49) for men and 1.91 (95% CI, 1.76–2.07) for women. When analyzed separately, the magnitude of each relationship was stronger with severe DED symptoms than with clinically diagnosed DED.ConclusionsSleep deprivation and poor sleep quality were significantly related to DED in a Japanese population.     

The economic burden of schizophrenia in Canada in 2004

ABSTRACT

Objective: To estimate the financial burden of schizophrenia in Canada in 2004.

Methods: A prevalence-based cost-of-illness (COI) approach was used. The primary sources of information for the study included a review of the published literature, a review of published reports and documents, secondary analysis of administrative datasets, and information collected directly from various federal and provincial government programs and services. The literature review included publications up to April 2005 reported in MedLine, EMBASE and PsychINFO. Where specific information from a province was not available, the method of mean substitution from other provinces was used. Costs incurred by various levels/departments of government were separated into healthcare and non-healthcare costs. Also included in the analysis was the value of lost productivity for premature mortality and morbidity associated with schizophrenia. Sensitivity analysis was used to test major cost assumptions used in the analysis. Where possible, all resource utilization estimates for the financial burden of schizophrenia were obtained for 2004 and are expressed in 2004 Canadian dollars (CAN$).

Results: The estimated number of persons with schizophrenia in Canada in 2004 was 234?305 (95% CI, 136?201–333?402). The direct healthcare and non-healthcare costs were estimated to be CAN$2.02 billion in 2004. There were 374 deaths attributed to schizophrenia. This combined with the high unemployment rate due to schizophrenia resulted in an additional productivity morbidity and mortality loss estimate of CAN$4.83 billion, for a total cost estimate in 2004 of CAN$6.85 billion. By far the largest component of the total cost estimate was for productivity losses associated with morbidity in schizophrenia (70% of total costs) and the results showed that total cost estimates were most sensitive to alternative assumptions regarding the additional unemployment due to schizophrenia in Canada.

Conclusions: Despite significant improvements in the past decade in pharmacotherapy, programs and services available for patients with schizophrenia, the economic burden of schizophrenia in Canada remains high. The most significant factor affecting the cost of schizophrenia in Canada is lost productivity due to morbidity. Programs targeted at improving patient symptoms and functioning to increase workforce participation has the potential to make a significant contribution in reducing the cost of this severe mental illness in Canada.     

BOOK REVIEWS

No abstract available for this article.     

卫生统计管理信息系统构建

简要阐述基于卫生综合管理信息平台的卫生统计管理系统建设目标和指导思想,具体介绍系统建设内容、原则与架构,并对卫生统计管理信息系统的使用效果进行总结。