National decision-making for the introduction of new vaccines: A systematic review, 2010–2020

BackgroundCompeting priorities make using a transparent and evidence-based approach important when deciding to recommend new vaccines. We conducted a literature review to document the processes and frameworks for national decision-making on new vaccine introductions and explored which key features have evolved since 2010.MethodsWe searched literature published on policymaking related to vaccine introduction from March 2010 to August 2020 in six databases. We screened articles for eligibility with the following exclusion criteria: non-human or hypothetical vaccines, the sole focus on economic evaluation or decision to adopt rather than policy decision-making. We employed nine broad categories of criteria from the 2012 review for categorization and abstracted data on the country, income level, vaccine, and other relevant criteria.ResultsOf the 3808 unique references screened, 116 met eligibility criteria and were classified as: a) framework of vaccine adoption decision-making (27), b) studies that analyse empirical data on or examples of vaccine adoption decision-making (45), c) theoretical and empirical articles that provide insights into the vaccine policymaking process (44 + 17 already included in the previous categories). Commonly reported criteria for decision-making were the burden of disease; vaccine efficacy/effectiveness, safety; impact on health and non-health outcomes; economic evaluation and cost-effectiveness of alternative interventions. Programmatic and acceptability aspects were not as often considered. Most (50; 82%) of the 61 articles describing the process of vaccine introduction policymaking highlighted the role of country, regional, or global evidence-informed recommendations and a robust national governance as enabling factors for vaccine adoption.ConclusionsThe literature on vaccine adoption decision-making has expanded since 2010. We found that policymakers and expert advisory committee members (e.g., National Immunization Technical Advisory Group [NITAG]) increasingly value the interventions based on economic evaluations. The results of this review could guide discussions on evidence-informed immunization decision-making among country, sub-regional, and regional stakeholders.     

蚤类的种间杂交及其分类学意义 (一)曲棘新蚤×思博新蚤

作者以曲棘新蚤（ＮｅｏｐｓｙｌａｔｅｒａｔｕｒａＲｏｔｈｓｃｈｉｌｄ，１９１３）和思博新蚤（Ｎ．ｓｉｂｏｉＹｅｅｔＹｕ，１９９３）为亲本进行了杂交试验。亲本蚤自新疆野外采集，在实验室饲养两代以上纯化后用于杂交试验。两种蚤的饲养器具完全分开，采用平皿湿滤纸法培育蚤的裸蛹，并在蛹期即将雌雄分开，以保证同种蚤亲代两性间无交配。设正交、反交、子代自交和回交四种组合。以能产生Ｆ２以上杂种者为杂交可育，否则为杂交不育。以雄性第９腹板后臂鬃的形态、可动突形状及第８腹板后缘鬃序为判定杂交后代归属的形态学特征。杂交结果表明，两亲本蚤杂交可育，产生了Ｆ２以上杂种。在正交Ｆ１和Ｆ２、反交Ｆ１以及回交子代中均出现了两亲本蚤形态特征之间的中间型个体，说明两亲本蚤间并不存在生殖隔离，它们实际上是同一个物种。本次试验的结果提示，目前蚤类分类工作中的传统的方法和标准有待通过遗传学试验及现代生物技术方法加以修正和完善。     

医学伦理学教学模式探讨

医学伦理学是医学科学和伦理学科学交叉的边缘科学 ,是医学道德的科学 ,是一般伦理学原理在医学实践中的具体运用。培养合格医学生 ,不仅要注重医学知识的教育 ,而且要重视医学伦理道德的引导和培养。本文从教育的目的、原则、内容及教学方法等方面探讨医学伦理学的教学模式 ,旨在从理论到实践提高医学生的医德修养     

由复方中单一组分微小效应引发的对中西医结合理论的思考

“霰弹理论”认为中药作用机制和途径表现为多向性、多层面、多靶点的药理学特点 ,这些特点决定了中药复方中任何一种单一组分均可具有微小的生物学效应。在药物组分之间的相互作用中 ,除了少数已证明具有受体效应的组分外 ,多数组分是微效组分 ,即 :中药药效 =A B C …N个微小效应的累加作用。对某一组分不能忽略其生物学的微小效应 ,也不能采用简单的检测手段和数学统计方法分析微小效应。采用细胞培养的方法结合数学概率论将组分的微小生物学效应合并成机体的整体的生物学效应 ,可以解决实验医学与中医结合中遇到的理论与实际相脱节、实验研究结果与临床效果相背离等问题。     

The efficacy and safety of traditional Chinese medicine Guilu Erxian Jiao in the treatment of knee osteoarthritis: A systematic review and meta-analysis

ObjectiveA systematic review was conducted to investigate the efficacy of Guilu Erxian Jiao (GEJ) in the treatment of knee osteoarthritis (OA).MethodsWe searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Chinese Electronic Periodical Services, and ClinicalTrials.gov to identify relevant randomized controlled trials or controlled clinical trials, from the inception of each source to April 20, 2021. Primary outcome included overall efficacy, pain score, and Lequesne index score; secondary outcome included adverse events. Methodological quality was assessed using the Cochrane risk of bias tool (RoB 1.0). The meta-analysis was performed based on a random-effects model due to anticipated clinical heterogeneity. The grading of overall evidence was assessed using the GRADE system. The study protocol was registered on PROSPERO (CRD42021233573).ResultsEight studies were included. Compared to controls, GEJ exhibited superior overall efficacy for treating OA (risk ratio (RR) = 1.20; 95% confidence interval (CI) = 1.06–1.35). Regarding pain score, there was no statistical difference between GEJ and controls (standardized mean difference (SMD) = 0.27; 95% CI = −0.91 – 1.46). No significant difference was found in Lequesne score between GEJ and controls (MD = −0.25; 95% CI = −0.52 – 0.01). No statistical difference in adverse reactions was observed between GEJ and controls (risk difference (RD) = −0.01; 95% CI = −0.05–0.03).ConclusionOur findings suggest that GEJ may have positive effects on overall efficacy in treating OA. However, there is insufficient evidence regarding pain score, Lequesne score, and knee joint function score.     

Creative versus repetitive dance therapies to reduce the impact of fibromyalgia and pain: A systematic review and meta-analysis

Background and purposePhysical exercise is one of the most effective interventions to reduce fibromyalgia symptoms. Previous studies have reported benefits of dance-based intervention on the fibromyalgia impact, health-related quality of life and pain, regardless the interventions were based on creative- or repetitive dance. This study aimed to compare the effectiveness of creative and repetitive dance interventions.MethodsPRISMA guidelines were followed in this systematic review. The Cochrane Library, PubMed, Trip, Google Scholar, Web of Science (WOS), Embase and Scopus databases were selected to identify potential articles. Studies were included if they met the following inclusion criteria: to be a clinical trial or a randomized controlled trial, include people with fibromyalgia, have a comparison group and evaluate the impact of the disease, pain or quality of life. Fifteen articles fulfilled the inclusion criteria. The methodological quality of the studies was assessed using the Cochrane Collaboration's tool.ResultsDance-based interventions significantly reduced fibromyalgia impact (standardized mean difference = −0.69), pain (standardized mean difference = −0.70 and increased quality of life (standardized mean difference = 0.43) of people with fibromyalgia. The effectiveness of dance interventions is increased when a creative component is added, since it can lead to higher improvements in pain, impact of the disease and improving quality of life.ConclusionDance-based interventions are significantly effective in reducing the impact of fibromyalgia, pain as well as increasing health-related quality of life. Subgroup analyses suggest that creative dance-based interventions could be more effective than repetitive dance-based interventions to reduce pain and fibromyalgia impact. However, results must be taken with caution due to the large heterogeneity and the small number of articles.     

浅议儒家道家思想对王冰的影响

通过对王冰《素问》注文的梳理，分析王冰学术观点与道家、儒家思想的理论传承关系。认为王冰的许多养生学观点均源于道家，如主张少私寡欲、自然无为、恬淡守道，注重饮食起居等等；在医理方面，其阴阳、天人相应、气机运动等观点均深受儒家求理思想的影响。强调道家、儒家思想对王冰的影响不是单一的，而是呈现重迭交融之态，同时指出，儒家道家的一些消极思想对王冰也有不良影响。     

中药材GAP种植基地建设探讨

中药材GAP种植基地建设是影响药材生态经济效益的关键因素之一。在基地建设中应重视量化基地环境因子，以地选材，以材定地，完善栽培方法，深入研究加工工艺，实行规范的“公司十基地十科研单位十农户”的经营运作方式。运用系统论概念，将基地建成最大效益的生态经济复合体。     

相似系数法在川贝母群落分类中的应用研究

目的　探讨数值分类方法应用于川贝母分布群落类型的划分。方法　以群落相似系数百分率划分川贝母分布的群落类型。结论　应用相似系数法可将川贝母野生抚育的适宜群落划定为窄叶鲜卑花灌丛、理塘杜鹃灌丛、硬叶柳灌丛、金露梅 +绣线菊灌丛、香柏灌丛、珠芽蓼 +圆穗蓼草甸等 6种类型