中国西部蜱类的分布及防制对策

蜱类是重要的医学媒介动物,传播多种人畜疾病,对畜牧业、野生动物和人类健康造成极大危害。本文分析了中国西部蜱类的分布,计有１１属９１种,占中国蜱类总数的８５．０４％;其中硬蜱科９属８５种,软蜱科２属６种。同时,对西部９省（自治区）的蜱种进行了分析。在此基础上,提出了蜱类防制的对策。     

Social HMOs and Other Capitated Arrangements for Children with Special Health Care Needs

Objective: Children with special health care needs are increasingly enrolling in managed care arrangements. However, existing managed care organizations, including traditional HMOs, are often poorly suited for caring for this population. In the adult health care area, new managed care entities, called Social HMOs (S/HMO) and Programs for the All-inclusive Care for the Elderly (PACE), have been created to integrate health and health-related services for chronically ill and disabled adults. We describe these models and assess their potential for serving children with special health care needs. Method: We reviewed the literature on managed care for children with special health care needs and evaluation findings from the S/HMO and PACE models for the elderly. Results: Evaluations of the S/HMO and PACE models have yielded mixed findings. Some of the more positive accomplishments include lower use and expenditures for long-term care services compared to other demonstration projects, greater integration of primary care physicians in decision making concerning long-term care, and improved management of transitions between care levels. On the negative side, start-up has been slow, prospective members have been hesitant to enroll, intermittent and sometimes frequent operating deficits have emerged, no discernible positive effects on health or social outcomes are apparent, and no significant overall savings have emerged. Conclusions: With mixed results so far, caution is required in applying these or similar models for vulnerable child populations. However, given the inadequacies of traditional managed care for this population, we believe experimentation with new models of care that integrate health and health-related services is important. Such experimentation should be fostered only to the extent that the models are carefully designed and then implemented in a manner that protects the interests of children with special health care needs.     

Relationship between self-rating and polygraphic sleep parameters — analysis of compiled data from 12 young Japanese adults —

An examination of the relationship of the self-rating sleep score to polygraphic sleep parameters was conducted. The self-rating sleep questionnaire, OSA, includes five sleep quality factors: sleepiness (Fl), sleep maintenance without interruption (F2), worry about daily life or poor emotional condition (F3), integrated or perceived sleep feeling (F4) and sleep initiation or induction (F5). Polygraphic sleep parameters including each sleep stage in minutes were used. If intercorrelation coefficients exceeded 0.8, only one of the related parameters was selected for multivariate analysis. Twelve male students slept a total of 88 nights, among which the first night was not included, in an experimental room. When absolute values of Spearman’s rank correlation coefficient of not less than 0.4 were tentatively selected, the following pairs were extracted: F2 score and S1 (-0.423) or S3+S4 (0.409), F5 score and sleep latency (-0.439). Deeper sleep was closely associated with sleep maintenance without interruption. Agreement between self-rating and a polygraphic sleep parameter was recognized between the F5 score and sleep latency. Each OSA factor score was predicted by other polygraphic sleep parameters using multiple regression analysis. MT significantly contributed to the Fl, F3 and F4 scores. The number of stage shifts per night significantly contributed to the Fl and F3 scores, and the number of sleep spindles significantly contributed to the F5 score. Though prediction of sleep quality by polygraphic sleep parameters is limited, the association between concrete subjective and objective sleep parameters was clarified as mentioned above, and their practical meaning was partially elucidated.     

Glutathione S-transferase activity in epithelial ovarian cancer: Association with response to chemotherapy and disease outcome

Background: Conflicting data have been reported about the associationbetween glutathione S-transferase (GST), a family of proteins implicated indetoxification of cytotoxic drugs in human ovarian in vitro models, andresponse to chemotherapy and prognosis in ovarian cancer patients. The aim ofthis study was to analyze the possible clinical role of GST activity in alarge series of primary ovarian cancer patients.Patients and methods: The study included a large series of primaryuntreated ovarian cancer patients who underwent cytoreductive surgery andchemotherapy and who were followed up in a single institution. GST activitylevels were assessed in tumor extracts by using a biochemical assay. A cut-offof 250 units of enzymatic activity was chosen according to the receiveroperating characteristics (ROC) curve.Results: GST activity levels were distributed in an asymmetrical manner(median: 266 units; range: 4–918 units) and did not seem to beassociated with stage, histopathological grading, ascites, or residual tumorafter surgery. Higher GST activity levels were found in patients who respondedto chemotherapy (median: 298 units, range: 50–691) than in those whoresponded only partially (median: 227 units, range: 19–747) or not atall to chemotherapy (median: 246 units, range: 4–811) (H = 7.02, P =0.029). Moreover, the percentage of cases with >250 units was significantlyhigher among complete responders (66%) than partial responders(37%) or non-responders (48%) (² = 7.32;P = 0.025). When multivariate analysis, including clinico-pathologicalparameters and GST activity status as predictors of response to chemotherapy,was carried out, residual tumor, stage and GST status retained independentpredictive value. Patients with high GST activity had more favourableprognosis than those with low GST activity. The median PFS was 42 months forpatients with high GST activity compared to 17 months for those with low GSTactivity (P = 0.037). The median overall survival was 72 months forhigh-GST-activity and42 months for low-GST-activity patients (P = 0.043). Substantially similarresults were obtained in the subgroup of stage II–III–IV ovariancancer patients. Multivariate analysis including the clinico-pathologicalparameters and GST activity status was performed in stage III–IV ovariancancer patients: Stage IV disease, residual tumor >2 cm, the presence ofascites and low GST activity status retained independent negative prognosticroles.Conclusion: A direct association between high GST activity and a betterclinical outcome in terms of response to chemotherapy and survival has beenobserved in a large series of primary untreated ovarian cancer patients. Theseresults, which are contrary to the expectations raised by in vitro studies,emphasize the need for caution when translating in vitro-generated hypothesesto the clinical setting.     

Medical assessment for licensing of taxi drivers by Scottish Local Authorities

In the UK, licensing of taxi drivers is dealt with by localgovernment authorities. In Scotland, before the recent reorganizationof local government, taxi licensing was under the jurisdictionof District Councils, so a telephone survey was conducted ofall 52 mainland Scottish District Councils to ascertain theprocedures which were being employed in assessing medical fitnessto drive a taxi, for which there is no national standard. Medicalenquiries relevant to fitness to drive were being made by 41(79%) of local authorities, but in 38 (73%) this was limitedto a single question about health. No enquiry regarding healthstatus was being made by 11 (21%) District Councils (all serving< 100,000 population size). Only three Scottish DistrictCouncils conducted a routine medical examination of all applicants.Thirteen of the 15 large (> 100,000 population size), and20 of the 21 medium-sized (50,000–100,000) Scottish DistrictCouncils carried out medical examinations either when a relevantmedical disorder was declared by the applicant, or when theapplicant was above a defined age (which varied between localauthorities). The small local authorities (population < 50,000)examined only those applicants who declared medical disorders.This survey has shown considerable variation and limitationsin the approach of the previously existing Scottish DistrictCouncils to the assessment of medical fitness to drive of applicantsfor taxi licences. It is suggested that national standards andguidelines are required for medical fitness to drive in relationto taxi licensing.     

Effects of benzodiazepine receptor ligands on the performance of an operant delayed matching to position task in rats: opposite effects of FG 7142 and lorazepam

The effects of a series of benzodiazepine (BZ) receptor ligands, ranging from a full agonist through to partial inverse agonists, were examined on short term working memory in the rat. The behavioural paradigm used was a discrete trial, operant delayed matching to position task, as originally described by Dunnett (1985), with delays of 0, 5, 15 and 30 s. The benzodiazepine receptor (BZR) full agonist lorazepam (0.25, 0.375 and 0.5 mg/kg) dose and delay dependently impaired matching accuracy. Lorazepam also increased the latency to respond and decreased the number of nose pokes made into the food tray during the delays. In contrast, the BZR partial agonist ZK 95 962 (1, 3, 10 mg/kg) did not affect matching accuracy, but did increase the speed of responding. The BZR antagonist ZK 93 426 (1.25, 5, 25 mg/kg) had no effects in this paradigm. The BZR weak partial inverse agonists Ro 15-4513 (0.1, 1 and 10 mg/kg) and ZK 90 886 (1, 3 and 10 mg/kg) did not affect accuracy of performance. However, both of these drugs increased the latency to respond and decreased nose poke responses. These motoric effects were particularly strong following 10 mg/kg Ro 15-4513. This shows that the effects of drugs on the accuracy of responding and on the speed of responding can be dissociated. The BZR partial inverse agonist FG 7142 had effects on matching accuracy that were dependent upon dose. The lowest dose of FG 7142 (1 mg/kg) significantly improved accuracy, whereas the highest dose (10 mg/kg) impaired accuracy. This impairment induced by FG 7142 (10 mg/kg) was accompanied by an increase in the latency to respond and a decrease in the number of nose pokes. Taken together, these results show that the accuracy of delayed matching performance can be modulated in opposite ways by the BZR full agonist lorazepam and a low dose of the BZR partial inverse agonist, FG 7142.     

Gynopia in nursing practice: the case of urethral catheterization

• ? A pilot study of catheterized women was designed to investigate their perceptions of pain and discomfort during the procedure.
• ? The study aimed to test the feasibility of conducting a larger randomized controlled trial.
• ? Problems were encountered during the execution of the study, due to the need to conform to established principles in clinical research.
• ? Restrictions on access to patients impinged upon the opportunity to ‘cast the net wide’ in order to generate meaningful data.

     

ROC曲线在评价铅中毒指标中的应用

目的评价几种铅中毒指标筛选不同水平职业性铅接触的准确性。方法连续性收集１５７名铅接触工人的血标本,同时测定血铅、红细胞游离原卟啉（ＦＥＰ）、锌原卟啉（ＺＰＰ）、尿铅、尿δ氨基酮戊酸（δＡＬＡ）,以血铅≥４０、≥６０μｇ／ｄｌ的铅接触水平为金标准,用ＲｅｃｅｉｖｅｒＯｐｅｒａｔｉｎｇＣｈａｒａｃｔｅｒｉｓｔｉｃ（ＲＯＣ受试者工作特征）曲线分析软件评价所测定指标筛选血铅≥４０、≥６０μｇ／ｄｌ职业性铅接触的价值,在ＲＯＣ曲线上制定各测定指标筛选上述２个铅接触水平的最佳临界点,用ＥＰＩＮＦＯＲ统计软件比较筛选血铅≥４０、≥６０μｇ／ｄｌ的平行试验的敏感度。结果筛选血铅≥４０、≥６０μｇ／ｄｌ的铅接触水平,ＲＯＣ曲线下的面积（ＡＵＣＲＯＣ）最大的是ＺＰＰ,其他依次为ＦＥＰ、尿铅、尿δＡＬＡ;联合ＺＰＰ与ＦＥＰ的平行试验的敏感度高于联合尿铅与尿δＡＬＡ的平行试验。结论筛选血铅≥４０、≥６０μｇ／ｄｌ水平的职业性铅接触,ＺＰＰ的准确性最高,并且联合ＺＰＰ与ＦＥＰ的平行试验的敏感度高于联合尿铅与尿δＡＬＡ的平行试验。     

HBV不同血清学标志组合中HBV—DNA的分布特征

采用聚合酶链反应（PCR）技术对270例HBV不同血清学标志及不同组合进行了HBV-DNA的检测。揭示HBV-DNA在HBeAg标志中检出率最高,阳性率为100．00％;其次是HBsAg、抗-HBc和抗一HBe,阳性率分别为66．0％、65．9％和46．2％;在抗-HBS标志物中未能检出HBV-DNA。并示出了HBV-DNA在HBV血清学标志不同组合中的阳性率有着非常显著性差别,研究表明,在HBeAg阴性组合中,采用聚合酶链反应技术检测HBV-DNA的临床意义,同明还分析了HBV-DNA与性别、HBsAg滴度及ALT的关系。     

Barriers to Prenatal Care for Mexican and Mexican American Women

Despite the presumed health benefits, Latinas are less likely than women from other ethnic groups to receive adequate prenatal care during their pregnancy. However, it is unclear whether this trend is the result of political economic conditions that limit access of many Latinos in the United States to adequate health services in general, or of sociocultural conditions that restrict the use of such services even when they are made available. Furthermore, it is unclear whether these barriers pose a risk for adverse birth outcomes in this population. To address these issues, we conducted a two-phase study of the political economic and sociocultural barriers to use of prenatal care services among Mexican and Mexican American women living in San Diego, California, and their association with adverse birth outcomes in this population. A quantitative assessment of information abstracted from the medical records of 173 Latinas who had given birth at a university medical center found that absence of Medi-Cal benefits or other forms of health insurance was the only significant predictor of inadequate prenatal care during pregnancy. However, neither lack of insurance nor adequate prenatal care was associated with any adverse birth outcomes. A qualitative analysis of information obtained from interviews of 30 Latinas receiving prenatal care services at a medical clinic for the homeless and medically underserved residents of San Diego identified three major themes underlying the lack of adequate prenatal care: lack of trust in formal versus informal institutions, wanted versus unwanted pregnancies, and the importance of the social network.