不同时期极低和超低出生体重儿神经发育预后比较

目的 探讨极低出生体重儿(very low birth weight infant, VLBWI)和超低出生体重儿(extremely birth weight infant, ELBWI)不同时期神经发育损害发生的变化趋势。方法 复旦大学附属儿科医院新生儿科2005年10月1日-2010年12月31日收治并救治成活的VLBWI和ELBWI, 纠正胎龄18～42个月, 完成贝莉婴儿发育量表-Ⅱ(Bayley Scales of Infant Development-Ⅱ, BSID-Ⅱ)的患儿有143例, 按入院时间分为两个阶段, 第一阶段为2005年10月1日-2008年12月31日入院的患儿, 共54例;第二阶段为2009年1月1日-2010年12月31日入院的患儿, 共89例。比较两个阶段患儿的神经发育预后情况。结果 两个阶段的研究对象在性别、胎龄、出生体重及分布上均相似。第一阶段患儿的智力发育指数得分(88.6±19.2)显著低于第二阶段(97.0±14.6)(P=0.004);第一阶段患儿智力发育指数<70的发生率(14.8%)显著高于第二阶段(3.4%)(P=0.014)。第一阶段患儿总体神经发育损害的发生率(22.2%)高于第二阶段(13.5%), 脑瘫发生率(9.3%)高于第二阶段(2.3%), 心理运动发育指数得分(83.6±16.1)低于第二阶段(85.0±13.6), 心理运动发育指数<70分的发生率(16.7%)高于第二阶段(12.4%), 但这几个方面的差异均无统计学意义。结论 医生和家长均应重视VLBWI和ELBWI的出院后随访及早期干预, 以改善患儿的神经发育预后。     

A Randomized Controlled Trial of a Community-Based Nutrition Education Program for Low-Income Parents

ObjectiveAssess effectiveness of the Expanded Food and Nutrition Education Program on nutrition behaviors post-education and longitudinally.DesignSwitching replications randomized experimental design. Participants randomly assigned to immediate education (IE) or delayed education (DE). Participants in IE received intervention the first 8 weeks, and those in DE the second 8 weeks, with no intervention during alternate periods. Data were collected in 3 repeated measures.ParticipantsParents (n = 168 randomized; n = 134 completed) of children in 2 Head Start and 6 low-income schools.InterventionEight weekly workshops, based on Eating Right is Basic-Enhanced adapted to incorporate dialogue approach with experiential learning.Main Outcome MeasuresTen-item self-reported behavior checklist on nutrition, food resource management, food safety, and food security; responses on a 5-point scale reporting frequency of behavior.AnalysisChi-square, analysis of variance, and multiple regression.ResultsGroups were demographically similar. Both groups reported improved behaviors pre- to post-education (P < .05). There was no significant difference between groups at Time 1 (T1) or DE control period (T1 vs T2). Changed IE behavior was retained T2 to T3. A multiple regression model of overall change, controlling for T1 score and educator, showed significant improvement (n = 134, β = 5.72, P < .001).Conclusions and ImplicationsPositive outcomes were supported by this experimental study in a usual program context, with reported behavior changes retained at least 2 months.     

Targeted Melanoma Prevention Intervention: A Cluster Randomized Controlled Trial

PURPOSE

Targeted interventions to reduce the risk and increase the early detection of melanoma have the potential to save lives. We aimed to assess the effect of such an intervention on patient prevention behavior.

METHODS

We conducted a pilot clustered randomized controlled trial, comparing a targeted screening and education intervention with a conventional information-based campaign in 20 private surgeries in western France. In the intervention group, 10 general practitioners identified patients at elevated risk for melanoma with a validated assessment tool, the Self-Assessment Melanoma Risk Score (SAMScore), examined their skin, and counseled them using information leaflets. In the control group, 10 general practitioners displayed a poster and the leaflets in their waiting room and examined patients’ skin at their own discretion. The main outcome measures were sunbathing and skin self-examinations among patients at elevated risk, assessed 5 months later with a questionnaire.

RESULTS

Analyses were based on 173 patients. Compared with control patients, intervention patients were more likely to remember the campaign (81.4% vs 50.0%, P = .0001) and to correctly identify their elevated risk of melanoma (71.1% vs 42.1%, P = .001). Furthermore, intervention patients had higher levels of prevention behaviors: they were less likely to sunbathe in the summer (24.7% vs 40.8%, P = .048) and more likely to have performed skin self-examinations in the past year (52.6% vs 36.8%, P = .029). The intervention was not associated with any clear adverse effects, although there were trends whereby intervention patients were more likely to worry about melanoma and to consult their general practitioner again about the disease.

CONCLUSIONS

The combination of use of the SAMScore and general practitioner examination and counseling during consultations is an efficient way to promote patient behaviors that may reduce melanoma risk. Extending the duration of follow-up and demonstrating an impact on morbidity and mortality remain major issues for further research.     

某中医医院连续3年女性生殖系统感染解脲脲原体的耐药性

目的了解某中医医院女性生殖系统解脲脲原体（Uu）感染患者连续3年的耐药现状和变化趋势。方法对该中医医院2011年1月-2013年12月皮肤性病科和妇科门诊及住院女性患者送检的白带及宫颈分泌物标本分离的Uu的耐药性进行回顾性分析。结果共分离Uu 327株,其3年耐药率,除多西环素（5.23%～6.12%）和交沙霉素（0～1.96%）较低外,其余抗菌药物均稍有增高,但差异无统计学意义（P＞0.05）。Uu对氧氟沙星、克拉霉素、司帕沙星的耐药率（42.11%～61.40%）较高,对交沙霉素、多西环素、美满霉素的耐药率（0～13.07%）较低,多药耐药现象较严重。结论该中医医院女性生殖系统感染患者分离的Uu耐药性较高。掌握Uu耐药现状和变化趋势,对于疾病的治疗和控制多药耐药菌株的产生非常必要。     

锁骨下静脉置管敷料更换时清洁消毒方法的改良

目的探讨改良锁骨下静脉置管敷料更换时清洁消毒的方法（简称换药方法）,对预防相关感染的效果。方法选择2012年1-6月某院重症监护室行右锁骨下静脉置管的患者120例,按置管日期分为对照组（单日）和实验组（双日）各60例。对照组采用传统的换药方法：2%碘酊消毒穿刺点及周围皮肤一遍,75％乙醇脱碘一遍;实验组采用改良换药方法：先用生理盐水擦拭穿刺点及周围皮肤3遍,清洁导管,再避开穿刺点用75％乙醇消毒周围皮肤3遍,用0.5%碘伏消毒穿刺点及周围皮肤3遍,最后消毒导管。对比两组相关感染率。结果实验组局部感染率为5.00%,导管相关性血流感染（CRBSI）率为1.67%,均显著低于对照组（分别为16.67%和13.33%）,差异均有统计学意义（均P＜0.05）。结论改良换药方法比传统换药方法效果好,能有效预防局部感染与CRBSI的发生。     

2012年四川省居民主要死因去死因期望寿命和减寿分析

目的分析各类死因对四川省居民期望寿命的影响,为政府就提高期望寿命、促进居民健康制定措施提供依据。方法采用DeathReg2005软件收集、整理2012年四川省居民死因监测数据,采用Excell软件、SPSS软件编制蒋氏简略寿命表、去死因寿命表,计算粗死亡率、标化死亡率、平均期望寿命、去死因期望寿命、潜在减寿年数、减寿率等。结果 2012年四川省居民粗死亡率621.78/10万,标化死亡率621.49/10万,平均期望寿命校正值75.22岁;去死因期望寿命分析显示循环系统疾病、呼吸系统疾病、肿瘤、损伤和中毒、消化系统疾病所致期望寿命损失年居前5位,去掉该死因,分别可增加4.51年、3.42年、3.34年、1.13年、0.39年。去单病种死因期望寿命分析,增值前5位为恶性肿瘤、脑血管病、慢性下呼吸道疾病、心脏病、机动车辆交通事故。潜在寿命分析,减寿率顺位为肿瘤、损伤和中毒、循环系统疾病、呼吸系统疾病、消化系统疾病,其导致每千人寿命缩短的人年数分别为18.67人年、12.21人年、10.35人年、5.44人年、2.55人年。不同性别和城市与农村间各类分析顺位略有差异。结论四川省居民期望寿命的提高需要加强对肿瘤、心脑血管疾病、呼吸道疾病及意外伤害等慢性非传染性疾病的预防和控制。     

疾病预防控制档案的长期趋势及影响因素分析

目的通过对绵阳疾控中心有史以来的全部归档文件从数量上的动态变动趋势及其影响因素的分析,预测今后一段时期疾控档案数量可能达到的规模,为疾控档案管理提供措施。方法应用动态数列理论对档案资料作动态变动趋势描述并作出预测;查阅相关历史文献、大众媒体公开资料探讨影响疾控档案动态走势因素。结果疾控档案在数量上随着时间的延续整体呈波浪上升态势,其定基发展速度为18.99倍,平均发展速度为1.25倍,平均增长速度是0.25倍,预计未来一段时间的2012-2014年归档文件数量平均每年将达到765.66件、2015-2017年将达956.96件;影响疾控档案归档文件数量动态变动趋势的因素有历史原因和档案本身原因。结论疾控档案资料的动态走势与疾控工作的工作量、档案工作的工作量呈正比,工作量越大存档文件越多;适时清理过期档案文件、档案资料在整理时准确归类是缓解储存空间压力的必要手段。     

径向基函数自适应减法器提取诱发电位的性能评价

目的：针对体感诱发电位（somatosensory evoked potentials,SEP）的特征,基于现场可编程门阵列（field programmable gate array,FPGA）硬件平台设计径向基函数自适应减法器,实现体感诱发电位的快速提取。方法：通过对各模块的硬件算法设计,利用Simulink仿真工具对5例接受脊柱侧弯手术患者的原始SEP信号进行仿真实验,以工频干扰、EEG脑电为噪声,对径向基函数自适应减法器提取SEP的性能进行评价。结果：不同输入信噪比条件下,径向基函数自适应减法器比单一自适应减法器输出信号的信噪比高;输入信噪比为-15dB时,单一的自适应噪声减法器（adaptive noise canceller．ANC）输出相对于模板信号的失真比径向基函数自适应减法器（ANC—RBF）小,但输入信噪比为-25、-30dB时,ANC输出相对于模板信号的失真比ANC—RBF大;ANC—RBF提取的SEP波形比较平滑。结论：径向基函数自适应减法器比单一自适应减法器对术中体感诱发电位具有更好的去噪效果,不仅提取信号的失真度较小,而且信号波形更为平滑,使SEP信号的潜伏期和幅值更易识别。