颅脑肿瘤术后并发静脉血栓栓塞症危险因素的Meta分析

目的明确颅脑肿瘤术后患者发生静脉血栓栓塞症(VTE)的危险因素。方法检索中国知网、万方、维普、中国生物医学文献、PubMed、The Cochrane Library、Web of Science、EMbase等数据库建库至2021年11月1日颅脑肿瘤术VTE危险因素的队列研究或病例对照研究。由两名研究人员独立进行文献筛选、资料提取以及文献质量评价。使用RevMan 5.4软件对纳入文献进行Meta分析。结果共纳入14篇文献,合计样本量40 552例,发生VTE1 801例。Meta分析结果显示,年龄＞45岁、术前D-二聚体升高、肥胖、女性、术前日常生活活动能力处于依赖状态、术前呼吸机依赖、术前曾患脓毒血症、高级神经胶质瘤、手术时间＞3.05 h、术后D-二聚体升高、术后下肢运动功能障碍、术后卧床不起、术后并发尿路感染为颅脑肿瘤术后患者发生VTE的危险因素。结论颅脑肿瘤术后VTE发生与多种因素有关。建议构建颅脑肿瘤术后VTE风险预测模型,关注高风险人群,落实规范化静脉血栓风险评估,注重血栓评估过程管控。     

实现多院区同质化医疗服务的路径:标准化管理

如何开展多院区医院一体化管理,共享不同院区的资源,做到不同地区间的横向协同和纵向一致,确保医院的每个区域都具有均质化的医疗质量,提供同质化的医疗服务等,这是多院区医院一体化管理亟需解决的主要问题。文章介绍了解放军总医院开展多院区标准化管理的策略,旨在通过对多院区的统一、规范化管理,为患者提供同质化的医疗服务。     

我国家庭医生服务签约意愿相关因素的Meta分析

目的探讨我国家庭医生服务签约意愿的相关因素,为家庭医生服务实践提供参考。方法检索PubMed、Embase、Cochrane Library、中国知网数据库（CNKI）、万方数据库、维普期刊数据库中公开收录的关于我国家庭医生服务签约意愿的横断面研究,提取相关数据后运用Stata 15软件进行Meta分析。结果最终纳入21篇文献,累计调查人数23 727人,签约家庭医生服务12 328人,签约率为51.96%。Meta分析显示,年龄≥60岁、有医疗保险、有婚姻史、有慢病、知晓家庭医生签约服务、接受社区首诊是家庭医生服务签约意愿的促进因素,民族为汉族、自评健康状况好或者一般是家庭医生服务签约意愿的阻碍因素。结论我国家庭医生服务签约仍有进一步发展空间,对于汉族、自评健康状况好或者一般的人群需要采取更多的鼓励措施。     

我国31家省级中医院医生福利待遇满意度及人口学影响因素研究

目的调查我国省级中医院医生福利待遇满意度及人口学影响因素。方法选取全国31个省（自治区、直辖市）31家省级中医院医生进行福利待遇满意度问卷调查。采用SPSS 25.0 软件对数据进行统计学分析。结果被调查中医院医生过去1 a税后实际收入中位数为12万元。薪酬、法定假期、学习深造、餐食、休息室数量满意度分别为27.83%、33.56%、58.67%、44.30%、69.84%。性别、年龄、行政职务是薪酬满意度影响因素,性别、学历、职称、科室和行政职务是法定假期满意度影响因素,性别、年龄、学历和行政职务是学习深造满意度影响因素,性别、学历、职称、科室和行政职务是餐食满意度影响因素,性别、职称、科室和行政职务是休息室数量满意度影响因素。结论被调查中医院医生福利待遇整体情况呈向好趋势,但实际收入不高,薪酬满意度较低。中医院应积极落实国家相关政策要求,根据不同人口学特征医生不同需求,多途径提高医生福利待遇。     

成都市40岁以上淡水养殖农户骨质疏松现状及相关因素研究

目的 探讨成都市40岁以上淡水养殖农户骨质疏松现状及相关因素。方法 2019年10月—2020年1月,采取便利抽样法在隶属成都市的24个乡镇中选择淡水养殖个体农户为研究对象,采用二元logistic回归分析淡水养殖农户骨质疏松的相关因素。结果 共纳入研究对象620名,骨质疏松检出率为25%,平均T值为（- 1.48±1.15）。logistic回归分析显示,女性（OR = 4.477,95%CI = 2.139～9.371）、BMI＜18.5 kg/m2（OR = 4.619, 95%CI = 1.739～12.269）、吸烟时间≥5年（OR = 4.751, 95%CI = 2.662～8.480）、患有类风湿性关节炎（OR = 70.794,95%CI = 38.515～130.127）、服用激素类药物（OR = 122.376,95%CI = 54.098～276.827）、从事淡水养殖时间≥5年（OR = 1.007,95%CI = 0.673～1.508）、血清维生素D含量低于正常（OR = 5.408,95%CI = 2.889～10.125）、居住地空气湿度≥60%（OR = 4.607,95%CI = 3.254～6.521）是骨质疏松发生的危险因素（P＜0.05）。结论 成都市40岁以上淡水养殖农户骨质疏松患病率较高,建议通过鼓励该类人群规律用药、合理饮食,改善BMI、维持维生素D含量等措施以降低淡水养殖农户骨质疏松发生风险。     

PET-CT对肺癌纵隔淋巴结转移的诊断效能及相关影响因素的研究

目的 探究正电子发射计算机断层显像（PET-CT）对肺癌纵隔淋巴结转移的诊断效能,分析影响诊断效能的相关因素以及肺癌淋巴结转移的影响因素,为临床提供理论参考。方法 选取我院2019年1月—2020年12月收治的经手术病理证实的181例肺癌（476枚淋巴结）患者临床资料进行分析,均行PET-CT进行诊断,分析诊断的效能（灵敏度、特异性、准确性以及阳性/阴性预测值）;分析影响PET-CT诊断效能的因素,以及肺癌患者发生纵隔淋巴结转移的相关危险因素。结果 PET-CT诊断肺癌淋巴结转移的灵敏度65.75%（96/146）,特异性89.39%（295/330）,准确率82.14%（391/476）,阳性预测值73.28%（96/131）,阴性预测值85.51%（295/345）,同手术病理结果相比,差异无统计学意义（P > 0.05）。真阳性淋巴结与假阳性淋巴结的短径、SUVmax值相比较,差异均无统计学意义（P > 0.05）;真阳性淋巴结与假阳性淋巴结的密度相比,差异有统计学意义（P < 0.05）。经Logistic回模型分析分析显示,肿瘤的病理类型为腺癌、中央型肺癌、低分化程度是肺癌患者发生纵隔淋巴结转移的危险因素（P < 0.05）。结论 PET-CT诊断肺癌纵隔淋巴结转移有较高的灵敏度、特异性、准确性;诊断的灵敏度受淋巴结的短径与SUVmax值影响,诊断的特异性受淋巴结的密度影响。纵隔淋巴结转移主要与病理类型、病灶部位、分化程度有关。     

Gastric cancer etiology: a biochemical hypothesis.

We have proposed a two-stage biochemical model for the etiology of "intestinal" gastric cancer. The model postulates that the gastric mucosal barrier is biochemically pierced as a result of chemical interactions between the mucoproteins and mucopolysaccharides of the barrier and ingested polysaccharrides (starches). This would allow the growth of gastric flora which could produce carcinogenic nitrosamines and/or nitrosamides. Observational and experimental evidence in favor of the model is provided. The model suggests various research initiatives, the results of which might provide the basis for biochemical and physiological methods for the prevention and/or treatment of gastric cancer. Various ways in which the model may be tested are also noted.     

Inter-organizational networks on the Dutch home health care market

The demand for home care in the Netherlands is growing and changing. A decreasing rate of institutionalization, combined with an increasing number of elderly people with special age-related, often complex health problems, has led to new groups of patients, to be cared for in their home settings. This requires a strong coordination of services between suppliers from the primary and secondary health care sectors. In order to promote coordinated care, Dutch health care providers are building inter-organizational networks. The development of such arrangements was the target of 12 demonstration projects, selected by the Ministry of Health for the National Home Care Programme. This article presents some of the results of an evaluation study of the Programme, with special attention given to the question of the extent to which such inter-organizational networks contribute to the balance between quality and cost.     

散发性甲型肝炎发病危险因素的病例对照研究

以浙江省嘉兴市１９９６ 年的１０３ 例确诊的甲肝散发病人为研究对象,进行１∶１ 配比的病例对照研究,用条件Ｌｏｇｉｓｔｉｃ回归模型进行多因素分析得出甲肝发病的危险因素。按ＯＲ值由大到小排列依次是：接触甲肝病人、在外就餐、家庭收支状况差、就餐点卫生条件差、家庭卫生设施差。建议对其中的某些可干预因素采取针对性的预防措施     

Visual evoked potentials in relation to factors of imprisonment in detention camps

Visual evoked potentials (VEPs) of the pattern shift reversal type were determined in a representative group of 57 prisoners of war (POWs) released in 1992 from detention camps in former Yugoslavia. The parameters were correlated with the conditions in four camps (1–4). All subjects were male, with a mean age of 34.75 years (SD ± 8.92), average length of imprisonment 192.7 days (SD ± 77.6), mean loss of body mass during imprisonment 19.32% (SD ± 9.54), and the average number of reported blows to the head and neck was 25.7 (SD ±20.3). VEPs were determined on average 290.5 days after the last craniocerebral trauma caused by blows to the head and neck (SD ± 152.0) i.e. on average 218.5 days after release from the camp (SD ± 164.3). Although all the 57 POWs reported being maltreated to a certain extent, 14 reported being subjected to particularly brutal forms of torture, 5 had been held in solitary confinement and 25 had lost consciousness at least once. Solitary confinement and loss of consciousness had the most significant effect on VEPs, and the altered VEP parameters correlated significantly with the craniocerebral trauma experienced, loss of body mass and the length of time since the last craniocerebral trauma until examination, and from release until examination. However, the length of imprisonment and treatment in the camps did not have a significant effect on VEP parameters. The study confirmed that under such conditions the age of the subject is a risk factor. The results of this study also confirmed that prisoners in one camp had been subjected to the worst maltreatment.