Percepciones y deseos sobre el parto en gestantes a término en Zamora

ObjectiveTo describe perceptions and wishes regarding childbirth in a group of full-term pregnant women in Zamora.MethodQualitative study of phenomenological character. Participants and scope of study: pregnant women (37-38 weeks), Zamora Sur and Santa Elena health centres (Zamora, Spain). Data collection: semi-structured interviews, until data saturation (16 interviews). Data analysis: analysis of thematic content.ResultsThe maternal feelings varied from joy to fear or stress. The interviewees said they did not feel capable of enduring the pain of childbirth. The needs that they felt most important were having support and accompaniment during delivery (especially of their partner) and receiving good treatment from the healthcare workers.ConclusionsThe importance and repercussion of childbirth for women are not only biological, but also largely mental, emotional and social. It is conditioned by multiple factors: maternal feelings, their ability to deal with the pain of childbirth, their needs, the changes they have made, the support they have and the health professionals who care for them.     

美国中东政策评析

美国在中东遇到大麻烦,主要战略目标未能实现。伊拉克安全形势持续严峻,巴以和谈停滞不前,伊朗核问题难以解决,压叙利亚屈服迄未奏效,恐怖活动越反越多,大中东改造计划受挫。美遇到的困难未超出其承受能力,美国在中东仍居主导地位,美中东政策在手法和策略上有所调整,实质上并无变化。     

Theta phase locking across the neocortex reflects cortico-hippocampal recursive communication during goal conflict resolution

EEG theta coherence, EEG theta power and subjective levels of response were examined in a continuous monitoring target detection task where periodic goal conflicts were introduced as 34 participants progressed through a stimulus sequence leading to response. EEG theta coherence revealed increases in phase locking between cortical areas at specific task stages involving goal conflict. Theta power also increased at points of goal conflict. The temporal characteristics of subjective response (measured continuously throughout the task) indicated a delay between participants actually experiencing goal conflict and overt indications of conflict. The starting point for the study was based on a specific aspect of Gray and McNaughton's [Gray, J.A., McNaughton, N., 2000. The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-Hippocampal System, 2nd ed. Oxford University Press, Oxford] behavioural inhibition system model—namely, septo-hippocampal system involvement in the resolution of goal conflicts. We drew on Gray and McNaughton's [Gray, J.A., McNaughton, N., 2000. The Neuropsychology of Anxiety: An Enquiry into the Functions of the Septo-Hippocampal system, 2nd ed. Oxford University Press, Oxford] suggestion that septo-hippocampal involvement in this process is reflected by EEG theta. While their theory explains many of our findings, we also drew upon Given's [Givens, B., 1996. Stimulus-evoked reseting of the dentate theta rhythm: relation to working memory. Neuroreport 8 (1), 159–163] proposal that the dentate theta rhythm is reset by behaviourally relevant stimuli. We made further proposals based on Makeig et al.'s [Makeig, S., Westerfield, M., Jung, T.-P., Enghoff, S., Townsend, J., Courchesne, E., Sejnowski, T.J., 2002. Dynamic brain sources of visual evoked responses. Science 295, 690–694] view that specific stimulus events invoke concurrent phase resetting and transient frequency domain coherence across different areas of neocortex. Relations with Go/NoGo event related potentials (P300 and N2; e.g., [Bokura, H., Yamaguchi, S., Kobayashi, S., 2001. Electrophysiological correlates of response inhibition in a Go/NoGo task. Clin. Neurophysiol. 112 (12), 2224–2232]) were also discussed, as well as parallels between our data and interpretation, and other theoretical models of theta (e.g., [Kahana, M.J., Selig, D., Madsen, J.R., 2001. Theta returns. Curr. Opin. Neurobiol. 11, 739–744]). Suggestions for further research were made.     

Decisions on Inclusion in the Swedish Basic Health Care Package—Roles of Cost-Effectiveness and Need

BACKGROUND: Inclusion or not of a treatment strategy in the publicly financed health care is really a matter of prioritisation. In Sweden priority setting decisions are governed by law in which it is stated that decisions should be guided by firstly the principle of need and secondly the principle of cost-effectiveness. OBJECTIVE: The purpose of the paper is to discuss and illustrate the roles of need and cost-effectiveness in decisions on inclusion or not of treatment strategies in the publicly financed health care. METHODS: The theoretical backgrounds of need and cost-effectiveness are discussed in short, both with respect to their meaning and to their potential roles in decisions on priority setting. Four treatment strategies, Viagra, Rivastigmine, statins, and lung transplants, are analysed with respect to whether either cost-effectiveness or need, or both, seem to have played a role in the decisions of inclusion or not in the basic health care package. RESULTS: Both need and cost-effectiveness are important and should be important aspects when making decisions on priority setting. From the examples of the four treatment strategies it seems that decisions are almost exclusively made with reference to the principle of need. CONCLUSIONS: The most evident conclusion to be drawn from this study is that decisions on priority setting are almost solely based on the principle of need. This implies that the principle of cost-effectiveness is given very little space, which is a problem as this means an obvious risk of inefficient resource use.     

Planning for health: the significance of life style

The health of a population is related to more than the volume and quality of health services available. Ischaemic heart diseases and cancers are the main causes of death for adults in most developed countries. Partly, these diseases are related to diet and other life style variables. The purpose of this article is to discuss some prevention possibilities related to health practices. Empirical data were collected by means of a questionnaire on health status and 'life style' among long-standing members of a Swedish popular movement for physical culture. The principal question was what could be learned for health planning and management. Genetic factors have lately come more in focus as an explanation of untimely death and disease while, for example, life style has been de-emphasized. There is a risk, thereby, that a purchaser-provider approach, where short-sighted returns are in focus, will give too low a priority to health promotion.     

Public involvement in health care priority setting: an economic perspective

Background  Public involvement in health care decision making and priority setting in the UK is being promoted by recent policy initiatives. In 1993, the British Medical Association called for public consultation where rationing of services was to be undertaken. The approach to priority setting advocated by many health economists is the maximization of quality adjusted life years (QALYs). Typically, for a particular health care programme, the QALY calculation takes account of four features: (1) the number of patients receiving the programme, (2) the survival gain, (3) the gain in quality of life and, (4) the probability of treatment success. Only one feature, that relating to quality of life, is based upon public preferences. If the QALY is to be used as a tool for health care resource allocation at a societal level then it should incorporate broader societal preferences.
Methods  This study used an interview-based survey of 91 members of the general public to explore whether the traditional QALY maximization model is a good predictor of public responses to health care priority setting choices.
Results and conclusions  Many respondents did not choose consistently in line with a QALY maximization objective and were most influenced by quality of life concerns. There was little support for health care programmes that provided a prognostic improvement but left patients in relatively poor states of health. The level of respondent engagement in the survey exercise was not sensitive to the provision of supporting clinical information.     

优势专科建设的效应

通过本院优势专科第一周期建设中取得的绩效,重点阐述了科研、人才培养、社会效应和经济效应等几个方面,充分体现了优势专科建设的必要性和优越性,明确了今后的目标和任务,重视优势专科建设,促进医院医疗水平再上新台阶.     

Executive function and general intellectual functioning in dyskinetic cerebral palsy: Comparison with spastic cerebral palsy and typically developing controls

AimTo comprehensively describe intellectual and executive functioning (EF) in people with dyskinetic cerebral palsy (DCP), by comparing their performance with that of: 1) age- and sex-matched typically developing controls (TDC); and 2) participants with spastic cerebral palsy (SCP) matched for age, sex, term/preterm and gross motor function classification system (GMFCS).MethodThis cross-sectional study was conducted by the University of Barcelona in collaboration with five institutions. Participants were people with DCP (n = 52; 24 females, median age 20.5 y: 5mo, interquartile range [IQR] = 13.75 y: 7mo; GMFCS I–V). As comparison groups, participants with SCP (n = 20; 10 females, median age = 20.5 y: 5.5mo, IQR = 13.75 y 9mo; GMFCS I–V) and TDC (n = 52; 24 females, median age = 20 y: 4mo, IQR = 12 y 7mo) were included. Intelligence and EF were assessed using common tests in all participants.ResultsBoth CP groups had lower intelligence than TDC and performed poorer in almost all EF tasks. Intelligence was higher in DCP than SCP (z = ?2.51, p = 0.01). Participants with DCP also performed significantly better in goal-setting tasks (z = 2.27, p = 0.03) and information processing (z = ?2.54, p = 0.01) than those with SCP.ConclusionPeople with DCP present lower general intellectual functioning and poorer EF across multiple domains than typically developing controls. People with DCP have higher general intellectual functioning and better EF than people with SCP when levels of motor severity are similar.     

PREFERENCES FOR THE NORMATIVE BASIS OF HEALTH CARE PRIORITY SETTING: SOME EVIDENCE FROM TWO COUNTRIES

The present paper concerns the criteria people would prefer for prioritising health programmes. It differs from most empirical studies as subjects were not asked about their personal preferences for programmes per se. Rather, they were asked about the principles that should guide the choice of programmes. Four different principles were framed as arguments for alternative programmes. The results from population surveys in Australia and Norway suggest that people are least supportive of the principle that decision makers should follow the stated preferences of the public. Rather, respondents expressed more support for decisions based upon health maximisation, equality and urgency. Copyright © 2012 John Wiley & Sons, Ltd.