胃肠减压在腹部外科疾病治疗中的应用及护理干预

目的探讨胃肠减压在腹部外科疾病治疗中的应用及护理干预。方法对80例腹部外科疾病患者临床资料进行回顾性分析,内容包括胃肠减压方法、护理干预措施、胃肠减压应用及护理效果、满意度等,将所得资料进行统计学分析后得出结论。结果 80例腹部外科疾病患者胃肠减压平均时间(4.4±1.2)d,减压管置入平均置入深度(60±3)cm;插管成功率100.0%,失败率0.0%(P<0.05);4例(5.0%)患者发生相关并发症,其中3例(3.8%)肺部感染、1例(1.2%)电解质紊乱;患者对护理满意度评分高达(93.2±2.1)分。结论胃肠减压在腹部外科疾病治疗过程中具有重要作用,经正确的护理配合后可有效提高插管成功率。     

Unraveling the Genetic Component of Multifactorial Diseases: Dream or Reality

The etiology of many human diseases is complex and very likely involves a combination of genetic and environmental risk factors. A popular strategy to detect genetic risk factors is to perform a systematic screening of the genome searching for linkage. The power of such and approach depends very much on the unknown characteristics of the genetic factors and the main difficulty is to establish a good trade-off between false positives and false negatives. Besides, a precise localisation of the risk factor will generally not be obtained. The set up of a candidate gene stratery is necessary to go further in genetic factor identification. It is likely that for multicfactorioal diseases the only genetic risk factors that can be detected are those with fairly strong effect. Even in that case, it is important to design strategies which increase the power of detection and provide for a better evaluation of the associated risks.     

Healthcare resource utilization by patients with treatment-refractory myasthenia gravis in England

Aims: To examine healthcare resource utilization associated with refractory myasthenia gravis (MG) in England.

Materials and methods: This was a retrospective cohort study of linked data from the Clinical Practice Research Datalink and the Hospital Episode Statistics database collected between 1997 and 2016. Included patients were ≥18?years of age at the index MG diagnosis. Patients with refractory MG were identified using an algorithm based on treatments received. Healthcare resource utilization since the index date was compared between refractory and non-refractory cohorts.

Results: The study included 1149 patients with MG, of whom 66 (5.7%) were refractory. Sex and age at diagnosis did not significantly differ between the refractory and non-refractory cohorts. Rates of healthcare resource utilization per person-year were significantly higher (p?p?Limitations: The algorithm for identifying refractory patients did not include clinical criteria. Also, treatments administered in hospitals or by specialists were not available in the databases.

Conclusions: Patients in England with refractory MG more often visit healthcare providers, are hospitalized and visit an emergency room than patients with non-refractory MG.     

铁路线路接头病害的成因分析及防治措施

本文详细介绍了铁路线路接头病害的常见种类,这些病害产生的原因和治理方法,并对这些方法在其他铁路单位采用后所取得的效果做了说明,对防治铁路线路接头病害,保障铁路运输安全,延长铁路线路设备使用寿命,具有积极的指导意义。     

Comparative financing analysis and political economy of noncommunicable diseases

The pandemic of chronic non-communicable diseases (NCDs) poses substantial challenges to the health financing sustainability in high-income and low/middle income countries (LMICs). The aim of this review is to identify the bottle neck inefficiencies in NCDs attributable spending and propose sustainable health financing solutions. The World Health Organization (WHO) introduced the “best buy” concept to scale up the core intervention package against NCDs targeted for LMICs. Population- and individual-based NCD best buy interventions are projected at US$170 billion over 2011–2025. Appropriately designed health financing arrangements can be powerful enablers to scale up the NCD best buys. Rapidly developing emerging nations dominate the landscape of LMICs. Their capability and willingness to invest resources for eradicating NCDs could strengthen WHO outreach efforts in Asia, Africa, and Latin America, much beyond current capacities. There has been a declining trend in international donor aid intended to cope with NCDs over the past decade. There is also a serious misalignment of these resources with the actual needs of recipient countries. Globally, the momentum towards the financing of intersectoral actions is growing, and this presents a cost-effective solution. A budget discrepancy of 10:1 in WHO and multilateral agencies remains in donor aid in favour of communicable diseases compared to NCDs. LMICs are likely to remain a bottleneck of NCDs imposed financing sustainability challenge in the long-run. Catastrophic household health expenditure from out of pocket spending on NCDs could plunge almost 150 million people into poverty worldwide. This epidemiological burden coupled with population ageing presents an exceptionally serious sustainability challenge, even among the richest countries which are members of the Organization for Economic Co-operation and Development (OECD). Strategic and political leadership of WHO and multilateral agencies would likely play essential roles in the struggle that has just begun.     

Financial and legislative aspects of drug development of orphan diseases on the European market – a systematic review

According to the European Commission, medical products for orphan diseases are those which affect fewer than five persons out of every 10 000. Producers are reluctant to develop these drugs under the common market conditions because the demand for these drugs does not guarantee return on investments into research and development of such products. Patients with orphan diseases, however, have the same rights for treatment as any other patient. To stimulate the research and development of drugs for orphan diseases, the governmental offices introduce various incentives for health and biotechnological industry. This started in the USA already in 1983 by passing a special law. Japan introduced this law in 1993 and Australia in 1997. Europe followed in 1999 by introducing common policy for all member states.

The aim of this article is to specify current economic and legislative conditions in European countries and compare them with the legislation and approaches of the countries which started this initiative, i.e. USA, Japan, Australia or Singapore. In addition, the treatment costs of orphan diseases are specified and prospects of this field are evaluated.     

Rethinking Urban Epidemiology: Natures,Networks and Materialities

How should we understand the relationship between urban environments and infectious diseases? This article addresses this question from three particular perspectives: that of the materialities of health, that of nature and that of networks. The first perspective analytically blends biological dynamics, environmental influence and social practice. The second perspective, mainly influenced by multispecies ethnographies, foregrounds the liveliness and unboundedness of cities. Finally, the third perspective analyses how health is drawn into the domain of security. The article argues that while globalization and urbanization are often discussed as having triggered the emergence and spread of pathogens, urban epidemics are not self‐evident and ‘natural' consequences of these pro‐cesses. They do not fall neatly into universal categories of space, modernity or risk; rather, they are produced and shaped by a range of social, political, biological and economic sites and scales. Accordingly, the emergence of pathogens depends on its articulation through specific analytical frameworks. This article suggests that a critical focus on how infectious diseases manifest themselves differently in different local contexts may not only provide insights into the manifold forms of urban life, but also into the multiple, complex and highly political constitution of health.     

中国罕见病研究现状及对策建议

罕见病是指发病率极低的一组疾病的统称,已成为全球非常严重的公共卫生问题。不同国家和地区依据流行病学标准、疾病严重程度、罕用药经济学标准来界定罕见病。中国目前无罕见病的官方定义,缺乏明确的界定标准,成为我国罕见病研究及罕用药可及性的限制因素。本研究探讨不同国家和地区有关罕见病的定义,结合中国罕见病研究现状,从流行病学、诊疗水平、医保体系、药物可及性等方面提出应对措施,以期为中国罕见病的界定提供指导和参考。     

Consumer food safety perceptions and self‐reported practices in Greece

A substantial proportion of foodborne illness is associated with food prepared in households. The primary understanding of how foods are handled in private homes comes mostly from questionnaire based studies and direct observation. The aim of this survey was to examine consumers' perceptions and knowledge of safe food handling practices in Greece. More specifically, their attitudes, opinions and self‐reported practices were studied. Data were collected from a total of 399 consumers living in Greece by the use of a self‐administered on‐line survey. The questionnaire consisted of four positive and five negative statements according to the 5‐point Likert scale, which grouped into three constructions using principal component analysis in order to investigate food safety perceptions of consumers. Furthermore, the survey included 11 demographic questions, two close‐ended questions (type yes/no) and four questions that are related to self‐reported food‐handling practices. The results showed that the most commonly known bacterium causing food‐related illness according to respondents' knowledge is Salmonella (99.7%), followed by Escherichia coli (73.9%) and Listeria (58.4%). The overall consumers' score concerning food safety was 32.8 ± 5.37 (full score was 45). No significant differences to the mean score of food safety knowledge were found according to gender, age or the incidence of foodborne illness over the past 12 months. Knowledge and awareness of safe food handling practices was enhanced at higher education levels, while homemakers were found to have deficiencies at this level. Information obtained from consumers can be used to shape educational programs and determine where food safety educational efforts would be most effective and the needed content of the messages.     

Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures

Aims: This study aimed to estimate the cost of platelet transfusion in patients with chronic liver disease (CLD)-associated thrombocytopenia undergoing an elective procedure in the United States.

Materials and methods: The study was conducted in two parts: development of a conceptual framework identifying direct, indirect and intangible costs of platelet transfusion, followed by the estimation of the total cost of platelet transfusion in patients with CLD-associated thrombocytopenia before an elective procedure in the United States using the conceptual framework and cost data obtained from a literature search. The cost of the entire care required to raise a patient’s platelet count before the procedure was considered.

Results: The final conceptual framework included the costs of generating the supply of platelets, the platelet transfusion itself, adverse events associated with platelet transfusion and refractoriness to platelet transfusion. When costs were accounted for in all the framework cost categories, the total direct cost of a platelet transfusion in a patient with CLD and associated thrombocytopenia was estimated to be in the range of $5258 to $13,117 (2017?US dollars) in the United States. The largest portion of costs was incurred by the transfusion event itself ($3723 to $4436) and the cost of refractoriness ($874 to $7578), which included the opportunity cost of a delayed procedure and subsequent platelet transfusions with human leukocyte antigen-matched platelets.

Limitations and conclusions: Although we were unable to include all cost components identified in the conceptual framework in our total cost estimate, thus likely underestimating the true total cost, and despite the data gaps and challenges limiting our estimate of the full cost of a platelet transfusion in patients with CLD-associated thrombocytopenia undergoing an elective procedure in the United States, this study outlines a comprehensive conceptual framework for estimating the cost elements of a platelet transfusion in these patients.