基于经络辨证的首尾取穴法结合冲击波治疗脑梗死后肩手综合征的临床观察

目的:观察基于经络辨证的首尾取穴法结合冲击波治疗脑梗死后肩手综合征的临床疗效。方法:将64例脑梗死后肩手综合征患者按照门诊号码末位数字的奇偶随机分为治疗组(奇数)和对照组(偶数),各32例,两组患者均进行基础治疗(包括脑梗死药物及瘫痪侧肢体针灸、康复治疗),对照组在基础治疗上进行冲击波治疗,治疗组在基础治疗上予基于经络辨证的首尾取穴法结合冲击波治疗。观察两组患者治疗前后VAS评分、FMA评分及患肢手肿胀评分,并在治疗结束后1个月进行电话随访。结果:治疗组总有效率为86.67%(26/30),对照组总有效率为74.19%(23/31),差异有统计学意义(P<0.01)。治疗后两组患者肩部疼痛均缓解,其中治疗组患者VAS评分、FMA评分、患肢手肿胀评分低于对照组(P<0.01)。结论:基于经络辨证理论的首尾取穴法结合冲击波可以明显改善脑梗死后肩手综合征患者的临床症状,减轻患肢的疼痛及水肿,促进肩关节功能恢复,提高生活质量。

利益相关者视角下我国药品集中带量采购政策研究——基于政策工具的文本分析

目的:通过对我国药品集中带量采购相关政策文本进行剖析,探讨现有政策侧重点及不足,以期为我国未来药品集中带量采购政策制定及优化提供参考依据。方法:采用内容分析法,选取16份药品集中带量采购相关政策为研究对象,基于政策工具及利益相关者两个维度进行分析。结果:政策工具维度共筛选出147个政策编码,其中命令与规制型工具占56.5%(83/147)、激励型工具占3.4%(5/147)、能力建设型工具占28.6%(42/147)、系统变革型工具占2.0%(3/147)、信息与劝诫型工具占9.5%(14/147);利益相关者维度共筛选出323个政策编码,其中药品生产企业占20.7%(67/323)、药品流通企业占6.8%(22/323)、政府相关部门占34.1%(110/323)、医疗机构占29.1%(94/323)、患者占9.3%(30/323)。结论:政策工具结构不均衡,利益相关者格局不协调,政策工具与利益相关者耦合性不强,应结合药品集中带量采购政策特征及发展趋势优化各类政策工具使用比例;兼顾多方利益相关者,增强利益相关者凝聚力;推进政策工具与利益相关者有效结合,提高政策的靶向精准度。

协同优势视角下突发公共卫生事件社区网格化治理研究

突发公共卫生事件对基层治理提出严峻挑战,为提高基层监测预警与响应处置能力,转变以往被动服务与静态管控、资源分散与主体单一的治理格局,社区网格化治理理念被提出。社区网格化治理强调服务理念共生、资源要素共享、多元主体共治的基层精细化协同治理,但在突发公共卫生事件基层协作过程中,仍存在多元主体的目标难以统一、“权力点”固化、成员结构模糊复杂、主体间信任缺失、领导力不足等“协同惰性”风险。利用协同优势理论的“反思性建构”逻辑,对社区网格化协同治理的困境机理进行分析,进而提出价值理念协同、制度体系协同、身份规范协同、考核标准协同、条块政社协同等消解路径,能够实现突发公共卫生事件基层精细化与协同化治理目标。

Effects of hydrodynamics processes on phosphorus fluxes from sediment in large,shallow Taihu Lake

The turnover of phosphorus （P） in lake sediments, a major cause of eutrophication and subsequent deterioration of water quality, is in need of deep understanding. In this study, effects of resuspension on P release were studied in cylindrical microcosms with Yshape apparatus. The results indicated that there was a positive correlation between flux of suspended substance across sediment-water interface （Fss） and the wind speed, and an increasing Fss during each wind process followed by a steady state. The maximal Fss under fight, moderate, and strong wind conditions were 299.9±41.1,573.4±61.7, and 2093.8±215.7 g/m^2, respectively. However, flux of P across sediment-water interface （Fp） did not follow a similar pattern as Fss responding to wind intensity, which increased and reached the maximum in initial 120 rain for fight wind, then decreased gradually, with maximal flux of 9.4±1.9 mg/m^2. A rapid increase of Fp at the first 30 rain was observed under moderate wind, with maximal flux of 11.2±0.6 mg/m^2. Surprisingly, strong wind caused less Fp than under light and moderate wind conditions with maximal flux of 3.5±0.9 mg/m^2. Fss in water column declined obviously during the sedimentation process after winds, but Fp varied with wind regime. No obvious difference was detected on Fp after 8 h sedimentation process, compared with the initial value, which means little redundant P left in the water column after winds.

Influence of Sediment Dredging on Chemical Forms and Release of Phosphorus

A laboratory experiment was carried out through a six-month incubation of undredged （control） and dredged cores to study the effect of sediment dredging on phosphorus （P） release from the sediment in the Taihu Lake. During the experiment, dredging the upper 30 cm layer could efficiently reduce the interstitial PO4^3-P concentration and different P forms in the sediment. The P fluxes of the undredged and dredged cores ranged from -5.1 to 3047.6 and -60.7 to 14.4μg·m^-2·d^-1, respectively. The fluxes of the dredged cores were generally lower than those of the control. Differences in the fluxes between the dredged and undredged cores were statistically significant （P 〈 0.05） from March to June 2006. The sediment P in the dredged cores had a lower release potential than that in the control. Dredging can be considered as a useful measure for rehabilitating the aquatic ecosystem after the external P loading in the Talhu Lake catchment was efficiently reduced.

Geochemistry of Iron,Sulfur and Related Heavy Metals in Metal-Polluted Taihu Lake Sediments

To understand the geochemical characteristics of iron and sulfur and the extent of iron-sulfide minerals influencing heavy metal behaviour in metal-polluted sediments of Talhu Lake, two sites, in Meiliang Bay （ML） and Wuli Lake （WL）, were selected to study the fractionation of iron, sulfur and related heavy metals. There were relatively high concentrations of Fe^2＋ and low concentrations of total S^2- in porewaters, indicating that conditions in these sediments favored iron reduction. The concentrations of acid volatile sulfides in sediments were 1.9-9.6 μmol g^-1 at ML and 1.0-11.7 μmool g^-1 at WL, both in the range of values detected in unpolluted lakes. Pyrite-S was 10.2-49.4 μmol g^-1 at ML and 10.3- 33.0 μmol g^-1 at WL, accounting for more than 69% of the reduced inorganic sulfur at both sites. The low degree of sulphidization （〈 14%） and pyritization （〈 10%） indicate that sulfate may be the limiting factor for pyrite formation. The extractability of Mn, Cu, Pb, Zn, Ni, and Cr in sediments all suggest that sulfides are not the major binding phase for these metals during early diagenesis. Sulfur may play a modest role in the geochemistry of iron and traced metals in the sediments.

老年流动人口线上健康教育利用现状及影响因素分析

目的 通过分析老年流动人口线上健康教育的现状,探究影响其使用线上健康教育的因素,为改进老年流动人口健康教育工作提出建议。方法 收集2017年全国流动人口卫生计生动态监测调查数据中流入时间≥6个月且≥60周岁流动人口的相关数据,利用SPSS软件分析老年流动人口线上健康教育的现状及影响因素。结果 老年流动人口5 729人,接受过线上健康教育的有902人,线上健康教育接受率为15.74%;9项健康教育内容中,线上接受率从高到低依次为控制吸烟、慢性病防治、突发公共事件自救、心理健康、结核病防治、性病/艾滋病防治、妇幼保健/优生优育、职业病防治、生殖健康与避孕,接受率分别为13.49%、13.06%、12.24%、11.50%、10.67%、10.12%、9.97%、9.37%、9.36%;年龄在70~<80岁(OR=0.78,95%CI:0.63~0.96)及≥80岁(OR=0.56,95%CI:0.32~0.98)、跨省流动(OR=0.77,95%CI:0.62~0.94)、随家属迁移(OR=0.77,95%CI:0.63~0.94)的老年人线上健康教育利用率较低。结论 老年流动人口线上健康教育的利用率较低,且线上健康教育项目利用的结构不均;不同年龄、文化程度、户口性质、婚姻状况、家庭月均收入、流动范围、流动原因、自评健康状况、健康档案建立情况、距最近医疗服务机构的时间及是否认同自己为本地人的线上健康教育接受率不同;年龄、文化程度、家庭月收入、流动范围、流动原因、自评健康状况、健康档案建立情况、距离最近医疗服务机构的时间是影响老年流动人口利用线上健康教育的因素。