国外卫生信息化建设对我军卫生信息化建设与发展的启示

为加快我国军队卫生系统的信息化建设,本文阐述了国外以及军内外卫生信息化建设的基本情况,系统分析了我军卫生信息化建设面临的一系列新挑战和问题,并提出了有针对性地应对措施,为全军卫生系统的信息化建设的长远规划打下了坚实的基础。     

社区卫生服务机构实施基本药物制度效果及建议

目的:对社区卫生服务机构实施基本药物制度的效果进行分析,并提出建议,促进基本药物制度顺利实施。方法:选取山东省20所实施基本药物制度的社区卫生服务机构为研究对象。通过查阅文献确定本次调查的指标,即基本药物配备量、门诊工作量、门诊收入、人均医疗费用等。制定调查问卷,由调查的社区卫生服务机构方面进行填写,通过对比分析对社区卫生服务机构实施效果进行评价。结果:基本药物配备量只占基本药物目录的58.9%;门诊量和处方张数增加25%以上,但人员编制只增加5.2%;门诊费用下降24.4%,药品费用下降39.6%,人均诊疗费用下降42.9%;财政补偿增长52.6%。结论:基本药物制度初见成效,能够降低患者门诊费用,使基本医疗下沉到社区,有效引导患者进入社区卫生服务机构就诊。但基本药物配备量不足,社区卫生机构人员编制缺乏等问题突出,配套政策仍需进一步完善,并且加大推行力度。     

WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders

This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer from the social disadvantage associated with severe mental illness. The parents (depending on the disorder, its severity and its persistence) may have intermittent or prolonged difficulties with parenting, which may sometimes result in childhood psychological disturbance or child maltreatment. This guidance considers ways of preventing, minimizing and remedying these effects. Our recommendations include: education of psychiatrists and related professions about the effect of parental mental illness on children; revision of psychiatric training to increase awareness of patients as caregivers, and to incorporate relevant assessment and intervention into their treatment and rehabilitation; the optimum use of pharmacological treatment during pregnancy; pre-birth planning when women with severe mental illness become pregnant; development of specialist services for pregnant and puerperal women, with assessment of their efficacy; community support for parenting by mothers and fathers with severe mental disorders; standards of good practice for the management of child maltreatment when parents suffer from mental illness; the importance of multi-disciplinary teamwork when helping these families, supporting their children and ensuring child protection; the development of child and adolescent mental health services worldwide.     

Cryptosporidiosis and Cryptosporidium species in animals and humans: A thirty colour rainbow?

Parasites of the genus Cryptosporidium (Apicomplexa) cause cryptosporidiosis in humans and animals worldwide. The species names used for Cryptosporidium spp. are confusing for parasitologists and even more so for non-specialists. Here, 30 named species of the genus Cryptosporidium are reviewed and proposed as valid. Molecular and experimental evidence suggests that humans and cattle are the hosts for 14 and 13 out of 30 named species, respectively. Two, four and eight named species are considered of major, moderate and minor public health significance, respectively. There are at least nine named species that are shared between humans and cattle. The aim of this review is to outline available species information together with the most commonly used genetic markers enabling the identification of named Cryptosporidium spp. Currently, 28 of 30 named species can be identified using the complete or partial ssrRNA, serving as a retrospective ‘barcode’. Currently, the ssrRNA satisfies the implicit assumption that the reference databases used for comparison are sufficiently complete and applicable across the whole genus. However, due to unreliable annotation in public DNA repositories, the reference nucleotide entries and alignment of named Cryptosporidium spp. has been compiled. Despite its known limitations, ssrRNA remains the optimal marker for species identification.     

Prevalence of antibody to hantaviruses in humans and rodents in the Caribbean region of Colombia determined using Araraquara and Maciel virus antigens

We tested sera from 286 agricultural workers and 322 rodents in the department of Córdoba, northeastern Colombia, for antibodies against two hantaviruses. The sera were analysed by indirect ELISA using the lysate of Vero E6 cells infected with Maciel virus (MACV) or the N protein of Araraquara virus (ARAV) as antigens for the detection of antibodies against hantaviruses. Twenty-four human sera were IgG positive using one or both antigens. We detected anti-MACV IgG antibodies in 10 sera (3.5%) and anti-ARAV antibodies in 21 sera (7.34%). Of the 10 samples that were positive for MACV, seven (70%) were cross-reactive with ARAV; seven of the 21 ARAV-positive samples were cross-reactive with MACV. Using an ARAV IgM ELISA, two of the 24 human sera (8.4%) were positive. We captured 322 rodents, including 210 Cricetidae (181 Zygodontomys brevicauda, 28 Oligoryzomys fulvescens and 1 Oecomys trinitatis), six Heteromys anomalus (Heteromyidae), one Proechimys sp. (Echimyidae) and 105 Muridae (34 Rattus rattus and 71 Mus musculus). All rodent sera were negative for both antigens. The 8.4% detection rate of hantavirus antibodies in humans is much higher than previously found in serosurveys in North America, suggesting that rural agricultural workers in northeastern Colombia are frequently exposed to hantaviruses. Our results also indicate that tests conducted with South American hantavirus antigens could have predictive value and could represent a useful alternative for the diagnosis of hantavirus infection in Colombia.     

Genetic polymorphism of vitamin D receptor gene affects the phenotype of PCOS

Aims

Polycystic ovary syndrome (PCOS), a common female endocrine disorder, represents a wide range of clinical manifestations and disease severity. Recent studies suggest an association between gene variants involved in vitamin D metabolism and common metabolic disturbances in PCOS. We aimed to examine the association of vitamin D receptor (VDR) gene variant with PCOS susceptibility and the severity of disease phenotype.

Methods

All participants, including 260 PCOS women (cases) and 221 normoovulatory women (controls), were recruited from a reproductive endocrinology clinic. Cases were divided into the severe and mild PCOS phenotype groups, based on their clinical and paraclinical features. An adenosine to guanine single nucleotide polymorphism of VDR gene (rs757343) was genotyped using the PCR–RFLP method.

Results

Distributions of genotypes and alleles did not differ between cases and controls, indicating that this SNP is not associated with increased risk for PCOS. However, this SNP was found to be associated with the severity of the PCOS phenotype. In particular, presence of the A allele is associated with a 74% increased risk of severe phenotype development (OR, 1.74; 95% CI, 1.07–2.82).

Conclusion

The genetic variant of the VDR was found to have an association with severity of clinical features of PCOS, but none with disease risk.     

Perspectives on providing good access to dental services for elderly people: patient selection,dentists’ responsibility and budget management

doi: 10.1111/j.1741‐2358.2012.00646.x Perspectives on providing good access to dental services for elderly people: patient selection, dentists’ responsibility and budget management Objectives: To suggest a model for organizing and financing dental services for elderly people so that they have good access to services. Background: There are few studies on how dental services for elderly people should be organized and financed. This is surprising if we take into consideration the fact that the proportion of elderly people is growing faster than any other group in the population, and that elderly people have more dental diseases and poorer access to dental services than the rest of the adult population. In several countries, dental services are characterized by private providers who often operate in a market with competition and free price‐setting. Private dentists have no community responsibility, and they are free to choose which patients they treat. Material and methods: Literature review and critical reasoning. Results: In order to avoid patient selection, a patient list system for elderly people is recommended, with per capita remuneration for the patients that the dentist is given responsibility for. The patient list system means that the dentist assumes responsibility for a well‐defined list of elderly people. Conclusion: Our model will lead to greater security in the dentist/patient relationship, and patients with great treatment needs will be ensured access to dental services.     

Oral healthcare issues in rural residential aged care services in Victoria,Australia

doi: 10.1111/j.1741‐2358.2012.00652.x Oral healthcare issues in rural residential aged care services in Victoria, Australia Objectives: To identify major issues in providing and accessing oral health care in Victorian rural residential aged care services from the perspectives of dentists, aged care staff and residents. Methods: Structured interviews were conducted with five dentists, nine aged care staff and six residents. Three focus groups were conducted with aged care staff. These data were thematically analysed independently by two researchers. Results: The challenges reported by dentists included complexity of care, infrastructure needs and need for skill development. Aged care staff reported lack of skills and confidence in providing oral hygiene care, especially in residents with natural teeth, and an increasing burden on their daily workload. Residents reported concern and shame regarding their declining oral health status and increased challenges accessing appropriate oral health care. Conclusion: These findings indicate the need to build and sustain aged care ‘oral health teams’ who are able to provide daily oral hygiene care for residents and mentor other staff. Rural dentists need access to gerodontic training, portable equipment and appropriate workspaces in aged care services. Aged care and oral health services need to establish clear referral and communication pathways.     

Factors associated with missing teeth in the Brazilian elderly institutionalised population

doi:10.1111/j.1741‐2358.2012.00655.x Factors associated with missing teeth in the Brazilian elderly institutionalised population Objective: Identify factors associated with missing teeth in the elderly institutionalised population in Brazil. Methodology: Cross‐sectional study of elderly institutionalised Brazilians with 1192 subjects. A questionnaire was applied as well as an epidemiological survey of oral health conditions in accordance with WHO. Factorial analysis was carried out with variables related to missing teeth, as well as the Fisher’s exact test, chi‐squared test and multiple logistic regression. Results: Mean age was 76.3 (±9.8), 53.5% (638) of subjects were women and 717 (60.2) were dependent. Mean of Decayed Missing and Filled Teeth Index (DMFT index) was 29.4 (±4.9). The subjects that did not use upper and lower dentures were 61.5% (732) and 79.2% (944), respectively. Median number of missing teeth per person was 27.88 (±6.8) with a mean of 4 (±6.6) teeth present and 2.4 (±4.5) caries‐free teeth. Factors associated with missing teeth following multivariate analysis were: age, sex, self‐assessment of oral health, access to health services, type of institution and area of the country. Conclusions: High level of tooth loss and low level of rehabilitation demonstrate precarious oral health. It is therefore necessary to improve institutional access mechanisms to public health facilities for the institutionalised elderly.     

When Work Calls—Associations Between Being Contacted Outside of Regular Working Hours for Work-Related Matters and Health

Boundaries between work and private life are diminishing, but little is known on how this influences worker health. Therefore, we examined the association between work-related contacts outside of regular working hours by e-mail or phone and self-reported health in a representative sample of European employees (n?=?23 760). The risk of reporting ≥1 health problem(s) was increased in workers contacted sometimes (odds ratio [OR]: 1.16, 95% confidence interval [CI]: 1.06–1.27) or often (OR: 1.23, 95% CI: 1.12–1.34) as compared with never, controlling for several demographic and workplace characteristics. Further research is needed to quantify work and nonwork patterns and their health effects.