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[The general practitioner in the hospital: from routine activities to a practice which energizes the health district]. [医院的全科医生:从日常活动到为卫生区注入活力的实践]。
H Van Balen
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引用次数: 0
Change in undergraduate medical education. 本科医学教育的变化。
W Van Damme

Undergraduate medical education didn't undergo major changes since the Flexner report in the beginning of this century and has since been copied without important modifications worldwide. The bulk of the medical education is given by subject specialists and general practice is only marginally covered. The result is that the training of medical doctors has become inappropriate and that a change is urgently needed. The aim is on the one hand to improve the clinical skills of doctors, on the other hand to prepare doctors for enhanced roles and to have some community perspective. Innovations such as problem-based learning and community-oriented education took mainly place in new medical schools. The need to change medical education is however greater in established medical schools, but innovation seems more difficult to reach there, although some successful experiences are described. Most innovations failed to tackle reform of the health system in which new graduates will function. This is probably one of the main reasons for their limited results. Five presentations to the Colloquium illustrate the difficulties and possible successes of change in undergraduate medical education.

自本世纪初Flexner报告以来,本科医学教育没有发生重大变化,此后在世界范围内没有进行重大修改就被复制。大部分医学教育是由学科专家提供的,一般实践只涉及很少一部分。其结果是,对医生的培训已经变得不合适,迫切需要做出改变。其目的一方面是为了提高医生的临床技能,另一方面是为了让医生为加强角色做好准备,并有一些社区的观点。诸如基于问题的学习和面向社区的教育等创新主要发生在新的医学院。然而,在现有的医学院,改变医学教育的必要性更大,但创新似乎更难以实现,尽管描述了一些成功的经验。大多数创新都未能解决新毕业生将在其中发挥作用的医疗体系改革问题。这可能是他们的结果有限的主要原因之一。研讨会上的五份报告阐述了本科医学教育变革的困难和可能的成功。
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引用次数: 0
[The general practitioner on the first step in the Third World]. [在第三世界迈出第一步的全科医生]。
M Van Dormael
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引用次数: 0
Epidemic schistosomiasis in the delta of the Senegal River Basin, Senegal: responses of the health care system. 塞内加尔塞内加尔河流域三角洲的流行血吸虫病:卫生保健系统的反应。
A Kongs, P Verlé, I Talla

Since 1988, the delta of the Senegal River Basin has experienced an exceptional epidemic of intestinal schistosomiasis, following the development of large irrigation projects. Urinary schistosomiasis was also rapidly spreading. The response of the health care system to the epidemics is described. Control was integrated in the existing health care system, according to the general health policy of Senegal. Control was based on passive detection, treatment, health education and information. The availability of praziquantel was assured. Priority was given to the development of health services in general. Initial reports have also attracted different research groups to the area. The variety of epidemiological situations made this area unique for research. Researchers would like to observe untreated communities to study the development of immune mechanisms. Inevitably such approach must lead to confrontation with local health services which should offer ethically and medically correct management of infected individuals and affected communities.

自1988年以来,随着大型灌溉项目的发展,塞内加尔河流域的三角洲地区出现了罕见的肠道血吸虫病流行。尿路血吸虫病也在迅速蔓延。描述了卫生保健系统对流行病的反应。根据塞内加尔的一般卫生政策,控制已纳入现有的卫生保健系统。控制以被动检测、治疗、健康教育和信息为基础。吡喹酮的供应得到了保证。优先发展一般的保健服务。最初的报告也吸引了不同的研究小组来到这个地区。流行病学情况的多样性使该地区具有独特的研究价值。研究人员希望观察未经治疗的群体,以研究免疫机制的发展。这种做法不可避免地会导致与地方卫生服务机构的冲突,而地方卫生服务机构应当对受感染的个人和受影响的社区提供道德上和医学上正确的管理。
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引用次数: 0
Multi drug resistant tuberculosis: what will happen in developing countries? 耐多药结核病:发展中国家将会发生什么?
R Colebunders, B Dujardin, H Taelman, F Portaels
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引用次数: 0
[Aedes albopictus and Aedes aegypti at Ile de la Réunion]. [留尼汪岛的白纹伊蚊和埃及伊蚊]。
M Salvan, J Mouchet

Aedes albopictus and Aedes aegypti are both found on the island. The former, being the probable vector of dengue on the island, is highly anthropophilic. It breeds in domestic environments as well as in natural breeding sites. The latter has a more restricted distribution and is never anthropophilic. Larvae of Ae. aegypti are only found in natural habitats, always associated with Ae. albopictus, but in small proportions. Such an ecology and behaviour for the typicus form of Ae. aegypti are abnormal. Several hypothetic explanations are proposed. Dengue prevention should be based solely on Ae. albopictus control.

白纹伊蚊和埃及伊蚊都在岛上发现。前者是岛上登革热的可能媒介,具有高度的亲人类性。它在家庭环境和自然繁殖地繁殖。后者的分布更受限制,从不亲人类。伊蚊幼虫。埃及伊蚊只在自然栖息地发现,总是与伊蚊有关。白纹伊蚊,但比例很小。这种生态和行为的典型形式的伊蚊。埃及伊蚊不正常。提出了几种假设解释。登革热预防应仅以伊蚊为基础。蚊控制。
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引用次数: 0
[Diagnosis of anemia at high altitude: problems encountered in Tibet]. 【高原贫血的诊断:西藏遇到的问题】。
P Kolsteren, P van der Stuyft

To test the hypothesis that Tibetans do not increase their haemoglobin concentration with increasing altitude, haemoglobin concentrations of children aged 6 to 72 months were analyzed. The mean haemoglobin concentrations in the different age groups are significantly lower than the mean concentrations expected at this altitude. Histograms and tests for normality show that the haemoglobin distributions are Gaussian. The probability plots confirm the coefficients of skewness, which indicate a superimposed subpopulation towards the lower range of haemoglobin values. A mixed distribution analysis identifies that the curvilinear deviation found in the probability plot encompasses 10 to 12% of the studied population. Together with the normality of the haemoglobin distributions, we are led to suppose that this is the anaemic population. These figures are considerably lower than those found using recommended cut-off values for this altitude; 40 and 46%. Two possible explanations are put forward: 1) the whole population is submitted to the same factor and hence the whole population should be considered anaemic, 2) Tibetans react differently to altitude than other mountain people and have adapted themselves without increase in haemoglobin.

为了验证西藏人血红蛋白浓度不随海拔升高而升高的假设,分析了6至72个月儿童的血红蛋白浓度。不同年龄组的平均血红蛋白浓度明显低于该海拔高度的预期平均浓度。直方图和正态性检验表明血红蛋白分布是高斯分布。概率图证实了偏度系数,这表明一个向血红蛋白值的较低范围重叠的亚群。混合分布分析表明,在概率图中发现的曲线偏差涵盖了研究人群的10%到12%。结合血红蛋白分布的正常性,我们推测这是贫血人群。这些数字远远低于使用该高度的推荐截止值得出的数字;40%和46%。提出了两种可能的解释:1)整个人群都受到相同的因素影响,因此整个人群都应该被认为是贫血的;2)西藏人对海拔的反应与其他山区的人不同,他们已经适应了自己,血红蛋白没有增加。
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引用次数: 0
Cost of drugs at an urban primary health care centre in Alexandra, South Africa. 南非亚历山德拉城市初级保健中心的药品费用。
P Ferrinho, A Valli

This report provides an analysis of expenditure on pharmaceuticals at the Alexandra Health Centre and University Clinic (AHC), South Africa. Drug costs increased at a rate higher than for the general expenditure budget. The drug cost per script per department varied from R9.43 for patients attending the diabetic clinic to R0.60 for antenatal care patients. In general, female consultations at the adult outpatient department (AOPD) were more expensive than male's and adult's more than paediatric's. The largest share of drug costs went to adult female patients in AOPD and the smallest share went into preventive and promotive care services. Again the same observations apply for drug costs as percentage of the total costs per clinical department. This study shows that drug costs were a significant contributor to the level of primary health care (PHC) expenditure. We discuss the alternatives to cost-recovery in a concrete situation like the peri-urban community being served by the AHC. It is concluded that in communities similar to Alexandra it would be possible to provide PHC at about R30 per capita per annum with about 15% being spent on pharmaceuticals.

本报告分析了南非亚历山德拉保健中心和大学诊所(AHC)的药品支出情况。药品费用的增长速度高于一般支出预算。每个科室的处方药费从糖尿病门诊患者的9.43兰特到产前保健患者的0.60兰特不等。一般来说,成人门诊(AOPD)的女性咨询比男性更贵,成人门诊比儿科更贵。在AOPD,成年女性患者的药费占比最大,预防和促进保健服务的药费占比最小。同样的观察结果也适用于药品成本占每个临床科室总成本的百分比。这项研究表明,药品费用是初级卫生保健(PHC)支出水平的重要贡献者。我们讨论了在具体情况下成本回收的替代方案,例如由AHC服务的城郊社区。结论是,在与亚历山德拉类似的社区,可以以每年人均约30兰特的价格提供初级保健,其中约15%用于药品。
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引用次数: 0
[Prospective reflections on malaria field research]. [对疟疾实地研究的前瞻性思考]。
V Robert, J F Trape, P Gazin, J Mouchet, P Carnevale
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引用次数: 0
[Relationship between Plasmodium parasitemia and febrile episodes in various population groups in Kinshasa, Zaire]. [扎伊尔金沙萨不同人群中疟原虫寄生虫病与发热发作的关系]。
P M Mulumba, M Wéry, N N Ngimbi, K Paluku, A De Muynck, P van der Stuyft

The objective of this study was to determine the relative importance of determinants of fever-episodes in an environment with perennial malaria transmission. In 6 neighbourhoods of Kinshasa with different degrees of urbanization, 120 clusters of children younger than 10 years were selected over a one year period and followed up for 2 weeks each. In the 4,816 children retained for analysis 906 fever episodes were registered, which corresponds to an average incidence rate of 4.9 episodes per child per year. Seven hundred (77.3%) of the fever cases had a positive thick film (IF) but of the 3,289 children with a positive TF only 21.3% presented fever during the observation period. Nevertheless, high parasite densities formed, without neglecting the role of other infectious etiologies, the mayor pathogenic mechanism associated with fever. The risk for a fever episode was, in multivariate analysis, 40 times higher in children with at least one positive TF than in children with a negative TF on both day 1 and day 14, and amongst the ones with a positive TF the risk was 3 times higher in children with a parasitemia above 3,000 trophozoites/microliter blood. The habitat constituted another important independent determinant: the relative risk for fever was 1.48 for non-urbanized neighbourhoods, which probably reflects the low malaria transmission in the urbanized ones, but 2.1 for semi-urbanized against peripheral neighbourhoods, where the parasite index is high. Low socio-economic status, the short dry season and young age formed, in this order, further factors to the take into account.

本研究的目的是确定在常年疟疾传播的环境中发烧发作的决定因素的相对重要性。在金沙萨6个城市化程度不同的社区,在一年的时间里选择了120组10岁以下的儿童,每组随访2周。在保留用于分析的4,816名儿童中,登记了906次发烧,相当于每个儿童每年平均发病率为4.9次。7百例(77.3%)发热病例厚膜(IF)阳性,3289例(TF)阳性患儿中仅有21.3%在观察期内出现发热。然而,在不忽视其他感染病因作用的情况下,高寄生虫密度形成了与发热相关的主要致病机制。在多变量分析中,在第1天和第14天,至少有一个TF阳性的儿童发烧发作的风险是TF阴性儿童的40倍,在TF阳性的儿童中,寄生虫血症高于3000滋养体/微升血液的儿童的风险是3倍。生境是另一个重要的独立决定因素:非城市化社区的相对发热风险为1.48,这可能反映了城市化社区的疟疾传播较低,而半城市化社区相对于外围社区的相对发热风险为2.1,而外围社区的寄生虫指数较高。社会经济地位低、旱季短和年龄小依次是进一步需要考虑的因素。
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Annales de la Societe belge de medecine tropicale
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