生命质量评价领域及其权重值的确定方法

目的 :探讨生命质量评价领域及其权重值的确定方法。方法 :比较归纳法和推论法确定生命质量评价领域的优缺点 ,以及 Delphi (专家询问法 )、AHP(层次分析法 )、因子分析方法等赋予生命质量评价领域权重值的优缺点。结果 :采用归纳法确定的领域比较全面且合理 ,但是花费的时间多且人力、物力均大 ,而由推论法得到的结果比较局限但是实施起来节省时间、人力、物力 ;Delphi、AHP等属主观构权法 ,简单实用 ,因子分析法则属客观构权法 ,其数学理论性强 ,但不易解释。结论 :生命质量评价领域的确定和权重值赋予有主、客观的方法 ,它们各有其优缺点 ,在实际研究中应该根据具体情况结合运用     

组合赋权法与Topsis分析法联用对整体护理质量的评价

以专家排序法、秩和比法和专家咨询法（Delphi)为基本赋权方法，对所赋权重进行组合，消除各种赋权方法的缺点。利用组合赋权法与Topsis分析法对11个科室进行综合评价，探讨整体护理质量评价方法，为整体护理质量评价提供客观、科学的依据。     

食品卫生监督工作质量综合评价中指标权重的确定

许多评价方法都考虑各因素权重对评价结果的不同作用，权重值是否合理严重影响评价的结果。权重的确定方法文献报道较多，目前主要的方法有经验评分法、比标法、灰色聚类法、综合定权法、RSR法、层次分析法等，其中层次分析法被广泛采用，本文采用层次分析法对食品卫生监督工作质量综合评价中指标权重的确定进行研究。     

7种确定评估指标权重方法的比较

权重是综合评价中的一个重要的指标体系,合理地分配权重是量化评估的关键。因此,权重的构成是否合理,直接影响到评估的科学性。确定权重的方法有很多,如专家咨询法(Delphi)、专家排序法、层次分析法、秩和比法(RSR)、相关系数法、主成分分析法和因子分析法等,但各种方法均有其优缺点。     

综合评价中权重系数及标准化方法的研究

目的：对全国30个省市生殖健康状况及保健水平进行综合评价，对各指标的权重系数及指标的标准化值的计算进行研究。方法：应用4种计算指标权重系数的方法：专家咨询权数法，因子分析权数法，信息量权数法和独立性权数法，应用线性插值法对指标进行标准化，结果：得出4种方法所计算的权重系数及指标的标准化值，并分析4种赋权方法所得结果之间的关系。结论：为实施生殖状况及保健水平的综合评价奠定了基础。     

层次分析法中求权重的一种改进

目的 以医保定点医院医保管理业务评价指标体系中指标权重的确定为例,探讨层次分析法中求指标权重的一种改进.方法 采用Delphi法由遴选出的32名专家对评价指标的重要性、代表性、可及性进行评价,共进行2轮咨询.采用改进的层次分析法计算一级指标的权重.结果 改进层次分析法所得指标权重与传统层次分析法相比,更逼近定点医院医疗保险业务监督评价的"实际优先次序".结论 改进的层次分析法充分利用原有判断矩阵的信息,体现既尊重个体判断的结果及其准确性程度,又重视群体综合意见的原则,是一种可行有效的方法.     

Delphi法确立宫内节育器综合评价指标体系

目的:采用德尔菲(Delphi)法对通过数理方法初步建立的IUD综合评价指标体系进行调整确立。方法:在数理方法初步建立的IUD综合评价指标体系基础上,按照Delphi法原理,选择副高级以上职称、对生殖健康领域研究感兴趣且在各自领域具有权威性的计划生育、妇产科和公共卫生学专家进行两轮咨询评分,总结归纳反馈意见,计算相关参数,调整确立IUD的综合评价体系,采用直接评分法和Satty's赋权法确定各指标权重。结果:调整确立了由3个一级指标、6个二级指标和20个三级指标及其权重构成的IUD综合评价体系。调整后的IUD综合评价体系与调整前相比,在指标数目上没有增减,但在二级指标项、三级指标项及其维度的划分、各指标权重方面均有较明显的变化。结论:Delphi法的结果及建立的IUD综合评价体系具有科学性、合理性和可靠性,可以应用其对IUD进行综合评价。     

综合评价中各指标加权系数确定方法的探讨

本文指出了单独使用特尔斐法、集值统计法或层次分析法确定各评价指标权重的优缺点。通过实例,说明了联合使用特尔斐法与层次分析法求权重的合理性,即:(1)构造各层因素的权重判断矩阵时用特尔斐法;同时指出了分级定量法赋值的极端性。(2)计算权重时用层次分析法;同时提出了通过判断矩阵求权重的一种精确、简便的方法——求最大特征根迭代法。     

层次分析法在艾滋病健康教育评价体系中应用

目的 确立性服务人群艾滋病健康教育和行为干预效果评价指标体系各级指标的权重,从而建立和完善对艾滋病干预项目不同地区实施效果进行综合评价的指标体系.方法 采用Delphi法由专家对效果评价指标体系的各项指标进行评分,并应用层次分析形成判断矩阵,从而计算指标权重并进行一致性检验.结果 效果评价指标体系各级指标权重最终确定,并且结果满足逻辑一致性的要求.结论 层次分析法用于艾滋病健康教育评价简单、科学、可行.     

主管护师综合评价指标体系权重的研究

目的确立主管护师综合评价指标及多方位评价方式的权重系数,实现主管护师科学化、规范化的综合评价。方莹利用Delphi法和层次分析法确定评价指标及不同评价方式的权重系数。结果主管护师综合评价指标体系（Supelvisor Nurse Comprehensive Evaluation Index System,简称SNCEIS）的4项一级指标、12项二级指标和47项三级指标的权重均被确立,各级指标权重判断矩阵排序一致性比率均小于0．100。自评与他评的权重系数分别为0．20和0．80,各类他评方式具有不同的权重系数。结论SNCEIS权重的研究使得SNCEIS的评价结果更为科学、合理。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.