应用德尔菲法构建健康社区评价指标体系

本文通过文献复习法、头脑风暴法、专题讨论和15位专家的两轮德尔菲咨询,初步构建一套完备的健康社区建设评价指标体系。两轮专家积极系数均为100.00%,专家权威系数为0.825,两轮指标的变异系数均0.30,一级指标和二级指标的专家协调系数分别为0.540和0.597。经过两轮德尔菲法专家咨询,建立的健康社区建设评价指标体系由4个一级指标、8个二级指标和40个三级指标组成。总的来说,该体系结构稳定,涵盖健康社区建设的主要因素,具有较强的科学性、适用性和可行性。     

基于德尔菲法和层次分析法构建健康企业评价指标体系的研究

目的探索应用德尔菲(Delphi)法和层次分析法探索构建科学、客观、全面的健康企业建设评价指标体系, 推动健康企业建设。方法于2022年10月, 通过德尔菲专家咨询法和层次分析法, 筛选指标并确定指标的权重, 建立健康企业评价指标体系。结果两轮专家积极系数均为100.00%, 专家权威系数为0.82, 两轮指标的变异系数均<0.30, 第一轮和第二轮专家协调系数分别为0.64和0.77(P<0.001)。经过两轮德尔菲法专家咨询, 构建了包含4个一级指标、14个二级指标、63个三级指标的健康企业评价指标体系。结论构建的健康企业评价指标体系具有较高的科学性和可靠性, 涵盖健康企业建设的主要因素, 为健康企业创建提供可靠、可量化的依据和自评依据。     

应用德尔菲法构建糖尿病患者健康信息素养评价指标体系

目的应用德尔菲法构建糖尿病患者健康信息素养评价指标体系。方法通过文献分析法初步构建糖尿病患者健康信息素养评价指标体系,在此基础上采用德尔菲法,通过对22名专家3轮问卷咨询来确定指标体系。结果确定的糖尿病患者健康信息素养指标体系,共有健康信息意识、健康信息知识和健康信息能力3个一级指标、9个二级指标和39个三级指标。3轮咨询专家积极系数为100%,专家平均权威程度为0.86,总指标的专家协调系数分别为0.292、0.464和0.482（P〈0.001）。结论专家代表性强,权威程度高,协调性好,初步构建的糖尿病患者健康信息素养评价指标体系较为科学合理。     

我国健康农村(县)综合评价指标体系构建研究

目的初步构建一套科学的、适合我国国情的、具有可推广性的"健康农村"(县级层面)综合评价指标体系,为农村地区健康发展建设及评估提供科学参考。方法通过文献研究和专家会议法,确定指标体系框架和指标备选库;在此基础上,进行3轮专家咨询,前2轮采用德尔菲法确定评价指标体系的指标内容;最后一轮采用层次分析法确定指标权重。结果32位相关领域专家参与专家咨询,2轮德尔菲咨询的专家积极系数分别为94.12%和100%,专家权威系数为0.86, 2轮协调系数的显著性检验均P0. 05。层次分析的判断矩阵一致性比率在0~0.0645,均低于0.1。经过德尔菲咨询和层次分析,构建了以人群健康、健康生活、健康服务、健康环境、健康社会、组织保障为主要结构框架的具有层次性的"健康县"综合评价指标体系,包括6个一级指标、15个二级指标和30个三级指标。一级指标中人群健康所占权重最高,为0.3227,其次为健康生活,为0.1976;人均期望寿命、居民健康素养水平为权重最高的2个三级指标,权重分别为0.1088和0.0941。结论本研究的专家咨询结果可信度较高。构建的指标体系具有较高的科学性、可落地性和可推广性,为政策制定者推进"健康农村"建设提供了一定的科学参考。     

应用德尔菲法构建网络健康信息质量评价指标体系

目的应用德尔菲法构建网络健康信息质量评价指标体系。方法通过文献复习初步构建网络健康信息质量评价指标词,选择相关领域11名专家,采用德尔菲法经过2轮专家咨询,建立网络健康信息质量评价指标。结果 11名咨询专家平均(48.55±6.79)岁,平均工作年限为(23.64±10.10)年,其中10名(90.91%)专家具有高级职称。2轮咨询专家积极系数分别为91.67%和100.00%;专家的平均权威系数为0.75;第1轮咨询专家协调系数为0.39(P0.01),第2轮咨询专家协调系数为0.51(P0.01)。确定的网络健康信息质量评价指标体系共有信息特性、媒体特性和发布特性3个一级指标,信息准确性、页面设计和编辑的权威性等15个二级指标。结论参与德尔菲法咨询的专家专业代表性强、积极性高,权威程度和协调性也较好,构建的网络健康信息评价指标体系适用性和评价客观性均较好。     

上海健康园区评价标准指标体系构建

目的 构建上海健康园区评价指标体系，为科学推进上海健康园区建设提供依据。方法 通过查阅文献资料和筛选，初步构建健康园区指标评价体系的指标池，通过德尔菲法进行两轮专家咨询，收集专家对指标重要性、可操作性、自评熟悉程度和判断依据的意见，并进行汇总分析。结果 两轮咨询共回收12份专家咨询意见，专家积极系数均为100%，重要性变异系数均<0.25，肯德尔协调系数为0.117和0.199（P<0.01），权威系数均>0.8，且第二轮结果高于第一轮。最终评价指标体系确定由5个基本条件指标（一票否决项）、5个一级指标、14个二级指标、60个三级指标及1个特色项目构成。结论 基于德尔菲法建立的上海健康园区评价指标体系具有科学性和可行性，有助于上海健康园区的建设。     

应用德尔菲法构建公众健康传播材料筛选指标体系

目的尝试利用德尔菲法构建一套完备的公众健康传播材料筛选指标体系。方法通过文献法初步构建公众健康传播材料筛选指标体系,在此基础上采用德尔菲法,邀请18名社区卫生、健康教育、疾病预防、专科医学专家,通过两轮专家调查确定公众健康传播材料筛选指标体系。结果通过德尔菲法两轮专家咨询,确定公众健康传播材料筛选指标体系,共有一级指标6项,二级指标17项,三级指标26项。两轮德尔菲专家咨询的专家协调系数分别为:第一轮0.08和0.11;第二轮0.17和0.20(P<0.05);专家的平均权威程度系数为0.80。结论初步建立较完备的公众健康传播材料筛选指标体系。     

基于德尔菲法的传染病诊断试剂遴选评价指标体系的构建

目的:基于德尔菲法构建传染病诊断试剂遴选评价指标体系。方法:采用系统文献综述,参考国内外文献中影响诊断试剂真实性、安全性、可及性等的因素,纳入敏感性和适用性较好的指标,初步拟订诊断试剂遴选评价指标体系。设计《传染病诊断试剂遴选评价指标体系咨询问卷》,遴选20名相关领域专家对咨询问卷实施2轮德尔菲法专家咨询,确定最终的指标体系。结果:2轮咨询的专家积极系数均为1;第1轮、第2轮咨询的专家权威系数分别为0.80、0.85,专家协调系数分别为0.554、0.569。最终构建的指标体系包括5个一级指标、22个二级指标,其中一级指标分别为真实性、安全性、创新性、可及性和勤务适用性,权重分别为0.3237、0.2421、0.0553、0.1342和0.2447。结论:采用德尔菲法构建的传染病诊断试剂遴选评价指标体系具有较高的权威性和可靠性,可为传染病诊断试剂的遴选和储备提供参考依据。     

基于模糊综合评价的社区健康管理水平评价指标体系的构建北大核心

目的构建一套社区健康管理水平评价指标体系,为社区层面的健康管理水平评价提供工具。方法基于2012版欧盟健康评价指标体系的维度,结合健康中国行动考核指标,采用头脑风暴法及文献综述法形成原始指标池,据此发放正式的专家咨询问卷。遴选18位相关领域专家进行两轮德尔菲咨询,最后由模糊综合评价法确定权重。结果专家积极系数:第1轮,88.89%;第2轮,93.75%。两轮专家的权威系数、熟悉程度系数、判断系数都在0.8以上;第2轮专家咨询完成后,专家意见协调系数为0.22~0.25,相较第一轮差异具有统计学意义(P<0.05);最终确定了涵盖一级指标4个、二级指标14个、三级指标59个及其对应权重的社区健康水平评价指标体系。结论初步建立了社区健康水平评价指标体系,纳入指标符合实际,权重合理,具有一定的可操作性。     

基于德尔菲法的高血压风险敏感指标体系的建立

目的应用德尔菲法构建一套比较完整的高血压风险敏感指标体系,为设计行为干预计划,进一步提高高血压患者的治疗依从性提供指导。方法通过查阅相关文献,专家讨论以及结合患者实际情况初步制定4个一级指标,25个二级指标,在此基础上运用德尔菲法,通过对15名专家2轮问卷咨询确定高血压风险敏感指标体系。采用SAS 9.13软件进行统计分析,重要性评价采用x±s进行描述,专家一致协调程度用变异系数及协调系数表示,采用Kendall W检验计算专家协调系数。结果确定的高血压风险敏感指标体系共有心血管风险指标、生化指标、脏器功能损伤、并发症风险和生活方式5个一级指标和23个二级指标;两轮专家的积极系数分别为100%和93.33%;两轮专家咨询的平均权威系数分别为0.89和0.91;两轮专家咨询意见的协调系数分别为0.283和0.435,有统计学意义(P0.01)。结论本次研究建立的"高血压风险敏感指标体系"具有一定的科学性,合理性,有待今后在高血压患者中进一步验证其效果。     

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.     

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.     

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.     

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.