诊断试验评价的Meta分析方法

目的介绍诊断试验评价的Meta分析方法。方法以7篇B超诊断脂肪肝的研究为例，运用调整SROC法对其进行综合评价。结果用调整SROC法求得B超的灵敏度为0．89(95％CI：0．87～0．92)，特异度为0．94(95％CI：0．92～0．96)，Q值为0．90。结果表明，B超的诊断价值较高，可作为脂肪肝诊断的有效方法。结论运用诊断试验评价的Meta分析方法，可对诊断试验的诊断价值做出综合评价，增加研究结论的统计功效，提高结论的可靠性。     

B超对无症状脂肪肝的诊断价值

为探讨B超在检查中对无症状脂肪肝的诊断价值。回顾性分析了2002年3－9月在武警部队干部体验1231例中，B超检出无症状脂肪肝246例，结果表明246例无症状脂肪肝中，≥40岁136例，占55．28％；＜40岁110例占44．72％。血脂增高者155例占63．0％，两组比较，差异有显著性（P＜0．05）。B超在体检中对无症状脂肪肝的诊断有一定价值。     

脂肪肝与胆固醇及甘油三酯的相关性

对我院 2 0 0 1年 10月体检中 ,经B超诊断为脂肪肝的 112例教职工进行血胆固醇 (TCH)及血甘油三酯 (TG)的测定 ,并随机抽取 12 0名非脂肪肝教职工作对照 ,进行比较 ,以期了解脂肪肝与TCH及TG的关系 ,现报告如下。1　对象和方法1.1　对象　河南工业职业技术学校 2 0 0 1年 10月参加体检的教职工 ,共 4 35人 (包括退休职工 ) ,其中男 30 7人 ,女 12 8人 ,年龄在 2 4～ 76岁之间。1.2　诊断标准　脂肪肝的临床表现及实验室检查缺乏特异性 ,而当肝细胞脂肪沉着时 ,对超声的吸收却明显增强 ,且后场发生明显减退。故B超诊断脂肪肝准确可靠 ,…     

出入境人员脂肪肝的超声诊断与相关因素分析

[目的] 探讨出入境人员脂肪肝的超声诊断与相关因素的关系。[方法] 2002年1～8月份出入境监测体检人员9978人，同时测量体重、身高，查血清总胆固醇(TC)、血清甘油三酯(TG)，B超检查肝脏等脏器。[结果] 检出脂肪肝554人。脂肪肝的患病率男性高于女性，并以41～60岁年龄段最高；体重过重或肥胖人群中、重度脂肪肝比例高达76．59％。脂肪肝患者合并血脂异常者占77．98％，其中以单纯甘油三酯增高占多数(56．48％)。[结论] 脂肪肝的发生率呈年轻化趋势，体重过重或肥胖者脂肪肝患病率高，并多合并血脂异常，加强健康宣传教育，参加体育锻炼，定期B超及血脂监测是提高人群健康水平的重要措施。     

脂肪肝与体重指数的相关性研究

目的：了解脂肪肝与肥胖程度之间的相互关系。方法：应用脂肪肝的超声诊断标准与体重指数的判断标准，对检出的脂肪肝、可疑脂肪肝与体重指数进行分析。结果：在79名被检者中，共检出脂肪肝、可疑脂肪肝共17例，检出率为21．5％；体重指数大于25者其检出率为62．5％(10／16)，小于25者检出率为11．11％(7／63)，两者有高度显著性差异(P＜0．01)；体重指数分布与相应检出率之间存在直线正相关(r＝0．905，P＜0．01)。结论：控制体重增加是防止脂肪肝发生的重要措施。     

CT在妇科肿瘤诊断中的价值研究

目的：探讨cT在妇科肿瘤诊断中的价值。方法：选取本院2010年1月-2012年1月妇科肿瘤患者56例,对患者分别进行CT与B超检查,将检查结果与病理最终诊断结果进行对比,评价诊断效果。结果：CT检查对妇科肿瘤患者的诊断效果明显好于B超检查（P〈0．05）,CT检查定位准确率为91．1％,病灶准确性为92．9％。结论：CT检查对妇科肿瘤患者的诊断效果非常显著,在临床中有较高的应用价值。     

脂肪肝与血生化指标的关系探讨

目的:探讨脂肪肝与血生化指标的关系。方法:对符合B超诊断的脂肪肝200例和对照组100例进行血生化检验。结果 200例脂肪肝中,轻度、中度、重度脂肪肝与对照组比较,TC、TG、APO-B显著高于对照组(P<0．05-0．01),HDL-C、APO -A1明显低于对照组(P<0．05-0．01)。ALT中、重度脂肪肝与对照组比较差异显著(P<0．01)。AST重度脂肪肝与对照组比较有显著性差异(P<0．01)。结论,部分血生化指标变化与脂肪肝及其程度有关,似可作为脂肪肝诊断的一种非特异性的辅助客观指标。     

CT及B超用于脂肪肝临床诊断的比较研究

[目的]探讨CT及B超对脂肪肝的诊断价值及特征性表现。[方法]回顾分析事业单位集体组织的医学体检人员中凡被诊断为脂肪肝共396例患者的CT及B超检查资料。[结果]3536例受检者中,CT诊断脂肪肝396例,B超诊断脂肪肝334例。[结论]CT对脂肪肝诊断的准确性和敏感性优于B超检查。     

妇科临床应用B超的诊断价值分析

目的：观察妇科临床应用B超的诊断价值。方法：资料选取本院2013年2月-2014年2月收治的疑似妇科疾病患者112例，对其进行B超检查与病理组织学检查，将B超检在结果做研究组，将病理组织学检查结果做对照组，观察两种检查方式的诊断结果，观察不同年龄段妇女的妇科疾病发病情况。结果：以对照组结果为参照，B超正确诊断92例，准确率为95．83％；在研究组诊断结果中，4049岁妇女的妇科疾病发病率最高，为36．96％。结论：B超诊断妇科疾病的准确率极高，可以为临床诊断提供参考依据．具有临床应用价值。     

某大学教职工脂肪肝患病率与年龄性别的关系

脂肪肝是多种原因所致的过多脂肪在肝细胞中沉积。轻度脂肪肝常无临床表现，中、重度脂肪肝可出现乏力、肝区隐痛，甚至可引起肝功能损害，如果不注意控制将会导肝硬化、肝坏死。B超作为一种无创伤性检查方法，在健康普查中已是常规检查项目，并且B超对脂肪肝的诊断敏感性超过90％，诊断准确率可达85％～97％。我校2877名教职工上腹部脏器B超检查发现脂肪肝患病率高达11．61％，居各种病症的首位。我们对其患病率与年龄和性别的关系进行了分析。     

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.