永州市结核病控制项目病人发现和治疗结果评析

目的：评价永州市结核病控制项目实施效果.方法：对永州市1993～2001年项目实施期间各种登记资料和报表进行分析和评价.结果：项目9年期间,全市累计检查可疑肺结核病人77 127人,可疑者年平均就诊率155.49/10万;累计发现涂阳肺结核病人14 912例,其中新发涂阳病人10 263例;初治涂阳病人平均治愈率为92.77%,复治涂阳病人平均治愈率为89.35%,初、复治比例逐年下降,病死率逐年下降.结论：提示病人发现、治疗与管理工作在项目实施前后有了质的变化.     

祁阳县世界银行贷款/英国赠款结核病控制项目实施结果及评价

目的对项目的技术策略、实施成果和问题进行客观评价。方法对祁阳县结核病控制项目的报表及相关资料进行分类统计,参考其他文献进行评价。结果2002-2006年祁阳县累计检查可疑肺结核病人12243例,可疑者年平均就诊率245.05/10万,全县涂阳病人平均发现率为38.15/10万。在1906例新发涂阳病人中,15～54岁年龄组占65.06%;初治涂阳病人平均治愈率为91.90%,复治涂阳病人平均治愈率为88.57%,复治比例逐年下降,病死率为0.35%。结论2002-2006年祁阳县结核病人的发现与治疗管理水平不断提高,各项指标达到了项目要求。     

2004-2010年保山市结核病控制项目实施效果评价

[目的]了解保山市2004-2010年结核病控制项目工作成效。[方法]对保山市2004-2010年结核病就诊查痰情况、归口管理（发现登记情况）、病人来源渠道、涂阳病人转归情况进行分析。[结果]2004～2010年,累计可疑肺结核者初诊16210例,平均可疑初诊率为0．94‰;平均查痰率为63．65％,痰检平均阳性率为42．55％。累计登记涂阳肺结核病人4276例,平均登记率为24．89／10万;累计登记新涂阳肺结核病人3842例,平均新涂阳登记率为22．35／10万;累计登记活动性肺结核病人4838例。涂阳肺结核病人中,来源渠道为转诊追踪的占77．70％,因症就诊的占9．61％,因症推荐的占11．32％,其他占1．38％。累计检出3842例初治涂阳病人,其中,男性占68．32％,15～64岁占91．51％;累计检出434例复治涂阳病人,其中,男性占68．20％,15～64岁占94．26％。治疗1年时,初治涂阳肺结核病人平均治愈率为93．54％,平均结核病病死率为1．12％;复治涂阳病人平均治愈率为88．94％,结核病平均病死率为0．99％。[结论]保山市实施结核病控制项目效果显著。     

山东省结核病控制项目的终期评价

目的 通过对世行贷款结核病控制项目（简称结控项目）10年实施情况分析，为山东省结核病控制可持续发展和项目结束后结核病防治对策提供科学依据。方法 收集项目实施以来的监测资料，终期评估调查表等资料进行对比分析。结果 1305741例可疑症状接受了免费检查，累计发现和登记196530例肺结核病人，其中涂阳病人143513例，涂阳新登记率辨有1991年的5．8／10万提高到项目平均水平的17．2／10万，初，复治涂阳病人构成比由44．8％下降到24．7％；截至2001年底，已治愈涂阳病人118976例，其中新发涂阳病人平均治愈率为95．1％，复治涂阳病人为90．9％，DOTS覆盖率91％，结防人员增加了27．3％。结论 项目取得了显的社会效益和巨大的经济效益。     

蒲江县世行贷款结核病控制项目实施效果分析

目的 评价我县世界银行贷款结核病控制项目的实施成效。方法 根据我县结核病报表和登记资料,以及1990、2000年两次结核病流调资料进行统计分析。结果 1995－2000年,结核病人涂阳新登记率年平均为13．0／10万、初治涂阳病人治愈率平均为93．9％,复治涂阳病人治愈率平均为90．8％,较项目实施前明显提高：患病率、涂阳患病率分别为1990年的1069／10万、164／10万下降为2000年的300．3／10万、60．1／10万。结论 我县的结核病控制策略是行之有效的,结核病控制项目取得了显著成效。     

克拉玛依市结核病控制项目10年效果分析

目的 总结克拉玛依市1993～2002年实施结核病控制项目的效果，为结核病控制可持续发展提供科学依据。方法 对克拉玛依市项目实施的报表其他相关资料进行绩计分析。结果 1993～2002年共接诊可疑肺结核患者6806例，发现、登记并治疗活动性肺结核病人1539例，发现涂阳肺结核患者760例，活动性肺结核登记率由1993年的18．38／10万上升到2002年的72．78／10万，涂阳登记率由9．19／10万提高到34．48／10万，新发涂阳治愈率达96．9％，复发涂阳治愈率达88．8％，涂阳总治愈率达95．4％。结论 克拉玛依市实施结控项目工作10年取得显著成效。     

寿宁县结核病控制效果分析

[目的]分析寿宁县实施福建省结核病控制项目和世行贷款／英国赠款中国结核病控制项目的效果。[方法]分析1999年1月至2004年6月实施两个结核病控制项目资料。[结果]1999年1月至2002年6月接诊可疑肺结核症状者852例，发现活动性肺结核病人381例(其中涂阳肺结核病人198例．新发涂阳154例)；新发涂阳登记率由1999年的6．39／10万上升到2002年6月的23．55／10万；初、复治涂阳病人治愈率分别达90．9％和86．4％。2002年7月至2004年6月实施世行贷款／英国赠款中国结核病控制项目，共接诊可疑肺结核病症状者866例，发现活动性肺结核病人406例(其中涂阳肺结核病人201例，新发涂阳163例)；新发涂阳登记率由2002年7～12月的26．69／10万上升到2001年1～6月的31．73／10万；初、复治涂阳病人治愈率分别达94．2％和87．5％。[结论]寿宁县实施结核病控制项目．实现了“高发现率”和“高治愈率”的目标，结核病控制水平整体提高．为继续实施世仟贷款／英国赠款结核病控制项目提供宝贵经验，促进寿宁县结核病控制工作的可持续发展。     

永州市芝山区结核病控制项目工作评析

对芝山区1993--2001年世界银行贷款结核病控制项目工作进行评价分析，可疑就诊人数9766例，年度平均就诊率1．92‰，共发现活动性肺结核2628例，其中涂阳病人1351例，涂阳病人新登记率平均为26．5／10万，初治涂阳和夏治涂阳病例治愈率分别为92.06％和85．0％，表明该项目病人发现和治疗在技术上是成功的，但如何提高可疑者就诊率是当前急需解决的主要问题。     

2002-2010年周宁县结核病控制项目实施效果评价

目的评价周宁县世行贷款／英国赠款结核病控制项目实施9年的效果。方法对2002-2010年周宁县结核病防治相关资料进行分析。结果2002～2010年累计接诊可疑肺结核病人3981例,年均可疑者就诊率为2．30％o,因症就诊者占74．99％,转诊占22．21％,因症推荐占0．15％,其他占2．65％。2002～2010年累计登记活动性肺结核病人961例,其中新涂阳534例,复治涂阳97例,新涂阴330例。2002-2005年涂阳肺结核、新涂阳肺结核登记率呈上升趋势（P〈0．05或0．01）,2006-2010年均呈下降趋势（P〈0．01）。治疗1年时平均治愈率,新涂阳病人为93．26％,复治涂阳病人为81．44％;死亡10例,病死率为1．58％。项目实施以来,避免5770-8655人感染肺结核病菌,减少289～433人发病,挽回82个健康生命,节约防治费用72．49～89．91万元,减少误工损失51．36万元,挽回DALY（生命质量调整年）6081人年,减少GDP（地区生产总值）损失2371．59万元。结论周宁县世行贷款／英国赠款结核病控制项目实施效果明显,达到高发现率和高治愈率的目标。     

2001-2010年青岛市肺结核发现与治疗管理资料分析

[目的]评价结核病防治规划实施情况和DOTS策略的执行效果,进一步为结核病防治提供科学依据。[方法]对2001-2010年青岛市结核病病人的发现、登记及治疗管理情况进行分析。[结果]2001-2010年全市累计接诊可疑肺结核病人90707例,年均可疑者就诊率为1．22‰,各年可疑者就诊率为0．76%（2001年）～2．57‰。2001-2010年全市累计登记活动性肺结核病人20085例,年均登记率为27．19／10万;登记涂阳肺结核病人12871例,涂阳登记率为17．34／10万。2001-2010年全市累计登记治疗初治涂阳肺结核病人11771例,治愈10662例,平均治愈率为90．58％;完成治疗的占3．92％,病死率为1．46％,治疗失败的占1．84％,其他占3．19％。[结论]青岛市实施DOTS策略期间肺结核病人的发现率与治愈率均有显著提高。     

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.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.     

Stress in police officers: a study of the origins,prevalence and severity of stress-related symptoms within a county police force

BACKGROUND: High levels of stress-related illness are causing concern across industry. Against a background of impending legislative moves to try to improve this situation, there is a need to identify key work-related stressors. Police work tends to be regarded as inherently stressful because of the personal risk of exposure to confrontation and violence and the day-to-day involvement in a variety of traumatic incidents. As a result, high levels of stress-related symptoms might be expected in this population. OBJECTIVE: To examine the sources of stress-related symptoms within police officers and measure the prevalence of significant associated mental ill-health. METHOD: A cross-sectional questionnaire survey of a population of 1206 police officers was performed to assess levels of strain associated with a series of potential home and work related stressors. Participants were then split into low and high scoring groups on the basis of a General Health Questionnaire (GHQ) threshold score in order to identify those stressors most associated with mental ill-health effects. RESULTS: Occupational stressors ranking most highly within the population were not specific to policing, but to organizational issues such as the demands of work impinging upon home life, lack of consultation and communication, lack of control over workload, inadequate support and excess workload in general. The high scoring group constituted 41% of the population and differed significantly from those with low scores in perception of all stressors, ranking both personal and occupational stressors more highly, and from personality constraints appeared significantly more 'stress-prone'. A significant association between gender and mental ill-health was found, with females more likely to score more highly on the GHQ than males. CONCLUSION: This study confirms previous findings of organizational culture and workload as the key issues in officer stress. Given that the degree of symptomatology appears to be worsening, management action is required. Further research is indicated within the police population into a possible increased susceptibility in female officers.