The effect of accident mechanisms and initial findings on the long-term course of whiplash injury

The aim of this study was to assess the relationships between accident mechanisms as well as initial findings and the long-term course of whiplash injury. A representative sample of 117 consecutive patients referred by primary care physicians was followed-up over 12 months. Fractures or dislocations of the cervical spine, head trauma and pre-existing neurological disorders were exclusion criteria. The interval between the accident and the baseline examination was 7.4 days (SD 4.2 days). Assessment included accident features (e.g. passenger position in the car, head restraint, head position, type of collision), initial symptoms (e.g. intensity and onset of pain, symptoms of neurological dysfunction, multiple symptom score), and signs (restricted neck movement, neurological deficits). At the 1-year examination, patients were divided into an asymptomatic and a symptomatic group and were compared with respect to accident features and baseline findings. Twenty-four percent of patients were still symptomatic after 1 year. Analysing accident mechanisms separately, rotated or inclined head position was the primary feature related to symptom persistence (P=0.005). The symptomatic group scored higher at baseline on the multiple symptom rating (P=0.004) and had a higher incidence of initial headache (P=0.004) and neurological symptoms (P=0.008) together with a higher intensity of headache (P=0.0002) and neck pain (P=0.0009). The following set of initial variables predicted persistence of symptoms at 1 year (logistic regression): intensity of neck pain (P=0.001) and headache (P=0.009), rotated or inclined head position (P=0.02), unpreparedness at the time of impact (P=0.01) and car stationary when hit (P=0.01). In conclusion, accident mechanisms and initial findings suggestive of more severe injury were significantly related to long-term persistence of symptoms after whiplash injury.This study was supported by the Swiss National Science Foundation (project number: 3.883-0.88) and the Swiss Accident Insurance Company (Schweizerische Unfallversicherungsanstalt), Berne     

Confrontations with reality: Crisis intervention services for traumatized families after a school bus accident in Norway

In August 1988 a Swedish schoolbus with 23 children and 11 adult passengers crashed into a tunnel wall in Norway. Twelve children and four parents died, 18 of the passengers survived. The victims' relatives (parents, spouses, siblings, and others) were transported to Norway and given a confronting support program at the University hospital in Bergen. The crisis intervention program is described: how the relatives were helped to confront and actively cope with some of the stressful situations from which traumatized families very often are protected. One year later 42 of the relatives answered a questionnaire evaluating the confronting support program that was offered during their stay in Norway. A majority of the respondents did not regret their participation in the program. The answers indicate that passivity and helplessness can be counteracted through a combination of confrontation with reality and emotional support.The study has received financial support from Skandia Insurance Co. (Sweden), Haukeland University Hospital and Norwegian Research Council for Science and the Humanities (377.92/021).     

论医疗事故赔偿纠纷的法律适用

由于我国医疗事故赔偿纠纷处理的有关法律、行政法规及司法解释之间存在着不统一、不配套的矛盾。因此,在审理医疗事故赔偿纠纷案件中的分歧颇大 这既不利于正确地维护医患双方的合法权益,也不利于医疗纠纷的顺利解决及社会秩序的稳定。因此,正确地认识与解决医疗事故赔偿纠纷法律适用中的矛盾,具有十分重要的意义。     

4个铁路区段提速列车噪声影响调查

为探讨提速列车噪声对铁路两侧环境及居民健康影响,依据声源,环境噪声等固定标准,对４个铁路运行区段进行了调查。     

刺络拔罐法对减低中风后上肢肌张力增高的临床研究

目的　观察刺络拔罐法对脑血管意外患者肌张力增高的改善情况。方法　将已出现肌张力增高的脑血管意外患者6 2例 ,随机分为刺络拔罐组 31例、对照组 31例。结果　刺络拔罐组在治疗后的肌张力较治疗前有显著降低 (P<0 .0 0 1) ,并且疗效优于对照组 (P<0 .0 5 )。结论　刺络拔罐法可显著改善脑血管意外患者肌张力增高的情况。     

脑卒中肢体瘫痪的早期康复治疗

目的探讨运动疗法为主的康复治疗对脑卒中恢复期肢体功能恢复的影响。方法采用以运动疗法为主配合中频治疗、作业治疗、电针、心理疏导对94例脑卒中患者瘫痪肢体进行康复治疗。结果94例患者的瘫痪肢体的功能有不程度的恢复，应用Brunnstrom偏瘫肢体功能评定法评定，发病后≤1个月的恢复较理想，与发病后1～3个月和3～6个月的进行肢体功能恢复比较，差异有显著意义（P〈0．01和P〈0．05）。结论早期康复治疗对脑卒中患者肢体功能的恢复效果显著。     

System weaknesses as contributing causes of accidents in health care.

OBJECTIVE: Accidents in health care, resulting in injury or death to the patient, are a matter of considerable concern. The aim of this study is to examine whether system weaknesses can contribute to these accidents, and if so, how. DESIGN: Eight consecutive accidents reported to the Health Authority in Sweden were analysed using MTO (Man-Technique-Organization) analysis. SETTING: Emergency care hospitals in Sweden. RESULTS: All cases that involved the system supported the assumption that system weaknesses are a contributing factor to accidents. In this study two types of latent failure could be identified: process control latent failures and interactional latent failures. The time span from activation of process control latent failures to operator error was very short, and the study demonstrates the simple relationship between situational factors and operator errors. Interactional latent failures exert system influence in a more indistinct manner. Latent failures, as seen in this study, act not only by creating opportunities for operator errors but also by hindering error detection in the time window available. Safety barriers, which might have prevented the accidents, could be proposed in seven out of eight cases. CONCLUSION: System weaknesses seem to play an important role in accident evolution. Consequently, certain measures can be suggested in order to improve patient safety: (i) sufficient resources should be allocated for research and development at both medical schools and hospitals in order to establish competence and procedures for systematic analyses of processes; and (ii) authorities handling accident cases should have adequate competence in system analysis.     

急性脑血管意外并发吸入性肺炎、窒息的相关因素分析

目的：探讨急性脑血管意外并发吸入性肺炎、窒息的相关因素及预防护理措施。方法：对862例急性脑血管意外案例进行回顾性总结。结果：与吸入性肺炎、窒息明显相关因素有脑卒中性质、神经元功能缺损程度、有无意识障碍、胃肠功能紊乱、吞咽障碍等症状。结论：及早给予插置胃管等相应护理措施可减少吸入性肺炎、窒息发生。     

高血压病患者血压各参数与其发生冠心病脑卒中的相关性研究

目的探讨高血压病患者血压各参数与其发生冠心病脑卒中的关系。方法回顾性分析1190例高血压病患者,年龄45～65岁,其中单纯高血压病患者400例,高血压并发冠心病者392例,高血压并发脑卒中者398例,分析3组患者的血压各参数关系,探讨收缩压、舒张压、平均血压、脉压与高血压并发冠心病、脑卒中的相关性。结果收缩压:脑卒中组与单纯高血压组或并发冠心病组比较有显著性差异(P<0.05);舒张压:冠心病组与单纯高血压组或并发脑卒中组比较有显著性差异(P<0.01);平均血压:脑卒中与单纯高血压组或并发冠心病组比较有显著性差异(P<0.05);脉压:并发冠心病组或脑卒中组与单纯高血压组比较有显著性差异(P<0.01)。Logistic回归分析显示:校正年龄、性别、高血压病程和其他危险因素(吸烟、糖尿病、高脂血症),脉压仍与冠心病、脑卒中的发生有显著相关性(P<0.05,P<0.01)。结论中老年高血压病患者,收缩压、平均血压与脑卒中的发生有显著相关性,舒张压与冠心病的发生有显著相关性,脉压与冠心病、脑卒中的发生均有显著相关性。校正年龄、性别、高血压病程和其它危险因素(吸烟、糖尿病、高脂血症),脉压是高血压并发冠心病、脑卒中的独立危险因素。     

苯的胺基及硝基化合物重大急性职业中毒分析

目的探讨苯的胺基及硝基化合物重大急性职业中毒的发生特点,为制定相应防治策略提供科学依据。方法对1989~2003年间全国报告的苯的胺基及硝基化合物重大急性职业中毒资料进行描述性分析。结果①1989~2003年间全国共报告苯的胺基及硝基化合物重大急性职业中毒17起,年均1.1起;直接导致中毒的物质约有8种;平均每起事故中毒者为6.6例,中毒死亡者0.1例,1起事故最高中毒病例数为27例;中毒率高,中毒死亡率相对低;②中毒主要集中在6~9月份,多发生在化学工业和运输与仓储业,在搬运和生产岗位中毒多发。中毒事故发生的主要原因是缺乏安全教育和个人防护设备。结论①加强安全教育和个人防护,严禁皮肤直接接触;②在修订《高毒物品目录》时考虑将苯的胺基及硝基化合物部分或全部剔除。