Screening vs. individual detection of industrial fluorosis: a decision analysis model

In preventive medicine and occupational health, decision-makers face uncertainty, divergent opinions, and varying needs. In the Swiss aluminum industry, screening for industrial fluorosis illustrates how decision analysis and cost-effectiveness analysis can provide rational and explicit models of decision-making in such contexts. Data on fluoride-exposed potroom workers are used to compare the cost-effectiveness of two strategies: mass screening of fluorosis versus individual detection of the disease on the basis of the worker's symptoms. A decision-analysis and a sensitivity analysis are performed to assess the impact of the screening program for different levels of expected prevalence of the disease. The optimal decision, in economic terms, is the one that minimizes the pension and screening-related costs and maximizes the number of years of full working capacity. Swiss data suggest that a diagnosis of clinical fluorosis is unlikely before 10 years of exposure to fluoride. Between 10 and 30 years of exposure to fluoride, mass screening may be more cost-effective than individual detection of the disease, even when the expected prevalence of the disease in a given industrial setting is less than 10%.     

Correspondence analysis as a screening method for indicants for clinical diagnosis

In clinical diagnosis, a patient's symptoms are observed and the probabilities of various diseases are assessed. A widely used method of formalizing this approach is independent Bayes in which symptoms are assumed to be independent conditional on the disease category. Correspondence analysis provides a method for examining the dependence between symptoms and assists in the selection of a reduced set of symptoms for the application of the independent Bayes method. This approach is illustrated on two data sets concerned with patients attending Accident and Emergency departments with chest pain and acute abdominal pain, respectively.     

Comparison of assays for determination of peptide content for lyophilized thymalfasin*

Abstract: Precise determination of the peptide content in drug substance samples depends highly upon the particular peptide compound and methodology used. Four independent methods were evaluated and compared to determine which would produce the best experimental precision for analysis of thymalfasin (thymosin α‐1). Four different methods were evaluated including elemental analysis (CHN), quantitative amino acid analysis (AAA), high‐performance liquid chromatography (HPLC), and Kjeldahl. This study demonstrates that the AAA method is highly variable in one laboratory while quite precise in another laboratory. Similarly, HPLC results depended on the laboratory conducting the study with more precise values obtained under cGMP. On the contrary, the CHN method yielded highly precise [i.e. <2% coefficient of variation (CV)] values. As precise knowledge of protein content is fundamental for the compounding of final pharmaceutical product of a specific potency, the CHN analysis is recommended for peptide content determination of the drug substance thymalfasin.     

Timing deficits in apraxia of speech

Summary This paper deals with a particular aspect of speech motor control in patients suffering from apraxia of speech. Three experiments are reported concerning the phase relations between individual speech gestures. These include the timing of laryngeal, velar and labial movements relative to lingual gestures.A total of 8 patients and 12 normal controls were examined using speech material which was designed according to appropriate phonetic paradigms. Evaluation was performed on the basis of speech signal parameters referring to the kinematics of inter-articulatory phasing. Deviations of the patient group were found in all three experiments. This suggests that disturbed phase relations of individual speech movements are a general feature of apraxic speech. It is further hypothesized that the described motor symptoms are the origin of a variety of phonemic errors. Support for this view is provided by appropriate examples which refer to the examined paradigms. By this argument, much of the disturbed phonemic structure of apraxic speech may be accounted for by timing deficits.     

急诊抗菌药物的使用调查与分析

目的考察了解急诊抗菌药物的使用情况。方法随机抽取2008年7—12月的急诊处方2700张，对其中抗菌药物的应用情况进行统计分析。结果急诊抗菌药物使用率49．1％，药物应用形式以单用为主（占66．3％）；给药途径以口服和静脉注射为主。不合理用药处方占抗菌药物处方的10．8％，分别在选药方案、给药方案、溶媒使用、联合应用等方面存在问题。结论我院急诊抗菌药物的应用基本合理，但仍存在一定问题，需进一步加强管理。     

Multivariate modelling of responses to conditional items: New possibilities for latent class analysis

Questionnaire data may contain missing values because certain questions do not apply to all respondents. For instance, questions addressing particular attributes of a symptom, such as frequency, triggers or seasonality, are only applicable to those who have experienced the symptom, while for those who have not, responses to these items will be missing. This missing information does not fall into the category ‘missing by design’, rather the features of interest do not exist and cannot be measured regardless of survey design. Analysis of responses to such conditional items is therefore typically restricted to the subpopulation in which they apply. This article is concerned with joint multivariate modelling of responses to both unconditional and conditional items without restricting the analysis to this subpopulation. Such an approach is of interest when the distributions of both types of responses are thought to be determined by common parameters affecting the whole population. By integrating the conditional item structure into the model, inference can be based both on unconditional data from the entire population and on conditional data from subjects for whom they exist. This approach opens new possibilities for multivariate analysis of such data. We apply this approach to latent class modelling and provide an example using data on respiratory symptoms (wheeze and cough) in children. Conditional data structures such as that considered here are common in medical research settings and, although our focus is on latent class models, the approach can be applied to other multivariate models. Copyright © 2009 John Wiley & Sons, Ltd.     

早期糖尿病视网膜病变药物治疗的药物经济学分析

目的：探讨不同方案治疗早期糖尿病视网膜病变的经济效果,找出既经济又有效的方案。方法：对目前临床常用的4种不同治疗方案（导升明、胰激肽原酶、复方血栓通胶囊、复方丹参滴丸,治疗时间均为90d）运用药物经济学方法进行成本-效果分析。结果：4种方案所需费用分别为1417.50元、810.00元、891.00元、656.10元;治疗有效率分别为94.25%、85.09%、85.17%、83.53%;成本-效果比分别为15.04、9.52、10.46、7.85。结论：复方丹参滴丸治疗效果较好,不良反应少,成本低廉。     

结节性甲状腺肿合并其他甲状腺疾病临床分析

目的探讨结节性甲状腺肿合并其他甲状腺疾病的临床特点。方法回顾性分析我院手术治疗的4622例结节性甲状腺肿中并存其他甲状腺疾病的临床资料。结果4622例结节性甲状腺肿中700例合并其他甲状腺疾病，1418例存在不同的诊断失误。结论在诊断结节性甲状腺肿的同时应注意其合并的其他甲状腺疾病。