2016—2017年南通市高温中暑流行病学特征分析

目的描述南通市2016—2017年高温中暑流行病学特征,为制定高温中暑的预防和控制措施提供参考依据。方法收集中国疾病预防控制信息系统中2016—2017年南通市高温中暑病例报告,采用SPSS 20.0对数据进行整理和分析。结果南通市2016—2017年共报告高温中暑145例,其中轻症中暑占53.79%(78/145),重症中暑占46.21%(67/145);死亡4例,均为重症中暑,病死率为2.76%(4/145),死亡病例3例为农民(户外作业),1例为居家老人(99岁)。男性高温中暑73例(50.34%),女性72例(49.66%);男性重症中暑35例(47.95%),女性32例(44.44%);不同性别高温中暑程度的差异无统计学意义(χ~2=0.179,P=0.672)。高温中暑平均年龄为(68.25±18.08)岁,男性(67.01±16.77)岁低于女性(69.50±19.34)岁,不同性别高温中暑年龄差异无统计学意义(t=-0.827,P=0.409)。70岁~、80岁~年龄组高温中暑占比最多,占49.66%;其中男性80~岁年龄组占比最多(27.40%,20/73),女性80~岁年龄组占比最多(25.0%,18/72)。按年龄组分层分析,40~岁年龄组的不同性别高温中暑程度的差异有统计学意义(P<0.05)。南通市高温中暑病例集中发生在7—8月,占97.93%(142/145);其中7月占82.76%(120/145)。结论南通市高温中暑好发于7月,轻症中暑比重症中暑病例稍多,性别与高温中暑关系不大,相比其他年龄段,80~岁年龄组的老年人为高温中暑易发人群,应加强对老年人高温中暑的预警和急救。     

The Effectiveness of a Directly Mailed Smoking Cessation Intervention to Australian Discharged Hospital Patients

Background. The objective was to assess the effectiveness of a directly mailed smoking cessation intervention to discharged hospital patients.Methods. A randomized controlled trial was used. In the 2 weeks after discharge, smokers in the intervention group were sent by mail a personally addressed letter from their medical consultant urging them to quit plus a self-help quitting manual, and smokers in the control group received usual care. Patients were surveyed about their smoking status at 6 and 12 months after discharge. A total of 1858 discharged patients responded to both questionnaires. The main outcome measures were self-reported smoking in past week at 6 and 12 months after discharge. Quitters at 12 months were biochemically tested for evidence of smoking.Results. The results failed to show that smoking cessation advice directly mailed to a broad cross-section of discharged hospital patients who smoke led to smoking cessation. However, the intervention increased cessation among smokers with medical conditions for which quitting is highly relevant. In general, patients who were more likely to quit were older, had entered the hospital as an emergency case, and had a medical diagnosis for which quitting is highly relevant.Conclusions. This study suggests that hospital patients who smoke and are also diagnosed with conditions which call for quitting are more likely to quit if they receive from their consultant a personalized letter advising them to quit and a self-help manual.     

流行病学信函调查方法的评价

信函调查是一种经济实用的流行病学调查方法。本文对信函调查和访问调查的资料作了比较和讨论,统计分析项目包括一般情况、身高体重、饮水情况、饮食习惯、烟酒嗜好、日常体力活动、医疗疾病史、双亲疾病史及经济收入等60余项,其中45项未见两次调查之间有显著差异,相关系数均极为显著;达到显著差异的16项主要集中在饮酒史、食油消耗量及经济收入等问题上,但其大部分仍呈正相关的关系(P<0.05)。信函调查的总应答率为87.1%。此外,对调查表也进行了审视和讨论。     

Peer Reviewed: Randomized Controlled Trial of a Mailed Toolkit to Increase Use of Body Mass Index Percentiles to Screen for Childhood Obesity

Introduction

Despite epidemic increases in childhood obesity rates, many providers fail to diagnose obesity. Body mass index (BMI)-for-age percentiles are the recommended screening test. We evaluated whether mailing a toolkit to physicians would increase use of sex-specific BMI-for-age percentiles to screen for childhood obesity.

Methods

We assigned a random sample of family physicians and pediatricians from New York State’s medical licensing database to either intervention or control groups in the summer of 2004. At baseline and at follow-up, we sent physicians a survey that asked how often they used various screening methods to identify childhood obesity. Between the surveys, we sent physicians in the intervention group a toolkit that consisted of professional guidelines for childhood obesity screening, a tool for calculating BMI, BMI-for-age growth charts, and educational information.

Results

At follow-up, more physicians in the intervention group than in the control group reported using BMI percentiles to screen for childhood obesity. Compared with physicians in the control group, physicians in the intervention group had a larger increase in their routine use of BMI percentiles to screen children aged 2 to 5, 6 to 11, and 12 to 20 years, although the differences in the older 2 groups did not attain statistical significance.

Conclusion

Directly mailing an educational toolkit to physicians can have a small but positive effect on clinical practice.     

Heterogeneity in Responses to a Universal Prevention Program

Because universal or primary prevention strategies often target heterogeneous populations, their effects may likewise be expected to be heterogeneous. We sought to explore the heterogeneity of outcomes of previously published results of a longitudinal Swedish study of a school-based socio-emotional learning program. By applying latent class regression analysis to two measures of well-being, we found three significantly different classes with different change trajectories that yielded different outcomes. We conclude that restricting outcome analyses of primary prevention programs to sample means may conceal important heterogeneity regarding individual outcomes.     

医院综合效益指数评价方法探讨

探讨医院的社会及经济效益指标系统的评价方法,方法根据系统要素分类法将指标分为社会与经济两大类,制定以定额标准为依据,历史标准为参考的评价标准值,采用层次分析法对各指标值赋邓不同的权数。结果运用层次分析加权法求出总指数,分析和评价医院的社会及经济效益情况。     

Inquiry: the pedagogical importance of a skill central to clinical practice

The skill of inquiry is central to the task of the doctor confronted with a patient problem. Despite its importance this skill is not given appropriate emphasis in the education of medical students or in research concerning the clinical reasoning skills of doctors.     

Apostasy to orthodoxy: debates before a Commission of Inquiry into chiropractic

This paper examines the arguments presented at the Royal Commission of Inquiry into chiropractic, which took place in New Zealand in 1978. Drawing on the work of Potter, it suggests that the protagonists in the debate, the medical profession and its allies on one side and the chiropractic profession on the other, developed rhetorical strategies to counter competing versions of the world. An unusual feature of this debate was that it took place before 'impartial' judges. The paper demonstrates the delicate process of negotiation performed by chiropractic groups when confronting medicine in an open forum. The paper concludes that in order to resolve the competing rhetorics, the Commissioners sought for a compromise, which at once embedded chiropractic within the public health service in New Zealand and 'de‐radicalised' its claims.     

Responses of domestic fowl to excess iodine: a review

Typically, poultry diets contain 1-2 mg I/kg, but higher concentrations are sometimes used to enhance the I content of eggs. In addition to an increased deposition of I in the yolk, other often adverse responses occur, especially at exceptionally high concentrations. Excess I in grower diets can prevent sexual maturation in male and female fowl, and in layer diets will progressively reduce egg production until, by about 2500 mg I/kg diet, ovulation is inhibited and egg production ceases. Most I accumulates in the thyroid gland, and it is likely that the mechanism responsible for these reproductive disorders involves a modification of thyroid hormone activity. Simultaneous with the declining rate of lay, feed intake declines, egg weight and yolk-cholesterol contents decrease and body weight increases. Whereas fertility is unaffected in female breeders, hatch of fertile eggs is reduced, hatch time extended and embryonic mortality and dead-in-shell proportions increased. In contrast, male fertility is decreased because of an increased incidence of dead spermatozoa, although hatchability of eggs from normally fed hens is unaffected. All reproductive variables, together with feed intake and body weight, are normalised within about 7 d of returning to a diet with normal I levels. Excess I suppresses growth in meat-type chickens, but does not affect feed conversion efficiency. There are transient increases in plasma I and cholesterol concentration during excess I intake in all types of bird. The evidence for varying responses to different I sources is equivocal, but the consensus is that source is probably not important.     

Sexual Experience and Responses to a Birth Control Film

The objective of this research was to examine the relationship between sexual experience and sexual and contraceptive attitudinal responses to a birth control film. A questionnaire was administered immediately before and after showing a birth control film to 103 college females. Subjects were classified into three groups according to their sexual and contraceptive experience. With perceived change measures, it was found that the film reinforced sexual and contraceptive beliefs. Significant group differences were found regarding reinforcement of sexual attitudes but not for contraceptive attitudes.