An investigation into hospitalized patients

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An investigation of the growing number of deaths of unidentified people in Russia

BACKGROUND: We examined mortality among working-age Russian men whose identity could not be determined, focusing on where and how they died. METHODS: Employing micro-data from deaths that occurred in Izhevsk (Ural region) between June 2004 and September 2005, we analysed the characteristics of decedent men aged 25-54 (n = 2158). Differences between completely identified (n = 1699) and unidentified deaths (n = 282) were compared via logistic regression. Data on all deaths in Russia in 2002 were used for supplemental comparisons. RESULTS: We found that relative to identified men, unidentified men were at a higher risk of death from exposure to natural cold, violence, alcoholic cardiomyopathy, acute respiratory infections and poisonings. Our results also revealed that alcohol played an important role in the mortality of unidentified men. The places and causes of death among these unidentified men provide substantial evidence of their homelessness and social isolation. CONCLUSION: The increase in deaths among unidentified men of working-age indicates the emergence of a health threat associated with homelessness and social marginalization. This vulnerable group is exposed to different levels and causes of mortality compared with the larger population and represent a new challenge that requires serious and immediate scholarly attention and policy responses.     

An investigation into the health of kapok workers.

Kapok is a cotton-like fibre obtained from the fruits of Ceiba pentandra, a tree surgeon in tropical countries. In Sri Lanka ginning of kapok is usually done by machine in poorly ventilated buildings where workers are exposed to a great deal of dust. Forty-one workers in five ginneries in Colombo were examined. Mill fever occurred in 28 (77-8%) of the 36 workers who were able to give a history. Chronic bronchitis, which is an uncommon condition in Sri Lanka, was detected to seven workers with an average of 20-9 years' service in the industry. It is suggested that chronic bronchitis is an occupational hazard of workers who are exposed to kapok dust for long periods. Byssinosis was not found in any of the workers studied.     

对滁州市实施新型农村合作医疗制度的调查与思考

20 0 3年 ,安徽省确定了 10个新型农村合作医疗试点县 (市 ) ,滁州市的天长市和凤阳县名列其中。经过近一年的运行 ,我市的新型农村合作医疗试点工作取得了明显成效 ,但同时也暴露了一些问题。为了摸清我市新型农村合作医疗制度试点工作状况 ,进一步规范和推动新型农村合作医疗制度建设 ,扩大试点和全面推行新型农村合作医疗制度提供决策依据 ,我们精心抽选了 10 0个参加新型农村合作医疗的农户 (以下简称“参保农户”)和 10 0个未参加的农户 (以下简称“未参保农户”) ,以及 10个定点医疗机构 (以下简称“定点机构”)进行问卷调查。1　新型…     

An investigation of the co-variation in circulating levels of a large number of environmental contaminants

We are daily exposed to many different environmental contaminants. Mixtures of these contaminants could act together to induce more pronounced effects than the sum of the individual contaminants. To evaluate the effects of such mixtures, it is of importance to assess the co-variance amongst the contaminants. Thirty-seven environmental contaminants representing different classes were measured in blood samples from 1016 individuals aged 70 years. Hierarchical cluster analysis and principal component analysis were used to assess the co-variation among the contaminants. Within each identified cluster, possible marker contaminants were sought for. We validated our findings using data from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 study. Two large clusters could be identified, one representing low/medium chlorinated polychlorinated biphenyls (PCBs) (≤6 chlorine atoms), as well as two pesticides and one representing medium/high chlorinated PCBs (≥6 chlorine atoms). PCBs 118 and 153 could be used as markers for the low/medium chlorinated cluster and PCBs 170 and 209 could be used as markers for the medium/high chlorinated cluster. This pattern was similar to data from the NHANES study. Apart from the PCBs, little co-variation was seen among the contaminants. Thus, a large number of chemicals have to be measured to adequately identify mixtures of environmental contaminants.     

An investigation into the acute vascular effects of riveting.

Measurements were made on 46 pairs of riveters and matched control subjects before and after a morning's work. Before starting work, the mean resting finger systolic pressure was 112 (SEM 3.3) mm Hg in the riveters, similar to 117 (1.7) in the control subjects. After cooling the middle phalanx to 10 degrees C for five minutes, 16 riveters but only one control subject exhibited digital vasospasm and these numbers were unaltered after a morning's work. A subgroup of riveters whose role was always to provide counter pressure to the rivet gun showed a higher incidence (45%) of cold induced vasospasm than did riveters who invariably held the gun (10%) or rotated between both roles (27%). Plasma levels of three markers of vascular activity, endothelin-1 (ET-1), von Willebrand factor antigen (vWFAg), and angiotensin converting enzyme (ACE), were measured in non-smoking riveters and control subjects. Before work, ET-1 concentrations were slightly lower (p < 0.05) in the riveters, but vWFAg concentration and ACE activity were similar in riveters and control subjects. Riveting for a morning did not alter ET-1 concentration or ACE activity but did induce a small increase (p < 0.05) in vWFAg concentration, which may indicate damage to the endothelium. This type of vascular assessment may be helpful in assessing vasospastic complications in workers exposed to vibration.     

An investigation into the cyclical incidence of dengue fever.

The purpose of this research was to review the topic of dengue fever transmission and investigate the relationship between seasonal temperature fluctuations and cyclical dengue fever incidence. Data from Puerto Rico (1988-1992) were used to test the model proposed. Dengue fever is a viral disease caused by any one of four antigenically distinct serotypes. It is transmitted by Aedes mosquitoes and infects 80 million people per year. Currently, dengue is endemic in specific tropical and subtropical regions worldwide and epidemic dengue has been reported in the Americas, Asia and some Pacific Islands. Data for Puerto Rico were collected from the NCDC/NOAA and a study conducted by Perez et al. (1994). Multivariate linear regression analysis was used to determine if a relationship exists between the monthly mean temperature lagged and the monthly incidence of dengue fever in Puerto Rico. Statistical significance was achieved and a second-order model produced an R2 of 0.71. A residual analysis reveals positive autocorrelation, thus weakening the model's power to predict monthly dengue incidence. This suggests that other forces or factors related to the history of the herd immunity, the introduction of a new serotype, or demographic transitions are also influencing the cyclical transmission of dengue fever. Case clustering information, regional dengue distributions, and population density transformations must also be obtained in order to assess the forecasting ability of this model. Additional research is needed to avoid oversimplifying the problem. Without such attempts at establishing significant correlations, dengue prevention and control will remain a formidable task for many developing and developed countries.     

住院病人的满意度调查分析

目的 为了解住院病人对医生、护士及医疗环境的满意度。方法 采用统一调查表，深入床边２次（中间间隔４２天）询问病人的方式，并表明调查者不代表患者所住医院实施调查。结果 对医生、护士的态度与质量满意度分别为５０．０％和５６．９％，５５．１％与６２．８％；环境满意度是５１．５％。上海市患者满意度７０．６％、外地为９１．９％，文盲、小学、初中、高中、大专及以上的患者的满意度分别为９３．３％、８２．５％、７     

白山市农村卫生工作的调查报告

为了解和掌握白山市农村卫生工作现状,为制定农村卫生体制改革政策提供准确、真实的客观依据,我们先后对全市6个县(市)区的农村卫生工作所存在的问题进行了深入细致的调查.     

An investigation into expectation-led interviewer effects in health surveys

Many large-scale health surveys use interviewers to obtain standardised information about the health of the general population. To improve response rates and data quality, the researchers/designers usually brief the interviewers to familiarise them with the survey procedures and stimulate their interest in the survey. However, it is possible that interviewers, having been exposed to researchers' expectations, may inadvertently influence respondents to produce outcomes consistent with those expectations. Such expectations are referred to here as 'expectation-led interviewer effects'. In this paper, the design and results from an experiment to test for expectation-led interviewer effects are described. The experiment involved conducting two health surveys, called the 'experimental' and the 'control', which were identical in every way except that researchers made a reference to a supposed link between childhood and adult health at the experimental survey briefing. The testing procedure was designed prior to data collection to preclude accusations of data dredging and to ensure that the type I error probability was less than 5 percent. No consistent evidence of expectation-led interviewer effects was found, bar a statistically significant effect for health questions requiring the recall of detailed quantitative information. This effect was small, however.     

An investigation into the bioaccessibility of potassium in unprocessed fruits and vegetables

Epidemiological studies and clinical trials have consistently shown an inverse association between potassium intake and blood pressure. As a means of raising potassium intake within the UK population, an increase in the consumption of fruits and vegetables is strongly advocated. The aim of this study was to determine the bioaccessibility of potassium in these foods. A 10-day crossover feeding trial was performed on 11 healthy volunteers. For 5 days a diet providing most of the potassium in the form of unprocessed fruits and vegetables was followed by a diet in which the potassium was believed to be almost wholly bioaccessible, being derived from animal foods and fruit juices. The potassium and sodium of the diets and the urine were determined by chemical analysis: 96.3% of the potassium in the ‘high bioaccessible diet’ was recovered in the urine, compared with 76.8% from the diet rich in fruits and vegetables. This difference is attributed to the cellular structure of plant foods. The relatively poor bioaccessibility of potassium diminishes the perceived nutritive value of these foods with regard to potassium intake.     

An investigation into the bioaccessibility of potassium in unprocessed fruits and vegetables

Epidemiological studies and clinical trials have consistently shown an inverse association between potassium intake and blood pressure. As a means of raising potassium intake within the UK population, an increase in the consumption of fruits and vegetables is strongly advocated. The aim of this study was to determine the bioaccessibility of potassium in these foods. A 10-day crossover feeding trial was performed on 11 healthy volunteers. For 5 days a diet providing most of the potassium in the form of unprocessed fruits and vegetables was followed by a diet in which the potassium was believed to be almost wholly bioaccessible, being derived from animal foods and fruit juices. The potassium and sodium of the diets and the urine were determined by chemical analysis: 96.3% of the potassium in the 'high bioaccessible diet' was recovered in the urine, compared with 76.8% from the diet rich in fruits and vegetables. This difference is attributed to the cellular structure of plant foods. The relatively poor bioaccessibility of potassium diminishes the perceived nutritive value of these foods with regard to potassium intake.     

An investigation into the cause of the 1983 whooping cough epidemic in the Netherlands

Despite more than 50 years of vaccination, whooping cough is still an endemic disease in the Netherlands with regular epidemic outbreaks. In the last 20 years, two periods of increased notifications were observed. The causes of the increased notifications in the first period, from 1983 to 1987, are contentious. At the time it was suggested to be a surveillance artifact, caused by changes in diagnostic procedures and increased awareness. An alternative explanation, a reduction in the vaccine dose, was downplayed at the time. The aim of this study was to reinvestigate the causes of the increased notifications by identifying changes in the Bordetella pertussis population. B. pertussis strains, isolated from 1965 to 1992, were characterized by means of fimbrial serotyping, multiple-locus sequence typing of virulence genes (MLST) and multiple-locus variable-number tandem repeat analysis (MLVA). Shifts in fimbrial serotypes and MLVA types were associated with changes in vaccine dose and increased number of notifications. One to three years after lowering of the vaccine dose, the predominant fimbrial serotype changed from Fim3 to Fim2, and the reverse trend was observed when the vaccine dose was increased. Significantly, changes in fimbrial serotypes were evident at least seven years before the increase in notifications. Our results provide evidence that the change in vaccine dose affected host immunity and, consequently, contributed to an increase in pertussis morbidity. Further, we show that MLVA and fimbrial serotyping of strains can be used as early warning for pertussis epidemics.     

An in-depth investigation into a food poisoning outbreak

On and shortly after the 6th May 1990, 16 people were affected by food poisoning in an old peoples' residential home, of whom two died. The vehicle of infection was identified as a baked Alaska contaminated by Salmonella enteritidis phage type (PT) 8 and, at an early stage of the investigation, the source was attributed to a single infected egg. A separate investigation by the author, however, revealed that the baked Alaska meringue had been dispensed from an inadequately cleaned piping bag which had been recovered from the kitchen a month after the outbreak. A pure, profuse culture of S. enteritidis PT8 was isolated from it. At least one secondary case may have been attributable to food made with this bag. Ministry of Agriculture Investigations of the flocks suspected of producing the eggs used for the baked Alaska demonstrated an absence of S. enteritidis. On this basis, the author considered a more likely cause of the outbreak to be the piping bag, contaminated from source or sources unknown within the kitchen. Furthermore, the possibility of human carrier transmission cannot be wholly ruled out. The incident underlines the dangers of jumping to conclusions at the outset of food poisoning investigations and emphasises that hypotheses formulated on sources of contamination must be properly tested, the absence of which, in this instance, led the investigators to unwarranted conclusions as to the cause of the outbreak.