562例正常男子精液质量的综合评价

目的了解我国男性精液质量的现状及探讨综合评价指标.方法对我国7个省市妇幼保健所进行婚前体检的562例正常男性志愿者进行精液质量检查及流行病问卷调查.资料分析方法采用一般描述性分析和主成分分析等.结果精液量为(2.61±1.10)ml,精子密度为(64.47±34.59)×10+6/ml,精子前向运动百分率(X2)为(59.89±17.11)%,精子存活率(X3)为(77.19%±11.87)%,精子正常形态率(X4)为(78.23±9.15)%.精液量、pH值、精子前向运动百分率、精子存活率及正常形态精子百分率的差值均在2%以内.精子密度的差值为6.18%.有效活精指数范围在0～8.01之间,中位数为0.87.精液质量各常规指标都符合WHO标准的对象仅占42.3%.结论常规精液质量指标与精液质量第一、第二主成分的相关分析显示第一主成分与精子前向运动百分率、精子存活率及正常形态精子百分率呈中、高度相关,和精液量及精子密度为低度相关;第二主成分与精液量及精子密度为中、高度相关,与精子前向运动百分率、精子存活率及正常形态精子百分率呈低度负相关.表明第一主成分能较好的代表精液质量中的精子质量指标,第二主成分能较好地代表精液质量中的精子数量指标.     

医院护理过程质量综合评价指标研究

目的 建立科学、实用、适应形势发展的医院护理过程质量评价指标体系，为医院护理管理部门合理评价、科学决策提供依据。方法 采用典型调查法，了解医院现行护理过程质量评价内容和方法；会议讨论确定评价指标体系的基本范畴；采用头脑风暴法、特尔斐法对指标进行筛选和论证，确立指标体系；用现场调查法对25个科室的护理过程质量进行评价和分析。结果 建立了医院护理过程质遣综合评价体系，涵盖护理服务、护理管理、护理技术和护理安全4个范畴并分解成不同层次的评价指标，整体结构由1个总目标、4项一级指标、12项二级指标、5项三级指标和290项子指标构成。结论 新指标体系强调护理服务理念、突出以病人为关注焦点的质量管理原则，层次清晰，操作性强，为科学合理评价护理过程质量提供了可靠保证。     

Methodological quality assessment of review articles evaluating interventions to improve microbial food safety

Review articles are a means of summarizing the potentially vast volume of research on a topic. However, the methodological quality of review articles varies, and reviews on the same topic may reach different conclusions. We evaluated 65 review articles published between 2000 and 2005 that addressed the effectiveness of microbial food safety interventions, using criteria for methodological soundness developed in the medical field. Overall, the methodological quality of the review articles was poor, with none of the reviews providing information on the method of locating primary research studies or the inclusion/exclusion criteria for selecting primary studies. None of the reviews included a critical appraisal of the methodological quality of the primary studies. Less than half of the reviews stated a focused research question, explored possible reasons for differences in the results of primary studies, discussed the generalizability of results, or proposed directions for future research. There is a need to improve the methodological quality of review articles on microbial food safety interventions if they are to be of use in policy and decision making.     

青岛市某学校室内空气质量卫生学评价

目的了解学校教室、实验室、阅览室、体育馆、餐厅的室内空气质量,为保护学生身体健康、改善室内环境质量提供依据。方法对青岛市某学校学生日常活动场所的室内温度、湿度、风速、CO、CO2、甲醛、PM10、空气细菌总数共8项指标进行检测和分析。结果该学校室内污染较严重的是甲醛、可吸入颗粒物,场所的超标率分别为80%和50%;污染较轻微的是CO2和空气细菌总数,场所的超标率分别为20%和10%。室内甲醛浓度和CO2浓度、室内PM10浓度与室外PM10浓度、空气细菌总数与室内风速指标间的相关性具有统计学意义(P<0.05)。结论学校应采取定时通风、安装智能室内通风系统、使用符合卫生要求的课桌椅和装修材料以及绿化校园等有针对性的措施改善教室空气质量。     

The effects of exercise interventions on quality of life in clinical and healthy populations; a meta-analysis

The aim of the study was to provide an overview of the effect of exercise interventions on subjective quality of life (QoL) across adult clinical populations and well people, and to systematically investigate the impact of the exercise setting, intensity and type on these outcomes. From a systematic search of six electronic databases, 56 original studies were extracted, reporting on 7937 sick and well people. A meta-analysis was conducted on change in QoL from pre- to post-intervention compared with outcomes from a no-exercise control group, using weighted (by the study's sample size) pooled mean effect sizes and a fixed-effects model. Significant differences in outcome were found when treatment purpose was compared; prevention/promotion (well populations), rehabilitation, or disease management. Three to 6 months post-baseline, a moderate positive effect of exercise interventions was found for overall QoL in rehabilitation patients, but no significant effect for well or disease management groups. However, physical and psychological QoL domains improved significantly relative to controls in well participants. Psychological QoL was significantly poorer relative to controls in the disease management group. This pattern of results persisted over 1 year. With some exceptions, better overall QoL was reported for light intensity exercise undertaken in group settings, with greater improvement in physical QoL following moderate intensity exercise. The implications for future health care practice and research are discussed.     

Risk assessment for obstetric interventions

AIM: This study was conducted to reveal the determinants of obstetric interventions in El Shatby maternity hospital, the only obstetric care facility providing tertiary care in Alexandria METHODS: Parturient admitted to the delivery room during the morning and afternoon shifts between April and February 2002 were enrolled in the study. Data were obtained by interview questionnaire complemented by thorough obstetric examination and close monitoring of the labor progress. Data were analyzed using the univariate and multivariate regression analyses. RESULTS: out of the 3201 parturient who attended the hospital, 1302 were included in the study. Nearly three-fifths (61.7%) of parturient had a vaginal delivery. For the remaining proportion, delivery was accomplished by an elective (20.3%) or emergency (17.1%) cesarean section while few (0.9%) had an instrumental vaginal delivery. Operative obstetric intervention was determined by both maternal and fetal factors. For both primiparae and multiparae, the risk of elective cesarean delivery was independently predicted by abnormal fetal presentation, signs of fetal distress, toxemia of pregnancy and frequent antenatal visits of more than four. In addition, it is independently predicted by post date for primiparae and prolonged rupture of the membranes, history of still birth as well as previous obstetric intervention for multiparae. As for emergency cesarean delivery, it is independently predicted by prolonged rupture of the membrane, signs of fetal distress, ante-partum hemorrhage in both primiparae and multiparae. In addition, for primiparae, it is independently predicted by abnormal fetal presentation and a birth weight of more than 3500 grams while for multiparae, it is predicted by previous obstetric intervention as well as the non use of contraception following the delivery of the previous child. CONCLUSION: Both elective and emergency cesarean deliveries are independently predicted by fetal as well as maternal factors, though a proportion may not be medically justified considering models' predictive value. The extent of obstetric interventions reflects only that of specialized tertiary facility. There is a need for an extensive study including different level of health facilities in order to illustrate the whole scope of obstetric intervention and to develop a better understanding of its determinants.     

Impact assessment of risk management interventions

Much effort has been invested in the development and implementation of international recommendations to manage the risk of foodborne antimicrobial resistance, and monitoring programmes to measure bacterial antimicrobial resistance and antimicrobial product volumes. A variety of approaches have been recommended for various stakeholders in the food animal and food production sectors. Interestingly, much less consideration has been given to the establishment of success criteria for the individual interventions and even less for the cumulative effects, when all interventions are considered together as consecutive 'hurdles' along the food chain. The author explores the outcome and unforeseen consequences of these various interventions and appropriate methods that could provide data to assess their impact, as well as key learning experiences that should lead to refinements of such interventions in the future.     

A review of community based healthy eating interventions

Background: Across the world the burden of diet related chronic disease is increasing rapidly (World Health Organization, 2003). Several global, European and national strategies acknowledge the issue and set targets for change but limited work has been carried out into the effectiveness of interventions to change the dietary behaviour of individuals. The aim of this study was to review the effect of community based healthy eating interventions on dietary behaviour within the general population. Methods: A literature review using a systematic approach was carried out using the electronic databases CINAHL, EMBASE, PubMed and Medline with the search terms ‘nutrition’, ‘healthy eating’, ‘community interventions’, and ‘evaluation’. The search was limited to primary research studies, published in English from 1996 to March 2006, conducted in westernised countries and reporting outcome indicators related to obesity and coronary heart disease. Studies focusing on older people, pre‐school children pregnant or breastfeeding women were excluded. In order to assess the methodological quality of the studies included in the review, an assessment tool was developed based on similar tools used in other reviews (Ammerman et al.,2002; Pomerleau et al., 2005). Results: Thirty‐one studies were retrieved and reviewed. These included 17 randomised controlled trials, 10 intervention studies and four evaluation studies. The mean methodological quality score was 58 (maximum possible score 100). In total there were six adult studies (three targeting adults living on a low income) five family studies (three targeting Black and Minority Ethnic groups), 15 children and adolescent studies (six targeting Black and Minority Ethnic groups) and five public policy development and evaluation studies. High intensity, multi‐faceted interventions had a greater effect on positive dietary changes than lower intensity interventions although innovative interventions using the Internet, videos, the media and supermarkets were a success. Discussion: The implications of this review for practice are varied and must be considered alongside government policy for improving health. The review has found that high intensity, multi faceted interventions are the most effective in promoting dietary change but without an increase in current resource for such interventions, low‐cost, low intensity interventions are more readily available. Conclusions: Community based healthy eating interventions were effective in changing dietary behaviour in the general population. The small number of studies retrieved and the methodological problems highlighted indicate that further, more robust research is needed to inform public health policy and practice in the future. References Ammerman, A.S., Lindquist, C.H., Lohr, K.N. & Hersey, J. (2002) The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence. Prev. Med. 35, 25–41. Pomerleau, J., Lock, K., Knai, C. & McKee, M. (2005) Interventions designed to increase adult fruit and vegetable intake can be effective: a systematic review of the literature. J. Nutr. 135, 2486–2495. World Health Organization. (2003) Diet, Nutrition and the Prevention of Chronic Disease. World Health Organization, Technical Report Series 916.     

Comprehensive school health in Canada

The Canadian education system is among the best in the world academically. In contrast, students' (children and youth) eating and activity levels are so poor that they have led to prevalence rates of overweight that are among the highest in the world. Given the enormous public health burden associated with poor nutrition and physical inactivity, Canada needs to address this health risk. Comprehensive school health (CSH) is a promising approach to promoting healthy eating and active living (HEAL). This article provides a review of CSH and discusses its four essential elements: 1) teaching and learning; 2) social and physical environments; 3) healthy school policy; and 4) partnerships and services. It also provides a common understanding of the implementation and broader benefits of CSH, which, in addition to health, include student learning and self-esteem. The article further discusses some complexities of a rigorous evaluation of CSH, which comprises proof of implementation, impact and positive outcome. Though such an evaluation has yet to be conducted, some studies did confirm successful implementation, and another study observed positive outcomes. Rigorous evaluation is urgently needed to provide a stronger evidence base of the benefits of CSH for learning, self-esteem and disease prevention. This evidence is essential to justify devoting more school time to promote HEAL and more resources to implement and support CSH to the benefit of both learning and health.     

Comparative impact assessment of child pneumonia interventions

Objective

To compare the cost-effectiveness of interventions to reduce pneumonia mortality through risk reduction, immunization and case management.

Methods

Country-specific pneumonia burden estimates and intervention costs from WHO were used to review estimates of pneumonia risk in children under 5 years of age and the efficacy of interventions (case management, pneumonia-related vaccines, improved nutrition and reduced indoor air pollution from household solid fuels). We calculated health benefits (disability-adjusted life years, DALYs, averted) and intervention costs over a period of 10 years for 40 countries, accounting for 90% of pneumonia child deaths.

Findings

Solid fuel use contributes 30% (90% confidence interval: 18–44) to the burden of childhood pneumonia. Efficacious community-based treatment, promotion of exclusive breastfeeding, zinc supplementation and Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae immunization through existing programmes showed cost-effectiveness ratios of 10–60 International dollars (I$) per DALY in low-income countries and less than I$ 120 per DALY in middle-income countries. Low-emission biomass stoves and cleaner fuels may be cost-effective in low-income regions. Facility-based treatment is potentially cost-effective, with ratios of I$ 60–120 per DALY. The cost-effectiveness of community case management depends on home visit cost.

Conclusion

Vaccines against Hib and S. pneumoniae, efficacious case management, breastfeeding promotion and zinc supplementation are cost-effective in reducing pneumonia mortality. Environmental and nutritional interventions reduce pneumonia and provide other benefits. These strategies combined may reduce total child mortality by 17%.     

Process evaluation on quality improvement interventions

To design potentially successful quality improvement (QI) interventions, it is crucial to make use of detailed breakdowns of the implementation processes of successful and unsuccessful interventions. Process evaluation can throw light on the mechanisms responsible for the result obtained in the intervention group. It enables researchers and implementers to (1) describe the intervention in detail, (2) check actual exposure to the intervention, and (3) describe the experience of those exposed. This paper presents a framework containing features of QI interventions that might influence success. Attention is paid to features of the target group, the implementers or change agents, the frequency of intervention activities, and features of the information imparted. The framework can be used as a starting point to address all three aspects of process evaluation mentioned above. Process evaluation can be applied to small scale improvement projects, controlled QI studies, and large scale QI programmes; in each case it plays a different role.     

Comprehensive hygienic assessment of solaria

The paper gives data on the positive and negative effects of human exposure to ultraviolet radiation (UVR). It provides the hygienic characteristics of solaria used to produce an artificial tan. This device has been found to present a high health risk to its users. There are considerable problems in the hygienic assessment of this type of exposure. The ways of solving the arising problems in developing the metrological monitoring of UVR and compiling a document regulating the sanitary-and-epidemiological surveillance of solaria are defined.     

Enhancing causal interpretations of quality improvement interventions

In an era of chronic resource scarcity it is critical that quality improvement professionals have confidence that their project activities cause measured change. A commonly used research design, the single group pre-test/post-test design, provides little insight into whether quality improvement interventions cause measured outcomes. A re-evaluation of a quality improvement programme designed to reduce the percentage of bilateral cardiac catheterisations for the period from January 1991 to October 1996 in three catheterisation laboratories in a north eastern state in the USA was performed using an interrupted time series design with switching replications. The accuracy and causal interpretability of the findings were considerably improved compared with the original evaluation design. Moreover, the re-evaluation provided tangible evidence in support of the suggestion that more rigorous designs can and should be more widely employed to improve the causal interpretability of quality improvement efforts. Evaluation designs for quality improvement projects should be constructed to provide a reasonable opportunity, given available time and resources, for causal interpretation of the results. Evaluators of quality improvement initiatives may infrequently have access to randomised designs. Nonetheless, as shown here, other very rigorous research designs are available for improving causal interpretability. Unilateral methodological surrender need not be the only alternative to randomised experiments.     

Working to keep school children healthy: the complementary roles of school staff and school nurses

BACKGROUND: Against a background of future uncertainty for school nursing and little previous research, this study aimed to identify and describe the distinctive role of the school nurse in working to keep school children healthy. Particular attention was paid to the 'interface' between nursing and the health-related work of teachers. The research was carried out in four health authority areas in England. METHODS: Seventy-eight semi-structured interviews were carried out with a range of respondents: school nurses, school Heads and teachers, health authority purchasers and NHS Trust managers. Seven focus group discussions were held with parents and eight with young people of secondary school age. RESULTS: Four key elements of the school nurse role were identified: safeguarding the health and welfare of children; health promotion; a pupils' confidante; and family support. In each of these aspects of work, nurses and teachers had shared or complementary roles. An over-arching role for the school nurse as 'health adviser' to pupils, parents and teachers was also identified. Despite these common elements, emphasis in the practice of individual school nurses varied widely. Difficulties for school nurses in developing their role were identified. Parents and young people saw school as an appropriate setting for health-related work. CONCLUSION: The research identified key components of the school nursing role and the complementary roles of nurses and school staff. To optimize school nurses' contribution to child health, a more strategic approach is required, in partnership with education, along with research into the effectiveness of school nursing interventions.     

A review of multidomain interventions to support healthy cognitive ageing

Objective

The risk for cognitive decline and for developing Alzheimer’s disease increases with age. The aetiology is assumed to be of multi-factorial origin, and treatment opportunities are lacking. Despite the multi-factorial origin, many intervention studies focused on single factors to influence cognitive health with inconsistent findings. In this view, more and more intervention studies aim to intervene on multiple factors simultaneously to affect or slow down cognitive decline. The purpose of this paper is to give an overview of these multidomain intervention trials.

Methods

We conducted a non-systematic literature search in Medline, Scopus, Cochrane Library, and clinical trials databases up to October 2011 to review multidomain interventions that investigated effects of combined lifestyle-related factors on cognitive decline and the progression of dementia.

Results

Interest in multidomain interventions increased over the past years. We identified six completed and published trials and eight ongoing or not yet published studies that investigated effects on cognitive outcomes. First completed trials yielded promising results for the combination of exercise and mental training and diet and behavioural weight management. Results of ongoing multidomain trials are awaited.

Conclusions

Some evidence suggests that strategies which target multiple factors simultaneously may prove more effective than those focusing on a single mechanism or domain. Larger high-quality randomized controlled trials are required to systematically investigate the cognitive effect of programs comprising physical and mental activity as well as nutritional aspects.