发展中国家中毒信息软件包简介

主要目的是加强发展中国家预防和处理中毒的能力,用多种语言(英文、法文、西班牙文)编写各种毒物专著(PIMs).主要内容为毒物的理化性质、毒性、分析、临床表现、诊断、治疗等信息.除了毒物专著外,软件包还可建立毒物分类、化学产品库、咨询病例库.     

毒物中毒信息系统研究

论述了毒物中毒信息系统的组成;毒物的分类、总编码和参考文献代码的编制:信息的收集和处理.整个系统由基础库、参考信息库和管理系统三大部分组成,每一部分又分为若干小块.毒物分为9类.每一类用一个字母代表.每一毒物用十位字母和数字编制的编码表示,编码起到系统主码(skelatal key)作用.参考文献代码是将参考文献用 6位字母、数字、符号编制,主要节省储存空间和提高检索速度.毒物信息包括名称、理化性质、用途、生产厂家、毒性毒理、临床表现、诊断治疗、诊断标准、毒物分析、参考文献.系统还包括了毒物中毒总论、专家名录、医院、中毒文献病例等参考信息.     

Waiting lists for transplantation in Italy

To plan health services it is essential to gauge the needs. In transplant field in Italy, the first suitable data for waiting lists were collected in 1998. The data collected by Istituto Superiore di Sanità gave us a shot of patients field in waiting list at that time. We here analyse more significant data about heart, liver and kidney waiting lists. The situation is very different among north, centre and south of Italy: in South, where transplant activity is low, we found rare transplant centres, and most of patients prefer north centres. In kidney waiting list we found 1100 patients living in southern regions but registered in the waiting list of a different region. These data can help in planning development lines in Italy.     

毒物中毒信息微机检索系统

毒物信息微机检索系统,通过不同的毒物名称和鉴别号,查询检索与毒物相关的理化性质、毒性毒理、临床诊断治疗、毒物分析等信息内容,以及检索的方法和应用.     

某聚氯乙烯生产企业化学毒物危害分析

目的分析某生产企业聚氯乙烯生产过程中产生的化学毒物及其危害关键控制点,为企业化学毒物防护提供依据。方法采用现场职业卫生学调查、工作场所化学毒物检测、个体TWA检测相结合的方法对企业存在的化学毒物进行分析。结果在聚氯乙烯的生产过程中,作业场所存在化学毒物较多,主要包括氯乙烯、聚氯乙烯、聚乙烯醇、过氧化物、异链烷烃类、聚乙烯乙酸酯、氢氧化钠、氨、盐酸、甲醇、柴油、一氧化碳、二氧化碳、二氧化硫、氮氧化物、臭氧、二氧化锰等。其中废水槽下风向的巡检位氯乙烯15min检测浓度最大值为35．4mg／m^3,超过最大超限倍数的0．4倍;气柜排放口、反应釜底部排放阀氯乙烯15min检测浓度分别为20．2mg／m^3和24．8mg／m^3,接近职业接触限值;其余检测点的各化学毒物浓度小于职业接触限值。结论化学毒物关键控制点为气柜排放口、反应釜排放阀以及废水槽,应加强其防毒措施。     

Diabetes management by hospital-affiliated diabetes centres in Lazio, Italy

BACKGROUND: In Italy, diabetes centres are considered to provide adequate care but little is known about their performance. METHODS: Inpatient and outpatient administrative databases were used to select and study a cohort of 2,568 diabetic patients. Adherence to guidelines and effect of patient characteristics and diabetes centre on treatment was assessed. Mortality rate was calculated. RESULTS: Patients averaged 9.3 outpatient visits per year. Each patient received a mean of 21.8 ambulatory services per year but only 2.21 Haemoglobin A1C tests, and only 0.56 procedures suggested by the guidelines. Diabetes management depended mainly on the care centre. A mortality rate of 6.9 per hundred person-years was observed. CONCLUSIONS: Hospital-affiliated centres do not ensure adequate diabetes management.     

Transplantation collaborative networks

The collaborative networks in Italy are described, with their objectives and the geographical areas covered. Their main features are: function of the reference centres, waiting lists, criteria for organ assignment, common programmes for some patients, services offered to the network members, organ procurement activity. The analysis of the activities performed included organ exchanges within and outside the network, common activities for tasks that could not be satisfactorily attained by a single centre or region, the collaborative studies. Finally, the role of the networks and of a national coordination, in order to better develop transplants nationwide, is discussed.     

慢性咽炎、鼻炎与接触粉尘、毒物关系的调查

目的　了解慢性咽炎、鼻炎与接触粉尘、毒物关系。方法　使用流行病学方法 ,调查现患率 ,计算暴露因素的比值比 (OR)。结果　接触粉尘、毒物组的现患率为 10 .6 9% ,对照组现患率为 6 .0 7% ,暴露因素的OR为 1.70 (P 0 .0 5 )。职业暴露组现患率为 19.99% ,职业暴露因素的OR为 2 .98(P 0 .0 1)。结论　接触粉尘、毒物与慢性咽炎、鼻炎可能存在一定的关系。     

Patient satisfaction: an indicator of quality in disablement services centres.

OBJECTIVES--To develop a patient satisfaction system for disablement services centres and to report on how the initial findings have been used in audit to improve their quality of care and services. DESIGN--Interview survey of randomly selected users attending in three centres: Birmingham (centre X), Oxford (centre Y), and Cambridge (centre Z) to establish core topics for developing a patient satisfaction questionnaire with incorporation into a computer patient satisfaction system (PATSAT) to enable collation of responses to the questionnaire. A pilot of the questionnaire was undertaken in the centres to assess the sensitivity of the questionnaire, which was subsequently used as part of clinical audit process during June 1991 and April 1992 in centre X and the patient satisfaction system used to monitor changes in routine practice. PATIENTS--123 amputees in the development phase, selected by cluster sampling, and 1103 amputees in the pilot study. MAIN MEASURES--Satisfaction scores for components of the service. RESULTS--The questionnaire included 16 core topics contributing to quality of care and services, including comfort of limbs, appointments, interpersonal aspects of care, a system of support and counselling, and organisation. The pilot survey demonstrated high satisfaction scores for aspects of interpersonal care, organisation, and physical surroundings of the centres and lower satisfaction for counselling services, comfort of the limb and the number of alterations made before the limb was considered acceptable. During the audit in centre X these results prompted changes to care and services which produced significant improvements in satisfaction. CONCLUSIONS--The early results suggest that the questionnaire, coupled with PATSAT software system, enable users' views to be expressed, collated, and fed back to staff; the information provided has already prompted change, and the system is sufficiently sensitive to measure changes in satisfaction with the service.     

Examining the nutritional quality of food and beverage consumed at Melbourne aquatic and recreation centres

Objective: Examine the nutritional quality of food and beverages consumed across a sample of community aquatic and recreation centres in metropolitan Melbourne, Australia. Methods: Interviewer‐administered surveys of randomly selected patrons attending four aquatic and recreation centres were conducted to ascertain food and beverage items consumed over two data collection periods (May–June 2014, January–February 2015). We selected centres in and around metropolitan Melbourne with a sit‐down cafeteria and children's swimming classes. We classified items by government nutrient profiling guidelines; ‘green’ (best choice), ‘amber’ (choose carefully) or ‘red’ (limit). Results: A total of 2,326 surveys were conducted (response rate 63%). Thirty‐five per cent of surveyed patrons consumed food or beverages while at the centre; 54% of patrons purchased from the café and 61% brought items to the centre. More than half the food consumed from the café was ‘red’, increasing to 92% for children. One in five children visiting the centre consumed a ‘red’ item bought from the centre café. Conclusions: The nutritional quality of food and beverages consumed at recreation centres was generally poor, with the on‐site cafés providing the majority of discretionary items consumed. Implications for public health: Community aquatic and recreation centres provide an opportunity to promote healthy eating by increasing the provision of healthy options and limiting discretionary food and drink items.     

Medical advice by telephone at Swedish health centres: who calls and what are the problems?

Advice by telephone is an important activity at Swedish health centres and is mainly dealt with by nurses. This telephone counselling was studied during one week (Monday to Friday) at six Swedish health centres which were representative of rural as well as of urban populations. Based on the figures obtained from this study it could be calculated that about 20 million calls of this type are dealt with at Swedish health centres each year (population of Sweden about eight million). It was more common for women than for men to contact the health centre by telephone. About 70% of the calls were made by the patients themselves. Pain was the most common reason for contacting the health centre by telephone, followed by signs of infection. The majority of the telephone calls dealt with sick care, a minority were classified as administrative. About 40% of all calls were managed by the telephone adviser without involving the doctor at the health centre. Of all incoming calls, 44% resulted in an appointment time for a visit to a physician at the health centre, more than half of these being given for a visit during the same day. As the telephone counsel function is an important part of the activity at a Swedish health centre, it is important to evaluate its content and consequences.     

Experience with asynchronous medical teleconsultation in the Alliance of the Italian hospitals worldwide

A store-and-forward teleconsultation system was established for 36 Italian hospitals located in 22 different countries. Referrals were made to a network of 33 health centres in Italy via a management centre (MC). The MC was equipped with a server to manage the service. The participating hospitals used client workstations with special software. The referring centres generated teleconsultation requests, which were sent to the MC and allocated manually by the latter to the most appropriate specialist on the basis of information provided in the message. From 1 June 2005 to 15 March 2006, 187 enquiries out of 221 were answered. The median response time was two days. A service satisfaction survey was conducted among the users and about 90% of the responses were positive. The teleconsultation system represents a mechanism for providing equitable access to health care for all the referring doctors.     

毒物信息系统的建立

该系统由毒物中毒信息管理系统;中毒信息微机检索系统;RTECS(CD-ROM)光盘检索系统:化学品中文文献题目检索系统四部分组成.系统可提供的毒物信息有化学物质、药物以及有毒动植物等的名称鉴别号、理化特性、毒性毒理等.毒物中毒的信息有中毒症状、临床治疗、解毒药以及毒物分析等,并附有各类信息来源文献.各系统自成为独立的检索系,因此,各系统又可以独立为用户检索服务.     

Storage of poisonous substances and firearms in homes with young children visitors and older adults

BACKGROUND: Most unintentional childhood poisonings and firearm injuries occur in residential environments. Therefore, a preventive strategy includes limiting children's access to poisons and firearms through safe storage. This study examines storage of poisons and firearms among households with older adults, and households where young children reside compared to those where they visit only. METHODS: Sample is from a 2002 national random-digit-dial survey of 1003 households. Analyses were weighted to reflect the national population. RESULTS: There were 637 households with children residents or visitors aged <6 years. Seventy-five percent of the households (n =480) had children aged <6 as visitors only, and 15% had older adult residents (aged >/=70 years). Poisons and firearms were stored less securely in homes with young children as visitors as compared to those homes with resident young children. In 55% of homes where young children lived, and 74% of homes where young children were only visitors, household chemicals were reportedly stored unlocked. Although firearm ownership was comparable between the two categories of households (33% vs 34%), homes in which children were only visitors were more likely to store firearms unlocked (56%), than homes in which children resided (33%). Homes with older adult residents had more firearms present. CONCLUSIONS: Children are at risk from improperly stored poisonous substances and firearms in their own homes and homes they visit. Strategies are needed to improve the storage practices of both poisons and firearms to minimize in-home hazards to young children, particularly raising awareness of these hazards to young visitors.     

Planning of transplantation centers

Health policies are correlated with the economics resources invested in each specific field. The planning of organ transplant centres depends on the relationship between health demand and health offer. The health demand is due to the number of the patients which are waiting for a transplant, while the health offer is represented by all the specific resources: number of cadaver donors and transplant centres. The analysis of transplant activity performed in Italy during the period 1996-1998 suggests that it is not necessary to increase the number of transplant centres but that of organ donors.     

Assessment of diet, physical activity and biological, social and environmental factors in a multi-centre European project on diet- and lifestyle-related disorders in children (IDEFICS)

Obesity is a major public health problem in developed countries. We present a European project, called Identification and Prevention of Dietary and Lifestyle-induced Health Effects in Children and Infants (IDEFICS), that focuses on diet- and lifestyle-related diseases in children. This paper outlines methodological aspects and means of quality control in IDEFICS. IDEFICS will use a multicentre survey design of a population-based cohort of about 17,000 2- to 10-year-old children in nine European countries (Belgium, Cyprus, Estonia, Germany, Greece, Hungary, Italy, Spain and Sweden). The project will investigate the impact of dietary factors such as food intake and food preferences, lifestyle factors such as physical activity, psychosocial factors and genetic factors on the development of obesity and other selected diet- and lifestyle-related disorders. An intervention study will be set up in pre-school and primary school settings in eight of the survey centres. Standardised survey instruments will be designed during the first phase of the project and applied in the surveys by all centres. Standard operation procedures (SOPs) will be developed, as well as a plan for training the personnel involved in the surveys. These activities will be accompanied by a quality control strategy that will encompass the evaluation of process and result quality throughout the project. IDEFICS will develop comparable Europe-wide health indicators and instruments for data collection among young children. Establishment of a new European cohort within IDEFICS will provide a unique opportunity to document the development of the obesity epidemic in the current generation of young Europeans and investigate the impact of primary prevention in European children populations.     

The clinical skills resource: a review of current practice

This review is based on the findings of the Southampton Clinical Skills Project, which was a needs assessment and feasibility study to consider the development of a multiprofessional Clinical Skills Resource at Southampton. The project spanned a period of 18 months and used a range of methods of data collection, including visits to 12 clinical skills facilities in the UK. Most existing clinical skills centres have developed in response to changing healthcare policy, curricular initiatives and increasing emphasis on the quality of assessments and competencies. There is also increasing recognition that clinicians are no longer able to teach effectively all skills to students in the traditional ways, and that clinical skills training and assessment, particularly for undergraduates, is an area of deficiency. The potential scope of clinical skills centres is broad and encompasses not only clinical and communication skills but medical informatics, computer assisted learning, multiprofessional learning and assessment. Skills centres can also promote self directed and lifelong learning methods. The planning of skills centres involves a variety of stakeholders and users, including undergraduates, postgraduates, acute and community Trusts, Postgraduate Deans and medical schools. A successful skills centre needs to be flexible in its design, integral to the curriculum and relevant to educational and training requirements. This requires planning, organization and resources. Different organizational models can be used, depending on local factors. The management of skills centres involves consideration of issues such as security, safety, supervision of learners and staff development, informed by a network of experts and everyday users. The development of skills centres should include ongoing educational evaluation of outcomes and educational research. The use of a clinical skills centre has potential benefits for staff and students, including the provision of a safe environment in which to learn and practise skills before using them in the real clinical setting. This can reduce anxiety in students and protect patients from novice practice. Clinical skills centres provide a setting for structured learning with feedback as well as assessment of competence. The limitations of a skills centre are that it can only provide simulated experiences which are an adjunct to, but can never replace real clinical experience.     

The analysis of continuous outcomes in multi-centre trials with small centre sizes

The standard analysis of clinical trials stratified by centre is to include centres as fixed effects, but if many centres contribute small numbers of patients, this approach results in a loss of power. Assuming no treatment by centre interaction, we used simulation to examine power and coverage of confidence intervals from three approaches to the analysis of continuous outcome in multi-centre trials: ignoring centres, including centres as fixed effects, and including them as random effects. The simulation incorporated eight sizes of centre effects; randomization in blocks of size 2 or 4; and two sample sizes, namely 100 and 200 patients per treatment arm in a parallel groups design. All simulated data sets included many centres with few subjects. The three different approaches were unbiased and had similar coverage. Fixed effects analysis was less powerful, particularly when centre effects were small. Incorporating block randomization with larger block size increased non-orthogonality in the design, contributing to loss of power. Where centre effects are small and recruitment in many centres is low, the approaches of ignoring centres or incorporating them as random effects have better performance than the traditional fixed effects analysis.     

The 1998 Australian external beam radiotherapy survey and IAEA/WHO TLD postal dose quality audit

The results of an updated Australian survey of external beam radiotherapy centres are presented. Most of the centres provided most of the requested information. The relative caseloads of various linear accelerator photon and electron beams have not changed significantly since the previous survey in 1995. The mean age of Australian LINACs is 7.1 years and that of other radiotherapy machines is 14.7 years. Every Australian radiotherapy centre participated in a special run of the IAEA/WHO TLD postal dose quality audit program, which was provided for Australian centres by the IAEA and WHO in May 1998. The dose quoted by the centres was in nearly every case within 1.5% of the dose assessed by the IAEA. This is within the combined standard uncertainty of the IAEA TLD service (1.8%). The results confirm the accuracy and precision of radiotherapy dosimetry in Australia and the adequate dissemination of the Australian standards from ARL (now ARPANSA) to the centres. The Australian standards have recently been shown to agree with those of other countries to within 0.25% by comparison with the BIPM.     

Childcare workers’ and centre directors’ beliefs about infant childcare quality and professional training

While there has been extensive research exploring quality in childcare programs for children older than three years, less attention has been directed to the nature of infants’ experiences in centre‐based childcare programs. In this study, six childcare workers and six centre directors located in centre‐based childcare programs in metropolitan Australia were interviewed about their beliefs about quality care and training for infants. In each of the participating centres, the infant programs were also observed using an observational measure that focused on the nature of adult–infant interactions. Both centre directors and childcare workers expressed beliefs that quality in infant care was related to affective dimensions (e.g. care, love, attention) and programming for infants’ learning and development. They also expressed views that infant care training should have a strong practical focus to provide the necessary knowledge and skills for interacting with infants. Only centre directors discussed beliefs about quality programming explicitly in terms of the impact on infants’ learning. Further, the centre directors were more likely to reflect on the nature of staff learning when engaged in infant care training programs. Implications for training are discussed.