Etiologic and prevention effectiveness intervention studies in occupational health

In this article a basic distinction is made between etiologic and prevention effectiveness intervention studies. Etiologic intervention studies focus on elucidating causes of disease, while the purpose of prevention effectiveness intervention studies is to study methods of prevention. The design requirements for each of these studies are very different: etiologic intervention studies usually need large study populations, large exposure contrasts, ascertainment of exposure, as well as health outcome. Ideally, randomization and blinding should also be applied. Effective preventive strategies may, on the other hand, be identified in small study populations with exposure as the only outcome measure, and randomization and blinding may be superfluous. At present, intervention studies are in great demand, and often there is a wish that etiologic questions as well as prevention effectiveness be addressed in the same study. We argue that this should not be done without careful consideration of possible conflicting design aspects. © 1996 Wiley-Liss, Inc.     

Human gene therapy and the slippery slope argument

The article investigates the validity of two different versions of the slippery slope argument construed in relation to human gene therapy: the empirical and the conceptual argument. The empirical version holds that our accepting somatic cell therapy will eventually cause our accepting eugenic medical goals. The conceptual version holds that we are logically committed to accepting such goals once we have accepted somatic cell therapy. It is argued that neither the empirical nor the conceptual version of the argument can provide a conclusive moral reason for banning somatic cell therapy. According to a third interpretation, referred to as the arbitrary result argument, the many apparent similarities between somatic cell therapy and eugenic-based human genetic engineering drive us to make principled choices concerning what differences and similarities between the two practices should be regarded as morally (ir)relevant. Decisions of this kind are likely to have unpredictable moral consequences. Thus formulated, the slippery slope argument has much plausibility. One objects to somatic cell therapy not so much because of what is at the bottom of the slope on which it lies, but because it is on a slope of which one does not know what is at the bottom. While the arbitrary result argument does not provide a conclusive reason for prohibiting human gene therapy, it reminds of a very important thing: when making bioethical decisions, we should be as specific and as consistent as possible about our basic moral and medical concepts. This revised version was published online in July 2006 with corrections to the Cover Date.     

孕前优生健康检查中病毒筛查的临床诊断价值

目的分析孕前优生健康检查中病毒筛查的临床诊断价值。方法选取2013年3月—2014年3月在本中心进行孕前优生健康检查的200对夫妇（400例）,观察并分析相关检测结果情况。结果在400例受检夫妇中,检测出70例高风险疾病者,女性66例分别是小三阳者16例,大三阳者14例,风疹病毒IgG者7例,巨细胞病毒IgM者5例,弓形体IgM者2例,梅毒者7例,血糖异常者8例;男性患者共检测出4例,小三阳和病毒者各2例;检测出低风险疾病女性患者共46例,其中阴道炎者15例,盆腔炎者12例,宫颈炎者9例,尿道炎者6例,子宫肌瘤者4例;男性患者共32例,肌酐水平下降者8例,谷丙转氨酶升高者24例;在200例受检女性中,体重肥胖者38例,超重者56例,正常体重者94例,低于正常体重者12例。结论开展孕前优生健康检查能够帮助计划怀孕夫妇及时发现风险因素,从而能够避免和减少不良妊娠结局,提高新生儿身体健康水平。     

旅行者腹泻的风险分析和健康干预

旅行者腹泻是国际旅行者最常见的疾病,了解其风险因素及干预措施对于保障国际旅行者的健康尤为重要。笔者对旅行者腹泻的风险因素从致病因素、传播途径、临床特点、易感人群、季节性、地理分布及危害性7个方面进行详细分析,并从事前干预和事后应对2方面提出了针对性的干预措施。本文为国际旅行者提供了有关旅行者腹泻的安全有效的旅行卫生保健服务。     

性病艾滋病防治健康教育干预实践与效果

目的:探索健康教育在性病艾滋病防治中的作用.方法:结合卫Ⅷ项目实施,把健康教育作为性病艾滋病干预的重要手段,比较实施前后相关知识知晓率和性病患病率变化情况.结果:健康教育作为干预手段取得明显效果,城区娱乐场所服务小姐STDs/HIV防治知识知晓率达70%以上,城区成人STDs/HIV知晓率达60%以上,农村成人知晓率达40%以上,中学生知晓率达到70%以上.性病患病率从项目实施前的62.35/10万下降到19.67/10万[1]结论:健康教育作为性病艾滋病干预的重要手段,能够取得良好的效果.     

艾滋病健康教育与行为干预模式研究

目的通过对临床中实习医务人员的问卷调查,评价其对艾滋病相关知识的掌握情况以及对待艾滋病患者的态度。方法采用调查问卷的形式,对188名实习医务人员进行了艾滋病知识及态度的调查。结果实习医务人员对艾滋病的知晓率在16.5%～100%,多数实习医务人员知道与艾滋病感染者握手、亲脸、抚摸不会感染艾滋病以外,超过80%的实习医务人员认为亲吻、共同使用餐具以及使用公共马桶等日常生活行为有可能会感染到艾滋病病毒。结论部分的实习医务人员对艾滋病知识的主要来源是通过教学宣传册以及大众媒体,这说明实习医务人员对艾滋病知识掌握的不全面性,以及夸大其危险性的现象。由于艾滋病知识培训普及面小,培训内容有限,很少可以持续进行。     

经桡动脉行冠脉介入治疗的临床观察

目的:观察并探讨经桡动脉行冠状动脉介入术治疗冠心病的疗效。方法:对经桡动脉行冠状动脉介入术治疗的130例冠心病患者临床资料进行回顾性分析。结果:130例患者经桡动脉穿刺成功者125例,成功率达96.2%。术中无1例患者出现心脏并发症。130例患者中有单支血管病变者30例,有2支血管病变者61例,有2支以上病变者39例。130例患者手术均取得成功,介入手术平均时间(84±17)min,术后卧床平均时间(5.2±0.8)h。130例患者术后均未见假性动脉瘤、肢体缺血、动静脉瘤等并发症,且无1例患者死亡。结论:经桡动脉行冠脉介入治疗创伤小、术后止血相对容易、不需绝对卧床、安全有效。     

社区居民健康教育干预试验

1997- 2 0 0 2年对邹城市 4个社区居民开展了健康教育干预 ,实验组受试对象卫生知识水平自干预前的6 2 .84分提高到 89.2 8分 ,卫生观念发生了明显的改变 ,8项卫生行为形成率显著提高 ,肠道寄生虫感染率较对照组低16 .0 1% ,所观察的 8种老年人常见慢性病发病率除恶性肿瘤发病率与对照组相近外 ,其余 7种均低于对照组     

GoWell: The challenges of evaluating regeneration as a population health intervention

Objective

Urban regeneration can be considered a population health intervention (PHI). It is expected to impact on population health but the evidence is limited or weak, in part due to the difficulties of evaluating PHIs. We explore these challenges using GoWell as a case study.

Method

A 10-year evaluation of housing improvement and urban regeneration in 15 deprived areas in Glasgow, Scotland (2005–2015).

Results

Challenges faced include: definition and changing nature of the intervention; identifying the recipients of the intervention; and constraints of study design affecting capacity to attribute effects. We have met these challenges by: adapting the evaluation to take account of changing intervention plans and delivery; making pragmatic choices about which populations to focus on for different parts of the study; and taking advantage of delayed delivery of some components to identify controls.

Conclusion

Commitment to a long-term evaluation by the Scottish Government and other partners has enabled us to develop a package of studies to investigate health and other outcomes, and the processes of a PHI. GoWell will contribute to the evidence base for interventions focused on tackling the wider determinants of health and help policymakers to be more explicit and realistic about what regeneration might achieve.     

医院210名女职工生殖健康普查结果分析与干预

目的：关注已婚育龄妇女的生殖健康，掌握我院在职育龄妇女生殖健康状况，对结果进行分析，同时提出干预措施。方法：医务处牵头，相关科室配合，采取病史询问、妇科检查、实验室行分泌物涂片和TCT检查、妇科B超、乳腺触诊及红外线乳腺探测仪等项检查分析，实际检查210例次，患病人数105例，患病率50．34％。结论：异清了危害妇女健康主要因素，重视职业性生殖道感染和乳腺增生疾病的防治，采取各种干预（如定期普查等），真正做到早预防、早发现、早治疗。     

Approaches for assessing the efficacy of occupational health and safety standards

The regulation of hazards is one of the most dramatic forms of intervention in occupational safety and health (OSH). Despite their high degree of potential social and economic impact, relatively little research has been conducted to specifically evaluate the effectiveness of OSH standards with regard to preventing occupational diseases and injuries. This paper reviews the basic scientific approaches that may be used to evaluate the efficacy of OSH standards. These approaches encompass the following research areas: (1) exposure surveillance, (2) disease surveillance, and (3) prospective studies following the introduction of the standard. Research on asbestos and asbestosis, respirable crystalline silica (quartz) and silicosis, and respirable coal mine dust and coal workers' pneumoconiosis (CWP) are used to illustrate these approaches and the type of information that is currently available. The examples (quartz coal dust, asbestos) reveal substantial limitations in the types of information currently available for evaluating the efficacy of these OSH standards. Ideally, plans for evaluating the efficacy of OSH standards should be developed for existing and future standards. These plans should include programs for the surveillance of exposures and adverse health effects and, when possible, for prospective studies designed to evaluate how the risk of disease (or injury) is modified by the introduction of the standard. (This article is a US Government work and, as such, is in the public domain in the United States of America.) © 1996 Wiley-Liss, Inc.     

心理干预对结核病患者心理健康状况的影响

目的 了解肺结核患者抗结核病治疗过程中心理干预的疗效.方法 采用症状自评量表(SCL-90)、社会支持量表及领悟社会支持评定量表(PSSS)对300例肺结核患者进行心理测试,并将这300例肺结核患者随机分为对照组和试验组,2组进行相同的药物治疗及护理,试验组增加为期6周的心理干预及个别心理辅导.评定及比较2组SCL-90、社会支持量表及PSSS分值.结果 肺结核患者SCL-90部分因子与全国常模有显著性差异,试验组患者负性心理明显好转,特别是人际关系敏感、抑郁、焦虑、恐怖等因子明显优于对照组,两组比较,差异有统计学意义(P＜0.01);但社会支持及PSSS量表各因子在心理干预前后无显著性差异.结论 系统有效的心理干预能有效改善肺结核患者负性心理,减轻心理压力,但不能改变个体对社会支持的利用及感受到的社会支持程度.     

武汉市农村居民健康素养干预效果评价

目的对农村居民存在的最突出的卫生及行为问题进行有针对性的干预,提高农村居民的健康素养水平,探索农村社区健康素养干预方式。方法采通过巡展、举办健康教育讲座、咨询、技能演示、视频教育等多种形式,对武汉市农村居民进行1年的干预,并对农村居民健康素养水平进行本底调查和干预评价。结果居民的总体健康知识知晓率提高了9.3%,健康行为形成率提高了4.8%,健康技能持有率提高了5.9%。结论农村居民在健康基本知识、行为生活方式与习惯及健康基本技能方面表现较干预前有较大提高。通过现场干预实践,提高了农村居民健康素养,干预效果显著。     

472名学龄前儿童口腔健康现状及干预效果评价

目的 调查沈阳市学龄前儿童口腔健康保健状况,制定干预方案,并评价干预效果。方法 在沈阳市内抽取2所条件相近、规模相当的幼儿园,选取就读于小班和中班的所有儿童作为研究对象。采用一般情况调查表、儿童口腔卫生保健知识需求问卷和儿童口腔健康检查表进行调查。制定干预方案,在干预后6个月、1年进行干预效果评价。结果 沈阳市地区学龄前儿童平均龋齿数为2.82颗,患龋率为62.9%,干预第6个月,两组儿童平均龋齿数、患龋率均有所增加,但干预组的患龋率增幅低于对照组,差异有统计学意义(P<0.05);干预1年时,干预组的平均龋齿数、患龋率均下降,与基线调查时无差异,对照组虽有所下降,仍高于基线调查时。干预过程中,患龋儿童龋病治疗率均得到了提高,但两组之间差异无统计学意义。结论 沈阳市学龄前儿童患龋率较高,及早进行健康教育并给予干预,可以减少儿童龋齿的发生。     

中国六城市医务人员戒烟服务的效果评价

目的评价6个城市医务人员提供戒烟服务的实施效果,探讨我国医务人员戒烟服务的工作模式。方法在北京、上海、天津、长沙、深圳和濮阳6个城市7个社区的所有医疗机构负责人和医务人员做戒烟服务研究,进行现场问卷调查。结果干预后共有25家医疗机构开展戒烟服务。医务人员对烟草危害相关知识的知晓率增加了12.8%(P<0.05),掌握戒烟方法和技巧的比例增加了9.2%(P<0.05),主动向病人提供戒烟服务的比例增加了7.3%(P<0.05)。结论培训不但是提高医护人员烟草相关知识和促进医护人员主动提供戒烟服务的有效措施,而且是其获得戒烟方法和技能的有效途径。     

赴非洲和东南亚劳务人员常见输入性蚊媒传染病干预研究

目的评价赴非洲和东南亚劳务人员常见输入性蚊媒传染病健康教育干预效果。方法根据非洲和东南亚蚊媒传染病流行实际,设计问卷调查表,共对542名劳务人员进行干预前后知识态度水平调查分析。结果干预后劳务人员知识态度水平有显著差异(P<0.01)。结论蚊媒传染病健康教育干预取得良好效果,应在劳务人员中注重推广,注重持久性;检验检疫加强蚊媒介传染病防控措施研究。     

机车乘务员心理健康水平综合干预效果评价

目的 探讨心理干预对机车乘务员心理健康水平的影响,为预防铁路交通事故提供参考依据。方法 采用SCL-90症状自评量表对广西柳州机务段机车乘务员进行心理健康状况调查,干预组323名,对照组403名;干预组依据SCL-90总分高低分别采取个体治疗、团体治疗、健康教育和心理热线电话综合干预措施。结果 干预组有108人总分≥160分,平均分为(153.92±48.89)分,心理异常检出率33.40%;对照组有152人总分≥160分,平均分为(160.09±55.45)分,心理异常检出率37.71%,2组SCL-90各因子分均高于国内常模(P<0.01);干预后,干预组SCL-90总分,与干预前比较,整体下降了8个百分点,平均分为(144.86±35.42)分,各因子得分除躯体化因子分与干预前比较无明显变化,其余8项因子分呈不同程度下降(P<0.05);与对照组比较,9项因子分均低于对照组(P<0.05);与邻近地区广铁集团机车乘务员调查结果比较,除强迫、偏执因子分无差异外,其余7项因子分均低于广铁集团调查结果(P<0.05)。结论 柳州机车乘务员心理健康水平低于国内常模,心理干预能够提高机车乘务员的整体心理健康水平。     

电子健康模式下孤独症谱系障碍的行为干预与管理

孤独症谱系障碍(ASD)是起病于婴幼儿期的神经发育障碍性疾病,目前尚无特异性药物,主要治疗方法是行为干预.目前国内外基于电子健康(e-health)模式开展孤独症谱系障碍行为干预与管理已成为普遍共识.本文就目前该领域进展作一介绍,供相关人员参考.