两种筛查量表早期发现产后抑郁的效果对比

目的比较产后抑郁筛查量表（PDSS）和爱丁堡产后抑郁量表（EPDS）在产后抑郁筛查中的应用价值。方法采用PDSS、EPDS及美国精神障碍诊断与统计手册第4版轴Ⅰ障碍定式临床检查患者版（SCID—I／P）同时对445名产后6周的妇女进行评定,以SCID—I／P作为产后抑郁诊断金标准。结果两种量表的临界值分别为74分和10分。PDSS的灵敏度（93．33％）和特异度（94．75％）的组合较好。PDSS与EPDS的ROC曲线下面积分别为0．978和0．872,差异均有统计学意义（P均〈0．05）。结论与EPDS相比,PDSS具有较好的筛检价值,是早期发现产后抑郁患者的简单、快速、准确的筛查工具。     

Cancer screening in men

Cancer screening is one of the most common requests directed to primary care physicians in the office setting. In this article, we look at current recommendations, evidence for, and controversy surrounding screening for cancers of the lung, colon, and prostate, which together account for 51% of cancer deaths in men. We also look at screening for testicular cancer, which, although a relatively minor contributor to cancer mortality, is a prototypically male cancer with a proposed screening test.     

Toxicological screening in trauma

OBJECTIVES: To determine the prevalence and patterns of alcohol and drug use in patients with major trauma. METHODS: Consecutive trauma patient enrollment, 24 hours a day, was envisaged with anonymised patient data on gender, age band, and mechanism of injury collected. The study group had surplus plasma quantitatively analysed for ethanol concentration, and urine samples were initially screened, via immunoassay, for opiates, cannabinoids, amphetamines, benzodiazepines, cocaine, and methadone. Confirmation and specification of individual positive results was then performed using thin layer or gas-liquid chromatography. Drugs of treatment given in the resuscitation room, if subsequently detected in the urine samples, were excluded from the final results. RESULTS: There were 116 eligible trauma patients assessed and treated in the resuscitation room over a six month period, of which 93 (80%) were enrolled. Altogether 27% of this trauma population had plasma ethanol concentrations greater than 80 mg/dl. There was a significantly higher prevalence of alcohol intoxication in the group not involved in a road traffic accident (RTA) compared with the group who were involved in a RTA. Initial screening of urine for drugs revealed a prevalence of 51%. After 12 exclusions due to iatrogenic administration of opiates, the final confirmed prevalence was 35% in this trauma population. The individual drug prevalence was 13% for cannabinoids, 11% for codeine, 8% for morphine, 6% for amphetamine, 6% for benzodiazepines, 3% for cocaine, 1% for dihydrocodeine, and 1% for methadone. CONCLUSIONS: There is a notable prevalence of drug and alcohol use in this British accident and emergency trauma population. A significantly higher prevalence for alcohol intoxication was found in the non-RTA group compared with the RTA group. The patterns of drug usage detected reflect local influences and less cocaine use is seen compared with American studies. The association between alcohol, drugs, and trauma, together with ethically acceptable methods of screening, are discussed.     

Toxicological screening in trauma

Objectives—To determine the prevalence and patterns of alcohol and drug use in patients with major trauma.

Methods—Consecutive trauma patient enrolment, 24 hours a day, was envisaged with anonymised patient data on gender, age band, and mechanism of injury collected. The study group had surplus plasma quantitatively analysed for ethanol concentration, and urine samples were initially screened, via immunoassay, for opiates, cannabinoids, amphetamines, benzodiazepines, cocaine, and methadone. Confirmation and specification of individual positive results was then performed using thin layer or gas-liquid chromatography. Drugs of treatment given in the resuscitation room, if subsequently detected in the urine samples, were excluded from the final results.

Results—There were 116 eligible trauma patients assessed and treated in the resuscitation room over a six month period, of which 93 (80%) were enrolled. Altogether 27% of this trauma population had plasma ethanol concentrations greater than 80 mg/dl. There was a significantly higher prevalence of alcohol intoxication in the group not involved in a road traffic accident (RTA) compared with the group who were involved in a RTA.

Initial screening of urine for drugs revealed a prevalence of 51%. After 12 exclusions due to iatrogenic administration of opiates, the final confirmed prevalence was 35% in this trauma population. The individual drug prevalence was 13% for cannabinoids, 11% for codeine, 8% for morphine, 6% for amphetamine, 6% for benzodiazepines, 3% for cocaine, 1% for dihydrocodeine, and 1% for methadone.

Conclusions—There is a notable prevalence of drug and alcohol use in this British accident and emergency trauma population.

A significantly higher prevalence for alcohol intoxication was found in the non-RTA group compared with the RTA group. The patterns of drug usage detected reflect local influences and less cocaine use is seen compared with American studies. The association between alcohol, drugs, and trauma, together with ethically acceptable methods of screening, are discussed.

     

Sensitivity in cancer screening

OBJECTIVE: We propose three concepts of sensitivity in cancer screening and apply to data on prostate cancer. Conceptual entities: Sensitivity is the indicator on the ability of screening to find cancer in the detectable preclinical phase (DPCP). The ability is usually specified as to the screening test. We call this entity the test sensitivity. Test positivity with histological confirmation refers to the full diagnostic process and we call the corresponding entity as episode sensitivity. Ultimately, a screening programme identifies a proportion of cancers in the DPCP in the total target population, that we call programme sensitivity. We derive the formulae for these three sensitivities consistent with the incidence method. EXAMPLE: Our example on estimation of the three sensitivities is from a randomized screening trial for prostate cancer in Finland. The estimates by incidence method were substantially different, 85% for test sensitivity, 48% for episode sensitivity and 36% for programme sensitivity. CONCLUSION: More than one concept of sensitivity with standard method of estimation is needed to describe the ability of screening to identify the disease in the DPCP.     

荧光酶免疫法在先天性甲状腺功能低下症筛查中的应用

目的 探讨荧光酶免疫法（ＦＥＩＡ）在新生儿甲状腺功能低下症筛查中的实用性。方法 对ＦＥＩＡ方法测定滤纸干血片促甲状腺激素（ＴＳＨ）含量进行方法学检测,同时与酶联免疫吸附法（ＥＬＩＳＡ）和免疫放射法（ＩＲＭＡ）相比较,并检测１７９４例新生儿ＴＳＨ正常水平及筛查切值（ｃｕｔ ｏｆｆ）。结果 该方法最低检测限为４．１４ｍＩＵ／Ｌ,批内平均变异系数（ＣＶ）为０．０８,批间平均变异系数（ＣＶ）为０．１１,高