农村居民两周患病未就诊原因及影响因素分析

目的了解宁夏回族自治区西吉县农村居民两周患病未就诊现状及影响因素。方法采用多阶段抽样方法于2009年对宁夏西吉县农村居民进行家庭健康询问调查。结果调查西吉县农村居民1 180户5 840人。自报两周内患病者719人,其中就诊264人,未就诊455人;未就诊者54.29%采取自我医疗,另外45.71%未采取任何治疗的原因分别为:经济困难占57.70%,自感病轻占21.60%,其他占20.70%。两周患病未就诊率为63.28%,男性(66.78%)高于女性(58.61%);汉族(68.89%)高于少数民族(59.91%)。非条件Logistic回归分析表明:性别、民族和患病严重程度对农村居民未就诊状况差异有统计学意义。结论西吉县农村居民两周患病未就诊率较高,对门诊服务利用程度较低;性别、民族、患病严重程度和经济因素是西吉县农村居民患病未就诊的主要影响因素。     

Gender and illness behavior among colorectal cancer patients

This study of 154 men and 152 women with cancer of the colon or rectum addresses the lag between the first recognition of symptoms and the securing of definitive diagnosis and treatment. Total treatment delay is divided into two categories: patient delay, or the lag between the patient's first recognition of symptoms and first physician contact; diagnostic delay, or the lag between the patient's first physician contact and treatment. The results do not support the contention that women are more prone than men to respond to cancer symptoms; women in this sample are not more likely than men to recognize and respond to symptoms and seek care. The results suggest that, among patients with cancer of the rectum, women are more likely than men to delay in seeking care. Among patients with cancer of the colon, women are more likely than men to experience diagnostic delay.     

Concepts of trust among patients with serious illness

This paper examines conceptions of trust among three groups of respondents diagnosed with either breast cancer, Lyme disease or mental illness. Interviews were carried out using an open-ended interview guide to explore how patients made assessments of trust in their doctors and health care plans. The guide followed a conceptual approach that asked questions about competence, agency/fiduciary responsibility, control, disclosure and confidentiality. Respondents were given ample opportunity to raise other areas of concern. The data were organized using the NUDIST software package for the analysis of non-numerical and unstructured qualitative data. Patients viewed trust as an iterative process and commonly tested their physicians against their knowledge and expectations. Interpersonal competence, involving caring, concern and compassion, was the most common aspect of trust reported, with listening as a central focus. Most patient comments referred to learnable skills and not simply to personality characteristics. Technical competence also received high priority but was often assessed by reputation or interpersonal cues. Patients were much concerned that doctors be their agents and fight for their interests with health care plans. Disclosure and confidentiality were less common concerns; most patients anticipated that doctors would be honest with them and respect their confidences. Patients' responses also appeared to vary by their disease, their socio-demographic characteristics, their involvement with self-help groups, and how their illness conditions unfolded.     

The risk of asthma among Finnish patients with farmer's lung

OBJECTIVES: To assess the incidence and risk of asthma in patients with farmer's lung in comparison with farm workers without farmer's lung. METHODS: The details of farmers and animal-husbandry workers notified in 1988-1999 for farmer's lung ( n=1,272) or other occupational disease ( n=5,045) to the Finnish Register of Occupational Diseases were followed until 31 December 2000 through two national registries of individuals eligible for reimbursement of the cost of asthma medication and the Population Register Center. Incidence rates of asthma were calculated, and a log-linear model adjusted for age, gender and occupation was used to estimate relative risks of asthma among those with farmer's lung compared to those with other occupational disease. RESULTS: Of the patients with farmer's lung, 109 (8.6%) were diagnosed with asthma during the follow-up compared with 202 (4.0%) incident cases of asthma among those in the reference population. The crude relative risk of asthma was 2.1 (95% CI 1.6-2.6) among those with farmer's lung compared with the reference population. The age- and occupation-adjusted relative risk of asthma among patients with farmer's lung was 2.5 (1.8-3.5) in men and 1.4 (1.0-1.9) in women. The rate of asthma was especially high during the first 2 years after notification of farmer's lung. CONCLUSIONS: Patients with farmer's lung have an increased risk of developing asthma in comparison to farm workers in general. Most of the cases of asthma occur relatively shortly after the diagnosis of farmer's lung, which should be taken into account in medical follow-up of patients with farmer's lung.     

Racial ideology and explanations for health inequalities among middle-class whites.

Middle-class whites' explanations for racial inequalities in health can have a profound impact on the type of questions addressed in epidemiology and public health research. These explanations also constitute a subset of white racial ideology (i.e., racism) that in itself powerfully affects the health of non-whites. This study begins to examine the nature of attributions for racial inequalities in health among university students who by definition are likely to be involved in the research, policy, and service professions (the upper middle class). Investigation of the degree to which middle-class whites attribute racial inequalities in cardiovascular health (between themselves and African Americans, American Indians, or Asian Americans) to biological, social, or lifestyle factors reveals that whites tend to attribute their own health to lifestyle choice and to biology rather than to social factors. These results suggest that contemporary middle-class whites' "self-serving" explanations for racial inequalities in health are comprised of two beliefs: implicit biologism (race is an attribute of organisms rather than a social relation) and liberal belief in self-determination, choice, and individual responsibility--some of the core lay beliefs of the worldview that sustains neoliberal capitalism. Contemporary white middle-class explanations for racial inequalities in health appear to include assumptions that justify class inequality. Liberal approaches to racism in public health are bound to miss a key component of racial ideology that is currently used to justify racial and class inequalities.     

Persistence of substance use-related hospital utilization among psychiatric consultation patients.

Among 86 consecutive consultation-liaison (C-L) patients with current substance use-related hospital attendance, the case records revealed an average history of 5.9 years in male patients and 5.3 years in female patients of repeated substance use-related hospital visits. A history of at least 1 year was found in 60% (52/86) of patients. The history had started at the age of early 30s with attempted suicide as the most common principal diagnosis. By the age of 40, there had been several hospital visits for various health problems. However, 48% (41/86) of the patients had never received substance use treatment. It appeared that opportunities to intervene with substance use were frequently missed on hospital encounters, a finding also observed in earlier studies.     

流动人口肺结核病人就诊延迟原因分析

目的 了解流动人口肺结核病人就诊延迟时间及其影响因素。方法 抽取山东省7个市12个县(市、区)共计314例流动人口肺结核病人,利用自制调查问卷进行调查。结果 314例流动人口肺结核病人中,就诊延迟平均天数为18.84 d,中位数为10 d;其中,从出现症状到就诊间隔≤2周186例,占59.2%,≥4周77例,占24.5%,2～4周51例,占16.2%;影响流动人口肺结核病人就诊延迟时间的因素包括每周工作天数、医疗保障情况、初始症状严重程度及距最近乡镇卫生院(社区卫生服务中心)的时间(P<0.05)。结论 流动人口肺结核病人就诊延迟时间较长,就诊延迟时间受多种因素影响。     

Cancer incidence and mortality among Finnish asbestos sprayers and in asbestosis and silicosis patients

Cohorts of Finnish asbestos sprayers and of asbestosis and silicosis patients were followed for cancer with the aid of the Finnish Cancer Registry in the period 1967–1994. Compared with the cancer incidence of the total Finnish population, asbestos sprayers had an increased risk for total cancer (standardized incidence ratio [SIR] 6.7, 95% confidence interval [95% CI] 4.2–10); lung cancer (SIR 17, 95% CI 8.2–31); and mesothelioma (SIR 263, 95% CI 85–614). The SIR of the asbestosis patients was 3.7 (95% CI 2.8–5.0) for all sites, 10 (95% CI 6.9–14) for lung cancer, and 65 (95% CI 13–188) for mesothelioma. The silicosis patients also had significantly high SIR values for all sites (1.5, 95% CI 1.0–2.1) and lung cancer (2.7, 95% CI 1.5–4.5). The values for the SIR and the standardized mortality ratio for all sites and lung cancer were very similar, and therefore it seems that both are reliable indicators of the occurrence of occupational cancer. It was concluded that pneumoconioses patients and asbestos-exposed workers have a markedly elevated risk for cancer. Asbestos-induced occupational cancers are not only diseases of the elderly, since the relative risk is high also for middle-aged people. Am. J. Ind. Med. 31:693–698, 1997. © 1997 Wiley-Liss, Inc.     

Job-stress and medical consultation rates for physical illness among blue collar workers of an electrical factory in Japan: a four-year prospective follow-up study

To investigate the relationship between job-stress and medical consultation rates for physical illness, a prospective study was conducted for male blue workers of an electrical factory in Japan. 8 job-stress variables and 8 possible confounders were assessed by means of mailed questionnaires in the initial study; 375 workers without medical history of illness were followed for four years; they were interviewed once a year and medical consultations for physical illness were recorded. Age-adjusted rates of medical consultation during the four-year period were significantly higher in the subjects with higher job-dissatisfaction scores than in those with lower job-dissatisfaction scores (p less than 0.05). The results of the multiple logistic regression analysis indicated that job-dissatisfaction together with age and education was significantly correlated with medical consultation (p less than 0.05). The results suggest that job-dissatisfaction is a potential factor for medical consultation in Japanese blue collar workers.     

Asbestos exposure according to different exposure indices among Finnish lung cancer patients

Summary During a 6-month period all lung cancer patients in a university hospital chest clinic were investigated for asbestos exposure by means of personal interview, bronchoalveolar lavage (BAL), roentgenograms, lung function testing, histology and measurement of fibre concentrations in lung tissue samples using scanning electron microscopy (SEM). About one-third of the patients (33%) were classified as having been exposed to asbestos on the basis of the interview. BAL was performed and AB counts were done in 51 patients. Fourteen (27%) BAL specimens had AB counts of 1 or more AB/ml, which is the conventional limit for non-trivial asbestos exposure. For a subgroup of 25 operated lung cancer patients fibre analysis was also available. In six cases (30%) the asbestos-containing samples had asbestos fibre concentrations equal to or more than 1 million fibres/g dry lung. In eight (32%) of the operated lung cancer patients histopathologically confirmed fibrosis was seen; five of these patients were in the two highest exposure classes. Pleural plaques on X-ray films were seen in six (24%) of the operated cases. With each indicator of exposure about 30% of lung cancer patients were found to have been exposed, confirming the one-third rule; however, when all the information was collated there were three cases (12%) in which exposure was most obvious according to the different parameters used in this study. In these three cases the cancer could well be attributed to asbestos. Anthophyllite was present in all asbestos-containing samples and anthophyllite was the main fibre type in 61% of these samples.     

青少年吸烟发生机制与对策

我国是一个有3亿多烟民的吸烟大国,控制吸烟、减少由于吸烟对人们健康的危害是现代社会和人们共同关心的问题。中小学校是开展青少年反吸烟教育的主要场所,为了加强青少年控烟工作,本文着重描述青少年吸烟的危害及发生机制,并制订对策。     

Equity in the use of antithrombotic drugs,beta-blockers and statins among Finnish coronary patients

Background  

Earlier studies have mainly reported the use of antithrombotic drugs, beta-blockers and statins among hospital patient populations or MI patients. This study aimed to describe the use of these drugs among middle-aged Finnish coronary patients and to identify patient groups in risk of being prescribed inadequate medication for secondary prevention of coronary heart disease.     

Occupational exposures and gastrointestinal cancers among Finnish women

A cohort including all female workers born 1906 through 1945 (n = 413,877) in Finland was identified through the Population Census of Finland of 1970. Incident cases of cancers of the gastrointestinal tract were explored during 1971 to 1995. Job titles in census records were converted to exposures of 31 occupational agents through a job-exposure matrix. For each agent, the product of level and probability of exposures was calculated and subdivided in three categories: zero, low and medium/high. Poisson regression models estimated relative risks (RR) for each agent, standardized for birth cohort, follow-up period, and socioeconomic status. Adjustment at job title level was done for alcohol use for cancers of the esophagus and liver and smoking for pancreatic cancer. The results showing either statistically significant RR at the medium/high level of exposure (RRH) or statistically significant trend (P < 0.05) over the exposure categories were considered as positive findings. Colon cancer risk (2009 cases) was positively associated with sedentary work (RRH 1.3, 95% CI = 1.1-1.6; P trend 0.001) and negatively associated with perceived workload (P trend = 0.007). For stomach cancer (1881 cases), we observed an association with exposure to electromagnetic fields (RRH 1.44, 95% CI = 1.01-2.05) and man-made vitreous fibers (MMVF) (p trend 0.03). Rectal cancer (1323 cases) showed an association with chromium (RRH 1.9, 95% CI = 1.2-3.1) and oil mist (RR 2.0; 95% CI = 1.0-3.9). For pancreas cancer (1302 cases) we found associations with exposure to chromium (RRH 1.8; 95% CI = 1.0-3.1; P trend 0.01), electromagnetic fields (RRH 1.8; 95% CI = 1.2-2.8; P trend 0.02), and sedentary work (RRH 1.3; 95% CI = 1.0-1.7; P trend 0.05). We found no significant associations between any FINJEM agents and cancers of the esophagus (389 cases), liver (389 cases), and gallbladder (651 cases). Having examined the associations between seven cancer sites and over 30 exposures there exists the real possibility that some of the associations detected are chance findings. Therefore, the associations observed should need to be confirmed in other studies.     

Incidence of asthma among Finnish construction workers

We wanted to explore the risk of asthma among male workers of the construction industry. All Finnish male construction industry workers and all those employed in administrative work were followed for asthma incidence through a register linkage in 1986 through 1998. Age-adjusted relative risks (RR) were estimated for 24 construction occupations. The risk was increased in nearly all construction occupations studied, but it was highest among welders and flame cutters (RR 2.34), asphalt roofing workers (RR 2.04), plumbers (RR 1.90), and brick layers and tile setters (RR 1.83). Only 45 (2%) of the cases of asthma among construction workers had been recognized as occupational asthma. Construction industry workers have an increased risk of adult-onset persistent asthma and cases of occupational asthma caused by well-established causative agents have only a minor contribution to this overall asthma excess.     

Ethical issues among Finnish occupational physicians and nurses

A postal survey was conducted among 200 Finnish occupational physicians and nurses on their ethical values and problems. Both groups considered 'expertise' and 'confidentiality' as the most important core values of occupational health services (OHS) corresponding with newly published national ethical guidelines for occupational physicians and nurses in Finland. Nearly all respondents had encountered ethically problematic situations in their work, but ethical problems with gene testing in the near future were not considered likely to occur. Only 41% of the nurses and 36% of the physicians had received some training in the ethics of OHS, and 76% of all respondents never used available ethical guidelines. According to the results, even if ethics play a vital role in OHS, the ability to critically evaluate one's own performance seems quite limited. This creates a need for further training and more practicable national guidelines.