明清苏州、扬州、徽州三地风俗的互动互融——兼谈“苏意”、“扬气”与“徽派”

苏、扬、徽风俗互动由徽商自任媒介,呈现不同方式。苏、徽之间因苏州文化底蕴厚,区位优势强,风俗互动表现为渗透基础上的互融;徽、扬之间,徽商在扬占主导地位,不仅塑造了扬州风俗的个性,还衍化为“扬气”,与“苏意”共领一代风骚;徽州本土既接受苏、扬风俗的辐射,产生与之有密切联系的“徽派”,也能基本保持原来的传统。     

关于氟病的发病机理问题——Ⅰ、氟化物的吸收、贮留、排出和氟对骨、软组织的作用

氟广泛存在于自然界中,含于矿物、矿石、土壤、大气、天然水、植物和动物中,可通过饮水、食物和空气进入人体而致病。因此,氟病(fluorosis)实际上是一种极其古老的地球化学性地方病。元素氟是强氧化剂,具有高度破坏性;氟离子     

脑动静脉畸形治疗需要考虑的问题——访南京鼓楼医院神经外科主任、教授杭春华

每当听到年纪轻轻就突发脑溢血的事件,许多人都感慨:咋年纪轻轻也脑溢血了?这其中一个最大的原因就是患者颅内可能存在脑血管畸形。脑血管畸形是我国10~40岁人群突发脑出血最常见的病因,临床上按照血管结构特征被分为多种类型,其中以动静脉畸形最多见。本期编辑部走访了南京鼓楼医院神经外科主任、主任医师、教授杭春华。请杭教授给读者介绍脑动静脉畸形防治的相关知识。     

漫谈卫生事业同社会经济协调发展问题——学习《中共中央、国务院关于卫生改革与发展的决定》的体会

从卫生事业同社会经济协调发展的角度论述了学习《中共中央、国务院关于卫生改革与发展的决定》的体会,指出,要通过各种途径,进行全新的社会发展的宣传与教育,使人们树立“全面发展”观念;要尽快制订一个适宜的卫生发展战略和合理的卫生经济政策,利用经济杠杆,调整和扭转卫生事业与社会经济发展不相协调的状态。     

采用聚类分析方法评价广州市地区卫生资源配置的合理性——对广州市地区“看病难”、“看病贵”问题进行探讨

本文结合广州市地区的实际情况,根据81间大医院业务指标,运用聚类分析方法[1],对广州市地区卫生资源配置情况进行分析,并以此为基础对“看病贵、看病难”的问题提出对策和建议。     

采用聚类分析方法评价广州市地区卫生资源配置的合理——对广州市地区"看病难"、"看病贵"问题进行探讨

本文结合广州市地区的实际情况,根据81间大医院业务指标,运用聚类分析方法[1],对广州市地区卫生资源配置情况进行分析,并以此为基础对"看病贵、看病难"的问题提出对策和建议.     

Pattern of answer changes to multiple choice questions in physiology

The belief that it is unwise to alter the initial response to a multiple choice question is questioned.
Among 39 380 MCQ responses, there were 1818 changes (4.62%) of which 21.9% were correct to incorrect responses, 46.3% incorrect to correct responses and 31.8% incorrect to incorrect.
This effect was very much more marked among the better students, incorrect to correct changes accounting for 61% of the responses in the upper group, 42% in the middle group and 34% in the lower group.     

The art and science of searching MEDLINE to answer clinical questions. Finding the right number of articles.

The current medical environment makes information retrieval a matter of practical importance for clinicians. Many avenues present themselves to the clinician, but here we focus on MEDLINE by summarizing the current state of the art and providing an innovative approach for skill enhancement. Because new search engines appear rapidly, we focus on generic principles that can be easily adapted to various systems, even those not yet available. We propose an idealized classification system for the results of a MEDLINE search. Type A searches produce a few articles of high quality that are directly focused on the immediate question. Type B searches yield a large number of articles, some more relevant than others. Type C searches produce few or no articles, and those that are located are not germane. Providing that relevant, high-quality articles do exist, type B and C searches may often be improved with attention to search technique. Problems stem from poor recall and poor precision. The most daunting task lies in achieving the balance between too few and too many articles. By providing a theoretical framework and several practical examples, we prepare the searcher to overcome the following barriers: a) failure to begin with a well-built question; b) failure to use the Medical Subject Headings; c) failure to leverage the relationship between recall and precision; and d) failure to apply proper limits to the search. Thought and practice will increase the utility and enjoyment of searching MEDLINE.     

On the pattern of responses to multiple choice questions

Candidates achieve lower scores on false alternatives and tend to refrain from attempting the latter, as compared to true alternatives, in multiple choice question papers.     

Effectiveness and efficiency of a literature search strategy to answer questions on the etiology of occupational diseases: a controlled trial

Objectives To evaluate the effectiveness and efficiency of a search strategy to find evidence-based answers to questions related to the possible occupational etiology of diseases. Methods A controlled trial of 70 occupational health physicians and 55 insurance physicians who were asked to answer one out of four ‘occupational disease case-vignettes’ following the steps of evidence-based medicine (EBM). The intervention group were given the search strategy as a tool. Results The intervention group scored significantly better than the control group in answering the main question of the case-vignette correctly (57% versus 37%) using more adequate search terms. The intervention group scored significantly better regarding satisfaction with the applied search strategy (28% very satisfied versus 8%). We found no differences in time spent in solving the case or in the intention of future practice of EBM. Conclusions The introduction and application of specific search strategies can have a positive effect on the effectiveness of searching literature. Future initiatives for developing and testing specific search strategies in the field of occupational health should be encouraged.     

Using the World Wide Web to answer clinical questions: how efficient are different methods of information retrieval?

BACKGROUND: The World Wide Web (Web) has the potential to revolutionize information retrieval in medicine. However, the best method of information retrieval from the Web is not known. The purpose of our study was to compare medical search engines, general-purpose search engines, medical meta-lists, and commercial sites on the Web with regard to their efficiency in retrieving medical information. METHODS: Ten questions were identified from a database of questions posed by primary care clinicians. Authoritative answers were identified. Searches were performed using 1 commercial site, 4 general search engines, 9 medicine-specific search engines, and 2 medical meta-lists. The main outcome measures were the number of questions answered by each Web site, the correctness of the answers, the number of links followed to get an answer, and how well documented the answer was using the Health on the Net criteria. RESULTS: MD Consult, a commercial site, answered 6 of 10 questions. Hardin MD (a meta-list) and Excite and HotBot (general search engines) each answered 5 questions. The medicine-specific search engines performed poorly, answering an average of only 1 question. MD Consult and HotBot required the least number of links to find an answer. MD Consult and Hardin MD had the best documented answers. CONCLUSIONS: Medicine-specific search engines on the Web fare poorly in answering clinical questions when compared with general search engines. MD Consult, Excite, HotBot, and Hardin MD found the greatest number of answers.     

On the importance of the phrasing of questions in medico-hygienic social surveys.

In connection with studies done on the effects, in the form of annoyance, that noise can produce in exposed individuals, certain methodological problems have come to light. One of these problems concerns the effect which alternative formulations of the questions could have on the results. In a laboratory experiment it was possible to show that the choice of verbal expression for the reaction can influence the incidence of annoyance reactions. The results from the laboratory study could not be verified in a field experiment, however.     

On food frequency questionnaires: the contribution of open-ended questions and questions on ethnic foods

BACKGROUND: Epidemiologic studies of diet must balance the goal of comprehensiveness with that of minimizing subject and study burden. Information on the impact of certain additional questionnaire elements may aid in such decisions. METHODS: We administered a food-frequency questionnaire in a large multiethnic cohort of women (Study of Women's Health Across the Nation) in 1996-1997. Ancillary questionnaires asked about "any other foods you eat at least once a week" and about consumption of 8-16 ethnic foods included for respondents of Hispanic, Chinese, or Japanese ethnicity. We assessed the impact of these 2 ancillary questionnaires by examining the mean nutrient amount they contributed and their effects on rank-order correlations and categorizations of nutritional estimates. We examined the impact of ethnic foods both within the relevant ethnic group and among non-Hispanic whites. RESULTS: Rank-order correlations (rs) between nutrient estimates with and without the open-ended question were 0.99 for almost all nutrients and all ethnic groups. Nutrient amounts added by the open-ended question rarely exceeded 2% of the total. Weighted kappa statistics for quintile classifications were greater than 0.9. Similarly, asking white respondents about ethnic foods added little to nutrient estimates, and all correlations between estimates with and without the ethnic foods were at least 0.95. The effect of ethnic foods on nutrient means within the relevant ethnic group was more substantial, although most correlations between estimates with and without the added foods were still above 0.9. CONCLUSIONS: Open-ended food questions added little to nutrient estimates or rankings in any of the ethnic groups. Specific questions about ethnic foods were useful only within ethnic groups, for which they increased mean nutrient estimates and had modest impact on ranking.