Teaching behavioral medicine using individual coronary heart disease risk factors

Two hundred twenty-one first-year medical students participated in a voluntary coronary heart disease risk factor self-change project designed to teach the principles of behavioral change. Blood pressure, serum lipids, percentage body fat, cardiovascular fitness, and smoking status were measured prior to the project. Students designed their own programs of behavior modification and, after 8 weeks, repeat measurements were obtained in students whose projects related to coronary heart disease risk (56% of entire group). Despite generally low initial coronary heart disease risk factors, most risk factor groups successfully altered the targeted risk factors. The subgroup attempting to lower serum cholesterol (n = 49) reduced total cholesterol 15 +/- 24 mg/dl (mean +/- SD) and low-density lipoprotein cholesterol 11 +/- 20 mg/dl (P less than 0.001 for both). The blood pressure group (n = 9) decreased systolic blood pressure 8 +/- 10 mm Hg (P less than 0.05), and the weight-loss group (n = 33) lost 3.0 +/- 2.9 kg (P less than 0.001), reducing estimated percentage body fat 1.7 +/- 1.8 (P less than 0.001). The self-change project was well received by the students and appears to be a useful technique for introducing the principles of behavioral medicine to first-year medical students.     

Population exposure from nuclear medicine procedures: measurement data

In order to estimate the public radiation burden from nuclear medicine studies, a TLD chip in a sealed plastic bag was taped on the abdomen of patients who received 111In as chloride or oxine, 201T1 chloride, or one of four common 99mTc agents. The TLD chip was removed after 24 h. Additionally, abdominal skin surface exposure rate measurements were performed with an ionization chamber survey meter at various times (0 to about 60 h). There was superb correlation between TLD and integrated exposure rate measurements and between TLD and ionization chamber measurements and MIRD calculated doses. Scenarios postulated for exposure of co-workers and family members yielded doses between 7 muSv (0.7 mrem) and 20 muSv (2 mrem) for the selected radiopharmaceuticals. Calculations of the total population exposure from nuclear medicine procedures indicate the per capita dose (amortized over the entire population) is approximately 0.4 muSv (0.04 mrem), a negligible dose compared to natural background and total medical irradiation.     

Population radiation absorbed dose from nuclear medicine procedures in The Netherlands

The mean radiation absorbed dose per patient and for the whole population per caput per year in the Netherlands from diagnostic nuclear medicine procedures has been estimated using patient data from 10 large hospitals during either 1984 or 1985. The mean effective dose equivalent and the mean gonad dose equivalent per patient were 2.7 mSv and 1.7 mSv, respectively. Extrapolating these figures to all diagnostic nuclear medicine procedures in the Netherlands, the mean effective dose equivalent and the mean gonad dose equivalent per caput per year were 0.037 mSv and 0.024 mSv, respectively.     

The antipyrine test in occupational medicine research--evaluation of individual reproducibility and frequency distribution of half-life

The antipyrine half-life is a reliable index of biotransformation capacity of the liver. The half-lives were estimated in 137 subjects; the result was a logarithmic normal distribution of these parameters. Therefore our patients were subdivided into groups of so-called fast, intermediate and slow metabolisers (fast: t50 less than 7.6 h and slow: t50 greater than 14.9 h). Under conditions given here the intraindividual coefficient of variation was about 11.5%. The antipyrine elimination curves were calculated by a computer programme and the values were analysed statistically.     

2002年莱芜市放射医学工作者个人剂量监测分析

随着放射技术的不断发展和应用领域的不断扩展,莱芜市从事放射医学工作的人员日益增多,为保障放射医学工作者的身体健康,加强放射医学工作者的防护管理,为放射卫生防护提供个人剂量监测数据,我站于2002年对莱芜市市、区、乡级医疗单位的放射医学工作者进行了个体剂量监测。1 对象与方法1.1对象 2002年对莱芜市160名放射医学工作者进行监测(其中市级医院50名,区级医院50名,乡镇级医院60名),每年监测4次。     

介入、核医学放射工作人员外照射个人剂量水平调查与分析

目的 掌握介入、核医学放射工作人员外照射剂量水平,评价放射工作人员的防护效果,为放射卫生防护与监督管理工作提供科学依据。方法 按照GBZ 207-2008《外照射个人剂量系统性能检验规范》、GBZ 128-2002《职业性外照射个人监测规范》的要求,对铅衣内、外热释光个人剂量计（TLD）的受照剂量进行监测。结果 2015年累计监测放射工作者324名,其中介入人员287人,核医学人员37人。不同级别医院（三甲、三级（未定等）、二甲）工作人员铅衣内人均年剂量当量中位值分别为0.9 mSv、1.14 mSv和0.86 mSv;铅衣外分别为1.96 mSv、5.86 mSv和1.37 mSv。各级医院之间差别有统计学意义,并且各级医院工作人员铅衣内、外差别也均有统计学意义。结论 本次调查的324名介入、核医学放射工作人员的个人年剂量水平,均在国家标准限值内;但铅衣内外、不同级别医院以及不同工种之间个人剂量受照水平存在较大差异,应采取有效防护措施降低放射工作人员的受照剂量,在放射防护实践中应加强重点工种人员的个人剂量监测与防护。     

Diversity,the individual,and proof of efficacy: complementary and alternative medicine in medical education

Patients will always have access to a variety of possibly effective, but unproved, therapies directed at maintaining health or treating illness. And there will always be complex, potentially therapeutic regimens that cannot be adequately tested for financial, ethical, or methodological reasons. Furthermore, even after adequate study of a given regimen, there will always be the fundamental uncertainty of medical practice: the fact that epidemiological research produces probabilistic results that cannot predict with certainty the best treatment for the single unique patient before us. The exploration of complementary and alternative medicine topics in the medical school curriculum helps to elucidate the complex and uncertain nature of medical practice, sharpens skills for clinical decisionmaking, increases cultural sensitivity, and provides ideas for future research.     

Population characteristics and absorbed dose to the population from nuclear medicine: United States--1982

Those in the U.S. population who receive nuclear medicine examinations have been characterized by age and sex. Males received 42% of examinations while females received 58%. More than one-third of the examinations were done on persons older than 64 y of age and more than two-thirds on patients older than 45 y of age. The per caput effective dose equivalent from nuclear medicine procedures in 1982 was 140 muSv (14 mrem); whereas, the per caput age-specific effective dose equivalent to the U.S. population was 50 muSv (5.9 mrem). These can be compared with 2 mSv (200 mrem) from natural background.     

Population effects on individual systolic blood pressure: a multilevel analysis of the World Health Organization MONICA Project

Individuals from the same population share a number of contextual circumstances that may condition a common level of blood pressure over and above individual characteristics. Understanding this population effect is relevant for both etiologic research and prevention strategies. Using multilevel regression analyses, the authors quantified the extent to which individual differences in systolic blood pressure (SBP) could be attributed to the population level. They also investigated possible cross-level interactions between the population in which a person lived and pharmacological (antihypertensive medication) and nonpharmacological (body mass index) effects on individual SBP. They analyzed data on 23,796 men and 24,986 women aged 35-64 years from 39 worldwide Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study populations participating in the final survey of this World Health Organization project (1989-1997). SBP was positively associated with low educational achievement, high body mass index, and use of antihypertensive medication and, for women, was negatively associated with smoking. About 7-8% of all SBP differences between subjects were attributed to the population level. However, this population effect was particularly strong (i.e., 20%) in antihypertensive medication users and overweight women. This empirical evidence of a population effect on individual SBP emphasizes the importance of developing population-wide strategies to reduce individual risk of hypertension.     

Viewpoint--Travel medicine and maritime medicine

Although travel medicine and maritime medicine study health problems of different populations of travelers, they have many common interests. Seafarers are a special kind of travelers and for them traveling is the essential part of their professional lives, so the health risks during travel are basically the risks of their profession and their working environment. In this paper similarities and differences between the practice of work in these two specialities of medicine are presented and discussed.     

Population preferences for non-pharmaceutical interventions to control the SARS-CoV-2 pandemic: trade-offs among public health,individual rights,and economics

Problem

Policymakers must decide on interventions to control the pandemic. These decisions are driven by weighing the risks and benefits of various non-pharmaceutical intervention alternatives. Due to the nature of the pandemic, these decisions are not based on sufficient evidence regarding the effects, nor are decision-makers informed about the willingness of populations to accept the economic and health risks associated with different policy options. This empirical study seeks to reduce uncertainty by measuring population preferences for non-pharmaceutical interventions.

Methods

An online-based discrete choice experiment (DCE) was conducted to elicit population preferences. Respondents were asked to choose between three pandemic scenarios with different interventions and impacts of the Corona pandemic. In addition, Best–worst scaling (BWS) was used to analyze the impact of the duration of individual interventions on people’s acceptance. The marginal rate of substitution was applied to estimate willingness-to-accept (WTA) for each intervention and effect by risk of infection.

Results

Data from 3006 respondents were included in the analysis. The DCE showed, economic effect of non-pharmaceutical measures had a large impact on choice decisions for or against specific lockdown scenarios. Individual income decreases had the most impact. Excess mortality and individual risk of infection were also important factors influencing choice decisions. Curfews, contact restrictions, facility closures, personal data transmissions, and mandatory masking in public had a lesser impact. However, significant standard deviations in the random parameter logit model (RPL) indicated heterogeneities in the study population. The BWS results showed that short-term restrictions were more likely to be accepted than long-term restrictions. According to WTA estimates, people would be willing to accept a greater risk of infection to avoid loss of income.

Discussion

The results can be used to determine which consequences of pandemic measures would be more severe for the population. For example, the results show that citizens want to limit the decline in individual income during pandemic measures. Participation in preference studies can also inform citizens about potential tradeoffs that decision-makers face in current and future decisions during a pandemic. Knowledge of the population’s preferences will help inform decisions that consider people’s perspectives and expectations for the future.

Survey results can inform decision-makers about the extent to which the population is willing to accept certain lockdown measures, such as curfews, contact restrictions, lockdowns, or mandatory masks.