Incidence of acute leukemias, lymphomas and thyroid cancers in children under 15 years, living around the Marcoule nuclear site from 1985 to 1995]

BACKGROUND: The aim of this investigation was to report incidence of childhood leukemia, lymphoma and thyroid neoplasms in children under 15 years of age living in the vicinity of the French Marcoule nuclear reprocessing plant. METHODS: This exhaustive and retrospective survey was carried out between 1985 and 1995 in children aged under 14 at the time of diagnosis and living inside a 35 kilometer zone around the nuclear site. 656 practitioners, 109 medical analysis laboratories and 5 hospitals or cancer institutes were investigated. A panel of experts checked each case. RESULTS: 48 cases of acute leukemia (39 acute lymphoid leukemia and 9 acute myeloid leukemia), 15 cases of lymphoma (8 Hodgkin lymphomas--53%--and 7 non hodgkinian lymphomas including 5 Burkitt lymphomas), 1 case of chronic myeloid leukemia and 1 case of papillary thyroid cancer, appeared among the 1,116,442 children-years followed. The total incidences of leukemias and lymphomas were respectively 4.12 and 1.29.10(-5). Standardised Incidence Ratios, calculated according to Poisson methods and bayesian inference, with various reference rates did not show any excess of risk: 100.67 (95% confidence interval 72-131) for leukemia. Children under 5 years old and living in non exposed areas to dominant winds or downstream rhodanian water drawing presented a 3 or 4 fold decreased risk of leukemia than others (the latter still having an identical risk to that of the general population). This was not true for lymphomas, nor for the other age groups. CONCLUSION: Over the entire zone, children do not have an increased risk of malignant hematology disease but health monitoring by a systematic collection of cases remains useful around Marcoule. The assumption of aquiferous or air contamination thus still remains questionable: further studies investigating models of contamination are needed to take into account all other nonionizing leucemogenic factors (benzene and viral injection in particular) or correlation studies between health indicators and dosimetry.     

不同年龄段急性心肌梗死患者合并传统危险因素现状研究

目的 分析不同年龄段急性心肌梗死(AMI)患者合并传统危险因素的现状,进而探讨不同危险因素对AMI发病年龄变化的影响.方法 记录2003年10月至2010年10月收治的AMI(包括ST段抬高性心肌梗死及非ST段抬高性心肌梗死)患者682例.分析不同年龄段AMI患者吸烟、高脂血症、2型糖尿病及高血压等传统危险因素的差异.结果 最终613例患者进入本研究,其中青年组43例,中年组216例,老年组234例,老老年组120例.(1)青年组与中年组、老年组及老老年组相比,吸烟与高脂血症比例均显著升高(P＜ 0.0125或＜0.001);中年组与老年组相比,吸烟比例显著升高(P＜ 0.001),两组高脂血症比例比较差异无统计学意义(P＞0.0125);中年组与老老年组相比,吸烟与高脂血症比例均明显升高(P＜ 0.001或＜0.0125).(2)正在吸烟的AMI患者发病年龄为(56.84±13.00)岁,从不吸烟的AMI患者发病年龄为(74.29±10.57)岁,两者比较差异有统计学意义(P＜0.01).合并高脂血症的AMI患者发病年龄为(62.92±15.04)岁,未合并高脂血症的AMI患者发病年龄为(68.63±13.93)岁,两者比较差异有统计学意义(P＜0.01).结论 吸烟及高脂血症,尤其吸烟是中青年AMI患者发病的重要危险因素,对于AMI发病年龄明显提前起到重要促进作用,而积极戒烟及控制血脂有望对减少中青年AMI发病率发挥积极意义.     

The current state and challenges for the future of health promotion in Polish older people

Objective  

Still in its early stages, much work remains to be done in terms of the health promotion of older people in Poland. The aim of this paper is to present the current state of health promotion in older people in Poland on the basis of research conducted within the framework of the healthPROelderly project, presenting the state of health promotion in older people after 1989, and to provide practical recommendations for future interventions.     

The background and current state of implementing a legal system for stress checks in Japan

This paper discusses the development process, outline, main design points, post-enactment operation, and related research trends based on my own experiences from the formulation of the stress check system. Additionally, it surveys related literature and is the first of its kind to discuss future developments from a legal point of view. The ultimate purpose of the stress check system is to stimulate concrete measures for workplace environment improvements. However, despite frequent group analysis, effective measures for improving the environment have been limited. In this paper, based on past studies, I argue that reduced stress and other effects can be observed in workplaces in which such measures have been implemented, providing qualitative outcomes for workers. In addition, basic data can and has been accumulated for subsequent policies and measures. I conclude that realizing human and organizational individuality as well as supporting growth and environmental adaptation are key to the implementation of effective mental health measures.     

The current state of medical education in the Federal Republic of Germany and some of its problems†

The current problems facing medical education in the Federal Republic of Germany can be accounted for largely by the effects of the Regulations for Doctors’ Licences introduced in 1970. The causes are complex, but the most important factors include: centralised multiple choice examinations which make students orientate their learning towards memorizing facts rather than acquiring medical skills; too little clinical experience, a scarcity of training opportunities (the intake of medical students has grown sharply over the last few years to between 11 000 and 12 000 a year); too few patients; and insufficiently experienced teachers.     

The model of state health policy and the system of medical assistance adopted in present-day Brazil]

A contribution to the analysis of the health reform presently occurring in Brazil is presented. The need to consolidate the theoretical background which supports the advances already achieved in order to understand recent events in the area is stressed. In this regard, the health reform is understood as a question transcending the mere administrative and managerial aspect of the health system, since it necessarily involves a redefinition of the concepts of health, disease and the medical practice adopted by the dominant mechanistic paradigm of medicine. The recent events which delineate the health system in Brazil are analysed and criticised in the light of this concern.     

The present state and forthcoming problems in the work of occupational health physicians engaged in the workplace]

The authors conducted a survey in July 2001 to examine the present state and forthcoming problems facing occupational health physicians (OHPs). The establishments investigated were those which employed 1,000 or more workers and had consulted us for the employment of OHPs. The number of establishments chosen was 1,658. A questionnaire was sent to the division chiefs responsible for the health management of the establishments, and those who supervised the OHPs engaged in the establishments were asked to complete the questionnaire. The questionnaire included items about the attributes of the perspective establishments, the work of OHPs and the personnel management system for the OHPs. Four hundred and forty-seven establishments (27.0%) out a total of 1,658 returned eligible responses for further analysis, and the major results were as follows: First, 79.2% of the manufacturing establishments which responded comprised those which employed 1,000 or more workers, even though the percentage of companies which employ 1,000 or more workers throughout Japan is 62.5%. The percentage of the establishments which employed full time OHPs was 64.2% in secondary industries (mining, constructing and manufacturing), and higher than the 40.8% in tertiary industries (other than farming, forestry, fishing and secondary industries). Second, although OHPs properly coped with the obligatory issues regulated by the related laws, the OHPs who routinely consulted with workers about their work-related health problems were few (36.7%). Third, despite the low percentage of the establishments (23.5%) which had recognized OHPs' work to be part of enterprise management, the budget of the health care section was kept unchanged (55.0%). And, in 49.0% of the establishments, the nomination of OHPs was recognized to be necessary irrespective of the presence of the related laws, and OHPs were expected to cope with the work-related health problems of workers (62.9%). On the other hand, the personnel management system for OHPs was insufficient, and the performance rating for OHPs' activity was prepared for only 50.3% of the establishments. In addition, when the subjects were confined to regular OHPs, they were allowed to attend internal training courses for regular employees in only 25.0% of the establishments. Taking the above into account, the activity of OHPs has to be developed more in tertiary industries. OHPs may also be asked to positively cope with workers' work-related health problems. Simultaneously, the personnel management system for OHPs has to be arranged properly.     

The current state of health care in the former Soviet Union: implications for health care policy and reform.

OBJECTIVES. Given the many profound health care problems facing Russia and the other former Soviet republics, there are a number of fundamental policy questions that deserve close attention as part of the reform process. METHODS. Summary data regarding Soviet health care issues were drawn from government agency reports, scholarly books and journals, recent press reports, and the authors' personal research. RESULTS. Smoking, alcohol, accidents, poor sanitation, inadequate nutrition, and extensive environmental pollution contribute to illness and premature mortality in Russia and the other newly independent states. Hospitals and clinics are poorly maintained and equipped; most physicians are poorly trained and inadequately paid; and there is essentially no system of quality management. While efforts at reform, which emphasize shifting to a system of "insurance medicine," have been largely unsuccessful, they have raised several important policy issues that warrant extensive research and discussion. CONCLUSIONS. Without considering the implications and consequences of alternative policy directions, Russia and the other states face the very real possibility of developing health care systems that improve the overall level of care but also incorporate limited access and escalating costs. Russian health care reform leaders can learn from the health care successes in the West and avoid repeating our mistakes.     

急性生理号陧性健康状况评分对有机磷中毒患者病情评估的价值

目的 探讨急性生理与慢性健康状况(APACHE Ⅱ)评分对有机磷中毒患者病情评估的临床意义.方法 对有完整记录出入院APACHE Ⅱ评分的287例有机磷农药中毒患者,回顾分析不同临床状态时的APACHE Ⅱ评分,建立回归模型,估算有机磷中毒患者的病死率,并与实际病死率比较.结果 存活病例的APACHE Ⅱ评分(12.74±5.76)明显高于死亡病例(23.26±5.08),差异有统计学意义(P＜0.01);多脏器功能衰竭患者APACHE Ⅱ评分(2:4.85±6.34)明显高于非多脏器功能衰竭患者(14.28±7.13),差异有统计学意义(P＜0.01);287例有机磷中毒患者的预计病死率为12.19%,与实际病死率(9.96%)比较.差异无统计学意义(P＞0.05).结论 APACHE Ⅱ评分结果与机磷中毒患者的临床危重程度一致,有助于对患者病情的评估.     

60例急性冠脉综合征患者血CRP、FIB 及HCY水平临床观察

目的:观察对比急性冠脉综合征与非急性冠脉综合征冠心病患者血清C-反应蛋白、纤维蛋白原及血浆同型半胱氨酸水平,从生化角度判断冠状动脉粥样硬化斑块的稳定性.方法:60例急性冠脉综合征患者,44例非急性冠脉综合征冠心病患者为研究对象,检测其外周血C-反应蛋白、纤维蛋白原及同型半胱氨酸水平并作比较.结果:急性冠脉综合征组血清C-反应蛋白、纤维蛋白原(分别为41.74±5.76 mg/L,604.53±264.73 mg/dl)显著高于非急性冠脉综合征组(分别为4.88±2.49mg/L,353.33±105.68mg/dl),P＜0.05.急性冠脉综合征组与非急性冠脉综合征组血浆同型半胱氨酸水平无差别(分别为22.39±16.5μmol/L,17.52±8.31μmol/L).结论:检测血清C-反应蛋白和纤维蛋白原水平对临床识别冠状动脉粥样硬化斑块的稳定性、鉴别急性冠脉综合征与非急性冠脉综合征冠心病有一定价值.     

长沙市中小学生学习障碍现况及自我意识水平对照研究

【目的】　了解长沙市中小学生罹患学习障碍的现况 ,探讨学习障碍儿童的自我意识水平。　【方法】　随机选择长沙市某小学及中学 ,评定自制儿童学习及行为情况调查表 ,儿童自我意识量表 ,瑞文联合型测验。与正常儿童进行对照分析。　【结果】　①量表回收率 94.4%,学习障碍发生率 7.4%,男女之比为 2 .1∶1;②学习障碍儿童自我意识量表各因子分及总分比正常对照组低 ,差异有非常显著性 (P <0 .0 1) ;③女性学习障碍儿童焦虑因子分比男性低 ,差异有显著性 (P <0 .0 5 ) ;④低年级组行为因子分低于高年级组 ,智力与学校因子分高于中年级组 ,差异均有显著性 (P <0 .0 5 )。　【结论】　学习障碍儿童自我意识水平普遍较低