Hospitalized occupational finger amputations,New Jersey, 1985 and 1986

About 19,000 finger amputations occur at work each year in the United States. Twenty percent of these injuries are severe enough to require hospitalization. Hospital discharge data from New Jersey (1985, 1986) were used to describe the demographic characteristics of persons with such injuries and to identify potential subjects for telephone interview. A total of 637 persons hospitalized for finger amputations were sent letters asking for their participation. Of 637 persons, 355 (56%) were contacted and 228 (36%) were interviewed, of whom 134 (59%) said their injury occurred at work. The annual rate of finger amputations at work was 9.3 per 100,000 employed persons. The rate was higher for males (14.7) than females (1.9). The age-adjusted rates were higher for Hispanic (52.8) and black (28.9) males than for white males (9.5). Persons working with machines or maintaining them in the manufacturing industry were at highest risk. Unjamming or repairing machinery (e.g., presses, saws, or slicers) while in operation was particularly hazardous. These data can be used to target occupations and industries for specific worksite intervention to prevent finger amputations. One limitation of this study, however, is that hospitalized occupational finger amputations may not be representative of all finger amputations, the majority of which are less severe and do not require hospitalization. © 1993 Wiley-Liss, Inc.     

Previously undetected silicosis in New Jersey decedents

BACKGROUND: Despite a reported decline in mortality and hospitalizations associated with silicosis [U.S. Department of Health and Human Services, 1999], this decline may be artifactual, stemming in part from underdiagnosis by physicians. METHODS: This study estimates, through radiological confirmation, the prevalence of unrecognized silicosis in a group of silica-exposed New Jersey decedents whose cause of death was chronic obstructive pulmonary disease (COPD), tuberculosis, or cor pulmonale. Two expert readers re-evaluated the chest X-rays of this group to determine the presence or absence of silicosis. The study population was considered to be presumptively exposed to silica dust by virtue of their usual industry of employment as listed on the death certificate. RESULTS: Radiographic evidence of silicosis was found in 8.5% of this population, and evidence of asbestosis was found in another 10.7%, for a total of 19.2%. CONCLUSIONS: The existence of previously unrecognized silicosis and asbestosis in 19.2% of this study group suggests that occupational lung disease is under-recognized and, hence, undercounted.     

Silicosis surveillance in New Jersey: targeting workplaces using occupational disease and exposure surveillance data.

To identify workplaces in New Jersey with potential for silica exposure, the New Jersey Department of Health compared four-digit Standard Industrial Classifications (SICs) identified by three different data sources: the National Occupational Exposure Survey (NOES), a new Jersey silicosis case registry, and regulatory agency compliance inspections in New Jersey. In total, the three data sources identified 204 SICs in New Jersey with potential for silica exposure. Forty-five percent of these SICs were identified by NOES only, 16% by registry cases only, 6% by compliance inspections only, and 33% by two or more sources. Since different surveillance sources implicate different SICs, this type of analysis is a useful first step in planning programs for prevention of silicosis.     

Asbestos disease in sheet metal workers: II. Radiologic signs of asbestosis among active workers

A review of chest x-rays of 707 currently employed New York metropolitan area sheet metal workers found that 29.3% of the workers with 20 years or more of union membership (a surrogate for years of exposure) had radiologic abnormalities characteristic of parenchymal and/or pleural asbestosis, with 18.6% having abnormalities characteristic of parenchymal asbestosis (International Labor Organization [ILO] classification 1/0 or higher) and 17.4% of pleural asbestosis. The prevalence of abnormalities characteristic of either parenchymal and/or pleural asbestosis in the group as a whole was 16.4%, with 10.9% exhibiting signs of parenchymal asbestosis and 9.2% of pleural asbestosis. There was a strong, statistically significant relationship between years in the trade and the prevalence of radiologic abnormalities. These findings underscore the need for medical surveillance of all asbestos-exposed construction workers, including retirees and workers who have had past exposure but who are no longer exposed.     

An evaluation of New Jersey's hospital discharge database for surveillance of severe occupational injuries

Computerized population-based hospital discharge data in New Jersey offer new opportunities for surveillance of serious work-related injuries. This database was evaluated for its potential in identifying selected injuries that occurred at work during 1985 and 1986. Hospital discharge data were compared with data collected by telephone interview of discharged patients. A total of 1,575 unique hospital discharge records for the selected injuries included finger amputation (1,041), thumb amputation (209), crush injury of the lower limb (208), toxic effects of heavy metals (69), and eye burns (48). Of 809 study subjects sent letters, 445 (55%) could be contacted and 289 (36%) were interviewed for the study. Sixty-one percent (175) said their injury was work related. A comparison was made between self-reported injury at work, and the presence of workers' compensation payer codes on the discharge database. The agreement beyond chance (Kappa) was 0.78 (95% CI + 0.67, 0.89). The sensitivity of this indicator of work relatedness was 83%; specificity was 98%. These data suggest that worker's compensation payment on the hospital discharge database may be a good to excellent proxy indicator of the work relatedness of these injuries. However, this proxy indicator will underestimate the number of work-related injuries by about 20%. Only 11% of hospital discharge records had external cause of injury codes (E-codes), which reduces the utility of the database for understanding the causal mechanisms of work-related injuries. © 1993 Wiley-Liss, Inc.     

Workmens' compensation and byssinosis in South Africa: a review of 32 cases.

Byssinosis has been compensable in the Republic of South Africa (RSA) since 1973. The legal and administrative provisions for byssinosis compensation are reviewed. A series of 32 cases of presumed byssinosis was submitted to the compensation authorities by the authors. Identical reports were submitted to an independent medical panel. The findings and outcomes in these cases are presented and compared. Seventeen of the 32 claims initially received compensation and four were subsequently accepted following appeals. Analysis of the medical basis of decision making indicated that seven claims were refused and at least four had their awards reduced as a consequence of inconsistent decisions. Arguable decisions resulted in five claims being refused and one award being reduced. Our experience illustrates problems inherent in the compensation system in South Africa. Initiation of a claim is expensive relative to wages in the industry, and awards are low since they are linked to wages (mean $60.47 per week). Processing of a claim took a mean of 13.8 months, while appeals for refusal to compensate took a further 29.8 months. It is argued that consensus medical definitions of compensable occupational disease should be used routinely and that provision must be made to facilitate entry of claimants into the compensation system.     

医院信息系统发展及对存储和数据安全的新要求

本文首先提出医院信息系统发展方向是数字化医院,核心内容是基本信息系统、临床信息系统、电子病历系统、决策支持系统、区域协同系统和患者服务系统,数据中心是医院信息系统发展的必然趋势,并对数据中心及其存储解决方案和信息系统安全提出自己的观点。     

湖南省2004—2013年细菌性痢疾时空格局GIS技术分析

目的了解湖南省细菌性痢疾的时空分布格局, 为强化公共卫生资源的优化配置、开展有效防治措施提供科学依据。方法收集湖南省2004—2013年细菌性痢疾发病的相关数据和资料, 描述细菌性痢疾发病的三间分布特征, 应用地理信息系统(GIS)对其时空分布格局进行分析。结果湖南省2004—2013年细菌性痢疾发病率为14.83/10万, 男性发病率为17.10/10万, 女性发病率为12.41/10万, 0~20岁发病率较高(32.6/10万), 职业构成以散居儿童(34.93%)、农民(25.49%)、学生(14.12%)为主;2004—2009年湖南省发病率逐年升高, 而2009—2013年发病率又逐渐下降, 常德、岳阳、长沙、益阳、娄底、邵阳、张家界和郴州等8个市发病例数呈先升后降的抛物线形状, 湘潭、衡阳、怀化呈持续下降趋势, 株洲、永州10年基本持平, 而湘西自治州在2013年出现升高现象;空间分布中, 湘西自治州发病率最高(39.99/10万), 其次是郴州(23.31/10万)和永州(20.20/10万), 2004—2013年湘西自治州一直属于高发地区, 郴州在2004、2006、2007、2008、2011、2012年高发, 长沙在2004—2006年高发后发病率逐渐降低, 怀化、邵阳、永州近年来较为高发。结论湖南省自2009年后, 大部分地区细菌性痢疾呈下降趋势, 但湘西自治州在2013年出现升高现象, 细菌性痢疾的发病主要集中在湖南省西部和南部地区, 中部以长沙为主, 北部地区菌痢发病率较低。     

平煤总医院信息系统的日常维护探讨

对平顶山煤业集团总医院信息系统（HIS）运行9年来的经验及工作日志进行了分析,从硬件、软件及管理协调等方面,阐述了HIS在医院的管理运行中发挥着不可替代的作用.同时也对新系统的上线工作及特性和上线后产生的效应做出了相应的阐述.     

未来的数字医院系统及其关键技术

新的科技创新的浪潮使我们能够获取、存储、处理和显示来自医院各个角落的、史无前例的、大量的关于生物医学的、医学工程的、临床诊断的、医药的、卫生经济、医院管理的、医院文化的各类数据和现象。这些数据和现象多为与医学、管理、经济、健康等相关的信息 ,它们是关于某医院某时某地某人所产生的某事件。如何搞清楚这些数据和现象的真正意义是极为重要的 ,这便是未来数字化医院所具备的基本功能。本文论述了未来的数字医院系统的基本架构及其实现的关键技术。     

Community-based reports of morbidity,mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic

The goal of this study was to assess morbidity, mortality, and health-seeking behaviours during the 2014 Ebola outbreak in Monrovia, Liberia. This study examined commonly reported symptoms of illness, pre-clinical diagnostic practices, typical healthcare-seeking strategies, and health resources available to populations, in order to identify salient needs and gaps in healthcare that would inform local emergency response efforts. Semi-structured interviews were conducted with household members in four Monrovia neighbourhoods. Researchers used a multi-stage cluster approach to recruit participants. Within 555 households sampled, 505 individuals were reported sick (69%) or recently sick (38%) or deceased (7%). Common self-diagnoses included malaria, hypertension, influenza, typhoid, and Ebola. The most cited health-seeking strategy was to purchase medications from the private sector. Respondents also obtained healthcare from community members known to have medical experience. Findings suggest that non-formal healthcare systems played an important role in managing morbidity during the West African Ebola virus disease (EVD) outbreak. Lay community members engaged in complex assessments of health symptoms and sought biomedical care at rates perhaps higher than anticipated during the response. This study highlights how informal networks of healthcare providers can play an important role in preventing and curbing future emerging disease outbreaks.     

湖南省公立医院效率及影响因素研究——基于DEA-Tobit模型

以湖南省公立医院为研究对象,运用DEA-BCC模型分析样本医院的综合效率、纯技术效率与规模效率,运用Tobit回归模型分析影响公立医院效率的主要因素.结果 表明:湖南省公立医院规模效率优于技术效率,但总体综合效率有效的医院数量占比较低;二级医院的综合效率高于三级医院;综合医院效率高于中医医院;卫技人员占比、总收入与医院...     

心脏超声联合颈部血管超声诊断老年冠心病的应用价值分析

目的:分析心脏超声联合颈部血管超声诊断老年冠心病的应用价值。方法:随机选择120例患者,均是于2018年2月~2020年2月在本院接受老年冠心病诊断的患者,随机分为联合组与单一组,前者有60例患者,应用心脏超声联合颈部血管超声诊断,后者有60例患者,应用心脏超声诊断,对比两组诊断符合率、诊断效果、检查结果。结果:两组的诊断符合率和诊断结果差异较大,联合组显著高于单一组;差异有统计学意义(P<0.05)。两组诊断效果不明显,差异无统计学意义(P>0.05);联合组的正常、轻度狭窄、中度狭窄、重度狭窄检出人数高于单一组,差异有统计学意义(P<0.05)。结论:心脏超声联合颈部血管超声诊断老年冠心病的应用价值更大,相比于应用心脏超声诊断的患者,接受心脏超声联合颈部血管超声诊断的患者诊断符合率与检出率更高。     

观察在对冠心病进行诊断时使用磁共振成像(MRI)和多层螺旋CT的诊断准确率

目的:探讨在对冠状动脉粥样硬化性心脏病(简称,冠心病)进行诊断时使用磁共振成像(MRI)和多层螺旋CT的诊断准确率。方法:选择2018年1月~2019年3月本院收治的冠心病患者67例为对象,对选择的对象进行MRI和多层螺旋CT、数字减影血管造影(DSA)这三种检查,将DSA检查结果作为金标准,比较MRI及多层螺旋CT与其联合检测的诊断准确率。结果:MRI和多层螺旋CT各自的诊断准确率与DSA比较存在较大差异,P<0.05;但MRI和多层螺旋CT的诊断准确率比较无差异,P>0.05;联合检测的诊断准确率与DSA比较无差异,P>0.05。结论:在对冠心病进行诊断时使用MRI和多层螺旋CT联合检测的诊断准确率高。     

应用集中度和圆形分布法分析西安市2010-2013年 手足口病的季节性特征

摘要:目的　探讨西安市手足口病流行的季节性特征,为制定防治策略和措施提供科学依据。方法　应用集中度及圆形分布法分析西安市2010-2013年的手足口病月发病规律。结果　西安市2010-2013年的手足口病季节性分布的总M值为0.534;手足口病发病平均高峰日为6月12日,流行高峰期为4月6日-8月19日。Rayleigh' test显示平均角存在（Z＝21670.92,P＜0.001）;M值与r值相关性显示M值和r值呈高度正相关（r＝1.000,P＜0.001）。结论　西安市2010-2013年手足口病发病分布有较强的季节性分布特征,4-8月为该病的流行高峰,有关部门应在流行高峰期内开展有针对性的防控措施。     

新型鼻塞持续气道正压通气治疗新生儿肺透明膜病的疗效观察

目的评价新型鼻塞持续气道正压通气(NCPAP)治疗新生儿肺透明膜病的疗效。方法 74例新生儿肺透明膜病患儿随机平均分为治疗组和对照组,治疗组采用新型鼻塞持续气道正压通气,设置参数为流量6~8 L/min,吸入氧浓度(FiO2)0.3~0.6,压力为4~8 cmH2O;对照组采用头罩吸氧(氧流量4~6 L/min)。治疗无效改用气管插管、机械通气治疗。观察两组患儿治疗疗效。结果治疗组33例治愈,3例改用气管插管,1例自动出院,治愈率89.2%;对照组13例治愈,22例改用气管插管,2例死亡,治愈率35.1%。两组治疗效果比较差异有统计学意义(P0.05)。结论 NCPAP治疗新生儿肺透明膜病具有良好的疗效,值得临床推广应用。