Hospitals play the role of test pilots

Computerized patient record developers are turning to providers for real-world tests of their new products. The experiences of these pioneers offer valuable lessons.     

Pregnant women's attitudes for accepting or declining a serum-alpha-fetoprotein test

This study analyzes attitudes which influence women in their decisions to accept or decline a serum-Alpha-FetoProtein (se-AFP) test. The survey covers all women who have visited antenatal clinics offering the se-AFP test in a given area during a specified period. All in all, the pregnant women answered four questionnaires: three before and one after delivery. 19% of the women declined the se-AFP test. During pregnancy, the women who did not take the se-AFP test said that the reason was anxiety about the results of the test. Many of the women who took the test said that they wanted assurance that the child was healthy. This entails obvious ethical problems when the test is positive. The test-routine does not have a major influence in the decision-making process. A change in routines to shorten the waiting time, and a different cut-off line might influence some of the declining women to accept the test.     

社区卫生服务机构内部服务质量指标评价体系研究

目的:参考内部服务质量理论,建立一套适合我国社区卫生服务机构的内部服务质量评价体系。方法:根据文献检索、参与式观察、深入访谈等结果编制社区卫生服务机构内部服务质量调查问卷,并对北京市的两家社区卫生服务中心及其下设各服务站进行实证研究。结果:问卷的专家评分均值为88.3分,内部一致性信度为0.956,因子分析抽取的7个因子可以解释75.457%的内容,说明问卷结构效度较好。结论:社区卫生服务机构内部服务质量评价体系能较好的反映员工对内部服务质量的评价,为社区卫生服务机构进行自身服务质量评价、改进内部服务质量提供一种工具。     

卫生检验检测机构通过各项资质认证体会

我中心于2003年～2005年先后通过了广东省卫生厅卫生监督检验检测机构认定（259项）、计量认证复评（342项）、广东省卫生厅职业卫生技术服务资质（54项）与职业健康检查机构认定，通过了广东省职业病诊断机构批准证书、中国实验室国家认可委员会认可（201项）。本文简要阐述中心通过一系列认证的体会。     

Enhancing surveillance of cryptosporidiosis: test all faecal specimens from children

The heightened risk of waterborne cryptosporidiosis, associated with heavy rainfall in autumn 2000, prompted us to survey laboratory practice in the South East Region of England in testing faecal specimens for Cryptosporidium spp. oocysts and reporting to the Public Health Laboratory Service Communicable Disease Surveillance Centre (PHLS CDSC). Varied practices were found. Ideally, all faecal specimens should be tested, but where laboratories are unable to do so, screening all faecal specimens from children age 15 years or younger would improve surveillance and could probably be accomplished with minimal additional resources.     

待遇改革对民航飞行员心理健康的影响

目的了解民航飞行员心理健康状况,以及飞行员待遇改革对其心理健康状况的影响。方法采用临床症状自评量表(SCL-90)以及自编的基本情况问卷,随机抽取某航空公司现役飞行员进行调查,在待遇改革措施实施前后,发放调查问卷,测量他们的心理健康状况。结果共调查81名现役飞行员,待遇改革前飞行员SCL-90总分为(140.49±41.90)分,高于中国成人常模(129.96±38.76)分(P<0.05),其中躯体化、强迫症状、抑郁、敌对和精神病性因子得分高于常模(P<0.05或P<0.01);待遇改革后飞行员SCL-90总分为(125.74±23.20)分,低于待遇改革前(P<0.05),其中抑郁、强迫症状、偏执和第十因子的得分明显低于改革前(P<0.05或P<0.01),且总分、人际关系敏感、焦虑和敌对因子得分均低于中国成人常模(P<0.05或P<0.01);改革后飞行员心理异常率(17.28%)比改革前(20.99%)减少了3.71%。结论待遇改革前受调查现役飞行员的心理健康水平较差,改善飞行员的待遇可以提高其心理健康水平,待遇问题对其心理健康有重要作用。     

我国0～6岁儿童忽视影响因素指标体系的构建

目的:初步构建我国0~6岁儿童忽视影响因素的指标体系,为忽视原因的后续研究提供量化参考标准。方法:在文献回顾的基础上,以对儿童忽视影响为总体目标分层次逐级分析、命名儿童忽视各级指标并初步构建体系框架,再与我国0~6岁儿童忽视临床实际情况结合并咨询儿童保健专家对指标进行修正及完善后确定指标体系。结果:我国0~6岁儿童忽视指标体系包括儿童因素、父母因素、家庭因素、社会因素共32项具体原因指标构成。结论:所建立的0~6岁儿童的忽视影响因素指标体系具有较好的代表性,对历史研究成果中涉及到忽视原因进行了系统总结,并利用临床经验及专家意见进行了丰富与完善,对儿童忽视科研及临床实际应用均有实用价值,也为进一步深入开展儿童忽视研究提供了新的思路。     

Prevalence of fatigue among commercial pilots

BACKGROUND: Short-haul pilots have largely been neglected in studies of fatigue, sleep loss and circadian disruption created by flight operations, but anecdotal evidence from pilots suggests that with the increasing amount of low-cost air travel, commercial pilots working short-haul operations may be becoming seriously fatigued. AIMS: This study attempted to ascertain how much subjective fatigue short-haul pilots reported, and makes comparisons between low-cost and scheduled airline pilots. METHODS: Pilots completed anonymous questionnaires (encompassing aviation factors, flight experience and a fatigue scale) posted on the Professional Pilots' Rumours Network website. RESULTS: Data were collected from 162 short-haul pilots and statistical adjustment for operational factors was made. Seventy-five percent reported severe fatigue and 81% reported the fatigue to be worse than 2 years ago. Eighty percent considered their thought processes were reduced while flying. Severe fatigue was reported more frequently by low-cost airline pilots than scheduled airline pilots (P = 0.05) and fatigue ratings were higher in this group (P = 0.03). Pilots who reported regularly flying into their 'discretion' hours had lower physical and psychological health, and overall fatigue scores, and poorer self-rated general health. Flying into discretion time occurred no more frequently in low-cost airline pilots than scheduled airline pilots. CONCLUSIONS: Identifiable fatigue problems are reported by short-haul pilots, but this cannot be attributed solely to the work schedules of low-cost airlines as regular use of discretion time appears to be associated with fatigue regardless of airline.     

Cancer incidence among Norwegian airline pilots

OBJECTIVES: In this retrospective cohort study, the cancer incidence of commercial pilots was studied to determine whether exposure at work has any influence on the incidence of cancer. METHODS: The cohort was established from the files of the Civil Aviation Administration and included people who had valid licenses as commercial pilots between 1946 and 1994. Basic data about their flight careers were recorded, and exposure to cosmic radiation was estimated. The cohort was linked to the Cancer Register of Norway. The observed number of cases was compared with that expected based on national rates. RESULTS: A group of 3701 male pilots was followed over 70 560 person-years. There were 200 cases of cancer versus 188.8 expected, with a standardized incidence ratio (SIR) of 1.06 and a 95% confidence interval (95% CI) of 0.92-1.22. No significant decreased risk was found for any cancer site. Excess risks were found for malignant melanoma (22 cases SIR 1.8, 95% CI 1.1-2.7) and nonmelanoma skin cancer (14 cases, SIR 2.4, 95% CI 1.3-4.0). For malignant melanoma, there was a significant trend for the SIR by cumulative dose. CONCLUSIONS: For most cancer sites, the incidence among pilots did not deviate from that of the general population and could not be related to block hours of flight time or dose. It seems more likely that the excess risks of malignant melanoma and skin cancer are explained by factors related to life-style rather than by conditions at work.     

Epidemiologic studies of pilots and aircrew

During flight, pilots and cabin crew are exposed to increased levels of cosmic radiation which consists primarily of neutrons and gamma rays. Neutron dosimetry is not straightforward, but typical annual effective doses are estimated to range between two and five mSv. Higher dose rates are experienced at the highest altitudes and in the polar regions. Mean doses have been increasing over time as longer flights at higher altitudes have become more frequent. Because there are so few populations exposed to neutrons, studies of airline personnel are of particular interest. However, because the cumulative radiation exposure is so low, statistical power is a major concern. Further, finding an appropriate comparison group is problematic due to selection into these occupations and a number of biases are possible. For example, increased rates of breast cancer among flight attendants have been attributed to reproductive factors such as nulliparity and increased rates of melanoma among pilots have been attributed to excessive sun exposure during leisure time activities. Epidemiologic studies conducted over the last 20 y provide little consistent evidence linking cancer with radiation exposures from air travel.     

构建全面建设小康社会卫生指标体系的一些基本思考和方法

改革开放以来我国的国民经济和社会发展进入了全新的历史时期,上世纪末完成了经济发展翻两番的战略目标,人民生活总体上达到了小康水平[1]。党的十六大进一步提出了“新三步”走的战略目标,2020年把我国全面建成更高水平的小康社会,进入中上等收入国家水平[2],这是一个惠及整个中华民族的伟大目标,符合我国的国情和现代化建设的实际与人民愿望。十六大文件在阐述全面建设小康社会战略目标的同时,明确提出全民族“健康素质”的概念,且把健康素质和思想道德素质、科学文化素质并列,充分说明了重视并提高健康素质在总目标中的重要地位。全面建…