The objective of the authors is to apply the control chart, a statistical method for quality control used in industry, to public health surveillance. A pilot study was conducted during the 1998 World Football Cup (WFC) by 553 sentinel general practitioners (GPs) throughout France. The average number of cases of communicable, environmental and societal diseases relating to mass gatherings, and the total number of referrals to hospital reported daily by a GP, were plotted on a u-chart for each condition monitored. This average was beyond the statistical control limits if it fell outside the 99.7% confidence interval of the baseline incidences estimated before the WFC. Seven hundred and forty data points representing 262 279 medical encounters were plotted. Nineteen points exceeded the statistical control limits. None of these alerts was confirmed for two consecutive days. Control charts ensured that the level of the items chosen for general community health surveillance remained under control. 相似文献
Background Recent observations established the role of altered cellular immunity and autoimmune hypothesis in the pathogenesis of vitiligo. There have been several reports discussing T‐cell and natural killer (NK) cell populations, but NK cell receptors were not evaluated in vitiligo. Objective The purpose of this investigation was to assess the role of T and NK cells as well as activatory and inhibitory NK cell receptor alterations in the pathogenesis of vitiligo and whether any aberrations were correlated with clinical findings of the disease. Patients/methods Fifty‐three patients with non‐segmental vitiligo and 45 age‐ and sex‐matched healthy controls were enrolled in the study. The percentages of lymphocytes, granulocytes, monocytes and CD3, CD4, CD8, CD14, CD16, CD56, CD45, CD45RA, CD54RO, CD28, CD80, CD94, CD158a, KIR3DL‐1 receptors as well as CD94, CD158a, KIR3DL‐1 receptors on CD16+ cells were detected by using flow cytometry. The patient and control groups were compared in terms of the results of flow cytometric analysis, and the results were assessed regarding the type and activity of vitiligo. Results The percentages of CD16+CD56+, CD3+CD16+CD56+, CD8+ and CD45RO+ cells were significantly increased in vitiligo group compared with the controls. No difference was detected between the patients and control groups in percentages of CD3+, CD4+, CD3?CD16+CD56+, CD28+, CD45+, CD45RA+, CD94+, CD158a+ and KIR3DL‐1+ cells. The percentage of CD16+CD158a+ cells was significantly decreased in a randomized selected group of vitiligo patients. There were no differences in percentage expression of studied cell surface antigens between patients in the active or stable period. CD3+ cells were significantly increased in generalized form, and CD45RO+ cells were significantly increased in acral/acrofacial form when compared with the other types of vitiligo. Conclusions These results indicate further evidence for T and NK cell abnormalities in non‐segmental vitiligo. The present data show that NK cell activation may be responsible in the pathogenesis of vitiligo in conformity with decreased inhibitory and increased activatory NK cell receptors. 相似文献
Non-invasive positive pressure ventilation (NPPV) has been used as an alternative strategy to provide ventilatory support for patients with acute respiratory failure. Most studies demonstrate that the use of NPPV in acute respiratory failure results in a reduction in the need for endotracheal intubation and an overall survival advantage. However, current evidence, in the form of randomized controlled trials, suggests that these benefits may be restricted to patients suffering from acute exacerbation of chronic obstructive pulmonary disease (COPD).
The clinical application of NPPV involves the development of competence in delivering the particular intervention. Clinical outcomes and thus valid comparisons with alternate methods of ventilatory support can only be made if attention is paid to the clinical indications for the application of NPPV and patient subgroups it is used to treat and the level of competence of care givers in its application and delivery. One essential element of competence is the establishment of an appropriate knowledge base and the development of clinical practice guidelines. This literature review identifies the current indications for NPPV and the relevant information for developing clinical practice guidelines for the management of this form of ventilatory support. 相似文献
This study aims to assess the association of sunlight exposure with breast cancer risk, measured by the breast density assessed from Tabár''s mammographic pattern in Chinese women.
Methods
A total of 676 premenopausal women were recruited to participate in this study, in which 650 completed a validated sunlight exposure questionnaire via telephone. The mammograms were classified according to Tabár''s classification for parenchyma, and patterns IV & V and I, II & III indicated respectively high and low risk mammographic patterns for breast cancer. The odds ratios (OR) and 95% confidence intervals (CIs) for sun exposure-related variables were estimated using unconditional logistic regression with adjustment for potential confounders.
Results
Among 646 participants, women with high breast cancer risk (Tabár''s patterns IV &V) had less hours spent in the sun than those with low risk (I, II & III) at any age stage. A higher level of sunlight exposure was associated with a significantly lower risk having high risk Tabár''s pattern. Women aged 40 to 44 years who were in the highest tertile of lifetime total hours spent in the sun had a multi-adjusted OR of 0.41 (95% CI, 0.18-0.92; p for trend=0.03) compared with those in the lowest tertile (>2.19 hr/day vs. <1.32 hr/day). For hours spent in the sun across the ages of 6 to 12 years, the comparable OR was 0.37 (95% CI, 0.15-0.91; p for trend=0.03).
Conclusion
These findings suggest that higher sunlight exposure is related to a lower risk of having high risk breast density pattern in premenopausal women. Our results also suggest the most relevant period of exposure is during earlier life. 相似文献