铁道车祸危险因素与行车安全经济效益的探讨

作者以1380名机车乘务员为研究对象,测查其生理心理指标,探讨发生车祸的危险因素,分析34年车祸流行的规律,并对行车安全的社会经济效盖进行了估算。研究结果显示,社会安定是减少车祸、保证行车安全的重要因素。通过多因素分析,揭示车祸的危险因素是低文化程度、过度疲劳、睡眠不足、视运动反应迟钝和弱神经类型,其间存在交互作用。实践表明,推行安全行车千日活动,可获巨大社会经济效益(1∶7)。     

Responsiveness and calibration of the general well-being adjustment scale in patients with hypertension

We examined the discriminant ability and responsiveness of the General Well-Being Adjustment Scale in patients enrolled in a randomized clinical trial of antihypertensive therapy. We also tried to translate the effects of physical symptoms on general well-being. This secondary analysis used demographic, clinical, physical symptom, and general well-being data for 545 white, male hypertensive patients. General well-being was measured by the General Well-Being Adjustment Scale (GWB) collected on 2 occasions over 8 weeks of treatment. Patients with any one of 14 physical symptoms or problems, compared to those without symptoms, had lower GWB scores (p < 0.003 to p < 0.0001). Decreases of 2.83–8.76 points in GWB scores were observed in patients developing physical symptoms over the 8 week study period (p < 0.05 to p < 0.0001). These effects were demonstrated in patients developing cold sensitivity, sexual problems, chest pain, shortness of breath, loss of taste, nausea, hot or cold spells, numbness and tingling, dry mouth, blurred vision, and dizziness. We conclude that the GWB is responsive to clinically meaningful changes in symptoms and may provide a more complete evaluation of the effects of medical treatment. The GWB is a valid and responsive measure of health status outcomes in the evaluation of antihypertensive treatment.     

Evidence for differential effects of 8-OH-DPAT on male and female rats in the Anxiety/Defense Test Battery

The Proxemics/Activity test and the Eat/Drink test, two components of the Anxiety/Defense Test Battery, were developed to measure defensive reactions to situations associated with a natural predator (cat). In the present studies the behavioral effects of 8-OH-DPAT treatment (0.01–1.0 mg/kg, SC) were entirely consistent with anxiety/fear reduction. These effects included an increase in time spent near the cat compartment, and a complimentary decrease in time spent farthest from this compartment, together with an increase in transits and locomote behavior. 8-OH-DPAT (1.0 mg/kg) also increased eat frequencies and durations (highly preferred food) both during and following cat presentation, without influencing drinking. This finding is discussed with reference to previous findings with 8-OH-DPAT in studies assessing both food intake and anxiolysis. Interestingly, 8-OH-DPAT was more potent in a majority of its effects in female subjects, a finding consistent with recent neurochemical data. These findings provide important behavioral evidence for a sexual differentiation in 5-HT function, and support the case for greater emphasis on female subjects in animal models of anxiety.Supported by NIH MH42803 and RCMI Grants RR03061 and RR01825     

道路伤害的病例对照研究

目的：探讨道路伤害危险因素。方法：采用病例对照研究方法，于2001年11月至2002年8月收集沈阳市皇姑区发生机动车交通事故的事故组驾驶员406例，并同期在皇姑区内于随机时间、随机地点调查道路上正常行驶的对照组驾驶员438名。采用统一问卷、面询方法，调查内容包括驾驶员的一般情况，连续驾驶时间，事故／调查前睡眠状况，急、慢性困倦程度(采用Stanford和Epworth困倦量表测量)，饮酒，吸烟，驾驶安全态度和行为，车速，车辆状况等。结果：处于慢性困倦状态的驾驶员发生事故的危险性是非困倦状态驾驶员的1．98倍(OR=1．98，95％CI：1．26—3．12)，事故组驾驶员的困倦程度高于对照组，但差异无显著性(OR＝2．38，95％CI：0．89—6．31)。夜班或倒班发生事故的危险是常白班的2．09倍(OR＝2．09，95％CI：1．48—2．94)，酒后驾车发生事故的危险性是非酒后驾车的3．59倍(OR＝3．59，95％CI：1．13--11．39)，无人约束时会违章的驾驶员发生事故的危险性是不违章驾驶员的1．73倍(OR＝1．73，95％CI：1．22—2．46)。结论：慢性困倦、夜班或倒班、酒后驾车、违章等是道路伤害的危险因素，急性困倦可能是道路伤害的一个潜在危险因素。     

Cardia: study design, recruitment, and some characteristics of the examined subjects

In 1984, a prospective cohort study, Coronary Artery Risk Development in Young Adults (CARDIA) was initiated to investigate life-style and other factors that influence, favorably and unfavorably, the evolution of coronary heart disease risk factors during young adulthood. After a year of planning and protocol development, 5,116 black and white women and men, age 18-30 years, were recruited and examined in four urban areas: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota, and Oakland, California. The initial examination included carefully standardized measurements of major risk factors as well as assessments of psychosocial, dietary, and exercise-related characteristics that might influence them, or that might be independent risk factors. This report presents the recruitment and examination methods as well as the mean levels of blood pressure, total plasma cholesterol, height, weight and body mass index, and the prevalence of cigarette smoking by age, sex, race and educational level. Compared to recent national samples, smoking is less prevalent in CARDIA participants, and weight tends to be greater. Cholesterol levels are representative and somewhat lower blood pressures in CARDIA are probably, at least in part, due to differences in measurement methods. Especially noteworthy among several differences in risk factor levels by demographic subgroup, were a higher body mass index among black than white women and much higher prevalence of cigarette smoking among persons with no more than a high school education than among those with more education.     

What has trust got to do with it? Cardiac risk reduction and family physicians' discussions of evidence-based recommendations

The management of patients through the use of evidence-based medicine has become the 'mantra' of medicine within many Western countries. Evidence-based medicine is aimed at providing the best objective, scientific care to all patients, and reducing as far as possible patients' risks of disease and complications from disease. Based on family physicians' discussions of the use of evidence-based recommendations for two cardiac diseases, this paper explores how subjectively-based trust enters into family physicians' decision to use evidence-based medicine. In addition, we show how trust influences physicians' work of recommending evidence-based medicine to patients, and physicians' perceptions of why patients follow recommendations aimed at risk reduction. We conclude that although much of the current discussion about evidence-based medicine assumes a 'rational' model of physician behaviour based on the application of the 'best objective scientific' results, subjectively-based perceptions of trust influence physician practices, and point to the need to understand the power of relational issues in influencing physician practices even when utilizing evidence-based knowledge.     

慢性酒精中毒酒戒断的震颤谵妄发作危险因素探析

目的探讨慢性酒精中毒患者发生震颤谵妄(DT)的高危因素。方法把148例慢性酒精中毒患者按入院后是否出现震颤谵妄分为震颤谵妄组(DT)和非震颤谵妄组(NDT),观察他们的人口学资料(如性别、年龄、民族、婚姻状态等)、饮酒依赖史(饮酒的年限、饮酒品种、饮酒量、戒酒史等)、既往史、个人史、家族史、入院时的体征和症状(包括生命体征、戒断症状等)和身体状况等项目,描绘其临床特征,并对23项变量进行Logistic回归分析,筛选出慢性酒精中毒患者发生震颤谵妄的高危险因素。结果148例慢性酒精中毒患者在住院期间发生震颤谵妄者共28例(占18.92%)。Logistic regression model结果显示慢性酒中毒者入院后发生震颤谵妄的具有显著相关意义的5个解释变量,即入院时观察指标中的急性感染疾病、心动过速、紧张焦虑状态、精神运动性兴奋和肝功能异常。结论出现震颤谵妄的慢性酒精中毒患者与未发生震颤谵妄的慢性酒精中毒患者在入院时的临床特征存在差异,对慢性酒精中毒患者入院时及之后监测急性感染疾病、心动过速、精神运动性兴奋、紧张焦虑状态和肝功能异常等5个高危因素,有利于及时有效的干预。     

不同饮水类型的若干癌症发病率研究

应用回顾前瞻性方法，在海宁市随机选择了８个乡（镇）作为研究区。１９７７至１９８８年间，研究区共有癌症病例１９８８人。研究结果示，饮用池塘水的肝、肺、胃、食道及结直肠的癌症平均发病率男女均为最高；而饮用井水的上述５种癌症的平均发病率最低。在各饮水类型问对各种癌症的平均发病率作了Ｐｏｉｓｓｏｎ检验，结果差异有统计学意义。将饮用井水作为非暴露，作相对危险度分析。表明饮用河水的ＲＲ值高达７．７９～１４．２５；饮用池塘水的ＲＲ则更高（２．５５～３６．９９）。本文揭示了不同饮水类型癌症发病率的差异及其联系。     

重庆市城市居民原发性高血压的病例对照研究

本研究采用１：４配比的方法，收集了３７０例确诊高血压病例与１４８０例对照，进行了病例对照研究。经条件ｌｏｇｉｓｔｉｃ回归模型分析发现与高血压有关的危险因素有以下五个：体重指数、吸烟年限、脉率、卫生知识水平和家族史。     

急性脑卒中患者应激性高血糖危险因素分析

目的 探讨重症监护室（ICU）急性脑卒中患者应激性高血糖的危险因素。方法对50例急性（发病5d内1非糖尿病脑卒中患者监测血糖7-14d，比较高血糖及正常血糖两组患者年龄、糖皮质激素、临床肺部感染评分等对血糖的影响。结果高血糖组临床肺部感染评分（CPIS）为4．77±2．11，显著高于正常血糖组的3．36±2．36（P〈0．05），急性生理学及慢性健康状况评分（APACHEⅡ）高血糖组为16．23＋5．40，也显著高于正常血糖组的12．43±3．83，有显著性差异（P〈0．01）。结论CHS和APACHEⅡ升高可能是ICU非糖尿病卒中后应激性高血糖的危险因素。