Development and evaluation of a breast cancer prevention decision aid for higher-risk women

Objective To develop and evaluate the effectiveness of a breast cancer prevention decision aid for women aged 50 and older at higher risk of breast cancer. Design Pre‐test–post‐test study using decision aid alone and in combination with counselling. Setting Breast Cancer Risk Assessment Clinic. Participants Twenty‐seven women aged 50–69 with 1.66% or higher 5‐year risk of breast cancer. Intervention Self‐administered breast cancer prevention decision aid. Main outcome measures Acceptability; decisional conflict; knowledge; realistic expectations; choice predisposition; intention to improve life‐style practices; psychological distress; and satisfaction with preparation for consultation. Results The decision aid alone, or in combination with counselling, decreased some dimensions of decisional conflict, increased knowledge (P < 0.01), and created more realistic expectations (P < 0.01). The aid in combination with counselling, significantly reduced decisional conflict (P < 0.01) and psychological distress (P < 0.02), helped the uncertain become certain (P < 0.02), and increased intentions to adopt healthier life‐style practices (P < 0.03). Women rated the aid as acceptable, and both women and practitioners were satisfied with the effect it had on the counselling session. Conclusion The decision aid shows promise as a useful decision support tool. Further research should compare the effect of the decision aid in combination with counselling to counselling alone.     

Intensive retreatment of adults and children with acute lymphoblastic leukemia.

Twenty-three patients (16 adults) failing their first or subsequent (n = 8) intensive treatment for de novo acute lymphoblastic leukemia (ALL) and chronic myeloid leukemia lymphoid blast phase (n = 2) were managed with protocol POG 8201, originally introduced in relapsed ALL of childhood. In this programme, a four-drug induction phase is followed by early consolidation with teniposide-cytarabine, intrathecal chemotherapy, continuation weekly chemotherapy alternating teniposide-cytarabine with vincristine-cyclophosphamide, and periodic reinduction courses. Fourteen adults and five children with ALL achieved a complete response (CR) (86 per cent). The highest response rate (100 per cent) was obtained in 12 patients treated at first relapse after an initial CR of greater than 18 months (p = 0.07). Median duration of CR was 8 months in adults and 11 months in children. A longer than previous one CR (inversion) was obtained in four cases. Four ALL patients were successfully transplanted from a matched sibling after 3-11 months from achievement of CR. Median overall survival in adults with ALL was 11 months, significantly longer than for 40 comparable cases treated intensively but without rotational continuation therapy in previous years (p less than 0.001). This regimen is applicable to adults with relapsed ALL, where prolongation of survival may allow time for effective salvage with bone marrow transplantation.     

Permissive Hypercapnia and Intravascular Oxygenator in the Treatment of Patients with ARDS

Abstract: This open clinical study was aimed at testing the hypothesis that an intravascular oxygenator (IVOX) may help to perform permissive hypoventilation in 10 patients with severe ARDS. After initial evaluation, we tried to reduce ventilator settings before and after IVOX implantation. Before IVOX, poor clinical tolerance and worsening oxygenation did not allow for a significant decrease in ventilator settings. With IVOX, peak inspiratory pressure (PIP) was reduced from 47 to 39 cm H₂O (p = 0. 005) and minute ventilation from 13 ± 3. 5 to 11 ± 3 L/min. CO₂ removal by IVOX allowed a significant decrease in Paco₂ from 66 ± 15 to 59 ± 13 mm Hg. Improvement of oxygenation with IVOX was not signify cant. Furthermore, interruption of oxygen flow through IVOX did not change oxygenation variables. Tolerance of the IVOX device was good, but insertion of the device was followed by a significant decrease in both cardiac index and pulmonary wedge pressure. In conclusion, IVOX improves tolerance of hypoventilation by limiting hypercapnia in ARDS patients. These preliminary results must be confirmed by a randomized controlled study     

师范大学学生艾滋病知识现况调查及健康教育近期效果评价

目的 了解师范大学学生艾滋病相关知识及行为现状，为高校制定艾滋病健康教育规划提供参考。方法 抽取天津师范大学2000年入学新生，通过集体讲座，使用统一的调查问卷在教育前后分别调查学生艾滋病相关知识及态度，并利用EPIinf0软件进行分析。结果 天津师范大学一年级学生健康教育后对艾滋病性质、主要传播途径等的正确回答率都有所提高，能够正确对待艾滋病病毒感染者，教育前后学生对性行为的态度无明显改变。学生希望获得艾滋病知识的前4位方式均为电视、报刊书籍、卫生课和医生。结论 从国情和现实需要出发，在大学生中开展适时、适度、适量的性健康教育和健康行为教育，对预防性病艾滋病有着积极的意义。     

An analysis of paediatric diagnostic decision-making: how should students be taught?

This study assesses the relative importance of history, examination and investigations in paediatric diagnosis, in the Paediatric Out-patient Department of the Central Middlesex Hospital, London, by means of a questionnaire-based record of 94 consecutive referrals. A diagnosis identical to the final diagnosis was made in 76% of referrals after taking a history. The general practitioner had proposed a diagnosis in 45% in the referral letter. Clinical examination changed the diagnosis in only 15% but increased diagnostic confidence in 33%. Ninety-one per cent of cases were diagnosed without recourse to investigations. Forty-two per cent of children referred had investigations performed. In the majority of paediatric cases the provisional diagnosis reached after taking a history was identical to that after examination or results of investigations were known. Although examination provided a final diagnosis in only 15% of all cases it played an important role in adding confidence in 33%. More educational effort should therefore be directed at clinical history-taking skills and the subsequent purpose of examination.     

社区居民健康相关行为讨论与分析

目的了解当前社区居民中健康认知和主要健康相关行为，为深入开展健康教育提供科学依据。方法对黄浦区8个街道117个居委2546名居民分别召开座谈会，讨论并分析健康认知与健康相关行为。结果在2546名居民中对健康有正确认识的948人，占37．2％．自我评价身体状态为健康的531人，占20．9％，个人不健康行为位于前三位的是吸烟、不合理膳食和缺乏运动。团体不健康行为位于前三位的是出售不健康食品、食品污染和公共场所脏乱。结论健康相关行为受多因素及其多水平的影响，必须运用健康教育行为改变理念，采纳健康相关行为的生态学的观点，结合相关学科的方法，开展健康教育，促进人们的健康行为。     

嘉兴外来人员生活环境与肠道传染病相关知信行现况调查分析

目的了解城郊结合部外来人员聚集地生活环境现况和霍乱等肠道传染病健康知信行情况,进一步明确肠道传染病防治健康教育与健康促进工作的重点开展方向。方法采用随机抽样的方法,运用统一设计的调查问卷对嘉兴市5县2区城郊结合部等外来人员聚集地进行流行病学调查。结果93.06%的调查对象以租房为主,90.61%的生活用水来源于自来水,9.25%用井水;78.61%的人知道霍乱传播途径,21.53%的人知道霍乱主要临床症状,28.03%的人知道肠道传染病全部预防措施;77.31%的知识来源于电视,其他顺位依次为书刊、广播、家人或朋友处;希望获得宣传资料形式:传单占46.68%,墙报占31.21%。结论外来人员租房人数居多,有部分人使用井水;肠道传染病相关知识了解的较少。应采取多部门齐抓共管来改善外来人员聚集地的生活环境,因地制宜地对外来人员开展有针对性的预防肠道传染病健康教育。     

预防艾滋病健康教育媒体材料效果评价比较研究

目的评价4种预防艾滋病健康教育媒体材料的信息传播效果和材料效果。该材料由课题组于2003-2005年间设计制作，包括“艾滋病知识”折页、“了解艾滋病”海报、“预防艾滋病健康教育手册”和“认识艾滋病”宣教片等4种。方法2005年12月在珠海市选取小学以上文化程度的18～60岁外来工为测试对象，随机分组对4种材料分别进行评价，各调查了251、248、257和252人，共1008人。通过问卷调查了解受访者的一般情况和对材料信息的可接受性、通俗性和材料形式的生动性等8项指标的评价，采用分级定量赋分的方法进行量化评分，采用SPSS10．1统计软件进行统计分析、比较。结果4种材料的信息传播效果和材料效果总得分平均值分别为74．2±15．0、77．7±13．5、73．0±13．8和77．2±13．6，得分最高的是海报，为77．7±13．5分，最低的是手册，为73．0±13．8分，差异有统计学意义，这种差异主要体现在信息传播效果的差异，而材料效果的差异无统计学意义。通俗性、简明性、生动性和可接受性是影响得分高低的主要因素。结论海报是最适合用于城市外来工进行预防艾滋病健康教育的传播材料，其次是宣教片。     

Graduate Education in the Field of Substance Abuse

Abstract: Twenty-six part-time students from a variety of professional backgrounds are enrolled in the first year of a Graduate Diploma in Social Science (Drug Dependence) at the Phillip Institute of Technology in Victoria. The course is conducted under the auspices of the School of Social Work and commenced in 1984. It is argued that the graduates from this unique course could play a key role in providing personnel to fill positions in the areas of clinical work, staff development, drug education, programme development and management and research.