Construct Validity of the EQ-5D in Low-Income Chinese American Primary Care Patients

OBJECTIVES: Although the EQ-5D has been used with increasing frequency to measure health-related quality of life, to date, the measure's validity has not been examined in Chinese American immigrants. We evaluated the construct validity of the EQ-5D by testing its performance with respect to sociodemographic and clinical characteristics of the population and comparing responses on the EQ dimensions with the SF-36 subscales. METHODS: The study surveyed low-income Chinese patients attending a community health center in New York City's Chinatown. Participants received self-administered versions of the EQ-5D and SF-36 and additional questions regarding demographic and clinical information. RESULTS: 856 patients were approached and data were collected from 523 patients (61%). Analysis of the EQ-5D responses by sociodemographic and clinical variables found significant differences among categories of age, gender, marital status, number of medical problems, self-rated health, and specific medical problems. Correlations between similar dimensions and subscale scores were stronger between the two measures than dissimilar ones. Patients without impairments on a given EQ dimension tended to have higher SF-36 subscale scores than patients reporting 'any' impairment (i.e. some/moderate or severe). CONCLUSIONS: The results provide initial support for the construct validity of the EQ-5D in our sample. Further studies should compare the performance of the EQ-5D with other preference-based measures in Chinese persons and examine the valuations that both low-income and Chinese persons place on core aspects of health.     

How well do parents know their children? implications for proxy reporting of child health-related quality of life

OBJECTIVES: This study examined parental knowledge of their children's oral-health-related quality of life (OHRQoL) (Objective 1), and the effects of different analytical techniques to manage 'Don't know' (DK) responses on the validity and reliability of the questionnaire (Objective 2) and the level of agreement between parental and child reports (Objective 3). METHODS: The parental (PPQ) and child (CPQ11-14) components of the Child Oral Health Quality of Life Questionnaire were used. Objectives 1 and 2 were addressed in the study that involved 221 parents and Objective 3 in the study that involved 63 pairs of parents and children. Four methods for treating DK responses in the PPQ were tested: listwise deletion, item mean imputation, imputation of the value zero and adjustment of scores to account for items with DK responses. RESULTS: Respectively, 26 and 11% of the parents gave > or = 3 and 6 > or = DK responses to 33 items comprising the PPQ. DK responses were associated with child's age and clinical condition, and parental gender. The methods of managing DK responses did not have differing effects on the measurement properties of the PPQ and the level of agreement between parents and children. CONCLUSION: Some parents have limited knowledge concerning their children's OHRQoL. However, given that parental and child reports are measuring different realities, information provided by parents is useful even if it is incomplete.     

Risk management and system failure analysis in mental health investigations

This editorial explores the way in which mental health investigations are developing in England and in particular those involving a homicide. A move away from traditional panel inquiries and towards investigations using root cause analysis (RCA) is aimed at shifting the focus from individual blame to identifying system failure. Thus it is envisaged by policy makers that the RCA approach will offer greater learning opportunities for mental health services. The key difficulties associated with panel inquiries are highlighted before describing the intended benefits of the RCA approach. Finally, five key areas where systematic research can support the development of this approach are suggested.     

牛奶及奶制品中兽药残留的监控

在食品安全领域中，兽药残留控制计划程序是一新的管理模式。本文较全面系统地阐述了食源性动物兽药的应用特点；制定监控计划的基本原则；主管机构、生产企业及检测实验室的主要责任；监控结果及反馈控制程序；监控样品抽取及传递程序；监控检测实验室及管理等各主要环节的制定原则及实施要点。为牛奶及奶制品中兽药残留监控计划的科学制定提供了系统的参考依据。     

非典后的启示--必须高度重视社会经济的协调发展

作者结合非典疫情及其它公共卫生问题对社会造成的影响 ,对如何促进社会经济的协调发展进行了探讨     

Sorting the hype from the facts in testicular cancer: is testicular cancer related to trauma?

PURPOSE: The rate of testicular cancer is increasing. Trauma severe enough to cause testicular atrophy is a putative risk factor for testicular cancer but the epidemiological evidence is not conclusive. A population based, multicenter case-control study was performed from 1995 to 1997 to investigate potential risk factors for gonadal and extragonadal germ cell cancer. MATERIALS AND METHODS: The study was done in 5 German regions. Interviews were performed with 269 eligible male patients with a histologically verified diagnosis and 797 controls. Detailed information on medical and family history was collected at personal interviews. RESULTS: We identified a significantly elevated risk for testicular cancer in relation to testis and/or groin trauma (odds ratio 2.5, 95% confidence interval [CI] 1.51 to 4.20). After introducing a lag time by excluding reports of trauma within the last 12 months before diagnosis or interview the corresponding odds ratio was 2.1 (95% CI 1.24 to 3.61). Analysis of the circumstances and the reported types of injury allowed us to restrict the study to testis trauma specifically, which had an odds ratio of 3.49 (95% CI 1.78 to 6.81). To account for a potential reporting bias analysis was restricted to traumatic episodes for which medical attention was sought. This restriction resulted in an odds ratio of 0.70 (95% CI 0.19 to 2.63) after excluding from study trauma reports within the last 12 months. CONCLUSIONS: The results of our study do not support the hypothesis that testicular trauma is an important risk factor for testicular cancer. The possibility of recall bias should be considered.     

单侧开颅额部大脑镰切开救治双额叶挫裂伤的疗效分析

目的评价单侧开颅额部大脑镰切开救治双额叶挫裂伤的疗效优点。方法回顾性分析了2000-01～2004-01行手术救治的双额叶或双额+一侧颞叶挫裂伤76例。其中A组36例,行单侧开颅大脑镰下切开术;B组40例,双额开颅手术。结果A组患者死亡率、致残率、平均手术时间、输血量、住院费用明显低于B组患者,二组有显著性差异(P<0.05)。结论单侧开颅额部大脑镰切开救治双额叶挫裂伤能能显著降低重型颅脑损伤患者的死亡率和致残率,明显减少手术时间、输血量及住院费用,具有较好的临床实用价值。     

难辨梭状芽孢杆菌致伪膜性肠炎的诊治现状

引起伪膜性肠炎的主要致病因素为难辨梭状芽孢杆菌,该病症可表现为轻微的水泻或致命性肠炎,临床对该病的诊断主要基 于对难辨梭状芽孢杆菌产生的A毒素和B毒素的检测,甲硝唑或万古霉素临床治疗该病被证实是有效的。     

脊柱椎弓根螺钉入路及手术方法的临床应用

目的：探讨椎弓根螺钉最佳入路及手术步骤。方法：对104例胸腰椎骨折脱位患者，分两组采用不同方法、步骤钻入椎弓根螺钉，并对其进行疗效比较。结果：经过技术改进后的方法较传统方法对骨折脱位的复位效果无明显差异，而两者在X线曝光次数、手术时间、出血量及并发症等方面存在显著性差异。结论：技术改进后的椎弓根螺钉进钉方法简单、安全、创伤小、疗效优良。