区域协同医疗服务体系创新战略研究

为制定区域协同医疗服务体系创新战略,应用系统论和协同论观点,将区域协同医疗服务体系的创新从横向和纵向进行划分。横向上分为以区域创新为主的支撑保障层、以自主创新为主的核心动力层和以模式创新为主的外在表现层;纵向上分为创新要素层和实施操作层。构建以信息技术为支撑的区域协同医疗服务体系必须将自主创新、模式创新和区域创新作为战略取向。这是消除医疗信息孤岛、促进区域协同医疗服务体系长期可持续发展的必由之路。     

腧穴主治标准化研究的关键问题

本文分析了影响腧穴主治标准化研究的3个关键难题:文献的鉴别与选择、文献的综合利用及腧穴主治的筛选,并通过具体的实例提出了处理这类问题的原则与方法。     

中国制药业发展趋势分析

我国制药企业并购浪朝高涨，药品价格处于下行通道，现代生物技术药挑战化学药地位，非处方药快速发展，化学制剂增长稳定，化学原料药增长趋缓，仿制药、传统中药面临大的发展空间，对制药企业既是机遇也是挑战。现对我国制药业的发展趋势作一分析。     

Update of a study of crude oil production workers 1946-94

OBJECTIVE—To update information on workers in the petroleum industry engaged in the production of crude oil to determine whether the patterns of mortality have changed with 14 additional years of follow up.
METHODS—All workers were employed at company production and pipeline locations sometime during 1946-94. The cohort now consists of 24 124 employees with an average of 22 years of follow up.
RESULTS—The overall mortality, and most cause specific mortalities were lower than or similar to those for the general United States population. For white men (81% of the cohort), there were 4361 observed deaths and 5945 expected, resulting in a significantly lower standardised mortality ratio (SMR) of 73. There were significant deficits for all the leading causes of death in the United States including all cancers, cancer of the lung, stroke, heart disease, respiratory disease, and accidents. Slightly increased mortality was found for cancer of the prostate, cancer of the brain and central nervous system, and cancer of other lymphatic tissue. For benign and unspecified neoplasms, the SMR was 152 (95% confidence interval (95% CI) 95 to 230). There was a significant increase for acute myelogenous leukaemia that was restricted to people who were first employed before 1940 and who were employed in production and pipeline jobs for >30 years. Overall mortality patterns for non-white men and women were similar to those for white men. Mortality patterns for white men were also examined by duration of employment, time first employed, and by job group.
CONCLUSIONS—The results of the updated study showed a favourable mortality experience for crude oil production workers compared with the United States population.


Keywords: petroleum industry; occupational cancer; mortality; crude oil     

化工废水非挥发性有机污染物致突变性的研究

本研究采用大孔树脂富集四种化工废水中非挥发性有机物，通过Ａｍｅｓ，ＳＯＳ、鱼类血细胞微核率三种生物试验方法检验其致突变性；结果表明，四种化工废水均含有致突变物，其中以炼油、印染两种废水的致突变性最强。     

Impact of the Pick the Tick food information programme on the salt content of food in New Zealand

The Pick the Tick programme of the National Heart Foundation of New Zealand aims to provide a framework for cooperation with the food industry to improve nutrition labelling and to develop a healthy food supply. Food manufacturers, whose products meet defined nutritional criteria, are able to display the Pick the Tick logo on food labels. The tick is used by 59% of shoppers in assisting them make healthy food choices. Food companies are encouraged to reformulate product composition if they fail to meet criteria and develop new products to specifically meet the Pick the Tick criteria. The objective of this study was to evaluate the impact of the programme on food formulation. The main outcome measure was the amount of salt not added to food products. Changes to sodium levels were multiplied by the volume of sales and then converted to salt in tonnes to provide a tangible measure of the impact of the programme. In a 1-year period, July 1998 to June 1999, Pick the Tick influenced food companies to exclude approximately 33 tonnes of salt through the reformulation and formulation of 23 breads, breakfast cereals and margarine. Breakfast cereals showed the largest reduction in sodium content by an average of 378 mg sodium per 100 g product (61%). Bread was reduced by an average of 123 mg per 100 g product (26%) and margarine by 53 mg per 100 g (11%). Pick the Tick appeals to the food industry as a tool for marketing food products and has provided an incentive to improve the nutritional value of foods. The tick on approved products not only acts as a 'nutrition signpost' for consumers but can also significantly influence the formulation of products without sacrificing taste or quality.     

Health interventions for the metal working industry: which is the most cost-effective? A study from a developing country

This study ranked the cost-effectiveness of health interventions in the metal working industry in a developing country. Data were based on 82 034 workers of the Northern region of Mexico. Effectiveness was measured through 'healthy life years' (HeaLYs) gained. Costs were estimated per worker according to type and appropriate inputs from selected health interventions. 'Hand' was the anatomical region that yielded the most gain of HeaLYs and amputation was the injury that yielded the most gain of HeaLYs. The most effective health intervention corresponded to training, followed by medical care, education, helmets, safety shoes, lumbar supports, safety goggles, gloves and safety aprons. In dollar terms, education presented the best cost-effectiveness ratio (US$637) and safety aprons presented the worst cost-effectiveness ratio (US$1 147 770). Training proved to be a very expensive intervention, but presented the best effectiveness outcome and the second best cost-effectiveness ratio (US$2084). Cost-effectiveness analyses in developing countries are critical. Corporations might not have the same funds and technology as those in developed countries or multinational companies.     

Clinical examinations to validate self-completion questionnaires: dermatitis in the UK printing industry

A self-completion questionnaire sent to 2600 Nottinghamshire members of the Graphical Paper and Media Union elicited a 62% response. Forty one per cent of respondents reported suffering a skin complaint at some time and 11% had a current skin problem on the hand. This paper reports the validation stage of the study. Samples of 45 'cases' of self-reported dermatitis and 60 'controls', who reported they had never suffered a skin complaint, were clinically examined. All 45 self-reported cases were clinically confirmed as dermatitis. Occupationally related irritant contact dermatitis (ICD) was diagnosed in 20 (44%); 26 (58%) complaints were thought to be induced or exacerbated by occupation. Of the controls, 21 (35%) were also diagnosed with a skin complaint, the majority being mild, with an occupational association in 17, the majority (15) being ICD. Sixteen ICD cases were patch tested resulting in positive reactions to colophony, neomycin, nickel and potassium dichromate (2 of each). Two cases of basal cell carcinoma on the face were also identified, of which the participants were unaware. Although there was no false positive self-reporting there was a considerable number of false negatives, demonstrating the importance of clinical validation of questionnaires relating to industrial skin disease. This study has highlighted the need for improvement in skin care provision in the printing industry.