上海市青浦区噪声作业人员听力状况分析

目的 了解近3年青浦区噪声作业人员的听力变化趋势,为预防职业性噪声聋提供依据。方法 收集2018-2020年青浦区噪声作业人员在岗期间的听力数据,并运用SPSS软件进行统计分析。结果 噪声作业人员的双耳高频平均听阈升高率2018-2020年分别为6.09%、5.16%、3.06%,呈逐年降低趋势(P<0.01);男性升高率高于女性(P<0.01);随着年龄、工龄的增加,升高率呈现增高趋势(P<0.01)。双耳高频平均听阈升高率位于前三的行业分别为建筑业(28.57%)、租赁和商务服务业(18.72%)以及批发零售业(13.89%)。结论 噪声作业人员的职业病防控工作仍不可放松,应及时对噪声作业重点人员进行有针对性的干预。     

焦虑水平与应付方式关系的初步研究

目的 探求学生焦虑水平与应付方式的关系。方法 用一般焦虑问卷（GAT）和应对方式问卷测查某中学初二学生共116名。结果 解决问题的应付方式和焦虑总水平及对人不安、身体征候、恐惧倾向三个焦虑分量表呈显著负相关;自责、幻想、退避和合理化的应付方式与焦虑水平之间存在显著正相关;而求助和焦虑总水平及各个焦虑分量表之间不相关或相关很小。结论 焦虑水平与应付方式之间关系密切,应付方式不同,焦虑水平就可能不同,为了降低焦虑水平,应掌握有效的应付方式。     

厦门市1993～2000年儿童死因动态及生存水平分析

目的　了解厦门市 5岁以下儿童死因变化及生存水平 ,提高儿童的生命质量及医疗保健服务水平。方法　通过市、区、街道 (乡 )妇幼保健三级网及儿童生命监测系统收集资料 ,对 1993～ 2 0 0 0年厦门市 5岁以下儿童死亡监测情况统计分析。结果　 5岁以下儿童死亡率呈逐年下降趋势 ,1993年为 2 7 88‰ ,2 0 0 0年为 11 6 6‰ ,(X2 =80 0 0 ,P <0 0 1)。厦门市 1993～ 2 0 0 0年 5岁以下儿童主要死因为肺炎、出生窒息、早产、先天畸形、腹泻 ,肺炎和腹泻呈下降趋势 ,早产、出生窒息、先天畸形呈上升趋势 ,其中先天畸形上升较明显。儿童死前均得到相应的医疗保健服务 ,死前就医、死前明确诊断、死于医疗保健机构者均达 90 %以上。结论　厦门市 5岁以下儿童死亡率逐年下降 ,已达到《九十年代中国儿童发展规划纲要》的要求。提高医疗保健机构的诊治水平和服务水平是社会的需求 ,也是提高儿童生存水平的措施之一 ,全社会都应重视这项工作。     

基层医院使用国产造影剂做静脉肾盂造影时毒副反应控制对策

目的:为了减少基层医院使用国产造影剂做IVP检查时毒副反应的发生。方法:对57例行IVP检查的患者进行认真细致的毒副反应发生情况的观察。结果:只要操作者思想上重视、技术上熟练,毒副反应将得以有效控制。结论:基层医院完全没有必要因担心毒副作用的发生而放弃IVP检查技术。     

What is the Level of Evidence Substantiating Commercial Payers’ Coverage Policies for Total Joint Arthroplasty?

BackgroundThe prevalence of total joint arthroplasty (TJA) in the United States has drawn the attention of health care stakeholders. The payers have also used a variety of strategies to regulate the medical necessity of these procedures. The purpose of this study was to examine the level of evidence of the coverage policies being used by commercial payers in the United States.MethodsThe references of the coverage policies of four commercial insurance companies were reviewed for type of document, level of evidence, applicability to a TJA population, and success of nonoperative treatment in patients with severe degenerative joint disease.Results282 documents were reviewed. 45.8% were primary journal articles, 14.2% were level I or II, 41.2% were applicable to patients who were candidates for TJA, and 9.9% discussed the success of nonoperative treatment in patients who would be candidates for TJA.ConclusionMost of the references cited by commercial payers are of a lower level of scientific evidence and not applicable to patients considered to be candidates for TJA. This is relatively uniform across the reviewed payers. The dearth of high-quality literature cited by commercial payers reflects the lack of evidence and difficulty in conducting high level studies on the outcomes of nonoperative versus operative treatment for patients with severe, symptomatic osteoarthritis. Patients, surgeons, and payers would all benefit from such studies and we encourage professional societies to strive toward that end through multicenter collaboration.     

Impacto del nivel socioeconómico sobre el perfil del paciente amputado de miembro inferior por causa no traumática

IntroductionTo analyse the influence of socioeconomic status on the clinical profile of patients undergoing non-traumatic lower-limb amputation.MethodsRetrospective study of 697 lower-limb amputee patients in an Angiology and Vascular Surgery Department during a 5-year period. Patients were classified according to their socioeconomic status (low, medium and high). We analysed demographic (age and gender) and clinical variables (cause of amputation, comorbidity, cardiovascular risk factors and amputation level).ResultsMean age was 70.5 ± 11.9 years, and the median was 72 years. The low socioeconomic status group presented a higher frequency of amputations in men. Cardiovascular risks factors were more frequent in this socioeconomic group, and the difference was statistically significant for diabetes (85.8% low, 69.3% medium, 65% high; P<.01) and obesity (31.4% low, 22.6% medium, 12.5% high, P<.01). Diabetic retinopathy was the only comorbidity with a significant association with low socioeconomic status (21.1% low, 15.3% medium, 12.5% high, P<.03). Regarding the cause for amputation, there was no difference in terms of socioeconomic status. The low socioeconomic level showed a higher frequency of major amputation, which was a significant difference (63.6% low, 41.2% medium, 55% high, P<.04) and a higher predisposition for this amputation level.ConclusionsThe low socioeconomic status has been shown to determine an unfavourable vascular risk profile in lower-limb non-traumatic amputees and a higher predisposition of a major amputation. This socioeconomic level demonstrates a negative influence on these patients’ diabetes, obesity and diabetic retinopathy.     

中国9个长寿地区65岁及以上人群氧化应激水平与高甘油三酯血症的关联研究

目的探讨我国长寿地区65岁及以上老年人氧化应激水平与高甘油三酯血症的关系。方法研究对象来源于2017-2018年“老年健康生物标志物队列研究”,最终将我国9个长寿地区2393名65岁及以上老年人群纳入研究。通过问卷调查和体格检测,收集调查对象的人口学特征、生活方式及健康状况等信息,同时采集调查对象的静脉血以检测丙二醛(MDA)、超氧化物歧化酶(SOD)及甘油三酯水平。采用限制性立方样条拟合多重线性回归模型分析MDA、SOD与甘油三酯的关联,采用广义线性混合效应模型分析氧化应激与高甘油三酯血症的关联。结果2393例调查对象年龄为(84.6±11.3)岁,最小65岁,最大112岁;男性1145名(47.9%);甘油三酯水平为(1.4±0.8)mmol/L,高甘油三酯血症检出率为9.99%(239名)。限制性立方样条拟合多重线性回归模型分析结果显示,MDA水平与甘油三酯水平呈线性关联;SOD水平与与甘油三酯水平呈非线性关联。广义线性混合效应模型分析结果显示,调整相关混杂因素后,MDA每升高1 nmol/ml,高甘油三酯血症检出风险增加[OR(95%CI)值为1.063(1.046,1.081)];SOD每升高1 U/ml,高甘油三酯血症检出风险降低[OR(95%CI)值分别为0.986(0.983,0.989)]。结论我国9个长寿地区65岁及以上老年人MDA和SOD水平与高甘油三酯血症发生风险有关联。     

“医教协同”模式下专业学位硕士研究生压力感知及学术能力提升需求调查

目的 对医学专硕学术科研水平的影响因素进行调研与分析,以期为提高其学术科研水平提供参考和借鉴。方法 选取某医院正在参与住院医师规范化培训的医学专硕作为研究对象,采用问卷调查的方式对其学术水平影响因素进行调研。结果 研究生对于提升自身学术科研水平有较大的需求,且普遍存在学术科研方面的压力,随着年级的上升其压力亦明显呈上升趋势（线性χ2 = 21.624,P＜0.001）。本科的知识储备、个人英语水平、兴趣爱好对其学术科研水平均有一定影响。结论 改革创新研究生学术科研水平的培养是各大高等医学院校亟待解决的问题,研究生学术科研水平的提高,需要学生、导师与高校三者进行有机结合通力协作。