Work-related musculoskeletal disorders and their prevention and control / 环境与职业医学

Work-related musculoskeletal disorders (WMSDs) are chronic and cumulative disorders that are affected by multiple ergonomic factors. They are widespread in occupational populations and have a high prevalence. They have caused a substantial economic and social burden, which has become a major occupational health problem worldwide. The mechanism of WMSDs needs to be clarified. More authoritative and unified diagnostic criteria and specific therapeutic drugs are required. Therefore, an in-depth epidemiological investigation on WMSDs involving occupational ergonomics is of great scientific value and practical significance, which aims to improve hazard identification and ergonomic load risk assessment and to facilitate the prevention, control, and intervention of WMSDs. This article introduced the concept, status report, risk factors, ergonomic assessment methods, and preventive measures of WMSDs. This special column on "occupational ergonomics and work-related musculoskeletal disorders" presented the prevalence and related risk factors of WMSDs in different industries, as well as working condition simulation studies for specific tasks, aiming to provide objective and detailed scientific data for the prevention and control of WMSDs.

Advances in evaluation methods of pubertal timing in children / 中国学校卫生

Abstract@#Over the past 40 years, there has been a long term trend of early pubertal onset in children in China. Early pubertal timing is closely associated with mental health and behavioral problems in children, and can even lead to cardiovascular and metabolic diseases, cancers of the endocrine system and abnormalities of the bone and joint system in adulthood. Prompt detection of early pubertal timing in children is important. There are many methods for evaluating pubertal timing, the appropriateness of which is worth exploring. This paper reviews previous literature publications, examines current research progress in evaluation methods of pubertal timing, evaluates their applicability in the study of children and adolescents, and provides a reference for the selection of an evaluation method to assess pubertal timing in children in China.

Application and comparison of three occupational health risk assessment methods in automobile manufacturing enterprises / 环境与职业医学

Background The complex and diverse occupational disease hazards in automobile manufacturing industry pose high occupational health risks to workers. Objective To explore the methods that can accurately reflect the workplace health risk grade of automobile manufacturing enterprises, and to guide enterprises to practice risk classification management. Methods Comprehensive index method, International Commission on Mining and Metals occupational health risk assessment method (ICMM method), and risk index method were used toassess health risks of occupational disease hazards in major workstations such as welding, polishing, and painting in three automobile manufacturing enterprises in Hunan Province. Kappa consistency test was used to test the grading results of the three assessment methods. The re-examine results and detection rate of contraindications of occupational health examinations in the past three years were used to verify the assessment results. Results The results of comprehensive index method showed that the hazards of each selected workstation in enterprises A and B were evaluated as grade 2-3, among which NO2 in enterprise A was grade 3, and welding fume, NO2, and formaldehyde in enterprise B were all grade 3. The hazards of each selected workstation in enterprise C were grade 3-4, among which NO2 and benzene in were grade 4, and welding fume, manganese and its compounds, grinding wheel dust, and xylene were grade 3. The hazards evaluated by ICMM quantitative method were grade 2 and grade 5, among which manganese and its compounds in enterprise A and welding fume, grinding wheel dust, and benzene series in enterprise C were graded as grade 5. The hazards evaluated by risk index method were grade 1-4, among which manganese and its compounds in enterprises A and B were grade 3, and manganese and its compounds and benzene in enterprise C were grade 4. The Kappa value between comprehensive index method and ICMM method was 0.084 (P>0.05), that between comprehensive index method and risk index method was −0.046 (P>0.05), and that between ICMM method and risk index method was 0.014 (P>0.05), indicating poor consistency. By comparing the results of occupational health surveillance with the results of occupational health risk assessment, one worker was found to have occupational contraindication of manganese exposure and 1 worker was found to have excessive manganese in hair in enterprise A. However, the comprehensive index method graded low risk for manganese and its compounds in enterprise A and the result is conservative. The key workstations identified by ICMM method were consistent with the occupational health examination results, but the assessment grades were all extremely high risk, and the results were too strict. One worker was found to be contraindicated to welding fumes, and 2 polishers were found to have severe mixed pulmonary ventilation dysfunction in enterprise C. Mild and moderate pulmonary ventilation dysfunction was found to be common in welding and polishing workstations in each enterprise. The assessment results of welding fumes and grinding wheel dust by the risk index method were negligible risks, which were inconsistent with the occupational health examination results. Conclusion The comprehensive index method, ICMM method, and risk index method can basically identify workstations with serious occupational hazards, but they have certain limitations and applicability. In general, the evaluation results of the comprehensive index method were generates more consistent with the results with occupational health surveillance than the other two methods, is more comprehensive and objective in consideration, and is more suitable for health risk assessment of automobile manufacturing enterprises.

Clinical study on the predictive value of regional cerebral oxygen saturation for the occurrence of sepsis-associated encephalopathy / 中华危重病急救医学

Objective:To evaluate the predictive value of regional cerebral oxygen saturation (rScO 2) for the occurrence of sepsis-associated encephalopathy (SAE). Methods:The data of 94 patients with sepsis admitted to the intensive care unit of Nanjing Drum Tower Hospital from September 2019 to June 2021 were collected. The patients were divided into SAE group and non-SAE group according to the evaluation results of daily intensive care unit confusion assessment method (CAM-ICU) during ICU treatment. The general data such as age and gender of the patients, rScO 2 on 1, 2, 3, 5, and 7 days of ICU admission, and prognostics were recorded. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of rScO 2 on SAE during ICU stay. Results:All 94 patients were enrolled in the analysis, of whom 59.6% (56/94) were male, and the mean age was (50.1±15.1) years old; the incidence of SAE was 31.9% (30/94). The levels of rScO 2 within first 3 days of ICU admission in the SAE group were significantly lower than those in the non-SAE group (1 day: 0.601±0.107 vs. 0.675±0.069, 2 days: 0.592±0.090 vs. 0.642±0.129, 3 days: 0.662±0.109 vs. 0.683±0.091, all P < 0.05). However, there was no significant difference in rScO 2 level on the 5th or the 7th day between the SAE and non-SAE groups (5 days: 0.636±0.065 vs. 0.662±0.080, 7 days: 0.662±0.088 vs. 0.690±0.077, both P > 0.05). ROC curve analysis showed that 1-day rScO 2 had the greatest predictive value for SAE [1 day: area under the ROC curve (AUC) = 0.77, 95% confidence interval (95% CI) was 0.65-0.89, P < 0.01; 2 days: AUC = 0.60, 95% CI was 0.48-0.72, P > 0.05; 3 days: AUC = 0.55, 95% CI was 0.41-0.68, P > 0.05]; with 1-day rScO 2 = 0.640 as the diagnostic threshold, the sensitivity was 73.4%, the specificity was 80.0%. Compared with the non-SAE group, the length of ICU stay and hospital stay in the SAE group were significantly longer [length of ICU stay (days): 13.6±7.1 vs. 9.0±4.3, length of hospital stay (days): 20.1±8.0 vs. 15.8±6.1, both P < 0.05], but the ICU mortality between the two groups was not statistically different. Conclusions:The incidence of SAE is relatively high in ICU patients, and the occurrence of SAE can be predicted by monitoring rScO 2. The rScO 2 value on the first day of ICU admission is closely related to the occurrence of SAE, and may be the target of sepsis resuscitation to guide the treatment and improve the long-term prognosis.

Amphibians of Serra das Torres Natural Monument: a reservoir of biodiversity in the Atlantic Forest of southeastern Brazil / Anfíbios do Monumento Natural Serra das Torres: um reservatório da biodiversidade da Mata Atlântica no sudeste do Brasil

Abstract The Brazilian Atlantic Forest holds a major part of the country's amphibian species richness and high rates of endemism. In this study, we conducted surveys using the Rapid Assessment (RA) method to sample the amphibian fauna of the Serra das Torres Natural Monument (MONAST), an Atlantic Forest remnant in southeastern Brazil. We sampled actively with a 6-10-person team to collect standard samples from 09:00 to 12:00 hours for the daytime period, and from 18:00 to 22:00 hours for the crepuscular/nighttime period, with a total of approximately 1,320 hours of sampling effort. We supplemented these data with 720 hours of passive sampling, using pitfall traps with drift fences (30 bucket-days). We recorded 54 amphibian species (two gymnophionans and 52 anurans), and the species richness estimated by the Bootstrap method indicates that a slightly larger number of species (n = 60) may occur in the study area. The most speciose family was Hylidae (n = 21), followed by Brachycephalidae (n = 8). Overall, 25% of the species (n = 13) were recorded only once (singletons) and 15% (n = 8) only twice (doubletons). Most amphibians recorded in this study (71%, n = 37 species) were restricted to the Atlantic Forest biome, two species (Euparkerella robusta and Luetkenotyphlus fredi) are endemic to the Espírito Santo state, and one of them, the leaf litter species E. robusta, is endemic to the MONAST. Euparkerella robusta is currently listed as Vulnerable by the IUCN and is classified as Critically Endangered in the Espírito Santo State red list, while L. fredi has yet to be evaluated due to its recent description. Thoropa lutzi is currently listed as Endangered (EN) by both the IUCN and in the State list. Nine species are listed as Data Deficient (DD) and populations of 13 species are considered to be declining by the IUCN. We extend the geographical distribution of two anuran species (Hylodes babax and Phasmahyla lisbella) and fill an important gap in the distribution of Siphonops hardyi. Amphibians associated with the forest floor represented 42% of the species richness from MONAST, and 43% of these species inhabit the leaf litter exclusively. Our study revealed that Serra das Torres preserves a considerable diversity of Atlantic Forest amphibians, which reinforces the need for the conservation of this forest remnant.

Resumo A Mata Atlântica brasileira guarda importante porção da riqueza de anfíbios e altas taxas de endemismos. Neste estudo, nós realizamos pesquisas usando o Método de Avaliação Rápida (RA) com o objetivo de inventariar a fauna de anfíbios de um remanescente da Mata Atlântica no sudeste do Brasil, o Monumento Natural Serra das Torres (MONAST). Amostramos ativamente com uma equipe de 6 a 10 pessoas para coletar amostras padronizadas entre 09:00 e 12:00 horas durante o peíodo diurno e entre 18:00 e 22:00 duranto período crepuscular/noturno, totalizando aproximadamente 1320 horas de esforço amostral. Complementamos estes dados com 720 horas de amostragem passiva usando armadilhas de queda com cercas-guia (30 dias de balde). Registramos 54 espécies de anfíbios (dois gimnofionos e 52 anuros) e a riqueza de espécies estimada pelo Bootstrap indicou um número relativamente maior de espécies (n = 60). A família mais especiosa foi Hylidae (n = 21), seguida por Brachycephalidae (n = 8). No geral, 25% das espécies (n = 13) foram registradas apenas uma vez - singletons e 15% (n = 8) apenas duas vezes (doubletons). A maioria dos anfíbios registrados neste estudo (71%, n = 37 espécies) esteve restrita ao bioma Mata Atlântica, duas espécies (Euparkerella robusta e Luetkenotyphlus fredi) são endêmicas do estado do Espírito Santo, sendo uma delas, a espécie de serapilheira E. robusta, endêmica do MONAST. Euparkerella robusta está atualmente listada como Vulnerável pela IUCN e classificada como Criticamente Ameaçada na lista vermelha do estado do Espírito Santo, enquanto L. fredi ainda não foi avaliada devido a sua descrição ser muito recente. Thoropa lutzi está atualmente listada como Ameaçada (EN) pela IUCN e na lista estadual. Nove espécies estão listadas como Deficiente de Dados (DD) e as populações de 13 espécies são consideradas em declínio pela IUCN. Estendemos a distribuição geográfica de duas espécies de anuros (Hylodes babax e Phasmahyla lisbella) e preenchemos uma importante lacuna na distribuição de Siphonops hardyi. Os anfíbios associados ao chão da floresta representaram 42% das espécies do MONAST e 43% destas espécies habitavam exclusivamente a serapilheira. Nosso estudo revelou que a Serra das Torres preserva diversidade considerável de anfíbios da Mata Atlântica, o que reforça a necessidade de conservação desse remanescente florestal.

A study of etiological profile of acute confusional state

Background: ACS (Acute confusional states) are on the rise taking the shape of an epidemic. These states are common among the elderly, but young individuals are also not spared. Prompt diagnosis and management of these states can decrease the associated morbidity and mortality.Methods: In this prospective observational study, etiological profile of ACS was evaluated in a total 100 patients, selected over a period of one year, after they fulfilled the CAM (Confusion Assessment Method) criteria.Results: Among 100 patients of ACS, mean age was 54.77�.50 years, males were 66% and 34% were females. The most common diagnosis provisionally made on the basis of history and clinical examination was metabolic encephalopathy in 37% patients, meningoencephalitis (24%), CVA (Cerebrovascular accident) (18%), seizures (9%), sepsis (6%), poisoning (6%). Whereas the final diagnosis made after subjecting the patients to relevant investigations, was metabolic encephalopathy in 37% of patients, meningoencephalitis (20%), CVA (18%), sepsis (12%), unprovoked seizures (6%), poisoning (6%) and undetermined in 1%. The final diagnosis matched the provisional diagnosis in most of the patients except sepsis as a provisional diagnosis was underdiagnosed. The mean duration of hospital stay was 7.6�67days and the hospital stay was most commonly complicated by aspiration pneumonia and acute kidney injury.Conclusions: This study emphasizes that the ACS is an emergency medical situation, where prompt identification, workup and treatment should be done parallelly and urgently to prevent the morbidity and mortality.

Dermal Exposure to Pesticides among Sprayers in Different Agriculture Subsectors in Malaysia: Observational Method using DREAM

Abstract@#Introduction: An assessment of dermal exposure to pesticide mixtures among sprayers was made as a function of crop type, in four agricultural subsectors in Malaysia. Methods: The potential and actual dermal exposures for 160 pesticide sprayers performing pesticide spraying task were estimated by using Dermal Exposure Assessment Method (DREAM). Results: Results showed that there was significant difference between nationality (p<0.001), highest education (p<0.001), monthly income (p=0.002), body mass index (p<0.001) and smoking habit (p<0.001) distributions of sprayers in different agriculture subsectors. Various types of pesticides were used by respondents, where class II (moderately hazardous) and class III (slightly hazardous) pesticides were the most frequently used pesticides. There was a significant difference in both tPDE (χ2 = 118.093, p<0.001) and tADE (χ2 = 84.980, p<0.001) between different agricultural sectors, where the prominent high tPDE was observed among paddy pesticide sprayers (151.39 ± 22.64 DU) while lowest exposure was recorded among oil palm plantation sprayers (47.67 ± 18.47 DU). Conclusion: Based on DREAM exposure categories, majority of the pesticide sprayers (68.9%) working in paddy farming were exposed in low dermal exposure while 26.7% of respondents were exposed to moderate exposure. Pesticide sprayers in other agriculture sectors were exposed to very low to low exposure level. Dermal exposure distributions on body parts were varied between sectors, influenced by several factors such as crop type, height, and spraying methods.

Advance in Muscle Strength Assessment for Critical Patients (review) / 中国康复理论与实践

The mechanism of muscle damage in critically ill patients mainly includes microcirculation disorder, changes in cells and metabolism, inflammation, increased myoprotein breakdown in muscular atrophy, and inactivation of ion channels. Manual muscle testing is the most commonly used muscle strength measurement for critically ill patients, which is simple and economic, but subjective, being not accurate and sensitive in evaluating muscle weakness of patients and distal limb function. Neuroelectrophysiological testing is safe, non-invasive, simple and objective, but it requires specialized equipment and trained qualified professionals, high medical costs, time and effort consumption, and lack of specificity. Dynamometer is a simple, objective, convenient and inexpensive assessment method, which has a good reliability and validity in application in the critically ill patients, but it is not widespread in China.

Application of two risk assessment methods in occupational health risk of 2-butoxyethonal / 中国职业医学

OBJECTIVE: To compare the results of occupational health risk of 2-butoxyethanol(2-BE) by two risk assessment methods. METHODS: Occupational health investigation and detecting 2-BE level in workplace were carried out in a bicycle manufacturing factory in Tianjin City, a printing factory in Shenzhen City and an automobile manufacturing factory in Beijing City. The occupational health risk of 2-BE was assessed by Singapore's semi-quantitative risk assessment model and occupational hazards risk assessment index method. The risk classification results of the 2 risk assessment methods were compared and analyzed. RESULTS: The results of Singapore's semi-quantitative risk assessment method showed that all the 2-BE risk ratios of the decals workshop in the bicycle manufacturing factory, the binding and printing workshops of the printing factory, the spray finishing and the intermediate painting and the electrophoresis workshops of the automobile manufacturing factory were 0.4. The classification of 2-BE risk ratios belongs to low risk level. The results of occupational hazards risk assessment index method showed that the risk ratios of decals workshop in the bicycle manufacturing factory, the binding and printing of the printing factory, the spray finishing and the intermediate painting and the electrophoresis of the automobile manufacturing factory were 0.4, 0.4 and 0.2, respectively, which correspondence to low, low and negligible risk classification, respectively. The two methods were consistent with the appraisal positions of decals post in the bicycle manufacturing factory and the evaluation of binding and printing positions of a printing factory, although the risk assessment results of key positions in the paint shop of an automobile manufacturing industry were inconsistent. CONCLUSION: The occupational hazard risk assessment index method takes into account of the health effects, exposure conditions and operating conditions, and can comprehensively and accurately assess the occupational health risks caused by 2-BE.

Medication Therapy Management Practice of A Chronic Disease Patient with Adverse Drug Reactions Caused by Candesartan / 中国药房

OBJECTIVE： To provide reference for the evaluation of the correlation between drugs and adverse drug reaction （ADR） and the implementation of medication therapy management （MTM）. METHODS： Clinical information of a elderly patient with chronic disease （hypertension and coronary heart disease） whose suffered from leukocyte and platelet counts reduction and abnormal liver biochemical examination after taking candesartan were analyzed retrospectively in outpatient department of Tianjin Third Central Hospital. MTM pharmacists analyzed the correlation of candesartan with ADR using Naranjo evaluation scale method. The reasons for abnormal liver biochemical examination were analyzed by Naranjo evaluation scale method combined with Roussel Uclaf causality analysis method （called RUCAM method for short）. The medication reconciliation was conducted according to the results， and pharmacists cooperated with doctors to set individualized medication regimen and follow-up. RESULTS： By Naranjo evaluation scale method， analysis results showed that candesartan was “probably related” to ADR. By RUCAM method， analysis results showed that candesartan was “probably related” to liver biochemical abnormalities. MTM pharmacists suggested that candesartan should be stopped in time and the patient’s medication should be adjusted. The physician and the patient adopted the pharmacist’s advice. After 38 days of drug withdrawal， the patient’s ADR symptoms disappeared， and leukocyte count， platelet count and liver biochemical examination were normal. After adjustment of medication， the patient was followed up for 6 months with normal blood pressure. CONCLUSIONS： Naranjo evaluation scale method and RUCAM are simple and feasible in evaluating the correlation of drugs with ADR and hepatotoxicity. The two methods are consistent in evaluating the correlation between drugs and hepatotoxicity. Naranjo scale method and RUCAM method can be combined to analyze the correlation between drugs and ADR with abnormal liver biochemical examination.

Current status and influencing factors of application of the Confusion assessment method for the Intensive Care Unit (CAM-ICU) / 中华护理杂志

Objective To investigate the current status of application of the Confusion assessment method for the Intensive Care Unit (Cam-ICU),and to explore its influencing factors.Methods A total of 300 patients admitted to were enrolled.The researchers and nurses used Cam-ICU to assess patients' delirium,respectively,and the differences in deliriun assessment were analyzed.Results For delirium assessment,the Kappa value was 0.546 between the researchers and nurses.The consensus rate was 17.6％ for hypoactive delirium,and 77.8％ for hyperactive delirium in 44 delirium patients.Logistic regression analysis showed that APACHE Ⅱ score,RASS score and delirium type were influencing factors of accurate assessment of delirium.Conclusion The consistence of assessment of delirium by ICU nurses is generally good,but the accuracy of assessment of hypoactive delirium is the worst.

Bright light prevents postoperative delirium in elderly tumor patients undergoing open hepatobiliary surgery / 中国实用护理杂志

Objective To explore whether perioperative bright light therapy could inhibit the occurrence of postoperative delirium in tumor patients undergoing open hepatobiliary surgery. Methods Totally120 elderly tumor patients scheduled for open hepatobiliary surgery and postoperative ICU treatment were recruited and randomized into bright light and control group with 60 cases per group in accordance with the random number table.Bright light was delivered to the patients at an intensity of 10 000 lux from 2 days before surgery to postoperative day 7.Each intervention began at 7 am and lasted for 2 hours.Delirium was screened using the Confusion Assessment Method for Intensive Care Unit(CAM-ICU) during the first 7 days after surgery. The differences in the incidence of postoperative delirium, the duration of delirium and the length of ICU as well as postoperative hospital stay were compared. Results Demographic characteristics and surgical outcomes were similar between groups. The incidence of postoperative delirium were 46.67%(28/60)and 23.33%(14/60)for control group and bright light group respectively with a significant difference (χ2=7.179,P=0.007). The difference was seen on postoperative days 3 (χ2=5.187, P = 0.023) and 4 (χ2=8.749,P = 0.003). The incidences of delirium on postoperative days 3 for bright light and control group were 5.08%(3/59)and 18.64%(11/59)respectively.On postoperative day 4, the incidences of delirium for bright light and control group were 0 (0/58) and 14.04% (8/57) respectively.There was no difference in the duration of delirium(χ2=1.248,P=0.264),the length of ICU stay (χ2=0.036,P=0.849)or the hospital stay(χ2=1.706,P=0.192). Conclusion Bright light is useful in preventing postoperative delirium in elderly tumor patients undergoing open hepatobiliary surgery.

Application and evaluation of direct observation of procedural skills in anesthesia-related teaching / 中华医学教育探索杂志

Objective To explore the application of direct observation of procedural skills (DOPS) in anesthesia-related effects skills teaching. Methods Anesthesia students in the Department of Anesthe-siology, Clinical Medical College, Yangzhou University between June 2013 and June 2015, received an anesthesia-related DOPS examination at the mid-internship and pre-delivery. Through the DOPS assessment results, the analysis of teachers' and students' satisfaction degree on the evaluation results, the teaching effect of DOPS was evaluated. At the same time, the students were surveyed to find out the satisfaction degree of DOPS. SPSS 18.0 was applied to processing the date. Measurement data were expressed as mean plus or minus standard deviation, and t test was used in the comparison between groups. Results Interim assessment indicators for each individual average of more than four points , the individual departmental rotation examination scores were higher than the overall average score interim assessment results. Compared with interim assessment, satisfaction of teachers has made great progress in the end of assessment [(8.46 ± 0.32) vs. (8.14 ±0.60)], satisfaction of students was [(8.57 ±0.59) vs. (8.20 ±0.45)], satisfaction of the students was higher than the teachers [(8.57±0.59) vs. (8.46±0.32)], and the differences were statistically significant. Conclusion DOPS as an effective anesthesia-related skill of teaching and assessment method, can improve the level of anesthesia anesthesia-related skills of college students.

Advances in Roussel Uclaf Causality Assessment Method for diagnosis of drug-induced liver injury and its comparison with structured expert opinion process / 临床肝胆病杂志

Up to now, the diagnosis of drug-induced liver injury (DILI) still relies on the exclusive method, and the Roussel Uclaf Causality Assessment Method (RUCAM) is the most commonly used scale. Since the release of the first version of RUCAM scale in 1993, the second version was released in 2015, in which the definition and scoring criteria of each key element were revised appropriately and explained in detail. The Structured Expert Opinion Process (SEOP) was designed by the workgroup of DILI network prospective study, but since it is too complicated and time- and energy-consuming, its application in clinical practice is limited. This article introduces the research and development history and application method of RUCAM, as well as the modifications made in the 2015 version of RUCAM, and briefly compares the difference in bias between RUCAM and SEOP in the diagnosis of DILI. It is pointed out that both RUCAM and SEOP have marked interobserver and intraobserver variabilities, and therefore, it is necessary to explore a more objective, reproducible, accurate, and convenient strategy for the diagnosis of DILI.

Establishment of a risk assessment model for laboratory biosafety of Crypto-sporidium / 中国血吸虫病防治杂志

Objective To evaluate the risk assessment model of Cryptosporidium laboratory,so as to provide the basis for laboratory personnel engaging in the operation of Cryptosporidium. Methods Firstly,the risk factors of Cryptosporidium infec?tion in laboratory were determined by the literature and Delphi,and then the weights of risk factors were determined by fuzzy an?alytic hierarchy process. A risk assessment model for laboratory biosafety of Cryptosporidium was established. Results Com?pared to the indexes,based on the risk assessment model,stool sample processing was the two steps in the laboratory with high risk of infection and high risk factors,with the combination weights of risk possibility and hazard rating were 0.111 and 0.107, respectively. Conclusion The risk assessment model established is feasible. It can be used to make some suggestions for the re?lated laboratory staff.

Development and validation of a food frequency questionnaire for dietary intake assessment among multi-ethnic primary school-aged children

<p><b>INTRODUCTION</b>This study aimed to develop and validate a food frequency questionnaire (FFQ) to assess habitual diets of multi-ethnic Malaysian children aged 7-12 years.</p><p><b>METHODS</b>A total of 236 primary school children participated in the development of the FFQ and 209 subjects participated in the validation study, with a subsample of 30 subjects participating in the reproducibility study. The FFQ, consisting of 94 food items from 12 food groups, was compared with a three-day dietary record (3DR) as the reference method. The reproducibility of the FFQ was assessed through repeat administration (FFQ2), seven days after the first administration (FFQ1).</p><p><b>RESULTS</b>The results of the validation study demonstrated good acceptance of the FFQ. Mean intake of macronutrients in FFQ1 and 3DR correlated well, although the FFQ intake data tended to be higher. Cross-classification of nutrient intake between the two methods showed that < 7% of subjects were grossly misclassified. Moderate correlations noted between the two methods ranged from r = 0.310 (p < 0.001) for fat to r = 0.497 (p < 0.001) for energy. The reproducibility of the FFQ, as assessed by Cronbach's alpha, ranged from 0.61 (protein) to 0.70 (energy, carbohydrates and fat). Spearman's correlations between FFQ1 and FFQ2 ranged from rho = 0.333 (p = 0.072) for protein to rho = 0.479 (p < 0.01) for fat.</p><p><b>CONCLUSION</b>These findings indicate that the FFQ is valid and reliable for measuring the average intake of energy and macronutrients in a population of multi-ethnic children aged 7-12 years in Malaysia.</p>

Assessment in Medical Education II: Detailed exposition / 医学教育

  In this manuscript, several approaches and methods of assessment based on Miller’s pyramid of competence are demonstrated.<br>●Deliberate assessment and its planning regulate a learner’s approach to learning and drives learning.<br>●In the design and conduct of assessments, the educational effect and the effect on learning should be taken into account.<br>● While knowing does not necessarily guarantee competence, competence does not necessarily guarantee knowing.<br>●It is important to design and perform an informative, continuing, comprehensive programmed assessment to maximize the benefits of outcome-based education.<br>●The importance of assessment should be understood by the members of an institution, and the assessment must be feasible with regards to the available educational resources.

Analysis on the Evaluation of Public Hospital Performance / 中国卫生经济

Objective: According to the medical system reform’s requirement of “strengthening supervision, increasing the public health investment, reforming the compensation mechanism of public hospital, establishing public hospital performance evaluation and incentive system”, public hospitals should continue to reform its management system optimization, performance appraisal is the core content of hospital internal reform performance appraisal method, which is an important guarantee for the results of hospital performance evaluation. Methods: The study on the assessment methods of hospital performance, use “public hospital”, “performance” and“performance evaluation” as the keywords to search the Chinese HowNet and Wanfang database retrieval and 142 articles; by reading the whole passage and the method of stratified sampling, the common performance appraisal method are used to collect and collate, eventually the assessment method of hospital performance of 32 Chinese literature references are included in the study. Results:Summarize the evaluation methods of hospital performance application condition advantages, disadvantages and present situation, and establish a set of performance evaluation methods with the management of public hospitals more perfect, scientific and detailed theoretical basis. Conclusion: In the process of the medical system reform, according to the characteristics of hospitals, to choose suitable and effective performance appraisal methods to help the performance management in hospital, and receive more economic benefits while maximize social benefits.

Implementation and evaluation on the reform of the assessment method for pharmacology courses in top-up program / 中华医学教育探索杂志

The assessment method for pharmacology courses in top-up program of Yanjing medical college was reformed supported by the principal foundation from China capital medical university.The reform specified the assessment content and examination syllabus,formed the multilayer assessing methods and assessing modes and assessed objectively through questionnaires and investigations.The results showed that the students were satisfied with the assessment mode,degree of standardization and the implementation effect. Pharmacology teaching was effectively assessed by the new method and students′ comprehensive ability was improved.

Reform of experimental course assessment methods of preventive medicine in undergraduates and its evaluation / 中华医学教育探索杂志

ObjectiveTo aim at the deficiencies of existing assessment methods,and put forward ideas,methods and contents to reform experimental course assessment methods for undergraduates.MethodsAll of the fifth-grade preventive medicine undergraduates were divided into experimental group (n=34) and control group(n=31),reformed and conventional assessment methods were used in experimental group and control group respectively.The difference in attendance,experimental skill and reports were compared between two groups.ResultsAttendance,test scores and experimental skill scores of students in experimental group were significantly higher than that in control group and compared with the control group students (P＜0,05),the experimental group students' understanding on the experimental principle,phenomena and data analysis were better.ConclusionReformed assessment methods of experimental course has an improved effect on teaching for undergraduates.