Рецензия на руководство для врачей «Профессиональные заболевания у работников железнодорожного транспорта»

Рецензія на посібник: Профессиональные заболевания у работников железнодорожного транспорта: учебное пособие / С.И. Ткач, А.И. Гоженко, А.Е. Лукьяненко, Е.Я. Николенко. -Одесса: Пальмира,2008. - 168 с

Large-scale stochastic flood hazard analysis applied to the Po River

Reliable hazard analysis is crucial in the flood risk management of river basins. For the floodplains of large, developed rivers, flood hazard analysis often needs to account for the complex hydrology of multiple tributaries and the potential failure of dikes. Estimating this hazard using deterministic methods ignores two major aspects of large-scale risk analysis: the spatial–temporal variability of extreme events caused by tributaries, and the uncertainty of dike breach development. Innovative stochastic methods are here developed to account for these uncertainties and are applied to the Po River in Italy. The effects of using these stochastic methods are compared against deterministic equivalents, and the methods are combined to demonstrate applications for an overall stochastic hazard analysis. The results show these uncertainties can impact extreme event water levels by more than 2 m at certain channel locations, and also affect inundation and breaching patterns. The combined hazard analysis allows for probability distributions of flood hazard and dike failure to be developed, which can be used to assess future flood risk management measures

Hyperthermia treatment planning including convective flow in cerebrospinal fluid for brain tumour hyperthermia treatment using a novel dedicated paediatric brain applicator

Hyperthermia therapy (40–44 \ub0C) is a promising option to increase efficacy of radiotherapy/chemotherapy for brain tumours, in particular paediatric brain tumours. The Chalmers Hyperthermia Helmet is developed for this purpose. Hyperthermia treatment planning is required for treatment optimisation, but current planning systems do not involve a physically correct model of cerebrospinal fluid (CSF). This study investigates the necessity of fluid modelling for treatment planning. We made treatments plans using the Helmet for both pre-operative and post-operative cases, comparing temperature distributions predicted with three CSF models: A convective “fluid” model, a non-convective “solid” CSF model, and CSF models with increased effective thermal conductivity (“high-k”). Treatment plans were evaluated by T90, T50 and T10 target temperatures and treatment-limiting hot spots. Adequate heating is possible with the helmet. In the pre-operative case, treatment plan quality was comparable for all three models. In the post-operative case, the high-k models were more accurate than the solid model. Predictions to within \ub11 \ub0C were obtained by a 10–20-fold increased effective thermal conductivity. Accurate modelling of the temperature in CSF requires fluid dynamics, but modelling CSF as a solid with enhanced effective thermal conductivity might be a practical alternative for a convective fluid model for many applications

The impact of educational and environmental interventions in Dutch worksite cafeterias

Environmental interventions as labeling of healthy foods and an increased availability of healthy foods may help consumers to meet the guidelines for a healthy diet. This article describes a study into the effectiveness of two environmental programs to be used in worksite cafeterias along with an educational program. The aim of the interventions was to reduce fat intake and increase fruit and vegetable intake. In the 'Labeling Program', low fat products were labeled. The 'Food Supply Program' comprised an increased availability of low-fat products and fruits and vegetables in worksite cafeterias. The 'Educational Program' consisted of information about healthy nutrition through brochures, table tents, a self help manual and posters. The design consisted of a pretest-posttest experimental control group design, with four conditions: the Educational Program, the Food Supply Program plus Educational Program, the Labeling Program plus Educational Program and a control group. Seventeen worksites were randomly assigned to one of the four research conditions. Total fat, fruit, and vegetable intake was measured with a quantitative, self-administered food frequency questionnaire (35 questions). Intake during lunch was measured by asking respondents to write down which food items they had purchased during their last lunch in the cafeteria. Furthermore, sales data for some targeted product categories were collected (milk, butter, cheese, meat products, desserts). For the whole study population, no significant effects on consumption data were found for any of the programs. The data showed a beneficial significant treatment effect of the Labeling Program on total fat intake, for respondents who believe they eat a high fat diet. Sales data revealed a significant effect of the labeling program on desserts, but not for the other products

How does context influence performance of community health workers in low- and middle-income countries? Evidence from the literature

Background Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in low- and middle-income countries (LMICs). Many factors intersect to influence CHW performance. A systematic review with a narrative analysis was conducted to identify contextual factors influencing performance of CHWs. Methods We searched six databases for quantitative, qualitative, and mixed-methods studies that included CHWs working in promotional, preventive or curative primary health care services in LMICs. We differentiated CHW performance outcome measures at two levels: CHW level and end-user level. Ninety-four studies met the inclusion criteria and were double read to extract data relevant to the context of CHW programmes. Thematic coding was conducted and evidence on five main categories of contextual factors influencing CHW performance was synthesized. Results Few studies had the influence of contextual factors on CHW performance as their primary research focus. Contextual factors related to community (most prominently), economy, environment, and health system policy and practice were found to influence CHW performance. Socio-cultural factors (including gender norms and values and disease related stigma), safety and security and education and knowledge level of the target group were community factors that influenced CHW performance. Existence of a CHW policy, human resource policy legislation related to CHWs and political commitment were found to be influencing factors within the health system policy context. Health system practice factors included health service functionality, human resources provisions, level of decision-making, costs of health services, and the governance and coordination structure. All contextual factors can interact to shape CHW performance and affect the performance of CHW interventions or programmes. Conclusions Research on CHW programmes often does not capture or explicitly discuss the context in which CHW interventions take place. This synthesis situates and discusses the influence of context on CHW and programme performance. Future health policy and systems research should better address the complexity of contextual influences on programmes. This insight can help policy makers and programme managers to develop CHW interventions that adequately address and respond to context to optimise performance

Cervical cancer screening in partly HPV vaccinated cohorts - A cost-effectiveness analysis

Background: Vaccination against the oncogenic human papillomavirus (HPV) types 16 and 18 will reduce the prevalence of these types, thereby also reducing cervical cancer risk in unvaccinated women. This (measurable) herd effect will be limited at first