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职业暴露和环境污染引起疾病的因果关系的判断:总体判断和个体判断
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作者 郑宁嘉 ben thomas 《环境与职业医学》 CAS 北大核心 2005年第2期181-183,共3页
Demonstration of a causal relationship between chemical exposure and injury in litigation of toxic tort cases is a key to winning the case in Court. To evaluate whether a case has merit,two levels of causations,genera... Demonstration of a causal relationship between chemical exposure and injury in litigation of toxic tort cases is a key to winning the case in Court. To evaluate whether a case has merit,two levels of causations,general causation and specific causation,are considered.“General causation” refers to the question,does exposure to the toxicant cause the type of injury? For example,does aluminum welding fume cause lung cancer? Bradford Hill’s nine criteria are used to analyze “general causation.”These criteria include strength of association,consistency,specificity,temporality,biological gradient,plausibility,coherence,experiment,and analogy.“Specific causation” refers to the question,did the Plaintiff’s exposure to the toxicant cause the injury in this individual.For example,was Mr.Smith’s lung cancer caused by his occupational exposure to aluminum welding fume? In court,the Judge and jury are asked to make a decision about specific causation,and award or deny damages accordingly. The expert witnesses testify as advisor to the court.As health consultants,we ask five questions to evaluate specific causation: 1.Was the individual exposed to a toxicant,and if so,what was the dose(route,concentration,duration,and frequency)? 2.What is known about the toxicity of that chemical?(e.g.,What specific adverse effects have been associated with exposures to that toxicant? How long does it take for symptoms to develop? What dose is required? The analyzing process of general causation is included in our question 2.) 3.Did the symptoms claimed by this individual appear in a manner and time sequence that is consistent with what is known about the toxicity of the chemical? 4.When exposure to the chemical ceased,did the symptoms get better or disappear in a manner and time sequence that is consistent with the known toxicology? 5.What other conditions or factors might have caused this symptom,and are they relevant to this case? By reviewing the available information relative to these five questions,the testifying expert helps the judge and jury decide whether the plaintiff’s injury was,or was not caused by his exposure to a chemical toxicant. 展开更多
关键词 因果关系 环境污染 职业暴露 个体 疾病
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不确定性 院前预警评分可否用来早期识别需要紧急治疗的疑似脓毒症患者?
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作者 Steve Goodacre ben thomas +3 位作者 Michael Smyth Jon M Dickson 刘雯丽(译) 梁志欣(校) 《英国医学杂志中文版》 2022年第1期46-51,共6页
脓毒症的早期识别和治疗对降低死亡率至关重要,但这只有当疑似脓毒症患者在紧急救护系统中接受优先治疗的情况下才能实现。一种可以识别这些患者的推荐方法是使用早期预警评分。这些评分使用简单的临床测量来计算指示不良结局风险,并且... 脓毒症的早期识别和治疗对降低死亡率至关重要,但这只有当疑似脓毒症患者在紧急救护系统中接受优先治疗的情况下才能实现。一种可以识别这些患者的推荐方法是使用早期预警评分。这些评分使用简单的临床测量来计算指示不良结局风险,并且一些指南对其在脓毒症早期识别中的应用提出了建议(框图1)。 展开更多
关键词 脓毒症患者 早期识别 紧急救护 早期预警评分 不良结局 临床测量 院前 不确定性
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