抽动-秽语综合征危险因素的病例对照研究

【目的】　探讨抽动 秽语综合征 (tourettesyndrome ,TS)发病的主要危险因素 ,为有效减少本病的发生提供依据。　【方法】　选择 10 4例TS患儿进行成组设计的病例对照研究 ,进行单因素分析后运用多因素非条件Lo gistic回归模型分析。 　【结果】　在α =0 .0 5水平 ,单因素分析共筛选出有显著意义的因素 12项 ,分别是 :抽动症家族史、精神性疾病家族史、母亲孕期精神刺激、妊娠呕吐、儿童高热次数多、热性惊厥病史、慢性扁桃体炎、食用膨化食品、长时间看电视、打骂体罚的教养方式、补体C3 及IgA水平下降。能进入多因素回归模型的变量有 7个 ,按照其对TS发病危险性的大小依次为 :抽动症家族史 (OR =10 .84) ,精神性疾病家族史 (OR =4.0 4) ,母亲孕期精神刺激 (OR= 3 .75 ) ,儿童慢性扁桃体炎 (OR =1.97) ,妊娠呕吐 (OR =1.61) ,打骂体罚的教养方式 (OR =1.46) ,长时间看电视(OR =1.44 )。　【结论】　TS的发生是遗传和环境两种因素综合作用的结果。为减少TS的发生 ,有抽动症家族史的儿童和孕母应作为高危人群进行预防     

学龄期单纯性肥胖儿童高血压的家庭相关因素分析

【目的】 研究影响肥胖学龄期儿童的血压升高的家庭相关危险因素,为儿童肥胖以及相关高血压的预防和治疗提供依据。 【方法】 采用Cox比例风险模型对124例肥胖儿童进行高血压的家庭相关因素分析。 【结果】 多因素Cox回归分析结果显示,母亲肥胖、父亲肥胖、家族高血压人数和出生体重在肥胖儿童发生高血压的相对危险度分别为2.117、1.969、1.828和1.777,P值均<0.05。 【结论】 父母肥胖、有高血压家族史以及出生体重巨大的肥胖儿童是早期发生高血压的高危人群。     

儿童孤独症192例临床分析

【目的】 探讨儿童孤独症的临床特点及危险因素,为该临床的早期发现、早期诊治提供依据。 【方法】 对2004 年11 月— 2010 年8 月复旦大学附属儿科医院儿童保健科收治的192例孤独症患儿的主诉、临床表现、 个人史及家庭状况(妊产期不利因素、家族史、父母文化、父母性格、家庭教育情况)、和辅助检查(脑CT/ MRI、EEG、BAEP) 进行回顾性分析。 【结果】 在192例孤独症患儿中,≤24个月龄的患儿21例(10.9%),病例主诉以语言障碍为主,尤以不会说话突出(62%)。母亲存在妊产期不利因素者共85例(44.3%),异常家族史者52例(27%),辅助检查中, EEG异常检出率较高。 【结论】 语言障碍最易为家长注意,建议常规健康体检中纳入和重视儿童社会能力的发展,以利于早期发现孤独症患儿。妊娠不利因素、家族史和父亲内向的性格特点与孤独症发病有密切关系。     

儿童发育性协调障碍孕产期危险因素的初步探讨

【目的】初步探讨儿童发育性协调障碍(developmental coordination disorder,DCD)的孕产期危险因素,为在国内开展DCD的预防和干预提供线索。【方法】在苏州市区选择一幼儿园339名儿童,采用结构式问卷对其父母进行调查。DCD筛查采用儿童发育协调障碍评估工具(Movement Assessment Battery for Children,M-ABC)。采用单因素和多因素的非条件Logistic回归模型分析DCD的危险因素。【结果】在控制了儿童性别、年龄、家庭文化和经济水平以及其他纳入分析的因素后,母亲妊娠时间大于(aOR=6.075,P=0.005)或小于(aOR=3.917,P=0.034)最佳年龄者,急性胎儿宫内窘迫史(aOR=4.415,P=0.018)和儿童出生体重(aOR=4.562,P=0.014)与DCD相关。【结论】母亲妊娠时年龄、急性胎儿宫内窘迫史和儿童出生体重可能是孕产期DCD的主要危险因素。     

儿童功能性构音障碍致病危险因素的分析

[目的]分析儿童功能性构音障碍发生的危险因素,及早对儿童采取干预措施. [方法]采用自拟的家庭社会环境因素调查表对41例功能性构音障碍患儿及38例正常儿童进行对照研究.对调查结果运用Logistic回归模型进行分析. [结果]采用Logistic回归分析,有4项因素差异有显著性,按危险度(OR值)高低排序,儿童FAD致病的危险因素依次为:不良饮食习惯、家庭中多种方言并存、母亲文化程度较低、说词组月龄迟. [结论]功能性构音障碍的形成可能受多种家庭社会环境因素的影响,应尽量避免影响言语发育的不良因素.     

兰州市学龄前儿童视力异常影响因素分析

【目的】 调查分析兰州市城区学龄前儿童视力异常发生率及其影响因素,为视力异常的防治提供科学依据。 【方法】 依据该地地理分布及社会功能区特征,参考幼儿园公私立等性质,采用随机整群抽样的方法抽取10所幼儿园的2 754名学龄前儿童进行调查。应用儿童图形视力表和标准对数视力表检查视力,采用美国伟伦公司Suresight手持验光仪对调查儿童进行屈光检查。同时对儿童家长进行视力异常相关因素问卷调查,应用Logistic回归模型进行危险因素分析。 【结果】 调查对象男、女童视力异常检出率均为13.9%,差异无统计学意义(P>0.05)。男、女童视力异常检出率均随年龄增长而下降(P<0.05)。在9项视力异常相关因素中出生体重、胎龄、父母视力情况和每天睡眠时间这4项影响学龄前儿童的视力。 【结论】 托幼机构与家庭应重视学龄前儿童眼保健工作,着力培养儿童良好的生活习惯,同时强化社会性健康教育,从社会、家庭、托幼机构等多方面采取综合干预措施控制视力异常的发生。     

中枢性协调障碍高危因素的调查与分析

【目的】探讨中枢性协调障碍(central coordination disturbance,CCD)患儿的高危因素,为临床诊治提供参考依据。【方法】收集2008年1月—2009年6月收治的308例CCD患儿为CCD组,同时设置健康对照组300例,对两组儿童相关病史资料进行回顾性统计分析。【结果】 1)308例CCD患儿中22例(7.1%)无明显危险因素,余286例(92.9%)各有一种或多种危险因素,共计1 026例次,其中产前母体因素429例次(41.8%);产时异常因素344例次(33.5%);产后新生儿期异常因素253例次(24.7%),平均每例计3.3个危险因素;2)含1种危险因素的儿童两组差异无统计学意义,含2种危险因素的儿童有统计学意义(P0.05),而含3种或3种以上危险因素的儿童两组差异有高度统计学意义(P0.001);3)采用条件Logistic回归分析发现剖宫产、病理性黄疸、多次人流、孕早期感冒、早产、糖尿病、后期发热、窒息/缺氧、先兆流产、化脓性脑膜炎及母亲高龄与CCD的发生相关。【结论】多种高危因素均可导致CCD的发生,而产前因素占主体因素。提示切实做好孕期保健,正确处理分娩时的异常情况,积极救治高危新生儿,能有效降低CCD的发生率。     

813例儿童变应性鼻炎的临床特征及影响因素分析

目的探讨儿童变应性鼻炎患儿的临床特征及影响因素。方法选取2015年10月-2018年11月在该院接受治疗的813例儿童变应性鼻炎患儿为观察组,同期在该院接受治疗的57例非儿童变应性鼻炎患儿为对照组,记录两组入选者一般资料,比较其变应原分布情况(临床特征),分析相关影响因素。结果 813例儿童变应性鼻炎患儿血清中总免疫球蛋白E (Ig E)检测结果均为阳性,其中4. 97%为单种变应原阳性,75. 03%为≥2种变应原阳性。食入性变应原中,牛奶、鸡蛋、花生阳性率较高,分别为14. 27%、15. 62%、17. 96%;吸入性变应原中,蟑螂、狗上皮、尘螨组合(粉尘螨、屋尘螨等)阳性率较高,分别为24. 97%、37. 27%、68. 88%。两组患儿年龄、父母平均受教育年限、家庭月均收入、早产儿、低体质量儿、存在家养动物史及居住环境潮湿比例比较,差异无统计学意义(P0. 05);观察组患儿男童、近1年内装修房屋及存在父母鼻炎家族史比例高于对照组,出生后6个月内母乳喂养率低于对照组,差异有统计学意义(P0. 05)。多因素Logistic回归分析结果显示,性别(男)、近1年内装修房屋及父母鼻炎家族史为儿童变应性鼻炎发生的危险因素(OR1,P0. 05),而出生后6个月内母乳喂养为保护因素(OR1,P0. 05)。结论儿童变应性鼻炎患儿均具有≥1种变应原,尘螨组合阳性率最高,且性别(男)、近1年内装修房屋、父母鼻炎家族史为诱导儿童变应性鼻炎发生的危险因素,临床与患儿家属应通过积极除螨、通风等措施,以控制患儿病情进展。     

温州市儿童白血病的环境危险因素研究

【目的】研究儿童白血病的环境危险因素,为临床有效干预提供参考依据。【方法】自行设计白血病危险因素调查表,对2004年7月—2008年12月期间在温州医学院附属育英儿童医院住院及登记的141例0～14岁白血病患儿进行l∶l配对病例对照研究,对所得资料进行单因素分析,选择其中有意义的进行多因素条件Logistic回归分析。【结果】84项指标单因素分析中有15项有统计学意义;其中患白血病前频繁感染、经常吃腌制食品、父亲经常接触有机溶剂、母亲孕期感染、母亲孕期经常接触石油产品、住房周围空气污染、住宅装修入住后有气味、居住地附近有变电所、居住地附近有信号发射塔9项指标在多因素条件Logistic逐步回归分析中有统计学意义。【结论】环境中的物理、化学、生物因素与儿童白血病关联。     

幽门螺旋杆菌感染与儿童过敏性紫癜相关性研究

目的探讨儿童过敏性紫癜与幽门螺旋杆菌感染的关系,分析过敏性紫癜患儿合并幽门螺旋杆菌感染的危险因素。方法 2016年1月-2017年12月在本院诊断为过敏性紫癜患儿164例,其中腹型过敏性紫癜组78例,非腹型过敏性紫癜组86例,采用~(13)C尿素呼气试验法检测幽门螺旋杆菌感染率。对过敏性紫癜合并幽门螺旋杆菌感染的相关危险因素进行多因素Logistic回归分析。结果 78例腹型过敏性紫癜患儿有37例~(13)C尿素呼气试验阳性,阳性率为47.44%;86例非腹型过敏性紫癜患儿有19例~(13)C尿素呼气试验阳性,阳性率为22.09%,2组差异有统计学意义(P=0.001)。多因素Logistic回归提示"消化道出血"是过敏性紫癜合并HP感染的危险因素(OR:1.050～17.202,P=0.043)。结论 "消化道出血"是儿童过敏性紫癜合并HP感染的危险因素。对于过敏性紫癜合并有消化道出血症状或者反复腹痛持续时间长、有胃炎家族史的患儿,建议筛查是否幽门螺旋杆菌感染。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.