绍兴市16～30月龄婴幼儿孤独症谱系障碍筛查结果分析

目的通过对16～30月龄的儿童进行孤独症谱系障碍(ASD)的筛查及诊断,得出绍兴市儿童ASD的患病率及早期筛查的可行性。方法使用改良版婴幼儿孤独症筛查量表(M-CHAT-R/F)对绍兴市妇幼保健院儿童保健门诊体检的1 944例儿童进行筛查,对筛查阳性者进行电话访谈、转诊及评估。结果共筛查出134例阳性儿童,筛查阳性率为6. 89%;共诊断出5例ASD患儿,总ASD患病率为2. 57‰。结论绍兴市ASD患病率与国内报道结果相符。在儿童健康体检时进行ASD早期筛查具有可行性,有利于儿童孤独症谱系障碍的早期诊断和干预。     

孤独谱系障碍早期筛查模式在儿童保健服务系统中的应用研究

目的 了解××市孤独谱系障碍(autism spectrum disorder,ASD)患病情况,探讨在儿童保健系统中实施ASD早期筛查有效模式。方法 采用分层整群抽样法,抽取1.5~3.0岁幼儿2 090人。应用定期反复三级筛查逐级转诊模式,孤独症筛查量表(CHAT-23)、克氏孤独症行为量表(Clancy Autism Behavior Rating Scale,CABRS)为一级筛查工具,可疑者由儿童精神科医生依DSM-Ⅴ标准进行确诊;半年后复查。结果 首次一级筛查,ASD阳性448人,筛查阳性率21.44%;半年复筛现漏诊4人,假阳性2人;终确诊ASD 26人,患病率1.24%。结论 据DSM-Ⅴ诊断标准,应用CHAT-23和CABRS为一级筛查工具,××市ASD患病率接近美国最近报道,普遍高于国内,提示在儿童保健系统中两量表结合,有助于早期识别ASD;采用定期反复三级筛查逐级转诊模式,利于ASD早期发现和减少漏诊,适合推广。     

深圳市18~24月龄婴幼儿孤独症谱系障碍筛查及3年随访研究

【目的】 通过对18~24月龄婴幼儿进行早期孤独症谱系障碍(autism spectrum disorders,ASD)筛查并随访3年,了解深圳市ASD的患病率及早期诊断的可行性。 【方法】 用婴幼儿孤独症检测表(Checklist for Autism in toddlers,CHAT)量表对深圳市南山区、宝安区和龙岗区的3 624名婴幼儿进行筛查,对筛查阳性者进行转诊、电话访谈、诊断评估及3年随访。 【结果】 筛查阳性婴幼儿244人,总筛查阳性率为5.77%;共诊断ASD儿童10名,其中3例PDD-NOS,7例孤独症,总患病率为2.76‰,均为男性。第一次诊断评估为可疑ASD患儿在3年随访后仍旧符合ASD的诊断标准。 【结论】 深圳市ASD患病率低于国外报道结果,高于国内其他地区的报道。利用儿童保健系统进行孤独症的早期筛查具有可行性,有利于孤独症的早期诊断和早期干预。     

早期孤独谱系障碍社区筛查量表的编制与信度、效度分析

目的 编制适用于社区的简单、便利、灵敏度高的早期孤独谱系障碍筛查量表,并对该量表进行信度和效度分析.方法 以美国精神障碍诊断统计手册第四版(DSM-Ⅳ)的孤独症临床表现和诊断标准为基础,参考婴幼儿孤独症筛查量表(CHAT)、孤独症行为量表(ABC)、儿童孤独症评定量表(CARS)、孤独症诊断访谈量表(中文修订本)(ADI-R)等编制成早期孤独谱系障碍社区筛查量表(EASSC).在深圳市随机选取6～24月龄儿童9 860人作为筛查对象,对该量表进行信度、效度检验.结果 该量表各因子和总分的评定者信度分别为0.945、0.973、0.874、0.952、0.962;重测信度分别为0.936、0.910、0.925、0.853、0.949.该量表的分半信度为0.917.该量表和ABC量表间的校标关联效度为0.835.当分界值为9分时,该量表的灵敏度为0.912,特异度为0.898.结论 该量表具有较好的信度和效度,费时少,容易填写,适用于早期孤独谱系障碍的社区筛查,具有一定的推广使用价值.     

孤独症的共病问题及其对诊疗的影响

正孤独症(autism)患病率高达0.1%~1%~[1-2],终身影响和社会负担之重已经引起广泛重视和重点研究。在2013年颁布的美国精神障碍诊断与统计手册第5版(DSM-5)中将孤独症归入孤独谱系障碍(autism spectrum disorder,ASD)~[3-4]。ASD是指以社会交往困难,语言交流障碍和兴趣范围狭窄及刻板行为主要临床表现的一组神经发育障碍。包含了     

海南省0~6岁儿童孤独症谱系障碍的现况调查及影响因素分析

目的 了解海南省0~6岁儿童孤独症谱系障碍的患病情况及其影响因素。方法 抽查海南省18个市（县）0~6岁儿童37 862人,采用儿童发育问题预警征象调查表筛查,再由专科医师现场诊断,采用一般描述统计、χ²检验、非条件logistic回归分析孤独症现况及影响因素。结果 共诊断235例孤独症儿童,总患病率为0.62%,其中男童为0.99%,女童为0.17%,男童高于女童（χ²=101.91,P=0.000）。随年龄增长孤独症患病率上升（χ²=288.62,P=0.000）。城市孤独症患病率高于其他地区,差异有统计学意义（χ²=114.77,P=0.000）。是否足月、新生儿窒息、父亲性格、父亲有嚼槟榔或吸烟习惯、母孕期总体情绪状态以及母亲人流史为孤独症的影响因素。结论 海南省0~6岁儿童孤独症谱系障碍的患病率居国内较高水平并受遗传因素、孕产过程、父母在孕前及孕期不良行为、习惯等综合因素的影响。     

孤独症筛查量表(CHAT-23)的应用研究

【目的】研究CHAT-23作为孤独症筛查量表在中国内地的可行性及有效性并探索一套适合于初级儿童医疗保健机构使用的筛查流程。【方法】选取卢湾区18~24月龄儿童作为筛查对象,运用CHAT-23量表对其进行ASDs筛查;选择孤独症谱系障碍患儿为病例组,正常儿童为对照组,计算CHAT-23家长填写问卷的灵敏度、特异度及阳性预测值;部分儿童家长重新填写问卷,计算问卷的重测信度。【结果】卢湾区共筛查了484人,发现2名疑似孤独症谱系障碍患儿;该问卷的灵敏度及特异度分别为0.941和0.884。问卷加Section B当面访谈的阳性预测值为50%;该问卷的重测信度(kappa值)为0.50。【结论】CHAT-23孤独症筛查量表灵敏度和特异度均较高,是一种适用于初级医疗保健机构的孤独症筛查量表,适合在中国内地推广。     

中文版量化的婴幼儿孤独症筛查量表信效度研究

目的 评估中文版量化的婴幼儿孤独症筛查量表(Q-CHAT)的信度和效度,以期为孤独症谱系障碍(ASD)的早期筛查提供合适的工具。方法 2019年7月-2020年1月分别采用量化的婴幼儿孤独症筛查量表(Q-CHAT)和儿童孤独症评定量表(CARS)对符合《精神障碍诊断和统计手册》第5版(DSM-5)ASD诊断标准的91例18~48月龄的患儿(ASD组)、45例年龄匹配的其他发育障碍患儿(DD组)以及60名正常发育儿童(TD组)进行评估和比较。结果 Q-CHAT量表的重测信度较高(r=0.89),Cronbach's α系数为0.67(P<0.05)。Q-CHAT评分与CARS总分显著相关(r=0.44,P<0.001), Q-CHAT量表各项目评分与CARS总分的相关系数为0.22~0.60之间。ROC分析显示曲线下面积为0.87,最大灵敏度(0.71)和特异性(0.92),Q-CHAT量表临界得分为45分。ASD组患儿Q-CHAT量表得分显著高于对照组(t=9.42,P<0.01),说明Q-CHAT量表区分效度较好。结论 Q-CHAT量表具有较好的信效度,可用于ASD患儿的早期筛查。     

95例孤独症儿童血串联质谱检测的分析报告

目的应用串联质谱(tandem mass spectrometry,MS/MS)技术进行孤独症谱系障碍(autism spectrum disorder,ASD)儿童的遗传代谢病(inborn errors of metabolism,IEM)筛查,了解ASD患儿的高发IEM病种,并探讨IEM与儿童ASD之间的关系。方法利用MS/MS技术对2010年11月-2013年12月于复旦大学附属儿科医院儿童保健科门诊就诊、根据DSM-Ⅳ诊断标准确诊的95名ASD患儿的血液样本进行IEM筛查。结果 1名(1.95%)患儿存在苯丙酮尿症,1名(1.95%)患儿戊二酸血症-II型不能除外,其他患儿(96.1%)均不存在本研究所涉及的IEM。结论本研究为晚诊断的苯丙酮尿症与ASD之间的关联提供了案例支持,苯丙酮尿症可能是儿童ASD的共患病之一;戊二酸血症-II型与ASD之间可能存在一定联系。对于IEM高危患儿、特别是生后未行新生儿筛查的ASD患儿,及时地进行IEM筛查对于全面诊断和治疗ASD有着重要意义。     

以DSM系统和ABC量表角度来看孤独症症状变化

目的了解孤独症患儿的症状特点,进一步理解DSM-Ⅴ的孤独谱系障碍(autism spectrum disorder,ASD)的诊断标准。方法对经DSM-Ⅳ诊断的466例孤独症患儿进行ABC评估,分析DSM-Ⅳ、ABC各个条目阳性率、不同性别及年龄段的阳性率。结果 1)466例孤独症患儿中,DSM-Ⅳ社交缺陷、言语缺陷、行为、功能延迟中,阳性率最高分别为95.3%,84.8%,79.8%,92.9%。5个条目存在年龄差异,2个条目存在性别差异,男性均高于女性。2)只有263名符合DSM-Ⅴ中社会交流和社会交往缺陷的标准。3)在ABC的57个条目中,阳性率最高的条目是38,占94%,最低的是条目34,占34.2%;男女生在第27条存在差异。结论使用DSM-Ⅴ之后,ASD诊断可能会下降,随着年龄增长,患者的社交和言语可能好转,但是行为问题表现更差,性别可能不是影响症状的原因。     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.