单绒毛膜双羊膜囊三胎妊娠围生期管理及结局分析

目的探讨单绒毛膜双羊膜囊(MCDA)三胎妊娠的围生期管理及其围生结局。 方法采用回顾性分析方法,收集2012年1月至2017年9月于四川大学华西第二医院产科分娩的4例MCDA三胎妊娠孕妇的一般临床资料,包括孕妇年龄、产妇类型、受孕情况、产前检查情况,并收集其妊娠结局,包括分娩方式、围生儿结局及围生儿死亡率。同时,于4例MCDA三胎妊娠孕妇分娩后,进行胎盘及脐带检查,以进一步明确MCDA诊断及脐带缠绕情况。 结果本组4例MCDA三胎妊娠孕妇的年龄为20～28岁,均为自然受孕的初产妇。其中,在本院接受定期产前检查的孕妇为2例(No.1、No.2孕妇),MCDA三胎诊断时,其孕龄分别为13^＋4、18^＋5孕周,并且分别于32^＋3、32^＋5孕周时采取剖宫产术分别分娩3例女活婴,共计6例女活婴,随访结果显示这6例新生儿均生长发育良好。另外2例孕妇(No.3、No.4孕妇)均因未足月胎膜早破(PPROM),分别于孕龄为28、21^＋3孕周时急诊转入本院。这2例孕妇孕期均未接受正规产前检查,均于产时确诊为MCDA三胎妊娠。其中,No.3孕妇因母体因素于孕龄为28^＋3孕周时采取剖宫产术终止妊娠,娩出3例男活胎,这3例新生儿分别于出生后6 d(1例)、23 d(2例)死亡。No.4孕妇于孕龄为21^＋3孕周时发生PPROM,1例胎儿入院前流产死亡(单独羊膜囊内胎儿),入院后另外2例胎儿随即流产死亡(1例合并唇腭裂、1例为无心畸胎)。本组MCDA三胎妊娠孕妇的围生儿死亡率为11.1%(1/9)。对本组4例MCDA三胎妊娠孕妇进行产后胎盘及脐带检查的结果均证实MCDA三胎的诊断,而且No.1、2、3孕妇三胎中处于同一羊膜囊内的双胎,均存在脐带缠绕、打结。 结论MCDA三胎妊娠十分罕见,为取得较好的围生结局,对其围生期管理宜早期诊断、定期规律产前检查、严密监护,完善产前保健,并与孕妇本人及其家属进行充分的病情沟通。     

妊娠期高血压疾病所致早产孕妇的母婴围生结局分析

目的探讨妊娠期高血压疾病所致早产孕妇的母婴围生结局。 方法选择2015年1月1日至2016年12月31日,滨州医学院烟台附属医院产科收治的妊娠期高血压疾病所致早产的87例单胎妊娠孕妇为研究对象,纳入病例组,其孕龄为28～36^＋6孕周。这87例孕妇中,合并子痫前期(PE)孕妇为73例,包括合并轻度PE(9例)、重度PE(60例)及慢性高血压并发PE者(4例);未合并PE者为14例,包括仅合并妊娠期高血压(10例)与慢性高血压者(4例)。选择同期在本院就诊的非妊娠期高血压疾病的自发性早产及胎膜早破性早产的单胎妊娠孕妇120例,纳入对照组。采用回顾性分析方法,比较2组孕妇的一般临床资料、妊娠结局及其分娩早产儿的出生体重、出生体重Z评分值、新生儿窒息发生率等围生结局。采用成组t检验,对2组孕妇的入院时孕龄、分娩孕龄等进行比较;采用Wilcoxon秩和检验,对2组孕妇的年龄、孕前人体质量指数(BMI)等进行比较;采用χ²检验、连续性校正χ²检验或者Fisher确切概率法,对分娩方式(阴道分娩与剖宫产术分娩)构成比,孕妇产前抗菌药物使用率及新生儿高胆红素血症、肺炎、胃肠功能紊乱发生率等进行比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。 结果① 2组孕妇的年龄、入院时孕龄、分娩孕龄和产妇类型构成比比较,差异均无统计学意义(P>0.05)。②病例组孕妇孕前BMI为23.5 kg/m²(21.1～27.7 kg/m²),显著高于对照组的22.4 kg/m²(20.3～24.6 kg/m²),2组比较,差异有统计学意义(Z＝－3.480,P＝0.001)。③2组孕妇分娩方式构成比比较,差异有统计学意义(χ²＝124.130,P<0.001)。病例组孕妇产前抗菌药物使用率为10.3%(9/87),显著低于对照组的24.2%(29/120),并且差异亦有统计学意义(χ²＝6.429,P＝0.011)。④病例组孕妇分娩早产儿的出生体重及其Z评分值分别为2 250.0 g(1 820.0～2 600.0 g)与－0.63(－1.27～0.10),均显著低于对照组的2 650.0 g(2 212.5～2 980.0 g)与0.33(－3.38～0.85),并且差异均有统计学意义(Z＝－3.866、－5.695,P<0.001)。病例组孕妇分娩早产儿中,胎龄为≥32～34周和胎龄为≥34～36^＋6周早产儿的出生体重及其Z评分值,均显著低于对照组孕妇分娩的同胎龄早产儿,组间比较,差异亦均有统计学意义(胎龄为≥32～34周早产儿：Z＝4.706、－3.690, P<0.001;胎龄为≥34～36^＋6周早产儿：Z＝－5.116、－5.555, P<0.001)。⑤病例组孕妇分娩早产儿生后1 min Apgar评分≤7分所占比例、新生儿窒息发生率和轻度窒息发生率分别为12.6%(11/87)、12.6%(11/87)和9.2%(8/87),分别高于对照组的3.3%(4/120)、3.3%(4/120)和3.3%(4/120),并且差异均有统计学意义(χ²＝6.504、9.017、7.514,P＝0.011、0.003、0.025)。⑥病例组孕妇中,合并PE与未合并PE者的分娩方式构成比、其分娩早产儿的新生儿科转诊率比较,差异均有统计学意义(P＝0.002; χ²＝4.351, P＝0.037)。 结论孕前合理饮食、控制体重,对预防妊娠期高血压疾病的发生、发展具有重要意义。妊娠期高血压疾病导致孕妇早产,可增加新生儿窒息发生风险。临床对妊娠期高血压疾病孕妇,应采取更加密切的监测和积极干预措施,降低早产发生。     

广西地区440例血红蛋白H病胎儿产前诊断

目的探讨广西地区胎儿血红蛋白(Hb)H病产前诊断情况、基因突变类型及其妊娠结局。 方法选择2015年1月1日至2019年12月31日,在本院接受胎儿产前地中海贫血基因检测的广西地区单胎妊娠α地中海贫血高风险胎儿中,被诊断为Hb H病的440例胎儿为研究对象。采用DNA提取试剂盒提取胎儿及其父母基因组DNA。采用跨越缺口PCR(Gap-PCR)法,检测其3种常见缺失型α地中海贫血基因(--^SEA、-α^3.7、-α^4.2)缺失突变情况;采用PCR-反向斑点杂交法,检测其常见α、β地中海贫血基因点突变情况。对于上述常规方法检测结果未见异常,而地中海贫血筛查提示高风险的夫妇,则进一步采用多重连接探针扩增技术(MLPA)及DNA测序技术进一步进行α、β地中海贫血基因检测。对本组胎儿2015-2019年每年的胎儿Hb H病检出率比较,采用线性趋势χ²检验。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。 结果①本研究胎儿Hb H病检出率为9.95%(440/4 421)。2015-2019年,每年的胎儿Hb H病检出率总体比较,差异无统计学意义(P>0.05)。②在440例Hb H病胎儿中,占比前4位的Hb H病基因型分别为-α^3.7/--^SEA(39.32%,173/440),α^CSα/--^SEA(30.23%,133/440),-α^4.2/--^SEA(14.09%,62/440)与α^WSα/--^SEA(10.91%,48/440)。另外,32例Hb H病胎儿被检出同时合并β地中海贫血基因突变,其中20例被检出合并β^CD41-42/β^N,6例合并β^CD17/β^N,2例合并β^CD17/β^CD17,2例合并β^CD71-72/β^N基因型,1例合并β^CD43/β^N,1例合并β^-28/β^N。③妊娠440例Hb H病胎儿的孕妇中,1例(0.23%)自然流产,228例(51.82%)选择人工终止妊娠;135例(30.68%)顺产分娩,65例(14.77%)剖宫产术分娩;11例(2.50%)妊娠结局不详。 结论近年广西地区胎儿Hb H的基因突变类型多样,少数合并β地中海贫血基因突变。妊娠Hb H病胎儿孕妇中,选择人工终止妊娠者的比例较高。对生育人群广泛开展地产前中海贫血筛查及其基因检测,对预防Hb H病新生儿出生缺陷具有重要意义。     

早产儿视网膜病变的筛查分析

目的探讨早产儿视网膜病变(ROP)的临床特点。 方法选择2010年7月8日至2012年9月6日在成都市妇女儿童中心医院新生儿科实业街分部收治的93例接受ROP筛查的早产儿、低出生体重(LBW)儿为研究对象。其中,男性为48例,女性为45例,平均出生体重为（1547 ± 345）g,胎龄为(27~ 36)孕周,平均为(31±2)孕周（本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得患儿家属的知情同意）。回顾性分析其ROP的临床特点。 结果93例接受ROP筛查的儿童中,10例出现ROP,发病率为10.75%。体重<1200 g者ROP发病率为3. 23 % (3/93) ,(1200～1700)g为5. 38%(5/93),(1701～2200)g为2. 15% (2/93)。分娩孕龄 ≤30孕周的ROP发病率为4. 30% (4/93),分娩孕周为（31～32）孕周的ROP发病率为6.45 % (6/93）。ROP相关因素的疾病表现为呼吸暂停(χ² = 5. 03,P<0. 05)、新生儿呼吸窘迫综合征(NRDS)(χ² =6. 84,P<0. 05)、新生儿肺炎(χ² = 7. 55,P<0. 05)、病理性黄疸(χ² = 3. 98,P<0. 05)、窒息(χ² = 8. 46 ,P<0. 05)和呼吸机相关性肺炎(VAP) (χ² =3. 56,P< 0.05)。 结论早产儿应及时行规范的眼底检查,对ROP应早发现、早治疗。     

晚期早产儿高胆红素血症的分析

目的探讨晚期早产儿高胆红素血症的发病情况及围生期管理。 方法选取2013年10月至2015年3月,于四川大学华西第二医院新生儿科住院治疗的276例晚期早产儿中,被诊断为高胆红素血症的35例晚期早产儿为研究对象,纳入研究组;再采取等距抽样方法,从其余241例非高胆红素血症的晚期早产儿中,选取35例纳入对照组。采用回顾性分析方法,收集2组患儿的一般临床资料,并逐一对以下项目进行分析：①采用χ²检验或Fisher确切概率法,对2组患儿的性别、出生胎龄、入院日龄、入院途径、适于胎龄(AGA)儿、小于胎龄(SGA)儿、大于胎龄(LGA)儿、分娩方式构成比,以及胎膜早破、宫内或生后窒息、头颅血肿及母亲孕期疾病发生率进行比较。②了解纳入研究的276例晚期早产儿中,高胆红素血症发生率,以及高胆红素血症患儿中男、女患儿所占比例。③研究组35例晚期早产儿患儿的性别、入院日龄、入院途径、出生胎龄、AGA儿与LGA儿、分娩方式、出生医疗机构构成比,以及重度与极重度高胆红素血症发生率及伴发疾病或病因、胆红素脑病发生率、再入院率。 结果①研究组与对照组患儿的出生胎龄、入院日龄及途径、早产儿类型、分娩方式构成比,以及胎膜早破发生率、宫内或生后窒息发生率比较,差异均有统计学意义(χ²＝12.011,P＝0.002;χ²＝16.931,P<0.001;χ²＝31.895,P<0.001;χ²＝13.473,P＝0.001;χ²＝18.913,P<0.001;χ²＝5.927,P＝0.019;χ²＝8.454,P＝0.004)。2组患儿的性别构成比、头颅血肿发生率、母亲孕期疾病发生率比较,差异均无统计学意义(P>0.05)。②纳入研究的276例晚期早产儿中,高胆红素血症发生率为12.7%(35/276)。35例高胆红素血症晚期早产儿中,男、女性别比为1.9∶1。③研究组35例高胆红素血症晚期早产儿中,出生胎龄为34^＋0～36^＋6周,重度与极重度高胆红素血症患儿均为15例,重度和极重度高胆红素血症患儿所占比例为85.7%(30/35),无危险性高胆红素血症发生;入院日龄≤7 d者居多,占60.0%(21/35),此类患儿系产科母婴同室出院后由门、急诊收入新生儿科者,再入院率高达94.3%(33/35)。研究组晚期早产儿的出生医疗机构中,二级医院和三级医院所占比例相当,分别占45.7%(16/35)和48.6%(17/35)。35例高胆红素血症晚期早产儿的伴发疾病或病因中,合并严重感染患儿的占比为17.1%(6/35)、ABO血型不合溶血病为11.4%(4/35)、头颅血肿为5.7%(2/35)、葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症为2.9%(1/35),同时合并上述多种病因为5.7%(2/35),但是仍然有57.1%(20/35)患儿未找到导致高胆红素血症发生的明确病因。研究组35例高胆红素血症晚期早产儿中,胆红素脑病发生率高,为40.0%(14/35),换血率亦较高,为62.9%(22/35)。 结论高胆红素血症晚期早产儿中,重度、极重度高胆红素血症所占比例高,胆红素脑病发生率高,其中患儿为男性、入院日龄≤7 d、出生胎龄为35^＋0～35^＋6周、AGA儿、自然分娩、有伴发疾病者所占比例高。临床重视对医护人员进行新生儿高胆红素血症规范管理的培训、强化对出院新生儿黄疸监测的力度等围生期管理措施,这对降低高胆红素血症晚期早产儿的伤残,提高其生存质量具有重要意义。     

乙肝病毒感染合并妊娠期肝内胆汁淤积症对母胎妊娠结局的分析

目的 探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)合并乙肝病毒(HBV)感染对围产期母胎的妊娠结局影响，为改善孕产妇及新生儿围产期结局提供理论依据。方法 选取2020年1月—2022年1月在北京市通州区妇幼保健院医院产科分娩的84例ICP合并HBV感染的孕妇为观察组，以200例单纯ICP患者为对照组。收集患者一般情况、孕期合并症、血常规及生化指标以及新生儿情况等资料，比较ICP合并HBV组和单纯ICP组间的差异。结果 观察组孕妇的孕前体重指数(χ²=2.842,P=0.015)、妊娠期糖尿病(χ²=4.945,P=0.026)、妊娠期高血压疾病(χ²=6.917,P=0.009)、脂肪肝(χ²=9.725,P=0.002)、肝功能异常(χ²=8.687,P=0.003)、胎膜早破(χ²=7.507,P=0.006)、羊水污染(χ²=11.435,P=0.001)、宫内感...     

早产儿红细胞分布宽度的动态变化及其临床意义

[目的]观察早产儿红细胞分布宽度的变化规律,以期探讨其与早产儿贫血的关系. [方法] 随机选取在本院住院的早产儿210例,分别于生后1、7、14、21 d和28 d采集足跟血,应用美国进口的Beckmart血球分析仪测定红细胞数目(RBC),血红蛋白(Hb),平均红细胞体积(MCV),红细胞分布宽度(RDW-CV),红细胞平均血红蛋白量(MCH)、红细胞平均血红蛋白浓度(MCHC). [结果]早产儿生后RDW-CV为(17.33±3.14)%,MCV为(111.16±4.85)fl/L,处于高值,随日龄增长,RDW-CV、MCV逐渐下降,RBC、Hb和MCH、MCHC也迅速下降,而至生后28 d,RBC、Hb和MCH、MCHC逐渐回升,RDW-CV和MCV则呈下降趋势,与初生第1 d相比较,除RBC和RDW-CV在生后第7 d、MCHC在生后第28 d差异无显著性外,其余时间点红细胞参数差异均有显著性(P<0.05). [结论] 测定红细胞分布宽度对诊断早产儿贫血有一定的临床价值.     

孕妇双胎妊娠合并肥厚型心肌病诊治分析及文献复习

目的探讨孕妇双胎妊娠合并肥厚型心肌病(HCM)的临床诊治及特点，并进行文献复习。 方法选取2017年10月12日，因孕龄为33⁺⁵孕周时皮肤瘙痒5 d，血液生化指标异常，于四川大学华西第二医院产科入院治疗的1例双胎妊娠合并HCM孕妇为研究对象。回顾性分析其临床资料、临床特点和诊疗过程，并进行相关文献复习。设定文献检索策略为，以"肥厚型心肌病""双胎""心肌病""twin pregnancy""hypertrophic cardiomyopathy""cardiomyopathy"为关键词，在中国知网、万方数据知识服务平台、维普中文期刊服务平台、PubMed及Web of Science(WOS)数据库中检索相关文献，检索时间设定为上述数据库建库至2020年1月1日。本研究符合2013年修订的《世界医学协会赫尔辛基宣言》要求。 结果①本例患者在本院诊治结果如下。病史采集：30岁，孕龄为33⁺⁵孕周，G₂P₀⁺¹，体外受精-胚胎移植技术(IVF-ET)术后(移植冻胚2枚)，HCM史4⁺年，反复告知孕妇夫妇妊娠风险，并由多学科团队(MDT)充分评估后，孕妇在产科及心内科共同监管下定期产前检查。因胎膜早破(PROM)后临产，于胎龄34⁺¹周在全身麻醉下急诊剖宫产术分娩，手术顺利。术后立即转入重症监护病房(ICU)。患者术后出现急性心力衰竭，经呼吸支持、镇静、抗感染、减轻容量负荷、改善心功能等治疗后病情平稳，经心血管科医师评估，给予口服美托洛尔控制心室率、降低心肌氧耗治疗，术后2 d病情好转。目前随访显示母婴情况均良好。②文献复习结果：根据本研究设定的文献检索策略，未检索到相关孕妇双胎妊娠合并HCM的相关报道，遂扩大检索范围，将检索词由"双胎"改为"妊娠"，共计检索到12篇国内外相关文献，涉及260例妊娠合并HCM患者，共计284次妊娠，所有患者均为单胎妊娠。这284次妊娠中，孕产妇发生心力衰竭为28次，2例死亡，其余患者均治疗有效。其中52次妊娠数据中新生儿未报道，余232次妊娠中，胎儿早产为46例，胎儿宫内死亡为5例。 结论多数无明显症状或轻症妊娠合并HCM孕妇可耐受妊娠及分娩，并且母儿结局多良好。但是，对于多胎妊娠合并HCM患者，即使孕妇孕期未发生相关不良心血管事件，分娩后由于血容量变化，对于本身罹患心肌病者是巨大挑战。     

小剂量换血治疗新生儿红细胞增多症的临床研究

目的:研究新生儿红细胞增多症小剂量换血的方法与治疗效果的关系。方法:对70例新生儿红细胞增多症患儿随机分为治疗组40例和对照组30例,两组患儿给予常规处理,在此基础上治疗组给予小剂量换血3～5 ml/(kg.次),观察指标包括治疗转归,临床症状的改善等情况。结果:治疗组治愈率95.0%,对照组治愈率53.3%(16/30),好转率46.7%(14/30);治疗组临床症状改善平均时间与对照组比较差异均有统计学意义(均P<0.01)。结论:根据新生儿红细胞增多症程度,采用小剂量换血1～2次,此方法安全,能有效改善临床症状,避免了后期贫血。     

妊娠期合并恶性肿瘤的临床分析

目的探讨妊娠期合并恶性肿瘤的治疗及对母婴结局的影响。 方法选择2006年1月至2011年12月,于本院产科分娩的妊娠期合并恶性肿瘤20例为研究对象。其中乳腺癌为6例(30.00%),宫颈癌为5例(25.00%),肝癌为3例(15.00%),卵巢癌为2例(10.00%),甲状腺癌为2例(10.00%),鼻咽癌为1例(5.00%),颅内恶性肿瘤为1例(5.00%)。妊娠期合并恶性肿瘤发生率为0.24%(20/8261)。回顾性分析患者的临床表现、诊断结果、孕期和产后治疗情况,分娩孕周,分娩方式,新生儿出生体重,生后1 min Apgar评分及有无畸形等,并电话随访患者的生存情况截至2012年4月(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,并与受试对象签署临床研究知情同意书)。 结果20例患者中,放弃妊娠行引产术为6例(30.00%),继续妊娠的14例(60.00%)患者中,孕期接受化疗者为4例,孕期行肿瘤手术治疗者为4例;剖宫产为11例,阴道分娩为3例。新生儿分娩时胎龄为30^＋5～39孕周,新生儿出生体重为(1380～3200)g,无一例新生儿窒息和畸形发生。 结论妊娠期合并恶性肿瘤以乳腺癌和宫颈癌最为常见。治疗应根据肿瘤分期、妊娠时间、孕妇意愿(是否继续妊娠)等因素综合考虑后,进行个体化治疗。中、晚孕期可相对安全地对部分患者实施手术治疗,并使用相对安全的化疗药物。     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

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.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.