中国儿童血铅水平及变化趋势研究

目的 描述近年我国儿童血铅水平、分布特征及变化情况,为制定环境铅污染控制措施,保护儿童健康提供科学依据.方法通过计算机检索中国生物医学文献数据库和中国全文期刊数据库及相关文献追溯等途径,收集国内2004至2007年8月公开发表的2001年以后采样调查的关于儿童血铅水平研究的论文,选用原子吸收分光光度法(石墨炉及其它原子吸收分光光度法)或者电感耦合等离子体质谱法,有严格的质量控制且样本量大于100的文献进行综合分析,并与2004年研究结果 (1995至2003年文献报道儿童血铅水平)进行比较.结果 35篇文献纳入研究,血液样品采集时间为2001至2007年,总样本量为100922人.分析结果 显示,我国儿童血铅平均值为80.7 μg/L(范围:45.5～165.3 μg/L),23.9%(范围:3.2%～80.7%)的儿童血铅值≥100 μg/L,明显低于1995至2003年儿童血铅研究结果 .本次入选文献涉及全国24个省、市、自治区.其中4个省(甘肃、贵州、山西、广东)儿童血铅平均值≥100 μg/L;与1995至2003年间的研究结果 相比,4个省(湖南、广东、甘肃、江西)儿童血铅均值及铅中毒率相比以前均有升高,其他省市自治区则明显降低;居住于工业区的儿童血铅水平高于市区和郊区儿童,郊区儿童高于市区,且差异均具有统计学意义(P＜0.001);男女儿童血铅平均值分别为79.3和76.9 μg/L,铅中毒率分别为22.5%和19.6%,男女儿童间的差异具有统计学意义(P＜0.001),男女儿童血铅值和铅中毒率较1995至2003年的结果 均有明显降低;0～6岁儿童血铅均值和铅中毒率随年龄增加而升高.结论 自2000年7月1日我国全面禁止使用含铅汽油后,我国儿童血铅水平随时间呈下降趋势,但仍显著高于发达国家水平,提示控制环境铅污染,降低我国儿童血铅水平将是一项长期任务.     

武汉市及周边地区儿童2006～2008年血铅水平及趋势

目的:分析近3年武汉市及周边地区不同年龄儿童血铅水平及变化趋势。方法:采用钨舟原子吸收光谱法对2006～2008年来儿童医院就诊和体检的24 980例儿童手指末梢血进行铅含量检测。受检儿童按年龄进行分组,并对检测结果进行统计分析。结果:武汉市及周边地区儿童血铅总体均值为58.26μg/L。其中,男性血铅的平均值为60.12μg/L,高于女性血铅的平均值(54.24μg/L),2006～2008年儿童血铅各年度平均值分别为(67.51±31.02)μg/L、(60.97±32.58)μg/L和(50.32±27.55)μg/L。在不同年份各年龄组中,男性血铅均值皆高于女性。24 980例受检儿童血铅水平为:50μg/L以下者占44.51%,51～100μg/L占48.13%、101～200μg/L占6.68%、201μg/L以上者占0.68%。本资料显示儿童血铅水平≥100μg/L(铅中毒)者占受检总数的7.35%,2006～2008年受检儿童铅中毒率分别为15.88%、7.74%和2.13%。与门诊儿童血铅水平进行比较,体检儿童的血铅水平明显偏低,差异具有统计学意义。结论:与以往的资料比较,武汉市儿童的血铅水平以及铅中毒率已明显下降。近3年来,武汉市及周边地区儿童血铅含量呈逐年递减趋势,其中以2008年度受检儿童血铅水平下降尤为明显。     

广东省梅州地区0～6岁儿童血铅浓度检测结果分析

[目的]了解广东梅州地区儿童的血铅水平以及铅中毒率,为该地区预防儿童铅中毒提供依据。[方法]应用ICP2MS法对2009年1～12月在某妇幼医院进行常规体检的该地区2650例6岁以下儿童的血铅含量进行测定。[结果]2560名儿童的血铅浓度水平范围为12.56～198.56μg/L,平均值为66.58μg/L,标准差为24.31μg/L,其中男童血铅水平为(71.23±25.23)μg/L,女童血铅水平为(60.67±22.23)μg/L,男女童之间血铅水平差异有统计学意义,各年龄组之间血铅水平分布差异有统计学意义。铅中毒儿童共400例,总检出率为15.63%,其中男童铅中毒率为20.59%,女童铅中毒率为10.00%,男女童之间差异有统计学意义,各年龄组之间铅中毒率分布差异有统计学意义。儿童血铅水平及铅中毒率随年龄的增大呈上升趋势。[结论]本地区儿童血铅浓度低于全国平均水平,铅中毒有一定检出率;随着年龄的增大,儿童血铅浓度及铅中毒率均呈增高趋势,应重视儿童铅中毒的预防。     

湖州市0～6岁儿童血铅水平检测结果分析

[目的]了解湖州市0～6岁儿童血铅水平。[方法]采用原子吸收光谱分析方法对3756例儿童进行末梢血血铅水平检测。[结果]3756例儿童血铅水平均值为(70.63±30.85)μg/L,其中血铅水平≥100μg/L者524例,铅中毒发生率为13.95%。2033例男童血铅水平均值为(71.45±31.63)μg/L,其中血铅水平≥100μg/L者293例,铅中毒发生率为14.41%。1723例女童血铅水平均值为(69.67±29.87)μg/L,其中血铅水平≥100μg/L者231例,铅中毒发生率为13.41%。男女儿童血铅水平均值及铅中毒率差异均无统计学意义(P﹥0.05);2285例城市儿童血铅水平均值为(70.51±30.10)μg/L,其中血铅水平≥100μg/L者331例,铅中毒发生率为14.49%,1471例农村儿童血铅水平均值为(70.82±31.99)μg/L,其中血铅水平≥100μg/L者193例,铅中毒发生率为13.12%。城乡儿童血铅水平均值、铅中毒率差异均无统计学意义(P﹥0.05);各年龄段之间血铅水平、铅中毒率差异有统计学意义(P﹤0.01);同年龄段男女儿童血铅水平、铅中毒率差异均统计学意义(P﹥0.05);儿童血铅水平、铅中毒率随年龄增长而升高。[结论]湖州市0～6岁儿童血铅水平低于公认允许水平,但血铅超标现象仍然存在,且有随年龄增长而升高趋势,应引起有关部门的重视,加强铅污染防治力度,加强健康教育和饮食指导等,保障儿童健康成长。     

达州市城区学龄前儿童血铅水平调查

目的了解幼儿血铅水平和铅中毒现况,为防治儿童铅中毒,保护儿童健康提供科学依据。方法随机选取达州市城区幼儿园2～7岁的无患病儿童,作血铅检测,问卷调查。结果达州市城区学龄前儿童血铅总体均值为(141.4±68.6)μg/L,男童为(146.6±68.9)μg/L,女童为(134.6±67.6)μg/L,性别间无差异。城区儿童铅中毒检出率为68.85%,高于国内儿童铅中毒平均水平(51.6%);铅中毒儿童以轻度中毒(Ⅱ级)居多,占铅中毒总人数的76.33%。结论达州市城区学龄前儿童血铅水平高于全国城市儿童平均水平(88.3μg/L)。     

学龄儿童血铅水平及其对脑电生理的影响

目的:探讨学龄儿童血铅水平及其对脑电生理的影响。方法:采用原子吸收光谱法对受试儿童进行血铅测定,并采用数字视频脑电图仪对高血铅组和对照组进行脑电图(EEG)描记。结果:受试的585例7~12岁儿童血铅平均值为52.14μg/L,其中47例儿童血铅≥100μg/L,铅中毒率为8.03%;不同年龄组间血铅水平及铅中毒率差异无统计学意义;不同性别儿童血铅水平及铅中毒率比较差异有显著意义;高铅组EEG异常发生率高于正常对照组。结论:呼和浩特市学龄儿童血铅水平不容忽视;铅中毒儿童EEG描记有临床意义。     

我国0～6岁儿童血铅水平及流行特征分析

目的描述我国自2008年以来0~6岁儿童整体血铅水平及分布特征,探讨其发展趋势,为进一步开展儿童血铅防治研究提供参考依据。方法以中国期刊全文数据库(CNKI)、万方、维普数据库为检索数据源,按照纳入标准收集并筛选国内2008年1月-2012年12月期间公开发表的关于儿童血铅研究的中文文献,进行分析。结果通过对27个省(市)涉及28万人所作的调查分析表明,近5年来我国0~6岁儿童的平均血铅水平为63.15μg/L,平均铅中毒率为12.31%;在27个省(市)中,除陕西省的平均血铅水平超过了100μg/L之外,其他省市均在100μg/L以下;男童血铅水平和铅中毒率均高于女童;0~5岁儿童血铅均值随年龄增加而升高,6~7岁时有所下降,铅中毒率在0~6岁时随年龄增加而增大。结论 2008年以来我国儿童血铅水平有了明显的改善,但与发达国家相比仍有显著差距,儿童铅中毒的预防任重而道远。     

珠海市香洲区6918例学龄前儿童血铅水平检测结果分析

目的:了解珠海市香洲区学龄前儿童血铅水平现状,为预防铅中毒提供科学基础数据。方法:采用原子吸收光谱分析法对儿童静脉血血铅浓度进行测定。结果:6 918名儿童血铅水平范围10～590μg/L,平均血铅浓度(53.8±35.5)μg/L,其中6 427名儿童血铅浓度<100μg/L,占调查总数的92.9%;491名儿童血铅浓度≥100μg/L,占调查总数的7.1%,其中445例为轻度铅中毒,占铅中毒总数的90.6%。结论:珠海市香洲区学龄前儿童平均血铅含量为53.8μg/L,铅中毒比例为7.1%,血铅平均浓度及铅中毒比例均随着年龄的增长而增加。     

南京市7～12岁儿童血铅水平状况调查

目的了解南京市7～12岁儿童血铅水平状况。方法对南京市1 113名7～12岁儿童血铅水平进行调查,采用石墨炉原子吸收光谱法进行检测。结果南京市儿童血铅均值为36.90μg/L,铅中毒率为1.8%;血铅水平男童为39.07μg/L,女童为34.55μg/L,差异有统计学意义(P<0.05);各年龄组儿童血铅水平差异有统计学意义(P<0.05)。结论南京市7～12岁儿童血铅平均水平及中毒率低于全国,但仍需通过环境治理及监管降低环境铅水平,同时加强健康宣传教育,提高儿童及家长防护意识。     

汕尾城区儿童血铅水平及铅中毒的风险因素分析

目的:调查汕尾城区0～7岁儿童血铅水平,分析铅中毒的风险因素,为防治铅中毒提供依据。方法:对汕尾城区1200例儿童用原子吸收光谱法检测儿童血铅值进行血铅水平测定,并进行相关因素的问卷调查,以SPSS10.0软件进行统计分析。结果:儿童血铅水平位于12μg/L～164μg/L之间,血铅平均值为(79.75±13.15)μg/L。铅中毒检出者为68例,占被调查儿童总数的5.67%。经Logistic回归分析得出,房间内墙皮脱落、住所靠近车流量大的主干道、父亲从事铅相关职业是铅中毒相关危险因素前3位。而玩具常清洗、服用钙锌铁剂为儿童铅中毒的保护因素。结论:汕尾市儿童铅中毒水平为5.67%,低于全国10.45%的平均水平;居住环境、饮食习惯、个人卫生为儿童铅中毒的危险因素,为铅中毒防治的主要方向。     

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.     

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.     

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.