小儿脑性瘫痪危险因素研究

目的探讨小儿脑性瘫痪（简称脑瘫）发病的危险因素。方法对51例脑瘫患儿及102例对照进行以医院为基础的1∶2配比病例对照研究,所获数据采用条件Logistic回归分析。结果单因素分析提示,类似疾病家族史、孕母高龄、孕母反复阴道流血、早产、低出生体重、新生儿窒息、核黄疸、颅内出血,特别是新生儿窒息和早产（OR=11.043和OR=5.975）与小儿脑瘫的发生有关联。多因素分析结果显示,低出生体重、类似疾病家族史、早产、新生儿窒息、孕母高龄为其发病的主要危险因素。结论脑瘫发病的相关危险因素主要集中在孕期和围产期,积极预防和消除各种致病危险因素,可降低脑瘫的发病率。     

脑性瘫痪致病因素与干预措施

目的:探讨小儿脑性瘫痪(脑瘫)相关的致病危险因素,制定降低脑性瘫痪发生率的相关措施。方法:对2002年6月～2005年6月在湖北省妇女儿童医院小儿神经康复科就诊的560例脑瘫致病危险因素进行回顾性分析。结果:560例脑瘫的致病因素按发生频度,排在前6位的分别是早产、低出生体重、窒息、母亲因素、多胎、黄疸。结论:加强孕期和围产期母婴保健,不断提高产前诊断水平,加强地区性新生儿急救转运网络建设,提高新生儿急救水平和基层医务人员业务水平是降低脑瘫发生率的重要措施。     

小儿脑瘫患者的危险因素分析

目的:探讨小儿脑瘫患者的危险因素。方法:回顾性分析北华大学附属医院神经科、儿科、产科及康复科门诊及住院的脑瘫患儿危险因素的相关资料,对其进行分析总结。结果:父、母亲脑瘫家族史、早产、胎盘功能不全、胎儿宫内窘迫、新生儿呼吸窘迫综合征、新生儿缺血缺氧性脑病、新生儿颅内出血、新生儿脑感染、新生儿ABO溶血是脑瘫的危险因素。结论:对脑瘫的危险因素有针对性地进行干预,对预防和降低脑瘫的发病,指导脑瘫患儿的治疗具有重要意义。     

先天性脑瘫患儿的致病因素探究

目的对先天性脑瘫患儿的致病因素进行分析与探讨,为临床研究提供依据。方法选取该院2012-2014年收治的218例先天性脑瘫患儿作为研究对象,采用匹配原则选取436例正常儿童为对照组,以调查问卷的形式取得相关信息,对信息进行分析与统计,最终分析出其致病因素。结果经过仔细回归分析后发现,共有15项主要的脑瘫患儿致病因素,即母亲学历、新生儿体重、孕期使用手机者、孕期不足32周、青紫肤色、高肌张力、孕期患泌尿系统疾病、孕期服用镇痛解热类药物、孕期经历重大事件、缺血缺氧性脑病、出生窒息、病理性黄疸、居住环境差、宫内窘迫及产次超过1次。结论先天性脑瘫患儿发生的危险因素众多,正确确定患儿的发病因素,积极预防和消除脑瘫患儿发病的危险因素,进而从根本上降低先天性脑瘫患儿的发生。     

农村地区儿童脑瘫危险因素的病例对照研究

目的 探讨母亲、孕期及围产期因素与农村地区儿童脑瘫的关系,分析妊娠不同阶段危险因素的相互作用。方法 以人群为基础的病例对照研究,分析病例97人,对照285人。χ~2检验作分析脑瘫的危险因素,根据妊娠不同阶段运用多因素Logistic回归分析危险因素间的相互作用,最后把各个阶段危险因素作Logistic回归分析。结果孕前危险因素为怀脑瘫儿童时母亲年龄30岁以上、有自然流产史,OR分别为2.99(95％CI 1.24～7.25)和3.66(1.74～7.70),母亲有自然流产史与月经周期长相关联。孕期后3个月不明原因瘙痒、服用中草药史亦与脑瘫有统计关联,但未进入最终Logistic回归模型。产程24h以上、在家分娩、新生儿黄疸2周以上等围产期因素为脑瘫主要危险因素,OR分别为6.27(95％CI 2.61～15.09)、1.89(95％CI 1.12～3.18)、4.52(95％CI 2.00～10.22)。新生儿哭声迟与产程长相关。结论 某些母亲因素可能增加了孕期胎儿神经发育的易损性,产程长及新生儿黄疸时间长等围产期因素仍为农村地区儿童脑瘫主要危险因素。     

新生儿死亡危险因素的病例对照研究

【目的】掌握罗湖区近3年新生儿死亡水平、死因分布情况,分析影响新生儿死亡的因素。【方法】调查2003-2005年死亡的110例新生儿,采用1∶2配比病例对照研究,按配比原则调查了220例活产儿作为对照,采用单因素和多因素统计方法进行分析。【结果】3年来罗湖区新生儿死亡率为4.61‰,前5位死因依次为早产和低体重儿、出生缺陷、新生儿窒息、新生儿肺炎、新生儿高胆红素血症;新生儿死亡的主要危险因素是:父母低收入水平、缺乏妇幼保健知识、母亲多胎计划外生育、产前检查次数少、出生缺陷、新生儿窒息(重度)、户籍为流动。【结论】加强围产保健,提高畸形的孕期筛查,加强早产和低出生体重、出生窒息的预防和治疗抢救,建立新生儿急救转运网络和绿色通道,加强流动人员的保健管理及保健知识宣传,能有效降低新生儿死亡率。     

厦门市小儿脑性瘫痪危险因素分析

目的探讨儿童脑性瘫痪(脑瘫)的可能致病因素。方法 2014年1月-6月在厦门市4个区进行了1~5岁小儿脑瘫的现况调查与病例对照调查。调查儿童总人数为20 918例,确诊脑瘫32例,发病率1.53‰。根据1∶2配比原则,以同村、同居民区(或邻村、邻居民区)、同性别、同岁为每1个病例选择2例正常儿童,进行病例对照研究。结果对9项脑瘫高危因素行Logistic回归分析,有3项因素在统计学上达到有意义的水平(OR值分别为35.864、31.923和19.861,均P0.05);其中窒息高危因素儿发生脑瘫的概率是非窒息儿的35.864倍;新生儿期患病患儿发生脑瘫的概率是无新生儿期患病的31.923倍;早产儿发生脑瘫的概率是非早产儿的19.861倍。而与新生儿出生时父母亲年龄、母亲孕期疾病、孕前月经周期紊乱史、流产、孕周、出生体重等因素无关。结论厦门经济发达地区多种因素可以导致脑瘫的发生,前3位为窒息、新生儿疾病因素、早产。     

315例婴幼儿智力发育水平影响因素的病例对照研究

目的 了解婴幼儿的智力发育情况及影响因素,为采取早期干预措施提供依据.方法 对315例3个月至3岁的小儿进行智力测评,并作病例对照研究,用logistic回归分析影响因素.结果 影响婴幼儿智力发育的主要危险因素是:低出生体重、早产、母亲文化程度低、父亲或母亲职业为工人和农民等.结论 预防早产和低出生体重、父母从事相对稳定的职业以及正确的早期教育,均有益于小儿智力发育.     

145例痉挛型小儿脑性瘫痪危险因素研究

目的 <\b>筛查痉挛型脑性瘫痪(脑瘫)的危险因素.方法 <\b>采用1∶2病例对照研究,选择2007年12月至2009年5月在黑龙江省小儿脑性瘫痪防治疗育中心就诊的脑瘫患儿145例为病例组,同时按照年龄±3个月及性别、民族相同原则进行匹配,选择同期在佳木斯大学附属第一医院就诊并排除中枢神经系统疾病的290名儿童作为对照组,通过问卷调查获取相关信息,采用条件logistic回归分析筛查危险因素.结果 <\b>单因素条件logistic回归分析共39项因素有统计学意义,多因素logistic回归分析有11项因素与脑瘫发生有关,分别是出生体重过低(＜2.5 kg)或过高(＞4.0 kg)、母亲大学及以上学历、新生儿出生时肌张力高、皮色青紫、孕期服用解热镇痛药、孕期经历重大事件影响、居室周围环境有污染、新生儿出生时患有颅内出血和出生窒息、宫内窘迫.结论 <\b>新生儿因素与脑瘫发生关系密切,普及孕产期保健知识,加强新生儿管理是减少脑瘫发生的重要措施.     

新生儿坏死性小肠结肠炎的发病情况及危险因素分析

目的探讨新生儿坏死性小肠结肠炎(NEC)的发病情况,分析相关危险因素。方法选取2014年5月-2016年3月恩施市中心医院儿科560例新生儿为研究对象,根据NEC发生情况分为NEC组(26例)和非NEC组(534例),回顾性分析临床资料,对NEC组和非NEC组新生儿的一般资料、母亲情况、出生后喂养情况、预防性应用益生菌情况等进行单因素及多因素Logistic回归分析,记录新生儿NEC的独立危险因素。结果 560例新生儿中,确诊为NEC的新生儿26例,发病率为4.64%(26/560)。出生体重、早产、新生儿窒息、新生儿呼吸衰竭、新生儿肺炎、新生儿败血症、感染性休克、母亲妊娠期糖尿病、母亲胎膜早破、产前应用糖皮质激素、产前应用抗生素、喂养方式、开奶量、预防性应用益生菌均为新生儿NEC发病的影响因素(P0.05)。非条件Logistic多元逐步回归分析结果显示:早产、新生儿败血症、母亲妊娠期糖尿病是NEC发病的独立危险因素(P0.05);纯母乳喂养及预防性应用益生菌是NEC发病的保护因素(P0.05)。结论 NEC发病与早产、新生儿败血症、母亲妊娠期糖尿病密切相关,纯母乳喂养及预防性应用益生菌能有效降低NEC的发生风险。     

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.     

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.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

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.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.