学龄阿斯伯格综合征儿童与注意缺陷多动障碍共患率调查及误诊原因分析

【目的】 调查阿斯伯格综合征(Asperger syndrome ,AS)学龄儿童注意缺陷多动障碍(attention deficit hyperactivity disorder ,ADHD)的共患率及分析其易误诊为ADHD的原因。 【方法】 应用Vanderbilt ADHD评定量表对门诊确诊的90例AS患儿(男85例,女5例)评估其ADHD的共患率,并与249例普通学龄儿童(男223例,女16例)ADHD患病率进行对比分析;曾在外院接受诊断的39例AS患儿的首诊情况,分析其误诊为ADHD的原因。 【结果】 90例AS学龄儿童中,符合ADHD诊断标准者44例(48.9%);249例普通学龄儿童中,符合ADHD诊断标准者9例(3.6%),AS病例组ADHD患病率明显高于普通学龄儿童,差异具有高度统计学意义(χ²=102.732 ,P<0.01)。在39例曾接受外院诊断的患儿中,只有6例诊断正确(占15.4%)。而误诊率高达84.6%,其中最常见的误诊为ADHD,共19例(达48.7%)。 【结论】 学龄期AS患儿ADHD的患病率显著高于正常对照组儿童,且极易误诊为ADHD。     

持续性注意测试与DSM-Ⅳ在诊断注意缺陷多动障碍中的意义

【目的】探讨持续性注意测试与《美国精神疾病诊断手册》第4版(DSM-IV)在诊断注意缺陷多动障碍(at-tention deficit hyperactivity disorder,ADHD)中的应用价值。【方法】同时由专业医师采用持续性注意测试与和DSM-Ⅳ对行为发育儿科门诊以ADHD之主诉就诊的178例儿童进行诊断并分析结果。【结果】持续性注意测试和DSM-Ⅳ诊断ADHD的阳性率分别为79.12%和74.16%,经χ2检验,两者呈正相关(r=0.34,P<0.01)。以DSM-Ⅳ为参照标准,持续性注意测试对ADHD诊断的敏感度为87.88%,特异度为45.65%,假阴性率为12.12%,假阳性率为56.52%。似然比(Likelihood Ratio,LR)为10.989,Kappa值为0.245(P<0.001),提示两者阳性检出率有较高的一致性。诊断符合率为82.27%,经χ2检验,两种方法检查结果差异无显著性(P>0.05)。【结论】持续性注意测试与DSM-Ⅳ诊断ADHD的符合率较高,可作为ADHD的有效辅助诊断工具,但仍需结合临床及DSM-IV等量表综合诊断。     

不同类型注意缺陷多动障碍的男性儿童行为特征研究

【目的】了解不同类型注意缺陷多动障碍(attention deficit/hyperactivity disorder,ADHD)儿童的行为特点。【方法】对湖南省六个地区进行抽样调查共9 495名儿童。采用二阶段流行病学调查方法,用半定式诊断检查表(K-SADS-PL)和DSM-IV对ADHD筛查阳性患儿进行临床诊断,凡符合ADHD诊断标准的由照管者填写Achenbach儿童行为量表。【结果】①ADHD三种亚型CBCL各行为问题分项中仅在退缩、性问题、活动情况三个分项中没有组间差异,其余分项中均存在组间差异;②两两分析比较在社交问题、注意问题、攻击行为、外化性问题、行为问题总分、社交情况、学校情况、社交能力总分等8个分项表现为一致的组间差异,即三种亚型与对照组相比差异均具有显著性,而三种亚型之间差异无显著性;而其余分项则在三种亚型间分别显示出不同的组间差异。【结论】ADHD三种亚型儿童行为问题在CBCL各分项中的表现不尽一致。     

未成年犯共患不同亚型注意缺陷多动障碍的调查研究

[目的]探讨男性未成年犯注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的患病情况、亚型分布、行为障碍类型,为早期预防未成年人犯罪提供理论依据.[方法]取在押男性未成年犯76名,采用Vanderbilt ADHD家长评定量表进行调查,诊断为ADHD的未成年犯...     

儿童注意缺陷多动障碍流行病学调查及疗效评价

【目的】调查掌握盐城市儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的发生情况及相关因素,对确诊ADHD患儿给予治疗并评价效果。【方法】采用Conners简明症状问卷对3 000名学龄儿童进行ADHD筛查,对阳性疑似患儿进行诊断,对相关因素进行调查。对确诊ADHD患儿运用不同的方法进行治疗,并比较疗效。【结果】ADHD筛查阳性率为6.02%,ADHD发病率为4.77%,男、女发病率差异有统计学意义(P0.005)。父母遗传、轻度脑损伤和脑发育迟缓史、血铅含量高、感觉统合失调、家庭环境等因素与ADHD发生有关系。药物配合行为干预、心理支持等方法治疗ADHD效果明显。【结论】ADHD危害严重,应及早预防,药物是治疗ADHD的首选,ADHD的综合治疗可提高ADHD的疗效。     

8~11岁注意缺陷多动男童的行为问题及其与父母应对方式的相关研究

【目的】 探讨注意缺陷多动男童的行为问题、父母的应付方式及其相关性,为注意缺陷多动障碍(attention deficit hyperactivity, ADHD)儿童的综合治疗提供依据。 【方法】 抽取ADHD男童30例和正常对照男童30例,由其父母分别填写Achenbach儿童行为量表和父母应付方式问卷。 【结果】 ADHD组的分裂性、抑郁、交往不良、强迫、多动、攻击、违纪因子分均高于对照组(P<0.05)。ADHD组母亲幻想、退避和合理化的因子分高于对照组(P<0.05)。ADHD组父亲解决问题的因子分低于对照组(P<0.05)。行为总粗分与母亲解决因子呈负相关,母亲合理化因子呈正相关;与父亲解决因子分呈负相关,与父亲退避和合理化呈正相关。 【结论】 ADHD儿童的行为问题不容忽视,对ADHD儿童进行干预时需同时对父母进行指导,进行综合治疗。     

注意缺陷多动障碍儿童用药依从性的影响因素研究

【目的】 研究注意缺陷多动障碍(attention-deficit/hyperactivity disorder,ADHD)儿童用药依从性的影响因素,以采取相应措施,进一步提高治疗依从性,改善ADHD儿童预后。 【方法】 2009年9月-2010年2月期间于上海市儿童医院儿保所门诊就诊的儿童,根据美国精神障碍诊断和统计手册第4版(DSM-IV)初次诊断为ADHD、排除共病、就诊前未接受治疗,就诊后使用中枢兴奋剂治疗者,首次用药6个月后由家长填写自行编制的ADHD儿童用药依从性家长问卷,共随访642例,其中男514例,女128例。用χ²检验以初步筛选影响用药依从性的因素,进一步用Logistic回归分析影响用药依从性的主要因素。 【结果】 用药依从性好者占39.8%,影响用药依从性的主要因素依次为是否参加父母培训(OR=0.076,P<0.01)、担心药物副反应(OR=0.126,P<0.01)、人均月收入(OR=0.149,P<0.05)、服药次数(OR=0.201,P<0.05)、医疗费用支付方式(OR=0.262,P<0.05)和疾病分型(OR=4.000,P<0.05)。 【结论】 提高父母对ADHD认知水平,探讨ADHD社区服务的模式,有助于提高ADHD药物治疗的依从性。     

医教结合筛查儿童注意缺陷多动障碍研究初探

目的:探讨医教结合干预儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的作用。方法:选取1所学校,筛查1～4年级学生中的疑似ADHD者,采用《韦氏儿童智力量表(中国修订本)》进行智力测定,并根据DSM-IV诊断标准完成ADHD确诊后,分别由教师和父母填写评估量表。结果:20名确诊ADHD的学生韦氏学龄儿童智力测定平均值:总IQ为(99.72±12.52),言语IQ为(98.50±14.72),操作IQ为(101.61±9.61)。根据学习障碍筛查量表筛查出有学习障碍的学生7人,占35.00%。同时,根据儿童行为量表筛查出存在多动表现的学生3人,占15.00%;有强迫表现的2人,占10.00%。由教师和家长分别填写的评估量表中,父母与教师评价之间的差异不具有统计学意义。结论:在ADHD学生的治疗中,教师与家长都起着非常重要的作用,医生应当充分发挥教师和家长的主动性。     

柳州城区小学生注意缺陷多动障碍现况与危险因素分析

了解柳州市学龄期儿童注意缺陷多动障碍(ADHD)的流行特征及影响因素,为儿童ADHD的综合防治提供参考.方法 采用分层随机整群抽样方法,抽取柳州市城区一~六年级共9 628名小学生进行注意缺陷多动障碍筛查.以美国精神障碍诊断和统计手册第四版为ADHD的诊断标准对可疑患儿及其家长进行诊断学访谈,对筛查与诊断结果进行统计.结果 共确诊ADHD儿童468例,ADHD患病率为4.86%,男生患病率(8.09%)高于女生(1.47%)(x2=228.146,P=0.000);9岁组儿童ADHD患病率最高(6.14%),不同年龄组间差异有统计学意义(x2=12.956,P=0.024).ADHD分型以注意缺陷为主型发生率最高(2.85%),其次是混合型(1.41%),多动/冲动为主型最少(0.60%).非条件多因素Logistic回归分析显示,女生患ADHD的风险低于男生(OR=0.17,95%CI=0.13~0.22),母亲孕期心情不佳和父母关系不好是发生ADHD的危险因素[OR值分别为1.45(95%CI=1.17~ 1.79)和2.01(95%CI=1.59~ 2.55)].结论 柳州市城区小学生ADHD患病率处于国内中等水平,且发生与儿童性别、母亲孕期心情及父母关系有关.应对家长、老师进行相关知识宣教,提高早期识别和诊断,促进儿童身心健康发展.     

注意缺陷多动障碍儿童与普通儿童家庭教养方式及学校教育方式对比研究

【目的】 对比注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童与普通儿童的家庭教养方式及学校教育方式。 【方法】 应用Vanderbilt ADHD家长及教师评定量表及自制的一般情况调查表确诊门诊ADHD儿童224例,其中男205例,女19例。同时随机抽取广州市一所普通小学部分1~6年级学生,完整填写上述量表及调查表,入选的非ADHD普通儿童共计326例,其中男217例,女109例,分别获取其家庭教养方式及学校教育方式信息。家庭教养方式及学校教育方式均分为正性和负性两种,然后分别对ADHD和非ADHD儿童的家庭教养方式及学校教育方式进行比较。 【结果】 非ADHD组接受正性家庭教养方式的比例为93.3%,ADHD儿童接受正性家庭教养方式的比例为47.3%,非ADHD儿童接受正性家庭教养的比率高于ADHD儿童(χ²=122.399,P<0.05);非ADHD组接受正性学校教育方式的比例为87.4%,ADHD儿童接受正性学校教育方式的比例为33.9%,非ADHD组接受正性的学校教育方式的比率高于ADHD组儿童,差异具有统计学意义(χ²=168.454,P＜0.05),二者均具有明显的统计学意义。 【结论】 ADHD儿童接受正性家庭教养方式及正性学校教育方式的比率明显低于非ADHD的普通儿童。     

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.