西宁地区0～14岁儿童哮喘流行病学调查

【目的】　探讨西宁 (亚高原地区 ) 0～ 14岁儿童哮喘患病情况及相关因素。　【方法】　根据不同年龄段采取整群抽样和分散家访相结合的方式。　【结果】　共调查 0～ 14岁儿童 10 714人 ,检出哮喘儿童 80人 ,患病率为 0 .74% ,其中儿童哮喘 12人 ( 15 .0 0 % ) ,婴幼儿哮喘 (包括婴幼儿哮喘既往 >2年缓解 ) 14人 ( 17.5 0 % ) ,咳嗽变异性哮喘 11人 ( 13 .75 % ) ,可疑哮喘 43人 ( 5 3 .75 % )。儿童哮喘和婴幼儿哮喘现患 13人 ,患病率为 0 .12 % ,男女患病之比为 1.1∶1,两者差异不显著。首次发病年龄小于 1岁者占 75 .0 0 %。好发季节以不定期和换季节为主 ,发病时辰以无规律者多 ,发病诱因主要是呼吸道感染、有个人过敏史 ,一、二级亲属有哮喘史占 11.2 5 %。　【结论】　西宁地区 0～ 14岁儿童哮喘患病率低 ,但诊断治疗儿童哮喘存在较大问题 ,亟待推广和普及儿童哮喘的GINA方案     

西安地区118例哮喘患儿家长行为调查及其干预效果分析

【目的】 了解西安地区儿童哮喘患儿家长对哮喘认知水平和行为现状,采取有针对性的行为干预措施,并分析其效果,为哮喘规范治疗和管理提供依据。 【方法】 采用问卷形式进行调查,选取本院儿童哮喘门诊就诊且哮喘规范化治疗超过6个月的哮喘患儿。 【结果】 118例问卷显示:1)患儿一般情况:患儿首次喘息发病年龄平均为(5.1±3.7)岁,首次喘息发作距确诊哮喘时间为(2.3±1.6)年;患儿中有50.8%合并过敏性鼻炎、50.6％有湿疹、28.8％有哮喘家族史; 2)哮喘患儿家长行为:56.6%知道在哮喘急性发作时应该吸入速效β2受体激动剂治疗,96.6%在哮喘没有症状时会坚持用药。在选择哮喘长期治疗药物种类时,有51.7%选择吸入激素与长效β2受体激动剂联合制剂、39.6%单独吸入激素、20.6%口服白三烯拮抗剂、13.7%使用抗过敏药物。家长不愿意给患儿使用长期控制哮喘药物原因,60.3%是担心对生长发育产生影响、22.4%是担心对药物产生依赖;3)给予哮喘知识和行为低于平均得分的46例进行干预,干预后家长哮喘知识、态度和行为得分明显提高(P>0.01)。 【结论】 今后应做好哮喘患儿及家长的管理和宣教工作,提高家长的哮喘知识,改善其态度和行为水平,促进患儿的干预效果。     

厦门市同安区儿童哮喘患病情况调查分析

目的 调查2012-2013年厦门市同安区0~14 岁儿童哮喘患病情况及哮喘发病的危险因素, 为今后儿童哮喘的防治工作提供科学依据。方法 通过多阶段分层随机整群抽样方法, 采用2010年第三次全国儿童哮喘流行病学调查问卷, 调查厦门市同安区10 168名0~14岁儿童哮喘患病情况;其次采用1∶1病例对照研究方法和Logistic 回归分析法对哮喘患儿的发病危险因素进行研究。结果 在调查的10 168人中, 哮喘患儿428人, 总患病率为4.21%。男性患病率(5.88%)高于女性(2.28%)(P＜0.001)。哮喘患儿中, 首次发病以3岁内居多占74.76%;发作诱因最常见的为呼吸道感染占85.61%;发作先兆最常见的为打喷嚏占95.20%;经常发作强度以轻度最常见占68.25%;发作类型以突然发作最多占78.50%;好发季节为换季占50.60%;好发时间为夜间和清晨占71.45%。通过对428例哮喘患儿及428例非哮喘儿童的病例对照研究并且经Logistic 回归分析显示, 哮喘发病的独立危险因素包括:个人过敏史、过敏性鼻炎、家族过敏史、家族哮喘史(P＜0.001)。结论 厦门市同安区0~14岁儿童哮喘患病率高于10年前厦门市区哮喘发病率。男性哮喘患病率高于女性。个人过敏史、过敏性鼻炎、家族哮喘史及家族过敏史是该地区儿童哮喘发病的独立危险因素。     

佛山市儿童哮喘患病率调查

【目的】　调查2000年佛山市儿童哮喘患病现状,探讨儿童哮喘发病的相关因素,为本地区儿童哮喘防治提供依据。　【方法】　采用整群抽样调查方法,抽取了佛山市有代表性的5 个地段共10 047 名15 岁以下儿童作为对象,采用问卷方法现场调查。　【结果】　全市儿童哮喘患病率为2.04%,男女比例为2.15∶1,首次发病年龄<4岁者占75.8%。陶瓷工业重点区发病率居全市首位,市区发病率明显高于市郊(χ2 =9.76,P<0.05)。相关因素显示:21.46%有婴儿湿疹史,24.88% 有过敏性鼻炎史,一、二级亲属有哮喘或过敏者占20%以上。诱发因素经多元逐步回归分析提示:呼吸道感染为主要诱因,其次为劳累、运动后、气味、天气变化,发病季节多在冬、春季。使用抗生素和全身激素比率仍较高,分别占94.15%和65.85%,而规范使用吸入型皮质激素比率只占41.95%。　【结论】　佛山市儿童哮喘患病率为2.04%,略高于全国平均水平,生活环境污染是儿童哮喘的重要诱发因素之一。对哮喘患儿应进行规范化治疗的健康教育。     

儿童哮喘门诊192例患儿发病相关因素分析

目的 通过对哮喘患儿发病与治疗的相关因素进行性分析, 了解影响儿童哮喘发病因素和防治状况。方法 对宝鸡市人民医院儿童哮喘专病门诊2009年1月-2010年12月诊治的192例儿童哮喘病患儿临床资料进行回顾性分析。结果 192例哮喘患儿发病以冬季秋季节为主, 冬季42.18%、秋季36.45%, 诱因以吸道感染为诱因63.54%最多见。并过敏性鼻炎有过敏性鼻炎54.6%、有湿疹者50.5%, 家族中一、二级亲属中有哮喘病史28.6%。规范化管理后患儿家长哮喘健康知识掌握明显提高(P均<0.05)。结论 哮喘发病与季节、家族史及个人过敏史等多种因素有密切关系, 对患儿进行系统管理和健康教育是哮喘防治的关键。     

2000年包头地区儿童哮喘流行病学调查

目的　了解包头市 0～ 14岁儿童哮喘发病情况及相关因素 ,并与十年前调查情况相比较 ,为更好地进行儿童哮喘的防治提供科学依据。　方法　采用整群抽样集中调查与分散家访相结合的方式 ,对我市昆区、青山区 110 80例 0～14岁儿童进行了哮喘流行病学调查。　结果　 (1)调查筛查出哮喘患儿 10 3例 ,包括可疑哮喘 7例 ,故实际患病率为0 .88%。其中儿童哮喘 5 9.2 % ,婴幼儿哮喘 2 8.2 % ,咳嗽变异性哮喘 5 .8%。男性患病率明显高于女性 (P<0 .0 1)。首发年龄 3岁前为 76 .7% ,而诊断年龄 3岁前为 5 6 .37% ,至 7岁明确诊断者为 90 .8%。 (2 )哮喘危险因素发现 1发病以冬春季及换季较高 ,分别为 2 3.35 %和 2 8.1% ,发病季节不定者为 33% ,以夜间多发为 4 9.5 %。感冒为其主要诱发因素96 .1% ,其次为天气变化 6 5 .0 %。2一级亲属中有哮喘史或其他过敏史分别为 6 .8%和 37.8%。个人过敏史以湿疹最多见73.8% ,过敏性鼻炎 7.1%。　结论　该市 0～ 14岁儿童哮喘患病率较 10年前明显增高 (10年前为 0 .5 5 % ) ,具有多种引起哮喘的危险因素存在。     

舟山海岛儿童哮喘患病率及其相关因素分析

【目的】调查舟山海岛地区儿童哮喘发病率、哮喘相关因素及对儿童、家庭和社会的影响。【方法】采用抽样调查的方法,调查舟山海岛城乡3～15岁哮喘患病率及相关因素。【结果】共调查1436名儿童,男742名,女694名,现患病率男∶女为1.93∶1,累计患病率男∶女为1.80∶1,最后确诊哮喘59例,近12月有喘息发作44例,哮喘现患病率3.06%,累计患病率4.11%。25例(42.37%)3岁以前发病,52.54%有家族过敏性疾病史,89.83%以受凉感冒为起病诱因,有4例(6.78%)为进食海鲜诱发,其中35例进行吸入性过敏原筛查阳性率68.57%。仅10例(16.94%)的患儿正规激素吸入治疗,1例(1.69%)进行脱敏治疗。16.94%的患儿因哮喘影响家庭成员请假10d以上。常食海鲜,煤气煮饭,油漆等气味刺激,使用海绵枕头等是哮喘的危险因素。【结论】舟山海岛属儿童哮喘的高发地区,应大力推广哮喘的规范化治疗和诊断。     

苏州市0~14岁儿童哮喘患病率及防治现状的调查

【目的】 了解苏州市儿童哮喘患病率、起病年龄、发病诱因及防治现状,为进一步制定儿童哮喘防治措施提供科学依据。 【方法】 采用整群抽样调查,分两步:第一步问卷筛查得到疑似哮喘儿童资料,第二步对疑似病例进行临床确诊,同时了解其发病诱因及防治情况。 【结果】 收回初筛问卷10 805份,筛出喘息相关儿童622例,经临床确诊哮喘540例,咳嗽变异性哮喘5例,可疑哮喘77例。哮喘累计患病率为5%,男女患病率分别为6.22%、3.51%。过敏性鼻炎1 130例,患病率为10.46%,男女患病率分别为12.37%、8.13%。湿疹884例,患病率为8.18%,男女患病率分别为8.85%、7.35%。哮喘在3岁以内起病占77.17%。98.23%哮喘儿童反复应用过抗生素,59.97%在急性发作期接受吸入治疗,但在缓解期进行维持治疗的仅为8.89%。 【结论】 2010年苏州市0~14岁儿童哮喘累计患病率为5%,较10年前有增加,男性高于女性。儿童哮喘起病年龄大多数在3岁以内,发病高峰在春秋换季时,上呼吸道感染为最常见诱发因素。大多数哮喘患儿治疗不规范,正确、合理、规范治疗儿童哮喘的新知识、新药物要宣传、普及。     

厦门市区0～14岁儿童哮喘流行病调查分析

【目的】　了解厦门地区儿童哮喘的流行病学因素。　【方法】　采用整群随机抽样方法 ,拟调查 0～ 14岁儿童 10 0 0 0名 ,在正式流调前进行参加人员的认真培训 ,严把质量关。　【结果】　历经 4个月共调查 1190 8名本市儿童 ,失访率 0 .5 3% ,填写正式调查表 5 0 9份 ,平均哮喘发病率为 3.96 % ,其中 2～ 6岁儿童发病率最高 ,平均达 6 .70 % ,哮喘的误诊率为 34.5 4% ,近 12个月内有过发作占 75 .6 4% ,近 2年内有过发作者占 85 .4 6 %。常见诱因为感冒、天气变化、刺激性气味及运动 ;同时或曾患其它过敏性疾病占 73.0 8% ,其一、二级亲属中有哮喘占 2 9.6 6 % ;治疗上 10 0 %患儿均使用过抗生素。　【结论】　哮喘的发病率正呈上升趋势 ,尤其是在幼儿期的儿童 ,诊疗上存在一定的误诊及漏诊现象。在其症状、诱因、个人过敏史及家庭成员哮喘发生情况方面 ,与国内及国外某些地区的统计差异无明显性 (P <0 .0 1)。     

儿童哮喘控制现状及家长对疾病认知水平调查——西安地区单中心研究

目的 了解西安地区儿童哮喘控制现状及患儿家长对哮喘的认知水平,并分析其影响因素,为哮喘规范治疗和管理提供依据.方法 选取在西安交通大学医学院第二附属医院儿童哮喘门诊就诊且哮喘规范化治疗超过6个月的哮喘患儿,采用问卷调查方法,哮喘专科医生与患儿及其家长面对面沟通,可由父母共同参与完成,填写完成后由医生当场核查,并对数据进行统计分析.结果 收集的118例问卷显示:①患儿首次喘息发病年龄平均为5.1±3.7岁,首次喘息发作距确诊哮喘时间为2.3±1.6年;患儿中有55.1%合并过敏性鼻炎、50.0%有湿疹、28.8%有哮喘家族史;②患儿在三甲医院确诊哮喘占67.8%、二级及以下医院确诊占32.2%.89.0%的患儿在哮喘未发作时能够定期复诊,59.3%的患儿在过去12个月内有喘息发作,发作次数平均为4.2±2.5次.78.8%的患儿进行了肺功能检查,32.2%的患儿进行过敏原检测;③51.7%的患儿使用吸入激素与长效β2受体激动剂联合制剂,39.8%单独吸入激素,62.7%的家长选择喘息发作大于3次诊断为哮喘;④家长哮喘知识79.7%来自医生的讲解、44.9%为大众媒体宣传、29.7%为哮喘健康知识讲座.72.9%的家长最希望与医护人员一对一交流获得哮喘知识.结论 通过对儿童哮喘疾病的管理,可改善儿童哮喘的控制与家长对疾病的认知水平.     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

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.     

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.     

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.