0～2岁儿童低血红蛋白与铅中毒对智能发育的影响

目的:了解铅中毒、低血红蛋白对儿童智能发育的影响及相关性。方法:在城区初级保健门诊随机对201例0~2岁儿童检测血铅、血红蛋白及发育指数。采用CDCC量表,通过智力发育指数(MDI)、心理运动发育指数(PDl)评估儿童智商状况。结果:血铅≥100μg/L32例,占15.92%,其MDI均值为(94.18±9.49),PDI均值为(91.43±10.70)。正常对照组MDI均值为(106.18±16.24),PDI均值为(94.42±12.55),两组相比智力发育有明显差异。血红蛋白≤110 g/L 24例,占11.94%,均为轻度贫血,其MDI为(102.25±16.50),PDI为(88.95±11.33),两项指标均为低水平,但差异不显著。结论:与轻度贫血相比,铅中毒更能导致婴幼儿智力发育落后,低浓度铅中毒与贫血相关性尚不明显。【关键词】血红蛋白铅中毒婴幼儿智能发育     

铅作业人员外周血红细胞参数测定分析

目的探讨铅对人体红细胞参数的影响。方法将铅作业者按血铅浓度分为铅接触组和铅中毒组,并与非接触铅作业者外周血红细胞参数（包括RBC,Hb,HCT,MCV,MCH,MCHC,RDW—CV）及显微镜下阕片结果进行统计学分析。结果铅接触组与对照组比对男女RBC、HCT均轻度下降但在正常参考范围内（平均4．565±0．315×10^9／L,39．695±2．94％）,血涂片下未见嗜碱性点彩红细胞。铅中毒组男女RBC、Hb、HCT均下降（平均3．67±0．8×10^9／L,103．8±21．32g／L,32．66±6．91％）,差异有统计学意义（P〈0．01）,与血铅含量呈负相关性;RDW—CV上升差异有统计学意义（P〈0．01）,与血铅含量呈正相关关系;嗜碱性点彩红细胞检出率90％。结论长期接触铅可引起RBC参数的改变。贫血因血铅浓度的升高而加重,同时血铅含量越高,其外周血RBC形态异常及点彩红细胞越多,临床症状越明显。     

儿童血铅水平对智商的影响分析

对无锡市４３８名１～５岁儿童进行双盲法血铅及智商测定,血铅检测采用石墨炉原子吸收法,１～２岁及 ４～５岁儿童分别采用ＣＥＣＣ及ＷＰＰＳＩ 进行智商测定。以智商＞１２０分及＜７０分为高智商组和低智商组,血铅≥１００ ｕｇ／Ｌ和＜１００ｕｇ／Ｌ分为高血铅组和低血铅组。结果４３８名１～５岁儿童血铅均值为８６．０７±３１．５３ｕｇ／Ｌ,智商均值为 ９５．８３±１１．２２分。儿童铅中毒（血铅值≥１００ ｕｇ／Ｌ）发生率为２８．５４％,血铅水平的高低与智商呈负相关。高血铅组智商 均值为９２．０６±１５．５８分,低血铅组智商均值为９８．６２±１５．７２分;高智商组血铅均值为７６．２２±２４．１８ ｕｇ／Ｌ,低智商组血 铅均值为９９．４２±３３． ５３ ｕｇ／Ｌ。经统计学分析,血铅水平与智商之间有显著性差别,高、低血铅组智商相差达６． ５６分。提 出高血铅对儿童智能发育起着阻碍作用,应引起重视。     

铅中毒对婴幼儿智能发育的影响

【目的】探讨铅中毒对婴幼儿智能发育的影响。【方法】对100例6个月～1岁婴幼儿进行血铅测定，采用要幼儿智力发育检测量表进行运动及智能发展指数的测定。【结果】铅中毒组智能发展指数(MDI)和运动发展指数(PDI)比对照组分别落后5．93和4．97分，经统计学处理；差异有显著性。【结论】铅污染影响要幼儿智能发育，值得广泛关注。     

昼夜节律形成对婴幼儿认知发育影响的研究

目的：探索婴幼儿昼夜节律的建立对其认知发育的影响。方法于2012年11月至2013年3月在湖南省浏阳市选择城乡各一个点作为项目点开展调查工作,共抽取2～30个月的婴幼儿156人。采用国际通用的简易婴儿睡眠问卷（ BISQ）评估婴幼儿睡眠状况;同时采用Bayley婴幼儿发育量表对婴幼儿认知发育进行评估。结果调查对象平均年龄11．69±7．81个月（2～30个月）。男童占55．8％,智力发育指数（MDI）为88．83±11．98,运动发育指数（PDI）为90．64±13．51。女童MDI为90．84±11．93,PDI为92．56±12．82。随着儿童月龄的增加,儿童夜间睡眠占每天总睡眠时间的比例显著增加（ r＝0．47,P＝0．000）。进一步采用多元线性回归分析发现,在控制了各种影响婴幼儿认知发育的影响因素后,夜间睡眠比例仍然对婴幼儿的智力发育指数和运动发育指数有独立的影响,即夜间睡眠占全天睡眠比例越高,婴幼儿智力发育以及运动发育水平越好（ MDI：r＝0．29,P＝0．000;PDI：r＝0．29,P＝0．000）。此外,父亲的受教育程度与婴幼儿的发育也呈显著相关性,父亲的受教育程度越高,儿童的MDI（F＝3．61,P＝0．03）和PDI（F＝3．29,P＝0．04）都明显越高。结论婴幼儿睡眠昼夜节律,尤其是夜间睡眠占总睡眠时间的比率对婴幼儿认知发育有显著的影响,因此需要更多关注早期培养婴幼儿形成成熟的昼夜节律,逐步提高夜间睡眠的占比。     

266 例辅助生殖技术出生 1-3 岁儿童体格和精神运动发育状况分析

目的：初步评价辅助生殖技术出生儿童的体格和精神运动发育情况。方法：收集通过辅助生殖技术出生的1．3岁儿童266例（单胎160例,双胎106例）,随机抽取同期自然妊娠出生的单胎1—3岁儿童129例,双胎84例作为对照,对比其出生、体格和精神运动发育情况。结果：辅助生殖技术出生单胎与自然出生单胎比较,双胎与自然出生双胎比较,除出生时父母年龄外,出生情况、体质量指数（BMI）、智力发育指数（MDI）、运动发育指数（PDI）的差异均无统计学意义（P〉0．05）;多因素分析结果显示,母亲文化程度对MDI有影响（P=0．028）,父亲文化程度（P=0．000）和出生时是否上呼吸机（P=0．001）对PDI的影响差异有统计学意义,受孕方式对MDI和PDI的影响差异无统计学意义（P〉0．05）。结论：辅助生殖技术出生儿童与自然出生儿童的体格和精神运动发育状况无明显差别。     

孤立性侧脑室增宽胎儿出生后智力与运动发育的研究

目的 研究孤立性侧脑室增宽胎儿的智力运动发育水平,用于孕期优生优育的指导和发育异常患儿的早期发现和治疗。方法 对孕期诊断为孤立性侧脑室增宽的患儿进行随访,采用儿童发育量表评估患儿的智力运动发育水平。结果 72例孤立性侧脑室增宽儿童中37例(51.4%)智力发育指数MDI≥80,27例(37.5%)神经运动发育指数PDI≥80 。57例妊娠末期侧脑室扩张未消失的儿童16例(28.1%)智力发育指数MDI≥80,18例(31.6%)神经运动发育指数PDI≥80。15例妊娠末期侧脑室扩张逐渐消失的儿童11例(73.3%)智力发育指数MDI≥80,10例(66.7%)神经运动发育指数PDI≥80。68例轻度侧脑室增宽儿童智力发育指数78.86±19.663,神经运动发育指数72.40±18.579。10例单侧侧脑室增宽儿童智力发育指数86.10±11.836,神经运动发育指数81.40±14.804。4例重度侧脑室增宽儿童智力发育指数<50,神经运动发育指数<50。轻度侧脑室增宽、单侧侧脑室增宽与重度侧脑室增宽的儿童智力发育指数和神经运动发育指数差异有统计学意义(P<0.05),轻度侧脑室增宽与单侧侧脑室增宽的儿童智力发育指数和神经运动发育指数差异无统计学意义(P>0.05)。三组儿童的智力发育指数和神经运动发育指数均低于健康儿童的平均水平。结论 孤立性轻度侧脑室增宽智力发育指数和神经运动发育指数均低于健康儿童的平均水平,且重度侧脑室增宽儿童出现了明显的发育障碍。今后应加强此类胎婴儿的监测,争取早期发现和治疗。     

儿童高铅血症和铅中毒分级及处理原则

1诊断与分级 儿童高铅血症和铅中毒要依据儿童静脉血铅水平进行诊断。高铅血症：连续2次静脉血铅水平为100—199mg／L；铅中毒：连续2次静脉血铅水平等于或高于200mg／L；并依据血铅水平分为轻、中、重度铅中毒。轻度铅中毒：血铅水平为200—249mg／L；中度铅中毒：血铅水平为250-449mg/L；重度铅中毒：血铅水平等于或高于450mg／L。儿童铅中毒可伴有某些非特异的临床症状，如腹隐痛、便秘、贫血、多动、易冲动等；血铅等于或高于700mg／L时，可伴有昏迷、惊厥等铅中毒脑病表现。     

2435名学龄前儿童血铅水平及铅中毒调查分析

目的：了解丽水市区学龄前儿童血铅水平和铅中毒情况，以便采取干预措施。方法：用BH2100型原子吸收光谱仪对丽水市区2435名学龄前儿童进行了血铅测定。结果：丽水市区学龄前儿童血铅水平为62．895=37．30μg／L，铅中毒（血铅值≥100μg／L）检出率为13．8％，男女童之间无显著性差异；各年龄组儿童血铅水平、铅中毒检出率，均有显著性差异（P〈0．05）。结论：丽水市区学龄前儿童铅中毒流行状况不容忽视，应对重点人群采取行之有效的措施，同时应引起儿童家长乃至全体市民的高度重视。     

临沂市区0～6岁儿童血铅水平调查

【目的】了解临沂市区0～6岁儿童血铅水平及铅中毒流行状况，为制定防止环境铅污染。保护儿童健康政策提供科学依据。【方法】在严格质量控制下．应用原子吸收光谱法对临沂市区2670名0～6岁儿煮进行血铅含量检测并统计分析。【结果】2670名0～6岁儿童血铅水平均值为0．344μmol／L。其中，血铅含量≥0．483μmol／L者387例．铅中毒检出率为14．5％。不同性别间儿童血铅水平均值和铅中毒率差异均无显著性（P〉0．05）；随着年龄增加。0～岁组、1～岁组、2～岁组血铅水平均值有逐渐增高趋势，而2～岁组、3～岁组、4～岁组随着年龄增加叉表现出血铅水平均值略有下降趋势。【结论】临沂市区0～6岁儿童血铅水平较高，铅中毒流行状况不容乐观，应引起儿童家长乃至全体市民的高度重视。     

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.     

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.     

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.     

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.