地震重灾区民警灾后两年的PTSD症状及与抑郁的相关性

目的调查和了解各地震重灾区民警的创伤后应激紊乱(PTSD)症状的分布和特点,以及与抑郁的相关程度,为相应的心理援助和公安队伍建设工作提供实证依据。方法使用创伤后应激障碍症状清单平民版(PCL-C)和抑郁自评量表(SDS),在绵竹、什邡、北川、青川,剑阁县市公安局随机抽取一线民警作为调查对象。结果地震重灾区民警具有较明显的PTSD症状,可以筛查为阳性的有22.6%;50岁以上的民警的PTSD症状较为突出;北川的PCL-C总均分以43.06显著高于其他地区(P<0.05);地震重灾区民警PTSD病状与抑郁症状呈显著相关(P<0.01)。结论①呈灾情越严重的地区的民警PTSD症状越严重的趋势;②呈年龄越大PTSD症状越严重的趋势,50岁以上年龄组较为突出;③PTSD的3组特征性症状中,警觉症状的均分值较其他2组症状要高,北川在3组特异性症状和PCL-C总分上均显著高于其他地区;④地震重灾区民警PTSD症状与抑郁症状的相关程度高,二者共病的可能性较大。     

地震极重灾区小学教师的创伤后应激障碍调查

目的了解地震极重灾区小学教师1年后的创伤后应激障碍(post-traumatic stress disorder,PTSD)的程度。方法用创伤后应激障碍自评量表(PTSD-SS)和暴露情况调查表对188名青川县小学教师进行测评。结果 71.2%的教师存在PTSD症状,男女教师之间的差异有统计学意义(P0.05);亲友死亡是导致PTSD的重要原因。结论地震极重灾区小学教师,尤其是男性教师,存在严重的慢性PTSD。     

汶川震后一个月受灾者心理应激状况

目的研究地震一个月后受灾者心理应激状况,分析心理应激与相关因素的关系。方法采用创伤后应激障碍（PTSD）症状自评量表及自编社会支持问卷、安全感问卷对受灾者进行调查。结果所调查的受灾群体中,创伤后应激反应符合轻度诊断标准的比率为17.65%,符合中重度诊断标准的比率为0.84%,男性均多于女性。获取社会物质支持、信息支持和心理支持越少,创伤后应激反应越严重;生活安全感、确定控制感和归属感越缺乏,创伤后应激反应越严重;暴露程度越高,创伤后应激反应越严重。结论汶川地震是强烈的应激事件,创伤后应激反应强烈,社会信息支持、生活安全感和确定控制感得分与创伤后应激反应有密切相关。     

大学生创伤后应激障碍及影响因素分析

目的 了解大学生创伤后应激障碍(Posttraumatic Stress Disotder,PTSD)的流行特征及影响因素.方法 采用分层、随机、整群抽样方法 ,以广州市某医药大学生为研究对象,采用自拟问卷和创伤后应激障碍症状自评量表(PCL-C量表)对大学生PTSD状况及影响因素进行横断面调查.分析PTSD阳性检出情况及不同性别、年级、专业PTSD的分布特征,并采用多因素非条件Logistic回归分析PTSD的影响因素.结果 在调查的1 081名大学生中,PTSD阳性症状者179名,占16.6%;暴露于创伤性事件的大学生PCL-C得分高于未暴露者,两者差异有统计学意义(P<0.05);不同性别的PCL-C得分差异无统计学意义(P>0.05),不同年级、不同专业间的PCL-C得分差异有统计学意义(P<0.05);不同专业,遭受性骚扰或性侵害,被人袭击、恶语中伤、殴打或伤害、与亲属发生矛盾压力、就业困难、人际关系差、环境不适应为PTSD的影响因素.结论 广州医药大学生创伤后应激障碍状况不容乐观,应引起学校相关部门重视,针对PTSD的影响因素采取相应的措施.     

汶川地震灾区中学生地震创伤后应激障碍与领悟社会支持的关系

目的 探讨汶川大地震灾区中学生地震创伤后应激障碍(PTSD)与领悟社会支持能力之间的关系.方法 使用创伤后应激障碍自评量表(PCL-C)和领悟社会支持量表(PSSS),对汶川地震灾区3所中学1966名中学生进行自填式问卷调查.结果 1966名中学生的PTSD筛查总阳性率为78.3%,重度PTSD占24.38%.不同领悟社会支持程度的学生PTSD阳性率差异有统计学意义(P<0.05),且PTSD严重程度与领悟社会支持高低程度呈负性相关(γ=-0.226,P<0.05);不同家庭内、外领悟社会支持程度的学生PTSD阳性率差异有统计学意义(P=0.009,P<0.05)且PTSD严重程度与家庭内、外领悟社会支持高低程度呈负性相关(γ=-0.176,P<0.05,γ=-0.214,P<0.05).结论 地震灾区中学生PTSD的发生率及严重程度与其领悟社会支持的高低程度存在一定关系,领悟社会支持越高者,PTSD发生率越低,程度越轻.对灾区中学生的心理干预应有针对性.     

“5.12”地震三年后北川县地震亲历者心理应激水平评估

目的探讨"5.12"地震三年后北川县地震亲历者心理应激水平及其影响因素。方法以自制一般情况调查表、创伤后应激障碍筛查量表(PCL-C)为调查工具,采用系统抽样方法,评估北川县605名地震亲历者的心理应激水平及其相关影响因素。结果地震三年后北川县地震亲历者中11.2%发生创伤后应激障碍(PTSD)。PTSD阳性者以反复重现体验和警觉性增高为常见症状。PTSD影响因素的Logistic回归分析显示:女性、财产损失重、有亲友死亡是PTSD发生的危险因素,其OR值分别为:2.848、1.778、3.297。结论地震三年后北川县地震亲历者的心理应激水平虽有所改善,但仍不容乐观。应重点关注女性、财产损失重、有亲友死亡的亲历者及反复重现体验和警觉性增高等症状。     

团体心理干预对初中生车祸创伤后应激障碍效果评价

探讨团体心理干预对初中生目睹班级成员车祸创伤后应激反应、焦虑、抑郁症状的作用,为开展学生突发事件的心理辅导与干预提供依据.方法 对石河子市某中学初三年级目睹同班同学遭遇车祸身亡事件者实施团体心理干预方案(3周5次).用创伤后应激障碍自评量表(PCL-C)、汉密顿焦虑量表(HAMA)及汉密顿抑郁量表(HAMD)进行测量,比较在干预前、干预1个月及3个月、6个月后各量表得分的变化.结果 干预前学生创伤后应激障碍(PTSD)症状筛查阳性为16.0%,22.0%出现不同程度的焦虑症状,8.0%出现抑郁症状;干预1个月后学生PTSD症状筛查阳性为4.0%,24.0%出现不同程度的焦虑症状,6.0%出现抑郁症状;干预3个月后学生PTSD症状筛查阳性为8.0%,20.0%出现不同程度的焦虑症状,6.0%出现抑郁症状;干预6个月后学生PTSD症状筛查阳性为2.0%,8.0%出现不同程度的焦虑症状,4.0%出现抑郁症状.干预1个月、3个月及6个月后与干预前比较,PCL-C量表B,C,D组得分及总分差异均有统计学意义(P值均<0.01);干预3个月及6个月后与干预前比较,HAMA总分及精神得分差异均有统计学意义(P值均<0.01);1个月后与干预前比较,HAMD总分差异有统计学意义(P<0.01);3个月后与干预前比较,迟缓得分差异有统计学意义(P<0.05).结论 目睹班级成员车祸身亡的初中生会出现创伤后应激、焦虑及抑郁症状,施行团体心理干预能缓解症状.     

汶川县中学生地震后1年创伤后应激障碍调查

目的了解汶川重灾区地震后1 a青少年创伤后应激障碍(Post-Traumatic Stress Disorder,PTSD)的现患情况,为制定干预措施提供科学依据。方法采用创伤后应激障碍自评量表(PTSD Checklist-Civilian Version,PCL-C),对汶川地震重灾区3所中学初一、初二、高一、高二年级的在校学生进行问卷调查,PTSD的诊断依据DSM-Ⅳ标准。结果地震后1 a重灾区中学生PTSD的筛查阳性率为6.1%,以警觉性过强所致易激惹症状(D组)阳性率最高(75.1%)。初二和高一年级,居住在农村、家庭有财产损失的学生PTSD阳性率及B,C,D 3组症候群阳性率较高;女生和地震中受伤学生B,C,D 3组症候群阳性率较高。结论地震后1 a青少年PTSD阳性筛查率仍较高,继续采取有效干预措施降低重灾区青少年PTSD造成的长期心理危害十分必要。     

汶川地震早期救援官兵心理应激特点及相关因素

目的探讨汶川地震早期救援官兵心理应激特点及相关因素,为制定救援官兵心理干预措施提供科学依据。方法采用整群抽样和自编一般情况问卷、创伤后应激反应症状自评量表(PCL-C)、领悟社会支持量表(PSSS)、应对方式问卷(SCSQ)对752名汶川地震早期救援官兵进行测评,结合半结构式访谈,确定急性心理应激障碍(ASD)组和对照组,对相关因素进行spearman分析。结果(1)汶川地震早期救援官兵心理应激障碍发生率为15.0%;(2)救援官兵心理应激反应的主要症状有7个:强烈的心理痛苦烦恼,反复闯入性痛苦性回忆,噩梦,睡眠障碍,创伤事件场景的重现,兴趣下降,烦躁不安和暴怒;(3)在解决问题、求助、主客观社会支持和对社会支持利用度等因子上,ASD组得分显著低于对照组(P0.01),而在幻想、退避、自责、合理化因子上,ASD组的得分显著高于对照组(P0.01);(4)解决问题、求助、社会支持总分和主客观支持分与PCL-C总分和3个因子分(创伤再体验,麻木与回避,警觉性增高)呈负相关,自责、幻想、退避因子与ASD总分和3个因子分呈正相关。结论救援官兵的急性心理应激障碍发生率较高,与应对方式、社会支持相关。     

创伤住院患者创伤后应激障碍与应对方式、社会支持及防御方式的关系的研究

目的了解创伤住院患者创伤后应激障碍(PTSD)的检出情况以及PTSD与防御方式、应对方式、社会支持之间的关系。方法选择新疆某三甲医院的创伤住院患者,以及目睹亲人经历重大创伤或者突然亡故的家属400名。以创伤后应激障碍症状清单平民版量表、社会支持量表、简易应对方式问卷和防御方式问卷为工具采用一对一面谈的方式对其进行调查。结果 (1)400例创伤患者中PCL-C评分均值为(36.975±14.090),PTSD的症状筛查阳性率为31%(PCL-C分值≥41分);(2)PCL-C阳性组采取消极应对方式多于积极应对方式;(3)PCL-C阳性组在防御方式上采取不成熟型和掩饰型多于PCL-C阴性组;(4)PCL-C阴性组在社会支持方面均高于PCL-C阳性组。结论经历创伤患者承受心理压力大,易采取消极的应对方式,心理防御方式存在明显的掩饰型和不成熟倾向,而好的社会支持可改善其应对方式。     

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.     

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.