Position of the Academy of Nutrition and Dietetics: Oral Health and Nutrition

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.     

Clinical manifestations and management of scorpion envenomation.

The most venomous scorpion species are Buthotus tamulus of India, the Leiurus quinquestriatus and Androctonus crassicauda of North Africa and the Middle East, the Tityus serrulatus of Brazil, and the Centruroides suffussus of Mexico. The severity of scorpion envenomation varies with the scorpion's species, age, and size, and is much greater in children. Systemic intoxication reflects the overstimulation of the CNS, the sympathetic and parasympathetic nervous system. Severity ranges from local pain and paresthesia to fatal cardiotoxicity and encephalopathy. Symptoms include: agitation, tachycardia, vomiting, abdominal pain, salivation, diaphoresis, dehydration, muscle rigidity and twitching, tremor, seizures, coma, pupillary changes, hyperthermia, tachyarrythmias and occasionally bradyarrhythmias, hypertension, and less often hypotension, cardiac failure, and priapism in males. Laboratory abnormalities include: hyperglycemia, leucocytosis, transient elevation of cardiac and pancreatic enzymes, ischemic changes in the ECG, and evidence of cardiac dysfunction on echocardiography. The principles of management are: observation, cardiac monitoring, supportive treatment with intravenous fluids and electrolytes, and a meticulous use of cardiovascular agents: vasodilators, adrenergic antagonists, or calcium channel blockers in the hypertensive phase; and inotropic agents in the event of hypotension. Antiarrhythmics such as lidocaine, may be required. There is increasing evidence for the efficacy of specific antivenom. The advance in supportive care and antivenom efficacy has markedly improved the outcome of patients with scorpion envenomation.     

Lactation in the horse: the mineral composition of mare milk

Changes in the mineral composition of mare milk during lactation were studied. Milk samples were obtained from five Thoroughbred mares one to three times weekly from the first to the eighth week of lactation and from two of the mares for an additional 8 wk. Samples averaging 500 mL were obtained after oxytocin was administered to the mares. Each sample was analyzed for total solids, ash, calcium, phosphorus, magnesium, sodium, potassium, copper and zinc. The concentration of all constituents except sodium and potassium decreased throughout lactation. The rates of decline of ash, calcium, phosphorus and magnesium concentration were similar, but the rates of decline of the other elements differed. Thus, the mineral composition of mare milk should be described in terms of the stage of lactation of the mare. The total solids and ash content of mare milk were 12 and 0.61% respectively, at the end of the first week of lactation, 10.5 and 0.45% at 4 wk, 10 and 0.38% at 8 wk and 10.2 and 0.32% at 16 wk. The calcium, phosphorus and magnesium concentrations at the end of the same periods were 1345, 943 and 118 micrograms/g of milk at 1 wk; 1070, 659 and 86 at 4 wk; 831, 574 and 58 at 8 wk and 700, 540 and 43 micrograms/g of milk at 16 wk. Copper and zinc concentrations were 0.85 and 3.1, 0.55 and 2.2, 0.29 and 1.9 and 0.28 and 1.8 microgram/g of milk at 1, 4, 8 and 16 wk, respectively.     

How mothers treat their children's physical symptoms

An important area of concern in community health is the widespread practice of individuals undertaking courses of treatment in the absence of medical advice or direction. This is especially a problem when it involves the administration of medicines to children. This study examines the extent, determinants, and quality of the independent use by mothers of medications for treating their children's symptoms. Data on mother-initiated medication behavior (MIMB) were obtained from a random sample of 500 mothers of children at two pediatric ambulatory care sites. Six expert pediatric judges rated every reported medication use (N=3,908) along three dimensions (usefulness, correctness, and harmfulness/helpfulness) and also evaluated the overall appropriateness of each mother's MIMB. Results indicate that: 1) mothers keep available and use for their children a considerable number of different medications; 2) clear relationships exist between mothers' socioeconomic status and the different categories of medications they employ; 3) mothers' perceptions of their children's vulnerability to specific illnesses, and of the efficacy of over-the-counter medications for treating those illnesses, were related to the possession and use of relevant medications; and 4) judges' ratings indicated little enthusiasm for the mothers' therapeutic actions. These findings suggest the need for pediatricians to become aware of the medications their patients may be ingesting as a result of MIMB, and to educate mothers concerning use and misuse of over-the-counter (and other) treatments.Lois A. Maiman, Ph.D., is Assistant Professor, Department of Pediatrics, and Department of Preventive, Family and Rehabilitation Medicine, School of Medicine and Dentistry, University of Rochester, New York. Marshall H. Becker, Ph.D., M.P.H., is Professor and Chairman, Department of Health Behavior and Health Education, School of Public Health, and Professor, Department of Pediatrics and Communicable Diseases, School of Medicine, University of Michigan, Ann Arbor, Michigan. Anne W. Katlic, B.A., is Research Assistant, Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, New York. Address reprint requests to: Dr. Lois A. Maiman, Department of Pediatrics, Box 777, School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642.This research was supported by Grants HD15357 and HD00538 from the National Institute of Child Health and Human Development, National Institutes of Health.     

新疆某医院入院患者高尿酸血症与常见慢性疾病关系研究

目的 探讨新疆维吾尔族人群高尿酸血症与常见慢性疾病的关系,为尿酸相关疾病预防、控制提供科学依据。方法 调查员经统一培训后对709名维吾尔族高尿酸血症患者进行问卷调查,并进行病例资料查询,获得生化指标和诊断,采用χ²检验和方差分析进行比较。结果 (1)入选的高尿酸血症中代谢综合征、高血压、高血糖、血脂紊乱的现患病率为42.3%、39.2%、12.12%、65.6%;呼吸、消化、肿瘤、循环、泌尿系统疾病的患病率为12.8%、9.2%、7.1%、35.4%、6.5%。其中最高的3种疾病为血脂紊乱、代谢综合征和高血压。代谢综合征、高血压、血脂紊乱、饮酒、吸烟的性别构成比男性均高于女性,χ2值分别为3.886、5.081、20.935、41.852和122.015,且差异具有统计学意义(P均＜0.05)。(2)随着尿酸水平的增高,男性比例、泌尿系统疾病、高血糖和血脂紊乱人群比率随之增高,χ2值分别为375.653、14.616、7.980和146.020(P均＜0.05);(3)随着尿酸水平的升高,收缩压、舒张压、FBG、甘油三酯逐渐增高,而HDL逐渐降低,F值分别为3.055、3.287、5.031、2.722和9.091(P均＜0.05)。结论 高尿酸血症患者中血脂紊乱、代谢综合征和高血压等代谢性疾病的患病率较高;随着尿酸水平的升高,男性、泌尿系统疾病比率和血压、血糖、血脂指标随之增高。     

山东省东平湖地区淡色库蚊对常用杀虫剂的抗药性调查

目的了解山东省东平湖淡色库蚊对常用5种化学杀虫剂的抗性状况,为合理有效地进行蚊虫化学防治提供依据。方法采用WHO生物测定方法,测定2010-2011年淡色库蚊敏感品系和现场种群对5种杀虫剂的抗性及增效系数。结果现场淡色库蚊种群对氯氰菊酯、残杀威、溴氰菊酯、三氯杀虫酯、DDVP的抗性指数,2010年分别为106.40、4.30、110.75、0.60和4.09倍,2011年分别为94.30、2.70、112.33、0.61和2.91倍。DDVP＋三氯杀虫酯、残杀威＋三氯杀虫酯复配增效系数分别为164.39~171.08和188.28~221.84。结论山东省东平湖淡色库蚊对5种常用化学杀虫剂均产生不同程度的抗药性,应采取多种杀虫剂复配和增效剂与杀虫剂合用措施,以克服或延缓蚊虫抗药性的产生和发展。     

Levels of heavy metals (Fe,Cu, Ni,Cr, Pb,and Zn) in tissue of Mugil cephalus and Trachurus mediterraneus from Iskenderun Bay,Turkey

Concentrations of iron, copper, nickel, chromium, lead, and zinc were determined in the muscle, skin and gonads of Mugil cephalus and Trachurus mediterraneus caught at three stations in Iskenderun Bay, Turkey. Heavy metal concentrations in the tissues tended to vary significantly among stations, and two stations thought to be contaminated by untreated domestic wastes and surrounding industrial environment showed particularly high metal concentrations. Generally, skin and gonads showed higher metal concentrations than muscle. The ranges of mean concentrations (micro g/g wet wt) in M. cephalus were as follows: the range of iron concentration was 70.28, 149.77, and 382.51, that of copper was 1.45, 5.36, and 35.37, that of nickel was 1.22, 2.72, and 7.35, that of chromium was 1.46, 3.22, and 10.06, that of lead was 7.45, 37.39, and 62.33, and that of zinc was 38.23, 100.56, and 281.51 in the muscle, skin, and gonads, respectively. The ranges of mean concentrations (micro g/g wet wt) in T. mediterraneus were as follows: the range of iron concentration was 41.84, 49.86, and 74.20, that of copper was 1.29, 3.33, and 11.37, that of nickel was 0.94, 2.02, and 0.99, that of chromium was 1.28, 10.90, and 10.60, that of lead was 1.03, 4.78, and 8.41, and that of zinc was 19.55, 60.79, and 38.44 in the muscle, skin, and gonads, respectively. The concentrations of some metals in some tissues exceeded the acceptable levels for a food source for human consumption. The results of this study indicated that the metals present in the bay were taken up by two fish species through food, water, and sediment, and regardless of their biological needs showed high metal concentrations.     

小切口胆囊切除术262例与腹腔镜胆囊切除术130例综合分析

分析小切口手术及腹腔镜手术的利弊，探讨其使用及推广价值。方法：采用小切口与腹腔镜胆囊 切除作前瞻性对比研究，观察对比了两组术前情况、术中切口、出血量、手术时间、腹腔引流次数、术后止痛剂次数、 抗菌治疗天数、恢复饮食时间、下床活动时间、创口愈合情况、并发症发生、住院天数及总费用等多种项目。结果： 小切口胆囊切除术和腹腔镜胆囊切除术同具有创伤小、愈合快、恢复早的特点，但小切口手术更具有并发症少、直 视灵活、费用低、易推广等优点。结论：小切口胆囊切除是一种较腹腔镜更安全的小创伤手术，开展小切口胆囊切 除须灵活应用，须注重有关问题。     

Activity and biological effects of neem products against arthropods of medical and veterinary importance.

Botanical insecticides are relatively safe and degradable, and are readily available sources of biopesticides. The most prominent phytochemical pesticides in recent years are those derived from neem trees, which have been studied extensively in the fields of entomology and phytochemistry, and have uses for medicinal and cosmetic purposes. The neem products have been obtained from several species of neem trees in the family Meliaceae. Six species in this family have been the subject of botanical pesticide research. They are Azadirachta indica A. Juss, Azadirachta excelsa Jack, Azadirachta siamens Valeton, Melia azedarach L., Melia toosendan Sieb. and Zucc., and Melia volkensii Gürke. The Meliaceae, especially A. indica (Indian neem tree), contains at least 35 biologically active principles. Azadirachtin is the predominant insecticidal active ingredient in the seed, leaves, and other parts of the neem tree. Azadirachtin and other compounds in neem products exhibit various modes of action against insects such as antifeedancy, growth regulation, fecundity suppression and sterilization, oviposition repellency or attractancy, changes in biological fitness, and blocking development of vector-borne pathogens. Some of these bioactivity parameters of neem products have been investigated at least in some species of insects of medical and veterinary importance, such as mosquitoes, flies, triatomines, cockroaches, fleas, lice, and others. Here we review, synthesize, and analyze published information on the activity, modes of action, and other biological effects of neem products against arthropods of medical and veterinary importance. The amount of information on the activity, use, and application of neem products for the control of disease vectors and human and animal pests is limited. Additional research is needed to determine the potential usefulness of neem products in vector control programs.     

Estrogen and progesterone differentially regulate carbonic anhydrase II,III, IX,XII, and XIII in ovariectomized rat uteri

Changes in the uterus expression of carbonic anhydrase (CA) II, III, IX, XII, and XIII were investigated under the influence of sex-steroids in order to elucidate mechanisms underlying differential effects of these hormones on uterine pH. Uteri of ovariectomised rats receiving over three days either vehicle, estrogen, or progesterone or three days estrogen followed by three days either vehicle or progesterone were harvested. Messenger RNA (mRNA) and protein levels were quantified by real-time PCR and Western blotting, respectively. The distribution of CA isoenzymes proteins were examined by immunohistochemistry. The levels of CAII, III, XII, and XIII mRNAs and proteins were elevated while levels of CAIX mRNA and protein were reduced following progesterone-only and estrogen plus progesterone treatment, compared to the control and estrogen plus vehicle, respectively. Following estrogen treatment, expression of CAII, IX, XII, and CAXIII mRNAs and proteins were reduced, but remained at a level higher than control, except for CAIX, where its level was higher than the control and following progesterone treatment. Under progesterone-only and estrogen plus progesterone influences, high levels of CAII, III, XII, and XIII were observed in uterine lumenal and glandular epithelia and myometrium. However, a high level of CAIX was observed only under the influence of estrogen at the similar locations. In conclusion, high expression of CAII, III, XII, and XIII under the influence of progesterone and estrogen plus progesterone could result in the reduction of uterine tissue and fluid pH; however, the significance of high levels of CAIX expression under the influence of estrogen remains unclear.     

Acute poisoning by aldrin: relationship between serum levels and toxic effects in humans

In the attempt to correlate clinical findings with serum levels of aldrin, sixteen patients were followed-up after acute intoxication by this agent. Eight of them, males and females, aged from 1 to 37 years, presented no or light symptoms (some discomfort and nausea). The serum of one of these patients was found to contain 16.6 ppb of aldrin and that of another, 1.41 ppb of dieldrin. A group of five patients, aged from two to 30 years, showed symptoms of moderate severity, reporting nausea, vomiting, drowsiness, dyspnea, sweating, mild jerking, rise in blood pressure and convulsions. Of these cases, two were accidental and three were attempted suicides, the majority achieving complete recovery within 24 hours. Serum levels of aldrin were between 6.98 ppb and 26.3 ppb and of dieldrin between 82.00 and 314.18 ppb. We found three severe cases, aged from 21 to 35 years, two attempted suicides and one occupational case. Two of these patients died and one of them presented hypothermia, coma, absence of reflexes and generalized convulsions, and another presented abdominal pain, paleness, sweating, cold extremities, dyspnea, hyperthermia and generalized convulsions. In the first one that died the serum levels were: of aldrin 30.00 ppb and of dieldrin 720 ppb. In the other levels of 747.3 ppb of aldrin and 1,314.00 ppb of dieldrin were found. The third had less serious symptoms and presented serum levels of aldrin of 31.05 ppb and of dieldrin 147.11 ppb.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diazinon-induced histopathological and hematological alterations in a freshwater teleost, Ophiocephalus punctatus

The histopathological changes in liver, stomach, intestine, kidney, and gills and the hematological changes produced by two sublethal concentrations of diazinon (0.2 and 0.4 mg/liter) in a freshwater teleost fish, Ophiocephalus punctatus, have been studied after 15 and 30 days of exposure. The most conspicuous pathological changes in the liver after 15 days were liver cord disarray, rupture of cell membrane, vacuolation in the cytoplasm of hepatocytes, and enlargement of nuclei. The liver damage became more severe in fish exposed for 30 days and was characterized by fibrosis, small degenerated nuclei, and invasion of a number of phagocytes into the necrosed tissue. The only visible change in the stomach was erosion of mucosa. In the intestine, a few villi were necrosed and nuclei were reduced in volume. In the kidney, shrinkage of the glomerular network and necrosis of proximal tubules were the most conspicuous changes. The distal and collecting tubules were ruptured and the nuclei were degenerated and pycnotic. Degeneration and thinning of epithelial lining of the lamellae, separation of the vascular layer from the epithelium, and in some cases fusion of the epithelium of adjacent villi were the alterations in the gill. In blood, hemoglobin, hematocrit, glucose, cholesterol, urea, sodium, and calcium levels increased while plasma proteins, chlorides, and inorganic phosphate remained unaltered. Among the serum enzymes, the activities of glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase, alkaline phosphatase, and amylase increased while acid phosphatase and cholinesterase activities decreased on exposure to diazinon.     

畲汉人群ACE基因多态性与原发性高血压关系的病例对照研究

目的探索浙江省畲汉两族人群ACE基因多态性分布情况及其与原发性高血压的关系。方法采用聚合酶链反应(PCR)检测215例畲汉两族原发性高血压(EH)及正常人群血中ACE基因16内含子I/D多态标记,分析计算各基因型(DD型、ID型、Ⅱ型)及等位基因频率,运用Logistic多元回归分析ACE基因型与原发性高血压的关系。结果浙江畲族EH组与对照组DD、ID、Ⅱ基因型频率分别为39.7%、32.8%、27.6%及18.8%、45.8%、35.4%,D和I等位基因分别为56.0%、44.0%及41.7%、58.3%。汉族EH组与对照组DD、ID、Ⅱ基因型频率分别40.7%、31.5%、27.8%及21.8%、40.0%、38.2%,D和I等位基因分别为56.5%、43.5%及41.8%、58.2%。Logistic回归显示DD基因型为原发性高血压危险因素(OR=2.746,P0.05)。结论畲汉两族之间ACE基因多态性构成没有差异,两族中带有DD基因型及D等位基因的个体易患原发性高血压。     

Inorganic constituents of breast milk from vegetarian and nonvegetarian women: relationships with each other and with organic constituents

Changes in concentrations of minerals, trace elements, protein, lactose and total lipids during 20 mo of lactation and correlations between levels of these milk constituents were studied in a carefully defined set of 222 milk samples collected from 52 women, one-half of whom were vegetarians. Milk samples from vegetarians and those from nonvegetarians contained similar levels of iron, copper, zinc, sodium, potassium, calcium, magnesium, lactose and fat. Following a brief but sharp initial decrease, levels of protein and iron did not change significantly between mo 2 and 20 of lactation. Levels of zinc, copper, sodium and potassium declined for the first 6 mo of lactation. Levels of lipid, sodium and zinc increased during later months of lactation while that of calcium decreased. Levels of lactose, copper, potassium and magnesium remained unchanged during mo 7-20. Stepwise multiple regression analysis showed positive correlations between levels of three pairs of inorganic constituents during the first 6 mo of lactation: copper and zinc, copper and potassium, and potassium and calcium. During the subsequent 14 mo of lactation, potassium was correlated with copper. The level of iron was positively correlated with that of lipid, while that of calcium was negatively correlated with that of lipid. These relationships, and others reported in the paper, are discussed in relation to current hypotheses of the mechanism of milk secretion and the binding of inorganic to organic milk constituents.     

Rethinking medical professionalism: the role of information technology and practice innovations

CONTEXT: Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology (IT), electronic health records (EHRs), improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care. METHODS: The potential of IT, EHRs, and other practice facilitators for professionalism is assessed through diverse but relevant literatures, examination of relevant websites, and experience in working with medical leaders on renewing professionalism. FINDINGS: IT and EHRs are the basis of needed efforts to reinforce medical competence, improve relationships with patients, implement disease management programs, and, by increasing transparency and accountability, help reduce some conflicts of interest. Barriers include the misalignment of goals with payment incentives and time pressures in meeting patients' expectations and practice demands. Implementing IT and EHRs in small, dispersed medical practices is particularly challenging because of short-term financial costs, disruptions in practice caused by learning and adaptation, and the lack of confidence in needed support services. Large organized systems like the VA, Kaiser Permanente, and general practice in the United Kingdom have successfully overcome such challenges. CONCLUSIONS: IT and the other tools examined in this article are important adjuncts to professional capacities and aspirations. They have potential to help reverse the decline of primary care and make physicians' practices more effective and rewarding. The cooperation, collaboration, and shared responsibility of government, insurers, medical organizations, and physicians, as well as financial and technical support, are needed to implement these tools in the United States' dispersed and fragmented medical care system.     

食品和公共场所从业人员HBV感染情况调查分析

目的：了解本辖区食品和公共场所从业人员乙型病毒性肝炎(HBV)感染情况及其分布特点及HBsAg阳性与HBeAg和ALT(谷丙转氨酶)之间的相互关系。方法：采用酶联免疫吸附试验(EELSA)，对1995--2002年本辖区食品和公共场所从业人员进行HBsAg、HBeAg检测和ALT测量。结果：1995--2002年共检测568193人份，其中HBsAg阳性人数为55151人份，HBeAg阳性人数为18940人份，ALT异常人数为878人份。1995—2002年HBsAg检出率分别为9．81％、10．97％、11．58％、11．98％、9．36％、8．46％、9．21％和7．69％。1995—2002年HBeAg检出率分别为3．51％、3.95％、3．93％、3．63％、2．93％、3．06％、3．48％和2．48％。ALT1995—2002年异常人数检出率分别为0．25％、0．23％、0．27％、0．30％、0．10％、0.07％、0．06％、0．06％。结论：本辖区食品和公共场所从业人员HBsAg感染率有所下降，但下降趋势不明显，HBeAg检出率和ALT异常人数检出率较低且每年相对稳定。建议健全食品和公共场所从业人员健康体检制度，进一步加强卫生监督。     

Process and outcome evaluation of preventive care for infants in two types of practices

Process and outcome of preventive and promotive infant care have been evaluated in a maternal and child health (MCH) service and compared with that of a comprehensive care family practice (FP), both serving a low middle class population in West Jerusalem. Both services are provided by the Community Health Center of the Department of Social Medicine. Community oriented primary care is integrated into the practices, including ongoing surveillance of the communities' health status. Preventive and promotive programs have been developed, implemented and evaluated.The process evaluation indicated a similar use of the preventive service in the MCH and FP services. Some of the routines were carried out to a lesser extent in the FP than in the MCH framework, such as growth monitoring, hearing tests and advice on iron supplementation. The small difference in compliance with routines did not affect a child's growth between birth and one year of age, but the anemia rate in the FP practice was higher than in the MCH practice. The high level of care and relatively small differences in process and outcome between the two types of services have been achieved by ongoing inservice training, a high level of personnel, similar protocols and supervision in both practices.H. Palti, M.D. M.P.H., Associate Professor, Head of Maternal and Child Health Unit, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; D. Haustein, M.D. M.P.H., former student at the School of Public Health, Hebrew University and Hadassah, Jerusalem. Present address: Chabrier 179, San Isidro, Lima 27, Peru; R. Gofin, M.D. M.P.H., Lecturer & Physician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; B. Knishkowy, M.D. M.P.H., Family Physician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel; B. Adler, M.Sc., Statistician, Department of Social Medicine, Hadassah, and School of Public Health, Hebrew University and Hadassah, P.O.Box 12000, Jerusalem 91120, Israel.This study was supported by The Temin Endowment Fund. We wish to express our thanks to staff of MCH and FP practices of the Hadassah Community Research and Health Center, for their ongoing contribution to the MCH programs.     

Differences of inflammatory and non-inflammatory indicators in Coronavirus disease-19 (COVID-19) with different severity

BackgroundA variety of inflammatory and non-inflammatory indicators were increased in severe and critical Coronavirus disease-19 (COVID-19) and some of them were used to evaluate the severity and predict prognosis of community-acquired pneumonia. The aim of this study was to investigate the association of these indicators in COVID-19 with different severity.MethodsClinical data of 46 patients with severe COVID-19 and 31 patients with critical COVID-19 were collected. The general characteristics and comorbidities of the patients were retrospectively analyzed. The initial and peak concentrations of serum troponin I (cTnI), D-dimer (D-D), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT), initial and peak neutrophil counts and initial and trough lymphocyte counts were compared between two groups. The correlation between the variation of cTnI, D-D, CRP, IL-6, PCT, neutrophils, lymphocytes and the severity of the disease was analyzed. The efficacy of the initial concentrations of cTnI, D-D, CRP, IL-6, PCT, the initial neutrophil and lymphocyte counts in predicting critical COVID-19 were evaluated by receiver operating characteristic (ROC) curve.ResultsThe initial and peak concentrations of cTnI, D-D, CRP, IL-6, PCT, initial and peak neutrophil counts in critical group were higher than those in severe group, the initial and trough counts of lymphocyte were lower than those in the severe group. Except for the initial level of PCT, the other differences were statistically significant (p < 0.05). The increase of cTnI, D-D, CRP, IL-6, PCT, neutrophils and the decrease of lymphocytes were related to the severity of the disease, OR values were 28.80, 2.20, 18.47, 10.80, 52.00, 9.60 and 21.08, respectively. Except for D-D, the other differences were statistically significant. The areas under ROC curves for predicting critical COVID-19 by initial concentrations of cTnI, D-D, CRP, IL-6, PCT, initial lymphocyte and neutrophil counts were 0.76, 0.78, 0.83, 0.95, 0.56, 0.68 and 0.62, respectively.ConclusionsThe severe and critical COVID-19 patients had significant differences in concentrations of serum cTnI, D-D, CRP, IL-6, PCT, neutrophil and lymphocyte counts. The increase of cTnI, CRP, IL-6, PCT, neutrophils and decrease of lymphocytes indicated severe condition. The initial IL-6 might be a good indicator of COVID-19 severity.     

湘西自治州2008-2011年狂犬病监测分析

目的了解狂犬病暴露人群及狂犬病疫情流行特征,评价预防处置效果,为预防和控制狂犬病提供依据。方法对2008-2011年湘西自治州狂犬病暴露人群资料及狂犬病疫情资料进行分析。结果 2008-2011年狂犬病年度暴露数分别为15 509例、11 412例、9 845例、8 986例,暴露率分别为62.80/万、46.03/万、39.53/万、35.27/万,年均暴露率45.81/万。犬伤暴露占87.24%。2008-2011年湘西自治州狂犬病共报告发病48例,1例猫伤暴露,2例不详外,45例犬伤暴露。发病率分别为0.53/10万、0.20/10万、0.68/10万、0.51/10万,年均发病率为0.48/10万。Ⅰ级暴露占18.78%,Ⅱ级暴露占45.19%,Ⅲ级暴露占36.03%。Ⅱ、Ⅲ级暴露41例,占85.4%。门诊处理伤口3例,自行处理8例,未处理36例。接种疫苗2例,接种狂免1例,不详1例。结论消除或控制狂犬病发生的关键在于提高犬只免疫率。而研发新型兽用狂犬病疫苗,及时发现狂犬病暴露人群,加强狂犬病防治知识宣传,加强医务人员的培训,规范处理伤口,全程使用狂犬疫苗等举措,都将有利于控制狂犬疫情。     

云南白族儿童30年青少年体格生长发育指标分析

目的 分析1985 - 2014年30年间中国白族儿童青少年体格生长发育和营养改善情况,评价并提出改善白族儿童青少年目前生长发育和营养现状的建议。方法 采用多阶段分层随机整群抽样的方法,在云南省大理州随机抽取2个县12所中小学7～18岁白族学生作为研究对象。采用WHO - 2006标准,对1985 - 2014年间历次参加全国学生体质健康调研的学生进行生长迟缓和消瘦检出率的变化情况的比较,并分析2000 - 2014年间学生体格生长发育的变化趋势。结果 白族7～18岁学生营养不良率全面下降。1985年、2000年、2010年和2014年7～18岁男生生长迟滞率分别为20.0%、16.2%、7.9%和4.3%,消瘦率分别为12.6%、8.1%、11.7%和8.6%,营养不良率分别为32.6%、24.3%、19.6%和12.9%;7～18岁女生生长迟滞率分别为21.3%、14.7%、8.9%和4.0%,消瘦率分别为8.4%、5.7%、8.9%和6.5%,营养不良率分别为29.8%、20.4%、17.8%和10.5%。2000 - 2014年15年间白族男、女生身高发育的突增期为12～14岁和10～12岁,女生比男生提前2年进入突增高峰年龄。2000年、2005年、2010年和2014年白族18岁身高性差分别为10.04cm、12.27 cm、12.30 cm和12.82 cm男女生身高突增值和突增幅度全距均呈现逐年递减的趋势。学生体重指数(BMI)的变化较为平稳。结论 白族儿童青少年营养状况显著持续改善,体格发育和营养状况处于旺盛的正向生长。