低出生体质量影响因素研究

目的探讨低出生体质量儿发生的危险因素,为控制和降低低出生体质量发生率提供理论依据。方法选取深圳市南山区2014-2016年出生的活产新生儿6 261例,3年间每年所分娩的活产儿分别分为病例组和对照组,利用χ~2检验及多因素Logistic回归模型进行分析。结果多因素分析结果显示,BMI18. 5 kg/m~2、文化程度低(高中及以下)、双胎、产检总次数≤5次、女婴、高危产妇及早产为低出生体质量儿的危险因素,差异均有统计学意义(均P0. 05)。结论低出生体质量儿受多种因素的联合作用,应加强孕前及孕期的宣传教育,加强高危孕妇的管理,降低低出生体质量儿的发生率。     

广西平果县和德保县壮族人群低出生体重的影响因素研究

目的 分析壮族人群低出生体重发生情况,探讨低出生体重儿的影响因素。方法 选取在广西平果县人民医院、妇幼保健院及德保县妇幼保健院2012年1月1日~2015年6月1日出生的4 915例壮族活产新生儿为研究对象,收集一般人口学资料及低出生体重相关的影响因素,采用多因素Logistic回归方法分析低出生体重儿的影响因素。结果 低出生体重儿358例,低出生体重率为7.28%。母亲孕龄≥35岁（OR=1.72）、身高150 cm以下（OR=2.75）、孕早期体质指数（body mass index,BMI）<18.5 kg/m2（OR=1.68）、血红蛋白浓度<110 g/L（OR=1.50）、孕中期增重少（OR=1.57）、流产史（OR=1.76）、妊娠期高压（OR =5.32）、多产次（OR=1.51）、孕期产前检查少于8次（OR=2.10）等为低出生体重儿发生的危险因素;母亲孕早期BMI≥24.0 kg/m2（OR=0.26）、分娩孕周37周及以上（OR =0.06）、单胎（OR=0.04）等为保护因素。结论 母亲孕龄、身高、孕早期BMI、血红蛋白浓度、流产史、妊娠期高血压、孕期产前检查次数等是壮族人群低出生体重的影响因素,应采取综合措施预防和减少低出生体重儿的发生。     

巨大儿发生危险因素的病例对照研究及预测模型

目的探讨影响巨大儿的危险因素,建立巨大儿发生的预测模型,为预防巨大儿的干预措施提供参考依据。方法选择2017年10月-2018年10月于广西壮族自治区妇幼保健院住院分娩巨大儿的产妇262例为病例组,同期分娩正常体质量儿的产妇293例为对照组,分析两组产妇年龄、孕前体质指数(BMI)、孕期总增重以及是否患妊娠期糖尿病等差异,找出巨大儿的危险因素并建立巨大儿发生的预测模型。结果根据多因素Logistic回归分析,身高≥160 cm,孕早期BMI≥24 kg/m2、产次≥2次,孕期体质量增长≥16 kg,患妊娠期糖尿病,男性胎儿,分娩孕周≥39周均为巨大儿发生的危险因素。筛选身高、孕早期BMI、产次、孕期总增重、患妊娠期糖尿病5个因素建立巨大儿发生的预测模型,差异有统计学意义(P0.05),且准确度为73.2%。结论根据巨大儿的危险因素和建立的预测模型,采取有针对性的预防措施,关注孕前超重或肥胖及高龄孕妇,监测并管理孕期体质量增长,防治妊娠期糖尿病,以降低巨大儿发生率。     

苏州市早产与低出生体重的趋势及危险因素研究

目的了解苏州市活产分娩婴儿中早产儿和低出生体重儿的发生率并探讨相关危险因素。方法选取2009-2013年苏州市单胎分娩的产妇189 935例为研究对象,收集产妇年龄、产次、孕次、孕周、新生儿出生体重等指标,利用χ~2检验及多因素Logistic回归模型评估相关性。结果 2009-2013年苏州市早产率及低出生体重率均呈现上升趋势,总体早产率为7.0%,低出生体重率为5.2%。孕妇文化程度为高中/职高、大专及以上、产次为2次是早产与低出生体重的保护因素,孕妇年龄40岁、剖宫产是早产与低出生体重的危险因素,孕次≥5次是早产的危险因素,孕妇年龄为20~40岁、孕次2~4次是低出生体重的保护因素。结论早产及低出生体重的发生是多因素联合作用造成的,因此在妇幼保健工作中应有计划、有针对性、有重点地开展孕前及孕期保健宣传,提高自我保健意识,对降低早产及低出生体重发生率有重要意义。     

叶酸摄入与低出生体质量儿的相关性研究

目的了解怀孕前1年及孕期叶酸摄入与低出生体质量儿的关联性,以期为低出生体质量儿的防治提供科学依据。方法以2011-2012年在兰州市某三甲妇幼保健院建卡并随访到分娩结局的孕妇为研究对象,用病例对照的研究方法分析孕前及孕期叶酸摄入与低出生体质量儿的关联性。结果在调整了混杂因素后,与未服用叶酸的孕妇相比,在整个孕期及孕前规律补充叶酸3个月是低出生体质量儿(OR=0.84,95%CI:0.74~0.96)和极低出生体质量儿(OR=0.74,95%CI:0.55~0.98)的保护因素,且均存在剂量反应关系(P趋势0.05);孕期膳食叶酸低于120.70μg/d是极低出生体质量儿(OR=1.88,95%CI:1.06~3.33)和足月低出生体质量儿的危险因素(OR=1.83,95%CI:1.01~3.34)。结论怀孕前1年及孕期叶酸摄入不足增加了低出生体质量儿的发生风险,建议育龄期妇女在孕前及孕期适量规律地补充叶酸,同时在孕期增加膳食中叶酸的摄入量。     

低出生体重儿的相关因素分析及其对母儿的影响

目的:了解低出生体重儿发生的相关因素及母儿的影响,为妇婴保健部门制订相应的预防对策提供参考.方法:选择2002年1月～2012年12月期间493例低出生体重儿为低出生体重儿组,选择11 817例正常体重儿为对照组,统计每例低出生体重儿临床证实相关因素、孕周、来自区域及母体孕期保健次数,随访并记录所有新生儿及母体围产期及出生后6个月内并发症.结果:低出生体重儿各相关因素构成比依次为:多胎(101/493)、高龄(98/493)、早产(84/493)、营养不良(79/493)、脐带因素(51/493)、新生儿窒息(46/493)、初孕(34/493).农村低出生体重儿构成比显著高于城市(P＜0.05).孕期保健≥7次低出生体重儿构成比显著低于孕期保健＜7次者(P＜0.05).孕周≥37周低出生体重儿构成比显著低于孕周＜37周的低出生体重儿(P＜0.05).低出生体重组新生儿并发症发生率为5.7％,显著高于对照组的0.8％(P＜0.05).低出生体重组母体并发症发生率为29.2％,显著高于对照组的5.2％(P＜0.05).结论:低出生体重儿主要相关因素为多胎、高龄、早产及营养不良等,这些因素会增加母体及新生儿并发症,应加强上述相关因素的预防保健工作.     

天津市低出生体重儿影响因素的研究

目的了解天津市低出生体重发生情况,分析低出生体重儿的影响因素,为制定降低低出生体重儿发生的措施提供依据。方法选取天津市全市所有2013年1-3月出生的活产新生儿作为研究对象,采用Logistic多元回归分析方法分析877例低出生体重儿的影响因素。结果研究显示胎儿窘迫、妊娠期高血压、分娩孕周小、多胎、女婴为低出生体重儿发生的危险因素,差异有统计学意义(P0.05);母亲高文化程度、多产次、母亲孕前体重重、孕期增重多为保护因素,差异有统计学意义(P0.05)。结论低出生体重儿受多因素联合作用影响,应加强孕前宣教及孕期保健管理,减少低出生体重儿的发生。     

低出生体重儿的影响因素研究

目的:应用描述性研究的方法,找出低体重儿的危险因素,为避免低体重儿的发生即优生优育提供可靠的理论依据。方法:符合纳入和排除标准的5842例确立为分析和研究的对象。结果:①通过低出生体重儿的影响因素单因素非条件Logistic回归分析发现:产次、孕次、孕周、产前空腹血糖、产前血压、季节、脐带长度有统计学意义(P<0.05),其中产次、孕次、孕周(37～40周)、产前血压是危险因素;秋季、脐带长度(30～70cm)是保护因素。②影响低出生体重儿的计量资料分析,通过成组t检验发现:产妇的产前体重、产妇的身高、胎盘重量有统计学意义,都对低出生体重儿有影响。③通过低体重儿多因素非条件Logistic回归结果发现:孕周、产前血压、秋季有统计学意义(P<0.05),其中孕周、秋季是保护因素,可避免低出生体重儿的发生;产前血压是危险因素,易导致低出生体重儿的发生。结论:孕妇的身高、体重、胎盘重量、孕次、产次、秋季是低出生体重儿的影响因素,其中孕周、秋季、产前空腹血糖、脐带长度是低出生体重儿的保护因素;产前血压是低出生体重儿的危险因素。     

270例巨大儿相关危险因素的病例对照研究

目的探讨巨大儿发生的影响因素,为制定预防分娩巨大儿的措施提供参考依据。方法选取2017年1-12月在厦门市妇幼保健院分娩巨大儿且有完整孕期信息资料的孕妇270例为巨大儿组。以上述孕妇的年龄为匹配因素,另收集同期在该院分娩胎儿出生体质量在2500～3999g之间、孕期信息资料完整的270例孕妇为正常组。分析两组孕妇孕前BMI、流产次数、不同孕期体质量增长及血脂水平等的差异。结果多因素分析结果显示,妊娠期糖尿病(OR=2.698),孕前BMI≥24.0 kg/m~2(OR=2.680),孕晚期低密度脂蛋白≥3.0 mmol/L (OR=2.799),孕晚期三酰甘油≥2.8 mmol/L (OR=4.868)、孕13～28周体质量增长≥9.0 kg (OR=2.407)、孕期总体质量增长≥16.0 kg (OR=4.079)均是分娩巨大儿的危险因素(P0.05)。其中孕晚期三酰甘油≥2.8 mmol/L对巨大儿的发生影响最大。结论合理控制孕期体质量增长,使得孕中期体质量总增长9 kg,整个孕期体质量增长16 kg是预防巨大儿发生的重要措施。产科医生应该关注孕期血脂水平,孕晚期三酰甘油≥2.8 mmol/L、低密度脂蛋白≥3.0 mmol/L对巨大儿的发生可能有促进作用。妊娠期糖尿病是分娩巨大儿的高危因素,临床应给予规范的饮食控制以降低巨大儿的发生率。     

中国低出生体重儿危险因素的病例对照研究

目的 探讨我国不同特征低出生体重儿发生的有关危险因素。方法 1998年7－10月,对我国11个省44个县市的999例低出生体重儿进行1：！病例对照研究。结果 我国低体重儿发生的危险因素主要为多胎、孕周不足、孕期异常、孕期营养差、母亲疾病史及母亲程度低等,其OR值分别为106．9、18．79、3．42、1．93、2．61和1．43。各危险因素在沿海、内地及边远地区的分布差异有显著性。农村低体重儿的原因主要为宫内发育迟缓（71．6％）,城市低体得儿的原因还包括多胎和早产。早产及宫内发育不全的低出生体重儿之间的危险因素存在差异。结论 有针对性地开展防治工作是降低我国低体重儿出生率的有效措施。     

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.