舟山市围产儿出生缺陷分析

目的分析2013—2018年舟山市围产儿出生缺陷发生情况及影响因素,为制定舟山市围产儿出生缺陷干预措施提供依据。方法收集2013—2018年县级及以上医疗助产机构分娩的孕周≥28周至产后7天的围产儿出生缺陷监测资料,对出生缺陷发生率、主要病种及顺位进行描述性分析。结果 2013—2018年舟山市共监测围产儿45 039人,出生缺陷1 067例,平均发生率为23.69‰;2013—2018年出生缺陷发生率呈上升趋势(P0.05)。男婴出生缺陷发生率为27.60‰,高于女婴的19.37‰(P0.05)。城镇围产儿出生缺陷发生率为49.28‰,高于农村的11.61‰(P0.05)。不同母亲年龄的围产儿出生缺陷发生率差异有统计学意义(P0.05)。出生缺陷前五位依次为先天性心脏病、手指(趾)畸形、外耳畸形、唇裂伴腭裂和腭裂,发生率依次为12.12‰、2.29‰、1.07‰、0.62‰和0.53‰。结论 2013—2018年舟山市围产儿出生缺陷发生率呈上升趋势,先天性心脏病居首位,出生缺陷与围产儿性别、户籍、母亲年龄有关。     

丽水市围产儿出生缺陷变化趋势分析

目的分析丽水市出生缺陷发生现状及变化趋势,探讨减少本地区出生缺陷发生的有效干预措施。方法对2006年10月1日—2016年9月30日丽水市3个监测县(市、区)8家出生缺陷监测医院住院分娩的孕28周至产后7d内的围产儿和28周的出生缺陷儿报表资料进行分析。结果共监测围产儿92 543人。报告出生缺陷2 907例,其中围产儿出生缺陷2 234例,28周出生缺陷儿673例;围产儿出生缺陷发生率为24.14‰,呈逐年上升趋势(P0.05)。围产儿出生缺陷发生率男婴(25.57‰)高于女婴(22.52‰),城镇(27.04‰)高于乡村(22.62‰)(均P0.05);不同年龄组母亲分娩出生缺陷围产儿的概率不同(P0.05),20岁(37.21‰)和≥35岁(30.21‰)女性娩出出生缺陷围产儿的风险较高。围产儿出生缺陷发生率前五位为先天性心脏病、多指/趾、唇腭裂、并指/趾和小耳。围产儿和出生缺陷围产儿死亡率分别为9.09‰和15.49%,均呈逐年下降趋势(P0.05);出生缺陷儿死亡占围产儿死亡的41.14%。结论丽水市围产儿出生缺陷发生率呈逐年上升趋势,以先天性心脏病为主,围产儿性别及其母亲的年龄和居住地区与出生缺陷的发生密切相关。     

2006~2013年鹿泉市出生缺陷监测结果分析

目的了解鹿泉市出生缺陷的发生情况,找出影响因素,提出干预措施。方法依照《中国出生缺陷监测方案》,利用妇幼保健三级网络对2006~2013年在鹿泉市妇幼保健院分娩的产妇及其围产儿的资料进行统计分析。结果 2006~2013年鹿泉市出生缺陷平均发生率为8.08‰,发生率呈逐年上升趋势,2013年前5位出生缺陷顺位为:先天性心脏病、指(趾)畸形、外耳畸形、唇腭裂、神经管畸形。产妇年龄≥35岁时出生缺陷发生率的危险性明显增加(P﹤0.05)。结论应加强宣传教育,引导妇女适龄生育,加强婚前、孕前保健,重视产前检查和产前诊断,降低出生缺陷的发生率。     

无锡市61425例围产儿出生缺陷监测结果分析

目的了解无锡市出生缺陷发生情况,为制定降低出生缺陷有效干预措施提供依据。方法对2011年无锡市61425例出生缺陷监测资料进行分析。结果2011年无锡市出生缺陷发生率为4．98‰,并逐年下降。出生缺陷发生在城乡间、本地与外地、男女性别、胎产次差异有统计学意义,城市高于农村,本地高于外地,男性高于女性,第一产高于第二产及以上。在发生季节和产母年龄差异无统计学意义。无锡市出生缺陷前五大类依次为肢体畸形、唇腭裂、先心、耳部畸形、消化系统畸形,占总缺陷3／4以上,其中,多指（趾）、先心、唇裂、唇腭裂、并指（趾）,前五位占总出生缺陷1／2以上。结论出生缺陷发生率不断降低,出生缺陷监测质量不断提高。应重点针对前五位出生缺陷病种,寻找突破口,实施有效地三级预防措施,降低出生缺陷发生率。     

2007—2011年灌南县围产儿出生缺陷监测分析

目的分析2007—2011年灌南县出生缺陷发生情况,为制定干预措施提供科学决策依据。方法根据《中国妇幼卫生监测统计工作手册》要求,对37 680例围产儿监测资料进行系统性分析。结果灌南县出生缺陷发生率为4.94‰;出生缺陷类型前5位依次为唇裂、指趾畸形、唇腭裂、神经系统畸形、小耳;出生缺陷儿男性明显多于女性;不同年龄产妇缺陷儿发生率间差异有统计学意义。结论灌南县控制出生缺陷发生率取得一定成效。应进一步完善三级预防措施,加强保健队伍培训,加大健康教育力度,降低出生缺陷发生率。     

265例出生缺陷因素分析

目的:为了解围产儿出生缺陷相关危险因素,为干预措施提供依据。方法:按全国出生缺陷监测方法对临安市进行监测,取1999~2007年9年资料进行发生率、构成比、2χ及OR分析。结果:围产儿出生缺陷发生率8.784‰,男性缺陷发生率10.334‰,女性6.674‰,男性高于女性(2χ=12.022,P=0.001);占前4位的类型是肢指(趾)畸形、脑神经管畸形、耳畸形、唇腭裂,4者占总数的66.451%。胎产次≥2次,母孕期服药(均P<0.05),母亲年龄≥35岁,文化程度大专以下,经济收入<2 400元,母孕期患病、接触有害物是先天缺陷发生的危险因素。结论:针对主要缺陷类型进行干预有望降低发生率。     

1998～2003年长春市出生缺陷监测资料分析

目的研究和分析长春市围产儿出生缺陷发生的动态情况,为制定和采取预防措施提供决策依据.方法按中国出生缺陷监测中心制定的出生缺陷诊断及统计标准对围产儿进行监测.结果出生缺陷发生率呈逐年增高趋势;缺陷儿围产期死亡率368.19‰,占围产儿死亡的28.72%;出生缺陷前6位依次为先心病、神经管畸形、唇腭裂、外耳畸形、多指(趾)、脑积水;农村围产儿畸形率明显高于城市,产母年龄35岁以上为出生缺陷高发年龄.结论出生缺陷工作的重点在农村,应加强优生知识宣传.提高产前诊断技术,降低出生缺陷发生率,提高人口素质.     

2013 - 2017年柳州地区出生缺陷监测结果分析

目的 了解2013 - 2017年柳州地区围生儿出生缺陷发生特征及变化趋势,为制定预防和干预措施提供科学依据。方法 依照《中国出生缺陷监测实施方案》对柳州地区114家助产机构分娩的孕满28周至产后7 d内的围生儿出生缺陷监测数据进行分析。结果 2013 - 2017年柳州地区发现出生缺陷儿5 018例,总发生率为17.49‰,2013 - 2017年柳州市出生缺陷发生率呈现逐渐下降趋势,产后确诊的出生缺陷儿数是产前确诊数量的5.17倍。出生缺陷发生率城镇(22.61‰)高于乡村(12.99‰),男性(19.59‰)高于女性(15.13‰)。≥35岁母亲子代出生缺陷发生率(21.26‰)明显高于其他年龄组。出生缺陷发生率较高的前5位是先天性心脏病(5.08‰)、多指/趾(3.07‰)、外耳其他畸形(1.06‰)、总唇腭裂(1.03‰)、并指/趾(0.76‰)。结论 柳州地区出生缺陷发生率高于广西平均水平,以先天性心脏病和多指(趾)为高发出生缺陷,生后确诊的出生缺陷儿显著多于生前确诊的。建议进一步加强产前筛查及产前诊断,提高产前检查专业技术水平,降低出生缺陷儿的发生率。     

1998～2003年长春市出生缺陷监测资料分析

目的 :研究和分析长春市围产儿出生缺陷发生的动态情况 ,为制定和采取预防措施提供决策依据。方法 :按中国出生缺陷监测中心制定的出生缺陷诊断及统计标准对围产儿进行监测。结果 :出生缺陷发生率呈逐年增高趋势 ;缺陷儿围产期死亡率 36 8.19‰ ,占围产儿死亡的 2 8.72 % ;出生缺陷前 6位依次为 :先心病、神经管畸形、唇腭裂、外耳畸形、多指 (趾 )、脑积水 ;农村围产儿畸形率明显高于城市 ,产母年龄 35岁以上为出生缺陷高发年龄。结论 :出生缺陷工作的重点在农村 ,应加强优生知识宣传 ,提高产前诊断技术 ,降低出生缺陷发生率 ,提高人口素质。     

10年围产儿出生缺陷调查研究

目的 探讨出生缺陷的状况及其影响因素,为降低出生缺陷干预措施的制定提供依据.方法 回顾性监测分析我院2001年1月至2010年12月10年间分娩的围产儿出生缺陷状况.结果 10年监测17 365例围产儿,其中出生缺陷儿205例,平均出生缺陷发生率为11.81‰,总体出生缺陷的年度发生率间无显著性差异(χ2=4.303,P=0.890>0.05),但2006年至2010年与2001年至2005年相比,神经管畸形的构成比明显下降(17.09%vs29.55%,χ2=4.474,P=0.034<0.05,OR=0.492).前5位出生缺陷依次为:神经管畸形,多并指(趾),唇、腭裂,泌尿道畸形,先天性心脏病,其发生率分别为:2.66‰,2.49‰,1.22‰,1.10‰和0.98‰.前3种出生缺陷发生率之和占总出生缺陷发生率的52.69%.出生缺陷发生率与产妇年龄(χ2=14.946,P=0.000<0.05,OR=1.712)、围产儿性别(χ2=6.488,P=0.011<0.05,OR=1.440)关系密切.52.20%的出生缺陷在产前确诊.B超为主要确诊方式(57.07%).结论本地区出生缺陷发生率有待降低,特别是神经管畸形,多并指(趾),唇、腭裂畸形类型.小剂量叶酸干预对预防神经管畸形效果明显.     

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.