241例注意缺陷多动障碍临床分型结果及伴学习障碍的分析

目的:对241例注意缺陷多动障碍(ADHD)患儿进行临床分型,分析各亚型的年龄、性别及与学习障碍之间的关系。方法:选择2004年8月~2006年8月在上海交通大学医学院附属新华医院儿保门诊就诊的241例患儿,按照DSM—Ⅳ量表、韦氏(WISC—R)智力测定量表及儿童临床诊断性会谈量表(CDIS)进行分析。结果:符合DSM—ⅣADHD标准诊断共241例,其中男197例(81·74%),女44例(18·26%),男:女为4·48:1。注意缺陷为主型(ADHD—I)106例,占43·98%;多动冲动为主型(ADHD—HI)41例,占17·01%;混合型(ADHD—C)94例,占39·00%。各型均为男生多于女生。低年龄组ADHD—HI较高年龄组多;高年龄组ADHD—I较低年龄组多;ADHD—C型随年龄变化无明显差异。伴学习障碍有103例,占42·74%,各亚型中伴学习困难ADHD—I型61例,ADHD—HI型7例,ADHD—C型35例。结论:ADHD男女患病率有显著差异。各亚型中以ADHD—I型最多,ADHD—HI型最少,ADHD—C型居中。ADHD—I型随年龄增长发病率升高。     

不同亚型注意缺陷多动障碍患儿脑电活动的特征

[目的]探讨儿童注意缺陷多动障碍（attention deficit hyperactivity disorder,ADHD）三个亚型儿童及正常对照组儿童脑电活动的特征.[方法]将门诊符合DSM-Ⅳ诊断标准的110例ADHD儿童分为注意缺陷为主型（PI）49例,多动或冲动为主型（HI）19例,混合型（CT）42例,对照组儿童35例,对其进行脑电图检查并进行比较.[结果]ADHD组儿童脑电频率明显慢于正常对照组（P＜0.05）.三个亚型ADHD患儿中HI型脑电频率最慢,PI型频率最快,三个亚型间两两比较差异有非常显著性（P＜0.01）.HI型内右前额、右额部及右枕部的脑电频率明显慢于左半球（P＜0.05）.三个亚型在右枕部的脑电频率均慢于左半球.[结论]ADHD存在有一定的神经生理基础,其发病机制可能与大脑发育不成熟有关.     

注意缺陷多动障碍儿童不同亚型的神经心理特征

[目的]分析注意缺陷多动障碍(ADHD)儿童不同亚型的神经心理特征. [方法]将门诊儿童符合DSM-IV ADHD诊断标准者172例分为注意缺陷为主型(PI)57例,多动/冲动为主型(HI)21例和混合型(CT)94例,对三型儿童进行视觉-运动整合发育测验(VMI)和联合型瑞文测验(CRT),并进行组间比较,将ADHD儿童的VMI测验结果和常模比较. [结果]随着年龄的增长,HI型比例下降,PI型比例上升,差异有显著性;HI型男童的构成比较大,PI型则女童的构成比较大.得到相同的VMI原始分的年龄,ADHD儿童大于常模组儿童;和常模组比较,原始分为9分组差异有非常显著性(P＜0.001),10～12分组差异有显著性(P＜0.05);ADHD三型之间的VMI结果有差别,PI型最差、HI型和PI型之间差异有显著性(P＜0.05).CRT结果PI型较差,但三型之间差异无显著性. [结论]ADHD的分型和年龄、性别有关;ADHD儿童的视觉运动整合能力较正常儿童差,VMI更能反映ADHD亚型中的注意力障碍问题;各亚型之间计划能力、一般智力没有明显的差异.     

抽动障碍儿童共患注意缺陷多动障碍的临床分析

目的研究抽动障碍(TD)儿童共患注意缺陷多动障碍(ADHD)的临床特点,以了解TD与ADHD之间的关系,拟探讨两者的发病机制。方法将TD患儿按美国精神病学会出版的《精神障碍诊断与统计手册》第5版(DSM-V)进行诊断分类,然后分别比较分析短暂性TD(TTD)组、慢性TD(CTD)组及Tourette综合征(TS)组中ADHD的患病率及分型。结果TTD组90例患儿共患ADHD14例,检出率为15.6%;CTD组84例患儿共患ADHD24例,检出率为28.6%;TS组80例患儿共患ADHD36例,检出率为45.0%;对照组100例儿童共患ADHD2例,检出率为2.0%。TTD组的14例ADHD中符合注意障碍型(IT)的5例,多动与冲动型(HIT)的10例;CTD组中有24例ADHD,其中符合IT的9例,HIT的17例;TS组中有36例ADHD,其中符合IT的10例,HIT的29例;对照组中有2例ADHD,其中符合IT的1例,符合HIT的2例。结论 TD患儿的ADHD共患率高,两者存在相同的病理基础的可能。     

柳州城区小学生注意缺陷多动障碍现况与危险因素分析

了解柳州市学龄期儿童注意缺陷多动障碍(ADHD)的流行特征及影响因素,为儿童ADHD的综合防治提供参考.方法 采用分层随机整群抽样方法,抽取柳州市城区一~六年级共9 628名小学生进行注意缺陷多动障碍筛查.以美国精神障碍诊断和统计手册第四版为ADHD的诊断标准对可疑患儿及其家长进行诊断学访谈,对筛查与诊断结果进行统计.结果 共确诊ADHD儿童468例,ADHD患病率为4.86%,男生患病率(8.09%)高于女生(1.47%)(x2=228.146,P=0.000);9岁组儿童ADHD患病率最高(6.14%),不同年龄组间差异有统计学意义(x2=12.956,P=0.024).ADHD分型以注意缺陷为主型发生率最高(2.85%),其次是混合型(1.41%),多动/冲动为主型最少(0.60%).非条件多因素Logistic回归分析显示,女生患ADHD的风险低于男生(OR=0.17,95%CI=0.13~0.22),母亲孕期心情不佳和父母关系不好是发生ADHD的危险因素[OR值分别为1.45(95%CI=1.17~ 1.79)和2.01(95%CI=1.59~ 2.55)].结论 柳州市城区小学生ADHD患病率处于国内中等水平,且发生与儿童性别、母亲孕期心情及父母关系有关.应对家长、老师进行相关知识宣教,提高早期识别和诊断,促进儿童身心健康发展.     

癫痫儿童共患注意缺陷多动障碍的临床分型及日常生活功能比较

目的 研究癫痫儿童共患注意缺陷多动障碍(ADHD)的临床分型及日常生活功能比较。方法 选取2020年5月至2021年4月于福建省立医院就诊的癫痫患儿200例,采用儿童困难问卷(QCD)、注意缺陷多动障碍(SNAP-Ⅳ)量表,评估患儿共患注意缺陷多动障碍及日常生活功能情况。结果 ADHD罹患率28.5%(57/200),其中ADHD-I型占64.9%(37例)、ADHD-C型占21.1%(12例)、AHDH-HI型占14.0%(8例);ADHD组与无ADHD组患儿性别差异无统计学意义(χ²=0.33,P>0.05);多组组间比较显示,ADHD-I型患儿的QCD总分、一天中除夜晚外剩余时间段得分及总体行为得分均低于无ADHD组;ADHD-C型患儿的QCD总分、清晨/上学前、在学校、晚上时段得分均低于无ADHD患儿。结论 癫痫患儿ADHD罹患率较高,以ADHD-I型为主,ADHD-I型、ADHD-C型对患儿日常生活功能的影响较为明显。     

注意缺陷多动障碍各亚型感觉统合功能分析

注意缺陷多动障碍（ADHD）是儿童期最常见的行为障碍,主要表现为与年龄不相符合的注意力不集中、多动和冲动.美国精神障碍诊断与统计手册第4版（DSM-IV）将ADHD分为3个亚型：以注意障碍为主型（PI）,以多动/冲动为主型（HI）,混合型（CT）.已有研究发现,ADHD多有感觉统合功能损害,ADHD具有高度异质性,不同亚型具有不同的认知特点,其治疗及预后也有所不同.本研究旨在探讨不同亚型ADHD的感觉统合能力发展水平及差异.     

不同亚型注意缺陷多动障碍患者的认知功能比较

目的 探讨注意缺陷多动障碍( attention deficit hyperactivity disorder,ADHD) 患儿中注意缺陷为主型(predominantly inattentive type,PI)和混合型(combined type,CT)的认知特征差别,为ADHD患儿的临床干预和治疗提供依据。方法 根据美国精神障碍诊断与统计手册第4 版诊断和分类标准,将171例ADHD患儿分为PI和CT两个亚型。采用韦氏儿童智力量表、威斯康星卡片分类测验、持续性注意测试和数字划消测验,对比分析PI型和CT型患儿的认知特点。结果 韦氏儿童智力测验中CT型的算术得分和总智商得分要高于PI型,持续性注意测试中CT型在点击数、虚报错误数及其T分上高于PI型(P均＜0.05)。两个亚型的患儿在威斯康星卡片分类测验和数字划销各指标的比较上差异无统计学意义。 结论 CT型患儿在一般智力水平上高于PI型,但CT型患儿反应抑制能力的受损较PI型更明显。     

633名小学生注意缺陷多动障碍调查与分析

[目的]探讨小学生注意缺陷多动障碍患病情况及危险因素,为开展该病的防治工作提供依据.[方法]选取南昌市-小学四年级全体633名学生,采用Conners问卷(家长及教师用问卷)做一级筛查,对阳性者使用CCMD-3诊断标准作二级诊断,同时进行相关因素调查分析.[结果]9～11岁在校小学生儿童注意缺陷多动障碍(ADHD)患病率为5.85%,男生为6.73%,女生为4.81%,男、女生患病率差异无统计学意义(χ2=1.05,P>0.05);ADHD学生Conners问卷中品行问题、学习问题、心身障碍、冲动-多动、焦虑5个因子得分均高于非 ADHD学生(P<0.05);Logistic分析显示分娩方式、孕期长短、父亲文化程度、母孕期心理创伤、家族中有多动-冲动行业者、学习成绩、家庭关系7项因素对小学生ADHD影响较大大.[结论]ADHD为小学生常见的心理疾病;ADHD患儿心理健康状况欠佳;家庭、学校、医院应密切配合,积极防治ADHD.     

177例儿童注意缺陷多动障碍的脑电图及神经心理特征分析

目的探讨儿童注意缺陷多动障碍(ADHD)的脑电图及神经心理特征情况,为儿童ADHD的诊治提供参考。方法选取2013年11月-2016年12月北京安定医院收治的ADHD患儿177例为研究对象,根据精神障碍诊断与统计手册(第4版)(DSM-IV)中ADHD分型分为多动/冲动为主型组31例,混合型组95例,注意缺陷为主型组51例。3组患儿入院后均采用日本光电EEG-4418K型脑电图进行测定,并对3组患儿进行视觉-运动整合发育测验(VMI)、联合型瑞文测验(CRT)、反应时测定,比较不同类型儿童ADHD的脑电图及神经心理特征情况。结果 177例ADHD患儿均行脑电图检查,其中79例脑电图正常,占44.63%,98例脑电图异常,占55.37%。异常脑电图患儿中56例轻度脑电图异常,42例中重度脑电图异常;多动/冲动为主型组VMI测定结果高于混合型组与注意缺陷为主型组,差异有统计学意义(均P<0.05);注意缺陷为主型组CRT测定结果高于多动/冲动为主型组与混合型组,差异有统计学意义(均P<0.05);混合型组平均反应时、最快反应时及最慢反应时长于多动/冲动为主型组与注意缺陷为主型组,差异有统计学意义(均P<0.05)。结论儿童ADHD伴有不同程度的脑电图异常,能显示特异性与非特异性改变,并且儿童的视觉-运动整合能力较差,VMI则能反应ADHD亚型中患儿注意力障碍问题。     

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.     

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.