江苏省青少年心理问题现状调查与分析

目的:了解江苏省青少年的心理状况及影响因素,为制定有效干预措施提供依据。方法:以“青少年健康危险行为调查”问卷为基础,对江苏省部分城市的在校中学及大学学生进行调查。结果:有消极情绪初中学生占13.8%,高中生占14.9%,大学生占16.5%;有自杀想法的初中学生占18.0%,高中生占18.8%,大学生占20.1%;有过自杀计划的初中学生占5.7%,高中生占6.6%,大学生占7.3%;企图自杀的初中学生占2.2%,高中生占2.9%,大学生占3.2%;想离家出走的初中学生占23.2%,高中生占27.4%,大学生占24.3%;尝试过离家出走的初中学生占4.2%,高中生占4.9%,大学生占4.8%。有消极情绪的城市学生占15.0%,农村学生占14.5%;有自杀想法的城市学生占19.5%,农村学生占16.3%;有过自杀计划的城市学生占6.3%,农村学生占6.4%;企图自杀的城市学生占2.6%,农村占3.0%;想离家出走的城市学生占25.4%,农村学生占23.7%;尝试过离家出走的城市学生占4.8%,农村学生占4.1%。结论:消极情绪与“想过自杀”、“计划过自杀”、“试图自杀”、“想过离家出走”、“尝试过离家出走”等因素有关。     

Factors related to the prevalence of respiratory symptoms in workers in a petrochemical complex

This study was performed to evaluate the prevalence of respiratory symptoms in workers in a petrochemical complex and to elucidate the relationship between the prevalence and work-related factors. A questionnaire was distributed to 5,983 male workers working in a petrochemical complex. As for the respiratory symptoms, cough was present in 2.4%, phlegm in 8.1%, wheezing in 2.8% and shortness of breath in 4.7% of the workers. The factors significantly related to respiratory symptoms were smoking history, wearing of protective devices, handling of substances toxic to the respiratory system, and history of atopy or respiratory disease (p<0.05). The substances toxic to the respiratory system were divided into 4 types, ie., dusts, solvents, metals, and vapors. When the analysis was performed to evaluate the effects of exposure to substance type on respiratory symptoms, the odds ratio of cough was 1.96 times higher in those workers exposed to dusts compared with those not exposed, 2.28 times for exposure to metals, 1.52 times for solvents, and 1.55 times for vapors, all showing significant differences (p<0.05). For phlegm, the odds ratio was 1.08 times higher in those workers exposed to dusts compared with those not exposed, 1.94 times for exposure to metals, 1.70 times for organic solvents, and 1.85 for vapors (p<0.05). For wheezing, the odds ratio was 2.38 times for exposure to dusts; for shortness of breath, it was 2.42 times for exposure to dusts, 2.89 times for metals, 2.10 times for organic solvents, and 2.14 times for vapors, all showing significant differences (p<0.05). In conclusion, work-related factors significantly affected the respiratory symptoms in workers working in the petrochemical complex. Especially, these respiratory symptoms were significantly related to exposure to toxic substances and the wearing of protective devices. Thus, safety education and management are needed for these workers.     

成都市某区托幼机构消毒效果监测分析

目的:了解成都市某区公立托幼机构和私立托幼机构消毒质量的差异和薄弱环节,为做好托幼机构内传染病的防控工作提供科学依据。方法:参照《医院消毒卫生标准》、《消毒技术规范》等,对室内空气、物体表面、人员手、玩具、餐具等进行采样和检测。结果:882份样品合格率为83.4%,室内空气合格率为74.6%,物体表面为81.7%,玩具为67.6%,工作人员手为88.1%,公立托幼机构的室内空气消毒效果较民办托幼机构好(P0.05)。结论:教育和卫生行政主管部门应联动起来,根据经营类别,经济水平和薄弱环节采取不同的监管和指导策略,促进托幼机构消毒质量与意识的持续提高,切实保障儿童身体健康。     

Retaining nurses in their employing hospitals and in the profession: effects of job preference, unpaid overtime, importance of earnings and stress

The purpose of this paper is to examine the effects of job preference, unpaid overtime, importance of earnings, and stress in retaining nurses in their employing hospitals and in the profession. Data come from our survey of 1396 nurses employed in three teaching hospitals in Southern Ontario, Canada. Data are analyzed first for all nurses, then separately for full-time, part-time, and casual nurses. Results show that the key to understanding the effects of these variables may be to pay attention to the work status of nurses. With regards to retaining nurses in their hospitals, working in their preferred type of job is important, particularly for part-time nurses. Working unpaid and longer than agreed hours is also a factor for increasing the likelihood of part-time nurses to leave the profession. All nurses are less inclined to leave as the importance of their earnings for the family increases, but it is particularly important for part-time nurses. Stress is an ongoing concern for retaining nurses in their hospitals and within the profession. We suggest managers and policy makers pay attention to employing nurses in jobs they prefer, decrease unpaid overtime, and consider the importance of earnings for them and their families in developing policies and programs to retain nurses. More importantly, stress levels should be lowered to retain nurses.     

Hexachlorocyclohexane use in the former Soviet Union

Because of the large size of the former Soviet Union (FSU) and the heavy use of organochlorine pesticides (OCPs) in the FSU, usage information regarding OCPs in the FSU is important in compiling global emission inventories and thus in studying the transport of OCPs among different environmental compartments worldwide. The availability of such information is limited. By analyzing the available 1,2,3,4,5,6-hexachlorocyclohexane (HCH) data in the FSU, this article presents estimates of HCH usage in this region from 1950 to 1990, when HCH was officially banned for agricultural use by the FSU government. The creation of HCH usage inventories for the FSU has paved the way to produce HCH emission inventories for this region. Total HCH usages for agricultural purposes in the FSU from 1950 to 1990 were estimated to be 1,960 kt for technical HCH and 40 kt for lindane. The total usage for the isomers was 270 kt for gamma-HCH, 1,270 kt for alpha-HCH, and 170 kt for beta-HCH. Use of HCH reached a peak in 1965: 130 kt for technical HCH, 2.7 kt for lindane, 18 kt for gamma-HCH, 86 kt for alpha-HCH, and 11 kt for beta-HCH. Gridded usage data sets in the FSU of technical HCH and lindane-and the alpha-HCH, beta-HCH and gamma-HCH isomers-on a 1degree x 1degree longitude and latitude grid system for 1980 are freely available to all users at http://www.msc.ec.gc.ca/data/gloperd/.     

Organ donation in a general hospital

There is an acute shortage of donor organs for transplantation in The Netherlands. It is presumed that many potentially available organs are lost due to insufficient alertness. A retrospective study was made of the results of the procedure for obtaining permission for post-mortem donorship. Records of patients succumbed in the Intensive Care Unit in the period 1983-1987 were checked to ascertain whether these patients had met the current selection criteria for donorship. According to these criteria, 104 of the 531 deceased patients had been suitable. Death had been due to irreversible brain damage in 71 cases, to CVA in 29, to a primary brain tumour in three and to an intoxication in one. The donation procedure was followed in 53 cases of death. In 20 cases relatives refused permission and in 12 there were insuperable practical and technical difficulties. Relatives of 19 deceased patients were not asked for permission for post-mortem donorship. Once the procedure for obtaining permission for post-mortem donorship was implemented according to protocol and on a multidisciplinary basis, the proportion of cases in which requesting permission was omitted fell from 37% to 3%. Greater alertness of those involved to the possibilities of organ donation and good organization result in a growing number of organs available for transplantation, reducing an acute shortage.     

Adjusting planning guidelines for cardiac-care units

The principal concern of this paper is the development of procedures for adjusting the criteria currently being used for federally-legislated health planning activities. These procedures would enable the planner to account for the demographic, geographic and health-system conditions which cause variations in the need for health-care services in local communities. A case-mix method, hospital chart abstract data and demographic, geographic and health-system data from New Jersey were used to: create a list of diagnoses eligible for treatment in a Cardiac-Care Unit (CCU): select a sample of hospitals for study, and conduct a step-wise regression analysis of CCU utilization in these hospitals. It was concluded that CCU utilization was affected by factors such as the in-hospital availability of CCu beds, the type of hospital, CCU-patients' clinical severity, and the availability of ambulances and mobile intensive care units. Procedure for adjusting planning criteria to account for local conditions have yet to be developed. However, a method for using the types of results presented in this paper to develop such adjustment procedures was presented and illustrated. It is recommended that this method be used to create such adjustment procedures for the planning criteria for all hospital services and hence to assist Health Systems Agencies in rationalizing the distribution of our hospital care.     

Shared parenting: A new childrearing trend?

Recent changes in the participation of women in paid employment, combined with an increased research interest in fathers, has led many social commentators and researchers to advocate the adoption of a shared parenting lifestyle. Little attempt has been made however, either to define shared parenting or to examine the possible antecedents and consequences of this family pattern. The present paper addresses these issues. It is argued that the critical factors in defining shared parenting are the acceptance and implementation of shared responsibilities for child management and socialization, combined with a shared contribution to providing for family needs for support and nurturance. Major findings from recent studies illustrate that although the adoption of such a pattern has many potential advantages, mothers and fathers both experience difficulties in adjusting to sharing responsibilities from their traditional domains. Proposals are put forward for changes in policies and practices which could help expand the options for families to adopt shared parenting. The need for policy integration and for equal status to be given to the options for women, men and children, are emphasised.

     

Training for skills

The World Federation for Medical Education Summit in Edinburgh in 1993 called for bold, clear, attractive and feasible strategies to equip doctors with the skills for the future of health care. There was special emphasis on skills for problem-solving, ethical and evidence-based medicine, effective communication, health promotion and illness prevention, and to educate and be educated. There were also skills for the shaping of the future of health services to form partnerships with other professionals and communities, to promote primary health care and to respond to culture and context. Strategies for effective training for skills include linking them to knowledge and attitude, selection of students of aptitude and motivation, training through practice with feedback, training teachers and assessors, and the reinforcement of skills after graduation. This presentation describes practical examples of these strategies in action to address each of the identified skills, all of them based on experience in the real world in Australia and Nigeria.     

1990～2004年龙岩市慢性铅中毒病例分析

[目的]了解龙岩市铅中毒发病规律，以便提出防治措施。[方法]对1990～2004年龙岩市职业病防治院和市以上职业病中毒诊断小组确诊的慢性铅中毒患者资料进行分析。[结果]合计发现异常者339例，其中慢性铅中毒241例（轻度中毒175例，中度中毒65例，重度中毒1例），观察对象98例；冶炼行业251例，蓄电池行业28例，印刷业1例，其他行业59例；男性319例，女性20例；18-20岁5例，21～30岁66例，31～40岁172例，41～50岁68例，51～72岁28例；工龄〈1年、1～5年、6～10年、11～15年、16～20年、21～25年、26～30年、〉30年的分别为12例、74例、93例、61例、38例、42例、17例、2例。摘要治疗与转归情况、铅中毒慢性轻度患者经一个疗程、部分二个疗程治疗基本治愈出院；铅慢性中度患者经二、三个疗程治愈出院，但最长治疗六个疗程治愈出院。[结论]龙岩市慢性铅中毒患者中，依次以冶炼、生活性（饮酒）、蓄电池接铅患病较多，男性多于女性，患病以31～50岁较多，工龄（包括生活性饮酒）以1．0～15年为主；今后职业病防治重点仍以从事冶炼、蓄电池行业为主。     

Introductory study of the once-a-month, injectable contraceptive cyclofem in Brazil, Chile, Colombia, and Peru

An introductory trial with the injectable contraceptive Cyclofem^® was carried out in Brazil, Chile, Columbia, and Peru, with participation by 3,183 women. Women were follewed-up for up to 2 years of use and the data were evaluated by life table analysis. A total of 29.676 women-months were accumulated for up to 2 years. No pregnancies were observed in the 2 years. The discontinuation rates for amenorrhea in the first year ranged from 3.4 in Brazil to 8.1 in Colombia, and for menstrual disturbances from 5.1 in Chile to 9.2 in Brazil. The discontinuation rates for other medical reasons ranged from 7.8 in Brazil to 26.3 in Colombia, and for personal reasons from 17.2 in Chile to 23.5 in Brazil. Continuation rates ranged from 42.3 in Colombia to 52 in Chile. In the second year of observation the rates of discontinuation were lower than those observed in the first year, with the exception of personal reasons in Brazil, which were the same as those observed in the first year. Continuation rates ranged from 19.4 in Brazil to 36.8 in Chile. The comparison of reasons for discontinuation in selected clinics showed that the rate for amenorrhea in one clinic in Chile was more than three times that in others and in Peru was seven times more in one clinic than in another. Regarding menstrual disturbances, in Peru one clinic presented a rate three times higher than the others. The main reasons for discontinuation due to other medical reasons were headache and weight gain. In conclusion, Cyclofem presented a high contraceptive efficacy and an acceptable rate of continuation and discontinuation for up to 2 years in the four countries.     

Traumatic occupational fatalities in South Carolina, 1989-90.

Death certificates for South Carolina for 1989 and 1990 were examined to identify deaths resulting from injury incurred in the workplace. There were 277 deaths in that category in the 2-year period, an average yearly rate for traumatic occupational fatalities of 8.84 per 100,000 workers. The groups of industries with the highest fatality rates were transportation-communication-utilities, construction, and agriculture-fishing-forestry. The leading causes of death were injuries from motor vehicle crash, homicide, and falls. The traumatic occupational fatality rate for men was about 13 times greater than that for women; however, a much higher proportion of women died from homicide on the job. The findings in general reflect trends reported in other studies. The death rates for workers in South Carolina for 1989-90, however, were higher than national averages for 1980-88. National data for 1989-90 were not available for comparison. The data suggest that more effective injury prevention efforts need to be applied to such causes of on-the-job injury as motor vehicle crash, homicide, and falls. Those three categories accounted for more than 56 percent of all traumatic occupational fatalities in South Carolina in 1989 and 1990. Motor vehicle crash prevention efforts particularly are needed in the transportation-communication-utilities industries. The findings show that particular efforts need to be directed to the retail trade category for prevention of homicide and to the construction industry for prevention of falls.     

Data and product needs for influenza immunization programs in low- and middle-income countries: Rationale and main conclusions of the WHO preferred product characteristics for next-generation influenza vaccines

In 2017, WHO convened a working group of global experts to develop the Preferred Product Characteristics (PPC) for Next-Generation Influenza Vaccines. PPCs are intended to encourage innovation in vaccine development. They describe WHO preferences for parameters of vaccines, in particular their indications, target groups, implementation strategies, and clinical data needed for assessment of safety and efficacy. PPCs are shaped by the global unmet public health need in a priority disease area for which WHO encourages vaccine development. These preferences reflect WHO’s mandate to promote the development of vaccines with high public health impact and suitability in Low- and Middle-Income Countries (LMIC). The target audience is all entities intending to develop or to achieve widespread adoption of a specific influenza vaccine product in these settings. The working group determined that existing influenza vaccines are not well suited for LMIC use. While many developed country manufactures and research funders prioritize influenza vaccine products for use in adults and the elderly, most LMICs do not have sufficiently strong health systems to deliver vaccines to these groups. Policy makers from LMICs are expected to place higher value on vaccines indicated for prevention of severe illness, however the clinical development of influenza vaccines focuses on demonstrating prevention of any influenza illness. Many influenza vaccine products do not meet WHO standards for programmatic suitability of vaccines, which introduces challenges when vaccines are used in low-resource settings. And finally, current vaccines do not integrate well with routine immunization programs in LMICs, given age of vaccine licensure, arbitrary expiration dates timed for temperate country markets, and the need for year-round immunization in countries with prolonged influenza seasonality. While all interested parties should refer to the full PPC document for details, in this article we highlight data needs for new influenza vaccines to better demonstrate the value proposition in LMICs.     

Relationship of “weight for height” to “height for age” — a longitudinal study

The development of four age cohorts of preschool children from 0 to 5, 6 to 11, 12 to 23 and 24 to 60 months according to weight for height and height for age, as well as weight for age, was followed for 1 year. All nutritional parameters declined in the two cohorts 0 to 5 and 6 to 11 month-old children. Weight for height recovered subsequently to almost the same level as that of the North American children in the age groups 12 to 60 months, whereas the age dependent parameters remained well below the North American standard. The individual variations of weight for height and height for age were followed up in 6 case studies for 20 months. It appears that the organism gives main priority to an optimal relationship of weight to height either, by reducing the growth spurt as was observed over the observation period, or, by limiting growth altogether. The phenomenom of “stunting” is interpreted as an adaptation process which is not necessarily due to undernourishment in the past. If the nutritional status is assessed by the parameter weight for age, investigators must recognize fully its limitations.     

Birth weight-specific infant mortality due to congenital anomalies, 1960 and 1980

The impact of mortality due to congenital anomalies in single-delivery births was compared in 1960 and 1980 birth cohorts; data were used from the 1960 National Center for Health Statistics national linkage of birth and death certificates and the 1980 National Infant Mortality Surveillance project. In 1960 there were 14,714 deaths due to congenital anomalies, compared with 8,674 in 1980, a 41 percent reduction. The infant mortality risk (IMR) due to congenital anomalies fell 31 percent. This is in contrast with the observed 54 percent decline in IMR due to all causes. This reduction in mortality due to congenital anomalies occurred for both whites and blacks in the postneonatal period and for whites only in the neonatal period. Changes ranged from a 1.8 percent increase for the black neonatal mortality risk to a 46.6 percent decrease for the white postneonatal mortality risk. In spite of these relative reductions, the absolute percentage of all infant deaths due to congenital anomalies had increased from 15.8 percent in 1960 to 24.1 percent in 1980. Two categories, cardiovascular and central nervous system anomalies, accounted for 72 percent of infant deaths due to congenital anomalies in 1960 and for 59 percent in 1980; cardiovascular anomalies accounted for 48 percent of all deaths due to congenital anomalies in 1960 and 40 percent in 1980. Infant mortality risks in the United States showed a 2:1 black to white ratio in both 1960 and 1980. However, for infant mortality due to congenital anomalies, the black and white mortality risks were approximately equal in both 1960 and 1980. For infants with birth weights of 500-2,499 g, the risk of neonatal mortality for blacks was less than half the risk for whites.     

Childhood and adulthood risk factors for socio-economic differentials in psychological distress: evidence from the 1958 British birth cohort

Social inequalities in psychological status have been attributed to health selection and to social causation. We used data from the 1958 British birth cohort, followed over three decades, to identify causes of inequality in adulthood. Psychological status prior to labour market entry influenced inter-generational mobility, but selection effects were weaker for intra-generational mobility, between age 23 and 33. However, selection failed to account for social differences in risk of distress of approximately threefold in classes IV&V compared with I&II. Both childhood and adult life factors appeared to contribute to the development of inequalities. The principal childhood factors were ability at age 7 for both sexes and adverse environment (institutional care for men and low class for women). Adult life factors varied, with stronger effects for work factors (job strain and insecurity) for men and qualifications on leaving school, early child-bearing and financial hardship for women. Gradients in psychological distress reflect the cumulative effect of multiple adversities experienced from childhood.     

Arsenic exposure and cardiovascular disease: a systematic review of the epidemiologic evidence

Arsenic exposure is a likely cause of blackfoot disease and a potential risk factor for atherosclerosis. The authors performed a systematic review of the epidemiologic evidence on the association between arsenic and cardiovascular outcomes. The search period was January 1966 through April 2005. Thirteen studies conducted in general populations (eight in high-arsenic areas in Taiwan, five in other countries) and 16 studies conducted in occupational populations were identified. Exposure was assessed ecologically in most studies. In Taiwan, relative risks comparing the highest arsenic exposure category with the lowest ranged from 1.59 to 4.90 for coronary disease, from 1.19 to 2.69 for stroke, and from 1.66 to 4.28 for peripheral arterial disease. In other general populations, relative risks ranged from 0.84 to 1.54 for coronary disease, from 0.69 to 1.53 for stroke, and from 0.61 to 1.58 for peripheral arterial disease. In occupational populations, relative risks ranged from 0.40 to 2.14 for coronary disease mortality and from 0.30 to 1.33 for stroke mortality. Methodologic limitations, however, limited interpretation of the moderate-to-strong associations between high arsenic exposure and cardiovascular outcomes in Taiwan. In other populations or in occupational settings, the evidence was inconclusive. Because of the high prevalence of arsenic exposure, carefully performed studies of arsenic and cardiovascular outcomes should be a research priority.     

Repeatability and validity of a field kit for estimation of cholinesterase in whole blood.

OBJECTIVES--To evaluate a spectrophotometric field kit (Test-Mate-OP) for repeatability and validity in comparison with reference laboratory methods and to model its anticipated sensitivity and specificity based on these findings. METHODS--76 farm workers between the age of 20 and 55, of whom 30 were pesticide applicators exposed to a range of organophosphates in the preceding 10 days, had blood taken for plasma cholinesterase (PCE) and erythrocyte cholinesterase (ECE) measurement by field kit or laboratory methods. Paired blinded duplicate samples were taken from subgroups in the sample to assess repeatability of laboratory and field kit methods. Field kits were also used to test venous blood in one subgroup. The variance obtained for the field kit tests was then applied to two hypothetical scenarios that used published action guidelines to model the kit's sensitivity and specificity. RESULTS--Repeatability for PCE was much poorer and for ECE slightly poorer than that of laboratory measures. A substantial upward bias for field kit ECE relative to laboratory measurements was found. Sensitivity of the kit to a 40% drop in PCE was 67%, whereas that for ECE was 89%. Specificity of the kit with no change in mean of the population was 100% for ECE and 91% for PCE. CONCLUSION--Field kit ECE estimation seems to be sufficiently repeatable for surveillance activities, whereas PCE does not. Repeatability of both tests seems to be too low for use in epidemiological dose-response investigations. Further research is indicated to characterise the upward bias in ECE estimation on the kit.