81例胎儿畸形临床分析

目的:探讨超声在产前诊断胎儿缺陷中的临床价值。方法:对2008年1月～2010年12月在海南医学院附属医院就诊的6 000例不同孕周孕妇采用实时彩色多普勒超声进行系统检查,对胎儿畸形进行筛查和诊断。结果:在6 000例孕妇中,经引产或出生后证实的各种畸形81例,彩超筛查诊断胎儿畸形75例,漏诊6例,其中先天性小眼球畸形1例,先天性心脏畸形2例,多指畸形1例,颈部椎骨缺损1例,胸部巨大淋巴囊腺瘤1例。75例胎儿畸形的产前超声诊断、合并畸形与产后结果均经出生或引产后尸检证实。结论:妊娠各期进行彩超筛查,可以对胎儿形态结构方面的明显畸形进行产前诊断,对于降低出生缺陷发生率,提高人口素质具有重要意义。     

北京市朝阳区860例先天性心脏病监测资料分析

目的通过分析2013-2015年北京市朝阳区先天性心脏病监测资料,了解朝阳区先天性心脏病的发生情况,为先天性心脏病的防控提供相关信息及依据。方法运用描述性统计学方法回顾性分析朝阳区出生缺陷监测资料。结果朝阳区先天性心脏病发病率为8.08‰;单纯先天性心脏病发病率前3位分别为动脉导管未闭、室间隔缺损及房间隔缺损;先天性心脏病合并其他畸形占总的先天性心脏病的比例为15.93%,合并21-三体最为常见;先天性心脏病产前诊断率49.07%。结论先天性心脏病发病率高;应加强对先天性心脏病患儿的染色体检查;推广新生儿心脏病筛查诊断适宜技术;加大三级预防控制力度,积极搭建胎儿先天性心脏病防控管理"一体化平台",避免和减少先天性心脏病的发生。     

济南市胎儿先天性心脏病的流行状况

目的:探讨济南市先天性心脏病(congenital heart disease,CHD)的流行状况、类型和构成。方法:选择2005年1月至2008年12月于济南市妇幼保健院接受胎儿心脏彩色多普勒超声检查的孕妇,共18 182例,随访围产儿预后情况,包括死胎、死产、活产、新生儿死亡、治疗性引产,结合尸体解剖及出生后超声检查,统计分析先天性心脏病的发病率、构成比等流行病学调查。结果:①18 182例孕妇宫内诊断胎儿先天性心脏病260例,未包括单纯房间隔缺损(继发孔型),平均发生率为14.3‰。其中单纯性室间隔缺损发病率最高,达8.58‰;其次为纠正性/完全性大动脉转位,发病率为1.1‰。②≥35岁的孕妇围产儿先天性心脏病发生率高于其他年龄组。结论:心脏彩色多普勒检查B超是胎儿CHD的一项有效的筛查手段,致死性及复杂严重的胎儿CHD得到了早期及时诊断,减少新生儿CHD的发生率,降低了社会及家庭的负担。≥35岁的孕妇发生胎儿心脏畸形率升高,建议选择合适的年龄受孕。     

宝安区2006～2010年围产儿先天性心脏病监测结果分析

目的:对深圳市宝安区5年围产儿先天性心脏病监测结果进行分析,为制定预防和干预措施或政策提供依据。方法:应用SPSS 13.0软件对宝安区2006～2010年围产儿出生缺陷监测资料进行统计分析。结果:5年间宝安区围产儿中共有926例先天性心脏病,其5年平均发生率为3.48‰,呈上升趋势(χ2=59.68,P<0.001);先天性心脏病合并其他畸形130例,占先天性心脏病的14.04%;单一类型的先天性心脏病前3位为动脉导管未闭、室间隔缺损、房间隔缺损。结论:先天性心脏病在出生缺陷构成比中居首位,诊断水平的提高和监测网络覆盖面的扩大是先天性心脏病发生率升高的主要原因;加大对流动人口的健康教育力度并进一步提高对先天性心脏病的监测能力,有利于降低先天性心脏病的发生率。     

四川省10年围产儿主要出生缺陷病种分析

目的 了解四川省围产儿主要出生缺陷病种发生率水平,为制定更有效的干预措施提供依据。方法 按照国家出生缺陷监测方案,以医院为基础的出生缺陷监测方法收集资料。结果 2001-2010年度四川省围产儿前五位出生缺陷病种依次为外耳及其他畸形22.41/10⁴,多指(趾)为14.11/10⁴、先天性心脏病8.81/10⁴,唇裂合并腭裂7.86/10⁴,唇裂5.12/10⁴,且前三者有逐渐增加趋势。以外耳及其他畸形、多指(趾)两类缺陷为主,产后确诊占95%以上,转归以活产为主;先天性心脏病、唇裂、唇裂合并腭裂产后确诊占60%,产前确诊的比例约30%,转归以活产为主,但死胎(包括治疗性引产)所占比例超过30%。结论 四川省围产儿外耳及其他畸形、多指(趾)、总唇裂等发生率处较高水平,围产儿先天性心脏病的发生率水平较低,建议在监测数据的基础上开展病因学或家系研究等内容,进一步提高各级医院产前筛查和诊断先心病的能力。     

珠海市2010至2015年围产儿先天性心脏病监测分析

目的 分析珠海市2010至2015年围产儿先天性心脏病的发生情况,为制定预防干预策略提供依据.方法 对珠海市2010年1月1日至2015年12月31日出生缺陷监测中围产儿先天性心脏病资料进行回顾性分析.结果 珠海市2010至2015年围产儿先天性心脏病平均发生率为52.11/万,呈逐年上升趋势(χ2=2 296 751.99,P<0.01);合并其他类型出生畸形占8.65%(78/902),以染色体异常、肾脏畸形为主;动脉导管未闭、房间隔缺损、室间隔缺损、法络氏四联症、大动脉转位分列先天性心脏病分类前五位;产前诊断率占9.53%(86/902);不同患儿性别、常住地、母亲年龄段间的先天性心脏病发病率差异均有统计学意义(χ2值分别为9.49、9.74、14.30,均P<0.05).结论 2010至2015年珠海市围产儿先天性心脏病发病率持续上升;利用已完善的妇幼保健网络,广泛持久开展相关健康教育,提高产前诊断水平,加强新生儿保健,有助于降低围产儿先天性心脏病的发病率.     

天门市2007～2010年出生缺陷监测结果分析

目的:了解天门市出生缺陷的发生率及相关因素,为有关部门制定干预措施提供依据。方法:对天门市2007～2010年期间出生缺陷新生儿的监测资料进行系统性分析。结果:4年总缺陷发生率为177.69/万,出生缺陷前5位依次为总唇裂(25.25/万)、外耳畸形(18.06/万)、多指(趾)(14.45/万)、先天性心脏病(11.56/万)、先天性脑积水(10.84/万)。总唇裂、外耳畸形持续处于较高水平,先天性心脏病的发生率明显增加。结论:天门市降低出生缺陷发生率的重点是总唇裂的防治、人口性别比例的控制、高龄孕产妇的管理。     

2017—2021年澄迈地区15 797名新生儿出生缺陷监测结果

目的 分析2017—2021年澄迈地区产科出生缺陷发生情况,并探讨出生缺陷发生的危险因素,为出生缺陷监测干预及预防工作提供数据支撑。方法 回顾性分析2017年1月1日至2021年12月31日澄迈县某医院产科的新生儿资料,采用描述性分析方法对新生儿出生缺陷情况进行分析。结果 2017年1月1日至2021年12月31日澄迈县某医院产科分娩新生儿15 797名,发生出生缺陷764例,发生率为4.84%。其中男婴426例,女婴338例,男女比例为1.26∶1;单发畸形604例,多发畸形160例;产前诊断128例,产后诊断636例。出生缺陷发生率逐年下降（P<0.01）。764例出生缺陷新生儿中先天性心脏病、肢体畸形、唇腭裂、尿道下裂、神经管缺陷依次居于前5位,构成比分别为33.12%、21.20%、12.96%、8.90%、6.81%。前5位出生缺陷类型占总出生缺陷数的82.98%。先天性心脏病例数逐年增加,发生率逐年上升,在每年出生新生儿中的占比及5年间同病种中的占比上升,唇腭裂的发生率逐年下降。先天性心脏多发畸形新生儿的出生结局分布差异有统计学意义（P<0.01）,肢体畸形、唇腭裂、尿道下裂多发畸形新生儿的出生结局分布差异无统计学意义（均P>0.05）。结论 澄迈地区新生儿出生缺陷发生率较高,类型多样且危险众多,尤其是先天性心脏病,应对育龄人群广泛开展孕期知识宣传及健康教育,加强产前诊断及优生咨询服务,降低出生缺陷发生率。     

深圳市2189例出生缺陷的畸形分布与诊断方法

目的:调查深圳市出生缺陷的发生状况、畸形分布及缺陷的主要诊断方法,为减少出生缺陷制定预防保健措施提供依据。方法:按深圳市统一的监测方案,对2007年度深圳市医院孕20周～产后7天内(包括活产、死胎、死产、引产及产后7天内死亡)分娩的围产儿进行逐一出生缺陷筛查并调查其诊断方法。结果:136902例围产儿出生缺陷发生率为15.99‰,活产畸形率为13.16‰,存活占缺陷的81.77%,足月分娩为71.45%,先心合并重大体表缺陷发生率为9.85‰,占缺陷的61.62%。单畸形发生率为11.11‰,占缺陷69.53%;二种以上畸形发生率为4.87‰,占缺陷30.47%。前5位主要出生缺陷构成为:先天性心脏病24.26%,多指/趾12.15%,小耳/外耳畸形10.14%,总唇裂9.91%,足外翻6.08%。先心、多指/趾、总唇裂、足外翻、尿道下裂的缺陷发生率均高于全国监测的发生率。出生后临床诊断66.69%,B超诊断31.97%。B超对先天性心脏病、脑积水、脊柱裂、无脑儿、肾脏异常等疾病的检出率较高,分别是75.52%、69.50%、60.71%、77.78%、84.62%,对尿道下裂、指/趾畸形、外耳畸形、足外翻等畸形检出率较低,分别为1.10%、4.94%、4.05%、5.26%,单腭裂36例未检出。结论:非单一的体表检查缺陷发生率高;重点加强重大体表缺陷28周前的产前诊断,减少重大体表缺陷的出生;急需胎儿、新生儿内外、专科的建立,而不是一味地引产减少缺陷;超声在产前胎儿影像学诊断上有一定的局限性,加强超声检查告知义务,减少医疗纠纷;不断提高监测水平,为制定出生缺陷的预防措施以及评价其效果提供依据。     

湖南省2009-2011年围产儿出生缺陷监测结果分析

目的 分析围产儿出生缺陷监测结果,探讨出生缺陷干预措施,降低出生缺陷发生率. 方法 对2009-2011年围产儿出生缺陷医院监测资料用SPSS软件进行统计分析. 结果 监测293 053例围产儿中,出生缺陷发生数5 766例,出生缺陷发生率为196.76/万,3年出生缺陷率差异有统计学意义(P＜0.05).前5位出生缺陷依次为:先天性心脏病、外耳其他畸形、多指(趾)、马蹄内翻足、唇裂合并腭裂.出生缺陷发生城市高于农村、孕母分娩无明显的季节分布、大于35岁组母亲出生缺陷发生率明显高于其他年龄组、男婴高于女婴. 结论 加强孕前、孕早期保健宣传,开展产前筛查、产前诊断和新生儿疾病筛查工作,避免和减少出生缺陷发生,提高出生人口素质.     

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.