结构化教育治疗51例儿童孤独症疗效观察

目的观察结构化教育对儿童孤独症的治疗效果,为儿童孤独症的治疗提供依据。方法对51例孤独症患儿实施结构化教育训练,训练时间每天不少于6 h,个别训练和集体训练相结合。训练前应用《儿童孤独症及相关发育障碍心理教育评定量表(中国修订版)》(C-PEP)对孤独症儿童进行基线测评,并于训练前及训练12个月后采用孤独症儿童行为检查量表(ABC)、孤独症治疗评估量表(ATEC)进行疗效评估。结果经过12个月的结构化训练,51名孤独症儿童ABC量表各因子得分及量表总分较训练前下降,其中感觉能力、交往能力训练前后差异均有统计学意义(P值均<0.05);运动能力、自理能力和语言能力得分前后比较,差异均有统计学意义(P值均<0.01)。51例患儿语言、社交、感知、行为方面及ATEc总分均较训练前明显下降,差异均有统计学意义(P值均<0.01)。结论结构化教育能改善孤独症患儿的症状,是孤独症的有效康复手段之一。     

结构化教育治疗48例儿童孤独症疗效观察

目的:观察结构化教育对儿童孤独症的治疗效果。方法:对48例孤独症患儿实施结构化教育训练,于训练前及训练9个月后采用孤独症儿童行为检查量表(ABC)、孤独症治疗评估量表(ATEC)及儿童孤独症及相关发育障碍心理教育评定量表(中国修订版)(C-PEP)评估疗效。结果:经过9个月的结构化训练,48例孤独症儿童ABC量表各因子得分及量表总分较训练前下降,其中感觉能力、交往能力及自理能力得分训练前后比较差异有统计学意义(P<0.05),运动能力和语言能力得分训练前后比较差异也有统计学意义(P<0.01)。训练后,48例患儿的语言、社交、感知、行为4方面得分及总分均较训练前明显下降(P<0.01)。患儿C-PEP评估各项目分值较训练前显著提高。结论:结构化教育能改善孤独症患儿的症状,是孤独症的有效康复手段之一。     

孤独症患儿45例短期综合训练疗效评价

目的探讨短期综合训练对孤独症患儿的疗效,为今后开展孤独症患儿康复、提高康复训练效果提供依据。方法采用结构化教学、感觉统合训练、多感官刺激等综合训练方法,对到哈尔滨医科大学儿童发育行为中心接受训练的45例孤独症患儿开展为期3个月的短期综合训练。每周训练6 d,每天训练3.5 h,采取一对一和一对三小组训练相结合,于训练前、训练3个月末分别采用孤独症行为评定量表(ABC)、孤独症治疗评估量表(ATEC)、儿童孤独症评定量表(CARS)、心理教育评定量表(PEP)对患儿进行评价。结果45例孤独症患儿ABC总分由训练前的92.95分下降至55.14分(P0.01);CARS总分由训练前的37.12分下降至29.48分(P0.01),ATEC总分由训练前的68.00分下降至57.09分(P0.05),其中行为因子由训练前的21.77分下降至17.86分(P0.05),但在语言、社交、感知觉因子的分值训练前后未见显著差异;PEP的发展分数由训练前的54.33分提高至84.38分(P0.01),7个方面均有显著提高,差异均有统计学意义(P值均0.01)。结论短期综合训练对孤独症的异常行为改善有较好的作用;但其语言、社交、沟通能力的提高尚需要长期、更高密集度的康复训练。     

高功能孤独症儿童综合训练效果分析

[目的]分析高功能孤独症儿童综合训练的效果.为临床治疗提供参考依据. [方法]对21例高功能孤独症患儿进行评估后,制定个别化训练计划.训练中应用结构化教育模式并结合应用行为分析法,坚持个别治疗与集体治疗相结合的综合训练.每天3 h,每周5 d,3个月为一个疗程,共训练12个月.训练前后用孤独症治疗评估量表(Autism Treatment Evaluation Checklist,ATEC)进行评估.[结果]21例患儿孤独症儿童量表平均总分由训练前的(77.14±29.57)分下降到(50.57±22.00)分(P<0.001),量表中语言、社交、知觉、行为四个分项目得分显著下降(P<0.001).患儿各方面能力得到提高. [结论]对高功能孤独症患儿进行综合训练有助于提高患儿的语言交流能力、社会交往能力、个人能力及动作行为能力.     

孤独症患儿家庭康复训练配合TEACCH早期康复治疗

目的结构化教育(treatment and education of autistic and related communication handicapped children,TEACCH)属于一种个性化训练项目,对孤独症患儿治疗及教育疗效较好,而家庭康复训练可将学习融入患儿生活中,有效提高患儿各项能力。本研究通过采用家庭康复训练结合结构化教育护理方法训练孤独症患儿,旨在探讨其联合使用在孤独症患儿早期康复治疗中影响。方法选取2015-01-01-2018-02-01郑州儿童医院收治的孤独症患儿,根据干预方式的不同分为对照组和观察组,根据1:1配比后,共纳入100例,每组50例。观察组采用TEACCH结合家庭康复训练护理方法,对照组仅采用TEACCH护理方法。采用美国孤独症治疗评估量表(autism treatment evaluation checklist,ATEC)和孤独症行为评分量表(autism behaviour checklist,ABC)对两组进行评分,比较两组康复效果。结果 6个月干预训练后,观察组ATEC总分为(50.48±8.23)分,低于对照组的(61.85±9.62)分,差异有统计学意义,t=6.351,P<0.001;观察组ABC总分为(57.18±1.16)分,低于对照组的(63.45±1.17)分,差异有统计学意义,t=5.099,P<0.001。结论家庭康复训练配合TEACCH在孤独症患儿早期康复治疗中可有效提高患儿生活各项能力。     

叶酸对孤独症儿童的辅助治疗效果研究

目的 探讨叶酸对参与结构化教育的孤独症儿童的辅助治疗效果,为进行靶向营养干预及综合辅助治疗提供科学依据。方法 采用开放性试验方法。随访66名参与结构化教学的孤独症儿童,遵循自愿原则分为叶酸干预组和对照组,采用孤独症行为量表（Autism Behavior Scale,ABC）、儿童孤独症评定量表（Children's Autism Rating Scale,CARS）、孤独症治疗评估量表（Autism Treatment Evaluation Checklist,ATEC）和自闭症儿童心理教育评核第3版（PEP 3）对其3个月前后的发育水平进行评估比较。结果 经过3个月的康复训练后,两组儿童ABC、CARS、ATEC量表总分均降低,PEP 3量表各项得分（除行为特征 非语言外）均有提高,且差异具有统计学意义（P<0.05）;训练前后各量表差值显示,叶酸干预组孤独症儿童ATEC量表中的语言交流项、PEP 3量表中的认知、语言理解和语言表达项的差值高于对照组,且差异具有统计学意义（P<0.05）。结论 孤独症儿童在参与结构化教学的同时补充叶酸,对认知和语言交流的改善作用优于单纯参与结构化教学。     

医院—社区—家庭联动干预模式对孤独症患儿康复的影响研究

目的探究医院—社区—家庭联动干预模式对孤独症患儿康复的影响。方法选取2015年12月-2016年12月无锡市第五人民医院及无锡市儿童医院收治的行常规干预的孤独症患儿59例作为对照组,另选取2017年1月-2018年1月两家医院收治的行医院—社区—家庭联动干预的孤独症患儿59例作为观察组。对比两组干预前后孤独症治疗评估量表(ATEC)评分、Gesell发育及孤独症行为评分(ABC评分)以及满意度。结果观察组干预6个月后社交、语言、健康行为、感知觉评分及总分均低于对照组(均P0. 05)。观察组干预6个月后Gesell发育评分高于对照组,ABC评分低于对照组,差异均有统计学意义(均P0. 05)。观察组干预6个月后治疗满意度高于对照组,差异有统计学意义(P0. 05)。结论对孤独症患儿行医院—社区—家庭联动干预模式可有效降低ATEC评分及ABC评分,改善Gesell发育,提高治疗满意度,值得大力推广。     

24例儿童孤独症应用综合治疗的临床疗效观察

摘要：目的研究应用整合社交技能训练、语言和言语训练、认知能力训练、行为矫正、精细运动和感觉统合训练等综合方法对于儿童孤独症的治疗效果。方法收集患儿24例,应用综合疗法进行训练,训练前后分别应用克氏孤独症行为量表（CARS）和孤独症儿童行为评定量表（ABC）进行评测,以确定治疗效果,患儿每天训练3h,平均训练（3．75±2．68）月。结果训练之后,患儿CARS评分中人际关系、模仿、情感反应、躯体运动能力等方面评分均较训练前改善,差异有统计学意义（P〈0．05）,但是,“与非生命物体的关系”和“活动水平”两项评分训练前后差异无统计学意义;治疗前、后ABC各项评分差异均具有统计学意义（P〈0．01）。结论综合方法对于儿童孤独症患者的康复具有显著疗效。     

结构化教育治疗儿童孤独症的疗效

【目的】观察结构化教育治疗儿童孤独症的疗效,为临床治疗提供参考依据。【方法】对32例儿童孤独症患儿进行评估后,制定个别化教育计划。训练中应用结构化教育模式,将视觉线索应用到各个活动场所,强调作息时间和教学环境的结构化,强调工作组织的结构化。每周5 d,每天6 h,共训练6个月。用孤独症治疗评估量表(AutismTreatment Evaluation Checklist,ATEC)及C-PEP进行疗效评估。【结果】32例患儿孤独症儿童量表平均总分由训练前的(96.09±18.95)分下降到(54.91±14.10)分(P<0.001),量表中言语、社交、感知觉、行为四个分项目得分显著下降(P<0.001)。C-PEP评估功能发展平均分值由训练前(28.00±11.08)提高到(48.00±11.27),年龄当量提高(9.00±5.32)个月,扣除生理增长6个月,实际年龄当量增长(3.00±5.32)个月。【结论】结构化教育治疗对孤独症是一有效的训练方法。     

儿童孤独症全血微量元素及血铅水平分析

目的探讨儿童孤独症与全血微量元素及血铅水平的关系。方法选取45例儿童孤独症患儿作为病例组抽取全血采用火焰原子吸收分光光度法测定铜、锌、钙、铁、镁的含量及石墨炉原子吸收光谱法测定铅的含量,同时选取同性别、同年龄的健康儿童45例作为对照组,并测定其全血微量元素及血铅的水平;采用儿童孤独症行为量表（Autism Behav—ior Checklist,ABC）对病例组的症状进行评估。结果孤独症患儿血锌水平明显低于正常对照组儿童（P〈0．05）,血铜、血铅水平明显高于正常对照组儿童（P〈0．05）。而血铁、血钙、血镁水平在两组中差异无统计学意义。儿童孤独症行为量表的得分与血锌水平呈显著负相关（r=-0．672,P〈0．001）,与血铜、血铅水平呈显著正相关（r=0．513,P〈0．01;r=0．66,P〈0．01）。结论孤独症儿童全血中微量元素含量有明显变化,其中血锌缺乏,血铜增高,有毒金属血铅增高,且与孤独症患儿症状的严重程度有相关性。     

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.     

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.     

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.     

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.