苯丙酮尿症32例干预情况分析

【目的】应用Gesell测查苯丙酮尿症(phenytkelonuria,PKU)患儿发育商,观察经过治疗的PKU患儿智力发育情况。【方法】Gesell测查32名PKU患儿发育商并与正常同龄儿童进行对照。【结果】经干预治疗的PKU患儿与同龄正常儿比较,在应物能(t=2.81,P0.01)应人能(t=2.22,P0.05),差异有统计学意义;而动作能,精细能和言语能无统计学意义(P均0.05)。【结论】加强高危孕妇的产前诊断及胎儿出生的早期诊断,并进行早期干预治疗,是超高PKU患儿生病质关的有力措施。     

DDST测试异常儿童430例临床分析

[目的]分析丹佛发育筛查量表(DenverDevelopmentalscreeningTest,DDST)在儿保临床工作中的实用性。[方法]采用DDST对0-6岁儿童的应人能、细动作应物能、言语能、运动能四个能区逐项测试。[结果]430例DDST异常儿童中,应人能、细动作应物能、言语能、运动能四个能区具有二项以上迟长的疾病有:脑性瘫痪、重度癫痫、精神发育迟滞、核黄疸后遗症、乙脑后遗症、脑外伤后遗症、先天愚型、小头畸型;运动能区出现二项以上迟长的有脊灰后遗症、多发性神经根炎后遗症、先天性髋关节脱位、进行性肌营养不良;言语能出现二项以上迟长有聋哑症及药物性耳聋。引起430例DDST异常的疾病,以围生期缺氧缺血性脑损伤所致的脑性瘫痪、重度癫痫、精神发育迟滞所占比例最大。[结论]DDST筛查能早期发现智力发育障碍儿童,以便早期干预,对基层儿保临床工作具有一定的实用价值。     

孤独症患儿言语及语言康复训练效果分析

【目的】分析孤独症患儿言语及语言训练的效果,为早期干预提供参考依据。【方法】对20例孤独症患儿的言语及语言障碍进行评估后,制定个别化训练计划。以一对一的形式训练。每周5次,每次30 min,共训练6个月。用儿童语音测试及小儿0~4岁精神发育检查表进行疗效评估。【结果】经过训练,20例孤独症患儿能有意识发出的声母数量由训练前的平均0.45个增至8.90个(P<0.001);语言发育商数由训练前的平均25.71分提高至44.22分(P<0.001);训练总有效率为100%。【结论】对孤独症患儿进行早期干预、言语及语言康复训练能有效地解决语言障碍的问题。     

324例同龄儿童心理发育障碍的对照研究

目的:了解同年龄孤独症及精神发育迟滞儿童发育水平的异同点,为临床诊疗提供参考依据。方法:162例儿童孤独症患儿及162例精神发育迟滞患儿采用发育商量表(Gesell)检测智能发育水平。结果:孤独症组男女儿童智能发育水平无统计学差异;同年龄组孤独症及精神发育迟滞患儿除语言项以外,各项发育商水平差异均有统计学意义(P<0.05)。男童、女童分别进行发育商对比分析,各功能区发育水平男童的临床表现比女童明显。结论:孤独症患儿大多数伴有精神发育迟滞,发育水平损伤程度不同,孤独症男、女儿童发育损伤表现略有不同,男性患儿临床症状更为明显。     

2~3岁语言发育迟缓儿童的智能发育分析

【目的】 了解2~3岁语言发育迟缓儿童的智能发育特点,以指导干预。 【方法】 以178例2~3岁语言发育迟缓儿童为研究对象,采用S-S语言发育评价法评定其语言水平,采用Gesell发育量表评估其智能发育的五个能区,对测得的发育商进行统计分析。 【结果】 该组儿童大运动发育正常(发育商>85分),语言水平低于实际年龄段,语言发育商<76分;其语言发育水平与适应行为、精细动作、个人社交行为发育水平明显相关(P<0.01);该组儿童适应行为、个人社交行为发育低下的发生率分别为72.5%、52.2%;适应行为、个人社交行为发育低下的发生率与语言发育缺陷的程度明显相关(P<0.01),精细动作发育低下的发生率为48.9%,精细动作发育低下的发生率与语言发育缺陷的程度不相关(P>0.05)。 【结论】 语言发育迟缓儿童常伴有适应行为、精细动作、个人社交行为的发育低下,临床需对语言发育迟缓儿童进行智能发育评估,并对存在的发育缺陷进行全面干预。     

0～3岁婴幼儿111例《盖泽尔》智能发育检查与分析

为了解我市0～3岁婴幼儿智能发育水平,于1993年8月对居住在我市海港区范围内的111例0～3岁婴幼儿用盖泽尔智能发育诊断法进行智力测验,结果分析如下:1.我市111例0～3岁婴幼儿总DQ为99.58±17.88,大运动DQ为104.45±16.45,应物能为99.16±15.51,语文能DQ为96.80±16.63,应人能DQ为101.50±17.47。低于北京、上海等发达城市。2.智能发育低下的发生率总DQ临界异常2人,占测查人数的1.83％;56～75之间者4人,占3.61％;36～55之间2人,占1.81％。3.从整个测查结果看,被测儿童普遍存在语言能发育较其它能区较差的情况,语言能临界异常人数明显大于其它三个能区,经检验有非常显著性差异,而语言能不正常的小儿占38.89％,总DQ不正常。由此可见早期开发语言是提高小儿智能的重要途径。4.发育商异常的病因分析:111例小儿总智商临界和异常共11名,与早产、窒息等出生时情况及遗传因素有密切关系。通过本次测查,初步掌握了我市0～3岁婴幼儿发育商的水平及影响因素,对今后加强孕产妇和儿童保健提供了可靠的依据。     

孤独症谱系障碍儿童早期智能特征和疗效分析

【目的】探讨孤独症谱系障碍(autisms disorder,ASD)儿童早期智能特征和治疗效果,为早期干预和判断预后提供依据。【方法】对治疗的106例ASD儿童和35例智能发育落后儿童用Gesell发育诊断量表进行发育评估,并对其中治疗满半年的28例ASD儿童和6名智能发育落后儿童进行治疗后评估,将各组结果进行对比。【结果】106例ASD儿童智能测评结果:适应性DQ51.65±19.46,大运动57.14±16.22,精细运动54.46±18.36,语言42±16.14,个人-社交45.25±10.61。智能发育迟滞组儿童35人,适应性DQ48.11±16.75,大运动DQ51.27±18.42,精细运动DQ48.78±18.91,语言DQ39.99±16.17,个人-社交DQ48.08±17.44。ASD儿童五个能区均明显落后于同龄儿童,其中语言和个人-社会能区明显低于大运动能区和精细运动能区。与智能发育迟滞儿童比较:适应性、大运动、精细运动高于智能发育迟滞组,语言,社交稍低于智能发育迟滞组,但各能区差异无统计学意义。【结论】ASD儿童经积极干预进步显著于智能发育迟滞儿童。     

不同发育障碍儿童家庭的依恋特点

【目的】 探索不同发育障碍儿童家庭的依恋特点。 【方法】 采用一般家庭情况问卷及亲密关系经历量表(ECR,中文版)分别对69例孤独症患儿(孤独症组)、18例Asperger综合征患儿(Asperger综合征组)、51例精神发育迟滞患儿(精神发育迟滞组)及69名正常儿童(正常对照组)的父亲和母亲进行问卷调查,分析不同发育障碍儿童家庭的父亲和母亲的依恋特点。 【结果】 组间父亲依恋回避、母亲依恋焦虑和母亲回避维度差异无统计学意义(P均＞0.05);父亲依恋焦虑维度差异有统计学意义(F=5.432,P＜0.01)。两两比较发现,父亲依恋焦虑维度评分孤独症及精神发育迟滞组明显高于正常对照组及Asperger综合征组(P＜0.05~0.01);正常对照组与Asperger综合征组间差异无统计学意义(P＞0.05)。 【结论】 不同发育障碍患儿家庭中,母亲依恋特征与正常儿童的母亲相同,但孤独症及精神发育迟滞患儿的父亲依恋焦虑维度增高,可能会影响其抚育患儿的方式。     

脑性瘫痪不同侧偏瘫患儿发育结构分析

目的观察脑性瘫痪不同侧偏瘫患儿的发育结构。方法 2009年3月-2014年12月在青岛市妇女儿童医院神经康复科门诊和住院治疗、确诊为脑性瘫痪(偏瘫型)的患儿54例,其中左侧偏瘫20例,右侧偏瘫34例,进行Gesell测查,测得各能区的发育商。将左侧和右侧偏瘫患儿相应能区的发育商进行对比,并对不同能区的发育商进行相关性研究。结果在大运动、精细动作、应物能及语言表达能区左侧偏瘫患儿明显好于右侧偏瘫患儿,而应人能、语言理解方面,两组患儿无明显差异。偏瘫患儿各能区间具有不同程度的相关性,其中应物能和语言表达的相关性最好,大运动和应物能、精细动作和语言表达间的相关性亦很密切;而大运动和精细动作间无显著相关性。结论左侧和右侧偏瘫患儿的发育结构有明显不同。     

护理干预新生儿缺血缺氧性脑病的影响

目的观察护理干预对新生儿缺血缺氧性脑病患儿康复的影响。方法将126例缺血缺氧性脑病患儿随机分为实验组和对照组各63例。对照组常规治疗护理,实验组在对照组治疗的基础上,进行全面护理干预。2组在第28天、3、9、12个月进行随访,12个月随访时进行Gesell初评测定。结果实验组第12个月在动作能、应物能、应人能、言语能4个能区的智能发育商得分高于对照组(P<0.05)。结论早期护理干预能提高缺氧缺血性脑病新生儿智能发育,对改善患儿的预后有积极的意义。     

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.