6月-36月婴幼儿缺铁性贫血相关因素分析

目的分析导致婴幼儿缺铁性贫血（iron deficiency anemia,IDA）的相关危险因素。方法 2010年10月-2011年10月在山西省儿童医院血液科住院治疗的缺铁性贫血患儿和同期在儿保科门诊体检的健康婴幼儿各65例,进行回顾性病例对照研究。收集其性别、年龄、胎龄、出生体重等信息,建立Logistic回归模型,进行单因素及多因素分析。结果单因素分析结果其中患儿居住地、家庭经济状况、母亲文化程度、父亲文化程度、是否接受育儿指导、母乳喂养、添加辅食时间、添加富含铁的食物、出生体重、是否早产、母亲晚期贫血等11个因素有统计学意义（P〈0.05）,提示这些因素可能和婴幼儿缺铁性贫血的发生有关。然后把这11项结果进行Logistic多因素分析,其中喂养方式、经济状况、母亲文化程度、添加辅食时间、辅食种类、出生体重、母晚期贫血情况7项指标在多因素条件Logistic回归分析中有统计学意义（P〈0.05）。结论结果提示喂养方式、经济状况、母亲文化程度、添加辅食时间、辅食种类、出生体重、母晚期贫血情况7项指标与婴幼儿缺铁性贫血的发病密切相关,可能为引起婴幼儿缺铁性贫血较显著的危险因素。     

农村地区6个月~7岁儿童贫血及铁缺乏情况调查及干预

目的：了解合肥市农村地区6个月~7岁儿童的贫血及铁缺乏情况及干预效果。方法采取随机抽样的方法抽取2095名6个月~7岁儿童进行问卷调查并测定血红蛋白,对贫血和(或)铁缺乏的儿童进行干预。结果2095名研究对象中,正常儿童1764名,检出贫血患儿331例,检出率为15.80%。其中铁缺乏检出114人,检出率为5．44%,贫血患儿中铁缺乏检出率为34．44%。在接受干预的281名儿童中有218名血红蛋白恢复到正常水平,即干预后正常儿童为1982名,占96．92%;轻度、中度贫血检出率均明显下降。结论合肥市农村地区儿童贫血及铁缺乏干预效果显著。加强儿童贫血相关健康教育,科学合理的喂养方法及早期正确的喂养行为可以有效防治婴幼儿贫血及铁缺乏。     

Blood lead levels in children aged 24 to 36 months in Vancouver.

OBJECTIVES: To determine the blood lead levels in children and to identify risk factors for elevated levels. DESIGN: Cross-sectional study. SETTING: Vancouver. PARTICIPANTS: Random sample of children aged 24 to 36 months, born and still resident in Vancouver. The sample was stratified proportionally by the median annual family income in the census tract where each family resided. OUTCOME MEASURES: Blood lead levels and risk factors for elevated blood lead levels, determined from a questionnaire administered to parents. RESULTS: Of the children in the sample, 42% (178/422) were ineligible or could not be located. Of the remaining children, 73% (177/244) participated and adequate blood specimens were obtained from 172. The mean blood lead level was 0.29 mumol/L (standard deviation 0.13 mumol/L). (A blood lead level of 1 mumol/L is equivalent to 20.7 micrograms/dL.) The lowest level was 0.06 mumol/L, and the highest was 0.85 mumol/L. Of children with adequate samples, 8.1% (14/172) had blood lead levels of 0.48 mumol/L or higher, and 0.6% (1/172) had a level higher than 0.72 mumol/L. The logarithms of the levels were normally distributed, with a geometric mean (GM) of 0.26 mumol/L (geometric standard deviation 1.56). Of approximately 70 possible predictors of blood lead levels analysed, those that showed a statistically significant association (p < 0.05) with increased blood lead levels were soldering performed in the home as part of an electronics hobby (GM blood lead level 0.34 mumol/L, 95% confidence interval [CI] 0.27 to 0.39 mumol/L), aboriginal heritage (GM blood lead level 0.33 mumol/L, 95% CI 0.28 to 0.39 mumol/L), dwelling built before 1921 (GM blood lead level 0.32 mumol/L, 95% CI 0.28 to 0.37 mumol/L), age of water service connection to dwelling (predicted blood lead level 0.00087 mumol/L [95% CI 0.00005 to 0.00169 mumol/L] higher per year since service connection) and decreased stature (predicted blood lead level 0.018 mumol/L [95% CI 0.0353 to 0.0015 mumol/L] higher for every standard deviation below the age-specific mean height). CONCLUSIONS: This study found much lower blood lead levels in children than those found in previous Canadian studies. The authors believe that this result is not an artefact due to differences in population sampling or methods of collection of blood specimens. The study showed no clear risk factors for elevated blood lead levels: although a few factors had a statistically significant association with increased blood lead levels, the differences in levels were small and unimportant.     

淮北地区6个月至6岁儿童缺铁性贫血调查

目的:探讨淮北地区6个月至6岁儿童缺铁性贫血(IDA)主要相关性因素及其影响。方法:原子吸收法检测微量元素铁,三分类血细胞分析仪检测血红蛋白及红细胞参数。结果:不同年龄组间缺铁、贫血率差异有统计学意义(P0.01);随着年龄的增加,缺铁、贫血率逐渐降低(P0.05),但同一年龄组不同性别儿童缺铁、贫血率差异无统计学意义(P0.05);6个月至6岁儿童IDA占8.0%,隐性IDA(血红蛋白正常,MCV、MCH减少)占5.4%。农村地区儿童贫血率8.20%高于城市地区2.55%(P0.01)。结论:微量元素铁的测定可以作为早期发现儿童IDA的筛查试验,特别是隐性IDA的早期诊断。积极采取综合干预措施,加强营养教育才能提高儿童健康水平。     

Prevalence of mycobacterial sensitivity in Montreal children

The prevalence of sensitivity to atypical mycobacteria was found to be low in 2152 Montreal first-grade children tested with tuberculin and one of four atypical antigens randomly allocated. Forty-nine had positive reactions to an atypical antigen. PPD-G produced more reactions than PPD-A, -B or -K. In Greater Montreal there was a higher prevalence of sensitivity to atypical mycobacteria than in the two suburban areas studied. The range of this prevalence, standardized for the type of antigen, was from 0.86 to 2.92% according to region. The highest prevalence of sensitivity to any single atypical antigen, 5.3%, was found for PPD-G in Greater Montreal.

Tuberculous infection was found in 1.35% of the children. Small tuberculin reactions (5 to 9 mm to stabilized PPD 5 TU) require clarification by differential tuberculin testing. More of them are caused by M. tuberculosis than by atypical mycobacteria in this particular age group and region.

Routine BCG immunization is not indicated for the particular population studied; when given to individuals at risk, its effectiveness should not be impaired by atypical sensitivity at the low level found locally. Future BCG plans require more epidemiologic data.

     

成都市城区6～12岁儿童超重和肥胖的流行现状

目的 为了解成都市城区学龄期儿童超重及肥胖的情况,及时对超重及肥胖儿童进行干预和治疗.方法 选取成都市3个城区6所小学共3769名6～12岁健康儿童进行调查,以身高别体重为参数,以WHO肥胖的诊断标准为依据.结果 儿童超重率和肥胖率分别为8.9%和8.5%,总体肥胖-超重比为1.05.肥胖发生率在7～10岁有随年龄增高的趋势,而在11～12岁有随年龄下降的趋势,10岁组肥胖率最高.整体人群中男童肥胖的发生率＞女童,χ2＝29.38,P＜0.01.结论 成都市城区学龄儿童超重及肥胖的发生率虽然远低于国外发达国家,但与国内城市比较仍处于一个较高的水平;特别是学龄期男孩的肥胖应该引起我们的高度重视.     

泰安地区7个月～7岁儿童缺铁性贫血流行病学调查分析

目的了解泰安地区7个月7岁以下儿童缺铁性贫血（iron deficiency anemia,IDA）现状及其影响因素。方法采取整群分层抽样方法,所抽取的市县基本一区（街道）一村,对其儿童进行体检、病史询问、膳食调查和末梢血血常规检测。结果泰安地区7个月7岁儿童IDA为8.8%,7个月12个月IDA为21.2%,13个月36个月IDA为8%,37个月7岁IDA为3.4%。各年龄组差异有显著意义（P〈0.001）。泰山区三联社区发病率最低,为2.8%,宁阳县鹤山乡最高,为15.7%。影响IDA的因素有家庭经济收入情况、父母的文化程度、职业、米粉及辅食添加时间、种类及是否患有腹泻、呼吸道疾病。结论不同年龄组儿童IDA患病率不同,年龄越低患病率越高;IDA的发生发展与经济水平和营养状况关系密切。     

社区0～36月龄儿童家长对儿童健康管理知识知晓情况分析

随机抽取0～36月龄儿童家长238人作为调查对象,进行问卷调查。其中月龄0～6个月儿童的家长92人,7～12个月者家长85人,13～18个月者家长33人,19～24个月者家长16人,〉24个月者家长12人;女性185人,男性53人;父母占99．2％（236／238）;大专以上文化程度家长占52．1％。女性家长对“最近半年内为儿童做过几次体检”的知晓率明显高于男性家长（P〈0．05）;家长对其余知识知晓情况性别差异无统计学意义。0～36月龄儿童家长半年内陪同儿童进行健康体检次数达（2．8±1．9）次;儿童出生（7．4±2．4）个月已开始添加肉食,其中肉、动物肝脏和蛋的摄人已达到每周7次以上。大专以上文化程度家长对儿童生长发育的关注程度及儿童常见营养性疾病佝偻病、贫血的重视程度等方面高于其他文化程度家长。纯母乳喂养儿童仅占37．O％（88／238）。提示,家长喂养行为、文化程度、育儿水平和执行力的明显提高,在社区儿童健康管理中发挥着重要作用。     

Effect of Vitamin C Supplementations on Iron Deficiency Anemia in Chinese Children

A total of 65 children with mild iron deficiency anemia(IDA)were divided into 5 groups,and received,0,25,50,100and 150mg/day of vitaminC(VC)respectively every day for 8 weeks.Hemoglobin,serum ferritin,free erythrocyte and hematocrit were determined every week.At a daily average intake of about 30mg of VC and 7.5mg of Fe,the results of the study indicate that:(1)VC supplement alone could effectively control children‘s IDA,and a dosedependant relationship was observed.(2)5mg/day of VC is the most efficient dosage and 6 weeks is the shortest time for an effective therapy.(3)With a diet predominately comprised of plant foods,it is suggested that appropriate dose of VC should be supplemented for the children during winter and spring in northeastern areas of China.     

Iron deficiency anemia in 1-year-old children of disadvantaged families in Montreal.

OBJECTIVES: To determine the prevalence of iron deficiency anemia among 1-year-old infants of disadvantaged families in Montreal as well as certain predictors of this condition. DESIGN: Cohort study. SETTING: Five poorest health districts in Montreal. PARTICIPANTS: Infants 10 to 14 months of age were identified from registration lists of births from May 1988 to August 1989. Those whose mother had less than 11 years of schooling and a family income below the government-defined low-income cutoff point were eligible. INTERVENTION: During a home visit capillary blood samples were obtained from the child, and the mother answered a questionnaire about infant-feeding practices. Infants with a serum ferritin level of 10 micrograms/L or less and either a hemoglobin level of 115 g/L or less or a mean corpuscular volume of 72 fL or less were considered as having iron deficiency anemia. RESULTS: Of the 299 mothers who were eligible and could be located 220 (74%) agreed to participate; 218 blood samples were available. Iron deficiency anemia was found in 25% of the infants (95% confidence interval [CI] 19% to 31%). The mean hemoglobin level was 115 (standard deviation 11) g/L. The serum ferritin level, assessed routinely in the last 62 infants, was 10 micrograms/L or less in 37% of the infants. The factors that were found to be predictors of iron deficiency anemia included the use of whole cow's milk before 6 months of age (odds ratio [OR] 3.56 [95% CI 1.07 to 11.26]) and the use of iron-fortified infant cereal for less than 6 months (OR 3.15 [95% CI 1.25 to 7.96]). A low birth weight and the use of iron-fortified formula for less than 6 months were associated with iron deficiency anemia. CONCLUSIONS: Despite a decrease in the prevalence of iron deficiency anemia among children of disadvantaged families in the United States socioeconomically disadvantaged infants in Montreal are at risk. Preventive measures must be taken to ensure adequate iron status in the first year of life.     

兰州地区2～6岁儿童睡眠障碍流行病学调查

目的了解兰州地区2～6岁儿童睡眠障碍的发生情况.方法2003年10月-2004年6月间在兰州市6个区县采用分层随机整群抽样方法抽取3125名2～6岁儿童,由专人负责对家长进行儿童睡眠状况问卷调查.结果2～6岁各年龄组儿童的平均日睡眠时间分别为11.38、11.06、10.75、10.60和10.28 h.儿童睡眠障碍症状发生率23.48%,其中睡眠频繁鼾症发生率为5.52%,喉头哽咽0.53%,张口呼吸3.31%,睡眠呼吸暂停0.19%,磨牙7.62%,梦呓0.37%,睡眠中肢体抽动1.55%,睡眠不安6.31%.不同症状的发生率存在性别、年龄和地区的差异.结论目前兰州市儿童睡眠障碍发生率较高,应引起儿科医生、儿保工作者及家长的重视.     

Prevalence of growth hormone deficiency of children in Beijing.

103,753 (male 51,994, female 51,759) primary and middle school students aged 6-15 years in two districts in Beijing city were surveyed from October 1987 to April 1989. The heights of the students were measured. According to the height standard of northern cities in China, 202 students with heights below the 3rd percentile for age were requested for detailed history, physical examination, screening GH test bone age, T4, SGPT, chest X-ray, routine urine test and sex chromatin (in female). If GH less than 10 micrograms/L, two provocative tests (L-dopa or clonidine and insulin hypoglycaemia test) were done. Then the heights of the short students were observed for 1/2-2 years. GHD was diagnosed in 12 cases based on the GH peak levels less than 10 micrograms/L in two provocative tests, whose growth velocity was slower than that for students of the same age and sex. Of these subjects with GHD, total GHD (GH less than 5 micrograms/L) was present in 7 and partial GHD (GH = 5-9.9 micrograms/L) in 5. The 12 GHD students (male 9, female 3) aged 8.9-15.7 years accounted for 1/8,646 in the total surveyed students. The male and female GHD accounted for 1/5,777 and 1/17,253 in the total males and females respectively.

     

婴儿缺铁性贫血影响因素的病例对照研究

目的：探讨长沙市8月龄婴儿缺铁性贫血状况及其影响因素。方法：采用病例对照研究,将8月龄规范 化血常规检测明确诊断为缺铁性贫血的105例婴儿纳入病例组,按1:4个体匹配,发生1个新病例的同时选取4例同 一街道、同一性别按相同标准诊断未发生缺铁性贫血的婴儿作入对照组,收集相关资料,运用χ2检验、条件logistic 回归分析婴儿缺铁性贫血发生的影响因素。结果：长沙市8月龄婴儿缺铁性贫血发生率为14.7%。8月龄婴儿发生缺 铁性贫血的危险因素包括：母亲孕晚期贫血(OR=3.540,95% CI：1.898~6.601)、6月龄内混合喂养(OR=1.682,95% CI：1.099~2.574)、6月龄内人工喂养(OR=4.162,95% CI：1.343~12.896)、6月龄前添加辅食(OR=1.423,95% CI： 1.022~1.982)、7月龄及以后添加辅食(OR=4.415,95% CI：2.150~9.064)、 8月龄内反复呼吸道感染(OR=2.878,95% CI：1.224~6.764)、8月龄内反复腹泻(OR=3.710,95% CI：1.533~8.980)。结论：长沙市8月龄婴儿缺铁性贫血仍有一定 的发生率,应改善母亲孕期贫血,提倡科学喂养,鼓励纯母乳喂养至6月龄,并及时合理添加辅食,积极治疗罹患呼 吸系统和消化系统疾病的患儿,预防婴儿缺铁性贫血的发生。     

Vaccination against hepatitis A in children aged 12 to 24 months [corrected

BACKGROUND: Current hepatitis A vaccines are either licensed for children >2 years of age, as in the U.S. or Chile, or >1 year of age, as in Europe and other parts of the world. Recent recommendations for immunization against hepatitis A have included routine vaccination of children in areas or regions of higher endemicity. However, data on hepatitis A vaccination in toddlers aged between 1 and 2 years are scarce. METHODS: This open clinical study investigated the reactogenicity and immunogenicity of two doses (0, 6-month schedule) of an inactivated hepatitis A vaccine (Havrix pediatric, Glaxco SmithKline Biologicals, Rixensart, Belgium) in 120 seronegative children aged 12-24 months. RESULTS: Pain at the injection site and irritability were the most frequently reported local and general symptoms, respectively. No serious adverse events related to the study vaccine were reported. One month after the first dose, all but one subject had antibodies against hepatitis A with a GMT of 159 mIU/mL. After the booster dose, all had antibodies with a GMT of 2,939 mIU/mL. CONCLUSIONS: Our data show that the inactivated hepatitis A vaccine was well tolerated by these toddlers and that the vaccine elicits a good immune response.     

安徽省2011年0～6岁儿童脊髓灰质炎抗体水平分析

目的 了解安徽省学龄前儿童脊髓灰质炎(脊灰)抗体水平,评估脊灰疫苗免疫策略效果。 方法 采用系统抽样方法,调查安徽省16个县(市、区)的0～7岁年龄组的1 754名儿童,进行脊灰中和抗体水平检测。 结果 所有调查对象均有脊灰疫苗免疫史,96.41%的调查对象接种3～5次;调查对象脊灰中和抗体Ⅰ、Ⅱ、Ⅲ型阳性率分别为99.43%、99.20%、98.86%;抗体几何平均滴度(geometric mean titers,GMT)分别为1∶193.40、1∶117.26、1∶85.03;98.29%的调查对象3种型别抗体均为阳性。各型间抗体阳性率和GMT差异均有统计学意义(P＜0.01);各年龄组的Ⅰ、Ⅱ、Ⅲ型抗体阳性率均＞97%,随年龄增长抗体GMT逐渐下降,差异有统计学意义(P＜0.05),抗体阳性率差异无统计学意义(P＞0.05);皖北、皖中、皖南地域脊灰抗体阳性率均＞98%,不同地域阳性率差异无统计学意义(P＞0.05),抗体GMT差异有统计学意义(除F_Ⅱ之外,P＜0.05);多元分析发现年龄、地域和3种型别均阳性对抗体GMT的影响差异有统计学意义(P＜0.01)。 结论 安徽省学龄前儿童脊灰抗体阳性率和几何平均滴度均保持在较高水平,通过脊灰疫苗接种,已建立牢固的脊灰免疫屏障。