家庭环境与4～5岁儿童注意缺陷多动障碍发生的单因素分析

[目的]调查学龄前儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)发生情况,探讨家庭环境与ADHD发生的关系. [方法]采取问卷调查和专家访谈相结合的方式,调查山东省滨州市2 136名4～5岁儿童ADHD患病情况;应用自编家庭环境问卷对患儿家庭环境进行测评. [结果] 1)ADHD患病率:总患病率为5.85%,其中男童检出率为7.34%(84/1 145),女童检出率为4.14%(41/991),男童检出率明显高于女童(x2=9.87,P＜0.01);2)家庭环境:单亲或重组家庭、家庭成员问关系紧张、父母经常在家庭中使用暴力、父亲有不良嗜好是ADHD发生的危险因素;父亲文化程度高是保护因素.儿童不同居住地之间、独生子女与非独生子女之间、母亲不同受教育程度之间,其儿童ADHD患病率差异均无统计学意义. [结论]ADHD患病率为5.85%,男童检出率高于女童;不良家庭环境在儿童ADHD的发生中起一定作用.     

福安市儿童注意缺陷多动障碍调查研究

目的了解本市儿童注意缺陷多动障碍(ADHD)的现状及影响因素。方法选取城区两所最大幼儿园和两所最大小学校儿童3738名,采用美国精神病学会颁发的《精神障碍的诊断与统计手册》第3版修订本ADHD的诊断标准,作为ADHD问卷进行筛查。结果本病检出率为4.23%,男女患儿之比为4.27∶1,男童的检出率随年龄增加呈下降趋势,而女童检出率变化不大。父母文化程度,养育方式不同,其检出率差异显著,婴幼儿期患严重疾病,母孕期各种疾病,围产期损伤等不利因素占ADHD患儿的48.73%,表明我市医疗保健卫生工作的削弱。结论本病的发生不是某一个因素的独立作用,而是多种因素相互作用的结果,提示ADHD的矫治必需由医院、家庭、学校密切配合,才能做到最好的效果。     

学龄期注意缺陷多动障碍儿童情绪和行为问题分析

目的探讨柳州市学龄期注意缺陷多动障碍(ADHD)儿童的情绪和行为特征,为制定科学有效的综合治疗方案提供依据。方法以符合DSM-IV诊断标准的468例ADHD儿童为病例组,采用长处与困难量表(SDQ)父母版比较ADHD儿童与1 404例正常健康儿童的情绪行为特征。结果两组SDQ得分比较,ADHD儿童情绪、品行问题、多动注意不能、同伴交往以及困难总分均高于对照组儿童(P=0. 000),亲社会因子得分对照组高于ADHD组(P=0. 000)。不同性别ADHD儿童SDQ得分比较,女童亲社会行为得分高于男童(P=0. 022)。品行问题和多动注意不能因子得分在不同年级ADHD儿童中比较差异有统计学意义(P0. 05)。结论 ADHD儿童多伴随情绪、品行问题、注意力集中不能等问题,ADHD男童的困难总分高于女童。ADHD儿童的干预训练要根据儿童行为特征及性别差异采取有针对性的方案。     

柳州城区小学生注意缺陷多动障碍现况与危险因素分析

了解柳州市学龄期儿童注意缺陷多动障碍(ADHD)的流行特征及影响因素,为儿童ADHD的综合防治提供参考.方法 采用分层随机整群抽样方法,抽取柳州市城区一~六年级共9 628名小学生进行注意缺陷多动障碍筛查.以美国精神障碍诊断和统计手册第四版为ADHD的诊断标准对可疑患儿及其家长进行诊断学访谈,对筛查与诊断结果进行统计.结果 共确诊ADHD儿童468例,ADHD患病率为4.86%,男生患病率(8.09%)高于女生(1.47%)(x2=228.146,P=0.000);9岁组儿童ADHD患病率最高(6.14%),不同年龄组间差异有统计学意义(x2=12.956,P=0.024).ADHD分型以注意缺陷为主型发生率最高(2.85%),其次是混合型(1.41%),多动/冲动为主型最少(0.60%).非条件多因素Logistic回归分析显示,女生患ADHD的风险低于男生(OR=0.17,95%CI=0.13~0.22),母亲孕期心情不佳和父母关系不好是发生ADHD的危险因素[OR值分别为1.45(95%CI=1.17~ 1.79)和2.01(95%CI=1.59~ 2.55)].结论 柳州市城区小学生ADHD患病率处于国内中等水平,且发生与儿童性别、母亲孕期心情及父母关系有关.应对家长、老师进行相关知识宣教,提高早期识别和诊断,促进儿童身心健康发展.     

小学生注意缺陷多动障碍与家庭因素的相关分析

目的探讨小学生注意缺陷多动障碍(ADHD)与家庭因素的关系,为开展防治工作提供依据.方法按年龄、性别对注意缺陷多动障碍儿童和正常儿童对照1∶1配对,对203对小学生进行家庭影响有关因素的问卷调查,并用条件Logistic回归模型进行多因素分析.结果父亲吸烟、父亲嗜酒、父亲童年多动、父亲为体力劳动者、夫妻不良关系、母亲孕期精神创伤、母亲血型及单双胎等8项因素与小学生ADHD呈统计学关联.结论小学生注意缺陷多动障碍的发生与家庭影响因素密切相关.     

家庭社会经济地位与学龄前儿童注意缺陷多动障碍的相关研究

目的 了解学龄前儿童注意缺陷多动障碍(ADHD)的流行情况,分析家庭社会经济地位与ADHD发生的关系,为儿童ADHD的防控和干预提供科学依据。方法 采用方便整群抽样的原则,从农村地区的5所幼儿园和城市地区的2所幼儿园共抽取1 142名4~7岁的儿童,对其家长进行问卷调查。采用《ADHD评估量表(第4版)-学龄前儿童版》评估ADHD的症状水平。结果 学龄前儿童ADHD症状阳性率为7.01%,男童检出率为7.38%,女童检出率为6.56%。农村地区检出率为7.99%,城市地区为6.67%。多因素分层回归显示,女童、父亲年龄较大者,家里儿童读物数量较多者,ADHD症状水平较低。此外,3岁后每年生活总花费较高者,其ADHD症状阳性率越高,这种趋势主要表现在城市儿童中,农村儿童则相反。结论 家庭社会经济地位,特别是对学龄前儿童生活的投入与儿童ADHD密切相关,但是城乡差异和儿童年龄差异在其间起重要的调节作用。     

教养方式与儿童注意缺陷多动障碍关系的队列研究

目的 探讨教养方式与儿童注意缺陷多动障碍(ADHD)患病率的关系,为预防和控制ADHD提供理论依据.方法 用自行设计的调查表,对深圳市龙岗区3 520名幼儿父母的行为习惯、教养方式进行调查.按教养方式不同将幼儿分为暴露组(不良教养方式)和非暴露组进行3 a的追踪,比较暴露组和非暴露组儿童ADHD患病率.结果 学龄前儿童ADHD患病率为14.4%,其中男童为16.6%,高于女童的11.7%(P<0.01).x2检验显示,母亲吸烟、饮酒,溺爱、父母打骂孩子等16个因素对儿童ADHD患病率有影响(P值均<0.05).多元Cox回归分析表明,母亲吸烟(RR=4.409)、溺爱(RR=1.428)、父亲责骂孩子(RR=1.404)、母亲打孩子(RR=1.401)、母亲心情不好骂孩子(RR=1.376),对儿童ADHD患病率有显著影响(P值均<0.01).结论 父母不良教养方式是儿童ADHD患病的危险因素.     

四川省凉山彝族自治州西昌市6～16岁儿童注意缺陷多动障碍的流行病学调查

目的 探讨四川省凉山彝族自治州西昌市6～16岁儿童注意缺陷多动障碍(ADHD)的患病率特征及其影响因素.方法 于2011年4至5月采用《一般情况调查表》和《注意缺陷及多动症状调查表》对西昌市6所小学和3所初级中学的6～16岁儿童进行整群-分层抽样调查,共计抽取学生2800例纳入本调查,其中男童为1202例,女童为1148例.根据入组儿童年龄,将其分为6～7岁组(n=399)、8～10岁组(n=958)及11～16岁组(n=993).对可疑ADHD患儿及其家长进行诊断性访谈,并采用统计学方法进行ADHD影响因素分析(本研究遵循的程序符合四川省凉山彝族自治州第一人民医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书).ADHD的诊断标准采用美国《精神障碍诊断和统计手册(第4版)》,根据患儿症状、病程、严重程度将其进一步分为注意缺陷为主型(ADHD-I)、多动-冲动为主型(ADHD-HI)和混合型(ADHD-C).结果 本地区6～16岁儿童的ADHD患病率为4.81％.其中,ADHD-Ⅰ型的患病率最高,为2.64％,ADHD-C型患病率次之,为1.40％,ADHD-HI型最低,为0.77％.3型ADHD患病率比较,差异有统计学意义(P＜0.05).男童ADHD患病率明显高于女童,并且差异有统计学意义(P＜0.05).6～7岁组的ADHD各型的患病率最高,与其他年龄组比较,差异有统计学意义(P＜0.05).年龄、性别、母亲的文化程度、家族史、产伤、对儿童的教育不当、亲子关系等是ADHD的影响因素.结论 四川省凉山彝族自治州西昌市6～16岁儿童中,ADHD-Ⅰ型患病率最高,而且以6～7岁组儿童的患病率最高,男童患病率明显高于女童.年龄、性别、父母的文化程度、家族史、产伤、对儿童的教育不当、亲子关系等是ADHD的影响因素.     

儿童注意缺陷多动障碍病因学研究进展

儿童注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是以与其年龄不相适应、注意力不集中、多动和冲动行为为特征的心理行为性疾病,在学龄儿童中广泛存在[1]。儿童ADHD的现患率在不同国家存在一定的差异,德国3~17岁儿童ADHD现患率为4.8%(男童7.7%,女童1.8%)[2],加     

我国小学男生注意缺陷/多动障碍与入学年龄的相关性

探索中国男性小学生注意缺陷/多动障碍(ADHD)与入学年龄的相关性,为探讨ADHD的影响因素并提出防控建议提供参考.方法 选择中国疾病预防控制中心青年基金“我国学龄儿童主要慢性病干预模式及适宜技术研究”中的男性小学生12 731名作为研究对象,采用长处和困难问卷(SDQ)(家长版)的注意缺陷与多动量表分析提前入学和适龄入学男童在ADHD问题上的差异.结果 提前入学男童比适龄入学男童ADHD得分更高(t=-2.373,P=0.018),进一步将该量表分为多动、冲动和注意缺陷因子,发现提前入学男童的注意缺陷得分高于适龄入学男童(t=-2.610,P=0.009),多动和冲动未发现统计学差异.提前入学男童在五、六年级时ADHD得分高于适龄入学者,一~四年级ADHD各因子分差异均无统计学意义(P值均>0.05).结论 男童提前入学可能是ADHD的危险因素.应严格限制入学年龄,并对提前入学的儿童给予更多关注,减少ADHD症状的发生.     

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.