心理干预对高危儿母亲情绪及育儿行为的影响

【目的】探讨在高危儿管理中，儿童保健医生对母亲的心理干预对母亲情绪、育儿行为及其婴儿生长发育的影响。【方法】把280例高危儿的母亲随机分为干预组（140例）和对照组（140例），干预组在对高危儿常规保健的同时，按“母亲心理干预方案”对母亲进行心理干预；对照组仅对高危儿进行常规保健。采用抑郁自评量表（SDS）进行母亲抑郁状态评估，对比两组母亲产后3个月抑郁自评标准分及参加保健情况、母乳喂养率、婴儿体格及智能发育情况。【结果】高危儿的母亲产后3个月内出现SDS标准分〉50分者59例，占21．07％;SDS标准分〉50分者，第1个月SDS标准分两组无显著差别，而干预组SDS标准分第2个月、第3个月低于对照组，差异有显著性（P〈0．05），两组6个月内母乳喂养率无显著差别（P〉0．05）;对照组6个月内流失率高于干预组（P〈0．001），6个月时，婴儿Kaup指数〈15者对照组多于干预组，≥15者干预组多于对照组，差异有显著性（P〈0．05）。【结论】高危儿的母亲产后3个月处在抑郁的高危状态，适当的心理干预可降低母亲的抑郁水平，提高高危儿保健质量，改善婴儿的营养状况，促进母婴身心健康发展。     

社区高危儿监测与管理模式研究

【目的】 探索适用于社区高危儿筛查、监测和干预的管理模式。 【方法】 建立高危儿社区监测网络,由高危儿筛查、登记、监测、转诊、康复治疗等环节构成高危儿管理程序,对辖区高危儿自生后进行定期监测随访。随即抽取340例高危儿分为系统干预组和非系统干预组,定期评估其神经运动发育及智能发育情况,采用t检验、χ²检验进行统计学分析。 【结果】 济南市高危儿社区管理覆盖率达94.44%。系统干预组智能发育评估各能区发育商明显高于非系统干预组,而神经运动发育异常率明显低于非系统干预组。 【结论】 建立社区高危儿监测网络,制定适合社区的高危儿监测与干预模式,对高危儿系统干预至少到2岁是提高群体儿童心理发育,降低儿童脑瘫和智力残疾发生的关键。     

高危儿童233例智力测验结果分析

【目的】用智力测试为手段,对高危儿精神发育进行跟踪测试,以早期获得高危儿不同时期神经精神发育的情况。【方法】对有高危因素的新生儿233例患儿采用智力测试及其他相应的检测。【结果】智力测试能评估高危儿智能发育水平,高危儿不同年龄段即分别在6、12、18、24个月中精神发育商存在差异,在同一年龄组五大领域发育商也存在明显差异。【结论】在高危儿管理中,用智力测试手段检测,根据结果可以对高危儿不同年龄段及不同领域发育进行早期干预,提高高危儿的智能水平。     

规范管理和早期干预对高危儿智能的影响

【目的】探讨高危儿规范管理和早期综合干预对高危儿智能的影响。【方法】高危儿干预组46例,均为2005~2006年中山市博爱医院新生儿重点护理病房(neonatal intensive case unit,NICU)住院新生儿;高危儿对照组230例,为2005年以前本院NICU住院新生儿,同期在本院儿保门诊常规体检的儿童作为正常对照组。用Gesell婴幼儿发育量表进行早期神经心理发育监测。【结果】高危干预组与高危对照组比较:1岁时高危干预组的语言和个人社交2个能区和平均发育商(developmental quotient,DQ)均高于高危对照组(P<0.05);而大运动、适应行为和精细动作DQ两组差异无显著性。高危干预组与正常对照组比较:大运动、个人社交和平均DQ两组差异无显著性;高危干预组精细动作和适应行为DQ比正常对照组儿童低(P<0.05);高危干预组的语言DQ比正常对照组儿童高(P<0.01)。高危对照组5个能区和平均DQ均低于正常对照组(P<0.01)。【结论】高危儿规范管理和早期综合干预能促进高危儿的神经心理发育。     

高危儿行为发育的早期干预治疗

【目的】　通过早期干预促进高危儿的行为发育。　【方法】　将 78例高危儿随机分为干预组、未干预组 ,并设正常新生儿对照组。仅对干预组患儿实施早期康复干预 ,定期随访 ,以《贝莉智能发育量表》进行智能发育评估 ;未干预组、对照组患儿只进行常规体格检查和育儿指导。 1岁时通过《Gesell发育诊断量表》对三组患儿进行智能发育的最终评估。　【结果】　 3、9月龄时干预组患儿智力发育指数及运动发育指数均高于未干预组 (P <0 .0 1) ,可达对照组水平 (P <0 .0 5 ) ;1岁时Gesell智能检查 ,干预组与未干预组比较除大运动能区不存在差异外 (P >0 .0 5 ) ,其它四大能区差异均存在非常显著性 (P <0 .0 1) ,与对照组比较五大能区差异均无显著性。　【结论】　早期干预可促进高危儿的行为发育 ,改善其预后。     

早期干预防治高危儿神经系统发育异常的临床评价

【目的】评价早期干预对防治围产期高危儿神经系统发育异常的临床价值。【方法】采用自身前后对照的方法。将106例围生期高危儿及10例足月健康新生儿分别分成早期干预组（A组：新生儿早期干预组58例;B组：婴儿期早期干预组41例）、非早期干预组（C组：1岁以后干预组7例）、正常新生儿对照组（D组10例）。干预组（A组、B组、C组）各自采用不同的针对性训练和康复方法进行干预；正常新生儿接受常规的健康训练和指导。新生儿期患儿在生后1周、4周各检查评估1次（采用20项神经行为测定法NBNA法）；婴儿期患儿每月随访1次（52项神经运动检查法）。【结果】A组患儿生后4周NBNA评分明显高于生后1周时评分（P〈0．01）；只有单一高危因素的新生儿与D组新生儿的NBNA评分比较差异无显著性（P〉0．05）;两组大运动发育检查发现A组与D组评分差距随年龄的增长迅速缩小，与B组和C组相比差异无显著性（P〉0．05）。B组患儿干预效果经随诊检查发现低于A组；C组患儿干预效果不佳（7例患儿中3例确诊为脑性瘫痪，其余4例都存在严重的运动落后）。D组正常新生儿生后1、4周时NBNA评分差异无显著性（P〉0．05）。【结论】早期干预措施对围生期高危儿有促进正常神经系统发育以及脑损伤后早期康复的作用。且干预开始越早效果越好。     

早期干预对高危儿认知发育影响

【目的】探讨早期干预对高危儿认知发育的影响,为临床进行有效的防治提供参考依据。【方法】将86例高危儿分为干预组(46例)和未干预组(40例),参照鲍氏早期教育资料制定干预计划,采用家庭式干预模式对干预组患儿进行早期干预,定期随访,以Gesell发育量表测定发育商,根据评估结果进一步指导干预。【结果】3月龄时两组发育商差异无显著性(P>0.05),6月龄时两组在精细动作和个人-社会交往方面存在差异,9~24月龄除大运动存在差异外其它四个能区差异均有显著性(P<0.05)。【结论】对高危儿进行早期干预、系统管理,可明显促进其认知发育,减少伤残的发生。     

早期家庭干预促进围产期高危儿智能发育的研究

【目的】　提高围产期高危儿的生命质量。　【方法】　将 5 38例围产期高危儿随机分为干预组 (2 6 9例 )和对照组 (2 6 9例 )。另设正常儿组 10 6例。干预组从出生起开始接受干预。干预以家庭为中心 ,研制一套适合我国国情早期干预的计算机软件系统。根据小儿不同年龄、不同智能发育指数 ,给家长打印出图文并茂针对性强的个体化有目的的具体训练方案及营养指导建议。　【结果】　高危儿干预组智能发育指数 (MDI)方面在其 12、18、2 4、30、36个月时得分均高于高危儿对照组及正常儿组 (P <0 .0 0 1)。在高危儿对照组中 3岁时智力低下 36例占 13 .38% ,而高危儿干预组无 1例智力低下。多元逐步回归分析显示影响干预效果的因素为 :孕期营养、母亲文化程度、喂养方式、母亲职业、母孕期年龄等。　【结论】　采用本软件系统进行早期家庭式干预对高危儿的智能发育成效显著     

1995年苏州地区双胎妊娠结局分析

【目的】分析出生指标。评价双胎妊娠结局。【方法】采用1995年苏州地区围产保健监测资料，比较单、双胎孕周、出生体重、Apgar评分、新生儿死亡率及死亡原因。【结果】双胎妊娠中早产儿占35．0％；低出生体重儿占49．2％；1min和5min Apgar评分窒息者分别占13．9%和5．6％；各指标均显著高于单胎。双胎新生儿死亡率为45．9‰；早期新生儿死亡率42．8‰；新生儿主要死亡原因为早产。【结论】与单胎儿相比，双胎妊娠胎儿宫内发育时间、发育状况、产后适应能力等均明显偏差，新生儿死亡率显著偏高。应采用多种干预措施，改善双胎妊娠不良结局。     

听力障碍高危儿147例脑干听觉诱发电位临床分析

【目的】通过对听力障碍高危儿的脑干听觉诱发电位（brainstem auditory evoked potential，BAEP）分析，探讨高危因素与听力损伤程度、损伤部位及预后的关系。【方法】从2002年1月～2004年6月，选取在本院儿保高危儿专科门诊随访的42d～3个月的高危儿863例作为研究对象，进行BAEP检查，对147例听力障碍高危儿进行BAEP和临床分析。【结果】资料显示低出生体重、高胆红素血症、母孕期病毒感染、窒息是听力障碍的主要高危因素（占85．7％）。听阈增高轻度62．5％，中度30．6％，重度6．9％。BAEP异常类型中外周障碍型51．7％，脑干障碍型20．4％，外周合并脑干障碍型27．9％。轻、中度听力障碍预后好，重度预后差。【结论】不同高危因素对听力的损伤程度和部位及预后产生不同的影响，BAEP对听力障碍高危儿的早期诊断、干预和预后判断具有重要价值。     

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.     

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.     

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.     

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.