二硫化碳作业女工受孕时间影响因素的研究

目的 探讨二硫化碳影响女工受孕时间的危险因素.方法前瞻观察欲生育女工妊娠所需的月经周期数,采用Cox回归分析方法筛选影响女工受孕时间的危险因素.结果接触组女工的平均受孕时间中位数为2.25个月,对照组女工的平均受孕时间中位数为1.70个月,接触组女工的受孕时间明显延长(P＜0.001);接触组女工的早早孕丢失率(29.57%)明显高于对照组的早早孕丢失率(13.11%,P＜0.001);Cox回归分析提示,二硫化碳作业女工受孕时间延长的主要危险因素是女工接触二硫化碳(P=0.001,RR=0.327)和工作紧张(P=0.001,RR=0.694).结论女工接触二硫化碳和工作紧张可能是导致该行业作业女工受孕时间延长的主要危险因素.     

二硫化碳作业女工早期生殖损伤危险因素的Logistic回归分析

目的：探讨导致二硫化碳（CS2）作业女工早早孕丢失的危险因素,方法：采用非条件Logistic回归分析方法筛选前瞻观察的30个危险因素,结果：导致早早孕丢失率明显升高的重要危险因素是女工接触CS2（P＝0．0414）和工作紧张感（P＝0．0301）,配偶接触CS2（P＝0．1740）、避孕史（P＝0．1035）痛经（P＝0．1840）等因素对早早孕丢失也有一定作用,结论：女工接触CS2和主观感觉紧绑是导致该作业女工早早孕丢失增加的主要危险因素。     

二硫化碳对作业女工妊娠影响的前瞻性研究

目的　进一步探讨二硫化碳 (CS2 )对生殖机能的损伤作用。方法　应用前瞻性流行病学研究方法 ,追踪观察待孕作业女工的受孕时间和确诊妊娠女工的妊娠经过和妊娠结局 ;监测研究现场CS2 浓度。结果　 (1) 2 5 7名接触组女工各月经周期妊娠率均明显低于 36 6名对照组女工 ;且受孕时间随其接触CS2 浓度的增高 (r=0 .1198,P =0 .0 2 4)及接触时间的增加 (r=0 .2 799,P <0 .0 0 1)而延长 ;(2 )接触组女工自然流产率 (8.5 5 % )、死胎率 (1.2 8% )、新生儿死亡率 (1.46 % )、出生缺陷率(0 .97% )、早产率 (3.42 % )、过期产率 (2 .5 6 % )和足月产率 (80 .0 5 % ) ,与对照组比较 ,均无明显差异 (P>0 .0 5 ) ;(3)新生儿体重、低出生体重发生率和性比两组比较 ,差异无显著性 (P >0 .0 5 ) ;(4)接触组女工各种妊娠并发症的发生率与对照组比较 ,均无明显差异 (P >0 .0 5 )。结论　 (1) 8.6 7mg/m3 CS2 平均接触 4.98a ,虽然使妊娠所需时间延长 ,但对妊娠结局、妊娠并发症及新生儿体重、低出生体重发生率和性比等均未见明显影响 ;(2 )妊娠时间可作为生殖损伤的筛选指标 ,提示毒物的早期胚胎损伤作用。     

二硫化碳致作业女工早期胚胎损伤剂量反应关系的探讨

目的　探讨女工二硫化碳 (CS2 )接触水平与胚胎早期发育障碍之间的剂量—反应关系。方法　前瞻观察欲生育女工妊娠所需的月经周期数 ;收集每个月经周期胚胎植入期尿样 ,检测绒毛膜促性腺激素含量 ;监测女工作业地点CS2 浓度。结果　①接触组女工各月经周期妊娠机率低于对照组 ,时间妊娠率随接触水平 (孕时CS2 接触浓度乘以CS2 接触工龄 )升高而降低 :妊娠率 =0 70 3 3 -0 0 0 15×接触水平 ( χ2 =64 71,P =0 .0 0 0 ;r =-0 .979,P =0 .0 0 0 ) ;②检测 3 4 0个月经周期尿样的早早孕丢失率 ,接触组明显高于对照组 ,且随接触水平升高而增加 :丢失率 =0 4717 0 0 0 2 8×接触水平 ( χ2 =2 5 .5 9,P =0 .0 0 1,r =0 .977,P =0 0 0 0 )。结论　随着接触水平的增高 ,早早孕丢失率明显增加 ;每个月经周期妊娠率降低 ,均呈现出明显的剂量—反应关系 ,表明CS2 对胚胎早期发育的损伤作用具有蓄积性     

妊娠时间作为妊娠早期生殖损伤筛选指标的探讨

目的 探讨妊娠时间作为妊娠早期生殖损伤观察指标的可行性。方法 以二硫化碳（CS2）作业女工为观察对象,（1）采用回顾性流行百闻不如一见 学研究方法调查已孕女工妊娠所需的月经周期数;（2）应用前瞻性流行病学研究方法。追踪观察待孕女工至临床妊娠时的月经周期数;（3）整理回顾性研究现场空气中CS2监测结果,监测前瞻性研究期间各观察时对象接触左浓度,结果 回顾性研究（127名接触者和108名对照）和前瞻性流行病学研究（257名接触者和366名对照结果均表明,女工接触CS2后各月经周期妊娠率明显低于对照组;且妊娠时间随其接触CS2浓度的增高（r=0.1198,P=0.024),腻主接触时间的增加（r=0.2799,P=0.000)而延长,结论 妊娠时间可作为妊娠早期生死损伤筛选指标之一。     

寿命表法分析二硫化碳对作业女工妊娠概率的影响

目的 探讨二硫化碳（CS2）对作业女工妊娠概率的影响。方法 用寿命表法,分析欲要生育女工每个月脂周期的受孕概率及未受孕率。结果 接触组女工未受孕概率明显高于对照组（P＝0．0004）;接触组女工平均受孕时间为4．53个月经周期,对照组女工平均受孕时间为3．37个月经周期（P＝0．0021）。结论 接触组女工生个月经周期的妊娠概率明显低于对照组;CS2作业女工获得一次临床可识别妊娠的概率明显降低。     

我国职业性铅接触对作业女工生殖健康影响的Meta分析

目的 综合分析职业性铅接触对作业女工生殖功能的影响,取得敏感性生殖效应指标.方法 检索和收集1979-2008年国内发表的关于职业性铅接触对作业女工生殖功能影响的文献,经严格的筛选后,应用Bev man软件对入选文献进行一致性检验并采用相应的数学模型进行数据合并,采用Meta分析合并相对危险度(RR)值作为各项目的 总效应指标.结果 共纳入16篇文献.与对照组比较,职业性铅接触与女性月经周期异常(RR=1.78,95%CI:1.51～2.09)、经量过少(RR=1.46,95%CI:1.20～1.78)、经前期综合征(RR=1.71,95%CI:1.19～2.45)、痛经(RR=1.42,95%CI:1.09～2.23)、妊娠高血压(RR=4.47,95%CI:1.50～13.32)、妊娠合并贫血(RR=3.23,95%CI:1.07～9.78)、早产(RR=3.39,95%CI:2.22～5.19)、自然流产(RR=3.51,95%CI:2.38～5.19)、死胎死产(Rr=5.25,95%CI:3.38～8.14)及女工子代低体质量出生(RR=2.80,95%CI:1.19～6.61)和出生缺陷(RR=4.72,95%CI:3.11～7.16)的正相关有显著性(P<0.05).结论 职业性铅接触可以引起女工月经周期异常和经量减少,增加痛经和经前期综合征的发生,同时还会影响妊娠及其子代发育,表现为增加妊娠合并高血压、妊娠合并贫血、早产、自然流产和死胎死产的发生,并导致其子代出生低体质量和出生缺陷.     

CS2作业工人红细胞膜收缩蛋白初探

目的　观察作业工人长期接触二硫化碳 (CS2 )对其红细胞膜收缩蛋白的影响。方法　气相色谱法测定作业场所CS2 浓度 ;分离 16名工人红细胞膜 (接触、对照各 8人 ) ,采用十二烷基硫酸钠 -聚丙烯酰胺凝胶电泳 (SDS PAGE)法分析红细胞膜蛋白谱。结果　车间空气CS2 浓度 (TWA)为 0～ 8.98mg/m3。CS2 接触工人红细胞膜收缩蛋白百分含量 (34.48% )高于对照工人 (2 6 .18% ) (t =5 .92 0 ,P <0 .0 0 1) ,CS2 浓度 (TWA)与收缩蛋白含量呈正相关 (r=0 .85 9,R2 =0 .738,P <0 .0 0 1) ,接触指数 (EI)与收缩蛋白含量也呈正相关 (r=0 .713,R2 =0 .5 0 8,P =0 .0 0 2 )。其中 2名长工龄高浓度CS2接触工人红细胞膜图谱在高相对分子质量区有可疑异常区带形成。结论　长期接触CS2 作业工人红细胞膜蛋白电泳图谱出现异常 ,提示该指标有希望成为CS2 接触工人的分子水平接触 -效应生物标志物。     

二硫化碳作业女工早早孕丢失的研究

目的　探讨二硫化碳（ Ｃ Ｓ２） 对作业女工孕早期胚胎发育的影响。方法　采用早早孕丢失为观察指标进行了研究,在观察期间共征集到１３９ 名欲要生育的女工,于每个月经周期２１ 天开始收集晨尿及隔日晨尿,至月经来潮或临床确诊妊娠止,共３４０ 个月经周期,２ ０４５ 份尿样,单克隆酶免方法定量测定尿样中绒毛膜促性腺激素含量。结果　接触组女工早早孕丢失率为４８ ．７ ％ ,明显高于对照组（２６ ．３ ％ , Ｐ＝ ０ ．００４ １） 。夫妻双方均接触 Ｃ Ｓ２ 时,早早孕丢失率明显升高（ Ｐ＝ ０ ．００７ ４） 。作业地点 Ｃ Ｓ２浓度与早早孕丢失率相关（ ｒ ＝ ０ ．９９９ , Ｐ＝ ０ ．００１） 。结论　接触 Ｃ Ｓ２ 的女工早早孕丢失的危险性升高, Ｃ Ｓ２ 浓度与早早孕丢失率之间有明显的剂量反应关系。     

二硫化碳对接触人群生殖毒性研究进展

二硫化碳(CS2)是工业上重要的生产原料和常用有机溶剂,长期接触低浓度CS2可造成神经、心血管、内分泌等多系统损伤。近年来,其生殖毒性引起国内外学者的广泛关注。CS2对接触人群生殖系统具有毒性作用,作业女工表现为月经异常、性激素水平紊乱、受孕时间延长及受孕力下降、妊娠并发症与不良妊娠结局等,男工表现为精子数量减少及形态异常、性功能减退、性激素分泌紊乱等,还可导致配偶流产率增高、子代发育异常等不良妊娠结局。     

Acceptability of willingness to pay techniques to consumers

Objective The purpose of this study was to assess and compare the proportion of usable responses and protest votes obtained with two willingness to pay (WTP) techniques, contingent valuation (CV) and discrete choice experiment (DCE) and to assess the acceptability of the techniques to respondents. Setting and participants Pregnant women attending the public antenatal clinics of a Sydney teaching hospital were surveyed. Main variables studied Preference for either Treatment A (artificial rupture of the membranes followed by intravenous oxytocin) or Treatment B (prostaglandin E₂ gel followed by oxytocin if necessary) was assessed. Then WTP for the preferred treatments was assessed using CV and WTP for specific attributes of the treatments in the DCE. In addition, the acceptability of the two techniques was compared in terms of responses deemed to be valid according to defined criteria, protest votes and comments recorded by consumers. Results With the CV, 74% of respondents chose gel and their maximum WTP was Aus$178 compared with $133 for the alternative. A total of 68% of responses were deemed to be valid including 5% who may have been expressing a protest vote. With the DCE, respondents were WTP $55 for every 1 h reduction in the length of time from induction to delivery. A total of 72% of responses were deemed valid and only two of these 258 women were considered to have expressed a protest vote. Conclusions Only a small number of women expressed objections to the use of WTP questions in health‐care and the majority of women completed both questions successfully.     

重视主要诊断的选择适应医保制度改革

目的了解在主要诊断选择中存在的问题及其对单病种费用的影响.方法首先依据病案内容判断主要诊断的正确性,然后进行医疗质量及单病种费用的统计和分析.结果在主要诊断的选择中存在着概念不清、人为拔高、错选它科疾病、诊断依据不充分及诊断名称不规范等问题.结论主要诊断选择不当可致医疗质量统计和病种费用统计失真,这将影响医院管理者或卫生管理部门的决策,也影响着病案资源的利用和共享.     

Factors influencing the conversion of carotenoids to retinol: bioavailability to bioconversion to bioefficacy

Vitamin A (retinol) is a necessary nutrient for vision, reproduction, growth, and immune function. Pro-vitamin A carotenoids are an important source, especially in developing countries. While preformed vitamin A is readily available from foods, carotenoids are much more difficult to assimilate. A number of factors have been identified that either enhance or hinder the bioavailability of carotenoids. These have been presented in the literature and given the mnemonic SLAMENGHI by some researchers. The following factors are summarized: Species of carotenoid, molecular Linkage, Amount in the meal, Matrix Properties, Effectors, Nutrient status, Genetics, Host specificity, and Interactions between factors. Identifying which of these are key issues for the general public, and promoting the increased consumption of fruits and vegetables with moderate and high levels of pro-vitamin A carotenoids, are important to vitamin A status and overall good health.     

Characteristics of men most likely to respond to an invitation to be screened.

Some of the characteristics of men, with known risk factors, who were most likely to respond to an invitation to be screened in a national randomized clinical trial to prevent heart disease were determined in 18,872 men, 35-57 years of age, members of the Kaiser Foundation Health Plan of Oregon. Demographic characteristics and risk factor variables (blood pressure, blood cholesterol, and cigarette smoking levels) were abstracted from medical records. The men were ranked high priority or low priority according to level of risk. All age-eligible men in the health plan received at least one invitation to be screened, with high-priority men receiving more invitations. Despite concentrated efforts to bring them in, less than one-half the high-priority men were screened. Participants were older and wealthier than non-participants, and more likely to have more dependents and to routinely use medical services. Whether or not a man received a medical care service within the preceding two years was a powerful discriminating variable in both the univariate and multivariate analyses reported. The findings suggest that health care programs serving a stable population group should give more consideration to screening in routine medical care.