180例正常足月新生儿早期血清胆红素监测结果分析

目的　通过对 180例母乳喂养的正常足月新生儿进行早期血清胆红素监测 ,计算正常足月新生儿血清胆红素水平超过现行高胆红素血症诊断标准的比例 ,围产因素对正常足月新生儿生理性黄疸的影响。　方法　生后第 1d起每天记录胎龄、分娩方式、母乳喂养情况、红细胞压积 (PCV)、出生体重及住院期间每天的体重 ,并在每天同一时间分别取微量血测血清胆红素和经皮测胆红素至生后第 14d。从低胆红素 (≤ 2 2 0 .5 μmol/L)样本中随机抽取相同例数作为对照组。　结果　 ( 1)本次监测正常足月新生儿生后第 2～ 3d开始出现黄疸 ,第 5d达高峰 ,血清胆红素平均值为 ( 190 .1±45 ) μmol/L ,峰值 >2 2 0 .5 μmol/L者占 2 8.3 %。 ( 2 )在围产因素中 ,新生儿早期血胆红素水平与胎龄、出生 1～ 3d的生理性体重下降、红细胞压积水平P值均 <0 .0 1,差异有非常显著性。　结论　正常足月新生儿黄疸出现的时间与国内外其它报道相似 ,但平均峰值高于既往报道的局部人群的峰值。血清胆红素峰值超过 2 2 0 .5 μmol/L者占 2 8.3 % ,提示正常足月新生儿高胆红素血症的诊断及干预标准应高于现行标准。     

高胆红素血症新生儿血清胆红素水平与听力损伤的相关性研究

目的探讨高胆红素血症新生儿血清胆红素水平与听力损伤的相关性。方法将84例足月高胆红素血症新生儿作为研究对象,按照新生儿胆红素水平分为轻(胆红素水平在210~255μmol/L之间)、中(胆红素水平在256~339μmol/L之间)及重度(胆红素水平340μmol/L),按黄疸出现时间分为≤48h组及48h组,并对新生儿胆红素水平与ABR阙值及黄疸出现时间与ABR阙值进行相关性分析。结果重度高胆红素血症患儿的ABR异常率显著高于轻度组(89.5%vs 60.7%)(P0.05);黄疸出现时间≤48h新生儿的ABR异常率显著高于黄疸出现时间48h新生儿(86.0%vs 63.4%),相关性分析发现,ABR阙值与胆红素水平呈现正关性(r=0.137),ABR阙值与黄疸出现时间呈现负相关性(r=-0.239)。结论足月新生儿高胆红素水平是引发ABR阙值的重要危险因素,且黄疸出现时间越早,新生儿ABR阙值异常率越高。     

中度高原地区新生儿高胆红素血症脑干听觉诱发电位检测

目的:通过脑干听觉诱发电位(BAEP)检测,探讨血清胆红素水平对新生儿听力的影响。方法:对48例足月新生儿高胆红素血症进行BAEP检测,以42例无黄疸患儿作为对照组。结果:高胆红素血症组BAEP异常率达60.41%,明显高于对照组,各波潜伏期、波间期均延长,高胆红素血症组与对照组比较差异显著(P<0.01),同时发现胆红素水平越高,BAEP异常率越高。结论:足月新生儿血清胆红素浓度超过256.5μmol/L,中枢神经系统即可受到损害,因此,可通过BAEP检测能早期发现听力异常,而进行早期干预治疗。     

新生儿黄疸护理研究进展

黄疸是新生儿常见的疾病[1]。是新生儿时期血清胆红素浓度（主要是未结合胆红素）增高而引起的皮肤黏膜﹑巩膜等黄染的现象,可以分为生理性黄疸和病理性黄疸两类。约50%~60%的足月儿和80%的早产儿出现生理性黄疸[2],一般在新生儿出生2~3d出现,4~5d达高峰,足月儿在2W内消退,早产儿可延到3~4W,血清胆红素浓度足月儿不超过205μmo1/L,早产儿不超过257μmol/L,     

219例壮族正常足月新生儿血清胆红素的动态监测

目的:了解壮族正常足月新生儿生理性黄疸早期血清胆红素的动态变化值,探索其与汉族的异同。方法:①用微量胆红素法测定219例壮族正常足月新生儿(1～7天)血清胆红素,将其按血清胆红素水平分为正常组和高胆组,比较两组间各种围产因素对血清胆红素的影响。②用同样方法测定280例汉族新生儿血清胆红素,将壮族、汉族新生儿分别设为研究组和对照组,比较两组间血清胆红素。结果:①壮族正常足月新生儿出生后第2～3天出现黄疸,第4天达到高峰,平均峰值为(188.29±35.87)μmol/L,≥220.5μmol/L者占22.83%,峰值的95%可信区间的上限为258.60μmol/L。男女性别两者比较:第1、2、3、7天差别无统计学意义(P>0.05),第4、5、6天差别有统计学意义(P<0.05)。②壮族新生儿血清胆红素平均峰值略高于汉族,但两组比较差别无统计学意义(P>0.05)。③在围产期因素中,壮族正常组与高胆组的比较:高胆组的母亲孕周小于正常组(P<0.01),婴儿出生体重、母亲年龄、母亲孕次两组比较差异无统计学意义(P>0.05)。结论:壮族正常足月新生儿黄疸出现的时间及峰值与汉族基本相同,亦与国内报道相似。监测壮族正常足月新生儿早期血清胆红素的动态变化,可为新生儿高胆红素血症的诊断提供依据。     

新生儿黄疸的诊治要点

新生儿黄疸(neonataljaundice)是新生儿最常见的症状．其发生的多少与民族、地区、胎龄和喂养方式有关。如东方人高于西方人，我国南方高于北方，早产儿高于足月儿，母乳喂养儿高于人工喂养儿。成人血清胆红素超过3-4mol／L(2mg/L)出现黄疸，而新生儿由于毛细血管丰富，要超过85umol/L(5mg/L)才显黄疸。新生儿黄疸可分为生理性黄疸和病理性黄疸，分述如下：     

足月新生儿黄疸延迟临床病因分析

目的 :探讨足月晚期新生儿高胆红素血症 (高胆 )发生率、病因及诊断。方法 :总结 2 w后持续黄疸的新生儿及婴儿临床资料 ,并提出治疗要点。结果 :92例中血清胆红素 (SB)均值 1 2 9.82 mol/L ,>1 1 9.7mol/L标准为高胆者仅 5% ,但均有确切病因 ,<1 1 9.7mol/L而无异常症状者多为“生理性黄疸延迟”、“母乳性黄疸”。结论 :诊治中应重在 SB监测和临床观察 ,避免不必要的检查治疗     

浅谈成功母乳喂养在预防新生儿高胆红素血症中的应用

新生儿高胆红素血症是指新生儿期血清胆红素浓度高于正常，足月新生儿血清胆红素浓度〉205mmol／L，早产儿〉256mmol／L。如黄疸发展快，胆红素浓度升高速度〉85mmol／L，即病理性黄疸，严重的可引起核黄疽，造成神经系统并发症。     

单纯高间接胆红素血症足月新生儿血清胆红素与尿酸关系的分析

目的:比较单纯高间接胆红素血症足月新生儿血清胆红素变化时尿酸变化的意义。方法:用全自动生化分析仪对238例单纯高间接胆红素血症足月新生儿同时检测血清胆红素及尿酸,并根据胆红素浓度分为重度升高组66例,总胆红素>340μmol/L;中度116例,340μmol/L>总胆红素>221μmol/L;轻度组56例,221μmol/L>总胆红素>171μmol/L;同时选30例同期足月健康新生儿作为对照组。结果:重度组患儿血清尿酸比对照组降低,比轻、中度组升高,但差异均无统计学意义(P>0.05);轻、中度组患儿血清尿酸比对照组明显降低,差异有统计学意义(P<0.01)。结论:足月新生儿血清胆红素轻、中增高可降低血清中尿酸水平。     

新生儿高胆红素血症32例围产期相关病因分析

新生儿高胆红素血症是新生儿时期常见疾病之一，正常新生儿在出生后1W内出现的皮肤黄疸，是由于新生儿胆红素代谢的特点引起的生理性现象，如果黄疸超过生理性范围，检测血清胆红素浓度，足月儿〉220．6umol／L，早产儿〉255umol／L，即称为新生儿高胆红素血症。     

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.