416例病残儿医学鉴定及相关情况分析

目的了解参加病残儿医学鉴定患儿的疾病种类和病种构成情况,为降低下一胎的再发风险提供理论依据。方法统计分析2010-2017年广州市白云区参加病残医学鉴定患儿的疾病种类、类型、顺位等。结果 416例病残儿中,男女比例为2. 15∶1;疾病发生系统主要集中在神经系统、眼耳鼻疾病、心血管系统、血液系统等。先天性疾病318例,占病残儿鉴定总数的76. 44%;疾病种类前5位依次为孤独症谱系障碍、肿瘤、先天性心脏病、智力低下和听力障碍。结论儿童残疾所涉及的病种多,先天性疾病比例高。通过病残儿医学鉴定为再生育家庭提供优生指导,实施孕前优生健康检查,积极开展出生缺陷干预,对减少病残儿的出生具有重要意义。     

深圳市一孩先天性残疾家庭的二孩同类病研究

本文对深圳市1990～1997年因独生子女先天残疾通过病残儿鉴定再生育二孩的家庭进行调查,并以同期通过鉴定的后天性残疾家庭为内对照,以农村地区一孩先天残疾未经病残儿鉴定生育二孩的家庭为外对照,了解其二孩先天残疾再发情况,尤其是同类病的再发情况,拟对独生子女病残儿医学鉴定和二胎生育指标的审批工作效果进行评价,为优生工作提供依据。研究结果表明,鉴定组一孩先天残疾家庭二孩先天残疾的患病率为5.81％,与广州市1986～1991年情况类似(5.9％),高于外省(辽宁1990～1992年为1.35％)。鉴定组二胎同类病发生率为2.8％,非鉴定组为4.55％,两组比较虽无统计学差异,但病种上却有不同,鉴定组为再发风险低的血友病、先天性共转性内斜视、脑萎缩,而非鉴定组为再发风险高的先天聋哑、进行性肌萎缩。提示病残儿鉴定工作颇有成效,避免了相当一部分遗传病家庭再次生育残疾儿,但某些环节有待进一步完善;对农村一胎先天残疾家庭生育二胎也必须纳入管理范围。     

广东省江门市1285例病残儿情况及再生育调查

目的:分析病残儿医学鉴定资料,掌握本市病残儿的疾病种类、病因,并对病残儿医学鉴定后允许再生育的情况进行随访。方法:根据国家人口计生委《病残儿医学鉴定管理办法》、《病残儿医学鉴定诊断标准及其父母再生育指导原则》以及《广东省病残儿医学鉴定参考标准》,对江门市2002～2009年经市级病残儿医学鉴定审批的1285例病残儿资料进行统计分析。结果:非遗传性疾病发病率远高于遗传性疾病,其中神经系统疾病为非遗传性疾病中高发病种,染色体病为遗传性疾病中高发病种。63%家庭再生育了子女,有5例为病残儿。结论:实施孕前优生健康检查,加强孕期保健管理对减少病残儿的出生具有重要意义。     

深圳市一孩先正确性一残疾家庭的二孩同类病研究

本文对深圳市１９９０～１９９７年因独生子女先天残疾通过病残儿鉴定再生育二孩的家庭进行调查,并以同期通过鉴定的后天性残疾家庭为内对照,以农村地区一孩先天残疾未经病残儿鉴定生育二孩的家庭为外对照,了解其二孩先天残疾再发情况,尤其是同类病的再发对独生子女疾残儿医学鉴定和二胎生育指标的审批工作效果进行了评价,为优生工作提供依据。研究结果表明,鉴定组一孩先天残疾家庭二孩先天残疾的患病率为５．８１％,与广州     

对第一胎病残儿父母再生育二胎时优生措施的探讨

为了减少病残儿家庭再生育的患病风险,我们采取建立优生管理四级网络、实施人员培训、强化优生知识宣传教育、及时进行优生咨询服务和产前诊断、跟踪随访等措施,对潍坊市1992～1995年所审批的第一胎病残儿准生二胎的1040对父母进行优生管理。二胎新生儿814人,其中2人有出生缺陷,缺陷率为0.25％,远低于没有进行管理的二胎出生缺陷率(P<0.01),也低于正常新生儿人群出生缺陷率(P<0.05)。遗传病残儿家庭二胎100％出生正常。提示优生管理网络对防止第二胎病残儿再发较为实用。     

重庆市病残儿童父母再生育情况调查分析

目的:了解重庆市病残儿童父母再生育情况。方法:对2003～2007年经重庆市病残儿童医学鉴定,符合再生育二胎的父母进行问卷调查,由调查员填写调查表。结果:病残儿童父母对再生育权的满意度为97.65%,但再生育政策的宣传途径单一,再生育指导、孕前咨询、产前检查不尽科学、合理、规范,优生优育跟踪监测还没有完全覆盖。病残儿及再生育二胎的性别比偏高。结论:应扩大对病残儿童父母再生育政策的宣传途径,尽快建立科学、合理、规范的再生育监测技术体系,加强出生人口性别比例失衡的综合治理。     

重庆市1002例出生缺陷病残儿父母再生育情况调查

目的:了解重庆市出生缺陷病残儿父母再生育情况。方法:对2003～2008年经重庆市病残儿童医学鉴定,符合再生育的出生缺陷病残儿父母进行问卷调查,由调查员填写调查表。结果:1 002例出生缺陷病残儿童父母中,982例父母得到再生育指导,有93.31%进行了孕前咨询;有809例生育二胎,其中有9胎患病;有81.04%已生育二胎家庭进行了产前检查,产前检查地点主要在县级医疗机构(53.69%),其次为乡镇卫生院(31.50%),市级医疗机构(14.78%);有93.15%再生育孕妇住院分娩,6.80%在家分娩;计生办对92.31%的再生育家庭建立了监测档案。结论:再生育指导、孕前咨询、产前检查不合理、不规范,建卡的优生优育跟踪监测还没有完全覆盖,应尽快建立科学、合理、规范的再生育优生技术管理服务体系。     

四川省病残儿先天性疾病性别、城乡顺位差异及年龄趋势分析

目的 了解四川省病残儿先天性疾病性别、城乡顺位差异及年龄趋势,为探讨疾病重点防治策略提供科学依据。方法 基于国际疾病分类编码体系,对四川省2004-2015年鉴定的18 897例先天性病残儿对应的21 059个鉴定诊断进行疾病编码,分析性别、城乡顺位差异及年龄趋势。结果 先天性心脏病在女性（30.85%）病残儿中构成比高于男性（19.08%）,脑先天性畸形、肌肉骨骼先天性变形构成比在男性（7.24%和4.76%）中高于女性（5.94%和3.92%）。脊柱及胸廓先天性畸形构成比随年龄增长而升高,先天性心脏病、脑先天性畸形、唐氏综合征则随年龄增长而降低（均有P<0.05）。唐氏综合征、先天性晶状体畸形在城镇组中构成比更高,肌肉骨骼先天性变形、上肢短小缺陷、唇腭裂在农村组中构成比更高。结论 四川省病残儿先天性疾病在性别、城乡顺位构成和年龄趋势上存在差异,应据此制订切实有效的重点防治策略,合理管控先天性病残儿家庭再生育风险,降低疾病发生率和致残率。     

上海市病残儿医学鉴定及其相关情况的调查研究

目的:了解上海市病残儿医学鉴定的相关情况。方法:采用回顾性资料分析及问卷调查的方式对上海市杨浦区、浦东新区、奉贤区1998～2006年第一孩鉴定为病残儿并已审批同意生育第二孩的429例家庭进行研究。结果:本次调查病残儿共涉及72个病种,其中神经系统疾病占50.8%;明确诊断为遗传性疾病的9种;先天及围产期致残占37.8%;先天性非遗传性和先天性遗传性疾病合计占45.0%;在已生育的241例二孩中,病残再发生率为2.1%(5例);有50.0%的第一胎遗传性疾病病残儿家庭因接受优生指导而避免了二胎病残儿的出生。结论:神经系统疾病仍是本市病残儿的第一大疾病;遗传性疾病有所减少;先天因素也是致残的主要原因,但不明原因的残疾已居首位。患有出生缺陷性疾病是申请病残儿鉴定的主要原因;二孩病残再发生率不高。     

上海市病残儿医学鉴定与第二胎再生育情况的调查分析

<正> 控制人口数量、提高人口素质是我国的一项基本国策。先天性或后天性的因素,遗传性或非遗传性的因素均可导致病残儿的发生,从而直接影响国民的人口质量、家庭幸福及社会稳定。为了解上海市病残儿医学鉴定工作情况,1999年8～9月我们对326例1993～1997年间第一孩鉴定为病残儿的鉴定资料及已生育第二孩或尚未生育者进行了回顾性分析及追踪调查,以期通过此项工作,为进一步完善病残儿医学鉴定工作提供科学依据。     

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.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

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.     

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.     

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.