小儿咳嗽变异性哮喘的临床特征及其发病影响因素分析

目的探讨小儿咳嗽变异性哮喘的临床特征及其发病影响因素。方法回顾性收集该院2015年12月-2018年12月收治的100例咳嗽变异性哮喘患儿临床资料作为试验组,另外收集同期到该院行健康体检的80例健康儿童的临床资料作为对照组。统计记录两组儿童基线资料,包括年龄、性别、是否肥胖、母亲孕期情况(有无特殊服药史、放射线接触史)、生产方式(剖宫产、顺产)、是否足月生产、喂养方式(人工喂养、母乳喂养、混合喂养)、有无食物性过敏原、有无吸入性过敏原、有无过敏性鼻炎病史、有无反复呼吸道感染病史、有无过敏性皮炎病史、有无吸烟环境、有无饲养宠物、家中有无种植花草、父母有无过敏性鼻炎或哮喘史等,对比两组儿童上述资料的差异性,分析上述原因在小儿咳嗽变异性哮喘发病过程中的影响作用,并分析小儿咳嗽变异性哮喘发病的临床特征。结果试验组儿童在年龄、性别、母亲孕期有无特殊服药史及放射线接触史、生产方式、是否足月生产、有无食物性过敏原、有无饲养宠物、家中有无种植花草、喂养方式等方面与对照组相比,差异均无统计学意义(均P>0. 05);试验组儿童在肥胖、吸入性过敏原、过敏性鼻炎、反复呼吸道感染、过敏性皮炎、吸烟环境、父母有过敏性鼻炎或哮喘史等方面与对照组相比,差异均有统计学意义(均P<0. 05);经Logistic多因素分析,肥胖、吸入性过敏原、过敏性鼻炎、反复呼吸道感染、过敏性皮炎、吸烟环境、父母有过敏性鼻炎或哮喘史使小儿发生咳嗽变异性哮喘的发病危险增加分别为2. 250 (1. 235~4. 100)倍、3. 619 (1. 159~11. 302)倍、6. 333 (2. 103~19. 076)倍、3. 857 (1. 654~8. 992)倍、4. 737 (1. 717~13. 070)倍、3. 083 (1. 174~8. 097)倍、5. 615 (2. 335~13. 506)倍;临床多表现为持续性干咳,常在清晨或夜间发作,遇冷空气、运动后咳嗽加重,伴有轻微喘息、胸闷;体格检查双肺呼吸音粗,偶可闻及痰鸣音;多有家族或个人过敏史;支气管激发试验提示气道高反应性。结论小儿咳嗽变异性哮喘主要以持续性干咳为临床表现,以清晨或夜间明显,运动后、遇冷空气后咳嗽加重。小儿咳嗽变异性哮喘的发生受多种因素影响,其中肥胖、吸入性过敏原、过敏性鼻炎、反复呼吸道感染、过敏性皮炎、吸烟环境、父母有过敏性鼻炎或哮喘史是小儿咳嗽变异性哮喘发生的危险因素,对合并上述危险因素的患儿应予以高度关注、治疗,以降低小儿咳嗽变异性哮喘的发生率,从而改善患儿预后。     

乌鲁木齐市住宅室内潮湿表征与儿童哮喘及过敏性疾病的相关性

[目的]研究乌鲁木齐市儿童哮喘及过敏性疾病与住宅室内潮湿的关系,为进一步提出有效预防儿童哮喘及过敏性疾病的措施提供科学依据。[方法]2011年10—12月,采取多阶段整群抽样的方法,对乌鲁木齐市7个行政区的5 650名1~8岁儿童进行问卷调查。调查问卷包括基本信息,儿童及家长的健康情况,住宅和建筑特征以及室内潮湿表征4个部分。应用卡方检验和非条件logistic回归方法估计室内潮湿表征与儿童哮喘及过敏性疾病的关联。[结果]有效问卷共4 618份,应答率81.7%,男童占53.7%。共有20.8%的住户报告"窗户凝结水",其次是"水损"(15.1%),"湿斑"(14.1%)和"霉点"(8.6%)。在所调查的疾病中,46.4%的儿童报告曾经出现鼻炎;近12个月里,42.7%的儿童出现鼻炎,25.3%出现喘息;医生诊断哮喘和鼻炎的报告率分别为3.7%和8.7%。室内潮湿与儿童哮喘及过敏性疾病显著相关,其中,"湿斑"与近12个月喘息症状显著相关[OR=1.57;95%置信区间(CI):1.27~1.95];"霉点"与医生诊断哮喘(OR=2.18;95%CI:1.30~3.67);"窗户凝结水"(OR=1.62;95%CI:1.09~2.40)和"水损"(OR=1.93;95%CI:1.35~2.76)与近12个月湿疹等均呈现正相关;且近12个月里出现的喘息、鼻炎和湿疹症状,其OR值随着潮湿表征评分的升高而增大。[结论]乌鲁木齐市住宅室内潮湿可能是儿童哮喘及过敏性疾病的潜在危险因素。     

武汉市4～14岁儿童过敏性鼻炎的危险因素分析

目的 回顾性分析武汉地区4～14岁儿童过敏性鼻炎的相关因素,以期为儿童过敏性鼻炎的防治提供指导。方法 选取2016年1月-2017年12月间因过敏性鼻炎症状在湖北大学医院和解放军武汉总医院门诊或住院治疗并采用敏筛过敏原体外半定量免疫试验检测方法而确诊的236名儿童纳入病例组进行回顾性分析,选择同期门诊体检健康的儿童60例为对照组;采用单因素分析及Logistic回归分析明确儿童过敏性鼻炎的危险因素。结果 2016年来院就诊儿童过敏性鼻炎排名前五位的过敏原依次为:粉尘螨135例(57.2%)、屋尘螨92例(38.9%)、霉菌混合65例(27.5%)、狗猫毛皮屑59例(25%)、牛奶45例(19%)。多因素Logistic分析结果显示,家族史(OR=2.87, 95%CI: 1.47～3.02)、过敏史(OR=2.67, 95%CI:1.72～8.37 )、剖宫产(OR=3.51, 95%CI:1.39～6.7 )、合并哮喘(OR=2.93, 95%CI:1.52～4.08 )、饲养宠物(OR=1.67, 95%CI:1.39～4.70 )、病程≥24个月(OR=1.09, 95%CI: 1.03～1.15)、食用海鲜(OR=1.78, 95%CI:1.06～4.81 )、处于吸烟环境(OR=2.23,95%CI:1.64～3.03 )等可能会增加儿童过敏性鼻炎的发病风险,而母乳喂养史为过敏性鼻炎的保护因素(OR=0.68,95%CI: 0.53～0.89)。结论 明确过敏原,减少或避免过敏原的接触,对儿童过敏性鼻炎的防治具有重要临床意义和指导作用。     

父母居室内吸烟对儿童呼吸系统疾病和症状的影响研究

目的探讨居室内烟草烟雾暴露对儿童呼吸系统疾病和症状的影响,为呼吸系统疾病的预防和控制提供依据。方法于2014年5—7月采用随机整群抽样方法,调查上海市某区8所小学和4所幼儿园4 101名4~12岁儿童持续咳嗽、喘息、哮喘现患、支气管炎患病情况,及儿童性别年龄、家庭社会经济因素、父母哮喘与过敏性疾病史、居室内外环境因素、家人在室内吸烟情况,分析二手烟暴露对儿童呼吸系统疾病和症状的影响。结果 47.11%(1 932/4 101)的被调查儿童暴露于二手烟。在调整了个体、家庭社会经济、遗传及居室内外环境等混杂因素后,多因素二分类非条件logistic回归分析结果显示,父亲吸烟、父母均吸烟是儿童持续咳嗽、喘息、支气管炎的危险因素(OR值分别为2.06,1.81,1.87和4.02,5.62,3.74,P0.05),母亲吸烟是儿童喘息、支气管炎的危险因素(OR值分别为2.36,1.95,P0.05),父母均吸烟时对呼吸系统疾病和症状的影响(OR值)均高于父母一方吸烟者,其他家庭成员吸烟的影响未见统计学意义(P0.05)。室内吸烟量与儿童呼吸系统疾病和症状有关联,随着吸烟量的增加,OR值逐渐升高(在1.62~2.80之间)。结论父母居室内吸烟是儿童呼吸系统疾病与症状的危险因素,室内二手烟暴露量趆高,发生呼吸系统疾病与症状的风险越高。     

早期健康状况对儿童超重和肥胖的影响分析

目的探讨影响儿童超重和肥胖的早期健康状况因素,为儿童超重和肥胖防治工作提供依据。方法随机抽取上海市小学和九年制学校各3所,对其中所有一、二年级学生1 511人进行回顾性问卷调查,并采用单因素和多因素logistic回归分析法分析儿童超重和肥胖的早期危险因素。结果单因素分析结果表明,较高出生体质量、患哮喘、过敏体质、慢性病疾病史、食欲较好和较大年龄被告知超重或肥胖的儿童,超重和肥胖检出率较高(P值均0.05)。多因素logistic回归分析结果显示,出生体质量(OR=2.699,95%CI为1.097~6.644)、过敏体质(OR=1.498,95%CI为1.044~2.149)、有慢性病患病史(OR=2.486,95%CI为1.327~4.659)和食欲(OR=22.011,95%CI为8.861~54.673)是影响儿童超重、肥胖发生的危险因素(P值均0.05)。结论需关注有较大出生体质量、过敏体质和慢性疾病史儿童的体质量控制问题,早期科学、合理喂养和培养良好的饮食习惯可能有助于儿童超重、肥胖的防治。     

青岛地区儿童哮喘影响因素病例对照研究

目的探讨儿童哮喘的影响因素。方法应用1：1配对的病例一对照研究方法，采用问卷调查方式，调查300对病例和对照儿童，并分析有关的暴露因素。结果单因素Logistic回归分析结果显示，有17个因素与儿童哮喘有关联，包括父亲呼吸系统疾病史、母亲呼吸系统疾病史、家庭收入情况、特应性体质、急性呼吸道感染史、食肉习惯、海产品摄入量、是否有泡沫制品、是否装修过、厨房排烟方式、排烟效果、是否饲养宠物、家族哮喘病史、家族过敏性鼻炎史、父母食物过敏史、父母粉尘过敏史、首次发病后是否经过系统治疗。多因素Logistic回归分析显示，7个因素进入主效应模型，其中父亲有呼吸系统疾病史（OR=3．771，95％CI：1．533～9．278）、家庭低收入（OR=I．503，95％CI：1．258～1．795）、特应性体质（OR=3．788，95％CI：2．368～6．058）、喜食肥肉（OR=2．042，95％CI：1．481～2．815）、家族哮喘病史（OR=I．710，95％CI：0．988～2．958）、家族过敏性鼻炎史（OR=I．991，95％CI：1．234～3.211）是儿童哮喘的危险因素，饲养宠物（OR=0．443，95％CI：0．265～0．739）是保护因素；回归系数分别为1．327，0．407，1．332，0．714，0．536，0．689，-0．814。结论儿童哮喘是遗传和环境双重因素共同作用导致的一种复杂疾病。     

过敏性鼻炎儿童发生支气管哮喘的影响因素分析

  目的  探讨过敏性鼻炎患儿发生支气管哮喘的危险因素,为鼻炎患儿发生哮喘的早期诊断、治疗和预防提供依据。  方法  纳入2019年11月至2020年10月在首都儿科研究所变态反应科门诊就诊的单纯过敏性鼻炎患儿(117例)和过敏性鼻炎继发哮喘患儿(111例),采集病史,检测过敏原,对其临床特征、过敏原种类及危险因素等进行统计分析。  结果  单因素分析显示,鼻炎病程、鼻炎严重度、鼻炎类型、季节特征、宠物接触史、过敏性疾病家族史、霉菌、豚草、粉尘螨和户尘螨致敏与过敏性鼻炎患儿哮喘的发生相关(χ2值分别为6.15,8.79,3.99,9.44,5.17,4.43,8.48,10.38,6.18,5.31,P值均 < 0.05)。多因素Logistic回归分析显示,鼻炎严重度(OR=7.03)、过敏性疾病家族史(OR=8.24)、霉菌(OR=5.19)、粉尘螨(OR=25.25)与过敏性鼻炎患儿哮喘的发生呈正相关(P值均 < 0.05),粉尘螨致敏患儿的风险最高。  结论  儿童过敏性鼻炎继发哮喘受多种因素影响,其中鼻炎严重度、过敏性疾病家族史、尘螨致敏是最主要的因素。     

黄岛区学龄前儿童不明原因中枢神经系统症状调查

目的探讨学龄前儿童不明原因一般中枢神经系统(CNS)症状发生现状及其可能的危险因素。方法通过问卷对青岛市黄岛区主要幼儿园720名3~6岁儿童进行调查,主要收集不良建筑物综合征(SBS)样症状、儿童个人信息、家庭住宅室内环境、幼儿园环境及室外环境等信息。结果被调查儿童不明原因CNS症状发生率为26.6%;多因素分析结果显示,三合板(OR=2.10,95%CI=1.30~3.41)、模压板家具(OR=2.45,95%CI=1.51~4.00)、靠近交通干道(OR=1.63,95%CI=1.04~2.54)、经常使用抗生素(OR=2.53,95%CI=1.47~4.35)及化学物质过敏(OR=1.14,95%CI=1.07~1.21)是不明原因CNS症状的危险因素,而湿拖把拖地(OR=0.45,95%CI=0.22~0.92)则是保护因素。结论学龄前儿童不明原因CNS症状发生率较高,家庭居室内家具材质、室内空气中的颗粒物质、交通污染、儿童自身疾病及过敏性体质是其可能的危险因素。     

乌鲁木齐市学龄前儿童过敏性鼻炎患病及相关症状影响因素分析

目的 了解新疆乌鲁木齐市学龄前儿童经医生诊断的过敏性鼻炎患病率及家长报告鼻炎相关症状发生情况，探讨与学龄前儿童过敏性鼻炎及鼻炎相关症状的影响因素，为学龄前儿童过敏性鼻炎及鼻炎相关症状的预防和控制提供理论依据。方法 采用横断面研究方法，于2019年8—12月问卷调查乌鲁木齐市60所幼儿园的8 153名学龄前儿童经医生诊断的过敏性鼻炎患病情况、家长报告的儿童鼻炎相关症状发生情况、遗传、个体及环境因素，分析儿童过敏性鼻炎及鼻炎相关症状的影响因素。结果 调查的8 153名学龄前儿童中，有7.6%的儿童曾经医生明确诊断为过敏性鼻炎，有27.4%的儿童既往曾出现过鼻炎相关症状。多因素logistic回归分析结果显示，年龄（5～7岁）（OR=1.36,95%CI=1.04～1.80）、独生子女（OR=1.24,95%CI=1.04～1.48）、出生方式（OR=1.21,95%CI=1.02～1.44）、父亲患鼻炎（OR=2.50,95%CI=2.10～2.98）、母亲患鼻炎（OR=3.29,95%CI=2.76～3.91）、父亲患哮喘（OR=1.95,95%CI=1.02～3.74）、住所的居住面积...     

母乳喂养与家养皮毛宠物对儿童哮喘及哮喘样症状的交互效应

目的探讨母乳喂养与家养皮毛宠物对儿童哮喘及哮喘样症状的影响,以及对儿童呼吸系统健康的交互效应。方法在沈阳市各个行政区整群随机抽取2所幼儿园和1所小学,抽取10所幼儿园和5所小学共8 212名儿童。采用国际统一的标准问卷对儿童的喂养方式、居住环境及呼吸系统疾病与症状等状况进行调查。结果沈阳市儿童母乳喂养率为78.87%;目前暴露家养皮毛宠物的儿童占14.56%;3.40%的儿童在母亲怀孕期间曾经暴露家养皮毛宠物。多因素Logistic回归分析显示,母乳喂养可降低儿童患有哮喘及哮喘样症状的风险;而暴露家养皮毛宠物与儿童哮喘及其相关症状存在正相关,且随着与家养皮毛宠物接触的程度越密切,儿童患有哮喘及其相关症状的风险性也越高。与未暴露宠物且母乳喂养的儿童相比,单纯非母乳喂养可使儿童患有哮喘的风险增高27%(OR=1.27,95%CI=1.00~1.61);单纯暴露皮毛宠物使儿童患有哮喘的风险性增高51%(OR=1.51,95%CI=1.15~1.97);而同时暴露于2个因素对哮喘的风险性增高了147%(OR=2.47,95%CI=1.66~3.66);宠物暴露和母乳喂养对儿童的哮喘存在一定的相加效应,但两者的相乘效应未达到统计学水平(P0.05)。结论母乳喂养可降低皮毛宠物对儿童哮喘及哮喘样症状的影响效应,但两者并不存在显著的相乘效应。     

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.