金昌市学龄前儿童血铅水平与8种微量元素的相关性研究

目的探讨甘肃省金昌市学龄前儿童高铅血症现状及血铅水平与微量元素铜、锌、钒、铬、锰、钴、镓、锗间的相互关系。方法随机抽取金昌市部分幼儿园的256名儿童,用石墨炉原子吸收分光光度仪进行血铅、铜、锌、钒、铬、锰、钴、镓、锗含量的测定。结果①256名儿童血铅含量为28.30～268.00μg/L,平均（126.19±52.91）μg/L,其中〉100μg/L者160名（占62.54%）。②钒、铜元素水平男高于女,差异有统计学意义（P〈0.05、0.01）;不同年龄组间锌、锗元素在6～7岁较2岁组降低,差异有统计学意义（P〈0.01）。③铜元素在高血铅组较低血铅组增高,锌、锰、钴元素在高血铅组较低血铅组降低,差异均有统计学意义（P均〈0.05）。④多元线性回归分析显示血铅与血锌、钴元素呈负相关。结论金昌市学龄前儿童高铅血症发生率高,应加强环境污染的治理,儿童应定期复查血铅水平,给予针对性的健康教育和营养指导。儿童高铅血症可导致血锌、锰、钴元素水平下降,血铜元素升高。     

儿童高铅血症和轻度铅中毒458例临床分析

目的 了解本地区儿童血铅水平,高铅血症患儿的临床症状、铅接触情况,以进一步防治儿童铅中毒.方法 对门诊2年中3 298例12岁以内儿童的血铅筛查资料进行归纳、分析.结果 发现高铅血症患儿399例,铅中毒59例.血铅平均水平(150.05±37.17)mg/L,均为高铅血症及轻度铅中毒,多数患儿能找出铅暴露危险因素,中毒的程度似与多重危险因素相关.所有患儿均给予去除铅暴露危险因素、营养指导等处理,2～3个月后复查,其血铅水平均有不同程度下降.结论 对儿童血铅水平的筛查,能及早发现儿童高血铅及铅中毒,达到及时干预和治疗的目的 .     

3岁以下儿童铅中毒临床分析

目的 了解婴幼儿铅中毒状态及程度。 方法 对前来保健门诊健康体检的4 543例3岁以下儿童进行血铅含量测定,并将婴幼儿分为1个月-、6个月-、12个月-、18个月-、24个月-、30-36个月6组。以SAS 8.0统计软件进行统计分析。结果 铅中毒检出率为2.05%,3岁以下儿童血铅水平随月龄的增长而增高。结论 在接受血铅水平检测的婴幼儿中,高铅血症的检出率随年龄增长而增加,铅中毒则年龄越小检出率越高。要注意控制婴幼儿接触铅的各种途径。     

Blood lead levels of children with pica and surma use

Blood lead levels of 253 Delhi children were estimated by dithizone method. In 82 (controls) children with no symptoms mean blood lead level was 9.6 μg/dl (±SD 6.8: median 10 μg); only 6 had high levels between 30–33 μg/dl. In 88 children with pica, the mean blood lead level was 23.0 μg/dl (±SD 13.82; median 17 μg) which was significantly higher than the control; 26 had high levels between 30–92 μg/dl. Sixteen children with pica and surma- use and 46 children suspected of lead poisoning showed lead level patterns like the pica group. However, 21 surma-using children without pica resembled the control group. Children with pica were significantly more anemic than the controls and showed higher prevalence of abdominal-neurological symptoms. Because, in India, blood lead cannot be estimated in most of the hospitals, it is suggested that children with severe pica, anemia, abdominal-neurological symptoms and exposure to surma or lead, be suspected of lead poisoning, kept in lead-free environment with corrected nutrition, and be given a short cautious therapeutic trial with oral penicillamine.     

补充钙剂治疗儿童铅中毒效果的系统评价

目的系统评价补充钙剂治疗儿童铅中毒的疗效与安全性。方法检索相关文献数据库,并手工检索相关领域其他杂志。纳入以轻、中度铅中毒,年龄0～14岁儿童为研究对象,比较补充钙剂与其他疗法的疗效的随机对照试验,评价纳入研究的文献质量,并用RevMan5.0软件进行meta分析。结果共检索到633篇文献,最终筛选出4篇研究,共306例患儿。分析结果显示:当补充钙剂达到每日需要量时,补充钙剂组比对照组血铅降低值比较差异有统计学意义,其WMD及95%CI为:42.22(23.06～61.37);过量补充钙剂与钙剂充足的安慰剂对照组血铅下降无统计学意义,其MD及95%CI为:8(26.58～42.58)。结论足量补充钙剂能显著降低缺钙铅中毒儿童的血铅,如儿童钙剂摄入充足,过量补充钙剂能否降低儿童血铅尚证据不足。     

湖南省城镇学龄前儿童血铅水平流行病学调查

目的：调查湖南省城镇学龄前儿童血铅水平及影响因素,为儿童铅中毒的防治提供科学依据。方法：2008年9月至2009年6月整群随机抽取湖南省12个地区城镇学龄前儿童2 044名,男1 108名,女936名,年龄2～6岁,平均4.4±1.1岁。采用原子吸收光谱法测定末梢血血铅水平, 并采用《中国部分城市儿童铅中毒防治项目调查表》进行问卷调查。Logistic回归分析血铅水平的影响因素。结果：湖南省学龄前儿童平均血铅值为81.9±34.5 μg/L。血铅水平≥100 μg/L者482例,占23.58%。其中血铅水平100～199 μg/L(高铅血症)472例,占23.09%,血铅水平≥200 μg/L（铅中毒）10例,占0.49%。不同年龄组间血铅异常(血铅水平≥100 μg/L)率差异有统计学意义(P<0.01)。男童的血铅异常率为28.99%,高于女童的 21.98% （P<0.01）。不同地区儿童血铅异常率差异亦有统计学意义 (P<0.01)。回归分析显示,男性(OR=1.449, P<0.01)、父亲从事铅暴露职业(OR=1.314, P<0.01)及母亲常用染发剂（OR=1.678,P<0.05）为儿童血铅异常的危险因素。结论：湖南省城镇学龄前儿童血铅异常率较高。该省城镇学龄前儿童血铅异常率与儿童所在地区和年龄有关。男性、父亲从事铅暴露职业及母亲常用染发剂为儿童血铅异常的危险因素。［中国当代儿科杂志,2010,12（8）：645-649］     

UF-1000i尿沉渣分析仪与相差显微镜在小儿血尿来源鉴别中的价值

目的 评价UF-1000i 尿沉渣分析仪(简称UF-1000i)与相差显微镜在小儿血尿来源鉴别中的价值.方法 选取血尿住院病例65例,分别用UF-1000i与相差显微镜检测分析尿液中红细胞的信息.结果 65例患儿UF-1000i检查的敏感性(98.0%)高于相差显微镜(85.7%,P ＜ 0.05);而相差显微镜的特异性(93.8%)高于UF-1000i(56.3%,P ＜ 0.05).结论 UF-1000i提示的红细胞信息易受干扰,不能完全代替镜检,其对鉴别小儿血尿有初步筛查作用.UF-1000i与相差显微镜结合使用是鉴别血尿来源的最有效手段.     

The adverse effect of marginally higher lead level on intelligence development of children: A Shanghai study

We surveyed 128 preschool children in a lead-polluted area in Shanghai to study the relationship between blood lead level and neuropsychological functions, assessed by age-appropriate psychological tests. The geometric means of blood lead level was 21.7+-10.8 ug/dl. Of 47 children aged below 30 months, there was no significant difference in BSID indices between the high and low lead subjects, although the high lead children tended to have poorer development scores than the low lead ones. On the other hand, of 81 children older than 46 months, the WPPSIIQ scores showed highly significant negative correlation with blood lead level. Step-wise regression and multiple analysis of covariance techniques were employed to find out and control the confounding factors. Even when 21 non-lead variables were considered, the IQ difference between high and low lead groups remained statistically significant. We concluded that the children, especially those older than 46 months, in the area investigated, did suffer from lead toxicity causing impairment in intelligence development. We support the view that marginally higher lead level in children should be taken seriously.     

Lead exposure and children's intelligence: Do low levels of lead in blood cause mental deficit?

It has come to be generally accepted that low levels of lead exposure may result in mental deficit. This causal inference is based on claimed time precedence of the lead exposure and on biological plausibility. The objective of this study is to argue that mental deficit causes pica which causes lead exposure (i.e. to support the theory of reverse causation).

Methodology:

The literature since the 1930s has been interpreted in the light of our own long experience in the investigation of lead exposure in children and adults to support the arguments in favour of reverse causation.

Results:

The arguments for reverse causation are based on: (i) analogy with mental retardation which causes increased lead exposure; (ii) the results of published prospective studies that show a special relationship between blood lead levels at 24 months and intelligence tested later, exactly what would be predicted by the reverse causation theory; and (iii) on an alternative explanation for mental retardation following lead encephalopathy (i.e. that mental retardation following encephalopathy is due to anoxia and not due to a direct destructive effect on the brain neurones). The arguments, which have been proposed for the conventional view, are rejected for the following reasons: (i) none of the prospective studies have found a relationship between cord blood lead levels and intelligence tested later, undermining the argument based on time precedence of lead exposure; and (ii) there is no convincing evidence that lead poisoning, short of encephalopathy, causes mental retardation.

Conclusion:

We believe that the reverse causation hypothesis is a more plausible explanation of the facts.     

Level of oxidative stress and damage in erythrocytes in apprentices indirectly exposed to lead.

BACKGROUND: Oxidative stress (OS) may result in damage to critical macromolecules, and an association between lead (Pb) toxicity and OS is a matter of research. Therefore, the aim of the present study was to investigate the effect of Pb on the oxidative system in indirectly Pb-exposed male apprentices. METHODS: Established parameters of Pb toxicity (aminolevulinic acid dehydratase index [ALAD index], zinc-protoporphyrin [ZPP]) as well as Pb-level in blood were determined in Pb-exposed apprentices (n > 25) and controls (n > 24). Enzymatic (glutathione peroxides [GPx], superoxide dismutase [SOD], catalase [CAT]) and non-enzymatic (alpha-tocopherol, beta-carotene) indices of OS, and malondialdehyde (MDA) level were also determined. RESULTS: There was a statistically significant increase in Pb level, ALAD index, ZPP concentration, GPx activity and MDA concentration in Pb-exposed apprentices when compared to controls. Although a statistically significant decrease in alpha-tocopherol and beta-carotene levels was seen, SOD and CAT activities were unaltered in Pb-exposed apprentices. Pb level and duration of Pb exposure were correlated with each other, as well as various indices of OS and MDA concentration. CONCLUSIONS: Chronic indirect Pb exposure results in lipid peroxidation in erythrocytes of apprentices via OS, and duration of Pb exposure is a reliable marker of Pb toxicity.     

Iron and zinc supplementation does not improve parent or teacher ratings of behavior in first grade Mexican children exposed to lead

OBJECTIVE: To determine the efficacy of iron and zinc supplementation on behavior ratings of lead-exposed children. STUDY DESIGN: In this double-blind, randomized trial, 602 first-grade children received 30 mg ferrous fumarate, 30 mg zinc oxide, both, or placebo daily for 6 months. Lead, iron, and zinc status were determined at baseline and follow-up. Parents and teachers provided ratings of child behavior using the Conners Rating Scales. RESULTS: The baseline mean (SD) blood lead concentration was 11.5 (6.1) mug/dL, with 51% of children > or = 10 microg/dL. The prevalence of attention deficit hyperactivity disorder, estimated by combined parent and teacher ratings, was 6%. At follow-up, parent ratings of oppositional, hyperactive, cognitive problems, and attention deficit hyperactivity disorder decreased by 1.5, 1.2, 2.5, and 3.4 points, respectively (P < .05). Teacher ratings of hyperactivity increased by 1.1 points (P = .008), and the mean cognitive problem score declined by 0.7 points (P = .038). There were no treatment effects on mean change in scores, but children receiving any zinc had a higher likelihood of no longer receiving clinically-significant teacher ratings of oppositional behaviors. CONCLUSIONS: This regimen of supplementation did not result in consistent improvements in ratings of behavior in lead-exposed children over 6 months.     

Practitioner Review: Communicating with Hospitalised Children: Review and Application of Research Pertaining to Children's Understanding of Health and Illness

There is growing recognition amongst child health care practitioners of children's rights to be informed about their condition and treatment, and to be actively involved in decisions pertaining to their care. In order to facilitate such understanding, there is a need to explore the ways in which such concepts can best be communicated, in particular to younger children whose conceptual ability may be regarded as limited. Consideration of the literature on how children's conceptualisation of health and illness develops reveals diverse perspectives, with seminal work heavily influenced by the work of Piaget (1929), and a belief that the understanding of younger children may be minimal. However, more contemporary theorists refute such beliefs, suggesting that children may have far more potential to understand complex illness concepts than they have previously been given credit for. The work of Carey (1985) and Vygotsky (1962) offers alternative developmental theories congruent with this perspective, which might more appropriately underpin current practice. A variety of clinical situations are then explored in the light of this debate, including preparation of children for hospitalisation, their competence to consent, their views of pain and death, and approaches to child health promotion. Guidelines are offered to practitioners throughout, with the aim of enhancing children's understanding of their conditions, and their active participation in care, which in turn has the potential to optimise care delivery.     

Effect of environmental exposure to lead and tobacco smoke on inattentive and hyperactive symptoms and neurocognitive performance in children

Background: The present study assessed the association between blood lead and urinary cotinine levels and inattentive and hyperactive symptoms and neurocognitive performance in children. Methods: A total of 667 children (age range 8–11) were recruited from nine schools in five Korean cities. The teachers and parents completed the Korean version of the Attention‐deficit/hyperactivity disorder Rating Scales (K‐ARS), and the children performed neurocognitive tests. Blood lead and urinary cotinine levels were then measured. Results: The inattentive, hyperactive, and total scores of the teacher‐rated K‐ARS were positively associated with blood lead level, and the results of the continuous performance test (CPT), Stroop Color–Word Test, and Children’s Color Trails Test were inversely associated with urinary cotinine level when controlled for age, gender, father’s educational level, maternal IQ, child’s IQ, residential area, birth weight, and cotinine (for lead) or lead (for cotinine). The association between blood lead level and commission errors score on the CPT disappeared when the effect of urinary cotinine level was controlled. Conclusions: These findings indicate that environmental exposure to tobacco smoke in children is associated with poor neurocognitive performance, and low levels of lead are associated with inattention and hyperactivity symptoms.     

The cost of understanding other people: social cognition predicts young children's sensitivity to criticism

BACKGROUND: Individual differences in sensitivity to teacher criticism, and their links with individual differences in social cognition, were examined in 141 young children from diverse family backgrounds. METHODS: Children's sensitivity to teacher criticism was assessed in their first year of school (mean age 5.13 years), using a puppet scenario in which a teacher criticises the child for making an error in school work. Understanding of false belief and mixed emotions was assessed at the same time. One hundred and thirteen of the children had been seen one year earlier in preschool, when comprehensive assessments were made of false belief and emotion understanding. RESULTS: Individual differences were apparent in children's sensitivity to teacher criticism, which were correlated with individual differences in both preschool and concurrent social cognition: children with more advanced social cognition were more sensitive to teacher criticism. Regression analyses showed that preschool social cognition was especially important, explaining unique variance in sensitivity to criticism over and above variance accounted for by concurrent sociocognitive ability. CONCLUSIONS: The results suggest that there are costs as well as benefits to understanding other people, at least for young children, and that individual differences in early social cognition may have distinct developmental trajectories. These issues, along with implications for research into children's responses to criticism and failure, are discussed.     

Conscious level in children with diabetic ketoacidosis is related to severity of acidosis and not to blood glucose concentration

OBJECTIVE: To ascertain whether initial depression of conscious level in children with diabetic ketoacidosis (DKA) is related to hyperosmolality, acidosis or other factors. METHODS: In 225 episodes of DKA without evidence of cerebral edema, we examined the relationship between conscious level and initial biochemical variables. We contrasted these findings with those in 42 children who later developed cerebral oedema. RESULTS: On admission, 42/225 (19%) had mild (pH 7.26-7.35); 96 (44%) moderate (pH 7.11-7.25); and 80 (37%) severe DKA (pH 相似文献