父母体质指数、母亲年龄及文化程度对张路指数的影响

【目的】探讨张路指数（Zhang—Baolin Lu-Qing Index，ZLI）的影响因素。【方法】对413例新生儿定时纵向测量体重、头围、身长，然后根据ZLI公式计算ZLI值，并对母亲妊娠前体质指数（body mass index，BMI）、母亲妊娠期增加BMI、父亲BMI、母亲文化程度、母亲年龄、新生儿性别与ZLI之间的关系进行相关分析。【结果】①母亲妊娠前BMI、妊娠期增加BMI除与生后12～14d时ZLI相关性无统计学意义外（P〉0．05），与其他各时段ZLI呈正相关（P〈0．05）；父亲BMI与各时段ZLI相关性无统计学意义（P〉0．05）。②母亲不同文化程度组、母亲不同年龄组及新生儿不同性别间ZLI差异无显著性（P〉0．05）。【结论】ZLI随母亲妊娠前BMI、妊娠期增加BMI的增大而增大，父亲BMI、母亲年龄、母亲文化程度、新生儿性别对ZLI影响不大。     

新生儿不明原因高间接胆红素血症临床分析

目的：探讨不明原因高间接胆红素血症（高胆）的临床特点及其相关因素，方法：对我院1990－1999年收治的不明原因高胆足月新生儿316例进行回顾性分析。结果：不明原因高胆患儿占同期高胆住院患儿的20．5％（316／1539），男：女＝1．6：1，轻度占20．6％（65／316），中度占61．7％（195／316），重度占17．7％（56／316），重度组母O型血所占比例和母子血型不合发生率高于轻，中度组，中度组，差异有显著性（P＜0．05），重度组胆红素值降到正常时间及光疗时间明显长于其它2组，差异有显著性（P＜0．05），结论：母亲O型血型可能为新生儿高胆发生和发展的危险因素，轻度高胆组可能包含有生理性黄疸，重度组可能包括部分新生儿ABO血型不合溶血病。     

新生儿缺氧缺血性脑病胆红素水平的变化

目的探讨新生儿缺氧缺血性脑病胆红素的变化以及经皮测胆的准确性.方法用抽血以及经皮测胆两种方法对59例确诊为缺氧缺血性脑病的新生儿于出生第2天及第5天进行胆红素测定,并将两种方法测定结果进行比较.结果出生第2天各组间胆红素值无显著性差异,出生第5天胆红素值随着缺氧缺血性脑病程度加重明显降低,且有显著性差异(P＜0.05).经皮测胆红素值轻度175.78±45.39;中度137.02±46.24;重度95.58±42.62.抽血测胆以及经皮测胆两种方法测得结果进行比较无显著性差异(P＞0.05).结论在出生第5天中重度缺氧缺血性脑病患儿胆红素值明显低于轻度组,各组间比较有显著性差异.经皮测胆是一种准确经济的测定胆红素方法.     

妊娠高血压母亲对新生儿血液细胞学的影响

【目的】研究妊娠高血压对新生儿血液细胞学的影响以及这些变化是否对新生儿预后产生不利影响。【方法】研究242例妊娠高血压母亲出生的新生儿的血液细胞学的变化,与140例无妊娠高血压母亲分娩的新生儿进行对比研究。【结果】妊娠高血压组中早产儿及小于胎龄儿的比例明显增高。妊娠高血压组新生儿血小板计数明显低于对照组(P<0.05),但并没有增加新生儿出血性疾病的发生率(如颅内出血);妊娠高血压组新生儿有核红细胞的数量及平均红细胞体积比正常对照组明显增加;两组新生儿的中性粒细胞计数差异无显著性(P>0.05)。【结论】妊娠高血压组新生儿在血液细胞学的某些方面与对照组新生儿存在明显的差异,但这些差异没有导致新生儿相关疾病(如败血症、颅内出血等)的发生率的明显增加。     

妊娠高血压综合征产妇分娩的新生儿缺氧缺血性脑病患儿血镁水平及其预后

【目的】探讨妊娠高血压综合征（简称妊高征）产妇分娩的新生儿缺氧缺血性脑病（hypoxic ischemic encephalopathy，HIE）患儿血镁水平及其预后，为提高HIE患儿的治愈率，降低死亡率，减少后遗症提供临床参考。【方法】将产前接受硫酸镁治疗的妊高征产妇分娩的87例HIE患儿定为观察组，把同期未接受硫酸镁治疗的妊高征产妇分娩的76例HIE患儿定为对照组，均在24h内检测血镁。两组HIE患儿给予同样的综合治疗，观察其治疗效果，并于2岁时进行智商检测。【结果】血镁值高的观察组治愈率、智商均高，神经系统症状恢复时间快，后遗症发生率低，与对照组相比差异有显著性（P＜0.05）。【结论】镁对新生儿缺氧缺血性脑损伤具有保护作用。     

6-磷酸葡萄糖脱氢酶缺乏致高胆红素血症的临床分析

【目的】了解6-磷酸葡萄糖脱氢酶(G-6-PD)缺乏婴儿高胆红素血症(高胆)的临床特点及有关因素。【方法】分析天河区妇幼保健院就诊58例G-6-PD缺乏致高胆的新生儿的临床资料。【结果】新生儿G6-PD缺乏诱发高胆的常见原因依次是：①宫内窘迫及产时窒息；②感染；③药物，包括母亲产前用药。部分合并其他原因如ABO溶血、母亲HBV携带等。【结论】加强围产期保健，及时诊治G-6-PD缺乏患儿，做好新生儿筛查工作。     

新生儿高胆红素血症的危险因素分析

目的：探讨新生儿发生高胆红素血症的相关危险因素。方法选择2013年6月-2013年12月间我院产科分娩和收住的580例活产新生儿按是否发生发生高胆红素血症分为观察组（发生高胆红素血症）和对照组（未发生高胆红素血症）,对相关危险因素进行多元回归分析。结果发生高胆红素血症者103例,占17.8%,无高胆红素血症者477例,占82.2%,观察组在胎龄、出生体重、1分钟Apgar评分、胎膜早破、头颅血肿、窒息或宫内窘迫、开始喂奶时间、母亲年龄、妊娠合并症等方面与对照组相比较差异均有统计学意义（P＜0.05）;经多元回归分析显示,新生儿高胆红素血症的发生与胎龄、出生体重、1分钟Apgar评分、胎膜早破、头颅血肿、窒息或宫内窘迫、妊娠合并症具有相关性。结论新生儿高胆红素血症的发生受多种因素影响,需加强围产期管理及评估,对具有高危因素的新生儿进行重点监测,以降低新生儿高胆红素血症发生、减少对新生儿的危害。     

181例新生儿窒息的产科因素分析

目的分析新生儿窒息的产科因素，并探讨其防治措施。方法对181例新生儿窒息的产科资料进行回顾性分析。结果脐带因素是新生儿窒息的首要原因；产程异常、高危妊娠、胎儿宫内窘迫是新生儿窒息的主要原因；自然分娩与剖宫产的新生儿窒息发生率无显著性差异，阴道助产的新生儿窒息发生率明显高于前两者（p〈0．05）。结论加强孕期保健及产时监护，积极治疗妊娠合并症和并发症，正确选择分娩方式，提高产科技术，可避免或减少新生儿窒息的发生。     

新生儿高胆红素血症产科原因的探讨

目的:探讨新生儿高胆红素血症(简称高胆)的产科原因。方法:选择2003年1月~2004年12月在产科出生的新生婴儿2170例,新生儿高胆624例,按其原因分成两组,进行回顾性分析。结果:624例高胆的原因:剖宫产368例,发生率36.90%。阴道分娩256例,发生率21.80%。剖宫产组黄疸出现时间(2.52±1.04)天,高峰时间(4.49±1.32)天,胆红素峰值(272.60±30.40)μmol/L。阴道分娩组黄疸出现时间(2.53±1.05)天,高峰时间(4.63±1.38)天,胆红素峰值(268.90±32.5)μmol/L。两组黄疸出现时间及程度比较差异无显著性(P>0.05),但两组平均胆红素峰值比较,差异有显著性(P<0.05)。结论:剖宫产、第二产程延长、新生儿窒息可能是引起新生儿高胆的围产因素。     

新生儿高胆红素血症围产高危因素分析

【目的】分析围产因素对新生儿高胆红素血症的影响，为临床早期防治及预后判断提供参考依据。【方法】对230例新生儿高胆红素血症作回顾性临床分析。【结果】相关围产因素进行Logistic回归分析表明：胎膜早破、宫内窘迫、高龄初产、胎龄、剖宫产、出生后头3d体重下降明显、母乳缺乏已成为新生儿高胆红素血症的主要危险因素。【结论】加强围生期保健，避免早产、早破水、宫内窘迫，恰当掌握剖宫产指征，并对高危儿娩出后进行胆红素监测，对早防早治有重要意义。     

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.