结构化教育治疗48例儿童孤独症疗效观察

目的:观察结构化教育对儿童孤独症的治疗效果。方法:对48例孤独症患儿实施结构化教育训练,于训练前及训练9个月后采用孤独症儿童行为检查量表(ABC)、孤独症治疗评估量表(ATEC)及儿童孤独症及相关发育障碍心理教育评定量表(中国修订版)(C-PEP)评估疗效。结果:经过9个月的结构化训练,48例孤独症儿童ABC量表各因子得分及量表总分较训练前下降,其中感觉能力、交往能力及自理能力得分训练前后比较差异有统计学意义(P<0.05),运动能力和语言能力得分训练前后比较差异也有统计学意义(P<0.01)。训练后,48例患儿的语言、社交、感知、行为4方面得分及总分均较训练前明显下降(P<0.01)。患儿C-PEP评估各项目分值较训练前显著提高。结论:结构化教育能改善孤独症患儿的症状,是孤独症的有效康复手段之一。     

结构化教育治疗51例儿童孤独症疗效观察

目的观察结构化教育对儿童孤独症的治疗效果,为儿童孤独症的治疗提供依据。方法对51例孤独症患儿实施结构化教育训练,训练时间每天不少于6 h,个别训练和集体训练相结合。训练前应用《儿童孤独症及相关发育障碍心理教育评定量表(中国修订版)》(C-PEP)对孤独症儿童进行基线测评,并于训练前及训练12个月后采用孤独症儿童行为检查量表(ABC)、孤独症治疗评估量表(ATEC)进行疗效评估。结果经过12个月的结构化训练,51名孤独症儿童ABC量表各因子得分及量表总分较训练前下降,其中感觉能力、交往能力训练前后差异均有统计学意义(P值均<0.05);运动能力、自理能力和语言能力得分前后比较,差异均有统计学意义(P值均<0.01)。51例患儿语言、社交、感知、行为方面及ATEc总分均较训练前明显下降,差异均有统计学意义(P值均<0.01)。结论结构化教育能改善孤独症患儿的症状,是孤独症的有效康复手段之一。     

高功能孤独症儿童综合训练效果分析

[目的]分析高功能孤独症儿童综合训练的效果.为临床治疗提供参考依据. [方法]对21例高功能孤独症患儿进行评估后,制定个别化训练计划.训练中应用结构化教育模式并结合应用行为分析法,坚持个别治疗与集体治疗相结合的综合训练.每天3 h,每周5 d,3个月为一个疗程,共训练12个月.训练前后用孤独症治疗评估量表(Autism Treatment Evaluation Checklist,ATEC)进行评估.[结果]21例患儿孤独症儿童量表平均总分由训练前的(77.14±29.57)分下降到(50.57±22.00)分(P<0.001),量表中语言、社交、知觉、行为四个分项目得分显著下降(P<0.001).患儿各方面能力得到提高. [结论]对高功能孤独症患儿进行综合训练有助于提高患儿的语言交流能力、社会交往能力、个人能力及动作行为能力.     

孤独症患儿言语及语言康复训练效果分析

【目的】分析孤独症患儿言语及语言训练的效果,为早期干预提供参考依据。【方法】对20例孤独症患儿的言语及语言障碍进行评估后,制定个别化训练计划。以一对一的形式训练。每周5次,每次30 min,共训练6个月。用儿童语音测试及小儿0~4岁精神发育检查表进行疗效评估。【结果】经过训练,20例孤独症患儿能有意识发出的声母数量由训练前的平均0.45个增至8.90个(P<0.001);语言发育商数由训练前的平均25.71分提高至44.22分(P<0.001);训练总有效率为100%。【结论】对孤独症患儿进行早期干预、言语及语言康复训练能有效地解决语言障碍的问题。     

以家庭为基地的短期结构化教育治疗儿童孤独症的疗效

[目的]为改善孤独症儿童预后,对孤独症儿童开展了为期6个月的以家庭为基地的短期结构化教育。[方法]将60例孤独症儿童随机分为治疗组和对照组。治疗组儿童在接受评估后制定训练计划,同时培训家长,之后家长根据计划在家庭进行训练,特别强调根据孤独症儿童的认知特点进行环境布置和视觉安排,按照预定的常规、程序时间表以及由上述训练要素构成的个人工作系统开展训练。要求每周7d,每天训练6h,于训练开始前以及6月后采用"孤独症治疗评估量表"进行疗效评估。[结果]与对照组相比,治疗组孤独症儿童量表的总分由训练前的76.2分下降至54.9分(P<0.01),量表的语言、社会交往、感知觉和行为四个分项目的分数也均有显著下降(P<0.05),表明通过训练在语言能力、社会交往能力得到提高,异常感知觉状态和异常行为得到减少。[结论]以家庭为基地的结构化教育能够有效地改善孤独症儿童的预后。     

开始训练年龄及训练持续时间对孤独症儿童转归的影响

【目的】 了解孤独症儿童开始训练年龄和训练时间对孤独症儿童转归的影响。 【方法】 对系统训练的194例孤独症患儿的开始训练年龄、训练时间及转归情况进行访谈。 【结果】 2岁前开始训练和训练时间超过6个月的孤独症患儿就读普通学校和幼儿园的比例明显高于4岁后开始训练和训练时间小于6个月的孤独症患儿(χ²值为11.33和6.14,P值均＜0.01)。 【结论】 早期、长时间系统训练可有效改善孤独症儿童的转归。     

孤独症患儿家庭康复训练配合TEACCH早期康复治疗

目的结构化教育(treatment and education of autistic and related communication handicapped children,TEACCH)属于一种个性化训练项目,对孤独症患儿治疗及教育疗效较好,而家庭康复训练可将学习融入患儿生活中,有效提高患儿各项能力。本研究通过采用家庭康复训练结合结构化教育护理方法训练孤独症患儿,旨在探讨其联合使用在孤独症患儿早期康复治疗中影响。方法选取2015-01-01-2018-02-01郑州儿童医院收治的孤独症患儿,根据干预方式的不同分为对照组和观察组,根据1:1配比后,共纳入100例,每组50例。观察组采用TEACCH结合家庭康复训练护理方法,对照组仅采用TEACCH护理方法。采用美国孤独症治疗评估量表(autism treatment evaluation checklist,ATEC)和孤独症行为评分量表(autism behaviour checklist,ABC)对两组进行评分,比较两组康复效果。结果 6个月干预训练后,观察组ATEC总分为(50.48±8.23)分,低于对照组的(61.85±9.62)分,差异有统计学意义,t=6.351,P<0.001;观察组ABC总分为(57.18±1.16)分,低于对照组的(63.45±1.17)分,差异有统计学意义,t=5.099,P<0.001。结论家庭康复训练配合TEACCH在孤独症患儿早期康复治疗中可有效提高患儿生活各项能力。     

听统刺激联合游戏疗法对孤独症儿童行为心理的干预

目的 探讨听觉统合训练联合游戏疗法对孤独症儿童行为心理的影响。方法 将孤独症患儿60例随机分为三组,A组(单纯的结构化教育治疗模式)、B组(结构化教育模式+游戏治疗)和C组(结构化教育治疗模式+游戏治疗+听觉统合治疗),每组各20例,治疗前后均采用儿童孤独症评定量表(CARS),孤独症儿童行为量表(ABC),Gesell发育诊断量表(社会适应性,个人社交,语言)进行评估。结果 三组患儿治疗6个月后的CARS、社会适应、语言、个人社交均有改善(P<0.05),其中在ABC及个人社交变化值方面,B组及C组较A组改善更为明显(P<0.05)。在语言变化值方面,C组变化值显著高于B组(P<0.05),同时B组变化值又显著高于A组(P<0.05)。结论 听觉统合训练联合游戏疗法在自闭症儿童行为心理治疗中,效果优于单纯结构化教育。     

孤独症患儿父母压力和情绪变化及相关因素

【目的】 探讨孤独症患儿父母压力和情绪变化及其相关因素。 【方法】 采用父母压力指数量表(PSI)、孤独症行为量表(ABC)、孤独症评定量表(CARS)、抑郁自评量表(SDS)和焦虑自评量表(SAS)对孤独症患儿父母进行评定;采用PSI、SDS和SAS量表对正常儿童父母进行评定。 【结果】 1)孤独症患儿父母PSI总分及各分量表分均显著高于正常儿童父母(P=0.000);2)患儿父、母亲SDS和SAS分均显著高于正常儿童父母(P= 0.000)。患儿母亲SDS和SAS分均高于患儿父亲得分(P=0.000),患儿母亲抑郁发生率高于父亲(P=0.000);3)患儿父母的压力与患儿症状严重度正相关(P<0.01);4)多元回归结果表明孤独症患儿ABC量表分、孤独症患儿母亲的焦虑以及患儿年龄影响孤独症儿童父母压力,解释了总变异的54.9%。 【结论】 孤独症患儿父母承受着较高的压力、焦虑和抑郁水平,孤独症患儿母亲比患儿父亲及正常儿童父母更易发生抑郁,患儿行为问题是父母压力的主要影响因素。     

孤独症儿童气质特征分析

【目的】 分析孤独症儿童的气质特征,为孤独症早期防治提供依据。 【方法】 采1∶2病例对照研究,对40例孤独症患儿及80例正常儿童采用《3～7岁儿童气质问卷》、自制的家庭与环境因素调查表、《孤独症治疗评定量表》进行评估。 【结果】 40例孤独症组儿童的气质维度中适应性、反应强度、坚持性、反应阈分值与正常儿童组比较差异有统计学意义(P<0.05);孤独症组ATEC量表中语言交流、社会能力、感知认知意识三个分量表分值与气质维度存在相关性(P<0.05)。 【结论】 孤独症组儿童气质维度与正常儿童组存在差异;孤独症儿童的社交、语言和认知等障碍影响气质维度的发展。     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.