Rapid repeat pregnancy and experiences of interpersonal violence among low-income adolescents

CONTEXT: Rapid repeat pregnancy (RRP) among adolescents, usually defined as pregnancy onset within 12-24 months of the previous pregnancy outcome, has frequently been the target of public health interventions, due to the exacerbation of negative consequences associated with recurrent adolescent pregnancy (and more specifically with childbearing). OBJECTIVE: To examine what, if any, relationship exists between RRP and the experience of interpersonal violence and abuse among low-income adolescents at one semi-urban health center. DESIGN: Case-control study using retrospective chart review. PARTICIPANTS AND SETTING: 100 women aged 13-21 who received prenatal care at one independent nonprofit health center that serves adolescents and their children from June 1994 through June 1996. MAIN OUTCOME MEASURES: Number and timing of pregnancies, occurrence of physical or sexual abuse; other psychosocial risk factors were evaluated. RESULTS: In this population, the experience of any form of physical or sexual violence during the study interval was associated with RRP within 12 months (p = 0.01, OR = 3.46) and 18 months (p = 0.013, OR = 4.29). Other previously reported predictors of RRP, including family stress, financial stress, and other environmental stressors did not reach statistical significance at either 12 months or 18 months in this sample. Of additional note, young women who experienced any form of abuse during the 12-month study interval were substantially more likely to miscarry than were their nonabused peers, and spontaneous abortion was also very strongly associated with RRP (p < 0.00001; OR = 22.6). CONCLUSIONS: The experience of interpersonal violence is correlated with rapid repeat pregnancy among low-income adolescents. This study strongly suggests a need for both extensive screening for partner and family violence among pregnant and postpartum adolescents, and follow-up safety planning support in combination with family planning interventions.     

内燃机车乘务员和轮轴工外周血淋巴细胞微核观察

本文作者对５１名内燃机车乘务员和车辆维修车间的３０名轮轴工外周血淋巴细胞微核进行了分析。结果表明,机车乘务员和轮轴工微核阳性检出率、微核细胞率和微核率均明显高于对照组（Ｐ＜０．０１）,而且随着作业工龄的延长,微核细胞率和微核率有接近显著（０．０５＜Ｐ＜０．０１）或显著（Ｐ＜０．０５）意义的增高。对两类作业工作人员微核增高的原因进行了讨论     

3种细胞因子在体外对阿糖胞苷细胞毒性的影响

采用对碘硝基四唑（ＩＮＴ）比色法,观察了１７例急性髓性白血病（ＡＭＬ）患者和８例正常人的骨髓,在体外对阿糖胞苷的敏感性,同时分别观察了粒细胞集落刺激因子（Ｇ－ＣＳＦ）,粒－巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）,白细胞介素－３（ＩＬ－３）３种细胞因子对其敏感性影响。结果显示ＡＭＬ细胞与正常细胞对Ａｒａ－Ｃ敏感性存在显著差异;Ｇ－ＣＳＦ,ＧＭ－ＣＳＦ,ＩＬ－３此３种因子均能增加Ａｒａ－Ｃ对ＡＭＬ细胞的     

铁路危险品货运站空气污染物的致遗传毒性作用研究

采用ＳＯＳ／ｕｍｕ 试验和ＳＯＳ 原位试验,对铁路危险品货运站（ 以下简称危货站） 空气污染物的致遗传毒性进行了研究。结果表明：在不加Ｓ９ 活化系统的条件下,危货站空气污染颗粒提取物具有致遗传毒性作用,可使ＴＡ１５３５／ＰＳＫ１００２ 菌株产生β半乳糖苷酶的量增加,并存在剂量—反应关系;加入Ｓ９ 活化系统后,则ＳＯＳ／ｕｍｕ 试验阴性。同时,应用ＳＯＳ 原位法,对危货站空气污染的综合致遗传毒性进行了现场监测。结果显示,随采样体积的增加,β半乳糖苷酶的量也增加,采样体积与酶诱导率之间,存在剂量—反应关系。     

锰对大鼠子代新生鼠黑质酪氨酸羟化酶的影响

为了研究锰对子代新生鼠黑质中酪氨酸羟化酶（ｔｙｒｏｓｉｎｅｈｙｄｒｏｘｙｌａｓｅ,ＴＨ）的影响,对雌性大鼠腹腔注射氯化锰（ＭｎＣｌ２·４Ｈ２Ｏ）,然后采用原位杂交组织化学技术检测其子代新生鼠黑质中ＴＨ．ｍＲＮＡ神经元。结果：对照组新生鼠黑质中观察到ＴＨ．ｍＲＮＡ神经元,各实验组均未观察到ＴＨ．ｍＲＮＡ神经元。提示：锰在基因水平上抑制了染锰者子代新生鼠黑质中ＴＨ活性,进而干扰和抑制了胺能神经递质的正常代谢     

地砷病患者部分生化指标的测定

对病区地砷病、非地砷病患者及对照组居民体内的部分生化指标进行了检测。结果表明,地砷病患者血清中的ＧＰＴ活性、ＵＮ和ＳＡ含量明显高于对照组,ＬＤＨ及ＧＳＨＰｘ活性明显降低;病区非地砷病患者ＬＤＨ活性、ＳＡ含量明显升高,ＧＳＨＰｘ活性明显降低,其它各组及各指标与对照组相比无显著差异。相关分析显示,病区病人组及非病人组血中ＳＡ含量与各自尿砷水平呈正相关（ｒ＝０５０,ｒ＝０４６）,ＧＳＨＰｘ与尿砷呈负相关（ｒ＝－０５１,ｒ＝－０４８）。提示,ＳＡ和ＧＳＨＰｘ可作为砷中毒的早期诊断指标。砷可能对接砷居民肝功、肾功产生一定影响。     

母婴同室产妇健康教育效果分析

为适应现代医学模式与产妇产褥期自我护理及新生儿护理的需求,采取小组教育、书面材料以及一对一相结合的健康教育形式对母婴同室产妇进行了较为全面的、有针对性、并有评价的健康教育。通过对１１７例产妇健康教育前后产褥期及新生儿护理知识与技能两方面的比较,教育前后存在显著性差异（Ｐ值均＜０．００１）,证明住院期间的健康教育明显提高了产妇产褥期卫生保健及新生儿护理知识水平及护理技能,同时该研究也阐明了母婴同室开展健康教育的重要性和必要性。     

乳腺癌（改良）根治术住院流程与平均住院日

参照业务流程重组的理论与方法研究了乳腺癌根治术的住院流程。结果显示,该病种住院流程存在的主要问题有：诊疗服务的随意性过大,等待诊疗服务的时间过长,患者入院标准的掌握过松,对该病种往院注程进行重组,将在不影响医疗服务质量的前提下有效缩短平均住院日。     

从部分贫困县住院分娩资料分析看农村地区围产保健对策

利用１９９６年在四川省和陕西省４个卫－Ⅵ项目县县乡两级医院,采用前瞻性研究方法收集的住院分娩资料,着重分析了产科床位使用率、产科接生工作负荷、产妇住院天数、剖腹产比例。结果显示：产科床位使用率不高,绝大多数医院都有５０％以上的产科床位日没有利用;接生工作负荷亦不高,各医院从事接生人员的１周平均接生数在０．５￣２．６之间;在一些乡卫生院产妇住院时间短,５０％以上的产妇住院不满１天;陕西的两县剖腹产比     

Methods for evaluation of retinal microvascular abnormalities associated with hypertension/sclerosis in the Atherosclerosis Risk in Communities Study

OBJECTIVE: To develop protocols to photograph and evaluate retinal vascular abnormalities in the Atherosclerosis Risk in Communities (ARIC) Study; to test reproducibility of the grading system; and to explore the relationship of these microvascular changes with blood pressure. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Among 4 examination centers, 11,114 participants (48-73 years of age) at their third triennial examination, after excluding persons with diabetes from this analysis. METHODS: One eye of each participant was photographed by technicians with nonmydriatic fundus cameras. Reading center graders evaluated focal arteriolar narrowing, arteriovenous (AV) nicking, and retinopathy by examining slides on a light box and measured diameters of all vessels in a zone surrounding the optic disc on enhanced digitized images. To gauge generalized narrowing, vessel diameters were combined into central arteriolar and venular equivalents with formulas adjusting for branching, and the ratio of equivalents (A/V ratio) was calculated. MAIN OUTCOME MEASURES: Retinal vascular abnormalities, mean arteriolar blood pressure (MABP). RESULTS: Among 11,114 participants, photographs were obtained of 99%, with quality sufficient to perform retinal evaluations in 81%. In the 9040 subjects with usable photographs, A/V ratio (lower values indicate generalized arteriolar narrowing) ranged from 0.57 to 1.22 (median = 0.84, interquartile range = 0.10), focal arteriolar narrowing was found in 7%, AV nicking in 6%, and retinopathy in 4%. Because of attrition of subjects and limitation of methods, prevalence of abnormality was likely underestimated. Controlling for gender, race, age, and smoking status, these retinal changes were associated with higher blood pressure. For every 10-mmHg increase in MABP, A/V ratio decreased by 0.02 unit (P < 0.0001), focal arteriolar narrowing had an odds ratio (OR) of 2.00 (95% confidence interval [CI] = 1.87-2.14), AV nicking had an OR of 1.25 (95% CI = 1.16-1.34), and retinopathy had an OR of 1.25 (95% CI = 1.15-1.37). For any degree of generalized narrowing, individuals with focal narrowing had MABP approximately 8 mmHg higher than those without (P < 0.0001). Masked replicate assessment of a sample found the following reproducibility: for A/V ratio, correlation coefficient = 0.79 and median absolute difference = 0.03; for focal arteriolar narrowing, kappa = 0.45; for AV nicking, kappa = 0.61; and for retinopathy, kappa = 0.89. CONCLUSION: Protocols have been developed for nonmydriatic fundus photography and for evaluation of retinal vascular abnormalities. Several microvascular changes were significantly associated with higher blood pressure; follow-up will show whether these are predictive of later cerebrovascular or cardiovascular disease independently of other known risk factors.