早期家长育儿干预与婴幼儿血铅水平的相关性研究

目的分析早期家长育儿行为干预对婴幼儿血铅水平的影响及降低小儿铅危害的有效措施。方法于2011年6月至2013年2月,对西安交通大学医学院一附院儿保门诊行健康检查的小于2月龄西安市健康儿童342例进行研究,按照奇、偶编号将被研究儿童分为早期育儿行为干预组（实验组）和常规干预组（对照组）。对照组进行常规检查和喂养指导,实验组儿童家长分别在首次检查、6月龄、12月龄和18月龄时增加铅中毒相关知识及相关健康行为干预;按照知情自愿的原则,在20～24月龄时用原子吸收法检测两组婴幼儿静脉血铅含量,同时对主要喂养人进行相关知识的问卷调查。结果实验组儿童无铅中毒检出,对照组2例儿童被检出铅中毒,实验组儿童血铅水平为37．30±16．73μg／L,显著低于对照组儿童的43．31±22．01μg/L、L（t=2．85,P〈0．05）,对两组儿童家长育儿行为进行比较,发现实验组在“避免孩子咬玩具、用湿式扫除、不用清晨水龙头第一壶水给孩子冲奶或做饭、重视孩子玩具的含铅情况”等方面优于对照组（x2值分别为8．82、25．46、20．80和10．58,均P〈0．05）。Logistic多因素分析显示,避免孩子咬玩具、不用清晨水龙头第一壶水给孩子冲奶或做饭,重视孩子玩具的含铅情况,均为影响血铅水平的保护因素,其OR值分别为2．378、2．136和1．699,均P〈0．05。结论早期对婴幼儿家长的育儿行为进行干预,与降低婴幼儿血铅水平有一定相关性。     

嘉兴市学龄前儿童多动行为及感觉统合失调分析

目的 了解嘉兴市城市学龄前儿童多动行为检出率的现状及该行为与感觉统合失调之间的关系,为早期诊断和干预提供依据。方法 采用整群抽样方法选取嘉兴市城区2所省一级幼儿园大班全部儿童作为研究对象。要求每位家长填写Conner’ s家长问卷和感觉统合能力发展评定量表。结果 多动行为筛查结果,总的检出率为17．9％,其中品行障碍检出率为15．0％（31／206）,学习问题检出率为17．0％（35／206）,心身问题检出率为9．2％（19／206）,冲动－多动检出率为16．0％（33／206）,焦虑检出率为1．4％（3／206）。感觉统合失调患儿检出情况,感觉统合失调患病率为26．4％（55／206）。其中本体感觉异常率为17．5％（36／206）,触觉过分防御为8．7％（18／206）,学习能力问题异常率为5．8％（12／206）,前庭平衡问题异常率为13．6％（28／206）。男性儿童感觉统合失调患病率及多动行为问题检出率明显高于女童。多动行为异常儿童中感觉统合失调儿童为56．8％,正常儿童中仅为20．1％,二者比较有显著性差异（χ^2＝20．82,P＜0．05）。结论 学龄前儿童多动行为异常检出率较高,是一种常见症状,应引起高度重视。建议从学龄前期开始进行筛查、诊断,对于合并感觉统合失调儿童建议早期开始训练,结合对家长进行多动儿童行为问题管理的培训,减轻入学后学习问题的严重程度。     

学龄前儿童异常瞬目的相关因素分析

目的探索学龄前儿童异常瞬目的相关因素。方法收集西安市儿童医院2011年871至2012年9月门诊诊断为异常瞬目的83例学龄前儿童的临床资料,进行比较分析。结果83例畀常瞬目的学龄前儿童中,男65例（占78．31％）,女18例（占21．69％）;有眼表疾患者57例;伴有行为异常者64例;偏食或食欲差者30例;屈光不正者23例。眼表疾患、行为异常、屈光不正为异常瞬目的危险因素（OR值分别为300．385、239．194和19．699,均P〈0．05）。结论儿童异常瞬目是一种多因素疾病,与眼表疾惠、行为异常及屈光不正有相关性,应采用综合措施进行防治。     

团体干预法对公交司售人员控烟知识态度与行为影响

目的探讨团体控烟干预对公交司售人员控烟知识、态度与行为的影响。方法采用包括成立领导机构、出台内部管理办法、创造控烟氛围、培训知识、主题研讨、提供戒烟帮助、典型经验会等综合措施对襄阳市公交公司进行团体控烟干预研究。结果干预6个月前后,364名调查对象知识得分分别为(45.1±6.7)分和(70.6±7.2)分,态度认知率分别为68.9%和86.3%,吸烟率前后分别为68.0%和32.7%,经t检验、χ2检验,差异有统计学意义(P0.05)。结论通过团体干预实施,有效的提高了司售人员的控烟知识水平,增强了控烟积极性,即时干预吸烟率有了明显下降,团体干预方法值得推广。     

Sensitivity of Crosswise Model to Simplistic Selection of Nonsensitive Questions: An Application to Estimate Substance Use,Alcohol Consumption and Extramarital Sex Among Iranian College Students

Background: Nonrandomized response (NRR) models are a new generation of surveys for sensitive issues. This study aims to evaluate the validity of estimates from the crosswise model (as one of the efficient models) through employing different response probabilities of nonsensitive questions. Methods: This cross-sectional study was conducted during October and November 2015 among 1777 students of Tabriz University of Medical Sciences. Estimates of monthly alcohol consumption, and at least one instance of illicit drug use and extramarital sex over the last year were determined using direct questioning (DQ) and the Crosswise model (CM). In the last model, the probability of positive response to the nonsensitive questions was determined by using five different methods: uniform distribution (I), Benford’s law (II), and estimations based on data from three other studies (III, IV, V). Results: Crosswise estimates of sensitive behaviors with different probabilities of a positive response to nonsensitive questions differed significantly. For example, estimates of history of using illegal opioids at least once in the last year among men varied significantly from 5.0% to 16.1% with different crosswise models based on the probability of being born in Spring using method I (0.250), III (0.287), IV (0.248), and V (0.310). The model based on Benford’s law (II) was applied to estimate alcohol and cannabis consumption, and its estimates showed significant discrepancy with results of crosswise models I and V. Conclusion: Estimates from crosswise model is highly sensitive to the response probability of nonsensitive questions. It seems that if this question is not selected carefully, the mentioned models will provide overestimates or underestimates, and the more-is-better hypothesis is not always valid. To achieve valid estimates, the exact probability of a positive response to the nonsensitive question must be known for the studied population.     

芎麻滴丸对血管性认知障碍大鼠社交行为的影响

目的 观察双侧颈总动脉结扎致血管性认知障碍大鼠社交行为的变化,探讨芎麻滴丸对其干预作用。方法 采用永久性结扎双侧颈总动脉法制备血管性认知障碍模型。实验大鼠随机分为假手术组（生理盐水10 mL·kg^-1）,模型组（生理盐水10 mL·kg^-1）,芎麻滴丸高剂量组（生药1.5 g·kg^-1）,芎麻滴丸低剂量组（生药0.75 g·kg^-1）。模型制备第28,42天采用Morris水迷宫对大鼠的学习记忆能力进行测试;模型制备第7,14,28,42天用社交行为仪检测大鼠社交能力的变化。结果 模型制备第7,14天大鼠社交行为无明显变化,模型制备第28天和第42天,模型组大鼠持续接触时间减少（P<0.05）;模型制备第42天,模型组大鼠接触次数减少,逃避潜伏期显著增加,穿越平台次数显著减少（P<0.01）。与模型组大鼠相比,模型制备第28天,芎麻滴丸高剂量组大鼠接触次数显著增加（P<0.05）;芎麻滴丸高、低剂量组大鼠持续接触时间显著增加（P<0.05或<0.01）;模型制备第42天,芎麻滴丸低剂量组大鼠接触次数和持续接触时间增加（P<0.05）,芎麻滴丸高、低剂量组大鼠逃避潜伏期显著减少（P<0.01）。结论 模型制备第42天大鼠出现学习记忆障碍;模型组大鼠第28天大鼠开始出现社交行为障碍,经芎麻滴丸干预后,接触时间和接触次数增加,即可认为其有效缓解由双侧颈总动脉结扎造成的社交能力障碍,且低剂量效果优于高剂量。     

Older person behavioral and psychological symptoms (BPS) and functional limitations mediate the association between older person cognitive impairment and depressive symptoms in the caregiver

We assess for the mediation of the association between older person cognitive impairment and caregiver depressive symptoms through older person BPS and functional limitations, and whether the mediation varies by caregiver–older person relationship (spouse/adult child). Data for 1111 older person (aged 75+ with activity of daily living (ADL) limitation)–caregiver dyads from Singapore were used. The outcome variable was dichotomous (caregiver clinically significant depressive symptoms [CSDS]: yes/no) in the primary analysis and continuous (caregiver depressive symptoms score) in the sensitivity analysis. The causal steps approach assessed for the mediation of the association between older person cognitive impairment (yes/no) and the outcome variable through the two potential mediators. A bootstrapping approach calculated point estimates and confidence intervals (CIs) of the indirect (∼mediated) effects. Variation of the indirect effects by caregiver–older person relationship was also assessed. In the primary analysis, the causal steps approach supported older person BPS and functional limitations as mediators. The bootstrapping approach confirmed both as significant mediators, though BPS (indirect effect odds ratio (OR) 1.32 [95% bootstrap CI 1.19,1.48]; %mediation: 70.6%) was a stronger mediator than functional limitations (1.04 [1.01,1.11]; %mediation: 11.5%). Variation of the indirect effects by caregiver–older person relationship was not supported. Results of the sensitivity analysis confirmed these results. We conclude that while caring for an older person with cognitive impairment is detrimental for the caregiver's mood, management of associated BPS and functional limitations, especially the former, among such older persons may reduce depressive symptoms among their caregivers. Spouse as well as adult child caregivers benefit.     

Fish navigation of large dams emerges from their modulation of flow field experience

Navigating obstacles is innate to fish in rivers, but fragmentation of the world’s rivers by more than 50,000 large dams threatens many of the fish migrations these waterways support. One limitation to mitigating the impacts of dams on fish is that we have a poor understanding of why some fish enter routes engineered for their safe travel around the dam but others pass through more dangerous routes. To understand fish movement through hydropower dam environments, we combine a computational fluid dynamics model of the flow field at a dam and a behavioral model in which simulated fish adjust swim orientation and speed to modulate their experience to water acceleration and pressure (depth). We fit the model to data on the passage of juvenile Pacific salmonids (Oncorhynchus spp.) at seven dams in the Columbia/Snake River system. Our findings from reproducing observed fish movement and passage patterns across 47 flow field conditions sampled over 14 y emphasize the role of experience and perception in the decision making of animals that can inform opportunities and limitations in living resources management and engineering design.Understanding how the design and management of civil infrastructure modifies the outcome of naturally evolved behavior in animals is critical for sustainably using limited environmental resources to spur economic development and maintain native species. The issue is particularly relevant for rivers, which make up only 0.0002% of water on Earth (1) but support more than 40% of the world’s human population (2, 3). River regulation to meet society’s needs has accelerated in the past two centuries (4), leaving over half of the world’s major rivers now fragmented by >50,000 large dams providing water, energy, flood control, and transportation (3, 5, 6). The demand for large hydropower continues, spurred by the need for economic development while limiting carbon use (7). However, dams impede the dispersal and migration of fish, a problem that, along with other factors, has contributed to the loss of populations and entire species (5). These losses have cultural, economic, and geopolitical repercussions (3, 8), because more than 40% of the world’s human population lives in internationally shared river basins (9) and declines in fish populations jeopardize the food security of hundreds of millions worldwide (10–12).In North America, the tension between economic development and living resource conservation is evident in the Columbia River basin. Flowing from Canada to the United States, the river once supported one of the world’s largest salmon runs, with annual returns of 10–16 million fish (13) sustaining tribal nations and ecosystems far from the ocean (14). However, years of overharvesting, land-use changes, ocean conditions, and dams have contributed to a decline in the annual return of salmon (15). To reverse the decline, millions of dollars are spent each year seeking a durable hydroelectric strategy to improve annual returns (1–2 million fish). A major emphasis in restoration is ensuring that millions of downstream migrating juvenile salmon reach the ocean where they grow before returning to the river as adults.Hydropower dams on the river provide three general routes of passage for downstream migrating fish: powerhouse turbines, a spillway, and often a bypass specifically designed for fish. These routes differ in their mortality effects on fish, so an understanding of how fish behavior determines route selection is important for mitigating the impacts of dams on the populations. However, route selection behavior is poorly understood. Not only has it been difficult to explain route passage patterns at one dam, but it has been even more difficult to explain why the pattern may be different at another dam with similar routes.     

The feasibility,acceptance, and key features of a prevention-focused oral health education program for HIV+ adults

Poor oral health is common in HIV+ adults. We explored the feasibility, acceptance, and key features of a prevention-focused oral health education program for HIV+ adults. This was a pilot substudy of a parent study in which all subjects (n = 112) received a baseline periodontal disease (PD) examination and provider-delivered oral health messages informed by the Information-Motivation-Behavioral Skills (IMB) Model. Forty-one parent study subjects were then eligible for the substudy; of these subjects, a volunteer sample was contacted and interviewed 3–6 months after the baseline visit. At the recall visit, subjects self-reported behavior changes that they had made since the baseline. PD was reassessed using standard clinical assessment guidelines, and results were shared with each subject. At recall, individualized, hands-on oral hygiene coaching was performed and patients provided feedback on this experience. Statistics included frequency distributions, means, and chi-square testing for bivariate analyses. Twenty-two HIV+ adults completed the study. At recall, subjects had modest, but nonsignificant (p > 0.05) clinician-observed improvement in PD. Each subject reported adopting, on average, 3.8 (± 1.5) specific oral health behavior changes at recall. By self-report, subjects attributed most behavior changes (95%) to baseline health messages. Behavior changes were self-reported for increased frequency of flossing (55%) and toothbrushing (50%), enhanced toothbrushing technique (50%), and improved eating habits (32%). As compared to smokers, nonsmokers reported being more optimistic about their oral health (p = 0.024) at recall and were more likely to have reported changing their oral health behaviors (p = 0.009). All subjects self-reported increased knowledge after receiving hands-on oral hygiene coaching performed at the recall visit. In HIV+ adults, IMB-informed oral health messages promoted self-reported behavior change, subjects preferred more interactive, hands-on coaching. We describe a holistic clinical behavior change approach that may provide a helpful framework when creating more rigorously designed IMB-informed studies on this topic.