多种维生素加早期干预对早产低出生体重儿体格发育的影响

【目的】了解维生素加早期干预对早产低出生体重儿体格发育的影响。【方法】选择在青岛市第八医院儿科出生存活的早产儿160例随机分为两组，一组为维生素加干预组（早产干预组），另一组为早产对照组（早产组）。另设足月对照组80例。【结果】体格发育综合指标比较：～6个月早产治疗组与早产对照组之间差异有显著性（F=2．67，P〈0．05），而与足月对照组之间差异无显著性（F=0．54，P〉0．05）。～12个月早产治疗组与早产对照组之间差异有显著性（F=3．65，P〈0．05），而与足月对照组之间差异无显著性（F=1．79，P〉0．05）。【结论】维生素加早期干预可促进早产低出生体重儿的体格发育。     

抚触对42天婴儿早期发育的影响

【目的】研究抚触对42d婴儿体格发育和神经行为发育的影响。为临床提供参考依据。【方法】选择正常健康的42d婴儿800例。随机抽取抚触组100例，对照组100例。抚触组婴儿从出生第1d开始皮肤抚触至42d，每天3次。每次15min。均于出生后42d测量体重、身长、头围．并对其行为发育进行测评。【结果】抚触组42d后体重、身长、头围的增长均高于对照组。差异有显著性（P〈0．05）。同时。对其测试俯卧抬头、视距追踪、听觉追踪和对测试者的微笑差异均有显著性（P〈0．05）。【结论】婴儿抚触对42d婴儿的体格发育及行为发育具有明娃的促进作用，值得大力提倡和推广，进而提高婴儿的身心发育水平。     

早期干预对早产儿1岁内体格发育促进效果的对照研究

【目的】探讨早期干预对早产儿1岁内体格发育的促进效果，为儿保工作者提供临床指导依据。【方法】筛选2003年1月～2005年12月间在本院儿保门诊进行健康体检的早产儿154名，其中愿接受干预者81名（干预组），不愿接受干预者73名（对照组），并与WHO标准进行比较。【结果】干预组男女婴儿体重及身长增长均优于对照组。干预组体重均值在生后第6个月已赶上WHO水平（P〉0．05），对照组体重均值在第6个月及第12个月仍低于WHO水平（P〈0．05）。早产儿体重月增长速率在生后前6个月优于WHO水平，其中第1、2、3个月最快，第4、5个月仍保持较高水平，从第6个月起，体重增长逐渐减慢并接近WHO水平；干预组身长在生后第4个月开始超过对照组（P〉0．05），第8个月时明显优于对照组（P〈0．05），1岁时接近WHO水平（P〉0．05）。对照组1岁时身长仍落后于WHO水平（P〈0．05）；早产儿身长月增长在生后第2～12个月多优于WHO水平，其中，第2、3、4个月明显优于WHO水平（P〈0．05），第5～12个月虽优于WHO水平，但无统计学差异（P〉0．05）。【结论】早期干预对早产儿1岁内（尤其是半岁内）体重及身长发育有明显促进效果，应引起广大儿保工作者重视。     

补充多元维生素对学龄前儿童生长的促进作用

【目的】探讨补充多元维生紊制剂对学龄前儿童生长速度的影响。【方法】将240例3～5岁的学龄前儿童分成两组，一组补充多元维生素片，另一组不补充，作为对照组，各组男女各半。每颗多元维生素片中含有VitA 5000U，Vit D 400U，Vit E 30U，Vit B1 1．5mg，Vit B2 1．7mg，，Vit B5 2mg，Vit B12 6μg，叶酸0．4mg，烟酰胺20mg，维生素C60mg。在补充前、6个月后、以及1年后，分别测定儿童的体重和身高的增长情况及其所处的百分位数变化。【结果】补充后儿童的体重和身高均明显地超过对照组体格生长情况。【结论】多元维生素可明显地促进学龄前儿童的生长速度，而且口味佳良。摄入日常膳食的儿童仍然需要补充适量的多元维生素制剂。     

深圳市母乳喂养现状及对儿童生长发育的影响

【目的】了解深圳市母乳喂养现状及影响因素，以及对2岁以下儿童生长发育的影响。【方法】专人负责，统一表格、标准和要求，进行统一规定的儿童体格检查和母亲喂养方式的1人1表问卷调查。【结果】小于4月龄儿童母乳喂养率为66．69蹦，纯母乳喂养率为46．5％，混合喂养为12．4％。影响母乳喂养的主要因素为产妇的营养状况，哺乳方式，习惯，哺乳时的生理和心理状况，以及有无缺乳家族史。母乳喂养组的～6月龄婴儿体重以及女婴身长均明显大于混合喂养组和人工喂养组（P〈0．05或0．01），母乳喂养婴儿独坐，叫爸妈的发育时间明显早于人工喂养儿（P均〈0．01）;母乳喂养组支气管炎及肺炎的发病率明显低于人工喂养组（P〈0．05）。而不同喂养方式的婴儿血红蛋白、血红细胞数，婴儿独走发育时间，婴儿感冒、腹泻、佝偻病的发病率等，差异均无显著性（P〉0．05）。[结论]母乳喂养对婴儿早期的体重身长、运动和语言发育优于人工喂养，且有利于婴儿肺炎和支气管炎的防治，应大力提倡科学母乳喂养，提高母乳喂养率和喂养质量。     

不同喂养方式对婴儿生长发育和常见病的影响

目的 比较不同喂养方式对婴儿生长发育和常见病发病的影响。方法 选取健康婴儿348名，按喂养方式分为4组：A组，纯母乳喂养：B组，母乳＋配方奶喂养；C组，配方奶喂养；D组，牛乳或其他喂养，6月龄时进行身长，体重测量，体格检查，近2个月呼吸道感染和腹泻发病情况的调查。结果 （1)体重或身高评价为上的婴儿C组高于其他组（P＜0．05），评价为下的C组最低，D组最高（P＜0．05）。（2）A，D组佝偻病，贫血患病率显著高于B，C组，P＜0．05。A。B组腹泻和呼吸道感染率显著低于C，D组（P＜0．05）。C组佝偻病，贫血患病率显著低于其他3组，P＜0．05。结论 纯母乳喂养可减少腹泻和呼吸道感染的发生，但应及时补充VD，铁剂，以预防佝偻病和贫血的发生。在母乳不足时，应选择接近有乳的配方奶喂养，牛乳不适宜喂养婴儿。     

上海市闵行区出生的巨大儿0~3岁体格发育评价

【目的】 了解闵行区出生的巨大儿0~3岁体格发育现状。 【方法】 接受闵行区儿童保健管理且出生的巨大儿,随访其0~3岁期间生长发育情况,共4 178人次。 【结果】 各年龄别体重均值明显高于2005 年上海市0～6 岁儿童体格发育调查结果。超重的发生率平均值为20.90%,肥胖症发生率平均值为3.37%,6个月和3岁为超重发生高峰期。呈现出男童明显高于女童的分布特点。 【结论】 预防超重和肥胖应从胎儿期抓起,并在学龄前期控制体重质量的增长速度。     

学龄前儿童单纯肥胖症群体干预中期效果评价

【目的】探索儿童单纯肥胖症的群体干预方法，降低学龄前儿童肥胖发病率。【方法】从朝阳区和大兴区各选择2所幼儿园的2～4岁儿童为研究对象，每区各有1所幼儿园为干预组，另1所为对照组。采用WHO身高标准体重值为肥胖判断标准。对干预组进行为期2年的群体干预，干预措施包括对儿童家长的健康教育、保证儿童运动锻炼时间、幼儿园提供平衡膳食、告知家长儿童体格测量结果等。对照组除与干预组同期体检外不接受任何干预措施。【结果】经过1年干预（干预中期），干预组肥胖率从7．72％降至5．34％，对照组肥胖率从3．96％上升为4．62％；干预组血压偏高检出率从5．05％降至2．76％，对照组从1．61％上升为3．11％；干预组儿童骨强度平均增长值高于对照组（P〈0．05）。【结论】肥胖群体干预方案在幼儿园实施1年来对学龄前儿童肥胖发病率的控制取得了一定的效果。     

北京市怀柔区O～18个月婴幼儿早期教育效果研究

【目的】探讨早期教育对．0～18个月正常婴幼儿体格潜能、智能发育的影响。【方法】选择2004年6月～2005年6月出生于怀柔区的正常足月新生儿60人，按照1：1配对分组，分为实验组和对照组各30名。对实验组进行早期智能开发指导，两组小儿均参加儿童保健定期监测和指导。并于生后1岁、1．5岁用《0～6岁儿童神经心理发育量表》进行智能发育测查。【结果】体格发育主要指标（体重、身长）两组差异无显著性（P〉O．05）；实验组于1岁、1．5岁时发育商（developmental quotient，DQ）明显高于对照组。【结论】早期教育可以促进和提高婴幼儿的智能发育。     

糖尿病母亲婴儿的生后管理及发育随访

【目的】探讨如何降低糖尿病母亲婴儿（infant of gestational diabetes mother，IDM）的围生期并发症及对婴儿期体格及智能发育的影响，为临床有效防治提供科学依据。【方法】对172例IDM进行了系统管理（IDM 1组），与97例非系统管理IDM（IDM 2组）进行了比较，观察其围生期并发症，对其体格及智能发育进行了随访。【结果】IDM出生体重与母亲孕期血糖控制水平有关；IDM 1组围生期总的并发症明显低于IDM 2组（P＜0.05）；其中以低血糖降低明显（P＜0.001）；IDM的体格发育随访，巨大儿组的体及体质指数（body mass index，BMI）一直高于正常体重组。随访发育商（developing quotient，DQ）显示有并发症组总的DQ值一直低于无并发症组，部分月龄、部分能区差异有显著性（P＜0．05）。【结论】IDM母亲孕期控制血糖，其婴儿出生后进行系统管理，可减少围生期并发症的发生，对婴儿近期体格和智能发育有一定影响，远期发育影响有待于进一步研究。     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

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.     

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.