在对"十三五"期间福州市医疗卫生资源配置分析的基础上,利用面板数据熵权法计算卫生资源综合评价指数,并进行空间分析.结果表明,福州市卫生资源明显增加,各县区的综合指数差距有所缩小,空间集聚现象缩小,但卫生资源集中在鼓楼等中心城区的总体特征没有改变.因此,福州市应加强卫生机构的能力建设,调整医疗卫生机构的空间分布,以满足城市发展的需要.

目的 探讨行动导向教学法在早产儿家长延续性健康教育中的应用成效.方法 选取就诊于某三级甲等妇幼保健院儿童保健中心的110例早产儿家长为研究对象,按照完全随机分组法分成试验组52例、对照组50例进行研究.试验组接受基于行动导向教学法的早产儿家长延续性健康教育模式;对照组用传统健康教育模式.用0～6岁小儿神经心理发育量表和早产儿家长延续性健康教育评价标准进行干预效果评价.结果 试验组早产儿12月龄总发育商(85.9±6.6)高于对照组(76.6±7.0),各能区发育商亦高于对照组;家长健康教育评价标准总得分(86.1±6.7)高于对照组(73.6±8.2),各维度得分均高于对照组.结论 基于行动导向教学法的早产儿家长延续性健康教育模式,可强化家长居家保健知识体系和健康意识,提高早产儿的智能发育水平.

Objective To investigate the influences of gestational diabetes mellitus (GDM) on physical and intellectual development of the offspring and it's influencing factors in Fuzhou and to provide a basis for the study of health management for offspring of mother with GDM. Methods a total of 106 infants of gestational diabetes mothers (exposure group) and 106 infants of mothers without GDM (control group) were selected from 3 districts of Fuzhou by stratified cluster sampling, and their body mass index and intellectual development were investigated at 12 months old. Results The body weight and body mass index of the exposure group were higher than those of the control group at the age of 12 months old (P ＜ 0. 05). There was no statistically significant difference in body length and head circumference between the two groups (P＞ 0. 05). In the exposure group, the scores of fine movement, adaptation, language, social ability and total developmental quotient were lower than those of the control group, and the difference was statistically significant (P ＜ 0. 05). There was no statistically significant difference in the gross motor between the two groups (P＞0. 05). The factors influencing the intelligent development of infants in the exposure group include maternal education, premature birth, history of intracranial hemorrhage at birth and average monthly family income. Conclusion GDM will affect the physical and intellectual development of the offspring, and the health management system should be established to reduce the risk.

目的 探讨婴幼儿过敏性疾病发病的危险因素,以指导临床有效早期预防和干预.方法 2016年3～9月到福建省妇幼保健院就诊、出生于福州地区的婴幼儿293例,分为过敏组(130例)、对照组(163例),进行25种影响因素的回顾性调查,用logistic回归模型分析其影响因素.结果 多因素logistic回归分析提示,孕期饮酒(OR=7.86)、过早添加辅食(OR=2.78)和过敏性疾病家族史(OR=2.35)是过敏性疾病的危险因素,而服用益生菌是保护因素(OR=0.51).结论 有家族过敏史的婴幼儿,更应重视后天生活方式及环境因素的影响,并合理使用益生菌.

目的 了解2009-2016年福建省托幼机构卫生保健工作的动态变化趋势,为适时采取干预措施,使卫生保健工作更加规范化,改进保健举措提供科学依据.方法 采用《福建省托儿所幼儿园卫生保健工作年报表》数据,对其中2009-2016年资料进行统计分析.结果 2009-2016年福建省托幼机构总数逐年增多,县(区)级及以上办园比例逐年增高至13.14％,以全日制园所为主,其所占比例逐年提高至70.70％.托幼机构卫生保健人员逐年增多,保健人员与幼儿比提高至1∶195.儿童体检率逐年提高至96.99％,儿童眼保健、口腔保健和听力保健率逐年提高至78.68％、76.53％和33.39％.结论 福建省托幼机构卫生保健整体水平逐年提高,但与国家标准仍有差距.托幼机构应积极落实各项卫生保健制度,提升卫生保健工作水平.

目的 探讨早产儿出院后保健管理模式对其体格生长发育的影响.方法 选择191例早产儿,用前瞻性随机对照研究方法,将早产儿分为干预组(94例)和对照组(97例),同时选择同期出生的正常足月儿作为正常对照组(100例).从满月干预至矫正月龄6个月,分别检测各个月龄的体格发育指标.结果 两组早产儿出生时的胎龄、体重和身长差异均无统计学意义.在矫正3月龄、4月龄时,干预组的体重、身高和头围,均比与对照组大.结论 早产儿出院后保健管理模式,可以加快早产儿体格发育的生长速度,更好地完成追赶性生长.

目的 探讨出院后系统保健管理模式对早产儿家长遵医依从性的影响.方法 便利抽样法选取2014年1-6月福建省妇幼保健院新生儿重症救护中心(neonatal intensive care unit,NICU)和产科出院的早产儿家长150例,采用自愿原则将其分为观察组和对照组各75例.对照组采用常规保健管理模式,观察组采用早产儿出院后系统保健管理模式,比较两组早产儿家长的遵医依从性.结果 观察组早产儿家长遵医依从性明显优于对照组(P＜0.001).结论 出院后系统保健管理模式可有效提高早产儿家长的遵医依从性,从而保证早产儿的居家照护,提高早产儿的生活质量.

A method for the determination of trans. fatty acid isomers in human milk fat was developed by gas chromatography. mass spectrometry (GC-MS), and applied to analyze TFAs in human milk fat. The fat was extracted with diethylether and petroleum ether after ammonia hydrolysis of human milk. C21:0 internal standard and boron trifluoride methanol solution were added to the extract for fat esterification. The solution then was refluxed in 80. water bath for 15 min. Finally the trans. fatty acid methyl ester isomers were extracted with hexane, and ana. lyzed by GC. MS. GC conditions were as follows: an HP. 88 column (100 mx0.25 mmx0.2 mu m) with inlet temperature of 260 degrees C, at a split ratio of 10:1, and a He flow rate of 1 mL/min. The initial column temperature was 140 degrees C (held for 5 min), then raised up to 240. at a rate of 4 degrees C/min (held for 15 min). The electronic ionization (EI) source energy was 70 eV, with auxil. iary (AUX) temperature of 280 degrees C, ion source temperature of 230 degrees C, quadrupole temperature of 150 degrees C in selected ion monitoring (SIM) mode. This method can analyze the 18 TFAs. The method detection limits (MDLs) of 12 TFAs were 4.0-47.1 mg/kg, and the average recoveries were 80% - 113% with the relative standard deviation (RSD, n = 6) range of 2.9% - 14.5%. TFAs were detected in some real samples and the contents were 9.5-46.9 mg/kg. The method is reli. able and sensitive, and would be better if the background interference of fatty acids should be diminished by silver ion solid phase extraction.

目的 探讨应用企业管理理念实施早产儿出院后管理对早产儿智能发育和气质的影响.方法 采取随机对照的方法,将110例早产儿分为实验组和对照组,各55例.实验组采用企业管理理念实施早产儿出院后管理,对照组接受常规保健模式.共96例早产儿完成了研究.比较两组早产儿4月龄、6月龄和12月龄神经心理发育检查得分和2月龄小婴儿气质问卷、12月龄幼儿气质评估表得分情况.结果 实验组早产儿除4月龄精细动作和适应性能区发育商与对照组比较,差异无统计学意义(P＞0.05),其余各能区发育商及总发育商均高于对照组(P＜0.05);2月龄实验组和对照组早产儿气质类型差异无统计学意义(P＞0.05);12月龄实验组早产儿E组例数多于对照组早产儿(P＜0.05).结论 应用企业管理理念实施早产儿出院后管理可有效促进早产儿的智能发育和气质培养.

目的 了解儿童饮食行为问题及其抚养人喂养行为的特点.方法 对有饮食行为问题的儿童636人及其抚养人进行问卷调查与分析.结果 调查的不良饮食行为儿童中,不良进食习惯者占54.2％、胃口差47.8％、挑食偏食26.7％、害怕进食11.8％,父母过度关心34.6％.喂养人的喂养行为以哄骗分散儿童注意力占比最高(60.7％),担心儿童营养不良占60.1％.结论 在儿童不良的饮食行为中,不良进食习惯占比最高;喂养人普遍存在不恰当的喂养行为.应加强抚养人的健康饮食和喂养行为指导,以帮助儿童养成良好的饮食习惯.

Objective:To understand the lifestyles and dietary structure of wet nurses in Fuzhou region and the interrelationship.Methods:A survey about lifestyles,nutritional and healthy conditions was conducted among the healthy wet nurses meeting the inclusion criteria and living in Fuzhou for one year or more than one year.Results:A total of 113 valid questionnaires were collected,the average daily intakes of poultry meat and eggs of wet nurses during puerperal period accounted for 439.5％ and 350.0％ of dietary reference intakes (DRIs) of wet nurses,respectively; fruits and vegetables accounted for 43.3％ and 25.0％ of DRIs of wet nurses,respectively; milk,milk products,beans,and bean products accounted for 0.0％ of DRIs of wet nurses,respectively.The average daily intake of energy accounted for 78.5％ of RNIs of wet nurses; the proportion of energy supplied by carbohydrate was low (34.3％),and the proportions of energy supplied by protein (27.9％) and fat (37.0％) were high.The average daily intakes of calcium and vitamin C accounted for 45.4％ and 73.8％ of RNI or AI of wet nurses,no calcium was from milk and beans.The intake and intake proportion of iron from grains among the exclusive breastfeeding nurses were less than those among the nonexclusive breastfeeding nurses; the intakes of fruits,iron,manganese,vitamin C,and carbohydrate among the wet nurses with history of drinking tea were higher than those among the wet nurses without history of drinking tea.Conclusion:The intakes of poultry meat and eggs of wet nurses during puerperal period are adequate even excess,but the intakes of vegetables,milk,milk products,beans,and bean products are extremely low,the intake of fruits is inadequate.The intake of total energy is inadequate,the energy proportions supplied by three nutriments are unreasonable,dietary structure of wet nurses are correlated with social factor.

目的 了解福州地区母乳中脂肪酸(FA)含量,研究其与乳母产褥期生活方式、膳食结构的关系,以指导乳母合理膳食和健康的生活方式.方法 采用描述性横断面调查,选取产后42 d居住于福州地区≥1年的健康乳母进行“乳母生活方式营养和健康状况调查”,包括一般情况、产后30 d膳食频率调查,并采集测定母乳中的FA含量.调查表与检测结果经核对、编码、赋值和EpiData数据双录入,用Excel软件、营养计算软件和SPSS 13.0软件进行统计分析评价.用非参数秩和检验(α=0.05)与Nemenyi多重比较(α=0.10)等统计方法分析FA与膳食结构、营养素摄入量的关系.结果 完成问卷113份,采集母乳123份,调查完整且进行母乳脂肪酸分析的101份.母乳脂肪酸中饱和脂肪酸(SFA)含量为57.43％,单不饱和脂肪酸(MUFA)为27.75％,n-6系列多不饱和脂肪酸(n-6 PUFA)为14.43％,n 3 PUFA为0.74％,n-6 PUFA/n-3 PUFA为19.28,亚油酸/α-亚麻酸(LA/ALA)为26.24.平原和沿海者必需脂肪酸(EPA)高于山区(P1=0.08,P2=0.07);研究生及以上学历乳母的LA/ALA比值高于高中及以下学历者(P=0.06);专业人员及公务员的二十二碳六烯酸(DHA)高于待业在家者(P=0.06);而纯母乳喂养者SFA含量较低(P=0.046),MUFA较高(P=0.043).结论 母乳FA中LA/ALA比值较高,需增加亚麻籽油、苏籽油、大豆油和深海鱼类、贝壳类水生动物和海藻等富含n-3系列FA的食物摄入.同时母乳FA含量,特别是不饱和脂肪酸含量还受到地理环境、社会因素与喂养方式等因素的影响,值得进一步研究.

目的探讨0～7岁儿童骨碱性磷酸酶(BALP)和骨密度(BMD)检测在小儿佝偻病早期诊断中的一致性。方法选取在福建省妇幼保健院儿保门诊体检的0～7岁儿童535例,分为婴儿组(42d至12月龄),幼儿组(13～36月龄)和学龄前组(37～84月龄)。测外周血BALP值,同时用超声BMD仪测量跟骨BMD值。结果 535例中,BALP值200～250U/L者占62.6%,>250U/L者占14.4%,以婴儿组异常率最高;BMD低于同龄标准者占46.7%,严重不足者占29.7%,以幼儿组异常率最高,BALP值与BMD相关性无统计学意义(Kappa=0.01,P=0.723)。结论进行儿童佝偻病诊断时,可能出现BALP值和超声BMD结果不符,应结合症状和体征,分析其他影响因素,有条件的给予相应微量元素与血铅等测定,以避免漏诊或"佝偻病"医源性过度治疗。

Objective:To evaluate the antigenicity of LigA protein which is obtained from Leptospira Copenhagen strain and expressed in E.coli by genetic engineering methods,and using LigA protein to detect 15 standard positive sera of domestic prevalent leptospira by WB and Elisa analysis.Methods:The LigA gene was amplified by PCR and constructed the recombinant expression plasmid with pET-30a,and then expressed in E.coli BL21(DE3)and induced with IPTG.The expression product was dissolved in urine solution and purified by affinity chromatography.We use Western-blotting and indirect ELISA to evaluate its antigenicity.Results:The recombinant protein was expressed with high yield in E.coli,meanwhile,the results obtained from Western-blotting and ELISA reveal that it has good antigenic activity.Conclusion:LigA sequence from Leptospira Copenhagen strain can be expressed in E.coli and maintains its antigenicity.It shows a potential role in the diagnosis of leptospirasis as well as the research on vaccine domain.

钩端螺旋体病(钩体病)是世界范围内广泛分布的人兽共患病,钩体病的诊断比较复杂,易与其他发热性疾病混淆。实验室诊断方法在钩体病诊断中占重要地位,本文就钩体病实验室诊断方法的新进展作综述。