土壤性质在出生缺陷环境风险中的指示作用

为研究土壤性质在出生缺陷环境风险中的指示作用,考虑了区域人口分布和疾病空间结构,使用Bayesian方法,对山西省和顺县连续4年的神经管畸形发生的数据进行了处理,并使用非参数统计的方法,结合土壤环境过程机理,对土壤的理化性质和出生缺陷的环境风险做了系统分析. 结果表明:土壤的机械组成,阳离子交换量(CEC),pH,有机质含量及碳酸钙含量都与神经管畸形发生率显著相关. 土壤砂粒含量高的地区,神经管畸形发生的风险会显著增加;土壤粘粒含量高的地区,神经管畸形发生的风险会显著降低. 土壤阳离子交换量高的地区,神经管畸形发生的风险会显著降低. 在偏碱性土壤且pH较高的地区,神经管畸形发生的风险会显著降低.在有利于土壤提供有效形态重金属及稀土元素的环境条件下,神经管畸形发生率会显著提高.在影响神经管畸形发生的环境因素中,土壤介质中各形态元素的有效含量比其总量具有更强的指示作用.      

Evaluation of prenatal diagnosis of associated congenital heart diseases by fetal ultrasonographic examination in Europe

Ultrasound scans in the mid trimester of pregnancy are now a routine part of antenatal care in most European countries. With the assistance of Registries of Congenital Anomalies a study was undertaken in Europe. The objective of the study was to evaluate prenatal detection of congenital heart defects (CHD) by routine ultrasonographic examination of the fetus. All congenital malformations suspected prenatally and all congenital malformations, including chromosome anomalies, confirmed at birth were identified from the Congenital Malformation Registers, including 20 registers from the following European countries: Austria, Croatia, Denmark, France, Germany, Italy, Lithuania, Spain, Switzerland, The Netherlands, UK and Ukrainia. These registries follow the same methodology. The study period was 1996–1998, 709 030 births were covered, and 8126 cases with congenital malformations were registered. If more than one cardiac malformation was present the case was coded as complex cardiac malformation. CHD were subdivided into ‘isolated’ when only a cardiac malformation was present and ‘associated’ when at least one other major extra cardiac malformation was present. The associated CHD were subdivided into chromosomal, syndromic non-chromosomal and multiple. The study comprised 761 associated CHD including 282 cases with multiple malformations, 375 cases with chromosomal anomalies and 104 cases with non-chromosomal syndromes. The proportion of prenatal diagnosis of associated CHD varied in relation to the ultrasound screening policies from 17.9% in countries without routine screening (The Netherlands and Denmark) to 46.0% in countries with only one routine fetal scan and 55.6% in countries with two or three routine fetal scans. The prenatal detection rate of chromosomal anomalies was 40.3% (151/375 cases). This rate for recognized syndromes and multiply malformed with CHD was 51.9% (54/104 cases) and 48.6% (137/282 cases), respectively; 150/229 Down syndrome (65.8%) were livebirths. Concerning the syndromic cases, the detection rate of deletion 22q11, situs anomalies and VATER association was 44.4%, 64.7% and 46.6%, respectively. In conclusion, the present study shows large regional variations in the prenatal detection rate of CHD with the highest rates in European regions with three screening scans. Prenatal diagnosis of CHD is significantly higher if associated malformations are present. Cardiac defects affecting the size of the ventricles have the highest detection rate. Mean gestational age at discovery was 20–24 weeks for the majority of associated cardiac defects. Copyright © 2001 John Wiley & Sons, Ltd.     

Health Impact Evaluation of Boron in Drinking Water: A Geographical Risk Assessment in Northern France

Objective: To evaluate health impact of boron in drinking water. Methods: A regional scale geographical study in Northern France was conducted. Assessment of boron blood levels in a group of 180 healthy individuals and correlation with boron content in drinking water were followed by an assessment of health indicators such as birth rates, mortality rates, and sex ratios in zones of different boron content in drinking water. Results: After necessary adjustments, men living in municipalities with more than 0.30 mg/L of boron in drinking water had elevated but not significant boron blood levels compared with those living in municipalities with boron water levels of less than 0.30 mg/L (159.1 versus 123.0 ng/g; p > 0.05). The standardized birth ratio adjusted for the reference geographic zone and calendar time period was 1.07 and 1.28 in the low and high (>0.3 mg/L) boron content municipalities, respectively. The birth rate in municipalities with high boron content in drinking water was higher than that of the reference geographic zone and of the French general population (p < 10^-4). The standardized mortality ratio adjusted for the reference geographic zone and calendar time period was 0.94 and 0.92 in the low and high boron content municipalities, respectively. The mortality rate in municipalities with high boron content in drinking water was less than that of the reference geographic zone and of the French general population (p < 10^-3). No statistical difference was noted in the male–female sex ratios between the different municipality zones (p = 0.45). Conclusions: The results of this study do not support the idea of a deleterious effect of boron on human health, at the boron water level contents found in this specific region. In fact, there is a tendency toward a beneficial effect with low-dose environmental exposure (less than 1 mg/L of boron) in drinking water.