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Objective:To analyze the surveillance data of Kashin-Beck disease (KBD) in Shandong Province, master the changes of KBD, and provide scientific basis for formulating prevention and control strategies of KBD and adjustment of the prevention and control focus of KBD.Methods:According to the requirements of the "National KBD Monitoring Plan" and the "Shandong KBD Monitoring Plan", from 2016 to 2020, the disease monitoring was carried out in the villages of KBD areas in Shandong Province, including the number of clinical positive cases, the number of X-ray positive cases, and the number of metaphyseal positive cases. The detection rate was calculated, and the dynamic changes of the disease was analyzed macroscopically.Results:From 2016 to 2020, a total of 1 816 children aged 7 - 12 years were clinically examined in Shandong Province, and no child with KBD was found. A total of 1 224 children were examined by X-ray, among which 1 positive patient was found in 2016 and 2017, respectively, both of whom were metaphyseal changes, with a total detection rate of 0.16%. There were 367 adult patients with KBD in Shandong Province, including 304 patients with grade Ⅰ, 47 patients with grade Ⅱ and 16 patients with grade Ⅲ. All villages in the KBD areas in Shandong Province had reached the elimination standard, with the elimination rate of 100%.Conclusion:No clinical case of KBD is detected in children aged 7 - 12 years in Shandong Province from 2016 to 2020, which has reached the elimination standard and is in a continuous elimination state.
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Objective:To evaluate the effect of health education of a three-year special action for prevention and control of drinking water-borne endemic fluorosis (referred to as drinking water-borne fluorosis) in Shandong Province, and to provide basis for formulating health education measures in the next step.Methods:Nineteen of the disease affected counties (cities and districts) were selected as project counties (cities and districts) in key areas for prevention and control of drinking water-borne fluorosis in Shandong Province in 2018, and 50 disease affected counties (cities and districts) were selected in 2019, and the project counties (cities and districts) were expanded to all of the 105 disease affected counties (cities and districts) in Shandong Province in 2020. Three disease affected townships (towns) were selected in each county (city and district), and health education activities on drinking water-borne fluorosis were carried out in Grade 4 to Grade 6 of the central primary schools and the three villages under its jurisdiction. Students and housewives were selected to conduct questionnaire surveys on prevention and control knowledge of drinking water-borne fluorosis before and after health education. The incidence of dental fluorosis among children aged 8 - 12 years was investigated annually in 6 villages (with children aged 8 - 12 years > 50) , where health education activity was implemented and the incidence of dental fluorosis among children was > 30%, water fluoride content was > 1.5 mg/L and water improvement time was < 5 years.Results:After health education, the awareness rates of drinking water-borne fluorosis in fifth grade pupils [92.46% (4 571/4 944) vs 65.80% (3 334/5 067) in 2018; 94.84% (12 897/13 599) vs 73.55% (9 993/13 587) in 2019; 95.59% (30 407/ 31 809) vs 77.52% (24 463/31 557) in 2020] and housewives [94.12% (2 400/2 550) vs 76.04% (1 939/2 550) in 2018; 94.99% (6 412/6 750) vs 72.00% (4 860/6 750) in 2019; 95.53% (16 183/16 941) vs 78.43% (12 971/16 539) in 2020] were significantly improved (χ 2 = 1 070.47, 2 315.27, 4 456.40, 328.25, 1 294.80, 2 174.63, P < 0.05). After health education in 2020, there were significant differences in the correct answer rates of epidemic causes, hazards and preventive measures of drinking water-borne fluorosis in the questionnaire of fifth grade pupils and housewives (χ 2 = 390.78, 164.94, P < 0.05). The awareness rates of drinking water-borne fluorosis in fifth grade pupils and housewives in the eastern region (Qingdao City, Yantai City and Weifang City) were significantly higher than those in the western region (Dezhou City, Liaocheng City and Heze City) before health education (χ 2 = 547.43, 210.12, P < 0.05), and after health education, the awareness rates increased to more than 90%. The detection rate of dental fluorosis in children decreased year by year (χ 2trend = 27.95, P < 0.05). Conclusions:Through implementation of a three-year special action for prevention and control of drinking water-borne fluorosis in Shandong Province, the awareness rate of fluorosis among target populations has been significantly improved. However, it is still necessary for government departments to further increase investment in health education and carry out health education activities in a deep-going way.
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Objective:To dynamically monitor the prevalence and trend of dental fluorosis in children in Shandong Province, and to evaluate the prevention and control measures for drinking water-borne endemic fluorosis (referred to as drinking water-borne fluorosis), and to provide scientific basis for the next step.Methods:Totally 40 counties (cities, districts) were selected as project counties (cities, districts) from drinking water-borne fluorosis areas in Shandong Province in 2018, and all counties (cities, districts) were selected in 2019 and 2020, to investigate the situation of water improvement, detect water fluoride content, and investigate the prevalence of dental fluorosis in children aged 8 - 12 years.Results:From 2018 to 2020, the detection rates of dental fluorosis in children aged 8 - 12 years were 10.30% (503/4 884), 8.94% (25 895/289 539) and 8.66% (24 061/277 689), respectively, with statistically significant differences (χ 2 = 27.10, P < 0.001), and the dental fluorosis indexes were 0.21, 0.18 and 0.17, respectively. The total detection rates of dental fluorosis in children of different age groups in the 3 years were 7.26% (6 590/90 775), 7.97% (9 303/116 680), 9.29% (12 167/130 915), 9.29% (12 238/131 670) and 9.95% (10 161/102 072), the differences were statistically significant (χ 2 = 615.71, P < 0.001). In the 3 years, the total detection rate of dental fluorosis was 8.93% (28 101/314 737) in boys and 8.69% (22 358/257 375) in girls, the difference was statistically significant (χ 2 = 10.27, P = 0.001). In 2018 and 2019, the detection rates of dental fluorosis of children aged 8 - 12 years in water fluoride qualified villages [5.74% (235/4 095) and 7.98% (20 200/253 082)] were significantly lower than those in villages with excessive water fluoride [33.97% (268/789) and 15.62% (5 695/36 457), χ 2 = 570.61, 2 283.76, P < 0.001]. Conclusions:The prevalence of dental fluorosis among children aged 8 - 12 years has been effectively controlled, and remarkable results have been achieved in prevention and treatment of drinking water-borne fluorosis in Shandong Province. However, the detection rate of dental fluorosis among children in a few endemic villages is high, so it is necessary to continue to strengthen the monitoring of fluoride content in drinking water and the condition of dental fluorosis among children.
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Objective To understand the defluoridation effect in the historical severe endemic fluorosis areas of Shandong Province,and to analyze characteristics of children's dental fluorosis and related factors.Methods In 2015,using cross-sectional survey,11 villages in historical severe endemic fluorosis counties were selected for water fluoride test according to previous investigation of endemic diseases in Shandong Province.In which,4 normal water fluoride villages,4 excessive water fluoride villages and 3 villages without water improvement were included.Dental fluorosis in children aged 7 to 12 was examined and urine fluoride was measured.Logistic regression was used to analyze the related factors affecting the detection rate of dental fluorosis.Results A total of 732 children aged 7 to 12 were examined,with total detection rate of dental fluorosis 73.2％ (536/732).The detection rate of dental fluorosis was 31.0％ (65/210),86.7％ (176/203) and 92.5％ (295/319) in the villages with normal,excessive and without water improvement villages,respectively.And the differences were statistically significant (x2 =270.498,P ＜ 0.01).The prevalence of dental fluorosis in girls (77.4％,264/341) was significantly higher than that in boys (69.6％,272/391,x2 =5.337,P ＜ 0.05),and the dental fluorosis prevalence in elderly group (10-12 years old,76.9％,382/497) was higher than that of younger group (7-9 years old,65.5％,154/235),the difference was statistically significant (x2 =10.445,P ＜ 0.05).In water fluoride normal villages,the detection rate of dental fluorosis in girls (40.0％,36/90) was higher than that in boys (24.2％,29/120,x2 =6.033,P ＜ 0.05).In water fluoride unqualified villages,the dental fluorosis prevalence rates in boys and girls were 89.7％ (243/271) and 90.8％ (228/251),and the difference was not statistically significant (x2 =0.202,P ＞ 0.05).The urinary fluoride content of children with dental fluorosis was higher than that of non-fluorosis children [(4.5 ± 2.7) vs (1.9 ± 1.5) mg/L,t =-8.125,P ＜ 0.01].Logistic analysis showed that the risk of children's dental fluorosis in unqualified water fluoride village was 14.362 times high than that of normal water fluoride villages.The risk of dental fluorosis in children with high urinary fluoride was 2.497 times higher than that in normal urinary fluoride group.The risk of detecting moderate and severe fluorosis in children in the elderly group was 2.270 times higher than that in the younger group.The risk of detecting moderate and severe dental fluorosis in girls was 1.988 times higher than that in boys.The risk of detecting moderate and severe dental fluorosis in children in unqualified water fluoride villages was 49.190 times higher than that in normal water fluoride villages.Conclusions Water-quality-improvement project is an effective means to control the epidemic of dental fluorosis in children in severe fluorosis areas.Age,gender and water fluoride are influencing factors associated with dental fluorosis.
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Objective To summarize the microsurgical techniques for removal of large neoplasms located in the suprasellar,back of sellar region and anterior part of third ventricle through bilateral frontobasal interhemispheric approach.Methods Fifty-six patients with large neoplasms located in the suprasellar,back of sellar region and anterior part of third ventricle,admitted to our hospital from January 2002 to January 2013 and performed removal via bilateral frontobasal interhemispheric approach; their clinical data and treatment efficacy were analyzed retrospectively.The microsurgical techniques were summarized,and the factors affecting the prognosis were analyzed.Results Total removal of the tumors was achieved in 49 patients (88％) and subtotal removal in 7 (12％).The pituitary stalk was reserved in 47 patients (84％),severed in 4 (7％),and unidentified in 5 (9％).The bilateral olfactory nerves were successfully preserved in 50 patients (89％) and unilateral severed in 6 (11％).Visual impairment was found in 41 patients before surgery,39 of them achieved postoperative visual improvement and 2 patients had no change during the follow-up at 6 months.In our series,there were no procedure-related mortalities and bacterial meningitis.Unilateral anosmia was detected on examination in 2 patients.Minimal frontal lobe contusion developed in 2 patients but resolved within 3 weeks.Cerebrospinal fluid leakage occurred in 1 patient,which was cured for 2 week.Transient diabetus insipidus developed in 25 patients but resolved within 1 month; permanent postoperative diabetes insipidus was present in 5 patients during the follow-up at 6 months.During the follow-up of 12 months,56 patients (100％) gained Glasgow outcome scale (GOS) scores of 5,only 4 (7％) patients with tumors resected partially had tumor relapse and received surgery again.Conclusions The bilateral frontobasal interhemispheric approach is appropriate for removing tumors located in the suprasellar,back of sellar region and anterior part of third ventricle.With sufficient exposure of lesion,the important anatomic structures such as the pituitary stalk,hypothalamic structure,perforating vessels,anterior communicating complex,the visual pathway,and the olfactory nerves could be preserved effectively.The surgery via this approach can increase total removal rate of the tumors,decrease the complications and achieve a good outcome.