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Fan Z.-X.,Shaanxi Institute for Endemic Disease Control and Research | Li Y.,Shaanxi Institute for Endemic Disease Control and Research | Li X.-Q.,Shaanxi Institute for Endemic Disease Control and Research | Bai G.-L.,Shaanxi Institute for Endemic Disease Control and Research | And 4 more authors.
Chinese Journal of Endemiology | Year: 2011

Objective: To investigate the running conditions of the water improvement projects and the role of these projects in reducing fluoride in drinking-water type of fluorosis in Shaanxi province, and provide a scientific basis for prevention and control of the disease. Methods: Forty-eight villages of 16 counties in Xi'an,. Baoji, and Yulin cities of Shaanxi province were monitored in 2009. Five water samples were collected randomly in water unimproved monitoring villages by the position of east, west, south, north, and center parts. In water improved monitoring villages, 3 tap water and one source water samples were collected. Water fluoride was tested using fluoride ion selective electrode method according to the "Standard Testing Methods for Drinking Water" (GB/T 5750-2006). All school children aged 8 to 12 in monitored villages were examined their dental fluorosis using Dean criteria. All people over 16 years old were examined clinical skeletal fluorosis, and 30% of the project counties were randomly selected, then randomly selected one village among these counties, clinically diagnosed patients with skeletal fluorosis were examined again by X-ray using "Diagnostic Criteria of Endemic Skeletal Fluorosis" (WS 192-2007). Urine samples of 30 children aged 8 to 12 and of 20 adults over the age of 16 were randomly collected, urinary fluoride was tested according to "the Determination of Urinary Fluoride by Ion Selective Electrode Method" (WS/T 89-1996). Results: Of the 22 water improvement projects that in normal operation, fluoride level of 8 source waters exceeded the standard, accounting for 36.36%(8/22), and projects scrapped 5. Two hundred and two water samples were tested. In water improved historical diseased areas, the median of water fluoride of source water and tap water were 0.72, 0.62 mg/L, respectively, and the average rate of water fluoride exceeded the standard ere 36.36% (8/22) and 31.94% (23/72), respectively. In water unimproved historical diseased areas, the median of water fluoride was 1.00 mg/L, and the average rate of water fluoride exceeded the standard was 39.81%(43/108). Detection rate of dental fluorosis among children aged 8 to 12 was 16.06% (367/2285), dental fluorosis index was 0.30, and the prevalence was negative. Detection rate of clinical skeletal fluorosis among adults over 16 years old was 5.09%(1542/30 272), a totally of 198 people had X-ray film taken, positive 68, the positive detection rate was 34.34%(68/198). One thousand and fifty-one copies of children's urine samples were tested, geometric mean of urinary fluoride was 0.95 mg/L; nine hundred and fourteen copies of adults urine samples were tested, geometric mean of urinary fluoride was 1.16 mg/L. Conclusions: Drinking-water type of fluorosis affects a large area in Shaanxi province, the disease is still serious, and the task of prevention remains very arduous. Further intensify the water improvement project in diseased areas, and strengthen disease monitoring, health education and water improvement project management is the key to prevention and control of endemic fluorosis.


Fan Z.,Shaanxi Institute for Endemic Disease Control and Research | Li Y.,Shaanxi Institute for Endemic Disease Control and Research | Li X.,Shaanxi Institute for Endemic Disease Control and Research | Li P.,Shaanxi Institute for Endemic Disease Control and Research | Bai A.,Shaanxi Institute for Endemic Disease Control and Research
Chinese Journal of Endemiology | Year: 2015

Objective: To investigate the current situation of coal-burning-borne endemic arsenism in the disease affected areas, the usage of anti-arsenism stove and the formation of related behavior; to evaluate the control effect, so as to provide a basis for development of control strategies. Methods: Surveillances were carried out according to the provisions and requirements of "The Surveillance Project for Shaanxi Institute Coal-Burning-Borne Endemic Arsenicosis (Trial.)". Four villages in two counties of Ankang city and Hanzhong city in Shaanxi Province were monitored in 2010-2014. Using simple random sampling method, 10 families in each village were randomly selected to survey the situation of the stove used and related behavior changes. Five households in each village were randomly selected; arsenic level in coal was determined; high arsenic exposed population was investigated according to "Endemic Arsenism Diagnostic Criteria" (WS/T 211-2001). Urine samples of 30 patients with arsenism were randomly selected to determine the arsenic content. Results: The proper utilization rate and the qualified households of improved stoves and iron stoves were all low; the correct drying rate and the correct storage rate of peppers and corns were higher than 95%. The washing rate of corns and peppers before eating were all 100%. A total of 100 copies of coal samples were tested and the arsenism content was between 12.295-455.827 mg/kg, and the geometric mean value of the arsenism content was (91.819 ± 80.989) mg/kg. Seventeen thousand eight hundred and fifty-five individuals were investigated and 1 232 cases of arsenism were diagnosed in the 4 villages; the prevalence rate was 6.90% (1 232/17 855); urinary arsenism content was between not detected - 0.287 mg/L; and the geometric mean value of the arsenic content was 0.033 mg/L. Conclusions The coal-burning-borne endemic arsenism in Shaanxi is in a prevalent state; many anti-arsenism stoves are out of order; and the proper utilization rate is low. To strengthen the disease surveillance, health education and management of antiarsenism stoves are key measures in control of coal-burning borne endemic arsenism in the future.


Dai H.,Shaanxi Institute for Endemic Disease Control and Research | Hua J.,Shaanxi Institute for Endemic Disease Control and Research | Ma Z.,Shaanxi Institute for Endemic Disease Control and Research | Zhou Y.,Shaanxi Institute for Endemic Disease Control and Research | And 5 more authors.
Chinese Journal of Endemiology | Year: 2014

Objective: To analyze the effectiveness of control measures on iodine, deficiency disorders (IDD), and to perfect the continued eliminating program of IDD control in Shaaxi Province. Methods: In 1995, 1997, 1999, 2002, 2005 and 2011, by using probability proportionate to size sampling(PPS) method, 30 counties (cities, districts) in Shaaxi Province were selected, and one school was chosen from each county (cities, districts); in each school 42 children aged 8-10 were selected to measure their, thyroid volumes and collect salt samples from their homes for determination of iodine content. Twelve out of the 42 children were selected to detect their urinary iodine content. In 2011, 3 townships (towns, street offices) were selec.ted near schools, and 5 pregnant and 5 lactating women were chosen, respectively, to test their urinary iodine content. In others 77 counties (cities, districts) of Shaanxi Province, each county (cities, districts) was divided into 5 areas according to their locations of east, south, west, north, and middle, and one school was chosen in each area; 15 students were sampled in each school, and the average daily salt intake of domestic residents of their family members was measured by 3 days weighing method. Results: The goiter rat of children aged 8-10 was decreased from 23.9%(574/2 400) to 4.5% (57/1 260) examined by palpation. The qualified rat of iodized salt was increased from 24.7% (593/2 400)' to 98.1%(1 236/1 260) in 1995 to 2011, and kept at higher than 95.0% since 2005. The urinary iodine medians were between 253/) and 288.0 μg/L since 1999, and 39.3%(141/359) - 59.9%(238/398) of them were more than 300 μg/L, which were in the over appropriate status. The urinary iodine content of pregnant and lactating women were between 12.4 and 1500.0 μg/L,which median was 235.5 μg/L, belonged to the appropriate status,and 46.1% (416/902) of them were more than 250 μg/L. The average daily salt intake of each person was (9.5 ± 3.2)g. Conclusions: The control measurements for IDD are well implemented in Shaaxi Province and the national standard for elimination of IDD is achieved. But the iodine nutrition of people is in the over appropriate level, and the iodine content of salt should be properly reduced.


Liu X.-L.,Shaanxi Institute for Endemic Disease Control and Research | Bai G.-L.,Shaanxi Institute for Endemic Disease Control and Research | Fan Z.-X.,Shaanxi Institute for Endemic Disease Control and Research | Li Y.,Shaanxi Institute for Endemic Disease Control and Research | And 3 more authors.
Chinese Journal of Endemiology | Year: 2010

Objective: To investigate the current situation of endemic fluorosis associated with drinking water in Shaanxi province in 2008, providing prevention and control work with scientific evidence. Methods: According to data of drinking water endemic fluorosis in Shaanxi, 15 counties in Yulin, Weinan and Xianyang city were divided into mild, moderate and severe diseased areas according to fluoride level in the drinking water or the fluorosis severity, and 12,39,45 endemic fluorosis villages were selected respectively from each area. Dental fluorosis for all the children aged 8-12 years old and clinical skeletal fluorosis for the people over the age of 16 were examined. In mild, moderate and severe areas, 30% of the survey villages received X-ray to examine skeletal fluorosis. Five water samples were collected from villages with unimproved water respectively from the east, the west, the south, the north, the middle; if there was less than 5 that could be sampled, then all were collected, moreover 3 peripheral and 1 central water samples were collected from villages with improved water. Also in mild, moderate and severe illness areas, 50% of the surveyed villages were selected ; in each village, 30 urine samples of the children aged 8-12 were collected, 6 portions in each age group. If less than 30 children in all the age groups or less than 6 in each age group, all their urine samples were collected to determine fluoride. Results: Totally 3652 children aged 8-12 years old were examined and 1930 cases of dental fluorosis were diagnosed, the rate was 52.85% and the index was 1.22. The rates in Dingbian, Jingbian and Pucheng village were higher, being 90.43% (170/188),82.89%(126/152),80.65%(325/403) respectively. A total of 40 543 adults over the age of 16 were examined and 5935 cases of skeletal fluorosis were diagnosed, in a rate of 14.64%. The rates of the mild, moderate, severe skeletal fluorosis were respectively 9.17%(3717/40 543),4.36%(1769/40 543),1.11%(449/40 543). All 706 adults were taken X-ray films, and 280 cases of positive change were diagnosed, the positive rate was 39.66%. The rates of the mild, moderate, severe change were respectively 17.28% (122/706), 17.00%(120/706),5.38% (38/706). All 427 water samples were collected, the fluoride content was (2.22 ±1.41) mg/L, and the abnormal rate was 85.01%(363/427). All 1393 portions of urine sample were collected in children and the median of fluoride was 2.37 mg/L. Conclusions: The endemic fluorosis associated with drinking water is still comparatively serious in Shaanxi. The preventive measures for improving water must be improved.


Bai A.,Shaanxi Institute for Endemic Disease Control and Research | Li Y.,Shaanxi Institute for Endemic Disease Control and Research | Fan Z.,Shaanxi Institute for Endemic Disease Control and Research | Li X.,Shaanxi Institute for Endemic Disease Control and Research | Li P.,Shaanxi Institute for Endemic Disease Control and Research
Chinese Journal of Endemiology | Year: 2014

Objective: To investigate the influence of fluoride and arsenic exposure on children's intelligence and growth development. Methods: The illness seriously and lightly affected areas in the coal-burning-borne arsenism and fluorosis areas in the south part of Shaanxi were selected as survey sites from 2011 to 2012, while the illness non-affected areas as controls. Children's IQ was tested, dental fluorosis and growth level of 8 -12-year-old students in the school were investigated by random sampling, and the differences of children's IQ and the level of their growth among different groups were analyzed. Urine samples of the children were collected to determine the fluoride and the arsenic content. Results: In the illness seriously affected, lightly affected and non-affected areas, the medians of urinary fluoride of children were 1.96, 0.81 and 0.54 mg/L, respectively; and the medians of their urinary arsenic were 0.023, 0.019 and 0.018 mg/L, respectively. The average IQ levels were 101.22 ± 15.97, 104.83 ± 12.78 and 107.92 ± 13.62, respectively. In illness seriously affected, lightly affected and non-affected areas, the differences of their height, weight, chest circumference and lung capacity between groups(x2 = 36.549, 25.859, 28.021 and 45.627, all P < 0.01) were significantly different. The height, weight, chest circumference and lung capacity of the children in illness seriously affected (136 cm, 31 kg, 64 cm, 1 432 ml) and lightly affected areas (137 cm, 30 kg, 65 cm, 1 433 ml) were all less than those of the illness non-affected areas (141 cm, 34 kg, 67 cm, 1 660 ml, Z=-5.858, -4.151, -4.196, -4.500, -5.189, -3.240, -6.698 and -4.008, all P < 0.01); lung capacity of children in illness seriously affected areas was less than that of the illness lightly affected areas (Z= -2.395, P < 0.05). Their urinary fluoride and arsenic levels were negatively correlated with their IQ (r= -0.560, -0.353, all P < 0.05). Conclusions: Fluorine and arsenic exposure is not conducive to children's intellectual development and growth. We propose to strengthen the measure of changing stove furnace in order to provide a healthy growth environment for children.


Fan Z.,Shaanxi Institute for Endemic Disease Control and Research | Liu X.,Shaanxi Institute for Endemic Disease Control and Research | Bai G.,Shaanxi Institute for Endemic Disease Control and Research | Li X.,Shaanxi Institute for Endemic Disease Control and Research | And 2 more authors.
Chinese Journal of Endemiology | Year: 2014

Objective: To investigate the characteristics of X-ray signs of water-related and coal-burning borne endemic fluorosis in Shaanxi Province, so as to provide a theoretical basis for revising X-ray diagnostic criteria of skeletal fluorosis in the future. Methods: The X-ray data of 2 525 cases of patients with endemic fluorosis from the central subsidies to local public health programs were collected from 2008 to 2011, and the X-ray signs, age, gender distribution, detection rate were analyzed statistically; skeletal fluorosis was diagnosed on the basis of skeletal diagnostic criteria (WS 192-2008). Results: The 2 525 cases observed were taken X-ray film on forearm and shank. In the X-ray signs of patients from fluorosis areas, the detection rates were higher, and these signs were mainly radial crest of increase, marginal sclerosis, surface thickening and forearm interosseous membrane ossification and forearm interosseous membrane calcification which showed bud break ground sign, which accounted for 29.91% (242/809), 17.92% (145/809) and 17.69% (143/809), respectively. Three X-ray signs occurred in the forearm, and the total detection rate based on the forearm signs was 88.12% (721/809); 682 cases of skeletal fluorosis were detected and the detection rate was 27.01% (682/2 525), including 401 mild cases accounting for 15.88% (401/2 525); 236 moderate cases that accounted for 9.35% (236/2 525); 45 severe cases accounted for 1.78% (45/2 525). With age, the prevalence increased gradually. After the age of 55 reached the peak, and the difference was significant statistically between different ages (χ2 = 228.58, P < 0.05). The total prevalence was not significantly different between male group and female group (χ2 = 0.74, P > 0.05). Conclusions: With age, the prevalence of skeletal fluorosis is increased, and the skeletal fluorosis is not different between different sexes. The X-ray sign results have showed that the prevalence based on forearm signs is high and specific. We suggest to diagnose skeletal fluorosis by the X-ray signs of the forearm in the diagnostic standard revision, so as to reduce financial input, workload and radiation level to the patient.

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