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研究生:謝佳容
研究生(外文):Chia-Jung Hsieh
論文名稱:一、出生體重及懷孕週數別新生兒及嬰兒死亡率二、探討陶斯松暴露對胎兒成長及神經行為發展之影響
論文名稱(外文):1.Birth Weight- and Gestational Age-Specific Neonatal and Infant Mortality 2.Exploring the Risk of Chlorpyrifos on Fetal Growth and Neonatal Neurobehavior
指導教授:陳保中陳保中引用關係
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:職業醫學與工業衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文出版年:2005
畢業學年度:93
語文別:英文
論文頁數:80
中文關鍵詞:陶斯松出生結果有機磷出生體重頭圍身長出生週數神經行為
外文關鍵詞:Chlorpyrifosbirth outcomesorganophosphatesChlorpyrifosbirth outcomesorganophosphatesbirth weighthead circumferencebirth lengthgestational birth weighthead circumferencebirth lengthgestational
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研究背景:農藥在世界上已被大量使用,而其主要用途是用來作為預防及殺死害蟲及用在農田作物上或居家的蟲害控制。在台灣,每年大約有500種農藥被允許使用,其使用量每年大約有10萬公噸。而在2003台灣使用最大量的農藥是有機磷殺蟲劑,其中更以陶斯松的使用量為最多。此種非持續性農藥被使用在室內及室外、都市及鄉村地區,在食物、飲用水、農田、家中、學校及公園中都能被發現。在室內的使用後,有機磷農藥都還能穩定的持續幾天或幾星期。以陶斯松為例,在室內分噴灑後其還能持續至少兩週以上。而其暴露可能的健康影響仍然尚未清楚,因此探討其健康危害就很重要。目前有三個美國的研究指出農藥暴露對於出生體重,頭圍,身長及出生週數有些微影響但未一致的結論。而其對於神經行為發展的影響在人類流行病學研究上是欠缺且上無定論的,因此此研究目的即探討有陶斯松暴露對於嬰兒生長及神經行為發展的影響。
研究設計:此研究設計是一橫斷性的研究。研究的族群是在2004年8月至2005年1月在臺北生產的孕婦及其嬰兒共81對。為了控制其他可能的影響出生結果的危險因子,我們剔除產婦年齡低於18歲或高於40歲、有抽煙史的產婦。我們在其產前即將其列入研究,並以結構性問卷進行問卷訪視、並收集母親血液、尿液及新生兒臍帶血,並分析臍帶血中陶斯松濃度,最後我們透過複迴歸統計方法探討暴露對出生結果及神經行為發展的影響。
結果:複線性迴歸統計結果發現,較高的臍帶血陶斯松濃度和較短的出生身長及較低的出生體重計有顯著的相關。而邏輯斯廻歸結果也顯示較高的臍帶血陶斯松濃度和較低出生身長及SGA 有關。
Background: Pesticides were widespread used all over the world. They were substances that were used to prevent or destroy pests, and were wildly used in agriculture on crops, and at homes for pest control. More than five hundred kinds of pesticides were licensed for use in Taiwan, and more than ten thousands metric tons of pesticides were applied annually. Organophosphates were the largest amount of used pesticides in Taiwan in 2003, and chlorpyrifos was the most one. These pesticides were used indoors and outdoors in either urban or rural areas, and could be found in food, water, agricultures, homes, schools, and parks. In the indoor settings, they could still remain stable for days or weeks; for example, chlorpyrifos could persist for at least two weeks after spreading. The potential health effect was still unknown, and exploring the health effect was important. Only three recent studies in the U.S. had reported inconsistent and slight effect on birth weight, head circumference, birth length and gestational age. The effect for neurodevelopment on human study was absence and not concluded. Thus, the aim of the study was to explore the risk of organophosphate pesticides on fetal growth and neurodevelopment.
Material and Methods: This study was a cross-sectional in design. The study populations were the mothers who gave births in Taipei between August 2004 and January 2005 and their infants. A total of 81 pregnancy women were included in the study. To control potential risk factors for adverse birth outcomes, we excluded women if they were younger than 18 years old or older then 40 years old, or had the history of cigarette smoking. We enrolled them before delivery, interviewed by a structured questionnaire, and collected mother’s blood and urine and umbilical cord blood and analysis chlorpyrifos concentration in cord blood. We shall use multiple regression models to explore the effect of chlorpyrifos exposure on birth outcomes and neurodevelopment.
Results: For multiple linear regression models, we found that the associations between birth length and birth weight and cord plasma chlorpyrifos were significantly. For multiple logistic regression models, we found that the associations between birth length and small for gestational age (SGA) and cord plasma chlorpyrifos were significantly.
Birth Weight- and Gestational Age-Specific Neonatal and Infant Mortality
致謝 2
Table of Content 4
List of Tables 5
List of Figure 7
Introduction 8
Material and Methods 9
Data sources 9
Study population 9
Statistics 10
Results 11
Discussion 12
References 26
Appendix 27

Table 1. Characteristics of gestational age between 20 weeks and 44 weeks newborns between 1998 and 2002 in Taiwan (n=1,339,951) 14
Table 2. Modeling early neonatal mortality rate (per thousand) in male live births between 1998 and 2002 in Taiwan 16
Table 3. Modeling neonatal mortality rate (per thousand) in male live births between 1998 and 2002 in Taiwan 17
Table 4. Modeling infant mortality rate (per thousand) in male live births between 1998 and 2002 in Taiwan 18
Table 5. Modeling early neonatal mortality rate (per thousand) in female live births between 1998 and 2002 in Taiwan 19
Table 6. Modeling neonatal mortality rate (per thousand) in female live births between 1998 and 2002 in Taiwan 20
Table 7. Modeling infant mortality rate (per thousand) in female live births between 1998 and 2002 in Taiwan 21
Table 8 .Poisson regression model result for mortality rate by different gender 22
Table 9. Male live births by birth weight and gestational age between 1998 and 2002 in Taiwan 27
Table 10. Early neonatal deaths in male live births between 1998 and 2002 in Taiwan 28
Table 11. Neonatal deaths in male live birth between 1998 and 2002 in Taiwan 29
Table 12. Infant deaths in male live births between 1998 and 2002 in Taiwan 30
Table 13. Early neonatal mortality rate (per thousand) in male live birth between 1998 and 2002 in Taiwan 31
Table 14. Neonatal mortality rate (per thousand) in male live births between 1998 and 2002 in Taiwan 32
Table 15. Infant mortality rate (per thousand) in male live births between 1998 and 2002 in Taiwan 33
Table 16. Female live births by birth weight and gestational age between 1998 and 2002 in Taiwan 34
Table 17. Early neonatal deaths in female live births between 1998 and 2002 in Taiwan 36
Table 18. Neonatal deaths in female live births between 1998 and 2002 in Taiwan 37
Table 19. Infant deaths in female live births between 1998 and 2002 in Taiwan 38
Table 20. Early neonatal mortality rate (per thousand) in female live births between 1998 and 2002 in Taiwan 39
Table 21. Neonatal mortality rate (per thousand) in female live births between 1998 and 2002 in Taiwan 40
Table 22. Infant mortality rate (per thousand) in female live births between 1998 and 2002 in Taiwan 41

List of Figure
Figure 1.The birth weight-specific mortality rate by gender between 1998 and 2002 in Taiwan 24
Figure 2. The gestational age-specific mortality rate by gender between 1998 and 2002 in Taiwan 25


Exploring the Risk of Chlorpyrifos on Fetal Growth and Neonatal Neurobehavior


摘要 44
Abstract 45
Table of Contents 47
List of Tables 48
Introduction 49
Material and Methods 51
Study population and design 51
Questionnaire 51
Biological sample collection and analysis 52
Birth outcomes 52
Neurodevelopment 53
Statistical analysis 53
Results 55
Discussion 61
Referencd 64
Appendix 1- literature Review 68
Appendix 2 - Inform Consent 78


Table 1. Distribution of maternal characteristics in Taiwan birth cohort study 57
Table 2. Distribution of infant characteristics in Taiwan birth cohort study 58
Table 3 Linear regression models of the concentrations of log10 transform chlorpyrifos concentration (ppb) in umbilical cord blood with birth outcomes and Neonatal Neurobehavioral examination score 59
Table 4 Univariate and multiple logistic regression models of the concentrations of chlorpyrifos (ppb) in umbilical cord blood with birth outcome and Neonatal Neurobehavioral examination score 60
一、出生體重及懷孕週數別新生兒及嬰兒死亡率
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二、探討陶斯松暴露對胎兒成長及神經行為發展之影響

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