Y Hpc VI$T NAM T H A N B e - S6 2(2011 Cue nifl'c Itftfng glil miK- Ad ulu'i tliii Hii
^j^j .V.I Ji(> mid Milng gidi hull li'HDg
Ui^iim.-vflci.V \ \\ SiCuil L i sii 11^
Hinh 2. Cue nw'v Ii6,mn iiui iiiih JOfihUJui llij.
V. KET LUAN
Si^u am B vS OCT cd nhijfng uu dilm vk nhUdc dilm ridng. NhUng dUdng nhu nhiJng nhUdc dilm cOa phUdng phcip ndy thi lai Id diem manh eOa phUdng phap kia. Ch^ng han nhu d nhCfng trUdng hdp m^t bj due mdi trUdng trong suot, sieu am B ed the khao sat phan sau nhan cau rat tot, nhung OCT thi khdng the nao thyc hien dUde. Mac du vay, doi vdi phij gai thj, cdn vj tri cu the phu nhieu nhat trdn gai Uij thi phai d\jta tren ket qua khao sat gai thi cija OCT.
TAI Lllu THAM K H A O
1. 0 5 Nhu-Hdn (2001), "Mdt V i tign bo gan doy trfln thg gidi ve ky thu$t chan doon v dieu tri b|nh 1^ vimg m?c djch kdnh", Noi san nhdn khoasd4.Xr6B-69.
2. B 8 Nhu" Hdn (200i;, Chuyen d§ d/ch kfnh vong m^CH Noi 2001.
3. Arevalo JF (2009), "Retinal and optical coherence tomograpliy" Springer science an<l business media. New York. USA.
4. Hee MR, Izzatt JA, Swanson EA, et al. Optical coherence tomography of the human retina, Amh Ophthalmol 1995; 113' 3 2 5 - 3 3 2 (s) 5. Hee MR, Pullafito CA, W o n g C, Duker JS,
Reichel E, Rutledge B, Schuman JS, Swanson EA, Fujlmoto J G . Quantitative assessment of macular edema with optical coherence tomography. Arch Ophthalmol 1995;
11: 1019-1029(3)
6. Hee MR, Puliafito CA, Wong C, et al. Optical coherence tomography of macular holes, Ophthalmology 1995; 102: 748-756 (s) 7. Houchine B, Massin P, Tadayoni R, Erginay
A, Gaudric A. Diagnosis of macular pseudoholes and iameliar macular holes t)y optical coherence tomography. Am J Ophthalmol 2004; 138 732 - 739 (s)
HIEU QUA AP DUNG MOT SO BIEN PHAP CAN THIEP CAI THIEN DIEU KIEN VE SINH 00 SOT, TRANG THIET Bj, DUNG CU SAN X U A T , CHE BIEN THUC PH^M OT BA LANG NGHE
SAN XUi^T THUC PHAM TRUYEN THONG CUA HA NOI
TOM TAT
Sau hon hai nSm ^p dung mot s6 bien phap tSng cudng quan 1^ va truyen thong - giao due ve sinh an toan thUc pham (VSATTP) doi vdi cac cd sd san xuat banh keo va banh day ci hai xa .l^ng nghe san xuSt (SX) thUc p h i m (TP) truyen thong (La Phu vS Nhj Kh6). Tlnfi hinh VS cd s6, trang thi^l bj, dung cy SX, che bien (CB) TP tai 108 cd s6 SX TP da duoc cai thien ro rSt theo chi^u hudng tdt hon lgn, cu the: Yeu c i u phai co sU each biet giij^ cac khu vUc CB TP de tranh 6 nhilm cheo tardc can thiep (CT) dat 45,4%. sau CT t5ng len 74.5% co sd (CSHQ dat 64,1%); 0 6 phong neng thay do bao ho trudc CT dat 54,6%, sau CT dat 82,7% (CSHQ dat 51,5%); Nha ve sinh c6 bon rCfa tay, xa phong v^
Nguyin Thanh Phong*, Le VSn Bao**
Nguyin Thj Lam*"
nude sach tmdc CT dat 68.5%. sau CT dat 96,3%
(CSHQ dat 40,6%).
TU khoa: V§ sinh an todn Uiuc pham. Idng ngh^ thyc pham tnjyen thong.
ABSTRACT
INTERVENTIONAL EFFICIENCY TO IMPROVE HYGIENE CONDmONS, EQUIPMENT, INSTRUMENTS
OF THREE TRADITIONAL TRADE VILLAGES OF FOOD PRODUCTION IN HANOI The research objective is assessirid effectiveness of some interventional measures ft strengthen the management and educating communication about food hygiene and safety for
*^ So y te; " Hoc vien QuSn y;"' Vi§n Dinh dudng Quoc gia
Y HQC VlgT NAM THANG 6 • sti 2/2011 more than two years in 108 food production
facilities of the traditional trade village of La Phu (producing confectionery) and Nhi Khe (producing rice cake). The results showed that, many criteria of the hygiene conditions, equipment and production instruments has improved markedly: the percentage of facilities obtaining the condition of the food processing sector to be far away from contaminated sources increased from 45.4% before inter/ention to 74.5% after intervention (value of efficacy -VE- reached 64.1%); the percentage of facilities having dressing room for safety working clothing increased from 54.6% to 82.7% (VE reached 51,5%); the percentage of facilities having toilet available hand basin, soap and clean water increased from 68.5%
to 96.3% (VE reached 40.6 %)...
Keywords: Food hygience and safety, traditional trade village.
I. OjEkT VAN o f
Sau khi ed ket qua dieu tra ve dieu kidn vd sinh (DKVS), trang thiet bi, dung san xusft (SX), che bien (CB) thyc pham (TP) tai 148 cd sd SX TP 6 ba xa lang nghe SX banh keo La Phu, gid cha Lfdc Ld va banh day Quan Ganh Nhi Khe, da phat hien thay t9 le cd sd SX TP dat yeu eau ve VS ed sd, trang thiet bj, dung cu ddi vdi mdt so ehi tidu thap, ed nguy cd g&y d nhiem TP va co t h i dan den ngo doe TP cho ngudi suf dyng. TU cd sd dieu tra thUc trang, nhdm tac gia nghien citu da phdi hdp vdi chinh quyen dja phUdng s6 tai va ed quan chuyen mdn quan \^ VSATTP hai xa lang nghe La PhiJ (huyen Hoai Difc) va Nhj Khe (huyen ThUdng Tin) tid'n hanh ap dung mot sd bidn phap can thiep ve tang cUdng quan If VSATP, tap huan, van ddng, truyen thdng giao due VSATTP...
nham muc tieu tSng t^ le cac cd sd SX thue pham dat yeu cau cac quy djnh VS cd sd, trang thiet bj, dyng eu SX, CB thue pham de
phdng ngUa d nhidm TP dan den nguy cd ngo doe TP cho ngudi sCf dung.
II. 061 TUONG VA PHUONG PHAP NGHIEN CUU 1. Oo'l tuang, dja diem, thdi gian nghien culi Cac DKVS CO s6, trang thiet bj, dung san xuat, che bien thyc phim tai 108 cd sd Sx thuc pham d 2 xa lang nghe La Phu - Ho^i DUc SX banh keo v^ Nhj Khd - ThUdng Tin SX b^nh d^y. Thdi gian nghidn ciru, tU thang 4/2008 den thang 10/2010.
2. PhUdng phap nghien curu - Thiet ke nghien cCru: ti^n eUu, dieu tra md ta ngang (trude - sau can thiep) ket hdp vdi phUdng phap hdi cUu v^ nghien euxj can thiep (khdng cd nhdm chung).
- C^c phUdng phap can thiep: Thanh lap Ban chl dao lien ng^nh VSATTP xa, to tdnh nguyen vidn ve VSATTP, to kiem tra ATVSTP.
Tap huan, hUdng dan npi dung hoat ddng cho Ban Chi dao, to kiem tra, to tinh nguyen vien; To chUc van ddng, tuyen truyen - giao due VSATTP cho cac ehCi cd sd, ngUdi trUc tllp SX, CB TP, ngudi dan trong cdng ddng bang nhieu hinh thUc khac nhau, ket hdp vdi viec tang cudng cdng tac kiem tra, giam sat VSATTP tai cac cd sd SX TP.
- PhUdng phap thu thap thdng tin: quan sat tryc tilp bing bang kiem danh gia cac DKVS cd sd, trang thiet bj, dyng SX, TP tai cac cd sd SX TP (trude - sau can thiep),
- Danh gia cac ch? tieu ve OKVS cd sd, trang thiet bi, dung SX, CB TP theo eae yeu cau quy d|nh trong Quyet dinh sd 39/2005/QD- BYT ngay 28/11/ 2005 ciia Bd Y te ve viec ban hanh "Quy dinh ve cac dieu kien ve sinh chung ddi vdi CO sd SX thyc pham" [1]. Oanh gia hieu qua can thiep bang ehi sd hieu qua (CSHQ).
III. KET QUA NGHIEN CGU VA BAN LUj|kN
1. Cai thien ve dieu kien ve sinh ddi vdi cd sd san xuat thirc pham
Bang 1. Dieu ki§n VS dja diem, mdi trudng khu SX. CB thUc phamKhu CB thuc pham t. .-
- Cach biSt vdi khu nudi si^c vat - C4ch biet vdi l<hu VS
- Co hd thonq conq ranh thoat nude tot
Trudc can thiep (n=108) SU 100 101 98
92,6
%
93,5 90,4
Sau can thiep 108) SL 107 106 106
99,1
%
98,1 98,1
P
<0,05
<0,05
<0;05 CSHQ
(%)
7,0 5,0 8,5
- Sau can thiep, t;^ le dat yeu cau ve cac dieu klen dja diem va mdi trudng sau can thidp deu
tang rd ret so vdi trUdo can thiep (p<0,05 \ih CSHQ dat tCr 5,0%-8,5%).
Y HQC VIgT NAM THAWG 6 - s 6 Zl2ni 1 Banq 2. B6 tr( l(hu s J n xuS't vS l(ho thtfc
Yeu cdu
Khu vut SX. CB duoc thift kS theo quy tSc m6t chi&
C6 SLT each biSt giffa cSc khu viic dS trdnh 6 nhilm ch6o
Kho TP khdnq bi moc, donq nuflc, ran ndt Kho TP c6 qia k& c6ch tudnq, each sAn, each trln Kho c6 thiS't bi bSo quan TP
p h ^ m Tri/dc can thi^p
(n=108) SL 84 49 101 96 101
77,8
%
45,4 93,5 88.7 93,5
Sau can thi^p (n=10S) SL 106 80 108 102 107
98,0
%
74,5 100,0 94,9 99,0
P
<0,01
<0,01
<0,01
<0,01
<0,01 CSHQ
(%)
25,9 60,1 10,1 14.8 9,0 Sau can thiSp, t j IS c4c cd sd dat cSc ySu cau v6 sinh dSu tSng r6 rSt so v6i trirac can thi^p, vdi p<0,01; CSHQ dat tif 0,1% d6n 60,1%.
Bang 3. H6 lh6'ng cCfa, Iran, san, mdng nha khu chg bign va kho chte thifc phim Trudc can thi^p
(n=108)
Sau can thi^p
(n=108) CSHQ
(%)
Ciia so, 6 thong gid nha kho c6 ludi
che chan dong vat va c6n trung 87,0
Ci>a so, 6 thdng gid khu SX cd It/di che chan ddng v5t va cdn trung TUdng, san nha, tran nha khu SX
khdng tha'm nUdc, de lam VS 9,5
Sau can thifep, t^ le cac cd s6 dat cac yeu cau v§ sinh deu tang len so v6i tn/6c can thifip (p<0,05; CSHQ dat tir 9,5% -21,6%).'
Bang 4. Tinh hinh v§ sinh be ni/dc
Ve sinh be nUdc - Khdnq ve sinh - Ve sinh 6 thdng/ lan - Ve sinh 1 nam/ lan
Trifdc can thiep (n=108) SL 23 7 78
21.3
%
6.5 72.2
Sau can thi^p (n=108) SL
8 10 90
7.4
%
9.3 83,3
P
<0,05
•=0,05
<0,05 CSHQ
(%)
43,0 15,4 Tinh hinh vS sinh be ni/6c da difac cai thien ro ret sau khi can thKp. So co sd kh6ng VS be nirdc da giam dang k l {CSHQ=65.2%).
Bang 5. ThiJng rac va xil 1^ rac. ch^t thai tai cac CO s5 SX thi/c phim Yeu c l u
Trudc can thi^p (n=108)
Sau can t h i ^ p
(n=108) CSHQ
0 6 thiing rac. khdng bj rd rl v^ c6 nap d|iy kin
VS thung rac ng^y mot l^n 4.4_
Rac, chat thai dUdc do vao thung rac chung
(thiJng kin) trong khuon vien cd sd 7.8
Sau can thiep, ty le cac co sd dat yeu cau ve vd sinh thijng rAc v& xijf ly ch^t thai sau can thiep deu tSng lien rd ret so vdi trude can thidp (CSHQ dat 4,4%-16,6%).
Bang 6. Tinh hinh ve sinh khu vtrc san x u l t thifc pham Yeu C([u khu vi^c
san xuat Duuc lam VS tnjdc va sau moi ca SX Cd bd tri bon rita tay cd ni/dc sach, xa phdng, khan sach d ^ iau tay t^i vj tri thuan tien
Trudc can t h i f p (n=108) SL 48 90
44,4
%
83,3
Sau can t h i | p (n=108) SL 57 105
52,8
%
97,2 P
<0,05
<0,C5 CSHQ
(%) -
18,9 ^ 16,7
Y HOC VIET NAM THANG 6-Sd'2/2011
Sau can thiep, t j le cac co s6 dat ySu cau ve ve sinh khu vt/c SX TP deu tang len r5 rSt so vffi tnrac can thiep (p<0,05 va CSHQ dat 16,7% va 18,9%),
Bang 7. Phong thay bao h6 iao dona tai cac cd sci SX, CB thi/c oham
Phdng thay do bao hoCd phdng rieng biet Khdnq cd phdng rieng
Trudc can thif p (n=108) SL 69 49
54.6
%
45.4
Sau can thif p (n=108)' SL 1 % 89 82,7 19 17,3 P
<0,01
<0,01 CSHQ
(%)
51,5
Sau can thigp, t} le cd sci SX, CB TP c6 phdng thay bJo ho lao dong riSng biSt da tang ISn ro ret so vai tn/ao can thiep (p<0,01 va CSHQ dat 51.59%).
Bang 8. He thong nha ve sinh tai cSc co sS sJn xult thi/c phim Yeu cSu dd'i vdi
nha v$ sinh Cd dO sd luwnq hap chuan cho cdng nhan Cd bdn rCra tav. xa phdnq va nude sach each Iv hoan toan vdi khu SX.CB TP
Trudc can thif p (n=108) SL 98 74 9
90,7
%
68,5 88,0
Sau can thif p (n=108) SL 108 104 98
100,0
%
96,3 90,7
p
<0,05
<0,06
>0,05 CSHQ
(•/.)
10,3 40,6 3,1
Sau can thiep, cac yeu cau ve nha VS ci3a cd sd SX, CB TP diu tang ISn ro r§t sd vdi tnrac can thiep (p<0,05 va CSHQ dat cao nhIt 40.6% va thlp nhIt 3,1 %).
2. Cai thien ve dieu l<ien ve sinh doi vdi trang thie) bj, dung cu SX, CB thirc pham Bang 9. Phttong lien rtfa va kha trung lay
Yeu cau
Cd thidt bi rita tay va khijr trung tai
khu CBTP • Trudc can thiep
(n=108)
Sau can thiep
(n=108) ' CSHQ
(%)
<0.05 Noi njra tay cd di^ nu'dc sach, xa
phdng. khan lau tav 91.7
Sau can thiep, cao ySu cau ve phUdng tien riJa tay va khil triing diu tang ISn r5 ret sd vdi truec can thiep (p<0,05; CSHQ dat 8.0% va 9,1%).
Bang 10. Chit sat triing tai cac cd s6 san xuat thtfc pham
Loai bansurdungDung trong bao bi de nhan biet, cd hi/dng dan si!r dunq
De each biet vdi ndi che bien, bao quan TP
Trudc can thiep (n=108) SL 97 67
%
89,8 62,0
Sau can thiep (n=108)' SL 103 101
%
95,4 93,5
P
<0,01
<0,01 CSHQ
(%)
6,2 50,8
Sau can thiSp, t^ IS cac co sd dat ySu cau
ve chit sat diu tang ISn ro ret so vdi tri/dc can thISp (p<0.01; CSHQ dat 6,2»^ vS 50,8%).
IV. KET LUljiN
Sau quS tilnh trIln l<hai ap dung mot so bien phap tang ci/dng ve quan ly, truyen thdng - giao due VSATTP d i i vai 108 co sd SX banh keo va banh day d hai xa lang nghl truyen thong (La Phu va Nhj Khe). Nhieu chl tieu ve yeu cau VS co sd, trang thilt bj, dung cu SX, CB thuc pham da dUOc cai thiSn theo chieu
hudng tot hon. Trong do, mot s6 ch? tiSu dat yeu cau vai ty IS cao nhiT: Phai c6 sir each bISt giOfa cac khu vuc CB TP de tranii 6 nhiem cheo dat 74,5% - sau CT/45,4% - tnrac CT (CSHQ=dat 64,1%); COfa so, 6 thSng gia cila khu SX CO ludi che chin ddng vSt va cdn triing dat 83,3% - sau CT)/68,5%' - tn/do CT (CSHQ=21,6%): B l nude sii dung SX, CB thtrc phim duoc lam VS dat 92,6% - sau CT/78,7%
- tnldc CT (CSHQ=1'7,8%); Khu vUC SX, CB
thuc phim dUdc lam VS trUdc va sau m6i ca
SX dat 52,8% - sau CT/44,4% - tnldc CT
(CSHQ=18,9%); c a phdng riSng thay d l bao
33
Y Hpc Vlgr NAM THANG 6 • S6 2/2011 hS dat 8 2 , 7 % - sau CT/ 5 4 , 6 % - trudc CT
(CSHQ=51,5%); Nha V S ca bfin riJa tay, xa phdng va nUdc sach dat 9 6 , 3 % - sau CT/68,5% - truac CT (CSHQ=40,6%)... Tif k i t qui nay, ca t h i t r i l n khai ap dung cac bi^n phap can thiep ra cac lang nghe SX thuc p h i m truyen thong cd dieu kiSn, hoan clinh tuong ti/, T A I LIEU T H A M K H A O
1. B f Y t f (2004). M^l s6 vin bin quin If Nhi nude v4 chS't lUQng v^ sinh an loin Ihi/C phSm (til 1998 - 2004). Ha Ndi.
2. B f Y te (2005). Ouydi d/nh s6 39/200S/QB- BYT ngiy 28/11/2005 v4 ii^ ban hinh "Quy
ainh vi cic aiu ki$n v$ sinh chung ddi vdi co sdsinxuillhucphSm".HaH^i
B? Y t f (2002). QuySl dinh sd 1052/2002/QB- BYT ngiy 29/3/2002 vi vi$c ban hinh Ihudng qui MSm tra nhanh chUt li/(}ng an tain v^ sink Ihifi phim, Ha Ndi.
B f Y t f (1999). QuySt dinh sS 419e/1999/OB- BYT ngiy 29/12/1999 vi viic ban hinh qui dinh vi chSl lupng v^ sinh an loin tht/c phSm, Ha Ndi.
Trfin Dang (2004). (5 nhiim Ihi/c phSm, Cue An toSn v f sinh thuc p h i m , Bd Y tS, Ha N6I.
XAY D U N G QUY TRINH XAC DjNH DOT BIEN GEN KRAS
Of BENH N H A N U N G THUTDAI T R U C T R A N G
T^ Thinh V i n ' , Nguyin Kioi Du', Tran Van Kh^nh' T 6 I « TAT
Gen Kiy\S cd ti le dgt bien khoang 30% trong ung thir dai tn/e trang, mpt so nghien cuU da cho thay dot bien tai codon 12 va 13 ciia gen KRAS ddng vai trd quan trpng trong qua trinh tien trien ung thir d^i tri/c bang va nguy cd khang thuoc iic che EGFR ciia khoi u.
Trong nghien cifu nay, xac djnh dot bien codon 12 va 13 cua gen KRAS da dude tien hanh tren 10 b#nh nhan ung thu" dai triTc trang sir dung ky thu?t giai trinh t u gen va ky thuat Scorpions ARMS (Sconaions- Amplification Refractory Mutation System). Ket qua cho thay 4/10 benh nhan cd dot bien codon 12 va 13 cua gen KRAS. Ket qua nay cung tu'dng tU nhU cac cdng bo tru'dc day. Nghien ciru nay da xay dutig thanh rong quy trinh xac dinh dot bien gen KRAS d bfnh nhan ung thu" dai tnrc trang.
Tir Idida: ting t k r d;i tn,il: bang, dgt blSi gen KRAS SUMMARY
The human KR/\S oncogene is mutated in over 30% of colorectal cancer and mutations in codon 12 and 13 appear to play a major roie in the progression therapy. In this study,
rodon 12 and 13 of KRAS gene are carried out in 10 rolorectal cancer patients using sequencing and Scorpions ARMS (Scorpions-Amplification Refractory Mutation System) methods. The results showed that 4 out of 10 colorectal cancer patients having the
mutation in codon 12 and 13 of KRAS gene. Tliis result is similar as previous reports. In condu^on.
Identification of KRAS gene mutation v«as successfijily applied in Vietnam.
Key word: Colorectal cancer, KRAS mutatkxi
I.
DAT VAN OEUng t h u dai t n / c trang (LTTOTO la i ^ trong ba can nguyen ung thu' gay tOf vong hang dau. Rieng khu vUc Dong Nam A hang nam co hdn 300 nghin b i n h nhan UTDTT mdi m k vfl gan 200 nghin tru'dng hop tOf tijr vong ( I J . Tai Viet Nam, Theo mot nghien cOrti ve djch te hoc phan tir gan day nhat ciia TS. Le Tran Ngoan v5 tinh hinh ung t h u tai 2 tinh thanh la Ha Npi v4 Thai Nguyen tir nSm 2005-2008 cho_ thay, LTTOTT diJng hang thir 5 sau ung thW phS, g a | da day va vom vdi ti le mac la 5,5/100.000 m N$l) va 5,7/100.000 (Thai Nguyen). Ty ^m vong ciia UTBTT dCrng hang thii' 4 vdi 7,5% ^1 Ha Ngl va 8 , 9 % tai Thai Nguyen, niJ chieJTjjtiJf cao hOn nam ( 2 ) . Chan doan sdm va dieu ^ and response of the colorectal cancer to targeted ^. . . ^ ^ ^ i ' , ^ _ ^ ^ therapy. In this study, identificabon of mutabon in ^ - ^ . r u ^ . , J r ^ T . » 7. V« ^ . V ' ' - . ,,A,
' day, dieu t n ITTDTT chu yeu la phau thu?t, hoB trj lieu va x^ trj ho^c la ket hop ca ba phiTdng phap, Gan day, cac nha khoa hpc da nghien dH mpt loai thuoc mdi tac dpng t n / c tiep len die th(
the te bao nham iTc che sir phat trien ciia te bji ung t h u gpl la lieu phap dieu trj ung thU triins
^Tning tam nghien cuii Gen-Protein, Truing Dai hoc YHa Noi 'Trung tam Y te huyen Me Linh, Ha noi
34
