广州市PM_(2.5)浓度与人群每日死亡风险的空间分布特征

目的了解广州市大气PM_(2.5)暴露对居民每日死亡的影响及其空间分布特征。方法收集2013年1月1日—2014年12月31日期间广州市十二个区(县级市)31个大气监测站点的PM_(2.5)每日数据、气象数据和居民每日死亡数据,采用克里格插值模型和分布滞后非线性模型的时间序列分析方法,分别从全市及12个行政区域的大气PM_(2.5)污染状况及其对居民每日死亡的影响进行评估分析。结果研究期间,全市PM_(2.5)的年平均暴露浓度为49.5±25.6μg/m3,呈西、南部区域PM_(2.5)污染重,东北区域相对较低的区域分布特征;全市范围PM_(2.5)暴露与每日总非意外死亡的滞后累积最大效应RR为1.017(1.001,1.034;95%CI);白云区、从化区、南沙区、越秀区和荔湾区PM_(2.5)暴露与每日总非意外死亡最佳滞后效应RR值范围1.010~1.014(此为各区RR值范围,而非95%CI),滞后累积最大效应RR值范围1.010~1.057(此为各区RR值范围,而非95%CI);从化区、南沙区、越秀区和荔湾区PM_(2.5)暴露与每日心血管系统疾病死亡的最佳滞后效应RR值范围1.006~1.021(此为各区RR值范围,而非95%CI),滞后累积最大效应RR值范围1.017~1.059(此为各区RR值范围,而非95%CI);南沙区和越秀区PM_(2.5)暴露与每日呼吸系统疾病死亡的最佳滞后效应RR值分别为1.004和1.034,滞后累积最大效应RR值分别为1.018和1.110。结论广州市不同区域大气PM_(2.5)暴露对当地居民每日死亡的影响各有不同;呈现南、北两端和西部部分人口密集,交通拥挤的区域风险较高,其他区域风险不明显的空间分布特征。     

广州地区日均气温与早产关系的时间序列研究

目的量化评估广州地区日均气温与早产的关联性。方法采用时间序列方法,利用广州市白云与越秀2个区2005—2011年的早产、气象与空气污染物资料,应用分布滞后非线性模型研究日均气温与早产的关联性,并评估高低气温对早产的冷热效应及累积冷热效应。结果广州市白云与越秀2个区2005—2011年共活产分娩263 322名,早产儿22 903例,早产率为8.70%(95%CI:8.59%~8.81%);日均出生早产儿(9.01±5.61)例;日均气温为(23.35±6.51)℃;日均相对湿度为(66.98±13.98)%;日均SO2浓度为(43.48±28.88)μg/m3;日均NO2浓度为(50.60±50.14)μg/m3;日均PM10浓度为(80.46±61.61)μg/m3。日均气温在不同滞后日与早产的关联呈非线性,暴露—反应关系近似U形,根据累积相对危险度最小的值对应确定参照气温为25.9℃。在滞后期第0~21天内,日均气温的累积风险效应从31℃开始显现出统计学意义,RR值为1.280 3(95%CI:1.014 9~1.615 1),并在34℃时达到最大,RR值为1.689 9(95%CI:1.076 7~2.652 6)。对于冷效应及累积冷效应,在整个滞后期内均无统计学意义。对于热效应,高温(日均气温为32℃),滞后1 d时风险效应最大,RR值为1.052 8(95%CI:1.014 2~1.092 9);对于累积热效应,在滞后期为第0~14天内达到最大,RR值为1.511 7(95%CI:1.210 5~1.887 8)。结论在广州地区,高温是造成早产的重要影响因素,可增加早产的发生风险。     

不同干预时机对妊娠期梅毒母儿结局的影响

目的评价妊娠期梅毒治疗及母婴阻断的有效时机。方法检索Pubmed(Medline)、EMbase、VIP、CNKI和万方数据库,检索妊娠期梅毒不同治疗时机母儿结局的队列研究,检索时间从建库至2016年4月1日,同时手检纳入文献的参考文献。由两人独立进行文献筛选、资料提取和质量评价,采用RevMan 5.2软件对孕早期与孕中晚期干预的母儿结局进行Meta分析,计算纳入研究的相对危险度(艘)及95%CI。结果共纳入20个研究(早孕期组660例,中晚孕期组2 201例)。Meta分析结果显示,不同干预时机不良妊娠结局及胎传梅毒的发生风险有差异。孕妇结局评价:①孕早期干预流产的发生风险低于孕中晚期[RR=0.28,95%CI:0.17~0.45,P0.001];②孕早期干预早产的发生风险低于孕中晚期[RR=0.25,95%CI:0.10~0.56,P0.001];③孕早期干预死胎/产的发生风险低于孕中晚期[RR=0.31,95%CI:0.15~0.64,P=0.002]。胎儿结局评价:①孕早期干预先天梅毒儿发生风险低于孕中晚期[RR=0.23,95%CI:0.17~0.31,P0.001];②孕早期干预低出生体重儿的发生风险与孕中晚期比较无明显统计学意义[RR=0.54,95%CI:0.28~1.03,P=0.06]。结论妊娠期梅毒患者在孕早期进行规范化治疗,能有效降低不良妊娠结局的发生风险,阻断梅毒的垂直传播,预防先天梅毒儿的出生。     

广州地区气象因素对早产影响的时间序列研究

目的研究广州地区气象因素与早产的关系。方法采用时间序列方法,利用广州市白云、越秀、番禺三区2004—2010年早产、气象与空气污染物资料,应用分布滞后非线性模型研究气象因素与早产的关联。结果广州市白云、越秀、番禺三区2004—2010年共活产分娩438 021例,早产儿29973例,早产率为6.84%(95%CI:6.77%~6.92%);日均出生早产儿(11.72±5.63)例,气温均值为(23.41±6.38)℃,相对湿度均值为(67.34±13.84)%,气压均值为(1012.94±6.88)h Pa;风速均值为(6.99±3.70)m/s。气象因素在不同滞后日与早产的关联呈非线性,总体上各气象因素与早产的风险效应呈正向关联。气温、相对湿度、气压和风速分别达到最大值(34℃、100%、1 032.2 h Pa、26 m/s)时,在滞后期(0~26、0~1、0~25、0~24 d)内总体风险效应达到最高,RR值分别为2.01(95%CI:1.28~3.16),1.25(95%CI:1.08~1.45),1.67(95%CI:1.03~2.71)和4.91(95%CI:0.63~38.11)。累积热效应在滞后期0~26 d内最高,RR值为1.47(95%CI:1.16~1.86);累积潮湿风险效应在滞后0 d时最高,RR值为1.12(95%CI:1.05~1.19);累积高气压效应在滞后期0~25 d内最高,RR值为1.34(95%CI:1.01~1.78)。首次怀孕、首次分娩、男婴及孕33~36周的早产亚组对气象因素较为易感,特别是对高温因素。结论广州地区的气温、相对湿度、风速和气压等气象因素可能是早产的重要影响因素。     

上海2004—2015年辅助生殖技术婴儿不良出生结局分析

目的探索辅助生殖技术(ART)妊娠分娩的新生儿不良出生结局发生情况及影响因素。方法采用数据库匹配方法,识别2004—2015年上海市出生监测数据库中ART婴儿5 858例,描述其出生特征,分析ART婴儿各种不良出生结局发生情况,并应用Poisson回归模型测算其相对危险度。结果 ART婴儿双多胎比例为35.73%,高于总体2.12%的水平。ART单胎婴儿早产、低体重和出生缺陷的发生风险均有所增高,发生率分别为8.34%、4.75%和1.65%,校正RR值分别为1.70(95%CI=1.52~1.90),1.68(95%CI=1.45~1.95)和1.66(95%CI=1.29~2.13)。ART双多胎婴儿早产、低体重和出生缺陷发生率分别为58.39%、44.19%和1.72%,与总体差异无统计学意义。结论 ART技术助孕后多胎率明显升高,ART新生儿早产、低体重和出生缺陷的风险也有所增高。     

孕期补锌对新生儿健康影响随机对照试验meta分析

目的采用meta分析方法系统定量评价健康孕妇孕期补锌对新生儿出生体重、出生身长、出生头围、早产、低出生体重和围生期死亡的影响,为孕妇合理补锌提供充分的科学依据。方法检索Pubmed、OVID、EMBASE、WOK、SCOPUS和万方、中国生物医学文献数据库等多个中英文数据库的相关文献,收集所有关于孕妇孕期补充锌与新生儿出生体重、出生身长、出生头围、早产、低出生体重和围生期死亡关系的随机对照试验原始研究数据,应用Rev Man 5.2软件进行meta分析。结果共纳入符合要求的原始文献15篇,包括14篇英文文献和1篇中文文献;meta分析结果显示,孕期补锌对出生体重影响的MD=18.13(95%CI=-26.72~62.99),对出生身长影响的MD=-0.10(95%CI=-0.24~0.03),对出生头围影响的MD=-0.04(95%CI=-0.13~0.05),对早产影响的相对危险度RR=0.84(95%CI=0.74~0.96),对低出生体重影响的RR=0.85(95%CI=0.66~1.11),对围生期死亡影响的RR=1.27(95%CI=0.68~2.38);孕期干预组单独补充锌对出生体重影响的MD=-30.73(95%CI=-86.82~25.35),对早产影响的RR=0.89(95%CI=0.71~1.11),对低出生体重影响的RR=0.77(95%CI=0.44~1.37);而含锌的多种微量营养素联合补充对出生体重影响的MD=38.13(95%CI=-20.60~96.85),对出生身长影响的MD=-0.08(95%CI=-0.24~0.08),对出生头围影响的MD=-0.02(95%CI=-0.18~0.13),对早产影响的RR=0.78(95%CI=0.64~0.95),对低出生体重影响的RR=0.80(95%CI=0.51~1.26)。结论孕期单独补充锌可降低早产的发生,但对新生儿出生体重、出生身长、出生头围、低出生体重和围生期死亡无影响。     

辅助生殖技术双胎受孕后不良妊娠结局风险评价的Meta分析

目的评价辅助生殖技术双胎受孕不良妊娠结局的风险。方法检索Pub Med、Cochrane图书馆、Google学术、中国生物医学文献数据库、万方数据资源系统、中国知网、重庆维普数据库。检索日期截至2015年6月。按照预先设定的标准检索、筛选、纳入和分析文献。用随机效应模型或固定效应模型对各个研究报告的结果进行合并,计算合并相对危险度(RR)及相应95%的可信区间(CI)。通过亚组分析识别异质性调节因子。采用漏斗图和Egger检验分析潜在的发表偏倚。结果最初共检索到3 432篇文献,最终纳入32篇文献,涉及33 465例辅助生殖技术受孕双胎和99 089例自然受孕双胎。Meta分析结果提示辅助生殖技术双胎受孕与自然双胎受孕比较早产(RR=1.08,95%CI:1.02~1.15)、低出生体重(RR=1.05,95%CI:1.01~1.08)、极低出生体重(RR=1.12,95%CI:1.00~1.26)和先天畸形(RR=1.12,95%CI:1.02~1.24)的风险分别增加8%、5%、12%和12%。尚未发现极早产(RR=1.13,95%CI:0.99~1.29)、胎儿子宫内生长受限(RR=1.21,95%CI:0.94~1.57)、小于胎龄儿(RR=0.87,95%CI:0.70~1.09)、围产期死亡(RR=1.00,95%CI:0.82~1.21)和新生儿呼吸窘迫综合征(RR=0.99,95%CI:0.64~1.54)的风险在两组间存在差异。漏斗图和Egger检验(P≥0.124)提示无发表偏倚。结论辅助生殖技术双胎受孕不良妊娠结局的风险高于自然双胎受孕。     

2010、2011年广州市越秀区空气污染物AQI与呼吸系统疾病死亡的Poisson回归分析研究

[目的]探讨广州市越秀区空气污染物AQI对呼吸系统疾病死亡的影响。[方法]收集2010、2011年广州市越秀区呼吸系统疾病死亡数据和越秀区气象及大气污染物数据,采用广义线性模型模块,拟合Poisson回归分析空气各污染物空气质量指数（AQI）、综合AQI和空气质量分级与呼吸系统疾病死亡的影响。[结果]2010、2011年广州市越秀区因呼吸系统疾病死亡病例有2 678例。SO2AQI与呼吸系统疾病死亡有统计学意义,SO2AQI每升高1个单位,其危险度约增加1%（RR=1.01,P〈0.05）;综合AQI的变化和空气质量等级与呼吸系统疾病死亡无统计学意义。[结论]广州市越秀区空气污染物中SO2是呼吸系统相关因素死亡的危险因素。     

孕期饮茶与早产、流产风险关联的Meta分析

目的系统评价孕产妇孕期饮茶与早产、流产风险的关联。方法系统检索中国知网、万方中国学术期刊数据库、维普中文科技期刊数据库、中国生物医学文献数据库、PubMed和Web of Science等中英文数据库,收集建库至2019年6月30日有关孕期饮茶与早产、流产风险关联的队列研究和病例对照研究文献,采用相对危险度(RR)或优势比(OR)作为效应指标进行Meta分析。结果初期共检索文献1 099篇,最终纳入文献14篇,其中队列研究9篇,包括暴露组18 295例,非暴露组71 890例;病例对照研究5篇,包括病例组1 351例,对照组3 059例。Meta回归分析结果显示,孕期饮茶与早产、流产风险无统计学关联(OR/RR=1.08,95%CI:0.99～1.18)。随机效应线性回归分析结果显示,随着孕期饮茶量增加,孕产妇早产、流产风险未发生明显变化(OR/RR=1.05,95%CI:0.99～1.11)。Begg's检验和Egger's检验均未发现发表偏倚。结论孕期饮茶与早产、流产风险未见统计学关联。     

孕前体重指数和孕期增重对不良妊娠结局影响的出生队列研究

目的探讨孕前体重指数(BMI)和孕期增重与早产、低出生体重、小于胎龄儿3种不良妊娠结局的关联。方法选取2014年6月—2015年2月在扬州市妇幼保健院分娩的3 943名孕妇,纳入出生队列,分析不同孕前BMI分组下的孕期增重状况与3种不良妊娠结局的关系。结果多因素logistic回归分析结果显示:孕前体重过低组中,孕期增重不足是发生早产的危险因素(RR=3.043,95%CI=1.104~8.387);孕前体重正常组中,孕期增重不足是发生早产与低出生体重的危险因素(RR=1.987,95%CI=1.146~3.444;RR=3.657,95%CI=1.905~7.021),孕期增重过度是发生小于胎龄儿的保护因素(RR=0.343,95%CI=0.180~0.652)。结论不同孕前BMI分组的孕期增重状况与不良妊娠结局有关联,保持适宜的孕前体重和孕期合理增重对改善出生结局具有重要意义。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.