广西沿海产盐区人群碘营养状况及甲状腺功能调查

目的 了解广西沿海产盐区人群碘营养状况及其甲状腺功能水平,为防治碘缺乏病提供科学依据.方法 选择沿海产盐区北海市铁山港区作为调查点,随机抽取637名成人进行问卷调查和甲状腺超声检查,采集尿样、血样,分别测定尿碘和血清甲状腺激素.结果 人群尿碘的中位数为62.05 μg/L,＜100 μg/L的比例高达75.20％.甲状腺肿大率为3.77％、甲状腺结节检出率为22.95％.甲状腺功能各项检测指标中位数分别为:甲状腺过氧化物酶抗体0.05 IU/mL,抗甲状腺球蛋白抗体0.12 IU/mL,游离碘甲状腺原氨酸4.14 pmol/L,游离甲状腺素15.07 pmol/L,促甲状腺激素1.45 μIU/mL;甲状腺功能异常率为8.48％,其中,低游离甲状腺素血症2.35％、亚甲减2.20％、甲减1.10％、亚甲亢1.73％、甲亢1.10％;甲状腺自身免疫性抗体阳性率为24.80％,其中,甲状腺过氧化物酶抗体阳性率为19.15％、抗甲状腺球蛋白抗体阳性率为17.58％.结论 当地人群碘营养状况欠佳,应加强常规碘营养和甲状腺功能监测,科学补碘持续消除碘缺乏病.     

沿海产盐区与非产盐区妊娠期妇女碘营养状况及甲状腺功能水平分析

目的了解福建沿海产盐区与非产盐区妊娠期妇女碘营养状况及其甲状腺功能水平,为防治碘缺乏病提供科学依据。方法选择产盐区翔安区和非产盐区集美区为调查点,每个点随机抽取60名以上妊娠期妇女作为调查对象,采集孕妇的家中盐样、尿样及血样,分别测定盐碘、尿碘及血清甲状腺激素。结果产盐区与非产盐区孕妇合格碘盐食用率分别为81.69%和100.00%;产盐区与非产盐区孕妇尿碘的中位数分别为120.55μg/L和153.35μg/L,尿碘〈150μg/L的比例分别为62.2%和46.8%,孕早期尿碘水平〉孕中期〉孕晚期;产盐区与非产盐区孕妇的甲状腺过氧化物酶抗体（thyroid peroxidase antibody,TPOAb）,抗甲状腺球蛋白抗体（antithyroid glubulin antibody,TgAb）,总三碘甲状腺原氨酸（total-triiodothyronine,TT3）,总甲状腺素（total thyroxine,TT4）,游离三碘甲状腺原氨酸（free triiodothyronine,FT3）,游离甲状腺素（free thyroxine,FT4）,促甲状腺激素（thyroid stimulating hormone,TSH）,甲状腺球蛋白（tryroglobulin,Tg）中位数均在正常范围,产盐区与非产盐区孕妇的FT3、FT4、TSH之间差异均有统计学意义,产盐区孕妇的FT3、FT4均低于非产盐区,而产盐区孕妇的TSH则高于非产盐区。结论孕妇是易缺碘人群,产盐区孕妇相对非产盐区碘缺乏更为严重。应对孕妇开展常规碘营养和甲状腺功能监测,进一步做好碘营养知识的宣传教育工作,控制碘缺乏病的发生。     

广西沿海产盐区哺乳期妇女碘营养状况及甲状腺功能分析

目的了解广西沿海产盐区哺乳期妇女碘营养状况及其甲状腺功能水平,为防治碘缺乏病提供科学依据。方法选择沿海产盐区北海市铁山港区作为调查点,随机抽取104名哺乳期妇女采集尿样、乳汁样和血样,分别测定尿碘、乳汁碘及血清甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(Tg Ab)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)和甲状腺球蛋白(Tg)等各项甲状腺功能指标。结果哺乳期妇女尿碘中位数为53.00μg/L,尿碘100μg/L的比例高达85.58%。乳汁碘中位数为167.92μg/L,乳汁碘与尿碘呈正相关。各甲状腺功能异常检出情况:低FT4血症17.31%、亚临床甲状腺功能减退(亚甲减)0.96%、临床甲状腺功能减退(甲减)3.85%、亚临床甲状腺功能亢进(亚甲亢)1.92%、临床甲状腺功能亢进(甲亢)1.92%、TPOAb阳性率13.46%、Tg Ab阳性率7.69%。结论哺乳期妇女是易缺碘人群,应开展常规碘营养和甲状腺功能监测,科学补碘预防碘缺乏病。     

沿海产盐区与非产盐区8～10岁儿童碘营养与智力水平分析

目的 了解和比较沿海产盐区和非产盐区8～10岁儿童碘营养状况与智力水平,为采取针对性防治措施提供依据.方法 选择产盐区翔安区和非产盐区集美区的小学为调查点,8～10岁儿童为调查对象,调查其家中碘盐食用情况、尿碘含量、甲状腺肿大情况和智商水平.结果 产盐区和非产盐区儿童合格碘盐食用率分别为81.5%和98.6%;甲状腺肿大率分别为3.0%和0.7%,尿碘中位数分别为202.8 μg/L和238.4 μg/L,＜50 μg/L的比例分别为3.5%和1.0%.产盐区8～10岁儿童智商均明显低于非产盐区儿童;产盐区8岁儿童智商明显高于9岁和10岁儿童;非产盐区8岁儿童智商明显高于9岁和10岁儿童,9岁儿童智商明显高于10岁儿童.结论 补碘能提高儿童智商,降低智力损害.要坚持食用碘盐,开展对孕妇、哺乳妇的碘营养监测.     

沿海产盐区与非产盐区8～10岁儿童碘营养与智力水平分析

目的了解和比较沿海产盐区和非产盐区8~10岁儿童碘营养状况与智力水平,为采取针对性防治措施提供依据。方法选择产盐区翔安区和非产盐区集美区的小学为调查点,8~10岁儿童为调查对象,调查其家中碘盐食用情况、尿碘含量、甲状腺肿大情况和智商水平。结果产盐区和非产盐区儿童合格碘盐食用率分别为81.5%和98.6%;甲状腺肿大率分别为3.0%和0.7%,尿碘中位数分别为202.8μg/L和238.4μg/L,<50μg/L的比例分别为3.5%和1.0%。产盐区8~10岁儿童智商均明显低于非产盐区儿童;产盐区8岁儿童智商明显高于9岁和10岁儿童;非产盐区8岁儿童智商明显高于9岁和10岁儿童,9岁儿童智商明显高于10岁儿童。结论补碘能提高儿童智商,降低智力损害。要坚持食用碘盐,开展对孕妇、哺乳妇的碘营养监测。     

城乡居民碘营养及甲状腺疾病患病情况调查

目的了解杭州市城乡居民碘营养现况及甲状腺疾病患病情况。方法分别从杭州市城区和农村随机抽取3个调查点,每个调查点随机抽取100户居民,检测其家中食盐盐碘浓度,计算每日盐摄入量;采集尿样及血样,检测尿碘、血清游离三碘甲状腺原氨酸（FT3）、血清游离甲状腺素（FT4）和血清促甲状腺激素（TSH）。结果城区盐碘和每日盐摄入量中位数分别为29．40mg／kg和6．35g／d,农村盐碘和每日盐摄入量中位数分别为29．65mg／kg和8．50g／d;城区尿碘中位数为120．00μg／L,低于农村的188．73μg／L;城区临床甲减、亚临床甲减、临床甲亢、亚临床甲亢和甲状腺疾病总患病率分别为0．13％、10．13％、0．26％、0．52％和11．04％,农村临床甲减、亚临床甲减、临床甲亢、亚临床甲亢和甲状腺疾病总患病率分别为0．85％、3．12％、0．57％、1．99％和6．52％,城区亚临床甲减、甲状腺疾病总患病率高于农村,亚临床甲亢患病率则低于农村。结论杭州市城乡居民碘营养均处于适宜水平,城区居民尿碘水平低于农村,但亚临床甲减和甲状腺疾病总患病率高于农村。     

广西沿海产盐区人群甲状腺结节流行状况及相关因素分析

目的掌握广西沿海产盐区人群甲状腺结节患病情况及其影响因素,为科学补碘提供依据。方法于2015年1月,从广西沿海产盐区选取620名20岁及以上成人进行问卷调查、甲状腺超声检查,同时检测尿碘、水碘、盐碘含量。结果人群尿碘中位数为60.12μg/L,甲肿检出率为3.55%,甲状腺结节检出率为22.90%。多因素非条件logistic回归分析结果提示,年龄较高人群易患甲状腺结节(OR=1.50,95%CI:1.16~1.95)。结论广西沿海产盐区人群碘营养状况欠佳,年龄是当地人群甲状腺结节的主要影响因素。     

潍坊市产盐区与非产盐区碘缺乏病防治资料分析

目的了解和评价潍坊市产盐区与非产盐区碘缺乏病的防治状况,探讨控制碘缺乏病的效果。方法对2005、2007、2009、2013年潍坊市碘缺乏病防治调查资料中碘盐、尿碘、甲状腺肿大和水碘等监测指标进行回顾性分析。结果4年检测13 983份盐,合格的12 970份,合格率为92.76%,合格碘盐食用率75.23%升至96.59%。尿碘中位数为185.80～282.71μg/L,呈逐年上升趋势,产盐区与非产盐区差异无统计学意义（z=-0.18、-1.27、-1.17、-1.25,P〉0.05）。全市儿童甲状腺肿大率为2.87%,各年度产盐区、非产盐区均〈5%。全市水碘中位数为5.02μg/L,产盐区、非产盐区为10.28、4.22μg/L。结论产盐区和非产盐区人群体内碘营养充足,甲状腺肿大率较低。     

甘肃省武威市成人碘营养及甲状腺功能状态分析

目的了解甘肃省武威市城市成人碘营养水平及甲状腺功能状态,为科学补碘提供依据。方法 2009年4月-2010年1月采用横断面调查方法随机调查甘肃省武威市18~45岁成人104人。采集样本人群空腹血样及任意一次尿样,检测FT3、FT4、TT3、TT4、TSH、TGAb、TMAb及尿碘。结果男、女尿碘中位数分别为139.3和212.6μg/L,女性尿碘明显高于男性(P0.05)。TT3、TT4、FT3、FT4、TSH均值均在正常值范围内,TT3、TT4、FT3、FT4、TSH异常率分别为1.9%、1.0%、3.8%、1.9%和16.3%。TGAb和TMAb阳性率女性均高于男性(P0.05)。甲状腺功能紊乱中以亚甲减最多(14.4%),其中女性高于男性(P0.05)。以尿碘水平将调查对象分为碘缺乏、碘适宜、碘过适宜和碘过量4组,TSH、FT3、FT4、TGAb、TMAb异常率组间均无统计学意义,但TGAb、TMAb阳性率有随着尿碘水平升高而上升趋势。除碘缺乏组无甲状腺功能紊乱者,其余3组均有病例,组间差异有统计学意义(P0.05)。结论武威市成人碘营养状况基本处于适宜,但女性明显高于男性;甲状腺功能紊乱以亚甲减为主;随着碘摄入量的增加,TGAb、TMAb阳性率呈上升趋势,女性患甲状腺疾病的风险高于男性。     

安徽省孕妇碘营养及甲状腺功能调查结果分析

目的调查了解全省孕妇碘营养水平和甲状腺功能现状,为开展科学补碘和甲状腺功能监测提供依据。方法 2016年4~9月,根据地理位置和地形在安徽省选择6个县(区),依托妇幼保健院或乡镇卫生院选择妊娠早、中、晚期孕妇,每个县(区)各100名,采集孕妇家庭食用盐、尿液和血清,分别测定盐碘、尿碘和甲状腺功能。结果共调查600名孕妇,盐碘和尿碘中位数分别为23.0 mg/kg和181.0μg/L,妊娠早、中和晚期的孕妇尿碘中位数分别为211.3μg/L、179.1μg/L和170.2μg/L。547名孕妇TSH、FT3和FT4的均数分别为1.8μIU/ml、5.7 pmol/L和13.8 pmol/L,TGAb和TPOAb中位数分别为29.3 IU/ml和1.5 IU/ml,均在正常范围内;甲状腺功能异常率为15.4%,其中甲亢、亚甲亢、甲减和亚甲减的检出率分别为1.1%(6/547)、1.8%(10/547)、5.7%(31/547)、6.8%(37/547)。不同孕期孕妇甲亢、亚甲亢检出率比较,差异有统计学意义。尿碘150μg/L的甲亢检出率(2.4%)与≥150μg/L的甲亢检出率(0.6%)差异有统计学意义。结论安徽省部分地区孕妇碘营养适宜,但仍有部分孕妇处于碘营养不足状态,甲状腺功能异常发生以亚甲减为主,碘营养不足的甲亢检出率较高。     

Salmonellas in pigs and animal feeding stuffs in England and Wales and in Denmark

A comparison has been made between the incidence of salmonellas in pigs and feeding stuffs in England and Wales and in Denmark. In Denmark there is veterinary legislation requiring the sterilization of imported and home produced feed ingredients of animal origin. There is no such legislation in England and Wales. In Denmark 0·3% of resterilized imported meat and bone meal was contaminated with salmonellas. This compared with 23% of meat and bone meal in England and Wales and 20-27% of other ingredients of animal origin. In England and Wales salmonellas were isolated from 7% of caecal samples and 6% of lymph node samples, while in Denmark they were isolated from 3% of caecal samples and 4% of lymph node samples. In England and Wales 25 serotypes were found in both pigs and feeds and these included nearly all the most prevalent human pathogens. In Denmark four of the six serotypes in pigs had been found in resterilized feed. One notable difference between the two studies was the very wide range of serotypes found in pigs in England and Wales and the narrow range in Denmark. A second was that Salmonella typhimurium formed 15% of all Salmonella strains isolated from pigs in England and Wales, and 60% of those in Denmark.     

Lunasin is prevalent in barley and is bioavailable and bioactive in in vivo and in vitro studies

Lunasin, a unique 43-amino acid peptide found in a number of seeds, has been shown to be chemopreventive in mammalian cells and in a skin cancer mouse model. To elucidate the role of cereals in cancer prevention, we report here the prevalence, bioavailability, and bioactivity of lunasin from barley. Lunasin is present in all cultivars of barley analyzed. The liver and kidney of rats fed with lunasin-enriched barley (LEB) show the presence of lunasin in Western blot. Lunasin extracted from the kidney and liver inhibits the activities of HATs (histone acetyl transferases), yGCN5 by 20% and 18% at 100 nM, and PCAF activity by 25% and 24% at 100 nM, confirming that the peptide is intact and bioactive. Purified barley lunasin localizes in the nuclei of NIH 3T3 cells. Barley lunasin added to NIH 3T3 cells in the presence of the chemical carcinogen MCA activates the expression of tumor suppressors p21 and p15 by 45% and 47%, decreases cyclin D1 by 98%, and inhibits Rb hyperphosphorylation by 45% compared with the MCA treatment alone. We conclude that lunasin is prevalent in barley, bioavailable, and bioactive and that consumption of barley could play an important role of cancer prevention in barley-consuming populations.     

Management of pregnancy and childbirth in England and Wales and in France

This paper reviews national data on obstetric and neonatal practices in England and Wales, and in France between 1970 and 1980. The data have been derived from national statistics and surveys on national samples of births in 1970, 1975 and 1980 in England and Wales, and 1972, 1976 and 1981 in France. The analysis shows that there was no major difference in pregnancy outcome, but wide variations in medical practices, and their trend over time. The main differences were: in England and Wales a higher number of antenatal visits, a higher percentage of inpatient admissions during pregnancy, a higher rate of induction, more episiotomies, a higher rate of resuscitation at birth, and admission to neonatal special care units; in France, a higher rate of caesarean sections before and during labour, some evidence of a more active management of labour, and a longer hospital post-natal stay. These differences in practice reflect differences in objectives and assessment of the effectiveness of care between the two countries: they point out the need for better monitoring and evaluation of obstetric and neonatal practices.     

Research and teaching in social and preventive medicine and in public health

Summary Both public health and social and preventive medicine are characterised by the common goal of promoting, maintaining and improving health and preventing disease, and both are concerned with a population-related, preventive and environmental perspective. But whereas public health is interdisciplinary and goes far beyond the medical focus, social and preventive medicine is medically based and forms a bridge between public health and medical practice. Research in a department of social and preventive medicine serves to support preventive and medico-social activities in medical practice as well as in public health. This is illustrated by results from research conducted at the author's department during the last twenty years. Examples are research in support of smoking cessation activities, and research used for the planning of care for the elderly. Both the research and the teaching activities of the department take into account the population focus of public health as well as the focus on individual medicine in clinical practice.

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Forschung und Lehre in Sozial-und Präventivmedizin und öffentlicher Gesundheit

Zusammenfassung Sowohl das Gebiet der öffentlichen Gesundheit als auch dasjenige der Sozial-und Präventivmedizin sind durch das Ziel der Förderung, Erhaltung und Verbesserung der Gesundheit sowie der Krankheitsvorbeugung gekennzeichnet, und beide beschäftigen sich mit einer bevölkerungsbezogenen, präventiven und umweltbezogenen Perspektive. Aber während die öffentliche Gesundheit stark interdisziplinär ist und weit über den medizinischen Fokus hinausreicht, ist die Sozial-und Präventivmedizin ein medizinisches Fach und stellt eine Brücke zwischen der öffentlichen Gesundheit und der ärztlichen Praxis dar. Die Forschung in einem Institut für Sozial-und Präventivmedizin dient der Förderung präventiver und sozialmedizinischer Tätigkeiten in der ärztlichen Praxis wie auch in der öffentlichen Gesundheit. Dies wird durch die Forschungstätigkeit des Instituts des Autors aus den letzten 20 Jahren illustriert, wobei Beispiele aus den Gebieten der Förderung der Raucherentwöhnung und der Betreuung behinderter Betagter dargestellt werden. Sowohl in den Forschungs-als auch in den Lehrtätigkeiten des Instituts finden der Bevölkerungsbezug der öffentlichen Gesundheit wie auch der individualmedizinische Ansatz der ärztlichen Praxis ihren Ausdruck.

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La recherche et l'ensignement en médecine sociale et préventive et en santé publique

Résumé La santé publique aussi bien que la médecine sociale et préventive sont caractérisées par le but commun de promouvoir, maintenir et améliorer l'état de santé et de prévenir les maladies, et elles s'orientent vers une perspective de population, de prévention et environnementale. Mais la santé publique est interdisciplinaire et va loin au-delà de la médecine, tandis que la médecine sociale et préventive est basée sur la médecine et représente le lien entre la santé publique et la pratique médicale. La recherche d'un institut de médecine sociale et préventive sert à appuyer les activités préventives et médico-sociales au cabinet médical aussi bien qu'en santé publique. Cela est illustré par des résultats de recherches conduites dans les vingt années passées à l'institut de l'auteur, et les exemples sont tirés de la recherche en appui de la promotion de la cessation de fumée et de la planification de la prise en charge des personnes âgées et handicapées. Les activités de recherche et de l'enseignement de l'institut tiennent compte de la perspective de population cacactéristique de la santé publique, aussi bien que de la dimension de médecine individuelle caractéristique de la pratique clinique.

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Paper presented at a symposium on The Public Health Perspective of Social and Preventive Medicine, in celebration of the 20th anniversary of the Department of Social and Preventive Medicine, University of Berne, 25 June 1992 in Berne.     

Eggs enriched in omega-3 fatty acids and alterations in lipid concentrations in plasma and lipoproteins and in blood pressure

Effects of dietary eggs enriched with omega-3 fatty acids on lipid concentrations in plasma and lipoproteins and blood pressure were determined in 11 men and women in two groups. Group 1 consumed four omega-3 eggs per day during the first 4-wk period and four control eggs for the second 4-wk period. Group 2 ate the same number of eggs in the reverse order. Mean plasma cholesterol concentration was significantly increased by control eggs (P less than 0.01) but unchanged by omega-3 eggs. Mean plasma triglyceride concentration was decreased by omega-3 eggs but increased by control eggs. Both systolic and diastolic blood pressures were significantly lowered by omega-3 eggs in group 1 whereas only systolic pressure was significantly decreased on omega-3 eggs in group 2. The control eggs did not change blood pressure. In conclusion, the omega-3 eggs may be more healthful than the control eggs.     

Bacteriology and constitutional health--genomics and proteomics: concepts in medicine and concepts in health insurance in the past and future

Future discussions on health issues on the individual or society level will be fundamentally linked to genetic dispositions. This genetic world will become reality in the same way the world of hygiene and bacteriology has become real for everyone. Approaches of molecular medicine for public health issues have not yet been created so far. The secret dreams of molecular eugenics must be made public and critically discussed. Up to now only a few monogenetically recessive hereditary diseases can be detected by screening. This kind of screening should be carefully considered. However, for the sciences, for medicine and thus for the physicians in practice, for health care sciences as well as for public health care, new tasks will emerge from genetics and molecular medicine. In individual as well as public health these new tasks will at first mainly turn in on the sphere of diagnosis and specific screening as well as health education and consultation. With regard to the considerable social implications the public health care sector should be aware of the coming issues of molecular medicine in time.     

成人社区及医院获得性肺炎病原菌及耐药性差异

 目的 比较非呼吸机相关医院获得性肺炎（NV-HAP）、呼吸机相关肺炎（VAP）与社区获得性肺炎（CAP）感染病原菌分布及耐药性。方法 回顾性调查2017年10月-2019年9月某院肺炎患者病历资料,按NV-HAP、VAP、CAP定义将患者分别列为NV-HAP组、VAP组、CAP组。收集三组患者痰、支气管肺泡灌洗液、血标本培养病原菌及药敏试验结果,分析三组患者感染病原菌构成和耐药性差异。结果 共纳入肺炎患者4 391例,NV-HAP组1 080例,VAP组126例,CAP组3 185例,各组分别检出病原菌841、191、1 440株,均以革兰阴性（G^-）菌为主,依次占72.77%、84.82%和61.18%,三组患者检出病原菌分布比较,差异有统计学意义（χ²=64.037,P<0.001）。鲍曼不动杆菌对头孢吡肟、头孢哌酮/舒巴坦、亚胺培南、庆大霉素、妥布霉素、左氧氟沙星、环丙沙星和复方磺胺甲口恶唑耐药率,铜绿假单胞菌对头孢哌酮/舒巴坦和亚胺培南耐药率,肺炎克雷伯菌对常用抗菌药物耐药率,三组比较差异均有统计学意义（均P<0.05）;金黄色葡萄球菌对红霉素、克林霉素和环丙沙星的耐药率比较,CAP组高于NV-HAP组（P<0.05）。结论 NV-HAP、VAP和CAP在病原菌分布及细菌耐药性方面均存在差异,在制定临床治疗方案时,要区别对待不同感染类型的肺炎。