慢性阻塞性肺疾病危险因素病例对照研究

目的探讨慢性阻塞性肺疾病（COPD）发病的相关危险因素，为开展COPD的一级预防提供依据。方法采用按年龄±3岁进行1：1配比的病例一对照研究方法，对435例来源于2003年1月-2006年4月某市级医院的COPD患者及其对照者应用条件Logistic回归进行危险因素分析。结果单因素分析结果显示，性别（OR=1．802，95％CI：1．385--2．346）、药物过敏史（OR=4．346，95％CI：2．838～6．657）、吸烟（OR=2．857，95％CI：2．145～3．807）、吸烟年限〉10a（OR=2．719。95％CI：2．041～3．621）、日吸烟量〉10支（OR=2．250，95％CI：1．601～3．161）、开始吸烟年龄≤20岁（0R=1．909，95％CI：1．140。3．198）、吸烟指数大于300年支（OR=2．241，95％CI：1．645-3．054）和高血糖（OR=2．469，95％CI：1．772～3．441）为COPD的危险因素。多因素分析结果显示，性别（OR=1．595，95％CI：1．124～2．264）、药物过敏史（OR=4．029，95％（CI：2．411～6．735）、吸烟（OR：2．635，95％CI：1．844～3．764）和高血糖（OR=2．390，95％CI：1．632-3．502）为COPD的危险因素。结论男性、药物过敏史、吸烟和高血糖为COPD的主要危险因素。     

DNA损伤结合蛋白2基因单核苷酸多态性相关的肺癌发病风险模型

[目的]研究DNA损伤结合蛋白2基因（DDB2基因）单核苷酸多态性位点rs3781620等位基因（nt23314 C〉G）多态与肺癌易感性的关系，并建立环境-遗传因素的肺癌发病风险模型。[方法]运用病例-对照研究，选择湖北省各地区医院经病理诊断确诊的原发性肺癌患者216例为病例组，社区人群448人为对照组，以Taqman探针基因分型的方法进行基因分型，采用多因素非条件Logistic回归后退法筛选肺癌相关危险因素并计算人群归因危险度百分比，绘制受试者工作特征曲线（ROC）。[结果]社区对照人群中DDB2基因的C和G两种等位基因分布频率分别为66．6％和33．4％。多因素分析结果表明与携带DDB2基因单核苷酸多态性位点rs3781620等位基因的野生型纯合子CC基因型者相比，携带CG或GG基因型的研究对象患肺癌危险度为OR=1．634（95％CI：1．104～2．420）；年长者（〉60岁）发生肺癌的危险度为OR=1．641（95％CI：1．110～2．426）；一级亲属家族有肿瘤史的危险度为OR=2．972（95％CI：1．452～6．084）；轻度和重度吸烟者分别为OR=1．649（95％CI：0．962～2．826）、OR=6．351（95％CI：3．978～10．139）；饮酒为OR=1．559（95％CI：1．034～2．349）；体育锻炼为OR=O．568（95％CI：0．383～0．844）。以上各因素的人群归因危险度百分比分别为11．27％、13．34％、7．16％、9．67％、44．90％、8．71％和-11．67％。Logistic回归模型ROC曲线下面积为0．786（95％CI：0．748-0．823）。[结论]遗传和环境因素在肺癌发病中起作用：一级亲属肿瘤家族史、DDB2基因单核苷酸多态性位点rs3781620 CG或GG基因型与肺癌易感性有关；不良的生活方式（吸烟、饮酒和缺乏锻炼）可增加肺癌的危险性。该模型对肺癌发病风险的评估能力中等。     

ILIB启动子区多态性与癌症风险的meta分析

IL1B（Interleukin 1 beta）是一种对抗感染的前炎症因子，在肿瘤的发生发展中起着重要的作用。IL1B基因启动子区-31C／T多态性位点通过影响IL1B的转录参与癌症的发生。针对已有的研究存在结论不一致的现状，为了阐明两者之间的关系，我们对47篇发表的病例对照研究进行meta分析，其中包括11125病例和14415例对照。比值比（Odds Ratio，OR）和95％可信区间（CI）用来评估多态性位点与癌症风险的关联程度。在所有的对比中没有发现此多态性位点与所有癌症相关联。通过分层分析发现，携带C等位基因的个体比不带C等位基因的个体患肝癌的风险低（CCVS TT：OR=0．87，95％CI：0．77—0．98，Phetermgrenty=0．103；TC vs TT：OR=0．77，95％CI：0．62-0．95，Phetermgrenty=0．734；TC＋CC vs TT：OR=0．74，95％CI：0．61～0．91，Phetermgrenty=0．472）。同样，C／C基因型个体相比T，T基因型个体患胃癌风险低（OR=0．87，95％CI：0．77-0．98，Rhetermgrenty=0．103）。运用隐性模型，患胃癌的风险显著下降（OR=0．88，95％CI：0．80～0．97，Phetermgrenty=0．158），在欧洲人群（OR=0．84，95％CI：0．73-0．97,Phetermgrenty=0．070）和感染-配埘研究（OR=0．75，95％CI：0．60～0．94，Phetermgrenty=0．220）中都发现有显著下降的风险；在乳腺癌中有显著增加的风险（OR=1．34，95％CI：1．18～1．61，Phetermgrenty=0．116）。虽然一些适度偏倚不能消除，此meta分析显示IL1B-3IC基因型是癌症发生的保护因素，特别是在感染人群中。     

道路交通伤害的病例交叉研究

目的探讨道路交通伤害的危险因素。方法采用病例交叉研究方法，通过专门设计的问卷对402名驾驶员进行面访，调查内容包括酒后驾驶、发怒水平、焦虑／烦躁、急性困倦状况、车辆故障、疏忽大意、不按规定让行和不按交通标志行驶等。应用1：1匹配的病例对照研究资料处理方法进行单因素分析，用条件logistic回归进行多因素分析。结果多因素分析结果显示的危险因素有：发怒水平高（OAS记分为5～7分）（OR=114．88，95％CI：4．29～3074．86）、不按规定让行（OR=46．96，95％CI：12．74～173．11）、不按交通标志行驶（OR=24．57，95％CI：8．69～69．45）、疏忽大意（OR=14．54，95％CI：6．85～30．86）、纵向间距不够（OR=14．30，95％CI：3．68～55．60）、感觉／判断错误（OR=14．67，95％CI：4．88～44．10）、车辆故障（OR=8．57，95％CI：1．38～53．27）和措施不当（OR=8．46，95％CI：2．46～29．14）。结论道路交通伤害的危险因素中，机动车驾驶员的不良行为、异常心理状态和驾驶技能等因素不容忽视，对驾驶员开展有针对性的道路交通安全教育十分必要。     

男性饮酒及体质指数与良性前列腺增生关系

目的探讨饮酒、体质指数与良性前列腺增生（BPH）的关系。方法采用病例对照研究方法。病例为2004～2006年临床诊断为良性前列腺增生、施行手术治疗、术后病理证实为BPH的患者，年龄为56～88岁。对照为同期住院的非前列腺增生患者，年龄与病例相同。以1：1匹配。病例与对照各334例，采用自行设计的调查表对研究对象进行调查。内容包括一般情况、身体测量、生活方式（吸烟、饮食、饮酒情况等）、既往史以及前列腺疾病的家族史等。采用Logistic回归模型计算OR值和95％CI。结果病例组脑力劳动者所占的比例高于对照组，但其所从事的职业性活动却低于对照组，二者差异有统计学意义（χ^2=4．446，P〈0．05）。与不饮酒者比较，每天酒精摄入量为31～45g者其OR=0．652,95％CI=0．484～0．878；洒精摄入量为46～60g／d者其OR=0．533，95％CI=0．307～0．924。但重度饮酒者这种相关性减弱，酒精摄入量〉60g／d者与不饮酒者比，OR值增大，OR=0．623，95％CI：0．438～0．886。结论酒精摄入量与BPH危险性间呈U型关系，而饮酒的年限、体重指数与BPH发病无关系。适量饮酒（酒精摄入量≤60g／d）可能是BPH发病的保护因素。     

青岛地区儿童哮喘影响因素病例对照研究

目的探讨儿童哮喘的影响因素。方法应用1：1配对的病例一对照研究方法，采用问卷调查方式，调查300对病例和对照儿童，并分析有关的暴露因素。结果单因素Logistic回归分析结果显示，有17个因素与儿童哮喘有关联，包括父亲呼吸系统疾病史、母亲呼吸系统疾病史、家庭收入情况、特应性体质、急性呼吸道感染史、食肉习惯、海产品摄入量、是否有泡沫制品、是否装修过、厨房排烟方式、排烟效果、是否饲养宠物、家族哮喘病史、家族过敏性鼻炎史、父母食物过敏史、父母粉尘过敏史、首次发病后是否经过系统治疗。多因素Logistic回归分析显示，7个因素进入主效应模型，其中父亲有呼吸系统疾病史（OR=3．771，95％CI：1．533～9．278）、家庭低收入（OR=I．503，95％CI：1．258～1．795）、特应性体质（OR=3．788，95％CI：2．368～6．058）、喜食肥肉（OR=2．042，95％CI：1．481～2．815）、家族哮喘病史（OR=I．710，95％CI：0．988～2．958）、家族过敏性鼻炎史（OR=I．991，95％CI：1．234～3.211）是儿童哮喘的危险因素，饲养宠物（OR=0．443，95％CI：0．265～0．739）是保护因素；回归系数分别为1．327，0．407，1．332，0．714，0．536，0．689，-0．814。结论儿童哮喘是遗传和环境双重因素共同作用导致的一种复杂疾病。     

云南省某市锡矿工人性病与艾滋病的流行病学调查

目的 估计云南省某市矿区锡矿工人性病、艾滋病感染状况及相关知识,并分析可能的危险因素。方法 2006年3-6月在云南省某市的5个矿区开展以矿区为基础的横断面研究,共纳入1796名矿工。采用标准化问卷匿名收集研究对象的性病与艾滋病知识、性行为等信息,并采集7ml静脉血和15ml尿检测4种性病和艾滋病感染情况。结果 调查矿工中共检出12例人类免疫缺陷病毒（human immunodeficiency virus,HIV）抗体阳性者,阳性率为0．7％（12／1760）,其他性病阳性率分别为梅毒1．8％（31／1760）,2型单纯疱疹（herpes simplex virustype-2,HSV-2）9．6％（169／1760）,淋球菌0．8％（14／1773）,沙眼衣原体4．8％（85／1773）,除HIV外的其他性病总患病率为14．9％（264／1776）。HIV感染和吸毒（调整OR=17．8;95％CI：4．0—78．8）、12个月内嫖娼次数（调整OR=8．7,95％CI：1．9—39．0）、文身（调整OR=6．6;95％CI：1．8—24．0）、手术（调整OR：6．0;95％CI：1．6—22．5）、共用牙刷（调整OR=5．6;95％CI：1．0—31．3）等因素的联系有统计学意义。性病感染和民族（调整OR=2．0;95％CI：1．5—2．7）、年龄（调整OR=1．7;95％CI．1．0—2．9）、吸毒（调整OR=2．3;95％CI：1．0～5．2）、和配偶住一起（调整OR=1．4;95％CI：1．1—1．9）及嫖娼（调整OR=1．9;95％CI：1．4—2．6）等因素的联系有统计学意义。艾滋病相关知识全部回答正确率为4．1％（49／1201）,有性经历的矿工中自我报告嫖娼的比例为21．6％（339／1569）。结论 该地区矿工性病、艾滋病感染率较高,性病、艾滋病知识匮乏,不安全性行为比较普遍,安全套使用率低,自我保护意识差,存在多种性病、艾滋病的传播途径,应加强该人群教育干预工作。     

谷胱甘肽转硫酶M1、T1基因型及烟酒嗜好与胃癌易感性的关系

[目的]探讨谷胱甘肽转硫酶基因多态性M1（GSTM1）、T1（GSTT1）及烟酒嗜好与胃癌易感性的关系，并对GST基因多态性GSTT1、GSTM1与烟酒暴露在胃癌发生中的交互作用进行分析。[方法]采用1：1配对病例-对照研究方法和PCR技术，检测121例原发性胃癌患者和相应对照的GSTM1和GSTT1基因型，结合研究对象的烟酒嗜好，应用SAS统计分析系统，分析GSTM1和GSTT1基因型及烟酒暴露与胃癌发病的关系，并对基因-基因，基因-烟酒暴露在胃癌发生中的交互作用进行分析。[结果]GSTM1（-）基因型频率在病例组和对照组中分别占44．63％和33．88%，分布无显著性差异（χ^2=2．6436，P〉0．05），GSTT1（-）基因型频率在病例组和对照组中分别为52．89％和44．63名，分布也无显著性差异（χ^2=1．1650，P〉0．05）。吸烟者比非吸烟者发生胃癌的危险高（OR=2．538，95％CI：1．336～4．823）；饮酒者比非饮酒者发生胃癌的危险高（OR=2．097，95％CI：1．025～4．291）。同时携带GSTM1（-）和GSTT1（-）基因型者发生胃癌的危险性高于GSTM1（＋）和GSTT1（＋）基因型携带者（OR=2．097，95％CI：1．025～4．291）；同时有烟酒嗜好的个体发生胃癌的危险性高于无烟酒嗜好者（OR=2．330，95％CI：1．211～4．482）。携带GSTM1（-）和GSTT1（-）且有烟酒嗜好者，发生胃癌的危险显著高于携带GSTM1（＋）和GSTT1（＋）的无烟酒嗜好者（OR=3．600，95％CI：1．025～12．650）。[结论]吸烟、饮酒与胃癌易感性增加有关，GSTM1和GSTT1基因型及烟酒嗜好在胃癌发生中存在一定的交互作用。     

空气污染暴露与妊娠期糖耐量异常：Viva队列项目

[背景]已知细颗粒物（PM直径≤2．5μm，PM2.5）暴露与2型糖尿病相关，但是PM2.5与妊娠期高血糖的相关性尚未进行充分的研究。[方法]对马萨诸塞州波士顿地区没有糖尿病史的孕妇进行研究。在妊娠期中位数28．1周时，通过临床葡萄糖耐量试验，确定妊娠期糖耐量减低（IGT）和妊娠期糖尿病（GDM）。通过中央监测地点和时空模型，使用住宅地址估计妊娠中期的PM2.5和炭黑暴露。估计住宅区交通密度和道路距离，作为交通源空气污染暴露的替代指标。进行多因素logistic回归分析，以社会人Iz／学协变量进行调整，并采用多重填补法解释丢失的数据。[结果]2093名妇女中，65名（3％）存在IGT，118名（6％）患有GDM。妊娠中期时空暴露范围为：PM2.5，8．5～15．9μm／m^3；炭黑，0．1-1．7μm／m^3。在100m范围内，交通密度为0—30860辆／日×道路长度（km）；281名（13％）妇女住宅距离主要道路≤200m。与最低四分位数相比，暴露于时空PM2.5和交通密度的最高四分位数的IGT患病率升高，分别为比值比（OR）=2．63，95％CI：1．15～6．01以及OR=2．66，95％CI：1．24—5．71。IGT也与其他暴露指标呈正相关，尽管这些关联没有统计学意义。无污染物暴露与GDM呈正相关。[结论]妊娠期PM2.5和其他交通源污染物暴露越高与IGT相关，与GDM不相关。空气污染可能导致妊娠期血糖异常。     

2型糖尿病危险因素的交互作用研究

目的探讨2型糖尿病危险因素及其交互作用，为开展糖尿病的预防、治疗工作提供科学依据。方法采用病例一对照研究方法．病例为在深圳市第一人民医院、深圳市第二人民医院及深圳市保健委员会办公室就诊及住院的2型糖尿病患者，共295例；对照为同期在门诊进行健康体检的非糖尿病人群，共214例。对研究因素进行单因素及多因素非条件Logistic回归分析．在此基础上进行对数线性模型分析。结果调查人群中，糖尿病家族史（OR=6．507，95％CI：3．788～11．178）、高血脂（TG：OR=2．625，95％CI：1．295—5．323；LDL—C：OR=6．337，95％CI：3．379-11．884）、工作压力（OR=1．901，95％CI：1．263—2．863）、高血压（SBP：OR=I．055，95％CI：1．022～1．089）是2型糖尿病的危险因素：文化程度（OR=0．724，95％CI：0．599—0．875）、运动锻炼（OR=0．499，95％CI：0．268～0．930）是保护因素。对数线性模型分析发现，糖尿病各危险因素之间广泛存在一阶或二阶交互作用，其中．糖尿病家族史、年龄和运动锻炼三者分别与多个危险因素有明显的交互作用。结论2型糖尿病是遗传因素与环境因素共同作用的结果。对糖尿病的防治应采取综合措施，尤其对于具有糖尿病家族史者以及中老年人群，更应控制各种危险因素。     

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 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.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.