糖尿病发病的社会心理风险因素流行病学研究进展

糖尿病的患病率和疾病负担不断增加,成为全球重大公共卫生问题。随着生物-心理-社会医学模式的提出,社会心理因素对糖尿病的影响逐渐引起重视。本文对影响糖尿病发病的社会心理因素流行病学研究进行综述,国外研究显示心理因素与糖尿病的发病密切相关,关于社会因素的研究较少且结论不一致。国内相关研究相对较少且多为小样本横断面研究,仍需更多纵向研究来证实社会心理因素对糖尿病发病的作用。     

河南省老年人社会参与和脑卒中的关联性研究

目的 调查河南省老年人社会参与和脑卒中患病率的流行现状,探讨社会参与和脑卒中患病风险的关联。方法 采用多阶段分层整群随机抽样的方法选取河南省18个省辖市60岁及以上的老年人为研究对象,采用logistic回归分析社会参与得分与脑卒中患病风险的关联,并使用限制性立方样条模型拟合社会参与得分与脑卒中患病风险的剂量-反应关系。结果 共纳入5 570名研究对象,社会参与平均得分为（1.55±2.94）,其中社会参与水平失能占19.5%,完全自理占80.5%;脑卒中患病率为5%。调整多种混杂因素后,社会参与水平得分与脑卒中患病风险有关联(P＜0.05),相比社会参与正常的人群,社会参与受限的人群脑卒中比值比升高366%（OR = 4.657,95%CI:2.398～9.044）,社会参与得分每升高1分,脑卒中的比值比升高9%（OR = 1.083,95%CI:1.047～1.120）,限制性立方样条模型显示社会参与得分与脑卒中易感性存在剂量 - 反应关系。结论 社会参与水平受限与脑卒中患病风险有关,社会参与得分与患脑卒中存在剂量 - 反应关系。     

脑卒中患者生存率及其影响因素的7年随访研究

目的对脑卒中患者7年随访，描述患者病后生存情况，并分析生存的影响因素。方法以1995年11月至1996年12月天津医科大学总医院神经内科就诊的脑卒中新发病例189例为研究对象，随访患者的复发、死亡及其他结局。整个随访工作2003年10月完成。应用Kaplan—Meier法进行生存率分析。应用Cox比例风险模型对影响患者生存与复发的因素进行单因素和多因素分析。结果随访期间，共82例患者死亡，其中因脑卒中（包括首发与复发）死亡58例，因心脏病死亡8例。患者1年生存率为79．86％，3年生存率为65．46％，7年生存率为57．46％。影响患者生存的主要因素有：年龄（RR=1．065，P〈0．001），首次发病前参加体育锻炼（RR=0．308，P〈0．001），既往有高血压病史（RR=1．785，P〈0．05）和脑卒中病史（RR=2．493，P〈0．001），与病情严重程度有关的因素如脑损害面积（RR=1．031，P〈0．001）；患者的生存情况还与出院时情况，以及出院后的康复与治疗、复发情况有关系；研究还发现，社会心理因素诸如对康复有无信心、病后有无压抑感与负面生活刺激、亲友帮助等因素对于患者的生存也有作用。结论既往有高血压病史与脑卒中病史，发病时脑损伤情况严重对于脑卒中患者的生存影响较大；发病前坚持锻炼，出院后坚持康复与治疗者预后好；复发患者生存率比未复发者低；社会心理因素对生存影响也有较大作用。     

社会心理因素与肿瘤（一）

社会心理因素与肿瘤（一）张宗卫１什么是社会心理因素现代医学将病因分为四大类，即物理类、化学类、生物类和社会心理类。社会－心理因素（Ｐｓｙｃｈｏｓｏ－ｃｉａｌＦａｃｔｏｒｓ）是一大类疾病的危险因素，它又包括社会因素和心理因素两大部分。社会因素包括：社会...     

工作紧张因素与健康的关系

近20年来，工业化国家的研究人员对工作环境中的社会心理因素与健康的关系进行了大量的研究，获得了大量的证据，其中已证实工作紧张因素可引起高血压、冠心病、慢性酒精中毒和心理疾患等疾病。本文对工作紧张因素和健康之间的关系以及这一关系链中的相关作用因素做一简述。（一）工作紧张因素对健康的影响与物理和化学因素不同，社会心理紧张因素并无明显的职业界限，潜在地暴露于这类健康危险因素是普遍存在的，现在认为工作环境中的很多社会心理因素是潜在的健康危险因素。这些因素与个体特征相互作用而导致心理和生理平衡失调或紊乱，这…     

高尿酸血症与脑卒中发病风险及高血压的中介效应研究

目的 研究高尿酸血症与脑卒中发病风险间的关联以及高血压的中介效应。方法 本研究以2015年中国成人慢性病与营养监测为基线数据，脑卒中发病数据来源于2013-2020年住院病案首页数据库，死亡数据来源于2015-2020年全国死因监测系统，将数据库进行匹配链接后建立回顾性队列。采用Cox比例风险回归模型分析高尿酸血症与脑卒中及其亚型发病风险间的关联强度，采用限制性立方样条分析血尿酸水平与脑卒中发病风险间的剂量-反应关系，采用因果中介效应模型分析高血压在高尿酸血症与脑卒中及其亚型发病风险间的中介效应，并按照性别和年龄组进行亚组分析。结果 共纳入研究对象124 352人，累计随访612 911.36人年，随访期间共4 638人发生脑卒中，其中缺血性脑卒中3 919人，出血性脑卒中689人，总人群脑卒中、缺血性脑卒中和出血性脑卒中发病密度分别为756.72/10万人年、641.37/10万人年和114.60/10万人年。Cox比例风险回归模型分析结果显示，调整混杂因素后，与非高尿酸血症患者相比，高尿酸血症患者的脑卒中发病风险升高16%［风险比（HR）=1.16，95%CI：1.06~1.27］、缺血性脑卒中发病风险升高12%（HR=1.12，95%CI：1.01~1.24）、出血性脑卒中发病风险升高39%（HR=1.39，95%CI：1.11~1.75）。因果中介效应分析结果显示，调整协变量后，高血压在高尿酸血症与脑卒中、缺血性脑卒中、出血性脑卒中发病风险间存在中介效应，中介效应百分比分别为36.07%、39.98%、25.34%，在男性和<65岁人群内的中介效应百分比更高。结论 高尿酸血症是脑卒中的发病危险因素，高血压在高尿酸血症与脑卒中发病风险关联中存在中介效应。     

早晨血压升高和夜间血压下降对脑卒中的预告意义

血压的昼夜升降（包括夜间血压降低及早晨血压升高）是否预告脑卒中的发生仍在争议中。作者随访日本Ohasama地区≥40岁的l430人，患脑卒中的10．4a。用Cox proportional hazards模型（调节了可能的混杂因子）分析脑卒中危险及血压水平昼夜间的关联。结果显示，脑卒中总发病危险与夜间血压降低、早晨血压升高之间无明显关联。     

佳木斯地区居民膳食营养素的摄入与缺血性脑卒中的相关性研究

目的:研究佳木斯地区居民膳食营养素的摄入与缺血性脑卒中的关系,寻找与缺血性脑卒中相关的危险因素及保护性因素。方法:选取年龄在45~85岁之间的缺血性脑卒中患者250人为病例组;另选取该区相匹配年龄的214例健康人作为对照组,采用半定量食物频率问卷法进行膳食调查,采用Logistic回归模型探究营养素摄入与缺血性脑卒中的关系。结果:控制主要非膳食因素后,蛋白质、膳食纤维、钾、VitA、VitC与缺血性脑卒中发生之间存在显著负关联;钠与缺血性脑卒中的发病存在显著正关联。结论:钠为缺血性脑卒中的危险因素;蛋白质、膳食纤维、钾、VitA、VitC为缺血性脑卒中的保护因素。     

人群癫痫危险因素及社会心理因素病例对照研究

目的：了解自然人群癫痫患者的危险因素及社会心理状况。方法：对上海市金山区朱泾镇普查出的71例原发性癫痫患者1：1配对进行危险因素调查及对包括10例继发性在内的癫痫患者进行配对的社会心理状况的问卷调查。结果：经过多因素逐步条件logistic回归分析发现，新生儿疾病（OR=6.517）、饮酒（OR=10.761）、癫痫家族史（OR=5.414）与癫痫有着很强的关联。病例组的社会心理状况与正常对照组存在着明显的差异，在≥17岁的成人患者中尤其明显。结论：新生儿疾病及产伤、饮酒、癫痫家族史是癫痫发病的危险因素，心理与精神异常在癫痫患者中发生率很高。     

基于孟德尔随机化的血脂六项与冠心病因果关系研究

目的 探究血脂六项指标（甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、载脂蛋白A、载脂蛋白B）与冠心病之间的因果关系，为血脂六项指标与冠心病发病风险关联提供遗传学证据支持。方法 研究采用MR-Egger回归、加权中位数法（weight median estimator, WME）、随机效应逆方差加权法（inverse-variance weighted, IVW）、加权模型4种回归模型对血脂六项指标与冠心病的因果关系进行孟德尔随机化分析。结果 IVW模型显示甘油三酯（OR=1.402）、总胆固醇（OR=1.414）、低密度脂蛋白（OR=1.867）、载脂蛋白B（OR=1.738）为冠心病的危险因素，高密度脂蛋白（OR=0.791）为冠心病的保护因素，IVW模型则显示载脂蛋白A为有统计学意义的影响因素；MR-Egger回归截距项P值均>0.05，即筛选出的SNP不存在基因多效性，因此孟德尔随机化在本研究中为因果推断的有效方法；异质性检验结果P值均<0.001，故应重点关注随机效应IVW模型。结论 利用两样本孟德尔随机化方法排除混杂因素和反向因果关联后，得到无偏估计的结果，据此可以确定甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、载脂蛋白B与冠心病之间存在因果关系。     

Occupational aging and cardiovascular diseases

A short review of occupational aging and cardiovascular disease is presented. Coronary and stroke events are typical diseases of aging, in which rare monogenic disorders and common polymorphisms interact with environmental factors. Among these factors, particular attention has been given to social and occupational organizations. Cardiovascular mortality apparently increases with heavy industrialization processes and lower socioeconomic and educational status. Similar data are now available for incidence and case fatality. Since traditional risk factors--e.g., cholesterol, blood pressure and smoking--follow the same pattern, but with a weaker association than expected, observational and preventive studies are considering risk possibilities beyond such factors. Job demand/job decision latitude is the most widely used paradigm to evaluate specific organizational risk at work. A few cohort or population studied and many cross-sectional studies have shown an independent and inverse relationship between decreasing control of the job, coronary disease and blood pressure levels. While such results need further confirmation, they suggest the need for more accurate research on the adverse or mutually protective influences of long-lasting adaptation processes required by prevailing work organization.     

Adult height and the risk of cardiovascular disease among middle aged men and women in Japan

An inverse association between height and risk of cardiovascular disease has been reported, but the evidence is limited for stroke subtypes, in particular in Asian populations. Further, few studies have examined how socioeconomic status in adulthood influence the relationship between height and risk of cardiovascular disease. This study examined the association between height and risks of stroke and coronary heart disease, and whether education level, an indicator of adult socioeconomic status, modify the effect of height on those risks, within a cohort of the Japan Public Health Center-based Prospective Study (JPHC Study). The hazard ratios for the incidence of cardiovascular disease associated with height were calculated by a 16-year follow-up of 15,564 Japanese men and women, aged 40–59. The hazard ratios were adjusted for age, gender, area, education, occupation and cardiovascular risk factors. Height was inversely associated with risks of total stroke, either hemorrhagic or ischemic stroke but not with coronary heart disease. The adjusted hazard ratios (95% confidence interval (CI)) of total stroke, hemorrhagic stroke, and ischemic stroke for a 1 SD height increments were 0.82 (95% CI: 0.74, 0.90), 0.80 (95% CI: 0.70, 0.92), and 0.83 (95% CI: 0.73, 0.95), respectively. No multiplicative interaction was observed between height and education level on stroke risk. Short stature was associated with increased risk of total stroke, either hemorrhagic or ischemic stroke, independent of adult socioeconomic status and cardiovascular risk factors, but not with risk of coronary heart disease in Japanese men and women.     

重庆市人群肺癌、肝癌和乳腺癌危险因素研究

对９０９对病例对照的人户调查进行单因素和多因素分析。研究表明吸烟、空气污染、职业危害、肺部疾患既往史、不良心理等是肺癌的危险因素。而本次研究获得吸烟与肺癌死亡相对危险度的剂量效应关系;再次证明二者之间存在着因果关系。肝癌的危险因素有乙型肝炎病毒感染、饮水污染、家族史和社会心理因素先前也腺癌的危险因素则有乳腺良性病史、职业接触、结婚年龄等。     

Role of statins in prevention of stroke and dementia]

There is accumulating evidence that statins reduce stroke risk, even though total cholesterol is not a risk factor for stroke. The explanation for this discrepancy is subject to discussion. It should be realised that the beneficial effects of statins on stroke risk have only been demonstrated in a select population, i.e. middle-aged men with ischaemic heart disease. Several clinical trials are underway to examine the effects of statins on stroke risk in more characteristic groups of patients who are at increased risk of developing stroke. The results of these studies should be awaited before statins are recommended for the prevention of stroke. Recently it has been reported that statins lower the risk of developing dementia. These conclusions were drawn from two cross-sectional studies. Because of the nature of the studies, only an association between the use of statins and a lower risk of developing dementia was shown, and not a causal relationship. Experimentally-controlled studies have to be designed to investigate the effect of statins on dementia.     

Dietary fiber consumption and risk of stroke

Observational studies suggest an association between dietary fiber consumption and risk of stroke, but the results are inconclusive. The authors conducted a meta-analysis of prospective cohort studies to evaluate the relation between dietary fiber consumption and stroke risk and mortality. Relevant studies were identified by searching PubMed, Embase, and ISI Web of Science through February 2013. We included prospective studies that reported relative risks (RRs) with 95 % confidence intervals (CIs) for the association between dietary fiber consumption and stroke risk and mortality. Both fixed- and random-effects models were used to calculate the summary risk estimates. Eleven prospective studies involving 325,627 participants were included in the meta-analysis. The pooled RR of stroke for the highest compared with the lowest dietary fiber consumption was 0.83 (95 % CI 0.74, 0.93). In addition, the increment in dietary fiber consumption was associated with decreased stroke risk in a dose–response manner. Sensitivity analysis restricted to studies with control for conventional risk factors yielded similar results, and omission of any single study had little effect on the combined risk estimate. Moreover, there was a trend toward an inverse association between higher fiber consumption and stroke mortality (RR 0.85; 95 % CI 0.60, 1.20), although it is not significant. This meta-analysis indicated that dietary fiber consumption is inversely associated with stroke risk, and the effect is probably independent of conventional risk factors. Our results support recommendations for higher consumption of fiber-rich foods to prevent stroke.     

The association between idiopathic environmental intolerance and psychological distress,and the influence of social support and recent major life events

Objectives  

Idiopathic environmental intolerance (IEI) is a disorder characterized by non-specific symptoms attributed to common airborne chemicals. Increasing evidence points to an association between IEI and symptoms of psychological distress. However, whether other risk factors influence this association has not been clarified. The objective of this study was to examine the association between psychological distress and IEI and to determine whether the association is confounded by social support and major life events.     

Social support and social networks: their relationship to the successful and unsuccessful survival of elderly people in the community. An analysis of concepts and a review of the evidence

Many studies suggest that there is a relationship between social support and physical and psychological health status, risk of institutionalization and mortality of the elderly. Although longitudinal analyses confirm these suggestions, all studies experience problems with network methodology, and none use comparable operational or working definitions. It is known that there is an effect between these variables, but the nature of the relationship is still unknown. This paper reviews existing research on social networks, social support and associations with health status, mortality and risk of institutionalization.