孕早期邻苯二甲酸酯暴露与孕晚期空腹血糖水平关联的队列研究

目的 分析孕妇孕早期邻苯二甲酸酯（PAE）暴露与孕晚期FPG水平的关联及患妊娠糖尿病（GDM）的风险。方法 选取2013年5月至2014年9月在马鞍山市妇幼保健院产前检查的3 474名孕妇为研究对象,于孕早、中、晚期分别随访,采用问卷调查收集研究对象的社会人口学资料,记录临床相关信息;收集孕妇晨尿样本,运用固相萃取-高效液相色谱-串联质谱法（SPE-HPLC-MS/MS）检测尿液样本中7种PAE代谢物浓度;在孕早、晚期测定FPG,在孕中期进行75 g口服糖耐量试验（OGTT）。运用线性回归模型分析尿PAE代谢物与孕晚期FPG间的关联性,运用logistic模型分析孕早期PAE暴露水平与孕晚期患GDM的风险。结果 GDM检出率为12.8%;孕早期邻苯二甲酸单甲酯（MMP）、邻苯二甲酸单乙酯（MEP）、邻苯二甲酸单丁酯（MBP）、邻苯二甲酸单苄酯（MBzP）、邻苯二甲酸单（2-乙基-5-羟基己基）酯（MEHHP）暴露水平与孕晚期FPG呈正相关（P<0.05）,邻苯二甲酸单（2-乙基己基）酯（MEHP）、邻苯二甲酸单（2-乙基-5-酮基己基）酯（MEOHP）暴露水平与孕晚期空腹血糖水平呈负相关（P<0.05）。孕早期MEHHP暴露增加正常组和GDM组FPG水平,MMP、MEP、MBP、MBzP、MEHP和MEOHP暴露只影响正常组的FPG水平,对GDM组的FPG水平无影响。孕早期MMP和MBP暴露增加孕晚期患GDM的风险,MEOHP暴露降低孕晚期患GDM的风险。结论 孕早期PAE暴露与孕晚期FPG水平存在关联,不同种类PAE代谢物与孕晚期FPG水平关联性存在差异,PAE代谢物对正常孕妇FPG水平的影响较GDM孕妇更为显著。不同种类PAE代谢物可能增高或降低孕妇孕晚期患GDM的风险性。     

邻苯二甲酸酯暴露的时间趋势：来自2001—2010年美国国家健康和营养调查的研究结果

[背景]邻苯二甲酸酯是无处不在的环境污染物。由于对人类健康的潜在不利影响,邻苯二甲酸丁基苄基酯[BBzP;代谢物,邻苯二甲酸单苄基酯（MBzP）]、邻苯二甲酸二丁基酯[DnBP;代谢物,邻苯二甲酸单丁基酯（MnBP）]、以及邻苯二甲酸二（2-乙基己基）酯（DEHP）正在被替代品所取代,包括其他邻苯二甲酸酯。然而,人群水平暴露的结果趋势却鲜为人知。[目的]研究普通美国人群中尿邻苯二甲酸酯代谢物浓度的时间趋势,以及该趋势是否随着社会人口学特征不同而发生变化。     

天津市郊区不同土地利用类型土壤中邻苯二甲酸酯含量的调查

目的探讨天津市表层土壤邻苯二甲酸酯(PAEs)的含量和污染特征。方法 2009年11月采集天津市5个郊区84个表层土壤样品,采用气相色谱-质谱法(GC-MS)分析邻苯二甲酸二甲酯(DMP)、邻苯二甲酸二乙酯(DEP)、邻苯二甲酸二丁酯(DBP)、邻苯二甲酸苄基丁基酯(BBP)、邻苯二甲酸二(2-乙基己基)酯(DEHP)和邻苯二甲酸二辛基酯(DOP)的含量。结果 6种PAEs在所有土壤样品中全部检出;其合计含量在50.39~1657.46μg/kg之间;DEHP含量最高,DMP和DEP相对较低;大田和撂荒地6种PAEs合计含量较高,果园较低;与美国土壤PAEs化合物控制标准相比,DMP、DEP和DBP分别超标28.57%,2.38%和33.33%。结论本次调查的天津市郊区不同土地利用类型土壤中不同程度地检出6种PAEs,且含量变异较大。     

孕妇尿中3种邻苯二甲酸酯类代谢物的含量及影响因素

目的 了解孕妇的邻苯二甲酸二丁酯(di-n-butyl phthalate,DBP)、邻苯二甲酸丁基苄基酯(butylbenzylphthalate,BBzP)和邻苯二甲酸二(2-乙基己基)酯[di(2-ethylhexyl)phthalate,DEHP]3种邻苯二甲酸酯类(phthalate esters,PAEs)...     

健康青年男性精液中4种邻苯二甲酸酯类物质的分布与精子活动度的关系

目的 了解男性精液中邻苯二甲酸二甲酯(DMP)、邻苯二甲酸二乙酯(DEP)、邻苯二甲酸二丁酯(DBP)和邻苯二甲酸二(2-乙基己基)酯(DEHP)4种邻苯二甲酸酯类(phthalate esters,PAEs)的暴露情况及与精子活动度的关系.方法 选择宁夏医科大学总医院生殖科体检的健康男性为研究对象,采用高效液相色谱法测定精液中的4种邻苯二甲酸酯类水平.结果 在172件精液样品中,DEP均未检出;DMP、DBP、DEHP的检出范围分别为未检出～0.56、未检出～9.95、未检出～0.85μg/L,中位数分别为未检出、1.24 μg/L、未检出,检出率分别为46％,94％,47％.3种PAEs暴露水平与各级精子百分率之间无显著相关性(P＞0.05).结论 在男性精液中检测出DMP、DBP、DEHP 3种PAEs,精液中DMP、DBP、DEHP的分布和精子活动度无相关性.     

哈尔滨市新生儿脐带血中邻苯二甲酸酯含量及其影响因素

为了解哈尔滨市孕妇新生儿脐带血中邻苯二甲酸酯(PAEs)含量水平,随机选取哈尔滨市区和农村孕妇-新生儿252对,采集脐带血,收集调查问卷表,应用气相色谱-质谱联用仪对血清中PAEs进行定量分析。脐带血中共计检出11种PAEs,其中邻苯二甲酸二正辛酯(DNOP)、邻苯二甲酸(2-丁氧基)乙酯(DBEP)和邻苯二甲酸二(4-甲基-2-戊基)酯(BMPP)的检测率低于20%,邻苯二甲酸二甲酯(DMP)、邻苯二甲酸二乙酯(DEP)、邻苯二甲酸二异丁酯(DIBP)、邻苯二甲酸二丁酯(DBP)、邻苯二甲酸二(2-甲氧基)乙酯(DMEP)、邻苯二甲酸二(2-乙氧基)乙酯(DEEP)、邻苯二甲酸二环己酯(DCHP)和邻苯二甲酸二(2-乙基)己酯(DEHP)检出率均高于90%;城市组DMP、DEP、DIBP和DBP中位数高于农村组(P0.05);城市组孕妇孕期染烫发、化妆品使用频次、使用塑料餐具和杯子及饮用桶装水的比例均明显高于农村组(P0.05);孕期化妆品使用与DMP和DEP含量呈正相关(P0.05),使用塑料餐具及杯子与DMP、DEP、DIBP和DBP含量呈正相关(P0.05),DEP、DIBP和DBP含量与孕期饮用桶装水呈正相关(P0.05)。提示孕期使用化妆品,饮食、饮水接触塑料类产品可能是导致新生儿脐带血中PAEs含量增高的危险因素。     

宁夏地区饮用水中4种邻苯二甲酸酯类污染现状研究

目的了解宁夏地区饮用水中邻苯二甲酸酯类(PAEs)物质的污染现状。方法于2009年4月,采集宁夏地区5个市(A～E市)共7个水厂的水源水、出厂水和管网末梢水以及4个县(F～I县)的农村窖水水样进行邻苯二甲酸二丁酯(DBP)、邻苯二甲酸二乙酯(DEP)、邻苯二甲酸二(2-乙基己基)酯(DEHP)和邻苯二甲酸二甲酯(DMP)含量的测定。结果宁夏地区城市饮用水中DBP、DEP、DMP和DEHP的检出范围分别为0.181～3.656、0.622～3.181、0.03～3.673、0.03～7.675μg/L。A市、B市和C市所采集的水样中主要的PAEs为DBP和DEP,其水源水、出厂水、管网末梢水中均有DBP被检出,且在水源水和管网末梢水中DBP含量较高,而在出厂水中其含量较低;DMP和DEHP在各种水样中也有被检出,但均未超标。D市水厂和E市水厂的水源水、出厂水、管网末梢水中均未检出DBP、DEP、DMP和DEHP。宁夏地区农村水窖水水样中主要的PAEs为DBP和DEHP,其含量范围分别为0.407～3.811和0.03～2.522μg/L,且所有检测水样中均检出DBP。仅在F县的2个采样点水窖水中检测出DMP和DEP,含量范围分别为2.607～5.401和0.06～0.759μg/L。结论宁夏地区饮用水中PAEs污染物目前以DBP和DEHP为主。     

饮用水中邻苯二甲酸酯的气相色谱-质谱测定法

目的探讨水中邻苯二甲酸酯的GC—MS测定法。方法采用Agilent6890GC-5973MS联用仪并选择离子检测方式测定了水中邻苯二甲酸酯[邻苯二甲酸二甲酯（DMP）,邻苯二甲酸二乙酯（DEP）,邻苯二甲酸二丁酯（DBP）,邻苯二甲酸二（2-乙基己基）酯（DEHP）,邻苯二甲酸二正辛酯（DOP）]浓度。结果DMP,DEP,DBP的检出限为0．3μg／L,DEHP和DOP的检出限为0．8μg／L。DMP,DEP,DBP,DEHP和DOP的加标回收率分别为71．7％,88．9％,96．0％,90．5％和76．2％。RSD分别为2．8％,9．0％,4．5％,4．3％,3．2％。结论GC．MS法适用于饮用水中邻苯二甲酸酯的测定。     

邻苯二甲酸酯暴露与血脂异常的关系研究

目的了解人群体内血液中邻苯二甲酸酯(PAEs)的暴露水平,探究其暴露水平与脂代谢异常的关系。方法采用以横断面研究为基础的方法对哈尔滨市区随机选取的321名调查对象进行问卷调查、体格检查、血脂相关指标及15种PAEs的检测。结果调查对象血液中15种PAEs检出情况:邻苯二甲酸二异丁酯(DIBP)、邻苯二甲酸二(2-甲氧基)乙酯(DMEP)、邻苯二甲酸二(2-乙氧基)乙酯(DEEP)、邻苯二甲酸二环己酯(DCHP)、邻苯二甲酸二(2-乙基)己酯(DEHP)、邻苯二甲酸二(4-甲基-2-戊基)酯(BMPP)、邻苯二甲酸(2-丁氧基)乙酯(DBEP)、邻苯二甲酸二戊酯(DPP)、邻苯二甲酸二己酯(DHXP)、邻苯二甲酸苄基丁基酯(BBP)的检出率均高于95%;邻苯二甲酸二甲酯(DMP)、邻苯二甲酸二乙酯(DEP)、邻苯二甲酸二壬酯(DNP)、邻苯二甲酸二丁酯(DBP)、邻苯二甲酸二正辛酯(DNOP)的检出率低于50%。Spearman相关分析显示,DIBP与甘油三酯(TG)呈正相关(P0.05),DEHP与总胆固醇(TC)、TG、低密度脂蛋白胆固醇(LDL-C)之间呈正相关(P0.05)。多因素Logistics回归结果显示,DEHP与血脂异常关联强度的OR值为3.741(1.475~9.488)。结论体内DEHP暴露可能会导致人体脂代谢异常。     

嘉兴市18家集中式供水水厂23种邻苯二甲酸酯调查

目的了解嘉兴市与饮用水中23种邻苯二甲酸酯类(PAEs)的污染情况。方法于2015年2—3月(枯水期),选取嘉兴市以运河水系(新塍塘、海盐塘、泰山港、长水塘、盐嘉塘、京杭大运河)、太湖水系(太浦河)为水源地的18座集中式供水水厂,采集水源水、出厂水与管网水水样检测23种PAEs[包括邻苯二甲酸二甲酯(DMP)、邻苯二甲酸二乙酯(DEP)、邻苯二甲酸二异丙酯(DIPr P)、邻苯二甲酸二烯丙酯(DAP)、邻苯二甲酸二丙酯(DPr P)、邻苯二甲酸二异丁酯(DIBP)、邻苯二甲酸二丁酯(DBP)、邻苯二甲酸二(2-甲氧基)乙酯(DMEP)、邻苯二甲酸二异戊酯(DIPP)、邻苯二甲酸二(4-甲基-2-戊基)酯(BMPP)、邻苯二甲酸二(2-乙氧基)乙酯(DEEP)、邻苯二甲酸二戊酯(DPP)、邻苯二甲酸二己酯(DHXP)、邻苯二甲酸丁基苄基酯(BBP)、邻苯二甲酸二(2-丁氧基)乙酯(DBEP)、邻苯二甲酸二环己酯(DCHP)、邻苯二甲酸二(2-乙基)己酯(DEHP)、邻苯二甲酸二庚酯(DHP)、邻苯二甲酸二苯酯(DPh P)、邻苯二甲酸二正辛酯(DNOP)、邻苯二甲酸二异壬酯(DINP)、邻苯二甲酸二异癸酯(DIDP)、邻苯二甲酸二壬酯(DNP)]。分别测定23件水源水、19件出厂水、21件管网末梢水。结果水源水、出厂水中检出8种PAEs(DIBP、DBP、BMPP、DIPP、BBP、DCHP、DHP、DEHP),管网末梢水中检出5种PAEs(DIBP、DBP、DCHP、DHP、DEHP)。其余15种PAEs均未检出。GB 5749—2006《生活饮用水卫生标准》规定的3种PAEs(DEHP、DBP、DEP)及GB 3838—2002《地表水环境质量标准》规定的2种PAEs(DEHP、DBP)均未超标。结论嘉兴市集中式供水PAEs含量达标,但仍需密切关注环境水质变化。     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.