基于医患双方的女性早期乳腺癌选择保乳手术的影响因素研究

目的 分析早期乳腺癌患者选择保乳手术的影响因素。方法 选取2015年1月1日至2019年12月31日在福建省立医院确诊为早期乳腺癌并接受手术治疗的女性患者作为研究对象。通过医院信息系统及电子问卷分别收集患者及其主治医生的相关资料。采用二分类logistic多元回归模型分析影响因素。结果 医生年龄、患者年龄、患者所在地区的居民人均可支配年收入是患者选择保乳手术的影响因素。在其他变量不变的条件下，相对于低收入地区，中等收入地区的患者更有可能接受保乳手术（OR=1.91，95%CI：1.01~3.62，P=0.05）；患者的主治医生平均年龄45岁时，患者年龄每增加1岁，选择保乳手术预测概率降低4%（95%CI：-0.07~-0.01，P=0.01）；患者平均年龄52岁时，其主治医生年龄每增长1岁，选择保乳手术的预测概率降低10%（95%CI：-0.19~-0.01，P=0.03）。医、患年龄的交互作用对部分医、患显著，平均影响效应为0.06%（Z=2.11，s_x=0.000 3，P<0.05）。结论 促进符合适应证的早期乳腺癌女性患者选择保乳手术，需要考虑医、患双方的因素。     

队列人群出血性卒中和缺血性卒中危险因素的对比研究

目的 分析与比较出血性卒中和缺血性卒中危险因素及其暴露水平的差异。方法 2003年在上海市奉贤区某农村社区建立卒中危险因素研究队列,对常见的卒中危险因素进行基线调查,检测脑血管血流动力学指标,按照统一的积分规则计算脑血管功能积分,随访卒中的发病。用队列研究的方法分析出血性卒中和缺血性卒中的危险因素,对2种亚型卒中的危险因素进行分析和比较。结果 纳入研究的队列人群10 565例,随访（11.15±2.26）年,新发生出血性卒中103例,缺血性卒中268例。脑血管功能积分降低、饮酒史、高血压病史和年龄升高是出血性卒中的独立危险因素,风险比（HR）值分别为1.56（95%CI：1.23~1.98）、2.46（95%CI：1.39~4.34）、1.75（95%CI：1.00~3.07）和1.07（95%CI：1.04~1.10）。脑血管功能积分降低、吸烟史、高血压病史、卒中家族史、左心室肥厚和年龄升高是缺血性卒中的独立危险因素,HR值分别为1.43（95%CI：1.25~1.65）、1.52（95%CI：1.13~2.05）、1.51（95%CI：1.10~2.07）、1.89（95%CI：1.13~3.15）、1.74（95%CI：1.07~2.81）和1.07（95%CI：1.05~1.08）。结论 脑血管功能积分降低、高血压病史、年龄升高是出血性卒中和缺血性卒中共同的独立危险因素,饮酒史是出血性卒中的独立危险因素,吸烟史、卒中家族史和左心室肥厚是缺血性卒中的独立危险因素。     

血清Mg2+浓度与急性缺血性脑卒中患者短期结局的关系

目的 探讨血清Mg²⁺浓度与急性缺血性脑卒中患者短期预后的关系,为改善其预后提供合理依据.方法 以2006年1月1日至2008年12月30日在山东省4家医院住院急性缺血性脑卒中患者为调查对象,收集人口统计学、生活方式、疾病史、血生化指标、入院血压水平等资料.研究结局定义为出院的脑卒中量表评分(NIHSS)≥10分或者死亡.按NIHSS(NIH卒中评分)将研究对象分为两组,即死亡/NIHSS≥10及NIHSS＜10组.血清Mg²⁺浓度按四分位数分为4个水平.采用Cox比例风险模型分析血清Mg²⁺浓度与急性缺血性脑卒中患者短期预后的关系.结果 死亡/NIHSS≥10组的血清Mg²⁺浓度、发病至入院时间低于NIHSS＜ 10组(P＜0.05);入院时收缩压水平高于NIHSS＜ 10组(P＜0.05);低密度脂蛋白胆固醇异常、空腹血糖受损及心房纤颤史的百分率均高于NIHSS＜ 10组(P＜0.05).单因素分析发现血清Mg²⁺浓度第4分位(最高水平)可以降低急性缺血性脑卒中患者发生死亡/NIHSS≥10的危险性(RR=0.47,P＜0.05);调整血清Ca²⁺、K⁺水平等其他因素后,血清Mg²⁺第4分位和第3分位水平均可降低发生死亡/NIHSS≥10的危险性(RR值分别为0.39和0.54,P＜0.05).无论是否调整其他因素,血清Mg²⁺浓度与发生死亡/NIHSS≥10的危险性均存在着剂量反应关系(趋势检验P＜0.05).结论 高浓度的血清Mg²⁺可降低急性缺血性脑卒中患者发生死亡/NIHSS≥10的危险性,并存在剂量反应关系.     

沈阳市15~30岁学生HIV/AIDS患者抗病毒治疗相关因素分析

目的 探讨沈阳市学生HIV/AIDS患者抗病毒治疗（ART）的影响因素。方法 横断面调查获得2007-2015年沈阳市艾滋病治疗定点医院（中国医科大学附属第一医院）15~30岁学生HIV/AIDS患者ART相关信息,多因素logistic回归模型探讨ART的影响因素。结果 2007-2015年该医院共收治15~30岁学生HIV/AIDS患者146例,占累计治疗HIV/AIDS患者的6.1%（146/2 379）。患者均为男性,男男性行为传播途径占93.2%（136/146）,HIV延迟诊断率[诊断时CD₄⁺T淋巴细胞计数（CD₄）≤ 350个/μl]为52.7%（77/146）,患者中ART的构成比为67.1%（98/146）。多因素logistic回归分析显示,HIV诊断年份（aOR=1.21,95%CI：1.02~1.44）、年龄24~30岁（aOR=8.15,95%CI：1.46~45.52）和延迟诊断（aOR=2.22,95%CI：1.05~4.71）是学生HIV/AIDS患者ART的独立影响因素。结论 HIV诊断时间越晚、年龄越大及延迟诊断可能增加学生HIV/AIDS患者的ART比例。。     

2011-2018年中国手足口病发病的时空特征及影响因素研究

目的 分析我国手足口病的时空特征,探讨社会、经济、人口和卫生服务等因素对我国手足口病发病的影响,为手足口病疫情防控提供参考依据。方法 采用贝叶斯时空模型对手足口病数据进行拟合,评估手足口病的时空变化,并识别手足口病发病风险与社会、经济、人口和卫生服务等因素的潜在关联。结果 2011-2018年,我国共报告手足口病例17 118 050例,死亡2 283例,2011-2014年报告发病率呈波动上升趋势,2014-2018年报告发病率呈波动下降趋势,报告死亡率一直呈波动下降趋势。手足口病的发病具有空间聚集性,报告发病率最高的地区为华南地区且为热点区域及高风险区域,报告发病率最低的为西北地区,冷点区域及低风险区域也集中在其部分区域。手足口病发病风险与人均地区生产总值（RR=3.54）、每万人规模以上工业企业单位数（RR=1.61）、城市化率（RR=3.00）、人口出生率（RR=2.36）、每万人医疗机构床位数（RR=3.40）和人均公园绿地面积（RR=0.57）有关。结论 2011-2018年我国手足口病防控重点区域为东南沿海地区,在加快城市化进程的同时需考虑增加人均公园绿地面积,以降低手足口病的发病率。     

急性缺血性脑卒中患者入院24小时血压波动最大值对预后的影响

目的 探讨急性缺血性脑卒中患者入院24 h血压波动最大值与出院预后的关系。方法 2016年4月至2017年3月在哈尔滨医科大学附属第一医院急诊神经内科,连续收集发病24 h内入院的急性缺血性脑卒中患者,并按照高血压诊断标准将患者分组,采用床旁监护仪测量入院24 h内动态血压值及收集患者基线资料,并在其出院时进行NIHSS评分,分析24 h内SBP及DBP波动最大值与出院预后关系。结果 共纳入521例急性缺血性脑卒中患者,正常血压组82例,高血压组439例。正常血压组24 h内SBP和DBP波动的最大值均服从正态分布（均P>0.05）,SBP波动最大值以均值146.6 mmHg（1 mmHg=0.133 kPa）为界分组,调整年龄、性别、文化程度、体力活动、人均月收入、吸烟、饮酒、高血压史、糖尿病史、冠心病史、房颤史、脑卒中病史、血脂、血糖、同型半胱氨酸、BMI、入院时NIHSS评分后,与血压波动最大值<146.6 mmHg相比,≥146.6 mmHg与出院预后不良的OR值（95% CI）为2.669（0.594～11.992）;DBP波动最大值以均值90.0 mmHg为界分组,调整上述相关因素后,与DBP波动最大值<90.0 mmHg相比,≥90.0 mmHg与出院预后不良的OR值（95% CI）为0.416（0.087～1.992）。高血压组24 h内SBP和DBP波动最大值均不服从正态分布（均P<0.05）,SBP最大值以中位数171.0 mmHg为界分组,调整上述相关因素后,波动最大值越大,出院预后不良的风险越大,OR值（95% CI）为1.636（1.014～2.641）;DBP波动最大值以中位数98.0 mmHg为界,调整上述相关因素后,波动最大值越大,出院预后不良的风险越大,OR值（95% CI）为1.645（1.003～2.697）。结论 入院时为正常血压的急性缺血性脑卒中患者,入院24 h内SBP和DBP波动最大值与出院预后无关;入院时为高血压的急性缺血性脑卒中患者,入院24 h内SBP和DBP波动最大值与出院不良预后有关联。     

山东省2007－2016年丙型病毒性肝炎流行趋势与影响因素研究

目的 分析2007－2016年山东省丙型病毒性肝炎（丙肝）疫情的流行病学特征,探索丙肝发病的影响因素,为制定防治策略提供依据。方法 收集2007年1月1日至2016年12月31日山东省丙肝发病监测数据,在县级单位上探索空间聚集性;在地市级水平上应用面板poisson回归分析丙肝发病时空差异的主要影响因素。结果 山东省丙肝报告发病率自2007年1.49/10万上升到2016年4.72/10万。丙肝高发地区集中在济南市、淄博市、威海市的主城区,并逐渐向周围地区扩散。丙肝病例以青壮年为主,53.16%为农民（14 711/27 671）。多因素面板poisson回归分析结果显示：人口密度（aIRR=1.07,95% CI：1.05～1.10）、十万人拥有医院数（aIRR=1.16,95% CI：1.08～1.24）、农村人均年医疗费支出（aIRR=1.21,95% CI：1.08～1.37）、第三产业比重（aIRR=1.08,95% CI：1.07～1.09）与地区丙肝发病率呈正相关。结论 2007－2016年来山东省丙肝新发病例快速增长,丙肝防控工作应重点关注高危人群,要做好经济相对落后和农村地区的丙肝筛查,多发现隐匿感染者,做到丙肝的早发现、早治疗。     

江苏省句容市既往有偿献血人群慢性丙型肝炎重度肝纤维化影响因素研究

目的 探索既往有偿献血人群慢性丙型肝炎患者严重肝纤维化发生的影响因素,以便对可能发展成为严重肝纤维化的病例进行早期干预治疗,降低病死率。方法 2015年3-5月对江苏省句容市年龄≥50周岁且居住≥5年者进行横断面调查,筛查出既往有偿献血途径感染慢性丙型肝炎的患者作为研究对象。应用EpiData 3.10软件和Stata 12.0软件对数据进行录入及统计学分析。采用描述性统计分析方法比较性别、文化程度、实验室生化指标、是否合并乙型肝炎感染等组间发生严重肝纤维化的差异,采用单因素和多因素logistic回归分析相关因素与严重肝纤维化发生的关系。肝纤维化诊断采用FIB-4指数法。结果 共纳入慢性丙型肝炎患者719例,其中肝纤维化285人;男性占21.84%,女性占78.16%。多因素logistic回归分析结果显示,文化程度高（OR=0.65,95% CI：0.47～0.90）和接受抗病毒治疗（OR=0.33,95% CI：0.22～0.49）者发生严重肝纤维化风险较低,FPG高（OR=1.80,95% CI：1.19～2.77）和白细胞计数异常（OR=2.77,95% CI：1.95～3.90）者发生严重肝纤维化的风险较高。结论 丙型肝炎患者严重肝纤维化的发生受到诸多因素的影响。其中文化程度高和抗病毒治疗是慢性丙型肝炎患者发生严重肝纤维化的保护因素,FPG高和白细胞计数异常是慢性丙型肝炎患者发生严重肝纤维化的危险因素。     

宁波市60岁及以上老年人肺炎流行病学特征及住院时间的相关因素分析

目的 了解宁波市≥60岁老年人肺炎流行特征以及肺炎住院时间的相关因素。方法 通过区域卫生信息平台收集2019年入院的宁波市≥60岁老年人肺炎住院病例数据，通过浙江省统计局获得当年全市人口数据资料，对老年人肺炎住院病例进行描述性分析，并探讨其住院时间的相关因素。结果 共收集到2019年宁波市≥60岁肺炎住院病例15 956例，肺炎发病率为1.02%（15 956/1 571 431），其中男性发病率为1.13%（8 613/760 357），女性发病率为0.83%（6 759/811 074），男女性病例比为1.27∶1。≥80岁组发病率最高（2.52%），60~69岁组发病率最低（0.58%）。3、2、1月为肺炎住院发生的高峰期。肺炎诊断种类以未特指的肺炎为主（65.12%），其次为细菌性肺炎（34.60%）。肺炎患者住院时间的M（Q₁，Q₃）为9（7，13） d，多因素logistic回归分析结果显示，性别（女性：OR=0.911，95%CI：0.849~0.978）、年龄较大（70~79岁组：OR=1.211，95%CI：1.111~1.321；≥80岁组：OR=1.486，95%CI：1.365~1.617）、结算方式（自费：OR=0.567，95%CI：0.464~0.691）、较高级别的医院（二级：OR=1.902，95%CI：1.723~2.100；三级：OR=1.546，95%CI：1.407~1.698）为宁波市≥60岁老年人肺炎住院时间的相关因素。结论 2019年宁波市老年人肺炎住院在冬春季高发，其中男性、高龄老人是高危人群。性别、年龄、结算方式、医院等级可能是肺炎住院时间的相关因素。     

2014-2015年中国慢性阻塞性肺疾病患者的患病相关知识知晓情况

目的 了解2014-2015年我国≥40岁慢性阻塞性肺疾病（慢阻肺）患者的患病相关知识知晓情况及其影响因素。方法 采用2014-2015年中国居民慢性阻塞性肺疾病监测数据，共调查75 107人。利用电子问卷采取面对面询问方式收集有关慢阻肺患病知晓及相关知识知晓等信息，通过肺功能检查舒张试验后FEV₁/FVC<70%诊断慢阻肺患者共9 134名，基于复杂抽样设计估计我国≥40岁慢阻肺患者的患病知晓和相关知识知晓率并分析其影响因素。结果 9 132名慢阻肺患者纳入分析。≥40岁慢阻肺患者的患病知晓率为0.9%（95% CI：0.6%～1.1%），慢阻肺相关知识知晓率为5.7%（95% CI：4.8%～6.6%），肺功能检查知晓率为3.4%（95% CI：2.8%～4.0%）。有慢性呼吸系统疾病史、有呼吸道症状和知晓慢阻肺相关知识的患者，其慢阻肺患病知晓率分别为3.9%（95% CI：2.9%～4.8%）、2.4%（95% CI：1.7%～3.1%）和7.1%（95% CI：4.5%～9.8%）。多因素logistic回归分析显示，慢性呼吸系统疾病史、呼吸道症状、职业粉尘和/或有害气体暴露以及慢阻肺相关知识知晓情况影响慢阻肺患者的患病知晓率。文化程度和慢性呼吸系统疾病史影响患者慢阻肺相关知识知晓率；民族、文化程度、慢性呼吸系统疾病史影响慢阻肺患者的肺功能检查知晓率。结论 我国≥40岁慢阻肺患者人群的患病知晓率、肺功能检查知晓率以及慢阻肺知识知晓率均较低，应采取综合的慢阻肺管理与干预措施，不断提高慢阻肺患者的诊断水平及患病知晓水平。     

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.