多环芳烃与p16、FHIT基因CpG岛甲基化在宫颈上皮内瘤变中的交互效应

目的 探讨多环芳烃与p16、FHIT基因CpG岛甲基化在宫颈上皮内瘤变（CIN）中的作用及其交互效应。方法 利用2014年6-12月建立的山西省阳曲县宫颈病变研究队列。包括经病理学确诊的CIN患者169例（CINⅠ86例,CINⅡ/Ⅲ 83例）和正常宫颈（NC）妇女91例。全部研究对象采用高效液相色谱法检测尿液中的1-羟基芘（1-OHP）浓度,甲基化特异性PCR法检测抑癌基因p16、FHIT CpG岛甲基化状态。应用SPSS 20.0软件进行相关资料的Kruskal-Wallis H检验、χ²检验、趋势χ²检验,应用logistic回归模型计算因素与宫颈疾病之间关联强度的OR值及其95%CI,应用广义多因子降维模型（GMDR）评价交互作用。结果 随着CIN程度加重,1-OHP水平逐渐上升（H=50.743,P<0.001）,1-OHP高暴露率逐渐升高（趋势检验χ²=20.146,P<0.001）。CINⅠ、CINⅡ/Ⅲ组p16、FHIT CpG岛甲基化率均高于NC组;随着CIN程度的加重,p16基因CpG岛甲基化率（趋势检验χ²=9.75,P=0.002）、FHIT基因CpG岛甲基化率（趋势检验χ²=10.39,P=0.001）均逐渐升高。GMDR交互作用分析显示,在CINⅠ和CINⅡ/Ⅲ组,1-OHP高暴露与p16、FHIT基因CpG岛甲基化呈交互作用。结论 1-OHP高暴露和p16、FHIT CpG岛甲基化均可增加CIN的风险,且在病变中具有协同作用。     

阴道微环境改变与HPV16感染在宫颈上皮内瘤变中的作用及其交互效应

目的 探讨阴道微环境改变和HPV16感染在宫颈上皮内瘤变中的作用及其交互效应。方法 研究对象来源于课题组前期在山西省建立的宫颈病变研究队列,包括623例正常宫颈（NC）妇女、303例低度宫颈上皮内瘤变（CINⅠ）患者和93例高度宫颈上皮内瘤变（CINⅡ/Ⅲ）患者。在收集其人口学特征和宫颈上皮内瘤变相关因素资料的同时,采用导流杂交技术检测HPV16感染状况,应用需氧菌性阴道炎/细菌性阴道病联合检测试剂盒检测阴道分泌物中的H₂O₂、β-葡萄糖醛酸苷酶、凝固酶、唾液酸酐酶和白细胞酯酶,以及阴道pH值和清洁度。应用SPSS 22.0软件进行数据的录入和资料分析。结果 随着宫颈病变的进展,HPV16感染率（趋势性χ²=55.45,P<0.001）、H₂O₂ （趋势性χ²=26.19,P<0.001）、pH值（趋势性χ²=5.06,P=0.024）、阴道清洁度（趋势性χ²=19.55,P<0.001）、β-葡萄糖醛酸苷酶（趋势性χ²=17.52,P<0.001）、唾液酸酐酶（趋势性χ²=14.90,P<0.001）的异常率均逐渐升高,而凝固酶和白细胞酯酶异常率未见相应趋势。广义多因子降维模型交互作用分析显示,在CINⅠ组,HPV16感染与H₂O₂、β-葡萄糖醛酸苷酶、凝固酶、唾液酸酐酶异常呈交互作用,在CINⅡ/Ⅲ组,HPV16感染与阴道清洁度、H₂O₂、β-葡萄糖醛酸苷酶、唾液酸酐酶异常呈交互作用。结论 阴道微环境改变和HPV16感染均可增加宫颈病变的发病风险,且在宫颈上皮内瘤变中具有交互作用。     

hnRNP K在宫颈上皮内瘤样变中的作用及其与HPV16交互效应

目的 探讨hnRNP K与HPV16感染在宫颈上皮内瘤样变（CIN）中的作用及其交互效应。方法 选取2014年6月至2015年6月在山西省介休市建立的社区队列中经病理学确诊的正常宫颈（NC）女性67例和CIN患者137例（CINⅠ患者69例、CINⅡ/Ⅲ患者68例）为研究对象。采用结构式问卷收集研究对象人口学资料及宫颈病变相关因素的基础上，采集宫颈脱落细胞和宫颈活检或手术组织，应用分子导流杂交法检测HPV16感染状况，并采用Western blot技术检测宫颈组织中hnRNP K蛋白表达水平。采用SPSS 23.0软件对资料进行整理分析，研究对象的人口学特征、相关因素、hnRNP K蛋白和HPV16感染在NC组、CINⅠ和CINⅡ/Ⅲ组的差异通过χ²检验、趋势χ²检验、Kruskal-Wallis H检验进行比较；hnRNP K蛋白表达量的组间两两多重比较采用Bonferroni法；采用非条件logistic回归模型计算hnRNP K蛋白、HPV16感染与CIN的关联强度OR值及其95% CI，采用相加交互模型及交互效应指标评价hnRNP K蛋白和HPV16感染两因素在CIN中的交互效应。结果 CINⅡ/Ⅲ组HPV16感染率（41.2%）高于NC（10.4%）、CINⅠ（14.5%），差异有统计学意义（P<0.001），且随着CIN程度加重，HPV16的感染率呈上升趋势（趋势χ²=18.512）。hnRNP K蛋白表达量在NC组、CINⅠ组和CINⅡ/Ⅲ组间差异有统计学意义（H=48.138，P<0.001），且随着CIN程度加重呈上升趋势（趋势χ²=21.765，P<0.001）。交互效应分析显示，hnRNP K蛋白高表达与HPV16感染在CINⅡ/Ⅲ组存在正相加交互作用（API=0.639，95% CI：0.083~1.196），在CINⅠ组尚未发现存在类似交互作用。结论 hnRNP K蛋白高表达、HPV16感染均可能增加CIN的发生风险，且在高度CIN发生中存在正相加交互作用。     

hnRNP E1与HPV16早期基因E2和E6在宫颈癌变中的作用及交互效应

目的 探讨核不均一核糖核蛋白（hnRNP）E1与HPV16早期基因E2和E6在宫颈癌变进展中的作用及相互关系。方法 从在山西省介休市建立的自然人群宫颈病变队列中,选取2014年6-9月经病理学确诊的正常宫颈（NC）女性56例,低度宫颈上皮内瘤变（CIN Ⅰ）病例58例和高度宫颈上皮内瘤变（CIN Ⅱ/Ⅲ）病例50例,以及同期在山西省肿瘤医院确诊的40例宫颈鳞状细胞癌（SCC）病例作为研究对象。采用结构式问卷收集研究对象的宫颈病变相关资料的同时,采集宫颈组织活检标本和宫颈脱落细胞。采用导流杂交法检测HPV感染状况,采用Western Blot检测hnRNP E1以及HPV16 E2和E6蛋白表达水平。采用SPSS 22.0软件进行Kruskal-Wallis H检验、χ²检验、趋势χ²检验和logistic回归分析,采用广义多因子降维法（GMDR）评价交互作用。结果 HPV16感染率在CINⅠ（15.52%,9/58）、CINⅡ/Ⅲ（40.00%,20/50）和SCC组（67.50%,27/40）均高于NC组（8.93%,5/56）,并随着宫颈病变程度的加重呈现升高趋势（趋势检验χ²=43.613,P<0.001）。hnRNP E1表达量在不同宫颈病变组间差异有统计学意义（H=9.98,P=0.019）,且随宫颈病变程度的加重呈现降低趋势（趋势检验χ²=9.495,P=0.002）。HPV16 E2（H=16.20,P=0.001）和E6（H=15.44,P=0.001）表达水平在不同宫颈病变组间差异均有统计学意义。采用GMDR分析显示,hnRNP E1低表达、HPV16 E2低表达与HPV16 E6高表达在CIN Ⅱ/Ⅲ和SCC组中存在交互作用（P<0.05）,而在CIN Ⅰ组未发现存在交互效应（P>0.05）。结论 hnRNP E1低表达和HPV16早期基因的异常表达可能会增加宫颈病变的发病风险,并在宫颈癌变中存在交互作用。     

红细胞叶酸对高危型人乳头瘤病毒感染转归影响的前瞻性队列研究

目的 探讨红细胞叶酸对高危型人乳头瘤病毒（HR-HPV）感染转归的影响。方法 从课题组于2014年在山西省建立的已婚女性自然人群队列中,选择经病理学确诊的低度宫颈上皮内瘤变（CINⅠ）患者564名为研究对象。采用前瞻性队列研究的方法,在基线收集研究对象一般人口学特征、HPV感染相关因素的同时,利用化学发光免疫分析法进行红细胞叶酸水平的测定,依此将研究对象分为不同水平暴露组并在第24个月对其进行随访。应用导流杂交技术对研究对象基线及随访结束时的宫颈脱落细胞进行HPV感染状况检测,依据其变化情况判定HR-HPV持续感染、由阳转阴、由阴转阳和持续阴性4种不同结局,探讨红细胞叶酸对HR-HPV感染转归的影响。采用SPSS 22.0软件进行资料分析。结果 483名女性完成了24个月的随访观察,随访率为85.64%（483/564）,HR-HPV持续感染率为52.45%（75/143）,由阳转阴率为47.55%（68/143）,由阴转阳率为19.71%（67/340）,持续阴性率为80.29%（273/340）。红细胞叶酸低水平组发生持续感染（aRR=2.50,95%CI：1.55~4.02）及由阴转阳（aRR=4.55,95%CI：2.52~8.23）的风险高于高水平组,特别是同型持续感染的发生风险（aRR=2.72,95%CI：1.51~4.90）较高。随着红细胞叶酸水平的降低,HR-HPV持续感染（趋势检验χ²=20.62,P<0.001）、由阴转阳（趋势检验χ²=31.76,P<0.001）和同型持续感染（趋势检验χ²=20.09,P<0.001）的发生风险呈升高趋势,在异型持续感染中未见类似结果。结论 红细胞叶酸低水平可增加HR-HPV持续感染和由阴转阳的风险,特别是HR-HPV感染女性,发生同型持续感染的危险性更大。     

FHIT基因甲基化及蛋白表达与HPV16感染在宫颈癌变中的交互效应

目的 探讨脆性组氨酸三联体(FHIT)基因甲基化及蛋白表达异常与HPV16感染在宫颈癌变中的作用及其交互效应。方法 选择2009年9月至2011年3月在山西省肿瘤医院、山西医科大学第二医院妇科、太原市妇幼保健院和介休市妇幼保健院就诊的宫颈鳞状细胞癌(SCC)新发患者100例,宫颈上皮内瘤样变(CIN)患者142例(72例CIN1,70例CIN2+)和正常宫颈(NC)妇女108例为研究对象。采用多重PCR法检测HPV16感染状况,应用甲基化特异性PCR(MSP)和Western Blot法分别检测FHIT基因甲基化状态和蛋白的表达水平。利用SPSS 20.0软件进行相关资料的t检验、方差分析、χ²检验、因素与疾病关联效应分析(OR值及其95%CI),应用相加效应模型进行交互作用评价。结果 HPV16感染率在CIN1组(45.8%)、CIN2+组(68.6%)和SCC组(73.0%)均高于NC组(28.7%),差异均有统计学意义(P<0.001);在NC、CIN1、CIN2+和SCC组,FHIT基因甲基化率分别为3.7%、13.9%、21.4%和38.0%,蛋白表达水平分别为1.255±0.130、1.184±0.172、1.133±0.126和1.099±0.148,各组的差异均有统计学意义(P<0.001);随宫颈病变程度的加重,HPV16感染率逐渐升高(趋势检验χ²=47.623,P<0.001),FHIT基因甲基化率逐渐升高(趋势检验χ²=40.147,P<0.001),FHIT蛋白低表达率也逐渐升高(趋势检验χ²=65.098,P<0.001);FHIT基因高甲基化、FHIT蛋白低表达与HPV16感染在不同宫颈病变组均存在正相加交互效应。结论 FHIT基因高甲基化和FHIT蛋白低表达与HPV16感染均可增加宫颈癌及其癌前病变的发生风险,FHIT基因高甲基化和FHIT蛋白低表达与HPV16感染在宫颈癌变中均具有协同作用。     

多环芳烃暴露对高危型人乳头瘤病毒感染转归影响的前瞻性队列研究

目的 探讨多环芳烃（PAHs）暴露对高危型人乳头瘤病毒（HR-HPV）感染转归的影响。方法 采用前瞻性队列研究方法,以课题组于2014年在山西省建立的自然队列人群中经病理学确诊的564名低度宫颈上皮内瘤变患者为研究对象。在收集人口学特征、HPV感染相关因素等基线资料的基础上,采用高效液相色谱法检测尿液中的1-羟基芘浓度以界定PAHs的暴露水平。于基线和24个月随访时应用导流杂交技术进行HPV分型检测,并以此确定HR-HPV的转归情况（持续感染、阳转阴、阴转阳和持续阴性）。结果 564名研究对象中共有483名完成了随访,随访率为85.6%（483/564）,其中,持续感染率为52.4%（75/143）、同型持续感染率为35.1%（51/143）、阳转阴率为47.6%（68/143）、阴转阳率为19.7%（67/340）、持续阴性率为80.3%（273/340）。PAHs高暴露组HR-HPV持续感染率（aRR=3.22,95%CI：1.85~5.62）和阴转阳率（aRR=2.84,95%CI：1.64~4.94）均高于低暴露组,而HR-HPV持续阴性率则低于低暴露组（aRR=0.55,95%CI：0.43~0.70）。经限制性立方样条模型分析显示,PAHs暴露对HR-HPV持续感染和同型持续感染的影响呈上升型线性剂量-反应关系（P>0.01）,而对阴转阳和持续阴性的影响分别呈上升和下降型非线性剂量-反应关系（P<0.01）。结论 PAHs高暴露可促进HR-HPV持续感染和同型持续感染的发生,积极预防和控制PAHs的暴露对于阻止HR-HPV感染的发生和持续感染具有重要意义。     

叶酸与p16蛋白在宫颈癌变中的作用及其相互效应

目的 探讨叶酸与p16蛋白在宫颈癌变中的作用及其相互效应。方法 选取经病理学确诊的80例正常宫颈（NC）妇女、55例低度宫颈上皮内瘤样变（CINⅠ）患者、55例高度宫颈上皮内瘤样变（CINⅡ/Ⅲ）患者、64例宫颈鳞状细胞癌（SCC）患者为研究对象。分别采用微生物法和Western-blot方法检测其血清叶酸水平和p16蛋白的表达量。同时采用体外细胞实验研究方法,对HPV阴性的宫颈癌细胞C33A和HPV16阳性的宫颈癌细胞Caski进行不同浓度叶酸干预,检测两种宫颈癌细胞的增殖和凋亡情况,以及p16蛋白的表达。结果 NC组、CINⅠ组、CINⅡ/Ⅲ组和SCC组血清叶酸含量分别为（5.96±3.93） ng/ml、（5.08±3.43） ng/ml、（3.92±2.59） ng/ml、（3.18±2.71） ng/ml,p16蛋白表达水平分别为0.80±0.32、1.33±0.52、1.91±0.77、2.09±0.72;随着宫颈病变的进展,血清叶酸含量逐渐降低（趋势检验 χ²=32.71,P<0.001）,p16蛋白表达量逐渐升高（趋势检验 χ²=56.06,P<0.001）。在CINⅠ、CINⅡ/Ⅲ、SCC组中血清叶酸缺乏与p16蛋白高表达均存在正相加交互作用。体外实验结果显示,随着叶酸浓度的增加,宫颈癌细胞的增殖抑制率（C33A：r=0.928,P=0.003;Caski：r=0.962,P=0.001）和凋亡率（C33A：r=0.984,P<0.001;Caski：r=0.986,P<0.001）均上升,p16蛋白表达量逐渐降低（C33A：r=-0.817,P=0.025;Caski：r=-0.871,P=0.011）,且p16蛋白表达量与宫颈癌细胞的增殖抑制率（C33A：r=-0.935,P=0.002;Caski：r=-0.963,P=0.001）和凋亡率（C33A：r=-0.844,P=0.017;Caski：r=-0.898,P=0.006）均呈负相关关系。结论 血清叶酸缺乏与p16蛋白高表达均可增加宫颈癌和癌前病变的发病风险,两者在宫颈癌和癌前病变中存在正相加交互作用。补充叶酸可逆转p16蛋白的异常表达,有效抑制宫颈癌细胞的增殖,促进凋亡。     

叶酸与HPV16 E6/E7 mRNA表达在宫颈癌变中的交互作用

目的 探讨叶酸与人乳头瘤病毒16型(HPV16)E6/E7 mRNA表达在宫颈癌变中的交互作用。方法 选取经病理学确诊的宫颈鳞状细胞癌(SCC)患者64例、低度宫颈上皮内瘤样变(CIN1)患者55例、高度宫颈上皮内瘤样变(CIN2+)患者55例和正常宫颈(NC)者80例作为研究对象。采用微生物法测定血清叶酸和红细胞叶酸水平,应用real-time PCR法检测HPV16 E6/E7 mRNA表达水平。利用SPSS 16.0软件进行相关资料的χ²检验、方差分析、Welch检验、Kruskal-Wallis H检验、有序logistic回归和Spearman秩相关分析,应用相加模型进行交互作用分析。结果 随着宫颈癌变的进展,血清叶酸和红细胞叶酸水平均呈逐渐降低趋势(χ²=32.71,P<0.001; χ²=16.32,P<0.001),且血清叶酸和红细胞叶酸含量呈正相关(r=0.41,P<0.001);HPV16 E6/E7 mRNA表达水平随着宫颈癌变的进展呈逐渐升高趋势(χ²=30.11,P<0.001; χ²=38.99,P<0.001);红细胞叶酸含量与HPV16 E6/E7 mRNA表达量呈负相关(E6:r=-0.14,P=0.009;E7:r=-0.21,P=0.001),红细胞叶酸缺乏与HPV16 E6/E7mRNA高表达在CIN1、CIN2+和SCC组均存在正相加交互作用。结论 叶酸缺乏和HPV16 E6/E7 mRNA高表达均可增加宫颈癌及癌前病变发生的风险,两者在宫颈癌变进展中存在协同作用。     

人乳头瘤病毒感染和阴道微环境紊乱与宫颈病变的关系

目的 探讨人乳头瘤病毒（HPV）感染和阴道微环境紊乱与宫颈病变的关系及其交互效应。方法 从课题组前期建立的自然人群队列中选取基线调查时确定的正常宫颈（NC）妇女623人、低度宫颈病变（CIN Ⅰ）妇女303人及高度宫颈病变（CIN Ⅱ/Ⅲ）妇女93人为研究对象。以NC为对照组、CIN为病例组，采用病例对照研究方法，在收集研究对象人口学特征、生殖情况、生活习惯、既往病史宫颈病变相关因素的基础上，应用导流杂交法检测HPV分型，需氧菌性阴道炎/细菌性阴道炎联合检测试剂盒检测阴道分泌物中的H₂O₂，精密pH试纸检测阴道pH值，涂片法检测阴道清洁度。利用SPSS 20.0软件进行相关资料的分析。结果 HPV（CINⅠ：aOR=1.39，95% CI：1.01~1.90；CIN Ⅱ/Ⅲ：aOR=11.74，95% CI：6.96~19.80）、H₂O₂（CINⅠ：aOR=2.09，95% CI：1.47~2.98；CIN Ⅱ/Ⅲ：aOR=4.12，95% CI：2.01~8.43）、清洁度（CIN Ⅱ/Ⅲ：aOR=2.62，95% CI：1.65~4.14）和综合指标（CIN Ⅰ：aOR=1.67，95% CI：1.24~2.25；CIN Ⅱ/Ⅲ：aOR=4.24，95% CI：2.30~7.81）均可增加宫颈病变的患病风险，随着宫颈病变的进展，HPV（趋势性χ²=81.33，P<0.001）感染率、阴道pH值（趋势性χ²=5.06，P=0.024）、H₂O₂（趋势性χ²=26.19，P<0.001）、清洁度（趋势性χ²=19.55，P<0.001）和综合指标（趋势性χ²=30.50，P<0.001）的异常率均呈逐渐升高趋势。交互作用分析显示，HPV感染与阴道微环境的综合指标在CIN Ⅱ/Ⅲ组中显示有正相加交互作用，而无论HPV感染与否，阴道微环境紊乱致CIN Ⅰ的OR值比较接近。结论 HPV感染和阴道微环境紊乱均可增加宫颈病变的患病风险，尤其在CIN Ⅱ/Ⅲ发生发展中两者可能存在协同作用，而在CIN Ⅰ发生中阴道微环境紊乱的作用不可忽视。     

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.     

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.     

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.