直接胆红素和血脂对颈动脉粥样硬化及颈动脉斑块发生风险的交互作用

目的分析直接胆红素和血脂对颈动脉粥样硬化及颈动脉斑块发生风险的交互作用。方法选取2016年3月—2018年12月在杭州市五云山疗养院健康体检者为研究对象,收集人口学资料、生化检测和颈动脉超声检查资料,采用多因素多分类Logistic回归模型分析直接胆红素、血脂以及直接胆红素和血脂交互作用对颈动脉粥样硬化和颈动脉斑块发生的影响。结果共纳入分析8 308人,其中颈动脉粥样硬化616例,占7.41%;颈动脉斑块2 409例,占29.00%。多因素多分类Logistic回归分析结果显示,直接胆红素升高是颈动脉粥样硬化(OR=0.701,95%CI:0.537～0.916)和颈动脉斑块(OR=0.647,95%CI:0.527～0.795)的保护因素;总胆固醇(TC)升高(OR=1.335,95%CI:1.106～1.611)、低密度脂蛋白胆固醇(LDL-C)升高(OR=1.338,95%CI:1.098～1.629)和高密度脂蛋白胆固醇(HDL-C)降低(OR=1.431,95%CI:1.148～1.783)是颈动脉粥样硬化的危险因素;TC升高(OR=1.325,95%CI:1.151～1.525)和LDL-C升高(OR=1.311,95%CI:1.130～1.520)是颈动脉斑块的危险因素。直接胆红素和TC、直接胆红素和LDL-C均对颈动脉斑块发生风险存在交互作用(P0.05);与直接胆红素升高且TC正常组比较,直接胆红素正常且TC升高组颈动脉斑块发生风险增加(OR=1.831,95%CI:1.438～2.333);与直接胆红素升高且LDL-C正常组比较,直接胆红素正常且LDL-C升高组颈动脉斑块发生风险增加(OR=1.814,95%CI:1.427～2.306)。结论 TC、LDL-C与直接胆红素对颈动脉斑块发生风险存在交互作用,对于直接胆红素水平正常而TC或LDL-C升高患者更应加强血脂控制以预防颈动脉斑块。     

北京市50～79岁社区人群血糖水平与颈动脉斑块关系的相关性研究

目的 分析北京市社区人群空腹血糖(FBG)水平与颈动脉斑块患病危险的关系,探讨不同血糖水平合并其他危险因素,与颈动脉斑块患病危险之间的关系.方法 研究人群来自“中国多省市心血管病危险因素前瞻性队列研究(CMCS)”.2007年对北京大学社区随访人群中依然存活的人群进行危险因素复查,对两次调查资料完整,且年龄50～79岁的1046人进行分析.FBG≥7.0 mmol/L或正在服用降糖药物定义为糖尿病.结果 研究人群FBG平均水平为5.89 mmol/L,颈动脉斑块患病率为56.3％.以FBG正常组为参照,仅在单因素和调整年龄时,随着FBG水平的增加,颈动脉斑块的患病危险增加.分性别分析,在调整了其他危险因素后,女性颈动脉斑块患病危险是参照组的2.2倍.将各危险因素异常和正常的两分组与FBG水平的三分组进行组合,男女两性均以各危险因素正常且合并FBG正常组为参照.在调整了其他危险因素后,女性各危险因素异常合并糖尿病组的颈动脉斑块患病危险最高,具有统计学意义,高密度脂蛋白胆周醇降低、低密度脂蛋白胆固醇升高、血压升高、腰围增大合并有糖尿病组的颈动脉斑块患病危险分别是参照组的2.8倍(P=0.014)、2.7倍(P=0.010)、2.4倍(P=0.013)、2.1倍(P=0.031).结论 FBG水平的增加与颈动脉粥样硬化患病危险间的关系在男女两性不一致,糖尿病与颈动脉粥样硬化患病危险间的关系仅存在于女性,FBG水平和其他心血管病危险因素组合后与颈动脉粥样硬化患病危险间存在联合作用.     

男性吸烟状况与颈动脉粥样硬化的剂量一反应关系研究

目的 探讨男性中老年人吸烟状况与颈动脉粥样硬化的剂量-反应关系.方法 从<广州生物库队列研究--心血管疾病亚队列>中随机抽取959名≥50岁相对健康的男性中老年人的个人资料与病史、体格检查(包括检测空腹血糖、血脂和血压)及应用彩色多普勒超声测量颈总动脉中-内膜厚度(IMT)及斑块形成.结果 (1)不吸烟者占39.1%、已戒烟者为25.7%和现在吸烟者为35.2%.受检者的平均颈动脉中-内膜厚度为0.78(95%CI:0.77～0.79)mm.其中18.4%受检者单侧或双侧颈动脉中-内膜厚度≥1.0 mm,34.1%的受检者检出颈动脉斑块.(2)在调整年龄、教育、体力活动、体重指数、空腹血糖、甘油三酯、高密度脂蛋白胆固醇、SBP和DBP等混杂因素后,现在吸烟者较从不吸烟者,颈动脉内膜增厚和斑块形成的危险明显增加(OR=1.82,95%CI:1.30～2.55和OR=1.95,95%CI:1.38～2.75,P值均＜0.001);颈动脉IMT和斑块形成的危险随每日吸烟量(支/日)、吸烟时间(年)和吸烟总量(包·年)的增加而明显增加(趋势检验P值均≤0.01).结论 广州市中老年男性人群中吸烟显著增加颈动脉粥样硬化的危险,且存在明显的剂量-反应关系.     

C反应蛋白和高血压在颈动脉粥样斑块患病中的联合作用

目的 探讨高血压和C反应蛋白(CRP)在颈动脉粥样斑块患病危险中的联合作用.方法　2002年对北京大学社区866人进行心血管病危险因素调查和颈动脉超声检查;以颈动脉粥样斑块作为评价指标,以高血压和CRP水平升高作为研究因素.结果　(1)血压水平分级和CRP四分位分层的偏相关系数为0.089(P=0.008);(2)男性颈动脉粥样斑块患病率随CRP四分位呈升高的趋势,CRP水平升高是颈动脉粥样斑块患病的独立影响因素(均为P＜0.01);(3)与仅有高血压或CRP升高组相比,同时有高血压和CRP升高组的颈动脉粥样斑块患病率最高,达50.4%(P＜0.01);(4)与无高血压和无CRP升高组相比,同时有高血压和CRP升高者患有颈动脉粥样斑块的危险上升了2.0倍(P＜0.01);(5)高血压和CRP升高的交互作用有统计学意义,Exp(B)为1.792(95%CI:1.189～2.701)(P=0.005).结论 高血压和CRP升高在颈动脉粥样斑块患病中具有协同作用,在控制高血压的同时降低血管炎性,对预防动脉粥样斑块可能具有更大的保护作用.     

颈动脉内膜增厚和斑块发生率及其相关因素分析

目的比较不同颈动脉分支粥样硬化斑块的发生率,找出与颈动脉内膜-中层(IMT)增厚和斑块发生相关的主要危险因素。方法采用整群随机抽样方法,抽取山东省临朐县农村社区2 000例40岁以上常住居民,从中筛查出脑卒中高危人群377例,对脑卒中高危人群进行问卷调查、实验室检查和颈部血管超声检查,分析不同颈动脉分支超声检查结果与脑卒中危险因素的相关性。结果脑卒中高危人群最易发生动脉粥样硬化斑块的部位是颈动脉窦部,最不易发生斑块的部位是椎动脉,斑块发生率的分布趋势差异均有统计学意义(P<0.05)。颈动脉分支IMT增厚和斑块的发生有不同的独立危险因素,其中,年龄、男性、吸烟和高血脂是IMT增厚的危险因素;颈动脉窦部斑块的危险因素最多[年龄、男性、高血压、既往脑卒中、既往短暂性脑缺血发作(TIA)],椎动脉的危险因素最少(既往脑卒中)。结论山东省临朐县农村地区脑卒中高危人群颈动脉粥样硬化斑块主要发生在颈动脉窦部,动脉粥样硬化斑块及IMT增厚与多个危险因素相关,但IMT增厚和不同颈动脉分支斑块的发生与不同的危险因素相关。     

社区高血压患者心血管危险因素调查及与颈动脉内中膜增厚或斑块相关性研究

目的调查社区高血压患者合并的心血管危险因素现况及与颈动脉内中膜增厚或粥样斑块的相关性。方法 2013年3月—2014年5月在山西省大同矿区某社区卫生服务中心及其社区卫生服务站开展40岁以上高血压患者的调查,共收集824例,内容包括问卷调查病史、体格检查、血生化检查,及双侧颈动脉血管彩超。计量资料采用t检验;计数资料采用χ2检验;采用二分类多因素Logistic回归分析颈动脉内中膜增厚或粥样斑块的相关影响因素。P0.05为差异有统计学意义。结果男性吸烟率为58.12%(229/394),女性为1.86%(8/430);超重为52.9%(436/824),肥胖为14.8%(122/824);合并血脂异常为60.19%(496/824);高HCY为64.20%(529/824);合并空腹血糖调节受损(impaired fasting glucose,IFG)为12.62%(104/824);合并有糖尿病为27.43%(226/824);彩超显示颈动脉内中膜增厚或斑块为48.79%(402/824);使用单一降压药的为70.39%(580/824),使用两种以上降压药的为20.63%(170/824)。高血压患者合并心血管危险因素0种,1~2种,≥3种上分别为3.52%(29/824)、38.71%(319/824)、30.34%(250/824)。Logistic回归显示,年龄越大,发生颈动脉内中膜增厚或粥样斑块的风险越高(OR=4.631,95%CI为2.163~9.916;OR=5.610,95%CI为2.537~12.406);合并≥3种危险因素是发生颈动脉内中膜增厚或粥样斑块的危险因素(OR=1.785,95%CI为1.611~4.634)。结论年龄越大、合并多种心血管危险因素、合并糖尿病,是发生颈动脉内中膜增厚或粥样斑块的危险因素。     

无心血管风险因素中老年人群颈动脉粥样硬化及其影响因素分析

目的探讨无心血管风险因素中老年人群颈动脉粥样硬化情况及其相关危险因素,为降低心血管疾病负担提供依据。方法于2017年9月-2018年5月,采用分层、整群抽样的方法选取调查对象,对辽宁省朝阳县和凌源市≥40岁的1449名无心血管危险因素的常住居民进行问卷调查、体格检查及实验室检查。无心血管风险因素人群定义采用Adult Treatment PanelⅢ标准。应用SPSS 21.0统计软件进行χ²检验、趋势χ²检验和多因素logistic回归分析。结果无心血管风险因素人群中,颈动脉粥样硬化患病率为23.4%,男性(37.1%)显著高于女性(20.1%),差异有统计学意义(P<0.05)。颈动脉粥样硬化患病率随年龄增加呈明显增加趋势(趋势χ²=62.068,P<0.01)。多因素logistic回归分析结果表明,年龄较大(与40~49岁组比较,50~59岁、60~69岁、70~79岁、≥80岁组的OR值分别为2.63、7.62、17.29和53.99)、男性(OR=1.87,95%CI:1.26~2.77)、高糖化血红蛋白(OR=1.90,95%CI:1.20~3.02)、高脉压差(OR=1.03,95%CI:1.01~1.05)及高密度脂蛋白胆固醇升高(OR=2.31,95%CI:1.75~3.04)与患颈动脉粥样硬化高风险相关。结论无心血管危险因素的中老年人群颈动脉粥样硬化患病率高,高年龄、男性、高糖化血红蛋白、高脉压差和升高的高密度脂蛋白胆固醇与动脉粥样硬化相关。提示在老年人、男性及糖化血红蛋白水平轻微增高的人群中,即使无心血管危险因素,也应该注意动脉粥样硬化的监测。     

颈动脉内膜-中层增厚和斑块的相关危险因素分析

目的分析颈动脉粥样斑块和内膜-中膜(IMT)增厚的相关危险因素。方法选取2013年1月~2016年4月在本科住院的年龄≤75岁的患者216例,依据颈动脉超声检查分为颈动脉粥样斑块和(或)IMT增厚患者117例(颈动脉异常组)和颈动脉正常患者99例(正常对照组),分析颈动脉粥样斑块和IMT增厚的相关危险因素。结果与正常对照组比较,颈动脉异常组的年龄、肱动脉脉压(PP)、中心动脉收缩压(c SBP)、中心动脉脉压(c PP)、增强压(AP)和增强指数(AIx)显著升高(P<0.05);高血压、冠心病和糖尿病患病率显著增多(P<0.05)。相关性分析显示,颈动脉粥样斑块和IMT增厚与年龄、c SBP、c PP、AP和AIx呈显著正相关(P<0.05),而与肱动脉血压则无明显的相关性。Logistic回归分析显示,年龄、c PP和AP是颈动脉粥样斑块和IMT增厚的独立危险因素。结论中心动脉压与颈动脉粥样斑块形成和IMT增厚具有显著的相关性。     

老年糖尿病合并高血压患者颈动脉粥样硬化的相关因素研究

目的 探讨老年糖尿病合并高血压患者颈动脉粥样硬化的相关因素,以及血压、血糖控制对颈动脉粥样硬化的影响.方法 以2009年1月～2011年12月在北京军区总医院内分泌科住院的60岁以上的糖尿病合并高血压患者共475例为研究对象,收集其相关临床资料和颈动脉超声检查数据进行分析.结果 该住院老年糖尿病人群中颈动脉粥样斑块的检出率为77.05％,颈动脉内中膜增厚(carotid intima-media thickness,CIMT)检出率为44.21％.多因素Logistic回归分析显示,高龄(OR=1.095,95％ CI:1.064 ～1.126)、收缩压升高(OR=1.027,95％ CI:1.010～1.043)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)升高(OR=1.430,95％ CI:1.121～1.823)和吸烟(OR=1.452,95％ CI:1.014～2.079)是颈动脉粥样硬化的危险因素;与血压严格控制组相比较,血压未控制组发生颈动脉粥样斑块和CIMT的风险比血压严格控制组分别增加了46.5％和38.7％;但血糖控制对其风险的影响未见差异.结论 高龄、收缩压升高、LDL-C增高与吸烟可能是住院老年糖尿病合并高血压患者颈动脉粥样斑块形成的危险因素.对于糖尿病合并高血压的老年患者,血压控制可能比血糖控制对防治颈动脉粥样硬化的进展更有意义.     

佛山市社区中老年人群颈动脉粥样硬化斑块形成危险因素调查与分析

目的探讨社区中老年人群颈动脉粥样硬化斑块形成的相关危险因素。方法对勒流社区入选的40～80岁的1976名中老年人进行问卷调查、体格检查、血生化检查和双侧颈动脉彩色超声检查。结果有颈动脉粥样硬化斑块形成1216例,总患病率为61.53%。年龄与患病率相关分析r值为0.9878,呈显著正相关。阳性组中老年人吸烟、血压、血糖、体重指数(BMI)和血脂较阴性组高,两组比较,P<0.05,有统计学差异;而在饮酒方面两组中老年人比较,P>0.05,无统计学差异。结论社区中老年人群颈动脉粥样硬化患病率随着年龄的增长而增加,与吸烟、BMI、高血压、高血糖和高血脂等因素相关。应在社区人群中开展颈动脉粥样硬化防治知识宣传及危险因素干预,以减少心脑血管疾病的发生。     

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.     

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.     

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.     

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.