不同类型前置胎盘产妇剖宫产产后出血的关联因素及妊娠结局的回顾性研究

目的探讨不同类型前置胎盘产妇剖宫产产后出血的关联因素及妊娠结局。方法本研究为回顾性的病例对照研究。收集2019年1月至2020年12月浙江大学医学院附属妇产科医院收治的因前置胎盘行剖宫产的产妇。根据术中出血量分为<1 000 ml的对照组和≥1 000 ml的产后出血组。分析产后出血在不同类型前置胎盘产妇中的关联因素及不良妊娠结局。采用t检验或χ2检验比较两组间的差异, 采用logistic回归模型分析产后出血的关联因素。结果共纳入研究对象962例, 产后出血产妇189例, 对照组产妇773例。在不同类型的前置胎盘产妇中, 两组产妇的孕次、产次、孕周、人工流产次数、胎盘植入和术前血红蛋白<110 g/L的差异有统计学意义(均P<0.05)。logistic回归模型分析显示, 胎盘植入(OR=12.713, 95%CI:4.296～37.625), 术前血红蛋白<110 g/L(OR=2.377, 95%CI:1.062～5.321), 产前阴道出血(OR=4.244, 95%CI:1.865～9.656)是低置胎盘产妇产后出血风险的危险因素;人工流产1次(OR=...     

湖南农村地区6～23月龄婴幼儿血红蛋白水平对发热和腹泻影响

目的探讨婴幼儿血红蛋白水平对发热和腹泻的影响,并分析其剂量反应关系。方法采用多阶段分层随机抽样方法,于2017年10—12月,在湖南省农村地区随机抽取3 630名6～23月龄婴幼儿为研究对象进行问卷调查,并检测其指尖末梢血血红蛋白,采用多因素非条件logistic回归模型控制潜在混杂因素来分析婴幼儿血红蛋白水平对发热和腹泻的影响。结果湖南省农村地区6～23月龄婴幼儿贫血患病率为28.7%(1 042/3 630),血红蛋白水平为100、100～109、110～119、120～129、≥130 g/L的比例分别为8.8%(319/3 630)、19.9%(723/3 630)、33.9%(1 229/3 630)、25.2%(916/3 630)、12.2%(443/3 630)。婴幼儿发热和腹泻两周患病率分别为15.1%(547/3 630)和14.0%(509/3 630)。多因素logistic回归分析显示,贫血是婴幼儿发热和腹泻的独立危险因素,其调整OR值分别为1.57(95%CI=1.29～1.91)和1.40(95%CI=1.14～1.71);血红蛋白水平对婴幼儿发热和腹泻的影响均存在剂量反应关系,血红蛋白水平越低,发热和腹泻的患病风险越高。以血红蛋白120～129 g/L为参照,血红蛋白100和100～109 g/L是婴幼儿发热的危险因素,其调整OR值分别为1.89(95%CI=1.34～2.67)和1.67(95%CI=1.27～2.21);血红蛋白100、100～109和110～119 g/L是婴幼儿腹泻的危险因素,其调整OR值分别为1.84%(95%CI=1.28～2.64)、1.67(95%CI=1.24～2.24)和1.34(95%CI=1.02～1.76)。结论湖南省农村地区6～23月龄婴幼儿发热和腹泻两周患病率较高,并且受血红蛋白水平的影响,积极防治婴幼儿贫血有助于降低其发热和腹泻患病率。     

武汉市江夏区农村成年人缺铁性贫血患病状况及影响因素分析

目的了解武汉市江夏区农村成年人贫血患病状况及影响因素,制定有效的干预措施。方法采用整群分层随机抽样法调查3 934名20岁以上的成年人,采用统一的方法进行问卷调查和实验室检查。应用非条件Logistic回归对贫血的影响因素进行分析。结果武汉市江夏区农村成年人血红蛋白检测平均值为(131.2±33.3)g/L,其中男性平均值为(136.5±34.7)g/L,女性为(128.7±32.7)g/L,共检出贫血患者891人,贫血患病率为23.00%,男性为17.30%,女性为24.40%,女性显著高于男性(χ2=15.23,P=0.001);居民血红蛋白水平有随年龄增大而降低的趋势,男性在70~岁年龄组贫血患病率最高(30.48%),而女性在20~岁年龄组贫血患病率最高(29.63%),70~岁年龄组次之(28.95%),非条件Logistic回归分析显示:年龄大(OR=1.37,95%CI:1.15~1.63)和女性(OR=3.14,95%CI:1.26~7.81)是贫血发生的危险因素,经济水平好(OR=0.60,95%CI:0.37~0.97)是贫血发生的保护因素。结论江夏区农村成年人贫血患病率较高,性别、年龄、经济水平对成人贫血率有明显的影响,对高危人群应采取综合措施预防贫血的发生。     

某铅蓄电池厂工人健康状况及其影响因素分析

[目的]了解某铅蓄电池厂铅作业工人健康状况及其影响因素,为企业健康监护提供基础资料。[方法]以该铅蓄电池厂1 179名铅作业工人作为研究对象,进行问卷调查和健康体检。[结果]1 179名研究对象血铅值中位数和第25、75百分位数[M(P25,P75)]为152.2(65.4,356.7)μg/L,血铅超标(血铅值≥400μg/L)120人,超标率为10.2%。男性心电图异常率为14.3%,高于女性的2.2%,血常规异常率为7.1%,低于女性的18.1%,差异均有统计学意义(P<0.01)。多因素logistic回归分析结果显示:铅接触组发生血铅异常的危险性是不接触组的7.469倍(95%CI:2.817~19.804);男性发生心电图异常的危险性是女性的7.974倍(95%CI:4.099~15.511),血铅水平在300~μg/L组发生心电图异常的危险性是对照组(血铅水平<100μg/L)的3.450倍(95%CI:1.724~15.690);男性发生贫血的危险性是女性的34.2%(95%CI:0.235~0.499),血铅200~μg/L组、300~μg/L组发生贫血的危险性分别是对照组(<100μg/L)的3.020倍(95%CI:1.234~8.562)、3.870倍(95%CI:1.985~16.398)。[结论]心电图异常率男性高于女性,贫血发生率则是女性高于男性;血铅是铅作业工人健康状况的独立危险因素,应进一步加强监测,组织工人定期体检,保护工人健康。     

女性盆腔手术中获得性压力性损伤影响因素及预防对策

目的：探讨女性盆腔手术术中获得性压力性损伤(IAPI)发生影响因素,并提出预防管理对策。方法：回顾性收集2019年6月-2022年12月医院女性盆腔手术出现IAPI的45例为IAPI组,未出现IAPI患者中按1:3比例随机选取135例为对照组。收集两组一般人口学资料、实验室检查资料、手术有关资料,采用多因素logistic回归分析确定女性盆腔手术IAPI发生影响因素。结果：两组BMI、合并糖尿病、术前血清白蛋白、血红蛋白水平、受压部位皮肤状态、术中体温、手术时间、术中出血量均有差异(P<0.05)。多因素分析显示,BMI异常(OR=2.477、95%CI 1.293～4.746)、合并糖尿病(OR=3.006、95%CI 1.591～5.680)、术前受压部位皮肤状态为瘀斑/水疱/重度水肿(OR=3.173、95%CI 2.048～4.916)、术中体温异常(OR=2.995、95%CI 1.472～6.094)、手术时间>2 h(OR=2.841、95%CI 1.527～5.286)均为女性盆腔手术IAPI独立危险因素,术前血清白蛋白水平≥35 g/L(OR=0.328、...     

2019—2020年安徽省城乡≥65岁老年人抑郁症状及其相关因素差异的研究

目的分析2019—2020年安徽省城乡≥65岁老年人抑郁症状及其相关因素的差异。方法利用2019—2020年安徽省实施全国老年心理关爱项目的68个社区调查数据, 采用患者健康状况抑郁量表评价老年人抑郁症状现况, 采用χ2检验比较不同特征城乡老年人抑郁症状检出率的差异, 采用logistic回归模型分析城乡老年人抑郁症状的相关因素。结果共纳入15 532名≥65岁老年人, 抑郁症状检出率为7.12%, 乡村(9.08%)高于城镇(6.48%), 差异有统计学意义(P<0.001)。logistic回归显示, 无论城乡, 患有慢性病均是老年人抑郁症状的危险因素, 老化态度积极和心理韧性好均是老年人抑郁症状的保护因素。有兴趣爱好(OR=0.64, 95%CI:0.45～0.91)、与子女关系好(OR=0.56, 95%CI:0.41～0.76)、与配偶关系好(OR=0.51, 95%CI:0.37～0.71)、朋友数量≥6个(OR=0.48, 95%CI:0.32～0.71)是城镇老年人抑郁症状的保护因素。与邻居关系好(OR=0.58, 95%CI:0.41～0.82)、朋友数量1～2...     

妊娠晚期血红蛋白浓度与早产和低出生体重关系的研究

目的分析妊娠晚期血红蛋白(Hb)浓度与早产和低出生体重之间的关系。方法研究对象为江苏和浙江省4个县(市)在1995—2000年间分娩的102 489名妇女。按妊娠晚期Hb浓度分四组比较各组早产和低出生体重的发生率;采用logistic回归模型控制年龄、职业、文化程度、孕次、产检次数和妊高征等因素后,估计Hb与早产和低出生体重的关联程度。结果妊娠晚期贫血患病率为48.2%,以轻度和中度贫血为主。轻、中度贫血不增加早产和低出生体重的风险。当Hb为90～99 g/L时,早产和低出生体重的发生率最低;当Hb升高或降低时,早产和低出生体重的风险均呈增加趋势。Hb为70～119 g/L时,早产和低出生体重的风险变化不大,但重度贫血和高血红蛋白则显著增加早产和低出生体重的风险:Hb<70 g/L组早产和低出生体重的OR(95%CI)分别为1.8(1.0～3.3)和4.0(2.1～7.5);Hb≥130 g/L组的早产和低出生体重的OR(95%CI)为1.2(1.0～1.4)和1.5 (1.2～1.9)。结论妊娠晚期Hb水平与早产和低出生体重的风险之间均呈"U"形趋势,妊娠晚期重度贫血以及高血红蛋白均是早产和低出生体重的危险因素。     

产褥期贫血患病率及预后影响因素分析

目的:了解产后3 d产妇贫血患病状况及产后42 d恢复情况,探讨与贫血恢复有关的影响因素,并提出干预措施。方法:于产后3 d对400例产妇进行血红蛋白筛查,贫血产妇共167例,产后42 d追踪贫血恢复情况。共追踪到145例,按照42 d血红蛋白水平分为贫血组(病例组)50例和血红蛋白正常组(对照组)95例。进行产褥期贫血未恢复影响因素的单因素分析及Logistic回归分析。结果:产后3 d贫血的患病率41.8%(167/400),至产后42 d复诊者恢复率为65.5%(95/145)。影响贫血恢复的相关因素为:水果摄入过少和产褥期未服用抗贫血药为产褥期贫血未恢复的危险因素,其OR值分别为2.470(95%C I:1.115~5.468)和2.343(95%C I:1.025~5.357);而孕期血红蛋白≥100 g/L、产后3 d血红蛋白≥100 g/L及人工喂养为保护因素,其OR值分别为0.328(95%C I:0.144~0.747)、0.419(95%C I:0.181~0.969)和0.024(95%C I:0.031~0.778)。结论:产褥初期产妇贫血患病率较高,且超过1/3的患者到产褥末期未恢复。因此妇幼保健工作者应重视产褥期保健工作,要针对影响贫血恢复的主要因素进行预防和控制,以提高产褥期贫血的恢复率。     

浙江德清农村社区已婚育龄女性饮茶与贫血的相关研究

目的了解中国浙江农村社区已婚育龄女性贫血状况及饮茶与其关系。方法采用流行病学现况研究设计,整群抽取浙江省德清县4个农村社区,面对面调查上述社区中20～49周岁的社区已婚育龄女性居民1425人。调查内容包括一般情况、健康状况、生活行为方式等。采用氰化高铁法测定血红蛋白。在SPSS11.0中进行数据分析,对于分类变量进行卡方检验;在二分类和多分类Logistic回归模型中检验饮茶与贫血的关联。结果在1425名调查对象中,平均血红蛋白(114.7±17.0)g/L,贫血患病率为63.3%,以轻中度贫血为主,20～30岁组、31～40岁组和41～49岁组的贫血患病率分别为63.5%、63.2%和63.4%,差异无显著性。饮茶者的平均血红蛋白水平高于非饮茶者(t=3.33,P=0.001);饮茶与贫血患病存在统计学关联,饮茶者贫血的校正OR=0.56(95%CI:0.45,0.70),进一步的分析中,饮茶对无论轻度、中度还是重度贫血均有不同程度的保护效应,其校正OR分别为0.57(95%CI:0.43,0.75)、0.57(95%CI:0.43,0.75)和0.28(95%CI:0.11,0.70)。结论转型期的浙江德清农村社区已婚育龄女性的贫血患病率依然较高,饮茶可能与其贫血有一定的关系。     

上海市社区居民代谢相关慢性病组合与非酒精性脂肪肝患病关联分析

目的了解上海市社区居民与非酒精性脂肪肝(NAFLD)患病率相关的代谢性慢性病组合。方法使用上海郊区自然人群队列和生物样本库基线数据, 根据问卷调查、体格检查及血生化检测获得肥胖、高血压、高脂血症、痛风及糖尿病5种代谢相关慢性病患病情况, 根据B超及问卷调查诊断NAFLD, 运用多因素logistic回归模型分析合并不同数量及类型的31种代谢相关慢性病组合与NAFLD患病的关联。结果 65 477名研究对象年龄M(Q1, Q3)为60(51, 66)岁, 男性占40.6%。NAFLD总患病率为38.2%, 无5种代谢相关慢性病中任1种者NAFLD患病率为12.0%。总人群(OR=37.94, 95%CI:31.02～46.41)、女性(OR=36.99, 95%CI:28.78～47.54)及≥60岁组(OR=36.19, 95%CI:28.25～46.36)与NAFLD患病关联最强的慢性病组合均为肥胖+高血压+高脂血症+痛风+糖尿病, 男性(OR=50.70, 95%CI:24.62～104.40)及<60岁组(OR=49.58, 95%CI:24.22～101.47)与NAFL...     

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.     

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.     

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.     

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.