农村地区妊娠期糖尿病的高危因素及妊娠结局的研究分析

目的 对新诊断标准下农村地区妊娠期糖尿病(GDM)高危因素进行分析和研究.方法 收集2015年6月至2015年12月在河北省廊坊市文安县医院就诊并诊断为GDM的284例孕妇作为病例组,同时随机抽取同期284例糖代谢正常的孕妇作为对照组,进行问卷调查,对两组孕妇在妊娠年龄、孕前体质量指数、孕期增重、糖尿病家族史、喜爱甜食、喜爱肉食、体力劳动情况及妊娠结局情况进行回顾性分析,找出GDM的高危因素,并总结GDM对妊娠结局的影响.结果 病例组的妊娠年龄、孕前体质量指数、孕期增重均高于对照组,差异有统计学意义(t值分别为6.365、4.820、4.935,均P＜0.01);病例组的糖尿病家族史、喜爱甜食、喜爱肉食的发生率均高于对照组(x2值分别为15.218、22.899、30.093,均P＜0.01),而参与体力劳动则少于对照组(x2=16.970,P＜0.01).多因素Logistic回归分析显示:妊娠年龄、孕前体质量指数、孕期增重、糖尿病家族史、喜爱甜食、喜爱肉食为GDM高危因素(OR值分别为1.182、1.138、1.053、2.140、1.729、2.099,均P＜0.05),而体力劳动为保护性因素(OR=0.177,均P＜0.05).GDM组与对照组相比剖宫产率明显增高(GDM组63.7％,对照组32.7％,x2=54.603,P＜0.01),新生儿中巨大儿的发生率也明显高于对照组(GDM组14.4％,对照组3.5％,x2=20.702,P＜0.01).结论 高妊娠年龄、高孕前体质量指数、孕期增重过多、有糖尿病家族史、喜爱甜食、喜爱肉食为GDM的高危因素,而参与体力劳动为GDM的保护因素.GDM孕妇的剖宫产率及巨大儿发生率明显高于对照组.     

妊娠期糖尿病筛查450例结果分析

目的分析妊娠期糖筛查异常与妊娠期糖尿病及妊娠结局的关系.方法对450例妊娠24周后的孕妇进行口服50 g葡萄糖筛查试验(50 g GCT),阳性者进一步行75 g葡萄糖耐量试验(OGTT),并观察妊娠结局.结果妊娠期糖尿病(GDM)发生率为2.44%,妊娠期糖耐量受损(GIGT)的发生率为6.89%,GDM组剖宫产率、早产率、羊水过多及新生儿并发症明显高于50 gGCT正常组(P＜0.05或P＜0.01).结论妊娠期糖尿病可导致母婴并发症增加,应重视GDM的早诊断、早治疗,降低母婴并发症,改善妊娠结局.     

农村地区妇女妊娠期糖尿病患病率情况调查

目的调查农村地区妊娠期妇女糖尿病发生情况,并分析其影响因素及妊娠结局。方法选取2017年10月-2019年4月某地区县医院、妇幼保健院接受糖尿病筛查的妊娠期妇女1 267例,均来自农村地区,其中153例诊断为妊娠期糖尿病(GDM)妇女作为GDM组,孕检且糖代谢正常的1 114例妇女作为非GDM组,分析该地区妊娠期糖尿病发生情况,并采用二分类Logistic回归模型对影响GDM的因素进行分析,观察妊娠结局。结果 1 267例妊娠期妇女中153例诊断为GDM,GDM发生率为12.08%。单因素分析结果显示,年龄、孕前BMI、产次、从事体力劳动、喜爱肉食/甜食、糖尿病家族史与GDM的发生具有相关性(P0.05);二分类Logistic回归分析显示,年龄≥30岁、孕前BMI≥24 kg/m2、喜爱肉食、喜爱甜食、有糖尿病家族史是影响GDM发生的独立危险因素(P0.05),从事体力劳动为保护性因素(P0.05)。GDM组胎儿窘迫、巨大儿、新生儿低血糖及新生儿高胆红素血症发生率均高于非GDM组,差异有统计学意义(P0.05); GDM组剖宫产、妊娠期高血压疾病、产后出血及胎膜早破发生率均高于对照组,差异有统计学意义(P0.05)。结论农村地区妊娠期妇女GDM发生率较高,GDM妇女剖宫产率、妊娠期并发症、围生儿并发症较多。高龄、肥胖、喜爱肉食甜食、有糖尿病家族史会使GDM发生率升高,从事体力劳动可在一定程度上可减少GDM发生。     

妊娠期糖尿病筛查与妊娠结局的研究

目的:探讨开展妊娠期糖尿病的筛查、诊断及观察其妊娠结局。方法:对2006年1月～2007年6月在该院进行产前检查并要求住院分娩的孕妇1100例,于孕24周进行口服50g葡萄糖筛查(GCT),血糖值≥7.8mmol/L者,于次日行75g葡萄糖耐量试验(OGTT),了解GDM的发病率及高危因素,观察其妊娠结局。结果:50g葡萄糖筛查(GCT)阳性率9.8%,妊娠期糖耐量受损(GIGT)发病率4.3%,妊娠期糖尿病(GDM)发病率3.0%,有高危因素者占GDM45.5%。GIGT组及GDM组妊娠高血压疾病、胎儿宫内窘迫、羊水过多、胎膜早破、早产、产后出血及剖宫产发病率均高于对照组,有显著性差异(P0.05);新生儿低血糖、高胆红素血症、巨大儿、新生儿窒息、NRDS与对照组比较有显著性差异(P0.05),均有统计学意义,GIGT组与GDM组比较无显著性差异(P0.05)。结论:应对GDM早筛查、早诊断、早治疗,可降低母婴并发症的发生,改善妊娠结局。     

饮食习惯和体力活动对妊娠期糖尿病的影响

目的 探讨饮食习惯和体力活动对妊娠期糖尿病发病的影响。方法 选择产科门诊确诊妊娠期糖尿病孕妇942列（GDM组）及其配对对照组作为调查对象,以问卷方式,对膳食史、饮食习惯和体力活动等情况进行回顾性调查。结果 GDM组每日膳食总热能、脂肪供热比、动物比脂肪百分比均显高于对照组（P＜0．05）;GDM组长期饱餐和喜甜食的比例显高于对照组（P＜0．05）;而GDM组平均体力活动量低于对照组（P＜0．05）。结论 孕期高热能、高脂肪的膳食,喜饱餐和喜甜食和较少的体力活动是诱使发生妊娠期糖尿病的重要影响因素。     

高龄产妇妊娠期糖尿病发病情况及相关影响因素分析

目的分析高龄产妇妊娠期糖尿病的发病情况及其相关影响因素,为临床诊治高龄产妇妊娠期糖尿病提供理论参考。方法选取2015年10月-2017年6月在武汉大学中南医院就诊的高龄产妇160例为研究对象,所有研究对象均行血糖水平检测,并收集临床资料,统计妊娠期糖尿病发生情况及妊娠结局,应用Logistic多元回归方程分析妊娠期糖尿病发生的影响因素。结果 160例高龄产妇中发生妊娠期糖尿病30例,发生率为18. 75%。妊娠期糖尿病产妇日运动量≥1 h、喜食甜食、高血红蛋白血症、糖尿病家族史、流产次数≥2次所占比例,孕前BMI及孕期增重均高于无妊娠期糖尿病产妇,差异有统计学意义(P0. 05)。多因素Logistic分析结果显示,喜食甜食、高血红蛋白血症、糖尿病家族史、流产次数≥2次、孕前BMI及孕期增重均为妊娠期糖尿病发生的危险因素(P0. 05),日运动量≥1 h为保护因素(P0. 05)。妊娠期糖尿病产妇早产、妊娠期高血压疾病及巨大儿发生率均高于无妊娠期糖尿病产妇,差异有统计学意义(P0. 05)。结论喜食甜食、糖尿病家族史、流产次数等多种因素均会增加高龄产妇妊娠期糖尿病风险,产生多种不良妊娠结局,故妊娠期应适当锻炼、注意健康饮食、控制体质量。     

OGTT筛查在妊娠期糖尿病患者中诊断的价值研究

目的探究妊娠期糖尿病(GDM)患者的临床表现及妊娠结局,从而对GDM患者可能出现的情况进行预防。方法选取2014年1-10月在该院进行常规性GDM筛查的3 134例孕妇,并根据口服糖耐量筛查(OGTT筛查)结果进行分析。结果孕妇的年龄、体重及产次,均与GDM呈正相关:随着年龄的增加,GDM的发病率逐渐增高,差异均有统计学意义(χ~2=7.84,P=0.003 5);随着BMI的升高,GDM的发病率逐渐增加,差异均有统计学意义(χ~2=7.16,P=0.003 0);随着孕产次数的增加,GDM的发病率逐渐增加,差异均有统计学意义(χ~2=7.89,P=0.002 7)。结论开展常规性GDM筛查,早期诊断及治疗对于保证母婴安全具有重要意义。     

基于多中心数据分析妊娠糖尿病危险因素及对妊娠结局的影响

借助多中心的临床数据分析妊娠糖尿病（GDM）的危险因素并探讨其对妊娠结局的影响。方法 选择重庆市3所医院产科2012年2月—2019年3月的孕妇病历5 038例,根据糖尿病诊断标准筛查GDM,分析影响GDM发生的危险因素,比较GDM组和非GDM组孕妇妊娠结局的差异。结果 不同年龄、孕前体型、孕期增体质量、产次、妊娠次数、剖宫产史孕妇的GDM患病率差异均有统计学意义（P<0.05）。经Logistic回归分析发现,年龄≥35岁、孕前超质量和肥胖、孕期增体质量过少、妊娠次数2~4次和多于5次、有剖宫产史是孕妇发生GDM的危险因素。此外,GDM组孕妇的妊娠期高血压疾病、水肿、胎膜早破、早产、剖宫产、巨大儿的发生率均显著高于非GDM组（P<0.05）。结论 年龄≥35岁、孕前超质量和肥胖、孕期增体质量过少等均为GDM发生的危险因素,且GDM孕妇的不良妊娠结局发生率较高。因此对于GDM孕妇,需早期进行血糖筛查,定期产检并有效控制血糖水平,对高危因素进行早期防控,才能够获得良好的母婴结局。     

妊娠期糖尿病患病危险因素及其对妊娠结局的影响

目的探讨妊娠期糖尿病(GDM)患病危险因素及其对妊娠结局的影响。方法选择2013年1月-2015年12月余杭区第一人民医院妇产科门诊及病房记录或收治入院的孕妇为研究对象,按照1∶2频数匹配方式分组,其中对照组为正常产妇124例,病例组为GDM产妇62例。对所有产妇进行问卷调查,将孕期可能引发GDM的危险因素进行比对分析,并对比两组患者最终妊娠结局差异。结果糖尿病家族史、妊娠期间进食水果多少、每日运动量1 h、妊娠前BMI24 kg/m~2、大学及以上学历、高血压病史、妊娠期间增重15 kg等7个相关因素比较,差异具有统计学意义(P0.05)。其中妊娠期间增重15 kg、妊娠期间每日运动量1 h是降低GDM发病的保护因素;甜食摄入量大是GDM发病的危险因素(P0.05)。对照组患者剖宫产、产后出血、胎膜早破及巨大儿的发病率均低于病例组,两组比较,差异具有统计学意义(P0.05)。结论 GDM的发病与妊娠期体质量增重过多、进食甜食过量、运动较少相关,而血糖升高增加了产妇剖宫产、产后出血剖宫产、产后出血、巨大儿及新生儿肺透明病的风险。因此孕妇在妊娠期间应注意健康饮食、适当锻炼、控制体质量,以避免以上危险因素的发生,预防和减少妊娠糖尿病的发病。     

孕前糖尿病和妊娠期糖尿病患者的母婴结局分析

目的观察孕前糖尿病和妊娠期糖尿病患者的母婴结局。方法选取2013年1月-2015年5月在该院营养门诊就诊并住院分娩的妊娠合并糖尿病患者879例进行回顾性分析,分为孕前糖尿病(PGDM,68例)和妊娠期糖尿病(GDM,811例)两组,对比分析母婴结局情况。结果本研究中妊娠期高血压疾病的总发病率为5.2%,PGDM患者妊娠期高血压疾病的发病率(16.2%)显著高于GDM患者(4.3%)(P0.05)。通过营养治疗,妊娠合并糖尿病巨大儿的发病率为6.5%,新生儿黄疸的发病率为5.0%。巨大儿的发病率、新生儿黄疸的发病率PGDM患者与GDM患者比较差异无统计学意义(P0.05)。PGDM患者新生儿低血糖发病率略高于GDM患者,但差异无统计学意义(P0.05)。PGDM患者新生儿肺炎和早产儿的发病率(19.1%、16.2%)显著高于GDM患者(9.5%、4.8%)(P0.05)。结论 PGDM患者的母婴并发症比GDM严重,应在孕期指导糖尿病患者饮食和运动相结合,并配合使用胰岛素,保持血糖平稳,降低母婴并发症的发病率。     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.