阜新市农村居民慢性疾病患病及经济负担调查

目的 调查辽宁省阜新市(高血压、冠心病、脑卒中、糖尿病)的患病率及经济负担.方法 2004～2006年,对辽宁省阜新市农村地区8个乡镇、85个自然村的35岁及以上的45 925名常住居民进行调查.应用患病比值比和人群归因危险度,计算超重和肥胖造成这4种慢性疾病的直接经济负担.结果 阜新市农村居民高血压、冠心病、脑卒中和糖尿病的患病率分别为37.8%,4.2%,2.5%和1.9%,而这4种慢性疾病造成的直接经济负担分别为5.2亿元,1.3亿元,1.7亿元和1.4亿元.其中归因于超重和肥胖的直接经济负担为2.3亿元,占4种病合计直接疾病负担的24.4%.结论 超重和肥胖对农村居民所造成的高血压、冠心病、脑卒中和糖尿病的直接经济负担较重,应加强农村居民健康教育,提高对肥胖危害的认识及预防措施.     

成年人中心性肥胖流行特征研究现状

近年来,超重和肥胖已被公认为心脑血管疾病、Ⅱ型糖尿病等慢性疾病的重要危险因素[1,2].根据世界卫生组织(WHO)超重和肥胖分类标准,我国成人体重超重与肥胖之比为8:1,而欧美国家的比例已达2:1甚至接近1:1.中国疾控中心学者2006年研究提示若不采取相应措施,当超重和肥胖率比值达到1.1:1时,归因于高血压、糖尿病、冠心病和脑卒中的直接经济负担将比2003年上述4种疾病的直接经济负担上升75.2%[3].     

2010年中国城乡居民超重和肥胖的直接经济负担分析

目的分析2010年中国城乡居民由超重和肥胖造成的主要慢性病(冠心病、脑卒中、高血压、癌症、糖尿病)的经济负担.方法利用2010年中国慢性病及其危险因素监测和2008年国家第四次卫生服务调查数据,采用疾病成本的方法计算超重和肥胖的直接经济负担.结果2010年中国城乡居民超重和肥胖所造成的主要慢性病合计经济负担高达907.68亿元人民币,占主要慢性病经济负担的42.9%.结论中国城乡居民超重和肥胖所造成的经济负担呈上升趋势,占2010年卫生总费用的4.5%.     

中国居民高血压造成冠心病和脑卒中的经济负担研究

目的评价中国居民高血压造成冠心病和脯卒中的直接经济负担，分析高血压知晓率和治疗率的相关关系，为制订人群高血压防治策略提供科学依据，确定知晓率作为社区高血压防治效果的评价指标。方法利用2002年中国居民营养与健康状况调查、2003年第二次国家卫生服务调查等相关资料，分别计算高血压、冠心病和脑卒中的直接疾病负担；根据人群归因危险度百分比计算高血压造成的冠心病和脑卒中的直接经济负担。利用2002年调查数据分析高血压知晓率和治疗率的关系。结果2003年中国35～74岁人群高血压、冠心病和脑卒中的直接经济负担分别为201．5、157．1和242．9亿元人民币，其中由高血压导致的冠心病和脑卒中的直接经济负扭达190．8亿元人民币，占这两种疾病直接疾病负担的47.7％。高血压知晓率与治疗率呈高度相天（r=0．9777，P〈0．0001），知晓率是影响治疗率的关键。结论中国居民高血压所造成冠心病和脑卒中的直接经济负担，已占该两种疾病直接疾病负担的近50％。以知晓率作为社区高血压防治效果的评价指标具有实用价值。     

常见恶性肿瘤归因2型糖尿病风险及医疗经济负担研究

目的研究常见恶性肿瘤归因2型糖尿病的风险和直接医疗经济负担。方法收集2007—2013年浙江省慢性病监测和随访数据库中糖尿病和恶性肿瘤发病资料及第五次卫生服务调查的医疗费用资料,分析2型糖尿病发生恶性肿瘤的人群归因危险度和恶性肿瘤直接医疗经济负担,进而估算2型糖尿病引起的恶性肿瘤直接医疗经济负担。结果 2型糖尿病患者发生恶性肿瘤归因危险度RR为1.68(95%CI:1.68~1.70);归因危险度百分比(AR%)为40.57%,以甲状腺癌最高(73.49%);人群归因危险度百分比(PAR%)为2.05%,以结肠癌最高(2.44%)。恶性肿瘤年均住院医疗费用110.99亿元,占当年卫生总费用的6.48%,其归因于2型糖尿病的直接医疗经济负担为2.28亿元。归因2型糖尿病的直接医疗经济负担前3位为肺癌、结肠癌和胃癌。结论 2型糖尿病增加恶性肿瘤发生风险,归因2型糖尿病的恶性肿瘤直接医疗经济负担达2.28亿元。     

超重及肥胖的现况调查

[目的]了解超重及肥胖的现况,并分析其与慢性疾病的关系。[方法]随机抽取2886人进行健康状况问卷调查和医学体检。分析超重及肥胖与冠心病、脑血管病、糖尿病、高血压、血脂异常相对危险度的关系。[结果]天津市居民冠心病、脑血管病、糖尿病、高血压、超重及肥胖、血脂异常的标化患病率分别为9.24%、4.33%、6.74%、34.05%、42.62%、19.98%。BMI≥24、中心性肥胖与高血压、糖尿病、血脂异常、冠心病、脑血管病密切相关。[结论]天津调查对象的超重及肥胖情况与多种慢性疾病有联系,对于BMI达到超重或肥胖标准及腹型肥胖者应加强合理膳食、适当运动,减少静坐时间的行为干预,预防和控制慢性疾病。     

武汉市老年人超重肥胖流行特征与常见慢性疾病的关系

目的 了解武汉市65岁及以上老年人超重肥胖流行特征及与常见慢性疾病的关系.方法 采用2012年武汉市65岁及以上老年人免费体检数据,对372 990名老年人调查问卷、体格检查、实验室检测和腹部B超结果进行分析.结果 老年人总体超重率29.03％,肥胖率8.36％;城市老年人超重率和肥胖率分别为33.37％和9.98％,高于农村的24.82％和6.78％;女性超重率和肥胖率分别为29.35％和9.87％,高于男性的28.66％和6.62％;随着年龄增长,超重和肥胖率均呈下降趋势.多因素Logistic回归分析结果显示在调整区域、性别、年龄等因素的情况下,体质指数增高是高血压、糖尿病、血脂异常、脂肪肝、冠心病、脑卒中患病的危险因素,是慢性阻塞性肺部疾病的保护因素.结论 武汉市65岁及以上老年人超重和肥胖发生率高,超重与肥胖是高血压、糖尿病等心脑血管疾病和代谢性疾病的的重要危险因素.     

云南省大姚县归因于肥胖的高血压疾病经济负担研究

目的分析云南省大姚县归因于肥胖的高血压疾病经济负担。方法采用多阶段分层随机抽样方法,抽取该地区≥35岁农村居民2479名进行问卷调查和体格检查。采用二步模型法估算高血压的直接经济负担,采用人力资本法估算其间接经济负担。结果大姚县高血压、肥胖和中心性肥胖的患病率分别为40.4%、4.6%和39.9%;其中男性分别为40.6%、4.4%、29.9%;女性分别为40.2%、4.9%、49.3%;女性中心性肥胖率明显高于男性(P0.01)。高血压的患病率和中心性肥胖率随年龄的增加而上升,随文化程度和人均年收入的增加而下降(P0.01);肥胖者和中心性肥胖者患高血压的风险均明显高于非肥胖者和非中心肥胖者(P0.01)。大姚县高血压的人均直接和间接经济负担分别为6802.2元和64.1元;总疾病经济负担为784百万元,其中归因于肥胖和中心性肥胖的高血压疾病经济负担分别为37.6百万元和286.1百万元。结论归因于肥胖和中心性肥胖的高血压疾病经济负担对当地经济影响显著。应采取措施减少当地肥胖和中心性肥胖的发生,从而降低其导致的经济负担。     

云南省白族居民归因于吸烟和被动吸烟的脑卒中经济负担研究

目的 分析云南省白族居民脑卒中与吸烟/被动吸烟的关系,估算出归因于吸烟/被动吸烟的脑卒中经济负担。方法 采用多阶段分层随机抽样方法,于2018年4-5月在云南省大理州剑川县抽取2501名≥35岁白族居民进行面对面问卷调查和体格检查。脑卒中直接经济负担的测算采用直接法,间接经济负担测算采用人力资本法 ,并与归因危险度 (PAR) 相结合测算归因于吸烟/被动吸烟的疾病经济负担。结果 云南省白族居民脑卒中患者的人均直接和间接负担分别为8720.33元和152.28元,总经济负担为101.653百万元,其中男性患者的人均直接经济负担高于女性（t=2.288, P=0.027）;多因素logistic回归分析结果显示,现在吸烟者和被动吸烟者患脑卒中的风险为非吸烟者和非被动吸烟者的3.596倍（OR=3.596,95%CI=2.468～5.238）和3.361倍（OR=3.361,95%CI=2.266～4.983）;归因于吸烟的脑卒中经济负担为44.920百万元,归因于被动吸烟的为33.802百万元。结论 云南省白族居民归因于吸烟和被动吸烟的脑卒中经济负担较重。采取有效措施减少吸烟和被动吸烟率,可进一步降低脑卒中的疾病经济负担。     

资讯链接

改善员工健康：是投资而非成本 我国65岁以上人口已超过总人口的7％,全国新增劳动力数量逐渐下降,50年后劳动力将出现匮乏。而调查表明,我国劳动力人口中广泛存在着慢性病多种高危行为,吸烟、超重和肥胖、高血压、血脂异常等人数均以亿计数。2003年,我国18～59岁劳动力人口罹患高血压、糖尿病、冠心病、脑卒中4种慢性病所导致的直接经济负担高达322亿元。     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

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.     

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.     

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.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.