2型糖尿病家系危险因素Logistic回归分析

目的研究家系人群中2型糖尿病(T2DM)的危险因素，为制定干预措施提供依据。方法利用葡萄糖耐量试验(OGTT)、PCR-RFLP和免疫法排除其他类型后确定了115个2型糖尿病家系，通过问卷调查和实验室检查收集危险因素的情况，并采用Logistic回归分析方法对新老2型糖尿病患者和糖耐量低减(IGT)患者危险因素进行分析。结果糖尿病患者的多因素分析显示，T2DM患者的年龄(OR=1．043，95％CI 1．024～1．062)、高血脂史(OR=4．471。95％CI 2．149～9．303)、高血压史(OR=2．075，95％CI 1．001～4．301)和腰臀比超标(OR=1．809，95％CI 1．00～4．301)是独立的危险因素，而新诊断患者仅高血压史(OR=6．068，95％ CI 1．697～21．689)是独立的危险因素，IGT患者的年龄(OR=1．398，95％CI～1．138～1．717)是危险因素。结论在本研究人群中，高血压、年龄、中心性肥胖可能是2型糖尿病的危险因素。     

深圳市糖尿病患者血糖管理现况及影响因素分析

目的评价深圳市糖尿病患者血糖控制现况及其影响因素,为糖尿病防治策略的制定提供依据。方法于2009年采用多阶段随机整群抽样法,抽取8487名20～69岁深圳常住居民中的441例糖尿病患者,进行问卷调查和体格检测。以血糖控制目标（空腹血糖〈7．0mmol/L）为应变量,进行多因素非条件logistic回归,探讨血糖控制影响因素。结果深圳市糖尿病患者的知晓率、治疗率和控制率分别为60．54％、53．74％和23．36％。多因素非条件logistic回归分析结果显示,导致血糖控制效果不佳的因素有年龄小（OR=1．051,95％CI：1．015～1．133）、文化程度低（OR=1．336,95％CI：1．164-1．539）、不进行药物治疗（OR=6．864,95％CI：3．342～13．534）及不控制饮食（OR=1．691,95％C1：1．017—2．876）。结论深圳市糖尿病血糖控制知晓率、治疗率和达标率较低,开展分类指导,优化规范化药物和非药物干预,可改善血糖控制效果。     

台州市社区2型糖尿病患者血糖控制的影响因素分析

目的评价台州市社区2型糖尿病患者血糖控制情况,了解血糖控制的影响因素,为有针对性地采取干预措施提供参考。方法于2012年8-9月,在台州市尚未实施免费药物配送的6个县（市、区）中随机选取30个社区卫生服务中心1087例2型糖尿病患者进行糖尿病相关知识、生活方式及行为、治疗需求等方面的问卷调查,测量身高、体重、腰围、臀围,计算体质指数和腰臀比,测定空腹血糖,运用多因素非条件logistic回归分析血糖控制的影响因素。结果台州市2型糖尿病患者对糖尿病的典型症状和诊断标准知晓率分别为35．9％和12．1％,经常参加体育锻炼率为35．8％,78．1％的调查对象坚持规律使用药物,血糖控制达标率为50．5％。多因素非条件logistic回归分析结果显示,经常参加体育锻炼（OR=1．348,95％CI：1．047-1．736）和不规律或未采取药物治疗（OR=1．569,95％CI：1．168～2．109）是控制血糖的有利因素,中等及以上劳动强度（OR=0．667,95％CI：0．474-0．940）和常吃蛋类（OR=0．659,95％CI：0．452—0．960）不利于血糖的控制。结论台州市糖尿病患者血糖控制不够理想,社区管理应在规范合理用药的同时,重视非药物干预手段,提高社区居民血糖控制水平。     

糖尿病与非糖尿病患者发生心律失常类型和危险区素分析

目的分析糖尿病与非糖尿病患者在住院期间发生心律失常的类型及危险因素。方法对我院2008年6月-2013年6月五年间3489例住院心律失常患者实施回顾性研究分析。将这些患者分为两组,即糖尿病患者组（501例）与非糖尿病患者组（2988例）。对这两组患者的心律失常类型及危险因素的构成比例进行比较。结果通过单变量分析显示,糖尿病疾病与房室传导受阻（P〈0．01）、心颤（P=0．01）等因素有关。通过多变量分析显示,心律失常同以下因素相对独立：冠心病（OR即相对危险度比值比：1．47;95％CI即可信区间：1．07～1．96;P=0．01）、胃炎（OR：0．59;95％CI：0．35～0．94;P=0．04）、甲状腺功能衰退症状（OR=3．11;95％CI：1．58-5．99;P〈0．01）、自身免疫疾病（OR=3．01;95％CI：1．31-6．81;P〈0．01）、高血压（OR=2．48;95％CI：1．98～3．18;P〈0．01）、年龄≥60（OR：1．57;95％CI：0．24～1．99;P〈0．01）、血糖增加（OR：2．21;95％CI：2．03～2．29;P〈0．01）。结论糖尿病与心颤、房室传导受阻有一定关系。而对于非糖尿病患者,他们出现心律失常症状主要与冠心病、胃炎、甲状腺功能降低症状、自身免疫疾病、高血压、高龄等合并症有关。而糖尿病患者组出现心律失常的患者相对年龄较轻,且与血糖增加等新陈代谢因素有关。     

非胰岛素依赖型糖尿病视网膜病变危险因素的探讨

目的：采用1：1配比的病例对照研究对DR患病的危险因素进行了初步探讨。方法：采用条件Logistic回归分析程序对105名DR病例和对照进行分析。结果：单因素分析显示：糖尿病病程,糖尿病诊断年龄,高血压,SBP,尿蛋白,使用胰岛素治疗与糖尿病视网膜病变有关。经多因素分析进入主效应模型的因素为病程,其OR＝2．32（95％CI：1．32－4．5）;SBP,其OR＝4．78（95％CI：1．83－12．52）;尿蛋白,其OR＝1．9％（95％:1．21－2．99）;胰岛素使用量,其OR＝1．98（95CI：1．05－3．74）。吸烟,饮酒,饮茶,运动锻炼,社会经济状况,看书时间,社会心理因素以及BMI与DR无关。结论：在糖尿病人群中,DR发生的危险因素为病程长,使用胰岛素治疗,尿蛋白增高和SBP增高。     

甘精胰岛素治疗新诊断2型糖尿病40例的成本-效果分析

目的 分析应用单纯口服降糖药物与甘精胰岛素联合口服降糖药物控制新诊断2型糖尿病患者血糖的成本-效果。方法将81例新诊断2型糖尿病患者分为两组：A组为单纯口服降糖药物、B组为甘精胰岛素联合口服降糖药物，治疗6个月后，观察其疗效，同时对两种治疗方法进行成本-效果分析。结果治疗6个月后，B组疗效较A组明显，B组患者空腹血糖、餐后2h血糖及糖化血红蛋白均显著低于A组（P〈0．05）。B组在治疗过程中停用甘精胰岛素及口服降糖药物的患者有19例，A组仅有2例。两组的平均每人费用及低血糖反应发生情况比较差异均无统计学意义（P〉0．05）。结论应用甘精胰岛素联合口服降糖药物控制新诊断2型糖尿病患者血糖效果更明显，且成本-效果较好。     

精神分裂症危险因素的病例对照研究

目的 探讨精神分裂症发病的主要危险因素，为精神病防治提供理论依据。方法 应用病例对照研究对10l例首发精神分裂症患和10l例正常对照进行1：1配对研究，通过单因素和多因素分析其危险因素。结果 发现4个主要危险因素，分别是：精神病家族史(OR＝7．98，95％CI＝2．58—32．58)、内向性格(OR＝3．32，95％CI＝1．60—6．94)、遭遇精神创伤事件(OR＝5．68，95％CI＝2．0l—15．63)、与父母关系不好(OR＝4．27，95％CI＝1．03一17．74)与精神分裂症的发病显相关。结论 精神分裂症的发病与遗传和多种环境因素有关。     

我国2型糖尿病人生活方式干预效果综述

目的：了解目前我国糖尿病的流行情况及生活方式干预研究现状,分析干预研究的效果及存在的问题,为更好地开展糖尿病的控制工作提供科学依据.方法在中国学术文献总库(CNKI)、中文科技期刊数据库(VIP) PubMed、Web of Science 等主要中英文数据库中,检索对我国2型糖尿病患者进行1年或1年以上生活方式干预的随机对照试验进行文献综述.结果12个随机对照试验共包括2806例2型糖尿病患者纳入综述,干预组1475例,对照组1331例.干预组空腹血糖(FDG)[WMD ＝-1．54,95％CI (-1．96,-1．12)]、饮食控制[OR ＝5．52,95％CI (2．42,13．05)]、合理运动[OR ＝2．23,95％CI (1．56,3．19)]、自我监测[OR ＝3．87,95％CI (2．23,6．69)]4项评价指标均优于对照组,差异有统计学意义(P ＜0．01).但也存在干预主要集中于城市、对患者心理健康重视不够和健康教育方案不完善等问题.结论对2型糖尿病患者进行生活方式干预可有效控制糖尿病的病情发展,提高患者的生活质量,但需要注重干预方案的完善和实施方式的改进.     

2型糖尿病危险因素的交互作用研究

目的探讨2型糖尿病危险因素及其交互作用，为开展糖尿病的预防、治疗工作提供科学依据。方法采用病例一对照研究方法．病例为在深圳市第一人民医院、深圳市第二人民医院及深圳市保健委员会办公室就诊及住院的2型糖尿病患者，共295例；对照为同期在门诊进行健康体检的非糖尿病人群，共214例。对研究因素进行单因素及多因素非条件Logistic回归分析．在此基础上进行对数线性模型分析。结果调查人群中，糖尿病家族史（OR=6．507，95％CI：3．788～11．178）、高血脂（TG：OR=2．625，95％CI：1．295—5．323；LDL—C：OR=6．337，95％CI：3．379-11．884）、工作压力（OR=1．901，95％CI：1．263—2．863）、高血压（SBP：OR=I．055，95％CI：1．022～1．089）是2型糖尿病的危险因素：文化程度（OR=0．724，95％CI：0．599—0．875）、运动锻炼（OR=0．499，95％CI：0．268～0．930）是保护因素。对数线性模型分析发现，糖尿病各危险因素之间广泛存在一阶或二阶交互作用，其中．糖尿病家族史、年龄和运动锻炼三者分别与多个危险因素有明显的交互作用。结论2型糖尿病是遗传因素与环境因素共同作用的结果。对糖尿病的防治应采取综合措施，尤其对于具有糖尿病家族史者以及中老年人群，更应控制各种危险因素。     

影响2型糖尿病患者药物治疗依从性的相关因素临床分析

目的：探讨影响2型糖尿病药物治疗依从性的相关因素。方法：随机选择2010年1月-2011年12月118例2型糖尿病患者作为研究对象,比较依从性差及依从性好患者年龄、性别、2型糖尿病疾病知识、降糖药物种类、病程、经济收入等差异。结果：治疗依从性差者占46．61％,依从f生好者占53．39％;依从性差组年龄（66．78±15．13）岁,降糖药物种类（2．40±0．39）种,缺少糖尿病疾病知识者占67．27％,高于依从性好组的（52．98±13．78）岁、（1．52±0．48）种、30．16％;经济收入（1332．40±241．39）元／月,低于依从陛好组（1920．54±378．65）元／月（P〈0．05）,是影响依从性的相关因素。结论：影响2型糖尿病药物治疗依从性因素复杂,通过加强健康宣教、简化治疗方案、对老年患者提供个体家庭服务,指导其制定合适、经济的治疗方案,提高依从性。     

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.     

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.     

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.     

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.