我国成年人群年龄对体质指数与高血压发病风险的修饰效应

目的 探讨中国成年人群年龄对BMI与高血压发病风险的影响。方法 采用整群随机抽样方法,选择河南省新安县≥ 18岁20 194名农村常住居民为研究对象,于2007-2008年开展基线调查,2013-2014年随访。采用logistic回归模型分析基线BMI、年龄别BMI与高血压发病风险的关系。结果 共纳入9 768名研究对象,在6年随访期内,发生高血压1 950例,其中男性784例,女性1 166例,相应的累积发病率分别为19.96%、20.51%和19.61%。以BMI<22 kg/m²组为参照,基线BMI为22~、24~、26~、≥ 28 kg/m²的研究对象发生高血压的RR值（95%CI）分别为1.09（0.93~1.27）、1.17（1.01~1.37）、1.34（1.14~1.58）和1.31（1.09~1.56）。青中年人群随着BMI的升高,高血压发病风险呈逐渐上升趋势（P<0.05）;老年人群随着BMI的增加,高血压发病风险则无显著变化趋势（P>0.05）。结论 BMI与高血压发病风险的关联受到年龄因素修饰的影响,在青中年人群中干预BMI可更有效降低高血压发病风险。     

中国成年人中心性肥胖与缺血性心脏病发病风险的前瞻性研究

目的 分析中心性肥胖评价指标腰围与发生缺血性心脏病（IHD）、急性冠心病事件（MCE）以及死于IHD风险的关联。方法 研究对象来自中国慢性病前瞻性研究,基线调查开展于2004年6月至2008年7月,剔除基线时患有冠心病、脑卒中、恶性肿瘤、慢性阻塞性肺疾病和糖尿病的个体,共纳入428 595人进行分析。统计学分析采用Cox比例风险模型。结果 研究人群平均随访9.1年,累积随访3 803 637人年,期间新发IHD 26 900例,MCE 4 320例,IHD死亡2 787例。调整了多种混杂因素和BMI后,与非中心性肥胖者（男性<85.0 cm,女性<80.0 cm）相比,中心性肥胖前期者（男性85.0～89.9 cm,女性80.0～84.9 cm）发生IHD、MCE和死于IHD的风险HR值（95% CI）分别为1.13（1.09～1.17）、1.15（1.05～1.26）、1.11（0.98～1.24）,中心性肥胖者（男性≥90.0 cm,女性≥85.0 cm）对应的风险效应值更高,HR值（95% CI）分别为1.29（1.24～1.34）、1.30（1.17～1.44）、1.32（1.16～1.51）。按BMI分层,即使在BMI正常的人群中,与非中心性肥胖者相比,中心性肥胖前期和中心性肥胖人群发生IHD、MCE或死于IHD的风险也会增加。结论 中心性肥胖是IHD风险独立的危险因素,IHD风险随中心性肥胖测量指标腰围的增加而增加。     

中国成年人吸烟与心血管疾病发病风险的关联及其性别差异分析

目的 分析中国成年人吸烟与不同心血管疾病发病风险的关联及其性别差异。方法 研究对象来自中国慢性病前瞻性研究,基线调查开展于2004年6月至2008年7月,剔除基线自报患有恶性肿瘤、冠心病、脑卒中的个体,最终纳入487 373名研究对象。随访人年数的计算从研究对象完成基线调查时开始,至最早出现以下任一事件的时间为止：心血管疾病（CVD）发病、死亡、失访或2015年12月31日。使用Cox比例风险模型计算吸烟行为特征和心血管疾病发病风险的关联。结果 研究对象平均随访8.9年。随访期间新发缺血性心脏病33 947人,急性冠心病事件6 048人,脑内出血7 794人,脑梗死31 722人。男性吸烟率（67.9%）远高于女性（2.7%）。与非吸烟者相比,吸烟能增加各类CVD结局的发病风险,风险效应值HR值 （95%CI）由大到小依次为急性冠心病事件1.54 （1.43～1.66）、缺血性心脏病1.28 （1.24～1.32）、脑梗死1.18 （1.14～1.22）、脑内出血1.07 （1.00～1.15）。当前吸烟者中,每天吸烟量和开始吸烟年龄与急性冠心病事件风险间的关联存在性别差异（性别交互作用P值分别为0.006、0.011）,主要表现为女性吸烟者风险高于男性。每天吸烟量和开始吸烟年龄与缺血性心脏病、脑内出血和脑梗死之间的关联均未见性别差异（性别交互作用P>0.05）。结论 吸烟能够增加各类CVD的发病风险,而女性吸烟者发生急性冠心病事件的风险远高于男性。     

浙江省嘉善县1990-2014年恶性肿瘤发病和死亡的性别差异分析

目的 描述和分析浙江省嘉善县居民恶性肿瘤发病和死亡的性别差异。方法 1990－2014年嘉善县恶性肿瘤发病和死亡资料源自当地肿瘤登记报告系统。以2010年全国人口为标准人口,计算标准化发病率和标准化死亡率,并计算相应性别发病率比值、死亡率比值及其95% CI。结果 1990－2014年嘉善县所有恶性肿瘤的标准化发病率为226.13/10万,其中男性为266.04/10万,女性为187.22/10万,男、女性发病率比值为1.42（95% CI：1.39～1.46）,发病差异有统计学意义（P<0.05）。所有恶性肿瘤的标准化死亡率为155.39/10万,其中男性为206.55/10万,女性为104.98/10万,性别死亡率比值为1.97（95% CI：1.91～2.03）,男、女性死亡差异同源有统计学意义（P<0.05）。分析恶性肿瘤类型发现,除胆囊癌及甲状腺癌以外,其他恶性肿瘤的发病率和死亡率均为男性高于女性。结论 浙江省嘉善县居民恶性肿瘤的发病和死亡均为男性高于女性,且存在显著性别差异。     

甘肃省2019-2022年原发性免疫性血小板减少症的流行病学特征分析

目的 描述甘肃省2019-2022年原发性免疫性血小板减少症（ITP）人群中发病水平及流行病学特征,为ITP的诊治、病因学研究及该病与疫苗接种的关联性分析判断提供证据支持。方法 使用Spark软件从甘肃省电子病历数据库中提取2019-2022年首次确诊的ITP病例,描述2019-2022年ITP新发病例的发病率及其流行病学特征,采用Poisson分布计算发病率,并估计其95%CI,使用Poisson回归进行组间差异比较。结果 2019-2022年甘肃省首次诊断为ITP共4 159例,总发病率为4.11/10万（95%CI：3.98/10万~4.23/10万）,男性为3.49/10万（95%CI：3.33/10万~3.65/10万）,女性为4.74/10万（95%CI：4.56/10万~4.94/10万）,差异有统计学意义（P＜0.001）;儿童及老年人发病率高,男性在＜10岁儿童及≥80岁老年人群中的发病风险高于女性,女性在成年以后（20~69岁）高于男性;甘肃省ITP发病峰值出现在夏季（6、7、8月）,谷值在2、10月,各年龄组人群发病水平在一年中呈周期性变化;地区分布为东部和西部发病风险高,中部发病风险低。结论 2019-2022年甘肃省儿童及老年人ITP发病率高,且男性发病风险高于女性,在总人群中女性发病风险较高,亦存在季节性和区域性高发现象。     

中国3个地区体检人群代谢综合征发病风险及其危险因素分析

目的 分析我国3个地区（北京、香港、台湾）体检人群MS发病风险及其危险因素。方法 选取台湾地区美兆体检数据库中2004—2010年首次体检,且与末次体检至少相差5年的≥ 18岁非MS人群6 828人,构建体检队列,采用中国成人血脂异常防治指南制订联合委员会2007年标准（JCDCG-2007）诊断MS。利用Cox模型比较3个地区体检人群发生MS的风险并探索其发生MS的危险因素。结果 北京、香港、台湾3个地区体检人群MS标化发病密度分别为3.14/100人年、2.19/100人年、2.03/100人年,调整性别、年龄、膳食模式等混杂因素后,北京、香港体检人群发生MS的风险分别是台湾地区体检人群的1.60（95% CI：1.34~1.91）倍和1.08（95% CI：0.83~1.41）倍,男性、高龄、吸烟、肉类食物为主的膳食模式以及基线患MS组分异常等因素与体检人群MS发病风险有明显的正相关性（均P<0.05）。结论 北京、香港、台湾地区体检人群发生MS的风险存在地区差异,男性、高龄、吸烟、肉类食物为主的膳食模式、基线患MS组分异常等因素是发生MS的危险因素。     

总胆固醇与男性肺癌发病关系的前瞻性队列研究

目的 探讨基线TC与中国男性肺癌发病风险的关联及其强度。方法 自2006年5月,以开滦集团全体在职及离退休男性职工为调查对象,建立开滦集团男性动态队列并随访。基线调查时收集研究对象的社会人口学、个人疾病史、身体测量指标和TC等基线信息,并利用随访收集肺癌发病结局信息。参考《中国成人血脂异常防治指南》与研究人群TC分布特征,TC按照五分位数进行分组：<160、160～、180～、200～、≥240 mg/dl,以TC 160～mg/dl组为参比组,利用Cox比例风险模型分析基线TC与男性肺癌发病风险的关联性、限制性立方样条曲线分析其非线性关系。结果 截至2014年12月31日,109 884名男性进入队列,共计随访763 819.25人年,随访时间M=7.88年,收集肺癌新发病例808例。调整年龄、文化程度、收入、吸烟、饮酒、粉尘暴露史、FPG、BMI后,以160～mg/dl组为对照,TC偏低（<160 mg/dl）和TC升高（≥240 mg/dl）组男性肺癌发生风险分别升高34%（HR=1.34,95% CI：1.04～1.72）和45%（HR=1.45,95% CI：1.09～1.92）。剔除随访2年内肺癌新发病例及有高血脂病史者后,结果无显著变化。结论 TC与男性肺癌发生相关,TC过高或过低男性的肺癌发病风险均升高,保持适当的TC水平可能是预防和控制肺癌的有效措施之一。     

中国成年人慢性阻塞性肺疾病与骨密度的相关性分析

目的 探究我国成年男性和女性中慢性阻塞性肺疾病（COPD）与骨密度的关系。方法 利用中国慢性病前瞻性研究第二次重复调查的数据,采用线性回归分析COPD及慢性阻塞性肺疾病全球倡议（GOLD）分级与跟骨骨密度指标（宽带超声衰减、超声声速、强度指数）之间的相关性。结果 共纳入23 876名研究对象,男性COPD患病率为34.3%（3 130/9 125）,女性COPD患病率为23.2%（3 416/14 751）。以健康男、女性为参照,男、女性COPD患者的宽带超声衰减、超声声速、强度指数均降低,男性对应的β值（95%CI）分别为-0.87（-1.37~-0.36）、-3.42（-5.42~-1.43）、-1.53（-2.34~-0.71）,女性对应的β值（95%CI）分别为-0.66（-1.09~-0.23）、-2.24（-3.92~-0.55）、-1.06（-1.71~-0.40）,男性中下降幅度更大（交互作用均P<0.05）。GOLD分级与宽带超声衰减、超声声速、强度指数呈负相关,且存在线性趋势（线性趋势检验均P<0.001）。亚组分析显示,男性年龄≥60岁、男性低体力活动水平者、男、女性非超重/肥胖者中COPD患者骨密度下降幅度更大。结论 COPD与骨密度呈负相关,应加强对COPD患者骨密度的关注,尤其应关注年龄大、体力活动水平低、非超重/肥胖的COPD患者。     

云南省德宏傣族景颇族自治州2004-2018年启动抗病毒治疗后HIV/AIDS贫血发病及危险因素回顾性队列研究

目的 了解德宏傣族景颇族自治州（德宏州）2004-2018年启动抗病毒治疗（ART）后HIV/AIDS贫血发病及其影响因素。方法 采用回顾性队列研究的方法,基于德宏州HIV/AIDS的ART数据库,纳入分析2004-2018年启动ART的HIV/AIDS。采用Cox比例风险模型分析启动ART后HIV/AIDS贫血和中重度贫血新发及其影响因素,用分段混合线性效应模型拟合基线不同贫血状况随访血红蛋白的变化轨迹。结果 共8 044例HIV/AIDS纳入分析。基线未患贫血者占78.8%（6 337/8 044）。6 337例基线未患贫血的HIV/AIDS中位随访时间为4.43（P₂₅,P₇₅：1.50,6.71）年,其中1 291例新发贫血和293例新发中重度贫血HIV/AIDS的中位随访时间分别为0.16（P₂₅,P₇₅：0.07,1.99）年、0.48（P₂₅,P₇₅：0.09,2.97）年,贫血和中重度贫血的发病密度分别为4.40/100人年、0.41/100人年。多因素Cox回归结果显示,启动ART后HIV/AIDS发生贫血的危险因素有年龄大、女性、傣族和景颇族、基线BMI<18.5 kg/m²、基线CD4⁺T淋巴细胞计数（CD4）<200个/μl、初始ART方案使用齐多夫定（AZT）,发生中重度贫血的危险因素有女性、傣族、基线BMI<18.5 kg/m²、基线轻度贫血、初始ART方案使用AZT。结论 2004-2018年德宏州HIV/AIDS启动ART后贫血的发病风险在某些特征人群中较高,如≥ 60岁老年人、女性、少数民族、BMI偏低、基线CD4<200个/μl、ART方案使用AZT者。应重点加强对这部分人群贫血的筛查及其防治措施。     

中国成年人饮酒行为特征与肥胖指标的相关性研究

目的 分析中国成年人不同饮酒行为与肥胖的关系。方法 本研究利用中国慢性病前瞻性研究基线调查数据,根据BMI和腰围（WC）分别划分一般性肥胖和中心性肥胖,采用logistic回归分析饮酒行为与一般性肥胖和中心性肥胖间的关系。结果 本研究纳入249 873名调查对象,男性饮酒量与BMI和WC间大体呈“J”形的曲线关系。以不饮酒者作为对照,少量饮酒组患一般性肥胖和中心性肥胖的比例较低,男性的OR值分别为0.65（0.59～0.71）和0.93（0.88～0.98）,女性的OR值分别为0.77（0.65～0.91）和0.89（0.80～0.99）;男性大量饮酒组患一般性肥胖（OR=1.21,95% CI：1.12～1.32）和中心性肥胖（OR=1.33,95% CI：1.27～1.40）的比例最高。饮酒频率为3～5 d/周组的BMI和WC值较高,患中心性肥胖的比例也最高（男性：OR=1.23,95% CI：1.16～1.31;女性：OR=1.13,95% CI：0.99～1.28）。20岁前开始每周饮酒的男性患中心性肥胖的比例是不饮酒者的1.24倍（95% CI：1.16～1.33）。饮啤酒者患一般性肥胖的比例较低（男性：OR=0.74,95% CI：0.67～0.82;女性：OR=0.54,95% CI：0.43～0.68）。结论 少量饮酒患肥胖的比例较低,大量饮酒者患肥胖的比例较高,开始饮酒的年龄越早肥胖的比例越高。     

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.     

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.     

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.     

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.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Hydrazine inhalation hepatotoxicity

Abstract Hydrazine is a hazardous chemical commonly used as a reactant in rocket and jet fuel cells. Animal studies have demonstrated hepatic changes after hydrazine inhalation. Human case reports of hydrazine inhalation hepatotoxicity are rare. We report a case of mild hepatotoxicity following brief hydrazine vapour inhalation in a healthy young man, which resolved completely on expectant management.     

Fitness standards in airline staff

Employers have a legal duty to manage safety and to meet this duty it is necessary to control risks arising from pre-existing medical conditions. Such conditions can be identified at the time of job placement, but there is little published information about the approach to fitness standards by most airlines. This review is therefore limited to the practice of one major airline. It is illustrated by reference to various occupations within the airline, with the associated rationale.