1990～1991年北京市城区大气污染与每日居民死亡关系的研究

本研究使用时间序列分析对北京市主要城区（西城区、东城区）１９９０～１９９１年大气污染和每日死亡数进行连续观察，并使用泊松回归模型分析空气中总飘尘（ＴＳＰ）和二氧化硫（ＳＯ２）的对数测定值对每日居民死亡的影响，结果显示：大气污染物有增加每日居民死亡数的危险性，心血管病患者受ＴＳＰ的影响和呼吸系统疾病患者受ＳＯ２的影响比其他疾病患者更大，６５岁及以上老年病人所受影响较大。     

北京市大气污染与城区居民死亡率关系的时间序列分析

为定量评价北京市大气污染对居民每日疾病死亡率的影响 ,运用时间 -序列分析方法 ,控制了流感、季节等混杂因素的影响后 ,对北京市主要大气污染物CO、SO2 、NOX、TSP、PM10 与居民相应疾病死亡率的相关关系进行了定量评价。以呼吸系统疾病、循环系统疾病、冠心病、慢性阻塞性肺病和消化系统肿瘤疾病死亡人数分别为因变量 ,大气污染物浓度和平均温度、湿度为自变量 ,进行了泊松回归分析。单变量分析结果表明 ,除TSP对冠心病死亡率的影响无显著意义外 ,大气中CO、SO2 、NOX 、TSP浓度与呼吸系统、心脑血管疾病、慢性阻塞性肺病和冠心病死亡率之间的正相关关系均有显著意义 ,而多因素泊松回归得到的暴露 -反应关系模型显示 ,SO2 浓度每提高 10 0 μg m3,呼吸系统、循环系统、冠心病和慢性阻塞性肺病疾病死亡率分别增加 4 2 1%、3 97%、10 68%和 19 2 2 % ;总悬浮颗粒物每增加 10 0 μg m3 ,呼吸系统疾病死亡率增加 3 19% ,循环系统死亡率增加 0 62 %。提示大气污染物浓度的升高会引起相应疾病死亡率的增加     

北京市大气二氧化氮水平与居民呼吸系统疾病死亡的关系

目的分析大气中主要气态污染物二氧化氮(NO2)急性暴露对北京市居民每日呼吸系统疾病死亡人数的影响。方法收集北京市2006—2009年居民每日呼吸系统疾病死亡资料、大气主要污染物(SO2、NO2、PM10)日均浓度资料和气象因素(日均气温、日均相对湿度)资料。采用时间序列的广义相加模型,通过平滑样条函数控制时间趋势、"星期几效应"和气象因素等混杂因素,拟合大气NO2浓度与居民每日呼吸系统疾病死亡人数之间的暴露-反应关系模型。对确定的最优拟合模型进行敏感度检验以检测其稳定性,并进一步建立双污染物模型,以检验NO2对居民每日呼吸系统疾病死亡人数的效应是否受到其他大气污染物的影响。结果 NO2浓度与北京市居民每日呼吸系统疾病死亡人数的关联无统计学意义(P0.05),但与居民每日肺炎死亡人数之间有统计学意义(P0.05)。建立的最优拟合模型稳定。日均NO2浓度每升高10μg/m3,居民每日肺炎死亡人数增加1.46%(95%CI:0.04%~2.90%)。在模型中加入PM10后,NO2对居民每日肺炎死亡的效应有增加,居民每日肺炎死亡人数增幅增加至1.88%(95%CI:0.12%~3.68%)。结论北京市大气中NO2浓度升高可能导致居民每日肺炎死亡人数增加。     

2010、2011年广州市越秀区空气污染物AQI与呼吸系统疾病死亡的Poisson回归分析研究

[目的]探讨广州市越秀区空气污染物AQI对呼吸系统疾病死亡的影响。[方法]收集2010、2011年广州市越秀区呼吸系统疾病死亡数据和越秀区气象及大气污染物数据,采用广义线性模型模块,拟合Poisson回归分析空气各污染物空气质量指数（AQI）、综合AQI和空气质量分级与呼吸系统疾病死亡的影响。[结果]2010、2011年广州市越秀区因呼吸系统疾病死亡病例有2 678例。SO2AQI与呼吸系统疾病死亡有统计学意义,SO2AQI每升高1个单位,其危险度约增加1%（RR=1.01,P〈0.05）;综合AQI的变化和空气质量等级与呼吸系统疾病死亡无统计学意义。[结论]广州市越秀区空气污染物中SO2是呼吸系统相关因素死亡的危险因素。     

大气二氧化硫与居民每日呼吸系统疾病死亡相关性的时间序列分析

目的 分析大气中主要气态污染物二氧化硫(SO2)急性暴露对北京市居民每日呼吸系统疾病死亡人数的影响.方法 采用时间序列的广义相加模型,在控制时间趋势和气象因素、“星期几效应”等混杂因素的基础上,分析北京市2006年1月1日2009年12月31日大气SO2浓度与居民每日呼吸系统疾病死亡人数的关系.结果 北京市大气SO2浓度每升高10 μg/m3,居民当日呼吸系统疾病死亡人数、滞后1d的每日肺炎死亡人数分别增加0.88％(95％CI:0.34％～1.41％)和1.43％(95％CI:0.51％～2.35％).结论 北京市大气SO2污染与居民每日呼吸系统疾病死亡人数和肺炎死亡人数有统计学关联.     

天津市可吸人颗粒物与城区居民每日死亡关系的时间序列分析

目的 研究天津市大气可吸入颗粒物(PM10)与城区居民每日死亡间的相关性.方法 通过收集天津市城区2005-2007年空气污染数据、日平均气温和相对湿度及每日死亡人数,采用广义相加模型,控制长期和季节趋势、气温和相对湿度等气象因素及二氧化硫(SO2)和二氧化氮(NO2)等气态污染物的影响,分析天津市PM10与居民每日死亡之间的关系.结果 大气PM10与人群每日非意外死亡、循环系统疾病死亡和呼吸系统疾病死亡间显著相关.PM10浓度每升高10 μg/m3,人群每日非意外死亡、循环系统疾病死亡和呼吸系统疾病死亡分别增加0.45%(0.21～0.69)、0.60%(0.29～0.91)和0.82%(0.04～1.61).结论 天津市大气PM10污染与城区居民每日死亡显著相关,尤其是循环系统疾病和呼吸系统疾病死亡.     

济南市热浪对居民非意外死亡的影响研究

目的研究评估济南市热浪对居民非意外死亡的影响。方法收集济南市2009、2010和2012年6—8月的死亡资料,以及同期的气象指标和大气污染指数,采用时间分层病例交叉研究,分析不同滞后天数热浪对该市居民非意外死亡及主要死因别循环系统疾病及其亚类急性心肌梗死、脑血管疾病,呼吸系统疾病,肿瘤死亡的影响。结果观察天数共计276d,期间非意外死亡共16427例;其中热浪期34d,非意外死亡2306例;非热浪期242d,非意外死亡14121例。济南市热浪对本地居民非意外死亡,循环系统疾病、呼吸系统疾病,脑血管疾病、急性心肌梗死死亡有显著影响,且存在滞后效应,在滞后2,2、1,2、4d时效应最大,对肿瘤死亡未发现显著影响。在控制了节假日效应、平均气压、平均相对湿度和污染指数后,热浪与居民非意外死亡,循环系统疾病、呼吸系统疾病．脑血管疾病、急性心肌梗死死亡的影响因素分析OR值分别为1．44,1．70、1．87,1．56、1．60。结论该研究提示热浪是济南居民健康的危险因素。热浪对居民呼吸系统疾病的死亡影响最大,其次是循环系统疾病死亡;相关部门应针对济南市当地的气候特点,采取相应的有效公共卫生预防措施,减少热浪对当地居民健康的危害。     

西安市大气PM_（2.5）污染与城区居民死亡率的关系

目的定量评价西安大气PM2.5污染对城区居民每日疾病死亡率的影响。方法以大气PM2.5浓度为自变量,以总死亡,呼吸系统疾病,心血管疾病,中风,慢性阻塞型肺部疾病,冠心病,下呼吸道感染等疾病为因变量,进行了单因素泊松回归分析。结果单变量分析结果表明：除PM2.5对下呼吸道感染死亡率的影响无显著意义以外,与其它各种疾病死亡率之间的正相关关系均有显著意义。暴露-反应关系模型显示：PM2.5浓度每升高100μg/m3,总死亡、呼吸系统疾病、心血管疾病、冠心病、中风、COPD的死亡率分别增加4.08%,8.32%,6.18%,8.32%,5.13%,7.25%。结论大气PM2.5浓度的升高会引起相应疾病死亡率的增加。     

北京市海淀区1992—1996年脑血管疾病死亡分析

为了研究脑血管疾病死亡的特点及规律，为脑血管疾病防制措施提供科学依据，本文对北京市海淀区１９９２～１９９６年脑血管疾病的死亡资料进行了分析。现报告如下。资料来源与方法（１）死亡资料：来源于北京市海淀区卫生防疫站历年居民病伤死亡原因年报表，该报表根据居...     

石家庄市PM2.5浓度对居民死亡的急性影响分析

目的 了解石家庄市PM2.5污染特征及其对居民死亡率的影响。方法 收集2013 - 2015年该市逐日大气PM2.5浓度、平均气温、平均相对湿度和居民的死亡数据,利用广义相加模型分析PM2.5日均浓度和居民死亡的关系。结果 研究期间石家庄市日均非意外死亡32人,其中循环系统疾病死亡17人,呼吸系统疾病死亡5人;PM2.5浓度范围为6.3～771.3 μg/m3,平均浓度为118.8 μg/m3。时间序列分析结果表明,该市大气PM2.5浓度每升高10 μg/m3,居民非意外总死亡（lag05）、循环系统疾病死亡（lag05）和呼吸系统疾病死亡（lag1）的风险分别增加0.73%（95%CI:0.42%～1.04%）、1.04%（95%CI:0.64%～1.46%）和0.63%（95%CI:0.07%～1.19%）。结论 石家庄市大气PM2.5浓度的升高可能导致居民非意外总死亡,尤其是循环系统疾病和呼吸系统疾病死亡的增加。     

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.     

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.     

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.     

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.