北京市崇文区职业人群慢性病患病情况及其危险因素

目的 了解北京市崇文区职业人群常见慢性病患病率及相关危险因素现状,以确定职业健康教育重点,为制定合理的健康促进策略提供依据.方法 应用多阶段整群抽样方法,从4类职业人群中抽取350人进行问卷调查、体格测量和血生化检查.结果 调查人群中高血压、糖尿病、血脂异常患病率分别为32.6％、12.6％和20.8％.呈现出随着年龄增长患病率升高的趋势,不同职业慢性病患病情况没有差别.logistic回归分析结果显示,年龄、腰围、饮酒、体重指数(BMI)、糖尿病是高血压患病的危险因素;男性、腰围超标、业余静态时间≥4 h、有慢性病家族史和糖尿病的人患血脂异常的危险性增加.结论 该区应将男性、超重肥胖、腰围超标的职工作为干预的重点,加强健康教育和宣传,改善危险因素水平.     

深圳市社区40岁以上人群脑卒中危险因素现况

目的通过对深圳市桃源社区40岁以上居民脑卒中高危人群筛查,了解我市本土化的脑卒中高危因素顺位及其人群分布情况,为制定社区居民脑卒中特异性干预措施提供依据。方法采用整群抽样方法,以深圳市桃源社区4 006例40岁以上常住居民为筛查对象,所有筛查对象均使用统一的脑卒中风险评估表进行风险初筛,并进行初步体格检查与实验室检查;对初筛判定为高危风险的人群进一步进行高危人群复筛。结果本社区4 006例筛查对象中的脑卒中风险因素顺位依次为血脂异常、高血压、明显超重或肥胖、体育锻炼少、吸烟、脑卒中家族史、糖尿病、房颤、脑卒中病史、短暂性脑缺血发作史。人群中具有1项、2项、3项、4项及以上危险因素者分别有1 275、878、429、278例;研究对象中,男性组的高血压、异常血脂、糖尿病、吸烟、明显超重或肥胖、体育锻炼少、脑卒中家族史、脑卒中病史的检出率均高于女性组(P<0.05);明显超重和肥胖、高血压在不同受教育程度者之间检出率均较高(P<0.05);40~69岁组,血脂异常、吸烟、明显超重或肥胖有随年龄增加而增加的趋势(P<0.001);筛查人群中有76人被诊断为脑卒中,脑卒中粗患病率为1.90%;脑卒中风险评估结果显示低危人群2 791人(69.67%),中危人群493人(12.31%),高危人群646人(16.12%)。结论桃源社区≥40岁人群脑卒中粗患病率为1.90%,与2012年全国粗患病率接近(1.96%);血脂异常、高血压、明显超重或肥胖为影响该社区居民脑卒中发病的主要危险因素。     

上海市延吉社区2型糖尿病患病率调查及危险因素分析

目的了解上海市延吉社区20～90岁居民2型糖尿病患病情况及其危险因素。方法采用按比例、整群抽样的方法,对该社区居民9660人进行2型糖尿病的横断面调查,使用多因素非条件logistic回归分析方法筛选2型糖尿病危险因素。结果该社区居民2型糖尿病的患病率为8．01％,男女患病率分别6．78％、9．17％,差异有统计学意义（P〈0．01）。患病率随年龄增加而增高（P〈0．01）。高血压、血脂异常及超重、肥胖人群中糖尿病患病率均分别高于正常人群的糖尿病患病率（均P〈0．01）。多因素非条件logistic回归分析显示,2型糖尿病的危险因素为年龄、糖尿病家族史、血脂异常史、腰围、高血压病史、收缩压、舒张压,高文化程度是其保护因素。结论上海市社区居民2型糖尿病患病率呈快速增长趋势,对有糖尿病家族史、高血压病史、血脂异常史及肥胖的中老年人群要重点预防与治疗。     

体检人群中超重和肥胖者糖尿病患病情况分析

目的了解体检人群中超重和肥胖者糖尿病患病率,分析体质指数(BMI)对糖尿病患病率的影响。方法2005年对深圳市部分银行23~59岁职工2025人进行BMI、血糖测量及问卷调查,按中国肥胖问题工作组数据汇总分析协作组的BMI标准将其分成3大组:正常组、超重组和肥胖组。结果生活及饮食习惯:BMI正常组抽烟者为13.3%,酗酒者为25.8%;BMI超重组抽烟者为20.3%,酗酒者为37.1%;BMI肥胖组抽烟者为9.4%,酗酒者为45.5%。腰围:BMI正常组男性平均腰围84.2±5.5,女性平均腰围75.0±4.1;BMI超重组男性平均腰围94.3±6.5,女性平均腰围82.9±5.0;BMI肥胖组男性平均腰围103±8.2,女性平均腰围90.5±7.5。BMI正常组的糖尿病患病率最低,男性为3.2%,女性为3.5%。BMI超重组的糖尿病患病率男性为12.6%,女性为10.6%。BMI肥胖组糖尿病患病率男性为22.5%,女性为19.1%。结论随着体质指数的增加,糖尿病的患病率升高,两者呈显著正相关,肥胖组人员糖尿病发病率高于其他两组,且酗酒者居多。加强对超重、肥胖人群的健康教育及行为干预,保持BMI在正常范围是预防糖尿病发生的有效措施。     

江苏淮安市老年2型糖尿病人群血脂异常的患病情况及其影响因素

目的了解淮安市老年2型糖尿病(以下简称"糖尿病")人群血脂异常患病情况及其影响因素,为社区老年糖尿病人群血脂异常的防治提供依据。方法采用随机整群抽样方法,纳入5 914名社区老年糖尿病患者,采用统一问卷询问其基本情况、饮食结构、生活方式和疾病史等,测量其身高、体重、腰围和血压,并检测其血糖和血脂,采用多因素logistic回归分析老年糖尿病人群血脂异常的影响因素。结果淮安市老年糖尿病人群血脂异常患病率为52.18%。多因素非条件Logistic回归分析显示,年龄增加、城市居住、血脂异常家族史、超重肥胖、中心性肥胖、高血压和血糖未控制是患血脂异常的危险因素,而大专及以上是患血脂异常的保护因素。结论淮安市老年糖尿病人群血脂异常患病率偏高,避免超重肥胖(中心性肥胖)、控制血压和血糖水平均有助于降低血脂异常的患病率,进而降低心血管并发症的发病风险。     

无锡市社区人群代谢综合征现况调查及特点分析

目的了解无锡市社区人群代谢综合征(MS)的患病水平及影响MS患病的相关因素与后果。方法采用整群抽样方法调查无锡市社区20岁以上人群10833人,按照国际糖尿病联盟(IDF)标准分析MS及其各组分代谢紊乱的患病情况和代谢综合征人群的空腹血糖受损及糖尿病患病率;logistic多因素分析MS患病危险因素以及MS人群发生空腹血糖受损和糖尿病的危险因素。结果无锡市社区人群MS标化患病率为18.8%。随年龄的增加MS患病率逐步增高,女性MS标化患病率高于男性。无论男性还是女性,中心性肥胖伴高血压、高血脂是MS患者的主要代谢紊乱表现。MS人群中空腹血糖受损的患病率为6.01%,糖尿病患病率为21.14%。logistic多因素分析结果显示,女性、年龄大、高血压家族史、饮食偏咸和常吃烟熏食物是MS患病的危险因素,糖尿病家族史是MS患者发生空腹血糖受损和糖尿病的危险因素,文化程度高是保护因素。结论无锡市社区人群中MS患者代谢紊乱状态以中心性肥胖伴高血压、高血脂为特点,MS人群中发生空腹血糖受损及糖尿病者高于一般人群,年龄大以及伴有糖尿病家族史的代谢综合征患者更易发生空腹血糖受损和糖尿病。     

上海市嘉定区35岁及以上居民糖尿病患病率及危险因素研究

目的调查上海市嘉定区35岁及以上常住居民糖尿病患病情况及危险因素。方法采用整群随机抽样的方法,在上海市嘉定区随机抽取10个居委作为研究现场,调查年龄≥30周岁的常住居民。采用集中调查的方式对社区居民进行调查,调查内容包括问卷调查、体格检查和实验室检测三个部分。结果本次调查共发现655例糖尿病患者,患病率为20.57%。其中男性317例,患病率为23.07%,女性338例,患病率为18.66%,糖尿病未诊断率为43.66%;发现糖调节异常患者(IGR)664人,检出率为20.85%,其中糖耐量受损患者472人(71.08%),空腹血糖受损患者192人(28.92%)。单因素分析发现:性别为男性、吸烟、高TG血症、低HDL-C血症、肥胖和超重、腹型肥胖、高血压(现场测量)、有家族史、IGR史和心脑血管疾病史的人群糖尿病患病率高于一般人群,糖尿病患者组的年龄和静坐时间高于正常组;logistic回归分析显示:有IGR史、IGR史不详、家族史、静坐时间、高TG血症、超重和肥胖、高血压和年龄是影响糖尿病患病的独立因素。结论上海市嘉定区35岁以上糖尿病患病形势较严峻,应适当整合医疗资源,在高风险人群中定期开展筛查;糖尿病高危人群应减少每日静坐时间,结合饮食调整,改善相关危险因素的现况。     

农村中老年人群肥胖与糖尿病的关系

目的 了解中老年人群超重肥胖和中心性肥胖与糖尿病的关系,为制定肥胖和糖尿病的防治措施提供科学依据.方法 采用整群抽样方法抽取天津市某区某镇2 969名45岁及以上常住居民进行调查,测量身高、体重、腰围以及血糖等.结果 2 969人中糖尿病患者392人,患病率为13.2％,标化患病率为12.2％.随体质指数(BMI)增高,糖尿病患病率上升,正常体重、超重、肥胖和中心性肥胖人群糖尿病患病率分别为10.8％、15.8％、18.8％和14.9％.单因素Logistic回归分析结果显示,超重、肥胖者和中心性肥胖者患糖尿病的OR值(95％ CI)分别为1.552( 1.216～1.981)、1.914( 1.420～2.579)和3.468(2.248～5.350),经年龄、性别和糖尿病家族史调整后,超重、肥胖和中心性肥胖与糖尿病的关系仍然存在,其OR值(95％ CI)分别为1.410( 1.090～1.824)、1.605(1.172～2.200)和2.559(1.547～4.233).结论 超重肥胖和中心性肥胖与中老年糖尿病患病有关,超重肥胖者和中心性肥胖者患糖尿病危险增加.     

上海市浦东新区社区居民肥胖和高血压的关系研究

目的 描述肥胖和高血压在上海市浦东新区社区人群中的分布,分析肥胖与高血压的关系.方法 采用横断面调查方法,随机对上海市浦东新区13个社区的5 927位居民进行身高、体重、腰围和血压等指标的测量.结果 社区人群超重、肥胖、腹型肥胖和高血压的患病率分别为34.9％、11.1％、43.7％和22.2％,其中男性分别为37.1％、10.9％、45.4％和22.4％,女性分别为33.1％、11.2％、42.3％和22.0％.社区人群超重、肥胖、腹型肥胖和高血压的患病率均随年龄的增加而上升.超重与肥胖、腹型肥胖与高血压患病显著相关,控制年龄和性别后,BMI、腰围与高血压的关联强度（OR）分别为1.142（1.109,1.176）和1.014（1.003,1.025）.结论 上海市浦东新区社区居民超重与肥胖、腹型肥胖和高血压患病显著相关,且患病率随年龄增加而上升.     

通辽市社区居民体质指数与慢性病关系调查

目的 为了解通辽市社区居民体质指数在不同人群的分布以及与慢性病的关系,为进一步制定干预措施提供科学依据.方法 采取随机整群抽样的方法,抽取两个社区＞30岁常住居民3 470人进行调查.结果 通辽市社区居民中超重率、肥胖率、中心肥胖率男性均高于女性.其中超重率(43.29％)、肥胖率(16.14％)、中心肥胖率58.62％;高血压在超重、肥胖、中心性肥胖人群中患病率显著增高;糖尿病在超重、肥胖、中心性肥胖人群中患病率显著增高.且随着体质指数(BMI)的增加,糖尿病的患病率明显增加.冠心病在超重、肥胖、中心性肥胖人群中患病率高.结论 超重、肥胖是导致各种慢性病发生的主要因素,与有关报道一致.     

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.