中国成人腰围、体质指数与高血压关系

目的 采用腰围(WC)、体质指数(BMI)综合评价中国18～69岁成年人中心性肥胖者高血压患病风险.方法 利用2004年中国慢性病及其危险因素监测样本人数,采用多级抽样方法抽取18～69岁成年人30 686人,采用问卷调查和人体测量方法收集数据,比较各BMI组别中心性肥胖者高血压患病的OR值.结果 体质指数正常、超重和肥胖组中,男性中心性肥胖者高血压患病率分别为26.1%,32.0%和49.2%;女性中心性肥胖者高血压患病率分别为22.5%,28.2%和41.5%;除男性肥胖组外,中心性肥胖者高血压患病率均明显高于同组内的正常腰围人数(P<0.01);调整混杂因素(年龄、吸烟状况、饮酒状况和锻炼等)后,与正常腰围人群比较,各BMI组别中男性中心性肥胖者患高血压患病的OR值分别为1.9(95%CI=1.6～2.3),1.6(95%CI=1.3～1.9),1.6(95%CI=0.7～3.7);女性患高血压患病OR值分别为1.5(95%CI=1.3～1.8),1.4(95%CI=0.2～1.6),2.5(95%CI=1.2～5.2).结论 中心性肥胖者与正常腰围者比较具有更高的高血压患病风险.     

沈阳市大气二氧化硫污染对呼吸系统疾病死亡率的影响

目的 研究沈阳市大气SO2污染对呼吸系统疾病死亡率的影响.方法 收集1996-2000年沈阳市城区大气SO2浓度资料及死于呼吸系统疾病的病例资料,运用生态学方法,采用Poisson回归和局部自动回归,对季节变化、温度、湿度、气压进行调整,将病例按性别、年龄分组.分别在各组中分析SO2对呼吸系统疾病死亡率的影响.结果 大气SO2浓度和死亡率的分布具有明显的季节性,且两者具有相似的分布形式.大气SO2浓度每增加0.05 mg/m3,总人群组呼吸系统疾病死亡率增加5.90%(95%CI:2.26%～9.68%,P＜0.05),其中儿童组为10.23%(95%CI:2.07%～19.04%,P＜0.05),中青年男子组为1.10%(95%CI:-9.51%～12.96%,P＞0.05),中青年女子组为9.58%(95%CI:-2.57%～23.23%,P＞0.05),中青年组为10.23%(95%CI:2.07%～19.04%,P＜0.05),老年男子组为5.26%(95%CI:0.01%～10.78%,P＜0.05),老年女子组为8.07%(95%CI:3.45%～12.89%,P＜0.05),老年组为4.66%(95%CI:1.44%～7.99%,P＜0.05).结论 大气SO2污染可以增加人群呼吸系统疾病的死亡率,尤其是儿童组、老年组(特别是老年女子组).     

1953-2010年中国10~24岁青少年全死因死亡率趋势和地区差异分析

目的分析1953-2010年中国10~24岁青少年全死因死亡率的趋势和地区差异。方法利用1953-2010年六次全国人口普查数据,计算中国10~24岁青少年全死因死亡率及其年变化率。将各地区人均国内生产总值作为社会经济水平指标,计算青少年死亡的Wagstaff标准化集中指数。结果1953-2010年,中国青少年死亡率总体表现为男性高于女性,20~24岁组高于15~19和10~14岁组,西部高于东部。中国10~24岁青少年男性全死因死亡率由1953-1964年的554.6/10万下降至2010年的55.7/10万,女性由488.4/10万下降至26.7/10万,女性下降百分比(94.5%)高于男性(90.0%)。1981-2010年青少年男性死亡率年均下降率最大的为北京(4.4%),最小的为青海(0.1%);女性最大的为湖北(6.4%),最小的为青海(0.8%);死亡率较高的省份年均下降率较小。1990、2000和2010年男性青少年死亡集中指数分别为-0.07(95%CI:-0.11^-0.03)、-0.13(95%CI:-0.18^-0.08)和-0.16(95%CI:-0.22^-0.10),女性分别为-0.07(95%CI:-0.13^-0.02)、-0.18(95%CI:-0.24^-0.12)和-0.18(95%CI:-0.26^-0.09)。男、女性在1990、2000和2010年的集中指数比较差异均无统计学意义(P>0.05)。结论近半个世纪以来,中国青少年总体死亡率大幅下降,但下降幅度存在性别差异和地区差异。     

上海市社区35岁及以上人群高血压筛查结果分析

目的了解上海市社区高血压筛查对象的血压水平分布及影响因素,为新时期高血压早发现政策和措施的制定提供依据。方法于2017年11—12月,采用多阶段抽样方法抽取上海市7个区共21 496名35岁及以上常住居民为调查对象,进行问卷调查、身体测量和实验室检测。采用SAS 9.4软件进行复杂抽样下一般线性模型分析、Rao-Scottχ2检验、趋势χ2检验和多因素有序多分类反应变量的logistic回归分析。结果本次调查共有高血压筛查对象(自报未患高血压者)13 980名,其平均收缩压为130.6 mm Hg(95%CI:127.8～133.5 mm Hg),平均舒张压为81.3 mm Hg(95%CI:79.6～83.1 mm Hg)。男性平均收缩压[132.5 mm Hg(95%CI:128.4～136.5 mm Hg)]和平均舒张压[83.4 mm Hg(95%CI:81.0～85.7mm Hg)]均高于女性[平均收缩压为128.8 mm Hg(95%CI:126.5～131.2 mm Hg),平均舒张压为79.4 mm Hg(95%CI:77.9～80.8 mm Hg)],均有统计学意义(P0.05,P0.01)。≥75岁组平均收缩压最高,为145.4 mm Hg(95%CI:141.8～149.0 mm Hg),而平均舒张压最高的是45～59岁组,为82.2 mm Hg(95%CI:80.1～84.3 mm Hg)。高血压筛查对象的高血压、正常高值检出比例分别为32.94%(95%CI:27.91%～37.96%)和45.62%(95%CI:42.90%～48.34%),男性高血压比例高于女性(P0.05),75岁以上年龄组高血压检出率最高,为61.57%(95%CI:52.95%～70.20%)。多因素回归分析表明,男性(OR=1.67,95%CI:1.43～1.95)、高年龄(45～59岁OR=1.53,95%CI:1.22～1.92;60～74岁OR=2.18,95%CI:1.83～2.59;≥75岁OR=5.08,95%CI:4.28～6.03)、现在饮酒(OR=1.30,95%CI:1.04～1.62)、糖尿病(OR=1.66,95%CI:1.30～2.11)、血脂异常(OR=1.45,95%CI:1.28～1.65)和超重或肥胖(OR=1.79,95%CI:1.61～1.98)人群血压水平升高的风险较高,均有统计学意义(P0.05,P0.01),而文化程度较高人群(高中或中专OR=0.67,95%CI:0.53～0.85;大专及以上OR=0.62,95%CI:0.52～0.73)血压水平升高的风险较低,有统计学意义(P0.01)。结论社区高血压筛查对象的正常高值、高血压检出率较高。需探索多途径、高效的筛查和干预模式,重视高血糖、高血脂、超重肥胖和饮酒等高血压危险因素的控制。     

我国大气污染物一氧化碳短期暴露对人群死亡影响的Meta分析

目的分析我国大气污染物一氧化碳短期暴露对人群总死亡率、心血管疾病死亡率、呼吸系统疾病死亡率的影响。方法通过检索Pubmed、Web of Science、万方、中国知网等数据库,收集我国1990-2018年发表的一氧化碳短期暴露与人群死亡风险的流行病学研究文献,采用Stata11对纳入文献进行Meta分析。结果共收集我国一氧化碳短期暴露与人群死亡风险的文献14篇,Meta分析结果显示,一氧化碳浓度每升高1 mg/m3,人群总死亡率、心血管疾病死亡率、呼吸系统疾病死亡率各增加3.2%(95%CI:2.0%～4.4%)、4.0%(95%CI:2.8%～5.3%)、3.2%(95%CI:1.6%～4.9%)。结论一氧化碳浓度上升会导致人群总死亡率、心血管疾病死亡率、呼吸系统疾病死亡率增加。     

中国中老年人群和高个成年人中心型肥胖的腰围界值点验证

目的 探讨中国中老年人群和高个成年人的适宜腰围界值点及其对糖尿病患病危险的预测价值.方法 利用2002年中国居民营养与健康状况调查数据,分析≥45岁人群和身高在全人群第85百分位数(P85)以上成年人的腰围分布特征,分析不同的腰同界值点与体重指数(BMI:kg/m2)≥24的诊断一致性,采用多元logistic回归分析不同腰围水平的调查对象患糖尿病和空腹血糖受损的相对风险,并以ROC曲线最短距离确定上述人群的适宜腰围界值点.结果 中国中老年人腰围男性均值为80.8 cm,女性均值为79.4 cm;高个男性腰围均值为84.1 cm,女性为77.9 cm.中老年人腰围以男性85 cm、女性80 cm作为界值点,与BMI≥24的诊断一致性最好,预测糖尿病的ROC曲线距离最短.与腰围<85 cm组相比,85 cm～组、90 cm～组和95 cm～组的中老年男性患糖尿病[OR值分别为2.1(95%CI:1.6～2.8)、3.0(95%CI:2.3～4.0)和4.5(95%CI:3.4～5.8)]和空腹血糖受损[OR值分别为1.6(95%CI:1.2～2.2)、2.6(95%CI:1.9～3.5)和3.5(95%CI:2.6～4.6)]的相对风险明显增加.与腰围<80 cm组相比,80 cm～组、85 cm～组和90 cm～组中老年女性患糖尿病[OR值分别为1.9(95% CI:1.4-2.6)、3.2(95%CI:2.4～4.3)和4.8(95%CI:3.7～6.1)]和空腹血糖受损[OR值分别为2.5(95%CI:1.8～3.4)、3.2(95%CI:2.4～4.4)和4.2(95%CI:3.2～5.6)]的相对风险明显增高.高个成年人腰围以男性90 cm、女性85 cm作为界值点,预测糖尿病患病的ROC曲线距离最短.与腰围<85 cm组相比,95cm～组高个男性患糖尿病和空腹血糖受损的相对风险明显增高[OR值分别为3.6(95%CI:2.1～6.4)和5.5(95%CI:3.0～10.1)].与腰围<80cm组相比,85 cm～、90 cm～组高个女性患糖尿病的相对风险明显升高[OR值分别为5.0(95%CI:2.7～9.4)和8.0(95%CI:4.6～14.1)],90 cm～组患空腹血糖受损的相对风险OR=3.7(95%CI:2.0～6.9).结论 男性85 cm和女性80 cm是中老年人群的适宜腰围界值点;对于高个成年人,此腰围界值点对于空腹血糖受损有预测价值;人群中心型肥胖预防指标建议使用男性85 cm和女性80 cm作为腰围界值点.     

基于孕前队列的备孕夫妇生育力及其关联因素分析

目的分析育龄夫妇生育力及其关联因素。方法基于复旦大学孕前队列, 选取2016—2021年参加嘉定区孕前检查的育龄夫妇, 分析夫妇妊娠等待时间(TTP), 采用Cox比例风险回归模型分析影响育龄夫妇TTP的关联因素;应用Kaplan-Meier法计算每个月经周期的累积妊娠率。结果本研究共纳入1 095对孕前夫妇, TTP的M(Q1, Q3)为4.33(2.41, 9.78)个月经周期。女性年龄(FR=0.90, 95%CI:0.85～0.95, P<0.001)、女性孕前超重或肥胖(FR=0.36, 95%CI:0.24～0.55, P<0.001)、女性孕前暴露于二手烟(FR=0.63, 95%CI:0.44～0.92, P=0.016)、女性孕前住处或办公室近2年内装修有异味(FR=0.46, 95%CI:0.26～0.81, P=0.008)与夫妇生育力受损有关;女性月经周期规律(FR=1.64, 95%CI:1.16～2.31, P=0.005)、女性孕前经常饮茶/咖啡(FR=1.55, 95%CI:1.11～2.17, P=0.011)以及男性孕前服用叶酸(FR=2...     

基于贝叶斯时空模型黑龙江省肺癌死亡风险及其影响因素分析

目的了解黑龙江省肺癌死亡的时空风险及其影响因素,为肺癌的预防控制提供参考依据。方法收集黑龙江省2008—2017年肺癌死亡数据,利用基于集成嵌套拉普拉斯逼近(INLA)的贝叶斯时空模型估计黑龙江省肺癌标化死亡比(SMR),并分析肺癌SMR的影响因素。结果黑龙江省2008—2017年不同区县肺癌SMR时空演变模式不同,但总体肺癌死亡风险显著增长,2008年132个区县中全人口肺癌死亡高风险(RR 1.0)区县为9个,2017年增长到69个。在全人口、男性和女性中,市级肺癌SMR多因素时空分析结果均未见≥60岁人口比例、人均年卷烟消费量(滞后20年)、PM2.5(滞后8年)、人均地区生产总值(滞后10年)、城镇采矿业就业人数比例(滞后5年)及农业人口比例(滞后20年)与黑龙江省肺癌SMR显著相关(RR值的95%CI均包含1),但慢性阻塞性肺疾病(COPD)的年龄标化死亡率(ASMR)均与肺癌SMR呈正相关(全人口:RR=1.10,95%CI=1.04～1.16;男性:RR=1.09,95%CI=1.03～1.16;女性:RR=1.10,95%CI=1.04～1.16)。区县级COPD的ASMR每增加1/10万,全人口肺癌SMR增加0.34%(95%CI=0.22%～0.46%),男性SMR增加0.29%(95%CI=0.19%～0.40%),女性SMR增加0.33%(95%CI=0.20%～0.46%)。结论黑龙江省2008—2017年肺癌死亡风险整体上逐年增加,COPD可能是该地区肺癌死亡的重要危险因素,建议在COPD患者中开展肺癌筛查,从而有效防控肺癌。     

上海市大气污染对不同特征居民呼吸疾病就诊人数影响

目的了解上海市大气污染对不同年龄、性别呼吸系统就诊人数的影响。方法基于2008年1月1日—2012年12月31日上海市呼吸系统就诊的日数据,利用广义线性的泊松回归模型分析了大气污染物[大气中直径≤2.5μm的颗粒物(PM2.5)、二氧化硫(SO2)、二氧化氮(NO2)]对不同年龄、性别呼吸系统就诊人数的影响。结果 PM2.5、NO2和SO2是呼吸系统的危险因子,大气污染对女性呼吸系统的影响明显高于男性,儿童和老人更易受大气污染物的影响,其中PM2.5每升高10μg/m3,男性的儿童(0~17岁)、成人(18~65岁)和老人(≥66岁)的呼吸系统就诊例数分别升高2.15%(95%CI=1.83%~2.47%)、0.01%(95%CI=-0.05%~0.06%)、0.67%(95%CI=0.60%~0.74%),女性分别升高2.48%(95%CI=2.14%~2.82%)、0.46%(95%CI=0.41%~0.51)、0.96%(95%CI=0.89%~1.03%)。结论大气污染对不同性别、年龄人群呼吸系统疾病就诊风险不同。     

抚顺城区大气悬浮颗粒物污染与心脑血管疾病死亡率的定量分析

目的 定量分析抚顺城区大气总悬浮颗粒物(TSP)对心脑血管疾病死亡率的影响.方法 采用生态学方法,分析1999-2003年抚顺市大气中TSP浓度与心脑血管疾病死亡率的相关关系.结果 在控制了时间、气象等因素后,当日TSP浓度每增加50μg/m3,男性组、老年男性组心脑血管疾病死亡率增加的OR值分别为1.015 42和1.02240;滞后4日TSP浓度每增加50μg/m3,总人群、男性组和老年男性组心脑血管疾病死亡率增加的OR值分别为1.008 26、1.016 27和1.016 65.结论 抚顺市区大气TSP污染可能与当地居民心脑血管疾病死亡率增加有关.     

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.     

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.     

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.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.