人乳头瘤病毒感染与非吸烟女性肺癌关系

目的 探讨人乳头瘤病毒(HPV)感染与非吸烟女性肺癌的相关性,以及HPV感染对脆性组氨酸三联体(FHIT)基因杂合性丢失的影响.方法 采用1:1匹配的病例对照研究方法,应用PCR技术检测肺癌组织与对照组织中HPV-DNA相关序列,同时检测FHIT基因杂合性丢失状况.结果 肺癌组织HPV-E6检出率高于对照组,OR=3.500,高危型HPV感染肺组织中FHIT基因杂合子丢失率较高.同时HPV感染与口服避孕药的使用、烹调油烟暴露及既往肺部疾病史间存在交互作用.结论 高危型HPV感染与女性肺癌的发生有关,HPV感染引发的肺癌可能与基因整合使FHIT基因杂合性丢失有关,同时与口服避孕药的使用、烹调油烟暴露及既往肺部疾病史等存在协同效应.     

非吸烟女性肺癌发病危险因素的Meta分析

目的：综合评价我国非吸烟女性肺癌发病的危险因素。方法：应用Meta分析方法对国内6个有关非吸烟女性肺癌危险因素的病例对照研究进行定量综合分析,共累积病例915例,对照1321例。统计处理采用Meta分析的随机效应模型。结果：肺部疾病史、家族肺癌史、油烟污染、煤烟污染、被动吸烟等5个研究 因素的合并OR值分别是2．87、2．79、2．51、1．42和1．29,进一步分层研究显示随着油烟污染程度的加重,其OR值也有明显的上升。结论：家族肺癌史、肺部疾病史、油烟污染、煤煨污染等因素可能与非吸烟女性肺癌的发生有关,被动吸烟的作用尚不能肯定。     

非吸烟女性肺癌发病危险因素的Meta分析

目的：综合评价我国非吸烟女性肺癌发病的危险因素。方法：应用Meta分析方法对国内7篇有关非吸烟女性肺癌危险因素的病例对照研究进行定量综合分析,共累积病例1115例,对照1520例。统计处理采用Meta分析的随机效应模型。结果：肺部疾病史、家庭肺癌史、油烟污染、煤烟污染、被动吸烟等5个研究因素的合并比值比（OR值）分别是2.87、2.79、2.52、1.42和1.64进一步分层研究提示随着油烟污染程度的加重,其OR值也有明显的上升。结论：家庭肺癌史、肺部疾病史、油烟污染、煤烟污染等因素可能与非吸烟女性肺癌的发生有关,被动吸烟的作用尚不能肯定。     

女性激素替代治疗、口服避孕药与女性肺癌关系的Meta分析

目的探讨女性激素替代治疗(HRT)与口服避孕药(OCs)对女性肺癌的影响。方法搜索Medline等计算机数据库,系统收集相关文献。采用固定模型或随机效应模型(研究结果存在异质性)计算合并OR。结果纳入Meta分析的文献共12篇,其中3篇为队列研究,9篇为病例对照研究。Meta分析HRT与肺癌合并OR值为0.88(95%CI:0.77～1.01)。按是否吸烟进行分层分析,吸烟者与非吸烟者中HRT的合并OR值分别为0.76(95%CI:0.61～0.95)和0.78(95%CI:0.64～0.95)。口服避孕药与女性肺癌无统计学关联(OR=0.95;95%CI:0.83～1.20)。结论HRT可能降低女性肺癌发生的危险度,其结果还需要进一步深入研究来验证。     

豆类食品摄入及EGFR、ESR2基因多态性在非吸烟女性肺癌发生中的作用

目的研究豆类食品的摄入及EGFR、ESR2基因多态性与非吸烟女性肺癌发病的关系。方法调查收集非吸烟女性肺癌患者和对照,分析豆类食品与女性肺癌发病风险的关系。对非吸烟女性肺癌患者和对照组进行SNPS检测,分析EGFR和ESR2基因多态性与非吸烟女性肺癌的关联关系,并对大豆异黄酮的摄入、EGFR和ESR2基因多态性与非吸烟女性肺癌两两之间的交互作用进行分析。结果分析发现豆类食品的摄入能够降低非吸烟女性肺癌的发病风险(P=0.015),随着膳食豆类食品摄入量的增加,女性肺癌的风险效应值减少。经Bonferroni校正后,发现EGFR基因的rs11534100位点与非吸烟女性肺癌的发生之间存在关联。未发现豆类食品的摄入与EGFR、ESR2的SNPs在非吸烟女性肺癌发生的交互作用。结论豆类食品能降低女性非吸烟肺癌的发病风险,增加膳食大豆异黄酮的摄入量能减少女性肺癌的风险效应值。EGFR、ESR2基因多态性与非吸烟女性肺癌的发病存在关联。     

非吸烟女性肺癌与月经生育史病例对照研究

目的探讨月经史、生育史及避孕药的使用与非吸烟女性肺癌的关系.方法对沈阳市区内非吸烟女性肺癌进行病例对照研究,共收集了新诊断的非吸烟原发性肺癌病例409例及按配比年龄与性别在一般人群中选对照436例.调查内容包括人口特征、月经史、生育史以及避孕药服用史.用Logistic回归模型分析危险因素.结果妊娠总数大（趋势检验P=0.018）、绝经年龄大（趋势检验P=0.065）的非吸烟女性,肺癌发生的危险性大.使用口服避孕药可增加肺癌发生的风险,其OR值为1.56（P=0.05）.结论雌激素可能在非吸烟女性肺癌发生中起一定作用.     

非吸烟女性肺癌危险因素病例对照研究

目的 探讨浙江省非吸烟女性患肺癌的危险因素。方法 采用1∶2配对的病例对照研究,收集浙江省30个县（区）2005年11月-2008年12月期间发病的新发非吸烟女性肺癌病例229例;配对对照选取患者,女性邻居、年龄＆#177;3岁、无吸烟史。通过面访调查收集有关危险因素的暴露史,采用单因素及多因素 Logistic 回归模型进行拟合,筛选肺癌的主要危险因素。结果 单因素分析发现有15个暴露因素与非吸烟女性肺癌的发生有关。多因素及因子分析发现,被动吸烟（OR ＝1.598,95％CI：1.016～2.512）、家族肿瘤史（OR ＝5.359,95％CI：1.658～17.326）、呼吸道病史（OR ＝24.427,95％CI：6.111～97.642）、精神心理因素不良（OR ＝2.622,95％CI：1.149～5.983）、人际关系不佳（OR ＝3.041,95％ CI：1.534～6.032）、做饭时自感油烟重（OR ＝1.856,95％CI：1.043～3.301）、常食用腌晒食品（OR ＝1.724,95％CI：1.205～2.466）和初潮年龄晚（OR ＝1.565,95％CI：1.086～2.253）等因素是肺癌发生的危险因素;收入水平高（OR ＝0.650,95％CI：0.484～0.873）和常食用新鲜蔬菜（OR ＝0.683,95％CI：0.504～0.926）是肺癌的保护因素。趋势性检验发现,非吸烟女性被动吸烟与肺癌的相对危险度之间存在一定剂量反应关系。结论 针对非吸烟女性肺癌的相关危险因素,需采取综合干预措施,以降低肺癌的发生率。     

中国非吸烟人群环境烟草烟雾暴露与肺癌发生关联的Meta分析

目的：采用Meta分析方法综合评价中国非吸烟人群环境烟草烟雾（ETS）暴露与肺癌发生危险的关系。方法以“肺癌/肺肿瘤”、“非吸烟”、“病例对照”、“危险因素”、“环境烟草烟雾/被动吸烟”、“lung cancer/lung neoplasm”、“non-smoking/non-smoker”、“China/Chinese”、“case-control/case control”、“risk factor”、“environmental tobacco smoke/passive smoking”为检索词,检索中国生物医学文献数据库、中国学术期刊全文数据库、万方知识服务平台、中国科技期刊全文数据库、PubMed和Web of Science数据库,系统收集1999年1月至2013年12月公开发表的有关中国非吸烟人群ETS暴露与肺癌发生关联的病例-对照研究,共检索到相关文献129篇。采用RevMan 5.2软件进行分析,计算合并OR（95%CI）值。结果最终纳入18篇文献,累计肺癌病例6145例,对照8132例。合并分析结果显示,中国非吸烟人群ETS暴露可增加肺癌发病的风险,合并OR（95%CI）值为1.52（1.42~1.64）;分层分析显示,ETS暴露与非吸烟女性及男性肺癌发生的关联均有统计学意义,合并OR（95%CI）值分别为1.58（1.42~1.75）和1.34（1.08~1.65）;来源于家庭及工作环境的ETS暴露均可增加患肺癌的风险,合并OR（95%CI）值分别为1.48（1.20~1.82）和1.38（1.13~1.69）;儿童期及成年期ETS暴露与肺癌发生的关联无统计学意义,合并OR（95%CI）值分别为1.37（0.98~1.91）和1.34（0.97~1.85）。结论 ETS暴露是中国非吸烟人群肺癌发病的重要危险因素。     

中国非吸烟女性肺癌危险因素的病例-对照研究

目的探讨中国非吸烟女性患肺癌的危险因素。方法应用1∶2配对的病例对照方法,收集2001年9月~2004年2月在北京、上海和成都指定医院经病理诊断确诊的非吸烟女性新发肺癌住院病例157例,按照性别、年龄(±2岁)、不吸烟等配对因素选取医院对照和人群对照。利用统一调查表对调查对象进行面对面问卷调查,收集病例和对照有关危险因素的暴露史等情况。通过单因素分析和多因素条件Logistic回归分析筛选肺癌的主要危险因素。结果单因素分析发现28个暴露因素与非吸烟女性肺癌发生有关。多因素分析发现,被动吸烟指数≥50人年(OR=1·77,95%CI为1·07~2·92)、经常吃动物内脏(OR=1·85,95%CI为1·06~3·22)、职业接触粉尘(OR=2·47,95%CI为1·21~5·03)和工作场所通风不良(OR=4·02,95%CI为1·74~9·29)为非吸烟女性肺癌发生的危险因素;常吃蔬菜(OR=0·26,95%CI为0·12~0·59)、经常服用维生素(OR=0·53,95%CI为0·30~0·93)、结婚后家庭人均月收入≥500元(OR=0·50,95%CI为0·28~0·91)和初次生育年龄在24~30岁之间(OR=0·53,95%CI为0·32~0·90)为非吸烟女性肺癌发生的保护因素。趋势性检验发现,被动吸烟与非吸烟女性发生肺癌的相对危险度之间存在一定剂量反应关系。结论被动吸烟、职业接触粉尘、经常吃动物内脏和工作场所通风不良会增加非吸烟女性患肺癌的危险性。常吃蔬菜和经常服用维生素等因素可以降低非吸烟女性发生肺癌的危险性。     

吸烟、居住环境、基因多态性与肺癌发病风险的关系

[目的]探讨肺癌发病的危险因素。[方法]采用病例对照研究方法,收集病例和对照各781例,进行流行病学调查及实验检测分析。[结果]室内烹调油烟、装修后刺激性气味、居室通风不良、吸烟、常自己炒菜可增加肺癌风险;而烧菜油温不过热和BRCA2基因rs144848 C等位基因具有保护作用。吸烟、室内烹调油烟和居住平房具有交互作用。[结论]肺癌与吸烟、环境污染有关,rs144848位点C等位基因可能具有保护作用。     

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.     

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.