中国出血性卒中和高血压性心脏病归因于饮酒的疾病负担研究

目的 描述我国2005-2018年各省份≥20岁成年人饮酒行为及变化趋势,分析各省份出血性卒中和高血压性心脏病死亡归因于饮酒的负担。方法 利用中国居民营养与健康状况监测、中国慢性病及危险因素监测、中国成人慢性病与营养监测和中国高血压调查数据,采用克里金插值结合局部加权回归,估计2005-2018年我国居民饮酒暴露水平;采用2019全球疾病负担研究方法以及中国死因监测数据,计算我国各省份不同性别≥20岁人群饮酒对出血性卒中和高血压性心脏病死亡的人群归因分值（PAF）和归因死亡人数,利用2010年中国人口普查数据计算归因标化死亡率。结果 2005和2018年男性过去12个月饮酒率分别为58.7%（95%CI：57.8%~59.5%）和58.4%（95%CI：57.6%~59.3%）,女性过去12个月饮酒率分别为17.0%（95%CI：16.6%~17.4%）和18.7%（95%CI：18.1%~19.3%）,男性饮酒者日均酒精摄入量分别为24.6（95%CI：23.8~25.3）g和27.7（95%CI：26.8~28.7）g,女性饮酒者日均酒精摄入量分别为6.3（95%CI：6.0~6.5）g和5.3（95%CI：5.0~5.6）g,东部地区高于西部,西北地区饮酒暴露水平最低。2005-2018年出血性卒中死亡归因于饮酒的PAF从5.5%升至6.8%,归因死亡人数从5.02万升至5.91万;高血压性心脏病死亡归因于饮酒的PAF从7.0%升至7.7%,归因死亡人数从1.52万升至2.93万。各省份饮酒导致的高血压性心脏病和出血性卒中的PAF均为男性远高于女性,中、东部地区高于西部,西北地区最低,2018年归因于饮酒的出血性卒中和高血压性心脏病标化死亡率分别为4.58/10万和2.11/10万。结论 我国男性居民饮酒率和饮酒者日均酒精摄入量均较高,特别是东部地区,女性饮酒行为则较少,应采取区域性措施降低男性居民和饮酒者日均酒精摄入量,以减少饮酒导致的健康问题。     

6～17岁儿童青少年全谷物及杂豆消费特点

目的探讨我国不同地区6～17岁儿童青少年全谷物及杂豆摄入状况。方法使用2010-2012年中国居民营养与健康状况监测的数据,对6～17岁儿童青少年共5676人的全谷物及杂豆消费情况进行分析。膳食调查方法为3d 24h膳食回顾法。结果 6～17岁儿童青少年全谷物及杂豆摄入量为12.7g/d, 85.5%的人群未达到膳食指南推荐量下限30g的摄入水平。农村儿童青少年的全谷物及杂豆平均摄入量高于城市人群,而城市儿童青少年全谷物及杂豆的消费率明显高于农村人群。结论我国儿童青少年膳食中存在全谷物及杂豆消费率较低,摄入量不足。[营养学报,2019,41(3):220-224]     

2018年中国居民归因于吸烟的脑卒中死亡分析

目的了解中国居民2018年脑卒中归因于吸烟的死亡情况,为进一步采取控烟措施提供科学依据。方法利用2013年中国慢性病及其危险因素监测数据和2018年死因监测数据,计算2013年吸烟流行率和吸烟量、戒烟年数等吸烟暴露水平以及2018年我国脑卒中死亡情况,使用2017年全球疾病负担研究(GBD 2017)的最新吸烟归因疾病负担的测算方法,计算我国吸烟导致脑卒中的人群归因分值(PAF),以及吸烟导致的脑卒中死亡情况。应用SAS 9.4对数据进行统计分析。结果2013年中国30岁及以上人群总体现在吸烟率为28.4%,其中男性为53.4%,女性为2.7%。30岁及以上人群戒烟率为5.8%,其中男性为10.9%,女性为0.6%。农村吸烟率(29.2%)和戒烟率(5.9%)均高于城市(分别为26.8%、5.7%)。脑卒中死亡率总体上随着年龄的增加而上升,并且男性各年龄组死亡率均高于女性。2018年中国30岁及以上人群归因于吸烟的脑卒中死亡人数为39.0万人,其中男性死亡人数为34.4万人,远高于女性死亡人数(4.6万人)。30岁及以上人群的PAF为21.8%,男性为34.1%,高于女性(5.9%)。吸烟归因脑卒中死亡率随年龄增加而上升。男性各年龄组的PAF均高于女性。结论我国男性人群吸烟率远高于女性。吸烟导致脑卒中的死亡水平较高,亟须采取更加严格的控烟措施,降低脑卒中等疾病的疾病负担。     

陕西省≥25岁居民血压升高导致的归因死亡和期望寿命损失研究

目的分析2015年陕西省≥25岁居民由于血压升高造成的归因死亡和期望寿命损失,为制定相关防治措施提供科学依据。方法收集2015年陕西省慢性病及其危险因素监测数据、死因监测数据和2015年全球疾病负担(GBD)资料,计算陕西省分性别、城乡的≥25岁居民中血压升高导致死亡的人群归因分值(PAF),估计由于血压升高导致的归因死亡和期望寿命损失。采用Excel 2016和SPSS 25.0软件进行统计分析。结果陕西省≥25岁居民收缩压(SBP)的平均水平为(136.41±21.96)mm Hg,且男性略低于女性、城市略低于农村。在全死因死亡中,陕西省≥25岁居民血压升高导致死亡的PAF为32.19%,其中男性为29.22%,女性为36.33%,城市为31.19%,农村为33.63%。血压升高导致的归因死亡数为10558例,归因死亡率为198.36/10万,其中归因死亡数男性大于女性、城市大于农村,归因死亡率男性高于女性、城市低于农村。由血压升高导致的死亡占心脑血管疾病全部死亡的58.20%,占慢性肾病死亡的52.58%。血压升高导致疾病死亡数最多的前3种疾病分别是缺血性心脏病(3969例)、出血性脑卒中(3290例)和缺血性脑卒中(1925例)。去除血压升高的影响后,陕西省≥25岁居民期望寿命提高4.53岁,其中女性(4.98岁)高于男性(4.14岁),农村(5.14岁)高于城市(3.99岁)。结论陕西省居民血压升高对死亡和期望寿命造成的影响较为严重,尤其是女性和农村居民,应加强高血压的预防与控制措施。     

2015年与2018年长寿区25岁及以上人群身体活动不足归因死亡和对期望寿命的影响

目的 分析并比较2015年与2018年长寿区25岁及以上人群身体活动水平以及其对归因死亡和期望寿命的影响.方法 利用2015年、2018年长寿区慢性病及其危险因素监测数据、死因监测数据、全球疾病负担研究中身体活动不足相关疾病及其相对危险度数据,计算长寿区≥25岁人群身体活动不足相关疾病的归因分值,及其造成的归因死亡数和...     

广州社区居民奶制品摄入频率与2型糖尿病的病例对照研究

目的 探讨广州社区人群奶制品摄入频率与2型糖尿病(T2DM)之间的相关性。方法 以2017—2018年广州市多家社区医院半年内确诊为T2DM的204例患者为病例，选择相同社区的532例非糖尿病居民为对照，收集两组对象的社会人口学资料、饮食习惯和行为及膳食中奶制品摄入频率，采用多因素logistic回归分析其与T2DM发病之间的相关性。结果 校正了社会人口学资料及饮食习惯和行为等混杂因素之后，多因素logistic回归分析显示：与酸奶摄入频率0次/月比较，酸奶摄入频率为≥1次/周(OR=0.133,95%CI:0.053～0.334)是糖尿病的保护因素。结论 增加酸奶的摄入频率是T2DM的保护因素。     

无锡市成年居民膳食碘摄入量评估

目的评估无锡市成年居民膳食碘摄入量状况。方法利用该市2005和2010年居民膳食调查资料,中国食物成分表及盐碘和水碘监测数据,计算成年居民膳食碘摄入量,并与我国推荐的膳食碘摄入量标准进行比较。结果无锡市成年居民膳食碘平均摄入量为353.6μg/d,为推荐摄入量(RNI)和可耐受最高摄入量(UL)的235.7%和35.4%。其中食盐碘摄入量270.2μg/d,其贡献率为76.4%。总人群中膳食碘摄入量在RNI～UL之间的个体占97.4%,≥UL的个体仅占0.5%。剔除碘盐,膳食碘主要来源于食物和水,总人群膳食碘摄入量中位数为45.4μg/d,仅为RNI的30.3%。结论无锡市居民膳食碘摄入水平总体是适宜和安全的。     

青岛地区成人牛奶摄入与2型糖尿病关联研究

目的探讨居民牛奶摄入频率、摄入量与2型糖尿病(T2DM)患病风险之间的关联,为T2DM的防治提供科学依据。方法于2009年1月采用多阶段分层随机抽样的方法抽取青岛市6 000名35～74岁成年居民为研究对象,实际调查5 110名,排除牛奶摄入以及空腹血糖(FPG)、餐后2 h血糖(2 h PG)信息缺失者,最终4 955名研究对象纳入本研究。对其进行问卷调查、体格检查和实验室检测。采用SPSS 23.0统计软件进行t检验、χ~2检验、单因素和多因素非条件logistic回归分析。结果 4 955名研究对象中,T2DM患者占16.29%,T2DM组与非T2DM组牛奶摄入频率、牛奶摄入量差异均有统计学意义(P0.01)。多因素logistic回归分析显示,在调整年龄、性别、糖尿病家族史、体质指数(BMI)、婚姻、受教育程度、饮酒、职业体力活动、酸奶摄入等混杂因素后,牛奶摄入频率≥7次/周(OR=1.40,95%CI:1.10～1.79)、牛奶摄入量≥250g/d(OR=1.39,95%CI:1.09～1.77)均与T2DM患病呈正相关。结论牛奶摄入频率≥7次/周、摄入量≥250 g/d与T2DM患病风险呈正相关,后续还需要长期研究或干预试验进一步验证。     

2011年与2017年南京市≥25岁居民归因于豆类摄入不足的缺血性心脏病疾病负担研究

目的了解2011年与2017年南京25岁及以上人群归因于豆类摄入不足的缺血性心脏病(IHD)疾病负担和期望寿命损失情况,为IHD的饮食防控策略提供数据支撑。方法本研究资料来源于2011年和2017年南京市慢性病及其危险因素监测、南京市死因监测和2017全球疾病负担(GBD)资料,采用GBD团队提供的Excel插件程序计算人群归因分值(PAF),估算豆类摄入不足导致的IHD死亡和寿命损失。使用SPSS 20.0软件进行t检验。结果2017年,南京市因豆类摄入不足导致IHD的死亡例数占IHD总死亡例数的13.73%,较2011年(12.44%)增长了10.37%。2017年南京市归因于豆类摄入不足的IHD死亡例数和过早死亡损失寿命年(YLL)分别为645例、8116人年,较2011年(449例、6610人年)分别上升43.65%、22.78%;而标化归因死亡率和标化YLL率分别由2011年的11.05/10万、155.72/10万下降至2017年的8.86/10万、118.66/10万,下降率分别为19.82%、23.80%。2017年,豆类摄入不足导致的IHD死亡使期望寿命损失0.17岁,男性、女性分别损失0.13、0.21岁;与2011年相比,2017年男性、女性及总人群归因于豆类摄入不足的期望寿命损失均上升。结论豆类摄入不足已成为影响南京市居民死亡和期望寿命的饮食危险因素之一,应积极倡导合理膳食,增加居民豆类摄入水平,从而减少心血管疾病负担。     

某医科院校学生全谷物摄入情况调查

目的 了解医学生的全谷物摄入量,分析影响全谷物摄入的因素,为促进全谷物摄入提供依据。方法 通过问卷调查221名医学生,采用自制图谱和食物频率问卷计算全谷物摄入量。结果 全谷物的摄入中位数为18.1 g/d,摄入率为93.7%,男女生全谷物摄入量具有统计学差异(U=3 906,P=0.004); 全谷物摄入量在不同意愿(H=20.493,P＜0.001)、不同日均步数(H=14.678,P=0.005)、不同运动频率(H=11.601,P=0.041)人群中分布不全相同。“健康”是影响选择全谷物的主要因素,玉米和燕麦是全谷物摄入主要来源,医学生主要通过食堂(63.8%)和网购(59.7%)获取全谷物食品。全谷物知识欠缺,正确率最低的判断题为“全谷物等同于我们日常生活中说的粗杂粮”,仅46.6%的人答对。结论 医学生的全谷物摄入水平不高,对全谷物认识存在误区,应注重应用网络途径对大学生进行健康指导。     

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.