原发性肝癌与出生顺序的研究

目的：分析原发性肝癌患者的出生顺序，探讨环境因素与肝癌的关系。方法：根据Greenwood及Haldane的出生顺序方法，对来自江苏省海门市8年随访队列的100个家系中100例先证者及22例患病同胞进行出生顺序研究，结果：Greenwood法分析结果显示，患者出生顺序在1－3胎次的个体较多，当控制了乙型肝炎病毒感染的影响后，结果仍显示肝癌病人好生出生顺序较早的个体。Haldane法计算∑6A实验值＝1806，∑A理论值＝1988，实际6A值与期望6A值相差两个标准差以上，|∑6A实际值－∑6A期望值|／√∑V6A=2.1657，差异有显著的统计学意义（0．02＜P＜0．05），实际6A值比期望6A值小，说明出生顺序越小的个体越容易患肝癌，生态学研究结果显示，海门市普及自来水10年后的肝癌死亡率随时间推移明显下降，经Spearman相关显著性检验，相关系数为－0．818（P＜0．01），提示早期出生的个体中肝癌的发病与当地饮用水的水质有关。结论：肝癌的发生与出生顺序有关，发生在出生较早的个体，这与国外报道的肝癌好发于出生顺序较晚个体的结论不一致。生态学研究表明，长期饮用沟塘水与肝癌好在出生顺序较早的个体有关，提示环境因素对肝癌的发生有一定的影响。     

住院患者鼻咽癌的出生序列分析

目的探讨环境因素和遗传因素在鼻咽癌发生中的作用。方法于2006年6月—2009年12月,调查了835例来自广西和广东省的经病理确诊为鼻咽癌的住院病人作为先证者,通过该病例确定家系,应用Haldane-Smith法和Greenwood-Yule法进行出生序列分析。结果 Haldane法分析结果显示,出生顺序越大的个体越易患鼻咽癌。Greenwood-Yule法分析结果显示,出生于第3胎次及以上的鼻咽癌患者实际分布值大于期望分布值,提示鼻咽癌多发生于出生较晚的个体。结论鼻咽癌的发生与出生顺序有关,好发于出生较晚者,提示环境因素对鼻咽癌的发生有较大的影响。     

遗传因素在乳头状甲状腺癌发生中的作用

目的探讨遗传因素在乳头状甲状腺癌(PTC)发生中的作用.方法采用以医院为基础的病例对照家系研究设计,采用Greenwood-Yule法和Haldane-Smith法,对172例PTC先证者及18例患PTC的亲属进行出生顺序分析.比较先证者一、二级亲属和一般人群的患病率,并进行零截尾负二项分布拟合检验,分析PTC是否具有家族聚集性.结果Greenwood-Yule法的分析结果显示,PTC出生顺序的实际分布与期望分布相近,各出生顺序的实际数与期望数的比值在1范围波动,表明PTC与出生顺序无关.Haldane-Smith法计算得C=|∑6A实际值-∑6A理伦值|/√∑V6A=0.567,P＞0.05,实际值与期望值的差异无统计学意义,亦表明PTC与出生顺序无关.PTC患者的一、二级亲属和人群患病率分别为1.08%、0.42%和0.09%,其中,一、二级亲属患病率的差异有统计学意义(x2=4.07,P=0.044),二级亲属与人群患病率的差异亦有统计学意义(Fisher P=0.046),PTC患病率存在一级亲属＞二级亲属＞一般人群的规律.零截尾负二项分布拟合检验结果表明,PTC在家系中的分布符合零截尾负二项分布(x2=0.13,P＞0.05),PTC的发生存在家族聚集性.结论遗传因素可能是PTC的主要危险因素,PTC可能是一种多因子遗传病.     

山东省儿童突破性乙型肝炎病毒感染发生率及原因初步分析

目的 了解山东省新生儿普种乙肝疫苗以来儿童中突破性乙肝病毒(hepatitis B virus,HBV)感染发生率及可能原因.方法 选取2006年山东省乙肝血清学调查中1～15岁(1992-2005年出生)且明确完成3剂次及以上乙肝疫苗免疫的儿童作为研究对象,共3527名.对所有研究对象进行问卷调查,同时采集静脉血标本,检测乙肝病毒表面抗原(hepatitis B surface antigen,HBsAg)、乙肝病毒表面抗体(antibody against HBsAg,Anti-HBs)和乙肝病毒核心抗体(antibody against hepatitis Bcore antigen,Anti-HBc);对其中HBsAg阳性儿童的父母进行随访,采集其静脉血标本检测HBsAg.采用logistic回归分析突破性HBV感染、突破性慢性HBV感染的相关因素.结果 3527名研究对象总体突破性HBV感染率为3.15％ (111/3527),随出生年份的后移而呈下降趋势(x2趋势=44.83,P＜0.01),其中1992年出生儿童最高(9.9％,16/161),2000年最低(0.8％,2/258);自述父、母亲及其他家庭成员HBsAg阳性者(15.22％,7/46、34.09％,15/44、17.65％,6/34)均高于阴性者(2.99％,104/3481、2.76％,96/3483、3.01％,105/3493)(x2值分别22.28、13.97、23.68,P值均＜0.01);首针接种不及时者(5.37％,41/763)高于及时者(2.53％,70/2764)(x2=15.60,P值均＜0.01).突破性慢性HBV感染率为1.08％ (38/3527),随出生年份的后移而呈下降趋势(x2趋势=9.96,P＜0.01),其中1992年出生儿童最高,为3.1％ (5/161),1997年出生儿童最低,为0.4％(1/261);自述父、母亲及其他家庭成员HBsAg阳性者(13.04％,6/46、29.55％,13/44、17.65％,6/34)均高于阴性者(0.92％,32/3481、0.72％,25/3483、0.92％,32/3493)(x2值分别62.62、338.80、88.44,P值均＜0.05);首针接种不及时者(1.83％,14/763)高于及时者(0.87％,24/2764),差异均有统计学意义(x2=5.16,P=0.02).多因素分析显示,自述父、母亲HBsAg阳性者突破性HBV感染风险高于阴性者[OR(95％CI)值分别为3.73(1.09 ～ 12.75)、26.76(11.86 ～60.37)],出生年份早(1992-2001年)会增加其风险[OR(95％CI)=1.91(1.10 ～ 3.32)],与东部城市相比西部城市的风险最高[OR(95％ CI)=6.00(2.50 ～ 14.40)],自述父、母亲及其他家庭成员HBsAg阳性者突破性慢性HBV感染的风险高于阴性者[OR(95％ CI)值分别为7.51(1.44 ～39.17)、99.99(34.29 ～ 291.62)、8.94(1.81 ～44.10)];与他人共用牙刷会增加其风险[OR(95％CI) =8.67(1.14-66.14)],与东部城市相比西部农村的风险最高[OR(95％ CI)=12.51(2.78 ～56.25)].随访发现,HBsAg阳性儿童母亲和父亲HBsAg阳性者比例分别为12/23和6/19.结论 山东省儿童突破性HBV感染率和突破性慢性HBV感染率均较低.母婴传播可能是儿童突破性HBV感染的主要原因,但家庭内水平传播亦不容忽视.     

山西省食管癌患者出生顺序研究

目的 分析山西省食管癌患者的出生顺序,探讨环境因素、遗传因素与食管癌的关系.方法 采用Greenwood和Haldane的出生顺序方法,以山西省肿瘤医院1101例住院食管癌手术患者为先证者进行遗传流行病学调查,并对1101例先证者及44例食管癌患病同胞进行出生顺序研究.结果 Greenwood法分析结果显示,食管癌患者较多发生在出生顺序1～3胎次.Haldane法计算6A实际值=17 118,6A理论平均值(X)=19 290,代入X=∣6A-(X)6A∣/√V6A=7.63(X＞2),差异有统计学意义(P＜0.01),表明胎次对食管癌发生具有效应.另外,6A实际值＜6A理论平均值,表明父母育龄小或先出生的胎儿易患食管癌.结论 环境因素对食管癌的发生有一定的影响.食管癌的发生与出生顺序有关,易发生在出生胎次较早的个体,这与国内其他食管癌出生顺序研究结果不一致.     

HBsAg阳性者胆囊息肉样病变发生率的观察

目的 探讨HBsAg阳性者胆囊息肉样病变(Ploypoid Lesions of Gallbladder , PLG)的发生率.方法 采用超声方法对1 250例HBsAg阳性者胆囊息肉样病变发生情况进行观察,并与同期HBsAg阴性者普通人群进行比较.结果 HBsAg阳性者胆囊息肉样病变检出率约17.28%,HBsAg阴性者胆囊息肉样病变检出率约4.56%.差异有显著意义(p＜0.05). 结论 HBsAg阳性者胆囊息肉样病变发生率较HBsAg阴性者为高.     

泰兴市原发性肝癌病例对照家系研究

[目的]评价遗传因素及环境因素在原发性肝癌发生中的作用.[方法]采用以人群为基础的1:1病例对照家系设计,应用条件logistic回归模型对泰兴市202例原发性肝癌病例家系和202例对照家系数据进行拟合,以AIC 值最小作为判断拟合优度的标准.[结果]HBsAg阳性为原发性肝癌发病的危险因素,而饮自来水是保护因素.父母表型与子女肝癌发病相关.[结论]原发性肝癌是环境因素与遗传因素共同作用的结果.     

单项抗—HBs阳性的流行病学意义

本文对102例单项抗-HBs 阳性者进行了血清流行病学研究,发现73例(71.56%)在体外可被 HBsAg 中和,其中 S/N<10者中和试验阳性率仅为20.83%,提示低水平单项抗-HBs 阳性者非特异性反应较多。经1年随访,102例单项抗-HBs 阳性者有53例(51.96%)转阴,其中 S/N<20者阴转率高达85.71%;在抗-HBs 中和试验阳性组中,抗-HBs 阴转率显著快于中和试验阴性组(p<0.001),且阴转率随 S/N 比值的增大而下降,而在抗-HBs 中和试验阴性组中,单项抗-HBs 的 S/N 比值与其阴转率间的关联性不显著(p=0.1995),说明低水平和抗-HBs 中和试验阴性的单项抗-HBs 阳性可能与 HBV感染无关。鉴于低水平单项抗-HBs 阳性者非特异性反应较多,在对“高危人群”用 RIA 法筛选 HBV 易感者时,宜将 S/N 比值提高至10作为对 HBV 有免疫力的标准。     

医院职工HBV标识物调查的随访观察

本文总结了湘雅医院职工1973年以来HBVM普查情况。HBsAg总阳性率血凝法10.61％,酶标法11.04％。按工种分组,组间无显著性差异。对68例HBsAg阳性者进行5～19年动态观察发现:HBsAg持续阳性率52.94％,阴阳反复率42.64％,转阴率4.41％。HBeAg总阳性率3.75％,其中HBeAg阳性而HBsAg阴性占1.6％。HBVM类型与转归结果提示:HBeAg与抗—HBc阳性,但抗—HBe阴性者多为HBsAg持续阳性;抗-HBc阳性、抗-HBe阳性者多为HBsAg阴阳反复;抗—HBc或抗—HBe单项阳性者再出现HBsAg阳性的可能性较少;仅单项抗-HBs阳性才可能不出现HBsAg阳性;单项HBsAg检查不能查出HBsAg阴阳反复者及HBsAg阴性,但HBeAg阳性者:单项HBsAg短期对比所得的转阴率实际上是阴阳反复率为主。     

乙型肝炎表面抗原携带者父子间传播的研究

目的：研究乙型肝炎表面抗原携带者及其子女间的遗传传递。方法：对乙型肝炎表面抗原携带者117个家庭234个个体进行了HBV五项血清标志物（HBsAg、抗－HBs、HBeAg、抗－HBe和抗HBc）及游离型HBV DNA检测。结果：HBsAg阳性父亲出生的子女与HBsAg阴性的父亲所生的子女相比,差异非常显著。在HBsAg父、子女同阳的63个家系中,HBV血清学标志组合父、子女同时阳性率为52．4％,其HBV DNA主要分布在父、子女同阳组合中,与其他标志组合相比,有非常显著性差异。HBV DNA与HBeAg标志呈一致性增高,HBeAg阳性父亲所生子女HBeAg和HBV DNA也都阳性。HBsAg高滴度的父亲HBV DNA与出生后的子女呈一致性增高。结论：HBsAg阳性者,通过父亲遗传传递给子代是有可能的。     

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 occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.