国家慢性病综合防控示范区居民糖尿病管理情况分析

目的 通过国家慢性病综合防控示范区（示范区）横断面调查,对≥ 35岁居民糖尿病管理现状及影响因素进行评价。方法 在2016年11-12月,采用多阶段整群抽样方法,对示范区≥ 18岁常住居民进行入户问卷调查,描述糖尿病自报患病、治疗及管理情况等,采用非条件logistic回归模型分析糖尿病管理影响因素。结果 ≥ 35岁居民3 213例。糖尿病患者自报患病率为11.48%（369/3 213）、自报治疗率为83.20%（307/369）、自报管理率为69.92%（258/369）、自报规范化管理率为53.66%（198/369）,其中55~64岁年龄组自报管理率（76.32%）和规范化管理率（59.65%）较高。多因素分析结果显示,自报慢性病管理实施评分较高的示范区糖尿病自报管理率（OR=3.499,95% CI：1.865~6.563）较高。东部地区（OR=2.942,95% CI：1.547~5.594）、已签约家庭医生者（OR=5.661,95% CI：3.237~9.899）以及未患有高血压者（OR=1.717,95% CI：1.010~2.920）的糖尿病规范化管理率也较高。结论 糖尿病防治和管理工作已达到示范区要求目标,示范区创建工作推动了糖尿病规范化管理工作的具体落实和深入开展。     

中国0~5岁儿童超重肥胖分布特征

目的 研究中国0~5岁儿童的超重肥胖现况及其分布特点。方法 数据来自"2010-2013年中国居民营养与健康状况监测"数据,2013年儿童调查采用多阶段分层整群抽样的方法,研究对象为全国30个省（自治区、直辖市）55个调查县（区）中0~5岁儿童32 862名。超重肥胖的判定：5岁以下儿童采用WHO 2006年生长发育标准;5岁儿童采用WHO 2007年生长发育参考值。结果采用2010年国家统计局的人口数据进行复杂加权计算。结果 2013年中国0~5岁儿童超重率为8.4%,男童和女童超重率分别为9.4%和7.2%;城、乡儿童超重率均为8.4%。0~、6~、12~、24~、36~、48~和60~71月龄组超重率分别为13.0%、11.1%、8.3%、6.0%、4.8%、3.9%和15.9%;家庭低、中和高收入水平儿童超重率分别为8.0%、8.8%和8.9%。0~5岁儿童肥胖率为3.1%,男童和女童肥胖率分别为3.6%和2.5%;城市和农村儿童肥胖率分别为3.3%和2.9%。0~、6~、12~、24~、36~、48~和60~71月龄组儿童的肥胖率分别为5.8%、3.8%、2.5%、1.6%、1.2%、1.3%和7.8%;低、中和高收入水平儿童肥胖率分别为2.8%、3.3%和3.5%。结论 中国0~5岁儿童的超重和肥胖率正在增高攀升,及时监测0~5岁儿童的超重肥胖状况和实施合理干预十分必要。     

海南省0~6岁儿童孤独症谱系障碍的现况调查及影响因素分析

目的 了解海南省0~6岁儿童孤独症谱系障碍的患病情况及其影响因素。方法 抽查海南省18个市（县）0~6岁儿童37 862人,采用儿童发育问题预警征象调查表筛查,再由专科医师现场诊断,采用一般描述统计、χ²检验、非条件logistic回归分析孤独症现况及影响因素。结果 共诊断235例孤独症儿童,总患病率为0.62%,其中男童为0.99%,女童为0.17%,男童高于女童（χ²=101.91,P=0.000）。随年龄增长孤独症患病率上升（χ²=288.62,P=0.000）。城市孤独症患病率高于其他地区,差异有统计学意义（χ²=114.77,P=0.000）。是否足月、新生儿窒息、父亲性格、父亲有嚼槟榔或吸烟习惯、母孕期总体情绪状态以及母亲人流史为孤独症的影响因素。结论 海南省0~6岁儿童孤独症谱系障碍的患病率居国内较高水平并受遗传因素、孕产过程、父母在孕前及孕期不良行为、习惯等综合因素的影响。     

健康管理对0~36月龄社区儿童生长发育的影响

目的 分析健康管理对0~36月龄社区儿童生长发育状况的影响。方法 采用多阶段分层随机抽样方法在全国8个试点区共选择18个社区卫生服务中心作为监测机构,实施社区0~36月龄儿童健康管理,以辖区内参与管理的0~36月龄儿童为研究对象,收集其健康档案资料。结果 2008－2010年共有13 464名0~36月龄社区儿童参与健康管理,完成59 648人次随访,其中男童7 306名(54.26%)。通过构建多层线性模型发现,相对于非规范管理组,规范管理组儿童平均身高(长)增长更快;规范管理组儿童体重增长得到了更有效控制。同时随着随访次数增加,管理儿童低体重、生长迟缓、消瘦和超重患病率均呈显著下降趋势(P<0.05)。结论 社区0~36月龄儿童的健康管理可有效改善生长发育状况。     

舌尖上的危险食物过敏小讲堂

正据统计,发达国家儿童食物过敏患病率约为3%~6%;然而,美国近10年来食物过敏的儿童患病率上升了18%;近5年英国儿童花生过敏患病率增长了1倍。我国目前尚无婴幼儿食物过敏的全国患病率资料。1999年重庆地区报告0~24个月婴幼儿食物过敏的检出率为3.5%~5.1%;10年后(2009年)再次调查的结果显示婴幼儿食物过敏的检出率     

50岁及以上男男性行为人群HIV感染及相关因素分析

目的 分析≥50岁MSM的HIV感染状况及其相关因素,为制定有效的干预策略和措施提供参考。方法 采用方便抽样法,利用同性社交软件Blued 7.1.6进行问卷调查,收集调查对象社会人口学、行为学及自报HIV感染状态等信息。对自报HIV感染相关因素进行单因素χ²检验和多因素logistic回归分析。结果 714例≥50岁MSM研究对象中,自报HIV感染率为17.6%（126/714）。自报HIV感染风险的多因素分析结果显示,离异/丧偶者是已婚者的2.07倍（95%CI：1.34~3.21）;HIV相关知识不知晓者是知晓者的1.92倍（95%CI：1.21~3.04）;有STD感染史者是无STD感染史者的3.17倍（95%CI：2.09~4.83）。结论 ≥50岁MSM的自报HIV感染率处于较高水平,离异/丧偶、HIV相关知识知晓率低、STD感染史等为自报HIV感染的相关因素。     

中国7个城市婴幼儿常见胃肠道不适症状流行病学特征现况调查

目的 对中国7个城市0～3岁婴幼儿常见的胃肠道不适症状进行现况调查,探讨婴幼儿常见胃肠道不适症状的患病率和流行病学特征。方法 应用分层、整群随机抽样方法对中国7城市0～3岁常住婴幼儿进行问卷调查,根据调查结果,按国际通用的婴幼儿功能性胃肠病Rome Ⅳ诊断标准判断常见胃肠道不适症状的患病率,并分析其地域、城乡、年龄和性别分布特征。结果 共回收有效问卷20 932份。0～1岁婴儿共10 193人,出现反流者共1 960人,患病率为19.2%,0～3月龄婴儿反流的患病率最高（29.8%）,之后随年龄增加逐渐降低,不同年龄组间差异有统计学意义。0～5月龄婴儿共4 470人,出现肠绞痛者共325人,患病率为7.3%,1～2月龄婴儿肠绞痛的患病率最高（10.0%）,不同年龄组婴儿肠绞痛的患病率差异有统计学意义。在0～3岁婴幼儿中,功能性便秘者1 755人,患病率为8.4%,0～3月龄婴儿患病率最低（6.2%）,30～36月龄婴儿患病率最高（10.0%）,不同年龄组间便秘的患病率差异有统计学意义。结论 反流、肠绞痛、功能性便秘等胃肠道症状在健康婴幼儿中普遍存在,患病率有明显的年龄差异特点。     

儿童家长预防接种后留观时间及其相关因素分析

目的 分析儿童家长预防接种后留观时间及其相关因素。方法 2019年12月至2020年1月,选取我国6个省份（山东省、广东省、河南省、四川省、内蒙古自治区和辽宁省）12个县（区）34个预防接种门诊,采用分阶段抽样方法招募预防接种0~3岁儿童家长,开展问卷调查。采用多因素logistic回归模型分析儿童家长预防接种后留观时间的相关因素。采用SAS 9.4软件进行统计学分析。结果 共招募0~3岁儿童家长3 292名,符合标准的研究对象为3 178名。儿童家长预防接种后正确留观时间≥30 min的比例为87.85%（2 792/3 178）。多因素logistic回归分析结果显示,影响儿童家长预防接种后留观时间的主要因素分别为预防接种工作人员正确告知家长留观时间≥30 min（OR=31.622,95%CI：19.847~50.384）、家长职业为医护人员（OR=2.779,95%CI：1.505~5.133）、参加预防接种宣传教育活动（OR=1.986,95%CI：1.438~2.743）、家长年龄≥35岁（OR=1.900,95%CI：1.215~2.971）、胎次为第1胎（OR=1.663,95%CI：1.282~2.156）、家庭人均年收入为8 000~元（OR=1.646,95%CI：1.168~2.319）、儿童年龄为0~12月龄（OR=1.646,95%CI：1.203~2.252）和13~24月龄（OR=1.506,95%CI：1.064~2.133）、信任预防接种工作人员的预防接种建议（OR=1.481,95%CI：1.067~2.055）。结论 儿童家长预防接种后正确留观时间≥30 min的比例较高。预防接种工作人员正确告知家长留观时间的影响最大。     

上海市居民奶类摄入状况及其影响因素

目的 了解上海居民奶类摄入情况,随季节变化状况及影响奶类摄入的因素。方法 于2012－2014年间4个不同季节在上海市开展人群追踪调查,采用膳食频率法调查奶类摄入情况。结果 上海市居民奶类消费以液态奶和酸奶为主。全年饮奶率为41.8%,饮奶者每天摄入奶类的M=145.3 g,占推荐摄入量的48.4%,全人群奶类摄入达标率为4.5%。四季和全年液态奶、酸奶和总奶饮用率在三类地区的差异有统计学意义（P<0.05）。春、夏和冬季的奶类摄入量存在地区间差异有统计学意义（P<0.05）。城市中心地区饮奶率最高,远郊地区最低。液态奶的摄入量在季节间差异有统计学意义（P<0.05）。Logistic回归分析显示家庭人均收入高于本地平均、受教育年限越长的人越可能饮奶。自报总体健康状况好和自报睡眠情况好的人较自报一般及差的人更可能饮奶（P<0.05）。结论 上海市居民饮奶率和饮奶量虽然与10年前相比有所上升但仍较低,远郊地区饮奶量最低,季节间差异无统计学意义。促进居民饮奶,需政府从宏观角度调控奶类价格,加强相关的健康教育,引导居民正确选择奶制品。     

中国西部两省(市)农村0?6岁儿童忽视现状及影响因素分析

目的 了解中国西部陕西省、重庆市农村0~6岁儿童受忽视的程度及影响因素。方法 采用分层多级整群随机抽样方法, 对两省(市)部分地区0~6岁农村儿童受忽视状况进行调查。结果 两省(市)共调查农村0~6岁儿童1488名, 儿童总忽视率和总忽视度分别为31.59%、48.32。男女童忽视率和忽视度组间差异无统计学意义(z2=0.86, t/=1.51, P>0.05)。高年龄组儿童受忽视程度显著高于低年龄组儿童(f=13.36, F=33.45, P<0.05)。三代同堂、核心家庭儿童受忽视程度显著低于单亲家庭和再婚家庭儿童(7/=10.03, F=2.83, P<0.05);留守儿童受忽视程度显著高于非留守儿童(Z2=30.30, f/=6.76, P<0.05);而陕西省儿童忽视程度低于重庆市儿童(%2=9.42, U=8.40, P<0.05)。多因素非条件logistic回归分析结果显示:是否留守(0R=1.54;95%C/：1.20~1.97)、家庭类型(Ofl=1.38;95%C/:1.16~1.65)、父亲职业(0ft=0.87;95%c/:0.78~0.97)、母亲的文化程度(0尺=1.27;95%C/:1.07~1.52)、父子间关系(Ofl=1.43;95%C/:1.07~1.91)5个因素是儿童受忽视的主要影响因素。结论 陕西省和重庆市农村0~6岁儿童受忽视程度比较严重, 应重视儿童忽视问题。     

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.     

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.     

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.     

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.     

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.     

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.     

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.