Incidence of sleep-disordered breathing in an urban adult population: the relative importance of risk factors in the development of sleep-disordered breathing

CONTEXT: Sleep-disordered breathing (SDB) is both prevalent and associated with serious chronic illness. The incidence of SDB and the effect of risk factors on this incidence are unknown. OBJECTIVE: To determine the 5-year incidence of SDB overall and as influenced by risk factors. DESIGN, SETTING, AND PARTICIPANTS: Of the 1149 participants in the Cleveland Family Study, those aged 18 years or older, from either case or control families, who had 2 in-home sleep studies 5 years apart. The first had to have been performed before June 30, 1997, and had to have normal results (apnea hypopnea index [AHI] <5). Data included questionnaire information on medical and family history, SDB symptoms; measurement of height, weight, blood pressure, waist and hip circumference, and serum cholesterol concentration; and overnight sleep monitoring. MAIN OUTCOME MEASURE: Apnea hypopnea index, defined as number of apneas and hypopneas per hour of sleep. Sleep-disordered breathing was defined by an AHI of at least 10 (mild to moderate) or of at least 15 (moderate). RESULTS: Forty-seven (16%) of 286 eligible participants, (95% confidence interval [CI], 13%-21%) had a second-study AHI of at least 10 and 29 (10%) participants (95% CI, 7%-14%) had a second-study AHI result of at least 15. For the AHI results of at least 15, we estimate that about 2.5% may represent test variability. By ordinal logistic regression analysis, AHI was significantly associated with age (odds ratio [OR] per 10-year increase, 1.79; 95% CI, 1.41-2.27), body mass index (BMI; OR per 1-unit increase, 1.14; 95% CI, 1.10-1.19), sex (OR for men vs women, 4.12; 95% CI, 2.29-7.43), waist-hip ratio (OR per 0.1 unit increase, 1.61; 95% CI, 1.04-2.28), and serum cholesterol concentration (OR per 10-mg/dL [0.25-mmol/L] increase, 1.11; 95% CI, 1.03-1.19). Interactions were noted between age and both sex (P =.003) and BMI (P =.05). The OR for increased AHI per 10-year age increase was 2.41 in women (95% CI, 1.78-3.26) and 1.15 in men (95% CI, 0.78-1.68), with the male vs female OR decreasing from 5.04 (95% CI, 2.19-11.6) at age 30 years to 0.54 (95% CI, 0.15-1.99) at age 60 years. The OR for increased AHI per 1-unit increase in BMI decreased from 1.21 (95% CI, 1.11-1.31) at age 20 years to 1.05 (95% CI, 0.96-1.15) at age 60 years. CONCLUSIONS: The 5-year incidence is about 7.5% for moderately severe SDB and 16% (or less) for mild to moderately severe SDB. Incidence of SDB is influenced independently by age, sex, BMI, waist-hip ratio, and serum cholesterol concentration. Predominance in men diminishes with increasing age, and by age 50 years, incidence rates among men and women are similar. The effect of BMI also decreases with age and may be negligible at age 60 years.     

上海市HIV阳性男性同性性行为者的抑郁症状及其影响因素

 目的  了解上海市艾滋病病毒(human immunodeficiency virus, HIV)阳性的男性同性性行为人群(men who have sex with men, MSM)抑郁症状发生情况及其影响因素。方法  采用横断面研究设计,于2014年11月至2015年11月期间对招募到的HIV阳性的MSM进行问卷调查,抑郁症状评估运用12个条目的流调中心抑郁量表(Center for Epidemiologic Studies Depression Scale, CES-D),得分≥9分则认为有抑郁症状。结果  共调查505名HIV阳性的MSM,中位年龄30岁,21～44岁年龄段为主(77.2%),非本市户籍占64.6%,73.1%未婚,大学及以上学历占62.1%。235人有抑郁症状,检出率为46.5%。多因素Logistic回归分析结果显示:非本市户籍较本市户籍人群(OR=1.66,95% CI:1.01~2.49)、过去一年性伴数>1个较性伴数≤1个的调查对象(OR=2.21,95% CI:1.43~3.41)更易出现抑郁症状;而高中或中专学历较初中及以下学历人群(OR=0.39,95% CI:0.21~0.74)、曾和主要性伴发生过不使用安全套性行为较没有主要性伴(OR=0.38,95% CI:0.17~0.85)的调查对象抑郁的风险降低。结论  HIV阳性的MSM人群抑郁症状检出率高,户籍、学历、是否曾和主要男性伴侣发生过性行为以及过去一年男性性伴数与抑郁的发生有关联,提示需进一步探讨针对该人群的心理干预措施。     

Repetition of deliberate self-poisoning in an Australian hospital-treated population.

OBJECTIVES: To describe the hospital-treated prevalences for repeat deliberate self-poisoning (RDSP) and the demographic characteristics of the RDSP group, and to compare the RDSP and non-RDSP groups. DESIGN: Prospective longitudinal cohort study, with a one- to four-year follow-up. SETTING: The Hunter Area Toxicology Service (HATS), a regional toxicology treatment centre in New South Wales. SUBJECTS: 1238 consecutive DSP patients referred to hospital, 1992-1994, with follow-up through 1995. OUTCOME MEASURES: Deliberate self-poisoning (DSP) admissions within one year (RDSP-1), within six months (RDSP-6m), and within 28 days (RDSP-28d) of any other DSP admission by the same patient; length of stay; demographic characteristics; and drugs ingested. RESULTS: 175 patients (14.1%) repeated DSP during the study; 165 (13.3%) were classified as RDSP-1, giving a patient prevalence of hospitalisation in the range of 14.6 to 20.7 per 100,000 per year. Fifty-six RDSP-28d patients (33.9% of RDSP-1) accounted for 49.8% of the RDSP-1 admissions, and 123 RDSP-6m patients (74.5% of RDSP-1) accounted for 83.5% of RDSP-1 admissions. For RDSP-1, the male:female ratio was 1:1.9, with 35.7% unemployed, 29.1% pensioners and 15.8% married or in de facto relationships. RDSP-1 patients had a shorter length of stay (3 h), which was not clinically important. RDSP was more likely for the 25-34 years age group (odds ratio [OR], 2.24; 95% confidence interval [CI], 1.17-4.29) and the 35-44 years age group (OR, 2.12; 95% CI, 1.02-4.39) than the 10-18 years group, and more likely for women than men (OR, 1.69; 95% CI, 1.17-2.46). Being married/de facto reduced the risk for repetition (OR, 0.55; 95% CI, 0.31-0.96) compared with being single. Medications indicated for psychiatric illness were most commonly used for DSP. CONCLUSIONS: Many patients who repeat DSP do so after a very brief interval and account for a disproportionate number of hospitalisations. Availability of psychiatric medications for DSP patients is a possible area of intervention.     

长期住院精神分裂症患者体重超重相关因素分析

目的调查长期住院精神分裂患者出现体重指数超重的相关影响因素,为长期住院精神分裂症患者的体重管理提供指导参考。方法于2017年8月1~5日期间选取服用抗精神病药物≥1年的符合ICD-10诊断标准的住院精神分裂症患者为研究对象,符合条件共238例,调查年龄、受教育程度、总病程、服用的抗精神病药物、总服药年限、肥胖家族史、伴发的躯体疾病、饮食结构、平均每天睡眠时间,测量身高、体重,计算体重指数。入组的患者按BMI分类,合并分组为两组:体重过低或正常为一组(n=118),体重超重或肥胖为一组(n=120)。结果两组患者在受教育程度、总服药年限、抗精神病药、合并苯海索、合并苯二氮卓类、合并抗焦虑抑郁药、合并心境稳定剂、合并糖尿病、饮食结构、每天睡眠时间等比较,差异无统计学意义(P0.05)。两组患者在性别、年龄、总病程、肥胖家族史、合并高血压差异均有统计学意义(P0.05)。二项分类Logistic回归结果表明,性别(OR=6.233,95%CI:2.778~13.987)、合并使用抗焦虑抑郁药物(OR=0.086,95%CI:0.013~0.570)、肥胖家族史(OR=4.175,95%CI:1.159~15.047)、每天睡眠时间(OR=1.249,95%CI:1.049~1.488)是长期住院精神分裂症患者体重指数超重或肥胖的危险因素。结论合并使用抗焦虑抑郁药物、有肥胖家族史、每天睡眠时间长等可能是长期住院精神分裂症患者体重指数增加的危险因素。     

Exploring the predictors of depression among Saudi adolescents: Time for urgent firm actions

Objectives:To estimate the prevalence of depression among Saudi adolescents and identify its correlates.Methods:This was a cross-sectional study using a multistage random technique that included students at the intermediate and secondary levels in Riyadh, Saudi Arabia. Patient Health Questionnaire (PHQ-9) was used as a tool, in addition to a survey of the potential risk factors. Binary logistic regression was conducted.Results:Out of 960 students, 32.4% were found to have moderate to severe depression. The age group of 16-19 years was more at risk. Female gender and low father’s education level were significant predictors of depression. Less internet use and more physical activity are considered a protective factor against depression, OR -0.531 (95% CI: 0.315-0.894) and OR -0.668 (95% CI: 0.468-0.953), respectively. Whereas the physical abuse, OR 2.047 (95% CI: 1.287-3.255) and emotional abuse, OR 2.576 (95% CI: 1.740-3.813) considered risk factors for depression.Conclusion:The prevalence of depression among Saudi adolescents is worrisome. Urgent and firm actions should be taken in response to the increasing prevalence of depression worldwide.     

扬州市MSM人群艾滋病高危行为特征?感染状况及影响因素分析

目的:了解江苏省扬州市男男性行为者(men who have sex with men,MSM)艾滋病高危行为特征?感染情况及其影响因素?方法:采用横断面调查设计,采取分类滚雪球抽样的方法于2008年5月起,对扬州市范围内的MSM人群就艾滋病知识态度?高危行为特征的面对面问卷调查结果,以及血样的人类免疫缺陷病毒(human immunodeficiency virus,HIV)及其他性传播疾病(sexually transmitted disease,STD)感染的实验室检测数据进行统计分析?结果:所调查300例MSM中,82.7%最近6个月发生过同性性行为,其中79.4%有多个同性性伴;48.7%曾与异性发生过性行为,其中21.2%有多个异性性伴;最近6个月与同性发生肛交性行为时坚持使用安全套的比例为52.0%,与异性发生性行为时该比例为21.2%?均采集血样进行了血清学检测,确证HIV阳性22例,阳性率为7.3%;确证梅毒抗体阳性66例,阳性率为22.0%;未发现丙型肝炎病毒抗体阳性?在多因素Logistic回归模型中,常通过互联网寻找性伴(OR=1.93,95%CI:1.01~3.67)和最近6个月曾与固定性伴发生性行为(OR=0.45,95%CI:0.25~0.79)与最近6个月同性性行为时安全套坚持使用率的关系有统计学意义;梅毒感染(OR=3.17,95%CI:1.25~7.99)与HIV感染的关系具有统计学意义?结论:扬州市MSM人群无保护性性行为及多性伴现象较为普遍,HIV和梅毒感染率较高,需要进一步加强对该人群的行为干预以防止艾滋病在该人群中的蔓延以及传播至一般人群?     

探讨胃十二指肠溃疡患者上消化道出血的危险因素

目的探讨胃十二指肠溃疡患者上消化道出血的危险因素。方法本研究纳入178例（男115例,女63例）在我院确诊为十二指肠或胃溃疡的患者,诊断采用上消化道内镜。所有患者进行非甾体类消炎药（NSAIDs）或乙酰水杨酸（ASA）治疗,冠状动脉疾病（CAD）、年龄及性别等危险因素采用f检验和Logistic回归分析进行评估。结果47例患者为胃或十二指肠球部溃疡出血,平均年龄为（65．7±12．5）岁,无出血患者的平均年龄为（46．8±15．0）岁。出血患者中ASA的使用比NSAID更常见（NSAID n=18例;ASA n=26例,P=0．036）。在胃十二指肠溃疡患者中,出血的比例女性为20％,男性为28％（P=0．056）。溃疡出血的危险因素有CAD（OR：24．66,95％CI=1．7-95．8,P=0．002）,ASA的使用（OR：9．67,95％CI=2．2—36．6,P=0．022）,NSAIDs的使用（OR：4．6395％CI=1．2—15．6,P=0．033）,年龄（OR=11．50,95％CI=2．8—11．2,P=0．002）,男性（OR：2．47,95％CI=0．9-8．7,P=0．053）。结论高龄、动脉粥样硬化、男性和非甾体抗炎药和乙酰水杨酸的使用是胃十二指肠球部溃疡患者上消化道出血的主要危险因素,其中乙酰水杨酸的使用导致胃十二指肠球部溃疡患者上消化道出血的风险最高。     

Factors associated with use of cardiopulmonary resuscitation in seriously ill hospitalized adults

CONTEXT: The epidemiology of do-not-resuscitate (DNR) orders for hospitalized patients has been reported, but little is known about factors associated with the use of cardiopulmonary resuscitation (CPR). OBJECTIVE: To identify factors associated with an attempt at CPR for patients who experienced cardiopulmonary arrest. DESIGN: Secondary analysis of data collected in 2 prospective cohort studies: the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT, 1989-1994) and the Hospitalized Elderly Longitudinal Project (HELP, 1994). Setting Five teaching hospitals across the United States. PARTICIPANTS: A total of 2505 seriously ill hospitalized patients and nonelectively admitted persons aged 80 years or older who experienced cardiopulmonary arrest. MAIN OUTCOME MEASURES: Medical records data on CPR efforts, DNR orders, disease severity, age, race, sex, length of stay, and survival; functional status and preferences concerning CPR obtained by interviews with patients or surrogates; and 2-month survival estimates provided by physicians. RESULTS: Five hundred fourteen study subjects (21 %) received CPR during their index hospitalization. Among them, 327 (63.6%) had CPR within 2 days of death and 93 (18.1 %) had resuscitation and survived their index hospitalization. Use of CPR was more likely in men (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.12-1.73), younger patients (OR per 10-year increase, 0.90; 95% CI, 0.84-0.96), African Americans (OR, 1.76; 95% CI, 1.33-2.34), patients whose reported preferences were for CPR (OR, 2.60; 95% CI, 1.91-3.55), who reported better quality of life (OR, 1.49; 95% CI, 1.10-2.03), or who had higher physician estimates for 2-month survival (OR per 10% increase, 1.14; 95% CI, 1.09-1.19). Rates varied significantly with geographic location and diagnosis; the adjusted OR for patients with congestive heart failure was 3.31 (95% CI, 2.12-5.15) compared with patients with acute respiratory failure or multiple organ system failure. CONCLUSIONS: Our data suggest that a resuscitation attempt is more likely when preferred by patients and when death is least expected. Further study is required to understand variation in use of CPR among sites and for patients with different diagnoses, race, sex, or age.     

广西部分地区男男性行为者安全套使用情况及影响因素分析

目的 分析广西部分地区男男性行为者（men who have sex with men, MSM）的危险行为、安全套使用情况及其影响因素。方法 在广西南宁市、柳州市和贺州市通过方便抽样的方法招募MSM,开展面对面问卷调查,收集其社会人口学、行为学、艾滋病相关知识、安全套使用等基本信息。采用卡方检验、Logistic回归模型分析最近6个月同性肛交坚持使用安全套的影响因素,计算OR（95%CI）值,以P<0.05为差异有统计学意义。结果 375名MSM中,认为当地MSM疫情严重占56.3%,曾经吸食过新型毒品占5.1%,最近6个月同性肛交性行为坚持使用安全套仅占58.4%,最近6个月性伴数3人以上占25.9%,最近6个月与异性发生过性行为占14.1%。多因素Logistic回归模型分析结果显示,文化程度高中或中专及以上[OR=1.86(95%CI:1.01~3.43)]、认为当地MSM艾滋病疫情严重[OR=3.79(95%CI:1.61~8.95)]、最近1年做过HIV检测[OR=1.93(95%CI:1.18~3.15)]、最近1年患过性病[OR=0.36(95%CI:0.14~0.90)]为最近6个月同性肛交坚持使用安全套的-影响因素。结论 广西MSM安全套坚持使用率低,需结合不同特点的MSM采取针对性干预措施,提高安全套坚持使用率,减少艾滋病的传播。     

Associations among condom use, sexual behavior, and knowledge about HIV/AIDS. A study of 13,293 public school students

BACKGROUND: This school-based study explored associations between Mexican young people's condom use, other sexual behaviors, and HIV/AIDS knowledge. METHODS: Students (n=13,293, 11-24 years of age) from a random sample of public schools in the central Mexican state of Morelos completed a self-administered questionnaire. We performed logistic regression analysis of condom use and sexual behavior variables and a knowledge-based index on HIV/AIDS prevention and transmission. RESULTS: Average age at sexual debut was 13.6 +/- 1.9 years among young men and 14.2 +/- 2.2 years among young women; 34.5% of sample participants reported using condoms during their first sexual intercourse. More students had intermediate HIV/AIDS knowledge levels (46%, 95% confidence interval [95% CI], 45.2-46.9) than high levels (37%, 95% CI 36.2-37.8, p <0.01). Students knew more concerning HIV transmission than about prevention of HIV infection. Among young men, high levels of HIV/AIDS knowledge increased likelihood of condom use (odds ratio [OR] 1.4, 95% CI, 1.1-1.7), while among young women high levels of knowledge decreased likelihood of using condoms (OR 0.7, 95% CI, 0.5-1.0). Young men with high levels of HIV/AIDS knowledge were more likely to have had three or more sexual partners (OR 1.7, 95% CI, 1.3-2.2), but young women with high knowledge levels were more likely to have only one lifetime sexual partner (OR 0.6, 95% CI, 0.4-0.9). CONCLUSIONS: As in previous studies in smaller samples, levels of knowledge with regard to HIV/AIDS were low in Mexican youth. HIV/AIDS education programs for Mexican students should focus on conveying knowledge on HIV prevention. Because apparently knowledge is not directly correlated with condom use among young women, prevention strategies that deal with social acceptability of condoms and social skills related with condom negotiation are also needed.     

宫颈癌相关危险因素致病风险的Meta分析

目的综合评价我国女性宫颈癌相关危险因素的关联强度。方法系统收集1990年1月～2011年6月宫颈癌相关危险因素的研究文献,纳入合格研究文献16篇,共计研究对象11 126例。按照NOS标准对纳入文献进行质量评价;采用Stata10.0软件进行Meta分析,得到各相关危险因素与宫颈癌发病风险关联强度合并的OR值及其95%可信区间。结果文献质量评价A级文献6篇、B级文献10篇。在分析的16个因素中有12个因素差异具有统计学意义,与妊娠相关的危险因素及其OR值(95%可信区间)分别为:怀孕≥3次2.384(95%CI:1.659～3.425)、分娩≥3次2.265(95%CI:1.669～3.074)、流产≥3次3.713(95%CI:2.470～5.581)和初次怀孕年龄≤21岁2.390(95%CI:1.731～3.225);与性行为相关的危险因素分别为:结婚≥2次2.522(95%CI:1.714～3.713)、初次性生活年龄≤20岁3.467(95%CI:2.456～4.893)、性伴侣≥3个2.539(95%CI:1.613～3.996);与妇科疾病相关的因素分别为:性传播疾病史5.861(95%CI:1.048～13.67)、妇科病史4.807(95%CI:2.899～7.971);另外,受教育程度≤9年3.536(95%CI:2.204～5.672)、主动或被动吸烟3.055(95%CI:2.435～3.833)和农村或郊区居住地2.134(95%CI:1.010～4.509)等环境因素也与发病风险相关。结论妊娠等相关因素与我国女性宫颈癌发病风险密切相关。     

Correlates of sexual activity and inconsistent condom use among high-school girls in Dominica

OBJECTIVE: To determine factors associated with sexual activity and inconsistent condom use among high-school girls in Dominica. METHODS: A cross-sectional study was conducted at five high-schools in Dominica in 2000 to assess behaviour that may put high-school girls at risk for HIV The main outcome variable, sexual activity, was defined as vaginal or anal sex, and inconsistent condom use defined as none to infrequent condom use. The convenience sample consisted of 204 girls (median age 16 years). RESULTS: Forty-one per cent (41%) of girls reporting at least one episode of sexual activity. Sexual intercourse was associated with past sexual coercion (OR = 7.2, 95% CI 2.4, 21.8), oral sex (OR = 8.0, 95% CI 3.0, 21.0) and smoking marijuana (OR = 8.2, 95% CI 2.9, 23.0). Among sexually active girls, 59% were inconsistent condom users. Variables associated with inconsistent condom use were being coerced (OR 2.8, 95% CI 0.9, 8.2) and low socio-economic status (OR 3.3, 95% CI 1.1, 9.6). CONCLUSION: Sexual activity and inconsistent condom use occur frequently among high-school girls in Dominica. Therefore, strategies directed at delaying the onset of sexual activities such as providing accurate and age-appropriate information on sexuality in the context of the economic and social conditions of their daily lives, and increasing condom use are important in HIV prevention in this population.     

High risk health behaviours among adult Jamaicans

The purpose of this study was to assess the prevalence of high risk health behaviours among adult Jamaicans aged 15-49 years in 2000, and to compare the results with the 1993 survey. A nationally representative sample of 2013 persons aged 15-74 years was surveyed in 2000 using cluster sampling in the Jamaica Healthy Lifestyle Survey (Wilks et al, unpublished). Interviewer administered questionnaires and anthropometrical measurements were done. Data for a sub-sample of adults aged 15-49 years were analyzed The sub-sample included 1401 persons (473 men and 928 women). Significantly more men (18.6%) than women (4.3%) reported never having had a blood pressure check (p = 0.0001). Approximately one-third of the women reported that they had never had a Pap smear (36.0%) or a breast examination (31.2%). Current cigarette smoking was reported in 28.6% of men and 7.7% of women (OR 3.73 CI 2.71, 5.15), while 49.0% of men and 15.0% of women ever smoked marijuana (OR 3.28 CI 2.56, 4.20). Significantly more men (28.0%) than women (11.7%) reported ever having a sexually transmitted disease (OR 2.93 CI 2.16, 3.97); having more than one sexual partner in the past year (49.1% vs 11.4%, OR 4.31 CI 3.22, 5.76) and usually using a condom during sexual intercourse (55.3% vs 40.5%, OR 1.3 CI 1.11, 1.68). Between 1993 and 2000, significant trends include: more persons reported having a blood pressure check, a reduction in multiple sexual partners, increased condom use at last sex (women), reduced crack/cocaine use (males) and increased marijuana smoking. Although there were some significant positive lifestyle trends between 1993 and 2000, high risk behaviours remain common among Jamaican adults. Comprehensive health promotion programmes are needed to address these risk behaviours.     

HMG-CoA reductase inhibitors and the risk of fractures

CONTEXT: Recent animal studies have suggested that 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) increase bone formation, volume, and density. It is unknown whether use of statins is associated with a decreased risk of fractures in humans. OBJECTIVE: To determine whether exposure to statins, fibrates, or other lipid-lowering drugs is associated with reduced bone fracture risk. DESIGN: Population-based, nested case-control analysis. SETTING: The UK-based General Practice Research Database (GPRD), comprising some 300 practices, with data collection from the late 1980s until September 1998. SUBJECTS: Within a base population of 91,611 individuals aged at least 50 years (28,340 individuals taking lipid-lowering drugs, 13,271 untreated individuals with a diagnosis of hyperlipidemia, and 50,000 randomly selected individuals without diagnosis of hyperlipidemia), we identified 3940 case patients who had a bone fracture and 23,379 control patients matched for age (+/-5 years), sex, general practice attended, calendar year, and years since enrollment in the GPRD. MAIN OUTCOME MEASURES: Use of statins, fibrates, or other lipid-lowering drugs in case patients vs control patients. RESULTS: After controlling for body mass index, smoking, number of physician visits, and corticosteroid and estrogen use, current use of statins was associated with a significantly reduced fracture risk (adjusted odds ratio [OR], 0.55; 95% confidence interval [CI], 0.44-0.69) compared with nonuse of lipid-lowering drugs. Current use of fibrates or other lipid-lowering drugs was not related to a significantly decreased bone fracture risk (adjusted OR, 0.87; 95% CI, 0.70-1.08 and adjusted OR, 0.76; 95% CI, 0.41-1.39, respectively). CONCLUSIONS: This study suggests that current exposure to statins is associated with a decreased risk of bone fractures in individuals age 50 years and older. This finding has a potentially important public health impact and should be confirmed further in controlled prospective trials. JAMA. 2000;283:3205-3210     

Association between Prenatal Environmental Factors and Child Autism:A Case Control Study in Tianjin,China

Objective To investigate the association between autism and prenatal environmental risk factors.
Methods A case-control study was conducted among 193 children with autism from the special educational schools and 733 typical development controls matched by age and gender by using questionnaire in Tianjin from 2007 to 2012. Statistical analysis included quick unbiased efficient statistical tree (QUEST) and logistic regression in SPSS 20.0.
Results There were four predictors by QUEST and the logistic regression analysis, maternal air conditioner use during pregnancy (OR=0.316, 95% CI: 0.215-0.463) was the single first-level node (χ2=50.994, P=0.000); newborn complications (OR=4.277, 95% CI: 2.314-7.908) and paternal consumption of freshwater fish (OR=0.383, 95% CI: 0.256-0.573) were second-layer predictors (χ2=45.248, P=0.000; χ2=24.212, P=0.000); and maternal depression (OR=4.822, 95% CI: 3.047-7.631) was the single third-level predictor (χ2=23.835, P=0.000). The prediction accuracy of the tree was 89.2%.
Conclusion The air conditioner use during pregnancy and paternal freshwater fish diet might be beneficial for the prevention of autism, while newborn complications and maternal depression might be the risk factors.     

海口市不同性角色MSM青年学生社会接纳和性行为特征

目的 了解海南省海口市不同性角色男男性行为（men who have sex with men,MSM）青年学生的社会接纳和高危性行为特征及危险因素,为开展MSM青年学生艾滋病预防干预提供精准化建议。方法 在高校中采用同伴推动抽样法（RDS）动员招募MSM青年学生至咨询检测门诊,通过匿名问卷调查,问卷内容包括社会人口学、社会接纳和高危性行为特征,同时采集血样进行HIV和梅毒抗体检测。结果 共调查159名MSM青年学生,有效调查问卷150份。调查对象据经常扮演的性角色分三组：被插入方（0号）60人（40.00%）,兼有插入和被插入方（0.5号）48人（32.00%）,插入方（1号）42人（28.00%）。0号、0.5号和1号组HIV感染率分别为3.33%、0.00%和7.14%,差异无统计学意义（P=0.170）;梅毒感染率分别为3.33%、10.42%和19.05%,差异有统计学意义（P=0.034）。觉得生活环境对待同性恋态度友好的39人（26.53%）,觉得一般的100人（66.70%）,觉得受到歧视的8人（5.30%）。性行为学变量中“首次性行为年龄、首次性行为对象是否为临时性伴、是否使用过兴奋剂、使用兴奋剂后有无发生性行为”有统计学意义（P<0.05）;“最近一年每次发生肛交性行为都坚持使用安全套”变量有统计学意义（P<0.01）;logistic多因素分析结果显示：0.5号性角色在二~五年级段是一年级的3.143倍（OR=3.143,95%CI：1.893~5.220）;不告知他人同性性倾向是0号和1号的8.093倍（OR=8.093,95%CI：2.496~26.243）;首次性行为年龄（<18岁）是0号和1号的 15.269倍（OR=15.269,95%CI：5.072~45.972）,是危险因素。0.5号性角色首次性行为对象相对固定,首次性行为对象为临时性伴是0号和1号的0.238倍（OR=0.238,95%CI：0.092~0.619）,是保护因素。结论 不同性角色的MSM青年学生社会接纳、高危性行为、安全套使用和梅毒感染率差异有统计学意义,建议分类提供针对性干预,提高该人群预防性传播疾病感染技能。