藐小棘隙吸虫流行病学研究Ⅲ．饮水与藐小棘隙吸虫感染的前瞻性定群研究

本文以前瞻性定群研究，报道了饮水与藐小棘隙吸虫感染的关系。结果表明：１．陈桥洲居民藐小棘隙吸虫年感染率为１１．２３％；２．饮用塘水和混饮江、塘水者感染藐小棘隙吸虫的相对危险度（ＲＲ）分别是饮江水者的３．７２倍和４．２８倍；３．饮生水人群的ＲＲ是４非饮生水者的８．１２倍，且分层分析后上述关系仍然成立；４．感染率与饮生水量呈剂量反应关系；５．其它寄生虫未见上述联系；６．当地人群特异危险度（ＰＡＲ）及特异危险度百分比（ＰＡＲ％）分别为９．４３％和８３．９７％。结果提示生饮塘水为当地居民感染藐小棘隙吸虫的主要途径。     

藐小棘隙吸虫流行病学研究：Ⅲ.饮水与藐水棘隙吸虫感染…

本文以前瞻性定群研究，报道了饮水与藐小棘隙吸虫感染的关系，结果表明：１，陈桥洲居民藐小棘隙吸虫感染率为１１．２３％，２．饮用塘水和混饮江，塘水者感染藐小棘隙吸虫的相对危险度（ＲＲ）分别是饮江水者的３．７２倍和４．２８；３．饮生水人群的ＲＲ是非饮生水者的８．１２倍，且分民支分析后上述关系仍然成立，４．感染率与饮生水量呈剂量反应关系，５．其它寄生虫未见上述联系，６．当地人群特异危险度（ＰＡＲ）及特异危     

人体自然感染藐小棘隙吸虫首次发现

本文报道首次在安徽和县发现人体自然感染藐小棘隙吸虫。60条成虫测量结果显示,成虫呈长叶形,大小为1519.4—2056.3×466.4—564.0μm。头领发达,具头棘24枚,背部中央间断。体棘自头领开始,分布至后睾丸后缘。口吸盘大小为107.9—148.6×102.5—148.6μm。腹吸盘大小为205.0—240.9×205.0—235.8μm。消化道有口、前咽、咽、食道和肠管。睾丸两个,前后相接排列于虫体后1/3部处。阴茎囊位于肠叉后方与腹吸盘之间。卵巢较圆,卵黄腺发达。子宫短,通常只含1个虫卵。虫卵长椭圆形,大小为95.1—116.2×54.3—72.8μm。 采用2.5—40mg/kg剂量的吡喹酮顿服治疗39例患者,均驱得成虫,表明吡喹酮是治疗藐小棘隙吸虫的有效药物。     

藐小棘隙吸虫病流行病学研究Ⅰ.终宿主感染情况及分布特征

１９９１－１９９３年对安徽省和县陈桥洲村进行了藐小棘隙吸虫终宿主感染情况的调查，结果。结果显示，居民、猫、犬的感染率分别为１３．７１％（８９９／６５５７）、３９．７６％（３３／８３）和６２．１６％（１１１５／１８５）。人群的感染与情况无，而与年龄密切相关，年龄越低，感染率越高。３－１０岁感染率最高，为２６．０１％；１１－２０岁、２１－３０岁、３１－４０岁、４１－５０岁与５１岁以上者感染率依次为２１     

藐小棘隙吸虫感染的季节分布及其影响因素的研究

为了解人群藐小棘隙吸虫感染的季节分布和影响因素以及年度感染情况，于１９９５年在安装和县陈桥村选择１所小学进行纵向观察研究。结果表明，在小学生中藐小棘隙吸虫感染呈明显季节性，秋季（９￣１０月份）是感染的高峰季节，生饮含有该虫尾蚴的池塘水是造成季节性感染的主要原因。各月份藐小棘隙吸虫感染率与饮生水率，饮水频次和饮生水量，经相关分析均有显著意义（ｒ分别为０．９６０，０．８３４和０．８９６，Ｐ〈０．０５）     

藐小棘隙吸虫病感染方式的研究

经流行病学调查及实验研究表明，居民感染藐小棘隙吸虫系由于生饮含有该吸虫见蚴的水或食入其活囊蚴。经常喝生水的居民的感染率为20.1％，较不喝生水居民的感染率1．5％高12．6倍。该地水体中仅检到该吸虫尾蚴．未发现囊蚴。因此可以认为，藐小棘隙吸虫感染人体的主要方式是尾蚴直接经口，而囊蚴经口感染为次要。     

藐小棘隙吸虫感染对儿童生长发育影响的研究

为了探讨藐小棘隙吸虫对儿童生长发育的影响，本文将７５例感染藐小棘隙吸虫的小学生随机分为２组，分别用吡喹酮和安慰剂５ｍｇ／ｋｇ顿服，治后５个月进行检查对比。结果吡喹酮和安慰剂组５项测量指标中４项差异均无显著意义（Ｐ＞０．０５），故初步认为藐小棘隙吸虫感染对少年儿童生长发育的影响尚不明显。     

藐小棘隙吸虫感染对儿童生长发育影响的研究

为了探讨藐小棘隙吸虫对儿童生长发育的影响,本文将76例感染藐小棘隙吸虫的小学生随机分为2组,分别用吡喹酮5mg/kg 和等剂量安慰剂顿服,治后5月进行检查对比。结果吡喹酮和安慰剂5项测量指标中4项差异均无显著意义(P<0.05),故可初步认为藐小棘隙吸虫感染对少年儿童生长发育的影响尚不明显。     

藐小棘隙吸虫尾蚴直接感染终宿主的研究

本实验为藐小棘隙吸虫尾蚴直接经口感染终宿主人、犬的可行性研究。9只幼犬分别喂以不同数量的尾蚴(4500～88000),并于感染后3.5h～34d分别解剖。结果:实验犬藐小棘隙吸虫感染率为100％,获虫率4.01％;感染后3.5b,部分尾蚴在胃中发育成囊蚴;8b,脱囊蚴虫在小肠内发现;13d,蚴虫发育成熟,虫卵在大便中检获。两自愿者分别感染尾蚴8400条和1500条,于感染后第15d、16d自粪中检获虫卵。提示人、畜生饮含有藐小棘隙吸虫尾蚴的水可致感染。     

藐小棘隙吸虫感染与其它寄生虫感染关系及化疗效果

五年研究发现,人群藐小棘隙吸虫感染率与蛔虫感染率明显相关,推测年龄趋向性行为系共同的易感因素;同时化疗后,与钩虫感染率明显负相关性及与鞭虫感染率明显相关性基本消失,与血吸虫感染率几无相关,可能因不同的感染方式、途径,及较低的感染率所致。吡喹酮治疗对人群藐小棘隙吸虫感染率下降效果显著。     

A prospective cohort study on orally administered heroin substitution for severely addicted opioid users

AIMS: To assess the efficacy and safety of orally administered heroin [diacetylmorphine (DAM)] tablets in substitution treatment of severely addicted opioid users. DESIGN: An open-label, prospective cohort study with two non-randomly assigned treatment arms and historical controls: DAM tablets only versus DAM tablets combined with injected DAM and/or other opioids, with an observation period of 1 year. SETTING: Twenty-one out-patient treatment centres of the Swiss heroin-assisted treatment programme. PARTICIPANTS: A total of 128 patients received DAM tablets only, and 237 patients received a combination of orally and intravenously applied DAM and other opioids. MEASUREMENTS: Retention rate after 1 year; number of serious adverse events; dosage of DAM over time; subjective tolerance of study medication. FINDINGS: In the intention-to-treat analysis, 1-year retention rates after 1 year in the DAM tablets-only group [0.804, 95% confidence interval (CI) = 0.735-0.873] as well as in the subgroup combining oral application of DAM with intravenous application or other opioids (0.843, 95% CI = 0.797-0.889) were higher compared to historical controls (Swiss cohort of patients who had been substituted intravenously with DAM; 1-year retention rate = 0.70). Rates of serious adverse events under study medication (tablets only = 0.038 per application year; tablets in combination = 0.028 per application year) were comparable to the historical rate of the Swiss heroin-assisted treatment (0.043). CONCLUSIONS: DAM tablets seem to be an effective and safe application mode of heroin-assisted substitution treatment. Randomized clinical trials to compare its relative efficacy to other substances are necessary.     

Association between glycated haemoglobin and the risk of chronic obstructive pulmonary disease: A prospective cohort study in UK biobank

Aims

To investigate the association between glycated haemoglobin (HbA1c) levels and chronic obstructive pulmonary disease (COPD) incidents in the general population, and the association between HbA1c levels and mortality in patients with COPD.

Materials and Methods

We investigated the association of HbA1c levels with COPD risk in the general population in the UK Biobank, using data from 420 065 participants. Survival analysis was conducted for 18 854 patients with COPD. We used restricted cubic spline analysis to assess the dose-response relationship between HbA1c levels and COPD risk and survival. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

During a median follow-up of 12.3 years, 11 556 COPD cases were recorded. HbA1c had a non-linear relationship with COPD risk (p for non-linearity < .05). Compared with the quintile 2 (32.2-<34.3 mmol/mol), those with HbA1c levels above 38.7 mmol/mol (quintile 5) had a 22% (HR, 1.22, 95% CI: 1.15-1.30) higher risk of COPD. Compared with the HbA1c decile 2 (30.5-<32.2 mmol/mol), the HRs (95% CI) of COPD risk were 1.16 (1.03-1.30) and 1.36 (1.24-1.50) in the lowest HbA1c decile (<30.5 mmol/mol) and highest decile (≥41.0 mmol/mol), respectively. The increased COPD risk associated with HbA1c was more pronounced in younger, current smokers, passive smokers, and participants with a higher Townsend deprivation index (all p for interaction < .05). Among patients with COPD, 4569 COPD cases died (488 because of COPD) during a median follow-up of 5.4 years. Regarding COPD survival, HbA1c had a non-linear relationship with all-cause death (p for non-linearity < .05). Those with HbA1c quintile 5 (≥38.7 mmol/mol) had a 23% (HR, 1.23, 95% CI: 1.10-1.37) higher risk of all-cause death compared with the quintile 2 (32.2-<34.3 mmol/mol). Compared with the HbA1c decile 4 (33.3-<34.3 mmol/mol), those in the lowest HbA1c decile (<30.5 mmol/mol) and highest HbA1c decile (≥41.0 mmol/mol) had 22% (HR, 1.22; 95% CI: 1.01-1.47) and 28% (HR, 1.28; 95% CI: 1.11-1.48) higher risk for overall death. However, no significant association was observed between HbA1c levels and the risk of COPD-specific death.

Conclusions

Our findings indicated that lower and higher HbA1c levels were associated with a higher risk of COPD. In COPD cases, lower and higher HbA1c levels were associated with a higher COPD all-cause death risk.     

Menstrual and reproductive factors and gastric cancer risk in a large prospective study of women

Background

Gastric cancer incidence rates are consistently lower in women than men in both high and low‐risk regions worldwide. Sex hormones, such as progesterone and estrogen, may protect women against gastric cancer.

Objective

To investigate the association of menstrual and reproductive factors and gastric cancer risk.

Methods

These associations were prospectively investigated in 73 442 Shanghai women. After 419 260 person‐years of follow‐up, 154 women were diagnosed with gastric cancer. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards models adjusted for age, body mass index, education, income, and cigarette use.

Results

No associations were observed between gastric cancer risk and age of menarche, number of children, breast feeding, or oral contraceptive use. In contrast, associations were observed with age of menopause (HR 0.80 per five‐year increase in menopausal age, 95% CI 0.66–0.97), years of fertility (participants with less than 30 years of fertility were at increased risk compared with those with 30–36 years of fertility, HR 1.90, 95% CI 1.25–2.90), years since menopause (HR 1.26 per five years, 95% CI 1.03–1.53), and intrauterine device use (HR for users 1.61, 95% CI 1.08–2.39).

Conclusions

These results support the hypothesis that female hormones play a protective role in gastric cancer risk.