社区老年人久坐行为与睡眠质量对认知功能的影响

目的 了解久坐行为与睡眠质量对社区老年人认知功能的影响。方法 采用匹兹堡睡眠质量指数量表、国际体力活动问卷短卷、简易精神状态量表及一般资料调查表,于2019年12月按照分层整群抽样法,从济南市随机抽取1 091名老年人开展问卷调查。结果 调整人口学变量后,二元logistic 回归分析结果显示,存在久坐行为的社区老年人患认知功能障碍的风险为非久坐行为者的1.880倍（OR值 = 1.880, 95 % CI = 1.267～2.790）,存在睡眠障碍的老年人发生认知功能障碍的风险为无睡眠障碍者的2.160倍（OR值 = 2.160,95 % CI = 1.391～3.356）。交互作用分析结果显示,久坐行为与睡眠障碍对老年人认知功能障碍患病率具有负相乘交互作用OR值（95%CI） = 0.414（0.174～0.984）。结论 久坐行为与睡眠障碍是老年人认知功能的危险因素,且二者存在相乘交互作用。     

中国老年人衰弱状况与社会参与及其交互作用对抑郁影响研究

目的 了解我国老年人衰弱状况与社会参与及其交互作用对抑郁影响。方法 收集2018年中国健康与养老追踪调查数据（CHARLS）中4 521名≥60岁老年人相关数据,采用logistic回归分析老年人抑郁的影响因素,并将衰弱状况和社会参与作为2个交互项,调整混杂因素,评价衰弱状况和社会参与交互作用对老年人抑郁的影响。结果 有抑郁症状者1 414人（31.27%）。抑郁与非抑郁老年人在性别（χ2 = 49.237,P＜0.001）、年龄（χ2 = 119.612,P＜0.001）、婚姻状况（χ2 = 14.016,P＜0.001）、文化程度（χ2 = 50.851,P＜0.001）、居住地（χ2 = 32.584,P＜0.001）方面有统计学差异。控制混杂因素后,多因素logistic回归分析结果显示,社会隔离(OR = 2.457,95%CI:1.384～3.532)和衰弱前期(OR = 1.201,95%CI:1.121～1.289)、衰弱(OR = 1.860,95%CI:1.290～1.976)是老年人抑郁发生的影响因素。交互作用结果显示,衰弱与社会隔离对老年人抑郁发生存在相乘(P交互＜0.001)和相加交互作用(OR = 7.715,95%CI:5.426～12.062),RERI(95%CI)、API(95%CI)、Index S(95%CI)分别为1.137(0.252～1.807)、0.316(0.158～0.476)、3.972(1.639～4.665)。结论 衰弱和社会隔离是老年人抑郁的危险因素且二者存在交互作用。     

老年人日常活动能力与睡眠质量及其交互作用对认知功能的影响

目的 探究我国老年人日常活动能力、睡眠质量及其交互作用对认知功能的影响。方法 基于2018年中国老年健康影响因素跟踪调查（CLHLS）数据,运用logistic回归模型进行危险因素分析。结果 控制相关变量后,多因素logistic回归结果显示,日常活动能力受损（OR = 3.941,95%CI:3.464～4.484）、睡眠障碍（OR = 1.370,95%CI:1.167～1.608）是老年人发生认知功能障碍的影响因素。交互作用结果显示,日常活动受损与睡眠障碍对认知功能障碍的发生具有相加交互作用（OR = 5.492,95%CI:4.380～6.888）,RERI（95%CI） = 1.261（0.092～2.430）,AP（95%CI） = 0.230（0.057～0.402）,S（95%CI） = 1.390（1.052～1.837）。结论 同时存在日常活动能力受损和睡眠障碍会增加老年人认知障碍的发生风险,通过有效措施提高老年人的睡眠质量和日常活动能力可有助于降低认知障碍的发生风险。     

老年人睡眠质量状况及影响因素分析

目的 了解老年人睡眠质量现状及其影响因素。方法 于2018年10月-11月,采用多阶段整群随机抽样的方法,对山西省太原市3637名60岁及以上老年人进行调查,用匹兹堡睡眠质量指数（PSQI）量表评估睡眠质量。运用多因素logistic回归对老年人睡眠质量的影响因素进行探讨。结果 3637名老年人睡眠质量的平均得分为（5.33±3.08）分,29.0%的老年人存在睡眠质量不良问题。Logistic回归结果显示,性别（参照:男性,女性OR=1.393,95%CI: 1.177~1.647）、年龄（参照:60~69岁;70~79岁OR=1.292,95%CI: 1.091~1.529;≥80岁OR=1.470,95%CI: 1.165~1.855）、文化程度（参照:文盲/半文盲;初中OR=0.750,95%CI: 0.586~0.961;高中/中专OR=0.663,95%CI: 0.508~0.866;大学/大专及以上OR=0.664,95%CI: 0.492~0.895）、婚姻状况（参照:已婚,丧偶OR=1.315,95%CI: 1.072~1.613）、饮酒状况（参照:从不饮酒;已戒酒OR=1.731,95%CI: 1.307~2.292;饮酒OR=1.670,95%CI: 1.329~2.098）、慢病数量（参照:0种;1种慢病OR=1.626,95%CI: 1.346~1.963;2种及以上OR=3.158,95%CI: 2.546~3.916）、抑郁（参照:不抑郁,抑郁OR=2.204,95%CI: 1.867~2.603）是老年人睡眠质量的主要影响因素（P<0.05）。结论 老年人睡眠质量较差,睡眠障碍的发生与多种因素显著相关,应有针对性的采取综合干预策略以改善老年人睡眠质量状况。     

农村中学生睡眠质量抑郁症状及其与非自杀性自伤的关联

目的 探讨农村中学生睡眠质量和抑郁症状及其交互作用与非自杀性自伤(non-suicidal self-injury, NSSI)的关联,为农村中学生NSSI的预防和早期干预提供参考依据。方法 采用多阶段整群抽样的方法,在江苏省徐州市随机抽取4所农村中学,按照学校年级分层、班级随机选取的原则对1 723名中学生进行调查。使用纸质调查问卷(包括人口学因素、自伤行为评估简表、匹兹堡睡眠质量指数量表、抑郁自评量表)进行问卷调查,采用Logistic回归模型分析农村中学生睡眠质量和抑郁症状及其交互作用与NSSI的关联。结果 30.5%的中学生存在NSSI行为;单因素分析结果显示,女生NSSI报告率(33.0%)比男生(27.3%)高,有睡眠障碍和抑郁症状者NSSI报告率更高,分别为46.8%和43.6%。多因素Logistic回归分析结果显示,存在睡眠障碍的学生发生NSSI的风险是无睡眠障碍者的1.80倍(OR值95%CI=1.42～2.28,P<0.01);存在抑郁症状的学生发生NSSI的风险是无抑郁症状者的3.32倍(OR值95%CI=2.60～4.24,P<0.01)。交互作用...     

不良生活方式和睡眠质量的交互作用与老年人抑郁症状的关联

目的探讨生活方式、睡眠质量及其交互作用与老年人抑郁症状的关联,为促进老年人心理健康提供指导依据。方法选取辽宁省抚顺市某企业≥60岁退休职工1268人作为调查对象,使用问卷调查法收集资料。结果老年人睡眠障碍和抑郁症状的总检出率分别为38.5%和30.8%。生活方式一般和不良,以及睡眠障碍会增加抑郁症状发生风险(OR=3.664,95%CI:2.410～5.570;OR=11.177,95%CI:7.062～17.690;OR=1.795,95%CI:1.363～2.363)。生活方式和睡眠质量的交互作用与抑郁症状之间存在相关性,相比较于无睡眠障碍和生活方式良好,无睡眠障碍和生活方式一般(OR=2.641,95%CI:1.132～6.164)、生活方式不良(OR=5.154,95%CI:2.425～10.952),有睡眠障碍和生活方式良好(OR=7.656,95%CI:3.532～16.593)、生活方式一般(OR=13.770,95%CI:6.327～29.970)、生活方式不良(OR=30.477,95%CI:12.899～72.009)的老年人抑郁症状发生风险增大。结论有睡眠障碍和不良生活方式的老年人,会增加抑郁症状的发生风险。通过改善生活方式,可有助于降低抑郁症状的发生。     

我国东中西部地区的农村老年人抑郁状况及影响因素

目的 了解我国东中西部农村老年人的抑郁状况及其影响因素。方法 以2013年中国健康与养老追踪调查数据中2 896名65岁及以上的农村老年人为研究对象,采用二分类Logistic回归模型,从社会人口、社会经济、生活方式以及健康状况四个方面探讨东中西部的农村老年人抑郁状况的影响因素。结果 东中西部的农村老年人患抑郁状况的差异有统计学意义（χ2=33.63,P<0.001）,东中西部农村老年人抑郁率分别为24.34%、30.11%、36.77%。东中西部农村老年人的抑郁症状主要受性别、婚姻状况、家庭月均支出、参加社交活动、饮酒、慢性病以及自评健康的影响（均有P<0.05）,有伴侣（OR=0.774,95%CI:0.640~0.936）、中等家庭月均支出（OR=0.797,95%CI:0.651~0.977）、参加社交活动（OR=0.788,95%CI:0.668~0.930）及饮酒（OR=0.789,95%CI:0.649~0.960）为抑郁的保护因素,女性（OR=1.736,95%CI:1.400~2.153）、慢性病（OR=1.328,95%CI:1.091~1.618）及自评健康不良（OR=2.924,95%CI:2.259~3.784）为抑郁的危险因素。结论 防治农村老年人的抑郁,需要注重农村地区老年人的心理干预,加强社会支持。同时还需防治慢性病,全面提高老年人健康水平。     

成都市社区老年人睡眠障碍与抑郁症状的相关性研究

目的 探讨成都市社区老年人睡眠障碍与抑郁症状发生之间的关联。方法 以成都市锦江区60岁及以上的老年人为研究对象,采用中文版匹兹堡睡眠质量指数量表（Pittsburgh sleep quality index,PSQI）评估社区老年人的睡眠障碍,包括主观睡眠质量、入睡时间、睡眠时长、睡眠效率、睡眠紊乱、日间功能障碍、催眠药物使用共7个睡眠维度。采用老年抑郁问卷自评版（the self-reported version of geriatric depression inventory,GDI-SR）评估老年人抑郁症状发生情况。采用二分类logistic回归分析社区老年人不同睡眠维度问题与抑郁症状之间的关系。结果 本研究共纳入587名社区老年人,抑郁症状检出率为16.0%,总体睡眠障碍率为39.5%。社区老年人主观睡眠质量（OR=2.738,95%CI:1.394～5.378）、睡眠紊乱（OR=2.351,95%CI:1.060～5.211）、日间功能障碍（OR=5.063,95%CI:2.911～8.805）、使用催眠药物（OR=2.521,95%CI:1.164～5.461）与抑郁症状...     

家庭关怀及社会支持对社区老年人社会隔离的影响

目的 了解社区老年人社会隔离的现状,明确家庭关怀及社会支持因素对其产生的影响,为采取应对措施提供理论依据。方法 于2017年12月-2018年8月采用社会网络量表（LSNS-6）、家庭关怀度问卷（APGAR）、社会支持评定量表(SSRS)对唐山市6所社区1526例老年人(≥60 岁)进行问卷评测。结果 社区老年人社会网络总均分为（16.16±5.447）分,其中发生社会隔离者占24.3%;多因素分析结果显示,患有慢病（OR=2.477,95%CI:1.948~3.057）、居住在3层楼房以上（OR=2.475,95%CI:1.747~3.505）是社会隔离的危险因素,家庭关怀度高（OR=0.644,95%CI:0.588~0.706）、社会支持度高（OR=0.806,95%CI:0.779~0.833）是社会隔离的保护因素;分层回归分析显示家庭关怀及社会支持能够独立解释30.1%的社会隔离。结论 唐山市社区老年人社会隔离发生率远高于北京市水平,加强家庭及社会支持可降低社会隔离的发生。     

合肥市65岁以上老年人抑郁焦虑症状检出率及影响因素分析

目的 分析抑郁、焦虑症状的检出率及影响因素,为积极应对老年心理健康问题,提升心理健康服务能力提供依据。方法 采用分层随机整群抽样的方法抽样,使用电子化结构式调查问卷入户现场调查,调查问卷包括基本信息、病人健康状况问卷抑郁量表和广泛性焦虑量表。抑郁焦虑症状检出率的影响因素分析采用logistic回归分析法,单因素和多因素logistic回归分析分别采用输入法和向前wald法。结果 本次研究共调查1382人,抑郁症状检出率为11.00%,焦虑症状检出率为6.95%,抑郁症状和焦虑症状同时检出率为5.72%。logistic回归分析结果发现对和子女的关系满意度（比较满意 vs. 一般满意: OR=0.193,95%CI:0.077~0.482; 非常满意 vs. 一般满意:OR=0.091, 95%CI:0.032~0.264）、患有心脏病（OR=3.715,95%CI:1.557~8.863）、患有糖尿病（OR=3.095,95%CI:1.237~7.744）和看电视（OR=0.336,95%CI:0.146~0.772）等因素影响抑郁症状检出率,焦虑症状检出率受到对和子女关系满意度（比较满意 vs. 一般满意: OR=0.719,95%CI:0.218~2.372; 非常满意 vs. 一般满意:OR=0.023, 95%CI:0.023~0.693）和看电视（OR=0.269,95%CI:0.079~0.910）等因素影响。结论 合肥市65岁以上老年人群抑郁、焦虑等心理健康问题值得引起人们重视,拥有较高的对和子女关系的满意度以及看电视是老年人抑郁、焦虑症状检出率的保护性因素,患有心脏病、糖尿病等慢性疾病患者的焦虑抑郁问题值得我们给予更多的关注。     

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.