Occupational exposure to heavy metals,alcohol intake,and risk of type 2 diabetes and prediabetes among Chinese male workers

ObjectiveBoth exposure to heavy metals and alcohol intake have been related to the risk of type 2 diabetes (T2D). In this study, we aimed to assess the potential interactions between metal exposure and alcohol intake on the risk of T2D and prediabetes in a cohort of Chinese male workers.MethodsWe conducted a cross-sectional analysis of 26,008 Chinese male workers in an occupational cohort study from 2011 to 2013. We assessed metal exposure and alcohol consumption at baseline in these workers who were aged ≥20 years. Based on occupations which were categorized according to measured urine metal levels, multiple logistic regression analyses were used to evaluate the independent and joint effects of metal and alcohol exposure on the risk of T2D and prediabetes.ResultsRisks of T2D (P_trend = 0.001) and prediabetes (P_trend = 0.001) were significantly elevated with increasing number of standard drinks per week, years of drinking, and lifetime alcohol consumption. An adjusted odds ratio (OR) of 6.1 (95% confidence interval [CI]: 4.8–7.8) was observed for the smelting/refining workers (highest metal exposure levels) who had the highest lifetime alcohol consumption (>873 kg) (P_interaction = 0.018), whereas no statistically significant joint effect was found for prediabetes (P_interaction = 0.515).ConclusionsBoth exposures to metal and heavy alcohol intake were associated with the risk of diabetes in this large cohort of male workers. There was a strong interaction between these two exposures in affecting diabetes risk that needs to be confirmed in future studies.     

Thirdhand smoke: Genotoxicity and carcinogenic potential

Thirdhand smoke (THS), the residual tobacco smoke remaining in the environment after tobacco has been smoked, represents a hidden and underestimated public health hazard. Evidence supports its widespread presence in indoor environments. Exposure to secondhand smoke (SHS), a precursor of THS, has been well documented as a risk factor for human cancers, especially lung cancer. However, the concept of THS as a distinct entity that poses health risks for small children has developed only recently and the associations of THS with cancer risk and other chronic diseases are poorly understood due to limited numbers of studies to date. In this perspective, we mainly summarize all published studies on the genotoxicity and carcinogenic potential of THS exposure. These studies begin to fill the knowledge gap in our understanding of cancer risk of THS. Accumulating data from existing and future studies will help reduce the tobacco-related cancer incidence through changes in lifestyle and tobacco control policies.     

Ambient air quality and the risk for Chronic Obstructive Pulmonary Disease among Metro Manila Development Authority traffic enforcers in Metro Manila: An exploratory study

BackgroundAir pollution and poor ambient air quality are significantly related to multiple health risks. One associated disease is chronic obstructive pulmonary disease (COPD), a preventable disease with several contributing factors and one of the leading causes of morbidity/mortality locally and globally. A potentially high-risk population are traffic enforcers who are constantly exposed to air pollution. In the Philippines, the MMDA has the widest coverage in traffic management. The study determined the risk of COPD among Metro Manila Development Authority (MMDA) traffic enforcers in relation to ambient air quality level, as well as identified other factors that increase the risk of developing COPD.MethodsFifty-two MMDA traffic enforcers deployed in PM_2.5 air quality sensor areas in Metro Manila from 2016 to 2018 were recruited through stratified sampling. The International Primary Airways Guidelines (IPAG) questionnaire was utilized to measure risk of COPD. Respiratory health and working history were obtained through questionnaires. Department of environment and natural resources provided PM_2.5 ambient air quality data which aided in the construction of the Exposure-Month Index. Ordinal logistic regression was used to examine the association of PM_2.5 together with the relevant factors and the risk of COPD.ResultsWe found statistically significant associations between PM_2.5 and COPD among high risk category [odds risk (OR): 1.24, 95% confidence interval (CI): 1.07–1.44]. Age (Moderate, OR: 1.16, 95% CI: 0.98–1.38 and High, OR: 10.06, 95% CI: 4.02–25.17) and chest pain (Moderate, OR: 68.65, 95% CI: 1.71–2.75 × 10³) were potential risk factors, whereas body mass index (BMI) (OR: 0.05, 95% CI: 0.01–0.53) exhibited protective effect.ConclusionsExposure to PM_2.5 was associated with an increased risk of COPD among high-risk category MMDA traffic enforcers. Age and chest pain were potential risk factors to risk of COPD, whereas BMI exhibited a potential protective effect. Results of this study can be used for clinical management of high-risk populations, such that of MMDA traffic enforcers.     

Air pollution and chronic obstructive pulmonary disease

There is considerable epidemiological evidence indicating that air pollution has adverse effects on human health and is closely related to respiratory diseases, including chronic obstructive pulmonary disease (COPD). These effects, which can be divided into short- and long-term effects, can manifest as an exacerbation of existing symptoms, impaired lung function, and increased hospitalization and mortality rates. Long-term exposure to air with a high concentration of pollutants may also increase the incidence of COPD. The combined effects of different pollutants may become more complex in the future; hence, there is a need for more intensive research on specific at-risk populations, and formulating corresponding protective strategies is crucial. We aimed to review the epidemiological evidence on the effect of air pollution on COPD, the possible pathophysiological mechanisms underlying this effect, as well as protective measures against the effects of air pollutants in patients with COPD.     

Mental health outcomes among patients from Fangcang shelter hospitals exposed to coronavirus disease 2019: An observational cross-sectional study

Background: The coronavirus disease 2019 (COVID-19) is not only attacking physical health, but it is also increasing psychological suffering. This study aimed to observe the impact of the COVID-19 pandemic on mental health outcomes among patients with mild to moderate illness in Fangcang shelter hospitals.Methods: We conducted an observational, cross-sectional study of 129 patients with mild to moderate illness from Jiangxia Fangcang shelter hospitals in Wuhan, China. The participants were assessed by quantifying their symptoms of depression, anxiety, insomnia, and stressful life events and analyzing potential risk factors associated with these symptoms. Using correlation analysis, we examined associations between exposure to COVID-19 and subsequent psychological distress in response to the outbreak.Results: In total, 49.6% of participants had depressive or anxiety symptoms. The depressive and anxiety symptoms were highly related to sleep disturbances and hypochondriasis (allr > 0.50,P < 0.01). The impact of the event was positively related to depressive symptoms, anxiety symptoms, sleep disturbances, hypochondriasis and life events (allr > 0.35,P < 0.01) but was negatively related to psychological resilience (r = -0.41,P < 0.01). The presence of the COVID-19 infection in this setting was associated with increased anxiety, depression and stress levels, and decreased sleep quality, and seriously affected patients’ quality of life as well as adversely affecting the course and prognosis of physical diseases.Conclusion: The sleep quality, anxiety, and depression of COVID-19 patients in Fangcang shelter hospitals were significantly related to the impact of the epidemic.     

冠心病心绞痛患者健康教育和心理护理效果

目的探讨对冠心病心绞痛患者给予健康教育联合心理护理干预后对其生活质量等方面产生的影响。方法选择我院2017年4月-2019年2月收治的100例冠心病心绞痛患者作为实验对象;抽签法分组后探究每组患者护理方式;对照组(50例):选择基础护理方式展开疾病护理;试验组(50例):选择基础护理+健康教育+心理护理方式展开疾病护理;对比各组患者表现出的护理工作满意度以及生活质量评定差异。结果试验组冠心病心绞痛患者护理工作总满意度(98.00%)高于对照组(82.00%)明显(P<0.05);试验组冠心病心绞痛患者睡眠情感、社会生活、精力以及躯体活动评分均高于对照组(P<0.05)。结论冠心病心绞痛患者在接受临床护理工作期间,对于护理工作满意度的提升,各项生活质量指标(睡眠情感、社会生活、精力以及躯体活动)评分结果的提升,均获得明显作用效果,最终对于冠心病心绞痛患者生活质量以及康复状态的显著提升,奠定基础。     

医科大学医学生健康教育培训需求度和满意度现状分析

目的 了解医学生学习《健康教育》课程的满意度、需求度现状及差异，为《健康教育》课程优化提供参考。方法 以某医科大学在校临床医学生为研究对象，分析医学生对课程内容的需求度和满意度及二者差异。课程内容包括服药依从性、戒烟干预、合理膳食、心理压力管理、中医康复技术、慢性传染病健康教育、急性传染病健康教育、移动健康技术教育、运动康复指导及健康促进理论。采用频数和构成比指标进行统计描述，采用卡方检验进行健康教育课程学习情况与专业/ 学制之间、相关课程内容学习的需求度与学制的差异，相关课程内容学习需求度与满意度的关联比较采用秩和检验。以P ＜ 0.05 为差异具有统计学意义。结果 戒烟干预、合理膳食、心理压力管理、中医康复技术、慢性传染病健康教育、急性传染病健康教育、移动健康技术教育及健康促进理论八项的学习需求度在长学制医学生与五年制医学生中的总体分布位置不同（U ＝ 2.4、2.2、2.5、2.3、2.4、2.4、2.3、2.0，P 均＜ 0.05）；服药依从性、戒烟干预、合理膳食、心理压力管理、慢性传染病健康教育、急性传染病健康教育、移动健康技术教育及运动康复指导八项的满意度与需求度之间的总体位置分布不同（U ＝ 6.2、5.2、7.2、9.2、5.9、6.1、2.1、3.2，P 均＜ 0.05）；不同学制的医学生对于慢性病人、老年人、孕产妇、传染病人、高危人群和职业暴露人群的健康教育重点关注人群侧重有所不同，其差异具有统计学意义（χ2 ＝ 8.9、14.2、9.9、6.9、23.9、17.8，P 均＜ 0.05）；在教学方式上，不同学制的医学生对于教师课堂讲授和小组讨论的偏好上的差异具有统计学意义（χ2=6.3、9.5，P 均＜ 0.05）。结论 当前健康教育课程的教学内容和结构未能完全满足不同学制、年级医学生的学习需求，需要对课程教学内容、教学方式和开设时间进行进一步的优化设计。     

Long non-coding RNAs as novel diagnostic and therapeutic targets in kidney disease

Long non-coding RNAs (lncRNAs) have critical roles in the development of many diseases including kidney disease. An increasing number of studies have shown that lncRNAs are involved in kidney development and that their dysregulation can result in distinct disease processes, including acute kidney injury (AKI), chronic kidney disease (CKD), and renal cell carcinoma (RCC). Understanding the roles of lncRNAs in kidney disease may provide new diagnostic and therapeutic opportunities in the clinic. This review provides an overview of lncRNA characteristics, biological function and discusses specific studies that provide insight into the function and potential application of lncRNAs in kidney disease treatment.     

新型健康教育护理模式在冠心病护理中的应用

目的评价冠心病患者临床治疗中应用新型健康教育护理模式干预的价值,为冠心病患者治疗护理工作提供参考。方法选择本院收治住院治疗的冠心病患者,总计70例。在常规对症支持治疗的基础上进行70例冠心病患者随机数字表法分组,经医院伦理委员会批准同意,参照组、试验组例数一致。参照组35例冠心病患者接受住院期间常规护理,试验组35例冠心病患者在常规护理基础上配合新型健康教育护理模式。对比参照组以及试验组冠心病患者疾病知识掌握度、遵医率、护理满意度。结果试验组冠心病患者护理干预后疾病知识掌握度、遵医率以及护理问卷满意度调查结果均明显高于参照组,P <0.05差异有统计学意义。结论冠心病患者住院常规治疗以及护理期间配合新型健康教育护理模式可以明显提高患者疾病知识掌握情况、护理满意度,从而规范患者治疗,提高患者治疗依从性以及治疗预后情况,护理价值显著。     

Early chronic obstructive pulmonary disease: A new perspective

Chronic obstructive pulmonary disease (COPD) is a respiratory disease with a high incidence, mortality, and disability rate. Because there are few symptoms in the early stages of COPD, diagnosis and treatment are seriously insufficient. It is necessary to find effective clues for early COPD diagnosis and provide appropriate interventions. Several studies suggest that small airway disease is the earliest stage of COPD because it is correlated with subsequent development of airflow obstruction. However, there are currently no globally accepted criteria for defining early COPD. This study mainly introduced risk factors, definition, diagnosis, and treatment of early COPD from a new perspective.     

Epidemiologic evidence linking oxidative stress and pulmonary function in healthy populations

Respiratory health in the general population declines regardless of the presence of pulmonary diseases. Oxidative stress has been implicated as one of the mechanisms involved in respiratory dysfunction. This review was to evaluate studies that relate oxidative stress factors with pulmonary function among the general population without prior respiratory illnesses. The search yielded 54 citations. Twenty-one studies qualified for incorporation in this review. Owing to the heterogeneity of the review, studies were discussed based on identified oxidative stress factors responsible for pulmonary dysfunction. Oxidative stress biomarkers, including gene polymorphisms of nuclear factor erythroid 2-related factor 2, heme oxygenase 1, glutathione S transferase, superoxide dismutase, and lipid peroxidation products were involved in lung function decline. In addition, the antioxidant status of individuals in reference to dietary antioxidant intake and exposure to environmental pollutants affected oxidative stress and pulmonary function, as indicated by forced expired volume in one second, forced vital capacity, and forced expiratory flow at 25%–75%_. This review indicated that oxidative stress is implicated in the gradual decline of lung function among the general population, and gene polymorphism along the antioxidant defense line and/or their interaction with air pollutants reduce lung function. Different polymorphic forms among individuals explain why the rate of lung function decline differs among people. Dietary antioxidants have respiratory health benefits in antioxidant gene polymorphic forms. Therefore, the genetic composition of an individual may be considered for monitoring and identifying people at risk of respiratory illnesses.     

Pulmonary embolism with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease. The incidence of COPD is growing annually in China, and it is a significant and growing public health burden. Multivariate analysis showed that COPD was one of the independent risk factors for the occurrence of pulmonary embolism (PE), and the incidence of PE was significantly higher in COPD patients than in normal subjects. However, PE is often overlooked in patients with acute exacerbation of COPD (AECOPD) because there are many similarities in clinical symptoms between PE and AECOPD, which are difficult to distinguish, resulting in the failure of timely treatment and poor prognosis. Therefore, it is of great significance to understand the clinical manifestations, diagnosis, and treatment of COPD combined with PE for making a more accurate diagnosis, providing timely and effective treatment, and improving the prognosis of such patients.     

年轻型缺血性脑血管病的特点及病因分析

目的观察分析年轻型缺血性脑血管病的特点及病因。方法选取医院(在2018年1月—2019年2月)收治的43例年轻型缺血性脑血管病患者(作为实验组),再选取医院同期搜集的43例健康体检者作为对照组。结果实验组年轻型缺血性脑血管病患者的男性发病率显著高于女性(P<0.05),实验组年轻型缺血性脑血管病患者的主要发病因素有:(1)经常吸烟;(2)经常酗酒;(3)患有高血压病史;(4)患有糖尿病病史;实验组年轻型缺血性脑血管病患者的吸烟所占比、酗酒所占比、患有高血压病史所占比、患有糖尿病病史所占比显著高于对照组(P<0.05),实验组年轻型缺血性脑血管病患者的颈动脉内中膜厚度、斑块检出率以及血脂水平与对照组比较有统计学意义(P<0.05)。结论年轻型缺血性脑血管病的特点为:男性患者发病率显著高于女性患者。     

Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019 (COVID-19) epidemic

COVID-19 has become a pandemic and it has already spread to at least 171 countries/regions. Chronic kidney disease (CKD) is a global public health problem with a total of approximately 850 million patients with CKD worldwide and 119.5 million in China. Severe COVID-19 infection may damage the kidney and cause acute tubular necrosis, leading to proteinuria, hematuria and elevated serum creatinine. Since the SARS-CoV-2 enters the cells by binding to the angiotensin-converting enzyme 2 receptor, some doctors question its ability to increase the risk and severity of developing COVID-19. Neither clinical data nor basic scientific evidence supports this assumption. Therefore, patients who take angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are not advised to change their therapy. Patients with CKD are generally the elderly population suffering from multiple comorbidities. Moreover, some patients with CKD might need to take glucocorticoids and immunosuppressants. Dialysis patients are recurrently exposed to a possible contaminated environment because their routine treatment usually requires three dialysis sessions per week. Considering all the above reasons, patients with CKD are more vulnerable to COVID-19 than the general population. The development of COVID-19 may worsen the impaired kidney function and further lead to rapid deterioration of kidney function and even death. Strict comprehensive protocols should be followed to prevent the spread of COVID-19 among patients with CKD. In this review, we provide some practical management recommendations for health care providers, patients with CKD, dialysis patients and dialysis facilities.     

疾病防控体系中公共卫生伦理学教育的意义与实践挑战

在国家公共卫生改革的背景下，公共卫生伦理学教育应成为疾病防控体系的重要支柱之一。公共卫生伦理学教育能够培养人的道德品质、责任感和伦理决策能力，通过保证疾病防控体系设计的合理性和实施的正当性，以应对客观存在的公共卫生伦理难题。公共卫生伦理学教育应在医疗卫生人才培养的基础上延伸为公民健康素养教育，对不同受教育对象应设置不同教育目标。此外，公共卫生伦理学教育还需应对外部教育环境改变与其自身研究力量薄弱等现实问题。     

妇女计划生育保健知识宣教对首次妊娠的妊娠结局影响

目的探讨妇女计划生育保健知识宣教对首次妊娠的妊娠结局影响。方法选取2018年1—6月于医院妇产科备产的初产妇236例作为研究对象,按照随机数字法进行分组,其中给予妇女计划生育保健知识宣教的127例初产妇作为观察组,未实施宣传教育的109例初产妇作为对照组,比较两组孕妇足月妊娠时体质量指数、分娩方式、新生儿Apgar评分等妊娠结局以及产后恢复情况。结果观察组首次妊娠妇女BMI指数明显低于对照组,差异具有统计学意义(P<0.05)。观察组首次妊娠妇女选择自然分娩的人数明显多于对照组,观察组选择阴道助产以及剖宫产的人数明显低于对照组,差异具有统计学意义(P<0.05)。比较两组首次妊娠妇女的新生儿Apgar评分差异不具有统计学意义(P>0.05)。观察组首次妊娠妇女泌乳始动时间、子宫降入盆腔时间以及恶露排出时间明显短于对照组,差异具有统计学意义(P<0.05)。结论加强给予初次产妇进行妇女计划生育保健知识宣教能够对产妇的产后恢复起到积极影响以及提升产妇的妊娠结局。     

青少年非自杀性自伤的研究分析

目的探讨青少年非自杀性自伤的原因,并提出相关对策。方法对四川某三甲医院2019年1月—2019年12月收治的120例非自杀性自伤青少年进行研究,展开青少年心理、生活、学习、人际关系等多层面的分析与探讨。结果青少年非自杀性自伤的原因多样,98例(81.7%)有抑郁症;67例(55.8%)有焦虑症;66例(55.0%)受到校园欺凌;56例(46.7%)单亲家庭或无父母陪同生活;54例(45.0%)学习压力大;38例(31.7%)具有人际交往障碍;25例(20.8%)具有网瘾。结论青少年在心理上受到多种因素影响常造成较大心理压力,当受到外界环境影响如语言、行为、意识冲击时,存在无明确意图对自身伤害的行为。在该类非自杀性自伤的病因上不具有特殊性,但通过对多重原因的分析,青少年在受到心理刺激时产生非自杀性自伤的概率较大,因此需要形成对青少年心理健康的教育与引导,减少青少年非自杀性自伤情况发生。     

不同药物在高血压并冠心病患者中的效果

目的研究分析在高血压合并冠心病患者中使用氨氯地平阿托伐他汀钙片治疗的临床效果。方法将2018年4年-2019年1月在本院接受治疗的高血压合并冠心病患者中的126例设为研究对象。经电脑随机法分组为观察组(63例)以及对照组(63例)。对照组中患者均采用氨氯地平进行治疗,观察组中患者在使用氨氯地平治疗的同时加用阿托伐他汀钙片治疗。对比两组患者的高血压治疗效率以及冠心病治疗效率情况。结果观察组中患者的高血压治疗效率显著高于对照组(P<0.05),观察组患者的冠心病治疗效率显著高于对照组(P<0.05)。结论临床上针对高血压合并冠心病患者采用氨氯地平联合阿托伐他汀钙片治疗效果良好,患者的高血压症状以及冠心病症状均显著改善。     

Association between timing of peritoneal dialysis initiation and mortality in end-stage renal disease

Despite the widespread use of chronic dialysis for end-stage renal disease (ESRD), there is no consensus on the optimal timing of initiating renal replacement therapy. Over the past decade, a worldwide trend toward increasing glomerular filtration rate at the initiation of dialysis has been noted. However, available data indicate that early dialysis has no survival benefit or is harmful. Peritoneal dialysis (PD) is one alternative for ESRD and has potential survival factors different from those of hemodialysis. The association between the timing of PD initiation and survival is unclear. This review examines the effect of the timing of dialysis on clinical outcomes in PD patients.     

PBL教学模式对医学教育环境影响的Meta分析

目的 评价PBL对医学教育环境的改善效果.方法 广泛检索1969年1月—2018年12月间发表的与PBL和医学教育环境相关的研究.最后入选9项PBL与传统教学法比较的随机对照研究.采用Cochrane偏倚风险评估工具对入选研究的质量进行评价.采用Review Manager(RevMan)5.3版软件进行数据统计分析.对医学教育环境影响的效应量用加权均数差(MD)和95%可信区间(CIs)表示.异质性评价采用Cochrane'sχ2检验和I2值.发表偏倚的评价应用漏斗图法.结果 由于教学研究的特点,对参与者施盲方面9项研究均为高风险,5项研究的测量偏倚存在高风险.其余方面的偏倚均为低风险.PBL对医学教育环境指标(DREEM评分)的影响优于传统教学法,差异具有统计学意义.结论 本研究表明PBL对医学教育环境的影响优于传统教学模式.