台风伤害及其影响因素的现场流行病学研究

目的分析台风伤害的危险因素。方法采用现场流行病学调查方法,1:2配对的病例对照研究。对照组选伤害者邻居,按照同职业、同村庄、同性别和年龄±5岁配对。结果台风造成392人受伤住院治疗,50人死亡。伤害罹患率为27．3／10万,伤害致死率为11．3％,伤害死亡率3．1／10万。调查了209名受伤者和31名死亡者。发现伤害主要发生在台风来临前,其中台风来临前1～6小时之间有病例155例,占64．6％。209例伤害病例中,67．5％的病例曾得到过台风预警,但138名应答者中重视预警的只有47人,仅占34．0％。发现“台风来临时不在家中”[调整OR值(MH)=3．9 (95％CI:1．9～7．7)]、“台风来临前未得到预警”[调整OR值(MH)=3．3(95％CI:1．3～8．6)]和“虽得到预警但不重视”[调整OR值(MH)=17(95％CI:4．2～68)]是台风伤害的危险因素。结论外出、不重视预警是台风伤害的危险因素,应加强台风来临的预警宣传力度。     

温岭市"云娜"台风伤害现场调查

目的了解温岭市"云娜"台风造成伤害的流行特征,探讨伤害原因.方法采用面访和电话调查的方法,对2004年8月12日0:00时至8月14日18:00时,温岭市因台风伤害而入院的392例住院病例进行调查;伤害危险因素采用1:2配对病例对照研究;数据录入access,转入EpiInfo 2002和SPSS 12.0软件分析.结果伤害高峰时间发生在台风登陆前4～5 h;男性高于女性(X2=21.414,P＜0.001);年龄与伤害发生之间存在正相关(r=0.929,P＜0.01);文化程度与伤害发生之间存在负相关(r=-0.822,P＜0.05);台风来临前未得到预警或不重视发生伤害的危险性是对照组的6.73倍(OR=6.73,95% CI:3.11～14.53);台风来临时在室外发生伤害的危险性是在室内的3.86倍(OR=3.86,95% CI 1.94～7.66).结论加强台风预警,台风登陆前后不外出.     

成都市青羊区居民跌倒伤害相关危险因素分析

目的了解成都青羊区居民跌倒伤害的流行病学特征及潜在危险因素,为伤害预防提供流行病学依据。方法根据2010-2014年成都青羊区伤害哨点监测收集跌倒伤害数据,分析描述跌倒伤害流行病学特征,采用二分类多元Logistic回归分析识别跌倒其危险因素。结果监测报告的33 273例跌倒伤害病例中,男性20 015例(60.15%)、女性13 258例(39.85%),性别比1:1.51;轻伤25 707例(77.26%)、重伤7 566例(22.74%);年龄构成15岁11981例(36.01%)、15~24岁3 933例(11.79%)、25~59岁12 752例(38.33%)、≥60岁4 607例(13.85%)。Logistic回归结果显示:在跌倒伤害监测病例中,严重跌倒伤害的保护因素有:年龄小于15岁(OR=0.410,95%CI:0.333~0.505)、15~24岁(OR=0.546,95%CI:0.470~0.633)、25~59岁(OR=0.693,95%CI:0.624~0.768);户籍为本辖区(OR=0.709,95%CI:0.661~0.761);伤害性质为挫伤(OR=0.556,95%CI:0.492~0.628)、开放伤(OR=0.747,95%CI:0.648~0.861)。危险因素有:男性(OR=1.096,95%CI:1.034~1.162)文化程度小学及以下(OR=1.301,95%CI:1.169~1.448)、职业学生(OR=1.183,95%CI:1.001~1.399)、工人农民(OR=1.273,95%CI:1.124~1.441)、伤害部位为头部(OR=1.177,95%CI:1.101~1.260)、躯干(OR=1.441,95%CI:1.289~1.613)、多部位(OR=3.374,95%CI:2.905~3.917)伤害性质为骨折(OR=3.802,95%CI:3.302~4.377)、器官损伤(OR=2.210,95%CI:1.894~2.578)、院前时间(OR=1.004,95%CI:1.002~1.006)。结论跌倒伤害全人群均易发生,其中在儿童青少年和60岁以上老年人群中,跌倒伤害容易造成需要住院治疗的伤害结局。应针对各年龄段居民,制定具体有效的卫生政策,开展伤害预防健康教育,改善环境安全设施,降低跌倒伤害事件特别是严重伤害事件的发生。     

银川市中小学生伤害危险因素病例对照研究

目的探讨中小学生伤害发生的危险因素，为开展伤害预防干预提供依据。方法选择银川市2所中学、3所小学的2574名中小学生进行横断面调查，按年龄、性别、班级1：1配对原则，选择213例伤害病例和对照进行病例对照研究。结果单因素分析显示，父母再婚、父亲是工人及无业者、学生在家排行老三、家庭子女数、接受安全教育、独自操作电器及使用锐利工具与伤害发生有关。多因素分析显示，父母再婚（OR=6.885）、父亲无业（OR=3.333）、父亲是工人（OR=1.530）、独自操作电器（OR=1.844）是中小学生伤害的危险因素，而接受安全教育（OR=0.547）为中小学生伤害的保护因素。结论中小学生伤害是多因素综合作用的结果，应针对伤害发生的危险因素采取有效预防措施，以减少中小学生伤害的发生。     

伤害监测病例伤害严重程度影响因素的有序分类Logistic回归分析

[目的]了解伤害监测病例伤害严重程度的影响因素,为下一步工作提供依据。[方法]采用有序分类Logistic回归分析方法,对米易县2006-2007年伤害监测哨点医院报告的14993例伤害病例进行分析。[结果]有序分类Logistic回归分析结果,影响严重伤害（中度、重度伤害）发生的危险因素是伤害原因中的中毒（OR=2．448）,伤害发生地点中的其他（OR=11．032）、工业和建筑场所（OR=2．735）、农场／农田（OR=2．701）、家中（OR=2．610）、公路街道（OR=2．083）;保护因素分别有女性（深=0．843）,中间年龄组5～14岁（OR=0．666）、15～24岁（OR=0．552）、25～59岁（OR=0．650）;与神经系统比较发生于其他部位的伤害是较轻的伤害。[结论]男性、老年人、中毒、自残／自杀是严重伤害发生的最主要危险因素。     

社区老年白内障患者伤害流行病学特征及影响因素分析

目的了解白内障患者伤害发生水平、流行病学特征和危险因素,为制定白内障患者伤害防制措施提供科学依据。方法采用随机抽样的方法选择居住在上海市长宁区的白内障患者830例。应用自行设计的调查表对过去1年的伤害发生情况和可能与伤害有关的危险因素进行入户调查。对危险因素分别进行单因素和二分类多因素logistic回归分析。结果白内障患者在过去1年里伤害发生率为12.3%。其中54.5%发生多次伤害,81.8%的伤害为跌倒。受伤者中23.2%发生骨折,30.3%到医院就诊,10.1%需要住院治疗。单因素分析发现,以伤害发生为因变量,性别(OR=2.629)、双眼最佳视力(OR=0.196)、睡眠质量(OR=1.893)、健康状况(OR=2.478)、患病数量(OR=1.126)和是否参加体育锻炼(OR=0.635)6个因素有统计学意义(P0.05,P0.01)。以多次伤害发生为因变量,性别(OR=2.446)、双眼最佳视力(OR=0.055)和健康状况(OR=2.996)3个因素有统计学意义(P0.05,P0.01)。多因素logistic回归分析发现,以伤害和多次伤害为因变量进入模型的因素只有性别和双眼最佳视力。结论白内障患者多次伤害发生率的比例较高,伤害造成的影响较大,干预重点应是跌倒的预防,改善视力是最有效的干预措施。     

金属制造业职业伤害危险因素的病例交叉研究

目的 探讨金属制造业职业伤害的瞬时危险因素.方法 采用配对病例交叉研究的方法,研究对象为广东省中山市4个职业伤害定点医院收治的来自金属制造业的由机械压力导致的职业意外伤害患者208人,采集伤害发生前30 min内危险因素的暴露情况,伤害发生前一天同一时段12种急性危险因素的暴露情况.结果 采用条件logistic回归分析,结果显示,更换工作岗位(OR =20.76,95％ CI=2.04～210.53),突然加班(OR =10.11,95％ CI=2.57～39.75)是职业伤害的危险因素(P＜0.01),而其他危险因素没有统计学意义.结论 更换工作岗位和突然加班是职业伤害的危险因素.     

安徽省长丰县农村留守儿童伤害分布及危险因素研究

目的 了解安徽省农村地区留守儿童伤害的分布及危险因素.方法 采用分层整群抽样方法抽取安徽省长丰县农村3617名中小学生进行问卷调查,了解留守儿童最近1年伤害的发生情况,并对其伤害发生的相关因素进行单因素和多因素logistic回归分析.结果 调查留守儿童1614名,占学生总数的45.83%.主要监护类型为单亲监护(55.82%).中小学生伤害发生率为32.25%,男生伤害发生率为45.22%,女生为35.28%,差异有统计学意义(χ2=16.245,P=0.000);其中留守儿童伤害发生率为40.90%,高于非留守儿童(24.95%),差异有统计学意义(χ2=101.730,P=0.000).留守儿童在跌伤、交通伤、动物咬伤等7种伤害类型上发生率高于非留守儿童,差异有统计学意义.多因素分析显示:非独生子女(OR=1.445)、性格外向(OR=1.062)、矛盾性(OR=1.150)、独立性(OR=1.110)、娱乐性(OR=1.096)可能是留守儿童伤害的危险因素,而女生(OR=0.598)、亲密度(OR=0.933)、控制性(OR=0.917)可能是留守儿童的保护性因素.结论 该地区留守儿童伤害由多种因素共同作用导致,家庭环境和个人性格起主要作用,应针对危险因素采取有效的预防措施,减少留守儿童伤害的发生.     

泸州市农村留守学生伤害流行特征及其危险因素分析

目的了解泸州市农村留守学生伤害发生特征及其危险因素,为制定预防措施提供依据。方法采用分层整群抽样方法抽取泸州市13所农村中学11 662名7~9年级在校学生进行问卷调查,了解留守学生伤害发生情况,并对伤害发生因素进行单因素和多因素非条件Logistic回归分析。结果留守学生占40.25%(4 694/11 662),伤害发生率12.93%(607/4 694)低于非留守学生14.16%(987/6 968),(χ~2=3.615,P=0.057)。男生伤害发生率14.79%(374/2529)高于女生10.76%(233/2 165)(χ~2=16.795,P=0.000)。前3位伤害为跌倒/坠落(38.97%)、割伤/刺伤(20.77%)和扭伤/拉伤(16.26%),其中故意自伤发生率(0.26%)高于非留守学生(0.09%)(χ~2=5.231,P=0.022);发生场所以学校(39.61%)、家里(36.26%)为主。多因素分析显示:男生(OR=1.385)、独生子女(OR=1.328)、骑自行车上学(OR=1.521)、乘校车上学(OR=2.421)是留守学生伤害的主要危险因素。结论泸州市农村留守学生伤害发生率较高,以跌倒/坠落为主,故意自伤不容忽视。学校和家庭是主要受伤场所,由多种因素相互作用所致,应加强预防干预措施的研究。     

某县农村学龄儿童伤害影响因素的病例对照研究

探讨农村学龄儿童伤害发生的影响因素,为开展伤害预防干预提供依据.方法 随机选取某县农村小学、初中各3所学校,分层整群抽取小学三~五年级、中学七~八年级共2 196名学龄儿童作为研究对象;筛选出1年内发生过伤害的354名学龄儿童作为病例组,按照同班级、同年龄、同性别的原则1∶1选取未发生伤害的学龄儿童作为对照组.采用自拟调查表对儿童基本情况及伤害情况进行调查.结果 过去1年内共有354人发生伤害,伤害人数发生率为16.12%;发生伤害375人次,伤害人次发生率为17.08%.非留守儿童(OR=0.467,95%CI=0.248~0.987)是伤害发生的保护因素,身体状况一般(OR=1.801,95%CI=1.187~2.733)、有伤害史(OR=3.161,95%CI=1.611~6.203)、非独生子女(OR=2.071,95%CI=1.413~3.037)是伤害发生的危险因素.结论 农村学龄儿童伤害发生比较普遍,儿童自身因素对伤害的发生有重要影响.     

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.     

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.