个体化医学营养治疗对不同糖化血红蛋白水平2型糖尿病病人感染率的影响

目的:探讨个体化医学营养治疗对不同糖化血红蛋白(HbA1c)水平的2型糖尿病(T2DM)病人感染率的影响. 方法:将97例T2DM病人随机分为干预组(n=51)和对照组(n=46),分别对其进行个体化医学营养治疗配合糖尿病综合治疗和单纯糖尿病综合治疗,连续观察6个月.在研究开始前和研究结束时行人体组织成分分析、血生化和CD4+、CD8+测定,同时记录饮食、运动、药物治疗和感染等情况. 结果:干预组病人HbA1c≤6.5％为15例,＞6.5％为36例;对照组HbA1c≤6.5％为14例,＞6.5％为32例.与对照组比,研究后干预组各亚组的CD4+和CD4 +/CD8+比值明显升高(P＜0.05),CD8+降低(P＜0.05).与研究前比较,两组HbA1c ＞6.5％者CD4+升高(P＜0.01),CD8+降低(P＜0.01).与对照组比较,干预组发热时体温升高和持续时间均显著降低(P＜0.05),HbA1c ＞6.5％者发热、上呼吸道感染、肺部感染、皮肤脓肿与破溃的发生率降低(P＜0.05),而HbA1c≤6.5％者泌尿系感染和口腔溃疡的发生率降低(P＜0.01). 结论:无论HbA1c控制如何,个体化医学营养治疗均可提高T2DM病人的免疫功能,减少感染患病率.而不同HbA1c水平下各组织中细菌繁殖能力亦不同.     

上海市奉贤区社区管理2型糖尿病患者血糖控制的影响因素

目的 评价上海市奉贤区社区管理2型糖尿病患者血糖控制情况,了解血糖控制的影响因素.方法 采用问卷调查和临床检查相结合的方法调查社区2型糖尿病患者的血糖控制情况,并分析血糖控制影响因素.结果 193名患者糖化血红蛋白(HbA1c)的平均值为(7.7±1.4)％.根据中华医学会糖尿病协会(CDS)的控制目标,24.4％的患者HbA1c达标(＜6.5％),根据ADA控制目标,34.2％的患者HbA1c达标(＜7.0％).多因素logistic回归分析结果显示,影响血糖控制效果的因素有人均月收入低、病程长、有家族史和无规律运动.结论 目前奉贤区2型糖尿病血糖控制达标率较低,血糖控制受多种因素影响.     

2型糖尿病颈动脉粥样硬化与血脂及胰岛素抵抗的关系

目的 探讨2型糖尿病(T2DM)患者颈动脉粥样硬化(AS)与血脂及胰岛素抵抗的关系,为有效预防和控制AS的发生发展提供科学依据.方法 选择沈阳医学院沈洲医院93例T2DM患者作为研究对象,测量患者颈动脉内中膜厚度(IMT)、斑块情况.根据IMT值将T2DM患者分为3组:单纯糖尿病(DM)组32例,中膜增厚组31例,斑块组30例.选取健康对照组30例.测定血脂、血糖、胰岛素抵抗指数(HOMA-IR).结果 IMT与空腹血糖(FPG)、空腹胰岛素(FINS)、HOMA-IR、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白a(Lp-a)呈正相关,与高密度脂蛋白胆固醇( HDL-C)、载脂蛋白A1(ApoA1)呈负相关,均有统计学意义(P＜0.01).logistic回归分析结果显示,TC是T2DM颈AS的危险因素(OR=23.649,95％ CI:2.410～232.104),HDL-C(OR=0.008,95％ CI:0.000～0.279)、载脂蛋白B(OR=0.000,95％CI:0.000～0.101)是保护因素.结论 T2DM颈AS与血脂及胰岛素抵抗密切相关.     

年龄分层下不同血糖控制水平与糖尿病视网膜病变的关联

目的探讨不同年龄段2型糖尿病(T2DM)患者血糖控制情况与糖尿病视网膜病变的关系,为有效预防糖尿病视网膜病变的发生提供临床依据。方法选取2018年1—12月在中国科学院大学深圳医院东院区内分泌科住院的439例T2DM患者为研究对象。进行实验室生化指标测定;由专业眼科医生进行双侧眼底照相,根据病变严重程度进行糖尿病视网膜病变分期;根据年龄和糖化血红蛋白(HbA1C)评价血糖控制情况(血糖控制良好为≥65岁人群HbA1C8.0%,65岁人群HbA1C6.5%)。用SAS 9.4软件进行t检验、非参数检验、χ~2检验、单因素和多因素非条件logistic回归分析。结果 439例患者中,糖尿病视网膜病变组138例,非糖尿病视网膜病变组301例。糖尿病视网膜病变组年龄、男性比例、糖尿病病程、高密度脂蛋白胆固醇、尿微量白蛋白/尿肌酐、糖尿病周围神经病变、高血压及服用降压药的比例均高于非糖尿病视网膜病变组;而尿酸、甘油三酯、血红蛋白和红细胞计数均低于非糖尿病视网膜病变组,差异均有统计学意义(P0.05,P0.01)。多因素logistic回归分析调整混杂因素后结果显示,血糖控制良好的T2DM患者发生视网膜病变的风险低于血糖控制差的患者(OR=0.450,95%CI:0.212～0.957),有统计学意义(P0.05)。进一步分析发现,血糖控制良好的T2DM患者发生Ⅱ期及以上视网膜病变的风险低于血糖控制差的T2DM患者(OR=0.326,95%CI:0.131～0.811),有统计学意义(P0.05)。结论 65岁以下T2DM患者HbA1C控制在6.5%以下,65岁及以上T2DM患者HbA1C控制在8%以下,能有效降低糖尿病视网膜病变的发病风险,特别是Ⅱ期及以上视网膜病变的风险。     

上海市金山区2型糖尿病患者血糖控制及用药现状调查

目的 评价金山区社区管理的2型糖尿病患者的血糖控制情况,描述2型糖尿病患者的用药现状.方法 采用单纯随机抽样的方法抽取本区2型糖尿病患者110人进行问卷调查和体检.结果 110位患者,糖化血红蛋白(HbA1c)平均值为(7.3±1.3)％.根据2007年中华医学会糖尿病学分会(CDS)推荐的控制目标,28.2％的患者HbA1c达标(＜6.5％),4.5％的患者HbA1c、血压(BP)和甘油三酯(TG)都达标(HbA1c＜ 6.5％,BP＜ 130/80 mm Hg,TG＜ 1.5 mmol/L);降糖药使用位居前3位的依次为磺脲类、双胍类、胰岛素,分别占使用降糖药总人数的63.5％、50.0％和15.4％;血糖控制组患者单用口服药比例高于糖控制不良组患者.结论 本区2型糖尿病患者仍有相当比例患者HbA1c水平不达标,接受胰岛素治疗患者比例低,需要加强糖尿病预防控制工作,逐步改善糖尿病防治状况.     

Ⅱ型糖尿病与乳腺癌关系病例对照研究

目的 探讨中国汉族人群Ⅱ型糖尿病(T2DM)与乳腺癌的关系.方法 采用非匹配病例对照研究方法,400例原发性乳腺癌患者来自于黑龙江省肿瘤医院,病例经病理证实为原发性乳腺癌,400名非乳腺癌女性来自黑龙江省电力医院体检中心,采用面对面问卷调查,同时实验室检测空腹血糖.结果 单因素分析T2DM为乳腺癌的危险因素(OR=6.204,95％ CI=3.008～12.799);只调整年龄时,T2DM仍然为乳腺癌的危险因素(OR=6.019,95％CI=2.903 ～ 12.476);调整年龄、文化程度、工作强度、月收入、吸烟、饮酒、体育锻炼、产第1胎(年龄、流产史、经历负性生活事件后,T2DM仍然是乳腺癌的危险因素(OR=3.912,95％CI=1.526 ～ 10.028).结论 T2DM与乳腺癌存在关联.     

三餐后有氧运动对糖尿病疗效观察

[目的]探讨三餐饭后有氧运动对2型糖尿病(type 2 diabetes mellitus,T2DM)患者疗效的影响.[方法]选择无运动禁忌证的T2DM患者60例,随机分为干预组和对照组各30例,干预组在药物、饮食治疗基础上坚持进行三餐后运动,3个月后检测空腹血糖(FPG)、早中晚三餐后2 h血糖(2 h PG)、耱化血红蛋白(HbA1c)及血压、体重、体重指数(BMI)等指标,前后自身对照及组间对照评价其治疗效果.[结果]干预组的FPG、三餐后2 h PG、HbA1c、体重、BMI、血压控制均明显优于对照组,差异有统计学意义(P＜0.05);经过干预治疗后患者的FPG、三餐后2 h PG、HbA1c、体重、BMI、血压均明显下降(P＜0.05).[结论]三餐饭后运动能有效地控制DM血糖、HbA1c、血压和体重等危险因素,防治DM及并发症的发生发展.     

链式分层管理模式对糖尿病患者血糖控制情况及其影响因素

目的 探讨链式分层管理模式对糖尿病患者血糖控制情况及其影响因素.方法 2007年始建立糖尿病患者健康管理档案库并进行链式分层管理,截至2011年共陆续管理2型糖尿病患者1010例,分析糖尿病患者血糖达标情况,运用多因素非条件Logistic回归分析血糖控制的影响因素.结果 1010例2型糖尿病患者糖化血红蛋白(HbAlc)为(8.21±2.70)％,血糖达标者487例,占48.22％,血压达标者303例,占30.00％,血脂达标者245例,占24.26％,血压、血脂、血糖同时达标者76例,占7.52％.多因素分析结果显示,职业(OR=2.521,95％CI:1.871～3.397)、文化程度(OR=1.890,95％ CI:1.642～2.174)、病程(OR=1.035,95％CI:1.016～1.055)、收缩压(OR=1.016,95％ CI:1.007～1.025)、三酰甘油(OR=1.204,95％ CI:1.063～1.365)是影响血糖控制的危险因素(P值均＜ 0.01).结论 链式分层管理模式有助于2型糖尿病患者的血糖控制,应结合血压、血脂、糖尿病病程等相关危险因素对2型糖屎病患者进行综合防治.     

2型糖尿病患者颈动脉内膜中层厚度危险因素的病例对照研究

目的 探讨2型糖尿病颈动脉内膜增厚的影响因素.方法 采用病例对照研究,研究对象来自广州市第一人民医院住院部,其中病例组(颈动脉内膜中层厚度＞1.0 mm)51例,对照组(颈动脉内膜中层厚度≤1.0 mm)51例,采用Logistic回归模型筛选2型糖尿病患者颈动脉内膜增厚的危险因素.结果 病例组与对照组在糖化血红蛋白(HbA1c)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)以及水果摄入量方面差异具有统计学意义(P＜0.05).Logistic回归分析显示,糖化血红蛋白(HbA1c)是2型糖尿病患者颈动脉内膜中层厚度的危险因素(OR=1.233),水果摄入量是2型糖尿病患者颈动脉内膜中层厚度的保护因素(OR=0.993).结论 HbA1c是2型糖尿病血管并发症的良好预测指标.倡导健康生活方式、合理的膳食结构,是预防与延缓2型糖尿病患者血管病变的重要措施.     

煤工尘肺合并2型糖尿病颈动脉病变的危险因素

目的探讨煤工尘肺合并2型糖尿病(T2DM)颈动脉病变(CAS)的危险因素。方法选取2009年1月—2010年12月间淮北矿业股份公司职业病防治院的T2DM患者90例为A组,煤工尘肺合并T2DM 97例为B组,同期健康检查的男性95例为对照组。对各组入选者均行彩色多普勒检测颈动脉内中膜厚度(CIMT)及观察颈动脉斑块、狭窄情况。同时监测血压、空腹血糖(FBG)、餐后2 h血糖(PBG)、糖化血红蛋白(HbA1c)、血脂谱、高敏C反应蛋白(hsCRP)、白细胞介素6(IL-6)。并进行对比分析,探讨危险因素。结果 B13组、A组的FBG、PBG、HbA1c、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDC-C)、hsCRP、IL-6与对照组比较差异均有统计学意义(P0.01)。B组的收缩压、脉压均高于A组和对照组,均P0.05;B组的FBG、HbA1c、hsCRP、IL-6均高于A组(P0.05)。B组CIMT、斑块检出率、狭窄率、大血管疾病发生率与对照组、A组比较,差异均有统计学意义(P0.05)。Logistic多元回归分析显示脉压、HbA1c、LDL-C、hsCRP、IL-6为煤工尘肺合并T2DM颈动脉病变的独立危险因素。结论煤工尘肺合并T2DM颈动脉病变的发生发展中除了传统的危险因素外,炎症因子也起了非常重要的作用。     

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.