湘西少数民族地区血脂异常患病情况及其影响因素

目的  了解湘西少数民族地区血脂异常患病情况及其影响因素,为该地血脂异常的防控提供科学依据。方法  采用多阶段随机抽样方法抽取湘西少数民族地区≥30岁的880名居民进行调查,并采用多因素logistic回归分析模型分析血脂异常可能的影响因素。结果  湘西少数民族地区人群血脂异常患病率为38.8%,高TC血症、高TG血症、低HDL-C血症和高LDL-C血症患病率分别为7.6%、18.1%、23.2%和3.9%。多因素logistic回归分析模型分析结果显示,糖尿病(OR=1.675)和中心性肥胖(OR=2.316)是血脂异常的危险因素,高强度体力活动(OR=0.715)和年龄≥60岁(OR=0.616)是血脂异常的保护因素。结论  湘西少数民族地区血脂异常率较高,应采取积极有针对性的措施开展血脂异常的防控工作。     

保定市更年期女性人群高血压前期检出率及其影响因素

目的研究更年期女性人群高血压前期的检出情况,分析更年期女性高血压前期的影响因素。方法对保定市2009—2010年参加健康检查的更年期女性进行问卷调查、体格检查及血液标本检测。结果共调查更年期女性3 750名,正常血压1 042名,高血压前期人群1 594名,高血压人群1 114名,高血压前期(120≤收缩压≤139 mm Hg,80≤舒张压≤89 mm Hg)检出率为42.5%。低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、血糖异常[空腹高血糖(IFG)及糖尿病(DM)]、血尿酸水平(UA)、血清C-反应蛋白水平(CRP)、心率、高盐饮食、久坐、腹型肥胖、高血压家族史、更年期症状与高血压前期发生有关系。结论更年期女性人群高血压前期检出率较高,而且影响最大的危险因素是超重、肥胖、高盐饮食。     

Prevalence and determinants of obesity among primary school children in Dar es Salaam,Tanzania

Background

Childhood obesity has increased dramatically and has become a public health concern worldwide. Childhood obesity is likely to persist through adulthood and may lead to early onset of NCDs. However, there is paucity of data on obesity among primary school children in Tanzania. This study assessed the prevalence and determinants of obesity among primary school children in Dar es Salaam.

Methods

A cross sectional study was conducted among school age children in randomly selected schools in Dar es Salaam. Anthropometric and blood pressure measurements were taken using standard procedures. Body Mass Index (BMI) was calculated as weight in kilograms divided by the square of height in meters (kg/m²). Child obesity was defined as BMI at or above 95th percentile for age and sex. Socio-demographic characteristics of children were determined using a structured questionnaire. Logistic regression was used to determine association between independent variables with obesity among primary school children in Dar es Salaam.

Results

A total of 446 children were included in the analysis. The mean age of the participants was 11.1±2.0 years and 53.1% were girls. The mean BMI, SBP and DBP were 16.6±4.0 kg/m², 103.9±10.3mmHg and 65.6±8.2mmHg respectively. The overall prevalence of child obesity was 5.2% and was higher among girls (6.3%) compared to boys (3.8%). Obese children had significantly higher mean values for age (p=0.042), systolic and diastolic blood pressures (all p<0.001). Most obese children were from households with fewer children (p=0.019) and residing in urban areas (p=0.002). Controlling for other variables, age above 10 years (AOR=3.3, 95% CI=1.5-7.2), female sex (AOR=2.6, 95% CI=1.4-4.9), urban residence (AOR=2.5, 95% CI=1.2-5.3) and having money to spend at school (AOR=2.6, 95% CI=1.4-4.8) were significantly associated with child obesity.

Conclusions

The prevalence of childhood obesity in this population was found to be low. However, children from urban schools and girls were proportionately more obese compared to their counterparts. Primary preventive measures for childhood obesity should start early in childhood and address socioeconomic factors of parents contributing to childhood obesity.     

The quality of life, mental health, and perceived stigma of leprosy patients in Bangladesh

The present study aims to determine the quality of life (QOL) and general mental health of leprosy patients compared with the general population, and evaluate contributing factors such as socio-economic characteristics and perceived stigma. A total of 189 patients (160 outpatients, 29 inpatients) and 200 controls without leprosy or other chronic diseases were selected from Dhaka district, Bangladesh, using stratified random sampling. A Bangladeshi version of a structured questionnaire including socio-demographic characteristics-the Bangla version of the World Health Organization Quality of Life Assessment BREF (WHOQOL-BREF)-was used to assess QOL; a Self-Reporting Questionnaire (SRQ) was used to evaluate general mental health; the Barthel Index to control activities of daily living (ADL); and the authors' Perceived Stigma Questionnaire was used to assess perceived stigma of patients with leprosy. Medical records were examined to evaluate disability grades and impairment. QOL and general mental health scores of leprosy patients were worse than those of the general population. Multiple regression analysis revealed that factors potentially contributing to the deteriorated QOL of leprosy patients were the presence of perceived stigma, fewer years of education, the presence of deformities, and a lower annual income. Perceived stigma showed the greatest association with adverse QOL. We conclude that there is an urgent need for interventions sensitive to the effects of perceived stigma, gender, and medical conditions to improve the QOL and mental health of Bangladeshi leprosy patients.     

中国精神障碍流行病学研究

进入新世纪以来,随着经济和社会的不断发展,生活节奏加快,竞争压力的日趋增加,精神疾病的种类、特点、患病率也发生着变化.国内对精神障碍的流行病学研究随着方法学的改善和地方政府重视资助的前提下有了较大的进展.     

重点中学学生心理健康状况影响因素研究

茸的探讨本市重点中学学生心理健康状况影响因素。方法采用症状自评量（SCL-90）表和父母教育方式评价表，随机抽样本市两所重点中学孥生508人进行同卷调查，有效问卷480份。结果心理问题检出率18．1％，多元回归分析表明中学生心理健康的主要影响因素有父母的拒绝与否认、父亲过度保护与偏爱、母亲的严厉惩罚与干涉及文化测定、性别、年级、学习负担和是否独生子女。结论学习压力、父母养育方式对其心理健康有明显影响。     

Behaviour disorders in urban primary school children in Dhaka, Bangladesh

Data on the prevalence and correlates of behaviour disorders in children are scanty or absent in many countries, including Bangladesh. A sample of primary school children in Dhaka city, Bangladesh, was screened during February to April 1994 with the Rutter B2 Scale to estimate the prevalences of different types of behaviour disorders and to assess whether and how these prevalences were associated with the children's age and gender, and gender segregation at school. Of the 1288 children in grades 1 to 5 screened, 13.4% had some type of behaviour disorder, with males more than twice as commonly affected as females (20.4 vs 9.9%). Emotional, conduct, and undifferentiated disorders were detected in 3.2, 8.9 and 1.2%, respectively, of the children. All three disorders were more prevalent in males than in females. In multivariate logistic regression analyses, significant positive correlates were male gender (odds ratio (OR):3.1) and higher grades (reference:grades 1-2; OR for grade 3:9.1; OR for grade 5:4.2) for conduct disorder, and male gender (OR:3.1) and higher grade (OR for grade 3:6.2) for all disorders combined. None of the three independent variables examined was significantly associated with emotional disorder. Separate analyses could not be done for undifferentiated disorder because of the small numbers involved. The high prevalence of behaviour disorders in Dhaka city primary school children suggest that a mental health care programme for these children comprising screening and, if indicated, full evaluation and expert care would be worthwhile.     

Comorbid mental disorders among adults in the mental health surveillance survey

Purpose

To examine the prevalence and correlates of mental disorder comorbidity in the adult U.S. household population.

Determinants of drinking arsenic-contaminated tubewell water in Bangladesh

Bangladesh has already experienced the biggest catastrophe in the world due to arsenic contamination of drinking water. This study investigates the association of drinking arsenic-contaminated water (DACW) with both personal and household characteristics of 9116 household respondents using the household data of the Bangladesh Demographic and Health Survey (BDHS) 2004. Here DACW means that arsenic level in the drinking water is greater than the permissible limit (50 microg/l) of Bangladesh. The overall rate of DACW was 7.9%. It was found to be significantly associated with education, currently working, and division of Bangladesh, either by cross tabulation or multivariate logistic regression analyses or both. Similarly, household characteristics -- namely television, bicycle, materials of the wall and floor, total family members, number of sleeping rooms, and availability of foods -- were significantly associated in bivariate analyses. Many household characteristics -- namely electricity, television, wall and floor materials, and number of sleeping rooms -- revealed significant association in the logistic regression analysis when adjusted for age, education and division. This study indicates that respondents from Chittagong division and lower socio-economic groups (indicated by household characteristics) are at significantly higher risk of DACW. These findings should be taken into account during the planning of future intervention activities in Bangladesh.     

我国精神卫生的现状和挑战

目的：描述新世纪我国精神障碍流行病学研究的方法学和调查结果,以及精神卫生服务的现状,分析精神障碍患病率的影响因素,为降低疾病负担提供依据。方法：回顾新世纪以来国内大样本精神障碍流行病学研究,总结近10年精神障碍患病率的调查结果。结果：国内不同地区采用不同调查方法,获得各类精神障碍的患病率有较大差异。精神卫生服务需求增加,但服务的资源和模式不能满足需要。结论：我国精神卫生面临着方法学改进、服务模式更新的挑战,提高精神卫生健康有利于降低精神障碍的疾病负担。     

深圳市户籍及非户籍居民精神疾病现况调查

目的 了解深圳市户籍及非户籍≥18岁居民各类精神疾病的患病率及分布特点.方法 以世界卫生组织一世界精神健康联盟(WHO-WMH)提供的复合性国际诊断访谈表(CIDI3.1)为访谈工具,采用多阶段分层随机抽样方法对7134名受访人进行面对面调查.结果 (1)深圳市居民各类精神疾病加权终生患病率为21.87%,其中户籍居民为19.99%,非户籍居民为22.34%明显高于户籍居民(OR=1.15,95%CI:1.03～1.29;P<0.05),女性患病率明显高于男性(22.68%vs.19.67%;OR=1.20,95%CI:1.07～1.34;P<0.05);情感障碍、焦虑障碍和精神病性障碍的患病率分别为9.62%、14.45%和1.40%.(2)各类精神疾病加权12个月患病率为13.42%,户籍居民为11.90%,非户籍居民为13.80%明显高于户籍居民(OR=1.19,95%CI:1.03～1.36;P<0.05).(3)精神疾病之间的伴随疾病患病率为35.76%.(4)患病率及病情严重程度与性别、户籍、婚姻状况、文化程度、经济状况和职业等因素有关.结论 精神疾病已经成为深圳市的常见病,非户籍居民及女性的精神健康问题尤应引起关注.     

Maternal determinants of timely vaccination coverage among infants in rural Bangladesh

Background

Timely vaccination, i.e., the receipt of all scheduled vaccinations in an age-appropriate fashion, is critical for the prevention of deadly diseases in infants and achievement of the UN Millennium Development Goal to reduce infant mortality. Infants, especially in rural or underprivileged settings often receive delayed vaccinations leaving them susceptible to vaccine-preventable illnesses early in the first year of life. In this study, we examined rates of timely vaccination among 24,435 infants born in Gaibandha and Rangpur rural districts of Bangladesh from 2001 to 2007.

Methods

Vaccinations due by 14 weeks of age and administered through routine government immunization services were assessed using interviews with enrolled mothers between 11 and 18 weeks postpartum. We created a Timely Vaccination (TV) score to classify infants as vaccinated fully and on schedule (TV = 1) or not (TV = 0), and used multivariable logistic regression to identify maternal characteristics associated with infant's timely vaccination status.

Results

Our results suggest that only 19% of infants in this cohort received scheduled vaccinations on time by 11–18 weeks postpartum. Mothers’ engagement in paid employment [OR = 1.13, 95% CI: 1.03–1.23], receipt of tetanus toxoid vaccination [OR = 1.24, 95% CI: 1.11–1.38], history of antenatal care [OR = 1.22, 95% CI: 1.12–1.32], or higher socioeconomic status [OR = 1.07, 95% CI: 1.03–1.11] were positively associated with timely vaccination of their infants. Mother's perception of small infant size at birth was negatively associated with timely vaccination [OR = 0.89, 95% CI: 0.82–0.97].

Conclusion

Timely vaccination coverage of infants in rural Gaibandha and Rangpur districts is extremely low. This analysis identifies important shortcomings associated with the 1-year vaccination benchmark of routine immunization performance and suggests the need for specific interventions based on potential maternal determinants as well as known system and programmatic barriers of timely vaccination among infants in rural Bangladesh.     

Social networks and contraception practice of women in rural Bangladesh

This paper analyzed the association of social networks with contraceptive use using both structural and attitudinal properties of social networks. Data were collected from seven villages in rural Bangladesh by face-to-face interviews using a structured questionnaire (N = 694). Sociometric data and the centrality positions of women in their social networks were analyzed as proxies for structural properties, and the perception of network members’ approval and encouragement towards family planning as attitudinal properties. The perception of network members’ attitude towards family planning and power within networks was found to be positively associated with contraception use. The strong association of the social network members’ encouragement of contraception and the significance over both in-degree (number of nominations received by the participant from other village women) and out-degree centrality (number of nominations given by a participant) provides further confirmation that immediate network members’ attitude is important to explain current contraceptive use of women in rural Bangladesh.     

芜湖市学龄前儿童孤独症谱系障碍患病现状及影响因素研究

目的 探讨2～6岁学龄前儿童孤独症谱系障碍(ASDs)患病现状及其影响因素.方法 以2019年1-12月在安徽省芜湖市某医院参加健康体检的2～6岁学龄前儿童作为研究对象.以问卷调查的方法收集数据,描述ASDs患病情况,并分析芜湖市学龄前儿童ASDs的影响因素.结果 共对13482名儿童完成调查,完整回答调查问卷的共有1...     

Determinants, self-management strategies and interventions for hope in people with mental disorders: systematic search and narrative review

Developing a recovery focus in mental health services is a policy goal internationally, and hope is a central component of recovery. Yet determinants of hope of people with mental disorders are not well known, nor are strategies and interventions that increase hope. This study aims to systematically summarise the available evidence to fill four relevant knowledge gaps: (1) hope scales used in psychiatric research, (2) determinants of hope, (2) hope-fostering self-management strategies, and (3) interventions to increase hope for people with mental disorders. We conducted a systematic literature search in April 2011 and a narrative synthesis of publications including qualitative and quantitative studies. Results for the first time provide a comprehensive overview of existing evidence and identify important scientific knowledge gaps: (1) Hope scales used do slightly vary in focus but are overall comparable. (2) Most published research used cross-sectional designs resulting in a high number of potential determinants of hope. No studies prospectively investigated the influence of these determinants. (3) Hope fostering self-management strategies of people with mental disorders were described in qualitative studies only with experimental studies completely missing. (4) While some recovery oriented interventions were shown to increase hope as a secondary outcome, there are no successful interventions specifically aimed at increasing hope. This review provides the basis for both practical and research recommendations: The five most promising candidate interventions to improve hope in people with mental disorders are (i) collaborative strategies for illness management, (ii) fostering relationships, (iii) peer support, (iv) helping clients to assume control and to formulate and pursue realistic goals, and (v) specific interventions to support multiple positive factors such as self-esteem, self-efficacy, spirituality and well-being. These may serve to directly improve care and to develop theory-based models and testable interventions to improve hope in mental health as well as in allied fields.     

Credit programs, patriarchy and men''s violence against women in rural Bangladesh

Although violence by men against women in Bangladesh occurs in most cases within the home, in a larger sense it does not originate in the home nor persist only within the home. It is simply one element in a system that subordinates women through social norms that define women's place and guide their conduct. This paper uses ethnographic and structured survey data from a study in rural Bangladesh to explore the relationship between domestic violence against women and their economic and social dependence. It describes some of the common situations in which violence against women occurs in Bangladeshi society, analyzes its larger context, and identifies factors that appear to lessen its incidence in this particular socio-economic setting. The study findings suggest that group-based credit programs can reduce men's violence against women by making women's lives more public. The problem of men's violence against women is deeply rooted, however, and the authors argue that much more extensive interventions will be needed to significantly undermine it.     

Assessment of early-life lead exposure in rural Bangladesh

Lead is a well-known neurotoxic metal and one of the most toxic chemicals in a child’s environment. The aim of this study was to assess early-life lead exposure in a pristine rural area of Bangladesh. The exposure was expected to be very low because of the absence of vehicle traffic and polluting industries. Lead was measured in erythrocytes, urine, and breast milk of 500 randomly selected pregnant women, participating in a randomized food and micronutrient supplementation trial in Matlab (MINIMat). Lead was also measured in urine of their children at 1.5 and 5 years of age, and in rice, well water, cooking pots, and materials used for walls and roof. All measurements were performed using ICPMS. We found that the women had relatively high median erythrocyte lead levels, which increased considerably from early pregnancy to late lactation (81-136 μg/kg), probably due to release from bone. Urinary lead concentrations were unchanged during pregnancy (median ∼3.5 μg/L) and non-linearly associated with maternal blood lead levels. Children, at 1.5 and 5 years of age, had a median urinary lead concentration of 4 μg/L, i.e., similar to that in their mothers. Rice, the staple food in Matlab, collected from 63 homes of the study sample, contained 1-89 μg/kg (median 13 μg/kg) dry weight and seems to be an important source of lead exposure. Other sources of exposure may be cooking pots and metal sheet roof material, which were found to release up to 380 and 4200 μg/L, respectively, into acidic solutions. Based on breast milk lead concentrations (median 1.3 μg/L) a median daily intake of 1.2 μg was estimated for 3 months old infants. However, alternatives to breast-feeding are likely to contain more lead, especially rice-based formula. To conclude, lead exposure in women and their children in a remote unpolluted area was found to be surprisingly high, which may be due to their living conditions.     

Arsenicosis in Bangladesh: prevalence and socio-economic correlates

The potential effects of arsenic-contaminated drinking water on health are of concern, but our understanding of the risk factors of arsenicosis remains limited. This study assessed the prevalence of and socio-economic differentials in arsenic-associated skin lesions in a rural community in Bangladesh. Data were collected from a village where the Bangladesh Rural Advancement Committee has operated a health surveillance system and a community-based arsenic mitigation project since 1999. In total, 1654 residents in the study village were examined in May 2000 for arsenic-associated lesions on their skin. Socio-economic information was extracted from the surveillance system database covering the village. Nearly 2.9% of the study population had clinical manifestations of arsenic poisoning. The prevalence of arsenicosis was associated with age, sex, education and the economic status of the household. Multivariate analysis identified age and economic status as significant predictors of arsenicosis controlling for education and gender. In conclusion, a clear understanding of the socio-economic distribution of arsenicosis in different demographic and socio-economic groups will be useful in identifying the high-risk groups from arsenic-affected communities. More studies are needed to design effective interventions to mitigate the effects of arsenic in Bangladesh.     

Elevated and variable groundwater iron in rural northwestern Bangladesh

Over the past 30 years, tubewells have become a ubiquitous source of potable groundwater in South Asia. Considered safer than surface water, groundwater naturally contains minerals that may impact human health; however, few data exist on tubewell water mineral content or its association with human nutritional or health conditions. We surveyed iron concentration in tubewell water across a 435 km², contiguous, rural area in northwestern Bangladesh to map and quantify levels of iron in drinking water. One tubewell was randomly sampled from each of 948 adjacent grid cells 675 m² in size. Water sampling was standardized and iron concentration measured using a field-based colorimetric kit. The median (interquartile range) concentration of iron in tubewell water was 7.6 (1.6, 17.6) mg l^-1. There was high geographic variation (range of 0–46.5 mg l^-1), and iron in only 3% of surveyed tubewells fell below the WHO aesthetic cut-off of 0.3 mg l^-1 suggesting elevated levels of iron throughout the area. Villagers accurately perceived groundwater iron concentration, based on a 4-point (‘none’, ‘a little’, ‘medium’, ‘a lot’) scale (p<0.001). Water source iron content can be readily quantified in population settings offering the potential to evaluate the health relevance of groundwater iron exposure in rural communities.     

Prevalence and determinants of smoking in Belarus: A national household survey, 2000

A clear, up-to-date picture of smoking prevalence and its determinants is needed to inform the development of effective tobacco control policy in Belarus and other parts of the former Soviet Union. It is particularly important in view of the way the tobacco industry has targeted this region since transition. A nationally representative household survey designed to explore smoking behaviour and its determinants was undertaken in Belarus in April 2000. Data were available on 1090 individuals aged 18 years and over (response rate 53.4%). Respondents were similar demographically to the population of Belarus. Fifty three percent of men and 9% of women are current smokers and an additional 18% and 7% respectively are ex-smokers. Differences in smoking habits between successive generations were identified. These included a ninefold higher rate of ever-smoking amongst 18–29 years old women compared with those aged over 60 years (p < 0.0001) and a higher proportion of current smokers starting in childhood amongst those aged 18–29 years compared with older smokers (p = 0.0005). Smoking in public places, particularly the workplace where 65% smoke, is common. Smokers are more likely than non-smokers to have positive beliefs about the health impact of active and passive smoking (p < 0.0001). Amongst women the odds of smoking is 13 times higher in those living in large cities compared with those living in villages. In men, disadvantage and a positive attitude to the west appear to increase the likelihood of smoking. To date policy responses have been inadequate. Unless effective tobacco control policies are introduced, tobacco will continue to make an increasingly large contribution to premature morbidity and mortality in Belarus.