中国10个地区成年人慢性肾脏病流行情况及其生活方式影响因素

目的描述中国慢性病前瞻性研究(CKB)项目人群的慢性肾脏病(CKD)分布, 分析生活方式与CKD发病风险的前瞻性关联。方法数据来源于CKB基线调查及随访监测(截至2018年12月31日), 描述CKD发病的地区和人群分布差异, 使用Cox比例风险回归模型分析生活方式因素与CKD的关联。结果研究纳入505 147名研究对象, 平均随访11.26年, 期间共有4 920例发病病例, 发病率为83.43/10万人年, 肾小球肾病为最主要亚型。CKD发病率在城市、男性、年龄≥60岁人群中更高, 分别为87.83/10万人年、86.37/10万人年、132.06/10万人年。相比于从不或偶尔吸烟者, 当前吸烟男性CKD风险增加(HR=1.18, 95%CI:1.05～1.31)。以非肥胖人群为参照组, 由BMI判定的全身性肥胖(HR=1.19, 95%CI:1.10～1.29)和腰围判定的中心性肥胖(HR=1.27, 95%CI:1.19～1.35)均与更高的CKD发病风险相关。结论 CKB项目人群CKD发病率存在明显的地区和人群差异, 且其发病风险受到生活方式多因素的影响。     

社会经济地位对城乡居民发生超重肥胖影响的队列研究

目的 了解社会经济地位(socio-economic status,SES)对超重肥胖发病的影响。方法 采用多阶段整群随机抽样的方法于2010年对贵州省9 280人进行基线调查,于2016—2020年对该队列所有参与者进行随访,排除失访、不符合分析的对象后,2 681人纳入分析。运用t/χ2进行单因素分析,COX风险比例回归模型分析SES综合得分及SES单个指标对超重肥胖发病的影响。结果 中位随访6.42年,人群发病密度41.72/千人年。多因素COX回归结果显示,与家庭人均年收入<2 667元的人群比较,收入为5 000～<10 000元、≥10 000元发病风险分别为HR=0.756 (95%CI:0.611～0.934)、HR=0.626(95%CI:0.498～0.787)(P趋势<0.001);与文盲、半文盲相比,小学毕业、初中毕业、高中/中专及以上人群发病风险分别为HR=0.740(95%CI:0.599～0.914)、HR=0.666(95%CI:0.541～0.820)、HR=0.634(95%CI:0.468～0.859)(P_趋势     

天津市成年人血清免疫球蛋白浓度与2型糖尿病发病风险的前瞻性队列研究

目的分析天津市成年人免疫球蛋白浓度与2型糖尿病(T2DM)发病风险的关联。方法选取2010年1月至2018年12月进入"天津人群慢性低度炎症与健康促进队列", 完成基线免疫球蛋白浓度和血糖浓度测量, 且基线时未诊断过任何类型糖尿病的成年人进入队列研究。收集的相关资料包括:免疫球蛋白(IgG、IgM、IgA和IgE)浓度、血糖浓度和其他潜在混杂因素。根据基线血清免疫球蛋白浓度的四分位数将研究对象分为4组(Q1～Q4组), 采用多因素Cox比例风险回归模型分析基线免疫球蛋白浓度与T2DM发病风险的关联。结果共纳入研究对象6 315例, 年龄(50.1±10.0)岁。随访期间共390例被诊断为T2DM, 发病率为16.8/1 000人年。调整年龄、性别、腰围、吸烟状况、饮酒状况、嗜酸性粒细胞比值、代谢综合征、一级或二级家族史及相互调整其他种类免疫球蛋白浓度后, 与Q1组相比, IgG浓度Q4组人群T2DM发病风险降低(HR=0.71, 95%CI:0.52～0.97), IgM浓度Q4组人群T2DM发病风险降低(HR=0.66, 95%CI:0.47～0.91), IgA浓度Q4组人群T2D...     

北京60岁及以上老年人吸烟状况与死亡风险的关联研究

目的分析北京城乡老年人群吸烟状况与相关死亡风险间的关联。方法基于北京城乡老年人群健康综合研究2009—2014年的队列数据, 纳入符合标准的60岁及以上老年人群4 499名, 随访其生存与死亡结局。采用Cox比例风险模型分析吸烟状态、吸烟指数、戒烟年数与死亡风险间的关联。结果 4 499名研究对象年龄M(IQR)为70.00(10.00)岁, 其中男性1 814名(40.32%);从不吸烟者、戒烟者和现在吸烟者分别有69.50%(3 127/4 499)、13.20%(594/4 499)和17.30%(778/4 499)。多因素Cox回归分析结果显示, 调整人口社会学特征、生活方式等混杂因素后, 以从不吸烟者为参照, 戒烟者全因死亡风险增加30.6%[HR(95%CI):1.306(1.043～1.636)];现在吸烟者全因、恶性肿瘤和肺癌死亡风险的HR(95%CI)分别增加50.0%[HR(95%CI):1.500(1.199～1.877)]、80.3%[HR(95%CI):1.803(1.226～2.652)]和212.6%[HR(95%CI):3.126(1.626～6.01...     

海南百岁老人抑郁症状对死亡与寿命影响的前瞻性队列研究

目的分析海南百岁老人抑郁症状与全因死亡风险间的关联。方法基于中国海南百岁老人队列研究, 对纳入基线且资料完整的1 002人随访其生存与死亡结局。抑郁症状根据简易老年抑郁量表(GDS-15)调查获得评分, 并划分成正常(≤5分)、轻度抑郁(6～9分)和重度抑郁(≥10分)。采用Cox比例风险回归模型分析抑郁症状与全因死亡风险间的关联强度。结果截至2021年5月31日, 随访时间M(Q1, Q3)为4.16(1.31, 5.04)年, 死亡人数为522人, 死亡密度为152.39/1 000人年。多因素Cox比例风险回归分析结果显示, 在控制人口社会学特征、生活方式等协变量后, GDS-15评分每增加1分, 全因死亡风险增加3.1%(HR=1.031, 95%CI:1.002～1.061);与正常百岁老人相比, 重度抑郁者死亡风险增高35.9%(HR=1.359, 95%CI:1.023～1.806), 重度抑郁者平均减寿1.94年。在女性百岁老人中, 相比于正常组, 轻度抑郁和重度抑郁组死亡风险分别增加29.3%(HR=1.293, 95%CI:1.053～1.590)和42.3%(HR...     

海南省成年人吸烟与心血管疾病发病风险的前瞻性研究

目的 探讨海南省成年人吸烟与各类心血管疾病发病风险的关联。方法 利用中英合作项目“中国慢性病前瞻性研究”项目海南省人群数据,剔除基线调查时自报患有冠心病、脑卒中和恶性肿瘤的个体后,纳入基线年龄为30～79岁的研究对象共28 940人,利用Cox回归分析计算非吸烟者、戒烟者和当前吸烟者的心血管疾病发病风险HR值和95%CI。结果 研究人群平均随访6.2年,累积随访177 279人年。随访期间男性1 310人,女性2 200人发病。男性吸烟率（47.0%）远高于女性吸烟率（0.3%）。多因素调整后,与非吸烟者相比,吸烟人群心血管疾病的发病风险有所增加,HR值(95%CI)分别为急性冠心病1.63(1.12～2.38)和缺血性心脏病1.53(1.22～1.91)。在当前吸烟者中,每天吸烟量多于30支的人群急性冠心病、缺血性脑卒中和出血性脑卒中的发病风险最高。结论 吸烟能够增加心血管疾病的发病风险,应基于不同心血管疾病风险制定吸烟者戒烟目标和全人群控烟措施。     

贵州省成年人群膳食模式与心血管疾病发病关系的队列研究

目的 分析不同膳食模式与心血管疾病(cardiovascular disease, CVD)发病的关系,为CVD的防控提供参考依据。方法 基于2010年11月建立的贵州省自然人群队列,采取分层整群抽样的方法抽取贵州省12个县(市、区)的≥18岁常住居民9 280人开展基线调查,于2016年12月19日―2020年6月1日对人群进行随访,将完成随访且基线信息和随访结局完整的7 897人纳入分析。采用半定量食物频率法获得人群膳食信息,通过因子分析确定膳食模式,使用Cox比例风险回归模型计算队列人群不同膳食模式和CVD发生的HR值和95%CI。结果 研究对象基线年龄为(44.46±15.14)岁,累计随访55 698.80人年,中位随访时间6.58年,随访期间221人发生CVD,发病密度为3.97/1 000人年。因子分析确定了油盐模式、蛋白模式、甜食模式、谷蔬模式、水产品模式。调整其他因素后,与各模式的低水平组相比,高水平油盐模式(HR=1.44, 95%CI:1.02～2.02,P<0.05)、中水平甜食模式(HR=1.47, 95%CI:1.04～2.06,P<0.05)、...     

海南百岁老人甲状旁腺激素水平与全因死亡关联的前瞻性队列研究

目的探讨海南百岁老人甲状旁腺激素(PTH)水平与全因死亡之间的关联。方法基于中国海南百岁老人队列研究, 对完成基线调查且资料完整的1 002人跟踪随访其生存和死亡结局。基线血清PTH水平作为自变量, 分别以连续变量、二分类变量和四分类变量纳入模型, 进行Cox比例风险回归模型分析基线PTH水平与全因死亡之间的关联。结果截至2021年5月31日, 研究随访时间M(Q1, Q3)为4.16(1.31, 5.04)年, 死亡人数为522人, 总死亡率为52.10%。多因素Cox比例风险回归模型分析结果显示, PTH每增加10 pg/ml, 全因死亡风险增加3.7%, HR值为1.037(95%CI:1.007～1.067);PTH水平高的Q4组全因死亡风险是PTH水平低的Q1组的1.458(95%CI:1.131～1.878)倍。结论海南百岁老人中, PTH水平的升高与全因死亡风险增加相关, 可作为社区长寿老人死亡风险预测的参考指标。     

子痫前期-子痫孕妇凝血功能指标与胎盘早剥的关联分析

目的探讨子痫前期-子痫孕妇不同妊娠阶段凝血功能指标与胎盘早剥(PA)的关联。方法选择2018年2月至2020年12月在首都医科大学附属北京妇产医院参加"中国出生人口队列研究"且被诊断为子痫前期、子痫、慢性高血压伴发子痫前期的孕妇为研究对象。采用问卷调查收集基线和随访信息, 通过医院病例系统获取孕早期和晚期的凝血功能指标。采用Cox比例风险回归模型, 分析不同妊娠阶段凝血功能指标与PA发生的关联;采用限制性立方样条曲线, 分析相关凝血功能指标与PA发生的剂量反应关系。结果共纳入研究对象1 340例, 年龄(32.50±4.24)岁, PA发生率为4.4%(59/1 340)。调整相关因素后, Cox比例风险回归模型分析显示, 与纤维蛋白原(FIB)高水平组相比, 孕早期中等水平(HR=3.28, 95%CI:1.27～8.48)和低水平组(HR=3.84, 95%CI:1.40～10.53)及孕晚期低水平组(HR=4.18, 95%CI:1.68～10.39)PA发生风险均显著增加;与孕晚期凝血酶原时间(PT)中等水平组相比, 低水平组(HR=2.67, 95%CI:1.48～4.82)...     

中国8省市成人血脂与糖尿病前期及糖尿病发病关系的前瞻性队列研究

目的探讨我国成人血脂水平与糖尿病前期及糖尿病的发病关系。方法将2010年中国慢性病及其危险因素监测数据作为基线数据,从2010年监测点中选取8个省,每个省选择2个点作为随访点,排除糖尿病前期及糖尿病者,共7046人进入随访队列,并于2016—2017年进行随访调查,共随访到4886人。采用Cox比例风险回归模型分析总人群及不同性别下血脂水平与糖代谢异常发病关系。结果共纳入4759名研究对象,随访期间糖尿病前期发病密度为26.1/1000人年,糖尿病发病密度为10.4/1000人年。多因素Cox分析结果显示,在总人群中,与TG<0.77 mmol/L相比,0.77≤TG<1.08 mmol/L糖尿病前期发病风险增加32%(HR=1.32,95%CI:1.11～1.94,P<0.05)。与HDL-C<0.91 mmol/L相比,HDL-C≥1.31 mmol/L糖尿病前期发病风险降低30%(HR=0.70,95%CI:0.54～0.90,P<0.05),P_趋势检验<0.05。与TG<0.77 mmol/L相比,TG≥1.57 ...     

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.     

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.     

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.     

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.