应用队列研究方法检验饮酒与肠癌发病的联系

目的:了解饮酒者与非饮酒者人群中肠癌发病情况,验证饮酒与肠癌发病之间的关系.方法:以1989年5月-1990年4月期间,参加浙江省嘉善县肠癌筛检的10个乡镇30岁及以上人口共64 102人为研究队列,其中29 044名饮酒者为暴露组,其余为非暴露组.随访时间为1990年5月1日至2001年12月1日,观察队列的肠癌发病情况,应用Cox回归模型计算两者的相对危险度(RR).结果:全队列64 102人,共观察658 100.24人年.暴露组29 044人,随访298 497.23人年;非暴露组35 328人,随访359 603.01人年.全队列中合计肠癌新发病例242例,其中暴露组新发病例108例,发病密度为36.18/10万,非暴露组新发134例,发病密度为37.26/10万,两者相比无显著性差异(Z＝0.52,P>0.05);饮酒与肠癌发病的粗RR值为0.97(95%CI为0.75～1.25),调整RR值为1.13(95%CI为0.87～1.48)无统计学显著意义.经计算,本研究的检验效能(1-β)为96.99%.结论:在嘉善县人群中,饮酒不是肠癌的危险因素.     

代谢正常肥胖转归糖尿病风险的前瞻性队列研究

目的  了解泸州社区40岁以上代谢正常肥胖（MHO）患病率及随访3年糖尿病发病率情况。 方法  2011年4月-2011年8月采用多级整群抽样方法,对泸州市3个社区不同街道40岁以上非糖尿病居民进行问卷调查、体格检查和生化检测,于2014年6月-2014年10月对其进行随访调查。结果  共计纳入2 442例人群（男性30.7%）。MHO、代谢正常非肥胖（MHNO）、代谢异常肥胖（MUHO）及代谢异常非肥胖（MUHNO）分别占14.8%、45.3%、19.5%和20.4%,男、女MHO患病率分别为11.2%和15.4%。随访3年,共计248例转归为糖尿病,与MHNO比较,MHO、MUHO及MUHNO糖尿病发病风险分别是MHNO的1.64（95%CI：0.99,2.70）,5.23（95%CI：3.72,7.36）及3.93（95%CI：2.74,5.64）倍,女性MHO糖尿病发病风险是MHNO的2.05（95%CI：1.15,3.65）倍。MHO组随访3年后TG、SBP、DBP、FBS和OGTT 2 h血糖指标异常百分比分别为34.3%、39.4%、22.6%、8.3%及43.4%,与MHNO组比较明显增加（P <0.05）。结论  ①MHO在女性和相对低龄的人群中患病率更高;②MHO组糖尿病发病率明显低于MUHO、MUHNO组,女性MHO组糖尿病发病率高于MHNO组;③与MHNO比较,MHO更易发生代谢异常。

     

Implementing surviving sepsis campaign bundles in China: a prospective cohort study

Background Surviving sepsis campaign (SSC) bundles have been demonstrated to significantly improve survival in sepsis and septic shock patients worldwide.Compliance with these protocols and resultant m...     

护士职业倦怠与护理差错关系研究

目的 了解病房一线护士职业倦怠程度,同时调查护士职业倦怠与护理差错之间的关系.方法 设计为前瞻性队列研究,采用Maslach职业倦怠量表对149位病房一线护士进行调查.按照标准方法记录护士发生的护理差错并计算护士平均每月发生护理差错次数.结果 共149位病房一线护士接受调查,其中98人(65.77%)符合职业倦怠的诊断标准,调查期间共查出护理差错257次.职业倦怠的病房一线护士发生护理差错的次数是非职业倦怠的病房一线护士的6.4倍;职业倦怠的病房一线护士平均每月发生护理差错为1.97次[95%CI(0.73,4.56)],非职业倦怠的病房一线护士平均每月发生护理差错为0.31次[95%CI(0.12,0.49)],两者比较差异有统计学意义(P＜0.001).职业倦怠的病房一线护士自我报告精神压抑最为常见,共有67人(68.37%)职业倦怠的病房一线护士有此项报告,而非职业倦怠的病房一线护士只有14人(27.45%)报告,两者比较差异有统计学意义(P＜0.001).结论 病房一线护士普遍存在职业倦怠精神障碍,职业倦怠病房一线护士较正常病房一线护士更容易出现护理差错.     

产前抑郁与产后抑郁相关性研究

目的:探讨产前抑郁与产后抑郁的关系。方法:选取进行产前检查并住院分娩的孕妇487例为研究对象,于孕龄>35周时进行抑郁自评量表(Self-rating Depression Scale,SDS)问卷调查,于产后28 d内再次进行SDS问卷调查,评定为产前抑郁患者209例做为研究组,评定无产前抑郁患者278例做为对照组。对比两组产后抑郁的发生率。结果:研究组产后抑郁的发生率高于对照组,两组比较差异有统计学意义(P<0.05)。结论:产前抑郁增加了产后抑郁的危险性,对于产前抑郁应积极治疗,以减少或减轻产后抑郁。     

Latrodectism: a prospective cohort study of bites by formally identified redback spiders

OBJECTIVE: To determine the spectrum of severity and early diagnostic predictors of redback spider bites (Latrodectus hasselti), and to examine the effect of intramuscular redback antivenom. DESIGN AND SETTING: Prospective cohort study of calls to New South Wales, Queensland and Western Australian poisons information centres and presentations to Royal Prince Alfred Hospital and Royal Darwin Hospital emergency departments. PATIENTS: 68 people with definite redback spider bites in which the spider was immediately collected and expertly identified (1 February 1999 to 30 April 2002). INTERVENTIONS: Intramuscular redback spider antivenom in a smaller cohort of hospitalised patients. MAIN OUTCOME MEASURES: Pain severity and duration, local effects and systemic envenomation (effects, prevalence, and persistence > 24 hours). RESULTS: The median duration of effects was 48 hours (interquartile range, 24-96 hours). Pain occurred after all bites and was severe in 42 (62%). Forty-five patients (66%) had pain lasting longer than 24 hours, and 22 (32%) were unable to sleep because of pain. Systemic effects occurred in 24 (35%). Increasing pain over one hour occurred in 37 cases (54%), and local/regional diaphoresis in 23 (34%); both these features were highly predictive of L. hasselti bites compared with bites of other spiders. One of six patients treated with intramuscular antivenom (17%) had no pain at 24 hours, compared with two of 17 untreated patients (12%) (difference, 5%; 95% CI, -36% to +64%; P = 0.95). There was no difference in duration of systemic effects with antivenom administration. CONCLUSIONS: Most redback spider bites cause severe and persistent effects. Intramuscular antivenom appears to be less effective than previously thought and its use by this route needs review.     

闭合式玻璃体切除手术后早期患者泪膜功能的变化

目的 观察闭合式玻璃体切除手术对泪膜的影响及术后泪膜功能的恢复情况.方法 42例(42眼)行玻璃体切除手术的患者,分别于术前1 d,术后1、3、7、14 d、1个月及3个月询问患者是否存在不适症状,并行泪膜破裂时间(Break-Up Time,BUT)、泪液分泌试验(Schirmer I test,SIt)、角膜荧光素染色(Cornea Fluorescein Staining,CFS)检查.结果 与手术前相比,术后第1天患者的不适症状评分和CFS评分较术前显著增加(P＜0.01),无法形成稳定的泪膜,而SIt显著增加,83.3%的患者(35例) SIt＞30.0 mm,其余7例患者SIt均＞25.0 mm.术后第3、7天的不适症状评分较术前增加且差异显著(P＜0.01,P＜0.05),至术后14 d恢复至术前水平(P＞0.05).术后第3、7、14天,BUT较术前减少且差异显著(P＜0.01),SIt和CFS较术前增加且差异显著(P＜0.01).至术后1个月,BUT较术前仍减少且差异显著(P＜0.05),SIt和CFS与术前相比差异不显著(P＞0.05),恢复至术前水平.至术后3个月,BUT也恢复至术前水平(P＞0.05).结论 玻璃体切除术可显著影响泪膜的稳定性,至术后3个月,所有检查项目完全恢复至术前水平.     

全膝关节置换术后康复影响因素的前瞻性队列研究

目的  探讨影响全膝关节置换术（TKA）患者术后康复的相关因素,为预测患者术后康复情况及制定预防控制措施提供科学依据。方法  采用前瞻性队列研究方法,选取2010年1月-2014年6月在该院住院治疗并行TKA的患者310例,组成队列资料。应用Spearman相关性分析及多元Logistic回归的方法,分析人口学因素、临床及手术因素对患者术后功能恢复的影响。结果  310例患者中,12例因故取消或推迟手术,19例于随访期内脱失,最终纳入综合分析患者共279例。Spearman相关性分析结果显示,性别、年龄、体重指数（BMI）、吸烟史、糖尿病史、低白蛋白血症、应用静脉血栓形成危险度（RAPT）评分、基于性能的功能测试（PBT）评分、手术时间、术中出血量、术后疼痛与患者术后康复相关（P <0.05）。多元Logistic回归结果表明,较大的年龄及BMI、糖尿病史、RAPT及PBT评分较差为延长患者住院时间的危险因素;较大的年龄、糖尿病史、低白蛋白血症为罹患术后并发症的危险因素;较大的年龄、糖尿病史为影响术后肢体功能恢复的危险因素,RAPT及PBT评分为术后肢体功能恢复的预测因子。结论  TKA患者术后康复与多种因素相关。临床应重点关注具有上述危险因素的患者,于术前及术中采取有效预防措施,促进患者康复。

     

临床特征对酒精依赖复发的影响:前瞻性队列研究

目的 探讨人口学因素和心理渴求对酒精依赖患者复发的影响。方法 采用前瞻性研究方法,选择2017年8月至2018年8月在3家精神专科医院招募符合《美国精神疾病诊断与统计手册》第4版(Diagnositic and Statistical Manual Disorder-Fourth Version, DSM-Ⅳ)酒精依赖诊断标准的住院治疗的男性患者158例,进行基线测查,并在基线后3个月进行随访,调查复饮情况。基线测查包括人口学资料、饮酒特征、临床机构酒精依赖戒断评估表(clinical institute withdrawal assessment-advanced revised, CIWA-Ar)、环境线索诱导及戒断期心理渴求视觉模拟标尺评分(visual analog scale,VAS)、密歇根酒精依赖筛查量表(Michigan alcoholism screening test, MAST)、焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(self-rating depression scale, SDS)及饮酒促迫性量表(alcohol urge questionnaire, AUQ)。根据随访结果,将“复发”定义为在基线和随访之间任何时刻饮用含有乙醇的饮料,“复发时间”定义为首次饮酒距离基线的天数。是否复发和复发时间是主要结局指标,采用Cox比例风险回归模型分析影响酒精依赖复发的因素。结果酒精依赖患者3个月复发率为63.7%, 多因素Cox比例风险回归模型分析发现年龄(OR=0.975,P=0.030)及CIWA-Ar评分(OR=1.126,P=0.010)是影响酒精依赖复发的因素,两种环境下心理渴求与复饮差异无统计学意义(P > 0.05)。结论 年龄与住院期间酒精依赖戒断症状严重程度是酒精依赖复发的影响因素,其中年龄大是保护因素,戒断症状的严重程度重是危险因素,而线索诱导及戒断期心理渴求对酒精依赖患者复发的影响作用较小。     

胸腔镜肺部手术后应用19F胸管引流的前瞻性队列研究

目的 探讨19F胸管在胸腔镜肺部手术后的引流效果及其与28F胸管比较具有的优势.方法 选取2018年8月至2019年8月在该院胸外科择期行胸腔镜肺部手术的患者134例,分别应用19F胸管(19F组,n=53)和28F胸管(28F组,n=81)行胸腔引流,分析术后胸腔引流量、胸腔积气、胸腔积液、皮下气肿、带管时间、疼痛评...     

Cancer risk and key components of metabolic syndrome: a population-based prospective cohort study in Chinese

Background  The key components of metabolic syndrome (MS) are waist circumference, blood pressure, fast blood glucose, high density lipoprotein cholesterol (HDL-c) and triglycerides (TG). These components have, separately and jointly, been associated with an increased risk of cardiovascular diseases. In this study, we aimed to explore the association between MS components and cancer risk in a population-based cohort in China.

Methods  We established a population-based cohort with 17 779 individuals aged 35 and above at baseline in 2004 and 2005 in Changzhou, Jiangsu Province, China. All participants were face-to-face interviewed to complete a questionnaire and were accepted physical examinations including blood tests for glucose and lipids and physical measurements for obesity and blood pressure. In 2009, a total of 16 284 subjects (6886 men and 9398 women, 91.6%) attended the flow-up interviews and the participants or their family members reported all the hospitalizations and diseases including cancer occurred during the follow-up period. Multivariate Cox regression was used to estimate the hazard ratios (HRs) of metabolic syndrome components and cancer incidence.

Results  There was a dose-response association between cancer risk and the number of MS components presented at baseline (P for trend=0.012) and the HR (95% confidence interval (CI)) was 2.63 (1.27–5.45) for subjects carrying 3 or more metabolic syndrome components after adjustment for possible confounding factors. Specifically, the multivariate-adjusted HRs (95% CIs) for cancer risk in subjects with central obesity, high fasting glucose, low HDL-c were 1.94 (1.01–3.74), 2.04 (1.10–3.77) and 2.05 (1.09–3.88), respectively.

Conclusions  In this population-based, prospective cohort study in China, we found MS components, e.g., central obesity, high fasting glucose, low HDL-c were risk factors for cancer development. Early intervention of MS components may be also beneficial to reduce cancer burden.

     

血小板计数与代谢综合征关联性的前瞻性队列研究

目的 探讨血小板计数与代谢综合征的关联性。 方法 基于大规模健康管理队列,选取随访期间进行过至少两次体检记录、重要指标无缺失、基线未患有代谢综合征的人群建立前瞻性队列。按照基线血小板计数四分位数将研究对象分为4组,比较各组的发病密度。对这4组人群的基线各变量的特征进行描述。使用Cox比例风险回归模型,分别以血小板计数的数值变量或四分位数分组作为研究的变量,逐渐调整年龄、性别、BMI、高血糖、高血压、血脂异常,探究血小板计数在调整混杂因素前后是否仍为代谢综合征的危险因素。 结果 共计14 173位年龄在21~60岁的体检者进入队列,总计随访41 014.8人年,平均随访时间2.89年,随访中共有1 611人被诊断为代谢综合征,总人群发病密度为39.28/1 000人年。血小板计数在模型1(单因素)、模型2(调整年龄、性别)、模型3(调整年龄、性别、BMI、高血糖、高血压和血脂异常)中的风险比(HR)始终有统计学意义,表明随着血小板计数的增大代谢综合征的发病风险增加。当以血小板计数四分位数分组为研究的变量时,在模型1的单因素回归中,Q2组与Q1组相比,代谢综合征发病风险并未增加;Q3组和Q4组均有较高的风险增加;在模型2和模型3调整混杂因素后,Q2、Q3、Q4组均有统计学意义,且它们相对于Q1组的HR逐渐增大,结果表明随着血小板计数增加,代谢综合征发病风险也会增大。 结论 血小板计数升高是代谢综合征发生的独立危险因素。     

大面积深度烧伤后广谱高效抗生素早期短程使用的临床疗效

目的 探讨大面积深度烧伤后广谱高效抗生素早期短程使用的效果。方法 将同一时期收治的17名患者随机分成抗生素短程用药组（EUS）和传统用药组（TUC）,比较在全身使用泰能和丁胺卡那霉素情况下两组的抢救成功率,血中细菌培养发生率以及体温,白细胞总数,血小板计数等与感染密切相关的指标。结果17名患者均成活,且无一例血培养细菌阳性者,两组体温、白细胞总数、血小板计数均无显著性差异（P>0.05）。结论 观察结果表明,大面积深度烧伤后,早期短程的广谱高效抗生素冲击治疗,既节省费用,又有效地防治了全身性感染。     

Republished paper: assessing and improving safety culture throughout an academic medical centre: a prospective cohort study

OBJECTIVES To describe the authors' hospital-wide efforts to improve safety climate at a large academic medical centre. DESIGN AND SETTING A prospective cohort study used multiple interventions to improve hospital-wide safety climate. 144 clinical units in an urban academic medical centre are included in this analysis. Interventions The comprehensive unit-based safety programme included steps to identify hazards, partner units with a senior executive to fix hazards, learn from defects, and implement communication and teamwork tools. Hospital-level interventions were also implemented. Main outcome measures Safety climate was assessed annually using the safety attitudes questionnaire. The safety culture goal was to meet or exceed the 60% minimum positive score or improve the score by ≥10 points. RESULTS Response rates were 77% (2006) and 79% (2008). For safety climate, 55% of units in 2006 and 82% in 2008 achieved the culture goal. For teamwork climate, 61% of units in 2006 and 83% in 2008 achieved the culture goal. The mean safety climate improvement (difference score) for 79 units at or above 60% in 2006 was 0.201 in 2008; the mean improvement for the 65 units below the threshold was 18.278. The mean teamwork climate improvement (difference score) for the 89 units at or above 60% in 2006 was 0.452 in 2008; the mean improvement for the 55 units below the threshold was 16.176. Climate scores improved significantly from 2006 to 2008 in every domain except stress recognition. CONCLUSIONS Hospital-wide interventions were associated with improvements in safety climate at a large academic medical centre.     

Oral contraceptives and breast cancer. A prospective cohort study

In 1976, information on oral contraceptive (OC) use as well as numerous risk factors for breast cancer was provided by 121,964 married female registered nurses aged 30 to 55 years. Ninety-two percent of women in the cohort completed follow-up questionnaires, and vital records were systematically searched to ascertain deaths among nonrespondents. After four years of follow-up, 592 incident cases of breast cancer were identified. Compared with never users, the age-adjusted relative risk (RR) of breast cancer, regardless of menopausal status, among all women who had ever used OCs was 1.0. Among premenopausal women compared with those who had never used OCs, the RR of breast cancer was 1.5 for current use of OCs in 1976 and 1.0 for past use. Among postmenopausal women, the RR for past use of OCs was 1.0. These estimates were essentially unaltered after controlling for other known risk factors for breast cancer in multiple logistic regression analysis. Furthermore, there was no modification of these effects by family history of breast cancer, age at first use, timing of the first birth, or other breast cancer risk factors. Data on past use of OCs provide substantial reassuring evidence that there is no large excess risk of breast cancer within a few years of cessation of pill use. The observed moderate elevation of breast cancer risk with current use was of borderline statistical significance. However, the observation was based on 29 cases and may reflect the effect of sampling variability, as most other studies have not observed a relationship between current use of OCs and breast cancer in women of this age.     

Impact of a collaborative shared antenatal care program for urban Indigenous women: a prospective cohort study

OBJECTIVES: To evaluate the impact of a community-based, collaborative, shared antenatal care intervention (the Mums and Babies program) for Indigenous women in Townsville. DESIGN AND PARTICIPANTS: Prospective cohort study of women attending Townsville Aboriginal and Islander Health Service (TAIHS) for shared antenatal care with a singleton Indigenous birth between 1 January 2000 and 31 December 2003 (456 women; the MB group), compared with a historical control group of 84 women who attended TAIHS for antenatal care before the intervention between 1 January 1998 and 30 June1999, and a contemporary control group of 540 women who had a singleton birth at Townsville Hospital between 1 January 2000 and 30 June 2003, but did not attend TAIHS for antenatal care. INTERVENTION: Integration of previously autonomous service providers delivering shared antenatal care from TAIHS. MAIN OUTCOME MEASURES: Patterns of antenatal visits, proportion of women undertaking key antenatal screening, and perinatal outcomes. RESULTS: The number of Indigenous women who entered the MB program and gave birth at Townsville Hospital rose from 23.8% in 2000 to 61.2% in 2003. The number of antenatal care visits per pregnancy increased from three (interquartile [IQ] range, 2-6) in the historical control group to seven (IQ range, 4-10) in the MB group (P < 0.001). 88% of women in the MB group had at least one ultrasound. About 90% of all women attending for antenatal care were screened for sexually transmitted infections. In the MB group, there was a significant reduction in preterm births compared with the contemporary control group (8.7% v 14.3%, P < 0.01). There was no significant reduction in the prevalence of low birthweight births or perinatal mortality. CONCLUSION: A community-based collaborative approach to shared antenatal care services increased access to antenatal care and was associated with fewer preterm births among Indigenous women in Townsville. The model may be adaptable in other urban centres with multiple antenatal care providers and significant numbers of Indigenous people across Australia.     

2型糖尿病与乙型肝炎病毒相关肝癌发病关系的前瞻性队列研究

目的 探讨2型糖尿病与乙型肝炎病毒相关肝癌发病风险的关系。方法 研究资料来源于2010年1月新余市人民医院建立的乙型肝炎病毒感染患者随访数据库。对基线非肝癌患者按是否合并2型糖尿病进行分组：糖尿病组和非糖尿病组。采用Cox比例风险回归模型分析2型糖尿病与乙型肝炎病毒相关肝癌发病风险的关系。结果 435例研究对象共随访2 245.89年,其中新发肝癌病例68例,肝癌发病密度为30.28/千人年。合并2型糖尿病者64例（糖尿病组）,非糖尿病组371例,糖尿病组和非糖尿病组分别共随访331.27年和1 914.62年,肝癌发病密度分别为51.32/千人年和26.64/千人年,两组肝癌发病密度差异有统计学意义（χ²=6.80,P<0.05）。控制年龄、职业、吸烟史和饮酒史等因素后,Cox回归多因素分析结果示,糖尿病组乙型肝炎病毒感染者的肝癌发病风险是非糖尿病组的2.13倍[95%置信区间（CI）：1.18~3.87]。结论 该队列人群中,2型糖尿病和乙型肝炎病毒相关肝癌发病有关,2型糖尿病增加了乙型肝炎病毒感染患者的肝癌发病风险。