粤北地区慢性阻塞性肺疾病患病率调查

目的　调查广东省粤北地区40岁以上人群慢性阻塞性肺疾病(COPD)的患病率及其危险因素。方法　采用统一的流行病学调查表格,以整群随机抽样方法,在韶关北部山区共调查 40 岁以上居民1498人,并进行肺功能检测,有支气管阻塞者行扩张试验。结果　资料完整的 1468 人,男性640人,女性828人,平均年龄54.3岁。COPD总患病率为12.0%(176/1468),男性患病率18.3%(117/640),显著高于女性患病率7.1%(59/828),P<0.01。只有80.7%COPD患者有咳嗽、咯痰、呼吸困难或气短等症状之一。该地区COPD诊断率过低,只有26.1%的 COPD病例曾诊断过慢性支气管炎、肺气肿或COPD。吸烟是极为重要的危险因素,78.4%COPD患者有吸烟史。该地区居民生物燃料暴露与COPD患病的关系尚待进一步研究。结论　粤北农村地区 COPD患病率远高于预期,吸烟是极为重要的危险因素。肺功能在COPD的诊断,尤其是早期诊断中非常重要。     

湖北省部分农村地区人群慢性阻塞性肺疾病患病率及危险因素研究

目的了解湖北省南部（鄂南）农村地区慢性阻塞性肺疾病（COPD）患病率及危险因素。方法采用统一的流行病学调查表格，以多阶段抽样方法，抽取鄂南农村居民1883人进行调查，并进行体检和肺功能检测。结果共检出COPD患者186例，总患病率为9．88％，病例中男性占13．68％，女性占6．46％，男性高于女性（X2=27．48，P〈0．001）。随年龄增高患病率逐渐上升（X2=79．22，P〈0．001）。单因素分析表明，性别、年龄、吸烟、做饭频率、用生物燃料做饭、家族史、14岁以前经常咳嗽、体重指数降低、近5年房屋装修等9项因素与COPD有关。多因素logistic分析发现，性别、年龄、吸烟、做饭频率、家族史、14岁以前经常咳嗽为COPD的危险因素。结论鄂南农村地区COPD患病率较高，应针对危险因素采取综合干预措施来控制COPD的发生。     

无症状慢性阻塞性肺疾病患者相关特征分析

[目的]了解鄂南农村居民无症状慢性阻塞性肺疾病(COPD)患病状况及患者的流行病学特征,为防治COPD提供科学依据。[方法]以多阶段抽样方法,抽取鄂南农村居民1883例进行问诊、体检和肺功能检测,并采用统一的问卷进行调查。[结果]共检出COPD患者186例,总患病率为9.88%,其中无症状者71例,占38.17%;有症状者115例,占61.83%。无症状COPD的患病率为3.77%。无症状组和有症状组患者年龄、性别、职业、受教育程度、行饮情况,使用燃料情况和吸烟史比较,差异均无统计学意义(P﹥0.05)。两组吸烟指数差异有统计学意义(P﹤0.01),肺功能检测显示,有症状组第1s用力呼气容积(FEV1)、第1s用力呼气容积占预计值百分比(FEV1占预计值%)与无症状组比较,差异均有统计学意义(P﹤0.05或P﹤0.01)。[结论]该地区COPD患病率较高,其中无症状COPD的比例也较高。如果单凭症状,易造成COPD的漏诊和对疾病危害的低估。     

贵州省40岁及以上人群慢性阻塞性肺疾病流行及影响因素

目的  分析研究贵州省40岁及以上不同性别人群慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)流行状况及其影响因素,为COPD预防提供依据。方法  采用多阶段分层整群抽样方法,抽取贵州省COPD监测地区2 599名40岁及以上常住居民,进行问卷调查、体格及肺功能检查。结果  贵州省监测地区COPD患病率为10.7%,男性患病率(13.0%)高于女性(7.6%)(χ²=16.951, P＜0.001)。Logistic回归分析模型分析结果显示,在男性人群中,年龄、吸烟、肺结核、慢性支气管炎病史与COPD患病密切相关;而女性人群中,年龄、脑血管、肺气肿病史、慢性支气管炎病史、鼻炎与COPD患病密切相关。结论  贵州省监测地区COPD患病率及影响因素存在性别差异,为降低COPD患病率,男性以控烟和采取呼吸系统疾病筛查为主要措施,女性重点加强呼吸系统疾病筛查。     

陕西省部分地区慢性阻塞性肺疾病流行情况及相关危险因素

目的  了解陕西省部分地区40岁及以上人群慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）的患病情况及影响因素。 方法  采用多阶段分层整群抽样的方法,在陕西省3个项目县区抽取了1 800名40岁及以上常住居民进行问卷调查、身体测量及肺功能检测,采用χ²检验和二分类Logistic回归分析模型对影响COPD患病率的相关因素进行分析。 结果  共获得有效样本1 638例,陕西省部分地区COPD的患病率为13.8%。其中男性患病率（18.5%）高于女性（9.6%）（χ²=27.399,P < 0.001）;70岁及以上年龄组患病率最高,占22.5%,其次为60~岁、50~岁和40~岁,患病率分别为20.4%、12.9%和8.5%,且随着年龄的增长患病率逐渐上升（χ_趋势²=31.970,P < 0.001）。多因素Logistic回归分析模型得出,年龄（OR=2.86,95% CI：1.52~5.39,P=0.001）,吸烟（OR=1.60,95% CI：1.12~2.27,P=0.031）,有呼吸系统疾病家族史（OR=1.83,95% CI：1.05~3.18,P=0.008）是居民患COPD的危险因素。 结论  陕西省部分地区居民COPD患病率较高,高龄、吸烟、有呼吸系统疾病家族史是患COPD的危险因素。     

重庆城市社区慢性阻塞性肺疾病流行病学调查

目的 获得重庆市城市地区慢性阻塞性肺疾病(COPD)患病率及其影响因素,为COPD早期防治提供依据.方法 2007年12月- 2008年1月,采用多级整群随机抽样方法,对重庆市南岸区城区南湖社区和裕华社区≥40岁常住居民2 133人进行问卷调查和肺功能检查,筛查其中的COPD患者,采用修订后的阻塞性肺疾病负担研究(BOLD)问卷进行调查.结果 2 024人调查问卷和肺功能检查合格,COPD患病率为7.9％( 160/2 024),男性患病率15.5％ (123/792),女性患病率3.0％ (37/1 232);吸烟者COPD患病率达15.9％ (118/743),COPD患者73.8％(118/160)有吸烟史;男性、高龄、低体质指数、有吸烟史、吸烟指数高、14岁以前经常咳嗽史、采用煤或生物燃料烹饪时无通风设备是COPD的重要危险因素,均OR＞1,差异均有统计学意义(均P＜0.01);COPD患者中,仅58.8％曾经被诊断为COPD等呼吸气流受限疾病,仅24.4％曾经进行过肺功能检查,23.1％ COPD患者无症状.结论 重庆市城区COPD患病率高,漏诊多,肺功能检查率低;吸烟是COPD主要危险因素;应重视COPD的早期诊断,早期防治.     

海安地区≥65岁人群慢性阻塞性肺疾病患病现状及相关因素

目的 调查海安地区≥65岁人群慢性阻塞性肺疾病（COPD）患病现状及相关因素,为制定COPD防控措施提供科学依据。方法 于2021年8月采用整群随机抽样的方法抽取海安地区≥65岁居民进行问卷调查及肺功能检查,采用描述性分析方法对COPD患病情况进行分析,并采用单、多因素分析方法对COPD患病影响因素进行分析。结果 本研究共完成832名海安地区≥65岁人群的资料收集及肺功能检查。年龄65~86岁,以70~79岁所占比例较高,为50.60%,男性占56.97%。检出COPD患者310例,患病率为37.26%,其中轻、中、重度与极重度分别占26.97%、30.91%、27.88%、14.24%。多因素Logistic回归分析,结果显示年龄（OR=1.495）、文化程度（OR=1.939）、吸烟（OR=1.876）、家庭有患哮喘者（OR=1.390）、家族有COPD患者（OR=1.539）均为≥65岁人群COPD患病的影响因素。结论 海安地区≥65岁人群COPD患病率较高,中、重度占比较大,应引用医疗卫生部门对老年人群COPD患病情况的重视,并针对相关因素开展预防控制工作。     

中北大学老年人慢性阻塞性肺疾病整群抽样调查

目的了解中北大学65岁以上教职工及家属(以下简称"老年人")的吸烟及慢性阻塞性肺疾病(COPD)患病情况。方法采取整群抽样的方法,选取全校812名老年人为研究对象,用自制问卷对其进行一般资料、吸烟情况、呼吸道症状的调查,并对204名有慢性呼吸道症状的老年人进行肺功能检测,对所得数据进行统计学分析。结果研究人群中,男性老年人COPD患病率为12.1%(52/430),女性COPD患病率为3.1%(12/382),男性老年人COPD患病率明显高于女性,差异有统计学意义(χ~2=22.33,P=0.000)。65岁组老年人COPD患病率为5.3%(19/356),75岁组老年人COPD患病率为8.2%(31/380),85岁组老年人COPD患病率为18.4%(14/76)。COPD患病率随着患者年龄的增大而增加,且不同年龄段老年人COPD患病率差异有统计学意义(χ~2=14.842,P=0.001)。男性老年人吸烟率为88.6%(381/430),女性老年人吸烟率为1.3%(5/382),男性老年人吸烟率明显高于女性,差异有统计学意义(χ~2=618.13,P=0.000)。结论我校老年人COPD患病率较高,且既往确诊率较低,应逐渐推广肺功能检测,力争做到COPD的早发现、早诊断、早治疗;同时应积极开展健康教育,帮助更多吸烟者戒烟,切实保障老年人的身体健康。     

泰州市居民2021年慢阻肺筛查结果分析

目的 对泰州地区40岁及以上人群进行慢阻肺(COPD)筛查,探讨泰州居民COPD患病情况及其相关危险因素,为本地区COPD的防治和政策制定提供科学依据。方法 选取泰州市40岁及以上常住居民作为研究对象,通过分层整群随机抽样的方法抽取样本进行问卷调查和肺功能检测。结果 本次共调查8 816人,COPD患病率为7.20%,男性患病率(10.88%)高于女性(4.25%)(χ²=142.89,P<0.05)。多因素logistic回归分析结果显示,男性、≥70岁、吸烟、BMI<18.5kg/m²、小学及以下文化程度、儿童期患过呼吸系统疾病、不进行规律运动是泰州市40岁及以上人群COPD的危险因素。结论 应加强对重点人群的健康教育和干预,对各类危险因素加以控制。     

云南省农村居民慢性阻塞性肺疾病患病现况及基于结构方程模型的影响因素

目的  分析云南省农村居民慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患病现况及其影响因素。方法  采用多阶段分层随机抽样方法抽取云南省农村地区7 572名≥35岁常住居民进行现场问卷调查和体格检查,采用主成分分析法(principal component analysis,PCA)构建个体社会经济地位(socioeconomic status,SES),运用结构方程模型(structure equation modeling,SEM)分析COPD患病的影响因素。结果  云南省农村居民COPD患病率为12.60%,男性患病率高于女性(χ² =57.973,P＜0.001);COPD患病率随年龄的增加而升高(χ_趋势²=165.616,P＜0.001);少数民族居民COPD患病率高于汉族居民(χ²=33.785,P＜0.001);SES越低,COPD患病率越高(χ_趋势²=10.751,P＜0.001)。SEM分析结果显示,性别、年龄、民族和SES对COPD患病具有直接和间接作用,其总路径系数分别为0.09、0.15、0.06和-0.05,而COPD家族史、低BMI、现在吸烟和被动吸烟对COPD患病只有直接作用, 其路径系数分别为0.06、0.03、0.08和0.08。结论  云南省农村居民COPD患病率较高,应加强对男性、高龄、吸烟、低BMI、有COPD家族史和SES较低人群的COPD健康教育和干预工作。     

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.