国内3个城市综合医院急诊饮酒模式和伤害风险的相关性研究

目的：探讨饮酒模式(饮酒量与频率)与伤害类型(故意伤害和非故意的交通伤害)之间的相关性。方法：对年龄≥18岁,受伤时间在6 h以内,且为首次治疗的伤害患者1 539 例进行调查。主要内容为：伤害类型、伤害前6 h时是否饮酒、饮酒量及频率和过去1年饮酒情况等。数据统计用logistic回归分析和病例交叉分析。结果：伤害前6 h饮酒者遭受故意伤害的风险高于伤前未饮酒者(OR=3.63),过去一年中的饮酒频率≥1次者遭受故意伤害的风险高于未饮酒者(OR=1.986)。过去1年中分别饮酒5~11个标准杯和饮酒12个标准杯及以上的频率≥1次者遭受故意伤害的风险均高于未饮酒者(OR分别为1.854和1.572)。伤害前6 h内饮酒者遭受交通伤害的风险高于伤前未饮酒者(OR=2.091)。过去1年中饮酒频率≥1次者发生交通伤害的风险高于未饮酒者(OR=1.533)。病例交叉分析法发现伤前6 h内饮酒者的所有伤害风险都高于伤前未饮酒者(OR=5.15)。伤前饮酒量分别低于6个标准杯、6~9个标准杯和9个标准杯以上的伤害风险均高于伤前未饮酒者(OR值分别为3.83,8.64和9.58)。结论：伤害前6 h饮酒增加了故意伤害和非故意的交通伤害风险。过去1年中饮酒频率≥1次者发生故意伤害和非故意的交通伤害的风险增加。伤害前6 h 内饮酒增加所有伤害发生的风险,随着饮酒量的增加,伤害发生的风险随之增加。伤害前6 h饮酒及过去1年的饮酒模式与伤害发生关系密切,为酒的相关政策的制定提供了科学依据。     

Parental alcohol use, problem drinking, and children's injuries.

OBJECTIVE--Millions of US children are exposed to parents who are problem drinkers, yet there is little evidence about the effect of parental alcohol consumption on children's health. The aim of this study was to assess the association between children's injuries and parental drinking. DESIGN--Survey of a nationally representative sample of the US population by household interview. PARTICIPANTS--12,360 children and parents from single-family households, with data from the Alcohol and Child Health supplements to the 1988 National Health Interview Survey. MAIN OUTCOME MEASURE--Serious injuries--injuries resulting in hospitalization, surgical treatment, missed school, one half day or more in bed. RESULTS--Children of mothers categorized as problem drinkers had 2.1 times the risk of serious injury as children of mothers who were nondrinkers (95% CI, 1.3 to 3.5). Other measures of mothers' alcohol consumption (ie, average, maximum, and self-rated consumption) were unrelated to child injuries, as were all measures of fathers' drinking. Children of women who were problem drinkers married to men rated as moderate or heavy drinkers had a relative risk of serious injury of 2.7 (95% CI, 0.8 to 8.6) compared with children of nondrinkers. CONCLUSION--Children of women who are problem drinkers have an elevated injury risk; children with two parents who are problem drinkers are at higher risk. Further research is needed on potential mechanisms and interventions. Primary prevention might be enhanced if physicians elicited information about parental drinking, helped secure appropriate treatment, and participated in public health efforts to reduce the deleterious effects of alcohol.     

Alcohol intake and the risk of coronary heart disease mortality in persons with older-onset diabetes mellitus.

CONTEXT: Despite nutrition information and guidelines that advise against depriving diabetic patients of the potential benefit of moderate alcohol intake against cardiovascular events, the association between alcohol consumption and risk of cardiovascular outcomes in diabetic individuals has not been determined. OBJECTIVE: To examine the relationship between alcohol intake and coronary heart disease (CHD) mortality in persons with older-onset diabetes. DESIGN: Population-based, prospective cohort study conducted from 1984 through 1996, with a follow-up of up to 12.3 years. SETTING AND PARTICIPANTS: A total of 983 older-onset diabetic individuals (mean [SD] age, 68.6 [11.0] years; 45.2% male; 98.5% white) were interviewed about their past-year intake of alcoholic beverages during the 1984-1986 follow-up examination of a population-based study of diabetic persons in southern Wisconsin. MAIN OUTCOME MEASURE: Time to mortality from CHD by category alcohol intake. RESULTS: Alcohol use was inversely associated with risk of CHD mortality in older-onset diabetic subjects. The CHD mortality rates for never and former drinkers were 43.9 and 38.5 per 1000 person-years, respectively, while the rates for those with alcohol intakes of less than 2, 2 to 13, and 14 or more g/d were 25.3, 20.8, and 10.0 per 1000 person-years, respectively. Compared with never drinkers and controlling for age, sex, cigarette smoking, glycosylated hemoglobin level, insulin use, plasma C-peptide level, history of angina or myocardial infarction, digoxin use, and the presence and severity of diabetic retinopathy, former drinkers had a relative risk (RR) of 0.69 (95% confidence interval [CI], 0.43-1.12); for those who drank less than 2 g/d (less frequent than 1 drink a week), the RR was 0.54 (95% CI, 0.33-0.90); for 2 to 13 g/d, it was 0.44 (95% CI, 0.23-0.84); and for 14 or more g/d (about 1 drink or more a day), it was 0.21 (95% CI, 0.09-0.48). Further adjustments for blood pressure, body mass index, education, physical activity, diabetes duration, hypertension history, overt nephropathy, peripheral neuropathy, lipid measures, or intake of medications such as aspirin and antihypertensive agents did not change the associations observed. CONCLUSION: Our results suggest an overall beneficial effect of alcohol consumption in decreasing the risk of death due to CHD in people with older-onset diabetes.     

冠心病易感基因载脂蛋白E、低密度脂蛋白受体多态性与烟、酒的交互作用的研究

目的　探讨载脂蛋白E(ApoE)、低密度脂蛋白受体 (LDL R)基因多态性与烟、酒对汉族人群冠心病的交互影响。方法　采用病例 -对照研究方法 ,ApoE基因多态性检测用多重特异性扩增突变系统快速分型法 ,LDL R基因AvaⅡ位点多态性采用多聚酶链反应 限制性片段长度多态性 ,血脂测定在全自动化分析仪上进行 ,资料分析用Logistic回归模型等。病例组 14 6人 ,平均年龄6 4岁±11岁 ;对照组 340人 ,平均年龄 6 3岁± 12岁。结果　 (1)病例组收缩压和舒张压 (132mmHg± 2 1mmHg ,81mmHg± 13mmHg ,1mmHg =0 133kPa)均显著高于对照组 (12 3mmHg± 17mmHg ,77mmHg±11mmHg) ,P <0 0 1;与对照组相比 ,病例组血清甘油三酯水平显著增高 (P <0 0 5 ) ,总胆固醇、低密度脂蛋白 胆固醇有增高趋势 ,但差异无显著意义 (P >0 0 5 )。 (2 )病例组ApoEE4 /3基因型 (2 4 0 % )和ε4等位基因型 (13 4 % )频率显著高于对照组 (12 9% ,7 2 % ) ;LDL RAvaⅡ位点 3种基因型和 2种等位基因型频率分布两组间差异无显著意义 ,但病例组携带ε4等位基因者同时携带AvaⅡ 位点的比例 (6 0 % )显著高于对照组 (31 8% ) ,P <0 0 5。 (3)调整年龄、性别、血压、体重指数后 ,两基因与烟、酒对冠心病发生的交互作用有显著意义的OR     

饮酒、吸烟及其交互作用与口腔癌关系的病例对照研究

目的探讨饮酒、吸烟与口腔癌的关系。方法采用病例对照研究收集相关资料,病例为福建医科大学附属第一医院口腔科经病理确诊的新发口腔癌病例206例,对照为体检人群及其他科室患者584例。每位研究对象进行面对面的问卷调查。采用非条件Logistic回归对资料进行分析,估算饮酒、吸烟与口腔癌发病风险的调整比值比（OR）及95％可信区间（95％CI）,并分析饮酒与吸烟的交互作用。结果饮酒、吸烟可显著增加口腔癌的发病风险,调整OR值为2．06（95％CI：1．33～3．20）,2．46（1．77～3．41）;开始饮酒年龄越早、平均每天饮酒精量的增加和饮酒年限的延长,饮酒者患口腔癌的危险性增大。其中平均每天饮酒精量超过60g者与口腔癌有显著关联（P〈0．05）,调整OR值为5．98（95％CI：3．26～10．95）;吸烟且饮酒者患口腔癌的危险性是不吸烟且不饮酒者的4．77倍（95％CI：2．71～8．39）,烟酒乘积项的调整OR值为3．58（95％CI：2．45～5．24）,调整后相对超危险度比（RERI）为2．87（95％CI：0．73～5．02）、归因比（AP）为0．60（95％CI：0．33～0．87）、交互作用指数（S）为4．20（95％CI：0．95～18．66）。结论饮酒、吸烟是口腔癌的危险因素,饮酒与吸烟二者有协同作用,可增加口腔癌的发病风险。     

宫颈癌相关危险因素致病风险的Meta分析

目的综合评价我国女性宫颈癌相关危险因素的关联强度。方法系统收集1990年1月～2011年6月宫颈癌相关危险因素的研究文献,纳入合格研究文献16篇,共计研究对象11 126例。按照NOS标准对纳入文献进行质量评价;采用Stata10.0软件进行Meta分析,得到各相关危险因素与宫颈癌发病风险关联强度合并的OR值及其95%可信区间。结果文献质量评价A级文献6篇、B级文献10篇。在分析的16个因素中有12个因素差异具有统计学意义,与妊娠相关的危险因素及其OR值(95%可信区间)分别为:怀孕≥3次2.384(95%CI:1.659～3.425)、分娩≥3次2.265(95%CI:1.669～3.074)、流产≥3次3.713(95%CI:2.470～5.581)和初次怀孕年龄≤21岁2.390(95%CI:1.731～3.225);与性行为相关的危险因素分别为:结婚≥2次2.522(95%CI:1.714～3.713)、初次性生活年龄≤20岁3.467(95%CI:2.456～4.893)、性伴侣≥3个2.539(95%CI:1.613～3.996);与妇科疾病相关的因素分别为:性传播疾病史5.861(95%CI:1.048～13.67)、妇科病史4.807(95%CI:2.899～7.971);另外,受教育程度≤9年3.536(95%CI:2.204～5.672)、主动或被动吸烟3.055(95%CI:2.435～3.833)和农村或郊区居住地2.134(95%CI:1.010～4.509)等环境因素也与发病风险相关。结论妊娠等相关因素与我国女性宫颈癌发病风险密切相关。     

Reduction in motor vehicle fatalities associated with an increase in the minimum drinking age

Motor vehicle injuries are responsible for nearly 40% of the deaths that occur among persons aged 15 through 24 years. Approximately half of these deaths involve drunk drivers. In response to the problem of driving under the influence of alcohol (DUI), some states raised their minimum drinking age, increased penalties for DUI, or both. Other states vigorously resisted federal pressure to increase their drinking age, and some researchers have questioned the utility of this approach. Tennessee increased penalties for DUI in 1982 and raised the drinking age to 21 years in 1984. Alcohol-related motor vehicle deaths declined by 33% among persons aged 15 through 18 years, probably because of publicity. Our results suggest that it may be particularly important to maintain continuous, high-profile anti-DUI programs within high schools. Alcohol-related motor vehicle deaths declined 38% among persons aged 19 through 20 years; this effect appears to be attributable to the increase in drinking age and to be durable despite decreased publicity.     

531 名急诊患者外伤与饮酒的相关性研究

目的：探讨饮酒与外伤风险之间的关系。方法：对年龄≥18 岁,受伤时间在6 h 以内,且为首次治 疗的外伤患者531 例,采用美国国立卫生研究院(National Institutes of Health,NIH) 提供的问卷对外伤类型、 外伤前是否饮酒及饮酒量、过去1 年饮酒情况等进行调查,采用病例交叉分析方法,研究饮酒与外伤风险的关系。 结果：受伤前6 h 饮酒者遭受故意伤害风险高于伤前未饮酒者(OR=2.79,95%CI：1.61~4.84);与遭受非故意伤 害者相比,遭受故意伤害者中男性、醉酒、酒精测试阳性者居多。与伤前未饮酒者相比,受伤前6 h 内饮酒增 加交通伤害的风险(OR=2.41,95%CI：1.29~4.51)。受伤前6 h 饮酒者的外伤风险高于伤前未饮酒者(OR=11.86, 95%CI：5.48~25.65);受伤前6 h 饮酒>6 个标准杯者的外伤风险远高于伤前未饮酒者(OR=24.52,95%CI： 5.84~102.86)。结论：受伤前6 h 内饮酒增加外伤发生及遭受故意伤害的风险,同时也增加与交通伤害有关的风 险,因而需要控制不良饮酒行为,减少与酒相关的外伤的发生。     

Changes in breast density associated with initiation, discontinuation, and continuing use of hormone replacement therapy

CONTEXT: Initiation of hormone replacement therapy (HRT) has been shown to increase breast density. Evidence exists that increased breast density decreases mammographic sensitivity. The effects on breast density of discontinuing and continuing HRT have not been studied systematically. OBJECTIVE: To examine the effects of initiation, discontinuation, and continued use of HRT on breast density in postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of 5212 naturally postmenopausal women aged 40 to 96 years and enrolled in a large health maintenance organization in western Washington State who had 2 screening mammograms between 1996 and 1998. MAIN OUTCOME MEASURES: Breast density, assessed using the clinical radiologists' BI-RADS 4-point scale, compared among women who did not use HRT before either mammogram (nonusers); who used HRT before the first but not before the second mammogram (discontinuers); who used HRT before the second but not before the first mammogram (initiators); and who used HRT prior to both mammograms (continuing users). RESULTS: Relative to nonusers, women who initiated HRT were more likely to show increases in breast density (relative risk [RR], 2.57; 95% confidence interval [CI], 2.12-3.08), while women who discontinued HRT use were more likely to show decreases in density (RR, 1.81; 95% CI, 1.06-2.98) and women who continued to use HRT were more likely to show both increases in density (RR, 1.33; 95% CI, 1.13-1.55) and sustained high density (RR, 1.45; 95% CI, 1.33-1.58). CONCLUSIONS: These results indicate that breast density changes associated with HRT are dynamic, increasing with initiation, and decreasing with discontinuation.     

国内饮酒与胃癌关系的Meta分析

目的探讨中国居民饮酒与胃癌发生的关系,为预防对策提供依据。方法采用M eta分析方法,对中国1991年至2005年关于饮酒与胃癌关系的27篇研究文献进行综合定量分析。累计病例5 346例,对照12 084例。一致性检验后,应用随机效应模型(D-L法)计算合并比值比(OR)及其95%的可信区间(95%C I)。结果饮酒的合并比值比(OR)及95%C I为2.03及1.74~2.37,失效安全数为554.2。饮酒高危人群患胃癌的归因危险百分比为50.74%,一般人群为17.78%。结论饮酒是我国居民胃癌发病的重要危险因素,加强节制饮酒的宣传教育,可有效降低胃癌的发病率和死亡率。     

Moderate alcohol intake is associated with survival in the elderly: the Dubbo Study

OBJECTIVE: To examine the relationship between alcohol intake and survival in elderly people. DESIGN AND SETTING: A prospective study over 116 months of non-institutionalised subjects living in Dubbo, a rural town (population, 34,000) in New South Wales. PARTICIPANTS: 1235 men and 1570 women aged 60 years and over who were first examined in 1988-89. MAIN OUTCOME MEASURES: All-causes mortality; gross cost of alcohol per life-year gained. RESULTS: Death occurred in 450 men and 392 women. Intake of alcohol was generally moderate (i.e., less than 14 drinks/week). Any intake of alcohol was associated with reduced mortality in men up to 75 years and in women over 64 years. In a proportional hazards model, the hazard ratio for mortality in men taking any alcohol was 0.63 (95% CI, 0.47-0.84) and in women was 0.75 (95% CI, 0.60-0.94). Cardiovascular deaths in men were reduced from 20/100 (95% CI, 14-26) to 11/100 (95% CI, 9-13) and in women from 16/100 (95% CI, 13-19) to 8/100 (95% CI, 6-10). The reduction in mortality occurred in men and women taking only 1-7 drinks/week--hazard ratios, 0.68 (95% CI, 0.49-0.94) and 0.78 (95% CI, 0.61-0.99), respectively, with a similar protective effect from intake of beer or other forms of alcohol. After almost 10 years' follow-up, men taking any alcohol lived on average 7.6 months longer, and women on average 2.7 months longer, compared with non-drinkers. The gross cost for alcohol per life-year gained if consuming 1-7 drinks/week was $5700 in men, and $19,000 in women. CONCLUSIONS: Moderate alcohol intake in the elderly appears to be associated with significantly longer survival in men 60-74 years and in all elderly women.     

Moderate alcohol consumption and risk of heart failure among older persons

CONTEXT: Heavy consumption of alcohol can lead to heart failure, but the relationship between moderate alcohol consumption and risk of heart failure is largely unknown. OBJECTIVE: To determine whether moderate alcohol consumption predicts heart failure risk among older persons, independent of the association of moderate alcohol consumption with lower risk of myocardial infarction (MI). DESIGN: Prospective cohort study conducted from 1982 through 1996, with a maximum follow-up of 14 years. SETTING AND PARTICIPANTS: Population-based sample of 2235 noninstitutionalized elderly persons (mean age, 73.7 years; 41.2% male; 21.3% nonwhite) residing in New Haven, Conn, who were free of heart failure at baseline. Persons who reported alcohol consumption of more than 70 oz in the month prior to baseline were excluded. MAIN OUTCOME MEASURE: Time to first fatal or nonfatal heart failure event, according to the amount of alcohol consumed in the month prior to baseline. RESULTS: Increasing alcohol consumption in the moderate range was associated with decreasing heart failure rates. For persons consuming no alcohol (50.0%), 1 to 20 oz (40.2%), and 21 to 70 oz (9.8%) in the month prior to baseline, crude heart failure rates per 1000 years of follow-up were 16.1, 12.2, and 9.2, respectively. After adjustment for age, sex, race, education, angina, history of MI and diabetes, MI during follow-up, hypertension, pulse pressure, body mass index, and current smoking, the relative risks of heart failure for those consuming no alcohol, 1 to 20 oz, and 21 to 70 oz in the month prior to baseline were 1.00 (referent), 0.79 (95% confidence interval [CI], 0.60-1.02), and 0.53 (95% CI, 0.32-0.88) (P for trend =.02). CONCLUSIONS: Increasing levels of moderate alcohol consumption are associated with a decreasing risk of heart failure among older persons. This association is independent of a number of confounding factors and does not appear to be entirely mediated by a reduction in MI risk.     

Changes in drinking behavior among evacuees after the Fukushima Daiichi Nuclear Power Plant accident: the Fukushima Health Management Survey

Introduction Traumatic experiences and disordered sleep are strongly associated with drinking problems. We examined the effects of experiencing the Great East Japan Earthquake and subsequent nuclear power plant accident, and of sleep problems, on behavioral changes observed in non-drinkers. Methods This study examined cross-sectional data from the Mental Health and Lifestyle Survey conducted among residents in restricted areas of Fukushima in 2012. Participants were 21,454 evacuees aged 20 years or older at the time of disaster. People who did not drink before the disaster but became drinkers afterwards were compared with the rest of the cohort. We analyzed the association between behavioral changes in non-drinkers and potentially predictive variables, using logistic regression. Results The behavioral change of non-drinkers becoming drinkers (n=2,148) was significantly related to being male (OR=1.93, 95% CI: 1.74-2.15), being younger (21-49 yrs, OR=1.85, 95% CI: 1.60-2.13), having less educational attainment (up to high school graduate, OR=1.21, 95% CI: 1.09-1.35), smoking (OR=1.22, 95% CI: 1.08-1.38), losing family or relatives (OR=1.21, 95% CI: 1.07-1.37), change in employment (OR=1.19, 95% CI: 1.07-1.32), having severe sleep problems as measured by a Japanese version of the Athens Insomnia Scale (3-8, OR=1.45, 95% CI: 1.30-1.62), and severity of traumatic symptoms as measured by the PTSD Checklist Stressor-Specific (PCL-S) score (<44, OR=1.33, 95% CI: 1.17–1.51). Conclusion Having sleep problems and having more severe traumatic symptoms are significantly related to non-drinkers becoming drinkers.     

Identifying potential need for cancer palliation in Nova Scotia

OBJECTIVE: To assess the degree to which Nova Scotia cancer patients who may need palliative care are being referred to the comprehensive Halifax-based Palliative Care Program (PCP). METHODS: The authors conducted a retrospective, population-based study using administrative health data for all adults in Nova Scotia who died of cancer from 1988 to 1994. Proportions and odds ratios (ORs) were used to determine where there were differences in age, sex, place of residence, cancer cause of death, year of death and use of palliative radiotherapy between those who were referred to the PCP at the Halifax Infirmary and those who were not, and between those who were referred late (within 14 days of death) and those who were referred earlier. RESULTS: Of the 14,494 adults who died of cancer during the study period, 2057 (14.2%) were registered in the PCP. Within Halifax County, 1582 (36.4%) of the 4340 patients with terminal cancer were seen in the PCP. Predictors of PCP registration were residence in Halifax County (OR 19.2, 95% confidence interval [CI] 15.4-23.9), younger age compared with those 85 years of age or older (for those 20-54 years of age, OR 4.9, 95% CI 3.2-7.6; 55-64 years, OR 3.4, 95% CI 2.2-5.1; 65-74 years, OR 3.1, 95% CI 2.1-4.5; 75-84 years, OR 2.1, 95% CI 1.4-3.1), and having received palliative radiation (OR 1.8, 95% CI 1.5-2.2). PCP referral was associated directly with head and neck cancer (OR 5.4, 95% CI 3.0-9.7) and inversely with hematopoietic (OR 0.2, 95% CI 0.4-0.9), lymph node (OR 0.3, 95% CI 0.1-0.4) and lung (OR 0.6, 95% CI 0.4-0.9) cancer. Predictors of late referral (being referred to the PCP within 14 days of death) were age 65-84 years (OR 1.4, 95% CI 1.1-1.8) and 85 years and over (OR 1.8, 95% CI 1.1-3.0), no palliative radiation (OR 2.0, 95% CI 1.4-3.1) and cancer cause of death. People dying within 6 months of diagnosis were somewhat less likely to have been referred to the PCP (OR 0.8, 95% CI 0.6-0.9), but those who were referred were more likely to have been referred late (OR 2.6, 95% CI 2.0-3.5). INTERPRETATION: Referral to the PCP and earlier rather than late referral were more likely for younger people with terminal cancer, those who received palliative radiation and those living closer to the PCP. Referral rates also varied by cancer cause of death and the time between diagnosis and death.     

High association of human papillomavirus infection with oral cancer: a case-control study

BACKGROUND: The aim of the present study was to determine the association of high-risk human papillomavirus (HR-HPV) in Mexican individuals with oral squamous cell carcinoma (OSCC) and their association with various risk factors. METHODS: We designed a matched case-control study. Cases were individuals with newly diagnosed OSCC, age- and sex-matched with controls (1:4). Demographic and clinical data were obtained; also a self-administered questionnaire about sexual behavior was included. DNA from oral brushing was purified to amplify HPV-DNA through MY09/MY11 and GP5+/GP6+ primers and subsequently subjected to sequencing. Conditional regression models were built to calculate odds ratios (ORs) and 95% confidence intervals (CI). RESULTS: Sixty two cases and 248 controls (53.2% males), median age 62 years (Q1-Q3=54-72 years) were included. HPV prevalence was 43.5% in cases and 17.3% in controls (HR-HPV: 37.1% cases, 9.7% controls). The most frequent types in cases were HPV-16 and HPV-18 (55.6 and 18.5%). The presence of HR-HPV was associated with OSCC (OR=6.2; 95% CI: 2.98-12.97) controlling for the most common risk factors. An interaction between smoking and drinking was detected, and family history of cancer was also significant (OR: 3.61; 95% CI=1.44-8.99). Early age at first sexual intercourse and large number of lifetime sexual partners showed an association with HR-HPV (p=0.019 and p=0.033, respectively). CONCLUSIONS: Oral HR-HPV was strongly associated with OSCC, suggesting that HPV-16 and -18 are risk factors for oral cancer in Mexican patients. A significant association of tobacco and alcohol was confirmed. In addition, family history of cancer was associated with OSCC. The results underline the role of HPV in OSCC and its multifactorial etiology.     

锯齿状息肉与传统腺瘤风险因素对比及结直肠癌适宜筛查年龄

目的 对锯齿状息肉(SPs)及传统腺瘤(CA)相关风险因素进行分析、对比,探讨两类息肉风险因素间异同.方法 收集南方医院消化内镜中心2012～2015行全结肠镜及息肉病理检查的病例.随机选取健康对照103例,SPs100例,CA 115例,采集各病例性别、年龄、身高、体质量等临床数据.运用SPSS软件,先对各因素进行组间多重比较,对具有显著性的因素再纳入多因素logistic回归分析,得到风险因素及其OR值.结果 SPs平均发病年龄48.87岁(95％CI 47.22-50.52),较CA更早(P=0.038).以青年组为参照,中年组发生SPs风险增加2.31倍(95％CI 1.46-3.65)、CA风险增加4.10倍(95％CI 2.50-6.72);老年组发生SPs风险增加2.77倍(95％CI 1.52-5.04)、CA风险增加6.00倍(95％CI 3.26-11.05).其中,年龄与CA的发生较SPs关系更为密切(老年组:OR=2.14,95％CI 1.21-3.78,P=0.009).男性较女性SPs发病风险增加2.75倍(95％CI 1.50-5.07)、CA增加2.19倍(95％CI1.22-3.95).BMI每增加1个单位,SPs发病风险增加1.18倍(95％CI 1.06-1.30)、CA增加1.20倍(95％CI 1.09-1.32).结论 两类息肉风险因素类别相同,可使用同一方案进行高危人群筛查.SPs平均发病年龄早于50岁且有可能快速进展为癌,提早CRC筛查年龄值得考虑.     

上海市虹口区15～69岁人群吸烟行为、态度及影响因素

目的 了解上海市虹口区居民的吸烟行为、态度和可能的影响因素,为开展控烟工作提供依据。方法 采用多阶段分层随机抽样方法,共抽取上海市虹口区15～69岁对象960人,其中958人完成了吸烟情况的调查。结果 该区15～69岁人群吸烟率和标化吸烟率分别为20.04%和18.73%,男性吸烟率和标化吸烟率分别为41.05%和30.07%,女性吸烟率和标化吸烟率分别为0.80%和1.70%,男性吸烟率高于女性（RR＝0.02,95%CI：0.01～0.03）;25岁以上各年龄组吸烟率高于15～24岁组;大专及以上文化程度人群吸烟率低于初中及以下文化程度人群（RR＝0.45,95%CI：0.25～0.79）;饮酒人群吸烟率高于不饮酒人群（RR＝2.68,95%CI：1.76～4.09）。家庭人均年收入越低、烟草危害知识得分越高的人群越反对吸烟,赞同禁烟。结论 上海市虹口区15～69岁人群吸烟率较低,性别、年龄、文化程度和饮酒情况是影响吸烟情况的因素。应加强对35岁以上人群的控烟教育;对文化程度较低的人群应加强吸烟有害知识的宣传,纠正其对吸烟和禁烟的态度;在控烟教育的同时应强调控制饮酒。     

饮酒与前列腺癌危险性关系的随访研究

目的对酒精的消费与前列腺癌的关系进行了随访研究。方法本研究为前瞻性的随机对照研究。研究对象根据年龄分为二个队列。队列1：从1991～1995年开始,包括了5766例男性,年龄25～74岁,平均随访时间为17年。队列2：从队列1抽取研究对象,从2002年开始到2004年,包括了3775例研究对象,平均随访时间9年。酒精消费的计算基线为患者平日的饮酒量,既往饮酒史为患者25、35、45和55岁饮酒情况。结果总共发生了254例前列腺肿瘤,与以前的大多数研究结果一致,酒精总的饮用量与前列腺癌没有明显关系（P〉0．05）,但在第2队列中,重度饮酒和前列腺癌之间存在逆相关[（RR）=0．23,95％CI=0．06～0．95],进一步研究发现;既往在25岁、35岁、45岁有大量饮酒的患者（每周〉25次）,与前列腺癌的发生逆相关。结论研究结果说明既往有大量饮酒史与前列腺癌发生有关。     

Initial effects of graduated driver licensing on 16-year-old driver crashes in North Carolina

CONTEXT: Since 1997, 32 states have enacted graduated driver licensing (GDL) systems to reduce crash rates among young novice drivers. OBJECTIVE: To determine the initial effect of the North Carolina GDL system on crashes among 16-year-old drivers. DESIGN, SETTING, AND SUBJECTS: Comparison of population-based North Carolina motor vehicle crash rates before (1996-1997) and after (1999) 16-year-old drivers were licensed under the GDL system. To control for other factors that might have influenced crashes, changes for 16-year-old drivers were compared with those of drivers 25 to 54 years of age. Crashes per licensed driver were also examined. INTERVENTION: The North Carolina GDL system, enacted December 1, 1997, requires beginning drivers 15 to 17 years of age to hold level 1 licenses, allowing driving only while supervised by a designated adult for a full year; followed by level 2 licensure, allowing unsupervised driving from 5 AM to 9 PM and supervised driving at any time for at least 6 months; and, finally, level 3-a full, unrestricted license. MAIN OUTCOME MEASURES: Rates of motor vehicle crashes among 16-year-old drivers in 1996-1997 vs 1999, overall and by crash severity (fatal, injury, and noninjury), time (night vs day), type (single vs multiple vehicle), driver alcohol use, and driving environment (more vs less rural counties). RESULTS: Crash rates declined sharply for all levels of severity among 16-year-old drivers after the GDL program was implemented. Following GDL, 16-year-old driver crashes were substantially less likely. Comparing 1996 with 1999, fatal crashes declined 57%, from 5 to 2 per 10 000 population (rate ratio [RR], 0.43; 95% confidence interval [CI], 0.27-0.70); crashes with no or minor injuries decreased 23%, from 1068 to 826 per 10 000 (RR, 0.77; 95% CI, 0.75-0.80). Nighttime crashes were 43% less likely (156 vs 88 per 10 000; RR, 0.57; 95% CI, 0.52-0.61) and daytime crashes decreased by 20% (951 vs 764 per 10 000; RR, 0.80; 95% CI, 0.78-0.83). Single-vehicle crashes (245 vs 175; RR, 0.71; 95% CI, 0.67-0.76) declined somewhat more than multiple-vehicle crashes (866 vs 681; RR, 0.79; 95% CI, 0.76-0.81). CONCLUSION: In its initial years, the North Carolina GDL system produced substantial declines in 16-year-old driver crashes.