上海市居民高血压危险因素病例对照研究

目的探讨上海市人群高血压发生的危险因素。方法采用病例对照方法对507名新诊断的高血压患者和11832名对照人群的危险因素用SPSS软件进行单因素和多因素Logistic回归。结果经单因素筛选,有14个暴露因素与高血压有关。多因素分析显示,年龄(OR=1.366,95%CI:1.199～1.555)、脑血管疾病家族史(OR=2.766,95%CI:1.504～5.087)、睡眠时间缩短(OR=1.936,95%CI:1.167～3.213)和体重超标(OR=1.908,95%CI:1.323～2.750)是高血压发生的独立危险因素。结论高血压是遗传与环境共同作用的结果。控制体重、改善睡眠可预防和减少高血压的发生。     

海岛居民高血压危险因素的配对病例对照研究

目的了解海岛地区人群高血压的危险因素,为海岛地区高血压的防治提供科学依据。方法采用整群随机抽样法对大连市长海县大长山岛镇的海岛居民进行问卷调查和相关体格检查。对检出病例按1∶1选择同性别、年龄±5岁、居住地相同或相近的对照进行匹配,并进行危险因素分析。结果单因素Logistic回归分析结果表明,体质指数、体重、腰围、臀围、家族史、糖尿病、血糖、甘油三酯、胆固醇、高密度脂蛋白、低密度脂蛋白、尿酸与海岛居民高血压的发生有关。多因素Logistic回归分析结果表明体质指数(OR=1.144,95%CI=1.062~1.233)、甘油三酯异常(OR=2.253,95%CI=1.087~4.671)及兄弟姐妹患高血压(OR=3.167,95%CI=1.766~5.677)是海岛居民高血压发生的主要危险因素。结论肥胖、家族史、甘油三酯升高是海岛居民高血压的主要危险因素,应采取针对性的措施进行干预。     

成人高血压和高血压前期影响因素研究

目的了解成人高血压和高血压前期的流行现状及影响因素,为制定高血压防制措施提供依据。方法采用多阶段分层随机整群抽样方法,对锡山区8个街道(乡镇)5 472名≥18岁常住居民开展人口学特征和生活方式问卷调查及身高、体重、腰围和血压测量等体格检查,采用多分类Logistic回归模型分析高血压和高血压前期患病的影响因素。结果发放问卷5 472份,回收有效问卷5 111份,有效率为93.40%。高血压前期检出率为44.00%,标化率为43.72%;高血压患病率为24.09%,标化患病率为23.17%。Logistic回归分析结果显示,高龄(OR=1.027,95%CI:1.021~1.033)、男性(OR=1.894,95%CI:1.601~2.241)、腰围大(OR=1.062,95%CI:1.049~1.075)和高BMI(OR=1.271,95%CI:1.106~1.461)是高血压前期的危险因素;高龄(OR=1.101,95%CI:1.093~1.109)、男性(OR=1.467,95%CI:1.157~1.860)、腰围大(OR=1.103,95%CI:1.086~1.120)、高BMI(OR=1.735,95%CI:1.449~2.078)、每天饮酒(OR=1.522,95%CI:1.066~2.174)和高血压家族史(OR=2.823,95%CI:2.305~3.459)是高血压的危险因素;家庭收入高、多参加体育锻炼、多吃水果是高血压前期和高血压的保护因素。结论男性、高龄、超重或肥胖人群是锡山区高血压防制的重点人群,应加强高血压前期筛查和生活方式健康教育干预。     

重庆社区居民高血压相关危险因素分析

目的了解重庆市社区居民高血压的患病情况及主要危险因素,为综合防治提供依据。方法通过分层整群抽样对9727名15岁以上人群进行调查,计算高血压患病率,应用Logistic回归分析的方法进行高血压的危险因素分析。结果重庆市高血压患病率22.34%,男性22.26%,女性22.41%,随着年龄的增长患病率呈增加趋势;多因素Logistic回归结果表明,年龄段(OR=1.24)、饮酒(OR=1.64)、经常参加体育锻炼(OR=0.80)、喜咸食(OR=1.13),体重指数(BM I)(OR=1.29),腰臀比(OR=1.23),高血压家族史(OR=4.47),糖尿病史(OR=2.45)是高血压独立的危险因素。结论高血压已成为重庆市社区人群的重要公共卫生问题,应尽早针对相关危险因素采取预防控制措施。     

天津市某社区50岁以上居民高血压患病情况及相关因素

目的 了解50岁以上居民高血压患病情况及相关危险因素,为制定高血压防治策略提供科学依据.方法 采用现况调查的方法,对某社区50岁以上全部居民3 763人进行调查,内容包括人口统计学特征、生活方式、睡眠情况、疾病史及疾病家族史等相关因素以及测量身高、体重、腰围、臀围、血压等.结果 高血压患病率为43%,男性患病率41.2%,女性患病率为44.5%,男女性高血压患病率差别有统计学意义(P＜0.05).单因素Logistic回归分析结果显示,年龄(OR=1.029,95%CI:1.021～1.037)、女性(OR=1.145,95%CI:1.005～1.305)、体质指数(OR=1.118,95%CI:1.097～1.140)、腰围(OR=1.025,95%CI:1.019～1.032)、腰臀比(OR=5.809,95%CI:2.047～16.489)、糖尿病(OR=2.186,95%CI:1.840～2.598)、高脂血症(OR=2.460,95%CI:1.558～3.885)、高血压家族史(OR=2.692,95%C/:2.307～3.142)及睡眠障碍(OR=1.354,95%CI:1.159～1.582)与高血压高危险有关.多因素Logistic回归分析与高血压有关的因素是:高血压家族史(OR=3.253,95%CI:2.611～4.052)、年龄(OR=1.053,95%CI:1.041～1.065)、BMI(OR=1.098,95%CI:1.071～1.126)、糖尿病(OR=2.248,95%C/:1.769～2.858)、高脂血症(OR=2.234,95%CI:1.378～3.623)及睡眠障碍(OR=1.370,95%CI:1.113～1.686).结论 高血压已成为影响50岁以上居民身体健康的重要公共卫生问题,年龄、体质指数、高血压家族史、糖尿病、高脂血症及睡眠障碍与高血压有关.     

上海市浦东新区某乡镇脑卒中危险因素分析

目的了解脑卒中发生的危险因素,为预防脑卒中提供参考依据。方法采用1∶1配对病例对照研究,2015年1—6月在上海市浦东新区祝桥镇施湾社区内选择200例脑卒中患者,按照性别、年龄配对200名未患有脑卒中的人群,对所有研究对象进行统一的问卷调查。采用单因素分析和多因素条件Logistic回归分析筛选出与脑卒中发生相关的危险因素。结果多因素条件Logistic回归分析显示,高血压、高脂血症、动脉粥样硬化、高盐饮食是脑卒中发生的危险因素(OR=1.747,95%CI为1.098~2.777;OR=1.827,95%CI为1.072~2.546;OR=1.935,95%CI为1.066~2.584;OR=1.526,95%CI为1.177~1.943)。结论脑卒中的发病与高血压、高脂血症、动脉粥样硬化和高盐饮食有关,今后要加强对高危人群的健康教育与干预可有效预防脑卒中的发生。     

南京市某职业人群糖尿病患病现状及相关危险因素

目的分析南京市化学工业园区某职业人群糖尿病流行现状及相关危险因素,为职业人群制定糖尿病防治措施提供理论依据。方法采取整群随机抽样的方法于2014年6—8月对某企业的3个职业场所的所有职工进行问卷调查、体格检查和实验室检查。采用χ2检验和二元logistic回归模型分析糖尿病的危险因素。结果共调查1 084例,平均年龄为(39.58±9.61)岁,其中男性785例,女性299例,糖尿病患病率为4.24%。该职业人群糖尿病相关因素暴露率前3位为吸烟(42.90%)、超重/肥胖(42.16%)和向心性肥胖(33.95%)。单因素分析表明性别、年龄、体质指数(BMI)、家族史、高血压、高脂血症、吸烟、饮酒、向心性肥胖与糖尿病的发生相关(均P0.05)。经多因素非条件逐步logistic回归分析表明,年龄(OR=3.038,95%CI:1.777~5.194)、家族史(OR=4.176,95%CI:1.880~9.276)、高血压(OR=2.038,95%CI:1.061~3.913)、高血脂症(OR=2.039,95%CI:1.054~3.943)、向心性肥胖(OR=3.309,95%CI:1.623~6.743)是糖尿病独立的危险因素。结论该职业人群糖尿病患病率低于全国平均水平,高龄、家族史、高血压、高脂血症和向心性肥胖是糖尿病发生的主要危险因素,应针对糖尿病危险因素采取综合防治措施。     

武汉居民甲状腺疾病患病情况及危险因素调查

目的了解武汉地区甲状腺疾病患病情况及危险因素。方法通过问卷调查、体格检查、甲状腺彩超及甲状腺功能检测等方法横断面调查武汉地区2 028名居民甲状腺疾病患病率,并通过Logistic回归分析影响甲状腺疾病发病的危险因素。结果该地区甲状腺疾病总检出率为23.3%,其中男性为9.1%,女性为37.6%,女性患病率显著高于男性(P<0.01)。多元Logistic回归分析表明:性别(OR=0.256,95%CI:0.138~0.289)、年龄(OR=2.180,95%CI:1.690~2.626)、甲状腺疾病家族史(OR=2.216,95%CI:1.916~2.901)、每日碘盐摄入量(OR=3.603,95%CI:2.960~3.991)、饮食习惯(频繁摄入海产品)(OR=2.697,95%CI:2.116~3.236)、收入水平(OR=1.230,95%CI:1.106~1.709)及学历(OR=1.362,95%CI:1.231~1.796)是影响甲状腺发病的危险因素。结论武汉地区甲状腺疾病患病率达23.3%,女性、年长者、有甲状腺疾病家族史、碘盐摄入过量、频繁摄入海鲜产品、高收入、高学历群体是甲状腺疾病的易感人群。     

湘西州土家族、苗族小学生营养状况及其影响因素

目的了解湘西州土家族、苗族小学生营养状况,并探讨其影响因素,为制定少数民族小学生营养状况改善对策提供依据。方法分层随机整群抽取682名土家族、420名苗族小学生进行体格测试和问卷调查,采用身高标准体重法评价学生营养状况,对可能影响营养状况的因素进行非条件logistic回归分析。结果土家族和苗族小学生中度营养不良和肥胖的比例分别为4.54%、11.43%。logistic回归显示,人均月收入(OR=1.368,95%CI 1.135~1.648)、父亲文化程度(OR=1.332,95%CI 1.108~1.602)是营养不良的独立危险因素;肥胖家族史(OR=7.688,95%CI 5.134~11.513)、人均月收入(OR=1.516,95%CI 1.204~1.910)、父亲文化程度(OR=1.466,95%CI 1.164~1.846)是营养过剩的独立危险因素。结论土家族、苗族小学生营养不良与营养过剩并存,肥胖家族史、人均月收入、父亲文化程度是学生发生营养不良和营养过剩的影响因素,应加强对学生及其看护人营养健康知识的普及和教育。     

踝/臂血压指数与传统心血管疾病危险因素聚集关系

目的 探讨踝/臂血压指数(ABI)与传统心血管疾病危险因素间聚集关系.方法 选取广西地区2 005人作为研究人群.采用t检验比较高血压、高TC、高血糖、低HDL-C、超重和肥胖、吸烟者与相应正常人群ABI值的差异.采用Logistic回归(后剔除法,进入P值0.05,移出P值0.10)分析ABI与年龄、性别、血压、总胆固醇(TC)、高密度脂蛋白胆同醇(HDL-C)、体质指数(BMI)、空腹血糖(FPG)、吸烟等因素间的关系.结果 该组人群中超重和肥胖、低HDL-C及吸烟者与相应正常人群间ABI值差别有统计学意义(P<0.05),高血压、高TC、高血糖者与相应正常人群间ABI值差别无统计学意义(P>0.05).Logistic回归分析表明性别(OR=3.874,95%CI:1.920～7.814)、高血压(OR=1.550,95%CI:1.013～2.372)、吸烟(OR=2.018,95%CI:0.930～4.376)为低ABI(ABI<0.9)的主要危险因素;男性以年龄(OR=2.125,95%CI:0.951～4.752)、吸烟(OR=2.332,95%CI:0.981～5.545)为低ABI的主要危险因素;女性以高血压(OR=1.595,95%CI:0.962～2.643)为其危险因素.60岁以上组人群的性别(OR=4.625,95%C/:1.803～11.867)、高血压(OR=2.085,95%CI:1.205～3.608)、吸烟(OR=3.617,95%CI:1.362～9.607)为其危险因素;其中,男性以吸烟(OR=6.817,95%CI:1.558～29.829)为主要危险因素,女性以高血压(OR=2.681,95%CI:1.345～5.342)为主要危险因素.60岁以下组人群的性别(OR=3.636,95%CI:1.721～7.681)为其主要危险因素,其中男女性均无独立危险因素.结论 ABI与传统心血管疾病危险因素间存在聚集关系.女性、高血压、吸烟增加低ABI的危险.     

Parenting adolescents

The period of adolescence is often thought to be one of intense stress and turmoil. Yet many parents and teens negotiate this developmental stage without extreme family conflict and without sacrificing close relationships. This review summarizes a portion of the literature on parent-adolescent relationships, focusing on monitoring and control of adolescent behavior and parenting style. Basic principles to emphasize when working with adolescents and parents are also included.     

Sensorially impaired adolescents

Information from publications by Lidz, Piaget, and Erickson to describe normal adolescence and the developmental tasks of that age is brought together in this paper. Primary sources were de la Cruz and LaVeck and Spock and Lerrigo for information on impaired young people and problems in their adaptation.Part of a baseline to describe the adolescent period with its sexual drive, are attitudes on the part of those who would help. Nonjudgementalism is necessary so as not to seal off any possibility of communication with those we are trying to help. A second attitude, universalism, comes from sharing with other persons in such a way that one perceives the many similarities between himself and his behavior and other human beings. Honesty is necessary for us to be aware and able to help others be aware that concerns about reproduction and hygiene do not make up the whole of sexuality, affection, intimacy, and closeness are also part of the human sexual experience.In their homes and in educational settings, we consider multi-impaired children first as children, second as impaired children. The deaf-blind adolescent child and youth is first an adolescent in contemporary American society. His impairments have caused vital limitations, yet he has the same life tasks and physical push of unimpaired adolescents.     

Health of adolescents

Adolescents are the future adults of the world. While adolescence is typically regarded as a period of life relatively free from health problems, adolescents are actually in need of the attention of health professionals and health services, especially with regard to sexual health. A trend of decreasing age at menarche and increasing age at marriage presents adolescents with a substantial number of years in which they will experiment with their developing reproductive organs and sexuality. Substantial psychological and physical change takes place during this period. Inconsistent and suboptimal users of contraception, youths are at high risk for reproductive health problems and sexually transmitted diseases. Substance abuse, unintentional and intentional injuries and their sequelae, academic underachievement and illiteracy, and obesity may also be problematic for adolescents. Adolescents are, however, most damaged by internalized and externalized homophobia. The authors point out that adolescents may be persuaded to learn and change their behaviors more readily than adults. Appropriate messages could be conveyed through targeted information, education, and communication strategies to complement medical and health care services which are available, accessible, and acceptable.     

Contraception for adolescents

In the contraceptive clinic of the Margaret Sanger Research Bureau, about 3000 patients are served each year, with at least 15% under 18. Of those attending the Teen Center as of 1972, aged 17 and younger, 15% used the diaphragm, 26% the IUD, 43% oral contraceptives, 10% foam or condom, and 5% a long-acting injectable. The Teen Center's program is limited to 200 girls, and along with contraceptive services, provides peer group discussions which help the girls decide which contraceptive to choose. Girls choose the diaphragm mostly when intercourse does not occur frequently. The IUD is best for those who fear the possibility of forgetting to use contraception. Although the IUD is not ideal for nulliparous women, gentle and slow insertion techniques reduce unpleasant symptoms. The girl who wishes to run no pregnancy risk whatsoever, who is not fearful of side effects, who has no strong feelings about ingesting chemicals, who is confident of not forgetting to take the pill regularly, and who desires the convenience of routine is most likely to select the oral contraceptive. The risks of the effect of oral contraceptives on the growing body are countered by the greater potential harmful effects of pregnancy producing much higher estrogen levels than caused by the pill. Because of the different needs of teenagers, they are seen every 3 months. Since the clinic's beginning in February 1971, about 8% have dropped from the program; 12 girls became pregnant and 9 had subsequent abortions. The low dropout rate is attributed to the teenagers' perception that the staff accepts and cares about them.     

Vaginitis in adolescents

Vaginitis is a common complaint of adolescent females. It can cause extreme distress for some patients, especially those with recurrent symptoms. Thus, it is important to take care when evaluating these patients and to acknowledge their frustration when appropriate. A thoughtful and thorough history will determine most causes, with the most common being yeast, trichomoniasis, and BV.     

Hematuria in adolescents

Hematuria is not a rare finding during adolescence. The high prevalence of microscopic hematuria is not surprising when one considers the vast number of ways in which RBC can end up in the urine. The adolescent presenting with gross hematuria, proteinuria, or microscopic hematuria in combination with other symptoms of genitourinary disease is more likely to require a therapeutic intervention than is the individual found incidentally to have microscopic hematuria. Screening for hematuria is not supported by current evidence. When it is discovered as the result of a screening examination, persistent microscopic hematuria in an otherwise asymptomatic individual may not require further investigation; however, the renal ultrasound examination has little risk and is helpful in diagnosing many of the conditions amenable to intervention. Serum studies offer little useful information in the evaluation of microscopic hematuria. Addressing isolated hematuria in a systematic, evidence-based fashion can help avoid untoward patient and parental worry and excessive health care costs, without missing treatable or progressive disease entities.     

Hypertension in adolescents

BP elevation in adolescence may be the first clue to underlying renal or other organ-system pathology, or it may be simply a warning sign of future cardiovascular risk. Careful measurement of BP and thorough evaluation of adolescents with sustained BP elevation should make possible the identification of those who require treatment. Usually a combination of pharmacologic and nonpharmacologic measures will result in satisfactory control of hypertension while permitting a normal quality of life.     

Epilepsy and adolescents

Anticonvulsant (AEDs) therapy in adolescence is very difficult because there is no-compliance in this special time of life. Many studies show that the factors that assured good compliance were good motivation, a good therapeutic result, the support of parents, medical and assistance personnel and the positive attitude to the disease and its treatment. Moreover, in recent years, many studies have shown the changes in endocrinology function and weight changes in adolescents after AEDs therapy and after long term therapy with valproate (VPA), carbamazepine (CBZ), gabapentin, felbamate and, topiramate. Abnormalities include weight increase, weight loss, polycystic ovaries and bone disease (osteopenia/osteoporosis, osteomalacia, etc). Thyroid hormone concentrations are involved too. Some study report that the children treated with CBZ may have subclinical signs of hypothyroidism, and these changes are more evident if CBZ is given in association with another drug for example with VPA.