大庆石油工人肾结石患病调查及其影响因素

目的 分析大庆油田石油工人肾结石的患病状况及肾结石形成的危险因素.方法 采用随机方法对1893名石油工人进行问卷调查和肾脏B超检查,用单因素及多因素Logistic回归方法对肾结石形成的危险因素进行分析.结果 1893名石油工人肾结石患病率为11.3％.经单因素及多因素logistic回归分析,年龄(OR=1.87,95％ CI:1.657 ～2.109)、饮食因素(OR=1.758,95％ CI:1.26～2.455)、尿路感染病史(OR=1.883,95％ CI:1.541 ～2.302)是影响肾结石的肯定因素.结论 年龄、饮食因素、尿路感染史是肾结石发病的危险因素.     

喀什地区小儿泌尿系结石危险因素的调查

目的 研究喀什地区维吾尔族小儿泌尿系结石发病的危险因素,为制定预防措施提供依据.方法 采用1∶1配比病例对照研究,选择喀什地区第一人民医院收治的115例维吾尔族小儿泌尿系结石患者作为病例组,按照民族、性别、年龄和居住地进行配比,应用条件Logistic回归分析方法处理资料.结果 单因素Logistic分析共有12个变量有统计学意义,但最终进入模型的因素有6个,母亲文化程度小学及以下(OR=2.385,95％CI:1.401～4.061)、饮用生水(OR=9.160,95％CI:3.354～25.015)、日饮水量少(OR=3.263,95％CI:1.605～6.332)、多食甜食(OR=8.945, 95％CI:3.062～26.133)是发病的危险因素,多食蔬菜(OR=0.154,95％CI:0.053～0.450)、夏季暴露日照时间＜2h/日(OR=0.344,95％CI:0.224～0.526)是发病的保护因素.结论 喀什地区维吾尔族小儿泌尿系结石发病受饮食生活习惯、家庭状况及地理环境的影响.     

女性非酒精性脂肪性肝病危险因素的病例对照研究

目的 探讨女性非酒精性脂肪肝的危险因素,为预防和控制女性人群非酒精性脂肪肝的发生提供流行病学依据.方法 采用成组匹配的病例对照研究方法,通过调查问卷、体格检查和生化检测等方法收集暴露因素,通过非条件Logistic回归方法探讨女性非酒精性脂肪肝的发病影响因素.结果 单因素非条件Logistic回归分析结果显示,女性非酒精性脂肪肝的危险因素有肥胖(BMI≥24 kg/m2)、食用油炸食品、食用烟熏和腊味食品、食用腌晒和盐渍食品、应酬频率、近五年体重变化、既往病毒性肝炎史、高血压史及高血脂病史;多因素非条件Logistic回归分析中,最终进入模型的变量有肥胖(BMI≥24 kg/m2)、不清楚既往病毒性肝炎史、不吃油炸食品、高血压史和高血脂病史,其中肥胖BMI≥24 kg/m2 (OR=4.084,95％CI=1.927～8.658)、不清楚既往病毒性肝炎史(OR=8.618,95％CI=1.915～38.773)、高血压史(OR=3.782,95％CI=1.097～12.673)和高血脂病史(OR=5.369,95％CI=2.521～11.435)是危险因素,不吃油炸食品(OR=0.052,95％CI=0.016～0.173)是保护因素.结论 通过合理膳食、改变不良生活饮食习惯、增加运动、减轻体重、治疗高血压病及脂质代谢紊乱等措施,有助于预防非酒精性脂肪肝.     

公务员人群中脂肪肝患病影响因素的病例对照研究

目的 了解公务员脂肪肝患病情况及其影响因素,探讨预防发病的干预措施.方法 于2008年9～12月,采用整群抽样的方法对天津市某区公务员进行健康状况及影响因素的问卷调查.应用SPSS17.0建立Logistic回归模型,对公务员人群的脂肪肝影响因素进行分析.结果 公务员人群中脂肪肝患病率为17.86％.多因素分析结果显示脂肪肝患病影响因素有:年龄(OR=0.074,95％CI:1.050～1.105)、性别(OR =-1.207,95％CI:0.223～0.402)、体重指数(OR=0.385,95％CI:1.360～1.587)、饮酒(OR=0.990,95％CI:1.459～4.964)、吸烟(OR=0.852,95％CI:1.485～3.707)、睡眠时间(OR=-0.165,95％CI:0.723～0.995)、按时吃饭情况(OR=0.693,95％CI:1.582～2.530)、高血压(OR=1.340,95％CI:3.031～4.817)、高血脂(OR=1.431,95％CI:2.700～6.483)、腰臀比(OR=2.734,95％CI:6.098～18.920)、亚健康分值(OR=-0.048,95％CI:0.936～0.970).结论 公务员人群脂肪肝患病率较高,公务员是各种慢性病发病的高危人群,是今后开展健康管理的重点群体.     

学龄前儿童反复呼吸道感染状况及相关因素分析

目的 探讨学龄前儿童反复呼吸道感染状况及相关因素,为制定预防措施提供依据.方法 采用随机抽样方法,抽取义乌市学龄前儿章850名的监护人进行问卷调查,内容包括社会经济状况、抚育因素、生活环境因素等.采用X2检验及多因素Logistic回归分析反复呼吸道感染影响因素.结果 义乌市学龄前儿童反复呼吸道感染率为24.9％,影响反复呼吸道感染的因素主要有家庭人均月收入(OR=1.22,95％CI=1.01～1.47)、母亲生育年龄(OR =0.95,95％ CI =0.91 ～0.99)、哮喘(OR =2.05,95％CI=1.15 ～3.68)、佝偻病(OR=3.91,95％CI=1.88 ～8.13)、零食(OR=1.54,95％CI=1.18 ～2.02)、孩子平常出行的交通方式(OR=1.34,95％CI=1.03～1.74)、同住者是否吸烟(OR=1.59,95％CI=1.16 ～2.20).结论 学龄前儿童反复呼吸道感染影响因素来自多个方面.应建立良好健康习惯,预防反复呼吸道感染的发生.     

发热伴血小板减少综合征重症及死亡危险因素的Logistic回归分析

目的 分析发热伴血小板减少综合征(SFTS)患者的临床特征和危险因素.方法 收集2011年5月至2012年7月解放军第一五四医院就诊的273例SFTS患者的相关信息,采用RT-PCR检测新布尼亚病毒(SFTSV),通过ELISA检测SFTSV-IgM和IgG抗体,采用Human BioPlex ProTM Assays 17-Plex Panel方法测定细胞因子.对确诊病例采用单因素、多因素Logistic回归模型分析SFTS病例重症和死亡发生的危险因素.结果 273例SFTS患者中180例SFTSV核酸阳性.主要临床表现为发热、乏力、肌肉酸痛和胃肠道症状.多因素Logistic分析显示,年龄≥60岁(OR=1.08,95％CI:1.03～1.13)、淋巴结肿大(OR =3.75,95％CI:1.45～9.66)、下呼吸道感染(OR=3.57,95％CI:1.40～9.11)、肌酐(Cr)＞97 mmol/L(OR=4.10,95％CI:1.55～10.82)及意识障碍(OR=3.35,95％CI:1.21～9.29)与重症病例发生显著相关.年龄≥60岁(OR=1.06,95％CI:1.00～1.12),下呼吸道感染(OR=4.33,95％CI:1.35～13.93),Cr＞97 mmol/L (OR=10.14,95％CI:3.19～32.21)及意识障碍(OR=3.47,95％CI:1.03～11.72)与死亡病例发生显著相关.结论 年龄≥60岁、合并下呼吸道感染、Cr＞97 mmol/L、意识障碍是SFTS患者预后不良的危险因素,应予重点治疗.     

兰州市儿童血铅水平及影响因素分析

目的 了解兰州市儿童血铅水平及其影响因素,为进一步防治儿童铅中毒提供科学依据.方法 采用单因素分析及多因素Logistic回归分析方法,对随机抽取兰州市某综合医院1 510例儿童血铅的可能的危险因素进行回顾性分析.结果 兰州市儿童血铅的几何均数为50 μg/L,铅中毒率为10.13％,引入logistic回归模型的因素有:居家附近的工厂(OR=1.814,95％ CI=1.282～2.567)、住所装修(OR=-0.472,95％ CI=0.435 ～0.896)、食用膨化食品(OR=0.234,95％CI=1.050 ～1.521)、进食前洗手(OR=-0.305,95％CI =0.558～0.974)、看图书(OR=-0.172,95％CI =0.711 ～0.996).结论改善儿童居住环境、改善饮食结构、鼓励儿童进食前洗手是控制儿童铅中毒的有效措施.     

重庆市机关事业单位工作人员高血压患病率及危险因素调查

目的 了解重庆市机关事业单位工作人员的高血压患病现状及危险因素,为该人群高血压防控工作提供科学依据.方法 采用横断面调查的方法,对重庆市1 000名机关事业单位工作人员进行问卷调查和体格测量,运用多因素Logistic回归分析高血压的影响因素.结果 有效完成问卷调查和体格测量929人,其中高血压患者136人,粗患病率14.6％,年龄标化患病率17.6％.年龄(OR=2.9S,95％ CI:2.77～3.19)、性别(OR =0.47,95％ CI:0.23～0.71)、食用豆制品(OR =2.35,95CI:2.13 ～2.57)、食用咸菜或泡菜(OR =0.67,95％CI:0.45～0.89)、坚持体育锻炼(OR=1.82,95％CI:1.55 ～2.09)、体质指数(OR=2.17,95％CI:2.02 ～2.32)是高血压的独立影响因素.结论 重庆市机关事业单位工作人员的高血压患病危险因素普遍存在,应通过健康教育、定期体检、对食堂进行干预等综合防控措施来有效抑制该人群的高血压流行形势.     

鲍曼不动杆菌院内获得性肺炎发生和死亡的危险因素分析

目的 探讨鲍曼不动杆菌(鲍氏不动杆菌)院内获得性肺炎(Ab-HAP)的易感因素和死亡的危险因素.方法 收集2012-2015年北京积水潭医院明确诊断的Ab-HAP患者65例,并随机收集同期非Ab-HAP患者80例作为对照组,分析人口学、基础疾病、治疗情况及转归等信息.采用Logistic回归法分析发生Ab-HAP的独立危险因素以及Ab-HAP患者30 d死亡的独立危险因素.结果 Ab-HAP组和对照组在合并基础病、意识障碍、APACHⅡ评分≥16、机械通气≥5 d、碳青霉烯抗生素暴露史方面差异有统计学意义(x2=36.327、31.208、72.616、22.029和64.476,P均＜0.01).多因素分析显示,APACHⅡ评分≥16(OR=1.140,95％CI:1.058～1.229)、碳青霉烯抗生素暴露史(OR=7.118,95％CI:1.965～25.787)是发生Ab-HAP的独立危险因素.Logistic回归分析证实,降钙素原≥2 ng/mL(OR=6.020,95％CI:7.428～2 819.026)、肺炎严重性评分(PSI)≥Ⅲ级(OR=4.260,95％CI:3.185～1 573.536)和脓毒性休克(OR=4.186,95％CI:2.056～2 104.507)是Ab-HAP患者30 d死亡的独立危险因素.结论 APACHⅡ评分≥16、碳青霉烯抗生素暴露史能增加Ab-HAP发生率;PSI≥Ⅲ级、降钙素原≥2 ng/mL和脓毒休克是Ab-HAP患者30 d死亡的独立危险因素.     

乌拉盖管理区高血压流行现状及影响因素分析

目的 了解乌拉盖管理区高血压患病、治疗与控制及相关危险因素,为内蒙古地区高血压社区防治策略的改进提供依据.方法 随机抽样抽取乌拉盖年龄≥10岁的1103名居民进行问卷调查及体格检查,采用多因素logistic回归分析高血压患病、治疗与控制的影响因素.结果 1103人中,高血压患病率为44.8％(标化率43.6％),知晓率为59.7％(标化率48.5％),治疗率为48.6％(标化率38.5％),控制率为14.6％(标化率11.7％).多因素logistic回归分析结果显示,男性(OR=1.67,95％CI:1.25～2.23,P＜0.01)、高年龄(35～＜55岁:OR=3.08,95％CI:2.10～4.52,P＜0.01;≥55岁:OR=5.43,95％CI1:3.55～8.30,P＜0.01)、中心性肥胖(OR =2.57,95％CI:1.92～3.45,P＜0.01)为高血压患病的危险因素,奶制品摄入200～＜300 g/d(OR=0.55,95％CI:0.35～0.85,P＜0.01)为保护因素;高年龄(35～＜55岁:OR=0.13,95％CI:0.05～0.40,P＜0.01;≥55岁:OR=0.08,95％CI:0.03～0.25,P＜0.01)、中心性肥胖(OR=0.61,95％CI:0.39～0.97,P＜0.05)、合并糖尿病(OR=0.37,95％CI:0.17～0.80,P＜0.05)、合并血脂异常(OR=0.38,95％CI:0.22～0.65,P＜0.01)为高血压治疗的保护因素,经常吸烟(OR=3.10,95％CI:1.80～5.33,P＜0.01)为危险因素;经常吸烟(OR=5.35,95％CI:1.88～15.15,P＜0.01)为高血压控制的危险因素,合并糖尿病(OR=0.34,95％CI:0.18～0.66,P＜0.01)为保护因素.结论 内蒙古乌拉盖管理区高血压患病率较高,知晓率、治疗率与控制率仍有待提高.     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.