659例巨大儿危险因素1∶1配比病例对照研究

目的探讨当前社会巨大儿发生的危险因素。方法对659例出生体重>4kg的巨大儿,按病例组和对照组1∶1配比方法,对总计1318户家庭进行了相关因素的调查和分析,所选儿童母亲为非糖尿病妊娠和非妊娠合并糖尿病患者。结果单因素和多因素条件Logist回归分析表明,最后3个月的饮食(偏回归系数1.541偏回归系数标准误=0.105,OR值=4.669)、祖辈的肥胖度(偏回归系数=3.148标准误0.532,OR值=23.292)、孕妇的职业(偏回归系数=0.454标准误=0.127OR值=1.575)、父亲的身高(偏回归系数=0.078标准误=0.22,OR值=1.081)和父亲的年龄(偏回归系数0.174标准误=0.52,OR值=11.090)与巨大儿发生相关,其中以饮食因素最为显著。结论巨大儿是多种因素造成的,环境因素中的多食已成为目前最主要的危险因素巨大儿的发生还与遗传因素和生活习惯关系密切。     

围产儿先天性外部畸形的1：2配比病例对照研究

目的：探讨先天性外部畸形发病的危险因素,方法：对宝安区各级医疗机构监测的52例先天性外部畸形病例进行1：2配比病例对照研究。结果：单因素和多因素条件logistic回归分析表明：宝安区先天性外部畸形的主要危险因素是：是否足月产（多因素条件logistic回归分析偏回归系数＝1．4171,标准误＝0．4601,OR＝4．115）,孕早期不良精神刺激（偏回归系数＝2．1870,标准误＝0．7873,OR＝8．909）,孕早期用药（偏回归系数＝1．9178,标准误＝0．8072,OR＝6．808）,孕早期接触有害化学因素（偏回归系数＝0．9602,标准误＝0．4262,OR＝2．612）。结论：先天性外部畸形是多因素性疾病,环境及精神因素与其发病有明显联系。     

围产儿先天性外部畸形的1∶2配比病例对照研究

目的探讨先天性外部畸形发病的危险因素.方法对宝安区各级医疗机构监测的52例先天性外部畸形病例进行1∶2配比病例-对照研究.结果单因素和多因素条件logistic 回归分析表明:宝安区先天性外部畸形的主要危险因素是:是否足月产(多因素条件logistic 回归分析偏回归系数=1.417 1,标准误=0.460 1,OR=4.115)、孕早期不良精神刺激(偏回归系数=2.187 0,标准误=0.787 3,OR=8.909)、孕早期用药(偏回归系数=1.917 8,标准误=0.807 2,OR=6.808)、孕早期接触有害化学因素(偏回归系数=0.960 2,标准误=0.426 2,OR=2.612).结论先天性外部畸形是多因素性疾病,环境及精神因素与其发病有明显联系.     

上消化道癌危险因素病例对照研究

目的：探讨饮食及其他生活习惯与上消化道癌发生的关系。方法：采用1：1配对病例对照研究，对1248对病例及对照进行饮食、生活行为等问卷调查。资料处理采用条件Logistic回归进行单因素和多因素分析。结果：影响上消化道癌发生有关的危险因素有饮白酒量（OR=1．393 P=0．0020）、食辛辣食物（OR=1．141 P=0．0020）、食小米、薯类（OR=1．180 P=0．0080，OR=1．256 P≤0．001）为危险因素；而食奶类（OR=0．755 P=0．0329）、蒜苔（OR=0．419 P≤0．001）、香蕉（OR=0．525 P=0．0303）、多食肉类、夏天灶火移出室外（OR=0．478 P=0．0670）、已婚（OR=0．392 P=0．0192）为保护性因素。结论：上消化道癌与饮食因素有关，营养素的缺乏是该病的主要危险因素。     

异位妊娠破裂发生的相关危险因素分析

目的探讨异位妊娠发生破裂的相关危险因素,为异位妊娠的治疗提供参考依据。方法采用回顾性病例对照研究对65例异位妊娠发生破裂患者和118例异位妊娠未发生破裂患者的临床资料进行分析,单因素分析采用卡方检验,多因素分析采用非条件性Logistic回归法。结果产次（DR=5．362,95％CI：0．843～9．785）、妊娠部位（OR=3．757,95％CI：0．458～6．857）、异位妊娠史（OR=3．785,95％CI：0．753～5．978）、异位妊娠史包块直径（OR=1．478,95％CI：0．742—2．424）是异位妊娠破裂的相关危险因素。结论妊娠部位、异位妊娠史、包块直径是异位妊娠破裂的相关危险因素,临床工作中应对具有上述危险因素的异位妊娠患者早期提高警惕性,避免发生破裂大出血导致严重的不良预后。     

巨大儿发生率及其影响因素研究

[目的]探讨巨大儿发生率及产妇分娩巨大儿的危险因素，为尽早识别出高风险产妇、预防巨大儿发生提供参考。[方法]收集曲靖市妇幼保健院2021年1月1日-12月31日在院分娩的7590例孕产妇，选取与出生体重有关的孕期相关危险因素，采用非条件Logistic回归分析危险因素的聚集情况。[结果]分娩巨大儿的产妇中，62.87%的产妇出现危险因素的聚集，当有2种危险因素聚集时，即年龄≥30岁有妊娠合并肥胖的产妇(OR=9.282,P<0.05)、妊娠糖尿病的经产妇(OR=9.282,P<0.05)分娩巨大儿的风险最高；3种因素聚集时，即身高≥160 cm合并妊娠肥胖的经产妇(OR=22.277,P<0.05)分娩巨大儿的风险最高；4种因素聚集时，即年龄≥30岁合并妊娠肥胖和妊娠糖尿病的经产妇(OR=18.564,P<0.05)分娩巨大儿的风险最高；有5种危险因素的产妇(OR=25.315,P<0.05)分娩巨大儿的风险高于其他所有产妇。[结论]孕期危险因素聚集可升高发生巨大儿的风险，孕期应及早识别并重视有风险特征的产妇，加强健康教育和孕期保健，减少巨大儿的发生。     

2型糖尿病危险因素的交互作用研究

目的探讨2型糖尿病危险因素及其交互作用，为开展糖尿病的预防、治疗工作提供科学依据。方法采用病例一对照研究方法．病例为在深圳市第一人民医院、深圳市第二人民医院及深圳市保健委员会办公室就诊及住院的2型糖尿病患者，共295例；对照为同期在门诊进行健康体检的非糖尿病人群，共214例。对研究因素进行单因素及多因素非条件Logistic回归分析．在此基础上进行对数线性模型分析。结果调查人群中，糖尿病家族史（OR=6．507，95％CI：3．788～11．178）、高血脂（TG：OR=2．625，95％CI：1．295—5．323；LDL—C：OR=6．337，95％CI：3．379-11．884）、工作压力（OR=1．901，95％CI：1．263—2．863）、高血压（SBP：OR=I．055，95％CI：1．022～1．089）是2型糖尿病的危险因素：文化程度（OR=0．724，95％CI：0．599—0．875）、运动锻炼（OR=0．499，95％CI：0．268～0．930）是保护因素。对数线性模型分析发现，糖尿病各危险因素之间广泛存在一阶或二阶交互作用，其中．糖尿病家族史、年龄和运动锻炼三者分别与多个危险因素有明显的交互作用。结论2型糖尿病是遗传因素与环境因素共同作用的结果。对糖尿病的防治应采取综合措施，尤其对于具有糖尿病家族史者以及中老年人群，更应控制各种危险因素。     

天津市农村人群2型糖尿病危险因素的病例对照研究

目的探讨天津市农村人群2型糖尿病的危险因素。方法对天津农村人群进行多级分层整群抽样调查,共抽取9961例居民。调查对象中已确诊的糖尿病患者为585例,通过年龄、性别频数配比选取620例非糖尿病调查对象进行社区为基础的病例对照研究。结果糖尿病家族史（OR=2．671）、精神压抑（OR=3．759）、体质指数升高（OR=1．502）、腰臀比升高（OR=1．740）、高血压史（OR=2016）和高血脂史（OR=1．867）可增加2型糖尿病发生的危险,而食用水果（OR=0．736）则减少2型糖尿病发生的危险。结论糖尿病家族史、精神压抑、超重、中心性肥胖、高血压史和高血脂史可能是天津农村2型糖尿病发生的危险因素,多食水果则可能是2型糖尿病发生的保护因素。     

海安县胃癌危险因素的病例对照研究

目的：初步探讨海安县胃癌的危险因素。方法：对1999年新发的128例胃癌例和128例健康对照，进行1：1病例对照组。采用logistic回归模型进行统计分析。结果：快食，口味偏咸与胃癌的发生呈正相关（OR分别为1．225和1．600），多食蔬菜，豆制品与胃癌的发生呈负相关（OR分别为0．507和0．699）。结论：饮食因素是海安胃癌发病的主要危险因素。     

济宁市糖尿病患者行为危险因素分析

目的探讨济宁市糖尿病患者相关行为及生活方式中的主要危险因素，为城市社区人群制定适宜的预防和干预措施提供科学依据。方法在济宁市医院和社区内随机选取糖尿病人和非糖尿病人各330例作为研究对象，利用自行设计的凋查表，进行成组设计的病例对照研究，采用单因素和多因素非条件logistic回归分析方法处理资料。结果多因素Logistic回归分析显示，糖尿病的发病与吸烟（OR=1．520，P=0．047）、吸烟指数（OR=t．223，P=0．010），嗜甜食（OR=18．497，P=0．000），嗜腌制食品（OR=12．783，P=0．000），重度职业性体力活动（OR=1．630，P=0．003），人际关系冲突（OR=1．214，P=0．027），亲人亡故（OR=1．355，P=0．038）呈正相关，与经常进行体育锻炼（OR=0．310，P=0．000），生活有规律（OR=0．381，P=0．028）呈负相关，均具有统计学意义。结论嗜甜食、嗜腌制食品、吸烟指数、重度职业性体力活动、精神创伤是影响糖尿病发病的独立危险因素，而经常参加体育锻炼、生活有规律是糖尿病的保护因素。因此倡导健康合理的生活方式,是预防和控制糖尿病的重要措施。     

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.     

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.     

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.     

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.