Risk of Active Pulmonary Tuberculosis among Patients with Coal Workers' Pneumoconiosis: A Case-control Study in China

The aim of this study was to estimate the association between occupational, environmental, behavioral risk factors, and active pulmonary tuberculosis (PTB) among coal workers' pneumoconiosis (CWP) patients. A matched case-control study was conducted in 86 CWP patients with active PTB and 86 CWP controls without TB. A standardized questionnaire was used for risk factors assessment. Conditioned logistic regression analysis was used to identify associations between the risk factors and active PTB among CWP patients. The results showed that the stage of CWP, poor workplace ventilation, family history of TB, and exposure to TB were independent risk factors for active PTB in patients with CWP with which recommendations for improving work environments, and for case finding activities in patients with CWP could be made.     

Relationship between perinatal characteristics and later activities of daily living in Chinese elderly people

Background There are no reports on the association between perinatal characteristics and comprehensive physical function in Chinese elderly people. In this study, we traced 875 subjects who were born at the Peking Union Medical College Hospital （PUMCH） of China from 1921 to 1941. The purpose of this study was to determine the effects of perinatal characteristics on activities of daily living （ADL） function in the geriatric period.
Methods Birth data of 875 subjects were obtained from obstetric birth records of PUMCH. Adulthood data collection was conducted in the outpatient clinics of PUMCH. During the clinic visits, trained research staff administered physical examinations, activities of daily living scale and a demographic questionnaire. ADLs of all subjects were assessed with the activities of daily living scale.
Results There were 101 subjects whose ADL function was limited and the rate of ADL limitation was 11.5%. Binary logistic regression analyses results showed that the main influencing factors of ADL were age, maternal age at birth, occupation, daily exercise and chronic disease. Subjects whose maternal age at their birth exceeded 35 years were at 2.202 times （1.188-4.083） greater risk of ADL limitation when we applied multivariate logistic rearession models.
Conclusions This study validated the relationship between perinatal characteristics and ADL in the geriatric period. An older maternal age at birth could predict a higher ADL limitation rate in the geriatric period.     

Association between sex hormone-binding globulin and kidney function in men: results from the SPECT-China study

Background: The association between sex hormone-binding globulin (SHBG) and renal function has rarely been reported in men. We aimed to investigate the above association in a community-based Chinese population.Methods: A total of 5027 men were included from the survey on prevalence for metabolic diseases and risk factors, which is a population-based study conducted from 2014 to 2016 in Eastern China. The estimated glomerular filtration rate (eGFR) was calculated according to the chronic kidney d...     

Serum interleukin-10 levels and adverse events in patients with acute coronary syndrome: a systematic review and meta-analysis

Background Several studies investigating the prognostic utility of interleukin-10 （IL-10） in patients with acute coronary syndrome （ACS） have provided conflicting findings.The aim of the study was to assess the existing evidence regarding association between serum IL-10 levels and adverse events.Methods Literature search was performed in PubMed,EMBASE,and Cochrane Trials Register databases from their inception to September 30,2012.In addition,reference lists of the included articles and their related citations in PubMed were also reviewed for additional pertinent studies.Results A total of 12 eligible studies comprising a total of 5882 patients were identified.The pooled relative risks for both studies reporting the risk estimates by IL-10 categories and studies reporting the risk estimates by unit IL-10 indicated an association between high IL-10 levels and adverse events.Sensitivity and subgroup analysis indicated that the results obtained in IL-10 categories were not stable.Conclusions Data from our meta-analysis supported the existence of a relationship between high serum IL-10 levels and adverse events in patients with ACS.Large study with longer follow-up is needed to confirm the findings.     

Risk Factors for Birth Defects：A Conditional Logistic Regression Analysis of a Case-Control Study in Guang-dong Province of China

In order to study risk factors and their association with birth defects,data were collected from 329 cases and 329 controls in 38 hospitals in Guangdong Province of China in 1988.Information was obtained from the same questionnaire(23 risk factors listed)of cases and controls.We used a multivariate logistic model,which described variables significantly increased risk of birth defects.The risk factors included maternal educa-tional levels,medicine taken during pregnancy and antenatal care.It was suggested to strengthen antenatal care was the main preventive measure against birth defects.     

Tea Consumption is Associated with Increased Risk of Kidney Stones in Northern Chinese: A Cross-sectional Study

Kidney stones are a common urinary system condition that can progress to kidney disease. Previous studies on the association between tea consumption and kidney stones are inconsistent. A cross-sectional study to investigate the association between tea consumption and kidney stones was conducted from 2013 to 2014 and recruited 9,078 northern Chinese adults. A total of 8,807 participants were included in the final analysis. Participants’ prevalence of kidney stones was 1.07%, 1.73%, and 2.25% based on their tea consumption frequency of never, occasionally, and often groups, respectively. Compared with the ‘never’ group, the odds ratios (95% confidence intervals) for the occurrence of kidney stones were 1.57 (1.00-2.46) and 1.65 (1.06-2.57) in the ‘occasionally’ and ‘often’ groups, respectively. After adjusting for sex, age, and other potential confounding factors, tea consumption still significantly increased the risk of kidney stones. Tea consumption is independently associated with an increased risk of kidney stones in the investigated population, suggesting that a decrease in the consumption of tea may be a preventive strategy for kidney stones.     

The Impact of Lipid-metabolizing Genetic Polymorphisms on Body Mass Index and Their Interactions with Soybean Food Intake:A Study in a Chinese Population

Objective To evaluate the association of known polymorphisms in the lipid metabolic pathway with body mass index （BMI）, and estimate their interactions with soybean food intake. Methods A community-based cross-sectional survey was conducted in a Chinese Han population. BMI, soybean food intake, and single nucleotide polymorphisms of rs599839, rs3846662, rs3846663, rs12916, rs174547, rs174570, rs4938303, and rs1558861 were measured in 944 subjects. A multivariate logistic regression was used to analyze the association of the studied polymorphisms with BMIs. The expectation-maximization algorithm was employed to evaluate the extent of linkage disequilibrium between pairwise polymorphisms. The gene-environment interaction was assessed in the general multifactor dimensionality reduction model. Results The polymorphisms of rs3846662 and rs3846663 were associated with 10% highest BMIs when comparing to the 10% lowest values both in individuals and haplotype-based association tests. Although no statistically significant gene-environment interactions were found, people with the haplotype composed of C allele in rs3846662 and T allele in rs3846663 and low frequency of soybean intake had significantly hisher risk to overweight and obesity as compared with those with the haplotype consisting of T allele in rs3846662 and C allele in rs3846663 and highly frequent soybean food intake, with an odds ratio of 1.64 （95% confidence interval： 1.15-2.34, P〈0.01） after adjusting for the common confounders. Conclusion Our study has sugsested that rs3846662 and rs3846663 may be the potential candidate polymorphisms for obesity, and their effect on the pathogenesis could be mediated by the frequency of soybean food intake.     

Significant association between Nijmegen breakage syndrome 1 657de15 polymorphism and breast cancer risk

Many studies were published to evaluate the association between Nijmegen breakage syndrome 1 （NBS1） 657de15 polymorphism and breast cancer risk, but the results remained inconsistent. To derive a more precise estimation on the possible association,we performed a meta-analysis of previous published studies. Case-control studies on the association between NBS1 657de15 polymorphisms and breast cancer risk were included into this meta-analysis. We used the odds ratio （OR） with 95% confidence interval （95% CI） to assess the strength of the association. Ten studies with a total of 25,365 subjects were identified and included into this meta-analysis. Meta-analysis of those ten studies showed that there was a significant association between NBS1 657de15 polymorphisms and breast cancer risk （pooled OR = 2.66,95 % CI 1.82 - 3.90, P 〈 0.001 ）. The cumulative meta-analyses showed a trend of a more significant association between NBS1 657de15 polymorphisms and breast cancer risk as data accumulated by publication year. Thus, our meta-analysis suggests that there was a significant association between NBS1 657de15 polymorphisms and breast cancer risk, and NBS1 657de15 polymorphism results in an increased risk of breast cancer.     

Polymorphisms of renin-angiotensin system in essential hypertension in Chinese Tibetans

Objective To evaluate the potential implications of the genetic variability of angiotensin converting enzyme, angiotensinogen and angiotensin Ⅱ type 1 receptor gene for essential hypertension in Tibetan. Methods A case-control study was conducted in 173 hypertensive individuals and 193 individuals with normal blood pressure. Multiple logistic regression analyses were used to estimate the risks of developing hypertension for different genotypes, and haplotype analyses of the angiotensinogen gene were used to determine the association between two-locus angiotensinogen gene polymorphisms and hypertension. Results As to the risk to high blood pressure and high systolic pressure, women with MM genotype were 7.7 (95% CI: 1.3-20.5) and 8.7 (95% CI: 1.8-20A) times higher than those with “IF genotype after adjustment for age and body mass index. Haplotype frequencies for M235T and G-6A were significantly different between hypertensive individuals and controls, which indicated an association of angiotensinogen gene haplotypes with hypertension, and a significant association of 235T/-6A haplotype with hypotensive effect. Condusion Our results suggest that angiotensinogen gene 235MM is a predictor for hypertension development in Tibetan women but not in men, and may exert its hypertensive effect on linkage disequilibrum with a possible function locus of G-6A.     

Alcohol Drinking,Dyslipidemia, and Diabetes:A Population-based Prospective Cohort Study among Inner Mongolians in China

ObjectiveNo previous studies have evaluated the association between dyslipidemia, alcohol drinking, and diabetes in an Inner Mongolian population. We aimed to evaluate the co-effects of drinking and dyslipidemia on diabetes incidence in this population. MethodsThe present study was based on 1880 participants from a population-based prospective cohort study among Inner Mongolians living in China. Participants were classified into four subgroups according to their drinking status and dyslipidemia. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curves were used to evaluate the association between alcohol drinking, dyslipidemia, and diabetes. ResultsDuring the follow-up period, 203 participants were found to have developed diabetes. The multivariable-adjusted odds ratios (95% confidence interval) for the incidence of non-dyslipidemia/drinkers, dyslipidemia/non-drinkers, and dyslipidemia/drinkers in diabetic patients were 1.40 (0.82-2.37), 1.73 (1.17-2.55), and 2.31 (1.38-3.87), respectively, when compared with non-dyslipidemia/non-drinkers. The area under the ROC curvefor a model containing dyslipidemia and drinking status along with conventional factors (AUC=0.746) was significantly (P=0.003) larger than the one containing only conventional factors (AUC=0.711). ConclusionThe present study showed that dyslipidemia was an independent risk factor for diabetes, and that drinkers with dyslipidemia had the highest risk of diabetes in the Mongolian population. These findings suggest that dyslipidemia and drinking status may be valuable in predicting diabetes incidence.     

Graduated driver licensing in Michigan: early impact on motor vehicle crashes among 16-year-old drivers

CONTEXT: Graduated driver licensing (GDL) programs are being adopted in many states to address the high rate of motor vehicle fatalities among teens by requiring teenaged drivers to gain experience and maturity under conditions of relatively low crash risk before gaining full driving privileges. OBJECTIVE: To evaluate the early impact of Michigan's GDL program on traffic crashes among 16-year-old drivers. DESIGN, SETTING, AND SUBJECTS: Analysis of Michigan motor vehicle crash data from 1996 (before GDL program implementation) vs 1998 and 1999 (after GDL program implementation) for 16-year-olds, adjusting for trends among persons 25 years or older. INTERVENTION: Michigan's GDL program, instituted April 1, 1997, for teens younger than 18 years entering the driver license system, includes 3 licensure levels, each with driving restrictions and requirements to progress to the next level. Requirements include extended, supervised practice in the learning level, 2-phase driver education, and night driving restrictions in the intermediate level. MAIN OUTCOME MEASURES: Rates in 1996 vs 1998 and 1999 for all police-reported crashes; for fatal injury, nonfatal injury, and fatal/nonfatal injury combined crashes; for day, evening, and night crashes; for single-vehicle and multivehicle crashes; and for alcohol-related crashes. RESULTS: Overall, the rate of 16-year-old drivers (per 1000 population) involved in crashes declined from 154 in 1996 to 111 in 1999 (relative risk [RR], 0.72; 95% confidence interval [CI], 0.71-0.73). After adjusting for populationwide trends, the overall crash risk for 16-year-olds was significantly reduced in 1999 from 1996 by 25% (adjusted RR, 0.75; 95% CI, 0.74-0.77). There were also significant reductions for nonfatal injury and combined fatal and nonfatal crashes; for day, evening, and night crashes; and for single-vehicle and multivehicle crashes. Fatal crashes declined from 1996 to 1999, but not significantly (RR, 0.74; 95% CI, 0.49-1.14), and alcohol-related crashes continued at a low rate (RR, 1.01; 95% CI, 0.80-1.29). CONCLUSIONS: Analysis of the first 2 full calendar years following Michigan's GDL program implementation indicates substantial crash reductions among 16-year-olds. Future research is necessary to determine if these reductions are maintained and if other jurisdictions achieve similar results.     

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.     

Impaired driving from medical conditions: a 70-year-old man trying to decide if he should continue driving

Some medical disorders can impair performance, increasing the risk of driving safety errors that can lead to vehicle crashes. The causal pathway often involves a concatenation of factors or events, some of which can be prevented or controlled. Effective interventions can operate before, during, or after a crash occurs at the levels of driver capacity, vehicle and road design, and public policy. A variety of systemic, neurological, psychiatric, and developmental disorders put drivers at potential increased risk of a car crash in the short or long term. Medical diagnosis and age alone are usually insufficient criteria for determining fitness to drive. Strategies are needed for determining what types and levels of reduced function provide a threshold for disqualification in drivers with medical disorders. Evidence of decreased mileage, self-restriction to driving in certain situations, collisions, moving violations, aggressive driving, sleepiness, alcohol abuse, metabolic disorders, and multiple medications may trigger considerations of driver safety. A general framework for evaluating driver fitness relies on a functional evaluation of multiple domains (cognitive, motor, perceptual, and psychiatric) that are important for safe driving and can be applied across many disorders, including conditions that have rarely been studied with respect to driving, and in patients with multiple conditions and medications. Neurocognitive tests, driving simulation, and road tests provide complementary sources of evidence to evaluate driver safety. No single test is sufficient to determine who should drive and who should not.     

昆明市出租车司机疲劳与相关健康和安全危险因素

［摘要］目的　确定昆明市出租车司机群体的疲劳发生率，了解出租车司机的一般工作和健康状况，并确定与疲劳驾驶相关的危险因素．方法　随机选取昆明市400名出租车司机为研究对象．采用自填式问卷调查方式，调查个人资料、社会习惯、工作模式和睡眠模式，同时测量身高和体重．采Epworth嗜睡量表评价疲劳和嗜睡水平．多元逻辑回归分析调整后的比值比，95%置信区间和出租车司机疲劳的危险因素的关系．结果　出租车司机群体患肥胖、高血压、糖尿病和高胆固醇的比例很高；疲劳驾驶与睡眠不足或睡眠质量差、额外兼职工作和每天驾车时间>10 h有关．结论　针对出租车司机的工作和健康状况，可为下一步干预提供参考，提高生产力和道路安全．     

Efficacy of mandatory seat-belt use legislation. The North Carolina experience from 1983 through 1987

The North Carolina General Assembly approved a law effective in October 1985 that mandated seat-belt use by front-seat occupants of passenger vehicles. In January 1987, a $25 fine for infractions of this law went into effect. This study examined numbers of car occupants with severe and fatal injuries in crashes in North Carolina, controlling for the amount of vehicle damage as a measure of crash severity. After the law, significant decreasing trends were seen in the percentages of front-seat occupants who had severe or fatal injuries in crashes, although the involvement of alcohol in crashes was still associated with an increased risk of such injury. Projections indicate that a reduction of approximately 1100 severe or fatal injuries per year can be attributed to the seat-belt law in North Carolina. This study supports the hypothesis that the societal burden of crash-associated injury can be reduced by mandating seat-belt use.     

射频消融治疗悬雍垂腭咽成形术后无效的阻塞性睡眠呼吸暂停低通气综合征

目的探讨等离子低温射频消融（Temperature-controlled radiofrequency ablation,RFA）治疗悬雍垂腭咽成形术（Uvulopalatopharyngoplasty,UPPP）、术后无效的阻塞性睡眠呼吸暂停低通气综合征（Obstructive sleep apnea hypopnea syndrome,OSAHS）的疗效。方法选择18例UPPP术后无效的0SAHS患者接受RFA治疗。比较治疗前后呼吸暂停低通气指数（AHI）、最低血氧饱和度（LSaO2）、鼾声评级和Epworth嗜睡程度评分,评价治疗效果。结果治疗总有效率66．67％,患者治疗6月后鼾声评级降低,Epworth嗜睡程度改善。治疗后6个月AHI较治疗前降低。结论对UPPP术后无效的OSAHS,等离子低温射频消融（RFA）是一种有效的治疗方法。     

首次急性缺血性卒中患者发病前睡眠障碍的调查

目的 探讨首次急性缺血性卒中患者发病前的睡眠状况.方法 纳入2015年7月至2016年7月在宣武医院神经内科住院的253例首次急性缺血性卒中患者,应用匹兹堡睡眠质量指数量表、Epworth思睡量表、STOP-BANG问卷、不安腿综合征筛查问卷、RBDSQ中文版量表针对患者住院以前有无失眠症状、睡眠呼吸暂停综合征高风险性,有无不安腿综合征,有无快速眼动睡眠期行为障碍(RBD)睡眠情况对患者本人及其家属进行问卷调查.结果 男性患者151例,年龄(68.4±9.4)岁;女性102例,年龄(69.7±9.5)岁.全部患者的匹兹堡睡眠质量指数量表(PSQI)评分为9.0±3.9,STOP-BANG评分为3.9±1.8,两者均高于正常范围.男性患者的STOP-BANG评分以及RBDSQ评分显著高于女性患者.全部患者中,有失眠症状(PSQI≥8分)的患者比例为47.4％(120/253),有日间思睡症状(ESS＞10分)的患者比例为24.5％(62/253),有睡眠呼吸暂停综合征高风险(STOP-BANG问卷＞3分)的患者比例为48.6％(123/253),临床诊断不安腿综合征比例为4.0％ (10/253),有RBD现象(RBDSQ中文版＞5分)的患者比例为7.1％ (18/253).其中男性患者的睡眠呼吸暂停综合征高风险的比例以及有RBD现象的比例显著高于女性患者.结论 首次急性缺血性卒中患者发病前伴有多种睡眠障碍,睡眠呼吸障碍、失眠以及不安腿综合征可能与卒中的发生有一定的相关性.     

Motor vehicle crash injury patterns and the Virginia seat belt law

Injuries to front seat occupants in tow-away crashes in the Charlottesville, Va, area were compared for 1 year before and 1 year after Virginia's seat belt use law took effect. Vehicle and occupant data were combined to examine crash and injury patterns. Reported seat belt use in crashes increased after the law, and there were substantial decreases in injuries. Front seat occupants were less likely to receive medical treatment following a crash in the postlaw period. The reduction in the number of injuries was greater for passengers in the right front seat than for drivers and for frontal crashes than for other types of crashes. The injury reduction effects occurred primarily through reductions in the number of head and face injuries, particularly those that occur from contact with windshields and instrument panels.     

The tole of towing services at motor vehicle crashes.

A survey of tow truck services operating in a defined area of the south-east suburbs of Melbourne was undertaken to determine their potential for delivering emergency medical care at the scene of crashes. Most towing firms have an association with a panel-beating shop, and operate within a limited area of one to three miles radius. The rapid response of tow trucks to crash scenes is due to their well-developed intelligence network of "spotters" and the short distances the trucks travel. Very little first aid is provided by the drivers, although one-fifth had some first aid training at some time. In about one-half of the calls to crashes a damaged vehicle is still at the scene, in about 20% an ambulance is called, and in about 5% a hospital admission occurs. Direct observation of 22 crashes suggests that on average, tow trucks arrive at a crash scene five minutes before the ambulance, and fifteen minutes before the police. There is a good case for making first aid training a preerequisite for issue of a tow truck operator's license.     

阻塞性睡眠呼吸暂停低通气综合征影响因素分析

目的探讨颈围(neck circumference,NC),体重指数(body mass index,BMI),嗜睡评分(Epworth sleepiness scale,ESS)与阻塞性睡眠呼吸暂停低通气综合征(Obstructive Sleep Apnea-Hy-popnea Syndrome,OSAHS)的发病和严重程度的相关性,并试图为OSAHS患者寻找一种简洁、快速、经济的初筛方法。方法临床疑似OSAHS的患者136例,对所有入选者行多导睡眠图(polysomnography,PSG)检查并记录身高、体重和颈围,计算BMI。对120例经多导睡眠图确诊的OSAHS患者采用Epowrth嗜睡评估表(ESS)进行测评,分析ESS、BMI、NC与呼吸紊乱指数(apnea hypopnea index,AHI)之间的相关性,并将以上各因素进行多元线性回归分析,推导出线性回归方程,再由回归方程计算出AHI的理论预测值,分析理论值与实测值的相关性,验证回归方程的有效性。结果以NC、ESS和BMI为自变量,以AHI为因变量推导出的多元回归方程为AHI=46.129 2.335BMI-2.546NC 4.863ESS,根据该方程计算得出的AHI理论值与AHI实测值比较,无显著性差异(P>0.05),理论值与实测值呈显著正相关(r=0.843,P<0.01)。结论NC、ESS和BMI与OSAHS的严重程度之间存在明显的相关性,可以作为临床对OSAHS病人进行初步筛选的良好指标。根据NC、ESS和BMI的回归方程计算得出的AHI理论值可以作为判定OSAHS的严重程度的一个参考指标。