产前检查妇女细菌性阴道病的筛检和相关危险因素的研究

目的：了解孕妇细菌性阴道病（BV）的患病率及其相关危险因素，为制定预防孕妇BV的措施提供科学依据。方法：采用现况调查的方法，对504例在医院妇产科门诊接受产前检查的孕妇进行BV筛检，非条件logistic回归分析探讨BV的有关危险因素。结果：孕妇的BV患病率为18．1％，以非市区居住、无业者和农民中较高。单因素分析显示：家庭居住地、职业、内裤材料、外阴清洗间隔、洗浴地点、即往分娩史、宫颈糜烂、心理压力、配偶受教育程度及配偶职业与孕妇BV关联有统计学意义；多因素分析表明：在公共浴池洗浴（OR=2．778，95％CI：1．421～5．428）、宫颈糜烂（OR=1．996，95％CI：1．203～3．312）与BV有正的关联。结论：孕妇有较高的BV患病率，为减少BV引起的不良妊娠结局．应针对相关的危除因素，加强育龄妇女有关BV防治的健康教育。     

宫内节育器与子宫内膜癌病例对照研究

目的探讨宫内节育器（IUD）使用与子宫内膜癌的关系。方法采用病例对照研究方法，调查上海市区1997年1月～2000年12月间确诊、年龄在30～69岁之间的子宫内膜癌患者（n=1204）和普通对照人群（n=1212）的一般情况、月经生育史、饮食、个人生活习惯、口服避孕药（OC）及宫内节育器使用情况、疾病及家族史等。采用非条件Logisfic回归模型分析宫内节育器使用与子宫内膜癌的关系。结果上海市区女性所使用的宫内节育器类型主要为金属环和V型塑料环。分别占使用者的68．1％和20．7％。与从未使用过宫内节育器的女性比较，使用者发生子宫内膜癌的危险性显著降低。调整后OR=0．57（95％CI=0．47～0．69），且随使用时间增加而降低。分层分析显示，在从未服用口服避孕药的女性中，曾使用IUD者发生子宫内膜癌的危险降低，OR=0．51（95％CI=0．41～0．64）。结论绝经前后女性使用宫内节育器可能会降低子宫内膜癌的风险。     

吸烟与细菌性阴道病关系的研究

目的:探讨吸烟与细菌性阴道病(BV)的关系。方法:对某医院妇产科门诊接受计划生育服务的育龄妇女非选择性地进行BV筛检。以筛检出的BV患者267例为病例组,其余478例未患BV且无BV史的妇女为对照组进行病例对照研究。结果:BV患者中吸烟者占8.99%(24/267),对照组中吸烟者占2.93%(14/478)。单因素非条件Logistic回归分析显示,吸烟与BV有统计学关联(OR=3.273,95%CI:1.663～6.442,P=0.001);经婚姻状况、性卫生、性行为习惯调整后,吸烟与BV之间的正关联仍有统计学意义(OR=3.425,95%CI:1.660～7.066)。结论:吸烟可以增加BV发生的危险,吸烟是BV独立的危险因素。控烟是预防BV发生的重要措施。     

停用宫内节育器后育龄妇女妊娠率的双向性队列研究

目的：探讨使用宫内节育器（IUD）对女性生育能力的影响。方法：采用双向性队列研究方法,以生育一孩的妇女采用IUD避孕对象作为观察队列（1 361例）,同期使用避孕套妇女作为对照队列（1 307例）,于2016年7月1日—2017年9月30日随访观察停用避孕措施后1年内的妊娠情况,计算1年累积妊娠率,采用Cox比例风险模型进行多因素分析。结果：IUD组和对照组停用措施后妊娠者平均受孕时间分别为（144.1±96.86）d和（122.5±91.33）d,差异有统计学意义（P＜0.05）。IUD组累积妊娠率低于对照组,差异有统计学意义（P＜0.05）。使用IUD时间小于5年者停用后1年累积妊娠率是停用避孕套者的0.866倍（95%CI：0.788～0.952）。多因素Cox回归分析显示,与使用避孕套妇女相比,使用高铜IUD妇女停用后对妊娠有影响（HR=0.826,95%CI：0.720～0.947）。结论：使用高铜IUD者1年累积妊娠率较使用避孕套者低,受孕时间延长,对于使用高铜IUD者如近期有再生育计划,建议及早取出IUD以做好生育准备。     

口服避孕药与育龄妇女子宫肌瘤发病风险的病例对照研究

目的：评价育龄妇女使用口服避孕药（OC）与子宫肌瘤发病风险的关系。方法：采用病例对照研究方法,对513例确诊为子宫肌瘤现患病例,按照1∶1比例匹配对照,使用统一的问卷、健康检查表进行调查,分析子宫肌瘤发生风险的影响因素。结果：与从未使用OC者比较,当前使用OC的育龄妇女发生子宫肌瘤的风险略有升高（调整OR=1.80,95% CI：1.19~2.71）;多因素Logistic回归分析显示,妇女子宫肌瘤发生风险升高的主要因素有当前使用OC（OR=1.73,95% CI：1.13~2.65）、体质量指数≥25 kg/m2（OR=1.35, 95% CI：1.02~1.78）。结论：当前使用OC、体质量指数≥25 kg/m2可能升高育龄妇女子宫肌瘤的发生风险,影响妇女子宫肌瘤的其他危险因素尚需进一步探讨。     

大姚县青石棉污染区肺癌、间皮瘤危险因素的病例对照研究

目的：探索云南省大姚县肺癌、间皮瘤高发的主要危险因素，为预防控制工作提供依据。方法：采用1：2配比病例对照研究的方法，对当地发现的47例病例（31例肺癌和16例间皮瘤）和匹配了性别、年龄的94例对照的各种可能与肺癌、间皮瘤有关的危险因素（包括吸烟习惯、石棉暴露情况及肿瘤家族史等）进行调查，用条件Logistic回归模型对资料进行分析。结果：资料分析显示，家庭环境中石棉污染、吸烟同肺癌和间皮瘤之间关联差异有显著性，OR分别为3．60（95％CI 1．03，12．62）和3．30（95％CI 1．90 ，10．02）；在石棉污染的几个因素中，使用石棉炉与肺癌的关联差异有显著性，OR为1．63（95％CI 1．30，20．24）。单因素分析发现，使用石棉炉时间的长短与肺癌有关，使用石棉炉在11－20年、21－30年及31年以上者的OR分别是5．34（95％CI 1．12，25．47）、8．50（95％CI0．78 ，93．23）、14．09（95％CI0．91，218．61）。结论：大姚县肺癌和间皮瘤的高发可能与当地的石棉环境污染有关，特别是与生活中石棉炉的使用有关。     

男性不育症危险因素的病例对照研究

目的：探讨男性不育症的危险因素，方法：对94对病例和对照1：1配比进行病例对照研究。结果：长期大量吸烟（OR＝3．45，95％ CI：1．95－6．10）、婚外性生活史（OR＝7．29，95％CI：2．54－20．89）、高温大棚蔬菜种植（OR＝6．73，95％CI：1．91－23．69）、苯类化学品接触（OR＝20．53，95％CI：4．67－90．25），解脲支原体感染（OR＝5．55，95％CI：2．8－13．533）与男性不育症有关联，为其危险因素，结论：男性不育症是由多种因素长期反复作用的结果，其预防应从整治环境污染，加强职业防护，提高自我防护能力，改变不良工作生活习惯等方面做起。     

尿石症危险因素人群病例对照研究

目的 探索尿石症发病的危险因素，为人群预防提供依据。方法 选取深圳市尿石症现况调查发现的334例患者为病例组，721名健康者为对照组，进行尿石症危险因素人群病例对照研究；采用非条件logistic回归对34个变量进行分析，采用Falconer回归法估算遗传变。结果 尿石症病例组和对照组配比条件均衡可比，单因素logistic回归分析共有17个变量有统计学意义，但最终进入模型的因素有10个，其中4个变量为尿石症发病危险因素，OR值大小依次为既往泌尿系慢性炎症史（OR＝4.09,95%CI:1.38-12.14)，一级亲属尿石症史（OR＝2.61,95%CI:1.70-4.01)和多食动物蛋白质（OR＝2．14，95％CI：1．71－2．69），暴露日照时间长（OR＝1．39，95％CI：1．16－1．66）；而较高文化程度（OR＝0．46，95％CI：0．29－0．73），日引水量多（OR＝0．59，95％CI：0．48－0．72），饮果汁（OR＝0．41，95％CI：0．18－0．94），多食奶及奶制品（OR＝0．82，95％CI：0．68－0．99），多食蔬菜（OR＝0．70，95％CI：0．55－0．91）和多食水果（OR＝0．78，95％CI：0．64－0．94）6个变量为尿石症发病的保护因素。一级亲属尿石症患病率病例组高于对照组，尿石症分离比为0．0109，95％CI：0．0050－0．0168，一级亲属尿石症的遗传度为28．48％，男，女分别为32．06％和24．60％。结论 尿石症主要受饮食习惯影响，尿石症家族史和社会经济状况也与发病有关。     

小于胎龄儿产科危险因素的病例对照研究

目的探讨产科因素及孕母文化程度与小于胎龄儿（SGA）之间的关系。方法采用病例对照方法，选取于2000年1月至2004年10月在第三医院出生的单胎活产SGA，全部病例共834例（男443例，女391例）作为病例组。以胎儿性别及出生胎龄进行频数匹配，按1：3的比例，采用完全随机抽样方法选取性别及胎龄别出生体重在10％～90％分位的适于胎龄儿2502名（男1329名，女1173名）为对照组，比较了病例组及对照组新生儿母亲年龄、文化程度及主要产科危险因素的比例。结果多因素logistic回归分析显示，SGA病例组母亲妊娠合并妊娠高血压综合征（妊高征）、羊水过少、有既往异常妊娠史和病毒性肝炎与对照组比较，OR值（95％Cj）分别为4．00（2．81～5．71）、2．95（2．27～3-83）、5．95（3．05～10．64）和0．50（0．30～0．84）；SGA母亲为初中及以下文化程度者与大专或以上文化程度者比较OR=3．46（95％CI：2．75～4．24）。其他因素与SGA无统计学意义的关联。结论孕母文化程度低、孕期合并妊高征、羊水过少、不良妊娠史可显著增加SGA发生的危险性。     

贲门癌危险因素病例对照研究

目的：探讨贲门癌发生的危险因素，为深入进行病因学研究提供线索。方法：对福州市6所医院2000年和2001年4月至7月的住院病人603例进行多组病例对照研究。贲门癌组为病理、手术和胃镜确诊的贲门癌191例，非贲门部胃癌190例，健康对照组为与肿瘤病例同期住院的骨科、泌尿外科的非肿瘤病人222例。采用统一调查表进行床边询问，对资料进行单因素及多因素Logistic分析。结果：贲门癌的主要危险因素有一一级亲属患肿瘤（OR＝4．286 95％CI：2．431－7．554）、进食速度快（OR＝2．028 95％ CI：1．142－2．912）、三餐不按时吃（OR＝1．909 95％ CI：1．396－2．610）、饮用井水（OR＝1．741 95％CI：1．042－2．910）每日吸烟量多（OR＝1．347 95％CI：0．989－1．835）。主要保护 因素有：常吃新鲜水果（OR＝0．645 95％CI：0．439－0．945）、使用冰箱年数长（OR＝0．731 95％CI：0．536－0．997）、化程度高（OR＝0．468 95％CI：0．276－0．74）。结论： 贲门癌与非贲门部胃癌可能有不同的危险因素，值得进一步研究。     

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.     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.