中晚期宫颈癌同步放化疗生存情况及其预后相关因素分析

目的观察同步放化疗治疗中晚期宫颈癌的远期疗效,并分析其预后的影响因素。方法回顾性分析2008年1月至2012年1月首都医科大学附属北京妇产医院收治的210例中晚期宫颈癌患者的临床资料,对其生存情况及预后相关因素进行分析。结果本研究中患者5年生存率为62.9%。单因素分析结果提示肿瘤病理类型、分化程度、放疗时间及临床分期是影响中晚期宫颈癌预后的独立因素(P<0.05),而年龄、肿瘤最大径线及治疗前血红蛋白水平不是影响中晚期宫颈癌预后的独立因素(P>0.05)。将单因素分析中对预后有统计学意义的因素纳入比例风险回归模型进行多因素分析,结果显示肿瘤病理类型、分化程度、放疗时间及临床分期是影响中晚期宫颈癌预后的独立因素(P<0.05)。结论肿瘤病理类型、分化程度、放疗时间及临床分期是影响中晚期宫颈癌预后的因素。     

Breast cancer in relation to some reproductive factors

Breast cancer is one of the most commonly occurring cancers in females in the Eastern Mediterranean Region. In Egypt women's breast cancer had the highest frequency. The present study was conducted to study the association between breast cancer and some reproductive factors as well as to find out (if possible) predictors for occurrence of breast cancer. A hospital based case control study was carried out in Alexandria Main University Hospital where, 129 histopathologically confirmed incident primary breast cancer cases were included. An equal number of a control group matched by age were selected from the visitors of the same hospital. Data related to women's reproductive period were collected from both cases and controls. The results revealed that there was no statistically significant difference between cases and controls as regards menopausal status, menstruation span, number of births, spontaneous and induced abortion, twin birth, breast feeding and use of oral contraceptives. There was an increasing risk of breast cancer, with the presence of positive family history of breast cancer decreasing age at menarche, increasing age at first full-term pregnancy, widening of the interval between menarche and first full-term pregnancy, increasing age at last full-term pregnancy and shortening of the interval since last birth. Multiple logistic regression analysis revealed that positive family history of breast cancer, young age at menarche, late age at last full-term pregnancy and wide inter-birth interval were significant predictors for occurrence of breast cancer. The results of the study pinpoint that conduction of public health education programmes focusing on the modifiable risk factors are required.     

Toxoplasmosis in Poznan region,Poland 1990-2000

The paper summarizes the results of the interdisciplinary studies on toxoplasmosis carried out in Poznan region, Poland. In the years 1990-2000 the specific Toxoplasma gondii seropositivity rates in pregnant women decreased from 58.9% to 43.7%. Significant was an increase in seropositivity in the age group 15-20 years. Cats were seropositive in 70.6%; relatively high seropositivity rate was observed in cats kept at home only (65.7%). Slaughtered pigs were positive in 13.2% with higher rates in older pigs and those originating from small private farms. Screening newborns with noncommercial tests by using Guthrie cards revealed that the congenital toxoplasmosis occurs in 0.55/1.000 pregnancies at screening for specific IgM and 1.08/1.000 pregnancies at screening for combined IgM and IgA. The prenatal screening for toxoplasmosis has not been introduced in Poland. However, the frequency of individual serological testing for Toxoplasma increased from 2.7% to 4.6% of pregnancies. Active health education was introduced in Poznan region and the awareness of toxoplasmosis risk increased from 24.3% to 45.2%. Still 54.7% of pregnant women were inadequately informed and 44.8% of pregnant women, being aware of the risk or not, did not respect specific hygienic measures. The rational control of congenital toxoplasmosis in Poznan region should be based on a routine newborn screening for congenital toxoplasmosis, continuous education of medical personnel and intensive, modern health education especially in adolescents and pregnant women from rural areas.     

Trends in colorectal cancer rates in urban shanghai, 1972-1996, in relation to dietary changes

PURPOSE: In urban Shanghai, the largest industrial and commercial city in China, the age-adjusted (world standard) incidence rates for colorectal cancer increased from 14.5 to 23.3 per 10(5) men and from 12.1 to 20.3 per 10(5) women between 1972 and 1996. This change was even more pronounced for colon cancer, whose incidence rates doubled from 5.95 to 13.7 per 10(5) men and from 5.77 to 12.5 per 10(5) women. The reasons for the rapid increases in cancer rates are not fully understood, but may involve dietary exposures that have changed substantially over the past two decades.METHODS: We calculated Pearson correlation coefficients (r) between colorectal cancer rates and the dietary factors of grain, vegetable oil, pork, poultry and vegetable consumption over the period of 1972 through 1996 in urban Shanghai.RESULTS: Statistically significant positive associations were observed between colon cancer rates and per capita consumption of vegetable oil (r = 0.91 for men, r = 0.94 for women), poultry (r = 0.90 for men, r = 0.90 for women), and pork (r = 0.78 for men, r = 0.81 for women). The correlation coefficients were not statistically significant between colon cancer and per capita consumption of grain (r = 0.38 for men, r = 0.37 for women) or vegetables (r = 0.16 for men, r = 0.14 for women). Similar weaker associations were observed between rectal cancer rates and vegetable oil, pork and poultry consumption.CONCLUSIONS: The findings in our study suggest that increases in dietary fat, poultry and pork intake may play a role in the rising colorectal cancer rates in Shanghai.     

Toxocariasis in Poznan region,Poland, in years 1990-2000

The results of multidisciplinary studies on toxocariasis in Poznan region, Poland carried out in 1990-2000 in co-operation with CDC, Atlanta GA, USA are summarised as follows. In Poznan region toxocariasis in dogs, cats and foxes is common. Environmental contamination with Toxocara spp. eggs was higher in courtyards between apartment houses in the centres of cities than in sandboxes and in rural or recreational areas. High percentage of the T. cati eggs found raises the yet unanswered question how frequent is T. cati toxocariasis in humans? Seroepidemiological studies demonstrated a rather high percentage of positive results in urban population as well as in adults. The majority of toxocariasis cases in humans is asymptomatic even in the foci with a high soil contamination. Optic density OD405 = 1.200 in a commercial ELISA test was accepted as a border line between the toxocariasis cases usually asymptomatic and the cases, which might have symptoms. In toxocariasis a high correlation was found between the value of OD, eosinophilia and the clinical expression. A new classification of clinical toxocariasis was proposed, including incomplete larva migrans syndrome and neurotoxocariasis and an up-dated definition of covert toxocariasis. It was found that 5 days treatment with albendazole is equally effective as 3-weeks treatment with diethylcarbamazine. Considering the risk of ocular toxocariasis in non-intensive invasions one course of treatment with albendazole is suggested in every case of infection, even asymptomatic.     

Births, gestation and birthweights in South Tees 1990-1996

BACKGROUND: The UK government has specified that all health authorities are to develop local health improvement programmes. Birthweight and gestational age are important health determinants, and therefore indicators of the health status of children in a community. They also have important resource implications for health and social services. Data regarding birthweight and its relationship to gestational age are not routinely available. This paper describes the results of the measurement of the birthweights and gestational ages of children born to residents in a UK health district, and their relationship with deprivation. METHODS: Routinely collected birthweight and gestational age data for children born to parents resident in the South Tees district during the period 1990-1996 inclusive were downloaded from the community child health department mainframe computer. The data were analysed and compared with national standards. RESULTS: The analysis showed that, despite the high levels of deprivation, birthweights were close to or slightly above average for most gestational ages. However, when compared with the average district in England and Wales, 8 per cent more low-birthweight children, of which 42 per cent were less than 28 weeks gestation, were born in the area. Materially deprived mothers were more likely to give birth to pre-term and light for gestational age infants. CONCLUSIONS: This study has shown that it is now possible to use routine sources of information to monitor local trends in birthweight and gestation, and their relationship with deprivation.     

Contribution of selected metabolic diseases to early childhood deaths--Virginia, 1996-2001

Sudden infant death syndrome (SIDS), or the death of an infant aged <1 year that remains unexplained after a thorough investigation, is the third most common cause of death among infants in the United States. Sudden, unexplained deaths also occur among children aged >/=1 year; however, the number of these deaths is not well documented. Certain cases of SIDS and sudden unexplained death beyond infancy might be attributable to complications of unrecognized metabolic diseases. Tandem mass spectrometry (tandem MS) can be used to screen for several of these disorders. Despite the low prevalence of these diseases, newborn screening for these disorders has been found to compare favorably with the cost of other screening programs. However, the contribution of these diseases to early childhood deaths is not well understood. To determine the proportion of sudden, unexpected early childhood deaths associated with selected metabolic diseases, CDC, the Office of the Chief Medical Examiner (ME) in Virginia, and a private laboratory conducted a population- based study. This report summarizes the results of the study, which indicate that 1% of children had a positive postmortem metabolic screen using tandem MS. Of the eight children with positive screening tests, seven might have had improved outcomes had they been identified and treated during the newborn period. The use of tandem MS in newborn screening programs could offer an opportunity to prevent early childhood mortality.     

1990-2018年云南省大理州HIV/AIDS生存分析

目的 分析1990-2018年云南省大理州HIV/AIDS生存状况及影响因素。方法 通过中国艾滋病综合防治数据信息系统收集1990-2018年现住址为大理州的10895 HIV/AIDS病例相关信息,应用寿命表法分析HIV/AIDS研究对象的生存率,采用乘积极限法（Kaplan-Meier法）计算研究对象的中位生存时间并绘制生存曲线。用Log-rank法比较治疗组与未治疗组的生存曲线。用Cox比例风险回归模型分析生存时间的影响因素。结果 10895例HIV/AIDS,全死因死亡3337例,中位生存时间15.58年（95%CI:14.83~16.5）。研究对象1、5、10、15、20年的累积生存率,抗病毒治疗组均高于未治疗组。根据不同防治措施分成1990-2004年、2005-2010年2011-2018年3个时期。相较于第一个时期,后两个时期5年生存率和7年生存率均有所升高而死亡风险均下降。Cox回归结果显示男性、初中及以下文化水平、样本来源于医疗机构、未进行抗病毒治疗、病程阶段是艾滋病、首次CD4水平低是研究对象死亡的危险因素。 结论 早发现,早治疗能降低HIV/AIDS患者死亡风险     

Trends in antimicrobial utilization in a university hospital, 1990-1996

OBJECTIVE: There is a worldwide concern about rational drug use, more specifically related to antimicrobial utilization. In developing countries, few resources are intended for monitoring on rational drug use. Moreover, there are limited data on the use of antimicrobial agents in hospitals. A study was carried out to describe patterns of use of antimicrobial agents over a 7-year period (1990 to 1996). METHODS: The study was conducted in a 690-bed tertiary care university hospital in Porto Alegre, Brazil. Hospital records were reviewed to identify inpatient antibiotics use. Results were expressed in defined daily dose per 100-beds/day. Cluster analysis was performed to determine the trends in use of individual agents. RESULTS: Antimicrobials use increased year after year, from 83.8 DDD per 100 beds-day in 1990 to 124.58 DDD per 100 beds-day in 1996. Penicillins were the drug group mostly used (39.6%), followed by cephalosporins (15.0%), aminoglycosides (14.4%), sulfonamides (12.8%), glycopeptides (3.6%), and lincosamides (3.1%). These groups were responsible for around 90% of all agents used. The use of antimicrobial agents was divided into thirteen groups based on cluster analysis. CONCLUSIONS: Antimicrobial use increased dramatically in the study period, and this increase was significantly higher when compared to other studies. When newer alternative agents became available in the hospital, the use of already existing drugs decreased and in some cases remained relatively stable. After implementing specific interventions, such as an effort for the correct use of cefoxitin, the expected changes in use were observed.     

Cervix uteri cancer incidence in relation to ethnic situation in Opole province,Poland

This paper presents results of a retrospective ecological analysis of cervix uteri cancer incidence in relation to the ethnic situation in the province of Opole, Poland. A few well-known methodological procedures were applied in the study. Detecting spatial disease clusters followed Tango's method. Estimates of relative risks of cancer morbidity were calculated via Clayton and Kaldor's empirical Bayes approach. To measure spatial correlation between neoplasmatic incidence and ethnic density, Moran's statistic was used. The Poisson modelling of the variables was performed using Markov Chain Monte Carlo technique--Gibbs sampling. The results presented in tables and graphs suggest a possible association between the ethnic pattern and risk of cervix uteri cancer in the analyzed province.     

Pedestrian fatalities by race/ethnicity in Arizona, 1990-1996

PURPOSE: To explore rates of pedestrian fatalities in Arizona, and how rates and circumstances of pedestrian deaths differ by race/ethnicity, urban or rural residence, age, and gender. METHODS: Using the Fatality Analysis Reporting System and the National Center for Health Statistics' Multiple Cause of Death file, pedestrian fatalities in Arizona from 1990 through 1996 were classified by gender, race/ethnicity, and urban or rural residence. Age-adjusted rates were calculated and adjusted for the proportion of rural residence. Age analyses compared pedestrian fatality rates in 10-year age groups by race/ethnicity. Conditions associated with pedestrian deaths were examined, including the time and day of occurrence, alcohol involvement, and degree of pedestrian contribution to the crash. RESULTS: American Indians had rates of pedestrian deaths 6 to 13 times those of non-Hispanic whites. Elevated rates for American Indians were found in urban and rural areas, in both genders, in all age groups in men, and in five of nine age groups in women. American-Indian pedestrian death rates and relative risks (RRs) were higher in rural areas than in urban areas. Compared to non-Hispanic whites, urban Hispanic males had an elevated RR of 1.56, rural Hispanic females had an RR of 2.45, and urban African-American (AA) females had an RR of 2.33. However, significantly elevated rates, compared to non-Hispanic whites, were limited to Hispanic males aged <5 years and African-American females aged 65 to 74 years. In all race/ethnic groups, except rural Hispanics, men had higher rates than women, although American-Indian women had higher rates than non-Hispanic whites, African Americans, and Hispanic men.Rural residence accounted for 27% of the excess American-Indian pedestrian mortality. Sixty-one percent of urban, American-Indian pedestrian deaths occurred on weekends, compared to 29% among non-Hispanic whites and 46% among Hispanics. American Indians had six times the rate of alcohol-related pedestrian deaths as non-Hispanic whites in urban areas and 16 times that respective rate in rural areas. Hispanics had an alcohol- involvement RR of 1.82 in urban areas, but the RR was not elevated in rural areas. When blood alcohol was measured, the blood alcohol concentration was >0.20 g/dL in 64.4% of American Indians, 35% of Hispanics, and 29% of non-Hispanic whites. CONCLUSION: A major disparity in pedestrian fatalities exists for both American-Indian men and women in urban and rural areas. Other racial/ethnic groups have elevated pedestrian fatality rates that are gender and residence specific, and are limited to specific age groups. Much of the American-Indian excess mortality is alcohol related and associated with residence in rural areas.     

河北省磁县2000-2002年恶性肿瘤生存分析

目的 分析河北省磁县2000-2002年恶性肿瘤生存情况,为肿瘤防治工作提供科学依据.方法 对河北省磁县肿瘤登记处登记的2000-2002年发病的4 170例恶性肿瘤患者生存资料进行分析,采用Kaplan-meier法计算观察生存率(OSR),Ede-r Ⅰ法计算相对生存率(RSR).结果 2000-2002年河北省磁县共登记恶性肿瘤发病4 170例,发病率为218.58/10万;发病前10位的恶性肿瘤依次为食管癌、胃癌、肺癌、肝癌、结直肠癌、乳腺癌、神经系统恶性肿瘤、子宫恶性肿瘤、白血病和淋巴瘤,中位生存期依次为17、15、9、6、16、40、10、18、7和17个月;2000-2002年恶性肿瘤患者1～5年OSR分别为34.92%、26.86%、20.98%、16.95%和14.99%;恶性肿瘤患者1～5年RSR分别为36.61%、28.86%、23.43%、19.71%、18.18%;其中食管癌、结直肠癌、乳腺癌和子宫恶性肿瘤的5年RSR＞ 20%;肺癌、肝癌和白血病的5年RSR＜ 10%;不同性别、年龄、地区及病理类型恶性肿瘤患者的1～5年RSR差异均有统计学意义(P＜0.01).食管癌、胃癌、肺癌5年OSR分别为17.83%、15.69%和5.76%;食管癌、胃癌、肺癌5年RSR分别为21.65%、19.35%和7.23%.结论 磁县人群恶性肿瘤生存率较低,主要影响因素为性别、年龄、地理分布和病理类型.     

边缘系统胶质瘤患者预后因素分析

的　探讨边缘系统胶质瘤患者的预后因素。方法　分析经手术治疗边缘系统胶质瘤 6 0例 ,分析其临床、影像学表现 ,,并予以随访 ,对所得的各项指标进行单因素及多因素分析。结果　用Kaplan -Meier法单因素分析显示年龄、术前KPS、病理级别、瘤 -脑组织界面、肿瘤内钙化、手术方式、术后放疗、肿瘤家族史等 8个因素是影响边缘系统胶质瘤患者生存期的危险因素 ;Cox回归多因素分析显示病理级别、手术方式、术后放疗三个因素对边缘系统胶质瘤患者生存期的影响具有统计学意义。结论　运用新的诊疗手段 ,结合预后影响因素、注意治疗中的各环节 ,合理安排治疗模式 ,将有助于不断改善边缘系统胶质瘤患者的预后。     

Survival of breast cancer patients in Connecticut in relation to socioeconomic and health care access indicators

The purpose of this study of 16,931 black and white Connecticut women diagnosed with invasive breast cancer in 1988–1995 was to examine survival in relation to surrogate or proxy indicators of both socioeconomic status (SES) and access to primary care. Patients were followed through 1998, and the risk of death was elevated for the lowest (vs. highest) SES category independent of stage at diagnosis and other characteristics, especially among patients diagnosed before age 65 years. The health care access indicator was not associated with risk of death when other patient characteristics (including the SES variable and stage at diagnosis) were taken into account. Unexplained elevations, relative to the rest of the state, in risk of death were found for patients diagnosed while living in two of the state’s four largest cities.     

南京市1 990～2000年围生儿出生缺陷监测结果分析

目的 为了解南京市围生儿出生缺陷的发生种类及分布情况,寻找影响出生缺陷的相关因素。方法 1990年1月-2000年12月监测南京市11所医院住院分娩孕28周-产后7 d的围生儿。按全国出生缺陷监测统一标准要求,由医院逐月上报《围生儿数月报表》、《出生缺陷登记卡》至市妇女保健所。结果 围生儿出生缺陷发生率7.95‰(1 254/157 637),唇腭裂,畸指(趾),神经管畸形是南京市围生儿出生缺陷前3位高发种类;男性出生缺陷发生率为8.75‰(721/82 432)高于女性6.86‰(516/75 188);产母年龄≥35岁是出生缺陷的高发风险因素。结论 进一步开展婚前生殖健康教育和医学检查,指导新婚妇女服用小剂量叶酸预防神经管畸形,孕期开展产前诊断、遗传咨询、Down综合征筛查和新生儿疾病筛查工作,降低出生缺陷的发生率。     

凉山州5个地区对宫颈癌高危因素认知差异影响因素的分析

目的 寻找凉山州5个地区妇女宫颈癌发病的高危因素差异,探讨降低宫颈癌的有效措施.方法 对凉山州5个地区县城及各乡镇周边村的成年妇女进行问卷调查,调查内容包括一般资料、既往病史、性行为和生育史、对宫颈癌筛查的知晓情况及参与情况等方面.结果 凉山州5个地区因存在民族、教育、生活环境、经济收入的不同,造成宫颈癌发病高危因素的差异.教育情况好的地区认知情况明显好于教育情况差的地区,有统计学差异(χ2 =16.11,P<0.05),认知情况由高到低依次为西昌、会理、冕宁、金阳、普格.汉族妇女的收入、教育、生活环境明显好于彝族妇女,且存在城镇、农村的差别;汉族之间、彝族之间不同生活环境的妇女对宫颈癌筛查目的 的认知亦存在差异,有统计学意义(χ2=27.85,P<0.05).上述原因影响5个地区妇女对宫颈癌易患因素(χ2=36.77)、需要治疗的宫颈病变的了解(χ2=49.03)及参与宫颈癌筛查(细胞学涂片检查:χ2=60.93,常规妇检:χ2=66.40)的情况,均存在统计学差异(均P<0.05).结论 5个地区间宫颈癌发病高危因素存在差异,从而引起不同发病率,提高对宫颈癌高危因素的认识,提高妇女自身素质,加大宫颈癌筛查力度及范围,控制高危因素则可降低地区间的差异.