用动态血压监测老年高血压病心血管事件的危险性初探

目的研究动态血压监测(ABPM)对老年高血压病发生心血管事件危险性的预测价值。方法分析68例老年高血压病ABPM各项指标,与老年对照组比较。分析老年高血压组发生心血管事件的ABPM相关预测指标。结果老年高血压24h收缩压(包括日间及夜间)均升高,24h平均压也升高,而舒张压则多数不高。24h收缩压负荷值为(43.2±16.9)mmHg,正常老年组为(15.6±14.5)mmHg,p<0.05,老年高血压组非勺型40人,占59%。老年高血压组24h平均脉压(mPP)为(68.8±9.3)mmHg,正常老年人组为(42.2±9.5)mmHg,t=2.08,p<0.05。以mPP60mmHg为界,老年高血压组大于此值者,冠心病23例占58.9%,其中心血管事件共17例占43.6%,而mPP低于此值者发生冠心病9例,占31%,心血管事件仅6例,占20.6%。二者心血管事件总的发生率比较2>1.98,p<0.05。结论老年高血压患者ABPM出现平均脉压增大,非勺型、超勺型血压、负荷血压增大等指标时,预示着心血管事件发生的危险性增加,要加强对这些指标的干预,以减少心血管事件危险性的发生。     

高血压患者脉压差变化与CRP、ET-1的相关性

目的探讨高血压患者脉压差(PP)变化与高敏C反应蛋白(hs-CRP)、ET-1的相关性。方法选择2009年10月至2011年8月在我院心内科住院的1～3级高血压患者共240例按脉压分成4组,<50mmHg(A组),50～60mmHg(B组),61～70mmHg(C组),>70mmHg(D组),同时选60例健康志愿者作为对照组,按标准方法测定PP,并检测其血中hs-CRP、ET-1的含量,分析三者的关系。结果在校正了平均血压及其他相关因素后,回归分析表明,PP与hs-CRP、ET-1均呈正相关。结论高血压患者的PP与hs-CRP、ET-1密切相关,推测炎症可能是增加血压变异性的一个独立危险因子。     

酒仙桥地区中老年人高血压患病调查

为了解酒仙桥地区老年人高血压的流行现状和主要危险因素 ,以制定合理的预防措施 ,于1996年 6～ 12月对北京酒仙桥地区 9个居委会 2 0 55名 50岁以上中老年人进行高血压患病调查。并抽查 2 39例高血压患者和 2 67名非高血压者进行 75g葡萄糖耐量试验和心电图检查。结果共发现临界高血压和确诊高血压 874例 ,临界高血压和确诊高血压患病率分别是 10 .9%和 31.6% ,合计 4 2 .5% ;男性确诊高血压高于女性 (P <0 .0 5) ;单纯收缩期高血压患病率为 7.5% ,随年龄增加而增加 (P <0 .0 5) ;男女单纯高血压患病率无差异 (P >0 .0 5) ;有 2 5.6%的患者否认或不知道有高血压 ;高血压病人组伴发糖尿病、糖耐量低减和冠心病患病率明显高于非高血压组 (P <0 .0 1)。结果表明 ,高血压是社区老年人的主要疾病之一 ,需加强社区高血压的管理和教育。     

高血压病患者动态脉压与血、尿β2-微球蛋白的关系

目的 观察高血压病患者动态脉压（PP）与血、尿β2-微球蛋白（β2-MG）的关系，并评价动态PP对反映早期肾损伤的价值。方法 用动态血压监测仪测量223例高血压病患者的动态PP，按动态PP水平分为四组：A组PP≤40mmHg（1mmHg=0．133kPa，54例）、B组PP41～60mmHg（73例）、C组PP61～80mmHg（67例）和D组PP〉80mmHg（29例）。采用免疫比浊法测定研究对象的血、尿β2-MG，并分析动态PP与血、尿β2-MG的关系。结果 随着动态收缩压（SBP）、动态PP水平的增大，血、尿β2-MG浓度明显增加，呈正相关。结论 动态PP与血、尿β2-MG密切相关，动态PP对高血压病早期肾损伤有重要的预测价值。     

社区65岁及以上老年人不同血压水平与其他代谢综合征指标的相关性

目的探讨社区65岁及以上老年人不同血压水平与其他代谢综合征指标的相关性,为社区老年人心脑血管事件的防治提供参考依据。方法选取2022年1-10月在福建省泉州市丰泽区北峰、清源2个街道社区卫生服务中心进行健康体检的65岁及以上老年人,剔除关键变量缺失及异常值46名,最终实际纳入3598名老年人作为研究对象。根据血压水平分为正常血压组[收缩压<120 mmHg(1 mmHg=0.133 kPa)和舒张压<80 mmHg]、正常高值血压组[收缩压120~139 mmHg和(或)舒张压80~89 mmHg]和高血压组[收缩压≥140 mmHg和(或)舒张压≥90 mmHg]。其中高血压组又分4个亚组:1级高血压组[收缩压140~159 mmHg和(或)舒张压90~99 mmHg]、2级高血压组[收缩压160~179 mmHg和(或)舒张压100~109 mmHg]、3级高血压组[收缩压≥180 mmHg和(或)舒张压≥100 mmHg]、单纯收缩期高血压组(收缩压≥140 mmHg和舒张压<90 mmHg)。比较不同水平血压组的一般资料和体质量指数(body mass index,BMI)、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血肌酐、血尿素氮及脂肪肝等代谢指标的差异。结果高血压患病率为50.64%(1822/3598),代谢综合征患病率为21.40%(770/3598),超重肥胖、血脂紊乱、高血压、高血糖检出率较高。随着血压水平的升高,各组BMI、腰围、腰高比、空腹血糖、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、血肌酐水平呈递增趋势,差异有统计学意义(P<0.05)。进一步对不同血压水平分组的上述代谢指标两两比较分析,正常高值血压组高于正常血压组,各级(1、2、3级)高血压组高于正常高值血压组,单纯收缩期高血压组与各级(1、2、3级)高血压组比较,差异有统计学意义(P<0.05)。线性趋势检验结果显示,年龄、BMI与血压水平之间存在线性关系,差异有统计学意义(χ^(2)值分别为43.22,21.92,P<0.01)。结论社区65岁及以上老年人群中具有较高的高血压及代谢综合征患病率,且不同血压水平与多代谢异常存在密切联系,需早期采取综合性干预措施。     

脉压对心脑血管疾病的影响

目的　探讨高血压病患者脉压对心脑血管疾病的影响。方法　收集 94 1例高血压病患者临床资料 (包括年龄、性别、脉压、合并心脑血管疾病的情况 ) ,进行统计学分析。结果　 (1)在≥ 6 0岁年龄组 :脉压 >4 0mmHg合并高血压心脏病 (CHD)的百分比小于脉压≤ 4 0mmHg组 ,P <0 .0 5 ;(2 )在 <6 0岁年龄组 :脉压 >4 0mmHg合并脑出血的百分比大于脉压≤ 4 0mmHg组 ,P <0 .0 1,而合并高心病的百分比小于脉压≤ 4 0mmHg组 ,P <0 .0 5。结论　脉压可作为预测高血压病患者心脑血管事件 (如高心病、脑出血、冠心病 )的危险因素     

动态血压监测指标与高血压靶器官损害的相关性分析

目的：探讨高血压病靶器官损害（TOD）与动态血压监测的收缩压（SBP）、舒张压（DBP）及平均动脉压（MBP）指标的相关性。方法：采用无创便携式动态血压监测仪对社区216例高血压病患者进行24h动态血压监测，根据MBP分为：I组，MBP≥120mmHg，共108例；Ⅱ组，MBP〈120mmHg，共108例。每组再以脉压（PP）分为三个亚组：A组，PP〈60mmHg；B组，pP在60～80mmHg；C组，PP〉80mmHg。比较各组TOD发生率的差异。结果：I组的SBP、DBP、MBP均大于Ⅱ组（P〈0．05）；随SBP增加，TOD发生率逐步增加（P〈0．05）；而两组中相同亚组的TOD发生率无差异（P〉0．05）。结论：高血压病患者TOD与PP关系更为紧密。     

阻塞性睡眠呼吸暂停综合征与高血压的关系初探

目的　认识打鼾患者睡眠时血压的改变 ,初步探讨阻塞性睡眠呼吸暂停综合征 (OSAS)与高血压之间的关系。方法　对 2 6 6例打鼾者进行Autoset诊疗系统监测及睡前、醒后肘部血压测定 ,16 6例诊断为OSAS患者作为OSAS组 ,10 0例未达到诊断标准者作为对照组 ,对两组进行上述各项指标的统计学处理 ,同时对OSAS伴高血压患者治疗 6个月左右 ,重复上述测定。结果　OSAS组睡前血压 (12 8 94± 19 32 /87 46± 12 30 )mmHg至次晨醒后血压 (139 6 6± 19 38/99 6 8± 16 2 8)mmHg明显升高 (P <0 0 1) ,与对照组睡前血压 (116 12± 11 17/78 2 2±10 18)mmHg及醒后血压 (116 76± 15 42 /78 6 6± 10 94)mmHg比较呈显著性升高 (P <0 0 1) ,OSAS组最低SaO2 (6 2 38± 18 2 4) % ,较对照组最低SaO2 (89 46± 7 6 6 ) %显著降低 (P <0 0 1) ,OSAS组有 88例 (5 3% )确诊为高血压病 ,经鼻面罩持续正压通气 (nCPAP)治疗 6个月有 5 2例患者血压明显下降 ,其中 2 7例患者血压恢复正常。结论　OSAS患者的低氧血症可能是相当部分OSAS伴发高血压的发病原因 ,nCPAP治疗有助于此类患者血压的恢复 ,本文对OSAS引起血压升高的机制作了初步探讨。     

食管癌围手术期老年人高血压发病状况及与术后并发症的关系

目的分析食管癌围手术期老年人(≥60岁)高血压发病状况及与术后并发症的关系。方法回顾214例≥60岁行经胸食管癌切除术病人,按照有无高血压分成高血压病组及非高血压病组,分析高血压病组在围手术期各期的发病状况,比较两组术后部分并发症发生情况及不同高血压危险度与术后部分并发症的关系。结果①术后一周内,老年人高血压发病的比例明显升高(术前32.24%,术后43.46%),P<0.05;术后4天内血压升高最明显,4天后血压慢慢稳定,一周后大部分病人(75%)血压可以恢复正常(<140/90mmHg);②高血压组与非高血压组的心律失常发生率的差异有统计学意义(P<0.05),其它术后并发症发生率的差异无统计学意义(P>0.05);③高血压危险度对术后并发症的发生有影响。结论食管癌围手术期老年人高血压发病比例较高,高血压危险度越高心律失常与低氧血症发生率越高,应重视正确控制食管癌围手术期老年人高血压。     

动态血压监测指导腹膜透析患者高血压治疗的临床观察

目的　探讨动态血压监测指导腹膜透析患者高血压治疗的意义。方法　使用非侵入性的动态血压监测仪监测 34例腹膜透析 (CAPD)合并有高血压的患者 ,通常从早上 9:0 0开始每 30分钟记录 1次血压 ,共监测 2 4小时。结果　所有病人 2 4小时的平均血压是 14 5 6 / 91 3mmHg ,39 6 %收缩压记录超过 15 0mmHg ,4 8 7%的舒张压记录超过 90mmHg。糖尿病肾病患者 (12例 )平均血压是 15 7 3/ 88 8mmHg ,5 8 5 %的收缩压记录和 4 4 6 %的舒张压记录超过 15 0 / 90mmHg。平均血压、心率和血压负荷白天和夜间没有显著性差异。结论　大多数的CAPD患者伴有高血压的病人其血压控制不佳 ,糖尿病患者血压控制情况更差。大多数CAPD患者血压 2 4小时节律性消失 ,白天和夜间高血压控制不佳并没有区别 ,使用动态血压监测仪评估血压可以指导降压治疗和增加降压达标。     

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.     

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.     

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.     

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.