体质指数动态变化与2型糖尿病发病关系的前瞻性研究

目的 探讨BMI动态变化对队列人群2型糖尿病（T2DM）发病的影响。方法 以2006年开展的浙江省德清县农村社区成年人群健康队列为基础,随机抽取3 043名基线未患T2DM对象构建亚队列,于2015年7-11月进行随访,共1 867名调查对象纳入研究,进行问卷调查、体格检查和实验室检测。以中国标准对基线BMI（kg/m²）分类：<24.0为正常,24.0～27.9为超重,≥28.0为肥胖;BMI每年变化<0.05 kg/m²表示基本无变化。用Cox回归模型分析基线BMI及其变化与T2DM发生的关系。结果 随访人时为（8.68±1.25）年,新发T2DM为213例,其中女性125例,发病密度为13.14/1 000人年。Cox回归模型分析显示,在调整其他可能影响因素后,与基线BMI<24.0 kg/m²人群相比,基线BMI≥28.0 kg/m²的人群发生T2DM的风险较高（aHR=2.12,95% CI：1.22～3.68）;在基线BMI<24.0 kg/m²的人群中,与BMI基本无变化的人群相比,BMI增加的人群发生T2DM的风险较高（aHR=2.21,95% CI：1.17～4.17）。结论 基线BMI和BMI改变均可增加T2DM的发病风险,尤其是基线BMI正常的人群,其BMI改变对T2DM的发生影响较大。     

中国18岁及以上成年人自报牙龈出血与2型糖尿病患病相关性研究

目的 了解我国成年人自报经常牙龈出血与2型糖尿病（T2DM）患病相关性。方法 利用2010年中国慢性病及其危险因素监测数据,描述性分析成年人中经常牙龈出血者的人口学及主要慢性疾病（糖尿病、高血压、血脂异常）患病情况,多因素分析经常牙龈出血与主要慢性疾病患病的相关性,进而分析年龄、高血压、血脂异常等因素与牙龈出血频率交互作用对T2DM患病的影响。结果 93 647名调查对象以汉族为主占87.4%（81 872/93 647）,女性调查对象经常牙龈出血的比例高于男性,分别为63.6%（2 020/3 178）和36.4%（1 158/3 178）;经常牙龈出血人群中初中文化程度者所占比例最高为30.1%。在45～60岁人群中有12.8%（2 839/22 179）无牙龈出血但患T2DM,15.6%（163/1 044）经常牙龈出血且患T2DM,经常牙龈出血与患T2DM相关（OR=1.29,95% CI：1.08～1.54,P<0.005）,年龄和经常牙龈出血对T2DM患病有交互作用（P<0.005）;30 316名男性无牙龈出血者中有3 638例患T2DM,与之相比,经常牙龈出血者患T2DM（152/1 143）的风险高1.30倍（95% CI：1.08～1.56,P=0.005）;在高血压人群中,与无牙龈出血者T2DM患病率（4 817/26 467）相比,经常牙龈出血者患T2DM的患病率高（21.1%,220/1 043）,OR=1.25（95% CI：1.07～1.46,P=0.006）,且高血压和牙龈出血频率与T2DM患病有交互作用（P<0.05）。结论 经常牙龈出血与T2DM患病有相关性,且与年龄、患高血压有交互作用;男性并且经常牙龈出血同样与T2DM患病相关。     

体质指数、血压与糖尿病发病关系的巢式病例对照研究

目的 探讨金昌队列人群BMI、血压与新发糖尿病的关系,为该人群防治糖尿病提供参考。方法 采用巢式病例对照研究,以金昌队列第一次随访（2013-2015年）期间新发1 021例糖尿病患者作为病例组,在同期随访期间未新发糖尿病、循环系统及内分泌系统疾病者中,按照性别相同、年龄±2岁进行1：1匹配,选取1 021例对照组,最终共纳入2 042名研究对象。采用多因素条件logistic回归模型、相加及相乘交互模型探讨BMI、血压与新发糖尿病的关系。结果 调整职业、饮酒、糖尿病家族史、高尿酸血症、高TC血症、高TG血症、低HDL-C血症、高LDL-C血症等因素后,多因素条件logistic回归分析结果显示,糖尿病的发生风险随BMI、血压的递增呈上升趋势（趋势检验P<0.05）。高血压与超重/肥胖对糖尿病的发生存在相乘交互作用,男性、女性超重/肥胖的高血压患者糖尿病的发生风险分别是体重及血压正常人群的2.04倍（95%CI：1.54~2.69）、3.88倍（95%CI：2.55~5.91）。肥胖且SBP≥160 mmHg（1 mmHg=0.133 kPa）者糖尿病发生风险是体重及SBP正常者的4.57倍（95%CI：2.50~8.34）,肥胖且DBP≥90 mmHg者糖尿病发生风险是体重及DBP正常者的3.40倍（95%CI：2.19~5.28）。结论 超重/肥胖及高血压可增加金昌队列人群糖尿病的发生风险,应加强该人群体重及血压健康教育,降低糖尿病发生风险。     

金昌队列人群代谢性疾病与脑卒中发病关系前瞻性研究

目的 了解金昌队列人群脑卒中发病状况,探讨代谢性疾病与脑卒中发病之间的联系,为人群脑卒中防治提供科学依据。方法 收集金昌队列随访人群33 042人的流行病学调查资料和体检数据,通过前瞻性队列研究的方法揭示金昌队列人群脑卒中的发病状况,研究代谢性疾病对脑卒中发病的影响,使用限制三次样线条法来分析各代谢性指标与脑卒中发病风险之间的剂量反应关系。结果 金昌队列人群脑卒中发病率为1.59%,标化发病率为3.99%。高血压（男性HR=2.20,女性HR=4.45）与血脂异常（男性HR=1.49,女性HR=1.79）是队列人群脑卒中发病的危险因素,糖尿病仅影响男性人群脑卒中的发病（HR=1.79）,肥胖仅影响女性人群脑卒中的发病（HR=1.64）,且罹患代谢性疾病种类越多,脑卒中发病风险越大。SBP与脑卒中发病风险之间呈非线性剂量反应关系,而DBP与脑卒中发病风险呈正向线性相关关系。结论 金昌队列人群脑卒中发病率在国内外均处于较高水平;代谢性疾病人群为脑卒中的高危人群,在脑卒中防治中应予以重视;DBP可能与脑卒中具有更密切的联系。     

内蒙古部分地区流动人口糖尿病现况调查

目的 了解内蒙古地区流动人口中糖尿病及糖尿病前期的患病现状。方法 采用按行业分层整群抽样方法进行等额抽样,调查内容包括问卷调查、身体测量和实验室检测。结果 内蒙古部分地区流动人口糖尿病及糖调节受损粗患病率分别为12.5%和12.8%,年龄标化患病率均为9.9%;男性糖尿病患病率高于女性,女性糖调节受损粗患病率高于男性;不同性别糖尿病患病率均随年龄的增长而增加（趋势χ²=11.162,P=0.001）;建筑业人群糖尿病患病率最高（19.2%）,糖调节受损患病率的差异无统计学意义;外省流入人群流动前糖尿病患病率高,糖调节受损患病率的差异无统计学意义,省内流动人群糖调节受损患病率随流动时间的增加而增长（趋势χ²=9.989,P=0.002）。结论 内蒙古部分地区流动人口糖尿病患病率较高,已接近大城市居民患病水平,其中中老年和建筑业人群患病率最高,省内流动人口糖尿病患病率对内蒙古地区流动人口患病率贡献较大。     

哈尔滨市血压正常居民糖尿病家族史和高血脂交互作用与糖尿病关系的研究

目的 探索血压正常人群中糖尿病家族史、高血脂及其交互作用与糖尿病的关系。方法 多阶段分层随机整群抽样获得哈尔滨市城区20~74岁居民代表性样本,对其中血压正常的糖尿病患者376例、血压和空腹血糖及口服葡萄糖耐量试验2 h血糖均正常的3 692人,进行糖尿病家族史与高血脂症联合作用的叉生分析与相加模型评估交互作用。结果 多因素logistic回归模型控制混杂因素后,发现糖尿病家族史与高血脂可能存在正相加交互作用。交互作用相对超额危险度、交互作用归因比、交互作用指数分别为1.97（95%CI：-0.32~4.26）、0.30（95%CI：0.03~0.57）、1.54（95%CI：0.96~2.47）。糖尿病家族史与总胆固醇和甘油三酯水平均高、单纯总胆固醇水平升高、单纯甘油三酯水平升高联合作用的OR值及95%CI分别为10.55（5.62~19.80）、7.81（3.65~16.71）、5.13（3.22~8.16）。结论 血压正常人群中,糖尿病家族史与高血脂症对于糖尿病患病可能存在协同作用。     

重庆市南岸区中老年人高血压合并糖尿病的患病率及影响因素分析

目的 了解重庆市南岸区中老年人高血压合并糖尿病的患病情况及相关影响因素,为有针对性地制定防治策略及措施提供科学依据。方法 采用分层多阶段整群抽样方法,选取≥40岁人群进行患病情况问卷调查和相关指标检测,采用描述性流行病学方法分析高血压合并糖尿病患病情况,应用logistic回归分析高血压合并糖尿病患者的危险因素和保护因素。结果 共调查24 792人,检出高血压合并糖尿病患者1 547人,患病率为6.2%。其中男性患病率为6.0%,女性患病率为6.4%,趋势性χ²检验结果显示总人群中高血压合并糖尿病的患病率随年龄增加呈上升趋势（趋势性χ²=343.766,P<0.001）。患者年龄、文化程度、吸烟、婚姻状况、缺乏锻炼、BMI、TG、TC、HDL-C、LDL-C等均为高血压合并糖尿病的相关影响因素。HDL-C偏高为高血压合并糖尿病的保护性因素（OR=0.817,95% CI：0.715～0.934）;年龄、文化程度、LDL-C偏高、缺乏锻炼等均为高血压合并糖尿病的危险因素（P<0.05）。结论 重庆市南岸区中老年人的高血压合并糖尿病患病率较高,今后应重视对高龄、超重或肥胖、文化程度较低、吸烟、TG、TC异常、LDL-C偏高居民的健康干预,以降低高血压合并糖尿病的患病风险。     

2018年中国15省份18~65岁居民肥胖与2型糖尿病患病的关联研究

目的 分析不同肥胖类型、不同BMI和腰围水平与成年人糖尿病患病风险的关联。方法 利用2018年中国健康与营养调查数据,依据《成人体重判定》（WS/T 428-2013）重新划分肥胖定义,包括非肥胖、单纯一般性肥胖、单纯中心性肥胖和复合型肥胖。应用两水平logistic回归模型及限制性立方样条模型分析不同肥胖类型、不同BMI和腰围水平与糖尿病患病风险的关联。结果 共纳入7 030名18~65岁居民,其中一般性肥胖率、中心性肥胖率分别为男性16.29%（502/3 082）和42.28%（1 303/3 082）;女性14.41%（569/3 948）和37.87%（1 495/3 948）;其中复合型肥胖率男、女性分别为14.70%和12.97%。糖尿病患病率为11.28%,其中男、女性复合型肥胖人群糖尿病患病率分别为18.98%和22.07%,高于单纯中心性肥胖人群（16.24%,15.26%）和非肥胖人群（9.65%,5.18%）。男性单纯中心性肥胖、复合型肥胖患糖尿病的可能性分别是非肥胖人群的1.61（95%CI：1.24~2.08）和2.11（95%CI：1.56~2.86）倍;女性单纯一般性肥胖、单纯中心性肥胖和复合型肥胖患糖尿病的可能性分别是非肥胖人群的2.70（95%CI：1.16~6.28）、2.62（95%CI：2.01~3.40）和4.47（95%CI：3.35~5.98）倍。限制性立方样条模型显示：BMI水平与糖尿病患病风险间呈近乎线性正关联;腰围水平与糖尿病患病风险呈显著正关联,其中女性呈非线性升高（非线性P=0.024）。男性BMI≥22.5 kg/m²、女性BMI≥23.0 kg/m²;男性腰围≥85.0 cm、女性腰围≥80.0 cm时,糖尿病患病风险显著上升。结论 复合型肥胖人群患糖尿病的风险更高。BMI处于正常高值、腰围水平处于中心性肥胖前期时,糖尿病患病风险明显上升。     

新疆喀什地区维吾尔族人群糖尿病患病情况及相关危险因素研究

目的 了解新疆喀什地区维吾尔族人群糖尿病流行状况并探讨患病危险因素,为糖尿病三级预防提供参考依据。方法 采用分层整群抽样方法,对新疆喀什地区疏附县≥18岁维吾尔族居民进行调查。调查方式包括问卷调查、人体测量及生化指标检测。比较不同年龄、性别人群糖尿病流行状况,采用logistic回归分析糖尿病患病的影响因素。结果 共纳入研究对象4 608人,男性、女性及全人群患病率分别为13.65%、10.04%和11.31%,年龄标化率为12.34%、9.83%及10.59%。糖尿病患病率及空腹血糖受损（IFG）率随着年龄的增加而升高,60岁前多表现为糖尿病患病率低于IFG率,60岁以上呈现糖尿病患病率高于IFG率的趋势,女性人群中尤为明显。糖尿病知晓率、治疗率、控制率分别为28.02%、21.31%及5.57%。多因素分析显示：45～岁、55～岁、>65岁人群糖尿病的患病风险明显增高,OR值男性分别为2.08（95% CI：1.24～3.48）、2.73（95% CI：1.63～4.56）和3.90（95% CI：2.24～6.78）,女性分别为2.63（95% CI：1.71～4.02）、3.14（95% CI：2.00～4.94）和5.56（95% CI：3.47～8.92）。有糖尿病家族史（男：OR=2.88,95% CI：1.45～5.72;女：OR=2.52,95% CI：1.49～4.26）、BMI≥28.0 kg/m²（男：OR=1.77, 95% CI：1.19～2.64;女：OR=1.80, 95% CI：1.30～2.50）等是影响糖尿病患病的危险因素。结论 新疆喀什地区维吾尔族人群糖尿病患病率高,知晓率、治疗率和控制率低,应提高糖尿病检出率并针对当地糖尿病流行特点采取有针对性的防治策略及措施。     

社区老年人群糖代谢异常、糖尿病患病率与糖尿病控制情况及影响因素分析

目的 了解社区老年人群糖尿病的患病情况以及糖尿病的控制情况,并探讨其主要的影响因素。方法 2009年9月至2010年6月采用随机整群抽样,选择北京市万寿路地区≥60岁老年人群进行横断面调查。收集社区老年人的一般健康状况、糖尿病患病情况、服药治疗情况,并进行化验检查。结果 共纳入2 102名（其中男性848名,女1 254名）社区老年人,年龄在60～95（71.2±6.6）岁之间。老年人文化程度较高,吸烟（21.1%）、饮酒（42.2%）比例较低,约有10%人群有糖尿病家族史。社区老年人群糖尿病的患病率为24.8%,约有33.1%的社区老年人存在糖调节受损,其中主要是糖耐量减低。糖尿病的知晓率和治疗率分别为78.5%和69.3%,控制率为15.9%。多因素分析结果显示,超重/肥胖、有糖尿病家族史的老年人糖尿病患病风险是对照组的1.42（95% CI：1.14～1.76）和3.42（95% CI：2.70～4.35）倍,且超重/肥胖、饮酒和家族史也是影响糖尿病控制情况的重要因素。结论 社区老年人群糖代谢异常和糖尿病患病率相对较高,糖尿病知晓率与治疗率较高,但控制率较低。超重/肥胖、饮酒与家族史是影响糖尿病患病与控制情况的重要因素。     

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.     

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.