不同性别人群免疫球蛋白G N-糖基化结构谱型比较

目的 对不同性别人群的免疫球蛋白G（IgG） N-糖基结构谱型进行分析比较。方法 采用整群抽样,以2012年1-6月在北京市宣武医院体检的669名居民为研究对象,留取空腹静脉血5 ml,对IgG N-糖基进行分离、纯化、标记后,采用超高压液相色谱串联质谱法对IgG N-糖基进行检测,最终得到24个色谱峰,每个峰代表不同的糖基结构。不同性别人群的糖基结构比较采用两独立样本t检验或非参数检验,P<0.05为差异有统计学意义。结果 669名参与者中男性235人（35.13%）,女性434人（64.87%）,平均年龄为（44.23±9.82）岁。女性核心岩藻糖基化水平Fⁿ（Z=-2.192,P=0.028）高于男性;女性半乳糖基化水平G0ⁿ（Z=-7.898,P<0.001）、G1ⁿ（Z=-2.343,P=0.019）低于男性,而G2ⁿ（Z=-8.414,P<0.001）水平高于男性;女性唾液酸化水平F^totalS1/F^totalS2（Z=-5.049,P<0.001）、FS1/FS2（Z=-3.336,P=0.001）高于男性。结论 IgG N-糖基结构水平可能与性别有关。     

2007-2015年四次横断面调查中陕西省居民吸烟变化情况分析

目的 分析2007-2015年陕西省成年人烟草流行现状及趋势变化。方法 利用2007、2010、2013和2015年全国慢性病及其危险因素监测数据,计算4次调查的吸烟率、吸烟量、戒烟率及二手烟暴露率,用趋势χ²检验计算其变化趋势,以抽样权重及2010年第六次人口普查数据计算加权率,以敏感性分析加以验证。结果 2007年陕西省成年人吸烟率为38.26%,2013年降至30.95%,但2015年上升到34.11%（趋势性χ²检验：Z=2.46,P=0.014）;2007-2015年,陕西省吸烟者吸烟量从16.90支/d,上升到17.76支/d;成年人戒烟率从11.02%上升到16.95%（趋势性χ²检验：Z=-4.18,P<0.01）;二手烟暴露率从2010年48.10%上升到2015年的63.88%（趋势性χ²检验：Z=-10.60,P<0.01）。敏感性分析趋势不变。结论 2007-2015年,陕西省成年人吸烟率和吸烟量保持在比较高的水平且变化不大,虽然吸烟人群的戒烟率逐渐提高,但非吸烟人群中二手烟暴露率迅速增加。     

北京市18~65岁居民高胆固醇血症流行现状与影响因素分析

目的 了解北京市18~65岁居民高胆固醇血症流行病学现状及影响因素,为其相关疾病的防控提供科学依据。方法 数据来自2014年北京市成人慢性病与危险因素监测。该监测以多阶段分层整群抽样方法在全市范围抽取调查对象进行问卷调查、身体测量和实验室检查。结果 17 662例有效样本中,血清胆固醇均值为（4.69±0.95）mmol/L,高胆固醇血症患病率为6.26%,边缘值升高率为21.34%。男性高胆固醇血症患病率为6.33%,女性为6.20%,差异无统计学意义（Z=1.64,P=0.10）;城区居民患病率为6.73%,高于郊区居民的5.59%（Z=-7.27,P<0.01）。高胆固醇血症患病率随年龄增加呈上升趋势（趋势检验 χ²=308.85, P<0.01）,其中男性（χ²=81.65,P<0.01）、女性（χ²=318.04, P<0.01）、城区居民（χ²=201.77, P<0.01）、郊区居民（χ²=114.65, P<0.01）均呈相同趋势。多因素logistic回归分析显示,高年龄组、女性（OR=1.23,95%CI：1.04~1.45）、超重（OR=1.56,95%CI：1.34~1.81）、肥胖（OR=1.82,95%CI：1.54~2.16）、每天吸烟（OR=1.24,95%CI：1.03~1.50）、每天饮酒（OR=1.40,95%CI：1.12~1.75）、牛羊肉摄入每周>1次（OR=1.19,95%CI：1.02~1.39）是高胆固醇血症的危险因素。结论 北京市18~65岁居民高胆固醇血症患病率低于全国平均水平,年龄、性别、地区、BMI、吸烟、饮酒、牛羊肉摄入频率为患病的主要影响因素。     

天津市2005-2017年医疗机构新报告HIV/AIDS特征分析

目的 分析天津市2005-2017年医疗机构新报告HIV/AIDS特征,为更好地在医疗机构中开展相关的艾滋病防治工作提供依据。方法 对新报告HIV/AIDS的流行病学调查及随访资料进行分析,同时回顾调查2005-2017年医疗机构新报告HIV/AIDS的科室来源及主要就诊疾病。结果 2005-2017年天津市医疗机构新报告HIV/AIDS 3 035例,医疗机构报告HIV/AIDS病例年均增长24.8%,其中49.2%（1 343/2 728）来源于住院病例,50.8%（1 385/2 728）来源于门诊病例,性病门诊就诊者检测在2011-2017年HIV阳性检出率呈现增长趋势（χ²=18.469,P=0.005）;医疗机构住院病例、门诊病例首次CD₄⁺T淋巴细胞计数（CD₄）（χ²=17.189,P=0.000）及新报告当年发生死亡比例（χ²=61.198,P=0.000）差异有统计学意义;二级医院与三级医院新报告HIV/AIDS首次CD₄值（χ²=16.751,P=0.000）及新报告当年发生死亡比例（χ²=18.926,P=0.000）差异有统计学意义;不同科室新报告HIV/AIDS首次CD₄值（χ²=37.620,P=0.000）及新报告当年发生死亡比例（χ²=95.489,P=0.000）差异有统计学意义。结论 2005-2017年天津市医疗机构门诊新报告HIV/AIDS较为及时,二级医院新报告HIV/AIDS比三级医院及时。在医疗机构重点科室门诊积极倡导医务人员中主动提供HIV检测服务,对于天津市艾滋病防治工作具有重要意义。     

北京市2006-2015年5岁以下儿童先天发育异常死亡趋势分析

目的 调查2006-2015年北京市<5岁儿童先天发育异常死亡的变化趋势。方法 采用“北京市5岁以下儿童死亡监测网”实时收集的2006-2015年<5岁儿童死亡监测资料,应用χ²检验的统计方法计算其先天发育异常死亡率的地区和年龄分布,探讨死因构成的年龄、时间和空间变化趋势。结果 北京市≤5岁儿童先天发育异常死亡率由2006年的1.909‰下降到2015年的0.703‰,下降了63.17%;其中新生儿期的降幅最大为71.50%（χ²=57.993,P<0.01）;除城区（χ²=3.384,P>0.05）外,远郊和近郊地区<5岁儿童先天发育异常死亡率均呈下降趋势（χ²值分别为40.637、50.646,P<0.01）。先天发育异常死亡占<5岁儿童死亡的比例由2006年的32.97%下降至2015年的23.24%,主要发生在婴儿期和新生儿期（χ²值分别为9.395、4.345,P<0.05）。先天性心脏病、神经管畸形、呼吸系统畸形和其他畸形儿童死亡构成比显著下降（χ²值分别为13.478、7.358、7.912和10.074,P<0.01）,染色体异常、多发畸形和消化道畸形下降不明显（χ²值分别为1.004、2.534和0.437,P>0.05）。死因顺位前4位先天发育异常中,先天性心脏病、神经管畸形和消化道闭锁的儿童死亡率下降明显（χ²值分别为70.868、18.431和9.225,P<0.01）,胆道闭锁的儿童死亡率变化差异无统计学意义。先天性心脏病和神经管畸形的儿童死亡率地区差异明显,远郊儿童死亡率均高于近郊和城区（χ²值分别为45.783、6.649,P值均<0.05）。结论 尽管北京市先天发育异常儿童死亡率逐年下降,但仍为<5岁儿童主要死因,需进一步加强相关疾病的防控水平。     

北京市18～65岁居民戒烟意愿、吸烟危害认知及其对吸烟情况的影响

目的 了解北京市18～65岁居民吸烟危害认知水平及戒烟意愿,对控烟工作及相关政策措施的制定完善实施提供科学依据。方法 数据来自2017年北京市成人慢性病及其危险因素监测,以多阶段分层整群的抽样方法在北京市16个区165个村/居抽取调查对象进行调查,采用logistic回归进行多因素分析。结果 11 594例有效样本中,49.93%不想戒烟,男性不想戒烟者比例为50.39%,女性为43.01%,差异有统计学意义（χ²=14.211,P=0.002）,郊区为56.78%,城区为45.30%,差异有统计学意义（χ²=51.977,P<0.001）。吸烟者与戒烟者戒烟动机中,因所患疾病原因,戒烟者中比例（29.88%）高于吸烟者（11.50%）,差异有统计学意义（χ²=85.865,P<0.001）。吸烟危害认知较好女性的比例（34.97%）高于男性（32.63%）,差异有统计学意义（Z=5.612,P<0.001）;郊区的比例（35.44%）高于城区（33.03%）,差异有统计学意义（Z=-3.734,P<0.001）;从不吸烟者的比例（35.15%）高于吸烟者（30.06%）,差异有统计学意义（χ²=62.277,P=0.005）。多因素logistic回归结果显示,认知一般者（OR=0.61,95% CI：0.39～0.94）与认知较差者（OR=0.67,95% CI：0.50～0.90）不易产生戒烟行为,认知一般者（OR=0.64,95% CI：0.53～0.76）与认知较差者（OR=0.87,95% CI：0.78～0.98）更易产生吸烟行为。结论 北京市18～65岁吸烟者戒烟意愿较低,戒烟动机主要出于健康考虑,从不吸烟者吸烟危害认知优于吸烟者,吸烟危害认知是吸烟情况的影响因素。     

HBsAg阳性母亲HBeAg和新生儿调节性T淋巴细胞关系及对HBV宫内传播的影响

目的 探讨HBsAg阳性母亲的HBeAg与新生儿CD₄⁺CD₂₅⁺Foxp3⁺调节性T淋巴细胞（Treg）含量的关系以及对增加新生儿HBV宫内传播发生风险的影响。方法 选择太原市第三人民医院妇产科分娩的270对HBsAg阳性母亲及其新生儿,收集一般人口学特征及分娩情况等资料,采用荧光定量聚合酶链式反应（FQ-PCR）和化学发光免疫试验（CLIA）检测母婴外周血HBV DNA及HBV血清学标志物;流式细胞术（FCM）检测新生儿外周血Treg等免疫细胞含量。结果 母亲HBeAg阳性是HBV宫内传播的危险因素（OR=4.08,95% CI：1.89~8.82）;母亲HBeAg阳性者新生儿Treg含量高于阴性者（Z=2.29,P=0.022）;按母亲HBeAg滴度分为5组,各组间新生儿Treg、HBeAg及母亲HBV DNA随母亲HBeAg滴度增高呈上升趋势,差异均有统计学意义（χ²=18.73,P<0.001;χ²=181.60,P<0.001;χ²=183.09,P<0.001）。偏相关分析中控制母亲HBV DNA以及新生儿HBeAg后,母亲HBeAg与新生儿Treg呈正相关（r_s=0.19,P=0.039）。新生儿Treg与浆细胞样树突状细胞（pDC）、CD₄⁺T淋巴细胞含量为负相关（r_s=-0.21,P=0.017;r_s=-0.23,P=0.009）。结论 HBsAg阳性母亲的HBeAg可能通过上调新生儿Treg含量,影响树突状细胞和效应T淋巴细胞的功能及其对HBV的免疫应答,从而增加新生儿发生HBV宫内传播的风险。     

天津市2007-2013年宫颈癌发病趋势及流行特征分析

目的 分析天津市宫颈癌发病趋势及流行特征。方法 利用天津市疾病预防控制中心肿瘤发病登记监测系统2007-2013年宫颈癌发病资料结合人口学资料,参照国际疾病分类(ICD-10)编码进行分类,计算宫颈癌发病率和年龄别发病率,并进行趋势分析。结果 2007-2013年天津市宫颈癌新发病例3362例,平均发病年龄为48.11岁,平均发病率为9.85/10万,标化发病率为6.65/10万。城市地区人群整体发病构成高于农村地区,但发病构成呈逐年下降的趋势(χ²=21.92,P=0.001),而农村地区人群发病呈上升趋势(χ²=12.70,P=0.048),差异有统计学意义。城市地区人群发病率总体保持平稳,年度变化百分比(APC)值为2.7%(95%CI:-9.1%~16.2%),差异无统计学意义(Z=0.564,P=0.597);农村地区人群发病率则呈上升趋势,APC值为13.4%(95%CI:3.5%~24.2%),差异有统计学意义(Z=3.549,P=0.016)。年龄别发病率曲线出现双峰,分别为40~44岁及75~79岁。结论 2007-2013年天津市宫颈癌发病率总体仍保持平稳,发病主要集中在中老年人群,其中农村地区发病率升高的趋势值得关注。     

北京市社区老年人跌倒发生与衰弱的相关性研究

目的 了解北京市社区老年人的衰弱状况,并分析跌倒发生及发生次数与衰弱状况的相关性。方法 2015年11月至2016年1月采用分层整群抽样的方法对北京市东城区（原崇文区）龙潭街道办事处所管辖社区≥60岁老年人,以面对面询问方式入户调查,应用衰弱指数（FI）评价老年人的衰弱状况,采用多因素logistic分析老年人跌倒与衰弱的相关性。结果 共调查1 557名老年人,跌倒发生率为17.8%（277/1 557）,其中女性跌倒发生率（21.0%,192/277）高于男性（13.3%,85/277）（χ²=15.288,P=0.000）。老年人FI值中位数（四分位间距）为0.09（0.08）,其中女性［0.10（0.08）］明显高于男性［0.08（0.07）］,Z=5.376,P=0.000。277名跌倒者FI值中位数（四分位间距）为0.12（0.11）,明显高于1 280名非跌倒老年人［0.08（0.07）］,Z=7.501,P=0.000。多因素logistic回归分析显示,老年人FI值越大,跌倒发生及其次数增加的风险越大（分别OR=1.093、2.234）;相比于年龄、性别等其他因素,FI值对跌倒发生及跌倒次数增加的风险影响最大。结论 北京市社区老年人跌倒的发生与衰弱状况密切相关,在预防跌倒时更应关注衰弱程度高的老年人。     

基于群组轨迹模型的含糖饮料摄入模式与儿童牙周健康关联的队列研究

目的 探讨童年期含糖饮料摄入模式对牙周健康的前瞻性影响。方法 以安徽省蚌埠市儿童4年随访队列为基础,应用群组轨迹模型（GBTM）建立童年期含糖饮料摄入轨迹发展模型,分别采用线性多元回归和logistic多元回归分析含糖饮料摄入模式不同分组与菌斑指数和牙龈炎发生的关联。结果 共有997名儿童纳入分析,其中男童418名,女童579名,第三次随访年龄为（11.00±0.70）岁。GBTM识别出4种含糖饮料摄入模式：持续较低组（80.70%）、渐降组（12.40%）、先升后降组（2.20%）和渐增组（4.70%）。相比于持续较低组,含糖饮料摄入渐增组菌斑指数较高（1.73±0.80 vs.1.08±0.70）（t=4.00,P<0.001）、牙龈炎检出率（12.80% vs.3.00%）较高（χ²=12.40,P<0.001）。控制相关混杂因素发现,相比于持续较低组,渐增组和先升后降组菌斑指数分别增加0.58（95% CI：0.27～0.89）和0.38（95% CI：0.03～0.73）。渐增组牙龈炎风险显著增加（OR=4.42,95% CI：1.65～12.20,P=0.003）。结论 童年期至青春期过渡阶段含糖饮料摄入较高儿童牙周疾病风险显著增加。     

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.