基于多中心横断面调查的中国人群代谢综合征的流行情况及危险因素

  目的  调查中国不同民族人群代谢综合征流行状况及危险因素。  方法  通过多阶段分层随机抽样,检测调查对象的代谢综合征相关指标,并按照国家第六次人口普查数据进行标化,多因素及对数线性模型分析危险因素及交互作用。  结果  多民族人群的代谢综合征（metabolic syndrome,MS）患病率为19.58%,朝鲜族的MS患病率最高,其次是汉族,哈萨克族的MS患病率最低;MS及超重肥胖等4项指标检出率,男性高于女性,随着年龄的升高而升高;多因素分析结果显示,女性患MS风险是男性的0.556倍;年龄越大,患MS的风险越大;中心型肥胖人群MS的风险比2.765,同时腰身比大于0.52的风险比为4.259;利用对数线性模型,分析超重/肥胖,高血糖、高血压和血脂紊乱,4个指标之间的关系,显示4个指标有独立的效应,因素之间又有交互作用,且存在部分3因素交互作用。  结论  不同民族MS发生率存在明显差异,MS的高发生率及各指标间存在正向交互作用。应从公共卫生的防控角度,检出更多的MS,并进行干预,减少MS的患病危险因素,降低心脑血管疾病和糖尿病等发生的风险。     

广西城乡居民代谢综合征流行病学特征分析

目的了解广西城乡居民代谢综合征（MS）的流行现况,探索MS人群分布。方法采用多阶段分层整群抽样的流行病学方法进行问卷调查、身体测量及生化检测,有效调查人数为4328人,并依据国际糖尿病联盟（IDF）标准（2005）对Ms进行诊断,应用多因素非条件logistic回归分析MS的影响因素。结果本调查人群MS患病率为14．5％（标化率为9．5％）。女性人群MS患病率（16．5％）明显高于男性（11．8％）,城市人群MS患病率（17．4％）明显高于农村（12．0％）,而农村人群MS患病率随着经济水平的增高而上升,差异均有统计学意义（P〈0．01）。不论男女和城乡,随着人群年龄的增加,MS患病率呈现升高趋势（趋势检验：X^2=137．579,P〈0．01）,特别是女性在45岁以后更为明显。调查人群MS组分中高血压检出率最高（40．1％）,其次为高甘油三酯血症（28．7％）和中心性肥胖（28．4％）;在中心性肥胖和超重肥胖人群中,MS其他组分聚集的检出率分别为51．2％、52．4％,显著高于非中心性肥胖和体重正常人群,差异有统计学意义（P〈0．01）。多因素logistic回归分析显示,年龄增加,MS患病风险增加（OR=1．525,95％CI：1．406—1．654）,超重肥胖人群患MS的风险高于体重正常人群（OR=1．452,95％CI：1．172～1．798）,城市居民患MS的风险高于农村居民（OR=1．275,95％CI：1．019～1．595）,男性患MS的风险低于女性（OR=0．599,95％CI：0．485～0．741）,中等强度及以上职业活动人群患MS的风险低于轻度体力职业活动人群（OR=0．767,95％CI：0．613～0．960）。结论广西城乡人群MS患病率较高。建议采取重点保护高风险人群如中老年妇女、年长者以及长时间静坐或站立的轻体力劳动者,倡导合理膳食、适量运动,降低人群MS患病风险。     

原发性高血压和血压正常者代谢综合征患病危险比较

目的研究原发性高血压和血压正常者代谢综合征(MS)患病危险比较.方法 采用多阶段分层整群抽样方法,对温州市鹿城,瓯海,龙湾3城区10 293名≥18岁居民进行问卷调查,体格检查和实验室检测,依据国际糖尿病联盟(IDF)2005版MS诊断标准对血压正常者和高血压患者进行谢综合征患病危险因素分析.结果原发性高血压组年龄,腰围,体重指数,血脂,血糖均高于正常组,高血压组拥有2~4个代谢综合征危险因素的风险是血压正常组的2.15,4.88,18.01倍.结论高血压患者MS各项危险因素均高于血压正常人群,合并危险因子越多,患代谢综合征的危险越高.     

主观认知下降患者不同BMI水平与执行功能的相关性研究

目的 探讨主观认知下降（SCD）患者不同BMI水平与执行功能之间的相关性，及影响BMI的危险因素。方法 招募福建省福州市5个社区符合要求的174例SCD患者，根据BMI水平分为正常体质量组（18.5kg/m²≤BMI＜24kg/m²）、超重和肥胖组（24kg/m²≤BMI≤36.5kg/m²），并进行问卷调查、身体测量和Stroop色词测验。采用单因素分析比较不同BMI水平SCD患者执行功能，采用二元logistic回归模型分析影响SCD患者BMI的危险因素。结果 与正常体质量组相比，超重和肥胖组Stroop干扰量（SIE）反应时更长，差异有统计学意义（P＜0.05）。二元logistic回归分析发现，男性患超重和肥胖的风险高于女性（OR=2.204, 95%CI:1.086~4.475, P=0.029），高血压患者患超重和肥胖的概率是无高血压患者的3.060倍（OR=3.060, 95%CI:1.194~7.838，P=0.020）。结论 与正常体质量组相比，超重和肥胖的SCD患者执行功能更差，而且受性别和高血压的影响。对男性SCD患者，控制高血压和体重可能可以有效预防其执行功能下降，降低患AD的风险。     

海南地区健康人群的肾功能轻度下降与代谢综合征各组分及不同组合类型的相关性分析

目的 探讨健康人群的肾功能轻度下降与代谢综合征(Metabolic Syndrome,MetS)组分及不同组合类型的相关性。方法 选取肾功能轻度下降组5097例及随机匹配同期体检的肾功能正常组5204例为研究对象；慢性肾脏病流行病学协作公式(CKD-EPI公式)计算估计肾小球滤过率(estimate glomerular filtration rate,eGFR)评估肾功能；logistic多因素回归分析MetS各组分及不同组合与肾功能轻度下降的相关性。结果 该人群肾功能轻度下降组的MetS发生率(26.4%)高于正常组(22.4%)，差异有统计学意义（P＜0.05，〖XC小五号.EPS;P〗=28.711）；logistic多因素回归分析结果显示，校正年龄、性别、血尿酸、吸烟史、饮酒史后，MetS单组分与肾功能轻度下降有相关性的是腰围(OR=1.124，95%CI:1.012~1.249)、空腹血糖(OR=0.771，95%CI:0.701~0.848)和收缩压(OR=0.456，95%CI:0.392~0.529)；1~5个组分的Mets发生肾功能轻度下降的风险分别为1.235（95%CI:1.090~1.400）,1.379(95%CI:1.210~1.573),1.492(95%CI:1.292~1.723)，2.064(95%CI:1.710~2.490)，2.982(95%CI:2.056~4.326)；含有腹型肥胖、高血糖或高血压的MetS类型发生肾功能轻度下降的风险更高。结论 腰围、空腹血糖和收缩压是该人群肾功能轻度下降的独立危险因素，且含有这3个独立危险因素的MetS类型发生肾功能轻度下降的风险更高。     

上海地区职业人群代谢综合征及其组分与早期肾损伤的相关性研究

目的 探讨上海地区职业人群代谢综合征（Metabolic Syndrome,MetS）和早期肾损伤的检出情况,分析MetS及其组分与早期肾损伤相关性。方法 选取2021年1—12月在华东疗养院进行健康体检的12251例上海地区职业人群为研究对象,以估算的肾小球滤过率(estimate glomerular filtration rate,eGFR)60≤eGFR＜90ml/( min·1.73m2)为依据诊断为早期肾损伤,MetS根据2017年版中华医学会糖尿病分会诊断标准进行诊断,研究该人群MetS及其不同组分中早期肾损伤的检出情况,并采用单因素与多因素logistic回归分析MetS及其组分与早期肾损伤的相关性。结果 该地区职业人群MetS和早期肾损伤的检出率分别为16.04%和24.86%,且eGFR值在MetS组与非MetS组间有统计学差异（t =2.967,P =0.003）;在MetS及其五个组分中,除高空腹血糖外,余阳性组的早期肾损伤检出率显著高于阴性组（P＜0.001）,且随着组分数0~5的增高,早期肾损伤检出率逐渐增高（趋势x²=139.225, P＜0.001）;回归模型分析显示,性别（OR=2.407,95% CI:2.184～2.652）、年龄（OR=5.661,95% CI:4.622～6.934）、腹型肥胖(OR=1.177,95% CI: 1.072~1.292）、高血压( OR=1.319,95% CI: 1.208~1.441）、高TG血症(OR=1.403,95% CI: 1.286~1.531）、低HDL-C血症(OR=1.245,95% CI: 1.109~1.397）是早期肾损伤的危险因素;男性发生风险是女性的2.209倍（95%CI:1.983～2.460）;50岁以上人群是≤30岁人群的5.477倍（95%CI:4.448～6.745）; MetS的1～5项组分数发生早期肾损伤的风险分别为0.704（95%CI:0.597～0.830）,1.124（95%CI:0.826～1.538）,1.502（95%CI:1.143～1.843）,1.697（95%CI:1.369～2.164）,1.913（95%CI:1.234～2.251）。结论 上海地区职业人群早期肾损伤检出率较高,男性、年龄增长、腹型肥胖、高血压、高TG血症、低HDL-C血症是发生早期肾损伤的危险因素。     

哈萨克族受检人群肥胖与代谢综合征的关系

目的分析哈萨克族受检人群肥胖与代谢综合征的关系。方法对哈萨克族受检人群进行抽样检查,采用氧化酶法测定甘油三酯(TG)、总胆固醇(TC)、空腹血糖(FPG);化学修饰酶法测定高密度脂蛋白胆固醇(HDL-C);直接一步法检测低密度脂蛋白胆固醇(LDL-C)水平。结果哈萨克族受检人群的代谢指标检测,除了高密度脂蛋白水平男性低于女性外,其他指标男性均高于女性,差异有统计学意义(P0.05)。随着年龄的增加,男性和女性代谢综合征检出率增加。肥胖情况下男性和女性代谢综合征的检出率分别是47.5%和23.3%,男性高于女性,差异有统计学意义(P0.05)。男性和女性肥胖人群罹患代谢综合征的发病风险分别是正常人群的14.854倍和16.739倍。结论哈萨克族受检人群MS及其代谢组分表现出性别差异和特点,肥胖情况下患病风险急剧增加。因此通过健康教育,减少体重,控制代谢性紊乱以及由其引发的心脑血管疾病发生具有重要的意义。     

泸州地区体检在职人群血脂异常流行情况及危险因素分析

目的 了解泸州地区体检在职人群血脂异常的流行情况及危险因素分析,为制定相关疾病防控策略和措施提供依据。方法 采用方便抽样的方法调查对2020年6-12月泸州地区三家三甲医院18~60岁4878名健康体检在职人群,通过面对面问卷调查、体格检查和血生化检测收集资料,剔除不合格及关键变量缺失问卷,最终有4274名调查对象纳入研究分析中,使用非条件logistic回归进行危险因素分析。结果 调查发现,血脂异常的检出率为48.13%,其中高TG血症、高TC血症、高LDL-C血症、低HDL-C血症检出率分别为41.93%、18.88%、5.85%、1.39%,女性血脂异常及高TG血症、高TC血症、高LDL-C血症、低HDL-C血症检出率低于男性（χ2=541.00,P<0.001;χ2=55.30,P<0.001;χ2=534.32,P<0.001;χ2=34.61,P<0.001;χ2=23.13,P<0.001）,而年龄增高使血脂异常及各成分异常检出率增加（χ2=153.93,P<0.001;χ2=113.31,P<0.001;χ2=168.69,P<0.001;χ2=28.55,P<0.001）,吸烟主要导致血脂异常、高TG血症（OR=1.41,95%CI:1.19~1.66;OR=1.70,95%CI:1.44~2.00）,膳食情况一般或较差是血脂异常的危险因素（OR=1.28,95%CI:1.10~1.48;OR=2.36,95%CI:1.50~3.70）,中心性肥胖、超重、肥胖是血脂异常的危险因素（OR=1.66,95%CI:1.42~1.94;OR=4.06,95%CI:2.42~6.88;OR=5.56,95%CI:3.19~9.69）,吸烟、膳食情况较差、糖尿病、中心性肥胖是HDL-C降低的危险因素（OR=1.95,95%CI:1.08~3.50;OR=4.05,95%CI:1.17~9.24;OR=2.57,95%CI:1.39~4.77）。结论 泸州地区体检在职人群血脂异常程度高于全国平均水平,高TG血症和高TC血症是该地区体检在职人群血脂异常的主要形式,应该从加强运动、控制体重、良好的膳食情况等方面加强血脂异常的防控与管理。     

苏州工业园区居民睡眠状况与高血压关系的现况研究

目的 探讨苏州工业园区居民睡眠状况与高血压的关系,为制定高血压干预措施提供理论依据。方法 按照整群随机抽样方法,对苏州工业园区4个街道35岁以上居民进行高血压、睡眠状况调查,计量资料采用t检验,计数资料采用〖XC小五号.EPS;P〗检验,使用logistic回归分析高血压与睡眠状况的关系。结果 该地区居民男女睡眠时间差别无统计学意义(t=1.54, P=0.464),女性睡眠障碍率高于男性（〖XC小五号.EPS;P〗=100.86, P＜0.001）,男性与女性之间睡眠障碍类型差别有统计学意义（〖XC小五号.EPS;P〗=116.44, P＜0.001）;女性睡眠时间不足能增加高血压的患病风险1.41（95%CI:1.04~1.92）倍,男性睡眠过多则增加高血压的患病风险1.89（95%CI:1.18~3.02）倍;女性睡眠障碍可增加1.47倍（95%CI:1.23~1.75)的高血压风险。结论 睡眠时间、睡眠质量与高血压密切相关,在高血压健康教育工作中,需关注患者的睡眠状况,必要时给予干预。     

中国3个地区体检人群代谢综合征发病风险及其危险因素分析

目的 分析我国3个地区（北京、香港、台湾）体检人群MS发病风险及其危险因素。方法 选取台湾地区美兆体检数据库中2004—2010年首次体检,且与末次体检至少相差5年的≥ 18岁非MS人群6 828人,构建体检队列,采用中国成人血脂异常防治指南制订联合委员会2007年标准（JCDCG-2007）诊断MS。利用Cox模型比较3个地区体检人群发生MS的风险并探索其发生MS的危险因素。结果 北京、香港、台湾3个地区体检人群MS标化发病密度分别为3.14/100人年、2.19/100人年、2.03/100人年,调整性别、年龄、膳食模式等混杂因素后,北京、香港体检人群发生MS的风险分别是台湾地区体检人群的1.60（95% CI：1.34~1.91）倍和1.08（95% CI：0.83~1.41）倍,男性、高龄、吸烟、肉类食物为主的膳食模式以及基线患MS组分异常等因素与体检人群MS发病风险有明显的正相关性（均P<0.05）。结论 北京、香港、台湾地区体检人群发生MS的风险存在地区差异,男性、高龄、吸烟、肉类食物为主的膳食模式、基线患MS组分异常等因素是发生MS的危险因素。     

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.     

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.