中国7~18岁人群应用生物电阻抗法估算体脂方程

目的建立生物电阻抗方法(BIA)测量中国儿童青少年体脂含量的应用方程。方法按《中国学龄儿童青少年超重、肥胖筛查BMI分类标准》中各性别和年龄段超重的BMI参考值,将总人群分为体重正常组和超重肥胖组。以水下称重方法为标准方法,采用多元线性逐步回归方法,建立不同BMI水平7~18岁儿童青少年BIA的应用方程。结果体重正常组方程:去脂体重(FFM,kg)=0.406weight+2.918sex+0.315H2/z+0.843;超重肥胖组方程:FFM(kg)=0.358weight+1.571sex+0.358H2/z+0.603;总人群方程:FFM(kg)=0.290weight+2.222sex+0.427H2/z+1.547。三个方程的调整回归系数(r2)和标准误(SEE)分别为:0.940和2.36;0.955和2.46;0.942和2.53,方程的统计学检验均有显著性意义(ANOVA,P<0.001)。结论本研究建立的BIA应用方程与国内外同类研究相比,具有较高的可靠性。     

营养不良炎症评分法在血液透析病人中的应用

目的:评价营养不良炎症评分法(MIS)对血液透析病人营养状态的评估作用. 方法:对80例维持性血液透析病人应用MIS法进行营养评估,同时测定血清清蛋白(ALB) 、转铁蛋白(TF) 、血红蛋白(Hb) 、血钙(Ca)、血磷(P)、C-反应蛋白(CRP)及透析前后血肌酐(Scr)和血尿素氮(BUN).计算透析充分性指标:尿素清除率(Kt/v)、尿素减少率(URR)和蛋白分解率(PCR).并用生物电阻抗法测量透析后人体组成指标:体重(WT)、体质指数(BMI) 、全身水量(TBW )、脂肪组织(FAT MASS)和非脂肪组织(FFM)等. 结果:蛋白质营养不良(ALB＜35 g/L)、贫血(Hb＜110 g/L)和高磷血症(P＞1.8 mmol/L)发生率分别为47.5%、73.8%和70.0%.所有病人的MIS评分均属于轻、中度营养不良.MIS评分与WT、BMI、FAT MASS、ALB、TRF、Hb、CRP和透析前Scr相关,差异均有统计学意义(P＜0.001,P＜0.05).Kt/v与URR、PCR呈正相关(P＜0.001,P＜0.05),与WT、BMI、FAT MASS、FFM、TBW呈负相关(P＜0.001,P＜0.005,P＜0.05). 结论:低蛋白血症、贫血、高磷血症是血液透析病人的主要营养问题.MIS法对血液透析病人有良好的营养评价作用,是一种有效的早期营养不良筛选方法.     

营养支持途径对人体组成影响的随机对照研究

目的用随机对照方法比较肠内和肠外营养支持途径对术后患者人体组成的影响。方法60例符合入选标准的择期手术患者参加本研究,按入组序号和随机表分别进入研究组(肠内途径)或对照组(肠外途径)。在等氮(0.18g·kg-1·d-1)和等能量(25kcal·kg-1·d-1)穴1kcal=4.18kJ雪摄入条件下,于手术前1天及手术后第12天测定总体水穴TBW雪、总体脂肪穴TBF雪、非脂肪组织穴FFM雪、体重指数、三头肌皮褶厚度、上臂围、上臂肌围和握力。结果穴1雪TBF:研究组术后较术前降低(-0.91±1.50)kg,而对照组升高(1.54±1.84)kg,两组比较具有显著性差异(P=0.001);穴2雪TBW:术后研究组和对照组分别降低(-0.20±1.40)kg和(-2.40±2.34)kg,两组比较对照组降低更为显著(P=0.002);穴3雪FFM:术后研究组和对照组分别降低(-0.27±1.92)kg和(-3.28±3.19)kg,两组比较对照组降低更为显著(P=0.002)。结论与肠内营养组比较,肠外营养组术后总体脂肪显著增加,而非脂肪组织的减少更为明显。     

儿童基础代谢率与人体组成的关系

目的通过对儿童基础代谢率与人体组成关系的研究,为临床基础代谢率的应用提供资料。方法对114名儿童进行基础代谢能量消耗和人体组成(脂肪组织和去脂组织)测定,分析其相关关系。结果基础代谢的能量消耗肥胖组儿童高于非肥胖组儿童,两者比较差异有显著意义(P<0.05)。用去脂组织(FFM)和脂肪组织(FM)校正后,肥胖组与非肥胖组无显著性差异(P>0.05),但男、女儿童间仍有显著性差异(P<0.05)。基础代谢率与FFM呈显著正相关(r=0.895,P<0.001),FFM可解释基础代谢率变化的80%,是影响基础代谢率的主要因素,性别和FM分别可解释其2.4%和2.7%。用去脂组织、脂肪组织和性别预测基础代谢能量消耗的回归方程:基础代谢率kJ/h=100.984 3.243×去脂组织 15.333×性别 1.533×脂肪组织(性别:男童为1,女童为0)。结论用FFM和FM对基础代谢率校正以后,基础代谢的能量消耗量肥胖儿童与非肥胖儿童无显著性差异。FFM是影响儿童基础代谢率的主要因素,FM对基础代谢率也有一定影响。     

成人BMI与体脂含量和脂肪分布的关系

目的 :　调查成人超重和肥胖的发生率 ,探讨体质指数 ( BMI)与体脂含量、腰臀围之间的关系。方法 :　对 1 0 0 5名健康成年人进行人体测量 ,按 WHO对亚洲成年人的 BMI新定义分为 5组 ,对腰围、臀围、腰臀围比值和生物电阻抗法 ( BIA法 )及皮褶厚度法体脂含量的分布进行分析。结果 :　以 BMI法判断超重和肥胖的发生率 ,男性超重率和 度肥胖率明显高于女性 ,男女人群中 度肥胖发生率均较低 ;在相同 BMI组中 ,男性的平均年龄比女性低 ( P<0 .0 1 )。而 BIA法和皮褶厚度法肥胖检出率明显低于 BMI法 ,且女性体脂含量、三头肌皮褶厚度及肩胛下皮褶厚度显著高于男性。不同年龄组 BMI均与体脂含量呈显著正相关。女性超重组的腰围平均值为 80 cm,而男性 度肥胖组的腰围平均值 >90 cm。结论 :　男性超重和肥胖发生的年龄早于女性。以 BMI法判断肥胖和以 BIA法及皮褶厚度法体脂含量法判断肥胖有很大差别 ,仅以 BMI判断肥胖不够准确 ,尚需考虑年龄、性别及运动情况等影响因素。     

能量平衡对腹膜透析患者体重的影响

目的 研究持续非卧床腹膜透析(CAPD)患者的能量摄入和消耗,探讨CAPD患者超重和肥胖的可能影响因素.方法 选择2011年5月至12月在北京大学第三医院门诊稳定透析的115例CAPD患者,根据体质量指数(BMI)分为正常组(18.5 kg/m2≤BMI< 24 kg/m2,n=61)和超重/肥胖组(BMI≥24 kg/m2,n =54).收集患者3d饮食记录,计算饮食热量、蛋白质、脂肪和碳水化合物摄入,测定24 h透析液中吸收的葡萄糖量,测定患者静息能量消耗(REE),收集3d活动记录计算总能量消耗(TEE),进行人体成分分析.结果 两组患者在年龄、身高、饮食热量摄入、饮食蛋白质和碳水化合物摄入、肌肉量、水负荷方面的差异无统计学意义.超重/肥胖组患者透析液中吸收的葡萄糖热量和饮食脂肪摄入量均显著高于正常组[(1 920.5 ±506.3) kJ/d比(1 673.6±535.6) kJ/d,x2=2.536,P=0.013; (62.5±19.8) g/d比(53.1 ±18.7) g/d,x2 =2.575,P=0.011].超重/肥胖组的REE显著高于正常组[(5066.8±1 029.3)kJ/d比(4 556.4±799.1)kJ/d,x2=2.979,P=0.004],但两组TEE差异无统计学意义[(7 819.9±728.0) kJ/d比(7 803.2±1 092.0) kJ/d,x2=0.770,P=0.939].Logistic回归分析显示,透析液吸收热量和饮食脂肪摄入量是超重/肥胖的危险因素(OR=1.003,95％ CI=1.000 ～1.007,P=0.029;OR=1.024,95％ CI=1.003 ～1.046,P=0.027).结论 与BMI正常的CAPD患者比较,超重和肥胖患者饮食脂肪摄入量和从透析液中吸收的葡萄糖多,但TEE差异无统计学意义,提示超重/肥胖的CAPD患者处于能量正平衡状态,应减少高浓度葡萄糖透析液使用,并鼓励体育锻炼.     

学龄期儿童有氧能力与人体成分的关系

目的　调查上海市学龄期儿童有氧运动能力现状,探讨人体成分与有氧运动能力之间的关系。方法　以上海市杨浦区一所小学63名儿童为研究对象,分析人体成分（生物电阻抗法）和有氧运动能力（固定功率运动试验,间接测定法）,测定体脂比例（FAT%）、去脂体质量(FFM)、肥胖度、最大氧摄取量（VO2max）、最大氧脉搏等指标,分析各项指标之间的关系,比较超重肥胖儿童与非超重肥胖儿童各项指标的差异。结果　除1名未进行人体成分测试者外,余62名受试儿童中,超重肥胖组男生与非超重肥胖组相比,VO2max绝对值更高而VO2max相对值更低［（1 038.50±157.93）ml/min比（923.90±82.03）ml/min, F=4.812, P=0.005;（23.62±4.22）ml/(kg·min)比（27.75±2.41）ml/(kg·min),F=5.633,P=0.002］,差异有统计学意义;超重肥胖组的最大氧脉搏有升高趋势,但差异无统计学意义（P＞0.05）。女生中,与非超重肥胖组相比,超重肥胖组的VO2max绝对值有升高趋势［（966.70±131.22）ml/min比（892.55±108.71）ml/min］,但无统计学意义（P＞0.05）;超重肥胖组的VO2max相对值低于非超重肥胖组［（23.84±4.30）ml/(kg·min)比(28.09±4.52）ml/(kg·min)］,差异有统计学意义（P＜0.05）;最大氧脉搏高于非超重肥胖组 ,但差异无统计学意义。控制年龄因素后,VO2max相对值与体质量指数（BMI）、肥胖度、FAT%、脂肪量（FM）、FFM、脂肪含量指数（FMI）、去脂体质量（FFMI）均呈显著负相关（男：r=-0.675,P＜0.000 1;r=-0.634,P＜0.000 1;r=-0.667,P＜0.000 1;r=-0.726,P＜0.000 1;r=-0.594,P＜0.000 1;r=-0.686,P＜0.000 ; r=-0.456,P=0.010。女：r=-0.651,P＜0.000 1;r=-0.552,P=0.002; r=-0.527,P=0.003; r=-0.633,P＜0.000 1; r=-0.520,P=0.004;r=-0.579,P=0.001;r=-0.597,P=0.001）。男生中,最大氧脉搏与BMI、FFM、FFMI均显著正相关(r=0.358,P=0.048;r=0.543,P=0.002;r=0.554,P=0.001);女生中,最大氧脉搏与FFM、FFMI呈正相关(r=0.378,P=0.043;r=0.449,P=0.014)。结论　学龄期儿童的有氧运动能力与人体成分有关。肥胖程度越高,有氧运动能力越差。最大氧脉搏与去脂体质量有一定相关性。     

慢性阻塞性肺病患者的人体组成

目的应用生物电阻抗分析法,检测慢性阻塞性肺病(COPD)患者的人体组成的改变。方法选择符合COPD诊断标准的37例住院患者作为研究对象,其中男性27例,女性10例,平均年龄(66.7±9.9)岁。49名健康志愿者作为对照,其中男性28名,女性21名,平均年龄为(64.3±8.3)岁。用生物电阻抗法测定人体组成。结果COPD患者的体重较健康志愿者显著降低(P<0.05),其中去脂体质(FFM)降低更加显著(P<0.01),脂肪含量(Fat%)相对增加(P<0.01);总体水(TBW)和TBW/体重明显低于健康志愿者(P<0.05),而女性患者TBW/FFM高于健康志愿者(P<0.05);男性患者的基础代谢率较健康志愿者显著降低(P<0.05)。结论COPD患者存在不同程度的瘦体质消耗增加,脂肪含量相对增加,造成机体总体水含量减少,基础代谢率降低。     

济南市7岁儿童BMI及体成分与血压水平的相关性分析

目的阐明儿童期BMI及体成分指数与血压水平的相关性,为成年期疾病的早期预防提供相关依据。方法对济南市910名7岁儿童进行身高、体重、血压和皮褶厚度测量,采用回归方程推算体脂比(BF%),计算脂肪组织指数(FMI)和非脂肪组织指数(FFMI)。结果 BMI,BF%,FMI,FFMI与收缩压和舒张压均呈一定程度正相关(P值均0.05),血压与FMI的相关性高于FFMI。高BMI、BF%百分位数组儿童的血压水平均显著高于低百分位数组(P值均0.05)。血压偏高的检出率为肥胖组超重组正常组消瘦组。结论儿童BMI及体成分指数与血压水平有显著的相关性。预防儿童高血压应从控制体脂肪、预防肥胖做起。     

青年学生体重指数与其父母体重指数的关系

目的 探讨青年学生体重指数与其父母体重指数的关系,进一步了解遗传和环境因素在超重和肥胖流行中的作用,希望能为超重和肥胖的预防提供一定的指导。方法 按照中国肥胖问题工作组对中国成人体重指数(BMI)分类标准进行分组,即低BMI组(BMI<18.5),正常BMI组(BMI为18.5～23.9),超重组(BMI为24.0～27.9)和肥胖组(BMI≥28.0)。统计了505名青年学生和993名父母的BMI结果 男女学生超重肥胖者,其父母中单方也患有超重肥胖的比率从20.0％到50.0％,父母双方均患有超重肥胖的比率从6.7％到10.0％ 青年学生与其父母相比,超重肥胖率有显著性差异,女学生父母明显高于女学生,P<0.01;男学生父母也明显高于男学生,P分别小于0.01和0.05。在BMI<18.5组中,女学生明显高于父母,男学生高于其父亲,P<0.01。男女学生的父母亲比较,以及城乡比较,超重率和肥胖率无显著性差异。结论 男女学生超重肥胖者,其父母中单方也患有超重肥胖的比率平均约为30.0%,父母双方均患有超重肥胖的比率平均约为8.0%,从而证明超重和肥胖与遗传有关。但从超重和肥胖的现患率男女学生的父母亲明显高于男女学生这一事实,其差异的显著性表明,环境等因素在超重和肥胖形成中的作用可能更重要,因此,大多数超重和肥胖是可预防的。     

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.