Validity of rheumatoid arthritis diagnoses in the Danish National Patient Registry

Discharge diagnoses following hospital admissions in Denmark are recorded in the Danish National Patient Registry (NPR). Such routine hospitalization records may serve as useful research tools in epidemiological studies. The aim of the study was to provide measures of the validity and completeness of rheumatoid arthritis (RA) diagnoses recorded in the NPR. We identified medical records for 217 patients recorded as having RA in the NPR between 1977 and 2001. Using two definitions of RA (clinically confirmed RA and fulfilment of the American College of Rheumatology (ACR) 1987 diagnostic criteria for RA), a rheumatologist assessed the proportion of RA diagnoses recorded in the NPR that could be confirmed by scrutiny of the original medical records. The completeness of RA diagnoses in the NPR was estimated by a two-sample capture–recapture method. Overall, 59 of the 217 RA diagnoses in the NPR were confirmed by information in the medical records. However, major differences were seen according to characteristics of the underlying hospital registrations. Generally, RA diagnoses were most often confirmed for patients registered as inpatients and for patients with more than one hospital registration with RA. Specifically, only 42 of patients with one RA registration from a rheumatology department were confirmed as having RA. In contrast, 91 of patients treated at a rheumatology department and having three or more hospital registrations with RA were confirmed as having RA. The completeness of the NPR with respect to RA satisfying the ACR 1987 classification criteria was estimated to 26. Our conclusion is that with careful attention to the limitations in the data, discharge diagnoses for patients with records of RA in the Danish NPR can be used for epidemiological research purposes; however, our findings prompt general carefulness when using non-audited registries for research in RA.     

Under-registration of gestational trophoblastic disease in the Swedish Cancer Registry

The paper presents a study of completeness of registration of hydatidiform mole and gestational trophoblastic neoplasia in the Swedish Cancer Registry. The study is based on patients treated in Stockholm County, Sweden from 1971 through 1986. Non-notified cases were identified through a computerized register covering nearly all hospital admissions in the region and local hospital patient register. The results show that 25% of the cases with a diagnosis of hydatidiform mole were not included in the cancer register. Of all patients treated for trophoblastic malignancy, 66% were not recorded in the Cancer Registry. The frequent absence of histopathological confirmation in cases with malignant trophoblastic disease was probably the main factor contributing to the observed under-registration. The study indicates that the Swedish Cancer Registry alone does not provide sufficient data for studies on the incidence of gestational trophoblastic disease.Corresponding author.     

中国第二次强化免疫日活动实施情况评价

中国第二次全国强化免疫日活动有效的控制和消除了零剂次儿童的持续累积，人群免疫水平显著提高，据免疫人群出生队例分析，我国多数省份的第二次强化免疫接种数明显较第一次强化免疫提高，全国１－３岁儿童接种数平均增加了７．９％和４．３％，其中主要含有第一次强化免疫漏服的０－岁组儿童。     

商场职工工作能力与生活方式和心理状态关系的探讨

目的　通过对部分商业职工的调查分析，探索生活方式与心理状态对工作能力的影响。方法　采用工作能力指数表对研究对象进行询问调查。结果　有业余爱好与进行体育锻炼者的工作能力指数较高，尤以每周体育锻炼２ 次者的工作能力指数高于性格内向者。结论　生活方式和心理状态均与工作能力有关。适当的体育锻炼和业余爱好以及良好的心理健康状况，均能十分明显地促进工作能力的提高，此外，心理特征也与工作能力有一定关系。     

The effect of censoring on cancer risk estimates based on the Canadian National Dose Registry of occupational radiation exposure

Cohort studies represent an important epidemiological tool for exploring the potential adverse health effects of low-dose exposure to ionizing radiation in the workplace. Analyses of data from the National Dose Registry of Canada have suggested that occupational radiation exposure leads to increased risk of several specific types of cancer, as well as increased overall risk of cancer. An important aspect of such studies is the censoring in recorded exposures induced by dosimetry detection limits. Such a censoring effect can lead to significant underestimation of cumulative doses which, in turn, can result in overestimation of the excess cancer risk associated with occupational radiation exposure. In this article, we present analytic results, supported by a simulation study, on the magnitude of overestimation of risk based on the additive relative risk model used in the analysis of the NDR data that can occur due to censoring. Our results indicate that overestimation of risk is modest, being less than 20% in all situations considered here. Because censoring also results in ovestimation of the precision of the risk estimates, the significance levels of Wald-type statistical tests for increased risk based on the ratio of the estimate to its standard error are virtually unaffected by censoring. These results suggest that although the application of the additive excess relative risk model in the presence of censoring may lead to some overestimation of risk, the model does not lead to invalid conclusions regarding the association between occupational radiation exposure and cancer risk based on data from the NDR.     

Congenital heart defects: 15 years of experience of the Emilia-Romagna Registry (Italy)

Objectives: Collection and assessment of data from the Emilia-Romagna Region on the occurrence of congenital heart defects in order to identify an homogeneous group of patients for further aetiologic and genetic studies. Materials and methods: The present study is based on 1549 stillborn and live born babies affected by congenital heart defect out of 330,017 consecutive births (4.7 per 1000). Results: The frequency and type of congenital heart defects have been identified together with the sex ratio, associated extracardiac anomalies, chromosomal anomalies and the risk of precurrence in relatives. The impact of prenatal diagnosis on prevalence was low during the study period. Conclusions: The study has provided epidemiological data for public health surveillance of congenital heart defects in the Emilia-Romagna region. The creation of a system for the nationwide recording of congenital heart defects designed with regard to the sources of ascertainment, the diagnostic criteria, and the system of classification is emphasised.     

Leptin Level and Skipping Breakfast: The National Health and Nutrition Examination Survey III (NHANES III)

Skipping breakfast is a common dietary habit considered to be unhealthy. However, the mechanisms underlying skipping breakfast have not been fully explored. Leptin is a hormone that regulates food intake and energy storage and secretes in a diurnal rhythm with lowest levels in the morning. We examined the association between the serum leptin level and skipping breakfast in 5714 adults in the U.S. National Health and Nutrition Examination Survey III, 1988–1994. We defined breakfast as any food or beverage consumed between 5:00 a.m. and 10:00 a.m. using a single 24-h recall. Skipped breakfast was seen in 13.1%. In the logistic regression models with and without adjusting for adiposity and sex, leptin levels were not associated with skipping breakfast. After adjusting for age, race/ethnicity, and time of venipuncture, the association remained insignificant. After further adjusting for potential confounders: physical activity, alcohol intake, smoking and diabetes and after further adjusting for: dietary factors, insulin and glucose levels, there was a 9% and 11%–12%, respectively, statistically significantly higher likelihood of skipping breakfast if the leptin level was more than 50% greater. Further investigation into the biological reasons for skipping breakfast may be useful for promoting healthy lifestyles.     

A birth weight for gestational age standard based on data in the Swedish Medical Birth Registry, 1985–1989

Birth weight curves according to gestational length are presented based on data from more than 480,000 singleton births, registered in the Medical Birth Registry and with gestational age based on ultrasound examinations in the majority of cases. Curves were constructed from the most common weights in each week (modes) for each sex and standard deviations were estimated under the assumption of a fixed coefficient of variation, the size of which was estimated from 40 weeks infants. This methodology makes it possible to construct graphs for specific subgroups of infants: such graphs for boys and girls for primiparous and multiparous women are given in the paper.     

Transforming the Mental Health Field: The Early History of the National Association for Mental Health

The paper begins by noting the absence of any sustained analysis of post-war mental health pressure groups and movements. This is deemed problematic because such movements and groups have had a strong presence during this period and because movements, as such, are afforded a central role in much contemporary sociology on account of their role in the process of social change. Next the paper considers how such analysis should be conducted, and suggests a three-phase model for periodising the activity of the groups and movements of the post-war era. The largest part of the paper is then devoted to an examination of one particular aspect of the first phase: the birth of the National Association For Mental Health and their activities in their first ten years of life. Much can be learned from the study of this group.     

镉对大鼠肾皮质钙泵和钠泵活性的影响

给大鼠皮下注射不同剂量的镉金属硫蛋白（ＣｄＭＴ）后１２ｈ,染镉组大鼠尿镉、尿钙和尿蛋白含量高于对照组,且与给予的镉剂量间呈正相关;肾皮质钙泵和钠泵的活性随染镉剂量增大则逐渐降低,两者呈负相关。体外试验中,镉能抑制钙泵活性,这种抑制作用能被谷胱甘肽（ＧＳＨ）和Ｌ半胱氨酸所消除。结果表明,镉对钙泵和钠泵的抑制作用是其引起钙尿症的机理之一,ＧＳＨ和Ｌ半胱氨酸对镉抑制肾皮质钙泵活性的作用有一定的保护作用     

大豆异黄酮对糖耐量异常大鼠肾损伤保护作用

目的 研究大豆异黄酮对D-半乳糖诱导的糖耐量异常大鼠早期肾损伤的保护作用.方法 采用剂量递增法持续腹腔注射D-半乳糖,诱导糖耐量异常大鼠模型;以大豆异黄酮作为拮抗糖耐量异常早期肾损伤的受试物,二甲双胍为阳性对照,观察正常大鼠、糖耐量异常模型大鼠及各受试物组大鼠的血糖,血浆尿素氮和尿微量白蛋白含量、肾脏超氧化物歧化酶(SOD)和谷胱甘肽过氧化酶(GSH-Px)活性、丙二醛(MDA)、晚期糖基化终产物(AGEs)含量变化以及肾细胞DNA氧化损伤程度.结果 模型组大鼠餐后2 h血糖,尿微量白蛋白、肾MDA和AGEs含量较正常对照组均明显增高(P<0.05),SOD活性明显降低(P<0.05),肾细胞DNA拖尾率明显升高.大豆异黄酮干预6周后,大鼠餐后2h血糖、尿微量白蛋白、肾MDA和AGEs含量较模型组明显降低(P<0.05),肾脏SOD活性明显增高(P<0.05),肾细胞DNA拖尾率明显降低.与二甲双胍组比较,大豆异黄酮高低剂量组AGEs含量显著降低(P<0.05),其他指标间比较,差异均无统计学意义.结论 D-半乳糖诱导的糖耐量异常大鼠存在早期肾脏损伤;大豆异黄酮对糖耐量异常大鼠早期肾损伤有保护作用,其机制与其改善糖耐量,提高机体抗氧化能力和抑制非酶糖基化反应有关;大豆异黄酮抑制非酶糖基化作用明显强于二甲双胍.     

The effect of Taiwan's National Health Insurance on infants' preventive care use and inpatient care use

OBJECTIVE: To test whether utilization of infant preventive care services has reduced utilization of inpatient care and to determine whether implementation of Taiwan's National Health Insurance (NHI) has brought about any differences in the utilization of infant health care services. DATA SOURCES: Data were taken from the 1989 and 1996 National Maternal and Infant Health Surveys (NMIHSs). In total, 1662 and 3623 effective samples were used in the study from the 2 years. STUDY DESIGN: We constructed a simultaneous recursive model to obtain efficient estimates by treating preventive care (neonatal care and well-baby care) and inpatient care (hospitalization admissions) as dependent variables. PRINCIPAL FINDINGS: Utilization of neonatal care had strongly negative significant coefficients for the likelihood of being admitted to the hospital. The impact of the NHI was found to be significant. CONCLUSIONS: The hypothesis that the NHI interferes with the effectiveness of preventive care at reducing inpatient care use was not reinforced. Since support from the NHI depends on a balance of push and pull between access to inpatient care and the benefits of preventive care, it can further improve infant health by promoting the benefits of preventive care while making both types of care more accessible.     

溶酶体铁代谢异常与肾脏损伤

溶酶体的完整性对维持细胞正常的代谢非常重要。溶酶体降解含铁的物质会使其内存在大量低质量铁。这些铁主要以还原型Fe（Ⅱ）形式存在并能诱导芬顿反应的发生,导致溶酶体膜完整性破坏。溶酶体膜透性增加会使一系列水解酶和还原铁进入胞浆进而诱导细胞损伤或死亡。此外,自噬在溶酶体铁代谢中也起着至关重要的作用。溶酶体铁处理的异常在一系列肾脏疾病中发挥着重要作用。     

Combined effect of Controlling Nutritional Status and Acute Kidney Injury on severe COVID-19 short-term outcomes

Introduction/ObjectivesAcute kidney injury (AKI) and malnutrition are two complications commonly reported in severe forms of COVID-19, their combined effect on short-term mortality is, however, not yet investigated. The objective of this study is to determine both their individual and combined effects on short-term prognosis.Materials and methodsThis is a prospective, uni-centric study, including 247 severe COVID-19 patients, admitted between April 25th and June 20th, 2020, at the University Hospital of Blida. AKI was defined according to the KDIGO-2012 guidelines. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. The association with in-hospital mortality was assessed using the Kaplan-Meier method and proportional Cox regression.ResultsAmong the 247 severely affected COVID-19 patients included in this study, 34.4% developed AKI, 30.4 and 1.2%, respectively, had moderate and severe CONUT scores, 17.7% worsened and progressed to a critical state and 26.7% did not survive. Both AKI and CONUT score were significantly associated with mortality in a dose-response manner (pLog-Rank < 0.0001). Their relative risks are respectively (HR = 3.25 CI 95% [1.99–5.3] and HR = 2.42 CI 95% [1.5–3.9], p < 0.0001). In multivariate analysis, the highest risk was observed for the AKI-CONUT-high combination (HR = 3.0, 95% CI [1.5–6.1], p = 0.002).ConclusionA possible synergistic interaction between AKI and CONUT score for COVID-19 short-term mortality has been highlighted. Monitoring of renal function associated with assessment of nutritional status should be performed routinely and systematically from the early stages of admission.     

美国国立卫生研究院博士后资助体系对我国博士后制度的启示

美国国立卫生研究院（National Institute of Health,NIH）是美国乃至世界最大、最具影响力的生物医学研究基地和资助管理机构。NIH通过多种方式资助博士后的科学研究和学术生涯发展,帮助青年科研人员实现从博士后到职业科学家的过渡。我国博士后制度创立20多年来发展迅猛,然而博士后资助体系还不十分完善。本文介绍NIH博士后资助体系并就我国博士后与科研项目结合、博士后薪酬福利、博士后基金资助、对医学等关系全民福祉及国家战略部属的重点学科进行政策倾斜等问题提出建议。     

口服木糖醇对糖尿病大鼠血糖及肾脏胰岛素样生长因子I的影响及机制的探讨

目的检测口服木糖醇对实验性I型糖尿病模型大鼠血糖及肾脏胰岛素样生长因子I（IGF—I）表达的影响,探讨口服木糖醇对于糖尿病大鼠肾脏的影响及机制。方法链脲佐菌素（STZ）一次性尾静脉注射造1型糖尿病大鼠模型,将成模的大鼠随机分为四组：糖尿病对照组（Dc组）、糖尿病5％木糖醇喂养组（D＋5％Xy组）、糖尿病10％木糖醇喂养组（D＋10％Xy组）、糖尿病20％木糖醇喂养组（D＋20％Xy组）。另外设置正常对照组（NC组）。实验前留取各组血糖测定结果。喂养中分别在饲料中添加不同比例的木糖醇。于实验第4周末处死动物,处死前测量血糖。通过SABC免疫组织化学方法检测各组大鼠肾脏IGF—I蛋白的表达水平。结果模型制备后,成模的大鼠血糖高于NC组,差异有显著性（P〈0．05）。差异性喂养4周后,各糖尿病组大鼠血糖仍高于Nc组（P〈0．05）,但D＋20％Xy组较Dc组的血糖下降,差异有显著性（P〈0．05）。肾皮质、髓质IGF—I的基础表达量不同（P〈0．01）,但变化趋势一致,除D＋20％Xy外,其他DM组较Nc组均增高,差异有显著性（P〈0．01）;与DC组相比,D＋5％Xy组肾脏皮质IGF—I表达增高（P〈0．01）,D＋10％Xy组、D＋20％Xy组降低,且D＋20％Xy组表现出差异显著性（P〈0．01）。结论口服木糖醇可调节糖尿病大鼠血糖水平,通过调节IGF—I表达进而影响。肾脏功能。     

The Role of the National Rural Health Alliance

ABSTRACT: This paper outlines the history and subsequent development of the National Rural Health Alliance. The mission statement and objectives of the Alliance are presented. An outline of the role and function of the Alliance both now and in the future is given. Details are given of the rural associations who are members of this national rural body and key players in rural health in Australia.     

胰岛素抵抗与慢性肾脏病关系的研究进展

慢性肾脏病(chronic kidney disease,CKD)早期即可出现胰岛素抵抗(insulin resistance,IR)和高胰岛素血症,炎症、氧化应激、血管紧张素Ⅱ的激活、肥胖、活性维生素D缺乏、甲状旁腺功能亢进、贫血等因素可影响胰岛素分泌,诱发IR的发生发展.IR和高胰岛素血症又可通过几个途径直接或间接损伤肾脏.IR与慢性肾病互为因果,是近年的研究热点.     

2011年北京市通州区儿童免疫规划疫苗接种率及其影响因素

目的了解北京市通州区儿童国家免疫规划疫苗基础免疫水平,分析及时接种影响因素,提出改进措施。方法按照PPS方法对在该区居住2个月以上、2009年1月1日-2010年10月31日出生的490名儿童（本市儿童235名、流动儿童255名）预防接种资料及相关数据进行分析。结果所评价的疫苗基础免疫合格接种率均〉90％,基础免疫及时接种率低于合格接种率;DPT、MV疫苗加强免疫合格接种率均〉90％;OPV、DPT、MV、五苗全程免疫及时接种率以及BCG、HBV合格接种率,本市儿童高于流动儿童。不合格接种针次中超期接种占47．34％,提前接种占30．18％,未种占23．67％。结论信息系统的应用、学龄前流动儿童强化查漏补种及较高的社会参与度,对提高流动儿童的接种率起到了积极的效果。由于流动儿童家长的文化水平、重视程度相对较低,疫苗接种及时性流动儿童与本市儿童仍有一定的差距。通过基础免疫的接种,流动儿童家长的按时接种意识、依从性有了很大的提高。临时禁忌症、体检发现的先天性出生缺陷、一类疫苗与二类疫苗不同时接种、BCG复查是影响及时接种率的主要因素。