大姚县青石棉天然暴露区主要恶性肿瘤死亡及其危险因素调查

目的:探讨云南省大姚县低剂量青石棉相关暴露与当地恶性肿瘤死亡的关联,为制定当地恶性肿瘤的防治策略提供依据。方法:对大姚县部分青石棉污染区的农村居民进行27年回顾性队列(1984年2月至2011年4日)研究。结果:观察队列共1 249人,随访总人年数为28 848.27人年,其中443人死亡,占全部随访对象的35.47%。队列中有121人死于恶性肿瘤,总死亡率为1 535.64/10万人年。居恶性肿瘤死因顺位首位的是肝癌,共29例,粗死亡率为100.53/10万人年(标化死亡率为51.22/10万人年);居第2位的是肺部恶性肿瘤(不含胸膜间皮瘤),共27例,粗死亡率为93.59/10万人年(标化死亡率为41.05/10万人年);居第3位的是胸膜间皮瘤,共26例,粗死亡率为90.13/10万人年(标化死亡率为54.36/10万人年)。肠癌与胃癌死亡率分别为45.06/10万人年(标化死亡率为23.68/10万人年)和41.60/10万人年(标化死亡率为18.27/10万人年)。多因素分析显示,当地主要青石棉暴露因素(生产石棉炉、使用石棉炉数量、石棉修路和居住时间)均与恶性肿瘤死亡相关。而且男性的相对危险度高于女性。结论:消化道恶性肿瘤已成为严重危害大姚县居民健康的首位癌种,以肝癌、肠癌及胃癌为主,青石棉相关暴露是当地恶性肿瘤高发的主要危险因素。     

饮酒与老年性痴呆关系的前瞻性队列研究

目的探讨饮酒和老年性痴呆的关系。方法对重庆市2632名≥60岁老年人进行2年前瞻性队列研究，受试者分为不饮酒，轻中度饮酒，重度饮酒，用简易智能量表（MMSE）和美国精神障碍诊断与统计手册第三版修订本（DSM—Ⅲ—R）进行痴呆诊断，随访时间内记录痴呆发生的例数，采用运用Logistic回归方法对饮酒和痴呆的关系进行分析。结果在调整了年龄、性别、教育、血压、吸烟、中风史、MMSE评分等危险因素后，与不饮酒者相比，轻中度饮酒使痴呆的危险度降低（RR=0.52，95％CI=0.32-0．85），与不饮酒者相比，轻中度饮酒者患阿尔茨海默病的相对危险度为0.63（RR=0．63，95％CI=0．55—0．72），其他类型痴呆为0.45（RR=0．45，95％CI=0.12-1.69），血管性痴呆为0.31（RR=0.31，95％CI=0.19-0．51）。与不饮啤酒者相比，轻中度饮啤酒者患痴呆的危险度增高（RR=2．47，95％CI=1．23—4.96）；与不饮葡萄酒者相比，轻中度饮葡萄酒者患痴呆的危险度降低（RR=0．68，95％CI=0．50—0．92）。结论轻中度饮酒与痴呆的危险度降低有关。     

四川省西昌市静脉吸毒人群3年随访的死亡情况分析

目的了解四川省凉山彝族自治州西昌市静脉吸毒人群死亡率及死因情况。方法于2002年11月招募静脉吸毒人群前瞻性研究队列376人，调查其社会人口学、吸毒行为和性行为特征。计算静脉吸毒人群3年随访的死亡率和死因构成，对其影响因素采用单因素和多因素Cox回归模型分析。结果在队列3年随访中，死亡44人，死亡率为42．60／1000人年（95％CI：30．02～55．19），标准化死亡比为27．35（95％CI：15．66～46．24）。吸毒过量占全部死因的68．2％（30／44）。多因素Cox回归模型分析未见与全死因有统计学意义的变量，但见吸毒年限≥10年（RR值，3．04；95％CI：1．42～6．50；P=0．0041）和近3个月静脉注射频率≥7次／周（RR值，2．70；95％CI：1．24～5．89；P=0．0127）与吸毒过量死亡差异有统计学意义。结论吸毒过量是西昌市静脉吸毒人群的主要死因，需进一步探讨吸毒过量死亡的影响因素及其干预对策。     

吸烟、酒精、胆石病和糖尿病作为胰腺癌的危险因素的研究

对170例胰腺癌和170例对照组非肿瘤疾病进行对比，计算其相对危险度（RR），评价糖尿病、胆石病、吸烟和饮酒作为胰腺癌危险因素的意义。结果显示吸烟者胰腺癌危险度明显增加（RR1.9，95％CI1.2～3.9），并随吸烟年限和吸烟量增加而增加；饮酒无相关性；胆石病（RR3．4，95％CI1．6～9．7）和糖尿病（RR3．27，95％CI2.61～4．05）胰腺癌的危险度均有增加。但糖尿病仅出现在胰腺癌发病前的2年内才有意义，它可能是胰腺癌的结果而不是危险因素。     

农民接触环境中青石棉后患肺癌和间皮瘤的危险

为了解在生活环境中接触青石棉２０～３０年后患肺癌和间皮瘤的危险，采用回顾队列调查方法，对１６１０名在环境接中触青石棉的农民进行追踪，以无石棉污染地区的７６４６名农民作对照。９年期间，肺癌和间皮瘤的死亡率分别为４３．７５／１０万，３６．４６／１０万。肺癌的相对危险度为５．６７，间皮瘤的ＲＲ为１８２．３（Ｐ＜０．０１），提示青石棉与肺癌和间皮瘤之间存在很强的病因学联系。     

云南省元江流域疟疾流行病学调查(English)

目的 了解元江流域不同海拔高度，不同人群中的疟疾流行程度和感染疟疾的相对危险度。方法 采用寄生虫学和血清学相结合的方法开展横断面调查，对资料进行层分析。结果 间接荧光技体实验(IFAT)结果显示，1)以低海拔地区的本地居民为对照，来自区外的流动人口，来自中海拔和高海拔地区的下坝生产人员感染疟疾的相对危险度(RR)分别是4．46(95％CI：3．44—5．78)，8．38(95％CI：6．41～10．92)和6．31(95％CI：4．92～8.90)；2)以年龄＜15岁为对照，中高海拔地区，≥15岁劳动力年龄组的服是2．76(95％CI：2．40～3．81)；3)带虫率分析显示，与当地居民相比，低海拔地区打临工的RR是20．64(95％CI：4．76-89.59)。结论 在该地区，疟疾的传播依然严重，并主要发生在低海拔地区；在野外过衣和缺乏个人防护措施是感染疟疾的危险因素。     

应用队列研究方法检验饮酒与肠癌发病的联系

目的:了解饮酒者与非饮酒者人群中肠癌发病情况,验证饮酒与肠癌发病之间的关系.方法:以1989年5月-1990年4月期间,参加浙江省嘉善县肠癌筛检的10个乡镇30岁及以上人口共64 102人为研究队列,其中29 044名饮酒者为暴露组,其余为非暴露组.随访时间为1990年5月1日至2001年12月1日,观察队列的肠癌发病情况,应用Cox回归模型计算两者的相对危险度(RR).结果:全队列64 102人,共观察658 100.24人年.暴露组29 044人,随访298 497.23人年;非暴露组35 328人,随访359 603.01人年.全队列中合计肠癌新发病例242例,其中暴露组新发病例108例,发病密度为36.18/10万,非暴露组新发134例,发病密度为37.26/10万,两者相比无显著性差异(Z＝0.52,P>0.05);饮酒与肠癌发病的粗RR值为0.97(95%CI为0.75～1.25),调整RR值为1.13(95%CI为0.87～1.48)无统计学显著意义.经计算,本研究的检验效能(1-β)为96.99%.结论:在嘉善县人群中,饮酒不是肠癌的危险因素.     

药物降脂治疗在女性患者中的应用

背景：有几项临床研究评价了药物降脂治疗冠心病(coronary heart disease，CHD)的作用。但是许多研究没有包括足够数量的女性患者，无法进行性别校正分析，也没有单纯关于女性的相关结果。目的：对药物治疗女性高脂血症预防CHD事件的证据进行汇总和评估，对药物治疗对死亡率的影响进行汇总分析。资料来源：我们通过MEDLINE、Cochrane数据库和有效性综述摘要数据库(the Database of Abstracts of Reviews of Effectiveness)检索了1966年至2003年12月发表的相关文献，复习了文章的参考文献并请教了相关专家。研究选择和数据提取：入选标准为治疗至少1年以上、评价了降脂治疗对临床预后的影响、有性别分层结果的有关门诊患者的研究。评价的指标有总死亡率、CHD死亡率、非致死性心肌梗死(myocardial infarction，MI)、血运重建和总CHD事件。通过随机效应模型计算有心血管病史和无心血管病史患者治疗的相对危险度(relative risks，RR)。数据综合：共入选13项研究。6项研究包括了11435例无心血管病的女性，并对降脂治疗的效果进行了评价。降脂治疗并未减少总死亡率(RR，0．95；95％可信区间[confidence interval，CI]，0．62～1．46)、CHD死亡率(RR，1．07；95％CI，0．47～2．40)、非致死性MI(RR，0．61；95％CI，0．22～1．68)、血运重建(RR，0．87；95％CI，0．33～2．31)或CHD事件(RR，0．87；95％CI，0．69—1．09)。由于现有研究中CHD事件太少，使一些统计分析受到了限制。8项研究包含了8272例女性心血管病患者，并对降脂治疗效果进行了评价，结果显示降脂治疗并未降低女性心血管病患者的总死亡率(RR，1．00；95％CI，0．77～1．29)。然而，降脂治疗降低了这些患者的CHD死亡率(RR，0．74；95％CI，0．55～1．00)、非致死性MI(RR，0．71；95％CI，0．58～0．87)、血运重建(RR，0．70；95％CI，0．55～0．89)和CHD事件(RR，0．80；CI，0．71～0．91)。结论：对于没有心血管病的女性，降脂治疗对总死亡率和CHD死亡率没有影响。降脂治疗可能会减少CHD事件，但是现有证据还不足以证明这一点。对于有心血管病的女性患者，治疗高脂血症可以有效减少CHD事件、CHD死亡率、非致死性MI和血运重建，但对总死亡率无影响。     

各种一线降压药物治疗的疗效——网络汇总分析

背景：确定不同降压药物的相对获益或损害的确定常常受比较研究复杂队列的影响。网络汇总分析(network meta-analysis)集中了直接和间接证据，可更好地判定降压治疗的危险和获益。目的：对现有各种一线降压药物安全性和疗效的临床试验证据进行总结，评估指标为主要心血管病终点和全因死亡率。数据来源和研究选择：采用汇总分析、MEDLINE检索以及1995年1月至2002年12月发表的杂志综述，从中挑选出以心血管病终点作为结局的长期随机对照试验。入选的研究包括安慰剂对照试验、空白对照试验和活性药物对照试验。数据提取：用网络汇总分析综合分析同一试验内不同药物的直接比较与其他试验的间接证据。间接比较保留试验内随机结果，用于采用同一种治疗手段的试验。数据综合：数据来自42项临床试验，共有192478例患者随机采用包括安慰剂在内的7种主要治疗方案。对于所有结局指标，小剂量利尿剂均优于安慰剂：冠心病(CHD；RR，0．79；95％可信区间[CI]，0．69～0．92)；充血性心力衰竭(CHF；RR，0．51；95％CI，0．42～0．62)；脑卒中(RR，0．71；0．63～0．81)；心血管病事件(RR，0．76；95％CI，0．69～0．83)；心血管病死亡(RR，0．81；95％CI，0．73～0．92)和总死亡(RR，0．90；95％CI，0．84～0．96)。对所有结局，没有一种一线治疗方案——β-受体阻滞剂、血管紧张素转化酶(ACE)抑制剂、钙通道阻滞剂(CCBs)、α-受体阻滞剂、血管紧张素受体阻滞剂——显著优于小剂量利尿剂。与CCBs相比，小剂量利尿剂了减少心血管病事件(RR，0．94；95％CI，0．89～1．00)和CHF(RR，0．74；95％CI，0．67～0．81)的危险性；与ACE抑制剂相比，减少了CHF(RR，0．88；95％CI，0．80～0．96)、心血管病事件(RR，0．94；95％CI，0．89～1．00)和脑卒中(RR，0．86；95％CI，0．77～0．97)的危险性；与β-受体阻滞剂相比，减少了心血管病事件(RR，0．89；95％CI，0．80～0．98)的危险性，与α-受体阻滞剂相比，减少了CHF(RR，0．51；95％CI，0．43～0．60)和心血管病事件(RR，0．84；95％CI，0．75～0．93)的危险性。各种治疗引起的血压变化相似。结论：小剂量利尿剂是预防心血管病发病和死亡的最有效的一线药物。临床实践和治疗指南应体现这一论点，未来试验应将小剂量利尿剂作为标准临床对照药物。     

流行病学分布研究进展

肺气肿、心脏病和高血压死亡归因危险比依次为9.3%、5.8%和 5.1%. Katzman等根据上海研究资料认为痴呆是老年人的一种"恶性"疾病.瑞典一个社区人群(≥75岁)AD死亡率为1.9/100 人年痴呆患者5年病死率为70%(非痴呆者为35%),AD导致死亡的RR为2.0 (95%CI 1.5～2.7),人群死亡归因危险比为14%.法国一项历时8年的人群队列研究显示AD患者死亡的RR为1.7 (95% CI 1.3～2.2),导致痴呆患者死亡的主要疾病为呼吸系统疾病(RR=2.8,95% CI 1.3～6.2)和脑血管病(RR＝1.7,95% CI0.8～3. 7).痴呆明显缩短患者寿命,不同研究报告痴呆患者的平均存活时间从3～10年不等.     

农民接触环境中青石棉后患肺癌和间皮瘤的危险

To assess the risk of lung cancer and mesothelioma after environmental exposure to crocidolite for 20-30 years, a retrospective cohort study was carried out in farmers who had been exposed to crocidolite in environment. 1610 subjects were followed up for 9 years (Jan. 1, 1987 Dec. 31, 1995). The control group consisted of 7646 farmers who resided in the noncrocidolite pollution rural area in the same province. The results showed that the annual mortality rate was 43.75 per 100,000 population for lung cancer, and 36.46 per 100,000 for mesothelioma. Significantly high risks of lung cancer (RR 5.67) and mesothelioma (RR 182.3) were noted. These results demonstrate a strong causal association between lung cancer, mesothelioma and exposure to crocidolite.     

四川省西昌市2008—2018年初始抗病毒治疗HIV感染者死亡和脱失情况

目的 了解四川省西昌市2008–2018年初始抗病毒治疗HIV感染者死亡和脱失的情况及其影响因素。方法 采用回顾性队列研究的方法,从艾滋病基本防治信息系统选取2008–2018年在西昌市首次开始抗病毒治疗（ART）的HIV感染者,分析抗病毒治疗者的死亡和脱失情况。采用Cox比例风险回归模型对影响抗病毒治疗HIV感染者病死率和脱失率的相关因素进行分析。结果 共计2 723例HIV感染者进入队列,总体病死率为1.92/100人年,总体脱失率为2.49/100人年。在开始抗病毒治疗的第1年内病死率和脱失率分别为10.83/100人年、13.89/100人年。Cox回归分析结果显示接受抗病毒治疗患者主要的死亡风险是年龄≥40岁（HR=2.30,95%CI：1.53~3.48）、男性（HR=1.94,95%CI：1.14~3.30）、ART前一年内结核感染（HR=1.92,95%CI：1.01~3.65）、ART前三个月出现艾滋病相关疾病/症状（HR=2.44,95%CI：1.50~3.99）、ART前乙肝感染（HR=2.50,95%CI：1.32~4.71）、CD4⁺T淋巴细胞计数< 200 cells/ul（HR=1.79,95%CI：1.12~2.86）。接受抗病毒治疗患者主要的脱失风险是年龄≥40岁（HR=1.53,95%CI：1.07~2.18）、男性（HR=5.60,95%CI：2.60~12.08）、静脉吸毒（HR=2.18,95%CI：1.46~3.27）、初始抗病毒治疗方案为EFV+3TC+TDF（HR=2.57,95%CI：1.32~5.01）。结论 西昌市HIV感染者的抗病毒治疗效果显著,但在开始治疗的第1年内病死率和脱失率较高。抗病毒治疗工作需采取针对性的措施,重点要减少静脉吸毒人群刑满释放后的脱失,从而提高抗病毒治疗效果。     

Predictions of future cases of asbestos-related disease among former miners and millers of crocidolite in Western Australia

In a cohort of 6502 male and 410 female former workers from the crocidolite (blue asbestos) mining and milling works at Wittenoom, Western Australia, there were 94 cases of malignant mesothelioma (12 cases of peritoneal mesothelioma), 141 cases of lung cancer and 356 successful compensation claims for asbestosis to the end of 1986. After adjusting for measured covariate effects by means of proportional hazards regression analysis, smooth curves were fitted to the resulting "underlying" incidence rates for malignant mesothelioma, lung cancer and asbestosis, separately, and for mortality of any cause. By the use of these curves and individual risk estimates, predictions have been made of the future incidence of these diseases to the year 2020. With the assumption that all subjects who were not known to be dead or departed overseas still were alive at December 31, 1986, and excluding persons of more than 85 years of age, the number of new cases of mesothelioma is expected to rise to a peak of around 25 cases per year in 2010, with an expected total number of 692 cases of mesothelioma (95% confidence interval [CI], 394-990 cases) between 1987 and 2020. A total of 2898 deaths (95% CI, 2284-3511 deaths) of any cause is expected in the same period. New cases of lung cancer and asbestosis are expected to continue at roughly the current rates of eight and 17 cases per year, respectively, before declining after the year 2000, leading to totals of 183 cases (95% CI, 34-335 cases) and 482 cases (95% CI, 236-728 cases), respectively, being expected by the year 2020. Predictions that were based on the censoring of subjects at the date that they last were known to be alive resulted in slightly higher, but probably less accurate, estimates.     

Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol: the Korea Medical Insurance Corporation Study

CONTEXT: Few studies have examined the interactive effects of smoking and serum cholesterol level on morbidity and mortality from cardiovascular dieseases. In East Asia, where the prevalence of smoking is among the highest in the world, morbidity and mortality from ischemic heart disease (IHD) is rapidly escalating. OBJECTIVES: To determine whether cigarette smoking is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) in the Republic of Korea (South Korea), a population that has relatively low levels of serum cholesterol, and to determine whether serum cholesterol levels modify the risk relationship between smoking and ASCVD. DESIGN: Prospective cohort study with a follow-up period of 6 years (1993-1998). SETTING AND SUBJECTS: A total of 106745 Korean men aged 35 to 59 years who received health insurance from the Korea Medical Insurance Corporation and who had biennial medical evaluations in 1990 and 1992. MAIN OUTCOME MEASURES: Hospital admissions and deaths from IHD, cerebrovascular disease (CVD), and total ASCVD. RESULTS: At baseline, 61389 (58%) were current cigarette smokers and 64482 (60%) had a total cholesterol level of less than 5.17 mmol/L (200 mg/dL). Between 1993 and 1998, 1006 IHD events (176 per 100000 person-years), 1364 CVD events (238 per 100000 person-years), and 716 other ASCVD events (125 per 100000 person-years) occurred. In multivariate Cox proportional hazard models controlling for age, hypertension, hypercholesterolemia, and diabetes, current smoking increased the risk of IHD (risk ratio [RR], 2.2; 95% confidence interval [CI], 1.8-2.8), CVD (RR, 1.6; 95% CI, 1.4-1.8), and total ASCVD (RR, 1.6; 95% CI, 1.5-1.8). For each outcome, there were significant dose-response relationships with amount and duration of smoking. Throughout the range of serum cholesterol levels, current smoking significantly increased the risk of IHD and CVD. In the lowest quartile of serum cholesterol levels (<4.42 mmol/L [171 mg/dL]), the RR from current smoking was 3.3 (95% CI, 1.7-6.2) for IHD and 1.6 (95% CI, 1.2-2.3) for CVD. There was no evidence of an interaction between smoking and serum cholesterol (P for interaction = .75, .87, and .92 for IHD, CVD, and total ASCVD, respectively). CONCLUSIONS: This study demonstrates that in Korea smoking is a major independent risk factor for IHD, CVD, and ASCVD and that a low cholesterol level confers no protective benefit against smoking-related ASCVD.     

感染碳青霉烯耐药的肠杆菌科细菌患者全因死亡的Meta分析

目的:评价耐碳青霉烯肠杆菌科细菌感染患者全因死亡风险?方法:检索Pubmed数据库?Embase数据库,并辅以文献追溯?手工检索,检索时间为2001年1月1日至2015年12月31日?纳入同时含有碳青霉烯耐药肠杆科细菌(CRE)及碳青霉烯敏感的肠杆菌细菌(CSE)的临床特征及预后的研究?采用Stata14.0软件进行文献数据进行分析,并评价Meta分析结果的稳定性和发表偏倚?结果:16项研究符合纳入标准,包括2 916例患者(CRE感染797例,CSE 2 119例)?根据纳入研究的设计类型分为队列研究?病例对照研究;根据感染患者细菌检出的标本类型分为血流感染组亚组?综合感染类型亚组(包括尿液?血液?痰等)?队列研究组的CRE感染全因死亡的相对危险度(risk ratio,RR)为2.44(95%CI:1.96~3.03,I2=16.1%,Pheterogeneity=0.312);血流感染亚组的RR为2.07(95%CI:1.59~2.69,I2=0.0%,Pheterogeneity=0.511);综合感染类型亚组的RR为3.35(95%CI:2.25~4.99,I2=0.0%,Pheterogeneity=0.868)?病例对照组的比值比(odds ratio,OR)为2.30(95%CI:1.49~3.55,I2=53.5%,Pheterogeneity=0.018);血流感染亚组的OR为2.85(95%CI:1.66~4.90,I2=60.8%,Pheterogeneity=0.018);综合感染类型亚组的OR为1.46(95%CI:0.73~2.90,I2=25.2%,Pheterogeneity=0.261)?结论:CRE患者病死率明显高于CSE患者,血流感染与患者死亡是密切相关的?     

上海市闵行区2型糖尿病患者恶性肿瘤的发病状况分析

 目的  揭示上海市闵行区2型糖尿病(type 2 diabetes mellitus,T2DM)患者全癌种恶性肿瘤发病状况。方法  以上海市闵行区2004—2014年各社区卫生服务中心进行登记管理的新发T2DM患者为研究对象,采用回顾性队列研究,于上海市恶性肿瘤登记系统追踪糖尿病患者恶性肿瘤的发病情况,计算T2DM患者的恶性肿瘤发病率及与当地一般人群的恶性肿瘤标准化发病比(standardized incidence ratio,SIR)和95%CI。 结果  男性和女性T2DM患者恶性肿瘤全癌种发病率分别为969.69/10万和834.17/10万人年(person year),世界人口年龄标化发病率(age standardized rate,ASR ［W］)分别为206.72/10万人年和285.80/10万人年,男女性全癌种恶性肿瘤的标化发病比分别为0.93 (95%CI:0.88～0.98)和1.07 (95%CI:1.01～1.12)。结论  与一般人群相比,T2DM患者特定癌种的发病风险增高,不同癌种的发病风险变化存在差异。     

感染碳青霉烯耐药的肠杆菌科细菌患者全因死亡的Meta分析

目的:评价耐碳青霉烯肠杆菌科细菌感染患者全因死亡风险?方法:检索Pubmed数据库?Embase数据库,并辅以文献追溯?手工检索,检索时间为2001年1月1日至2015年12月31日?纳入同时含有碳青霉烯耐药肠杆科细菌(CRE)及碳青霉烯敏感的肠杆菌细菌(CSE)的临床特征及预后的研究?采用Stata14.0软件进行文献数据进行分析,并评价Meta分析结果的稳定性和发表偏倚?结果:16项研究符合纳入标准,包括2 916例患者(CRE感染797例,CSE 2 119例)?根据纳入研究的设计类型分为队列研究?病例对照研究;根据感染患者细菌检出的标本类型分为血流感染组亚组?综合感染类型亚组(包括尿液?血液?痰等)?队列研究组的CRE感染全因死亡的相对危险度(risk ratio,RR)为2.44(95%CI:1.96~3.03,I2=16.1%,Pheterogeneity=0.312);血流感染亚组的RR为2.07(95%CI:1.59~2.69,I2=0.0%,Pheterogeneity=0.511);综合感染类型亚组的RR为3.35(95%CI:2.25~4.99,I2=0.0%,Pheterogeneity=0.868)?病例对照组的比值比(odds ratio,OR)为2.30(95%CI:1.49~3.55,I2=53.5%,Pheterogeneity=0.018);血流感染亚组的OR为2.85(95%CI:1.66~4.90,I2=60.8%,Pheterogeneity=0.018);综合感染类型亚组的OR为1.46(95%CI:0.73~2.90,I2=25.2%,Pheterogeneity=0.261)?结论:CRE患者病死率明显高于CSE患者,血流感染与患者死亡是密切相关的?     

阳江高本底放射地区1979～1995年恶性肿瘤死亡调查分析

目的 探索平均年有效剂量为６．４ｍＳｖ的广东省阳江地区天然高本底放射的致癌危险,方法 对１９７９￣１９８６年的恶性肿瘤死亡资料通过前瞻性调查从一个动脉队列来收集,对１９８７￣１９９５年资料通过回顾性调查和（或）前瞻性调查从一个固定人群队列获得。恶性肿瘤死亡资料现场调查分队列成员追踪和死因确认两步骤。个人累积剂量估算包括内照射和外照射。按以坟平均的居民年外照射剂量水平,将研究人群分为４个剂量组进行比     

Estrogen replacement therapy and ovarian cancer mortality in a large prospective study of US women

CONTEXT: Postmenopausal estrogen use is associated with increased risk of endometrial and breast cancer, 2 hormone-related cancers. The effect of postmenopausal estrogen use on ovarian cancer is not established. OBJECTIVES: To examine the association between postmenopausal estrogen use and ovarian cancer mortality and to determine whether the association differs according to duration and recency of use. DESIGN AND SETTING: The American Cancer Society's Cancer Prevention Study II, a prospective US cohort study with mortality follow-up from 1982 to 1996. PARTICIPANTS: A total of 211 581 postmenopausal women who completed a baseline questionnaire in 1982 and had no history of cancer, hysterectomy, or ovarian surgery at enrollment. MAIN OUTCOME MEASURE: Ovarian cancer mortality, compared among never users, users at baseline, and former users as well as by total years of use of estrogen replacement therapy (ERT). RESULTS: A total of 944 ovarian cancer deaths were recorded in 14 years of follow-up. Women who were using ERT at baseline had higher death rates from ovarian cancer than never users (rate ratio [RR], 1.51; 95% confidence interval [CI], 1.16-1.96). Risk was slightly but not significantly increased among former estrogen users (RR, 1.16; 95% CI, 0.99-1.37). Duration of use was associated with increased risk in both baseline and former users. Baseline users with 10 or more years of use had an RR of 2.20 (95% CI, 1.53-3.17), while former users with 10 or more years of use had an RR of 1.59 (95% CI, 1.13-2.25). Annual age-adjusted ovarian cancer death rates per 100 000 women were 64.4 for baseline users with 10 or more years of use, 38.3 for former users with 10 or more years of use, and 26.4 for never users. Among former users with 10 or more years of use, risk decreased with time since last use reported at study entry (RR for last use <15 years ago, 2.05; 95% CI, 1.29-3.25; RR for last use >/=15 years ago, 1.31; 95% CI, 0.79-2.17). CONCLUSIONS: In this population, postmenopausal estrogen use for 10 or more years was associated with increased risk of ovarian cancer mortality that persisted up to 29 years after cessation of use.     

Predictors of acute complications in children with type 1 diabetes

CONTEXT: Diabetic ketoacidosis and severe hypoglycemia are acute complications of type 1 diabetes that are related, respectively, to insufficient or excessive insulin treatment. However, little is known about additional modifiable risk factors. OBJECTIVE: To examine the incidence of ketoacidosis and severe hypoglycemia in children with diabetes and to determine the factors that predict these complications. DESIGN, SETTING, AND PARTICIPANTS: A cohort of 1243 children from infancy to age 19 years with type 1 diabetes who resided in the Denver, Colo, metropolitan area were followed up prospectively for 3994 person-years from January 1, 1996, through December 31, 2000. MAIN OUTCOME MEASURES: Incidence of ketoacidosis leading to hospital admission or emergency department visit and severe hypoglycemia (loss of consciousness, seizure, or hospital admission or emergency department visit). RESULTS: The incidence of ketoacidosis was 8 per 100 person-years and increased with age in girls (4 per 100 person-years in < 7; 8 in 7-12; and 12 in > or =13 years; P<.001 for trend). In multivariate analyses, sex-adjusted and stratified by age (<13 vs > or =13 years), the risk of ketoacidosis in younger children increased with higher hemoglobin A(1c) (HbA(1c)) (relative risk [RR], 1.68 per 1% increase; 95% confidence interval [CI], 1.45-1.94) and higher reported insulin dose (RR, 1.40 per 0.2 U/kg per day; 95% CI, 1.20-1.64). In older children, the risk of ketoacidosis increased with higher HbA(1c) (RR, 1.43; 95% CI, 1.30-1.58), higher reported insulin dose (RR, 1.13; 95% CI, 1.02-1.25), underinsurance (RR, 2.18; 95% CI, 1.65-2.95), and presence of psychiatric disorders (for boys, RR, 1.59; 95% CI, 0.96-2.65; for girls, RR, 3.22; 95% CI, 2.25-4.61). The incidence of severe hypoglycemia was 19 per 100 person-years (P<.001 for trend) and decreased with age in girls (24 per 100 patient-years in < 7, 19 in 7-12, and 14 in > or =13 years). In younger children, the risk of severe hypoglycemia increased with diabetes duration (RR, 1.39 per 5 years; 95% CI, 1.16-1.69) and underinsurance (RR, 1.33; 95% CI, 1.08-1.65). In older children, the risk of severe hypoglycemia increased with duration (RR, 1.34; 95% CI, 1.25-1.51), underinsurance (RR, 1.42; 95% CI, 1.11-1.81), lower HbA(1c) (RR, 1.22; 95% CI, 1.12-1.32), and presence of psychiatric disorders (RR, 1.56; 95% CI, 1.23-1.98). Eighty percent of episodes occurred among the 20% of children who had recurrent events. CONCLUSIONS: Some children with diabetes remain at high risk for ketoacidosis and severe hypoglycemia. Age- and sex-specific incidence patterns suggest that ketoacidosis is a challenge in adolescent girls while severe hypoglycemia continues to affect disproportionally the youngest patients and boys of all ages. The pattern of modifiable risk factors indicates that underinsured children and those with psychiatric disorders or at the extremes of the HbA(1c) distribution should be targeted for specific interventions.