Poisson回归在脑卒中死亡危险因素筛选中的应用

[目的]通过Poisson回归,筛选四川省农村地区中老年人群脑卒中死亡的危险因素.[方法]利用1991年对四川省西充县农村地区抽样调查的1633例随访对象的流行病学调查资料,在SAS V9软件中用Poisson回归进行脑卒中死亡危险因素的筛选.[结果]1991～1999年脑卒中死亡35人,脑卒中累积死亡率21.43‰,脑卒中死亡的危险因素有年龄(按10岁分组)、心肌梗塞史和血压水平(5级).[结论]应重点加强老年人群的血压监测,倡导健康生活方式,加强高血压干预来降低农村中老年人群的脑卒中死亡率.     

长沙市社区居民十年死因及心脑血管病危险因素干预效果评价分析

目的　研究心脑血管病危险因素综合性社区干预对社区人群死亡率的影响。方法　分析 1991年～ 2 0 0 0年的人群平均标化死亡率、平均标化死因别死亡率 ,并比较分析干预组和对照组的死亡率。结果　长沙市社区人群 10年标化死亡率 5 5 7 2 7/ 10万。死因顺位前五位分别为脑血管病、心脏病、恶性肿瘤、呼吸系统疾病、损伤和中毒 ,分别占总死因的 2 4 5 6 %、16 83%、15 6 6 %、13 71%和 6 33%。干预组死亡率低于对照组 (P <0 0 5 ) ,干预组标化死亡率为 5 49 2 1/ 10万 ,对照组为 5 78 75 / 10万。其中干预组脑血管病和心脏病死亡率均明显低于对照组 ,干预组脑血管病标化死亡率为 115 72 / 10万 ,心脏病为 90 77/ 10万 ,对照组脑血管病标化死亡率为15 2 5 5 / 10万 ,心脏病为 10 4 0 4 / 10万。结论　脑血管病和心脏病是长沙市社区居民的主要死因 ,心脑血管病危险因素综合性社区干预可明显降低心脑血管病死亡率 ,从而降低人群总死亡率。     

90年代上海社区脑卒中发病率、死亡率及其危险因素动态分析

目的：了解90年代上海社区人群脑卒中发病和死亡情况及其危险因素的变化趋势。方法：在人群中建立疾病监测风,按照世界卫生组织“多国心血管病趋势和决定因素监测”方案,监测1991－1999年35－74岁每年脑卒中的发生率和死亡率。分别于1992年1998年在监测人群中整群随机抽取35－39岁男女各类,约1000人进行危险因素调查,结果：监测社区1991－1999年间35－74岁年龄组脑卒中平均年发病率为168．2／10万,其中男性为194．5／10万,明显高于女性（144。9／10万）脑卒中发病率呈上升趋势,而且,男性的每年增长速度也高于妇性。脑卒中年平均死亡率为79．2／10万,其中男性87．2／10万 ,明显高于妇性（71．4／10万）脑卒中死亡率呈下降趋势。无论男女,脑卒中发病随着年龄的增长而增长;男女发病年龄差异不大,但1996－1999年平均发病年龄为66．1岁,比1991－1995年提前了3．5岁（69．6岁）。无论男女、血中总胆固醇均值,血压均,体重指数,高血压患病率、动脉粥样硬化指数、腰臂比值,高胆固醇现患率、低高0密度脂蛋白现患率等因素皆有升高趋势,另外男性甘油三酯也有升高趋势仅吸烟率和饮酒率有下降趋势,尤其在男性中,结论：90年代上海社区脑卒中发病率呈上升趋势,同时大部分脑卒中危险因素也呈上升趋势,而脑卒中死亡呈下降趋势。     

绵竹市农村居民1989-1998年恶性肿瘤、脑卒中、冠心病流行趋势分析

目的 掌握农村居民慢性非传染病的流行趋势，为制定防治对策提供依据。方法 按四川省慢性病监测方案，绵竹市在1989-1998年期间对6镇农村10万人群进行连续10年的恶性肿瘤，脑卒中，冠心病的发病，死亡监测。结果 总计发病1645例。死亡1412例，年平均发病率为144.94/10万，死亡率124.34/10万；恶性肿瘤发病率78.68/10万，死亡率70.13/10万；脑卒中发病率60.73/10万，死亡率51.19/10万；冠心病发病率5.55/10万。死亡率3.08/10万，3种病死亡占全死因的22.77%，发病年龄主要集中在45-65岁之间，恶性肿瘤前5位依次是；胃癌，食道癌，肝癌，肠癌，肺癌，脑卒中发病在45岁以后随年龄增加而急剧上升。结论 绵竹市农村肿瘤，脑卒中，冠心病发病率逐年上升，已成为危害居民健康的主要疾病。     

军队男性中老年人脑卒中发病和死亡的队列研究

目的：前瞻性探讨军队男性中老年人脑卒中发病及死亡的危险因素。方法：采用队列研究设计。研究对象为居住西安市22个军队干休所的1268名男性军队离退休干部。1987年基线调查的主要内容包括：年龄、体重指数(BMI)、血压、血脂、吸烟、饮酒、既往病史及家族史等。终点指标为新发脑卒中、脑卒中死亡和总死亡。结果：随访至2001年6月，观察人年为15 546。新发脑卒中113例，调整发病率为727／10万人年；脑卒中死亡45例，调整死亡率为289／10万人年。调整了年龄、血脂、吸烟、饮酒、既往心脑血管病病史及家族史等主要危险因素后，基线血压水平、BMI和既往冠心病和高脂血症病史是影响该人群脑卒中发病和死亡的主要危险因素。结论：军队男性中老年人群的脑卒中发病率和死亡率低于一般同龄人群，中老年人体重和血压水平进行监测和控制对预防中老年人群的脑卒中发病和死亡有重要意义。     

阜宁县恶性肿瘤流行现状及趋势分析

目的 掌握阜宁县恶性肿瘤发病和死亡现状及流行趋势。方法 收集整理2015—2019年肿瘤登记资料,分癌种、年龄和性别计算2019年发病(死亡)率、构成比、中国人口标化率(中标率)、0～74岁累积发病(死亡)率、截缩率(35～64岁)等。结合2015—2019年阜宁县户籍人口数据,利用Joinpiont软件计算5年发病(死亡)粗率及中标率的平均年度变化百分比。结果 2019年恶性肿瘤的发病率为297.11/10万,中标率为157.01/10万,0～74岁累积率为18.00%,截缩率(35～64岁)为218.84/10万;死亡率为232.70/10万,中标率为120.07/10万,0～74岁累积率为13.84%,截缩率(35～64岁)为156.82/10万。2015—2019年恶性肿瘤标化发病率呈明显下降趋势(P<0.05),男性标化发病率高于女性;5年间恶性肿瘤的发病率及标化死亡率均无明显的波动(P值均>0.05)。结论 阜宁县恶性肿瘤发病率和死亡率处于较高水平,应针对不同的癌种和人群制定综合防控措施,开展高危人群预防工作。     

中老年人高血压变化情况及脑卒中危险因素筛选

[目的]了解四川省西充县农村地区中老年人群血压变化情况,高血压病患者患病率变化,以及脑卒中死亡率和其死亡危险因素。[方法]于1991年对四川省西充县农村地区抽样调查了1633例中老年人血压,1999年复查血压,同时调查脑卒中死亡率,筛选其死亡危险因素。[结果]间隔8年收缩压、舒张压都有所增长;高血压患病率从1991年的16.4%上升为1999年的22.2%;脑卒中死亡危险因素为年龄,本人高血压史和有无高血压。[结论]应在农村中老年人群中加强高血压干预来降低脑卒中死亡率。     

厦门市2002～2009年大肠癌死亡状况及YLL分析

目的 了解2002～2009年厦门市大肠癌死亡率、分布特征及寿命损失情况.方法 对2002～2009年厦门市大肠癌死亡登记资料和人口数据进行统计分析,计算粗死亡率、标化率、累积率及寿命损失年(YLL)等指标,绘制死亡率分布地图.结果 2002～2009年厦门市大肠癌平均死亡率为7.66/10万,标化死亡率为4.57/10万,0～ 74岁累积率为0.75％,居恶性肿瘤死亡顺位第5位,显著低于2006年全国肿瘤登记地区大肠癌死亡水平(标化死亡率6.2W10万),但总体呈明显上升趋势,女性死亡率上升幅度明显高于男性.大肠癌主要危及中老年人群,平均死亡年龄为66.2岁,86.45％死亡病例发生在50岁以上人群,城市死亡率高于农村,男性死亡率高于女性.2002～2009年厦门市大肠癌PYLL　为10127.5人年,占全死因PYLL的1.62％,AYLL为10.5人年,减寿率为0.80‰.结论　厦门市大肠癌死亡率上升趋势明显,对中老年人群危害日益严重,对女性尤为突出,应积极采取有效干预措施.     

沈阳市2008-2018年户籍居民脑卒中死亡变化趋势分析

目的 了解沈阳市户籍居民脑卒中死亡特征，为制定脑卒中防控政策提供依据。方法 依据ICD-10编码提取沈阳市户籍居民全死因数据库中的脑卒中死亡数据，计算粗死亡率,标化死亡率, 性别、年龄别死亡率，死亡构成比及相关指标，并进行趋势分析。结果 2008-2018年沈阳市户籍居民脑卒中死粗死亡率为173.11/10万（男性206.88/10万、女性139.81/10万），标化死亡率为117.42/10万（男性140.69/10万、女性94.99/10万），男性粗死亡率（x2=5158.701，P<0.05）、标化死亡率（x2=8.977，P<0.05）均高于女性；脑卒中粗死亡率随年份变化呈现上升趋势（x2=1102.135，P<0.05），标化死亡率呈现波动性变化趋势（x2=2.521，P>0.05）；脑卒中粗死亡率随年龄增长呈上升趋势（x2=326362.844，P<0.05），除5~岁组外，其他各年龄组男性粗死亡率均高于女性；缺血性脑卒中（χ²=1347.661，P<0.05）、失血性脑卒中（x2=38.604，P<0.05）粗死亡率随年份变化呈上升趋势，缺血性脑卒中（x2=0.471，P>0.05）、失血性脑卒中（x2=3.508，P>0.05）标化死亡率呈现波动性变化趋势，缺血性脑卒中占脑卒中死亡的64.51%。结论 沈阳市2008-2018年户籍居民脑卒中死亡率居高不下，应以男性、老年人群为重点防控对象，加强缺血性脑卒中危险因素的干预工作，针对性地开展重点防控和早期筛查工作。     

2015年重庆市常住人口脑卒中发病与死亡情况

目的 了解重庆市2015年居民脑卒中发病及死亡情况,为重庆市脑卒中防治方案的制定提供科学依据.方法 利用2015年重庆市心脑血管事件登记报告系统的数据,按2010年全国第六次普查标准人口构成,采用报告发病/死亡率、标化发病/死亡率等指标,采用Poisson回归模型检验不同人群间率的差异,以及率随年龄的变化趋势对脑卒中的发生和死亡情况进行统计分析.结果 2015年重庆市常住人口脑卒中报告发病率为278.82/10万,其中男性308.27/10万,女性248.65/10万;标化发病率为219.27/10万,其中男性232.41/10万,女性203.68/10万.2015年重庆市常住人口脑卒中报告死亡率为81.31/10万,其中男性93.02/10万,女性69.31/10万;标化死亡率为63.28/10万,其中男性68.98/10万,女性56.45/10万.男性发病率、死亡率均高于女性,发病率、死亡率在55岁前较低,55岁后呈快速上升的趋势.各型脑卒中以脑梗死最多,占总发病例数的59.54％,发病率亦为最高.结论 应加强心脑血管疾病的监测和管理,重点做好60岁以上老年人群,尤其是男性老年人群的脑卒中预防控制工作.     

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.