健康管理中的营养指导

健康管理的核心是对健康危险因素的管理。近年来,我国居民慢性病的患病率及死亡率持续上升,其原因除了人口老化之外,就是慢性病的危险因素未得到有效的控制,这些危险因素主要有：不健康的饮食,体力活动缺乏,吸烟饮酒和长期心理压力或精神紧张。本文就我国居民目前存在的主要的不健康饮食习惯展开讨论,并探讨改变和干预居民营养不合理问题的方法,以便为广大社区医护人员、健康管理工作者在开展一般人群及慢性病高危人群的营养教育和干预提供参考。     

示范点社区慢病现况及主要危险因素分析

目的 了解示范点社区慢性非传染性疾病（以下简称慢病）流行现况及主要危险因素，为有效地在社区开展慢病预防和控制工作提供参考。方法 采用整群抽样法，示范点社区内6966名居民被抽取为调查对象，分别进行了身高、体重、腰围、血压测量及问卷调查。结果 社区内19种疾病的患病率前五位依次为高血压（31.93％）、慢性胃肠疾病（17．60％）、慢性支气管炎（11．00％）、冠心病（7，97％）、骨质疏松或骨折（5.76％）。超重与肥胖、吸烟、缺乏体育锻炼等是慢病的主要危险因素。结论 示范点社区居民高血压患病率高、超重与肥胖、吸烟、饮酒及缺乏体育锻炼的现状已经对其健康构成威胁。因此，应该采取相应的干预措施，降低危险因素的暴露水平，预防和控制高血压，减少心脑血管疾病的发生。     

沈阳市大东区2013年主要慢性病及其危险因素现况调查

目的 为了尽快完善沈阳市大东区慢性病综合防治体系,推动社区卫生服务与慢性病防治相结合的综合防治工作,为制定大东区慢性病防治对策提供参考依据.方法 采取多阶段分层整群随机抽样方法,随机抽取大东区28个社区2 449名18岁以上居民进行慢性病患病率及相关危险因素调查.结果 大东区居民高血压患病率为17.35％,糖尿病患病率为4.12％,男女性慢性病患病率均随着年龄的增长而上升;吸烟、饮酒、缺乏运动和超重等因素是社区慢性病的主要危险因素.结论 大东区高血压和糖尿病发病处于中等水平,随着年龄的增加患病率明显上升.因此,针对居民中的吸烟、有害饮酒及活动量不足等慢性病主要危险因素采取干预措施,加强健康教育,提高居民的健康知识水平、控制危险因素的技能和居民的生活质量,已经成为当前公共卫生面临的重大问题,也是疾病预防控制工作的重要内容.     

北京市东城区东河沿社区慢性病相关危险因素现况分析

目的掌握东河沿社区居民慢性非传染性疾病（以下简称慢性病）相关危险因素现状,为制定社区慢性病管理及慢性病健康教育措施提供依据。方法采用随机抽样方法,抽取北京市东城区东河沿社区15—70岁常住居民367人,以统一印制的调查问卷对其进行问卷调查,调查内容包括人口学基本情况、慢性病患病情况、自我保健情况、慢性病相关危险因素情况以及、健康相关的知识。慢性病问卷记录调查信息。结果慢性病的患病率为26．2％,其中高脂血症、高血压病、糖尿病和肿瘤的患病率分别为19．3％、18．5％、5．4％和1．6％。调查对象中经常参加体育锻炼和定期体检比例分别为65．7％和74．7％。调查对象中有慢性病家族史、吸烟、不进行体育锻炼和体重超重的比例分别为60．1％、19．9％、33．9％和31．6％。调查对象对吸烟、饮酒与慢性病的关系的知晓率在13．9％-94．0％。结论社区居民慢性病较高,慢性病相关危险因素的暴露率较高,加强居民对于慢性病相关危险因素的认识,并且给与积极准确地指导十分必要。     

随州市部分农村居民慢性病及相关行为危险因素调查

目的对随州市部分居民慢性病患病情况、相关危险因素及基本健康知识进行调查，找出慢性病防治工作的主要病种及工作的切入点。方法采取整群抽样法，选取淅河镇3个村（居委会）和3个镇办企业35岁及以上居民作为调查对象。由专业人员进行问卷及现场体检。结果随州居民主要慢性病为心脑血管系统疾病、慢性阻塞性肺病、肿瘤等。高血压、脑血管疾病、慢性阻塞性肺病、肿瘤患病率分别为32．44％，3．61％，3．94％，2．17％。主要不良生活习惯为缺少锻炼、饮酒、吸烟、嗜腌熏食品等，分别占调查人数的88．77％，32．83％，22．92％，22．19％。结论居民对高血压及糖尿病防治知识缺乏。对居民进行慢性病防治知识的宣传教育并作好健康促进工作应作为慢性病防治的工作重点。     

哈尔滨市曲线社区人群慢性病共病现状及 不良生活方式共存现象研究

摘要：目的　研究哈尔滨市曲线社区人群常见慢性病共病率及不良生活方式因素的共存现象，为本社区人 群慢性病的预防和控制提供依据。方法　采用横断面研究的方法，２０１６ 年３～９ 月以哈尔滨市曲线社区≥ ５０岁居民为调查对象。采用调查问卷、体格检查、器官功能检查、查体和实验室辅助检查获取调查对象的 信息，以高血压、糖尿病、肥胖、脑卒中及血脂异常为５种常见慢性病，以吸烟、饮酒、嗜盐及缺乏体力 活动为４种常见不良生活方式，统计常见慢性病共病率及不良生活方式共存情况。结果　本研究共调查≥ ５０岁人群１１３９例，患病率分别为：高血压２９．４１％、糖尿病１０．９７％、肥胖４５．７４％、脑卒中８．６０％ 、血 脂异常５１．７１％。５种慢性病总患病率４６．１９％。同时患２、３、４、５ 种疾病的共病率分别为２９．８５％， １３．３５％，２．８１％，０．１８％。男性吸烟率和饮酒率均高于女性，差异有统计学意义（χ ２＝２０８．０６，１２２．９２， 犘＜０．０１）。女性缺乏体力活动率（４８．７１％） 高于男性（４１．８３％）， 差异有统计学意义（χ ２ ＝４．９６，犘＝ ０．０２６０）。同时存在２、３、４种不良生活方式构成比分别为３８．２８％、５．００％、１．２３％。结论　哈尔滨市曲 线社区人群常见慢性病共病情况和不良生活方式因素共存情况严重，应加强对社区人群慢性病和不良生活 方式的定期监测和开展有针对性的防治。 关键词：慢性病；共病；不良生活方式；社区；老年居民 中图分类号：Ｒ１８１　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１８）１２ ０８９９ ０５     

周家桥社区老年人慢性病及不良生活方式调查

目的了解周家桥社区老年人慢性病患病情况及主要不良生活行为，为制订相应的防治策略提供依据。方法以居委会为单位整群随机抽样，入户访谈获取老年人慢性病及相关资料。结果本组老年人慢性病总患病率为58．2％。疾病构成顺位依次为高血压、心脏病、脑血管疾病、高脂血症、慢性支气管炎等。老年人主要不良生活方式依次为低纤维饮食（67．52％）、缺乏锻炼（53．83％）、吸烟（21．13％）、高盐饮食（19．92％）、饮酒（12．73％）。结论老年人慢性病防治应列为神区卫生保健的重要内容，慢性病的防治应以健康教育和健康促进为基础，面向全人群，重在教育人们改变不良生活习惯。     

珠海高新区社区慢性非传染性疾病及相关危险因素调查分析

目的为了尽快完善珠海市高新区慢性非传染性疾病(下简称慢性病)综合防治体系,推动社区卫生服务与慢性病防治相结合的综合防治,并为制定珠海市高新区慢性病防治对策提供参考依据。方法通过随机抽样对高新区四个社区5 678名15岁以上的居民进行慢性病患病率及相关危险因素调查。结果样本人群慢性病患病率为24.27%,男女慢性病患病率均随年龄增长而上升;吸烟、饮酒、不合理膳食以及缺乏体力活动等是社区慢性病的主要危险因素。结论社区慢性病患病率较高,且35岁以上各年龄组人群高血压患病率处于较高水平;因此,加强对高危人群的健康检查以及慢性病及其引起的相关并发症的筛查是非常重要和必要的,对探索建立社区慢性病综合防治体系有积极的推动作用。     

张家港市主要慢性非传染性疾病调查分析

目的：通过社区调查找出本社区的主要公共卫生问题,探索可能的危险因素,为社区慢性病综合防治提供科学依据,方法：在社区慢性病流行病学基线调查的基础上,结合现有资料,采用统计学检验和非条件Logistic因归分析。结果：恶性肿瘤、脑血管疾病、呼吸系统疾病等慢性病是造成本社区居民减寿的主要原因,家族史、高血压史、吸烟、口味偏重是目前影响该社区居民健康的可能危险因素,结论：通过改变不良行为和生活方式,可降低该社区慢性病的患病率。     

上海松江岳阳社区居民慢性病患病现状及行为危险因素分析

[目的]了解上海市松江区岳阳社区居民慢性非传染性疾病的流行现状及行为危险因素。[方法]采用分层随机抽样的方法，按国家卫生部“中国成人慢性病危险因素调查”的要求，抽取在该社区居住满1年的18～69岁常住居民1984名，进行问卷调查和体格检查。[结果]72．1％的样本人群具有≥1种危险因素，33．1％的样本人群患有≥1种慢性病。吸烟率、饮酒率、超重率、肥胖率分别为24．1％、21．5％、27．5％、6．6％；样本人群中，34．7％缺乏体力活动，49．1％钙质摄入不足，6．9％维生素B、C摄入不足，45．3％蛋白质摄入不足，9．7％嗜腌制品（苯丙胺类致癌物质及高钠食品）；高血压和糖尿病的患病率分别为26．6％、5．5％。Logistic回归分析显示：高血压、糖尿病的共同危险因素为40岁以上人群、高血脂、肥胖。[结论]行为危险因素的持续存在，已导致慢性病的高发。大力开展社区健康教育与健康促进，应采取综合性干预措施，遏止慢性病流行。     

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.     

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.