A 20-year follow-up study on the effects of long-term exposure to thorium dust

Objective The purpose of this study is to investigate the possible effects of long-term exposure to dust containing thorium and thoron progeny dust-exposed miners. Methods A negative, high voltage, exhaled thoron progeny measurement system was used to estimate the miners’ thorium lung burden. Results The highest thorium lung burden of 638 miners was 11.11 Bq. The incidence of stage 0+ pneumoconiosis was higher among dust-exposed miners. Lung cancer mortality of the dust-exposed miners was significantly higher than that of controls (P<0.005). Conclusion There is a difference in cancer rates between those who have long-term exposure to dust containing thorium (in which carcinogenic ThO2 and SiO2 exist) and thoron progeny and those who have not.     

高血压患者不良生活习惯与心血管疾病死亡和全因死亡风险关系的研究

目的 探讨吸烟对饮酒高血压患者心血管疾病死亡(CVDM)和全因死亡(ACM)风险的影响,分析吸烟量和饮酒量同时升高对饮酒高血压患者死亡和全因死亡风险是否存在协同作用.方法 选取2004年1~12月我院老年病科诊治的饮酒高血压患者1000例.收集所有患者的人口统计学信息、吸烟信息及个人疾病史等资料,随访记录患者的CVDM和ACM.采用COX比例风险模型分析吸烟指标对饮酒高血压患者CVDM和ACM风险的影响.结果 在CVDM风险和ACM发生风险方面:每日吸烟量>10支高于1~10支,累计吸烟量≥20包/年高于0.1~19包/年,吸烟年限>35年高于1~35年,开始吸烟年龄<20岁高于>20岁,差异均具有统计学意义(P<0.05);当每日饮酒量>200 ml/d,累计饮酒量≥20(盅/年),饮酒年限>35年或饮酒开始年龄≤20岁患者的CVDM风险分别为RR=2.352、2.693、2.254、2.336;ACM风险分别为RR=3.092、2.346、1.936、2.018.结论 吸烟可增加饮酒高血压患者CVDM和ACM风险,风险的大小与吸烟量和吸烟年限呈剂量反应关系;饮酒量和吸烟量同时升高可进一步增加此风险.     

Effects of decline in renal function with age on the outcome of asymptomatic carotid plaque in healthy adults: a 5-year follow-up study

Background  It has been long suggested that abnormal clinical factors in the body, such as dyslipidemia and diabetes, can affect the presence of atherosclerosis. However, few studies on the effect of factors within the normal range, such as the loss of renal function with age, on the prevalence of atherosclerosis are few know in healthy individuals. The aim of this study was to investigate risk factors affecting the presence of asymptomatic carotid plaques in a middle-aged and elderly healthy population.

Methods  In this regard, we prospectively evaluated 245 healthy individuals (98 males and 147 females) at baseline and after 5 years. Changes in the presence of carotid plaque between 2003 and 2008 were categorized into four groups, i.e. subjects without plaque at entry (n=165): Group 1 (without plaque on two occasions, n=129) and Group 2 (with nascent plaque at follow-up, n=36); subjects with plaque at entry (n=80); Group 3 (with plaque regression at follow-up, n=29) and Group 4 (with plaque on two occasions, n=51).

Results  Univariate analysis showed that the positive rate of carotid plaques in males was higher than that in females at the baseline, and that a significantly inverse correlation existed between the prevalence rate of plaque and aging. Logistic regression analysis of cross-sectional research showed that independent risk factors for the prevalence of atherosclerosis were male gender, lower estimated glomerular filtration rate (eGFR) and higher low-density lipoprotein cholesterol (LDL-C) at the baseline, and older age and lower eGFR were involved in the presence of carotid plaques at follow-up point. However, logistic regression analysis of the longitudinal data showed that older age, decreased eGFR and increased systolic blood pressure (SBP) independently predicted the presence of carotid plaques after 5 years in subjects without plaque at entry. In addition, in subjects with plaque at entry, age, changes in eGFR and the baseline levels of serum albumin (ALB) and serum total bilirubin (BIL) dependently influenced the outcome of carotid plaque.

Conclusion  Physiological decline of renal function, together with advancing age, was an independent risk factor which consistently affected the presence of carotid atherosclerosis in two categories of healthy individuals.

     

多重动脉粥样硬化患者踝臂指数与全因、心因性死亡的相关性研究

目的探讨踝臂指数作为冠心病独立危险因素的地位和作用。通过随访,评估不同ABI水平对于具有多重动脉粥样硬化危险因素的住院患者长期预后的意义、目前所需采取的措施。方法多中心随机抽取符合条件的3 732例住院患者,分为≤0.4,0.4相似文献   

Important risk factors for death in adults: a 10-year follow-up of the Nutrition Canada survey cohort.

Data on mortality among over 8000 Canadians aged 35 to 79 years who participated in the Nutrition Canada survey are presented. The effects of various risk factors on mortality were assessed with a multivariate Poisson regression analysis. Factors associated with a significantly increased risk of death over a 10-year follow-up period ending in 1981 included cigarette smoking, hypertension and diabetes mellitus. A shallow U-shaped mortality pattern was observed for body mass index and for serum cholesterol level. No statistically significant increases in risk were associated with alcohol consumption. The population attributable risks for smoking, hypertension and diabetes were 39%, 8% and 6% respectively for men and 21%, 12% and 7% respectively for women.     

Role of blood pressure on stroke-related mortality: a 45-year follow-up study in China

Background: Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations.Methods: This is a 45-year follow-up cohort study and a total of 1696 subj...     

中老年人群血脂异常发病率及发病风险3年随访研究

目的 对40岁以上血脂正常中老年人群进行3年随访研究,分析中老年人群血脂异常发病率及其相关危险因素.方法 2011年随机抽取贵阳市城区大于或等于40岁的3 059名血脂正常人群作为研究对象,通过问卷调查、体格检查及血糖、血脂的测定等收集基线资料,于2014年再次对上述人群进行3年随访研究,分析贵阳市中老年人群3年血脂异常发病率,通过巢式病例对照研究分析其危险因素.结果 贵阳市中老年人群血脂异常3年累积发病率为54.6％,其中低高密度脂蛋白胆固醇(HDL-C)血症、高低密度脂蛋白胆固醇(LDL-C)血症、高总胆固醇(TC)血症、高三酰甘油(TG)血症3年累积发病率分别为3.5％、26.0％、43.8％、19.9％,除低HDL-C血症外,女性血脂异常发病率均高于男性.其危险因素包括年龄、性别、腰围.结论 中老年人群血脂异常的发病率较高,尤以高TC血症、高LDL-C血症为主,女性为中老年人群血脂异常发病的最重要的因素,故女性更应该积极防治.     

Relationship between urinary cadmium and mortality in habitants of a cadmium-polluted area: a 22-year follow-up study in Japan

Background  Several studies have suggested that the exposure to cadmium (Cd) increased mortalities from renal diseases, cardiovascular diseases and malignant neoplasm, including lung cancer and prostate cancer among inhabitants living in Cd-polluted areas and factory workers. This study aimed to assess the influence of environmental exposure to Cd on long term outcome of inhabitants living in an area polluted by Cd.

Methods  A 22-year follow-up study was conducted with 3119 inhabitants (1403 men and 1716 women) living in the Cd polluted Kakehashi River basin in Japan. The subjects were divided into 4 groups according to the amount of urinary Cd level (<3.0 μg/g creatinine (Cr), 3.0–4.9 μg/g Cr, 5.0–9.9 μg/g Cr, and ≥10.0 μg/g Cr). Mortality was calculated by the person-years method. Hazards ratios (HR) and 95% confidence intervals (CI) were assessed by the Cox’s proportional hazard model.

Results  Compared with urinary Cd <3.0 μg/g Cr group, the HR of 5.0–9.9 μg/g Cr and ≥10.0 μg/g Cr groups were significantly increased after adjustment for age in both sexes: 1.24 (95% CI 1.01–1.51) and 1.48 (95% CI 1.17–1.90) for men; 1.64 (95% CI 1.17–2.28) and 1.78 (95% CI 1.27–2.50) for women. The most frequent cause of death was malignant neoplasm in men and cardiovascular diseases in women. The significant increase in mortality risk for cardiovascular diseases was observed in the subjects with ≥10 μg/g Cr in both sexes: 1.79 for men (95% CI 1.02–3.12) and 2.38 for women (95% CI 1.11–5.07). When the subjects were divided into 2 categories (<20 μg/g Cr and ≥20 μg/g Cr), the HR of the urinary Cd ≥20 μg/g Cr group for nephritis and nephrosis were 4.82 (95% CI 1.07–21.61) in men and 7.92 (95% CI 1.77–35.33) in women, respectively. The significant increase was not observed for malignant neoplasm.

Conclusion  These results suggest a dose-response relationship between Cd body burden and mortality for cardiovascular diseases, cerebrovascular diseases and nephritis and nephrosis.

     

1995年和2005年广州地区心血管病患者血脂水平调查

目的 研究1995年与2005年广州心血管病患者的血脂水平,以及10年间血脂变化情况.方法 采取整群抽样的方法将南方医院1995年和2005年心内科住院病人作为研究样本(1768人),并分为单纯高血压患者、单纯冠心病或其等危症患者、冠心病合并冠心病等危症患者、高血压合并冠心病或者合并冠心病等危症患者、高血压合并冠心病合并冠心病等危症患者、其他心血管病患者6组,然后由统计教研室对其血脂水平及分布特点进行统计学分析.结果 (1)1995年与2005年调查人群血脂水平均有显著性差异,TG、TC、HDL-C水平均为2005年高于1995年,而LDL水平2005年低于1995年;(2)1995年调查人群的血脂水平在性别上无显著性差异,而2005年调查人群的血脂TG、HDL-C水平在性别上均有显著性差异,表现为TG男性高于女性,HDL-C女性高于男性,而TC、LDL-C无性别差异;(3)1995年心血管病不同患病人群组血脂TG、TC、LDL-C水平均有显著性差异,且均为单纯高血压患者组最高.而2005年不同患病人群组血脂4项水平均有显著性差异,表现为高血压合并冠心病或者合并冠心病等危症患者组、高血压合并冠心病合并冠心病等危症患者组TG水平最高,高血压合并冠心病合并冠心病等危症患者组TC水平最高,冠心病合并冠心病等危症患者组HDL-C水平最低,单纯高血压患者组LDL-C平均最高.结论 广州心血管病患者血脂水平10年来发生了显著性变化,并且存在性别差异.单纯高血压患者组血脂水平普遍高于其他患病组人群.     

BMI and BMI Changes to All-cause Mortality among the Elderly in Beijing: a 20-year Cohort Study

Objective To explore the association between body mass index (BMI) and all-cause mortality among the elderly in Beijing. Methods This analysis was based on the Beijing multidimensional longitudinal study of aging (BLSA), which included 2,090 subjects over 55 years old and was followed-up from 1992 to 2012. BMI-mortality curves were drawn to find the optimal BMI range with the lowest mortality. Cox proportional hazard models were used to obtain the hazard ratios (HRs) for BMI and BMI changes in the overall population and in specific stratified populations. Results During follow-up, 1,164 deaths were recorded; BMI-mortality curve was U-shaped, with the lowest mortality at a BMI of approximately 25 kg/m2. After adjusting for gender, age, smoking, drinking and some pre-existing diseases, HRs for underweight, overweight and obesity compared with normal weight were 1.372 (95% CI: 1.154-1.631), 0.767 (95% CI: 0.666-0.884) and 0.871 (95% CI: 0.830-1.246), respectively. HR for BMI drop was 3.245 (95% CI: 0.824-12.772) in the underweight group and 1.892 (95% CI: 0.830-1.246) in the normal weight group, HR for BMI rise was 1.795 (95% CI: 1.243-2.591) in normal weight group and 1.962 (95% CI: 1.202-3.203) in the overweight group. Conclusion Keeping BMI in an overweight status and stable is related to a reduced mortality.     

The physical, sexual and emotional violence history of middle-aged women: a community-based prevalence study

OBJECTIVES: To determine current and lifetime rates of the experience of partner abuse and sexual violence in a community-based sample of middle-aged women and compare these to figures obtained in a general practice setting. DESIGN AND METHODS: This research was part of the Melbourne Women's Midlife Health Project (MWMHP), an observational, longitudinal, population-based study of 438 Australian-born women conducted over nine years. In 1996, during the sixth year of the study, we asked the MWMHP participants to complete a self-administered "violence questionnaire", incorporating a modified Conflict Tactics Scale and questions on sexual abuse experienced during childhood and adult life. RESULTS: Of the 395 women remaining in the sixth year of follow-up of the MWMHP, 362 (92%) completed the questionnaire. Overall, 28.5% (n = 101) of the women had experienced some form of domestic violence (physical, sexual or emotional) during their lifetime; 5.5% (n = 15) of women had experienced severe physical abuse in the past year at the hands of a partner; and 11.8% (n = 42) of the women had experienced rape or attempted rape between the age of 16 and the time of our survey. Regarding abuse in childhood, 8.9% (n = 32) of women had experienced physical abuse, 42.3% (n = 152) had experienced non-contact sexual abuse, and 35.7% (n = 128) contact sexual abuse. Compared with the general-practice-based study, rates of childhood physical abuse and penetrative sexual abuse were similar, but rates of less intrusive child sexual abuse were significantly higher in our study. CONCLUSIONS: Doctors in all areas of medicine who are dealing with middle-aged women need to be aware of the levels of violence sustained by women throughout their lives. Such experiences may have a substantial impact on women's physical and mental wellbeing.     

心率变异性的混沌特征与脑卒中患者预后

目的探讨心率变异性混沌特征参数-分维数(fractal dimension,FD)变化预测脑卒中患者发生死亡和猝死的价值及贝它乐克对FD的影响.方法检测250例急性期脑卒中患者和206例健康对照的FD,分析脑卒中患者发生死亡和猝死与其FD变化之间的关系,然后用随机对照方法检测贝它乐克对62例脑梗死患者FD的影响.结果 FD≤1.05为预测脑卒中患者发生猝死的最佳临界点;FD≤1.05预测脑卒中患者发生猝死的敏感性为71.42%,特异性为90.25%,准确性为89.20%,阳性预报值为30.30%,阳性似然比为7.33.贝它乐克可明显改善脑梗死患者的FD值.结论 FD能有效预测脑卒中患者猝死的发生,FD≤1.05的脑卒中患者预后不良.检测FD有助于发现处于猝死高危状态的脑卒中患者,对这些患者给予贝它乐克可获得有益的结果.     

Relationship of Helicobacter pylori eradication with gastric cancer and gastric mucosal histological changes: a 10-year follow-up study

Background Helicobacter pylori （Hp） is a common and potentially curable cause of gastric mucosa lesion. This study investigated the relationship of Hp infection with histological changes in gastric mucosa and gastric cancer in Hp-positive patients compared with Hp-eradication patients followed up for ten years. Methods From an initial group of 1 006 adults, 552 Hp-positive subjects were randomly assigned to a treatment group （T; n=276） or a placebo group （P; n=276）. In the randomized, double-blind, placebo-controlled, parallel trial, T group subjects received oral doses of omeprazole, amoxicillin and clarithromycin for 1 week; those in the P group received a placebo. One month after treatment ended, a 13C urea breath test was performed, and Hp was undetectable in 88.89% of the T group. All subjects were followed at 1, 5, 8, and 10 years after treatment, with endoscopy and biopsies for histological examination. Results Gastric mucosa inflammation was significantly milder in the T group than that in the P group one year after Hp eradication and this persisted for 10 years. Glandular atrophy and intestinal metaplasia （IM） had deteriorated in both groups during ten years. However, the increased score of glandular atrophy at both the gastric antrum and corpus, and IM only at the gastric antrum, in the P group was more obvious than that in the T group. During the 10 years, 9 patients were diagnosed with gastric cancer （2 in the T group; 7 in the P group; P=0.176）. When mucosal atrophy was absent at the gastric antrum and corpus when entering the study, the incidence of gastric cancer in the P group （n=6） was much higher than that in the T group （n=0, P=0.013）. Conclusions Hp eradication may significantly diminish and delay the development of IM and atrophy gastritis. Hp especially in the early stage of Hp infection. and help halt progression of gastric mucosal inflammation eradication is helpful for reducing the risk for gastric cancer,     

Long-term efficacy of BCG vaccine in American Indians and Alaska Natives: A 60-year follow-up study

Context  The duration of protection from tuberculosis of BCG vaccines is not known. Objective  To determine the long-term duration of protection of a BCG vaccine that was previously found to be efficacious. Design  Retrospective record review using Indian Health Service records, tuberculosis registries, death certificates, and supplemental interviews with trial participants. Setting and Participants  Follow-up for the period 1948-1998 among American Indians and Alaska Natives who participated in a placebo-controlled BCG vaccine trial during 1935-1938 and who were still at risk of developing tuberculosis. Data from 1483 participants in the BCG vaccine group and 1309 in the placebo group were analyzed. Main Outcome Measures  Efficacy of BCG vaccine, calculated for each 10-year interval using a Cox regression model with time-dependent variables based on tuberculosis events occurring after December 31, 1947 (end of prospective case finding). Results  The overall incidence of tuberculosis was 66 and 138 cases per 100 000 person-years in the BCG vaccine and placebo groups, respectively, for an estimate of vaccine efficacy of 52% (95% confidence interval, 27%-69%). Adjustments for age at vaccination, tribe, subsequent BCG vaccination, chronic medical illness, isoniazid use, and bacille Calmette-Guérin strain did not substantially affect vaccine efficacy. There was slight but not statistically significant waning of the efficacy of BCG vaccination over time, greater among men than women. Conclusion  In this trial, BCG vaccine efficacy persisted for 50 to 60 years, suggesting that a single dose of an effective BCG vaccine can have a long duration of protection.