Cyto- and histological criteria for a risk of environment-induced diseases

The author proposes morphological criteria determining the risk of environment-induced diseases. The experimental studies analyzing 23 indices of the development of reparative regeneration in the liver of rats exposed to environmental factors have revealed that a significant change in the ratio of uni- and binuclear tetraploid hepatocytes is a criterion for the risk of hepatotoxic effect. Evaluation of the cytological status of nasal and oral mucosae, by using 21 indices has indicated that a significant reduction in the proportion of individuals with the normal cytological status is a criterion for the risk of environment-induced diseases.     

Recent trends in infectious diseases for travellers

In the early 1970s medicine was considered to have conquered infectious diseases. The following three decades have shown this optimism to be misplaced, with both traditional infections increasing in prevalence and novel diseases appearing. Many of these diseases have become major problems in developing countries, and coupled with the exponential growth in international traffic now pose a significant risk to the traveller. The threat to the package tourist differs greatly from that to the businessman, soldier or backpacker. The latter groups may have little control over their food and water supplies and be exposed to vector-borne and zoonotic infections normally restricted to remote locations. However the package holidaymaker may be involved in mass outbreaks of food poisoning with novel pathogens or acquire unusual infections from close proximity to other tourists. All groups may be susceptible to diseases transmitted during travel, and these may be more common than is presently recognised. The common factor is that all such infections may be transported around the world within their incubation period, and that any disease can now present to any doctor. Today more than ever before it is incumbent on any practitioner to ask not only 'where have you been?' but also 'what were you doing there?'     

Socioeconomic status and trends in risk factors for cardiovascular diseases in the Danish MONICA population, 1982-1992

STUDY OBJECTIVE: The decline in cardiovascular mortality in Denmark during the 1980s has been greatest in the highest socioeconomic groups of the population. This study examines whether the increased social inequality in cardiovascular mortality has been accompanied by a different trend in cardiovascular risk factors in different educational groups. DESIGN: Data from three cross sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92, were analysed to estimate trends in biological (weight, height, body mass index, blood pressure, and serum lipids) and behavioural (smoking, physical activity during leisure, and eating habits) risk factors in relation to educational status. SETTING: County of Copenhagen, Denmark. PARTICIPANTS: 6695 Danish men and women of ages 30, 40, 50, and 60 years. MAIN RESULTS: The prevalence of smoking and heavy smoking decreased during the study but only in the most educated groups. In fact, the prevalence of heavy smoking increased in the least educated women. There was no significant interaction for the remaining biological and behavioural risk factors between time of examination and educational level, indicating that the trend was the same in the different educational groups. However, a summary index based on seven cardiovascular risk factors improved, and this development was only seen in the most educated men and women. CONCLUSION: The difference between educational groups in prevalence of smoking increased during the 1980s, and this accounted for widening of an existing social difference in the total cardiovascular risk.     

慢性肝病患者医院感染危险因素分析

目的 了解慢性肝病患者医院感染特点及其危险因素。方法 对2000年1月～2002年12月在某院住院的1797例慢性活动性肝炎重度、慢性重型肝炎及肝硬化患者医院感染情况进行回顾性调查。结果 医院感染率为6．34％，感染组病死率为29．82％，高于非感染组(10．99％)；腹腔感染占首位，病原菌以革兰阴性杆菌为主；医院感染的发生与高胆红素和低蛋白血症密切相关。结论 慢性重型肝炎和肝硬化活动期肝病患者医院感染率较高；医院感染可影响预后。     

Epidemiological research trends in chronic diseases

Identification of adult risk factors has contributed to a decrease in the occurrence of cardiovascular diseases and some types of cancer, particularly in developed countries. However, the prevailing etiologic model emphasizes risk factors associated with life style and occupational exposures. This emphasis leads to an excessive individualization of risk, weakening the link between epidemiology and public health. This article comments on the opinions of epidemiologists concerning the failures, limitations, and evolution of modern epidemiology that have helped redirect the field's theoretical underpinnings. Alternatives to the current model tend to integrate findings from molecular biology with classic risk factors and early adverse conditions in life, taking into account all these causal influences in hierarchical levels of organization. The author identifies and comments on three important approaches in this evolution: molecular epidemiology, the theory of early life factors, and multilevel models.     

空军飞行员心血管疾病危险因素分析

目的 了解空军飞行员心血管疾病危险因素状况,为心血管疾病的防治提供参考依据.方法 对空军总医院近6年来参加健康体检的2563名飞行员进行问卷调查及相关生化检查.结果 在被调查的飞行员中,吸烟、高三酰甘油(TG)、低高密度脂蛋白胆固醇(HDL-C)、高低密度脂蛋白胆固醇(LDL-C)、高胆固醇(TC)、高尿酸血症、高血压、高血糖发生率依次为50.80％、23.13％、20.64％、17.93％、16.30％、11.47％、9.78％、2.23％.其中41～50岁飞行员吸烟、高TG、低HDL-C、高血压、高尿酸血症发生率最高,依次为53.43％、40.75％、31.39％、22.87％、16.01％;而高LDL-C、高TC、高血糖检出率随年龄增长逐渐增高,最高年龄段为≥51岁,分别为35.24％、27.62％、11.43％.结论 飞行员心血管疾病危险因素随着年龄的增长处于较高水平,采取控制高血脂、高尿酸血症、高血压为主的干预措施是防治心血管系统疾病的关键.     

Scientific trends in risk assessment research

The use of risk assessment approaches to evaluate the effects of toxic chemicals had its primary origin in 1976 when the U.S. Environmental Protection Agency (EPA) adopted the first federal guidelines to commit a major regulatory agency to risk assessment approaches for the evaluation of suspect carcinogens. The accompanying policy statement also adopted a risk management policy, which acknowledged that the agency would accept risk in making public health policy decisions; in essence, this represented a primary departure from the zero-risk goal that had dominated the first half of the environmental movement of the 70s. The approach adopted in 1976 was based on the experience of risk assessment approaches used for assessing low-dose-radiation effects on human health. To be certain that no public health risk be underestimated, particularly in light of the prior zero-risk goal, the practice of risk assessment for the first decade relied heavily on extremely protective assumptions in all aspects of the assessment process. For example, these assumptions included ranking the weight-of-evidence according to results in all related studies without regard for distinctions of tumor end point relevance to humans and the possibility that low-dose effects at environmental exposures might not be the same as high-dose effects. For low-dose-response characterization, the practice has been to characterize a plausible upper bound on risk by the use of a low-dose linear non-threshold dose-response curve. Exposure assessment likewise relied on maximum plausible assumptions to characterize exposure. More recently, more attention is being paid to developing accurate scientific databases that advance almost every aspect of the risk assessment process in the direction of more accurate risk characterization. This paper will discuss the recent trends in weight-of-evidence characterization, dose-response modeling, and exposure assessment and will compare the outcomes of these refined assessments to those evaluations that have relied on the earlier, conservative approaches. In essence, if the practices of the first decade for establishing plausible upper bounds on the risk were accurate, improved scientific data by and large should be expected to lower the overall theoretical risk. Indeed, this is the case when recent risk assessment research is applied but there are examples to the contrary. This paper represents a survey of recent trends and applications.     

苏州市区居民主要慢性非传染性疾病及其危险因素分析

[目的]　了解苏州市区慢性非传染性疾病(慢病)的流行状况,为今后社区综合防治提供依据。[方法]　用整群随机抽样的方法在苏州市平江区抽取35周岁以上常住人口2万名作为调查对象,数据用非条件logistic回归进行多因素分析。[结果]　苏州市区35周岁以上常住人口的患病率处于较高的水平。主要的慢病为高血压、慢性胃肠道疾病、慢性阻塞性肺病、冠心病和胆结石。调查还发现了许多影响健康的行为危险因素。[结论]　慢病已成为一个主要的公共卫生问题,防治亟待加强     

Universal risk factors for multifactorial diseases

The risk for multifactorial diseases is determined by risk factors that frequently apply across disorders (universal risk factors). To investigate unresolved issues on etiology of and individual's susceptibility to multifactorial diseases, research focus should shift from single determinant-outcome relations to effect modification of universal risk factors. We present a model to investigate universal risk factors of multifactorial diseases, based on a single risk factor, a single outcome measure, and several effect modifiers. Outcome measures can be disease overriding, such as clustering of disease, frailty and quality of life. "Life course epidemiology" can be considered as a specific application of the proposed model, since risk factors and effect modifiers of multifactorial diseases typically have a chronic aspect. Risk factors are categorized into genetic, environmental, or complex factors, the latter resulting from interactions between (multiple) genetic and environmental factors (an example of a complex factor is overweight). The proposed research model of multifactorial diseases assumes that determinant-outcome relations differ between individuals because of modifiers, which can be divided into three categories. First, risk-factor modifiers that determine the effect of the determinant (such as factors that modify gene-expression in case of a genetic determinant). Second, outcome modifiers that determine the expression of the studied outcome (such as medication use). Third, generic modifiers that determine the susceptibility for multifactorial diseases (such as age). A study to assess disease risk during life requires phenotype and outcome measurements in multiple generations with a long-term follow up. Multiple generations will also enable to separate genetic and environmental factors. Traditionally, representative individuals (probands) and their first-degree relatives have been included in this type of research. We put forward that a three-generation design is the optimal approach to investigate multifactorial diseases. This design has statistical advantages (precision, multiple-informants, separation of non-genetic and genetic familial transmission, direct haplotype assessment, quantify genetic effects), enables unique possibilities to study social characteristics (socioeconomic mobility, partner preferences, between-generation similarities), and offers practical benefits (efficiency, lower non-response). LifeLines is a study based on these concepts. It will be carried out in a representative sample of 165,000 participants from the northern provinces of the Netherlands. LifeLines will contribute to the understanding of how universal risk factors are modified to influence the individual susceptibility to multifactorial diseases, not only at one stage of life but cumulatively over time: the lifeline.     

Global trends in the use of insecticides to control vector-borne diseases

Background: Data on insecticide use for vector control are essential for guiding pesticide management systems on judicious and appropriate use, resistance management, and reduction of risks to human health and the environment.Objective: We studied the global use and trends of insecticide use for control of vector-borne diseases for the period 2000 through 2009.Methods: A survey was distributed to countries with vector control programs to request national data on vector control insecticide use, excluding the use of long-lasting insecticidal nets (LNs). Data were received from 125 countries, representing 97% of the human populations of 143 targeted countries.Results: The main disease targeted with insecticides was malaria, followed by dengue, leishmaniasis, and Chagas disease. The use of vector control insecticides was dominated by organochlorines [i.e., DDT (dichlorodiphenyltrichloroethane)] in terms of quantity applied (71% of total) and by pyrethroids in terms of the surface or area covered (81% of total). Global use of DDT for vector control, most of which was in India alone, was fairly constant during 2000 through 2009. In Africa, pyrethroid use increased in countries that also achieved high coverage for LNs, and DDT increased sharply until 2008 but dropped in 2009.Conclusions: The global use of DDT has not changed substantially since the Stockholm Convention went into effect. The dominance of pyrethroid use has major implications because of the spread of insecticide resistance with the potential to reduce the efficacy of LNs. Managing insecticide resistance should be coordinated between disease-specific programs and sectors of public health and agriculture within the context of an integrated vector management approach.     

Changing trends of diseases in Eastern Europe: closing the gap

One of the greatest challenges in Europe at the beginning of the 21st Century is the wide east-west health gap. In 2008, the difference in life expectancy between men in some Western European countries and Russia was 20 years. Whilst trends for life expectancy at birth have improved in many areas around the world, those for Russia, as well as those for some other former Soviet Union countries, have fluctuated greatly and have not shown signs of growth since the middle of the 20th Century. This problem is most acute in Russia and former Soviet Union countries, but is also far from being solved in the states that have made significant progress since 1990 and joined the European Union in the 21st Century. One of the priorities of the Polish presidency of the European Union, which began in July 2011, is the call for a European solidarity for health that could help to close the health gap dividing Europe.     

某院感染性疾病科9年间感染性疾病变化趋势分析

目的分析感染性疾病科连续9年内收治的感染性疾病构成比变化趋势,了解综合性医院感染性疾病科抗感染能力。方法采用回顾性调查研究的方法,回顾性分析2006-2014年连续9年间感染性疾病科出院患者的诊断资料,以第一诊断为疾病分类依据,将疾病诊断分为感染性疾病和其他疾病,分析感染性疾病的构成比变化趋势,以及感染性疾病中的感染部位构成比及其变化趋势;分析呼吸科收治呼吸系统感染患者构成比变化趋势。结果连续9年感染性疾病科出院患者总数14169人,其中感染性疾病患者4412人占31.14%,分析趋势发现,感染性疾病患者比例在2006、2007年为25%左右,之后连续7年的比例波动在30%之间;感染性疾病感染部位中呼吸系统感染、血流感染、胃肠道感染、中枢神经系统感染、泌尿系统感染等合计占总体感染性疾病的比例近70%,其中处于前3位的是呼吸系统感染占30.05%、血流感染占13.67%、胃肠道感染占12.92%;从构成比不同年份变化趋势来看,呼吸系统和泌尿系统上升较为明显,前者由2006年21.61%上升至2014年的31.82%,后者由2006年的1.01%上升至2014年的5.33%,胃肠道系统感染由2006年的31.66%下降至2014年的6.79%,血流感染比例略有提升;9年的趋势显示,呼吸系统感染在呼吸科比例呈现先升高后降低趋势。结论感染性疾病科连续9年内收治的感染性疾病具有一定的稳定性,并且占比不高,与目前国家对综合性医院感染性疾病科的发展要求还不符合;收治的感染性疾病病种以呼吸系统感染、血流感染、胃肠道感染为主。感染性疾病科收治呼吸系统感染增多原因,可能与呼吸科收治减少有关。由传染科转变而来的感染性疾病科应加大感染性疾病的收治力度,真正提升医师抗感染的治疗水平,为全院抗菌药物的合理使用提供强有力的技术支持。     

2007—2012年全国职业病发病情况及趋势分析

目的了解我国2007—2012年职业病发病现状,分析职业病疾病谱等特征以及发病趋势。方法汇总卫生部通报的2007—2012年间我国职业病数据,以确诊职业病病例作为分析对象。结果 2007—2012年全国共报告职业病病例数130 707例,其中新发尘肺病110 706例,占职业病发病总数的84.70%。尘肺病最主要的类型为矽肺和煤工尘肺。造成急性中毒的首要物质是一氧化碳,造成慢性职业中毒的物质主要是铅及其化合物和苯。2007—2012年全国共报告职业性肿瘤417例,职业性肿瘤分类主要以焦炉工人肺癌和苯所致白血病为主。结论我国职业病发病人数逐年上升,导致其逐年上升的主要疾病是尘肺病,每年职业中毒人数保持稳定的较高水平,职业性肿瘤人数逐年上升。我国职业病总体发病情况仍比较严重,职业病防控工作任重道远,须加紧采取防控措施。     

Managing drugs for rare genetic diseases: trends and insights

Managed care organizations generally pay for expensive drugs that treat rare genetic diseases because few patients have these conditions, the conditions are often life threatening, and the benefit design mandates coverage. In most cases, the cost-control measures and management restrictions applied to many other specialty pharmaceuticals do not make sense for the orphan drugs used to treat extremely rare genetic conditions because treatment alternatives usually are lacking for rare conditions (e.g., Gaucher's disease) and because the per member per month costs for truly rare conditions are low. The increasing number of biologic and injectable therapies for more common conditions, however, is prompting managed care decision makers to manage these new therapies more actively. There is a potential that treatments for rare disorders will be swept up in this broad-based response. This article provides definitions, background, and stakeholder perspectives on this topic and describes recent trends and challenges in health system management of exceedingly rare genetic diseases. The author suggests that current protocols are appropriate for managing rare and ultra-rare diseases, and that applying more active management practices to less rare diseases is neither efficient nor productive; in fact, it may be counter-productive.     

Recent trends in coronary risk factors in the USSR.

The soviet Union has experienced an increase in the incidence of coronary heart disease over the last 15 years sufficient to result in an overall deterioration in the health of adults. The distribution of coronary risk factors, and the secular trends in diet and cigarette consumption, provide a potential explanation for the upsurge in death rates. The animal fat content of the Soviet diet has been steadily enriched since the 1950s and cigarette production increased 72 per cent from 1959 to 1980. The post-Stalin orientation of the Soviet economy toward a policy of motivating the work force primarily through the provision of consumer goods, in a pattern comparable to western capitalist countries, appear to have laid the basis for these developments. Given the central control of Soviet society, the negative impact of current economic policy on the public health could be viewed as paradoxical. Our analysis suggests that the paradox is only apparent, however, and that the basis for the widespread occurrence of coronary heart disease is similar in the Soviet Union and western societies.     

Secular trends in the epidemiology of major infectious diseases among Israeli soldiers

BACKGROUND: Army personnel, albeit in general young and healthy, are at greater risk for infectious morbidity owing to higher crowding, compromised hygienic conditions, and exposure to new geographic and climatic factors. We describe the changing trends in the incidence of major infectious diseases of public health importance in the Israeli military: hepatitis A, measles, meningococcal disease, and diarrheal diseases. METHODS: Departments of Epidemiology and Medical Statistics of the Israel Defense Forces Medical Corps monitor the incidence of infectious diseases within the military. Notifiable diseases are predefined and their reporting is mandatory. RESULTS: The incidence of hepatitis has declined significantly since the introduction of prophylaxis with immune serum globulin in the 1970s, and complete control of outbreaks has been achieved. Outbreaks of diarrheal diseases have decreased, probably as a result of intensive control measures begun in the last decade. However, sporadic diarrheal morbidity continues to rise. The vaccination of recruits against Neisseria meningitidis was begun in 1994, following an increase in cases caused by serogroup C bacteria. So far, the program has proved efficacious in reducing morbidity. Measles morbidity in the military was much higher than in the civilian sector over the years. It has become negligible since 1995, when the first cohorts with 2 vaccination doses began their service. CONCLUSION: Despite improvements in personal and environmental health measures, immunization remains the most efficient means for preventing infectious diseases in the military.