山东省40岁及以上居民慢性阻塞性肺疾病患病情况及危险因素分析

目的 了解山东省≥40岁居民慢性阻塞性肺疾病患病率及危险因素,为制定防控策略提供依据。方法 2015年7月—2016年2月,采用分层整群随机抽样的方法在山东省抽取3 600名≥40岁居民进行问卷调查、体格检查及肺功能检查。采用复杂抽样加权估算慢阻肺的患病率,并应用多因素logistic回归模型分析患病的危险因素。结果 本次调查项目全部完成且质控合格的共3 317人,慢阻肺患病471人,经复杂加权后山东省≥40岁居民慢阻肺患病率为13.391%,男性患病率为20.200%,女性为6.632%,男性高于女性（χ2 = 95.359,P＜0.001）,40～49岁、50～59岁、60～69岁、≥70岁年龄组的患病率分别为6.549%、10.837%、19.991%、23.632%,随年龄的增长患病率增高（χ2 = -12.018,P＜0.001）;多因素logistic回归分析显示,性别（OR = 2.416,95%CI = 1.639～3.561）、年龄（OR = 3.749,95%CI = 1.883～7.467）、有慢性支气管炎（简称慢支）等慢性呼吸系统疾病家族史（OR = 1.444,95%CI = 1.127～1.849）、儿童时期严重肺部感染史（OR = 3.183,95%CI = 1.414～7.168）、吸烟（OR = 2.207,95%CI = 1.805～2.698）、做饭时不通风（OR = 1.361,95%CI = 1.021～1.814）等是慢阻肺患病的危险因素。结论 山东省≥40岁居民慢阻肺患病率较高,应从各项危险因素入手,特别是男性、高龄、有慢性呼吸系统疾病家族史、吸烟、儿童时期严重肺部感染史、室内空气污染等方面,加强对慢阻肺的防控。     

永嘉县居民慢性阻塞性肺疾病患病率及危险因素调查

目的调查永嘉县40岁及以上居民慢性阻塞性肺疾病(COPD)患病率及其危险因素,为制定COPD预防控制策略和评估相关卫生政策提供依据。方法依据《中国慢性阻塞性肺疾病监测工作手册》(2014)要求,抽取600名≥40岁的永嘉县居民进行问卷调查、身体检查及肺功能检查。应用Logistic回归分析COPD的危险因素。结果 585名常住居民完成调查,发现COPD 85例,患病率为14.53%。男性COPD患病率高于女性(P0.01),患病率随年龄增长呈上升趋势(P0.01)。多因素Logistic回归分析显示男性(OR=1.962,95%CI:1.025~3.757)、咳痰(OR=2.346,95%CI:1.148~4.794)及高龄(OR=2.561和7.438,95%CI:1.221~5.372和3.601~15.361)是造成COPD的危险因素。结论永嘉县居民COPD患病率偏高,应重视40岁及以上咳痰男性的COPD监测和干预。     

湖南省长沙市18岁以上居民慢性阻塞性肺疾病流行现状及其影响因素

目的了解湖南省长沙市居民慢性阻塞性肺疾病流行现状及其影响因素。方法 2017年5—7月,采用横断面研究方法,通过多阶段整群随机抽样,对长沙市18岁常住居民进行入户问卷调查、体格检查和肺功能检测。结果共获得5 800例调查对象的有效数据,其中慢性阻塞性肺疾病患者225例,长沙市慢性阻塞性肺疾病总体患病率为3.88%(95%CI:3.38%～4.38%),其中男患病率为4.28%(95%CI:3.52%～5.05%),女性患病率为3.53%(95%CI:2.88%～4.18%)。多因素分析结果显示,年龄(OR=2.27,95%CI:1.72～2.99)、居住在农村(OR=1.40,95%CI:1.05～1.88)、吸烟(OR=3.66,95%CI:2.67～5.03)、使用生物燃料(OR=2.63,95%CI:2.00～3.46)会增加慢性阻塞性肺疾病的患病风险。结论年龄、农村、吸烟、使用生物燃料与慢性阻塞性肺疾病患病有关,应加强对老年人群、吸烟人群的健康教育和早期检查,戒烟控烟和减少生物燃料使用是降低慢性阻塞性肺疾病的有效措施。     

海南省常住居民慢性阻塞性肺疾病及其危险因素调查分析

目的了解海南省常住居民慢性阻塞性肺疾病(COPD)患病率及其危险因素,为制定相应的防控措施提供科学依据。方法于2015年9-12月,采用多阶段分层整群随机抽样的方法,在琼海市和五指山市抽取1 200名40岁及以上常住居民作为调查对象。采取面对面调查方式进行问卷调查,进行体格检查、基础肺功能检查以及支气管舒张试验后肺功能检查。用SPSS 20.0软件对数据加权后计算该省患病率,率的比较采用X~2检验,采用多因素logistic回归分析COPD的相关危险因素。结果共调查1 103人,其中COPD患者113例,加权后总患病率为10.4%;琼海市患病率(11.7%)高于五指山市患病率(4.7%),男性患病率(13.1%)高于女性患病率(7.0%),差异均有统计学意义(P0.01)。多因素logistic回归分析结果显示,男性(OR=0.452,95%CI:0.218～0.934)、高龄(OR=1.124,95%CI:1.094～1.155)、高吸烟指数(OR=1.298,95%CI:1.015～1.661)、儿童期因呼吸疾病住院史(OR=4.033,95%CI:1.695～9.598)、呼吸系统疾病史(OR=2.368,95%CI:1.369～4.094)是COPD发病的危险因素。结论男性、高龄、吸烟、儿童期因呼吸疾病住院和反复呼吸道感染是COPD发病的危险因素,应通过加强健康教育、控烟、体育锻炼和普及肺功能检查等手段预防COPD的发生发展。     

溧阳市农村居民慢性阻塞性肺疾病患病率及危险因素研究

目的了解溧阳市≥40岁农村居民慢性阻塞性肺疾病(COPD)的患病率及危险因素。方法采用多阶段分层整群抽样方法,抽取溧阳市农村地区≥40岁常住居民,进行调查询问和肺功能检测与身体测量,并利用logistic回归模型分析其危险因素。结果≥40岁常住农村居民COPD患病率为11.87%,男性患病风险高于女性(OR=3.24,95%CI:1.12~9.37);60~69岁和≥70岁年龄组的患病风险高于40~49岁组(OR=4.87,95%CI:1.92~12.39;OR=13.92,95%CI:3.96~48.93);有哮喘家族史患病风险显著高于无哮喘家族史居民(OR=2.61,95%CI:1.25~5.44);有呼吸道症状患病风险显著高于无呼吸道症状居民(OR=2.76,95%CI:1.41~5.40);烟民患病风险显著高于不吸烟居民(OR=16.81,95%CI:2.60~108.96)。结论 COPD是多因素综合作用的结果,可采取有效的干预措施,控制其危险因素,减少COPD的发生。     

合肥市知识分子人群冠心病患病及危险因素分析

目的 分析安徽省合肥市知识分子人群冠心病(CHD)的患病情况及主要危险因素,为冠心病防治提供依据.方法 采用整群抽样方法 ,对合肥市4 726名35岁以上知识分子进行冠心病患病情况调查.比较不同年龄、性别的冠心病患病率,同时进行相关危险因素Logistic回归分析.结果 调查对象中共检出冠心病患者265例,患病率为5.6%;其中男性为5.1%,女性为6.9%,女性高于男性(χ2=6.126,P<0.05);男女性患病率均随年龄增长呈增加趋势,男性χ2=149.056,P<0.001;女性χ2=111.099,P<0.001).多因素分析显示,冠心病的主要危险因素为年龄(OR=3.627,95%CI=2.905～4.529,P=0.000)、性别(OR=0.692,95%CI=0.501～0.955,P=0.025)、冠心病家族史(OR=2.347,95%CI=1.656～3.327,P=0.000)、高血压(OR=1.537,95%CI=1.144～2.064,P=0.004)、腰臀比(OR=1.463,95%CI=1.091～1.961,P=0.011)、食盐摄入(OR=1.236,95%CI=1.009～1.516,P=0.041).结论 合肥市知识分子人群冠心病患病率较高,应作为冠心病高危人群进行干预预防.     

唐山市农村地区慢性阻塞性肺疾病危险因素病例对照研究

目的 分析唐山市农村地区慢性阻塞性肺疾病(COPD)的危险因素.方法 以唐山市农村地区40岁以上人群COPD流行病学调查中确诊的190例(男120例、女70例)患者作为病例组,按性别相同、年龄±5岁的条件从每位患者的邻居中选取两名健康者作为对照组(男240例、女140例),进行1:2匹配的病例对照研究,应用条件Logistic回归进行危险因素分析.结果 单因素分析结果显示,职业性粉尘或化学物质暴露(OR=4.738,95%CI:3.045～7.371)、吸烟(OR=3.973,95%CI:2.749～5.742)、吸烟指数(OR=3.751,95%CI:2.602～5.407)、低体重(OR=2.785,95%CI:2.018～3.844)和呼吸疾病家族史(OR=2.231,95%CI:1.434～3.472)与COPD的关联具有统计学意义(P＜0.05).多因素分析结果显示,职业性粉尘或化学物质暴露(OR=4.997,95%CI:3.033～8.234)、吸烟(OR=3.311,95%CI:1.175～9.327)、低体重(OR=2.479,95%CI:1.732～3.547)和呼吸疾病家族史(OR=2.217,95%CI:1.311～3.750)为COPD的危险因素(P＜0.05).结论 职业性粉尘或化学物质暴露、吸烟、低体重和呼吸疾病家族史是唐山市农村地区人群患COPD的危险因素.     

湖南省长沙市区居民慢性阻塞性肺疾病流行现状和相关危险因素分析

目的 了解湖南省城市居民慢性阻塞性肺疾病的患病情况和相关危险因素,为防治慢性阻塞性肺部疾病提供科学依据.方法 以单纯整群抽样方法抽取湖南省长沙市芙蓉区五里牌街道车站北路社区年龄在15岁以上的居民4248例进行调查,所有样本人群采用统一的慢性阻塞性肺疾病流行病学调查问卷表进行问卷调查,并进行体格检查和肺功能普查,对肺功能结果FEV1/FVC＜70%的高危人群进一步进行心电图和X光片检查,对COPD的危险因素进行单因素和多因素1ogistic回归分析.结果 调查应答率为92%,总患病率为4.81%,其中,男性患病率为6.6%,女性为3.0%,男性高于女性（x2=29.92,P＜0.01）,随着年龄增大患病率逐渐上升（P＜0.01）,随着文化程度增高患病率逐渐下降,对单因素logistic分析的相关危险因素引入多因素回归模型进行逐步回归分析结果：COPD相关危险因素中年龄的OR值为1.92（P＜0.01）、性别（以女性为对照）的OR值是1.81（P＜0.01）,房间采光差,COPD患病的危险增加（OR=4.25,P＜0.01）,喂养宠物会大大增加COPD的患病危险（OR=12.08,P＜0.01）,吸烟与COPD患病的OR值为1.74（P＜0.01）并且与吸烟的量有关,吸烟指数（年支数即每日吸烟支数×吸烟年数）在500以上增加COPD患病的危险,被动吸烟与COPD患病的OR值是16.39（P＜0.01）,父亲家族有慢性肺部疾病家族史与COPD患病的OR值是2.13（P＜0.01）、母亲家族有慢性肺部疾病家族史与COPD患病的OR值是2.11（P＜0.01）、教育程度（以未上学为对照）与COPD患病的OR值是0.52（P＜0.01）.结论 湖南省长沙城区COPD患病率较高,住房采光、喂养宠物、下厨、男性、高龄、吸烟、被动吸烟、父母亲家族史是COPD在城市发病的可能危险因素,教育程度是COPD的保护因素,应该针对相关危险因素进行干预,以降低COPD的患病率.     

汶川地震后重灾区人群重性抑郁障碍流行病学调查

目的 了解中国汶川5·12地震后重灾区居民的重性抑郁障碍患病率、患者的人口学和社会文化特征及患病相关危险因素.方法 采用分层整群抽样方法随机抽取≥15岁人群14 503人,以一般健康问卷12项(GHQ-12)为筛选工具,采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查版(SCID-Ⅰ/P)为调查诊断工具.结果 重性抑郁障碍现患180例,时点患病率为1.27%,终生患病率为1.36%;女性(OR=1.56,95%CI:1.136～2.143,P＜0.05)、合并躯体疾病(OR=4.02,95%CI:2.75～5.90,P＜0.05)、地震中受伤(OR=3.29,95%CI:1.92～5.65,P＜0.05)、财产损失(其中10万～20万元OR=2.09,95%CI:1.18～3.69,P＜0.05;＞20万元OR=2.54,95%CI:1.38～4.68,P＜0.05)、家人去世或失踪(OR=3.79,95%CI:2.08～6.89,P＜0.05)以及中年人群(OR=2.31,95%CI:1.38～3.86,P＜0.05)为危险因素.有职业为保护性因素(OR=0.60,95%CI:0.43～0.83,P＜0.05).结论 重性抑郁障碍是目前地震灾区较为多发的精神疾病.     

成都市城乡居民高血压患病率、知晓率、治疗率及控制率分析

目的 了解成都市城乡居民高血压患病率、知晓率、治疗率及控制率情况,为高血压防治提供科学依据。方法 2016年8月—2017年2月采用整群随机抽样的方法,对成都市城市及农村社区≥18岁的5 022例居民进行问卷调查及体格检查。结果 成都市城乡居民高血压标化患病率为27.7%。城市高于农村（32.3% vs24.0%,P＜0.001）;男性高于女性（37.7% vs20.0%,P＜0.001）。高血压知晓率、治疗率及控制率分别为64.2%、44.5%、17.7%。城市居民知晓率（68.1％ vs57.7％,P＜0.001）、治疗率（50.5％ vs 33.3％,P＜0.001）、控制率（21.9％ vs 9.7％,P＜0.001）均高于农村居民。男性的知晓率（62.3％ vs 66.6％,P＜0.001）、治疗率（38.2％ vs 50.5％,P＜0.001）、控制率（14.1％vs 21.0％,P＜0.001）均低于女性。logistic多因素分析显示城市居民的危险因素包括,男性（OR = 1.358)、年龄增高（30～39岁:OR = 3.288;40～49岁:OR = 4.641;50～59岁:OR = 8.558;60～69岁:OR = 9.650;70～79岁:OR = 13.330 ;≥80岁:OR = 15.474）、超重（OR = 1.535）、肥胖(OR = 2.459)、高血压家族史(OR = 3.935) 、中心性肥胖(OR = 1.235)、糖尿病(OR = 2.186) 、血脂异常(OR = 1.283)、饮酒(OR = 1.592)。农村居民危险因素包括男性（OR = 1.549）、年龄增高（30～39岁:OR = 4.161;40～49岁:OR = 8.365;50～59岁:OR = 19.122;60～69岁:OR = 25.146;70～79岁:OR = 34.495;≥80岁:OR = 57.136）、超重（OR = 1.980）、肥胖(OR = 3.281)、高血压家族史(OR = 2.837)、年均收入＞20 000元(OR = 2.081)。结论 成都市城乡居民高血压患病率高,而知晓率、治疗率及控制率低。应针对城乡居民差异,采取不同的高血压防控措施。     

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.