Closer correlation of cadmium in urine than that of cadmium in blood with tubular dysfunction markers in urine among general women populations in Japan

Objectives  

The objectives of the present study are to investigate whether cadmium in blood (Cd-B) and cadmium in urine (Cd-U) correlate with each other irrespective of age among general populations and which one of Cd-B or Cd-U correlates more closely with three renal tubular dysfunction markers in urine of α₁-microglobulin (α₁-MG-U), β₂-microglobulin (β₂-MG-U) and N-acetyl-β-d-glucosaminidase (NAG-U).     

Dose-response analysis of cadmium in man: Body burden vs kidney dysfunction

The primary objective of this study was to develop dose-response relationships of cadmium in human beings. In vivo measurements of kidney, liver, urine, and blood cadmium, and urinary levels of β₂-microglobulin and total protein were obtained in 82 industrially exposed workers and 30 control subjects. The values of 200 μg/g creatinine for urinary β₂-microglobulin and 250 mg/g creatinine for urinary total protein were used to define the upper limit for normal kidney function. Forty-one of the cadmium workers (18 active, 23 retired) were classified as having abnormal kidney function; all control subjects had normal kidney function. Most workers with Cd above 70 ppm in the liver were judged to have some evidence of kidney abnormalities. The dose-response relationship for liver cadmium for the actively employed workers could be described by a linear logistic regression model:

$\text{ln}\text{p}\text{1?p}\text{0.118 ×}\text{liver cadmium (ppm)}\text{? 5.00}$

where p is the individual's probability of having kidney dysfunction. The loss of cadmium from the kidney following dysfunction prohibited a direct logistic analysis of the kidney cadmium data. However, when the linear relationship between kidney and liver cadmium for the subjects with normal kidney function was combined with the logistic equation for the liver, a predicted-response curve was obtained for the kidney. The logistic models predict a 50% probability of having kidney dysfunction at 38.4 mg for the kidney and 42.3 ppm for the liver, respectively.     

Correlation between urine and blood concentrations, and dietary intake of cadmium and lead among women in the general population of Japan

Objective: To examine whether lead (Pb) in urine and cadmium (Cd) in blood, especially the former, can be used as markers of environmental exposure of general populations to these metals. Methods: Between 1991 and 1998, spot urine and peripheral blood samples, together with 24 h duplicates of food intake were collected from 607 non-smoking adult women in 30 survey sites (SS) in seven administrative regions all over Japan. Urine, blood and food duplicate samples were analyzed by inductively-coupled plasma spectrometry, for Cd and Pb in urine (Cd-U and Pb-U), in blood (Cd-B and Pb-B) and in food duplicates (Cd-F and Pb-F). Correlation between the measurements was examined by regression analysis. Results: The Cd-B correlated closely with Cd-U, and both Cd-B and Cd-U with Cd-F, on an individual basis (n = 607), on an SS basis (n = 30) and on a regional basis (n = 7). The Pb-U however did not correlate with Pb-B on a regional basis although they correlated with each other when analyzed on an individual as well as SS basis. Moreover, the correlation coefficients between Pb-U and Pb-B were much smaller than those between Cd-U and Cd-B. Neither Pb-U nor Pb-B showed significant correlation with Pb-F on any levels of statistical analysis. Conclusions: Both Cd-B and Cd-U can be employed as biomarkers of environmental Cd exposure. The reliability of Pb-U for use in place of Pb-B appeared to be small. Received: 21 January 1999 / Accepted: 2 November 1999     

No clear-cut evidence for cadmium-induced renal tubular dysfunction among over 10,000 women in the Japanese general population: a nationwide large-scale survey

OBJECTIVE: To examine whether environmental exposure to cadmium has been inducing kidney dysfunction among middle-aged women in the general population in Japan. METHODS: This study was conducted in 2000 and 2001. Morning spot urine samples were collected from 10,753 women (mostly aged 35 to 60 years) in ten prefectures all over Japan (thus about 1,000 women per site). Urine samples were analyzed for cadmium (Cd-U), calcium (Ca-U), magnesium (Mg-U), zinc (Zn-U), alpha(1)- and beta(2)-microglobulins (alpha(1)- and beta(2)-MG-U). The urinary analyte concentrations were corrected for creatinine (cr) concentration (i.e., Ucr). The data thus obtained were subjected to statistical evaluation by chi-square test, ANOVA, multiple comparison test, and simple regression analysis (SRA) as well as multiple regression analysis (MRA) including logistic regression analysis (LRA). Log-normal distribution was assumed for Cd-Ucr, alpha(1)-MG-Ucr and beta(2)-MG-Ucr, whereas normal distribution was considered for age, Ca-Ucr, Mg-Ucr and Zn-Ucr. RESULTS: Geometric mean values (GM) of Cd-Ucr were distributed unevenly, depending on the sampling areas, with a grand GM of 1.3 microg/g cr, the highest (3.2 microg/g cr) and lowest GM values(0.8 microg/g cr) being significantly different from GMs of other areas. Correlation matrix analysis with subjects of all ages showed that log alpha(1)-MG-Ucr and log beta(2)-MG-Ucr correlated significantly (r=0.272 and 0.202, respectively) with log Cd-Ucr, but they correlated also with age (r=0.280 and 0.213, respectively). The same analysis with the two selected age groups (41-50 and 51-60 years), however, failed to show close correlation of alpha(1)-MG-Ucr and log beta(2)-MG-Ucr with Cd-Ucr. Both MRA and LRA indicated that age was a confounding factor in the evaluation of the effect of Cd-U on the two MG levels. Whereas the LRA with the all-age group showed a positive influence of log Cd-Ucr on log alpha(1)-MG-Ucr and log beta(2)-MG-Ucr, such effect disappeared in parallel with the disappearance of age effects when LRA was conducted with the two selected age groups. An exceptional observation was the influence of log Cd-Ucr on log alpha(1)-MG-Ucr (but not on log beta(2)-MG-Ucr) in LRA when a cut-off value of 5.00 mg for alpha(1)-MG-U/g cr was applied. Comparison between the low and high Cd-U groups showed that both alpha(1)-MG-Ucr and beta(2)-MG-Ucr were higher in the high Cd-U groups, but prevalence of cases with alpha(1)-MG-Ucr and beta(2)-MG-Ucr in excess of the cut-off values did not differ between the two groups except when a cut-off value of 5.00 mg/g cr was employed for alpha(1)-MG-U. CONCLUSIONS: In over-all evaluation, no clear-cut evidence was obtained in the present study to show that environmental exposure to Cd has induced tubule dysfunction among middle-aged women in the general population in Japan. It might be the case, however, that an increase in alpha(1)-MG-U was associated with Cd exposure. In this sense, it is apparently desirable from public health viewpoints to make further efforts to reduce the intensity of the general population's exposure to environmental Cd.     

Possible effects of environmental cadmium exposure on kidney function in the Japanese general population

Objectives: To examine whether the current level of environmental exposure to cadmium (Cd) is associated with kidney dysfunction among general populations in Japan. Methods: A nationwide survey was conducted in Japan from 1991 to 1997 at 30 survey sites (with no known environmental heavy metal pollution), by the collection of 24-h food-duplicate samples, peripheral blood specimens and morning spot urine samples. In practice, 607 non-smoking adult women provided these samples. After being wet-ashed, the samples were analyzed for Cd in food duplicates (Cd-F), in blood (Cd-B) and urine (Cd-U) by inductively-coupled plasma mass spectrometry (ICP-MS). Urine samples were also analyzed for α₁-microglobulin (α₁-MG), β₂-microglobulin (β₂-MG) and retinol-binding protein (RBP), creatinine (cr) and specific gravity. Possible tubular dysfunction in association with Cd exposure was examined by simple, multiple and logistic regression analyses, and comparison among three different Cd-dose groups. To minimize the confounding effects of aging, 367 women from 41 to 60 years old were selected and subjected to the same statistical analyses. Results: The analysis of a whole population of 607 women showed that α₁-MG and possibly β₂-MG increased as a function of Cd-F, Cd-B and Cd-U. When the analysis was repeated with the selected population of 367 women aged 41–60, the Cd dose-dependent changes in α₁-MG and β₂-MG became less evident. The distribution of the selected population with α₁-MG above two low cut-off values of >4.9 and >8.4 mg/g cr or with β₂-MG above the lowest cut-off value of >400 μg/g cr, was biased toward the group with higher Cd-Ucr, but such bias was not significant for both α₁-MG and β₂-MG when higher cut-off values were employed. No bias was detected with RBP. Logistic regression analysis with α₁-MG, β₂-MG and RBP (with cut-off values given above) in combination with age, Cd-F, Cd-B and Cd-Ucr gave essentially the same results. Conclusions: The evidence for kidney dysfunction was of borderline significance in the present study population for which geometric mean Cd-F, Cd-B and Cd-U were 24.7 μg/day, 1.76 μg/l, and 3.94 μg/g cr, respectively. The findings might suggest at the same time that the safety margin is small for the Japanese general population regarding environmental Cd exposure. Received: 26 February 1999 / Accepted: 24 July 1999     

Analysis for threshold levels of cadmium in urine that induce tubular dysfunction among women in non-polluted areas in Japan

OBJECTIVE: To examine if there is a threshold in urinary cadmium concentration that induces elevation in urinary microglobulins. METHODS: The database developed in a previous field survey (Ezaki et al. 2002) was employed. In the survey conducted in 2000 and 2001, more than 10,000 middle-aged women (with no occupational exposure to Cd) in ten prefectures all over Japan gave morning spot urine samples, which were analyzed for cadmium (Cd-U), calcium (Ca-U), magnesium (Mg-U), zinc (Zn-U), alpha(1)- and beta(2)-microglobulins (alpha(1)- and beta(2)-MG-U), and creatinine (cr). The urinary analyte concentrations were corrected for cr concentration (to be expressed as, e.g., Cd-Ucr), and the data thus obtained were subjected to statistical evaluation. The largest geometric mean (GM) for Cd-Ucr among the ten prefecture was 3.2 microg Cd/g cr, and the maximum Cd-Ucr observed among the women studied was 20.9 microg Cd/g cr. RESULTS: Both alpha(1)-MG-Ucr and beta(2)-MG-Ucr increased as a function of the increase in Cd-Ucr among all the women and also in sub-populations of narrow age ranges (i.e., 41-50 and 51-60 years), with no apparent threshold Cd-Ucr. Comparison of the cases exceeding cut-off alpha(1)-MG-Ucr and beta(2)-MG-Ucr levels also indicated a Cd dose-dependent increase in the prevalence, similarly without a threshold Cd-Ucr. In addition, such findings were essentially reproducible when elevation in alpha(1)-MG-Ucr and beta(2)-MG-Ucr levels was examined with the three essential elements, especially with Ca-Ucr and Mg-Ucr, although less clearly with Zn-Ucr. The observations as a whole suggest a possibility that the dose-dependent increases in alpha(1)-MG-Ucr and beta(2)-MG-Ucr with no apparent threshold for element concentration is not specific to Cd-Ucr but common to other elements. CONCLUSIONS: No threshold Cd-Ucr was detected in relation to the increases in alpha(1)-MG-Ucr and beta(2)-MG-Ucr. The element dose-dependent increases in the two MGs with no threshold in the element concentration might be not limited to Cd, but common to other elements. Further studies are apparently necessary.     

低浓度环境镉暴露对全年龄段人群肾功能的影响

目的旨在确定镉暴露是否与儿童、青少年和成人的早期肾损害生物标志物相关联。方法按分层抽样方法,抽取1 235名调查对象,采集血、尿等生物样本进行检测,并对结果进行流行病学分析。结果男性尿镉的中位数为0.38μg/g肌酐,女性为0.42μg/g肌酐。多元线性回归表明,校正了性别、BMI、血铅和尿肌酐之后,在包含儿童的所有年龄组中,尿镉与肾小管生物标志物(NAG酶和β2微球蛋白)呈正相关,且儿童血镉和肾小管生物标志物呈正相关。结论在包含儿童在内的一般人群中,暴露于低浓度的镉依然会影响肾小管功能。     

The relationship between cadmium exposure or body burden and the concentration of cadmium in blood and urine in man

Summary Cadmium concentration in whole blood (Cd-B) and in urine (Cd-U) has been determined in more than 100 workers exposed to cadmium and in a comparable group of non-exposed workers. The relationship between both parameters and the duration of employment or the intensity of current exposure has been analyzed.In control workers slightly exposed to environmental pollution by cadmium, Cd-U but not Cd-B is significantly correlated with duration of exposure.In exposed workers both Cd-U and Cd-B are correlated with the intensity of exposure but not with the duration of exposure. It is suggested that Cd-B reflects current exposure but that Cd-U may reflect body burden of cadmium when exposure is low (environmental pollution) and current exposure when exposure is high (industrial situations).This work was supported by the Commission des Communautés Européennes and the Fonds National de la Recherche Scientifique.     

Relation of child birth and breast-feeding burden with cadmium and tubular dysfunction marker levels in urine of adult women in non-polluted areas in Japan

Background and objectives

Cd absorption may be enhanced in association with iron (Fe) deficiency. Women have increased risks of Fe loss at the time of child birth as well as breast-feeding of children. Possible effects of these two factors were investigated in the present study.

Methods

Data were drawn from previous publications from this group on Cd and tubular dysfunction markers (i.e., α₁-microglobulin, β₂-microglobulin, and N-acetyl-β-d-glucosaminidase) in urine of adult women in non-polluted areas in Japan. Information including age, smoking, number of children, and types of child feeding was obtained by self-administered questionnaires at the time of urine sampling. In practice, 17,468 cases were available, from which 12,869 cases were employed in the present analyses after exclusion of smokers, former or current patients of anemia or hypertension, and those with incomplete answers. Lactation burden was scored after coding of breast, mixed, and bottle feeding with 2, 1, and 0 for each child followed by summation for all children born to a mother. In order to exclude possible effect of aging, women were stratified by 5 years of age to randomly select equal numbers of cases and controls, followed by summation for all ages for comparison.

Results

The arithmetic mean age and the geometric mean Cd (as observed) were 49.7 years and 1.13 μg/l urine. The number of children was 0–7, and lactation burden score ranged from 0–12. Multiple regression analyses were conducted with age and either number of children or lactation burden scores as independent variables and Cd as a dependent variable. The results showed that age was an influential variable. Comparison after matching for age showed that having 1, 2, or 3 children or lactation burden score up to 2 were associated with a significant increase in Cd. Lactation burden score up to 2 was also associated with increased Cd in urine and such trend persisted up to the highest score of 5–12. The results of trend tests were generally in agreement with these observations. Further comparison after age-matching showed that women having 2 or 3 children but no lactation burden had higher Cd than those with no children. In contrast, Cd was not higher for those having 2 or 3 children with substantial lactation scores (i.e., 2–4 or 3–6) than for those with the same number of children without lactation burden.

Conclusions

Giving birth to 1–3 children was associated with an increase in urinary Cd, suggesting that child birth might be associated with elevation in Cd body burden. The effect of lactation is probably attributable to that of number of children. Further studies are necessary to examine whether the association is also observable in mothers who have 3 or more children.     

Impact of menstrual blood loss and diet on iron deficiency among women in the UK

Women of childbearing age are at risk of Fe deficiency if insufficient dietary Fe is available to replace menstrual and other Fe losses. Haem Fe represents 10-15 % of dietary Fe intake in meat-rich diets but may contribute 40 % of the total absorbed Fe. The aim of the present study was to determine the relative effects of type of diet and menstrual Fe loss on Fe status in women. Ninety healthy premenopausal women were recruited according to their habitual diet: red meat, poultry/fish or lacto-ovo-vegetarian. Intake of Fe was determined by analysing 7 d duplicate diets, and menstrual Fe loss was measured using the alkaline haematin method. A substantial proportion of women (60 % red meat, 40 % lacto-ovo-vegetarian, 20 % poultry/fish) had low Fe stores (serum ferritin <10 microg/l), but the median serum ferritin concentration was significantly lower in the red meat group (6.8 microg/l (interquartile range 3.3, 16.25)) than in the poultry/fish group (17.5 microg/l (interquartile range 11.3, 22.4) (P<0.01). The mean and standard deviation of dietary Fe intake were significantly different between the groups (P=0.025); the red meat group had a significantly lower intake (10.9 (sd 4.3) mg/d) than the lacto-ovo-vegetarians (14.5 (sd 5.5) mg/d), whereas that of the poultry/fish group (12.8 (sd 5.1) mg/d) was not significantly different from the other groups. There was no relationship between total Fe intake and Fe status, but menstrual Fe loss (P=0.001) and dietary group (P=0.040) were significant predictors of Fe status: poultry/fish diets were associated with higher Fe stores than lacto-ovo-vegetarian diets. Identifying individuals with high menstrual losses should be a key component of strategies to prevent Fe deficiency.     

Intestinal absorption of dietary cadmium in women depends on body iron stores and fiber intake.

Measurements of intake and uptake of cadmium in relation to diet composition were carried out in 57 nonsmoking women, 20-50 years of age. A vegetarian/high-fiber diet and a mixed-diet group were constructed based on results from a food frequency questionnaire. Duplicate diets and the corresponding feces were collected during 4 consecutive days in parallel with dietary recording of type and amount of food ingested for determination of the dietary intake of cadmium and various nutrients. Blood and 24-hr urine samples were collected for determination of cadmium, hemoglobin, ferritin, and zinc. There were no differences in the intake of nutrients between the mixed-diet and the high-fiber diet groups, except for a significantly higher intake of fiber (p < 0.001) and cadmium (p < 0.002) in the high-fiber group. Fecal cadmium corresponded to 98% in the mixed-diet group and 100% in the high-fiber diet group. No differences in blood cadmium (BCd) or urinary cadmium (UCd) between groups could be detected. There was a tendency toward higher BCd and UCd concentrations with increasing fiber intake; however, the concentrations were not statistically significant at the 5% level, indicating an inhibitory effect of fiber on the gastrointestinal absorption of cadmium. Sixty-seven percent of the women had serum ferritin < 30 micrograms/l, indicating reduced body iron stores, which were highly associated with higher BCd (irrespective of fiber intake). BCd was mainly correlated with UCd, serum ferritin, age, anf fibre intake. UCd and serum ferritin explained almost 60% of the variation in BCd.(ABSTRACT TRUNCATED AT 250 WORDS)     

Urinary calcium as a biomarker of renal dysfunction in a general population exposed to cadmium

Urinary beta 2-microglobulin and N-acetyl-beta-D-glucosaminidase have been recommended as sensitive indicators of renal dysfunction induced by cadmium. However, an increase in urinary calcium in early renal damage induced by cadmium has been reported both in humans and in animal experiments. To investigate the feasibility of using urinary calcium as a biomarker of renal dysfunction induced by cadmium, two areas were selected in this study, namely, a polluted area with a 3.71 mg/kg cadmium concentration in rice and a control area with a 0.07 mg/kg cadmium concentration. The total number of participants was 499, made up of 252 in the control group and 247 from the cadmium-polluted area. Urinary cadmium, urinary calcium, and zinc concentrations were measured by atomic absorption spectrometry, and beta 2-microglobulin and N-acetyl-beta-D-glucosaminidase in urine were analyzed. The levels of urinary cadmium and urinary calcium in persons from the exposed area were significantly higher (P < 0.05) than those in the control area for both men and women, but there was no significant difference regarding urinary zinc between the two areas. A significant dose-response relationship between the prevalence of hypercalciuria and the excretion of urinary cadmium was observed, and a significantly increased prevalence of calciuria was found when excretion of urinary cadmium exceeded 2 micrograms/g creatinine. The findings were similar to those for excess urinary secretion of beta 2-microglobulin and N-acetyl-beta-D-glucosaminidase. Because cadmium can affect Ca2+ uptake by tubular cells, with decreased renal Ca2+ reabsorption, calciuria may reflect tubular cell damage caused by cadmium. It was concluded that cadmium exposure can result in increased excretion of urinary calcium in a general population and that there is a significant dose-response relationship. Urinary calcium can therefore be used as a biomarker of renal dysfunction induced by cadmium.     

口服铁剂改善妊娠缺铁性贫血效果及铁储备状态的研究

目的:探讨口服铁剂改善孕期贫血及铁储备状态的作用。方法:选择144例妊娠贫血孕妇(贫血组,口服多糖铁复合物胶囊150 mg/次,2次/天)、100例正常孕妇(预防组,口服多糖铁复合物胶囊150 mg/次,1次/天)和50例正常孕妇(对照组,膳食补铁),测定血红蛋白(Hb)、红细胞计数(RBC)、血清铁蛋白(SF)、血清铁(SI)。结果:贫血组和预防组Hb和RBC呈现早-中期下降(P<0.05)、中-晚期上升(P<0.05)的变化,对照组各孕周Hb、RBC呈逐渐下降趋势(P<0.05)。整个孕周3组孕妇SF均呈进行性下降(P<0.01)。3组孕妇SI早-中期下降较为明显(P<0.01)。结论:单纯膳食补铁不能满足孕期对铁的需求。孕期铁储备处于持续消耗状态。需重视孕早期及孕中期铁剂补充。     

Reference values for cobalt, copper, manganese, and nickel in urine among women of the general population in Japan

Objective: The present study was initiated to establish the reference levels of Co, Cu, Mn, and Ni in urine of women in the general Japanese population. Methods: Stored urine samples were subjected to the analysis. The samples were collected from 1,000 adult women all over Japan, who had no occupational exposure to these elements. Co, Cu, Mn, and Ni in urine were analyzed by graphite furnace atomic absorption spectrometry. The concentrations were distributed log-normally, and were presented in terms of geometric mean (GM) and geometric standard deviation, as observed or after correction for creatinine concentration or a specific gravity of urine of 1.016. Results: The GM values of observed levels (i.e., with no correction for urine density) and of the levels after correction for creatinine (cr) concentration (values in parenthesis) were 0.68 g/l (0.60 μg/g cr) for Co, 13.4 g/l (11.8 g/g cr) for Cu, 0.14 μg/l (0.12 g/g cr) for Mn and 2.1 g/l (1.8 g/g cr) for Ni. There was a life-long age-dependent increase in Cu. Mn levels reached the maximum at 60 to 69 years of ages. In contrast, age-dependency was not substantial in Co and Ni. Conclusions: Comparison with values reported in literatures for other areas showed that Co and Ni levels in urine of Japanese women are higher than, Cu level is comparable with, and Mn level is lower than others. The reasons for high Co and Ni levels deserve further study.     

Impact of urinary cadmium on mortality in the Japanese general population in cadmium non-polluted areas

PurposeThe aim of the present study was to evaluate the dose–effect relationship between urinary cadmium (U-Cd as an index of internal Cd exposure) and mortality in a cohort of the Japanese general population.MethodsA 19-year cohort study was conducted in 897 men and 1307 women who lived in two non-polluted areas in Japan. The subjects were categorized into four quartiles based on creatinine adjusted U-Cd (μg/g cre). Hazard ratio (HR) and 95% confidence interval (95%CI) of the quartiles of U-Cd for mortality was calculated using a proportional hazards regression. Forward stepwise model selection was applied to the potential covariates such as age, body mass index, mean arterial pressure, various lifestyle factors and present illness.ResultsThe mortality rates per 1000 person years were 27.8 and 12.5 in men and women, respectively. In men, the fourth quartile of U-Cd (≥2.919 μg/g cre) showed a significant, positive HR (1.50, 95%CI: 1.11–2.02) for mortality compared to the first quartile (<1.014). In women, the fourth quartile of U-Cd (≥3.943 μg/g cre) also showed a significant HR (1.50, 95%CI: 1.08–2.09) for mortality compared to the first quartile (<1.140).ConclusionThe present study clarified that U-Cd was significantly associated with increased mortality, indicating the worsened life prognosis of the general population in Cd non-polluted areas in Japan. These results highlight the importance of further discussion of the health risk assessment of Cd exposure in the general population.     

Urinary N-acetyl-beta-D-glucosaminidase isoenzymes as biomarker of renal dysfunction caused by cadmium in a general population.

N-Acetyl-beta-D-glucosaminidase (NAG) and its isoenzymes in urine have been studied in a population group residing in a polluted area in China. The area studied was contaminated by industrial wastewater from a nearby smelter that discharged cadmium-polluted wastewater into a river used for the irrigation of rice fields. Cadmium concentrations in rice were 3.70, 0.51, and 0.07 mg/kg for the highly and moderately polluted areas and the control area, respectively. Cadmium concentrations in urine exceeded 5 microgram/liter in the majority of subjects in the most highly polluted area. There was a marked dose-dependent increase in NAG and NAG B content of urine related both to urinary cadmium and to the calculated cadmium uptake. It is concluded that urinary NAG and its isoenzymes could serve as a sensitive biomarker of renal dysfunction in cadmium-exposed populations. The mechanisms underlying the increase in NAG and its isoenzymes after cadmium exposure need to be studied further.     

Attitudes towards terminal care among the general population and medical practitioners in Japan]

OBJECTIVES: Assessment of attitudes held by the general population and medical practitioners in Japan regarding medical interventions in cases of painful terminal illness or a prolonged vegetative state. METHOD: A mail survey was conducted in 1998. The subjects were 5,000 persons randomly sampled members of the general population age 20 years or more, and 3,104 doctors and 6,059 nurses in hospitals, clinics, palliative units, and visiting nursing service stations randomly sampled. The response rates were 48% among general population, 51% among doctors, 56% among nurses. RESULTS: 1. 68-76% of the general population and medical practitioners expressed disapproval of life-extending medical treatment of terminal patients suffering pain. The application of euthanasia in certain cases was acceptable to 13% of the general population but only 1% of the medical practitioners. 2. Respondents in almost groups favored a home care setting for terminal patient in pain, and regarded relocation to a palliative unit as acceptable if necessary. 3. 46% of doctors and 22% of nurses indicated knowledge of the WHO method for cancer pain relief, and 45% of doctors and 25% of nurses showed that they were able to explain appropriate opioid administration. 4. 74-79% of general population and medical practitioners opposed life-extending medical intervention for patients in a vegetable state. 26% of the general population favored termination of all means of life support, while about 10% of the medical practitioners held this view. 5. Most medical practitioners felt that some medical treatments, such as bedsore care, should be continued in lieu of life support, but there were differences in opinion between practitioners at various types of medical facilities regarding the necessity of such specific measures as, for example, blood pressure monitoring by automatic sphygmomanometer among the medical facilities. CONCLUSION: Both the general population and the medical practitioners in Japan tended to oppose life-extending medical treatment for painful terminal cases and patients in a prolonged vegetable state. There are some differences in opinion between the general population and practitioners at various types of medical facilities regarding the extent of desirable medical care in such circumstances.     

妊娠期铁缺乏和缺铁性贫血对母胎影响的研究进展

妊娠期铁缺乏(Iron Deficiency,ID)和缺铁性贫血(Iron Deficiency Anemia,IDA)是近年产科研究的热点之一。本文综述了近年来国内外文献,概括妊娠期铁缺乏和缺铁性贫血的流行现状,探讨铁缺乏和缺铁性贫血对孕妇和妊娠结局的影响,以及近年来动物实验中铁缺乏和缺铁性贫血对子代的影响。     

Prevalence of iron deficiency and iron overload in the adult icelandic population

The aim of this cross-sectional study was to estimate the prevalence of iron deficiency and overload in the adult population in Iceland, a developed Scandinavian country. The study population consisted of 4240 individuals aged 25–74 years randomly selected from the national roster. Basic hematological, S-iron, S-total iron binding capacity (TIBC), and S-ferritin measurements were obtained on 2588 individuals (61.0%). The results indicated unusually large iron stores in the adult Icelandic population and significantly larger iron stores in the rural compared to the urban population. Iron deficiency was rare except in urban premenopausal women, where 1 in 4 showed evidence of iron deficiency and 3.2% had iron deficiency anemia. Seven patients with hereditary hemochromatosis were identified from a subgroup of 1887 subjects, resulting in a prevalence of 0.37%. Two of the hereditary hemochromatosis patients had been gastrectomized. Measures to improve the iron balance in urban premenopausal women cannot therefore include increased iron fortification of food but must be more directed towards the target group.