维生素D缺乏与脓毒症风险的Meta分析

目的探讨维生素D缺乏与脓毒症风险的关系。方法以"维生素D""脓毒症"等为关键词检索中国知网、维普中文期刊数据库等中文数据库,以"vitamin D""sepsis"等为关键词检索Embase、Pub Med等英文数据库,检索维生素D与脓毒症风险病例对照研究的相关文献,时间范围为2000年1月—2017年10月。采用Stata 12.0软件进行Meta分析。结果共检索到相关文献343篇,最终纳入11个病例对照研究,其中病例组5 431例,对照组16 915人。Meta分析结果显示,维生素D缺乏者患脓毒症的风险是维生素D正常者的1.68倍(95%CI:1.58~1.80)。依次剔除6篇结果差异较大或大样本文献进一步分析,结果无明显改变,说明本研究结果稳定可信。本研究结果未显示发表偏倚(P0.05)。结论维生素D缺乏是脓毒症发生的重要危险因素之一。     

解脲支原体、沙眼衣原体感染与女性不孕症相关性的meta分析

目的:运用meta分析的方法探究女性不孕症与解脲支原体(Uu)和沙眼衣原体(Ct)感染之间的关系。方法:拟定严格的文献纳入标准和排除标准,检索中国知网以及维普、万方、中国生物医学文献数据库等中文数据库和PubMed等外文数据库,时间限定在2000~2014年。由两名研究者独立对检索后的文献进行质量评价,然后采用RevMan5.3软件对筛选出的文献进行数据定量分析。结果 :1共检索出相关文献181篇,其中中文文献132篇,英文文献49篇,仔细阅读相关文献的题目和摘要,对相关度高的文献详细阅读全文,严格依照以上的纳入和排除标准,最终共筛选出中文相关文献13篇,英文文献0篇,共纳入13个符合要求的研究,包含3760例患者;2将上述筛选后的文献进行meta分析,得出单纯Uu感染、单纯Ct感染以及两者混合感染合并后的OR分别为6.41(95%CI:4.85~8.47)、6.76(95%CI:5.33~8.58)、10.74(95%CI:6.87~16.81),各组与其相应对照组之间不孕症患病率差异均具有统计学意义。结论 :单纯的Uu或是Ct感染与女性不孕症相关,当两者混合感染时,女性患不孕症的危险度会更高,因此,在检测女性不孕症病因时,应该注重对Uu和Ct感染的检测。     

气象因素与儿童支气管哮喘发病关系的meta分析

目的采用meta分析的方法评价气温暴露对儿童哮喘发病人数的影响。方法检索中国知网(CNKI)、万方数据知识服务平台中文数据库,并以"气温""儿童""哮喘""发病"或"急诊""门诊""住院"为检索词;通过检索Medline、EMBASE、Google Scholar英文数据库,并以"climate change""temperature""Weather""morbidity""asthma""emergency medical services""Ambulatory Care""hospitalization"或"child"为检索词,收集国内外公开发表的关于气温与儿童哮喘发病关系研究的文献。按照纳入排除标准对文献进行筛选,应用Revman 5.3软件,根据异质性结果选择相应的模型进行meta分析。结果共检出相关文献202篇,最终纳入11篇文献,中文9篇,英文2篇。Meta分析结果显示,气温与儿童哮喘发病相关,差异有统计学意义(P<0.01),与儿童哮喘发病的比值比OR(95%CI)=2.62(2.35,2.92)。结论气温在一定程度上影响着儿童哮喘的发病。     

红肉摄入和类风湿性关节炎发生关联的meta分析

目的 采用meta分析的方法，评估红肉摄入和发生类风湿性关节炎之间的关联。方法 检索中国知网(CNKI)、万方、维普、PubMed和Web of Science中英文数据库，收集建库至2021年12月31日有关红肉摄入与类风湿性关节炎发生关联的队列研究、病例对照研究和横断面研究。采用优势比(odds ratio,OR)及其95%置信区间(95%confidence interval, 95%CI)作为效应指标进行meta分析。结果 初步共检索文献3 374篇，最终纳入12篇文献，其中队列研究5篇，包括暴露组6 000例，非暴露组403 837例；病例对照研究7篇，包括病例组3 762例，对照组6 856例。二分类meta分析结果显示人群红肉摄入与类风湿性关节炎的关联存在高度异质性(I²=90.3%),且在饮食文化上存在层间异质性(P=0.017)。进一步通过高剂量红肉摄入与类风湿性关节炎患病风险的meta分析，发现高剂量红肉摄入可增加类风湿关节炎的风险(OR=1.19,95%CI:1.00～1.42)。剂量-反应meta分析结果显示，红肉摄入剂量与类风湿性关节炎呈...     

育龄妇女受教育程度与其对叶酸补充认知及服用关系的Meta分析

目的:利用已发表文献,采用荟萃分析方法分析我国育龄妇女受教育程度与其对叶酸补充的认知及服用情况的关系。方法:分别在Pubmed采用"folic acid"、"pregnancy"和"China"等关键词组合进行检索;在中国生物医学文献服务系统(Sinomed)、中国期刊全文数据库(CNKI)、维普中文期刊全文数据库(VIP)等数据库中采用"叶酸"、"妇女"等关键词组合检索相关文献,检索所有2014年4月19日及此前的相关文献,并对文章的参考文献也进行了检索。纳入标准为:观察性研究;包含受教育程度与育龄妇女对叶酸补充的认知或服用关系信息;研究对象为中国育龄妇女。结果:共获得中英文全文文献436篇,其中中文339篇、英文97篇。最终纳入符合标准的文献15篇。采用随机效应模型进行荟萃分析,以受教育水平为初中及以下者为对照,其余调查对象知晓叶酸的OR值及其95%CI分别为:高中/中专2.12(1.65,2.72)、大学及以上6.24(4.24,9.19);调查对象服用叶酸的OR值及其95%CI分别为:高中/中专1.63(1.39,1.93)、大学及以上3.48(2.35,5.16),差异均有统计学意义。结论:我国育龄妇女受教育水平与其对叶酸的认知及服用叶酸有关。应重点加强受教育水平较低的育龄妇女对叶酸的认知和正确服用的相关教育,以进一步降低新生儿神经管畸形发生的概率,提高我国母婴健康水平。     

寒潮对我国人群死亡影响的meta分析

目的定量评价寒潮对我国人群死亡的影响。方法检索了PubMed、Scopus、Web of Science和Medline的英文数据库,以及国内的国家知识基础设施和万方数据的中文数据库,并按照纳入标准纳入文献。运用R 3.4.3软件进行meta分析。结果本研究共纳入11篇研究寒潮对我国人群死亡率影响的研究。经meta分析合计得到,寒潮对我国人群非意外死亡、心血管疾病与呼吸系统疾病人群死亡的风险(Risk ratio,RR)分别为1.25(95%CI:1.11～1.40)、1.36(95%CI:1.16～1.58)与1.46(95%CI:1.21～1.75)。2008年寒潮对全人群影响的RR值为1.38(95%CI:1.18～1.61)。对于不同个体人群,寒潮对≥65岁的老年人、教育程度低下者的影响更大;而性别间寒潮的影响无差异。结论寒潮对我国人群健康有较为严重的影响,需要在省或全国范围内构建并应用基于健康风险的寒潮预警系统,从而对敏感人群进行精准保护。     

TCu220C宫内节育器安全性和有效性的meta分析

目的:评价TCu220C宫内节育器(IUD)的安全性和有效性,比较TCu220C与其他含铜IUD的使用效果,为群众安全避孕提供科学依据。方法:基于PubMed、EMBASE、CENTRAL和POPLINE英文数据库检索,ClinicalTrials、Current Controlled metaRegister、FDA、WHO和相关企业网站检索,CBMDisc、CMCI、CNKI、VIP和Wanfang中文数据库检索,按照PICOS原则制定纳入和排除标准,所得题录导入EndNote X7软件进行文献管理并排除各数据库内重复的文献;采用EpiData 3.1软件进行信息录入,用RevMan 5.3.3和OpenMeta Anglyst软件进行meta分析,加权合并效应,计算率、RR及95%可信区间。采用"偏倚风险评估"标准进行文献方法学质量评价,采用GRADE系统进行证据质量的分级。结果:最终纳入28个涉及TCu220CIUD的随机对照临床试验和准随机对照临床试验,包括自1983~2014年正式发表的31篇文献,其中中文文献24篇和英文文献7篇。研究对象为43 239例,TCu220C组有15 794例,对照组(使用其他含铜IUD)共27 445例。国内合并研究效应与国外的合并研究效应比较,TCu220C国内外使用的总终止率及与IUD使用相关的终止率、因症终止率、副反应发生率存在显著差异,但尚未见国内外使用TCu220C在脱落率与妊娠率方面的差异。meta分析表明:人工流产术时放置可升高TCu220C脱落的风险;流产后即时/哺乳期放置的因症终止(主要因出血/疼痛终止)风险明显升高。结论:尽管其使用受到放置时期和使用对象的影响,目前仍可有选择地在适宜人群中使用。     

中国社区控烟干预效果评价的Meta分析

目的评价我国社区控烟干预的效果,为开展社区控烟干预提供依据。方法检索中国生物医学文献数据库、中国知网、万方数据知识服务平台、维普中文科技期刊数据库、 PubMed、 Embase、 Scopus、 Cochrane对照试验中心注册库(CENTRAL)、护理和保健文献积累索引(CINAHL)及教育资源信息中心(ERIC),收集从建库至2018年3月22日中国社区控烟干预的文献,以相对危险度(RR)和95%置信区间(95%CI)为干预效果测量指标,采用R 3.3.3软件进行分析。结果共检索到相关文献1 699篇(中文文献978篇,英文文献721篇),最终纳入文献23篇(中文文献22篇,英文文献1篇),其中以吸烟率为指标的研究16篇,合并效应RR=0.77 (95%CI:0.70~0.85);以戒烟率为指标的研究7篇,合并效应RR=3.47 (95%CI:2.08~5.81)。Egger's检验和漏斗图均显示没有发表偏倚(P0.05)。敏感性分析显示结果较为稳定。结论我国社区控烟干预能够有效预防人群吸烟并促进吸烟者戒烟。     

手动负压吸引人工流产术有效性的系统评价

目的:系统评价手动负压吸引人工流产术(MVA)的有效性。方法:检索CBMdisc(1978~2014年)、CNKI(1979~2014年)、万方数据库(1982~2014年)、维普数据库(1989~2014年)、PUBMED(1966~2014年)、Cochrane Library(2014年第1期)中相关杂志,纳入MVA与电动负压吸引人流术(EVA)相比较的随机对照试验。评价纳入研究的方法学质量,采用RevMan5.0软件进行meta分析。结果:纳入5篇文献,其中B级3篇,C级2篇。分析结果显示MVA与EVA在完全流产率、流产不全率、流产失败率等方面,差异无统计学意义[RR及95%CI分别为1.00(0.99,1.01),1.18(0.38,3.64),1.02(0.06,16.18)]。结论:尽管缺乏低偏倚风险的原始研究,但是基于当前最佳证据可以认为,MVA具有与EVA相似的有效性。     

孕期饮茶与早产、流产风险关联的Meta分析

目的系统评价孕产妇孕期饮茶与早产、流产风险的关联。方法系统检索中国知网、万方中国学术期刊数据库、维普中文科技期刊数据库、中国生物医学文献数据库、PubMed和Web of Science等中英文数据库,收集建库至2019年6月30日有关孕期饮茶与早产、流产风险关联的队列研究和病例对照研究文献,采用相对危险度(RR)或优势比(OR)作为效应指标进行Meta分析。结果初期共检索文献1 099篇,最终纳入文献14篇,其中队列研究9篇,包括暴露组18 295例,非暴露组71 890例;病例对照研究5篇,包括病例组1 351例,对照组3 059例。Meta回归分析结果显示,孕期饮茶与早产、流产风险无统计学关联(OR/RR=1.08,95%CI:0.99～1.18)。随机效应线性回归分析结果显示,随着孕期饮茶量增加,孕产妇早产、流产风险未发生明显变化(OR/RR=1.05,95%CI:0.99～1.11)。Begg's检验和Egger's检验均未发现发表偏倚。结论孕期饮茶与早产、流产风险未见统计学关联。     

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.