孕期被动吸烟对妊娠并发症及妊娠结局的影响

目的了解孕期被动吸烟发生情况,并探讨其对妊娠并发症及结局的影响。方法选取2012年4月―2013年3月在我国15家医疗保健机构分娩的8926例单胎活产产妇作为研究对象,使用自制调查问卷收集孕期被动吸烟发生情况、妊娠并发症和结局等信息,采用单因素和多因素Logistic回归分析模型分析孕期被动吸烟对妊娠并发症及结局的影响。结果共1801例产妇在孕期经历被动吸烟。控制混杂因素后,孕期经历被动吸烟的产妇妊娠期糖尿病(gestational diabetes mellitus,GDM)的发生风险是非被动吸烟者的1.359倍(95%CI:1.146~1.612,P<0.001),胎膜早破的风险为1.290倍(95%CI:1.095~1.520,P=0.002),早产的风险为1.367倍(95%CI:1.155~1.619,P<0.001),娩出低出生体重儿的风险为1.341倍(95%CI:1.079~1.668,P=0.008)。与非被动吸烟者相比,平均每周被动吸烟天数≥4天者胎膜早破、早产和低出生体重儿的发生风险分别为非被动吸烟者的1.402倍(95%CI:1.104~1.780,P=0.006)、1.690倍(95%CI:1.339~2.132,P<0.001)和1.584倍(95%CI:1.172~2.141,P=0.023)。结论被调查产妇孕期被动吸烟率较高,孕期经历被动吸烟能够增加妊娠期糖尿病、胎膜早破、早产和低出生体重儿的发生风险。     

前置胎盘临床高危因素分析及其与妊娠结局的相关性研究

目的探讨前置胎盘的临床高危因素及其对母婴的影响,为其预防提供理论依据。方法选取2010年9月—2013年6月期间住院的单胎前置胎盘孕产妇(112例)为研究组,同期住院的健康、单胎、非前置胎盘孕产妇(177例)为对照组,回顾性分析前置胎盘临床常见病因及其对母婴的影响。结果研究组中年龄≥35岁者43例,占38.4%,无业30例,占26.8%,工人32例,占28.6%,分娩史≥3次者29例,占25.9%,人工流产史≥3次者48例,占42.9%,剖宫产史者22例,占19.6%,盆腔炎史者39例,占34.8%,均高于对照组;经统计学分析比较,两组患者年龄、人工流产史、剖宫产史、分娩史、盆腔炎史差异有统计学意义(均P0.05),Logistic回归分析显示,高龄、多次人工流产史、剖宫产史及分娩史暴露率相对较高,是前置胎盘的常见病因;两组产妇妊娠结局比较,研究组剖宫产、胎盘粘连、胎盘植入、产后出血、产褥期感染、早产、低出生体重儿、新生儿窒息发生率明显高于对照组,差异均有统计学意义(均P0.05)。结论年龄、人工流产史、剖宫产史、分娩史是前置胎盘的高危因素,严重威胁母婴生命,应做好生殖卫生、实行计划生育、减少人工流产次数、降低剖宫产率等防治措施。     

Population attributable numbers and fractions of deaths due to smoking: a pooled analysis of 180,000 Japanese

Objective

Age- and sex-specific population attributable fraction (PAF) and premature deaths attributable to smoking were estimated from a pooled analysis of cohort studies in Japan.

Methods

A pooled analysis of individual participant data from 13 well-qualified cohort studies throughout Japan (a total of 183,251 Japanese aged 40-89, 69,502 men and 113,749 women; the baseline years between 1987 and 1995 with average 10 years of follow-up) was performed. Poison regression model was used to estimate age- and sex-specific hazard ratios, and their PAFs of all-cause deaths and number of annual premature deaths attributable to smoking were estimated.

Results

Overall PAF attributable to smoking was 24.6% in men and 6.0% in women. The estimated number of annual premature deaths due to smoking was 121,854 (men: 109,998; women: 11,856) in Japan. The age-specific PAF was largest in men aged 60-69 (47.7%) and in women aged 50-59 (12.2%). In the older group aged 70-79 and 80-89, PAF was 15.4% and 8.0% in men and 3.5% and 1.5% in women, respectively.

Conclusions

Age-specific PAFs attributable to smoking in Japanese men are much larger than that reported from other Asian countries.     

Mortality attributable to smoking in Vietnamese men in 2008

Objective

Smoking prevalence among Vietnamese men is among the highest in the world. Our aim was to provide estimates of tobacco attributable mortality to support tobacco control policies.

Method

We used the Peto–Lopez method using lung cancer mortality to derive a Smoking Impact Ratio (SIR) as a marker of cumulative exposure to smoking. SIRs were applied to relative risks from the Cancer Prevention Study, Phase II. Prevalence-based and hybrid methods, using the SIR for cancers and chronic obstructive pulmonary disease and smoking prevalence for all other outcomes, were used in sensitivity analyses.

Results

When lung cancer was used to measure cumulative smoking exposure, 28% (95% uncertainty interval 24–31%) of all adult male deaths (> 35 years) in Vietnam in 2008 were attributable to smoking. Lower estimates resulted from prevalence-based methods [24% (95% uncertainty interval 21–26%)] with the hybrid method yielding intermediate estimates [26% (95% uncertainty interval 23–28%)].

Conclusion

Despite uncertainty in these estimates of attributable mortality, tobacco smoking is already a major risk factor for death in Vietnamese men. Given the high current prevalence of smoking, this has important implications not only for preventing the uptake of tobacco but also for immediate action to adopt and enforce stronger tobacco control measures.     

妊娠早期被动吸烟与不良妊娠结局的队列研究

目的分析城市孕早期妇女被动吸烟状况,探讨被动吸烟对不良妊娠结局的影响,减少不良妊娠结局的发生。方法调查孕早期妇女被动吸烟状况,将其分成被动吸烟组与无被动吸烟组,追踪其妊娠结局,采用χ2检验和Logistic回归分析方法,分析被动吸烟与不良妊娠结局的关系。结果城市孕早期妇女被动吸烟率为38·2%,被动吸烟与不良妊娠结局呈一定的剂量-反应关系,每日被动吸烟的时间越长发生不良妊娠结局的可能性就越大,每日被动吸烟的时间超过3h对不良妊娠有显著影响。结论被动吸烟可使不良妊娠发生的危险增加,每日被动吸烟的时间超过3h是不良妊娠的强危险因素。加强孕前对孕妇的宣教和指导,尽量避免暴露于吸烟环境,可减少不良妊娠结局的发生。     

Individual and social environment influences on smoking in children and adolescents

OBJECTIVES: A precise knowledge of the risk factors for childhood and adolescent smoking is crucial for the development of appropriate preventive measures. This study investigated current smoking prevalence and the social and regional correlates for smoking among minors (children and adolescents aged 12-17 years) in Germany. METHODS: Bivariate data analysis was performed on the basis of a representative national cross-sectional study performed in 2004, and multivariable logistic regression models were calculated separately for boys and girls. All correlates identified as significant in the bivariate model were used in the multivariable analysis. STUDY DESIGN: The database used in this research was from the study 'Drug Affinity of Young People in the Federal Republic of Germany 2004', with approximately 1298 children and adolescents aged 12-17 years. RESULTS: Twelve percent of male and 9% of female adolescents in Germany reported that they are habitual smokers, and 12% of male and 13% of female adolescents reported that they are occasional smokers. Multivariable data analysis shows that living in a large city is protective for adolescents in terms of local disparities. The educational level of the respondents also correlates significantly with smoking behaviour. The percentage of adolescent smokers is lowest among those with a high level of education. The presence of smokers in the household is associated with a significantly higher prevalence of smoking among adolescents compared with those growing up in a non-smoking household. CONCLUSION: Smoking is a major public health problem among German children and adolescents. Control measures must tackle the structural and social pressures that shape smoking behaviour during childhood.     

农民农药暴露与不良妊娠结局关系的Meta分析

目的 对农民在农业种植过程中农药暴露与不良妊娠结局的关系进行分析.方法 收集1990至2012年2月国内外发表的有关农药暴露与妊娠结局关系的文献,应用revman 4.2软件对符合纳入标准的文献进行Meta分析.结果 共有12篇文献纳入研究,与对照组相比,农药暴露农民自然流产的合并OR为1.52(95％CI∶1.04,2.21,P=0.03);早产的合并OR为1.33 (95％CI∶1.09,1.61,P=0.005);死胎的合并OR为1.22(95％CI∶1.16,1.29,P＜0.01),农药暴露可使自然流产、早产、死胎的危险性增加.死产的合并OR为1.90(95％CI∶0.58,6.28,P=0.29);畸形的合并OR为2.02(95％CI∶0.84,4.69,P=0.12);低出生体重的合并OR为1.62(95％CI∶0.60,4.39,P=0.34);新生儿死亡的合并OR为2.18 (95％CI∶0.54,8.88,P=0.28);生育延迟的合并OR为1.43(95％CI∶0.93,2.18,P=0.1),故尚不能认为农药暴露与死产、畸形、低出生体重、新生儿死亡、生育延迟有相关性.结论 农药暴露可以导致农民的不良妊娠结局,使自然流产、早产、死胎的危险性增加.     

2013年中国居民吸烟对归因死亡和期望寿命的影响

目的 分析2013年我国吸烟的归因死亡和对期望寿命的影响。方法 利用2013年死因监测数据和慢性病及其危险因素监测数据,针对不同疾病特点,将以现在吸烟率作为暴露水平的直接法和以吸烟影响比作为暴露水平的间接法相结合,计算吸烟导致不同疾病死亡的人群归因分值,从而估计吸烟对于死亡和期望寿命的影响。结果 2013年中国人群由于吸烟导致约159.33万人死亡,占总死亡人数的17.38%,其中男性吸烟导致的死亡占比（23.66%）远远高于女性（8.30%）,城市人群吸烟导致的死亡占比（17.24%）略低于农村人群（17.51%）,东部地区人群吸烟导致的死亡占比最低（16.81%）,西部地区最高（17.91%）。2013年中国人群吸烟导致死亡人数在前三位的疾病是肺癌、COPD和缺血性心脏病,吸烟导致死亡归因分值最大的前三位疾病是肺癌、COPD和鼻咽癌。2013年中国人群吸烟导致期望寿命损失2.04岁,其中最高的为西部地区男性,共损失3.05岁。结论 吸烟仍是我国重要的公共卫生问题,针对重点地区人群开展控烟工作,可以降低吸烟相关疾病的死亡,有效地提高我国人群健康水平。     

2013-2014年安徽省成人吸烟和戒烟行为状况分析

目的 了解安徽省成人居民吸烟和戒烟行为状况,为制定烟草控制措施提供依据。方法 利用2013-2014年安徽省成人慢性病及其危险因素监测项目调查数据,使用事后分层权重调整和复杂抽样设计方法进行统计分析。结果 有效样本量为7 182人,现在吸烟率为26.2%（95% CI：23.9%~28.4%）,男性高于女性,分别为51.2%（95% CI：45.5%~56.8%）和1.4%（95% CI：0.5%~2.4%）;男性现在吸烟率随文化程度提高出现降低趋势（P<0.001）。现在每日吸烟率为23.7%（95% CI：21.4%~26.0%）,男性（46.5%,95% CI：41.7%~51.3%）高于女性（1.2%,95% CI：0.5%~1.9%）。现在吸烟者日均吸烟量为17.1（95% CI：16.5~17.6）支,男女分别为17.2（95% CI：16.7~17.8）支和10.5（95% CI：9.4~11.7）支,且男性日均吸烟量随着年龄升高而增加（P=0.048）,随文化程度升高而减少的趋势（P=0.003）。二手烟暴露率为57.6%（95% CI：51.2%~64.0%）。男性现在吸烟者中仅有37.6%（95% CI：25.0%~50.2%）打算戒烟,男性戒烟率为13.8%（95% CI：7.5%~20.1%）,成功戒烟率为9.1%（95% CI：5.1%~13.0%）。结论 安徽省成人居民吸烟行为普遍存在,二手烟暴露率较高,成年男性烟草使用率高,戒烟和成功戒烟率水平低。     

前置胎盘的相关因素分析及其妊娠结局

目的:通过临床分析了解前置胎盘的相关因素及其妊娠结局。方法:回顾性分析34例发生前置胎盘患者前置胎盘位置、发病原因及治疗情况。结果:34例患者有过宫腔操作的32例,占94.12%,其中1~2次的患者21例占到总数的61.76%,在5次以上的患者有4例。34例患者有15例为阴道分娩占总数的44.12%,有19例为剖宫产,产妇没有死亡病例发生,但有2名新生儿死亡。结论:引起胎盘前置的主要因素是患者有过宫腔操作史,但经过有效的治疗可以得到良好的妊娠结局。     

The extrapolation of attributable risk to new populations

I develop a method for extrapolation of attributable risk estimated from one population, to other populations with a different rate of risk factor exposure and/or rate of outcome. The method uses the relationship between attributable risk and the product moment correlation.     

Smoking prevalence and smoking attributable mortality in Italy, 2010

Objective

To provide updated information on smoking prevalence and attributable mortality in Italy.

Method

A representative survey on smoking was conducted in 2010 on a sample of 3020 Italian adults (1453 men and 1567 women). We used SAMMEC software to update smoking attributable mortality in Italy.

Results

In 2010, 21.7% of Italians (23.9% of men and 19.7% of women) described themselves as current smokers. Smoking prevalence was higher in men than in women in all age groups, except for the middle-aged population (45-64 years; 25.6% in men and 25.9% in women). Age-standardized smoking prevalence was higher in men than in women among less educated subjects and in southern Italy. No substantial difference was observed either in educated subjects or in northern and central Italy. Overall, 71,445 deaths in Italy (52,707 men and 18,738 women, 12.5% of total mortality) are attributable to smoking.

Conclusion

The overall smoking prevalence of 21.7% in 2010 is the lowest registered over the last 50 years. Since 1998, smoking related deaths declined by almost 15%. Given that Italy has now reached the final stage of the tobacco epidemic, anti-smoking strategies should focus on support for smoking cessation.     

Cost-effectiveness of smoking prevention measures in adolescents

Introduction In view of the serious health risks and high costs to the health care system of tobacco consumption, getting young people to avoid smoking is an important element of preventive health care. The aim of this study was to give an overview of the scientific literature on cost-effectiveness in smoking preventive interventions within this age group. Methods A literature search was conducted in publicly available databases. Results Eight studies confirming the cost-effectiveness of those programmes were identified. These publications evaluate behaviour-based as well as environment-related interventions. Depending on the specific measures used, the results varied enormously. Nevertheless, in most scenarios the cost-effectiveness was favourable with less than 20,000 euros per life year gained (LYG) or quality-adjusted life year (QALY). In the long-term perspective some studies estimate significant cost savings from a societal perspective. Conclusion According to the available evidence, the authors assume that smoking prevention in adolescents is cost-effective. Due to the small number of comparable studies, there is a lack of reliable evidence regarding the economic aspects of primary tobacco prevention.     

妊娠早期被动吸烟与不良妊娠结局关系的队列研究

目的:分析城市孕早期妇女被动吸烟状况,探讨被动吸烟与不良妊娠结局的关系。方法:调查孕早期妇女被动吸烟状况,追踪其妊娠结局,采用卡方检验和Logistic回归分析的方法,分析被动吸烟与不良妊娠结局的关系。结果:城市孕早期妇女被动吸烟率为38.2%,被动吸烟与不良妊娠结局有一定的剂量反应关系,每日被动吸烟时间超过3 h对妊娠结局有显著影响。结论:被动吸烟可使不良妊娠结局发生的危险增加,每日被动吸烟时间超过3 h是不良妊娠的高危因素,孕妇应尽量避免暴露于吸烟环境,以减少不良妊娠结局的发生。     

Use of the transtheoretical model to predict stages of smoking cessation in Korean adolescents

BACKGROUND: Smoking is popular among Korean male high school adolescents, with the prevalence of 20.7% differing markedly with the type of school, being 16.3% and 27.6% in academic and vocational technical high schools, respectively. The purpose of this study was to identify significant variables that predict stages of smoking cessation among Korean high school students using the transtheoretical model (TTM), in order to provide an empirical basis for developing smoking cessation programs. METHODS: Cross-sectional data were collected in April and May 2004 from 300 male students at 3 vocational technical high schools in Korean metropolitan areas. The survey variables comprised decisional balance, self-efficacy, stages and processes of change, nicotine dependence, and use of smoking cessation aids. RESULTS: Current and former smokers comprised 26.3% and 22.7% of the cohort, respectively, of which 71.4% had experienced smoking cessation at least once and 55.1% utilized smoking cessation aids to help stop smoking. Nicotine-free tobacco and nicotine gum were the most common smoking cessation aids. Decisional balance, use of behavioral processes, and higher self-efficacy were significant in explaining stages of smoking cessation after controlling for nicotine dependence. CONCLUSIONS: The study results suggest that smoking cessation programs developed based on the TTM may help adolescents to progress through stages, with it being important to include information regarding the use of smoking cessation aids.     

Maternal smoking during pregnancy and rapid weight gain from birth to early infancy

Background

Although several studies have focused on the association between maternal smoking during pregnancy and rapid weight gain (RWG) during infancy, the dose-response relationship has not yet been confirmed, and very few studies have included Asian populations. Using a record-linkage method, we examined the association between maternal smoking during pregnancy and RWG in infants at around 4 months of age to clarify the dose-response relationship.

妊娠风险评估分级对母婴妊娠结局影响临床分析

目的分析不同妊娠风险评估分级对母婴妊娠结局的影响。方法收集2018年10月-2019年5月在南开区各社区医疗服务中心接受妊娠风险评估及系统管理的4 118例孕产妇的临床资料,统计各妊娠风险评估等级孕产妇例数、构成比和导致孕产妇高风险评估等级的前十位高风险因素,并选取其中妊娠风险评估为绿色(低风险)、黄色(一般风险)及橙色(较高风险)共计4 094例孕产妇为研究对象,分别从剖宫产率、早产率、低出生体重儿发生率、巨大儿发生率及出生缺陷儿发生率等方面进行回顾性分析。结果妊娠风险评估低风险、一般风险及较高风险的孕产妇其剖宫产率、早产率、低出生体重儿发生率、巨大儿发生率差异均有统计学意义(P<0.01)。其出生缺陷儿发生率差异无统计学意义(P>0.05)。结论不同妊娠风险评估分级对母婴妊娠结局产生影响,实施妊娠风险评估及分级管理对规范孕产妇围生期管理具有重要意义。     

辽宁省五城市校外青少年吸烟现状调查

目的了解辽宁省校外青少年吸烟现状及其相关规律，为制定控制青少年吸烟教育策略及实施干预措施提供依据。方法采取随机抽样方法抽取辽宁省五市校外青少年，以自填式问卷方法进行调查。结果调查校外青少年604人，总吸烟率为45．9％，其中男性吸烟率为69．0％，女性吸烟率12．2％；校外青少年吸烟行为在校内就已经形成，有31．3％的吸烟者认为吸烟是同伴影响，开始吸第一支烟的地点在校内和同学家分别为22．3％和18．4％，以朋友提供第一支烟居多，占40．6％，其次为同学，占36．3％；校外青少年知道吸烟易患心脑血管疾病的人仅占20．7％；知道我国有公共场所禁止吸烟的法规人数近50％，没听说过《烟草控制框架公约》的为73．0％。结论辽宁省校外青少年吸烟率较高，对吸烟有害健康的认知率较低，校外青少年吸烟基本上是从在校时开始，因此，应把校内青少年列为控烟重点人群。     

Psychosocial determinants of smoking in Swiss adolescents with special reference to school stress and social capital in schools

SummaryObjectives To identify the major psychosocial determinants of smoking in adolescents and the school influence on these determinants.Methods Cross-sectional questionnaire survey in 8^th grade (age 14.8 years, n=459) of 14 schools. Logistic regression with smoking as the dependent, and psychosocial indicators as independent variables. Total climate score for each school computed as the sum of scores of five school-related indicators. Linear regression analysis on aggregate data (school level), controlling for gender, ethnicity, and social class.Results Five out of 15 tested psychosocial indicators were identified as independent protective factors. The prevalence of smoking decreased steeply with an increasing number of protective factors. In the regression analysis on the aggregate level the mean number of protective factors per school and the prevalence of smoking were significantly related to the school climate score (R²=0.650, p<0.001, and R²=0.456, p<0.0001).Conclusions Provided a causal interpretation of the cross-sectional statistical associations is correct, efforts to improve the general climate in schools appear as a promising strategy to enhance individual protective factors. Longitudinal evaluative studies are needed to prove the effectiveness of such a strategy.

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ZusammenfassungFragestellung Identifikation der psychosozialen Determinanten des Rauchens bei Jugendlichen und die Bestimmung der schulischen Einflüsse auf diese Determinanten.Methoden Fragebogenerhebung in 8. Klassen (Alter 14.8 Jahre, n=459) von 14 Schulen. Logistische Regression mit der abhängigen Variable Rauchen und psychosozialen Indikatoren als unabhängige Variablen. Summe der Werte von fünt Schulindikatoren als Gesamt-Klima-Score für jede Schule. Linear Regression auf dem Niveau Schule (n=14), mit dem Geschlecht, der Sozialschicht und dem Ausländeranteil als Kontrollvariablen.Resultate Fünf von 15 getesteten psychosozialen Indikatoren wurden als unabhängige Schutzfaktoren identifiziert. Die Raucherprävalenz sank markant mit zunehmender Anzahl Schutzfaktoren. In der Regressionsanalyse auf der aggregierten Ebene waren die durchschnittliche Anzahl Schutzfaktoren und die Raucherprävalenz mit dem Schulklima assoziiert (R²=0,650; p<0,001, bzw. R²=0,456; p<0,001).Schlussfolgerungen Unter der Voraussetzung, dass eine kausale Interpretation der statistischen Zusammenhänge korrekt ist, erscheinen Anstrengungen zur Verbesserung des Schulklimas als vielversprechende Strategie zur Förderung individueller Schutzfaktoren. Zum Nachweis der Wirksamkeit einer solchen Strategie sind longitudinelle Evaluationsstudien notwendig.

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RésuméObjectifs Identification des principaux déterminants psychosociaux du tabagisme des adolescents et de l'influence scolaire sur ces déterminants.Méthodes Enquête par questionnaire aupr`es d'écoliers de huitième classes (âge 14.8 ans, n=476) dans 14 écoles. Régression logistique avec l'habitude de fumer comme variable dépendante et les indicateurs psychosociaux comme variables indépendantes. Mesure du climat scolaire basée sur les valeurs de cinq indicateurs scolaires. Régression linéaire sur le niveau écologique (écoles), avec le sexe, la proportion d'immigrants et la classe sociale comme variables de contrôle.Résultats Parmi 15 indicateurs psychosociaux cinq étaient identifiés comme facteurs protecteurs indépendants. La prévalence de fumeurs descendait rapidement avec le nombre de facteurs protecteurs. Par régression linéaire sur le niveau des écoles, l'influence du climat scolaire sur le nombre de facteurs protecteurs et la prévalence de fumeurs étaient démontrée (R²=0,650; p<0,001; et R²=0,456; p<0,001).Conclusions Pourvu qu'une interprétation causale des associations statistiques soit correcte, les efforts pour améliorer le climat dans les écoles se prêtent comme stratégie prometteuse pour promouvoir les facteurs protecteurs. Pour prouver l'efficacité de telles stratégies, des études d'évaluation longitudinales sont nécessaires.

     

Maternal psychological distress during pregnancy does not increase the risk for adverse birth outcomes

ABSTRACT

Maternal psychological distress during pregnancy is a potential risk factor for various birth complications. This study aimed to explore psychological factors associated with adverse birth outcomes. Symptoms of psychological distress, individual characteristics, and medical complications were assessed at two time points antenatally in 285 women from Australia and New Zealand; birth outcomes were assessed postpartum, between January 2014 and September 2015. Hierarchical multiple regression analyses were conducted to examine the relation of psychological distress to adverse birth outcomes. Medical complications during pregnancy, such as serious infections, placental problems and preeclampsia, and antenatal cannabis use, were the factors most strongly associated with adverse birth outcomes, accounting for 22 percent of the total variance (p < .001). Symptoms of depression and/or anxiety, low social support, and low sense of coherence were not associated with birth complications. In unadjusted analyses, self-reported diagnosis of anxiety disorder during pregnancy and an orientation toward a Regulator mothering style were associated with adverse birth outcomes; however, after controlling for medical complications, these were no longer associated. Our study results indicate that antenatal depressive and/or anxiety symptoms were not independently associated with adverse birth outcomes, a reassuring finding for women who are already psychologically vulnerable during pregnancy.