膳食纤维对2型糖尿病的治疗作用

膳食纤维对人类健康的有益作用正逐渐被认可,其在防治2型糖尿病方面具有非常重要的作用。膳食纤维可以通过增加饱腹感、延缓碳水化合物吸收、调节脂代谢、减轻体重等多个方面调节机体血糖水平,有利于降低糖尿病的发病率,延缓并发症及改善其临床结局。近年来,国内外有关膳食纤维对2型糖尿病有利作用方面的研究不断深入。该文主要是对与其相关的研究予以综述。     

不同主食对2型糖尿病患者早餐后血糖影响的研究

目的探讨不同早餐主食对2型糖尿病患者餐后血糖的影响。方法在江苏省盐城市黄海社区分批选取诊断明确、生活规律、病情稳定的2型糖尿病患者共34例,连续3天早餐分别以相同交换份的发芽糙米粥、大米粥、馒头为主食,其他饮食内容及治疗措施不变,每日监测空腹血糖(FPG)及早餐后半小时血糖(PG0.5h)、餐后1小时血糖(PG1h)、餐后2小时血糖(PG2h)。结果馒头组PG0.5h略低,PG1h、PG2h均最高;糙米粥组PG1h、PG2h低于馒头组、大米粥组,P﹥0.05。结论馒头对餐后血糖控制的影响无明显优势,2型糖尿病患者可保留食粥的传统习惯,煮粥时提倡多用糙米等粗杂粮。     

高纤维素膳食有利于型糖尿病患者控制血糖

一项新的研究发现 ,对于老年性糖尿病患者 ,高天然纤维膳食比美国糖尿病协会( ADA)推荐的膳食更有利于血糖的控制。在ADA膳食中 ,饱和脂肪被单不饱和脂肪取代 ,这被认为是地中海膳食有利于人体健康的基础。然而 ,ADA膳食很少强调天然纤维的摄入量。 Chandala等对仅通过增加膳食中天然纤维能否改善血糖控制的问题进行了研究。1 3名 型糖尿病患者 (平均年龄 6 1岁 ) ,随机分为 ADA膳食组 (纤维 2 4g/d)和高纤维膳食组 (纤维 5 0 g/d) ,为期 6周。再进食相同热量的膳食 7d,然后互换膳食方案 ,进食 6周多。试验中仅使用一些富含可溶性纤…     

低还原糖当量值玉米麦芽糊精用于管饲膳食对2型糖尿病血糖及胰岛素的影响

目的 探讨低还原糖当量（DE）值玉米麦芽糊精用于管饲膳食对2型糖尿病患者血糖和血胰岛素水平的影响。方法20例血糖已稳定的2型糖尿病志愿者分别于第1和8天给予两种不同的膳食作为早餐。两种早餐的总热能，蛋白质、脂肪、碳水化合物的供能比均基本相同，但试验早餐选用糖尿病管饲膳食（含一定量的低DE值玉米麦芽糊精替代部分大米），使膳食的粘稠度降低；而对照早餐选用稠厚的匀浆膳，不含麦芽糊精。应用同体比较的t检验，对比两种早餐的血糖和血胰岛素应答反应及不良反应。结果两种早餐相比，对照早餐和试验早餐前的空腹血糖、空腹血胰岛素水平、餐后30、60、120、180分钟的血糖以及血胰岛素浓度、血糖曲线下面积、血胰岛素曲线下面积差异均无显著性（P〉0．05）；服用两种早餐后均未发现任何不适反应。结论含低DE值玉米麦芽糊精的自制管饲膳食对2型糖尿病患者的血糖和血胰岛素水平无负面影响，而且患者对它的耐受性较好。     

摄入不同谷物对糖尿病患者血糖的影响

目的　探讨不同谷类食物对Ⅱ型糖尿病患者血糖的影响 ,筛选出有利于糖尿病患者血糖控制的食物。方法　选择 8例Ⅱ型糖尿病患者作为研究对象 ,每天早晨进食一种谷物作为早餐 ;以白米作为食物参照标准 ,每份谷物均含碳水化合物 5 0g。测定空腹及餐后 30、6 0、1 2 0、1 80min共 5个时点的血糖值 ,计算血糖指数。结果　进食不同谷物后血糖峰值均出现在餐后 6 0min ,餐后 1 80min时血糖均降至空腹水平 ,符合人体进食后的血糖变化规律。进食各种谷物的餐后各时点血糖值之间作单因素方差分析 ,进食荞麦米后 30min的血糖值低于相应时点红米和黑米的血糖值 (P <0 0 5 )。将参照标准白米的血糖指数定为 1 0 0 0 0 ,各种试验谷物的血糖指数分别为 :荞麦米 90 90±1 6 1 2 ,黑米 94 6 1± 1 5 1 3,红米 97 1 2± 1 5 39。结论　荞麦米是可供糖尿病患者选择的较好的低血糖指数食物。     

某社区158例中老年2型糖尿病患者营养状况调查

[目的]通过开展某社区中老年2型糖尿病患者营养现况调查,为在糖尿病患者中开展营养干预研究提供科学依据。[方法]从某社区中选取已确诊的非住院2型糖尿病患者158例为调查对象,采用24h膳食回顾法记录调查对象3d膳食情况,录入＂营养之星专家系统＂进行膳食分析,并对其进行体检和血糖、血脂、肝肾功能等生化指标检测,以分析其营养状况。[结果]糖尿病患者脂肪和胆固醇摄入偏高,膳食纤维摄入较少,均存在各种营养素如钙、锌、硒等和多种维生素摄入不足。体检结果显示血尿素氮、三酰甘油、游离脂肪酸、糖化血红蛋白、尿微量蛋白、空腹血糖、餐后2h血糖均值超标。血糖控制率仅为15.2%。[结论]2型糖尿病患者膳食结构不合理,血糖控制不佳,需加强对糖尿病患者合理膳食的指导。     

膳食结构调整后不同发病年限糖尿病患者空腹血糖与餐后2小时血糖的变化规律

膳食结构的调整对 2型糖尿病的疗效具有重要意义。临床经验启示 ,膳食结构调整后不同发病年限糖尿病患者血糖降低的变化不一致。现对 10 0例2型糖尿病患者 ,膳食结构调整后空腹血糖 (ＦＢＧ)和餐后 2ｈ血糖 (ＰＢＧ)的变化规律进行探讨 ,报告如下。1　资料和方法研究对象 :随机选择门诊 (糖尿病饮食咨询门诊 )无严重并发症的 2型糖尿病患者 10 0例。根据就诊病人发病年限分 4组 ,Ⅰ组 2 8例 ,发病 1个月～ 1年 ,男 19例 ,女 9例 ,年龄 4 1～ 5 5岁 ;Ⅱ组 30例 ,发病 2～ 5年 ,男 16例 ,女 14例 ,年龄 4 5～ 60岁 ;Ⅲ组 2 0例 ,发病 6～ 10年…     

豆渣纤维的提取及临床降糖实验观察

目的　为改善糖尿病病人膳食结构提供依据。方法　从豆渣中提取膳食纤维 ,选购市售低聚果糖 ,按照特定加工工艺制成功能性食品 ,对糖尿病人进行膳食干预。将 6 0例糖尿病患者随机分为豆渣纤维 (A)组、低聚果糖 (B)组和二者混合 (AB)组 ,分别补充相应的高纤维食品进行实验观察。结果　补充豆渣纤维或低聚果糖的两组糖尿病人 ,在实验前与实验后 2周、实验后 4周各时段空腹血糖、餐后血糖均依次降低 ,但无统计学意义 (P >0 0 5 ) ,说明膳食纤维和低聚糖具有一定的降糖作用 ,两者相比 ,前者降糖效果优于后者 ;而添加豆渣纤维和低聚果糖的混合组 ,实验各期受试者空腹血糖和餐后血糖均显著降低 (P<0 0 5 )。结论　添加豆渣纤维和低聚果糖组的病人 ,实验各期受试者空腹血糖、餐后血糖均显著降低     

不同步行强度对2型糖尿病患者餐后血糖的影响

目的比较不同步行强度对老年2型糖尿病患者餐后2 h血糖水平的影响,为优化2型糖尿病步行运动效果提供参考。方法将120例符合入组标准的2型糖尿病患者按随机数字表分为4组,4组均保持前期治疗方法不变,在早餐后1 h增加不同强度的户外快步行走,比较4组患者运动前后餐后2 h血糖水平。结果 4组患者运动后餐后2 h血糖均较运动前明显下降,其中Ⅱ组、Ⅲ组、Ⅳ组下降明显(P<0.01),Ⅳ组下降程度最大,但Ⅳ组大部分患者出现心慌、气短等反应;Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组运动后耗氧量分别为(22±6)%、(31±7)%、(40±8)%、(44±7)%,以40%～45%最大耗氧量的较低运动强度为Ⅲ组。结论在早餐后1 h户外快步行走3000步,速度控制为1000步/10 min,能有效地调节和控制血糖水平,且患者耐受性良好,可作为2型糖尿病安全、有效的运动疗法。     

主食替换对2型糖尿病患者餐后血糖的影响

目的 通过药食同源主食替换传统主食,评价其对2型糖尿病患者餐后血糖的影响.方法 将72例2型糖尿病患者按病情随机分为试验组(32人)和对照组(40人),试验组患者在原有膳食模式不变的基础上等量替换其主食2d,对照组不变.收集干预前、后2组患者的空腹血糖、3餐后2h血糖、3餐后最大血糖波动幅度.结果 干预前2组患者空腹血糖、3餐后2h血糖、3餐后最大血糖波动幅度水平间差异均无统计学意义(P＞0.05);干预后试验组患者3餐后2h血糖较对照组显著降低,差异有统计学意义(P＜0.05),而空腹血糖、3餐后最大血糖波动幅度水平2组患者比较差异无统计学意义(P＞0.05).结论 药食同源主食对降低2型糖尿病患者餐后血糖具有一定的效果.     

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.