糖尿病家族史和三高聚集与糖尿病患病的关系

目的 了解糖尿病家族史和三高聚集与糖尿病患病的关系,为制定适宜的糖尿病防治策略提供参考依据。方法 2019年10月至2020年4月采用多阶段随机抽样的方法,在江苏省南通市海门区随机抽取8981名18周岁以上常住居民,进行问卷调查和体格检查,采用t检验、x2检验、多因素非条件logistic回归研究糖尿病家族史和三高聚集对糖尿病患病的影响。结果 江苏省南通市海门区18周岁以上常住居民最终纳入8350名,糖尿病患病率11.2%,标化患病率5.4%。在调整了性别、年龄、文化程度、职业、总静态时间等混杂因素后,多因素非条件logistic回归分析结果显示,有糖尿病家族史者糖尿病患病风险是无家族史者的3.43倍（OR=3.43,95%CI=2.86～4.11）,超重肥胖者糖尿病患病风险是非超重肥胖者的1.60倍（OR=1.60,95%CI=1.39～1.83）,高三酰甘油血症者糖尿病患病风险是非患者的4.99倍（OR=4.99,95%CI=4.17～5.98）,高血压患者糖尿病患病风险是非患者的3.14倍（OR=3.14,95%CI=2.73～3.62）。当家族史合并1高时,以家族史合并高三酰甘油血症人群的糖尿病患病风险最高（OR=4.60,95%CI=4.01～5.29）,当家族史合并2高时,以家族史合并高三酰甘油血症、超重肥胖人群的糖尿病患病风险最高（OR=4.67,95%CI=4.08～5.37）,当家族史合并3高时,糖尿病患病风险达到最高（OR=5.72,95%CI=5.14～6.42）。结论 家族史合并危险因素聚集越多,糖尿病患病风险越高,应及时做好干预工作。     

蒙古族高血压遗传及环境危险因素分析

目的探讨蒙古族高血压的遗传环境影响因素。方法在现况调查基础上,以其中无血缘关系的579名蒙古族人（高血压者298人,正常血压者281人）为研究对象进行病例对照研究。调查相关的环境因素并采集血样,对肾素基因一处新发现的插入/缺失（insertion/deletion,I/D）多态性、血管紧张素转换酶基因的插入/缺失（ivseaion/deletion.I/D）多态性,采用PCR技术结合凝胶电泳和银染方法进行基因分型。采用非条件Logistic回归模型进行遗传、环境多因素分析。结果年龄、体质指数（BMI）、每日饮酒量、肾素基因I/D多态性对高血压的发生差异有统计学意义（P〈0.05）。年龄每增加10岁发生高血压的危险性是增加前的1.28倍（OR95%CI=05～1.57）;BMI≥24 kg/m^2发生高血压的危险性是BMI〈24 kg/cm^2的2.44倍（OR95%CI=1.66～3.64）;每日饮酒量每增加一个等级发生高血压的危险性是增加前的1.61倍（OR95%CI=1.25～2.08）;肾素基因I/D多态性以II基因型为参照,ID、DD基因型的OR分别为2.39（OR95%CI=1.31～4.48）,2.41（OR95%CI=1.27～4.68）。结论超重或肥胖、长期过量饮酒是蒙古族人群高血压的危险因素,肾素基因I/D多态性D等位基因可增加蒙古族人群高血压的危险性。     

重庆市计划妊娠夫妇高血压危险因素聚集对高血压患病的影响

目的：分析重庆市计划妊娠人群高血压危险因素聚集状况及其与高血压患病之间的关系。方法于2013年4—12月,采用按比例多阶段分层整群随机抽样方法抽取了重庆市19个区（县）的11953对计划妊娠夫妇,对其进行问卷调查、体格检查和血糖检测。采用多因素二分类非条件logistic回归方法,分析危险因素聚集与高血压之间的相关性,高血压患病风险采用OR（95%CI）值表示。根据重庆市第6次人口普查数据对高血压患病率进行标化。结果重庆市计划妊娠人群高血压标化患病率为15.6%（95%CI：15.1%～16.0%）,丈夫标化患病率为16.7%（95%CI：16.0%～17.4%）,妻子标化患病率为14.2%（95%CI：13.6%～14.9%）。调查对象暴露比例较高的3项危险因素为经济压力（95.1%,22732/23906）、家族遗传史（24.9%,5950/23906）、超重和肥胖（22.3%,5341/23906）。丈夫组,具有家族遗传史、超重肥胖、吸烟、饮酒、有经济压力者患高血压风险分别是无家族遗传史、体重正常、不吸烟、不饮酒、无经济压力者的2.49（1.88~3.31）、1.85（1.68~2.03）、1.29（1.22~1.37）、1.16（1.11~1.23）、1.09（1.03~1.16）倍。妻子组,具有家族遗传史、高血糖、饮酒、有经济压力者患高血压风险是无家族遗传史、血糖正常、不饮酒、无经济压力者的3.07（2.43~3.89）、2.92（2.52~3.38）、1.28（1.12~1.49）、1.21（1.05~1.39）、2.52（1.40~4.53）倍。随着高血压危险因素聚集项数的增加,丈夫和妻子高血压患病风险升高：丈夫组危险因素聚集2~5项者高血压患病风险是危险因素聚集0项者的3.45（1.41~8.46）、5.68（2.32~13.93）、9.61（3.92~23.59）和15.20（6.10~37.87）倍;妻子组聚集2~4项者是危险因素聚集0项者的3.85（1.41~10.52）、6.18（2.23~17.15）和9.30（3.15~27.48）倍。结论家族遗传史、超重肥胖、吸烟、饮酒、有经济压力是重庆市计划妊娠夫妇高血压的主要危险因素;随着危险因素聚集项数的增加,高血压患病风险升高。     

遵义地区脑卒中患者生活方式和饮食习惯现状调查及危险因素分析

目的 调查遵义地区脑卒中患者的生活方式和饮食习惯现状,探讨该地区脑卒中的危险因素。方法 采用病例对照研究方法,以在遵义市第一人民医院住院的患者为研究对象,于2017年1月- 2019年1月期间收集280对病例对照,研究遵义地区脑卒中患病的危险因素。结果 遵义地区脑卒中患病的危险因素有超重或肥胖（OR = 2.782,95%CI = 1.742～4.442）、高血压（OR = 3.124,95%CI = 1.689～5.778）、吸烟（OR = 2.456,95%CI = 1.543～3.912）、饮酒（OR = 2.324,95%CI = 1.288～4.191）、缺乏运动（OR = 1.873,95%CI = 1.108～3.168）、高盐（OR = 3.074,95%CI = 2.069～4.568）、高脂（OR = 2.421,95%CI = 1.381～4.242）、尿酸（OR = 2.547,95%CI = 1.582～4.100）、空腹血糖（OR = 2.032,95%CI = 1.300～3.177）、TG（OR = 1.928,95%CI = 1.340～2.770）和LDL - C（OR = 1.903,95%CI = 1.202～3.010）（P＜0.05）,保护因素为摄入充足的蔬菜（OR = 0.438,95%CI = 0.221～0.866）（P＜0.05）。结论 遵义地区脑卒中患病的危险因素众多,应根据上述危险因素对该地区的高危人群提出有针对性地干预措施,以达到有效预防脑卒中发生的目的。     

中国人群BMI与肺癌发病风险的Meta分析

目的：探讨肥胖与中国人群肺癌发病风险的关系,分析BMI与肺癌发病风险的剂量-反应关系。方法系统性检索国内外公开发表的有关中国人群BMI与肺癌发病关系的文献,并辅以文献追溯等方法,检索数据库包括中国知网、万方数据知识服务平台、PubMed、Embase和Google Scholar,时间范围从各数据库建库至2014年9月,共检索到93篇文献。采用Meta分析方法计算肥胖与肺癌发病风险的合并OR（95%CI）值,运用广义最小二乘估计方法（GLST）估计BMI与肺癌发病风险的剂量-反应关系。结果最终纳入文献7篇,纳入肺癌病例2351例。Meta分析结果表明,肥胖与肺癌发病风险呈负相关（OR=0.68,95%CI：0.59～0.79）,并且这种负相关不受研究类型、性别、吸烟状况、BMI获取方式和病例来源的影响,异质性检验结果I2=0,P=0.594。BMI与肺癌发病风险呈线性剂量-反应关系,BMI每增加5 kg/m2,肺癌发病风险降低21%（OR=0.79,95%CI：0.71～0.89）,异质性检验结果q=22.43,P=0.002。结论 BMI较高是中国人群肺癌发病的一个保护性因素,由于吸烟是肺癌最重要的危险因素,可能有一定的混杂作用。     

中国居民高尿酸血症危险因素的Meta分析

目的 系统评价中国居民高尿酸血症的危险因素,为预防控制决策提供依据.方法 应用Meta分析方法,对我国20130-2008年间公开发表的有关高尿酸血症危险因素病例-对照研究的10篇文献资料进行定量综合分析;运用Review Manager4.2进行一致性检验,并且进行合并OR值和95%CI的计算.结果 各因素合并OR值分别为:体质指数OR=3.09(95%CI:1.08～8.83);高甘油三酯OR=2.19(95%CI:1.45～3.30);肥胖OR=1.91(95%CI:1.63～2.24);饮酒OR=1.85(95%CI:1.42～2.43);高血糖OR=1.38(95%CI:1.16～1.65);高血压OT=1.20(95%CI:1.03～1.39).结论 高尿酸血症发生的可能主要危险因素为体质指数、高甘油三酯、肥胖、饮酒、高血糖、高血压.     

山东省发热伴血小板减少综合征发病危险因素分析

目的 探讨影响山东省发热伴血小板减少综合征（SFTS）发病的危险因素,为科学防制该病提供依据。方法 应用1∶2匹配的病例对照研究方法,调查收集病例、对照的基本情况、可疑暴露因素等信息,采用单因素和多因素的配对条件logistic回归分析发病危险因素。结果 本研究共纳入374例SFTS确诊病例和748例对照。分析结果显示,有病例接触史（OR = 5.84,95%CI:1.11～30.88）、有家养动物（OR = 1.74,95%CI: 1.02～2.96）、近1个月见过蜱（OR = 5.85,95%CI: 2.73～12.53）、近2周有蜱叮咬史（OR = 29.58,95%CI: 6.70～130.60）、从事田间作业（OR = 2.63,95%CI:1.41～4.91）、住宅周围环境有杂草/农作物/菜地（OR = 3.24,95%CI:1.74～6.05）和住宅卫生条件差（OR = 2.20,95%CI:1.32～3.66）是SFTS发病的危险因素（P＜0.05）,近1个月有亲邻发病（OR = 0.01,95%CI:0～0.03）、采取防护措施（OR = 0.21,95%CI:0.10～0.46）是SFTS发病的保护因素（P＜0.05）。结论 接触病例、饲养家养动物、蜱叮咬、无防护措施的野外作业及住宅周围环境卫生较差等是影响山东省SFTS发病的危险因素。应加强重点人群SFTS健康教育和行为干预,减少危险因素暴露,以控制SFTS传播。     

呼伦贝尔蒙古族地区居民高血压及相关危险因素

目的 调查呼伦贝尔蒙古族地区居民高血压患病率与相关影响因素.方法 采用多阶段抽样方法,按性别、年龄分层,抽取呼伦贝尔市新右旗阿镇18岁以上居民453人进行问卷调查,测量血压、身高、体重、腰围,并计算体质指数,统计分析高血压患病率与相关危险因素.结果 被调查人群高血压患病率为34.5%,标化率为45.4%,其中男性为48.9%,女性为25.4%,男性高血压患病率高于女性(P<0.05);超重肥胖者的高血压患病率高于非超重肥胖者(P<0.001);腹型肥胖者高血压患病率高于腰围正常者(P<0.001);饮酒者高血压患病率高于非饮酒者(P<0.01).非条件Logistic回归分析表明,体质指数(OR=2.255,95%CI:1.180～4.311)、性别(OR=2.788,95%CI:1.461～5.323)、饮酒(OR=2.306,95%CI:1.287～4.134)和年龄大于50岁(OR=11.312,95%CI:4.309～22.132)是高血压的危险因素.结论 呼伦贝尔蒙古族地区高血压标准化患病率较高,高龄、超重与肥胖、男性和饮酒为高血压的主要危险因素.政府和卫生部门应针对危险因素加强健康教育和健康促进,预防和控制高血压.     

成都市就业流动人口高血压患病现状及相关因素分析

目的 了解成都市就业流动人口高血压患病现状并探索其相关因素,为制定流动人口高血压预防策略及措施提供依据。方法 采用应答推动抽样（RDS）法在成都市抽取≥18岁非成都市户籍就业人员进行问卷调查和体格检查。高血压患病率的比较采用x2检验,患病相关因素分析采用多因素logistic回归模型。结果 共调查就业流动人口2351人,高血压患病率为29.82%。Logistic回归结果显示,年龄≥31岁［31～45岁（OR=1.979,95%CI=1.466～2.670）、46～60岁（OR=3.673,95%CI=2.758～4.892）、≥61岁（OR=6.240,95%CI=4.272～9.116）］、吸烟（OR=1.597,95%CI=1.064～2.396）、经常在外就餐/点外卖（OR=1.429,95%CI=1.091～1.871）、超重（OR=2.577,95%CI=1.475～4.503）、肥胖（OR=3.954,95%CI=2.204～7.094）及职业为运输/仓储（OR=1.972,95%CI=1.177～3.304）为高血压患病的危险因素;女性（OR=0.614,95%CI=0.472～0.799）、不饮酒（OR=0.714,95%CI=0.557～0.916）、无高血压家族史（OR=0.687,95%CI=0.556～0.848）是保护因素。结论 成都市就业流动人口高血压患病率较高,需重点关注男性、老年、运输/仓储职业、有高血压家族史的人群高血压患病情况。积极制定和完善流动人口高血压防控策略,针对可改变的危险因素,采取多种干预措施,提高其健康水平。     

中国人群体重指数与食管癌发病风险的Meta分析

摘要:目的　探讨中国人群肥胖与食管癌发病风险的关系,评估BMI与食管癌发病风险的剂量反应关系。方法　系统性检索国内外公开发表的有关中国人群BMI与食管癌发病关系的中英文文献,并辅以文献追溯等方法,检索数据库包括中国知网、万方数据知识服务平台、PubMed、Embase和Google Scholar,时间范围从各数据库建库至2014年9月,共检索到60篇文献。采用Meta分析方法计算肥胖与食管癌发病风险的合并OR值（95%CI）,运用最小二乘估计方法（GLST）估计BMI与食管癌发病风险的剂量反应关系。结果　最终纳入文献5篇,纳入食管癌病例7 215例。Meta分析结果表明,肥胖与中国人群食管癌发病风险呈负相关（OR＝0.56,95%CI:0.35～0.90）,并且这种负相关不受研究类型、地区、BMI获取方式和病例来源的影响。BMI与食管癌发病风险呈线性剂量反应关系,BMI每增加5 kg/m2食管癌发病风险降低（OR＝0.57,95%CI:0.54～0.60）。结论　本次Meta分析结果显示高BMI是中国人群食管癌发病的一个保护性因素。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

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.     

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.     

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.