肥胖儿童血压与体质指数及血清胰岛素关系

目的 探讨青春期肥胖儿童血压与体质指数(BMI)及空腹血清胰岛素(INS)的关系.方法 选取13-14岁青春期肥胖儿童65名和体重正常儿童87名为研究对象,测量身高、体重、血压,并计算BMI,用放免法测定空腹血清INS.结果 青春期肥胖组儿童高血压发生率(26.15%)明显高于对照组儿童(2.35%)(P=0.000),肥胖组高血压发生的相对危险度为11.377;肥胖组儿童空腹血清INS平均为(26.87±11.57)mU/L,高于对照组儿童(16.34±5.28)mU/L(P=0.000);收缩压(SBP)和舒张压(DBP)与空腹血清INS在控制BMI后均无相关性(P<0.05);SBP和DBP与BMI在控制INS后仍显示存在正相关关系(P<0.05).结论 肥胖儿童发生高血压的危险性明显高于体重正常儿童;肥胖儿童高血压的发生与BMI呈正相关,与血清INS水平变化无关.     

北京3～6岁儿童体质指数及腰围与血压的关系

【目的】分析北京市3~6岁儿童血压与体质指数(body mass index,BMI)、腰围(waist circumference,WC)的关系,探讨儿童高血压与肥胖及肥胖类型的关系。【方法】选取2004年4—10月进行的北京市儿童代谢综合征研究(Beijing children metabolic syndrome study,BCAMS)中1 862名3~6岁儿童(男942,女920人)为研究对象,分析其血压水平与BMI及WC的关系;以BMI标准分别划分儿童超重和肥胖,以WC标准划分腹型肥胖,分析肥胖与高血压状态的变化及其趋势。【结果】北京3~6岁儿童收缩压(systolic blood pressure,SBP)和舒张压(diatolic blood pressure,DBP)均值按BMI和腰围正常、超重和肥胖组顺序依次升高;控制年龄和性别后,BMI、腰围与SBP和DBP呈独立正相关(P0.001);超重组和肥胖组的高血压患病率均显著高于正常组(P0.001),BMI肥胖组高血压患病率为45.9%,高血压发生风险是正常组的3.3倍;腹型肥胖组高血压患病率为38.6%,高血压患病风险是正常组的2.6倍。【结论】儿童BMI、WC与SBP和DBP呈正相关,用BMI和腰围评价的肥胖均可增加儿童高血压的患病风险,高血压患病率随着肥胖程度增加呈现成倍上升趋势。控制儿童BMI和腰围可以降低儿童血压水平,从而降低高血压发病风险。     

营养不良儿童血清瘦素水平与BMI、能量摄入的相关性分析

【目的】　探讨营养不良儿童血清瘦素水平的变化及其与能量摄入的相关性。　【方法】　检测32例营养不良患儿的空腹血清瘦素水平、体质指数(body mass index,BMI)、能量摄入量,并与32例健康儿童比较,同时分析血清瘦素水平与BMI、能量摄入的相关性。　【结果】　①病例组与对照组间的血清瘦素水平比较有统计学差异(F=4.574,P<0.05),病例组明显降低;②病例组中患儿的血清瘦素水平与BMI、能量摄入均有显著相关性(P<0.05);对照组中血清瘦素水平与BMI存在显著相关性(P<0.05), 但血清瘦素与能量摄入无显著相关性(P>0.05) 。　【结论】　营养不良儿童血清瘦素水平明显降低;其低下的原因,除了患儿脂肪含量下降致瘦素分泌减少外,还与能量摄入的减少有关。     

单纯性肥胖儿童血脂及内皮素检测与分析

【目的】对不同程度单纯性肥胖儿童的血脂成份、内皮素(ET)结合临床进行分析,探讨单纯性肥胖儿童血脂和ET的变化及临床意义。【方法】选择单纯性肥胖儿童50例和对照组儿童42例,对两组儿童进行临床检查和血总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、ET的检测。【结果】①单纯性肥胖组与对照组比较,体质指数(BMI)、血压(BP)均增高,差异均有显著性(P<0.05);②单纯性肥胖组血清TC,TG,LDL,ET较对照组各项均增高,差异有显著性,且增高程度与BMI呈正相关;HDL水平两组比较差异无显著性。【结论】单纯性肥胖儿童存在血脂代谢紊乱,血清TC,TG,LDL和ET水平均升高,应对单纯性肥胖儿童进行早期干预,从儿童时期开始预防动脉粥样硬化性心血管疾病。     

腰围/身高比值:预测儿童代谢综合征有效简便的中心性肥胖指标

【目的】探讨和评价腰围/身高比值(waist/height ratio,WHtR)作为中心性肥胖指标预测儿童代谢综合征(metabolic syndrom,MS)的可行性和价值。【方法】对2003年10月~2006年5月就诊于山东省立医院儿科内分泌门诊的中重度肥胖儿童进行体检和生化检测,检出符合MS诊断标准的38例和无生化异常的单纯性肥胖儿童20例作为观察组,210名性别、年龄匹配的健康儿童作为正常对照组。对三组进行WHtR、体质指数(body mass index,BMI)、腰围(waist circumference,WC)比较并进行相关性分析。【结果】①正常儿童WC与年龄显著相关,BMI青春期者高于青春期前者,WHtR与年龄、性别无关,且反映中心性肥胖,正常儿童不超过0.5;②MS组WHtR、BMI及WC均显著高于正常组和单纯肥胖组,单纯肥胖组显著高于正常对照组;③WHtR、BMI及WC三者之间均呈显著直线正相关。【结论】WHtR作为简单易行的体检指标,无年龄性别差异,与BMI、WC高度相关,为预测儿童代谢综合征有效简便的中心性肥胖指标之一,大于0.5的儿童应注意饮食平衡和锻炼。     

青春期肥胖儿童血清瘦素与胰岛素关系

目的 探讨青春期肥胖儿童血清瘦素(LEP)与空腹血清胰岛素(INS)的关系,为有效开展儿童肥胖防治工作提供参考.方法 选取73对13～14岁青春期肥胖儿童和体重正常儿童为研究对象,测量身高、体重,并计算体质量指数(BMI),用放射免疫法测定空腹血清LEP和INS.结果 青春期肥胖组男、女儿童平均血清LEP(20.35±6.88和28.21±3.65 μg/L)均高于对照组(8.10±4.28和17.64±4.78 μg/L),且男童LEP低于女童(P<0.01);肥胖组男、女儿童平均血清INS(29.40±14.08和25.20±11.72 mIU/L)均高于对照组(17.23±7.13和16.85±5.08 mIU/L),但未发现性别间差异(P>0.05).在控制BMI后,LEP与INS在肥胖组和对照组男童中均存在正相关关系(P<0.05),在女童中均未发现相关性(P>0.05).结论 青春期肥胖儿童存在瘦素抵抗和胰岛素抵抗.肥胖儿童血清LEP女童高于男童,血清INS无性别差异.LEP与INS的相关性存在性别差异.     

肥胖儿童血清瘦素指标检测及其与中枢性性早熟女童青春期发育关系的探讨

目的:观察肥胖儿童血清瘦素水平,探讨瘦素和体重指数(BMI)的关系,同时研究特发性中枢性性早熟(ICPP)女孩青春各期血清瘦素变化规律。方法:肥胖组为2002~2004年度在吉林省医院门诊就医的体重高于同年龄小儿标准体重20?的患儿50例,对照组为体检正常的儿童50例,年龄均为5~11岁;另外选择35例处于青春各期的特发性中枢性性早熟女孩(ICPP)为观察组,以17例正常青春前期女孩作为对照组。分别测量各组瘦素和BMI。结果:(1)肥胖儿童血清瘦素水平均高于非肥胖儿童,与BMI呈正相关;(2)ICPP女孩青春早、中、晚期血瘦素均高于对照组(P<0.05)。结论:(1)儿童瘦素水平与BMI高度相关,肥胖儿童存在瘦素抵抗现象。(2)ICPP女孩血清瘦素水平均在青春早期明显升高并与青春期发育过程平行。     

单纯性肥胖学龄儿童纵向生长与血清IGF-1/IGFBP3变化

【目的】 调查单纯性肥胖儿童生长变化及血清胰岛素样生长因-1(IGF-1)/胰岛素样生长因子结合蛋白3(IGFBP-3)浓度。 【方法】 根据广州两所小学从7岁开始建立的身高/体重纵向体检资料,然后依据体质指数分类标准筛选7岁以来一直处于正常体重和肥胖的11岁儿童,同时以父母身高中值为配对因素,选取一直肥胖的儿童31人(男20,女11)和一直体重正常的儿童42人(男20,女22)分析身高纵向变化,并测试空腹血清IGF-1/IGFBP3浓度。 【结果】 肥胖组男童身高高于同龄时正常体重儿童,且11岁时IGF-1/IGFBP3浓度皆高于正常体重儿童(P<0.05);女童肥胖组与正常组身高差异则无统计学意义,11岁时IGF-1/IGFBP3浓度也无显著变化。 【结论】 单纯性肥胖并不影响青春期前(或青春期)儿童的生长或反使生长加速,相应的血清IGF-1/IGFBP3浓度无改变或增加。     

分泌型卷曲相关蛋白5和脂联素在肥胖儿童体重指数与血压关联中的中介效应分析

目的 探讨肥胖高血压患儿血中脂肪细胞因子水平变化在体重指数(BMI)与血压关联的中介效应,为控制肥胖儿童高血压的进展提供一定理论依据及临床指导。方法 以2012年6月—2014年8月就诊于西安交通大学第二附属医院小儿内分泌门诊的120例肥胖儿童为研究对象,根据血压测量结果对高血压组儿童进行为期6个月的生活方式干预,入院后及生活方式干预前后测量所有儿童及高血压组儿童身高、体重、腰围、BMI及血压,用酶联免疫法检测血中脂联素、趋化素、瘦素、分泌型卷曲相关蛋白5(Sfrp5)、Wnt家族分泌性相关蛋白a(Wnt5a)、超敏C反应蛋白(hsCRP)和肿瘤坏死因子α(TNF-α)浓度。以给予生活干预前后细胞因子的变化作为中介变量,BMI的变化为自变量(ΔBMI),舒张压及收缩压的降低为因变量(ΔSBP和ΔDBP)进行中介效应分析。结果 高血压组儿童与非高血压组比较,Sfrp5及脂联素显著降低,而趋化素、瘦素、Wnt5a、hsCRP显著升高,差异有统计学意义(P<0.05);TNF-α在两组间比较差异无统计学意义(P<0.05);生活方式干预后肥胖高血压组儿童血中脂联素及Sfrp5与干预前相比显著升高,而趋化素、瘦素、Wnt5a、hsCRP则显著降低(P<0.05)。肥胖高血压患儿在接受生活方式干预后BMI的变化(ΔBMI)与收缩压及舒张压的变化关联中,控制协变量后,ΔSfrp5及Δ脂联素具有部分中介效应,而Δ趋化素及ΔhsCRP在BMI的变化(ΔBMI)与收缩压及舒张压变化的关联中无中介效应。结论 Sfrp5和脂联素在肥胖儿童血压升高的过程中具有一定中介作用。     

单纯性肥胖儿童血压与体重指数的关系

目的:探讨青春期单纯性肥胖儿童血压与体重指数(BMl)的关系。方法:选取13～14岁青春期单纯性肥胖儿童50名和体重正常儿童67名为研究对象,测量身高、体重、血压并计算BMI。结果:青春期单纯性肥胖组儿童高血压发生率(26.0%)明显高于对照组儿童(3.0%),肥胖组高血压发生的相对危险度为11.377。结论:单纯性肥胖儿童发生高血压的危险性明显高于体重正常儿童,肥胖儿童高血压的发生与BMI呈正相关。     

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.