上海市社区老年居民主要慢性病共病流行情况

目的 分析上海市≥60岁社区居民常见慢性病共病流行情况和模式，为制定防治策略提供依据。方法 利用2017年上海市慢性病及其危险因素监测中12 507名≥60岁调查对象数据，基于多阶段复杂抽样加权，计算超重肥胖、高血压、糖尿病、血脂异常、慢阻肺、慢性肾脏疾病和慢性消化系统疾病等7种慢性病患病率和共病患病率，采用关联规则分析7种慢性病的共病模式及关联强度。结果 94.37%的老年居民至少患有纳入7种慢性病中的1种，高血压患病率最高，为58.75%(95%CI:55.96%～61.49%),其次为超重肥胖50.01%(95%CI:47.65%～52.37%)。共病(患慢性病种数≥2种)患病率为65.91%(95%CI:63.17%～68.54%),75～79岁组共病患病率最高，不同年龄组共病患病率差异有统计学意义(χ²=7.75,P<0.05)。关联规则分析显示，总体指向高血压的关联规则最多，{糖尿病}→{高血压}为首位强关联规则，其次为{血脂异常}→{高血压}和{慢性消化系统疾病}→{超重肥胖}。随着年龄增长，产生的符合条件的强关联规则越多，共病模式也越多。75...     

辽宁省城区居民主要慢性病流行现况及影响因素分析

目的了解辽宁省城区居民主要慢性病流行现况及其影响因素。方法采用多阶段分层随机整群抽样法,在辽宁省14个城区抽取31 825名常住居民进行问卷调查及体格检查,采用Logistic回归模型对主要慢性病患病的影响因素进行分析。结果共发放问卷31 825份,回收有效问卷30 953份,问卷有效率为97.26%。辽宁省城市居民慢性病患病率为39.25%,标化患病率为32.29%。慢性病患病率前三位依次为高血压、糖尿病和血脂异常,标化患病率分别为21.13%,9.48%和5.25%。Logistic回归分析结果显示,年龄增加(OR:1.266~7.325)、超重或肥胖(OR:1.107~2.982)是高血压、糖尿病患病和血脂异常的共同危险因素,且3种慢性病互为危险因素(OR:2.424~3.121);低收入(OR=1.320,95%CI:1.241~1.404)、吸烟(OR=1.123,95%CI:1.038~1.215)、饮酒≥1次/周(OR=1.102,95%CI:1.003~1.212)、盐摄入过多(OR=1.118,95%CI:1.056~1.184)是高血压患病的危险因素,女性(OR=0.884,95%CI:0.830~0.941)、高中及以上文化程度(OR:0.675~0.785)、身体活动量≥6千步当量(OR=0.870,95%CI:0.818~0.926)是高血压患病的保护因素;油摄入过多(OR=1.243,95%CI:1.153~1.339)是糖尿病患病的危险因素,身体活动量≥6千步当量(OR=0.843,95%CI:0.777~0.915)是糖尿病患病的保护因素;高中及以上文化程度(OR:1.404~1.888)、高收入(OR=2.335,95%CI:1.804~3.022)、吸烟(OR=1.212,95%CI:1.073~1.369)、饮酒≥1次/周(OR=1.298,95%CI:1.124~1.500)是血脂异常的危险因素。结论高血压、糖尿病和血脂异常是影响辽宁省城市居民健康的主要慢性病,年龄增加、超重或肥胖是其共同的危险因素,且这3种慢性病相互影响,应针对重点人群和危险因素采取相应防治措施。     

河北省成年居民慢性病流行特征及其相关因素分析

目的了解河北省成年居民慢性病及相关危险因素的流行水平。方法采用多阶段随机抽样,通过问卷、体格测量及血样检测等方法,调查分析河北20个区(县)4200名成人慢性病及相关危险因素与流行水平。结果人群超重率、肥胖率、向心性肥胖率、高血压患病率、血脂异常率、糖尿病患病率分别为35.19%,16.38%,52.98%,38.50%,39.62%,5.81%;标化率分别为30.28%,14.05%,44.32%,27.86%,32.71%,4.00%。以上几种慢性病患病率随年龄增长而升高,55岁以下组男性高于女性,55岁以上组女性高于男性,城市高于农村。河北省男性吸烟率、饮酒率高于女性(P<0.01)。居民参加体育锻炼率为22.86%。多因素Logistic回归分析显示,超重是向心性肥胖、高血压、血脂异常和糖尿病的危险因素(OR值和95%CI分别为10.69,6.62～17.26;1.95,1.58～2.40;1.38,1.13～1.69;1.72,1.05～2.81);高血压是超重、向心性肥胖、血脂异常的危险因素(OR值和95%CI分别为1.99,1.60～2.46;1.60,1.33～1.92;1.57,1.35～1.82);血脂异常是超重、向心性肥胖、高血压和糖尿病的危险因素(OR值和95%CI分别为1.40,1.14～1.72;1.56,1.31～1.86;1.58,1.36～1.83;1.66,1.22～2.26)。结论河北省成人慢性病患病率处于全国较高水平,防治处于较低水平。超重、向心性肥胖、高血压、血脂异常是河北省成年居民应重点防治的慢性病,中老年人群是慢性病防治的重点。     

居民血脂异常影响因素的列线图分析

目的调查杭州市上城区居民血脂异常及影响因素,并建立列线图分析居民血脂异常风险。方法采用多阶段随机抽样方法,从上城区随机抽取5个街道,每个街道各抽取2个社区,每个社区抽取153户家庭,纳入家庭户中≥18岁居民进行问卷调查,体格检查和血糖、血脂检测;采用Logistic回归模型分析血脂异常的影响因素,并采用列线图分析血脂异常风险。结果有效调查3 061人,检出血脂异常536例,患病率为17.51%,标化患病率为13.74%。多因素Logistic回归分析结果显示,年龄≥45岁(OR45岁～=2.623, 95%CI:1.738～3.961; OR65岁～=3.941, 95%CI:2.632～5.900; OR75岁～=3.264, 95%CI:2.095～5.084)、超重/肥胖(OR=1.725, 95%CI:1.390～2.140)、糖尿病(OR=3.103,95%CI:2.369～4.063)、高血压(OR=2.789,95%CI:2.196～3.542)、有冠心病家族史(OR=2.215,95%CI:1.443～3.399)是血脂异常的危险因素;日常锻炼(OR=0.790,95%CI:0.630～0.991)是血脂异常的保护因素。建立的血脂异常风险列线图显示,年龄45～64岁为70分,65～74岁为100分,≥75岁为86分,患高血压为75分,患糖尿病为83分,有冠心病家族史为58分,日常不锻炼为17分,超重/肥胖为40分,总分0～373分,一致性指数C-index为0.790 (95%CI:0.779～0.801)。结论年龄≥45岁、超重或肥胖、患糖尿病、患高血压、有冠心病家族史和缺乏日常锻炼与血脂异常相关,根据上述影响因素建立的列线图对个体血脂异常风险有一定预测作用。     

北京市城乡结合部居民心血管疾病危险因素及其与饮食习惯和体力活动的关系

目的 评估北京市城乡结合部居民心血管疾病危险因素流行状况及其与饮食习惯和体力活动的关系.方法 2007年采用多阶段整群随机抽样方法对20 655名18～76岁北京市城乡结合部居民进行横断面调查,通过问卷调查、体格检查和实验室检查收集资料进行分析.结果 北京市城乡结合部居民肥胖、糖尿病、高血压、血脂异常和代谢综合征的标化患病率分别为31.9%,6.1%,33.6%,30.3%和11.6%.嗜咸饮食增加高血压和代谢综合征患病风险,OR值分别为1.72(95%CI:1.29～2.03)和1.48(95%CI:1.16～1.77).嗜甜饮食增加肥胖、糖尿病和代谢综合征患病风险,OR值分别为1.37(95%CI:1.14～1.67)、1.26(95%CI:1.09～1.51)和1.55(95%CI:1.20～1.84).嗜油饮食分别增加肥胖和血脂异常风险,OR值为2.26(95%CI:1.61～2.69)和1.97(95%CI:1.48～2.24).素食饮食和增加体力活动降低肥胖、糖尿病、高血压、血脂异常和代谢综合征的患病风险(P＜0.05).结论 北京市城乡结合部居民具有较高的肥胖、糖尿病、高血压、血脂异常和代谢综合征患病率,健康饮食和体力活动可以降低上述心血管疾病危险因素的患病风险.     

肥胖与四种常见慢性病的相关性分析

目的分析肥胖与高血压、糖尿病、血脂异常和高尿酸血症的相关性,为防控慢性病提供依据。方法于2018年6—10月采用多阶段整群随机抽样方法,选取深圳市宝安区10个社区≥18岁的常住居民为调查对象,采用调查问卷收集基本人口学信息,测量身高、体重、血压和腰围,实验室检测空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和尿酸等生化指标。采用多因素Logistic回归模型分析肥胖与4种慢性病的关联。结果共调查宝安区常住居民2 004人,有效问卷1 994份,有效率为99.50%。宝安区成人超重、肥胖和中心性肥胖检出率分别为32.90%、9.03%和26.28%;高血压、糖尿病、血脂异常和高尿酸血症检出率分别为21.97%、5.97%、36.76%和13.24%。多因素Logistic回归分析结果显示,超重、肥胖均与高血压(OR:1.824～2.745,95%CI:1.350～4.338)、糖尿病(OR:1.725～3.267,95%CI:1.117～5.675)、血脂异常(OR:1.536～1.844,95%CI:1.201～2.796)和高尿酸血症(OR:2.089～2.773,95%CI:1.468～4.563)存在统计学关联;体重过轻与血脂异常(OR=0.418,95%CI:0.221～0.791)存在统计学关联;中心性肥胖与高血压(OR=1.651,95%CI:1.212～2.249)、糖尿病(OR=2.754,95%CI:1.863～4.070)、血脂异常(OR=1.884,95%CI:1.427～2.487)和高尿酸血症(OR=1.868,95%CI:1.325～2.633)均存在统计学关联。结论宝安区居民超重、肥胖和中心性肥胖情况不容乐观,肥胖与高血压、糖尿病、血脂异常和高尿酸血症均存在统计学关联。     

江苏省老年人体质指数和腰围与主要慢性病的关系

目的探讨江苏省老年人体质指数(BMI)、腰围(WC)与高血压、血脂异常和糖尿病等常见慢性病的关系。方法利用江苏省2010年成人慢性病及其危险因素监测中≥60岁老年常住居民的数据,运用t检验或方差分析、偏相关分析和非条件logistic回归等方法,分析BMI、WC与血压、血脂和血糖及高血压、血脂异常和糖尿病等常见主要慢性病的关系。结果江苏省老年人肥胖、中心性肥胖和慢性病粗患病率分别为13.5%、54.3%和82.6%,患病率居于前3位的慢性病为高血压、血脂异常和糖尿病。BMI、WC均与收缩压(SBP)、舒张压(DBP)、TC、LDL-C、TG和FPG呈正相关,而与HDL-C呈负相关(P0.05)。肥胖、中心性肥胖、BMI和WC均与高血压、血脂异常和糖尿病显著相关,高血压、血脂异常和糖尿病患病风险随着BMI和WC的增加而不断升高(P0.05)。BMI每增加1个标准差(SD),高血压、血脂异常和糖尿病患病风险分别升高79%(OR=1.79,95%CI:1.61~2.00)、67%(OR=1.67,95%CI:1.52~1.84)和56%(OR=1.56,95%CI:1.38~1.76);WC每增加1个SD,高血压、血脂异常和糖尿病患病风险分别升高63%(OR=1.63,95%CI:1.47~1.80)、74%(OR=1.74,95%CI:1.58~1.91)和66%(OR=1.66,95%CI:1.46~1.89)。结论高血压、血脂异常和糖尿病是江苏省老年人常见主要慢性病。BMI、WC与高血压、血脂异常和糖尿病密切相关。     

丽水市区居民高血压患病及影响因素分析

目的 分析丽水市区居民高血压患病情况及影响因素.方法 采用多阶段整群随机抽样的方法,对2684名18岁以上居民进行现况调查.研究内容包括问卷调查,体格检查(身高,体重,腰围,血压)和实验室检查(空腹血糖,总胆固醇,高密度脂蛋白,低密度脂蛋白,甘油三脂). 结果丽水市区居民高血压粗患病率为33.1%,标化率为22.14%.男性高血压粗患病率为35.2%,标化率为26.10%;女性高血压粗患病率为31.6%,标化率为19.78%.多因素分析结果显示,高血压的影响因素包括血脂异常(OR=1.5, 95%CI 1.23~1.83),中心型肥胖(OR=1.29, 95%CI 1.01~1.66),超重和肥胖(OR=1.71, 95%CI 1.43~2.05),高血压家族史(OR=6.53, 95%CI 5.22~8.18),民族(OR=1.82, 95%CI 1.30~2.57),糖尿病(OR=1.31, 95%CI 1.00~1.71),年龄(OR=1.36, 95%CI 1.31~1.41). 结论丽水市市区居民高血压患病率较高,主要与血脂异常,糖尿病,中心型肥胖,超重和肥胖,遗传等因素有关.在老龄化社会的客观形势下,高血压综合防治工作中应在加强中老年人高血压三级预防的基础上,针对行为影响因素加强宣传教育与干预.     

广西壮族自治区百色市慢性非传染性疾病及其危险因素现况调查

目的了解百色市城乡居民主要慢性非传染性疾病及其危险因素的流行状况,为制定慢性病预防控制策略和措施提供科学依据。方法采用多阶段分层整群抽样的方法,抽取百色市2县(区)18岁及以上常住居民1 200人,进行问卷调查和身高、体重、腰围、血压及血糖、血脂测量;采用Epi Data3.0软件建立数据库,用SPSS 18.0软件进行统计分析。结果人群吸烟率、饮酒率分别为18.8%、10.3%;食盐摄入过多率、红肉摄入过多率、蔬菜水果摄入不足率分别为16.4%、48.5%、75.1%;体力活动不足率为8.3%;人群超重率、肥胖率、高血压患病率、糖尿病患病率分别为28.0%、6.4%、35.1%、9.8%,标化率分别为26.4%、6.7%、26.3%、7.7%;高胆固醇血症患病率、低高密度脂蛋白血症患病率、高低密度脂蛋白血症患病率、高甘油三脂血症患病率分别为9.6%、13.5%、10.0%、11.5%,标化率分别为7.0%、12.1%、8.0%和10.5%。多因素非条件logistic回归分析结果显示,年龄(OR=1.965,95%CI:1.725-2.238)、性别(OR=0.536,95%CI:0.379-0.758)、民族(OR=1.616,95%CI:1.275-2.047)、饮酒(OR=3.027,95%CI:1.904-4.814)、体质指数≥24.0 kg/m~2(OR=2.011,95%CI:1.508-2.682)、低高密度脂蛋白(OR=0.564,95%CI:0.359-0.887)、高甘油三酯(OR=1.724,95%CI:1.063-2.797)等是高血压的独立影响因素。结论百色市城乡居民超重率、肥胖率、高血压患病率、糖尿病患病率、血脂异常率处于较高水平,人群中吸烟、危险饮酒、膳食结构不合理和体力活动不足,应作为城乡居民慢性病预防与控制干预的重点对象。     

南浔区50岁及以上人群2型糖尿病患病率调查

目的了解南浔区≥50岁人群2型糖尿病(T2DM)患病率及影响因素,为制定社区糖尿病干预策略提供依据。方法于2017年6—11月,采用多阶段随机整群抽样方法抽取1 612名≥50岁的常住户籍居民进行问卷调查、体格检查和生化指标检测,采用Logistic回归模型分析T2DM患病的影响因素。结果有效调查1 551人,有效率为93.32%。调查发现T2DM 127例,患病率为8.19%。Logistic回归分析结果显示,高血压(OR=2.394, 95%CI:1.480～3.872)、糖尿病家族史(OR=34.487, 95%CI:21.533～55.232)、超重(OR=1.746, 95%CI:1.420～3.427)、肥胖(OR=1.906, 95%CI:1.427～3.393)和中心性肥胖(OR=1.602, 95%CI:1.394～1.920)是≥50岁人群T2DM患病的危险因素,日均蔬菜摄入量500 g (OR=0.423, 95%CI:0.229～0.780)是T2DM患病的保护因素。结论南浔区50岁及以上人群T2DM患病率为8.19%,高血压、糖尿病家族史、超重、肥胖和中心性肥胖是当地50岁及以上人群患T2DM的危险因素。     

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.     

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.