北京市社区脑卒中高危人群血压干预效果的评价

目的 了解北京市45-79岁社区脑卒中高危人群的血压干预效果.方法 2011年5月至2012年4月对北京市7604名45-79岁社区脑卒中高危人群每月随访-次,由社区医生制定个体化的随访管理方案,分析干预后血压平均水平、高血压控制率、脑卒中发病率.结果 干预前高血压患病率为64.1％.干预后,收缩压、舒张压分别下降2.9、1.5 mm Hg,血压下降明显(t值分别为-20.987、-15.494,P值均为0.000);前四次随访血压下降幅度最大;收缩压下降幅度表现为高年龄组下降幅度大(F=14.287,P=0.000),男性高于女性(t=-2.885,P=0.004),郊区人群高于城区(t=5.314,P=0.000),初中及以下文化程度者下降幅度大(t=-6.943,P=0.000);舒张压下降幅度表现为低年龄组人群下降幅度大(F=22.864,P=0.000),男性高于女性(t=-2.259,P=0.024),初中以上文化程度者下降幅度大(t=2.428,P=0.015).干预后高血压控制率由67.7％上升到87.9％,明显升高(χ²=324.595,P=0.000).脑卒中发病率为2.7‰,郊区人群明显高于城区(χ²=5.293,P=0.021).结论 社区干预可降低脑卒中高危人群的血压平均水平,提高高血压控制率,进而降低脑卒中发病率;以早期血压干预效果好,其中男性血压下降明显.     

浙江省非超重成年人血脂异常患病率及影响因素分析

目的 探讨浙江省非超重成年人血脂异常流行特征及影响因素。方法 选择参加2010年浙江省代谢综合征流行病学调查的10 868名年龄≥18周岁非超重/肥胖居民(BMI<24.0 kg/m²)为研究对象,进行问卷调查、体检和血脂检测,采用多因素logistic回归模型分析影响因素。结果 该人群血脂异常患病率为41.38%,男性(43.19%)显著高于女性(39.84%)(χ²=12.53,P<0.001);随年龄增长,男性血脂异常患病率降低(趋势χ²=47.61,P<0.001),女性患病率升高(趋势χ²=3.88,P<0.05),<50岁男性患病率明显高于女性;农村人群患病率(41.49%)略高于城市(41.21%),但差异无统计学意义(χ²=0.08,P=0.774);多因素logistic回归分析显示,性别、慢性病家族史、现在吸烟、现在饮酒、高肉蛋类饮食、烹调使用动物油、体力活动、中心性肥胖和BMI是非超重成年人血脂异常的影响因素。结论 浙江省非超重成年人血脂异常患病率较高,家族史、吸烟、高脂饮食、体力活动不足、中心性肥胖等是主要影响因素。     

宁夏回族自治区回、汉族居民烟草、酒精使用调查

目的 了解宁夏回族自治区(宁夏)回、汉族居民烟草、酒精使用情况及其分布特征,为民族地区改善戒烟、限酒措施提供参考。方法 采用多阶段系统抽样法,抽取宁夏地区≥18岁居民6 476人进行入户调查。烟草和酒精使用障碍根据国际疾病分类-10(ICD-10)标准采用复合型国际诊断交谈表3.0(CIDI 3.0)中文版评估。结果 共有5 811名受访者完成全部调查,目前吸烟率为19.15%,其中男性吸烟率高于女性(44.73% vs. 1.51%),差异有统计学意义(χ²=1 693.25,P< 0.001);男性中回族吸烟率低于汉族(33.19% vs. 51.95%),差异有统计学意义(χ²=79.99,P< 0.001)。男性烟草依赖患病率为1.75%,回、汉族男性烟草依赖患病率差异无统计学意义(χ²=0.02,P=0.958)。目前饮酒率为5.78%,其中男性饮酒率高于女性(12.48% vs. 1.16%),差异有统计学意义(χ²=329.94,P< 0.001);男性中回族饮酒率低于汉族(4.71% vs. 17.34%),差异有统计学意义(χ²=82.03,P< 0.001);男性酒精使用障碍患病率为6.03%,男性回族酒精使用障碍患病率低于汉族(3.50% vs. 7.61%),差异有统计学意义(χ²=16.68,P< 0.001)。结论 宁夏地区回族成年人烟草和酒精使用率低于同地区汉族,当地的回族文化对减少人群烟草、酒精使用可能具有积极的影响。     

内蒙古部分地区流动人口糖尿病现况调查

目的 了解内蒙古地区流动人口中糖尿病及糖尿病前期的患病现状。方法 采用按行业分层整群抽样方法进行等额抽样,调查内容包括问卷调查、身体测量和实验室检测。结果 内蒙古部分地区流动人口糖尿病及糖调节受损粗患病率分别为12.5%和12.8%,年龄标化患病率均为9.9%;男性糖尿病患病率高于女性,女性糖调节受损粗患病率高于男性;不同性别糖尿病患病率均随年龄的增长而增加（趋势χ²=11.162,P=0.001）;建筑业人群糖尿病患病率最高（19.2%）,糖调节受损患病率的差异无统计学意义;外省流入人群流动前糖尿病患病率高,糖调节受损患病率的差异无统计学意义,省内流动人群糖调节受损患病率随流动时间的增加而增长（趋势χ²=9.989,P=0.002）。结论 内蒙古部分地区流动人口糖尿病患病率较高,已接近大城市居民患病水平,其中中老年和建筑业人群患病率最高,省内流动人口糖尿病患病率对内蒙古地区流动人口患病率贡献较大。     

天津市2007-2013年宫颈癌发病趋势及流行特征分析

目的 分析天津市宫颈癌发病趋势及流行特征。方法 利用天津市疾病预防控制中心肿瘤发病登记监测系统2007-2013年宫颈癌发病资料结合人口学资料,参照国际疾病分类(ICD-10)编码进行分类,计算宫颈癌发病率和年龄别发病率,并进行趋势分析。结果 2007-2013年天津市宫颈癌新发病例3362例,平均发病年龄为48.11岁,平均发病率为9.85/10万,标化发病率为6.65/10万。城市地区人群整体发病构成高于农村地区,但发病构成呈逐年下降的趋势(χ²=21.92,P=0.001),而农村地区人群发病呈上升趋势(χ²=12.70,P=0.048),差异有统计学意义。城市地区人群发病率总体保持平稳,年度变化百分比(APC)值为2.7%(95%CI:-9.1%~16.2%),差异无统计学意义(Z=0.564,P=0.597);农村地区人群发病率则呈上升趋势,APC值为13.4%(95%CI:3.5%~24.2%),差异有统计学意义(Z=3.549,P=0.016)。年龄别发病率曲线出现双峰,分别为40~44岁及75~79岁。结论 2007-2013年天津市宫颈癌发病率总体仍保持平稳,发病主要集中在中老年人群,其中农村地区发病率升高的趋势值得关注。     

海南省0~6岁儿童孤独症谱系障碍的现况调查及影响因素分析

目的 了解海南省0~6岁儿童孤独症谱系障碍的患病情况及其影响因素。方法 抽查海南省18个市（县）0~6岁儿童37 862人,采用儿童发育问题预警征象调查表筛查,再由专科医师现场诊断,采用一般描述统计、χ²检验、非条件logistic回归分析孤独症现况及影响因素。结果 共诊断235例孤独症儿童,总患病率为0.62%,其中男童为0.99%,女童为0.17%,男童高于女童（χ²=101.91,P=0.000）。随年龄增长孤独症患病率上升（χ²=288.62,P=0.000）。城市孤独症患病率高于其他地区,差异有统计学意义（χ²=114.77,P=0.000）。是否足月、新生儿窒息、父亲性格、父亲有嚼槟榔或吸烟习惯、母孕期总体情绪状态以及母亲人流史为孤独症的影响因素。结论 海南省0~6岁儿童孤独症谱系障碍的患病率居国内较高水平并受遗传因素、孕产过程、父母在孕前及孕期不良行为、习惯等综合因素的影响。     

北京市2010-2015年法定报告传染病流行特征分析

目的 分析北京市2010-2015年法定报告传染病发病趋势和流行特征,为完善法定报告传染病防控策略提供数据参考。方法 收集2010-2015年中国疾病预防控制信息系统中北京市报告的甲乙丙类法定报告传染病监测数据,进行流行病学分析。结果 2010-2015年,北京市共报告法定报告传染病病例764290例,年报告发病率在498.95/10万~828.45/10万之间,呈逐年下降趋势(χ²=1.25×10⁴,P<0.01)。肠道传染病和呼吸道传染病年报告发病率均呈逐年下降趋势(χ²=1.25×10⁴,P<0.01;χ²=4.97×10²,P<0.01);分别占甲乙类报告总例数的39.72%和33.01%。男性报告发病率高于女性,7岁以下学龄前儿童年均发病率高于其他年龄组人群,占报告总例数的47.79%,高发职业主要是散居儿童,占全部报告病例的31.64%。发病顺位居前三位的病种连续6年均为其他感染性腹泻病、手足口病和痢疾。法定报告传染病实验室诊断率为16.67%,呈逐年升高趋势。结论 肠道传染病是目前北京市较为严重的法定报告传染病,应加强学龄前儿童尤其是散居儿童的传染病预防控制,进一步提高实验室诊断率以有效控制传染病的流行。     

中国2004-2015年不同预防接种阶段甲型肝炎和戊型肝炎流行病学特征比较

目的 比较甲型肝炎（甲肝）和戊型肝炎（戊肝）在不同预防接种阶段的流行病学特征,并结合疫苗使用情况,为优化戊肝疫苗使用建议提供参考。方法 将2004-2015年分为2004-2007、2008-2011和2012-2015年3个阶段,年龄划分为0~、20~、30~和≥ 40岁组,比较不同时段、不同年龄组报告发病率的差异;同时描述疫苗批签发及甲肝疫苗使用情况。结果 2004-2015年,中国甲肝报告发病率呈逐渐下降趋势（t=-12.15,P<0.001）,戊肝报告发病率呈逐渐升高趋势（t=6.63,P<0.001）。甲肝和戊肝月均报告发病数分别由2004-2007年的6 515、1 491例变化为2012-2015年的1 986、2 277例,戊肝每年3月出现发病峰值且持续出现。东、中、西部地区甲肝报告发病率均下降明显,但西部（3.46/10万）仍明显高于东部（1.13/10万）和中部（1.14/10万）（χ²=32 630,P<0.01）;中、西部地区戊肝上升明显,东部地区较为平稳（2.66/10万）,但仍高于中部（1.74/10万）和西部（1.58/10万）（χ²=6 009,P<0.01）。甲肝0~19岁人群下降84.36%;戊肝≥ 20岁人群报告发病率逐渐上升,且年龄越高、报告发病率越高。甲肝疫苗接种率由62.05%提高到93.54%,接种率与甲肝报告发病率呈负相关（F=10.69,χ²<0.05）。结论 2004-2015年中国甲肝发病快速下降,戊肝发病仍在上升,应推动戊肝疫苗在人群中的使用。     

1996-2014年中国HIV-1毒株CRF01_AE亚型传播簇和传播网络研究

目的 了解我国HIV-1毒株CRF01_AE亚型在省内和省际的传播规律和风险因素,为实施精准干预提供参考依据。方法 收集我国19个省份1996-2014年已有的2 094条CRF01_AE pol区基因序列,利用PhyML 3.0软件构建系统进化树,确定传播簇,利用Cytoscape 3.6.0软件构建传播网络,结合背景信息分析传播风险。结果 发现82个传播簇,包含255条序列（12.18%,255/2 094）,省内传播簇数量和包含序列数（61个,173条）明显多于跨省传播簇（21个,82条）。传播簇中男男性传播人群的成簇比例随时间上升趋势明显,由1996-2008年的2.41%（2/83）上升为2013-2014年的23.61%（72/305）（χ²=27.800,df=1,P=0.000）。跨省传播簇的男男性传播人群比例明显高于省内传播簇,由1996-2008年的0.67%（2/297）上升为2013-2014年的6.36%（30/472）,具有随时间的上升趋势（χ²=20.276,df=1,P=0.000）。跨省传播簇中男男性传播的比例（86.59%,71/82）明显高于省内传播簇（56.65%,98/173）,差异有统计学意义（χ²=22.792,P=0.000）。含2种及以上传播途径的跨省传播簇的比例（33.33%,7/21）明显高于省内传播簇（13.11%,8/61）,差异有统计学意义（χ²=4.273,P=0.039）。传播网络分析发现,跨省传播簇内高传播风险人群比例（51.22%,42/82）明显高于省内传播簇（26.59%,46/173）,差异有统计学意义（χ²=14.932,P=0.000）。跨省传播簇以男男性传播人群为主。结论 我国HIV-1毒株CRF01_AE亚型存在复杂的传播网络,跨省传播簇快速增长,其中高风险传播者对HIV-1亚型的大范围传播起到重要作用,应深入进行传播网络研究以指导精准干预。     

北京市18~65岁慢性病患者吸烟状态、戒烟态度及危险因素分析

目的 了解北京市18~65岁高血压、糖尿病、血脂异常、COPD、哮喘患者的吸烟状态、戒烟态度及危险因素。方法 数据来源于2014年北京市成人慢性病与危险因素监测,即在北京市16个区/县采用多阶段分层整群抽样方法抽取180个社区共19 815名调查对象,以其中18~65岁人群作为研究对象。结果 18 405例有效样本中,男性高血压、血脂异常患者现在吸烟比例均高于非患者（分别χ²=17.695,P<0.001;χ²=39.292,P<0.001）;女性高血压、COPD、哮喘患者现在吸烟者比例均高于非患者（分别χ²=6.649,P=0.010;χ²=6.276,P=0.012;χ²=8.245,P=0.004）。吸烟者中,高血压患者1年内想戒烟比例低于非高血压患者（χ²=20.487,P<0.001）,COPD患者1年内想戒烟比例高于非COPD患者（χ²=6.085,P=0.048）。男性中糖尿病（χ²=9.219,P=0.010）、血脂异常（χ²=13.513,P=0.001）患者中已戒烟者控制情况好于现在吸烟者。多因素logistic回归结果显示,吸烟是高血压（OR=1.17）、血脂异常（OR=1.25）、COPD（OR=1.78）、哮喘（OR=1.57）的影响因素。结论 北京市18~65岁居民中部分慢性病患者现在吸烟比例高且戒烟意愿低;吸烟是高血压、血脂异常、COPD、哮喘的危险因素。     

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.