上海市初中生2013年与2019年烟草流行情况比较分析

目的 了解上海市初中生烟草流行情况和变化趋势,探索初中生吸烟行为的影响因素,为制定青少年控烟干预策略提供数据支持和科学依据。方法 采用多阶段分层整群随机抽样的方法,分别于2013年抽取8个区,2019年抽取10个区,调查上海市初中在校学生的烟草流行情况。采用χ²检验比较2次调查的烟草流行率,多因素logistic回归分析相关影响因素。结果 2019年上海市初中生现在吸烟率为0.6%,尝试吸烟率为2.9%,均低于2013年水平（分别为0.7%和6.9%）;2019年现在电子烟使用率（0.6%）较2013年无明显变化（0.6%）;2019年听说过电子烟的比例（78.4%）显著高于2013年水平（47.2%）;2019年初中生在家中、室内公共场所、室外公共场所、公共交通工具二手烟暴露率为72.5%,略低于2013年水平（73.0%）,以上比较均差异有统计学意义（P<0.05）。多因素logistic回归分析结果显示,2019年,好朋友吸烟（OR=27.381,95%CI：12.037~62.287）、校内看到有人吸烟（OR=2.477,95%CI：1.155~5.312）、认为二手烟可能没有危害（与认为二手烟肯定有危害相比,OR=8.471,95%CI：1.464~49.005）的初中生现在吸烟率更高。≥15岁（与≤12岁相比,OR=8.688,95%CI：1.922~39.266）、室外二手烟暴露（OR=8.608,95%CI：1.048~70.692）、好朋友吸烟（OR=8.115,95%CI：1.754~37.545）的初中生现在电子烟使用率更高,认为吸烟使社交更不舒服［与认为吸烟使社交更舒服相比（OR=0.105,95%CI：0.018~0.615）］的初中生现在电子烟使用率更低,以上均差异有统计学意义（P<0.05）。结论 上海市初中生烟草流行情况在近年保持较低水平,但二手烟暴露情况不容乐观。初中生吸烟行为与个人对烟草的态度认知、二手烟暴露、同伴吸烟及学校控烟状况密切相关,应从多维度开展预防和干预,切实保护青少年远离烟草危害。     

江西省居民吸烟行为及烟草消费情况分析

目的 了解江西省居民吸烟行为,分析烟草消费隋况及烟草价格上涨对吸烟行为潜在影响。方法 采用三阶段随机整群抽样方法,在江西省11个设区市中选择上饶市和宜春市作为调查现场,利用KISH码在32个街道/镇820户家庭中选择15岁及以上居民进行问卷调查。结果最终人组的805名居民中,现在吸烟者218人,吸烟率为27.08%(男性吸烟率为46.62%,女性吸烟率为3.05%)。218名吸烟居民中,烟龄最短1年,最长50年,烟龄中位数为20年。96.33%的吸烟居民通过“自己购买”获得卷烟,54.59%吸烟居民吸5～9元一包的卷烟,20.64%吸l～4元一包的卷烟,18.8l%吸10～15元一包的卷烟,仅13名吸烟居民平常吸15～30元一包的卷烟。吸烟居民平均每月最少花费20元,最多花费800元,平均花费192元,占个人月收入的13%。根据218名吸烟居民关于卷烟价格上涨对其吸烟行为影响的回答绘制曲线图,可了解卷烟价格上涨对吸烟者吸烟行为的潜在影响情况。结论 江西省吸烟居民的烟草经济负担较重,烟草价格上涨将促使吸烟者改变吸烟行为。应考虑中国烟草价格低、价格跨度大等现实问题,合理提高烟草销售价格,改变吸烟人群的吸烟行为,进而逐渐降低人群吸烟率。     

中国农村地区现在吸烟者戒烟意愿及其影响因素研究

目的 了解中国农村地区现在吸烟者戒烟意愿,探索其影响因素,为控烟工作提供参考。方法 本研究数据来源于2018年中国慢性病及危险因素监测,采用多阶段分层整群抽样的方法抽取184 509名≥18岁居民,其中10 241名农村现在吸烟者纳入研究。采用χ²/F检验对戒烟意愿与人口学信息、烟草使用情况、烟草相关危害知识的认知、慢性病患病情况等因素进行单因素分析,多因素分析采用非条件多因素logistic回归分析。结果 3 453名（37.46%）考虑在未来12个月内戒烟。logistic回归分析显示,偶尔吸烟者的戒烟意愿高于每天吸烟者（OR=0.693,95%CI：0.494~0.971）,每天吸烟量<1包者的戒烟意愿高于≥1包者（OR=0.628,95%CI：0.511~0.771）,12个月内有戒烟经历者的戒烟意愿高于12个月内未戒过烟的现在吸烟者（OR=0.438,95%CI：0.357~0.537）,烟草危害认知程度高者戒烟意愿更高（OR=1.056,95%CI：1.028~1.086）,差异均有统计学意义（P<0.05）。结论 中国农村地区现在吸烟者戒烟意愿与吸烟状况、吸烟量、戒烟情况、烟草危害认知有关。建议加强对农村地区的健康教育宣传,提供简短的戒烟干预,提高农村现在吸烟者的戒烟意愿。     

中国15岁及以上吸烟人群复吸率及其影响因素研究

目的 描述我国≥15岁吸烟人群复吸情况,分析影响复吸行为的主要因素。方法 本研究数据来源于2018年中国成人烟草调查,覆盖31个省（自治区、直辖市）的200个区/县的400个居委会/村,以面对面调查的方式收集≥15岁居民吸烟和复吸的相关数据。采用SAS 9.4软件进行数据清洗和分析,logistic回归模型分析复吸率的影响因素。结果 调查共完成个人问卷19 376份,应答率为91.50%。2018年我国≥15岁吸烟者中复吸率为66.05%,其中男性66.59%,女性55.79%;15~24岁年龄组复吸率最高（82.63%）。多因素分析结果显示,15~24岁年龄组（OR=4.618,95%CI：1.981~10.763）、现在使用电子烟（OR=9.782,95%CI：3.139~30.490）、过去30 d看到过烟草广告、促销和赞助（OR=1.710,95%CI：1.291~2.265）人群的复吸率较高;与家中室内允许吸烟或没有规定相比,完全不允许吸烟（OR=0.562,95%CI：0.439~0.719）和部分允许吸烟（OR=0.487,95%CI：0.366~0.647）的人群复吸率较低。结论 中国吸烟者的复吸率较高,尤其是年轻人。建议针对本研究发现的影响因素开展相应的干预以降低复吸率,助力实现“健康中国2030”既定的控烟目标。     

山东省小学生吸烟行为与健康素养的相关性分析

目的 探讨4~6年级小学生吸烟行为与健康素养的相关性。方法 采用多阶段分层整群抽样方法,以问卷形式调查2017年山东省4~6年级小学生健康素养水平及烟草使用情况,收集调查对象一般人口学资料、健康素养水平、吸烟情况,采用二分类logistic回归分析烟草使用与健康素养的相关性。结果 共发放9 240份调查问卷,合格问卷9 210份,调查对象应答率为99.7%。4~6年级小学生现在吸烟率为2.6%,男生现在吸烟率（3.1%）高于女生（2.0%）;总体健康素养水平为60.8%,其中男生为56.7%,女生为64.9%。吸烟者健康素养水平为14.4%,非吸烟者为62.0%。logistic回归分析显示,影响吸烟的自变量有年级、父亲文化程度、经济发展水平、自我评价学习成绩和健康素养水平（P<0.01）。控制了混杂因素影响后,不具有健康素养水平小学生吸烟率是具有健康素养水平的8.62倍（1/0.116）。结论 山东省4~6年级小学生吸烟行为与健康素养水平存在相关性。     

黑龙江省中学生电子烟流行现状及影响因素分析

目的 描述黑龙江省中学生电子烟使用现状及其影响因素,为制定省级青少年电子烟防控策略提供循证依据。方法 2021年采用多阶段分层整群概率抽样方法,涵盖黑龙江省10个监测区（县）56所初、高中学校180个班级在校学生8 340人,抽中班级内学生统一自填问卷。采用SAS 9.4软件进行数据清洗加权和分析。采用χ²检验比较组间差异,采用两水平logistic回归模型分析中学生电子烟使用的影响因素。结果 共8 329份调查问卷纳入分析。黑龙江省中学生使用过电子烟和现在使用电子烟的比例分别为18.27%和5.46%。在使用过电子烟方面,男生（23.94%）高于女生（12.35%）;职业高中生（39.18%）高于普通高中生（24.11%）高于初中生（11.27%）。在现在使用电子烟方面,男生（7.08%）高于女生（3.76%）;职业高中生（14.56%）高于普通高中生（7.70%）高于初中生（2.67%）。在一周内可支配的零花钱＞40元、身边父母、朋友、教师吸烟、现在吸卷烟、看到过电子烟广告组内,使用过电子烟及现在使用电子烟的比例均在同组内相对较高。两水平logistic回归模型显示,性别、现在是否吸卷烟、好友吸烟状况、是否看到过教师在学校吸烟、是否看到过电子烟广告、对电子烟易感的态度是中学生现在使用电子烟的影响因素。结论 黑龙江省中学生使用过电子烟和现在使用电子烟的比例较高。电子烟广告、好友吸烟状况、是否看到过教师在学校吸烟等是影响黑龙江省中学生电子烟使用的主要因素,需要在全省无烟校园建设中,重点关注无烟环境的建设以及增加电子烟危害知识相关健康教育内容。     

山东省15岁及以上居民电子烟流行现状及影响因素分析

目的 了解山东省≥15岁居民对电子烟的知晓和使用情况，分析其影响因素，探讨电子烟使用和戒烟的关系，为进一步开展电子烟相关研究提供初步数据。方法 使用全球成人烟草调查标准问卷，采用分层多阶段整群概率抽样法，在山东省抽取6 401名调查对象，用掌上电脑进行电子数据采集，对样本进行复杂加权后，使用复杂抽样模块对数据进行分析。结果 调查对象电子烟知晓率为37.6%，曾经使用率为3.8%，现在使用率为0.6%。Logistic回归分析显示居住地为城市、年龄较小、现在或以前吸烟、看到过吸烟危害或者鼓励戒烟的信息是吸电子烟的危险因素。电子烟使用者的尝试戒烟率（30.1%）明显高于不使用者（19.5%）（P<0.05），但戒烟率却远远低于不使用者（P<0.05）。结论 电子烟的知晓率和使用率呈上升的趋势，需引起社会的广泛关注，下一步应加强并规范电子烟使用情况的监测，为制定有针对性的干预措施提供依据。     

我国40岁及以上吸烟人群烟草依赖严重程度及其影响因素分析

目的 了解我国≥40岁吸烟人群烟草依赖情况及其影响因素,为我国广泛开展戒烟干预提供科学数据。方法 本研究数据来源于2014-2015年中国居民慢性阻塞性肺疾病监测,覆盖31个省（自治区、直辖市）的125个监测点,以面对面询问调查的方式收集≥40岁居民吸烟和烟草依赖的相关变量。应用复杂抽样加权估计我国≥40岁现在吸烟和现在每日吸烟人群烟草依赖率及其95%CI并分析其影响因素。结果 纳入分析现在吸烟者22 380人,现在每日吸烟者19 999人。≥40岁现在吸烟人群的重度烟草依赖率为31.1%（29.3%~32.9%）,其中男性为32.0%（30.2%~33.9%）,高于女性17.6%（13.4%~21.7%）;乡村为32.7%（30.2%~35.2%）,高于城镇;40~59岁年龄组重度烟草依赖率较高,为33.3%（31.3%~35.2%）。≥40岁现在每日吸烟人群的重度烟草依赖率为35.0%（33.0%~37.0%）,男性为35.8%（33.8%~37.8%）,女性为22.0%（16.8%~27.2%）。在现在吸烟人群和每日吸烟人群中,文化程度越低,重度烟草依赖率越高;18岁以前开始吸烟者重度烟草依赖率明显高于18岁及以后开始吸烟者;有慢性呼吸道症状者的重度烟草依赖率明显高于无症状吸烟者;慢性呼吸系统疾病患者和非患者的重度烟草依赖率差异无统计学意义（P>0.05）;患有糖尿病、心脑血管疾病和高血压的吸烟者的重度烟草依赖率略低于非患者（P<0.05）。多因素logistic回归分析结果显示,男性、中部和东部地区、40~59岁年龄组、从事农林牧渔水利、生产运输和商业服务职业、文化程度低、18岁以前开始吸烟者患重度烟草依赖的风险高。结论 我国≥40岁吸烟人群的重度烟草依赖水平较高,戒烟干预服务客观需求巨大,应采取有效措施推动我国戒烟干预工作的开展。     

山东省2016-2017年人群烟草使用及其影响因素调查

目的 了解山东省人群烟草使用现状以及主要影响因素。方法 运用多阶段分层整群抽样方法,在山东省36个区（县）216个村（居委会）抽取调查对象,使用非条件logistic回归模型进行多因素分析。结果 有效调查6 271人,经过复杂加权计算后,≥ 15岁人群现在吸烟率为23.93%,其中男性为45.58%,女性为1.18%;不同年龄组人群现在吸烟率差别较大,45~64岁年龄组现在吸烟率最高（25.07%）;不同文化程度人群吸烟率不同,初中文化程度者现在吸烟率最高（28.94%）;农村现在吸烟率（24.98%）高于城市（23.08%）;现在每日吸烟率为20.23%,吸烟者开始吸烟平均年龄为21.21岁,日平均吸机制卷烟量为16.31支;在调查所有曾经和现在吸烟者中,戒烟率为20.79%。多因素logistic回归分析结果显示,性别、年龄、职业、地区、健康知识得分与吸烟行为存在关联。男性现在吸烟率高于女性（OR=49.625,95%CI：37.832~65.093）,45~64岁组现在吸烟率高于15~24岁组（OR=1.830,95%CI：1.048~3.194）,农林牧渔从业者现在吸烟率分别高于医务人员（OR=0.403,95%CI：0.187~0.866）和离退休人员（OR=0.648,95%CI：0.481~0.873）,中部地区居民现在吸烟率低于东部（OR=0.724,95%CI：0.606~0.865）,吸烟危害健康知识得分1~3分组现在吸烟率高于4~6分组（OR=1.432,95%CI：1.240~1.654）。结论 山东省人群吸烟率处于较高水平,应对吸烟者开展控烟健康教育等综合性干预措施,以降低人群吸烟率。     

农村男性吸烟者戒烟意愿影响因素分析

目的 了解农村男性现在每天吸烟者戒烟意愿影响因素及其相对重要性。方法 采用横断面研究方法,以山东省临沂市莒南县14个行政村的男性现在每天吸烟者为研究对象,逐一入户,进行面对面问卷调查,共得有效问卷1 287份。应用logistic回归分析、优势logistic回归分析探讨戒烟意愿影响因素及其相对重要性。结果 1 287名每天吸烟者中有318人（24.7%）打算在未来6个月内戒烟。logistic回归分析显示,有既往戒烟经历（OR=1.691,95%CI：1.458～1.962）、吸烟量少（OR=0.751,95%CI：0.639～0.884）、烟草危害认知程度高（OR=1.038,95%CI：1.001～1.077）、患慢性病（OR=1.765,95%CI：1.013～3.075）的男性吸烟者更倾向有戒烟意愿。优势logistic回归分析显示,既往戒烟经历是戒烟意愿首位影响因素,其他依次是吸烟量、烟草危害认知以及慢性病患病情况。结论 农村男性吸烟者戒烟意愿比例较低。戒烟意愿主要与吸烟者自身因素有关,其中有既往戒烟经历是增加戒烟动机的首位影响因素。     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

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.