口服避孕药暴露及血管紧张素基因多态与女性脑卒中发病风险的关联研究

目的 <\b>探讨口服避孕药(OC)暴露和血管紧张素原(AGT)基因多态及其联合作用与中国女性脑卒中发病风险的关联.方法 <\b>在“女性避孕药和宫内节育器使用队列”随访的基础上前瞻性收集确诊的脑卒中新发病例,采用病例对照研究方法(按年龄和地区匹配健康对照和医院对照),应用实时荧光定量PCR(Taqman)检测其基因型.结果 <\b>(1)OC轻度升高出血型脑卒中发病风险(OR=1.83,95％CI:1.25～ 2.66).(2)A-6G的AG/GG基因型降低脑卒中发病风险(OR=0.78,95％CI:0.61 ～ 0.99)；Cl1535A的CA/AA基因型使梗塞型脑卒中风险略有降低(OR=0.62,95％CI:0.45 ～ 0.85),AA基因型则使出血型脑卒中的发病风险升高(OR=2.57,95％CI:1.03～6.42).(3)OC和AGT基因的联合作用使得出血型脑卒中的发病风险略有升高.结论 <\b>AGT基因多态性与中国女性脑卒中的发病有关,OC与AGT基因多态性之间的联合作用可能升高出血型脑卒中的发病风险.     

上海市社区人群高血压危险因素聚集与患病关系的研究

目的 <\b>研究超重与中心型肥胖、家族遗传史、不适量饮酒、吸烟、血脂异常和高血糖6项危险因素的聚集与高血压患病间的关系.方法 <\b>利用2008-2011年对15 158名35 ～ 74岁上海市社区居民进行的心脑血管疾病社区综合防治研究项目数据,采用单因素和多因素统计方法,描述危险因素聚集与高血压之间的相关性,使用纵向队列进一步对因果关系进行探讨.结果 <\b>基线调查高血压总现患率为41.9％.随着高血压危险因素聚集数目的增加,与高血压患病关联的OR值(按年龄调整)增大.聚集数目为1～5项及以上的男性其OR值依次为3.157 (95％CI:2.152 ～ 4.630)、6.428 (95％CI:4.435 ～ 9.319)、11.797 (95％CI:8.135～ 17.105)、19.723 (95％CI:13.414 ～ 29.000)、33.051 (95％ CI:21.449～50.930),聚集数目为1～4项的女性其OR值依次为2.917 (95％CI:2.374～ 3.585)、6.499 (95％CI:5.307～ 7.959)、15.717 (95％CI:12.609～ 19.591)、31.719(95％CI:21.744～ 46.270).在纵向队列中,男性和女性的2年发病率分别为1.9％和1.6％.同无危险因素人群相比,聚集数目较多的人群2年发病率较高,女性中当聚集数目为2及3项时其RR值分别为2.111(95％CI:1.024 ～ 4.350)、3.000(95％CI:1.287 ～ 6.995),差异有统计学意义.结论 <\b>随着危险因素聚集数目的增加,高血压患病风险升高,应对危险因素进行综合防控.     

孕前体质指数及孕期增重对新生儿出生体重影响的前瞻性队列研究

  目的   分析孕妇孕前体质指数(body mass index, BMI)及孕期增重(gestational weight gain, GWG)与新生儿出生体重的关联性, 并探究孕妇孕前及孕中体重动态变化对新生儿低出生体重(low birth weight, LBW)及巨大儿的影响。   方法   收集中国孕产妇队列·协和纳入的孕早期孕妇孕前体重, 并随访至分娩后, 收集分娩前体重及新生儿出生结局。将孕妇孕前BMI分为低体重组、正常体重组及超重/肥胖组, 将GWG分为适宜、不足及过多组。采用多因素多分类(多项)Logistic回归分析模型探讨孕前BMI及GWG与新生儿出生体重的关系。   结果   孕前BMI及GWG与子代出生体重相关(均有P < 0.05)。孕前超重/肥胖(OR=2.339, 95% CI:1.674~2.282, P < 0.001)、GWG过多(OR=1.398, 95% CI:1.188~1.978, P=0.048)显示为巨大儿的危险因素, GWG不足(OR=1.479, 95% CI:1.461~1.679, P=0.035)显示为LBW的危险因素, GWG过多会降低LBW的发生风险(OR=0.428, 95% CI:0.225~0.817, P=0.010)。低BMI-GWG不足(OR=1.335, 95% CI:1.048~2.319, P=0.048)是LBW的危险因素; 正常BMI-GWG过多(OR=1.088, 95% CI:1.016~1.675, P=0.038)和超重/肥胖-GWG过多(OR=1.498, 95% CI:1.244~2.017, P=0.046)是巨大儿的危险因素。   结论   孕前BMI及GWG是影响新生儿出生体重的重要因素, 提示女性应合理控制孕前及孕中体重变化。     

低出生体重儿发生的相关危险因素分析

目的 研究低出生体重儿发生的相关危险因素,探讨降低低出生体重儿的相关措施.方法 应用病例对照研究方法,对100例低出生体重儿和300例正常新生儿的相关资料进行单因素分析及非条件多因素Logistic回归分析.结果 母亲年龄(OR=3.232;95％ CI:0.453～ 3.348)、孕周(OR=2.454;95％CI:0.975 ～ 2.349)、双胎及多胎妊娠(OR=2.642;95％ CI:0.723 ～ 2.348)、妊娠期高血压疾病(OR=2.236;95％ CI:0.455～ 2.445)是低出生体重儿发生的相关危险因素,母亲文化程度(OR=3.642;95％ CI:1.347 ～ 3.425)、家庭月收入(OR=3.532;95％ CI:1.436～2.335)是低出生体重儿发生的保护性因素.结论 针对母亲年龄、孕周、双胎及多胎妊娠、妊娠期高血压疾病等危险因素开展针对性的防治工作是降低低出生体重儿发生率的有效措施.     

先天性消化道畸形影响因素的病例对照研究

目的探讨先天性消化道畸形发病的影响因素,为预防先天性消化道畸形发病提供参考。方法采用以医院为基础的病例对照研究方法,对2011年4月至2012年8月在湖南省儿童医院住院的120例先天性消化道畸形患儿及同期同科室住院的170例非先天性消化道畸形患儿父母进行问卷调查,数据分析采用SPSS 18.0软件。结果先天性消化道畸形与母亲孕前3个月内或孕期服用药物(OR=3.35,95％CI：1.5l～7.41)、服用叶酸(OR=O.28,95％CI：0.15～0.52)、接触油性漆(OR=5.05,95％C1：1.32～19.29)、接触农药(OR=15.20,95％C1：1.55～148.99)及母亲孕前短期内患儿父亲服用药物(OR=3.70,95％CI：1.13.12.10)、吸烟(OR=2.39,95％CI=1.24～4.62)、饮酒(OR=2.47,95％C1：1.20～5.07)、接触室内清洗剂(OR=16.42,95％c,：1.71—157.92)、接触油性漆(OR=9.92,95％C／：2.66～36.98)有关。结论先天性消化道畸形的发生受多种环境因素影响,其中母亲孕前短期内或孕期服用药物、接触油性漆、接触农药、母亲孕前短期内患儿父亲服用药物、吸烟、饮酒、接触室内清洗剂为危险因素,母亲孕前短期内或孕期服用叶酸为保护因素。     

上海某区足月新生儿低出生体重的影响因素分析

[目的]探讨孕期健康及行为相关因素对足月新生儿低出生体重的影响. [方法]采用队列研究,将上海某区孕期＜20周的孕早期妇女纳入队列,最后分娩单胎足月活产儿的孕妇共2768人.采用x2检验和logistic回归分析孕期被动吸烟、文化程度、经济状况等因素和低出生体重的关系. [结果]在2768名产妇中,有1284人(46.4％)至少在孕早期或孕晚期有二手烟暴露的情况,孕妇低身高(模型1:OR=0.9,95％CI为0.840～0.996;模型2:OR=0.9,95％CI为0.860～0.998)及怀孕后患有疾病(模型1:OR=2.7,95％CI为1.1～6.5;模型2:OR=2.7,95％CI为1.1～6.6)会增加发生低出生体重儿的风险,孕早期或孕晚期的被动吸烟史对胎儿的出生体重没有影响. [结论]本研究并未发现孕期被动吸烟与胎儿低出生体重发生率之间的关联.     

杭州市城区初中生蔬菜水果摄入情况及影响因素分析

目的 了解杭州市城区初中生蔬菜水果摄入情况及影响因素.方法 在杭州市3个城区初中生中开展横断面自填问卷调查,了解学生每周蔬菜水果的摄入频率、摄入量及相关社会人口学特征,采用logistic多因素回归法分析影响每周吃蔬菜≥21份和水果≥14份的因素.结果 纳入分析的3724名初中生每周每日食蔬菜水果为54.7％,每周进食蔬菜≥21份和水果≥14份(相当于每日食蔬菜≥3份和水果≥2份)为23.6％.女生、母亲文化程度较高、家庭社会经济水平较高的初中生每周蔬菜水果摄入频率和摄入量均较高(P＜0.05).控制了5种社会人口学因素后,每日体力活动≥60 min(OR=1.667,95％CI:1.216 ～ 2.203)、家人每日鼓励多进食蔬菜水果(OR=1.881,95％CI:1.498 ～ 2.363)、每日表扬食蔬菜水果(OR=1.275,95％CI:1.025 ～ 1.586)、每周3 ～6 d(OR=1.691,95％CI:1.310～2.183)和每日(OR=2.944,95％CI:2.348～ 3.690)准备好蔬菜水果、每周3 ～6 d(OR=1.392,95％CI:1.056 ～ 1.835)和每日(OR=2.817,95％CI:2.217～3.580)一起进食蔬菜水果、早餐通常自家做(OR=1.364,95％CI:1.158～1.607)、蔬菜水果健康益处的课程教育(OR=1.238,95％ CI:1.035 ～ 1.480)和认知(OR=3.150,95％CI:1.121 ～ 8.856)与初中生每周食蔬菜≥21份和水果≥14份均有正性关联.结论 杭州市城区初中生蔬菜水果的摄入水平与社会人口学特征、体力活动、家庭饮食环境、蔬菜水果健康益处的教育和认知程度有关.     

尿道下裂危险因素的病例对照研究

目的 探讨尿道下裂病因。方法 采用以医院为基础的1:2配比的病例对照研究方法,以统一的调查表及调查方式对107倒尿道下裂及214例对照进行面对面问卷调查,应用SAS 6.12软件对所有调查因素进行单因素及多因素logistic回归分析。结果 胎儿尿道下裂的发生与母亲孕前自然流产史(OR=3.87,95％CI:1.60～9.39)、孕期发生先兆流产(OR=3.57,95％CI:1.31～9.64)、孕早期感冒伴发热(OR=7.63,95％CI:2.50～23.24)、孕中期用抗感染和/或解热止痛药(OR=16.46,95％CI;3.46～78.21)、父亲职业性接触农药(OR=3.70,95％CI:1.49～9.16)及胎儿低出生体重(OR=12.62,95％CI:2.97～53.67)呈正相关,与母亲孕早期增加蛋白质类营养(OR=0.33,95％CI:O.15～0.74)呈负相关。结论 母亲孕前自然流产史、孕期发生先兆流产、孕早期感冒伴发热、孕中期用抗感染和/或解热止痛药、父亲职业性接触农药、胎儿低出生体重等可能增加胎儿发生尿道下裂的危险,而母亲孕早期增加蛋白质类营养可能降低胎儿发生尿道下裂的危险。     

辽宁省大棚作业农民慢性阻塞性肺疾病危险因素分析

目的 探讨大棚作业人群慢性阻塞性肺疾病(COPD)患病危险因素.方法 2006-2009年采用随机、分层、整群抽样方法,对辽宁省800余个大棚从事作业的农民进行统一问卷调查、体格(血常规、血气分析、胸部X线及肺功能)检查,COPD确诊按照中华医学会呼吸病学分会制定的《慢性阻塞性肺疾病诊治指南》(2007年修订版)诊断标准.结果 共调查从业人员5880人,有效应答者5420人,有效应答率92.18％.年龄(x²＝32.530,P=0.000)、棚内日劳作时间(x²=21.311,P=0.000)、大棚通风频率(x²=9.79l,P=0.007)及大棚面积(x²=73.645,P=0.000)危险因素存在地区差异.logistic回归分析提示,吸烟(OR=1.976,95％CI:1.672～2.334)、年龄(OR=4.188,95％CI:3.718 ～ 4.718)、菌棚(相对于蔬菜棚,OR=1.302,95％CI:1.016 ～ 1.669)、花卉棚(相对于蔬菜棚,OR=1.503,95％CI:1.201～1.880)为大棚作业农民COPD的危险因素;从业年限(OR=0.684,95％CI:0.609 ～ 0.767)是大棚作业农民COPD的保护因素.结论 辽宁省大棚作业农民COPD的发生与多种因素相关,应重视其防治.     

中国2009-2010年18岁以下人群甲型H1N1流感相关肺炎住院病例危险因素分析

目的 描述2009-2010年中国＜18岁人群甲型H1N1流感(甲流)相关肺炎住院病例的临床和流行病学特征,分析并发肺炎的危险因素.方法 对2009年9月1日至2010年7月4日中国“甲型H1N1流感信息管理系统”甲流住院病例(＜18岁)个案数据进行分析,描述其人口学、临床治疗、并发症、慢性基础性疾病等特征,分为并发与未并发肺炎2组进行单因素和多因素logistic分析.结果 共得到4240份甲流相关住院病例个案数据,其中4107例有“是否并发肺炎”方面的信息[2289例(55.7％)并发肺炎].甲流相关肺炎住院病例年龄中位数低于未并发肺炎者(4.9:13.1,P＜0.0001),且出现呼吸窘迫综合征、呼吸衰竭、需要ICU治疗、需要机械通气治疗以及出现死亡的风险均显著增加(P＜0.000l).多因素分析显示,与5～17岁人群相比,＜6月龄(OR=7.08,95％CI:4.15～ 12.06)、6～23月龄(aOR=8.26,95％CI:6.10～11.20)及2～4岁(aOR=9.53,95％CI:7.39～ 12.29)甲流相关住院病例并发肺炎的危险显著增高;哮喘(OR=12.19,95％ CI:5.18～28.72)、心血管疾病(OR=5.19,95％CI:1.94 ～ 13.90)、慢性肾脏疾病(OR=2.14,95％ CI:1.02～4.53)、慢性肝脏疾病(OR=5.26,95％CI:1.40～ 19.81)及过敏(OR=2.54,95％ CI:1.64～3.93)是＜18岁人群甲流住院病例并发肺炎的危险因素;与发病到抗病毒药物治疗的时间间隔不超过2d相比,时间间隔3～4d(OR=1.85,95％CI:1.45～2.36,P＜0.0001)、超过4d(OR=2.91,95％CI:2.29 ～ 3.71,P＜0.0001)显著增加并发肺炎的危险.结论 甲流相关住院病例并发肺炎的比例很高.与未并发肺炎者相比,甲流相关肺炎住院病例的病程更长和转归较差.     

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.     

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.     

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.     

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.