山西省农村地区18～59岁居民血压水平变化追踪

目的 分析山西省农村地区18～59岁居民血压水平及其变化情况,为探索我国农村地区血压水平及防控措施提供参考。方法 研究对象来自山西营养与慢性病家庭队列,剔除2002年基线调查时年龄<18岁或年龄≥60岁研究对象、基线时患有高血压的个体和2015年随访调查时近2周正在服用降压药物者,共纳入1 629名基线调查时18～59岁的调查对象,分析2002年基线调查和2015年随访调查时的血压水平及变化情况。结果 2002年18～59岁人群的SBP由（122.7±10.4）mmHg（1 mmHg=0.133 kPa）增长至2015年的（132.8±17.6）mmHg,DBP由（72.7±6.9）mmHg增长至（78.8±10.3）mmHg,男性和女性SBP增长率分别为6.7%和9.5%。男性和女性DBP增长率分别为9.3%和7.8%。18～、30～、40～和50～59岁年龄组人群SBP增长率分别为5.0%、6.7%、9.4%和11.8%。而DBP增长率分别为12.2%、8.2%、8.2%和6.5%。结论 山西省农村地区18～59岁居民SBP和DBP均值水平均呈现明显的增长趋势,SBP增加水平呈现女性高于男性,随年龄增加而递增趋势,DBP增加水平呈现男性高于女性,随年龄增加而递减的趋势。     

煤矿工人血清中GGT水平与血压相关性分析

目的探讨肝功能指标血清中γ谷氨酰胺转肽酶(GGT)与血压水平的相关性。方法采用横断面研究方法,选取邯郸地区2 372名在岗男性煤矿工人为研究对象,通过职业健康检查获取资料,包括年龄、性别、职业史、家族史、生活史等,测量其身高、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血红蛋白(Hb)等。将所入选的受检者根据血压水平(mm Hg)分为3组,正常血压组(n=957):SBP120、DBP80;高血压前期组(n=958):SBP 120~139、DBP;高血压组(n=457):SBP≥140、DBP≥90。按血清中GGT水平四分位数分为4组,以SPSS 17.0统计软件分析其血清中GGT与SBP、DBP、FPG、TG、TC、HDL-C、BMI之间的相关性。结果①该人群的血清中GGT随血压水平的升高而逐渐升高,差异有统计学意义(P0.01);②年龄、BMI、腰围、TG、TC、FPG、Hb随血压水平的升高而逐渐升高,差异有统计学意义(P0.01);HDL-C随血压升高而逐渐降低,差异有统计学意义(P0.05)。③根据GGT水平四分位组比较,随着GGT水平升高,年龄、SBP、DBP、TC、TG、FPG、Hb、ALT、AST、腰围和BMI均升高,差异均有统计学意义(P0.01),HDL-C随GGT升高而降低,差异有统计学意义(P0.01)。④以血清中GGT水平为因变量,年龄、TG、TC、HDL-C、FPG、Hb、SBP、DBP、ALT、AST为自变量进行逐步回归分析显示,GGT可显著影响SBP、TG、TC、FPG、Hb,未发现对DBP有独立影响。结论血清中GGT水平与血压呈显著正相关,是收缩压的独立风险因素。     

我国成年居民膳食胆固醇摄入量与血清总胆固醇水平关系的研究

目的 了解我国成年居民膳食胆固醇摄入量与血清总胆固醇(TC)水平的关系。 方法 资料来源于2009年第八轮“中国健康与营养调查”。将参加2009年中国健康与营养调查并有完整个人信息的18~65岁成年居民作为调查对象。分析调查对象膳食胆固醇摄入量与TC水平的相关关系, 探讨膳食胆固醇摄入对TC水平的影响及膳食胆固醇摄入过量人群高胆固醇血症的患病风险。结果 我国成年居民膳食胆固醇摄入量与TC水平及LDL-C水平呈显著正相关(均P<0.05);多元回归分析显示, 成年居民膳食胆固醇摄入量是影响TC水平(P<0.05)及女性LDL-C水平的重要因素(P=0.01);调整混杂因素后, 膳食胆固醇摄入过量(≥300 mg/d)的男女性人群发生高胆固醇血症的危险性明显增高(OR=1.21, 95%CI: 1.03~1.42, P=0.019;OR=1.18, 95%CI: 1.00~1.40, P=0.044)。结论 我国成年居民膳食胆固醇摄入量与其TC水平存在一定关联, 降低居民膳食胆固醇摄入量可以预防高胆固醇血症的发生。     

糖尿病肾病发病的相关因素分析

目的 <\b>探讨糖尿病肾病(DN)发病的相关因素.方法 <\b>选取2009-2011年天津市第四中心医院住院治疗756例2型糖尿病患者,按尿微量白蛋白排泄率(UAER)分为三组,即＜20μg/min为无DN组(A组),20 μg/min＜UAER＜200 μg/min为微量DN组(B组),≥200 μg/min为大量DN组(C组).记录患者的一般资料,检测实验室指标,用多因素logistic回归分析DN的相关因素.结果 <\b>756例2型糖尿病患者中DN患者(B组和C组)228例,患病率为30.2％.DN患者年龄、病程、DBP和SBP均显著高于无DN组(A组)(P＜0.05)；大量DN组(C组)年龄、病程、DBP和SBP分别为(64.08±11.71)岁、(14.67±7.34)年、(87.43±14.36)mm Hg、(152.45±18.48)mmHg,与微量DN组(B组)对比,差异均有统计学意义(P＜0.05)；B组空腹血糖(FPG)、TG、TC、HDL-C、尿酸(UA)、糖化血红蛋白(HbAlc)、空腹胰岛素(FINS)、空腹C肽(FCP)分别为(9.27±3.06)mmol/L、(1.98±0.37) mmol/L、(5.01±1.08) mmol/L、(1.05±0.35) mmol/L、(312.78±39.83)mmol/L、(9.33±1.47)％、(11.45±7.83) μU/ml、(509.73±132.78) pmol/L,与A组对比,差异均有统计学意义(P＜0.05)；大量DN组(C组)FPG、TG、HDL-C、UA、FINS、FCP分别为(9.29±3.12)mmol/L、(2.02±0.36) mmol/L、(1.04±0.27) mmol/L、(389.72±46.32) mmol/L、(11.09±8.29)μU/ml、(575.77±143.29) pmol/L,与A组对比,差异均有统计学意义(P＜0.05)；大量DN组(C组)与微量DN组(B组)对比,UA、FINS、FCP的差异均有统计学意义(P＜0.05).多因素logistic回归分析表明,病程、BMI、SBP、HbAlc、FPG、UA与DN的发生有关.结论 <\b>DN的发生与病程、年龄及血糖、血脂、血压、尿酸水平密切相关.     

心血管病高危人群腰围和体重变化与血压水平变化关系的随访研究

目的 探讨心血管病高危人群中腰围和体重变化与血压水平变化的关系,为高血压及心血管病防治提供理论依据和参考。方法 选取2016年纳入随访调查的12 931名心血管病高危人群作为研究对象,将其2017-2019年长期随访数据纳入分析。统计学分析采用t检验、χ²检验和广义估计方程。结果 在心血管病高危人群中,腰围、体重和BMI增加,血压水平升高的风险高;腰围、体重和BMI减少,血压水平升高的风险低。腰围每增加1 cm,SBP增加0.200（95%CI：0.164~0.236） mmHg,DBP增加0.085（95%CI：0.066~0.105） mmHg;体重每增加1 kg,SBP增加0.355（95%CI：0.289~0.421） mmHg,DBP增加0.182（95%CI：0.144~0.220）mmHg;BMI每增加1 kg/m²,SBP增加1.100（95%CI：1.194~1.258） mmHg,DBP增加0.365（95%CI：0.273~0.456） mmHg。心血管病高危人群中农村居民相对于城市居民,SBP随腰围和体重变化更大,DBP随腰围变化更大（交互作用P<0.05）;随访高血压不患病相对于随访高血压患病人群,SBP随腰围和BMI变化更大,DBP随BMI变化更大（交互作用P<0.05）。结论 在心血管病高危人群中,腰围、体重和BMI的变化与血压水平的变化均存在正向线性相关。     

超重/肥胖成年人体脂与血压关联中血脂中介效应的分析

目的 探索超重/肥胖成年人体脂与血压关联中血脂的中介效应。方法 选取20~55岁超重/肥胖个体作为研究对象,测量其血压、血脂、体脂率指标,采用中介效应模型分析体脂率与血压关联中血脂的中介效应。结果 男性和女性体脂率与SBP、DBP均呈正相关(SBP: β值分别为0.208 3和0.188 4,DBP: β值分别为0.205 2和0.209 6,P值均<0.001)。男性体脂率与HDL-C水平呈负相关(β =-0.142 2,P<0.01),与LDL-C水平呈正相关(β =0.180 5,P<0.001);女性体脂率与TC、LDL-C水平均呈正相关(β值分别为0.172 1和0.233 5,P<0.001)。控制体脂率后,男女性TC、TG水平与DBP均呈正相关(男: β值分别为0.095 6和0.090 5,女: β值分别为0.117 6和0.083 1,P值均<0.05),且女性TG水平与SBP呈正相关(β =0.127 2,P<0.001);女性体脂率与DBP的关联中,LDL-C水平具有中介效应(中介效应值为0.019 4,P<0.05),中介效应百分比为9.26%。结论 体脂率与血压呈正相关,男性体脂率与血压关联中血脂无中介效应,女性体脂率与血压关联中LDL-C水平具有中介效应。     

职业人群的体质指数和血脂水平在饮酒行为与高血压关联间的中介效应

目的 探讨职业人群饮酒行为与高血压及SBP、DBP的关联, 分析体质指数（BMI）和血脂水平的中介作用,为职业人群的高血压预防提供参考。方法 基于西南地区职业人群队列,通过问卷调查、体格和血生化检查收集人口学特征、行为生活方式、血压和血脂等情况。采用logistic回归分析和线性回归分析饮酒行为与高血压及SBP、DBP的关联,采用因果中介分析估计BMI、HDL-C、LDL-C、TG和TC的独立和联合中介效应,并结合网络分析探索饮酒行为、BMI、血脂水平与高血压之间的相互关联。结果 共纳入22 887名研究对象,其中新发高血压1 825名。Logistic回归分析发现, 与从不饮酒人群相比,现在饮/既往饮酒可使高血压风险增加33%（OR=1.33,95%CI：1.19~1.48）;饮酒行为可使SBP（β=1.05,95%CI：0.69~1.40）和DBP（β=1.10,95%CI：0.83~1.38）增加。联合中介分析发现, BMI和血脂介导了饮酒行为与高血压及SBP、DBP间21.91%、28.40%和22.64%的效应,其中BMI和TG为主要的中介因素,也是饮酒行为、BMI、血脂水平和血压网络中边权和桥强度中心性最高的2个中介节点。结论 饮酒行为与患高血压风险升高有关,BMI和TG是重要的中介因素和网络中关键节点,提示应重点关注饮酒行为、BMI和TG,有助于职业人群的高血压预防。     

天津市20041名3～6岁入托儿童血脂水平分析

目的 了解天津市3～6岁儿童血脂水平和血脂异常检出率.方法 采集天津市48所幼儿园20041名3～6岁儿童末梢血,采用东芝120全自动生化分析仪检测血浆总胆固醇(TC)和甘油三酯(TG)水平.结果 20041名入托儿童TC和TG分别为(4.17±0.69) mmol/L和(0.86±0.44) mmol/L;血脂异常总检出率为11.4％,其中TC异常检出率为7.1％,TG为4.9％,两项均异常的检出率为0.6％.不同性别儿童TC异常检出率女童高于男童,差异有统计学意义(x²=51.77,P＜0.001).不同年龄组儿童TC和TG异常检出率的差异均有统计学意义(x²=10.29,P=0.016;x²=10.93,P=0.012),但未见明显的年龄变化趋势.不同肥胖程度儿童TC异常检出率的差异无统计学意义,TG异常检出率差异有统计学意义(x²=211.8,P＜0.001),肥胖儿童TG异常检出率明显高于正常和超重儿童.城乡地区儿童TC和TG异常检出率差异均有统计学意义(x²=22.09,P＜0.001;x²=11.26,P=0.001),TC异常检出率城市儿童高于农村,TG异常检出率农村儿童高于城市.结论 天津市3～6岁儿童血脂异常率较高,且存在性别、年龄、肥胖程度、地区差异,应有针对性开展儿童血脂异常筛查与干预.     

健康体检人群脉搏波传导速度特征及其与心血管疾病危险因素关系的分析

目的　分析健康体检人群脉搏波传导速度特征,及其与心血管疾病危险因素的相关性。方法　选择四川省人民医院13841名健康体检人员,询问疾病史,测量身高、体重、BMI、血压等,检测FPG、血脂、UA等生化指标,应用动脉硬化仪检测踝臂脉搏波传导速度(baPWV)。结果　健康体检男女性人群baPWV值均随年龄增长而逐渐升高,<60岁男性baPWV值明显高于女性。多元线性回归分析显示年龄、SBP、BMI、FPG、UA和TG水平均为baPWV的影响因素,其中年龄、SBP对baPWV的影响最大,标准化回归系数>0．42。结论　健康体检人群的baPWV值随性别、年龄呈不同的分布特征。应加强对老年人群,尤其是老年女性的baPWV监测,早期预防高危人群心血管事件的发生。     

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.     

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.     

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.     

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.