中学生酒精烟草药物拒绝技能影响因素分析

了解青少年拒绝技能普及率及拒绝技能变化的影响因素,为预防青少年药物滥用措施的制定提供参考.方法 以百色市2所高中285名学生(14 ~20岁)为调查对象,采用问卷调查方式评价青少年感觉寻求、情绪智力、拒绝技能、应对方式和不良同伴状况.结果 青少年在首次选择中更多选择“拒绝”策略(83.51%),再次选择中更多选择“离开”策略(87.02%);青少年在首次酒精烟草和药物(ATOD)供给时采用“拒绝”、“解释”、“离开”策略分别有5.88%,5.79%,3.90%.再次ATOD供给时均选择“接受”.Poisson回归分析显示,影响拒绝技能变化的因素主要包括性别、积极应对、消极应对(P值均<0.05).结论 性别和应对方式影响青少年拒绝技能的变化情况.提示在今后实施干预时,男女生间的干预方案应具有性别上的针对性,同时帮助青少年建立积极的应对方式.     

基于三元影响理论的中等职业学校学生毒品使用倾向相关因素分析

目的 探索基于三元影响理论（TTI）的中等职业学校学生（中职学生）毒品使用倾向的相关因素，为毒品预防教育提供理论依据。方法 2013年9月至2014年12月采用多阶段整群抽样的方法从5个城市共抽取8 870名中职学生进行自填式问卷调查，调查内容包括感觉寻求、父母监管、毒品可及性、社会效益期待、拒绝效能、社会规范及毒品使用倾向。以TTI为基础，运用logistic回归模型探索中职学生毒品使用倾向的相关因素。结果 TTI个体内影响流中，高感觉寻求是毒品使用倾向的危险因素（OR=1.71，95% CI：1.22～2.41，P<0.01），中等拒绝效能（OR=0.18，95% CI：0.14～0.23，P<0.001）和高拒绝效能（OR=0.17，95% CI：0.13～0.22，P<0.001）均为毒品使用倾向的保护因素；TTI人际间影响流中，父母中等监管（OR=0.46，95% CI：0.37～0.56，P<0.001）和高监管（OR=0.33，95% CI：0.24～0.46，P<0.001）均为毒品使用倾向的保护因素，觉知他人吸毒和觉知他人赞同其吸毒为毒品使用倾向的危险因素（均P<0.001）；TTI社会文化环境影响流中，认为毒品获得容易（OR=3.47，95% CI：2.69～4.48，P<0.001）、具有毒品社会效益期待（OR=2.04，95% CI：1.69～2.46，P<0.001）是毒品使用倾向的危险因素。结论 高感觉寻求、毒品容易获得、高社会效益期待、觉知他人吸毒、觉知他人赞同其吸毒可正向预测中职学生的毒品使用倾向，青少年毒品预防教育应重视对上述因素的监控，并重视提高父母监管力度及传授中职学生毒品拒绝技能。     

性感觉寻求与青少年男男性行为人群危险性行为的关系

目的 研究25岁及以下青少年男男性行为人群(YMSM)性感觉寻求与其艾滋病相关危险性行为的关系。方法 于2013年5-11月通过互联网宣传、外展活动以及例行的艾滋病自愿咨询检测服务招募403名YMSM, 采用匿名问卷调查, 回收375份(93.05%)有效问卷。结果 YMSM中有37.9%首次同性性行为未使用安全套, 最近6个月有55.7%发生多性伴行为, 51.7%有“419”(一夜情)行为, 5.6%有群交行为。性感觉寻求与首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为呈正相关(偏相关系数分别为0.247、0.218、0.296、0.252)。分别以首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为作为因变量进行logistic回归分析, 结果显示性感觉寻求高者更有可能发生以上危险性行为。结论 青少年性感觉寻求水平对危险性行为有影响, 应加强基于人群性感觉寻求分析的艾滋病相关知识及行为教育, 强化艾滋病相关危险性行为的风险意识, 从而更有效开展YMSM艾滋病干预。     

男男性行为人群HIV暴露前预防需求与使用障碍研究

目的 了解MSM对HIV暴露前预防（PrEP）的实际需求及阻碍其使用的相关因素。方法 通过同性社交Blued 6.5.0软件、MSM同伴推荐等方法招募MSM为调查对象，估算样本量600人。利用"问卷星"平台，在调查员的指导下进行匿名电子问卷调查，调查内容包括一般情况、PrEP相关知识和使用意愿与顾虑、PrEP实际需求及PrEP使用自我效能等。结果 共调查622名MSM，知晓和曾使用过PrEP的比例分别为56.4%（351/622）和4.3%（27/622）；67.2%（418/622）有PrEP实际需求，PrEP使用自我效能良好的为21.2%（132/622）。结构方程模型分析结果显示，PrEP相关知识和使用顾虑对PrEP使用自我效能发挥直接正向作用，效应系数分别为0.08和0.13，自我歧视是由于PrEP使用顾虑而间接影响PrEP使用自我效能，效应系数为0.035；广义线性混合模型分析结果表明，曾使用过PrEP可增加使用自我效能（OR=5.55）；PrEP相关知识和使用顾虑每增加1分，PrEP使用自我效能分别增加0.14倍和0.07倍。担心药物副作用、预防效果和费用者分别占61.1%（380/622）、60.1%（374/622）和53.2%（331/622）；期望获取PrEP服务途径主要为CDC（75.6%，470/622）、MSM社会组织（65.4%，407/622）和互联网（63.8%，397/622）。结论 MSM对PrEP呈现高需求与低使用的较大差距，PrEP相关知识缺乏、自我歧视、对药物预防效果、副作用及费用的顾虑是阻碍MSM使用PrEP的因素，故需要建立适合MSM特点的PrEP服务模式，以满足MSM对PrEP干预的需求。     

应用社会网络分析法选择大学生性教育同伴教育者的研究

目的 通过社会网络调查与分析,结合“关键人物”本人意愿,确定性教育同伴教育者。方法 2014年3月通过自填式问卷调查,收集四川省成都市某中医药大学2个班119名大学新生人口学信息、个体社会网络以及“以班级为单位”的整体社会网络信息,运用SPSS 23.0软件对人口学信息进行描述分析,UCINET 6软件分析社会网络并绘制网络示意图。结果 调查对象最主要的行为亲密和私密话题网络成员是大学同学,调查对象能够获得大学同学经济支持、与其外出玩耍和聊私密话题的比例分别为95.8%（114/119）、96.6%（115/119）和91.6%（109/119）。调查对象向大学同学寻求健康咨询的比例为89.1%（106/119）。2个班共确定性教育同伴教育者17人,其中10人为班干部。结论 大学同学是大学生最重要的社会网络成员,社会网络分析可确定合适的同伴教育者。     

大学前不同阶段同伴欺凌经历与大学生生活质量的关联研究

目的 探讨大学前不同阶段同伴欺凌经历对大学生生活质量的影响。方法 2018年10月采用分层整群抽样方法选取安徽省合肥市4所高校4 034名在校大学生作为研究对象,调查研究对象大学前不同阶段同伴欺凌经历和当前的生活质量。采用t检验和方差分析比较不同组各维度得分差异,采用多元线性回归模型分别分析大学前不同阶段欺凌经历、不同欺凌种数与大学生生活质量的关系。结果 4 034名大学生生活质量4个维度（生理、心理、社会关系和环境）得分分别为12.61±2.02、14.09±2.62、13.72±2.71和13.77±2.46。多元线性回归分析（控制相关混杂因素）结果显示,大学生在小学（β=-0.21）、中学（β=-0.27）和两阶段（β=-0.56）被言语欺凌、中学阶段被关系欺凌（β=-0.21）、中学阶段被躯体欺凌（β=-0.38）和两阶段躯体欺凌（β=-0.67）均与大学生生活质量生理维度得分呈负相关;大学生在两阶段被言语欺凌（β=-0.41）和中学阶段被关系欺凌（β=-0.42）与大学生生活质量心理维度得分呈负相关;大学生在中学阶段被关系欺凌（β=-0.32）、中学（β=-0.51）和两阶段被躯体欺凌（β=-0.57）均与大学生生活质量社会关系维度得分呈负相关;大学生在小学和两阶段被言语欺凌（β=-0.20、-0.46）和关系欺凌（β=-0.35、-0.90）均与大学生生活质量环境维度得分呈负相关,差异均有统计学意义（P<0.05）。欺凌受害指数与大学生生活质量生理、心理、社会关系和环境4个维度得分呈负相关（β=-0.33、-0.36、-0.30、-0.33）;实施欺凌指数与大学生生活质量4个维度得分也呈负相关（β=-0.28、-0.31、-0.23、-0.28）,相关性差异均有统计学意义（P<0.001）。结论 大学前不同阶段欺凌经历均与大学生生活质量各维度得分降低有关联,应加强大学前不同阶段同伴欺凌的预防控制。     

同伴关系自我效能感与青少年网络成瘾的关系

探讨青少年同伴关系、自我效能感与网络成瘾的关系,为青少年网络成瘾的预防和干预提供依据.方法 采用中学生同伴关系问卷、一般自我效能感量表和网络成瘾量表,对整群抽取的广东省6所中学573名学生进行问卷调查.结果 33.5%的青少年至少存在轻度网络成瘾行为,男生网络成瘾率(46.70%)高于女生(20.88%),初中生网络成瘾率(37.67%)高于高中生(28.94%),差异均有统计学意义(x2值分别为24.08,6.02,P值均<0.05).网络成瘾青少年在同伴关系及自我效能感上得分均低于非成瘾青少年(P值均<0.01);青少年网络成瘾与同伴关系3个维度及总分呈负相关(r值分别为-0.229,-0.105,-0.210,-0.253,P值均<0.05),与自我效能感亦呈负相关(r=-0.628,P<0.01).同伴关系对网络成瘾有明显的直接效应(β=-0.253,P<0.01),且自我效能感中介效应有统计学意义(β=-0.605,P<0.01),中介效应占总效应的比例为68.2%.结论 自我效能感在同伴关系与网络成瘾间起部分中介作用.     

中国6~17岁儿童青少年腰围水平及中心性肥胖流行特征

目的 分析我国6~17岁儿童青少年腰围水平及中心性肥胖流行特征。方法 利用"2010-2012年中国居民营养与健康状况监测"中6~17岁儿童青少年调查资料,分析儿童青少年腰围水平及中心性肥胖流行现状。利用腰围的P₉₀（同年龄、同性别）作为中心性肥胖的判断界值。结果 我国各年龄组儿童青少年腰围均为男生大于女生（P<0.000 1）,城市大于农村（P<0.05）,家庭收入水平高的儿童青少年大于中、低家庭收入儿童青少年（P=0.000 3）。6~17岁儿童青少年中心性肥胖率为11.2%,其中男生和女生分别为10.7%和11.8%,差异无统计学意义（P>0.05）。城市和农村男生的中心性肥胖率分别为13.2%和8.5%,女生分别为12.3%和11.2%。按家庭经济收入水平分,高、中、低家庭收入男生中心性肥胖率分别为15.8%、11.5%和8.8%,女生分别为13.5%、11.9%和11.6%。结论 男生的腰围较女生更易受城乡和家庭收入水平的影响。     

陕西省不良妊娠结局的流行病学研究

目的 了解陕西省不良妊娠结局的流行病学现况。方法 利用2010-2013年陕西省出生缺陷现况及其危险因素调查数据,提取不良妊娠结局的数据资料进行统计描述与分析。结果 2010-2013年陕西省不良妊娠结局发生率为25.45%,其中各年份分别为26.84%、26.11%、24.96%、24.80%。不良妊娠结局顺位依次为巨大儿（31.91%）、低出生体重儿（23.42%）、自然流产（18.94%）、早产（16.65%）、出生缺陷（7.38%）和死胎及死产（1.70%）。不良妊娠结局在不同年龄组间差异有统计学意义（P<0.001）,年龄越大,不良妊娠结局发生率越高（P<0.001）。不良妊娠结局在不同年份间差异有统计学意义（P<0.05）。不良妊娠结局发生率最高的区县是礼泉县（37.49%）,其次是武功县（35.50%）、乾县（35.13%）。结论 陕西省不良妊娠结局发生率较高,且有地区差异,以巨大儿、低出生体重儿、自然流产为主,高龄孕产妇不良妊娠结局发生危险增高。     

中国6~17岁儿童青少年超重肥胖流行特征

目的 分析我国6~17岁儿童青少年超重肥胖流行情况,为制定肥胖防治策略提供科学依据。方法 利用"2010-2012年中国居民营养与健康状况监测"中6~17岁儿童青少年调查资料,分析我国儿童青少年超重肥胖现状。6岁儿童采用WHO 2007年推荐的分年龄性别BMI超重肥胖判定标准判定超重肥胖,7~17岁儿童青少年采用《中国学龄儿童青少年超重和肥胖预防与控制指南》中的分年龄、性别的BMI超重肥胖判定标准进行判定。结果 6~17岁儿童青少年超重率和肥胖率分别为9.6%和6.4%,其中城市儿童青少年超重率和肥胖率分别为11.0%（男生：12.8%,女生：9.0%）和7.7%（男生：9.7%,女生：5.5%）,农村儿童青少年超重率和肥胖率分别为8.4%（男生：9.3%,女生：7.4%）和5.2%（男生：6.2%,女生：4.1%）。按家庭经济收入水平分,高、中和低家庭收入儿童青少年的超重率分别为12.3%、10.7%和8.2%,肥胖率分别为8.6%、7.2%和5.7%。结论 2012年,我国6~17岁儿童青少年超重肥胖表现为城市高于农村,男生高于女生;患病率与家庭经济收入水平有关。     

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.