不同类型前置胎盘产妇剖宫产产后出血的关联因素及妊娠结局的回顾性研究

目的探讨不同类型前置胎盘产妇剖宫产产后出血的关联因素及妊娠结局。方法本研究为回顾性的病例对照研究。收集2019年1月至2020年12月浙江大学医学院附属妇产科医院收治的因前置胎盘行剖宫产的产妇。根据术中出血量分为<1 000 ml的对照组和≥1 000 ml的产后出血组。分析产后出血在不同类型前置胎盘产妇中的关联因素及不良妊娠结局。采用t检验或χ2检验比较两组间的差异, 采用logistic回归模型分析产后出血的关联因素。结果共纳入研究对象962例, 产后出血产妇189例, 对照组产妇773例。在不同类型的前置胎盘产妇中, 两组产妇的孕次、产次、孕周、人工流产次数、胎盘植入和术前血红蛋白<110 g/L的差异有统计学意义(均P<0.05)。logistic回归模型分析显示, 胎盘植入(OR=12.713, 95%CI:4.296～37.625), 术前血红蛋白<110 g/L(OR=2.377, 95%CI:1.062～5.321), 产前阴道出血(OR=4.244, 95%CI:1.865～9.656)是低置胎盘产妇产后出血风险的危险因素;人工流产1次(OR=...     

湖南农村地区6～23月龄婴幼儿血红蛋白水平对发热和腹泻影响

目的探讨婴幼儿血红蛋白水平对发热和腹泻的影响,并分析其剂量反应关系。方法采用多阶段分层随机抽样方法,于2017年10—12月,在湖南省农村地区随机抽取3 630名6～23月龄婴幼儿为研究对象进行问卷调查,并检测其指尖末梢血血红蛋白,采用多因素非条件logistic回归模型控制潜在混杂因素来分析婴幼儿血红蛋白水平对发热和腹泻的影响。结果湖南省农村地区6～23月龄婴幼儿贫血患病率为28.7%(1 042/3 630),血红蛋白水平为100、100～109、110～119、120～129、≥130 g/L的比例分别为8.8%(319/3 630)、19.9%(723/3 630)、33.9%(1 229/3 630)、25.2%(916/3 630)、12.2%(443/3 630)。婴幼儿发热和腹泻两周患病率分别为15.1%(547/3 630)和14.0%(509/3 630)。多因素logistic回归分析显示,贫血是婴幼儿发热和腹泻的独立危险因素,其调整OR值分别为1.57(95%CI=1.29～1.91)和1.40(95%CI=1.14～1.71);血红蛋白水平对婴幼儿发热和腹泻的影响均存在剂量反应关系,血红蛋白水平越低,发热和腹泻的患病风险越高。以血红蛋白120～129 g/L为参照,血红蛋白100和100～109 g/L是婴幼儿发热的危险因素,其调整OR值分别为1.89(95%CI=1.34～2.67)和1.67(95%CI=1.27～2.21);血红蛋白100、100～109和110～119 g/L是婴幼儿腹泻的危险因素,其调整OR值分别为1.84%(95%CI=1.28～2.64)、1.67(95%CI=1.24～2.24)和1.34(95%CI=1.02～1.76)。结论湖南省农村地区6～23月龄婴幼儿发热和腹泻两周患病率较高,并且受血红蛋白水平的影响,积极防治婴幼儿贫血有助于降低其发热和腹泻患病率。     

武汉市江夏区农村成年人缺铁性贫血患病状况及影响因素分析

目的了解武汉市江夏区农村成年人贫血患病状况及影响因素,制定有效的干预措施。方法采用整群分层随机抽样法调查3 934名20岁以上的成年人,采用统一的方法进行问卷调查和实验室检查。应用非条件Logistic回归对贫血的影响因素进行分析。结果武汉市江夏区农村成年人血红蛋白检测平均值为(131.2±33.3)g/L,其中男性平均值为(136.5±34.7)g/L,女性为(128.7±32.7)g/L,共检出贫血患者891人,贫血患病率为23.00%,男性为17.30%,女性为24.40%,女性显著高于男性(χ2=15.23,P=0.001);居民血红蛋白水平有随年龄增大而降低的趋势,男性在70~岁年龄组贫血患病率最高(30.48%),而女性在20~岁年龄组贫血患病率最高(29.63%),70~岁年龄组次之(28.95%),非条件Logistic回归分析显示:年龄大(OR=1.37,95%CI:1.15~1.63)和女性(OR=3.14,95%CI:1.26~7.81)是贫血发生的危险因素,经济水平好(OR=0.60,95%CI:0.37~0.97)是贫血发生的保护因素。结论江夏区农村成年人贫血患病率较高,性别、年龄、经济水平对成人贫血率有明显的影响,对高危人群应采取综合措施预防贫血的发生。     

某铅蓄电池厂工人健康状况及其影响因素分析

[目的]了解某铅蓄电池厂铅作业工人健康状况及其影响因素,为企业健康监护提供基础资料。[方法]以该铅蓄电池厂1 179名铅作业工人作为研究对象,进行问卷调查和健康体检。[结果]1 179名研究对象血铅值中位数和第25、75百分位数[M(P25,P75)]为152.2(65.4,356.7)μg/L,血铅超标(血铅值≥400μg/L)120人,超标率为10.2%。男性心电图异常率为14.3%,高于女性的2.2%,血常规异常率为7.1%,低于女性的18.1%,差异均有统计学意义(P<0.01)。多因素logistic回归分析结果显示:铅接触组发生血铅异常的危险性是不接触组的7.469倍(95%CI:2.817~19.804);男性发生心电图异常的危险性是女性的7.974倍(95%CI:4.099~15.511),血铅水平在300~μg/L组发生心电图异常的危险性是对照组(血铅水平<100μg/L)的3.450倍(95%CI:1.724~15.690);男性发生贫血的危险性是女性的34.2%(95%CI:0.235~0.499),血铅200~μg/L组、300~μg/L组发生贫血的危险性分别是对照组(<100μg/L)的3.020倍(95%CI:1.234~8.562)、3.870倍(95%CI:1.985~16.398)。[结论]心电图异常率男性高于女性,贫血发生率则是女性高于男性;血铅是铅作业工人健康状况的独立危险因素,应进一步加强监测,组织工人定期体检,保护工人健康。     

老年人失能的性别差异及其影响因素研究

目的 分析老年人失能的性别差异，探讨影响失能性别差异的相关因素。方法 调查资料来源于中国老年人健康长寿影响因素调查(CLHLS)2018年横断面调查数据，共14 952名65岁及以上老年人纳入分析。采用日常生活能力评定量表评估老年人失能情况，采用基于Logistic回归模型的Fairlie分解法分析老年人失能性别差异及其影响因素。结果 老年人中，女性失能率高于男性(8.0%vs. 6.4%, Rao-Scott χ²=8.301,P=0.004)。多因素Logistic回归显示，年龄、受教育程度、跌倒史、自评家庭经济水平、脑血管病史是老年男性和老年女性失能的共同影响因素；BMI<18.5 kg/m²(OR=1.98, 95%CI:1.43～2.75)、居住地为农村(OR=0.77, 95%CI:0.61～0.98)、糖尿病史(OR=1.50, 95%CI:1.09～2.07)是老年女性失能的影响因素，焦虑(轻度焦虑OR=2.28, 95%CI:1.50～3.48,中重度焦虑OR=2.65, 95%CI:1.31～5.38)是老年男性失能...     

女性盆腔手术中获得性压力性损伤影响因素及预防对策

目的：探讨女性盆腔手术术中获得性压力性损伤(IAPI)发生影响因素,并提出预防管理对策。方法：回顾性收集2019年6月-2022年12月医院女性盆腔手术出现IAPI的45例为IAPI组,未出现IAPI患者中按1:3比例随机选取135例为对照组。收集两组一般人口学资料、实验室检查资料、手术有关资料,采用多因素logistic回归分析确定女性盆腔手术IAPI发生影响因素。结果：两组BMI、合并糖尿病、术前血清白蛋白、血红蛋白水平、受压部位皮肤状态、术中体温、手术时间、术中出血量均有差异(P<0.05)。多因素分析显示,BMI异常(OR=2.477、95%CI 1.293～4.746)、合并糖尿病(OR=3.006、95%CI 1.591～5.680)、术前受压部位皮肤状态为瘀斑/水疱/重度水肿(OR=3.173、95%CI 2.048～4.916)、术中体温异常(OR=2.995、95%CI 1.472～6.094)、手术时间>2 h(OR=2.841、95%CI 1.527～5.286)均为女性盆腔手术IAPI独立危险因素,术前血清白蛋白水平≥35 g/L(OR=0.328、...     

2019—2020年安徽省城乡≥65岁老年人抑郁症状及其相关因素差异的研究

目的分析2019—2020年安徽省城乡≥65岁老年人抑郁症状及其相关因素的差异。方法利用2019—2020年安徽省实施全国老年心理关爱项目的68个社区调查数据, 采用患者健康状况抑郁量表评价老年人抑郁症状现况, 采用χ2检验比较不同特征城乡老年人抑郁症状检出率的差异, 采用logistic回归模型分析城乡老年人抑郁症状的相关因素。结果共纳入15 532名≥65岁老年人, 抑郁症状检出率为7.12%, 乡村(9.08%)高于城镇(6.48%), 差异有统计学意义(P<0.001)。logistic回归显示, 无论城乡, 患有慢性病均是老年人抑郁症状的危险因素, 老化态度积极和心理韧性好均是老年人抑郁症状的保护因素。有兴趣爱好(OR=0.64, 95%CI:0.45～0.91)、与子女关系好(OR=0.56, 95%CI:0.41～0.76)、与配偶关系好(OR=0.51, 95%CI:0.37～0.71)、朋友数量≥6个(OR=0.48, 95%CI:0.32～0.71)是城镇老年人抑郁症状的保护因素。与邻居关系好(OR=0.58, 95%CI:0.41～0.82)、朋友数量1～2...     

妊娠晚期血红蛋白浓度与早产和低出生体重关系的研究

目的分析妊娠晚期血红蛋白(Hb)浓度与早产和低出生体重之间的关系。方法研究对象为江苏和浙江省4个县(市)在1995—2000年间分娩的102 489名妇女。按妊娠晚期Hb浓度分四组比较各组早产和低出生体重的发生率;采用logistic回归模型控制年龄、职业、文化程度、孕次、产检次数和妊高征等因素后,估计Hb与早产和低出生体重的关联程度。结果妊娠晚期贫血患病率为48.2%,以轻度和中度贫血为主。轻、中度贫血不增加早产和低出生体重的风险。当Hb为90～99 g/L时,早产和低出生体重的发生率最低;当Hb升高或降低时,早产和低出生体重的风险均呈增加趋势。Hb为70～119 g/L时,早产和低出生体重的风险变化不大,但重度贫血和高血红蛋白则显著增加早产和低出生体重的风险:Hb<70 g/L组早产和低出生体重的OR(95%CI)分别为1.8(1.0～3.3)和4.0(2.1～7.5);Hb≥130 g/L组的早产和低出生体重的OR(95%CI)为1.2(1.0～1.4)和1.5 (1.2～1.9)。结论妊娠晚期Hb水平与早产和低出生体重的风险之间均呈"U"形趋势,妊娠晚期重度贫血以及高血红蛋白均是早产和低出生体重的危险因素。     

产褥期贫血患病率及预后影响因素分析

目的:了解产后3 d产妇贫血患病状况及产后42 d恢复情况,探讨与贫血恢复有关的影响因素,并提出干预措施。方法:于产后3 d对400例产妇进行血红蛋白筛查,贫血产妇共167例,产后42 d追踪贫血恢复情况。共追踪到145例,按照42 d血红蛋白水平分为贫血组(病例组)50例和血红蛋白正常组(对照组)95例。进行产褥期贫血未恢复影响因素的单因素分析及Logistic回归分析。结果:产后3 d贫血的患病率41.8%(167/400),至产后42 d复诊者恢复率为65.5%(95/145)。影响贫血恢复的相关因素为:水果摄入过少和产褥期未服用抗贫血药为产褥期贫血未恢复的危险因素,其OR值分别为2.470(95%C I:1.115~5.468)和2.343(95%C I:1.025~5.357);而孕期血红蛋白≥100 g/L、产后3 d血红蛋白≥100 g/L及人工喂养为保护因素,其OR值分别为0.328(95%C I:0.144~0.747)、0.419(95%C I:0.181~0.969)和0.024(95%C I:0.031~0.778)。结论:产褥初期产妇贫血患病率较高,且超过1/3的患者到产褥末期未恢复。因此妇幼保健工作者应重视产褥期保健工作,要针对影响贫血恢复的主要因素进行预防和控制,以提高产褥期贫血的恢复率。     

上海市社区居民代谢相关慢性病组合与非酒精性脂肪肝患病关联分析

目的了解上海市社区居民与非酒精性脂肪肝(NAFLD)患病率相关的代谢性慢性病组合。方法使用上海郊区自然人群队列和生物样本库基线数据, 根据问卷调查、体格检查及血生化检测获得肥胖、高血压、高脂血症、痛风及糖尿病5种代谢相关慢性病患病情况, 根据B超及问卷调查诊断NAFLD, 运用多因素logistic回归模型分析合并不同数量及类型的31种代谢相关慢性病组合与NAFLD患病的关联。结果 65 477名研究对象年龄M(Q1, Q3)为60(51, 66)岁, 男性占40.6%。NAFLD总患病率为38.2%, 无5种代谢相关慢性病中任1种者NAFLD患病率为12.0%。总人群(OR=37.94, 95%CI:31.02～46.41)、女性(OR=36.99, 95%CI:28.78～47.54)及≥60岁组(OR=36.19, 95%CI:28.25～46.36)与NAFLD患病关联最强的慢性病组合均为肥胖+高血压+高脂血症+痛风+糖尿病, 男性(OR=50.70, 95%CI:24.62～104.40)及<60岁组(OR=49.58, 95%CI:24.22～101.47)与NAFL...     

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.     

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.