Ⅱ型糖尿病与乳腺癌关系病例对照研究

目的 探讨中国汉族人群Ⅱ型糖尿病(T2DM)与乳腺癌的关系.方法 采用非匹配病例对照研究方法,400例原发性乳腺癌患者来自于黑龙江省肿瘤医院,病例经病理证实为原发性乳腺癌,400名非乳腺癌女性来自黑龙江省电力医院体检中心,采用面对面问卷调查,同时实验室检测空腹血糖.结果 单因素分析T2DM为乳腺癌的危险因素(OR=6.204,95％ CI=3.008～12.799);只调整年龄时,T2DM仍然为乳腺癌的危险因素(OR=6.019,95％CI=2.903 ～ 12.476);调整年龄、文化程度、工作强度、月收入、吸烟、饮酒、体育锻炼、产第1胎(年龄、流产史、经历负性生活事件后,T2DM仍然是乳腺癌的危险因素(OR=3.912,95％CI=1.526 ～ 10.028).结论 T2DM与乳腺癌存在关联.     

2型糖尿病慢性并发症影响因素的病例对照研究

目的 研究影响2型糖尿病(T2DM)患者慢性并发症发生的主要因素.方法 运用以医院为基础的频数匹配的病例对照研究方法,以性别、年龄和民族进行频数匹配,运用单因素和多因素方法分析总慢性并发症及糖尿病心血管并发症、糖尿病眼病、糖尿病神经病变发生的影响因素.结果 (1)T2DM总慢性并发症的危险因素及其OR值:高C反应蛋白(CRP)(OR=5.568)、血脂异常(OR=4.400)、高尿素氮(BUN)(OR=4.399)、高LDL-C(OR=3,594)、住院总时间(OR=2.612)、病前喜食油腻(OR=2.300)、高糖化血红蛋白(HbA1c%)(OR=1.747)、病后缺乏锻炼(OR=1.672)、糖尿病病程(OR=1.509)、精神压力大(OR=1.427);保护因素及其OR值:睡眠质量高(OR=0.606)、血糖控制佳(OR=O.517)、血脂控制佳(OR=0.299)、使用胰岛素(OR=0.155).糖尿病心血管并发症的主要危险因素为高BUN、高血压、高CRP、高LDL-C.糖尿病眼病的主要危险因素为高BUN、高CRP、病前喜食油腻.糖尿病神经病变的主要危险因素为喜食甜食.结论 (1)高CRP、血脂异常、高BUN、高LDL-C是导致T2DM慢性并发症发生的主要危险因素;使用胰岛素、血脂控制佳是T2DM慢性并发症的主要保护因素.(2)心血管并发症独有的危险因素为高LDL-C、精神压力大,神经病变独有的危险因素为病后缺乏锻炼、喜食甜食,眼病并无其独有的危险因素;心血管疾病、神经病变、眼病共同的危险因素为糖尿病病程,共同的保护因素为使用胰岛素.     

基于甲状腺激素血清学多指标相关性对2型糖尿病患者血管并发症的诊断效能评价

目的探讨2型糖尿病(T2MD)患者甲状腺功能血清学多指标间的相关性,以及甲状腺激素水平对大血管和微血管病变的影响。方法回顾性研究2014年12月—2017年12月锦州市中心医院收治的276例T2MD患者,以是否患有亚临床甲减作为分组标准,将患者分为单纯2型糖尿病组(T2DM组)147例和2型糖尿病合并亚临床甲减组(T2DM+SCH组)129例,观察比较两组血管并发症发生率、甲状腺激素与血管并发症及生化指标的相关性;多因素logistic回归分析合并亚临床甲减的T2MD患者的血管病变危险因素。结果 (1)微血管病变与病程、TSH和SBP呈正相关(P0.05),与TT3、FT4和FT3呈负相关(P0.05);(2)大血管病变与病程、年龄、吸烟史、TSH、SBP、UA和LDL-C均呈正相关(P0.05);(3)有吸烟史的糖尿病合并亚临床甲减患者大血管病变发生率比非吸烟者增加1.63倍,TSH与合并亚临床甲减的T2DM患者大血管病变和微血管病变均存在相关性。结论甲状腺激素水平对T2MD患者血管病变存在直接影响,对糖尿病血管并发症具有诊断效能。     

2型糖尿病家系危险因素Logistic回归分析

目的研究家系人群中2型糖尿病(T2DM)的危险因素，为制定干预措施提供依据。方法利用葡萄糖耐量试验(OGTT)、PCR-RFLP和免疫法排除其他类型后确定了115个2型糖尿病家系，通过问卷调查和实验室检查收集危险因素的情况，并采用Logistic回归分析方法对新老2型糖尿病患者和糖耐量低减(IGT)患者危险因素进行分析。结果糖尿病患者的多因素分析显示，T2DM患者的年龄(OR=1．043，95％CI 1．024～1．062)、高血脂史(OR=4．471。95％CI 2．149～9．303)、高血压史(OR=2．075，95％CI 1．001～4．301)和腰臀比超标(OR=1．809，95％CI 1．00～4．301)是独立的危险因素，而新诊断患者仅高血压史(OR=6．068，95％ CI 1．697～21．689)是独立的危险因素，IGT患者的年龄(OR=1．398，95％CI～1．138～1．717)是危险因素。结论在本研究人群中，高血压、年龄、中心性肥胖可能是2型糖尿病的危险因素。     

睡眠质量及时间与2型糖尿病风险交互作用的研究

目的 探讨睡眠质量和睡眠时间与2型糖尿病(T2DM)的关系,并分析两者间对T2DM交互作用的强度.方法 采用横断面研究方法于2013年3-5月调查9 622名徐州市社区常住居民,利用非条件logistic回归模型分析睡眠时间和睡眠质量与T2DM的关系,通过Bootstrap法计算相对超额危险度比(RERI)、归因比(AP)和交互作用指数(S)以评价睡眠时间和睡眠质量之间的相加交互作用.结果 T2DM患者和非T2DM患者的匹兹堡睡眠质量量表各组分及总分比较,除入睡时间和催眠药物外,其他差异均有统计学意义(P＜0.01).睡眠质量好者与睡眠质量差者相比、睡眠时间6～8h与睡眠时间＜6h者相比,T2DM患病率差异均有统计学意义(P＜0.01).调整性别、年龄、文化程度、职业、糖尿病家族史、吸烟、饮酒、非职业性体育活动、BMI等混杂因素后,睡眠质量差且睡眠时间＜6h者与睡眠质量好且睡眠时间在6～8h者相比,罹患糖尿病的风险高3.78倍(OR=4.78,95％CI:3.32～6.99);睡眠质量差且睡眠时间＞8h者,罹患T2DM的风险增加0.92倍(OR=1.92,95％CI:1.18 ～ 3.31);睡眠质量差合并每天睡眠时间＜6 h对发生T2DM的交互作用分别为RERI=2.33 (95％CI:1.23～8.79),AP=0.67 (95％CI:0.21 ～ 0.83),S=6.87(95％CI:2.33～ 10.75);睡眠质量差合并每天睡眠时间＞8h对发生T2DM的交互作用分别为RERI=0.33(95％CI:-0.12 ～ 1.13),AP=0.17(95％CI:-0.03 ～ 0.51),S=1.56(95％CI:0.76～2.74).结论 睡眠质量差和睡眠时间短对罹患T2DM有正相加交互作用.     

组蛋白去乙酰化酶基因多态性和环境因素对2型糖尿病的影响

目的探讨组蛋白去乙酰化酶(histone deacetylase,HDACs)的3个单核苷酸多态性位点与2型糖尿病(type 2 diabetes mellitus,T2DM)的关联,以及各位点与环境间交互作用对T2DM易感性的影响,为T2DM预防和治疗提供依据。方法2017年在广州市花都区17个行政村和2个社区居委中随机抽取10个村做基线调查后选取T2DM者为病例组,以同性别、年龄相差不超过5岁和来源于同一行政村为条件,1∶1个体匹配方法匹配对照组。采用条件Logistic回归分析模型分析基因和环境及其交互作用对T2DM的影响。结果共调查499名病例,平均年龄(61.53±13.08)岁,男性占37.88%;499名对照的平均年龄(61.48±13.09)岁,男性占37.88%。甘油三酯(triglyceride,TG)异常(OR=2.410,95%CI:1.755~3.310,P<0.001)和总胆固醇(total cholesterol,TC)异常(OR=1.436,95%CI:1.046~1.972,P=0.025)是T2DM的危险因素。rs72792338 TT+TC基因型携带(OR=0.526,95%CI:0.349~0.793,P=0.002)是T2DM的保护因素。结论甘油三酯和总胆固醇异常是T2DM的危险因素,rs72792338 TT和TC基因型携带是T2DM的保护因素,未发现HDACs基因与环境对T2DM的影响存在交互作用。     

2型糖尿病慢性并发症影响因素的病例对照研究

目的 研究影响2型糖尿病(T2DM)患者慢性并发症发生的主要因素.方法 运用以医院为基础的频数匹配的病例对照研究方法,以性别、年龄和民族进行频数匹配,运用单因素和多因素方法分析总慢性并发症及糖尿病心血管并发症、糖尿病眼病、糖尿病神经病变发生的影响因素.结果 (1)T2DM总慢性并发症的危险因素及其OR值:高C反应蛋白(CRP)(OR=5.568)、血脂异常(OR=4.400)、高尿素氮(BUN)(OR=4.399)、高LDL-C(OR=3,594)、住院总时间(OR=2.612)、病前喜食油腻(OR=2.300)、高糖化血红蛋白(HbA1c%)(OR=1.747)、病后缺乏锻炼(OR=1.672)、糖尿病病程(OR=1.509)、精神压力大(OR=1.427);保护因素及其OR值:睡眠质量高(OR=0.606)、血糖控制佳(OR=O.517)、血脂控制佳(OR=0.299)、使用胰岛素(OR=0.155).糖尿病心血管并发症的主要危险因素为高BUN、高血压、高CRP、高LDL-C.糖尿病眼病的主要危险因素为高BUN、高CRP、病前喜食油腻.糖尿病神经病变的主要危险因素为喜食甜食.结论 (1)高CRP、血脂异常、高BUN、高LDL-C是导致T2DM慢性并发症发生的主要危险因素;使用胰岛素、血脂控制佳是T2DM慢性并发症的主要保护因素.(2)心血管并发症独有的危险因素为高LDL-C、精神压力大,神经病变独有的危险因素为病后缺乏锻炼、喜食甜食,眼病并无其独有的危险因素;心血管疾病、神经病变、眼病共同的危险因素为糖尿病病程,共同的保护因素为使用胰岛素.     

武汉市2型糖尿病患者慢性并发症发生情况及其影响因素分析

目的 探究2型糖尿病(T2DM)患者慢性并发症的发生情况及相关影响因素。方法 采用方便抽样方法抽取2022年4月至2023年4月于武汉市第三医院光谷中医老年病科、武汉市洪山区关山街社区卫生服务中心和武汉市洪山区中医医院就诊的2型糖尿病患者作为研究对象,收集患者的信息,包括基本资料、一般检查信息、实验室检查结果和糖尿病并发症信息,采用描述性分析方法对2型糖尿病患者并发症发生情况进行分析,并采用单、多因素分析方法对并发症发生影响因素进行分析。结果 721例患者年龄29~72岁,平均年龄(56.65±8.87)岁;病程≤20年,平均病程(9.95±2.31)年。2型糖尿病患者慢性并发症以周围神经病变(69.76%)、肾病(49.10%)及视网膜病变(47.02%)为主,其中出现1种并发症的410例(56.87%),同时出现2种并发症的202例(28.02%),3种并发症的78例(10.82%),出现≥4种并发症的31例(4.30%)。多因素logistic回归分析结果显示病程(OR=9.856)、空腹血糖(FBG)(OR=4.245)均是周围神经病变的危险因素,病程(OR=4.429)、FBG(OR=2.730)是影响2型糖尿病合并肾病的独立危险因素,病程(OR=4.416)、FBG(OR=3.862)均为影响2型糖尿病合并视网膜病变的独立危险因素。结论 武汉市2型糖尿病患者慢性并发症以周围神经病变、肾病及视网膜病变为主,且病程、FBG均与慢性并发症的发生有关,需对此人群多加关注。     

短病程2型糖尿病大血管病变的相关因素分析

目的　探讨短病程 2型糖尿病 (T2DM)患者大血管病变的相关因素。方法　 2 6 8例短病程T2DM患者 (新诊断或病程在 1年以内 )通过超声波大动脉内中膜厚度 (IMT)检测 ,界定有无动脉粥样硬化 (AS)分为AS组 (10 1例 )和非AS组 (16 7例 ) ,对两组患者的多项临床指标进行比较及相关分析。结果　 (1)AS组的年龄、BMI、吸烟指数 (SI)、高血压病程、收缩压、舒张压、总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL -Ch)、C -反应蛋白 (CRP)均高于非AS组(P <0 .0 5 ) ;有DM家族史的比率及胰岛素敏感性指数 (ISI)低于非AS组 (P <0 .0 5 )。 (2 )两组间性别、DM病程、空腹血糖 (FPG)、服糖后 2h血糖 (2hPG)、糖化血红蛋白 (HbA1 c)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL -Ch)、空腹胰岛素 (FINS)的差异无显著性。 (3)Pearson相关分析 ,提示大动脉平均IMT与年龄 (r =0 .346 ,P <0 .0 0 1)、BMI(r=0 .2 2 9,P =0 .0 0 1)、SI(r =0 .349,P <0 .0 0 1)、收缩压 (r =0 .2 5 8,P <0 .0 0 1)、舒张压 (r =0 .2 0 7,P =0 .0 0 2 )、LDL -Ch(r=0 .178,P =0 .0 0 8)呈显著正相关。结论　短病程T2DM患者合并大血管病变主要与年龄、吸烟、超重或肥胖、高血压、高LDL -Ch血症、胰岛素抵抗 (IR)及CRP等因素相关     

老年2型糖尿病患者合并肌少症影响因素分析

目的分析老年2型糖尿病(T2DM)患者合并肌少症的影响因素,为T2DM患者预防肌少症提供依据。方法选取南通市医院内分泌科门诊就诊的老年T2DM患者进行现场问卷调查及体成分、肌力和躯体功能检查,收集性别、年龄、病程、治疗方式、日常生活能力和体力活动情况等资料,采用Logistic回归模型分析老年T2DM患者合并肌少症的影响因素。结果共调查T2DM患者430例,其中男性191例,占44.42%;女性239例,占55.58%。年龄为60～94岁,平均(69.83±7.44)岁。合并肌少症患者95例,患病率为22.09%。其中女性患病率为26.36%,高于男性的16.75%(P0.05)。多因素Logistic回归分析结果显示,高龄(OR=1.072,95%CI:1.020～1.127),高空腹血糖(OR=1.156,95%CI:1.044～1.280),BMI25 kg/m~2(OR=12.089～77.845,95%CI:5.204～350.472),自理功能轻度缺陷(OR=3.343,95%CI:1.129～9.895),低体力活动强度(OR=2.531,95%CI:1.030～6.219)是老年T2DM患者合并肌少症的危险因素。结论老年T2DM患者中合并肌少症患病率为22.09%,BMI25 kg/m~2、自理功能轻度缺陷、低体力活动强度、高空腹血糖是其肌少症患病的危险因素。     

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.     

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.     

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.     

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.     

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.