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1.
目的探讨围绝经期女性血脂异常与糖尿病的关系。方法选取2015年-2018年在本院就诊或健康体检围绝经期女性3961例作为研究对象,进行问卷调查,分析血脂异常与糖尿病的关系。结果围绝经期女性血脂异常患病率为40.3%,其中总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(nonHDL-C)升高率在11.0%~23.0%,高密度脂蛋白胆固醇(HDL-C)降低率为6.5%;糖尿病患病率为17.7%。相关分析显示,TC、LDL-C、TG、non-HDL-C与空腹血糖均呈正相关(r值分别为0.238、0.209、0.235、0.251,P<0.01),HDL-C与空腹血糖呈负相关(r=-0.033,P<0.05);多因素Logistic回归分析结果显示,血脂异常的围绝经期女性,糖尿病患病风险是血脂正常围绝经期女性的1.450倍~1.938倍;TC、TG、LDL-C、non-HDL-C每增加1个标准误差或HDL-C每减少1个标准误差,糖尿病患病风险增加21.6%~39.3%。结论围绝经期女性血脂异常与糖尿病有着密切联系,应加强血脂异常与糖尿病的综合防治。  相似文献   

2.
目的了解浙江省农村2型糖尿病(T2DM)患者血脂异常情况,并分析其影响因素,为预防农村T2DM患者血脂异常提供依据。方法选取嘉善县、遂昌县所有社区和永康市6个社区2016年社区登记管理的10 343例T2DM患者为研究对象。从居民健康档案和社区慢性病管理系统导出人口学信息,测量血压、身高、体重和腰围,实验室检测糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C),分析血脂异常谱。采用多因素Logistic回归模型分析T2DM患者血脂异常的影响因素。结果农村T2DM患者血脂异常率为66.91%,TC升高率、TG升高率、LDL-C升高率和HDL-C降低率分别为41.76%、41.28%、15.89%和16.92%。血脂异常以单纯TC升高、TC升高合并TG升高和单纯TG升高为主,异常率分别为11.84%、11.75%和11.47%。男性血脂异常以TG升高合并HDL-C降低为主,异常率为11.32%;女性血脂异常以TC升高合并TG升高为主,异常率为14.60%。多因素Logistic回归分析结果显示,女性(OR=1.499,95%CI:1.352~1.663)、年龄(OR=0.992,95%CI:0.988~0.996)、HbA1c控制不佳(OR=1.241,95%CI:1.141~1.351)、中心性肥胖(OR=1.169,95%CI:1.064~1.285)、超重(OR=1.384,95%CI:1.257~1.524)和肥胖(OR=1.582,95%CI:1.352~1.852)均与血脂异常存在统计学关联。结论浙江省农村T2DM患者血脂异常率总体偏高,以单纯TC升高、TC升高合并TG升高和单纯TG升高为主;应重点监测血糖控制不佳、肥胖和女性居民的血脂异常情况。  相似文献   

3.
目的探讨成人肥胖测量指标与血脂异常患病关系。方法用多阶段整群随机抽样方法,在江苏省14个成人慢性病及其危险因素监测点随机抽取8400名≥18岁常住居民进行问卷调查、体格检查和实验室检测。运用偏相关和非条件Logistic回归方法,分析体质指数(BMI)、腰围(WC)和腰身比(WHtR)等肥胖测量指标与血脂水平及血脂异常患病关系。结果江苏省成人血脂异常患病率为35.0%,肥胖率为13.7%,中心型肥胖率为50.8%。不同BMI、WC和WHtR组别间的TC、TG、HDL-C和LDL-C平均水平差异均有统计学意义(P<0.05)。BMI、WC和WHtR等肥胖测量指标与TC、TG和LDL-C成正相关,与HDL-C成负相关。随着肥胖程度的增高,血脂异常患病风险显著上升(P<0.05),且BMI、WHtR和WC每增加1个标准差,血脂异常患病风险分别增加75%(OR=1.75,95%CI 1.67~1.84)、77%(OR=1.77,95%CI 1.68~1.87)和80%(OR=1.80,95%CI 1.71~1.89),BMI、WHtR和WC对血脂异常患病风险的影响依次升高。结论 BMI、WC和WHtR与血脂异常患病密切相关,血脂异常患病风险随肥胖程度的增加而升高。  相似文献   

4.
  目的  研究天津市成人脂质比值TC/HDL-C、TG/HDL-C和LDL-C/HDL-C与胰岛素抵抗、糖尿病和糖尿病前期的关联性,以期探索、评估这三项脂质比值在糖尿病的公共卫生预防、临床诊断、病情预测等方面的价值。  方法  根据中国成人慢性病与营养监测方案,调查天津市河西区等7个区18岁及以上常住居民,收集其空腹静脉血,检测血脂四项、FPG和胰岛素水平。将TC/HDL-C、TG/HDL-C和LDL-C/HDL-C按照四分位数法进行分组,采用二分类Logistic回归分析模型分析其与胰岛素抵抗、糖尿病和糖尿病前期的OR值及其95% CI。  结果  天津市调查人群中糖尿病患病率合并糖尿病前期患病率为46.6%(2 030/4 356)。总人群中,TC/HDL-C和TG/HDL-C升高均能增加胰岛素抵抗风险,但是与LDL-C/HDL-C < 1.78组相比,只有≥2.86组胰岛素抵抗患病风险增加(OR=1.78, 95% CI:1.21~2.63);不论是男性还是女性,随着TC/HDL-C和TG/HDL-C的升高,糖尿病、糖尿病前期的患病风险增加,关联性较强,且与LDL-C/HDL-C的关联性低于TC/HDL-C和TG/HDL-C;与男性相比,女性TC/HDL-C、TG/HDL-C和LDL-C/HDL-C增加会导致糖尿病、糖尿病前期和糖尿病合并糖尿病前期患病风险的增加。  结论  TC/HDL-C和TG/HDL-C的升高,会增加胰岛素抵抗、糖尿病和糖尿病前期的患病风险;LDL-C/HDL-C与胰岛素抵抗、糖尿病和糖尿病前期的患病风险关联性较弱。  相似文献   

5.
王珥梅  陆晓荣 《职业与健康》2014,(11):1483-1484
目的探讨常州地区当前一般人群血脂异常的流行特点。方法利用2012年1 259名健康检查者资料,分析并比较不同性别、不同年龄人群血清甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的异常率以及TG与TC、LDL-C、HDL-C的关系。结果①男性TG、TC、LDL-C、HDL-C异常率均高于女性,按年龄分层,男女TC、LDL-C异常率均随年龄增加呈上升趋势,但男性TG异常率与年龄不呈正比。无论男性还是女性,不同年龄段HDL-C异常率未见统计学差别。②男性血脂异常者中有49.9%为混合型,女性则有52.2%为混合型。③logistic回归分析表明,校正性别、年龄后,TG异常与TC异常呈正相关(OR 95%CI=1.563~3.409),与HDL-C异常呈负相关(OR 95%CI=0.246~0.974)。结论常州地区成年人血脂异常率较高,且混合型血脂异常占较高比例,今后应积极开展预防血脂异常的健康教育。  相似文献   

6.
目的探讨江苏省老年人体质指数(BMI)、腰围(WC)与高血压、血脂异常和糖尿病等常见慢性病的关系。方法利用江苏省2010年成人慢性病及其危险因素监测中≥60岁老年常住居民的数据,运用t检验或方差分析、偏相关分析和非条件logistic回归等方法,分析BMI、WC与血压、血脂和血糖及高血压、血脂异常和糖尿病等常见主要慢性病的关系。结果江苏省老年人肥胖、中心性肥胖和慢性病粗患病率分别为13.5%、54.3%和82.6%,患病率居于前3位的慢性病为高血压、血脂异常和糖尿病。BMI、WC均与收缩压(SBP)、舒张压(DBP)、TC、LDL-C、TG和FPG呈正相关,而与HDL-C呈负相关(P0.05)。肥胖、中心性肥胖、BMI和WC均与高血压、血脂异常和糖尿病显著相关,高血压、血脂异常和糖尿病患病风险随着BMI和WC的增加而不断升高(P0.05)。BMI每增加1个标准差(SD),高血压、血脂异常和糖尿病患病风险分别升高79%(OR=1.79,95%CI:1.61~2.00)、67%(OR=1.67,95%CI:1.52~1.84)和56%(OR=1.56,95%CI:1.38~1.76);WC每增加1个SD,高血压、血脂异常和糖尿病患病风险分别升高63%(OR=1.63,95%CI:1.47~1.80)、74%(OR=1.74,95%CI:1.58~1.91)和66%(OR=1.66,95%CI:1.46~1.89)。结论高血压、血脂异常和糖尿病是江苏省老年人常见主要慢性病。BMI、WC与高血压、血脂异常和糖尿病密切相关。  相似文献   

7.
目的探讨成人血脂异常与高血压的关系。方法利用江苏省2010年成人慢性病及其危险因素监测数据,运用双变量相关和非条件logistic回归方法,分析血脂水平与血压及血脂异常与高血压的关系。结果江苏省成人高血压患病率为49.1%,血脂异常率为35.0%,均为男性高于女性,患病率随年龄增长呈上升趋势,分布差异有统计学意义(P0.05)。双变量相关分析结果表明,TC、LDL-C和TG与收缩压和舒张压均成正相关;HDL-C与收缩压成正相关,但与舒张压成负相关。非条件logistic回归分析显示,血脂异常、TC升高、HDL-C降低、LDL-C升高和TG升高均与高血压显著相关;TC、LDL-C、TG每增加1个标准差(s)和HDL-C每降低1个s,高血压患病风险分别增加23%、20%、55%和6%。结论血脂异常与高血压密切相关,是重要公共卫生问题,应加强血脂异常和高血压的综合防治。  相似文献   

8.
目的研究北京市顺义区人群中心型肥胖与心血管疾病危险因素和其聚集性的关系,为探讨干预对策提供依据。方法采用与人口规模成比例的概率抽样方法,抽取18~79岁顺义区常住居民3840人进行面对面问卷调查及体检,获取血压、血糖、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、胆固醇(TC)、甘油三酯(TG)等指标数值,所得资料采用SPSS 16.0统计软件进行多因素Logistic回归分析。结果顺义区人群中心型肥胖率为64.8%,男性高于女性(P0.05);不同腰围组之间的收缩压、舒张压、空腹血糖、TC、TG、HDL-C和LDL-C水平差异均有统计学意义(P0.01);经过多因素Logistic分析,随着腰围的增加,高血压、糖尿病、血脂异常患病率和危险因素聚集率均呈上升趋势(P0.01);轻、重度中心型肥胖组发生高血压的风险是正常组的1.942倍(OR=1.942,95%CI:1.581~2.387)和4.265倍(OR=4.265,95%CI:3.462~5.254),发生糖尿病的风险是正常组的2.128倍(OR=2.128,95%CI:1.557~2.908)和4.095倍(OR=4.095,95%CI:3.023~5.547),发生血脂异常的风险是正常组的2.806倍(OR=2.806,95%CI:2.316~3.399)和4.391倍(OR=4.391,95%CI:3.593~5.367);发生危险因素聚集的风险是正常组的3.282倍(OR=3.282,95%CI:2.495~4.316)和7.531倍(OR=7.531,95%CI:5.745~9.873)。结论北京市顺义区人群中心型肥胖率较高,且随着中心型肥胖程度增加,发生心血管疾病危险因素及其聚集性风险增大。  相似文献   

9.
目的 探讨常州市成年居民血脂异常与糖尿病之间的关系。方法 本研究为现况研究,采用多阶段整群随机抽样方法,抽取12 325名年龄≥35岁的常州市居民进行相关研究,血脂异常与糖尿病关系采用多因素logistic回归方法分析。结果 发生血脂异常的常州市成年居民患病率为32.94%,其中研究人群的总胆固醇(TC)的升高率为2.88%,甘油三酯(TG)的升高率为13.29%,高密度脂蛋白(HDLC-C)的降低率为22.53%,低密度脂蛋白(LDL-C)的升高率为5.89%;糖尿病患病率为8.20%;通过相关性分析发现,研究人群的TC、TG及LDL-C均与空腹血糖水平成正相关( r =0.099,P<0.001; r =0.220,P<0.001; r =0.055,P<0.001),而HDL-C与空腹血糖水平呈负相关( r =-0.100,P<0.001);血脂异常、TG升高和HDL-C降低是常州市成年居民糖尿病发病的独立危险因素,其OR值(95%CI)分别为1.59(1.39-1.83)、1.42(1.18-1.69)和1.50(1.27-1.36)。结论 常州市成年居民血脂异常和糖尿病密切相关,因此对血脂异常和糖尿病采取综合防控措施,对于预防心脑血管疾病发生具有重要意义。  相似文献   

10.
目的了解吉林省社区糖尿病患者血脂异常的特征,为糖尿病患者血脂异常的管理提供依据。方法基于2012年吉林省成人慢性病患病率及危险因素调查,采用多阶段分层随机整群抽样方法,对其中检出的1825名糖尿病患者进行问卷调查(年龄、性别、近一年慢性病患病情况)、血生化指标检测(血糖、总胆固醇、甘油三酯、高密度脂蛋白和低密度脂蛋白)及身体测量(身高和体重)。结果糖尿病患者共1825人,其中男性883人(48.4%),女性942人(51.6%),平均年龄为(55.73±10.27)岁。TG、TC、LDL-C和HDL-C的平均水平分别为2.17、5.17、3.10和1.20mmol/L,女性患者TC、LDL-C和HDL-C水平均高于男性(P0.001)。血脂异常率为66.9%(男性为69.0%,女性为65.0%)。男性血脂异常率随年龄的增加而降低(P0.001),女性随年龄增长而升高(P0.001)。18岁~、35岁~、45岁~年龄组男性血脂异常率高于女性(P0.05、P0.001、P0.001),而55岁~、65~79岁则低于女性(P0.05);超重(71.8%)及肥胖(75.8%)者血脂异常率高于BMI正常者(55.2%)(P0.001)。TG、TC、LDL-C及HDL-C异常率分别为47.8%、19.2%、14.5%和29.2%;糖尿病患者中27.1%为二项血脂指标异常,17.4%为TG升高合并HDL-C降低,其次15.9%为单纯TG升高。结论吉林省社区糖尿病患者的TC、TG及LDL-C平均水平均高于一般人群,18~54岁男性、55岁及以上女性与超重或肥胖的糖尿病患者的血脂异常率较高,血脂异常以混合型为主,TG升高合并HDL-C降低较多。  相似文献   

11.
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.  相似文献   

12.
Worker education in the primary prevention of occupational dermatoses   总被引:1,自引:0,他引:1  
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.  相似文献   

13.
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.  相似文献   

14.
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.  相似文献   

15.
BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.  相似文献   

16.
BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.  相似文献   

17.
Organophosphate toxicity and occupational exposure   总被引:5,自引:0,他引:5  
The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.  相似文献   

18.
This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.  相似文献   

19.
The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.  相似文献   

20.
BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.  相似文献   

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