孕期抑郁与妊娠期糖尿病发病风险关系的meta分析

目的 系统评价孕期抑郁与妊娠期糖尿病发病风险之间的关系。方法 检索Web of Science、PubMed、CBM、CNKI、万方及维普数据库中关于孕期抑郁与妊娠期糖尿病关系的研究，检索时限为建库至2021年12月25日。进行纳入文献的资料提取、质量评价。采用Stata16.0软件进行分析。结果 共纳入7项队列研究，共含13 139名孕妇。meta分析结果显示孕期抑郁可增加妊娠期糖尿病发病风险(OR=1.412,95%CI:1.186～1.682)。亚组分析进一步提示，研究国家[美国(OR=1.728,95%CI:1.276～2.338)、澳大利亚(OR=1.850,95%CI:1.140～3.001)]、研究类型[前瞻性研究(OR=1.356,95%CI:1.124～1.636)、回顾性研究(OR=1.850, 95%CI:1.140～3.001)]、是否校正BMI[是(OR=1.379,95%CI:1.138～1.671)、否(OR=1.580, 95%CI:1.040～2.400)]、糖尿病诊断方式[未描述(OR=1.639,95%CI:1.288～2.085)]、抑郁评估工具...     

便秘与帕金森关系的meta分析

目的 系统评价便秘与帕金森之间的关系。方法 计算机检索中国知网、万方、维普、Pubmed、Web of science、Cochrane Library等中英文数据库,检索时限从建库至2020年5月。文献检索采用主题词结合自由词的方式,并对纳入的文献进行质量评价与数据提取,采用Stata 14.0软件进行meta分析。结果 最终纳入11篇文献,纳入文献质量评价均在中等及以上。meta分析显示便秘与帕金森诊断之间呈正相关（OR = 2.41,95%CI:2.02～2.88,P＜0.001),同时,亚组分析显示不同地区［英国（OR = 1.85）、美国（OR = 3.20）］、性别［男（OR = 3.08）、女（OR = 2.19）］、随访时间［0～5年（OR = 2.43）、6～10年（OR = 2.23）、＞10年（OR = 2.68）］、研究类型［病例对照（OR = 2.15）、队列研究（OR = 2.80）］中便秘均与帕金森诊断之间呈正相关。结论 便秘与患帕金森的风险增加有关。     

心血管手术患者压力性损伤危险因素Meta分析

目的 通过Meta分析明确心血管手术患者压力性损伤的危险因素。方法 检索The Cochrane Library、PubMed、EMbase、Web of Science、CNKI、CBM、VIP数据库,从建库至2020年8月,收集有关心血管手术患者压力性损伤危险因素的研究。通过文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行分析。结果 共纳入11篇文献。经Meta分析各危险因素合并OR/SMD(95%CI)分别为:年龄≥70岁∶OR=3.72, 95%CI［2.76, 5.01］;BMI[DK]∶OR=2.62, 95%CI ［1.65, 4.14］;性别:OR=2.11, 95%CI ［1.53, 2.90］;糖尿病:OR=3.10, 95%CI［2.12,4.54］;急诊手术:OR=7.61, 95%CI ［3.10,18.69］;手术时间:SMD=59.31, 95%CI［35.20, 83.42］;体外循环时间:SMD=26.67, 95%CI ［18.35, 34.99］;围手术期皮质类固醇的使用:OR=4.32, 95%CI［1.93, 9.66］;低血红蛋白:SMD=-23.76, 95%CI ［-43.69, -3.83］;低红细胞压积SMD=-3.67, 95%CI［-5.66, -1.69］。结论 心血管手术患者压力性损伤的发生与上述多种危险因素有关。医护人员在临床工作中应重视这些危险因素,并积极实施预防措施,以降低心血管手术患者压力性损伤的发生。     

产后抑郁症相关危险因素调查

目的调查产后抑郁症的发生因素以及研究对应的临床管理措施,为临床防治提供参考。方法选取2015年8月-2017年8月在解放军八一医院妇产科生产且产后发生抑郁的产妇110例纳入研究,应用爱丁堡产后抑郁(EPDS)量表于产后1周筛查产妇抑郁症状,采用SAS9.4软件行单因素和多因素非条件Logistic逐步回归分析产后引发抑郁的相关危险因素。结果 Logistic逐步回归分析显示,引发抑郁的独立危险因素包括:分娩知识的了解(OR=12.26,P=0.015)、待产准备(OR=15.39,P=0.037)、生物学因素(OR=27.81,P=0.002)、原有妊娠史影响胎儿(OR=5.18,P=0.002)、胎盘类固醇(OR=0.72,P=0.001)、雌二醇(OR=0.78,P=0.001)及雌酮(OR=0.81,P=0.001);分娩知识的了解、担心家族史及健康教育因素等与产后发生抑郁呈负相关性(OR=12.26,P=0.015、OR=4.09,P=0.002、OR=1.29,P=0.001);EPDS量表评价显示,产后6周的胎盘类固醇、雌二醇、雌酮及孕酮水平显著低于产前1周,差异具有统计学意义(P0.01)。结论产前激素水平、待产准备不足和担心分娩等问题是造成产后并发抑郁的主要危险因素,产后的健康教育干预及产中的心理支持和疏导属临床客观环境因素。     

中国HIV/AIDS患者抑郁影响因素的META分析

目的 探讨中国HIV感染者/AIDS患者抑郁的影响因素。方法 检索PubMed、Web of Science、The Cochrane Library、Embase、中国知网、万方数据库、维普数据库和中国生物医学数据库,查找自建库至2021年3月期间国内外公开发表的有关中国HIV感染者/AIDS患者抑郁影响因素分析的文献。用RevMan 5.3软件进行数据分析,根据异质性检验结果采用固定效应模型或随机效应模型进行分析,并对结果进行敏感性分析和发表偏倚评价。结果 共纳入22篇文献,研究对象共7101例。有8个因素的合并OR值有显著意义。结果显示年龄［OR=1.52,95%CI(1.18,1.95)］、居住情况［OR=1.35,95%CI(1.05,1.74)］、户籍类型［OR=1.50,95%CI(1.14,1.97)］、CD4水平［OR=1.56,95%CI(1.28,1.91)］、疾病分期［OR=1.79,95%CI(1.08,2.95)］、感知羞辱或歧视［OR=6.07,95%CI(4.50,8.19)］、社会支持［OR=0.50,95%CI(0.41,0.61)］、经济状况［OR=0.51,95%CI(0.39,0.66)］是中国HIV/AIDS患者抑郁的影响因素。结论 年龄≥50岁、户籍为农村、独居、CD4+T淋巴细胞＜200个/μl、疾病分期为艾滋病期、感知歧视或羞耻是HIV感染者/AIDS患者抑郁的危险因素,经济水平和社会支持较好是保护因素。     

骨质疏松与认知障碍关系的Meta分析

目的 系统评价骨质疏松与认知障碍的关系,为认知障碍患者的预防提供循证支持。方法 计算机全面检索Embase,Web of Science,PubMed,Cochrane Library,知网,中国生物医学文献数据库,万方,维普等数据库中关于认知障碍与骨质疏松关系的队列研究及病例-对照研究,时限均自建库至2021年4月23日。所得数据采用RevMan 5.3结合Stata 15.1软件进行Meta分析。结果 最终纳入7篇文献,共77417个患者。纳入文献均为中高等质量水平。Meta分析结果显示:与对照组相比,骨质疏松组认知障碍的发病率更高（OR=1.97,95% CI:1.37～2.82,P<0.001）。同时,亚组分析结果显示,不同性别［男性（OR=1.68,95% CI:1.22～2.32,P=0.001）、女性（OR=1.76,95% CI:1.28～2.42,P<0.001）］、年龄［老年（OR=1.77,95% CI:1.26～2.50,P=0.001）、中年（OR=2.38,95% CI:1.43～3.97,P=0.001）］、测量部位［腰椎（OR=2.18,95% CI:1.49～3.20,P<0.001）、股骨颈（OR=2.41,95% CI:1.23～4.73,P=0.010）］、认知障碍严重程度［痴呆（OR=2.22,95% CI:1.63～3.03,P<0.001）］、国家［亚洲（OR=2.31,95% CI:1.61～3.30,P<0.001）］下,认知障碍与骨质疏松症呈正关联。结论 骨质疏松与认知障碍的风险增加有关。     

失眠与老年性痴呆相关性的Meta分析

目的系统评价失眠与老年性痴呆的关系。方法检索中国知网、维普、万方、PubMed、Web of Science、Embase、Cochrane Library、Medline、CINAHL PLUS等中英文数据库,筛选失眠与老年性痴呆相关性的队列研究,时限均从建库至2021年1月10日。对最终纳入的文献进行数据提取与质量评价,并通过Stata 14.0软件进行meta分析。结果本研究最终纳入10篇文献,共含236 552例样本。纳入文献质量均处于中高水平。meta分析结果显示:失眠与老年性痴呆有相关性(OR=1.31,95%CI:1.14～1.50,P0.001)。亚组分析显示:不同研究地区或国家[欧洲(OR=1.39)、美国(OR=1.12)、中国(OR=2.34)]、失眠评估工具[问卷调查(OR=1.16)、ICD-9(OR=1.54)]、痴呆诊断工具[临床诊断(OR=1.30)、ICD-9(OR=1.54)]下,失眠与老年性痴呆具有相关性。结论失眠与老年性痴呆的发生具有相关性,失眠是老年性痴呆的危险因素。     

益生菌缓解焦虑疗效的Meta分析

目的 系统评价益生菌缓解焦虑的疗效。方法 计算机检索Embase、PubMed、Web of Science、中国生物医学文献、知网、万方、维普等数据库中益生菌缓解焦虑疗效的随机对照研究,并对纳入的文献进行质量评价与数据提取,采用Stata 14.0进行Meta分析。结果 最终纳入15篇文献,患者共1350例。Meta分析结果显示:益生菌有助于缓解焦虑［SMD=-0.29,95%CI(-0.52,0.06),P=0.012］;同时亚组分析发现,在干预周期＜8周、健康人群组、非健康人群组、发达国家组及非发达国家组中,益生菌对其焦虑的减轻均具有统计学意义(P＜0.05)。结论 益生菌能够显著缓解焦虑。     

PBL教学模式对预防医学生课程教学效果的系统评价

目的 系统评价PBL教学模式对预防医学生课程教学效果的影响。方法 检索PubMed、CNKI、WanFang Data、CBM和VIP数据库,搜集PBL应用于预防医学生教学的RCT研究,采用R软件（3.6.2版本）进行Meta分析。结果 共纳入23篇文献,包括2 108例研究对象。Meta分析结果显示,PBL组预防医学生的理论成绩［ SMD =1.13,95% CI (0.65,1.60)］、实践操作成绩 ［ SMD =1.27,95% CI (0.91,1.63)］、教学满意度［ RR =1.33,95% CI (1.17,1.52)］、学习兴趣［ RR =1.61,95% CI (1.37,1.89)］、自主学习能力 ［ RR =1.63, 95% CI (1.39,1.92)］、团队协作能力［ RR =2.11,95% CI (1.54,2.89)］、解决问题能力［ RR =1.58,95% CI (1.36,1.83)］均显著优于LBL组。亚组分析结果显示PBL联合教学组预防医学生的理论成绩［ SMD =1.27,95% CI (0.46,2.09)］、实践操作成绩［ SMD =1.39,95% CI (0.82,1.96)］、团队协作能力［ RR =2.27,95% CI (1.41,3.64)］均优于单独使用PBL组,PBL在毒理学课程中对提高预防医学生的理论成绩［ SMD =1.44,95% CI (1.10,1.79)］和实践操作成绩［ SMD =1.16,95% CI (0.74,1.59)］效果均较为显著。结论 PBL对预防医学生的教学效果具有显著影响;PBL联合教学比单独使用PBL的教学效果更显著;未来需纳入更多严谨的试验设计来验证其应用效果。     

CDKAL1基因rs7754840和rs7756992位点多态性与妊娠期糖尿病相关性的Meta分析

目的 评价CDKAL1基因rs7754840和rs7756992位点多态性与妊娠期糖尿病(GDM)的相关性。方法 检索PubMed、EBSCO、中国知网、万方数据库中CDKAL1基因rs7754840和rs7756992多态性与GDM相关性的研究,日期截至2019年10月。采用RevMan 5.3软件进行Meta分析。结果 共纳入9篇病例对照研究,包含病例3 115例,对照4 112例。Meta分析显示,CDKAL1基因rs7754840多态性与GDM有相关性(等位基因模型:OR = 1.19,95%CI:1.10～1.28,P＜0.001;显性模型:OR = 1.26,95%CI:1.07～1.48,P = 0.006;隐性模型:OR = 1.26,95%CI:1.10～1.44,P = 0.0007),亚组分析中国人群rs7754840多态性与GDM有相关性(等位基因模型:OR = 1.15,95%CI:1.06～1.25,P = 0.0008;隐性模型:OR = 1.18,95%CI:1.01～1.36,P = 0.03)。CDKAL1基因rs7756992多态性与GDM无相关性(5个模型均P＞0.05),中国人群也显示rs7756992位点多态性与GDM无相关性。结论 CDKAL1基因rs7754840位点多态性与GDM的发病风险有显著相关性,但未发现rs7756992位点多态性与GDM易感性有关。     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.