1型糖尿病患者勃起功能障碍的患病情况及相关因素分析

目的 探讨1型糖尿病(T1DM)患者勃起功能障碍(ED)的患病情况及相关影响因素.方法 收集182例已婚男性T1DM患者,用无记名问卷形式根据国际勃起功能指数问卷进行自我评分,并对年龄、病程、糖化血红蛋白(HbA1c)、睾酮、尿微量白蛋白排泄量、肾功能、血压、吸烟史、饮酒史、应用药物等因素进行调查,分析其与ED的关系.结果 T1DM患者ED患病率为37.36%(68/182).Logistic逐步回归分析结果显示,病程、年龄、HbA1c、收缩压、尿微量白蛋白排泄量与T1DM患者ED发生独立相关,病程增加5年、年龄增加10岁、HbA1c增加2%、收缩压增加4 kPa及尿微量白蛋白排泄量的OR值分别为1.6275、1.1613、2.4211、2.3715、1.5234,P均＜0.01.结论 加强对T1DM患者ED高危因素的关注和定期检测,有助于早期发现ED.     

2018-2021年郑州市2型糖尿病微血管并发症的流行病学特点及危险因素分析

目的 研究郑州市2型糖尿病微血管并发症的流行病学特点，探讨其危险因素。方法 收集2018-2021年郑州市781例资料完整的2型糖尿病（T2DM）患者临床资料，根据是否合并微血管并发症，将T2DM微血管并发症（DR+DN）303例作为微血管并发症组（DNR组），单纯T2DM患者368例作为无微血管并发症组（DM）。结果 781例T2DM患者中，糖尿病视网膜病变157例，占20.10%，糖尿病肾病235例，占30.09%。随着年龄和病程的增加，糖尿病微血管并发症的发生率不断增加（P均<0.05）。与DM组比较，DNR组年龄、BMI、收缩压、病程、空腹血糖、糖化血红蛋白（HbA1c）、高密度脂蛋白胆固醇（LDL-C）、肌酐明显增加（P均<0.05）。多因素logistic回归分析结果显示，病程、BMI、收缩压、空腹血糖、HbA1c、肌酐、LDL-C是糖尿病微血管并发症的独立危险因素（OR值分别为1.177、1.023、1.956、1.167、1.395、2.490、1.303）。结论 郑州市T2DM患者微血管并发症发病率高，且随着年龄和病程增加而升高，病程、BMI、收缩压、空腹...     

2型糖尿病视网膜病变相关因素Logistic回归分析

目的研究影响2型糖尿病视网膜病变（DR）的相关因素。方法对720例2型糖尿病患者的糖尿病病程、糖尿病家族史、心脑血管病史、吸烟史、居住地域等进行调查,测量血压、血脂、体质指数（BMI）、糖化血红蛋白（HbA1c）、空腹血糖（FPG）、24h尿微量白蛋白等,检查糖尿病周围神经病变,并对上述DR相关因素进行Logistic回归分析。结果单因素Logistic回归分析结果显示,居住地域、糖尿病病程、血压、糖尿病周围神经病变、HbA1c、24h尿微量白蛋白与DR发生之间的联系有统计学意义（P〈0．05）;多因素Logistic回归分析结果显示,糖尿病病程、HbA1c、24h尿微量白蛋白与DR发生之间的联系有统计学意义（均P〈0．05）。结论糖尿病病程、HbA1c、24h尿微量白蛋白与DR发生相关。     

2型糖尿病患者伴下肢血管病变的危险因素分析

目的 探讨2型糖尿病患者伴下肢血管病变的危险因素。方法 2型糖尿病患者伴下肢血管病变79例（LEAD组），元下肢血管病变67例（NLEAD组），分别记录其性别、年龄、糖尿病病程、血压，测定其空腹血糖（FBG）、糖化血红蛋白（HbA1c）、总胆固醇（TC）、甘油三酯（TC）、低密度脂蛋白-胆固醇（LDL-C）、高密度脂蛋白-胆固醇（HDL-C）、载脂蛋白A1（APOA1）、载脂蛋白B（APOB）及24h尿白蛋白，并行下肢彩色多普勒超声检查。结果 LEAD组与NLEAD组比较，平均年龄、平均病程、24h尿白蛋白、收缩压、舒张压、TC、TG、LDL-C、HDL-C、APOA1、APOB、HbA1c差异均有统计学意义（P〈0．01或〈0．05）。2型糖尿病患者伴下肢血管病变各危险因素的Logistic回归分析结果表明，TC、年龄、收缩压、24h尿白蛋白四项是其独立危险因素。结论 TC、年龄、收缩压、24h尿白蛋白是2型糖尿病患者伴下肢血管病变的独立危险因素。     

2型糖尿病患者尿微量白蛋白检测的临床意义

目的探讨尿微量白蛋白检测在2型糖尿病（T2DM）患者中的临床价值。方法随机选取临床确诊的60例T2DM患者,另将60例健康体检者作为对照组。2组分别测定空腹血糖和尿微量白蛋白。结果对照组空腹血糖和尿微量白蛋白分别为（4．82±1．59）mmol／L和（18．60±4．48）mg／d,T2DM组空腹血糖和尿微量白蛋白数值较对照组明显升高,分别为（15．65±4．97）mmol／L和（64．77±11．59）mg／d,2组比较差异有统计学意义（P〈0．01）。结论T2DM患者微量白蛋白尿发生率较高,尿微量白蛋白检测可以作为T2DM患者的常规检查项目。     

100例2型糖尿病患者尿微量白蛋白／肌酐检测结果临床分析

目的探讨2型糖尿病患者尿微量白蛋白（MALB）、MALB／尿肌酐（Cr）比值与糖化血红蛋白（HbA1c）、糖尿病病程的关系。方法采用免疫透射比浊法测定MALB，用酶法检测尿Cr，并计算MALB／Cr比值。结果糖尿病肾病的检出率与病程、HbA1c呈正相关。结论检测尿MALB和MALB／Cr比值是早期诊断糖尿病性肾病灵敏、可靠的实验室指标．     

某医院624例2型糖尿病患者视网膜病变患病率及其危险因素分析

目的探讨某医院624例2型糖尿病(T2DM)患者视网膜病变(DR)患病率及影响其发生的相关危险因素。方法选取2014年1月至2016年12月于某院门诊及住院部就诊的624例T2DM患者作为研究对象,采用回顾性分析法分析所有患者的临床资料,根据资料结果记录所有患者的一般情况、相关实验室检查、系统眼科检查结果以及DR发生情况,并比较不同DR患者间上述资料的差异性,研究影响T2DM患者发生DR的相关危险因素。结果 (1)本组624例T2DM患者中,检出DR患者168例,占26.92%;(2)合并DR与未合并DR的T2DM患者在年龄、收缩压、舒张压、病程、LDL-C及尿微量白蛋白水平上比较,差异均具有统计学意义(P0.05);(3)经非条件多因素Logistic回归模型分析得出,年龄过大、血压过高、病程较长、LDL-C和尿微量白蛋白水平过高是导致T2DM患者并发DR的独立危险因素(P0.05)。结论 T2DM患者DR发病率较高,且年龄过大、血压过高、病程较长、LDL-C和尿微量白蛋白水平过高是导致T2DM患者并发DR的独立危险因素。     

2型糖尿病患者不同肥胖指标和微量白蛋白尿的关系研究

目的分析不同肥胖指标和2型糖尿病患者微量白蛋白尿的关系,探讨预测2型糖尿病患者微量白蛋白尿发生风险的适宜肥胖指标。方法选取2010年1月-2014年10月2型糖尿病住院患者1 887例,按尿白蛋白/肌酐(尿A/C)分为微量白蛋白尿组和正常蛋白尿组,比较与微量白蛋白尿发生相关的影响因素。结果和正常蛋白尿组比较,男性患者中微量白蛋白尿组年龄、病程、收缩压、体质指数(BMI)、腰围(WC)、腰臀比(WHR)、腰身比(WHtR)明显增加,血肌酐、甘油三酯(TG)、糖化血红蛋白(HbAlc)明显增高,低密度脂蛋白胆固醇(LDL-C)明显降低;女性患者中,微量蛋白尿组年龄、病程、收缩压、WC、WHR、WHtR明显增加,TG、HbA1c明显增高;以上差异均有统计学意义(P值均0.05)。多因素logistic回归结果显示,校正了年龄、病程、收缩压、TG、HbA1c等影响因素后,男性患者BMI、WC、WHR、WHtR与微量白蛋白尿发生相关,OR值分别为1.097、1.043、1.348、2.212(P值均0.01);女性患者WHR、WHtR与微量白蛋白尿相关,OR值分别为1.448、2.432(P值均0.01)。男、女性WHtR ROC曲线下面积均最大,与WC、WHR及BMI ROC曲线下面积相比,男性组差异无统计学差异(P0.05),女性组差异有统计学意义(P0.05)。WHtR预测微量白蛋白尿发生的切点:男性0.54(敏感性59%,特异性61%),女性0.57(敏感性58%,特异性67%)。结论 WHtR是预测2型糖尿病微量白蛋白尿发生的适宜肥胖指标。合理减重,控制WHtR对2型糖尿病患者早期肾病的防治及减少相关死亡有重要意义。     

初诊Ⅱ型糖尿病患者踝肱动脉指数危险因素分析

目的研究踝肱动脉血压指数（ABI）在初诊中老年2型糖尿病（T2DM）患者下肢动脉病变（PAD）中临床意义与影响因素。方法采用多普勒血流探测仪检测129例初诊中老年T2DM患者足背动脉、胫后动脉与肱动脉血压的比值，以0．9为切割点，分析比较中老年两组ABI及临床参数差别。结果129例初诊中老年T2DM患者中ABI〈0．9为14例。占总数10．9％，老年组ABI、吸烟率、甘油三酯低于中年组，而PAD患病率、BMI、收缩压、高血压患病率、高血压病程、空腹血糖、餐后2小时血糖、HbA1c高于中年组，差异有统计学意义（P〈0.05），ABI与年龄（r=-0．461，p=0.001）、高血压病程（r=-0．318，p=0．029）、HbA1c（r=-0.361，p=0．046）呈负相关，多元逐步回归分析显示年龄（p=0.02）、高血压病程（p=0.01）是ABI独立影响因素。结论初诊中老年T2DM中ABI〈0.9者占10．9％。老年组患病率及危险因素高于中年组，年龄、高血糖、高血压为PAD的主要危险因素。     

老年2型糖尿病患者臂踝脉搏波速度与微量白蛋白尿的关系

目的评价老年2型糖尿病患者臂踝脉搏波速度(baPWV)与尿微量白蛋白的关系及其临床意义。方法连续入选87例老年2型糖尿病患者,测量baPWV、血压,测定血糖、血脂、糖化血红蛋白(HbA1c)、肌酐及尿微量白蛋白值。根据尿白蛋白/肌酐比值(ACR)是否异常分为尿微量白蛋白正常组和尿微量白蛋白异常组。结果两组比较,尿微量白蛋白异常组baPWV较快,收缩压和脉压、HbA1c、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)水平均高于尿微量白蛋白正常组,差异有统计学意义(P0.001)。多元逐步回归分析显示,收缩压、年龄、ACR是影响baPWV的独立危险因素,其标准化回归系数分别为:收缩压0.497,t=5.266,P0.001,年龄0.265,t=3.292,P=0.002,ACR0.248,t=2.649,P=0.009。结论除收缩压和年龄外,尿微量白蛋白是影响baPWV的独立危险因素,这种影响可能和血压、血糖及血脂水平有关。     

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.