目的 调查骨科医护人员对疼痛管理的认知情况,分析其影响因素,为完善骨科患者疼痛临床规范管理体系提供依据.方法 采用分层随机抽样方法抽取武汉市6所不同等级医院的411名骨科医护人员为调查对象,采用汉化版疼痛管理知识和态度调查量表(KASRP)收集数据,运用多重线性回归分析方法进行多因素分析.结果 医护人员对疼痛认知得分为12～26(18.60±3.39)分,32.50％的调查项目正确率低于30％,医生与护士得分差异无统计学意义(P＞0.05).骨科医护人员对疼痛管理认知情况主要与其所在医院级别、学历、亚专业为肿瘤、婚姻状况、年龄5个因素有关(P＜0.05,P＜0.01).结论 目前骨科医护人员的疼痛认知与管理水平较低,亟待提高.需要继续加强对疼痛知识的系统性培训,加强医护患一体化疼痛管理,促进有效疼痛管理.

Giving comprehensive description and evaluation of domestic and foreign research of altruistic behavior in medical students, the role of altruistic behavior in the physician's professional spirit, career choice and consideration of patients'interests was expounded.The factors associated with altruistic behaviors in medical students such as gender, grade, origin, empathy and mental health were analyzed.The methods of cultivating medical students' altruistic behavior were discussed to promote the human-istic education of medical students in China.

OBJECTIVE To explore the effects of related environment, occupational, lifestyle, genetic factors as well as their interactions on the etiology of major chronic diseases in an occupational population. METHODS Dongfeng-Tongji cohort (DFTJ cohort), one of the large prospective cohort studies with biobank. Baseline study was conducted in Shiyan city, Hubei province from 2008 to 2009. This cohort study included questionnaire, physical examination and tests on blood samples. Dongfeng-Tongji cohort was followed up every 5 years and the first follow-up program was completed, from April to October in 2013. During the first follow-up period in 2013, questionnaire, physical examination, clinical and blood sample tests were conducted again. RESULTS 27 009 retired participants with mean age of 63.6 years including 44.6% males, were recruited in this study. In the first follow-up program in 2013, among 38 295 subjects (44.7% males), 40.5% of them received diploma from high school or above. Prevalence rates of current regular smokers were 33.6% in men and 2.0% in women and the rates on current alcohol drinkers were 39.9% in men and 10.6% in women. The prevalence rates on self-reported hypertension, hypercholesterolemia, diabetes mellitus, coronary heart disease, stroke, chronic bronchitis, and asthma were 41.1%, 24.3%, 13.9%, 16.7%, 5.1%, 12.7% and 4.0%, respectively. The self-reported prevalence of hypertension and stroke in males was higher than that in females. 25 978 individuals who were involved in the baseline database successfully completed the followed up program in 2013, with the follow-up rate as 96.2%. CONCLUSION The DFTJ cohort study offered us an opportunity to explore the effects of environmental, genetic, as well as their interactions with major chronic diseases in a Chinese occupational population.

目的 分析治疗后梅毒患者(包括隐性梅毒,血清固定型,已治愈患者)行体外受精-胚胎移植(IVF-ET)和卵胞浆内单精子显微注射(ICSI)的结局,为其知情选择提供帮助.方法 回顾性分析2009年～ 2014年在我院行IVF/ICSI治疗的不孕症夫妻,将其分为非梅毒患者、单独男方梅毒患者、单独女方梅毒患者、双方梅毒患者4组,比较其正常受精率、优质胚胎率、临床妊娠率及流产率.结果 双方梅毒患者,正常受精率为54.5％ (P＜0.01)明显低于其它组,结果有统计学差异(P均＜0.05).然而这4组的优质胚胎率、临床妊娠率及流产率均无统计学差异(P均＞0.05).结论 治疗后梅毒患者行IVF/ICSI时,虽然双方梅毒患者的正常受精率偏低,但受精后形成优质胚胎、临床妊娠率及流产率与其它组均无显著性差异.治疗后梅毒患者,不影响IVF/ICSI的妊娠结局.故医护人员在告知治疗后梅毒患者行IVF/ICSI时可不必过分担心与非梅毒患者的正常受精率、优质胚胎率、临床妊娠率及流产率差异,减轻病人的心理压力.

Objective To explore the applications of grey model in predicting the incidence of syphilis in Hainan Province, and to forecast the incidence trends in syphilis from 2014 to 2018 by grey model, in order to provide a scientific base for reasonable distribution of health resource to prevent and control syphilis. Methods Gray model were adopted for fitting and predicting the incidence of syphilis in Hainan Province from 2009 to 2013. Results The prediction model was , and the estimation test results of model were C=0.290 7<0.35, P=1. Extrapolating the syphilis incidence in Hainan Province in next five years, it is estimated that the syphilis inci-dences would be 45.98/100 000, 52.60/100 000, 60.19/100 000, 68.85/100 000 and 78.78/10 0 000. Conclusion The GM(1,1) model is fit for predicting the incidence of syphilis. The incidence of syphilis is sustainably on growing tread in the next five years.

Hypoxia is a prominent characteristic of inflammatory tissue lesions. It can affect platelet function. While mean platelet volume (MPV) and platelet distribution width (PDW) are sample platelet indices, they may reflect subcinical platelet activation. To investigated associations between adiposity indices and platelet indices, 17327 eligible individuals (7677 males and 9650 females) from the Dongfeng-Tongji Cohort Study (DFTJ-Cohort Study, n=27009) were included in this study, except for 9682 individuals with missing data on demographical, lifestyle, physical indicators and diseases relative to PDW and MPV. Associations between adiposity indices including waist circumstance (WC), waist-to-height ratio (WHtR), body mass index (BMI), and MPV or PDW in the participants were analyzed using multiple logistic regressions. There were significantly negative associations between abnormal PDW and WC or WHtR for both sexes (p trend<0.001 for all), as well as abnormal MPV and WC or WHtR among female participants (p trend<0.05 for all). In the highest BMI groups, only females with low MPV or PDW were at greater risk for having low MPV (OR=1.33, 95% CI=1.10, 1.62 p trend<0.001) or PDW (OR=1.34, 95% CI=1.14, 1.58, p trend<0.001) than those who had low MPV or PDW in the corresponding lowest BMI group. The change of PDW seems more sensitive than MPV to oxidative stress and hypoxia. Associations between reduced PDW and MPV values and WC, WHtR and BMI values in Chinese female adults may help us to further investigate early changes in human body.

OBJECTIVE:Evidence from epidemiological studies suggested that shorter and longer duration of nocturnal sleeping may increase the risk of hypertension for older adults. Little is known about the duration of midday nap on the variability of blood pressure among older adults. In this study, we examined whether duration of habitual midday nap is associated with level of blood pressure or the risk of hypertension in a middle-aged and older Chinese population.METHODS:A total of 27 009 participants (mean age 63.6 years) from Dongfeng-Tongji Cohort Study received baseline examination including physical examination and laboratory tests, and a face-to-face-interview including demographic information, disease history, and lifestyle. Participants were categorized into five groups according to nap duration, such as no napping, less than 30 min, 30∼60 min, 60∼90 min, and at least 90 min. A series of categorical logistic regression models was used to examine the odd ratios of nap duration with hypertension.RESULTS:The level of SBP and DBP increased significantly with longer duration of habitual midday napping. Nappers with longer nap duration had considerably higher rate of hypertension. The longer duration of napping was related to higher blood pressure level and was associated with a higher risk of hypertension. After adjusting for possible confounders, the longer duration (>60 min) of napping was still associated with hypertensionCONCLUSION:: Our findings showed that the practice of longer afternoon nap is associated with a higher increased risk of hypertension, independent of several covariates. Further prospective researches are needed to examine the midday nap duration for development of hypertension.

Objectives To investigate the recognition of HIV/AIDS among vocational-technical school students from rural areas.Methods 1 91 5 vocational-technical school students were sampled by stratified cluster sampling and investigated by questionnaire survey on anonymous basis.Results The awareness rate of the students was only 13.1 1% according to UNGASS.The transmission awareness was 59.41% with regards to AIDS transmission via maternal-neonatal routes and 66.69% of the vocational-technical school students knew that refusing to unsafe sexual behaviors was one of HIV/AIDS preventive measures;The way for students to get information on AIDS was prima-rily from internet,TV and radio (60.45%)and books (31.57%).The awareness indicator of male students was apparently higher than that of female students.Conclusions The health education on AIDS for the vocational-tech-nical school students should be strengthened.

OBJECTIVETo investigate the effect of passive smoking on the changes in mean platelet volume (MPV) in healthy adults.METHODSParticipants (N = 17,825) were drawn from the Dongfeng-Tongji cohort. Multiple logistic regression analysis was used to examine relationships between MPV and selected variables among subgroups of MPV clarified by the MPV reference range for Chinese adults.RESULTSFemale never smokers exposed to passive smoke ≥ 60 minutes every day (OR: 1.471, 95%CI: 1.147-1.886) or ≥ 30 years had a higher risk of having low MPV (OR: 1.260, 95%CI: 1.004-1.583).CONCLUSIONSCertain duration of passive smoke exposure (≥ 60 minutes/day or ≥ 30 years) was associated with higher risk of having low MPV in female never smokers.

BACKGROUND:The prevalence of metabolic syndrome (MetS) is growing rapidly in China. Tai chi and dancing are common types of exercise among middle-aged and elderly Chinese. It remains unclear whether these activities are associated with a lower risk of MetS. METHODOLOGY/PRINCIPAL FINDINGS:A total of 15,514 individuals (6,952 men, 8,562 women) aged 50 to 70 years from the Dongfeng-Tongji Cohort in Shiyan, China participated in a cross-sectional study. Physical activity and other lifestyle factors were assessed with semi-structured questionnaires during face-to-face interviews. MetS was defined by the current National Cholesterol Education Program/Adult treatment Panel III criteria for Asian Americans. The prevalence of MetS was 33.2% in the study population. In the multivariable-adjusted logistic regression analyses, total physical activity levels were monotonically associated with a lower odds of MetS [OR 0.75 comparing extreme quintiles, 95% confidence interval (CI) 0.66-0.86, P<0.001]. Compared with non-exercisers in a specific exercise type, jogging (OR 0.82, 95% CI 0.68-1.00, P = 0.046), tai chi (OR 0.72, 95% CI 0.60-0.88, P<0.001), and dancing (OR 0.56, 95% CI 0.47-0.67, P<0.001) were associated with significantly lower odds of MetS. Furthermore, each 1-h/week increment in tai chi and dancing was associated with a 5% (95% CI 2%-9%) and a 9% (95% CI 6%, 12%) lower risk of MetS. CONCLUSIONS/SIGNIFICANCE:Jogging, tai chi and dancing are associated with a significantly lower risk of having MetS in middle-aged and older Chinese. Future intervention studies should consider the role of jogging, tai chi and dancing in preventing MetS.

<正>随着中国市场经济体制的不断完善,越来越多的农民工进入到城市,作为危害严重的感染性疾病艾滋病也威胁着广大农民工群体并且给国家和人民造成了严重的经济负担。由于农民工文化程度偏低、信息相对闭塞、处于性活跃年龄,极易发生感染艾滋病的高危行为,而大规模的农民工流动无疑加速了艾滋病的传播和流行。同时艾滋病相关知识的知晓情况与农民工对艾滋病人的态度密

OBJECTIVE:Tumour biomarkers are used as indicators for cancer screening and as predictors for therapeutic responses and prognoses in cancer patients. We aimed to identify genetic loci that influence concentrations of cancer antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA) and α fetoprotein (AFP), and investigated the associations between the significant single nucleotide polymorphisms (SNPs) with risks of oesophageal squamous cell (OSCC), pancreatic and hepatocellular cancers. DESIGN:We carried out a genome wide association study on plasma CA19-9, CEA and AFP concentrations in 3451 healthy Han Chinese and validated the results in 10 326 individuals. Significant SNPs were further investigated in three case control studies (2031 OSCC cases and 2044 controls; 981 pancreatic cancer cases and 1991 controls; and 348 hepatocellular cancer cases and 359 controls). RESULTS:The analyses showed association peaks on three genetic loci for CA19-9 (FUT6-FUT3 at 19p13.3, FUT2-CA11 at 19q13.3 and B3GNT3 at 19p13.1; p=1.16×10(-13)-3.30×10(-290)); four for CEA (ABO at 9q34.2, FUT6 at 19p13.3, FUT2 at 19q13.3 and FAM3B at 21q22.3; p=3.33×10(-22)-5.81×10(-209)); and two for AFP (AFP at 4q11-q13 and HISPPD2A at 15q15.3; p=3.27×10(-18) and 1.28×10(-14)). These explained 17.14% of the variations in CA19-9, 8.95% in CEA and 0.57% in AFP concentrations. Significant ABO variants were also associated with risk of OSCC and pancreatic cancers, and AFP variants with risk of hepatocellular cancer (p<0.05). CONCLUSIONS:This study identified several loci associated with CA19-9, CEA and AFP concentrations. The ABO variants were associated with risk of OSCC and pancreatic cancers and AFP variants with risk of hepatocellular cancer.

Our aim was to study whether there is causal association between serum uric acid and metabolic syndrome (MetS). A cross-sectional study was performed, including a total of 27,009 subjects (23,345 subjects having uric acid data) from the Dongfeng-Tongji Cohort study. The MetS was defined by the International Diabetes Foundation criteria of 2005. Association analysis was performed by logistic regression. A genetic risk score was calculated by adding the uric acid increasing alleles in two SNPs (rs11722228 in SLC2A9 and rs2231142 in ABCG2) which were identified from our genome-wide association study on uric acid levels. The causal association was examined by mendelian randomization analysis. Among a middle- and old-age Chinese population, serum uric acid concentrations were strongly associated with the risk of MetS and its several components (P < 0.0001). The effects were stronger in women than in men. Despite the lack of statistical significance, both SNPs exhibited a trend with increased MetS risk (rs11722228, OR = 1.06, 95 % CI 0.99–1.14; rs2231142, OR = 1.02, 95 % CI 0.95–1.10), consistent with their increasing uric acid effects. Each additional uric acid increasing allele in the genetic risk score was associated with 3 % increased MetS risk (OR = 1.03, 95 % CI 0.98–1.09; P = 0.23). Further adjustment for serum uric acid attenuated the trend of individual SNP and genetic risk score with increased MetS risk (all OR < 1.0). These findings suggested that serum uric acid was associated with MetS risk in a middle- and old-age Chinese population. Whether this association was causal remained to be investigated in the future studies.

Objectives: Afternoon napping is a common habit in China. We used data obtained from the Dongfeng-Tongji cohort to examine if duration of habitual afternoon napping was associated with risks for impaired fasting plasma glucose (IFG) and diabetes mellitus (DM) in a Chinese elderly population.Methods: A total of 27,009 participants underwent a physical examination, laboratory tests, and face-to-face interview. They were categorized into four groups according to nap duration (no napping, <30, 30 to <60, 60 to <90, and >= 90 min). Logistic regression models were used to examine the odds ratios (ORs) of napping duration with IFG and DM.Results: Of the participants, 18,515 (68.6%) reported regularly taking afternoon naps. Those with longer nap duration had considerably higher prevalence of IFG and DM. Napping duration was associated in a dose-dependent manner with IFG and DM (P < .001). After adjusting for possible confounders, longer nap duration (>60 min; all P < .05) was still significantly associated with increased risk for IFG, and longer nap duration (>30 min) was associated with increased risk for DM; however, this finding was not significant in the group with a nap duration of 60-90 min.Conclusions: Longer habitual afternoon napping was associated with a moderate increase for DM risk, independent of several covariates. This finding suggests that longer nap duration may represent a novel risk factor for DM and higher blood glucose levels. (C) 2013 Published by Elsevier B.V.

China has seen rapid socio-economic and epidemiolo-gical changes over the past several decades. Economicgrowth plus shifts in environment, lifestyles and diethave increased life expectancy, but they have also ledto a higher burden of chronic, non-communicablediseases. Stroke, coronary heart disease (CHD), cancerand diabetes account for 80% of the deaths and 70%of the disability-adjusted life-years lost in China.

Objective:To evaluate the implementation of rural health construction,poverty alleviation projects,and total effect in Hainan province by comparing the current situation of rural clinics in Hainan province before and after the implementation of the project,provide a theoretical basis for making development policies of rural health protection and reform measures in Hainan province.Methods:A comprehensive study of combination of qualitative,quantitative and literature retrieval methods was conducted for baseline investigation,mid-evaluation,and terminal evaluation and research of the project.Results:After implementation of the project,the environment of rural health institutions were improved,the number of dangerous buildings was reduced,the build and distribution was increased,the allocation rate of equipments was increased,and the evaluation score increased;but there was still many problem needing to be solved.Conclusion:The project plays an important role in the construction of rural health institutions and training of medical workers in Hainan province,the effect is good.The key points of rural health protection development include enhancing construction of departments in medical institutions,solving human resources,enlarging investments,attaching importance to absorb experiences,promoting and developing incentive effect of the project.

Objective:To understand the current situation of reproductive health in women from areas in Middle-West China after intervention,and analyze the effect of health behaviors on reproductive tract infection of them.Methods:A total of 2 087 married women from from areas in Middle-West China received questionnaire survey about health behaviors in November 2010.Results:Among the respondents,467 women(22.3%) were found with at least one kind of reproductive tract infection,the common disease was vulva pruritus;among the health behaviors,hygienic products during menstrual period,the frequency of bathing,the ways of bathing,washing vulva frequently or not,and washing genital or not of their husbands or sex partners were statistically correlated with the incidence of reproductive tract infection in women from areas in Middle-West China.Conclusion:The awareness of reproductive health in women of childbearing age after intervention from rural areas in Middle-West China is weak,health education should be conducted to promote them to form good living habits and improve reproductive health status.

Objective:To study the change of serum Cystatin C(CysC) and IL-6 levels and its clinical significance in patients with acute coronary syndrome(ACS). Method:One hundred and two patients with CHD from August 2010 to December 2011 were selected and divided into acute myocardial infarction(AMI) group,unstable angina(UAP) group and stable angina(SAP) group.Seventy-seven patients without CHD were selected in non-CHD group.The level of CysC and IL-6 were detected. Result:The level of CysC in UAP group was higher than that in non-CHD group and SAP group(P0.05).The level of CysC in AMI group was lower than that in UAP group and SAP group(P0.05),and there was no significant difference between in non-CHD group and AMI group(P0.05).The levels of IL-6 from high to low order were AMI group,UAP group,SAP group and non-CHD group. Conclusion:The expression of CysC and IL-6 may play a key role in the occurrence of ACS.Detecting CysC and IL-6 levels have a certain guiding significance in prediction of ACS occurrence.

Objective:To understand the situations of human resources before and after the implementation of poverty alleviation project of rural health construction in Hainan province.Methods:Stratified sampling method was used to investigate the basic situations of construction of rural health institutions in Hainan province.Results:The proportions of women in human resources in township hospitals in 2007 and 2010 were higher than those of men,35-45-year-old staff accounted for most of human resources,after implementation of the project,the proportion of the staff with university degree and junior high school degree increased(P<0.05),there were no staff with advanced level accountant,there was no significant difference in the proportion of professional title before and after the implementation of the project;the mean age of the doctors in village clinics was 41.80 years,which was younger than baseline investigation(43.36 years),but there was no significant difference(P=0.581 6).83.33% of the village doctors had certificate of rural doctors,and 16.67% of them held certificate doctor's qualification for medical practice recognized nationally.Conclusion:The change of situations of human recourses in township hospitals and villages clinics after the implementation of the project is not obvious,but the total quality is improved significantly;it is necessary to stabilize the existing human resources,pay attention to the training of their own personnel,and develop training plans and programs.

Objective:To understand the current situation and characteristics of anemia among the children under six years in rural areas of Hainan province,analyze the related effect factors.Methods:A stratified random sampling method was used to select 3 041 children under six years from ten project counties in Hainan province from 2007 to 2008.All the children received hemoglobin detection and investigation of familial general conditions.The data were analyzed by SPSS 18.0 statistical software,hemoglobin level<110 g/L was designed as the diagnostic criterion of anemia among the children aged six months-six years which was proposed by WHO and UNCF.Results:The total incidence of anemia among the children under six years in project counties of Hainan province was 11.4%,the incidence of anemia among the children under six years in Wuzhishan city was the highest(20.7%) and the incidence of anemia among the children under six years in Qionghai city was the lowest(5.5%).The children aged 1-2 years had high incidence of anemia,and the incidence of anemia decreased with age,there was significant difference in the incidence of anemia among the children of different nationalities.The results of multivariate logistic regression analysis showed that there was statistical correlation between age,gender,nationality and anemia among the children,but there was no correlation between parental educational levels,familial types,feeding types of the children,birth weight,the time to add complementary feed,the weaning time and anemia among the children.Conclusion:Some children in rural areas of Hainan province were found with anemia,especially the children aged 1-2 years;age,gender,and nationality are the main factors causing the difference of incidence of anemia among the children in rural areas.