汕头地区钩端螺旋体菌型分布

本文对汕头地区1959年以来钩端螺旋体病的病原学和血清学调查结果作一综合分析。6412伤病人及宿主生物的检材中分离得钩体263株,菌群鉴定233株,分属七个群,即:黄疸出血群、爪哇群、犬热群、致热群、波摩那群、巴达维亚群和豕群。从病人分离到的主要是犬热群。宿主动物中,猪主要是波摩那和犬热群,鼠以爪哇群为主。1280份人抗体阳性的血清,共有十三个血清群,其中波、犬、沃、秋、流、黄血清群占86.5％。     

洱源县血吸虫病流行区小型兽类调查

目的：了解不同生境小兽的种群组成、分布和密度。方法：用鼠笼、鼠夹和电网捕鼠,并测定密度。结果：共采集标本１０３６只,隶属４目５科９属１４种。以褐家鼠、黄胸鼠和大足鼠为主要种类,分别占３３．０１％、２７．２２％和２２．６８％。夹夜密度居民区为１５．１２％,以褐家鼠为优势种;农耕区为１０．７３％,以大足鼠为优势种;果园为１２．６１％,以斯氏家鼠为优势种。结论：该地小兽种类多,密度高,部分种类可自然感染日本血吸虫     

滇西、南水和土中致病性钩端螺旋体分布调查

水体和土壤保存致病性钩端螺旋体（简称钩体）是钩体病地理流行病学观察研究的重要问题之一．１９８８～１９９２年笔者在滇西、滇南的５个县市进行了调查。采用过滤培养分离法，结果在雨季取样的孟连、华坪县得到的全是水生性钩体，干季取样的耿马、保山及盈江３个县市中的耿马县及保山市的水、土中共分离得致病性钩体８株，两地平均检出率为３．３１％（８／２４２），其中水２．１４％（３／１４０）、土４．９％（５／１０２）．分属６个血清群：黄疸出血、致热群各２株，犬、流感伤寒、赛罗及澳洲群各１株，与当地人和动物感染的菌群相一致，为阐述钩体病疫源地结构等提供了新资料。     

西沙群岛鼠型动物及体外寄生虫的调查

１９９４年４～５月对西沙群岛鼠型动物及体外寄生虫进行了调查。结果表明，该群岛有鼠型动物２目２科２属３种，数量组成以臭最高，褐家鼠次之，黄胸鼠最低。寄生的恙螨１科３属３种，地里纤恙螨为优势种；革螨１科１属３种，毒厉螨占优势；蚤１科２属２种，印鼠客蚤占优势。平均带虫指数和带虫率，恙螨为２．２６和４２．９８％，革螨为０．６８和１８．８８％，蚤为０．７３和２５．７０％，而带虫指数和带虫率均较高的鼠型动物，恙螨为臭，革螨为黄胸鼠，蚤为褐家鼠和黄胸鼠。鼠型动物及体外寄生虫在各种类型生境和各岛的分布均有所不同。     

中国钩端螺旋体宿主动物及其地理分布调查

我国迄今已发现钩端螺旋体宿主动物６５种，其中啮齿目２９种，两栖蛙类８种，食虫目和家畜各６种，食肉目和实验动物各３种，兔形目、鸟类、偶蹄目和爬行动物各２种，鱼类和节肢动物各１种。除鸟类和昆虫外，其它动物既带菌又能排菌，不仅为储存宿主，也是传染源。鼠类是我国稻田型钩体的主要宿主动物，黑线姬鼠、黄胸鼠、黄毛鼠尤为重要；猪和犬是洪水型和雨水型钩体的主要传染源，长江流域及其以南地区鼠类密度大，带菌率高；黄河流域及其以北地区猪和犬的带菌率相对高，牛作为七日热型钩体的传染源意义值得进一步调查。由此表明，我国钩体的宿主动物种类多、分布广，且主要宿主动物分布不平衡。     

清远市17年间钩端螺旋体病流行病学分析

目的:探讨钩端螺旋体病(钩体病)流行规律。方法:对清远市1988~2004年钩体病流行病学调查及监测资料进行统计分析。结果:(1)全市钩体病年均发病率为1·67/10万,死亡率为0·09/10万,病死率为5·31%;钩体病发病有明显的地区、时间和人群分布特征。(2)从病人血和动物脏器中分离鉴定了16株钩体,分属4种菌群,分别为犬热群、秋季热群、赛罗群和爪哇群;健康人血清和疑似病人血清抗体阳性率分别为25·25%和12·86%,菌群均以黄疸出血群为主;鼠血清抗体阳性率为27·84%,菌群以爪哇群为主;水禽(鸭)血清抗体阳性率为4·00%。结论:清远市人群钩体隐性感染和鼠带菌率均处于较高水平,从人群中分离出赛罗群钩体以及从水禽类(鸭)血清检出拜伦群和致热群钩体抗体在广东省属首次报告。需继续对钩体流行菌株和流行特征进行监测调查,控制钩体病的流行。     

福建省鼠类钩端螺旋体感染状况的调查

目的 了解福建省钩端螺旋体（钩体）病主要宿主动物的密度、种类、感染率和感染菌群的分布情况,为钩体病防控提供科学依据。方法 2011-2016年根据疫情选取14个调查点,采用笼夜法捕获鼠类并采集血液或肾脏标本进行钩体培养,测定血清抗体,分析感染状况和感染菌群。结果 共捕获鼠1 312只,鼠密度为6.29%,闽东最高（9.98%）,闽中最低（3.25%）。鼠种以黄毛鼠、黄胸鼠、褐家鼠和针毛鼠为主,占87.57%,不同地区鼠种构成不同。分离10株钩体,血清抗体阳性率为26.42%,感染菌群以秋季群、爪哇群为主,占73.50%。不同地区鼠感染率不同,闽北最高（45.00%）,闽中最低（15.56%）。黄胸鼠、青毛鼠和黄毛鼠感染率较高,依次为35.53%、31.58%、27.57%。结论 福建省鼠种构成复杂,黄毛鼠、黄胸鼠、褐家鼠和针毛鼠为优势鼠种,鼠类钩体感染水平较高,不同地区鼠种及感染率不同。     

闽东耕作区的鼠类生态学研究

目的：调查闽东耕作区的鼠类及其体外寄生虫。方法：笼捕活鼠，进行鼠及体外寄生虫分类鉴定。结果：鼠类隶属啮齿目鼠科９种，食虫目科２种；种群的空间配置，从边缘地带住宅到山地灌木林区依次为褐家鼠、小家鼠、黄胸鼠、臭、卡氏小鼠、黄毛鼠、黑线姬鼠、水麝、社鼠、针毛鼠和白腹巨鼠。鼠体外寄生虫有恙螨２科３亚科１２属２７种，其中水纤恙螨为一新种，高山真棒恙螨为我省新纪录；革螨３科１１属１３种；蚤２总科４科９属１１种。结论：基本摸清该地区鼠类及其体外寄生虫本底     

广东省清远市2007年钩端螺旋体病监测分析

目的对2007年广东省清远市钩端螺旋体病（以下简称钩体病）疫情、人群及宿主动物监测情况进行分析，为制定防治措施提供科学依据。方法采集相关人群及宿主动物血清，用显微镜凝集试验（MAT）进行抗体测定；采集相关人群全血、宿主动物脏器做钩端螺旋体分离培养及分群鉴定。结果报告钩体病8例，发病率0．23／10万。流行前健康人血清抗体阳性率为19．897％，菌群以黄疸出血热为主；流行后期健康人血清体抗阳性率为15．54％，菌群以七日热为主；流行期疑似病人血清抗体阳性率为0．88％，菌群为七日热。鼠血清抗体总阳性率为18．15％，黄毛鼠、板齿鼠、褐家鼠、臭鼬鼯和施氏屋顶鼠的血清抗体阳性率在14．08％～50．00％之间，菌群以秋季热群为主，其次为波摩那群，黄胸鼠和青毛鼠血清抗体阳性率为零；水禽（鸭）血清抗体阳性率为2．0％，菌群为犬热群。未从人群及宿主动物中分离出钩端螺旋体。结论该市人群及宿主动物钩体病隐性感染水平均较高，出现钩体病发病年龄组后移。     

在重庆黑线姬鼠中发现巴达维亚群钩端螺旋体

据资料统计,１９９７年重庆市未直辖前的四川省已从２６种动物中检出钩端螺旋体（钩体）,分属１７群３１型。其啮齿目鼠科姬鼠属中的黑线姬鼠系四川主要带菌动物,又是大部份地区优势鼠种,且携带钩体血清群达１０群,主要为黄疽出血群,占９７．刀％,是四川稻田型钩体病主要传染源。１９９８年,我站钩端螺旋体病实验室对重庆市卫生防疫站送检的钩体（１９９７年秋从黑线姬鼠中分获）进行血清群鉴定（１５群１５型参考株诊断血清由中国药品生物制品检定所提供）,结果显示：该株钩体与巴达维亚群诊断血清发生正：３２００ｏ的凝集反应,…     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

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.     

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.     

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.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.