藏区非结防医生结核疑似病人确诊延迟分析

目的 探讨四川省藏区非结核病防治机构医生对结核疑似病人确诊延迟的影响。方法 通过问卷收集初次到若尔盖和石渠县结防机构诊治的结核疑似病人的资料，调查首诊为非结防机构医生的结核疑似病人确诊延迟情况。结果 80．0％结核疑似病人首诊选择非结防机构医生，且其中最后被结防机构确诊为活动性肺结核的42例患者中，54．8％发生了确诊延迟；不同类非结防机构医生在各自接诊的病人中，藏医首诊结果怀疑结核病的比例低于个体医生、乡村医生与县级医生等（P〈0．001）；首诊选择藏医的结核疑似病人确诊延迟发生率高于选择乡村医生和县级医生等的（P=0．008）；未被非结防医生推荐到结防机构就诊者较被推荐者确诊延迟发生率高（P〈0．001）。结论 非结防机构医生的类型、首诊结果及其是否推荐结核疑似病人到结防机构就诊与结核疑似病人的确诊延迟有关；培训非结防机构医生的结核病知识、加强归口管理可减少结核疑似病人的确诊延迟。     

苏北农村地区结核病患者首诊机构选择和配置研究

目的：比较农村结核病控制项目地区和非项目地区病人对首诊机构的选择，和首诊机构在结核病诊断和转诊中存在的问题。方法：对苏北结核病控制项目县（建湖县）和非项目县（阜宁县）2002年全年登记的493名新诊断结核病人进行问卷调查。结果：首次就诊直接去县结防所的痛人比例仅为1％左右．首次就诊比例最高的机构为村诊所。项目县县市级医院和乡镇医院获得转诊的比例显著高于非项目县。结论：应着力于促使乡镇医院和县市医院及早对病人进行相应检查和及时转诊，完善转诊管理体系。     

山东省设立乡镇查痰点地区结核病人的确诊延误情况

目的：探讨山东省设立乡镇卫生院查痰点地区结核病人的确诊延误情况及影响因素。方法：按地理特点、乡镇查痰点查痰情况多阶段分层抽样，抽取8个县作为调查现场，对抽取到的疑似肺结核患者调查。结果：共调查245例疑似患者，其中结核病人112例（45．71％）；结核病人平均确诊延误天数为28．26天（中位数为5天），其中34例（30．4％）确诊延误天数超过14天。女性患者发生确诊延误的危险性高于男性；首诊选择村卫生室的结核病人发生确诊延误的危险性高于首诊选择乡镇卫生院及以上者；确诊前就诊次数越多的患者发生确诊延误的危险性越高。结论：结核病人确诊延误的影响因素是性别、首诊机构和确诊前就诊次数。     

深圳市龙岗区2000～2004年结核病归口管理队列分析

目的：分析深圳市龙岗区5年来结核病归口管理情况。方法：辖区各综合医院预防保健科对医院各科报告的可疑结核病报告卡进行汇总每月上报并对病人进行转诊，由区慢性病防治院结防科汇总分析。结果：5年间肺结核平均到位率为89．4％，确诊肺结核病例数占报告卡数的53．5％，综合医院截留病人率为3．8％，拒绝到位2．4％，自行回原籍占4．4％。结论：深圳市龙岗区的结核病疫情报告情况良好；综合医院是结核病病人发现的主要途径；重点解决截留、拒诊和流动人口结核病人去向。     

温州市1997-2002年呼吸道传染病发病情况分析

[目的] 分析世行贷款结核病控制项目县初诊病人就诊和痰检情况。[方法] 对实施项目满1年的17个县(市、区)，察看、核对其3个登记本有关资料与数据，并填入督导调查表；分析初诊病人就诊率、就诊方式、痰检率和痰检阳性率等指标。[结果] 17个县(市、区)1年来初诊就诊率1.67‰，有症状主动到结防机构就诊者占57．2％，医院转诊占26．9％，涂阳病人中以主动就诊方式发现者占39．0％，而转诊高达51．3％，查痰率仅64．6％，阳性检出率27．5％，涂阳病人所占比例52.3％。[结论] 要辩证对待初诊病人就诊率指标，不要片面追求高就诊率；在强调转诊的同时，也要注重基层推荐病人工作；要提高初诊病人的查痰率、查痰次数,严格涂阴肺结核诊断，防止过诊。     

发现结核病例4种途径的效果评价

目的 比较和评价4种发现结核病例途径的应用价值.方法 分析就诊、转诊、集中推荐、日常推荐结核病阳性发现率的高低.结果 就诊和转诊与集中推荐相比,结核病阳性发现率差异有统计学意义(χ2值分别为14.62和45.26,P值均＜0.01).结论 发现结核涂阳病人应以就诊和转诊途径为主.     

苏北农村结核病流行及管理状况比较研究

目的 比较研究苏北农村结核病控制项目县与非项目县结核病的流行状况及管理模式的区别。方法 通过整群抽样调查，选取江苏北部项目县与非项目县各一县为研究对象。收集两县1997—2002年结核病报表资料、会议资料及实施细则等，利用率、比等描述指标进行比较分析。结果 1997—2002年项目县新发结核病新登记率低于非项目县，涂阳结核病新登记率项目县高于非项目县，涂阳占新登记病例百分比分别为75．83％和33．70％；两县1997—2002年涂阳肺结核男性多于女性，男女性别比约为2～3：1；两县结核病发现和病人管理模式不同。结论 项目县新发结核病人涂阳比例高于非项目县，痰涂片检查的数量和质量都好于非项目县。强化项目管理有可能进一步提高结核病人的早期发现率。     

不同发现方式在肺结核病人发现中的作用

目的分析不同方法在结核病人发现中的作用,促进滨州市的结核病防治工作。方式收集2005-2008年滨州市结核病控制年报表,分析病人来源构成比。结果 4年间就诊方式发现可疑肺结核病人45 261例,占疑似肺结核病人总数64.6%;就诊方式发现可疑肺结核病人8 029例,占发现肺结核病人的56.1%.通过就诊方式肺结核病检出率17.7%。转诊方式发现疑似肺结核病人11 818例,占发现肺结核病人总数的16.9%;转诊方式发现肺结核病人5 661例,占发现肺结核病人总数的39.6%;转诊方式发现肺结核病检出率为47.8%,显著高于其他方式的检出率。日常推荐发现病人的比例逐年提高。结论因症就诊是发现肺结核病人的主要方式,综合医疗机构的转诊对发现肺结核病人起到不可替代的作用,日常推荐方式在早期发现结核病人中的作用日渐突出。     

河北省4个县结核病与艾滋病双向筛查结果分析

目的提高结核病与艾滋病双重感染病例的发现率。方法省、市、县三级分别建立结核病和艾滋病防治机构合作机制。对确诊的结核病人进行咨询及HIV抗体检测；对确诊的HIV／AIDS进行结核病筛查。结果2007年1-9月，河北省4个县共确诊结核病人844例，有HIV高危行为人数51例，占7．0％，未检测出HIV抗体阳性病人。397例HIV／AJDS病例中确诊结核病人8例，TB／HIV双重感染率为2．0％。结论应在结核病人和HIV／AIDS中开展结核病与艾滋病双重感染监测，提高TB／HIV双重感染病人发现率，防止传播和蔓延。     

非定点医院肺结核病例网络报告调查分析

目的：探讨杭州市萧山区非定点医院在结核病发现工作中的作用和不足，发现问题，及时建议。方法：调查886例非定点医院报告的现住址在本辖区的肺结核病例，分析非定点医院痰检情况，病例的主动到位和未主动到位病人的追踪情况，网报及时情况。结果：非定点医疗单位初诊痰检率6．55％；病例主动到位率41．08％，追踪后总到位率88．71％，网报及时率71．16％。结论：萧山区非定点医院是大多数肺结核病人因症就诊的主要场所，是发现结核病人的重要来源，通过追踪可以大大提高肺结核病人的到位率，但非定点医院传染病网络报告的质量有待进一步提高。     

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 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.     

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.     

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.     

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.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

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.