上海市14所医院自来水中潜在病原菌检测及相关因素分析

目的 调查上海地区14所医院自来水中常见潜在病原菌的污染程度,并分析革兰阴性杆菌阳性检出率与供水系统特征的相关性.方法 采用培养方法检测医院自来水水样中的丝状真菌、非结核分枝杆菌和革兰阴性杆菌.结果 所有医院供水系统中均能分离到非结核分枝杆菌、丝状真菌和革兰阴性杆菌,84份水样的检出率分别为66.7％、50.6％和45.2％,仅少数水样中检出铜绿假单胞菌、嗜麦芽寡养单胞菌和曲霉菌属;革兰阴性杆菌阳性检出率与水管道管龄、水龙头类型间存在相关性.结论 医院供水系统普遍受到病原菌污染,临床医师应对自来水相关的水源性感染提高警惕.     

病区水龙头相关物表铜绿假单胞菌污染分析

目的 了解中山市中医院31个住院病区医生办公室水池相关物表污染情况,分析相关危险因素,为医院水源性感染防控措施提供科学依据。方法 按国家规范采集医院住院大楼31个病区医生办公室水池相关样本,包括水龙头相关物表、水池旁饮水机相关物表、水样本等三种类型共201份样本。记录每个采集部位特征,包括水龙头采样部位、有无安装起泡器、朝向、环境类型、龙头类型、手柄特征等信息。采用微生物法检测样本和进行铜绿假单胞菌的鉴定来掌握物表污染情况。结果 201份样本三种类型物表检出铜绿假单胞菌的阳性率有统计学意义(用Fisher精确独立性检验P <0. 001),其中水龙头相关物表铜绿假单胞菌检出的阳性率最高16. 216%。对水龙头相关物表进行单因素分析,显示水龙头不同采样部位的铜绿假单胞菌检出的阳性率有差异,结果有统计学意义(2=4. 874,P <0. 050),水龙头体的污染风险最高。将龙头类型、手柄特征、朝向、科室类型、菌落数是否合格、龙头口无安装起泡器等因素作为自变量进行非条件Logistic回归分析,发现这些因素对铜绿假单胞菌检出的阳性率,无统计学意义(Fisher精确独立性检验P>0. 05)。但水龙头不同采样部位、龙头口有无安装起泡器两个自变量同时加入Logistic模型,拟合优度检验AIC值最低61. 696,显示没有安装起泡器的水龙头体容易检出铜绿假单胞菌。结论 病区医生办公室内水龙头污染严重,清洁易被忽视。制定规范的水源性相关感控措施,切断医院感染传播途径有必要。     

血液科铜绿假单胞菌血流感染流行病学调查报道

目的 调查血液科铜绿假单胞菌血流感染流行病学的情况.方法 对血液内科病房3例白血病患者发生铜绿假单胞菌血流感染进行临床资料及危险因素调查,并行环境微生物监测、分子流行学调查.结果 环境微生物采样中48份标本共榆出3株铜绿假单胞菌,其中患者口腔溃疡面1株,治疗窒水龙头1株,拖把池排水口1株;对分离出的3株铜绿假单胞菌和1例患者的血培养铜绿假单胞菌(另两例患者的血培养标本未保留)进行随机扩增多态性DNA(RAPD)基因分型显示2株为Ⅰ型,Ⅱ、Ⅲ型各1株,1例患者口腔溃疡面和血培养标本铜绿假单胞菌基因型相同,而与拖把池排水口和治疗室水龙头的标本铜绿假单胞菌基因型都小相同.结论 该次血液科病房3例白血病患者发生铜绿假单胞菌血流感染,不能断定为医院感染暴发.     

广州市荔湾区泳池水中铜绿假单胞菌污染状况

目的了解广州市荔湾区游泳场馆泳池水中铜绿假单胞菌的污染状况,为防控游泳池水传播的疾病提供科学依据。方法依据GB9667--1996《游泳场所卫生标准》要求,对2012--2013年广州市荔湾区内游泳场馆游泳池水质进行检测,在国家标准规定的6项指标基础上,增加了对铜绿假单胞菌的检测项目。结果从46家游泳场馆共计285份泳池水中检出铜绿假单胞菌阳性水样27份,阳性率为9．47％。尿素和游离余氯含量与铜绿假单胞菌的检出与否有关系。细菌总数和大肠菌群指标不合格更容易检出铜绿假单胞菌。结论泳池水中铜绿假单胞菌污染状况不容忽视,应加强游泳池水质监测和由游泳池水传播疾病的防控工作。     

包装饮用水中铜绿假单胞菌污染状况调查研究

目的开展包装饮用水生产过程中铜绿假单胞菌污染状况的调查,针对性地提出控制措施。方法采用国家标准方法,对湖北省地区15家包装饮用水生产企业的水源水、过程水、成品水及包装容器等共计116份样品进行铜绿假单胞菌及常规微生物的检测。结果精滤后水、活性炭过滤后水、石英砂过滤后水和水源水受铜绿假单胞菌的污染较为严重,检出率分别为66. 7%、66. 7%、46. 7%、40. 0%。铜绿假单胞菌阳性菌株主要为产绿脓菌素的黄绿色菌落形态,占阳性菌株的比例为79. 2%。大肠菌群的合格率与铜绿假单胞菌检出率比较,差异有统计学意义(χ2=13. 901,P 0. 01)。结论包装饮用水在生产过程中存在铜绿假单胞菌的污染,企业应加强对设备、管道、储罐等清洁消毒,同时监管部门应加强对包装饮用水生产过程的监管。     

徐州市市区小学饮水机桶装水铜绿假单胞菌污染监测与溯源

目的 调查小学饮水机水中铜绿假单胞菌污染情况。方法 2015年10月采集徐州市市区5所小学50个饮水机内的水样50份,按照《2015年江苏省食品微生物及其致病因子监测工作手册》中《铜绿假单胞菌检验标准操作程序》进行检测。结果 铜绿假单胞菌检出率为24.00%(12/50);定量结果最高为510 cfu/mL,最低为1 cfu/mL;合格率为76.00%(38/50)。同一学校不同饮水机检出的2株铜绿假单胞菌的相似系数为100.00%,距离相近学校检出的铜绿假单胞菌相似系数达60.00%～80.00%;距离相对较远的学校饮水机中检出的铜绿假单胞菌相似系数为60.00%;不同学校检出的铜绿假单胞菌比同一所学校不同饮水机水检出的铜绿假单胞菌相似系数高;不同学校检出的铜绿假单胞菌的同源性比同一所学校不同的桶装水检出的铜绿假单胞菌相似系数高。结论 小学饮水机桶装水中有铜绿假单胞菌污染,应提高中小学生桶装水卫生知识,并定期对饮水机进行消毒,建立监管制度,防止校园内学生腹泻疾病的发生。     

广州市荔湾区集中空调系统冷却水塔铜绿假单胞菌污染状况

目的了解集中空调冷却水塔铜绿假单胞菌污染状况,为铜绿假单胞菌的防控工作提供科学依据。方法 2010年4—9月,对荔湾区公共场所28个集中空调冷却水塔水样的pH值、嗜肺军团菌、铜绿假单胞菌等微生物指标进行检测,嗜肺军团菌按照卫生部《公共场所集中空调通风系统卫生规范》（2006）检测,铜绿假单胞菌分析按照GB 8538-2008饮用天然矿泉水检验方法进行,pH值按照《生活饮用水检验标准方法》（GB/T 5750-2006）中检验方法进行。结果检测的28份冷却水塔中的水样品,铜绿假单胞菌总阳性检出率为57.14%,嗜肺军团菌阳性检出率为60.71%,两者比较,差异无统计学意义（P〉0.05）,铜绿假单胞菌的阳性检出率和pH值之间存在负相关关系。结论集中空调冷却水塔铜绿假单胞菌污染严重,应加强冷却水塔的清洗消毒。     

ICU自来水非结核分枝杆菌污染状况调查

目的 了解医院重症监护病房(ICU)自来水非结核分枝杆菌(NTM)的污染与分布.方法 采集医院ICU水龙头水样,过滤后进行NTM培养,培养出的NTM经Ziehl-Neelsen染色初筛后,用16S rRNA基因测序方法鉴定细菌种类.结果 6个ICU共收集水样28份,检出NTM 25株,检出率为89.3％,检出浓度范围为2～300CFU/L,各NTM检出率差异无统计学意义;培养获得NTM 28株,分属5种,包括鸟分枝杆菌8株占28.6％、堪萨斯分枝杆菌6株占21.4％、微黄分枝杆菌6株占21.4％、脓肿分枝杆菌5株占17.9％和马德里分枝杆菌3株占10.7％.结论 ICU自来水NTM污染情况普遍,部分为临床常见致病菌,存在引发医院感染的隐患,应予以重视.     

烧伤病房铜绿假单胞菌多重耐药流行病学调查

目的了解烧伤病房铜绿假单胞菌环境寄生及烧伤患者多重耐药表型、产酶情况,铜绿假单胞菌医院感染的流行病学。方法全自动细菌鉴定和药敏分析系统(VITEK-32);改良三维法对β-内酰胺酶进行分析;金属酶试验用Etest条;随机扩增多态性DNA基因扩增(RAPD)方法对患者分离株和环境分离株分型,从检出时间、地点或部位进行动态分析。结果4 246份样本共检出铜绿假单胞菌352株,分离率为8.3%;患者与环境及医护人员检出的铜绿假单胞菌未见有关联;铜绿假单胞菌可产生多种β-内酰胺酶。结论铜绿假单胞菌广泛存在于烧伤病房的患者及环境中;铜绿假单胞菌医院感染外源性因素不主要,患者多是自身感染。     

基于二代测序分析血液透析水处理系统水样中微生物多样性

目的基于Illumina MiSeq测序平台,分析血液透析水处理系统水样中微生物多样性和丰度。方法采集血液透析水处理设备供水处自来水、活性碳罐后软化水、出水口反渗水水样各两份,分为Ⅰ、Ⅱ两个组别,Ⅰ组水样进行传统微生物培养;Ⅱ组水样进行二代测序。结果Ⅰ组经微生物培养细菌总数均不超标,质谱鉴定为假单胞菌种;Ⅱ组经二代测序,获取可操作分类单元(OTU)总数依次为3 957,3 245,4 880,分别来自428,494和369个微生物类群。反渗水水样在门、纲、目、科、属的OTU数均明显高于自来水和软化水水样;其Chao1和ACE丰富度估计指数最高,表明群落中实际存在的物种数最多。分类组成分析反渗水水样从科、属分类上约58.92%为假单胞菌科,58.90%为假单胞菌属;26.41%为莫拉菌科,26.23%为莫拉菌属;4.73%为普氏菌属。结论二代测序技术反映了血液透析水处理系统水样中微生物的多样性和丰度,传统微生物培养方法的局限性使其严重低估了反渗水中细菌数量及菌群结构,使透析用水污染引起透析患者微炎症反应被忽视。     

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.     

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.     

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.     

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.