全球传染病爆发流行信息(2001年8～11月)

炭疽:至11月1日,美国疾病预防控制中心(CDC)公布的炭疽病例数为22例,其中佛罗里达州确诊2例(均为吸入性炭疽);纽约市确诊4例(皮肤炭疽3例、吸入性炭疽1例),可疑病例4例(均为皮肤炭疽);新泽西州确诊5例(2例吸入性炭疽、3例皮肤炭疽),可疑2例(均为皮肤炭疽);华盛顿地区确诊5例(均为吸入性炭疽)。4例吸入性炭疽病人已死亡。至11月21日,CDC报道的炭疽病例数增至23例,其中确诊病例     

外伤性延迟性脾破裂11例临床分析

为探讨外伤性脾破裂的临床特点及诊断治疗方法。分析11例住院病例临床资料。结果显示诊断迟发性脾破裂8例，误诊肝破裂、腹膜后血肿、肾挫裂伤各1例；所有病例伤后出现脾破裂的时间均在48h以上，全部病例手术治疗治愈出院，其中脾切除7例，保脾手术4例。认为外伤性脾破裂特点是症状隐匿及出现时间延迟，临床易误诊，诊断除病史、表现外，及时进行必要辅助检查，治疗以手术为主。     

2015—2017年青海省玉树市皮肤炭疽流行特征

目的 分析皮肤炭疽流行特征,提高专科医师对皮肤炭疽的认识及针对皮肤炭疽流行情况做好防控工作。方法 采用描述流行病学分析方法对2015—2017年青海玉树藏族自治州玉树市皮肤炭疽病例资料进行分析。结果 2015—2017年青海玉树藏族自治州玉树市共报告皮肤炭疽病例16例,男性9例（占56.25%）,女性7例（占43.75%）。病例年龄4~70岁,成年病例14例（占87.50%）。15例藏族病例均为牧民。6—9月感染发病共10例（占62.50%）。感染来源均为接触病死的牦牛或病死牦牛污染的物品;感染部位为手指、手背及上臂,其中手指3例（占18.75%）,手背6例（占37.50%）,上臂4例（占25.00%）。14例（占87.50%）出现发热,38 ℃~39 ℃者6例（占37.50%）,39 ℃~40 ℃者8例（占50.00%）;13例（占81.25%）病例早期均未出现明显自觉症状,11例迅速出现皮肤软组织高度肿胀。13例（占81.25%）白细胞总数升高,13例（占81.25%）中性粒细胞计数升高;16例（100.00%）皮肤溃疡处分泌物检出革兰染色阳性呈竹节状的杆菌。给予青霉素G 400万~1 600万单位/d静注抗感染治疗后全部治愈,无死亡病例。结论 青海省玉树市皮肤炭疽的防控工作形势严峻,仍需要加强皮肤炭疽防治知识的宣传力度,建立联防联控机制。     

2018年四川省红原县1起炭疽暴发疫情调查分析

目的分析炭疽疫情调查和处置过程,为今后炭疽疫情处置提供经验和参考。方法对疫情数据、现场调查信息及处置措施进行流行病学分析和统计描述。结果此次疫情共报告7例炭疽病例,其中肠炭疽5例,皮肤炭疽2例,死亡2例。所有病例均为炭疽疫区常住居民,其中3例肠炭疽有病死牛(马)肉类食用史,2例肠炭疽感染途径不详,2例皮肤炭疽有病死牛(马)畜接触史。2例死亡病例在基层医疗机构未被及时正确诊断。经采取流行病学调查、疫点处置、病例治疗、健康教育等措施,疫情得到及时控制。结论牧民接触、食用病死牛(马)是感染炭疽的主要途径,牧区基层医疗机构对该类疾病的诊断意识较弱。建议加大牧民炭疽健康教育力度,提高牧民健康防病意识;加大基层医疗机构炭疽病例的诊断治疗技术的培训力度,提高基层医疗机构炭疽病例早期识别能力。     

糖尿病足68例综合护理体会

2006年来，笔者除对糖尿病足进行常规治疗的同时，给予精心护理。现将护理体会报道如下。1临床资料本组68例，男36例，女32例，糖尿病史均10年以上，男性吸烟30例，已戒11例。均符合糖尿病足诊断标准。患者表现为皮肤瘙痒，肢端发凉，颜色发暗，疼痛，感觉迟钝或消失，皮肤出现皲裂、溃疡、水泡、坏死。     

探讨皮肤炭疽护理流程临床应用效果

目的:探讨利用药物冲洗、湿敷在皮肤炭疽皮疹护理效果,总结皮肤炭疽护理常规和皮肤护理流程。方法:先利用2%双氧水、9g/L氯化钠注射液、0.5g/L高锰酸钾溶液冲洗,再用康复新液对14例皮肤炭疽患者局部皮肤进行湿敷30分钟,每日进行2次,恶性水肿型每日可进行4次,康复新液能显著促进肉芽组织生长,加速坏死组织脱落,迅速修复创面的作用。结果:14例患者均有新生肉芽组织生长,焦痂脱落,皮肤愈合出院,1例病例留有瘢痕。结论:利用药物冲洗、湿敷的方法总结的皮肤护理流程针对皮肤炭疽破损皮肤创面效果显著,特别针对恶性硬性水肿型皮肤皮损均能促进愈合。     

宁夏同心县一起皮肤炭疽暴发的流行病学调查

目的查明宁夏同心县皮肤炭疽暴发的原因，给该地区炭疽防治提供科学依据。方法用回顾性调查与现况调查的方法，调查炭疽的流行过程，并采集病人患处分泌物进行检验。结果2006年9月，同心县某镇发生疑似皮肤炭疽暴发，6例病例均接触过同一病牛（肉）；患者的临床症状为患处皮肤出现水肿、瘙痒、疼痛、破溃，有脓性分泌物流出。病人的分沁物在光学显微镜下发现两端平齐、革兰染色阳性的粗大杆菌。结论农村居民的防病意识淡薄是本病暴发的根本原因，对农村居民应加大传染病防治知识的宣传教育，提高其防病水平。     

一起炭疽病流行病学调查

炭疽病是由炭疽杆菌引起的一种人畜共患的急性传染病。该病原系牛、马、羊等家畜的疾病，人类炭疽主要是由于接触病、死畜或其皮毛而受感染。临床上可分为皮肤型、肺型、肠型3种。皮肤型主要表现为局部皮肤坏死的特异病灶，肺型和肠型表现为肺、肠急性感染而出现的相应症状，3者均有形成败血症和并发脑膜炎的可能。2002年8月上旬，我市某农村发生一起皮肤炭疽疫情，由于当地政府的高度重视，处理及时，迅速控制了疫情。经过两年的观察，再无此种病例发生，现将情况报告如下。     

6例Gilbert综合征临床分析及文献复习

目的 探讨Gilbert综合征(GS)的临床特点、治疗及预后.方法 回顾性分析6例GS的临床资料,并结合文献进行总结.结果 6例患者均有皮肤巩膜黄染,乏力4例,食欲下降2例,恶心1例;所有病例均有总胆红素(TBIL)、间接胆红素(IBIL)轻、中度升高,其余肝功能指标无明显异常.结论 Gilbert综合征以慢性、间歇性、轻度高非结合型胆红素血症为特征,临床诊断缺乏特异性,苯巴比妥试验(+)有助于诊断,无特效治疗方法,预后好,可不予治疗.     

1例带状疱疹的临床诊断体会

带状疱疹是由水豆带状疱疹病毒感染，潜伏体内再发所致，临床表现为受累部神经沿体表部位皮肤上出现成簇水泡，带状分布，痛如火燎的急性疱疹性皮肤病，皮肤上有红斑水疱，累累如串珠，每多缠腰而发，典型病例较易诊断，仅以疼痛为表现的诊断较为困难，易误诊。现举一个病例，供大家借鉴。     

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.     

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.     

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.     

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.