芜湖市镜湖区新型冠状病毒肺炎首例确诊病例流行病学调查

【目的】对安徽省芜湖市镜湖区新型冠状病毒(SARS-CoV-2)肺炎首例确诊病例开展流行病学调查,为此类疫情的调查处置提供参考。【方法】开展现场流行病学调查,采集患者咽拭子标本,用实时荧光聚合酶链反应(RT-PCR)法检测SARS-CoV-2核酸;追踪排查密切接触者,落实相关预防控制措施。【结果】该患者常住西安,1月22日返回芜湖;23日发病后经2次SARS-CoV-2核酸检测阴性后排除COVID-19诊断;26日该患者再次因为发热、胸闷等症状入院,27日SARS-CoV-2核酸检测呈阳性,再经安徽省疾病预防控制中心复核后确诊为COVID-19。该患者无武汉旅行史或居住史,无野生动物及集贸市场接触史,但返回芜湖前与1位COVID-19确诊患者有密切接触史。【结论】根据流行病学史、临床症状和核酸检测结果,该病例被判定为镜湖区首例COVID-19报告病例。     

基于健康大数据平台的鄞州区新型冠状病毒肺炎监测病例流行病学特征分析

目的 分析鄞州区基于健康大数据平台的新型冠状病毒肺炎（COVID-19）监测病例流行特征,为COVID-19监测网络体系建设提供依据。方法 收集鄞州区新型冠状病毒肺炎监测与预警信息系统每日COVID-19监测病例数据,分析COVID-19监测病例人群构成、流行病学史比例、核酸检测率、核酸阳性检出率和确诊病例监测发现率。结果 2020年1月1日至3月30日共报告COVID-19监测病例1 595例,其中社区人群和重点人群分别占79.94%和20.06%。监测病例现场调查核实率100.00%,有武汉市或湖北省接触流行病学史占6.27%,社区和重点人群中有流行病学史者占比分别为2.12%和22.81%（P<0.001）。COVID-19核酸总检测率18.24%（291/1 595）,有、无流行病学史者核酸检测率分别为53.00%和15.92%（P<0.001）,COVID-19核酸阳性检出率1.72%（5/291）。监测确诊病例发现率0.31%（5/1 595）,监测确诊病例和其他确诊病例初次就诊至初次核酸检测时间间隔差异无统计学意义（P>0.05）。结论 基于健康大数据平台的COVID-19监测工作运转良好,但确诊病例监测发现率有待提高。     

14例新型冠状病毒肺炎病例流行病学和临床特征

 

目的 了解新型冠状病毒肺炎（COVID-19）确诊病例、排除病例的流行病学特征及临床特征,为临床诊疗提供建议。方法 将某院留观的COVID-19疑似患者,新型冠状病毒（2019-nCoV）核酸检测阳性的患者列为确诊病例组（确诊组）,2019-nCov核酸检测至少二次阴性,经上海市静安区专家组会诊后予以排除的患者列为排除病例组（排除组）,比较两组患者在流行病学、 临床表现、实验室检查以及影像学资料方面的差异。结果 确诊组14例 患者中,男女性别比1.33∶1,年龄中位数为 51.5（38.3,63.0）岁,有明确流行病学史的10例（71.43%）;排除组 84例患者中,男女性别比0.95∶1,年龄中位数37（29.0,59.75）岁,有明确流行病学史的14例（16.67%）;两组在年龄分布、流行病学史上差异均有统计学意义（均P<0.05）,在性别、居住地分布以及临床表现上差异均无统计学意义（均P>0.05）。确诊组白细胞正常或降低的患者数占比高于排除组（92.86% VS 72.62%）,差异有统计学意义（P<0.001）,淋巴细胞百分比减少的患者数占比低于排除组（P=0.001）。两组胸部CT结果比较,确诊组患者磨玻璃样渗出影、斑片渗出影等改变所占的比例高于排除组患者,差异有统计学意义（P<0.05）;确诊组患者由散在或多发肺炎进展为 磨玻璃样肺炎的中位时间为3（2,5）d。结论 患者年龄、明确的流行病学史、白细胞计数、淋巴 细胞百分比,肺部磨玻璃样等CT表现是 COVID-19的特征因素,临床医生在诊疗时应加以甄别,进一步提高 COVID-19诊断的准确性。

     

扬州市新型冠状病毒肺炎病例流行特征分析

目的了解江苏省扬州市2020年1月23日—2月16日报告的新型冠状病毒肺炎(COVID-19)流行特征,为提高COVID-19疫情防控能力提供依据。方法以2020年1月23日—2月16日扬州市报告的23例COVID-19确诊病例为研究对象,根据《新型冠状病毒肺炎防控方案(第五版)》开展现场流行病学调查,收集病例性别、年龄、职业、首次发病临床症状和流行病学史等信息,排查密切接触者,检测严重急性呼吸道综合征冠状病毒2型(SARS-Co V-2)核酸,分析病例的临床表现、三间分布和暴露史等流行特征。结果扬州市报告的23例COVID-19确诊病例中,临床分型为普通型12例,占52.17%;轻型10例,占43.48%;重型1例。首发症状以发热为主,17例占73.91%;所有病例胸部CT均显示肺部有磨玻璃影。男性10例,女性13例,男女比为0.77∶1,40～59岁14例,占60.87%;职业以工人和离退休人员为主,各4例占17.39%。病例发病高峰为1月23日—29日,分布在江都区、宝应县、邗江区和广陵区4个地区。发病前14 d有武汉市旅居史14例,有本地COVID-19确诊病例接触史6例,有武汉市归来人员接触史2例,有太原市旅居史1例。2例病例肛拭子检出SARS-Co V-2核酸阳性。结论扬州市23例COVID-19确诊病例症状较轻,首发症状以发热为主,均存在肺部影像学改变;病例年龄集中在40岁及以上,多数为输入病例。     

多次核酸阴性后确诊COVID-19病例临床特征

目的分析新型冠状病毒鼻咽拭子核酸检测多次阴性后确诊为新型冠状病毒肺炎(COVID-19)患者临床特征。方法筛选2020年2月5日-2月25日武汉大学人民医院隔离病房住院患者,选取73例多次新型冠状病毒鼻咽拭子核酸检测阴性,疑似或者临床诊断为COVID-19的患者作为研究对象,将其分为三组(排除COVID-19组、核酸阴性组和核酸阳性组),收集其临床资料,分析临床症状、实验室检查、新型冠状病毒核酸检测、胸部CT影像学。结果与排除COVID-19组比较,核酸阴性组发病到住院时间较长(P=0.002),淋巴细胞计数较低(P=0.047),更容易出现乏力(P0.05)。与核酸阳性组比较,核酸阴性组重型及危重型患者较多(P=0.012),更容易出现乏力(P0.05)。白细胞总数排除COVID-19组较核酸阴性组、核酸阳性组明显升高(P0.05)。4例患者痰液核酸检测阳性,1例患者同时出现粪便及痰液核酸检测阳性。临床诊断为COVID-19患者新型冠状病毒抗体检测呈阳性,排除COVID-19患者新型冠状病毒抗体检测呈阴性。临床诊断为COVID-19的58例患者影像学均呈典型COVID-19影像学改变。结论 COVID-19诊断一定要结合流行病学资料、临床特点、实验室和影像学检查及病程发展、治疗反应等综合评估。     

新型冠状病毒肺炎患者治愈后再入院病情分析探讨

目的分析探讨新型冠状病毒肺炎(Corona virus disease 2019,COVID-19)治愈后再入院患者核酸复检阳性可能的原因,为COVID-19患者的诊断、治疗和治愈出院患者的管理、防护提供依据。方法收集湖北医药学院附属东风医院2020年2月18-20日收治的5例COVID-19复查核酸阳性再次入院的患者病例,回顾性分析其临床资料、影像学特征和核酸检测结果等。结果 5例COVID-19再入院患者中,年龄最大60岁,最小19岁;4例患者有基础疾病;5例均有流行病学史,首发症状主要为发热和腹泻;入院诊断中4例为COVID-19普通型,1例为重型;确诊依据中4例核酸检测阳性确诊,1例临床诊断确诊;胸部影像学检查均表现为磨玻璃影,首次入院给予抗病毒药物和对症治疗后均好转;首次住院时间为(13.60±3.93)d,从首次出院到再次入院时间为(7.40±1.36)d。结论治愈后再入院患者核酸复检阳性的原因可能与多种因素有关,应警惕复阳患者成为慢性病毒携带者;应从标本的采集运送、检测试剂的比对、药物治疗疗程、病毒本身原因、机体免疫力等方面入手,尽量避免复阳情况的发生。     

金华市首例新型冠状病毒肺炎报告病例流行病学调查

目的对金华市首例新型冠状病毒肺炎(COVID-19)报告病例开展流行病学调查,为控制COVID-19疫情提供依据。方法按照《新型冠状病毒感染的肺炎病例流行病学调查方案(第二版)》对病例进行现场流行病学调查,收集病例发病诊疗情况和流行病学史等;追踪感染来源,排查管理密切接触者;采集病例和密切接触者咽拭子标本检测严重急性呼吸道综合征冠状病毒2型(SARS-Co V-2)核酸。结果该病例为金华市某百货公司财务人员,1月13日—14日在杭州市参加会议,其间与武汉籍且有发热症状的同事聚餐且相邻而坐,1月17日出现发热和心慌,1月21日至婺城区某医院发热门诊就诊,胸部CT显示左肺上叶片状高密度影,1月22日采集咽拭子标本送金华市疾病预防控制中心检测SARS-Co V-2核酸阳性,1月23日经浙江省疾病预防控制中心复核确认。2月5日病例痊愈出院,2月20日复查咽拭子和粪便标本SARS-Co V-2核酸均为阴性。病例发病前14天无武汉市旅居史,无家禽、家畜和野生动物接触史,发病后至就诊前无外出史,未接触过武汉市及周边地区返回金华市人员。共追踪到密切接触者130人,其中7人出现发热、咳嗽等呼吸道症状,经检测均排除SARS-Co V-2感染。结论金华市首例COVID-19确诊病例的感染来源可能为共同参会的武汉籍同事,传播途径为在同一密闭空间和(或)同桌进餐时经呼吸道飞沫和直接接触传播;经有效控制,尚未发现二代传播。     

新型冠状病毒肺炎疫情形势下的急诊应对策略

目的分析中山大学附属第三医院粤东医院发热门诊接诊病例和确诊住院的新型冠状病毒肺炎(COVID-19)患者临床特征,为COVID-19早发现、早诊断提供临床依据,探索当前疫情形势下的急诊应对策略。 方法回顾性分析中山大学附属第三医院粤东医院2020年1月25日至2020年2月6日发热预检分诊处分诊的537例临床资料和分诊结果;同时对收住院的7例已确诊的COVID-19患者,就其流行病学资料,入院时临床资料、影像学检查、实验室检查,以及新型冠状病毒(2019-nCoV)核酸检测阳性结果(咽拭子＋大便)进行回顾性分析。 结果发热预检分诊处共分诊537例,其中分诊至普通发热门诊469例(占87.3%),均行胸部CT检查,影像学表现为肺部炎症37例(占7.8%),全部病例经咽拭子和大便2019-nCoV核酸检测为阴性;分诊至特殊发热门诊68例(占12.7%),其中负压救护车接回41例,确诊6例;自行来院就诊27例,确诊1例,确诊患者占特殊发热门诊患者10.3%。确诊患者均与武汉疫源区有关(包括武汉疫源区居住史或与疫源区人员密切接触史),临床表现主要为发热和(或)呼吸道症状(咽痛,咳嗽、咳痰,胸闷,声嘶,鼻塞、咽干,乏力等),入院时病程1～8 d,平均3.7 d;全部患者胸部CT扫描均表现肺部炎症,其中双肺肺炎占71.42%;仅1例患者外周血白细胞计数、淋巴细胞比例、淋巴细胞绝对值和C反应蛋白异常;7例COVID-19患者咽拭子2019-nCoV核酸检测均为阳性,4例同时伴大便2019-nCoV酸检测阳性,大便核酸检测阳性时间均晚于咽拭子核酸检测阳性1～7 d,平均3.25 d。 结论根据流行病学史进行急诊快速预检分诊,在抗击COVID-19疫情中体现出接诊效率高,可最大程度减少误诊和预防院内交叉感染,值得推广应用。     

驻马店市154例新型冠状病毒感染者核酸检测Ct值的动态变化分析

目的 回顾性分析新型冠状病毒(COVID-19)感染者临床特征及核酸检测Ct值的动态变化,为疫情防控提供依据.方法 收集驻马店市新冠肺炎确诊病例和无症状感染者背景信息及核酸检测结果,对不同样本类型、不同临床症状感染者样本检测Ct值进行比较,并探讨感染人群中核酸阳性率及Ct值的动态变化.结果 共有154例COVID-19感染者,确诊病例139例(占90.26％),无症状感染者占9.74％;以20～＜40岁为主(占69.48％),职业多为农民及民工(占57.79％),101例(占65.58％)有武汉暴露史.确诊病例和无症状感染者性别、年龄、武汉暴露史、治愈时间差异均无统计学差异(P值均＞0.05).首轮核酸检测的阳性率85.06％,3轮核酸检测阳性率为100.00％.确诊病例主要临床表现为发热(占82.01％)、干嗽(占97.41％)、咳痰(占25.90％)、乏力(占22.30％);不同临床症状、不同样本类型样本首轮核酸阳性检出率和检测Ct值差异均无统计学意义(P值均＞0.05).采取及时干预措施后2～3周感染者核酸检测结果均转为阴性.结论 COVID-19感染者存在一定比例的无症状感染者,需要加强筛查和管理;单轮核酸检测存在假阴性现象,需要结合流行病学史,多次核酸检测避免漏检或复阳现象.     

血清抗体检测在一起新型冠状病毒肺炎疫情传播链推断中的应用

【目的】探讨血清抗体检测在新型冠状病毒肺炎(COVID-19)疫情传播链推断中的应用,为疫情防控提供科学依据。【方法】对确诊病例和密切接触者进行现场流行病学调查,采用实时逆转录聚合酶链反应(RT-PCR)法检测咽拭子、肛拭子标本新型冠状病毒核酸,采集血清进行IgM单独检测和IgM/IgG联合检测。【结果】确诊病例A无明确COVID-19流行病学史;病例C、D与A同餐同住,且与其他COVID-19确诊病例(H、L)有接触史和聚餐史。病例A新型冠状病毒核酸检测结果阳性,病例C和D均阴性。病例A和C单独IgM检测均阳性,病例D阴性;病例A、C和D IgM/IgG联合检测结果均阳性。病例C无临床症状,而病例D有临床症状。【结论】血清抗体检测可作为COVID-19传播证据链推断的有效补充,为找寻传染源和完善证据链提供参考依据。     

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.     

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.     

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.     

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.