COVID-19出院患者“复阳”情况及原因分析

国内新型冠状病毒肺炎（COVID-19）疫情虽已得到基本控制,但有部分患者在出院后康复隔离观察期核酸检测再次呈阳性,即出现“复阳”现象,具体原因尚不明确。可能由新型冠状病毒（SARS-CoV-2）的病原学特点决定,也可能与病毒入侵后产生的机体免疫反应、患者的病程和病情以及样本采样部位、处理方式、检测等一系列因素相关,因此对出院患者的核酸检测仍需重视。本文就COVID-19出院患者核酸检测复查阳性情况及其可能存在的原因进行综述,为后续复阳患者的防控工作和科学研究提供理论支持。     

2例新型冠状病毒肺炎确诊病例出院后核酸复检阳性案例的启示

新型冠状病毒是一种新发现的新型病毒,科学认知在不断完善,防控措施也在不断调整。本文对2例新型冠状病毒肺炎(简称新冠肺炎)病例的诊疗经过和出院后核酸检测情况进行报道,为新冠肺炎疫情防控提供依据。     

甘孜州93名出院新型冠状病毒肺炎患者和无症状感染者粪便中新型冠状病毒核酸检出情况

目的对出院的新型冠状病毒肺炎(简称"新冠肺炎")患者和无症状感染者粪便进行新型冠状病毒(简称"新冠病毒")核酸检测,了解出院人员粪便中带毒状况,为疫情防控提供科学依据。方法用实时荧光RT-PCR法对2020-02/04甘孜州93名出院新冠肺炎患者和无症状感染者粪便进行核酸检测,用SPSS 20软件对检测结果进行分析。结果 93份粪便样本中检出SARS-CoV-2阳性18份,阳性率为19.35%。其中73份出院新冠肺炎患者粪便,阳性率为20.54%,20份出院无症状感染者粪便,阳性检出率为15.00%;民族分布为藏族82名,汉族11名,阳性检出率为分别为19.51%和18.18%;性别分布为男性51名,女性40名,阳性检出率为22.64%和15.00%;年龄分布从3岁到77岁,平均年龄39岁,阳性检出率在临床分型、民族、性别和年龄上差异均无统计学意义。结论提示新型冠状病毒核酸在呼吸道检测阴性后,消化道持续核酸阳性,存在较大的潜在感染风险,应加强对已出院新冠患者和无症状感染者管理,建议粪便样本核酸检测做为解除隔离条件,同时应加强隔离点卫生消毒处理。     

郴州市39例新型冠状病毒肺炎确诊病例病毒核酸检测结果分析

目的 分析郴州市39例新型冠状病毒肺炎(简称新冠肺炎)确诊病例不同时期不同标本的新型冠状病毒核酸检测情况,为新冠肺炎临床诊疗和管理提供科学依据。 方法 以郴州市新冠肺炎疫情期间确诊的39例新冠肺炎病例为研究对象,收集其从确诊、住院诊疗到院后康复管理过程中新型冠状病毒核酸检测的相关信息,描述不同阶段、不同标本的检测结果。 结果 新冠肺炎疫情期间,郴州市共完成了39例新冠肺炎确诊病例301人次核酸检测。新冠肺炎病例均以单独咽拭子标本核酸检测确诊,出院后随访复查采用同一病人不同种类标本联合检测为主。出院后病例新冠病毒核酸检测复阳率为12.82%。 结论 增加病例不同时期标本核酸检测次数和同一时期不同种类标本联合检测可提高阳性检出率,应对出院后病例“复阳”现象开展进一步研究并加强健康管理。     

常熟市1例新型冠状病毒肺炎出院复阳病例的调查报告

目的 对常熟市1例新型冠状病毒肺炎(简称新冠肺炎)出院复阳病例的流行病学调查,为新冠肺炎病例出院后跟踪随访提供参考。 方法 按照国家卫生健康委员会《新型冠状病毒肺炎防控方案(试行)》要求对病例开展现场流行病学调查和接触者判定,采集病例、接触者等相关标本,采用荧光定量PCR法进行新型冠状病毒核酸检测,并对复阳再次入院至出院相关信息进行描述。 结果 该病例2020年1月7日自武汉坐高铁回常熟;1月20日,病例出现发热、肌肉酸痛和腹泻等症状,最高体温38.9 ℃;25日胸部CT报告显示两肺感染性病变;26日新型冠状病毒核酸检测阳性,27日省疾病预防控制中心复核阳性,经省专家组会诊确认为新冠肺炎确诊病例;2月15日治愈出院进行居家隔离观察;3月1日核酸复查阳性,即转至苏州定点医院进行观察治疗; 3月9日再次出院,进行集中隔离医学观察;24日核酸复查单靶阳性,29日、31日两次核酸检测阴性后解除集中隔离医学观察返回家中。 结论 该病例为一例新冠肺炎病例出院后复阳病例,提示在今后的疫情防控中,要进一步做好出院病例的跟踪随访和健康监测。     

新型冠状病毒肺炎出院患者核酸复检阳性分析

目的了解新型冠状病毒肺炎(简称新冠肺炎)治愈患者出院后14 d内核酸复检阳性率,分析复检阳性影响因素和传播风险,为有效管理出院患者提供依据.方法对86例出院患者的随访信息和核酸检测结果进行分析,计算出院后14 d内的核酸复检阳性率,分析性别、年龄、感染来源、临床严重程度、病程和住院时间等因素与复检阳性的统计学关联.结果...     

广东省新型冠状病毒肺炎确诊病例出院后复检病毒核酸阳性特征及影响因素分析

目的:分析广东省2020年初国内输入疫情阶段新型冠状病毒肺炎（新冠肺炎）确诊病例出院后复检新型冠状病毒核酸阳性（复检阳性）特征及影响因素。方法:收集广东省新冠肺炎确诊病例（发病时间在2020年3月1日以前）的人口学资料、流行病学调查及出院后标本采集与检测等信息。采用logistic回归模型分析确诊病例复检阳性的影响因素...     

入境人员集中隔离点新型冠状病毒核酸检测阳性病例特征分析

目的 了解浙江省湖州市某入境人员集中隔离点2021年12月18日-2022年1月12日新型冠状病毒(新冠病毒)核酸阳性病例特征,为新型冠状病毒肺炎(新冠肺炎)境外输入疫情防控提供依据.方法 收集该入境人员集中隔离点2021年12月18日-2022年1月12日境外输入新冠病毒核酸阳性病例的基本信息、核酸检测和流行病学调查...     

商丘市91例新型冠状病毒肺炎流行病学特征分析

目的 了解商丘市新型冠状病毒肺炎(简称新冠肺炎,COVID-19)的流行病学特征,为下一步疫情防控工作提供依据。方法 对截至2020年3月4日商丘市报告的91例新冠肺炎确诊病例的流行病学特征进行描述,同时对临床特点和病原学检测结果进行分析。结果 商丘市91例新冠肺炎确诊病例中,输入性病例44例(48.35%);发病年龄以18~59岁为主,占83.52%;人际传播主要在家庭中发生;临床分型以普通型为主,占65.93%;治愈率96.70%,病死率为3.30%;经两次及以上核酸检测确诊者占15.39%;治愈出院后核酸复检阳性4例(4.55%)。结论 商丘市新冠肺炎疫情防控工作取得阶段性成果,外防输入是今后疫情防控工作的重点。     

不同人群新型冠状病毒核酸检测的临床价值

 目的 探讨新型冠状病毒（SARS-CoV-2）核酸检测在发热门诊、隔离病房、易感人群以及大规模筛查等不同人群中的应用价值,为SARS-CoV-2实验室检测提供参考依据。方法 采集2020年2月1日-3月22日郑州人民医院不同人群的咽拭子,包括发热门诊、隔离病房患者,一线疫情防控医护人员,以及无新型冠状病毒肺炎（COVID-19）症状的住院患者、陪护家属和复工人员。采用逆转录聚合酶链反应（RT-PCR）方法,使用A、B两种国产检测试剂盒对发热门诊、隔离病房的患者进行SARS-CoV-2核酸检测。结果 共检测15 497份咽拭子标本,SARS-CoV-2核酸阳性24份,核酸阳性病例均来自发热门诊和隔离病房。24例咽拭子SARS-CoV-2核酸阳性患者同时送检的血标本核酸结果均呈阴性。A、B两种试剂首次咽拭子核酸检测结果一致,2例确诊COVID-19患者治疗后复查咽拭子标本,A组试剂检测为阳性,B组试剂检测为阴性。该院疫情防控一线医护人员、未出现COVID-19症状的住院患者、陪护家属和复工体检人员核酸检测均为阴性。结论 复工人员、住院患者、陪护家属和一线疫情防控人员SARS-CoV-2核酸筛查均未发现阳性,咽拭子标本SARS-CoV-2核酸检测阳性率高于血标本,不同核酸检测试剂检测阳性率稍有差异。     

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.