福州市2007-2011年病毒性肝炎流行病学特征分析

目的掌握福州市2007-2011年病毒性肝炎流行特征及规律,为制定病毒性肝炎防控策略提供科学依据。方法采用描述性流行病学方法对福州市2007-2011年病毒性肝炎疫情资料进行统计分析,深入探讨影响福州市病毒性肝炎流行特征的有关因素。结果 2007-2011年福州市共报告病毒性肝炎87887例,年平均发病率为261.44/10万,以乙肝最多,占83.88%。甲肝、乙肝发病率总体上呈逐年下降趋势;丙肝、戊肝发病率总体上呈上升趋势。甲肝无明显的季节性,乙肝、丙肝、戊肝以冬春季为发病高峰。病毒性肝炎年平均发病率居前三位的地区为连江县、永泰县、仓山区,不同地区发病率差异有统计学意义(χ2=521.909,P=0.000)。男性发病率高于女性(χ2=67.203,P=0.001)。不同年龄组的乙、丙、戊型肝炎发病率差异有统计学意义(χ2=487.743、15.052、18.582,P=0.000、0.020、0.005),乙肝为20～岁年龄组高发,丙肝为30～岁年龄组高发,戊肝为60～岁年龄组高发。发病以家务待业及农民为主。结论病毒性肝炎的防治应以乙肝防治为重点,在抓好新生儿、儿童乙肝疫苗、甲肝疫苗免疫接种工作的基础上,应继续扩大疫苗免疫范围。     

15～55岁人群病毒性肝炎流行趋势分析及对血液安全性的影响

目的分析南宁市潜在献血人群中病毒性肝炎的流行趋势及其对血液安全性的影响,为血液筛查策略的调整提供依据。方法在对南宁市2004-2013年病毒性肝炎的发病情况进行描述性分析的基础上,用χ2检验比较男女的发病情况和分析发病趋势。并用自回归滑动平均混合模型(Autoregressive integrated moving average,ARIMA)对2014-2018年的发病情况进行预测。结果南宁市15~55岁人群中男性各型别病毒性肝炎的发病率均显著高于女性,男性患甲肝、乙肝、丙肝、戊肝的风险分别是女性的2.47倍、2.17倍、1.96倍、2.39倍。2004-2013年甲肝发病率逐年下降(χ2=80.515,P=0.000),乙肝、丙肝、戊肝的发病率逐年上升(χ2=650.836,P=0.000;χ2=1590.867,P=0.000;χ2=254.376,P=0.000)。ARIMA模型的预测结果显示2014-2018年甲肝和戊肝的发病呈持续上升趋势,乙肝和丙肝的发病呈持续下降趋势。结论过去10年以及未来5年的发病情况均显示南宁市15~55岁人群中戊肝的发病呈持续上升趋势。结合当前客观存在的发病特征及献血特点,我们必须直面现有血液筛查策略下输血途径传播戊肝风险的挑战。     

彭阳县1990-2009年甲型病毒性肝炎流行病学特征分析

目的 总结彭阳县20年甲型病毒性肝炎(简称甲肝)流行病学特征,为今后制定防控策略和措施提供参考依据.方法 采用描述流行病学方法分析1990-2009年彭阳县甲型病毒性肝炎的发病特点,数据分析采用χ2检验.结果 1990-2009年彭阳县甲肝发病率虽上下波动但总体呈上升趋势,每3～5年出现1个发病高峰.秋冬季发病高峰逐渐由冬季高峰月为主向秋季高峰月为主前移;发病率较高的乡镇以地理、经济、交通条件较好的南部乡镇为主;发病年龄构成以5～19岁各年龄组为主,平均占56.87%,呈5～19岁组发病逐年上升,0～4岁和≥20岁以上年龄组发病逐年下降趋势,即单峰型发病年龄高峰更加突起,男性发病高于女性且差异有统计学意义(χ2=35.92,P＜0.01);发病职业构成比前5位是学生(45.39%)、农民(33.49%)、散居儿童(12.43%)、干部职员(2.37%)、幼托儿童(1.58%),呈学生发病逐年上升,其他人群发病下降趋势.结论 甲型病毒性肝炎在彭阳县每年都居病毒性肝炎发病数首位,已成为危害当地人民健康的最主要疾病之一.传染源及暴露因素持续存在、甲肝疫苗(hepatitis A vaccine,HepA)接种率低、疫情报告的灵敏性和特异性增强是发病率上升主要原因.今后要加强以学校为主的甲肝防治健康教育和宣传以及提高HepA接种率.     

2004～2006年山东省甲型病毒性肝炎疫情分析

[目的]了解山东省甲型病毒性肝炎(甲肝)的发病情况及其变化趋势,指导制定甲肝防制策略.[方法]对2004～2006年山东省甲肝疫情资料进行分析.[结果]2004～2006年山东省报告甲肝病人4 442例.其中,2004年1 974例,发病率为2.15/10万;2005年1 413例,发病率为1.62/10万;2006年1 055例,发病率为1.14/10万.3年的发病率逐年下降(P＜0.01).累积发病率,男性为6.71/10万,女性为2.91/10万(P＜0.01).3年中,3～5月合计发病1 489例,占33.52%,其中3月占12.36%.累积发病率,威海市最高(23.19/10万),潍坊市最低(1.87/10万);50～59岁最高(7.27/10万).总病例中,农民占55.45%,学生占14.12%.[结论]山东省近年甲肝疫情呈下降趋势,沿海地区是高发地区,男性、农民、50岁以上是发病的重点人群.     

2004 - 2016年荆州市甲型病毒性肝炎流行特征分析

目的 分析2004 - 2016年荆州市甲型病毒性肝炎（甲肝）流行病学特征并提出防控建议。方法 采用描述性流行病学方法分析2004 - 2016年荆州市甲肝疫情资料,采用集中度值法分析甲肝季节特征,采用系统聚类分析甲肝地区分布特征。结果 荆州市2004 - 2016年共报告甲肝2 232例,年均发病率为2.89/10万,13年间荆州市甲肝发病率呈下降趋势（χ2 （趋势） = 158.445,P＜0.05）,年平均下降速度为5.93％。各年份发病无明显季节性。地区发病顺位为:城乡结合部＞中心城区＞远郊（χ2 = 31.907,P＜0.05;χ2 = 15.178,P＜0.05）。男性发病高于女性（χ2 = 18.268,P＜0.05）,人群分类以农民为主（62.10％）。发病高峰年龄:2004 - 2008年病例以30～54岁为主,2008 - 2012年病例以35～59岁为主,2013 - 2016年病例以40～69岁为主,病例发病年龄有后移现象。2009以来荆州市甲肝疫苗报告接种率均在99％以上。结论 2004 - 2016年荆州市甲肝发病呈下降趋势,甲肝疫苗预防接种为主的预防控制措施成效明显。今后应在进一步做好小年龄组儿童免疫接种工作的同时,加强高发地区高危人群的疫苗接种工作。     

2004 - 2017年楚雄彝族自治州肺结核流行病学特征分析

目的 分析楚雄彝族自治州（以下简称楚雄州）肺结核的流行病学特征,为控制该州肺结核疫情提供科学依据。方法 收集中国疾病预防控制信息系统数据资料,采用描述性流行病学分析方法对楚雄州2004 - 2017年肺结核流行病学特征进行分析。结果 14年间,楚雄州共报告肺结核21 860例,年均发病率57.93/10万,发病率呈缓慢下降趋势（χ2趋势 = 225.141,P＜0.001）。菌（-）构成比呈上升趋势（χ2趋势 = 122.716,P＜0.001）,涂（+）构成比呈下降趋势（χ2趋势 = 17.609,P＜0.001）。发病居前3位县市为南华县（83.81/10万）、双柏县（75.50/10万）、楚雄市（67.04/10万）。1 - 3月为发病季节高峰。农民（占82.98%）发病最多,学生（占2.48%）发病一直处于前几位。男性发病高于女性,男女比为2.20∶1。发病年龄高峰为45～70岁组中老年人（占60.15%）;0～14岁组儿童发病呈逐年下降趋势（χ2趋势 = 159.039,P＜0.001）。结论 应加强肺结核病例的发现和督导管理等综合防制措施,尤其加强重点人群（农民）和高疫情地区（南华县、双柏县、楚雄市）的防控工作。同时做好学校肺结核的防控,防止学校肺结核聚集性疫情的发生。     

2005-2013年新乡市甲型病毒性肝炎流行病学特征分析

目的了解2005-2013年新乡市甲型病毒性肝炎(甲肝)的流行病学特征,为甲肝防控提供流行病学参考依据。方法对法定传染病报告系统报告的新乡市甲肝发病情况进行描述性流行病学分析。结果 2005-2013年甲肝发病率波动在0.49/10万~12.02/10万之间,年均发病率为5.38/10万,2007年最高,以后总体呈下降趋势;发病高峰在7-9月份,农村与城市发病率差异无统计学意义(χ2=0.595,P=0.440)。病例以15岁以下儿童为主,占69.96%,男性高于女性(χ2=126.553,P=0.000),学生占发病总数的比例最高(34.09%)。其次为农民和散居儿童,分别占23.66%和20.46%。结论建议甲肝防治应采取以预防接种为主,加强疫情监测和开展健康教育的综合性防控措施。     

2013－2017年新乡市病毒性肝炎的流行特征及趋势分析

目的 分析新乡市2013－2017年病毒性肝炎的流行情况,为制定防治方案提供科学依据。 方法 整理并分析新乡市2013－2017年病毒性肝炎疫情资料汇编,通过描述性流行病学方法对新乡市2013－2017年病毒性肝炎的发病情况、流行特征及趋势进行分析。 结果 2013－2017年间新乡市病毒性肝炎报告发病率随时间变化总体呈下降趋势(χ²_趋势=225.567,P=0.000);甲肝、丙肝及未分型肝炎的报告发病率逐年降低,呈下降趋势(χ²_趋势=11.209、268.194、21.723,P=0.001、0.000、0.000);乙肝的报告发病率随时间变化呈总体下降趋势(χ²_趋势=3.913,P=0.048),戊肝的报告发病率报告发病率随时间变化呈总体下降趋势(χ²_趋势=4.268,P=0.039)。自2013年以来,乙肝的构成比总体呈上升趋势(χ²_趋势= 113.182,P=0.000),丙肝及与未分型肝炎的构成比总体呈下降趋势(χ²_趋势= 99.649、12.917,P=0.000、0.000)。男性发病人数高于女性,男女性别比为2.18:1。发病主要集中在20~64 岁人群,共 28 543例,占病例总数的 84.16%,其中25~29岁人群的构成比最高,占病例总数的13.41%。发病以农民为主(56.21%)。报告病例主要集中在郊区市县,累计报告病例数前3 位依次为延津县(21.57%)、卫辉市(13.88%)和封丘县(11.73%)。 结论 新乡市居民的病毒性肝炎报告发病率整体呈逐渐下降趋势,但仍需加强对病毒性肝炎的监测和预警,控制病毒性肝炎的传播,降低其感染的发生率。     

河北省2005年甲型肝炎疫情分析

[目的]通过分析河北省2005年甲型肝炎流行特征,为制定防治策略提供依据.[方法]对河北省2005年甲型肝炎疫情资料进行分析,有关数据用卡方检验进行统计处理.[结果]河北省甲肝发病率继续呈下降趋势,2005年甲肝发病率为2.52/10万,较2004年下降12.35%;甲肝发病男女性别比为1.68：1;不同年龄组甲肝发病构成比差异有统计学意义,5～14岁组最高,为24.42%;不同职业中以农民、学生和散居儿童为主,病例数构成比分别为43.18%、26.81%和9.40%;未接种过甲肝疫苗的1～15岁儿童中,抗-HAV阳性率平均为37.25%.[结论]应采取“预防为主、综合防治”的策略,加强重点人群的预防和监测工作,控制甲肝流行.     

脊灰减毒活疫苗免疫强度对甲型肝炎报告发病率的影响

目的分析TOPV免疫强度与甲肝报告发病率变化的关系和内在联系.方法数据来自西安市1989-2003年疫情年报资料,应用x2、rs、RR等方法处理数据.结果自1993年实施TOPV强化免疫后甲肝发病呈明显下降趋势(I=10,P＜0.01),与TOPV免疫强度有明显的剂量-反应关系(rs=-1.000),但以扫荡式强化下降幅度最为显著(x2=322.3736,P＜0.001),经分组比较:年龄组下降以接种组(0～47月龄)最为显著(x2=1217.6138,P＜0.001),职业组下降以散居儿童最显著(x2=340.8883,P＜0.001);强化服苗后季节发病亦有显著变化(x2=251.5852,P＜0.001).结论在西安市未实施甲肝疫苗普种出现发病率明显下降可能与1993年以来TOPV强化有关,其机制可能与肠道病毒间干扰作用有关.     

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.