河南省肾综合征出血热不同类型疫区监测比较研究

目的：研究河南省不同类型肾综合征出血热（HFRS）疫区的人间疫情、宿主动物监测及影响因素，为控制该病提供依据。方法：应用描述流行病学、血清流行病学、分子生物学及计学方法进行研究。结果：（1）1990至2000年，河南省HFRS呈稳定下降趋势，其中姬鼠型疫区一直呈下降趋势，家鼠型有一定有春、冬两个季节高峰。（3）家鼠型疫区居民区以褐家鼠为优势鼠种（58.07%），黄胸鼠、小家鼠次之。野外以黑线姬鼠（33.67%）和大仓鼠（42.5%）为优势种。姬鼠型疫区居民区以褐家鼠（46.12%）、小家鼠（42.92%）为优势种；野外以黑线姬鼠占绝对优势（83.04%），大仓鼠为次要鼠种（11.49%）。混合型疫区居民区褐家鼠为优势鼠种（73.8%），黄胸鼠为次要鼠种（17.83%）；野外以黑线姬鼠为优势种（49.66%），大仓鼠次之（36.43%）。（4）家鼠型疫区居民区褐家鼠带病毒率较高，其次为黄胸鼠、小家鼠，野外为褐家鼠、黑线姬鼠。姬鼠型疫区居民区以黑线姬鼠带病毒率最高，褐家鼠及小家鼠次之，野外仅有黑线姬鼠带病毒。混合型疫区居民区带病毒鼠包括褐家鼠、黄胸鼠及小家鼠，野外为黑线姬鼠、大仓鼠、黑线仓鼠。（5）在姬鼠型疫区褐家鼠、黄胸鼠及小家鼠中发现带有Ⅱ型HFRS病毒。说明我省姬鼠型疫区已发生向混合型疫区的转化。结论：我省HFRS不同疫区呈不同流行特点，制定防制措施应根据监测结果分别实施，并密切观察不同疫区的演变。     

青岛市2000～2004年肾综合征出血热监测资料分析

[目的]掌握青岛市近年来肾综合征出血热（HFRS）的流行特点,指导今后的防治工作.[方法]对青岛市2000～2004年HFRS监测资料进行分析.[结果]5年间发病率为3.70/10万～9.55/10万,平均6.19/10万;病死率为1.99%.年内发病有春夏季高峰与秋冬季高峰,合计发病数占总数的78.90%.郊区病例占总数的99.37%.年均发病率平度市和胶南市最高;病例中,农民占83.07%,20～50岁占78.36%,男女之比为2.53：1.鼠密度为1.57%,室内主要鼠种为褐家鼠和小家鼠,野外优势鼠种为黑线姬鼠;带毒率为5.13%,其中黑线姬鼠、褐家鼠和小家鼠带毒率分别为4.58%、7.19%和4.24%.[结论]青岛市是家鼠型与野鼠型的混合型疫源地,近年发病率较高.     

青岛市肾综合征出血热流行特征、存在问题与对策

[目的]掌握青岛市肾综合征出血热的流行病学特征和存在问题，指导防治工作。[方法]对历年监测资料进行分析。[结果]青岛市1977～2007年HFRS发病率波动在0～33．34／10万之间，平均为6．85／10万；病死率在0～27．27％之间，平均为5．04％。分为早期、第1次高峰期、平稳期、第2次高峰期和缓慢下降期5个阶段。秋冬季发病是夏秋季的2．26倍。20-59岁占80．93％，男女之比为2．38：1，农民占83．83％。郊区5个市和黄岛区发病较重。野外宿主动物密度为1．10％，带病毒率为2．47％；居民区密度为1．89％，带病毒率为2．33％。黑线姬鼠和褐家鼠是主要鼠种。2000-2007年带病毒率比1990-1999年增高。[结论]青岛市近年HFRS发病率降低，但宿主动物带病毒率上升，存在流行的潜在危险，预防措施应该加强。     

1961-2010年南充市肾综合征出血热监测

目的探索南充市肾综合征出血热(HFRS)的流行规律与特征,为其防制提供科学依据。方法统计1961-2010年疫情资料,分析人群血清学和宿主动物监测结果。结果 1961-2010年全市HFRS平均发病率为3.92/10万,病死率为4.09%,1976-1995年为发病的高峰期,呈现5月～7月和10月～翌年1月2个发病高峰,主要发病地区为3个市辖区和相邻的蓬安县,发病以青壮年男性农民为主;共捕鼠9种6 881只,总鼠密度10.80%,居民区以褐家鼠为优势鼠种,野外以四川短尾鼩和黑线姬鼠为优势鼠种,鼠肺HFRS抗原阳性率为4.75%,带病毒鼠主要为黑线姬鼠(8.75%)和褐家鼠(4.30%),HFRS发病与总鼠密度、野外黑线姬鼠密度及居民区内褐家鼠密度相关。结论南充市属姬鼠型为主的混合HFRS疫区,发病呈高度散发和相对集中的流行特点。黑线姬鼠与褐家鼠是南充市HFRS的主要宿主动物及传染源,应综合预防,加强监测。     

青岛市肾综合征出血热流行趋势与疫区演变

目的掌握青岛市肾综合征出血热（HFRS）的流行趋势与疫区演变，指导防治工作。方法对历年监测资料进行分析。结果青岛市1977—2006年HFRS发病率波动在0～33．34／10万之间，年平均为7．07／10万；病死率在0-27．27％之间，年平均为5．06％。流行过程分为早期、第1次高峰期、平稳期、第2次高峰期和缓慢下降期5个阶段。每期发病均有明显的秋冬季高峰，从平稳期开始出现了春夏季增高。秋冬季发病与夏秋季之比为2．26：1，前者病死率较高。发病年龄为0-85岁，20-59岁年龄组占80．93％，男女之比为2．37：1，农民占83．83％。主要发病地区为郊区5个市和黄岛区。发病率远郊高于近郊，近郊高于城区。宿主动物密度为1．56％，阳性率为2．45％。野外和居民区小兽带病毒率分别为2．42％和2．46％。黑线姬鼠、褐家鼠分别是野外和居民区的优势种。荧光抗体法检测发现黑线姬鼠、褐家鼠、小家鼠、大仓鼠、黑线仓鼠和臭鼠句鼯带病毒抗原。结论青岛市HFRS疫区由姬鼠型疫区演变为以姬鼠型为主的混合型疫区。近年来，虽然发病率较低，但宿主动物带病毒率增高，应采取措施加强防治。     

应用圆形分布法分析肾综合征出血热在我国的季节性分布规律

[目的]了解我国1995～2000年肾综合征出血热发病及其媒介生物黑线姬鼠与褐家鼠季节分布特征的变化趋势。[方法]运用圆形分布法进行统计分析，计算角度离散度指标r值、平均角、推算高峰日，并进行雷氏检验。[结果]我国肾综合征出血热第1峰出现的时间在3月29日，第2峰的平均时间为10月25日；黑线姬鼠的捕获率第1峰平均时间在3月30日，第2峰平均时间在9月28日；褐家鼠的季节性分布与黑线姬鼠相似，第1峰平均时间在4月13日，第2峰的平均时间9月30，r值分别介于0．6～0．8。[结论]2个鼠种(黑线姬鼠、褐家鼠)的活动高峰与肾综合征出血热发病的高峰基本重合，提示只有控制这2个鼠种的数量，才能从根本上降低本病的流行。     

2005-2006年河北省肾综合征出血热宿主动物监测分析

目的通过分析河北省肾综合征出血热(HFRS)宿主动物流行特征,为HFRS的防制提供科学依据。方法鼠密度监测采用常规夹夜法,将鼠肺冷冻切片,采用免疫荧光法检测鼠肺病毒抗原。结果居民区鼠密度平均为1.84%,带病毒率为3.33%,鼠种构成为褐家鼠、小家鼠和大仓鼠,褐家鼠带病毒率最高为3.35%;野外鼠密度平均为1.13%,带病毒率为2.44%,鼠种构成为褐家鼠、小家鼠、黑线姬鼠、大仓鼠、东方田鼠、大林姬鼠和社鼠,黑线姬鼠带病毒率最高为6.67%。不同区域鼠类均有褐家鼠分布,且为优势鼠种;小家鼠和大仓鼠分布于9个市,构成比位居第2位;黑线姬鼠和东方田鼠分布区域较少。结论褐家鼠是河北省HFRS主要的宿主动物和传染源,在HFRS的传播中起重要作用。因此,应对该鼠种有针对性地制定综合防制措施,以控制HFRS的流行。     

2006—2019年淄博市肾综合征出血热流行特征分析

目的 探讨淄博市肾综合征出血热（hemorrhagic fever with renal syndrome,HFRS）流行特征,为防控工作提供科学依据。方法 收集全市出血热疫情和宿主动物监测资料,用描述性流行病学方法进行统计分析。结果 2006—2019年全市报告肾综合征出血热1 157例,死亡10例,平均发病率为1.83/10万,病死率0.86%。沂源县、淄川区和博山区报告病例数占全市72.77%,60岁以上年龄组构成比22.64%。每年有春季和秋冬季两个发病高峰。全市平均鼠密度为2.84%,居民区和野外分别以褐家鼠和黑线姬鼠为优势鼠种。褐家鼠和黑线姬鼠带毒率分别为6.00%和4.17%,差异无统计学意义（χ2 = 0.947,P = 0.331）。褐家鼠携带的病毒为汉城型汉坦病毒（seoul virus,SEOV）,黑线姬鼠携带的病毒为汉滩型汉坦病毒（hantaan virus,HTNV）。结论 淄博市HFRS发病呈现波动式下降趋势,发病年龄有老龄化倾向。鼠密度和鼠带病毒率仍高于周边地市,疫情形势依然严峻,应持续在高发区县加强疫情和宿主动物监测,在重点地区开展出血热疫苗接种和健康教育。     

1984-2005年台州市肾综合征出血热监测研究

目的掌握台州市肾综合征出血热(HFRS)人间和动物间疫情动态变化,有针对性地采取防制对策。方法选择天台、仙居监测点和部分县(市、区)疫源地调查点,开展人间和宿主动物HFRS疫情监测,采用间接免疫荧光法检测抗体,直接免疫荧光法检测抗原。结果1984-2005年台州市共报告HFRS病人13752例,年均发病率11.90/10万,以1986年发病率最高为34.85/10万,天台县发病例数和发病率均居全市首位;以11月至次年1月为发病高峰,4-6月有发病小高峰,发病曲线呈双峰型;20~49岁发病数占66.57%,男女之比为2.58∶1,农民发病占80.95%。疑似病人和临床诊断病人诊断符合率68.72%,健康人群隐性感染率3.13%。小兽总密度10.94%,野外密度13.07%,明显高于居民区(8.79%)(P<0.01)。小兽种群分布共2目16种,野外以黑线姬鼠为优势种,占76.89%;居民区以褐家鼠为优势种,占77.37%。黑线姬鼠和褐家鼠带病毒率分别为4.48%和3.95%,带病毒鼠指数分别为0.044和0.036。小兽密度季节消长、带病毒率季节分布和带病毒鼠指数季节分布与人间疫情季节分布基本吻合,均出现11月至次年1月和4-6月冬、春季高峰,以冬峰为主。病人血清和鼠肺抗原分型,姬鼠(Ⅰ)型分别占60.91%和53.52%,家鼠(Ⅱ)型分别占32.51%和37.42%,未定型分别占6.58%和9.06%。结论台州市属以姬鼠型为主的混合型HFRS疫区,鼠密度和带病毒率较高,宜采取双价HFRS疫苗接种和灭鼠防鼠为主的综合性防制措施。     

浙江省开化县肾综合征出血热监测结果分析

目的　掌握肾综合征出血热 (HFRS)流行规律与疫源地类型 ,控制HFRS流行 ,制定防制对策。方法　采用间接免疫荧光法检测HFRS病人血清中抗体 ,采用直接免疫荧光法检测鼠肺汉坦病毒抗原。结果　监测点 19年来共发病 45 11例 ,检测小兽 40 93只 ,阳性 2 5 9只 ,带病毒率为 6.3 3 %,野外鼠种以黑线姬鼠为优势种 ,占 82 .3 0 %,其带病毒率为 8.90 %;褐家鼠为居民区优势种 ,占 66.70 %,居民区大足鼠带病毒率为 6.47%,褐家鼠带病毒率为 5 .3 8%;夏季和冬春季有两个发病高峰 ,以青壮年农民发病最多。结论　疫区宿主动物带病毒率较高 ,应选择灭鼠、健康教育和疫苗接种控制疫情。     

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.     

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.