一起生食螺肉导致的广州管圆线虫病疫情调查

目的 调查昆明市2011年4月一起广州管圆线虫病疫情暴发的原因.方法 对在某餐馆聚餐的9人进行回顾性调查及血清抗体检测,同时采集餐馆和农贸市场福寿螺样本进行病原学检测.结果 9人中有6人发病,罹患率为66.67％,共采集患者血清标本6份,阳性2份,抗广州管圆线虫抗体阳性率为33.33％,全部患者均有生食螺肉史.结论 此次疫情是一起因生食感染了广州管圆线虫的螺肉导致的广州管圆线虫病暴发.     

海南省居民广州管圆线虫感染血清学调查

广州管圆线虫病是人兽共患的食源性寄生虫病.近年来由于广州管圆线虫中间宿主福寿螺、褐云玛瑙螺在中国南方地区大量繁殖,加上居民猎奇进食鲜活的螺肉等食品,导致广州管圆线虫病近20年来相继在中国各地不断暴发或散发流行[1-3].为了解海南省居民感染广州管圆线虫情况,于2009年6-9月,对居民进行血清流行病学调查.     

广东省首次广州管圆线虫感染局部暴发的流行病学调查

目的了解一起外来民工集体感染广州管圆线虫疫情的流行因素。方法对广宁县文坑村疑似广州管圆线虫感染的云南白族民工、其他民工和当地居民进行现场流行病学调查;采集疑似病人和部分民工血清检测广州管圆线虫抗体;在疫点及周围捕捉老鼠,采集福寿螺、东风螺和新鲜鼠粪进行病原学检查。结果2007年3月24日17名云南白族民工共同进食在居住地附近的田地里采集的福寿螺,其中先后有6人发病,罹患率为35.29%(6/17),全部患者均进食过生螺肉。仅捕获黄胸鼠1只,未发现广州管圆线虫感染;采集新鲜鼠粪8份,其广州管圆线虫感染率为75%(6/8)。检查福寿螺189只,平均感染率为2.12%(4/189),感染度为平均每只螺含37条广州管圆线虫幼虫,其中大福寿螺的感染率较高,为21.43%(3/14);未采集到东风螺。采集5份患者和2份无症状民工的血清,其中2份患者血清的广州管圆线虫抗体呈弱阳性。结论广宁县横山镇文坑村是广州管圆线虫病的重要自然疫源地。外来民工同吃生福寿螺是引起广州管圆线虫感染局部暴发的主要因素。     

北京市某医院2006年141例广州管圆线虫病患者流行病学分析

目的 对北京市某医院141例广州管圆线虫病患者进行流行病学分析.方法 采用描述性流行病学方法,对2006年6-9月北京市局部小范围暴发广州管圆线虫病进行流行病学分析.结果 2006年6-9月共收治141例广州管圆线虫病患者,发病高峰在7月和8月,分别为61例和68例,无死亡病例.患者均来自北京市某酒楼就餐者,均有1次或1次以上半生食来源于广西桂林市的福寿螺及相关菜品史,症状以发热(56.79%)、头痛(93.83%)、颈部僵直感(100%)、皮肤异常感觉(77.78%)为主,外周血和脑脊液中嗜酸性粒细胞出现不同程度升高,平均35.53%±19.13%.结论 本次暴发的广州管圆线虫病传染来源为福寿螺及其相关菜品.     

中华人民共和国卫生部公告(2006年第15号)

近期,北京市发生一起因食用凉拌螺片引起的广州管圆线虫病暴发的事件,北京市卫生部门已部署将生吃或半生吃的淡水螺类食品纳入夏季食品、生活饮用水专项卫生监督检查范围。针对摄食生鲜水产品可能感染食源性寄生虫病的健康风险,卫生部2004年发布了第6号食品卫生预警公告,警示食     

永嘉县发现广州管圆线虫报告

广州管圆线虫病是由于人们生食或半生食福寿螺（蛞蝓）感染广州管圆线虫幼虫而引起的疾病。1945年在我国台湾省首先发现第1例病例。1984年中国大陆首例广州管圆线虫病由何竞智在广东徐闻县发现。1997年10月中旬-11月中旬,温州市区突然发生一批以头痛伴躯体多处游走性疼痛为主要症状的患者共计87例,初步诊断为“流行性神经痛”,并高度怀疑由广州管圆线虫引起的嗜酸细胞性脑脊髓膜神经根炎,最后诊断为广州管圆线虫病,此系我国大陆首次群体发生广州管圆线虫病。2006年5—6月间北京的2家酒店由于凉拌螺肉（福寿螺）而导致广州管圆线虫病感染引起较大规模流行,最后北京市共诊断70例患者为广州管圆线虫病。至今,全世界发现本病已超过3000例。     

河南省卫生厅发布消费预警勿食生田螺

河南省卫生厅日前发布消费预警，生吃未加热熟透的螺类水产品，可能引发食源性寄生虫病。据有关人士介绍，近期云南省大理州陆续发生33例广州管圆线虫病病例，病人均有生食螺类和生鱼片的经历。广州管圆线虫病是一种人畜共患寄生虫病，可引起头痛、头晕、发热、颈部僵硬、面神经瘫痪等症状，严重者可致痴呆。     

云南省广州管圆线虫病疫源地调查

目的掌握云南省部分地区广州管圆线虫病疫源地分布情况,为预防控制广州管圆线虫病提供科学依据。方法按照卫生部广州管圆线虫疫源地调查方案要求进行。结果在抽样点调查采集到的7种广州管圆线虫中间宿主,19个被调查县中13个县有福寿螺分布,占68.42%,在捕获的3874只螺类生物中,福寿螺占51.83%,褐云玛瑙螺占6.56%;在对景洪、勐腊县福寿螺调查中查到广州管圆线虫Ⅲ期幼虫,阳性感染率分别为0.56%和0.26%。结论云南省存在广州管圆线虫病自然疫源地。     

广州管圆线虫中间宿主福寿螺的综合防治研究进展

广州管圆线虫为动物寄生虫,可侵入人体,寄生在人的中枢神经系统引起嗜酸性粒细胞增多性脑膜脑炎（广州管圆线虫病）。目前该病主要见于亚太地区,尤其是东南亚国家和我国的南方各省。福寿螺是广州管圆线虫的重要中间宿主之一,近年浙江省温州市和福建省长乐市等广州管圆线虫病暴发均由食用福寿螺引起。目前对福寿螺的防治仍集中于单一的物理防治、农业防治、化学防治等,还未形成一套行之有效的综合防控技术体系。该文主要对国内外福寿螺近年的防治研究进展做一简单介绍。     

北京市2006年市售福寿螺中广州管圆线虫感染状况调查

目的了解2006年北京市水产市场出售的福寿螺中广州管圆线虫的感染状况。方法分别从北京市三个水产市场不同摊点采集福寿螺样本共47只,采用胃蛋白酶消化法从螺体中分离广州管圆线虫幼虫,并用直接镜检法在消化后的沉渣中查找广州管圆线虫幼虫,幼虫的分期根据管圆线虫不同时期形态特点进行判定。结果采集的47只福寿螺有9只检出广州管圆线虫幼虫,感染率为19.15%,其中有1件样本检出Ⅰ期幼虫,8件样本检出Ⅱ期幼虫。结论北京市水产市场出售的福寿螺部分感染有广州管圆线虫。     

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.     

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.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.