2014-2015年武汉地区4 232例儿童呼吸道人类博卡病毒感染流行病学特征

目的 分析武汉地区4 232例急性呼吸道感染(ARTI)的儿童人类博卡病毒(HBoV)感染的临床及流行病学特征。 方法 收集2014年1月1日-2015年12月31日期间4 232例7岁以下儿童经确诊为ARTI的鼻咽抽吸物(NPA),利用RT-PCR法对HBoV进行筛查,同时对流感病毒A型(Inf-A)、流感病毒B型(Inf-B)、呼吸道合胞病毒(RSV)、腺病毒(ADV)及副流感病毒Ⅰ型(PIV-Ⅰ)、副流感病毒Ⅱ型(PIV-Ⅱ)、副流感病毒Ⅲ型(PIV-Ⅲ)7种呼吸道病毒进行检测以了解其混合感染情况,并结合病例临床资料对其流行病学特征进行分析。 结果 4 232例NPA标本中,HBoV检出率为1.23%(52/4 232)。1～<3岁儿童HBoV阳性检出率最高,为2.81%(24/854)。HBoV在春夏秋冬各季节的检出率分别为3.05%、0.60%、0.52%、0.24%, 差异均有统计学意义(χ²=36.784,P=0.002),其中以春季检出率最高。HBoV与其他病毒混合感染率为69.23%(36/52)。以支气管肺炎患儿HBoV阳性检出率(51.92%)最高。 结论 2014-2015年HBoV为武汉地区儿童发热呼吸道症候群的主要病原之一,1～<3岁儿童检出率最高,与其他病毒有较高的混合感染率,且春季流行。     

下呼吸道感染住院患儿人博卡病毒感染的临床特征

目的 研究＜1岁急性下呼吸道感染患儿人博卡病毒(HBoV)感染的临床特征.方法 采用实时荧光定量PCR法对2009年11月-2010年12月453例因急性下呼吸道感染的＜1岁患儿鼻咽部抽吸物进行博卡病毒检测,阳性病例采用实时荧光定量PCR对其DNA载量进行测定,并结合其临床特征进行综合分析.结果 HBoV阳性检出35例,总阳性检测率为7.73％,平均年龄10.5月龄,季节性及性别差异无统计学意义;HBoV感染重症感染患儿(4.2×108拷贝/ml)与普通感染患儿(1.7×108拷贝/ml) HBoV的病毒载量差异无统计学意义;HBoV协同感染(6.5×106拷贝/ml)与独立感染(1.3×106拷贝/ml)患儿病毒载量差异也无统计学意义.结论 博卡病毒是＜1岁患儿下呼吸道感染的重要病原体,常年均可见HBoV检出病例,其病毒载量与临床表现严重程度无明显相关性,博卡病毒不是＜1岁患儿急性下呼吸道感染的惟一因素.     

呼吸道常见病毒和新型病毒与儿童呼吸道感染的关系

在全球范围内,呼吸道感染是儿童时期的主要疾病之一,肺炎仍然是5岁以下儿童死亡的第1位原因[1].病毒是婴幼儿期急性呼吸道感染(acute respiratory infection,ARI)的重要病原,常见的病毒是呼吸道合胞病毒、流行性感冒(简称流感)病毒(influenza viruses,Inf)、副流感病毒(parainfluenza viruses,PIV)和腺病毒(adenovirus,ADV)等.近年来新的呼吸道病毒不断被发现,如人类偏肺病毒(human Metapneumovirus,hMPV)[2]、人类博卡病毒(human bocavirus,HBoV)[3].     

天津地区儿童人博卡病毒感染及基因型分析

目的 了解天津地区急性下呼吸道感染儿童中人博卡病毒(HBoV)的感染情况及病毒基因特性.方法 采集2008年9月- 2009年5月急性下呼吸道感染住院儿童的鼻咽吸取物标本202份,进行PCR扩增来检测HBoVNP-1基因,对VP1及VP2基因进行扩增及序列测定,与GenBank中登录的序列进行比较,分析序列特征并绘制种系发生树,同时采用多重PCR方法检测其他12种呼吸道病毒及WU多瘤病毒.结果 202份标本中,6.9％( 14/202)为HBoV阳性,所有阳性患儿的年龄均≤6岁,6月～12月龄患儿感染率最高,为14.3％ (6/42);所有感染者均为肺炎和喘息性支气管炎患儿,各月份均有检出;HBoV与其他病毒的混合感染率为85.7％ (12/14),其中58.3％ (7/12)为3种以上呼吸道病毒混合感染;VP1/VP2基因种系发生树分析表明13株HBoV均属于Ib簇,同源性分析表明,天津地区HBoV VP1基因与从GenBank下载的Ⅰ型序列比较,核酸及氨基酸的同源性分别为99.0％～ 99.8％及99.0％ ～99.9％.结论 天津地区存在HBoV流行,感染者多为＜6岁儿童,HBoV与其他呼吸道病毒混合感染常见,HBoV病毒均属于Ib簇.     

武汉地区人类博卡病毒呼吸道感染患儿的临床特点

目的研究武汉地区住院患儿呼吸道感染人类博卡病毒(Human Bocavirus,HBoV)的临床特点。方法选择2017年1-12月武汉市第三医院因呼吸道感染住院患儿1 438例以及健康儿童310名为研究对象。应用RT-PCR检测1 438例患儿咽拭子病毒感染情况;比较健康儿童和HBoV阳性患儿炎症指标水平;分析HBoV阳性患儿临床症状;采集HBoV阳性患儿咽拭子,进行扩增后基因测序,分析基因突变情况。结果 1 438例呼吸道感染住院患儿中HBoV阳性333例(23.16%)其中1～5岁患儿HBoV阳性率为46.4%;与对照组健康儿童相比,HBoV阳性患儿白细胞(WBC)、中性粒细胞计数(NEUT)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平显著升高,差异具有统计学意义(P0.05); 333例HBoV阳性患儿,其中高载量病毒(10~4 copies/ml)224例,低载量病毒109例,高载量与低载量病毒患儿的呼吸道症状无明显差别,但高载量病毒患儿更容易出现腹泻(P=0.016),更容易引起肺炎(P=0.034); 333例HBOV阳性临床标本基因测序,共获得48个全基因序列,其中15个为NP1基因序列,NP1基因236位点(G236A)、447位点(A447G)突变的样本中,病毒载量显著低于未突变的样本,差异具有统计学意义(P0.05)。结论呼吸道感染患儿中,HBoV阳性率较高,感染患儿易引起肺炎,炎症指标水平升高。某些位点基因突变可能影响病毒基因复制。     

苏州地区人博卡病毒在儿童急性呼吸道感染中的流行特征

目的分析人博卡病毒(human bocavirus,HBoV)在苏州地区儿童急性呼吸道感染患儿中的流行特征。方法收集6108例急性呼吸道感染的住院儿童鼻咽分泌物标本,实时荧光PCR法检测HBoV,同时采用实时荧光定量PCR检测肺炎支原体(MP),直接免疫荧光法检测呼吸道合胞病毒(RSV)、流感病毒A型、B型(IVA,IVB)、副流感病毒1~3型(PIV1~3)和腺病毒(ADV)。结果共检出HBoV感染378例(6.19%,378/6108),其中HBoV与其他病原体混合感染73例(19.31%,73/378)。与HBoV混合感染的前三位病原体分别为RSV(64.38%,47/73),PIV-3(16.44%,12/73),MP(12.33%,9/73)。HBoV感染阳性率在夏秋季分别为9.06%和11.35%,而在冬春季3.52%和2.37%,夏秋和冬春各季之间阳性率存在显著性差异(均P<0.01)。HBoV感染在7~12月和1~3岁儿童中的阳性率分别为11.14%和10.40%,而在0~6月组、3~5岁组、5~6岁组和≥6岁组的阳性率分别为2.83%、4.29%、3.11%和1.97%,7月~3岁患儿与其它年龄组间HBoV阳性率存在显著性差异(χ2=144.26,P<0.01)。结论人博卡病毒是苏州地区儿童急性呼吸道感染的主要病原之一,苏州全年均存在HBoV感染,以夏秋季高发。HBoV易与其它病原混合感染,尤其是RSV。HBoV感染在7月~3岁儿童中高发。     

杭州地区急性呼吸道感染患儿人博卡病毒的检测及分析

目的了解杭州地区人博卡病毒(HBoV)的流行情况和基因变异情况。方法对杭州地区160例儿童急性呼吸道感染患者咽拭子样本进行HBoV检测,并对阳性样本进行常见呼吸道病毒的检测,最终选取HBoV单一阳性的HZ1株和HZ2株进行VP1基因扩增,将获得的序列上传Genbank并与其他国家和地区的8株HBoV的VP1基因进行序列比对和分析。结果杭州地区HBoV的检出率为6.9%(11/160),与其他常见呼吸道病毒的合并感染率达到45.5%(5/11),HZ1株和HZ2株与其他国家和地区的8株HBoV的VP1基因相似性达到99%以上。结论研究证明杭州地区急性呼吸道感染患儿中存在HBoV的感染,与其他呼吸道病毒有较高的合并感染,从分离到的HZ1株和HZ2株来看,杭州地区流行的是ST2基因型,其外壳蛋白VP1基因变异很小。     

从我国儿童呼吸道标本中首次检出人博卡病毒

目的 调查国内儿童急性呼吸道感染中是否存在人类博卡病毒（human Boeavirus）感染。方法 采用聚合酶链反应（PCR）技术对湖南地区急性呼吸道感染儿童的鼻咽抽吸物（NPA）进行包括HBoV等12种病毒基因筛查，然后将PCR扩增阳性产物构建到Ppbs-T载体进行TA克隆及步移法测序，获取全长cDNA，登录Gen Bank作对比研究。结果 从某儿童急性肺炎的呼吸道标本中，检获到HBoV基因，该患者11种常见呼吸道病毒PCR均为阴性，唯检出HBoV。患者表现咳嗽、低热、呼吸困难等临床症状，在儿科诊断为肺炎。结论 国内儿童急性呼吸道感染中，特别是在中国南方地区的急性呼吸道感染患儿中，有部分可能系HBoV感染引起，应引起临床医护人员重视。     

武汉市呼吸道感染儿童博卡病毒的检测及临床分析

目的分析武汉市呼吸道感染儿童博卡病毒(HBoV)感染的临床特点,为临床治疗提供理论依据。方法收集2014年12月1日-2015年12月1日期间在本院儿科住院的365例急性呼吸道感染患儿为研究对象,在疾病急性期用一次性吸痰管采集患儿鼻咽分泌物(NPA)标本液2ml。先进行7种常见呼吸道病毒的筛查,然后采用PCR方法检测HBoV基因,对阳性标本进行序列验证及分析。结果1)对365份标本进行免疫荧光检测,结果显示呼吸道合胞病毒(RSV)的阳性检出率最高18.90%(69/365),其他依次为腺病毒(ADV)阳性15例(4.11%),副流感病毒Ⅲ(PIV-Ⅲ)阳性8例(2.20%),甲型流感病毒(IFV-A)阳性5例(1.37%),乙型流感病毒(IFV-B)阳性3例(0.82%),副流感病毒Ⅱ型(PIV-Ⅱ)阳性2例(0.55%)。2)365例标本中,32例(8.77%)出现HBoV的PCR扩增产物,均为单一条带,大小约为354bp,与预期的扩增片段大小相符合,显示为HBoV阳性。32例阳性标本进行测序后经Blast分析,HBoV1型28例(7.67%),HBoV2型3例(0.82%),HBoV3型1例(0.27%)。3)32例HBoV阳性患儿中,其中男19例,女13例,男女比例为1.47∶1;年龄3~13个月,平均6.87个月。结论 HBoV感染是引起武汉市小儿呼吸道感染的重要病毒之一,主要以HBoV1型感染为主,而且多为混合感染。应加强对婴幼儿的预防保健工作,以便进行合理用药、早期治疗。     

小儿急性呼吸道感染与人博卡病毒相关性的研究

目的:了解小儿急性呼吸道感染与人博卡病毒(Human Bocavirus,HBoV)的相关性。方法:对2008年1～5月在长春市儿童医院住院的1007例急性呼吸道感染患儿鼻咽深部分泌物样本用PCR扩增的方法进行HboV NS1基因检测。随机选取8例HBoV阳性产物进行测序,并将测到的序列与GenBank中的基因序列和HBoV阳性病例的临床资料进行分析。结果:1007例标本共检测出44例HBoV阳性,阳性率为4.37%,其中急性上呼吸道感染、急性支气管炎、毛细支气管炎和支气管肺炎患儿人博卡病毒阳性检出率分别为1.29%(2/155)、5.71%(2/35)、8.70%(2/23)和4.79%(38/794)。HboV急性呼吸道感染的年龄分布为1岁以下39例,占88.64%;1岁以上5例,占11.36%;男女性别比值是1.75∶1;临床表现咳嗽伴喘憋占97.56%,咳嗽伴腹泻占34.14%,入院时体温升高占54.55%,肺部听诊闻及干和/或湿性罗音者占95.12%,X线胸片片状影占87.80%,病程平均为13.79天。结论:人博卡病毒是引起小儿急性呼吸道感染的病原之一;HboV所致呼吸道感染部位多在下呼吸道;感染患儿以1岁以内婴儿为主。     

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.     

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.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.