广州市儿童诺如病毒胃肠炎临床流行病学分析

目的 研究广州市5岁以下儿童秋冬季诺如病毒(NVs)急性胃肠炎临床特征及危险因素.方法 NVs急性胃肠炎临床特征的探讨采用软状病毒(RV)急性胃肠炎进行频数匹配的两样本研究,危险因素研究采用1:1配对病例对照研究.结果 NVs胃肠炎最早出现的症状是呕吐47.0%(48.102),主要临床症状有呕吐80.3%(82.102)、发热52.9%(54.102)、脱水23.5%(24.102)和腹痛7.8%(8.102)等,与RV感染胃肠炎相似.NVs感染胃肠炎发病的危险因素是吃生冷食品,可疑危险因素是同胃肠炎患者接触及家庭内有腹泻患者.保护因素是勤剪指甲.结论 NVs感染胃肠炎的临床特征及轻重程度与RV相似.其疾病负担仅次于轮状病毒;防止食物或水受到NVs污染以及避免同胃肠炎患者接触,保持良好的个人卫生习惯是预防NVs感染胃肠炎的有效措施.     

广州市某医院儿童秋冬季腹泻诺瓦克样病毒感染的分子流行病学研究

目的 了解广州市某医院2003年秋冬季儿童腹泻中诺瓦克样病毒(NLVs)感染的流行病学特点及病毒的基因型。方法 收集2003年10月至2004年1月临床诊断为病毒性腹泻而就诊的患儿粪便标本，采用引物JV12Y／JV13I进行逆转录-聚合酶链反应检测NLVs，阳性标本的PCR产物经纯化、测序进行基因分析。结果 收集的358份标本中检测出NLVs42份，阳性率11．73％。3岁以下的婴幼儿阳性40例，占95．24％，其中6月龄～1岁组与1～2岁组阳性率最高，分别占38．10％、35．71％。年龄最小者只有25天龄。4个月中，11月阳性率最高为17．27％，其次是2004年1月、2003年10、12月，阳性率分别为15．79％、8．11％、11．36％。抽取11份阳性标本进行测序分析，结果5份为GⅡ-3群，5份为GⅡ-4群，1份为GⅡ型，但尚不确定所属群。随机抽取20份轮状病毒阳性标本检测NLVs，未发现合并感染。结论 广州市某医院儿童腹泻的散发与NLVs感染有关，并且存在着不同的基因型，流行优势株为GⅡ-3群与GⅡ-4群的病毒株。     

婴幼儿轮状病毒腹泻发病危险因素的病例对照研究

目的探讨5岁以下婴幼儿轮状病毒（RV）腹泻发病的危硷因素,为该病的预防控制提供科学依据。方法选择深圳某街道2007年10月—2009年12月,5岁以下的RV实验室确诊病例166例作为病例组,按照1∶1匹配随机选择同期未出现呕吐或腹泻症状,且与确诊病例同一或相邻楼层、相同性别、相同月龄段者作为对照。自行设计问卷,由统一培训的调查员对儿童家长进行面访调查,收集相关信息。采用EPI INFO 3.3软件建立数据库,然后使用SPSS 13.0软件包进行统计分析。结果 166例病例中,腹泻占98.80%（164/166）,发热（≥37.5℃）的占55.42%（92/166）,呕吐的占48.80%（81/166）。曾口服RV疫苗的56例病例中,服苗14 d内发病的占32.14%（18/56）,服苗超过1年后发病的占58.93%（33/56）。单因素条件logistic回归分析结果显示,接触过呕吐（腹泻）病人和到过某医院门诊部的是危险因素,口服RV疫苗、母乳喂养和喂孩子之前洗手是保护因素（均P〈0.05）。口服RV疫苗的疫苗效力（VE）=（1-0.57）×100%=43%。多因素条件logistic回归分析结果显示,接触过呕吐（腹泻）病人是危险因素,口服RV疫苗每年二三次和喂孩子之前洗手是保护因素（均P〈0.05）[1]。口服RV疫苗2次/a的VE=（1-0.48）×100%=52%;口服RV疫苗3次/a的VE=（1-0.35）×100%=65%。结论腹泻、发热、呕吐是轮状病毒感染主要的症状;口服RV疫苗需要经过2周后方可产生抗体,免疫力只能维持1 a;避免接触呕吐（腹泻）病人,每年口服RV疫苗二三次和喂孩子之前洗手等可减少感染RV。     

婴幼儿轮状病毒腹泻发病危险因素1：2配对病例对照研究

WHO估计全球每年有453 000例5岁以下儿童因感染轮状病毒（RV）腹泻而死亡，大部分发生在发展中国家[1]；亚洲5岁以下儿童腹泻中RV检出率高达55.0%，我国住院腹泻患儿RV检出率为46.0%，门诊为29.0%[2]；RV可通过受污染的手和物品以及呼吸道进行传播[3]。为此本研究于2007-2008年对甘肃省5岁以下儿童RV腹泻患病的危险因素开展1：2配对病例对照研究。     

影响小儿轮状病毒感染腹泻流行的气象因素

急性腹泻是儿童最常见的疾病之一，而轮状病毒（Rotavirus，Rv）惑染是引起小儿腹泻最重要的病原。有报道，RV腹泻占住院腹泻患儿的52．9％～58．6％，而小儿病毒性腹泻中，RV感染高达78％。RV感染有其流行病学特点，许多国家和地区存在明显的季节高峰，但高峰月份有时也有小变动，造成RV感染流行特点的因素不甚明了，本研究旨在探讨，小儿RV腹泻流行的气象学因素。     

2009年广州地区轮状病毒分子流行病学研究

目的了解广州地区引起婴幼儿腹泻轮状病毒（Rotavirus,RV）的血清型特征。方法采用酶联免疫吸附试验（ELASA）及巢式逆转录聚合酶链式反应（NestRT—PCR）,对2009—01／12来自广州地区5间监测医院的5岁以下腹泻门诊患儿粪便标本,进行RV抗原检测和血清型分型。结果检测腹泻门诊患儿粪便361份,男性228份,女性133份,经ELISA法检测RV抗原阳性的标本146份（阳性率为40．44％）,男性阳性率39．04％,女性阳性率42．86％;7～12月龄RV腹泻患儿最多,占45．21％;秋冬季为（1月,10～12月）为发病高峰季节,占76．71％;对132份ELISA阳性标本进行G、P分型,G分型中主要为G1型（43．94％）,其他依次为G3型（28．03％）,G1＋G3混合型（24．24％）,G9型（1．52％）,G1＋G9型、G1＋G3＋G9型及未分型均为（0．76％）;P分型中主要为P[8]型（47．73％）,其他依次为P[4]型（25．76％）,P[4]＋P[8]混合型（23．48％）,未分型（1．52％）,P[6]＋P[8]混合型（0．76％）;G型和P型组合情况以G1P[8]型多见,33株,G3P[8]次之,18株。结论RV是广州地区2009年婴幼儿腹泻的主要病原,RV腹泻阳性率男女无差异,主要高发于秋冬季,RV发病以7～12月龄人数最多,G、P分型分别以G1和P[8]为主要流行毒株,组合型G3P[8]为流行优势株,混合感染亦很常见。     

0-5岁婴幼儿腹泻病例轮状病毒（RV）感染及流行病学情况分析

目的：了解长兴地区轮状病毒（RV）在0-5岁婴幼儿中的感染发病及流行病学特征,为RV疫情防控提供参考依据。方法：采用轮状病毒试剂盒,对粪便标本及时检测轮状病毒抗原。结果：0-5岁婴幼儿腹泻病例中,RV感染率为32．7％;感染的主要对象为0-2岁的婴幼儿,占96．5％;发病率高峰期为10月份到2月份,占RV感染数的89．6％;最高感染率在12月份,感染率为61．7％。结论：与我国每年的10月份至次年的1月份为高发季节基本相似,临床医生应重视腹泻病原的检测,以明确诊断,在高发季节应做好预防工作。     

长沙地区婴幼儿A群轮状病毒腹泻的流行病学特征

目的了解长沙市婴幼儿急性腹泻病例中A 群轮状病毒（RV）感染的特点。方法收集某省儿童医院2006年5月-2007年4月间1 724例＜5岁腹泻患儿的粪便标本, 采用标记金的A群RV单克隆抗体,以免疫层析双抗体夹心法检测标本中的A群RV抗原。分析阳性患儿流行病学资料。结果1 724份腹泻患儿粪便标本中，RV抗原检测阳性342份，阳性率19.84%。2006年5-6月RV抗原检测阳性率为9.21%，而11-12月及2007年1-2月其阳性率分别达36.61%、24.37%，后两者与其他月份阳性率比较，差异有显著性（χ2=107.18，P＜0.001）。不同年龄段患儿RV感染率以6个月～1岁、～1.5岁、～2岁年龄段较高，分别为26.57%、31.48%和29.55%，6个月～2岁年龄段与其他年龄段的RV抗原检出率比较，差异有显著性（χ2＝79.30，P<0.001）。男性RV感染率为16.27%，女性为23.94%，前者显著低于后者（χ2=15.87，P<0.005）。结论长沙地区RV感染高峰期在11月至次年2月，患儿年龄为6个月～2岁。对婴幼儿腹泻应尽早做RV检测，以及时发现病原体，合理治疗，避免滥用抗菌药物，防止传播。     

北京地区79例婴幼儿诺如病毒腹泻的临床特点分析

目的分析婴幼儿诺如病毒腹泻的发病特点，为临床诊断提供依据。方法对2002年1月至2006年12月在首都儿科研究所附属儿童医院就诊的318例急性腹泻患儿采集粪便标本，用酶联免疫吸附试验（ELISA）检测粪便诺如病毒抗原，同时用聚丙烯酰胺凝胶电泳（PAGE）检测轮状病毒。结果经检测的318份粪便标本中，诺如病毒阳性标本共79份，阳性检出率为24．8％（79/318）。其中有48例在10-12月份检出，占阳性标本的60．8％（48/79）。2岁以内患儿占91．2％。有16例同时合并轮状病毒感染。经统计学分析，轮状病毒混合感染组与单纯诺如病毒感染组在发热的严重程度上有差异，但是在腹泻严重程度上的差异无统计学意义。诺如病毒阳性患儿中有14例是以其他疾病住院，分别于住院1-11d出现腹泻。结论诺如病毒是引起婴幼儿急性腹泻的病原之一，也是医院内感染性腹泻的病因之一。     

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.     

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.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.     

Stress in police officers: a study of the origins,prevalence and severity of stress-related symptoms within a county police force

BACKGROUND: High levels of stress-related illness are causing concern across industry. Against a background of impending legislative moves to try to improve this situation, there is a need to identify key work-related stressors. Police work tends to be regarded as inherently stressful because of the personal risk of exposure to confrontation and violence and the day-to-day involvement in a variety of traumatic incidents. As a result, high levels of stress-related symptoms might be expected in this population. OBJECTIVE: To examine the sources of stress-related symptoms within police officers and measure the prevalence of significant associated mental ill-health. METHOD: A cross-sectional questionnaire survey of a population of 1206 police officers was performed to assess levels of strain associated with a series of potential home and work related stressors. Participants were then split into low and high scoring groups on the basis of a General Health Questionnaire (GHQ) threshold score in order to identify those stressors most associated with mental ill-health effects. RESULTS: Occupational stressors ranking most highly within the population were not specific to policing, but to organizational issues such as the demands of work impinging upon home life, lack of consultation and communication, lack of control over workload, inadequate support and excess workload in general. The high scoring group constituted 41% of the population and differed significantly from those with low scores in perception of all stressors, ranking both personal and occupational stressors more highly, and from personality constraints appeared significantly more 'stress-prone'. A significant association between gender and mental ill-health was found, with females more likely to score more highly on the GHQ than males. CONCLUSION: This study confirms previous findings of organizational culture and workload as the key issues in officer stress. Given that the degree of symptomatology appears to be worsening, management action is required. Further research is indicated within the police population into a possible increased susceptibility in female officers.