淮安市淮安区输入性疟疾病例流行病学分析

摘要:目的　了解淮安区输入性疟疾病例的流行病学特征。方法　收集2009-2013年淮安区上报的疟疾病例流行病学调查资料进行相关分析。结果　2009-2013年淮安区共报告53例境外输入性病例,输入地为7个非洲国家,其中间日疟2例、恶性疟48例、卵形疟3例,全年各月均有疟疾病例报告,均为男性,年龄分布在22～53岁之间,以40～49岁为主,占67.92%。结论　2009-2013年淮安区上报的疟疾病例均为到非洲地区务工感染后的返乡人员,以恶性疟为主,应特别加强对恶性疟疾高流行区归国人员的监测、管理、宣教工作,并提高医务人员诊断及镜检技术水平。     

常州市2006～2010年输入性恶性疟调查分析

目的通过对常州市输入性恶性疟进行个案分析,研究该病的流行趋势。方法对常州市2006～2010年27例输入性恶性疟病例的个案资料进行回顾性调查和分类统计。结果 27例输入性恶性疟病例均为从非洲高疟区回国人员,无明显的发病季节,部分恶性疟病人因未及时就诊而出现重症表现。结论对来往于非洲等高疫区人员加强疟疾监测,从高疟区回归人员发热临床医生应提高首先考虑恶性疟的意识。     

百色市一例境下输入性重症恶性疟流行病学调查

目的　对百色市报告的1例输入性重症恶性疟病例进行流行病学调查,为巩固消除疟疾成果并防止输入性病例出现死亡提供参考依据。方法　对患者的流行病学史、诊疗经过等资料进行收集、整理和分析。结果　该例患者有明确的外出非洲史,驻地为疟疾流行区,回国后发病,血检、PCR证实恶性疟原虫感染阳性。百色市2009年至2017年未发现本地感染疟疾病例,推断病例为境外感染本地发病,回国后多次就诊未能及时诊断是导致患者发展成为重症疟疾的主要原因。结论　百色市辖区内需加强临床医生对疟疾知识的培训以及境外返乡人员的监测力度,尽早发现输入性疟疾病例并及时治疗,以防止输入性继发病例以及重症甚至死亡病例的出现。     

1例境外输入性恶性疟配子体的检出

目的了解恶性疟配子体发生、发展原因及检出经过。方法根据流行病学调查及疟疾血检结果对1例疟疾案例进行分析。结果报道了1例境外输入性恶性疟病例的诊疗情况。患者非洲务工1年,感染疟疾数次,回国前再次发病并在当地抗疟治疗6 d,10 d后回国再次感到发热、出汗、头痛。到乳山疾控中心采血镜检,后经威海市疾控中心复核及山东省寄生虫病防治研究所疟疾诊断参比实验室复核,确诊为恶性疟。因为及时给予患者科泰复药物治疗,痊愈,3个月随访,未见异常。结论由于近几年对疟疾认识的提高,早发现早治疗使得恶性疟很少发展成配子体,因此恶性疟配子体的检出显得弥足珍贵。     

2004-2013年广西玉林市疟疾的流行病学分析

摘要:目的　了解和掌握玉林市疟疾的流行特征。方法　采用Excel 2003对2004-2013年玉林市疟疾病例的流行病学特征进行描述性统计分析。结果　2004-2013年玉林市疟疾发病率为0.02/10万～0.33/10万,共报告疟疾病例70例,其中间日疟41例,恶性疟22例,疟疾（未分型）7例,病例分布于全市5县（市）2区,发病季节呈全年分布,男女性别比为16.5∶1,年龄在10～55岁间,职业主要为农民、民工,感染来源地主要为东南亚及非洲国家疟疾流行区。结论　输入性疟疾病例是玉林市疟疾的主要疫情特点,加强对东南亚及非洲国家务工返乡人员的疟疾监测是预防和控制疟疾危重和死亡病例增多的重要措施。     

一例输入性恶性疟疾的调查处理

2011年,湖北省仙桃市发生1例输入性恶性疟疾病例,经及时规范抗恶性疟治疗8日后痊愈出院. 1基本情况 患者沈某,男,20岁,仙桃市剅河镇双谭路居民,患者发病前曾在国外务工.该市历年来未曾报告过恶性疟病例,近3年该镇本地疟疾病例也未见发生.2011年3月5日,患者的母亲到仙桃市疾病预防控制中心咨询有没有抗疟药,遂引起中心疟防专业人员的注意,后经省市两级实验室检测复核确诊为输入性恶性疟.     

舟山市13例输入性疟疾临床检测分析

目的探讨舟山市输入性疟疾临床特征及其实验室特征,为输入性疟疾的早期诊断及治疗提供依据。方法回顾性分析2007年-2013年舟山市13例输入性疟疾的临床特征和实验室特征。对疑诊患者采集外周血制作厚、薄血涂片,经瑞氏染色后在油镜下查找100个视野,找到疟原虫即为阳性。结果 13例输入性疟疾实验室诊断恶性疟10例(76.9%),间日疟3例(23.1%),13例疟疾均未见配子体。实验室检查23.1%的患者白细胞降低,15.4%的患者血红蛋白降低,76.9%的患者血小板减少,69.2%的患者胆红素升高。结论舟山市境外输入性疟疾以有非洲旅居史的中年男性患者为主,恶性疟多见。临床表现复杂,并发症多,血红蛋白下降不明显,对来自疟区的可疑患者诊治中需多次反复查找疟原虫,以提高阳性率,尽早发现及时治疗,可减少脑型疟疾等重型并发症的发生。     

国境口岸输入性恶性疟的现状与预防控制

目的了解近年来我国境外输入性恶性疟疫情,探讨现阶段恶性疟预防与控制措施。方法查阅了2006年以来所有详细报道我国国境口岸输入性恶性疟的文献,对有关感染地区、诊疗状况等相关资料进行分析。结果输入性恶性疟最主要的感染地为非洲和东南亚地区,其中非洲地区的尼日利亚、安哥拉、几内亚、赤道几内亚,东南亚的缅甸是我国输入性恶性疟来源最多的国家。恶性疟易引起误诊,感染者常因未得到及时有效的抗疟治疗而死亡。疟疾病人的实验室诊断率有待提高,采用疟原虫抗原快速检测法和PCR法等疟疾诊断新技术作为镜检的补充,有助于提高疟疾诊断水平。赴非洲等恶性疟高发区的归国劳务人员,恶性疟发病率高、复燃比例高,采用以青蒿素类药物为主的联合疗法可提高疗效和阻止疾病传播。结论我国国境口岸输入性恶性疟防治重点是加强境外输入性疟疾监测与管理,提升恶性疟的诊疗水平,提高出国人员疟疾的自我防护能力。     

锦州市2017年输入性恶性疟个案实验室检测及分析

目的调查锦州市境外输入性恶性疟病例流行病学特征和实验室检测能力,为疾控部门防治和快速检测恶性疟原虫提供依据。方法分析患者的临床病历和流调信息,采用镜检、快检实验(rapid diagnostic test,RDT)及荧光定量PCR(fluorescence quantitative PCR,qPCR)3种方法对患者血样进行检测。结果患者在喀麦隆疟疾高度流行区务工期间感染疟疾,经青蒿素类复方治疗8 d;回国后1个月以持续性发热、头痛、畏寒、腹泻等症状入院治疗。镜检见疟原虫环状体、配子体,恶性疟RDT抗原和qPCR基因检测均为阳性,确诊为恶性疟原虫感染。结论应加强务工归国人员的管理,并通过镜检联合RDT及qPCR检测以提高疟原虫血检效率,对患者进行早期诊断和治疗提供实验室依据。     

河南省一例输入性恶性疟病例调查与分析

目的了解输入性疟疾病例的诊治和管理情况,为消除疟疾阶段输入病例的防控提供参考。方法访谈病人和家属了解病例的发病、诊疗过程、流行病学接触史和周围人员的发病状况;访谈医务人员和查阅病历了解实验室诊疗情况。电话回访病人出院后恢复情况和接触者后续发病情况。结果患者回国后11 d无明显诱因出现血尿7 d,发热伴头痛、寒战、乏力5 d就医,当地诊所按感冒治疗3 d,治疗无效且病情加重入院;疟原虫免疫学快速检查示阳性,血涂片镜检发现恶性疟原虫环状体、滋养体,疟原虫密度为960 000个/μL。病例2016年4月25日～2016年5月10日在西非加纳采矿,当地为恶性疟高流行区,在加纳期间的工作地点在野外,工作期间经常被蚊虫叮咬,国外是否发病、诊断及治疗情况。归国后居住地河南省Z市,当地无恶性疟流行。病例治疗及转归,按照"1-3-7措施"落实情况。确定为一例输入性恶性疟病例,感染地为外出务工地西非加纳。结论本例病人为加纳感染归国后发病的恶性疟确诊病人。目前个体诊所在恶性疟病人的发现和初步诊断方面存在一定不足。建议加强个体医务人员疟疾相关知识的培训尤其是病人流行病学暴露史的问询,及时发现输入性病例,减少本地传播。同时,强调出国务工人员疟疾相关知识的宣传,加强自我防护,降低感染风险。     

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.     

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.