西昌市吸毒人群HIV感染模式研究

目的：了解四川省西昌市吸毒人群吸毒方式及性行为与HIV感染的关系.方法：采用现况调查对四川省西昌市吸毒人群的社会人口学、共用注射器具静脉吸毒方式、伙伴人数和性行为情况与HIV感染的关系进行调查.同时采集血样进行HIV和梅毒抗体检测.结果：吸毒人群619人中,HIV感染率为8.6%（53/619）,其中静脉吸毒者的HIV感染率为10.1%（33/327）.在单因素分析和控制其他因素分析中,至今共用注射器具静脉吸毒的伙伴总人数与HIV感染差异均有统计学意义.趋势性检验发现随着至今共用注射器具静脉吸毒的伙伴人数的增加,吸毒人群HIV感染率也在增加.在多因素Logistic回归模型分析中,发现与HIV感染差异有统计学意义的变量是共用注射器具静脉吸毒的伙伴总人数（1～3人OR=2.47,95%CI为1.21～5.04;≥4人OR=5.13,95%CI为2.30～11.46）和彝族（OR=3.71,95%CI为2.04～6.75）.结论：吸毒人群共用注射器具静脉吸毒的社会网络大小与HIV感染有关.     

社区静脉吸毒人群人类免疫缺陷病毒感染现状

目的　了解四川省凉山彝族自治州静脉吸毒人群人类免疫缺陷病毒 (HIV)感染率及其危险因素。方法　于 2 0 0 2年 11月 8～ 2 9日 ,以社区招募方式调查凉山彝族自治州地区静脉吸毒人群的社会人口学、静脉吸毒共用注射器具和性行为方式与HIV感染的关系。采集血样进行HIV和梅毒抗体检测。结果　提供知情同意和符合纳入标准的 379人 ,HIV感染率为 11 3% (43人 )。在单因素χ2 分析中 ,民族、近 3个月共用注射器具总次数、近 3个月共用棉球和梅毒感染与HIV感染有关。在多因素logistic回归模型分析中 ,近 3个月共用注射器具总次数 (OR =2 2 8;95 %CI为 1 18～ 4 4 3)和梅毒感染 (OR =3 10 ;95 %CI为 1 4 8～ 6 4 8)与HIV感染有关。结论　近 3个月共用注射器具总次数和梅毒感染与HIV感染有关。     

直接和间接共用注射器具静脉吸毒方式与HIV感染关系的研究

目的了解四川省凉山彝族自治州地区吸毒人群直接和间接共用注射器具静脉吸毒方式与HIV感染的关系。方法于2004年5月至7月，从社区中招募吸毒人群调查其社会人口学特征、近3个月直接和间接共用注射器具静脉吸毒方式、近6个月性行为情况。采集研究对象的血样进行HIV抗体检测。结果在调查的吸毒人群中HIV感染率为15．1％（68／451），其中静脉吸毒人群HIV感染率为17．8％（66／370）。多因素Logistic分析结果显示，民族（OR为2．40；95％CI为1．39～4．13）、近3个月共用针头和注射器（OR为2．02；95％CI为1．12～3．63）、近3个月共用洗针头或注射器用水（OR，4．00；95％；CI，1．28～12．54）与HIV感染关系有统计学意义。结论四川省凉山彝族自治州吸毒人群HIV感染率高，直接和间接共用注射器具静脉吸毒行为以及高危性行为普遍，应加强对此类行为的干预。     

以社区为基础的静脉吸毒人群丙型肝炎病毒感染危险因素研究

目的　了解四川省凉山州地区静脉吸毒人群丙型肝炎病毒感染情况及其危险因素。方法　以社区为基础调查静脉吸毒人群丙型肝炎病毒感染危险因素 ,通过检测研究对象的丙型肝炎病毒抗体确定是否感染丙型肝炎病毒。结果　静脉吸毒人群丙型肝炎病毒感染率为 71.0 % (2 6 9/379)。在多因素 logistic回归模型分析中 (P<0 .0 5 ) ,共用注射器具次数的 OR值为 2 .0 5 3,其 95 %CI为 1.4 5 8～ 2 .891。在单因素χ2 分析中 (P <0 .0 5 ) ,共用注射器具次数、共用注射器具吸毒年限、近 3个月平均每天静脉吸毒频率等多个因素同丙型肝炎病毒感染有关。结论　需进一步研究阐明静脉吸毒共用注射器具方式对丙型肝炎病毒感染的影响     

静脉吸毒共用注射器具方式和性行为与丙型肝炎病毒感染关系的研究

目的 了解四川省凉山州某地区静脉吸毒人群共用注射器具方式及性行为与丙型肝炎病毒(HCV)感染的关系。方法 以社区为基础使用标准化问卷调查静脉吸毒人群人口学特征和静脉吸毒共用注射器具方式、性行为情况;通过检测研究对象的HCV抗体确定是否感染HCV。结果 在静脉吸毒379人中,静脉吸毒人群HCV感染率为对71.0％(269/379)。单因素分析结果显示近3个月共用针头或注射器和既往感染梅毒在HCV感染方面差异有统计学意义。趋势性检验发现随着共用针头或注射器、共用洗针头或注射器水的频率以及共用注射器具伙伴数的增加HCV的感染率也在增加。多因素分析结果显示,近3个月共用针头或注射器。既往感染梅毒是HCV感染的危险因素,其OR值分别为1.468(95％CI:1.045～2.061)和2.914(95％CI:1.327～6.398)。未见性行为对HCV感染的影响。结论 需考虑采用定群血清流行病学研究来进一步阐明静脉吸毒共用注射器具方式及性行为同HCV感染的关系及其联系强度。     

钦州市吸毒人群性传播疾病感染状况及HIV感染影响因素分析

目的了解钦州市吸毒人群人类免疫缺陷病毒(HIV)、丙型肝炎病毒(HCV)和梅毒(TP)的感染状况,探讨HIV感染的影响因素,为制定疾病防控策略提供科学依据。方法选取2014年4月～2016年7月在钦州市辖区内活动的吸毒人员作为研究对象,通过问卷调查收集相关信息,并采集5.0 mL静脉血进行HIV、HCV及梅毒抗体检测。结果 3 148例研究对象中,男女性别比为37.9:1;平均(32.66±7.59)岁;HIV、HCV和梅毒感染率分别为4.7%、59.5%和3.6%;女性HCV和梅毒感染率高于男性(P0.05),采用注射方式吸毒者HIV和HCV感染率则明显高于非注射方式吸毒者(P0.05);多因素Logistic回归分析结果显示,年龄≥41岁(OR=9.50, 95%CI:1.25～72.38)、离异或丧偶(OR=1.83, 95%CI:1.06～3.17)、曾经共用针具(OR=2.95, 95%CI:2.06～4.22)和感染HCV(OR=6.43, 95%CI:3.32～12.46)是吸毒人群感染HIV的危险因素;在婚(OR=0.64, 95%CI:0.42～0.97)和知晓艾滋病相关知识(OR=0.55 95%CI:0.34～0.87)是吸毒人群感染HIV的保护因素。结论钦州市吸毒人群HIV、HCV和梅毒的感染率较高,感染HIV的影响因素较多,应针对各个因素制定综合干预措施,控制相关疾病的传播蔓延。     

2009—2015年乌鲁木齐市女性吸毒者艾滋病哨点监测结果

目的了解乌鲁木齐市女性吸毒者的人类免疫缺陷病毒(HIV)感染状况及其影响因素,为吸毒人群艾滋病预防和控制及效果评价提供科学依据。方法 2009—2015年,调查乌鲁木齐市739名女性吸毒者的HIV感染率及行为学特征,采用多因素logistic回归分析其影响因素。结果 2009—2015年乌鲁木齐市女性吸毒者HIV感染率为20.0%,历年的感染率依次为34.3%、21.1%、20.8%、17.1%、16.8%、16.4%和16.4%。多因素logistic回归分析显示,乌鲁木齐市女性吸毒人群感染HIV的主要影响因素包括民族、吸毒方式、是否共用针具、和最近1年内做过HIV检测等;少数民族感染HIV的危险性高于汉族(OR=0.269,95%CI=0.152~0.475),注射吸毒者高于非注射吸毒者(OR=11.973,95%CI=4.212~34.040),共用针具者高于未共用针具者(OR=8.107,95%CI=4.987~13.180),最近1年内做过HIV检测者感染HIV的危险性低于未检测者(OR=0.503,95%CI=0.334~0.758)。结论乌鲁木齐市女性吸毒人群高危行为较普遍,HIV感染率较高,应进一步制定针对性的高危行为干预等防治措施。     

北京市社区吸毒人群艾滋病病毒感染相关因素分析

目的了解北京市社区吸毒人群艾滋病病毒(HIV)感染率及其相关因素,为在该人群中开展监测和行为干预提供依据。方法 2007年9~12月采用滚雪球的方法对北京市社区吸毒者进行专题调查,调查采用结构式问卷,内容包括人口学信息、吸毒行为、性行为的情况等,同时采集静脉血进行HIV抗体检测(WB阳性即判定为阳性)。结果共调查529名社区吸毒者,其中62.8%为京籍,社区吸毒者HIV感染率为2.7%(14/525),社区吸毒者HIV感染的相关因素有维族(OR=21.622,95%CI=3.879~120.521)和共用针头/注射器(OR=8.074,95%CI=1.832~35.589)。结论 应适当调整北京市吸毒人群监测网络,加强社区吸毒人群的监测力度;社区吸毒者的干预重点是美沙酮维持治疗和清洁针具交换。     

乌鲁木齐市1516名吸毒人员HIV、HCV和梅毒感染率和高危行为特征调查

目的了解2010年乌鲁木齐市吸毒人群人类免疫缺陷病毒(HIV)感染率及相关行为特征。方法查询公安部门资料结合滚雪球办法招募吸毒人员,进行面对面的问卷调查,采集血样进行HIV、丙型肝炎病毒(HCV)和梅毒抗体检测。结果本组共调查和采样吸毒人员1 516名,检出HIV、HCV和梅毒的感染者分别占20.38%(309/1 516)、36.02%(546/1 516)和2.24%(34/1 516)。高危行为分析吸毒者中男性(OR:0.62;95%CI:0.40～0.96)、维吾尔族(OR:0.45;95%CI:0.34～0.60)、未接受过预防艾滋病服务者(OR:2.32;95%CI:1.65～3.26)共用注射器的比例高;安全套的使用上维吾尔族(χ2=11.98,P=0.0005),艾滋病基本知识得分低者(χ2=4.85,P=0.0275)安全套的使用率低。结论乌鲁木齐市吸毒人群HIV流行形势严峻,如何采取行之有效的干预措施降低高危行为势在必行。     

新疆吸毒人群艾滋病感染现状及其影响因素分析

目的 为了解新疆吸毒人群艾滋病病毒(HIV)感染现状及其影响因素,为艾滋病防治工作效果评价提供科学依据.方法 于2010年8-12月对新疆乌鲁木齐市及伊犁州4 493名吸毒者进行问卷调查和血清学检测.结果 新疆吸毒人群艾滋病感染率为21.4％ (963/4 493),其中男性感染率为20.7％ (864/4 175),女性感染率为31.1％(99/318);维吾尔族感染率为30.1％(800/2 660),汉族感染率为7.0％(74/1 050),回族感染率为11.3％ (64/566);≤30岁者感染率为10.0％(174/1 739),＞30岁者为28.6％(789/2 754);多因素logistic回归分析结果表明,吸毒者感染HIV的风险女性高于男性(OR=2.12,95％CI=1.56～2.88),维吾尔族、回族均高于汉族(OR=7.66、2.06,95％ CI=5.79～10.13、1.41 ～ 3.01),注射吸毒者高于非注射吸毒者(OR=11.95,95％ CI=9.26 ～ 15.42),共用针具者高于非共用针具者(OR =4.02,95％ CI=3.35～4.83).结论 与其他吸毒人群聚集区比较,新疆吸毒人群HIV感染率处于中等水平,吸毒人群感染HIV的主要影响因素包括性别、民族、吸毒方式和是否共用针具等,据此应制定针对性的防治措施.     

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.