三峡库区宜昌监测点居民法定报告传染病漏报调查

目的掌握三峡库区宜昌监测点法定报告传染病的发病情况,为制定传染病防控策略提供理论依据。方法按随机抽样的原则,对各监测点居民法定报告传染病及医疗机构法定报告传染病漏报情况进行调查。结果共调查居民法定报告传染病患者33例,漏报14例,漏报率为42．42％。其中乙类传染病漏报率为15％,丙类传染病漏报率为84．62％,丙类传染病漏报率明显高于乙类传染病,有统计学意义差异钎：15．63,P〈0．01）。共调查医疗机构登记传染病362例,报告342例,漏报20例,漏报率为5．52％。结论三峡库区宜昌监测点丙类传染病漏报率较高,村级医疗机构漏报严重,需加大法定报告传染病报告工作的监督管理力度。     

海南省2006年居民法定传染病漏报调查分析

[目的]调查海南省居民法定报告传染病漏报情况,掌握比较接近实际的发病水平,为制定卫生决策提供科学依据. [方法]采取随机整群分层抽样方法选取调查样本,根据<海南省2006年居民法定传染病漏报调查工作方案>开展调查,采用流行病学方法进行统计分析. [结果]共调查5个市县(区)15个乡镇(街道),总计调查26 718人,查出乙丙类法定传染病9种,确诊病例293例,漏报210例,漏报率71.67%.丙类漏报率明显高于乙类,2者差异有统计学意义(x2=112.36,P<0.005).漏报率最高的病种为其他感染性腹泻94.44%,其次是流行性腮腺炎67.57%,第3是麻疹64.29%. [结论]丙类传染病漏报严重,导致乙丙类传染病总估计发病率较高,应加强丙类传染病报告管理,进一步提高传染病监测敏感性;加强临床医生传染病诊断、报告知识培训,提高诊断能力,从而提高各类传染病的发现及报告率,减少漏报.     

郴州市2005年法定传染病和死亡病例漏报调查分析

目的通过对医疗机构、居民法定传染病漏报调查和对医疗机构死亡病例漏报调查,了解郴州市传染病发病动态、迟报及漏报原因,推算出比较接近实际的发病水平,掌握死亡病例报告水平。方法按照随机的原则现场调查医疗机构和居民法定传染病漏报情况并与2005年医疗机构传染病年报对比;对医疗机构的死亡病例与网络直报核对。结果郴州市2005年法定传染病漏报率为3.90%,95%可信区间3.19%~4.61%;居民漏报率为61.43%,95%可信区间50.02%~72.84%。医疗机构乙、丙类传染病按不同病种漏报情况估计实际发病率为222.96/10万,95%可信区间129.86~316.06/10万。医院诊断至录入报告卡在24h内的占64.74%,报告卡录入至疾控机构审核在24h内的占62.45%。结论法定传染病和死亡病例漏报、迟报主要原因是医疗机构部分医务人员报告意识不强。强化医疗机构医务人员法定传染病和死亡病例报告的责任,建立和完善医疗机构的网络直报系统是提高报告完整性和及时性的根本措施。     

三峡库区医疗机构传染病漏报调查

目的了解三峡库区医疗卫生机构传染病漏报情况。方法随机抽取监测点内15家不同级别的医疗机构,调查2005年1-3季度法定传染病漏报情况和报告及时性。结果共查出乙、丙类传染病488例,漏报76例,漏报率15.57%,其中县级医院漏报率6.77%,乡镇卫生院35.33%,市级医院无漏报;丙类传染病漏报率35.92%（36/102）,乙类传染病漏报率10.36%（40/386）;报告及时率为75.00%。结论县、乡级基层医疗机构传染病报告漏报率较高,需加大传染病报告工作的监督管理力度。     

福田区1997～2000年传染病漏报调查

目的 探讨法定传染病疫情的报告情况和漏报原因,为制订传染病防治策略提供理论依据。方法 采用随机抽样方法对辖区内医疗机构进行流行病学调查。结果 医疗机构漏报率为0.98％,甲乙类传染病漏报率为0.64％,丙类传染病漏报率为2.10％,漏报较严重的病种是流行性腮腺炎,漏报率为4.86％;医疗机构传染病报告卡填写完整率为85.00％,报告及时率为88.97％。结论 传染病疫情报告存在漏报、迟报情况,应不断完善报告制度,提高报告质量。     

三峡库区兴山县疾病监测点1997-2006年传染病疫情分析

目的监测库区法定传染病发病情况。方法按照三峡工程坝区及库区疾病监测方案,收集兴山县疾病监测点1997-2006年法定传染病报告资料进行分析,并进行居民传染病漏报率调查。结果10年间共发生乙类传染病9种1025例,传染病平均报告发病率为351.58/10万,报告发病率最高为1997年（761.25/10万）,最低为2002年（167.79/10万）,痢疾、肺结核、病毒性肝炎3种传染病占报告传染病总数的88.98%。传染病漏报率平均为36.96%,校正发病率为638.86/10万。消化道传染病发病逐年下降,虫媒传染病发病处于基本消灭状态,丙类传染病时有流行。结论漏报情况仍较高,应进一步加强疫情报告管理,提高疫情报告质量。     

湖北省医疗机构2007年法定传染病漏报调查

[目的]了解我省医疗机构法定传染病漏报情况和漏报原因,为进一步提高传染病网络直报工作质量提供依据. [方法]采用分层抽样的原则在全省抽取298家医疗机构开展调查, [结果]本次调查共收集传染病个案14041例,全省医疗机构传染病总的漏报率为7.80%,无甲类传染病,乙、丙类传染病漏报率分别为7.99%和6.48%;医疗机构不同级别和不同科室传染病漏报率的差异均有统计学意义,市级、县级、乡镇级医疗机构传染病漏报率分别为12.05%、6.02%、8.23%,门诊、住院部、化验室传染病漏报率分别为5.92%、6.97%和21.17%.[结论]我省医疗机构传染病报告工作比较薄弱,医疗机构需加强传染病报告工作的规范化管理,建立有效的信息沟通报告机制.各级卫生行政部门应定期开展医疗机构传染病疫情报告工作的督导检查.     

金山区2006年度农村居民传染病漏报调查分析

[目的]为进一步了解某区目前传染病的发病动态;掌握农村居民中传染病的漏报情况;推算出比较接近实际的发病水平,为制订控制和消灭传染病的规划及防治措施,提供可靠依据. [方法]农村居民中的法定传染病病例漏报调查,选定本区东、南、西、北、中5片有代表性的乡镇农村作为调查点,按分层随机整群抽样的原则进行回顾性入户调查. [结果]共对5个镇1610户5205名居民进行法定传染病漏报入户回顾性调查,结果调查到传染病7种18例,无甲类传染病,发病率为345.82/10万.其中到医疗机构就诊并诊断和治疗的16例,漏报3例,漏报率18.75%;未到医疗机构就诊2例,漏报2例,漏报率100%. [结论]农村居民中法定传染病存在漏报现象,规范对居民传染病疫情管理势在必行.     

1990年河南省疾病监测点传染病漏报调查分析

<正> 为检查和评价我省各疾病监测点传染病报告质量,推算各监测点较接近实际的发病率,以便给当地卫生行政部门制定卫生防病保健规划提供可靠参考资料。根据中国预防医学院流研所和卫生厅的安排与要求,我们组织本省各疾病监测点于当年11月至12月分别进行了传染病监测漏报调查工作。居民中传染病漏报调查结果,这次全省9个监测点共调查了居民66917人,查出传染病1842例其中漏报了1049例、总漏报率为56.95％,总报告发病率为1567.61/10万。校正发病率为2752.66/10万。其中有乙     

连州市2008～2009年法定传染病报告漏报率和及时率分析

[目的]分析连州市法定传染病漏报率和及时率,为进一步完善传染病管理措施提供科学信息。[方法]参照《全国疾病预防控制机构工作规范(2001版)》和《全国法定传染病漏报调查方案》,每年对不同级别医疗机构法定传染病报告情况进行调查和分析。[结果]2008～2009年共查出医疗机构报告法定传染病种1175例,漏报210例,平均漏报率为17.87%。2008年、2009年的漏报率分别为16.09%、19.15%。县级、乡镇级和其他(民营和卫生站)医疗机构平均漏报率分别为13.30%、19.74%、25.00%,医疗机构级别越高漏报率越低。乙、丙类传染病的漏报率分别为22.37%、12.16%,乙类传染病漏报率明显高于丙类。2008～2009年未及时报告率分别为5.81%、3.08%,总未及时报告率为4.20%,其中县级医院、乡镇卫生院、其他(民营医院)未及时报告率分别为3.61%、10.31%、0%,乡镇卫生院未及时报告率明显高于县级医院。[结论]连州市传染病漏报率和未及时报告率仍然较高,建立健全传染病疫情报告相关管理制度并贯彻落实,加强传染病防治知识培训,提高医务人员传染病报告意识,加大监督力度,是提高连州市传染病疫情报告质量的重要措施。     

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.     

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.