中国莱姆病螺旋体主要生物媒介的调查研究

为研究中国莱姆病螺旋体的生物媒介———蜱的种类、带菌状况及在传播莱姆病中的作用 ,采用布旗法和动物诱捕法在山林地区采集蜱 ,进行分类鉴定 ,应用直接荧光抗体染色法查蜱中肠带菌率 ,BSK培养基分离病原体 ,单克隆抗体鉴定菌株。调查蜱叮咬率与人群莱姆病感染率、患病率以及蜱的季节消长与莱姆病慢性游走性红斑 (ECM )病例发生的季节性关系。在全国 2 0个省 (市、区 )共采集到170 0 0多只蜱 ,分属为 2科 8属 2 3种 ,蜱类分布的地区差异较大 ,北方林区以全沟硬蜱为优势种 ,南方则以二棘血蜱和粒形硬蜱为优势种。 9种蜱的中肠携带莱姆病螺旋体 ,其带菌率以全沟硬蜱、二棘血蜱和粒形硬蜱为高 ,分别为 2 0 .0 0 %～ 4 5.0 0 %、16.0 0 %～ 4 0 .0 0 %和 2 4 .0 0 %。从 8种蜱分离出 10 8株莱姆病螺旋体 ,其单克隆抗体反应与美国B31菌株有明显的差异 ,绝大多数中国菌株对H6831呈阴性反应。蜱叮咬率高的人群 ,莱姆病的感染率和患病率也高。全沟硬蜱的季节消长与ECM发生的季节性相一致。证实多种蜱的中肠内携带莱姆病螺旋体 ;我国北方林区莱姆病螺旋体的主要生物媒介是全沟硬蜱 ,南方林区二棘血蜱和粒形硬蜱是重要的生物媒介。     

全沟硬蜱在黑龙江小兴安岭莱姆病螺旋体传播中的作用

目的：探讨全沟硬蜱在莱姆病螺旋体传播中的作用。方法：用布旗法在林区草地采蜱，并分类鉴定；用直接荧光抗体法检查蜱类中肠带菌情况，并分离菌株。结果：全沟硬蜱为当地优势蜱种，人群发病与该蜱叮咬率密切相关；该蜱中肠带菌率为４０％，并从１４组（７０只）蜱中分离出２株莱姆病螺旋体；新分离株的单克隆抗体反应与国内分离株Ｍ７相同，而与美国菌株Ｂ３１有区别。结论：当地全沟硬蜱是莱姆病螺旋体的主要生物媒介。     

全沟硬蜱是我国北方地区莱姆病螺旋体的主要传播媒介

研究我国北方地区莱姆病螺旋体的生物媒介—蜱的种类、带菌状况及在传播莱姆病中的作用。用布旗法和动物诱捕法在山林地区采集蜱，分类鉴定，直接荧光抗体染色法查蜱中肠带菌率，ＢＳＫ培养基分离病原体，单克隆抗体鉴定菌株。调查蜱叮咬率与人群莱姆病感染率、患病率以及蜱的季节消长与莱姆病慢性游走性红斑（ＥＣＭ）病例发生的季节性关系。在北方１０省（市、区）共采集到１００００多只蜱，分属为２科７属１１种，以全沟硬蜱为优势种，占８０％～９５％。４种蜱的中肠携带莱姆病螺旋体，全沟硬蜱的带菌率高达２０．００％～４５．００％。从４种蜱分离到９８株莱姆病螺旋体，其中９０％以上是从全沟硬蜱分离的。全沟硬蜱叮咬率高的人群，莱姆病的感染率和患病率也高。全沟硬蜱的季节消长与ＥＣＭ发生的季节性相一致。证实我国北方地区至少有４种蜱的中肠内携带莱姆病螺旋体，莱姆病螺旋体的主要生物媒介是全沟硬蜱。     

中国20个省、区、市动物莱姆病初步调查研究

目的：广泛调查我国动物莱姆病分布情况。方法：血清流行病学和病原学研究。结果：１９８７～１９９７年间，牛、羊、狗、野兔和８种野鼠有莱姆病的感染存在，其中牛、羊、狗和野鼠的感染率分别为１８．１８％～３２．６１％、１７．１２％～６１．２１％、３８．５％～６０．００％和４１．１８％～８６．０５％；从黑线姬鼠和白腹巨鼠的胎鼠分离到莱姆病螺旋体，证实莱姆病螺旋体可通过胎盘垂直传播。９种蜱的中肠携带莱姆病螺旋体，带菌率以全沟硬蜱、二棘血蜱和粒形硬蜱为高，分别为２０．００％～４５．００％、１６．００％～４０．００％和２４．００％。从华南兔、８种野鼠和８种蜱分离出１２８株莱姆病螺旋体。证实黑线姬鼠和棕背是中国莱姆病螺旋体的重要储存宿主；多种蜱的中肠内携带莱姆病螺旋体，我国北方林区莱姆病螺旋体的主要生物媒介是全沟硬蜱，南方林区二棘血蜱和粒形硬蜱是重要的生物媒介。结论：我国动物莱姆病广泛存在     

河北省莱姆病的调查

１９９０￣１９９２年在河北省进行了莱姆病的调查。调查结果表明，河北省有莱姆病的流行。坝上高原人群感染较普遍，平均感染率为２．８５％，在太行山区呈灶性分布，平均人群感染率为１．２２％，平原林场人群也有０．４５％的感染率。全沟硬蜱是主要媒介蜱，日本血蜱是首次在河北省发现的优势蜱种。     

大兴安岭林区蜱和鼠中莱姆病螺旋体感染及其基因分型研究

目的 了解内蒙古大兴安岭林区蜱和鼠中伯氏疏螺旋体的感染及基因分型情况。方法 应用巢式PCR扩增蜱和鼠中伯氏疏螺旋体5S-23SrRNA间隔区片段，对阳性产物进行限制性片段长度多态性（RFLP）分析和单链构象多态性（SSCP）分析，RFLP分析显示特殊带型的样本测序分析。结果 检测全沟硬蜱1336只，293只阳性，阳性率为21．93％；森林革蜱144只，6只阳性，阳性率为4．17％；嗜群血蜱144只，未发现有伯氏疏螺旋体感染。检测鼠9种145只，感染伯氏疏螺旋体的4种5只，感染率为3．45％；其中检测8只棕背鼠平，2只阳性。RFLP分析及序列分析显示蜱中有B．garinii20047亚型、B．gariniiNT29亚型、B．afzelii基因型以及不同基因型或亚型伯氏疏螺旋体的混合感染；鼠感染的伯氏疏螺旋体包括B．garinii20047亚型和B．gariniiNT29亚型。SSCP分析结果显示带型多于36种。结论 大兴安岭林区蜱及鼠中均存在伯氏疏螺旋体的感染，其中全沟硬蜱的感染率较高；B．garinii型为主要基因型，且该地区伯氏疏螺旋体存在遗传多态性。单只蜱中存在同时感染不同基因型伯氏疏螺旋体的情况，人和宿主动物是否存在不同基因型伯氏疏螺旋体混合感染尚待进一步研究。全沟硬蜱和棕背鼾分别是该林区伯氏疏螺旋体的主要媒介和主要储存宿主。     

宁夏蜱类种群及分布

目的：调查宁夏蜱类种群及分布情况。方法：用布旗法在自然生境采集，以牛、羊体表直接查捉，并鉴定种群。结果：已知蜱类隶属２种６属１８种，其中１属４种（扇头蜱属的血红扇头蜱、卵圆硬蜱、全沟硬蜱、嗜群血蜱）为宁夏首次发现。本次共采集鉴定１４１只蜱，全沟硬蜱占６８８％，为优势种群。按宁夏昆虫地理划分及区系分布，蜱类分布于３个昆虫区（Ⅰ～Ⅲ）和３个昆虫亚区（Ⅲ１～Ⅲ３），且各有其分布特点。结论：全沟硬蜱是当地莱姆病的生物媒介     

湖北省英山县莱姆病的调查

１９９２～１９９３年对湖北省英山县进行了莱姆病的流行病学调查。人群感染率林场工人为１０．８％，林场小学生为１９．０％，非林区居民为２．０％，从豪猪血蜱（２／４０）、二棘血蜱（３／２０）中检出伯氏疏螺旋体。本调查证实在湖北省东部的英山县有莱姆病存在，人群感染莱姆病与环境性蜱暴露有密切关系。     

大兴安岭林区莱姆病人群患病状况调查

目的了解大兴安岭林区莱姆病人群患病状况。方法经IFA检测IgG抗体。结果共调查755人，其中一般人群671人，精神异常者84人（现患）。一般人群中发现292人具有蜱咬史，叮咬率为43．52％，经IFA检测疑似病例96人，IgG抗体阳性70人，阳性率为72．92％，患病率为10．43％。84例精神异常者IgG抗体阳性28人，阳性率为33．33％。结论该病各年龄组均有发生，主要集中在10～至50～组，以30～组最高。不同性别间没有差别，不同职业问叮咬机会以工人和学生为高危人群，患病率以工人和干部为高。阳性病例的临床表现以慢性游走性红斑、类感冒样症状、关节炎等出现率高。林区莱姆病1期以ECM和类感冒症状为主；Ⅱ期以一心脏异常、面神经麻痹为主；Ⅲ期以关节炎、精神异常为主要表现。     

内蒙古大兴安岭林区森林脑炎流行现状

森林脑炎于９０年代初在内蒙古大兴安岭林区发生并流行，呈逐年上升趋势。作者对其流行规律进行了调查。１材料与方法：选择具有代表性的７个高发区内有明确蜱咬史和森林脑炎临床症状居民；布旗法从林间植被上收集９８２只蜱，其中全沟硬蜱占７１３８％，嗜群血蜱占２...     

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.