河南省2005～2009年细菌性痢疾流行概况及病原特性分析

[目的]了解河南省细菌性痢疾发病规律,为制定防治措施提供依据.[方法]采用描述流行病学方法,对河南省2005～2009年细菌性痢疾发病资料、菌型检测、药敏试验和携带毒力基因情况进行分析.[结果]2005～2009年河南省细菌性痢疾发病率波动在16.15～31.51/10万之间,年均发病率23.43/10万.6～10月为发病高蜂;各年龄组中5岁以下耍幼儿发病率最高,为110.85/10万,不同职业中农民发病最高,其次是散居儿童和学生.分离的流行菌株优势菌型是F2a、F4c和F1a,流行菌株对蓁啶酸、四环素、利福平、氨苄西林和氨霉素高度耐药,对庆大霉素、环丙沙星、头孢噻肟、头孢噻吩耐药率逐年上升,耐7种以上抗生素的菌株达51.8%.有79.51%的菌株同时携带4种毒力基因.[结论]2005～2009年河南省菌痢发病率延续平稳下降趋势,流行菌株的菌型变化、耐药及多重耐药日益严重,毒力基因携带率高,给菌痢的防治工作带来了一定难度.     

2004 - 2017年安徽省细菌性痢疾流行特征及病原特性分析

目的 分析安徽省细菌性痢疾的发病规律和流行特征,为科学制定安徽省菌痢监测与防控策略提供依据。方法 采用描述性流行病学分析方法,对安徽省2004 - 2017年细菌性痢疾发病资料、菌型检测、药敏试验等进行回顾性分析。结果 安徽省2004 - 2017年细菌性痢疾年发病率在10.26/10万～29.13/10万之间波动,年平均发病率为19.55/10万。每年5 - 10月为菌痢的流行高峰期,皖北地区和合肥市等人口稠密区发病率较高,3岁以内的婴幼儿发病率最高。职业构成以农民为主,其次为散居儿童和学生。流行的优势菌型为F2a和F4c,皖北地区与长江以南地区福氏菌的检出率差异有统计学意义（χ2 = 131.06,P＜0.01）。流行菌株对氨苄西林、萘啶酸、阿莫西林、利福平、四环素高度耐药,对诺氟沙星敏感。结论 2004 - 2017年安徽省菌痢发病率有波动,整体处在较低发病水平。3岁以下散居儿童和农民是防控重点人群,流行菌型的不断变迁,常见抗生素的耐药率不断升高,给菌痢防治工作带来困难和挑战。     

新罗区2005-2015年细菌性痢疾监测分析

目的 了解新罗区近10年细菌性痢疾发病特征及规律,为制订防治对策提供依据.方法 对2005-2015年细菌性痢疾的监测结果进行回顾性分析.结果 新罗区2005-2015年共报告菌痢179例,无死亡.年均发病率2.65/10万,总体呈下降趋势.春末夏初发病数逐渐增多,6～8月达高峰,秋末进入低发期;发病率＜10岁组最高(1.07/10万),其次为＞60岁组(0.31/10万);男女发病率类似;散居儿童(22.4％)和农民(25.7％)为主要感染人群.179例中,临床诊断占60.8％,实验室诊断占39.1％;实验室诊断菌株57.1％为宋内志贺菌,42.9％为福氏志贺菌.结论 菌痢仍是新罗区传染病防治重点之一,应针对高发人群及主要流行菌株制定有效防控措施,避免菌痢暴发.     

新疆维吾尔自治区2004-2014年细菌性痢疾流行概况及耐药分析

目的 了解新疆维吾尔自治区（新疆）细菌性痢疾（菌痢）的流行概况及病原特征。方法 采用描述性流行病学方法,对2004-2014年新疆菌痢的发病资料、菌型监测、药敏试验等进行分析。结果 2004-2014年新疆共报告菌痢123 238例,年发病率波动在25.91/10万～76.04/10万之间,年病死率在0.00～46.90/10万之间。东疆地区的发病率高于其他地区。7-9月为发病高峰。男性发病率高于女性。各年龄组中以<5岁组发病率最高。职业分布中以散居儿童最高,其次是农民和学生。福氏志贺菌是优势菌群,其中F2a最多。流行菌株对链霉素、青霉素、强力霉素及四环素等抗生素等高度耐药,对青霉素、四环素、强力霉素和链霉素耐药率逐年上升,且多重耐药现象严重,耐5种抗生素的菌株达71.43%。结论 2004-2014年新疆菌痢发病率保持平稳下降的趋势,但是个别地区的发病率仍然高于全国平均水平,应该对重点地区、重点人群、高发季节采取有针对性的措施。耐药及多重耐药现象严重,给防治工作带来了一定难度,该疾病仍然是新疆传染病防治的重点。     

北京市海淀区1999～2005年细菌性痢疾流行特征

目的了解海淀区7年来细菌性痢疾发病规律、流行特征，为2008年北京奥运会传染病保障工作提供基础本底资料，为细菌性痢疾防治策略提供科学依据。方法根据海淀区1999～2005年细菌性痢疾传染病疫情报告作描述性分析，对2004年60株志贺菌进行血清学分型。结果1999～2005年细菌性痢疾发病率波动在134．05／10万～353．98／10万之间，年均发病率在234．02／10万，总体呈下降趋势；发病以5～9月份为主，发病最高峰在每年的8月份；0～4岁组婴幼儿发病率最高达93．8．15／10万；不同职业发病数前三位是学生、干部职员、散居儿童。志贺菌60株分型，福氏志贺菌37株占61．67％，宋内氏志贺菌23株占38．33％，福氏37株以福氏4为主（15株，占40．52％）。结论海淀区近7年来细菌性痢疾发病率呈下降趋势，但发病率远远高于全国平均水平，始终占据法定传染病发病首位。夏秋季为细菌性痢疾发病高峰期；0～4岁组、学生、干部职员为重点防治对象。以福氏志贺菌、宋内氏志贺菌两型为流行株。     

2010～2013年福建省细菌性痢疾监测分析

目的探讨福建省细菌性痢疾发病趋势和流行特征,为制订防控策略提供科学依据。方法采用描述流行病学方法对福建省2010～2013年细菌性痢疾疫情资料进行分析。结果 2010～2013年福建省累计报告细菌性痢疾4 077例,年均发病率为2.73/10万,疫情呈散发状态。细菌性痢疾发病率2010～2013分别为4.10/10万、2.58/10万、2.26/10万、1.99/10万。2010～2013年年均发病率最高的是厦门市（6.87/10万）,其次为龙岩市（5.93/10万）,不同地区发病率的差异有无统计学意义（P〈0.01）;男性为3.16/10万,女性为2.28/10万（P〈0.01）;本病全年均可发生,呈季节性分布;各年龄组均可发病,0～5岁婴幼儿发病率最高,为18.07/10万;在不同职业中,发病顺位由高到低依次为散居儿童、农民、幼托儿童和学生。4个菌痢监测点监测总检出率为0.34%,仅发现福氏志贺菌（52.63%）和宋内志贺菌（47.37%）;分离的志贺菌对环丙沙星高度敏感,对庆大霉素和头孢菌素类抗生素出现了不同程度的耐药。结论全省菌痢发病率维持在低发水平,但有些地区发病率仍较高。流行菌型不断变迁,志贺菌耐药日益严重,给菌痢的防治工作带来了一定难度。     

济南市1951-2005年细菌性痢疾流行情况分析

目的 探讨济南市细菌性痢疾流行特征,为有效控制细菌性痢疾流行、制订控制措施提供科学依据.方法 对济南市1951-2005年细菌性痢疾发病资料和防治资料进行流行病学分析,50余年间共发病485 333例,人群分布分析病例数少于总发病,系因文革期间资料不完整所致.结果 50多年来,济南市细菌性痢疾发病呈逐年下降态势,平均发病率为283.10/10万,各年代间发病率经χ2检验差异有统计学意义(χ2=14.99,P＜0.05).期间出现4次大的流行高峰,发病率均在1000/10万左右;发病年龄主要集中在0～4岁、20岁～、30岁～3个年龄段;工人占30.31%,散居儿童占22.71%,农民占17.90%;发病集中于7-9月,占71.57%,8月为发病高峰;市区发病率最高为550.94/10万.结论 经过几代卫生疾病控制人员的努力,济南市细菌性痢疾发病已控制在较低发病水平.今后除继续做好城区的细菌性痢疾预防控制外,应进一步继续加强农村地区细菌性痢疾防治管理工作;F2a菌型的生物学特性研究是今后工作的重点.     

贵州省2007-2010年细菌性痢疾流行特征及病原分析

目的了解贵州省2007-2010年细菌性痢疾的流行特征和菌型分布,为制定防控策略提供依据。方法以2007-2010年来源于＂中国疾病监测信息报告管理系统＂的菌痢疫情为资料,分析菌痢的人群、地区、时间分布特征,并对146株菌痢菌株进行血清学分型和药敏试验。结果 2007-2010年贵州省共报告菌痢48 222例,平均发病率为31.92/10万,病死率为0.049%,总体发病呈逐年下降趋势。发病主要集中在0～5岁组,发病率为151.76/10万,其次为65岁以上组,发病率为36.66/10万。男性多于女性,男女性别比为1.5∶1;职业分布以农民最多占46.04%,其次为散居儿童和学生分别占29.73%、11.06%;年均发病率最高的地区是黔东南州,发病率为49.06/10万,其次是黔南和黔西南;贵州省菌痢有明显的季节性,5-9月为发病高峰。菌型分布以宋内为主,其次是福氏志贺菌。菌株的多重耐药严重,84.93%的菌株存在多重耐药。结论菌痢是贵州省主要的传染病之一,2007-2010年贵州省菌痢发病率呈逐年下降趋势,发病以婴幼儿和农民为主,流行菌株以宋内和福氏志贺菌为主,多重耐药现象严重。     

福建省2005—2009年细菌性痢疾监测分析

[目的]了解福建省细菌性痢疾(菌痢)发病规律,掌握流行趋势,为制订防治对策提供科学依据。[方法]对疫情报告和监测点病例作回顾性分析。[结果]2005—2009年全省菌痢发病率4.31/10万～9.28/10万,年均发病率6.58/10万。发病有明显的季节性;0～5岁组发病率最高(41.20/10万);发病顺位依次为散居儿童、农民、幼托儿童和学生。5年监测总检出率为2.5%,仅发现福氏志贺菌(B群)和宋内志贺菌(D群);97例确诊病例中有典型临床症状的病例较少;分离的志贺菌对环丙沙星,庆大霉素及头孢噻肟高度敏感。[结论]福建省菌痢发病率有些地区仍较高,患者症状较轻,易造成误诊漏诊,流行菌型不断变迁,耐药日渐严重,菌痢防治工作有一定难度。     

福建省2000—2006年细菌性痢疾流行病学分析

目的了解福建省细菌性痢疾发病规律，掌握流行趋势，为制定细菌性痢疾的防治对策提供科学依据。方法对2000—2006年福建省发生的细菌性痢疾病例作回顾性分析。结果2000—2006年福建省细菌性痢疾发病率波动在5．40／10万-9．28／万之间，年均发病率为7．16／10万。本病全年均可发生，以夏秋季为高峰；各年龄组均可发病，0～5岁婴幼儿发病率最高，为409．74／10万；在不同职业中，发病顺位由高到低依次为散居儿童、农民、幼托儿童和学生。分离的志贺菌对头孢噻肟、环丙沙星及头孢噻酚高度敏感。临床诊断总符合率为81．82％。结论全省菌痢发病率维持在低发水平，但有些地区发病率仍较高。流行菌型不断变迁，志贺菌耐药日益严重，给菌痢的防治工作带来了一定难度。     

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.