海南省2008年狂犬病流行因素分析

目的调查海南省2008年狂犬病发病急剧上升的原因,为制定有效的防制对策提供科学依据。方法对海南省2008年各市、县（区）上报的狂犬病病例个案调查表进行分析。结果海南省2008年狂犬病发病108例,发病率为1．28／10万;疫情波及11个市县,陵水县发病率最高为4．11／10万,琼中县发病率最低为0．53／10万,发病率各市县间差异有统计学意义;男女发病数之比为2．09：1,男性发病率为1．64／10万,女性发病率为O．88,10万：70岁以上年龄组发病率最高为4．93／10万;夏秋季发病较多。结论应加强狂犬病防治知识宣传,规范暴露后伤口处理和注射狂犬病疫苗接种及人源免疫球蛋白使用,加强犬只的“管、免、灭”,以遏制狂犬病的流行。     

临床护士针刺伤的现状调查与预防对策

目的了解临床护士在工作中发生针刺伤的真实情况。方法采取问卷法对547名护士进行回顾性调查,收集有关污染锐器处理情况、针刺伤的发生率、与针刺伤有关的主要环节、针刺伤后的处理。结果被调查的547名护士有82.08%发生过针刺伤,且主要发生在针头套帽、分离针头、处理针头及注射等操作环节上。护士在针刺伤发生后采取的主要措施是局部处理,上报率较低。结论临床护士针刺伤防范意识薄弱、发生率高,污染锐器处理方法欠妥。因此,加强医护人员职业安全培训与教育,规范医疗废物的处理,是当前职业防护面临的紧迫课题。     

感染科护士职业暴露的危险因素调查及防护措施

目的探讨感染科护士职业暴露的危险因素及防护措施。方法 2009年1月至2012年3月对我院感染科护士进行职业暴露的危险因素调查及防护情况进行回顾性分析。结果本组调查的职业暴露中被刀、剪、针等锐器损伤及皮肤接触血液为主要危险因素,经防护知识培训干预后与干预前比较,职业暴露的发生率明显减少,与治疗前比较差异显著(P<0.05),具有统计学意义。结论感染科护士在护理操作过程中的危险性相应增加,给护士的身心构成了极大的威胁。应加强护理人员职业暴露防护知识的培训,有效避免和减少职业危害的发生。     

Analysis of mortality in chrysotile asbestos miners in China

In order to investigate the mortality of a cohort of chrysotile asbestos miners in China and evaluate its association with exposure to chrysotile,a fixed cohort of 1932 workers in chrysotile asbes-tos mine was established in 1981 and followed till June 1,2010.Information on vital status,cause of death and smoking habits was collected.The workers were divided into two groups according to their exposure status.The exposed group was composed of frontline workers who worked directly on mining or processing asbestos products.The control group consisted of those who were not directly exposed to asbestos in their work.Standardized mortality ratio (SMR) was calculated according to Chinese national death rates.Cox proportional hazards model was applied to estimate the adjusted relative risks of deaths from major causes in exposed and control groups.The results of this study showed that main causes of mortality were malignant neoplasm,cardiovascular disease,cerebrovascular disease and respiratory disease for chrysotile miners.The mortality rate was 939.20 per 100 000 person-years for workers.The SMR for all causes of death was 1.46 in the cohort.Statistically significant mortality excesses were found for lung cancer (SMR=1.51),pulmonary heart disease (SMR=2.70),respiratory disease (SMR=1.93),asbestosis (SMR=9.62),and accident (SMR=1.59).The mortalities from malignant neo-plasm,lung cancer,cerebrovascular disease and digestive disease in the exposed group were signifi-cantly higher than those in the control group.The findings indicate that chrysotile exposure is a risk factor for lung cancer,respiratory disease,cerebrovascular disease and digestive disease.     

Lack of effect of menthol level and type on smokers’ estimated mouth level exposures to tar and nicotine and perceived sensory characteristics of cigarette smoke

Menthol can reduce sensory irritation and it has been hypothesised that this could result in smokers of mentholated cigarettes taking larger puffs and deeper post-puff inhalations thereby obtaining higher exposures to smoke constituents than smokers of non-mentholated cigarettes. The aim of our study was to use part-filter analysis methodology to assess the effects of cigarette menthol loading on regular and occasional smokers of mentholated cigarettes. We measured mouth level exposure to tar and nicotine and investigated the effects of mentholation on smokers’ sensory perceptions such as cooling and irritation. Test cigarettes were produced containing no menthol and different loadings of synthetic and natural l-menthol at 1 and 4 mg ISO tar yields. A target of 100 smokers of menthol cigarettes and 100 smokers who predominantly smoked non-menthol cigarettes from both 1 and 4 mg ISO tar yield categories were recruited in Poland and Japan. Each subject was required to smoke the test cigarette types of their usual ISO tar yield. There were positive relationships between menthol loading and the perceived ‘strength of menthol taste’ and ‘cooling’ effect. However, we did not see marked menthol-induced reductions in perceived irritation or menthol-induced increases in mouth level exposure to tar and nicotine.     

How are asthmatics included in the derivation of guideline values for emergency planning and response?

Guideline values for emergency planning and response are aimed to protect the general public, including asthmatics and other susceptible groups, during sudden airborne releases of chemicals. A precondition of asthma may increase the individual susceptibility to acute exposures. This paper studies to what extent experimental data on asthmatics are included in the rationale and derivation of guideline values. An analysis of the Technical Support Documents (TSDs) of the Acute Exposure Guideline Levels (AEGLs) shows that only 23 of the 176 TSDs include references to experimental studies on asthmatics, 30 include a statement on asthmatics but no reference to experimental data, and 123 lack any explicit statement on asthmatics. The TSDs were further compared with the support documents of nine other programs for acute or occupational short-term values. All programs were incomplete with respect to experimental data on asthmatics. Omission of asthmatics may interfere with trustful and efficient health protective actions. We suggest that the availability of data on asthmatics should be carefully examined in the development of guideline values, and that the lack of such data should be explicitly noted. In the latter case, available data for other irritants may be used to justify an appropriate assessment factor.     

Influence of the drug exposure definition on the assessment of the antipsychotic metabolic impact in patients initially treated with mood-stabilizers

AIMS

To assess the influence of three definitions of antipsychotic exposure on the comparison between first generation (FGAP) and second generation (SGAP) antipsychotic drugs and ‘conventional’ mood stabilizers towards the risk of metabolic events using (i) a dichotomous measure (exposed/non-exposed over the follow-up), (ii) a categorical measure taking into account the chronology of exposure at the time of the metabolic event (current, recent and no use) and (iii) a continuous measure (cumulative duration).

METHODS

A historical fixed cohort was identified from the 2004–2006 claims database of the French health insurance programme for self-employed workers, including 3172 patients aged 18 years and over who used conventional mood stabilizers over a 3 month period. A metabolic event was defined as an incident dispensing of an anti-diabetic or lipid-lowering drug.

RESULTS

A metabolic event occurred in 367 patients (11.6%). At least one FGAP had been prescribed in 29% of patients who did not develop a metabolic event and in 22% of patients who developed a metabolic event. In addition, at least one SGAP had been prescribed in 12% of patients who did not develop a metabolic event and in 7% of patients who developed a metabolic event. Compared with conventional mood stabilizers, the risk of a metabolic event was negatively associated with exposure to SGAPs over the follow-up period (HR 0.53, 95% CI 0.34, 0.82, P = 0.004), positively associated with recent, but not current, exposure to SGAPs (HR 2.1, 95% CI 1.2, 3.7, P = 0.006) and not associated with cumulative duration of SGAPs (HR 1.001, 95% CI 0.999, 1.003, P = 0.20).

CONCLUSIONS

The definition of exposure to antipsychotics in epidemiological studies exploring their metabolic impact is of paramount importance in understanding this association. Different definitions can lead to opposite and seemingly nonsensical results. Not taking into account past exposure, in order to minimize the depletion of susceptible effects, may lead to absurd results.     

Deepened extinction of cocaine cues

Background

A method for reducing the power of drug cues could help in treating drug abuse and addiction. Extinction has been used, with mixed success, in such an effort. Research with non-drug cues has shown that simultaneously presenting (compounding) those cues during extinction can enhance the effectiveness of extinction. The present study investigated whether this procedure could be used to similarly deepen the extinction of cocaine cues.

Methods

Rats were first trained to self-administer cocaine during tone, click, and light stimuli. Then, these stimuli were subjected to extinction in an initial phase where they were presented individually. In a second extinction phase, one of the auditory stimuli (counterbalanced) was compounded with the light. The other auditory stimulus continued to be presented alone. Rats were then given a week of rest in their homecages prior to testing for spontaneous recovery of cocaine seeking.

Results

The cue that was compounded with the light during the second phase of extinction training occasioned less spontaneous recovery of cocaine seeking than the cue that was always presented individually during extinction. Increasing the number of compound cue extinction sessions did not produce a greater deepened extinction effect.

Conclusions

The present study showed that simultaneously presenting already-extinguished cocaine cues during additional extinction training enhanced extinction. This extends the deepened extinction effect from non-drug cues to drug cues and further confirms predictions of error-correction learning theory. Incorporating deepened extinction into extinction-based drug abuse treatments could help to reduce the power of drug cues.     

Biological monitoring of indoor-exposure to dioxin-like and non-dioxin-like polychlorinated biphenyls (PCB) in a public building

The release of PCBs from sealant material in public buildings and the resulting indoor air levels have raised growing concerns about possible human health effects connected with this exposure. Ambient monitoring of PCBs in a public building has revealed a contamination with the more volatile lower chlorinated PCB 28, PCB 52 and PCB 101. This gave reason for a large biological monitoring study in order to examine the internal exposure to PCBs in persons working in that building. Blood samples from 209 persons employed in the PCB-contaminated building were drawn. 98 persons matched for age and gender working in non-contaminated buildings served as control group. Plasma samples were analysed for the six indicator PCBs (PCB 28, 52, 101, 138, 153, 180) and 12 dioxin-like PCBs using GC/MS (LOD: 0.01 μg/L). Significant differences between both collectives were only found for the plasma levels of the lower chlorinated PCB 28, PCB 52 and PCB 101 and for the dioxin-like congeners PCB 105 and PCB 118, which are due to inhalative exposure to these congeners via indoor air. Median plasma levels of PCB 28, PCB 52 and PCB 101 in the employees of the contaminated building were 0.087 μg/L, 0.024 μg/L and 0.012 μg/L, respectively. The concentrations of the higher chlorinated PCBs and all other dioxin-like congeners investigated were within the normal range of the general population. There was no relationship between indoor air measurements and internal exposure of the employees in the corresponding office, but estimated lifetime exposure of the employees turned out to be a significant factor for plasma levels of PCB 28. Our biomonitoring results served as a basis for individual risk communication and successful risk management.