国内六地区饮酒情况及相关问题调查 Ⅲ.四种特殊职业人群饮酒情况及相关问题

目的：描述我国六地区四种特殊职业人群的饮酒情况及与饮酒相关问题发生率，并与普通人群相比较。方法：抽样调查，使用定式问卷及ＤＳＭ－ＩＩ－Ｒ诊断标准向９８００名受试者（１８－６５岁）调查饮酒情况、饮酒相关的社会、心理和躯体问题。结果：男女及总饮酒率分别为８６．２％、４４．１％和７４．１％，年平均饮酒量分别为８．２５、０．５６及６．００升纯酒精。酒依赖的男性、女性和总的时点患病率分别为１０．５４５％、０．１４１％和７．５６１％，急性酒中毒的半年患病率分别为７．９１６％、０．０７１％和５．６６８％。与普通人群相比，四种特殊职业人群的饮酒率、年饮酒量和与饮酒相关的损害均较高。结论：职业环境是影响饮酒的重要因素之一，处于特殊环境的人群是出现酒问题的高危人群。     

Comparison of multiple-locus variable-number tandem repeat analysis and pulsed-field gel electrophoresis in a setting of polyclonal endemicity of vancomycin-resistant Enterococcus faecium.

In order to assess whether multiple-locus-variable number tandem repeat analysis (MLVA) could replace pulsed-field gel electrophoresis (PFGE) for genotyping vancomycin-resistant isolates of Enterococcus faecium (VREF), this study compared the typeability, discriminatory power, concordance and costs of these methods for VREF isolates obtained from patients, environmental samples and the hands of healthcare workers (HCWs) in a medical intensive care unit (ICU) where VREF was endemic. Over a 58-day period, 393 VREF isolates (373 vanA, one vanA/B, 19 vanB) were cultured from patient rectal swabs (n = 76), the environment (n = 270) and the hands of HCWs (n = 47). PFGE was able to divide 358 (91.1%) isolates into 19 PFGE types (>six bands different) and 24 subtypes (one to three bands different). MLVA was able to type 391 (99.5%) isolates into 11 genotypes. The discriminatory power of PFGE subtypes was 83%, as compared to 68% for MLVA. Concordance between the two methods, based on matched or mismatched MLVA types and PFGE types or subtypes, was 67.5% and 82.8%, respectively. Using PFGE, 13 isolates could be genotyped in 3 days; MLVA genotyped 94 isolates in 2 days. For both methods, the estimated costs were Euro 7 ($10)/isolate. PFGE and MLVA produced highly concordant results when assigning genotypes to nosocomial VREF isolates. MLVA was faster, but PFGE subtyping was more discriminatory.     

An epidemiologic approach to computerized medical diagnosis—AEDMI program

A program called “An Epidemiological Approach to Computerized Medical Diagnosis” (AEDMI) is presented. Using an interactive questionnaire, physician-patient interviews are conducted and a summary of the relevant clinical data is provided. Standard items, obained on a multi-centre basis, form a large-scale data base. Simultaneously, the reasoning of clinical experts in each real case is analyzed to obtain a knowledge-rules data base. The methodology of the program combines Bayesian systems, expert systems, and other new lines of researcg such as neural networks or case-based reasoning. The general concepts of clinical decision making aid systems are reviewed. This publication is aimed at obtaining international cooperation.     

Distribution of Δ32 alelle of the CCR5 gene in the population of Poland

The chemokine receptor CCR5 constitutes a major co-receptor for the R5 strains of HIV-1, and a mutant allele of the CCR5 gene, especially in the homozygous form Δ32/Δ32, confers resistance against infection by the virus. The frequency of the Δ32 allele was determined in blood donors from 16 provinces, covering the entire territory of Poland. Among 861 individuals 182 (21.1%) were carriers of the mutated allele; 7 of them (0.8 %) were homozygotes Δ32/Δ32, and 175 (20.3%) were heterozygotes +/Δ32, resulting in a 10.9% frequency of the Δ32 allele. The highest frequencies of the mutated allele were found in the eastern and western provinces, and the lowest frequencies of the Δ32 allele were detected in the provinces in the center of the country. This pattern of distribution may reflect the migration of the population from the eastern territories of Poland to the western part of the country after World War II. Received: March 17, 2000 / Accepted: May 29, 2000     

41例女性慢性输血后丙型肝炎10～15年后的感染状态

目的　了解我国女性输血后丙型肝炎病毒 (HCV)感染的慢性化规律和影响因素。方法　对河北省固安县 1989～ 1993年 4 1例女性慢性输血后丙型肝炎患者的现状进行调查 ,包括临床表现 ,血清生物化学指标 ,病毒学标志检测及B型超声检查。其中 ,HCVRNA的测定采用荧光定量PCR方法 ,抗 HIV ,抗 HCV和HBsAg测定采用酶联免疫吸附试验。结果　 4 1例女性丙型肝炎患者平均年龄 (40± 7)岁 ,随访时间 10～ 15年 ,HCVRNA间隔半年两次检测 ,自然阴转率为 19 5 1% (8 4 1)。 30例(73% )现在有症状 ,以乏力最为常见 (77% )。总的丙氨酸转氨酶 (ALT)和 (或 )天冬氨酸转氨酶 (AST)异常率为 32 % (13 4 1) ,均为轻度异常 ,无中度和重度。B超轻度慢性肝炎占 83% (34 4 1) ,中度占 17%(7 4 1) ,无重度。结论　平均感染 (13± 1)年的女性输血后慢性丙型肝炎患者多数肝脏炎症轻微慢性感染进程中有部分感染者出现HCVRNA自发阴转。     

环孢子虫的研究进展

环孢子虫是一种新出现的致病性球虫,经食物或水源传播,可引起人和动物胃肠炎和持续性腹泻,引起全球关注。本文仅对其病原生物学、流行病学及诊断方法等方面的研究进展进行综述。     

Blutdruck,relatives Körpergewicht,Alkoholkonsum und Elektrolytausscheidung in der BRD und der DDR: Die Intersalt-Studie

Summary The relationships between body mass index (BMI) and age, alcohol consumption, 24-hr urinary electrolyte excretion, and BP were studied in 588 subjects from three German centers participating inIntersalt, a highly standardized, previously reported protocol. Men and women aged 20–59 were sampled in Bernried, FRG; Cottbus, GDR; and Heidelberg, FRG. The subjects from the three centers did not differ in BMI, level of education, physical activity, cigarette- or alcohol-consumption patterns, or urinary Cl excretion. Mean Na excretion was 167, 147, and 172 mmol/24 hr in Bernried, Cottbus, and Heidelberg, while mean K excretion was 72, 55, and 73 mmol/24 hr, respectively. The excretion of these electrolytes was significantly lower in Cottbus than in Bernried or Heidelberg. BMI increased progressively in men with age; in women BMI plateaued until the 5th decade, after which it increased to equal that of men. In individual centers, the excretion of electrolytes was correlated with BML Sodium and chloride excretion were highly correlated. The data from each individual center were fitted to a multiple regression model. Age, BMI, sex, and alcohol consumption entered the model.

     

Heritability of C-Reactive Protein and Association with Apolipoprotein E Genotypes in Japanese Americans

Numerous studies have demonstrated that increased C‐reactive protein (CRP) levels predict coronary heart disease, stroke, peripheral vascular disease, and diabetes, and are associated with features of the metabolic syndrome. Only three previous studies have investigated the heritability of CRP levels, primarily in samples of Caucasian families.The purpose of the present study was to estimate the magnitude of genetic influences on CRP levels, and to examine potential associations between variation in the APOE gene and CRP levels, using a sample of 562 individual Japanese Americans from 68 extended kindreds. In general, correlation coefficients between first‐degree relatives for CRP were approximately 0.2, and spouse correlations did not differ from zero, consistent with genetic influences. Heritability estimates were approximately 0.3 (p < 0.01), even with adjustment for factors known to influence CRP levels. A significant relationship was seen between unadjusted CRP levels and APOE genotypes (p = 0.02), with the highest mean CRP level among ?2 carriers (1.20 mg/L), and nearly the same mean levels among ?3/?3 subjects and ?4 carriers (0.72 and 0.74 mg/L, respectively). However, this relationship was diminished with adjustment for covariates (p = 0.07). These results demonstrate the presence of both genetic and environmental effects on CRP levels among Asian Americans, and additional studies are needed to determine if the APOE gene contributes to these genetic influences.     

Clinical epidemiology of ciprofloxacin-resistant Proteus mirabilis isolated from urine samples of hospitalised patients

This study investigated the clinical characteristics of ciprofloxacin-resistant Proteus mirabilis isolates from urine samples associated with nosocomial infection or colonisation, and identified the risk-factors for ciprofloxacin resistance. Data for patients with ciprofloxacin-resistant P. mirabilis isolates (n=13) were compared with those for randomly selected patients with ciprofloxacin-susceptible P. mirabilis isolates (n=40) who were matched by temporal occurrence as control patients. The majority of ciprofloxacin-resistant P. mirabilis isolates were multiresistant, and ciprofloxacin resistance was associated significantly with previous use of fluoroquinolones and production of extended-spectrum beta-lactamases.