2013-2015年绵阳市手足口病流行特征及重症病例病原分析

目的 研究2013-2015年绵阳市手足口病(HFMD)的流行情况及重症病例病原学特点,为HFMD重点防控提供依据.方法 对2013-2015年绵阳市HFMD疫情资料进行描述性流行病学分析.结果 2013-2015年,绵阳市累计报告HFMD11 825例,发病率为74.4/10万,其中重症480例,死亡5例,2013-2014年总发病率及重症病例的发病率明显增加,2015年重症病例明显下降.男性重症HFMD的比例明显高于女性(X2=16.29,P＜0.05),发病年龄主要集中在1～3岁年龄组(68.75％).HFMD重症病例的发病高峰集中在4-6月,11-12月.重症病例病原以肠道病毒71型(EV 71)为主,占79.58％.结论 绵阳市HFMD尤其是重症病例的发病率明显下降,但仍呈周期性变化,需重点加强托幼机构及基层医院宣教、监测管理.     

湖北省2011年手足口病流行特征分析

目的了解湖北省2011年手足口病(HFMD)流行特征,为制定防治措施提供依据。方法采用描述流行病学方法,对2011年湖北省各地上报HFMD病例以及重症、死亡病例数据进行分析。结果 2011年湖北省共报告HFMD病例63 767例,发病率为111.41/10万;其中重症病例159例,死亡24例。高发年龄为6月龄～3岁儿童,发病时间呈4～7月和10～12月双流行高峰,重症和死亡病例主要发生在4～7月流行高峰。病原学检测结果为肠道病毒71型(EV71)阳性1 439例(占53.02%),科萨奇病毒A16型(CoxA16)阳性776例(占28.59%),其他肠道病毒阳性499例(占18.39%),EV71为重症和死亡病例绝对优势病原。结论 2011年湖北省HFMD疫情处于较高流行水平,应重点加强第一个流行高峰和高发地区的HFMD预防控制工作。     

2011年广东省深圳市龙岗区重症手足口病流行病学特征

目的 分析2011年广东省深圳市龙岗区重症手足口病(HFMD)流行病学特征,为制定重症HFMD预防控制策略提供参考依据.方法 收集《国家疾病报告信息管理系统》和《深圳市疾病控制信息管理系统》中相关的HFMD疫情监测资料及龙岗区重症HFMD个案调查表等资料,采用描述流行病学方法迸行综合分析.结果 2011年深圳市龙岗区HFMD病例数为12 098例,发病率为341.50/10万;重症病例数为55例,重症发生率为0.45％;死亡4例,病死率为0.03％.重症发病主高峰集中在5-7月,次高峰集中在9-11月.龙岗区11个街道中8个街道报告重症手足口病例,其中以坂田街道病例数最多(18例),占32.7％.部分地区出现聚集性.人群特征年龄集中在3岁以下幼儿,占65.45％.职业以散居及托幼儿童为主,各占80.00％和14.55％.重症HFMD病原体以肠道病毒EV71为主,占84.38％.结论 深圳市龙岗区重症HFMD病例数逐年增加,已成为该地区严重的公共卫生问题,应进一步研究可能导致重症病例发生的各类因素,并采取综合性防治措施,切实预防和控制重症HFMD的发生,减少病例数,降低病死率.     

衡阳市2010年手足口病实验室检测结果分析

目的对衡阳市2010年4-12月手足口病（HFMD）实验室检测结果进行分析,了解衡阳市HFMD流行特征,为今后制定或调整HFMD防治措施提供参考。方法对2010年4-12月衡阳市各县区疾病预防控制中心（CDC）及各类医疗机构送检的625例临床诊断为HFMD患者标本,应用实时荧光（Real-time）RT-PCR法检测标本中的人肠道病毒（HEV）、肠道病毒71型（EV71）和柯萨奇病毒A组16型（CVA16）特异性核酸。结果 625例HFMD患者标本中,EV71阳性率为26.08%（163/625）,CVA16阳性率为8.80%（55/625）,其它HEV阳性率为19.84%（124/625）;95例HFMD重症病例中,EV71阳性率（67.80%,40/95）最高,并且男性阳性率（50.85%）略高于女性（27.78%）,未检出CVA16型;9例HFMD重症死亡病例中,6例为EV71型,阳性率为66.67%。4-7月为HFMD高发期,3岁以下为高风险年龄组,重症病例及重症死亡病例比其它年龄组高。结论衡阳市2010年HFMD发病率较高,EV71型是引起重症及重症死亡病例的优势病毒型,应加强监测,特别是3岁以下婴幼儿的监测。     

NT-pro BNP在手足口病患儿中的表达及临床意义

目的　探讨氨基末端脑钠肽前体（N-terminal pro-brain natriuretic peptide, NT-pro BNP）在手足口病（hand-foot-mouth disease, HFMD）患儿血清中的表达及其临床意义。方法　收集2013年1月—2017年8月在鄂州市中心医院、鄂州市第二医院及广西中医药大学第一附属医院诊治的185例HFMD患儿的临床资料，185例中重症HFMD患儿110例，普通HFMD患儿75例；采用多因素Logistic回归分析重症HFMD患儿的相关危险因素及死亡危险因素。分析血清NT-pro BNP在重症HFMD患儿中的表达情况。采用Pearson相关分析分析血清NT-pro BNP与小儿危重病例评分的相关性。结果　死亡重症HFMD患儿血清NT-pro BNP均值为（4846.50±314.61）ng/L，表达水平明显高于非死亡重症HFMD患儿的[（1468.07±454.58）ng/L]；多因素Logistic回归分析结果表明NT-pro BNP是重症HFMD及死亡的危险因素（P均＜0.05）；Pearson相关分析结果显示血清NT-pro BNP表达水平与小儿危重病例评分呈负相关（r=-0.771，P=0.000）。结论　血清NT-pro BNP可以作为一个有效生物标志物，对评估重症HFMD患儿的预后具有良好的参考价值。     

2011年昆明地区手足口病患儿临床及病原学究

目的 探讨昆明地区2011年住院手足口病(HFMD)患儿的临床及病原学特点,为临床诊断提供依据.方法 对2011年1至12月1449例住院患者的临床表现、病原学、流行病学、治疗方法及转归进行回顾性分析.结果 HFMD发病主要集中于4～7月,男女性别比为1.27∶1,发病年龄主要集中在5岁以下(92.62％).对其中1400例患儿的粪便行荧光定量RT-PCR核酸检测:检出病原1018例(72.71％),其中EV71阳性915例(89.88％),CoxA16阳性103例(10.11％).1449例住院患儿中重症病例1186例(81.85％),治疗结果为3例死亡,2例好转,其余1444例痊愈出院.结论 昆明地区2011年HFMD发病高峰期为4～7月,以5岁以下儿童为主体,引起死亡和重症的病原体为EV71.早期诊断和合理治疗是最大程度降低HFMD死亡率、致残率的关键.     

2010-2014年南宁市手足口病流行病学特征

目的 分析近年南宁市手足口病(HFMD)分布特点和流行趋势,为制定HFMD防制对策提供依据.方法 从《国家疾病监测信息报告管理系统》和《突发公共卫生事件报告管理信息系统》分别收集2010-2014年7月南宁市报告的HFMD病例资料和暴发及聚集性疫情的现场调查资料,用描述流行病学方法进行分析.结果 2010-2014年7月南宁市共报告HFMD 230 874例,重症2 042例,死亡76例.为5岁及以下儿童发病221 617例,发病率为8 280/10万,占发病总数的95.99％.全年各月份均有病例出现,发病高峰在4-7月,其病例数占总病例数的62.38％,职业以散居和幼托儿童为主,分别占总病例数的70.97％和26.32％.实验室诊断3 144例,其中肠道病毒71(EV71)型占44.27％,柯萨奇病毒A16(Cox A16)型占24.49％;HFMD死亡儿童感染的病毒主要为EV71型,占死亡总数的82.89％.近5年来,南宁市发生5例以上的聚集性HFMD疫情50起,其中49起发生在托幼机构.结论 南宁市HFMD发病呈逐年上升趋势,隔年出现以EV71型为主的流行,重症和死亡病例也增多,对此应加强研究5岁以下儿童的防治.     

2009-2013年济南地区重症手足口病病原学及流行病学分析

] 目的了解2009-2013年济南地区重症手足口病(HFMD)病原及流行特征,为防控提供科学依据。方法对辖区哨点医院送检的138例重症HFMD病例标本,应用RT-PCR技术检测肠道病毒71型(EV71)、柯萨奇病毒A组16型(CVA16)、非EV71和CVA16的其它肠道病毒(EV);并采用描述流行病学方法对重症HFMD病例进行流行病学分析。结果138例重症HFMD病例中,有132例感染了肠道病毒,阳性率为95.65%。其中感染EV71的有114例,占阳性病例的86.36%;感染CVA16的有9例 (6.82%),感染其他EV的9例 (6.82%)。HFMD重症病例呈散发,主要集中于5~8月份 (74.64%),病例人群男性明显高于女性(х²=48.75, P<0.01),其中3岁以下幼儿是重症病例发生主要年龄段 (84.06%)。结论重症HFMD具有明显的人群特征,EV71是重症及死亡病例的主要病毒类型;应关注高危人群,早期识别重症并及时干预治疗是降低病死率的关键。     

手足口病病区医院感染控制措施

手足口病(hand,foot and mouth disease,HFMD)主要在婴幼儿期发病,近几年在中国台湾、安徽、山东等地发生流行,少数病例病情危重,并造成死亡,引起社会恐慌和关注.2009年即墨市也发生较大规模流行,该市人民医院及时成立HFMD防控领导小组及HFMD门诊和病房,采取了一系列防控措施,有效降低了重症病例的发生,控制了医院感染,现将结果总结如下.     

河北省2008-2017年手足口病流行和病原特征分析

  目的  分析2008-2017年河北省手足口病（hand-foot-mouth disease，HFMD）的流行病学及病原特征，为HFMD的防控提供科学依据。  方法  收集2008-2017年HFMD疫情资料和实验室检测结果，进行描述流行病学分析。  结果  2008-2017年河北省累计报告HFMD病例690 368例，重症4 939例，死亡208例，年均发病率为95.53/10万。2009年，轻型病例报告病例数最多，而重症和死亡则是2010年。报告发病人数呈隔年增加但总体减少的趋势。2008年、2009年和2012年4~6月份间形成春夏季发病主高峰，2010年、2011年和2013-2017年5~7月份出现春夏主高峰，主峰值落在的月份呈向后延迟趋势。男女的性别比是1.59:1，死亡病例以散居儿童和幼托儿童为主。其它肠道病毒、肠道病毒71型（human enterovirus 71，EV-A71）和柯萨奇病毒A组16型（coxasckievirus A16，CV-A16）交替成为普通病例的主要病原，不同病例类型的病原构成不同且差异有统计学意义（χ2=2 274.17，P<0.001）。  结论  报告死亡和重症病例数呈大幅减少趋势，应适时调整防控重点，提高对HFMD轻型病例的重视，进一步加强对其他肠道病原谱的监测。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.