云南省德宏州2015年新报告缅甸籍HIV感染者晚发现比例及其影响因素

目的 了解云南省德宏州2015年新报告缅甸籍HIV感染者晚发现比例及影响因素.方法 通过“艾滋病综合防治信息系统”收集德宏州2015年新报告缅甸籍HIV感染者社会人口学信息、感染途径及其他相关信息.结果 526例新报告缅甸籍HIV感染者中,110例(20.9％)为晚发现病例.多因素Logistic回归分析显示,与25岁以下年龄组相比,25 ～ 34岁(OR=2.72,95％ CI:1.33 ～5.56,P=0.006)以及≥35岁(OR=4.93,95％CI:2.29 ～10.63,P＜0.001)年龄组晚发现比例较高;与羁押人员相比,由医疗机构(OR =3.15,95％CI:1.48～6.71,P=0.003)和自愿咨询检测门诊(OR=5.48,95％ CI:2.66 ～11.31,P＜0.001)以及阳性者配偶或性伴送检(OR =3.08,95％ CI:1.47 ～6.44,P=0.003)检测发现的感染者中晚发现比例较高.结论 德宏州2015年新报告缅甸籍HIV感染者晚发现比例较高,德宏州艾滋病防治机构需加强对缅甸籍人群的主动检测,以尽早发现HIV感染者并进行抗病毒治疗.     

上海市某区医疗机构开展HIV检测结果分析

目的评估上海市静安区开展医务人员主动提供HIV检测咨询服务(PITC)工作的效果。方法收集静安区2008—2014年HIV检测数以及HIV感染者和艾滋病人数,分别计算总体HIV阳性率、PITC阳性率和非PITC阳性率的时间变化趋势,分析PITC发现的感染者人口学特征和临床特征。结果 98.00%的检测数来自PITC,64.62%的感染者通过PITC发现,检出率为57.95/10万。2008—2014年总体HIV报告阳性率(P0.001)、PITC(P0.001)与非PITC(P0.001)的报告阳性率均呈上升趋势。三级医疗机构为开展PITC的主要场所,且性病门诊的阳性检出率最高。与非PITC发现的感染者相比,PITC发现的HIV感染者中,50岁及以上(P=0.011)、女性(P=0.002)及非同性传播(P0.001)者比例更高。结论 PITC是静安区HIV检测数和阳性数的主要来源。为达到尽可能多发现、早发现HIV感染者的目的,静安区应长期坚持开展PITC。     

云南省德宏州艾滋病病毒感染者中早发现率及其影响因素研究

目的了解云南省德宏州HIV感染者早发现率及其影响因素。方法利用艾滋病综合防治信息系统,对2009年1月～2010年6月期间德宏州新报告的HIV感染病例进行分析。结果多因素Logistic回归分析显示,外地或外籍、景颇族和已婚的HIV感染者中早发现率显著低于本地、汉族和未婚的HIV感染者;而20～29岁年龄组HIV感染者中早发现率较50岁以上者高;经由自愿咨询检测、戒毒所人员检测、婚前检查、孕产期检查发现的HIV感染者中早发现率均较医院就诊检测的早发现率高。结论德宏州HIV感染者中早发现率较低,必须继续推进在自愿咨询检测门诊、戒毒所、婚前体检和孕产妇体检中全面开展HIV检测工作,重点加强对外地或外籍、景颇族和已婚人群的HIV检测监测工作。     

德宏州2014年新报告HIV感染者早发现率及影响因素研究

目的了解德宏州HIV感染者早发现率及早发现的影响因素。方法通过艾滋病综合防治信息系统收集云南省德宏州2014年新报告HIV感染者信息,进行统计分析。结果在纳入研究的885例HIV感染者中,有215例(24.3%)为早发现病例。多因素logistic回归分析显示,18~29岁年龄组感染者早发现率高于50岁及以上年龄组感染者;女性感染者早发现率高于男性;注射毒品途径感染者早发现率高于性传播途径感染者。结论德宏州HIV感染者早发现率较低,需加强对高危人群的监测。     

淮安市HIV/AIDS既往检测情况及影响因素

目的了解淮安市HIV/AIDS既往接受HIV抗体检测情况,为完善艾滋病检测策略提供依据。方法从中国艾滋病综合防治信息系统下载淮安市截止到2017年底的HIV感染者数据,对HIV/AIDS既往检测情况的影响因素进行分析。结果共纳入研究对象794例,其中15.62%的感染者既往接受过HIV抗体检测。多因素分析显示,高中及以上文化程度(OR=6.06,95%CI:2.85～12.88)、样本来源于检测咨询(OR=4.39,95%CI:2.41～7.98)和专题调查(OR=2.17,95%CI:1.05～4.50)、确证年份在2013年以后是影响艾滋病感染者既往接受HIV抗体检测的因素。结论淮安市HIV/AIDS既往接受检测的比例较低,其他就诊者检测是发现感染者的重要途径,应进一步推广PITC服务,扩大检测覆盖面。     

渝东北新发现HIV感染者首次CD4+T淋巴细胞检测分析

目的了解渝东北片区新发现HIV感染者CD4+和CD8+水平及相关情况,为早期对艾滋病(AIDS)患者开展抗病毒治疗提供依据。方法采用流式细胞术对采集的抗凝全血标本进行CD4+和CD8+检测,并进行统计分析。结果 2010—2013年能随访到的741例新发现HIV感染者首次CD4+T淋巴细胞绝对值均数为(302.86±216.99)个/μL,不同年度CD4+T淋巴细胞绝对值均值差异无统计学意义(F=0.63,P=0.59>0.05),不同年龄组HIV感染者首次CD4+T淋巴细胞绝对值均值差异有统计学意义(F=8.80,P=0.000001<0.01),且随年龄组增大CD4+T淋巴细胞绝对值均值有下降趋势。结论 1/3的HIV感染者发现时已经进入AIDS期。今后应加强宣传,早发现、早干预、早管理,以提高HIV感染者的生存质量。     

惠州市自愿咨询检测与医务人员主动提供检测咨询发现艾滋病患者对比分析

目的对比分析惠州市艾滋病自愿咨询检测(VCT)与医务人员主动提供艾滋病检测咨询(PITC)工作中发现的艾滋病病毒感染者和艾滋病患者(HIV/AIDS)的状况,探讨优化本地艾滋病防治工作的方式。方法收集2013-01-01/2015-12-31期间本地发现、随访的HIV/AIDS资料,使用SPSS 21.0对数据进行统计学分析。结果 VCT组172例与PITC组369例HIV/AIDS对比分析发现,VCT组病例男男性行为史比例,同性传播比例、CD4+T淋巴细胞检测率、抗病毒药物治疗入组人数比例高于PITC组;PITC组病例晚发现比例、死亡人数比例高于VCT组;两组病例关于接触史、感染途径、CD4+T淋巴细胞检测率、基线CD4+T淋巴细胞检测数、抗病毒药物治疗人数比例、死亡人数比例等因素的差异均有统计学意义(P0.05)。结论可在本地开展以VCT为切入点的男男性行为者干预工作;在医疗机构同时开展VCT与PITC,对早期发现艾滋病患者,降低晚发现比例,及时提供检测转介治疗,提高抗病毒药物治疗覆盖率,延长患者生存时间有积极意义。     

江阴市新发现HIV/AIDS病例的晚发现影响因素及预测模型

目的 了解江阴市新报告艾滋病病例晚发现情况及影响因素,并建立晚发现预测模型。方法 利用艾滋病综合防治信息系统数据,对2007—2017年江阴市新发现的628例人类免疫缺陷病毒感染者/艾滋病患者(HIV/AIDS)病例进行资料整理和分析,采用logistic回归进行晚发现影响因素分析,应用分类树建立晚发现预测模型。结果 628例病例中晚发现187例,晚发现率为29.78%。近5年的晚发现率未呈现明显的下降趋势(χ2趋势=3.61,P0.05)。同性传播(OR=2.87,95%CI=1.62～5.10)、医疗机构检测发现(OR=3.12, 95%CI=2.03～4.81)及既往无HIV检测史(OR=4.76,95%CI=1.41～16.11)是晚发现的危险因素。分类树模型共3层,9个节点,筛选出3个解释变量:样本来源、感染途径和确诊年龄,其中样本来源是晚发现的最重要影响因素,来源于医疗机构、通过同性传播且28岁的感染者晚发现的风险最高。该模型Risk值为0.269,ROC曲线下面积为0.715(95%CI:0.671～0.759)。结论 江阴市艾滋病晚发现情况不容忽视,应提高≥50岁、本地户籍、已婚和男男同性人群艾滋病主动检测意识,提高检测服务可及性,全面推动医疗机构医务人员主动提供艾滋病检测咨询(PITC)服务,促进高危人群早发现早治疗。     

2021年青岛市新发现HIV感染者和艾滋病患者晚发现及治疗情况分析

目的 分析2021年青岛市不同样本来源人类免疫缺陷病毒(human immunodeficiency virus, HIV)感染者/艾滋病患者新发现病例的晚发现情况和治疗情况。方法 通过“国家艾滋病综合防治数据信息管理系统”收集2021年青岛市新发现HIV感染者/艾滋病患者的基本信息、首次CD4值和治疗情况，对晚发现、快速抗病毒治疗(antiretroviral therapy,ART)比例进行评估。结果 2021年共报告新发病例534例，通过医院、青岛市和其他区(市)疾病预防控制中心(Center for Disease Control and Prevention,CDC)和社会组织发现的HIV感染者/艾滋病患者中晚发现比例分别为46.15%、29.30%和11.11%，差异有统计学意义(χ²=46.24,P<0.01)。医院、CDC和社会组织发现病例启动治疗的比例分别为86.92%、91.08%、96.58%，差异有统计学意义(χ²=8.73,P=0.01)；在启动治疗的患者中，医院、CDC和社会组织发现病例的ART率分别为63....     

男男性传播HIV感染者对早期抗病毒治疗的可接受性及影响因素研究

【目的】探索男男性行为人群(MSM)中艾滋病病毒(HIV)感染者对早期抗病毒治疗的可接受性及其影响因素,为推动上海市MSM人群治疗作为预防(Tas P)策略实施提供依据。【方法】选择2015年1月—2017年6月上海市静安区新发现的、未开始治疗的且愿意配合开展流行病学调查的男男性传播HIV感染者共193例,采用自行设计的问卷,在知情同意的情况下,以面对面的方式进行问卷调查,内容包括人口学特征、艾滋病知识知晓情况、行为学特征、目前身体状况、抗病毒治疗知识、对早期抗病毒治疗的认知情况及接受意愿等。【结果】男男性传播HIV感染者对艾滋病早期抗病毒治疗政策的知晓率为14.5%,HIV感染者早期抗病毒治疗的接受率为82.4%。是否知晓早期抗病毒治疗的相关知识均与是否愿意接受早期抗病毒治疗显著相关(P值均0.05)。多因素logistic回归分析结果显示,认为艾滋病目前可以治愈(OR=4.60,95%CI:1.45~14.61)、认为早期抗病毒治疗可以延缓发病(OR=4.58,95%CI:1.11~18.94)和认为可以预防性伴/配偶被感染(OR=3.56,95%CI:1.29~9.78)的HIV感染者更倾向于接受早期抗病毒治疗。【结论】上海市男男性传播HIV感染者对早期抗病毒治疗可接受性较高,但对早期抗病毒治疗政策的了解较少,应进一步加强MSM人群早期抗病毒治疗的动员和宣传,提高感染者对早期抗病毒治疗的全面认知,更好地促进Tas P策略的实施,进而预防HIV在MSM人群的传播。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

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.     

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.     

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.     

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.     

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.