2006年义乌市结核病疫情监测结果分析

结核病监测是DOTS策略五大要素之一，通过监测，掌握结核病的疫情变化，考核现行的防治措施效果和存在问题，使结核病管理更加规范化、制度化、科学化，加快结核病控制步伐。2006年10月起义乌市在实施以往的CIDA—WHO中国结核病控制项目基础上又启动了全球基金第五轮结核病项目流动人口结核病防治项目。现对2006年义乌市结核病疫情监测结果进行分析，为今后制定结核病控制措施提供依据。     

1992～2001年湖南省世界银行贷款结核病控制项目实施效果分析与评价

目的 分析和评价湖南省1992—2001年实施世行贷款结核病控制项目工作成效。方法 对湖南省1992—2001年世行贷款结核病控制项目报表资料和终期评估调查资料统计分析。结果 1．全省以县为单位DOTS策略覆盖率达100％，全省DOTS策略人口覆盖率达95％以上，引进了DOTS新技术；2．采取世行贷款和各级政府经费配套的筹资模式，加强了政府对结核病控制的经费投入，项目经费投入超过项目实施前40年经费投入的总和，3．免费发现活动性肺结核病人243553例，免费治疗传染性肺结核病人和重症涂阴肺结核病人200448例。涂阳病人登记率自1992年的4.9／10万提高到2001年的30．1／10万,平均治愈率为91．2％．达到项目目标。结论 1．项目推行的DOTS策略．加强了政府对结核病控制的领导．提高了政府对结核病控制的经费投入．建立起了结核病控制由政府领导，多部门合作、全社会参与的结核病控制机制；2．执行DOTS策略的各项技术措施，提高了传染性肺结核病人的发现率和治愈率，有效地控制了传染源；3．是最符合成本-效益原则的结核病控制项目。     

舟山市结核病防治效果分析

2009年,中国在多年来实施现代结核病控制(DOTS)策略的基础上,优化资源,结合全球遏制结核病策略,实行现阶段适合我国结核病防治形势的中国结核病控制策略.浙江省舟山市从2002年起积极开展DOTS策略,实施浙江省结核病控制项目,以发现并治愈传染性肺结核病人为重点,促进全市结核病控制项目的快速健康发展.现将舟山市2002-2008年结核病防治工作效果分析如下.     

绩溪县2002～2010年实施结核病控制项目效果分析

DOTS策略是现代控制结核病最有效的技术策略[1],绩溪县是安徽省第一批实施DOTS策略项目点之一。现对绩溪县实施＂中国结核控制-日本援助项目＂、全球基金结核病项目以及中央财政补助安徽省公共卫生专项资金结核病项目等多个项目以来,结核病人的发现登记和化疗督导管理与控制效果间的关系,进行分析与综合评价,找出绩溪县实施项目工作取得成效的因素和重点环节,加速控制结核病疫情。     

结核病控制项目的成本-效果成本-效用成本-效益分析

目的 研究世界银行结核病控制项目、卫生部和非项目地区3种预防措施的成本效果、效用和效益。方法 在6省17个县结核病防治机构和1700名初复治病人进行病程、治疗费用及经济负担调查。结果 世界银行项目采用全程督导短程化疗策略。投资成本低,效果、效益及效用明显,结核病控制是低投入、高产出的项目。建议 为结核病防治工作可持续发展,应继续开展新一轮结核病控制项目,实现我国结核病防治工作目标。     

湖北省结核病世行贷款控制项目经济学评价

目的 运用成本-效果、成本-效益方法对湖北省结核病控制项目进行卫生经济学评价，为推行DOTS结核病控制策略，加强结核病控制的经济支持能力提供依据。方法 根据湖北省世行项目结核病人控制费用调查表及卫生经济与评价方法。结果 初治病人每l元的投入最高可获得14．87元的收益；项目每多投入l万元，可多发现初治涂阳病人12人；与初治病人比较，复治病人治疗成本高，效果差，经济负担重。结论 结核病世行控制项目具有较高的经济效率，鉴于结核病人疾病负担重，且多发于贫困人群，建议继续推行DOTS策略。     

2002～2004年南宁市结核病控制项目实施效果分析

目的分析南宁市世行贷款结核病控制项目实施3年的效果。方法收集并分析2002-2004年南宁市8个项目执行单位项目季报表及有关资料。结果到2004年，全市DOTS策略覆盖率达100％，3年来共接诊可疑肺结核患者24556人，发现3548例涂阳肺结核病人，初治涂阳病人治愈率由2002年的53．9％提高到2003年的87．7％。结论结核病防治工作必须依靠政府支持，落实配套经费及DOTS策略，才能有效地控制结核病。     

结核病控制项目的实施策略及效果评价

从2002年起，我国在山东、江苏、浙江3省实施加拿大国际发展部／世界卫生组织中国结核病控制项目(简称CIDA项目)，通过扩展现代结核病控制策略(DOTS策略)和提高涂阳肺结核病人的发现。以促进结核病防治工作。本文对3省CI-DA项目执行情况进行分析，以期全面、客观地总结和评价该项目实施一年后的效果和取得的经验与教训，为以后的项目管理和实施提供借鉴，并为制订中国结核病控制策略提供科学依据。     

2002-2005年漯河市结核病发现状况与转归

不断提高结核病人发现与治疗管理工作水平，是现代结核病控制的重要策略，也是降低结核病疫情必要的措施，按照《全国结核病防治规划（2001-2010年）》和卫生部制定的《全国结核病防治规划（2001-2010年）2002-2005年实施计划》要求，漯河市近年来通过加大对结核病防治工作的力度，有效落实各项防治措施，取得了显著的成绩。笔者通过对全市2002年实施结核病控制项目以来，结核病人的发现、登记及治疗管理情况进行分析，进一步为漯河市结核病控制提供依据。     

宁波市结核病监测县实施控制项目的评价

[目的 ]　探索宁波市结核病控制项目可持续发展问题 ,为制定项目防治对策提供科学依据。　 [方法 ]　对我市 4个结核病监测县实施控制项目前后的结核病防治工作进行对比分析。　 [结果 ]　项目实施后传染源发现率较实施前提高 2 .5倍 ,综合防治效应提高 2 .9倍。　 [结论 ]　只有实施正确的防治策略和得到必需的经费支持 ,结核病控制工作才能持续性发展     

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.