麻疹发病与麻疹疫苗接种的病例对照研究

目的探讨甘肃省部份地区发生麻疹爆发或流行的原因,分析麻疹减毒活疫苗(MV)效力与麻疹发病之间的关系。方法选择4个县进行1∶1配对病例对照研究。结果共调查病例和对照各358人,病例中<7岁儿童占27.65%,7~14岁占66.48%,平均年龄8.62岁。病例组MV接种率36.87%,对照组MV接种率89.94%;接种MV后≥5年发病者占68.94%,7~9岁发病儿童距接种MV≥5年的占74.47%。1∶1配对病例对照研究计算,接种MV与麻疹发病的比值比95%可信区间为0.028~0.079,MV效力95%可信区间为92.1%~97.2%。结论甘肃省部份地区发生麻疹爆发或流行的主要原因是MV接种率过低,存在免疫空白。提高MV接种率,缩短MV 2针接种间隔时间,适时开展MV强化免疫可有效控制麻疹。     

一起医院内暴露导致的麻疹爆发疫情分析

目的 探讨正阳县麻疹爆发危险因素,为控制麻疹提供科学依据.方法 采用描述流行病学、病例对照研究分析危险因素.结果 2006年12月～2007年3月,正阳县共报告麻疹357例,发病率达47.2/10万,全县均有病例分布,51.3%的病例<3岁.对71例麻疹和91例对照进行麻疹发病危险因素的病例对照研究.麻疹减毒活疫苗(Measles Attenuated Live Vaccine,MV)接种率的比值比(OR)=0.3,95%,可信区间(CI)=0.1～0.8;发病前1～2周医院暴露史的OR=22.7,95%CI=6.1～99.5;与麻疹病人密切接触史的OR=40.4,95%CI=5.5～829.1.为避免MV接种的影响,将<8月龄的儿童单独进行分析,结果显示,仅医院暴露史有显著统计学意义,OR=15.1,95%CI=1.4～377.2.结论 除较低的MV接种率外,发病前1～2周的医院暴露是本次疫情爆发的主要危险因素,必须重视医院内感染在控制麻疹爆发中的作用.     

德惠市0～3岁儿童麻疹患者发病危险因素分析

目的探讨德惠市麻疹流行因素,为控制麻疹提供科学依据。方法采用回顾性调查研究方法计算麻疹疫苗(MV)效力(VE),采用病例对照研究进行传播因素分析。结果MV接种率为97.3%,VE为85%,说明MV仍是有效的保护因素;病例与对照相比,医院就诊比值比(OR)=6.7[95%可信区间(CI)=2.6~17];≥2家医院就诊OR=9.7(95%CI=2.6~38),高于到1家医院就诊OR=5.4(95%CI=1.9~16)。到医院就诊≥5dOR=15.6(95%CI=4.5~59),远高于就诊2~4dOR=4.5(95%CI=1.2~18)。而就诊1d病例组与对照组差异无显著的统计学意义(OR=1.4,95%CI=0.2~8)。与麻疹病人接触OR=5.0(95%CI=1.4~20)。医院暴露和与病人接触是此次麻疹传播的重要危险因素。结论提高MV效力、加强病人和密切接触者的管理、防止医院内感染是控制麻疹爆发或流行的有效措施。     

河南省陕县2005年~2006年麻疹流行特征分析

目的了解陕县麻疹流行特征指导麻疹控制工作。方法对2005年~2006年报告的麻疹疫情资料进行描述性流行病学分析。结果陕县2005年~2006年共报告麻疹病例204例,年平均发病率为29.42/10万,明显高与往年。病例以14岁以下儿童居多,发病高峰在(3~5)月份。发生乡级麻疹爆发一起,罹患率为5.49%。结论儿童MV基础全程接种率低;MV接种质量;免疫空白和免疫成功率低是造成发病增多和出现局部流行的主要因素。对降低麻疹发病,控制局部流行提出了具体措施。     

绵阳市2005年7起麻疹暴发疫情流行因素分析

[目的]了解绵阳市2005年麻疹暴发疫情的流行因素,总结控制工作中的经验。[方法]根据绵阳市麻疹监测系统资料,对2005年麻疹疫情进行描述流行病学分析。描述绵阳市麻疹流行近况;流行病学分析麻疹的流行因素,包括人群免疫状况、感染方式、传染源管理、麻疹疫苗（MV）保护效力,对免疫干预预防措施效果进行评价。[结果]2005年共发生麻疹348例,发病率为6.73/10万,较2004年上升7.74倍;发生暴发疫情7起154例;72.41%的病例﹤15岁;86.21%的病例发生在3～6月份和9月份;72.13%的病例无麻疹疫苗（MV）免疫史或免疫史不详;麻疹监测指标达到监测方案要求。[结论]流动儿童MV接种率低于常住儿童,是供方未及时对流动儿童提供第1针MV免疫服务的重要原因;不在学校接种MV,后期又无督促机制,严重影响MV第2针接种率。麻疹发病率上升的原因主要与存在免疫空白和免疫失败人群有关,控制麻疹暴发的重点在学校,高质量的麻疹疫苗常规免疫接种是减少麻疹发病和控制麻疹暴发的重要措施之一。感染麻疹的主要因素为医院暴露、与病例接触、未接种MV。传染源管理目前存在薄弱环节。按卫生部新免疫程序针对6岁以上儿童不开展MV接种,绵阳市可通过对入托、入学查验预防接种证确保所有儿童完成全程接种。针对≥15岁成人麻疹的控制,尚需现场证据证明其有效和可行性。减少暴露机会、控制传染源等措施引起重视。     

286例麻疹确诊病例流行病学分析

目的了解郑州市麻疹病例流行病学特征,探索麻疹流行规律,为控制麻疹提供科学依据。方法采用抗体捕捉酶联免疫吸附试验(ELISA)对疑似病例血清进行麻疹抗体(1gM)检测,对确诊病例进行个案调查和流行病学分析。结果2月~4月为麻疹的高发季节,占全年总病例的77.62%;麻疹发病主要集中在8月龄-2岁年龄组,占50.70%;麻疹疫苗(MV)预防接种史不详病例占15.73%,无免疫史的占74.13%,有免疫史的占10.14%;286例麻疹病例中,184例属于流动人口,102例属于非流动人口,流动人口与非流动人口麻疹病例的预防接种史、发病年龄构成均有显著差异。结论麻疹发病与MV实际接种率不高和免疫失败有关,其中流动人口是MV预防接种工作的薄弱环节。今后应进一步加强MV的初免和复种工作,改进对流动儿童的计划免疫服务方式,在切实提高MV及时接种率和免疫覆盖率的同时提高免疫成功率。     

2005年-2007年获嘉县麻疹流行特征和应急免疫效果分析

目的了解获嘉县麻疹流行病学特征和麻疹疫苗（MV）应急免疫控制麻疹暴发流行的效果,为消除麻疹策略提供依据。方法采用描述流行病学研究方法对获嘉县2005年-2007年疫情网络直报和麻疹监测系统麻疹发病资料及2007年MV应急免疫接种率资料进行分析。结果三年共报告确诊麻疹病例150例,2005年-2007年各年麻疹发病率分别为4.53/10万、4.74/10万和27.93/10万。疫情呈散发和局部暴发并存,2007年3月-4月份出现麻疹暴发流行。暴发疫情病例占总病例的49.33%,主要发生在幼儿园和小学低年龄段。麻疹发病以散居儿童、小学生、托幼儿童发病为主,〈10岁病例占总病例的74.67%;另外,〈8月龄和〉20岁的病例分别占总病例的14%和16.67%。8月龄-14岁儿童无免疫史或免疫史不祥占63.64%。实施MV应急免疫报告接种率、快速评估调查接种率分别为96.38%、98.10%,应急免疫后麻疹疫情得到有效控制。结论无MV免疫史致使易感人群的大量积累,是造成麻疹疫情回升和暴发流行的根本原因。保持高质量的常规免疫接种率,及时对适龄儿童进行MV复种,同时在3年-4年后开展MV后续免疫,以及敏感的麻疹监测系统是加速控制麻疹的主要措施。     

泉州市鲤城区1986～1996年麻疹流行与接种率分析

目的 配合麻疹疾病监测,为控制和消除麻疹提供科学依据。方法 对泉州市鲤城区1986～1996年麻疹流行与接种率情况进行综合分析,并将11a来麻疹发病率与同期报告的接种率用Excel软件作图分析对比。结果 ①1986～1996年中有4个麻疹爆发和流行年,分别是1990、1992、1993、1996年。1993年发病率高达66.79/10万;1991年为最低发病率0.2/10万;郊区发病高于城区,季节分布以上半年1～7月为重,年龄分布以散居儿及小学低年级学生为主。发病年龄后移,青少年和成年人占有一定比例。②1986～1996年报告麻疹疫苗(MV)接种率与同期麻疹发病率呈现出不太合理的曲线分布图。结论 鲤城区麻疹再度小流行的潜在因素有待消除,基层报告的MV接种率偏高,原因在多方面。其中与流动人口骤增因素、易感人群累积因素有一定关系。控制和消除麻疹的策略依然应从全面提高MV接种质量入手。     

浙江省2005年麻疹爆发疫情流行因素分析

目的了解浙江省2005年麻疹爆发疫情的流行因素,总结控制工作中的经验。方法描述流行病学分析浙江省麻疹流行近况;流行病学分析麻疹的流行因素,包括人群免疫状况、感染方式、传染源管理、麻疹病毒基因型和麻疹疫苗(MV)保护效力,对免疫干预措施效果进行评价。结果流动儿童MV接种率低于常住儿童,儿童家长文化程度低,对免疫规划缺乏了解,是限制需方主动获得免疫服务的原因。流出地未提供免疫服务,流入地卫生人力资源配置不足,是供方未及时对流动儿童提供第1针MV免疫服务的重要原因;不在学校接种MV,后期又无督促机制,严重影响MV第2针接种率。成人发生麻疹主要是由于既往未获得免疫,目前尚不能排除继发性免疫失败的可能。感染麻疹的主要因素为医院暴露、与病例接触、未接种MV。传染源管理目前存在薄弱环节。本次流行的麻疹毒株基因型仍为H1亚型,毒株虽发生了一些变异,但现用MV仍有很好保护效果。结论提高流动儿童MV接种率需要按照全人群比例配置卫生资源,多部门联合,或专门的“流动人口管理单位”管理。按卫生部新免疫程序针对2~6岁儿童开展MV接种,浙江省可通过对入托、入学查验预防接种证确保所有儿童完成全程接种。针对≥15岁成人麻疹的控制,尚需现场证据证明其有效和可行性。减少暴露机会、控制传染源等措施需引起重视。     

学龄儿童麻疹疫苗效力和接种率研究

为探讨安徽省学龄儿童麻疹爆发原因和预防麻疹爆发,运用1∶2匹配的病例对照方法研究学龄儿童麻疹疫苗(MV)的效力.在经实验室确诊的麻疹爆发中,选6～15岁的学生患者为对象,其同年出生、同班或邻居而又未患过麻疹的学生为对照.共调查了156例麻疹患者,309名对照.以预防接种卡/证MV记录统计,学龄儿童中1剂次MV效力估计为65%,95%的可信区间(CI)为38%～81%;2剂次MV效力估计为78%,95%CI为43%～92%;≥1剂次MV效力估计为69%,95%CI为45%～83%.学龄儿童性别、居住地和年龄对MV效力有影响,男性、农村及≥10岁学生MV效力较低.学龄儿童≥1剂次MV估计接种率＜70%,2剂次MV接种率＜50%.学龄儿童中较低的MV效力和/或较低的MV接种率是麻疹爆发的主要原因.提高和维持高水平2剂次MV接种率是预防麻疹爆发的关键,在学龄儿童中应开展MV强化免疫活动.     

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.