云南省脊髓灰质炎不同时期不同免疫对策的作用和效果分析

在云南省近年脊髓灰质炎（脊灰）相关资料的基础上，从流行病学的角度，分析了不同时期不同免疫对策对降低脊灰发病率的作用和效果。结果表明：实施计划免疫前的免疫活动对降低脊灰的发病率效果不理想；常规免疫活动显著地降低了脊灰的发病率，但局部仍有免疫空白和易感人群的累积；辅以强化免疫对进一步控制脊灰的疫情，提高人群免疫水平，消除免疫空白，减少易感儿童累积，阻断野病毒的传播等方面发挥了重要作用，是消灭脊灰的需要和补充。脊灰免疫策略调整的作用和效果，也有助于其它适宜的干预策略的制定     

甲型肝炎疫苗免疫的成本效益分析

目的　为提高甲型肝炎疫苗接种的经济效益和为制订甲肝疫苗免疫策略提供依据。方法　采用成本效益分析、成本效益平衡点分析和抗体水平平衡点分析等卫生经济学评价方法。结果　发现调查地嘉兴市在甲型肝炎发病率为４１．１５／１０ 万的情况下,甲型肝炎疫苗接种的成本效益比为２．５３ ,成本效益平衡点甲型肝炎的发病率应为１６．２６／１０ 万,对甲型肝炎抗体阳性率５０％ 以上的人群接种时,抗体筛选后再接种能节省费用。结论　开展甲型肝炎疫苗的大规模人群接种具有较高的经济效益,１５ ～２９ 岁的人群为接种的首选对象,对２５ 岁以上人群接种前先进行抗体筛选能节省成本。     

结核病防治DOTS方案的经济学评价

目的:从经济学角度评价河北省世界银行贷款结核病控制项目,在DOTS策略干预下发生的成本、效果及效益,探讨DOTS策略的经济合理性,探讨DOTS策略成功的因素,探讨DOTS策略对提高结核病防治综合效应的作用,探讨低投入、高效益的结核病控制方法,为结核病控制的可持续发展提供科学依据.结论:DOTS策略是成本效果、成本效益俱佳的卫生干预措施,符合低投入、高效益原则,其实施是经济合理的.     

安徽省学龄儿童口腔疾病综合干预项目卫生经济学评价

目的 评价安徽省7~9岁学龄儿童窝沟封闭试点项目卫生经济学效果，为推动儿童口腔疾病综合干预项目提供参考。方法 利用安徽省2017年度儿童口腔疾病综合干预项目资料，通过建立决策树模型对4万名适龄儿童13万颗第一恒磨牙窝沟封闭效果进行成本效果与成本效益分析，并采用单因素敏感性分析评价模型稳定性。结果 研究显示每避免1名儿童患龋需花费221.53元，成本效益比为1.24；每避免一颗龋齿发生需花费89.57元，成本效益比为1.21。单因素敏感性分析显示当每名儿童干预总成本超过164.51元时，现行干预策略将不再具有经济学效益。结论 安徽省学龄儿童口腔疾病综合干预项目经济学效益良好，建议今后在经济条件允许的地区逐步扩大窝沟封闭干预范围并加强干预项目经济学评价，为政府评价省内各地区干预项目工作效率及确定是否继续或扩大购买、推广该公共卫生服务提供决策依据。     

福建省14岁以下儿童麻疹强化免疫效果评价

目的 评价福建省3年来的麻疹强化免疫效果。方法 据流行病学、血清学和经济成本进行综合评价。结果 强化免疫后麻疹平均发病率为2.39/10万，比强化免疫前的6.52/10万下降了63.3%，5岁以下儿童麻疹的发病率从1997年的33.47/10万下降到2000年的5.74/10万；强化免疫后人群的麻疹抗体阳性率和GMT均有显著的上升；3年强化免疫费用-效益比值为1：2.38。结论 通过麻疹强化免疫后，福建省的麻疹发病率明显下降，人群免疫水平明显上升，社会效益和经济效益显著。     

宁波市实施乙肝疫苗纳入免疫规划策略的经济学评价

目的:评价宁波市实施乙肝疫苗纳入免疫规划策略的成本-效果、成本-效益。方法:通过自回归移动平均模型测算宁波市乙肝期望发病和死亡人数,结合现场调查数据计算成本与疾病负担,对宁波市2002—2017年实施乙肝疫苗纳入免疫规划策略进行成本-效果、成本-效益评价。结果:宁波市2002—2017年实施乙肝疫苗免疫规划策略投入5 381.12万元,减少乙肝发病12 480例,死亡232例,成本效益比为1:20.29。结论:宁波市乙肝疫苗纳入国家免疫规划策略取得了显著的经济学效益,应继续做好乙肝疫苗接种工作,进一步扩大免疫规划人群覆盖范围。     

辽宁省肾综合征出血热干预措施效果评价

目的 评价肾综合征出血热(HFRS)综合干预措施的流行病学效果.方法 选取2002～2004年辽宁省连续高发且2004年发病率在30.10万以上的8个县(区)作为干预现场,采用实验流行病学方法,评价以疫苗免疫为主的综合干预措施的效果.结果 实施综合干预措施后,8个干预试验县(区)2005～2007年HFRS发病水平持续下降,发病率由干预前的57.72.10万降到干预后的5.09.10万,效果指数达11.521 0,保护率达91.32%.同时还取得了良好的经济效益,效益.成本比值为9.20.结论 综合干预措施对控制肾综合征出血热的流行病学效果和经济效益显著.     

河南省两种麻疹免疫策略的成本-效果分析

目的　以河南省人口、经济和麻疹流行病学资料为基础 ,从经济学角度对强化免疫策略与两剂免疫策略进行比较和评价。方法　采用卫生经济学中成本 -效果分析方法 ,时间区间为1997～ 2 0 2 0年 ,效果指标为失能调整寿命损失年 (disabilityadjustedlifeyears,DALY) ,成本 -效果比(cost-effectivenessratio ,CER) =强化免疫策略与两剂免疫策略的费用差 /强化免疫策略与两剂免疫策略的效果差。结果　随年份的增长 ,CER呈下降趋势 ,从 2 0 13年起强化免疫策略有正效益。结论　强化免疫策略不仅在降低麻疹发病、阻断麻疹传播方面有很好的效果 ,在经济上也是合算的     

1991～1996年天津市慢性病综合干预项目成本-效用和成本-效益分析

1991～ 1996年天津市在社区开展以人群为目标的慢性病预防与控制综合干预项目。本研究以该项目为基础进行卫生经济学评价 ,研究结果表明 :1991～ 1996年贴现 ( 3% )的累积成本为 16 10 885 6元 ,干预实现三年后 ,效益 -成本比开始大于 1,干预时间越长 ,效果越好 ,干预措施对脑卒中的干预效果优于冠心病。 1991～ 1996年由于开展项目累积增加的 QAL Ys为 12 75 8,每 1QAL Y成本为 983元 ,效益 -成本比为 2 .48。以上结果表明天津慢性病综合干预项目所采取的策略和干预活动取得了良好的经济效果。     

山东省肾综合征出血热综合干预措施效果评价

[目的]评价HFRS综合干预措施的流行病学效果。[方法]选取1998～2000年山东省临沂市年发病均在30／10万以上的6个县（区）作为试验现场，借助实验流行病学方法，评价以疫苗免疫和灭鼠为主的综合干预措施的效果。[结果]实施综合干预措施后，6个试验县（区）2001～2005年HFRS发病水平不断下降，发病率由干预前的57．55／10万降到干预后的13．69／10万，效果指数达4．3579（95％CI：3．94～4．83），保护率达74．74％（95％CI：72．31～77．18），流行病学效果良好。同时还取得了良好的经济效益，效益／成本的比值为9．18。[结论]肾综合征出血热综合干预措施流行病学效果和经济效益显著。     

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.     

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.     

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.     

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.