探讨外科医生乙肝病毒职业感染的监控方法

目的：探讨外科医生乙型肝炎病毒（HBV）职业感染的监控方法。方法：在确定手术中HBV传染性和感染阈值的基础上，探讨外科医生HBV职业感染的监控方法。结果：HBV经单层手套感染的阈值为105ID／ml；经双层手套感染的阈值为106ID／ml；HBsAg阳性，HBeAg阳性和HBeAg阴性患者的传染性分别是0～109，102～109和0～106ID／ml；分别有19．2％，83．9％和3．2％患者的传染性超过单层手套的感染阈值，为手术中的传染源；86．7％的传染源分布在HBeAg阳性患者中，最大传染性为104ID／ml。80.8％的HBeAg阳性传染源的传染性超过双层手套的感染阈值．最大传染性为103 ID／ml。结论：在外科医生普遍进行HBV特异性免疫预防的基础上．以HBeAg取代HBsAg作为手术中HBV传染源监控指标是可行的。     

乙肝病毒标志与外科医生职业感染可能性分析

目的探讨乙肝病毒(HBV)经手术传播的情况。方法在确定手术中HBV传染性和感染阈值的基础上,观察单层、双层手套对HBV的防护效果。结果HBV经单层、双层手套感染的阈值分别为105ID.mL-1和106ID.mL-1;HBsAg阳性、HBsAg阴性、HBeAg阳性和HBeAg阴性患者的HBV DNA阳性率分别为73.7%、9.0%、100.0%和67.2%,传染性分别是0~109、0~104、102~109和0~106ID.mL-1,分别有19.2%、0.0%、83.9%和3.2%患者的传染性超过单层手套的感染阈值,有80.0%HBeAg阳性患者的传染性超过双层手套的感染域值,均为手术中的传染源。结论HBsAg阴性者都不能,而阳性者绝大部分不能成为手术中的HBV传染源;HBeAg阴性者几乎都不能,而阳性者绝大部分都能成为手术中的HBV传染源。     

以HBsAg为传染源替代指标的实验及其优缺点分析

目的分析以乙型肝炎表面抗原(HBsAg)为传染源替代指标的优缺点。方法在测定HBsAg携带者病毒浓度和经手术传染感染阈值的基础上,分析以HBsAg为传染源替代指标的优缺点。结果 9.0%HBsAg阴性者HBVDNA阳性,传染性在0～104ID/ml;73.7%HBsAg阳性者HBVDNA阳性,传染性在0～109ID/ml;HBV经单层手套传播的感染阈值为105ID/ml,经双层手套传播的感染阈值为106ID/ml;HBsAg阴性者病毒浓度都在感染阈值之下,单层手套可使80.8%HB-sAg阳性者的传染性消失,双层手套可使另外4.5%传染性消失,剩余14.7%仍具有传染性,其病毒浓度高出感染低限1000倍。结论 HBsAg监控法对手术中HBV传染源的筛查效果很好,但控制HBV经手术传染的效果较差。而且不是最经济的防护方法 。     

医、患两者的乙肝病毒医院感染特点分析

目的探讨医务人员和手术患者HBV医院感染特点是否相同。方法在HBsAg携带者传染性定量测定的基础上,比较医、患双方HBV医院感染在易感性和感染预后、传播方式和入体血量、免疫能力和防护方法方面的差异。结果 15.7%手术患者HBsAg阳性者,HBV浓度在0-109ID/ml,9.0%的HBsAg阴性者HBV DNA阳性,病毒浓度在0-104ID/ml;乙肝疫苗接种前HBV经单层手套传播的感染阈值为105ID/ml,经双层手套传播的感染阈值为106ID/ml。乙肝疫苗接种后HBV经单层手套传播的感染阈值为108.5ID/ml,经双层手套传播的感染阈值为109.5ID/ml;使用单层手套时只有0.6%HBsAg阳性者可成为传染源,使用双层手套可使传染性消失。结论医务人员和住院患者HBV医院感染特点存在很大差异,防护措施也应有所区别。     

双层手套对乙型肝炎病毒经手术感染的防护效果

目的评价双层手套预防乙型肝炎病毒(HBV)经手术传播的效果。方法在确定乙型肝炎表面抗原(HBsAg)阳性者的HBV传染性、手术中HBV感染阈值和双层手套防护阈值基础上,评价单、双层手套对HBV感染的防护效果。结果HBsAg阳性者的HBV传染性范围为100~109感染剂量(ID)/mL,阴性者为100~104ID/mL。单层手套的防护阈值为105ID/mL;双层手套的防护阈值为106ID/mL,可杜绝23.33%传染源的传染性。结论双层手套只能杜绝部分手术中HBV传染源的传染性;在外科医师普遍接种乙型肝炎疫苗的基础上再使用双层手套防护,才能在理论上完全防止HBV经手术传播。     

乙型肝炎病毒经手术传播感染阈值的实验研究

目的探讨围术期乙型肝炎病毒（HBV）感染阈值。为建立其监控方法以及评价该方法的防护效果提供依据。方法使用ELISA法检测992例手术患者的HBsAg和HBeAg．套式PCR法检测156例HBsAg阳性和100例阴性者的HBVDNA。套式PCR极量稀释法检测HBVDNA阳性者的感染剂量,缝针刺伤接种模拟试验法检测HBV经手术传播的感染阈值。结果HBsAg阳性和阴性、HBeAg阳性和阴性者的HBVDNA阳性率分别为73．7％和9．0％、100．0％和67．2％：其传染性范围分别在0—109ID/ml和0～104ID/ml、102-109ID!ml和0～106ID／ml。缝针刺伤单层手套传播HBV的感染阈值为手术传播的基本阈值,其值是105ID／Ⅱd,HBsAg阴性HBV携带者都不能成为传染源;保护手术患者的感染闽值是103ID／ml,68．6％HBsAg阳性者不能成为传染源．15．2％HBeAg阴性者可成为传染源：保护外科医生的感染阂值是108.5ID!ml,所有HBeAg阴性者和99．4％HBsAg阳性者不能成为传染源。结论围术期保护医生或患者的HBV感染阈值不同．使用的防护措施也应该不同。     

测定乙型肝炎病毒的医院感染阈值

目的 测定乙型肝炎病毒(HBV)的医院感染阈值.方法 在确定HBV携带者的感染剂量、最大传染性和传染所需最小血量的基础上,使用血液系列稀释法测定HBV的医院感染阈值.结果 HBsAg阳性和阴性、HBeAg阳性和阴性者的最大传染性分别是109、104、109、106 ID/ml,传染所需的最小血量分别是10-9、10-4、10-9 、10-6ml;HBV经单层手套传播的感染阈值为105ID/ml,经双层手套传播的防护阈值为106ID/ml,HBV感染阈值随接种血量的增加而减低,HBV浓度随感染阈值的升高而升高.结论 感染阈值包含了病毒浓度和人体血量两方面的内容,与前者呈正相关,与后者呈负相关,在选择正确的传染源替代指标、制定合理的监控方法 方面有实用价值.     

外科医生经手术感染乙型肝炎病毒的防护

目的 选择乙型肝炎病毒(HBM)经手术感染外科医生的防护方法.方法 在比较东、西方国家现有HBV经手术传播防护方法的基础上,阐述以乙型肝炎e抗原(HBeAg)作为手术期间HBV传染源监控指标的特点.结果 乙型肝炎表面抗原(HBsAg)、HBeAg阴性者和HBeAg阳性者的HBV浓度分别为(100～104)、(100～106)、(102～109)ID/ml;HBV经单层手套传播的感染阈值为105ID/ml,经双层手套传播的感染阈值为106ID/ml;HBsAg阴性者的病毒浓度均达不到手术感染阈值,83.88%HBeAg阳性者的病毒浓度达到手术感染阈值,有80.65%在乙型肝炎疫苗低度反应者的防护范围之内,其余3.23%超过了这种防护能力.结论 以HBeAg作为手术期间HBV传染源监控指标的方法属零危险性防护标准,更适合我国现在的国情.     

预防手术患者经手术感染乙型肝炎病毒

目的探讨手术患者经手术感染乙型肝炎病毒(HBV)的防护方法。方法在HBV传染性定量和测定HBV经手术传播感染阈值的基础上,探讨手术患者经手术感染HBV的防护方法。结果 HBV经手术传播的感染阈值为105ID/ml,HBsAg阳性、HBeAg阴性和阳性者中传染源比率分别为19.2%、3.2%和83.9%;HBV经双层手套传播的防护阈值为106ID/ml,HBsAg阳性和HBeAg阳性者中传染源比率分别为14.7%和67.8%;以103ID/ml为禁止外科医师做手术的淘汰阈值。结论手术患者感染HBV的主要传染源是外科医师,禁止可能成为传染源的外科医师从事具有侵入性的医疗操作是有效的防护方法,如何识别外科医师中的传染源是制定具体防护措施的关键所在。     

以HBsAg为指标的手术中传染源监控方法的特点分析

[目的]分析以HBsAg为指标的手术中HBV传染源监控方法的特点. [方法]在确定HBV经手术感染的阁值和HBV传染性定量检测的基础上,分析以HBsAg为指标的手术中HBV传染源监控方法的特点. [结果]HBV经单层手套传播的感染阈值为105ID/ml.26.30%HBsAg阳性手术患者HBV DNA阳性,传染性范围在0-109 ID/ml:9.00%HBsAg阴性手术患者HBV DNA阳性,传染性范围在0～104 ID/ml.80.77%HBsAg阳性手术患者的HBV浓度在经手术传播的感染阈值之下,0.64%在乙肝疫苗的防护范围之上.HBsAg阴性HBV携带者的病毒浓度都在经手术传播的感染阈值之下. [结论]以HBsAg为指标虽可将所有手术中HBV传密源处于监控之下,但检出传染源的闪确性较低.因此,HBsAg不是一个好的手术中HBV传染源筛查指标.     

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.     

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.     

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.     

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.