区域疫苗冷链温度实时监控系统的建立与应用研究

目的建立覆盖全区预防接种单位的冷链温度远程实时监控系统,实现疫苗冷链温度全程实时监控、预警处理,消除预防接种安全隐患。方法各接种单位统一配置医用冷藏冰箱,安装GPRS无线温度监测仪,自动记录和实时监测冷链温度,根据实际情况设置3种预警模型并即时自动启动,系统能够通过短信预警平台向预设管理人员发送报警短信,实现无人值守。结果冷链温度远程实时监控系统能够完成冰箱内温度实时采集、数据上传及报警等功能,使用医用冷藏冰箱贮存疫苗,系统运行更稳定,温度数据准确可靠。结论采用物联网技术对基层预防接种单位实施疫苗冷链温度全程监控技术可靠,监管势在必行。     

疫苗冷链温度实时监管系统应用效果评价

目的分析评价宁波市鄞州区接种门诊运行疫苗冷链温度实时监管系统4年后的应用效果。方法通过区域疫苗监控B/S平台追溯疫苗冷链日最高温度、日最低温度及预警短信,评价和分析冰箱温度稳定性和冷链异常原因,并对所有冷链监管人员就疫苗冷链温度实时监管系统运行效果方面问题进行个人访谈。结果医用常温冰箱温度稳定性优于家用常温冰箱,医用低温冰箱温度稳定性优于家用低温冰箱,差异均具有统计学意义(P0.001)。工作时间冰箱温度异常预警占92.17%,预警有效率为10.85%,非工作时间占7.83%,预警有效率为16.67%,冰箱开启时间过长为温度超标的主要原因,占有效预警的50.00%;24位冷链监管人员均认为系统应用效果良好且冷链监管质量得到很大提高,普遍认为冷链监管便捷性有所提高。结论接种门诊疫苗冷链温度实时监管系统应用效果良好,值得在疫苗监管领域推广。建议接种门诊加强疫苗冷链温度稳定性评价与冰箱日常使用和维护管理,并以医用冰箱作为疫苗储存首选设备;建立疫苗冷链应急管理机制,核查预警信息,避免疫苗冷链运转异常而导致疫苗报废的经济损失。     

基于物联网云平台的上海市闵行区疫苗冷链监测系统运行分析

目的建立基于物联网云平台的疫苗冷链监测系统,分析评价系统运转质量,为进一步完善疫苗冷链监管工作提供依据。方法收集2012年7月—2014年12月上海市闵行区冷链监管数据,进行描述性统计分析。结果⑴2012年7月—2014年12月上海市闵行区冷链监测系统共监测到4 551次报警,其中高温报警2 038次,低温报警1 614次,断电报警899次。报警原因分析显示:冷链设备故障、供电故障及监测设备故障分别占77.74%、19.75%及2.50%。报警规范处置率为99.82%(4 543次)。⑵非医用冰箱冷链评估值的M、Q1、Q3均相对较高,四分位数间距(Q3-Q1)较大,温度稳定性较差;医用冰箱、冷库的冷链评估值的M、Q1和Q3相对较低,温度稳定性较好。⑶社区预防接种门诊冷链管理质量高于产院及其他接种门诊(大中专院校、犬伤门诊和特需门诊)。结论上海市闵行区基于物联网云平台的疫苗冷链监测系统技术可靠,各级冷链管理工作人员能够及时掌握疫苗储存设备温度运转情况、报警接收和处置情况,系统能够智能地评估各接种单位的冷链设备现况及冷链管理质量,冷链监管工作的效率和层次提高。     

2014年天津市预防接种门诊疫苗冷链事故调查分析

摘要:目的　了解天津市预防接种门诊疫苗冷链事故发生情况,分析存在问题并提出解决对策。方法　收集整理2014年天津市预防接种门诊冷链设备档案资料以及冷链事故发生情况,利用描述性流行病学分析方法进行统计分析。结果　全市预防接种门诊冷链冰箱使用年限在6～10年的占31.80%,≥11年的占12.55%。全年共发生疫苗冷链事故15次,涉及冰箱22台,造成疫苗损失8166支（粒）,其中第一类疫苗7295支（粒）,占89.33%;第二类自费疫苗871支,占10.67%。事故发生时间主要在5-10月份,占86.67%。事故原因中冰箱机械故障、电源断电、温度超标、雷击发生率分别为2.13%、1.77%、1.06%、0.12%。结论　我市预防接种门诊冷链运转情况整体良好,但仍存在部分设备老旧、运行稳定性不足、缺失有效管理措施等问题,未来应重视冷链设备的更新维护以及配套管理机制的制定与落实,并可逐步利用信息化技术手段,提升冷链监测管理水平。     

江西省冷链温度自动监控系统的建立与运行状况

目的评价江西省冷链温度自动监控系统建立后的运行状况,确保疫苗质量。方法在冷链设备中安装温度自动监控设备,实现冷链设备温度的自动采集和报警。建立B/S终端管理平台,实现对冷链设备的信息化管理及其温度的自动监控。通过系统统计功能了解各单位各种冷链设备的运转、温度及报警情况。通过访谈了解用户体验。结果全省共10 491台冷链设备(其中普通冰箱6 496台,占65.2%)98.8%处于正常运转状态。从系统启用后的5个月内,共监测到所有设备报警18 006次,占温度采集次数的0.06%;涉及报警的单位87个,占所有单位总数的74.6%;涉及报警的冷链设备92台,占所有自动温控设备的16.8%。通过访谈发现系统有利于提高工作人员管理质量和管理效率。结论江西省冷链温度自动监控系统运行稳定,提高了冷链设备管理的效率。应进一步完善系统功能,与预防接种信息管理系统进行对接,实现数据共享。     

疫苗冷链温度自动监测系统与人工监测效果评价

目的了解预防接种门诊冷链运转情况,评价疫苗冷链温度自动监测系统使用效果。比较疫苗冷链温度自动监测系统与人工监测效能,为进一步推广和优化冷链温度自动监测系统提供科学依据。方法从全市随机选取8个预防接种门诊,对所选取门诊的所有常温冰箱和低温冰箱进行自动监测和人工监测温度及异常事件发生情况进行分析比较。结果疫苗冷链温度自动监测系统冷藏温度高于人工监测,配对t检验显示二者差异有统计学意义(P0.01)。疫苗冷链温度自动监测系统冷冻温度与人工监测冷冻温度差异无统计学意义(P0.05)。疫苗冷链温度自动监测系统超温率为0.256 8%,高于人工监测超温率为0.006 8%(P0.01)。研究期间疫苗冷链自动监测系统统计电源断电共为186次,人工监测记录为118次,人工监测数据低于疫苗冷链温度自动监测系统。疫苗冷链温度自动监测系统监测设备故障数量为6次,人工监测数量为17次,人工监测数据高于疫苗冷链温度自动监测系统。结论疫苗冷链温度自动监测系统可以对整个冷链全程、持续、高效监测,温度监测灵敏度高,但在设备故障监测报警、温度校准、智能化等方面还有待进一步优化。     

合肥市冷链建设和疫苗管理工作现状调查分析

目的了解合肥市级、县（区）级疾病预防控制中心（CDC）和预防接种门诊点的冷链配置及使用、疫苗管理情况,为规范全市冷链建设和疫苗管理工作提供依据。方法采用横断面调查方法,通过现场访谈和实地实物查看,了解全市各级CDC和预防接种门诊冷链和疫苗管理现状。结果共调查216家单位,冷链储存容积较为紧张,基层仍然需要更新和优化冷链设备。其中5个县区CDC需要冷藏车,26个预防接种门诊点需要立式冷藏柜。有30.20%～32.70%的单位没有冷链管理制度和疫苗管理制度;有39.70%的单位建立了冷链和疫苗管理的应急预案;有33.80%的单位药房的疫苗储存温度记录不健全;26.10%的单位周末或假日不记录冰箱温度;大部分县区CDC和预防接种门诊点未实施冷库和冰箱温度短信报警工作。46.80%的单位对于过期或者破损疫苗履行报废手续,并送至定点单位进行报废处理。结论合肥市目前冷链配备尚不能完全满足工作需求,冷链和疫苗信息化管理程度不高。     

疫苗冷链实时温度监控系统对医用与家用冰箱作用差异性分析

目的分析基于物联网技术的疫苗冷链温度监控系统的作用,比较医用及家用冰箱作用的差异性。方法通过冷链温度实时监控系统,使用Web采集2016年每月15日12:00及24:00冷链监控医用和家用冰箱温度,比较其温度波动情况。结果采集冷链设备数据54台,医用冰箱22台,家用冰箱32台。日温度最大波动6.7℃,最小为0;医用冰箱温度波动明显较家用冰箱小(P0.05);12月温度连续监测最大波动10.1℃,最小为0.5℃;医用冰箱温度波动明显较家用冰箱小(P0.01)。监测发现有3家预防接种门诊的3台冰箱温度出现8次不符合规范情况,占0.62%,医用、家用冰箱无显著差异(P0.05)。结论疫苗冷链温度监控系统对提升冷链管理水平有较大作用,医用冰箱较家用冰箱温度稳定。     

物联网技术在疫苗冷链监测系统中的应用

为了达到对疫苗冷链设备温度实时监管目标,北京市顺义区将最新的物联网、云计算等技术应用于疫苗冷链监测工作,建成了"北京市顺义区疫苗冷链实时监管系统",现对该系统建设背景、功能和实时监测效果进行介绍。该系统是北京市第一家实现区疾控中心与基层预防接种单位全覆盖的疫苗冷链网络实时监测平台,开创了全市疫苗冷链系统管理的新模式,更大程度上保证了疫苗安全。     

武汉市洪山区疫苗冷链温度监测系统应用效果评价

目的分析和评价武汉市洪山区疫苗冷链温控系统运行状况,为进一步提高疫苗冷链监管水平奠定基础。方法 2016年8月—2017年7月收集洪山区疾病预防控制中心等30家预防接种单位的温湿度监控系统数据,采用Excel、 SPSS等软件对数据进行统计分析。结果全区共设置冷链设备监测点115个,一年来监测温度数据7 495 849条,其中发出异常预警信息8 171条,预警发生率为1.09‰。预警发生原因中,断电、温度超标预警信息分别占13.00%和87.00%。预警信息处理率为94.90%, 30家接种单位预警信息平均及时处理率为58.97%(38.26%～80.00%)。冷藏、冷冻冰箱预警发生率分别为1.26‰和0.55‰,差异有统计学意义(x~2=634.14、 P0.05)。预防接种门诊、产科接种单位预警发生率分别为1.28‰和1.12‰,差异有统计学意义(x~2=10.39, P0.05)。结论该温湿度监控系统可有效监控全区冷链设备运行状况并及时发送预警信息,保障了疫苗冷链的安全有效。但监测力度及处理速度仍存在改善空间,进一步提升疫苗冷链监管水平是今后工作的目标。     

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.     

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.