Professional risk, knowledge, attitudes and practice of health care personnel in Serbia with regard to HIV and AIDS

The aim of our investigation was to assess HIV/AIDS-related professional risk, knowledge, attitude and practice of health care workers in Nis. A cross-sectional study of health personnel from Primary Health Centre, Clinical Medical Centre and Dental Clinic in Nis was performed. The data were collected by an anonymous questionnaire. Mantel-Haenszel X2 testing and multiple logistic regression analysis were applied. Results show that 89% of health personnel perceived high professional risk of acquiring HIV infection. The risk perception of acquiring HIV infections was higher among those who were frequently exposed to patients' blood and other body fluids (OR = 10.1 95% CI = 3.1-32.5), and those who had treated HIV-positive patients (OR = 3.0 95% CI = 1.0-8.8). The majority of respondents had insufficient knowledge about the modes of HIV transmission. Nearly two thirds of health personnel agreed that every hospitalized patient should be tested for HIV, and more than four fifths of them agreed that their personal protection was more important than the confidentiality of patient's HIV/AIDS status. Twenty nine percent of health personnel use adequate protection during their daily work with patients. These findings indicated a need for urgent educational and training initiatives of HIV and AIDS for all categories of health care workers.     

Safety practice and professional exposure to blood and blood-containing materials in serbian health care workers

Safety practice is an important element of workplace safety and quality of health care. To investigate the safety practice and professional exposure to blood and blood-containing materials during a one-year period among Health Care Workers (HCWs) in Serbia. Cross-sectional study of 1559 Serbian HCWs using a self-administered questionnaire. Mantel-Haenszel statistics and multiple logistic regression analysis were used in statistical analysis. Fifty-nine percent (921) of HCWs had skin contact with patients blood, followed by 51% (791) with needle stick injuries, 38% (599) with cuts from sharp instruments, and 34% with contact of eye and other mucosa with patient's blood. Nurses reported professional exposure more often than others. Safety practices consisted of using appropriate barriers (gloves, mask, glasses) in all procedures with patients and were used by 58%, 23%, and 4% of HCWs, respectively. Doctors protected themselves more regularly than others. Hospital protocols for post exposure prophylaxis and safety disposal of medical waste are not common in Serbian health care settings. Safety practices in use were having hospital guidelines for safety practice in hospitals [odds ratio (OR)=1.58, 95% confidence interval (CI)=1.14-2.19], carrying out some form of intervention with risks of infection (OR=3.76, 95% CI=2.57-5.51), and HCWs aware of the professional risk of acquiring infection (OR=1.48, 95% CI=1.28-1.79). This study indicates that emphasis on work practice, attire, disposal systems and education strategies, should be employed to reduce professional exposure to blood and blood containing materials among HCWs in Serbia.     

Health status of professional divers and offshore oil industry workers

AIMS: To compare the health status of UK professional divers and age-matched non-divers and to contrast offshore divers (OSDs) with non-offshore divers (NOSDs). METHODS: A postal survey sent to 2958 male professional divers, registered with the UK Health & Safety Executive (HSE) before 1991, and 2708 men who had worked in the offshore oil industry in 1990-92 (non-divers). The questionnaire addressed lifestyle, occupation and health status. RESULTS: In all, 56% of divers and 51% of non-divers responded. Three per cent of participants reported ill-health retirement or being off-work on sickness benefit with no difference between groups. Divers were less likely to report asthma or hypertension. Health-related quality of life (SF-12) was within normal limits for both groups but the mental component summary was higher in divers who were also less likely to be receiving medical treatment. Divers were more likely than non-divers to report 'forgetfulness or loss of concentration' (18% versus 6%, OR 3.8, 95% CI 2.7-5.3), musculoskeletal symptoms (41% versus 34%, OR 3.8, 95% CI 2.7-5.3) and 'impaired hearing' (16% versus 11%, OR 1.6, 95% CI 1.2-2.0). These differences were attributable to increased symptom reporting in OSDs and were not present for NOSDs, with the exception of cognitive symptomatology which was commoner in both OSDs (22%, OR 4.8, 95% CI 3.4-6.8) and NOSDs (9%, OR 1.9, 95% CI 1.1-3.3) than in non-divers (6%). CONCLUSIONS: There was increased symptom reporting in OSDs. However, there was no evidence to suggest any major impact on long-term health of UK divers who had started their career before 1991.     

Prevalence of tuberculin skin test positivity and conversions among healthcare workers in New York City during 1994 to 2001.

OBJECTIVE: To determine the prevalence of and risk factors for tuberculin skin test positivity and conversion among New York City Department of Health and Mental Hygiene employees. DESIGN: Point-prevalence survey and prospective cohort analysis. Sentinel surveillance was conducted from March 1, 1994, to December 31, 2001. PARTICIPANTS: HCWs in high-risk and low-risk settings for occupational TB exposure. RESULTS: Baseline tuberculin positivity was 36.2% (600 of 1,658), 15.5% (143 of 922) among HCWs born in the United States, and 48.5% (182 of 375) among HCWs not born in the United States. There were 36 tuberculin conversions during 2,754 observation-years (rate, 1.3 per 100 person-years). For HCWs born in the United States, the risk for tuberculin conversion was greater in high-risk occupational settings compared with low-risk settings (OR, 5.7; CI95, 1.7-19.2; P < .01). HCWs not born in the United States and those employed at the Office of the Chief Medical Examiner (OCME) were at high risk for baseline tuberculin positivity (OR, 3.2; CI95, 1.7-5.8; P < .001); OCME HCWs (OR, 4.7; CI95, 2.3-9.4; P < .001), those of Asian ethnicity (OR, 4.3; CI95, 1.4-13.5; P < .01), and older HCWs (OR, 1.0; CI95, 1.0-1.1; P < .05) were at a higher risk for conversion. CONCLUSIONS: Although the prevalence of tuberculin positivity decreased after the peak of the recent TB epidemic in New York City, the conversion rate among HCWs in high-risk occupational settings for TB exposure was still greater than that among HCWs in low-risk settings. Continued surveillance of occupational TB infection is needed, especially among high-risk HCWs.     

Factors influencing uptake of influenza vaccination among hospital-based health care workers

BACKGROUND: Vaccination of health care workers against influenza has been shown to lower mortality among elderly patients, but uptake of voluntary vaccination among health care workers remains low. AIMS: Factors influencing uptake of vaccination were examined among a cross-section of health care workers based in an NHS Trust. METHODS: A structured, self-administered questionnaire was mailed to a random sample of health care workers based in the acute services sector of a UK National Health Service Trust, 6 months following a voluntary immunization programme implemented as part of the Scottish Executive Health Department winter planning arrangements for 2000-2001. The programme was promoted using posters in clinical areas and a single leaflet given to all staff through a paycheck advice note. RESULTS: Five hundred and fifty-one health care workers (53%) responded to the questionnaire and influenza vaccination was accepted by 150 (28%). The occupational health poster strongly influenced the decision to accept vaccination [odds ratio (OR) = 11.01; 95% confidence interval (CI) = 2.13-56.80; P < 0.0001]. Other significant influences included female sex (OR = 9.11; 95% CI = 1.26-65.72) and perceived risk of contracting flu without the vaccine (OR = 7.70; 95% CI = 1.44-41.05). Misconceptions regarding the purpose of the vaccination campaign were common and concern regarding possible side-effects was a deterring factor for vaccination uptake. CONCLUSION: Our study showed that visual material displayed throughout the workplace strongly influenced the acceptance of influenza vaccination. Future campaigns should also emphasize the positive benefits to patients of health care worker immunization, with readily accessible information regarding side-effects available from all sources.     

Air blast circuit breaker noise and hearing loss: a multifactorial model for risk assessment

The assessment of the risk to hearing from impulse noise exposure may be a problem for the occupational physician because existing legislative and international noise exposure standards deal primarily with continuous noise, and are not valid in excess of the peak exposure limit of 200 pa (140 dB). Noise exposure in excess of this level, for example that due to firearms, is frequently perceived as harmful, but this is not necessarily the case, as impulse noise standards do, in fact, allow exposure with a maximum in the order of 6.3 kPa (170 dB). To illustrate this, a cross-sectional group of electrical transmission workers have been studied who were exposed to significant levels of impulse noise from air blast circuit breakers and firearms. Important hearing loss factors have been identified by means of a specially designed questionnaire. Using the Health & Safety Executive definition, the risk of hearing loss was determined by calculating prevalence odds ratios (ORs) for exposure to these factors. The OR for those with fewer than eight unprotected air blast circuit breaker exposures was 2.27 (95% confidence interval (CI), 1.01-5.08), whilst for those with more than eight exposures the OR was 2.10 (95% CI, 0.97-4.54). For firearm exposure, ORs of 1.61 (95% CI, 0.95-2.74) were noted in the medium exposure group and 2.05 (95% CI, 1.08-3.86) in the high exposure group. When all the factors were included in the model, the most significant factor was age. The study gives support to the impulse noise exposure criteria, confirming the borderline risk from air blast circuit breaker noise exposure and the relative safety of moderate gunfire exposure.     

Hospital laundry workers--an at-risk group for hepatitis A?

Twenty-two laundry personnel at St. Luke's Hospital, Malta, were tested for seropositivity to hepatitis A together with 37 nursing aides working in paediatric and infectious disease wards, matched for age, who were used as controls. IgG antibodies were found in 54.5% of laundry workers and 13.5% of nursing aides [odds ratio (OR) = 7.68; 95% confidence interval (CI) = 1.87-33.83]. Furthermore, laundry personnel consistently handling dirty linen prior to washing showed an OR of 16.50 (CI = 1.19-825.57) as compared with colleagues handling only clean items. These results would suggest that the increased exposure of hospital laundry workers to potentially infected linen can constitute a risk of occupational hepatitis A for this group of employees.     

Occupational asthma in New South Wales (NSW): a population-based study

BACKGROUND: The proportion of asthma in adults that is due to occupational exposures is not known. AIM: To examine the contribution of workplace exposures to the development of asthma in adults in New South Wales (NSW) in a cross sectional, population-based study. METHODS: A randomly selected population of 5,331 18- to 49-year olds completed and returned a mailed questionnaire (response rate 37%). In adult-onset asthmatics we examined the association of asthma with reported exposure, within 1 year of asthma onset, to a list of occupations and exposures known to be at risk for occupational asthma (high-risk jobs and exposures). RESULTS: Among 910 subjects (18%) with asthma, 383 (7%) subjects reported adult-onset disease. After adjusting for sex, age and smoking, working in any high-risk job or exposure at the time of asthma onset was significantly associated with adult-onset asthma (OR 1.51, 95% CI 1.19-1.92). The population attributable risk (PAR) of adult-onset asthma for either a high-risk job or an exposure was 9.5%. Sudden onset, irritant or reactive airways dysfunction syndrome type exposures were associated with adult-onset asthma (OR 4.65, 95% CI 1.64-13.2). The PAR of adult-onset asthma for these exposures was 0.2%. CONCLUSION: Reported adult onset of asthma is common and occupational exposures may be associated with 9.5% of prevalent cases of adult-onset asthma in NSW.     

Risk factors for cytomegalovirus seropositivity in a population of day care educators in Montréal, Canada

BACKGROUND: Horizontal transmission of cytomegalovirus (CMV) is common in the day care setting. Day care educators appear to be at a high risk of infection; however, studies are limited. AIMS: To determine the proportion of CMV-seropositive female educators in the day care setting and to identify associated risk factors. METHODS: Educator- and day care-level risk factors for CMV seropositivity were obtained by questionnaires from day care educators and directors, respectively. Sera were collected from educators and analyzed by enzyme-linked immunosorbent assay. Significant independent risk factors for CMV seropositivity were determined using a multivariable logistic regression model which was fitted using the generalized estimating equation method. RESULTS: CMV seroprevalence in 473 female educators from 81 day care centers in Montréal, Canada, was 57%. Significant risk factors for CMV seropositivity were (i) increasing age (OR5-yr = 1.19; 95% CI = 1.05-1.35), (ii) low-income country of birth (OR = 10.23; 95% CI = 2.64-39.50) or middle-income country of birth (OR = 4.99; 95% CI = 2.39-10.40), (iii) having > or =2 children of their own (OR = 1.98; 95% CI = 1.19-3.31) and (iv) child-to-educator ratio >6 (18-35 months old) in a day care center (OR = 1.87; 95% CI = 1.25-2.81). CONCLUSIONS: Day care educators have risks for CMV infection related to their work in the day care setting, as well as personal risk factors. A review of current guidelines for the prevention of CMV infection in day care is needed to ensure that recommendations are evidence based.     

Risk factors for intestinal invasive amebiasis in Japan, 2003-2009

We determined yearly change in prevalence and risk factors for amebic colitis caused by intestinal invasive amebiasis among persons who underwent endoscopy and assessed differences between HIV-positive and HIV-negative persons in Japan. A total of 10,930 patients were selected for analysis, of whom 54 had amebic colitis. Prevalence was in 2009 (0.88%, 12/1360) compared with 2003 (0.16%, 3/1904). Male sex (odds ratio [OR] 8.39, 95% CI 1.99-35.40), age <50 years (OR 4.73, 95% CI 2.43-9.20), history of syphilis (OR 2.90, 95% CI 1.40-5.99), and HIV infection (OR 15.85, 95% CI 7.93-31.70) were independent risk factors. No differences in risk factors were identified between HIV-positive and HIV-negative patients. Contact with commercial sex workers was a new risk factor among HIV-negative patients. Homosexual intercourse, rather than immunosuppressed status, appears to be a risk factor among HIV-positive patients.     

Factors associated with tuberculin reactivity in two general hospitals in Mexico.

OBJECTIVE: To identify risk factors associated with tuberculin reactivity in healthcare workers (HCWs). DESIGN: Cross-sectional survey of tuberculin reactivity (2 TU of purified protein derivative (PPD) RT23, using the Mantoux two-step test). SETTING: Two general hospitals located in a region with a high prevalence of tuberculosis and high bacille Calmette-Guerin (BCG) coverage. PARTICIPANTS: Volunteer sample of HCWs. RESULTS: 605 HCWs were recruited: 71.2% female; mean age, 36.4 (standard deviation [SD], 8.2) years; 48.9% nurses, 10.4% physicians, 26.8% administrative personnel; mean time of employment, 10.9 (SD, 6.7) years. PPD reactivity (> or =10 mm) was found in 390 (64.5%). Multivariate analysis revealed an association of tuberculin reactivity with occupational exposure in the hospital: participation in autopsies (odds ratio [OR], 9.3; 95% confidence interval [CI95], 2.1-40.5; P=.003.), more than 1 year of employment (OR, 2.4; CI95, 1.1-5.0; P=.02), work in the emergency or radiology departments (OR, 2.0; CI95, 1.03-3.81; P=.04), being physicians or nurses (OR, 1.5; CI95, 1.04-2.11; P=.03), age (OR, 1.04; CI95, 1.02-1.07 per year of age; P<.001), and BCG scar (OR, 2.1; CI95, 1.2-3.4; P=.005). CONCLUSIONS: Although the studied population has a high baseline prevalence of tuberculosis infection and high coverage of BCG vaccination, nosocomial risk factors associated with PPD reactivity were identified as professional risks; strict early preventive measures must be implemented accordingly.     

Physicians as clinical directors: working conditions, psychosocial resources and self-rated health

BACKGROUND: Physicians in clinical directors' positions fulfil their commitments in demanding work environments characterized by organizational changes and economic cutbacks. Little is known about the self-rated health of this group. AIM: To investigate whether self-rated health was associated with psychosocial working conditions, professional networks, job support, social networks and social support, sick leave and salary in Swedish physicians working as clinical directors. METHODS: A self-reported questionnaire was sent to 373 clinical directors. Odds ratios (ORs) were used for estimating the bivariate association between self-rated health and psychosocial resources. RESULTS: A total of 274 clinical directors agreed to participate in the study. The response rate was 73%. The clinical directors exposed to high job demands had a significantly higher probability of low self-rated health [OR = 3.4 and 95% confidence interval (CI) = 1.6-7.0] than those who were not in this situation. Furthermore, participants who were exposed to high job demands had an increased risk of low self-rated health (OR = 3.8 and 95% CI = 1.8-8.1) irrespective of available social support inside or outside work. High average working hours more than doubled the risk of low self-rated health (OR = 2.2 and 95% CI = 1.1-4.4). CONCLUSION: The job demands on physicians in clinical directors' positions may exceed ordinary means of support with consequent adverse effects on self-rated health. More research is needed to investigate the interaction between job demands and support systems in this group of health care workers.     

Factors associated with critical-care healthcare workers' adherence to recommended barrier precautions during the Toronto severe acute respiratory syndrome outbreak.

OBJECTIVE: To assess factors associated with adherence to recommended barrier precautions among healthcare workers (HCWs) providing care to critically ill patients with severe acute respiratory syndrome (SARS). SETTING: Fifteen acute care hospitals in Ontario, Canada. DESIGN: Retrospective cohort study. PATIENTS: All patients with SARS who required intubation during the Toronto SARS outbreak in 2003. PARTICIPANTS: HCWs who provided care to or entered the room of a SARS patient during the period from 24 hours before intubation until 4 hours after intubation. METHODS: Standardized interviews were conducted with eligible HCWs to assess their interactions with the SARS patient, their use of barrier precautions, their practices for removing personal protective equipment, and the infection control training they received. RESULTS: Of 879 eligible HCWs, 795 (90%) participated. In multivariate analysis, the following predictors of consistent adherence to recommended barrier precautions were identified: recognition of the patient as a SARS case (odds ratio [OR], 2.5 [95% confidence interval {CI}, 1.5-4.5); recent infection control training (OR for interactive training, 2.7 [95% CI, 1.7-4.4]; OR for passive training, 1.7 [95% CI, 1.0-3.0]), and working in a SARS unit (OR, 4.0 [95% CI, 1.8-8.9]) or intensive care unit (OR, 4.3 [95% CI, 2.0-9.0]). Two factors were associated with significantly lower rates of consistent adherence: the provision of care for patients with higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (OR for score APACHE II of 20 or greater, 0.4 [95% CI, 0.28-0.68]) and work on shifts that required more frequent room entry (OR for 6 or more entries per shift, 0.5 [95% CI, 0.32-0.86]). CONCLUSIONS: There were significant deficits in knowledge about self-protection that were partially corrected by education programs during the SARS outbreak. HCWs' adherence to self-protection guidelines was most closely associated with whether they provided care to patients who had received a definite diagnosis of SARS.     

Factors associated with dentists' willingness to treat HIV/AIDS patients in the National Health System in Belo Horizonte, Minas Gerais, Brazil

A cross-sectional study was conducted among dentists in the Unified National Health System (SUS) in Belo Horizonte, Minas Gerais, Brazil, to identify factors associated with their willingness to treat HIV/AIDS patients. Questionnaires were distributed at the participant's workplace. Some 140 out of 345 selected dentists (41.0%) participated. Prevalence of willingness to treat was 55.0%. Results adjusted by multiple logistic regression showed that willingness to treat was significantly associated with a realistic perception of occupational risk (OR = 4.8; 95%CI: 1.32-18.04), knowledge of the exposure protocol (OR = 4.5; 95%CI: 1.61-13.07), positive attitudes towards dealing with the epidemic (OR = 3.2; 95%CI: 1.37-7.45), previous professional experience with HIV/AIDS patients (OR = 3.0; 95%CI: 1.30-7.19), and opposition to compulsory testing of patients for HIV (OR = 2.3; 95%CI: 0.96-5.40). Dentists with prior accidental exposure to potentially contaminated material showed less willingness to treat (OR = 0.4; 95%CI: 0.15-0.85). Fear of contamination was the main source of anxiety for health workers dealing with HIV/ AIDS patients.     

Occupational factors associated with low back pain in urban taxi drivers

BACKGROUND: Urban taxi drivers differ from other professional drivers in their exposures to physical and psychosocial hazards in the work environment. Epidemiological data on low back pain (LBP) of this occupational group are very scarce. AIMS: To examine LBP in taxi drivers and its association with prolonged driving and other occupational factors. METHODS: We analyzed the cross-sectional data from the Taxi Drivers' Health Study. Standardized instruments were used to collect information on personal factors, work-related physical and psychosocial factors and driving time profiles. LBP prevalence was assessed using the modified Nordic Musculoskeletal Questionnaire. Multiple logistic regression models were employed for statistical analyses. RESULTS: Of 1242 drivers, 51% reported LBP in the past 12 months, significantly (P < 0.001) higher than other professional drivers (33%) in Taiwan. After adjusting for the effects of demographic characteristics, lifestyle factors, anthropometric measures and socioeconomic positions, we found that driving time >4 h/day [prevalence odds ratio (POR) 1.78; 95% CI 1.02-3.10], frequent bending/twisting activities while driving (adjusted OR 1.86; 95% CI 1.15-2.99), self-perceived job stress (POR 1.75; 95% CI 1.20-2.55), job dissatisfaction (POR 1.44; 95% CI 1.05-1.98) and registration type were the major occupational factors significantly associated with higher LBP prevalence in taxi drivers. CONCLUSIONS: We have identified that long driving time and several physical and psychosocial factors are associated with high prevalence of LBP in taxi drivers. This should be further investigated in prospective studies. Future studies are needed to examine the potential adverse effects of prolonged exposure to low levels of whole-body vibration.     

Substance use, risk situations, and HIV seroprevalence among individuals seeking free HIV testing in Porto Alegre, Brazil]

OBJECTIVE: To describe substance use, HIV seroprevalence, and risk of exposure to HIV infection in individuals seeking HIV testing in two screening centers (a municipal one and a state one) in the city of Porto Alegre, Rio Grande do Sul, Brazil. METHODS: Using a cross-sectional design, we enrolled a convenience sample of 1 026 men and women between 15 and 60 years of age. We included all the subjects who, after an initial triage, reported any drug use or any behavior or situation with risk of HIV transmission. A Brazilian-Portuguese version of the Risk Assessment Battery was used to assess exposure to risk situations. Blood samples were tested for anti-HIV antibodies, using enzyme-linked immunosorbent assay. Before the blood test, individuals participated in a group counseling session (with a maximum of 20 participants) on HIV and AIDS, in line with the criteria of the Ministry of Health of Brazil. RESULTS: Among the sample, a high overall HIV seroprevalence was found, 15.1%. Drug use did not explain all of the risk exposure. In comparison to those who reported no injecting drug use, the odds ratio (OR) for being HIV-positive for those who reported injecting drug use at some point in their life was 7.6 (95% confidence interval (CI) = 4.4 to 13.0). However, only 10.3% of the sample reported any injecting drug use. The variables that were associated with HIV seropositivity were: male gender (OR = 1.8; 95% CI = 1.1 to 2.8), monthly family income below three times the minimum-salary amount (OR = 2.1; 95% CI = 1.3 to 3.5), age over 25 (OR = 1.7; 95% CI = 1.1 to 2.7), and having had sexual relations with a partner who was possibly HIV-positive (OR = 1.8; 95% CI = 1.1 to 3.2). CONCLUSIONS: Even irregular or occasional drug use increases the odds of seropositivity, particularly if intravenous drugs are used. Sexual transmission played an important role in seropositivity in this sample, indicating that drug use can affect the judgment of risk and thus contribute to HIV transmission.     

Exposures to blood and body fluids in Brazilian primary health care

Background Primary health care workers (HCWs) represent a growingoccupational group worldwide. They are at risk of infectionwith blood-borne pathogens because of occupational exposuresto blood and body fluids (BBF). Aim To investigate BBF exposure and its associated factors amongprimary HCWs. Methods Cross-sectional study among workers from municipal primaryhealth care centres in Florianópolis, Southern Brazil.Workers who belonged to occupational categories that involvedBBF exposures during the preceding 12 months were interviewedand included in the data analysis. Results A total of 1077 workers participated. The mean incidencerate of occupational BBF exposures was 11.9 per 100 full-timeequivalent worker-years (95% confidence interval: 8.4–15.3).The cumulative prevalence was 7% during the 12 months precedingthe interview. University-level education, employment as a nurseassistant, dental assistant or dentist, higher workload score,inadequate working conditions, having sustained a previous occupationalaccident and current smoking were associated with BBF exposures(P 0.05). Conclusions Primary Health Care Centres are working environmentsin which workers are at risk of BBF exposures. Exposure surveillancesystems should be created to monitor their occurrence and toguide the implementation of preventive strategies.     

HIV阳性男男性行为者对男性固定性伴性传播危险分析

目的 了解有高危性行为的HIV阳性男男性行为人群（men who have sex with men,MSM）对男性固定性伴的性传播危险状况,探讨对固定性伴性传播危险相关联的因素。方法 采用滚雪球抽样方法,在上海和成都市招募有高危性行为的HIV阳性MSM作为研究对象,运用匿名方式,进行一对一问卷调查。结果 研究对象中,最近6个月对男性固定性伴有性传播危险的比例为26.9%（83/308）;多因素分析显示,确认HIV感染时间<1年者对男性固定性伴传播危险,分别是HIV感染确认时间在1～2年和≥3年者的3倍（OR=0.34,95%CI:0.15～0.79）和6倍（OR=0.17,95%CI:0.06～0.49）;将HIV感染状况告知全部男性固定性伴的调查对象,对男性固定性伴的传播危险是全部未告知者的1/25（OR=0.04,95%CI:0.01～0.13）;家人知晓HIV感染状况者对男性固定性伴传播危险降低到1/4（OR=0.24,95%CI:0.10～0.55）;通过互联网寻找性伴者对男性固定性伴的传播危险是其它途径的3倍（OR=0.33,95%CI:0.14～0.78）。结论 HIV阳性MSM与男性固定性伴间存在的性传播危险可能加速HIV在MSM人群中的扩散。强化性伴告知、及早抗病毒治疗及新媒体干预等方法可望发挥遏制HIV继续传播的作用。     

一起医务人员HIV职业暴露的追踪调查与反思

目的了解某院医务人员人免疫缺陷病毒（HIV）职业暴露情况,发现存在的问题,进行针对性管理,以提高职业防护能力。方法对2007年3月发生的一起医务人员HIV职业暴露事件进行回顾性调查和血清学追踪监测。结果此次事件中共36名医务人员发生HIV职业暴露,经完整皮肤暴露率为72.22%（26人）, 损伤性暴露率25.00%（9人）,黏膜暴露率2.78%（1人）。发生职业暴露后,严格按规范要求实施急救处理者仅1人（2.78%）。所有职业暴露人员经临床追踪12个月,全部HIV血清学监测阴性。结论医务人员是HIV职业暴露的高危人群,该院职业防护管理工作存在重大隐患,必须加强培训和教育。     

Anxiety and depression predict musculoskeletal disorders in health care workers

Incidence of musculoskeletal disorders (MSDs) is high among health care workers (HCWs). To determine whether MSDs are associated with preexisting anxiety and/or depression, a case-control study was carried out in female HCWs (56 cases/55 controls). Cases were HCWs with a first-time clinical diagnosis of MSD within the previous 2 years. Occupation, workplace, work shift, direct patient assistance, and anxiety/depression scores (Goldberg scale) were assessed. Increased risk of incident MSDs (multivariate logistic regression) was found in workers with preexisting anxiety/depression compared to those without (OR 5.01; 95% CI 2.20–12.05; p < .01). Other significant risk factors were direct patient assistance (OR 2.59; 95% CI 1.03–6.92; p = .04) and morning work shift (OR 2.47; 95% CI 0.99–6.48; p = .05). Preexisting anxiety/depression was associated with incident MSDs in HCWs, adjusting for occupational exposure risk factors.