广东省2008年狂犬病病例流行病学及危险因素分析

目的分析广东省2008年狂犬病病例个案特点及犬伤人群发病的相关因素,以期为狂犬病防治工作提供科学依据。方法收集2008年广东省狂犬病病例个案资料及犬伤暴露者资料,用描述性统计学方法分析流行特点,用回顾性队列研究方法分析狂犬病发病的危险因素。结果2008年广东省共报告狂犬病319例,21个地级市共有18个地市报告病例,95%的病例发生在农村人口中,仅5%的病例发生在城镇人口中。男、女性年均发病率分别为0.45/10万和0.22/10万,差异有统计学意义(P<0.01)。狂犬病病例以15岁以下低年龄组和40岁以上高年龄组为多,但发病率以50岁以上年龄组为高。个案信息完整的314例病例中未进行伤口处理、疫苗接种和注射免疫球蛋白的比例分别为56.9%、91.7%和97.8%。52.35%的病例职业为农民。对犬伤人群队列研究分析结果显示狂犬病发病与性别、年龄、伤口部位、受伤程度、伤人动物、伤口处理和接种疫苗相关。结论犬伤人群伤口处理不规范、没有进行免疫接种或未按要求全程接种是造成狂犬病发病的危险因素,今后要加强伤口处理的规范性,提高犬伤人群的伤口处理率和免疫接种率。     

湖南省2009年狂犬病监测分析

目的分析湖南省2009年狂犬病监测资料,评价预防处置效果,为预防和控制狂犬病提供依据。方法根据《湖南省狂犬病监测实施方案》,收集全省狂犬病监测资料进行流行病学分析。结果 2009年共报告狂犬病200例,发病率为0.31/10万。Ⅱ级、Ⅲ级暴露者占98.0%,伤口未处理者达65.5%,病例均无暴露前免疫史,暴露后只有13.0%注射了狂犬疫苗,133例Ⅲ级暴露者仅9.77%联合应用了抗狂犬免疫球蛋白或血清。狂犬病门诊监测中,湖南全省共报告267 133例暴露者,Ⅱ、Ⅲ级暴露者占85.60%。暴露者中有94.59%在预防门诊接受伤口处理,97.62%暴露后全程接种了疫苗,Ⅲ级暴露者中42.47%注射了抗狂犬免疫球蛋白或血清。伤人动物主要是犬,全省犬密度为6.309只/100人,兽用疫苗接种率为47.78%,犬只狂犬病毒感染率是0.56%。结论犬密度较高、犬群有较高的感染率,兽用疫苗接种率较低,群众防治意识不强以及暴露后未能得到规范处理是目前狂犬病高发的主要相关因素。加强犬只＂管、免、灭＂,规范暴露后伤口的规范处理,是遏制狂犬病高发行之有效的综合措施。     

高州市1998-2008年狂犬病流行病学分析

目的分析高州市1998-2008年狂犬病流行情况,为制定预防控制措施提供依据。方法采用描述性流行病学分析方法对高州市1998-2008年报告的狂犬病资料进行统计分析。结果高州市1998-2008年共报告狂犬病75例,死亡75例,年平均发病率为0.42/10万,病死率为100%。其中2006年年均发病率最高,达0.97/10万,2000年和2001年无病例报告;病例集中在农村;病例男女性别比为2.1∶1,发病年龄以10～19岁为多。职业分布以农民为多,占53.33%(40/75),其次为学生,占32.00%(24/75)。93.33%传染源为犬只,92.00%病例暴露后伤口未作处理或未及时正确处理,89.33%病例未接种人用狂犬病疫苗。结论犬只免疫接种率低,犬只管理不善,犬伤后处理不及时、不规范等是高州市狂犬病发病的主要原因,因此提高群众预防意识,加强各部门合作是防制狂犬病的有效措施。     

浙江省嘉兴市1983-2011年狂犬病流行特征分析

目的 了解嘉兴市狂犬病疫情特点、流行趋势及其发病危险因素,为防控工作提供科学依据.方法 对1983-2011年全市法定传染病疫情报告监测系统报告的狂犬病流行病学个案调查表和暴露处置门诊等资料进行收集、整理分析.结果 1983-2011年全市共报告狂犬病50例,年发病率≤0.29/10万,疫情出现2个波峰,2006-2011年病例数在1～5例之间;各县(区)均有病例报告,94.44％的为农村病例,夏秋季发病较多,男女性别比为1.78:1,年龄以5～9岁及60～64岁为主;可疑动物均无免疫史,所有病例暴露后未开展伤口处置与疫苗接种.结论 嘉兴市狂犬病疫情与犬只免疫率低,暴露后未能及时、规范处置有关;因此要加强犬类管理,提高动物疫苗接种率;加强防治知识宣传;降低接种费用,提高暴露后伤口处理和狂犬病疫苗接种率,尤其是农村地区.     

连云港市58例狂犬病流行病学分析

目的分析连云港市狂犬病流行特征,探讨一年来狂犬病发病率急剧升高的原因,并提出相应防制对策。方法收集2003年7月—2004年12月连云港市狂犬病病人个案调查表进行分析。结果58例病例中,因犬咬伤致发病的55例(94.8%),发病人群以农民为主(72.4%);大部分病人(87.9%)伤口未处理或只自行处理,74.1%的病例未接种狂犬疫苗。结论养犬数增多且免疫接种率低、伤口未经医院正规处理、未接种狂犬疫苗是我市狂犬病发病率陡然上升的原因。因此,应建立狂犬病防制工作长效管理机制,提高犬类免疫接种率,提倡圈养,加强农村地区狂犬病防制力度。     

1985--2007年衢州市狂犬病流行情况及监测分析

目的分析衢州市1985--2007年狂犬病流行特征,探讨发病回升的原因并提出相应的防制措施。方法收集1985—2007年衢州市狂犬病疫情资料,用Excel 2003和SPSS13．0软件对所有数据进行整理和分析。结果衢州市自1985年建市以来共报告狂犬病31例,死亡31例,病死率100％。发病主要集中在1992年前,1993—2003年无病例报告,2004年开始疫情又有回升的趋势。全市除开化县外,其他各县均有病例报告,全年各月均可发病,发病以儿童和青壮年为主,男性多于女性,职业分布主要是农民,占发病总数的77．42％。病例以犬伤为主,绝大部分未进行伤口处理和免疫接种。近年来,人群暴露率有逐年上升的趋势,但暴露后免疫接种率反而有所下降。结论衢州市狂犬病疫情呈快速增长趋势。犬类数量增加致使人群暴露率上升,群众防病知识缺乏,未能及时规范处理暴露伤口和免疫接种,以及狂犬病疫苗价格上涨是导致疫情回升的主要原因,需采取针对性措施控制疫情。     

2004～2009年宾阳县狂犬病流行病学分析

目的分析2004～2009年宾阳县狂犬病流行情况,为制定预防控制措施提供依据。方法采用描述性流行病学分析方法,对2004～2009年宾阳县报告的狂犬病资料进行统计分析。结果 2004～2009年宾阳县共发生狂犬病43例,死亡43例,病死率为100%,年平均发病率为0.79/10万。其中2005年发病率高达1.79/10万,疫情波及13乡镇、38个村委会、2个街道社区。病例集中在农村,男女性别比为1.87∶1,发病年龄以40～60岁,0～20岁为多,职业分布以农民为主,占65.12%,其次为学生,占18.60%。95.35%的传染源为犬只,79.07%病例暴露后伤口未作处理且未接种人用狂犬病疫苗。结论犬只免疫接种率低,犬只管理不善、犬伤后处理不及时、不规范是宾阳县狂犬病高发的原因,提高群众预防意识,加强各部门合作是防制狂犬病的有效措施。     

宜春市2012年狂犬病暴露人群监测分析

目的对宜春市2012年狂犬病门诊暴露人群监测结果进行分析,为制定狂犬病防控措施提供参考。方法采用描述性流行病学方法,对宜春市2012年1-12月狂犬病暴露者的暴露及预防处置情况进行分析。结果 2012年宜春市共报告狂犬病暴露病例28 220例,暴露率为498.48/10万。夏季为病例暴露高峰;男性多于女性;病例以15岁以下青少年为主,占总数的48.64%;病例职业以学龄前儿童居多,占总数的21.36%;伤人动物主要为犬,占83.54%;暴露程度Ⅰ级4.81%、Ⅱ级60.70%、Ⅲ级34.49%;暴露人群狂犬疫苗全程接种率为92.98%,Ⅲ级暴露被动免疫制剂使用率为64.79%。结论宜春市狂犬病暴露人群预防处置依从性有待提高;犬只免疫率低下。今后应加强犬类管理,提高犬免疫率,加大狂犬病防治知识的宣传力度,提高狂犬病暴露人群及时、规范处置率。     

1980-2010年广州市狂犬病监测分析

目的分析广州市1980-2010年30年间狂犬病的流行病学特征。方法收集狂犬病疫情资料及狂犬病病例个案调查表,用回顾性调查方法分析资料;采集疫区犬脑组织,用免疫荧光法和RT？PCR法检测狂犬病病毒抗原。结果 1980-2010年广州市共报告655例人间狂犬病,其中597例为1980-1989年报告的病例,占总病例数的91.15%,45例为2005-2010年报告的病例,占总病例数的6.87%,形成了2次流行高峰;45例患者中男性多于女性,10～55岁年龄组发病人数较多,学生、民工和农民居多。在疫区共捕捉86只犬,取脑组织,经免疫荧光和PCR检测,全部为阴性。结论广州市过去30年人间狂犬病有2次流行高峰;1990年以前犬免疫率低,人暴露后疫苗接种率低使人狂犬病发病率达到最高峰;2005年后,养犬数增多,人们预防狂犬病的意识放松,忽视伤口处理及暴露后免疫,导致狂犬病发病率回升;86只犬中未检测到狂犬病病毒,说明广州地区狂犬病病毒在家养犬中的流行强度较低。     

镇江市2005～2006年狂犬病疫情分析及防制策略

[目的]分析镇江市2005～2006年狂犬病流行情况,探讨其流行回升的因素.[方法]收集1981年以来镇江市狂犬病疫情资料及对2005～2006年流行病学调查资料进行分析.[结果]镇江市2005～2006年狂犬病疫情波及全市5个辖市、区的15个乡镇;全年9个月有发病,有较明显的夏秋季高峰;60～69岁年龄组年平均发病率0.72/10万为最高,其次为50～59岁组(0.58/10万),最低为3～29岁组(0.05/10万);发病人群以农民为主,占86.67%.肇事动物均为犬类;患者被致伤后,46.67%未作伤口处理,真正规范处理的为零;20%患者在暴露后接种了狂犬疫苗,其中全程接种占66.67%.[结论]养犬数增加而管理滞后,犬的免疫接种率低,患者暴露后伤口处理不及时、不规范或未处理,未注射狂犬疫苗或免疫球蛋白,疫苗的质量等因素是导致镇江市狂犬病疫情回升的原因,因此加大以上各方面的管理是防制狂犬病的有效措施.     

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.     

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.