慢性肝病患者医院感染危险因素分析

目的 了解慢性肝病患者医院感染特点及其危险因素。方法 对2000年1月～2002年12月在某院住院的1797例慢性活动性肝炎重度、慢性重型肝炎及肝硬化患者医院感染情况进行回顾性调查。结果 医院感染率为6．34％，感染组病死率为29．82％，高于非感染组(10．99％)；腹腔感染占首位，病原菌以革兰阴性杆菌为主；医院感染的发生与高胆红素和低蛋白血症密切相关。结论 慢性重型肝炎和肝硬化活动期肝病患者医院感染率较高；医院感染可影响预后。     

无偿献血人群病毒感染流行病学调查分析

目的 分析无偿献血人群乙型肝炎表面抗原（HBsAg)、丙型病毒性肝炎（HCV）、人类免疫缺陷病毒（HIV）感染率，从而探讨我地区公民HBV、HCV、HIV感染者的感染率、分布及流行趋势。方法 回顾性调查分析1998年10月－1999年10月无偿献血人群13166例。结果 无偿献血人群HBV、HCV、HIV感染率分别为3．59％、1．25％、0．16％。结论 应加强献血者的筛选；健康人群的预防接种；艾滋病危害性的宣传教育，从而减少HBV、HCV、HIV的感染。     

419例肝病患者医院感染的调查分析

本文统计和比较了４１９例各种病毒性肝炎、肝炎后肝硬化和原发性肝癌的医院感染率。结果显示，总感染率为１８．９％，其中重型肝炎和肝硬化的感染率分别为６９．９％和３４．３％，明显高于其它肝炎（Ｐ＜０．０１）；慢活肝的感染率（２３．５％）明显高于急性肝炎（１０．６％）和慢迁肝（６．８％）。老年组感染率（３４．６％）高于非老年组（２１．７％）。医院感染的相关因素包括广谱抗生素和激素的使用、侵袭性操作、肝炎病毒重叠感染以及严重的并发症。医院感染明显的影响肝病的预后。     

血液透析患者病毒性肝炎感染的情况调查

目的 调查血液透析患乙型、丙型和庚型肝炎病毒感染有其多重感染的情况，探讨其感染的危险因素。方法 对1478例血透患的血清进行HBsAg、HBsAb、HBeAb、HBcAb、HBV－DNA、anti－HCV、anti－HGV的检测。并随机抽取100例anti－HGV和anti－HGV阳性轿清RT－PCR方法检测HCV－RNA和HGV－RNA。结果 1478例轿清中HBV感染率为43．9％，HBV－DNA感染率为7．9％；HCV感染率42．6％；HGV感染率为46．4％。随机抽取100例anti-HCV和anti－HGV阳性血清；HCV－RNA和HGVRRNA的感染率分别为73％和77％。HBV合并HCV天津25．4％，HCV合并HGV感染21．0％，HCV、HBV、HGV3合并感染10．4％。结论 血透透析患存在着经血行感染乙型、丙型和庚型肝炎病毒的高危因素。     

重型病毒性肝炎患者医院感染与对策

采用回顾调查方法，对某医院传染科两年来收治的１５４例重型病毒性肝炎（重型肝炎）患者的医院感染情况进行了调查，结果显示，重型肝炎病人继发感染率为６６．８８％；死亡病例的感染率高达９２．５９％。表明感染是重型肝炎主要和严重的并发症。根据上述情况，应该加强管理，采取有效措施控制医院感染，这对提高重型肝炎患者治疗效果，降低病死率有重要意义。     

中国丙型病毒性肝炎医院感染防控指南(2021年版)

 丙型病毒性肝炎是严重威胁人民健康的公共卫生问题。目前尚无预防丙型肝炎病毒（HCV）的疫苗,但直接抗病毒药物联合治疗可以治愈95%以上的慢性丙型病毒性肝炎。加强HCV感染者的筛查,针对确诊HCV感染者尽早进行有效的治疗,是消除传染源,阻断HCV传播的有效措施。本指南在2012年版《中国丙型病毒性肝炎医院感染防控指南》基础上进行修订和更新,主要内容包括丙型病毒性肝炎流行病学及医院感染现状,HCV感染的实验室检测方法与临床意义,以及医院感染防控措施等,为预防和控制丙型病毒性肝炎医院感染提供帮助。     

48例静脉药瘾者多重病毒感染临床分析

目的探讨静脉药瘾病毒性肝炎患者多重病毒感染率及转归。方法对48例静脉药瘾病毒性肝炎患者进行乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）、人免疫缺陷病毒（HIV）血清标志物及核酸测定,并进行临床分析。结果48例静脉药瘾病毒性肝炎患者中,HBV、HCV双重感染率为31.25%,HBV、HIV双重感染率为4.17%,HBV、HCV、HIV三重感染率为62.50%;重型肝炎者占70.83%。重型肝炎患者住院时间为（48.67±19.25）d,与同期住院的非药瘾重型肝炎患者住院时间（65.32±31.49）d相比,明显缩短（U=4.25,P＜0.01）。结论静脉药瘾者病毒重叠感染率高,且重型肝炎患者多,但相对非药瘾重型肝炎患者恢复较快。     

血液透析患者感染乙型和丙型肝炎病毒的调查

采用基因扩增技术，对医院５８例血液透析患者进行医院性感染乙型和丙型肝炎病毒的调查分析。发现乙型肝炎病毒感染者４例，感染率为６．９０％；丙肝病毒感染者１２例，感染率为２０．６９％。随透析次数的增加，丙肝病毒的感染机率明显增加。提示血液透析患者接受疫苗免疫的重要性。由于透析前患者接受过乙型肝炎疫苗的免疫，调查者中有３４．４８％的患者产生了保护性抗体，且乙型肝炎病毒感染率远低于丙型肝炎。指出了血液透析是传播病毒性肝炎的危险因素，并对其防治措施进行了探讨。     

368例重型病毒性肝炎患者医院感染调查

对368例重型病毒性肝炎患者医院感染进行了调查分析。结果显示：重型病毒性肝炎患者的医院感染率为47．8％；感染部位以腹膜腔最为多见，占49．4％，其次为肠道，占17．4％；感染病原菌以革兰氏阴性菌为主，占69．9％；医院感染与侵入性医疗操作有密切关系；重型病毒性肝炎合并医院感染组的病死率明显高于无合并医院感染组（X2＝16．99，P＜0．001）。结果提示：加强重型病毒性肝炎患者医院感染的预防和监控有十分重要的意义。     

乙丙型和乙戊型肝炎病毒双重感染的危险因素

目的 了解乙型病毒性肝炎（HepatitisB)患重叠感染丙型肝炎病毒（HCV）和戊型肝炎病毒（HEV）的危险因素。方法 对55例HBV和HCV双重感染及51例HBV和HEV双重感染病例,以1：1配对方式选取对照,用酶联免疫吸附测定法（ELISA）和聚合酶链反应（PCR）法检测各型肝炎病毒感染指标,配对x^2分析和多因素条件Logistic回归分析法确定危险因素。结果 单因素分析发现：输液史、牙科手术史、输血史、家庭外肝炎接触史、外餐习惯等因素与乙丙型肝炎病毒双重感染有关,其OR值分别为5．67、23．0、41．0、8．0、3．0。logistic多因素逐步回归分析,输血史为乙丙型肝炎病毒双重感染的独立 危险因素。家族成员肝火史和家庭外肝炎接触史与乙戊型肝炎病毒双重感染有相关性,其OR值分别为35．0和12．0。家庭成员乙型肝炎史为乙戊型肝炎病毒双重感染的危险因素。结论 输血史为乙丙型肝炎病毒双重感染的危险因素,家庭成员乙型肝炎史为乙戊型肝炎病毒双重感染的危险因素。     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

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.