珠海市消灭脊髓灰质炎工作策略和效果评价

目的 评价珠海市消灭脊髓灰质炎（脊灰）工作策略和效果。方法 对珠海市历年脊灰疫情，OPV免疫接种资料及脊灰免疫学，病原学监测资料进行统计分析。结果 珠海市消灭脊灰工作主要经历了四个时期；使用口服脊灰疫苗（OPV）前期（1961-1964年），无有效预防措施，每年均有脊灰病例发生，年均发病率4.73/十万；使用OPV时期（1965-1978年），发病率下降，年均发病率1.56/十万；计划免疫时期（1979-1992年）和消灭脊灰时期（1993-2000年），连续22年无脊灰病例发生，主要采取策略有：（1）常规免疫；初期不定期上门接种或突击接种，1979年实行计划免疫统一免疫程序，1987年实行冷链运转和集中门诊规范接种，1988-1996年实现儿童免疫接种率三个85%目标；（2）强化免疫；1993年开展消灭脊灰工作，在常规免疫基础上开展强化免疫活动，8年间21轮强化免疫接种率均达96.0%以上；（3）急性弛缓性麻痹（AFP）监测；建立AFP监测系统，开展常规报告，病例快速报告和对哨点医院进行主动监测，系统敏感性，特异性，及时性指标达到无脊灰证实要求；（4）不断加强计划免疫组织，管理和制度建设，结论 珠海市消灭脊灰工作效果显，常规免疫是预防和控制脊灰的有效措施；强化免疫对消除免疫空白，阻断脊灰野病毒传播发挥重要作用；建立敏感，特异的AFP监测系统对准确发现疑似病例，及时报告处理，防止脊灰疫情蔓延必不可少。     

我国现阶段维持无脊髓灰质炎状态面临的挑战和对策

中国通过使用口服脊髓灰质炎（脊灰）减毒活疫苗（OralPoliomyelitisAttenuatedLiveVaccine,OPV）、加强OPV常规免疫和开展补充免疫活动,以及加强急性弛缓性麻痹（AcuteFlaccidParalysis,AFP）病例监测,消灭脊灰已取得了重大进展。1994年报告最后1例本土脊灰野病毒（WildPoliovirus,WPV）病例,2000年包括中国在内的世界卫生组织西太平洋区实现无脊灰目标。随后中国实施了维持无脊灰策略和措施,但2011年新疆维吾尔自治区发生了输入脊灰疫情。在现阶段中国维持无脊灰状态面临的挑战包括：WPV输入风险很大,疫苗衍生脊灰病毒（Vaccine—derivedPoliovirus,VDPV）和疫苗相关麻痹型脊灰病例时有发生,常规免疫存在薄弱环节,脊灰疫苗免疫策略需要调整。为继续维持无脊灰状态,直至全球消灭脊灰,中国要大力加强OPV常规免疫,适时引入脊灰病毒灭活疫苗和调整脊灰疫苗免疫策略,保持高水平AFP病例监测质量,及时和有效地处置可能发生的WPV输入和VDPV循环事件,开展WPV、VDPV及其感染或潜在感染性材料的封存和安全处理。     

莱芜市消灭脊髓灰质炎研究

[目的]对莱芜市消灭脊髓灰质炎(简称脊灰)工作进行回顾分析,为无脊灰证实提供依据,并为其他疾病控制提供借鉴.[方法]采取回顾性分析方法,对该市历年脊灰疫情、急性迟缓性麻痹(AFP)病例监测、脊灰减毒活疫苗(OPV)免疫活动、免疫监测等资料利用EPI 2000及Excel 2000进行分析.[结果]莱芜市1957～1989年脊灰年均报告发病率为1.54/10万,1966年发病率最高,达22.72/10万.随着OPV的广泛应用,脊灰年均发病率由OPV使用初期(1961～1972年)的3.02/10万下降至计划免疫时期(1986～1990年)的0.02/10万,1989年后无病例发生.[结论]莱芜市已彻底阻断了脊灰野病毒的循环,达到无脊灰的目标;免疫策略应作调整.以控制疫苗衍生病例的发生.     

无锡市控制和消灭脊髓灰质炎现状

目的 通过对无锡市控制与消灭脊髓灰质炎（下称脊灰）的现状分析，提出要继续保持高水平的急性驰缓性麻痹（AFP）病例监测系统敏感性，特别要作好流动儿童常规免疫和强化免疫工作，及时发现、应对各种野病毒输入情况，才能巩固无脊灰成果。方法 根据对该市人群免疫水平、疫苗免疫原性监测及15岁以下儿童的（AFP）病例监测系统的敏感性评价等分析该市控制与消灭脊灰的现状。结果 控制与消灭脊灰的现状分析结果表明，人群有较好的免疫水平，AFP监测系统敏感；但是，免疫空白的外来儿童是控制和消灭脊灰的薄弱环节，应引起高度重视。结论 该市的控制和消灭脊灰的现状表明，从上世纪印年代使用脊灰疫苗（OPV），特别是实施儿童计划免疫以来，接种率和人群免疫状况维持和稳定在较高水平。上世纪90年代脊灰发病已得到有效控制，已连续15a无脊灰野毒病例报告。要继续保持高水平的AFP病例监测系统敏感性，特别要作好流动儿童常规免疫和强化免疫工作，及时发现和应对野病毒的输入，才能巩固无脊灰成果。     

徐州市2001～2002年消灭脊髓灰质炎策略实施效果评价

我国于2000年10月成功实现了无脊髓灰质炎(脊灰)的目标.提高和维持高水平脊髓灰质炎疫苗(OPV)常规免疫接种率,继续对高危地区和高危人群开展高质量的OPV强化免疫活动以及进一步完善急性驰缓性麻痹病例(AFP)监测系统,维持高水平的流行病学和实验室监测的工作质量,是保持无脊灰状态,乃至最终消灭脊灰的主要策略.现对徐州市2001～2002年消灭脊灰策略实施情况进行分析评价.     

南京市2005年维持无脊髓灰质炎工作评价

目的 评价南京市2005年维持无脊髓灰质炎（脊灰）工作情况,巩固无脊灰成果.方法 应用EPI info和中国免疫规划监测信息管理系统软件进行分析.结果 南京市2005年急性弛缓性麻痹（AFP）病例监测系统报告19例本市AFP病例,＜15岁儿童非脊灰AFP病例报告发病率为2.7/10万.其他各项监测指标均达到世界卫生组织和卫生部要求.口服脊灰疫苗（OPV）基础免疫报告接种率为99.92%,加强免疫报告接种率为99.75%.2005-2006年度OPV强化免疫活动中,第1轮常住儿童接种率97.27%,流动儿童接种率98.29%;第2轮常住儿童接种率98.07%,流动儿童为97.76%.结论 南京市2005年继续保持无脊灰状态.今后仍须保持敏感的AFP病例监测系统,开展高水平、高质量的OPV常规免疫和强化免疫活动.     

泰安市消灭脊髓灰质炎的研究报告

目的　通过对该市消灭脊灰工作的回顾 ,为无脊灰证实提供依据 ,并为其他疾病控制提供借鉴。方法　利用回顾性分析方法 ,对该市历年脊灰疫情、OPV免疫、AFP病例监测、免疫监测、科学管理等资料进行分析 ,数据采用excel2 0 0 0处理。结果　泰安市历史上曾是脊髓灰质炎的高发区之一 ,1970年发病率达 9.6 2 / 10万。依据OPV使用情况 ,消灭脊灰工作先后经历了 :①自然感染期 (196 0年以前 ) ,②部分使用OPV期 (196 1～ 1972年 ) ,③广泛应用OPV期(1973～ 1985年 ) ,④冷链运转期 (1986～ 1990年 ) ,⑤消灭脊灰期 (1991～ 2 0 0 0年 )五个时期。回顾消灭脊灰工作进程 ,一是适龄儿童OPV接种率水平和接种质量的不断提高 ,是实现消灭脊灰的关键手段。二是正确实施AFP病例监测是消灭脊灰的重要依据。三是加强科学管理、规范服务水平、强化技术培训与宣传动员是实现消灭脊灰的基础保障。结论　该市自 1991年 5月以来已彻底阻断了脊灰野病毒的循环 ,对于其他疾病的控制或消除制定措施提供了借鉴。     

江苏省消灭脊髓灰质炎的回顾及策略

江苏省历史上是脊髓灰质炎 (以下简称脊灰 )的高发省份之一 ,在无有效预防措施前 ,每年均有病例发生 ,并时有局部暴发。广泛使用脊灰疫苗后 ,发病率大幅度下降 ;制定消灭脊灰策略后 ,全省自 1993年起已无脊灰野病毒引起的麻痹病例。为系统总结、评价江苏省所采取的消灭脊灰策略 ,并为其它疾病的控制提供借鉴 ,特对江苏省消灭脊灰的进程及采用的策略进行回顾和分析。1　资料来源　　脊灰疫情资料来自全省法定传染病报告系统和 AFP病例监测系统 ,脊灰疫苗免疫接种资料来自全省接种率报告系统 ,脊灰免疫监测和病毒学监测资料来自江苏省卫生防…     

徐州市2001～2002年消灭脊髓灰质炎策略实施效果评价

我国于2000年10月成功实现了无脊髓灰质炎(脊灰)的目标。提高和维持高水平脊髓灰质炎疫苗(OPV)常规免疫接种率，继续对高危地区和高危人群开展高质量的OPV强化免疫活动以及进一步完善急性驰缓性麻痹病例(AFP)监测系统，维持高水平的流行病学和实验室监测的工作质量，是保持无脊灰状态，乃至最终消灭脊灰的主要策略。现对徐州市2001～2002年消灭脊灰策略实施情况进行分析评价。     

济南市污水中监测到Ⅱ型疫苗高变异脊髓灰质炎病毒/疫苗衍生脊髓灰质炎病毒后的流行病学调查和处置

目的对济南市环境污水中监测到Ⅱ型（Type2）疫苗高变异脊髓灰质炎（脊灰）病毒（Vaccine Hypervariable P0liovirus,VHPVⅡ）/疫苗衍生脊灰病毒（Vaccine-derived Poliovirus,VDPVII）后,进行流行病学调查和处置,为维持无脊灰提供参考。方法对济南市口服脊灰减毒活疫苗（Oral Poliomyelitis Attenuate dLive Vaccine,OPV）常规免疫和补充免疫活动进行评估,开展0～47月龄儿童OPV接种率调查,对急性弛缓性麻痹（Acute Flaccid Paralysis,AFP）病例监测情况进行评价,继续采集污水标本开展脊灰病毒监测。结果济南市适龄儿童OPV各剂次接种率均〉99％,2010～2012年全市〈15岁儿童非脊灰AFP病例报告发病率均〉1/10万,合格粪便标本采集率均〉90％,AFP病例监测系统灵敏,能够及时发现病例,后续采集的污水中未检测到VHPV/VDPV。结论VHPV/VDPV在当地引起传播的风险较小,但污水采集点辐射范围内流动人口较多,应进一步加强AFP病例监测和OPV接种,防止VHPV/VDPV在人群中循环。     

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.     

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.