浙江省2002～2005艾滋病职业暴露分析

目的 为了解艾滋病(HIV)职业暴露现状,探讨职业暴露后应急预防处理的影响因素.方法 对浙江省2002～2005报告的由于职业因素引起的HIV暴露案例进行调查并统计分析.结果 44起56人包括医务人员,公安司法职业暴露,暴露类型包括针头刺伤,抓咬伤和血液接触皮肤或粘膜,50人实施暴露后预防(PEP),有43人采用基本用药程序进行干预治疗,占76.8%(43/56);有7人采用强化用药程序;有6人自愿不实施PEP.目前所有病例随访未发现HIV抗体阳转者,有一例发生丙肝病毒(HCV)抗体阳转.结论 HIV职业暴露后感染的危险度较低,但是要注意加强对其他各类血液传播疾病的阻断防护.     

云南省5年HIV职业暴露因素分析

[目的]分析艾滋病病毒（HIV）职业暴露现状,探讨职业暴露后应急预防处理方法。[方法]对云南省2005年～2010年报告的由于职业因素引起的HIV暴露案例进行分析。[结果]2005年～2010年共发生职业暴露1138人,包括医护人员和公安司法人员;暴露类型主要包括针刺伤647例（56．9％）、血液接触皮肤粘膜305例（26．8％）和抓伤96例（8．4％）。974（85．6％）人实施暴露后预防（PEP）,采用基本用药程序或强化用药程序进行干预治疗,所有病例随访未发现HIV抗体阳转者。[结论]HIV职业暴露后感染的危险度较低,但是应严格遵守安全防护措施,暴露后及时使用预防用药,可有效阻断发生艾滋病职业暴露后感染。     

2011—2014年南宁市艾滋病职业暴露情况及处理结果

目的分析南宁市近4年人类免疫缺陷病毒(HIV)职业暴露情况及处理结果,完善发生职业暴露后的处理措施。方法对南宁市2011—2014年由于职业原因引起的HIV暴露案例进行统计分析。结果 2011—2014年南宁市共发生职业暴露249人,包括医护人员235人(94.4%)和公安司法人员14人(5.6%);暴露方式主要包括针刺或割伤195例(78.3%)、破损皮肤或黏膜接触48例(19.3%),抓咬伤6例(2.4%)。184人(73.9%)实施暴露后预防(PEP)用药,167人采用基本用药程序、17人采用强化用药程序进行干预治疗。在184人中暴露源不明74人,占40.2%;轻度63人,占34.3%;重度47人,占25.5%。经应急处理或预防用药后,所有暴露者经随访未发现HIV抗体阳转。结论 HIV职业暴露后采取规范的处理措施可降低感染HIV的风险。发生职业暴露后应尽快对暴露源进行检测,降低暴露源不明所占比例,以避免不必要的预防服药引起的不良反应。     

云南省德宏州2010-2015年艾滋病病毒职业暴露状况分析

目的 了解云南省德宏州艾滋病病毒（human immunodeficiency virus,HIV）职业暴露发生、暴露后预防以及预后随访现状,为开展和加强HIV职业暴露防护工作提供依据。方法 对德宏州2010-2015年上报的所有HIV职业暴露者的个案登记记录进行汇总和统计分析。结果 2010-2015年期间,德宏州共报告323例,均未发现HIV抗体阳转者。其中220人（68.11%）为女性,229人（70.90%）年龄小于35岁,209人（64.71%）为医务人员。暴露方式以针刺或锐器刺伤为主,占72.14%（233/323）;暴露发生地点以医疗单位为主,占82.66%（267/323）;发生职业暴露后,323人立即对皮肤或粘膜进行清洗或消毒处理,279人在职业暴露后采用了预防性用药,156人完成了28 d的暴露后预防（post-exposure prophylaxis,PEP）疗程,6年HIV职业暴露人数变化浮动较大。结论 坚持"普遍性防护原则"、暴露后立即采取应急措施、暴露评估后尽早接受PEP有益于避免和降低职业暴露者感染HIV的风险。     

2007-2011年四川省艾滋病病毒职业暴露分析

目的 了解四川省艾滋病病毒(HIV)职业暴露状况,探讨HIV职业暴露的影响因素及防治办法.方法 对四川省2007-2011年报告的HIV职业暴露人员进行流行病学个案调查,并作描述性分析.结果 2007-2011年四川省报告HIV职业暴露人员464人,主要来自于卫生、公安司法机构,医护人员占77.58％(360/464)),其次是公安司法人员15.09％(70/464),其他人员7.33％(34/464)人.暴露方式包括针刺伤、锐器伤或接触暴露等,以针刺伤和切割伤为主,占61.43％(285/464).HIV暴露后预防(PEP)采取清创94.83％ (440/464)和预防性服药89.44％(415/464)措施,暴露后4h内服药的人员占35.07％ (148/415).随访监测未发现HIV抗体阳转者.结论 医务人员和警察是HIV职业暴露的主要人群,暴露后采取预防措施可有效预防HIV感染.HIV暴露防护知识的培训、防护药品的可及性是今后工作的重点.     

2009-2013年红河州艾滋病病毒职业暴露情况分析

摘要:目的　了解云南省红河州艾滋病病毒（HIV）职业暴露发生、暴露后预防（PEP）及预后,促进HIV职业暴露防护工作。方法　对2009-2013年红河州报告的所有HIV职业暴露者进行流行病学个案调查和统计分析。结果　2009-2013年红河州报告436人发生HIV职业暴露,其中医护人员占78.90%,公安司法人员占18.58%。暴露方式以针刺或锐器刺伤为主,占74.77%;暴露级别以Ⅰ级、Ⅱ级为主,分别占91.06%、8.26%。94.04%（410/436）的暴露者按规范采取紧急处理,72.25%（315/436）的暴露者进行了预防性服药,91.16%（284/315）的暴露者采用了合理的服药方案。27.75%（121/436）未进行预防性服药,其中有83.47%（101/121）的暴露者是真正无需进行预防性服药。随访未发现HIV抗体阳转者。结论　应进一步加强部份人员艾滋病安全操作和职业防护培训,对职业暴露人员开展心理疏导以减少不必要的恐慌。     

2014—2020年广州市HIV职业暴露变化趋势及暴露后预防相关因素分析

目的 分析广州市HIV职业暴露情况,为加强HIV职业暴露防护工作提供依据。方法 收集并分析2014—2020年广州市报告的HIV职业暴露个案,内容包括暴露者的基本情况、暴露方式、暴露等级与暴露源感染情况、暴露后紧急处理方式、暴露后预防用药时间及暴露者HIV抗体检测等信息。结果 2014—2020年,广州市累计报告HIV职业暴露个案455例,医务人员占86.8%（395/455）,锐器损伤占54.3%（247/455）,II级暴露占63.3%（288/455）,规范化暴露后处理占93.8%（427/455）,暴露后2 h内预防用药占35.4%（161/455）;医务人员暴露后2 h内预防用药比例高于警务人员（P<0.01）;男性、锐器损伤、皮肤/黏膜接触暴露、I级暴露、暴露源为轻度、强化用药方案、2 h内及2~24 h内预防用药的构成比均呈上升趋势（P<0.05或P<0.01）;传染病专科医院、II级暴露、超过24 h预防用药的比例呈下降趋势（均P<0.01）;传染病专科医疗机构暴露个案更倾向于及早预防用药（OR=0.305）,暴露源不明的暴露个案预防用药时间更晚（OR=2.713）。结论 应重点提高医护人员和一线警务人员防护意识及技能,增加暴露后预防用药的便利性;同时加强暴露源检测,减少对预防用药及时性的影响。     

四川省HIV职业暴露后预防现状研究

随着艾滋病疫情发展，艾滋病职业暴露问题也逐渐凸显，各行业工作人员因职业感染艾滋病病毒（HIV）的风险越来越大，职业暴露的发生率不断增加，如何做好暴露后预防是摆在广大医务人员面前很严峻的问题。国外有关暴露后预防的研究较多，国内有关暴露后预防的研究较少。本文针对四川省近年来HIV职业性暴露及暴露后的预防现状，以及暴露后预防的影响因素进行探讨，旨在增强医护人员及其他行业对HIV病毒职业暴露的自我防护意识，提高暴露后预防用药的水平，从而达到减少职业感染HIV风险的目的。     

2000-2017年国际HIV暴露后预防研究热点的文献计量分析

目的 从文献计量分析角度对国际HIV暴露后预防（post-exposure prophylaxis,PEP）的发文量、研究热点及其变化趋势等方面进行分析和研究,旨在为我国相关研究开展及防治条例制订提供参考依据。方法 利用CiteSpace 5.1软件对Web of Science核心合集数据库收录的2000－2017年间所有PEP相关文献进行可视化分析。结果 国际上PEP相关研究发文量平均增速为10.78%,2016年发文量达到顶峰（34篇）,近年相关研究热点从预防HIV职业暴露向MSM等高危人群的HIV非职业暴露后阻断转移,聚类分析显示PEP研究热点主要集中于强化干预减少HIV感染风险、全球HIV PEP的形势、德国-奥地利预防指南3个领域。结论 近年高危人群尤其MSM人群的HIV非职业暴露后预防日益受到国际关注,相关研究主要集中于提高PEP在MSM人群中的知晓和使用度以及服药过程中的依从性等方面。在我国MSM人群HIV疫情较为严峻且未得到有效控制的背景下应加强PEP对MSM人群HIV感染风险的评估和探索,以便为医务人员实施HIV非职业暴露阻断及相关部门制定PEP用药指南提供参考依据。     

一起医务人员HIV职业性暴露的调查分析

目的完善预防HIV感染的防控措施，寻求的最佳途径促进有效的HIV职业防护。方法对为手术抢救一例患者发生HIV职业性暴露的医务人员进行暴露途径、暴露时间、暴露后处理方式调查和HIV跟踪检测。结果本次职业暴露者有36人，其中13人暴露时间长达2～8h，占总职业暴露人员的36．11％。发生职业暴露后，严格按规范要求实施急救处理的只有2．28％。结论医务人员面临极大的HIV职业暴露危险，必须加强和重视相关的职业防护。     

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.     

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.     

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.     

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.