徐州市255例病毒性肝炎血清学分型诊断质量调查

目的 通过对急性病毒性肝炎病例进行血清学分型,了解报告诊断肝炎型别与实验室诊断的符合情况. 方法 随机选取2011年传染病疫情信息系统中的病毒性肝炎255例,用酶联免疫吸附实验检测抗HAV-IgM、HBsAg、抗HBc-IgM、抗HCV、抗HEV-IgM. 结果 255例中经实验室检测核实诊断196例,符合率为76.86％;甲肝符合率为4.76％;乙肝符合率96.73％;丙肝符合率37.84％;戊肝符合率81.08％;未分型肝炎符合率42.86％. 结论 各级医疗机构对乙肝和戊肝的诊断准确率较高,其他型别的肝炎诊断准确率相对较低.徐州地区多数医疗机构仅仅开展乙肝的实验室检测,绝大多数一级医疗机构对于其它型别的病毒性肝炎,尤其是甲型肝炎的诊断存在着一定的随意性.可以通过增加投入、加强培训等多种措施提高实验室诊断水平.     

淮安市医疗机构病毒性肝炎诊断报告现状调查

目的了解淮安市病毒性肝炎诊断报告的现状,为进一步提高病毒性肝炎监测数据质量提供依据。方法2013年12月份采用问卷对淮安市30家不同等级医疗机构的临床医生和预防保健医生进行调查。结果二级和三级医疗机构报告的病毒性肝炎病例数多于一级医疗机构;戊肝实验室检测条件在两个层次的医疗机构中有差别（Fisher确切概率P<0.01）;未分型病毒性肝炎的诊断标准在一级医疗机构回答的正确率为38.89%,二级和三级为81.25%,差别有显著性（Fisher确切概率P<0.05）;预防保健医生回答未分型病毒性肝炎诊断标准的正确率为7.14%,临床医生为51.92%（χ²=34.21,P=0.01）;二级和三级与一级医疗机构的培训材料是否依据卫生行业标准方面存在差别（Fisher确切概率P<0.05）。结论各医疗机构应加强病毒性肝炎诊断标准的培训,规范报告程序,提高病毒性肝炎诊断报告质量。     

合肥市病毒性肝炎网络报告数据质量分析

目的了解合肥市病毒性肝炎网络报告数据质量,为校正病毒性肝炎报告发病率提供科学依据。方法抽查不同级别医疗机构住院病例,按照国家相关规范和病毒性肝炎诊断标准,评估病毒性肝炎的诊断及报告数据质量,同时抽取部分临床医生调查病毒性肝炎的诊断和报告标准知晓率。结果 63家被调查单位均能开展肝功能和乙肝两对半检测,开展甲肝、丙肝和戊肝Ig M抗体检测的单位分别占60.3%、60.9%和65.1%,46.0%的开展丙肝RNA检测。临床医生病毒性肝炎诊断和报告标准知晓率为69.9%。调查病毒性肝炎1 319例,报告率96.5%,及时报告率89.1%,重报率4.1%。网络报告病例诊断准确率84.6%,准确报告率56.2%。结论合肥市不同级别医疗机构的病毒性肝炎诊断准确率和准确报告率不高,临床医生病毒性肝炎诊断和报告标准知晓率低,应加强对临床医生的培训,提高病毒性肝炎报告数据质量。     

乙型病毒性肝炎病例报告现况调查分析

目的了解乙型病毒性肝炎报告质量,为进一步规范报告乙型病毒性肝炎与数据利用提供科学依据。方法抽取县级及以上医疗机构15家,随机抽取2010年网络报告实验室诊断乙肝病例556例,均为住院病例,查阅病案资料,根据卫生部新修订的WS-2008传染病诊断标准分析乙肝诊断情况和病例报告状况。结果报告的556例患者,急性乙肝和慢性乙肝病例分别占6.83%、60.80%,未分类病例占32.37%;慢性乙肝患者病史长,超过1年的占55.33%;556例患者符合"卫标"诊断标准的248例,占44.60%,临床医生和"传染病诊断标准"诊断一致率50.90%。临床医生诊断与"传染病诊断标准"(金标准)诊断结果差异有统计学意义(χ2=186.66,P0.001)。结论乙肝病例报告质量不高,提高医生乙肝诊断准确性,减少或避免病史超过1年的慢性乙肝患者网络报告病例,有助于乙肝监测数据分析利用价值。     

2005年淮安市部分乙型病毒性肝炎病例核实诊断结果分析

[目的]了解淮安市乙型病毒性肝炎（乙肝）疫情报告质量，分析乙肝疫情现状，为今后规范乙肝疫情报告工作提供科学依据。[方法]2005年8月，疾病预防控制机构与医疗机构合作，对淮安市2005年8～9月由全市各级各类医疗机构通过国家疾病监测信息报告管理系统报告的现住本市的乙肝病例进行核实诊断调查。[结果]调查260例乙肝病例，经流行病学调查与血清学检测，最后判定为新发乙肝病例165例，复发乙肝病例77例，乙肝病毒携带者7例，诊断依据不足10例，1例排除肝炎。[结论]疾病预防控制机构与医疗机构密切配合，对开展相关疾病的核实诊断工作是可行的方法。     

海口市乙型肝炎病例报告质量调查及分析

[目的]掌握海口市医疗机构乙型肝炎病例报告现状,为探索乙型肝炎病例最佳报告模式提供科学理论论据. [方法]以<全国2006年医疗机构乙肝病例报告专题调查工作实施方案>为标准,通过抽查医疗机构登记的乙型肝炎病例个案及病例的实验室检查结果,进行结果判定,并核对病例报告情况.通过问卷调查方式了解临床医生对乙肝病例诊断、报告知识的知晓率. [结果]诊断符合率为32.93%,漏报率为64.27%,确诊病例急慢性判定准确率100%,误报率为66.67%,重报率为26.63%,临床医生乙肝病例诊断、报告知识知晓率为27.78%. [结论]海口市医疗机构在乙型肝炎的诊断和报告存在诊断符合率低,漏报率、误报率和重复报告率高的问题,报告质量亟待提高.     

甘肃省2005-2011年乙型病毒性肝炎报告情况分析

目的 分析甘肃省近年来乙型病毒性肝炎（简称乙肝）报告现状,为探索提高乙肝报告质量提供依据.方法 对甘肃省2005-2011年乙肝报告情况进行描述性分析.结果 乙肝在病毒性肝炎报告病例中的比例最高;实验室诊断病例占74.03％,呈逐年上升趋势;未分型乙肝所占比例较高（62.70％）,呈逐年下降趋势;综合医院报告乙肝病例最多,超过83.00％;按报告单位级别分析,县级医疗机构报告最多,占58.02％.结论 甘肃省乙肝病例报告质量逐年提高,但误诊、误报现象依然存在,仍需进一步提高乙肝病例的报告质量.     

浙江省乙型病毒性肝炎诊断符合率调查

目的：了解浙江省县以上各级医疗单位的乙型病毒性肝炎（以下简称乙肝）的诊断符合情况，修正全省乙肝报告发病率。方法：分层抽取27家医院，按国家诊断标准对作疫情报告的661例乙肝病例的化验结果进行复核。结果：符合急性乙肝诊断的217例，符合率为32．83％;符合乙肝诊断的为509例，符合率为77．00％;急性乙肝、乙肝诊断符合率均以省级医院最高，市级医院次之。县级医院最低。导致不符合诊断标准的最重要原因是未检急慢性感染标志物（抗-HBcIgM）。有79．21％;其次是肝功能（ALT）未检或不符，有33．50％;血清学未检或不符的有13．30％。结论：急性乙肝的诊断符合率过低，并提出了改进措施。     

≥65岁人群甲型病毒性肝炎报告高发病率调查分析

目的分析≥65岁人群甲型病毒性肝炎(甲肝)报告发病率高发原因。方法选择山西省太原市、运城市)和重庆市江津区、南川区作为调查地区,通过收集不同统计口径人口数据,分析其对甲肝报告发病率的影响;通过对2013年1~9月期间报告的≥15岁甲肝病例回顾性调查和医疗机构实验室开展甲肝病毒抗体Ig M(抗-HAV Ig M)检测,以及临床医生对甲肝诊断、报告工作的知识、态度和行为(Knowledge,Attitude and Practice,KAP)调查,评估医疗机构甲肝诊断能力。结果疾病监测信息报告管理系统中≥65岁人口数据与统计年鉴人口数据差异较大。≥65岁人群就诊机会较大,被医院筛查出抗-HAV Ig M阳性后作为甲肝病例上报的可能性较高。实验室检测结果准确性不高,责任医生诊断标准掌握不规范。结论≥65岁人群甲肝实际发病率可能被高估。≥65岁人群就诊机会大、医院抗-HAV Ig M筛查增加、检测结果不准确、执行诊断标准不规范导致甲肝病例报告数增加。     

对临床医生乙型病毒性肝炎诊断标准掌握情况的调查

目的:了解济宁市临床医生对乙型病毒性肝炎病人诊断标准掌握和执行情况,为进一步提高乙型病毒性肝炎疫情报告质量提供科学依据.方法:采用面对面访谈方法问卷调查临床医生对乙型病毒性肝炎病人诊断标准的掌握和执行情况,选取2006年1～8月全国法定传染病报告系统报告的15岁以下乙型病毒性肝炎病例进行病例诊断情况核实.结果:临床医生诊断乙型病毒性肝炎主要参考实验室检查,通过对2006年报告的26例乙型病毒性肝炎病例核实发现,仅有8例(30.8%)病例符合乙型病毒性肝炎诊断标准(GB 15990-1995),17例(65.4%)为乙型病毒性肝炎携带者.结论:仅30.8%报告病例符合乙型病毒性肝炎诊断标准,说明临床医生对乙型病毒性肝炎诊断标准执行不严格,乙型病毒性肝炎的诊断必须实验室检查结合临床症状统一考虑.     

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.