深圳市福田区急性呼吸道感染病毒病原谱分析

目的了解深圳市福田区常见急性呼吸道病毒感染流行病学特征,为疾病诊断治疗和预防提供参考。方法 2018年12月1日-2019年11月30日,采集深圳市福田区第二人民医院及下辖社区健康服务中心4 511例急性呼吸道感染就诊患者咽拭子,采用免疫荧光法,进行7种常见呼吸道病毒的检测,并对结果进行描述分析。结果 4 511例急性呼吸道感染就诊患者中7种呼吸道病毒阳性1 193例,总阳性率为26.4%,其中A型、B型流感病毒和呼吸道合胞病毒阳性检出数占总阳性数的87.4%。7种病毒阳性率依次为A型流感病毒11.0%、B型流感病毒7.3%、呼吸道合胞病毒4.8%、腺病毒2.0%、副流感Ⅲ型(PIV-3)0.9%、副流感Ⅰ型(PIV-1)0.4%、副流感Ⅱ型(PIV-2)0.2%。3～5岁组病毒阳性检出率最高(29.3%),其次为6～14岁组(28.9%),不同年龄组间差异有统计学意义(χ~2=25.62,P0.05)。0～2岁组主要病毒类型为呼吸道合胞病毒,其他年龄组均以A型、B型流感病毒为主。男性阳性率为26.8%,女性为26.1%,差异无统计学意义(χ~2=0.25,P0.05)。春、夏、秋、冬季阳性率分别为22.4%、27.9%、11.8%、33.9%,差异有统计学意义(χ~2=98.50,P0.05)。春季、夏季均以B型流感为主(各占45.2%、56.0%),冬季A型流感占67.4%,秋季腺病毒占31.8%。结论深圳市福田区急性呼吸道病毒感染以A型和B型流感病毒为主,呈现冬夏季高发的季节特征,儿童及青少年是防控重点人群。     

荧光定量PCR检测急性呼吸道感染患者常见呼吸道病毒的研究

目的分析2011年8月至2012年8月期间惠州市急性呼吸道感染病毒性病原谱的构成及流行特征,为临床诊断、治疗和呼吸道传染病的预防控制提供病原学依据。方法应用荧光定量PCR方法,对485例鼻咽拭子样本同时进行甲型流感病毒、乙型流感病毒、腺病毒、博卡病毒、副流感病毒、鼻病毒、呼吸道合胞病毒、人偏肺病毒、人冠状病毒的检测,并进行统计学分析。结果 485份样本中检出228份呼吸道病毒阳性的样本,阳性率为47.01%,其中混合感染20份,占阳性样本的8.77%。病毒病原谱构成前三位为乙型流感病毒、鼻病毒和甲型流感病毒。病毒检出阳性率的时间分布有一定规律性：1月至次年2月阳性率较高,不同月份检出的优势病毒不同。各年龄组病毒阳性率差异有统计学意义（χ2=19.414,P〈0.05）,不同年龄组病毒感染的病原谱构成也不同：0～5岁年龄组以鼻病毒为主;5岁以上各年龄组均以流感病毒为主。不同性别患者之间病毒核酸检出率差异无统计学意义（χ2=0.522,P〉0.05）。结论乙型流感病毒、鼻病毒和甲型流感病毒是惠州市急性呼吸道感染主要病原体。部分病原体的感染与年龄和季节有一定的关联;ARTI患者中部分合并感染其他呼吸道病毒,应长期监测呼吸道病毒的活动水平。     

湖北地区儿童急性呼吸道感染病原体研究

目的了解湖北地区儿童急性呼吸道感染(ARI)的病原谱,为临床抗感染及病原体检测提供依据。方法收集947例拟诊断为ARI患儿的血清标本,采用间接免疫荧光法检测其中9种常见病原体的IgM抗体。结果 947例患儿中抗体阳性882例,阳性率为93.1%,其中≤1、1~3、3~6、>6岁各年龄组阳性率分别为87.5%、94.3%、97.0%、96.9%,各组间差异有统计学意义(P<0.05);9种病原体中肺炎支原体阳性率最高,其他依次为乙型流感病毒、呼吸道合胞病毒、副流感病毒、腺病毒、甲型流感病毒、嗜肺军团菌血清Ⅰ型、Q热立克次体、肺炎衣原体;混合感染718例,占81.4%,主要是两种的病原体混合感染。结论湖北地区引起儿童急性呼吸道感染的病原体的主要是肺炎支原体、乙型流感病毒和呼吸道合胞病毒;混合感染比较普遍,主要是肺炎支原体和乙型流感病毒的混合感染;病原体感染在各年龄组中存在差异。     

2013年湖南省儿童医院住院患儿急性下呼吸道感染病原体分析

目的 了解湖南省儿童医院急性下呼吸道感染患儿常见非典型呼吸道病原的感染和流行情况,为临床诊断急性下呼吸道感染患儿提供病原学依据。 方法 采集该院2013年1-12月诊断为急性下呼吸道感染的1 726例住院患儿的血清标本,用间接免疫荧光法(IFA)快速检测和鉴定肺炎支原体、乙型流感病毒、呼吸道合胞病毒、副流感病毒(1.2.3)、腺病毒、嗜肺军团菌、甲型流感病毒、肺炎衣原体、Q热立克次体九种非典型呼吸道病原体。采用χ²检验分析检出率的人群、季节、时间分布差异。 结果 1 726例患儿肺炎支原体检出率为56.78%,其次为乙型流感病毒19.99%、呼吸道合胞病毒12.40%、副流感病毒9.21%、腺病毒5.16%、嗜肺军团菌5.16%,甲型流感病毒2.43%,肺炎衣原体1.10%,Q热立克次体0.9%;其中肺炎支原体检出率存在性别差异(χ²=6.04, P<0.05);副流感病毒、乙型流感病毒、呼吸道合胞病毒、肺炎衣原体、肺炎支原体、腺病毒检出率存在年龄差异(P<0.05);肺炎衣原体检出率不存在季节差异,其它病原体在检出率存在季节差异(P<0.05)。副流感病毒、甲型流感病毒检出率5月达最高峰;Q热立克次体秋冬季未检出;肺炎支原体、乙型流感病毒1月是检出高峰。重复感染率22.25%,其中肺炎支原体合并其他病原体感染率高达16.3%。 结论 导致该院儿童急性下呼吸道感染的主要病原体是肺炎支原体、乙型流感病毒、呼吸道合胞病毒;肺炎支原体与其它病原体混合感染普遍。     

西安地区呼吸道疾病病毒病原谱分析

目的分析陕西省西安地区呼吸道疾病病毒病原谱分布情况。方法收集西安市6家医院的呼吸道感染病例971例,采集咽拭子标本进行16种型别呼吸道病毒核酸检测。结果 971份标本的检出率为32.65%(317/971),检出16种病毒。多种呼吸道病毒在冬季高发,各人群检出率(χ2=31.566)、各年龄组检出率(χ2=25.312)均存在统计学差异(P<0.05),主要集中在15岁以下散居儿童。住院病例检出率(41.52%)与门诊病例(27.82%)有统计学差异(χ2=18.906,P<0.05),两者的混合感染比例也存在统计学差异(χ2=10.718,P<0.05)。上呼吸道感染以腺病毒居多,下呼吸道感染以呼吸道合胞病毒居多。结论西安地区的呼吸道病毒性疾病有16种型别被检出,冬春季高发,流感病毒、呼吸道合胞病毒和腺病毒所占比例较高,儿童为呼吸道病毒感染的高发人群,混合感染多为小年龄组的住院病例。     

1499例深圳市急性呼吸道感染者呼吸道病毒抗原监测分析

目的对在广州医科大学附属深圳沙井医院求诊的急性呼吸道感染(ARTI)者进行呼吸道病毒抗原监测并对其进行分析,探讨其流行规律。方法对2013年1-12月在广州医科大学附属深圳沙井医院求医的急性呼吸道感染者,共采集1 499人份鼻咽分泌物标本,用免疫荧光法对标本进行七种呼吸道病毒抗原检测。结果共检测出阳性标本354份,总阳性率为23.6%,其中,呼吸道合胞病毒(RSV)阳性率为2.5%(38/1 499);腺病毒(ADV)阳性率为1.0%(15/1 499);A型流感病毒(IVA)阳性率为14.3%(215/1 499);B型流感病毒(IVB)阳性率为4.8%(72/1 499);副流感Ⅰ型病毒(PIV-1)阳性率为0.53%(8/1 499);副流感Ⅱ型病毒(PIV-2)阳性率为0.47%(7/1 499);副流感Ⅲ型病毒(PIV-3)阳性率为0.27%(4/1 499)。在七种呼吸道病毒的感染中,IVA检出阳性率最高,而RSV是0~5岁组儿童呼吸道感染的高发期病毒,是七种呼吸道病毒在0~5岁年龄组中感染率最高的(13.3%)。不同的季节感染率差异明显,秋季病毒感染率最高,达到30.9%,春季最低(12.1%),季间差异有统计学意义(P0.001)。结论在不同的季节、不同的年龄存在不同的病毒感染率,A型流感病毒是本地2013年呼吸道感染的主要病毒,呼吸道合胞病毒是儿童呼吸道病毒感染的主要病毒。     

小儿急性下呼吸道病毒感染的临床流行病学特征

目的 了解小儿呼吸道病毒感染的临床流行病学特征.方法 采集浙江大学金华医院儿科2012年5月至2013年4月诊断为急性下呼吸道感染(A LRTI)的560例患儿的鼻咽拭子样本进行直接荧光法检测7种呼吸道病毒(呼吸道合胞病毒、流感病毒A型及B型、副流感病毒Ⅰ、Ⅱ、Ⅲ型、腺病毒),比较不同季节、年龄、性别、疾病类型患儿呼吸道病毒阳性检出率的差异,连续监测56例病毒检出患儿治疗过程中的病毒感染状况.结果 560例ALRTI患儿中,呼吸道病毒阳性138例,阳性率24.64％,其中单一病毒检出率为23.21％,混合感染检出率为1.43％.不同季节、年龄组和疾病类型的病毒阳性检出率差异有统计学意义(x2=43.76、24.98、97.60,P＜0.01),其中冬春季节发病、1岁以内、支气管哮喘发作和毛细支气管炎患儿的病毒阳性检出率较高.56例患儿治疗后病毒检出下降,但直至出院时,仍有9例能够检出病毒.结论 小儿下呼吸道感染的病毒检出率较低,以呼吸道合胞病毒单一感染为主,冬春季节、1岁以下幼儿及支气管哮喘和毛细支气管炎患儿病毒检出率较高,部分患儿经治疗后病毒转阴较慢.     

学龄前儿童呼吸道感染病原体流行趋势

目的了解本地区近2年学龄前儿童呼吸道感染病原体流行趋势。方法调查2017年1月至2018年12月本院收治的呼吸道感染患儿1733例,免疫荧光发检测呼吸道感染患儿的血清病原体IgM抗体,包括呼吸道合胞病毒、腺病毒、甲型流感病毒、乙型流感病毒、副流感病毒、肺炎链球菌、肺炎支原体、肺炎衣原体、柯萨奇病毒A、柯萨奇病毒B及埃克病毒。对结果进行流行病学分析。结果1733例呼吸道感染患儿中检出病原体阳性544例,阳性率为31.39%。1139例男性患儿中病原体阳性378例(33.19%),594例女性患儿中病原体阳性171例(28.79%),男性患儿病原体总阳性率明显高于女性患儿,差异有统计学意义(P<0.05)。男性患儿乙型流感病毒和肺炎支原体感染率明显高于女性患儿,差异均有统计学意义(均P<0.05)。4~12个月、13-36个月及37-72个月的患儿中病原体阳性分别为110例(24.23%),281例(36.73%)及158例(30.74%),组间比较差异有统计学意义(P<0.05)。乙型流感病毒和肺炎支原体感染率在4~12个月J3-36个月及37-72个月的患儿间比较差异均有统计学意义(均P<0.05)。春季、夏季、秋季及冬季病原体阳性分别为138例(33.09%).107(24.37%),146(32.52%)及158(36.92%),差异有统计学意义(P<0.05);冬季病原体感染率明显高于其他季节,春季和秋季病原体感染率明显高于夏季。合胞病毒、乙型流感病毒、肺炎支原体及埃克病毒的感染率在不同季节间比较差异均有统计学意义(均P<0.05)。结论本市学龄前儿童呼吸道感染病原体检出率最高的为肺炎支原体,其次为乙型流感病毒;应重视男性、13~36个月儿童以及冬季的呼吸道感染防控工作。     

儿科重症监护室和普通病房小儿下呼吸道感染病原学分析

目的 探讨儿科重症监护室(PICU)和普通病房小儿下呼吸道感染病原谱的异同.方法 选择2011年5月至7月于本院儿科住院的下呼吸道感染患儿397例为研究对象,其中男性患儿为240例(60.45％),女性为157例(39.55％).将其按照患儿入住不同病房,分为普通病房组(n=320)和PICU组(n=77).2组患儿的性别、年龄等比较,差异无统计学意义(P＞0.05)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意).应用间接免疫荧光法(IFA),对所有下呼吸道感染患儿监测呼吸道合胞病毒(RSV),腺病毒(ADV),甲型流感病毒(IV-A),乙型流感病毒(IV-B),副流感病毒1,2,3型(PIV-1,2,3)等5种(共7型)病毒的IgM抗体,以及肺炎支原体(MP),嗜肺军团菌Ⅰ型(LP 1),肺炎衣原体(CPn)、Q热立克次体(QFR)等4种非典型病原体的IgM抗体.结果 PICU组(n=77)患儿检出病原呈阳性为43例,阳性率为55.84％,非典型病原体检出率为68.83％(53/77),病毒检出率为19.48％ (15/77),混合感染占阳性患儿的51.16％(22/43).普通病房组(n=320)患儿检出病原呈阳性者为115例,阳性率为35.94％,非典型病原体阳性率为42.5％(136/320),病毒阳性率为16.56％(53/320),混合感染占呈阳性患儿的50.43％ (58/115).MP为2组患儿感染率最高的病原体(41.56％ vs.24.69％).非典型病原体阳性率,2组比较,差异有统计学意义(P＜0.01),其中MP阳性率比较,差异有统计学意义(P＜0.01);病毒阳性率比较,差异无统计学意义(P＞0.05).结论 非典型病原体是儿科下呼吸道感染的主要病原,MP为最常见病原,感染以PICU患儿多见.儿科下呼吸道混合感染较为常见,以MP+LP1双重感染最为多见.     

住院患儿急性呼吸道病毒感染病原学调查

目的了解和准确掌握卫辉市急性呼吸道病毒感染患儿的病原体分布及相关临床特征,为急性呼吸道病毒感染的临床防治提供借鉴和参考依据。方法选取2012年12月-2013年12月入医院接受治疗的484例急性呼吸道感染住院患儿为研究对象,针对患儿的鼻咽部分泌物进行了实验室的病毒检测。结果 484例急性呼吸道感染患儿中病毒感染有230例占47.52%;检出病毒共244株,其中流感病毒65株占13.43%,呼吸道合胞病毒128株占26.45%,腺病毒17株占3.51%,副流感病34株占7.02%;男性患儿呼吸道合胞病毒感染率显著高于女性患儿,差异有统计学意义(χ2=4.2235,P0.05);4岁患儿的腺病毒感染率显著高于其他年龄组患儿,差异有统计学意义(χ2=23.54,P0.01)。结论卫辉市急性呼吸道感染住院患儿发病的主要病毒为呼吸道合胞病毒和流感病毒,患儿的临床症状存在一定程度的差异。     

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.