388例HIV／AIDS患者临床特点与机会性感染发病谱

目的了解本地HW／AIDS患者的一般情况、传播途径,分析其临床特点,总结出本地艾滋病患者的机会性感染发病谱从而指导早期诊断和治疗。方法对长沙市传染病医院2003年4月-2009年8月底收治的388例HIV／AIDS患者进行回顾性分析。结果388例HIV／AIDS患者以农民、小城镇外出打工人员为主;主要传播途径为性传播;40．98％的患者胸片检查异常,绝大多数的患者CD4^＋T淋巴细胞〈200个／tA;最常见的临床症状为发热、体重减轻、咳嗽、慢性腹泻、皮肤病变及淋巴结肿大;机会性感染发生率为91．75％,最常见的机会性感染是口腔真菌感染（占54．12％）,肺部感染（占45．10％）（其中包括卡氏肺孢子虫肺炎及肺结核）,合并感染结核者占36．08％（包括肺结核及肺外结核）。结论本地HIV／AIDS的人群以农民、打工人员为主,传播途径主要是性传播;机会性感染以鹅口疮最为常见,其次为肺部感染,且表现为多系统、多种致病微生物并存,细菌、真菌、病毒均为常见病原,呼吸、消化系统以及皮肤软组织为常见感染部位。     

862例HIV／AIDS住院患者统计分析

目的了解1998-2006年HIV／AIDS住院患者的基本情况、感染途径以及主要的机会性感染，为广西地区防治和研究艾滋病提供基础数据和信息。方法提取1998-2006年HIV／AIDS住院患者862例归档病案进行统计分析。结果HIV／AIDS患者中男性居多，占83．76％，农民和无业者占75．52％；感染的主要途径为吸毒和性传播，夫妻感染呈现上升趋势；结核病、口腔真菌感染、丙肝和肺孢子菌病是主要的并发症。结论HIV／AIDS患者逐年增加，近2年增加幅度更大，并由高危人群向普通人群扩散。     

服务行业女性从业人员性病、艾滋病认知调查

目的了解深圳市某娱乐场所从业人员的人口学状况、行为特征及对HIV／AIDS相关知识的知晓程度。方法利用随机抽样方法，对深圳市某社区13家娱乐场所的245名女性从业人员进行性病、艾滋病知识的宣传教育；教育前后进行现场调查。结果首次性生活年龄最小13岁、最大25岁，中位数19岁；曾自愿接受HIV抗体检测占9．2％；经常使用安全套的仅占13．6％；教育前：HIV／AIDS相关知识知晓率2．0％（5／245）；HIV/AIDS经性传播相关知识知晓率22．0％（54／245）；教育后：HIV/AIDS相关知识知晓率16．7％（41／245）；HIV／AIDS经性传播相关知识知晓率35．5％（81／245）。结论娱乐场所从业人员对性病、艾滋病相关知识的了解和安全性行为的认知度低。有必要加强教育，以减少该人群性病和艾滋病的发生。遏制性病、艾滋病由高危人群向一般人群的蔓延。     

132例艾滋病机会性感染临床特征分析

[目的]分析云南省红河州艾滋病（AIDS）机会性感染的临床特点。[方法]回顾性分析本院1998年6月～2007年6月收治的132例艾滋病病例的临床资料，总结艾滋病机会性感染的临床特点。[结果]132艾滋病病例中，机会性感染结核病84例，占63．6％，真菌感染58例，占40．9％，HIV／HCV合并感染46例，占34．8％，带状疱疹、沙门氏茵感染、致病性大肠埃希杆菌肠炎、金黄色葡萄球菌肺炎、弓形虫脑病亦有发病。[结论]艾滋病机会性感染临床表现复杂多样，结核病是最常见的机会感染，其次是真菌感染，HIV／HCV合并感染率高。     

广州地区10年入境境外人员中HIV/AIDS的流行病学调查及国内传播危险因素分析

[目的]了解广州地区入境境外人员中HIV／AIDS的感染、罹患情况，流行病学特征，评估HIV／AIDS引发国内人群传播和流行的风险性。[方法]对1996-2005年发现的HIV／AIDS资料进行回溯性流行病学调查，分析其可能引发在国内人群传播和流行的各种危险因素。[结果]10年间共发现HIV／AIDS43例，检出率为0．10％。其中HIV-1感染41例，HIV-1＋2感染2例；被诊断为艾滋病病人的4例，其中已死亡2例；HIV感染并发梅毒6例。通过性接触（同性屏性）和吸毒感染的28例（占65．12％）；手术输血感染2例（占4．65％），否认感染史或未接受流行病学调查13例（占30．23％）。他们在中国（境内）平均居留290d，承认在我国（境内）有性伴侣／不洁性接触史的有15例（占性接触感染者的53．57％），性伴侣最多的达50多个，最少的也有2个。[结论]艾滋病正通过入境境外人群不断地从境外传入国内，造成国内人群传播和流行的风险性日益增大。     

重庆市228例首诊AIDS住院患者流行病学及临床特征分析

目的通过对重庆市公共卫生医疗救治中心首诊艾滋病（acquired immunodeficiency syndrome，AIDS）患者的病例档案资料进行整理分析，探讨重庆市AIDS患者的流行病学及临床特征，为临床治疗和疾病控制的深入研究提供科学依据。方法检索重庆市公共卫生医疗救治中心（重庆市唯一一家收治AIDS的定点医院）1995年12月～2008年12月AIDS患者的病例档案，对AIDS首诊住院患者的病例档案进行归类整理，采用统计学方法对病例的年龄、性别、职业、传播途径和临床症状等分布特征进行描述。结果从1995年12月至2008年12月，重庆市公共卫生医疗救治中心首诊AIDS确诊患者共228例，其中1995年为1例，2008年为91例；病例以重庆市区及邻近的区县为主（占78．51％）；男女比例为2．30：1；30～50岁占72．81％，年龄最小为7个月，最大为92岁；异性性接触为主要传播途径（70．18％），其次为静脉吸毒（12．72％）；临床以机会感染症状为主要表现，其中结核分枝杆菌感染占60．53％（138／228），合并肺部细菌感染（包括葡萄球菌、链球菌、肺炎球菌等），占57．89％（132／228）；口腔白色念珠菌病，占46．93％（107／228）；临床检验中CD4淋巴细胞计数〈50个／μl 140例、50～200个／μl 70例、〉200个／μl 18例。结论重庆地区艾滋病疫情呈加速上升趋势，应当加大市区及邻近区县青壮年人群的AIDS控制力度，重视异性性传播的干预；患者第一次入院多因机会性感染就诊，临床医生必须提高对AIDS的警觉性。     

2005-2008年兴文县HIV／AIDS流行病学分析

目的了解2005_2008兴文县年HIV／AIDS的流行病学特征。方法监测兴文县境内2005-01一01／2008．12-31HIV／AIDS高危感染人群,对兴文县疾病预防控制中心初筛后经四川省疾病预防控制中心确认的HIV／AIDS患者进行流行病学分析。结果2005m1一01／2008-12-31初筛高危人数11341人,经确认的HIV／AIDS为37例,占初筛人数的0．33％（37／11341）,占该县总人口数8．40／10万（37／44万）,TB／HIV人数为5例,占初筛的0．04％,占HIV／AIDS的13．51％;HIV／AIDS中农村人口占67．57％（25／37）,城市人口占32．43％（12／37）;发病前3位的职业分别为农民／民工48．65％（18／37）、FSW（女性商业性工作者）18．92％（7／37）、无业13．51％（5／37）。男性发病人数高于女性,分别为64．86％（24／37）和35．14％（13／37）,发病高峰期年龄段为20～50岁,占86．49％（32／37）;37例患者通过性传播途径,注射吸毒传播、母婴垂直传播及其他传播途径感染HIV／AIDS分别为25例、9例、1例和2例,患者中初中及以下文化程度占81．08％。结论兴文县HIV／AIDS患者以性传播感染为主,男性高于女性,发病人群主要集中在文化程度较低的农民／农民工和FSW,发病高峰期年龄为青壮年。     

连云港市1996-2005年HIV/AIDS流行病学分析

目的探讨连云港市HIV／AIDS流行病学特征。方法收集1996-2005年发现的22例HIV／AIDS流行病学资料进行分析，HIV／AIDS诊断按GB16000—1995国家标准。结果22例HIV／AIDS感染者（病人），1例为外籍希腊船员，余均为中国本土人，其中本市籍17人（77．3％）；年龄除外籍船员52岁，中国人均在21-46岁，AIDS发病最小年龄21岁（女）；HIV携带者最长已达11a；性传播是本市HIV／AIDS的主要传播途径（86．4％），其中配偶间传播2对；HIV／AIDS发现途径有义务献血（3例），性病门诊（5例），注射吸毒者（5例），术前筛查（2例），AIDS早期症状（4例），归国体检（1例）。结论改变HIV／AIDS感染者（病人）以及具有感染HIV危险行为人群的高危险行为，是控制AIDS流行的有效措施。     

对北京护理人员HIV／AIDS的知识、态度调查和HIV／AIDS医源性暴露风险评估

目的：了解北京护理人员对HIV／AIDS的知识、态度以及评价医源性HIV／AIDS暴露的风险。方法：以分层随机抽样的方法，对北京市6所医院的1300名护理人员进行问卷调查，了解其对HIV／AIDS的知识、态度及医院对侵袭性医疗器械的使用、收集、消毒情况；对北京地坛医院艾滋病病房的全体护理人员（22人）进行问卷调查，做HIV／AIDS医源性暴露情况的10年回顾性研究。结果：90．3％以上的护士对HIV／AIDS有很全面的认识，但仅31．8％的护士愿意给艾滋病患提供全护理，好们掌握HIV／AIDS知识的程度与愿意接纳艾滋病患的态度之间不呈正相关（P＜0．05）；从事HIV／AIDS工作的护理人员“侵袭性医疗操作”误伤率31．8％；北京市各级医院中侵袭性医疗器械重复使用率1．3％－27．1％。收集用过的侵袭性医疗器械的容器，不符合安全标准的占33．3％，消毒用过侵袭性医疗器械的程序不正确的占17．2％。结论：北京护士掌握HIV／AIDS知识较好，但对HIV感染／AIDS患仍有相当的排斥。进行侵袭性医疗操作及使用、收集、消毒侵袭性医疗器械的过程中也存在HIV／AIDS医源性暴露的风险。制定有关的医疗防护政策是必要的。     

娱乐场所女服务员性病艾滋病知识和高危行为调查

目的 调查龙岩市娱乐场所女服务员性病艾滋病知识掌握情况及与HIV感染相关危险行为发生状况，探讨HIV／AIDS流行趋势，为制定适合本地情况的HIV／AIDS干预措施提供科学依据。方法 分层随机抽取娱乐场所女服务员456人为调查对象，采用问卷调查进行AIDS有关知识、避孕套使用及高危行为的调查。结果 89．7％的女性服务员曾提供过商业性服务，女性服务员对经血、性接触传播途径认识率较高，分别为56．8％和55．9％，但仅有34．2％的人认为母婴传播能感染艾滋病；在过去的一个月中与朋友发生性关系每次都使用避孕套的占12．9％，最近一次性生活使用的占32．7％。结论 龙岩市娱乐场所女服务员提供性服务的比率较高，且AIDS知识知晓率低，应在娱乐场所女服务员开展STD／AIDS防治知识和安全性行为的宣传教育活动，并实施干预，以减少HIV的性传播。     

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.     

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.     

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.     

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.     

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.