流行性脑脊髓膜炎的预防与控制

流行性脑脊髓膜炎(流脑)是脑膜炎奈瑟菌(Nm)感染引起的急性传染病。Nm为需氧、革兰氏染色阴性双球菌,根据荚膜多糖抗原的不同,可分为13个血清群,致病的血清群主要为A、B、C群,Y、W135群的发病在一些国家有增加趋势。A、B、C、Y、W135、X群都可引起爆发,但以A群最常见,且常引起大范围的流行,特别是在非洲流行带地区。1临床表现与诊断Nm感染可有多种临床表现,如肺炎、关节炎、菌血症、脑膜炎等,脑膜炎是最常见的表现形式[1]。流脑潜伏期为2~10d,一般3~4d。临床表现主要有急性发热、剧烈头痛、恶心、呕吐、颈强直、畏光、皮肤瘀斑等。10…     

吕梁市健康人群抗脑膜炎奈瑟菌抗体监测分析

流行性脑脊髓膜炎（简称流脑）是由脑膜炎奈瑟菌（neisseria eningitides,Nm）感染引起的急性呼吸道传染病,多发生于15岁以下儿童。根据Nm荚膜多糖的特异性将Nm分成13个血清群,所有血清群均可致病,但以C群致病力最强,     

ACYWl35群脑膜炎球菌多糖疫苗应用指南

流行性脑脊髓膜炎(流脑)是脑膜炎奈瑟菌(Neisseria meningitidis，Nm)感染引起以脑膜炎和败血症为主要临床表现的呼吸道传染病。     

中国2006年流行性脑脊髓膜炎监测结果分析

目的分析中国(未包括香港、澳门特别行政区和台湾地区,下同)2006年流行性脑脊髓膜炎(流脑)重点监测省及国家级监测点流行病学监测和实验室监测结果,评价流脑监测现状,为预防控制流脑爆发、流行及探索经济有效的预防控制策略提供依据。方法利用重点监测省及监测点上报的资料、中国疾病预防控制中心(CDC)传染病预防控制所国家流脑实验室检测资料及法定传染病报告系统的资料,对2006年监测结果进行分析。结果全国2006年流脑报告发病率<0.2/10万,重点监测省中以安徽省发病数较多(261例);监测重点省<15岁儿童平均发病率为0.45/10万,儿童、学生报告病例数分别占重点监测省报告病例总数的25.35%和41.31%。重点监测省报告病例中检出A群脑膜炎奈瑟菌(Neisseria meningitidis,Nm)占44.83%,C群Nm占41.38%;健康人群中检出A群Nm占17.76%,B群Nm占48.68%,C群Nm占17.11%;健康人群A群Nm抗体阳性率平均为78.36%,C群为58.67%。结论流脑流行菌群仍以A群Nm为主,C群Nm检出增多;健康人群带菌以B群Nm为主,C群Nm抗体阳性率明显低于A群。应针对薄弱环节,继续加强流脑监测,防止流脑爆发、流行。     

潍坊市健康人群A、C群脑膜炎奈瑟菌抗体水平调查

目的 了解潍坊市健康人群A、C群脑膜炎奈瑟菌(Nm)抗体水平,为制定预防控制流行性脑脊髓膜炎(流脑)措施提供依据.方法 采用分层随机抽样方法 ,在5个县市区共采集1 125名健康人群血清标本,应用酶联免疫吸附试验检测A、C群Nm抗体.结果 调查的1 125名健康人群中,A群Nm抗体阳性率22.58%(254/1 125),几何平均滴度(GMP)为1:1.70;C群Nm抗体阳性率11.73%(132/1 125),GMP为1:1.30.结论 潍坊市健康人群A、C群Nm抗体水平均较低.     

鉴别脑膜炎奈瑟菌A、B、C、Y、W135群的多重聚合酶链反应诊断方法

目的建立一种能鉴别脑膜炎奈瑟菌（Nm）A、B、C、Y、W1355个血清群的多重聚合酶链反应（PCR）方法.方法首先PCR扩增Nm crgA基因,确定Nm感染;再通过多重PCR扩增荚膜表达基因orf-2和siaD基因,根据特异条带区分不同群Nm.结果多重PCR检测61株Nm与4株非Nm,能准确地鉴定并可将Nm分成5个血清群;检测4例流行性脑脊髓膜炎患者的脑脊液,2例出现A群400 bp的特异条带,而细菌培养和胶乳凝集方法检测均为阴性;检测18份流行性乙型脑炎患者标本,与胶乳凝集试验结果一致.结论多重PCR诊断方法能正确鉴别不同群Nm,对流行性脑脊髓膜炎的临床诊断与流行病学调查有重要意义.     

山东省首例C群流行性脑脊髓膜炎死亡病例病原学分析

目的 对山东省首例C群流行性脑脊髓膜炎(流脑)死亡病例进行病原学分析.方法 对山东省首例C群流脑病例进行流行病学调查,标本采集,菌株分离、鉴定、血清学分群及药物敏感性检测,并进行脉冲场凝胶电泳(Pulse Field Gel Electrophoresis,PFGE)和多位点序列分型(Muhilocus Sequence Typing,MLST)分析.结果 山东省首次从流脑病人脑脊液中分离到C群脑膜炎奈瑟菌(Neisseria Meningitidis,Nm),该菌株对环丙沙星、左氧沙星、复方新诺明耐药.PFGE分析为AH30型,MLST分析为ST-3200型.结论 从山东省首例C群Nm引起死亡病例的腩脊液中分离的菌株,其基因型为ST-3200型,是中国首次发现的C群ST-3200型菌株.应加强对C群Nm的监测,密切关注C群流腩的发病及流行趋势.     

海南省健康人群抗脑膜炎奈瑟菌抗体监测分析

目的 了解海南省健康人群抗脑膜炎奈瑟菌(Neisserid meningitides,Nm)感染的抗体水平.方法 按<海南省流行性脑脊髓膜炎(流脑)监测方案>的要求,于2006年采集海口市琼山区、东方市、儋州市各年龄组健康人群的静脉血676份,采用酶联免疫吸附试验测定血清中A群和C群Nm多糖抗体(IgG),抗体含量≥2μg/ml为保护性抗体.结果 676份血清中,A群IgG抗体≥2μg/ml者420人份,保护率为62.13%;C群IgG抗体≥2μg/ml者195人份,保护率为28.85%.不同年龄组人群Nm多糖抗体水平差异有非常显著的统计学意义(X2A=72.64,X2C =56.47;P均<0.01),其中35～45岁组Nm多糖抗体水平最高.不同地区A群Nm多糖抗体保护率差异有非常显著的统计学意义(X2=54.76,P<0.01).但C群Nm多糖抗体保护率差异无显著的统计学意义(X2=3.92,P>0.05).结论 海南省部分地区健康人群A群Nm IgG抗体处于中等水平,C群Nm IgG抗体处于较低水平.建议加强脑膜炎球菌多糖疫苗(menignococcal polysaceharide vaccine,MPV)的接种,同时推广使用A C群MPV.     

正常人群A、C群脑膜炎奈瑟氏菌免疫水平调查

[目的]了解盐城市正常人群A、C脑膜炎奈瑟氏菌(Nm)抗体水平状况,为制定流行性脑脊髓膜炎(流脑)防控措施提供依据.[方法]选择流脑发病水平不同的3个地区,按不同的年龄组采集一定数量的血清标本,采用酶联免疫吸附试验(EHSA)检测A、C群Nm抗体.[结果]在调查的正常人群中,A群Nm抗体阳性率为60.31%(541/897),几何平均滴度(GMT)为1:7.79;C群Nm抗体阳性率为40.05%(34/854),GMT为1:2.06.A、C群Nm抗体水平均处于较高的水平,相对而言,A群Nm抗体水平更高,这与长期以来广泛接种脑膜炎菌多糖疫苗有关.[结论]接种A、C群脑膜炎菌多糖疫苗效果是非常明显的,对预防和控制流脑具有重要的意义.     

山东省2005～2007年流脑疫情病原学监测及分析

目的:分析山东省2005/2006年度(2005年10月～2006年9月)、2006/2007年度(2006年10月～2007年9月)流行性脑脊髓膜炎(流脑)疫情病原学监测结果,了解脑膜炎奈瑟菌(Nm)菌群分布、变异状况及耐药性特征.方法:对2005/2006、2006/2007年度流脑病例脑脊液和密切接触者咽拭子标本,用Nm双抗培养基分离培养,进行生化试验、血清学鉴定、乳胶凝集试验及药物敏感性监测.结果:2005/2006年度共培养鉴定出Nm C群13株,A群3株;2006/2007年度共培养鉴定出C群3株,A群1株.A群和C群表现出不同的耐药特征.结论:山东省2005～2007年的流脑疫情以C群为主,应密切注意C群流脑扩散趋势,进一步加强流脑病原学及Nm耐药特征监测.     

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.