桂林市厨师职业人群SARS血清流行病学调查

1 调查资料从事厨师职业3 mo上及不接触生肉加工的非厨师职业如零售服务员、餐厅服务员及旅馆服务员共计464(男212,女252)人. 按卫生部《非典型肺炎病例实验室检测标本采集技术指南(试行)》采集新鲜血清样本并进行灭活处理.     

从SARS暴发流行及其防治工作中引发的几点思考

2003年冬春季在我国许多省市严重急性呼吸综合征(SARS)暴发流行，目前疫情趋缓，但远未结束，或许有些地方还刚刚开始。我们在与SARS进行紧张而顽强的搏斗，同时在思考一系列与此次SARS暴发流行及其防治工作相关的一些问题。     

某医院医务人员院内感染SARS的流行病学调查及分析

目的 调查某医院医务人员院内感染SARS的流行病学特征。方法 对此次SARS院内感染的相关人员进行流行病学调查。结果 共13例护理人员发生院内SARS感染,输入性传染源为一女性肿瘤患者的丈夫,这名确诊SRAS的丈夫在发病期间与其妻至少有2周医院内密切接触史。13例中8名是后来借调入该肿瘤患者入住科室的,她们感染SARS的平均潜伏期为12.6 d。对与13例SARS病例在潜伏期内(1例为发病早期)有密切接触者共57人进行追踪观察1月,结果无1例感染SARS。结论 SARS病人在潜伏期没有传染性或传染性不大。感染SARS与接触传染源的程度以及持续接触时间有关。SARS的发病可能与机体的免疫状况有关,SARS的病理基础可能与免疫损害有关。免疫抑制病人可能成为SARS的无症状病毒携带者和传染源。     

1601例医院感染病例流行病学调查

目的：为了解医院感染与临床科室及易感人群的相互关系，采取有效控制措施，降低医院感染率。方法：对１９９７年、１９９８年住院病例进行回顾性调查。结果：医院感染多发于血液、造血、循环及内分泌系统的科室。血液肿瘤患及６０岁以上和１４岁以上的患是造成医院感染的主要人群。感染部位以呼吸道为主（５９．７８％）。结率：提醒要加强支持疗法，增强病后的感染能力，对病区管理及病房消毒应予以高度重视。     

江门市某医院职工SARS血清流行病学调查

目的了解江门市定点收治SARS患者的某医院职工SARS血清流行病学情况。方法分别在流行终止后半年和1年半采用酶联免疫吸附试验（ELISA）检测医院职工血清SARS冠状病毒抗体IgG。结果半年后的检测结果中，临床确诊病例组阳性率为82．6％，疑似及医学观察病例组5．9％，SARS病区医务人员组和其余人员组均为阴性，临床确诊病例组与其它组之间阳性率的差异有显著性（P〈0．01）；1年半后临床确诊病例组阳性率为73．9％，其他各组SARS—CoV抗体IgG阳性率无明显变化。结论临床确诊病例血清SARS—CoV抗体IgG阳性率较高，1年半后仍有89．47％检出SARS—CoV抗体。     

对SARS流行病学调查工作的体会

去冬今春以来,一场突如其来的大灾难波及我国部分省区及世界20多个国家和地区。是一种人类过去从未发生过的传染病。在疫情开始处理前一个月即组建了流调大队,集中封闭办公。对全市176例医院报告的SARS病例、疑似病例及SARS患者开展了流行病学调查,对120余例发热门诊可以发热病例进行了流行病学调查。通过这次流调,更进一步体会到流调报告的重要性:流调工作是预防和控制传染性疾病的的核心手段其诊断治疗以及控制传染源,切断传播途径,保护易感人群都离不开流行病学的支持。上海,广东来的专家,省卫生厅流调检查组、世界卫生组织官员、卫生部的技术官员及传染病执法检查组对成功的流调工作给予高度评价。     

SARS过后对流行病学的再思考

虽然今年SARS流行已经过去,但大多数人们对流行病学概念的认识并不因为它曾经“流行”而真正理解,经过流行病学回顾性的描述性研究方法与SARS流行期间人们对病原体、传染源、传播途径、易感人群认识及所采取的措施等实例相结合进行分析．目的是以SARS作为例子阐述流行病学概念,并从经验教训中认识流行病学实用性．流行病学研究范围不仅涉及传染病,而且也涉及广大民众关注的各类与健康有关的问题．它是一种方法学,是医学领域中的哲学,它来自于多学科,形成规律后指导并应用于这些学科．     

禽流感与高致病性禽流感流行病学

禽流感(avian influenza)是禽流行性感冒的简称，又称真性鸡瘟或欧洲鸡瘟，主要发生在鸡、鸭、鹅、鸽子等身上，是一种从呼吸病到严重性败血症等多种症状的急性传染病。这种症状上的不同，主要是由禽流感的毒型决定的。根据禽流感致病性的不同，可以将其分为高致病性禽流感、低致病性禽流感和无致病性禽流感。     

2003年北京市东城区SARS爆发流行特征

目的 分析2003年3月～5月间北京市东城区严重急性呼吸综合征(severe acute respiratory syndrome,SARS)爆发流行特征。方法 根据东城区疾病预防控制中心的疫情日报表,以及从其他渠道收集补充的信息进行分析。病例的诊断按照卫生部颁布的标准。用Excel软件建立数据库,用SPSS软件统计分析。结果 东城区首例发生于3月14日(3月16日人院),至4月中、下旬发病达高峰,5月5日开始下降,5月22日后未再发生新的临床诊断病例,5月24日、6月10日曾发生3例疑似SARS,后均被排除。共报告572例住院,99例在住院治疗过程中因被确诊为上感、普通肺炎、出疹性疾病等排除了SARS的诊断,实有473例SARS及疑似SARS。各年龄组人群普遍易感,以20～50岁最多,占总病例数的68．7％,平均发病年龄为40．7岁。病例的男女比例差异无显著性。SARS病例呈现明显的家庭聚集现象。医务人员病例占总数的18．0％,离退休人员占15．4％。全区10个街道均有病例发生。按常住人口计算,罹患率为28．3／10万。报告病例中,先后在区属二级医院住院的230例,占40．2％。85例医务人员SARS及疑似SARS病例中,18例发生在四所区属二级医院,占其在SARS病房或发热门诊工作的医务人员总数的4．5％。34．7％的SARS病例在病前无任何接触史。4l例SARS病例死亡,病死率8．7％。SARS病例的密切接触者罹患率为7．4％。结论 2003年3月～5月间东城区爆发流行SARS,人群普遍易感,主要威胁青壮年、医务人员、离退休人员。与患者直接接触是主要的传播方式。民工集中的建筑工地、医院是SARS防控的重点。现行的防治策略和措施对控制SARS流行是有效的。     

香港医护人员SARS流行因素研究

目的评价流行病学相关因素对香港特区医护人员SARS流行的影响。方法采用构筑式多元逐步回归和Logistic逐步回归法评估气象、时间、各类SARS病例、干预措施和医院感染等因素对香港医护人员SARS流行的影响。结果在消除其他因素的可能影响后，日平均气温每上升1℃，香港医护人员SARS每日病例可能下降约0．7例。在港府加强前线医护人员的防护装备后，医护人员SARS每日病例可能减少5．4例。随着时间的推延，医护人员SARS每日病例可能减少约0．1例。ICU的SARS病人每增加100例，医护人员SARS每日病例可能增加约3例。日平均气温低于24．6℃时，医护人员SARS爆发的危险性是平均气温高于24．6℃时的18．18倍。港府加强前线医护人员防护装备之前，医护人员爆发SARS的估计危险性是防护装备加强后的15．87倍。结论日平均气温、加强防护装备、流行时间及ICU的SARS病人可能对医护人员SARS的流行构成影响。     

Outcome of severely injured trauma patients at a designated trauma centre in the Hong Kong Special Administrative Region

Background The Hong Kong Special Administrative Region （HKSAR） of the People＇s Republic of China （PRC） has seen significant changes in its trauma service over the last ten years including the implementation of a regional trauma system. The author＇s institution is one of the five trauma centres designated in 2003. This article reports our initial clinical experience. Methods A prospective single-centre trauma registry from January 2004 to December 2008 was reviewed. The primary clinical outcome measure was hospital mortality. The Trauma and Injury Severity Score （TRISS） methodology was used for bench-marking with the North America Major Trauma Outcome Study （MTOS） database. Results There were 1451 patients. The majority （83.9%） suffered from blunt injury. The overall mortality rate was 7.8%. Severe injury, defined as the Injury Severity Score 〉15, occurred in 22.5% of patients, and was associated with a mortality rate of 31.6%. A trend of progressive improvement was noted. The M-statistic was 0.99, indicating comparable case-mix with the MTOS. The Z- and W-statistics of each individual year revealed fewer, but not significantly so, number of survivors than expected. Conclusions Trauma centre designation was feasible in the HKSAR and was associated with a gradual improvement in patient care. Trauma system implementation may be considered in regions equipped with the necessary socio-economic and organizational set-up.     

Phenylketonuria in Hong Kong Chinese: a call for hyperphenylalaninemia newborn screening in the Special Administrative Region, China

Hyperphenylalaninemia is one of the commonest inborn errors of metabolism affecting approximately 1 in 15 000 live births. Among Chinese, BH4 deficiency leading to hyperphenylalaninemia is much commoner than in Caucasians. Exact diagnosis is important for the treatment and genetic counseling. In 2000, newborn screening for phenylketonuria is mandatory by law in China throughout the whole country. However, it is not yet included in the newborn screening program of the Hong Kong Special Administrative Region, China. Published data on hyperphenylalaninemia among Hong Kong Chinese are largely lacking. We report a 1-year-old Hong Kong Chinese girl with severe 6-pyruvoyl-tetrahydropterin synthase (PTPS) deficiency. The patient presented with infantile hypotonia and was misdiagnosed as cerebral palsy. She had very mild hyperphenylalaninemia (95 µmol/L), significantly high phenylalnine-to-tyrosine ratio (3.1), and elevated prolactin of 1109 mIU/L. Genetic analysis confirmed a homozygous known disease-causing mutation PTS NM_000317.1: c.259C>T; NP_000308.1: p.P87S in the proband. In our local experience, while the estimated prevalence of hyperphenylalaninemia due to PTPS deficiency was reported to be 1 in 29 542 live births, not a single case of phenylalanine hydroxylase deficiency has been reported. Furthermore, there is a general lack of awareness of inherited metabolic diseases in the community as well as among the medical professionals. Very often, a low index of clinical suspicion will lead to delay in diagnosis, multiple unnecessary and costly investigations, prolonged morbidity and anxiety to the family affected. We strongly recommend that expanded newborn screening for hyperphenylalaninemia should be implemented for every baby born in the Hong Kong Special Administrative Region, China.

     

A prospective epidemiological study on tinea pedis and onychomycosis in Hong Kong

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香港的中医药发展

从制定管理制度和标准、设立良好的教育及培训系统、设立优质中医药诊疗中心、促进科研和创新、推动产业发展、未来工作方向6个方面全面论述了香港的中医药发展。     

香港医院的手术核对工作透视

手术室核对制度作为手术室核心制度之一,是医疗安全制度的一个重要组成部分。笔者在香港公立医院手术室为期10个月的实践中,对香港医院手术室的患者核对工作有了深入的了解和体会; 同时也了解到世界卫生组织正在为规范手术核对进行一系列的改革尝试。本文介绍并分析了香港手术室患者核对方法、手腕带的使用、如何执行和记录,希望可以为改革和完善手术室的核对制度和规范核对流程提供参考。     

Awareness and knowledge of hepatitis B infection and prevention and the use of hepatitis B vaccination in the Hong Kong adult Chinese population

Background  Hepatitis B virus (HBV) infection remains a global public health problem and it is an important cause of acute, chronic and fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma. The prevalence of HBV infection in Hong Kong over the past decade remained unchanged at 10%, despite the implementation of universal neonatal and availability of adult vaccination. We suspect that the current state of affairs is attributable to inadequate awareness and knowledge of HBV transmission and prevention in the general population, resulting in a low rate of uptake of HBV vaccination by the lay public. Therefore, we have embarked in this study to evaluate the awareness and knowledge on HBV infection in our local Chinese population, their attitude on the prevention of horizontal transmission of HBV, and the use of HBV vaccination, especially in those who were born before the era of universal neonatal vaccination.

Methods  The factors associated with HBV screening, vaccination uptake, and knowledge were examined in a face-to-face questionnaire survey on a group of adult Chinese in Hong Kong.

Results  Within this group, 14% was considered to have good knowledge for HBV infection, and 26% had HBV vaccination. Age, occupation, having children, and family monthly income, are independent factors associated with vaccination.

Conclusion  This study suggests insufficient public awareness of HBV infection in the Hong Kong Adult Chinese population.

     

Clinical characteristics of adult epilepsy patients in the 1997 Hong Kong epilepsy registry

Objective　To study the clinical characteristics of 2952 patients with epilepsy who had received drug treatment from the neurology outpatient clinics of eight major hospitals in Hong Kong. Methods　Retrospective review of outpatient records. Results　1601 (54.3%) males and 1351 (45.7%) females with a median age of 35.8 years (range, 10-94.8) were studied. Seizure types included generalized tonic-clonic in 80.7% of patients, complex partial in 28.3%, simple partial in 14.4%, atypical absence in 2.6% and myoclonic in 1.4%, and 30.4% of patients had more than one seizure type. EEG, CT brain, MRI brain and neuropsychological evaluation were obtained in 81.2%, 61.7%, 17.0% and 2.2% of patients, respectively. The etiology of epilepsy was cryptogenic in 59.9%, symptomatic in 35.1% and idiopathic in 3.9%; the commonest were intracranial infection, cerebral vascular disease, cranial trauma and perinatal insult. Phenytoin, carbamazepine and valproate were the most frequently used drugs and 25.9% of patients were taking more than two drugs. 48.3% of patients had active seizures in the past six months and 26.4% were considered to have unsatisfactory control of their epilepsy. Medical refractoriness of epilepsy was associated with a history of perinatal insult, intracranial infection, congenital brain malformation, intracranial neoplasm, cerebral vascular disease, hippocampal sclerosis, mental retardation and a history of status epilepticus (P<0.05). Conclusion　In this local cohort of adult patients with epilepsy under specialist care, there were a considerable number of patients falling into the category of cryptogenic epilepsy. Risk factors associated with medical refractoriness are similar to previous studies.     

香港理工大学《功能解剖》授课模式的启示

通过介绍香港理工大学知名教授进行《功能解剖》教学时的授课模式和授课特点,并归纳其带来的教学启示,从而增加对香港理工大学《功能解剖》授课模式的了解,为高校以后开展《功能解剖》教学提供参考。     

香港中文大学与中山大学医学教育课程教学的比较

以香港中文大学和中山大学为代表,分别从理论课、实验课授课情况以及临床教学开展情况对粤港医学教育课程教学进行比较,发现两校的课程结构各有优势与不足,应互相借鉴以共同提高。而重视早期接触临床和实践教学,为医学生成为合格的临床医生奠定坚实基础则是两校的共同点。