山东省2003～2005年艾滋病确认实验室检测指标分析

目的：分析山东省艾滋病实验室检测的有关指标及相关资料，为艾滋病防治提供依据。方法：采用EXECL数据库和SPSS11．5统计软件对山东省21303～21305年艾滋病实验室检测数据和网络直报个案资料进行整理、分析。结果：21303～21305年我省累计报告艾滋病病毒（HIV）感染者703例，其中外来人员376例，占总数的53．5％。结论：应进一步加强艾滋病检测实验室网络建设，积极组织有针对性的HIV抗体专项调查工作，尤其是加强对流动人口、外来妇女的监测，尽快发现HIV感染者，有效遏制艾滋病的传播。     

Public health surveillance and knowing about health in the context of growing sources of health data

The past decade has brought substantial changes in how data related to a community's health are collected, stored, and used to inform decisions about health interventions. Despite these changes, the purpose of public health surveillance has remained constant for more than a century. Public health surveillance is the ongoing, systematic collection, analysis, and interpretation of health-related data with the a priori purpose of preventing or controlling disease or injury, or of identifying unusual events of public health importance, followed by the dissemination and use of information for public health action. Surveillance is an important and necessary contributor to knowledge of a community's health. The public health system is responsible for ensuring that public health surveillance is conducted with appropriate practices and safeguards in order to maintain the public's trust.     

Medical surveillance of workers previously exposed to asbestos

According to current Italian law health surveillance of workers exposed to asbestos in the past must be maintained even after cessation of asbestos exposure (D.Lgs. 277/91). The law, however, makes no reference to timescales or time limits for clinical monitoring, nor to who is responsible. The main aims of health surveillance of individuals formerly exposed to asbestos can be summarized as follows: early diagnosis of the principal diseases associated with asbestos; counselling for workers; work-related disease certification; epidemiological studies. Medical check-ups entail a complete personal and work history, Chest X-Ray, respiratory function tests, TLCO. In all cases the worker must undergo a LDCT. We propose two new possible biological markers for the health surveillance of past-exposed patients: serum mesothelin and osteopontin.     

Recommendations for the investigation of abnormal hepatic function in asymptomatic workers.

Occupational medicine programs use medical surveillance tests to measure physiologic parameters that may be affected by workplace exposures. Surveillance tests can detect early detrimental changes before workers manifest recognizable symptoms. Hepatic function testing is one type of surveillance test used to monitor workers exposed to hepatotoxins. However, a significant proportion of these test reports return showing abnormal hepatic function without a readily apparent etiology. Follow-up investigation of abnormal liver enzyme tests is a commonly encountered problem in occupational medicine clinics. The algorithm proposed in this paper will outline a systematic approach for investigating abnormal hepatic function tests from asymptomatic workers.     

Use of an Interatrial Baffle To Correct Transposition of the Great Arteries

Despite the difficulties of operating on small and sick babies, definitive surgery for CTGA should be undertaken as early as possible to minimize the detrimental changes in the pulmonary vasculature. The case presented was diagnosed at birth, an immediate palliative procedure carried out, and the child placed under close cardiologic surveillance until, at age 12 months, it was apparent nothing more could be gained by waiting.     

试论我国食品安全问题现状及对策

目的：了解我国食品安全问题,探讨可能的解决策略,以期改善我国食品安全问题现状。方法：通过查阅文献及相关资料,对我国食品安全问题现状进行分析并提出相应对策。结果：我国食品安全问题层出不穷,生化因素、新技术因素、制度及管理因素以及法律因素是问题发生的几种主要原因。结论：我国食品安全问题现状亟待改善,对于不同食品安全问题根据具体原因而制定的针对性策略包括：构建食品安全评估和预警系统、完善食品安全相关法律体系、制定相应政策措施和构建毒物发现、监测的新技术及新方法。     

Weight change and lung function: implications for workplace surveillance studies.

This study evaluated the relationship between weight change and longitudinal measurement of lung function among 361 men providing at least five pulmonary function tests. The men in this study were participants in a workplace pulmonary surveillance program for subjects with exposure to refractory ceramic fibers (RCFs). Occupational and environmental studies are generally designed to evaluate factors suspected of causing excess decline in lung function. Failure to adequately account for all significant factors may lead to erroneous conclusions regarding change in lung function. This study utilized two different statistical models to evaluate longitudinal changes in a cohort of RCF workers. What was unique to this study was the modeling of longitudinally measured initial weight, weight change, and longitudinal exposure before and during the period of observation. Results showed a strong relationship between weight gain and longitudinal loss in lung function that approximated forced vital capacity declines of 16 mL for every kilogram of weight gain per year in both models. This value is comparable or greater in magnitude and significance to other factors known to be inversely related to lung function, such as age and pack-years smoking to time of initial testing. In conclusion, weight gain was found to have a significant impact on longitudinal change in lung function. Therefore, weight gain becomes a very important variable that requires consideration whenever longitudinal studies of pulmonary function are conducted.     

A conditional maximized sequential probability ratio test for Pharmacovigilance

The importance of post‐marketing surveillance for drug and vaccine safety is well recognized as rare but serious adverse events may not be detected in pre‐approval clinical trials. In such surveillance, a sequential test is preferable, in order to detect potential problems as soon as possible. Various sequential probability ratio tests (SPRT) have been applied in near real‐time vaccine and drug safety surveillance, including Wald's classical SPRT with a single alternative and the Poisson‐based maximized SPRT (MaxSPRT) with a composite alternative. These methods require that the expected number of events under the null hypothesis is known as a function of time t. In practice, the expected counts are usually estimated from historical data. When a large sample size from the historical data is lacking, the SPRTs are biased due to the variance in the estimate of the expected number of events. We present a conditional maximized sequential probability ratio test (CMaxSPRT), which adjusts for the uncertainty in the expected counts. Our test incorporates the randomness and variability from both the historical data and the surveillance population. Evaluations of the statistical power for CMaxSPRT are presented under different scenarios. Copyright © 2009 John Wiley & Sons, Ltd.     

A practical approach to public health surveillance of violent deaths related to intimate partner relationships

OBJECTIVES: Articles describing the epidemiology of intimate partner homicide (IPH) have often been positioned as one-time research projects utilizing a single data source for case identification. However, researchers without access to centralized repositories for data pertinent to IPH can ascertain cases by using multiple extant data sources. The authors describe a surveillance system that can serve as a model for state health departments and others seeking to quantify and characterize violent deaths related to intimate partner relationships on an ongoing basis. METHODS: Retrospective surveillance was conducted to identify and characterize deaths related to intimate partnerships by linking the following data sources: death certificates, newspaper articles, law enforcement reports, and medical examiners' records. RESULTS: The authors identified at least 34% more IPHs using multiple data sources than would have been recognized solely using Supplementary Homicide Reports--the most frequently cited data source for IPH case ascertainment--and 22% more cases than newspaper data alone would have allowed for. CONCLUSIONS: While it was discovered that at least 181 IPHs--and at least 128 other deaths related to intimate partnerships--occurred in Michigan from 1999-2001, this frequency of occurrences is probably conservative. This limitation is due, in part, to the researchers not having access to information from all possible data source contributors. However, in the absence of statewide data systems, the authors demonstrate the utility of using multiple data sources for violent death surveillance to address incomplete case ascertainment.     

Routine surveillance data on AIDS and HIV infections in the UK: a description of the data available and their use for short-term planning

In the UK surveillance of AIDS and HIV infection is based on routine reporting systems. Whilst attempts are made to ensure that AIDS data are as complete as possible, numbers of reports fluctuate from month to month for reasons which are described. In 1986 there was an increase in death certificates naming AIDS as a cause of death in patients who were not identifiable in the surveillance data. More active surveillance is now undertaken in order to minimize this and other possible discrepancies. It is probable that most cases of AIDS are reported and therefore these data can be used to describe trends in the epidemic by 'risk group'. Laboratory reports of HIV antibody-positive tests could give an earlier indication of trends because of the long incubation period of AIDS. But these laboratory data are difficult to interpret because they represent an incomplete and biased sample of all positive persons. AIDS cases are still being reported at a rate which is increasing approximately exponentially. Short-term predictions are presented showing a growth in the epidemic which is consistent with previously published predictions. Most cases are in the homosexual risk group. New asymptomatic homosexual patients with HIV antibody are still being identified. The epidemic of AIDS in haemophilia patients should be of finite size although new cases of AIDS are likely to continue to be diagnosed for several years. AIDS due to blood transfusion given in the UK before donor screening appears to be a much smaller epidemic. The epidemic in drug abusers is increasing. Heterosexually acquired AIDS and HIV infections are being reported in small but increasing numbers.     

Simulating the bovine spongiform encephalopathy situation in Japan

Despite various measures taken by the Japanese government to protect the cattle population from exposure to the bovine spongiform encephalopathy (BSE) agent, the first case of BSE was detected in September 2001. Subsequently, BSE surveillance was enhanced, involving mandatory reporting and investigation of all clinical BSE suspects, and testing of fallen stock and all cattle slaughtered for human consumption. Tests on over nine million cattle led to the detection of 35 additional cases by the end of May 2009. Using the surveillance data and other information as input variables, models were developed to explore the possible source of introduction of BSE into Japan, evaluate the effectiveness of control measures, estimate the prevalence of BSE in different birth cohorts, predict a future BSE epidemic, and simulate the impact of changes in surveillance strategies. Despite difficulties associated with the availability and uncertainty of some of the input variables, these models provided an objective insight into the BSE situation in Japan.     

Creutzfeldt-Jakob disease surveillance in Australia January 1970 to December 2003.

The Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR) was established by the Commonwealth Government in October 1993 in response to the recognition of four probable human pituitary hormone related Creutzfeldt-Jakob disease (CJD) deaths. An inquiry into CJD in Australia and the use of human pituitary hormones under the Australian Human Pituitary Hormone Program suggested the expansion of some activities of the Registry to include retrospective case ascertainment from 1 January 1970. In parallel with monitoring possible medically acquired (iatrogenic) cases of CJD, the ANCJDR prospectively monitors and investigates all suspect cases of transmissible spongiform encephalopathies occurring within the states and territories of Australia, including sporadic and familial, and the potential occurrence of variant CJD. The ANCJDR also actively participates in an international surveillance consortium. This brief report summarises methods of classification and ascertainment as well as current epidemiological findings and new surveillance techniques that are being adopted to improve case ascertainment.     

Isocyanate Medical Surveillance: Respiratory Referrals From a Foam Manufacturing Plant Over a Five‐Year Period

This study assesses the causes of medical surveillance changes leading to specialist referral from one isocyanate‐using company where 39 workers (about 20% of all employees) were referred to a hospital occupational clinic during a 5‐year period for concerns regarding their surveillance respiratory questionnaire or spirometry results. The respiratory assessment determined that the questionnaire had detected 5 workers with non‐occupational asthma, 2 with possible occupational asthma (OA), and 1 with subsequently confirmed OA, while no additional asthmatics were detected by spirometry without questionnaire findings. The surveillance questionnaire in this study was sensitive but not specific (no additional compensation claims for OA were made during this time period): workplace spirometry, however, did not add to the detection rate of asthma. Am. J. Ind. Med. 35:87–91, 1999. © 1999 Wiley‐Liss, Inc.     

苯那普利致咳嗽不良反应的监测及其危险因素研究

目的 研究苯那普利相关咳嗽不良反应的危险因素。方法 对1831例高血压患者进行连续3年的用药观察，随访记录咳嗽不良反应发生情况，并嵌套病例对照研究，进行危险因素分析。结果 服用苯那普利后半年内，咳嗽不良反应的发生率女性为18．35％，男性为12．11％。logistic回归分析显示，女性(OR＝2．193，95％CI：1．500—3．206)、肾功能失代偿的女性(OR＝3．432，95％CI：1．954—6．028)、女性65岁以上(OR＝1．672，95％CI：1．040—2．688)、男性饮白酒100g／日以上(OR＝2．478，95％CI：1．148—5．347)发生咳嗽不良反应的危险性增加。结论 女性、老年、饮白酒、肾功能失代偿是苯那普利致咳嗽不良反应发生的可能危险因素，但不是主要的危险因素。     

Posttraumatic Stress Disorder and Posttraumatic Growth in Breast Cancer Patients: A Systematic Review

Breast cancer, potentially a traumatic stressor, may be accompanied by negative outcomes, such as posttraumatic stress disorder or positive changes, such as posttraumatic growth. The authors reviewed 24 studies published from 1990 to 2010 that measured posttraumatic stress disorder and posttraumatic growth in women with breast cancer, in terms of frequency rates, factors associated with posttraumatic stress disorder and posttraumatic growth, and their interrelationships. A relatively small percentage of women experienced posttraumatic stress disorder, while the majority of them reported posttraumatic growth. Age, education, economic status, subjective appraisal of the threat of the disease, treatment, support from significant others, and positive coping strategies were among the most frequently reported factors associated with these phenomena. Moreover, posttraumatic stress disorder and posttraumatic growth were not related. Future research should shed more light on posttraumatic growth and posttraumatic stress disorder among women with breast cancer, the parameters that influence them, and their possible relationship.     

Posttraumatic stress disorder and posttraumatic growth in breast cancer patients: a systematic review

Breast cancer, potentially a traumatic stressor, may be accompanied by negative outcomes, such as posttraumatic stress disorder or positive changes, such as posttraumatic growth. The authors reviewed 24 studies published from 1990 to 2010 that measured posttraumatic stress disorder and posttraumatic growth in women with breast cancer, in terms of frequency rates, factors associated with posttraumatic stress disorder and posttraumatic growth, and their interrelationships. A relatively small percentage of women experienced posttraumatic stress disorder, while the majority of them reported posttraumatic growth. Age, education, economic status, subjective appraisal of the threat of the disease, treatment, support from significant others, and positive coping strategies were among the most frequently reported factors associated with these phenomena. Moreover, posttraumatic stress disorder and posttraumatic growth were not related. Future research should shed more light on posttraumatic growth and posttraumatic stress disorder among women with breast cancer, the parameters that influence them, and their possible relationship.     

疟疾病例监测采血标准的推导

针对当前疟疾血检效率过低的现状,通过一定的方法进行推导计算,从26种不同的采血标准中选择出山东省当前最合理的标准。即血检发热病人中间歇发热的病人并血检发热加寒战的病人。这一标准能有效地针对当前的疟防实际,及时发现病人,降低成本,可操作性强。建议在当地试点推广。     

Action-oriented information systems: subsidies for activities by workers' health programs at the local level

Over the course of recent decades, Brazil has become an industrialized society. From an epidemiological perspective and considering changes that have been occurring in the Brazilian population, particularly concerning demographic and epidemiological transitions, this paper discusses the need to adapt the epidemiological surveillance system in order to incorporate the surveillance of non-transmissible diseases. The authors analyze the information system for work-related accidents in the Workers' Health Program, under SUDS (the Unified Decentralized Health System) for the Mandaqui Region (in the Northern part of the city of S?o Paulo), based on data from a local metalworking industry identified by the information system as a high-risk site for work-related accidents. The article also focuses on the importance of organized workers participating in actions to control work-related accidents. Although such participation is not always possible, the health sector must incorporate the workers' own concrete experience in order to develop more effective actions to prevent accidents at the workplace.     

Public health surveillance: historical origins, methods and evaluation.

In the last three decades, disease surveillance has grown into a complete discipline, quite distinct from epidemiology. This expansion into a separate scientific area within public health has not been accompanied by parallel growth in the literature about its principles and methods. The development of the fundamental concepts of surveillance systems provides a basis on which to build a better understanding of the subject. In addition, the concepts have practical value as they can be used in designing new systems as well as understanding or evaluating currently operating systems. This article reviews the principles of surveillance, beginning with a historical survey of the roots and evolution of surveillance, and discusses the goals of public health surveillance. Methods for data collection, data analysis, interpretation, and dissemination are presented, together with proposed procedures for evaluating and improving a surveillance system. Finally, some points to be considered in establishing a new surveillance system are presented.     

Design and implementation of an epidemiological surveillance system for mental health]

OBJECTIVE: To design and test a surveillance system to detect and rank the most significant mental health problems in a community and to establish their association with the living conditions in that community. METHODS: The system was designed and tested at a primary health care center in the community of La Florida, which is in the metropolitan region of Santiago, the capital of Chile. The health problems that were under surveillance, with monthly monitoring, were: addiction (to alcohol, tobacco, and benzodiazepines or other drugs), violence (domestic violence and sexual abuse, real or suspected), and disorders in children (attention deficit and behavioral disorders). By means of a computerized geographical information system (GIS), those surveillance data were combined with other data. These other data included sociodemographic information on the persons who went to the health center for care as well as data on local risk factors and protective factors for health problems, some of which are indicators of the local residents' living conditions. RESULTS: The proposed epidemiological surveillance system, which takes into account local living conditions and environmental variables, is a good tool for health action. The proposed system also complements the incomplete perspective of monitoring systems, which do not include variables describing the local context and that focus only on health problems. The information synthesized in the GIS maps makes it possible to simultaneously display different layers of information on factors related to the health problems studied, linked to a specific area and all its environmental variables, in an easy-to-read, self-explanatory format. CONCLUSIONS: These results and the concurring opinions of the participating physicians show that the experimental system effectively met the basic requirements of an epidemiological surveillance system of this kind.