2010—2012年广东省发热伴出疹症候群的病原学研究

目的分析2010年8月至2012年8月期间广东省发热伴出疹性疾病（rash and fever illness,RFIs）的病原谱构成及流行特征,为临床诊断、治疗和RFIs的预防控制提供科学依据。方法应用实时荧光定量聚合酶链反应（real-time quantitative polymerase chain reaction,real-time PCR）方法和酶联免疫吸附测定（enzyme-linked immu-nosorbent assay,ELISA）方法对519例临床标本进行风疹、麻疹、肠道病毒、水痘-带状疱疹、人类小DNA病毒B19、伤寒副伤寒等病原学检测,并进行统计分析。结果 519例样本中检出314例RFIs病原体阳性标本,阳性率为60.50%。病原谱构成前3位为肠道病毒、水痘病毒和风疹病毒。不同年龄组感染的病原谱构成也不同：0～和5～岁年龄组以肠道病毒71型（human enterovirus 71,EV71）为主,风疹在15～岁年龄组的检出率高于其他年龄组,而水痘在60岁以上年龄组的检出率高于其他年龄组;不同性别患者之间病原体检出率差异无统计学意义。不同病原体在不同年龄组阳性率差异均有统计学意义（均有P〈0.05）。结论肠道病毒是本地RFIs感染的主要病原体。部分病原体的感染与年龄有一定的关联,应长期监测RFIs病原体的活动水平。加速肠道病毒疫苗的研制,积极推行水痘、麻疹等疫苗的接种是控制RFIs发病的主要措施。     

2010-2017年上海市浦东新区发热伴出疹性疾病病原学分析

目的  分析2010年1月~2017年12月浦东新区发热伴出疹性疾病(rash and fever illness,RFIs)的病原谱构成及流行特征,为RFIs防控提供科学依据。 方法  采用酶联免疫吸附法和实时荧光定量聚合酶链反应对2 381例临床标本进行肠道、麻疹、风疹等病毒的病原学检测,并进行统计分析。 结果  2 381例样本中RFIs检测阳性1 633例(68.59%)。病原谱构成前4位病毒分别是肠道(52.54%)、麻疹(28.54%)、风疹(13.04%)、水痘-带状疱疹(3.37%)。男性风疹病原体检出率高于女性,差异有统计学意义(P=0.026)。年龄组分布中,肠道病毒集中在3~6岁年龄组,水痘-带状疱疹病毒集中在6~18岁年龄段,麻疹病毒、风疹病毒、登革热病毒、小DNA病毒集中在18岁以上年龄段,不同年龄组的病原体检出率差异均有统计学意义(均有P < 0.05)。RFIs发病集中在春季(41.52%),冬季最少(15.00%),其中肠道、麻疹、风疹、登革热病毒在不同季节的病原体检出率差异有统计学意义(P < 0.05)。 结论  肠道和麻疹病毒是本地RFIs感染的主要病原体,应长期监测RFIs病原体的活动水平。     

呼和浩特地区2009～2011年发热伴出疹性疾病病原谱监测结果分析

目的 探讨呼和浩特市地区发热伴出疹症性疾病(RFIs)的病原谱构成.方法 2009～2011年,采用酶联免疫吸附试验(ELISA)对RFIs患者急性期血清标本进行麻疹、风疹、水痘、肠道病毒、小DNA病毒B19、登革热IgM抗体检测,采用Real-time PCR方法对咽拭子标本检测病毒核酸.结果 对31份血清进行IgM抗体检测,其中3份为阳性结果,检出率为9.68％.对294份咽拭子样本进行核酸检测,其中117份为阳性,阳性率为39.80％.共104份为肠道病毒阳性,占所有阳性样本的86.67％,18份为水痘带状疱疹病毒,3份麻疹病毒,1份小DNA病毒B19,其中6份为混合感染.麻疹阳性病例均无免疫史,水痘阳性病例94.44％无免疫史.结论 2009～2011年,呼和浩特地区RFIs病原以肠道病毒为主,其次是水痘病毒.加速肠道病毒疫苗的研制,积极推行水痘、麻疹等疫苗接种是控制RFIs发病的主要措施.     

2009—2010年天津滨海新区(塘沽)发热伴出疹性疾病监测分析

目的探讨天津市塘沽地区发热伴出疹症性疾病(RFIs)病原谱构成。方法采用酶联免疫吸附试验(ELISA)对2009年9月—2010年5月塘沽传染病医院就诊的发热伴出疹性疾病患者急性期血清标本进行麻疹、风疹和水痘IgM抗体检测,咽拭标本采用RT-PCR方法分离病毒。结果 243份血清标本中麻疹IgM抗体阳性检出率为51.44%,风疹IgM抗体阳性检出率为5.76%,水痘IgM阳性检出率为4.12%,三者全部阴性者占38.27%。236份咽试标本中麻疹病毒核糖核酸(RNA)阳性62份,风疹病毒RNA阳性27份。塘沽地区RFIs病例主要为20岁以上成人发病,占总病例的87.65%。麻疹IgM抗体阳性病例中,无免疫史和不详者占92.80%,风疹和水痘IgM抗体阳性病例均无免疫史。结论目前,塘沽地区发热出疹性疾病以麻疹为主,发病以大年龄组人群为主,同时具有一定的风疹和水痘病例,积极推行疫苗接种是控制麻疹、风疹和水痘发病的主要策略。     

2010～2012年北京市顺义区手足口病病原学检测结果分析

目的 通过对2010～2012年北京市顺义区手足口病（Hand-foot-and-mouth disease,HMFD）实验室检测结果分析,了解顺义区手足口病病原学特征,为手足口病防控工作提供科学依据.方法 对2010～2012年顺义区684例临床诊断为手足口病患者标本,应用实时荧光定量RT-PCR法检测标本中的肠道病毒71型（EV71）、柯萨奇病毒A组16型（CVA16）、非EV71和CVA16的其它肠道病毒（EV）特异性核酸.结果 684例HFMD患者标本中,肠道病毒阳性率为47.37％ （324/684）.病原谱构成以CVA16型为主,占55.56％（180/324）,其次为EV71占32.41％（105/324）,其他肠道病毒占12.03％ （39/324）;4～7月为HFMD检出高峰期;0～5岁为高风险年龄组;性别比1.49∶1,男性阳性率略高于女性,但差异无统计学意义（x2 =0.163,P＞0.05）;散居病例阳性检出率较高.结论 2010 ～2012年顺义区HFMD病例病毒阳性检出率较高,CVA16是优势病毒型别;每年春夏季节,应加强对流动人口聚居区5岁以下儿童的手足口病防控工作.     

聊城市2010-2011年手足口病病原学流行特征研究

目的分析2010-2011年聊城市手足口病病原学流行特征及病原谱变化规律,为制定预防控制措施提供科学依据。方法采用描述性流行病学分析方法对2010-2011年病原学检测结果进行分析。结果 2010和2011年分别报告实验室确诊病例3 303例和2 078例;2010年以肠道病毒71型（enterovirus71,EV71）感染为主,2011年以柯萨奇病毒A16型（CA16）感染为主。手足口病发病有季节性,4～7月份为发病高峰,不同发病时段的优势病原体主要为EV71和CA16,二者呈交替流行;发病主要集中在5岁以下年龄组（95.56%）,以散居儿童为主（90.24%）,托幼儿童中EV71的检出率高于CA16的检出率（χ^2=71.02,P〈0.001）;1～岁组的重症发生率最高,感染EV71的重症发生率明显高于感染CA16者（χ^2=216.47,P〈0.001）。结论手足口病的主要病原体是EV71和CA16,二者在不同时段可交替或相伴流行;病原谱的变化有规律性;EV71是造成重症的主要病原体。     

2009-2018年湖南省手足口病病原学特征分析

目的 分析2009-2018年湖南省手足口病（HFMD）病原学变化趋势，为制定HFMD防控策略提供依据。方法 收集湖南省各级CDC病原学监测结果，使用实时荧光定量PCR方法对手足口监测病例标本进行肠道病毒核酸检测，采用描述性流行病学方法进行分析。结果 2009-2018年共采集HFMD标本78856份，总体阳性率为70.0%。EV-A71、CV-A16和其他肠道病毒所占比例分别是29.3%、21.3%和49.4%。湖南省病原谱的构成:2009年优势病原为其他肠道病毒，2010和2012年优势病原为EV-A71（54.1%和56.8%），2011年EV-A71、CV-A16和其他肠道病毒比例相当（分别占34.4%、34.3%、31.3%），2013-2018年均以其他肠道病毒为主（分别为67.3%、41.4%、70.7%、42.5%、71.2%和65.2%）。轻症病例中，2009-2012年优势病原依次为其他肠道病毒、EV-A71、CV-A16、EV-A71，2013-2018年均以其他肠道病毒为主。重症病例中，除了2013、2015、2017和2018年优势病原为其他肠道病毒外，其他年份均以EV-A71为主。EV-A71是死亡病例的优势病原。各年龄组（x2=1190.6，P＜0.001）、不同性别（x2=7.6，P＜0.023）病原谱差异有统计学意义。粪便阳性率最高（77.3%），其次为多部位采样（75.8%）、疱疹液（71.2%）、肛拭子（64.8%）、（鼻）咽拭子（55.8%）、其他标本（31.1%）。结论 手足口病由肠道病毒多种血清型共同循环引起，2009-2018年湖南省手足口病的优势病原不断变化，2013年以后其他肠道病毒成为优势病原体，EV-A71仍是重症和死亡病例的主要优势病原。建议优先采集粪便标本。     

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。     

五华县2010—2013年手足口病病原学监测结果

目的了解五华县手足口病病原学特征,为防控提供依据。方法采集五华县2010—2013年哨点医院手足口病病例粪便标本,用荧光定量PCR法进行肠道病毒71型（EV71）、柯萨奇病毒A组16型（CoxA16）和其他肠道病毒核酸检测。结果共检测214份标本,肠道病毒总检出率67.3%,其中EV71检出率17.8%、CoxA16型检出率14.5%、其他肠道病毒检出率35.0%;男女EV71、CoxA16和其他肠道病毒的检出率类似;手足口病主要病原2010年是EV71型,2011年至现在为其他肠道病毒;患儿检出率随年龄升高而降低,5岁以下病例占98.6%（142/144）。结论五华县手足口病感染率较高,开展手足口病流行病学和病原学研究,有助于提出有针对性的防控措施。     

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.     

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.     

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.