抗病毒治疗对美沙酮门诊HIV感染者吸毒和高危性行为影响的定性研究

目的 了解美沙酮门诊HIV感染者参加抗病毒治疗(ART)后高危行为是否变化,探索变化及发生高危行为的原因.方法 对云南省美沙酮门诊参加ART的34名HIV感染者进行调查,包括一般情况,HIV感染情况,美沙酮维持治疗(MMT)情况,接受ART情况,ART前后性伴数量、性行为频率、安全套使用、毒品使用、针具共用情况.结果 受访者平均年龄38.5岁,男性居多(70.6％),均表示参加ART后不安全性行为和共用针具等行为未增加,主要原因是获得HIV相关知识培训、免费安全套、清洁针具并受到MMT影响,存在偷吸(12/34)和不坚持使用安全套(3/19)等高危行为,同时出现ART药物与美沙酮相互作用导致偷吸、对ART的态度乐观导致不安全性行为等新挑战.结论 参加ART未引起MMT门诊HIV感染者高危行为增加,但高危行为仍然存在,应重视ART高期望引起的新挑战.     

云南和广西地区部分美沙酮门诊HIV感染者抗病毒治疗现状及其影响因素

目的 了解参加美沙酮维持治疗(MMT)的HIV感染者接受抗病毒治疗(ART)现况及影响因素.方法 在云南和广西地区6个MMT门诊中选取291名HIV感染者,调查内容包括研究对象-般人口学特征、海洛因滥用、HIV感染、MMT及ART接受情况.结果 研究对象中共有男性217人(74.6％),女性74人(25.4％),平均年龄(38.4±5.9)岁,以高中以下文化程度、已婚、无业人员为主.单因素分析发现,有固定工作、独自居住、自报过去1个月饮酒、家人对MMT不支持/不了解/无所谓、自报过去1个月未能每天进行MMT、未享受MMT门诊优惠政策、未将HIV感染告知他人、自觉身体状况较好或-般、过去6个月从未和家人谈论ART话题、不知道家人对ART态度以及缺乏对ART效果的正确认识是影响MMT门诊HIV感染者接受ART的主要因素;多因素logistic回归分析发现,独自居住、未将HIV感染告知他人、自觉身体状况好、过去6个月从未和家人谈论ART相关话题和不知道家人对ART态度是影响MMT门诊HIV感染者接受ART的5个主要因素.结论 重视MMT对ART的积极作用,加强对MMT门诊HIV感染者及其家属ART知识宣传,积极促进HIV感染者获得家庭支持,有可能促进MMT门诊吸毒HIV感染者接受ART.     

广西某美沙酮维持治疗门诊HCV抗体阳性就诊者病毒载量及相关因素分析

目的 检测广西某美沙酮维持治疗(methadone maintenance treatment,MMT)门诊丙型肝炎病毒(hepatitis C,HCV)抗体阳性者的HCV病毒载量探讨其相关影响因素.方法 对广西南宁市MMT门诊HCV抗体阳性就诊者进行调查,收集一般人口学信息、吸毒及HIV感染情况等,并进行HCV病毒载...     

社区美沙酮维持治疗门诊中HCV感染者接受抗病毒治疗现状及影响因素

抗病毒治疗是降低吸毒人群丙型肝炎病毒（Hepatitis C virus，HCV）感染及肝硬化发生的成本效益最优的措施，参加社区美沙酮维持治疗（Methadone maintenance treatment，MMT）人群HCV感染率高达60.1%，但接受抗病毒治疗率及影响因素目前尚不清楚。本文结合国外社区MMT运行模式及丙肝抗病毒治疗方案的应用，系统综述我国社区MMT人群HCV感染者接受抗病毒治疗现状，并从卫生服务提供方角度阐述其影响因素，为社区MMT更好地防控吸毒人群HCV感染提供理论依据。     

美沙酮维持治疗吸毒患者偷吸海洛因相关因素研究

目的分析湖南省美沙酮维持治疗(MMT)门诊患者偷吸海洛因比例、地区、时间分布及影响因素。方法对湖南省7个MMT门诊吸毒患者进行问卷调查,并进行吗啡尿检和HIV检测。结果湖南省MMT门诊515名吸毒患者中有163人偷吸海洛因,偷吸率为31.65%,平均偷吸时刻为参加治疗后第30d,偷吸时刻中位数为第20d,中位生存时间为第22d,偷吸相关因素主要与美沙酮口服液剂量、家庭关系、毒友关系及心理状况有关。结论吸毒患者存在一定比例的偷吸海洛因现象,参加MMT后的第20～30d是其"心理危险期";对吸毒人员在开展美沙酮维持治疗的同时,还需要开展心理辅导,实施社会帮教。     

美沙酮维持治疗者中艾滋病、丙肝病例分析

目的了解广东东莞市美沙酮维持治疗(MMT)门诊患者人类免疫缺陷病毒(HIV)、丙型肝炎病毒抗体(HCV)感染情况。方法对2007年1月～2008年10月东莞市新涌医院美沙酮维持治疗门诊200例患者进行面对面问卷调查,并采静脉血检测抗-HCV抗体、抗HIV抗体。结果200例美沙酮维持治疗门诊患者中HIV感染者5例,感染率为2.5%(5/200);HCV感染者161例,感染率为80.5%(161/200)。其中5名HIV感染者合并感染HCV,静脉吸毒者中HCV感染率明显高于全国水平。结论本市戒毒人群中HIV、HCV感染率较高,静脉吸毒和共用针具吸毒是HIV和HCV传播的高危因素,不洁性行为增加了HIV、HCV由吸毒人员向其它人群传播的危险性。     

伊犁哈萨克自治州接受美沙酮维持治疗的HIV感染者死亡情况

目的 了解伊犁哈萨克自治州美沙酮维持治疗门诊中HIV感染者的死亡率及其影响因素.方法 采用回顾性队列研究方法,从AIDS综合防治信息系统中的美沙酮维持治疗系统和HIV/AIDS报告系统中收集新疆维吾尔自治区伊犁哈萨克自治州5个美沙酮门诊就诊者中所有HIV阳性就诊者(860例)的基线、治疗、随访和死亡信息.收集的信息包括人口学特征、美沙酮每日服药情况、CD4检测情况、抗病毒治疗情况以及死亡情况等.基线信息从2005年8月建立第一个美沙酮门诊起开始收集,随访信息收集到2011年5月.对缺失数据采用回归插补法进行处理,采用Cox比例风险回归对影响死亡的因素进行研究,使用Schoenfeld检验对比例风险假设进行检验.采用R软件对数据进行整理和统计学分析.结果 共分析860例HIV阳性海洛因成瘾者,平均年龄为(32.9±6.4)岁,67.3％( 579/860)的为已婚.美沙酮服药剂量为(38.2±20.7)mg/d,27.8％(239/860)参加了抗病毒治疗,38.7％(333/860)的从未检测过CD4.观察期间出现151例死亡病例,研究队列共观察了 2192.9人年,平均每人观察2.6年,全死因死亡率为68.9‰.Cox比例风险模型分析显示,参加抗病毒治疗(HR =0.53,95％CI:0.32～0.88)、基线CD4计数在200～350个/μl(HR=0.35,95％ CI:0.20 ～0.60)、基线CD4计数大于350个/μl(HR=0.16,95％CI:0.09～0.29)、已婚(HR =0.55,95％CI:0.37 ～0.82)是保护因素;年龄大于45岁(HR=5.20,95％ CI:2.60～10.20)、曾经共用过注射器(HR=1.40,95％CI:1.02 ～2.00)与参照组比较是死亡的危险因素.结论 伊犁哈萨克自治州美沙酮门诊中HIV感染者的死亡率较高,坚持抗病毒治疗有利于降低感染者的死亡率.     

广东省45家美沙酮维持治疗门诊接受治疗者传染病干预需求

目的 分析广东省美沙酮维持治疗(methadone maintenance treatment,MMT)门诊受治者的传染病感染现状,为门诊采取针对性的干预措施提供依据.方法 分析全省45个MMT门诊受治者的一般情况和艾滋病病毒(human immunodeficiency virus,HIV)、丙型肝炎病毒(hepatitis C virus,HCV)和肺结核(tuberculosis,TB)感染率,比较不同人群的感染率差异,分析重叠感染情况和感染者的特征.结果 13 566名受治者中,7 508人(55.3％)至少感染HIV、HCV或TB中的一种.所有受治者的HIV、HCV和TB感染率分别为5.92％、68.16％和1.87％.注射吸毒者3种疾病感染率均高于非注射吸毒者.6.0％的感染者为双重或三重感染,双重感染比例由高到低依次为HCV和HIV(4.44％)、HCV和TB( 1.31％)、HIV和TB(0.05％);54.95％的HIV感染者和57.31％的TB感染者合并HCV感染,HCV感染者以单纯感染为主(93.81％).从感染者特征来看,3种疾病感染者以男性、30～ 40岁、初中文化水平、待业/无业、注射吸毒、本地入组占多数.结论 广东省MMT门诊受治者HCV感染率高,对相关干预的需求量大;HIV和TB感染者合并HCV感染可能性大,应特别注意HCV的筛查.建议门诊积极开展针对感染者的转诊、治疗和行为干预等服务,提高项目效益.     

云南省大理市2005--2013年HIV阳-美沙酮维持治疗者治疗依从性及其影响因素分析

目的了解2005～2013年云南省大理市HIV阳性美沙酮维持治疗(MMT)人员治疗依从性及其影响因素：方法从“社区美沙酮信息系统”提取2005年11月19日至2013年4月30日大理市MMT门诊治疗人员一般人口学信息、既往毒品滥用行为、参加MMT情况及抗病毒治疗开始时间等信息。利用服药记录计算MMT依从性,运用多因素非条件logistic回归模型分析其影响因素。结果480名研究对象的MMT依从性为58.11%。多因素分析结果显示,参加抗病毒治疗(OR=1.52,95%CI：1.03～2.24)、就业(0尺=1.69,95%C1：1.1l～2.56)、入组前有强制戒毒经历(OR=1.78,95%CI：1.04～3.04)者依从性高(P<0.05),最近一次尿吗啡测阳性(OR=O.38,95%Cho.24～o.59)者依从性低(JD结论大理市HIV阳性MMT者治疗依从性较差,应提高无业、近期尿吗啡检测阳性、人组前未强制戒毒患者的MMT依从性。     

中国7省2007～2008年美沙酮维持治疗工作的比较分析

[目的]描述2007～2008年第四轮中国全球基金艾滋病项目(GF4)覆盖的7省美沙酮维持治疗(MMT)工作的季度变化趋势和地区间差异.[方法]对MMT工作报表及相关资料进行质量评价,描述MMT的覆盖、保持情况及门诊HIV感染者/艾滋病人(PLWHA)的纳入、检测和治疗情况,并分析其纵向变化趋势和横向地区差异.[结果]7省单个MMT门诊的在治人数中位数为106人;平均粗保持率为51.0%,该指标呈降低趋势(P<0.01),在江西、四川较高.湖南、新疆等较低(P<0.05),并与参与项目的机构组织数正相关(P<0.01).各MMT门诊的平均HIV阳性率为17.9%.在贵州、湖南和云南较高,广西、新疆较低(P<0.01),与各县接受VCT的吸毒者的HIV阳性率正相关(P<0.01);门诊平均抗病毒治疗率为23.8%,在各季度呈增长趋势(P<0.01),在广西、湖南和云南较高,四川、新疆较低(P<0.05或0.01),并与门诊CD4检测率正相关(P<0.01)、与HIV阳性率负相关(P<0.01).[结论]2007年7月～2008年12月7省MMT覆盖人数不断增加,发现和纳入了较多的HIV阳性吸毒者,且各门诊PLWHA的抗病毒治疗率不断提高;但各MMT门诊存在平均治疗人数较少、覆盖率较低、保持率较低、CD4检测率较低及地区工作情况差异显著等问题.     

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.