北京市3家餐馆就餐者点餐营养素水平综合评价

目的 分析北京市3家中餐馆就餐者点餐营养素含量,采用富含营养素食物(Nutrient-Rich Foods,NRF)指数法综合评价一餐的营养搭配。方法 选择北京市某商业区内经营温州菜、鲁菜和云南菜的3家中餐馆,收集全部菜品的主、配料重量,计算每道菜品的营养素含量;结合3家餐馆一段时期内的点餐流水单,计算人均点餐营养素含量,并利用NRF指数综合评价一餐营养素水平。结果 3家餐馆就餐者一餐人均点餐能量为4973.9(P₂₅~P₇₅:3575.6~6971.0)kJ,参照午餐3347.2 kJ和晚餐2510.4 kJ的能量推荐摄入标准,88.2%桌次的人均点餐能量含量高于推荐摄入量。限制营养素含量:3家餐馆就餐者一餐人均点餐脂肪和胆固醇含量均达到日推荐摄入量的70%及以上;且一餐人均点餐钠含量均高于一日钠适宜摄入量(1500 mg),超标率为87.9%。3家餐馆就餐者一餐人均点餐膳食纤维、钙、维生素A、维生素C、维生素E含量远低于各营养素推荐摄入量。温州菜餐馆NRF_9.3较高为5.50,云南菜餐馆最低为2.26(P<0.001)。结论 在外就餐者人均一餐营养素综合水平不理想,能量及3种限制营养素含量显著高于《中国居民膳食营养素参考摄入量(2013年修订版)》推荐或适宜摄入量、9种推荐营养素则远低于推荐摄入量。     

江西省南昌市32家餐馆菜品钠含量调查及方法学比较

目的了解江西南昌餐馆菜品钠含量及来源,比较询问调查和实验室检测法所得菜品钠含量差异。方法随机抽取32家餐馆,通过询问收集所有菜品名称、类别、烹调方式、原材料和调味品名称及用量,结合中国食物成分表,计算菜品钠含量及来源;每家餐馆采集5道畅销菜,使用火焰原子吸收光谱法检测钠含量,比较两者结果差异。结果通过询问,收集合格菜品信息1445道,钠含量范围和P50为7.6～10 087.1、709.9 mg/100 g,不同规模餐馆和烹饪方式间无差异(P均0.05),汤菜较凉菜、热菜、主食/点心和其他类别高(P均0.05)。每份菜品总钠含量范围和P50为45.4～85 740.1、3860.8 mg,89.4%菜品总钠含量≥2000 mg。菜品钠含量主要来源食盐(53.9%),其次为鸡精/鸡粉/味精(19.6%)、酱油(11.6%)。实验室检测159道菜品,询问调查与实验室检测所得菜品钠含量存在差异(P 0.05),前者较后者高估8.6%。结论 32家餐馆大部分菜品钠含量和总钠含量较高;钠主要来源食盐,但其他调味品的钠也不容忽视;应加强餐馆减少调味品使用的宣传及减盐综合干预。询问调查法是可接受的菜品钠含量信息收集方法。     

广州市新型冠状病毒肺炎病例密切接触者核酸检测灵敏度和特异度分析

目的 分析广州市新型冠状病毒肺炎（COVID-19）疫情防控不同阶段中,密切接触者新型冠状病毒（新冠病毒）核酸检测的灵敏度和特异度,为优化疫情防控策略提供科学依据。方法 2020年2月21日至9月22日广州市COVID-19病例的密切接触者20 348例,均已接受新冠病毒核酸检测。针对疫情防控的不同阶段,比较核酸检测的灵敏度和特异度。结果 20 348例密切接触者中,男性12 462例（61.24%）,年龄M（P₂₅,P₇₅）为31.0（23.0,43.0）岁,核酸检测次数M（P₂₅,P₇₅）为2.0（1.0,3.0）次,隔离天数M（P₂₅,P₇₅）为12.0（8.0,13.0）d。研究对象经过7次核酸检测后,共确诊病例256例。第1、2、3和第7次核酸检测的灵敏度与特异度分别为69.14%与99.99%（确诊177例）、89.84%与99.99%（确诊230例）、97.27%与99.99%（确诊249例）、100.00%与99.98%。基于我国COVID-19疫情防控分为3个阶段（国内输入、境外输入和境外输入关联）,首次核酸检测的灵敏度分别为70.68%、68.00%和67.35%,特异度分别为99.98%、100.00%和100.00%。结论 建议做核酸检测3次,可提高灵敏度并降低假阴性风险。对于广州市COVID-19疫情防控3个阶段,密切接触者核酸检测的灵敏度结果较为一致,但略有降低趋势,这可能与疫情防控后期阶段的无症状感染者比例增多相关。     

中国2005-2011年人狂犬病不同地区季节分布特征研究

目的 用简单定量方法描述中国不同地区狂犬病发病季节分布特征和规律,分析地理位置对其影响,为狂犬病风险评估、疫情预测提供依据.方法 以全国法定传染病报告系统中2005-2011年29个省份报告的17 800例临床与实验室确诊狂犬病病例为研究对象,从国家地理信息中心获得各省地理经纬度资料,利用Excel 2003软件绘制季节分布曲线,利用SPSS 18.0软件计算季节分布曲线的第25百分位数(P₂₅)、P₅₀、P₇₅、四分位数间距(Q)和峰度,并分别分析P₂₅、峰度与纬度的线性相关关系.结果 全国狂犬病发病以2月为低点,夏、秋季为发病高峰,峰值在8月.各省份狂犬病发病季节分布曲线的P₂₅、P₅₀、P₂₅、Q和峰度不同,纬度越高地区的P25越大,Q值越小,峰度越大;在年均报告病例数＞100例的9个省份,P₂₅、峰度与纬度间的相关系数r值分别为0.9342、0.8528 (P＜0.05).结论 中国狂犬病发病具有季节性,且存在地理差异和规律性,纬度越高地区季节性特征越明显.     

广东省新型冠状病毒肺炎病例临床转归及其影响因素

目的 分析广东省新型冠状病毒肺炎（COVID-19）病例的临床转归及其影响因素,为优化医疗救治及疫情防控的策略提供参考依据。方法 通过流行病学调查和进程追踪,收集广东省截至2020年3月4日COVID-19确诊病例1 350例的基本人口学特征、既往病史、就诊经过和临床转归等信息,分析确诊病例的临床分型、病程特点及其相关影响因素。结果 广东省COVID-19确诊病例1 350例中,临床分型为轻型、普通型、重型和危重型（重症）分别为5.3%（72/1 350）、77.7%（1 049/1 350）、12.1%（164/1 350）和4.3%（58/1 350）,粗死亡率为0.5%（7/1 350）。病程时间中位数为23（P₂₅,P₇₅：18,31）d,住院时间中位数为20（P₂₅,P₇₅：15,27）d。出现重症时间中位数为发病第12（P₂₅,P₇₅：第9,15）天,重症持续时间中位数为8（P₂₅,P₇₅：4,14）d。1 066例已出院/死亡病例中,入院轻型病例出现普通型的占36.4%（36/99）,出现重型的占1.0%（1/99）;入院普通型病例出现重型、危重型的分别占5.2%（50/968）、0.6%（6/968）;重型病例出现危重型的占11.4%（10/88）。病例出现重症的影响因素包括男性（aHR=1.87,95% CI：1.43~2.46）、年龄较大（aHR=1.67,95% CI：1.51~1.85）、发病至首诊第2~3天就诊（aHR=1.73,95% CI：1.20~2.50）、合并糖尿病（aHR=1.75,95% CI：1.12~2.73）、合并高血压（aHR=1.49,95% CI：1.06~2.09）。结论 广东省COVID-19病例病程和住院时间普遍较长,且与其临床分型严重程度有关,重症病例主要集中在特定人群,在疫情高发时期,为确保医疗资源的合理配置,需根据隔离和救治等防控需求对病例分类管理。     

云南省德宏傣族景颇族自治州2004-2018年启动抗病毒治疗后HIV/AIDS贫血发病及危险因素回顾性队列研究

目的 了解德宏傣族景颇族自治州（德宏州）2004-2018年启动抗病毒治疗（ART）后HIV/AIDS贫血发病及其影响因素。方法 采用回顾性队列研究的方法,基于德宏州HIV/AIDS的ART数据库,纳入分析2004-2018年启动ART的HIV/AIDS。采用Cox比例风险模型分析启动ART后HIV/AIDS贫血和中重度贫血新发及其影响因素,用分段混合线性效应模型拟合基线不同贫血状况随访血红蛋白的变化轨迹。结果 共8 044例HIV/AIDS纳入分析。基线未患贫血者占78.8%（6 337/8 044）。6 337例基线未患贫血的HIV/AIDS中位随访时间为4.43（P₂₅,P₇₅：1.50,6.71）年,其中1 291例新发贫血和293例新发中重度贫血HIV/AIDS的中位随访时间分别为0.16（P₂₅,P₇₅：0.07,1.99）年、0.48（P₂₅,P₇₅：0.09,2.97）年,贫血和中重度贫血的发病密度分别为4.40/100人年、0.41/100人年。多因素Cox回归结果显示,启动ART后HIV/AIDS发生贫血的危险因素有年龄大、女性、傣族和景颇族、基线BMI<18.5 kg/m²、基线CD4⁺T淋巴细胞计数（CD4）<200个/μl、初始ART方案使用齐多夫定（AZT）,发生中重度贫血的危险因素有女性、傣族、基线BMI<18.5 kg/m²、基线轻度贫血、初始ART方案使用AZT。结论 2004-2018年德宏州HIV/AIDS启动ART后贫血的发病风险在某些特征人群中较高,如≥ 60岁老年人、女性、少数民族、BMI偏低、基线CD4<200个/μl、ART方案使用AZT者。应重点加强对这部分人群贫血的筛查及其防治措施。     

基于区间删失数据估计方法的COVID-19潜伏期分布估计

目的 新型冠状病毒肺炎疫情已经成为全球关注的公共卫生问题,其潜伏期等流行病学特征尚不明确,本研究旨在对新型冠状病毒肺炎的潜伏期分布进行估计。方法 收集各省份卫生健康委员会官方发布信息平台的确诊病例暴露与发病信息,利用区间删失数据估计方法,基于Log-normal、Gamma和Weibull分布,对新型冠状病毒肺炎的潜伏期分布进行估计。结果 本研究共收集确诊病例109例,平均年龄为39.825岁。基于Log-normal分布的潜伏期M=4.938（P₂₅～P₇₅：3.451～7.304）d,Gamma分布的潜伏期M=5.064（P₂₅～P₇₅：3.489～7.301）d,Weibull分布的潜伏期M=5.678（P₂₅～P₇₅：3.653～7.666）d。Gamma分布的对数似然函数值最大。结论 COVID-19的潜伏期服从Gamma分布,基于区间删失数据的估计方法可用于传染病潜伏期分布的估计。     

基于公共数据库挖掘肝细胞癌预后相关的长链非编码RNA分子标签

目的 通过对癌症和肿瘤基因图谱（TCGA）公共数据库中肝细胞癌病例癌和癌旁组织RNA测序数据的分析,挖掘与肝细胞癌预后相关的长链非编码RNA（lncRNA）分子标签。方法 截至2018年2月,从TCGA数据库中获得377例肝细胞癌病例的癌及癌旁组织RNAseq数据及临床预后信息,将50对癌和癌旁组织的lncRNA表达水平进行差异t检验分析,进而采用LASSO Cox回归分析筛选肝细胞癌预后相关的lncRNA,并构建lncRNA分子标签。将所有病例按分子标签表达水平分为4组（<P₂₅、P₂₅～、P₅₀～、≥P₇₅）,采用Cox回归计算P₂₅～、P₅₀～、≥P₇₅组相对于<P₂₅组的预后风险比,进而评估分子标签表达水平对肝细胞癌病例总体生存率的影响。结果 筛选出951个癌和癌旁组织中表达水平有统计学意义差异的lncRNA,通过LASSO Cox回归分析进一步筛选出3个lncRNA（LNCSRLR、MKLN1-AS及ZFPM2-AS1）,并构建分子标签。分子标签表达水平≥P₇₅组的死亡风险是<P₂₅组的1.57倍（95% CI：1.06～2.31,P<0.05）。结论 通过对TCGA数据库的挖掘,由LNCSRLR、MKLN1-AS及ZFPM2-AS1构建的lncRNA分子标签表达水平与肝细胞癌病例的预后有关。     

儿童家长接受预防接种服务额外消耗时间对总体满意率的影响

目的 了解儿童家长对预防接种服务的总体满意率,以及接受预防接种服务额外消耗时间对其满意率的影响。方法 2019年12月至2020年1月,对0~3岁儿童家长基本情况、接受预防接种服务额外消耗时间以及对预防接种服务的总体满意情况进行问卷调查。共3 178名儿童家长纳入分析。采用二分类logistic回归模型和限制性立方样条模型分析儿童家长接受预防接种服务额外消耗时间对总体满意率的影响。结果 儿童家长对预防接种服务的总体满意率为92.32%。儿童家长从家到预防接种门诊时间M（P₂₅,P₇₅）为10.00（10.00,20.00）min,办理预约登记等候时间M（P₂₅,P₇₅）为10.00（5.00,15.00）min,等待进行注射疫苗时间M（P₂₅,P₇₅）为5.00（3.00,10.00）min,额外消耗总时间M（P₂₅,P₇₅）为30.00（20.00,45.00）min。二分类logistic回归分析结果显示,调整相关因素后,有利于提高儿童家长总体满意率的额外消耗时间因素依次为办理预约登记等候时间（4~min组与8~min组相比,OR=1.863,95%CI：1.307~2.657）、等待进行注射疫苗时间（<4、4~min组与8~min组相比,OR=1.529,95%CI：1.102~2.120;OR=1.534,95%CI：1.104~2.130）、额外消耗总时间（15~min组与30~min组相比：OR=1.470,95%CI：1.094~1.976）。限制性立方样条模型分析显示,儿童家长办理预约登记等候时间（非线性检验χ²=13.18,P=0.001）、等待进行注射疫苗时间（非线性检验χ²=13.50,P=0.001）以及额外消耗总时间（非线性检验χ²=9.38,P=0.009）与总体满意情况的关联强度呈非线性的倒“V”形剂量反应关系。结论 儿童家长办理预约登记等待时间、等待进行注射疫苗的时间和接受预防接种服务额外消耗总时间影响总体满意率。其中,办理预约登记等待时间的影响最大,且该环节等待时间较长,建议预防接种门诊利用信息化技术（如建立微信公众号、APP等）开展分时段预约,并控制单位时间服务人数,对预防接种人群进行有效分流。     

中国18个长寿地区65岁及以上老年人肌肉重量和力量的分布特征

目的 了解中国18个长寿地区≥65岁老年人肌肉重量和力量的分布特征。方法 研究对象来自在我国18个长寿地区开展的中国老年健康生物标志物队列研究,将2021年横断面调查的4 662名≥65岁老年人纳入研究。通过问卷调查和体格检查收集研究对象的社会人口学特征、生活方式、膳食摄入等信息,采用专业电子握力计测量手握力,生物电阻抗分析法测量全身肌肉重量（TSM）,同时采用身高的平方和BMI调整后得到相对指标TSM_Ht2和TSM_BMI,并根据亚洲肌少症工作组（AWGS）推荐的方法判定人群低肌肉重量和力量的比例。描述性分析研究对象肌肉重量和手握力的人群和地区分布特征,并采用广义可加模型分析肌肉重量和手握力随年龄的变化趋势。结果 4 662名研究对象年龄为（82.69±10.54）岁;男性占46.85%（2 184名）;汉族占96.27%（4 488名）。男性TSM、TSM_Ht2和TSM_BMI的M（Q₁,Q₃）分别为23.30（20.50,26.20） kg、9.02（8.13,9.89） kg/m²、1.01（0.90,1.13） kg·（kg/m²）^-1,均高于女性［18.20（15.70,20.70） kg、8.18（7.42,9.07） kg/m²、0.79（0.69,0.90） kg·（kg/m²）^-1］,差异有统计学意义（均P＜0.001）。男性手握力［M（Q₁,Q₃）：24.50（17.80,30.80） kg］高于女性［M（Q₁,Q₃）：15.60（11.10,19.90） kg］,差异有统计学意义（P＜0.001）。南方男性老年人TSM、TSM_Ht2均低于北方男性老年人（均P＜0.001）,但南北方男性老年人的TSM_BMI差异无统计学意义（P＞0.05）;南方女性老年人的TSM_Ht2、TSM_BMI均高于北方女性老年人（均P＜0.001）,而南北方女性老年人的TSM差异无统计学意义（P＞0.05）。进一步根据AWGS推荐的方法判定后,低肌肉量和低握力老年人均具有年龄较大、小学以下文化程度、未婚/离异/丧偶、咀嚼能力差、日常生活活动能力损伤、位于南方地区等特征。结论 中国18个长寿地区≥65岁老年人肌肉重量和力量存在人群和地区差异,且随着年龄增加呈下降趋势。     

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.