青岛市1990～2003年成人麻疹病例流行病学特征分析

青岛市 1990～ 2 0 0 3年共报告成人麻疹 2 30例 ,年平均报告发病率为 0 30 /10万 ( 0～ 1 17/10万 )。 1997年以前 ,成人麻疹呈散发 ,而 1998年以后发病明显增加 ,1998～ 2 0 0 3年年平均报告发病率为 0 6 0 /10万 ( 0 13/10万～1 17/10万 ) ,与 1990～ 1997年的年平均报告发病率 0 0 7/10万相比 ,上升了 7 5 7倍。发病高峰在每年的 3～ 5月。 71 31%的病例为 18～ 2 4岁 ,196 9年及以后出生人群的发病危险是 196 9年以前出生人群的 19 83倍。外来人口病例占总病例的 4 8 2 6 % ,外资和民营企业的工人 (占 4 4 35 % )、大学生 ( 14 78% )、农民 ( 11 74 % )等是成人麻疹发病的重点人群。外来人口发病是青岛市成人麻疹报告发病率升高的主要因素 ,无麻疹疫苗免疫史、免疫失败是导致成人麻疹发病增高的关键原因。     

Visceral leishmaniasis in Brazil: rationale and concerns related to reservoir control

The control of zoonotic visceral leishmaniasis is a challenge, particularly in Brazil, where the disease has been gradually spreading across the country over the past 30 years. Strategies employed for decreasing the transmission risk are based on the control of vector populations and reservoirs; since humans are considered unnecessary for the maintenance of transmission. Among the adopted strategies in Brazil, the sacrifice of infected dogs is commonly performed and has been the most controversial measure. In the present study, we provide the rationale for the implementation of different control strategies targeted at reservoir populations and highlight the limitations and concerns associated with each of these strategies.     

迁西县自然疫源性和虫媒传染病流行因素分析

目的通过分析迁西县2005年1月-2011年6月迁西县自然疫源性和虫媒传染病的发病情况和影响因素,为有效预防和控制自然疫源性和虫媒传染病的发生和蔓延提供科学依据。方法应用描述性流行病学方法对资料进行分析,数据采用Excel2003软件进行统计。结果迁西县2005年1月～2011年6月通过网络直报报告自然疫源性和虫媒传染病包括狂犬病(2例)、肾综合症出血热(25例)、布鲁氏菌病(简称布病5例)、斑疹伤寒(8例)、流行性乙型脑炎(1例)、疟疾(1例)6种传染病共42例病例,死亡2例,年平均发病率为1.61/10万,病死率4.76%。气候变暖、生态环境变化、畜牧养殖业快速发展、防治宣传教育不足等因素是影响迁西县自然疫源性和虫媒传染病发病与流行的重要影响因素。结论在开展自然疫源性和虫媒传染病监测、宿主动物和病媒生物带毒情况监测和人群免疫状况监测的同时应加强气候和生态环境变化的监测,各相关部门加强合作,开展综合防治。     

Sex-discrete role of depressive symptomatology on 10-year first and recurrent cardiovascular disease incidence: results from ATTICA and GREECS prospective studies

ObjectiveThe sex-specific effect of depressive symptomatology on 10-year first and recurrent cardiovascular disease (CVD) events was evaluated.MethodsThe Greek samples from ATTICA (2002-2012, n = 845 free-of-CVD subjects) and GREECS (2004-2014, n = 2,172 subjects with acute coronary syndrome (ACS)) prospective epidemiological studies with baseline psychological assessments were used for the first and the recurrent event, respectively. Depressive symptomatology was assessed at baseline, through Zung Self-Rating Depression Scale in the ATTICA study, and through the Center for Epidemiological Studies-Depression scale in the GREECS study.ResultsACS as well as free-of-CVD women scored significantly higher for depressive symptomatology. Men scored higher than women against first (19.7% vs. 11.7%) and subsequent CVD events (38.8% vs. 32.9%). In participants with depressive symptoms man-to-woman first and recurrent CVD event rate ratio was below 1, confirming that depressive women were more likely to have a CVD event than depressive men. Multiadjusted analysis revealed that depressive symptomatology had an independent aggravating effect on the first (hazard ratio (HR) = 2.72, 95% confidence interval (95% CI) 1.50, 9.12) and recurrent (HR = 1.31, 95% CI 1.01, 1.69) CVD events only in women. Mediation analysis in women revealed that 35% (23%, 44%) of excess first-CVD-event risk of depressive symptoms was attributed to conventional risk factors. The respective number for recurrent CVD events was 46% (23%, 53%); different patterns of ranking regarding the mediating effect corresponding to each adjustment factor were observed.ConclusionsThe present work augments prior evidence that psychological stressors possess important drivers of CVD onset and progression mainly in women, while it gives rise to research toward unidentified paths behind this claim.     

Role of phytoestrogens in prevention and management of type 2 diabetes

Type 2 diabetes(T2D)has become a major public health threat across the globe.It has been widely acknowledged that diet plays an important role in the development and management of T2D.Phytoestrogens are polyphenols that are structurally similar to endogenous estrogen and have weak estrogenic properties.Emerging evidence from pre-clinical models has suggested that phytoestrogens may have anti-diabetic function via both estrogendependent and estrogen-independent pathways.In the current review,we have summarized the evidence linking two major types of phytoestrogens,isoflavones and lignans,and T2D from epidemiological studies and clinical trials.The cross-sectional and prospective cohort studies have reported inconsistent results,which may due to the large variations in different populations and measurement errors in dietary intakes.Long-term intervention studies using isoflavone supplements have reported potential beneficial effects on glycemic parameters in postmenopausal women,while results from short-term smallsize clinical trials are conflicting.Taken together,the current evidence from different study designs is complex and inconsistent.Although the widespread use of phytoestrogens could not be recommended yet,habitual consumption of phytoestrogens,particularly their intact food sources like soy and whole flaxseed,could be considered as a component of overall healthy dietary pattern for prevention and management of T2D.     

Healthcare-associated infections: challenges to public health in Brazil

This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.     

Developmental neurotoxicity of MDMA. A systematic literature review summarized in a putative adverse outcome pathway

The increasing use of illegal drugs by pregnant women causes a public health concern because it is associated with health risks for mothers and their developing children. One of such drugs is MDMA (3,4-methylenedioxymethamphetamine) or ecstasy due to its high consumption in relevant age and sex groups and its adverse effects on human and rodent developing brains. To thoroughly review the current knowledge on the developmentally neurotoxic potential of MDMA we systematically collected and summarized articles investigating developmental neurotoxicity (DNT) of MDMA in humans and animals in vivo and in vitro. In addition, we summarized the findings in a putative adverse outcome pathway (AOP). From an initial 299 articles retrieved from the bibliographic databases Web of Science, PubMed and DART, we selected 39 articles according to inclusion/exclusion criteria for data collection after title/abstract and full text screening. Of these 3 where epidemiological studies, 34 where in vivo studies in mice and rats and 2 were in vitro studies. The three epidemiological studies reported from the same longitudinal study and suggested that MDMA exposure during pregnancy impairs neuromotor function in infants. In rat, postnatal exposure towards MDMA also caused locomotor deficits as well as impaired spatial learning that might be associated with decreased serotonin levels in the hippocampus. In vitro MDMA caused cytotoxicity at high concentrations and effects on the serotonergic and neuritogenic alterations at lower concentrations which are in line with some of the in vivo alterations observed. Considering the adverse outcomes of developmental MDMA described in humans and in rodents we summarized the first putative AOP on developmental compound exposure leading to impaired neuromotor function in children. For generation of this AOP, MDMA exposure was taken as a model compound. In addition, we hypothesized a second AOP involving developmental disturbance of the dopaminergic system. However, further in vitro mechanistic studies are needed to understand the molecular initiating event(s) (MIE) triggering the downstream cascades and obtain consistent evidences causally linking the adverse outcome to effects at the cellular, organ and organism level.     

某航空大学在校学员听力变化情况分析

目的了解目前某航空大学在校学员听力状况及听力变化情况,为制定飞行学员听力损失的防治策略提供科学依据。方法应用纯音测听检查方法了解在校701名飞行学员的听力状况及入校后的变化情况,通过问卷调查分析听力损失的危险因素。结果与入校前相比,新出现听力超标284人(占总人数的40.5%),其中频率250Hz超标44耳(3.1%),500Hz超标181耳(12.9%),1000Hz超标45耳(3.2%),2000Hz超标10耳(0.7%),3000Hz超标8耳(0.6%),双耳高频听力总和超标7人(1.0%)。被调查人群中耳塞式耳机的使用率为79.3%,平均每天使用时间(1.28±1.22)h,73.2%的使用者使用音量超过最大音量的2/3。结论部分学员入校后出现一定程度的听力减退,不正确应用耳机是造成学员听力损失的主要原因,应引起高度重视,加强对噪声性听力损失的预防、保健等相关知识的科普宣传,避免过多接触噪声。     

Evaluation of national health‐care related infection criteria for epidemiological surveillance in neonatology

Objectiveto assess the use of the Brazilian criteria for reporting of hospital‐acquired infections (HAIs) in the neonatal unit and compare them with the criteria proposed by the National Healthcare Safety Network (NHSN).Methodsthis was a cross‐sectional study conducted from 2009 to 2011. It included neonates with HAI reporting by at least one of the criteria. Statistical analysis included calculation of incidence density of HAIs, distribution by weight, and by reporting criterion. Analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the national criteria was performed considering the NHSN as the gold standard, with agreement assessed by kappa.Resultsa total of 882 newborns were followed, and 330 had at least one infection notified by at least one of the criteria. A total of 522 HAIs were reported, regardless of the criteria. An incidence density of 27.28 infections per 1,000 patient‐days was observed, and the main topographies were sepsis (58.3%), candidiasis (15.1%), and conjunctivitis (6.5%). A total of 489 (93.7%) were notified by both criteria, eight infections were notified only by the national criteria (six cases of necrotizing enterocolitis and two cases of conjunctivitis), and 25 cases of clinical sepsis were reported by NHSN criteria only. The sensitivity, specificity, PPV, and NPV were 95.1%, 98.6%, 98.4%, and 95.7%, respectively, for all topographies, and were 91.8%, 100%, 100%, and 96.3% for the analysis of sepsis. Kappa analysis showed an agreement of 96.9%.Conclusionthere was a high rate of agreement between the criteria. The use of the national criteria facilitates the reporting of sepsis in newborns, and can help to improve the specificity and PPV.