据WHO数据,全球范围内每10人中有3人,也就是约21亿人缺少安全的饮水供应,饮水相关疾病在全球范围内造成巨大的经济负担[1].作为一个拥有约5.5亿农村人口的发展中农业大国,农村饮水安全,事关农民群众身体健康和生命安全,事关农村经济社会可持续发展,政府在解决农村饮水困难和饮水不安全问题方面高度重视.进入21世纪以来,我国先后实施农村饮水解困和农村饮水安全工程建设,取得了显著成效.解决农村饮水安全问题成为脱贫攻坚的重要任务,已被纳入脱贫攻坚考核范围."十三五"以来,我国全面打赢农村饮水安全脱贫攻坚战,超额完成"十三五"巩固提升规划任务,农村自来水普及率达到83％.2021年是"十四五"开局之年,我国将继续实施农村供水保障工程,提升供水保障水平,持续强化农村供水工程管理管护.

厕所虽小,却浓缩了民生.厕所是我们每个人每天必须接触和使用的基础设施,使用清洁卫生的厕所是每个人的基本权利.随着生活水平的改善和健康水平的提高,厕所与人的关系越来越多元化,不仅是关乎最基本的生理需求和健康需求的设施,更体现着人们的生活水平以及实现和维护个人尊严的主观要求.一个国家的厕所状况体现了民族的卫生文化和国家的文明程度.从这个意义上看,厕所设施的改善、卫生如厕行为的形成、健康厕所文化的树立既是个人和家庭的私事,也是国家和民族的大事.

Objective To investigate the heavy metal concentrations and their potential ecological risk of sediments in the water source in the Chongqing section of the three gorges reservoir. Methods A total of 21 sediment samples were collected from the upper, middle and downstream sections of the Chongqing section of the three gorges reservoir in April, 2018. The concentrations of Hg, Cr, Cd, Pb and Ni were determined. The index of geoaccumulation and potential ecological risk index were employed to evaluate the pollution degree of heavy metals in the sediments. Results The average contents of Hg, Cr, Cd, Pb and Ni in the sediments were 0.09, 65.77, 0.83, 34.31 and 29.51 mg/kg, respectively. The assessment by the geoaccumulation index showed that the pollution degree of heavy metals was: Cd＞Ni＞Pb＞Cr＞Hg, and Cd was mild to moderate pollution, and others are non-polluting. The assessment by potential ecological risk index indicatd that the potential ecological risk of heavy metal was: Cd＞Hg＞Pb＞Ni＞Cr, and the overall level was in the mild to medium ecological hazard. Cd and Hg were in a very strong ecological hazard level in some sampling points, and Cd was the predominant contributor among them. Correlation analysis indicated that Hg, Cr, Cd, Pb and Ni were significantly correlated with each other at the 0.01 level.Conclusion Cd and Hg are the main pollutants of ecological risk and should be used as the main control pollutants.

我国饮水问题比较突出,近年来因气候变化导致的极端天气事件发生的频率和强度有所增加,其可通过水源、水处理过程、供水系统、居民饮用水行为等环节影响水质和水量,加剧居民饮水安全和健康问题.在全球气候变化背景下,简述了其对各国不同地区饮水安全、水相关疾病及其适应性管理3方面的研究进展,分析了气候变化对饮水安全与居民健康的相互关系.指出影响饮水安全及其健康问题的主要气象因素有气温、降水量和蒸发量;同时,在干旱期或暴雨期,降水量比温度更易对水质、水量和健康产生负面影响,但不同微生物种类、季节和水源类型、居民饮水行为及社会因素会因气候变化的相互作用而使影响更为复杂.建议:需建立气候变化与饮水安全和居民健康影响的相互关系模型,在此基础上制定有效的水质风险评估和管理对策,对缓解气候变化导致的缺水地区居民饮水安全和健康问题起至关重要作用.

目的 调查饮水氟超标临界地区儿童膳食营养状况,分析并探讨儿童氟斑牙患病与膳食营养之间的关系.方法 采用1∶1病例-对照研究方法,于2017年5-6月,在河南省清丰县整群随机抽取改水时间超过5年以上的地氟病村的氟斑牙及非氟斑牙(对照)的8～12岁儿童各30名(男女各半),进行连续3d的“双份饭法”膳食营养调查.结果 氟斑牙组与对照组儿童每日饮水氟、食物氟和总摄氟量间比较,差异均无统计学意义(P＞0.05).与氟斑牙组比较,对照组儿童仅食用肉类的比例较高,差异有统计学意义(P＜0.05);而食用大豆类、蛋类、蔬菜、水果的比例无明显变化.与对照组比较,氟斑牙组儿童仅膳食磷的摄入量较高,差异有统计学意义(P=0.027);而膳食蛋白质、钙、镁、铁、锌、硒、铜和维生素C的摄入量均无明显变化.与氟斑牙组比较,对照组儿童膳食蛋白质和镁摄入量≥RNI的比例较高,差异均有统计学意义(P＜0.05);而膳食钙、磷、铁、锌、硒、铜、维生素C摄入量≥RNI的比例均无明显变化.多因素条件logistic回归分析结果显示,膳食镁摄入量≥RNI(OR=0.231,95 ％CI=0.064～0.831)是儿童患氟斑牙的保护性因素.结论 膳食镁可能是儿童氟斑牙发病保护性因素.为预防儿童氟斑牙,建议氟病区儿童日常膳食营养中应保证充足的镁摄入.

目的 了解农村居民饮水行为现状及影响因素.方法 通过多阶段随机抽样和面对面现场问卷调查的方式,于2014-2016年在河南省A、B两个县的466户家庭进行调查,收集10类与农村居民饮水相关的情况,运用多因素logistic回归分析农村居民饮水行为的影响因素,同时对家庭饮水中微生物指标进行检测.结果 73.39％(342/466)的家庭饮用开水,其中,25.11％(117/466)的家庭用电烧开水,48.28％(225/466)的家庭用其他燃料烧开水;25.11％(117/466)的家庭饮用桶装水,1.50％(7/466)的家庭饮用生水.A县农村家庭饮用开水率[98.67％(223/226)]高于B县[49.58％(119/240)],差异有统计学意义(P＜0.01).开水、桶装水和生水微生物指标合格率分别为68.75％(231/336),69.03％(78/113)和20.00％(1/5).多因素logistic回归分析显示,污水随意排放(0R=0.155,95％CI=0.039～0.614)、喜欢饮用开水(OR=241.482,95％CI=83.924～694.835)的农村家庭居民饮用开水率较高.结论 农村居民饮水行为和饮水卫生质量存在健康隐患,应加强饮水行为的卫生宣传和健康教育,提升农村居民饮水安全水平.

Background: Exposure to phthalates may affect thyroid hormone status. However, there were inconsistent observations for the associations of phthalates exposure with altered thyroid hormones. Objectives: The aim of this study was to investigate effects of urinary excretion of phthalate metabolites on the levels of thyroid hormones among workers engaged in waste plastic recycling in China. Methods: We measured serum levels of thyroid hormones and urinary levels of eight phthalate metabolites among 317 participants (165 workers engaged in waste plastic recycling and 152 farmers), analyzed relationships between urinary phthalate metabolites and thyroid function parameters by multivariate linear regression analysis and structural equation modelling as well as assessed the dose-response relationships between them by restricted cubic spline functions. Results: Maximum urinary values of eight phthalate metabolites in the occupational exposed workers were higher than the controls. Compared with the controls, the workers had higher levels of urinary monobenzyl phthalate (MBzP, 1.12 vs. 0.92 mu g/g creatinine), mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP, 38.84 vs. 32.55 mu g/g creatinine), mono-n-octyl phthalate (MOP, .11 vs. 0.09 mu g/g creatinine), serum total triiodothyronine (T3, 1.04 vs. 0.92 ng/mL) and the T3 to thyroxine (T4) ratio (1.44 vs. 1.09) (all P < 0.05). The results from structural equation modelling analysis showed that phthalates metabolites were positively associated with total T3 (beta = 0.044, SE = 0.021, P < 0.05) or the T3/T4 ratio (beta = 0.053, SE = 0.022, P < 0.05) among all participants. Among the workers, there were the non-monotonic dose-response associations between urinary monomethyl phthalate (MMP) and serum total T3 or the T3/T4 ratio, as well as between urinary monoethyl phthalate (MEP) and the T3/T4 ratio (all P < 0.05). Conclusions: The dose-response relationships between urinary phthalate metabolites and thyroid hormone parameters may be non-monotonic among the workers. Further investigations are needed to corroborate these findings.

Objective To examine the status and the related factors of drinking water behavior among households in rural areas of Guangxi Zhuang Autonomous Region (Guangxi) and to explore effective drinking water treatment methods other than water-boiling in rural households.Methods We conducted a face-to-face questionnaire survey among 450 households selected with multi-stage stratified random sampling in two counties of Guangxi between 2013 and 2014.We collected information on 10 aspects related to drinking water treatment.We adopted multivariate logistic regression to analyze influencing factors of drinking water behavior among the households.Results Ofall the households surveyed,47.5 ％,35.0 ％,and 17.5 ％ reported taking boiled,bottled,and unboiled water as drinking water,respectively.There was a significant difference in the proportion of households taking boiled water as drinking water (x2 =9.547,P =0.002).Multivariate logistic regression analyses showed that the households with higher level of relevant knowledge (odds ratio [OR] =0.290,95 ％ confidence interval[95 ％ CI]:0.097-0.865),not discharging sewage at will (OR =0.295,95 ％ CI:0.112-0.776),without household water storage (OR =0.059,95％ CI:0.013-0.269),and not preferring to drink boiled water (OR =0.001,95 ％ CI:0.000-0.005) were more unlikely to take boiled water as drinking water.Conclusion In rural areas of Guangxi,the proportion of households using electric kettle to boil water for drinking is not high and a number of households use fuelbased method to boil drinking water or drink bottled water;some households even drink unboiled water;the over standard rate of microbial indicators is relatively high for samples of the drinking water for the households.

目的 了解长江流域重庆段饮用水水源地水源水和沉积物中多溴联苯醚(PBDEs)的污染情况.方法 于2018年3-4月,在长江流域重庆段上游、中游和下游共选择20个饮用水水源地,分别采集水源水和表层沉积物,检测31种PBDEs的水平.采用调查问卷收集水源地基本情况.结果 水源水中31种PBDEs均未检出.水源地沉积物中31种PBDEs的含量范围为未检出～15.66 ng/g,主要检出同系物为BDE-62、BDE-66和BDE-209.采样点4沉积物中的PBDEs含量最高,达到15.66 ng/g.结论 长江流域重庆段饮用水水源地沉积物受到不同程度的PBDEs污染;工业中多溴联苯醚的使用和生活污水的排放是水源地沉积物PBDEs的主要污染来源.

Objective To find risk evaluation method which is applicable to centralized water supplies.Methods Risk indices of each water supply of 1 302 centralized water supplied which were selected based on cluster sampling principle in five counties in China were calculated.Two-phase clustering algorithm was used to prioritize cluster number.Systematic clustering and K-means clustering algorithm were employed to analyze the risk indices base on the prioritized cluster number and cluster number recommended by national technical standard respectively.Results Two-phase clustering analysis result showed that four clusters was the prioritized cluster number for research objects;Systematic clustering analysis results of four clusters showed that 97.8％ of the total was categorized in the second cluster,which presented most objects were evaluated as middle risk level;Systematic clustering analysis results of three clusters showed that 98.5％ of the total was categorized in the first cluster,which presented most objects were evaluated as low risk level;K-means clustering analysis result of four clusters showed 14.0％,16.0％,30.6％ and 39.5％ of the total were categorized in the 1st,2nd,3rd and 4th cluster respectively;K-means clustering analysis result of three clusters showed 26.3％,34.2％ and 39.5％ of the total were categorized in the 1st,2nd and 3rd cluster respectively.Conclusion Four clusters is testified more applicable for risk evaluation of centralized water supply,which indicates high,relatively high,relatively low and low risk level respectively.K-means clustering analysis is regarded as the more applicable algorithm in this field based on the data characteristics.

Objective The aim of this study was to determine the prevalence of Listeria species in food products in Maanshan,Anhui Province.Methods From January 2009 to December 2014,a total of 2 372 food products,including meat,poultry,fishes,shrimps,animal viscera,cooked food,vegetables,flour products,bean products,eggs,juice,dairy products and ice creams,were randomly collected from restaurants,supermarkets and retail markets in Maanshan.Listeria spp.strains were isolated according to GB 4789.30-2010 method.Furthermore,all the Listeria monocytogenes were examined for the presence of virulence genes.Results Out of 2 372 tested samples,332 (14.00％) were contaminated with Listeria spp.,of which 25.15％ (82/326) were isolated from meats,23.98％ (82/342) from poultry meats,16.20％ (104/642) from fishes and shrimps,11.66％ (26/223) from animal viscera,8.49％ (31/365) from cooked food,2.88％ (4/139) from vegetables,2.20％ (2/91) from flour products and 1.33％ (1/75) from bean products.There was no Listeria spp.isolated in eggs,juice,dairy products and ice creams.The highest prevalence of Listeria spp.occurred in 2009 (23.97％,70/292),followed by 2011 (15.62％,67/429),2012 (15.36％,49/319),2014 (11.65％,48/412),2013 (11.11％,47/423) and 2010 (10.26％,51/497).The difference of the prevalence rates of Listeria for different years were statistically significant (x2 =26.80,P ＜ 0.05).Six virulence genes,including hly,prfA,plcB,inlA,actA and iap,were observed in all of the L.monocytogenes isolates.Conclusion There were different contamination levels of Listeria in different food and years in Maanshan.This study revealed the potential risk of foodborne disease outbreak caused by L.monocytogenes.Persistent surveillance on the contamination of Listeria spp.in food products should be strengthened to prevent foodborne listeriosis.

Objective To know the microbiological monitoring situation in drinking water and to analyze the correlation between indicator bacteria regulated by Standards for Drinking Water Quality GB 5749-2006 and waterborne infectious diseases.Methods Data for 2014 national incidence of waterborne infectious disease and monitoring results of conventional indicator bacteria in drinking water from Public Health Science Data Center.They were analyzed using principal component analysis and Spearman correlations.Results Higher grade of qualified rate of indicator bacteria was found in Heilongjiang,Jiangsu,Beijing and Hebei among 22 provinces and cities.There was no correlation between mean of conventional indicator bacteria and morbidity of common waterborne infectious diseases except the total coliform bacteria and paratyphoid fever,four conventional indicator bacteria showed positive correlation two by two during dry season;There was no correlation between mean of conventional indicator bacteria and morbidity of common waterborne infectious diseases except the total coliform bacteria and typhoid,paratyphoid fever,four conventional indicator bacteria showed positive correlation two by two except E.coli and total bacterial count during wet season.Conclusion In general,there is no significant correlation between incidence of common waterborne infectious diseases and indicator bacteria regulated by GB 5749-2006.Further research should be conducted on quantitative relationship between waterborne infectious diseases and indicator bacteria,and new indicator bacteria should be explored as well.

目的 研究开发便于农村基层饮水卫生管理人员使用的数据信息采集设备.方法 基于饮用水风险管理系统所需的信息内容,开发适宜于农村饮用水卫生管理的数据采集终端手持机和现场水质检测设备,安装植入饮用水风险管理系统软件,并现场示范应用.结果 研发农村集中式供水水质系统信息采集设备,采集数据通过网络实时或离线上传至数据处理平台,使得卫生管理人员能够及时准确掌握辖区内饮水安全卫生基础信息和风险水平及其变化情况,并通过反馈控制模块将信息以短信或其他形式发送至决策者或基层卫生监管对象.结论 该设备为饮水卫生安全风险的早发现、早识别、早处理提供基础,并辅助科学决策,提升信息化水平.

目的 分析水氟浓度与膳食氟含量之间的关系,为氟中毒防控提供依据.方法 采用多阶段随机抽样方法,在6个省份各抽取6个水氟浓度不同的村,每个村随机称取10名8 ～12岁的儿童,采用双份饭法调查3d24h膳食,检测膳食氟含量.采用单因素回归分析水氟浓度与膳食氟含量之间的关系.结果 在调查的6个省份29个村的饮水水氟浓度范围在0.41～2.85 mg/L之间,均值和标准差为(1.25±0.54) mg/L.儿童膳食氟含量范围在2.19～8.76 mg/kg,均数和标准差为(4.69 ±2.11) mg/kg.水氟浓度与膳食氟对数之间的线性回归方程具有统计学意义(F=6.89,P＜0.05),回归方程为logssf =0.505 4 +0.114 8 sf,R2=0.20.结论 水氟浓度与儿童膳食氟对数之间有普遍相关性.在饮水型氟中毒地区,除饮水外还应重视膳食氟的危害.

目的 评价北方某地农村饮水水质所带来的人群健康风险.方法 利用2015年某地区农村饮水水质监测数据,通过健康风险评价模型,计算基因毒物质和躯体毒物的个人年风险.结果 基因毒物质评价结果显示,饮水中砷和铬的风险比较大.躯体毒评价结果显示,该区各乡镇饮用水躯体毒物质的风险度均较低.毒物总风险评价结果显示,砷的毒性风险度在总风险中成了关键.结论 该地区部分乡镇农村饮水砷的健康风险较大.

目的评估云南彝良地震灾区集中安置点公共卫生状况和应急工作需求。方法于2012年9月11—14日,按照《救灾安置点公共卫生需求快速调查评估表》内容对彝良城区所有9个集中安置点进行快速调查评估。结果集中安置点住宿全部以帐篷方式实现;安置点饮水以定型包装水为主,8个安置点的生活用水来源于自来水,且采取集中式供水;食品基本来自政府供给或社会捐赠,5个集中安置点采取集中供餐方式供餐;8个集中安置点开展环境消毒工作并设有垃圾集中收集点,但存在垃圾未及时清运现象,所有安置点内蚊子、苍蝇等病媒生物密度较低;7个集中安置点内设有临时医疗点,所有医疗点均开展了传染病登记报告及症状监测登记报告。结论彝良城区的集中安置点公共卫生状况有待改善,仍存在肠道和呼吸道传染病的传播风险。

Objective To provide a basis for making effective strategies and measures on measles. Methods Descriptive epidemiology was used on measlesepidemic data in Chaoyang District, Beijing in 2008-2014. Results A total of 1649 cases of measles were reported during 2008-2014,with the average annual incidence of 7.66/100,000 and immunization coverage of 99.91%.In 2008 to 2012, the incidence of measles decreased year by year, with a low incidence of 0.49/100,000 in 2012. Howrver,it tended to be adverse from 2013.Besides,male cases accounted for 73.25% among the seven years.Patients with measles more than 14-year-old accounted for 59.98% and migrant cases accounted for 72.95% in our population. Con-clusion We need to focus on carrying outmeasles vaccine immunization in older group in time, paying attention on control of migrant children and adults and improving the immune level of populations.

氟在环境中的多途径暴露可导致多种健康危害.该文综述了氟中毒相关健康效应指标,将氟中毒的暴露途径总结为饮水暴露、饮茶暴露、食物暴露、呼吸道及其他暴露,分析氟暴露与氟中毒的关系,发现水氟浓度对氟斑牙发生的贡献率存在地区差异,提出应重视氟的多途径暴露识别,从总摄氟量的角度评价人群氟暴露水平.同时分析了氟暴露与健康效应的影响因素,应考虑氟中毒不同健康效应,综合评价其他途径氟暴露及影响因素在氟中毒中的作用,从而为氟中毒的防治提供科学的依据.

目的 了解高氟地区改水后儿童氟斑牙现状及膳食营养摄人情况,通过膳食调查探讨膳食营养素对氟斑牙的影响.方法 于2014年在6个省各随机抽取6个不同水氟浓度且改水5年以上地氟病村进行了饮水氟含量测定、8～12岁儿童氟斑牙患病情况及膳食营养状况调查.结果 膳食营养调查结果发现检出氟斑牙与未检出氟斑牙儿童在膳食钙、镁、铁摄人量方面差异有统计学意义.多因素非条件logistics回归分析结果显示膳食镁与氟斑牙的检出率之间呈负相关(β=-0.165,P＜0.05),膳食镁的摄入量每增加推荐摄入量(RNI)的10％,氟斑牙的患病风险是原来的0.848倍(OR=0.848).膳食铁与氟斑牙的检出率之间呈正相关(β=0.070,P＜0.05),膳食铁的摄人量每增加推荐摄入量(RNI)的10％,氟斑牙的患病风险是原来的1.073倍(OR=1.073).结论 在总摄氟量一定的条件下除膳食钙以外,膳食镁与膳食铁是氟斑牙发病的影响因素,膳食镁可能是氟斑牙发病的保护因素,而膳食铁可能是危险因素.