美国狂犬病的预防策略与挑战

狂犬病是由狂犬病毒所导致的人畜共患疾病.欧美国家的狂犬病流行毒株包括犬株、蝙蝠株和浣熊株等[1].美国在第二次世界大战后,通过对宠物犬疫苗接种和野犬等的有效控制,人畜狂犬病的病例数显著下降.1946年,美国报告8384只病犬狂犬病和33例人狂犬病确诊病例.     

某职业技术学院学生狂犬病知识知晓现状与健康教育效果评价

狂犬病是由狂犬病病毒引起的人畜共患传染病,一旦发病,病死率几乎为100%[1].据WHO统计,全球99%的狂犬病主要分布在亚洲、非洲和拉丁美洲等发展中国家[2].每年亚洲死亡人数约3.5万,其中80%以上病例发生于印度,中国次之.近年来,我国每年狂犬病死亡病例超过2 000例,且有逐年增加趋势[3].我国95%以上的人狂犬病由带毒犬传染,高发人群为农民和青少年[4];在校大、中学生的狂犬病致死病例时有发生[5-7].在校大学生正处于青少年时期,本身属于危险的高发人群.因此,在校大学生对狂犬病知识知晓现状就显得尤为重要.本课题旨在通过对在校大学生狂犬病知识现状调查以及健康教育进行有效性分析,以提高在校大学生对狂犬病知识的知晓率,并通过他们加强狂犬病知识的宣传.     

预防控制狂犬病的新策略和措施

狂犬病是一种发病凶险、危害极大的人畜共患传染病,病死率100%.全球98%的狂犬病病例集中在亚洲,我国是狂犬病的高发地区,其死亡人数、病死率在我国所有法定报告传染病中居首位,2008年报告3300例.近年来,由于人用和兽用狂犬病疫苗研制取得重大进展及流行病学和免疫学认识的深入,对狂犬病防控策略和方法措施也随之更科学更完善,从而大大推进了狂犬病的预防控制.     

犬类动物咬伤12 809例患者流行病学调查

狂犬病是一种人畜共患的自然疫源性疾病,犬是狂犬病的主要传染源.我国是全球第2大狂犬病国家,近年来,每年有超过3000人死于狂犬病,疫情形势日益严峻.为了解被犬类动物咬伤的流行规律,完善狂犬病防治措施,笔者对近4年邹城市发生的21例狂犬病病例及12 809例动物咬伤患者进行了调查,现将结果分析如下.     

开平市控制狂犬病的策略与效果研究

狂犬病是一种人畜共患传染病 ,病死率几乎达 1 0 0 % ,对人民生命健康和畜牧业发展造成严重威胁。目前世界上对于狂犬病的治疗尚缺乏有效的方法。开平市从 5 0年代至 1 990年前均有狂犬病疫情 ,流行较为严重 ,年发病率最高是 1 95 8年 (4 0 2 /十万 ) ,80年代起各级政府高度重视 ,在公安、畜牧、卫生等各部门通力合作下 ,狂犬病防治工作卓有成效 ,1 991年及以后已无狂犬病发病报告 ,现将开平市狂犬病控制策略与效果总结分析如下 :1　材料与方法收集、统计、整理建国以来广东省开平市的人畜狂犬病疫情资料 ,并进行人狂犬病病例的流行病学调查…     

东台市狂犬病病例特征分析及干预措施评估

狂犬病是一种严重的人畜共患传染病,病死率100%.东台市近年来狂犬病发病率有上升趋势,为有效控制狂犬病的发生和流行,东台市采取了加强宣传教育,强化犬类管理,规范处理伤口,联合应用狂犬疫苗和抗狂犬病血清等措施.现将1995年～2000年东台市狂犬病流行特征及干预措施分析报告如下.     

2005年福田区疾控中心门诊2552例动物咬伤病例分析

狂犬病是一种病死率极高、人畜共患的急性传染病.随着经济的发展,人们的生活行为也在发生变化,饲养宠物的家庭增多,动物咬伤病例逐年增加[1].本文对2005年深圳市福田区疾病预防控制中心(简称疾控中心)门诊就诊的动物咬伤病例人口社会学及流行病学特征进行统计分析,为政府及相关部门制定预防控制狂犬病的策略、措施提供依据.     

昆明市狂犬病流行病学调查分析

狂犬病为人畜共患传染病,病死率几乎为100%。为掌握狂犬病在昆明市的流行状况,分析发病因素,有效控制狂犬病的流行,现将昆明市2004-2011年狂犬病流行病学情况分析报告如下。1资料与方法1.1资料病例资料来自2004-2011年昆明市传     

湖北省孝昌县2008-2011年动物致伤病例分析

动物致伤是导致狂犬病发生、流行最直接的原因,而狂犬病是一种人畜共患传染病,一旦致病,传染性强,流行面广,致死率100.00％[1],严重威胁着人们的健康.为了解孝昌县动物致伤性疾病的流行态势,对全县2008-2011动物致伤病例进行调查分析.     

狂犬病防治的新问题

狂犬病是一种人畜共患病毒性传染病,随着经济发展养犬防盗和宠物热升温,使广大城乡犬密度急剧上升,在我国70年代末,狂犬病有所抬头,80年代中期,人畜狂犬病例逐年增多。每年有5000～8000人死于狂犬病,居世界第二位,近年来随着各地健康犬伤人致病死亡病例的不断出现,健康犬狂犬病抗体的检出,为狂犬病防治提出了新课题。1 健康带毒犬与野生动物成为传染源危险性的发展 以往认为,人类狂犬病的主要传染源是狂犬,广东罗会明等于1990～1991年对1258只健康犬用荧光抗体法作脑带毒率调     

河南省卫辉市农村男性居民酒依赖与酒滥用状况调查

随着我国经济发展,酒生产和消费日益增加,饮酒相关健康问题和社会问题愈加突出,对人类的危害仅次于心脑血管疾病和肿瘤而位居第三[1].为此对河南省卫辉市农村男性居民的酒依赖和酒滥用状况进行流行病学调查,为制定预防和干预措施提供科学依据.     

汶川地震对灾区乡村妇幼卫生信息能力的影响评估

汶川地震对灾区妇女儿童健康造成极大影响,因此必须准确获得震后妇幼健康信息,为及时干预提供依据.我国妇幼健康信息来源于妇幼卫生信息系统(MCHIS).由于MCHIS在震中受到很大程度破坏,且乡村级为MCHIS的基础部分,其信息能力决定了整个MCHIS信息产出质量.本研究通过层次分析法(AHP)评价汶川地震对乡村妇幼信息能力的影响及相对影响程度,利用聚类分析明确灾后MCHIS重建的重点区域,为灾区妇幼卫生体系重建提供决策依据.     

联合应用依折麦布对他汀治疗冠心病患者血脂达标率的影响

目的 观察联合依折麦布对单独应用他汀类药物未能使低密度脂蛋白胆固醇(LDL-C)达标的冠心病合并糖尿病患者血脂的影响.方法 61例应用他汀治疗12周后LDL-C未达标(<2.07mmol/L)的冠心病合并糖尿病患者,在原用药基础上联合应用依折麦布(10mg/d),观察治疗8周后的血脂水平,及对丙氨酸氨基转氨酶(ALT)、天门冬氨酸氨基转氨酶(AST)及肌酸激酶(CK)的影响.结果 干预前LDL-C未达标的61例患者LDL-C分别为(2.74±0.43)nmaol/L和(2.19±0.32)mmol/L(P=0.03);干预后LDL-C水平下降20.1%(P<0.05),总胆固醇(TC)下降19.1%(P<0.05),LDL-C水平达标率为74%(45/61).干预前后甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)无显著变化(P>0.05),AST、ALT和CK等指标也无显著变化(P>0.05).结论 联合应用依折麦布可以提高他汀类药物治疗冠心病合并糖尿病患者的LDL-C达标率,使LDL-C水平进一步降低.     

The pivotal role of cholesterol absorption inhibitors in the management of dyslipidemia

Elevated low-density lipoprotein (LDL)-cholesterol is associated with a significantly increased risk of coronary heart disease. Ezetimibe is the first member of a new class of selective cholesterol absorption inhibitors. It impairs the intestinal reabsorption of both dietary and hepatically excreted biliary cholesterol. Ezetimibe is an effective and safe agent for lowering LDL-C and non HDL-C. Short term clinical trials have established the role of ezetimibe monotherapy and its use in combination with statins. Furthermore, ezetimibe and statin combination therapy increased the percentage of patients who achieved their LDL-C treatment goal.     

2型糖尿病合并冠心病患者调脂治疗达标情况分析

目的了解2型糖尿病（T2DM）合并冠心病（CHD）患者调脂治疗的达标情况。方法对6个月内接受过调脂治疗的161例合并CHD的T2DM患者进行血脂检测,并以2007年《中国2型糖尿病防治指南》为标准分析其达标情况。结果 LDL-C、HDL-C和TG水平分别为（2.71±0.67）、（1.15±0.43）和（2.06±0.87）mmol/L,经t检验,HDL-C水平达标（P〉0.05）,LDL-C和TG水平未达标（P均〈0.05）。LDL-C、HDL-C和TG的达标率分别为33.5%、65.2%和46.6%。结论 T2DM合并CHD患者调脂治疗达标率较低,需进一步提高患者对调脂治疗的依从性和医生应用调脂药物的水平。     

Combination therapy in cholesterol reduction: focus on ezetimibe and statins

Although widely used in lipid lowering therapy, HMG CoA reductase inhibitors (even when administered at high doses) are frequently insufficient to achieve guideline-recommended LDL-C goals for many patients with hypercholesterolemia in everyday clinical practice. Many patients do not achieve LDL-C goal on the initial dose of statin and the majority of these patients does not reach their goal after 6 months. As a consequence, a wide therapeutic gap exists between target LDL-C levels and those typically achieved in clinical practice. A recent and more effective therapeutic hypocholesterolemic strategy is to treat the two main sources of cholesterol simultaneously (production of cholesterol, mainly in the liver, and absorption of cholesterol in the intestine) with a complementary mechanism of action, by co-administering ezetimibe, a novel agent inhibiting cholesterol absorption, with a statin, which inhibits cholesterol production in the liver. Ezetimibe can be effectively and safely co-administered with any dose of any statin and, compared with the single inhibition of cholesterol production, afforded by statins alone, provides consistently greater reductions in LDL-C through dual inhibition of both cholesterol production and absorption. We summarize the pivotal role of both the liver and intestine in the overall balance of cholesterol in the body and describe the clinical impact and relevance of using ezetimibe either alone or co-administered with statins in controlling elevated levels of plasma LDL cholesterol.     

Lost Therapeutic Benefit of Delayed Low-Density Lipoprotein Cholesterol Control in Statin-Treated Patients and Cost-Effectiveness Analysis of Lipid-Lowering Intensification

ObjectivesAttainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in statin-treated patients remains suboptimal. We quantified the health economic impact of delayed lipid-lowering intensification from an Australian healthcare and societal perspective.MethodsA lifetime Markov cohort model (n = 1000) estimating the impact on coronary heart disease (CHD) of intensifying lipid-lowering treatment in statin-treated patients with uncontrolled LDL-C, at moderate to high risk of CHD with no delay or after a 5-year delay, compared with standard of care (no intensification), starting at age 40 years. Intensification was tested with high-intensity statins or statins + ezetimibe. LDL-C levels were extracted from a primary care cohort. CHD risk was estimated using the pooled cohort equation. The effect of cumulative exposure to LDL-C on CHD risk was derived from Mendelian randomization data. Outcomes included CHD events, quality-adjusted life-years (QALYs), healthcare and productivity costs, and incremental cost-effectiveness ratios (ICERs). All outcomes were discounted annually by 5%.ResultsOver the lifetime horizon, compared with standard of care, achieving LDL-C control with no delay with high-intensity statins prevented 29 CHD events and yielded 30 extra QALYs (ICERs AU$13 205/QALY) versus 22 CHD events and 16 QALYs (ICER AU$20 270/QALY) with a 5-year delay. For statins + ezetimibe, no delay prevented 53 CHD events and gave 45 extra QALYs (ICER AU$37 271/QALY) versus 40 CHD events and 29 QALYs (ICER of AU$44 218/QALY) after a 5-year delay.ConclusionsDelaying attainment of LDL-C goals translates into lost therapeutic benefit and a waste of resources. Urgent policies are needed to improve LDL-C goal attainment in statin-treated patients.     

Statins and elevated liver tests: what's the fuss?

Order liver function tests before starting statin therapy, 12 weeks after initiation, with any dose increase, and periodically for long-term maintenance therapy. Mild elevations of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) (<3 times the upper limit of normal [ULN]) following statin therapy do not appear to lead to significant liver toxicity over time. Other medications that lower low-density lipoprotein (LDL), and might be substituted for statins, may not improve morbidity and mortality.     

The Performance Gap between Clinical Trials and Patient Treatment for Dyslipidemia

Cardiovascular disease is the primary cause of death in the US. Controlling dyslipidemia, particularly elevated low-density lipoprotein-cholesterol (LDL-C), is considered a primary strategy to reduce cardiovascular risk. HMG-CoA reductase inhibitors (statins) are the most effective agents available to lower LDL-C. Moreover, evidence from numerous prospective clinical trials has shown that statins reduce both cardiovascular disease morbidity and mortality in patients with dyslipidemia. Newer evidence has resulted in updated consensus guidelines that list reducing LDL-C values to a greater degree than has previously been recommended as therapeutic options for certain at-risk populations. Despite these conclusive benefits, most patients at risk for cardiovascular disease have LDL-C values that are above recommended goal values. Observational studies have identified several problems in managing dyslipidemia. These include infrequent screening for dyslipidemia by measuring fasting lipid panels, not prescribing statin therapy in high-risk individuals, incomplete monitoring in patients receiving statin therapy, and a general inability to attain recommended LDL-C goal values in patients receiving statin therapy. This gap between efficacy from clinical trials and treatment in clinical practice is particularly important to managed care organizations because statin therapy can reduce cardiovascular risk and may result in reduced overall healthcare costs. Many drug-based and system-based strategies can be implemented by managed care organizations to reduce this gap. Using high-potency statins, selecting appropriate initial statin doses based on the degree of LDL-C reduction that is required, and combination therapy (e.g. a statin with ezetimibe, bile acid sequestrants, niacin, or fibric acid derivatives) can result in greater LDL-C lowering than by simply using the lowest starting dose of any given statin. System-based models that utilize specific disease state management clinics, therapeutic intervention programs that target population-based improvements in LDL-C goal attainment, and judicious formulary management that includes therapeutic conversion initiatives have all been successfully implemented in managed care environments.     

Effects of ezetimibe add-on therapy for high-risk patients with dyslipidemia

Background  

Ezetimibe (Zetia^?) is a potent inhibitor of cholesterol absorption that has been approved for the treatment of hypercholesterolemia. Statin, an inhibitor of cholesterol synthesis, is the first-choice drug to reduce low-density lipoprotein-cholesterol (LDL-C) for patients with hypercholesterolemia, due to its strong effect to lower the circulating LDL-C levels. Because a high dose of statins cause concern about rhabdomyolysis, it is sometimes difficult to achieve the guideline-recommended levels of LDL-C in high-risk patients with hypercholesterolemia treated with statin monotherapy. Ezetimibe has been reported to reduce LDL-C safely with both monotherapy and combination therapy with statins.