民族地区艾滋病抗病毒治疗管理实践与探索

目的 探索与评价2009年7月～2011年12月艾滋病抗病毒治疗县、乡、村三级医疗网络管理模式.方法 新模式的主要做法有:(1)充分发挥县和乡镇党委政府的领导、组织、协调职能,调动多部门在抗病毒治疗工作中的积极性; (2)明确县、乡镇、村三级医疗机构职责和任务,采取三位一体的医疗服务网络管理摸式,实施艾滋病抗病毒治疗管理; (3)加强对治疗病人的依从性教育,采取“人盯人”方式,提高艾滋病人服药依从性; (4)针对特殊病人,按月分装药品,提高治疗质量; (5)将入院治疗机会性感染的病人纳入抗病毒治疗对象.结果2009年7～12月,新增治疗153人,2010年新增治疗532人(其中:儿童治疗8人),2011年新增治疗501人(其中:儿童治疗33人);累计抗病毒治疗1 224人,治疗人数和质量逐年上升.结论 新的医疗网络管理模式,有效地推动了艾滋病抗病毒治疗工作的开展,为少数民族地区艾滋病抗病毒治疗管理摸索出了一套较为成功的经验.     

云南省第二轮防治艾滋病人民战争抗病毒治疗工作评估

根据《云南省第二轮防治艾滋病人民战争评估方案（2008—2010年）》，从治疗管理体系、治疗服务和治疗效果三个方面，对艾滋病抗病毒治疗的临床工作进行了评价。通过评估，云南省2008～2010年第二轮防治艾滋病人民战争中抗病毒治疗工作取得了以下成效：全省的抗病毒治疗网络功能不断增强；增加了艾滋病病人获取治疗服务的可及性；治疗的规范性不断提高；通过治疗，艾滋病病人病死率明显下降。同时，还存在病人入组晚、覆盖率不够高的问题以及持续开展面临的困难。     

新医改对完善艾滋病防治体系的影响研究

目的分析艾滋病防治工作现状,结合新医改主要内容,探讨深化医药卫生体制改革对艾滋病防治体系的影响。方法对6个省份45名从事艾滋病防治工作5年以上的领导或专家进行调查。结果艾滋病防治工作面临防治模式可持续性不强、疾控机构负责药品管理存在法律风险、未能充分发挥基层医疗卫生机构的作用等主要问题。结论提出艾滋病防治工作与新医改相结合的主要思路:明确各类医疗卫生服务机构的防艾职责和工作内容,将艾滋病抗病毒治疗职能调整至医疗机构,把艾滋病防治纳入基层医疗卫生机构的工作范畴,完善艾滋病医保政策,调整抗病毒治疗药品管理体系。     

艾滋病抗病毒治疗“一站式”服务模式的实践与探索

艾滋病抗病毒治疗能有效降低机体内病毒载量,降低病死率。昆山市自2017年起试点开展艾滋病抗病毒治疗"一站式"服务项目,即将已确诊的艾滋病感染者直接转诊至艾滋病抗病毒治疗定点医院,定点医院提供专业的抗病毒治疗、结核病筛查、抗机会性感染等综合干预服务,提高了艾滋病抗病毒治疗时效性、可及性及服务满意度。本文就艾滋病抗病毒治疗"一站治式"服务模式工作开展相关情况进行探讨,以供其他地区参考和借鉴。     

喀什地区艾滋病治疗“一站式服务”模式试点工作体会

目的在喀什地区启动艾滋病治疗"一站式服务"模式试点工作,缩短病人从检测到治疗的时间,从而提高治疗覆盖率,降低艾滋病病死率。方法收集疏附县2014年3月1日—2016年3月31日,莎车县2015年3月1日—2016年3月31日所有新报告的艾滋病病毒感染者和艾滋病病人及既往已报告但尚未接受国家免费艾滋病抗病毒治疗的艾滋病病毒感染者和艾滋病病人的抗病毒治疗数据进行分析。结果抗病毒治疗覆盖率得到明显提高,新发现病例得到及时治疗;既往报告阳性人员核查与转介治疗工作取得新突破;艾滋病综合示范区管理指标进一步提高;及时为病人提供了治疗、救助服务,及时实施抗病毒治疗;促进县乡村三级艾滋病综合防治网络建设。结论在疏附县、莎车县开展了艾滋病抗病毒治疗"一站式服务"试点项目以来,项目成果显著,新诊断符合艾滋病抗病毒治疗标准的感染者/病人得到救助治疗的时间从80天左右缩短到20天左右,做到了"早检测、早治疗",从而真正实现了降低病死率的目标。     

社区艾滋病感染者/病人随访管理模式成效评价

目的:评价以社区为基础的艾滋病感染者和病人管理模式.方法:依托社区卫生服务中心-疾控体系,建立艾滋病感染者/病人随访管理网络,明确职责和工作方法,规范艾滋病随访管理工作.结果:模式建立后,从事艾滋病随访管理的专业人员是建立前的近10倍,HIV感染者综合随访率达到74.6％,CD4检测率达到64.3％,配偶(性伴)检测率达到81.3％,抗病毒治疗覆盖率达到80.2％,各项主要工作指标有大幅度上升.结论:建立以社区为基础的艾滋病感染者/病人随访管理模式,有助于推动艾滋病的随访管理和监测工作,可以提高艾滋病综合防治效果.     

卫生系统内艾滋病防治工作的主要问题、原因及解决思路

目的:归纳卫生系统内各类医疗卫生机构开展艾滋病防治工作的主要问题,分析原因,提出解决策略.方法:对30个省份的184个省市县三级医疗卫生机构中从事艾滋病防治工作五年以上的领导或专家进行问卷调查,调查内容为艾滋病防治各领域及工作中存在的问题、原因及解决思路.结果:根据调查对象的打分和专家论证,确定了主要问题,包括:疾控机构人力存在不足、相关机构参与程度不够、艾滋病病人手术难、检测力度不够、艾滋病病人随访困难、医疗保障有缺陷等.结论:在分析问题及其原因的基础上,提出解决策略:清晰界定各类医疗卫生机构的防艾工作职责、促进基层医疗卫生机构开展艾滋病防治工作、健全艾滋病病人医疗服务体系、完善艾滋病医疗保障政策、改革抗病毒治疗药品的管理体制、加强疾病预防控制中心的技术支撑作用等.     

艾滋病治疗管理模式的建立及评价

目的 建立嘉兴市艾滋病＂医院-疾控中心-社区＂综合治疗管理体系（Hospital-CDC-community treatment system,HCCTS）,并评价其艾滋病治疗管理医疗救治效果.方法 建立市、县、乡（镇）三级艾滋病医疗诊治机构救治体系,每县确定1家综合性医疗机构为艾滋病定点诊治医院,负责艾滋病患者的治疗、医疗随访;社区卫生服务中心负责对病人的社区关怀及跟踪随访;疾控中心负责抗病毒治疗的艾滋病病人管理工作,督导开展关怀、救助工作,组织落实＂四免一关怀＂政策.结果 嘉兴市自2011年启动艾滋病毒感染者和艾滋病病人（HIV/AIDS）治疗管理新模式,艾滋病病人的随访管理率、CD4T检测率和抗病毒治疗覆盖率分别从2010年的92.83%、89.88%和85.91%,提高到2012年的99.31%、98.80%和96.56%,且差异有统计学意义（P〈0.05）,性伴的感染率从23.38%下降到16.67%.结论 通过实施＂医院-CDC-社区＂的治疗管理模式,提高了患者的随访和治疗依从性,及时处置了抗病毒治疗的毒副反应,扩大治疗覆盖面,提高了病人的生存质量,也减少艾滋病的传播.     

四川省布拖县艾滋病抗病毒治疗管理模式分析

目的 探索医疗资源有限的地区艾滋病抗病毒治疗管理模式,推广成功的经验与做法.方法 以布拖县人民医院为艾滋病抗病毒治疗中心,建立县-乡-村三级医疗网络,提高艾滋病抗病毒治疗的可及性和规范性.结果 2011年全县已建立31个艾滋病抗病毒治疗点,93.01％(1105/1188)的患者在乡(镇)接受治疗,2009-2011年艾滋病抗病毒治疗人数从162人增长至1 188人,服药人员坚持治疗1年的比例从75.00％提高至92.70％.结论 布拖县艾滋病抗病毒治疗点建在乡(镇),有效扩大了艾滋病治疗覆盖面,提高治疗工作质量.     

什么是艾滋病的三级预防

艾滋病属于传染性疾病，从广义上说，传染病的预防可以分为三级：一级预防是预防未感染的人感染艾滋病病毒；二级预防是使感染能够早期诊断、早期得到治疗、教育和咨询服务，延缓艾滋病病毒感染发展成艾滋病病人，同时减少艾滋病病毒在人群中的进一步传播；三级预防是通过医疗和其他社会支持服务改善艾滋病病人的生命质量、延长他们的生存时间。     

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 human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

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.     

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.     

The risk of heat exhaustion at a deep underground metalliferous mine in relation to surface temperatures

The risk of heat exhaustion at a deep underground metalliferous mine was assessed in relation to thermal conditions prevailing on the surface. For each day of a 1-year prospective case series of heat exhaustion, surface 24-h mean wet and dry bulb temperatures were recorded. From this data, 24-h mean wet bulb globe temperatures were derived using certain assumptions. The three surface temperature variables were significantly higher on those days on which heat exhaustion occurred, compared to those days on which it did not occur (P < 0.001). The relative risk of heat exhaustion on days when the 24-h mean wet bulb globe temperature was in the range 26.0-28.0 degrees C was 4.82 (95% confidence interval 2.12-10.96). Surface temperature data could be used at this mine to warn miners about the risk of heat exhaustion.