星子县疟疾防治情况回顾分析

星子县位于长江中下游地区 ,南临鄱阳湖 ,北连庐山。境内以丘陵和平原为主 ,全年平均气温 17.3℃。疟疾曾是严重危害该县人民身体健康的主要地方病 ,1969年疟疾发病率高达 918.82 /万 ,占到该县同年传染病发病总数的 62 .65 %。自1976年列入九江地区 5县区疟疾联防以来 ,实施“二根治、一预防”(疟疾现症病人根治、疟疾休止期根治和高疟地区全民预防服药 )。使发病率逐年减少 ,效果显著 ,1990年发病率为1.4/万 ,1991年后无病例报告 ,达到了卫生部《控制疟疾标准》的要求。1　流行概况据 195 0 - 1990年疫情报告统计全县共发生疟疾 675 88例…     

旅行者疟疾

保护旅行者免受疟疾感染的关键在于增强旅行者对疟疾风险的认识、采取有效措施防止传疟媒介的叮咬、以及按规定服预防药。本文作者认为降低旅行者疟疾发病率的首要措施是个人防护以避免蚊虫叮咬。由于恶性疟对药物抗性的不断增加,没有任何一种药物或联合用药方案具有100%的效果。常用化学预防药如甲氟喹,强力霉素、氯喹和氯胍的副作用较轻。但除氯胍外,上述药物偶尔也会引起严重的副反应。乙胺嘧啶/磺胺多辛、阿莫地喹由于副作用大已不用于疟疾预防。由于疗效和毒性方面的原因,能作为旅行者自我治疗的药物均有其局限性,从而为安全有效地应用这些药物提供明确的指征增加困难。     

四川省疟疾不同时期防治策略的效果分析

目的评估四川省不同抗疟措施的防治效果。方法按发病率 >1 0 /万为流行 ,>1 /万～≤ 1 0 /万为控制流行 ,≤ 1 /万为基本消灭 ,作为疟疾流行程度划分标准。评估“两根治一预防”、“两根治 +灭蚊”和“水旱轮作”3种抗疟措施的效果。结果两根治—预防的抗疟措施 ,消灭了恶性疟和三日疟 ,控制了疟疾暴发流行 ,降低了发病率。两根治 +灭蚊措施 ,控制了疟疾流行 ,降低了危害。水旱轮作措施从根本上改变了疟疾流行条件 ,疟疾发病率连续 8年下降并巩固在 1 /万以下。结论水旱轮作是推进疟疾防治可持续发展的战略措施。     

2010年海南省疟疾疫情分析

2010年海南省报告疟疾78例,发病率为0.09/万, 流动人口血检阳性率高于本地居民, 居民抗体阳性率高于学生,现症病例均得到规范治疗, 间日疟根治服药率为96.56%, 高危人群预防服药率为94.15%。杀虫剂喷洒4 086户, 保护人口 26 843人; 杀虫剂浸泡/喷洒蚊帐153 116顶, 保护人口250 851人。2010年海南省消除疟疾措施有效, 但应加强疟疾疫情报告、 病例核实、 疫点处理、 流动人口疟疾防治、 疟疾监测等工作。     

四川省疟疾不同时期防治策略的效果分析

目的 评估四川省不同抗疟措施的防治效果。方法 按发病率＞10／万为流行，＞1／万－≤10／万为控制流行，≤1／万为基本消灭，作为疟疾流行程度划分标准。评估“两根治一预防”、“两根治＋灭蚊”和“水旱轮作”3种抗疟措施的效果。结果 两根治一预防的抗疟措施，消灭了恶性疟和三日疟，控制了疟疾暴发流行，降低了发病率。两根治＋灭蚊措施，控制了疟疾流行，降低了危害。水旱轮作措施从根本上改变了疟疾流行条件，疟疾发病率连续8年下降并巩固在1／万以下。结论 水旱轮作是推进疟疾防治可持续发展的战略措施。     

C-反应蛋白和触珠蛋白用于对社区疟疾控制计划的评价

在非洲疟疾流行区,根据社区疟疾的发病率对抗疟规划作出评价并进行纵向监测极为重要。但需大量人力、物力和财力。一般对疟疾发病率的调查依靠对人群样本的横向观察。然而,脾肿率、贫血、发热、疟原虫血症等指标在评价社区疟疾控制计划上有很大局限性。本文研究C-反应蛋白(CRP)和触珠蛋白作为替代的疟疾发病率指标的价值,以及它们与常用疟疾指标间的关系。测定蚊帐使用怎样影响CRP和触珠蛋白的水平。     

献血员疟疾的控制方法与效果

金坛市是以中华按蚊为单一媒介的间日疟流行区 ,5 0年代末和 70年代初发生两次疟疾暴发流行 ,年最高发病率达 30 % ,最高发病人数 10万。经采取综合性防治措施后 ,疟疾疫情得到有效控制 ,1983年疟疾发病率已降至 1 以下。但 1986年以后 ,因出现献血员疟疾 ,疫情出现回升 ,1987年献血员较多乡镇的疟疾发病率比全市疟疾发病率高 10倍 ,献血员疟疾病例占全市总病例的 83% ,为探讨献血员疟疾流行特点 ,制定有效的防治对策 ,控制献血员疟疾传播 ,1988年起进行献血员疟疾控制研究 ,取得了满意的结果。1　材料与方法1.1　一般材料　献血员疟疾流行…     

安徽阜阳市1952～2005年疟疾疫情与防治对策

目的分析阜阳市1952～2005年疟疾流行规律,评价疟疾防治措施及防治成果,总结疟疾防治经验。结果收集1952～2005年疟疾流行状况、防治措施落实、防治效果评价等。结论通过消除疟疾传染源、防蚊灭蚊等综合性防治措施地落实,阜阳市疟疾疫情由上世纪50至80年代中期持续高发状态,并每十年一次大爆发的流行规律得到了彻底遏制,上世纪末疟疾发病率曾下降到0.1/十万以下。结论阜阳市实施的疟防措施扎实可靠,疟疾发病率明显下降。但近几年疟疾发病又出现上升势头,应引起高度重视,疟疾控制工作十分艰巨,任重道远。     

恶性疟原虫对青蒿素产生抗性的研究进展

青蒿素及其衍生物是我国发明的强效抗疟药,WHO已推荐以青蒿素为基础的联合用药(ACTs)为治疗恶性疟的一线药物。青蒿素及其衍生物的应用已使全球疟疾流行得到了有效控制,疟疾发病率和死亡率逐年下降。但近年来,在东南亚多个地区陆续报道恶性疟原虫(Plasmodium falciparum)对青蒿素类药物产生抗性,并有进一步扩散的趋势,这已严重威胁到全球疟疾防治和消除疟疾计划的实施。本文综述近年来恶性疟原虫对青蒿素产生抗性研究领域的相关研究进展,包括青蒿素抗药性的检测方法、抗性相关的分子标记、抗性虫株的起源及传播流行等。     

1992—2000年云南省疟疾IFAT纵向监测

目的为我省制定疟疾防治对策提供参考依据。方法用滤纸干血滴法 ,按 IFAT常规操作方法进行试验。结果 1 992 -1 996年的 IFAT阳性率和疟疾发病处于低度波动状态 ,1 997-2 0 0 0年呈现逐年下降的趋势 ,阳性GMRT亦下降至 40以下 ,但 IFAT阳性率高于疟疾疫情发病率若干倍。边境地区、元江流域和内地高发区 9年平均的 IFAT阳性率、阳性 GMRT、疟疾发病率均以边境地区为高 ,元江流域次之 ;边境地区 1 992 -1 995年的抗体阳性率明显高于元江流域地区 ,发病率则低于元江流域地区。结论各地 IFAT阳性率、阳性 GMRT的高低与疟疾发病率的升降情况相一致 ,我省中缅边境的疟疾流行程度明显高于中越边境。     

Randomized controlled trial of a pictorial aid intervention for medication adherence among HIV-positive patients with comorbid diabetes or hypertension

As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/or hypertension (HTN) attending a clinic for underserved patients and at risk for poor health outcomes were enrolled. Patients were randomized to receive either a pictorial aid intervention (a photographic representation of their medications, the indications, and the dosing schedule) or a standard clinic visit discharge medication list. Adherence to antiretroviral therapy (ART) for HIV and therapy for DM or HTN was compared. Predictors of ART adherence at baseline were determined using logistic regression. Medication adherence was assessed using medication possession ratio (MPR) for the 6-month interval before and after the intervention. Change in adherence by treatment group was compared by ANOVA. Among the 46 participants, there was a trend towards higher adherence to medications for HIV compared with medications for hypertension/diabetes (baseline median MPR for ART 0.92; baseline median MPR for the medication for the comorbid condition 0.79, p?=?0.07). The intervention was feasible to implement and satisfaction with the intervention was high. With a small sample size, the intervention did not demonstrate significant improvement in adherence to medications for HIV or comorbid conditions. Patients with HIV are often medically complex and may have multiple barriers to medication adherence. Medication adherence is a multifaceted process and adherence promotion interventions require an approach that targets patient-specific barriers.     

Medical expert systems: Design and applications in pulmonary medicine

Expert systems are computer applications with a built-in knowledge of a special field to solve problems like a human expert on this subject. An expert system consists of an inference component for problem specification and solving, a knowledge base for storage of data, facts, rules and heuristics, an interface for knowledge acquisition, another for the interaction with the user, and a component for reasoning. Pulmonary expert systems are used for automatic interpretations of lung function data which are measured on-line and directly computed. There are also some expert systems for consultation in difficult pulmonary cases and for protection against overlooking rare diseases. Perhaps the most successful applications of pulmonary expert systems are for educational purposes and a large variety of teachware is available. Pulmonary expert systems are presently limited to small applications; often it is necessary to type in large amounts of data and to follow a deeply structured cumbersome dialog. Also, the problem of responsibility for computer decisions has to be mentioned. But pulmonary expert systems as integrated supplements of normal pulmonary measuring devices, as decision support, and as parts of pulmonary teachware will be helpful tools for the pneumological physician.     

No Association of PROP Taster Status and Paternal History of Alcohol Dependence

Taste sensitivity to bitter substances, including ethanol, may play a moderating role both in the initiation of drinking and in the intensity and frequency of drinking once it is initiated. A study (Pelchat and Danowski, Physiol Behav 51:1261-1266, 1992) showed an association between the capacity to taste PROP (6-n-propylthiouraciI), a bitter tasting compound, and a family history of alcoholism. The implication of that finding is that family-history-negative individuals may be protected from early initiation of drinking or heavy consumption of alcohol once drinking is initiated. The present study sought to replicate those findings by using direct interview methods (versus history methods) to obtain alcohol use and alcohol problem information from the parents of "at risk" individuals and by examining a larger number of subjects. A bimodal distribution of the ability to taste PROP was found, similar to that observed in the general population. No association was found between the ability to taste PROP and a paternal history of alcoholism, regardless of the taste threshold employed or after controlling for several potentially confounding variables. A lack of association with alcoholism risk was also observed for subjects' self-reports of reasons for drinking or not drinking alcohol based upon taste preference: high-risk and low-risk for alcoholism groups were not distinguished by either a stated preference for the taste of alcohol as a reason for drinking or a stated dislike for the taste of alcohol as a reason for limiting drinking. Thus, neither taste sensitivity for PROP nor the palatability of ethanol appear to influence the choice to drink among adolescent and young adult individuals at high risk for developing alcohol-related problems.     

The birth and early growth of a comprehensive multidisciplinary diabetes center in a community hospital: the Bildirici Center for Diabetes Care and Research at Laniado Hospital

Diabetes is a multisystem disorder. Diabetes care is a multidisciplinary process. The Bildirici Center for Diabetes Care and Research opened its doors to its first patients in August 2007, as the first center in Israel to offer comprehensive integrated multidisciplinary care for people with diabetes. In addition to direct patient care, the Center has organized courses, lectures and workshops for people with diabetes, as well as for professionals caring for people with diabetes and for the general community. The ability of individuals within different departments to develop and implement such a center may have been facilitated by the smallness of our institution and the familiarity they share as a result. We have shown how a community hospital, without ties to a major medical center or academic institution, can establish a multidisciplinary inpatient and outpatient diabetes center, the first of its kind in a country.     

Benign asbestos-related pleuropulmonary diseases

Among the non malignant diseases related to asbestos exposure, pleural plaques are the most frequent. Pleural effusion and diffuse pleural thickening, as well as asbestosis, are uncommon nowadays in asbestos-exposed screened populations. Despite the absence of any useful treatment, accurate diagnoses of these diseases are needed for two reasons: on the one hand in order to save patients from anxiety related to diagnostic and prognostic discrepancies, and on the other hand in order to ensure a proper attribution of the high social and financial compensations which are provided in France for asbestos affected patients. CT scan of the thorax is the most sensitive and specific tool for a precise diagnosis of these lesions, but it often displays minute abnormalities which may give rise to major diagnostic discordances, owing to the absence of any tomodensitometric reference in populations proved to be free from any asbestos exposure. There is a need to seek for a suitable standardization of imaging technique and interpretation, for a consensus in the characterization of CTscan abnormalities that warrant compensation, and for a careful medico-psychologic assistance for patients affected by asbestos-related benign diseases.     

Dissecting obesogenic behaviours: the development and application of a test battery for targeting prescription for weight loss

There are limited practical tools to help clinicians or public health workers manage obesity in their patients. We have previously developed a scanning technique for diagnosing environments leading to obesity (Analysis Grid for Environments/Elements Leading to Obesity). Here we describe the development of a tool for identifying behaviours in an individual most likely to lead to obesity. A questionnaire battery of five tests called the DAB-Q (Diet, Activity and Behaviour Questionnaire) was developed, piloted and internally validated with overweight women from a commercial weight loss programme. Outcome from the tests, which are available free on the Internet, provides clinicians with a simple, effective and time-saving tool for ranking foods, drinks and activities likely to be most effectively targeted for weight loss in an individual. This is based on total scores derived from measures of frequency, potential for change and potency of each item as a potential contributor to overweight.     

Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback

The degree of enthusiasm for prostate cancer screening seems high given the limited evidence of benefit and the well-documented harms of treatment that include impotence and incontinence. The purpose of this review is to understand the reasons for enthusiasm and positive reinforcement perceived in clinical decisions about whether to screen, whether to choose aggressive therapy for cancer, and in how to view adverse effects following therapy. We discuss a case of a man who must decide whether to undergo prostate-specific antigen screening and treatment to illustrate the kinds of reinforcement that may occur for each decision.Strong positive reinforcement for each decision would make screening and aggressive therapy appear to be successful and the correct decision even if prostate cancer screening and therapy were not beneficial. A physician is positively reinforced for recommending screening, regardless of the test result, because a negative result makes a patient grateful for reassurance and a positive result makes a patient grateful for early detection. A patient who is impotent and incontinent after a decision for curative treatment may attribute his survival to surgery and be grateful for having his cancer cured. Individual experience provides almost no negative feedback that early detection and aggressive treatment may not work. Although reinforcement operates similarly in other medical decisions, the example of prostate cancer provides insight into the strength of the forces at work because the personal harms, which are relatively common and dramatic, are readily discounted or explained away.Even if prostate cancer screening is eventually demonstrated to provide benefit for asymptomatic persons, it is important to appreciate the strength of forces that may act independently of benefit and reinforce decision makers' choices to be aggressive about screening and treatment. Interventions should be considered to temper possible overenthusiasm for screening and treatment.     

Diagnosing Renal Artery Stenosis: A Comparison Between Conventional Renography, Captopril Renography and Ultrasound Doppler in a Large Consecutive Series of Patients with Arterial Hypertension

The purpose of the study was to compare the positive and negative predictive values of conventional renography (Reno-A), captopril renography (Reno-B) and ultrasound Doppler (UD) with regard to the diagnosis renal artery stenosis. These three tests, and in addition a renal angiography, were performed in consecutively admitted patients with arterial hypertension, owing to either suspicion of renovascular hypertension or refractoriness to treatment. Patients with occlusion of a renal artery or a serum creatinine level higher than 300 μmol/1, or a previous investigation for renovascular hypertension at another hospital, were excluded from the analysis. The European Multicenter Study (EMS) criteria and local criteria for abnormal renography were compared. Of 131 patients, 28 had a renal artery stenosis (RAS) exceeding 50% reduction in diameter of the artery and 19 exceeding 70%. Using the EMS criteria for renography the predictive values of a negative test for a RAS more than 50% were 0.88 for Reno-A, 0.90 for Reno-B, 0.86 for changes from Reno-A to Reno-B, 0.92 for abnormalities either in Reno-A, Reno-B or changes from Reno-A to Reno-B, and 0.91 for UD. The corresponding values for a RAS more than 70% were 0.94, 0.97, 0.93, 0.98 and 0.96, respectively. The predictive values of a positive test were clearly lower, ranging from 0.20 to 0.75, but best when changes from Reno-A to Reno-B were used, 0.69-0.75. Using local criteria for renography the predictive values of a negative test were almost equal to those obtained by using the EMS criteria, but the predictive values of a positive test were slightly lower. It is concluded that conventional renography, captopril renography and ultrasound Doppler all are very good screening tests for renal artery stenosis, but the positive predictive values are clearly highest when using changes from conventional renography to captopril renogrdphy. It is suggested that captopril renography always should be performed when conventional renography is abnormal and vice versa to obtain the highest positive predictive value, on the assumption that total renal function is normal or almost normal, and that renal function is not absent in the affected kidney.     

Personalized Medicine for Diabetes: Detecting Undiagnosed Type 2 Diabetes: Family History as a Risk Factor and Screening Tool

A family history of diabetes is a major risk factor for the disease. As such, it is often included in a variety of tools designed to detect either people at risk of diabetes or people with undiagnosed diabetes. One of the reasons to screen for diabetes is that it has a prolonged asymptomatic phase, which includes impaired fasting glucose, impaired glucose tolerance, and the early stages of diabetes. In terms of prevalence, diabetes is a major public health problem. Evidence shows that the detection of impaired glucose metabolism in its early stages (prediabetes) could lead to the delay or prevention of the disease and its complications. However, the issue of using family history to screen for diabetes must be discussed within the context of screening for diabetes in general. Screening for a disease among asymptomatic people must meet a series of stringent requirements to ensure the best possible outcomes. Screening for diabetes meets most of these requirements but the ones it does not meet are still important. Therefore, based on systematically collected evidence or simply by consensus among scientists, influential organizations recommend screening only among high-risk individuals. As a result, researchers have developed a variety of simple tools to identify high-risk individuals for diabetes in populations. Family history is included as a key variable in the vast majority of them. This article is a brief overview of the reasons to screen for diabetes in general, the tools available for conducting this screening, and the role of family history in these tools.