1987～2005年金华市艾滋病监测结果及流行病学分析

目的分析1987～2005年金华市艾滋病监测结果及流行病学特点,为制定艾滋病防治策略提供依据。方法对金华市艾滋病监测及流行病学管理资料进行统计分析。结果1987～2005年金华市累计报告艾滋病病毒(HIV)感染者94例,其中艾滋病病人(AIDS)14例,以青壮年为主,男女性别比为2.92∶1;传播途径以静脉注射毒品和性接触感染为主,分别占46.80%和39.36%;47.87%的感染者文化程度为小学及以下。其中,31.00%为常住人口,以性接触途径感染为主,占79.31%,部分是HIV阳性配偶或性伴侣间感染,占24.13%。1987～2005年共完成重点人群监测122180人,检出HIV抗体阳性87例,阳性率为0.07%。结论金华市艾滋病流行态势由传入期进入播散期,AIDS流行正由高危人群向一般人群扩散蔓延,并已造成了家庭内传播。预计今后重点人群中HIV感染者将大幅度增长,需加大防治力度。     

广州地区HIV感染者的临床和流行特征分析

目的：了解人类免疫缺陷病毒(HIV)感染者中HIV感染途径、HIV／HBV及HIV／HCV合并感染情况和机会性感染的发生率及类型。方法：检测HIV感染者／获得性免疫缺陷综合征(AIDS)患者HBV、HCV感染标志，确定HIV／HBV、HIV／HCV合并感染情况，了解其HIV感染途径，对是否存在机会性感染情况进行临床和实验室指标的综合诊断。结果：55例HIV感染者中静脉吸毒、性接触、输血或血制品及垂直传播分别占40％、36．4％、20．0％及3．6％。HIV／HBV、HIV／HCV合并感染率分别为16．4％和41．8％，两者比较有显著差异。机会性感染发生率为85．5％，感染类型由高至低依次为：肺炎、口腔毛状黏膜白斑(OHL)、口腔真菌感染、各种感染性腹泻、各种结核病、败血症、疱疹病毒感染。结论：广州地区HIV感染途径由高到低的顺序为：静脉吸毒传播、性传播、输血或血制品传播、母婴传播，其中以静脉吸毒和性接触方式感染为主。广州地区存在HIV／HBV、HIV／HCV合并感染情况，尤其是HIV／HCV合并感染率情况较严重；来医院住院治疗的HIV感染者绝大部分为已发生机会性感染的AIDS患者。     

1992 - 2010年陕西省HIV/AIDS报告病例分析

目的 描述1992 - 2010年陕西省HIV/AIDS流行特征和发展趋势。 方法 对陕西省1992 - 2010年艾滋病疫情报告资料进行流行病学分析。 结果 陕西省1992 - 2010年累计报告HIV/AIDS病例1913例;感染途径前期以既往有偿供血和静脉注射吸毒传播为主,后期以性传播和静脉注射吸毒传播为主;病例以中青年为主,主要集中在16~50岁,约占90%;男性占总数的78.36%;女性占总数的21.64%;文化程度以初中及以下为主;职业以农民及家政待业人员为主。 结论 陕西省HIV/AIDS报告病例呈逐年增长的趋势;感染者以年轻人为主,感染途径多样化;美沙酮维持治疗、健康的性观念和安全套普及是针对有高危险行为人群的主要干预手段。     

河南省204例HIV/AIDS患者的临床和治疗概况

目的：报道河南省204例人类免疫缺陷病毒－1（HIV－1）感染和艾滋病（AIDS）患的临床表现和治疗概况，为进一步计划HIV／AIDS的综合防治措施提供依据。方法：分析自1998年2月至2001年7月收治的204例HIV／AIDS患的一般情况、流行病学资料、临床表现、治疗情况。结果：感染多为青壮年，感染途径以经血液感染为主，但性接触传播和母婴传播亦相继出现。有症状、无症状组中的平均病毒载量和CD4、CD8 T细胞计数及CD4／CD8比例呈现明显差别。结论：HIV感染的传播途径非常明确，因而其传播是完全可以预防的。早期预防，早期诊断，加强治疗，实行综合防治措施，有助于控制HIV感染的流行。     

HIV感染者/AIDS患者病耻感现状调查及其影响因素分析

目的 :调查HIV感染者/AIDS患者病耻感现状并分析其影响因素。方法 :采用便利抽样法,选取符合纳入标准的122例HIV感染者/AIDS患者,使用一般资料调查表、社会影响量表对其进行问卷调查。结果:122例调查对象病耻感标准化总得分为(64.64±15.70)分,4个维度得分分别为:社会排斥得分(22.90±6.41)分、经济无保障得分(8.19±2.55)分、内在羞耻感得分(15.11±3.58)分、社会隔离得分(18.44±5.19)分。多元线性回归分析结果显示,文化程度、HIV感染时间及感染途径为病耻感总体水平的影响因素,可解释总体变异的32.6%。结论 :HIV感染者/AIDS患者存在较高的病耻感,护理人员应根据患者不同的文化程度、HIV感染病程、感染途径,加强对HIV感染者/AIDS患者的管理。     

获得性免疫缺陷综合征合并弓形虫脑病8例

随着获得性免疫缺陷综合征(HIV/AIDS)感染者进入艾滋病期,机会性感染增多,弓形体脑病是机会性感染之一。该病起病缓慢,无典型症状,缺乏特异性诊断依据,疗效差,易复发。为此,笔者将2002年来我院收治的8例HIV/AIDS合并弓形虫脑病患者的临床资料进行分析总结,探讨弓形虫脑病的临床诊断和治疗方法。1资料与方法1.1病例选择我院2002年1月至2006年1月住院患者。男3例,女5例,年龄25~48岁,中位年龄29岁。感染途径:性途径感染4例(50%),输血感染3例(37.5%),感染途径不明1例(12.5%),每例患者均通过蛋白印记迹(WB)法确定为HIV抗体阳性,均有宠物…     

2011-2015年我国新发现成年女性艾滋病感染者流行特征分析

目的 了解我国成年女性艾滋病病毒（HIV）携带者的流行特征，探索性分析影响成年女性感染HIV的潜在因素。方法 收集2011-2015年我国新发现15岁女性HIV感染者/艾滋病患者（HIV/AIDS）的人口学、行为学信息，分析该人群的传播途径特征和流行趋势变化。结果 2011-2015年每年新发现成年女性HIV/AIDS病例数有所上升。异性传播尤其是非婚异性性接触感染是主要传播途径，其构成比逐年上升。2012年开始，40~94岁组女性感染者为首要受累人群，非婚异性性行为和配偶/固定性伴感染均占较大比例；40岁女性病例的报告数和构成比基本稳定，20~24岁年龄组出现下降，以非婚异性性行为接触为主要感染方式。结论 新发现女性病例的年龄峰值向高年龄组推进，应重视高年龄组女性艾滋病防治工作。扩大检测尽早发现感染者，避免女性被动感染。     

1990-2008年北京市丰台区艾滋病病毒感染者/艾滋病患者感染疫情分析

目的分析1990-2008年北京市丰台区艾滋病疫情变化趋势。 方法对761例艾滋病病毒感染者/艾滋病患者(HIV/AIDS)个案资料进行统计学分析。结果1990-2008年丰台区共报告HIV/AIDS感染者761例，其中HIV感染 604例，AIDS病例157例。761例HIV感染，病例中男性600例，占78.84%，女性161例，占21.16%。传播途径主要以性传播为主，占61.50%。2005年以后，经性传播的病例数增加，尤其是同性传播的比例明显增加；经采供血和输血/血制品感染的比例下降。结论北京市丰台区的艾滋病疫情已进入快速增长期，并正由高危人群向一般人群扩散。同性传播已经成为丰台区最主要的传播途径，因此应继续加大对该人群的艾滋病防控力度。     

1998-2012年浙江省湖州市艾滋病流行特征分析

目的掌握浙江省湖州市1998-2012年艾滋病病毒(HIV)感染者/艾滋病患者(AIDS)流行特征及规律,为政府制定防控策略提供参考依据。方法收集1998-2012年湖州市HIV/AIDS流行病学资料,采用描述性流行病学方法进行统计分析。结果湖州市自1998年发现首例HIV感染者,至2012年共报告380例HIV/AIDS,男女性别比为3.2∶1;经性接触传播为主要传播途径(82.6%);感染者年龄以20~49岁为主(83.4%);已婚占54.0%;本市户籍占36.1%,外省占60.0%;职业分布以工人(含外来民工)最多(31.8%),其次是农民(29.2%);文化程度在初中及以下的占79.3%;样本来源以医疗机构的术前检测最多,占24.4%。湖州市自2007年以来性传播持续成为主要传播途径,注射毒品构成比则呈现下降趋势,近3年男男性行为者经性途径传播构成比明显上升。结论湖州市艾滋病疫情呈上升趋势,性接触传播已成为主要途径,男男性行为者感染率快速上升,需加强重点人群艾滋病宣传教育和艾滋病检测力度,建议试行早发现早治疗策略,以控制疫情的进一步上升。     

药物滥用者HIV检测与流行病学调查报告

目的 进一步认识与研究静脉注射毒品与艾滋病迅速传播的关系，为政府有关部门采取干预措施提供科学的依据。方法 对2495例海洛因滥用者进行HIV血清抗体检测，并采用自行设计的《海洛因滥用情况登记表》及《艾滋病、性病知识调查表》进行问卷。结果 HIV血清学检测抗体阳性反应36例，全部为静脉注射毒品滥用者，并有经常共用注射器具史，所有病例对引发艾滋病传播的途径缺乏认识。结论 静脉注射毒品已成为我国目前艾滋病传播的最主要途径，吸毒群体已成为潜在的HIV感染的高危人群。提出加强对高危人群预防艾滋病的宣传、教育，进行对高危行为的干预，将有利于控制艾滋病的传播；对吸毒人员进行常规的HIV抗体检测，以监控HIV流行趋势变化和发展。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.