广东省乙肝疫苗纳入免疫规划四年成本-效益分析

目的 通过对广东省乙肝疫苗纳入免疫规划4年的成本-效果/效益分析,为今后制定科学的免疫规划策略提供依据.方法 在2002、2006年广东省乙肝血清流行病学资料基础上进行成本-效果/效益分析.结果 乙肝疫苗纳入免疫规划4年内,广东省减少了HBsAg携带者110316例.HBV感染者404493例、急性乙肝患者7391例、慢性肝病患者27579例、肝硬化患者3309例、以及原发性肝癌患者110例.广东省4年间对新生儿实施乙肝疫苗接种产生的直接经济效益,即净效益约7.96亿元人民币,成本-效益比1∶9.86.结论 广东省新生儿接种乙肝疫苗产生显著的经济、社会效益,具有良好的成本-效果/效益比,是预防和控制乙肝流行最经济、最有效的手段.     

澄江县新生儿乙肝疫苗接种卫生经济学效果评价

对澄江县1992～2002年新生儿接种乙肝疫苗后的资料进行分析，运用成本测算方法计算乙肝疫苗接种成本，估算接种乙肝疫苗后减少人群乙肝及并发症患者人数为效益指标。结果显示，澄江县11年来接种新生儿乙肝疫苗23932人，投入成本762234．2元，减少HBsAg携带者2850例，慢性乙肝285例，肝硬化29例，肝癌3例，产出效益25681120．74元，效益成本比为1：33．7。表明澄江县新生儿接种乙肝疫苗效果显著，效益是非常可观的。     

中国新生儿乙肝疫苗免疫效果评估

目的 评估我国1992～2005年实施新生儿乙肝疫苗免疫预防策略的经济效果.方法 在综合国内有关重要研究资料的基础上,构建我国乙肝疫苗免疫预防14年效果评估决策树模型,采用成本效益和成本效果分析指标.结果 我国新生儿乙肝疫苗免疫策略使得1992～2005年出生新生儿累计避免发生乙肝病毒(HBV)感染6522.95万例(城市2 442.35万例,农村4 080.60万例),其中急性乙肝1 304.59万例,慢性乙肝65.23万例,肝硬化6.01万例,肝癌0.60万例;每预防1例HBV感染的费用为81.99元,可获得2 674.77亿元的净效益,效益成本比为51.01:1(城市为49.59:1,农村为51.91:1).结论 我国新生儿乙肝疫苗免疫策略实施14年获得巨大经济效益,决策树模型应用于乙肝疫苗接种效果评估具有定量决策和综合多因素等优点.     

广东省新生儿乙型肝炎疫苗免疫效果分析和免疫策略探讨

目的分析广东省新生儿乙型肝炎疫苗的免疫效果,为制定广东省乙型肝炎疫苗免疫策略提供依据。方法分析广东省1992~2003年乙型肝炎疫苗接种率、乙型肝炎发病率和人群乙肝病毒表面抗原(HBsAg)携带率等资料。结果乙肝疫苗1992年纳入计划免疫管理,2002年纳入计划免疫,新生儿乙肝疫苗免疫逐渐完善,1997年、2003年新生儿乙型肝炎疫苗接种率分别为73.6%、93.1%;1993~2003年乙型肝炎平均报告发病率为33.80/10万,从1993年的28.85/10万上升至2003年的33.00/10万,其中0~4岁组和5~9岁组分别由17.05/10万、26.10/10万下降至6.36/10万、6.72/10万;1~59岁人群HBsAg携带率由1992年的16.76%下降至2002年的13.28%,其中1~4岁组和5~9岁组分别由16.76%1、9.14%降至4.86%、6.39%,10~59岁组变化不大。结论实施新生儿乙肝疫苗免疫能显著地降低乙肝发病率和HBsAg携带率;今后在实施新生儿乙肝疫苗免疫的同时,应考虑开展对未接种过乙肝疫苗的儿童和重点人群进行乙肝疫苗免疫。     

上海市新生儿乙型肝炎疫苗接种成本效果、效益与效用分析

目的 研究上海市1992～2001年新生儿乙型肝炎(乙肝)疫苗接种的成本效果、效益与效用。方法 运用项目成本测算方法计算乙肝疫苗接种成本;估计接种乙肝疫苗后减少人群携带HBsAg人数与慢性乙肝、肝硬化、肝癌患者人数为直接效果指标;运用调查表形式调查乙肝、肝硬化和肝癌患者患病时间与治疗费用;专家访谈了解乙肝患者的治疗与病程;运用成本效益分析方法计算乙肝疫苗接种的成本效益;运用失能调整生命年计算其疾病负担作为效用指标。结果 乙肝疫苗接种成本投入501 129.49元将会减少1例肝癌发生,10例肝硬化发生,100例慢性乙肝患者发生,1000例HBsAg阳性率携带者;上海市新生儿乙肝疫苗免疫接种10年总成本为0.24亿元,获得总效益为41.22亿元,成本效益比是1:172元;估计挽回乙肝、肝硬化、肝癌的疾病总负担为59 762.55个失能调整寿命年(DALY),挽回1个DALY的成本为402.50元。结论 新生儿乙肝疫苗接种是一种低成本投入高效果产出策略。     

宁波市实施乙肝疫苗纳入免疫规划策略的经济学评价

目的:评价宁波市实施乙肝疫苗纳入免疫规划策略的成本-效果、成本-效益。方法:通过自回归移动平均模型测算宁波市乙肝期望发病和死亡人数,结合现场调查数据计算成本与疾病负担,对宁波市2002—2017年实施乙肝疫苗纳入免疫规划策略进行成本-效果、成本-效益评价。结果:宁波市2002—2017年实施乙肝疫苗免疫规划策略投入5 381.12万元,减少乙肝发病12 480例,死亡232例,成本效益比为1:20.29。结论:宁波市乙肝疫苗纳入国家免疫规划策略取得了显著的经济学效益,应继续做好乙肝疫苗接种工作,进一步扩大免疫规划人群覆盖范围。     

中国乙型肝炎疫苗免疫预防效果和现行策略的经济学和决策学评估

目的 对中国儿童乙型肝炎(乙肝)疫苗免疫预防14年(1992-2005年)效果评估和对现行的乙肝疫苗接种方案进行优化.方法 构建适合中国乙肝疫苗免疫预防实际效果评估和方案优化决策树模型,模型中参数根据相关研究文献或由专业机构提供.主要分析指标为成本效果比(CER)和效益成本比(BCR),用敏感度分析和阈值分析对各参数影响大小进行评估. 结果 14年间,中国直接和间接地用于新生儿乙肝疫苗接种总投入约为53.48亿元,而获得的总效益达2728.25亿元,即乙肝疫苗接种的净效益为2674.77亿元;同期由于疫苗接种避免发生HBV感染约6523万人,每预防一例HBV感染的费用为81.99元,但每投入1元获得的收益为51.01元.中国现行乙肝疫苗接种采用新生儿3剂5 μg,并于出生24 h内完成第一针;对孕妇筛检HBsAg,阳性者新生儿加注一剂乙肝免疫球蛋白(HBIG)均为最优方案.而新生儿以外的1～60岁人群乙肝疫苗接种仍町以获得正效益,尤其是在20岁以前接种效益更明显;但"筛检后再接种"均优于"直接接种". 结论 中国既往14年间在新生儿中实行的乙肝疫苗接种策略,从实际的预防效果和投资的经济效益看都是值得的;现行的新生儿优先接种并保持高覆盖率的策略仍为合理方案.     

上海市乙型肝炎疫苗免疫接种工作回顾

自国产乙肝疫苗问世不久，我市于1986年起在部分区、县开展了新生儿乙肝疫苗免疫预防的区域性接种试点。在试点接种工作的基础上，有计划有步骤地逐步扩大覆盖面。1991年3月，我市制订了《上海市新生儿（婴儿）乙肝疫苗接种实施细则》，1992年起全市范围内全面开展新生儿乙肝血源疫苗的接种，2003年11月新生儿乙肝疫苗接种纳入计划免疫，进一步推动了我市的乙肝疫苗接种工作。1997年1月起基因工程乙肝疫苗替代血源疫苗，使接种工作得到了进一步加强，接种工作走向制度化、正规化、规范化的管理轨道。现将我市乙肝疫苗接种工作总结如下。     

1981～2009年三江县乙型肝炎疫情分析

目的了解三江县不同时期乙型肝炎的发病情况,为制订乙肝防治策略提供科学依据。方法收集1981~2009年三江县乙肝疫情资料进行分析。结果 1981~2009年三江县乙肝年平均发病率、死亡率、病死率分别为40.06、0.02/10万和0.05%。发病呈散发态势,以农民发病为主,男女之比为2.33∶1。经疫苗接种和采取母婴阻断措施,15岁以下儿童乙肝发病率下降明显,1992~2002年计划免疫管理期、2003~2009年计划免疫期与1981~1991年免疫前期比分别下降63.61个百分点和83.55个百分点。结论预防控制乙肝有效办法是接种乙肝疫苗。提示今后在确保新生儿乙肝疫苗接种的同时,开展针对不同人群的乙肝疫苗接种工作。     

成人乙型肝炎疫苗预防接种的成本-效益分析

为了解成人接种乙型肝炎(乙肝)疫苗后的经济效益和社会效益,为预防成人乙肝提供依据.以1990～1991年接种乙肝疫苗与否,采用多级分层抽样的方法,调查接种者1344人,调查未接种者1476人,对116名乙肝患者进行乙肝费用调查.结果表明,成本-效益1990～1991年攀枝花钢铁公司投入成本235.58万元(1999年的贴现值),产出的效益9283.81万元,净效益9048.23万元,效益成本比值为39.41.社会效益这次乙肝疫苗接种减少乙肝病人669人,减少乙肝病毒表面抗原(HBsAg)携带者1737人,减少工作寿命损失639.47人年,减少寿命损失1418.30人年.研究结果提示成人接种乙肝疫苗具有巨大的经济效益和社会效益.     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.