二类疫苗纳入深圳市社会医疗保险研究概述

目的为推广二类疫苗纳入社会医疗保险支付范围的卫生策略提供决策信息。方法综合运用问卷调查、专题访谈、专家咨询、基金风险测算等方法,研究深圳市二类疫苗纳入社会医疗保险支付范围的具体可操作政策。结果90%的社区居民认为将二类疫苗纳入社会医疗保险支付有必要;医务人员对社保支付二类疫苗基本持支持态度;二类疫苗纳入社保支付具有显著的经济效益;二类疫苗纳入社保支付的基金风险具有可控性。结论二类疫苗有必要纳入深圳市社会医疗保险支付,但在实施和技术操作方面仍然存一定的局限和挑战。     

二类疫苗纳入深圳市社会医疗保险支付范围的定性研究

目的 了解目前深圳市二类疫苗纳入社会医疗保险支付范围的可行性,分析存在的问题,为深圳市制定及完善相关政策提供参考.方法 通过定性研究的方法,对深圳市、区疾控机构和社区健康服务中心免疫管理人员进行半结构式个人深入访谈,对访谈结果进行归类分析.结果 75%访谈对象认为二类疫苗应纳入社保支付范围,所有访谈对象认为二类疫苗的资金来源是影响二类疫苗纳入社保支付的主要问题,其次50%访谈对象认为政策覆盖人群也是问题之一;67%访谈对象认为应该根据人群所参与的社保类型,成熟先行,分类分步实施,即社保支付二类疫苗费用,综合医保人群可先推行,住院、少儿和农民工医保人群暂缓推行.结论 二类疫苗应分类、逐步纳入社保支付范围,同时探索公共卫生服务与社保之间的关系,建立一种合理的运行体制.     

佛山市流动儿童家长对第二类疫苗的认知及儿童疫苗接种情况调查

目的了解广东省佛山市流动儿童家长对第二类疫苗的认知情况和儿童疫苗接种情况。方法采用分层随机抽样的方法,调查流动儿童617名,内容包括儿童及家长基本信息、家长对第二类疫苗的认知、儿童第二类疫苗接种情况等。结果对第二类疫苗认知能力较高(答对3/5题量及以上)的儿童家长仅占8.9%,儿童家长年龄、文化程度、家庭月收入对第二类疫苗认知能力有影响;第二类疫苗接种率为40.8%,父亲文化程度、家庭月收入、家长对疫苗认知能力对第二类疫苗接种率有影响。结论广东省佛山市流动儿童家长对第二类疫苗认知能力普遍偏低,儿童第二类疫苗接种率较低,需有针对性地开展多种渠道的健康教育,提高接种率。     

2013年深圳市福田区本地和流动儿童一类与二类疫苗接种现况调查分析

目的了解深圳市福田区儿童预防接种的现况,比较一类疫苗和二类疫苗接种情况。方法采用按容量比例概率抽样法,调查7岁以下儿童一类疫苗和二类疫苗的接种情况。结果福田区儿童9种一类疫苗接种率均保持在较高水平,高于98%;不合格接种原因中超期最多,其次是未种。5种二类疫苗接种率均远远低于一类疫苗,流动儿童除水痘疫苗和肺炎疫苗外,流感疫苗、b型流感嗜血杆菌(HIB)疫苗、口服轮状病毒疫苗接种率均低于本地儿童。结论保持一类疫苗高接种率,进一步加大国家免疫规划投入,将更多的二类疫苗纳入一类疫苗管理;加强对流动儿童家长宣传,进一步提高二类疫苗接种率,更有效预防控制疫苗针对传染病。     

长春长生疫苗事件对徐州市儿童家长二类疫苗接种态度的影响调查

目的:了解长春长生疫苗事件对徐州市儿童家长二类疫苗接种态度的影响,分析影响儿童家长接种二类疫苗的影响因素.方法:于2018年9-12月,采用分层随机抽样方法,抽取徐州市1250名儿童家长进行问卷调查,回收有效问卷1170份.结果:1170名儿童家长中,570名(48.7%)家长愿意为孩子接种二类疫苗.多因素Logistic回归结果显示,影响儿童家长对二类疫苗接种意愿的因素包括文化程度、家庭月收入、二类疫苗可承受价格、是否能区分一类和二类疫苗、是否听说过长春长生疫苗事件、疫苗接种服务时间段是否方便居民接种、疫苗接种人员是否会主动推荐二类疫苗、对疫苗接种人员的医疗技术是否满意(P<0.05).结论:长春长生疫苗事件后,儿童家长对二类疫苗接种的信任度下降,接种意愿较低,各级卫生部门应做好舆论导向工作,加大对儿童家长二类疫苗相关知识的宣传教育,降低公众接种二类疫苗的经济负担,提高儿童家长对二类疫苗的接种意愿,从而进一步提高二类疫苗的接种率.     

广州市从化区0～3岁儿童二类疫苗接种现状及影响因素分析

目的调查广州市从化区0～3岁儿童二类疫苗接种情况,并探寻其相关影响因素,为后续免疫规划工作的开展提供新的参考依据。方法于2019-01/03,采用方便抽样的方法,随机抽取广州市从化区4个社区及6个村的预防接种点,以适龄儿童及家长为调查对象,采用自制问卷收集0～3岁儿童及其家长的一般情况、儿童接种信息以及家长的主观认知情况,采用卡方检验和因素Logistic回归进行统计分析。结果本次调查最终纳入统计分析的有440名儿童和338名家长。0～3岁儿童二类疫苗接种率为76.82%,排名前5位的疫苗依次为B型流感嗜血杆菌疫苗(71.59%)、流感疫苗(67.50%)、水痘疫苗(41.82%)、轮状病毒疫苗(27.05%)和乙肝疫苗(自费,17.72%)。单因素分析显示,不同居住地、家庭月均收入、母亲文化程度、家长年龄、居住地到接种点距离及家长是否知晓二类疫苗相应的0～3岁儿童二类疫苗接种率间的差异有统计学意义(P0.05)。多因素分析显示,居住城市、母亲大专及以上文化程度、家庭月均收入在5 000元以上、母亲年龄≥25岁、居住地距离接种点5 km及家长知晓二类疫苗者,相应的儿童二类疫苗的接种率较高(P0.05)。结论广州从化地区0～3岁儿童二类疫苗接种率较高,不同种类二类疫苗接种率差异有统计学意义。针对影响儿童二类疫苗接种的因素,需充分发挥政府和市场的调节作用,实施针对性的宣传教育和干预措施,以进一步扩大二类疫苗的普及范围、充分发挥其对全民健康的维护作用。     

西安市60岁以上老年人肺炎疫苗接种意愿及其影响因素

目的 研究西安市老年人对肺炎球菌疫苗的认知和接种意愿的影响因素,促进老年人接种肺炎疫苗,为更好地落实老年人肺炎疫苗接种工作提出政策建议.方法 从西安市6个城区中随机抽取一个区,在所抽区中随机抽取2个社区,每个社区各选取300名60岁以上的常住老年人,进行面对面问卷调查,收集一般情况,健康状况,肺炎疫苗的知晓情况及接种意愿、接种情况等信息.采用单因素和多因素logistic回归分析方法,分析影响西安市老年人肺炎疫苗接种意愿的因素及相关情况.结果 西安市60岁以上老年人肺炎疫苗接种意愿与文化程度、经济收入、是否患有慢性病有关,文化程度、经济收入越高及自身患有慢性病的人更愿意接种肺炎疫苗.肺炎疫苗未接种的原因主要是身体健康患肺炎的概率很小(59.50％),不清楚有肺炎疫苗(42.50％)和疫苗不在医保,价格难以支付(24.33％).Logistic回归模型显示疫苗认知和接种意愿与月收入、是否有慢性病有统计学关系(P＜0.05).结论 积极开展有针对性的宣传,提高老年人群对肺炎疾病防制及疫苗的知识水平,引导老年人主动接种肺炎疫苗,另外将肺炎疫苗费用支付纳入医保范围,减轻居民的经济负担也是提高老年人肺炎疫苗接种率的有效办法.     

天津市0～6岁儿童二类疫苗接种现状及影响因素

目的了解天津市儿童二类疫苗接种率及儿童家长对二类疫苗的认知情况,分析二类疫苗接种影响因素,为制定相关疫苗接种策略提供科学依据。方法采用分层随机抽样的方式抽取3个区针对6岁以下儿童家长开展问卷调查,问卷调查内容包括儿童家庭一般情况、家长对二类疫苗认知情况以及儿童二类疫苗接种情况等相关内容。结果共调查450名儿童家长,其中344名儿童(76.44%)接种过二类疫苗,水痘疫苗接种率最高(56.00%),七价肺炎疫苗接种率最低(4.89%)。经多因素Logistic回归分析表明,儿童年龄、家庭收入、母亲健康情况及家长对疫苗接种信息知晓程度是影响儿童二类疫苗接种的相关因素(P0.05)。家庭收入越高、母亲越健康、家长对疫苗接种信息了解越多,相应的儿童二类疫苗接种水平越高。结论目前天津市儿童二类疫苗接种水平有待进一步提高,需采取多种措施宣传引导儿童家长增强疫苗认知,规范疫苗接种服务管理,提高儿童二类疫苗接种水平,有效防控相关传染病发生。     

丽水市不同支付模式下第二类疫苗接种意愿的调查研究

目的调查不同支付模式下第二类疫苗接种意愿,为政府决策提供参考。方法选择相关领域专家,使用头脑风暴法筛选可行的第二类疫苗支付模式;分层随机抽样15岁以上人群,采用入户面对面调查。使用Excel 2003和SPSS 16.0软件进行统计分析,单因素分析采用χ2检验,以P0.1为标准纳入logistics回归模型作多因素分析,检验水准α=0.05。结果共调查360人,有效问卷358份,男女比为1∶1.40,平均年龄(44.92±12.52)岁;农村居民占59.50%;调查对象过去1年中自费疫苗接种率仅8.66%,未接种的原因以"价格太高"的比例最高,达30.73%;logistics回归分析显示城乡差别和收入水平是接种的影响因素;定性研究提出全额财政统一支付、商业保险、社会医疗保险、混合保险、全额个人支付等五种支付模式,其中在财政统一支付的情况下,接种意愿最高,达61.73%,商业保险16.76%,社会医疗保险14.53%,混合保险5.31%,最低的是个人支付模式,仅占1.68%。结论财政统一支付模式可以有效提高第二类疫苗的接种意愿。     

社区居民二类疫苗接种不同宣传模式效果比较

目的评价3种不同宣传模式对社区居民二类疫苗知识、接种态度及行为改变的干预效果,探讨有效的疫苗接种宣传模式。方法选择金华市三江、江南和苏孟3个乡镇(街道)居民,分别采用"预防接种妈妈班"模式(A模式)、接种门诊"告知-预约"模式(B模式)和社区责任医生推荐模式(C模式)进行干预。干预时间为2014年3—9月。通过对干预前后社区居民二类疫苗知识知晓率、接种必要性认知率、接种依从率和适龄儿童接种率等指标比较评价3种模式的宣传效果。结果 3种模式干预前后居民人口学特征差异均无统计学意义(P0.05);A、B模式干预后社区居民二类疫苗相关知识知晓率、接种必要性认识和接种意愿有所改善,0~3岁儿童二类疫苗接种率较干预前有提高(P均0.05);而C模式干预前后,除4种疫苗相关知识知晓率有所改善外(P0.05),其他指标均未见改善,干预前后差异无统计学意义(P0.05)。CMHχ2检验显示,控制时间因素后,A、B模式对居民二类疫苗相关知识、接种态度及行为的改善效果均优于C模式(P0.05)。结论"预防接种妈妈班"模式和接种门诊"告知-预约"模式对二类疫苗接种宣传效果明显,社区责任医生推荐模式有待改进。     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

Hydrazine inhalation hepatotoxicity

Abstract Hydrazine is a hazardous chemical commonly used as a reactant in rocket and jet fuel cells. Animal studies have demonstrated hepatic changes after hydrazine inhalation. Human case reports of hydrazine inhalation hepatotoxicity are rare. We report a case of mild hepatotoxicity following brief hydrazine vapour inhalation in a healthy young man, which resolved completely on expectant management.     

Fitness standards in airline staff

Employers have a legal duty to manage safety and to meet this duty it is necessary to control risks arising from pre-existing medical conditions. Such conditions can be identified at the time of job placement, but there is little published information about the approach to fitness standards by most airlines. This review is therefore limited to the practice of one major airline. It is illustrated by reference to various occupations within the airline, with the associated rationale.