基于非惩罚制度下989例用药错误事件回顾性分析与风险防范

目的：通过回顾性分析989例用药错误（medication error，简称ME）事件，明确用药错误的环节并提出针对性改进措施，为保障患者用药安全提供依据。方法：采用回顾性分析法对989例ME不良事件进行统计分析，包括ME分级、分类、错误环节、发生原因、事件责任主体及上报人员分布情况。结果：ME分级中，B级ME发生率最高占60.77%；ME主要发生在处方开具与转录环节占68.35%，其次是给药监测环节占22.14%；ME分类中用药剂量错误，用药途径错误，遗漏用药，用药频次错误，混淆药品错误居前五位，占比依次为23.96%，15.17%，14.36%，9.50%，6.88%；医护人员用药知识技能培训不足是导致ME的主要原因；ME的责任主体以医师为主占62.90%，其次是护士占30.03%；ME主要是由药师上报占64.71%。结论：医师处方错误是造成ME的首要原因，药师参与是保障用药安全的关键，提高医护人员的整体风险意识水平和综合素质是减少ME的重要途径，医院应进一步加强用药安全信息化建设及用药安全培训以保障患者用药安全。     

Frequency of injecting among people who inject drugs: A systematic review and meta-analysis

BackgroundPeople who inject drugs (PWID) do so at varying frequencies. More frequent injecting is associated with skin and soft tissue infection, blood borne viruses, and overdose. The aims of this review are to estimate the prevalence of injecting frequency among PWID and compare these estimates to current needle–syringe distribution coverage estimates, and identify socio-demographic and risk characteristics, and harms associated with daily or more injecting.MethodsWe conducted a systematic review of the peer-reviewed and grey literature from 2008 to 2018 and extracted needle–syringe distribution coverage data from a recent systematic review. We generated country-, region-, and global-level estimates of daily or more injecting. We also ran meta-regression analyses to determine associations between daily or more injecting and socio-demographic characteristics, injecting risk behaviour, non-fatal overdose, injection site skin infection, and blood borne virus prevalence.ResultsOur search resulted in 61,077 sources, from which 198 studies were eligible for inclusion in this review. There were 74 countries with estimates for injecting frequency. Globally, we estimated that 68.1% (95%CI 64.5-71.6%) of PWID, equating to approximately 10.5 (95% UI 6.8–15.0) million people, inject daily or more frequently. There was a higher percentage of participants reporting daily or more injecting among samples with shorter injecting careers, more male participants and higher reporting of opioids as their main drug injected. Daily or more injecting was also associated with samples reporting a higher prevalence of HIV and hepatitis C antibody (anti-HCV), non-fatal overdose, and receptive needle sharing in the previous month.ImplicationsWHO recently recommended a needle–syringe distribution target of 300 needles per PWID per year which is unlikely to be sufficient for the majority of PWID injecting daily or more who are out of drug treatment.FundingThe Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, University of New South Wales     

Temporal trends of legacy and emerging persistent organic pollutants in inuit preschoolers from Northern Quebec (Canada)

ABSTRACT

In this study, we report the temporal trends of persistent organic pollutants (POPs) in 181 preschool Inuit children from Nunavik and the influence of confounding factors on blood contaminant levels. From 2006 to 2010, no significant trends were detected in Σpolychlorinated biphenyls (ΣPCBs), Σorganochlorine pesticides (ΣOPs), Σtoxaphene, and Σper- and polyfluoroalkyl substances (ΣPFASs). On the contrary, significant downward trends ranging from 9.3% to 14.3% per year were found for polybrominated diphenyl ethers (PBDEs). Breastfeeding was significantly associated with increased levels of POPs. Age was positively and significantly related to ΣPCBs, ΣOPs and Σtoxaphene. Compared with girls, boys had significantly higher concentrations of ΣPBDEs, but lower concentrations of ΣPFASs. Weight-for-height or body mass index z-scores were negatively and significantly related to ΣPCBs and ΣOPs. Passive smoking was positively and significantly associated with ΣOPs and Σtoxaphene. In conclusion, continued efforts to reduce contaminant exposure are needed to protect children’s health and development.     

High occurrence of witnessing an opioid overdose in a sample of women who use heroin in Tanzania: Implications for overdose prevention

BackgroundOpioid overdose is preventable and reversible. To target overdose prevention training and naloxone distribution, it is important to understand characteristics of those people who use drugs most likely to witness an overdose. In this paper we report the proportion and characteristics of women who use heroin that have witnessed an opioid overdose in Dar es Salaam, Tanzania.MethodsWe conducted a cross-sectional survey with 200 women who use heroin. We fitted unadjusted and adjusted logistic regression models with witnessing an opioid overdose as the dependent variable and sociodemographic and drug use-related variables as independent variables.ResultsThe majority of participants (85%) reported having ever witnessed an opioid overdose. Age (adjusted Odds Ratio [aOR] = 1.09; 95% CI: 1.02–1.12), having ever attempted to stop heroin use (aOR = 11.27; 95% CI: 2.25–56.46), history of arrest (aOR = 3.75; 95% CI: 1.32–10.63), and spending time daily in places where people use drugs (aOR = 3.72; 95% CI: 1.43–9.64) were found to be independently associated with ever witnessing an overdose.ConclusionsFindings suggest the need for expanded access to naloxone to lay people and community and peer-based overdose prevention training in Tanzania, including the distribution of naloxone in settings with high drug use.     

The role of the environment in pediatric practice in Minnesota: attitudes, beliefs, and practices

Pediatricians can help limit children's exposures to environmental hazards, but few studies have assessed their comfort with discussing and dealing with environmental health issues. We surveyed the membership of the Minnesota Chapter of the American Academy of Pediatrics to assess pediatricians' attitudes and beliefs about the effect the environment can have on children's health, and to assess their practices in regard to screening for, diagnosing, and treating illnesses related to environmental exposures. Results showed that Minnesota pediatricians agree that children are suffering from preventable illnesses of environmental origin but feel ill-equipped to educate parents about many common exposures and their consequences. Responses also indicated significant demand for education on the subject and for a referral center that can evaluate patients who may be suffering from environmental exposures.     

大学生预包装食品营养标签认知度调查

摘要:目的　了解石河子大学大学生对预包装食品营养标签的认知情况,为大学生食品营养标签健康教育提供依据。方法　随机抽取17个学院4228名大学生进行食品营养标签认知度问卷调查。结果　大学生食品营养标签知识平均得分（4.51±1.78）分,医药学部得分最高（4.79±1.78）分,人文科学学部得分最低（4.14±1.76）分,差异有统计学意义（χ2＝120.261,P＜0.001）;女生得分［（4.61±1.76）分］高于男生［（4.39±1.80）分］,差异有统计学意义（Z＝-4.277,P＜0.001）。书籍、报刊或杂志是大学生获得食品营养标签知识的主要途径。78.5%的学生认为有必要在食品包装上标注营养标签。68.9%的学生对食品营养标签的内容与形式比较满意。29.3%的学生经常阅读食品营养标签。结论　大学生食品营养标签知识得分不高,需要加强宣教和引导,普及营养知识,提高大学生对营养标签的认知和科学使用。     

人类白细胞抗原DRB1*和DQB1*基因多态性与尘肺发病的相关性

目的探讨人类白细胞抗原（HIA）DRB1＊和DQB1＊位点基因多态性与尘肺发病的关系。方法采用1：1配比的病例一对照研究方法。尘肺病例组为113名Ⅰ期尘肺患者，对照组为与尘肺病例组年龄相近、同性别、同民族、同一工作地点、开始接尘时间和累积接尘工龄相差不超过2年的接尘工人。用聚合酶链反应序列特异性引物分析方法检测HIA-DRB1＊和DQB1＊共9个位点的等位基因。用SAS6．12软件进行单因素和多因素分析。结果尘肺病例组的HIA—DRB1＊08等位基因频率高于对照组，差异有统计学意义（P〈0.01），OR值为6．000，95％CI：1．906～18．941：HIA—DRB1＊09、HLA—DQB1＊06等位基因频率低于对照组，差异有统计学意义（P〈0．01），OR值为0．259、0．300，95％CI为：0．115～0．584、0．144～0．627；1：1条件logistic回归分析表明，HIA-DRB1＊08、HIA—DRB1＊09和HIA—DQB1＊06等位基因频率与尘肺有关联，调整OR值分别为：7．804、0．225和0．269，95％CI分别为：2．077—29．307、0．083—0．609和0．117～0．613。生存分析表明，HIA—DRB1＊08等位基因为尘肺潜伏期的危险因素；HIA—DQB1＊06为保护因素。结论HIA—DRB1＊08等位基因可能为尘肺易感的危险因素，HLA—DQB1＊06可能是抗尘肺的保护性的等位基因。     

在流行病学教学中应用案例教学法的效果评价

[目的]探讨案例教学法在流行病学课堂教学中的应用效果,不断提高课堂教学质量。[方法]2007年2月,在潍坊医学院整群随机抽取1106名医学和护理学等专业本科学生对案例教学的作用和效果等进行调查。[结果]其调查1106人,认为案例教学与基础理论讲解同等重要和根据章节不同灵活选择的分别占51.96%和37.40%,认为案例教学法效果很好和好的占77.32%,79.96%认为案例的应用对理解教学内容有帮助。[结论]在流行病学教学中应用案例教学法能够提高课堂教学效果,但在具体应用中需要不断改进。     

城乡产褥期妇女关于婴幼儿生命知识的现状调查分析

目的：研究产褥期妇女对婴幼儿生命知识现状。方法：在参考大量文献的基础上，通过咨询多年从事妇幼保健工作的专家并结合当地实际自行设计调查表，采用面对面访谈形式调查了产褥期妇女关于婴幼儿生命知识现状，包括婴幼儿知识的10个问题和7种相关生命知识现状的途径。选择潍坊市5家不同级别的医院作为调查点：对2003年7-11月期间在以上医院分娩的妇女用单纯随机抽样方法抽取调查对象；在产妇分娩6周内对调查对象进行访谈，获取关于婴幼儿相关知识现状的资料。结果：产褥期妇女关于婴幼儿生命知识水平较低，尤其是农村妇女，对多数婴幼儿生命知识问题的知晓率都低于城市妇女。结论：保健人员需加强产褥期妇女的健康教育工作，积极宣传产褥期保健知识以增强该群体的自我保健能力以及对婴幼儿的保健能力。同时，大力普及农村及郊区产褥期妇女关于婴幼儿的生命知识，尤为重要。