江苏省乳腺X射线摄影医疗照射剂量调查

目的］ 通过调查和测量计算江苏省乳腺X射线摄影受检者乳房压缩厚度（compressed breast thickness,CBT）和腺体平均剂量（average glandular dose,AGD）,了解江苏省乳腺X射线摄影的AGD分布情况及影响因素。 ［方法］ 抽样调查来自5 城市17 个医疗机构中17 台次340 个乳腺X射线摄影的曝光参数,使用X线质量控制检测仪测量其入射体表空气比释动能（entrance surface air kerma,ESAK）。使用国际通用方法计算AGD,并分析其与CBT等因素的关系。［结果］ 在江苏省抽取的340 个乳腺X射线摄影参数中,AGD均数为1.66 mGy。CBT 服从正态分布,均数和标准差分别为4.22 cm和1.12 cm。两种不同体位的CBT 差异有统计学意义（t=-3.481,P 〈 0.05）,两种体位的AGD水平差异无统计学意义（t=-0.791,P 〉 0.05）。 ［结论］ CBT 可能通过不同机制影响AGD水平,可为建立适合我国乳腺X射线摄影受检者剂量指导水平提供依据。     

剂量分布仪对医用电子直线加速器X射线泄漏辐射检测方法的探讨

目的：测量与分析医用电子直线加速器的泄漏辐射水平,探讨使用剂量分布仪等剂量扫描装置检测加速器泄漏辐射水平。方法：依据国家标准“电子加速器放射治疗放射防护要求”中提供的方法,以一台医用电子直线加速器为对象,使用IBA公司生产的Startrack型剂量分布仪对该加速器M区域内X射线泄漏辐射进行检测分析。结果：M区域内X射线泄漏辐射与最大吸收剂量点比值为0.07%,平均吸收剂量与最大吸收剂量比值为0.04%。结论：研究探讨使用剂量分布仪等剂量扫描装置进行加速器的X射线泄漏辐射检测具有十分重要的意义。     

Accessing HIV testing and treatment among men who have sex with men in China: A qualitative study

Barriers to HIV testing and HIV care and treatment pose significant challenges to HIV prevention among men who have sex with men (MSM) in China. We carried out a qualitative study to identify barriers and facilitators to HIV testing and treatment among Chinese MSM. In 2012, seven focus group (FG) discussions were conducted with 49 MSM participants in Nanjing, China. Purposive sampling was used to recruit a diverse group of MSM participants. Semi-structured interviews were conducted to collect FG data. Major barriers to testing included gay- and HIV-related stigma and discrimination, relationship type and partner characteristics, low perception of risk or threat, HIV is incurable or equals death, concerns of confidentiality, unaware that testing is offered for free, and name-based testing. Key facilitators of testing included engaging in high-risk sex, sense of responsibility for partner, collectivism, testing as a part of standard/routine medical care, MSM-friendly medical personnel, increased acceptance of gay/bisexual men by the general public, legal recognition and protection of homosexuals, and home self-testing. Barriers to treatment included negative coping, nondisclosure to families, misconceptions of domestically produced antiretroviral drugs (ARVs) and the benefits of treatment, and costs associated with long-term treatment. Facilitators of treatment included sense of hopefulness that a cure would be found, the cultural value of longevity, peer social support and professional psychological counseling, affordable and specialized treatment and care, and reduced HIV-related stigma and discrimination. Finally, for both testing and treatment, more educational and promotional activities within MSM communities and among the general public are needed.     

江苏省乳腺X射线摄影频度调查及乳腺癌风险评估

目的 调查估算江苏省乳腺X射线摄影的频度,进而估算乳腺摄影对江苏省女性人口的剂量负担,并评估乳腺摄影对江苏省各年龄组女性人口诱发乳腺癌的风险。方法 采用分层随机抽样调查的方法,通过调查30台乳腺摄影设备年检查人数和受检者年龄分布,估算全省乳腺摄影的频度,并计算乳腺摄影对女性人口的剂量负担。使用美国科学院电离辐射生物效应报告BEIR-Ⅶ中的超额归因风险（EAR）模型估算乳腺摄影检查对3个年龄组诱发乳腺癌的风险。结果 江苏省乳腺摄影检查的频度为3.77次/千人口;乳腺摄影对江苏省女性人口剂量负担为0.02 mGy/人。每次乳腺摄影检查对0~15岁组、16~40岁和>40岁3个年龄组的乳腺癌终生归因风险（LAR）分别为138/10万人、14.7/10万人和1.0/10万人。结论 乳腺摄影对人群乳腺癌诱发风险较小,但低年龄组的风险较大,提示针对低年龄乳腺摄影检查仍应慎重。     

2011－2019年江苏省不同型别流感病毒流行特征差异分析

  目的  了解2011 — 2019年江苏省流行性感冒（流感）病毒不同亚型和系之间的流行病学特征差异,为本地区流感的精准防控提供依据。  方法  对2011 — 2019年中国流感监测系统中报告的江苏省实验室确诊的流感病例进行分析,分类资料的分布差异比较使用χ2检验,使用logistic回归识别危险因素并计算OR值。  结果  在2011年1月至2019年12月期间,江苏省共报告26 934例流感确诊病例,A（H3）亚型占比最多,占40.40%。 在不同监测年度和地区间,流感病例中各个亚型和系分布比例的差异有统计学意义（χ2=13588.399,P<0.001;χ2=180.333,P<0.001）。 A（H3）亚型在12月至次年1月以及8 — 9月呈双峰流行,A（H1）亚型和B-Y系在1 — 2月出现高峰,B-V系则滞后至3 — 4月病例数增多。 在人群分布上,各年龄组、职业的流感亚型和系分布差异有统计学意义（χ2=1126.665,P<0.001;χ2=70.724,P<0.001）。 多因素logistic回归分析显示,经调整地区和月份,不同年龄组人群感染流感病毒各亚型和系的风险差异有统计学意义,0～5岁儿童更容易感染A（H1）亚型,6～15岁易感染B-V系,而65岁以上老年人易感染A（H3）亚型和B-Y系。  结论  江苏省流感病毒型别交替变化并呈现一定规律,不同亚型、系流行具有型别特异的季节性特征和人群感染风险,及时分析不同病毒亚型和系的流行特点是流感精准防控的关键。     

HIV misdiagnosis: A root cause analysis leading to improvements in HIV diagnosis and patient care

BackgroundStandard diagnostic testing for HIV infection has traditionally relied on a high sensitivity HIV antibody screening test using an enzyme-linked immunosorbent assay (ELISA) followed by a high specificity antibody confirmatory test such as a Western Blot. Recently several of the screening assays have been enhanced with an ability to identify p24 antigen thereby narrowing the diagnostic window.ObjectivesTo explore the implications of enhanced HIV screening methods that may be leading to HIV misdiagnoses.Study designA patient deemed to be an HIV infected ‘elite controller’ was found to be misdiagnosed when undergoing detailed investigations prior to initiating antiretroviral therapy. A root cause analysis was performed to identify the causative factors of this misdiagnosis. A retrospective review of all “elite controllers” in Alberta, Canada revealed challenges of current HIV testing algorithms.ResultsTechnical and human factors were identified as being causative in this HIV misdiagnosis including (i) high rates of false reactive results on the Abbott ARCHITECT HIV-1&2 COMBO EIA, (ii) human error in reading the initial Western blot, (iii) HIV algorithmic directives in which confirmatory (Western blot) testing was not performed on a repeatedly reactive screen test. The outcome of this analysis identified opportunities for improvement, including implementation of a newly approved (automated) confirmatory assay and improved communication between the clinician and laboratory.ConclusionsHIV testing remains problematic despite significant advances in HIV test performance and algorithm development, presenting new and unexpected issues. Ensuring a high-quality management system including implementation of the latest HIV technologies and algorithms along with human resources and policies are required to minimize the impact of false positive diagnoses, especially in the era of universal screening and ‘test and treat’ recommendations.     

运用健康促进策略提高产盐地区碘盐覆盖率的方法研究

目的运用健康促进策略,在沿海产盐区建立可持续提高碘盐覆盖率的工作机制.方法2002年1月至2003年4月间,江苏省选择赣榆县为试点地区,开展以组织间关系和发展理论为指导、运用健康促进策略提高碘盐覆盖率的方法研究.干预措施为社会动员和健康教育.实施干预14个月后,对921名家庭主妇及940名小学生进行碘缺乏相关知识问卷调查,同时测定部分人群尿碘含量以了解人群碘营养水平.结果干预后,家庭主妇和小学生的碘缺乏危害知晓率、碘盐覆盖率等均有较大提高,差异有统计学显著性.干预后的成人尿碘中位数为259.0μg/L,较干预前相比(P＜0.05)具有统计学显著差异.结论运用健康促进策略所建立的工作模式,可持续、有效地提高沿海丰产盐区的碘盐覆盖率.