从医务人员新型冠状病毒感染思考医疗机构的职业卫生工作

在COVID-19流行期间，医务人员受到新型冠状病毒的影响，让人们再次反思医疗机构的职业防护问题。就医疗机构在紧急（异常）状态下启动职业防护、识别“异常”状态、针对可能的“异常”采取必需的应急准备、个人防护用品的最适化、职业卫生工作常态化以及多学科的融合等话题进行了讨论，期望引起重视整合，推动医疗机构的职业卫生工作。提出政府和职业卫生专业机构要在指导、帮助医疗机构做好相关工作方面发挥重要作用。     

Obesity and chronic kidney disease in patients with chronic heart failure: an insight from the China Heart Survey

Background  

Obesity and decreased kidney function have been shown to be prevalent in Western patients with heart failure; however, whether this phenomenon exists in Chinese patients with chronic heart failure (CHF) is not known.     

Contribution of rural-to-urban migration in the prevalence of drug resistant tuberculosis in China

Increased drug resistance rates to the first-line anti-tuberculosis drugs and multidrug resistance (MDR) were observed in China. The objectives of this study were to determine the prevalence and risk factors for drug-resistant tuberculosis (TB) in urban China and, more specifically, to determine the contribution of migration to case burden and drug resistance rates of urban cities. A facility-based epidemiological study of all active TB patients reported in the four districts of Shanghai and Ningbo between April 1, 2008 and March 31, 2009 was conducted. Residents had significantly higher drug-resistance rates than migrants (any drug resistance: 29.8% vs. 23.5%, respectively, P = 0.038; MDR: 10.9% vs. 6.1%, P = 0.048). Previously treated migrant patients were more likely to harbor drug-resistant TB and MDR-TB than new migrant cases, with adjusted odds ratios of 3.85 and 6.52, respectively. In total, 46.2% of the previously treated cases were resistant to INH, 38.5% to SM, 33.3% to RMP and 30.8% to EMB, while 13.1%, 17.5%, 7.0% and 6.8% of new cases were resistant to the four agents, respectively. To prevent the transmission of drug-resistant TB among migrants and residents, improved case management and appropriate treatment regimens should be sustained to prevent acquired drug resistance.     

Carriage of Haemophilus influenzae in the oropharynx of young children and molecular epidemiology of the isolates after fifteen years of H. influenzae type b vaccination in Italy

BackgroundHaemophilus influenzae is an important pathogen able to cause a wide spectrum of diseases in children. Colonization of the upper respiratory tract is a risk factor for developing disease. This study aimed to investigate the oropharyngeal carriage rate of H. influenzae in young children in two Italian cities, 15 years after H. influenzae type b (Hib) vaccination was introduced. Antibiotic resistant traits and genotypes of the colonizing H. influenzae isolates were investigated.MethodsOropharyngeal swabs were obtained from 717 healthy children aged <6 years (June 2012–July 2013). Potential risk factors for H. influenzae colonization were investigated. H. influenzae isolates from carriage were characterized by PCR capsular typing, ampicillin susceptibility testing, resistance-associated gene sequencing and multilocus sequence typing (MLST). For comparison purposes, 38 non-typeable H. influenzae (NTHi) isolates from invasive disease were genotyped by MLST.ResultsThe overall H. influenzae carriage rate was 14.1% (101/717). Age, study site, presence of young siblings, and complete Hib vaccination status were independently associated with colonization. Of 101 isolates, 98 were NTHi, 2 were type e and 1 was type f. The overall ampicillin resistance rate was 15.8% (16/101). Resistance was mediated by TEM-1 β-lactamase production in half of isolates (n = 8) or modifications in penicillin-binding protein (PBP) 3 in the other half (n = 8). Several substitutions were discovered in PBP3 including the Asn526Lys change. Seventy-six different STs were identified among 98 NTHi isolates from carriage, with only 4 STs (ST12, ST57, ST238, ST1238) encompassing ≥3 isolates. Comparison of carriage and disease isolates found that several STs were shared between the two sources, although none of the major disease-associated STs were observed in carriage isolates.ConclusionsNTHi is the predominant serotype in carriage. The importance of monitoring both NTHi colonization rate and circulating genotypes should be emphasized in the era of the Hib conjugate vaccines.     

常用卫生领域绩效评价框架的发展和比较研究

目的:为我国卫生领域绩效评价提供借鉴。方法:阐述常用卫生领域绩效评价框架的发展,从评价对象、主要目标、评价维度、评价指标、应用情况等方面进行比较分析,并讨论其对我国的启示。结果与结论:在进行绩效评价时,需借鉴国外绩效评价理论,辩证地看待评价框架的优缺点,根据评价对象和实际情况选取合适的评价框架。     

我国民营医疗机构的现状与问题分析

通过文献评阅总结归纳我国民营医疗机构的现状、特点和存在问题,为进一步研究民营医疗机构的发展定位和策略提供依据。目前,我国民营医疗机构数量较多,对公立医疗机构的补充作用不可忽视。但是,民营医院的医疗服务量仍较少,在政策环境、医院自身经营管理、人力资源配置方面,仍有较多的问题制约着民营医疗机构的发展。提出有针对性、可操作的民营医疗机构发展策略,引导民营医疗机构的合理、良性化发展,是下阶段针对民营医疗机构研究的重要方向。     

关于疾病预防成本节约的经济学思考

从经济学评价角度阐述了成本节约的概念以及疾病预防成本节约的影响因素,并在此基础上提出了推进基本公共卫生服务项目实施的若干启示。     

上海市某社区常住居民吸烟状况分析

[目的]通过深入调查上海市某区常住社区居民的吸烟情况及影响因素,为进一步开展有效控烟提供科学依据。[方法]2007年9—12月,采取整群抽样的方法,对上海市某社区11个居委的13 567名全年龄段常住居民进行问卷调查。调查内容包括：人口学特征资料、个人吸烟、饮酒、饮茶情况。应用卡方检验和非条件logistic回归方法评估吸烟与调查因素的关联。[结果]调查对象总吸烟率21.0%（2 083/9 903）。除家庭人均月收入外,不同性别、年龄、文化程度、婚姻状况、工种、饮酒状况、饮茶状况人群吸烟率差异均有统计学意义（P〈0.05）。吸烟者开始吸烟年龄为（22.7±6.4）岁,65.4%的居民起床后60 min以内开始吸第一支烟。多因素分析显示：男性吸烟率高于女性（OR=46.97,95%CI：33.26,66.32）;20~、30~、40~岁年龄组吸烟率均大于〈20岁组,OR值（95%CI）分别为3.56（2.06,6.17）、4.42（2.50,7.83）、4.16（2.43,7.14）;大专及以上文化程度者吸烟率低于初中及以下（OR=0.59,95%CI：0.43~0.81）;从事脑力劳动者吸烟率低于从事体力劳动者（OR=0.78,95%CI：0.61~0.98）;已婚者和丧偶者的吸烟率高于未婚者,OR值（95%CI）分别为2.21（1.07,4.58）、2.19（1.70,2.81）;饮酒者吸烟率高于不饮酒者（OR=2.53,95%CI：1.97~3.26）;饮茶者吸烟率高于不饮茶者（OR=2.29,95%CI：1.87~2.81）。[结论]上海市某社区常住居民的总体吸烟率较高。男性、中年人、较低的文化程度、体力劳动者以及有饮茶和饮酒习惯的人群,与吸烟行为的关系更密切。     

我与杂志同成长——贺《环境与职业医学》杂志创办30年

3月下旬参加《环境与职业医学》杂志稿件终审定稿会,会上编辑部同仁讲到,杂志创办至今已30年,年底要组织一些纪念、庆祝活动。编辑部同仁半开玩笑半当真地嘱托我为杂志写篇文章。我当即应允并答复,文题已有眉目——我与杂志同成长。虽然答应,却一直没有下笔。除了工作繁忙,思绪的＂纷杂＂也是一个重要原因。的确,杂志创办至今的30年,也是我大学毕业后的近30年。