国内外公共卫生领域标准化工作管理体制比较与思考

目的 为了更好地促进我国的卫生健康标准化工作,为建立完善我国卫生健康领域标准化的发展战略、管理体制提供依据。方法 本文收集了公共卫生领域标准化相关国际组织标准管理机制方面的资料,并将收集到的信息进行汇总分析。结果 公共卫生领域的各种标准在各国际组织的管理体制不同,在组织性质、标准种类、应用、发布、组织结构、标准制定原则、优点、转化、宣贯、评估等方面均有较大不同。结论 针对我国卫生健康标准化具体工作,国际标准化相关机构的工作机制提供了许多可供我国借鉴的经验。     

上海市松江区成年人高尿酸血症与慢性肾病关系的队列研究

目的 分析社区成年人高尿酸血症（HUA）与慢性肾病（CKD）发病风险的关系。方法 基于华东区域自然人群队列,对7 276例基线时未患CKD的上海市松江区20~74岁常住居民进行基于社区的前瞻性队列研究。CKD的诊断根据美国肾脏基金会慢性肾脏病实践指南的标准,HUA定义为血清尿酸（SUA）>420 μmol/L（男性）或>360 μmol/L（女性）。采用Cox比例风险模型分析HUA与CKD发病风险的关联。结果 经过中位时间2.65年的随访,队列人群新发CKD病例301例,累积发病率为4.14%,发病密度为16.01/1 000人年（95% CI：14.20~17.82）。CKD发病人群HUA的基线患病率显著高于非CKD发病人群。多因素Cox回归分析显示,HUA与CKD发病风险呈显著正关联,HUA患者的CKD发病风险HR值为1.92（95% CI：1.46~2.53）。在对性别、年龄、BMI、2型糖尿病、高血压等因素分层后,HUA与CKD发病风险仍呈显著正关联;在相加模型中,年龄与HUA存在交互作用,交互作用指数为1.78（95% CI：1.18~2.68）。结论 上海市松江区成年人CKD的发病率较高,HUA为CKD发病的独立危险因素。     

A nationwide post-marketing survey of knowledge,attitude and practice toward human papillomavirus vaccine in general population: Implications for vaccine roll-out in mainland China

BackgroundHuman papillomavirus (HPV) vaccine has been increasingly discussed in mainland China since its first approval in 2016. To date, nearly all studies assessing HPV vaccine perceptions and attitudes were implemented during pre-licensure period. Therefore, the nationwide post-marketing survey was conducted to update knowledge, attitudes and practice on HPV vaccine among general population in mainland China.MethodsParticipants aged 18–45 years living in mainland China were recruited in April 2019 by multi-stage non-randomized sampling. Sociodemographic factors, HPV and HPV vaccine related awareness, knowledge, attitudes, vaccine uptake and potential obstacles were assessed in questionnaires. Bivariate analysis and multivariate regression were used to identify disparity among subgroups with different sociodemographic characteristics.Results4,000 women (32.1 ± 7.81y) and 1,000 men (31.8 ± 7.96y) were included in final analysis. Less than one third of participants had heard of HPV (female: 31%; male: 22%) and HPV vaccine (female: 34%; male: 23%). Knowledge score was also unfavorable on HPV (female: 3 out of 13; male: 1.8 out of 13) and HPV vaccine (female: 3 out of 6; male: 2 out of 5). Only 3% females had been vaccinated three years after HPV licensure in China, although willingness to get vaccinated among those unvaccinated were high (mean willingness score ± SD: female: 3.3 ± 0.97; male: 3.0 ± 0.98). Industry of employment and household income were the major factors related to awareness and knowledge of vaccine, whereas HPV and HPV vaccine awareness were key influential factors for willingness. The main obstacles of vaccination were safety concerns, lack of knowledge, and high price of HPV vaccines.ConclusionsFindings highlight a lack of vaccine awareness, knowledge, and poor uptake in mainland China and underscore the necessity of health education campaigns. The identified priority groups, contents to be delivered and practical obstacles could furthermore provide insight into health education to reduce disparities and accelerate HPV vaccine roll-out in China.     

台州市2017-2018年新报告HIV/AIDS巨细胞病毒血症现患率及影响因素研究

目的了解2017-2018年台州市新报告且未接受抗病毒治疗(ART)的HIV/AIDS血浆巨细胞病毒血症现患率及其影响因素。方法收集台州市新报告且未接受ART的成年HIV/AIDS血浆样本,提取核酸后采用荧光定量PCR检测巨细胞病毒DNA水平,采用单因素与多因素logistic回归分析其影响因素。结果研究对象612例HIV/AIDS中,男性480例(78.4%),年龄>60岁125例(20.4%),同性性传播者177例(28.9%),异性性传播者430例(70.3%)。巨细胞病毒血症现患率为13.4%(82/612)。多因素logistic回归分析结果显示,CD₄⁺T淋巴细胞计数(CD4)≤200个/μl者现患巨细胞病毒血症的风险显著高于CD4>500个/μl者(OR=5.10,95%CI:1.74~14.96,P=0.003);82例现患巨细胞病毒血症者的血浆巨细胞病毒DNA载量(log10)中位数为1.57(P₂₅,P₇₅:1.04,2.13),CD4≤200个/μl者的巨细胞病毒载量最高(P<0.01)。结论2017-2018年台州市新报告未接受ART的HIV/AIDS中,巨细胞病毒血症现患率与免疫缺陷状态显著关联,巨细胞病毒血症对HIV/AIDS病程的影响有待进一步研究。     

Low vaccination coverage of pneumococcal conjugate vaccines (PCVs) in Shanghai,China: A database analysis based on birth cohorts from 2012 to 2020

BackgroundPneumococcal vaccines have been developed to protect infants and young children from pneumococcal diseases. Vaccination coverage studies are important in determining a population’s vaccination status and strategically adjusting national immunization programs (NIP). In this paper, we aim to describe the coverage of pneumococcal conjugate vaccines (PCVs) immunization for birth cohorts from 2012 to 2020 and discussed the factors influencing the coverage.MethodsVaccination data were collected via the vaccination information database in Shanghai, China, for children born from 2012 to 2020. The population data used in this study were collected from each community from 2012 to 2020. The coverage of initial immunization (1^st dose), basic immunization (three doses) and full immunization (3 + 1 doses) for PCVs was calculated according to the number of doses received. As vaccination coverage was assessed each year, Annual Growth Rate (AGR) was used to describe the variation trend of vaccination coverage. Immunization time and completeness of different PCVs were also analyzed.ResultsThe total number of births from 2012 to 2020 was 38,268 in Huangpu District, Shanghai, China. The initial immunization coverage of PCVs increased from 12.26% in 2012 to 49.65% in 2020, and the highest coverage was 50.61% in 2019. The cumulative vaccination coverage of PCVs was 19.4% for initial immunization and 16.8% for basic immunization from 2012 to 2020. And cumulative full immunization coverage of PCVs was 12.3% from 2012 to 2019. The PCVs coverage of most vaccination statuses showed an obvious upward trend from 2017 to 2020.ConclusionsDespite an upward trend in vaccination coverage of PCVs, the vaccination coverage of initial, basic and full immunization among children is still low. And given the heavy burden of Streptococcus pneumoniae (Sp) among children in China and the fact that the current vaccination coverage cannot effectively protect children, it is recommended that the government include PCVs into the NIP as soon as possible.     

上海市闵行区家长对学生用眼卫生健康服务态度评估

  目的  评估上海市《闵行区儿童青少年近视防控三年行动计划(2019—2021年)》实施1年后家长对学生用眼卫生健康服务的态度,为优化干预措施提供科学依据和决策参考。  方法  采用多阶段分层整群抽样的方法进行样本选择,最终完成20 176份有效学生家长问卷,进行对学生眼卫生健康服务态度评估。  结果  家长对学生用眼卫生健康服务满意率前3位分别是定点医疗机构提供的服务6 849名(84.65%)、提供视力筛查结果反馈方式16 915名(83.84%)、定点医疗机构检查流程6 704名(82.91%)。认为需要改善的环节前3位分别是用眼行为和用眼环境干预8 476名(42.01%)、家长告知7 850名(38.91%)、定期随访管理7 222名(33.67%)。不同学段、既往眼部疾病诊断史对学生用眼卫生服务的满意率和改善环节需求有影响,差异均有统计学意义(P值均＜0.05)。  结论  干预实施1年后,家长对学生用眼卫生健康服务整体较满意,不同特征学生家长对卫生健康服务需求有所侧重,建议进一步提供精细化、个性化的用眼卫生健康服务。     

上海市虹口区儿童青少年脊柱弯曲异常现状及影响因素分析

  目的  了解上海市虹口区中小学生脊柱弯曲异常发生率及影响因素,为脊柱弯曲异常防治工作提供科学依据。  方法  采取分层整群随机抽样方法,抽取虹口区7所学校1 884名小学四年级至高中三年级中小学生进行脊柱弯曲异常筛查和影响因素的问卷调查。  结果  虹口区中小学生脊柱弯曲异常检出率为7.2%,随着学段的升高,脊柱弯曲异常检出率升高,普通高中(15.7%)>职业高中(8.1%)>初中(3.4%)>小学(1.8%),差异有统计学意义(χ2=91.24,P < 0.01);男生脊柱弯曲异常率为5.9%,女生为8.6%,女生高于男生(χ2=5.27,P < 0.05)。多因素Logistic回归分析显示, 影响脊柱弯曲异常发生的因素有学段、营养状况、每天户外活动时间(P值均<0.05)。  结论  脊柱弯曲异常是危害儿童青少年健康的常见疾病之一。需要学校、学生、家长的共同参与,加强筛查、预防工作。     

阿托伐他汀药物在脑卒中高危人群中应用的效果研究

目的:通过有效的阿托伐他汀药物干预,探讨药物在卒中发病前及脑细胞并未处于完全性缺血缺氧状态下给予有效干预措施的效果。方法:于2017年4—6月,在上海市青浦区选择人口密度、经济水平相当但不相邻的2个社区60岁以上老年人进行高危险因素调查,筛选出至少具有2种危险因素的暴露人群,并对其进行颈动脉B超检查,筛选出颈动脉斑块的人群217例作为重点观察对象,其中一个社区为干预组(108例),口服立普妥及阿司匹林药物,另一个社区为对照组(109例),仅服用阿司匹林药物作为干预手段,比较两组治疗前后血脂和颈动脉斑块内-中膜厚度的变化情况。结果:干预组TC、LDL-C和HDL-C较对照组有明显的改善,干预组70.4%高血脂症转归至正常血脂,对照组仅有18.5%的高血脂症转归为正常;干预组中13.2%的人有新发内膜增厚现象,而在对照组中有31.3%的病例发生IMT内膜增厚;干预组中9.2%的研究对象由单侧斑块发展为双侧斑块,对照组中21.2%病例由单侧斑块发展为双侧斑块;且差异存在统计学意义。结论:立普妥可作为颈动脉粥样硬化斑块脑卒中高危人群的有效干预措施,辅以多普勒超声进行干预前后观察斑块变化,操作性强,重复性好,便于普及,必将在缺血性卒中的防治中发挥更大的作用。     

Influenza vaccination hesitancy and its determinants among elderly in China: A national cross-sectional study

BackgroundThe Chinese elderly face a significant threat from seasonal influenza, owing to the consistently low vaccination coverage. This study investigated the prevalence and determinants of influenza vaccination hesitancy among the Chinese elderly.MethodsIn 2019, 3849 elderly individuals from 10 provinces in China were recruited in a cross-sectional survey. Multinomial logistic regression was applied to investigate the determinants of influenza vaccination hesitancy.ResultsAmong the elderly respondents, 37.18% expressed some degree of hesitancy towards influenza vaccination: 19.28% were hesitant, and 17.90% refused influenza vaccination, including 19.28% acceptors with doubts and 17.90% refusers. Only 39.10% of the respondents considered themselves as the priority group for influenza vaccination, and 13.93% reported receiving a recommendation for vaccination from healthcare workers. Respondents with higher education levels and from urban areas had significantly higher odds of vaccine hesitancy than their counterparts. Confidence in the safety of vaccines was negatively associated with vaccine hesitancy, but confidence in vaccine efficacy had no such association. Respondents who perceived themselves as highly susceptible to influenza (AOR = 0.85; 95 %CI = 0.77–0.93) and those aware of the elderly as a priority group for influenza vaccination (AOR = 0.51; 95 %CI = 0.41–0.64) had a significantly lower odds of being refusers.ConclusionThis study found a high prevalence of hesitancy towards influenza vaccination among the Chinese elderly, especially well-educated and urban-dwelling respondents. The government should address vaccine hesitancy through culturally appropriate communication, subsidies for vaccination, and actively promoting vaccines through primary care professionals.     

Establishment of a model to assess mumps virus neurovirulence in neonatal Wistar rats

Mumps virus (MuV) is highly neurotropic and neurovirulent, hence, the neurovirulence of virus seeds used in the production of mumps vaccines must be tested. The previous neurovirulence evaluation method involves measuring the area of the cavity in the Lewis neonatal rat brain caused by MuV through paraffin sectioning and hematoxylin-eosin (HE) staining. However, the processes of paraffin sectioning and HE staining are time consuming and complicated. To solve this problem, in this study, a vibratome sectioning system was first deployed to evaluate MuV neurovirulence in the rat brain instead of paraffin sectioning and HE staining. The results showed that the vibratome sectioning method could assess the neurovirulence potential of MuV more objectively and efficiently. In addition, the effects of different MuV doses and the ages of the rats in days on this evaluation method were explored. The results indicate that MuV at no less than 10 50 % cell culture infective dose (CCID₅₀) could cause obvious cavity formation in 1-day-old rat brains. The neonatal rat model developed in this study could evaluate the neurovirulence of different MuV strains with high sensitivity and good repeatability.