The missing cases of tuberculosis in Malawi: the contribution from cross-border registrations

Low case detection rates of new smear-positive pulmonary tuberculosis (PTB) patients globally are a cause for concern. The aim of this study was to determine for patients registered for TB in Malawi the number and percentage who lived in a neighbouring country and the registration, recording and reporting practices for these 'foreign' patients. All 44 non-private hospitals, which register and treat all TB patients in the public health sector in Malawi, were visited. Ten (23%) hospitals in 2001 and 14 (32%) in 2002 maintained a separate register for cross-border TB cases. Patients recorded in these registers were not formally reported to the Malawi National TB Programme (NTP), the neighbouring country's NTP, nor to WHO. They therefore constitute missing cases. In Malawi, the number of cross-border new smear-positive PTB cases was 77 in 2001 and 91 in 2002, constituting about 3% of missing smear-positive cases in those hospitals that maintain cross-border registers and about 1% of missing cases nationally.     

鹿泉市娱乐场所性服务者艾滋病综合干预效果评价

目的研究在娱乐场所性服务人员中如何开展艾滋病(AIDS)干预,为预防控制艾滋病提供依据。方法对鹿泉市所有娱乐场所的性服务人员进行综合干预,干预前后通过问卷方式进行干预效果评估。结果性服务人员的艾滋病知识知晓率由干预前72.10%,提高到干预后90.67%(x2=32.53,P0.01);最近1次商业性行为时,安全套使用比例从干预前的46.12%,增加到干预后的76.00%(x2=6.94,P0.01);最近1个月商业性行为时,安全套每次使用比例从干预前的49.23%,增加到干预后的61.00%(x2=1.17,P0.05)。结论AIDS综合干预措施能有效提高安全套使用率,降低HIV感染机会,但需要形成长效工作机制,才能取得更好的效果。     

萍乡市娱乐场所性服务小姐行为干预调查

目的通过在安源区湘东区对商业性服务人员（FSWs）实施一年的行为干预措施,提高FSWs艾滋病（AIDS）、性病（STD）知识知晓率,降低其危险行为。方法对FSWs开展以宣传教育、安全套推广、性病诊疗服务、自愿咨询检测和社区干预网络为主要内容的AIDS综合干预措施,通过比较研究对象干预前后的知识、态度和行为的改变及两区性病发病率来评价干预效果。结果干预前后分别调查140名和187名社区FSWs,研究对象对AIDS知识知晓率从干预前的38.50%提高到干预后的83.32%;最近1周的商业性行为中每次使用安全套的比例由干预前的34.29%%提高到64.71%（χ^2=38.91,P〈0.005）;能正确使用男用安全套的比例由干预前的36.67%上升到66.67%（χ^2=11.088,P=0.001）;安源区干预当年性病发病率比上一年下降29.28%,湘东区下降9.80%;安源区FSWSHIV感染率为0.20%,湘东区FSWSHIV感染率为0.49%。结论采取综合干预措施能有效提高研究对象的AIDS防病知识和安全套使用率,从而降低其感染艾滋病病毒（HIV）及性病的危险性。     

2009—2011年北京市西城区暗娼艾滋病知识行为调查分析

目的了解2009—2011年北京市西城区暗娼(FSW)人群艾滋病知识认知水平、行为特征和人类免疫缺陷病毒(HIV)、梅毒感染率,为开展有针对性的行为干预和宣教工作提供依据。方法使用问卷每年对200人进行艾滋病防治相关知识与行为调查;采集静脉血标本,检测HIV、梅毒螺旋体抗体。结果 2009—2011年,FSW的艾滋病知识知晓率分别为77.5%、81.0%和99.0%,差异有统计学意义(χ2=43.78,P0.01)。最近1次商业性行为时安全套使用率分别为56.5%、46.0%和93.0%(P0.01)。梅毒检出率分别为1.5%、1.0%和1.0%,HIV抗体阳性检出率分别为0.5%、0、0。结论 2009—2011年,北京市西城区FSW人群艾滋病知识知晓率逐年上升。2011年最近1次商业性行为时安全套使用率较2009和2010年明显上升,但安全套坚持使用率仍较低,应继续加强安全套推广工作,继续做好对该人群艾滋病性病的宣传教育及干预工作。     

四川省某市街头暗娼及其顾客艾滋病相关行为研究

目的了解街头暗娼及其顾客的社会人口学特征、艾滋病相关行为及其影响因素。方法以站桩点(街头暗娼聚集地)为调查现场,由街头暗娼同伴教育者识别对象,调查员主动接近并面对面匿名调查街头暗娼和男性顾客,运用SPSS 12.0进行统计分析。结果100名性服务男性顾客平均38.03岁;在街头的性交易频率为16次/年;最近1年商业性性交易中坚持使用安全套的比例14%,与艾滋病知识得分呈正相关(OR=2.25);36%的男性顾客最近1次商业性行为中使用了安全套,与年龄(OR=1.45)和艾滋病知识得分(OR=4.54)呈正相关。43名街头暗娼平均35.03岁,吸毒者比例较大(37.21%),平均每周接待客人14.07次,其服务对象多为工地工人、老年人和农民。结论街头商业性性交易频率高,安全套使用率低,应主动对街头暗娼及其顾客采取针对性干预措施。     

上海市公安局收容教育所暗娼艾滋病知识行为干预效果

目的探讨上海市公安局收容教育所暗娼性病/艾滋病（STD/AIDS）相关知识的知晓情况,通过出入所知晓率的比较,对收教所内宣教、干预效果进行初步评估。方法按照国家统一制定的国家级暗娼综合点调查表,同时结合上海市宝山区健康教育性病相关知识条目开展调查：收集人口学资料、STD/AIDS相关知识条目等信息。在2008、2009年新入所学员中随机抽取196名开展出入所自身对照调查。结果 196名接受出入所调查的暗娼中,已婚者85人,占43.4%;未婚者78人,占39.8%;同居者1人,占0.5%;离异丧偶者32人,占16.3%。20岁以下18人,占9.2%;20-29岁89人,占45.4%;30-39岁70人,占35.7%;40岁以上19人,占9.7%。入所时暗娼艾滋病知识知晓率为76.2%,出所时知晓率为98.2%,经卡方检验,差异有统计学意义（P〈0.01）。结论入所时暗娼人群中艾滋病知识知晓率偏低,但通过在收教所内的多次干预,该人群中艾滋病防治知识知晓率有了明显提高,提示健康宣教在艾滋病性病防治工作中的重要性。     

Essential levels of health information in Europe: An action plan for a coherent and sustainable infrastructure

The European Union needs a common health information infrastructure to support policy and governance on a routine basis. A stream of initiatives conducted in Europe during the last decade resulted into several success stories, but did not specify a unified framework that could be broadly implemented on a continental level.The recent debate raised a potential controversy on the different roles and responsibilities of policy makers vs the public health community in the construction of such a pan-European health information system.While institutional bodies shall clarify the statutory conditions under which such an endeavour is to be carried out, researchers should define a common framework for optimal cross-border information exchange.This paper conceptualizes a general solution emerging from past experiences, introducing a governance structure and overarching framework that can be realized through four main action lines, underpinned by the key principle of “Essential Levels of Health Information” for Europe.The proposed information model is amenable to be applied in a consistent manner at both national and EU level. If realized, the four action lines outlined here will allow developing a EU health information infrastructure that would effectively integrate best practices emerging from EU public health initiatives, including projects and joint actions carried out during the last ten years.The proposed approach adds new content to the ongoing debate on the future activity of the European Commission in the area of health information.     

The impact of the EU Directive on patients’ rights and cross border health care in Malta

The patients’ rights and cross-border health care directive was implemented in Malta in 2013. Malta's transposition of the directive used the discretionary elements allowable to retain national control on cross-border care to the fullest extent. This paper seeks to analyse the underlying dynamics of this directive on the Maltese health care system through the lens of key health system stakeholders. Thirty-three interviews were conducted. Qualitative content analysis of the interviews reveals six key themes: fear from the potential impact of increased patient mobility, strategies employed for damage control, opportunities exploited for health system reform, moderate enhancement of patients’ rights, negligible additional patient mobility and unforeseen health system reforms. The findings indicate that local stakeholders expected the directive to have significant negative effects and adopted measures to minimise these effects. In practice the directive has not affected patient mobility in Malta in the first months following its implementation. Government appears to have instrumentalised the implementation of the directive to implement certain reforms including legislation on patients’ rights, a health benefits package and compulsory indemnity insurance. Whilst the Maltese geo-demographic situation precludes automatic generalisation of the conclusions from this case study to other Member States, the findings serve to advance our understanding of the mechanisms through which European legislation on health services is influencing health systems, particularly in small EU Member States.