健康教育对流动儿童家长免疫规划知信行的影响评估

[目的]分析干预前后城市流动儿童家长免疫规划相关知识、态度和行为的变化,为探索有效的基层免疫规划健康教育模式提供依据。[方法]选取2个外来人口较为集中的社区,抽取暂住期在6个月以上的0～4周岁流动儿童家长234人,开展干预前调查,并在实施多形式干预后进行效果评价。[结果]健康教育干预前后,流动儿童家长免疫规划知识知晓率从43.47%提高到86.17%(χ2=1 028.87,P<0.01),具有免疫规划积极态度的比例从46.26%提高到85.15%(χ2=314.10,P<0.01),具有免疫规划积极行为的比例从42.95%提高到92.95%(χ2=268.61,P<0.01)。[结论]流动儿童家长的免疫规划知识知晓率、具有积极态度和行为的比例均偏低,健康教育干预可以显著提高流动儿童家长免疫规划的知信行,提高流动儿童免疫规划接种率。     

Strengthening vaccination policies in Latin America: An evidence-based approach

Despite many successes in the region, Latin American vaccination policies have significant shortcomings, and further work is needed to maintain progress and prepare for the introduction of newly available vaccines. In order to address the challenges facing Latin America, the Commission for the Future of Vaccines in Latin America (COFVAL) has made recommendations for strengthening evidence-based policy-making and reducing regional inequalities in immunisation. We have conducted a comprehensive literature review to assess the feasibility of these recommendations. Standardisation of performance indicators for disease burden, vaccine coverage, epidemiological surveillance and national health resourcing can ensure comparability of the data used to assess vaccination programmes, allowing deeper analysis of how best to provide services. Regional vaccination reference schemes, as used in Europe, can be used to develop best practice models for vaccine introduction and scheduling. Successful models exist for the continuous training of vaccination providers and decision-makers, with a new Latin American diploma aiming to contribute to the successful implementation of vaccination programmes. Permanent, independent vaccine advisory committees, based on the US Advisory Committee on Immunization Practices (ACIP), could facilitate the uptake of new vaccines and support evidence-based decision-making in the administration of national immunisation programmes. Innovative financing mechanisms for the purchase of new vaccines, such as advance market commitments and cost front-loading, have shown potential for improving vaccine coverage. A common regulatory framework for vaccine approval is needed to accelerate delivery and pool human, technological and scientific resources in the region. Finally, public–private partnerships between industry, government, academia and non-profit sectors could provide new investment to stimulate vaccine development in the region, reducing prices in the long term. These reforms are now crucial, particularly as vaccines for previously neglected, developing-world diseases become available. In summary, a regionally-coordinated health policy will reduce vaccination inequality in Latin America.     

潜江市扩大国家免疫规划工作现状调查

目的了解潜江市扩大国家免疫规划进展情况,及时发现工作中存在的问题和薄弱环节,为解决问题提供科学依据,促进免疫规划工作健康发展。方法采取查阅资料、入户调查和问卷访谈等方式在全市范围内进行调查。结果潜江市建立了比较完善的管理体系和专业队伍,儿童基础免疫各疫苗上报接种率均达到99％以上,“老五苗”入户调查接种率均高于90％,但部分流动儿童管理不到位。结论潜江市扩大国家免疫规划总体上运行良好,但也存在一些问题。     

深圳市宝安区计划免疫工作者的SCL-90量表调查及影响因素分析

目的 了解宝安区计划免疫工作者心理健康状况,提出改善措施. 方法 使用SCL-90量表和自制的问卷进行调查,调查结果与全国常模比较. 结果 83名计划免疫工作者的症状总体情况良好,总均分与全国常模基本一致,躯体化、强迫症状较全国常模分值高.不同程度的家庭支持对计划免疫工作者的躯体化症状没有影响（F=1.74,P＞0.05）,但对计划免疫工作者的强迫症状分值有影响（F=4.269,P＜0.05）;对计划免疫工作意义认识度越高,躯体化、强迫症状分值越低;对工作待遇的不同感知者对其躯体化症状分值和强迫症状分值均没有影响（t躯体=0.87,P＞0.05;t强迫=-0.15,PP＞0.05）. 结论 当前宝安区计划免疫人员工作压力较大,应给他们适当减压,同时应大力宣传计划免疫工作的必要性和重要性,提高计划免疫工作者的工作自豪感和荣誉感,鼓励社会、家庭成员支持计划免疫工作.     

上海市青浦区社区免疫规划人力资源现状调查

目的了解上海市青浦区社区免疫规划工作人员基本情况,为科学配置免疫规划人力资源提供依据。方法设计统一调查表开展免疫规划人力资源基本情况调查,结合接种数据进行工作量分析。结果 2012年青浦区各社区卫生服务中心从事免疫规划人员合计58人,平均年龄34.96岁,平均工龄14.93年,平均从事免疫规划工作年限6.14年;中级职称占27.59%,初级职称占67.24%,无职称占5.17%;接种门诊工作强度较大。结论青浦区应增加免疫规划人员数量,进一步优化人员结构、加强业务培训,以适应免疫规划发展需要。     

Report on: “The 1st Workshop on National Immunization Programs and Vaccine Coverage in ASEAN Countries,April 30, 2015, Pattaya,Thailand”

The 1st Workshop on National Immunization Programs and Vaccine Coverage in Association of Southeast Asian Nations (ASEAN) Countries Group (WNIPVC-ASEAN) held a meeting on April 30, 2015, Pattaya, Thailand under the auspices of the Pediatric Infectious Diseases Society and the World Health Organization (WHO). Reports on the current status and initiatives of the national immunization program (NIP) in each ASEAN countries that attended were presented. These reports along with survey data collected from ministries of health in ASEAN countries NIPs demonstrate that good progress has been made toward the goal of the Global Vaccine Action Plan (GVAP). However, some ASEAN countries have fragile health care systems that still have insufficient vaccine coverage of some basic EPI antigens. Most ASEAN countries still do not have national coverage of some new and underused vaccines, and raising funds for the expansion of NIPs is challenging. Also, there is insufficient research into disease burden of vaccine preventable diseases and surveillance. Health care workers must advocate NIPs to government policy makers and other stakeholders as well as improve research and surveillance to achieve the goals of the GVAP.     

Phase stability in fMRI time series: effect of noise regression, off-resonance correction and spatial filtering techniques

Although the majority of fMRI studies exploit magnitude changes only, there is an increasing interest regarding the potential additive information conveyed by the phase signal. This integrated part of the complex number furnished by the MR scanners can also be used for exploring direct detection of neuronal activity and for thermography. Few studies have explicitly addressed the issue of the available signal stability in the context of phase time-series, and therefore we explored the spatial pattern of frequency specific phase fluctuations, and evaluated the effect of physiological noise components (heart beat and respiration) on the phase signal. Three categories of retrospective noise reduction techniques were explored and the temporal signal stability was evaluated in terms of a physiologic noise model, for seven fMRI measurement protocols in eight healthy subjects at 3 T, for segmented CSF, gray and white matter voxels. We confirmed that for most processing methods, an efficient use of the phase information is hampered by the fact that noise from physiological and instrumental sources contributes significantly more to the phase than to the magnitude instability. Noise regression based on the phase evolution of the central k-space point, RETROICOR, or an orthonormalized combination of these were able to reduce their impact, but without bringing phase stability down to levels expected from the magnitude signal. Similar results were obtained after targeted removal of scan-to-scan variations in the bulk magnetic field by the dynamic off-resonance in k-space (DORK) method and by the temporal off-resonance alignment of single-echo time series technique (TOAST). We found that spatial high-pass filtering was necessary, and in vivo a Gaussian filter width of 20 mm was sufficient to suppress physiological noise and bring the phase fluctuations to magnitude levels. Stronger filters brought the fluctuations down to levels dictated by thermal noise contributions, and for 62.5 mm³ voxels the phase stability was as low as 5 mrad (0.27°). In conditions of low SNR_o and high temporal sampling rate (short TR); we achieved an upper bound for the phase instabilities at 0.0017 ppm, which is close to the dHb contribution to the GM/WM phase contrast.