免疫接种服务中一次性注射器处理方法及成本分析

利用山东省和陕西省现场调查资料,分析了2省不同层次医疗机构的一次性注射器的处理方式,并通过计算不同处理方式的成本,提出具有成本效果的一次性注射器的处理方式。结果表明:消毒/毁形、焚烧、掩埋和回收是主要的处理方法,在被调查的所有医疗机构中,没有一家医疗机构使用安全盒处理使用过的一次性注射器。由于没有使用规定的焚烧设备,实际调查结果表明,焚烧和掩埋的处理成本相对较低,是目前在村卫生室水平最适合的一次性注射器处理方法,而对于乡级和县级卫生机构而言,消毒/毁形和回收是目前较为适宜的处理一次性注射器的方法。     

Seizing the big missed opportunity: linking HIV and maternity care services in sub-Saharan Africa

This paper draws on two reviews commissioned by the UK Department for International Development in 2006-2007 that explore progress in linking HIV prevention and maternity services in sub-Saharan Africa. Although pilot and demonstration projects have been successful, progress in scaling up PMTCT has been slow, reaching just 11% of pregnant HIV positive women in much of Africa, less than half the percentage of coverage achieved by antiretroviral treatment programmes for adults in need. Despite ongoing efforts to promote comprehensive approaches, significant policy, financing and institutional barriers, and weak co-ordination and leadership, continue to hamper progress. Maternal health services face human and financial resource shortages which affect their capacity to integrate HIV prevention. Both HIV and maternal health programmes often receive targeted financial and technical assistance that does not take the other into account. However, proposals in 2007 from a number of countries to the Global Fund to Fight AIDS, TB and Malaria incorporate sexual and reproductive health programming that will have an impact on HIV, including certain maternity services. Moreover, Botswana, Kenya and Rwanda have shown that progress can be made where national commitment and increased resources are enabling maternal and newborn care to address HIV.     

What Are the Etiology and Epidemiology of Out‐of‐hospital Pediatric Cardiopulmonary Arrest in Ontario,Canada?

Background: Pediatric cardiopulmonary arrest (CPA) outside of the hospital has a very high mortality rate. Objectives: To evaluate the etiology and initial compromise of pediatric CPA cases in hopes of developing strategies to improve out‐of‐hospital resuscitation. Methods: The Ontario Prehospital Advanced Life Support (OPALS) study was a large multicenter initiative to evaluate the impact of emergency medical services (EMS) programs on 17 communities with 40,000 critically ill and injured patients who were older than 11 years. As part of this study, the authors conducted a retrospective observational cohort study that included all children younger than 18 years of age with out‐of‐hospital CPA, during an 11‐year period from 1991–2002. CPA was defined as patient being pulseless, apneic, and requiring chest compressions. Data were collected from ambulance call reports and centralized dispatch data and were reviewed by two independent investigators. Results: There were 503 children with CPA in the sample. Mean age was 5.6 years (range, 0–17 yr); 58.4% of patients were male, and 37.8% were younger than 1 year of age. Cardiopulmonary resuscitation (CPR) first was started by a bystander in 32.4% of cases, whereas 66.0% were unwitnessed arrests. Initial rhythms were asystole 77.2% of the time, pulseless electrical activity 16.4% of the time, and ventricular fibrillation or ventricular tachycardia 4% of the time. Annual incidence was 9.1/100,000 children. CPA was witnessed in 34.0% of cases; 80.7% of these were bystander‐witnessed, and 18.1% were EMS‐witnessed. Primary pathogenic cause of arrest was medical in 61.2% of cases, trauma in 37.2% of cases, and indeterminate in 1.6% of cases. Initial underlying physiologic compromise of witnessed arrests was judged to be respiratory in 39.8% of cases, sudden collapse (presumed electrical) in 16.4% of cases, progressive shock in 1.2% of cases, and indeterminate in 42.6% of cases. Presumed etiology was trauma, 37.6%; sudden infant death syndrome (SIDS), 20.3%; and respiratory disease, 11.6%, most commonly. Survival to hospital discharge was 2.0%. Conclusions: This is one of the largest population‐based, prospective cohorts of pediatric CPA reported to date, and it reveals that most pediatric arrests are unwitnessed and receive no bystander CPR. Those that are witnessed most often are caused by respiratory arrests or trauma. Trauma, SIDS, and respiratory disease are the most common etiologies overall. These data are vital to planning large resuscitation trials looking at specific interventions (i.e., increasing bystander CPR) and highlight the need for better strategies for prevention and early recognition.     

Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement.

OBJECTIVES: Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda. Methods: We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries. Results: On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic. Conclusion: A wide gap exists between current evidence-based standards and current levels of provider competence.     

A 5-year retrospective analysis of employer-provided dental care for Finnish male industrial workers

Abstract The treatment-mix, treatment time, and dental status of 268 male industrial workers entitled to employer-provided dental care were studied. The data were collected from treatment records of the covered workers over the 5-year period 1989-93. Treatment time was based on clinical treatment time recorded per patient visit, and the treatment procedure codes were reclassified into a treatment-mix according to American Dental Association categories, with a modification combining endodontics and restorative treatment. The mean number of check-ups followed by prescribed treatment (treatment courses) during the 5 years was 3.7 among those who had entered the in-house dental care program prior to the monitored period (old attenders). Their treatment time was stable, 57–63 min per year, while the first-year mean treatment time (170 min) of those who had entered the program during the study period (new attenders) was significantly higher (P<0.01) than the 5-year mean of the old attenders (61 min). Over the first 2 years, the treatment-mix of the new attenders showed a rise in diagnostic and preventive procedures from one-third to about one-half of all procedures, as it was for the old attenders. The new attenders' mean number of carious teeth (2.7), registered at the initial check-up visit, paralleled the mean recently demonstrated in the similar non-covered population. It was significantly higher than the 5-year mean of the old attenders (0.5) (P<0.001), but declined to the same level after the first year of treatment. It was concluded that the studied program seemed to contribute to a stabilization of treatment-mix, and to the establishment of a shorter annual treatment time within the first 2 years of treatment.     

季节因素对医疗卫生服务需求和利用的影响

本文通过对朝阳门社医连续性卫生服务调查的资料分析，探讨季节因素对医疗卫生服务供需的影响及连续性卫生服务调查方法在我国城市社医的应用。研究结果可为其他断面性卫生服务调查的数据调整提供依据。     

Presenile dementia: Sufferers,carers and services

An extensive search was made for people with presenile dementia (PSD) still under 65 years living in the Southampton Health District. Twenty-seven sufferers were identified. People with PSD had a high degree of cognitive, behavioural and self-care disabilities and carers showed considerable stress. Services were received from the old age psychiatry team, and to a lesser extent from social services and the Community Rehabilitation Unit. Community psychiatric nurses were the commonest form of support. The four sufferers in receipt of no services were less impaired. Identified needs included more counselling and advice and specific provision for the more physically active sufferer.