Influenza vaccine effectiveness in healthy 6- to 21-month-old children during the 2003-2004 season

OBJECTIVE: To assess the clinical effectiveness of influenza vaccine in preventing influenza-like illness (ILI) office visits. STUDY DESIGN: We analyzed billing and immunization registry data for healthy 6- to 21-month-olds from 5 Denver, Colorado pediatric practices (n = 5193). ILI and pneumonia/influenza (a subset of ILI) were defined from International Classification of Diseases, Ninth Revision, Clinical Modification codes for office visits occurring during peak influenza season. Partially vaccinated (PV) and fully vaccinated (FV) patients were defined as having 1 shot and 2 shots, respectively, more than 14 days before the first ILI visit. The likelihood of an ILI visit was determined using a Cox proportional hazards model accounting for patient characteristics, practice site, and immunization status. RESULTS: A total of 28% of the patients had an ILI office visit, and 5% had a pneumonia/influenza visit. Hazard ratios (HRs) for FV versus UV were 0.31 (95% confidence interval [CI] = 0.3 to 0.4) for ILI and 0.13 (95% CI = 0.1 to 0.2) for pneumonia/influenza, corresponding to a vaccine effectiveness (1 - HR x 100) of 69% for ILI and 87% for pneumonia/influenza. The corresponding HRs for PV versus UV were 1.0 (95% CI = 0.9 to 1.2) and 1.1 (95% CI = 0.8 to 1.5). CONCLUSIONS: Although 2 doses of vaccine were 69% effective against ILI office visits and 87% effective against pneumonia/influenza office visits, 1 dose did not prevent office visits during the 2003-2004 influenza season.     

宾馆及医院候诊室空气消毒效果的研究

目的探讨四种消毒剂对宾馆及医院候诊室空气消毒的效果及对人体不良反应的影响。方法使用复方过氧化氢、多聚甲醛、过氧乙酸、二氧化氯等四种消毒剂对宾馆、医院候诊室室内空气进行消毒,并对空气消毒前后的空气细菌总数进行检测和分析,询问有关人员对消毒剂的不良反应。结果四种消毒剂均能有效的杀灭细菌,从自然菌消亡率来分析,以复方过氧化氢效果最佳。四种消毒剂的自然菌消亡率为92.86%～95.35%,均能达到自然菌消亡率的合格水平(自然菌消亡率≥90%则判定为合格)。结论四种消毒剂均能对公共场所室内空气进行有效的消毒,但从消毒剂效果和人体不良反应来分析,以复方过氧化氢为最佳。应加强对公共场所室内空气的消毒和检测。     

突发公共卫生事件信息公开浅论

及时公开突发公共卫生事件有关信息，有其必要性和重要性。我国目前的突发公共卫生事件信息公开制度虽然在制度建设上取得了一定的成就，但还存在着不少“软性”的制约因素，尤其是政府部门主观意识上的欠缺，严重影响信息公开制度的运行。应该建立完善信息公开的动力机制，促使有关部门及时、准确、全面地公开相关信息。     

Alcohol effects on motor vehicle crash injury

CONTEXT: Although alcohol is frequently present in injured patients, whether it exacerbates injury and whether tolerance to alcohol changes such a relationship is less clear. Most clinical studies do not consider other important predictors of injury, making interpretation of their findings problematic. OBJECTIVE: To examine alcohol's role in injuries, taking into account other important factors, and to examine the effect of tolerance, if any. DESIGN: Prospective cohort study. SETTING: University hospital and community hospital emergency departments and morgue. PATIENTS: 1362 Motor Vehicle Crash patients age >/=18, treated and released, admitted, and deceased. MAIN OUTCOME MEASURES: Excess injury measured by Injury Severity Scale (ISS) 90, Weighted Revised Trauma Score (WRTS), and G-Score. RESULTS: Using regression analysis, the best predictors of injury severity were vehicle crush (TAD), safety belt use, and their interaction, and age. Alcohol use further predicted injury. Using the final regression model, the effect of alcohol was to increase ISS90, on average, by about 30% (from a predicted ISS90 of 5.1 to 6.8, all else being equal). The adjusted odds ratio for serious injury (ISS90>15), was 1.59 for a patient with a positive blood alcohol concentration (alc+) compared to a alc- patient. This potentiating effect is seen even for patients with low levels of alcohol (<22 mmol/liter; <0.100 BAC) but is not linear with increasing alcohol level. Tolerance to alcohol did not affect the potentiation of injury by alcohol. CONCLUSION: When other relevant variables are considered, alcohol increases injury, but the effects of alcohol level and alcohol tolerance are less clear. These findings have important implications for injury prevention, treatment, and research.     

北京市月坛社区卫生服务中心服务项目的成本测算

目的测算北京市月坛社区卫生服务中心(中心)项目成本,为政府完善社区卫生服务补偿机制提供参考依据。方法调查中心2006年度社区卫生服务项目数据。对全科医生、社区护士、防保人员的工作内容及其所用时间进行一周的追踪调查。应用项目成本测算方法计算出各社区卫生服务项目成本。结果2006年度中心开展各类社区卫生服务项目60个(政府制定了收费标准的项目13个)。个体卫生服务项目11个,公共卫生、准公共卫生服务项目49个。单位服务实际成本较高的项目有慢性疾病普查、各类健康教育和健康指导、肠道门诊、传染病访视、应急接种与强化免疫、城市病媒监测与报告和计划免疫资料统计评价与管理。结论社区卫生服务机构提供的服务以公共卫生、准公共卫生服务项目为主,需要政府大力支持。缺乏符合社区卫生服务特色的收费价格体系。     

公共场所性服务小姐艾滋病知识及性相关行为现状研究

目的了解公共场所性服务小姐对艾滋病知识的知晓情况和性相关行为现状。方法随机抽取59家公共场所235名性服务小姐进行匿名问卷调查。结果性服务小姐对艾滋病知识了解不全面，总体知晓率为33．62％，对安全套的防病作用认识较高，100％安全套使用率为75．74％，这一人群流动频繁，存在较多健康问题，如一天内多次性交易、经期也同男人“做”、性相关疾病患病率高、人工流产比例高、患病后到正规医院就诊比例低、定期健康检查人数少等。结论应在性服务小姐中开展多种形式的健康教育工作，指导其树立正确的求医观念，以降低艾滋病感染的危险性。     

全面改革预防医学教学 培养新型公共卫生人才

新形势下预防医学和公共卫生工作者应当具备多方面的能力:发现、分析和解决实际问题的能力;获取、处理和交流有关信息的能力;执行、实施和评价卫生政策及卫生项目的能力;社会动员和组织能力等。但是,传统的预防医学和公共卫生本科教育由于教学内容陈旧,理论性太强,教学方式单一而不能达到上述要求。实施新的教学方法后,减少了教学时数,增加了选修课程,开设了讨论课、现场实践教学课及针对学生的讲座并且改革了考试方法,取得了较好的效果。     

Are Essential Medicines in Malaysia Accessible, Affordable and Available?

Objective: To assess the pharmaceutical sector to know whether people have access to essential medicines. Setting: The study was conducted in 20 public health clinics, five public district drug stores and 20 private retail pharmacies selected randomly in five different areas randomly selected (four states and a federal territory). Method: The methodology used was adopted from the World Health Organization study protocol. The degree of attainment of the strategic pharmaceutical objectives of improved access is measured by a list of tested indicators. Access is measured in terms of the availability and affordability of essential medicines, especially to the poor and in the public sector. The first survey in the public health clinics and public district drug stores gathered information about current availability of essential medicines, prevalence of stock-outs and affordability of treatment (except drug stores). The second survey assessed affordability of treatment in public health clinics and private retail pharmacies. Main Outcome Measure Availability, stock-out duration, percent of medicines dispensed, accessibility and affordability of key medicines. Results The average availability of key medicines in the public health clinics for the country was 95.4%. The average stock-out duration of key medicines was 6.5 days. However, average availability of key medicines in the public district drug stores was 89.2%; with an average stock-out duration of 32.4 days. Medicines prescribed were 100% dispensed to the patients. Average affordability for public health clinics was 1.5 weeks salary and for the private pharmacies, 3.7 weeks salary. Conclusions: The present pharmaceutical situation in the context of essential medicines list implementation reflected that the majority of the population in Malaysia had access to affordable essential medicines. If medicines need to be obtained from the private sector, they are hardly affordable. Although the average availability of essential medicines in Malaysia was high being more than 95.0%, in certain areas in Sabah availability was less than 80.0% and still a problem.     

Dust exposure in Munich public transportation: a comprehensive 4-year survey in buses and trams

Objectives: Published data obtained from outdoor stationary sampling stations cannot be applied directly to the exposure situation in vehicles. The aim of this study, therefore, was to assess the dust exposure relevant to passengers and drivers in public buses and trams. Method: In the years 1993 to 1996, PM₁₀ samples were taken during 201 journeys of typically 4 h duration on 14 routes (nine bus routes, five tramways) which were representative for the overall Munich transportation system with respect to area characteristics and traffic density. The concentrations of the samples were compared with those collected at the same time at sampling stations of the Bavarian State Office for Environmental Protection (OEP). Dust exposure was continuously and synchronously recorded by means of a tyndallometric device. Traffic and passenger density, weather conditions, special events, etc. were noted by our personnel, travelling on every journey. Results: The average PM₁₀ dust concentration for all rides was 155 μg/m³ (single journey max. 686 μg/m³, min. 13 μg/m³). Interior concentrations were 1.7 to 4.0 times above those collected at the static outdoor stations. We found only minor associations between dust concentrations and traffic density or time of day. During several journeys continuous recording disclosed anomalies, dependence on weather conditions and cyclic track characteristics. Conclusions: Interior PM₁₀ particulate concentrations were comparable to those found elsewhere in truck drivers' cabs and are in the region of German regulative limits established for the general population's long term outdoor exposure. Indoor concentrations were well above the values found at stationary outdoor stations. Additional continuous recording of dust concentrations proved to be helpful in unveiling anomalies and dependencies on external effectors. Received: 10 August 1999 / Accepted: 20 November 1999     

Pharmakoökonomie und Public Health

The main purpose of Public health is improvement of the health state of the population. Thereby necessary coasts have to be considered. Public Health research is directly practice-related because of the development and implementation of health policy strategies. Important aims of the public health research are the realization of interventions in practice and their reevaluation. Health economy is an essential point of Public health. The public health research aims at analyzing the medical care and control systems. Further aims of the health economy are the individual processes of decisions of participating persons (e.g. physicians, patients)are object of research. Pharmacoeconomic aspects belong to an optimal therapy, that means the quality assurance and improvement with regard to circumstances. Quality assurance is not possible without the consideration of the state of knowledge. Only on the basis of actual data from the medical care system specific interventions on the political and individual level may be established. Subsequently these programs can be evaluated according to quality and cost outcomes. Drug information services and pharmacotherapy circles (Peer review groups)can contribute to an optimization in medical treatment. As a result these interventions are of consequence for health economy and medical care.