娱乐场所服务小姐艾滋病行为学监测及血清学检测分析

目的：对娱乐场所100％推广使用安全套试点项目（100％CUP）后提供商业性服务的服务小姐（FSWs）中艾滋病相关行为现状及变化趋势进行监测，为艾滋病的干预措施和效果评价提供相关信息和依据。方法：通过定性和定量研究获取FSWs的知识、态度、行为等方面信息，同时采集标本检测HIV和梅毒感染情况，在2004年、2005年进行两次重复横断面调查。结果：FSWs报告最近一次提供商业性性服务时使用安全套比例2004年、2005年分别为91．8％、97．6％；FSWs AIDS相关知识知晓率和行为认知率明显提高；梅毒感染率分别为3．0％、1．0％。结论：100％CUP试点项目取得明显效果，在项目结束后应继续对FSWs开展健康教育和行为干预工作。     

Legal and ethical issues in telemedicine and robotics.

Modern medical concerns with telemedicine and robotics practiced across national or other jurisdictional boundaries engage the historical, complex area of law called conflict of laws. An initial concern is whether a practitioner licensed only in jurisdiction A who treats a patient in jurisdiction B violates B's laws. Further concerns are whether a practitioner in A who violates a contract or treats a patient in B negligently incurs liability in B, A, or both, and, if treatment lawful in A is unlawful in B, whether the practitioner commits a crime. Judicial procedures are set by courts in which proceedings are initiated, but courts may decline jurisdiction due to inconvenience to parties. If courts accept jurisdiction, they may apply their own substantive legal rules, but may find that the rules of a conflicting jurisdiction should apply. Cross-border care should not change usual medical ethics, for instance on confidentiality, but may mitigate or aggravate migration of specialists.     

HIV/AIDS among pastoralists and refugees in north-east Africa: a neglected problem

The eight member states (Djibouti, Eritrea, Ethiopia, Kenya, Somalia, South Sudan, Sudan and Uganda) of the Intergovernmental Authority for Development (IGAD) have the largest proportions of cross-border mobile pastoralists and refugees in Africa. Although all IGAD countries have had national HIV/AIDS prevention, care and treatment programmes since the late 1980s, the IGAD Regional HIV & AIDS Partnership Program was (IRAPP) established in 2007 to mitigate the challenges of HIV among neglected pastoral and refugee communities. This article assesses vulnerability of pastoralists and refugee communities to HIV and interventions targeting these groups in the IGAD countries. Outcomes from this study may serve as a baseline for further research and to improve interventions. Published articles were accessed through web searches using PubMed and Google Scholar engines and unpublished documents were collected manually. The search terms were HIV risk behaviour, vulnerability, HIV prevalence and interventions, under the headings pastoralists, refugees, IGAD and north-east Africa for the period 2001–2014. Of the 214 documents reviewed, 78 met the inclusion criteria and were included. Most HIV/AIDS related studies focusing of pastoral communities in IGAD countries were found to be limited in scope and coverage but reveal precarious situations. Sero-prevalence among various pastoral populations ranged from 1% to 21% in Ethiopia, Kenya, Somalia and Uganda and from 1% to 5% among refugees in Sudan, Kenya and Uganda. Socioeconomic, cultural, logistic, infrastructure and programmatic factors were found to contribute to continuing vulnerability to HIV. Interventions need to be further contextualised to the needs of those impoverished populations and integrated into national HIV/AIDS programmes. HIV/AIDS remains a major public health concern among the pastoral and refugee communities of IGAD countries. This calls for IGAD to collaborate with national and international partners in designing and implementing more effective prevention and control programmes. Furthermore, interventions must extend beyond the health sector and improve the livelihood of these populations.     

Moving health professionals as an alternative to moving patients: The contribution of overseas visiting medical specialists to the health system in Malta

Cross-border healthcare has become a major policy issue in the past years across the European Union. Professional mobility, as a means of providing specialised health services has not been given sufficient attention in both the research and policy agendas. This paper presents a case study of the contribution made by visiting overseas medical specialists to the health system in Malta. Twenty-five semi-structured interviews were conducted. A grounded theory approach was utilised in view of the limited amount of literature available on the subject. Qualitative content analysis revealed one superordinate theme, being the value of the service, and three further subthemes, which include the quality of the service provided, its longevity and durability, as well as the critical contributions of expatriates. The service is an integral component of the local health service. This study makes an important contribution to the literature on cross-border healthcare. Lessons learnt may be transferable to other small island states and territories. The European Reference Networks being developed at EU level may need to focus more on the benefits that can accrue through short term professional mobility than has been the case to date. The findings also serve to propose several important features that need to be in place to increase the chances of longevity, sustainability, quality and cost effectiveness in cross border health care services.     

北京市城郊两区娱乐服务场所暗娼艾滋病相关危险行为调查分析

目的了解北京市城郊两个区娱乐服务场所的暗娼艾滋病相关危险行为现状,评估暗娼感染艾滋病的风险,为在暗娼中开展行为干预提供科学依据。方法采用方便抽样方法对娱乐场所进行抽样,对场所内暗娼进行面对面问卷调查及采血检测。结果调查341名暗娼,最近一周商业性伴数中位数为3人。最近一次与商业性伴和固定性伴发生性关系时,使用安全套的比例分别为72.9%和49.3%;最近一月与商业性伴和固定性伴每次都用安全套的比例分别为44.1%和26.7%。城区暗娼商业性伴数高于郊区,最近一次与商业性伴使用安全套的比例和最近一月与商业性伴每次都用安全套的比例,均小于郊区。2.9%的暗娼吸毒。最近一年出现性病相关症状的比例为41.1%,其中到正规医院就诊的占75.7%。无一例感染艾滋病,梅毒快速血浆反应素环状卡片试验和梅毒螺旋体抗体阳性检出率分别为1.17%和12.1%。结论北京市城郊两区娱乐服务场所暗娼中存在引起艾滋病感染和流行的危险行为因素,且城区暗娼感染艾滋病的风险高于郊区。提示应加强娱乐服务场所的艾滋病干预工作,尤其是应把城区作为干预工作的重点。     

澜沧江-湄公河次区域HIV-1分子流行病学及跨境传播研究进展简

澜沧江-湄公河次区域是全球人类免疫缺陷病毒Ⅰ型（HIV-1）感染最为严重的地区之一,流行多种HIV-1病毒亚型,并且存在跨境传播的现象。该文总结了近年来澜沧江-湄公河次区域各个国家（省）的HIV-1感染情况和流行亚型。另外,对该区域流行的主要HIV-1亚型：B亚型、C亚型和CRF01_AE的跨境传播以及CRF07_BC和CRF08_BC在中国境内的跨省传播进行了介绍,希望能为该区域,特别是云南省和我国HIV-1的病毒起源、传播路线等研究提供一定的参考,也为该地区艾滋病（AIDS）疫情的预防控制提供科学依据。     

2011～2013年泉州市艾滋病哨点暗娼人群监测结果

目的评价暗娼人群艾滋病综合干预措施效果。方法对泉州市2011～2013年艾滋病哨点暗娼人群的监测资料进行分析。结果 2011～2013年合计调查暗娼2 576人,艾滋病防治知识知晓的1 996人,平均知晓率为77.48%（P〈0.01）。承认有吸毒行为的36人,占1.40%;最近1次与客人发生性行为时使用安全套的1 671人,占64.87%;患过性病的90例（淋病5例、梅毒20例、生殖道沙眼衣原体感染7例、尖锐湿疣23例、生殖器疱疹10例、其他性病14例）,占3.49%;最近1年接受过安全套宣传与发放或艾滋病咨询与检测的1 168人,占45.34%;接受同伴教育的115人,占4.46%。合计检测血液2 519份,HIV抗体均为阴性;梅毒抗体阳性的39份,阳性率为1.55%;HCV抗体阳性的11份,阳性率为0.44%。结论泉州市暗娼人群HIV感染率较低,但艾滋病知识知晓率和安全套使用率都不高。     

Mental health problems and disability pensions: trends and measures in a cross-national perspective

The article reports on a cross-border investigation into disability pension receipt due to mental health problems. The quantitative part comprised an analysis in how far disability benefit receipt due to mental health problems is similar with regard to size, trends, diagnostic patterns and risk groups across six countries (Belgium, Canada, Germany, the Netherlands, Sweden and Switzerland). The second part included a cross-border inventory of measures aiming at prevention, rehabilitation and “return to work measures” (RTW), focusing on sickness absence and disability due to mental health problems. Despite the generally rising trend in all countries (as to disability pension receipt due to mental health problems), there are considerable differences in the scope of the phenomenon. But in most countries the need is felt to act. The inventory of (new) policies that aim to affect this trend showed three categories of policies: early identification of vulnerable groups, work resumption measures and specific tools for social insurance administrators. For each category some examples of instruments developed or under consideration are given. It is concluded that good practices for dealing with work incapacity due to mental health problems are in the stage of development, whereas in some countries new work resumption approaches have been implemented, some giving greater responsibility to the employer and employee instead of medical authorities.