广东省城乡街头食品存在问题分析

1994年随机抽取广东省20个市315家街头食品经营户，按《广东省街头食品卫生检查评分标准》进行审评，结果，一类户占8．6％，二类户占43．8％，三类占47．6％．存在主要问题是饮食经营场所不卫生和设施简陋．食具消毒卫生质员不能有效得到保证．食品交叉污染因素较多，存在引发食物中毒潜在危险．食品从业人员个人卫生意识差．食品卫生监督力量薄弱，管不胜管．     

Matching Special Olympics registration data with administrative health databases: Feasibility and health status differences in children and youth with IDD

BackgroundChildren and youth with intellectual and developmental disabilities (IDD) experience health disparities. What is unknown is if data collected from children and youth with IDD who participate in Special Olympics is representative of children and youth with IDD who do not.ObjectivesAim 1: determine the feasibility of matching a database of registrants from Special Olympics Ontario (SOO), with population-based health services databases in Ontario, Canada housed at ICES. Aim 2: evaluate the differences between the database sources with regards to demographic variables and clinical status.MethodsUsing deterministic and probabilistic matching, registration data from SOO were matched to administrative health databases. Established algorithms were used to determine the prevalence of asthma, diabetes, and mental disorder in addition to demographic variables.ResultsThe matching rate was over 90%; 8404 were attributed to children and youth between the ages of 0–19 years. When comparing SOO participants with IDD to non-SOO participants with IDD, children and youth who participate in SOO were, on average, older with no further differences between groups on clinical or demographic variables. When comparing those previously not identified in the health services databases (from SOO) to those with IDD identified by ICES, the SOO participants appear to use the health system less, possibly indicating a better health status.ConclusionsResearch conducted on child and youth who participate in Special Olympics Ontario can be generalized to the broader population of children and youth with IDD in Canada when adjusted for age; however, care should be taken when comparing levels of overall morbidity.     

Comparison of local influenza vaccine effectiveness using two methods

BackgroundIn some settings, research methods to determine influenza vaccine effectiveness (VE) may not be appropriate because of cost, time constraints, or other factors. Administrative database analysis of viral testing results and vaccination history may be a viable alternative. This study compared VE estimates from outpatient research and administrative databases.MethodsUsing the test-negative, case-control design, data for 2017–2018 and 2018–2019 influenza seasons were collected using: 1) consent, specimen collection, RT-PCR testing and vaccine verification using multiple methods; and 2) an administrative database of outpatients with a clinical respiratory viral panel combined with electronic immunization records. Odds ratios for likelihood of influenza infection by vaccination status were calculated using multivariable logistic regression. VE = (1 ? aOR) × 100.ResultsResearch participants were significantly younger (P < 0.001), more often white (69% vs. 59%; P < 0.001) than non-white and less frequently enrolled through the emergency department (35% vs. 72%; P < 0.001) than administrative database participants. VE was significant against all influenza and influenza A in each season and both seasons combined (37–49%). Point estimate differences between methods were evident, with higher VE in the research database, but insignificant due to low sample sizes. When enrollment sites were separately analyzed, there were significant differences in VE estimates for all influenza (66% research vs. 46% administrative P < 0.001) and influenza A (67% research vs. 49% administrative; P < 0.001) in the emergency department.Conclusions:The selection of the appropriate method for determining influenza vaccine effectiveness depends on many factors, including sample size, subgroups of interest, etc., suggesting that research estimates may be more generalizable. Other advantages of research databases for VE estimates include lack of clinician-related selection bias for testing and less misclassification of vaccination status. The advantages of the administrative databases are potentially shorter time to VE results and lower cost.     

2012—2018年澳门新确诊HIV感染病例流行病学特征

目的了解澳门新确诊艾滋病病毒(HIV)感染病例流行病学特征。方法回顾性分析2012—2018年澳门卫生局的艾滋病感染情况统计有关数据。结果澳门总体HIV报告发病率从2012年的5.67/10万下降至2018年的5.54/10万,男性HIV报告发病率从2012年的7.14/10万升至2018年的9.91/10万,女性则由4.31/10万降至1.69/10万,但变化趋势均无统计学差异。男性HIV报告发病率高于女性,澳门新确诊HIV病例以澳门本地居民、男性为主,主要分布于20~39岁。2012—2018年,≤19岁新确诊HIV病例构成比有下降趋势。2013—2015年澳门新确诊HIV病例传播途径以异性性接触为主,2016年异性性接触与同性性接触所占比例相等,2017—2018年则以同性性接触为主。新确诊HIV病例共用针筒注射传播的构成比呈下降趋势。结论澳门HIV报告发病率低于全球水平,澳门HIV感染防控关键人群为男男性行为者。     

吉林省艾滋病病人抗病毒治疗工作管理模式的建立

目的 在吉林省建立艾滋病病人抗病毒治疗工作的管理模式。方法 调查治疗点医疗卫生人力、物力资源分布及艾滋病病人对医疗卫生服务需求情况；做好抗艾滋病病毒治疗工作的组织工作，明确职责任务；培训有关领导和医务人员，配备医疗资源，建立服务网络，筛选治疗对象，实施抗病毒治疗。结果 从吉林省农村医疗卫生资源的实际情况出发，建立了适合吉林省抗艾滋病毒治疗管理工作模式。经过这种模式的治疗，患者的CIM和劳动能力在治疗前后的X^2值分别为8．58、8，27（P〈0.01）。结论 建立了符合该省抗艾滋病毒治疗工作的三级网络，明确了三级医疗卫生网络为抗病毒治疗提供医疗卫生服务工作的职责，接受抗艾滋病病毒治疗的病人身体状况有了很大改善，恢复了劳动能力，提高了生活质量，延长了艾滋病人的生命。     

行政干预与健康教育对提高肺结核病例发现率的影响

目的 评价行政干预和健康教育活动对提高医疗卫生单位的结核病防治工作参与，以及提高肺结核病例转诊率和发现的效果。方法 在湖南省三个市辖38个县（区），采取一系列卫生行政干预措施，开展对卫生服务提供者的健康教育和培训，加强卫生行政部门和医疗卫生单位对结核病防治工作的参与，分析通过肺结核病例的转诊和追踪后肺结核病例发现的变化以及对全省肺结核病例发现效果的影响。结果 三市、38县卫生行政部门对辖区结核病防治工作的行政干预和参与率为100％，各县人民医院肺结核病例转诊工作参与率100％，其他县级医疗卫生单位和乡镇卫生院结核病例转诊工作参与单位数，由项目实施前的230个增加到780个；医疗机构肺结核病例转诊率为90．6％，总到位率为85．8％；新涂阳患者发现数为10596例，比项目实施前一年增加了113．8％；在新涂阳病例总数中，由医疗机构转诊发现病例数为4546例，占40．7％；项目期间新涂阳病例发现数占全省同期新涂阳病例发现数的42．6％。结论 加强卫生行政部门的干预和对卫生服务提供者的健康教育和培训，是促进医疗卫生机构的合作和参与，提高结核病例的转诊和到位，有效地提高肺结核病例发现的重要措施。     

Developing an expert panel process to refine health outcome definitions in observational data

ObjectivesDrug safety surveillance using observational data requires valid adverse event, or health outcome of interest (HOI) measurement. The objectives of this study were to develop a method to review HOI definitions in claims databases using (1) web-based digital tools to present de-identified patient data, (2) a systematic expert panel review process, and (3) a data collection process enabling analysis of concepts-of-interest that influence panelists’ determination of HOI.MethodsDe-identified patient data were presented via an interactive web-based dashboard to enable case review and determine if specific HOIs were present or absent. Criteria for determining HOIs and their severity were provided to each panelist. Using a modified Delphi method, six panelist pairs independently reviewed approximately 200 cases across each of three HOIs (acute liver injury, acute kidney injury, and acute myocardial infarction) such that panelist pairs independently reviewed the same cases. Panelists completed an assessment within the dashboard for each case that included their assessment of the presence or absence of the HOI, HOI severity (if present), and data contributing to their decision. Discrepancies within panelist pairs were resolved during a consensus process.ResultsDashboard development was iterative, focusing on data presentation and recording panelists’ assessments. Panelists reported quickly learning how to use the dashboard. The assessment module was used consistently. The dashboard was reliable, enabling an efficient review process for panelists. Modifications were made to the dashboard and review process when necessary to facilitate case review. Our methods should be applied to other health outcomes of interest to further refine the dashboard and case review process.ConclusionThe expert review process was effective and was supported by the web-based dashboard. Our methods for case review and classification can be applied to future methods for case identification in observational data sources.     

Effect of change in coding rules on recording diabetes in hospital administrative datasets

AimDuring 2008–2011 Australian Coding Standards mandated a causal relationship between diabetes and inpatient care as a criterion for recording diabetes as a comorbidity in hospital administrative datasets. We aim to measure the effect of the causality mandate on recorded diabetes and associated inter-hospital variations.MethodFor patients with diabetes, all admissions between 2004 and 2013 to all New South Wales acute public hospitals were investigated. Poisson mixed models were employed to derive adjusted rates and variations.ResultsThe non-recorded diabetes incidence rate was 20.7%. The causality mandate increased the incidence rate four fold during the change period, 2008–2011, compared to the pre- or post-change periods (32.5% vs 8.4% and 6.9%). The inter-hospital variation was also higher, with twice the difference in the non-recorded rate between hospitals with the highest and lowest rates (50% vs 24% and 27% risk gap). The variation decreased during the change period (29%), while the rate continued to rise (53%). Admission characteristics accounted for over 44% of the variation compared with at most two per cent attributable to patient or hospital characteristics. Contributing characteristics explained less of the variation within the change period compared to pre- or post-change (46% vs 58% and 53%). Hospital relative performance was not constant over time.ConclusionThe causality mandate substantially increased the non-recorded diabetes rate and associated inter-hospital variation. Longitudinal accumulation of clinical information at the patient level, and the development of appropriate adoption protocols to achieve comprehensive and timely implementation of coding changes are essential to supporting the integrity of hospital administrative datasets.     

Switching from intravenous to oral antibiotics in hospitalized patients with community-acquired pneumonia: A real-world analysis 2010–2018

The Japanese Respiratory Society 2017 guidelines strongly recommend switching from intravenous (IV) to oral antibiotics in patients with community-acquired pneumonia (CAP), following improvement in clinical symptoms and laboratory findings. Here, we retrospectively investigated the real-world, nationwide treatment and switching patterns for hospitalized patients with CAP in Japan using administrative data from 372 Japanese Diagnosis Procedure Combination hospitals from April 2010 to December 2018. Hospitalizations for CAP (patient age ≥20 years) with an A-DROP classification for CAP severity and IV antibiotics initiated on the admission date were included. Overall, 210,314 hospitalizations (moderate CAP: 61.7%) in 183,607 patients were analyzed. The median (interquartile range [IQR]) age at admission was 79 (70–86) years. Penicillin (51.9%) and cephalosporin (38.9%) were the most common IV antibiotic classes used and the median (IQR) duration of IV use was 8 (6–11) days. Switching to oral antibiotics during a hospitalization occurred in 30.1% (n = 63,311) of patients after a median (IQR) of 7 (5–10) days of IV treatment. The most frequently used oral antibiotic classes after a switch were fluoroquinolone (45.9%) and penicillin (24.8%). The switch rate was higher among hospitalizations with milder CAP, in respiratory medicine ward and in larger hospitals. The overall switch rates did not change over the study period. The findings from this analysis suggest that early switch from IV to oral antibiotics was not widely implemented during the 8 years of the study period. Further observation will be needed to see the potential impact of the guidelines update in 2017 in Japan.