Rapid behavioral assessment of barriers and opportunities to improve vaccination coverage among displaced Rohingyas in Bangladesh,January 2018

Background

In November 2017, the World Health Organization received initial reports of suspected diphtheria cases in camps established for displaced Rohingyas in Cox’s Bazar district, Bangladesh. By January 11, 2018, over 4,000 suspected cases of diphtheria and 30 deaths were reported. The Bangladesh government and partners implemented a diphtheria vaccination campaign in December 2017. Outbreak response staff reported anecdotal evidence of vaccine hesitancy. Our assessment aimed to understand vaccination barriers and opportunities to enhance vaccine demand among displaced Rohingyas in Bangladesh.

Reducing the probability of falsely elevated HbA1c results in diabetic patients by applying automated and educative HbA1c re-testing intervals

IntroductionToo frequent HbA1c measurements may lead to unnecessary treatment modifications of diabetic patients. The aim of this study was to estimate the percentage of falsely elevated HbA1c results in two hospitals, Landeskrankenhaus/Uniklinikum Salzburg (LKH) and Landesklinik St. Veit (STV), as well as to retrospectively investigate the effect of an automated and an educative 60-day re-testing interval (RTI).MethodsThe amount of estimated falsely elevated results (eFER), based on odds calculated using the baseline and the follow-up values and the time between these measurements, the number of HbA1c re-testings within 60 days as well as the overall number of ordered and performed HbA1c analyses were calculated. In LKH, an automated algorithm cancelling inappropriate HbA1c testing was applied, and in STV, educational actions were taken.ResultsBefore RTI-implementation, eFER were 0.9% and 2.1% and within-60-days-re-testing were 15.0% and 7.4% of cases in LKH and STV, respectively. After RTI-implementation, these numbers decreased to 0.2% (p < .001) and 1.8% (p = .869) and within-60-days-re-testing decreased to 1.1% (p < .001) and 3.6% (p = .003) in LKH and STV, respectively. Median monthly HbA1c measurements decreased by 15.8% (p < .001) and 21.1% (p = .002) in LKH and STV, respectively.ConclusionBoth the educational and the automated 60-day-RTI were proven to be efficient in reducing overall HbA1c measurements, re-testing within 60 days and eFER.     

非洲学员对我国援非疟疾防治培训的需求分析

目的了解非洲学员对我国援非疟疾防治培训的需求,为援非培训班的对象选择和课程设置提供参考。方法采用整群抽样调查方法,对2014年和2015年参加江苏省寄生虫病防治研究所疟疾防治研修班的4期非洲学员进行问卷调查,对调查对象基本情况、从事疟疾工作情况和培训需求关系等进行统计分析。结果共调查培训学员161人,其中法语培训班学员占41.6%,英语培训班学员占58.4%。培训班学员构成以男性为主(69.3%),受教育专业背景以临床类专业为主(40.0%),工作年限在10年以内居多(56.4%)。48.2%的调查对象平时从事的疟疾预防和控制工作占总工作量的76%以上,80%以上的调查对象在市级及以上机构工作。调查对象工作类型集中在临床类(41.4%)和官员类(29.9%),其他为研究类职位(11.9%)。调查显示,非洲亟需的培训以疟疾防控策略为主(65.5%),对象以临床类人才(39.2%)为主。从语种上看,法语班学员更希望得到策略类培训(χ~2=12.528,P0.01);从工作级别看,在国家级机构工作的学员也更希望得到策略类培训(χ~2=10.508,P0.05)。结论目前我国援非疟疾防治培训项目可基本满足学员的需求,但应进一步根据学员职业背景、国家情况、参加疟疾工作年限和级别来制定有针对性的课程。     

Demand and supply factors affecting the rising overmedicalization of birth in India

Objective

To understand the interaction between health systems and individual factors in determining the probability of a cesarean delivery in India.

Methods

In a retrospective study, data from the 2007–2008 District Level Household and Facility Survey was used to determine the risk of cesarean delivery in six states (Punjab, Delhi, Maharashtra, Andhra Pradesh, Kerala, and Tamil Nadu). Multilevel modeling was used to account for district and community effects.

Results

After controlling for key risk factors, the analysis showed that cesareans were more likely at private than public institutions (P < 0.001). In terms of demand, higher education levels rather than wealth seemed to increase the likelihood of a cesarean delivery. District-level effects were significant in almost all states (P < 0.001), demonstrating the need to control for health system factors.

Conclusion

Supply factors might contribute more to the rise in cesarean delivery than does demand. Further research is needed to understand whether the quest for increased institutional deliveries in a country with high maternal mortality might be compromised by pressures for overmedicalization.     

我国长期照护保险需求影响因素分析——基于江苏省的实证研究

目的:对我国长期照护保险需求的影响因素进行探究,为我国建立完善长期照护保险制度提供参考。方法:以江苏省调研数据为例,采用因子分析、多元回归和Logistic回归等计量方法进行分析。结果:(1)从主观态度角度来看,护理费用、家属支付能力、保险观念、护理需求和慢性病认知均与长期照护保险需求存在正相关关系,并且影响显著;(2)从人口统计学角度来看,文化程度高的居民购买长期照护保险的意愿更高。结论:我国应充分考虑长期照护保险需求的影响因素,提高城乡居民收入,加大宣传力度,鼓励护理机构多层次发展,构建以政府为主导的长期照护服务体系。     

护士长要洞悉护士的心态与需求

目的：通过护士长主动洞悉护士的心态与需求，以调动护士的工作积极性。方法：护士长主动洞悉护士的心态与需求。结果：科室团队精神进一步凝聚，工作效率进一步提升。结论：洞悉护士的心态与需求是护士长的基本要求和基本职责，是促进工作的有效办法之一。     

糖尿病患者对糖尿病眼部并发症的认知与需求调查

目的 调查糖尿病患者对眼部并发症的知识、态度、行为及其需求.方法采用自设问卷,对58例有眼病及51例无眼病的门诊糖尿患者进行调查.结果 50%以上的患者对糖尿病眼病的危险因素认识不足;80%以上认为糖尿病患者需要定期进行眼科检查;无眼病组患者中,82.4%出现过一种或几种眼部症状,且近10%经常出现症状,但52.4%的患者不做任何处理;80%以上的患者希望获得糖尿病眼病的相关知识.其现有知识和希望获得途径均为眼科医生、媒体、内科医生、其他糖尿病患者等,从护上获得知识的比例非常低.结论多数糖尿病患者对糖尿病眼病的危险因素认识不足,未形成良好的定期眼科检查的保健行为,今后需加强内科医生、护士在糖尿病眼病健康宣教中的作用.     

广州市某区居民对社区卫生服务的需求利用和满意度分析

目的　了解广州市居民对社区卫生服务机构的利用情况、公共卫生基本项目的知晓情况和满意度情况,为改善广州市社区卫生服务质量提供方向和参考依据。方法　2020年12月,采取多阶段随机抽样的方法在广州市某区抽取1 050名居民进行问卷调查。单因素分析采用Pearson卡方检验,多因素分析采用二元logistic回归。结果　共发放问卷1 092份,收到有效问卷1 050份,有效率96.2%。受访居民过去一年在社区卫生服务中心看病或接受其他卫生服务的次数为（4.60±4.10）次;对公共卫生基本服务项目总知晓率为91.6%（962/1 050）,总知晓免费率为89.5%（940/1 050）;居民的社区卫生服务机构总体满意度得分为（4.61±0.75）分,其中得分最高为基本医疗服务情况,最低为机构设施、制度及基本情况。单因素分析发现,医保类型、就诊首选的医疗机构、步行到社区中心的时间和就诊服务时间等10个因素是居民总体满意度的影响因素;多因素分析发现机构设施、制度及基本情况,基本医疗服务情况,医疗费用情况,首诊医院4个因素为居民总体满意度的影响因素（OR值分别为21.294、109.013、18.203和20.989）。结论　广州市某区居民对社区卫生服务的利用情况较好,公共卫生服务项目的知晓率较高,但居民的社区卫生服务满意度仍有待提高,尤其是设施设备和医护人员服务效率等方面。     

Commentary: PDA – public display of affection or pathological demand avoidance? – reflections on O'Nions et al. (2014)

A group of children presents with a rather peculiar type of oppositional behaviours, sometimes now subsumed under the label of ‘pathological demand avoidance’ syndrome, also increasingly referred to as PDA. Boys and girls with ‘this kind of PDA’ will do anything to avoid meeting demands of adults and children alike. The behaviours ‘used’ in maintaining avoidance range from openly oppositional or manipulative to ‘extreme shyness’, passivity and muteness. These behaviours in terms of expression of affection are rather the opposite of those associated with the commonly used meaning of PDA. However, the avoidant behaviour is quite often ‘publicly displayed’ and with no feeling for the inappropriateness of the, sometimes even, exhibitionist style of extreme demand avoidance (EDA). The ‘disorder’ was first heard of in 1980, when Elisabeth Newson presented the first 12 cases of what she believed to be a ‘new’ and separate syndrome and that she referred to as PDA. Even though PDA has attracted quite a bit of clinical attention in the United Kingdom and other parts of Europe (including Scandinavia), virtually no research has been published in the field so far (Newson, Le Maréchal, & David, 2003 ). Experienced clinicians throughout child psychiatry, child neurology and paediatrics testify to its existence and the very major problems encountered when it comes to intervention and treatment. It is therefore a major step forward that O′Nions and co‐workers (this issue) have developed a new ‘trait measure’ for PDA (‘the EDA‐Q’), a measure that appears to hold considerable promise for research, and eventually for clinical practice.