对新型冠状病毒肺炎疫情期间口腔器械使用原则、洗消、管理的思考

自新型冠状病毒肺炎疫情暴发至今,国内外都出现了大量的确诊病例。随着疫情的蔓延,感染病例数的增加,尤其是最新报道指出存在气溶胶传播途径感染的可能,引起了口腔行业的重视,并由此引发了口腔工作者们对口腔诊疗日常感染控制工作的思考：如何在日常口腔诊疗工作中控制感染,避免医源性交叉感染的发生?本文根据各级疫情防控经验,结合多年传染病专科医院口腔科门诊工作经验,着重从器械使用、洗消及管理方面对口腔科门诊的防控工作提出一些建议和思考,期望对口腔科的日常诊疗工作,尤其是针对烈性呼吸道传染病、血源性传染病患者的诊疗工作提供一定的指导和帮助。     

A measurement and comparison of the fluid intake in people with and without back pain

Background The aim of this study was to investigate and compare fluid intake of people with and without chronic back pain (BP). The research hypothesis was that fluid intake is lower in people with chronic BP. Method A diary to record fluid intake in the general public was piloted. Seventy‐seven people with chronic BP and 88 without BP were recruited from outpatient clinics and asked to record their fluid intake using this diary for nine consecutive days. Data were analysed to compare the intake of fluid in the two groups. Results T‐tests showed that there is a higher fluid intake among the cohort with BP for the total daily fluid intake 2344 ± 669 mL (P = 0.008), and daily fluid intake excluding alcohol 2065 ± 658 mL (P = 0.039). Conclusions This study found that a sample of people with BP drank more fluid than a similar group with no BP.     

Could oral fluid be used to evaluate anti-hepatitis A virus status in individuals living in difficult-to-access areas?

A strategy adopted by different countries to reduce the number of new cases of hepatitis A is the vaccination. However, the mosaic of the epidemiological profile in developing countries has hampered the establishment of a unified nationwide vaccination program. To determinate national vaccination policies, the results of epidemiological studies need to be carefully considered. For this monitoring, the use of oral fluid is very important due to the painless and non invasive collection characteristics. There are few studies investigating which oral fluid collection device is optimal to detect low antibody levels and its use in selecting individuals for vaccination. So, the present study aimed to evaluate different oral fluid collection devices to detect humoral immune response against hepatitis A virus and its application in epidemiological studies. Therefore, 90 matched serum and oral fluid samples were collected from volunteers with different immune status, under ideal conditions of collection (optimization panel); and 224 matched samples in difficult-to-access areas (epidemiological study). Serum was collected by venipuncture and the oral fluid was obtained using three commercial devices: Salivette^®, OraSure^® and ChemBio^®. Serum and oral fluid were submitted to a commercial immunoblot to detect total anti-HAV antibodies. The optimization panel demonstrated that ChemBio^® device had the best performance (100% agreement), followed by OraSure^® (95.4%) and Salivette^® (90.8%). The optimal collection device (ChemBio^®), tested in a difficult-to-access area and evaluated under precarious conditions of collection, showed similar prevalence of total anti-HAV between serum and oral fluid, 80.8% and 79%, respectively. A follow-up was performed to evaluate the stability of oral fluid and it was observed that 210 days after the collection it was possible to detect anti-HAV antibodies. Oral fluid can be used to detect low levels of specific-antibody, being important to select age groups to be vaccinated. Therewith, the choice of proper collection device is essential to evaluate HAV antibodies in the epidemiological scenario.     

A comparison of two surface sample collection devices for use in polymerase chain reaction based detection of Pneumocystis carinii in house dust

A polymerase chain reaction assay was optimized to detect P. carinii cysts in composite dust samples. The optimal assay was capable of detecting as few as 10(3) P. carinii cysts in 50 mg of dust. Two dust collection devices were evaluated for efficiency and precision of collection of bulk dust and compatibility with the optimized PCR protocol for P. carinii DNA detection. A handheld vacuum cleaner equipped with a high-retention bag was found to be superior to a 37-mm filter cassette attached to an electrically powered vacuum pump in terms of dust collection efficiency (87% [n = 37] versus 81% [n = 35]), although the precision of the two devices as assessed by the standard deviation was similar (6.2% versus 6.3%). However, the vacuum cleaner method was not as compatible with the PCR-based detection assay as the filter cassette method. The filter cassette appears to be a better device for use in conjunction with PCR-based detection of P. carinii DNA in bulk dust samples from both smooth and carpeted surfaces.     

医疗器械监测在医院感染预防中的作用

目的 提高消毒灭菌医疗器械操作效能,有效减少医院感染.方法 采用实时监控、采样监测的方法,对监测结果统计分析.结果 共监测样本566份,合格526份,总合格率为92.93％,其中口腔器械、消毒包、灭菌剂、紫外线灯合格率分别为62.50％、95.26％、91.67％、60.00％.结论 及时分析监测数据,采取干预管理措施,可以有效预防医院感染.     

一种半自动透析液搅拌装置的研制

本文介绍了一种半自动透析液搅拌装置的工作原理及主要特点。该装置操作简单,使用方便,明显提高了工作效率。     

A population-based prevalence study of hepatitis A, B and C virus using oral fluid in Flanders, Belgium

Ten years after the first seroprevalence study performed in Flanders, the aim of this cross sectional study was to follow the evolution of hepatitis A, B and C prevalence. The prevalence of hepatitis A antibodies, hepatitis B surface antigen and hepatitis C antibodies was measured in oral fluid samples collected by postal survey. Using the National Population Register, an incremental sampling plan was developed to obtain a representative sampling of the general population. A total of 24,000 persons were selected and 6,000 persons among them contacted in a first wave. With 1834 participants a response rate of 30.6% was achieved. The prevalence was weighted for age and was 20.2% (95% CI 19.43–21.08) for hepatitis A, 0.66% (95% CI 0.51–0.84) for hepatitis B surface antigen and 0.12% (95% CI 0.09–0.39) for hepatitis C. The prevalence of hepatitis A and C in the Flemish population is lower in 2003 compared with the results of the study performed in 1993. The difference may be due to a real decrease of the diseases but also to differences in the methodology. The prevalence of hepatitis B surface antigen remains stable. Considering the 30% response rate and the high quality of the self-collected samples as reflect of a good participation of the general population, saliva test for prevalence study is a good epidemiological monitoring tool.     

口腔修复手法治疗老年口腔疾病患者的疗效观察

目的观察口腔修复手法在老年口腔疾病患者治疗中的临床疗效。方法选取2014年6月—2015年6月本院牙科收治的120例老年口腔疾病患者进行观察,采用随机分组法分为观察组对照组。观察组患者采用口腔修复手法治疗,对照组患者采用常规治疗。随访1年,观察2组患者的临床治疗效果、复发情况以及患者对治疗的满意度。结果观察组治疗有效率为95.00%,对照组治疗有效率为80.00%,观察组优于对照组,组间差异有统计学意义(P0.05);观察组患者对临床治疗满意度为96.67%,对照组患者对临床治疗满意度为81.67%,观察组优于对照组,组间差异有统计学意义(P0.05);随访1年,观察组无患者复发,对照组复发率为10.00%,观察组优于对照组,组间差异有统计学意义(P0.05)。结论口腔修复手法对老年口腔疾病的临床疗效理想,患者对治疗的满意度高,治疗后患者复发少,值得在临床应用。     

医疗器械上市后安全性监测框架模式的构建实例研究

针对心脏瓣膜典型案例,围绕信息收集、分析评价及控制环节存在的问题及可借鉴的经验进行访谈,剖析医疗器械上市后安全性监测过程中可能存在的问题,并提出改进建议。     

四川省3个县农村育龄妇女宫内节育器使用情况调查

目的:了解四川省农村育龄妇女宫内节育器(IUD)使用情况。方法:采用多阶段分层整群抽样的方法,对四川省3个县农村,共2107例于2004年7月1日～2005年6月30日期间放置IUD妇女进行横断面及前瞻随访研究。结果:3个县育龄妇女普遍使用的3种IUD分别是:母体乐375、TCu380A、宫铜,不同地区使用种类不同(P<0.001)。平均续用率为86.9%,75.3%IUD在乡级服务机构放置。IUD使用失败原因前3类依次为脱落、因症取器和下移取器,分别占4.7%、2.8%、2.7%;带器妊娠率为1.0%。logistic单因素分析显示,防止IUD脱落的保护因素是施术者5年内接受培训(OR=0.817,P=0.007)。结论:建议引入以循证医学为基础的临床路径的管理模式,针对各型IUD特点制定相应的标准操作程序作为技术指南,促进服务质量提高。     

医疗器械使用管理的几个焦点

医疗器械的不正确选择、管理和使用导致医疗费用的显著增加已经引起各国的广泛关注,2010年由世界卫生组织（WHO）组织的第一届全球医疗器械论坛针对医疗器械使用管理中的几个问题开展了广泛的讨论．文中对讨论的几个焦点问题进行了综述。     

Adjustments for oral fluid quality and collection methods improve prediction of circulating tetanus antitoxin: Approaches for correcting antibody concentrations detected in a non-invasive specimen

ObjectivesTo examine whether anti-tetanus toxoid (anti-TT) immunoglobulin G (IgG) levels measured in oral fluid and adjusted for collection difficulties and specimen quality are associated with total IgG and anti-TTIgG in oral fluid and assess if statistical adjustment for them improves prediction of anti-TT IgG in serum.Methods267 children, ages 12 to 15 months, enrolled in the M-SIMU randomized controlled trial participated in this nested cross-sectional analysis. Venous blood and oral fluid (OF) specimens were collected, and OF collection difficulties such as crying or gagging were recorded. OF volume was documented and total IgG was measured in OF specimens and anti-TT IgG was measured in OF and serum by enzyme immunoassay (EIA). Collection difficulties, volume and sociodemographic characteristics were assessed in relation to total IgG and anti-TT IgG in OF via multivariate regression. These models were extended to evaluate the association between anti-TT IgG in OF and in serum. A prediction model was developed to adjust anti-TT IgG in OF estimates as proxy for serum.ResultsBlood in the specimen, sores in the mouth and crying were positively associated with total IgG concentration while high oral fluid volume and sucking on the swab were inversely associated. None were significant predictors of anti-TT IgG in OF after adjusting for total IgG (geometric mean [GM] ratio: 1.99; 95% confidence interval: 1.78–2.24) and vaccination history (GM ratio: 2.44; 95% CI: 1.98–3.01). When predicting anti-TT IgG levels in serum with OF, total IgG modified the effect of anti-TT IgG in OF.ConclusionsAnti-TT IgG in OF is a good proxy for levels in serum, after controlling for total IgG in the specimen and other variables. Post hoc adjustments for OF volume and total IgG concentration are an important consideration when conducting serosurveys with oral fluid.     

口服耐受在治疗妇女自身免疫病中的应用

口服耐受可以防治自身免疫病 ,其作用机制十分复杂 ,涉及到调节性T细胞、树突状细胞、辅助性T细胞及凋亡等一系列免疫反应及调节的步骤。口服耐受具有操作简单、无明显的毒副作用的优点 ,可以为治疗自身免疫病提供一种新的方法和思路     

A comparison of multiphasic oral contraceptives containing norgestimate or desogestrel in acne treatment: a randomized trial

Objective

This study aimed to compare the effectiveness and safety of triphasic combined oral contraceptives (OCs) containing ethinyl estradiol (EE) and norgestimate (NGM) and biphasic combined OCs containing EE and desogestrel (DSG) in the treatment of mild to moderate acne.

Study design

This was an investigator-blinded, randomized, parallel group trial conducted at 3 centers in Thailand. Female subjects 18–45 years old were assigned to one or the other OCs and evaluated for efficacy and safety parameters at the baseline visit and after 1, 3 and 6 months of treatment.

Results

Among 201 randomized subjects, data from 93 subjects in the EE/NGM group and 95 subjects in the EE/DSG group were analyzed. After 6 months of treatment with EE/NGM and EE/DSG, no differences between formulations were found for the decrease in total acne lesion counts (74.4% vs. 65.1%, respectively, p=.070) or facial improvement score. More women using EE/NGM showed a decrease in severity of facial seborrhea than those using EE/DSG (p=.005). No changes in weight were noted in either group as compared to baseline.

Conclusion

Multiphasic OCs containing EE/NGM and EE/DSG provided comparable efficacy and tolerability in the treatment of acne. However, EE/NGM had a more beneficial effect on facial seborrhea reduction than EE/DSG.

Implications

EE/NGM and EE/DSG are multiphasic OCs, which were shown to be clinically equally effective for mild to moderate facial acne, and the multiphasic combined OC with NGM was more effective for women with facial seborrhea. Clinicians may apply the results of this study when considering treatment options for facial acne and seborrhea.     

The use of Xylitol chewing gum in oral health promotion for Finnish students

The beneficial effects of xylitol, a noncariogenic sweeteningagent, on oral health have been conclusively demonstrated ininternational trials, its therapeutic mechanisms have been thoroughlyinvestigated. A four-week trial was conducted to study universitystudents' conceptions of xylitol and their willingness to usexylitol chewing gum to improve their oral health. The trialwas carried out in a large student's refectory operated by theState Catering Centre in Turku. During the first test periodevery student eating in the refectory was given one packet ofxylitol gum free and during the second period only on request.Students' use of the gum after meals was monitored, and theiropinions were surveyed One thousand two hundred and twenty-onestudents returned completed questionnaires. Virtually everystudent was either chewing or about to chew when separatelymonitored on leaving the refectory. Students' attitudes towardsuse of xylitol chewing gum in the refectory diet were favourable:66% recommended it unconditionally and 31% accepted it. Thestudents were aware of the properties and benefit to oral healthof xylitol. Thirty-eight per cent of the students studied consideredxylitol chewing gum to be of considerable benefit to dentalhealth. Fifty-seven per cent considered it to be moderate benefitto dental health. Most students considered their teeth to bein good condition; only 2% felt they were not. Two thirds ofthe students stated that they used chewing gum at least oncea week Fifteen per cent of students regularly used chewing gumafter meals. The results of the trial demonstrated that universitystudents reacted favourably to provision of xylitol chewinggum in connection with refectory meals. There would seem tobe potential for the promotion of post prandial use of xylixolchewing gum.     

The importance of supportive environments for oral health promotion in school-aged children in Tanzania

Children in Tanzanian primary schools are being provided witheducation for oral health. A supportive environment is neededto enable and reinforce them to sustain behaviour conduciveto oral health. Some aspects of the home and school that mightsupport or conflict with such behaviour were studied. In 10urban and rural primary schools from one district, 200 childrenwere interviewed, and the surroundings of the schools observed.The children were being advised by their parents to brush theirteeth and to avoid sugary snacks, but the economic realitiesand school environments were less supportive of these behaviour.Tooth brushes and toothpastes were available but appeared tobe costly. Rural children, in particular, went to school withoutbreakfast. At school there were no organized meals but sugarysnacks were being sold by vendors and shopkeepers. The abilityof children to sustain behaviours conducive to oral health taughtat the schools can be questioned. The need is evident for intersectoralaction to improve the availability and affordability of healthyfoods and proper toothcleaning materials to school-aged childrenin Tanzania.     

Comparison of alternative methods of collection of service use data for the economic evaluation of health care interventions

Economic evaluation of health care interventions usually requires the collection of service use data to estimate the total cost of participants in an evaluation. There are a number of methods available to measure the quantity of services used but little is known about the relative accuracy of alternative methods. In a multicentre randomised controlled trial of interventions for the treatment of adults with recurrent episodes of deliberate self-harm (the POPMACT trial), health service data were collected by patient self-report after six and twelve months and also from GP records by independent investigators. Agreement for overall costs was relatively high. However, this hides substantial variation in agreement between the two sources of information for different services. The results suggest that GP records provide more accurate data on the use of general practice-based contacts than patient report, but less reliable information on contacts with other health services. Thus reliance on GP records for data on hospital services and other community health services based outside of general practice surgeries is not recommended. Future research should explore the level of agreement between patient report and other providing sector records, such as hospital records.     

Characterizing the acceptability of a vaccine for West Nile virus by public health practitioners

This study examines health care personnel's knowledge of West Nile virus (WNv) and attitudes towards a proposed chimeric yellow fever/WNv vaccine within the province of Saskatchewan. Telephone and in-person interviews with medical health officers and public health nurses provided information with which to assess the acceptability of implementing vaccination as a component for prevention of WNv within the province with the highest number of WNv cases to date in western Canada. The majority of health care professionals felt confident in the potential efficacy of vaccination for prevention of WNv but suggested that targeted vaccination programs could be most effective.