传染病暴发或流行的探测、监测和预警

传染病继续成为全球发病死亡主要原因之一,影响公众健康生命、社会经济发展甚至国家安全。早期探测重点是及时、敏感地发现传染病暴发流行异常信息,并进行现场调查和核实,也是有效监测、预警系统的前期;有效监测、预警系统能够全面准确地认识特定传染病暴发流行可能发生的事实条件、驱动因素和传播链,并提出科学有效预防控制策略措施;因衡量收集具体数据的资源支撑和价值大小,难以及时、完整、准确地获得流行病学、病原学等数据信息。本文综述传染病早期探测、有效监测、有效预警理论技术,整合利用中国有效传染病监测预警体系和多时空节点触发与多学科渠道监测暴发流行情况、病因、风险、过程和驱动因素的多源数据,构建运行敏感特异、分期度量的中国（急性）传染病监测、预警和响应创新技术体系,为加强新发重大传染病和传染病突发公共卫生事件监测预警、避免应对不力传染病蔓延与防止过度响应资源浪费提供依据。     

Nutritional interventions through primary health care: impact of the ICDS projects in India

In 1975 the Government of India initiated an integrated approach for the delivery of health care as well as nutrition and education services for deprived populations at the village level and in urban slums through centres, each of which was run by a local part-time female worker (anganwadi) who was paid an honorarium and had a helper. This national programme, known as the Integrated Child Development Services (ICDS), began with 33 projects but, by March 1986, had expanded to 1611 projects covering 23% of the country's population and representing about 50% of the population in the socioeconomically backward areas. The ICDS can therefore be considered to function as a primary health care programme for preschool children (under 6 years old), pregnant women, and lactating mothers. The present study investigated the impact on the nutritional status of the target population after 3-5 years and after 8 years of ICDS interventions, compared with the nutritional status of non-ICDS (control) groups. The results showed that the ICDS nutrition intervention programmes achieved better coverage of the target population and led to a significant decline in malnutrition among preschool children in the ICDS population, compared with the non-ICDS groups that received nutrition, health care and education through separate programmes. This example may lead other developing countries to introduce integrated programmes with certain modifications to suit local conditions. International agencies and national governments should strive to bring about the integration of nutritional services with primary health care and development programmes for children because of the good results in terms of child survival and child development.     

Surveillance in developed countries with particular reference to child growth.

Surveillance of biological function rather than of disease events is a possible method of detecting early changes in population health. The reasons for and methods of a pilot surveillance scheme of the growth of schoolchildren in Britain are discussed. The study, started in 1972, supports the feasibility of surveillance using simple growth measurements and information provided by parents on self-administered questionnaires. Other possible applications of this type of surveillance include growth and nutrition at other stages of life as related to nutrition intervention programmes, and respiratory function as related to environmental changes or the introduction of new substances such as 'safer' cigarettes.     

Nutrition intervention in ethnic minority groups

Development of effective intervention strategies to meet the needs of people with ethnic minority origins is dependent on two factors: an understanding of the modifiable risk factors which can form the basis of intervention; an understanding of the relevant health behaviours so that appropriate strategies can be designed. The present paper briefly reviews the evidence concerning the part that nutritional and dietary factors play in the aetiology of the observed patterns of disease in these groups and the limitations of the data as a basis for intervention. Consideration is also given to the available information concerning factors influencing health behaviour (particularly eating behaviour) and the applicability of commonly-used models of behaviour change to people of ethnic minority origin. Finally, the results of nutrition intervention programmes will be examined with a view to identifying lessons for the future.     

Methods of nutrition surveillance in low-income countries

Background

In 1974 a joint FAO/UNICEF/WHO Expert Committee met to develop methods for nutrition surveillance. There has been much interest and activity in this topic since then, however there is a lack of guidance for practitioners and confusion exists around the terminology of nutrition surveillance. In this paper we propose a classification of data collection activities, consider the technical issues for each category, and examine the potential applications and challenges related to information and communication technology.

Analysis

There are three major approaches used to collect primary data for nutrition surveillance: repeated cross-sectional surveys; community-based sentinel monitoring; and the collection of data in schools. There are three major sources of secondary data for surveillance: from feeding centres, health facilities, and community-based data collection, including mass screening for malnutrition in children. Surveillance systems involving repeated surveys are suitable for monitoring and comparing national trends and for planning and policy development. To plan at a local level, surveys at district level or in programme implementation areas are ideal, but given the usually high cost of primary data collection, data obtained from health systems are more appropriate provided they are interpreted with caution and with contextual information. For early warning, data from health systems and sentinel site assessments may be valuable, if consistent in their methods of collection and any systematic bias is deemed to be steady. For evaluation purposes, surveillance systems can only give plausible evidence of whether a programme is effective. However the implementation of programmes can be monitored as long as data are collected on process indicators such as access to, and use of, services. Surveillance systems also have an important role to provide information that can be used for advocacy and for promoting accountability for actions or lack of actions, including service delivery.

Conclusion

This paper identifies issues that affect the collection of nutrition surveillance data, and proposes definitions of terms to differentiate between diverse sources of data of variable accuracy and validity. Increased interest in nutrition globally has resulted in high level commitments to reduce and prevent undernutrition. This review helps to address the need for accurate and regular data to convert these commitments into practice.

     

对孕妇缺铁性贫血的社区营养干预病例对照研究

目的：对孕妇缺铁性贫血进行社区营养干预,探索有效的孕期社区营养干预模式。方法对140名孕妇采用病例对照研究方法（实验组及对照组各70人）,社区干预措施包括膳食调查与监测和健康教育处方,效果评估指标时间分别为孕周〈12周、第20和30周,评估指标为铁摄入量、细胞血溶比和血清铁蛋白。结果实验组在干预后各项指标均优于对照组,差异有统计学意义。结论以膳食调查和健康教育处方为代表的社区营养干预对孕妇缺铁性贫血具有较好的效果。     

Effect of Digital Nutrition Education Intervention on the Nutritional Knowledge Levels of Information Technology Professionals

The purpose of the study was to determine the changes in knowledge of information technology (IT) professionals after receiving a nutrition education intervention for a month. The sample comprised of 40 IT professionals (29 males and 11 females). The sample was drawn from four IT companies of Hyderabad city using random sampling techniques. The data on the general information of the subjects was collected. The data regarding the commonly accessed sources of nutrition and health information by the subjects was also obtained from the study. The intervention study group received nutrition education by distribution of the developed CD-ROMs to them followed by interactive sessions. To assess the impact of nutrition education intervention, the knowledge assessment questionnaire (KAQ) was developed and administered before and after the education programme. A significant improvement in the mean nutritional knowledge scores was observed among the total study subjects from 22.30 to 40.55 after the intervention (p < 0.05). The findings support the importance of providing professionals with nutrition knowledge to promote healthy dietary behaviors.Thus, the method of e-learning and development of CD-Rom is essential for teaching the educated groups on nutrition, physical activity and overall health education to improve their health, lifestyle and eating habits.     

Perspectives of Dietary Assessment in Human Health and Disease

Diet and human health have a complex set of relationships, so it is crucial to identify the cause-effects paths and their management. Diet is crucial for maintaining health (prevention) and unhealthy diets or diet components can cause disease in the long term (non-communicable disease) but also in the short term (foodborne diseases). The present paper aims to provide a synthesis of current research in the field of dietary assessment in health and disease as an introduction to the special issue on “Dietary Assessment and Human Health and Disease”. Dietary assessment, continuously evolving in terms of methodology and tools, provides the core information basis for all the studies where it is necessary to disentangle the relationship between diet and human health and disease. Estimating dietary patterns allows for assessing dietary quality, adequacy, exposure, and environmental impact in nutritional surveillance so on the one hand, providing information for further clinical studies and on another hand, helping the policy to design tailored interventions considering individual and planetary health, considering that planetary health is crucial for individual health too, as the SARS-CoV-2 (COVID-19) pandemic has taught. Overall, dietary assessment should be a core component in One-Health-based initiatives to tackle public health nutrition issues.     

Nutritional surveillance in Australia: a case of groping in the dark?

Nutritional surveillance means to watch over nutrition in order to make decisions and take actions to improve nutrition in populations. The information obtained through the surveillance system can be used in at least four areas--policy analysis, planning, program management and research. However, in Australia the information currently available is less than adequate for many key questions in these areas. The present state of infrequent and irregular data collection and analysis handicaps our efforts to understand the nutrition situation and to implement effective strategies to improve the nutritional health of Australians.     

Integrated NHANES: uses in national policy

The National Nutrition Monitoring and Related Research Program (NNMRRP) arose from Congressional concern about lack of information regarding the occurrence in the American population of undernutrition and diet-related risk factors for chronic diseases. Congressional appropriations and executive branch decisions about budget priorities have been the major determinants of the scope and number of nutrition monitoring surveys and surveillance activities fielded and therefore the information available for policy and research uses. The nutrition data collected in the NNMRRP are used by federal agencies, the private sector and academia for a variety of purposes, including public policy (e.g., development and evaluation of monitoring and surveillance, regulatory and nutrition programs), normative standards (e.g., growth charts, reference data for hematological and biochemical indicators of nutritional status or Dietary Reference Intakes) and research (e.g., cross-sectional, longitudinal and time-trends studies of dietary and nutritional status, health status, disease morbidity and mortality). Although the importance of the NNMRRP to national policy is difficult to quantify, in a 5-y period 97 proposed and final regulations citing NNMRRP data were published in the Federal Register by federal agencies responsible for nutrition and food safety programs. The NNMRRP-derived dietary and nutritional status data are essential information for quantitative risk assessments increasingly relied on by regulatory agencies as the basis for programmatic decisions and regulations development. Users of NNMRRP data in government agencies, academic institutions and the private sector have come to recognize the value of data from the surveys and surveillance systems for a wide variety of programmatic and research purposes.     

Building climate-sensitive nutrition programmes

The food system and climate are closely interconnected. Although most research has focused on the need to adopt a plant-based diet to help mitigate climate change, there is also an urgent need to examine the effects of climate change on food systems to adapt to climate change. A systems approach can help identify the pathways through which climate influences food systems, thereby ensuring that programmes combating malnutrition take climate into account. Although little is known about how climate considerations are currently incorporated into nutrition programming, climate information services have the potential to help target the delivery of interventions for at-risk populations and reduce climate-related disruption during their implementation. To ensure climate services provide timely information relevant to nutrition programmes, it is important to fill gaps in our knowledge about the influence of climate variability on food supply chains. A proposed roadmap for developing climate-sensitive nutrition programmes recommends: (i) research aimed at achieving a better understanding of the pathways through which climate influences diet and nutrition, including any time lags; (ii) the identification of entry points for climate information into the decision-making process for nutrition programme delivery; and (iii) capacity-building and training programmes to better equip public health practitioners with the knowledge, confidence and motivation to incorporate climate resilience into nutrition programmes. With sustained investment in capacity-building, data collection and analysis, climate information services can be developed to provide the data, analyses and forecasts needed to ensure nutrition programmes target their interventions where and when they are most needed.     

Consensus of the Nutrition Screening Initiative: risk factors and indicators of poor nutritional status in older Americans

Dietetics professionals must become even more proactive in taking the lead in the nutritional screening and assessment of older Americans. They can do so by encouraging all health care providers to become familiar with each older American's circumstances and needs. In addition, as individuals and as a professional health care association, we should urge our colleagues and institutions to establish regular longitudinal surveillance and continuity of care in nutrition services delivery. The timely, appropriate, and cost-effective delivery of nutritional screening, assessment, and care will improve the health and well-being of this valued segment of the US population. Dietetics professionals are a vital part of this process.     

Community nutrition programmes, globalization and sustainable development

On an international scale, the last seventy-five years have been a period of deep social, economic and political transformation for the developing countries. They have been especially influenced by the international phenomenon of globalization, the benefits of which have been unequally distributed among countries. In this context, the strategies used to improve the general nutritional health of the population of developing countries include broad approaches integrating nutritional interventions in a context of sustainable community development, while valuing the existing relations between fields as diverse as agriculture, education, sociology, economy, health, environment, hygiene and nutrition. The community nutrition programmes are emblematic of these initiatives. Nevertheless, in spite of the increasing evidence of the potential possibilities offered by these programmes to improve the nutritional status and contribute to the development and the self-sufficiency of the community, their success is relatively limited, due to the inappropriate planning, implementation and evaluation of the programmes. In the present article, I attempt to emphasie the importance of community participation of the population of developing countries in the community nutrition programmes within the context of globalization. This process is not only an ethical imperative, but a pragmatic one. It is a crucial step in the process of liberation, democratization and equality that will lead to true sustainable development.     

Status of nutrition surveillance activities in 24 State and metropolitan health departments

A study was undertaken to examine nutrition surveillance activities and their usefulness in managing programs of nutrition intervention. Questionnaires were returned by 24 of 26 directors of nutrition units in State or metropolitan health departments participating in 1981 in the coordinated nutrition surveillance system of the Centers for Disease Control, which monitors high risk pediatric patients and pregnant women. The mean years of experience in surveillance activities among the agencies was 4. Only 25 percent of the responding departments reported a self-sufficient computerized surveillance system. Personnel most involved in the coordinating, analyzing, and interpreting of the data were nutritionists who spent an average of 17 hours per month. Major uses of surveillance data reported for purposes of the nutrition programs were to (a) identify collection sites with problems such as errors in measuring heights and weights and hematocrits warranting checks for quality control, (b) define the extent of nutrition-related disorders in the target populations, (c) provide objective local data to assist in decision-making and program planning, (d) enhance followup of specific clients, and (e) provide feedback to clinic staffs about the quality and relative impact of their services. The survey results yielded evidence that nutrition surveillance activities have important consequences for the planning, implementation, and evaluation of programs of nutritional intervention.     

Health threats and health system crises. An approach to early warning and response. 2008 SESPAS Report

The world is changing more and faster than ever before. New diseases are coming to light each year, controlled diseases are reemerging as potential threats, and natural or man-made disasters are increasingly affecting human health. The "International Health Regulations (2005)" reflect the changes in the response of public health to this new situation. Surveillance of specific diseases and predefined control measures have been replaced by surveillance of public health events of international concern and control measures adapted to each situation. The public health events of international interest are characterized by their seriousness, predictability, the risk of international spread and potential for travel or trade restrictions. The development of the European Early Warning and Response System in 1998 and the creation of the European Center for Disease Prevention and Control in 2005 demonstrate political commitment in Europe, with early detection of and response to public health threats. However, timely risk evaluation and response at a national level requires improved data digitalization and accessibility, automatic notification processes, data analysis and dissemination of information, the combination of information from multiple sources and adaptation of public health services. The autonomous regions in Spain are initiating this adaptation process, but interoperability between systems and the development of guidelines for a coordinated response should be steered by the National Interregional Health Council and coordinated by the Ministry of Health. Efficient early warning systems of health threats that allow for a timely response and reduce uncertainty about information would help to minimize the risk of public health crises. The profile of public health threats is nonspecific. Early detection of threats requires access to information from multiple sources and efficient risk assessment. Key factors for improving the response to public health threats are the development of surveillance methods and operational research in public health.     

加强国民营养监测,采取有效干预策略,减少营养性疾病的发生

国民营养事关国民健康素质的提高和社会经济的发展,营养与健康状况监测信息,是公共卫生及疾病预防控制工作不可缺少的基础信息,为全民营养健康状况改善、食物生产及慢性病防控策略的制定提供技术支持。近年来,我国营养供给能力显著增强,国民营养健康状况明显改善。本期“营养健康监测”栏目发表的论文来自中国居民营养与健康监测及省（市）级自主开展的营养监测报告,这些数据为制定全国或地方性营养与健康策略提供了科学的参考。当前,我国营养工作面临多重挑战,党中央、国务院始终把人民群众的营养与健康摆在十分重要的位置,为促进全民健康,我国政府已实施多项营养促进政策或策略,营养监测又将进一步评估这些措施实施的效果。     

Development and Implementation of a Surveillance Network System for Emerging Infectious Diseases in the Caribbean (ARICABA)

Dengue fever, including dengue hemorrhagic fever, has become a re-emerging public health threat in the Caribbean in the absence of a comprehensive regional surveillance system. In this deficiency, a project entitled ARICABA, strives to implement a pilot surveillance system across three islands: Martinique, St. Lucia, and Dominica. The aim of this project is to establish a network for epidemiological surveillance of infectious diseases, utilizing information and communication technology. This paper describes the system design and development strategies of a “network of networks” surveillance system for infectious diseases in the Caribbean. Also described are benefits, challenges, and limitations of this approach across the three island nations identified through direct observation, open-ended interviews, and email communications with an on-site IT consultant, key informants, and the project director. Identified core systems design of the ARICABA data warehouse include a disease monitoring system and a syndromic surveillance system. Three components comprise the development strategy: the data warehouse server, the geographical information system, and forecasting algorithms; these are recognized technical priorities of the surveillance system. A main benefit of the ARICABA surveillance system is improving responsiveness and representativeness of existing health systems through automated data collection, process, and transmission of information from various sources. Challenges include overcoming technology gaps between countries; real-time data collection points; multiple language support; and “component-oriented” development approaches.     

Un nouveau langage en communication nutritionnelle

Obesity, diabetes, and their consequences for public health, keep developing. The inefficiency of communication campaigns in their attempt to compensate the lack of valid nutritional information on processed food leads to seek improvements in nutrition labels.Food groups and servings seem to be understood by a majority of consumers. Their quantitative expression using a simple, yet accurate, language should help to reach this goal.Labelling industrial foods by means of selected nutrients is not enough. We propose to add to each label a “visual” complement based on food groups: the nutritional profile of the food, and, possibly, symbols selectively warning against potential risks for health.     

Effects of home-visit nutrition education on nutritional status improvement of an urban community-dwelling elderly women in Korea

PURPOSE: This study was conducted to evaluate the effects on home-visit nutrition education by a dietitian on nutritional status improvement of an urban community-dwelling elderly women in Korea. METHODS: In the baseline survey, information on general characteristics, health-related characteristics, anthropometric measurements, biochemical measurements, nutritional knowledge. nutritional attitude, dietary habits, and food and nutrient intakes of 183 elderly people were obtained. The intervention group received weekly home-visit nutrition education over 4 months. RESULTS: After home-visiting nutrition education, nutritional knowledge, nutritional attitude and dietary habit were increased significantly by 1.8, 2.1 and 6.9 in the intervention group (P<0.01), respectively, who also appeared to consume more cereals and their products, legumes and their products, vegetables, seasonings, milk and dairy products than the control group. It was found that the nutrient intake increased significantly regarding energy, protein, calcium, iron, phosphorus, thiamin and riboflavin (P<0.05). The MAR (mean nutrient adequacy ratio) increased by 0.22 during the period of the study in the intervention group, and 0.09 in the control group, the difference being statistically significant (P<0.01). Differences between in mean change of anthropometric and biochemical indices between the intervention and control groups were not significant. CONCLUSIONS: These findings suggest that home-visit nutrition education by a dietitian is effective for improvement of the nutritional status of elderly women in an urban community. In conclusion, home-visit nutrition education should be recommended for nutritional status improvement and health promotion in the community elderly.     

Food and nutrition policies of Nordic countries: how have they been developed and what evidence substantiates the development of these policies?

The present paper addresses the emergence and development of Nordic food and nutrition policies, with some reference to the types of nutrition policies characteristic of other North European countries. Nutrition programmes aimed at dietary change have a long history of public responsibility in several Nordic and North European countries. The extent of involvement, the orientation and (indication of) success have, however, varied considerably between countries. First, different types of policies are characterised by their choice of programmes and measures, e.g. information campaigns v. market regulation or catering and public services. Second, the distinctions are associated not only with programmes, but also with the status and validity of nutritional advice and dietary guidelines in public policy making. Third, when focusing on how and on what grounds the governments have developed nutrition policies, it is evident that while more or less the same participants and issues are involved, their roles and relationships may be different. In this case the role and involvement of nutritional expertise and scientific arguments in various countries will be discussed. Finally, nutrition policies may entail conflicts of interest, particularly when health concerns are confronted with food industry and agricultural interests. This situation is quite evident in the question of animal fat. The present paper addresses how these issues have been dealt with quite differently in various countries.