Hospitals and health systems: the best of times and the worst of times

Hospitals and health systems, whether general acute care hospitals or specialty-driven hospitals, are attempting to prosper in a unique time. This year, hospitals throughout the country will see increased reimbursement for hospital inpatient services, rather than decreased reimbursement. Many hospitals are examining a multitude of options for debt financing and a number of the nation's hospitals are in the process of renovating, expanding, or replacing their current hospitals. Further, more private equity and venture capital funds are pursuing hospital investments than seen in several years. Despite the positive signals stemming from many of the country's hospitals, this remains a time of tremendous uncertainty and risk in the hospital industry. This article discusses five strategic and development issues facing many hospitals and addresses how hospitals can prepare for the future should the current climate, supportive of growth, development, investment, and debt financing, change.     

南昌地区2004—2005年度流感监测情况分析

目的了解和掌握南昌地区流感流行动态及病原学特征。方法依照《国家流感监测方案》要求的标准进行流行病学和病原学监测。对门诊就诊病人和流感样病人按时间和年龄组进行登记和统计上报；对符合采样条件的流感样病例进行鼻咽拭子采样，送江西省疾病预防控制中心采用细胞培养法分离鉴定流感病毒。结果2004-2005年度共监测流感样病例12197例，门诊病例总数135646例，流感样病例占门诊病例总数的8．99％；共采集流感样病例鼻咽拭子标本736份，检出阳性标本124份，病毒分离率为16．85％。结论2004-2005年度南昌地区的流感疫情处于相对稳定状态，以初春至初夏季节（3～7月）为流感流行的高峰期，多以散发病例存在，每年流行优势毒株有所不同。     

宜昌市流行性感冒监测结果分析

流行性感冒是由流感病毒引起的一种急性呼吸道传染病,主要通过空气飞沫传播,经常在世界范围内流行,严重危害人类健康。由于流感病毒易发生变异。世界卫生组织（WHO）将其列为垒球范围内监测的重点疾病之一。2004年以来,在湖北省疾病预防控制中心指导下,宜昌市在城区开展了综合医院流感样病例及上呼吸道疫情的监测工作。现报道如下。     

Influenza vaccine effectiveness among elderly persons living in the community during the 2003--2004 season

To examine the effectiveness of influenza vaccine among community-dwelling elderly (65-79 years old), we conducted a population-based cohort study during the 2003--2004 influenza season. A total of 4787 elderly individuals were interviewed regarding acute febrile illness, hospital visits, hospitalization and death by telephone every month. The vaccination status and physician-diagnosed clinical influenza (hereinafter referred as clinical influenza) were determined based on data obtained from the city office and hospitals, respectively. After adjusting for confounders, the odds ratio (OR) of vaccination for influenza-like illness (ILI) with high-fever, which was defined as an acute febrile illness (> or =38.5 degrees C) during the epidemic period, was 0.38 (95% confidence interval [CI], 0.17-0.85) and the OR for clinical influenza was 0.76 (95%CI, 0.28-2.06). Due to the inadequate sample size, ORs for preventing hospitalization for influenza or pneumonia (OR, 0.37; 95%CI, 0.09-1.47) and death (OR, 3.68; 95%CI, 0.75-18.12) were not conclusive. These results suggested that vaccination was therefore effective for elderly persons living in the community.     

Influenza surveillance in Victoria, 2005

Influenza activity remained within normal seasonal activity with a well-defined peak at week 29 (beginning 18 July) during the Victorian influenza season from May to September 2005. Surveillance was based on sentinel general practice influenza-like illness (ILI) notifications with laboratory confirmation, medical locum service ILI notifications and laboratory notification of influenza detections. One thousand and eighty-seven consultations for ILI were reported from 38 general practices, while medical practitioners from the locum service reported 317 consultations for ILI. The average weekly rate of ILI from sentinel surveillance was 7.3 per 1,000 consultations. Similar numbers of influenza A subtypes H1N1 and H3N2 were detected; 45 per cent of which were A/California/7/2004-like (H3), 44 per cent were A/New Caledonia/20/99-like (H1) and 11 per cent were A/Wellington/1/2004 (H3). Of the influenza B samples, 67 per cent were B/Hong Kong/330/2001-like and 33 per cent were B/Shanghai/361/2002-like. The influenza vaccine for 2005 contained: A/New Caledonia/20/99(H1N1)-like virus, A/Wellington/ 1/2004(H3N2)-like virus, and B/Shanghai/361/2002-like virus. Although the predominant H3 and B circulating strains were not included in the vaccine, there was reasonable serological cross protection between vaccine and circulating strains.     

Influenza surveillance in Victoria, 2004.

Influenza activity during the traditional Victorian influenza season from May to October 2004 was low with no well-defined peak. Surveillance was based on sentinel general practice influenza-like illness (ILI) notification with laboratory confirmation, locum service ILI notification and laboratory reporting of influenza detections. Eight hundred and fifteen consultations for ILI were reported from 38 general practices and 216 consultations for ILI were reported from the locum service. The average weekly rate of influenza-like-illness from sentinel surveillance was 5.4 cases per 1,000 consultations, representing normal seasonal activity. Influenza A (H3N2) was the predominant circulating sub-type, 88 per cent of which were identified as A/Fujian/411/2002-like and 12 per cent as A/Wellington/1/2004. All influenza B was B/Shanghai/361/2002-like. There was some mismatch with the 2004 influenza vaccine, which contained A/New Caledonia/20/99(H1N1)-like virus, A/Fujian/411/2002(H3N2)-like virus, and B/Hong Kong/330/2001-like virus.     

Cervical cancer incidence and mortality in the best and worst of worlds

BACKGROUND: Globally speaking, cervical cancer is a common cause of death. The cancer is caused by a human papillomavirus (HPV) infection, and hence is preventable. Pap smear screening allows for the early detection of precancerous lesions that are easily treated in a pre-invasive phase of the disease. New tests and treatment methods have the overall aim of lowering cervix cancer incidence and death. However, whether a woman will or will not develop cervix cancer depends on a complex number of interacting variables. AIM: The aim of the present study was to identify factors that might have an impact on cervix cancer incidence and mortality, and rank them according to the weight of their relative influence. METHODS: By using a forecasting model called the scenario method, factors were identified that could have an impact on cervix cancer development, and their relative importance was ranked by using a special matrix. The figures given for each factor were summed and presented in a System Grid, which made it possible to determine the most important variable. RESULTS: The cultural structure of the female population, as well as women's habits and behaviour, all seem to be more important factors than the Pap smear test or the treatment in relation to cervical cancer incidence and mortality. CONCLUSION: In the endeavour to prevent cervical cancer one must consider the whole chain of events, i.e. population-tests-treatment-outcome. New and improved test methods and treatment procedures are of little use if women refrain from coming for a test when called.     

Annual report of the National Influenza Surveillance Scheme, 2005

Surveillance of influenza in Australia is based on laboratory isolation of influenza viruses, sentinel general-practitioner reports of influenza-like illness, and absenteeism data from a major national employer. In 2005, 4,575 cases of laboratory-confirmed influenza-like illness were reported, which was 115 per cent higher than in 2004. The influenza season started in the first week of June, with peak activity in early August, a month earlier than in 2004. Influenza A was the predominant type notified (73%), while influenza B activity continued to increase compared to previous years. During 2005, the influenza notification rate amongst persons aged over 65 years (22 cases per 100,000 population) was 70 per cent higher than the mean rate of the last four years. One thousand one hundred and seventy-four influenza isolates from Australia were antigenically analysed: 689 were A(H3N2), 210 were A(H1N1) strains and 275 were influenza B viruses. Continued antigenic drift was seen with the A(H3N2) viruses from the previous reference strains with approximately one quarter of isolates being distinguishable from A/Wellington/1/2004-like viruses and more closely matched to A/California/7/2004-like viruses.