Summary of New Guidance on Selected Immunizations

In 2022, the Centers for Disease Control and Prevention (CDC) updated its Adult Immunization Schedule Recommendations for Ages 19 Years or Older to provide the most current evidence-based recommendations following comprehensive reviews of data related to vaccines. In its report, the CDC highlighted the importance of health care professionals staying up to date on the latest evidence. During the novel coronavirus pandemic, the ability to provide routine vaccinations to the adult population was limited and even halted at times. As in-person health care visits continue to resume, it is imperative for nurses to refocus on and be familiar with the most up-to-date vaccine recommendations. Here, we summarize information on vaccine guidelines, safety, and special considerations for women, and we highlight changes to the 2022 adult immunization schedule. Keeping individuals free of vaccine-preventable diseases is one of the most effective and important public health interventions in health care.     

Herpes Zoster Meningitis in a Young,Immunocompetent Adult

BackgroundVaricella-zoster virus is typically encountered in the emergency department (ED) in two forms: varicella (chickenpox) in children and zoster (shingles) in older adults. Zoster is infrequently encountered in young, healthy adults, and neurological complications are extremely rare.Case ReportWe describe a case of a previously healthy 36-year-old woman who presented to the ED with fever, nuchal rigidity, and headache 4 days after being diagnosed with herpes zoster and started on oral valacyclovir. Lumbar puncture confirmed herpes zoster meningitis. Despite initiation of antivirals within 48 h of symptom onset, progression to zoster meningitis occurred.Why Should an Emergency Physician Be Aware of This?Emergency physicians must be aware that neurological complications of varicella zoster can develop despite initiation of oral antivirals. These patients must be identified in the ED, as admission for intravenous antivirals is indicated.     

Myths and Misconceptions: Varicella-Zoster Virus Exposure,Infection Risks,Complications, and Treatments

Varicella zoster and herpes zoster are infections caused by the highly contagious varicella-zoster virus (VZV). Despite widespread availability of vaccines against VZV, as well as varicella vaccination rates >95%, VZV remains a public health concern because of several common myths and misconceptions. Because of the success of routine varicella vaccination programs, some people mistakenly believe that varicella and herpes zoster are now no longer a threat to public health. Another common misconception is that shingles is less infectious than varicella; however, clinical evidence indicates otherwise. Several knowledge gaps exist around VZV transmission and the availability and use of varicella zoster immune globulin (human) for postexposure prophylaxis against VZV. To help reduce the incidence of severe disease in high-risk individuals (eg, elderly people, pregnant women, unvaccinated persons, infants, and immunocompromised children and adults), this article addresses misbeliefs and broadens awareness of VZV exposure, infection risks, complications, and treatments.     

Primary Care Updates in Human Papillomavirus-Associated Oropharyngeal Cancers

Human papillomavirus-associated oropharyngeal cancers (HPV-OPCs) are a major health problem globally. Trends indicate increasing incidence of HPV-OPCs. Vaccination allows opportunities to prevent HPV-OPC and other HPV-associated cancers. However, US vaccination rates are very low. Those diagnosed and treated for HPV-OPC have long-term effects impacting the rest of their lives. This article will focus on HPV-OPC trends and major staging classification changes, reviews treatment modalities and survivorship issues, and will discuss primary prevention to impact the incidence of HPV-OPCs.     

36例成人散发急性乙型肝炎伴脂肪性肝病临床分析

目的分析成人散发急性乙型肝炎（AHB）伴脂肪性肝病（FLD）患者的生化学及病毒学特点,探讨影响其预后的可能因素。方法以236例成人AHB伴FLD患者为观察组,33例成人AHB不伴FLD患者为对照组,比较两组间在生化指标、病毒学指标及其转归方面有无差异。结果合并有FLD的AHB患者较不合并FLD的AHB患者入院时HBV DNA阴转率低,HBsAg定量、HBV DNA定量值高,阴转时间长,差异有统计学意义;患者生化指标及复常时间、HBeAg定量及阴转时间的差异无统计学意义。结论合并有FLD的AHB患者较不合并FLD的AHB患者不利于HBV的清除。     

连续健康教育对慢性乙型病毒性肝炎患者家属的影响

目的探讨连续健康教育对慢性乙型病毒性肝炎（简称乙肝）患者的家属的知识水平、健康行为、焦虑、抑郁、生活质量和肝功能等方面的影响以及在预防慢性乙肝家庭传播中的作用。方法将101例慢性乙肝患者的家属按随机数字表法分为试验组（51例）和对照组（50例）。对照组给予常规护理教育;试验组在常规护理的基础上采用连续健康教育（疾病相关知识的宣教、生活方式和行为习惯与疾病的关系、生活方式和行为习惯在预防疾病中的作用、如何正确认识疾病、饮食在疾病治疗中的作用以及如何运动等）。试验开始及结束后采用乙肝相关知识测试表（SAS、SDS、SF-36评分表）对2组患者家属进行测试,并对结果进行比较。结果 2组患者家属干预6个月后慢性乙肝知识得分均高于干预前（P〈0.05）,但试验组知识得分均明显高于对照组（P〈0.05）。试验组干预6个月后SAS、SDS评分较干预前明显下降（P〈0.05）,而对照组干预前与干预6个月后SAS、SDS评分比较差异均无统计学意义（均P〉0.05）。结论对慢性乙肝患者的家属实施连续健康教育,能够提高慢性乙肝患者家属对乙肝知识的认知水平及生活质量水平,降低家属的焦虑和抑郁水平;连续健康教育是促进家属肝功能稳定的一个重要因素。     

慢性乙肝患者行为特征与心理健康状况的相关性分析

目的对慢性乙肝患者的行为特征和心理健康状况进行分析,探讨二者的相关性,并分析慢性乙肝患者行为特征对其心理健康状况的影响,为临床慢性乙肝患者的心理健康干预提供参考。方法以我院2010年10月至2011年10月216例慢性乙肝患者作为研究对象,对其采用临床精神卫生症状自评量表（SCL-90）和艾森克人格问卷（EPQ）进行调查评估。分析慢性乙肝患者行为特征与心理健康状况之间的相关性以及行为特征对心理健康的影响情况。结果216例慢性乙肝患者SCL-90评分结果显示,其总分明显高于常模;EPQ评分结果显示,患者的神经质或情绪稳定性、人格稳定性评分均明显高于常模,而精神质评分明显低于常模;对SCL-90量表中的9个项目与EPQ量表中的4个项目进行相关性分析发现,内向-外向与强迫、抑郁、焦虑、恐惧、偏执5个因子呈显著正相关;神经质或情绪稳定性与强迫、人际关系敏感、偏执、精神病肚4个因子呈显著正相关。结论慢性乙肝患者的行为特征与其D理健康状况具有相关性,行为特征发生变化,心理健康状况也发生相应变化。     

Improving Human Papillomavirus Vaccine Uptake in the Family Practice Setting

Low uptake of the human papillomavirus (HPV) vaccine is a challenging problem in the primary care setting. Interventions are needed to dispel barriers, improve patient education, and increase provider recommendation. The purpose of this quality improvement project was to evaluate the use of a provider-based intervention to help meet this challenge. A survey was used to assess for changes in HPV knowledge, perceived barriers, and vaccine recommendations. The results showed 12% improvement in HPV knowledge and a decrease in perceived provider/system barriers; there was no significant change in recommendations shown. An upward trend in vaccine initiation and completion was appreciated.     

Abdominal Compartment Syndrome in Adult Trauma Patients

Abdominal compartment syndrome is often easily overlooked while an adult trauma patient is being stabilized. It demands meticulous physical examination by the provider. The patient’s mortality rate is determined by the severity and time of the symptoms recognized by the provider. Intra-abdominal hypertension (measured by intra-abdominal pressure) and abdominal compartment syndrome are established causes of death among critically ill patients. Therefore, recognizing early signs and symptoms in an adult trauma patient can aid the provider in deciding the appropriate course of treatment, ultimately evading the life-threatening decompressive laparotomy.     

乙肝相关性肝病患者幽门螺杆菌感染的研究

目的研究慢性乙型肝炎(乙肝)、乙肝肝硬化、乙肝后肝癌等肝病患者幽门螺杆菌(Hp)感染情况。方法收集慢性乙肝、乙肝肝硬化、乙肝后肝癌等肝脏疾病患者273例,日期正常体检人群60例,采用免疫层析法检测患者血清中抗Hp抗体(Hp-IgG),定量PCR检测HBV DNA。结果乙肝相关性肝病患者Hp感染率73.3%,正常体检人群为40.0%,2组比较差异有统计学意义(P<0.01);慢性乙肝、乙肝肝硬化、乙肝后肝癌3组患者Hp感染率分别为62.7%、77.0%、79.7%,后二者Hp明显高于慢性乙肝患者(P<0.05);按病毒载量分级,HBV DNA阴性组Hp感染率低于HBV DNA阳性组,而阳性组按低、中、高分组,各组间Hp感染率分别为69.4%、65.0%、66.1%(P>0.05);乙肝肝硬化患者按Child-push分级后,A、B、C各级之间的Hp感染率分别为51.9%、63.4%、65.6%(P>0.05)。结论 Hp感染可能参与乙肝肝病患者肝脏损伤,显示Hp具有肝细胞毒性作用;肝硬化、肝癌感染率高于慢性乙型肝炎,提示Hp感染与慢性肝病疾病进展和肝癌的发生有一定相关性。     

慢性乙型肝炎患者健康教育需求调查分析

目的：为了解慢性乙型肝炎患者对乙肝相关知识的了解程度,对健康教育内容和方式的需求,为临床实施健康教育提供依据。方法：采用问卷调查方式,问卷为自行设计,经反复修改,并行预调查,证明可行。发出调查问卷141份,收回113份,回收率80.1%.由专职护士在统一指导语下先对患者作必要的解释,然后由患者独立完成问卷;将资料量化后输入计算机,数据用统计软件SPSS11.0处理,问卷总分用x-±s进行t检验。结果：从113例慢性乙肝患者问卷平均得分为（11.54±2.65）,基本达到及格要求,反映出患者有一定的健康信息储量,但缺乏较深层次的健康知识指导;慢性乙肝患者对乙肝相关知识的了解情况与文化程度及病程长短相关;对能解决实际问题的教育内容需求较多,最受欢迎的健康教育方式为发放健康手册,一病一卡（建立患者档案,医护定时上门）。结论：慢性乙肝患者有一定的健康信息储量,但不全面;患者对健康教育有较强的需求愿望;患者受着不同程度的心理压力,且知行未完全合一;因此,对慢性乙型肝炎患者的健康教育需加强知识的深度和广度,重视教育内容和方式的有机结合,还要加强对慢性乙肝患者的心理疏导,情感支持,也是至关重要的。     

Preparedness for short‐term isolation among Queensland residents: Implications for pandemic and disaster planning

Objective: Short‐term isolation might occur during pandemic disease or natural disasters. We sought to measure preparedness for short‐term isolation in an Australian state during pandemic (H1N1) 2009. Methods: Data were collected as part of the Queensland Social Survey (QSS) 2009. Two questions related to preparedness for 3 days of isolation were incorporated into QSS 2009. Associations between demographic variables and preparedness were analysed using χ², with P < 0.05 considered statistically significant. Results: Most respondents (93.6%; confidence interval [CI] 92.2–94.9%) would have enough food to last 3 days, but only 53.6% (CI 50.9–56.4%) would have sufficient food and potable water if isolated for 3 days with an interruption in utility services. Subpopulations that were less likely to have sufficient food and potable water reserves for 3 days' isolation without utility services included single people, households with children under 18 years of age, people living in South‐East Queensland or urban areas, those with higher levels of education and people employed in health or community service occupations. Conclusions: The majority of Queensland's population consider themselves to have sufficient food supplies to cope with isolation for a period of 3 days. Far fewer would have sufficient reserves if they were isolated for a similar period with an interruption in utility services. The lower level of preparedness among health and community service workers has implications for maintaining the continuity of health services.     

我镇成人大规模免疫乙肝疫苗的无应答状况及影响因素分析

目的探讨自然人群中成人接种重组乙肝疫苗后无应答者分布状况和影响因素。方法对我镇21,699名16岁以上成人按0、1、6方案接种10μg乙肝疫苗后进行免疫学检测,描述无应答的分布并分析影响因素。结果成人全程接种重组乙肝疫苗第三针后1个月,总抗体保护性阳转率97．23％,无应答率2．77％,16—49岁人群无应答率低于50岁以上人群。影响因素分析表明年龄越大抗体保护性阳转率越低（P〈0．01）,无应答率越高,男性无应答率高于女性（P〈0．05）。结论成人全程接种10μg重组乙肝疫苗免疫效果较好,无应答率较低,50岁以上男性无应答率较高。     

慢性乙型病毒性肝炎患者生活方式依从性现状

目的了解慢性乙型病毒性肝炎(chronic hepatitis B,CHB)患者依从性现状,分析目前存在的主要问题,为今后护理工作提供科学依据。方法对104例住院CHB患者生活方式依从性进行问卷调查。结果生活方式依从性总体得分为(6.76±1.24)分,其中生活隔离、戒酒的依从性得分较高,合理运动的依从性得分最低。结论CHB患者的生活方式总体依从性不佳,合理运动的依从性应引起更多关注。     

反向斑点杂交技术应用于青少年女性HPV感染检测的研究

目的利用反向斑点杂交技术检测青少年女性的人乳头状瘤病毒(HPV)的感染情况并进行型别分析,为该类人群的HPV感染情况提供流行病学数据。方法应用PCR-反向斑点杂交(RDB)法对85例青少年女性进行23种HPV亚型检测(低危型为HPV6、11、42、43、45和高危型为HPV16、18、31、33、35、39、45、51、52、53、56、58、59、66、68、73、83、MM4)。结果 85例样本中,HPV感染者40例,阳性率为47.06%,高危型占感染例数的50.62%,低危型占49.38%,二型或二型以上混合感染占52.5%(21/40)。结论应大力加强青少年女性HPV感染的宣传和筛查力度;反向斑点技术是很好的青少年女性HPV感染的筛查手段。