城乡医务人员HIV／AIDS职业暴露防护知识调查分析

目的了解城乡医务人员HIV／AIDS职业暴露和防护知识的知晓情况，为防护知识培训提供依据。方法自行设计问卷对湖北省某县7个乡镇及某市的医务人员338名（乡镇180名、城市158名）进行HIV／AIDS职业暴露及防护知识调查。结果城乡医务人员对HIV／AIDS职业暴露及防护知识的知晓率偏低；乡镇医务人员在部分防护能力及暴露后的应对知识方面与城市医务人员比较，差异有显著性意义（P〈0．05，P〈0．01）。结论加强城乡医务人员HIV／ALDS职业暴露及防护知识的培训，扩展乡镇医务人员培训面，以提高基层卫生工作者HIV／AIDS职业暴露的防护能力和暴露后的及时应对，减少HIV／AIDS感染的发生是目前迫切的任务。     

微视频结合微信平台用于基层医院护士HIV/AIDS知识培训

目的探讨提高基层医院护士HIV/AIDS职业防护水平的培训方式。方法设计微课程教学并搭建微信交流平台,对295名基层医院护士进行HIV/AIDS知识与防护行为培训,培训6周后,对同一目标人群追踪调查,并评价干预效果。结果培训后护士HIV/AIDS相关知识与职业防护行为评分显著高于培训前(均P0.01)。结论微视频结合微信平台用于基层医院护士HIV/AIDS知识培训,可提高其HIV/AIDS相关知识和防护行为依从性。     

人类免疫缺陷病毒感染/获得性免疫缺陷综合征合并脊柱疾患外科治疗与职业暴露防护策略

目的探讨人类免疫缺陷病毒感染/获得性免疫缺陷综合征(HIV/AIDS)合并脊柱外科疾患围手术期手术治疗与医务人员职业暴露及防护应对措施。 方法回顾性分析2010年1月至2016年2月首都医科大学附属北京地坛医院收治的需脊柱外科手术治疗的HIV/AIDS患者共56例,其中行颈椎手术者14例,腰椎手术者24例,胸椎手术者10例,椎间盘镜手术者8例。其中有36例脊柱手术围手术期应用数字骨科导航技术。监测入组HIV/AIDS患者行脊柱外科手术过程中医务人员发生职业暴露次数、方式、部位和暴露级别;总结暴露后应对措施及暴露后感染情况。 结果医务人员发生一级暴露者20例,二级暴露者2例,三级暴露者3例。暴露方式和部位主要以术中针刺伤、黏膜溅染为主,双手是职业暴露发生的主要部位15例(60%),其次是黏膜喷溅6例次(24%);左手发生直接暴露者11例(44%)、右手暴露者4例(16%),但差异无统计学意义(χ²= 0.68、P= 0.56);各手指部位暴露统计：食指(20%)>拇指(16%)>手掌(12%)>手背(8%)>中指(4%)。经严格按照职业暴露后预防处理原则,无1例医务人员发生HIV感染。 结论HIV/AIDS患者脊柱外科手术中职业暴露风险不容忽视,围手术期应在遵循骨科手术基本原则的前提下,利用数字骨科导航技术,实施精准定位微创小切口手术,严格执行预防职业暴露相关防护规范化流程,可有效避免医务人员发生职业暴露及暴露后感染。     

HIV/AIDS患者骨科术式、操作方法及防护策略探讨

目的探讨HIV/AIDS患者骨科手术方式、操作方法及防护策略,减少手术对机体功能的干扰,降低医务人员发生职业暴露的风险。方法收集2011年9月至2016年11月广州市第八人民医院收治的110例(112次)HIV/AIDS骨科手术患者的临床资料,总结其骨科术式、操作方法及防护策略,观察患者术后HIV/AIDS疾病进展、疼痛症状改善及骨科病情恢复状况,记录术后并发症及医务人员职业暴露发生情况。结果骨科手术术程顺利,术后未有切口感染,也未出现机会性感染和/或恶性肿瘤加重扩散及脏器功能障碍改变,未有医务人员发生职业暴露,术后视觉模拟量表评分较术前明显改善(P0.05),随访结果表明骨科病情预后良好。结论通过做好术前准备和评估,遵循精准定位、微创切口、规范化操作的手术原则,强调手术操作习惯的改变以及建立职业暴露防护措施,HIV/AIDS骨科手术患者可获得满意的临床疗效,同时起到减少手术并发症、降低职业暴露发生率的作用。     

TOT模式在新疆护理人员艾滋病知识培训中的应用

目的提高新疆护理人员艾滋病防护知识。方法采用TOT培训模式对新疆艾滋病重点疫区20所医院的护理人员进行艾滋病相关知识培训。结果培训后护理人员艾滋病知识知晓率、对HIV／AIDS患者接纳率、防护HIV职业暴露正性行为采用率显著高于培训前（均P〈0．01）。结论TOT模式是一种有效的健康教育手段,可提高护理人员的艾滋病知识认知率,减少对艾滋病患者的歧视态度,规范了护理人员的职业防护行为。     

普通病房护士HIV职业暴露及其防护行为调查

目的调查普通病房护士HIV职业暴露现状及其防护行为,为采取针对性措施预防HIV职业暴露提供参考。方法选择江西省3所三级甲等综合性医院163名呼吸科和急诊科在职注册护士进行调查,收集护士HIV职业暴露相关信息。结果护理人员职业暴露发生率为29.4%,88.3%接受过职业危害培训。职业暴露后仅37.5%接受检查,16.7%使用病毒阻断药物治疗。HIV职业暴露后27.1%不会评估暴露情况,89.6%的护理人员没有暴露后的随访。结论普通病房护理人员发生HIV职业暴露的概率较高,但护理人员自我防护意识较弱,发生职业暴露后处理不到位。管理者应加大防护设施投入,对普通病房护士进行定期、系统、规范的职业暴露相关知识培训。     

普通病房护士HIV职业暴露及其防护行为调查

目的调查普通病房护士HIV职业暴露现状及其防护行为,为采取针对性措施预防HIV职业暴露提供参考。方法选择江西省3所三级甲等综合性医院163名呼吸科和急诊科在职注册护士进行调查,收集护士HIV职业暴露相关信息。结果护理人员职业暴露发生率为29．4％,88．3％接受过职业危害培训。职业暴露后仅37．5％接受检查,16．7％使用病毒阻断药物治疗。HIV职业暴露后27．1％不会评估暴露情况,89．6％的护理人员没有暴露后的随访。结论普通病房护理人员发生HIV职业暴露的概率较高,但护理人员自我防护意识较弱,发生职业暴露后处理不到位。管理者应加大防护设施投入,对普通病房护士进行定期、系统、规范的职业暴露相关知识培训。     

HIV感染者骨科手术中医务人员职业暴露和防护?

目的探讨骨科人类免疫缺陷病毒(HIV)感染者围手术期应用预防职业暴露相关防护规范化流程对医务人员减少职业暴露的作用。方法回顾性分析2010年1月至2015年2月首都医科大学附属北京地坛医院收治的需行骨科手术治疗的HIV感染者共66例,其中给予切开复位钢板螺钉内固定术42例,脊柱椎间融合内固定术11例,关节置换术9例,带锁髓内钉固定术4例。术中精细操作、规范手术操作流程;严格执行预防职业暴露相关防护规范化流程。监测2010至2015年骨科手术医务人员发生职业暴露38例/次。结果医务人员发生一级暴露24例,二级暴露9例,三级暴露5例。经严格按照职业暴露后预防处理原则,无1例医务人员发生HIV感染。结论围手术期严格执行职业暴露相关防护规范化流程可以有效避免医务人员职业暴露后的感染。     

ICU医护人员艾滋病职业暴露的预防干预研究

目的探讨重症监护病房（ICU）内人类免疫缺陷病毒（HIV）职业暴露的原因和综合预防干预的疗效。方法选择2009年1月至2010年12月本院ICU发生HIV职业暴露的患者为对照组（25例）,自2011年1月至2012年12月采用综合预防干预措施的患者作为干预组（53例）。对照组采用口罩、手套、隔离服等防护措施;综合干预组在对照组防护措施的基础上,采取AIDS患者进入ICU后常规在日间放置深静脉置管、动脉置管、密闭式吸痰管和防护面罩,由高年资、心理素质好的医护人员进行有创操作等综合预防措施。比较两组HIV职业暴露人数/收治获得性免疫缺陷综合征（AIDS）病例数比值的差异。结果 4年间本院ICU共收治AIDS危重患者78例,发生HIV职业暴露共7例,采取综合干预措施使HIV职业暴露人数/收治AIDS病例数的比值由20%减低至4%（χ^2=13.2,P〈0.05）。结论 ICU内收治AIDS患者发生HIV职业暴露的风险较高,采取综合干预措施能够降低ICU内HIV职业暴露的风险。     

实习护生职业防护知识的培训

目的 评估实习护生职业防护知识与技能培训的效果.方法 实习前护理部分别对全院带教教师及护生进行职业防护知识及14项常见技能示范培训,实习中期自制调查表采用方便抽样法对122名护生及26名临床带教教师进行跟踪调查,分析影响知识掌握的主观、客观因素.结果 不同学历护生在防护用具使用、接触体液戴手套、处理针头、处理锐器、操作前后手卫生、手受伤是否戴手套等6项职业防护知识方面存在统计学差异(P<0.05,P<0.01);护生与带教教师在护生自身知识缺乏、没有进行相关培训、防护评估不到位及医院防护用具未配备4项上存在统计学差异(P<0.05,P<0.01);带教教师对护生职业防护知识培训结果最差的2项为护生发生职业伤害后上报记录的完整性和发现护生发生职业伤害的及时性.结论 护生对职业危害有一定的认识,但重视程度不够,实习中带教教师应不断强化对护生职业防护知识及操作技能培训.     

HIV/AIDS prevalence among South African health workers.

INTRODUCTION: Studies on HIV prevalence among health workers usually focus on occupational exposure to HIV. Little is known about HIV prevalence in this group. However, it is expected that HIV prevalence among health workers will reflect prevalence in their society. OBJECTIVE: To determine HIV prevalence among South African health workers. METHOD: A stratified cluster sample was drawn of 5% of health facilities in South Africa (N = 222) representative of the public and private health sectors in South Africa. The sample was designed to obtain a nationwide representative sample of medical professionals and non-professional health workers. A subsample comprising health workers in four provinces was tested for HIV status. The Orasure HIV-1 device in combination with the Vironostika HIV UNI-Form II plus O enzyme-linked immunosorbent assay (ELISA) kits were used to collect oral fluid specimens for HIV testing. RESULTS: Based on a sample of 721 health workers and a response rate of 82.5% (or 595 respondents), the study found that an estimated 15.7% (95% confidence interval (CI): 12.2-19.9%) of health workers employed in the public and private health facilities located in four South African provinces, were living with HIV/AIDS in 2002. Among younger health workers, the risk is much higher. This group (aged 18-35 years) had an estimated HIV prevalence of 20% (95% CI: 14.1-27.6%). Non-professionals had an HIV prevalence of 20.3%, while professionals had a prevalence of 13.7%. CONCLUSION: HIV prevalence among health workers in South Africa is high; this calls for the introduction of antiretroviral programmes targeting them. In addition, there is a need for the development of new policy regarding placement of infected health workers in tuberculosis (TB) wards, coupled with vigorous human resource planning to replace the health workers likely to die from AIDS. Infection control procedures also need to be reviewed.     

赴利比里亚维和中国军人的艾滋病认知程度调查及相关健康教育课的效果分析

目的:为保证维和任务的顺利完成,调查分析赴利比里亚维和的中国军人对艾滋病的认知程度,并进行有针对性的艾滋病知识的健康教育,同时评价健康教育对提高军人的艾滋病防治知识水平的效果。方法:运用在WHO推荐的知、信、行调查问卷基础上修改编写而成的问卷,对528名赴利比里亚维和军人在教育前后分别进行1次艾滋病相关知识和对艾滋病态度的调查,并比较教育前后的结果。结果:教育前调查对象对艾滋病的认知有较大的欠缺,教育后对艾滋病的认知和态度有明显进步,前后比较差异有显著性(P<0.01)。结论:中国赴利比里亚维和军人对艾滋病的认知有欠缺;艾滋病知识健康教育能明显提高维和军人对艾滋病相关知识的掌握,对完成维和任务非常必要。     

Sexual behaviour and knowledge of AIDS among urban black mothers. Implications for AIDS intervention programmes

Questionnaires were administered to 122 urban black mothers of teenagers in order to: (i) understand aspects of their sexual behaviour and knowledge of the acquired immunodeficiency syndrome (AIDS); and (ii) assess their communication with their teenage children with regard to AIDS and sexual behaviour. The subjects comprised a 12.5% random sample of all houses in Lamontville, a black township south of Durban. The level of AIDS knowledge among mothers was high, while their sexual behaviour, characterised by a high pregnancy rate and a high proportion who have had children by more than one consort, placed them at high risk of acquiring human immunodeficiency virus (HIV) infection. No mother had experienced sexual intercourse during which her partner used a condom. Communication with their teenage children was poor; none of the mothers had spoken with them about AIDS and 89.3% had not discussed contraceptive methods with their teenage children. We found that urban black mothers were at high risk of acquiring HIV and, despite their knowledge of the modes of transmission and prevention of HIV infection, they had not begun using condoms as a risk-reducing measure, nor had they communicated the risk of unprotected sex to their teenage children. We recommend that AIDS intervention strategies should not concentrate only on passing on knowledge but also on providing women with the communication skills to negotiate the use of condoms with their partners and to convey the risk of HIV infection to their teenage children.     

Concerns,attitudes, and practices of orthopaedic surgeons towards management of patients with HIV/AIDS in Nigeria

The increasing number of people living with HIV/AIDS is causing concern among surgeons over risk of occupationally acquired HIV infection. This may influence their attitude to such patients. The purpose of this study was to develop a cross-sectional survey of orthopaedic surgeons to assess their concerns, attitudes, and practices towards management of HIV-positive patients in Nigeria. All respondents were males, 55 (73.3%) of them indicated concern over the risk of occupational acquisition of HIV infection and 37 (49.3%) had examined or operated on at least one HIV/AIDS patient. Sixty (79.9%) were willing to be tested for HIV and 51 (67.9%) were previously tested. Fifty-seven (75.9%) would order preoperative HIV screening of high risk patients, and 67 (89.3%) would operate on HIV-positive patients. Most orthopaedic surgeons in Nigeria would operate on HIV-positive patients.     

Assessment of comprehensive HIV/AIDS knowledge level among in-school adolescents in eastern Ethiopia

Introduction

In Ethiopia, more adolescents are in school today than ever before; however, there are no studies that have assessed their comprehensive knowledge of HIV/AIDS. Thus, this study tried to assess the level of this knowledge and the factors associated with it among in-school adolescents in eastern Ethiopia.

Methods

A cross-sectional school-based study was conducted using a facilitator-guided self-administered questionnaire. The respondents were students attending regular school in 14 high schools located in 14 different districts in eastern Ethiopia. The proportion of in-school adolescents with comprehensive HIV/AIDS knowledge was computed and compared by sex. The factors that were associated with the comprehensive HIV/AIDS knowledge were assessed using bivariate and multivariable logistic regression.

Results

Only about one in four, 677 (24.5%), in-school adolescents have comprehensive HIV/AIDS knowledge. The knowledge was better among in-school adolescents from families with a relatively middle or high wealth index (adjusted OR [95% CI]=1.39 [1.03–1.87] and 1.75 [1.24–2.48], respectively), who got HIV/AIDS information mainly from friends or mass media (adjusted OR [95% CI]=1.63 [1.17–2.27] and 1.55 [1.14–2.11], respectively) and who received education on HIV/AIDS and sexual matters at school (adjusted OR [95% CI]=1.59 [1.22–2.08]). The females were less likely to have comprehensive HIV/AIDS knowledge compared to males (adjusted OR and [95% CI]=0.60 [0.49–0.75]).

Conclusions

In general, only about a quarter of in-school adolescents had comprehensive HIV/AIDS knowledge. Although the female adolescents are highly vulnerable to HIV infection and its effects, they were by far less likely to have comprehensive HIV/AIDS knowledge. HIV/AIDS information, education and communication activities need to be intensified in high schools.     

Survey of knowledge and attitude about AIDS among six areas

<正> Objective:To explore the circumstances,influencing factors,and the extent of discrimina-tion and prejudice towards AIDS.Methods:This is a cross-sectional study.One county from each of the six provinces was se-lected.800 respondents were then chosen from each province through cluster sampling.A closed-ended questionnaire was used to study the demographic characteristics,AIDS knowledge,and re-lated attitudes towards AIDS.Results:In this survey,3,095 respondents(64.5%)feared AIDS;66.5% of respondentsthought AIDS patients or HIV infectors should be treated separately;40.1% of respondentsthought that AIDS patients or HIV carriers should have been confined in freedom;and 1,497 re-spondents(31.2%)said that they were not willing to donate to AIDS patients.Discrimination andprejudice towards AIDS among the six regions were different partially(P<0.01).Conclusion:Discrimination and prejudice commonly occur.Gender,characteristics of theregistered residence,educational level,and knowledge about AIDS are the main factors related todiscrimination and prejudice.Many respondents had prejudice against AIDS,because they werelacking correct knowledge about the transmission ways of AIDS.Among the six regions,discrim-ination and prejudice were lowest in a region in Henan province and highest in Jiangsu province.     

Screening and management of mental health and substance use disorders in HIV treatment settings in low‐ and middle‐income countries within the global IeDEA consortium

Introduction

Integration of services to screen and manage mental health and substance use disorders (MSDs) into HIV care settings has been identified as a promising strategy to improve mental health and HIV treatment outcomes among people living with HIV/AIDS (PLWHA) in low‐ and middle‐income countries (LMICs). Data on the extent to which HIV treatment sites in LMICs screen and manage MSDs are limited. The objective of this study was to assess practices for screening and treatment of MSDs at HIV clinics in LMICs participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.

Methods

We surveyed a stratified random sample of 95 HIV clinics in 29 LMICs in the Caribbean, Central and South America, Asia‐Pacific and sub‐Saharan Africa. The survey captured information onsite characteristics and screening and treatment practices for depression, post‐traumatic stress disorder (PTSD), substance use disorders (SUDs) and other mental health disorders.

Results

Most sites (n = 76, 80%) were in urban areas. Mental health screening varied by disorder: 57% of sites surveyed screened for depression, 19% for PTSD, 55% for SUDs and 29% for other mental health disorders. Depression, PTSD, SUDs and other mental health disorders were reported as managed on site (having services provided at the HIV clinic or same health facility) at 70%, 51%, 41% and 47% of sites respectively. Combined availability of screening and on‐site management of depression, PTSD, and SUDs, and other mental health disorders was reported by 42%, 14%, 26% and 19% of sites, respectively. On‐site management of depression and PTSD was reported significantly less often in rural as compared to urban settings (depression: 33% and 78% respectively; PTSD: 24% and 58% respectively). Screening for depression and SUDs was least commonly reported by HIV programmes that treated only children as compared to HIV programmes that treated only adults or treated both adults and children.

Conclusions

Significant gaps exist in the management of MSDs in HIV care settings in LMICs, particularly in rural settings. Identification and evaluation of optimal implementation strategies to scale and sustain integrated MSDs and HIV care is needed.