深圳市预防与控制梅毒母婴传播项目成本效益分析

目的对2005年深圳市预防与控制梅毒母婴传播项目进行成本效益分析,探索适合深圳市情的妊娠梅毒和先天梅毒防治模式。方法运用卫生经济学理论,结合国内外相关研究资料,根据2005年纳入项目干预管治的妊娠梅毒病例数,假设这部分妊娠梅毒病例未接受筛查及治疗,通过比较假设与真实之间的妊娠结局发生情况,对项目进行成本效益分析。结果①2005年项目共投入干预成本522.75万元,其中机构成本239.37万元,占45.79%;个人成本283.38万元,占54.21%。②共挽救4045.86个DALY。③总效益为24549.75万元,其中直接效益为31.11万元,间接效益为24518.64万元;净效益为24027.01万元,成本效益比为1:46.96。结论深圳市预防与控制梅毒母婴传播项目不仅具有巨大的经济效益,还蕴藏着巨大的社会远期效益。     

祥云县世界银行贷款结核病控制项目成本效益分析

[目的]对云南祥云县世界银行贷款结核病控制项目进行成本-效益分析,为卫生管理决策提供参考依据。[方法]对项目实施人员、临床专业人员、项目病人家庭调查,收集各种报表,运用经济学成本-效益理论,分析项目实施效益情况。[结果]结核病控制项目总成本为46731408.75元,其中直接成本596282.75元,占1.28%;总效益为733683105.60元,其中直接效益为2346102.90元,间接效益为731337002.7元。6年来,净效益为686951696.85元。效益成本比为15.69∶1,直接成本效益比为0.25∶1。[结论]结核病控制项目是一个有较低投入,较高产出的疾病防治项目,具有明显的经济社会效益。     

血清固定人群神经梅毒筛查的成本效益分析

目的对深圳市梅毒血清固定人群神经梅毒筛查措施进行成本效益分析,探讨神经梅毒筛查的可行性和推广性,为制定和调整梅毒防控策略提供依据。方法运用卫生经济学统计方法计算2013年在深圳市慢病中心就诊的血清固定人群进行神经梅毒筛查和治疗所消耗的成本及获得的效益,比照患者若未进行筛查和治疗,按神经梅毒自然病程发展,两者所产生的成本和效益进行卫生经济学分析。结果 2013年项目共对61名血清固定患者进行神经梅毒筛查,投入总成本为17.13万元,平均每例投入成本2807.92元,并节省1.95万元/例的治疗成本;共发现6例无症状神经梅毒,避免5例症状性神经梅毒的发生,获得427.61万元经济效益,其中直接经济效益为4.78万元,间接经济效益为422.83万元,净效益为410.48万元,成本效益比为1:24.97。结论血清固定人群的神经梅毒筛查投入成本低,效益显著,适合在全市甚至全国范围内推广,建议对所有血清固定患者行神经梅毒筛查。     

天津市梅毒筛查成本效益分析

目的 了解天津市梅毒筛查项目实施效果,从卫生经济学角度评价天津市梅毒筛查的成本效益,为项目的高质量发展提供科学参考。方法 收集2019年天津市梅毒筛查项目开展情况,结合全国医院病案首页、天津市基本公共卫生服务项目经费核定标准、天津市职工年平均工资、天津市人均地区生产总值、天津市党政机关差旅伙食补助费和市内交通费标准、现场调查及相关文献资料数据,估算天津市梅毒筛查项目的成本和收益,并进行敏感性分析。结果 成本总额为1 093.72万元,其中直接医疗成本为928.91万元,直接非医疗成本为90.15万元,间接成本为74.66万元。效益总额为50 444.36万元,其中避免梅毒配偶间传播效益为12 030.28万元,避免梅毒母婴传播婴儿死亡效益为32 420.88万元,避免梅毒母婴传播婴儿存活效益为5 993.20万元。成本效益比为1∶46.12。结论 天津市梅毒筛查项目具有较高的经济效益,应继续实施和完善该项目,优化服务流程,并强化出生缺陷防治责任落实。     

深圳市艾滋病自愿咨询检测点梅毒综合防控项目的成本效益分析

目的:对深圳市艾滋病自愿咨询检测点梅毒综合防控项目进行成本效益分析,探讨卫生资源使用的合理性及项目的可持续性和推广性,为制定梅毒防控策略提供依据.方法:根据2014年-2018年艾滋病自愿咨询监测点梅毒综合防控项目开展情况,对比假设未开展该项目,咨询者中的梅毒患者按照梅毒自然病程发展,两者所产生的成本和效益,从社会角度对项目进行成本效益分析.结果:①2014-2018年共筛查梅毒96722例,发现梅毒1890例,阳性率1.95％;治疗梅毒1175例,避免二代传播527例,避免三期梅毒385例,避免误诊漏诊265例.②项目总成本1631.31万元,平均筛查成本147.74元、平均治疗成本1722.23元/例;不开展项目时共产生824.70万元成本,梅毒患者成本10270.19元/例.③项目共产生36664.07万元效益,净效益35032.76万元;成本效益比为22.48.④敏感度分析表明,三期梅毒发生率越低、梅毒传播概率越低、筛查误工时间越少、隐性梅毒治疗率越高,该项目将具有更高的成本效益.结论:深圳市艾滋病自愿咨询监测点梅毒干预项目具有较好的成本效益,项目值得持续开展和推广.     

深圳市新生儿疾病筛查成本-效益分析

目的评估深圳市新生儿疾病筛查方案的经济效益。方法根据深圳市新生儿疾病筛查结果、调查所得数据和深圳市经济数据,测算新生儿疾病筛查的成本和效益。结果深圳市开展新生儿疾病筛查的净效益为5.4亿元,先天性甲状腺功能减低筛查的成本-效益比为1∶19.83,苯丙酮尿症筛查的成本-效益比为1∶2.83,葡萄糖-6-磷酸脱氢酶缺乏症筛查的成本-效益比为1∶141.96,半乳糖血症筛查的成本-效益比为1∶1.17。结论深圳市新生儿疾病筛查工作具有良好的经济效益,优化筛查方案可进一步提高筛查率和复查率。     

天津新生儿听力筛查与救助项目成本效益分析

目的 为使卫生资源获得最大的经济效益和社会效益,从经济学角度对天津市2009至2011年新生儿听力筛查与救助项目进行分析.方法 从政府购买服务角度,分别收集新生儿听力筛查与救助项目的成本和效益.成本为政府投入用于新生儿听力筛查和救助的费用,来自天津市妇幼卫生信息系统;效益包括直接效益和间接效益,通过电话追访、现有文献或资料检索获得.采用成本效益比对结果进行描述分析.结果 2009至2011年项目免费新生儿听力筛查25.13万人,其中106人需佩戴助听器.政府共投入1 037.03万元,包括筛查费用1 005.23万元,救助费用31.80万元;带来的总效益为120.05亿元.2009至2011年整体成本效益比为1∶11.58,且成本效益随着项目的推进逐年增加.结论 天津市2009至2011年听力筛查与救助项目符合卫生经济学的成本效益原则,对控制出生缺陷有重要意义.     

深圳市预防与控制梅毒母婴传播项目成本效果分析

目的研究深圳市预防与控制梅毒母婴传播项目的成本效果。方法运用卫生经济学理论,结合国内外相关研究资料,根据2005年纳入项目干预管治的妊娠梅毒病例数,假设这部分妊娠梅毒病例未接受筛查及治疗,按妊娠梅毒自然病程各种妊娠结局发生率发展,通过比较两者之间的妊娠结局发生情况,同时查阅项目办公室财务报表和回顾性调查,掌握项目机构成本和个人成本,在成本测算的基础上,对项目进行成本效果分析。结果成本测算结果显示2005年该项目共投入干预成本522.75万元,其中机构防治成本及个人成本分别占45.79%、54.21%。共对159 017例孕产妇进行了免费梅毒血清学检测,发现孕产妇梅毒阳性827例,其中627例梅毒孕产妇选择继续妊娠,200例终止妊娠。妊娠期间接受规范青霉素抗梅毒治疗的584例梅毒孕产妇,发生各种不良妊娠结局30例,其中先天性梅毒患儿4例,新生儿死亡1例,低体重出生儿25例;不良妊娠结局干预成功率为90.72%,避免各种不良妊娠结局293例,每避免1例不良妊娠结局投入的干预成本为1.78万元;先天性梅毒阻断成功率为96.80%,阻断先天性梅毒活产儿121例,每阻断1例先天性梅毒投入的干预成本为4.32万元;三期梅...     

2011—2020年甘肃省新生儿听力筛查及救治项目成本-效益分析

目的 评估甘肃省贫困听障儿童救治项目的实施效果,对项目的成本效益进行卫生经济学评价,为项目的改进提供依据。方法 针对2011年5月—2020年5月参与项目的患儿,通过现场调查收集资料,并且结合甘肃省卫生健康委员会项目数据、甘肃省统计年鉴数据,分析甘肃省听力救治项目的成本和效益,并对项目复筛率进行敏感性分析。结果 甘肃省项目开展期间平均听力筛查率为89.47%,平均听力复筛率为23.04%;最终确定听力救助患儿985例。项目10年总成本21 587.17万元,人均成本20.38万元;总效益为54 885.86万元,人均效益55.72万元。项目开展期间每年的成本效益比在1∶1.90~1∶3.72,10年的总成本效益比为1∶2.54。结论 政府将人工耳蜗与听力筛查相结合进行投资是可行的,目前甘肃省听力救助项目还存在提升空间,建议对项目管理以及资金分配进行进一步的优化。     

深圳市乙型肝炎相关疾病经济负担及其影响因素分析

目的 明确深圳市乙型肝炎(乙肝)相关疾病的直接费用、间接费用和无形费用及探讨其影响因素.方法 采用时间阶段连续病例整群抽样方法,对符合条件的乙肝患者进行问卷调查;待患者出院后,收集住院费用及其相关信息.总费用包括直接、间接和无形费用.采用多元线性回归分析,对各种费用的影响因素进行探讨.结果 *乙肝所致相关疾病患者年均总费用为81 590.23元,其中直接、间接和无形费用分别为30 914.79元(37.9%)、15 258.01元(18.7%)和35 417.43元(占43.4%).原发性肝癌的总费用最高,为194 858.40元,其次为重型乙肝144 549.20元、失代偿期肝硬化120 333.60元、代偿期肝硬化79 528.81元、慢性乙肝66 282.46元、急性乙肝为39 286.81元.直接与间接费用之比为2.0∶1,其中原发性肝癌为0.7∶1、慢性乙肝2.2∶1、肝硬化2.5∶1、重型乙肝2.8∶1和急性乙肝3.3∶1;直接医疗费用大于直接非医疗费用(16∶1).乙肝相关疾病每例年均总费用占患者年均收入的比例为285.3%,占家庭年均收入的比例为75.4%;其中直接费用占患者和家庭年收入的比例分别为108.1%和28.6%.各类乙肝相关疾病患者间接费用合计为8123.38元,陪护间接费用为7134.63元,相应的误工天数分别为55.74 d和19.83 d.多元线性回归分析表明,年龄是各种费用的影响因素.结论 乙肝相关疾病患者和家庭承受着沉重的经济负担,随病情加重费用趋于增高;直接费用大于间接费用,直接医疗费用大于直接非医疗费用,患者误工费大于陪护误工费.     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.