金湖县疟疾快速诊断技术规范使用试点项目分析

目的了解疟疾快速诊断(RDT)技术规范使用试点项目在金湖县的实施情况,为探讨适合现场和基层卫生单位的疟疾快速诊断方法提供科学依据。方法收集疟疾快速诊断(RDT)技术相关资料及项目实施1年来的疟疾快速诊断(RDT)检测登记表、血检登记表及防治资料进行统计分析。结果 RDT技术综合性能优于镜检疟原虫技术;两种方法结果一致,符合率为100.00%,无误诊及漏诊病例;18名检测人员均优先选择RDT技术检测,选择率为100.00%。结论RDT方法比较适合现场和基层卫生单位应用。     

基于扎根理论疟疾风险管理现状及策略研究

目的挖掘和总结疟疾风险管理的经验及存在问题,为疟疾消除阶段的疟疾风险管理工作提供策略建议。方法借鉴扎根理论(GTM),于2015年6月—2016年3月随机抽取广西、湖北、安徽三省疟疾防控系统的24名相关人员分别进行时长为半小时的面对面半结构式访谈,并补充访谈了河南和山东两省疾病预防控制中心的2名一线疟疾防控专家,对收集的定性资料进行整理和分析。结果样本地区疟疾风险管理工作的顺利开展主要受政府的重视,规范的疟疾预防、监测筛查、病例处置以及注重科研探索等因素的影响;然而当前疟疾风险管理面临的主要问题为:疟疾经费不足、居民及基层防控工作人员疟疾防控意识淡薄、流动人口加剧输入性疟疾传播风险、二代病例与疟原虫变异使监测更加困难等。结论疟疾消除阶段政府需要继续重视疟疾风险管理工作,适当增加和调整疟防经费及科研经费投入,协调建立多部门的疟疾防控机制。     

基层疟疾防治人员工作满意度及影响因素分析

目的了解基层疟疾防治人员工作满意度水平及其影响因素,为基层地区实现消除疟疾目标提供参考依据。方法于2013年12月—2015年12月采用典型抽样方法对河南、湖北和海南3个省6个县(区)抽取的382名基层疟疾防治人员进行问卷调查,分析基层疟疾防治人员的工作满意度水平,并运用多元线性回归模型分析其影响因素。结果基层疟疾防治人员工作满意度总分为(3.956±0.750)分;对政策及领导、工作环境、设施网络配置、药物配备、培训活动、患者和居民配合度的满意度得分分别为(4.134±0.785)、(3.946±0.844)、(3.859±0.862)、(3.893±0.934)、(4.047±0.898)、(3.780±0.854)分;多元线性逐步回归分析结果显示,河南省基层疟疾防治人员工作满意度高于海南省,县(区)级疾病预防控制中心、乡镇卫生院和村卫生室的基层疟疾防治人员工作满意度均低于县(区)级医院,其他专业基层疟疾防治人员工作满意度低于临床专业,基层疟疾防治人员职称越高工作满意度越低。结论基层疟疾防治人员工作满意度水平较高,其中地区、单位类型、专业和职称是基层疟疾防治人员工作满意度的主要影响因素。     

快速检测试剂推广前后疟疾检测结果分析

目的分析快速检测试剂(RDT)推广前后石家庄市疟疾检测情况,探讨消除后阶段监测工作,为措施制定提供依据。方法从寄生虫防治信息管理系统收集2015年-2016年各县(市)区血检月报表和疟疾个案信息,对血检情况进行整理分析。结果 2015年完成血涂片5 899份,检测结果阳性率为0.49%(29/5 899);2016年完成血涂片1 572份,快速检测试纸(RDTs)1 282份,阳性率分别为2.99%(47/1 572)、4.13%(53/1 282)。市区检测阳性率显著高于平原县和山区县。血涂片镜检的敏感度为88.68%,RDT的敏感度为100.00%。经一致性检验,镜检、RDT的Kappa值为0.66,两方法检测结果中度一致(P0.01)。结论降低发热患者血涂片镜检数量要求,能大幅提升血检效率,符合当前输入性疟疾疫情形势。RDT敏感度高,对技术要求低,在疟疾消除后阶段推广RDT检测,有利于医疗机构疟疾病例的发现。     

基层医务人员疟疾防治知识技能培训效果分析

目的了解基层医务人员疟疾防治知识技能培训的效果及其影响因素,评估疟疾监测体系的敏感程度。方法对绍兴市越城区所辖8个乡（镇）卫生院、社区服务中心从事疟疾工作的临床内科、检验和疾控的医务人员进行疟疾相关基础知识、临床知识和预防知识的问卷调查。结果本次调查有效问卷为305份,平均知晓率为52.50%,基础知识知晓率为67.20%,临床知识和预防知识的知晓率分别为43.25%和40.00%。所有接受调查的医务人员中,知晓率最高的是公共卫生岗位人员（72.25%）、中级以上职称人员（60.92%）和本科学历人员（56.33%）。结论基层医务人员对疟疾防治知识技能知晓率还没有达到国家消除疟疾行动计划要求的目标,建议通过各种形式培训提高疟疾防治知识。     

消除疟疾培训效果分析及思考

目的对南平市消除疟疾的培训效果进行分析,探讨消除疟疾后培训思路。方法用描述流行病学方法,对南平市各级医疗机构疟疾培训的人员、频次、间隔时间等进行分析。结果全市疟防人员疟疾防治知识合格率48.8%,镜检技术合格率56.2%。随着培训次数的增加,防治知识和镜检技术合格率均有增高的趋势;随着培训间隔时间延长,防治知识和镜检技术合格率均呈下降趋势。结论疟疾相关培训效果显而易见。在消除疟疾后应加强对医务人员的培训,不论医院等级和年龄层次,这是消除疟疾成果可持续性的重要保证。     

四川省全球基金疟疾项目管理效果分析

目的总结四川省全球基金疟疾项目管理经验,为疟疾防治工作提供借鉴的模式。方法按照全球基金实施方案结合四川实际,建立独立运作的项目办公室,开展督导评估,培训,信息交流,多部门协调合作,强化资金、物资管理。结果项目实施提高了基层疟疾防治机构和人员的整体素质,创造了疟疾防治的支持性环境,项目与疟疾防治规划紧密结合,极大推动了项目地区疟疾防治工作的有序开展,使项目地区疟疾发病得到有效遏制,比计划提前2年达到了基本消除疟疾标准,项目效果显著。结论可借鉴全球基金项目全程督导评估,基于绩效的财务管理等理念,将项目工作与日常防治工作结合,推广以项目促进防治工作的模式,促进全省疟疾防治工作的深入开展。     

四川省青神县疟疾基线调查报告

目的了解青神县消除疟疾行动计划启动初疟疾流行情况、防治工作基础和能力状况,为达到消除疟疾目标提供基线数据。方法按四川省消除疟疾行动计划实施方案中基线调查方法开展疟疾流行情况、传疟媒介、防治工作和能力现状等调查。结果 2006年后无疟疾本地感染病例,人群疟疾抗体水平滴度均〈1：20,传疟媒介为中华按蚊,密度为4只/夜;居民、中小学生疟疾防治知识知晓率分别为53%、64%;县、乡、村临床医生接受疟疾知识培训比例分别为10%、52%、14%;县、乡接受疟原虫镜检培训比例分别为39%、27%。结论今后消除疟疾工作应加强临床医生和镜检人员知识培训与居民、学生、外出疟区务工人员疟防知识宣传。     

福建省基层医务人员疟疾防治知识知晓率调查

目的了解福建省基层医务人员疟疾防治知识知晓情况,评估疟疾监测体系的敏感程度,为消除疟疾提供依据。方法对全省84个县(市、区)、1 291个乡(镇)卫生院(社区服务中心)从事疟疾防治工作的临床、检验和疾控机构的医务人员进行问卷调查。结果该调查的有效问卷为5 128份,总合格率为51.1%(临床医生合格率为49.2%,疾控人员为68.3%)。总优秀率为25.3%,基础知识的合格率为63%,临床知识的合格率为50.3%,预防知识的合格率为29.4%。结论基层医务人员对疟疾防治核心知识的知晓率还未达到国家消除疟疾行动计划要求的目标,需进一步加强培训和宣传。     

2013年四川省疟疾流行病学特征分析

摘要:目的　分析四川省2013年疟疾流行特征,为制定和调整适合本省有效的消除疟疾策略和措施提供科学依据。方法　对四川省网络直报的疟疾疫情数据、疟疾病例的流行病学调查资料进行统计分析。结果　2013年四川省报告疟疾病例238例,发病率为0.03/万。其中恶性疟155例,占65.13%,有3例重症恶性疟病例死亡。238例病例均为输入性,其中境外输入233例,占97.90%。每月均有病例报告,5月和6月是间日疟的高峰,共29例,占间日疟总数的40.28%。成都、广安、南充、内江、宜宾报告病例156例,占总数的65.55％。患者从发病到初次就诊时间中位数为2 d。157例患者初次就诊结果为疟疾,占65.97%。98例病例由市级医疗机构确诊,占41.18%。结论　四川省境外输入性疟疾形势严峻,基层医疗机构诊治疟疾能力不足。为了如期实现消除疟疾目标,需加强医疗机构疟疾诊治技能培训,加强劳务输出归国人员的监测管理。     

消除阶段的疟疾患者分布及就医选择分析

目的:了解我国疟疾消除阶段的患者分布及就诊机构特征。方法:采用多阶段分层整群抽样的方法,抽取浙江、江苏、安徽、河南、四川、云南六省共102家医院作为样本医院,收集样本医院2014年1月1日—2016年12月31日所有疟疾患者在医院治疗过程中的病历、门诊和住院病例治疗费用原始明细结算清单。采用Excel 2016和SPSS 20.0等软件进行统计分析。结果:本次调查共收集疟疾病例1 633例,发现我国疟疾患者在就诊月份上呈现W型分布。疟疾分型以恶性疟为主,河南和四川的间日疟患者有反弹趋势。77.10%的患者选择了三级医院,52.05%的住院患者在市级医疗机构,23.58%的患者在省级医疗机构。结论:疟疾发病高峰期出现新的时间段,具备疟疾治疗能力的医院防线逐渐收缩,疟疾救治能力相对集中在影响较大的高水平医院。建议构建区域疟疾治疗防线,加强培训重症疟疾治疗知识,提高疟疾救治能力。     

Malaria: knowledge and behaviour in an endemic rural area of Turkey

This cross-sectional study was conducted to determine the knowledge and behaviour of people in the Sanliurfa province of Turkey regarding the prevention of malaria. A modified 30-cluster sampling method based on the traditional Expanded Programme for Immunization coverage surveys was employed to select a representative sample from 210 households. A questionnaire that focused on sociodemographic characteristics, knowledge and behaviour of malaria prevention, treatment-seeking behaviour and the use of antimalarials was applied. Eighty-nine percent of respondents knew at least one of the classical symptoms of malaria, and fever and chills were the most commonly reported symptoms (78.6%). Of the people interviewed, 33% believed that malaria can be acquired from dirty water, by changing place of residence, by working in cotton or tomato fields, or from malaria patients' belongings. None of the respondents knew how mosquitoes acquire the parasite. Twenty-five percent of respondents believed that elimination of breeding sites was one way to prevent malaria, and 8% identified the use of bednets. Fifty-five percent of respondents reported protective behaviours that are not directly associated with malaria transmission. Almost 47% of respondents reported that they completed their antimalarials, and only 21% of respondents indicated that they would seek treatment for febrile disease from physicians or a malaria unit. Understanding community perceptions of aetiology, symptom identification and treatment of malaria is an important step towards disease control.     

Activities of occupational health professionals in academic environments

We surveyed American and Canadian medical schools to assess the extent to which occupational health professionals provided services to their own institutions. Ninety-two of 155 schools (60 percent) responded to a mailed questionnaire. Forty-six (51 percent) of the respondents had an occupational health service distinct from an employee health service. Two thirds of the respondents provided occupational health services to business and industry. Such professionals based in nonclinical departments were more likely to provide educational and epidemiologic services for hospital employees than were professionals based in clinical departments. In those institutions with risk management, biohazards, or health and safety committees, less than one half of the occupational health professionals in those institutions were members of those committees. Five respondents felt that there were financial disincentives to providing occupational health services to their institution's employees. We conclude that academic-based occupational health professionals have inadequate input into the provision of such services at their own institutions.     

Knowledge, practices, and perceptions about malaria in rural communities of Zimbabwe: relevance to malaria control.

A survey of 411 household heads was undertaken in Gokwe district, Zimbabwe, to assess villagers'' knowledge, practices and perceptions about malaria and their implications for malaria control. Our results show that although the government has sustained an annual indoor insecticide spraying programme for over four decades, about 50% of respondents did not adequately understand its purpose, with 26% believing that the programme was intended to kill domestic pests, not including mosquitos. During the 1991-92 spraying cycle, 72% of the villagers had their homes sprayed. However, 21% of such villagers refused to have some rooms in their homes sprayed. Householders'' understanding of the function of the spraying programme was significantly related to their compliance with it (P < 0.05). A total of 82% of respondents reported not taking any measures to protect themselves from malaria. Taking preventive measures was significantly related to knowledge of the causes of malaria (P < 0.05). The study shows the importance of involving communities in a control programme intended to be to their benefit and of informing them about available options for protection against malaria.     

Is there a time and place for health education in chain pharmacies? Perspectives of Polish community pharmacists

Pharmaceutical practice has evolved significantly from the provision of drugs to a more patient-centred model. However, the ownership structure of pharmacies may impact the level of cognitive services provided by them. The discrepancy may be observed between pharmacists’ opinions on how involved they should get and their actual involvement in health promotion and disease prevention. Given the growing market share of pharmacy chains in Europe, this study aimed to investigate the attitudes of pharmacists employed in them towards their role as health educators. It applies Ajzen's theory of planned behaviour to examine pharmacists’ perspectives with the use of semi-structured in-depth interviews. A total of 10 semi-structured face-to-face interviews were conducted in May 2017 among Polish pharmacists employed in chains. Obtained results showed that respondents welcomed the possibility of providing health education, but simultaneously they seek physicians’ and patients’ acceptance for undertaking this task. Competency gaps and unfavourable working conditions may also decrease pharmacists’ intention to serve as health educators. Including the role of a health educator to the scope of the pharmacists’ practice requires a precise definition of their competencies and responsibilities together with additional training aimed to fill potential gaps in their qualifications. The pharmacists’ image as a health educator should also be widely communicated to patients and other healthcare professionals.     

我国疾病预防控制机构信息化人才队伍现状和问题分析

目的分析疾病预防控制机构卫生信息专业人才队伍的建设现状和问题,为十二五规划提供建议。方法通过在线调查方式对全国疾病预防控制机构信息化人才队伍建设进行调查。结果近年来我国疾控机构信息化人才队伍人员在数量和质量(年龄、学历和职称等)方面都取得了较大的提升,但仍然存在着一些不容忽视的问题。首先,从人员绝对数量来看,与医疗机构相比有一定差距;其次,人才队伍发展不平衡;然后是专业化程度有待提高。结论我国疾病预防控制机构信息化人才队伍数量和质量还有待提高,建议在提高现有信息化人才素质同时,应通过多种方式提高人员的数量和质量。     

Knowledge and practice of malaria prevention methods among residents of arba minch town and arba minch zuria district, southern ethiopia

Background

To date, there is no effective vaccine or no effective drug for mass chemoprophylaxis against malaria. Thus, proper know-how and use of prevention methods is crucial. This study aims to assess the knowledge and practice of malaria prevention methods among the residents of Arba Minch area, Southern Ethiopia.

Methods

A community-based cross-sectional study that utilized a two-stage sampling was conducted from January 22 to February 1, 2007 on a sample of 454 household heads or their deputies. SPSS 16 for windows was used for data analysis. Chi-square and Fisher''s exact probability tests were used to assess the association of selected variables with place of residence.

Results

Majority (86.8%) of the respondents mentioned fever as a symptom of malaria, and 98.2% of the respondents reported mosquito bite as the cause of malaria. Three hundred and eighty four (84.6%) of the respondents mentioned mosquito nets as protective measures against mosquito bites. The protective measure mostly used by the respondents or other household members in the last 12 months was mosquito net (73.3%) followed by aerosol insecticide (13%) with the former being used more in rural areas and the latter in urban areas.

Conclusion

The study subjects'' awareness regarding the cause, symptoms and preventive measures of malaria was high. Use of mosquito net as protective measure against mosquito bites in the last 12 months was high. However, use of other preventive measures was low. Behavioral change communication is required to increase the use of other preventive measures along with mosquito nets.     

Creating opportunities for patient participation in managing medications across transitions of care through formal and informal modes of communication

BackgroundCommunicating about medications across transitions of care is important in older patients who frequently move between health care settings. While there is increasing interest in understanding patient communication across transitions of care, little is known about older patients'' involvement in formal and informal modes of communication regarding managing medications.ObjectiveThe aim of this paper was to explore how older patients participated in managing their medications across transitions of care through formal and informal modes of communication.MethodsThe study was conducted across two metropolitan hospitals: an acute hospital and a geriatric rehabilitation hospital in metropolitan Melbourne, Australia. A focused ethnographic design was used involving semi‐structured interviews (n = 50), observations (203 h) and individual interviews or focus groups (n = 25). Following thematic analysis, data were analysed using Fairclough''s Critical Discourse Analysis.ResultsData analysis revealed two major discursive practices, which comprised of an interplay between formal and informal communication and environmental influences on formal and informal communication. Self‐created patient notes were used by older patients to initiate informal discussion with health professionals about medication decisions, which challenged traditional unequal power relations between health professionals and patients. Formal prompts on electronic medication administration records facilitated the continuous information discourse about patients'' medications across transitions of care and encouraged health professionals to seek out older patients'' preferences through informal bedside interactions. Environmental influences on communication comprised health professionals'' physical movements across private and public spaces in the ward, their distance from older patients at the bedside and utilization of the computer systems during patient encounters.ConclusionOlder patients'' self‐created medication notes enabled them to take on a more active role in formal and informal medication communication across transitions of care. Older patients and family members did not have continuous access to information about medication changes during their hospital stay and systems often failed to address older patients'' key concerns about their medications, which hindered their active involvement in formal and informal communication.Patient or Public ContributionOlder adults, family members and health professionals volunteered to be interviewed and observed.     

欠发达地区门诊患者就诊机构选择及影响因素——基于我国西部地区县级医院及乡镇卫生院的实证研究

目的:调查西部农村地区医疗机构门诊患者治疗常见病的就诊机构选择,并分析其影响因素。方法:研究收集我国西部11省的县级医院和乡镇卫生院门诊患者常见病就诊机构选择情况,采用非条件无序多分类logistic回归和卡方检验分析就诊选择的影响因素。结果:共纳入4 233名样本,其中45.5%选择乡镇卫生院。样本来源机构、省份和受访者性别、教育程度、职业、月收入、医保类型等自身因素对患者的选择意愿有显著影响。就诊机构的"距离"、"收费的合理性"、"医务人员服务态度"及"医务人员技术水平"是就诊选择的主要外部原因。结论:男性、务农务工群体、教育程度较低、收入较低的患者,倾向于在级别较低的医疗机构就诊;农村居民对村卫生室的医疗需求多为方便、及时,对较高级别的医疗机构(如县级及以上医院)的需求则定位于更好的服务态度和技术水平,因此村卫生室、乡镇卫生院应更注重提高基本医疗服务的可及性,而县级及以上医疗机构应着眼于提升医疗服务水平、改善患者的可负担性及满足患者较高层次的卫生服务需求。     

2019年江苏省外籍疟疾流行病学分析

目的 对2019年江苏省11例外籍疟疾病例进行流行病学分析,以提高外籍疟疾病例的防控效果。方法 收集2019年江苏省11例外籍疟疾病例的个案信息、流行病学调查报告以及住院病历,对发病时间、诊断过程、治疗情况进行汇总分析。结果 11例外籍疟疾病例中恶性疟9例、间日疟和卵形疟各1例。其中留学生和留学生家属占外籍疟疾病例的90.90%,9月份病例数占全部病例的54.55%。11例外籍疟疾病例来华国家中非洲10例、南亚1例。除1例间日疟病例来华后至发病时间为38 d,其余外籍病例均在来华后10 d内发病。11例外籍病例初诊单位为江苏国际旅行卫生保健中心3例、外商合资民营医院1例、县级医疗机构1例、市级医疗机构5例、省级医疗机构1例。其中3例是至江苏国际旅行卫生保健中心进行体检,2例镜检查见疟原虫,为无症状感染者;1例体检时镜检未查见疟原虫,第2 d出现发热症状,到县级医疗机构就诊,RDT检测显示恶性疟阳性,镜检查见疟原虫,确诊为恶性疟病例。对11例外籍疟疾病例均遵循安全、有效、合理、规范的原则,结合患者的临床症状与体征合理用药。8例病例经住院治疗后痊愈出院;3例轻症者(含2例无症状感染者)未住院,经口服药治疗后症状消失。经随访调查,11例病例无再燃或复发。结论 外籍疟疾病例以留学生和留学生家属为主。因此,应加强对来华留学生疟疾防治知识的宣教,提高其就诊意识,以确保留学生的身体健康。