Regulatory systems for prevention and control of rabies, Japan

Japan is one of the few rabies-free countries. Although 3 imported cases of human rabies were seen in 1970 and 2006, no other cases have been reported for approximately 50 years. The elimination of rabies in Japan is attributed to not only its geographic isolation but also to effective prevention and control measures, such as registration and vaccination of domestic dogs, required quarantine of susceptible imported animals, and national plans of action based on scientific research. Countermeasures against rabies have been upgraded; an improved management system for domestic dogs under the amended Enforcement Regulations of the Rabies Prevention Law has been in effect since April 2007. The latest regulatory systems for preventing and controlling rabies provide an effective model for elimination of the disease worldwide.     

2005-2009年中国人禽流感(H5N1)病例流行病学特征分析

目的了解中国2005-2009年人禽流感(H5N1)病例的流行病学特征,为防控策略和措施的调整提供科学依据。方法以2005-2009年我国确诊的人禽流感病例为研究对象,分析病例的时间、空间和人群分布特点。结果 2005-2009年全国共确诊人禽流感病例38例,其中有2例为军队病例。2005-2006年冬春季和2009年初的人禽流感疫情有明显的报告发病高峰。病例分布在17个省份,前三位为安徽(5例)、湖南(5例)和福建(4例),占所有报告病例数的37%。病例的年龄中位数26岁(2～62岁),女性(53%)略多于男性。病死率为66%。感染来源主要是病死禽,活禽市场也是一个重要的感染危险因素,而人禽流感病例或隐性感染者作为传染源的意义很有限。结论人禽流感病例有较明显的季节分布特点,感染人群以50岁以下的青壮年为主,性别和职业分布无明显特点。病死禽和活禽市场暴露在我国人禽流感病例的发病中有重要意义。     

安徽省人感染高致病性禽流感健康传播项目效果评价

目的:评价在家禽养殖和加工/销售人员开展"预防人感染高致病性禽流感健康传播项目"的效果。方法:抽取安徽省两个项目县部分家禽养殖和加工/销售人员,采取小组访谈和问卷调查的方法评价项目干预前后知信行变化。结果:干预前后家禽养殖和加工/销售人员在禽流感预防的核心信息的知晓率由干预前的30.0%~57.5%提高到55.9%~88.2%,对国家预防和控制禽流感相关政策持赞同态度的由干预前的67.5%~82.5%上升到85.3~97.1%,认为自己作用非常重要,由干预前的67.5%上升为94.1%,与干预前日常接触禽类后很少防护相比,干预后被调查人员均注意手和衣物的清洗消毒。结论:人感染高致病性禽流感健康传播项目对提高禽类养殖和加工/销售者相关知识、信念和行为效果明显,传播干预策略有效,应建立一种持续、长效的健康传播机制。     

人禽流感疫区居民对防控措施效果满意度调查

目的了解江西省遂川县人禽流感发生1年后疫区居民对防控措施的评价。方法采用以户为单位的系统抽样方法,在疫区抽取396名14岁~居民进行问卷调查。结果89.2%的疫区居民对政府在人禽流感发生后所采取的防控措施感到满意;56.3%的居民认为将来不会再发生人禽流感疫情,且非疫点居民信心度低于疫点居民(P<0.001);77.2%的居民认为当前防控措施有效。结论对政府在1年前的疫情处理,疫区居民基本上满意;对当前政府防控同类事件的措施和能力也有较好的评价,但对将来不会再发生人禽流感事件的信心显得不足,尤其是非疫点居民。     

深圳市禽类销售人员预防人禽流感健康传播研究

目的通过对深圳市龙岗区禽类销售人员进行健康教育和危险因素的强化干预,评价预防人感染禽流感健康传播活动的效果。方法采用横断面调查方法,面对面询问调查对象,进行多种形式的健康传播活动1个月,干预前后数据的比较采用X^2检验．采取整群抽样方法,于2006年12月-2007年2月选取深圳市龙岗区28个大型农贸市场和三乌批发市场的禽类销售人员作为调查对象。结果人禽流感核心信息的知晓率干预后均有不同程度的上升。结论本次为期1个月的防治人禽流感健康传播活动取得了较好的效果,说明针对高危人群开展的防治人禽流感健康教育活动与突击性的宣传月活动相结合,在提高禽类销售人员自我防护能力、普及人禽流感防治知识等方面均有强化传播效果的作用。     

医院感染监控的效果与效益

几年来医院感染监控研究的结果，阐明了医院感染监测与控制能有效降低医院感染率和病死率，能明显缩短患者的平均住院时间与提高床位周转率，从而大大减少患者的医疗费用和国家的财政开支。同时由于医院感染监控及时发现与处理问题，亦防止了疾病在医院中的暴发与流行。     

Assessing the evaluability of complex public health interventions: five questions for researchers, funders, and policymakers

Context: Evidence to support government programs to improve public health often is weak. Recognition of this “knowledge gap” has led to calls for more and better evaluation, but decisions about priorities for evaluation also need to be addressed in regard to financial restraint. Methods: Using England's Healthy Community Challenge Fund as a case study, this article presents a set of questions to stimulate and structure debate among researchers, funders, and policymakers and help make decisions about evaluation within and between complex public health interventions as they evolve from initial concept to dissemination of full‐scale intervention packages. Findings: This approach can be used to identify the types of knowledge that might be generated from any evaluation, given the strength of evidence available in response to each of five questions, and to support a more systematic consideration of resource allocation decisions, depending on the types of knowledge required. Conclusions: The principles of this approach may be generalizable, and should be tested and refined for other complex public health and wider social interventions.     

Full-Genome Analysis of Avian Influenza A(H5N1) Virus from a Human,North America, 2013

Full-genome analysis was conducted on the first isolate of a highly pathogenic avian influenza A(H5N1) virus from a human in North America. The virus has a hemagglutinin gene of clade 2.3.2.1c and is a reassortant with an H9N2 subtype lineage polymerase basic 2 gene. No mutations conferring resistance to adamantanes or neuraminidase inhibitors were found.     

Anti-bullying interventions at school: aspects of programme adaptation and critical issues for further programme development

Recently, a growing interest in problems at school of peer aggression and victimization was observed. As a result, intervention strategies appropriate for this kind of problem were required. The Norwegian anti-bullying intervention that was developed and evaluated by Olweus (1992) in the region of Bergen was considered to be a good model for other countries to implement interventions against peer aggression within the school environment. It was therefore adapted to the educational settings of other countries. This paper aims to discuss the adaptation processes of the Bergen anti-bullying programme and to give guidelines to advance further programme development. For this, the DFE Sheffield Bullying Project (Smith and Sharp, 1994), the Anti-bullying Intervention in Toronto schools (Pepler et al., 1994) and the Flemish anti-bullying project (Stevens and Van Oost, 1994) were considered in the analyses. Discussion of the adaptation processes of the Bergen model programme revealed that the adapted interventions largely succeeded in incorporating the core components of the Bergen model programme, taking into account the characteristics of the implementation environment. This suggests that for bully/victim interventions, the dilemma of programme fidelity and programme adaptation could be solved adequately. However, from a health promotion perspective, some critical issues for programme improvement were observed. Three suggestions for change were made, indicating that anti-bullying actions at schools may benefit from: (i) a clear overview of the learning objectives, specified per target population; (ii) more attention to parental involvement and family interventions; and (iii) additional information about the adoption processes of the anti-bullying interventions within schools.     

Higher Viral Stability and Ethanol Resistance of Avian Influenza A(H5N1) Virus on Human Skin

Evaluating the stability of highly pathogenic avian influenza viruses on human skin and measuring the effectiveness of disinfectants are crucial for preventing contact disease transmission. We constructed an evaluation model using autopsy skin samples and evaluated factors that affect the stability and disinfectant effectiveness for various subtypes. The survival time of the avian influenza A(H5N1) virus on plastic surfaces was ≈26 hours and on skin surfaces ≈4.5 hours, >2.5-fold longer than other subtypes. The effectiveness of a relatively low ethanol concentration (32%–36% wt/wt) against the H5N1 subtype was substantially reduced compared with other subtypes. Moreover, recombinant viruses with the neuraminidase gene of H5N1 survived longer on plastic and skin surfaces than other recombinant viruses and were resistant to ethanol. Our results imply that the H5N1 subtype poses a higher contact transmission risk because of its higher stability and ethanol resistance, which might depend on the neuraminidase protein.     

Developing an evidence base for policies and interventions to address health inequalities: the analysis of "public health regimes"

Systematic reviews have become an important methodology in the United Kingdom by which research informs health policy, and their use now extends beyond evidence-based medicine to evidence-based public health and, particularly, health inequalities policies. This article reviews the limitations of systematic reviews as stand-alone tools for this purpose and suggests a complementary approach to make better use of the evidence. That is, systematic reviews and other sources of evidence should be incorporated into a wider analytical framework, the public health regime (defined here as the specific legislative, social, political, and economic structures that have an impact on both public health and the appropriateness and effectiveness of public health interventions adopted). At the national level this approach would facilitate analysis at all levels of the policy framework, countering the current focus on individual interventions. It could also differentiate at the international level between those policies and interventions that are effective in different contexts and are therefore potentially generalizable and those that depend on particular conditions for success.     

How to effectively design public health interventions: Implications from the interaction effects between socioeconomic status and health locus of control beliefs on healthy dietary behaviours among US adults

This study investigated whether individuals with different socioeconomic status (SES) should be provided differently tailored health messages to promote healthy dietary behaviour (HDB). Prior research has suggested that people with different SESs tend to exhibit different types of beliefs about health, but it remains unclear how SES interacts with these beliefs to influence health outcomes. To better understand the differences in HDB between high‐ and low‐SES populations and propose effective intervention strategies, we examined (i) how SES is associated with HDB, (ii) how internal health locus of control (HLC) and powerful others HLC are associated with HDB, and (iii) how SES interacts with internal and powerful others HLC to influence HDB. Using data from the Annenberg National Health Communication Survey, collected from 2005 to 2012 (N = 6,262) in the United States, hierarchical multiple regression analyses were conducted. Education level was found to be positively associated with HDB, while income level was not. Both internal and powerful others HLC beliefs were positively associated with HDB. The positive relationship between internal HLC and HDB strengthened as the level of education and income increased, whereas the positive relationship between powerful others HLC and HDB weakened as respondents' education level increased. These results suggest that the design and delivery of communication messages should be tailored to populations' specific SES and HLC beliefs for effective public health interventions. For example, messages enhancing internal HLC (e.g. providing specific skills and knowledge about health behaviours) might be more helpful for the richer and more‐educated, while messages appealing to one's powerful others HLC beliefs (e.g. advice on health lifestyles given by well‐known health professionals) might be more effective for less‐educated people.     

Poultry movement networks in Cambodia: Implications for surveillance and control of highly pathogenic avian influenza (HPAI/H5N1)

Movement of poultry through markets is potentially important in the circulation and spread of highly pathogenic avian influenza. However little is understood about poultry market chains in Cambodia. We conducted a cross-sectional survey of 715 rural villagers, 123 rural, peri-urban and urban market sellers and 139 middlemen from six provinces and Phnom Penh, to evaluate live poultry movement and trading practices. Direct trade links with Thailand and Vietnam were identified via middlemen and market sellers. Most poultry movement occurs via middlemen into Phnom Penh making live bird wet markets in Phnom Penh a potential hub for the spread of H5N1 and ideal for surveillance and control.     

Development of cervical cancer control interventions for Chinese immigrants

The objective of the study was to develop a culturally relevant video and a pamphlet for use as a cervical cancer screening educational intervention among North-American Chinese women. The project conducted 87 qualitative interviews and nine focus groups to develop a culturally tailored intervention to improve Pap testing rates. The intervention consisted of an educational/motivational video, a pamphlet, and home visits. Less acculturated Chinese women draw on a rich tradition of herbal knowledge and folk practices historically based on Chinese medical theory, now mixed with new information from the media and popular culture. The video, the pamphlet, and the outreach workers knowledge base were designed using these results and combined with biomedical information to address potential obstacles to Pap testing. Culturally relevant information for reproductive health promotion was easily retrieved through qualitative interviews and used to create educational materials modeling the integration of Pap testing into Chinese women's health practices.     

Health benefits of primary care social work for adults with complex health and social needs: a systematic review

The prevalence of complex health and social needs in primary care patients is growing. Furthermore, recent research suggests that the impact of psychosocial distress on the significantly poorer health outcomes in this population may have been underestimated. The potential of social work in primary care settings has been extensively discussed in both health and social work literature and there is evidence that social work interventions in other settings are particularly effective in addressing psychosocial needs. However, the evidence base for specific improved health outcomes related to primary care social work is minimal. This review aimed to identify and synthesise the available evidence on the health benefits of social work interventions in primary care settings. Nine electronic databases were searched from 1990 to 2015 and seven primary research studies were retrieved. Due to the heterogeneity of studies, a narrative synthesis was conducted. Although there is no definitive evidence for effectiveness, results suggest a promising role for primary care social work interventions in improving health outcomes. These include subjective health measures and self‐management of long‐term conditions, reducing psychosocial morbidity and barriers to treatment and health maintenance. Although few rigorous study designs were found, the contextual detail and clinical settings of studies provide evidence of the practice applicability of social work intervention. Emerging policy on the integration of health and social care may provide an opportunity to develop this model of care.     

浙江省人感染H7N9禽流感流行特征与防控对策

目的 分析人感染H7N9禽流感的流行特征、研究进展和目前防控面临的问题,提出防控对策。方法 采用流行病学个案调查与描述性分析方法,收集人感染H7N9禽流感确诊病例流行病学和防控措施相关资料,分析病例流行病学特征和疫情防控措施效果。结果 浙江省共确诊人感染H7N9禽流感病例44例,死亡6例;男性27例,占61.36%;平均年龄60.18岁(32~86岁);≥50岁35例,占79.55%;农民和离退人员30例,占68.18%。40例(90.91%)集中于杭州和湖州。78.38%(29/37)有慢性基础性疾病,78.95%(30/38)发病前有禽类暴露史;病例的1004名密切接触者均未发现感染。病例可疑暴露场所外环境标本H7N9阳性率高达43.21%(35/81)。暂停市场活禽交易对控制疫情有效。结论 人感染H7N9禽流感流行特征尚未完全明了,需要多部门联合开展监测、研究和防控。     

关于吸烟问题若干名词定义

目的 探索福建省人感染H7N9禽流感发病危险因素,以期为制定和调整防控策略提供科学指导。 方法 采用病例对照研究方法,连续地收集2014年11月 — 2017年10月确诊共75个病例,运用多因素logistic回归分析危险因素。 结果 病例和对照组在性别、年龄组、城乡和体质指数（BMI）构成方面无统计学差异。单因素分析提示36个因素与发病相关,经多因素逐步logistic回归分析显示：患肺部疾病（OR = 4.95）、糖尿病（OR = 4.46）、暴露活禽市场（OR = 3.66）、暴露使用机械脱毛摊点（OR = 5.78）、触摸家禽笼舍（OR = 5.77）、暴露野鸟排泄物（OR = 2.77）是人感染H7N9禽流感危险因素;经常洗手（OR = 0.07）,可使发病风险降低,得到的回归方程对训练样本预测一致率为89.40 %,拟合优度良好（C = 0.90）。 结论 患肺部疾病、患糖尿病、暴露活禽市场、暴露使用机械脱毛摊点、家禽笼舍、野鸟排泄物是福建省人感染H7N9禽流感的危险因素;经常洗手是保护因素。     

新标准下医疗机构卫生人力资源配置的系统动力学方法

目的:就本省新一轮区域卫生规划中各地医疗机构卫生人力资源配置量的计算过程进行系统动力学模拟.方法:以各市基本卫生分类指标为基础,以医疗机构卫生人员内部构成比例为限定,用系统动力学软件计算其配置量.结果:由各地指标高低及其医师拥有基量,得出其每千人口医疗机构卫生人员配置量从4.76至9 47人不等.结论:系统动力学为卫生人力资源配置及基本预测提供了一种便捷工具.     

Health benefits,safety and cost of physical activity interventions for mental health conditions: A meta-review to inform translation efforts

BackgroundMental illness is a leading cause of the global burden of disease. Physical activity (PA) can improve physical and mental health outcomes for people with mental illness, yet routine implementation of PA within standard care remains ad-hoc. The reasons for this are unclear, although the dissonance between the evidence produced in research settings and that needed in real-world environments may be key.PurposeTo explore the effectiveness of PA interventions as a treatment for mental illness. We synthesised past systematic reviews and meta-analyses.MethodsWe conducted a systematic review of reviews from database inception to 09/2017. Reviews were included that considered any mental health condition (diagnosed via standardised criteria) and where PA interventions were a stand-alone or adjunctive treatment. Effectiveness was defined as outcomes that are important in real-world healthcare (i.e. expected clinical outcomes, intervention safety and cost).ResultsFrom 4008 hits, 33 reviews (including 155 unique studies) were included and 32 reported that PA has a positive effect on at least one main outcome of interest (symptoms of mental illness, quality of life and/or physical health). There was inconsistent reporting of adverse events and no cost data was identified. The AMSTAR quality rating suggests inconsistencies in review quality.ConclusionsThe research agenda must expand to report on outcomes that can support evidence translation efforts (i.e. cost and adverse events). Without such a shift, research in PA and mental health may fail to achieve translation to routine care and may have limited impact on patient outcomes.