新疆昌吉州农村人群结核病防治知识的调查

2005年新疆昌吉回族自治州(简称昌吉州)疾病预防控制中心对所辖5县3市农村及城镇人群进行了一次结核病防治知识的问卷调查.该项调查每县市抽取2～3个乡镇卫生院,通过乡镇卫生专干发放调查表,主要以农村人群为主.因此本调查主要反映了农村人群对结核病防治知识的知晓情况.     

监狱结核病疫情及防治现状

结核病是目前全球死亡率最高的传染病,逐渐受到世界各国的重视,随着WHO结核病控制策略DOTS的施行,全球结核病控制已取得一些成绩。然而,监狱在押犯人结核病容易受到忽视,往往成为DOTS策略的盲点。据估计,全球在押犯人约800～1 000万,并与社会普通群体之间处于双向流动状态,即社会人群因各种原因进入监狱,在押犯人因刑满释放等原因回归社会,据此测算,每年进监狱的人群达在押犯的4～6倍。     

制定我国潜伏性结核感染全人群防控策略

加强潜伏性结核感染(latent tuberculosis infection,LTBI)人群的有效管理,是实现结核病防控目标的重要路径之一。目前,我国LTBI管理存在高危人群对结核病发病率贡献率偏低、发病风险特征尚未明确、现有筛查手段普遍存在局限性、预防性服药推广困难等问题。为改善上述现状,笔者提出LTBI全人群防控策略,通过加强全社会健康教育,尤其是国家政策引导及采用适宜在全人群中普及的公共卫生手段,降低疾病对全社会的危害。作为患者管理策略及高危人群策略的重要补充,科学可行的LTBI全人群管理策略,包括充分借助现阶段创新技术手段开展主动筛查、人群监测等措施,对于制定新时代我国结核感染控制规划和政策,逐步实现“终止结核病”战略目标将具有重要意义。     

采取因地制宜的措施加强重点人群结核病防控

随着结核病防治工作的不断深入,加强重点人群防控的重要性越来越凸显。笔者总结中国现行重点人群结核病防控策略的要点,分析其存在的问题和不足。同时,基于中国地域广阔,结核病疫情不均衡,各地重点人群特征亦有不同的特点,笔者建议应依据各地实际情况界定重点人群、重点场所和重点时段,并提出了具体施策意见。     

监狱系统结核病控制现状

由于监狱场所的特殊性,在相当长的时期内,监狱的结核病较难控制。近几年,一些国家虽然对监狱结核病的控制制定了有关政策,2004年我国司法部和卫生部联合印发了《全国劳教场所结核病预防与控制实施办法》,但到目前为止,多数监狱的结核病疫情仍较为严重,疫情远高于社会普通人群。     

普通人群与高危人群结肠息肉检出率的对比研究

目的探讨高危人群与普通人群进行结肠镜常规体检的最佳年龄及结肠镜体检的必要性。 方法收集2015年3月至2019年8月经山西医科大学附属肿瘤医院内镜中心行结肠镜检查的5 213例体检者的内镜诊断报告,回顾性分析不同人群结肠息肉的检出率及其检出率在不同性别和不同年龄段的差异性。 结果5 213例受检者中高危人群772例,普通人群4 441例,其中,男3 469例、女1 744例,发现结肠息肉2 735例(占52.46%)。高危人群中59.33%受检者内镜下诊断为结肠息肉。普通人群中51.27%受检者内镜下诊断为结肠息肉。40岁及以上的普通人群与高危人群的检出率两者比较差异无统计学意义。不论普通人群还是高危人群,男性的结肠息肉检出率高于女性,而且随着年龄的增加,结肠息肉检出率呈上升趋势。 结论40岁及以上要定期做结肠镜常规体检检查,而不是仅限于高危人群才进行常规结肠镜体检,特别是男性。     

结核病诊治与防控新技术、新方法研讨会暨学习班征文

由中国人民解放军第三0九医院全军结核病研究所、《中国防痨杂志》和《结核病与肺部健康杂志》编委会联合主办,海南省预防医学会协办的国家继续教育项目“结核病诊治与防控新技术、新方法研讨会暨学习班”拟定于2014年11月3-6日在海南省海口市召开。     

结核病诊治与防控新技术、新方法研讨会暨学习班征文

由中国人民解放军第三0九医院全军结核病研究所、《中国防痨杂志》和《结核病与肺部健康杂志》编委会联合主办,海南省预防医学会协办的国家继续教育项目“结核病诊治与防控新技术、新方法研讨会暨学习班”拟定于2014年11月36日在海南省海口市召开。本届会议将邀请国内著名结核病基础研究专家、临床检验专家与临床专家针对结核病基础研究新进展、诊断和治疗的新技术、新方法和新经验进行专题学术讲座、学术交流,并共同研讨与会者在工作中遇到的新情况、新问题。现征集有关论文。     

结核病诊治与防控新技术、新方法研讨会暨学习班征文

由中国人民解放军第三0九医院全军结核病研究所、《中国防痨杂志》和《结核病与肺部健康杂志》编委会联合主办,海南省预防医学会协办的国家继续教育项目“结核病诊治与防控新技术、新方法研讨会暨学习班”拟定于2014年11月36日在海南省海口市召开。本届会议将邀请国内著名结核病基础研究专家、临床检验专家与临床专家针对结核病基础研究新进展、诊断和治疗的新技术、新方法和新经验进行专题学术讲座、学术交流,并共同研讨与会者在工作中遇到的新情况、新问题。现征集有关论文。     

我国学校结核病预防与控制的思考

学校结核病防控一直是我国结核病防治工作的重点,学校结核病控制涉及千家万户,政策性强,稍有不当,会造成很大的社会影响。作者对学校结核病防控的重点人群、暴发公共卫生事件的定义,以及学生结核病休复学问题提出了一些不同见解,希望引起业界同道的关注、思考和讨论,更好地为政府制定切实可行和有效的学校结核病控制策略提供科学依据。     

结核病患者老年密切接触者结核病防治知识知晓情况调查分析

目的调查结核病患者老年密切接触者对结核病防治知识知晓情况,为制定其结核病防治对策提供依据。方法选取2019年6—12月于湖南省胸科医院住院的结核病患者老年密切接触者(年龄≥60岁)作为调查对象,进行问卷调查。调查问卷为自行设计,内容包括:调查对象一般情况、结核病防治核心知识及获得知识的途径。共发出问卷199份,剔除无效问卷后回收193份,有效率97.0%。对调查对象的结核病防治核心知识知晓情况及影响因素进行分析。结果 193名调查对象以小学文化程度为主[47.2%(91/193)],职业以农民为主[62.2%(120/193)];对7条结核病防治核心知识总知晓率为56.3%(760/1351)。7条结核病防治核心知识中,以"结核病是一种严重危害人类健康的传染病"及"咳嗽咳痰2周以上,应怀疑得了肺结核"的单一知晓率较高,分别为74.1%(143/193)和60.1%(116/193);以"结核病的诊断方法"及"结核病防治定点医疗机构检查治疗结核病是否有减免政策"的单一知晓率最低,均为47.7%(92/193)。单因素分析显示,大专及以上文化程度者结核病防治核心知识知晓水平得分[中位数(四...     

广州市部分高校大学生结核病防治知识知晓情况调查

目的了解广州市大学生结核病知识知晓情况、对待结核病患者的态度以及获取结核病知识的主要途径,为更好地开展学校结核病健康教育提供参考依据。方法采用分层随机整群抽样的方法在广州市10所高校中共抽取47个班级的学生,采用自行设计调查表进行问卷调查,共调查1588名,合格问卷1534份,导入SPSS 13.0软件进行统计分析。采用卡方检验比较组间差别,采用logistic回归模型进行影响因素的多因素分析,以P<0.05为差异有统计学意义。结果在合格的1534份调查问卷中,高校学生对结核病核心信息的总知晓率为62.9%（4824/7670）,其中减免治疗政策的知晓率为27.1%（416/1534）,核心信息全部知晓者仅占总人数的13.4%（206/1534）。22.9%（351/1534）的学生对待结核病患者表现出疏远态度。高校学生的知识知晓率与性别(男:59.3%,2321/3915;女:66.3%,2490/3755;χ²=38.73,P<0.001)、生源地（城镇:63.8%,2544/3985;农村:61.5%,2265/3685;χ²=5.95,P=0.015）、父母职业（务农或无业:59.8%,1648/2755;非农业:63.8%,3138/4915;χ²=9.02,P=0.003）及亲友有无结核病史（有:69.9%,619/885;无:61.7%, 4189/6785;χ²=20.16,P<0.001）关系密切;对待结核病患者的态度与年级组（低年级:21.4%,294/1373;高年级:35.4%,57/161;Waldχ²=15.83,P<0.001）、生源地（城镇:26.9%,214/797;农村:18.6%,137/737;Waldχ²=17.96,P<0.001）和亲友有无结核病史（有:37.3%,66/177;无:21.0%,285/1357;Waldχ²=19.74,P<0.001）三者有关联,其OR值（95%CI）分别为2.07（1.45~2.96）、0.58（0.46~0.75）和0.46（0.33~0.63）。结论广州市高校学生结核病知识知晓率比较低,学校应联合社会各界开展针对性的宣传教育活动,加强大学生对结核病防治知识的掌握,有利于全社会结核病的防治。     

浙江省公众结核病防治知识调查分析

目的　调查公众对结核病防治知识的知晓情况,为结核病健康促进工作提供参考依据。方法 通过多阶段分层系统随机抽样法抽取6000例调查对象,使用统一设计的结核病防治相关知识调查问卷对公众进行入户面对面询问式调查。结果 调查人群对结核病防治知识的核心信息总知晓率为36.9%,其知晓率因其文化程度和职业的不同而异,文化程度与知晓率间存正比关系,医务人员的总体知晓率最高,其次是教师、行政管理人员,最低是农民和学生。结论 需加强对公众的结核病健康教育,增加公众的结核病防治知识。同时结核病健康教育应结合特定目标人群进行,根据不同的需求,提供形式多样的健康教育。     

安徽省流动人口结核病防治干预措施的效果评价

目的了解安徽省流动人口肺结核患者治疗管理现状,评价全球基金项目干预措施对提高流动人口结核病患者的治疗依从性的效果。方法调查点选择实施全球基金结核病流动人口项目的全部5个地区（项目组）和按照单纯随机抽样方法在全省抽取5个非项目地区（非项目组）,纳入2010年10月至2011年10月期间完成疗程的流动人口肺结核患者,按照患者就诊的时间顺序,共计纳入230例患者。对全部患者进行问卷调查,收回有效问卷229例,问卷有效率为99．57％;其中项目组111例,非项目组118例。调查数据采用EpiData3．1双人双重录入计算机,用SPSS13．0统计软件进行分析。主要评价指标为漏服药率、不良反应发生率、是否医务人员访视与医务人员访视类型、服药意识等。样本率比较采用7。检验,以a-0．05为检验水准。结果项目组111例患者中有19例患者发生漏服药,占17．12％,而非项目组118例患者中有42例患者发生漏服药,占35．59％,差异有统计学意义（X2=9．99,P〈0．05）;项目组（因1例缺项,总例数为110例）有35例患者发生不良反应,占31．82％（35／110）,非项目组有56例患者发生不良反应,占47．46％（56／118）,差异有统计学意义（X2=5．81,P〈0．05）;项目组有93例患者（83．78％）接受过医务人员访视,显著高于非项目组（缺项1例）的84例患者（71．79％）,差异有统计学意义（7。一4．72,P〈0．05）;且两组患者接受访视的医务人员（县医、乡级医生、村级医生）类型中,项目组接受县（乡）医访视占75．27％（70／93）,非项目组接受县（乡）医访视只占59．52％（50／84）,差异有统计学意义（X2=5．01,P〈0．05）;经过治疗,疗程未结束,症状消失,项目组有4例患者（3．60％）认为可以停止服药,而非项目组（缺项7例）有12例患者（10．81％）认为可以停止服药,差异有统计学意义（X2=4．31,P〈0．05）。结论通过全球基金流动人口项目有效的干预措施,项目地区流动人口肺结核患者的治疗依从性及正确服药意识显著优于非项目地区,不良反应发生率也低于非项目地区。     

北京口岸出境人员结核病防治知识知晓情况调查分析

目的 对北京口岸出境人员进行结核病防治知识知晓情况调查,为开展口岸结核病防控及其宣传教育提供依据.方法 采用《全国第五次结核病流行病学抽样调查现场知晓率调查问卷》设计的5条核心信息,及针对出境人员的检疫要求采用自行设计的6条信息,统计知晓率并分析影响因素.调查采用整群抽样,对2013年1月1日至12月31日经我部门进行出境体检的5290名体检者进行结核病防治知识知晓一对一问卷调查.5290份调查问卷全部收回有效,有效率100.00％.5条核心信息知晓情况采用二项分布Z检验、秩和检验,自行设计6条信息知晓情况采用F检验和f检验.以P＜0.05为差异有统计学意义.结果 （1）5条核心信息总知晓率为63.14％（16 700/26 450）.核心信息知晓情况的影响因素分别与性别、户籍、学历和职业等相关,其中男性（65.41％,7950/12 155）高于女性（61.21％,8750/14 295）（Z=6.428,P＜0.05）、15～岁年龄组（61.33％,5336/8700）低于其他年龄组[30～岁年龄组为64.01％（5518/8620）,45～岁年龄组为64.01％（4468/6980）,60岁年龄组为64.09％（1378/2150）]（Z=14.503,P＜0.05）;大专及以上学历人群（64.72％,9465/14 625）高于其他学历人群[小学组为59.09％（650/1100）,初高中＋中专为61.24％（6568/10 725）（Z=25.718,P＜0.05）;城市户籍人群（63.72％,14 475/22 715）高于农村户籍人群（59.57％,2225/3735）（Z=4.01,P＜0.05）;医务人员（75.22％,346/460）高于其他职业人群[管理技术人员为67.80％（4644/6850）,劳务人员为60.31％（7678/12 730）,留学生为62.73％（2942/4690）,商务人员为63.37％（1090/1720）（Z=114.227,P＜0.05）.（2）自行设计6条信息中“肺结核患者在迁徙中有病情加重及传播的风险”知晓率较高（65.52％,3466/5290）,“疑似肺结核时需要进行痰检”的知晓率较低（38.90％,2058/5290）.调查结果显示年龄和职业是知晓率的影?     

Tuberculosis control among homeless populations

The prevalence of tuberculosis infection and disease among homeless persons is high. Several recent outbreaks have been reported in shelters for the homeless. To address this problem, the Centers for Disease Control, Atlanta, convened a group of consultants who made the following recommendations: (1) Tuberculosis should be suspected and sputum samples should be collected from any homeless individual with a productive cough. (2) Diagnosed or suspected tuberculosis in a homeless individual should be immediately reported to the health department. (3) Therapy should be fully supervised by a responsible person, and an intensive multidrug, six-month regimen should be utilized whenever possible. (4) A contact investigation should be conducted around each infectious case, and preventive therapy should be prescribed for high-risk infected individuals. (5) Shelter staff should receive a tuberculin skin test when they start work and every six to 12 months thereafter. (6) Skin test reactors should be considered for preventive therapy according to current guidelines. (7) Installation of ultraviolet lights to reduce transmission should be considered in some situations.     

Amendment of tuberculosis prevention law and prospect of tuberculosis control program

Tuberculosis Control Law, which provides a legal basis for national tuberculosis control, was amended in 2004 and entered into force on April 1, 2005. As it is more than half a century since its initial enactment, the law has been drastically amended based on some of the relatively new important ideas such as up-to-date scientific evidence, recent epidemiological conditions of tuberculosis, decentralization and respect for human rights. Japan has once seen a time when considerable part of producing population were affected with tuberculosis which caused severe infliction on the whole Japanese society including economical damage. With progress in medical technology such as development of chemotherapy and improvement of sanitary conditions, there was a major decline in incidence rate and death rate during the 1960s and 1970s. However, the decrease in TB incidence began to stagnate in the 1980s, partly explained by aging of the overall society and worsening of the urban tuberculosis conditions. Since then, there has been a discussion on review of national tuberculosis control program, and the increase in the number of tuberculosis patients in 1997, which happened for the first time in 38 years, precipitated the process. In 1999, 'Tuberculosis Emergency Declaration' was announced by the Minister of Health, which led to emergency national tuberculosis survey in 2000, and based on the result came forward the Recommendation on Comprehensive Review of National Tuberculosis Plan. Main ideas and spirits of the Recommendation were taken full account of during the process of the amendment of the law and were mostly reflected on the final outcome. Five key elements include; Establishment of National Tuberculosis Fundamental Guideline and Prefectural Tuberculosis Prevention Plan, Review on TB screening, Review on BCG vaccination policy, Promotion of a Japanese version of DOTS, Review on Tuberculosis Advisory Committee 1. Establishment of National Tuberculosis Fundamental Guideline and Prefectural Tuberculosis Prevention Plan With a view to establishing a comprehensive plan in the context of local tuberculosis situation, it was deemed to be necessary for both the central government and local governments to set out a detailed and comprehensive plan that may supplement the newly amended law. Prior to the amendment of Tuberculosis Prevention Law, it was made obligatory in the amended Infectious Diseases Control Law for the central government to establish National Fundamental Guideline and for local governments to establish Prefectural Prevention Plan. 2. Review on TB Screening With a view to promoting early detection of tuberculosis, tuberculosis screening system was totally reviewed to be turned into more effective and efficacious means for the purpose. Previously, all people above 19 years of age were to be screened annually for tuberculosis with chest X-ray. By this means, however, only 1,600 tuberculosis patients were detected out of 20,000,000 people screened which means the detection rate is 0.0067%. Thorough analysis was made to identify who would benefit from regular X-ray screening in terms of detection of tuberculosis patients and was decided to be those who have certain risk factors to develop tuberculosis such as the elderly and socio-economically challenged people and those who, once develops tuberculosis, may easily infect others such as school teachers, healthcare workers and such. Also the procedure of contact trace was reviewed and in highly required cases, compulsory examination implemented by health care officers has become a choice. 3. Review on BCG vaccination policy Previously national BCG policy included BCG vaccination for young children who tested negative on tuberculin skin test before they become 4 years old. However due to low sensitivity of tuberculin skin test and resulting too many of false-positive cases, the estimated number of unnecessary chemoprophylaxis was thought to be more than justifiable. Also, as regards the timing for vaccination, it was'thought of as best to give BCG vaccination before one gets infected, which may happen even before 4 years of age. For reasons above, new national BCG policy include direct BCG vaccination for infants younger than 6 months of age. 4. Promotion of a Japanese version of DOTS DOTS (Directly Observed Treatment, Short-course) is, needless to say, a tuberculosis control policy advocated worldwide by World Health Organization (WHO) since early 1990s. Japan has a long history of supporting tuberculosis patients through various activities by health care workers such as home-visit follow-up, although it is worthwhile to note that in a newly amended law there is a reference to having patients take medicine in the law itself as direction by a doctor or a director of the public health care center. 5. Review on Tuberculosis Advisory Committee The Tuberculosis Advisory Committee is a regional commi- ttee that gives advice on issues such as treatment of tuberculosis and hospitalization order based on the law. The amendment includes review on committee members to select at least one committee member from non-medical staff from the perspective of human rights protection. We acknowledge this time's amendment of the law is a significant step forward in the history of national tuberculosis control and it is our sincere hope that this will eventually lead to great improvement of national tuberculosis condition.