Lessons from Africa: developing a global human rights framework for tuberculosis control and prevention

Background

Tuberculosis is a highly contagious disease, and there has been a rise in recent years of drug-resistant cases no longer responding to standard treatment.In order to address this threat and contain possible transmission of drug-resistant cases, some countries have taken strong action, including the compulsory detention of non-adherent drug-resistant patients. These measures have been strongly criticized by human rights advocates, and they raise the question of how to legally protect both citizens and the community.

Discussion

Following discussions with National Tuberculosis Programs in Africa (the continent with the highest incidence rates of tuberculosis worldwide), we show that of all the countries surveyed, all but one (Swaziland) had either no specific policy addressing tuberculosis, or only general policies regarding public health applicable to tuberculosis. Six countries also reported having policies that address non-adherence to treatment with containment (isolation in health facilities or incarceration), but laws are not adequately enforced. If the international community wants to effectively respond to the threat of tuberculosis transmission, there is a need to go beyond national tuberculosis policies and to implement an international framework for tuberculosis control, inspired by the Framework Convention on Tobacco Control, a key model for future public health treaties that address global burdens of disease. The framework, for which we clarify the conditions and procedures in this piece, would define the rights and responsibilities of the different stakeholders involved: patients, doctors, pharmaceutical firms and public authorities. To facilitate the governance of the national obligations under the Convention, a coordinating body should be set up, under the leadership of the World Health Organization and the Stop TB Partnership.

Summary

Successfully implementing policies for tuberculosis that simultaneously address patients’ rights and communities’ wellbeing will have positive implications for those affected by the disease and serve as a basis for other global health conventions to truly ensure the global right to health.

     

成都市霍乱预防控制策略框架构建与效果评价

目的 构建适合成都市本地资源优势和社会发展形势、可操作性强的霍乱预防控制策略框架并评价其应用效果. 方法 (1)对成都市1994-2004年本地霍乱疫情资料分析,确定本市霍乱防治工作存在的主要问题和已采用措施的有效性和不足,形成基本策略框架;(2)邀请55名专家对策略框架进行初步评分后,提取72项具体措施形成措施条目...     

Work related diseases and injuries on an oil rig

The analysis of diseases and injuries in the workers on an American oil rig, operating in the Mediterranean Sea, was done in the period of one year, from 1 May 1996 to 1 May 1997. In total, 518 medical examinations of sick and injuried workers were conducted. At the first place in morbidity, there were injuries and poisonings (26.7% of all registered cases). Then followed musculo-skeletal (17.5%), respiratory (14.2%), gastrointestinal diseases (12.1%), mental disorders (10.3%), nervous system (9.2%), skin (6.5%), urogenital (2.9%) and circulatory system diseases (0.6%). Out of all cases, the hand and finger injuries (48.3%) were most frequent, followed by injuries of the leg (13.4%), eye (11.3%), head and neck (10.1%), arm (7.9%), foot (6.7%) and trunk (2.3%). To reduce the incidence of diseases and injuries, special attention should be paid to the workers' basic medical education, to protective measures and providing first aid at the work site.     

Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review

The purpose of this review is to emphasize the role of tobacco prevention and control in cardiovascular health (CVH) promotion and cardiovascular disease (CVD) prevention, including the importance of these endpoints for measuring the full impact of tobacco-related policies, programs, and practices. In this review, we describe an overview of tobacco control interventions that have led to substantial declines in tobacco use and the relationship between these declines with CVH and CVD. We review interventions that have had success in high-income countries (HICs) as well as those that are gaining traction in low- and middle-income countries (LMICs). We emphasize the challenges to comprehensive tobacco prevention and control strategies faced by LMICs, and highlight the special role of cardiovascular health professionals in achieving CVH promotion and CVD prevention endpoints through tobacco control. Tobacco prevention and control strategies have a strong scientific basis, yet a distinct gap remains between this evidence and implementation of tobacco control policies, particularly in LMICs. Health professionals can contribute to tobacco control efforts, especially through patient-level clinical interventions, when supported by a health care system and government that recognize and support tobacco control as a critical strategy for CVH promotion and CVD prevention. Understanding, supporting, and applying current and evolving policies, programs, and practices in tobacco prevention and control is the province of all health professionals, especially those concerned with CVH promotion and CVD prevention. A new tobacco control roadmap from the World Heart Federation provides a strong impetus to the needed interdisciplinary collaboration.     

工伤事故的监测、预防和控制

在人类历史上．导致过早死亡的两大主要死因是传染病和意外伤害（包括工伤、交通事故、自杀和暴力等）;且仍继续是影响各国或地区期望寿命的决定因素。在发达国家,大多数传染病已被控制,但意外伤害仍在肆虐。在我国,城市居民中意外伤害死亡（损伤和中毒等）为第四位死因,而 在农村地区居民为第五位死因（６９．２２／１０万）,在上海,自 ８０年代初,意外伤害（中毒和损伤类）一直在死因谱中排 在肿瘤和心、脑血管疾病之后,位居第四位［１］,且近年有上 升趋势。此外,在我国３５岁以下人群,意外伤害所致的潜 在寿命损失年数占２…     

科学构建我国疾病预防控制绩效考核框架

介绍了科学构建疾病预防控制绩效考核框架的研究思路、方法与基本步骤：首先运用系统论和卫生系统宏观模型等方法初步形成考核的系统框架,包括社会环境、工作基础、工作过程、系统结果和健康结果5个维度;在此基础上借鉴层次结构分析理论和卫生系统宏观模型＂子模—概念/维度—指标＂的思路,实现对考核框架的层次化和条理化;经过反复的专家咨询与论证,确保了构建的考核框架与疾病预防控制工作紧密结合,实现对疾病预防控制绩效的系统表达,为确立绩效考核指标体系勾勒了框架范围。     

Pressure injuries: causes and prevention

Pressure injuries are caused by peripheral circulatory failure in acutely ill or traumatized patients, which is exacerbated by increased tissue deformability over bony prominences as a result of hypotension, dehydration or poor muscle tone.     

Alcohol-related injuries: evidence for the prevention paradox

PURPOSE The risk of an injury increases exponentially with alcohol consumption on a given occasion, but the conclusion that alcohol-related injuries are attributable primarily to heavy drinking may or may not be correct. The prevention paradox states that a large number of people at small risk may contribute more cases of a particular condition than a smaller number of people who are individually at greater risk. We sought to determine the extent to which the prevention paradox applies in the relationship between alcohol consumption and injury.     

浅谈地震灾区卫生防疫工作的几点体会

地震能造成大量人员伤亡,同时损坏房屋,破坏城市公用设施和自来水管网,破坏整个生态环境,灾区因此面临广泛的公共卫生问题.通过分析这次援川抗震救灾防疫工作的经验和不足,探讨解决地震灾区公共卫生问题时需开展的防疫工作内容及工作方法.我们认为在灾区应重视的公共卫生问题有饮水卫生、食品卫生、环境卫生等;应急救援队伍应及时总结经验,平时就要准备充分以备应急;灾区防疫工作应根据当地的具体灾情而分段有重点地展开.     

我院医疗质量监控体系的构建

在分析数据挖掘技术的基础上,围绕医疗质量和患者安全管理的目标,结合医院管理需求,对医院信息系统中的数据进行梳理、挖掘,并在必要时对电子病历系统的数据表进行有效的改造,初步构建了一套基于电子病历系统的具有实时监测和预警功能的医疗质量监控体系.整套体系包括危重病例监控、手术及有创操作监控、整体情况监控、中医特色优势应用情况监控4个系统.     

Developing a framework for comprehensive cancer prevention and control in the United States: an initiative of the Centers for Disease Control and Prevention.

The Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, is working with state health agency staff and other stakeholders to develop a comprehensive and integrated approach to cancer control. To help stakeholders visualize the approach, a graphic model was developed based on stakeholder input and a literature review of existing models. Phases of the model include setting optimal objectives (data driven), determining optimal strategies (science driven), establishing feasible priorities (capacity driven), and implementing effective strategies (outcome driven). The model currently is being validated through case studies of state-level cancer planning in six states.     

分级诊疗视角下传染病防治体系改革的战略选择——基于一种新型SWOT-CLPV分析模型

通过将SWOT-CLPV模型与利益相关者理论结合,构建了一种新型战略选择分析模型。与原有的SWOT-CLPV模型相比,新模型通过各元素所涉及的利益相关的数量为各元素赋予权重,可以量化分析系统的内外挑战,同时为决策者提供基于利益相关者的多维度分析视角,提高了分析结果的科学性和可靠性。据此模型对分级诊疗视角下传染病防治体系改革进行分析,确定了与传染病分级诊疗密切相关的6个利益相关方的抑制性、杠杆效应、脆弱性以及重大问题的数量及其内涵,厘清了利益相关者们之间的相互关系和基于利益的行事逻辑。据此结果,本研究认为贯彻以病人中心的医学服务理念、完善顶层设计、明确授权并建立问责机制、贯彻强基层战略、慎用医保梯度报销政策是推进分级诊疗政策,优化传染病防治体系行之有效的战略选择。     

Invasive meningococcal disease epidemiology and control measures: a framework for evaluation

Background  

Meningococcal disease can have devastating consequences. As new vaccines emerge, it is necessary to assess their impact on public health. In the absence of long-term real world data, modeling the effects of different vaccination strategies is required. Discrete event simulation provides a flexible platform with which to conduct such evaluations.     

内镜相关感染及其预防与控制研究进展

随着医疗技术的发展,内镜已广泛应用于临床诊断、治疗及科学研究中。但是近年来大量内镜相关感染不断被报道,其中也不乏暴发事件;由内镜相关感染引起的严重危害,在全球范围内是一个新的公共健康威胁,已引起医务人员和患者的高度重视,因此内镜的医院感染预防与控制工作显得尤为重要。近年来,国内外对内镜医院感染的预防与控制工作进行了大量研究,笔者就内镜的医院感染预防与控制措施及其效果进行综述,以期为内镜的医院感染防控提供借鉴。内镜作为一种侵入性的诊疗设备,直接接触患者体腔和黏膜,并且其材料和形状特殊、结构复杂,不耐高温高压,用后清洗消毒难度大,故易发生内镜相关感染,从2000年开始已出现多次因内镜污染而造成的病原菌感染暴发流行,见表1。病原菌有革兰阴性菌（主要为假单胞菌属）及革兰阳性菌（主要为葡萄球菌属）,部分内镜甚至检出多重耐药菌,如耐碳青酶烯类肠杆菌（CRE）［1］、多重耐药铜绿假单胞菌（MDRPA）［2］等;检出的病毒主要有乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）［2 3］,给内镜的消毒灭菌带来新的考验。内镜室医务人员在诊疗活动中不可避免的接触患者的血液、体液［4］,以及来自患者的多种致病微生物,如幽门螺杆菌、HBV、HCV、分枝杆菌、铜绿假单胞菌、葡萄球菌属和人类免疫缺陷病毒（HIV）等,故职业暴露发生率较高。     

Clinical prevention and population health: curriculum framework for health professions

The Clinical Prevention and Population Health Curriculum Framework is the initial product of the Healthy People Curriculum Task Force convened by the Association of Teachers of Preventive Medicine and the Association of Academic Health Centers. The Task Force includes representatives of allopathic and osteopathic medicine, nursing and nurse practitioners, dentistry, pharmacy, and physician assistants. The Task Force aims to accomplish the Healthy People 2010 goal of increasing the prevention content of clinical health professional education. The Curriculum Framework provides a structure for organizing curriculum, monitoring curriculum, and communicating within and among professions. The Framework contains four components: evidence base for practice, clinical preventive services-health promotion, health systems and health policy, and community aspects of practice. The full Framework includes 19 domains. The title "Clinical Prevention and Population Health" has been carefully chosen to include both individual- and population-oriented prevention efforts. It is recommended that all participating clinical health professions use this title when referring to this area of curriculum. The Task Force recommends that each profession systematically determine whether appropriate items in the Curriculum Framework are included in its standardized examinations for licensure and certification and for program accreditation.