衢州市柯城区2009-2013年暗娼人群艾滋病哨点监测结果及影响因素分析

目的了解衢州市柯城区2009-2013年不同档次暗娼的艾滋病知识和行为变化特征,以及艾滋病病毒(HIV)和梅毒感染的情况,为开展暗娼人群艾滋病行为干预工作提供依据。方法依据《全国艾滋病哨点监测方案》,于2009-2013年通过分层抽样方法抽取暗娼人群进行监测,资料采用SPSS 13.0统计分析。结果 5年间共调查暗娼1860名,暗娼艾滋病知识知晓率从2009年的70.47%上升到2013年的93.84%;安全套使用率从2009年的57.48%上升到2013年的94.50%。最近一个月安全套使用影响因素的分析显示,居住时间短、低档次、低学历、高年龄的暗娼安全套使用率最低。5年间暗娼人群均未发现HIV抗体阳性者,但梅毒检出率从2009年的1.57%上升到2013年的6.16%。其中主要是中低档次暗娼梅毒检出率上升。结论暗娼的艾滋病知识水平和安全套使用意识有了明显提高,但中低档次暗娼仍存在安全套使用率低、梅毒感染率高的现象,提示应以低档和中档暗娼人群为重点,加强和改进艾滋病行为干预工作,不断提高干预效果。     

2009-2011年上海市金山区暗娼哨点监测分析

目的了解金山区暗娼艾滋病性病流行状况及相关危险因素,为评估艾滋病性病防治工作及制定暗娼人群干预策略提供科学根据。方法采用问卷调查,现场收集金山区哨点监测对象的相关行为信息,并采集血液标本进行艾滋病病毒(HIV)、梅毒抗体检测。结果 2009-2011年,金山区暗娼艾滋病防治知识知晓率分别为82.0%、97.3%、86.3%,不同年龄段的暗娼对艾滋病知识知晓程度差异有统计学意义(χ2=47.35,P<0.01),且20～40岁年龄段艾滋病知识知晓率高于<20岁和>40岁年龄段。暗娼最近一次安全套使用率分别为56.9%、79.0%、87.3%,最近一次安全套使用率呈逐年上升趋势,差异有统计学意义(χ2=108.83,P<0.01)。暗娼对艾滋病防治知识知晓率不同与最近一次安全套使用率差异有统计学意义(χ2=18.04,P<0.01),安全套使用率随知晓率上升而上升。HIV抗体阳性率均为0,梅毒抗体阳性率分别为2.3%、3.8%、2.5%。结论通过采取综合性防治措施,暗娼艾滋病知识知晓率和商业性行为坚持使用安全套的比例在逐步上升。虽然HIV处于低流行态势,但存在性病流行,因此疫情存在上升风险,需不断开展干预和综合防治工作。     

2006-2008年北京市暗娼人群梅毒和HIV感染率及梅毒感染率影响因素

目的了解暗娼人群梅毒、艾滋病病毒（HIV）感染率及梅毒感染率的影响因素。方法根据《国家级HIV综合监测点监测方案》,2006—2008年,每年对北京市性服务场所进行分层抽样,对抽中的性服务场所内的暗娼进行HIV抗体检测、梅毒快速血浆反应素试验（RPR）检测和问卷调查。结果2006、2007、2008年,暗娼人群HIV抗体阳性检出率分别为0．12％、0、0．04％,梅毒RPR阳性率分别为1．2％、1．4％和0．8％。影响梅毒阳性率的因素包括：文化程度、婚姻状况、从事性服务的时间、最近一周客人数、与固定性伴发生性行为时安全套使用情况。结论暗娼的性病艾滋病风险不仅来源于商业性行为,还可能来源于非商业性关系。在开展艾滋病行为干预工作时,需要提示暗娼注意与固定性伴性关系中的疾病风险,并鼓励她们坚持使用安全套。文化程度低的暗娼应成为预防干预工作的重点。     

北京市石景山区暗娼和嫖客人群艾滋病相关知识和危险行为

目的了解石景山区暗娼（CSW）和嫖客人群艾滋病相关知识、危险行为以及艾滋病感染状况,为有针对性地开展干预工作提供依据。方法采用标准化问卷,匿名收集2010—2011年石景山区拘留所收押的暗娼和嫖客人群的信息,包括一般人口学特征、艾滋病相关知识知晓情况及艾滋病相关高危行为等,同时采集5mL静脉血检测艾滋病病毒（HIV）和梅毒皿清抗体。结果197名暗娼中检出1例HIV抗体阳性者,182名嫖客中未检出HIV抗体阳性者。暗娼梅毒抗体及梅毒快速血浆反应素（RPR）试验阳性率分别为8．1％和4．6％;嫖客梅毒抗体及梅毒RPR试验阳性率分别为6．6％和3．8％,暗娼和嫖客人群HIV和梅毒感染水平差异无统计学意义（P〉0．05）。暗娼和嫖客人群艾滋病知识知晓率分别为84．3％和89．0％,二者差异无统计学意义（x^2=1．831,P=0．176）。暗娼和嫖客自报最后一次商业性行为安全套使用率分别为83．2％和84．1％,二者差异无统计学意义（x^2=0．046,P=0．830）。暗娼最近一年接受过艾滋病干预服务的比例为45．7％,高于嫖客的22．5％（x^2=2．431,P=0．000）。暗娼最近一年做过HIV抗体检测的比例为35％,高于嫖客的11．5％（x^2=28．820,P=0．000）。结论暗娼和嫖客人群HIV感染较低,梅毒感染相对较高,传播风险不容忽视;今后应有针对性地开展艾滋病预防干预服务,扩大暗娼和嫖客人群的HIV抗体检测覆盖面。     

新疆伊宁市暗娼人群艾滋病哨点监测分析

目的了解新疆伊宁市暗娼人群艾滋病流行现状和相关危险因素,为制定综合防控措施提供参考依据。方法采用分层随机抽样法,抽取伊宁市从事商业性性交易的女性作为调查对象,每年不少于400人;使用国家哨点监测统一问卷调查艾滋病相关知识知晓情况,并检测HIV、梅毒和HCV抗体。结果 2009─2014年共监测暗娼2 400人,年龄最小13岁、最大55岁,平均年龄(25.4±7.4)岁;未婚占63.1%、新疆户籍占63.8%、汉族占74.1%、初中文化占53.7%;艾滋病防治知识总体知晓率为98.6%,最近一次发生商业性性行为时安全套总体使用率为99.3%,最近一个月发生商业性性行为时安全套每次使用率98.0%;检测HIV、梅毒和HCV抗体,阳性率分别为0.6%、2.2%和1.0%。结论伊宁市暗娼人群艾滋病相关知识知晓率及安全套使用率呈下降趋势,应调整对娱乐场所暗娼人群的干预模式,加强行为干预、规范性病诊疗工作,降低艾滋病发病率。     

2005-2009年江西省抚州市暗娼人群HIV及相关知识和行为变化趋势

目前,中国艾滋病流行的特点之一,是经性传播成为主要传播途径。暗娼人群在其中起到了重要的“桥梁”作用。为了解暗娼人群艾滋病、梅毒感染及相关知识和行为变化趋势,更好地实施干预活动,2005—2009年每年5月,抚州市疾病预防控制中心对市城区的暗娼进行了艾滋病病毒（Human immunodeficiency virus,HIV）、梅毒监测及相关知识和行为学调查,结果如下。     

常德市武陵区2010年暗娼人群艾滋病哨点监测分析

目的了解武陵区暗娼人群艾滋病相关知识、行为现状及艾滋病、梅毒、丙型肝炎(丙肝)的感染状况,为干预工作提供依据。方法按照《全国艾滋病哨点监测实施方案(试行)》(2010年版)要求,抽查辖区内暗娼人群进行问卷调查和艾滋病病毒(Human immunodeficiency virus,HIV)、梅毒、丙肝病毒(Hepatitis C virus,HCV)抗体的检测。结果共调查400名暗娼,年龄中位数26岁,25～47岁占55.00%,本省户籍占90.00%,初中及以下文化占79.00%,有过婚史或有固定性伴者占58.00%。艾滋病知识知晓率为80.00%,最近1次与客人发生性行为时使用安全套的比例,最近1个月与客人发生性行为时坚持使用安全套的比例,分别为94.00%和77.50%。最近一年做过HIV检测并知晓检测结果的占34.50%,HIV、梅毒、HCV抗体阳性检出率分别为0.25%(1/400)、3.25%(13/400)、1.25%(5/400),HIV确认阳性率为0.25%。对HIV感染者追踪调查发现,第二代和第三代HIV感染者各1例。结论低档次的本土暗娼是该区性服务场所的"主力军",尽管目前HIV、梅毒、HCV的感染率较低,但传播风险不容忽视,控制传播是现阶段艾滋病性病防控工作的重点。     

2009-2014年德州市不同档次暗娼艾滋病知识行为及HIV/梅毒感染状况调查

目的分析德州市不同档次娱乐场所暗娼的艾滋病知识、行为及艾滋病病毒(HIV)/梅毒感染状况,为制定有针对性的暗娼人群干预策略提供科学依据。方法于2009-2014年,对德州市不同档次娱乐场所的暗娼人群开展问卷调查及血清学监测。结果监测不同档次娱乐场所暗娼2218人,其中低档456人(20.56%),中档1340人(60.41%),高档422人(19.03%)。历年艾滋病知识知晓率分别为50.50%(202/400)、58.50%(234/400),87.50%(350/400)、98.25%(393/400)、87.47%(314/359)、93.82%(243/259)。20岁暗娼的艾滋病知晓率32.69%(17/52),20~29岁79.72%(1631/2046),30~39岁74.23%(72/97),≥40岁69.57%(16/23)。2009-2014年,最近一个月商业性行为安全套坚持使用率分别为30.50%(122/400)、39.00%(156/400)、59.25%(237/400)、58.50%(234/400)、65.46%(235/359)、72.97%(189/259);最近一年HIV检测率分别为20.50%(82/400),40.25%(161/400)、46.25%(185/400)、53.00%(212/400)、80.50%(289/359)、91.51%(237/259),呈逐年升高的趋势。HIV抗体检测全部阴性,梅毒确证阳性率2.03%(45/2218)。结论不同档次娱乐场所暗娼人群艾滋病认知及行为存在差异,应结合各自特征采取有针对性的健康教育及行为干预措施。     

攀枝花市少数民族与汉族暗娼艾滋病哨点监测结果分析北大核心

目的对比分析攀枝花市少数民族和汉族暗娼艾滋病哨点监测结果,为综合干预提供依据。方法利用2009-2013年攀枝花市艾滋病哨点监测资料,将暗娼按照"民族"分为少数民族暗娼和汉族暗娼,并对其艾滋病病毒(HIV)感染状况及相关行为进行分析。结果 2009-2013年,共监测暗娼3904人,汉族暗娼3354人,少数民族暗娼550人。少数民族与汉族暗娼的HIV抗体阳性率分别为2.5%(14人)、0.8%(28人),差异有统计学意义(χ2=12.992,P<0.001)。少数民族暗娼初中及以上文化程度占36.4%、艾滋病知识知晓率为88.4%、安全套坚持使用率为36.4%、吸毒比例为3.6%、做过HIV检测的比例为18.0%,分别与汉族暗娼的72.4%、93.0%、59.9%、1.7%、29.3%比较,差异均有统计学意义;少数民族与汉族暗娼接受过干预服务的比例分别为95.5%、95.4%,差异无统计学意义。艾滋病知识、民族、干预服务、户籍、文化程度、年龄、艾滋病检测、固定性伴、工作时间等,是暗娼坚持使用安全套的影响因素。结论少数民族暗娼更容易感染HIV,应提高暗娼综合干预工作的针对性和可接受性。     

2010-2012年黑龙江省暗娼人群艾滋病哨点监测结果分析

目的了解黑龙江省暗娼人群艾滋病病毒(HIV)、梅毒流行趋势,为相关防控工作提供依据。方法2010-2012年4-7月间,在黑龙江省19个国家级暗娼监测点以重复横断面调查方法,对娱乐场所暗娼人群进行问卷调查并采集静脉血检测HIV、梅毒抗体。结果 3年间共监测样本22 753例,监测对象HIV抗体阳性检出率(中位数)均为0;梅毒抗体阳性检出率(中位数)分别为:1.5%、1.23%、1.5%,各年低档场所暗娼的梅毒检出率分别为3.45%、4.58%、4.97%,高于高档场所的2.43%、1.76%、2.07%,且安全套持续使用率较低,3年分别为42.9%、76.1%、59.5%。各年≥30岁年龄组暗娼的梅毒检出率(2.83%、3.39%、2.95%)高于30岁年龄组(1.60%、1.75%、2.05%),2010、2011年≥30岁年龄组暗娼安全套持续使用率(46.8%、67.6%)低于30岁的(54.1%、72.4%),各年差异有统计学意义。结论低档场所≥30岁年龄组暗娼人群,是黑龙江省暗娼人群干预重点。应进一步探寻高年龄组和低档场所暗娼人群安全套使用率低及梅毒检出率高的原因,探索针对该人群的更为合理的干预模式。     

云南省施甸县1996～2005年输入性疟疾特点分析

施甸县1996～2005年共报告疟疾发病1736例,其中输入性病例1685例,占97.06%。1685例输入性病例分布在全县15个乡镇126个行政村;患者8～50岁的1628例,占96.62%;男性1548例,占91.87%;赴缅甸返回发病1568例,占93.06%;间日疟1388例,占82.37%;恶性疟247例,占14.58%;未分型50例,占2.97%。加强对外出务工人员疟防知识的宣传及对医务人员疟疾检验、诊断技术的培训,加强对输入性疟疾管理与监测将是施甸县今后疟防工作的重点。     

Effectiveness of a Screening Program for Hepatitis C

We sought to determine the outcomes of a screening program for hepatitis C virus (HCV) infection. Of 536 veterans initially screened between July 2000 and June 2001 for risk factors and then tested positive for antibody for HCV, only 260 (48.5%) kept their initial appointments for further evaluation; 51 were not viremic and only 19 (9.1%) were treatment eligible. Of the 276 who did not keep their initial appointments, 92 were subsequently evaluated over the next 2 years and 23 (25%) were treatment eligible, along with another 15 from the first group. Thus, with appropriate intervention and long-term follow-up, there were 57 treatment candidates. In conclusion, most veterans who tested positive either failed to keep their appointment or were ineligible for treatment when first evaluated. Over the following 2 years, some were lost to follow-up, many continued to have contraindication(s) to antiviral therapy, and relatively few were treatment candidates.     

刚地弓形虫VEG株速殖子感染宿主细胞最优接种比的曲线拟合分析

目的 探讨不同浓度梯度的刚地弓形虫速殖子体外感染对侵蚀宿主细胞能力的影响及二者之间的最优接种比。方法 依照耗材规格和建议上液量,将宿主Vero细胞依次铺入96孔、24孔、12孔、6孔细胞板和25T培养瓶后培养12 h;常规纯化和计数VEG株速殖子并倍比稀释出8个梯度,分别用来感染上述细胞,使首个感染量与宿主细胞铺入数相等;继续培养4 d后全量收集培养物,经DNA提取和Real-time PCR定量检测,以7种回归模型对所得速殖子数的均值进行拟合分析(n=3),选出最佳函数类型并求极值,以此明确弓形虫感染与宿主细胞间的接种关系。结果 Real-time PCR定量结果显示,VEG株速殖子最初感染量及所用耗材培养规格对弓形虫侵蚀宿主细胞的能力均有影响,并且四次多项式函数为弓形虫感染宿主细胞4 d时的最佳拟合曲线方程;经求导和求极值发现,同种耗材培养条件下,弓形虫VEG株速殖子感染数与宿主Vero细胞间存在最优接种比例关系。结论 96孔、24孔、12孔、6孔细胞板和25T培养瓶内弓形虫速殖子与宿主细胞间的接种比例依次为1/7.20、1/5.32、1/4.53、1/4.03和1/43.02。     

Use of record linkage to examine alcohol use in pregnancy

BACKGROUND: To date, no population-level data have been published examining the obstetric and neonatal outcomes for women with an alcohol-related hospital admission during pregnancy compared with the general obstetric population. This information is critical to planning and implementing appropriate services. METHODS: Antenatal and delivery admissions to New South Wales (NSW) hospitals from the NSW Inpatient Statistics Collection were linked to birth information from the NSW Midwives Data Collection over a 5-year period (1998-2002). Birth admissions were flagged as positive for maternal alcohol use where a birth admission or any pregnancy admission for that birth involved an alcohol-related International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) code. Key demographic, obstetric, and neonatal variables were compared for births to mothers in the alcohol group with births where no alcohol-related ICD10-AM was recorded. RESULTS: A total of 416,834 birth records were analyzed over a 5-year period (1998-2002). In this time, 342 of these were coded as positive for at least 1 alcohol-related ICD-10-AM diagnosis. Mothers in the alcohol group had a higher number of previous pregnancies, smoked more heavily, were not privately insured, and were more often indigenous. They also presented later on in their pregnancy to antenatal services and were more likely to arrive at hospital unbooked for delivery. Deliveries involved less epidural and local and more general anesthesia. Cesarean sections were more common to women in the alcohol group and were performed more often for intrauterine growth retardation. Neonates born to women in the alcohol group were smaller for gestational age, had lower Apgar scores at 5 minutes, and were admitted to special care nursery more often. CONCLUSIONS: This study shows that linked population-level administrative data provide a powerful new source of information for examining the maternal and neonatal outcomes associated with alcohol use in pregnancy.     

开放性骨折伤口感染创面细菌学观察及耐药性研究

目的探讨开放性骨折患者手术后伤口的细菌学特点及对抗生素的耐药性分析。方法为回顾性病例分析,本院2010年2月-2013年2月收治的开放性骨折手术后伤口感染患者152例,取伤口分泌物,做细菌学检查及药敏试验,分析不同细菌对抗生素的耐药情况。结果开放性伤口创面感染的细菌以G-杆菌为主,占51.45%,其中铜绿假单胞细菌占19.67%;G+球菌中以金黄色葡萄球菌为主,占19.32%,不同细菌对青霉素的耐药率较高,G+球菌对万古霉素敏感性最高,万古霉素为100%,即未发现耐药菌株;G-杆菌中大肠埃希菌菌数比例最高,13.5%,其对青霉素的耐药率为87.6%,对亚胺培南敏感性最高,为97.4%。结论开放性骨折患者手术伤口感染的细菌以G-杆菌多见,该组菌对万古霉素及亚胺培南均敏感。但不同种类的细菌其致病毒理有所变化,应结合临床经验,根据不同细菌学特点和药敏试验结果制定外伤后及术前、术中、术后的抗生素应用方案,并加强对患者伤口的护理,以控制或减少开放性骨折手术后伤口感染的发生。     

Health care expenditures for Medicaid‐covered males with haemophilia in the United States, 2008

Summary. Although haemophilia is an expensive disorder, no studies have estimated health care costs for Americans with haemophilia enrolled in Medicaid as distinct from those with employer‐sponsored insurance (ESI). The objective of this study is to provide information on health care utilization and expenditures for publicly insured people with haemophilia in the United States in comparison with people with haemophilia who have ESI. Data from the MarketScan^® Medicaid Multi‐State, Commercial and Medicare Supplemental databases were used for the period 2004?2008 to identify cases of haemophilia and to estimate medical expenditures during 2008. A total of 511 Medicaid‐enrolled males with haemophilia were identified, 435 of whom were enrolled in Medicaid for at least 11 months during 2008. Most people with haemophilia qualified for Medicaid based on ‘disability’. Average Medicaid expenditures in 2008 were $142,987 [median, $46,737], similar to findings for people with ESI. Average costs for males with haemophilia A and an inhibitor were 3.6 times higher than those for individuals without an inhibitor. Average costs for 56 adult Medicaid enrollees with HCV or HIV infection were not statistically different from those for adults without the infection, but median costs were 1.6 times higher for those treated for blood‐borne infections. Haemophilia treatment can lead to high costs for payers. Further research is needed to understand the effects of public health insurance on haemophilia care and expenditures, to evaluate treatment strategies and to implement strategies that may improve outcomes and reduce costs of care.     

Sensitivity and specificity of Anti‐HBc screening assays – which assay is best for blood donor screening?

Compared to HIV and hepatitis C virus, the residual infectious risk of hepatitis B virus (HBV) posed by blood products is about 10 times higher. In addition to HBsAg testing, screening for anti-HBc was recommended by the German Advisory Committee Blood in March 2005. Prevalence of anti-HBc in German blood donors was investigated at five test sites located in different geographic regions. In total, 12,000 blood donors were screened for anti-HBc by PRISM HBcore, and a statistically representative number of these were tested with Abbott Murex anti-HBc total, bioMérieux Hepanostika anti-HBc uniform, Bio-Rad Monolisa anti-HBc PLUS and Dade Behring Enzygnost anti-HBc. Anti-HBc repeat reactive samples were tested for anti-HBs, anti-HBe and HBV DNA by individual donation NAT. The mean prevalence of anti-HBc was 1.75% in donors that had not been tested for anti-HBc in the past. The percentage of anti-HBs in anti-HBc repeat reactive donors was 93.7%. Samples that were additionally reactive for anti-HBe were anti-HBc reactive in all tested assays. The sample to cut-off (S/Co) values for anti-HBc were lower (competitive assays) in samples that were also positive for anti-HBe, when compared to samples that were only anti-HBc reactive. Most commercially available anti-HBc assays provide sufficient sensitivity for routine screening purposes, and lacking specificity is no longer a serious issue for most of them. Assay differences were recognized for samples that were anti-HBc only reactive. The overall loss of 1.75% of positive testing donors can be significantly reduced to 0.45% by implementation of re-entry procedures for donors with an anti-HBs titre of over 100 IU/l and negative by sensitive ID-NAT.     

2009-2013年上海金山区疟疾疫情监测及流行特征分析

目的 分析上海市金山区2009-2013年疟疾疫情流行特征,为科学防治疟疾和消除疟疾目标提供依据. 方法 通过中国疾病预防控制网络直报系统收集金山区2009-2013年疟疾监测数据、流行病学调查资料数据,运用Microsoft Excel 2003软件进行统计学分析. 结果 2009-2013年,金山区共报告疟疾147例,其中死亡1例,未发现本地感染病例.发病月份以6-9月居多,有77例,占全部报告病例的52.38％.5年中报告的病例全部为输入性病例,感染来源地以非洲最多,有115例,占78.23％.病人户籍地主要来自江苏、浙江、上海、安徽,有90例,占全部报告数的61.22％.感染虫种分型以恶性疟原虫为主,有79例,占53.74％.年龄分布以20～49岁的青壮年为主,有113例,占76.87％.职业分布以境外务工人员和干部职员为主,有107例,占72.79％. 结论 2009-2013年,金山区未发现本地感染疟疾病例,全部为输入性疟疾,应重点加强对输入性疟疾的监测和防控.     

Predisposing factors and precipitants for bathing disability in older persons

OBJECTIVES: To identify potential predisposing factors and precipitants for bathing disability. DESIGN: Prospective cohort study. SETTING: Greater New Haven, Connecticut. PARTICIPANTS: Seven hundred fifty-four community-living residents aged 70 and older. MEASUREMENTS: Potential predisposing factors were measured every 18 months for 6 years during comprehensive home-based assessments. Participants were followed with monthly telephone interviews for a median of 61 months to ascertain exposure to potential precipitants, which included illnesses and injuries leading to hospitalization or restricted activity, and to determine the occurrence of persistent disability in bathing. RESULTS: Over the course of nearly 8 years, 333 (44.2%) participants developed persistent disability in bathing. After accounting for age, sex, and race, nine predisposing factors were independently associated with persistent bathing disability. The strongest associations were found for inability to rise from a chair, low bathing self-efficacy, and low physical activity, each of which more than doubled the risk of persistent bathing disability. After the potential precipitants were added to the final model, the associations between the predisposing factors and persistent bathing disability were only modestly diminished. The effects of the precipitants on persistent bathing disability were large, with multivariable hazard ratios of 24.6 for hospitalization and 3.01 for restricted activity only. The relative contributions of the predisposing factors and precipitants to the development of persistent bathing disability were 47.7% and 27.1%, respectively. CONCLUSION: Disability in bathing is attributable to a combination of predisposing factors that make community-living older persons vulnerable and intervening illnesses or injuries that act as precipitants. These factors and precipitants may be suitable targets for the prevention of bathing disability.