世界卫生组织和联合国儿童基金会对大规模免疫接种活动安全注射的政策宣言

１一次性注射器和注射针头的重复使用对公众致病和死亡具有极高的危险性。２由于一次性使用的自毁式注射器不能被重复使用，因此可以使人与人之间的血源性致病因子传播疾病的危险性降低。自毁式注射器是：（ａ）在预防接种工作中要首选的一次性注射器材；（ｂ）也是大规模...     

推广自毁式注射器可行性研究的框架与思路

我国卫生行政管理部门和国际组织十分关注不安全注射对我国人民健康造成的影响，积极探讨符合成本一效益的干预措施，减轻医源性感染造成的巨大经济负担。为此，联合国儿童基金会提出了“推广自毁式一次性注射器”的解决方案。其基本假设是：利用自毁式一次性注射器可以自毁、不可重复使用的特点，用技术手段纠正“只换针头，不换针管”的不安全注射行为，消除一次性注射器回流市场、重复使用的可能性，用经济可行的技术手段限制医生不良行为、弥补管理的不足。本课题对上述假设进行了可行性研究。     

自毁式注射器推广路漫漫

近日,在由中国医疗器械行业协会主办的“安全注射信息与技术研讨会”上,联合国儿童基金会的叶雷博士历陈一次性注射器的弊端和自毁式注射器的安全性,并希望自毁式注射器企业能在中国推广使用,希望国家药品监督管理局对生产自毁式注射器的企业进行有效监管。他同时还向与会者透露,到2005年,如果中国在免疫注射和医疗注射时使用这种产品的话,其需求量最高可达16亿支左右。     

“迈向安全注射”计划研讨会召开

中国医疗器械行业协会3月11～12日在北京召开“迈向安全注射”计划研讨会，以推动“自毁式注射器”在我国的生产和应用。据介绍，自2000年开始，世界卫生组织、联合国儿童基金会等国际组织就致力于推广安全注射技术和使用“自毁式注射器”。2001年1月1日始，联合国儿童基金会不再采购普通的一次性注射器，已有16个国家效法。此次研讨会上，联合国儿童基金会高级项目官员叶雷博士介绍了该组织在全球包括中国推动安全注射的宣传计划。摘自《健康报》2002. 3. 19. 第3版“迈向安全注射”计划研讨会召开     

自毁式注射器替代普通一次性注射器的成本-效益分析

目的：对自毁式注射器（AD）替代普通一次性注射器的安全注射措施进行成本－效益分析，探讨该措施的经济可行性。方法：现场调查乙型肝炎（乙肝）患者的直接医疗费用，并根据1998年国家卫生服务调查资料和现场调查结果，计算乙肝所造成的失能调整生命年损失及其疾病经济负担。将安全注射减轻的乙肝患者疾病负担作为效益指标，并将AD替代普通一次性注射器增加的直接费用作为成本，对该干预措施进行成本－效益分析。结果：2001年中国乙肝患者总的医疗费用为161．95－201．67亿元，年人均治疗费用为1755.38-1409.64元。AD代替普通一次性注射器方案的总成本比为32.46-97.39，具有良好的经济效益，且农村优于城市。当两种注射器的差价＞0．24元时，AD替代方案的直接效益成本比值开始＜1。结论：用AD替代普通一次性注射器的方法来解决安全注射问题在经济上是可行的，符合成本效益原则。     

甘肃省2006年预防接种安全注射现状调查分析

目的：通过对甘肃省2006年预防接种安全注射开展状况进行调查研究，了解在全球疫苗免疫联盟（简称GAVI）项目启动后，甘肃省基层接种点预防接种安全出现的新问题并提出改进策略。方法：采用分层多阶段抽样方法对全省20％的接种点进行安全注射现况调查。结果：调查接种点注射器使用以一次性和自毁型注射器为主，占68．47％；部分农村接种点仍有使用玻璃注射器现象，占3．23％，100％达到“一人一针一管”；使用后的一次性注射器安全处理率达95％以上，但各级仍存在丢弃、掩埋等不安全处理，约为3％～1％。结论：随着一次性注射器及自毁型注射器的推广使用，使用后如何合理回收和处理使用过的一次性注射器是目前安全注射面临的严重挑战，同时，卫生人员安全注射知识的强化和卫生管理的薄弱也是影响甘肃本省预防接种安全注射实施的因素。     

上蔡县预防接种安全注射现状调查

目的了解上蔡县基层预防接种安全注射现状,促进预防接种安全注射。方法采用分层多阶段随机抽样方法,对25个城乡基层接种点进行了预防接种安全注射现状调查。结果除1个接种点是一次性注射器与玻璃注射器混合使用外,其余均使用一次性注射器或自毁型注射器;99.2%的接种点实行了"一人一针一管"但仍有5.8%的接种点不能正确处理用后的一次性注射器。个别乡村医生不知道乙型肝炎疫苗的接种部位和贮存条件,存在不安全注射隐患。结论加强对基层计划免疫人员的培训及督导很必要。     

甘肃省部分县预防接种点注射器使用干预研究

目的：了解甘肃省全省预防接种注射器使用、处理情况，评价自毁型注射器（AD）在全省预防接种中的效果、影响，为卫生行政部门进行预防接种安全注射管理提供依据。方法：在全省按照典型抽样方法抽取3个县，设立对照组和干预组，采取问卷调查、现场观察等措施，并进行统计学分析评价。结果：干预前，对照乡和干预乡在预防接种工作中都使用一次性注射器，部分使用AD注射器，使用后仍有一定比例的接种人员采取掩埋、随意丢弃的方式进行处理；在干预后，干预组村医在注射器材使用后100％都能对使用后一次性注射器进行安全处理，并认为使用AD注射器可以促进安全注射工作，而对照乡人仍有部分村医不能正确处理使用后的注射器；干预乡的儿童监护人有152人（90．77％）选择使用AD注射器进行预防接种，明显高于对照组。结论：各接种点在配发足量的一次性白毁型注射器，以及对村医进行经常性、短期的强化培训，可以明显提高村医使用安全注射器以及正确处理注射器，达到安全注射的要求。     

山西省预防接种安全注射现状的调查

为了解山西省基层预防接种安全注射现状 ,促进预防接种安全注射工作 ,采用分层多阶段随机抽样方法 ,对1 2 0个城乡基层接种点进行了预防接种安全注射现状调查。结果显示 :除 1个接种点是一次性注射器与玻璃注射器混合使用外 ,其余均使用一次性注射器或自毁型注射器 ;99 2 %的接种点实行了“一人一针一管” ,但仍有 5 8%的接种点不能正确处理用后的一次性注射器。个别乡村医生不知道乙型肝炎疫苗的接种部位和贮存条件 ,存在不安全注射隐患。建议 :加强对基层计划免疫人员的培训及督导 ,对公众开展安全注射知识的宣传。     

四川省基层接种点安全注射现状调查结果分析

目的 了解四川省基层接种点预防接种安全注射现状以及接种人员和儿童家长对安全注射的认知水平,探讨控制不安全注射行为的策略. 方法用分层多阶段随机抽样方法抽取四川省150个抽样单位,采取现场调查和问卷的形式对150个基层接种点、310名接种人员、305名儿童家长进行调查,数据用Excel软件进行统计分析. 结果目前四川省基层接种点开展预防接种时全部使用一次性或自毁型注射器,比1999年一次性注射器的使用比例(45.60%)大幅度提高.作为医用垃圾统一运走和焚烧后深埋是四川省目前一次性及自毁型注射器使用后处理的主要方式(79.33%).基层接种人员对安全注射知识的认知水平较低,不合格率接近50%,尤以农村地区突出.儿童家长对安全注射的认知水平较好. 结论应采取加强基层接种点注射器使用后的处理回收、强化基层接种人员的安全注射意识和职业道德、加强督导调查以及开展广泛宣传等多项干预措施,提高四川省安全注射水平.     

以项目形式开展吸毒者艾滋病综合防治研究

目的：探索以项目的形式在静脉吸毒者中开展有效的艾滋病综合防治的模式.方法：建立项目管理机制;开展政策倡导、宣传教育、针具交换、自愿咨询检测、安全套推广、美沙酮社区维持治疗等综合防治活动,采取定量和定性方法进行效果评估.结果：吸毒者的艾滋病知识知晓率从23.9%上升到68.6%,最近1次和最近1月共用针具高危行为分别从32.0%和54.1%减少到7.0%和18.4%,多因素分析结果显示知识改变对行为改变起到的作用有限,采取多项综合防治措施对高危行为的改变起到正向作用.结论：以项目的形式在社区针对静脉吸毒者开展包括政策倡导、宣传教育、针具交换、自愿咨询检测、安全套推广、美沙酮治疗等的综合防治措施是控制HIV在静脉吸毒者中传播的有效手段.     

Health promotion projects: skill and attitude learning for medical students

OBJECTIVES: The aim of this health promotion project is to introduce students to appropriate skills and attitudes--as well as knowledge about health promotion strategies and methods. As part of this process, standardized procedures have been established to ensure that the projects are scientifically and ethically appropriate and adequately supervised. This project-centred course introduces the discipline of health promotion to third-year medical students at Monash University. It is aimed at introducing students to the range of health promotion concepts, providing them with experience of health promotion activities and involving them in consideration of the scientific, political and ethical issues arising from doctors' participation in health promotion. DESIGN: As the major learning and assessment component of the unit, students participate in self-selected project groups of three to five students. Each group develops a topic for a health promotion activity in the community, carries out that project and presents the results as a poster as well as a written report. SETTING: Monash University. SUBJECTS: Third-year medical students. RESULTS: Sixty per cent of each student's mark for the unit is based on the project. The posters produced by the project groups are placed on public display in a major teaching hospital for a week at the end of the unit. Public display of the posters helps each student to appreciate the variety of possible health promotion activities, and to appreciate health promotion as a scientific discipline. It also makes the project findings available to the public. CONCLUSIONS: Student evaluation of the project, and community response to the projects--especially the poster display-- indicate that the project is both a highly effective learning experience and a health-promoting activity in its own right.     

The impact of a needle exchange's closure

OBJECTIVE: The Windham, Connecticut, needle exchange closed in May 1997 after becoming embroiled in a public controversy in which it was blamed for the city's drug problem, discarded syringes, and even the economic decline of the city itself. The authors interviewed injection drug users and conducted a community survey of discarded drug paraphernalia to explore the effects of the needle exchange's closure. METHODS: After the needle exchange was closed in March 1997, the authors re-recruited former participants in an AIDS prevention research project, the majority of whom were clients of the needle exchange. The authors analyzed responses from these respondents' pre-closure interviews and from III post-closure initial interviews and 78 post-closure follow-up interviews as well as data on discarded syringes and "dope bags". RESULTS: Following the closure of the needle exchange, significant increases were found in the percentage of respondents who reported an unreliable source as their primary source of syringes, in respondents' reports of the frequency of reusing syringes, and in the percentage of respondents who reported sharing of syringes. Surveys of outdoor drug-use areas found that the closure of the needle exchange did not reduce the volume of discarded syringes and other drug-injection debris. CONCLUSIONS: The problems in Windham that led to the closure of the exchange still remain, and the city's drug injectors are engaging in higher levels of HIV risk behavior.     

北京市239厂健康促进项目中期评估报告

目的 对北京市239厂2001-2003年期间健康促进干预的效果进行评估。方法 调查239厂职工吸烟、饮酒、不参加体育锻炼的情况，对不健康行为进行干预。结果 职工吸烟率、饮酒率、不参加体育锻炼率等下降，职工健康知识知晓率提高，项目覆盖了65％的人群，79％的职工对健康教育表示满意。结论 239厂健康教育工作得到了加强，多部门合作的机制已形成。工厂还要加大多部门配合，提高群众参与健康促进的力度。     

Gesundheitsförderung im oetrieb — was kann die sportwissenschaft beitragen?

Within the sport science there is currently a surge of interest in the topic sport and health. It is widely acknowledged that physical activity can contribute to the improvement of physical health resources. As a result of these findings, concepts have been developed on how to improve physical health through physical exercise. They have centred on influencing the cardiovascular system, as well as the musculoskeletal system. Apartfrom looking at the physical effects of sporting activities, further investigations have become increasingly concerned with their psychological effects. The concepts for health promotion, developed due to these studies, focused themselves at models such as Antonovsky’s idea of “saluto-genesis”, which were seen as also suitable for use in worksite health promotion. A research project, investigating the problems of transposing those models, identified the typical users of behavioural workplace health promotion programs as persons who already enjoy a marked awareness on health issues. Real risk persons however were hardly achieved. On balance, it is inevitable that workplace health promotion, that contains only behaviour prevention, will remain limited in its effect. Apartfrom the unsatisfactory range of employees attracted by worksite health promotion programs, it was estimated that around only about five to ten per cent of the enterprises offer health promotion. For clarifying the actual spreading representative surveys were conducted at about one thousand private and public sector companies. The results indeed showed that, in many businesses measures of workplace health promotion were yet to be implemented but that health promotion, in the sense of an integrated, interdisciplinary process, existed in only ten to fifteen per cent of the enterprises. In particular small and medium-sized businesses still need more information on the subject of health promotion, accompanied with an intensified support by experts of the health promotion.     

Health promotion in the medical curriculum

It has been argued that health promotion should be included in the medical curriculum, if medical education is to match the needs and health goals of communities. In spite of the medical profession's awareness of the importance of health promotion, few universities in the UK have introduced a substantive course on the subject. This paper describes the teaching of health promotion in Nottingham Medical School. It identifies the aims and objectives of the course which are amongst others to develop an understanding of: the factors which influence the perception and experience of health and illness; the concepts of health promotion and health education; the scientific basis of health promotion; the relative effectiveness of approaches used; the measurement of health status and health behaviour; and health policy and planning. An innovative element of the teaching involves a community project which gives students experience of health promotion in practice. Evaluation of the impact of the course suggests that students perceive it to be interesting, stimulating and enjoyable, whilst examination and continuous assessment indicate that it has also influenced students' knowledge and understanding of the subject.     

Ongoing use of conventional devices and safety device activation rates in hospitals in Ontario, Canada

This study assessed voluntary compliance with the use of sharp safety devices in lieu of conventional ones and the activation status of these safety devices: VanishPoint syringes, Terumo Surshield butterflies, and Insyte Autoguard IV catheters. Sharps disposal containers from various wards in three private, not-for profit, university-affiliated Ontario hospitals were audited during 9 days in August 2007. In the 149 audited sharps containers, 55% of all syringes found were conventional compared with 45% that were safety syringes. In the three hospitals, the percentages of conventional (non-safety) vs. safety syringes found in used sharps containers were as follows, respectively: (i) 72% conventional and 28% safety, (ii) 55% conventional and 45% safety, and (iii) 65% conventional and 35% safety. In addition, it was found that 77% of 2131 Terumo butterflies, 97% of 1117 Insyte Autoguard IV catheters, and 87% of 4897 VanishPoint syringes in the containers had been activated. This study, carried out approximately 1 year before it was legally required to use safety instead of sharp conventional devices, found that most devices in use were conventional ones. It was also found that only the activation rate for the safety IV device was acceptable.     

Editorial – What is health promotion ethics?

What does it mean to think about the ethics of health promotion? When most of us think ‘ethics’ we think of the Human Research Ethics Committee applications required for research projects. But I'm thinking of something quite different here: the ethics of health promotion practice. Health promotion ethics is an attempt to answer questions such as: Can we provide a moral justification for what we are doing in health promotion? or What is the right thing to do in health promotion, and how can we tell? As other authors have argued, sometimes these questions are ignored in health promotion in favour of scientific and technical questions about effectiveness. But there is increasing recognition that health promotion is a moral project, that health promotion can be practised in ways that are more or less ethical, and thus that considering ethics in health promotion is just as important as – and related to – considering the evidence about whether or not health promotion works.