医务人员艾滋病病毒职业暴露

根据国务院防治艾滋病工作委员会办公室、卫生部、联合国艾滋病中国专题组联合发布的<2007年中国艾滋病防治联合评估报告>,截至2007年底,我国现存艾滋病病毒(HIV)感染者和病人约70万,其中艾滋病病人8.5万人.2007年,新发HIV感染者5万,因艾滋病死亡2万人.随着国家政策的倾斜,医疗卫生服务的可及性以及艾滋病感染者和患者就诊意识的提高,医务人员与他们的接触越来越多.     

HIV/AIDS workshop for primary health care staff

The purpose of this study was to develop and pilot a workshop to train general practitioners and other primary care workers to become competent in the primary, secondary and tertiary prevention of acquired immunodeficiency syndrome (AIDS). The development of the workshop took place at four venues in the South West Thames Region and involved 41 general practitioners and 33 primary care nurses. Questionnaire evaluation before and immediately after each workshop showed a significant improvement in participants' attitudes towards the prevention and management of human immunodeficiency virus (HIV) infection in general practice. We conclude that a suitably designed workshop can be effective in improving the attitudes of primary health care workers towards AIDS prevention and care.     

Survey of HIV/AIDS knowledge and attitudes of Kuwaiti family physicians

OBJECTIVES: This study aimed to explore Kuwaiti family physicians' attitudes and knowledge about HIV/AIDS. METHODS: One hundred and sixty-two Kuwaiti family physicians (95 females and 67 males) from all four health catchment areas have completed a 30-item self-administered questionnaire to measure HIV/AIDS-related attitudes and knowledge. RESULTS: Knowledge was lacking in areas dealing with HIV-related neuropsychiatric complications and other issues concerning HIV/AIDS, special populations and range of normal sexuality. The majority of physicians expressed negative attitudes toward homosexuality and about AIDS patients in general. Eighty-three per cent of Kuwaiti family physicians would opt out of treating AIDS patients. More than half of the physicians would avoid coming into social contact with HIV-seropositive persons. No significant difference was found for the total knowledge and attitude scores for gender. CONCLUSION: The results of this survey revealed that even in the second decade of the AIDS epidemic, some Kuwaiti family physicians continue to have a lack of proper knowledge about HIV and harbour negative attitudes toward AIDS patients. There is a need to promote an AIDS education early in the medical internship training years which addresses many underlying socio-cultural factors.     

A telemedicine service for HIV/AIDS physicians working in developing countries

In 2003, the Institute of Tropical Medicine (ITM) in Antwerp set up an Internet-based decision support service to assist health-care workers in the management of difficult HIV/AIDS cases. This service is available to physicians working in resource-limited settings. Between April 2003 and December 2009, the telemedicine service received 1058 queries, from more than 40 countries, mostly resource-constrained. In the first six years there were 952 queries, of which 459 (49%) were posted on the web-based telemedicine discussion forum and the rest sent by email. All queries were handled by a co-ordinator who forwarded them to a network of specialists, based at the ITM and at other institutions. The average time to provide a first reply was 24 hours. Almost half of the queries received in the first six years (n = 466) were related to the use of antiretroviral medications. The response rate to a user questionnaire was 19% (73 questionnaires returned out of 387 delivered): half of those (n = 37) came from active users and the remainder (n = 36) from clinicians who had never used the system. The user survey showed that telemedicine advice was valuable in the management of specific cases, and significantly influenced the way that clinicians managed other similar cases subsequently. Nonetheless, there was a declining trend in the rate of use of the service.     

Primary care physicians and barriers to providing care to persons with HIV/AIDS

Primary care physicians play an increasingly important role in the care of persons with HIV/AIDS due to the rising number and changing geographic distribution of persons infected with HIV/AIDS. The study explored the relationship between barriers to health services and the experience and willingness of primary care physicians to care for persons with HIV/AIDS. The study was based on a random survey of primary care physicians in South Carolina. The results indicate that although primary care physicians' willingness to treat persons with HIV/AIDS is significantly associated with many self-reported barriers (i.e., financial, structural, knowledge, and attitudinal), their HIV/AID care experience was most significantly correlated with self-reported knowledge that overrides financial and structural barriers. The results emphasize the importance of programs and policy initiatives aimed at enhancing the primary care physicians' knowledge level and improving their attitudes related to HIV/AIDS.     

Growing up with HIV/AIDS: a study on adolescents with HIV/AIDS and their family caregivers

This is an exploratory study with a qualitative approach, which looks at the adolescent process with HIV/AIDS. The purpose is to identify how the adolescent process occurs, from the perspective of these teenagers and their family caregivers. The investigation was performed in Porto Alegre, RS between May and July 2005, and the subjects were four adolescents and three caregivers. Data were collected by means of interviews, which were subject to the content analysis technique. The study revealed that both teenagers and family caregivers did not show concern with the changes typical of the period, especially regarding sexuality questions. Yet, the underlying diagnosis and coping with HIV remain in the family core in order to protect these agents against the stigma of the disease.     

Integrating HIV / AIDS care in family welfare services: the PSS experience

In India, participants of a consultative meeting in early February 1994 in Haryana State on STD (sexually transmitted disease) and AIDS prevention in family welfare programs and those at a December 1994 workshop in Jaipur State on integration of RTI (reproductive tract infections)/STD/HIV prevention activities into family welfare programs agreed on the need to broaden the scope of family welfare programs to include RTI/STD/HIV prevention and control. The meeting participants examined 4 case studies on the issue of RTI and STDs in the context of family welfare programs. One case study reviewed activities of the New Delhi-based Parivar Seva Sanstha (PSS), which provides comprehensive reproductive health services. All PSS staff have received training in HIV prevention. In Madras, PSS initiated a pilot project to integrate RTI/STD services into its mainstream family planning services. It tailored experiences of the Colombian Family Welfare Association (PROFAMILIA) to fit PSS project objectives. Formative research revealed that both men and women seek STD diagnosis and treatment services from the private sector despite the high costs and poor quality of care. Based on these findings and the PROFAMILIA experiences, PSS developed a model for integrated services for implementation, evaluation, and eventual replication. PSS has increased its focus on the use of condoms for contraception and HIV/STD prevention. All female clients now have access to standard screening, diagnosis, and treatment. PSS will create a new clinic offering reproductive health services for males. It will also develop systems for partner referral and community-based programs to provide education and motivation for family planning and RTI/STD/HIV prevention. Operational research will provide insight into the needs and perceptions of the population, process evaluation of the project, and RTI/STD/HIV control. Based on the case studies, certain ideas for future actions emerged (e.g., a major advocacy drive) as well as ideas for training, education, counseling, and social marketing and research and evaluation.     

Knowledge and attitudes of prison staff towards HIV/AIDS: a European study

The goal of this European pilot study was to evaluate the knowledge, attitudes and beliefs of prison staff from five countries towards HIV infection and to identify factors related to the potential discrimination of HIV-positive inmates. The survey revealed that the levels of knowledge with regard to HIV transmission and the degrees of tolerance varied significantly between prisons. A large proportion of staff overestimated the prevalence of HIV in their prison and feared being contaminated. The willingness of the staff to know the inmates' HIV seropositive status was negatively correlated to their level of tolerance; however, it was positively correlated to their knowledge of the modes of HIV transmission. This study underlines the necessity to improve HIV/AIDS prevention policy for prison staff in order to strengthen good practice in terms of managing the risk of contamination and hindering discrimination.     

Knowledge on,and attitude toward,HIV/AIDS among staff of an international organization in Bangladesh

Two hundred and ninety-three randomly-selected members of the staff of ICDDR,B: Centre for Health and Population Research were surveyed anonymously in June 1998, using a pre-tested and self-administered questionnaire, to assess their knowledge on, and attitude toward, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). All except 4 (1.4%) heard of AIDS. Main sources of information were radio and television (93%), newspapers and magazines (84.8%), posters and leaflets (70.2%), and friends (59.2%). About 94% of the respondents believed that HIV might spread in Bangladesh. Only 61.6% knew about the causative agent for AIDS. More than 96% had knowledge that HIV could be detected through blood test. The respondents were aware that unprotected sexual intercourse (92%), transfusion of blood and blood components (93.8%), sharing unsterile needles for injections (94.1%), and delivery of babies by infected mothers (82.7%) could transmit HIV. Similarly, the respondents had the knowledge that HIV infection could be prevented by using condom during sexual intercourse (85.5%), having sex only with an HIV-negative faithful partner (87.2%), avoiding transfusion of blood not screened for HIV (88.9%), and taking injections with sterile needles (86.5%). However, only 33.0% had the knowledge that HIV-infected persons can look healthy, and 56.4% were unaware of transmission through breastmilk. Most members of the staff, particularly at lower level, had misconceptions about transmission and prevention of HIV/AIDS. More than 40% of the respondents had the attitude that HIV-infected persons should not be allowed to work, while another 10% did not have any idea about it. The findings of the study suggest that the members of the Centre's staff have a satisfactory level of essential knowledge on HIV/AIDS, although half of them have poor attitudes toward persons with HIV/AIDS. Therefore, preventive strategy for the staff should be directed toward behaviour change communication.     

Public image and governance of epidemics: comparing HIV/AIDS and SARS

A comparative analysis of the 2002-2003 infectious disease outbreak, severe acute respiratory syndrome (SARS), and the HIV/AIDS epidemic that has affected the world over the past two decades reveals the significant role of socio-cultural beliefs and attitudes in the shaping of people's lifestyles and approaches to the control and prevention of epidemics. The main research question is: what can we learn from the SARS experience about effective prevention of HIV/AIDS? The sources of data include population figures on the development of these epidemics and findings from two sociological studies of representative samples of Singapore's multi-ethnic population. The comparative study illustrates the impact of cultural beliefs and attitudes in shaping the public image of these two different infectious diseases; the relevance of public image of the disease for effective prevention and control of epidemics.     

Evidence-based medicine in primary care: qualitative study of family physicians

Background

The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice.

Method

Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians.

Results

Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician.

Discussion

Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.

     

HIV/AIDS and home-based health care

This paper highlights the socio-economic impacts of HIV/AIDS on women. It argues that the socio-cultural beliefs that value the male and female lives differently lead to differential access to health care services. The position of women is exacerbated by their low financial base especially in the rural community where their main source of livelihood, agricultural production does not pay much. But even their active involvement in agricultural production or any other income ventures is hindered when they have to give care to the sick and bedridden friends and relatives. This in itself is a threat to household food security. The paper proposes that gender sensitive policies and programming of intervention at community level would lessen the burden on women who bear the brunt of AIDS as caregivers and livelihood generators at household level. Improvement of medical facilities and quality of services at local dispensaries is seen as feasible since they are in the rural areas. Other interventions should target freeing women's and girls' time for education and involvement in income generating ventures. Two separate data sets from Western Kenya, one being quantitative and another qualitative data have been used.     

The healthcare system in HIV/AIDS: an inextricable component in the experience of family care

Through a phenomenological study following van Manen's approach, family care experiences of caregivers and care receivers in the context of HIV/AIDS were studied in Mumbai, India. Data gathered through conversational interviews were analysed using the holistic and highlighting approaches. Interactions with the formal healthcare system contributed to the essential meaning of participants’ experiences even though the context of care was primarily familial. These interactions included instances of violations of testing and confidentiality guidelines and refusals to provide treatment in the private and some public health centres, and the provision of instrumental and affective support by the voluntary sector. The poor quality of care at public sector hospitals serving HIV-positive individuals was also described. The paper makes recommendations for improving the interventions of the healthcare system since experiences here are linked to the overall subjective experience of caregiving and care receiving.     

艾滋病医护人员工作压力源、应对方式与工作倦怠的关系

目的 了解艾滋病医护人员工作倦怠与工作压力源和应对方式的关系.方法 采用中式工作倦怠量表(CMBI),简易应对方武问卷(SCSQ)以及自编工作压力源问卷对342名艾滋病医护人员进行调查.结果 ①工作倦怠3个维度与工作压力源和应对方式的多个因素有显著相关关系(P＜ 0.05和0.01).②管理问题和职业风险的压力对情感耗竭以及职业风险对人格解体的预测作用均极其显著(P＜0.01);消极应对对于情感耗竭和人格解体具有显著正向预测作用(P＜ 0.01和0.05),而积极应对对成就感降低具有显著反向预测作用(P＜0.01).③Amos路径分析表明,职业风险的压力和消极应对方式直接影响情感耗竭和人格解体,人际排斥的压力直接影响成就感降低,而积极应对反向作用于成就感降低;消极应对在压力源和工作倦怠中起着部分的中介作用.结论 应当重视艾滋病医护人员的工作压力问题,指导他们使用积极的应对方式,以降低其工作倦怠水平,提高工作生活质量.     

Self-care and HIV/AIDS patients: nursing care systematization

This research aimed at systematizing nursing care to HIV/aids patients in view of Orem's Self-care Deficit Nursing Theory, using the convergent-care method and the Self-Care Nursing Process. Subjects were thirteen HIV/AIDS patients attended at a non-governmental organization in Fortaleza/CE, Brazil. We used interview techniques, physical examination, observation and information records, with a structured instrument, addressing requisites related to universal self-care, development and health alterations. Self-care deficits corresponded to nineteen nursing diagnoses, named according to NANDA's Taxonomy II, ten of which were based on the requisites for universal self-care, five on the requisites for self-care related to development and four on the requisites for self-care related to health deviations. In care planning, goals were established and the system and health methods were selected, prioritizing support-education actions in order to engage HIV/aids patients in self-care.     

HIV/AIDS and long-term care: A state perspective

Long-term care services for people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) were fostered in New York State by passage of HIV-specific regulations that set program standards and authorized reimbursement rates sufficient to support these standards. A rapid expansion of HIV-specific capacity has occurred. Demographic and selected clinical characteristics of the populations in AIDS residential health care facilities and AIDS adult day health care programs in New York State are presented. Aspects of the service models for these two program types that have changed to meet new needs are discussed. Ms. Chorost is from the Chronic Care Section, Division of HIV Health Care, AIDS Institute; Dr. Chesnut is from the Information Systems Office of the AIDS Institute.     

Self-reported HIV and AIDS experience, practices, and knowledge of Pennsylvania family physicians.

BACKGROUND: Patients with disease caused by the human immunodeficiency virus (HIV), while still more commonly treated in urban settings, are being seen in nonurban areas in numbers rapidly outstripping the local availability of specialists with expertise in HIV or acquired immunodeficiency syndrome (AIDS). METHODS: A questionnaire designed to measure self-assessed experience, practices, and knowledge regarding basic aspects of HIV was mailed in 1989 to the 2177 members of the Pennsylvania Academy of Family Physicians. RESULTS: The response rate was 72 percent. Approximately 95 percent of physicians surveyed had been asked questions by patients about AIDS, 30 percent had a patient with a confirmed positive blood test, and 27 percent had a patient with symptomatic HIV disease in their practice. CONCLUSIONS: Although most family physicians indicated that they were comfortable in recognizing persons at risk, counseling, and using tests to diagnose HIV and AIDS, more than one-half reported practice patterns at variance with published guidelines. Respondents were most uncomfortable with their knowledge and skills regarding legal issues, state and community resources, and caring for patients with AIDS. Continuing medical education courses at local hospitals and written materials were the two methods of AIDS education most likely to be used by respondents.