网络直报肺结核病人不到位原因分析

目的探讨综合医院网络直报肺结核病人到位情况,分析不到位的相关因素。方法对2007年1～12月网络直报肺结核病人到位情况进行分析汇总,对追踪未能到位的585病人进行相关因素分析。结果辖内综合医院网络直报辖内肺结核病人2 062例,转诊主动到位453例,需要追踪1 609例,实际追踪1454例,追踪到位869例,总体到位1 322例,总体到位率64.1%,未追踪到位585例（40.2%）,其中其他原因拒治146例（25.0%）,地址不详120例（20.5%）,查无此人86例（14.7%）,住院109例（18.6%）,其他71例（12.1%）,外出33例（5.6%）,死亡20例（3.4%）。城市到位率高于农村到位率（P〈0.05）。综合医院查痰者拒治率明显小于未查痰者（P〈0.05）。结论影响综合医院网络报告肺结核病人不到位因素有多个,除结防机构自身未追踪因素外,拒治、地址不详、查无此人为主要因素,占不到位病人总数的50%,占追踪不到位人数的60%。     

海宁市传染病网络直报系统结核病发现情况分析

为进一步提高全市肺结核病的发现率，推动全市结核病防治工作水平的提高，从2004年开始，通过中国传染病网络直报系统强化对我市肺结核病人的搜索，并对发现的病人实施归口治疗和督导管理，取得了显著成效，现将实施情况和效果报告如下。     

网络直报方式对提高传染性肺结核发现率的评价

目的评价网络直报对提高传染性肺结核发现率的作用。方法对杭州市2003年传统的邮寄传报卡与2004年实施网上直报后的涂阳肺结核报告登记及检查资料进行分析。结果全市2004年肺结核转诊到位率为87．31％，比2003年的83．94％提高了4．01％，涂阳肺结核新登记率达30．00／10万，比2003年的21．77／10万上升了37．80％，其中新涂阳登记率达23．16／10万。经统计学处理，两者差异有统计学意义。结论网络直报信息的快捷、即时性有利于对肺结核病人的追踪，对有效提高传染性肺结核发现率有重要的意义，充分利用网络直报信息对病例及时核对、追踪是至关重要的。     

结核病网络专报系统对提高肺结核病人发现水平的分析

目的讨论通过结核病网络专报系统,综合医院转诊可疑肺结核对提高病人发现的作用。方法加强干预,规范转诊登记程序和追踪制度,实施转诊激励政策和健康促进。结果 2005-2007年内发现涂阳病人35 457例,和专报系统实施前三年比增加21 852例,增加160%,其中医院转诊发现涂阳病人13 986例,增加42.2%。转诊人数、到位人数有非常明显提高,查痰率提高了13个百分点,涂阳检出率无变化。结论利用专报系统,加强医防合作,建立完善的报告、转诊、追踪制度是提高病人发现水平的重要途径。     

激励机制对提高肺结核病人发现率的影响

[目的 ]评价激励机制对提高肺结核病人发现的影响。[方法 ]对 2 0 0 1— 2 0 0 3年全省结防工作季报表、年报表及2 0 0 3年项目调查表进行统计分析。[结果 ]①项目县病人发现速率高于其他县的平均水平 ,2 0 0 3年增长率分别为 3 2 2 %、18 9% ;比 2 0 0 2年同期多发现 5 72例涂阳病人 ;②完成病人发现指标的县数明显增多 ;③涂阳病人治疗达到预期效果 ,治愈率达 85 %以上。[结论 ]激励机制可调动工作人员的积极性 ,提高发现病人的水平。     

盐城市肺结核病网络直报转诊和追踪工作情况分析

开展非结防机构可疑肺结核病人网络直报,积极发现、转诊和追踪肺结核病患者,特别是传染性肺结核病患者,可以使其尽早获得规范的治疗和管理,消除传染性,恢复健康。盐城市自2004年8月开展此项工作以来,陆续采取了多项措施,提高了转诊和追踪到位率。现将2005年~2006年的资料分析报告如下。1材料与方法1.1资料按网络直报时间,2004年8月~2006年12月中国结核病控制工作月报表,非结防机构网络报告转诊追踪病人登记本、初诊病人登记本和结核病人登记本。1.2方法按照要求,医疗机构(非结防机构)对发现的可疑肺结核病人进行登记,开具三联转诊单,分别交…     

龙岩市农村肺结核病患者发现情况分析

目的为了解农村结核病患者发现状况,有效指导结核病防治工作。方法通过对乡镇卫生院可疑肺结核病患者发现情况进行调查分析。结果14家卫生院7个月共登记肺结核可疑症状者和疑似病例141例,最多的一家卫生院发现66例,4家为0例,平均每家卫生院每月发现可疑肺结核患者1.4例。结论乡镇卫生院可疑肺结核患者发现很少,必须加强卫生院对结核病患者的发现工作。     

军队卫生统计网络直报系统设想

本文阐述了军队卫生统计网络直报必要性和可行性,重点提出网络直报的基本思路、总体目标、建设原则、直报流程、上报内容、硬件环境,以及具体组织实施步骤。     

河南省2006～2009年非结防机构网络直报肺结核病人发现情况分析

目的根据网络直报信息分析我省非结防机构肺结核病人发现转诊工作中存在的成绩和问题,为进一步完善和制订非结防机构疑似肺结核病人的转诊报告工作提供参考。方法收集和分析2006～2009年河南省非结防机构网络直报肺结核病人转诊/追踪情况报表及结防机构结核病控制工作报表资料。结果 2006～2009年河南省非结防机构疑似肺结核病人的总转诊到位率逐年上升,从30.8%上升到89.6%,直接转诊到位率和追踪到位率均有所上升,但4年间仍有45.3%的可疑病人没有到结防机构就诊,有40.5%的人没有追踪,有0.98%的人拒绝转诊,2.4%的病人追踪未到位。结论 2006～2009年河南省非结防机构疑似肺结核病人的转诊到位率和追踪到位率逐年提高,但仍有部分疑似病人丢失现象,病人的追踪工作需进一步加强。     

阜新市结核病疫情网络直报前后病人发现比较

2004年1月1日起,我国结核病疫情报告已由过去每月按行政单位逐级上报改为全部医疗机构网络直报,满足了结核病疫情监测和疑似结核病人追踪的要求。本文分析比较了辽宁省阜新市网络直报前后结核病人发现方式和发现数量的变化,以评价网络直报系统运行的意义和效果。现报告如下。     

结防机构与医疗机构合作提高肺结核患者发现率

目的了解目前医疗机构与结防机构间合作提高肺结核患者发现方法的实施效果及存在问题。方法采用回顾性调查方法,调查各县区结防门诊根据转诊登记资料、追踪登记表和日常对医疗机构的督导记录;搜集综合医疗机构结核患者发现、报告以及转诊情况数据,搜集医疗机构发现患者到结防机构后诊断复核情况。结果①城市和农村地区医疗机构发现肺结核患者的报告和转诊情况有差异,报告情况城市好于农村,转诊情况农村好于城市;②医疗机构发现肺结核患者的查痰率低仅为13.3%;③结防机构对医疗机构发现未到结防机构就诊肺结核患者的追踪率为94.1%,不同追踪方式追踪到位情况有差异,结防机构医生追踪到位情况最好,到位率为74.2%。追踪未到位原因主要是报告卡姓名或地址等信息有误和患者住院治疗;④实施医疗机构与结防机构间合作措施后,被调查地区结防机构的就诊人数和发现的活动性肺结核患者数均较去年同期增加。结论医疗机构与结防机构间合作实施结核病控制,可提高肺结核病患者发现数量和治疗管理质量。     

对不同人群采用不同方法肺结核病人检出率的研究

目的 了解我国目前肺结核可疑症状者在全人口中的比例和不同人群不同方法肺结核病人检出率。方法 对无肺结核可疑症状者和有肺结核可疑症状者，分别采用胸透筛选、直接摄片、直接痰菌检查等不同方法对照研究。结果 有肺结核可疑症状者占全人口的1．27％；无症状者采用胸透筛选法检出活动性病人数、菌阳病人数和涂阳病人数分别仅占无症状者人数(受检人数)的0．13％、0．04％和0．03％，有症状者检出活动性病人数、菌阳病人数和涂阳病人数分别占有症状者人数(受检人数)的16．82％、7．98％和6．。76％。有肺结核可疑症状者采用：直接摄片的活动性肺结核病人、菌阳病人和涂阳病人检出率，分别为17．92％、8．37％和6．83％；直接痰培养的菌阳病人检出率为8．95％。直接痰涂片：2个痰标本与3个痰标本的涂阳病人检出率分别为6．17％和7．08％。结论 1．27％的全人口肺结核可疑症状者是评价可疑症状者就诊率的指标；对咳嗽、咳痰≥3周或有咯血的肺结核可疑症状者进行检查是最符合成本效益原则的结核病人发现方法。对有肺结核可疑症状者应当采用直接摄片法和3个痰标本进行病人发现；直接痰培养的菌阳病人检出率最高，有条件的单位可开展痰培养检查。     

Substandard and Falsified Medicines: Proposed Methods for Case Finding and Sentinel Surveillance

The World Health Organization and others warn that substandard and falsified medicines harm health and waste money, especially in low- and middle-income countries. However, no country has measured the market-wide extent of the problem, and no standardized methods exist to estimate the prevalence of either substandard or falsified medicines. This is, in part, because the task seems overwhelming; medicine markets are huge and diverse, and testing medicines is expensive. Many countries do operate some form of postmarket surveillance of medicine, but their methods and goals differ. There is currently no clear guidance on which surveillance method is most appropriate to meet specific public health goals. In this viewpoint, we aimed to discuss the utility of both case finding and risk-based sentinel surveillance for substandard and falsified medicines, linking each to specific public health goals. We posit that choosing the system most appropriate to the goal, as well as implementing it with a clear understanding of the factors driving the production and sale of substandard and falsified medicines, will allow for surveillance resources to be concentrated most efficiently. We adapted principles used for disease outbreak responses to suggest a case-finding system that uses secondary data to flag poor-quality medicines, proposing risk-based indicators that differ for substandard and falsified medicines. This system potentially offers a cost-effective way of identifying “cases” for market withdrawal, enhanced oversight, or another immediate response. We further proposed a risk-based sentinel surveillance system that concentrates resources on measuring the prevalence of substandard and falsified medicines in the risk clusters where they are most likely to be found. The sentinel surveillance system provides base data for a transparent, spreadsheet-based model for estimating the national prevalence of substandard and falsified medicines. The methods we proposed are based on ongoing work in Indonesia, a large and diverse middle-income country currently aiming to achieve universal health coverage. Both the case finding and the sentinel surveillance system are designed to be adaptable to other resource-constrained settings.     

Patient Diagnostic Rate as Indicator of Tuberculosis Case Detection,South Africa

To address the uncertainty of the indirectly measured tuberculosis case detection rate, we used survey data stratified by HIV status to calculate the patient diagnostic rate, a directly measurable indicator, in 8 communities in South Africa. Rates were lower among HIV-negative than HIV-positive persons. Tuberculosis programs should focus on HIV-negative persons.     

结防机构与综合医院合作提高肺结核患者发现率和转诊到位率

目的探索加强结防机构与综合医院的合作,运用传染病网络报告系统,达到提高肺结核患者发现率和转诊到位率的目标。方法实施全球基金第四轮结核病控制项目,加强结防机构与综合医院合作,开展结核病网络直报、转诊和追踪管理,强化工作制度和实行奖励措施,建立医疗单位结核病网络报告、转诊和追踪的有效机制。结果新发涂阳肺结核病登记率从18.5/10万上升到实施项目后的40/10万,新发涂阳肺结核患者发现率提高了116%;转诊到位率从54%上升到66%。结论通过加强结防机构与综合医院合作,能有效提高肺结核患者发现率和转诊到位率。     

农村社区慢性咳嗽患者线索调查主动发现结核病人的效果分析

目的探讨通过社区慢性咳嗽患者线索调查主动发现肺结核病人的方法及效果。方法以江苏省扬中市为研究现场,按照分层随机抽样的原则选择5个镇21个村的15岁以上常住居民为研究对象,利用入户询问的方法筛查出有连续咳嗽3周以上病史的结核病可疑症状者,然后对他们进行痰涂片和X线检查进一步明确诊断。结果33549人中发现有慢性咳嗽史的可疑症状者170名,罹患率5.1‰(男性6!1‰,女性4!1‰)。随年龄增加,罹患率相应增加,65岁以上人群的罹患率明显高于低年龄组。可疑症状者中152人参加了痰涂片检查,痰检率为89.4%,128人参加了胸部X线检查,X线检查率为75.3%。新发现8例肺结核患者,可疑症状者结核病检出率为5.2%(男性7.9%,女性1.6%)。8例新发现肺结核病例中,X线检查阳性而痰涂片阴性的有4例,痰涂片阳性而X线检查阴性的1例,两种筛查方法均阳性的3例。比较性别、年龄、文化程度、婚姻状况、经济状况和本次咳嗽就诊史等主要特征对可疑症状者参加X线检查和痰涂片检查的影响情况,未发现2组人群间存在有统计学意义的差异。结论以慢性咳嗽为主要症状的可疑者筛查结合痰涂片和X线确诊的方法是目前农村主动发现结核病传染源的有效途径,但如何提高可疑症状者的就诊依从性值得进一步探讨。     

Cohort Profile: Korean Tuberculosis and Post-Tuberculosis Cohort Constructed by Linking the Korean National Tuberculosis Surveillance System and National Health Information Database

We aimed to review the current data composition of the Korean Tuberculosis and Post-Tuberculosis Cohort, which was constructed by linking the Korean Tuberculosis Surveillance System (KNTSS; established and operated by the Korean Disease Control and Prevention Agency since 2000) and the National Health Information Database (NHID; established by the National Health Insurance Service in 2012). The following data were linked: KNTSS data pertaining to patients diagnosed with tuberculosis between 2011 and 2018, NHID data of patients with a history of tuberculosis and related diseases between 2006 and 2018, and data (obtained from the Statistics Korea database) on causes of death. Data from 300 117 tuberculosis patients (177 206 men and 122 911 women) were linked. The rate of treatment success for new cases was highest in 2015 (86.7%), with a gradual decrease thereafter. The treatment success rate for previously treated cases showed an increasing trend until 2014 (79.0%) and decreased thereafter. In total, 53 906 deaths were confirmed among tuberculosis patients included in the cohort. The Korean Tuberculosis and Post-Tuberculosis Cohort can be used to analyze different measurement variables in an integrated manner depending on the data source. Therefore, these cohort data can be used in future epidemiological studies and research on policy-effect analysis, treatment outcome analysis, and health-related behaviors such as treatment discontinuation.     

城市结核病控制中的问题与对策的案例研究

目的深入地分析上海市结核病诊断治疗和管理中存在的问题，为防制决策服务。方法对上海市某区疾病预防控制中心1999—2003年期间的日常结核病报表资料进行分析。结果暂住人口结核病登记率低于本地人口，暂住人口结核病患者诊断后失访率远高于本地人口，已知治愈率远低于本地人口。暂住人口结核病患者中痰菌阳性的比例高，绝大部分是自费医疗，暂住人口大部分病人首诊不在定点医院。暂住人口结核病的防治管理亟待改善。结论要进一步控制城市的结核病流行，除了要在提高结核病发现率方面采取措施外，更重要的是改善暂住人口的结核病患者管理和规范治疗，同时户籍人口的结核病患者的诊断治疗管理也有待改善。     

武汉市居民死亡漏报调查及死因监测质量评价

摘要：目的了解武汉市居民死亡个案的漏报情况，评价死因监测系统报告的完整性与准确性。方法采用多阶段分层随机整群抽样方法，从武汉市13个行政区抽取26条街道、乡镇的104个社区居委会、自然村作为抽样点，从武汉市死因监测系统之外的多种渠道收集2007-2008年间抽样点居民死亡数据，与死因监测系统死亡报告数据进行比较，计算漏报率。，对抽样点死因监测系统死亡报告卡进行审核，评估死因诊断的可靠性和编码质量。结果抽样点总死亡漏报率为7．90％，其中，中心城区2．11％，远城区为14．69％，城乡之间差异有显著性（x2=170．913，P〈0．001），死因监测系统数据总体完整性较好；死者生前最高诊断单位达到区县级及以上医疗机构占78．70％，未就诊的比例较低（7．10％），死因诊断可靠性较高；全市死因编码不准确率为8．48％，编码错误率为4．12％，编码质量合格。结论武汉市死因监测质量较好，在全人群的范围内能合理反映全市居民的死因模式。     

The Organizational Structures and Human Resources Allocation of Infectious Disease Surveillance System in Rural China

Objective

To understand the structure and capacity of current infection disease surveillance system, and to provide baseline information for developing syndromic surveillance system in rural China.

Introduction

To meet the long-term needs of public health and social development of China, it is in urgency to establish a comprehensive response system and crisis management mechanism for public health emergencies. Syndromic surveillance system has great advantages in promoting early detection of epidemics and reducing the burden of disease outbreak confirmation (1). The effective method to set up the syndromic surveillance system is to modify existing case report system, improve the organizational structures and integrate new function with the traditional system.

Methods

Since August 2011, an integrated syndromic surveillance project (ISSC) has been implemented in China. Before the launching of the project, a cross-sectional study was carried out in Fengxin County and Yongxiu County of Jiangxi province during October 11 to 18, 2010. Institution information were investigated in the county hospital, township hospital and County Center for Disease Control and Prevention (CDC) to understand the performance of existing case report system for notifiable infectious diseases with regard to its structure, capacity and data collection procedure. Health care workers from each township hospital and village health station were questionnaire interviewed for information on qualification of human resources, basic healthcare delivery condition, hardware and software needs for ISSC.

Results

An internet-based real-time (quasi real-time) case report system for notifiable infectious diseases, based on the three-tier public health service System, had been established in these two counties since 2004. The farthest end of net user in case report system was township hospital. Blood routine test, urine routine test, B ultrasound and electrocardiogram were available in all township hospitals. There was no laboratory equipment in village health stations in these two counties. All the township hospitals in these two counties were equipped with land-line telephones and desktop computers. The internet covers all township hospitals in both counties. Most clinical doctors in township hospital(TH) and village health station(VHS) were male. The age of doctors ranged from 21 to 72 years old, with the average at 42 and median at 40 years. The village health workers were significantly older, less educated and served in health care longer than the township hospital doctors. In Yongxiu County, 95.6% of the village health stations were equipped with computers, including private-owned computers, and 80.7% of them had access to the internet; while in Fengxin County, 66.5% of the village health stations possessed computers, among which most were private property of village doctors, and only 44.2% of them had access to the internet.

Conclusions

The current case report system, with full coverage and stable human resource, has established a solid basis for developing syndromic surveillance system in rural China. The syndromic surveillance system could play its role in early detection of infectious disease outbreaks in rural area where laboratory service for infectious disease diagnosis are not available. However, the lack of computerized patient registration in village and township health care facilities and incomplete internet coverage in rural area and relatively low quality of human resource in village level should be taken into consideration seriously before establishing the syndromic surveillance system in rural China.