Costs of Immunization Programs for 10 Vaccines in 94 Low- and Middle-Income Countries From 2011 to 2030

ObjectivesUnderstanding the level of investment needed for the 2021-2030 decade is important as the global community faces the next strategic period for vaccines and immunization programs. To assist with this goal, we estimated the aggregate costs of immunization programs for ten vaccines in 94 low- and middle-income countries from 2011 to 2030.MethodWe calculated vaccine, immunization delivery and stockpile costs for 94 low- and middle-income countries leveraging the latest available data sources. We conducted scenario analyses to vary assumptions about the relationship between delivery cost and coverage as well as vaccine prices for fully self-financing countries.ResultsThe total aggregate cost of immunization programs in 94 countries for 10 vaccines from 2011 to 2030 is $70.8 billion (confidence interval: $56.6-$93.3) under the base case scenario and $84.1 billion ($72.8-$102.7) under an incremental delivery cost scenario, with an increasing trend over two decades. The relative proportion of vaccine and delivery costs for pneumococcal conjugate, human papillomavirus, and rotavirus vaccines increase as more countries introduce these vaccines. Nine countries in accelerated transition phase bear the highest burden of the costs in the next decade, and uncertainty with vaccine prices for the 17 fully self-financing countries could lead to total costs that are 1.3-13.1 times higher than the base case scenario.ConclusionResource mobilization efforts at the global and country levels will be needed to reach the level of investment needed for the coming decade. Global-level initiatives and targeted strategies for transitioning countries will help ensure the sustainability of immunization programs.     

产褥期乳腺炎影响因素分析

目的探讨导致产妇发生产褥期乳腺炎(PM)的影响因素。 方法选择2020年9月1日至12月31日,在成都市某三甲妇女儿童医院分娩,并进行产后42 d随访的1 162例产妇为研究对象。根据产妇产后42 d内是否发生PM,将其分为PM组(n＝103)与对照组(n＝1 059)。采用本研究自行设计的《产褥期乳腺炎相关影响因素调查问卷》(以下简称为《调查问卷》),联合《中国简式心理状态剖面图(POMS)量表》(以下简称为《POMS量表》),分别对2组产妇进行调查。《调查问卷》内容主要包括产妇一般人口学资料、妊娠及疾病、药物使用、母乳喂养、饮食及生活习惯等10个维度,共计50个条目。《POMS量表》包括心理焦虑等7个维度,共计40个条目。对2组产妇《调查问卷》条目及《POMS量表》评分,采用独立样本t检验、χ²检验及Fisher确切概率法等进行统计学比较。本研究遵循的程序符合病例收集医院医学伦理委员会要求,经过该伦理委员会批准[审批文号：科研伦审2021(29)],并与研究对象签署临床研究知情同意书。2组产妇的年龄等一般临床资料比较,差异无统计学意义(P>0.05)。 结果①本研究纳入产妇的PM发生率为8.9%(103/1 162),产后第3、4周PM发生率最高,分别为2.7%(31/1 162)与2.4%(28/1 162)。②本研究2组产妇围生期补充铁剂及口服益生菌占比,乳头皲裂程度、吸奶器使用时间及频率、乳头保护罩与乳头保护霜使用频率构成比,哺乳衔接姿势正确率,哺乳时乳房疼痛程度、哺乳内衣穿戴率等分别比较,差异均有统计学意义(P<0.05)。③PM组产妇《POMS量表》焦虑评分为(7.1±5.0)分,显著高于对照组的(5.3±4.1)分,并且差异有统计学意义(t＝-3.540、P＝0.001)。④将上述影响产妇发生PM的单因素分析中差异有统计学意义因素,并结合已有研究结果与临床经验,纳入10项影响因素,进行多因素非条件logistic回归分析结果显示,产妇围生期补充铁剂(OR＝3.351,95%CI：1.949~5.758,P<0.001),乳头皲裂(OR＝3.564,95%CI：1.909~6.654,P<0.001),吸奶器使用频率>1次/d(OR＝5.102,95%CI：1.047~24.876,P＝0.044),乳头保护霜使用频率>1次/d(OR＝2.147,95%CI：1.156~3.987,P＝0.016),哺乳衔接姿势不正确(OR＝2.311,95%CI：1.202~4.445,P＝0.012),穿戴不舒适哺乳内衣(OR＝2.322,95%CI：1.008~5.347,P＝0.048),不穿戴哺乳内衣(OR＝3.516,95%CI：1.821~6.789,P<0.001),焦虑评分高(OR＝1.073,95%CI：1.007~1.143,P＝0.029),均为导致产妇发生PM的独立危险因素;而围生期口服益生菌(OR＝0.110,95%CI：0.025~0.478,P＝0.003)是其独立保护因素。 结论通过制定临床干预措施,指导产褥期产妇纠正不正确行为,如围生期补充铁剂、吸奶器与乳头保护霜使用不当,哺乳内衣穿戴及哺乳行为不规范等,提倡产妇围生期口服益生菌,缓解产妇焦虑情绪,对预防产妇PM发生具有重要意义。     

上海市预防接种工作人员疑似预防接种异常反应监测认知和报告影响因素

目的了解上海市预防接种工作人员疑似预防接种异常反应(Adverse events following immunization,AEFI)监测的知识和态度以及影响AEFI报告的因素。方法采用方便抽样在上海市所有459个预防接种门诊选择预防接种工作人员开展问卷调查,分析AEFI监测知识得分(满分6分)和态度,采用多因素Logistic回归分析AEFI报告的影响因素。结果1379名调查对象的AEFI监测知识平均得分为3.30±1.31分;认为开展AEFI监测有必要、报告AEFI是自身职责、AEFI监测是额外工作负担的调查对象分别占98.84%、92.75%、30.38%。69.62%的调查对象近1年报告过AEFI;社区接种门诊、免疫规划专职人员、近1年接受过AEFI培训、AEFI监测知识得分高的调查对象报告AEFI的比例高[OR(95%CI):19.55(14.16-26.98)、1.95(1.45-2.64)、3.14(1.76-5.59)、1.91(1.38-2.63)]。结论上海市预防接种工作人员AEFI监测知识水平不高,对AEFI监测存在一定认识误区;需加强AEFI监测培训,进一步提高其AEFI报告意识。     

新型冠状病毒肺炎下护理人员心理状况调查及应对策略研究

目的 了解郑州市新型冠状病毒肺炎患者定点收治医院护理人员的心理状况,从而为应对突发公共卫生事件医务人员的心理卫生、心理干预咨询提供参考的理论依据及指导.方法 选择本市新型冠状病毒肺炎疑似及确诊患者定点救治医院护理人员,共收集到462名护理人员信息,采用填写网络问卷SCL-90量表的方法进行调查,并与常模数据做对比,用SPSS19.0统计软件进行统计分析.结果 最终完成436名护理人员调查统计与分析,SCL-90量表总得分为(144.51±36.20),高于1986年全国常模(129.96±38.26)分以及2006年全国常模(130.021±33.626)分.其中,躯体化、强迫、抑郁、焦虑、恐怖因子分高于护士常模(P＜0.05)及全国常模(P＜0.05).结论 新型冠状病毒肺炎疫情期间,本市护理人员存在一定的心理压力.我们应注意到护理人员的心理压力以及引起压力的主要危险因素,并采取积极有效的方式应对,采取针对性措施进行疏导,减轻护理人员的心理压力,保证护理人员工作有效顺利进行.     

Strand-Specific Reverse Transcription PCR for Detection of Replicating SARS-CoV-2

We developed an assay that detects minus-strand RNA as a surrogate for actively replicating severe acute respiratory syndrome coronavirus 2. We detected minus-strand RNA in 41 persons with coronavirus disease up to 30 days after symptom onset. This assay might inform clinical decision-making about patient infectiousness.     

Maternal Age at Menarche and Pubertal Timing in Boys and Girls: A Cohort Study From Chongqing,China

PurposeThis study explored the association of maternal age at menarche (AAM) with pubertal timing among girls and boys in Chongqing, China.MethodsPubertal development of 1,237 children (542 girls and 695 boys) were examined half-yearly through inspection and palpation from April 2014 to June 2019. Characteristics of parents and maternal AAM were collected by a parental questionnaire at baseline. Maternal AAM was used both as a continuous and a categorical variable in Cox regression models.ResultsA total of 1,198 children (528 girls and 670 boys) were included in the study. In the simple Cox model, earlier maternal AAM was associated with girls' earlier menarche, breast and pubic hair development, and boys' first ejaculation, testicular development, and genital development. When adjusting for children's body mass index z-scores (BMIz) and socioeconomic covariates, we found that girls whose mothers had early AAM had a higher risk of earlier onset of menarche (hazard ratio [HR]: .922, 95% confidence interval [CI]: .852–.998 for continuous maternal AAM, HR: 1.297, 95% CI: 1.041–1.616 for maternal AAM ≤13 years), and boys whose mother achieved menarche earlier experienced a higher risk of earlier onset of first ejaculation (HR: .896, 95% CI: .830–.968). Children's BMIz were related to all nine pubertal milestones. Parental education and relationship, birth weight, parity, and family type were also associated with pubertal timing.ConclusionsEarlier maternal AAM was related to earlier pubertal timing in both girls and boys in Chongqing, especially girls' age at menarche and boys' first ejaculation. Children's BMIz was the most consistent factor for pubertal timing. Children's BMIz and socioeconomic conditions had greater influence on most pubertal milestones than maternal AAM.     

干细胞治疗子宫内膜损伤的研究进展

感染因素或宫腔手术操作导致的子宫内膜损伤阻碍胚胎的着床和发育,严重影响妇女的身心健康与生育能力。但目前治疗手段有限且效果欠佳。干细胞具有自我更新和分化潜能,在病变损伤组织的修复过程中发挥重要作用。骨髓间充质干细胞、脐带间充质干细胞、子宫内膜干细胞、脂肪干细胞和人羊膜上皮细胞等多种干细胞治疗子宫内膜损伤已在动物模型和临床研究中开展,并展现出巨大的潜力。干细胞治疗可促进子宫内膜细胞再生,改善子宫内膜厚度和微血管密度,提高受孕率并改善生育结局。干细胞治疗从形态和功能上改善子宫内膜,促进月经和生殖功能的恢复,为治疗子宫内膜损伤提供一种新策略。     

肝硬化上消化道出血患者血浆TXB2、6—酮—PGF1α及vWF的变化

为进一步探讨肝硬化患者上消化道出血的发生机制及病理生理意义,采用ELISA方法分别定量测定40例肝硬化患者与10例对照组患者血浆血栓素B2（TXB2）、6－酮－前列腺素F1α（6－酮－PGF1α）及血管性假血友病因子（vWF）的水平。结果显示：肝硬化患者无上消化道出血组血浆TXB2水平、TXB2／6酮－PGF1α比值较对照组明显降低（P＜0．05）,较出血组显著增高（P＜0．05或0．01）;而血浆6－酮－PGF1α与vWF水平较对照组明显增高（P＜0．05或0．01）,较出血组显著降低（P＜0．05）。结果表明,肝硬化患者上消化道出血与血浆TXB2下降、6－酮－PGF1α升高及其比例衡有密切关系,vWF水平升高能反映肝硬化血管内皮损伤及上消化道出血倾向。     

东菱精纯克栓酶对荷瘤裸鼠全血Casson值的影响

为观察并了解东菱精纯克栓酶对荷瘤裸鼠全血Casson值的影响,采用锥板式粘度计对移植了胃癌和鼻咽癌的荷瘤裸鼠使用东菱精纯克栓酶前后的全血粘度进行检测,并采用线性回归的方法求出各组Casson粘度(CV)及Casson屈服值(CY)。结果显示,使用东菱精纯克栓酶后两组荷瘤裸鼠全血(CV)值皆明显下降(P＜0.01);(CY)值在胃癌组明显下降(P＜0.01),鼻咽癌组无明显变化(P＞0.05)。结果表明,使用东菱精纯克栓酶对荷瘤裸鼠的血液流变学参数有明显改善,提示有可能将其应用于临床预防肿瘤转移及扩散。     

五参平律汤合律平治疗早搏96例临床观察

目的：观察五参平律汤合心律平对早搏的临床疗效,探讨可能的作用机理,方法：在对症治疗的基础上,随机分成五参平律汤合心律平组（治疗组）,和单用心律平组（对照组）进行临床观察,结果：治疗组抗早搏总有效率为865,对照组为71．75,两组差异显著,P＜0．01。结论：五参平律汤合心律平治疗早搏明显优于单用心律平,可能机能为补心平律,活血通络,改善心肌营养,抑制异位节律及折返传导,是否同时具有抗心律平的致心律失常作用有待以后验证。