公安边防部队基层预防保健工作浅探

边防部队的预防保健工作集医疗、预防、保健为一体,有其特殊的管理职能与使命。作为部队基层卫生队要适应这种形势,树立"大卫生"观念,把部队基层预防保健工作摆上重要的位置,建立一个规模适宜、技术适宜、设备适宜、人才适宜、科学管理配套的基层预防保健工作体系。     

Formulation of a model for automating infection surveillance: algorithmic detection of central-line associated bloodstream infection

Objective

To formulate a model for translating manual infection control surveillance methods to automated, algorithmic approaches.

Design

We propose a model for creating electronic surveillance algorithms by translating existing manual surveillance practices into automated electronic methods. Our model suggests that three dimensions of expert knowledge be consulted: clinical, surveillance, and informatics. Once collected, knowledge should be applied through a process of conceptualization, synthesis, programming, and testing.

Results

We applied our framework to central vascular catheter associated bloodstream infection surveillance, a major healthcare performance outcome measure. We found that despite major barriers such as differences in availability of structured data, in types of databases used and in semantic representation of clinical terms, bloodstream infection detection algorithms could be deployed at four very diverse medical centers.

Conclusions

We present a framework that translates existing practice—manual infection detection—to an automated process for surveillance. Our experience details barriers and solutions discovered during development of electronic surveillance for central vascular catheter associated bloodstream infections at four hospitals in a variety of data environments. Moving electronic surveillance to the next level—availability at a majority of acute care hospitals nationwide—would be hastened by the incorporation of necessary data elements, vocabularies and standards into commercially available electronic health records.     

Factors influencing European GPs' engagement in smoking cessation: a multi-country literature review

Background

Smoking cessation advice by GPs is an effective and cost-effective intervention, but is not implemented as widely as it could be.

Aim

This wide-ranging Europe-wide literature review, part of the European Union (EU) PESCE (General Practitioners and the Economics of Smoking Cessation in Europe) project, explored the extent of GPs'' engagement in smoking cessation and the factors that influence their engagement.

Method

Two searches were conducted, one for grey literature, across all European countries, and one for academic studies. Data from eligible studies published from 1990 onwards were synthesised and reported under four categories of influencing factors: GP characteristics, patient characteristics, structural factors, and cessation-specific knowledge and skills.

Results

The literature showed that most GPs in Europe question the smoking status of all new patients but fewer routinely ask this of regular patients, or advise smokers to quit. The proportion offering intensive interventions or prescribing treatments is lower still. Factors influencing GPs'' engagement in smoking cessation include GPs'' own smoking status and their attitudes towards giving smoking cessation advice; whether patients present with smoking-related symptoms, are pregnant, or heavy smokers; time, training, and reimbursement are important structural factors; and some GPs lack knowledge and skills regarding the use of specific cessation methods and treatments, or have limited awareness of specialist cessation services. No single factor or category of factors explains the variations in GPs'' engagement in smoking cessation.

Conclusion

Strategies to improve the frequency and quality of GPs'' engagement in smoking cessation need to address the multifaceted influences on GPs'' practice and to reflect the widely differing contexts across Europe.     

The relationship between post-traumatic stress disorder,depression, and lung disorders in Northern Plains and Southwest American Indians

Objective. Research within the past decade has suggested that mental disorders are associated with lung disorders. This study compared the association of lifetime post-traumatic stress disorder (PTSD) and lifetime major depression with lung disorders in two American Indian (AI) tribal communities.

Design. A total of 2622 tribal members (1414 in the Northern Plains and 1208 in the Southwest) aged 18–57 years completed an interview assessing psychiatric diagnoses and physical health, including lung disorders. Logistic regression analyses were used to estimate odds ratios for the association of PTSD and major depression with lung disorders.

Results. The prevalence of lung disorders was 17% (95% Confidence Interval [CI]: 15, 19) in the Northern Plains and 13% (95% CI: 11, 15) in the Southwest. In the Northern Plains, men with lung disorders had a higher prevalence of PTSD and major depression than men without lung disorders, and women with lung disorders had a higher prevalence of major depression than women without lung disorders. Neither PTSD nor major depression was associated with lung disorders in men or women living in the Southwest. In the Northern Plains, major depression remained significantly associated with lung disorders in both men (OR=3.1, 95% CI: 1.5, 6.4) and women (OR=2.2, 95% CI: 1.2, 4.1) even after adjusting for age, education, smoking, alcohol abuse, and PTSD.

Conclusions. Depression, but not PTSD, was associated with lung disorders in AIs living in the Northern Plains. Differences between the Northern Plains and the Southwest underscore the importance of recognizing unique characteristics of tribes and tribal communities. The increasing prevalence of lung disorders in AIs heightens the need for further work to help explain social, cultural, and clinical determinants of these disorders and their associations to PTSD and depression, and ultimately to help provide more effective clinical treatment and preventive care.     

A replication defective recombinant Ad5 vaccine expressing Ebola virus GP is safe and immunogenic in healthy adults

Ebola virus causes irregular outbreaks of severe hemorrhagic fever in equatorial Africa. Case mortality remains high; there is no effective treatment and outbreaks are sporadic and unpredictable. Studies of Ebola virus vaccine platforms in non-human primates have established that the induction of protective immunity is possible and safety and human immunogenicity has been demonstrated in a previous Phase I clinical trial of a 1st generation Ebola DNA vaccine. We now report the safety and immunogenicity of a recombinant adenovirus serotype 5 (rAd5) vaccine encoding the envelope glycoprotein (GP) from the Zaire and Sudan Ebola virus species, in a randomized, placebo-controlled, double-blinded, dose escalation, Phase I human study. Thirty-one healthy adults received vaccine at 2 × 10⁹ (n = 12), or 2 × 10¹⁰ (n = 11) viral particles or placebo (n = 8) as an intramuscular injection. Antibody responses were assessed by ELISA and neutralizing assays; and T cell responses were assessed by ELISpot and intracellular cytokine staining assays. This recombinant Ebola virus vaccine was safe and subjects developed antigen specific humoral and cellular immune responses.     

Anxiety and Attentional Bias to Threat in Children at Increased Familial Risk for Autism Spectrum Disorder

Anxiety and threat bias were examined in 6-8-year-old children at familial-risk for Autism Spectrum Disorder (ASD) and low-risk (LR, n?=?37) controls. The high-risk (HR) group was divided into those who met diagnostic criteria for ASD (HR-ASD, n?=?15) and those who did not (HR-non ASD, n?=?24). The HR-ASD group had highest levels of parent-reported anxiety. The HR-non ASD group exhibited increased threat bias on a spatial-cueing task, while the HR-ASD group did not. Anxiety symptoms were associated with both threat bias and ASD severity. These findings suggest that the mechanisms underlying anxiety in HR siblings without ASD are similar to those in non-ASD populations. However, among children with ASD, hypersensitivity to threat may not underlie anxiety symptoms.     

Immune reconstitution and predictors of virologic failure in adolescents infected through risk behaviors and initiating HAART: week 60 results from the PACTG 381 cohort

The responses to HAART in HIV-infected adolescents infected through risk behaviors are not well defined. PACTG 381 collected intensive immunologic and virologic data on youth naive to or with minimal exposure to antiretroviral therapy who began HAART. Subjects were evaluated according to their weeks 16-24 virologic response. Comparisons with a cohort of HIV-uninfected adolescents from the REACH cohort were performed. Cox proportional hazards models were used to identify baseline and week 24 predictors of virologic failure. Only 69 of 120 subjects (58%) achieved virologic suppression by weeks 16-24, whereas 55 of 69 (80%) demonstrated control to week 60. Higher CD4+ naive T cells (CD4+/62L+/RA+: hazard ratio [HR], 2.13; p = 0.018), higher CD8+ activated T cells (CD8+/CD38+/DR+: HR, 1.40, p = 0.028 per 100 cells/mm3) and higher CD8+ naive T cells (CD8+/62L+/RA+: HR, 1.72; p = 0.005) at weeks 16-24 in subjects with early viral success were predictive of subsequent failure. By week 60, total CD4+ T cells remained significantly lower than in uninfected controls. Adolescents beginning HAART achieve moderate rates of viral suppression by weeks 16-24. In those who do achieve early virologic control, suppression to week 60 is high although total CD4+ T cells remain significantly lower than in uninfected controls. Several T cell markers were predictive of subsequent virologic failure in subjects achieving short-term success. Further study is warranted to determine whether these predictors provide any benefit to clinical management.     

Phase 1 safety and immunogenicity evaluation of a multiclade HIV-1 candidate vaccine delivered by a replication-defective recombinant adenovirus vector

BACKGROUND: The development of an effective human immunodeficiency virus (HIV) vaccine is a high global priority. Here, we report the safety, tolerability, and immunogenicity of a replication-defective recombinant adenovirus serotype 5 (rAd5) vector HIV-1 candidate vaccine. METHODS: The vaccine is a mixture of 4 rAd5 vectors that express HIV-1 subtype B Gag-Pol fusion protein and envelope (Env) from subtypes A, B, and C. Healthy, uninfected adults were randomized to receive 1 intramuscular injection of placebo (n=6) or vaccine at dose levels of 10(9) (n=10), 10(10) (n=10), or 10(11) (n=10) particle units and were followed for 24 weeks to assess immunogenicity and safety. RESULTS: The vaccine was well tolerated but was associated with more reactogenicity at the highest dose. At week 4, vaccine antigen-specific T cell responses were detected in 28 (93.3%) and 18 (60%) of 30 vaccine recipients for CD4(+) and CD8(+) T cells, respectively, by intracellular cytokine staining assay and in 22 (73%) of 30 vaccine recipients by enzyme-linked immunospot assay. Env-specific antibody responses were detected in 15 (50%) of 30 vaccine recipients by enzyme-linked immunosorbant assay and in 28 (93.3%) of 30 vaccine recipients by immunoprecipitation followed by Western blotting. No neutralizing antibody was detected. CONCLUSIONS: A single injection induced HIV-1 antigen-specific CD4(+) T cell, CD8(+) T cell, and antibody responses in the majority of vaccine recipients. This multiclade rAd5 HIV-1 vaccine is now being evaluated in combination with a multiclade HIV-1 DNA plasmid vaccine.