Breaking the inertia in coverage: Mainstreaming under-utilized immunization strategies in the Middle East and North Africa region

Vaccination coverage rates have stagnated in the past several years in many middle-income countries (MICs), especially in the UNICEF Middle East and North Africa region, with political and economic turmoil as contributing factors. This paper reviews country experiences with three under-utilized strategies aimed at increasing vaccination coverage and reducing disparities between socio-economic and geographic groups in MICs. These strategies include: (1) identifying and accounting for displaced, mobile and neglected populations; (2) assessing and addressing missed opportunities for vaccination, including by expanding immunization into the second year of life and beyond; and (3) engaging effectively with the private/nongovernmental health providers in the coordination, provision and reporting of immunization services. The examples focus primarily on quality data collection, analysis, use and reporting aspects of the strategies. While data are limited, there is evidence from MICs that each of these strategies can have a positive impact on vaccination coverage, especially among marginalized populations.     

浮针联合麻桂温经汤加味治疗肩袖损伤血虚寒凝证临床研究

目的:观察浮针联合麻桂温经汤加味治疗肩袖损伤血虚寒凝证的临床疗效。方法:选取本院收治肩袖损伤的患者共80例,按随机数字表法分为2组各40例。对照组给予Mulligan动态关节松动术;观察组给予浮针联合麻桂温经汤加味治疗。连续治疗6周后,比较2组疼痛视觉模拟评分法(VAS)、肩关节功能美国加州大学肩关节评分(UCLA)评分、肩关节活动度(ROM)、临床疗效。结果:治疗后,2组VAS评分明显下降,UCLA评分显著升高(P<0.01);观察组治疗后VAS评分明显低于对照组,UCLA评分显著高于对照组(P<0.01)。治疗后,2组前屈、外展、体侧外旋的角度显著增大(P<0.01);观察组治疗后前屈、外展、体侧外旋的角度显著大于对照组(P<0.01)。观察组的优良率为97.50%,高于对照组的80.00%,差异有统计学意义(P<0.05)。结论:浮针联合麻桂温经汤加味治疗肩袖损伤血虚寒凝证疗效确切。     

青岛市已婚女性流动人口妇科自觉不适症状及求医行为调查

目的:了解已婚女性流动人口妇科自觉不适症状发生及求医行为情况,分析影响求医行为的因素。方法:采用流行病学现况调查方法,对青岛市10个工厂中的1 831名已婚女性流动人口进行问卷调查。结果:有737人(40.3%)自我报告在过去6个月内至少有1种妇科不适症状。其中不作任何处理者74人(10%),自己买药者241人(32.7%);到医疗机构治疗者407人(55.2%)。Logistic回归统计分析发现,过去6个月没有获得过生殖健康信息、不知道哪里治疗生殖道感染是不能正确求医的危险因素,OR值分别是1.748和3.294。结论:针对妇科症状自我报告率高,但多数人不能正确寻求治疗情况,应加强对流动人口的相关知识宣传,多渠道提供生殖道感染诊疗信息,提高她们的生殖健康水平。     

江苏省流动妇女心理健康状况及影响因素分析

目的:了解居住地在江苏的流动妇女心理健康状况和影响心理健康的因素。方法:采用症状自评量表(SCL-90)和社会支持评定量表对1 178例流动人口进行调查,其中流动妇女729例。结果:①流动妇女总分、躯体化、焦虑、敌对、恐怖、精神病性因子的均分高于中国普通人群常模,在躯体化、恐怖、精神病性因子与中国常模差异有统计学意义(P0.001)。②流动妇女总分和各因子均分除偏执因子外均高于男性流动人口,躯体化、人际关系敏感、焦虑、恐怖和总分与男性流动人口差异有统计学意义(P0.05)。③按标准化偏回归系数显示影响流动妇女心理健康的因素为每天工作时间、是否签订劳动合同、客观支持、尚未找到工作、对生活状况满意程度、打零工和暂时不打算工作。结论:流动妇女存在一定程度的心理健康问题。     

18城市不同类别流动人口对艾滋病病毒感染者和病人的歧视及相关因素调查

目的了解不同类别流动人口对艾滋病病毒感染者和病人（people living with HIV／AIDS,PLWHA）歧视的现状及其影响因素。方法采取横断面研究设计,在黑龙江、吉林、辽宁、内蒙古、甘肃、宁夏、重庆7个省（市）的18个城市采用两阶段分层抽样,抽取4类流动人口即建筑工人、工矿企业工人、外来务工人员、长途卡车司机共15622人进行了问卷调查。结果调查对象总歧视率为63．2％,不同类别流动人口对PLWHA的歧视差异有统计学意义（P〈0．01）,对不同PLWHA的歧视存在差异（P〈0．01）,家庭中的PLWHA被接受程度最高;对PLWHA歧视受性别、年龄、文化程度、职业、艾滋病知识的影响。结论流动人口对PLWHA的歧视仍普遍存在,其存在及PLWHA受歧视的差异提示仍需加大力度和深度进行艾滋病健康教育和反歧视的宣传,提高艾滋病知识认知水平,加强正确意识的引导及关爱,进而降低或消除对PLWHA的歧视。     

深圳市流动人口生殖健康服务的绩效评价

目的:综合评价深圳市计划生育系统开展流动人口生殖健康服务的成绩和效果,为完善和改进服务提供依据。方法:采用资料收集和问卷调查方法,了解流动人口基本情况、生殖健康服务内容、服务量、人员配备、经费投入等服务开展情况;流动人口接受服务情况及对服务的评价。结果:①近50%流动人口在本地接受过计划生育部门提供的生殖健康宣教服务,60%左右知晓目前流动人口计划生育政策和相关服务信息,80%知道两种以上避孕方法和艾滋病预防知识;②已婚妇女70%得到查环查孕服务,60%得到避孕节育知情选择指导及随访、可以领到免费的避孕药具,得到生殖健康检查尚不足50%;③75%的对象对服务质量各方面表示满意;④全市流动人口综合节育率达90.3%,计划生育率达90.8%。存在不足是基本服务投入不足,服务投入不均衡,技术服务效率有待提高,投入与服务过程指标存在正相关,而与结果指标(综合节育率、计划生育率)相关不明显。结论:深圳市初步实现了流动人口计划生育的基本服务和管理目标,但仍需适当增加投入,同时注重服务效率;对流动人口计划生育工作评价时,在注重结果的同时更要侧重过程指标的评价。     

Microaggressions and marijuana use among college students

This study examines the association between exposure to microaggressions and marijuana use, using original survey data from a sample of racial/ethnic minority college students (n?=?332) from a large Division I university in the United States. Nearly all of our sample (96%) reported at least one experience with microaggressions in the past 6 months, while 33% reported using marijuana regularly. We modeled regular use of marijuana using multiple logistic regression, with consideration of sex, age, race/ethnicity, and microaggression scale scores as covariates. Age, sex, the microinvalidations subscale score, and the full microaggression scale score were significantly associated with marijuana use in our full models (p?p?=?.01; p?=?.02; p?=?.03, respectively). With each additional experience of microaggression, the odds of regular marijuana use increase. Academic communities may consider the primary prevention of discriminatory behavior when addressing student substance use.     

In the absence of hard data,Is soft data better than no data at all?

Where total anonymity and confidentiality were previously respected in drug research, a tendency towards the provision of “hard” data such as verifiable personal details seriously disadvantages researchers working with “hidden groups” who use drugs in a relatively problem free way. This particularly applies to those who use substances generally regarded as highly addictive and problematic, such as heroin. Funding for a follow-up to an earlier research project was sought; the original investigated non-problematic heroin users, whereas the chief aim of the follow-up was to examine “resilience” to the problems commonly associated with the use of heroin. An illustration of attempting to put the gathering of “hard” verifiable data into action is presented here along with the immediate consequences. Unsurprisingly, the response of potential participants to the idea of providing personal details was largely negative, as the perceived consequences of being “outed” as a heroin user were generally regarded as worse than any of the issues associated with the use of the drug itself. An irony of the situation is that this “resilience” may be due to participant refusal to compromise their anonymity. This raises some obvious ethical issues. A number of potential longer term consequences on substance use/misuse research are also discussed.     

我国七省流动人口健康素养及其影响因素研究

目的 了解我国七省流动人口的健康素养情况及其影响因素,为开展有针对性的健康素养干预措施提供科学依据。方法 采用2016年全国流动人口卫生计生动态监测调查问卷数据,共纳入2 335名流动人口进行分析。t检验和SymbolcA@²检验用于组间比较。二元logistic回归模型用于分析流动人口健康素养的影响因素。结果 2016年七省流动人口总体健康素养水平为36.7％,其中健康生活方式与行为素养水平较低（36.5%）,传染病防治（33.0%）、基本医疗（27.8%）、慢性病防治素养（22.8%）水平较低。受教育程度更高（初中OR=1.625,P=0.001,高中OR=1.621,P=0.004,大专及以上OR=2.066,P<0.001）、流动次数较少（OR=0.919,P=0.049）、城市地区（OR=1.677,P<0.001）的流动人口健康素养水平更高。结论 流动人口健康素养水平有待提升。应针对受教育程度低、流动次数多的重点人群以及农村重点地区开展干预措施,加强传染病、慢性病防治等健康知识的宣传力度。     

半夏种内不同居群花粉粒形态比较研究

目的:研究半夏不同居群的花粉粒形态特征,以便为进一步研究半夏的遗传多样性提供孢粉学资料。方法:借助扫描电镜对栽培在同一生境下的18个半夏居群的花粉形态、大小及表面纹饰等特征进行观测比较。结果与讨论:半夏各居群的花粉粒大小存在较大的差异:17个有珠芽半夏居群花粉粒的平均值为17.42μm×14.86μm,其中花粉粒最大的姜堰居群为20.43μm×18.16μm,而最小的沛县居群仅有15.23μm×12.82μm,灵谷寺无珠芽半夏居群的花粉粒大小明显小于所有有珠芽半夏居群,仅有13.23μm×11.98μm;各半夏居群花粉粒表面均具刺状突起,但刺的长短、疏密及刺端和刺基变化因居群不同而有所不同;半夏花粉粒可能为有孔盖萌发孔类型。