深圳市淋病报告发病率影响因素分析

目的：分析影响深圳市淋病报告发病率的因素,并评估其影响程度。方法：用按比例分层随机抽样法从全市144家性病网络直报医疗机构中抽取34家作为调查点,将2009年10月1日至2009年lO月31日期间,首次主动前往调查点皮肤性病科、妇产科、泌尿外科门诊寻求性病诊疗服务的就诊者作为研究对象。评价是否检测淋球菌、实验室淋球菌检测能力和是否漏报等环节对淋病报告发病率的影响。结果：2534名就诊者中性病门诊实验室淋球菌漏检率为7．3％,漏诊率为62．3％,误诊率为18．6％。性病门诊检测阳性结果的漏报率为6．2％。性病门诊报告发病数为实际发病数的37．1％。结论：漏检、漏诊、误诊和漏报等因素对淋病报告发病率造成了不同程度的影响,在不考虑其他影响因素的情况下,淋病报告发病率只反应了真实发病率的37．1％。     

性病患者心理状态及其相关因素分析

目的：调查性病患者焦虑抑郁情绪的发生率及相关因素，方法：采用Zung抑郁自评量表，焦虑自评量表及相关因素问卷进行测评及相关分析，结果：性病患者焦虑、抑郁情绪的发生率分别为66．7％及65．0％，其发生与患者的病程，疾病的各类，初次就诊情况，性病知识来源，治疗情况及躯体症状密切相关，结论：性病患者存在严重的心理问题，规范治疗同时给予心理干预则有助于性病患者的康复。     

深圳某社区娱乐场所女性从业人员艾滋病/性病认知现状分析

目的：了解深圳市社区娱乐场所女性从业人员艾滋病/性病知识水平，为政府决策提供参考依据，以实施有效的干预。方法：收集整理某社区娱乐场所265名女性从业人员艾滋病／性病知识问卷，并进行统计学分析。结果：娱乐场所从业人员大部分未婚为主，高中／中专文化程度，来自农村，93．6％听说过艾滋病，70．6％认为“艾滋病病毒感染者无症状也能传染”。从业人员对淋病、梅毒、艾滋病有较高的认知率，但对尖锐湿疣、生殖器疱疹、非淋菌性尿道炎及软下疳等认知率较低；大部分了解艾滋病的三条传播途径，但对日常生活不传播艾滋病存在着认识误区；72．5％的从业人员知道正确使用安全套能有效预防艾滋病，但实际安全套使用率低；接受过艾滋病病毒检测的仅占6.8％；生殖器部位异常时，77．4％会选择去公立医院或国家指定的专科医疗机构看医生。结论：社区娱乐场所女性从业人员艾滋病／性病的知识欠缺，导致安全套的使用率低，在社区娱乐场所广泛开展有针对性的艾滋病／性病健康教育，促进安全性行为，倡导正确的求医，有效地预防艾滋病／性病的流行。     

性病门诊女性患者支原体感染的调查研究

目的　研究性病门诊女性患看和妇科体检人群的解脲支原体 (UU)、人型支原体 (MH)和沙眼衣原体 (CT)感染的情况。方法　用支原体致病浓度培养基和衣原体免疫抗原检测方法检测宫颈分泌物标本。结果　 5 0 7例病例组和 1 3 0例对照组UU≥1 0 4 和UU <1 0 4 阳性结果和阴性结果比较存在明显的差异 (P <0 . 0 0 1 ) ,单纯性沙眼衣原体感染、支原体阳性合并衣原体抗原阳性结果比较也存在明显差异 (P <0 . 0 0 1 ) ,对照组无一例单纯性衣原体或合并衣原体抗原阳性。 1 3 0例对照组在不同时间培养解脲支原体和人型支原体阳性结果存在明显的差异 (P <0 . 0 0 1 ) ,随着培养时间的延长 ,阳性率增加。结论　在性病门诊中开展支原体致病浓度培养具有一定的临床意义。     

STD就诊者阴道加特纳菌及其它病原体感染研究

目的:探讨女性STD就诊者阴道加特纳菌(GV)及其它病原菌的感染情况.方法:检测疑为STD患者标本890份(患者组)和健康人标本120份(对照组),用实时荧光PCR检测患者解脲脲原体(Uu)、淋病奈瑟菌(NG)、沙眼衣原体(Ct)和阴道加特纳菌(GV),同时用超高倍显微诊断系统在相差视野下镜检念珠菌(CD)和阴道毛滴虫(TV).结果:STD患者组GV的阳性率为32.14%在CD(40.11%)之后占第2位、对照组GV的阳性率为7.5%.结论:STD患者GV阳性率较高,对STD患者应注意GV的检测和治疗.     

Multidrug-resistant bacteria in geriatric clinics,nursing homes,and ambulant care – Prevalence and risk factors

Colonization/infection with multidrug-resistant bacteria (MDRB) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, is an increasing problem not only in hospitals but also in long-term care facilities. The aim of this study was to determine the prevalence as well as the risk factors of colonization/infection with MRSA, VRE, and ESBL producing Enterobacteriaceae in geriatric clinics, nursing homes, and ambulant care in Frankfurt am Main, Germany. 288 patients from 2 geriatric clinics (n = 46), 8 nursing homes (n = 178), and 2 ambulant care facilities (n = 64) as well as 64 staff members were screened for MDRB in the time period from October 2006 to May 2007. 58 patients (20.1%) and 4 staff members (6.2%) were colonized with MDRB. Among patients, 27 (9.4%) were colonized with MRSA, 11 (3.8%) were screened positive for VRE, and 25 (8.7%) were found to be colonized with ESBL producing Enterobacteriaceae. Prevalence of MDRB in geriatric clinics, nursing homes, and ambulant care facilities were 32.6%, 18.5%, and 15.6%, respectively. Significant risk factors for MDRB were immobility (OR: 2.7, 95% CI: 1.5–4.9; p = 0.002), urinary catheter (OR: 3.1, 95% CI: 1.7–5.9; p < 0.001), former hospitalization (OR: 2.1, 95% CI: 1.1–4.0; p = 0.033), and wounds/decubiti (OR: 2.3, 95% CI: 1.5–4.9; p = 0.03). Finally, the high level of MDRB in geriatric clinics, nursing homes, and ambulant care points to the importance of these institutions as a reservoir for dissemination.     

Study on the Prevalence of Leptospirosis among Fever Cases Reported from Private Clinics in the Urban areas of Villupuram District,Tamil Nadu,India

Objectives

To know the prevalence of leptospirosis cases reported in private clinics among fever cases in Villupuram District, Tamil Nadu, India to know its real magnitude of the problem and to diagnose Leptospirosis among fever cases from differential diagnosis.

Methods

1502 Blood serum samples collected from three urban towns namely Kallakurichi (Latitude: 11° 73′ N; Longitude: 78° 97′ E), Villupuram (Latitude: 11° 75′ N; Longitude: 79° 92′ E) and Thindivanam (Latitude: 12° 25′ N; Longitude: 79° 65′ E) in fifteen clinics based on case definition of leptospirosis delineated by the National Vector Borne Disease Control Programme (NVBDCP), Government of India. Samples were tested in the laboratory of the Zonal Entomological Team (ZET), Cuddalore with Macroscopic Slide Agglutination Test (MSAT) and Ig-M ELISA.

Result

There were 65 positive cases detected from 1502 blood serum samples in both MSAT and Ig-M ELISA. It could be known that there was 4% cases contributed from private clinics among fever cases. From this study, further it was known that all age groups of people affected irrespective of sexes based on their living condition associated with the environment prevailed of the disease.

Conclusion

From this study, it was quantified that 4% of cases reported in private clinics among fever cases and its findings ascertained both the importance of differential diagnosis as well as reports that should be included to the Government for knowing its real magnitude for planning.     

Optimizing management and financial performance of the teaching ambulatory care clinic

OBJECTIVE: To examine how to optimize teaching ambulatory care clinics performance with regard to access to care, access to teaching, and financial viability. DESIGN: Optimization analysis using computer simulation. METHODS: A discrete-event simulation model of the teaching ambulatory clinic setting was developed. This method captures flow time, waiting time, competition for resources, and the interdependency of events, providing insight into system dynamics. Sensitivity analyses were performed on staffing levels, room availability, patient characteristics such as "new" versus "established" status, and clinical complexity and pertinent probabilities. MAIN RESULTS: In the base-case, 4 trainees:preceptor, patient flow time (registration to check out) was 148 minutes (SD 5), wait time was 20.6 minutes (SD 4.4), the wait for precepting was 6.2 minutes (SD 1.2), and average daily net clinic income was $1,413. Utilization rates were preceptors (59%), trainees (61%), medical assistants (64%), and room (68%). Flow time and the wait times remained relatively constant for strategies with trainee:preceptor ratios <4:1 but increased with number of trainees steadily thereafter. Maximum revenue occurred with 3 preceptors and 5 trainees per preceptor. The model was relatively insensitive to the proportion of patients presenting who were new, and relatively sensitive to average evaluation and management (E/M) level. Flow and wait times rose on average by 0.05 minutes and 0.01 minutes per percent new patient, respectively. For each increase in average E/M level, flow time increased 8.4 minutes, wait time 1.2 minutes, wait for precepting 0.8 minutes, and net income increased by $490. CONCLUSION: Teaching ambulatory care clinics appear to operate optimally, minimizing flow time and waiting time while maximizing revenue, with trainee-to-preceptor ratios between 3 and 7 to 1.