盘锦市2005年～2013年艾滋病流行特征分析

分析盘锦市艾滋病瘦情流行特征,为预防控制提供依据.对盘锦市2005年～2013年艾滋病瘦情数及流行病学调查资料进行统计分析.结果盘锦市2005年～2013年累计报告HIV/AIDS 127例,病例逐年上升,男性显著高于女性,发病年龄以20岁～44岁的青壮年,未婚占54.88％,感染途径以性途径为主,占95.28％,男男同性占61.42％,病例主要发现途径为医疗机构的检测及疾控机构的检测咨询.因此,盘锦市的艾滋病瘦情呈上升趋势,以性传播途径为主,尤其是男男同性增加明显.     

大连市2006年～2012年流感流行特征分析

分析大连市流行性感冒(流感)的流行趋势和毒株流行情况.收集2006年～2012年大连市18家哨点医院流感监测数据进行描述性分析,并对流感样病例(ILI)咽拭子进行病毒分离检测.2006年～2012年监测医院共接诊患者10 751 432例,其中流感样病例676 860例,流感样病例占门诊病例的百分比(ILI％)为6.30％.流感流行高峰出现在2009年9月～11月和2006年3月～4月.0岁～4岁组和5岁～14岁组的ILI构成比例居前2位,7年间共检测流感样病例咽拭子1 174份,鉴定出流感病毒203株,阳性率为17.29％.2012年与2011年阳性率最高,分别为62.39％和12.15％.此间流感病毒主要以H3型、BY型为主.本文旨在通过监测掌握大连市流感毒株变异情况和流行规律,为下一步流感防控工作提供科学依据.     

我国艾滋病流行的特点

我国艾滋病的流行有其自身的特点：１．人口多,多发病低,即使以目前的估计ＨＩＶ感染数３０万计,在世界上仍属极低水平;２．传播途径以吸毒为主,性传播为次,二者约为１０与１之比,这和世界各国正好相反;３．高危人群ＨＩＶ阳性率,指性病门诊者,妓女（暗娼）的阳性率都极低,约占０．０６％～０．０７％。目前我国还是以男性吸毒者为主要防治对象。     

2009年贵阳市住院儿童手足口病病原学及临床特点

为了解贵阳地区2009年4月～9月儿童手足口病的病原学及临床特点.从住院的820例手足口病患儿中采集部分伴有重症倾向的244例患儿的肛试子和咽试子标本进行RT-PCR技术检测,并进行临床观察.218例检测到肠道病毒,占89.34%.其中138例为EV71,占63.30%.72例为CA16,占33.02%,两者之比1.92:1.不同年龄组的病原构成差异有统计学意义(P＜0.01).重症病例EV71感染明显高于轻症病例,两者在临床特征方面差异有统计学意义(P＜0.01).2009年贵阳市住院儿童手足口病的主要病原是EV71和CA16;1岁～3岁的惠儿EV71感染明显高于CA16,EV71比CA16更易引重症手足口病,重症病例与轻症病例在临床表现上有明显差异.     

我国药物性肝损伤病因演变的Meta分析

评价我国1999年～2012年药物性肝损伤（DILI）病因变化特点。在Medline、EMBASE、Wanfang、VIP和CNKI中国期刊全文数据库中检索已发表的关于DILI的病例序列研究。利用R软件对各药物所占比率进行单个率的Meta分析。Meta分析表明：抗结核药是1999年～2005年DILI的首要病因,其构成比为26．54％。2006年～2012年DILI的病因则以中药为主,其构成比为30．38％,而抗结核药所占比例下降（构成比为20．57％）,抗肿瘤化疗药所占比例（构成比为10．26％）较1999年～2005年（构成比为8．73％）增加。我国DILI病因存在时间演变,中药及抗肿瘤化疗药所占比例上升,抗结核药所占比例有所下降,但仍是DILI主要病因之一．     

第二讲：循证临床实践成功的范例

1循证临床实践的背景 1．1全球疾病负担呈升高趋势 随着经济与医疗科技的发展,尽管很多经典的疾病诊断标准及治疗方案在疾病控制方面发挥了重要作用,但据近期WHO数据,全球疾病负担趋势仍令人担忧：15岁～59岁劳动力人群的伤残调整生命年（disability-adjusted life year,DALY）占全球总人口的49％（其中0岁～4岁占29％,5岁～14岁占7％,60岁以上占15％）;预测2002年-2030年主要疾病死因顺位依次为肿瘤、缺血性心脏病、中风、HIV／艾滋病、其他感染性疾病、交通事故、结核及疟疾,大都呈上升趋势,见图1。     

新疆生产建设兵团某综合性大学2007年新生乙型肝炎病毒感染现状分析

为了解本校2007级新生乙肝病毒感染情况,为今后在高校开展乙型肝炎防治工作提供科学依据,采用酶联免疫吸附试验法,检测我校2007级入校新生的HBsAg及HBsAg阳性者的“乙肝病毒血清学检验”指标。结果显示2007级新生HBsAg阳性率为6．7％,男、女生阳性率分别为8．18％,4．13％,男女之间差异有统计学意义;汉族学生HBsAg阳性率高于其他少数民族学生;新生HBsAg阳性模式中以HBsAg、HBeAg、HBcAb和HBsAg、HBeAb、HBcAb模式为主,分别占41．24％和48．02％。因此,在人口密集的高校学生中应通过多种途径加强乙肝的预防治疗及宣传工作。     

2009年全球甲型H1N1流感流行病学特征分析

截至8月30日,全球5大洲177个国家或地区共报告甲型H1N1流感确诊病例254206例,死亡2837人,病死率1．12％。病例以青壮年为主,无性别差别,年龄中位数12岁～17岁（范围0岁～85岁）,约10％需住院治疗,37％的住院病例和80％的死亡病例有基础性疾病史或妊娠。全球甲型H1N1流感总体较温和,适时将其纳入季节性流感常规监测,掌握其流行病学和病原学变化,研制安全有效的疫苗;提高医务人员重症病例救治能力均能有效地预防控制甲型H1N1流感。     

导言:老年人心血管病危险因素的控制策略

社会老龄化是人人都体会到的事实,在医院里更是突出.近期统计了我院普通心内科病房住院患者的平均年龄为63.3岁±13.1岁.世界卫生组织(WHO)对老年人的定义是≥65岁,按照美国人口普查局1971年出版的《人口学方法与资料》提出的划分标准,65岁为老年人口的年龄起点,当65岁及以上老年人口比例在5％以下的人口为年轻型人口,10％以上的是老年型人口,介于两者之间的是成年型人口.联合国统计,世界80岁以上的人口正以每年3.8％的最快速度增长,预计到2025年,老年人将占总人口的4％～5％左右.我国2004年底全国≥60岁者10.97％,其中11省超过此水平.2020年我国老人将占17.17％,2.48亿.从1950年到2040年,中国≥65岁的人口百分比增加了5倍,而美国只增加了2.5倍.另外我国≥65岁老年人口由7％增加到14％估计经历26年(2000年～2026年),而美国经历了69年(1944年～2013年).即中国老年人口的增长速度大大快于美国.这些都是今后我们会越来越多面临的患者群体,充分认识到这种趋势,及早做好应对准备,使我们工作中能够游刃有余是本期圆桌会议的目的.     

第二讲:循证临床实践成功的范例

1循证临床实践的背景 1.1全球疾病负担呈升高趋势 随着经济与医疗科技的发展,尽管很多经典的疾病诊断标准及治疗方案在疾病控制方面发挥了重要作用,但据近期WHO数据,全球疾病负担趋势仍令人担忧:15岁～59岁劳动力人群的伤残调整生命年(disability-adjusted life year,DALY)占全球总人口的49%(其中0岁～4岁占29%,5岁～14岁占7%,60岁以上占15%)[1];预测2002年～2030年主要疾病死因顺位依次为肿瘤、缺血性心脏病、中风、HIV/艾滋病、其他感染性疾病、交通事故、结核及疟疾,大都呈上升趋势,见图1.     

When are AIDS patients to blame for their disease? Effects of patients' sexual orientation and mode of transmission

This study examined three factors affecting college students' attributions of blame for an AIDS patient's disease: sexual orientation of the patient, mode of HIV transmission, and the sex of the subject. 148 subjects read one of six vignettes describing an hypothetical AIDS patient who was described as either an heterosexual or an homosexual man who contracted HIV through one of three avenues: blood transfusion, sexual contact, or IV drug use. The homosexual AIDS patient was considered more to blame for his illness than the heterosexual AIDS patient, but only when mode of transmission was sexual contact. In addition, mode of HIV transmission was a significant factor in attributions of responsibility, as the patient who contracted HIV through a blood transfusion was rated as less responsible than the patient who contracted HIV through sexual behavior or IV drug use. Women consistently rated the AIDS patient as less responsible than did men.     

Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997-2005.

OBJECTIVE: Beliefs about HIV treatment effectiveness and the impact of HIV treatments on HIV transmission risks were initially related to sexual risk-taking in the late 1990s when multidrug HIV treatments first became available. This study examined changes in beliefs about the effects of HIV treatment for preventing HIV transmission and their association to sexual risk behaviors between the years 1997 and 2005. DESIGN: Anonymous surveys were administered to a convenience sample of gay and bisexual men attending a large community event in Atlanta, Georgia in 1997 (N = 498) and again at the same community event in 2005 (N = 448). Analyses were performed for men living with HIV/AIDS and for men who have not been diagnosed with HIV/AIDS. MAIN OUTCOME MEASURES: Rates of unprotected anal intercourse in the previous 3 months. RESULTS: There were significant increases in high-risk sexual practices that coincided with increased beliefs that HIV treatments can reduce the chance of transmitting HIV. However, optimistic beliefs about the health benefits of HIV treatments decreased over the 8 years and were not related to risk behaviors. CONCLUSIONS: Beliefs about how HIV treatments impact HIV infectiousness remain associated with HIV transmission risk behavior and interventions targeting at-risk as well as HIV-positive men who have sex with men must directly address these beliefs and perceptions.     

The AIDS epidemic in Cuba

The strategy of the Cuban government to control HIV consists of examining the whole adult population and quarantining all seropositive persons in local institutions. Between 1986 and 1990, a total of 8,832,726 HIV tests were done using domestic ELISA and Western blot methods. 497 persons (362 men and 135 women) were found to be HIV-positive. 122 infections were directly attributed to Cuban intervention in Africa. 150 infected men were homosexuals and bisexuals. Infected blood products caused 9 cases, and neonatal transmission produced 3 infections. 63 AIDS cases were reported since December 1989. Compulsory testing would be more acceptable if HIV infected persons would get zidovudine (AZT) for secondary prevention. It is estimated that this policy has prevented 4000 new infections. The violation of human rights by quarantining people with false positive results is real: 23-53 such people are estimate to be quarantined. Tourists are not examined because of the economic need for more revenue from tourism, thus HIV transmission could continue despite quarantines. The cost of testing is high, although health care already made up 12% of the budget in 1989, increasing from 7.8% in 1983. Tracing sexual contacts requires 450 nurses and 200 epidemiologist. The public education campaign about AIDS involved 30 television programs and several hundred radio programs by groups of experts discussing transmission, AZT treatment, and treatment of opportunistic infections. Since 1988, schools have also included AIDS education from the 5th grade on. Condom use is stressed, but machismo often hinders its acceptance. While AIDS is a menace, the rate of syphilis increased from 7.2/100,000 in 1970 to 84.3/100,000 in 1987. Stressing personal responsibility in preventing HIV infection skirts the need for modification of high risk behavior and lulls the public into a false sense of security because of the belief that full protection from AIDS is provided by the quarantine.     

Empathy,Knowledge, and Personal Distress as Correlates of HIV‐/AIDS‐Related Stigmatization and Discrimination

This study investigated the influence of empathy, knowledge, and personal distress on HIV‐/AIDS‐related stigmatization and discrimination in a normal population (N = 346). Participants ranging in age from 18 to 69 years responded to a validated questionnaire. The results showed a significant main and joint influence of empathy, knowledge, and personal distress on stigmatization and discrimination. Stigmatization and discrimination are thus identified as great obstacles in the fight against and prevention of HIV/AIDS. Stakeholders in the HIV/AIDS arena should embark on mass education to increase knowledge of HIV/AIDS; also attitudinal change programs should be initiated, while health institutions should be effectively monitored to ensure best practices.     

Primary relationships affect the psychological health of homosexual men at risk for AIDS.

Less is known about the effects of primary relationships on psychological health for homosexual men and women than for heterosexual men and women. Given the HIV/AIDS epidemic, the primary relationships of homosexual men are especially important to examine at the present time. Using questionnaire data collected from 259 homosexual men, this study examined the effects of status and quality of relationship on psychological health. Analysis indicated that homosexual men who are in primary relationships experience fewer depressive symptoms and greater well-being than other homosexual men but that being in a relationship does not predict changes in these outcomes over time. Men who report high quality of relationship show improvements over time in psychological health. These findings are discussed in light of the HIV/AIDS epidemic.     

AIDS and pediatric HIV infection: the problem of the infected mother and her newborn

The number or pediatric AIDS cases in the US was around 2000 in 1990, and children under 13 accounted for about 2% of reported cases. Pediatric cases are increasing as the number of infected women increases. Such cases are concentrated in poor urban populations, aggravating the lack of resources of already overtaxed health services. Ethnic minorities are overrepresented among AIDS cases. In the US, 52% of AIDS cases in adult women are in blacks, 27% in non-Hispanic whites, and 20% in women of Hispanic origin. Among children under 13, 53% are in blacks, 25% in Hispanics, and 22% in whites. The majority of children with AIDS were 5 and were probably infected by vertical transmission. Over 80% were born to mothers with AIDS or at risk of HIV infection, 11% received transfusions of contaminated blood, and 5% received contaminated blood products. Through December 1989, 53% of white, 91% of black, and 85% of Hispanic children with AIDS were infected vertically by their mothers. In the US, over 1/2 of cases of vertical AIDS transmission are due to maternal IV drug abuse and 1/5 to mothers who have sexual relations with IV drug abusers. The rate of infection in children born to seropositive mothers has not been established. Estimates of rates of transmission range from 20% to 50%. The factors causing HIV transmission in 1/3 of infants and protecting the other 2/3 have not been identified. Transmission to the infant may occur during pregnancy or delivery or through breast feeding. There is no evidence that cesarean delivery can protect against infection. The risk of intrauterine infection is probably much greater than that of infection during delivery. Diagnosis of HIV infection in young infants is difficult. There are no physical characteristics distinguishing infected newborns, and laboratory diagnosis is unhelpful because maternal HIV antibodies cross the placental barrier to the fetus. There is as yet no vaccine or curative treatment for HIV infection. Prevention of pediatric HIV infection requires prevention of the infection and the disease in pregnant women. Primary prevention in women depends on their being adequately informed about risks and able to change risk behaviors. Secondary prevention is achieved through use of AZT, which slows the progression of the disease, and prevention or treatment of complications. There is no conclusive evidence as yet that pregnancy hastens the progression of maternal HIV infection. Seropositive mothers should avoid breast feeding if adequate substitute foods are available. The average age at appearance of symptoms in infected children is 8 months. Mortality is higher among children manifesting the disease in the 1st year, with a median survival of 38 months. Full information about HIV infection and voluntary and confidential screening should be available to all women contemplating pregnancy.     

Development of the HIV/AIDS Stress Scale

Development of a self-report measure of stress specific to HIV/AIDS is needed to advance our understanding of the role of stress in adaptation to HIV/AIDS; hence, the aim of this study was the development of the HIV/AIDS Stress Scale. A total of 132 homosexual/bisexual men with HIV/AIDS were interviewed and completed the HIV/AIDS Stress Scale and measures of coping strategies, appraisal, social support and adjustment (global distress, depression, social adjustment, number of HIV symptoms, and subjective health status) at three time points. Thirty-nine primary caregivers were interviewed and completed measures of stress and adjustment. Exploratory factor analyses of the HIV/AIDS Stress Scale items revealed three factors: Social, Instrumental and Emotional/Existential Stress. Factors had adequate internal reliabilities and were stable over 12 months. Construct validation data are consistent with recent stress/coping research that links higher levels of stress with more HIV symptoms, reliance on emotion-focused coping, lower social support, poorer levels of adjustment and higher levels of caregiver stress. Results extend this research by revealing new differential relations between various stress dimensions and stress/coping variables. Convergent validation data suggest that the HIV/AIDS Stress Scale shares conceptual similarity with threat appraisal, and differs from controllability and challenge appraisals. The HIV/AIDS Stress Scale shows potential for the elucidation of the role of stress in coping and adaptation to HIV/AIDS and disease progression in both research and clinical applications.     

Perceived emotional and life change impact of AIDS on homosexual men in two countries

Abstract

A comprehensive self-administered life event inventory examining both general life stress and stress from events specific to the homosexual and bisexual male population was developed in order to assess the impact of AIDS and HIV infection on homo- and bisexual men. Ranking of questions revealed that while general stressors affected homosexuals similarly to heterosexuals, there were critical stressors affecting homosexuals not measured by conventional inventories. Specifically, emotional distress from receiving an HIV antibody positive result was not significantly different to that caused by a diagnosis of AIDS or ARC, the diagnosis of AIDS in a lover or the death of a lover. A sharp discrepancy in emotional distress between current safer sex behaviour and current unsafe sexual behaviour was also found, and the implications for behavioural modification in this area noted. Those who were HIV antibody positive tended to evaluate the anticipated impact of further AIDS related diagnoses as having a greater emotional impact than those who had tested negative. There would appear to be a closer relationship between emotional distress and life change in homosexual men than in heterosexual samples. The relative emotional impacts and life change assessments of AIDS and HIV infection are discussed.     

HIV/AIDS Awareness of In—School Adolescents in Nigeria: Implications for Adolescence Sexuality

This study investigated HIV/AIDS awareness of in-school adolescents in Nigeria to determine their risk for contracting HIV/AIDS. A total of 892 purposively selected adolescents (mean age = 16. 5 years; SD = 5. 2; males = 492; females = 400) participated in the study. The participants responded to the HIV/AIDS Awareness Inventory (HAAI). The questions on the survey included the following aspects: meaning of HIV/AIDS; prevalence; mode of transmission; consequences and prevention. Differences in gender, age, school location and father's educational background in understanding HIV risk were examined. A group means comparison procedure revealed a significant difference in HIV awareness by gender, age, school location and father's educational background. Female adolescents, the older adolescents, those living in urban centres and those whose fathers are literate had higher HIV/AIDS awareness than their counterparts from rural areas. Nigerian adolescents need education regarding HIV/AIDS awareness.