public health interventions

公共卫生干预措施
  • 文章类型: Journal Article
    抗菌素耐药性(AMR)对全球健康构成重大威胁。损害治疗各种感染的功效。世界卫生组织强调了AMR对医疗保健结果的影响,包括发病率增加,死亡率,和成本。接种疫苗是对抗AMR的关键策略,促进对感染的免疫防御,随后减少对抗菌药物的需求。本文评估了疫苗接种在管理AMR中的作用,特别是在抗菌药物管理计划(ASP)的范围内,通过审查现有疫苗接种策略的有效性及其融入社区。使用GoogleScholar等数据库进行了全面的文献综述,Scielo,和PubMed,分析2005年至2024年的研究。在筛选了132篇文章的相关性和合格性之后,共纳入了13项研究。这些研究强调了疫苗在减少对抗生素的依赖方面的重要作用,特别是对于弱势群体,比如老年人,孩子们,和那些有慢性病的人。例如,结合肺炎球菌疫苗的引入显著降低了耐药肺炎链球菌的感染率.该综述还讨论了广泛接种疫苗的间接好处,包括群体免疫和抗性菌株传播减少。疫苗接种是对抗AMR的关键因素。协调良好的ASP,通过促进全面的疫苗接种计划,可以显著缓解耐药感染的上升,优化抗菌剂的使用,并改善医疗保健环境中的患者预后。概述的战略反映了全球卫生目标,并强调需要持续努力提高疫苗覆盖率和接受度。
    Antimicrobial resistance (AMR) poses a significant threat to global health, impairing the efficacy of treatments against various infections. The World Health Organization highlights the impact of AMR on healthcare outcomes, including increased morbidity, mortality, and costs. Vaccination is a pivotal strategy to counter AMR, promoting immune defenses against infections and subsequently reducing the need for antimicrobials. This article assesses the role of vaccination in managing AMR, particularly within the scope of antimicrobial stewardship programs (ASPs), by reviewing the effectiveness of existing vaccination strategies and their integration into the community. A comprehensive literature review was concluded using databases such as Google Scholar, Scielo, and PubMed, analyzing studies from 2005 to 2024. A total of 13 studies were included after screening 132 articles for relevance and eligibility. The studies highlight the substantial role of vaccines in reducing the reliance on antibiotics, especially for vulnerable populations, such as the elderly, children, and those with chronic conditions. For instance, the introduction of conjugate pneumococcal vaccines significantly decreased rates of drug-resistant Streptococcus pneumoniae infections. The review also discusses the indirect benefits of widespread vaccination, including herd immunity and decreased transmission of resistant strains. Vaccination is a critical element in the fight against AMR. Well-coordinated ASPs, by facilitating comprehensive vaccination programs, can significantly mitigate the rise of resistant infections, optimize antimicrobial usage, and improve patient outcomes in healthcare settings. The strategies outlined reflect global health objectives and emphasize the need for sustained efforts to enhance vaccine coverage and acceptance.
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  • 文章类型: Journal Article
    2023年10月18日,卫生部宣布卢萨卡地区爆发霍乱。在卢萨卡地区和该国其他热点地区,采用多部门方法实施了公共卫生干预措施。我们记录了多部门应对工作及其对赞比亚卢萨卡地区霍乱疫情的影响。我们强调了主要挑战及其对热点地区疾病流行病学模式的相关影响。
    我们对卢萨卡地区的霍乱反应活动进行了描述性观察研究。我们在医疗机构中使用了疾病预防和控制中心的直接面对面观察工具,使用了定量和定性非参与者技术。我们审查了监测记录,以估计疫情的严重程度,以人为特征的案件,地点,和时间。我们使用情况报告记录了应对干预措施和挑战。
    在2023-2024年霍乱爆发期间,截至2024年2月12日,卢萨卡地区是受影响最严重的地区,有13,122例病例和498例死亡。尽管有一个完善的协调技术支持和资源调动的系统,卫生条件不足和获得清洁水的机会有限仍然是卢萨卡地区霍乱爆发的潜在风险。
    卢萨卡地区可能经历了该国历史上最严重的霍乱流行之一,正如社区和治疗中心报告的快速传播和死亡率增加所表明的那样。多部门协调改善卫生系统,获得干净的水,健康教育策略,疫苗接种运动导致霍乱病例减少。
    UNASSIGNED: on October 18, 2023, the Ministry of Health declared an outbreak of cholera in the Lusaka district. Public health interventions were implemented using a multisectoral approach in the Lusaka district and other hotspots in the country. We documented the multisectoral response efforts and their impacts on the cholera epidemic in the Lusaka district of Zambia. We highlighted the major challenges and their associated impacts on the epidemiologic patterns of disease in hotspot areas.
    UNASSIGNED: we conducted a descriptive observational study of cholera response activities in the Lusaka district. We used quantitative and qualitative non-participant techniques using the Centers for Disease Prevention and Control\'s direct in-person observation tool in healthcare settings. We reviewed surveillance records to estimate the magnitude of the outbreak, and characterized cases by person, place, and time. We documented the response interventions and challenges using situation reports.
    UNASSIGNED: during the 2023 - 2024 cholera outbreak, Lusaka district was the most affected district with 13,122 cases and 498 deaths as of 12th February 2024. Despite having a well-established system for coordinating technical support and resource mobilization, inadequate sanitation and limited access to clean water remained potential risks for cholera outbreaks in Lusaka district.
    UNASSIGNED: Lusaka district may have experienced one of the most severe cholera epidemics in the nation\'s history, as indicated by its rapid spread and increased mortality reported from both the community and treatment centers. A multisectoral coordination for improved sanitary systems, access to clean water, health education strategies, and vaccination campaigns contributed to the decline in cholera cases.
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  • 文章类型: Journal Article
    本案例研究描述了德国高级传染病能力和治疗中心常设工作组的经验,被称为STAKOB(StändigerArbeitskreisderKompetenzund-undBehandlungszentrenfürKrankheitendurchhochpathogeneErreger)。STAKOB将公共卫生当局(能力中心)和高级隔离单位(治疗中心)召集在一起,以合作处理高后果传染病(HCID)和新出现的传染病的临床管理。该网络由罗伯特·科赫研究所协调,德国联邦公共卫生研究所。STAKOB的主要任务是加强HCID的临床和公共卫生管理,并增加有关德国HCID和非HCID新兴传染病的专家知识。STAKOB能够交流知识和经验;制定感染预防和控制措施指南,临床管理,和治疗;以及对世界卫生组织和其他国际疫情应对措施的支持。过去几年表明,STAKOB网络对德国的重要性-不仅在为HCID病例提供重症监护方面,而且还提高了支持公共卫生和新出现的传染病病例的临床管理的能力。然而,在德国维持几个高级隔离单位需要高度的财政承诺,材料,和人力资源。由于HCID和新出现的传染病事件的罕见,保持适当的准备水平和确保足够的投资是一项持续的斗争。然而,至关重要的是,在生物安全和传染病格局不断变化的时候,有一个网络随时准备应对HCID和非HCID新兴传染病。
    This case study describes the experience of the German Permanent Working Group of Competence and Treatment Centers for High Consequence Infectious Diseases, known as STAKOB (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger). STAKOB brings together public health authorities (competence centers) and high-level isolation units (treatment centers) to collaborate on the clinical management of high-consequence infectious diseases (HCIDs) and emerging infectious diseases. The network is coordinated by the Robert Koch Institute, Germany\'s federal public health institute. The main tasks of STAKOB are to strengthen HCID clinical and public health management and increase expert knowledge on HCID and non-HCID emerging infectious diseases in Germany. STAKOB enables the exchange of knowledge and experiences; development of guidelines on infection prevention and control measures, clinical management, and therapy; and support for the World Health Organization and other outbreak responses internationally. The past years have shown how important the STAKOB network is for Germany-not only in providing critical care for HCID cases but also increasing capacity to support public health and clinical management of emerging infectious disease cases. However, maintaining several high-level isolation units in Germany requires a high commitment of financial, material, and human resources. Due to the rarity of HCID and emerging infectious disease events, maintaining the appropriate level of preparedness and ensuring sufficient investments is an ongoing struggle. Nevertheless, it is essential to have a network ready to react to HCID and non-HCID emerging infectious diseases in times of a changing biosecurity and infectious landscape.
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  • 文章类型: Journal Article
    评估中风运动和相关的行为变化对于评估干预效果和指导未来策略至关重要。我们旨在评估患者和旁观者对卒中体征和症状的预知以及他们在卒中发作时的反应。如果中风患者患有致残性中风,我们使用经过验证的问卷或他们的旁观者采访了中风患者。问卷是对165名参与者进行的,142例(86.1%)卒中患者和23例(13.9%)旁观者。平均年龄为52.6(SD=11.7),男女比例为7:1。在参与者中,33人(20.1%)对中风体征有预见性认识,其中,27人(16.5%)知道卡塔尔的中风运动。中风发作时的行为反应包括;激活急诊医疗服务(EMS)(n=55,33.3%),打电话给朋友/亲戚(n=69,41.8%),开车去医院(n=33,20%),等待病情改善(n=21,12.7%)。没有种族联系,婚姻状况,或活动意识与EMS激活。尽管社区对中风迹象和运动的认识有限,通过EMS激活寻求帮助的行为普遍较高,强调需要有针对性的教育工作和公共卫生干预措施。
    Evaluating stroke campaigns and associated behavioural changes is crucial to assess intervention effectiveness and inform future strategies. We aimed to evaluate patient\'s and bystanders\' foreknowledge of stroke signs and symptoms and their response at stroke onset. We interviewed stroke patients using a validated questionnaire or their bystanders if the stroke patient had disabling stroke. The questionnaire was administered to 165 participants, 142 (86.1%) stroke patients and 23 (13.9%) bystanders. The mean age was 52.6 (SD = 11.7), and male-female ratio was 7:1. Among the participants, 33 (20.1%) had foreknowledge of stroke signs, and of these, 27 (16.5%) were aware of the stroke campaign in Qatar. The behavioural responses at stroke onset included; activating Emergency Medical Services (EMS) (n = 55, 33.3%), calling friends/relatives (n = 69, 41.8%), driving to hospital (n = 33, 20%), waiting for improvement in condition (n = 21, 12.7%). There was no association of ethnicity, marital status, or campaign awareness with EMS activation. Despite limited community awareness of stroke signs and campaign, help-seeking behaviour through EMS activation was generally high, underscoring the need for focused educational efforts and public health interventions.
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  • 文章类型: Journal Article
    与交通相关的排放仍然是美国和全球空气污染的重要来源。有证据表明,以前实施的限制交通流量的政策影响了空气污染水平。因此,与COVID-19大流行相关的缓解策略改变了人群水平的流动模式,为研究美国各地的空气污染变化提供了独特的机会。例如,为了减缓大流行的蔓延,州和地方政府开始实施各种缓解措施,包括呆在家里的指令,社会距离措施,学校关闭,和旅行限制。这项范围审查旨在总结有关美国大流行期间空气质量如何通过缓解措施而发生变化的现有证据。我们发现66篇文章符合我们的纳入标准。一般来说,综合结果显示,二氧化氮(NO2)和一氧化碳(CO)在全国范围内下降。研究观察到细颗粒物和粗颗粒物(PM2.5,PM10)的混合方向和变化幅度,臭氧(O3)二氧化硫(SO2)。很少有文章试图通过关联背景因素来解释空气质量变化中这种显著的异质性,比如流动性,交通流量,和人口因素。然而,所有的研究都认为,空气污染的变化在美国各地是不均匀的,甚至在一个城市内是不同的。
    Traffic-related emissions continue to be a significant source of air pollution in the United States (US) and around the globe. Evidence has shown that previous policies implemented to restrict-traffic flows have affected air pollution levels. Thus, mitigation strategies associated with the COVID-19 pandemic that modified population-level mobility patterns provide a unique opportunity to study air pollution change across the US. For instance, to slow the spread of the pandemic, state and local governments started implementing various mitigation actions, including stay-at-home directives, social distancing measures, school closures, and travel restrictions. This scoping review aimed to summarize the existing evidence about how air quality changed through mitigation practices throughout the pandemic in the US. We found 66 articles that fit our inclusion criteria. Generally, the consolidated results revealed that nitrogen dioxide (NO2) and carbon monoxide (CO) decreased across the country. Studies observed mixed directions and magnitudes of change for fine and coarse particulate matter (PM2.5, PM10), ozone (O3), and sulfur dioxide (SO2). Few articles tried to explain this notable heterogeneity in air quality changes by associating contextual factors, such as mobility, traffic flow, and demographic factors. However, all studies agreed that the change in air pollution was nonuniform across the US and even varied within a city.
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  • 文章类型: Journal Article
    肥胖影响美国1470万儿童和青少年。儿童的健康行为受到父母健康行为的影响。因此,儿童肥胖干预措施应包括父母.这项研究的目的是评估参加TEEEN计划的不同人群的自我报告健康行为的变化,以子父母二元的动机访谈为关键组成部分,1年。
    在这里,我们评估了家庭和营养与身体活动(FNPA)筛查工具得分的变化,一种评估肥胖行为的工具,在一个种族中,子父双子的MI,种族,和参加青少年(青少年,赋权,教育,锻炼,营养)计划,马萨诸塞州的非诊所和家庭行为计划,1年。
    参与TEEEN计划,其中包括子-父二元的MI,与整体FNPA评分的显着增加相关(中位数变化=4分,P=.007)。我们观察到76.5%的儿童BMI%和BMIz评分下降。BMI%的变化(中位数=-0.9,P=.006)和BMIz评分的变化(中位数=-0.2,P=.008)具有统计学意义。
    根据FNPA筛选工具的各个方面和体重参数的变化,参与TEEEN计划似乎是有益的。FNPA筛查工具增强了对儿童-父母双体的动机性访谈,显示出有望成为解决肥胖行为的一种方法。这项研究为医疗提供者提供了一个详细的框架,以解决非诊所环境中的儿童肥胖问题,并且时间限制较少。
    UNASSIGNED: Obesity affects 14.7 million children and adolescents in the United States. Children\'s health behaviors are affected by parental health practices. Therefore, pediatric obesity interventions should include parents. The objective of this study was to assess the changes in self-reported health behaviors in a diverse population attending the TEEEN program, with motivational interviewing of child-parent dyads as a key component, for 1 year.
    UNASSIGNED: Here we assessed the changes in Family and Nutrition and Physical Activity (FNPA) screening tool scores, a tool that assesses obesogenic behaviors, in the context of MI of child-parent dyads in a racially, ethnically, and socioeconomically diverse population who attended the TEEEN (Teens, Empowerment, Education, Exercise, Nutrition) program, a nonclinic and family-based behavior program in Massachusetts, for 1 year.
    UNASSIGNED: Participation in the TEEEN program, which includes MI of child-parent dyads, was associated with a significant increase in the overall FNPA score (median change= 4 points, P = .007). We observed that 76.5% of children experienced a decrease in BMI% and BMI z-score. The change in BMI% (median= -0.9, P = .006) and change in BMI z-score (median= -0.2, P = .008) were statistically significant.
    UNASSIGNED: Participation in the TEEEN program seemed to be beneficial based on aspects of the FNPA screening tool and changes in weight parameters. The FNPA screening tool enhanced-motivational interviewing of child-parent dyads shows promise as an approach to address obesogenic behaviors. This study provides a detailed framework for medical providers to address pediatric obesity in a nonclinic setting with less time constraints.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    流行病的准确预测模型对于优化分配生物医学资源和制定政策至关重要。已经提出了数十种病例预测模型,但它们随时间和模型类型的准确性仍不清楚。在这项研究中,我们系统分析了美国疾控中心所有的COVID-19预测模型,首先对它们进行分类,然后计算它们的平均绝对百分比误差,波浪式和完整的时间表。我们将他们的估计与政府报告的病例数进行比较,彼此,以及两个基线模型,其中病例计数保持静态或遵循简单的线性趋势。比较显示,大约三分之二的模型无法超过简单的静态案例基线,三分之一的模型无法超过简单的线性趋势预测。模型的逐波比较表明,没有任何整体建模方法优于其他建模方法,包括集成模型和建模中的错误在大流行期间随着时间的推移而增加。这项研究引起了人们对在包括美国疾病预防控制中心在内的卫生组织的官方公共平台上托管这些模型的担忧,这些模型可能会给它们一个官方的认可,并用于制定政策。通过为大流行预测模型提供通用的评估方法,我们希望这项研究能够成为开发更准确模型的起点。
    Accurate predictive modeling of pandemics is essential for optimally distributing biomedical resources and setting policy. Dozens of case prediction models have been proposed but their accuracy over time and by model type remains unclear. In this study, we systematically analyze all US CDC COVID-19 forecasting models, by first categorizing them and then calculating their mean absolute percent error, both wave-wise and on the complete timeline. We compare their estimates to government-reported case numbers, one another, as well as two baseline models wherein case counts remain static or follow a simple linear trend. The comparison reveals that around two-thirds of models fail to outperform a simple static case baseline and one-third fail to outperform a simple linear trend forecast. A wave-by-wave comparison of models revealed that no overall modeling approach was superior to others, including ensemble models and errors in modeling have increased over time during the pandemic. This study raises concerns about hosting these models on official public platforms of health organizations including the US CDC which risks giving them an official imprimatur and when utilized to formulate policy. By offering a universal evaluation method for pandemic forecasting models, we expect this study to serve as the starting point for the development of more accurate models.
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  • 文章类型: Journal Article
    登革热(DF)是热带气候中普遍存在的公共卫生问题,人口稠密的地区,比如印度,不成比例的影响。解决这一问题需要对导致登革热感染风险的环境和社会文化因素有多方面的了解。这项研究旨在确定斋浦尔DF的高风险区域,拉贾斯坦邦,印度,通过整合物理,人口统计学,和流行病学数据在一个全面的风险分析框架。我们调查了环境变量,如土壤类型和植物覆盖,为了描述埃及伊蚊的潜在栖息地,主要登革热载体。同时,评估人口统计学指标以评估人群对登革热暴发的易感性.通过综合人口密度和每个病房发病率的比较分析,系统地确定了高危地区。结果显示,人口密度高与登革热风险增加之间存在显着相关性,主要由垂直传输促进。空间上,这些高风险区集中在斋浦尔的北部和南部,北部和西南部病房表现出最严重的风险。这项研究强调了在脆弱地区开展有针对性的公共卫生干预和疫苗接种运动的重要性。它进一步为未来评估此类干预措施有效性的研究奠定了基础,从而有助于制定强有力的基于证据的登革热风险缓解策略。
    Dengue fever (DF) is a pervasive public health concern in tropical climates, with densely populated regions, such as India, disproportionately affected. Addressing this issue requires a multifaceted understanding of the environmental and sociocultural factors that contribute to the risk of dengue infection. This study aimed to identify high-risk zones for DF in Jaipur, Rajasthan, India, by integrating physical, demographic, and epidemiological data in a comprehensive risk analysis framework. We investigated environmental variables, such as soil type and plant cover, to characterize the potential habitats of Aedes aegypti, the primary dengue vector. Concurrently, demographic metrics were evaluated to assess the population\'s susceptibility to dengue outbreaks. High-risk areas were systematically identified through a comparative analysis that integrated population density and incidence rates per ward. The results revealed a significant correlation between high population density and an increased risk of dengue, predominantly facilitated by vertical transmission. Spatially, these high-risk zones are concentrated in the northern and southern sectors of Jaipur, with the northern and southwestern wards exhibiting the most acute risk profiles. This study underscores the importance of targeted public health interventions and vaccination campaigns in vulnerable areas. It further lays the groundwork for future research to evaluate the effectiveness of such interventions, thereby contributing to the development of robust evidence-based strategies for dengue risk mitigation.
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  • 文章类型: Editorial
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