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Objective To study the emergency staff's knowledge, skills and their training demand in centers for disease control and prevention (CDC) at county and municipal levels in Zhejiang Province. Methods Using multistage cluster sampling, 518 emergency staff from 34 CDCs in Zhejiang Province were involved in this study. A questionnaire survey was conducted among the emergency staff to evaluate their emergency knowledge and training demand. The differences between the staff from CDCs at county and municipal levels were evaluated. Results The average score of the emergency staff was 2.93 about all emergency knowledge. Some items' scores were lower, such as nuclear radiation control, first aid, risk management, ethics, laws and emergency system. The score of the survey items were similar at county and municipal level except education degree, positional title, and proportion of staff in emergency training, score of epidemiology, risk management and first aid. The highest degree of training demand was professional knowledge related to emergency response. The emergency staff inclined to the training mode (≥4) about short-term training, field guidance, drill and exercise and case study. Conclusion We should improve the health emergency training according to the demand and target of fostering inter-disciplinary talents for fieldwork. We should strengthen training of basic theories, basic knowledge and basic skills, to cover the shortage. The short-term training and practical training should be the main training model.
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Objective To learn the status and equity of human resource allocation for health so as to provide evidence for health administrative department. Methods Descriptive analysis and annual percent changes (APC) were used to analyze the numbers and trends of human resource allocation for health from 2011 to 2015, and Gini coefficients were used for equity evaluation. Results In 2015, Hangzhou had the largest number (12.62) of medical personnel per 1000 persons while Jiaxing had the least amount (7.43) . Hangzhou had the largest number (10.32) of medical technical personnel per 1000 persons while Wenzhou had the least amount (6.23) . Hangzhou had the largest number (3.86) of licensed (assistant) doctors per 1000 persons while Jiaxing had the least amount (2.15) . Hangzhou had the largest number (4.23) of registered nurses per 1000 persons while Wenzhou had the least amount (2.42) . Jiaxing had 8.06 medical personnel, 7.03 medical technical personnel, 2.33 licensed (assistant) doctors and 2.86 registered nurses per square kilometer which were all the largest number while Lishui had 1.21 medical personnel, 1.00 medical technical personnel, 0.39 licensed (assistant) doctors and 0.38 registered nurses per square kilometer which were all the least. The doctor-to-nurse ratio was only 1:1.01 in 2015. Both numbers of human resources for health per 1000 persons and per square kilometer increased year by year from 2011 to 2015, and Gini coefficients of each index expressed by per 1000 persons were all under 0.2, while it ranged from 0.2 to 0.3 when they were expressed by per square kilometer. Conclusion Numbers of human resource allocation for health had an increasing trend and the allocation was fair, but the equity evaluated by service population was better than by service areas, and the research about accessibility of regional human resource allocation for health needs to be concerned.
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Objective To provide diagnostic clue for the investigation and laboratory examination in outbreak of common respiratory infectious diseases using a computer -aided classification model.Methods The variables were extracted from medical literature,case data of infectious diseases,reports of outbreaks such as symptoms and signs,abnormal lab test results,epidemiologic features,the incidence rates of the infectious diseases.Then a classification model was constructed using Naive Bayesian classifier and SAS 9.1 .3 Data from eight historical outbreaks of respiratory infectious diseases were used to test the model.Results Among eight outbreaks,the discriminate probability of diagnosing a disease correctly by ranking it first on the output lists of the model was 53.85%.The sensitivity was 53.85%,and specificity was 1 00.00%, and +LR was from 5.73 to ∞.The discriminant probability of diagnosing a disease correctly by ranking it within the three most probable diseases on these lists was 98.34%.The sensitivity was 98.34% and the specificity was 82.1 4%,and +LR was from 1 .26 to ∞.Conclusion A Bayesian classification model could be applied to classification and discriminant of common respiratory infectious diseases,and could improve the ability for early diagnosis of the outbreak caused by respiratory infectious diseases.
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Objective To establish a evaluation indicator system for the emergency response capability of CDC by taking Zhejiang Province as an example.Method The manuscript of evaluation indicator system for Zhejiang province was established based on literature review and expert meeting.A 3 -rounds Delphi process was conducted and the specialist participating level,authority coefficient and Kendall's W were calculated to assess the indicator system.The weight of index was calculated by method of proportionate allocation.Results Three rounds of Delphi consultations was conducted by 1 7 consulters that from the administrative department of public health,scientific research institution or CDCs,and the response rate were 94.1 2%,87.50%,88.24% respectively.The specialist authority coefficient was 0.81 ±0.05.The final indicator system was consisted of 7 first -class indicators (Emergency response system,Emergency response team, Emergency response supply,Emergency coping capability,Surveillance and early warming,Scientific research and exchange,Communication and cooperation),22 second -class indicators and 77 third -class indicators.The W for each class of indicator were 0.701 ,0.531 ,0.547 and 0.697,0.629,0.548 respectively (P <0.01 ).The CV for each indicator ranges from 0.00 to 0.24.Conclusion The indicator system established in the study has good reliability and feasibility,and the specialists'opinions were consistent.The indicator system could be used in common assessment of CDC's emergency response capability in Zhejiang Province.
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<p><b>OBJECTIVE</b>To evaluate the epidemiological and serological efficacy after 10 years of vaccination against hemorrhagic fever with renal syndrome (HFRS) vaccines in Zhejiang province.</p><p><b>METHODS</b>One county was randomly chosen as the research unit with all the healthy people between 16 and 60 years old were equally divided into study and control groups. The study group was vaccinated. Immunofluorescent antibody assay was used to test specific IgG antibody and Mcro-CPE method was used to test the titer of neutralizing antibody.</p><p><b>RESULTS</b>Two weeks after the full-course immunization, the seroconversion rate became 100% (67/67, with 95% CI as 96.3%-100%) by immunofluorescent antibody test (IgG) and 44.4% (8/18 with 95% CI as 22.0%-69.0%) by neutralization test with GMT titers as 72.1 and 4.6 respectively. Booster immunization was provided one year later. Time span as two weeks prior to, one year, one and half years, two years, three years and five years after booster immunization, the rates of seroconversion on immunofluorescent antibody using IFAT method, were 28.6%, 83.3%, 75.0%, 53.1%, 22.6%, 10.0% and 55.0% respectively, and rates of seroconversion of neutralizing antibody by Mcro-CPE method were 14.8%, 55.6%, 35.0%, 31.3%, 26.0%, 10.0% and 50.0% respectively. Nine years after the reinforcement, the rates of seroconversion of immunofluorescent antibody by IFAT method was only 7.1%. The vaccinated group had no patient seen but the control group appeared 34 patients including 3 deaths. According to the ten-year observation, the vaccine seemed effective with the protection rate in population reached 100%.</p><p><b>CONCLUSION</b>HFRS vaccine was effective on epidemiological, social and economical efficacy.</p>
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Adolescent , Adult , Animals , Female , Humans , Male , Middle Aged , Rats , Young Adult , Hemorrhagic Fever with Renal Syndrome , Epidemiology , Allergy and Immunology , Immunization, Secondary , Methods , Vaccination , Methods , Viral Vaccines , Therapeutic UsesABSTRACT
<p><b>OBJECTIVE</b>To study the variation of specific antibody among convalescent of severe acute respiratory syndrome (SARS) patients through a three-year program.</p><p><b>METHODS</b>Sera samples were collected from SARS cases in the 5th, 20th and 35th month after onset of the illness. The SARS-CoV specific antibody was detected for all of them by ELISA and neutralized test simultaneously. The titer of neutralizing antibodies was calculated using Reed-Muench method, and the comparison between different time groups was analyzed regarding the variance of data on repeated measures after logarithm conversion.</p><p><b>RESULTS</b>13, 17 and 13 sera samples were collected in the 5th, 20th and 35th month after onset. Results showed that despite the fact that the positive rates of ELISA antibody were 100%, 82.4% and 84.6% respectively,the neutralizing antibody was still positive for all the samples. The average neutralizing antibody titers were 1:43 (1:16-1:203), 1:36 (1:17-1:59) and 1:21 (1:10-1:39) on the 5th, 20th and 35th month after onset, and the differences were statistically significant (F = 60.419, P < 0.001). On the 35th month after the onset, 30.8% (4/13) of the patients were still having the neutralizing antibody level of above 1:36, but the neutralizing antibody level in another 30.8% (4/13) of the patients had decreased to as low as 1:10, when the cut-off level was set as 1:8.</p><p><b>CONCLUSION</b>Results of the study indicated that the neutralizing antibody of SARS cases could last for at least three years, but the sera specific antibody in SARS cases decreased gradually when time went by. However, neutralizing antibody in some of the cases decreased to a lower level on the 35th month. Further follow-up study was worthwhile to observe the long-lasting profile of antibody existence on SARS cases.</p>
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Humans , Antibodies, Neutralizing , Enzyme-Linked Immunosorbent Assay , Follow-Up Studies , Severe Acute Respiratory Syndrome , Allergy and ImmunologyABSTRACT
Doing a good job of guarding against medical risks can effectively improve medical safety and reduce waste of medical resources. In recent years, marked results have been attained in the US in studies on the use of FMEA, a prospective quality analysis tool, to minimize medical risks. Similar studies, though not many, have been made in some other countries, such as Italy and Australia. No reports, however, have been published at home on studies in this field. The paper gives an account of the use and theoretical studies of FMEA in medical risk management in the US, illustrates cases wherein it was used to lower risks in prescribing drugs to patients and ensure the safe use of hospital software and hardware, and puts forward issues that shouldn't be ignored in using FMEA so as to arouse the attention of domestic hospital management departments.