HIV母婴阻断的研究进展

人类免疫缺陷病毒(H IV)的广泛流行已成为全球最为瞩目的公共卫生问题和社会问题.据估计全球每年大约有220万妇女和60万儿童感染H IV,其中90%的儿童是通过母婴传播途径感染的,所以进行H IV母婴阻断对控制H IV的流行具有非常重要的意义.目前主要的母婴阻断方式包括抗逆转录病毒治疗、剖宫产及人工喂养等.     

艾滋病疫苗

理想的艾滋病疫苗对预防H IV感染、延缓病程进展、阻止H IV病毒的继续传播等具有重要意义.本文综述了艾滋病疫苗的工作原理、开发策略与主要作用,对目前正在研究之中的艾滋病疫苗种类,研发现状,以及治疗性疫苗的研究进展等进行了回顾.     

浅谈艾滋病病毒职业暴露风险与预防

艾滋病在我国正处于快速发展阶段,传播的方式也由高危人群转向一般人群,因而控制职业暴露和预防非常重要,因为到目前为止还没有找到特效药来治疗。暴露的环境大多在治疗室、手术室、抢救室等治疗护理较集中的地方,感染的方式主要是带血的锐器刺伤皮肤和病人的血液、体液溅入眼睛粘膜而引起感染。预防是最重要的,首先从业人员必须预防接种,其次,熟练操作流程,最后是注意个人防护。对于暴露后预防,立即用流动水或生理盐水反复冲洗,局部消毒,然后请专家进行评估,进行全身用药。已有报道暴露后预防失败,因而预防远重于治疗。     

中药"病毒克"颗粒剂对人工感染鸡新城疫的肝功指标影响

目的:观察中药"病毒克"颗粒剂对人工感染鸡新城疫病防治的肝功指标的影响.方法:试验用75只1日龄罗曼鸡人工感染NDV后,分每千克体重给"病毒克"颗粒剂0.5g、1g治疗组和0.5g预防组,并设阳性对照组和健康对照组,测定各组肝功能指标.结果:血清总蛋白(TP)0.5 g治疗组极显著高于阳性对照组(P＜0.01);白蛋白各治疗组极显著高于阳性对照组,预防组显著高于阳性对照组;r-谷氨酰转移酶(GGT)和胆固醇(CHO)阳性对照组显著低于治疗组;乳酸脱氢酶(HDBH)阳性对照组显著高于各治疗组和预防组等.结论:中药"病毒克"颗粒剂对肝功能有较好的保护作用.     

中药"病毒克"颗粒剂对人工感染鸡新城疫的肝功指标影响

目的:观察中药"病毒克"颗粒剂对人工感染鸡新城疫病防治的肝功指标的影响.方法:试验用75只1日龄罗曼鸡人工感染NDV后,分每千克体重给"病毒克"颗粒剂0.5g、1g治疗组和0.5g预防组,并设阳性对照组和健康对照组,测定各组肝功能指标.结果:血清总蛋白(TP)0.5 g治疗组极显著高于阳性对照组(P＜0.01);白蛋白各治疗组极显著高于阳性对照组,预防组显著高于阳性对照组;r-谷氨酰转移酶(GGT)和胆固醇(CHO)阳性对照组显著低于治疗组;乳酸脱氢酶(HDBH)阳性对照组显著高于各治疗组和预防组等.结论:中药"病毒克"颗粒剂对肝功能有较好的保护作用.     

低年资护士对职业暴露认知现状的调查分析

目的:了解呼和浩特地区低年资护理人员对生物性、物理性、化学性职业暴露的认知现状,为相关部门进行针对性的预防和知识培训提供依据。方法:采用自行设计的问卷,随机抽取内蒙古医科大学附属医院180例护士对职业暴露的认知情况(如职业暴露的种类、危害因素、传播途径,危害及暴露后的防护知识),知识需求程度,管理方面意见等内容进行调查。结果:附属医院低年资护士对职业暴露知识掌握不足,职业暴露类别认知36.25%;污染锐气伤的处理流程16.88%;其防护手套使用率手部皮肤破损时55.63%;更换化疗药物时11.83%;防护眼睛使用率16.88%;隔离衣使用率11.83%等。结论:调查显示低年资护理人员对职业暴露知识掌握不足。     

论职业教育与非职业教育的分类

教育都是要为受教育者从事职业(工作)服务的。把教育分为职业教育与非职业教育的标准和依据是教育与职业的关联度(或称相关性),职业教育是直接为从业服务的教育,非职业教育是间接为从业服务的教育。从本质内涵上看,与职业教育对应的非职业教育应该称之为学科知识教育;从两类教育的功能和相互关系的角度,可将职业教育称之为应用(技术)教育,非职业教育称之为基础(知识)教育;将与职业教育对应的非职业教育称为普通教育不尽科学,离弃了区分这两类教育的质的规定性。     

肝移植后肝功能异常的诊断及内科处理

已度过围手术期的肝移植患者,肝功能再次异常的原因主要包括原发病的复发,特别是乙型和丙型肝炎的复发、新病毒感染,特别是巨细胞病毒的感染、慢性排斥反应、排斥药物中毒所致肝损害等.临床诊断除常规检测肝功能外,主要依靠病毒学检测及病理诊断.内科治疗方法包括手术前的抗病毒治疗、预防呼吸道病毒感染、定期检测抗排斥药物的浓度、及时更换抗排斥药物等.     

抗甲流药物达菲——莽草酸创新试题

目前我们常用的抗病毒药物有两大类,一是金刚烷胺类药物,二是达菲等神经氨酸酶抑制剂类药物.据现在研究的情况,甲型H1N1流感病毒对金刚烷胺类药物不敏感,而对神经氨酸酶抑制剂类药物还是敏感的.可以说达菲是治疗甲型H1N1流感病毒的特效药物.     

食管癌和贲门癌术后呼吸衰竭21例分析

目的探讨食管癌和贲门癌术后呼吸衰竭的原因、预防及治疗。方法:对我院1976.3～2000.3月食管癌和贲门癌术后发生呼吸衰竭的21例患者中17例行机械通气治疗,13例行气管切开。结果:术后呼吸衰竭发生率16.2％(21/130),死亡率28.6％(6/21)。结论:术前心肺功能异常、呼吸道感染、麻醉、手术创伤、伤口疼痛等是引起术后呼吸衰竭的主要原因。早期诊断、及时治疗、机械通气是抢救成功的关键,加强术后呼吸道管理、避免手术并发症对预防术后呼吸衰竭至关重要。     

HIV post-exposure prophylaxis for child rape survivors in KwaZulu-Natal, South Africa: who qualifies and who complies?

OBJECTIVE: Our objective was to audit the provision and utilization of HIV post-exposure prophylaxis (PEP) to child rape survivors in the Province of KwaZulu-Natal, South Africa. METHODS: A prospective design was used to collect data from a convenience sample of 200 consecutive cases of child rape referred for medico-legal assessment to a state hospital located to the north of the City of Durban (South Africa) in the period October to December 2004. For each case, information was obtained regarding demographic characteristics of the child, the child's HIV status at presentation, any excluding factors for PEP therapy, and the extent of adherence to the antiretroviral therapy regimen. RESULTS: One hundred and twenty children (60%) qualified for PEP provision, with children being excluded because they refused initial HIV testing (1.5%), tested HIV positive at presentation (6.5%), or because of delayed (>72hour) presentation (32%). Of the 113 children who were followed through the PEP provision system, 40 (35.4%) returned for the full 28-day course, and only 4 (3.5%) returned at both 3- and 6-month follow up. CONCLUSIONS: Adherence rates for PEP therapy following child rape in South Africa are extremely low, with low adherence rates being associated with a theoretical risk of both reduced efficacy and drug resistance. In this context, there is a need for further research designed to identify the reasons for such non-adherence as well as a need for secondary prevention programs designed to both encourage more immediate reporting of child rape and to increase adherence to the PEP regimen.     

HIV post-exposure prophylaxis in children and adolescents presenting for reported sexual assault

BackgroundThe appropriate use of antiretroviral medications to protect against infection with human immunodeficiency virus (HIV) is unclear in cases of sexual assault of children, for whom the perpetrator's risk of HIV is often unknown, and physical proof of sexual contact is usually absent.ObjectiveIn an effort to clarify prescribing practices for HIV post-exposure prophylaxis (PEP) at our institution, we examined records of all children tested for HIV for prevalence of infection, our experience with prescribing PEP, and follow-up rates.Design/methodsMedical records at a sexual abuse clinic of all children tested for HIV during a 38-month period were reviewed for information concerning risk factors for HIV acquisition, STI test results, and PEP experience. Children were defined as PEP-eligible if they were within 96 hours of assault, and there was a report of sexual contact with the potential to transmit HIV.ResultsOne thousand seven hundred and fifty children were tested for HIV during the study period. Five children had a positive HIV ELISA, but only one child was confirmed HIV-positive. Three hundred and three children were eligible to receive HIV-PEP, but it was only offered to 16 (5.3%), of whom 15 accepted the medications. None of the children prescribed PEP completed follow-up, but 11 children had limited follow-up.ConclusionsOur results indicate that the prevalence of HIV infection among sexually abused children in our population is low, and follow-up rates are poor. Intensive efforts to try to ensure follow-up are warranted whenever PEP is prescribed. Further research may help better define the efficacy of PEP in sexually abused children and adolescents.     

Occult drug exposure in young children evaluated for physical abuse: An opportunity for intervention

BackgroundAlthough screening for drug exposure is an important consideration in the evaluation of suspected child maltreatment, limited data are available on the frequency of drug exposure in children with suspected physical abuse.ObjectiveTo examine occult drug and pharmaceutical exposure in young children with suspected physical abuse.Participants and settingChildren ages 2 weeks –59 months evaluated for physical abuse by a tertiary referral center Child Protection Team.MethodsCross-sectional study of young children diagnosed with high, intermediate, or low concern for physical abuse and tested for occult drug exposure from 2013-2017. Chart review was performed to determine adherence to recommended testing and drug test results with comparison between groups.ResultsOccult drug exposures were found in 5.1% (CI 3.6–7.8) of 453 children tested: 6.0% (CI 3.6–10.0) of 232 children with high concern for physical abuse, 5.0% (CI 2.7–9.3) of 179 children with intermediate concern, and 0% of 42 children with low concern. As adherence to protocol-based screening improved during the second half of the study, so did the overall rate of detection of occult drug exposures (7.9%, CI 5.2–11.9) in 252 children with intermediate or high concern for physical abuse. Most exposures were to cocaine, although non-prescribed pharmaceutical exposures were also detected.ConclusionsUp to 7.9% of young children suspected of being physically abused also had an occult drug exposure. Given the adverse health consequences associated with exposure to a drug-endangered environment, screening for occult drug exposure should be considered in the evaluation of young children with intermediate or high concern for physical abuse.     

Assessing the relationship between child sexual abuse and marginal living conditions on HIV/AIDS-related risk behavior among women prisoners

OBJECTIVE: There were two aims in this research. First, to examine the relationships between childhood sexual abuse and HIV drug and sexual risk taking behaviors among female prisoners, and second, to examine the relationship between a marginal adult living context and HIV drug and sexual risk taking behavior among female prisoners. METHOD: The data were collected through face-to-face interviews with a random sample of 500 women at admission to prison in 1994. Differences between women who were sexually abused while growing up (n = 130) were compared to women who reported no sexual abuse (n = 370) along various demographic, and HIV drug and sexual risk taking dimensions. RESULTS: A history of sexual abuse while growing up was associated with increased sexual risk taking behaviors in adulthood. A marginal adult living situation also emerged as an important factor increasing the risk for HIV infection. Examining the co-occurrence of both childhood sexual abuse and adult marginal living context revealed a strong relationship between these two factors and HIV risk taking activities. CONCLUSIONS: The findings indicate that childhood sexual abuse may be a predictor for HIV sexual risk taking behaviors among incarcerated women. The marginal and chaotic adult living style of these women was also associated the extent of their HIV drug and sexual risk taking behaviors. Our research suggests that the co-occurrence of sexual victimization and marginality is a stronger predictor of HIV risk than each variable alone.     

Does the “Pupil Enterprise Programme” Influence Grades Among Pupils With Special Needs?

This paper asks whether the Pupil Enterprise Programme (PEP) is a suitable working method for improving academic performance among pupils with special needs. Overall, 20% of pupils participate in PEP at some point during lower secondary school. Results from multilevel regression modelling indicate that pupils with special needs who have participated in PEP attain better grades in Written Norwegian and Mathematics than those pupils with special needs who did not participate in PEP. The difference between PEP participants and non-participants in Written English was insignificant. The positive results for Norwegian and Mathematics seem to be related to the organisation and content of PEP. The data are from a study of 1,880 pupils in the 10th Grade.     

Use of antiretroviral HIV post-exposure prophylaxis in sexually abused children and adolescents treated in an inner-city pediatric emergency department

BACKGROUND: In 2002, Georgia had the United States' eighth highest number of persons living with AIDS. Human immunodeficiency virus (HIV) transmission as a result of sexual abuse is uncommon but definitely occurs. In certain circumstances of sexual abuse, antiretroviral post-exposure prophylaxis (ARV-PEP) has been suggested as a means to decrease the risk of HIV infection. Our objective was to assess the utilization of ARV-PEP in patients being evaluated for sexual abuse at a pediatric emergency department in a city with high HIV prevalence. METHODS: A retrospective survey of the characteristics of sexual abuse victims was conducted using information abstracted from sexual abuse report forms of minors examined in 2002 at an inner-city Atlanta children's hospital. RESULTS: Of 227 victims, aged 9 months to 18 years, most were Black, inner-city residents; 190 (84%) patients were female. Only 87 of 227 (38.3%) were seen within 72 h of the abuse, the time frame for offering ARV-PEP. Twenty-three of the 87 had anogenital trauma or bleeding. Five (5.7%), were provided ARV-PEP, whereas 60 (69%) received antibiotic prophylaxis for non-HIV diseases. Those assaulted by strangers were greater than 10 times more likely to be provided ARV-PEP than others (p=.02). Assailants of the 82 victims who did not receive ARV-PEP included 22 strangers and 60 "acquaintances" of unknown serostatus. CONCLUSIONS: For a high HIV prevalence area, the proportion of sexual abuse victims prescribed ARV-PEP was small in relation to those at risk of HIV sexual exposure. Clinicians should be provided guidance on interpretation of community HIV and sexual abuse victim data to assess the appropriateness of ARV-PEP.     

Challenges in Meeting HIV/AIDS Counselling Needs in Nigeria

The HIV/AIDS pandemic is recognized globally as the greatest health challenge of the present generation. It is widely acknowledged to be the foremost killer disease in Africa. Since the first Aids case was publicly announced in 1986, the astronomical increase in victims has been a matter of concern. The rates of HIV/AIDS infection indicate that Nigeria currently has the third largest rate of HIV/AIDS patients. The UNAIDS (2008) reported that as at 2007, the population of children and adults with HIV/AIDS in Nigeria was 2.6 million. Due to the fact that there is no cure for the virus, HIV/AIDS, counselling is an important aspect of its management. Counsellors in Nigeria have provided pre- and post-test counselling, preventive education seminars, and referrals to other health professionals. However, counsellors’ efforts have only yielded limited success because of a number of major challenges. This paper examines some of the challenges involved in meeting the HIV/AIDS counselling needs of Nigerians. Specifically, it addresses challenges faced by government, potential clients, and the Counselling Association of Nigeria, as well as challenges associated with existing cultural practices (indigenous counselling practices). It concludes with specific recommendations for various stakeholders.     

Lessons learned from more than two decades of HIV/AIDS prevention efforts: implications for people who are deaf or hard of hearing

In contrast with the nearly 30 years of HIV/AIDS research with the hearing community, data on HIV infection among persons who are deaf and hard of hearing is primarily anecdotal. Although the few available estimates suggest that deaf and hard of hearing persons are disproportionately affected by HIV infection, no surveillance systems are in place to identify either frequency or mode of HIV infection within this population. Moreover, to date, all empirically validated HIV prevention interventions have relied on communication strategies developed for persons who hear. Therefore, understanding and developing effective prevention methods is crucial for persons who are deaf or hard of hearing. The authors explore (a) factors among this population that may contribute to HIV-related behaviors, (b) four key concepts consistently included in successful interventions, and (c) practical ways in which to use this information to tailor effective intervention strategies for this population.     

Quantitative assessment of the infection rate of the entomophthoraceous fungus, Zoophthora anhuiensis against the green peach aphid Myzus persicae

A two-step method was developed to quantitatively assess the infection rate of the entomophthoraceous fungus, Zoophthora anhuiensis (Li) Humber, on the green peach aphid, Myzus persicae (Sulzer). Firstly, a standard time-dose-mortality relationship, established by modeling data from bioassay 1 at varying conidial dosages (0.4-10.4 conidia/mm2) of Z. anhuiensis F97028, was used to yield an estimate of expected mortality probability at a given dosage. Secondly, bioassay 2 was conducted by simultaneously exposing six ≤4-day-old nymphal colonies to a shower of Z. anhuiensis conidia at each of four dosages (resulting from exposures of 0.3-8.0 min). Subsequently, the colonies were separately immersed in a 0.1% chlorothalonil solution for 0.5 min to disinfect all surviving conidia on the host integument from 1-12 h after exposure under temperature treatments of 15 and 20℃, respectively. The infection rate during a specific period from the end of the exposure to the immersion was then estimated as the ratio of the observed mortality over the expected mortality probability at a particular dosage. The results showed that the infection of M. persicae from Z. anhuiensis was highly rapid with little difference between aphid colonies maintained at 15 and 20℃ before being immersed in the fungicidal solution after exposure. The first 6-hour period after exposure was most crucial to successful infection of the fungus with the infection rate greatly depending on conidial dosages. It took ≤1 h to infect>50% of the aphids at a dosage of >1.5 conida/mm2 and >90% at >50 conidia/mm2.     

An actor‐network theory reading of change for children in public care

The education of children in public, or Local Authority (LA), care, known in the United Kingdom (UK) as looked‐after children (LAC), is supported by government initiatives to reduce the attainment gap that exists between LAC and their non‐LAC peers. These children often find remaining in education a challenge, are twice as likely to be permanently excluded, and three times more likely to receive a fixed‐term exclusion than other school‐age children. A high proportion (61%), have been labelled as having special educational needs (SEN) (DfE, 2015a ). In the UK, the Virtual School (VS) has a statutory role in the education of LAC (DfE, 2014a) and aims to encourage more stringent monitoring and intervention for pupils. This is partly achieved through the creation of a personalised education plan (PEP) for each LAC pupil, which outlines progress, strategies intended to accelerate attainment, and resources needed for doing so. The process involves the pupil, their social worker and the designated teacher (responsible for the welfare of LAC pupils) of the school attended. The current study uses Actor‐Network Theory (ANT, e.g. Latour, 1999 ) as a lens through which to conceptualise change for LAC pupils during the PEP process. The focus is upon three PEP meetings in one LA setting, in order to explore the people and things that are active in driving forwards change for LAC, with a view to examining the efficacy of the process and the roles of those involved. The analysis made visible the importance of the role of the designated teacher in the PEP process, in contrast to the relative inactivity of social workers and of pupil voice.