目的 调查云南省香格里拉市棘球蚴病流行情况,分析防控措施及效果,为控制或消除棘球蚴病对策的制定提供参考依据. 方法 查阅2018-2019年云南省香格里拉市人群棘球蚴病检测数据,了解人体棘球蚴病流行情况.对调查村随机抽取养犬户,每户采集犬粪样,ELISA检测犬棘球绦虫粪抗原.采用内脏剖解法检查家畜棘球蚴感染情况,并发放问卷调查. 结果 两年人群棘球蚴病筛查共23 623人,检出棘球蚴病患者6例,患病检出率为0.03％,均为细粒棘球蚴病.其中,医院被动筛查和人群主动病例筛查患病检出率分别为0.02％(3/12813)和0.03％(3/10810),差异无统计学意义(x2 =0.083,P＞0.05).病例回顾性调查、医院被动筛查和主动病例筛查共检出棘球蚴病患者29例.其中,医院和主动筛查病例占总病例数的72.41％(21/29)和27.59％(8/29),疑似、临床和确诊病例占总病例数的6.90％(2/29)、27.59％(8/29)和65.52％(19/29),肝、肺和胸膜腔病例占总病例数的93.10％(27/29)、3.45％(1/29)和3.45％(1/29).女性病例数多于男性,以中老年病例数较多,藏族病例数多于其他民族.犬棘球绦虫粪抗原阳性率为20.07％(237/1181),家畜动物感染率为4.26％(15/352).居民家庭自宰户比例占总调查户的73.52％(175/238),家庭自宰杀和邻家宰杀时见过包囊脏器的人数分别占15.13％(36/238)和8.82％(21/238),家畜动物病变脏器扔掉、喂犬、掩埋或焚烧分别占32.57％(12/38)、44.73％(17/38)和23.68％(9/38).人群主动病例调查1人的费用为20.81元,发现1例棘球蚴患者的费用为12 224.34元.检查1份犬粪的费用为16.60元,发现1只阳性犬的费用为55.70元. 结论 香格里拉市犬棘球绦虫感染率较高,存在棘球蚴病流行风险,应主动开展人群棘球蚴病筛查,进一步加大和实现棘球蚴病的可持续防控.

目的 了解和分析全国人体重点寄生虫病的流行现状和态势,为制定防治规划提供科学依据.方法 2014-2016年在全国31个省(直辖市、自治区,未包括港澳台地区)的农村地区根据全国生态功能区划分和各县农民年人均纯收入划分(高、中、低),采用分层整群随机抽样的方法,在每省抽取4～36个县,每县抽取2～4个自然村,共1 890个调查点,每个调查点抽样调查常住居民250人,采集粪便,应用改良加藤厚涂片法(Kato-Katz法,一粪二检)检测蠕虫感染情况,生理盐水涂片法和碘液涂片法检测原虫感染情况,对3～6岁儿童采用透明胶纸肛拭法检测蛲虫感染情况.同时,在城镇地区调查人群华支睾吸虫感染情况,按感染水平将全国划分为5类华支睾吸虫流行区(Ⅰ～Ⅴ),不同流行区类型的各省抽取2～37个县,在城镇地区以居委会为调查点,共抽样517个调查点,每个调查点调查常驻居民250人,仅调查华支睾吸虫感染情况. 结果 全国31个省(直辖市、自治区)共调查617 441人,其中农村484 210人,城镇133 231人,检出重点寄生虫感染者20 351例,检出率为3.30％;查出虫种34种,其中蠕虫23种,原虫11种.重点寄生虫加权感染率为5.96％,推算感染人数约为3 859万.其中蠕虫加权感染率为5.10％,肠道原虫加权感染率为0.99％,推算感染人数约为642万;土源性线虫加权感染率为4.49％,推算感染人数约为2 912万;3～6岁儿童蛲虫感染率为3.43％,推算感染人数约为155万;带绦虫加权感染率为0.06％,推算感染人数约为37万.全国华支睾吸虫加权感染率为0.47％,推算感染人数约为598万;农村华支睾吸虫加权感染率为0.23％,推算感染人数约为152万;城镇华支睾吸虫加权感染率为0.71％,推算感染人数约为446万.重点寄生虫感染流行呈明显区域性分布,土源性线虫中、高度流行区主要分布在四川、海南、贵州、云南、重庆、广西、广东和江西等省(直辖市、自治区).华支睾吸虫流行区主要集中在广东、广西、黑龙江和吉林等省(自治区);带绦虫感染仍然主要分布在西藏;3～6岁儿童蛲虫高感染地区主要集中在海南、江西、广东、广西、贵州和重庆等省(直辖市、自治区).50％以上的肠道原虫感染者集中分布在西藏、贵州和广西等西部省(自治区). 结论 全国重点寄生虫感染率大幅降低,尤其是土源性线虫病下降最明显,绝大部地区处于低度流行或散发状态,且流行区域也明显缩小,但仍有一些省或局部地区感染较严重.重点寄生虫感染流行呈明显区域性分布,土源性线虫中、高度流行区主要分布在西南和南部两大片区,华支睾吸虫流行区主要分布在华南和东北两大片区,带绦虫仍然主要分布在西藏,3～6岁儿童蛲虫高感染地区主要集中在华南和西南地区,肠道原虫呈现出局部地区感染率较高的特点,主要分布在西部省份.我国农村地区重点寄生虫感染人数仍然较多,防控任务仍然艰巨.

为更好地理解和执行《包虫病防治技术方案(2019年版)》,指导各地防治工作,本文比较了国家于2007年印发的《包虫病防治技术方案(试行)》与2019年印发的《包虫病防治技术方案(2019年版)》,对2019年版方案修订的主要内容进行了解读,并重点对流行区分类、病例复查随访和建档管理、病例个案调查和疫点调查、犬驱虫分类施策等内容修订的原因、意义及相关考虑进行了说明,供各地在包虫病防治工作实践中参考.

The prevention of iodine deficiency through salt iodization has been recognized as a global success story, and China stands at the forefront of this achievement with one of the most successful programs in the world. High level political commitment, national mandatory legislation, a state-managed edible salt industry and a complex and highly sophisticated surveillance system have facilitated the success of the program. Challenges have arisen however, including: (i) concern that adequate iodine status in pregnant women cannot be achieved without causing above adequate iodine intakes in children; (ii) declining iodine intake as a result of reductions in salt consumption and increased consumption of processed foods, which may not be made with iodized salt; (iii) the existence of areas with high iodine content in the water; and (iv) declines in household use of iodized salt due to concerns about excess iodine intake and thyroid disease. This article reviews the achievements and challenges of the Chinese Iodine Deficiency Disorders (IDD) Elimination Program and reflects on lessons learned and implications for other national salt iodization programs.

In 2012,General Office of the State Council forwarded "the'12th Five-Year Plan'on National Prevention and Control of Endemic Diseases",which was jointly developed by the Former Ministry of Health,Development and Reform Commission,and Ministry of Finance.During the "12th Five-Year Plan" period,the national prevention and control of endemic diseases had made steady progress.This article mainly summarized the progress made in prevention and control of endemic diseases in China during the "12th Five-Year Plan" period.The main problems encountered in prevention and control of endemic diseases in China were discussed.The prevention and key research tasks of the "13th Five-Year Plan" on national prevention and control of endemic diseases were introduced.In the "13th Five-Year Plan",key issues in prevention and control of endemic diseases will be the existing main problems,to carry out targeted prevention and control,and to develop scientific and accurate prevention and control plan according to law.

Objective: To monitor iodized salt consumption and evaluate iodine deficiency status in 2014 in China.

目的 对血吸虫病传染源控制措施实施效果分析,为进一步完善传染源控制措施和巩固防治效果提供科学依据.方法 于2007-2014年在湖北省选择8个行政村为研究点.每年开展钉螺调查,人群感染情况调查,耕牛感染情况调查.所有研究村均按照防治要求,实施以机械代替耕牛耕作措施.结果 2007-2014年,研究点的钉螺面积每年均维持在488 hm2左右.活螺平均密度呈波浪型变化,高点超过0.60只/0.1 m2;钉螺感染率和感染性钉螺平均密度均呈快速下降趋势,2007年与2014年相比,下降幅度为100％,2012-l014年连续3年未查获感染性钉螺.人群感染率从3.52％(2007年)下降至0.48％(2014年),下降幅度为86.40％.耕牛感染率自2007年5.59％下降至2012年1.02％,随后连续2年均为0,2013和2014年,研究点发现饲养耕牛900头次.结论 通过实施传染源控制措施,人群、耕牛和钉螺的血吸虫感染率均呈显著下降.但是,由于钉螺孳生环境依然存在,钉螺密度未明显下降,并存在耕牛,仍然存在血吸虫病高传播风险.

During the twelfth "Five-year Plan" period, the Chinese government further strengthened the implementation of several medium and long-term plans on disease control, which resulted in the acceleration of the control of schistosomiasis, malaria and echinococcosis. To further elucidate the endemic status and control experience during the stage, this article described current situation on the major parasitic diseases and put forward the challenges and consequent countermeasures for planning the control programs in the next five years and laying a foundation for the next Five-year Planning.

OBJECTIVE To evaluate the schistosomiasis control effect of the measures of replacing cattle with machine for cultivation and forbidding depasturage of livestock on marshlands in marshland and lake regions. METHODS The retrospective review and field survey were implemented in the Jiangling and Gongan counties of Hubei Province where were implemented with the measure of replacing cattle with machine for cultivation, and Yuanjiang and Huarong counties of Hunan Province where were implemented with the measure of forbidding the depasturage of livestock on marshlands. The schistosome infection status of human, cattle, and Oncomelania hupensis snails, and schistosome-infested field excreta were surveyed from 2007 to 2013. The effects of the interventions were compared before and after their implementations. RESULTS The 6 villages of Hubei Province were implemented with the measure of replacing cattle with machine for cultivation, and 7 villages of Hunan Province were implemented with the measure of forbidding the depasturage of livestock on marshlands. From 2007 to 2013, the schistosome infection rates of residents declined from 3.95% to 0.70% (χ2 = 128.376, P < 0.05), with the descend range of 82.53%. The descend ranges of the measures of replacing cattle with machine for cultivation and forbidding the depasturage of livestock on marshlands were 83.081% and 81.62% respectively, and there was no significant difference between the two measures (χ2 = 0.132, P > 0.05). The infection rate of cattle decreased from 3.66% in 2007 to 0.65% in 2013, and the descend range was 82.24% (χ2 = 13.692, P < 0.05). The field excreta was surveyed in the snail breeding place in 2013. The investigated area was 157.435 hm2, and 625 samples of field feces of cattle were collected with the density of field excreta of 3.97/hm2, and the positive rate was 1.12% (7/625). The schistosome infection rate of snails and the density of infected snails decreased successively from 2007, and no infected snails were detected from 2011 to 2013. CONCLUSIONS The schistosomiasis endemic situation are decreased significantly after the interventions of replacing cattle with machine for cultivation and forbidding the depasturage of livestock on marshlands. Therefore, schistosomiasis control effect of these measures is notable in the marshland and lake regions.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:在考虑精神障碍住院治疗"急慢分治"需求的前提下,提出适合我国国情的精神科床位配置方案,为制定全国性精神卫生服务资源配置规划提供参考。方法:通过文献复习、专家咨询,获得目前使用住院服务的主要精神障碍（精神病性障碍、双相情感障碍、重性抑郁障碍和老年期痴呆）的患病率和急慢性住院治疗的比例、平均住院日的数据,根据世界卫生组织推荐的精神科床位配置计算公式,计算精神科床位配置方案。结果:全国精神科床位的最低配置（满足可能有危害社会行为的精神病性障碍和双相情感障碍患者的急、慢性住院治疗需要）为262562张（床位密度1.97张/万人口）,其中急性床位112206张,慢性床位150356张;中等配置（在最低配置基础上,进一步满足有严重自杀倾向重性抑郁障碍患者和有明显精神行为症状老年期痴呆患者的急性住院治疗需要）需618461张（4.64张/万人）,其中急性468105张,慢性150356张;较高配置（在中等配置基础上,进一步满足可能致残的精神病性障碍和双相情感障碍患者的急、慢性住院治疗需要）需1141340张（8.56张/万人）,其中急性692517张,慢性448823张。结论:精神科床位资源配置应分阶段进行,首先满足最低配置,逐步加强床位建设。在各档配置中首先应满足急性住院的需要,在此基础上,进一步增加慢性治疗床位建设。</span>

5·12汶川大地震是新中国成立以来受灾面积最大、受灾人数最多和损失最大的地震灾害[1].地震不仅造成了巨大的生命和财产损失,也给经历家园丧失、亲人伤亡和身体伤害的人们带来了复合性、灾难性和持续性的重大心理创伤.2008 ～ 2011年间,在党中央、国务院的领导和社会各界的支持下,卫生部多次要求加强汶川地震灾区受灾群众心理援助工作,与其他政府部门、有关非政府组织、地震灾区和对口支援省市各级卫生行政部门和业务技术机构密切配合,加大行政管理和技术支持力度,引导、规范各方资源开展心理援助,对缓解灾区群众的心理压力,延缓、减少精神障碍的发生起到了积极的作用.现就卫生系统灾后心理援助的工作措施、成效、问题及对策进行探讨,为应对将来的突发公共事件提供参考.

5.12汶川特大地震灾害,既使中国精神心理健康状况与心理咨询、心理治疗、灾后心理救援成为重大社会政策议题,又使精神健康社会工作服务体系、社会服务体系与实务模式建设成为当务之急,还使心理学与社会工作的区别成为重大的政策议题.本文从不同层面,全面、系统地区分了心理学与社会工作的本质差异,为灾后社会重建和中国特色精神健康社会工作制度框架设计、服务体系与实务模式的建设奠定了理论和学科基础.本文的基本结论是,中国应优先发展精神健康社会工作实务模式,科学定位心理学服务层次.

生物医学模式向生物-心理-社会医学模式水平转型过渡已成世界医学发展趋势,实质是生物医学范围由单一生理疾病扩大到精神心理障碍、行为障碍与社会问题,精髓是生物医学模式范围横向或水平性扩展.同时,生物医学模式向生理-心理-社会-精神医学模式战略升级,实质是生物医学模式由平面性生理疾病升级为立体性生理-心理-社会-精神医学模式,精髓是生物医学模式纵向或垂直性结构分化.中国精神心理健康已成重大社会问题,精神健康社会工作在精神疾病防治体系中处于战略地位,扮演举足轻重角色,发挥重要作用.文章从精神心理健康角度,简要论述精神健康社会工作的紧迫性、必要性和重要性.

受德中心理治疗研究院(German-chinese Acade-my for Psycllotherapy,德文简称DCAP)等单位的邀请,中国医院协会组织心理治疗考察团于2008年11月30日至12月7日访问了德国.

日益严峻的精神心理问题,迫切需要精神卫生社会工作服务.文章区分五种精神卫生社会工作服务模式异同之处,探讨发展中国特色精神卫生社会工作服务模式的策略.

Objective: To study the application of Yi-wu model on financing practice of mental health treatment and prevemtion;Methods: Based on analyzing the investment and reimbursement of mental health institution,patients and their family member in Yi-wu,exploring their strength and issues in this system and preconditions when its extend to the broad areas;Results: Mental health institution should provide more independence under the management model of seperation of revenue and expenditure;government investment need increase follows the economic growing;and non residency registered patients should be convered in this system;Conclusions: The management model of seperation revenue and expenditure adequate in the basical mental health institutions;whole coverage input need support by the local economic level;and more feasible policies should be development for mental patients.

The relationship between the medical humanisms,the education of medical humanisms,the medical professionalism and the health system reform is a key foundation of the Chinese scientific philosophy research,the medical and pharmaceutical policy,professional education,and social welfare policy.This article briefly introduces seven aspects of the definition of the medical humanism and medical professional spirits.It aims to find out factors exterminating the structure,mechanism,and system of the medical humanism and the professional education.It demonstrates that the government plays an important role in the medical humanism and professional education.The key role is to construct the role of public finance,health financing,and social welfare culture.

OBJECTIVETo better understand and measure the impact from immunization activities over the last 10-years, we conducted a sero-epidemiological study using the remaining blood samples of a nationwide survey on Nutrition and Health in Chinese residents, in 2002.METHODSHBsAg, anti-HBs and anti-HBc in blood samples were tested using enzyme-linked immunosorbent assay(ELISA) reagents and revised by solid phase radioimmunoassay and Abbott ELISA reagents.RESULTSAmong population older than 3 years, the prevalence rates of HBsAg, anti-HBs and hepatitis B virus(HBV) infection were 9.09%, 37.48% and 50.04% but for children between 3 and 12 year olds, they were 5.03%, 45.33% and 29.10% respectively. Among population older than 3 years, the rates of HBsAg and HBV infection in urban area were 4.61% and 43.51%, but the rates in rural area were 9.41% and 56.77% respectively while for children from 3-years to 12-years old, they rates were 2.10%, 20.45% in urban area and 8.25%, 39.22% in rural areas, respectively.CONCLUSIONResults revealed that since the hepatitis B vaccine was introduced into the expanded program on immunization(EPI) from 1992, the prevalence rates of HBsAg and HBV infection, especially in the children from 3 to 12 years of age, had obviously declined, suggesting that some changes had happened in the epidemic characters of hepatitis B in China.

Objective To understand and measure the effect of 10-years immunization activities,we decided to conduct seroepidemiological study using the remaining blood sampling of Nationwide Survey of Nutrition and Health in Chinese residents,which was conducted in 2002.Methods HBsAg,anti-HBs,and anti-HBc in blood samples were detected using ELISA reagents and revised by SPRIA and Abbott ELISA reagents.Results(1)Among the vaccinated population,the adjusted prevalence rate of HBsAg is 5.28%,and the rate of HBV infection is 54.44%.For the vaccinated children from 3-12 years old,the rate is 3.63% and 26.88%,respectively.(2)Among the unvaccinatted population,the rate of HBsAg is 9.51% and the rate of HBV infection is 64.63%.For the children of 3-12 years old,the rate is 11.19% and 47.03% respectively.(3)Among the vaccinatted population,the rate of HBsAg is 2.55% in urban area and 7.10% in rural area.For the unvaccinatted population,the rate is 7.24% and 10.12%,respectively.Among the vaccinatted children from 3-12 years old,the rate of HBsAg is 1.96% in urban area and 6.65% in rural area.For the unvaccinated children,the rate is 2.39% and 10.84%,respectively.Conclusion The results showed that the effect of 10years immunization activities is prominent and suggested that it was the most important to improve the coverage of hepatitis B vaccine in the rural children for prevention and control campaign of hepatitis B.