目的 建立适合武汉市MSM人群线上使用的风险评估模型，为后续开发电子化风险评估工具提供科学基础。方法 通过武汉市MSM人群“互联网+HIV自检服务平台”进行问卷调查。2020年6月1日—12月31日期间获得合格调查问卷2 843份。使用列线图和专家评估法建立风险评估模型，根据受试者工作特征曲线和曲线下面积对模型进行选择，并用C指数对模型预测能力进行评估。结果 参与互联网线上自检的MSM人群HIV检出率为1.8%。逐步logistic回归构建的模型预测能力较好且预测变量较少，最终筛选出的危险因素是近6个月HIV阳性性伴情况、近6个月有性病感染症状或被诊断为性病、近6个月性角色、文化程度和月经济收入，根据筛选出的危险因素建立的列线图C-指数为0.790。结论 本研究构建的MSM人群HIV感染个体风险评估模型具有较好的区分能力和校准度，可为后续有针对性地干预提供科学依据。

目的:了解餐饮服务人员丙型肝炎防治知识知晓率、相关行为及影响因素,为防治丙型肝炎提供参考依据.方法:采用分层随机整群抽样的方法,对武汉市中心城区和郊区2家体检机构1195名接受体检服务的餐饮服务人员进行问卷调查,并进行χ2检验和logistic回归分析.结果:餐饮服务人员的丙型肝炎防治知识的知晓率为16.6％.有16.4％接受过纹身(包括纹唇、纹眉)、打耳洞等,3.8％有多个性伴侣;1.2％曾与他人共用注射器、针头,24.7％检测过丙型肝炎.受教育程度影响丙型肝炎防治知识的知晓率,高中或中专及以下较中专及以上的从业人员知晓率低.结论:餐饮服务人员丙型肝炎防治知晓率较低,存在一定程度的高危行为,接受过丙型肝炎检测的比例较低,应制定相应的干预策略,加强从业人员的健康教育.

目的:了解武汉市高校低年级学生对艾滋病(AIDS)自愿咨询检测(VCT)服务的认知情况.方法:采用整群抽样的方法,对武汉市13所高校1615名大一、大二学生进行VCT服务认知情况的匿名问卷调查.结果:44.9％的学生知晓VCT服务,54.7％的学生有意愿利用VCT服务.多因素Logistic回归(Wald 向前法)分析显示,知晓VCT服务(OR=1.304)、认为发生不安全性行为后应主动寻求VCT服务(OR=2.630)、认为通过接受免费VCT服务可以知晓自己是否感染AIDS(OR=1.667)的学生VCT服务的利用率更高.认为自身与AIDS距离较近(OR=1.719)的HIV感染风险意识高的学生、男性学生(OR=1.298)以及周围同学接受过VCT服务(OR=2.697)的学生更愿意利用VCT服务.结论:应加强对VCT服务的宣传,提高高校低年级学生VCT服务认知水平和感染HIV的风险意识,转变其对AIDS 的恐惧和歧视心理,提高其HIV检测率.

;目的 调查武汉市医院丙型病毒性肝炎(简称丙肝)报告病例,探讨丙肝疫情控制策略.方法 采用分层随机抽样方法选取武汉市6家医院作为调查单位,对2017年4月-2018年3月期间诊断并报告的丙肝病例进行问卷调查,并进行统计学分析.结果 本研究共调查272例新发丙肝报告病例,男女比例为2.18∶1,平均年龄为(53.41±13.50)岁.病人因医疗服务前筛查、转氨酶升高和急性丙肝症状进行HCV感染检测的比例分别为67.65％、63.60％和13.24％,病人主动要求检测或因体检进行HCV感染检测的比例为23.16％.病例中,78.68％无高危行为,11.03％曾接受过血液或血制品,8.46％曾进行过不安全注射、共用针具吸毒或街边店美容纹身等操作.丙肝病例诊断类型的正确率为94.12％.病例中,29.00％天冬氨酸氨基转移酶/血小板比值指数(APRI》＞2.确诊病例中本次选择抗病毒治疗的比例为25.81％,其中90.00％为小分子药物抗病毒治疗.结论 有针对性地开展丙肝防制工作,促进丙肝病例早发现、早诊断和早治疗,有助于控制丙肝疫情的发展.

目的 了解武汉市社会组织(CBO)参与艾滋病防治工作现状和效果,为进一步推进CBO建设与发展,不断提高艾滋病防治工作能力和质量提供参考.方法 采用定性与定量相结合的调查方法,对参与武汉市艾滋病防治工作的6个社会组织进行问卷调查和访谈收集数据,同时收集同期相关专业机构相关数据并进行统计学分析.结果 6个社会组织中,经民政部门注册的3个;均有固定场所;负责人均为全职,工作人员以志愿者为主(82.28％);参与艾滋病防治服务范围与内容较全面;面临资金短缺、人员不稳定、工作能力和质量不高等突出问题和相关需求.2016-2017年本市通过社会组织进行艾滋病病毒(HIV)检测31 467例,检出阳性357例,检出率1.13％,高于相关专业机构阳性检出率0.73％(x2=48.361,P＜0.001).结论 社会组织在艾滋病防治尤其是在高危人群干预、检测方面具有明显优势和效果,但参与艾滋病防治现状尚未得到根本性改善,资金来源是面临的最大问题和需求.建议多途径加大对社会组织资金支持,进一步提升社会组织参与艾滋病防治能力和可持续性.

随着政府职能转变以及社会服务需求的增加,较多公共服务产品以政府采购的形式出现,“绩效”的理念也被引入到政府购买服务的研究框架当中.我国政府采购目录按货物、工程和服务等区分了三种类型的采购项目.服务类政府采购项目与货物、工程等有形的实物不同,侧重于提供服务,具有无形的特性.本文以武汉市政府购买社会组织艾滋病防治服务项目(简称“武汉市购买艾滋病服务项目”)为分析对象,从实践操作层面对政府购买服务项目的绩效实施进行总结与探讨,希冀对服务类型的政府采购项目绩效管理的实施提供借鉴.

The methadone maintenance treatment (MMT) has been initiated in Wuhan, China since early 2006. To understand the social-demographic, behavioral, and infectious diseases characteristics of drug users enrolled in their first-ever-MMT between 2006 and 2015, a retrospective observational study was implemented to also provide evidence for health policy-decisions to reduce harm and control disease. Pearson chi-square tests and t-tests were used to assess significant differences between two 5-year periods, 2006–2010 and 2011–2015. We observed increases in the mean age (38.65 vs. 42.43 years, P < 0.001), mean age of initial opioid drug use (28.18 vs. 31.07 years, P < 0.001), employment (11.9% vs. 30.7%, P < 0.001), married/co-habiting (42.4% vs. 47.8%, P < 0.001), and declines in higher education level (93.6% vs. 84.8%, P < 0.001), injection (82.3% vs. 75.1%, P < 0.001), syringe sharing (27.7% vs. 9.9%, P < 0.001), HCV infection rates (72.9% vs. 70.5%, P = 0.017). The number of drug users enrolling each year reduced following a continuous rapid growth in the first 3 years. The findings imply for adjusting in treatment services and allocation of resources to respond to emerging trends. In addition, the data will also be helpful for identifying needs and getting a baseline insight of the social-demographic and behavioral characteristics of the opioid abusers in the area.

Through the analysis of the institution of disease prevention and control resources and the situation of disease prevention and cure in Wuhan city circle at present,thinking and discussing how to construct the supporting city circle's disease control system,putting forward a few conceives for the construction of disease prevention and control system in Wuhan city circle.

大量研究表明,对海洛因等阿片类物质成瘾者进行美沙酮维持治疗,可较有效控制毒品滥用和艾滋病传播[1].为遏制艾滋病经吸毒途径传播,我国从2003年开始建立美沙酮维持治疗试点[2].武汉市自2006年3月首个试点开诊以来,截至2010年12月底已建立20个试点,现将这些试点的维持治疗率及用药量进行分析.

M.sp.SDM11是一株能以甲醇为唯一碳源生长的细菌,初步发酵检测发现能转化甘氨酸为L-丝氨酸。QscR基因产物是甲基营养菌中丝氨酸循环的一个转录调控关键因子,根据在GenBank中已报道的QscR基因序列（登录号:NC 0 12988.1）设计引物,以M.sp.SDM11的染色体DNA为模板,利用PCR扩增得到一大小为987 bp的QscR基因,将该基因克隆到广泛宿主载体pLAFR3上,在帮助质粒pRK2013的介导下,利用三亲本结合使其导入到菌株SDM11中构建重组菌株SDM12。对SDM12进一步研究发现,重组菌株中与L-丝氨酸合成相关的关键酶丝氨酸羟甲基还原酶（SHMT）的酶活比野生型菌株SDM11要低,约为野生型菌株的70%左右,另一个酶——羟基丙酮酸还原酶（HPR）的酶活力也只有野生型的75%。进一步将菌株进行产L-丝氨酸研究,结果表明,重组菌的产L-丝氨酸能力也明显降低,约为野生型菌株的67%左右。

To clone glyA gene from Methylobacterium.sp SDM11 and study its properties to enrich the gene resources for serine hydroxymethyltransferase(SHMT),primers were designed based on the glyA sequence of the reported Methylobacterium extorquens AM1(accession number is L33463)in GenBank,and an about 1.4 kb DNA fragment was amplified with the genomic DNA of SDM11 as a template.The sequence analyzied result showed that this fragment had an ORF encoded 468 amino acids,and had 95% and 98% identities with the glyA gene of M.extorquens AM1 respectively.The predicted molecular is 52.2 kD and its isoelectric point is 7.02.The ORF was amplified by PCR,and cloned into expression vector pETBlue-2,then transferred into E.coli Tunner(DE3).After introduced by IPTG,the target protein was expressed,which showed SHMT activity after purification.

爱沙尼亚恢复独立后,卫生体制经历了重大改革,建立了卫生体系的分权体制。为了适应社会经济发展和人群健康需求,提高卫生服务质量和可及性,爱沙尼亚在以往改革的基础上,又经历了两次重大变革,从卫生服务立法、筹资、提供以及组织管理等各方面对旧的卫生体制进行了改革,取得了较好的成绩。

Objective To analyze the factors influencing attitudes and practices related to HIV/AIDS discrimination among rural inhabitants and provide basis for making policy or strategy of eliminating HIV/AIDS discrimination.Methods The investigation was conducted in Xiangcheng District of Xiangfan City and Nanzhang County,and 2 villages in each city were randomly selected and 50 persons in each village were visited,finally 196 questionnaires were utilized for analysis.The data were analyzed by using rank sum test and Logistic regression.Results The awareness of general knowledge was correlated to attitude(r=0.2916,P<0.01),but not to practice.The awareness of knowledge on transmitted routes was not only correlated to attitude(r=0.4444,P<0.01),but also to practice(r=0.3525,P<0.01).Meanwhile,there was correlation between attitude and practice(r=0.6523,P<0.01).It was showed from Logistic regression that the awareness of knowledge on transmitted routes,gender and marital status were related to the attitude,and the most important factor influencing the practice was the awareness of knowledge on transmitted routes.Conclusion The awareness of knowledge on transmitted routes is closely related to attitudes and practices related to HIV/AIDS discrimination.When making related policy or strategy,health education on HIV transmitted routes should be paid more or special attention to reduce or eliminate HIV/AIDS discrimination.

斯洛伐克在一定的社会经济背景下,针对不同历史时期卫生体制的具体问题实施了一系列重大改革.通过改革,在卫生保健服务提供、卫生法制与管理体制建设、卫生筹资、资源配置、成本控制、国际交流与国际组织等领域取得了较大成效.对斯洛伐克卫生体制改革进行了回顾和分析.

Objective Objectives to investigate the knowledge level,attitude and practice related to HIV/AIDS among inhabitants at some rural epidemic areas of HIV/AIDS in Hubei province,and hence to provide basis for conduct specific health education.Methods The investigation was conducted in Xiangcheng district of Xiangfan City and Nanzhang County,and 2 villages in each city were randomly selected and 50 persons in each village were visited,finally 196 questionnaires were utilized for data analysis by using Chi-square test and t test.Result The awareness rate of general knowledge was 59.13%,and the awareness of transmitted route was 81.27%.The stigma and discrimination to HIV/AIDS still exist,42.35% of respondents thought that the persons infected with HIV were frightening,30.61% of them thought that the patients should be isolated and 26.02% thought that being infected with HIV was stigmatized.Regarding their practices,25.51% of respondents didn't permit their kids to play with those whose families were HIV positives,about 18% of respondents avoided to contact with HIV positives and did not go to market,chat,play or eat together with them.Conclusions There is quite high awareness rate of knowledge among rural inhabitants,the working on prevention and control has showed the effectiveness.However,the stigma and discrimination to HIV/AIDS need to be eliminated.

波兰正在进行的卫生体制改革始于1989年。对波兰的卫生体制概况、卫生体制改革及改革的特点进行了介绍,为我国的卫生体制改革提供借鉴。

冰岛是一个相对地广人稀的海岛国家,是世界上人口健康状况最好的国家之一.在过去的几十年里,冰岛在中央行政机构、初级卫生保健、医院系统和制药业等方面经历了几次重大的卫生体制改革.分析研究冰岛卫生体制改革的成功经验,为我国的卫生体制改革提供参考和借鉴.

新西兰的卫生体制在过去的20多年间经历了多次重大变革和调整.从20世纪80年代的区域化服务,到90年代准市场模式的变化,以及区域行政管理再次成为主要特征的现行模式.新西兰卫生服务提供系统适应着人口结构及医疗需要和需求的变化,并向组织、结构和功能整合的方向发展.总结新西兰卫生保健体制改革的背景、措施和成败经验,对我国的卫生改革和完善具有重要的指导和借鉴意义.

20世纪70年代以来,瑞典卫生保健部门在一定的社会经济背景下,针对卫生体制内的具体问题,开展了关于公平、成本、效率和组织结构等方面的一系列改革.通过改革,在法制建设、卫生筹资、卫生服务提供、费用控制和资源配置等领域取得了较大成效.对瑞典卫生体制改革的回顾和分析有利于总结瑞典卫生体制改革的成功经验,为我国的卫生体制改革提供借鉴.