開學季到 腸病毒登革熱雙重防疫

2015-09-18  16:46

　　〔記者洪美秀／新竹報導〕登革熱疫情未趨緩，隨著九月開學，腸病毒疫情也蠢蠢欲動！新竹市衛生局表示，依疾病管制署歷年監視資料顯示，腸病毒疫情每年從3月開始上升，竹市今年1到8月國小一、二年級及幼托機構，幼兒因罹患疱疹性咽峽炎與手足口病的腸病毒症狀，共停課243班次，與去年同期242班比較，變化不大，仍提醒家長及學校不可掉以輕心。

　　新竹市衛生局表示，開學至今，已有23個班次因腸病毒疫情停課，目前仍是腸病毒流行期，呼籲各幼教托育機構人員與家長，要教導學童養成勤洗手的個人衛生習慣，就不怕腸病毒上身。

　　衛生局表示，登革熱疫情未趨緩，加上9月開學，學生南北交流頻率大增，登革熱疫情還會再攀升，而腸病毒也隨著開學，學童增加互動頻率，感染機率提高，提醒家長及學校密切注意，包括清除孳生源及注意幼童衛生習慣，呼籲仍應加強環境整潔，並輔以勤洗手，降低感染機會。

　　衛生局強調，腸病毒傳染力強，在人與人密切接觸、互動頻繁的處所，最容易傳播，提醒家中有5歲以下幼兒的家長及教托育機構，務必隨時注意個人及幼童衛生習慣，若幼童經醫師診斷感染腸病毒時，最好讓病童在家休息至少1星期，避免傳染他人，同時應注意腸病毒重症的病徵，把握治療黃金時間。

新聞來源：http://news.ltn.com.tw/news/society/breakingnews/1448926

登革熱、腸病毒齊發 桃園校園皮皮剉

2015-09-15 03:03:19 聯合報 記者顏彙燕／桃園報導

　　

　　登革熱疫情持續發燒，又逢開學進入腸病毒傳染高峰期，桃園市現有11班級停課，衛生局呼籲幼童勤洗手、校方加強校園環境清潔、消毒。

　　衛生局疾病管制科長陳雪莉說，開學首周共接獲135名腸病毒輕症個案，桃園市6至12日腸病毒急診就診率千分之6.06高於全國的千分之5.5，感染幼童症狀穩定並無大礙，但隨著開學季，預期疫情會略微上升。

　　國小一、二年級學生或幼兒園學童、課後照顧服務班及托嬰中心，一班級一周內出現2名腸病毒通報病例，即達7天停課標準，若未依規定停課，將可處1萬5千元罰鍰，並在衛生局網站公布機構名稱。

　　陳雪莉表示，這波腸病毒以「克沙奇A16型」為主，出現高燒不退、嘔吐、肢體無力、睡夢中抽搐等重症前兆時，應盡速就醫，「孩子若生病就應在家休息，降低群聚感染可能」，預防腸病毒掌握「溼、搓、沖、捧、擦」要訣多洗手。

　　另外，登革熱疫情同樣引關注，桃園市昨天新增一例本土登革熱確診，累計達38例，其中本土個案20例，新增確診患者曾有南部旅遊史，已至個案住家和周遭環境進行消毒。

　　桃園市38例確診登革熱個案中，居住中壢區最多，桃園區次多，龜山區居三，目前僅剩大溪、復興、觀音、新屋區未有確診感染病例。

新聞來源：

http://udn.com/news/story/8504/1187015-%E7%99%BB%E9%9D%A9%E7%86%B1%E3%80%81%E8%85%B8%E7%97%85%E6%AF%92%E9%BD%8A%E7%99%BC-%E6%A1%83%E5%9C%92%E6%A0%A1%E5%9C%92%E7%9A%AE%E7%9A%AE%E5%89%89

八成肝癌個案有B或C型肝炎病史

http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=25&now_fod_list_no=12321&level_no=2&doc_no=85500
由於B、C型肝炎病毒感染為肝癌發生的主要危險因子，因此國民健康局於本(101)年起試辦肝癌個案申報B型或C型肝炎感染情形，初步分析已申報之2,188筆肝癌資料發現約8成肝癌個案曾感染B或C型肝炎。
國人約有290萬人為B型肝炎帶原者，73萬人為C型病毒肝炎
?防治肝炎，國民健康局自民國100年8月1日起於成人預防保健服務提供民國55年或以後出生且年滿45歲之民眾終身1次B、C型肝炎檢查，由100年8月至101年4月申報B、C型肝炎檢查結果顯示，B型肝炎陽性有16%、C型肝炎陽性有3.9%，由此結果估算20歲以上成人約有290萬人有B型肝炎，73萬人有C型肝炎。
B、C型肝炎藥物治療可以有效降低肝癌發生
依據高醫余明隆醫師等人之研究，對B型肝炎帶原者且HBeAg陽性施予藥物治療，經追蹤1-17年，約可降低47％肝硬化的發生及78％肝癌的發生；而對慢性C型肝炎感染者施予抗病毒及干擾素治療，經追蹤1-15年，約可降低65％肝癌的發生，因此B、C型肝炎藥物治療成效非常好，可以有效降低肝硬化或肝癌的發生。
因臨床實證顯示肝炎藥物治療B肝控制率可達8成，C肝根治率可達7成，故中央健康保險局於民國92年起開始給付慢性B、C型肝炎患者抗病毒或干擾素治療，惟截至101年4月底累積接受治療人數約14萬人，依潛在符合治療人數約60萬人估計，僅約23%B、C肝民眾接受藥物治療。國民健康局呼籲慢性B、C型肝炎患者及早接受治療，並遵照醫師醫囑定期追蹤與檢查。
B、C型肝炎應定期追蹤檢查，有助早期發現肝癌，提高5年存活率
另分析94-98年有申報期別的42,892名肝癌病人資料，各期別之5年存活率，第1期可達45.8%，第2期為31.6%，第3期8.6%，第4期則1.6%。由於肝癌初期並無症狀，發現時約有5成已經是肝癌第3、4期，因此國民健康局邱淑媞局長呼籲B、C型肝炎患者，應定期就醫追蹤與檢查。

世界衛生組織將7月28日訂為「世界肝炎日」，國民健康局呼籲民眾要避免肝癌上身，需一知、二要、三不；簡言之：
一知：瞭解自己是否為B型肝炎帶原者或C型肝炎感染者
二要：要定期追蹤檢查與正確治療，亦即B型肝炎帶原者或C型肝炎感染者要定期做超音波檢查，如果符合健保慢性B、C型肝炎治療條件，應接受治療
三不：不亂服藥物補品，不抽菸，不過量飲酒。

北市愛滋感染者 20至29歲 躍居第1名

北市愛滋感染者 20至29歲 躍居第1名

〔記者林相美／台北報導〕愛滋感染者年齡往下降，台北市衛生局統計，北市愛滋感染者通報累計兩千七百七十八人，廿至廿九歲年齡層的累計人數，今年首度超過卅至卅九歲的年齡層，其中因性行為感染高達九成。衛生局擔心，暑假轟趴、派對機會多，若未防範，恐暴露於性病、愛滋風險。

衛生局疾病管制處副處長林國甯昨天指出，依北市近三年統計，青少年已成為愛滋病毒感染的主要族群，每年新通報感染人口中廿至廿九歲約佔四成。

衛生局觀察，去年北市累計通報愛滋感染者為兩千四百七十二人，以卅至卅九歲最多，八百八十八人佔卅五．九二％，其次為廿至廿九歲，八百八十四人佔卅五．七六％。不過，今年以來，廿至廿九歲的累計通報個案已超過卅至卅九歲，廿至廿九歲為一千零一十二人，佔卅六．四三％，卅至卅九歲為九百九十四人，佔卅五．七八％。

林國甯解釋，上述個案可能是因病就醫或匿名篩檢時發現，但愛滋病潛伏期最長可達十年，推估有些個案可能於青少年時期即染愛滋病毒。他也提醒，放暑假是青少年最歡樂的時光，參加網路轟趴、性派對及多重性伴侶等危險性行為的聚會時，不要因為一時的誘惑，將自己暴露於染病風險，單一性伴侶、安全性行為及全程使用保險套，才能有效保護自己。

國民健康調查

美國版的國民健康調查

• The National Center for Health Statistics (NCHS)
• 
  
• The National Health Interview Survey (NHIS)
• 
  
• CDC WONDER DATA 2010(The Health People Database 2010)
• 
  
• The Child and Adolescent Health Measurement Initiative (CAHMI)
• 
  
• The Young Adult Health Care Survey (YAHCS)
• 
  
• The Youth Risk Behavior Surveillance System (YRBSS)

Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore, BMJ 2009;338:b880.

Julia Hippisley-Cox, professor of clinical epidemiology and general practice¹,Carol Coupland, senior lecturer in medical statistics¹, John Robson, senior lecturer in general practice², Aziz Sheikh, professor of primary care research and development³, Peter Brindle, research and development strategy lead⁴

¹ Division of Primary Care, Tower Building, University Park, Nottingham NG2 7RD, ² Centre for Health Sciences, Queen Mary’s School of Medicine and Dentistry, London E1 2AT, ³ Centre for Population Health Sciences: GP Section, University of Edinburgh, Edinburgh EH8 9DX, ⁴ Avon Primary Care Research Collaborative, Bristol Primary Care Trust, Bristol BS2 8EE

Correspondence to: J Hippisley-Cox Julia.hippisley-cox@nottingham.ac.uk

QDScore diabetes risk calculator

http://www.qdscore.org/

Objective To develop and validate a new diabetes risk algorithm (the QDScore) for estimating 10 year risk of acquiring diagnosed type 2 diabetes over a 10 year time period in an ethnically and socioeconomically diverse population.

Design Prospective open cohort study using routinely collected data from 355 general practices in England and Wales to develop the score and from 176 separate practices to validate the score.

Participants 2 540 753 patients aged 25-79 in the derivation cohort, who contributed 16 436 135 person years of observation and of whom 78 081 had an incident diagnosis of type 2 diabetes; 1 232 832 patients (7 643 037 person years) in the validation cohort, with 37 535 incident cases of type 2 diabetes.

Outcome measures A Cox proportional hazards model was used to estimate effects of risk factors in the derivation cohort and to derive a risk equation in men and women. The predictive variables examined and included in the final model were self assigned ethnicity, age, sex, body mass index, smoking status, family history of diabetes, Townsend deprivation score, treated hypertension, cardiovascular disease, and current use of corticosteroids; the outcome of interest was incident diabetes recorded in general practice records. Measures of calibration and discrimination were calculated in the validation cohort.

Results A fourfold to fivefold variation in risk of type 2 diabetes existed between different ethnic groups. Compared with the white reference group, the adjusted hazard ratio was 4.07 (95% confidence interval 3.24 to 5.11) for Bangladeshi women, 4.53 (3.67 to 5.59) for Bangladeshi men, 2.15 (1.84 to 2.52) for Pakistani women, and 2.54 (2.20 to 2.93) for Pakistani men. Pakistani and Bangladeshi men had significantly higher hazard ratios than Indian men. Black African men and Chinese women had an increased risk compared with the corresponding white reference group. In the validation dataset, the model explained 51.53% (95% confidence interval 50.90 to 52.16) of the variation in women and 48.16% (47.52 to 48.80) of that in men. The risk score showed good discrimination, with a D statistic of 2.11 (95% confidence interval 2.08 to 2.14) in women and 1.97 (1.95 to 2.00) in men. The model was well calibrated.

Conclusions The QDScore is the first risk prediction algorithm to estimate the 10 year risk of diabetes on the basis of a prospective cohort study and including both social deprivation and ethnicity. The algorithm does not need laboratory tests and can be used in clinical settings and also by the public through a simple web calculator (www.qdscore.org).

© Hippisley et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 
http://creativecommons.org/licenses/by-nc/2.0/

數字會說話:慢性病的成本 USA

Costs of Chronic Disease

CDC, USA

The United States cannot effectively address escalating health care costs without addressing the problem of chronic diseases:

• In 2005, 133 million people, almost half of all Americans lived with at least one chronic condition.
• Chronic diseases account for 70% of all deaths in the United States.
• The medical care costs of people with chronic diseases account for more than 75% of the nation’s $2 trillion medical care costs.
• Chronic diseases account for one-third of the years of potential life lost before age 65.
• Hospitalizations for pregnancy-related complications occurring before delivery account for more than $1 billion annually.
• The direct and indirect costs of diabetes is $174 billion a year.
• Each year, arthritis results in estimated medical care costs of nearly $81 billion, and estimated total costs (medical care and lost productivity) of $128 billion.
• The estimated direct and indirect costs associated with smoking exceed $193 billion annually.
• In 2008, the cost of heart disease and stroke in the U.S. is projected to be $448 billion.
• The estimated total costs of obesity was nearly $117 billion in 2000.
• Cancer costs the nation an estimated $89 billion annually in direct medical costs.
• Nearly $98.6 billion is spent on dental services each year.

Leading Causes of Death
United States, 2005
Number of deaths

Diseases of the heart: 652,000
Cancer: 559,000
Stroke: 144,000
Chronic respiratory disease: 131,000
Unintentional injuries: 118,000
Diabetes mellitus: 75,000
Alzheimer's disease: 72,000
Influenza and pneumonia: 63,000
Inflammatory kidney disease: 44,000
Blood poisoning: 34,000

More Information

Centers for Disease Control and Prevention
Chronic Disease Prevention and Health Promotion:
Chronic Disease Overview
http://www.cdc.gov/nccdphp/overview.htm

Agency for Healthcare Research and Quality
The National Hospital Bill: Growth Trends and 2005 Update on the Most Expensive Conditions by Payer
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb42.jsp

Agency for Healthcare Research and Quality
Patient Self-Management Support Programs: An Evaluation
Contract No. 282-00-0005
http://www.ahrq.gov/qual/ptmgmt/

The Commonwealth Fund
What Works in Chronic Care Management: The Case of Heart Failure
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=773545&#doc773545