With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been ...With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been well understood and evaluated.We undertook a scoping review to identify current TB strategies,research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets.Databases of Embase,MEDLINE,Global health and EBM reviews were searched for original studies,review articles,and policy papers published in English between January 1990 and December 2015.Articles examining TB strategy,program,guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria.Most of them were qualitative studies,issued in high-and middle-income countries and after 2000.To break the chain of TB transmission and reactivation in the elderly,infection control,interventions of avoiding delay in diagnosis and containment are essential for preventing transmission,especially in elderly institutions and aged immigrants;screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people;optimizing early case-finding with a high index of suspicion,systematic screening for prioritized high-risk groups,initial empirical and adequate follow-up treatment with close monitoring and evaluation,as well as enhanced programmatic management are fundamental pillars for active TB elimination.Evaluation of TB epidemiology,risk factors,impacts and cost-effectiveness of interventions,adopting accurate and rapid diagnostic tools,shorter and less toxic preventive therapy,are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway.The framework and principals identified in this study will help to evaluate and improve current program,develop targeted strategy,as well as raise more discussions on the research priority settings and policy transitions.Given the scarceness of policy and evaluated interventions,as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries,the increasing need of a ready TB program for the elderly warrants further research.展开更多
目的分析2002—2017年全国31省(自治区、直辖市)传染病防控人力资源的有效激励水平及变化趋势,针对人员激励现状探讨有效激励因素的地区分布情况。方法系统收集中国知网(CNKI)和Web of Science数据库中1997—2017年发表的全国31个省(自...目的分析2002—2017年全国31省(自治区、直辖市)传染病防控人力资源的有效激励水平及变化趋势,针对人员激励现状探讨有效激励因素的地区分布情况。方法系统收集中国知网(CNKI)和Web of Science数据库中1997—2017年发表的全国31个省(自治区、直辖市)关于传染病防控人员激励问题的研究文献,运用内容分析法进行评阅,判断人员激励问题的严重程度。将文献中提到的人员激励问题的影响因素分成4类并计数,运用卡方检验分析各地区人员有效激励因素的分布情况。结果当前我国传染病防控队伍的有效激励水平不高,仅为31.84%;而且地区差异大,2017年结果显示,地区之间变异系数为32.44%。2002—2017年,各地传染病防控队伍有效激励的改进幅度有限,增长幅度仅为11.13%。全国范围内,经济类因素成为影响传染病防控人员工作积极性的主要原因,在各类因素中占46.25%。在地区层面,中部地区人员激励水平(28.03%)一直落后于东部地区(35.90%)和西部地区(30.67%)。在有效激励因素上,东部地区对教育类因素的关注度(东部地区为17.53%,中部地区为6.82%,西部地区为6.25%)和西部地区对个人与专业支持类因素的关注度(东部地区为15.46%,中部地区为18.18%,西部地区为35.71%)明显高于其他地区。结论我国传染病防控人员激励机制有待完善,特别是中部地区尤为迫切。经济类因素如薪酬待遇已然成为全国范围内影响人员队伍稳定性的主要因素。此外,西部地区应在改善卫生人员生活与工作条件方面继续加强,而东部地区仍可在人才培养、继续教育方面进一步完善激励机制。展开更多
基金This scoping review was kindly supported by the Health and Medical Research Fund[Number:CU-15-C12]Food and Health Bureau,Hong Kong Special Administrative Region,China.
文摘With the rapid pace of population ageing,tuberculosis(TB)in the elderly increasingly becomes a public health challenge.Despite the increasing burden and high risks for TB in the elderly,targeted strategy has not been well understood and evaluated.We undertook a scoping review to identify current TB strategies,research and policy gaps in the elderly and summarized the results within a strategic framework towards End TB targets.Databases of Embase,MEDLINE,Global health and EBM reviews were searched for original studies,review articles,and policy papers published in English between January 1990 and December 2015.Articles examining TB strategy,program,guideline or intervention in the elderly from public health perspective were included.Nineteen articles met the inclusion criteria.Most of them were qualitative studies,issued in high-and middle-income countries and after 2000.To break the chain of TB transmission and reactivation in the elderly,infection control,interventions of avoiding delay in diagnosis and containment are essential for preventing transmission,especially in elderly institutions and aged immigrants;screening of latent TB infection and preventive therapy had effective impacts on reducing the risk of reactivation and should be used less reluctantly in older people;optimizing early case-finding with a high index of suspicion,systematic screening for prioritized high-risk groups,initial empirical and adequate follow-up treatment with close monitoring and evaluation,as well as enhanced programmatic management are fundamental pillars for active TB elimination.Evaluation of TB epidemiology,risk factors,impacts and cost-effectiveness of interventions,adopting accurate and rapid diagnostic tools,shorter and less toxic preventive therapy,are critical issues for developing strategy in the elderly towards End TB targets.TB control strategies in the elderly were comprehensively mapped in a causal link pathway.The framework and principals identified in this study will help to evaluate and improve current program,develop targeted strategy,as well as raise more discussions on the research priority settings and policy transitions.Given the scarceness of policy and evaluated interventions,as well as the unawareness of shifting TB epidemiology and strategy especially in developing countries,the increasing need of a ready TB program for the elderly warrants further research.
文摘目的分析2002—2017年全国31省(自治区、直辖市)传染病防控人力资源的有效激励水平及变化趋势,针对人员激励现状探讨有效激励因素的地区分布情况。方法系统收集中国知网(CNKI)和Web of Science数据库中1997—2017年发表的全国31个省(自治区、直辖市)关于传染病防控人员激励问题的研究文献,运用内容分析法进行评阅,判断人员激励问题的严重程度。将文献中提到的人员激励问题的影响因素分成4类并计数,运用卡方检验分析各地区人员有效激励因素的分布情况。结果当前我国传染病防控队伍的有效激励水平不高,仅为31.84%;而且地区差异大,2017年结果显示,地区之间变异系数为32.44%。2002—2017年,各地传染病防控队伍有效激励的改进幅度有限,增长幅度仅为11.13%。全国范围内,经济类因素成为影响传染病防控人员工作积极性的主要原因,在各类因素中占46.25%。在地区层面,中部地区人员激励水平(28.03%)一直落后于东部地区(35.90%)和西部地区(30.67%)。在有效激励因素上,东部地区对教育类因素的关注度(东部地区为17.53%,中部地区为6.82%,西部地区为6.25%)和西部地区对个人与专业支持类因素的关注度(东部地区为15.46%,中部地区为18.18%,西部地区为35.71%)明显高于其他地区。结论我国传染病防控人员激励机制有待完善,特别是中部地区尤为迫切。经济类因素如薪酬待遇已然成为全国范围内影响人员队伍稳定性的主要因素。此外,西部地区应在改善卫生人员生活与工作条件方面继续加强,而东部地区仍可在人才培养、继续教育方面进一步完善激励机制。
