REDISSE in Benin and Lessons Learned for the Management of Public Health Emergencies after Five Years of Implementation

Introduction: Benin was embarked on phase 3 of the REDISSE Benin project (Regional Disease Surveillance Systems Enhancement) which began in 2018. The objectives were in five key components namely, Surveillance and health information;Laboratory capacity building;Emergency preparedness and response;Human resources management for effective disease surveillance and epidemic preparedness;and Institutional Capacity Building, Project Management, Coordination and Advocacy. After five years of implementation, this study aimed at the documentation of lessons learned and best practices. Methods: A descriptive cross-sectional study. Apart from individual semi-structured interviews, a thematic workshops bringing together the project’s main stakeholders recruited on an exhaustive way by component to identify and validate lessons learned, good practices and propose improvement mechanisms to be taken into account by the sector. Criteria were set up and used to validate best practices and lessons learned. Results: A total 54 (Surveillance workshop), 47 (Preparedness & response workshop), 53 (Human Resources workshop), 26 (Laboratories workshop) participated to the thematic workshops, and five interviews. The good practices (33: 9 for animal health, 7 for human health and 17 crosscutting) and lessons learned (10: 3 for animal health and 7 for human health) have been identified and have been the subject, depending on the case, of proposals for improvement or conditions necessary for their maintenance. Discussion: The richness of a project lies not only in the immediate achievement of its results, but also and above all, in its usefulness for similar interventions, whether in the local, regional, national or international context. It is in this context that the REDISSE project has set out to make public the various lessons learned and best practices from the implementation of its activities over a period of some five consecutive years.

Sustainable Community Epidemic Prevention Countermeasures against Public Health Emergencies

How to deal with public health emergencies is an important issue related to the normal life of community residents. However, after the corresponding understanding, it is found that a series of unsustainable epidemic prevention factors have been exposed in the community in the COVID-19, such as blocked access to basic materials, unsafe living environment, and lack of social platforms. In view of these problems, based on Maslow’s hierarchy of needs, the changes in the hierarchy of needs of residents during the epidemic were analyzed, and sustainable community epidemic prevention strategies were proposed from five aspects of material storage, safe environment, social platform, respect opportunity and self-worth realization, so as to provide effective reference for future response to public health emergencies.

An Analysis of the Evolution of Online Public Opinion on Public Health Emergencies by Combining CNN-BiLSTM + Attention and LDA

In this paper, the Foxconn epidemic event in Zhengzhou was taken as an example to analyze the evolution of online public opinion on public health emergencies. In order to improve the performance of online public opinion analysis, based on the life cycle theory and LDA theory, the emotional changes of Internet users in four stages of the Foxconn incident centered on the evolution of inscription were divided. The emotions of netizen speech at different stages are analyzed based on CNN-BiLSTM + Attention model, which uses Convolutional Neural Network (CNN) to extract local features. Bi-directional Long Short-Term Memory (BiLSTM) is used to efficiently extract contextual semantic features and long distance dependencies, and then combined with attention mechanism to add emotional features. Finally, Softmax classifier realizes text emotion prediction. The experimental results show that: compared with TextCNN, BiLSTM, BiLSTM + Attenion, CNN-BiLSTM model, the emotion classification model has better effects in the accuracy rate, accuracy rate, recall rate and F value. By analyzing the emotional distribution and evolution trend of public opinion under “text topic”, the paper accurately deconstructs the development characteristics of public opinion in public health emergencies, in order to provide reference for relevant departments to deal with public opinion in public health emergencies. .

Survey on the Status Quo of Emergency Response Capabilities of Public Health Emergencies in Grassroots Disease Control Institutions in a Certain Area

Objective:To survey and study the emergency response capabilities of grassroots disease control institutions in a certain area for public health emergencies,and to put forward suggestions for rectification.Methods:The study was carried out from March 2022 to March 2023.Field surveys,questionnaire surveys,and interviews were used to investigate and analyze the emergency response capabilities of public health emergencies in 5 county Centers for Disease Control and Prevention(CDCs)in the region.Results:Through the survey,it was found that the professional level of the existing emergency team personnel of the grassroots disease control institutions in this region needs to be improved.There was an overall lack of emergency plans,and the compliance rate of the equipment,inspection,and testing items was low.The health emergency system of the CDCs in the region and the ability of the talent team need to be further improved.Conclusion:The emergency response capacity of grassroots disease control institutions in this region needs to be improved.For this reason,government departments need to increase investment and strengthen the construction of talent teams and hardware settings,and grassroots disease control institutions need to strengthen the construction of the public health emergency system to improve the ability to respond to public health emergencies.

Emergency Optimization Design of Living Room of High-rise Residence Based on Major Public Health Emergencies

When a major public health emergency comes,people are forced to be isolated at home.During the period of residential isolation by epidemic,use of indoor space in high-rise residential buildings puts forward higher requirements for the health and variability of indoor space in addition to meeting the basic living needs.By analyzing the current situation and characteristics of living room space design of high-rise residence,combined with basic health protection awareness of residents and environmental sanitation requirements,this paper explores the basic functions of living room space design,and puts forward suggestions on space optimization design.

Study on Emergency Management Mechanism of Public Health Emergencies

The outbreak of SARS in 2003 opened the way of public health emergency management in China.COVID-19 which suddenly outbroke in 2019 is still raging all over the world,and emergency management mechanism of China is being tested.Efforts to improve the emergency management mechanism can provide effective institutional guarantee for the overall victory of anti epidemic and the prevention and control of public health emergencies.

Work experience of special workers returning to work after the public health emergency:taking ICU nurses who have been infected with COVID-19 as example

Objective:The occurrence of some public health events inevitably endangers medical personnel,and medical personnel,as a special group,have to resume work on time to treat patients.This coronavirus disease-2019(COVID-19)infection is a good example,and what intensive care unit(ICU)nurses experience as the primary caregivers of critically ill patients after COVID-19 infection is our focus.To explore the work experience of ICU nurses after recovery from COVID-19,and to provide a theoretical basis for the intervention to improve the physical and mental health level and work experience of special workers in public health emergencies.Methods:We conducted an explorative descriptive study using an inductive thematic analysis.Using the maximum differential sampling method,a semi-structured interview was conducted among 13 ICU nurses suffered from COVID-19 in a tertiary grade A hospital in Qingdao,Shandong Province.This study carried on the theme analysis according to the inductive content analysis method and used MAXQDA 2020 Analytics Pro(VERBI Software GmbH,Berlin,Germany)to manage and summarize the interview data.Results:After being infected by the virus,SARS-Coronavirus-2(SARS-CoV-2),the pathogen of COVID-19,the work experience of ICU nurses was extracted from the following 5 themes:(1)Stress and challenge caused by the change of work focus;(2)downsizing,overtime,taking up work with illness,and physical discomfort;(3)dedication and family debt;(4)unknown fear and helplessness;and(5)professional responsibility and sense of benefit.Conclusions:Under the pressure of COVID-19,ICU nurses face multiple pressures and challenges,and their emotions are complex.We suggest that nursing managers should take corresponding measures to alleviate nurses'physical and psychological pressure and improve their work experience.

Assessing healthcare workers’knowledge and confidence in the diagnosis,management and prevention of Monkeypox

BACKGROUND Monkeypox(Mpox),is a disease of global public health concern,as it does not affect only countries in western and central Africa.AIM To assess Burundi healthcare workers(HCWs)s’level of knowledge and confidence in the diagnosis and management of Mpox.METHODS We conducted a cross-sectional study via an online survey designed mainly from the World Health Organization course distributed among Burundi HCWs from June-July 2023.The questionnaire comprises 8 socioprofessional-related questions,22 questions about Mpox disease knowledge,and 3 questions to assess confidence in Mpox diagnosis and management.The data were analyzed via SPSS software version 25.0.A P value<0.05 was considered to indicate statistical significance.RESULTS The study sample comprised 471 HCWs who were mainly medical doctors(63.9%)and nurses(30.1%).None of the 22 questions concerning Mpox knowledge had at least 50%correct responses.A very low number of HCWs(17.4%)knew that Mpox has a vaccine.The confidence level to diagnose(21.20%),treat(18.00%)or prevent(23.30%)Mpox was low among HCWs.The confidence level in the diagnosis of Mpox was associated with the HCWs’age(P value=0.009),sex(P value<0.001),work experience(P value=0.002),and residence(P value<0.001).The confidence level to treat Mpox was significantly associated with the HCWs’age(P value=0.050),sex(P value<0.001),education(P value=0.033)and occupation(P value=0.005).The confidence level to prevent Mpox was associated with the HCWs’education(P value<0.001),work experience(P value=0.002),residence(P value<0.001)and type of work institution(P value=0.003).CONCLUSION This study revealed that HCWs have the lowest level of knowledge regarding Mpox and a lack of confidence in the ability to diagnose,treat or prevent it.There is an urgent need to organize continuing medical education programs on Mpox epidemiology and preparedness for Burundi HCWs.We encourage future researchers to assess potential hesitancy toward Mpox vaccination and its associated factors.

Linking Perceived Risk of Public Health Emergency to Psychological Distress among Chinese College Students: The Chain Mediation Role of Balanced Time Perspective and Negative Coping Styles

Background:With public health emergencies(PHE)worldwide increasing,the perceived risk of PHE has been one of the critical factors influencing college students’psychological distress.However,the mechanisms by which the perceived risk of PHE affects college students’psychological distress are not clear.The study’s purpose was to investigate the mediation roles of deviation from a balanced time perspective(DBTP)and negative coping styles between the perceived risk of PHE and psychological distress.Methods:A convenience sampling method was used to survey 1054 Chinese college students with self-reporting.Data was collected using the Public Risk Perception Scale(PRPS),the Zimbardo Time Perspective Inventory(ZTPI),the Simplified Coping Style Questionnaire(SCSQ),the PHE Anxiety Scale,and the Chinese version of the Patient Health Questionnaire(PHQ).The associations between the perceived risk of PHE,DBTP,negative coping styles,and psychological distress were clarified using the correlation analysis.Additionally,the mediating roles of DBTP and negative coping styles between the perceived risk of PHE and psychological distress were investigated using a structural equation model.Results:The findings revealed low to moderate correlations between the variables studied.Students’perceived risk of PHE was a positive predictor of their psychological distress(b=0.219,p<0.01).DBTP and negative coping styles played chain mediation roles between them with the effect being 0.009 and a 95%Boot CI of[0.003,0.023].This chain mediation model had an excellent fit index(χ^(2)/df=4.732,CFI=0.973,TLI=0.930,RMSEA=0.048,SRMR=0.047).Conclusion:These findings showed how the perceived risk of PHE affected college students’psychological distress.Specifically,these results suggested that improving students’mental ability to switch effectively among different time perspectives depending on task features and situational considerations and reducing their negative coping styles might be effective ways to promote their mental health.

Organizational Changes Needed in Disasters and Public Health Emergencies:A Qualitative Study among Managers at a Major Hospital

Most hospitals have a contingency plan,based on all-risks and all-hazards assessment principles.However,emerging threats and risks often necessitate a flexible approach to emergency management at several levels of a disaster response system,for example,in hospitals.Sweden,and possibly other countries,has limited possibilities of surge capacity in the management of large-scale disasters and emergencies,which necessitates a local/national partnership and a flexible local disaster and contingency plan.This study evaluates the opinions of a selected managerial group,both at operative and strategic levels,regarding possible changes in a major hospital's contingency plan during the ongoing COVID-19 pandemic.Semistructured interviews were conducted to explore the elements of surge capacity and an operational tool,consisting of command and control,safety,communication,assessment,triage,treatment,and transport.The results show a need to create feasible management methods that can be evaluated,establish clear leadership,put preparedness as a constant point on the highest managerial agenda,improve external monitoring,and create a regional coordinating center.Furthermore,the results emphasize the significant role played by the incident command system and qualified leadership to facilitate competent and crucial medical decision making,as well as to provide reliable communication,collaboration,and coordination in a multi-agency response system during dynamic and unexpected emergencies.These steps enable a constant connection between reactive contingency plans and the proactivity in continuous risk assessment and enhance the flexibility of the contingency plans.

Leadership,communication,and science:three pillars essential to public health emergency response and closing the gap in the HIV response among key populations

Globally,there have been multiple public health emergencies in recent decades.High rates of morbidity,occasionally mortality,and economic instability are usually associated with pandemics.One of the epidemics that has significantly increased morbidity and mortality worldwide is the human immunodeficiency virus(HIV)and acquired immune deficiency syndrome(AIDS)pandemic.HIV has a disproportionately negative impact on key populations.Strong leadership,effective communication,and sound science are necessary for public health emergency(PHE)responses to be successful.These three PHE response pllars are also essential for bridging the HIV response gap among key populations in the setting of restrictive laws.In this review,we explored the importance of these three pillars of successful PHEs responses,and how they are essential to closing the gap in the HIV response among key populations.Leaders must make decisions and instil a sense of authority in the populace during PHEs to foster trust and confidence.Leaders should base their choices on scientific evidence.Effective communication during PHEs should be proactive,polite,imaginative,innovative,and constructive.To address gaps in the HIV response among key populations,leaders must create a supportive environment for effective communication and scientific research,communication should be used to raise awareness of HIV and to dispel stigma and discrimination,while science should provide evidence of efficacy and effectiveness of interventions amongkey populations.

Personalized Management of Chronic Myeloid Leukemia Presenting with Ovarian Apoplexy and Review of Health Emergency Cases

Introduction: Chronic myeloid leukemia (CML) may significantly affect quality of life and life expectancy in the accelerated and acute phases, especially if presented with health emergencies. Objective: The purpose of the study was the evaluation of the personalized management milestones in CML cases presented with ovarian apoplexy and the analysis of the international experience on health emergencies in this leukemia. Materials and Methods: An original, case-report study was performed. The diagnosis was confirmed by cytological, cytogenetic and molecular examinations of the peripheral blood and bone marrow at the comprehensive research cancer center— Institute of Oncology from Moldova. The real-time PCR was performed for quantitative detection of BCR-ABL gene p210 and p190 transcripts. The ECOG Scale and complete hematologic response (CR) estimated the short-term results. The ECOG performance status served as a measure of functional status. Its scores range from 0 to 5 and correlate with the level of patient functioning. CR is the disappearance of all detectable clinical and hematological signs of malignant neoplasm in response to treatment. CR span was assessed in months. The overall and relapse-free survivals asserted the long-term results of treatment, and were evaluated in months as a case. Results: CML may be manifested by life-threatening conditions, including infections and thrombotic events, splenic infarcts and ruptures, bleedings, etc. CML with the uncommon onset under the form of the ovarian apoplexy is described. The hematological CR was obtained under the treatment with imatinib mesylate. The molecular CR and the long-lasting overall survival (197.5 months) were achieved after the treatment with nilotinib. Under the treatment with tyrosine kinase inhibitors, the patient did not experience the disease burden and side effects, and resumed her work, with a good life quality (ECOG score is 0). Discussion: CML may be manifested by life-threatening health emergencies, especially thrombotic events, splenic infarcts and ruptures, bleedings, etc. The CML patients with high leukocyte and platelet counts may experience also different symptoms of hyperviscosity: tinnitus, priapism, stupor, visual abnormalities and cerebrovascular accidents. However, the management of CML with the life-threatening conditions, especially in the accelerated and acute phases, should be realized with participation of the multidisciplinary teams. Conclusions: The ovarian apoplexy may serve as a presenting feature of CML in young females with a highly elevated leukocyte count. The reported CML case underwent successful personalized management with 2 generations of tyrosine kinase inhibitors, even if designated with Socal intermediate-risk score and complicated by a health emergency.

Enlightenment from the COVID-19 Pandemic:The Roles of Environmental Factors in Future Public Health Emergency Response

The coronavirus disease 2019(COVID-19)pandemic is challenging the current public health emergency response systems(PHERSs)of many countries.Although environmental factors,such as those influencing the survival of viruses and their transmission between species including humans,play important roles in PHERSs,little attention has been given to these factors.This study describes and elucidates the roles of environmental factors in future PHERSs.To improve countries’capability to respond to public health emergencies associated with viral infections such as the COVID-19 pandemic,a number of environmental factors should be considered before,during,and after the responses to such emergencies.More specifically,to prevent pandemic outbreaks,we should strengthen environmental and wildlife protection,conduct detailed viral surveillance in animals and hotspots,and improve early-warning systems.During the pandemic,we must study the impacts of environmental factors on viral behaviors,develop control measures to minimize secondary environmental risks,and conduct timely assessments of viral risks and secondary environmental effects with a view to reducing the impacts of the pandemic on human health and on ecosystems.After the pandemic,we should further strengthen surveillance for viruses and the prevention of viral spread,maintain control measures for minimizing secondary environmental risks,develop our capability to scientifically predict pandemics and resurgences,and prepare for the next unexpected resurgence.Meanwhile,we should restore the normal life and production of the public based on the“One Health”concept,that views global human and environmental health as inextricably linked.Our recommendations are essential for improving nations’capability to respond to global public health emergencies.

Leveraging the Public Health Emergency Operation Center (PHEOC)for pandemic response: opportunities and challenges

Public Health Emergency Operation Center (PHEOC) was conceptualized and established for coordinatinginformation and resources towards goal-oriented response in large scale public health emergency. Yet, theactivities undertaken by PHEOCs and their intended goals have not been fully optimized in current scenario.This paper revisited the collective efforts invested in PHEOC conceptualization and development, identified theopportunities and challenges in compliance with standards and framework, demonstrated the accountabilityof PHEOC network, thereby promoted best practice guidance for global public health emergency preparednessand response. This review will help navigate emergency response complexities leveraging PHEOC partnershipsand advance the ability to detect and respond to public health emergencies in low resource settings. The reviewshows that the information on how to adapt best practice guidance to local circumstances could incentivizethe full implementation of prevention, early detection and response to outbreaks. Identifying and correctingdeficiencies in effectiveness evaluation will provide the basis for continuous PHEOC improvement. With thegradually reopening economies and public services in some countries, there is an urgent need to emphasize andvalidate the collective efforts undertaken by PHEOCs for tackling the COVID-19 pandemic.

2022 Monkeypox outbreak:Why is it a public health emergency of international concern?What can we do to control it?

The World Health Organization(WHO) called the recent monkeypox(MPX)outbreak a Public Health Emergency of International Concern on July 23,2022.The United States of America(US) alarmed the recent MPX outbreak as the US public health emergency on August 4,2022.Since early May 2022,more than 35000 MPX cases and 12 deaths had been reported to WHO from 92 countries and territories by August 17,2022,and MPX cases continue rising rapidly with improved surveillance,access to diagnosis,and continuous virus spreading globally.Approximately 99% MPX cases are men,of which 95% cases are men who have sex with man.No evidence of MPX being sexually transmitted infections(STIs) is found;however,a high percentage(25%) of concurrent STIs and frequent anogenital symptoms suggest transmission through local inoculation during close intimate contact or sexual activity.Many approaches including a comprehensive international vaccination strategy and adequate supplies are mandatory to prevent MPX pandemic.Education,vaccination,MPX scrutiny and careful monitoring,and crossborder collaborations with international sectors are practical strategy to contain MPX outbreaks.People are educated to reduce the risk of exposure and to reduce the number of sexual partners especially new ones,to avoid contacting travelers from epidemic regions or animals that may carry MPX virus,and avoid traveling to endemic areas.

Discussion on the Information Collection Methods of Public Health Emergency Files

In public health emergencies, the collection of archival information in the area of public health emergencies is very important, which can provide a reference for the early warning and processing mechanism. At the present stage, the unlimited demand of archival users for resources and the convenience of obtaining resources have become the two driving forces to promote the “transformation” and “growth” of archives. Public health emergencies, the transformation of archives collection and service mode, social media has become an indispensable platform for user information exchange, sharing and transmission, which requires archives to change the mode of archives acquisition and storage. Archival users require more interactive, targeted and cutting-edge forms of access and archival services are also developing toward diversified functions and connotations. Archival information resource sharing is also an important link in this development trend. This paper attempts to analyze the collection methods of archives departments in public health emergencies, and then puts forward the corresponding measures for archives departments to play their functions, such as flexibly solving the needs of archives access, strengthening the development of information resources, doing a good job in the collection of relevant archives, and publicizing archives work in combination with hot spots. This paper discusses the completeness of archival data collection, the means of archival management, the scientific classification of archival data, the ways of archival data collection and so on.

长三角区域公共卫生应急协同联防联控机制研究

目的 了解长三角区域公共卫生应急协同联防联控机制的现状,构建长三角区域卫生应急协同机制框架,提出完善长三角区域公共卫生应急协同联防联控机制的建议。方法 在文献检索、专家访谈的基础上,设计长三角区域卫生应急协同机制框架,编制专家咨询问卷,选择18位相关领域专家对长三角区域卫生应急协同机制框架的三级主题从重要性、现状完备程度、优化难易程度进行评分,并对专家咨询数据的可靠性进行分析。结果 长三角区域卫生应急协同机制框架包括应急指挥决策的跨区域协同机制、监测预警与风险评估的跨区域联防机制、跨区域应急处置的协同响应机制和跨区域联防联控能力建设机制等4个一级主题,分13个二级主题和29个三级主题。专家积极程度为100%。总体专家权威系数Cr=0.86,表明专家咨询的结果具有一定的权威性。专家意见的Kendall W协调系数为0.60,P <0.001,说明专家评估意见一致性高的结果是可信的。各主题条目的重要性得分均数> 3.9,表明本研究框架中的所有主题均比较重要,有继续发展完善的价值,其中现状完备程度较低、优化较易的主题为联席会议制度、区域专家库建设、应急联合会商研判、区域联合预警、密接协查与跨省追踪、信息联合通报与共享、联合复盘与评估、人才交流与互访、联合应急培训、区域应急梯队建设和应急科研合作。结论 长三角区域协同联防联控机制发挥成效需要顶层设计、政策支持、技术专业人员全面深度融合。建议长三角三省一市加强协同监测预警和信息互通共享,强化跨区域协同应急联合处置,加强人员交流和队伍联合培训,深化区域科研合作和标准化建设,发挥优势,引领全国。

Comparative Analysis of Social Forces Participating in Emergency Management of Public Health Events in China, Australia, Germany and the United States

Objective To provide a reference and suggestions for Chinese social forces to participate in the emergency management of public health events.Methods Through literature research method,comparative research method and SWOT matrix analysis,four aspects of prevention,early warning,response and recovery of the social forces in China,Germany,Australia and the United States participating in emergency management were studied comparatively.Results and Conclusion In the emergency management of public health events,China’s social forces play greater role in the response and recovery phase than that in the prevention and response phase.As to its shortcomings,the following suggestions are made,such as incorporating social forces into the national emergency management system,strengthening the construction and training of social forces,popularizing public health knowledge and awareness,clarifying property rights and using incentives and punishment together.

医疗卫生应急演练规范化管理的设计和政策建议

目的开展上海市医疗卫生应急演练工作规范化管理的设计,统筹全市医疗卫生应急演练的组织,指导医疗卫生单位应急演练项目的实施。方法2023年4—5月,对上海市应急管理和医疗卫生相关21名专家进行半结构化访谈,从计划、组织、指挥、协调、控制五大管理职能维度进行分析。结果医疗卫生应急演练规范化管理的设计基于“医疗卫生应急演练的规划”和“医疗卫生应急演练项目的组织实施”两个层面开展。工作计划要将目标分解到时间和资源上以形成执行方案,组织安排要在既定的目标下进行任务梳理和职责分解,指挥活动要按照规定或工作流程进行程序化决策,不断地沟通和调整来协调成员单位一致行动,通过检查考核等手段来评价演练工作是否达到预期目标。结论建议进一步开展示范性案例回顾,解析医疗卫生应急演练规范化管理的关键要素;从管理职能出发明确医疗卫生应急演练管理的适用范围、参与主体和工作原则,基于演练进一步完善医疗卫生应急预案;通过长期系统性规范管理,推动医疗卫生应急演练工作高质量发展。

上海市公共卫生重点学科建设与人才培养的实践与思考:以2020—2022年上海市疾病预防控制中心承担项目为例

目的以上海市疾病预防控制中心承担项目为例,对上海市公共卫生重点学科建设与人才培养的实践进行客观评估,总结项目实施经验,完善项目评估机制,强化学科发展与人才培养对上海市健全公共卫生应急管理体系的支撑作用。方法基于学科建设验收评估申请书,通过定量、定性方法对学科建设期间的项目基本情况、学科建设成效、跨机构科研协作、参与公共卫生实践以及人才培养与建设等进行描述和分析。结果各学科团队承担的科研项目级别较高,较好促进了学科创新发展;各学科团队注重公共卫生实践与应用能力建设,实现了科研成果的转化落地;上海市疾病预防控制中心和复旦大学在论文发表合作网络中占据了主要地位,在多部门科研协作中发挥了重要作用;专业机构和高等院校的合作促进了公共卫生复合型人才培养。结论上海市公共卫生重点学科建设与人才培养取得了良好成效。