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1 内部刊物仅供参考新东城卫生舆情第五十五期北京市东城区公共卫生信息中心 2011 年 06 月 9 日本期目录 1 卫生部给出 EHEC 感染临床诊断病例定义 2 非公医疗机构发展束缚少了 3 内地医改可借鉴香港经验 4 今年手足口病疫情变数多 5 德国疾病防控教训初现 6 民营医院医托庸医乱象频生形象信誉成发展瓶颈 7 北京医院预约挂号新政满一周专家看病效率提高 8 北京 120 和 999 急救系统月底有望统一调度 9 北京市成立专家组监测蜱虫病 10 东莞开展医院收费检查乱收费最高 5 倍罚款 11 齐齐哈尔严把社区医疗机构准入关 12 中国侨联启动健康光明联合行动救助贫困白内障患者 13 疾控中心 : 德国大肠杆菌疫情传入我国风险较低 14 砒霜对脑胶质瘤有良好疗效 15 Drug Can Reduce Risk of Breast Cancer, Study Says 1 标题 : : 卫生部给出 EHEC 感染临床诊断病例定义来源 : 健康报链接 : nt.jsp?docid=220715&cat=0d 截至 6 月 6 日, 欧洲报告 EHEC 感染病例总数已达 2333 例, 死亡 22 人根据德国卫生部联邦风险评估研究所评估, 溶血性尿毒综合征 (HUS) 病例持续发生, 血性腹泻就诊人数仍在上升, 暴发感染源仍然存在 ; 疫情系食源性暴发, 存在经人与人之间接触 ( 粪口途径 ) 1

费检查乱收费最高 5 倍罚款 11 齐齐哈尔严把社区医疗机构准入关 12 中国侨联启动健康光明联合行动救助贫困白内障患者 13 疾控中心 : 德国大肠杆菌疫情传入我国风险较低 14 砒霜对脑胶质瘤有良好疗效 15 Drug Can Reduce

2 引起续发聚集性病例可能性 ; 无证据表明受污染食品已扩散至德国以外地区根据中国 CDC 视频会议部署, 发病前 10 天有疫区旅行史 ( 德国 ),), 且有血性腹泻腹部痉挛性疼痛等症状, 或有溶血性贫血血小板减少及肾功能受损等 HUS 临床表现者, 可定义为临床诊断病例临床诊断病例符合下列两项之一者从粪便标本中分离到 EHEC O104:H4 菌株, 且 STX2 毒素检测或其基因检测阳性 ; 从粪便标本中检测到至少 stx2 terd terd rfbo104 rfbo104 及 flic H4 基因扩增阳性, 可定义为实验室确诊病例 2 标题 : 非公医疗机构发展束缚少了来源 : 健康报链接 : 卫生部近日下发通知, 提出进一步做好非公立医疗机构设置审批和管理的 10 条意见记者仔细梳理后发现,10 项举措大致可分 3 个方面 : 解决社会资本举办医疗机构的进入难限制多问题, 鼓励和引导社会资本更好发挥作用, 加强非公立医疗机构监管等同等条件优先考虑社会资本办医民营医院人员可参加专家委员会质控组织医疗技术临床应用管理不分姓公姓私 3 标题 : : 内地医改可借鉴香港经验来源 : 新华社链接 : d=220718&cat=0d 据新华社香港 6 月 7 日电 ( 记者王小旎 ) 卫生部部长陈竺 6 日在香港出席香港医院管理局 2011 研讨大会开幕典礼时致辞表示, 内地医改情况复杂, 是世界性难题, 可以借鉴香港完善的医疗卫生保障制度, 向内地公民提供有效及廉价的医疗服务据介绍, 香港医管局研讨大会是亚太地区最大规模的医疗会议之一为期 2 天的 2011 研讨大会以共建民康为主题 4 标题 : : 今年手足口病疫情变数多来源 : 健康报链接 : /document.jsp?docid=220717&cat=0d 5 月中旬以来, 全国每天报告手足口病发病病例都在 1 万例以上, 其中重症病例数和死亡病例数也在快速上升卫生部疾病预防控制局国家卫生监察专员肖东楼日前接受本报记者专访时说, 今年的手足口病疫情与去年相比有多个不同 : 一疫情高峰期时段不同二今年全国总疫情不及去年重, 但局部几个省的疫情均明显重于去年, 有的省手足口病发病病例数比去年上升了 50% 三去年报告发病病例数多的省, 其报告死亡病例数也多 ; 今年报告发病病例数多的省与报告病死病例数多的省不完全相同四今年有些省病原谱流行有较大变化去年流行的主要是柯萨奇 A16 型病毒, 而今年 EV71 型病毒的流行占优势 2

增阳性, 可定义为实验室确诊病例 2 标题 : 非公医疗机构发展束缚少了来源 : 健康报 2011-06 06- 链接 :http://www.jkb.com.cn/document.jsp?

3 5 标题 : : 德国疾病防控教训初现来源 : 新华社链接 : 据新华社柏林 6 月 6 日电 ( 记者班玮 ) 德国肠出血性大肠杆菌感染疫情持续蔓延, 特别是传染源至今仍未查明, 这让德国人开始反思本国疾病防控体系存在的问题专家和媒体批评比较集中的一点是, 德国医疗卫生事务由各州分而治之的联邦制管理体系造成疫情应急反应不力 6 标题 : : 民营医院医托庸医乱象频生形象信誉成发展瓶颈来源 : 中国青年报链接 : 近年来, 随着我国医疗卫生事业加快改革, 民营医院异军突起 2010 年卫生事业发展统计公报显示, 我国目前已拥有 7068 家民营医院, 超过全国医院总数的 1/3 在数量快速发展的同时, 民营医疗行业也面临着良莠不齐乱象丛生的局面作为一名已从业 10 多年的民营医院院长, 于保法见证了这个行业的风风雨雨他介绍说, 部分民营医院存在一切向钱看的倾向, 夸大宣传医疗力量治疗效果或者对患者实施过度治疗, 误导甚至欺骗消费者, 从而影响了民营医院的整体形象 7 标题 : : 北京医院预约挂号新政满一周专家看病效率提高来源 : 北京晚报链接 : 从本月 (6 月 )1 日开始,( 北京 ) 市属 21 家大医院全面实行预约挂号新政记者近日探访京城部分医院发现, 患者和医生逐渐适应了挂号不点名的举措, 医院就诊秩序好转一些试点医院知名专家的号源不再直接对患者开放, 而是需团队医生初诊后根据病情再进行转诊, 大专家不用再接诊常见病多发病患者, 而是专门迎接具有挑战性的病例, 忙碌程度没变, 却大大提高了效率 8 标题 : : 北京 120 和 999 急救系统月底有望统一调度来源 : 京华时报链接 : 到明年年底, 本市将新增和调整 110 个急救站点, 使全市急救站点总数达到 350 个本市着力打造的 120 和 999 联合指挥调度交互平台拟于本月底前建成, 届时两大急救系统将实现统一调度市卫生局表示, 本市将进一步缩短急救服务半径, 快速应对急救事件具体目标包括 : 两年内实现接到呼叫后 10 秒钟内应答受理 ; 平均急救反应时间 ( 接到呼救到救护车抵达现场时间 ) 城区为 17 分钟以内郊区为 20 分钟以内边远地区为 30 分钟以内 ; 全市急救呼叫满足率达到 95% 以上目前 120 在城区的平均急救反应时间约为 20 分钟, 因急救站点设置及路程较远等因素, 郊区县及山区的急救反应时间更长 999 的急救反应时间全市平均约为 16 分钟 3

卫生事务由各州分而治之的联邦制管理体系造成疫情应急反应不力 6 标题 : : 民营医院医托庸医乱象频生形象信誉成发展瓶颈来源 : 中国青年报 2011-06- 链接 :http://www.jkb.com.cn/document.jsp?

4 9 标题 : : 北京市成立专家组监测蜱虫病来源 : 京华时报链接 : 随着本市进入盛夏时节, 人们在野外活动时遭遇吸血虫的风险陡然增加昨天, 记者从市卫生局获悉, 卫生部门已成立市级专家组, 开展对有蜱虫叮咬史饲喂家畜等人员的疫情监测工作市卫生局称, 此项监测旨在掌握本市发热伴血小板减少综合征疫情动态及时发现和处理相关疫情监测对象为体温超过 37.5 且有相关流行病学史的人员 10 标题 : : 东莞开展医院收费检查乱收费最高 5 倍罚款来源 : 南方日报链接 : 南方日报讯 ( 记者 / 欧雅琴 ) 医院收费是否有暗箱操作? 从 5 月底到 6 月上旬, 东莞市卫生局组织开展了一次全市非营利性医疗单位医药服务价格大检查, 检查范围除 40 家公立医院外, 还包括广济医院同济光华医院两家率先转轨为非营利性医院的民营医院, 这也是民营医疗机构首次被纳入卫生部门物价专项检查根据要求, 对重大价格违法案件, 除没收全部违法所得外, 将处以最高 5 倍罚款 11 标题 : : 齐齐哈尔严把社区医疗机构准入关来源 : 鹤城晚报链接 : 东北网齐齐哈尔 6 月 8 日讯为使居民更好地享受到优质的医疗卫生服务, 我市在扶持社区基层医疗机构的同时, 严把准入关, 加强准入管理市卫部门坚持对社区卫生机构实施清理整顿, 并实行不良积分记录在规范服务站工作中, 各区对不符合要求的服务站进行了转型或取缔, 以铁锋区为例, 去年就将辖区内 11 家社区卫生服务站取消了 7 家, 迁址 1 家, 对社区卫生服务中心人员重新梳理备案登记, 净化了社区卫生服务市场 12 标题 : : 中国侨联启动健康光明联合行动救助贫困白内障患者来源 : 新华网链接 : 0I 新华网北京 6 月 8 日电 ( 记者崔静 ) 中国侨联 7 日在京启动历年来规模最大的一次健康光明联合行动, 以帮助更多贫困白内障患者重见光明全国人大常委会副委员长韩启德出席启动仪式按照计划, 中国侨联将自 6 月 8 日起组织数支医疗队, 分赴全国 8 个省区 30 余个市县, 为贫困白内障患者实施 2000 余例复明手术, 并相机在甘肃建立 2 至 3 个眼科培训点中国侨联主席林军表示, 健康光明联合行动是中国侨联近年来开展的健康光明行动的延续自 2004 年以来, 中国侨联先后在甘肃西藏云南湖北等省区开展免费复明手术, 已先后帮助 667 名贫困白内障患者重见光明 4

掌握本市发热伴血小板减少综合征疫情动态及时发现和处理相关疫情监测对象为体温超过 37.5 且有相关流行病学史的人员 10 标题 : : 东莞开展医院收费检查乱收费最高 5 倍罚款来源 : 南方日报 2011-06 06- 链接 :http://www.

5 13 标题 : : 疾控中心 : 德国大肠杆菌疫情传入我国风险较低来源 : 新京报链接 : 据新华社电针对近期德国肠出血性大肠杆菌引起的暴发疫情, 中国疾病预防控制中心 7 日召开视频会议, 向各省 ( 区市 ) 和重点口岸城市疾控中心通报疫情进展, 布置监测实验室检测和防控工作与会专家认为, 就目前情况分析, 疫情传入我国风险较低, 但仍需做好预防控制工作专家表示, 德国肠出血性大肠杆菌疫情的暴发为食源性传播, 目前尚未发现人与人之间的接触所致广泛传播的证据由于我国进口的生鲜蔬菜和其他食品数量有限, 暴发菌株通过食品传入我国风险低此外, 尽管可能出现赴德旅行或归国人员在德感染病例, 但病菌在国内引发进一步广泛传播可能性较小专家同时指出, 肠出血性大肠杆菌可能感染导致患上溶血性尿毒综合征 (HUS), ),), 这种病例病死率较高, 必须关注病例救治, 各地医疗机构要做好病例的发现报告和检测 14 标题 : : 砒霜对脑胶质瘤有良好疗效来源 : 健康报链接 : 由哈尔滨医科大学附属第一医院神经外科主任赵世光教授领衔的课题组在国际上首次发现, 传统中药三氧化二砷 (As2O3, 俗称砒霜 ) 可诱导胶质瘤细胞凋亡和细胞周期俘获 ; 抑制胶质瘤细胞内热休克蛋白的表达可显著增强其对 As2O3 的敏感性通过化疗新药开发化疗给药途径改进放化疗增敏等多种综合手段, 课题组在临床中将胶质母细胞瘤病人存活时间由平均 12.5 个月延长到 18 个月专家评价指出, 课题组在国际上首次确认中药砷剂对脑胶质瘤具有良好的疗效, 并针对胶质瘤特点建立了颅内缓释剂化疗和脂质体包埋技术两种新的给药途径, 从而提高了 As2O3 的用药效果在进行放化疗增敏研究中, 课题组还锁定了可作为增敏靶点的敏感基因及蛋白, 有助于延长胶质瘤患者的生存期据悉, 该项名为胶质瘤化疗放疗及其增敏研究的科研项目, 日前获 2010 年度教育部科技进步奖二等奖 15 标题 : : : Drug Can Reduce Risk of Breast Cancer, Study Says 美国 : 研究表明抗复发药物还可以降低乳腺癌原发部位的发病风险来源 : 纽约时报链接 : ref=health 内容 : CHICAGO A drug now used to prevent recurrences of breast cancer can also reduce the risk of it occurring in the first place, providing a new option for women at high risk of getting the disease, researchers reported here on Saturday. Two drugs, tamoxifen and raloxifene, are already approved to prevent breast cancer but both are rarely used for that purpose, in part because they can have serious side effects like blood clots. The researchers said the new option, exemestane, does not have those 5

就目前情况分析, 疫情传入我国风险较低, 但仍需做好预防控制工作专家表示, 德国肠出血性大肠杆菌疫情的暴发为食源性传播, 目前尚未发现人与人之间的接触所致广泛传播的证据由于我国进口的生鲜蔬菜和其他食品数量有限, 暴

6 side effects and might be more acceptable. There s a very safe therapy that looks highly effective in preventing breast cancer, Dr. Paul E. Goss, professor of medicine at Harvard and Massachusetts General Hospital, said at a news conference at the annual meeting of the American Society of Clinical Oncology. He was the lead investigator in the study, which was presented at the conference and published online by the New England Journal of Medicine. Exemestane, also known by the brand name Aromasin, is one of a class of compounds known as aromatase inhibitors. These drugs stop the production of estrogen, which fuels tumor growth. They have proven superior to tamoxifen in preventing recurrence of cancer after a breast tumor is removed. So researchers have long suspected that aromatase inhibitors would also reduce the risk of an initial occurrence of breast cancer, though this is the first big randomized study to demonstrate that. The trial involved 4,560 post-menopausal women in the United States, Canada, France and Spain who were considered to be at a higher than normal risk of developing breast cancer either because of being over at least 60 or other factors. After a follow-up of about three years, 11 women getting the drug had developed invasive breast cancer compared with 32 of the women receiving a placebo. That is a reduction in risk of 65 percent. But in absolute terms, 1.4 percent of women in the placebo group developed cancer compared with about one-half of 1 percent of women taking the drug. About 94 women would have to be treated for three years to prevent one case of breast cancer, Dr. Goss said. In the trial, exemestane side effects were acceptable, he said. But women who took exemestane had more hot flashes and arthritis than those who had the placebo. Still, whether exemestane will catch on where the other drugs have not remains to be seen. Some doctors and patient advocates said that aromatase inhibitors had known side effects like bone pain and joint pain that caused many women who already had had cancer to stop taking them. For healthy women, that would be an even harder sell. People are going to think very, very hard about it before they are going to take an aromatase inhibitor in this setting, said Dr. Eric Winer, a breast cancer specialist at the Dana-Farber Cancer Institute in Boston. He noted the study was not designed to show whether women who took exemestane lived longer. Diana Zuckerman, president of the Cancer Prevention and Treatment Fund, a patient education group, said that the results were promising but that women in the study were followed for only three years, too short a period to judge long-term effects from taking the drug. Dr. J. Leonard Lichtenfeld, deputy medical director of the American Cancer Society, said the drugs would be more accepted if there were a way to better predict who was truly at risk of getting breast cancer. Another factor working against broad use is that aromatase inhibitors are now prescribed by oncologists. But for prevention, They would have to be prescribed by gynecologists and family doctors, said Dr. George W. Sledge Jr., a breast cancer specialist at Indiana University. These doctors are not comfortable with these drugs. 6

He was the lead investigator in the study, which was presented at the conference and published online by the New England Journal of Medicine.

7 Patent protection on the drug expired in April. Generic versions will mean lower prices. But generic competition also means that Pfizer, which sells Aromasin, has little incentive to seek regulatory approval for the drug for preventing breast cancer. The drug could still be available to women off label, but insurers might be reluctant to pay. Pfizer declined to comment on whether it would seek such approval. Pfizer helped pay for the study, and Dr. Goss has received honorariums from the company. Two other studies presented at the conference show that the widely used cancer drug Avastin is effective in delaying the progression of ovarian cancer. But both studies so far have narrowly missed showing that the drug can prolong lives, the ultimate test of a cancer drug. That threatens to embroil the use of Avastin for ovarian cancer in a debate similar to the one surrounding its use in breast cancer. The drug s manufacturer, Roche, has filed for approval in Europe to market the drug as a treatment for ovarian cancer. But its American subsidiary, Genentech, is still in discussions with the Food and Drug Administration about whether there is enough evidence for an approval. One question is whether it will be necessary to show that the drug prolongs lives, said Dr. Sandra Horning, who runs cancer clinical trials for Genentech. The F.D.A. is now moving to revoke the approval of Avastin for use in treating breast cancer in part because the drug has not prolonged lives in clinical trials. The F.D.A. will hold a hearing on this issue soon. One study presented here involved 484 women whose ovarian cancer had recurred after an initial drug treatment. All received two standard drugs, and half of them also received Avastin. The median time that women lived before their cancer worsened was 12.4 months for those who got Avastin compared with 8.4 months for those who received only the two other drugs. After two years, more women given Avastin were alive, but the difference was not quite statistically significant. Too few women had died to draw conclusions. It really is not appropriate statistically to say we really know anything about overall survival here, said Dr. Carol Aghajanian of the Memorial Sloan-Kettering Cancer Center, the lead investigator. The trial was sponsored by Genentech. The other trial, partly paid for by Roche, involved adding Avastin to the standard drugs used as initial therapy. There were 178 deaths in the Avastin arm and 200 among those who got the standard drugs, a finding that narrowly missed statistical significance. However, in a subset of patients considered to be at higher risk of recurrence, there was a statistically significant improvement in survival. 审核 : 林刚供稿 : 党跃辉刘红 7

The drug could still be available to women off label, but insurers might be reluctant to pay. Pfizer declined to comment on whether it would seek such approval.

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