新疆14个地州市卫生资源配置现状的秩和比法分析

[目的]通过分析新疆卫生资源配置现状,为新疆卫生资源“十二五”期间的优化配置提供依据。[方法]采用秩和比法（RSR）对全疆14个地州市的床位、卫生技术人员、医师、护士、设备以及补助收入情况进行综合评价。[结果]全疆卫生资源配置情况分成四档,一档（多）：乌鲁木齐市、克拉玛依市：二档（中等）：哈密、昌吉、巴州、博州;三档（偏少）：阿勒泰、塔城、伊犁、吐鲁番、克州;四档（少）：阿克苏、和田、喀什。[结论]全疆各地州卫生资源配置存在明显差异,乌鲁木齐以及北疆、东疆地区人均卫生资源拥有量均高于南疆地区。     

新疆地区卫生资源配置空间公平性分析研究

目的:评价新疆14个地州市卫生资源配置的人口与地域空间公平程度,为促进新疆卫生资源的合理配置提供依据。方法:采用基尼系数对2010-2015年卫生资源配置人口公平性进行评价;应用全局、局域空间自相关分析对地域空间上卫生资源配置的空间公平性进行探索性分析。结果:2010-2015年新疆各卫生资源指标基尼系数在0.484~0.711之间,从基尼系数变化趋势看,各卫生资源指标基尼系数整体呈现下降趋势;全局空间自相关分析提示,新疆卫生资源配置存在相互影响;局域空间自相关分析提示,卫生资源配置"冷点区域"主要分布在喀什地区、克孜勒苏柯尔克孜族自治州、和田地区、阿克苏地区;卫生资源配置"热点区域"主要分布在昌吉回族自治州。结论:新疆卫生资源配置存在不公平性现象,需针对卫生资源人口、空间分布差异,从人口、地域特征出发,对各地区给予特殊的政策扶持。     

云南省卫生资源区域分类指标研究

目的 筛选适合于云南省卫生资源优化配置的区域分类指标。用这些指标将云南省16个地州市进行适当分类。方法 采用专家咨询打分法，离散趋势法，主成分分析法和聚类分析法进行分析。结果 从50多个影响因素中筛选出对区域分类有代表性好，灵敏度高，独立性强，具有实用性的7个指标。用这7个分类指标对云南省16个地州市1999年资料进行系统聚类，将云南省16个地州市分成五类地区。结论 这种区域分类与云南省实际区域是相同的，云南省区域分类指标研究结果为云南省区域分类和区域卫生资源配置标准的制定提供了科学依据。     

云南省卫生资源区域分类指标的聚类分析

为了制定云南省区域卫生资源配置标准 ,必须研究云南省卫生资源区域分类指标 ,从众多的有关指标中精选出几个分类指标 ,将云南省所有地州市进行适当分类。目前 ,国内有关卫生资源区域分类指标研究报道比较少〔1- 6〕,我们对云南省 16个地、州、市1990～ 1999年 10年的卫生资源的有关指标进行了调查研究 ,目的是为筛选云南省卫生资源区域分类指标 ,用这些指标将云南省 16个地州市进行适当分类 ,为制定合理的卫生资源区域配置标准提供科学依据1　资料和方法1 1　调查内容与方法 :从云南省政府、云南省卫生厅和云南省统计局等单位提供的云南省…     

用无量纲化构建法对卫生资源配置区域分类结果的验证

目的:采用无量纲化构建法验证2000年云南省卫生资源配置中对16个地州市进行区域分类的正确性,并得到云南省各区域的综合标志值。方法:以资料中7个分类指标为基础,用无量纲化构建法建立区域分类标志值的测算公式,将各区域的7个指标及其增长速度值代入区域分类标志值测算公式得出各区域标志值,并划分为不同的类别。结论:两种分类方法得出的结果完全一致,可以认为指标选择是合理的,具有很好的代表性和稳定性,同样可以认为把云南省分为五类区域的结论是科学合理的。     

世界卫生资源配置模式探讨

采用主成分回归方法对138个国家的代表经济，文化、人口、健康和卫生资源配置等方面的指标进行研究，探讨卫生资源配置与社会，经济、文化和人口等因素的关系，为建立适宜于卫生资源配置的区域分类方法和分类制定卫生资源配置标准提供依据。     

我国卫生区域划分研究

目的:我国不同地区卫生资源发展不平衡,制定区域卫生规划要综合考虑不同地区的经济、社会、人口、健康等方面的状况。方法:利用统计年鉴数据,考虑经济、社会、人口、健康等因素,分别通过主成分分析和因子分析方法计算不同地区的综合得分,然后对综合得分进行聚类分析。结果:主成分分析综合得分和因子分析综合得分的聚类分析将全国以省(自治区、直辖市)为单元划分为6类地区,两种分析方法的分类结果类似。结论:将全国卫生区域分为六类,第一类地区:上海市、北京市;第二类地区:天津市;第三类地区:江苏省、浙江省、广东省;第四类地区:辽宁省、山东省、福建省、内蒙古自治区、吉林省、重庆市、陕西省、湖北省、黑龙江省、山西省、河南省、湖南省、河北省、海南省、四川省、江西省、安徽省;第五类地区为:广西壮族自治区、宁夏回族自治区、新疆维吾尔自治区、甘肃省、青海省、贵州省、云南省;第六类地区为:西藏自治区。分类结果基本符合中国31个省(自治区、直辖市)的卫生发展实际。     

农村公共卫生投融资机制研究样本抽取的区域分类方法

目的：构建农村公共卫生投融资机制抽样研究的区域分类指标体系,并计算分类标志值.方法：本文在广泛收集我省农村公共卫生投融资方面的资料数据的基础上,运用专家咨询法确立符合本研究领域特征的指标体系和指标权重,并运用极差法对实际数据进行无量纲化处理,采用加权平均法计算出我省14个地州市的区域分类标志值.结果：我省14个地（州、市）的分类标志值虽然极差较大（反映发展不平衡）,但主要分布于（40,70）这一区间内,其中,大于60的有5个地（州、市）,小于50的有5个,在50-60之间的有4个,我们依此将其分为三个类别的区域.结论：经过专家咨询所筛选的9个指标所计算的标志值能够较好地反映一个地区的农村公共卫生投融资的现状,可以作为本研究抽样的依据.     

新疆卫生资源配置公平性分析

[目的]评价新疆卫生资源配置的公平性。[方法]通过查阅2009年和2010年新疆维吾尔自治区统计年鉴,利用2009年和2010年新疆省18个地州市卫生设施(病床)与卫生人力资源(医疗技术人员、医生和护士)以及卫生财力资源(卫生总收入)配置方面的数据资料,采用基尼系数法从人口分布角度对新疆卫生资源配置的公平性进行评价。[结果]2009年和2010年除乌鲁木齐外,其他17个地州市病床、卫生技术人员、医生及护士的公平性均较低,2009年各地区总收入均不足,2010年博尔塔拉蒙古自治州总收入过高,卫生总收入总体公平性较差。[结论]由于新疆特殊的人口分布情况,新疆卫生资源配置的公平性有待提高。     

基于区域聚类的新疆卫生资源配置均衡性研究

采用系统聚类的方法,根据卫生、人口及经济等指标将新疆分为三类地区,并通过三类地区泰尔指数的测算,对新疆卫生资源配置的均衡性进行分析.结果显示,新疆卫生资源配置总量丰富且逐年增加,但区域分化较为严重,卫生资源主要集中在经济较为发达的一类地区,而三类地区卫生资源配置的总体不均衡性较为突出.在分析的三类卫生资源中,以护士的不公平性为最严重,其次为医师配置,床位的配置不公平程度最小,对泰尔指数进行分解,发现区域间差异是造成新疆卫生资源配置不均衡的主要原因,且差异所占的比重逐年增大.     

Breast cancer mortality in women of Southern Brazil, 1980-1999

OBJECTIVE: To analyze time and geographical trends of breast cancer mortality. METHODS: Annual mortality rates per 100,000 female inhabitants aged 20 to 59 years for the Baixada Santista metropolitan area, the city and state of S?o Paulo and Brazil, from 1980 to 1999, were standardized by age groups and analyzed. The analyses included regression models to estimate and compare time trends of each area.? RESULTS: Increasing mortality rate trends were observed for all areas. However, intrametropolitan variations have higher baselines and time trends than the other areas. Santos had standardized mortality rates between 25 and 35 per 100,000 women, which were the highest in the study. Differences between Santos rates and the rates of other cities included in the study were statistically significant (p<0.001). The cities of S?o Vicente, Cubat?o and Peruíbe of the Baixada Santista metropolitan area also showed increased mortality rates trends and higher rates than those for the state of S?o Paulo and Brazil. CONCLUSIONS: A similar increasing trend in mortality rates was observed in all cities of the study area and higher rates were seen in Santos. There is a need for further studies in order to identify the determinant conditions for this trend.     

1990年与2013年中国人群溺水死亡疾病负担分析

目的 了解1990年与2013年中国及各省份人群的溺水疾病负担及变化情况,为制定溺水预防控制策略和措施提供参考依据。方法 运用2013年全球疾病负担研究的测量框架及标准化估算方法,使用来自于全国疾病监测点系统、全国妇幼卫生监测网、中国CDC死因登记报告信息系统、中国澳门地区和香港地区的伤害死亡数据和来自于全国伤害监测系统及文献回顾的伤害发生数据,采用死亡数/率、过早死亡损失寿命年（YLL）/标化YLL率、伤残损失寿命年（YLD）/标化YLD率、伤残调整寿命年（DALY）/标化DALY率等指标,分析描述中国及各省份人群的溺水疾病负担及变化情况。结果 2013年中国人群溺水死亡人数为63 619,标化死亡率为5.29/10万,占伤害总死亡的8.0%,位列总人群伤害死因第四位,是<5岁及5~14岁儿童首位伤害死因。2013年中国人群溺水造成的YLL为349.08万人年、YLD为4.13万人年、DALY为353.22万人年。与1990年相比,2013年中国人群溺水的标化死亡率、标化YLL率、标化YLD率、标化DALY率均下降。2013年人群溺水标化死亡率最高的5个省份依次为新疆（10.08/10万）、江西（8.44/10万）、安徽（7.92/10万）、贵州（7.77/10万）、四川（7.68/10万）,与1990年比较,2013年各省份人群的溺水标化死亡率均下降。结论 与1990年相比,2013年中国人群尤其是儿童的溺水疾病负担明显下降,但相比国际和其他国家的溺水死亡水平,中国的溺水问题仍然较为严重。儿童人群和男性人群应是我国溺水预防的优先目标人群,西部和中部地区是我国溺水高死亡地区,亟待开展溺水预防研究和项目。     

Recent changes in the geography of social disparities in premature mortality in Québec

Most recent research reveals that social inequalities in premature mortality are widening. Such findings mainly apply to countries as a whole. In this study, we model recent changes in the association between premature mortality and a deprivation index (a small area-based index) in four geographic settings in Québec, namely the Montréal metropolitan area, other Québec metropolitan areas, mid-size cities, and small towns and rural areas. Deaths from all-cause and specific causes of mortality among people under age 75 are considered for the periods 1989-1993 and 1999-2003. Mortality rates are modeled using negative binomial regressions. Models are fitted for the overall population and for men and women, separately, in every geographic setting. Three measures of inequalities are used: mortality rates for different population groups, rate ratios and rate differences. Results show that social inequalities in premature mortality increase everywhere in Québec except in the Montréal metropolitan area. Presently, the highest mortality rates among deprived groups are found in mid-size cities, small towns and rural areas; the highest rate ratios in the Montréal metropolitan area and other metropolitan areas of Québec; and the highest rate differences in the Montréal metropolitan area, other metropolitan areas of Québec and mid-size cities. These results are discussed with reference to possible explanatory factors, namely relative deprivation, smoking, immigration and internal migration. Indications on future research and policy implications are provided.     

"Love thy neighbour"-it's good for your health: a study of racial homogeneity,mortality and social cohesion in the United States

This paper explores the idea that in societies that experience racial tension, increasing racial heterogeneity will be associated with poorer health outcomes, and this effect will be observable in the health of both the minority and the majority group. Here, the association between mortality and racial homogeneity in the United States is examined. The level of racial homogeneity, indexed by the proportion of blacks in each state of the 50 states in the US, was examined in relation to all-cause mortality, adjusted for age and disaggregated by race and sex. The level of poverty in each state was controlled for in ordinary least squares regression models. The level of racial homogeneity was significantly associated with age adjusted mortality rates for both blacks and whites, accounting for around 30% of the variance in mortality rates in the total population and the white population. Every 1% increase in the percentage of the state population who were black was associated with an increase in the total mortality rate of 5.06 per 100000 and an increase in the white mortality rate of 3.58 per 100000. Based on the data, this suggests, for example, that racial heterogeneity in Mississippi accounts for around 14% of the white mortality rate and in New York and Delaware it accounts for around 7%. These results appear to support the social cohesion thesis that in societies that are intolerant, mortality rates will increase as the proportion of racial or ethnic minorities increase in population. Limitations and explanations for the findings are discussed.     

中国城乡脑中风的流行病学:1986年死亡率分析

在全国范围内(台湾省未查)抽取199个调查点,共查5 790 864人,发现当年死于脑中风者4 446例,粗死亡率为76.78/10万,其95%置信区间为74.52~79.04/10万;用中国1986年农村和城市人口构成调整后,死亡率为77.15/10万;用中国1982年人口构成比标化后为57.25/10万;用世界标准人口标化后为80.94/10万。分别计算了各大区和省的脑中风死亡率,并且对脑中风标化死亡率和经、纬度的关系作了相关回归分析,发现均呈正相关,并有线性回归关系。也就是说,在中国,脑中风的死亡率从南向北逐渐升高,从东向西逐步降低。脑中风死亡率城市明显高于农村,大城市的市区明显高于其郊区。用趋势检验法和圆型分布法分析了死亡病例的按月分布,发现在一月份有一个不十分明显的,但在统计学上有意义的死亡高峰。脑中风的死亡率随年龄的增长而升高,两者之间的关系符合Logistic曲线的轨迹。     

Infant mortality: comparison between two birth cohorts from Southeast and Northeast, Brazil

OBJECTIVE: To obtain population estimates and profile risk factors for infant mortality in two birth cohorts and compare them among cities of different regions in Brazil. METHODS: In Ribeir?o Preto, southeast Brazil, infant mortality was determined in a third of hospital live births (2,846 singleton deliveries) in 1994. In S?o Luís, northeast Brazil, data were obtained using systematic sampling of births stratified by maternity unit (2,443 singleton deliveries) in 1997-1998. Mothers answered standardized questionnaires shortly after delivery and information on infant deaths was retrieved from hospitals, registries and the States Health Secretarys' Office. The relative risk (RR) was estimated by Poisson regression. RESULTS: In S?o Luís, the infant mortality rate was 26.6/1,000 live births, the neonatal mortality rate was 18.4/1,000 and the post-neonatal mortality rate was 8.2/1,000, all higher than those observed in Ribeir?o Preto (16.9, 10.9 and 6.0 per 1,000, respectively). Adjusted analysis revealed that previous stillbirths (RR=3.67 vs 4.13) and maternal age <18 years (RR=2.62 vs 2.59) were risk factors for infant mortality in the two cities. Inadequate prenatal care (RR=2.00) and male sex (RR=1.79) were risk factors in S?o Luís only, and a dwelling with 5 or more residents was a protective factor (RR=0.53). In Ribeir?o Preto, maternal smoking was associated with infant mortality (RR=2.64). CONCLUSIONS: In addition to socioeconomic inequalities, differences in access to and quality of medical care between cities had an impact on infant mortality rates.     

The politics of preventable deaths: local spending, income inequality, and premature mortality in US cities

OBJECTIVE: To examine the association between (1) local political party, (2) urban policies, measured by spending on local programmes, and (3) income inequality with premature mortality in large US cities. DESIGN: Cross sectional ecological study. OUTCOME MEASURES: All cause death rates and death rates attributable to preventable or immediate causes for people under age 75. PREDICTOR MEASURES: Income inequality, city spending, and social factors. SETTING: All central cities in the US with population equal to or greater than 100 000. RESULTS: Income inequality is the most significant social variable associated with preventable or immediate death rates, and the relation is very strong: a unit increase in the Gini coefficient is associated with 37% higher death rates. Spending on police is associated with 23% higher preventable death rates compared with 14% lower death rates in cities with high spending on roads. CONCLUSIONS: Cities with high income inequality and poverty are so far unable to reduce their mortality through local expenditures on public goods, regardless of the mayoral party. Longitudinal data are necessary to determine if city spending on social programmes reduces mortality over time.     

Anencephalus and drinking water composition.

The mortality rate (stillbirths and infant deaths) from anencephalus from 1950-1969 in 36 cities of over 50,000 population in Canada showed a negative association (r = -.39) with the concentration of magnesium in water sampled at domestic taps. The mortality rates showed negative associations with mean income and longitude, and a multiple regression model using the three factors showed significant effects of each and accounted for 69% of the intercity variation in rates. There were no significant associations seen with water calcium concentration or total hardness. Income, magnesium and longitude were also negatively associated with mortality rates from spina bifida, hydrocephalus, other congenital abnormalities, and total stillbirth and infant death rates, but the association with magnesium was significant only for total stillbirths. The negative association of anencephalus mortality and magnesium levels was also seen in a sample of 14 smaller towns in Ontario.     

2004-2013年新疆伤寒、副伤寒流行病学特征分析

摘要:目的　了解新疆伤寒、副伤寒发病动态,为做好疾病预防与控制工作提供依据。方法　根据新疆疫情统计资料和实验室资料,对该区2004-2013年伤寒、副伤寒流行概况进行分析。结果　2004-2013年新疆伤寒、副伤寒年均发病率3.12/10万,年均死亡率0.00048/10万,年均病死率0.0153％。全年8-9月为发病高峰期,发病人群以农民和学生为主。10年间共发生暴发疫情9起,多数发生在喀什地区。结论　2004-2013年新疆伤寒、副伤寒发病率呈平缓下降趋势,但有些地区发病率仍较高,优势茵型仍是伤寒沙门茵。     

Comparative Assessment of the Effects of Climate Change on Heat- and Cold-Related Mortality in the United Kingdom and Australia

Background: High and low ambient temperatures are associated with increased mortality in temperate and subtropical climates. Temperature-related mortality patterns are expected to change throughout this century because of climate change.Objectives: We compared mortality associated with heat and cold in UK regions and Australian cities for current and projected climates and populations.Methods: Time-series regression analyses were carried out on daily mortality in relation to ambient temperatures for UK regions and Australian cities to estimate relative risk functions for heat and cold and variations in risk parameters by age. Excess deaths due to heat and cold were estimated for future climates.Results: In UK regions, cold-related mortality currently accounts for more than one order of magnitude more deaths than heat-related mortality (around 61 and 3 deaths per 100,000 population per year, respectively). In Australian cities, approximately 33 and 2 deaths per 100,000 population are associated every year with cold and heat, respectively. Although cold-related mortality is projected to decrease due to climate change to approximately 42 and 19 deaths per 100,000 population per year in UK regions and Australian cities, heat-related mortality is projected to increase to around 9 and 8 deaths per 100,000 population per year, respectively, by the 2080s, assuming no changes in susceptibility and structure of the population.Conclusions: Projected changes in climate are likely to lead to an increase in heat-related mortality in the United Kingdom and Australia over this century, but also to a decrease in cold-related deaths. Future temperature-related mortality will be amplified by aging populations. Health protection from hot weather will become increasingly necessary in both countries, while protection from cold weather will be still needed.Citation: Vardoulakis S, Dear K, Hajat S, Heaviside C, Eggen B, McMichael AJ. 2014. Comparative assessment of the effects of climate change on heat- and cold-related mortality in the United Kingdom and Australia. Environ Health Perspect 122:1285–1292; http://dx.doi.org/10.1289/ehp.1307524