2002—2017年上海市浦东新区居民脑卒中死亡特征及减寿率分析

背景　脑卒中是在全球范围内严重威胁人类健康的一类疾病,上海市浦东新区居民脑卒中死亡流行病学资料目前依然缺乏。目的　了解2002—2017年上海市浦东新区居民脑卒中死亡特征与减寿情况,为制定相应的干预措施提供依据。方法　以上海市浦东新区户籍居民为研究对象,从浦东新区死因监测系统中提取死亡日期为2002—2017年死因为脑卒中死亡居民的资料进行分析。不同人群间粗死亡率比较采用Poisson分布资料Z检验,标化死亡率比较采用Mantel-Haenszel检验。脑卒中死亡率年均变化百分比（APC）采用Joinpoint 4.0.4计算。减寿指标包括潜在减寿年数（PYLL）、潜在减寿率（PYLLR）、平均减寿年数（AYLL）、标化潜在减寿年数（SPYLL）以及标化潜在减寿率（SPYLLR）。人口因素与非人口因素对于脑卒中死亡率变化的贡献采用率差别分解法进行评价。结果　2002—2017年浦东新区累计报告居民脑卒中死亡56 180例,年均粗死亡率为129.85/10万,标化死亡率为47.03/10万。2002—2017年脑卒中粗死亡率保持稳定（Z=1.362,P=0.195）;标化死亡率呈逐年下降趋势（APC=-3.78%,Z=-14.950,P<0.001）;其中缺血性脑卒中粗死亡率呈逐年上升趋势（APC=3.62%,Z=14.055,P<0.001）,标化死亡率呈逐年下降趋势（APC=-0.74%,Z=4.639,P<0.001）;出血性脑卒中粗死亡率与标化死亡率均呈逐年下降趋势（APC粗死亡率=-1.46%,Z粗死亡率=-5.739,P粗死亡率<0.001;APC标化死亡率=-5.43%,Z标化死亡率=-13.409,P标化死亡率<0.001）。男性居民脑卒中粗死亡率低于女性（Z=-5.465,P<0.001）,标化死亡率高于女性（Z=-35.779,P<0.001）。儿童组、青年组、中年组、低龄老年人组、高龄老年人组年龄别死亡率分别为0.15/10万、2.52/10万、27.86/10万、248.02/10万、2 019.20/10万。年龄别死亡率趋势分析显示,2002—2017年青年组、中年组、低龄老年人组、高龄老年人组居民脑卒中死亡率均呈逐年下降趋势（P<0.001）。脑卒中PYLL为87 302年,PYLLR为2.02‰,AYLL为1.55年/人。2017年浦东新区居民脑卒中死亡率高于2002年,其中人口因素影响死亡率升高,而非人口因素作用使死亡率下降。结论　2002—2017年浦东新区居民脑卒中死亡率保持稳定,导致了严重的疾病负担,人口老龄化因素发挥主要促进作用,应采取综合性的防控措施。     

上海市浦东新区COPD患病率及其环境行为因素

目的 了解浦东新区COPD患病率及其相关环境行为因素,为新区COPD防治提供支持。方法 通过横断面调查设计,采用集中问卷调查和肺功能检查获取2016年40岁及以上社区居民患病率,运用Logistic回归分析相关影响因素。结果 COPD患病粗率为5.69%（标化率4.67%）。与COPD患病相关环境行为因素有吸烟（≥200 000支 VS 从不吸烟:OR = 1.908,95%CI:1.365～2.668,1～199 999支 VS从不吸烟:OR = 1.420,95%CI:1.003～2.011）、从事过的工作觉得胸闷、气喘或呼吸困难（OR = 2.339,95%CI:1.482～3.692）、儿童时期肺炎（OR = 2.120, 95%CI:1.346～3.338）、居住在人均面积小于30 m2房屋的年限（≥40年VS＜10年:OR = 1.539,95%CI:1.159～2.044）、BMI指数（OR = 0.908,95%CI:0.874～0.944）。结论 浦东新区COPD患病率低于全国水平,应重视早期筛查避免漏诊误诊,加强控烟及改善居民居住、工作环境有利于控制COPD的发生。     

大气颗粒物与上海浦东新区流感确诊病例相关性的时间序列研究

目的 了解大气颗粒物与上海市浦东新区流感确诊病例的相关性,为制定相关控制措施提供依据.方法 收集上海市浦东新区2014年1月1日至2018年12年31日气象因素(平均气温、相对湿度、大气压)、大气污染物(PM2.5、PM10、SO2、NO2、CO、O3)及不同年龄和性别流感确诊病例数等资料,拟合Poisson分布广义相...     

The immunogenicity and protection effect of an inactivated coxsackievirus A6, A10, and A16 vaccine against hand,foot, and mouth disease

Coxsackievirus belongs to the Enterovirus genus of the Picornaviridae family and is one of the major pathogens associated with human hand, foot, and mouth disease (HFMD). Historically, outbreaks of HFMD have mainly been caused by enterovirus 71 and coxsackievirus A16. Recently, coxsackieviruses A6 and A10 have been associated with increased occurrences of sporadic HFMD cases and outbreak events globally. In this study, the immunogenicity of coxsackieviruses A6, A10, and A16 (CA6, CA10, and CA16), which were inactivated by formalin or β-propiolactone (BPL) under different conditions, was evaluated as multivalent vaccine candidates. CA6 induced similar immune responses with both inactivation methods, and the immune efficacy of CA10 and CA16 was better following inactivation with BPL than with formalin. There was no sufficient cross-reactivity or cross-protectivity against heterologous strains in groups vaccinated with the BPL-inactivated (BI) monovalent vaccine. Sufficient neutralizing antibody and cell-mediated immune responses were induced in the BI-trivalent vaccinated group. These findings suggest that BI-CA6, CA10, and CA16 are potential multivalent vaccine candidates and that a multivalent vaccine is needed to control HFMD. The coxsackievirus multivalent vaccine could be useful for the development of effective HFMD vaccines.     

Life satisfaction and degree of suicide intent: A test of the strain theory of suicide

BackgroundVarious factors contribute to suicide. Psychological strains are hypothesized to precede suicidal thought and attempt. Life satisfaction can be a measure of relative deprivation strain and aspiration–reality strain.AimsThis study was to compare the suicide attempters with various levels of life satisfaction and find out how life satisfaction affects the degree of suicide intent among medically serious suicide attempters.MethodsSubjects for study were recruited in some rural counties in China. Interview data were from hospital emergency rooms with medically serious attempters of suicide (n = 791). The subjects were aged between 15 and 54 years and 293 males and 498 females. Face to face interview was conducted for each suicide attempter with a semi-structural protocol including life satisfaction, physical health, demographic, sociological, and psychological measures, as well as psychological strains.FindingsThe multiple linear regression analysis showed that mental disorder, aspiration strain and relative deprivation strain were significant risk factors for high intent of suicide among suicide attempters. The interaction between the two psychological strains also indicated that both failed aspiration and self-perceived low economic status in village play an important role in suicidal intent.ConclusionLow level of life satisfaction is associated with strong intent for suicide. Lack of life satisfaction is exemplified by relative deprivation perceived by the individuals and the discrepancy between an individual's aspiration for life and his/her reality. The findings from the suicide attempt data in rural China support the Strain Theory of Suicide.     

Application of toxicokinetics to improve chemical risk assessment: Implications for the use of animals

While toxicokinetics has become an integral part of pharmaceutical safety assessment over the last two decades, its use in the chemical industry is relatively new. However, it is recognised as a potentially important tool in human health risk assessment and recent initiatives have advocated greater application of toxicokinetics as part of an improved assessment strategy for crop protection chemicals that could offer greater efficiency, use fewer animals and provide better data for risk assessment purposes. To explore the potential scientific and animal welfare benefits of increased use of toxicokinetic data across the chemical industry, an international workshop was held in 2008. Experts from a wide range of chemical industry sectors, including industrial chemicals, agrochemicals and consumer products, participated in the meeting as well as representatives from relevant regulatory authorities. Pharmaceutical industry experts were also invited, in order to share experiences from the extensive use of toxicokinetics in drug development. Given that increased generation of toxicokinetic data could potentially result in an increased number of animals undergoing testing, technologies and strategies to reduce and refine animal use for this purpose were also considered. This paper outlines and expands upon the key themes that emerged from the workshop.     

Effects of repeated maternal oral exposure to low levels of trichlorfon on development and cytogenetic toxicity in 3-day mouse embryos

Trichlorfon is a widely used broad-spectrum agricultural insecticide. Few studies have evaluated the effects of trichlorfon on developing fetuses, especially at early stages of development after low-level maternal exposures. In this study, we evaluated the direct effects of trichlorfon on preimplantation mouse embryos after 30 days of maternal exposure (2, 10 and 50 mg/kg/day) via drinking water.On gestation day 3 (dg3), blastocysts were collected and evaluated for changes in gross morphology; cell number; the presence of interphase, metaphase, micronuclei (MN) cells and fragmented and pycnotic nuclei. Embryos in the 50 mg/kg/day group had a significantly reduced mean cell number per embryo. Furthermore, there was a significant increase in the frequency of pycnotic nuclei and an absence of metaphase cells in the 50 mg/kg/day treated group. None of the developmental endpoints evaluated were observed in the 2 and 10 mg/kg/day trichlorfon-treated groups. A simultaneous decrease in the cell number and an increase in the frequencies of absent metaphases and pycnotic nuclei indicate that embryonic developmental deficits observed in the 50 mg/kg/day exposure group were associated with cytotoxicity.     

上海市浦东新区吸毒人群HIV检测需求及其影响因素

目的对吸毒人群HIV检测的意愿进行调查,分析HIV检测的促进和阻碍因素,为今后该人群的HIV检测,干预策略的制定、落实提供参考依据。方法对浦东新区中致社管理的吸毒人员进行HIV检测和问卷调查。结果共调查吸毒人员429人,其中男性333人,女性96人;年龄分布18～64岁;有过静脉注射吸毒史人的占64.37%,而第1次静脉吸毒年龄最小的15岁,最大的52岁;在参与HIV检测的促进因素中社会工作宣传、动员起绝对主导作用,达到48.25%,共用注射器的为33.10%,担心HIV感染的为29.14%,因输血来进行HIV裣测的占20.29%,由同伴介绍和家庭鼓励支持来检测的分别占6.29%和4.43%;参与HIV检测的阻碍因素中不敢面对结果的为33.10%,担心被家庭抛弃占的25.87%,没有钱治疗的占20.05%,怕被同事歧视、不知道在什么地方检测的分别为16.32%、15.38%,担心单位开除的占6.29%,社会工作宣传、动员不到位的占4.66%,检测单位离住地太远只占3.26%。检测的429人中HIV阳性2例,阳性率为0.47%;HCV阳性130人,阳性率为30.3%。吸毒人员对自己目前的生存状态感到好和一般的分别占22.42和50.47%。结论浦东新区中致社的禁毒社会工作在促进吸毒人员进行HIV检测中作用显著;未来在吸毒人员中积极开展心理疏导,提高他们对HIV感染的预防和治疗的认识水平,勇敢面对现实,减少相关歧视,对推进在吸毒人群深入开展HIV检测具有重要意义。     

一起小学诺如病毒胃肠炎暴发流行调查

目的 调查上海市浦东新区某小学多名学生出现急性胃肠炎症状事件的影响因素,为今后的防控提供参考。方法 制订病例定义开展病例搜索,进行现场流行病学调查,采用病例对照研究对学校食堂和饮用水进行卫生学调查;现场采集病例、食堂从业人员、环节等标本进行检测分析。结果 该校学生875名,共发生急性胃肠炎90例,罹患率为10.29%,主要症状以恶心、呕吐、腹痛为主;男性罹患率为10.78%,女性为9.70%,不同性别罹患率差异无统计学意义（P>0.05）;不同班级罹患率分别为74.19%、36.11%、67.65%、48.28%、3.03%和47.06%,组间比较差异有统计学意义（P<0.001）;病例对照结果显示5月3日午餐中的红烧肉圆、白菜油方、菜瓜肉片和榨菜肉丝汤为危险因素;5份病例和1份食堂从业人员肛拭子检出诺如病毒核酸阳性。结论 结合现场调查和病例对照研究结果,判定本次事件是一起由诺如病毒引起的感染性胃肠炎暴发事件,病原体通过食物传播。建议学校加强食品安全管理,杜绝食源性胃肠炎的发生。