Spatiotemporal Variations in Chronic Obstructive Pulmonary Disease Mortality in China: Multilevel Evidence from 2006 to 2012

Mortality of Chronic Obstructive Pulmonary Disease (COPD) is on the decline in China. It is not known if this trend occurs across all areas or whether spatiotemporal variations manifest. We used data from the nationally representative China Mortality Surveillance System to calculate annual COPD mortality counts (2006–2012) stratified by 5-year age groups (aged > 20), gender and time for 161 counties and districts (Disease Surveillance Points, or DSP). These counts were linked to annually adjusted denominator populations. Multilevel negative binomial regression with random intercepts and slopes were used to investigate spatiotemporal variation in COPD mortality adjusting for age, gender and area-level risk factors. COPD mortality rate decreased markedly from 105.1 to 73.7 per 100,000 during 2006 to 2012 and varied over two-fold between DSPs across China. Mortality rates were higher in the west compared with the east (Rate ratio (RR) 2.15, 95% confidence intervals (CI) 1.73, 2.68) and in rural compared with the urban (RR 1.87, 95% CI 1.55, 2.25). Adjustment for age, gender, urban/rural, region, smoking prevalence, indoor air pollution, mean body mass index and socioeconomic circumstances accounted for 67% of the geographical variation. Urban/rural differences in COPD mortality narrowed over time, but the magnitude of the east-west inequality persisted without change. Immediate action via large-scale interventions to enhance the prevention and management of COPD are needed specifically within China's western region in order to tackle this crucial health inequality and leading preventable cause of death.     

基于VPDN和CDMA1X技术的移动采血数据传输

VPDN是利用公共网络的拨号及接入网实现的虚拟专用网,为移动办公人员提供接入服务.通过采用CDMA1X技术,在移动采血车上配置PC和无线上网卡,同时利用现有的卫生网络资源,为中心血站的移动采血办公人员提供接入服务,实时将移动采血车上的采血数据传输到采供血信息系统中.实践证明,采用该技术可以为中心血站的移动采供血网上办公提供不间断的、可靠的数据传输及应用服务.     

青岛市临床医生吸烟状况及控烟诊疗活动调查分析

目的了解青岛市临床医生吸烟状况、将控烟纳入诊疗工作的情况等,为今后控烟工作提供参考。方法采用多阶段随机抽样的方法,在青岛市12个区市中抽取5所三级医院、10所二级医院、9所社区卫生服务中心共24家医院的临床医生进行问卷调查。结果青岛市临床医生现在吸烟率为19.3％,男性医生现在吸烟率为33.9％;15.9％和53.6％的医生经常和有时在上班时吸烟,其中27.3％的医生曾经在病人面前吸烟,48.4％的医生在办公室里吸烟;42.1％的医生在看病时主动询问过病人的吸烟情况,硕士及以上文化程度（59.0％）和内科医生（49.2％）主动询问的比例高;在过去一年中,仅25.1％的医生接受过有关戒烟方法的培训;影响医生控烟问诊的多因素Logistic回归分析发现：上班时是否吸烟是影响医生主动询问病人吸烟情况的最强因子（OR=2.141）。结论应尽快完善医院禁烟立法,开展无烟医院创建,制定措施将控烟纳入到诊疗活动中,同时加强不同文化层次、不同专业科室医生控烟培训。     

2012-2018年青岛市A型(H1N1)pdm09流感病毒奥司他韦耐药株基因特征

目的 了解2012-2018年青岛市人群A型(H1N1)pdm09流感病毒奥司他韦耐药株基因特征。方法 收集2012年4月-2018年3月间青岛市A(H1N1)pdm09毒株397份,逆转录聚合酶链反应(RT-PCR)扩增神经氨酸酶(Neuraminidase,NA)和血凝素(Hemagglutinin,HA)基因全长,序列测定后进行耐药位点和氨基酸变异及进化分析。结果 5株发生了H275Y突变,为奥司他韦耐药株;另有4株S247N突变,可能为奥司他韦耐药株。2012-2018年H275Y突变株检出率依次为2.8 %、2.0 %、0.0 %、1.1 %、0.0 %和0.7 %。NA和HA进化树显示,2012-2013年青岛H275Y突变株与美国耐药株A/Tennessee/03/2013更接近,2013-2014年青岛H275Y突变株与国内株和日本札幌耐药株更接近,这两个年度耐药株的毒株起源可能有所不同。突变株在酶活性位点、抗原决定簇、受体结合位点及其他功能位点(如HA位点D222、Q223和NA位点V241I、N369K和N386K)的转变与野生敏感株一致。结论 青岛市A型(H1N1)pdm09流感病毒奥司他韦耐药株明显增加且流行起源不同,但并未取得比野生株更强的流行能力。奥司他韦仍可作为流感预防和治疗的有效手段。     

青岛郊区2000～2005年肾综合征出血热分析

[目的]掌握青岛郊区肾综合征出血热的流行特征,指导防治工作。[方法]对2000～2005年的监测资料进行分析。[结果]2000～2005年,我市郊区肾综合征出血热发病率波动在3.59～12.09/10万之间,平均为7.14/10万,病死率为2.04%。总体上呈明显下降趋势。春夏季高峰为3至7月,5或6月达最高;秋冬季高峰为10至次年1月,11或12月达最高。发病年龄为2～85岁,20～60岁年龄组占78.43%,农民占83.33%,男性为女性的2.53倍。黑线姬鼠、褐家鼠分别是野外和居民区的优势种,直接荧光抗体法检测发现黑线姬鼠、褐家鼠、小家鼠和臭鼩鼱带病毒,野外和居民区带病毒率分别为5.91%和4.15%。[结论]部分地区的肾综合征出血热发病率较高,应采取措施,加强防治。     

Status and progress of hepatitis B control through vaccination in the South-East Asia Region, 1992–2015

In 2016, the Immunization Technical Advisory Group of the South-East Asia Region (SEAR) endorsed a regional goal to achieve ≤1% prevalence of hepatitis B surface antigen (HBsAg) among 5-year-old children by 2020. Chronic hepatitis B virus (HBV) infection is largely preventable with a birth dose of hepatitis B vaccine (HepB-BD) followed by two to three additional doses. We reviewed the progress towards hepatitis B control through vaccination in SEAR during 1992–2015. We summarized hepatitis B vaccination data and reviewed the literature to determine the prevalence of chronic HBV infection pre- and post-vaccine introduction. We used a mathematical model to determine post-vaccine prevalence of HBsAg among 5 year olds in countries lacking national serosurvey data and estimated the impact of vaccination on disease burden. Regional coverage with three doses of hepatitis B vaccine (HepB3) increased from 56% in 2011 to 87% in 2015. By 2016, 7 of 11 countries had introduced universal HepB-BD. Regional HepB-BD coverage increased from 9% in 2011 to 34% in 2015. In 2015, estimated HBsAg among 5 year olds was 1.1% with variability among countries. Myanmar (3.8%), Timor-Leste (2.7%), Indonesia (1.8%), and India (1%) had the highest prevalence of HBsAg. During 1992–2015, vaccination prevented approximately 16 million chronic HBV infections and 2.6 million related deaths. In 2015, around 197,640 perinatal HBV infections occurred in SEAR with majority occurring in India (62%), Bangladesh (24%), and Myanmar (8%). Myanmar had the highest rate of perinatal chronic HBV infections at 16 per 1000 live births. Despite significant progress in the control of HBV, SEAR needs to secure political commitment for elimination and consider additional strategies, such as promoting health facility births, universal birth dose administration, developing strong coordination between health sectors, and using alternative vaccine delivery methods, to improve HepB-BD coverage and subsequently achieve HBV control and elimination.     

粪大肠菌群快检试纸的研制及其效果观察

目的研究污水粪大肠菌群快检试纸,检测其实用效果。方法将乳糖发酵培养基进行改良,制成快检试纸,进行了应用效果检验,并与试管发酵法作平行比较。结果快检试纸接种的10株大肠菌群反应均为阳性,8株非大肠菌群反应均为阴性,快检试纸检测阳性结果与发酵法完全一致。纸片法和发酵法检测出现阳性结果的最高稀释度完全相同,出现的阳性份数基本相近。抗干扰试验证明,变形杆菌和阴沟肠杆菌对纸片法和发酵法均有干扰作用,变形杆菌对纸片法有干扰作用,阴沟杆菌对试管法干扰较明显,其他菌种则均无明显干扰。现场试验显示,纸片法和发酵法共同检出阳性标本98份,阴性标本67份;共有15份标本两种方法检测结果不一致,但这15份标本均证明为粪大肠菌群阳性。结论纸片法检测污水中粪大肠菌群与试管发酵法检测结果符合率为97.2%,纸片法检测污水中粪大肠菌群具有特异性强、敏感性高、使用方便、操作简单的优点,可以用于医院污水和城市污水中粪大肠菌群的检测。     

口腔诊疗器械消毒与灭菌质量调查

为了解青岛市医疗机构口腔诊疗器械污染情况及其消毒与灭菌质量,加强口腔诊疗器械消毒灭菌工作,以提高医源性感染控制水平,采用直接采样检测方法对口腔诊疗器械污染及消毒灭菌情况进行了调查。结果,口腔诊疗器械HBsAg检出阳性率为15.59%,无菌检验合格率为86.24%;牙钻手机HBsAg阳性率为15.9%,灭菌合格率为87.5%;牙钻车针HBsAg阳性率为19%,灭菌合格率为81%。部分个体牙科诊所没有配备压力蒸汽灭菌器,少数诊所不进行消毒。结论,青岛市医疗机构口腔诊疗器械HBsAg污染严重,灭菌合格率比较低,需要加强口腔诊疗器械消毒与灭菌管理。