2名健康儿童检出脊髓灰质炎疫苗衍生病毒的调查

[目的]评价上海市徐汇区2名健康儿童检出脊髓灰质炎疫苗衍生病毒（VDPV）的调查处置措施。[方法]分别对2名病毒携带者进行个案调查、粪便消毒处置、测定免疫功能,采集粪便标本分离病毒。对密切接触者和周围健康儿童粪便标本进行带毒调查、儿童脊髓灰质炎减毒活疫苗（OPV）接种率调查、OPV查漏补种及医疗机构急性弛缓性麻痹（AFP）病例主动搜索。[结果]2名健康儿童分别检出Ⅲ型VDPV和脊灰疫苗高变异株病毒。当地儿童OPV免疫接种率较高,粪便标本均未检出阳性病毒。未发现VDPV病例。[结论]VDPV未在当地造成循环。     

The emergency department “carousel”: An ethnographically-derived model of the dynamics of patient flow

Emergency department (ED) overcrowding reduces efficiency and increases the risk of medical error leading to adverse events. Technical solutions and models have done little to redress this. A full year’s worth of ethnographic observations of patient flow were undertaken, which involved making hand-written field-notes of the communication and activities of emergency clinicians (doctors and nurses), in two EDs in Sydney, Australia. Observations were complemented by semi-structured interviews. We applied thematic analysis to account for the verbal communication and activity of emergency clinicians in moving patients through the ED. The theoretical model that emerged from the data analysis is the ED “carousel”. Emergency clinicians co-construct a moving carousel which we conceptualise visually, and which accounts for the collective agency of ED staff, identified in the findings. The carousel model uniquely integrates diagnosis, treatment and transfer of individual patients with the intellectual labour of leading and coordinating the department. The latter involves managing staff skill mix and the allocation of patients to particular ED sub-departments. The model extends traditional patient flow representations and underlines the importance of valuing ethnographic methods in health services research, in order to foster organisational learning, and generate creative practical and policy alternatives that may, for example, reduce or ameliorate access block and ED overcrowding.     

Ebola and Marburg haemorrhagic fever

Ebolaviruses and Marburgviruses (family Filoviridae) are among the most virulent pathogens for humans and great apes causing severe haemorrhagic fever and death within a matter of days. This group of viruses is characterized by a linear, non-segmented, single-stranded RNA genome of negative polarity. The overall burden of filovirus infections is minimal and negligible compared to the devastation caused by malnutrition and other infectious diseases prevalent in Africa such as malaria, dengue or tuberculosis. In this paper, we review the knowledge gained on the eco/epidemiology, the pathogenesis and the disease control measures for Marburg and Ebola viruses developed over the last 15 years. The overall progress is promising given the little attention that these pathogen have achieved in the past; however, more is to come over the next decade given the more recent interest in these pathogens as potential public and animal health concerns. Licensing of therapeutic and prophylactic options may be achievable over the next 5–10 years.     

上海市乙肝病毒感染家庭聚集性及感染模式研究

目的了解上海市乙肝病毒感染的家庭聚集性状况及其感染模式,为完善乙肝防治策略提供依据。方法 2010年抽取上海市6个区的乙肝病人337例和乙肝表面抗原阳性者292例,对其全部家庭成员进行调查,并采集静脉血5 ml检测乙肝血清学指标。结果 1 567名调查对象乙肝总感染率为77.28%,629户家庭共有15种乙型肝炎病毒（hepatitis B virus,HBV）感染模式,其中以乙肝表面抗体（hepatitis B surface antibody,anti-HBs）和乙肝核心抗体（hepatitis B core antibody,anti-HBc）二项阳性,乙肝表面抗原（hepatitis B surface antigen,HBsAg）、乙肝e抗体（hepatitis Be antibody,HBeAb）、anti-HBc三项阳性和anti-HBs、HBeAb、anti-HBc三项阳性等模式为主,构成比分别为30.64%、26.67%和10.24%。20岁以下年龄组HBV感染率（27.40%）低于其他年龄组（P<0.001）;男性家庭成员HBV感染率（78.51%）稍高于女性...     

上海部分初中生家长对干预子女肥胖相关行为的意愿和影响因素分析

[目的]了解初中学生家长对干预子女肥胖相关行为的意愿,并通过对家长意愿的影响因素分析,为随后开展的学生肥胖相关行为干预提供依据。[方法]从上海市的徐汇区和长宁区的初中学校中各随机抽取2所,对其中的初中预备班和初一的所有学生家长和学生进行问卷调查。经逻辑纠错后分析有效问卷,对数据进行卡方检验、相关分析和逐步Logistic多因素分析。[结果]90％学生家长认为自己的孩子存在与肥胖相关的不良行为;有77．2％的家长希望在未来的6个月中孩子能够改变这些与肥胖相关的行为。家长的知识得分,家长在调查前1周内是否陪伴孩子锻炼、是否给孩子买零食与改变孩子的行为意愿有关。家长的意愿与孩子的意愿不一致。[结论]对干中学生行为的干预不能仅仅局限于家庭的范围,而应该扩展到学校、社区和社会。增加家长的知识和促进家长采取积极的行动,可以帮助学生减少与肥胖相关的行为。     

1995～2004年上海市徐汇区居民恶性肿瘤减寿分析

[目的]研究恶性肿瘤对居民寿命的影响。[方法]用2000年的世界人口作为标准人口，对1995～2004年徐汇区居民恶性肿瘤死亡资料进行分析，估计恶性肿瘤年龄别寿命损失，对10年去恶性肿瘤死因期望寿命的时间趋势拟合回归直线，计算恶性肿瘤潜在减寿年数（YPLL）、标准化潜在减寿率（SYPLL‰）和平均减寿年数（AYLL）。[结果]徐汇区居民男性恶性肿瘤死亡率高于女性，标化性别比为l，64：l；死亡率居前的是肺癌、胃癌、肠癌、肝癌和女性乳腺癌；10年居民期望寿命均存在直线上升趋势（P〈0．001），恶性肿瘤年龄别寿命减少率40岁以后上升较快，75岁之后趋于平稳；YPLL最高的男女均为肺癌，AYLL第1位是白血病。[结论]徐汇区恶性肿瘤死亡率最高的为肺癌，主要影响人群为中老年人；平均减寿年数最多的是白血病，主要影响人群是青壮年；对中老年人应主要关注肺癌，青壮年主要关注白血病、鼻咽癌、女性乳腺癌及男性肝癌。     

Descriptive epidemiology of varicella based on national surveillance data before and after the introduction of routine varicella vaccination with two doses in Japan, 2000–2017

Routine childhood immunization using two doses of the varicella vaccine was introduced in Japan in October 2014. In this study, we analyzed the data extracted from national varicella surveillance, including pediatric sentinel surveillance from 2000 to 2017 and hospitalized varicella surveillance from the 38th week of 2014 to the 37th week of 2017. Compared with the 2000–2011 baseline data, the number of varicella cases per sentinel decreased substantially by 76.6% overall and by 88.2% among children aged 1–4 years in 2017. Of 997 hospitalized patients, we found a decreasing trend in the number of cases among children aged <5 years. We also found a decreasing trend in the number of cases with complications among children aged 1–4 years. Data on the self-reported transmission sites in 35.5% (354/997) of the hospitalized varicella patients showed that transmission of varicella zoster virus (VZV) occurred frequently in household, at school for young children, in the workplace for adults, and at hospital for all age groups. Data from 29.0% (289/997) of the hospitalized patients with a self-reported source of infection showed that transmission of VZV occurred from a patient with herpes zoster (HZ) in 30.4% (88/289) of cases. Our data demonstrate a substantial decrease in the number of varicella cases in young children following introduction of routine childhood vaccination program with two-dose varicella vaccination in Japan. These data highlight the unique aspects of transmission sites across age groups and the important role of HZ cases in disease circulation.     

2007年上海市徐汇区性病门诊就诊者艾滋病/性传播疾病综合监测分析

目的　了解性病门诊就诊者艾滋病/性传播疾病态度行为情况及感染状况，为制定防制策略提供科学依据。方法　对性病门诊就诊者进行问卷调查，同时采血做艾滋病病毒（HIV）抗体检测及梅毒血清学检测。结果　共监测性病门诊就诊者283人，以已婚中青年为主；艾滋病相关知识的知晓率为67.5%；70.3%的监测对象认为自己不会感染艾滋病；29.3%的监测对象最近3个月内有商业性行为，其中从未使用安全套占50.3%，最近一次商业性行为没用安全套的占67.5%；HIV抗体阳性2例，检出率0.7%；梅毒RPR检测阳性47例，检出率17.2%；临床诊断居前3位的是梅毒、尖锐湿疣、淋病。结论 　性病门诊就诊者是艾滋病的高危人群，要加强性病门诊规范化诊治，开展有针对性的行为干预和长期动态的监测。     

基于系统动力学的2型糖尿病管理模型构建与初步仿真

目的 探索系统动力学模型用于评价2型糖尿病健康管理的可行性,构建适用于本地人口的模型。 方法 以2型糖尿病人口动力为研究对象,参考美国疾病预防控制中心相似模型,通过确定边界、绘制流图,编写方程式,构建系统动力学模型,根据徐汇区的情况调整了亚裔人糖尿病的风险比、人口数、患病数、诊断率、管理率等参数后进行模型初始仿真。 结果 构建了适用于本地人口的2型糖尿病管理系统模型,初始仿真结果显示,从2010－2020年,徐汇区2型糖尿病患病率将从6.6%上升到11.6%,上升趋势未放缓,同期因病死亡率则从32/10万上升到70/10万,上升趋势有所放缓。 结论 系统动力学模型能对2型糖尿病的患病率和因病死亡率等指标进行有条件预测,为评价和调整健康管理机制提供了一种新视角、新方法。     

1990-2019年中国慢性阻塞性肺疾病的疾病负担情况分析

目的 探讨1990-2019年中国慢性阻塞性肺疾病（COPD）疾病负担及其危险因素的变化趋势。方法 基于2019年全球疾病负担中国研究数据,利用伤残调整寿命年（DALY）、伤残损失寿命年（YLD）、早死损失寿命年（YLL）和患病水平等指标对不同性别和年龄人群1990-2019年的疾病负担变化趋势进行描述,并结合人群归因分值（PAF）分析COPD危险因素的变化情况。结果 2019年我国年龄COPD标化DALY率、标化YLL率、标化YLD率分别为1 102.77人年/10万、862.37人年/10万和240.40人年/10万,标化患病率为2 404.41/10万。男性标化DALY率和标化YLL率高于女性,女性标化YLD率和标化患病率高于男性。COPD排名前5位的危险因素为吸烟、颗粒物污染、职业粉尘和有害气体、低温和二手烟。吸烟在1994年超越颗粒物污染,成为造成COPD疾病负担的首位因素,此后各危险因素的次序未发生变化。环境颗粒物污染的PAF年均上升1.78%,从1990年的15.22%上升至25.37%;固体燃料致室内空气污染年均下降5.59%,从1990年的40.30%下降至7.59%。结论 1990-2019年,COPD对我国人群造成的人均健康损失总体呈下降趋势,但老龄化使人群的COPD疾病负担仍处于较高水平。COPD相关危险因素的PAF发生了变化,环境因素的重要性相对下降,吸烟等相关危险行为的地位日益突出。COPD防治重点可侧重于高危人群（≥40岁、吸烟、空气污染重、有职业暴露）筛查、戒烟教育以及环境治理。