2008～2012年揭东县法定传染病疫情分析

目的：了解揭东县法定传染病疫情变化情况,为制定传染病预防控制策略提供科学依据。方法对揭东县2008～2012年法定传染病疫情资料进行描述性流行病学分析。结果揭东县2018～2012年共报告法定传染病23种14522例,年平均发病率为225.88/10万,发病前3位的依次为肺结核5571例（占38.36%）,乙型肝炎3861例（占26.59%）,手足口病1919例（占13.21%）。结论肺结核、病毒性肝炎仍是揭东县最常见传染病,梅毒、淋病、手足口病、感染性腹泻的发病率呈上升趋势,需要进一步加强监测和预防控制。     

The Global Activity Limitation Index mainly measured functional disability,whereas self-rated health measured physical morbidity

ObjectivesAs the Global Activity Limitation Index (GALI) has only recently been created and it is not yet known whether it adds any additional information to self-rated health (SRH), two hypotheses were tested: (1) GALI is primarily correlated with functional disability and secondarily with morbidity and (2) SRH is primarily correlated with morbidity and secondarily with functional disability.MethodsThe data source used was a subsample of the 2006 Spanish National Health Survey comprising people aged more than 64 years (N = 7,835). Age, sex, social class, physical and mental morbidities, and functional disability were selected as predictors in multinomial logistic regression models, in which GALI and SRH were the outcome variables. Fractional polynomials were used to handle the continuous predictors.ResultsThe results supported, generally, both hypotheses: functional disability was the main correlate of GALI and physical morbidity, rather than mental morbidity, was the main correlate of SRH. Furthermore, mental morbidity was as strong a correlate of GALI as SRH, but physical morbidity was notably less strong a correlate for GALI than for SRH.ConclusionIn older people, GALI mainly measured functional disability, whereas SRH mainly measured physical morbidity.     

Effects of supplemental measles immunization on cases of measles admitted at the Wesley guild hospital,Ilesa, Nigeria

Background

Measles is a highly contagious vaccine-preventable infection which continues to be a significant cause of childhood morbidity and mortality in developing countries particularly those with poor routine immunisation coverage. Supplemental immunisation activities (SIAs) were thus introduced to improve vaccine coverage.

Objective

This study was carried out to assess the impact of the supplemental measles vaccinations on the cases of measles admitted at a tertiary health facility in South west Nigeria.

Methods

Weretrospectivelylooked at therecords of cases of measles in children admitted to the Wesley Guild Hospital, Ilesa over a ten year period (2001 – 2010); five years before and five years after the nationwide commencement of supplemental measles immunisation activities (SIAs) in the region in 2006. Measles cases were defined using the WHO case definition.

Results

Over the ten year study period, a total of 12,139 children were admitted andmanaged; out of which 302 (2.5%) were cases of complicated measles. There was no difference in the mean (SD) of children admitted in the years before and after the introduction of the SIAs {6040 (122.7) vs.6099 (120.2); t-test 0.02, p =0.988.} There was however a remarkable reduction in the proportion of the cases of measles admitted after the introduction of SIAs compared to the period before SIAs (4.3% vs. 0.6% x2=169.580; p < 0.001)

Conclusion

SIAs have remarkably reduced morbidity and mortality associated with measles in the region. We advocate for sustenance of these efforts as well as improvement in routine immunisation coverage to avoid a backlash which can lead to devastating measles outbreak.     

The effect of day care attendance on infant and toddler’s growth

Aim: We aimed to study the association between day care attendance and changes in the height, weight and weight/height ratio over a 6‐month period. Methods: Data were retrieved from three maternal and child health care centres. Parents were asked to fill a short questionnaire regarding the infant/toddler life style, the day care facilities and the family demographic information. Results: One hundred and seventy infants participated in the study. The research group consisted of 85 infants that had placed in day care centre prior to the age of 18 months. The control group consisted of 85 infants who had placed in day care at a later age. The research group had significantly shorter stature 3 months after day care enrolment (mean height percentiles of 56.9 versus 66.3, respectively, p = 0.024,). This trend was more pronounced after 6 months (mean height percentiles of 52.3 versus 63.7, p = 0.022). We could not, however, demonstrate a concomitant significant deceleration in weight or weight/height percentiles. Conclusions: The explanation for this rather dramatic finding remains speculative. Possible mechanisms are stress‐related growth hormone suppression. Our findings reinforce the importance of monitoring infant/toddler weight and height growth velocities, especially when he/she is introduced to day care.     

Colorectal surgery in octogenarian patients—outcomes and predictors of morbidity

Introduction  Surgery for elderly patients pose a constant challenge. This study aims to review the outcome and find predictors of adverse outcome in octogenarians undergoing major colorectal resection for cancer. Methods  A review of 121 octogenarians who underwent colorectal cancer surgery between September 1992 and May 2008 was performed. Comorbidities were quantified using the weighted Charlson Comorbidity Index and ASA classification. CR-POSSUM scores and ACPGBI scores and the predicted mortality rates were calculated. Outcome measures were morbidity rates and 30-day mortality rates. Results  The patients had a mean age of 83.5 years (range, 80–99). The mean index of comorbidity was 3.1 (2–7) and 12.5% of patients were classified ASA III and above. The mean predicted mortality rate based on CR-POSSUM and ACPGBI scoring models were 11.2% and 5.4% respectively. The overall observed morbidity rate was 30.7% and 30-day mortality was 1.6. Factors found on bivariate analysis to be significantly associated with an increased risk of morbidity were tumor presenting with complication, comorbid coronary heart disease, serum urea levels, ASA classification ≥3 and comorbidity index 3 of 5 ≥ 5. Multivariate analysis revealed the latter two factors to be independent predictors of morbidity. Conclusion  Octogenarians undergoing major colorectal resection have an acceptable perioperative morbidity and mortality rate and survival rate and should not be denied surgery based on age alone. Comorbidity index scores and ASA scores are useful tools to identify poor risk patients.     

Morbidity and Mortality Conference: Its Purpose Reclaimed and Grounded in Theory

Issue: The morbidity and mortality conference (MMC) remains a central activity within the departments of our academic healthcare institutions. It is deeply rooted in the premise that we can learn from our mistakes, thereby improving the care we provide. Recent advances in our understanding of medical error and quality improvement have challenged the value of traditional models of MMC. As a result the purpose of MMC has become clouded and ill-defined: Is it an educational conference that promotes mastery of clinical acumen, or is it a venue to drive quality improvement by addressing systems-based issues in delivering care? Or can it serve both purposes? Evidence: Review of the history of MMC, the literature, and critical application of education theory demonstrates the source of the confusion and the challenges in viewing it through the exclusive lens of either education or quality improvement. Application of experiential learning theory helps resolve this discord showing how the conference facilitates the development of clinical mastery while informing quality improvement programs about important and relevant systems-based issues. Implication: Building on this, we present a model for MMC involving five essential elements: case-based involving an adverse patient event, anonymity for participants, expert guided critical analysis, reframing understanding of the case presentation and related systems-based factors, and projection to practice change. This model builds on previously described models, is grounded in the literature, and helps clarify its role from both the educational and the quality improvement perspectives.     

Morbidity and Mortality in Jeju Residents over 50-Years of Age with Hip Fracture with Mean 6-Year Follow-Up: A Prospective Cohort Study

This prospective cohort study was performed to estimate the morbidity and mortality with 790 patients over 50-yr of age that sustained a femoral neck or intertrochanteric fracture from 2002 to 2006, followed-up for a mean of 6 yr (range, 4 to 9 yr). Crude and annual standardized mortality ratios (SMRs) were calculated; and mortalities in the cohort and the age and sex matched general population were compared. The risk factors on mortality and activities pre- and post-injury were assessed. Accumulated mortality was 16.7% (132 patients) at 1 yr, 45.8% (337 patients) at 5 yr, and 60% (372 patients) at 8 yr. SMR at 5 yr post-injury was 1.3 times that of the general population. Multivariate analysis demonstrated that age (OR, 1.074; 95% CI, 1.050-1.097; P<0.001), woman (OR, 1.893; 95% CI, 1.207-2.968; P=0.005), and medical comorbidity (OR, 1.334; 95% CI, 1.167-1.524 P<0.001) were independently associated with mortality after hip fracture. Only 59 of the 150 patients (39.3%) who were able to ambulate normally outdoors at preinjury retained this ability at final follow-up. Patients with a hip fracture exhibits higher mortality at up to 5 yr than general population. Age and a preinjury comorbidity are associated with mortality.     

Selective resection of colorectal liver metastases.

AIMS: Safety of liver surgery for colorectal cancer liver metastases after neoadjuvant chemotherapy has to be re-evaluated. PATIENTS AND METHODS: Two hundred Patients were prospectively analyzed after surgery for colorectal cancer liver metastases between 2001 and 2004 at our institution. Special emphasis was given to perioperative morbidity and mortality under modern perioperative care. RESULTS: There was no in-hospital mortality and the perioperative morbidity was 10% (20/200). Four patients had to be reoperated due to bile leak or intraabdominal abscess. The remainder either had infectious complications or pleural effusion and/or ascites requiring tapping. Variables strongly associated with decreased survival were T, N, G and UICC (International Union against cancer) classification of the primary, hepatic lesions>5 cm and elevated tumour markers. Short disease free interval and neoadjuvant chemotherapy without response predicted impaired recurrence free survival (RFS). Multivariate analysis revealed lymph node status and differentiation of the primary, presence of extrahepatic tumour and gender as factors associated with decreased survival. Administration of neoadjuvant chemotherapy was not associated with higher postoperative morbidity or prolonged hospital stay. CONCLUSIONS: Modern dissection techniques and improved perioperative care contributed to a very low rate of surgery-related morbidity (10%) and a zero percent mortality which was also observed in patients pretreated with neoadjuvant chemotherapy prior to resection. Liver resection in experienced hands has become a safe part in the potentially curative attempt of treating patients with metastatic colorectal cancer.