湖南省新型冠状病毒肺炎聚集性疫情流行特征分析

目的 分析湖南省195起新型冠状病毒肺炎聚集性疫情的流行病学特征,为新型冠状病毒肺炎聚集性疫情防控提供科学依据。方法 收集2020年1—2月湖南省195起新型冠状病毒肺炎疫情资料,采用描述流行病学方法进行分析。结果 195起新型冠状病毒肺炎聚集性疫情,发病696 例,无死亡病例;报告事件数位居前三的是长沙市(51起)、岳阳市(31起)、邵阳市(22起)。疫情起数、发病数在1月31日均达到高峰。男女性别比1.02∶1;平均年龄44.7岁,其中15岁以下儿童42例(6.3%);无症状感染者55例(8.28%);病例以轻型和普通型为主,占79.5%。仅发生一代病例的事件为28起(14.4%),二代病例的事件154起(79.0%),三代病例的事件10起(5.1%),四代病例的事件3起(1.5%)。一代病例与二代病例代际间隔平均为6.2 d(95%CI:5.1~7.3),中位数5.0 d。家庭暴露聚集性疫情续发率范围0.7%~100%,中位11.8%;医疗机构续发率范围0.9%~20.0%,中位6.9%。127起(65.1%)为湖北输入型疫情。696例聚集性病例中,268例(38.5%)为首代病例,387例(55.6%)为二代病例,32例(4.6%)为三代病例,9例(1.3%)为四代病例。事件暴露方式多种多样,184起有同住暴露,185起有同车暴露,118起有聚会暴露,149起有聚餐暴露,165起有交谈暴露,8起有会议培训暴露。结论 湖南省新型冠状病毒肺炎聚集性疫情主要发生在家庭,应关注重点地区、重点人群、重点场所,落实各项防控措施,有效处置新型冠状病毒肺炎聚集性疫情,防止疫情进一步扩散。     

K-Means Clustering to Elucidate Vulnerable Subpopulations Among Medicare Patients Undergoing Total Joint Arthroplasty

BackgroundThe role of preoperative laboratory values for risk stratification following joint arthroplasty is currently ambiguous. In order to improve upon existing risk stratification within joint arthroplasty, this study sought to define novel phenotypes of total hip or total knee arthroplasty patients based entirely on preoperative laboratory measures. These phenotypes (“clusters”) were compared to elucidate statistically and clinically significant differences in outcomes.MethodsA total of 134,252 patients were gathered from the National Surgical Quality Improvement Program database between 2005 and 2015. “K-means” with 3 clusters was applied using 9 preoperative laboratory values: sodium, blood urea nitrogen (BUN), creatinine, albumin, bilirubin, white blood cell count, hematocrit, platelet count, and international normalized ratio of prothrombin values (INR). Outcome measures included 30-day readmissions, severe adverse events, and discharge to nonhome.ResultsCluster 2 was characterized by elevated preoperative BUN, creatinine, and INR and demonstrated almost twice the rate of adverse events (3.52% vs 2.20% and 2.22%), 30-day readmissions (6.39% vs 3.31% and 3.71%), and discharge to nonhome (47.97% vs 30.50% and 35.85%). Cluster 3 was characterized by a slightly higher risk of discharge to nonhome than cluster 1 and was overwhelmingly female (79.5% female, 35.8% discharge to nonhome). Cluster 1 represents the lowest-risk subgroup, experiencing the lowest rates of readmissions, adverse events, and discharge to nonhome.ConclusionPreoperative laboratory values, namely BUN, creatinine, and INR, are useful in identifying patients at risk of adverse outcomes. This analysis supports the existing surgical literature pushing for preoperative hydration as a targeted intervention to expedite recovery.     

Patterns of intervention utilization among school-aged children on the autism spectrum: Findings from a multi-site research consortium

When designing and interpreting results from clinical trials evaluating treatments for children on the autism spectrum, a complicating factor is that most children receive a range of concurrent treatments. Thus, it is important to better understand the types and hours of interventions that participants typically receive as part of standard of care, as well as to understand the child, family, and geographic factors that are associated with different patterns of service utilization. In this multi-site study, we interviewed 280 caregivers of 6-to-11-year-old school-aged children on the autism spectrum about the types and amounts of interventions their children received in the prior 6 weeks. Reported interventions were coded as “evidence-based practice” or “other interventions,” reflecting the level of empirical support. Results indicated that children received a variety of interventions with varying levels of empirical evidence and a wide range of hours (0–79.3 h/week). Children with higher autism symptom levels, living in particular states, and who identified as non-Hispanic received more evidence-based intervention hours. Higher parental education level related to more hours of other interventions. Children who were younger, had lower cognitive ability, and with higher autism symptom levels received a greater variety of interventions overall. Thus, based on our findings, it would seem prudent when designing clinical trials to take into consideration a variety of factors including autism symptom levels, age, cognitive ability, ethnicity, parent education and geographic location. Future research should continue to investigate the ethnic, racial, and socioeconomic influences on school-aged intervention services.     

一种度量细胞网络结构的方法

文题释义： 复杂网络：是指具有自组织、自相似、小世界、无标度中部分或全部特征的网络。小世界效应和无标度特性是复杂网络最显著的特点。小世界是指网络具有大的簇系数和较小的平均路径长度，无标度是指网络节点的连接度分布服从幂律分布。 细胞网络：在多细胞生物体中，单个细胞除了完成自身功能外，各个细胞间的通讯联络是必不可少的，如维持生物体的生长发育、各种生理活动的协调等。如果将每个细胞抽象为一个节点，每两个细胞间的通讯抽象为一条边，那么众多细胞及其之间的通讯将抽象成为一个巨大的细胞网络。 背景：在多细胞组成的生物体社会中，细胞之间的通讯必不可少。众多细胞之间相互通讯、相互联系，形成了一个复杂的细胞网络结构。对细胞网络结构相关属性值进行度量和评价，显得极其重要。 目的：基于复杂网络，提出了一种细胞网络结构的度量方法。 方法：结合文献研究及实际应用，搭建细胞网络结构的度量框架，分别从细胞节点的度、细胞网络的度分布、细胞网络的平均路径长度、细胞网络的簇系数等方面对细胞网络结构进行度量。以某小型实验为例，进行了实例验证。 结果与结论：细胞网络的度分布中，绝大部分细胞节点的度值比较小，只有较少量细胞节点的度值较高。细胞网络中细胞节点的度分布P(k)的幂律分布特点越是明显，则此细胞网络结构越是合理，细胞网络越正常；同时，许多细胞网络结构具有较小的平均路径长度。细胞网络的簇系数越大，表明该细胞网络具有较高的聚集特性。一般情况下，细胞网络结构越“紧密”，细胞网络结构的“集团化”特性越明显，细胞网络越正常。 ORCID: 0000-0002-2483-032X(张雨) 中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程     

基于EHR对骨质疏松分级诊疗管理模式的探索与实践

目的探讨EHR对骨质疏松分级诊疗管理模式的临床效果。方法以上海市某社区慢性病管理团队为例,依托瑞金-卢湾医联体"全-专门诊"进行分级诊疗,介绍该区域医联体内专科与全科医生团队如何开展区域医联体特色的家庭医生"1+1+1"签约服务,建立个人EHR,通过调阅区、市两级EHR查阅患者区域内就诊信息,对签约骨质疏松患者进行管理,分析管理效果。结果研究对象疼痛症状、身体机能、社会适应能力和精神心理功能较一年前得分均有下降(P0.05);骨代谢指标β-CTX、PICP、PTH和BGP明显下降(P0.05),维生素D升高(P0.001);L1～3、股骨颈、wards三角、大粗隆和total髋的骨密度有提高(P0.05)。结论 EHR对骨质疏松分级诊疗、实施区域医联体特色的签约服务和建立个人EHR等方案可改善骨质疏松患者生活质量,值得推广。     

Association Between Parental Marital Status and Types of Suicidal Behavior Among Korean Adolescents: A Cross-sectional Study

ObjectivesAdolescent suicide is a global problem. This study aimed to identify associations between parental marital status and suicidal behavior.MethodsThis study analyzed 118 715 middle and high school students from the 13th and 14th Korea Youth Risk Behavior Web-based Survey. The odds ratios (ORs) of suicidal ideation, planning, and attempts were calculated based on parental marital status, living situation, and socioeconomic factors. The data were analyzed using multiple logistic regression.ResultsWhen compared to those living with 2 married biological parents, the ORs of suicidal ideation among adolescents living with either remarried or no parents were 1.34 (95% confidence interval [CI], 1.17 to 1.53) and 1.36 (95% CI, 1.11 to 1.66), respectively. For suicidal planning, the OR of those living with 1 remarried biological parent was 1.24 (95% CI, 1.01 to 1.52), and that of those living without parents was 1.28 (95% CI, 0.95 to 1.73), when compared to adolescents living with 2 married biological parents. For suicide attempts, when compared to adolescents with 2 married biological parents, the OR of those living with 1 remarried biological parent was 1.48 (95% CI, 1.17 to 1.87) and that of those living without parents was 2.02 (95% CI, 1.44 to 2.83). For adolescents living with 1 remarried biological parent, suicidal behavior was strongly associated with having no siblings and were weakly associated with not living with grandparents.ConclusionsSuicidal behavior among adolescents was associated with the remarriage and loss of parents. Therefore, special attention and interventions are needed for adolescents in those situations.     

济南市2014—2018年猩红热流行特征及时空聚集性分析

目的 研究济南市猩红热的流行特征,并对时空聚集性进行分析,为猩红热的防控工作提供依据。方法 从国家疾病监测信息报告管理系统中获取济南市2014—2018年猩红热疫情资料,采用描述性流行病学方法及时空重排扫描统计方法分析猩红热病例的流行病学和时空分布特征。结果 2014—2018年济南市累计报告猩红热7 297例,年均发病率20.46/10万。全年出现冬季和春季2个发病高峰。病例主要集中在1~9岁儿童,幼托儿童、学生及散居儿童发病数占总病例数的99.70%,男女性别比1.70∶1。市中区、历城区、槐荫区、天桥区、历下区是主要高发地区,占病例总数的83.50%。按年进行时空聚集性分析,每年均探测到3个时空聚集区,具有显著时空聚集性。结论 2014—2018年济南市猩红热处于上升趋势,学校和托幼机构是发病的高危场所,应根据时空分布及流行特征,制定相应的防控措施,控制猩红热的发生和扩散。     

中国精神分裂症患者不同家庭干预措施效果比较的meta分析

目的对中国精神分裂症患者采取家庭干预的研究文献进行综合回顾和系统评价, 比较不同条件下家庭干预效果的差异。方法在中国知网、维普、万方、中国生物医学文献数据库四大中文数据库及OVID Medline、Science Direct、Web of Science、EBSCO四大英文数据库中, 检索各数据库建库至2015年1月为止使用社会功能缺陷筛选量表(SDSS)、简明精神病(科)量表(BPRS)、阳性与阴性症状量表(PANSS)研究中国精神分裂症患者家庭干预效果的文献, 以标准化加权均数差( SMD)作为效应量, 采用meta分析比较不同干预时间、不同干预类型、对不同病程和不同严重程度的精神分裂症患者的家庭干预效果差异。 结果共纳入57篇符合标准的文献。SDSS、PANSS分析结果显示:① 干预时间越长干预效果越好( P < 0.0001、 P=0.0025);② 单独家庭干预比多个家庭合并单独家庭干预的效果更明显( P < 0.0001、 P=0.0131);③ 干预对于病情较重患者效果较好( P < 0.0001、 P=0.0280)。SDSS量表还显示家庭干预对于病程短的患者效果更好( P < 0.0001)。 结论家庭干预更适合病程较短的精神分裂症患者, 干预应实施较长时间; 单独家庭干预更有利于患者阴性症状的改善和社会功能的康复, 且对于病情较轻患者的阴性症状改善效果更好。     

Integrating family planning and HIV services in western Kenya: the impact on HIV-infected patients’ knowledge of family planning and male attitudes toward family planning

Little information exists on the impact of integrating family planning (FP) services into HIV care and treatment on patients’ familiarity with and attitudes toward FP. We conducted a cluster-randomized trial in 18 public HIV clinics with 12 randomized to integrated FP and HIV services and 6 to the standard referral-based system where patients are referred to an FP clinic. Serial cross-sectional surveys were done before (n = 488 women, 486 men) and after (n = 479 women, 481 men) the intervention to compare changes in familiarity with FP methods and attitudes toward FP between integrated and nonintegrated (NI) sites. We created an FP familiarity score based on the number of more effective FP methods patients could identify (score range: 0–6). Generalized estimating equations were used to control for clustering within sites. An increase in mean familiarity score between baseline (mean = 5.16) and post-intervention (mean = 5.46) occurred with an overall mean change of 0.26 (95% confidence intervals [CI] = 0.09, 0.45; p = 0.003) across all sites. At end line, there was no difference in increase of mean FP familiarity scores at intervention versus control sites (mean = 5.41 vs. 5.49, p = 0.94). We observed a relative decrease in the proportion of males agreeing that FP was “women’s business” at integrated sites (baseline 42% to end line 30%; reduction of 12%) compared to males at NI sites (baseline 35% to end line 42%; increase of 7%; adjusted odds ration [aOR] = 0.43; 95% CI = 0.22, 0.85). Following FP–HIV integration, familiarity with FP methods increased but did not differ by study arm. Integration was associated with a decrease in negative attitudes toward FP among men.