我国疾病预防控制中心人员编制配置水平的空间分析

目的:本文分析了2004—2019年省级疾病预防控制中心(以下简称疾控中心)编制人员空间分布及变化特征,提出人员优化配置建议。方法:通过GeoDa分析编制人员全局和局域空间差异。结果:我国疾控中心编制人员配置总体上由西向东递减;2019年,23个省疾控中心人员数量不符合编制标准,14个省专业技术人员占比、3个省卫生技术人员占比低于标准;人力资源全局空间聚集水平不断下降,西部高—高聚集、东部低—低聚集,差异有统计学意义;不同时间段人力资源空间格局及其演变趋势受重大事件或政策影响。结论:疾控中心人力资源总体空间分布差距不断缩小,但省级水平分布不均,内部结构有待改善;应兼顾提升编制人员整体数量、改善不同类别编制人员占比,针对性弥补疾控中心的人员缺口。     

Does Infection Initiate Graves Disease?: A Population Based 10 Year Study

In order to detect whether micro-organisms could initiate the autoimmune process in Graves' disease we have studied the temporal and spatial distribution of 857 cases of hyperthyroidism occurring in a community over ten years. Cases were identified through biochemistry laboratory records and following the exclusion of patients with toxic nodular goitre or with insufficient clinical data there were 599 with Graves' disease - an average annual incidence of 15.9 per 100,000. There was a tendency for cases to present in the summer months. The reported onset of symptoms, however, peaked in December and June. There was no evidence of clustering of cases in space and time using two different statistical methods. Incidence rates doubled between 1976 and 1980 and then declined - a trend that could neither be explained by changes in laboratory or clinical diagnosis nor did it correlate with any pattern of microbial disease in the area.

We conclude that it is unlikely that infections that behave in an epidemic manner have a causative role in triggering Graves' disease.     

Diabetic cardiorenal syndrome: insights into its pathogenesis

A subset of diabetic patients develops renal or cardiovascular complications: the cardiorenal syndrome. A constellation of risk factors coexist and appear to interact. Raised arterial pressure, poor metabolic control and dyslipidaemia are already present at the stage of microalbuminuria, which in itself is associated with significant glomerular pathology. Family histories of diabetic nephropathy, hypertension or cardiovascular disease are all significantly related to the development of proteinuria in the diabetic proband. The presence of elevated red cell sodium-lithium countertransport increases the risk of proteinuria by approximately fourfold and is related to reduced insulin sensitivity, a phenomenon that itself is linked to cardiovascular risk in the general population. Susceptibility factors, most probably genetic, which are associated with a familial disposition to cardiovacular disease therefore appear crucial for the development of the cardiorenal syndrome of diabetes.     

Familial aggregation in inflammatory bowel disease：Is it genes or environment？

Inflammatory bowel disease (IBD) develops in genetically susceptible individuals due to the influence of environmental factors, leading to an abnormal recognition of microbiota antigens by the innate immune system which triggers an exaggerated immune response and subsequent bowel tissue damage. IBD has been more frequently found in families, an observation that could be due to either genetic, environmental or both types of factors present in these families. In addition to expanding our knowledge on IBD path...     

Clustering of cardiovascular risk factors in type 2 diabetes mellitus: prognostic significance and tracking

Summary
Aim   Little attention has been paid to the prognostic significance and tracking effect of risk factor clusters characteristic of type 2 diabetes mellitus. We studied the clustering of eight cardiovascular risk factors (smoking, high body mass index, elevated systolic blood pressure, high serum, low density lipoprotein (LDL) cholesterol, high serum LDL triglycerides, low serum, high density lipoprotein (HDL) cholesterol, high fasting blood glucose and high plasma insulin concentration) and their effect on the prognosis and the tracking effect.
Methods   This study is a population-based prospective follow-up of newly diagnosed type 2 diabetic subjects (n = 133, aged 45–64 years) in Eastern Finland. The following end points were used: all-cause mortality, cardiovascular mortality, and incidences of first myocardial infarction and first stroke. Furthermore, we studied the 'tracking effect' of the risk factor clusters during the 10-year follow-up period.
Results   When the clustering of risk factors typical of type 2 diabetes mellitus was taken into account, all-cause mortality increased from 28.6% to 50.0% (p < 0.05) and cardiovascular disease mortality increased from 14.3% to 50.0% (p < 0.01) depending on the number of risk factors present. The incidence of first myocardial infarction increased from 0% to 40.0% (p < 0.05) as the number of risk factors increased from 0 to 5. In survivors, the proportion of individuals with no risk factors decreased and the proportion on individuals with three to four risk factors increased during the 10-year follow-up period despite the high mortality among the group with many risk factors.
Conclusions   The risk factor clusters among type 2 diabetic subjects are of great predictive value and when not aggressively treated, show a relentless increase despite selective mortality.     

The role of insulin in clustering of serum lipids and blood pressure in children and adolescents

Summary In adults hyperinsulinaemia is associated with an atherogenic risk profile including obesity, low levels of HDL-cholesterol, high levels of triglycerides and elevated blood pressure. To examine these associations in the young we studied the cross-sectional relationships of insulin with obesity indices (body mass index, subscapular skinfold thickness), serum lipids and blood pressure in 1,865 children, adolescents and young adults aged 6–24 years. We also used longitudinal data to study the value of a single insulin measurement to predict high risk factor levels and clustering of multiple risk factors after a 6-year follow-up. In cross-sectional analyses the levels of triglycerides, HDL-cholesterol, systolic blood pressure and obesity indices were usually significantly different across the quartiles of fasting insulin in both sexes among children, adolescents and young adults. In general, no associations were seen with total cholesterol or LDL-cholesterol. In prospective analysis elevated baseline insulin was related to the incidence of hypertriglyceridaemia (95th percentile) at the follow-up. This relationship persisted even after adjustments for baseline obesity or 6-year change in obesity status. Moreover, baseline insulin concentration was higher in subjects who subsequently showed clustering of high triglycerides, low HDL-cholesterol and high systolic blood pressure levels at the follow-up. We conclude that high fasting insulin levels measured in children and adolescents predict the development of hypertriglyceridaemia years later. In addition, high insulin levels seem to precede the development of a potentially atherogenic risk factor profile including low HDL-cholesterol, high triglycerides and high systolic blood pressure.Abbreviations SBP Systolic blood pressure - DBP diastolic blood pressure - BMI body mass index     

Clustering of albumin excretion rate abnormalities in Caucasian patients with NIDDM

Summary Proteinuria and nephropathy have been found to cluster in families of non-insulin-dependent diabetic (NIDDM) Pima Indian, and in Caucasian insulin-dependent diabetic (IDDM) patients. No information is at present available for Caucasian NIDDM patients. The aim of the present study was to determine whether micro-macroalbuminuria (AER + ) is associated with albumin excretion rate abnormalities in diabetic and non-diabetic siblings of probands with NIDDM and AER + . We identified 169 Caucasian families with one NIDDM proband (the patient with longest known NIDDM duration) (101 families with only NIDDM siblings, 33 families with both NIDDM and non-NIDDM siblings and 35 families with only non-NIDDM siblings). Of the probands 56 had AER + [Prob-NIDDM-(AER + )], 78 had AER– [Prob-NIDDM-(AER–)], 74 siblings of Prob-NIDDM-(AER + ), and 113 siblings of Prob-NIDDM-(AER–) also had NIDDM. Data on albuminuria and retinopathy from multiple sibling pairs when the size of the sibship was more than two was adjusted according to a weighting factor. The odds ratio for AER + , in siblings of Prob-NIDDM-(AER + ) adjusted for age, hypertension, glycated haemoglobin A_{1 c} and other confounding variables was 3.94 (95 % confidence intervals: 1.93–9.01) as compared to siblings of Prob-NIDDM-(AER–). The 74 siblings of Prob-NIDDM-(AER + ) had higher prevalence of proliferative retinopathy than siblings of Prob-NIDDM-(AER–) (14 vs 2 %; p < 0.01). We also identified 66 non-diabetic siblings of 41 NIDDM probands with AER + and 36 non-diabetic siblings of 27 NIDDM probands with AER–. Albumin excretion was two times higher, although still within the normal range, in the non-diabetic siblings of Prob-NIDDM-(AER + ) than in siblings of Prob-NIDDM-(AER–) [median = 13.5 (range 0.5–148) vs 6.6 (range 1–17) μg/min (p < 0.05)]. In conclusion higher rates of albumin excretion aggregate in Caucasian families with NIDDM. Proliferative retinopathy is more frequently observed in families showing a clustering of AER + and NIDDM. These findings suggest that familial factors play a role in the pathogenesis of renal and retinal complications in NIDDM. [Diabetologia (1997) 40: 816–823] Received: 6 November 1996 and in revised form: 17 February 1997     

A highly efficient design strategy for regression with outcome pooling

The potential for research involving biospecimens can be hindered by the prohibitive cost of performing laboratory assays on individual samples. To mitigate this cost, strategies such as randomly selecting a portion of specimens for analysis or randomly pooling specimens prior to performing laboratory assays may be employed. These techniques, while effective in reducing cost, are often accompanied by a considerable loss of statistical efficiency. We propose a novel pooling strategy based on the k‐means clustering algorithm to reduce laboratory costs while maintaining a high level of statistical efficiency when predictor variables are measured on all subjects, but the outcome of interest is assessed in pools. We perform simulations motivated by the BioCycle study to compare this k‐means pooling strategy with current pooling and selection techniques under simple and multiple linear regression models. While all of the methods considered produce unbiased estimates and confidence intervals with appropriate coverage, pooling under k‐means clustering provides the most precise estimates, closely approximating results from the full data and losing minimal precision as the total number of pools decreases. The benefits of k‐means clustering evident in the simulation study are then applied to an analysis of the BioCycle dataset. In conclusion, when the number of lab tests is limited by budget, pooling specimens based on k‐means clustering prior to performing lab assays can be an effective way to save money with minimal information loss in a regression setting. Copyright © 2014 John Wiley & Sons, Ltd.     

河北省2010-2015年重症手足口病流行特征及时空聚集性分析

目的 了解河北省2010-2015年重症手足口病(HFMD)流行特点及时空聚集性.方法 收集河北省2010-2015年HFMD监测数据,描述重症HFMD流行病学特征,应用GeoDa l.8.10进行空间自相关分析,SaTScanTM9.4.2进行时空聚集性分析,ArcGIS 10.2软件绘制专题地图进行结果可视化展示.结果 河北省2010-2015年共报告重症HFMD病例3641例,平均重症率0.85/105,其中2010年重症率最高(2.49/105),疫情波动呈“大小年”现象,5-7月发病高峰,季节分布明显,总体呈下降趋势.专题地图及空间自相关分析显示,各县区HFMD重症率差异较大,地区聚集性明显(Moran’sI＞0,P＜0.05).局部自相关分析显示,高值聚集区随时间变化较大,主要分布在河北省的中部和南部的部分地区.时空扫描分析确证,河北省南部邢台地区(隆尧县为中心,方圆60.96公里,20个区县)为最大可能聚集区(RR=38.08,LLR=1267.00,P＜0.001);次级高发聚集区集中在省会石家庄西北部(14个县区,RR=12.35)、沧州(16个,RR=11.35)、廊坊(8个,RR=44.04)和承德(17个,RR=10.32)等地区,其发病风险RR均在10以上,聚集时间主要集中在2010-2012年5-8月.2013-2015年重症数下降明显,唐山、邯郸、张家口和保定的大部分地区为低发聚集区(RR＜1).另对2207例实验室确诊病例病原构成分析显示,河北省重症HFMD病例仍以EV71(79.70％)感染为主.结论 河北省2010-2015年重症HFMD报告发病率存在时空聚集性,聚集地区主要集中在河北省的中南部地区,但总体疫情呈现波动下降趋势.     

基于PubMed 数据库的直升机紧急医疗服务 热点的共词聚类分析

目的 通过文献计量学方法归纳直升机紧急医疗服务研究领域的热点方向。方法 制定检索策 略,搜索PubMed 数据库中近10 年直升机紧急医疗服务相关的研究,将研究的书目信息下载后导入到书目共 现分析系统进行统计分析,并将书目数据中的主题词共现矩阵导入图形聚类工具进行聚类分析。结果 检索 到2 365 篇文献,通过整理,最终得出直升机紧急医疗服务研究的时间分布、国家分布、高频主题词分布,主 题词双向聚类分析共显示出11 个聚类。结论 直升机紧急医疗服务研究热度逐年上升,相关的热点词汇主要 包括：创伤、组织管理、标准、心脏骤停、气管插管、心肌梗死、心肺复苏等。研究热点主要包括：直升机 紧急医疗服务在院外心脏骤停等疾病中应用的可行性;直升机紧急医疗服务救援人员技能培训;直升机紧急 医疗服务气管插管人员技能及插管工具的选择对插管质量的影响;创伤、心肌梗死等疾病直升机紧急医疗服 务的转运效果;直升机紧急医疗服务实施的影响因素;直升机紧急医疗服务相关指南6 个方面。