2003—2007年上海市低温寒流季节超额死亡分析

[目的]分析低温寒流天气对上海市居民超额死亡的影响,为加强极端气候应急预警,提高防灾减灾能力提供依据。[方法]收集2003—2007年低温期间（当年11月20日至次年3月30日）的死亡个案资料,与同期气象数据进行对比,分析寒流季节气温变化与居民超额死亡关系。[结果]2008年1月中旬至2月下旬,上海市各旬日平均气温较历年平均气温偏低1.13～5.17℃。2007年低温期期间,上海市共死亡43441人,较往年同期平均超额死亡2641人。2003—2007年低温期间,随着日平均气温、最高气温和最低气温的下降,每日死亡人数随之上升,死亡人数与气温之间存在明显负相关关系（相关系数分别为r平均气温=-0.45、r最高气温=-0.38、r最低气温=-0.49）。[结论]低温天气灾害带来的气温骤降和天气急剧变化影响群众生命健康,导致居民超额死亡的增加。     

Sudden death in school children: Role of physical activities and meteorological conditions

BACKGROUND: This current study is aimed at investigating the effect of physical activities and meteorological conditions on the sudden deaths of children without obvious causes at school. METHODS: The subjects are 76 victims of sudden death at school in the 12 years from 1983 to 1994 in Aichi Prefecture, Japan. The incidence of these sudden deaths is shown by month of the year, day of the week and hour of the day in relation to physical activities and meteorological factors. The analysis of Hayashi's quantitation type II was used for evaluation of the relationship between sudden deaths under the different physical conditions, such as sedentary (at rest or slow walking) or active (running, competitive sports or swimming) conditions, and meteorological or weather factors such as, season of the year, wind-chill factor, atmospheric pressure and relative humidity. RESULTS: Of 76 cases, 21 died suddenly under sedentary physical conditions and 55 under active conditions. The incidence of sudden death was highest from 10.00 to 11.00 h and on Thursday. Sudden death under sedentary conditions was associated with autumn and winter or with winter with high humidity and low atmospheric pressure. Sudden deaths during running were associated with spring with low humidity and high pressure and sudden deaths during competitive sports were associated with dry and cloudy weather. CONCLUSION: Sudden deaths in children at school may be associated with physical activities and meteorological conditions.     

唐山地区气象因素与急性缺血性卒中患者转归的关系

目的　探讨唐山地区气象因素与急性缺血性卒中（AIS）患者转归的关系。方法　回顾性分析唐山市协和医院神经内科收治的636例AIS患者,发病后3个月应用改良Rankin量表（mRS）评估临床转归,0~2分为转归良好,>2分为转归不良,转归良好组413例,转归不良组223例。比较2组患者临床基线资料、实验室检查指标以及入院当天的气象指标,应用多因素Logistic回归分析影响AIS患者转归不良的危险因素。结果　转归不良组患者的年龄、女性比例、卒中史比例、入院收缩压、入院美国国立卫生研究院卒中量表（NIHSS）评分、合并肺炎比例、白细胞（WBC）、纤维蛋白原（FIB）以及入院当天的日温差、日平均风速和日最大风速均高于转归良好组（P＜0.05）;而转归不良组患者的白蛋白（ALB）、红细胞（RBC）、血红蛋白（HGB）以及入院当天的日平均气温和日平均相对湿度均低于转归良好组（P＜0.05）。多因素Logistic回归分析显示,患者的入院高NIHSS评分、入院当日较大的日温差、较高的日最大风速是AIS患者转归不良的危险因素。结论　日温差、日最大风速与AIS患者转归有关。     

海南省疟疾发病情况及利用气象因子进行发病率拟合的研究

目的 探索海南省气候因素与疟疾流行之间的关系并建立能够表达疟疾发病率变化的气象因子拟合模型，以用于预测海南省疟疾发病率。方法 收集1995～2000年海南省月度气象资料(温度、湿度和降雨量)和月度疟疾发病率资料，应用Spearman等级相关分析气象因子与疟疾发病率之间的相关关系，用逐步回归建立气象因子拟合发病率变化的拟合模型。结果 气温和降雨量与疟疾发病率有相关性。应用逐步回归分析得到的拟合模型为：全省，I=-1.041 0．061t0.2，r^2=0．590(I：全省月发病率，t02：当前月及其前两个月期间的平均气温)；中南部高发地区，I=-5．701 0．382t02-0．147t02min，r^2=0．626，(t02/min：当前月及其前两个月期间的平均最低气温)。而如果引入I2(2个月前发病率)时，可以得到拟合效果更好的回归模型：全省，I=-1．701 0．064t4.2 0．47I2 0．025d2，r^2=0．72(d2:2个月前最高气温和最低气温之差)；中南部高发地区，I=-4．754 0．179t0.2 0．447I2 0．063d2，r^2=0．73。结论 气候因素能够影响疟疾的流行，可以利用气象因子拟合疟疾流行趋势并应用拟合模型对人群未来疟疾发病率进行预测。     

从古论今谈中医气象医学与防治温疫——“非典”

“非典”的肆虐正在震撼着世界。但是从另一个角度上,却正在彻底改变着人们沿袭已久的不良生活习惯与整体卫生环境。同时,也在向医学界提出了严肃的课题：“类似温疫的流行,是否可预测及有效防治”。历史上有多次类似“非典”的温疫发生,而中医气象病理医学五运六气学,及温病学对于分析预测疾病的发生及有效的救治有独特的理论方法与治疗经验。本人就中国历史上几次温疫大流行,做了一下简单的回顾并特别强调指出乾隆癸未年1793年,发生在中国河北北京一带的温疫大流行,其中医学气象病理医学因素与今年2003年的医学气象病理学因素是完全一样的。而当时余师愚根据中医气象病理学五运六气学说分析创制清温败毒饮重用“生石膏”,救活了无数病人的宝贵经验,对于今天“非典”发展趋向的评估及救治,提供了非常宝贵的借鉴。     

医学气象学与SARS流行的相关性研究

目的从医学气象学角度探讨SARS流行与气象因素的相关性。方法以SARS高发区广州、北京为例,通过网络、报刊等媒介获取两地在SARS流行前后的相关气象因子(日最高温度、日最低温度、相对湿度)及SARS疫情报告,运用EXCEL2000及相关矩阵法统计分析气象因子与SARS流行的关系,并从医学气象学角度对其相关性作出探讨。结果①SARS在12.8～23.5℃发病率最高,且与最高温度呈负相关。②SARS发病与最低温度呈负相关,高发前期有明显的降温过程。③广州的相对湿度较北京高,但与SARS的流行相关性不大。④2001年冬平均气温高于往年。结论①相对湿度较大有利于SARS的发生。②SARS发生于温热天气,气温波动有助于其流行。③气候异常变化是SARS发生的诱因。     

The Black Canyon Forecast Station: Experiences And Lessons Learned

Objective

To evaluate the sociological effect on indigenous biological event signature recognition and community resilience due to the operational activities of an infectious disease forecast station.

Introduction

The nation’s first operational infectious disease forecast station, modeled after warning protocols developed in the meteorology community, was activated in 2011. The approach was originally pioneered in Haiti following the 2010 earthquake.

Methods

We assembled global event signature and forecast libraries that reflected locally diagnosed infectious disease activity and infrastructure impact in a rural community from a public health, veterinary, and human clinical medicine perspective. The deployment site is home to a variety of infectious disease including hantavirus, plague, tularemia, and West Nile in the context of high wildlife-livestock-human interfacing. Information derived from the issuance of forecasts coupled to situational awareness was shared with the public, local officials, public health officers, veterinarians, healthcare providers, and patients through various social media methods.

Results

Provision of 30-60-90 day forecasts for routine and non-routine endemic infectious disease activity and impact facilitated better coordination of public health messaging and daily conversation with patients in the inpatient and outpatient settings. The signature of an unusual, infrastructure-disruptive outbreak of metapneumovirus and respiratory syncytial virus was recognized and communicated with enough time to activate effective clinical mitigation protocols. Cost estimates demonstrated financial benefit at a local level to anticipating surges of infectious disease activity with enough time to mitigate patient demand. Community-wide engagement with infectious disease forecasts and live event advisories included the promotion of proactive infection control and public health surveillance and response, healthcare provider recognition of non-routine infectious disease, clinical sampling and diagnostic testing protocols, clinician and patient education, and synchronization of proactive disease reporting both in the routine daily clinical setting and in times of crisis. Collateral benefit of consistent messaging delivered to the public by the participating entities was noted. Community awareness of the repertoire of indigenous infectious disease activity was expanded beyond the official public health notification list. Neither issuance of infectious disease forecasts nor advisories issued during crises triggered an influx of anxious well phone calls or visits to the medical system that was deemed operationally relevant.

Conclusions

Activation of a local infectious disease forecast station modeled after a local weather station promotes routine communication of a broader array of infectious disease activity than that monitored by public health; facilitates proactive, cost effective healthcare; and enabled recognition of unusual, disruptive infectious activity with enough time to enable mitigation of clinical, infrastructure, and financial impact to the community. Routine communication of comprehensive infectious disease forecast and situational awareness information promotes community adaptive fitness to a wide variety of infectious hazards. The results suggest it is possible to transform the traditional public health model of data collection and analysis to one of transparent and open data availability to support innovative reduction in morbidity and mortality.     

兰州市日均气温对荨麻疹发病的滞后效应研究

目的 探讨兰州市日均气温对荨麻疹发病的影响,以及不同人群中的差异。 方法 收集兰州大学第一、二医院皮肤科2007年1月1日至2013年12月31日,荨麻疹就诊人数的时间序列资料和相应的气象资料,运用分布滞后非线性模型分析气温与荨麻疹发病的关系,并按性别和年龄进行分层分析。 结果 日均气温与荨麻疹患者日均发病关系是非线性的,低温对兰州市荨麻疹发病影响有明显的滞后,在6 ℃,滞后18 d时,RR值达到最大。按性别和年龄进行分层分析发现,除老年人群外,高温影响效应在暴露当天即已显现,而在该人群中,其影响效应在暴露当天出现下降。低温对各人群影响效应随滞后日的变化呈现比较一致的趋势,其影响相对较延迟,即在暴露当天效应并不明显,而在暴露后2 ~ 4 d出现效应。 结论 兰州市气温对荨麻疹发病有影响,低温对荨麻疹的发病有明显的滞后效应,高温则无。     

基于时空地理加权回归模型的中国肺结核发病情况及影响因素研究

背景 现有针对肺结核发病影响因素的研究大多是独立的时间或空间回归分析,研究结果存在局限性。目的 探索中国肺结核分布的时间和空间异质性,并分析肺结核发病情况与气象和空气质量因素在时间和空间上的相关关系,为制订相应结核病防控措施提供科学参考。方法 使用2016—2018年全国分地区肺结核分月统计数据,将肺结核发病率作为因变量,将气象和空气质量因素作为自变量,在预先进行多重共线性和空间自相关检验后,分别构建普通最小二乘(OLS)模型、地理加权回归(GWR)模型、时空地理加权回归(GTWR)模型,评估并比较模型优度,选取最优模型以描述肺结核发病情况。分别绘制各变量拟合系数的核密度分布图和时空分布图,以描述拟合系数的时空特异性。结果 我国肺结核总发病率在逐年下降,且空间分布较为集中。GTWR模型的R²值均比OLS和GWR模型要高,同时GTWR模型的修正后的赤池信息量(AICc)值均比OLS和GWR模型要小,表明GTWR模型能更好地解释自变量对肺结核发病情况的影响。各变量核密度图结果显示,风速的增加对大多数城市的肺结核发病呈现显著的保护作用;湿度及空气污染物浓度的增加将显著增...