Maternal Age at Menarche and Pubertal Timing in Boys and Girls: A Cohort Study From Chongqing,China

PurposeThis study explored the association of maternal age at menarche (AAM) with pubertal timing among girls and boys in Chongqing, China.MethodsPubertal development of 1,237 children (542 girls and 695 boys) were examined half-yearly through inspection and palpation from April 2014 to June 2019. Characteristics of parents and maternal AAM were collected by a parental questionnaire at baseline. Maternal AAM was used both as a continuous and a categorical variable in Cox regression models.ResultsA total of 1,198 children (528 girls and 670 boys) were included in the study. In the simple Cox model, earlier maternal AAM was associated with girls' earlier menarche, breast and pubic hair development, and boys' first ejaculation, testicular development, and genital development. When adjusting for children's body mass index z-scores (BMIz) and socioeconomic covariates, we found that girls whose mothers had early AAM had a higher risk of earlier onset of menarche (hazard ratio [HR]: .922, 95% confidence interval [CI]: .852–.998 for continuous maternal AAM, HR: 1.297, 95% CI: 1.041–1.616 for maternal AAM ≤13 years), and boys whose mother achieved menarche earlier experienced a higher risk of earlier onset of first ejaculation (HR: .896, 95% CI: .830–.968). Children's BMIz were related to all nine pubertal milestones. Parental education and relationship, birth weight, parity, and family type were also associated with pubertal timing.ConclusionsEarlier maternal AAM was related to earlier pubertal timing in both girls and boys in Chongqing, especially girls' age at menarche and boys' first ejaculation. Children's BMIz was the most consistent factor for pubertal timing. Children's BMIz and socioeconomic conditions had greater influence on most pubertal milestones than maternal AAM.     

Characteristics of pediatric invasive pneumococcal diseases and the pneumococcal isolates in Suzhou,China before introduction of PCV13

BackgroundData on characteristics of invasive pneumococcal diseases (IPD) is limited in China. We aimed to understand the clinical features and explore the molecular characteristics of the pneumococcal isolates in China.MethodsSince 2010, we prospectively collected the pneumococcal isolates and the IPD patients’ demographic and clinical information in Suzhou University Affiliated Children’s Hospital (SCH). The antibiotic susceptibility, serotypes, genotypes of Streptococcus pneumoniae strains were identified by E-test, quellung reaction and/or multiplex PCR, and multi-locus sequence typing, respectively.ResultsDuring the period from January 2010 to December 2015, a total of 80 IPD patients were identified. They were diagnosed as meningitis (31.3%), septicemia (27.5%), pneumonia (21.3%) and others (20.0%). About half of them required vancomycin treatment, 42.5% were admitted to ICUs, 36.2% had complications and 6.2% were hospitalized for over 1 year. The most common serotypes of the pneumococcal isolates were serotypes 6B and 14, the coverage of PCV13 was 92.5%, and CC236s and CC199s were the most common clone complexes.ConclusionsPediatric IPD patients had severe clinical symptoms, demanded intensive treatment, suffered poor prognosis and substantial burden. The pneumococcal isolates’ serotype coverage of PCV13 vaccine was high, which leads to implication of PCV vaccine usage among children in China.     

华东某省实现“十二五”人群增寿目标的可行性分析与工作策略

目的 :分析华东某省实现"十二五"期间"期望寿命增加1岁"的可行性,并提出相应的工作策略。方法 :收集华东某省2011—2015年人口预测资料、1950—2010年分年龄组的人口、发病和死亡数据资料,利用简略寿命表法、时间序列分析等思路和方法,分析2010—2015年间期望寿命的变化幅度,明确规划目标的实现程度;通过改变防控工作力度,预测实现规划目标的可行途径。结果 :自然趋势下,华东某省2010—2015年期望寿命将增加0.86岁,距规划目标还有0.14岁的差距;通过疾病预防控制工作整体加强0.3%、心脏病防控加强8%、脑血管病防控加强6%、肿瘤防控加强6%、意外伤害防控加强4%等途径可弥补0.14岁的差距,实现规划目标。结论 :加强慢性病和意外伤害防控是未来期望寿命再提升的主要源泉和途径。     

上海市浦东新区公立综合性医院医疗质量控制体系建设研究

良好的医疗质量控制体系将有助于提高诊疗水平、服务意识及患者的满意程度,降低医疗事故、纠纷的发生率,直接影响到医院未来的发展。在前期对浦东新区公立综合性医院医疗质量控制体系研究的基础上,通过焦点组访谈,提出了浦东新区公立综合性医院医疗质量控制体系的建设方案。此建设方案不仅为浦东新区改善医疗质量控制体系提供了决策信息,也为我国其它地区改善医疗质量控制体系提供了一定的参考作用。     

公立医院横向医疗资源整合的模式研究

提出对公立医院横向医疗资源整合的整体设计:整合的目标为对具有相同资产权属、相同能级的公立医院中的医疗资源进行统筹安排,提高资源使用效率。最适合进行横向整合的情况是拥有优势资源的医院与资源相对薄弱的医院之间整合资源,实现强弱互补。横向整合中的关键问题为利益分配机制,人事制度、资产归属、管理体制、绩效评价。提出上海市级医院横向医疗资源整合的适宜模式为学科整合、人才整合、科研平台建设、信息共享、设备共享、委托检验检查和集团化采购的建议。     

Epidemiological study of Spinal Cord Injury individuals from halfway houses in Shanghai,China

Objective: To describe the characteristics of spinal cord injury (SCI) individuals in Shanghai and examine their treatment and rehabilitation for traumatic and complete SCI individuals.

Design: Community-based secondary data analyses.

Setting: Shanghai, China.

Methods: We analyzed gender, age at injury, complications, disturbances of function, treatment, etiology, and severity of injury of SCI individuals that enrolled in “halfway houses”, government-supported community co-op centers. Bivariate statistical analyses were conducted to examine the factors associated with complete and traumatic SCI.

Results: We analyzed 808 SCI individuals who participated in halfway houses in Shanghai during 2009–2015. The male-to-female ratio was 2.1:1. The proportion of middle or elder age groups at injury (age 46 to 60 and age 61 or over) showed a rising trend from 1970 to 2015. The leading causes of SCIs in Shanghai were traumatic injuries (58%), followed by disease (29.5%). The proportion of traumatic injuries decreased over time, while the proportion of non-traumatic injuries rose significantly. A majority of traumatic injury individuals were aged between 16–45.

Conclusion: The middle or elder age groups at injury among SCI individuals increased continuously from 1970 to 2015. The principal causes of injury in Shanghai were traumatic injuries and disease-related injuries. Men had a higher prevalence of traumatic SCI in Shanghai. Preventive measures should focus on male and middle-aged adults. As a fast-aging society in Shanghai, more effective prevention, medical care, and rehabilitation schemes should be implemented for aging SCI individuals.     

基于德尔菲法的乡村医生脆弱性内涵界定研究

目的对乡村医生脆弱性内涵进行界定。方法在文献分析的基础上,于2015年10—11月,在对乡村医生和卫生管理人员进行定性访谈的基础上,运用德尔菲专家咨询法,对初步界定的乡村医生脆弱性内涵进行咨询和论证。对数据进行描述性统计。结果两轮咨询分别咨询了20位专家和16位专家。经过两轮咨询,专家对7个咨询单元的认同率从74.29%提高到93.16%。结论界定了乡村医生的脆弱性,其是指乡村医生自身内在应对力和获得的外部支持力难以应对其受到的扰动的状态,其由乡村医生所受扰动力和对扰动的应对能力共同决定。     

The determinants of vaccine hesitancy in China: A cross-sectional study following the Changchun Changsheng vaccine incident

IntroductionVaccine hesitancy is cited as one of the top threats to global health. The Changchun Changsheng Biotechnology Company was found to have violated good manufacturing practices in July 2018, leading to widespread distribution of sub-potent vaccines in China. We estimated the prevalence and determinants of vaccine hesitancy following the Changchun Changsheng vaccine incident (CCVI).MethodsWe conducted a cross-sectional survey in China in January 2019, and 2,124 caregivers of children < 6 years old completed self-administered questionnaires. Multinomial logistic regression was used to assess the determinants of vaccine hesitancy; the potential determinants included demographics, socioeconomic status, vaccine confidence, and knowledge of the CCVI. Adjusted Odds Ratios (AORs) and 95% confidence intervals (CI) are reported.ResultsAround 89% of caregivers had heard of the CCVI. Although 83% and 88% of caregivers agreed that vaccines are safe and effective, respectively, 60% expressed some hesitancy about vaccination. Of those hesitant, 26% vaccinated their children at times with doubts, 31% delayed vaccination and 3% refused specific vaccines. Multinomial regression analysis showed that confidence in vaccine safety was associated with a reduced odds of doubts on vaccination (AOR = 0.64; 95%CI = 0.44–0.94), whereas caregivers who had heard of the CCVI had a significantly higher odds of doubts on vaccination (AOR = 1.61; 95%CI = 1.05–2.45). Confidence in the vaccine delivery system and government were associated with a lower odds of vaccine hesitancy. Caregivers with higher education and Buddhism or other religions were significantly more hesitant to vaccinate their children.ConclusionVaccine hesitancy was prevalent following the CCVI. Over half the caregivers either accepted childhood vaccination with doubts or delayed vaccines; only a small number were active refusers. Our findings highlight the importance of addressing vaccine hesitancy, especially following vaccine incidents. Tailored communications are needed to reduce vaccine hesitancy, especially among the highly educated and Buddhist caregivers.     

长期护理保险第一批试点城市保险筹资方案比较分析

目前我国已全面开展长期护理保险制度试点。通过对第一批四个试点城市的长期护理保险筹资方案进行梳理,比较分析各城市保险的筹资性质、筹资来源、筹资水平、筹资公平性,发现长期护理保险筹资来源较单一、缺乏激励措施、筹资总体水平不高、筹资公平性有待改善等问题。为完善长期护理保险筹资方案制度设计,本文提出需要特别注意的几个问题:完善筹资来源,应逐步形成合理稳定的筹资来源,拓宽筹资渠道,提高筹资水平;改善筹资公平性,从完善参保制度、加强宣传等方面提高筹资公平性;理顺保险筹资管理体系。