Geographical Variations in the Prevalence of COPD in Spain: Relationship to Smoking,Death Rates and other Determining Factors

BackgroundThe EPI-SCAN study (Epidemiologic Study of COPD in Spain), conducted from May 2006 to July 2007, determined that the prevalence of COPD in Spain according to the GOLD criteria was 10.2% of the 40 to 80 years population. Little is known about the current geographical variation of COPD in Spain.ObjectivesWe studied the prevalence of COPD, its under-diagnosis and under-treatment, smoking and mortality in the eleven areas participating in EPI-SCAN. COPD was defined as a post-bronchodilator FEV₁/FVC ratio <0.70 or as the lower limit of normal (LLN).ResultsThe ratio of prevalences of COPD among the EPI-SCAN areas was 2.7-fold, with a peak in Asturias (16.9%) and a minimum in Burgos (6.2 %) (P<.05). The prevalence of COPD according to LLN was 5.6% (95% CI 4.9–6.4) and the ratio of COPD prevalence using LLN was 3.1-fold, but with a peak in Madrid-La Princesa (10.1%) and a minimum in Burgos (3.2%) (P<.05). The ranking of prevalences of COPD was not maintained in both sexes or age groups in each area. Variations in under-diagnosis (58.6% to 72.8%) and under-treatment by areas (24.1% to 72.5%) were substantial (P<.05). The prevalence of smokers and former smokers, and cumulative exposure as measured by pack-years, and the age structure of each of the areas did not explain much of the variability by geographic areas. Nor is there any relation with mortality rates published by Autonomous Communities.ConclusionThere are significant variations in the distribution of COPD in Spain, either in prevalence or in under-diagnosis and under-treatment.     

特异性口服免疫耐受诱导的免疫学机制及其临床应用

特异性口服免疫诱导(specific oral tolerance induction,SOTI)是一种将曾经使患者发生过敏反应的食物作为抗原,从极低剂量开始给患者口服,以后逐渐缓慢增大剂量,维持一段时间后使患者对此抗原发生免疫耐受的现象。SOTI的发生发展受到多种免疫机制和诸多因素的影响,对SOTI免疫学机制深入细致地研究将为进一步了解食物过敏反应发生的机制,及其治疗和预防发挥积极的作用。     

广东省1991～2000年伤害死亡趋势及原因分析

目的 探讨广东省伤害死亡的原因和趋势，为采取干预措施提供基础数据，方法 通过疾病监测系统收集资料，用描述性流行病学方法阐述伤害死亡趋势和原因。结果 广东省10年伤害的平均死亡率为32.00/10万，占总死亡的7.24%，在死因顺位中排第5位。但按潜在寿命损伤年（YPLL）排第1位；伤害死亡率农村高于城市，男性高于女性，伤害是青壮年死亡的主要原因，10年伤害的死亡率呈逐年上升趋势，交通事故，淹死，自杀，坠落和中毒是伤害死亡的前5位原因，不同年龄组人群伤害死亡的原因顺位是不同的，结论 伤害是广东省居民的主要死因之一。且呈上升趋势，必须把伤害纳入疾病预防控制规划，采取有效的干预措施。     

广东省1990～2000年登革热流行病学分析

目的 明确广东省登革热流行因素。探讨预防控制对策。方法 调查分析1990-2000年登革热病例的分布特征和流行因素，测定登革Ⅰ型病毒地方分离株E/NS1基因片段核苷酸序列。结果 1990-2000年间，广东省共报告登革热病例9747例，死亡3例。年发病率在0/10万-9.75/10万之间，平均为1.27/10万。流行多呈爆发，疫情涉及13个市（占全省21个市的61.9%)。主要集中在广州，潮州，肇庆和佛山市，呈现高度集中而相对分散特点，敏月均有登革热病例报告，其中1-6月份为散发输入病例，7-12月份为流行期，男性：女性为1.04:1，所有年龄组均易感，四个型别的登革病毒均发生过流行，同一地区不同年份可流行不同型别病毒，同一年份不同地区也可流行不同型别病毒，广东省12株登革Ⅰ型病毒地方分离株E/NS1基因片段核苷酸序列，显示广东省登革Ⅰ型代表毒株可分为两个基因亚型。临床表现以典型登革热为主，广东省存在有利于登革热流行的自然因素和社会因素。结论 广东省登革热疫情同国外登革热流行程度相关联。流行呈输入性流行的特征，至今仍无证据表明已成为地方性疾病。     

广东省传染性非典型肺炎流行病学特征初步调查

目的 了解广东省局部地区流行的传染性非典型肺炎(SARS)的流行病学特征，为制定预防控制对策和措施提供科学依据。方法 采用统一的流行病学个案调查表对病例进行调查。利用EPI6．0软件分析SARS病例在广东省的流行过程，地区、时间、人群分布及聚集性等特征。结果 SARS在广东省的发病率为1．72／10万，病死率为3．64％。发病主要集中在1月下旬至2月下旬(2月上旬达到高峰)，占病例总数的61．88％。地区分布以经济发达、人口流动频繁的珠江三角洲地区为主，占病例总数的96．66％；患者以青壮年居多；医务人员是高发人群，占病例总数的24．9％；有明显的家庭和医院聚集，聚集性病例占37．1％。结论 SARS是一种呼吸道传播为主的传染病，目前发现传染源是人，潜伏期1—12天，中位数4天；通过短距离飞沫和密切接触传播；人群普遍易感，病例主要集中在经济发达、人口流动频繁的珠江三角洲地区。     

Social and behavioral determinants of attitudes towards and practices of hepatitis B vaccine birth dose in Vietnam

BackgroundHepatitis B virus (HBV) infection is a significant public health issue in Vietnam. Our goal was to understand the determinants of attitudes towards and practices of hepatitis B vaccine birth dose (HepB-BD) in certain regions of Vietnam.MethodA rapid qualitative assessment was conducted in three geographically diverse provinces that reported low coverage (<50%) of HepB-BD. Using purposive sampling of participants, 29 focus group discussions and 20 in-depth interviews were held with caregivers (n = 96), healthcare providers (n = 75), and healthcare administrators (n = 16). Summary notes from these were translated, and inductive coding was used to derive themes. The SAGE Vaccine Hesitancy Determinants Matrix was used as a theoretical framework to organize barriers and facilitators associated with the themes into three levels of influence.ResultsAt the individual and group level, caregivers who had higher levels of knowledge about HepB-BD sought the vaccine proactively, while others with lower knowledge faced barriers to the vaccine. Some caregivers reported a negative attitude toward health services because of a language barrier or had generalized concerns about HepB-BD due to media reporting of the past adverse events. Distress arising from potential adverse events was equally common among healthcare providers. At the contextual level, the physical environment made it difficult for caregivers to access healthcare facilities and for providers to conduct outreach. Home births posed a challenge for timely administration of HepB-BD, while health facility births facilitated it. Vaccination-specific barriers included misinterpretation of pre-vaccination screening criteria and asking for the consent of caregivers. Inadequate resources for service delivery negatively influenced HepB-BD attitudes and practices.ConclusionGiven the diversity of barriers associated with attitudes towards and practices of HepB-BD in the three provinces, tailored interventions will be necessary for both demand- and supply-side factors. Rural areas, often with more home births and geographic barriers, may require focused attention.     

广东地区流感流行、爆发和分子变异研究

广东地区在中国乃至全球流感大流行中占有重要地位。本文总结近年广东地区流感流行、爆发和分子变异的资料，归纳出本地区的流感流行特征，揭示了流感爆发和变异的部分规律，为预报流感爆发和预防控制流感流行提供科学依据。