Acute respiratory infections in children: a case management intervention in Abbottabad District, Pakistan

Between 1985 and 1987, a community-based case-management programme for acute lower respiratory infection (ALRI) was conducted in a rural district of northern Pakistan. The impact on infant and child mortality of this programme, which included active case-finding and maternal health education, was evaluated. In 1985-86, the ALRI-specific mortality rate among children less than 5 years old in 31 intervention villages was 6.3 deaths per 1000 children per year, compared with 14.4 in seven control villages (P = 0.0001). Within one year of the interventions being extended to the control villages in 1987, the ALRI-specific mortality rate in these villages dropped by 55% to 6.5 per 1000 children per year (P = 0.06). The total child mortality rate in 1985-86 was 29.0 per 1000 children per year in the intervention villages and 39.4 per 1000 children in the control villages, a difference of 26% (P = 0.01). With the interventions in 1987, the total child mortality rate in the control villages declined by 29% to 27.8 per 1000 children per year (P = 0.09). Similar intervention-associated declines in the infant mortality rate were also observed. Case management of acute respiratory infection by village-level community health workers backed up by local health centre staff appeared to significantly reduce both ALRI-specific and total infant and child mortality rates in this setting.     

Impact of case ascertainment on recent trends in diabetes incidence in Rochester, Minnesota

The authors previously reported an increase in the incidence of diabetes mellitus among Rochester, Minnesota, residents during the period 1970-1989. This study provides updated rates from data collected through 1994. Trends in diabetes surveillance, i.e., the proportion of residents who had a blood glucose measurement in each year between 1987 and 1994, are also provided. The authors reviewed medical records to identify residents aged 30 years or more who first met National Diabetes Data Group criteria for diabetes between January 1, 1970, and December 31, 1994. Age- and sex-adjusted incidence rates were calculated for successive quinquennia (5-year periods), and Poisson regression was used to test for an effect of calendar year; calendar period (1970-1989 vs. 1990-1994) was added to assess whether the association with calendar year varied in the most recent quinquennium. Altogether, 1,992 Rochester residents first met National Diabetes Data Group criteria for diabetes between 1970 and 1994. The age-adjusted incidence per 100,000 person-years increased 67% for males (267.0 vs. 444.8) and 42% for females (225.4 vs. 319.1) between 1970-1974 and 1990-1994. Calendar year (p < 0.001) and calendar period (p = 0.026) were significant, suggesting that rates accelerated during 1990-1994. The proportion of residents with at least one blood glucose measurement per year was unchanged (p = 0.181) from 1987 to 1994, while the incidence of diabetes increased (p = 0.033). Thus, the authors conclude that the increase in diabetes incidence accelerated over the last quinquennium and was not due to increased surveillance.     

Evaluation of the hypothesis that Balkan endemic nephropathy is caused by drinking water exposure to contaminants leaching from Pliocene coal deposits

Balkan endemic nephropathy (BEN) is a kidney disease that has been reported in only certain rural villages in Serbia, Bulgaria, Romania, Croatia and Bosnia. The cause of BEN remains a mystery, but researchers seem to agree that exposure to one or more environmental agents is at least partially responsible. The Pliocene lignite hypothesis suggests the disease is due to long-term exposure to polycyclic aromatic hydrocarbons (PAHs) or other toxic organic compounds that have leached into drinking water supplies from low-rank coals. Although this hypothesis has been promoted by some researchers, efforts to substantiate it have been inconclusive due to limitations in sample size and methodology. The present study was designed to further examine this hypothesis by analyzing PAHs, which were implicated in the original hypothesis, in a larger number of water samples from endemic and nonendemic villages in Bulgaria and for other chemical differences between the villages. Results show that levels of all PAHs were low, with none exceeding the drinking water standard for benzo-[a]-pyrene, the most toxic PAH, and the only one for which a maximum contaminant level (MCL) has been set for drinking water. Comparison of additional unidentified chromatographic peaks from high-pressure liquid chromatography (HPLC) technique designed to detect dissolved organic compounds (DOCs) that leach from coal failed to show higher levels in BEN villages. This study finds no basis to connect PAHs or other unknown DOCs to the etiology of BEN, and suggests that the evidence in support of the Pliocene lignite hypothesis is limited to the spatial association originally proposed.     

Pelvic Fracture Rates in Community-Living People With and Without Disability and in Residents of Nursing Homes

ObjectivesThere are limited data on the epidemiology of pelvic fractures. The purpose of this study was to calculate incidence rates of pelvic fractures leading to hospital admission and to compare incidence rates between residents of nursing homes and community-dwelling persons with and without care need.MethodsData were retrieved from a database of the largest health insurance company in Bavaria, Germany. Between 2004 and 2009, 10,170 pelvic fractures were observed in 751,101 women and 491,098 men. Age- and gender-specific incidence rates were calculated. Incidence rates were further stratified by setting (nursing home versus community) and functional status (no care need versus care need for those in the community). In addition, the average cumulative risk for a pelvic fracture at different ages was calculated.ResultsThe incidence rate increased from 0.54 and 0.38 per 1000 person-years in women and men aged 65 to 69 years to 9.35 and 4.45 per 1000 person-years in women and men aged 90 years and older, respectively. Persons living in a nursing home or living at home with care need had considerably higher incidence rates than community-dwelling older persons without care need. The average cumulative risk at the age of 65 years for an incident pelvic fracture until the age of 90 years was 6.9% in women and 2.8% in men.ConclusionThe incidence of pelvic fractures leading to hospital admission is higher in women than in men and rises dramatically with increasing age. Persons with care need have a particularly high risk for pelvic fracture.     

社区居民肥胖、中心性肥胖与冠心病发病风险的前瞻性队列研究

目的 探索肥胖、中心性肥胖与冠心病发病风险的关系。方法 2013年在上海市浦东新区社区居民中采用多阶段分层随机抽样选取人群开展基线调查,收集6685名队列研究对象的人口学特征、暴露因素、身体测量指标等信息。随访观察中位时间3.00年,记录队列人群的冠心病发病情况。单因素分析采用t检验、Kruskal-Wallis检验和卡方检验,多因素分析采用COX比例风险模型。结果 队列总计观察人年数为19759.93人年,共有260人发生冠心病,男性101例,女性159例。队列人群总体发病率3.89%,发病密度13.16/千人年。冠心病发病率随BMI升高呈上升趋势（〖XC小五号.EPS;P〗趋势=6.761,P=0.009）。中心性肥胖人群发病风险是正常人群的1.39倍(P =0.019, 95%CI: 1.06-1.82),中心性肥胖合并高血压患者发生冠心病的风险是正常人群的1.77倍(P=0.001, 95%CI:1.26-2.49)。结论 中心性肥胖是冠心病发病的重要危险因素。     

宁波市鄞州区2016-2021年系统性红斑狼疮发病的流行病学研究

目的描述2016-2021年宁波市鄞州区系统性红斑狼疮(SLE)发病密度及其在不同年龄、性别的分布情况。方法基于鄞州区域健康信息平台2015-2021年的数据开展回顾性队列研究, 纳入鄞州区常住居民, 利用《国际疾病分类》第十版编码"M32"或中文文本"狼疮"模糊匹配的方式识别出SLE疑似病例。提取疑似病例的门/急诊和住院记录信息后, 采用2012年系统性红斑狼疮国际协作组和2019年欧洲抗风湿病联盟联合美国风湿病学会分类标准进行病例验证, 依据验证结果确定识别SLE病例的算法, 并以1年为洗脱期识别新发病例。采用泊松分布估算SLE发病密度及其95%CI。结果 2016-2021年鄞州区累计登记的常住人口共1 551 921人, 其中女性占51.52%, 入组年龄的M(Q1, Q3)为40.38(27.54, 53.54)岁, 随访时间M(Q1, Q3)为3.83(0.41, 5.83)年。SLE新发病例451例, 其中女性352例(78.05%)。总人群6年发病密度为8.14/10万人年(95%CI:7.41/10万人年～8.93/10万人年), 男性发病密度为3.68/10万人年(...     

From birth to adulthood in rural Ethiopia: the Butajira Birth Cohort of 1987

Long‐term birth cohorts from developing countries are uncommon. Here a unique birth to 18‐years cohort based on all births during 1987 in a rural area of Ethiopia is presented. This was the first year of the ongoing Butajira Rural Health Programme, since when the sampled population has been followed up in regular household visits. A total of 1884 livebirths in 1987 formed the cohort, corresponding to a birth rate of 0.31 per woman per year; the male : female ratio was 1.10. Perinatal mortality was 22 per 1000 livebirths, and infant mortality 65 per 1000 livebirths. Survival from birth to 18 years was 760 per 1000. Living in Butajira town had a considerable survival advantage compared with the surrounding villages. Most deaths were due to infections. Four per cent of the cohort experienced the death of their mothers before the age of 18 years, and 15 of the girls delivered their own children, suggesting that 1 in 25 women may bear a child before their eighteenth birthday in this community. The children in the cohort received no consequent special care or attention, and so they probably accurately represent the harsh realities of growing up in rural Ethiopia at the turn of the Millennium. The huge gaps between their experience and that of their contemporaries in more affluent settings are a scandal of the 21st century.     

北京城乡老年队列中基线痴呆的全死因死亡率及死亡风险研究

目的 通过对目标人群的追踪观察,探讨老年期痴呆的死亡率及死亡风险.方法 1997年采用按类分层、分阶段随机抽取区(县)、街道(乡)、居委会(自然村),按照整群抽样原则获得研究样本.分两阶段调查基线痴呆患病率,第一阶段完成问卷调查及筛查量表(MMSE)等测试,第二阶段由神经内科医师对MMSE得分低于界值和部分正常的老年人进行病史搜集、临床查体及神经心理测验等,最后由2名神经内科医师根据DSM-Ⅲ-R和NINCDS-ADRDA等诊断标准完成痴呆的临床诊断.最终获得有效调查样本2788例.在2000和2004年对研究样本进行全面随访同时记录死亡及失访原因和时间,总计随访7.25年.结果 基线共诊断痴呆171例,累积死亡133人.全样本的痴呆粗死亡率和年龄标化率分别为7.8/1000人年和5.5/1000人年,且随年龄的增加而呈指数增加;痴呆组其粗死亡率和年龄标化率分别为236/1000人年和206/1000人年;非痴呆组累积死亡680人,粗死亡率和年龄标化率分别为40/1000人年和31/1000人年,两组粗死亡率差异有统计学意义.痴呆的死亡风险比在60～74岁各组均高于≥75岁各组.经多因素Cox回归调整,痴呆的死亡风险比为2.181(95％CI:1.751～2.717)、阿尔茨海默病为2.524(95％CI:1.964～3.243)、血管性痴呆为1.859(95％CI:1.213～2.850).结论 老年期痴呆的粗死亡率及死亡风险比大大高于一般人群,提示痴呆是预示老年人死亡的最主要危险因素之一.     

2011年乌鲁木齐市米东区农村土壤中蛔虫卵污染情况调查

[目的]了解农村居民菜园土壤蛔虫卵污染状况。[方法]2011年7月,在乌鲁木齐市米东区的5个乡镇的20个行政村,采集居民的菜园土壤采用饱和的硝酸钠漂浮镜检法进行蛔虫卵污染状况检测。[结果]在5个乡镇20个监测村采集100户居民的菜园土壤,有86户检出蛔虫卵,检出率为86.00%。其中75户检出活虫卵,活蛔虫卵检出率为75.00%。活蛔虫卵检出率,铁厂沟镇为70.00%,长山子镇为75.00%,羊毛工镇为75.00%,古牧地镇为75.00%,三道坝镇为80.00%(P>0.05)。[结论]米东区农村居民的菜园土壤中蛔虫卵污染较为严重。     

Mortality analysis on wastewater exposure in Shijiazhuang,Hebei, China,from 2007 to 2011

The study investigated the age-adjusted mortality rate and disease odds among deceased residents living in areas exposed to wastewater and cleanwater from 2007 to 2011, in Shijiazhuang, China. Mortality data for eight villages exposed to wastewater and 16 villages not exposed to wastewater were collected and crosschecked from multiple sources. Overall mean age-adjusted mortality rate for wastewater areas was 798/105 (95?% Confidence Interval (CI)?=?±?68), insignificantly higher than the mean mortality rate for cleanwater area, 726/105 (95?% CI?=?±?46), p?>?0.05. Malignant neoplasms and respiratory mortality and disease odds were higher in wastewater areas than in cleanwater areas, OR?=?1.7 (95?% CI?=?1.3–2.2, p?p?p?p?相似文献   

Incidence of herpes zoster among children and adolescents in a community with moderate varicella vaccination coverage

Active surveillance for herpes zoster (HZ) was conducted for 2 years (2000-2001) in the Antelope Valley community of 312,000 residents among 290 public and private schools, daycares, and healthcare providers. The true ascertainment-adjusted HZ incidence rate is 307 per 100,000 person-years and 138 per 100,000 person-years among children <10 and individuals aged 10-19, respectively. The unadjusted rate among vaccinated children is 9.5 per 100,000 person-years and an estimated 22 per 100,000 vaccine doses. Unvaccinated children with a previous history of varicella may have greater sensitivity to exogenous exposures (boosting) and a poorer cell-mediated response following primary infection relative to older age groups.     

Prisoners are at risk for hepatitis C transmission

Objective: Determine the incidence of hepatitis C virus antibodies among a cohort of prisoners. Design: Follow-up study of a random sample of prisoners who participated in a cross-sectional survey in 1996. Setting: 29 correctional centres in New South Wales (Australia). Participants: 181 adult prisoners (163 men and 18 women). Results: The incidence of hepatitis C virus antibody among the 90 inmates who were seronegative at the first test in 1996 was 7.1 per 100 person-years (16 seroconverters). Among the 90 inmates, 37 had re-entered the prison system following release into the community and 53 had been continuously detained. The seroconversion rate was higher among the re-entrants compared with those who had been continuously incarcerated (10.8 vs. 4.5 per 100 person-years, p=0.07). However, when the data was stratified by injecting status, the seroconversion rate in the two groups was similar. Most of the seroconverters had histories of injecting drug users (14/16). The overall incidence among injectors was 19.3 per 100 person years (95% CI: 9.1–29.2). Conclusions: Hepatitis C transmission occurs inside the prison with injecting drug use the likely cause. Among non-injectors, tattooing was the most likely mode of transmission. Harm minimisation measures with proven effectiveness need to be considered for this environment.     

Risk of Respiratory Cancer around a Sewage Plant in Prato,Italy

In this study, the authors evaluated the risk of respiratory cancer related to environmental pollutants among a population that resided near a sewage plant in Prato, Italy. Subjects included lung cancer deaths (1987-1996) and incident cases of lung and laryngeal cancers (1987-1994) among residents of Prato. The authors used the mortality or incidence rates for the entire population of Prato (by gender and by 5-yr age group) to calculate the expected cases in each census unit. Data were analyzed and adjusted for an index of social deprivation (Stone test). Among males, the excess risk of lung cancer mortality decreased as distance from the plant increased for 2 time periods (1987-1996 [p = .008] and 1990-1996 [p = .030]) and for lung cancer incidence during 1987-1994 (p = .011). Similar results were obtained when sewage plant workers were excluded from the analysis. A similar, but not statistically significant, trend was observed among female incident lung cancer cases, as well as among male incident laryngeal cancer cases. Despite methodological limitations common to geographic studies, the results were consistent with those previously published on mortality excesses for lung cancer among plant workers under study. The role of environmental pollutants as a risk for respiratory cancer must be further clarified with additional epidemiological studies and an environmental monitoring program.     

Waterborne epidemic outbreak of Shigella sonnei gastroenteritis in Santa Maria de Palautordera, Catalonia, Spain

In August 2002 an outbreak of Shigella sonnei infection occurred in a Spanish town of 6343 inhabitants. In total, 756 people developed acute gastroenteritis and 181 cases were shigella-confirmed. The peak incidence was during 5-6 August 2002. The estimated primary attack rate was 9.97%; the attack rate for secondary cases was 38%. The <15 years ago group was most affected (16.49%). The town and its surroundings were served by two water systems, A and B. The cases had consumed water provided by system A (attack rate 164 cases/1000 population). Microbiological analysis of water from system A did not show the presence of coliform bacteria or shigella. This shigellosis outbreak was the largest reported in Spain. The impact of the epidemic was probably greater than the incidence detected.     

Gender,literacy, and survival among Ethiopian adults, 1987 - 96

OBJECTIVE: To examine relationships between gender, literacy and survival among adults in Meskan and Mareko district, Ethiopia. METHODS: On the basis of an established demographic surveillance system, an open-cohort analysis of 172726 person-years covering the period January 1987 to December 1996 was conducted in 10 randomly selected local communities. FINDINGS: The crude mortality rate was 11.2 per 1000 person-years among adults aged > or =15 years; the values for males and females were 11.9 and 10.6 per 1000 person-years, respectively. Kaplan - Meier estimates showed that literacy and being female were both favourable for survival throughout adulthood. Cox's regression models showed that age, gender, literacy and area (rural lowland, rural highland and urban) were significant factors in survival: younger, female, literate urban dwellers were the most favoured. Gender differences in mortality were small in the rural areas, possibly because of the harsh living conditions and the marginalization of women. Literacy was a more significant factor for survival in the rural areas, where mortality was highest, while gender was more important in the one urban area studied. The levels of literacy were lowest among rural females. CONCLUSION: Special attention should be given to raising literacy levels among rural women with a view to improving their survival.     

Human cutaneous leishmaniasis in two communities in eastern Sinai,Egypt

Cutaneous leishmaniasis (CL) (L. major) has been documented in soldiers of the Multinational Force in the Sinai as well as in visitors to the area. However, little is known about the prevalence of this disease in the local populations. We identified 2 villages in northeastern Sinai near the infected camps of the Multinational Force and, in a population-based study, measured the prevalence of CL.Populations studied included residents in 2 towns as well as a Bedouin family living on the village periphery. Leishmanial parasites were identified from smears taken from cutaneous lesions. Three of 90 residents in I village and 3 of 8 Bedouins had CL. None of 43 residents examined in the second town had CL. Two of 6 individuals had multiple lesions, and at least I had recurring ulcers. Five of the 6 affected individuals were males and the 6 represented all age groups. The 6 infected individuals came from 3 families. Infected individuals had traveled outside of the village more frequently than uninfected individuals, suggesting that transmission was more common outside of residential areas.     

2007-2016年贵州省黔南州居民软组织肉瘤发病特征及变化趋势分析

目的 分析2007-2016年贵州省黔南州户籍居民软组织肉瘤发病特征及变化趋势,为科学地制定有效的防治决策提供参考依据。方法 提取贵州省黔南州肿瘤登记处以人群为基础的癌症发病登记数据库资料中2007-2016年确诊的软组织肉瘤的发病信息进行性别、年龄分析,计算发病率、中标率、世标率、年度变化百分比(APC)等。结果 2007-2016年贵州省黔南州户籍居民软组织肉瘤发病149例(男性82 例,女性67例),发病率为4.58/10万,中标率为3.05/10万,世标率为3.49/10万。10年中发病率、中标率、世标率的APC分别为4.73%、3.99%和3.96%。各年龄段发病率有缓慢上升趋势,≥76岁以后有所下降。男性和女性各年龄段软组织肉瘤发病率上升趋势基本一致。病理形态学诊断主要以脂肪肉瘤、纤维肉瘤、恶性纤维组织细胞瘤、恶性神经鞘瘤和上皮样肉瘤为主,分别占17.45%、14.75%、14.09%、13.42%、12.08%。结论 贵州省黔南州户籍居民10年来软组织肉瘤发病率有上升趋势,应引起高度重视。     

Incidence,risk, and associated risk factors of stroke among people with different disability types and severities: A national population-based cohort study in Taiwan

BackgroundThe number of people with disabilities is increasing. People with disabilities are more likely to be physically inactive, which can lead to chronic diseases, including stroke. Stroke is a leading cause of illness and death worldwide, but little is known regarding stroke among people with disabilities.ObjectiveTo evaluate the incidence density rate, relative risk, and associated risk factors of stroke and measure the risk of death due to stroke among people with disabilities in Taiwan.MethodsThis retrospective cohort study used nationwide data from the National Health Insurance Research Database, National Disability Registry Database, and Cause of Death File. Incidence density rates of stroke were estimated as new cases per 1000 person-years. Cox proportional hazard models were used to estimate the relative risk of stroke, adjusted survival curves, and adjusted cumulative incidence curves.ResultsA total of 670,630 people with disabilities were included in our analyses. The average person-years of observation was 9.43 ± 5.31, with a yearly rate of 16.72 new cases of stroke per 1000 person-years. The highest risk of stroke was found among people with balance disorder (hazard ratio [HR] = 2.27, 95% confidence interval [CI] = 2.00–2.57) and intractable epilepsy (HR = 1.85, 95% CI = 1.56–2.19). The highest risk of death due to stroke was found among people with dementia and multiple disabilities.ConclusionsStroke rates were higher among people with disabilities than among the general population, and certain disabilities were associated with a higher stroke risk and death rate.