上海虹口区2004—2007年伤害病例监测分析

伤害已经成为21世纪上海一个重要的公共卫生问题。开展伤害监测和干预已成为疾病预防控制工作的重要内容之一，建立完善的伤害监测体系是伤害防制工作基础，而社区伤害监测则是整个伤害监测体系中重要的一环，可以弥补二级和三级医院中急诊的监测不全。通过分析虹口区历年社区伤害监测的数据，初步揭示近期本地社区伤害发生的流行特征，探讨社区伤害防制的策略，为进一步完善社区伤害监测体系以及进行社区伤害干预提供相关依据。     

儿童意外伤害社区干预策略方案的选择

意外伤害严重影响着儿童的生命质量 ,不仅给儿童和家庭带来身心痛苦 ,也造成严重的社会经济负担。儿童伤害的有效干预和控制过程是一项涉及多学科协作、多部门参与的社会系统工程 ,积极提倡和推行社区干预是一个有效、经济、符合我国国情的理想选择。结合对中国儿童意外伤害现状的统计分析 ,对儿童意外伤害社区干预的原则、策略的选择方案进行分析探讨。     

社区安全促进研究现状

该文结合世界伤害发生及其危害概况、社区伤害的主要问题，提出社区伤害干预的重点人群，分析和选择了社区伤害干预策略，以期最大程度地保障社区群众的安全和健康。     

广西3城市居民伤害死亡调查

伤害与其他疾病一样都是一个公共卫生问题，是可以被认识、被预防和被控制的。为了解伤害对广西壮族自治区城市居民健康危害程度及其所致的寿命损失，我们对桂林、柳州、南宁三城市居民1997～2001年伤害死亡原因进行了调查，以探讨广西伤害的发生、发展规律，并为制定防制伤害策略、措施及相应卫生政策提供理论依据。     

我国伤害现状及研究进展

伤害是一个不容忽视的社会公共卫生问题,严重威胁着人们的生命健康,并消耗大量医疗资源和国民生产力.我国的伤害研究工作始于20世纪80年代,其中道路交通伤害和对儿童、青少年、社区人群的伤害研究较多.现在我国正逐步建立各类各级伤害监测系统,监测伤害发生动态和趋势,对某一类型或某一高危人群的伤害研究将成为今后工作的重点.同时伤害干预工作也十分必要,目前有"安全社区"模式、Haddon伤害预防十大策略等预防措施正在推广.对伤害现状及研究进展作一综述.     

WHO安全社区模型在伤害预防中的研究进展

伤害已成为世界性的公共卫生问题之一,创建安全社区、推进以社区为基础的安全促进计划,成为近10a来公共卫生领域的焦点。WHO安全社区模型于1989年正式提出,经过不断完善和发展,已得到全世界公共卫生领域的认可,在有效预防和控制伤害、降低伤害防制成本方面取得了显著成效。阐述WHO安全社区模型在伤害预防中的意义,目前面临的困难和问题,以及其在中国的研究进展情况。     

火灾伤害的防制策略研究

目的 了解火灾及其伤害的危害程度、流行原因及其规律，为制定火灾伤害的防制对策提供依据。方法 运用流行病学理论与方法，对火灾的危害状况、发生条件以及火灾伤害的流行原因与特征进行定性分析与描述。结果 火灾监测、报警、救援不及时，安全疏散不畅，公众防火安全意识与逃生自救知识缺乏等人为因素是火灾伤害发生的主要原因。火灾伤害是完全可以预防和控制的。结论 提出将火灾伤害纳入我国疾病预防控制和初级卫生保健体系，建立健全火灾伤害的预防、监测、警报体系，以及伤害后紧急救援体系等防制策略和建议。     

造船企业工人职业伤害知信行调查

选择杨浦区2家造船企业,分层整群抽取284名工人进行职业伤害知信行情况问卷调查。结果表明,造船企业工人普遍具有一定的安全意识,但21．48％工人对职业伤害的可控可防性认识不足,20％左右的工人在实际作业中存在着明显的不安全行为。提示社会相关部门应进一步加强对造船企业工人的职业伤害防制宣教工作,重点提升职工对职业伤害可防可控性的认识,促使工人的安全意识真正转化为安全行为．并通过加强技能和操作规程的培训,从根本上减少和杜绝工人的不安全行为,防制职业伤害的发生。     

宁波市5所中小学学生伤害认知情况分析

目的：为了解宁波市中小学生伤害的认知情况。为开展伤害干预提供依据。方法：选择宁波市鄞州区5所中小学，对7～17岁6234名学生进行问卷调查。结果：81．6％的中小学生的听说过伤害，64．9％的学生认为伤害是可以预防的，不是意外，小学生对伤害知识的掌握程度最差，90％以上的学生伤害防制知识来自学校教育、大众媒体宣传和父母亲教育。结论：应加强中小学生和家长防制伤害知识的健康教育。开展提高自我保护能力的技能培训,以减少伤害的发生。     

科学运用有害生物防制策略

有害生物防制策略是根据有害生物防制的形势发展而制定的防制方针和方法，是全局性的、长远的、发展的方略。不单是几种防制手段合并使用的方法学，同时亦是防制理论，是有害生物防制的重大发展，亦是今后走向有害生物综合治理的重要步骤。就是说，从有害生物及其生态环境以及社会经济效应的整体观念出发，以治本为主而又本标兼治，实施有效、经济、简便、安全及对环境无害的原则，综合采用诸多有效防制措施，组合成一套有害生物治理系统，把有害生物种群控制在低于受害允许水平，进而达到除害灭病的目的，保障人民的身体健康。     

Estimating mortality and causes of death in Turkey: methods, results and policy implications

BACKGROUND: Cause-specific mortality statistics are primary evidence for health policy formulation, programme evaluation, and epidemiological research. In Turkey, a partially functioning vital registration system in urban areas yields fragmentary evidence on levels and causes of mortality. This article discusses the application of innovative methods to develop national mortality estimates in Turkey, and their implications for national health development policies. METHODS: Child mortality levels from the Demography and Health Survey (DHS) were applied to model life tables to estimate age-specific death rates. Reported causes of death from urban areas were adjusted using re-distribution algorithms from the Global Burden of Disease (GBD) Study. Rural cause structure was estimated from epidemiological models. Local epidemiological data was used to adjust model-based estimates. RESULTS: Life expectancy at birth in 2000 was estimated to be 67.7 years (males) and 71.9 years (females), about 8-10 years lower than in Western Europe. Leading causes of death include major vascular diseases (ischaemic heart disease, stroke) causing 35-38% of deaths, chronic obstructive lung disease and lung cancer in men, but also perinatal causes, lower respiratory infections and diarrhoeal diseases. Injuries cause about 6-8% of deaths, although this may be an underestimate. CONCLUSIONS: Mortality estimates are uncertain in Turkey, given the poor quality of death registration systems. Application of burden of disease methods suggests that there has been progress along the epidemiological transition. Key health development strategies for Turkey include improved access to communicable disease control technologies, and urgent attention to the development of a reliable, nationally representative health information system.     

The National Tobacco Control Program: focusing on policy to broaden impact

Tobacco use is the single most preventable cause of death and disease in the United States, causing more than 440,000 premature deaths annually. We can dramatically reduce the health and economic burden of tobacco use by employing proven tobacco control and prevention strategies. Policy interventions offer the greatest opportunity to influence decisions regarding tobacco use at the societal level. Tobacco control policy can drive social, environmental, and systems changes, and has a substantially greater impact than interventions that target individuals. A policy approach engages the larger community and empowers it to establish healthy social norms. Health departments, the primary governmental institutions charged with protecting the health of the public, play many different roles in advancing policy. The National Tobacco Control Program funds state health departments to educate the public and decision makers regarding evidence-based policy strategies. This article outlines those strategies, critical success factors, and challenges associated with policy-based interventions.     

The high burden of injuries in South Africa

OBJECTIVE: To estimate the magnitude and characteristics of the injury burden in South Africa within a global context. METHODS: The Actuarial Society of South Africa demographic and AIDS model (ASSA 2002) - calibrated to survey, census and adjusted vital registration data - was used to calculate the total number of deaths in 2000. Causes of death were determined from the National Injury Mortality Surveillance System profile. Injury death rates and years of life lost (YLL) were estimated using the Global Burden of Disease methodology. National years lived with disability (YLDs) were calculated by applying a ratio between YLLs and YLDs found in a local injury data source, the Cape Metropole Study. Mortality and disability-adjusted life years' (DALYs) rates were compared with African and global estimates. FINDINGS: Interpersonal violence dominated the South African injury profile with age-standardized mortality rates at seven times the global rate. Injuries were the second-leading cause of loss of healthy life, accounting for 14.3% of all DALYs in South Africa in 2000. Road traffic injuries (RTIs) are the leading cause of injury in most regions of the world but South Africa has exceedingly high numbers - double the global rate. CONCLUSION: Injuries are an important public health issue in South Africa. Social and economic determinants of violence, many a legacy of apartheid policies, must be addressed to reduce inequalities in society and build community cohesion. Multisectoral interventions to reduce traffic injuries are also needed. We highlight this heavy burden to stress the need for effective prevention programmes.     

2007年上海市闸北区居民死因监测分析

目的了解上海市闸北区2007年居民病、伤、死亡原因特点，为制定相应公共卫生政策提供科学依据。方法应用流行病学方法对居民死亡资料进行统计分析。结果2007年闸北区居民粗死亡率为8．02‰，标化死亡率为2．46‰。前5位死因依次为循环系统疾病、肿瘤、呼吸系统疾病、损伤中毒和内分泌营养代谢性疾病。在老年组和中年组中，糖尿病已成为主要死因，肿瘤是中年组人群的首位死因，损伤中毒（伤害）是青年组的首位死因。居民减寿率为30.00‰，前5位减寿死因依次是恶性肿瘤、损伤中毒、脑血管疾病、心脏病和传染病。结论慢性非传染性疾病是本区面临的主要公共卫生问题，对众多危险因素的控制和干预应列出主要对策，对伤害的防范更应予以重视。     

Estimating cause-specific mortality from community- and facility-based data sources in the United Republic of Tanzania: options and implications for mortality burden estimates

OBJECTIVE: To compare mortality burden estimates based on direct measurement of levels and causes in communities with indirect estimates based on combining health facility cause-specific mortality structures with community measurement of mortality levels. METHODS: Data from sentinel vital registration (SVR) with verbal autopsy (VA) were used to determine the cause-specific mortality burden at the community level in two areas of the United Republic of Tanzania. Proportional cause-specific mortality structures from health facilities were applied to counts of deaths obtained by SVR to produce modelled estimates. The burden was expressed in years of life lost. FINDINGS: A total of 2884 deaths were recorded from health facilities and 2167 recorded from SVR/VAs. In the perinatal and neonatal age group cause-specific mortality rates were dominated by perinatal conditions and stillbirths in both the community and the facility data. The modelled estimates for chronic causes were very similar to those from SVR/VA. Acute febrile illnesses were coded more specifically in the facility data than in the VA. Injuries were more prevalent in the SVR/VA data than in that from the facilities. CONCLUSION: In this setting, improved International classification of diseases and health related problems, tenth revision (ICD-10) coding practices and applying facility-based cause structures to counts of deaths from communities, derived from SVR, appears to produce reasonable estimates of the cause-specific mortality burden in those aged 5 years and older determined directly from VA. For the perinatal and neonatal age group, VA appears to be required. Use of this approach in a nationally representative sample of facilities may produce reliable national estimates of the cause-specific mortality burden for leading causes of death in adults.     

Perceptions, knowledge and beliefs about prevention of cardiovascular diseases in Villa Nueva, Guatemala

Background

In Guatemala, cardiovascular diseases are becoming the leading cause of mortality and disability. The rising burden of these diseases makes it imperative to formulate effective community-based interventions. The success of these interventions will depend on the felt needs of the community. Therefore, in this study we assessed perceptions, knowledge and beliefs about cardiovascular diseases in community members, health workers and policy makers from Villa Nueva, a community selected by the Ministry of Health of Guatemala as a site to develop a cardiovascular disease prevention programme. This study provides baseline information for designing and implementing the demonstration programme.

Methods

Qualitative methods (focus group discussions and in-depth interviews) were used to elicit the views of community members, health workers, and policy makers on the magnitude, impact, risk factors and prevention of cardiovascular diseases and infrastructure in Villa Nueva.

Results

Community members perceive cardiovascular diseases as a serious health problem that has increased in recent years. They consider cardiovascular diseases to be acute dramatic events of sudden onset. According to health professionals and policy makers, the adoption of Western lifestyles by the population is the most important contributor to the increase of cardiovascular diseases in Guatemala. They indicated that prevention requires education of the population, together with adequate health policies. According to most participants, the infrastructure for the management of cardiovascular diseases at the primary health care level is inadequate.

Conclusion

Findings from this study suggest strategies for context-specific formulation of the cardiovascular prevention programme.     

The increasing burden of injuries in Eastern Europe and Eurasia: making the case for safety investments

Injuries are one of the leading causes of death and disability in Europe. Within Europe, death rates due to injuries are 60% higher in Eastern compared to Western Europe. This is especially due to unintentional injuries such as road traffic injuries, which is the 2nd leading cause of death in those 5-29 years. The cost of injuries is estimated at 1-2% of GNP. Compared to the burden, the number and types of programs are limited in the Eastern European region. However, the literature reveals the existence of cost-effective interventions for regional and national policy consideration. This is a need to appreciate this problem and promote investments to prevent the high economic and societal costs due to injuries. Results from selected injury prevention programs have shown considerable success and these, if effectively adopted in this region, will make a significant difference in reducing the heavy toll of injuries on lives of people. This paper calls on aid donor agencies and governments to plan and implement injury prevention programs as part of their portfolio of investments, in the Eastern European region.     

Tackling Africa's chronic disease burden: from the local to the global

Africa faces a double burden of infectious and chronic diseases. While infectious diseases still account for at least 69% of deaths on the continent, age specific mortality rates from chronic diseases as a whole are actually higher in sub Saharan Africa than in virtually all other regions of the world, in both men and women. Over the next ten years the continent is projected to experience the largest increase in death rates from cardiovascular disease, cancer, respiratory disease and diabetes. African health systems are weak and national investments in healthcare training and service delivery continue to prioritise infectious and parasitic diseases. There is a strong consensus that Africa faces significant challenges in chronic disease research, practice and policy. This editorial reviews eight original papers submitted to a Globalization and Health special issue themed: "Africa's chronic disease burden: local and global perspectives". The papers offer new empirical evidence and comprehensive reviews on diabetes in Tanzania, sickle cell disease in Nigeria, chronic mental illness in rural Ghana, HIV/AIDS care-giving among children in Kenya and chronic disease interventions in Ghana and Cameroon. Regional and international reviews are offered on cardiovascular risk in Africa, comorbidity between infectious and chronic diseases and cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe. We discuss insights from these papers within the contexts of medical, psychological, community and policy dimensions of chronic disease. There is an urgent need for primary and secondary interventions and for African health policymakers and governments to prioritise the development and implementation of chronic disease policies. Two gaps need critical attention. The first gap concerns the need for multidisciplinary models of research to properly inform the design of interventions. The second gap concerns understanding the processes and political economies of policy making in sub Saharan Africa. The economic impact of chronic diseases for families, health systems and governments and the relationships between national policy making and international economic and political pressures have a huge impact on the risk of chronic diseases and the ability of countries to respond to them.     

Developing socio-spatial knowledge networks: a qualitative methodology for chronic disease prevention

Chronic disease is a significant and costly social problem. The burden is even more pronounced in communities with high rates of a particular chronic disease. Assessment of health belief systems and the local geographies of health beliefs can assist community health planners to create cost-effective strategic intervention programs where populations are at high risk for chronic diseases. In this paper, we elaborate the concept of socio-spatial knowledge networks (SSKNs) and demonstrate that SSKNs can be useful in informing the design of health care prevention strategies. In our project, we demonstrate how to identify key socio-spatial information for intervention strategies which will prevent or delay the onset of a particular chronic disease, Type 2 diabetes. Our qualitative framework allows us to determine which sites might be best characterized as socio-spatial knowledge network nodes for sharing diabetes information and which sites might be less suited to such exchange. Our strategy explores cross-cultural similarities, differences, and overlap in a multi-ethnic rural North Carolina context through simple techniques such as mapping social networks and sites in which people share their knowledge and beliefs about diabetes. This geographical analysis allows us to examine exactly where health knowledge coincides with other social support, and where such resources may be improved in a particular community. Knowing precisely what people in a community understand about a chronic disease and its treatment or prevention and knowing where people go to share that information helps to (1) identify strategic locations within a community for future interventions and, (2) evaluate the effectiveness of existing interventions. The geographical approach presented here is one that can serve other communities and health practitioners who hope to improve chronic disease management in diverse local environments.     

Reducing the growing burden of cardiovascular disease in the developing world

Cardiovascular disease (CVD) has become the number-one cause of death in the developing world. This epidemic has the potential to place a large social and economic burden on developing countries, where CVD tends to strike those in their prime working years. Since resources for managing CVD are limited, it is important that interventions be guided by cost-effectiveness results for low- and middle-income countries. Despite the burden, cost-effective strategies exist at the population and individual levels for reducing CVD. Integral to all personal intervention strategies is an adequate assessment of the underlying risk of disease.