中日医院感染管理分析

目的 分析日本大分医科大学附属医院感染管理与中国医院感染管理现状,了解医院感染管理的动态,不断探索医院感染管理的新途径.方法 用中、日两国对感染管理工作的认识和作法进行对比,探讨医院感染管理的发展方向.结果 世界各国每所医院都十分重视感染管理工作,但具体做法则各有不同.结论 通过考察对比,在保持各自个性特点的同时,取长补短,使医院感染管理工作不断创新.     

Hospital Deaths Increased After Reforms Regardless of Dementia Status: An Interrupted Time-Series Analysis

ObjectivesDying in a hospital is highly stressful for older adults and families. Persons with dementia who are hospitalized are particularly vulnerable to negative outcomes. The objective of this study is to fill an evidence gap on whether the 2015 Dutch long-term care reforms were effective in increasing deaths at home while avoiding increases in hospital deaths for the total population aged ≥65 years and by dementia status.DesignWe used annual cross-sectional, nationally representative data from 2012 to 2017. We performed an interrupted time-series analyses to evaluate changes in location of death after the implementation of the Dutch long-term reforms.Setting and ParticipantsDutch population aged ≥65 years (N = 727,519) who died between 2012 and 2017 using data from Statistics Netherlands.MethodsThe primary outcome was death in a long-term care facility (LTCF), home, hospital, or elsewhere.ResultsAfter adjusting for seasonality and sex, we found significantly increased adjusted relative risk ratios (aRRRs) for the total older adult population having a death at home [aRRR 1.17, 95% confidence interval (CI) 1.12.-1.23] and hospital (1.09, 1.04-1.15) compared to deaths in an LTCF after the reforms. For persons with dementia (N = 81,373), hospital deaths increased (2.03, 1.37-3.01) compared with long-term care deaths after the implementation of the long-term care reforms; however, there was no change in the aRRR for death at home. For people without dementia (N = 646,146), we found increased aRRR for death at home (1.21, 1.16-1.28) and death at hospital (1.12, 1.07-1.19) vs LTCF deaths following the reforms.Conclusions and ImplicationsHospital and home deaths increased for the total population. Hospital deaths increased for persons with dementia after the long-term care reforms despite evidence of negative outcomes associated with end-of-life hospitalizations. The Netherlands may have overlooked the merits of home care and LTCFs, particularly for people with dementia.     

Evaluating the Use of microRNA Blood Tests for Gastric Cancer Screening in a Stratified Population-Level Screening Program: An Early Model-Based Cost-Effectiveness Analysis

ObjectivesTo evaluate cost-effectiveness of a novel screening strategy using a microRNA (miRNA) blood test as a screen, followed by endoscopy for diagnosis confirmation in a 3-yearly population screening program for gastric cancer.MethodsA Markov cohort model has been developed in Microsoft Excel 2016 for the population identified to be at intermediate risk (Singaporean men, aged 50-75 years with Chinese ethnicity). The interventions compared were (1) initial screening using miRNA test followed by endoscopy for test-positive individuals and a 3-yearly follow-up screening for test-negative individuals (proposed strategy), and (2) no screening with gastric cancer being diagnosed clinically (current practice). The model was evaluated for 25 years with a healthcare perspective and accounted for test characteristics, compliance, disease progression, cancer recurrence, costs, utilities, and mortality. The outcomes measured included incremental cost-effectiveness ratios, cancer stage at diagnosis, and thresholds for significant variables.ResultsThe miRNA-based screening was found to be cost-effective with an incremental cost-effectiveness ratio of $40 971/quality-adjusted life-year. Key drivers included test costs, test accuracy, cancer incidence, and recurrence risk. Threshold analysis highlights the need for high accuracy of miRNA tests (threshold sensitivity: 68%; threshold specificity: 77%). A perfect compliance to screening would double the cancer diagnosis in early stages compared to the current practice. Probabilistic sensitivity analysis reported the miRNA-based screening to be cost-effective in >95% of iterations for a willingness to pay of $70 000/quality-adjusted life-year (approximately equivalent to 1 gross domestic product/capita)ConclusionsThe miRNA-based screening intervention was found to be cost-effective and is expected to contribute immensely in early diagnosis of cancer by improving screening compliance.     

大学新生肺结核检出情况分析

目的了解新生肺结核的发病情况,为结核病的防治提供依据。方法对19146名大学新生进行胸透等检查,查出的肺结核病人进行统计分析,并对确诊病例采取相应的治疗与预防措施。结果确诊肺结核病例25人。2005、2006年检出率分别为1.2‰、1.3‰。男生的肺结核检出率(2.22‰)高于女生(0.48‰),差异具有统计学意义(χ2=11.31,p<0.01)。结论大学新生体检中肺结核的检出率仍较高,对结核病的防治工作决不能松懈。     

大学新生肺结核检出情况分析

目的 了解新生肺结核的发病情况,为结核病的防治提供依据.方法 对 19 146名大学新生进行胸透等检查,查出的肺结核病人进行统计分析,并对确诊病例采取相应的治疗与预防措施.结果 确诊肺结核病例25人.2005、2006年检出率分别为1.2 ‰、1.3 ‰.男生的肺结核检出率(2.22 ‰)高于女生(0.48 ‰),差异具有统计学意义(χ2=11.31,p＜0.01).结论 大学新生体检中肺结核的检出率仍较高,对结核病的防治工作决不能松懈.     

大气PM10与心血管疾病就诊人次的时间序列分析

目的 研究大气PM10污染对居民心血管系统疾病日就诊人次的影响.方法 采用广义相加Poisson回归模型的时间序列分析,在控制长期趋势、星期几效应、气象因素等混杂因素的影响后,对2002年1月1日-2002年12月31日北京市大气PM10日均浓度与居民心血管系统疾病日就诊人次进行定量回归分析,并考虑滞后效应和其他空气污染物的影响.结果 大气PM10浓度每上升10μg/m~3,当天的心血管系统疾病日就诊人次增加O.380%(95%CI:0.326%～0.433%);滞后4 d PM10的健康效应最强,超额危险度为1.166%(95%CI:1.121%～1.212%);考虑CO、NO_2、SO_2:的影响均使PM10的健康效应估计值增高.结论 北京城区大气PM10污染与居民心血管系统疾病日就诊人次之间存在正相关.

Abstract：

Objective To estimate quantitatively the impact of the ambient PM10 on the hospital outpatients for cardiovascular diseases of local residents. Methods Time serial analysis using generalized addictive model (GAM) was applied. After controlling for those confounding factors such as long-term trend, weekly pattern and meteorological factors, considering lag effect and the influence of other air pollutants, excess relative risks (ER) of daily hospital visits associated with increasing PM10 level were estimated by fitting a Poisson regression model. Results A 10 μ.g/m~3 increase in PM10 levels was associated with an ER of 0.380% (95%CI: 0.326%～0.433%) for hospital visits for cardiovascular diseases. Lag effect of 4 days with an ER of 1.166% (95%C/:1.121%～1.212%) were observed. The ER value increased when CO, NO_2, SO_2 concentrations were introduced. Conclusion The ambient PM10 concentration is positively associated with daily hospital visits for cardiovascular diseases in Beijing.     

从SARS医院感染分析医院感染管理缺陷

目的 从SARS医院感染角度探讨医院感染管理方面存在的缺陷与改善的措施。方法 以现有的信息资料和实践经验从医院感染管理角度分析对突发疫情控制存在的缺陷，探讨改善的措施。结果 医院感染管理方面存在的缺陷主要是医院感染信息监控网没有充分发挥应有的作用；医院感染管理机构对医院感染重视不够，指导措施不力；医护人员有法不依、有章不循；某些现代化的医院基础设施不利于医院感染的控制。结论 尽快完善和加强医院感染信息监控网的职能；医院感染管理机构高度重视和正确指导医院感染管理工作；加大医院感染规范执行力度及加强医院感染基础设施投资和改造是提高医院感染管理水平的当务之急和关键措施。     

大学生营养K-A-P调查分析

目的了解大学生的营养知识、态度及饮食行为(K-A-P)状况,为进一步改善大学生的生活饮食习惯提供依据。方法采用自行设计的问卷,对玉林师范学院97名大学生进行营养知识、态度和饮食行为的调查。结果各年级大学生营养知识得分最低分为0分,最高分14分。不同年级大学生的营养知识得分情况不同。低分数(0~5分)人群中,学生年级越高,所占比例越低,而高分数(11~14分)人群中,学生年级越高,所占比例越高。大一、大二及大三年级学生中分别有93.55%,90.91%和93.94%的学生想了解更多营养与健康方面的知识。51.55%的学生不能每天吃早餐,29.90%的学生不能定时定量进餐,23.71%的学生存在偏食或者挑食。结论应利用多种途径加强对大学生相关营养知识的宣传教育,以纠正不健康的饮食行为。     

广州市灰霾天气对城区居民心血管疾病影响的时间序列分析

目的 探讨灰霾天气(haze)和PM10、PM2.5、SO_2、NO_2浓度对心血管疾病日门诊量的影响,为进一步制定有效的环境法规、保护易感人群提供依据.方法 收集广州市中心城Ⅸ某医院心血管疾病日门诊量资料及同时期大气污染物浓度、气象监测资料,采用时间序列的自回归模型,在控制了长期趋势、短期趋势、气象因素等混杂因素的基础上,分析广州中心城区2006年1月1日-2008年12月31日灰霾天气及空气污染物与居民心血管疾病发病的关系.结果 自回归模型显示,2008年的门诊量水平高于2006年.每年4和12月的门诊量高于1月,工作日都高于休息日;灰霾的水平与医院心血管门诊病人量呈正相关,灰霾天气每增加1 d,医院门诊病人量就上升2.12个单位;前第2天的灰霾的水平(lag2)对当天的疾病水平是负影响.而残差部分表明前1 d和前3 d的疾病门诊残留量(AR1、AR3)对当天的门诊残留量是正影响(分别增加52.25%,26.1%),前2d的疾病门诊残留量(AR2)对当天的门诊残留最是负影响(下降17%).另外,各种空气污染物(PM10、PM2.5、SO_2、NO_2)之间呈现一定正相关性,并且具有滞后现象.结论 由悬浮颗粒物、气象因素和气体污染物产生的灰霾天气是心血管疾病发病的环境病因,而单个空气污染物指标对心血管门诊病人量的影响被灰霾污染的综合效应所弱化.

Abstract：

Objective To explore the effects of atmospheric haze and air pollutants(PM 10, PM2.5). SO_2, NO_2 on hospital visits for cardiovascular diseases. Methods The relationship among atmospheric haze, air pollution and the outpatients data of Guangzhou for cardiovascular disease had been investigated by collecting the air pollution data, the meteorological data and cardiovascular diseases' outpatients data in Guangzhou city from January 1, 2006 to December 31,2008 . The time-series analysis by auto-regression model was used, controlling for long-term trends, seasonal patterns and meteorological variables. Results Auto-regression model showed that the number of outpatients in 2008 was higher than that in 2006.The number was larger in April and December compared with that in January, and it was higher on Monday, Tuesday, Wednesday, Thursday and Friday than on Saturday, Sunday. There was a positive correlation between the haze level and cardiovascular outpatients. The number of hospital outpatients increased by 2.12 units with each additional day of the atmospheric haze. The haze level (lag2) of the former second day had a negative impact on the intraday data of outpatients. The residual parts showed that outpatients' residual data (AR1, AR3) of the former first and third day had a positive effect on intraday outpatients' residual data (increased by 52.25%, 26.1%), while the outpatients' residual data of the former second day (AR2) had a negative effect on outpatients' residual data of the present day (decreased by 17%). In addition, a variety of air pollutants (PM10, PM2.5, SO_2, and NO_2) showed some positive correlation, and had hysteresis. Conclusion The atmospheric haze, generated from suspended paniculate, meteorological factor and gaseous pollutants, is the environmental pathogenic factor for the cardiovascular diseases, while the effects of single air pollutant on the hospital visit for cardiovascular diseases can be weakened by the haze pollution.     

Optimal Design of Population-Level Financial Incentives of Influenza Vaccination for the Elderly

ObjectivesTo identify how monetary incentives affect influenza vaccination uptake rate using a randomized control experiment and to subsequently design an optimal incentive program in Singapore, a high-income country with a market-based healthcare system.Methods4000 people aged ≥65 were randomly assigned to 4 treatment groups (1000 each) and were offered a monetary incentive (in shopping vouchers) if they chose to participate. The baseline group was invited to complete a questionnaire with incentives of 10 Singapore dollars (SGD; where 1 SGD ≈ 0.73 USD), whereas the other three groups were invited to complete the questionnaire and be vaccinated against influenza at their own cost of around 32 SGD, in return for incentives of 10, 20, or 30 SGD.ResultsIncreasing the total incentive for vaccination and reporting from 10 to 20 SGD increased participation in vaccination from 4.5% to 7.5% (P < .001). Increasing the total incentive from 20 to 30 SGD increased the participation rate to 9.2%, but this was not statistically significantly different from a 20-SGD incentive. The group of nonworking elderly were more sensitive to changes in incentives than those who worked. In addition to working status, the effects of increasing incentives on influenza vaccination rates differed by ethnicity, socio-economic status, household size, and a measure of social resilience. There were no significant differential effects by age group, gender, or education, however. The cost of the program per completed vaccination under a 20-SGD incentive is 36.80 SGD, which was the lowest among the three intervention arms. For a hypothetical population-level financial incentive program to promote influenza vaccination among the elderly, accounting for transmission dynamics, an incentive between 10 and 20 SGD minimizes the cost per completed vaccination from both governmental and health system perspectives.ConclusionsAppropriate monetary incentives can boost influenza vaccination rates. Increasing monetary incentives for vaccination from 10 to 20 SGD can improve the influenza vaccination uptake rate, but further increasing the monetary incentive to 30 SGD results in no additional gains. A partial incentive may therefore be considered to improve vaccination coverage in this high-risk group.     

Systems Science and Obesity Policy: A Novel Framework for Analyzing and Rethinking Population-Level Planning

Objectives. We demonstrate the use of a systems-based framework to assess solutions to complex health problems such as obesity.Methods. We coded 12 documents published between 2004 and 2013 aimed at influencing obesity planning for complex systems design (9 reports from US and Canadian governmental or health authorities, 1 Cochrane review, and 2 Institute of Medicine reports). We sorted data using the intervention-level framework (ILF), a novel solutions-oriented approach to complex problems. An in-depth comparison of 3 documents provides further insight into complexity and systems design in obesity policy.Results. The majority of strategies focused mainly on changing the determinants of energy imbalance (food intake and physical activity). ILF analysis brings to the surface actions aimed at higher levels of system function and points to a need for more innovative policy design.Conclusions. Although many policymakers acknowledge obesity as a complex problem, many strategies stem from the paradigm of individual choice and are limited in scope. The ILF provides a template to encourage natural systems thinking and more strategic policy design grounded in complexity science.Obesity is widely recognized as a complex problem emerging from a system composed of many diverse, interacting variables.1–3 Several factors make the obesity system difficult to shift, including but not limited to the presence of feedback loops and delays; an abundance of nonlinear, overlapping interdependencies; and the heterogeneity of individuals and organizations.1,4 Policymakers and planners have responded to the obesity epidemic by producing a large number of frameworks, strategies, and action plans. Although past efforts have been criticized for emphasizing individual lifestyle change as the solution,5,6 recent efforts have embraced socioecological models of intervention, emphasizing the obesogenic environment and its impact on individual weight gain.3,7 The many options available to policymakers have the potential to result in what Lang and Rayner6^(p166) termed a “policy cacophony” of noise drowning out effort.Efforts to shift the systems that support the emergence of chronic disease and obesity are starting to benefit from a focused effort to apply systems science,8 as has been done with other pressing public health issues such as tobacco.9 Obesity, tied up with difficult ideological and political questions regarding responsibility and stigma,10–13 is a particularly wicked social problem for which reductionist science may be less helpful. Systems science can complement socioecological models of health promotion by examining not just the causes of obesity but also interactions across its contributing subsystems.14 The UK government’s Foresight program contributed to the perception of obesity as a complex problem with the development of an obesity system map highlighting the diversity of factors involved in subsystems such as food production and consumption, individual physical activity and the physical activity environment, social and individual psychology, and physiology.4 The heuristic value of the Foresight map in demonstrating the complexity of obesity and the interdependencies between the system’s variables is an example of a systems science tool that may help to advance the conversation about what actions need to be taken.Although the Foresight map helps to focus dialogue on the complex nature of obesity, it does not immediately lead to discussion of solutions appropriate for this complex problem. We recently developed a systems science framework that may be a useful and accessible means of operationalizing systems thinking toward solutions. The intervention-level framework (ILF) was adapted from Donella Meadows’15 list of 12 places to intervene in complex systems. Meadows, a pioneering environmental scientist, spent decades analyzing the complexities of economic growth and environmental sustainability, and she grew frustrated with the unintended consequences that resulted when simple solutions were applied to complex problems. We collapsed the original 12 points of intervention into 5 more mutually exclusive levels that retain all of the original ideas but allow for the sorting of content in a reproducible fashion. These levels account for system operation at the levels of paradigm, goals, system structure, feedback and delays, and structural elements. To date, the ILF has been used in framework analyses of content concerning actions to improve food systems, wherein it was useful in elucidating points of conflict and convergence to make them more healthy, green, fair, and affordable.16In this article, we explore the application of the ILF to the obesity system by analyzing recent strategies and reports aimed at influencing policy and planning. Our interest was in developing a deeper, more integrated understanding of how best to act in addressing the complex problem of obesity. Using a systems lens, we sought to advance our understanding of the various system levels and the specific interventions required to support large-scale change. We also sought to further the application of systems-based frameworks in the analysis of complex health problems in a manner accessible to public health practitioners and policymakers lacking expertise in systems science methodologies.     

大学生“一夜情”现状调查与分析

目的了解大学生"一夜情"现状及性常识、性观念、性态度,为大学生性健康教育提供理论依据。方法调查组采用在线网络问卷调查及随机抽样现场调查方法对大学生进行无记名问卷调查。结果在被调查人群中,有性行为的大学生占17.5%,3.3%的大学生承认自己有过"一夜情"经历,12.2%的大学生对"一夜情"持认同和接受态度。结论目前大学生性态度日趋多元化,性行为甚至"一夜情"客观存在,家庭、学校、社会应及时对大学生进行性健康与性安全教育和指导。     

The Influence of Average Temperature and Relative Humidity on New Cases of COVID-19: Time-Series Analysis

BackgroundThe influence of meteorological factors on the transmission and spread of COVID-19 is of interest and has not been investigated.ObjectiveThis study aimed to investigate the associations between meteorological factors and the daily number of new cases of COVID-19 in 9 Asian cities.MethodsPearson correlation and generalized additive modeling (GAM) were performed to assess the relationships between daily new COVID-19 cases and meteorological factors (daily average temperature and relative humidity) with the most updated data currently available.ResultsThe Pearson correlation showed that daily new confirmed cases of COVID-19 were more correlated with the average temperature than with relative humidity. Daily new confirmed cases were negatively correlated with the average temperature in Beijing (r=–0.565, P<.001), Shanghai (r=–0.47, P<.001), and Guangzhou (r=–0.53, P<.001). In Japan, however, a positive correlation was observed (r=0.416, P<.001). In most of the cities (Shanghai, Guangzhou, Hong Kong, Seoul, Tokyo, and Kuala Lumpur), GAM analysis showed the number of daily new confirmed cases to be positively associated with both average temperature and relative humidity, especially using lagged 3D modeling where the positive influence of temperature on daily new confirmed cases was discerned in 5 cities (exceptions: Beijing, Wuhan, Korea, and Malaysia). Moreover, the sensitivity analysis showed, by incorporating the city grade and public health measures into the model, that higher temperatures can increase daily new case numbers (beta=0.073, Z=11.594, P<.001) in the lagged 3-day model.ConclusionsThe findings suggest that increased temperature yield increases in daily new cases of COVID-19. Hence, large-scale public health measures and expanded regional research are still required until a vaccine becomes widely available and herd immunity is established.     

The Value of Interrupted Time-Series Experiments for Community Intervention Research

Greater use of interrupted time-series experiments is advocated for community intervention research. Time-series designs enable the development of knowledge about the effects of community interventions and policies in circumstances in which randomized controlled trials are too expensive, premature, or simply impractical. The multiple baseline time-series design typically involves two or more communities that are repeatedly assessed, with the intervention introduced into one community at a time. It is particularly well suited to initial evaluations of community interventions and the refinement of those interventions. This paper describes the main features of multiple baseline designs and related repeated-measures time-series experiments, discusses the threats to internal validity in multiple baseline designs, and outlines techniques for statistical analyses of time-series data. Examples are given of the use of multiple baseline designs in evaluating community interventions and policy changes.     

Associations of Fine Particulate Matter Species with Mortality in the United States: A Multicity Time-Series Analysis

Background: Epidemiological studies have examined the association between PM_2.5 and mortality, but uncertainty remains about the seasonal variations in PM_2.5-related effects and the relative importance of species.Objectives: We estimated the effects of PM_2.5 species on mortality and how infiltration rates may modify the association.Methods: Using city–season specific Poisson regression, we estimated PM_2.5 effects on approximately 4.5 million deaths for all causes, cardiovascular disease (CVD), myocardial infarction (MI), stroke, and respiratory diseases in 75 U.S. cities for 2000–2006. We added interaction terms between PM_2.5 and monthly average species-to-PM_2.5 proportions of individual species to determine the relative toxicity of each species. We combined results across cities using multivariate meta-regression, and controlled for infiltration.Results: We estimated a 1.18% (95% CI: 0.93, 1.44%) increase in all-cause mortality, a 1.03% (95% CI: 0.65, 1.41%) increase in CVD, a 1.22% (95% CI: 0.62, 1.82%) increase in MI, a 1.76% (95% CI: 1.01, 2.52%) increase in stroke, and a 1.71% (95% CI: 1.06, 2.35%) increase in respiratory deaths in association with a 10-μg/m³ increase in 2-day averaged PM_2.5 concentration. The associations were largest in the spring. Silicon, calcium, and sulfur were associated with more all-cause mortality, whereas sulfur was related to more respiratory deaths. County-level smoking and alcohol were associated with larger estimated PM_2.5 effects.Conclusions: Our study showed an increased risk of mortality associated with PM_2.5, which varied with seasons and species. The results suggest that mass alone might not be sufficient to evaluate the health effects of particles.Citation: Dai L, Zanobetti A, Koutrakis P, Schwartz JD. 2014. Associations of fine particulate matter species with mortality in the United States: a multicity time-series analysis. Environ Health Perspect 122:837–842; http://dx.doi.org/10.1289/ehp.1307568     

某高校学生肺结核病聚集感染情况分析

本文报告黄山学院在3个月内发生肺结核病人17例,其中1个班同时出现9例肺结核病人,该班级的同系203名学生中,PPD检测24例强阳性(+++),174例呈阳性,感染率高达97.5%。分析该校肺结核病的流行病学资料,对其发病、防控和预防情况进行了总结,探讨了导致该校出现肺结核病聚集感染的几个因素,如对结核病认识不足、心理压力、营养不良等,并为高校防治结核病提出了一些建议。     

某高校学生肺结核病聚集感染情况分析

本文报告黄山学院在3个月内发生肺结核病人17例,其中1个班同时出现9例肺结核病人,该班级的同系203名学生中,PPD检测24例强阳性(+++),174例呈阳性,感染率高达97.5%。分析该校肺结核病的流行病学资料,对其发病、防控和预防情况进行了总结,探讨了导致该校出现肺结核病聚集感染的几个因素,如对结核病认识不足、心理压力、营养不良等,并为高校防治结核病提出了一些建议。     

Food Insecurity Among College Students: An Analysis of US State Legislation Through 2020

Many US college students experience food insecurity (FI). Given most students are excluded from receiving federal nutrition assistance, additional efforts are needed to alleviate student FI. This perspective discusses proposed and enacted state statutes, resolutions, and bills addressing college FI to date, which range in depth, breadth, and success. Overall, states have demonstrated their promising role in addressing FI; however, college FI promises to be a continuing challenge, particularly given continued widespread unemployment that began with the onset of coronavirus disease 2019 and the global struggle for economic recovery.     

基于ARIMA模型的中国卫生总费用预测分析

卫生总费用是研究和评价卫生改革与发展政策的重要工具.文章利用1978至2007年卫生总费用占GDP比重的历史数据,采用ARIMA(1,1,6)模型进行拟合,在模型进行检验适用的前提下对2010年的卫生总费用占GDP比重进行预测,结果发现2010年我国卫生总费用占GDP比重为4.73%,仍低于世界卫生组织规定的最低标准5%,提出加大公共卫生投入,扩大健康保障制度覆盖面来适度提高卫生总费用占GDP重,实现卫生资源配置优化.