常德市2001-2009年新涂阳肺结核发现及治疗管理评价

目的评价常德市2001-2009年新涂阳肺结核患者的分布特征以及治疗转归情况。方法收集湖南省常德市2001-2009年中国疾病预防控制信息系统结核病管理信息系统以及相关登记资料、纸质文书、报表等材料,按照《中国结核病防治规划实施工作指南》[1]和其它相关要求进行统计分析。结果常德市2001-2009年新涂阳肺结核患者年登记率由2001年的21.00/10万上升到2009年的42.45/10万。分年龄组以55~64岁居第1位,其次是65岁以上年龄组,男女患者性别比例为2.66：1;年登记率超过40/10万的有临澧县、津市、澧县、石门县、桃源县。登记新涂阳患者全部接受治疗,新涂阳患者治疗2月末总体阴转率为95.8%,治疗3月末阴转率为97.6%;新涂阳肺结核患者总治愈率为89.99%,完成疗程率5.43%,治疗成功率95.42%。结论实施DOTS策略,可提高新涂阳肺结核患者的治愈率,减少结核病的传播。     

HIV in Predominantly Rural Areas of the United States

BACKGROUND: The burden of HIV/AIDS has not been described for certain rural areas of the United States (Appalachia, the Southeast Region, the Mississippi Delta, and the US-Mexico Border), where barriers to receiving HIV services include rural residence, poverty, unemployment, and lack of education. METHODS: We used data from Centers for Disease Control and Prevention (CDC) HIV/AIDS Reporting System to determine the rates of HIV (data from 29 states) and AIDS diagnoses (data from 50 states and the District of Columbia) in 2000 for the 4 regions by demographic and residential (rural and economic indicators of county of residence) characteristics. Results: The rate of HIV diagnoses in 2000 was lower in rural areas (7.3 per 100,000) than in suburban (8.6 per 100,000) or urban areas (22.7 per 100,000). The highest race-adjusted rate was observed for the US-Mexico Border (21.1 per 100,000), followed by the Mississippi Delta (17.3 per 100,000), Southeast Region (14.7 per 100,000), and Appalachia (10.4 per 100,000). Heterosexually acquired HIV was more common in the Southeast Region and the Mississippi Delta than elsewhere. The Mississippi Delta had the highest proportion of HIV diagnoses among young people aged 13-24 years (18.4%). More than three quarters of people diagnosed with HIV in the Mississippi Delta and the Southeast Region were black, and diagnosis rates were higher among blacks and Hispanics than whites in all regions. The distribution of demographic and residential characteristics among people with AIDS was similar to that of all people with a diagnosis of HIV. CONCLUSION: Strategies are needed to reach the populations of these areas to reduce transmission of HIV.     

Appalachian versus non-Appalachian U.S. traffic fatalities, 2008–2010

PurposeAlthough myriad health disparities exist in Appalachia, limited research has examined traffic fatalities in the region. This study compared traffic fatality rates in Appalachia and the non-Appalachian United States.MethodsFatality Analysis Reporting System and Census data from 2008 through 2010 were used to calculate traffic fatality rates. Poisson models were used to estimate unadjusted (rate ratio [RR]) and adjusted rate ratios, controlling for age, gender, and county-specific population density levels.ResultsThe Appalachian traffic fatality rate was 45% (95% confidence interval [CI], 1.42–1.47) higher than the non-Appalachian rate. Although only 29% of fatalities occur in rural counties in non-Appalachia versus 48% in Appalachia, rates in rural counties were similar (RR, 0.97; 95% CI, 0.95–1.00). However, the rate for urban, Appalachian counties was 42% (95% CI, 1.38–1.45) higher than among urban, non-Appalachian counties. Appalachian rates were higher for passenger vehicle drivers, motorcyclists, and all terrain vehicle riders, regardless of rurality, as well as for passenger vehicle passengers overall and for urban counties. Conversely, Appalachia experienced lower rates among pedestrians and bicyclists, regardless of rurality.ConclusionsDisparities in traffic fatality rates exist in Appalachia. Although elevated rates are partially explained by the proportion of residents living in rural settings, overall rates in urban Appalachia were consistently higher than in urban non-Appalachia.     

基于传染病监测系统的肺结核疫情和流行特征

目的探讨2011—2020年长沙市肺结核发病趋势和流行特征。方法采用回顾性分析方法,从中国疾病预防控制信息系统的传染病监测系统中导出长沙市2011—2020年肺结核报告发病信息,对肺结核病例在时间、地区、年龄、性别和职业等方面的分布特征及流行趋势进行描述性分析。结果2011—2020年间,长沙市肺结核报告发病人数共48587例,年均报告发病率为62.94/10万(56.44/10万~84.34/10万);报告病原学阳性肺结核共18455例,年均报告发病率23.91/10万(19.91/10万~28.88/10万);2017—2020年报告利福平耐药共251例,年均利福平耐药发病率0.81/10万(0.61/10万~0.85/10万)。长沙市2011—2020年肺结核报告发病率总体呈下降趋势(Z=32.4355,P=0.0001),年递降率为4.36%。地区分布位居前三位的分布是浏阳市、宁乡市和望城区,年均发病率分别为79.98/10万、79.31/10万和67.80/10万;性别分布以男性为主,年均报告发病率男性和女性分别为87.92/10万和39.71/10万,男性和女性年均递减率分别为5.38%和2.47%。年龄分布中,<15岁年龄组、15~岁组和65岁及以上组的年均肺结核报告发病率分别为2.38/10万、62.31/10万和150.19/10万。职业分布中以农民为主,其次是家务及待业人员和离退人员;学生的发病数及占比都有明显升高,2020年占比达第四位(5.64%)。结论2011—2020年长沙市肺结核报告发病总体呈稳定下降趋势,应进一步加强对农村人口、学生和65岁以上老年人等重点人群的结核病防控工作。     

2012—2018年重庆市精神障碍死亡率及疾病负担变化趋势

目的 了解重庆市精神障碍死亡率与疾病负担变化趋势,为开展精神障碍防治工作提供建议。 方法 收集2012—2018年重庆市精神障碍死亡个案,分析死亡率、标化死亡率、早死导致寿命损失年率、平均寿命损失年和年度变化百分比(annual percent change, APC)。不同性别、不同地区间死亡率的比较采用χ²检验,率的趋势变化采用APC,对其检验采用t检验。 结果 重庆市精神障碍死亡率与标化死亡率分别由2012年的1.86/10万、1.63/10万上升至2018年的2.66/10万、2.04/10万,APC分别为6.61%与4.29%,死亡率变化趋势差异有统计学意义(t=3.00,P=0.030)。各年度男女精神障碍死亡率差异均无统计学意义(P>0.05)。城市与农村精神障碍死亡率比较发现,2014年与2016年农村死亡率高于城市,2018年城市高于农村,差异均有统计学意义(P<0.05)。精神障碍死亡率随年龄的增长而上升。重庆市精神障碍早死所致的寿命损失年率(years of life due to premature death, YLL)波动于0.47‰～0.58‰,平均寿命损失年(average years of life lost due to premature death,AYLL),由2012年的26.08年下降至2018年的17.83年,APC为-6.67%,变化趋势有统计学意义(t=7.09,P=0.001)。 结论 2012—2018年重庆市精神障碍死亡率呈上升的趋势,高于其它省市精神障碍死亡率,平均寿命损失年呈下降的趋势,精神障碍纳入社区管理成效明显。     

广州市第四次结核病流行病学抽样调查

目的 调查结核病疫情现状。方法 分层整群随机抽样,按《2000年全国结核病流行病学抽样调查实施细则》在广州市城乡10个点开展流调。结果 活动性肺结核患病率145．7／10万,涂阳患病率48．6／10万,患病率和涂阳患病率的年均递降率分别为4．8％和3．0％。结核病死亡居各类死因的第9位,死亡专率5．5／10万。患病趋势随着年龄增长而增高,城乡之间的差异缩小。结论 广州市结核病疫情持续改善,但下降速度缓慢。     

2004-2005年湖南省居民伤害死亡水平与分布特征分析

目的探讨湖南省城乡人群伤害死亡特征,为制定预防措施提供依据。方法应用2004-2005年湖南省第3次死因回顾抽样调查资料,分析不同人群伤害死亡率、构成比以及外部原因构成的差异。结果 2004-2005年湖南省10个县（市、区）居民伤害死亡率为67.40/10万,其中城市和农村伤害年平均死亡率分别为65.98/10万、67.87/10万;男性是女性1.91倍（P〈0.01）,伤害死亡占全部死亡数的11.08%,居所有疾病死因的第四位。居民伤害前4位死因依次为交通伤害、自杀、跌落、溺水。结论伤害已成为危害城乡人群的主要死因之一,应根据湖南省不同人群伤害死亡的特点,开展系统研究和实施干预措施。     

泰州市肺结核发病率的预测

目的:预测泰州市肺结核的发病率,掌握疫情动态,为科学合理地调配肺结核的防治资源提供依据。方法:建立灰色预测模型,对7年来肺结核疫情资料进行预测分析。结果:建立的预测模型精度指标后验差比值C为0.36,小误差频率P为1.00,属于“合格”一级,预测2005 年泰州市肺结核发病率为53.14/10万,相对误差为13.84%。结论:灰色数列预测模型预测性能可靠,可以对该地肺结核的发病率做短期预测。     

2011-2015年上海市金山区肺结核流行特征分析

目的 了解2011-2015年金山区肺结核病的流行状况,为今后结核病防治工作开展提供参考依据。方法 通过全国结核病信息管理系统收集2011-2015年上海市金山区肺结核疫情资料,采用描述流行病学方法对数据进行分析。结果 2011-2015年共登记肺结核患者1 091例,年均肺结核发病率分别为29.06/10万,涂阳率、菌阳率分别为48.49%和65.26%;户籍人口和流动人口肺结核年均发病率分别为30.03/10万和26.90/10万;肺结核类型以继发性 (Ⅲ型)为主(98.99%),患者主要来源于因症就诊(60.59%);4~10月份为该区肺结核相对高发月份;男女性别比为2.44:1,肺结核发病以55岁及以上患者为主,占47.84%;职业分布以农民为主(30.34%),其次为离退人员(16.41%)、工人(13.84%)、家务及待业(11.46%)。结论 上海市金山区肺结核疫情维持在较低水平,但2011-2015年期间并未见明显下降趋势,涂阳率和菌阳率居高不下,发病以男性居多,集中在成人尤其是老年人。在今后工作中,应继续加强该区结核病防控工作,尤其应重点关注肺结核高发人群。     

2001-2009年常德市结核病控制效果分析

目的分析常德市结核病控制项目实施9年的效果,为结核病防治工作可持续发展提供依据。方法收集2001-2009年湖南省常德市中国疾病预防控制信息系统资料、13个县(市、区)中国结核病防治规划登记资料、相关纸质文书、报表等资料。按照《中国结核病防治规划实施工作指南》和其它相关要求进行统计分析。结果常德市2002年启动现代结核病控制策略,2004年以县为单位DOTS策略覆盖率达到100%。2001-2009年全市共接诊结核病可疑症状者123 538例,可疑者年就诊率从2001年的113.74/10万上升到2009年的324.61/10万;发现涂阳肺结核患者25 758例,其中新涂阳患者21 800例,新涂阳肺结核登记率平均为40.07/10万,新涂阳肺结核发现率平均为65.63%;初治涂阳平均治愈率为88.8%,复治涂阳平均治愈率为82.0%。结论实施DOTS策略,可提高肺结核患者的发现率和治愈率,减少结核病的传播,产生明显的社会防治效益。     

2013—2018年重庆市儿童白血病发病死亡趋势分析

目的 分析重庆市儿童白血病发病和死亡趋势,为开展儿童白血病防治提供建议。 方法 选取2013—2018年0~14岁重庆市白血病发病死亡个案,资料来源于重庆市肿瘤登记点,采用SPSS 25.0统计分析发病率、年龄别发病率、死亡率和年龄别死亡率、年度变化百分比(annual percent change, APC)。男性与女性、城市与农村儿童白血病发病率、死亡率比较采用χ²检验,趋势分析以APC表示。 结果 重庆市儿童白血病发病率由2013年4.37/10万下降至2018年的1.98/10万,APC为-13.41%,变化趋势差异无统计学意义(t=2.50,P=0.067)。各年度男性与女性发病率差异均无统计学意义(P>0.05)。女性白血病发病率以年均10.24%下降,变化趋势差异有统计学意义(t=2.91,P<0.05)。各年度城市与农村地区儿童白血病发病率差异均无统计学意义(P>0.05),农村地区儿童白血病发病率以年均16.64%下降,变化趋势差异有统计学意义(t=3.31,P<0.05)。重庆市儿童白血病死亡率由2013年的1.91/10万下降至2018年1.50/10万,APC为-7.32%,变化趋势差异无统计学意义(t=2.69,P=0.055)。各年度男性与女性死亡率差异均无统计学意义(P>0.05)。男童白血病死亡率以年均6.20%下降,变化趋势差异有统计学意义(t=2.87,P<0.05)。各年度城市与农村白血病死亡率差异均无统计学意义(P>0.05)。白血病各年龄段均有发病与死亡,其中5～9岁年龄组白血病发病率以年均16.72%下降,变化趋势差异有统计学意义(t=2.84,P<0.05)。 结论 重庆市儿童白血病发病率与死亡率较高,女童和农村儿童白血病发病率下降明显,应重视儿童白血病的防治工作。     

Epidemiological analysis of tuberculosis in Ethiopia: a ten-year trend analysis

Tuberculosis has been one the major causes of morbidity and mortality in Ethiopia for long. Accordingly, the Ethiopian Ministry of Health and its stakeholders have their unreserved and integrated efforts on this health problem. Among these efforts was the well developed HMIS for Tuberculosis programs. However, the direction to where Tuberculosis in Ethiopia is heading hasn't been well analyzed and unpackaged by epidemiologically relevant factors. The overall aim of this study was to examine the epidemiological trends of Tuberculosis in Ethiopia for the ten-year period from 2000-2009. The trends were investigated from spatial, temporal, disease type and gender perspectives. A time-series study design was applied to analyze the ten-year trends of Tuberculosis in Ethiopia. Data on ten-key indicators for the period of 2000-2009 was obtained from the Ministry of Health public documents. Five stratifying variables were used to analyze the trends in the key TB indicators. The data on the indicators have undergone five stages of analysis: Aggregation, computation, summarization, graphics and model fitting. The incidence rate of tuberculosis is increasing in Ethiopia at a rate of 5 new TB cases per 100,000 population per year. Urban agro-ecological zones have been more affected by the disease throughout the ten-year period. Extra-pulmonary rate and smear-negativity has shown a modest increment during the study period. Masculine gender was also disproportionately affected by tuberculosis during the ten-year study period. On the other hand case detection rate and treatment success rate are found to be increasing at a rate of 0.5% per year.     

Adaptations to health care barriers as reported by rural and urban providers

Barriers to ethical and effective health care in rural communities have been well-documented; however, less is known about strategies rural providers use to overcome such barriers. This study compared adaptations by rural and urban health care providers. Physical and behavioral health care providers were randomly selected from licensure lists for eight groups to complete a survey; 1,546 (52%) responded. Replies indicated that health care providers from small rural and rural communities were more likely to integrate community resources, individualize treatment recommendations, safeguard client confidentiality, seek out additional expertise, and adjust treatment styles than were providers from small urban and urban communities. Behavioral health care providers were more likely than physical health care providers to integrate community resources, individualize treatment recommendations, safeguard client confidentiality, and adjust their treatment styles; physical health care providers were more likely than behavioral health care providers to make attempts or have options to seek out additional expertise.     

河北省城乡居民卫生服务需求与利用趋势分析与对策

目的:了解河北省城乡居民的卫生服务需求与利用情况,为制定政策提供依据。方法:采取多级分层整群随机抽样,确定5 998户的20 529名常住居民作为调查对象,用统一的调查表进行询问调查。结果:调查人群的两周患病率为18.75%,城市高于农村,与1993年相比有上升趋势;慢性病患病率为16.9%,城市高于农村,与1998年相比有上升趋势;两周就诊率为14.32%,比1993年明显下降,两周未就诊率为57.60%。居民住院率为2.56%,与1993年相比有下降趋势。结论:城乡居民的卫生服务需要量呈上升趋势,卫生服务的需求量及利用率呈下降趋势。应采取有效措施,提高卫生服务利用率。     

Tuberculosis in Havana City, 1995-1999

OBJECTIVE: Tuberculosis is a worldwide health problem getting a prioritized attention by the Cuban National Health System. To describe the main indicators of the Cuban Tuberculosis Control Program. METHODS: Based on surveillance data from the Provincial Center of Hygiene and Epidemiology, the health care network and strategies of the tuberculosis control program were reviewed; incidence rates, case finding indicators, diagnosis and case management were described. RESULTS: Eight subjects with respiratory symptoms were found per 1,000 attending general medical care services. The incidence rates of all tuberculosis types declined from 16.4 in 1995 to 12.0 x 10(5) people in 1999. Pulmonary tuberculosis incidence rate was reduced from 15.1 in1995 to 10.4 x 10(5) in 1999, whereas extrapulmonary tuberculosis had an increment from 1.3 to 1.6 x 10(5) in the same period. Of all new cases, 40-50 % were diagnosed at multispecialty clinics, 67.6% were diagnosed by positive smears, 15.2 % by positive cultures, 13.8 % by clinical and X-rays evidences only; and 0.9 % and 1.5 % were respectively diagnosed by biopsy and necropsy. There was an increase in the incidence rate in the age group 15-64 years in 1996 and 1997 but it declined again in 1998 and 1999. The age group 64 years and over showed a rate reduction from 1995 to 1999. In general, incidence rates diminished in the overall period. The average delay between onset of symptoms and diagnosis improved from 42 days in 1995 to 28.6 days in 1999. CONCLUSIONS: There seems to be a halt in reporting trends of new cases in 1996. Tuberculosis indicators reveal satisfactory changes in the study period.     

An epidemiological study of acute carbon monoxide poisoning in the West Midlands

OBJECTIVES: To describe the epidemiology of carbon monoxide (CO) poisoning in a defined population, identifying those at greatest risk from acute poisoning resulting in admission to hospital or death. METHODS: A retrospective study with routinely collected information, set in the former West Midlands Regional Health Authority; population of 5.2 million. The data comprised 939 deaths and 701 hospital admissions due to CO poisoning between January 1988 to December 1994. The main outcome measures were age and sex standardised incidence rates (SIRs) for non-intentional, suicidal, and undetermined poisonings for health authorities and the linear relation with socioeconomic deprivation. RESULTS: Overall rate of non-intentional poisonings over the 7 year period was 7.6/100,000, an annual rate of 1.1/100,000. The 7 year rates were highest in people > or = 85; men 24.0/100,000 and women 19.7/100,000. For suicides the 7 year rate was 19.6/100,000, an annual rate of 2.8/100,000. The 7 year rates were highest for men of 35-39, 64.1/100,000, and for women aged 45-49, 15.3/100,000. None of the causes of poisoning were related to deprivation. Non-intentional poisonings showed a strong seasonal variation with the highest rates being recorded in the months October to March. Increased rates of poisoning were found in the rural districts of the West Midlands. There seems to have been a decline in suicides coinciding with the introduction of three way catalytic converters on cars. CONCLUSIONS: Elderly people and the very young are at the greatest risk from non- intentional CO poisoning and rates are highest in the winter months. Although deaths from non-intentional CO poisoning are declining nationally, in the West Midlands they have remained stable and hospital admissions are increasing. It is not solely an urban phenomenon with rates for non-intentional CO poisoning and suicides higher in the rural districts. Health authorities need to consider all populations in any prevention programme. Further work is needed to establish the extent of the burden of chronic CO poisoning and the impact of catalytic converters on suicides.

 

     

Imbalances in the health labour force: an assessment using data from three national health facility surveys

Accurate knowledge of the characteristics of the health labour force that can affect health care production is of critical importance to health planners and policymakers. This study uses health facility survey data to examine characteristics of the primary health care labour force in Nicaragua, Tanzania and Bangladesh. The characteristics examined are those that are likely to affect service provision, including urban/rural distribution, demographic characteristics, and experience and in-service training, for three types of providers (physicians, nurses and auxiliary nurses). The profiles suggest a pattern of urban/rural imbalances in Nicaragua and Tanzania. The Bangladesh facility survey did not include hospitals, thereby making concrete conclusions on the supply and distribution of providers difficult to make. Multivariate logistic regressions are used to assess the relationship between the urban/rural placement of providers by health need, population demand and facility characteristics. Health need, as measured by child mortality rates, does not have a significant association with the placement of providers in either country, unlike population size and annual growth rates. The mean number of years providers have worked at a facility is significantly associated with a decreased likelihood of rural placement for the three types of providers in Nicaragua. The mean age and percentage of female providers at each facility has a negative association with the placement of rural providers in Tanzania. The use of health facility data to profile the health care labour force is also discussed.     

White infant mortality in Appalachian states, 1976-1980 and 1996-2000: changing patterns and persistent disparities

Purpose: Appalachian counties have historically had elevated infant mortality rates. Changes in infant mortality disparities over time in Appalachia are not well‐understood. This study explores spatial inequalities in white infant mortality rates over time in the 13 Appalachian states, comparing counties in Appalachia with non‐Appalachian counties. Methods: Data are analyzed for 1,100 counties in 13 Appalachian states that include 420 counties designated as Appalachian by the Appalachian Regional Commission. Area Resource File data for 1976‐1980 and 1996‐2000 provide county‐ and city‐level infant mortality rates, poverty rates, rural‐urban continuum codes, and numbers of physicians per 1,000 residents. Multiple regression analyses evaluate whether Appalachian counties are significantly associated with elevated white infant mortality in each time period, accounting for covariates. Findings: White infant mortality rates decreased substantially in all sub‐regions over the last 2 decades; however, disparities in infant mortality did not diminish in Appalachian counties compared to non‐Appalachian counties. After accounting for poverty, rural/urban status, and health care resources, Appalachian counties were significantly associated with comparatively higher infant mortality during the late 1970s but not in the late 1990s. At the more recent time point, higher poverty rates, residence in more rural areas, and lower physician density were associated with greater infant mortality risk. Conclusion: Appalachian counties continue to experience relatively elevated infant mortality rates. Poverty and rurality remain important dimensions of health service need in Appalachia.     

2005-2014年抚州市法定传染病疫情分析

目的 分析2005-2014年抚州市法定传染病的发病与流行变化趋势,为控制法定传染病疫情提供科学依据。方法 采用Excel和SPSS22.0对2005-2014年抚州市法定传染病疫情资料进行描述性流行病学分析。结果 2005-2014年抚州市报告法定传染病31种,发病105 719例,年均发病率270.80/10万,年均死亡率0.37/10万,病死率0.14％,发病率为223.19/10万~328.09/10万,2005-2010年呈下降趋势,而2010-2014年呈上升趋势;肠道传染病、血源及性传播传染病呈上升趋势,呼吸道传染病发呈下降趋势。年均发病率前5位的法定传染病依次为肺结核、病毒性肝炎、手足口病、感染性腹泻病、痢疾,占总发病数的87.30%。结论 抚州市重要传染病病种为肺结核、病毒性肝炎(乙肝)、手足口病、其他感染性腹泻、痢疾、流行性腮腺炎、梅毒、淋病、麻疹等,法定传染病防治工作重点为肺结核、乙型肝炎、手足口病、感染性腹泻病、痢疾,应加强梅毒、艾滋病等性传播传染病管理与监测。     

郑州市10年神经管缺损发生率的变化趋势

目的 描述1996-2005年郑州市围产儿神经管缺损(neural tube defects,NTDs)的流行病学特征及动态变化趋势.方法 采用医院监测的方法进行数据收集,调查孕满28周至产后7 d住院分娩的围产儿中NTDs的发生情况,分别按年份、围产儿性别、产妇户口所在地(城/乡)、产妇年龄计算其发生率.共监测围产儿162 074名,全市同期出生围产儿496 203名,监测比例为32.66%.结果 NTDs 238例,总发生率为14.68/万,年度发生率呈下降趋势.NTDs的发生率乡村为29.28/万,城镇为9.63/万;女性为17.74/万,男性为11.42/万;产妇年龄别发生率的差异有统计学意义(χ2=22.952,P=0.000),＜20岁和≥35岁组高于其他年龄组,其发生率分别为53.76/万和21.74/万.结论 郑州市NTDs发生率乡村高于城镇、女性高于男性.10年间年度发生率呈下降趋势.