利用多水平模型探讨HIV／AIDS报告现患率与宏观社会因素关系的研究

目的分析和探讨我国HIv／AIDS报告现患率与宏观社会因素的关联。方法收集各省份经济、人口和卫生等社会因素数据资料,利用主成分分析方法提取以上社会因素的综合指标;收集截至2011年底各县区分性别、年龄组的报告现存活HIV／AIDS病例数及人口数,利用两水平负二项分布模型分析县区HIV／AIDS报告现患率与省份宏观社会因素的关系。结果我国男性HIV／AIDS报告现患率（3．56／万人）显著高于女性（1．70／万人）,男女问差异有统计学意义（P〈0．05）;20岁以下年龄组HIv／AIDS报告现患率最低（0．24／万人）,而20～39岁年龄组最高（4．84／万人）。两水平负二项分布模型分析发现,水平2（省份）单位下各水平1（县区）单位的HIV／AIDS报告现患率存在聚集性,即调整性别和年龄因素后,各省份问HIV／AIIXS报告现患率差异亦有统计学：苣义（δu^2=2．612,P〈0．05）。纳入水平2宏观社会因素变量O进行单因素和多因素分析均发现,人H流动水平高或经济生活水平低（N3）、少数民族人口比例高（M4）、HIV筛检人次数多（M5）与HIV／AIDS报告现患率呈正相关（P〈0．05）。结论我国各地区艾滋病流行形势与其宏观社会因素密切相关,制定艾滋病防治政策时应综合考虑地区的社会背景,做到有的放矢。     

Performance assessment in the context of multiple objectives: a multivariate multilevel analysis

The pursuit of multiple objectives by public sector organisations makes it difficult to assess and compare their performance. Considering objectives in isolation ignores the possibility of correlations between objectives, and a single index of performance requires subjective judgements to be made about the relative value of each objective. An alternative approach is to estimate a multivariate system of equations in which objectives are analysed individually but correlations across objectives are considered explicitly. We analyse the performance of English health authorities against 13 objectives using hierarchical data for electoral wards that are nested within health authorities. We find evidence of correlation across objectives, suggesting that some are complementary and others subject to trade-off. The estimates generated when assessing performance with multivariate multilevel models as compared to ordinary least squares or multilevel models differ, with the magnitudes varying by objective and health authority.     

时间序列法预测细菌性痢疾发病文献回顾

目的描述时间序列分析在细菌性痢疾发病预测领域的研究现状。方法设定纳入标准后在中国知网数据库中收集该主题相关文献。结果自2009年以来,共有19项研究利用时间序列分析方法进行菌痢发病率的预测分析,研究分布在11个省、自治区和直辖市。其中15项研究在地区层面基于地级市的数据进行预测分析。结论时间序列分析已在传染病发病率预测预警领域引起广泛关注和应用。     

儿童艾滋病16例临床分析

目的 探讨儿童艾滋病的病因、临床特点和CD4计数的临床意义,为儿童艾滋病的控制提供依据. 方法 回顾性分析2005年以来我院感染病科诊治的16例儿童艾滋病的临床资料. 结果 15例艾滋病患儿的父亲和(或)母亲有注射吸毒和(或)性乱史,l例病因不清.患儿临床表现多样,主要表现为发育迟缓(50.00%)和营养不良(43.75%)、发热(81.25%)、咳嗽(50.00%)、贫血、肝脾肿大等.2例患儿CD4计数在1000/mm3以上,但已出现肺部感染、贫血及发育迟缓症状;另外2例患儿CD4计数较低,抗病毒治疗1年余,未出现机会性感染表现.CD4计数经治疗均有所回升. 结论 儿童艾滋病主要通过母婴垂直传播,临床症状重,预后差,患儿CD4计数大多下降,但其数值的高低和临床表现不相一致,因此应提高对其特点的认识,以利尽早诊断和治疗.     

119例新发尘肺病例发病特征分析

目的通过分析某区10年间新发的119例尘肺病例,了解尘肺病例的发病特征,为预防和控制尘肺提供实践依据。方法收集和整理某区10年间收到的尘肺病例职报卡,将职报卡上的内容录入EpiData3.1数据库,运用SPSS13.0对数据进行描述性统计分析。结果某区10年间新发尘肺病例119例,其中男性107例、女性12例。发病人数居前三位的分别是铸工尘肺、矽肺和电焊工尘肺。男性尘肺患者的发病年龄集中在40～60岁之间,平均发病年龄(50.95±13.47)岁,女性尘肺患者发病年龄集中在50～60岁之间,平均发病年龄(59.50±11.37)岁。约有四分之一的尘肺病例是在退休后被诊断的。男性平均接尘工龄(19.73±11.37)年,女性平均接尘工龄(16.60±9.55)年。有3个企业的累积尘肺病例多于10例。结论某区历年均有新发尘肺病例,其中发病人数较多的是铸工尘肺、矽肺和电焊工尘肺,尘肺病例仍是严重威胁工人健康最常见的职业病。尘肺病例的发病年龄均集中在40岁以后,最短平均接尘时间为16.60年,并且尘肺病例的发生有明显的企业集聚现象。因此,应进一步加强企业的职业健康安全管理,以有效预防和控制尘肺病例的发生。     

多水平模型在吸烟行为研究中的应用

目的介绍多水平模型及其应用领域。方法以中国/WHO控烟能力建设合作项目——学校控烟子项目中天津地区中学的学生基线调查资料为例,应用多水平模型分析并与传统logistic回归分析的结果进行比较。结果经检验,数据中存在层次结构。利用多水平模型分析显示,中学生吸烟的影响因素为性别、年龄、态度、环境及班级水平下的宣传教育。此外,在未引入班级水平下宣传教育这一变量时,利用多水平模型分析得到变量的标准误均小于相应的传统logistic回归分析的结果。结论多水平模型适于分析具有层次结构的数据资料,在分层或整群的流行病学或社区调查中具有较高的应用价值。     

不同移动频次艾滋病病例特征及影响因素分析

摘要:目的 分析不同移动频次艾滋病病例特征及影响因素。方法 收集内蒙古自治区2015年6月前艾滋病病例报告病例数据信息,按5年平均移动频次分为6类（f = 0次,0 ＜ f ＜ 2,2 ≤ f ＜ 4,4 ≤f ＜ 6,6 ≤ f ＜ 8,8 ≤ f）,采用SPSS19.0软件包进行统计分析。结果 不同移动频次病例间年龄、性别、民族、文化程度、职业、婚姻状况和户籍省、性病史、疾病状态、本次诊断为HIV阳性前HIV检测情况、接触史和感染途径均有统计学差异（P ＜ 0.05）,且移动频次与年龄、性别、文化程度、婚姻状况、户籍所在省、性病史、疾病状态、本次诊断为HIV阳性前是否做过HIV检测均有关。高移动频次病例的特征及影响因素主要为:25～44岁年龄段、男性、未婚、汉族、初中及以上文化、省内移动、有性病史、疾病状态为HIV、有非婚异性接触史和同性接触史、异性传播和同性传播。结论 不同移动频次的艾滋病病例特征不同,影响因素较多且复杂。     

Population exposure to ultraviolet radiation in Finland 1920-1995: Exposure trends and a time-series analysis of exposure and cutaneous melanoma incidence

Ultraviolet radiation (UVR) is the principal cause of cutaneous malignant melanoma (CMM). However, the relation between CMM and UVR exposure is not clear. We present the trends of population exposure to UVR and conduct a time-series analysis of the relation between UVR exposure and incidence of CMM. Data on CMM incidence were obtained from the Finnish Cancer Registry. Clothing coverage of the body was scored from archival photographs and the proportion of uncovered skin was used as a measure of solar exposure. Information on the number of sunny resort holidays, duration of annual holidays, and sunscreen sales were obtained from various sources. Exposed skin area doubled from 1920 to 1985. The average duration of annual holidays increased 30-fold. The number of sunny resort holidays and the sales of sunscreens increased rapidly from 1980. CMM was most strongly associated with solar exposure of 5-19 years earlier. There is a considerable decrease in clothing coverage during the 20th century. UVR exposure preceding CMM occurrence 4 years or less does not appear relevant, whereas the period 5-19 years prior to CMM occurrence might be the most relevant period. However, findings of ecological studies may not be applicable at the individual level.     

云南省2个边境地区新报告艾滋病病毒感染者HIV-1基因亚型分析

目的 了解云南省2个边境地区新报告HIV感染者HIV-1基因亚型分布特征。方法 2015年11月至2016年10月在云南省德宏傣族景颇族自治州（德宏州）和红河哈尼族彝族自治州（红河州）边境地区,连续纳入年龄≥ 18岁新报告HIV感染者共233例,提取病毒RNA,扩增pol和env基因区,进行基因分型检测和序列分析。结果 233份标本共有146份获得HIV-1基因亚型。德宏州有8种HIV-1基因亚型,以独特重组型（URFs）为主（52.8%,57/108）,其中中国籍的URFs占56.8%（21/37）,缅甸籍的占50.7%（36/71）;红河州有4种HIV-1基因亚型,以CRF01_AE为主（71.1%,27/38）,其中越南籍的占81.0%（17/21）,中国籍的占58.8%（10/17）。2个州HIV-1基因亚型总体分布的差异有统计学意义（χ²=61.072,P<0.001）。结论 云南省2个边境地区新报告HIV感染者HIV-1基因亚型分布差异较大,应对中国籍和外国籍HIV感染者采取有针对性的防治措施。     

Quantitative assessment of changes in patients' constructs of quality of life: An application of multilevel models

It has often been proposed that quality of life (QL) instruments should account for potentially changing conceptualisations of QL as patients adapt to disease (response-shift). Most instruments do not do this, and some that do are relatively complicated and burdensome for patients. The extent to which patients reconceptualise QL is unknown, and it is unclear whether this additional complication is necessary. This paper reviews existing methods for assessing response-shift and introduces an alternative approach using multilevel models. The method is described using data from a cancer clinical trial, and its performance is evaluated in simulations. The models reveal substantial response-shift in these cancer patients. Simulations under the null hypothesis of zero response-shift confirm that the method performs correctly in terms of its risk of type I error, and further simulations illustrate its statistical power to detect pre-defined levels of response-shift. The method is a relatively simple extension of familiar multiple regression models and yields parameters with a simple interpretation, representing the changes in importance of QL domains over time. It can be applied to existing datasets collected with other analysis strategies in mind and may have application in the investigation of response shifts and other manifestations of adaptation.     

云南省德宏傣族景颇族自治州2016年新报告艾滋病病毒感染者的基因亚型分析

目的 分析2016年云南省德宏傣族景颇族自治州（德宏州）新报告HIV感染者HIV基因亚型,了解中国籍和缅甸籍HIV感染者基因亚型分布特征。方法 对2016年德宏州新报告的HIV感染者提取核酸,使用RT-PCR法对HIV基因gag、env和pol进行反转录扩增,直接测序扩增产物,综合分析3个基因的测序结果,确定最终基因亚型。结果 2016年德宏州新报告HIV感染者1 112例,成功测定基因亚型的感染者860例。C亚型所占比例最大（占33.6%,289/860）;其后为独特重组（unique recombinant forms,URFs）（占28.4%,244/860）、CRF01_AE（占18.6%,160/860）等亚型;URFs中主要包括4种形式的重组,其中以CRF01_AE和C亚型重组为主。缅甸籍感染者的亚型分布与民族和传播方式相关。结论 德宏州2016年新报告HIV感染者基因亚型主要集中在C、URFs和CRF01_AE亚型,URFs分布依然复杂多样。     

A Confirmatory Factor-Analytic Validation of the Tripartite Model of Depression and Anxiety Among Undergraduates in Spain

The tripartite model of depression and anxiety proposes that low positive affect is a specific indicator of depression, whereas high physiological hyperarousal is a specific marker of anxiety. High negative affect, while common to both syndromes, is specific to neither. To test the validity of the tripartite model, we administered self-report scales on positive affect, negative affect, and physiological hyperarousal to 388 undergraduates in Spain. LISREL confirmatory factor analytic techniques were used. Consistent with the predictions of the tripartite view and with previous work on North American samples (e.g., Joiner, 1996), a three-factor model with Positive Affect, Physiological Hyperarousal, and Negative Affect as factors, provided the best fit for the observed data. These findings contribute to an emerging literature on the validity of the tripartite model, and, furthermore, are the first to indicate that the model and its implications may be applied cross-culturally.     

浙江省义乌市2015-2016年新报告艾滋病病毒感染者和艾滋病患者感染来源及特征分析

目的 分析2015－2016年浙江省义乌市新报告艾滋病病毒感染者和艾滋病患者（HIV/AIDS）感染来源及特征,为当地开展有效的艾滋病防控措施提供依据。方法 招募2015年1月1日至2016年12月31日义乌市新报告HIV/AIDS作为研究对象,采用个案调查问卷面对面收集研究对象的人口学、行为学、感染途径及感染来源等相关信息。采用EpiData 3.0和SPSS 19.0软件进行数据整理和统计学分析。结果 招募HIV/AIDS共393人,完成调查320人,主要以男性（268,83.8%）、未婚（141,44.1%）、外省户籍（217,67.8%）、初中文化程度（128,40.0%）和年龄25～44岁（166,51.9%）为主。新感染病例数占可判断感染时间研究对象的35.1%（107/305）,本地感染病例占可判断感染地点研究对象的74.9%（200/267）。新感染病例以男男性行为感染、最近1年有临时性伴、主动检测发现为主;义乌市户籍的病例更有可能经在义乌本地发生的异性商业性行为感染HIV。结论 2015－2016年义乌市新报告HIV/AIDS主要以既往感染和本地感染为主。外省户籍、男男性行为感染、临时性行为对义乌市HIV的传播影响较大。     

2013-2017年云南省红河州新报告艾滋病病毒感染者/艾滋病病人晚发现情况分析

目的 了解云南省红河州艾滋病病毒(HIV)感染者晚发现率及其影响因素。方法 通过整理2013 - 2017年“艾滋病综合防治信息系统”历史卡片数据,采用χ2检验及logistic回归法对红河州HIV/AIDS病例晚发现情况进行分析。结果 红河州2013 - 2017年报告HIV/AIDS病例共10 655例,其中,晚发现病例3 685例。历年晚发现比例呈递增趋势（χ趋势2 = 20.019,P＜0.001）。男性晚发现病例占37.4%（2 647/7 074）,女性晚发现病例占29.0%(1 038/3 581),不同性别间晚发现比例差异有统计学意义(χ2 = 74.700,P＜0.001)。多因素logistic回归分析显示,男性医院就诊者样本来源的病例晚发现的风险是咨询检测的1.318倍,女性医院就诊者样本来源的病例晚发现的风险是咨询检测的1.302倍。结论 红河州2013 - 2017年新报告HIV感染者的晚发现率呈现逐年上升趋势,医院就诊者晚发现风险较高,仍需扩大监测检测覆盖面,提高大众主动检测意识。     

A multilevel analysis on the determinants of regional health care expenditure: a note

Health care in most countries is a rather “local good” for which the fiscal decentralization theory applies and heterogeneity is the result. In order to address the issue of multijurisdictional health care in estimating income elasticity, we constructed a unique sample using data for 110 regions in eight Organisation for Economic Co-operation and Development (OECD) countries in 1997. We estimated this sample data with a multilevel hierarchical model. In doing this, we tried to identify two sources of random variation: within- and between-country variation. The basic purpose was to find out whether the different relationships between health care spending and the explanatory variables are country specific. We concluded that to take into account the degree of fiscal decentralization within countries in estimating income elasticity of health expenditure proves to be important. Two plausible reasons lie behind this: (a) where there is decentralization to the regions, policies aimed at emulating diversity tend to increase national health care expenditure and (b) without fiscal decentralization, central monitoring of finance tends to reduce regional diversity and therefore decrease national health expenditure. The results of our estimation do seem to validate both these points.

A multilevel analysis of social capital and self-rated health: Evidence from the British Household Panel Survey

Social capital is often described as a collective benefit engendered by generalised trust, civic participation, and mutual reciprocity. This feature of communities has been shown to associate with an assortment of health outcomes at several levels of analysis. The current study assesses the evidence for an association between area-level social capital and individual-level subjective health. Respondents participating in waves 8 (1998) and 9 (1999) of the British Household Panel Survey were identified and followed-up 5 years later in wave 13 (2003). Area social capital was measured by two aggregated survey items: social trust and civic participation. Multilevel logistic regression models were fitted to examine the association between area social capital indicators and individual poor self-rated health. Evidence for a protective association with current self-rated health was found for area social trust after controlling for individual characteristics, baseline self-rated health and individual social trust. There was no evidence for an association between area civic participation and self-rated health after adjustment. The findings of this study expand the literature on social capital and health through the use of longitudinal data and multilevel modelling techniques.     

杭州市2015-2017年非婚非商业的异性性传播新报告艾滋病病毒感染者特征分析

目的 了解2015-2017年杭州市经非婚非商业异性性传播的新报告HIV感染者特征及其相关因素。方法 利用我国艾滋病综合防治基本信息系统,研究对象为2015年1月1日至2017年12月31日新报告HIV感染者,且现住址为杭州市、传播途径为非婚异性性传播。采用SPSS.20软件统计分析,比较不同特征的感染者经非婚异性性传播的比例,采用多因素logistic回归模型分析非婚非商业异性性传播感染HIV的相关因素。结果 新报告HIV感染者中的非婚异性性传播占38.03%（1 393/3 663）,其中,非商业性传播占非婚异性性传播的50.83%（708/1 393）,商业性传播占非婚异性性传播的49.17%（685/1 393）。男女性别比为3.51：1（1 084/309）。男性以非婚商业性传播为主（61.81%,670/1 084）,女性以非婚非商业性传播为主（95.1%,294/309）。多因素分析结果显示,非婚非商业异性传播的相关影响因素包括女性（aOR=48.25,95% CI：26.94~88.44）、年龄<30岁组（aOR=2.43,95% CI：1.31~4.51）、30~岁组（aOR=1.92,95% CI：1.11~3.33）、40~岁组（aOR=1.80,95% CI：1.08~3.00）、已婚和未婚（与离异或丧偶相比,aOR=1.57,95% CI：1.10~2.24;aOR=1.78,95% CI：1.15~2.78）、高中及以上文化程度（与小学及以下相比,aOR=1.82,95% CI：1.18~2.80）、职业为干部/职员（与农民相比,aOR=2.03,95% CI：1.04~1.91）、非婚性伴数<5个（与非婚性伴数≥ 5个相比,aOR=10.65,95% CI：6.41~17.42）。结论 2015-2017年杭州市非婚异性性传播HIV感染者比例高,不同性别、年龄、婚姻状况、文化程度和职业的HIV感染者在非婚非商业异性性传播的风险上存在差异,应采取针对性的防治措施。     

巴中市5例HIV/AIDS感染者的流行特征分析

目的　了解流动人口HIV/AIDS流行情况。方法　应用酶联免疫吸附试验进行初筛 ,后经蛋白印迹试验确认 ,结合个案流行病学调查 ,进行统计分析。结果　流动人口HIV/AIDS疫情有加快的趋势 ,HIV/AIDS通过性传播在流动人口中成了主要传播途径 ,感染者已涉及到一般人群 ,自愿献血和结核病患者发现HIV/AIDS的机会增多 ,母婴传播HIV/AIDS的危险加重。结论　提高各级领导的认识 ,针对各种危险因素 ,加强流动人口的管理 ,积极采取措施 ,控制HIV/AIDS在流动人口中流行。