出生缺陷监测的现场实施

出生缺陷监测是公共卫生监测的重要组成部分,其在公共卫生事件应对、出生缺陷病因研究、相关卫生政策制订、医疗卫生资源分配及卫生干预措施效果评价等诸多方面具有重要作用,而监测系统是获取出生缺陷监测资料的基础。现就出生缺陷监测系统在现场建立和运转过程中一些重要问题进行探讨。     

2007年菏泽市围产儿出生缺陷监测资料分析

[目的]掌握围产儿出生缺陷发生情况,为制定干预措施,提高出生人口质量提供依据。[方法]对菏泽市2007年围产儿出生缺陷监测资料进行分析。[结果]2007年菏泽市共有围产儿83 786名,出生缺陷865例,出生缺陷发生率为103.24/万。出生缺陷发生率,城镇为79.02/万,农村为119.50/万(P<0.01);男性为116.65/万,女性为87.87/万(P<0.01)。出生缺陷儿前5位类型为总唇裂(占15.84%)、先天性心脏病(占14.45%)、多指趾(占14.34%)、神经管畸形(占7.40%)、先天性脑积水(占5.55%)。[结论]菏泽市围产儿出生缺陷发生率较低,总唇裂、先天性心脏病、多指(趾)、神经管畸形和先天性脑积水是最多发的出生缺陷类型。     

17538名围产儿出生缺陷监测结果

出生缺陷是影响出生人口素质的重要因素,为了解我县出生缺陷发生率、出生缺陷分布及相关情况,及时发现病因线索,积极探讨干预措施,有效地降低出生缺陷发生率,本文对我县近4年出生缺陷资料进行了分析.     

The Risk of Birth Defects in Multiple Births: A Population-Based Study

Objectives: To determine if multiple births have higher risks of birth defects compared to singletons and to identify types of birth defects that occur more frequently in multiple births, controlling for seven sociodemographic and health-related variables. Methods: A retrospective cohort study was conducted of all resident live births in Florida during 1996–2000 using data from a population-based surveillance system. Birth defects were defined as in the 9th edition of the International Classification of Diseases—Clinical Modification (ICD-9-CM) code for the 42 reportable categories in the Centers for Disease Control and Prevention (CDC) Birth Defects Registry list and eight major birth defects classifications. Relative risks (RR) before and after adjusting for control variables and 95% confidence intervals (95% CI) were calculated. The control variables included mother's race, age, previous adverse pregnancy experience, education, Medicaid participation during pregnancy, infant's sex and number of siblings. Results: This study included 972,694 live births (27,727 multiple births and 944,967 singletons). Birth defects prevalence per 10,000 live births was 358.50 for multiple births and 250.54 for singletons. After adjusting for control variables, multiple births had a 46% increased risk of birth defects compared to singletons. Higher risks were found in 23 of 40 birth defects for multiple births. Five highest adjusted relative risks for birth defects among multiple births were: anencephalus, biliary atresia, hydrocephalus without spina bifida, pulmonary valve atresia and stenosis, and bladder exstrophy. Increased risks were also found in 6 out of 8 major birth defects classifications. Conclusions: Multiple births have increased risks of birth defects compared to singletons.     

富阳市1999～2001年出生缺陷监测分析

为了动态观察出生缺陷儿的消长情况 ,及时发现影响出生缺陷的可疑因素 ,为病因学研究提供线索 ,我市于1999年加入了浙江省妇幼卫生监测网 ,现对 3年的监测结果分析如下。对象与方法1　对象　监测对象为在监测点富阳市妇幼保健院、富阳市第二人民医院住院分娩的孕 2 8周～出生 7天内的围产儿 ,包括死胎、死产和 7天内死亡的新生儿。2　方法　每个监测点由一位受过培训的专业人员负责 ,详细检查每一例新生儿 ,若发现畸形儿 ,填写出生缺陷个案表 ,于每季度上报市妇幼保健院。3　质量控制　为保证质量 ,执行全国统一的诊断标准 ,使用全国统一的…     

佛山市南海区407例出生缺陷监测资料分析

目的分析广东省佛山市南海区出生缺陷发生的种类及相关因素,了解出生缺陷变化趋势,探讨干预措施。方法对2002年10月1日～2006年9月30日在佛山市南海区市级2家医院住院分娩的孕满28周至出生后7天的围生儿进行出生缺陷监测,分析出生缺陷发生率、类别、构成比及相关因素。结果 2003～2006年期间监测医院共出生围生儿21593例,其中有出生缺陷407例,出生缺陷发生率呈逐年增高趋势。在407例出生缺陷儿中,单发畸形369例,多发畸形38例。出生缺陷前5位畸形依次为：多指（趾）、先天性心脏病、唇腭裂、尿道下裂、并指（趾）。出生缺陷的发生率农村明显高于城市（χ2=22.25,P〈0.001）;出生缺陷发生的性别分布为男性高于女性,经检验有显著性差异（χ2=13.88,P〈0.01）。结论佛山市南海区出生缺陷发生率呈逐年上升的趋势,且农村高于城市,男性高于女性。     

我国出生缺陷干预效果评价指标体系框架探讨

目的:探索适合我国国情的、科学全面的出生缺陷干预效果评价指标体系理论框架,为进一步研究出生缺陷干预效果评价指标体系奠定基础.方法:文献研究及现场调查.结果:基于各学科理论和多项研究,构建我国出生缺陷干预效果评价指标体系基本框架,包括4个一级指标:出生缺陷干预地区社会经济指标、出生缺陷一级干预指标、出生缺陷二级干预指标、出生缺陷三级干预指标,以及16个二级指标.重点介绍了构建框架的思路和依据,及各类指标的评价内容,并提出进一步研究该指标体系的几点思考.结论:结合我国出生缺陷干预现状,首次对我国出生缺陷干预效果评价指标体系基本框架做了探讨,对于进一步研究该指标体系,继而评估、指导我国出生缺陷干预工作具有重大现实意义.     

Defining Sickle Cell Disease Mortality Using a Population-Based Surveillance System, 2004 through 2008

Objective

Population-based surveillance data from California and Georgia for years 2004 through 2008 were linked to state death record files to determine the all-cause death rate among 12,143 patients identified with sickle cell disease (SCD).

Methods

All-cause death rates, by age, among these SCD patients were compared with all-cause death rates among both African Americans and the total population in the two states. All-cause death rates were also compared with death rates for SCD derived from publicly available death records: the compressed mortality files and multiple cause of death files.

Results

Of 12,143 patients identified with SCD, 615 patients died. The all-cause mortality rate for the SCD population was lower than the all-cause mortality rate among African Americans and similar to the total population all-cause mortality rates from birth through age 4 years, but the rate was higher among those with SCD than both the African American and total population rates from ages 5 through 74 years. The count of deceased patients identified by using population-based surveillance data (n=615) was more than twice as high as the count identified in compressed mortality files using SCD as the underlying cause of death alone (n=297).

Conclusion

Accurate assessment of all-cause mortality and age at death requires long-term surveillance via population-based registries of patients with accurately diagnosed SCD.Ongoing public health surveillance of sickle cell disease (SCD) is critical to understanding its course and outcomes. Such surveillance is vital for medical management, clinical and translational research, new therapy development, public health planning, and patient, family, and provider education.Multiple research studies have used data collected through limited surveillance activities to better understand age at death for patients with SCD. Studies published in the 1970s showed a poor prognosis for patients with SCD, with a median age at death of approximately 14 years, high mortality in the first five years of life, and only about 15% of deaths occurring after age 30 years.¹ Results from a 1978 study based on a newborn screening cohort in Jamaica found that 13% of children with hemoglobin SS disease and 5% of children with hemoglobin SC disease died in the first two years of life.² Follow-up studies in Jamaica confirmed this observation and showed that only 25% of deaths among those with SCD occurred in patients older than 30 years of age.³The Cooperative Study of Sickle Cell Disease, which followed SCD patients in the United States from 1978 through 1988, reported patient survival in its academic center cohort, with a median age at death of 48 years for women and 42 years for men with hemoglobin SS disease, and 68 years for women and 60 years for men with hemoglobin SC disease.⁴ This study also reported that 50% of hemoglobin SS disease deaths occurred in patients older than 45 years of age. A 2001 study, using excess mortality simulation of a Jamaican cohort, predicted that 50% of SCD deaths would occur in those older than 53 years of age.⁵ Additional studies based on newborn screening cohorts enrolled in comprehensive care systems in the United States (published in 2004 and 2010), the United Kingdom (published in 2007), and Brazil (published in 2014) indicated that mortality in the first five years of life was significantly lower than in the 1978 Jamaican report, with the expectation that 86% to 98% of children with SCD would live to adulthood.^2,6–9However, not all recent research indicates similar findings in SCD mortality. A study using data from the National Center for Health Statistics'' (NCHS''s) compressed mortality (CM) files, 1999 through 2006, estimated the mean age at death for patients with SCD to be 39 years in 2006.¹⁰ In that study, among the 483 SCD deaths in the United States reported during that year, 9% occurred in those aged 20 years or younger and 35% occurred in those older than 45 years of age. A study using NCHS''s multiple cause of death (MCOD) files, 1979 through 2005, to estimate age at death and death rates similarly found median ages at death among women and men with SCD to be 42 and 38 years, respectively.¹¹One important caveat to previous mortality studies is that researchers relied on death certificate reporting of SCD^10,11 or on populations seen at high-volume hematology clinics.^2–9 Studies based on death certificates assumed accurate and complete coding in the death record, while the clinic-based studies may have been biased to include the sickest SCD patients, who are more likely to be seen at specialty care centers. To address these limitations, we used data on SCD patients from California and Georgia who were identified during the Registry and Surveillance System for Hemoglobinopathies project and linked them to all state death record files to estimate the all-cause mortality rate and mean and median ages at death for SCD in these two states.¹²     

2002～2009年勐海县2家医院围产儿出生缺陷监测结果分析

[目的]了解我县开展三网监测工作以来,出生缺陷发生情况及影响因素。[方法]按照《中国出生缺陷医院监测方案》要求,对县级2002~2009年2家医院出生的孕28周至出生后7 d的围产儿进行监测。[结果]2002~2009年监测围产儿7 236人,发生出生缺陷的85例,出生缺陷发生率11.75‰。出生缺陷发生率2004年最低,2007年最高(P0.01);出生缺陷发生率男性10.58‰,女性13.02‰(P0.05)。主要缺陷为肢体短缩(占17.65%)、唇腭裂(占16.47%)、马蹄足内翻(占8.24%)、脑膨出(占7.06%)、无脑儿(占5.88%)。[结论]加强婚前检查,孕期保健、产前检查、产前诊断,可降低出生缺陷的发生。     

两种出生缺陷监测方法中缺陷率的比较研究

我们利用河北省沧州地区1986年出生缺陷监测资料分析比较了以医院为基础和以人群为基础监测的出生缺陷率的关系。1986年沧州地区监测7 742例总出生,其中在县级及以上医院出生4 245,占监测总数的55%,非医院出生3497,占45%。分析结果发现,医院监测的出生缺陷率为30.9%,人群监测的出生缺陷率为10.5‰,二者之间的差别有显著意义(P<0.05),医院监测出生缺陷率较人群监测缺陷率高可能主要与在医院分娩产妇中高危妊娠的比例较一般人群大,而且高危妊娠中畸形儿的发现率较高有关,医院与人群监测的缺陷率之间的定量关系及各因素的影响作用有待进一步研究。     

我国农村地区神经系统缺陷的五年监测

１９８６￣１９９０年在我国农村１１个县监测１６７２７４名围产儿，发现社系统出生缺陷儿３６７例，占全部缺陷儿的３１．４５％，缺陷率２．１９‰。其中，脑积水１４９例，发生率居首位，其次为无脑儿１４５例，第三是开放性脊柱裂６１例。神经系统缺陷的发生率冬春季高于夏秋季，北方地区高于南方地区，差异均有显著性。采用单因素与Ｌｏｇｉｓｔｉｃ回归分析的方法对神经系统缺陷的影响因素进行了探讨。     

2005～2009年张家港市28家医院分娩的围产儿出生缺陷监测分析

[目的]了解张家港市2005～2009年出生缺陷发生情况,为进一步减少出生缺陷,制定预防保健措施及开展干预工作提供依据。[方法]对2005～2009年在张家港市28家医院分娩的围产儿出生缺陷监测资料进行描述性分析。[结果]2005～2009年累计检测围产儿47740名,监测时间延长至产后3个月的出生缺陷儿739例,出生缺陷发生率为154.79/万,孕28周至产后7天出生缺陷发生率为46.50/万（P〈0.01）。739例出生缺陷中,先天性心脏病501例,总唇腭裂64例,多指多趾24例,小耳23例,神经管畸形16例,其他112例。出生缺陷发生率（/万）,2005～2009年分别为104.93、147.21、173.04、179.39、157.17（P〈0.01）;农村为163.85,城区为128.13（P〈0.01）;男婴为164.79,女婴为142.38（P〈0.05）;母亲年龄〈20岁、20～34岁、〉34岁的分别为551.72、149.79、217.32（P〈0.01）;母亲文化程度小学及以下、初中、高中、大专及以上的分别为135.57、177.29、163.65、122.55（P〈0.01）。[结论]张家港市2005～2009年出生缺陷发生率较高,先天性心脏病是最为常见的出生缺陷。     

Systems Biology and Birth Defects Prevention: Blockade of the Glucocorticoid Receptor Prevents Arsenic-Induced Birth Defects

Background: The biological mechanisms by which environmental metals are associated with birth defects are largely unknown. Systems biology–based approaches may help to identify key pathways that mediate metal-induced birth defects as well as potential targets for prevention.Objectives: First, we applied a novel computational approach to identify a prioritized biological pathway that associates metals with birth defects. Second, in a laboratory setting, we sought to determine whether inhibition of the identified pathway prevents developmental defects.Methods: Seven environmental metals were selected for inclusion in the computational analysis: arsenic, cadmium, chromium, lead, mercury, nickel, and selenium. We used an in silico strategy to predict genes and pathways associated with both metal exposure and developmental defects. The most significant pathway was identified and tested using an in ovo whole chick embryo culture assay. We further evaluated the role of the pathway as a mediator of metal-induced toxicity using the in vitro midbrain micromass culture assay.Results: The glucocorticoid receptor pathway was computationally predicted to be a key mediator of multiple metal-induced birth defects. In the chick embryo model, structural malformations induced by inorganic arsenic (iAs) were prevented when signaling of the glucocorticoid receptor pathway was inhibited. Further, glucocorticoid receptor inhibition demonstrated partial to complete protection from both iAs- and cadmium-induced neurodevelopmental toxicity in vitro.Conclusions: Our findings highlight a novel approach to computationally identify a targeted biological pathway for examining birth defects prevention.     

2012年广东省食源性疾病监测结果分析

目的通过对2012年广东省食源性疾病监测结果进行分析,探讨食源性疾病综合监测模式。方法对2012年广东省收集的所有发病人数在2例及以上（或死亡1例及以上）的食源性疾病（含食物中毒）事件,在12个地市27家监测医院开展的疑似食源性异常病例/异常健康事件,以及在监测医院收集的以腹泻症状为主诉的疑似食源性就诊个案和病例粪便/肛拭标本病原菌监测的所有监测结果,采用描述性流行病学方法进行分析。结果 2012年广东省共报告96起食源性疾病（含食物中毒）事件,共计发病1 037例,死亡6例,病死率5.8‰。食源性疾病（含食物中毒）的发生,以第三季度的发生起数和中毒人数最多,占全年总起数的35.4%（34/96）和中毒总人数的37.1%（385/1 037）;发生场所以宾馆饭店最多,发生起数和中毒人数分别占31.3%（30/96）及32.9%（341/1 037）,其次为家庭（19起115例）和单位食堂（17起260例）;发病年龄以16~60岁组为主,占77.0%（798/1 037）;由微生物污染引发的事件共发生49起600例,其中以副溶血性弧菌（17起193例）和沙门菌（11起155例）为主;引发食源性疾病（含食物中毒）事件的前3位食品分别是肉与肉制品（23.8%,19/80）、豆类及其制品（13.8%,11/80）、海产品（10.0%,8/80）及毒蕈（10.0%,8/80）。全省12个地市27家监测医院均无疑似食源性异常病例/异常健康事件报告。2012年全省共收集到2 192例疑似食源性疾病个案,病例主要集中在5—8月（60.9%,1 334/2 192）,主要症状为腹泻（55.2%,1 211/2 192）、发热（28.5%,625/2 192）和呕吐（16.4%,360/2 192）。从主动监测医院上送的21 358份粪便/肛拭标本中共分离到790株沙门菌、9株志贺菌以及32株副溶血性弧菌;沙门菌主要血清型包括鼠伤寒沙门菌（26.1%,206/790）、鼠伤寒沙门菌变种（I 4,5,12：i：-）（15.6%,123/790）、肠炎沙门菌（14.7%,116/790）及斯坦利沙门菌（10.6%,84/790）;沙门菌对磺胺甲二唑、四环素、氨苄西林、萘啶酸、链霉素的耐药率分别为62.4%、59.5%、58.4%、57.5%、50.8%,对头孢他啶、头孢吡肟、头孢噻肟、环丙沙星的敏感率分别为88.9%、86.3%、79.7%、65.9%。广东省全年共发现9起疑似食源性病例聚集事件,经调查核实1起沙门菌感染,其余8起未能明确感染原因。结论 2012年广东省食源性疾病（含食物中毒）的发生呈季节性波动,致病因素以微生物污染为主。广东省食源性疾病监测能一定程度地反映出目前的食源性疾病发生状况,较客观地达到预期的监测目的,但仍存在不少问题与较大的改进空间,高效的综合监测模式有待进一步探讨与研究。     

马鞍山市1997～2006年围产儿出生缺陷监测报告

目的了解马鞍山市出生缺陷发生的状况,寻求预防和控制出生缺陷的措施。方法对马鞍山市1997—2006年围产儿出生缺陷监测资料进行回顾性分析。结果1997～2006出生缺陷平均发生率为6．24‰,不同围产儿性别、孕母年龄的出生缺陷发生率差异有显著性。出生缺陷发生顺位依次为总唇腭裂、多指（趾）畸形、先天性脑积水、先天性心脏病、肢体短缩畸形、外耳及其他畸形等。结论马鞍山市属于出生缺陷低发地区,居全省平均水平以下,今后应加强产前诊断等三级预防措施。     

Long-Term Survival Among Histological Subtypes in Advanced Epithelial Ovarian Cancer: Population-Based Study Using the Surveillance,Epidemiology, and End Results Database

BackgroundActual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported.ObjectiveThis study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (≥5 years) of advanced EOC.MethodsWe performed a retrospective analysis of data among patients with stage III-IV EOC diagnosed from 2000 to 2014 using the Surveillance, Epidemiology, and End Results cancer data of the United States. We used the chi-square test, Kaplan–Meier analysis, and multivariate Cox proportional hazards model for the analyses.ResultsWe included 8050 patients in this study, including 6929 (86.1%), 743 (9.2%), 237 (2.9%), and 141 (1.8%) patients with serous, endometrioid, clear cell, and mucinous tumors, respectively. With a median follow-up of 91 months, the most common cause of death was primary ovarian cancer (80.3%), followed by other cancers (8.1%), other causes of death (7.3%), cardiac-related death (3.2%), and nonmalignant pulmonary disease (3.2%). Patients with the serous subtype were more likely to die from primary ovarian cancer, and patients with the mucinous subtype were more likely to die from other cancers and cardiac-related disease. Multivariate Cox analysis showed that patients with endometrioid (hazard ratio [HR] 0.534, P<.001), mucinous (HR 0.454, P<.001), and clear cell (HR 0.563, P<.001) subtypes showed better ovarian cancer-specific survival than those with the serous subtype. Similar results were found regarding overall survival. However, ovarian cancer–specific survival and overall survival were comparable among those with endometrioid, clear cell, and mucinous tumors.ConclusionsOvarian cancer remains the primary cause of death in long-term ovarian cancer survivors. Moreover, the probability of death was significantly different among those with different histological subtypes. It is important for clinicians to individualize the surveillance program for long-term ovarian cancer survivors.     

2012-2014年贵州省流感监测分析

摘要:目的　了解2012-2014年贵州省流行性感冒（流感）流行特征,为流感防制提供参考依据。方法　收集2012 -2014年贵州省流感样病例（ILI）监测数据和病原学监测数据,分析ILI占门诊就诊病例百分比（ILI%）、流感病毒各亚型的变化规律。结果　哨点医院共报告ILI 229694例,ILI%平均为5.91%。网络实验室共检测哨点医院采集的流感样病例标本32111份,阳性率12.12%。其中病原构成为季节性流感H3亚型占41.00%,次为BY型占27.47%,甲型H1N1占26.54%,混合型占0.96%。结论　2012年以来贵州省流行的流感病毒多种,但主要是季节性流感H3亚型、BY型,以及甲型H1N1亚型;流感监测网络的建立,对发现新发、不明原因疾病起着重要的作用。     

甘肃省5县（市）出生缺陷干预实施前后先天缺陷发病率对比分析

目的探讨先天缺陷重点干预对策。方法比较分析敦煌市、泾川县、徽县、渭源县和永靖县基线及终末调查结果,孕28周以上出生的新生儿（包括活产、死胎和死产）先天缺陷发生率及构成的变化。结果甘肃省5县（市）围产儿先天缺陷发生率,终末调查时为8.35‰,较基线调查时的14．02‰,下降了40．44％。基线与终末调查时先天缺陷发生顺位及构成不同,终末调查先天缺陷发生率排在前三位的分别是先天性心脏病、神经管畸形及色素痣;病死率居前四位的分别为唐氏综合征、神经管畸形、直肠或肛门闭锁及先天性心脏病,其中唐氏综合征病死率达100．00％。结论各类先天缺陷中,先天性心脏病高发,死亡率明显上升。先天性心脏病已经成为影响我省5县（市）新生儿健康的主要问题。建议进一步加强优生优育教育,推广引用新技术,做好产前筛查及产前诊断,减少先天缺陷儿的出生。