Birth prevalence and recurrence rates of neural tube defects in southern Alberta in 1970-81.

Given the observed variation in birth prevalence and recurrence rates of neural tube defects, it is important to obtain such data specific to a given locality for research and genetic counseling purposes. A review of hospital medical charts, the patient lists of the Medical Genetics and Myelomeningocele clinics at Alberta Children's Hospital and data from the Canadian Congenital Anomalies Surveillance System revealed the annual birth prevalence rate of neural tube defects in southern Alberta in 1970-81 to be 1.62/1000 total births. This figure suggests southern Alberta to be a low-frequency area. There was no significant variation in the annual rates of spina bifida, encephalocele or all neural tube defects combined over the study period. A significant linear decline in the frequency of births of anencephalic infants, however, was noted (p = 0.025). Information on the total reproductive history of the mothers revealed that the empiric risk of recurrence of a neural tube defect was 2.2%, and the risk to all siblings was estimated to be 2.3%. In future prevalence studies multiple sources of case ascertainment should be used, including data on pregnancies terminated because of a fetal neural tube defect.     

Chemicals, birth defects and stillbirths in New Brunswick: associations with agricultural activity.

We describe a series of investigations that were conducted in support of the Task Force on Chemicals in the Environment and Human Reproductive Problems in New Brunswick. Geographic and temporal analyses and case-control studies, with the use of vital statistics, hospital records, the Canadian Congenital Anomalies Surveillance System and chemical databases, revealed no association between pesticides used in forestry and reproductive problems. Evidence of an association between the potential exposure to agricultural chemicals and three major anomalies combined as well as spina bifida without hydrocephalus was found. More plausible was an association between stillbirths and such exposure during the second trimester of pregnancy. This finding, along with the cyclic patterns of stillbirth in the agricultural Saint John River basin and the somewhat higher stillbirth rates in New Brunswick than in adjacent provinces or in Canada as a whole, suggests that further attention should focus on possible associations between agricultural activity and stillbirths.     

湖南省〈15岁人群乙型病毒性肝炎监测及流行病学分析

目的通过分析、比较疾病监测信息报告管理系统和中国免疫规划监测信息管理系统报告的〈15岁人群组乙型病毒性肝炎病例（乙肝）的基本信息、发病、诊断情况及发病因素等指标，了解我省近年来〈15岁人群组乙肝病例的报告及发病情况，为准确评价现有乙肝防治策略的效果提供依据。方法利用SPSS及Excel分析软件对两个系统报告的〈15岁人群组乙肝病例的基本信息及可疑影响因素进行分析和比较。结果我省通过中国免疫规划监测信息管理系统进行的乙肝监测的质量逐年提高，漏报情况明显下降，但报告人员对监测病例的定义掌握不够，存在错报现象。结论建立科学、有效的乙肝监测系统，制定统一的、便于临床医生操作的乙肝诊断标准对准确掌握乙肝实际发病情况，正确评价乙肝防治效果，调整乙肝防治策略是非常重要的和必要的。     

Congenital heart disease, maternal age and parental consanguinity in children with Down's syndrome

OBJECTIVE: Analyze the role of parental consanguinity and/or maternal age on the occurrence of congenital cardiac anomalies in infants with Down's syndrome (DS). MATERIAL AND METHODS: A large group of patients with or without congenital heart disease, registered between May 1st, 1999 and June 30th, 2006, at the National Register of Paediatric and Congenital Heart Disease, Lebanese Society of Cardiology. 217 children with DS have been enrolled over this period. Group I: DS with cardiac anomalies (n:119). Group II: DS without cardiac anomalies (n:98). The consanguinity rate was compared to a study made in 2000 by UNICEF in Lebanon, in which the consanguinity rate was 14.9% of 1st degree cousins and 25% of all degrees together. RESULTS: Congenital cardiac anomalies were found in 54.2% of babies with DS. First degree cousins in both groups I and II was 143% (close to the general population), and it was lower in group I compared to group II (11.8% and 17.3% respectively ; p = 0.205) ; this difference was not statistically significant for all degrees together. Maternal age ranged from 20 to 47 years, with a mean of 29.5 +/- 5.3 years. The risk of congenital cardiac anomaly was greater (p < 0.05) when maternal age was equal or below 32 years. As in the international literature, complete atrioventricular canal and ventricular septal defect were the most frequent cardiac anomalies. CONCLUSION: In children with DS, the risk of congenital cardiac anomalies was not associated with the parents consanguinity. Maternal age above 32 years seem to be associated with a lesser occurrence of congenital cardiac anomaly in children with DS.     

Development of a surgical site infection (SSI) surveillance system, calculation of SSI rates and specification of important factors affecting SSI in a digestive organ surgical department

We have developed an original system to conduct surgical site infection (SSI) surveillance. This system accumulates SSI surveillance information based on the National Nosocomial Infections Surveillance (NNIS) System and the Japanese Nosocomial Infections Surveillance (JNIS) System. The features of this system are as follows: easy input of data, high generality, data accuracy, SSI rate by operative procedure and risk index category (RIC) can be promptly calculated and compared with the current NNIS SSI rate, and the SSI rates and accumulated data can be exported electronically. Using this system, we monitored 798 patients in 24 operative procedure categories in the Digestive Organs Surgery Department of Mazda Hospital, Mazda Motor Corporation, from January 2004 through December 2005. The total number and rate of SSI were 47 and 5.89%, respectively. The SSI rates of 777 patients were calculated based on 15 operative procedure categories and Risk Index Categories (RIC). The highest SSI rate was observed in the rectum surgery of RIC 1 (30%), followed by the colon surgery of RIC3 (28.57%). About 30% of the isolated infecting bacteria were Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Using quantification theory type 2, the American Society of Anesthesiology score (4.531), volume of hemorrhage under operation (3.075), wound classification (1.76), operation time (1.352), and history of diabetes (0.989) increased to higher ranks as factors for SSI. Therefore, we evaluated this system as a useful tool in safety control for operative procedures.     

成人冠状动脉造影中先天异常的分析

目的：研究冠状动脉造影患者中成人先天性冠状动脉异常的检出频度。方法：回顾性总结2795例患者的冠状动脉造影资料，并准确判断出各种先天性冠状动脉异常。结果：检出冠状动脉起源及分布异常39例，检出率1．40％，其中各种右冠状动脉起源及分布异常占79．5％（31／39），左冠状动脉起源及分布异常占15．4％（6／39），单一冠状动脉占0．51％（2／39）；检出各种冠状动脉瘘21例，检出率0．75％，其中冠状动脉-肺动脉瘘16例；检出先天性冠状动脉扩张2例。结论：成年人冠状动脉先天异常的检出率与以往文献报道相似，但具体类型有所不同。冠状动脉造影是确诊冠状动脉先天性异常最重要的检查方法。     

Obstetric outcome of women with uterine anomalies in China

Background Congenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aimed to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations. Methods This retrospective study evaluated the fertility and obstetric outcome of 116 inpatients with uterine malformations with pregnancy in Peking University Third Hospital from June 1998 to June 2009. A total of 270 randomly selected pregnant women with a previously confirmed normally shaped uterus as a control group. Student＇s t test and analysis of variance （ANOVA） were used to compare means for normally distributed variables. The analysis was carried out using the SPSS. Results Among 21 961 deliveries in Peking University Third Hospital, 116 （0.45%） were in women with uterine anomalies. A septate uterus was present in 43 （37.1%） and the uterus didelphys in 28 （24.2%） of the 116 women identified. Bicornuate uterus, arcuate and unicomate uterus were observed in 12 （10.3%）, 18 （15.5%） and 15 （12.9%） patients, respectively. Patients with uterine anomalies had significantly higher rates of malpresentation （38.8%）, preterm delivery （19.8%）, and cesarean section （78.5%） compared with the group of women with a normal uterus. Patients with uterine anomalies had significantly lower mean birth-weight neonates and a significantly higher incidence of small for gestationalage （SGA） neonates; women with uterus didelphys more frequently required infertility treatment than patients with other uterine anomalies （P 〈0.001）. The rate of malpresentation was significantly higher in patients with septated uterus in comparison with patients with uterus unicorns （P 〈0.05）. Conclusions Women with congenital uterinemal formation usually have higher incidence of complications during pregnancy and delivery. A septate uterus appears to be associated with poorer obstetric outcomes.     

1996-2015年长治市婴儿死亡率变化趋势及相关因素分析

目的：：通过对长治市近20年婴儿死亡率变化趋势及相关因素的分析,提出干预措施,为政府部门制定儿童生存、保护和发展的方针和政策提供科学依据。方法：对长治市1996—2015年婴儿死亡监测资料进行整理、统计,分析婴儿死亡率变化趋势及死亡分布特征。结果：长治市婴儿死亡率从1996年的30.98‰至2015年的4.96‰,20年时间里呈逐年下降趋势,下降幅度为30.99%,年均下降率为9.19%。农村下降幅度快于城市,城乡差别缩小。先天畸形、早产/低体重、新生儿窒息、肺炎和先天性心脏病是长治市婴儿的主要死亡原因。结论：做好孕期保健,提高产科接生技术,减少早产、窒息、先天缺陷儿的出生。加强新生儿科建设,鼓励儿科医生进产房,提高新生儿救治水平以及婴儿健康管理工作,是降低婴儿死亡率的关键。     

2006-2008年广州市霍乱监测结果分析

目的 分析2006-2008年广州市霍乱监测结果 ,为制定防控策略提供依据.方法 对广州市2006-2008年霍乱监测资料进行分析.结果 3年共监测各类标本89 017宗,霍乱弧菌阳性40宗,其中病例10例,外环境16宗,水产品14宗,阳性率分别为0.02%、0.15%和0.12%.外环境中珠江水体霍乱弧菌共检出11宗,占阳性标本68.75%(11/16).病人为流行株,其它均为非流行株或非毒力株.结论 重点加强珠江水体和水产品的监测,了解其携带毒力的变化情况,防止霍乱的暴发和流行.     

Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada

CONTEXT: Prenatal diagnosis and termination of affected pregnancies can prevent infant deaths due to congenital anomalies, but an effect at the population level has not been shown. OBJECTIVE: To examine the impact of recent changes in congenital anomaly-related fetal and infant deaths on overall population-based infant mortality. DESIGN, SETTING, AND SUBJECTS: Birth cohort-based study of all live births, stillbirths, and infant deaths in Canada (excluding Ontario) for 1991-1998. MAIN OUTCOME MEASURES: Cause-specific infant mortality rates and gestational age-specific fetal death rates. RESULTS: The birth cohort-based infant mortality rate fluctuated between 6.4 and 6.1 per 1000 live births between 1991 and 1995, then dropped to 5.4 per 1000 in 1996 and 5.5 per 1000 in 1997. The rate of infant death from congenital anomalies was stable between 1991 and 1995 but declined by 21% (95% confidence interval, 19%-32%) from 1.86 per 1000 in 1995 to 1.47 per 1000 in 1996 and 1997. Fetal deaths due to pregnancy termination at 20 to 23 weeks' gestation increased dramatically in 1994, while fetal deaths due to congenital anomalies at 20 to 21 weeks increased in 1995 and subsequently. Provinces/territories with high rates of fetal death due to pregnancy termination/congenital anomalies at 20 to 23 weeks had fewer infant deaths due to congenital anomalies. CONCLUSION: A large decrease in infant deaths due to congenital anomalies was associated with the most recent decline in infant mortality in Canada, suggesting that increases in prenatal diagnosis and pregnancy termination for congenital anomalies are related to decreases in overall infant mortality at the population level.     

螺旋CT三维重建和纤维支气管镜对小儿气管支气管畸形的诊断价值

目的探讨螺旋CT三维重建和纤维支气管镜对小儿先天性气管支气管畸形的诊断价值。方法2004年2月至2008年6月间收住温州医学院附属育英儿童医院呼吸科,符合相应标准的0-14岁儿童128例,其中男86例,女42例;年龄〈3个月28例,-1岁53例,-3岁31例,-14岁16例。全部患儿给予螺旋CT和纤维支气管镜检查以明确有无先天性气管支气管畸形,利用诊断试验计算并比较螺旋CT与纤维支气管镜在诊断气管支气管畸形中的敏感性、特异性、阳性预测值和阴性预测值。结果（1）诊断为先天性气管支气管畸形共46例,其中气管支气管软化10例;支气管起源异常15例;气管支气管狭窄21例。（2）10例气管支气管软化均有纤维支气管镜检查明确;螺旋CT三维重建对诊断气管支气管起源异常的特异性和纤维支气管镜相仿,但敏感性明显高于纤维支气管镜;CT三维重建对诊断气管支气管狭窄的敏感性和准确率与纤维支气管镜相当。结论螺旋CT三维重建对气管支气管起源异常和支气管狭窄有较大的诊断价值,纤维支气管镜则能弥补CT对气管支气管软化诊断的不足,两者联合能有利于小儿气管支气管畸形的早期诊断。     

107例先天梅毒临床流行病学研究

目的先天梅毒(congenital syphilis,CS)近年在中国呈快速上升趋势,本文通过研究先天梅毒临床流行病学,旨在分析当前先天梅毒诊疗中存在的问题。方法对1999年2月至2003年2月间复旦大学附属儿科医院收治的107例先天梅毒患儿围产期、临床诊疗资料进行分析。结果在先天梅毒患儿母亲中,89.7%为流动人口,30.8%未进行妊娠期梅毒血清学筛查,94.4%未予正规青霉素治疗。先天梅毒新生儿期表现多变,以皮肤黏膜、骨骼损害较为特异,其比例分别为72%、40%。结论先天梅毒的发生多见于流动人口,孕妇缺乏梅毒血清学筛查和正规青霉素治疗是导致先天梅毒发生的最主要因素,政府应该加强对流动人口先天梅毒防治的管理。     

洛阳市涧西区2005-2006年麻疹监测与控制分析

目的解洛阳市涧西区麻疹流行病学特征和麻疹监测系统运转状况。方法对2005-2006年麻疹监测和预防接种资料进行分析、评价。结果涧西区2005-2006年共报告疑似麻疹病例247例,较法定传染病报告系统(218例)多13·30%,其中诊断麻疹152例。麻疹发病有明显春未夏初季节高峰。疑似麻疹病例的及时报告、及时调查、合格血清标本采集率分别为69·44%、78·29%。2005-2006年麻疹减毒活疫苗(MV)常规免疫,强化免疫的报告接种均(90%。结论接种MV是控制麻疹的基础,适时开展MV强化免疫,消除免疫空白,提高麻疹监测质量是加速控制麻疹的关键。     

先天性气管狭窄18例临床分析

目的分析经纤维支气管镜诊断的先天性支气管狭窄的临床特点。方法回顾分析了2009年4月至2012年5月在深圳市儿童医院呼吸科确诊的18例先天性支气管狭窄患儿的临床资料。结果 18例患儿中仅3例为单纯气管狭窄,其余均合并有其他畸形,其中11例患儿合并有呼吸系统以外的畸形,以心血管畸形居首位。先天性支气管狭窄患儿主要表现为喘息,但严重的气管狭窄可出现呼吸困难、气管插管困难和气管插管拔管失败。结论先天性气管狭窄可伴多发畸形,以心血管畸形多见,需及时完善心血管方面的相关检查;对怀疑气管狭窄的可疑患儿,需及时行支气管镜检查明确诊断。     

Computer surveillance of hospital-acquired infections and antibiotic use

Surveillance of hospital-acquired infections and antibiotic use is required of US hospitals. The time and cost needed to actively perform this surveillance can be extensive. We developed a computerized infectious disease monitor that automatically generates four types of surveillance "alerts" for patients with hospital-acquired infections, not receiving antibiotics to which their pathogens are susceptible, who could be receiving less expensive antibiotics, or who are receiving prophylactic antibiotics too long. Surveillance personnel using computer screening for two months found more hospital-acquired infections when compared with our traditional surveillance methods, while requiring only 35% of the time. In addition, alerts from the computer identified 37 patients not receiving appropriate antibiotics, 31 patients who could have been receiving less expensive antibiotics, and 142 patients, during one month, receiving prolonged cephalosporin prophylaxis. Computer screening can help focus the activities and improve the efficiency of hospital surveillance personnel.     

医院感染监控直报系统开发及实践

介绍了北京大学第三医院开发利用医院感染监控直报系统提高监管质量的实践。系统通过实现医院内部系统集成以及与北京市感染监控系统集成,优化流程、规范数据结构化、标准化采集和逻辑校验等措施,加强了数据准确性、完整性、一致性,实现了主动实时监控及上传直报,提高了工作效率和管理质量,为进一步深入应用提供参考。     

Cerebral arteriovenous malformation in Noonan's syndrome.

Noonan''s syndrome involves the association of multiple congenital abnormalities including neck webbing, pectus excavatum, facial anomalies with a variety of cardiac defects. In this paper the association of Noonan''s syndrome with a large cerebral arteriovenous malformation is reported. Congenital cerebrovascular abnormalities are not a recognized feature of the syndrome. The paper also reviews previous reports of neurological associations with Noonan''s syndrome, the commonest being mild intellectual impairment and ptosis.     

Detecting polio through surveillance for acute flaccid paralysis (AFP)

Accurate surveillance for polio is essential for eradication. Surveillance systems for polio has been developed under the guidance of the global polio eradication initiative. Surveillance of cases of acute flaccid paralysis among children less than 15 years of age is a key component for a well functioning polio surveillance system. The surveillance system works through a network of surveillance medical officers, the responsibility of them lies in assisting the health services departments of all states and maintaining a network of acute flaccid paralysis reporting sites and rapidly investigating the cases. Surveillance activities begin when a child comes in contact with a healthcare provider who in turn informs the officer in charge of acute flaccid paralysis surveillance. The goal of the polio network laboratories is to provide accurate and timely results of wild poliovirus detection in stool samples of cases of acute flaccid paralysis. Strong linkages have been established between the acute flaccid paralysis surveillance system and the laboratory network. Laboratories complete poliovirus isolation and if poliovirus is isolated, these are submitted for intratypic differentiations. Acute flaccid paralysis surveillance in India has demonstrated that the eradication activities implemented in India led to dramatic reduction and restriction in the number of cases and geographic spread of poliovirus transmission.     

广州市2011年登革热疫情流行病学特征分析

目的分析广州市2011年登革热疫情流行病学特征,为登革热预防控制工作提供参考依据。方法对广州市疫情监测与报告信息系统和实验室监测信息系统,以及相关的现场调查报告、疫情简报等进行统计与分析。结果广州市2011年报告登革热病例51例,本地感染33例,输入性病例18例,累计发病率0．4／10万,无死亡病例,输人性病例占全年报告病例的35．29％。除1、2、7月外,其余月份均有病例;共报告突发公共卫生事件1起,为海珠区龙凤街登革热暴发疫情（16例）。实验室监测表明,2011年广州市病毒流行株为登革I型病毒。结论2011年广州市登革热流行处于散发流行状态,输人性病例或异地来广州就诊的登革热病例对广州市登革热流行存在潜在风险。     

Data use and effectiveness in electronic surveillance of healthcare associated infections in the 21st century: a systematic review

Objective

As more electronic health records have become available during the last decade, we aimed to uncover recent trends in use of electronically available patient data by electronic surveillance systems for healthcare associated infections (HAIs) and identify consequences for system effectiveness.

Methods

A systematic review of published literature evaluating electronic HAI surveillance systems was performed. The PubMed service was used to retrieve publications between January 2001 and December 2011. Studies were included in the review if they accurately described what electronic data were used and if system effectiveness was evaluated using sensitivity, specificity, positive predictive value, or negative predictive value. Trends were identified by analyzing changes in the number and types of electronic data sources used.

Results

26 publications comprising discussions on 27 electronic systems met the eligibility criteria. Trend analysis showed that systems use an increasing number of data sources which are either medico-administrative or clinical and laboratory-based data. Trends on the use of individual types of electronic data confirmed the paramount role of microbiology data in HAI detection, but also showed increased use of biochemistry and pharmacy data, and the limited adoption of clinical data and physician narratives. System effectiveness assessments indicate that the use of heterogeneous data sources results in higher system sensitivity at the expense of specificity.

Conclusions

Driven by the increased availability of electronic patient data, electronic HAI surveillance systems use more data, making systems more sensitive yet less specific, but also allow systems to be tailored to the needs of healthcare institutes’ surveillance programs.