Use of hospital care and hospital case-fatality of myocardial infarction during three years' follow-up in Finland

The epidemiology and use of hospital care of myocardial infarction was studied at the population level with routinely collected hospital discharge data of the whole country during a three-year follow-up. The study population was a one-year-cohort of 13,520 patients with an acute myocardial infarction in 1981 in Finland. The incidence figures were comparable with the previous data attained from expensive and laborious special registries or population studies. With the possibility of record linkage and follow-up we could get information on the use of hospital care of these patients. We conclude that routinely collected hospital discharge data in Finland give information valuable for epidemiological studies, for the planning of health services and for the evaluation of hospital care.     

湖州市心脑血管疾病与气象因素的关系分析及预报研究

目的探讨气象因素与湖州市心脑血管疾病的关系,并建立医学气象预报模型对心脑血管疾病发病水平进行预测。方法收集湖州市中心医院和湖州市第一人民医院2006～2007年门诊就诊资料和同期该地区气象资料,采用Spearman相关分析,并用自动交互检测方法(AID)建立预报模型,数据处理用SPSS10.0和SAS EM 4.1统计软件。结果我市心脑血管疾病发病冬春季高于夏秋季节,其发病与日平均气压、平均气温、最低气温、日较差、水汽压、降水量、日照时数等气象因子存在相关性,按周建立了气象因素与心脑血管疾病预报模型和四个预警等级,模型拟合值为0.279。结论心脑血管疾病发病与气象因素密切相关,按周建立预警、预测模型效果较好。     

Low mean temperature rather than few sunshine hours are associated with an increased incidence of type 1 diabetes in children

The well-known north–south gradient and the seasonal variability in incidence of childhood type 1 diabetes indicate climatological factors to have an effect on the onset. Both sunshine hours and a low temperature may be responsible. In the present study we tried to disentangle these effects that tend to be strongly connected. Exposure data were sunshine hours and mean temperature respectively obtained from eleven meteorological stations in Sweden which were linked to incidence data from geographically matched areas. Incident cases during 1983–2008 were retrieved from the population based Swedish childhood diabetes register. We used generalized additive models to analyze the incidence as a function of mean temperature and hours of sun adjusted for the time trend, age and sex. In our data set the correlation between sun hours and temperature was weak (r = 0.36) implying that it was possible to estimate the effect of these variables in a regression model. We fit a general additive model with a smoothing term for the time trend. In the model with sun hours we found no significant effect on T1 incidence (p = 0.17) whereas the model with temperature as predictor was significant (p = 0.05) when adjusting for the time trend, sex and age. Adding sun hours in the model where mean temperature was already present did not change the effect of temperature. There is an association with incidence of type 1 diabetes in children and low mean temperature independent of a possible effect of sunshine hours after adjustment for age, sex and time trend. The findings may mirror the cold effect on insulin resistance and accords with the hypothesis that overload of an already ongoing beta cell destruction may accelerate disease onset.     

Bayes判别分析在肾综合征出血热发病预测研究中的应用

目的研究肾综合征出血热（HFRS）发病与气象因素和动物宿主的关系并建立合理的数学预报模型。方法首先选取逐月及逐年的气象指标,包括气压、气温、降雨量、相对湿度、日照时数和日照百分率作为代表因素;然后对HFRS与气象因素和动物宿主间的关系进行Pearson、Kendall及Spearman相关分析,最后利用气象因素和包括鼠密度及鼠带病毒率的动物宿主信息作为解释变量进行Bayes判别分析。结果HFRS年发病疫情与鼠密度关系最为密切（r=0．738,P=0．000）,而影响鼠密度最显著的气象因素是日照时数、日照百分率和降雨量。其中日照时数与鼠密度呈正相关（r=0．494,P=0．016）,而降雨量与鼠密度近似呈负相关（r=-0．350,P=0．101）。利用气象及动物宿主资料预测当年的人间发病强度时,逐步判别分析及全变量判别分析均具有良好的效果。逐步判别分析的组内回代及弃一交叉验证准确率均为82．6％（19／23）,而全变量判别分析的组内回代准确率为90．9％（20／22）,弃-交叉验证准确率为81．8％（18／22）。当预测下一年的发病强度时,逐步判别分析的组内回代及弃一验证正确率均为86．4％（19／22）,而全变量判别分析的组内回代分类正确率为100％（21／21）,弃-交叉验证分类正确率仅为57．1％（12／21）。结论气象因素影响动物繁殖及动物间疫情,进而影响人间的HFRS疟情．Bayes诼彤判别分析在预测HFRS疫情方面具有一定实际应用价值。     

乌鲁木齐市流感样病例与气象因素的ARIMAX模型预测分析

目的分析气象因素对乌鲁木齐市流感样病例(influenza-like illness,ILI)例数的影响,建立ARIMAX(autoregressive integrated moving average model-X)模型对ILI例数进行短期预测,为乌鲁木齐市流感的预防与控制提供理论依据。方法利用乌鲁木齐市2015年1月至2017年9月的ILI例数和同期气象数据,建立ARIMAX模型,预测乌鲁木齐市2017年10月至2018年3月的ILI病例数,并与实际ILI例数进行比较。结果2015年1月—2017年9月发病数建立了ARIMA(0,1,1)(1,1,0)12模型,AIC=200.09;通过残差序列互相关函数(CCF)得出月平均相对湿度与ILI例数之间存在正相关关系,月日照时数与ILI例数之间存在负相关关系。将月平均相对湿度和月日照时数作为影响变量,建立ARIMAX模型,其中,纳入滞后0阶月日照时数的ARIMAX模型的AIC最小(AIC=197.63),且模型各参数差异均具有统计学意义。与一元时间序列ARIMA模型相比,拟合的平均绝对百分误差(MAPE)降低1.3687%,预测的MAPE降低5.25%,预测精度提高。结论本研究建立的带有气象因素的ARIMAX模型能较好预测短时间内ILI病例数发病趋势,为流感监测和预防控制提供依据。     

Validity of coronary heart diseases and heart failure based on hospital discharge and mortality data in the Netherlands using the cardiovascular registry Maastricht cohort study

Incidence rates of cardiovascular diseases are often estimated by linkage to hospital discharge and mortality registries. The validity depends on the quality of the registries and the linkage. Therefore, we validated incidence rates of coronary heart disease (CHD), acute myocardial infarction, unstable angina pectoris, and heart failure, estimated by this method, against the disease registry of the cardiovascular registry Maastricht cohort study. The cohort consists of 21,148 persons, born between 1927 and 1977, who were randomly sampled from Maastricht and surrounding communities in 1987–1997. Incident cases were identified by linkage to the Netherlands causes of death registry and either the hospital discharge registry (HDR) or the cardiology information system (CIS) of the University Hospital Maastricht. Sensitivities and positive predictive values were calculated using the CIS-based registry as gold standard. Relatively high sensitivities and positive predictive values were found for CHD (72 and 91%, respectively) and acute myocardial infarction (84 and 97%, respectively). These values were considerably lower for unstable angina pectoris (53 and 78%, respectively) and heart failure (43 and 80%, respectively). A substantial number of cases (14–47%) were found only in the CIS-based registry, because they were missed or miscoded in the HDR-based registry. As a consequence, the incidence rates in the HDR-based registry were considerably lower than in the CIS-based registry, especially for unstable angina pectoris and heart failure. Incidence rates based on hospital discharge and mortality data may underestimate the true incidence rates, especially for unstable angina pectoris and heart failure.     

日光照射时间对2015—2018年深圳宝安区儿童手足口病的影响

目的 探讨逐日日照时间与深圳宝安区儿童手足口病发病风险的关系,分析其暴露-滞后效应。方法 收集深圳市宝安区2015—2018年0～5岁儿童手足口病资料及同期气象资料。以广义相加模型探讨日照时间与逐日发病之间的线性关系,再使用分布滞后非线性模型定量分析日照时数对发病的单日效应及多日累积效应。按性别、年龄段对研究人群进行分层分析,并绘制累积暴露-效应曲线。结果 研究期间共报告0～5岁手足口病病例65 071例,平均日照时数为5.2 h,二者之间存在曲线关联。单日效应结果表明,日照时间超过7 h是发病的危险因素。多日累积效应曲线呈“M”形。日照时数在较高区间 (＞7 h)内增多时,各组儿童累积发病风险均上升;每增加1 h,累积风险增加4%(RR = 1.04,95%CI = 1.03～1.05)。日光照射对多日累积发病的滞后作用最大可达3 d(RR = 1.11,95%CI = 1.01～1.23)。结论 日照时间超过7 h能增大深圳宝安区儿童手足口病的发病风险,各组儿童普遍受其影响。日照时数增多时,应加强儿童手足口病的防控工作。     

株洲市气象因子对手足口病发病的滞后效应研究

目的 分析株洲市气象因子对手足口病发病的影响,为手足口病预防控制工作提供科学依据。 方法 收集2010-2016年株洲市手足口病日发病数据及日气象数据,在描述其数据特征的基础上,采用分布滞后非线性模型,分析气象因子与手足口病发病的关系及其滞后效应。 结果 2010-2016年株洲市共报告手足口病病例53 877例,其中2016年报告病例最多,为12 355例;发病呈现双高峰状态。株洲市气温、风速和日照时数与手足口病发病呈正相关(P<0.05),气压、相对湿度与手足口病发病呈负相关(P<0.05)。以气温18.18 ℃为参照,日平均气温在30.6 ℃,滞后0 d时相对危险度(relative risk,RR)值最高,为1.28(95%CI:1.12~1.46),且有统计学意义(P<0.05);以最低气压1 003.58 hpa为参照,日最低气压在1 032.2 hpa,滞后25 d时RR值最高,为1.68(95%CI:0.97~2.93);以风速3.8 m/s为参照,日均最大风速在0 m/s,滞后0 d时RR值最高,为1.17(95%CI:0.92~1.49);以相对湿度74.8%为参照,日均相对湿度在28%,滞后2 d时RR值最高,为1.61(95%CI:0.81~3.17);以日照时数4.18 h为参照,日均日照时数在13 h,滞后0 d时RR值最高,为1.06(95%CI:0.97~1.17),以上四项均无统计学意义(P>0.05)。 结论 气象因子是影响株洲市手足口病发病的重要因素,对手足口病发病的影响呈非线性且具有滞后性。     

气象因素变化与大连市肠道传染病发病时间分布关系的研究

目的探讨大连市气象因素对肠道传染病发病时间分布的影响,为有关部门制定肠道传染病防治对策及措施提供理论依据。方法肠道传染病中选择细菌性痢疾作为研究病种,气象因素与细菌性痢疾发生的关系采用单因素相关分析和多元回归分析,同时应用圆形分布法探讨肠道传染病发病的时间规律。结果分析1981-2010年大连市气象资料显示,30年间最高气温共上升0.80℃,最大风速共下降5.23m/s、日照时数共减少23.98h;多元回归分析结果显示大连市细菌性痢疾的发病数主要由前3个月的日照时数、前1个月的平均最高气温、前3个月的最大风速和前1个月的平均气压所决定,回归系数分别为0.785、8.726、10.633和7.479;应用圆形分布法计算不同年代的发病高峰日和高峰期,结果显示除2001-2005年外,30年间大连市细菌性痢疾每5年发病高峰时点逐渐前移,同时发病高峰期逐渐延长,共延长36d。结论大连市肠道传染病的发生与气象因素有关,且气象因素影响大连市肠道传染病发病的时间分布规律,表现为随着气温的升高、日照时数的减少和风速的下降,大连市细菌性痢疾的发病高峰日前移,高峰期间也有所延长,因此大连市肠道门诊开放的时间应根据气象特点做相应调整。     

基于气象因素的衡阳市手足口病疫情预警模型的建立

目的 通过分析2011-2014年衡阳市手足口病的流行病学特征,结合同期气象因素,探讨建立手足口病预警模型,为手足口病防控方式提供新依据。 方法 收集衡阳市2011-2014年手足口病发病资料及同期气象资料,采用描述性流行病学方法分析手足口病流行趋势,利用Spearman相关性矩阵,综合考量各气象要素与手足口病发病的相关性,通过层次分析法构建权重矩阵,构建预警模型。 结果 衡阳市2011-2014年手足口病每年发病呈双高峰形态,主高峰在4-7月(23 904例,占56.21%),小尾峰在9-10月(9 847例,占23.16%)。手足口病发病数与温度和日照时间呈相关关系(r=0.706、0.441);利用层次分析法构建的手足口病发病预警模型提示:衡阳市2014年无红色预警月,黄色预警月份为4、5、6、8月。 结论 衡阳市手足口病发病与气温、气湿、降雨量、日照时间等气象因素有关,利用气象因素建立的预警模型可以较好地为防控策略提供参考。     

上呼吸道感染性疾病与气象条件的关系及预报研究

目的研究气象条件变化对上呼吸道感染性疾病发生的影响程度，建立气象因子与发病趋势的最佳模型，开展预警预报服务。方法收集湖州市中心医院2006年门诊就诊资料和同期该地区气象资料，采用Pearson相关分析和Spearman相关分析，并用自动交互检测方法（AID）建立预报模型，数据处理用统计软件。结果湖州市上呼吸道感染性疾病在春季高发；水汽压、平均气压、降水量和温差是影响发病的主要气象因子，当平均气压〈1019．45HPa且水汽压〈7．9HPa时，发病水平最高；水汽压≥12．25HPa且降水量≥0．05mm时，发病水平最低。按周发病数据拟合上呼吸道感染性疾病预警模型和预警等级，模型拟合R2值为0．3793。结论水汽压、平均气压、降水量和日照时数等气象因子与上呼吸道感染性疾病发生密切相关，可利用AID建立预警预报模型。     

急性闭角型青光眼小梁切除术后浅前房临床分析

目的分析急性闭角型青光眼小梁切除术后浅前房的原因及处理方法。方法对2006年1月至2009年5月就诊于我院的急性闭角型青光眼患者330例422眼行小梁切除术,术中联合应用丝裂霉素C0.4g·L-1。对术后浅前房100例(116眼)进行原因分析及治疗效果观察统计。结果本组330例422眼小梁切除术后眼压均下降,发生浅前房100例116眼。原因:房水滤过过强58眼,结膜瓣渗漏30眼,睫状体脉络膜脱离20眼,恶性青光眼8眼。保守治疗88眼,手术治疗28眼。结论急性闭角型青光眼患者小梁切除术中应用丝裂霉素C后浅前房较常见,大多数浅前房可通过保守治疗治愈。     

急性闭角型青光眼小梁切除术后浅前房临床分析

目的分析急性闭角型青光眼小梁切除术后浅前房的原因及处理方法。,方法对2006年1月至2009年5月就诊于我院的急性闭角型青光眼患者330例422眼行小梁切除术,术中联合应用丝裂霉素C0．4g·L^-1。对术后浅前房100例（116眼）进行原因分析及治疗效果观察统计。结果本组330例422眼小梁切除术后眼压均下降,发生浅前房100例116眼。原因：房水滤过过强58眼,结膜瓣渗漏30眼,睫状体脉络膜脱离20眼,恶性青光眼8眼。保守治疗88眼,手术治疗28眼。结论急性闭角型青光眼患者小梁切除术中应用丝裂霉素C后浅前房较常见,大多数浅前房可通过保守治疗治愈.     

肾综合征出血热发病率与气象因素关系的研究

目的 探索影响肾综合征出血热发病率的气象因素及其定量关系.方法 运用病例交叉设计思想,对某监测点历年逐月的HFRS疫情资料和气象资料,建立气象因素对HFRS发病率影响的分季节多变量logistic回归模型.结果 影响HFRS流行的主要气象因素,春季为前6个月最低气温、前12个月平均气温、前6个月降雨量、前12个月降雨量、当月平均相对湿度、前3个月平均相对湿度、前3个月平均气压、前6个月平均气压、当月平均风速;夏季为当月平均气温、当月降雨量、前3个月平均相对湿度、前12个月平均相对湿度、前3个月总日照时间、前3个月平均风速;秋季为前6个月平均气温、当月平均相对湿度、当月总日照时间、前3个月平均风速;冬季为前3个月降雨量、前6个月降雨量、前12个月降雨量、当月平均相对湿度、前3个月平均相对湿度、前3个月日照时数、前3个月平均风速.结论 平均气温、降雨量、相对湿度、日照时数、平均气压、风速等气象因素均不同程度地影响HFRS,不同季节各气象变量的作用不同.     

Congenital rubella syndrome in the United States, 1970-1985. On the verge of elimination

The National Congenital Rubella Syndrome Registry, a passive surveillance system, and the Birth Defects Monitoring Program, a newborn hospital discharge data set, are used to monitor the incidence of congenital rubella syndrome in the United States. Reports to the registry contain clinical and laboratory data which allow cases to be classified into six categories according to the likelihood of having congenital rubella syndrome. The monitoring program records newborn discharge diagnoses, without detailed information, of a nonrandom sample of about one fourth of the births in the United States annually. To evaluate the two systems and to estimate the actual incidence of congenital rubella syndrome, the authors collected hospital discharge summaries on all cases as reported by the monitoring program from 1970-1985 and classified them by the registry criteria. Of the 392 cases reported to the monitoring program during 1970-1985, 24% (n = 93) could be classified as confirmed or compatible compared with 79% (n = 415) of the 526 cases reported to the registry (rate ratio = 3.3; 95% confidence interval (CI) 2.9-3.8). Diagnosis of congenital rubella syndrome was made during the neonatal period for 68% (263 of 389) registry cases for whom such data were available. When the Lincoln-Peterson capture-recapture method of estimating population size for independent surveillance systems was used, an estimated 1,064 confirmed and compatible cases (95% CI 668-1,460) diagnosed during the neonatal period occurred during 1970-1979, for an average of 106 cases per year. During 1980-1985, an estimate of 122 neonatal confirmed and compatible cases (95% CI 8-236) occurred, for an average of 20 cases per year. A downward secular trend in the incidence of congenital rubella syndrome beginning in 1980 was observed. The registry detected 22% of all neonatal confirmed and compatible cases, the monitoring program detected 8%, and the two systems combined detected a total of 28%. The results indicate that congenital rubella syndrome may be on the verge of elimination in the United States.     

Is the incidence of hypospadias increasing? Analysis of Finnish hospital discharge data 1970-1994

Reports suggesting an increasing incidence of male genitourinary anomalies such as hypospadias, possibly related to environmental factors such as environmental estrogen-like compounds, have recently received considerable publicity. These reports are based on birth defects registry data, and there may be variation in the completeness of the registries used. We analyzed temporal trends in the prevalence of hypospadias in Finland to assess the previously reported low overall prevalence and to detect any possible increasing tendencies during the past decade. We identified all patients who were surgically treated for hypospadias before the age of 9 years among boys born 1970-1986 in the national hospital discharge registry. We calculated the cumulative prevalence by dividing the number of patients by the number of male births, and we used Poisson regression analysis. Out of 549,176 boys born in Finland in 1970-1986, 1,543 were treated for hypospadias by the age of 8 years (28.1 surgically treated patients per 10,000 male live births; 95% confidence interval, 26.7-29.5). The prevalence of hypospadias in Finland remained constant throughout the study period and appears to have been approximately three times higher than previously reported. Changes in completeness of registration may account for a substantial proportion of the reported increases in the prevalence of hypospadias in Finland and possibly also elsewhere.     

山东省猩红热发病与气象因素相关性研究

目的探讨气象因素与猩红热发病的关系。方法将山东省2000-2007年猩红热发病率资料进行正态化处理,对可能影响其发病的气温、降水和日照时数三个气象因素进行单因素相关分析和多元逐步回归分析。结果猩红热发病率与平均气温(r=0.622,P>0.05)和平均降水(r=0.115,P>0.05)呈正相关,但差异无统计学意义,与平均日照时数(r=-0.889,P<0.05)呈负相关,且差异有统计学意义。结论当日照时数偏低时,应加强对猩红热的监控。     

Low serum folate concentrations are associated with an excess incidence of acute coronary events: the Kuopio Ischaemic Heart Disease Risk Factor Study

OBJECTIVE: To test the hypothesis that low serum folate concentrations are associated with an increased risk of acute coronary events in men free of prior coronary heart disease. SETTING: Research Institute of Public Health, University of Kuopio, Kuopio, Finland. DESIGN: Prospective study in a cohort of 734 men aged 46-64 y examined in 1991-1993 as part of the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) and followed for 5 y and 3 months. INTERVENTION: Acute coronary events during the follow-up period were obtained by national hospital discharge registry. Baseline serum folate concentrations were measured by radioimmunoassay. RESULTS: During the follow-up, six (2.5%) men with higher serum folate concentrations (highest third>11.3 nmol/1) and 28 (5.7%) men with lower serum folate (two lowest thirds) developed an acute coronary event (P=0.008). In a Cox model adjusting for age, examination years, and plasma lycopene concentration, in men with higher serum folate concentrations the relative risk for an acute coronary event was 0.31 (95% CI 0.11-0.90, P=0.031) when compared with men with lower serum folates. CONCLUSION: This prospective cohort study in middle-aged men from eastern Finland indicates that moderate-to-high levels of serum folate are associated with a greatly reduced incidence of acute coronary events.     

2015-2018年杭州地区手足口病流行病学特点及与气象的相关性研究

目的探讨2015-2018年杭州地区手足口病(HFMD)的流行病学特征、病原学特点以及HFDM发病率与气象因素的关系。方法回顾性统计2015-2018年杭州地区HFMD的临床病例进行流行病学特点分析;利用实时荧光定量聚合酶链反应检测病毒核酸;多元线性回归对HFMD阳性率与气象因素进行相关性分析。结果2015-2018年共临床诊断HFMD通用型阳性病例2652例,其中柯萨奇病毒A16型(CA16)8例,阳性率为0.30%,未检出肠道病毒71型(EV71)。HFMD发病时间聚集以5~7月份为高峰,平均年龄(2.45±1.66)岁,男女比例为1.6∶1。多元线性回归分析显示,肠道病毒阳性率与平均气温、相对湿度、降雨均呈正相关(P<0.05);与日照时数无明显相关性(P=0.203)。结论杭州地区2015-2018年HFMD仍以1~3岁散居男童为主,病原学以肠道病毒通用型为主;HFMD发病率与平均气温、相对湿度、降雨量密切相关,与日照时数无明显相关性。     

The feasibility of combining data from routine Hospital Discharge and Causes-of-Death Registers for epidemiological studies on stroke

We assessed the validity of hospital discharge data on stroke in Finland and the feasibility of linked hospital discharge and causes-of-death data for epidemiological studies using the FINMONICA Stroke Register as the reference. The results showed that such data can, with some caution, be used for incidence studies and for identifying first stroke events. They cannot, however, be used for assessing secular trends in all stroke events.