全国第三次死因流调四川省儿童死亡分析

目的了解第三次全国死因流调四川省5岁以下儿童死亡率及死亡原因。方法利用第三次全国死因回顾抽样调查资料,对四川省10个调查点5岁以下儿童死亡率、根本死因进行分析。结果10个调查点5岁以下儿童、婴儿和新生儿死亡率,分别为12.10‰、7.07‰和4.31‰。各点之间5岁以下儿童、婴儿、新生儿死亡率差异有统计学意义(χ2分别为854.34,364.84,245.18;P0.01)。婴儿死亡占5岁以下儿童死亡的58.41%,新生儿死亡占婴儿死亡的60.98%。肺炎是5岁以下儿童死亡的第1位死因,起源于围生期的其他情况是婴儿、新生儿死亡的第1位死因。结论新生儿死亡是5岁以下儿童死亡的主要年龄段,肺炎、起源于围生期的其他情况是5岁以下儿童和新生儿死亡的主要根本死因。     

2004-2005年广东省第3次死因回顾性调查样本代表性与数据质量评价

目的阐述2004—2005年广东省第3次死因回顾调查样本代表性与数据质量,为资料利用提供依据。方法通过多阶段分层整群抽样方法,对广东省13个县（市、区）2004-2005年全部死亡人群进行回顾调查,依据人口学特征、拟舍优度检验、玛叶指数等对2004-2005年广东省第3次死因回顾调查样本（其中12个调查点数据）的代表性进行评价,从死因诊断依据、死亡率、死因编码质量等方面评价数据质量。结果本次调查覆盖全省12个市、县（区）共758．5472万人口,无论是年龄构成还是性别比、地域和社会经济等指标统计学检验,还是年龄构成的拟合优度检验,调查样本与2000年广东省人口普查户籍人口相比,差异均无统计学意义（均P〉0．05）;选取调查样本10—69岁和20～79岁2个年龄组样本,计算玛叶指数为3．59,说明调查样本人口数据无年龄偏好。本次调查地区共收集2004-2005年12个调查点死亡个案99919例,平均粗死亡率为658．6／10万,10个调查点粗死亡率符合质控要求,婴儿死亡率为6．7％。,全部死亡个案的死因最高诊断单位以县及以上医疗机构为主,达62．48％,死因最高诊断依据以临床＋理化和临床诊断为主,合占85．93％;其中死于恶性肿瘤个案的诊断单位以县及以上医疗机构诊断比例最高,达89．33％,诊断依据以尸检、病理、手术和临床＋理化等合计比例达83．76％。全部调查个案的编码总体准确率达96．07％,死因不明率为1．89％,死因不准确率为1．56％,死因错误率为0．48％。结论2004—2005年广东省第3次死因回顾调查样本代表性良好,调查结果可代表全省情况,调查过程质控严格,数据完整性、可靠性和准确性指标均符合质控要求,数据质量良好。     

五峰县第三次死因回顾抽样调查结果分析

目的通过死因调查了解五峰县居民死亡率。方法按照全国第三次死因调查实施方案,将收集到的2551份死因调查资料（2004～2005年）进行分析。结果全县居民死亡2551例,死亡率为6．18‰,（其中男性死亡率为6．58‰,女性死亡率为5．71‰）。死亡率排在前五位的依次为损伤中毒（1．6‰）、呼吸系统疾病（1．3‰）、恶性肿瘤（1．2‰）、循环系统疾病（1．2‰）、消化系统疾病（0．3‰）。结论五峰县居民死因：青年期以损伤和中毒占首位,中、老年期以恶性肿瘤为主要死因（肝癌死亡率在恶性肿瘤中占第一位、宫颈癌占第二位、肺癌占第三位;宫颈癌为该县妇女的主要死因）,其次呼吸系统疾病是老年期的主要死因。     

全国第三次死因流调四川省恶性肿瘤死亡分析

目的了解四川省主要恶性肿瘤流行特征。方法按照全国第三次死因回顾抽样调查方案,对2004-2005年四川省10个县区以恶性肿瘤为主的死因进行回顾性抽样调查,分析主要恶性肿瘤死亡率及其死亡构成。结果2004-2005年四川省10个县区居民恶性肿瘤2年平均粗死亡率和标化死亡率分别为142.6/10万和111.3/10万,是被调查地区总死亡原因的第1位死因,占总死因的比例为23.79%;男性和女性标化死亡率分别为139.3/10万和80.4/10万,男性标化率明显高于女性（u=25,P〈0.01）;主要恶性肿瘤粗死亡率随着年龄增高而呈现增高的趋势;居前5位的恶性肿瘤死亡依次为胃癌、肝癌、肺癌、食管癌和结直肠癌,其粗死亡率分别为29.7/10万、29.2/10万、26.1/10万、22.8/10万和8.7/10万。结论四川省恶性肿瘤死亡水平呈上升趋势,已成为严重危害居民生命和健康的常见病和多发病,主要癌种为胃癌、肝癌、肺癌、食管癌和结直肠癌等。     

重庆工业污染区1991～1998年居民死因及潜在减寿年数分析

目的 分析20世纪90年代重庆市工业污染区居民主要死因。方法 应用死亡率、死因顺位、潜在减寿年数（YPLL）及潜在价值减寿年数（VYPLL）等指标分析该区1991～1998年死因资料。对照组为该市非工业污染文化社区。结果 该区平均粗死亡率为7.34‰（标化死亡率4.61‰）。主要死因顺位为：恶性肿瘤、脑血管病、呼吸系病、心脏病和意外死亡。恶性肿瘤死率为198.07/10万（标化死亡率126.35/10万）,其中肺癌居第一位,死亡率为65.49/10万（标化死亡率45.27/10万）。主要死因标化潜在减寿率（SYPLL率）和标化潜在价值减寿率（SVYPLL率）顺位的第一位都为意外死亡。结论 为了降低该居民死亡率,既要进一步加强其自然环的治理,也应重视社会环境的治理。     

2010-2012年泰安市泰山区居民死因和减寿分析

目的分析泰安市泰山区居民的2010-2012年主要死亡原因和减寿情况,为制定有效预防控制政策提供科学依据。方法使用卫生部指定的死因专用软件＂DeathReg2005＂、SPSS 13.0和Excel 2003软件,对2010-2012年泰山区居民死因监测数据进行数据整理和统计分析,分析指标包括：死亡率、标化死亡率、死因顺位、潜在减寿年数（PYLL）、减寿率（PYLL‰）和平均减寿年数（AYLL）。结果 2010-2012年泰山区居民平均死亡率为505.70/10万,标化死亡率为480.14/10万,呈逐年递增趋势。男性死亡率为603.93/10万,女性死亡率为406.04/10万,差异有统计学意义（χ^2=39.01,P〈0.01）,前5位死因依次是恶性肿瘤（145.06/10万）、心脏病（136.36/10万）、脑血管病（94.63/10万）、呼吸系统疾病（42.27/10万）、损伤和中毒（30.61/10万）;对泰山区居民寿命损失影响最大的前5位死因是恶性肿瘤（12.35‰）、损伤和中毒（7.58‰）、心脏病（5.87‰）、脑血管病（5.19‰）、呼吸系统疾病（0.94‰）。结论慢性非传染性疾病和伤害是造成泰山区居民死亡和减寿的主要死因,应加强慢性病综合防控。     

2008-2012年福建省劳动力人口伤害死因分析

目的了解福建省劳动力（0～59岁）伤害死亡动态和主要死因,为劳动力人群伤害的预防与控制提供科学依据。方法对2008-2012年福建省劳动力意外死亡资料进行流行病学分析。结果2008～2012年福建省死因登记报告信息系统累计报告劳动力人I=I伤害死亡17350例,年均粗死亡率为10．77／10万,标化死亡率为10．56／10万;伤害死亡累计减寿664603人年,年均粗PYLL率为4．31‰,标化PYLL率为4．44‰。标化死亡率2011年最低,2012年最高;标化PYLL率2009年最低,2012年最高（P〈0．01）;中年劳动力标化死亡率高于其余类型劳动力,男性高于女性;标化PYLL率壮年劳动力高于其余类型劳动力,男性高于女性;各种伤害死因中,2008～2012年平均标化死亡率居前3位的依次为交通事故（5．18／10万）、溺水（1．34／10万）、摔落和跌倒（1．04／10万）,平均标化PYLL率居前3位的依次为交通事故（1．85‰）、溺水（0．48‰）、摔落和跌倒（0．37‰）。结论交通事故是目前福建省劳动力人群伤害死亡的首位死因,壮年、中年男性是伤害防制的主要方面。     

2004-2005年四川省居民胃癌死亡状况

目的 了解2004-2005年四川省居民胃癌死亡特征.方法 按ICD-10的标准,对2004-2005年全国第三次死因回顾抽样调查四川省10个调查点居民胃癌死亡率进行分析.结果 10个调查点胃癌年均粗死亡率为29.71/10万,标化死亡率22.60/10万,10个调查点胃癌死亡率在9.86/10万～64.22/10万之间,且各调查点间死亡率差别有统计学意义(x2=918.57,P＜0.000 1),盐亭县和康定县的胃癌死亡率分别居第1、2位,标化死亡率分别为47.30/10万、40.21/10万.随着年龄的增大胃癌死亡率呈逐渐增加的趋势(P＜.000 1);男、女性胃癌标化死亡率分别为28.88/10万、15.72/10万,男性高于女性(x2=264.87,P＜0.000 1).结论 四川省居民胃癌死亡率较高,盐亭县和康定县达到国家胃癌高发县(区)的标准,胃癌是威胁中老年人健康的主要恶性肿瘤.     

张家港市2011年居民死亡资料分析

目的分析张家港市2011年居民死亡资料,为相关部门制定卫生工作决策和评价疾病预防控制工作的防治效果提供基础信息和科学依据。方法利用DeathReg 2005《死亡医学登记系统》进行分析,计算居民的粗死亡率、分性别死亡率、婴儿死亡率、新生儿死亡率、平均期望寿命、死因构成和死因顺位等统计指标。利用SPSS 13.0软件计算不同性别间死亡率差异有无统计学意。结果 2011年张家港市居民粗死亡率为693.78/10万,标化死亡率为311.69/10万,男性死亡水平高于女性;婴儿死亡率为3.68‰,新生儿死亡率为2.39‰;平均期望寿命为81.34岁;前10位死因依次为恶性肿瘤、脑血管病、损伤和中毒、呼吸系统疾病、心脏病、内分泌营养代谢疾病、其他疾病、精神障碍疾病、消化系统疾病、神经系统疾病,共占全部死因的95.85%,其中男性前3位死因是恶性肿瘤、脑血管病和呼吸系统疾病,女性前3位死因是脑血管病、恶性肿瘤和损伤和中毒。结论恶性肿瘤、脑血管病和损伤和中毒已经成为影响居民健康的重要公共卫生问题,应将以上因素的预防控制措施作为今后工作的重点,从而提高居民的生活质量。     

2007年甘肃省疾病监测点死因谱及潜在减寿年数构成特征

目的了解甘肃省疾病监测点死因谱及潜在减寿年数构成特征,为制定甘肃省重大疾病的防制策略提供科学依据。方法对甘肃省各监测点依据死亡医学证明书收集的死因数据进行核对,按照ICD标准进行死因编码,然后由甘肃省CDC进行分类汇总和统计分析。结果2007年甘肃省疾病监测点死因构成顺位第1位是循环系统疾病,粗死亡率为187.84/10万（标化率为277.51/10万）,构成比为35.99%。处于第2位的是肿瘤,粗死亡率为103.15/10万（标化率为130.63/10万）,构成比为19.77%;处于第3位的是呼吸系统疾病,粗死亡率为103.09/10万（标化率为160.93/10万）,构成比为19.75%;损伤和中毒排第4位。潜在减寿年数构成顺位第1位是损伤和中毒,减寿率为19.86‰,第2位是循环系统疾病,减寿率为11.88‰,第3位是肿瘤,减寿率为11.68‰。结论2007年甘肃省疾病监测点死亡率最高的是循环系统疾病,而造成早死的主要原因是损伤和中毒。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.