宁波市流行性感冒相关超额死亡分析

目的评估2010—2014年宁波市流行性感冒(流感)相关超额死亡情况,为流感防控工作提供参考。方法采用率差模型方法,分析2010—2014年宁波市的死亡数据和流感监测数据,估计流感流行导致的流感和肺炎(PI)、呼吸和循环系统疾病(RC)、缺血性心脏病(IHD)、慢性阻塞性肺疾病(COPD)和全死因(AC)这5种死因的超额死亡率。结果 2010—2014年宁波市流感活动占优势时期(P1时期)共37周;其中2010—2013年流行优势毒株分别为B型、H1N1、B型和H3N2,2014年为H1N1和H3N2。2010—2014年宁波市全人群AC平均每周超额死亡率为2.54/10万;各年份全人群AC超额死亡率分别为12.66/10万、15.19/10万,27.86/10万、12.66/10万和25.32/10万;全人群5种死因(PI、RC、IHD、COPD和AC)年平均超额死亡率分别为1.68/10万、12.83/10万、1.34/10万、0.84/10万和18.74/10万;各年度均以RC超额死亡率最高;≥65岁人群5类死因年平均超额死亡率均高于全人群平均水平,0~4岁人群5类死因的年平均超额死亡率均低于全人群平均水平。结论宁波市流感活动占优势时期主要在冬春季,≥65岁老年人以及慢性心肺疾病患者因流感引起的超额死亡较高,是流感疫苗接种的重点人群。     

Serfling回归模型在深圳市流感超额死亡估计中的应用

目的 运用Serfling回归模型评估深圳市2013-2015年深圳市因流感引起的死亡负担,为了解深圳市流感的流行程度和制定疫苗接种策略提供参考依据。方法 收集深圳市2013-2015年根本死因为全死因（all-cause,AC）、呼吸和循环系统疾病（respiratory and circulatory disease,R&C）、流感和肺炎（pneumonia and influenza,P&I）三类死亡数据,并划分全年龄组、<65岁组和≥ 65岁组,分别拟合Serfling回归模型,估计深圳市2013-2015年的超额死亡数和超额死亡率。结果 2013-2015年用AC估计的深圳市年平均流感超额死亡数为652.80人,年均超额死亡率为6.11/10万。用R&C估计的深圳市年平均流感超额死亡数为449.78人,年均超额死亡率为4.21/10万。用P&I估计的深圳市年平均流感超额死亡数为44.94人,年均超额死亡率为0.42/10万。结论 Serfling回归模型显示老年人是流感超额死亡发生的高危人群,尤其是已患有呼吸和循环系统疾病的人群。     

成都市大气PM_(2.5)相关的老年人超额死亡风险评估

目的探讨成都市大气颗粒物(PM_(2.5))污染所致老年人超额死亡风险。方法收集2013—2016年成都市大气颗粒物(PM_(2.5))日平均浓度、死亡个案数据及气象因素,利用广义相加模型,控制时间的长期趋势、气象因素等混杂因素,分析PM_(2.5)浓度对老年人死亡的影响。收集2017年成都市大气颗粒物(PM_(2.5))日平均浓度和死亡个案数据,根据健康损失计算模型,估算2017年成都市PM_(2.5)污染造成的老年人超额死亡人数。结果单污染物模型显示成都市PM_(2.5)浓度每升高10μg/m~3,老年人非意外总死亡风险增加0.36%(95%CI:0.25%～0.48%),呼吸系统疾病死亡风险增加0.51%(95%CI:0.30%～0.72%),循环系统疾病死亡风险增加0.36%(95%CI:0.16%～0.56%)。多污染物模型中,成都市PM_(2.5)浓度每升高10μg/m~3,老年人非意外总死亡风险增加0.33%(95%CI:0.21%～0.45%),呼吸系统疾病死亡风险增加0.48%(95%CI:0.26%～0.69%),循环系统疾病死亡风险增加0.29%(95%CI:0.09%～0.49%)。2017年成都市老年人因PM_(2.5)污染造成的非意外、呼吸系统疾病、循环系统疾病超额死亡数分别为1 252、540、409人,占当年老年人同死因别总死亡数的1.95%、2.72%、1.94%。结论 PM_(2.5)污染增加老年人超额死亡风险。     

大气二氧化硫与居民每日呼吸系统疾病死亡相关性的时间序列分析

目的 分析大气中主要气态污染物二氧化硫(SO2)急性暴露对北京市居民每日呼吸系统疾病死亡人数的影响.方法 采用时间序列的广义相加模型,在控制时间趋势和气象因素、“星期几效应”等混杂因素的基础上,分析北京市2006年1月1日2009年12月31日大气SO2浓度与居民每日呼吸系统疾病死亡人数的关系.结果 北京市大气SO2浓度每升高10 μg/m3,居民当日呼吸系统疾病死亡人数、滞后1d的每日肺炎死亡人数分别增加0.88％(95％CI:0.34％～1.41％)和1.43％(95％CI:0.51％～2.35％).结论 北京市大气SO2污染与居民每日呼吸系统疾病死亡人数和肺炎死亡人数有统计学关联.     

2015～2019年南平市常住居民死因分析

目的了解2015～2019年南平市常住居民死因状况及特征,为疾病预防提供依据。方法利用人口死亡登记系统中南平市的数据,并采用ICD-10进行死因分类,使用Excel 2019和IBM SPSS Statistics 21进行数据整理和统计分析。结果 2015～2019年南平市居民的粗死亡率为572.54/10万,标化死亡率566.47/10万。其中男性(673.10/10万)高于女性(470.11/10万)(P0.01)。死因前3位是循环系统疾病、恶性肿瘤、呼吸系统疾病,这3位死因占全死因构成比较大(占73.22%)。不同年龄组的死因构成差异也较大(P0.01),0～14岁的前3位死因是起源于围生期的某些情况、先天畸形变形和染色体异常、伤害;65岁以上年龄组主要死因是循环系统疾病、恶性肿瘤、呼吸系统疾病。结论南平市居民死亡率低于福建省平均水平,循环系统疾病、恶性肿瘤和伤害是南平市居民死亡的主要原因,且不同特征人群死因顺位不同。     

2011-2015年北京市西城区流感相关超额流感样病例数估计

目的 通过拟合负二项回归模型,对北京市西城区流感病毒流行导致的超额流感样病例数进行估计.方法 以北京市西城区报告的流感样病例数为因变量,流感病原学监测结果、时间等为自变量,拟合负二项回归模型,估计超额流感样病例数.结果 对2011-2015年流感样病例数构建模型,共208周中共104周估计存在流感相关超额病例,超额病例数占同期流感样病例总数的9.96％.分年龄组分别拟合模型,0～4岁组、5～ 14岁组、15 ～24岁组、25～59岁组、60岁以上组超额病例占全部病例的百分比分别为8.36％、8.88％、25.95％、33.15％、29.97％.流感病毒各亚型中,流感样病例数与甲型H1N1及甲型H3N2流感病毒阳性率呈正相关,与乙型流感病毒阳性率呈负相关.甲型H3N2流感病毒引起的超额流感样病例数所占比例最高.结论 通过模型估计,发现各年龄组均有一定比例的流感相关超额流感样病例,尤以15岁以上人群比例更高.可考虑通过对成人及老年人采取流感疫苗接种、健康教育等干预手段,降低流感样症状发病率,减轻疾病负担.     

银川市大气颗粒物对人群循环系统疾病死亡影响的时间序列分析

目的探讨银川市大气颗粒物污染水平及其对居民循环系统疾病死亡的暴露-反应关系。方法通过收集银川市2013—2015年空气质量监测数据、气象监测数据和居民死亡监测资料,采用广义相加模型,分析银川市大气颗粒物物对与居民循环系统疾病死亡的暴露-反应关系。结果大气PM_(10)和PM_(2.5)年均浓度均超过GB 3095—2012《环境空气质量标准》二级标准。大气PM_(10)和PM_(2.5)浓度每升高10μg/m~3对人群循环系统疾病死亡的超额危险度分别为0.56%(95%CI:0.15%~0.97%),1.33%(95%CI:0.46%~2.21%);大气PM_(10)和PM_(2.5)浓度对小于65岁组的循环系统疾病死亡的影响无统计学意义(P0.05),对65岁以上年龄组人群循环系统疾病死亡的超额危险度分别在滞后7、5 d时达到最大效应,分别为1.24%(95%CI:0.21%~2.28%)和0.57%(95%CI:0.08%~1.06%);大气PM_(10)、PM_(2.5)浓度对女性循环系统疾病死亡的超额危险度高于男性。结论研究期间银川市大气颗粒物浓度较高,且对人群循环系统疾病死亡存在一定的暴露-反应关系。     

南通市2011-2012年≥60岁老年人死因分析

目的 了解南通市≥60岁老年人的主要死亡原因.方法 按国际疾病分类标准ICD-10进行死因分类编码,计算≥60岁老年人死亡率、老年保健效益指数(GEI)等指标,分析主要死因.结果 南通市2011-2012年老年人平均死亡率为3 550.75/10万,死亡率随年龄增加呈上升趋势(P＜0.01).男性死亡率(3 865.46/10万)高于女性(3 264.22/10万),各年龄组男性死亡率均高于女性,差异均有统计学意义(P值均＜0.01).死亡率居前5位的死因依次为循环系统疾病、恶性肿瘤、呼吸系统疾病、损伤和中毒、内分泌营养代谢疾病等.60～ 75岁组恶性肿瘤死亡率最高;≥75岁组循环系统疾病死亡率最高.男性全死因GEI为0.560、女性为0.636,其中呼吸系统的GEI均居首位.结论 循环系统疾病、恶性肿瘤、呼吸系统疾病应作为该市老年人疾病预防与控制工作的重点.     

2012 - 2014年重庆市合川区居民主要死因分析

目的 了解合川区居民死亡水平及主要死亡原因,为制定疾病预防控制措施提供科学依据。方法 死亡个案信息来源于2012 - 2014年全国死因登记信息系统,死亡病例依据国际疾病分类标准（ICD-10）进行疾病分类,用死因分析软件DeathReg2005进行统计分析,计算粗死亡率、标化死亡率、构成比及死因顺位等指标。结果 2012 - 2014年合川区居民报告死亡率为676.83/10 万,标化死亡率为 389.16/10万,男性死亡率高于女性,各年龄组死亡率及死因顺位差异明显。全人群主要死因为循环系统疾病(243.52/10万)、肿瘤（209.07/10万）、呼吸系统疾病（124.88/10万）、损伤和中毒外部原因（56.85/10万）、传染病和寄生虫病(8.89/10万),占总死因的95.03％;前五位具体疾病依次为脑血管病(138.07/10万)、慢性下呼吸道疾病(122.88/10万)、肺癌(66.61/10万)、急性心肌梗死(62.29/10万)和肝癌(42.53/10万),占总死因的63.88%。结论 慢性疾病与伤害为合川区居民的主要死因。大力开展健康教育及行为于预,预防和控制慢性病与伤害的发生,才能从根本上降低居民死亡率。     

北京市昌平区大气NO2对心血管系统疾病死亡及寿命损失年的影响

目的研究北京市昌平区大气NO_2对心血管系统疾病死亡的超额危险度及寿命损失年(YLL)的影响。方法收集北京市昌平区2014—2017年逐日空气污染物浓度、气象及死因监测数据,采用分布滞后非线性模型(DLNM)分析NO_2对不同性别及年龄组人群心血管系统疾病死亡的超额危险度及YLL。结果北京市昌平区大气NO_2日均浓度为34.8μg/m3,心血管系统疾病日均死亡5.2例,平均YLL为59.0年。滞后第1天NO_2每增加10μg/m~3,0～65岁组人群心血管系统疾病死亡的寿命损失为0.81年。滞后第14天时,NO_2每增加10μg/m~3,全人群心血管系统疾病死亡的超额危险度为0.004%(95%CI:0.001%～0.007%),男性及65岁组分别为0.006%(95%CI:0.002%～0.011%)和0.004%(95%CI:0.001%～0.008%);滞后第14天时,NO_2每增加10μg/m~3,全人群心血管系统疾病死亡的寿命损失为0.22年,男性及65岁以上组人群分别为0.23年和0.15年,而对女性及0～65岁组的影响无统计学意义(P0.05)。结论北京市昌平区大气NO_2可能增加心血管系统疾病的死亡风险和YLL,以男性和65岁以上人群更敏感。     

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.