上海市首次碘缺乏病的人群监测

在ＩＤＤ非流行区的上海，首次开展了人群的病情监测，结果表明在２６４０名９～１３岁学生中触诊法的甲肿率为１．５５％，均为Ｉ度肿大者，男女学生的甲肿率分别为０．８０％和２．３８％，有显著性差别（Ｘ＾２＝１０．７１，Ｐ〈０．００１）；Ｂ超的甲肿率为１．５７％（市区学生２０／１２７７）。５１２名成人的甲肿率为３．７１％，２６４０名学生的尿碘中位数值为６４．５０μｇ／Ｌ，其中市区学生为６９．６２μｇ／Ｌ，闻     

Epidemiology of preterm birth in China in 2015 and 2016: a nationwide survey

Background

Preterm birth is the most common cause of perinatal morbidity and mortality. China has one of the highest numbers of preterm births worldwide each year. However, the epidemiology of preterm birth in China remains unclear.

Growth patterns of infants aged 0 to 24 months in China: a multicentre prospective birth cohort study across China

Background

Assessment of a child's growth is important for detecting aberrations, whether too much or too little or growth. Poor growth in early life may have long-lasting programming effects on later non-communicable diseases. We examined the growth patterns of healthy Chinese infants from birth to 24 months to provide a baseline from which to detect cases of too much or too little growth.

Guidelines for the diagnosis and treatment of pancreatic adenocarcinoma (2018 edition): A standardized procedure recommended in China

正Pancreatic adenocarcinoma is the fifth leading cause of cancerrelateddeathsworldwide,andthisincidenceisprojectedtoincreasefurtherinfuturedecades[1].Furthermore,despiteyears ofattemptingtoimprovetreatmentforpatientswithpancreatic adenocarcinoma, the 5-year overall survival rate remains low at 7%[2]. Thus, this cancer is devastating, and effective treatment     

Changes in lung cancer incidence by sex and smoking status in China: a multicentre observational study

Background

Lung cancer is traditionally more prevalent in elderly people, men, and smokers, and is usually diagnosed at an advanced stage. However, as low-dose CT (LDCT) lung cancer screening is increasingly popular in some regions of China, and since it might lead to the detection of more small-sized lung cancers, we hypothesised the spectrum of lung cancer might change.

上海市普陀区非户籍人口结核病经济负担及其影响因素分析

目的 了解上海市普陀区非户籍人口新发肺结核患者疾病经济负担及其影响因素。 方法 采用回顾性研究方法,对2008年普陀区新登记并完成治疗的初治非户籍人口活动性肺结核患者开展问卷调查,收集其家庭基本情况、诊疗经过及结核病诊疗全程的相关医疗费用等信息。共发出问卷105份,收回问卷97份,均为有效问卷。同时,结合病史和报表资料等核对患者基本情况、结核病诊疗全程的相关费用等信息。采用SPSS 15.0软件分析非户籍人口结核病患者2008年家庭年度不同类别收支情况和治疗相关费用及占家庭收入的比率,比较不同患者医疗费用及占年家庭收入比率的差异,以P<0.05为差异有统计学意义。 结果 研究对象人均结核病经济负担为5177元,平均占家庭年收入的16.29%,其中医疗费用为2452元,平均占家庭年收入的8.23%。男、女性患者平均医疗费用分别为3174、1840元,占家庭年收入的平均比率分别为9.92%、5.94%,两者差异均无统计学意义（Z_费用=－1.722,P=0.085;Z_比率=－1.664,P=0.096）。小学及以下文化程度、初中、高中和（或）中专、大专及以上文化程度者平均医疗费用分别为3634、3109、1997和1745元,差异无统计学意义（χ²=4.094,P=0.251）;但四者费用占家庭年收入的平均比率分别为10.50%、9.92%、9.61%和3.79%,差异有统计学意义（χ²=9.225,P=0.026）。有医保、无医保及不清楚自身医保情况者平均医疗费用分别为2765、1943和6115元,差异有统计学意义（χ²=8.218,P=0.016）;但三者医疗费用占家庭年收入的平均比率分别为8.22%、7.61%和17.60%,差异无统计学意义（χ²=3.777,P=0.151）。涂阳患者和涂阴患者的平均医疗费用分别为2046、3078元,占家庭年收入的平均比率分别为7.69%、8.50%,两者差异均无统计学意义（Z_费用=－0.685,P=0.493;Z_比率=－0.094,P=0.925）。有住院史和单纯门诊治疗的患者平均医疗费用分别为21 001、1988元,占家庭年收入的平均比率分别为54.99%、7.27%,两者差异均有统计学意义（Z_费用=－5.233,P<0.001;Z_比率=－4.392,P<0.001）。 结论 普陀区非户籍人口肺结核患者是结核病防控的重点人群,结核病诊断和治疗给患者造成较大的经济负担,特别是有住院治疗史、无医疗保险覆盖、文化程度低的患者,其疾病负担高于其他患者,故应积极探索切实有效的方式,减轻患者在治疗期间的经济负担。     

二种影响TSH测定结果的因素分析

目的　了解影响采样地区和测定方法对 Ｔ Ｓ Ｈ 测定值的因素。方法　以碘缺乏病重度流行区（四川）和非流行区（上海）新生儿脐带血样,用 Ｉ Ｒ Ｍ Ａ 法和 Ｅ Ｌ Ｉ Ｓ Ａ 法对血样的 Ｔ Ｓ Ｈ 浓度进行测定。结果　以两种方法对两地的 Ｔ Ｓ Ｈ 比较和用两地的样本对两种方法的比较,差异均有非常显著性意义（ Ｐ＜ ０．０１）。与其他地区的相关关系的比较表明：虽然 Ｉ Ｒ Ｍ Ａ 法和 Ｅ Ｌ Ｉ Ｓ Ａ 法所测定的 Ｔ Ｓ Ｈ 值之间存在着相关的联系,但不同测定者之间尚有一定的差异。结论　为说明 Ｔ Ｓ Ｈ 的测定值与其它指标之间的背离现象提供了一些数据,同时认为有必要进一步对 Ｔ Ｓ Ｈ 的测定方法做全国性的标准化和对其上限值（切点）进行讨论和确定。     

上海地区2005年儿童麻疹临床流行病学特征分析

目的对上海地区2005年1月至6月儿童麻疹流行和临床特征进行分析。方法对567例麻疹初诊病例及其中333例住院病例进行临床流行病学分析。结果567例初诊患儿中有64例为外地发病至上海就医者,在上海发病的503例患儿中:外来儿童305例,占60.6%,本市儿童198例,占39.4%;<9月龄为301例,占59.8%,≥9月龄为202例(其中81.7%为外来儿童)。发病高峰为4～5月份。333例住院患儿中仅20例可以确定接种过麻疹疫苗,临床上仍以典型麻疹为主要表现,麻疹合并肺炎181例,占54.4%,其中129例为<1岁婴儿,占71.3%。529例送检麻疹特异性IgM抗体,502例为阳性,占94.9%。结论本次麻疹发病数明显高于往年,发病者绝大部分未接种过麻疹疫苗,高发年龄为<9月龄婴儿。肺炎仍是婴儿麻疹的常见并发症。     

Alpha-fetoprotein response following transarterial chemoembolization indicates improved survival for intermediate-stage hepatocellular carcinoma

Background

To investigate the clinical value of the alpha-fetoprotein (AFP) response following transcatheter arterial chemoembolization (TACE) in intermediate-stage hepatocellular carcinoma (HCC).

上海市金山区民工子弟学校肠道线虫感染情况调查

目的 了解上海市金山区外来民工子弟学校学生肠道线虫感染现状. 方法 应用Kato-Katz法对金山区民工子弟学校502名学生进行粪检,同时进行肠道线虫防治知识基线调查,并在健康教育后进行相同问卷的二次调查. 结果 502名学生中肠道线虫感染者31例,总感染率为6.18%.蛔虫、钩虫和鞭虫感染率分别为2.59%(13/502)、0.60%(3/502)和3.39%(17/502).男、女生感染率差异无显著性(χ2=0.099,P＞0.05);寄生虫病防治知识知晓率,宣传干预前为45.04%,干预后提高到70.59%. 结论 金山区民工子弟学校学生的肠道线虫感染率高于本地学生,是肠道寄生虫病防治的重点人群.     

上海市肺结核患者直接医疗费用及经济负担分析

目的 了解上海市肺结核患者确诊及治疗过程的直接医疗费用及其对家庭造成的经济负担,为进一步完善肺结核减免政策,控制肺结核医疗费用,减轻患者负担提供依据。 方法 对上海市松江、杨浦、徐汇、长宁、普陀、浦东新区和闵行7个区共491例完成治疗的肺结核患者进行定量问卷调查,主要了解肺结核患者的社会经济情况、确诊及治疗过程的各项直接医疗费用等。用秩和检验方法对不同类型肺结核患者的各项费用及相应减免比例、各项费用占家庭年人均纯收入比例等进行分析。 结果 肺结核患者的直接医疗总费用及相应减免比例的中位数（上下四分位数）分别为4000(2500,10 500)元/人次、54.9%(32.3%,70.0%),有34.4%（169/491）的患者发生过住院费用,全程门诊治疗患者和曾经住院治疗患者的直接医疗总费用的中位数（上下四分位数）分别为3000(2000,4000)元/人次、14 955(9200,21 705)元/人次,两者差异有统计学意义（Z=-16.059, P=0.000）。涂阳患者和涂阴患者的直接医疗总费用减免比例的中位数（上下四分位数）分别为57.1%(40.0%,71.5%)、52.1%(25.0%,69.2%),两者差异有统计学意义（Z=-2.092, P=0.036）。全程门诊治疗患者与曾经住院治疗患者的自付医疗费用占家庭年人均纯收入比例的中位数（四分位数范围）分别为9.4%(3.8%,18.0%)、29.5%(14.8%,89.2%),两者差异有统计学意义（Z=-7.463, P=0.000）。 结论 上海市肺结核患者确诊及治疗过程的直接医疗费用相对较高,给患者家庭造成了较重的经济负担。     

Management of solid pseudopapillary neoplasms of pancreas: A single center experience of 243 consecutive patients

BackgroundSolid pseudopapillary neoplasm of the pancreas (SPN) is a rare neoplasm, which mainly affects young women. The aim of this study was to investigate the clinicopathological features and surgical management of SPNs in our institution.MethodsPatients who underwent surgery for a pathologically confirmed SPN in our institution between January 2008 and October 2018 were collected. Their clinical characteristics and survival associations were analyzed.ResultsIn total, 243 pathologically confirmed patients were analyzed in this study, including 181(74.5%)females and 62(25.5%) males. The mean age was 35.3 years old (range: 12–64 years old) with average tumor size of 4.83 cm (range: 0.8–16 cm). 239 patients underwent complete surgical resection. After median follow-up of 46 months (range: 10–118 months), four patients died due to tumor progression. All the other people were absent of local recurrence or distant metastasis.ConclusionsSPN is a latent malignant tumor with excellent prognosis. Surgical resection is recommended even in the presence of liver metastasis. If possible, function-preserving surgery is advocated. High Ki67 index may predict the malignant potential and poor prognosis of SPNs.     

Effects of a Quality Improvement Program to Reduce Central Venous Catheter-Related Infections in Hemodialysis Patients

BackgroundCentral catheter infections are of concern in patients on hemodialysis because of the high risk of catheter-related bloodstream infections, sepsis, and death. Adequate nursing is critical for the prevention of such infections. This study aimed to use the PDCA (plan-do-check-act) method to reduce the incidence of central venous catheter infection using management in the maintenance of central venous catheter in patients on hemodialysis, compared with routine care.MethodsThis pilot study recruited patients on hemodialysis via central venous catheterization at the Blood Purification Center of Ruijin Hospital between November 2017 and November 2018. The patients were randomized to the routine and PDCA groups. All participants received routine nursing. The PDCA group received central venous catheter management by PDCA. The incidence of central venous catheterization-related infections, nursing satisfaction, and quality of life were compared between the two groups.ResultsA total of 122 participants were enrolled in each group. The incidence of central catheter-related bloodstream infection, as the primary outcome, was 0.8 and 8.8 cases per 1000 catheter days in the PDCA and routine groups, respectively (P < 0.001). In addition, as the secondary outcomes, the scores of nursing satisfaction (health guidance, nursing technology, and therapeutic effects) score and quality of life (physiological, psychological, social, and environmental status) were better in the PDCA group than in the routine group (all P < 0.01).ConclusionsThis pilot study suggests that the PDCA cycle model can effectively reduce the incidence of central venous catheter-related infections and improve satisfaction and quality of life in patients on hemodialysis.     

2011-2020年上海地区犬只狂犬病本底状况回顾性分析

目的 为掌握上海市犬只狂犬病免疫状况、抗体水平和流行情况,评估犬只狂犬病流行风险.方法 利用统计学方法对上海市2011-2020年犬只狂犬病血清学和病原学检测数据进行回顾性分析.结果 上海市注册犬只狂犬病免疫抗体平均合格率为83.8％ (95％CI:83.3％～84.3％),流浪犬抗体平均合格率为17.7％ (95％C...     

上海市闵行区肺结核患者卫生服务需要与利用情况分析

目的 分析上海市闵行区肺结核患者卫生服务需要与利用情况,评价卫生服务利用的影响因素。 方法 上海市闵行区2010年共建立1 286 830份电子健康档案,其中749例登记肺结核专档。 以这749例肺结核患者和其中502例已治愈患者作为研究对象,分析其流行病学和疾病管理、卫生服务需要与利用情况,并针对肺结核患者卫生服务利用情况进行单因素和多因素logistic回归分析。 结果 2010年上海市闵行区建档人群的肺结核患病率为58.21/10万,活动性肺结核（菌阳）患病率为30.62/10万,慢性病患病率为51.54%（386/749）。其中,治愈和满疗程的502例患者的人均就诊次数、检测检验次数和受访视次数分别为2.74、9.02和5.47次。年龄在65岁以上（β值=－2.513,Wald χ²值=0.508,P值=0.000,OR（95.0% CI）值=0.081（0.030~0.219））、因肺结核和其他慢性病就诊（β值=－3.987,Wald χ²值=0.458,P值=0.000,OR（95.0% CI）值=0.136（0.047~0.491））使得肺结核患者就诊次数增加。 结论 上海市闵行区肺结核患者对区域卫生服务需要量较高,利用率较低。肺结核患者的防控工作要针对不同人群开展针对性的防治措施,掌握他们的卫生服务需要,提高其卫生服务利用水平。     

上海市新生儿脐血TSH值分布的初步探讨

用免疫放射法（ＩＲＭＡ）测定上海市新生儿脐血ＴＳＨ，以初步探讨上海市人群的碘营养状况。上海市新生儿ＴＳＨ值≥５ｍＩＵ／Ｌ者占２９．６％；上海市新生儿母亲（孕妇）尿碘值≥１００μｇ／Ｌ者占２７．４％；９８％的上海市居居食盐碘含量为零。提示上海市居民存在碘缺乏。