Application of DALYs in Measuring Health Effect of Ambient Air Pollution： A Case Study in Shanghai, China

INTRODUCTION Epidemiologic researches during the past 10-20 years confirmed that exposure to air pollution contributes to both mortality and morbidity in China or worldwide. The health consequences associated with air pollution include respiratory symptom…     

Quantitative Analysis on Economic Contribution of Community Health Service in China

In China, the implementation of community health service shows that the prevention is an essential and important part of our national health system and is helpful to decrease the medical expenditure gradually. According to the data from Health Statistic Information Center of Ministry of Health in China, we calculated that the total health expenditure of China would be decreased 8000.0 million yuan only in 2001, among which, 1188.3 million, 1953.9 million and 4833.0 million yuan were respectively saved for the government budget, the society and resident if implementing the policy of community health service powerfully. And every outpatient can save 15.46 yuan pertime. By the quantitative analysis on the economic contribution of community health service, it can be proved that a great economic benefit could be gotten from the implementation of community health service.     

National Public Health Surveillance in China：Implications for Public Health in China and the United States

Study Objective:Throughout the world,political developments have brought new demands to communities to prevent and intervene in the incidence of infectious and noninfectious conditions.Historically,these developments have required new and more effective public health surveillance ac-tivities.This report describes public health surveillance practice in the People‘s Republic of China,making comparisons with selected aspects of surveillance in the United States with respect to collec-tion,analysis,dissemination,and use of data.Main results:In both the People‘s Republc of China and the United States.political change has affected health,and multiple surveillance system are used in public health practice.Surveillance of acute infectious diseases based on the reporting of legally notifiable diseases and the use of vital records for surveillance have the longest established history in both countries.In both countries,da-ta from the surveillance systems have been used to affect public health policy.Conclusions:in comparing surveillance practices in these countries,we find similarities in con-ditions reported and in the dissemination of the data.At the same time,legal,social,cultural,and economic differences between the nations have affected the practice of surveillance in analysis and evaluation.We make explicit recommendations for improement and evaluation of systems in both countries,including sentinel surveillance system and data quality measures in China and computer networking and data analysis in the United States.     

Natural Gas and Indoor Air Pollution： A Comparison With Coal Gas and Liquefied Petroleum Gas

Objective The study was designed to compare the combustion products of coal gas, liquefied petroleum gas and natural gas in relation to indoor air pollution. Methods Regular pollutants including B(a)P were monitored and 1-hydroxy pyrene were tested in urine of the enrolled subjects.Radon concentrations and their changes in four seasons were also monitored in the city natural gas from its source plant and transfer stations to final users. To analyze organic components of coal gas,liquefied petroleum gas and natural gas, a high-flow sampling device specially designed was used to collect their combustion products, and semi-volatile organic compounds contained in the particles were detected by gas chromatograph-mass spectrograph (GC/MS). Results Findings in the study showed that the regular indoor air pollutants particles and CO were all above the standard in winter when heating facilities were operated in the city, but they were lowest in kitchens using natural gas;furthermore, although NO2 and CO2 were slightly higher in natural gas, B(a)P concentration was lower in this group and l-hydroxy pyrene was lowest in urine of the subjects exposed to natural gas.Organic compounds were more complicated in coal gas and liquefied petroleum gas than in natural gas. The concentration of radon in natural gas accounted for less than 1%0 of its effective dose contributing to indoor air pollution in Beijing households. Conclusion Compared to traditional fuels, gases are deemed as clean ones, and natural gas is shown to be cleaner than the other two gases.     

Improving Sexual and Reproductive Health of Young People in China： Shaping the Future

Nearly one in five adolescents (10-19 years) in the world live in China. Therefore, the status of and progress in adolescent sexual and reproductive health in China will have an important bearing on the global situation. Yet, it was not a long time ago, when there was a complete lack of information and absence of a discussion on the critical issues of adolescent sexuality and reproduction. Indeed the concept that it was difficult to conduct research and projects dealing with the subject of adolescent sexuality was generally disapproved. By 2004, however, the situation has transformed and bears little resemblance to that in the late 1980s and early 1990s. As a result of the withering away of the traditional cultural and political norms towards the taboo subject of adolescent sexuality, many research studies and action programmes have been successfully launched and completed. Much evidence has been accumulated to inform policies and programmes to better address adolescent sexual and reproductive health needs. Much of this progress owes to the persistent commitment of concerned scientists to document the needs of adolescents and young people and to learn of their perspectives. However, political commitment to addressing these issues has been equally important in making the rapid progress. This paper traces the evolution of WHO-supported social science research on adolescent sexual and reproductive health in China and highlights selected findings.     

Health Inequalities during 20 Years of Rapid Economic Development in China （1980-2000）：A Mortality Analysis

Objective To examine the influence of China's economic reforms on population health and regional mortality rates.Methods Longitudinal study measuring the mortality trends and their regional variations.Using data from the three most recent national censuses,we used the model life table to adjust the mortality levels within the population for each census,and to calculate life expectancy.We then examined the variation in patterns of mortality and population health by economic status,region and gender from 1980...     

Socioeconomic Distribution of Health and Health Care Utilization in a New Town in Hong Kong, China

Objectives To assess the association of socioeconomic indicators with various chronic and acute illnesses and the utilization of public health care in a new town in Hong Kong, China.Methods Illness experience and socioeconomic and demographic data of 7570 residents from 2022 randomly selected households were collected through telephone interviews. The relationships between indicators and illnesses/choice of health care were explored using stepwise logistic regressions after adjusting for sex and age. Results Significant positive associations were noted between low household income and diabetes meUitus, any chronic illnesses among adults and flu among younger subjects; low educational level and accident-related illness among adults; being born in Chinese mainland and flu, any acute illness in adults. For the utilization of public health care, low household income was the most consistent risk factor. Conclusion This study did not demonstrate a unidirectional socioeconomic gradient in health but supported the hypothesis that socioeconomic deprivation was associated with the utilization of public health care.     

Effects of Cesarean Section on Infant Health in China： Matched Prospective Cohort Study

Objective To compare the medical outcomes of infants delivered by cesarean section with those of infants delivered vaginally. Methods A total of 301 healthy women with cesarean section and a matched control group of 301 women delivered vaginally were identified at three district-level hospitals in Shanghai from May 2001 to February 2003. Two groups were matched according to their medical indications for cesarean section. Their infants were assessed at delivery, 1 month, 6 month and 1 year after birth. Results The incidence of neonatal complications and infant morbidities at all measurement occasions did not differ significantly between groups. Rehospitalization was found to be more likely among infants delivered by cesarean section in the first month after birth. However, there was no difference between two groups in the incidence of rehospitalization in the first year after birth. Cesarean section was also associated with a higher risk of infant diarrhea (adjusted relative risk=1.25, 95% CI: 1.01, 1.56). Conclusion Infants did not have health benefits from cesarean section if the pregnancy was at low risk.     

Considerations in applying the general equilibrium approach to environmental health assessment

There are currently two commonly used approaches to assessing economic impacts of health damage resulting from environmental pollution： human capital approach （HCA） and willingness-to-pay （WTP）. WTP can be further divided into averted expenditure approach （AEA）, hedonlc wage approach （HWA）, contingent valuation approach （CVA） and hedonlc price approach （HPA）. A general review of the principles behind these approaches by the authors indicates that these methods are incapable of unveiling the mechanism of health impact from the point of view of national economy. On a basis of economic system, the shocks brought about by health effects of environmental pollution change the labor supply and medical expenditure, which in turn affects the level of production activity in each sector and the total final consumption pattern of the society. The general equilibrium approach within the framework of macroeconomic theory is able to estimate the health impact on national economy comprehensively and objectively. Its mechanism and applicability are discussed in detail by the authors.     

A time series analysis of outdoor air pollution and preterm birth in Shanghai, China

Objective To investigate the relation between air pollution exposure and preterm birth in Shanghai, China. Methods We examined the effect of ambient air pollution on preterm birth using time-series approach in Shanghai in 2004. This method can eliminate potential confounding by individual risk factors that do not change over a short period of time. Daily numbers of preterm births were obtained from the live birth database maintained by Shanghai Municipal Center of Disease Control and Prevention. We used the generalized additive model (GAM) with penalized splines to analyze the relation between preterm birth, air pollution, and covariates. Results We observed a significant effect of outdoor air pollution only with 8-week exposure before preterm births. An increase of 10 μg/m3 of 8-week average PM10, SO2, NO2, and O3 corresponded to 4.42% (95%CI 1.60%, 7.25%), 11.89% (95%CI 6.69%, 17.09%), 5.43% (95%CI 1.78%, 9.08%), and 4.63% (95%CI 0.35%, 8.91%) increase of preterm birth. We did not find any significant acute effect of outdoor air pollution on preterm birth in the week before birth. Conclusion Ambient air pollution may contribute to the risk of preterm birth in Shanghai. Our analyses also strengthen the rationale for further limiting air pollution level in the city.     

Relationship between ambient air pollution and daily mortality of SARS in Beijing

Objective To study the relationship between ambient air pollution and daily mortality of SARS in Beijing. Methods The approach of time-series Poisson regression was used to assess the relationship between daily SARS mortality, ambient air pollution, and other factors from April 25 to May 31, 2003 in Beijing. Results An increase of each 10 μg/m3 over a 5-day moving average of PM10, SO2 and NO2 corresponded to 1.06 (1.00-1.12), 0.74 (0.48-1.13) and 1.22 (1.01-1.48) relative risks(RRs) of daily SARS mortality, respectively, The relative risks (RRs) values depended largely on the selection of lag days.Conclusion The daily mortality of SARS might be associated with certain air pollutants in Beijing.     

我国大气污染对居民健康影响的回顾和展望

大气污染是我国主要的环境问题之一,已引起各界的广泛关注。本文简要地描述了我国大气污染现状,分别从急性健康效应研究、慢性健康效应研究和干预研究的角度出发回顾了我国大气污染与人群健康研究,最后对未来的研究方向进行了展望。     

Impact of Ambient Air Pollution on Public Health under Various Traffic Policies in Shanghai,China

Objective To investigate the potential impact of ambient air pollution on public health under various traffic policies in Shanghai. Methods The exposure level of Shanghai residents to air pollution under various planned traffic scenarios was estimated, and the public health impact was assessed using concentration-response functions derived from available epidemiological studies. Results Our results showed that ambient air pollution in relation to traffic scenarios had a significant impact on the future health status of Shanghai residents. Compared with the base case scenario, implementation of various traffic scenarios could prevent 759-1574, 1885-2420, and 2277-2650 PM10-related avoidable deaths （mean-value） in 2010, 2015, and 2020, respectively. It could also decrease the incidence of several relevant diseases. Conclusion Our findings emphasize the need to consider air pollution-related health effects as an important impact of traffic policy in Shanghai.     

住宅新装修后不同时间室内空气甲醛监测

目的监测不同档次新装修住宅室内空气中甲醛污染水平,探讨防止甲醛污染的措施。方法对18户不同档次新装修住宅室内空气中的甲醛浓度进行了为期1年的追踪测定。结果室内空气中的甲醛浓度装修后明显升高,随时间推移大体呈下降趋势,6个月后超标率明显降低;不同档次装修的住房,大约在1年后都能降低到国家规定的标准以下。甲醛浓度还受室内温度、装修档次的影响。结论住宅装修完工后要加强室内的通风,至少于装修6个月后再行入住,方可减少甲醛污染对人体健康造成的损害。     

大气污染对中老年高血压和心脑血管疾病患者卫生服务需求的影响：基于 CHARLS数据的分析

目的：探讨大气污染对中老年高血压和心脑血管疾病患者卫生服务需求的影响,为我国环保政策和卫生服务政策的完善提供科学依据。方法： 选取2011年和2013年中国健康与养老追踪调查数据中17个省62个市的高血压、心脏病以及脑卒中患者的自评健康、门诊需求和住院需求的调查数据,并收集2011年和2013年各省市的大气可吸入颗粒物（particulate matter 10,PM10）、二氧化硫（SO2）、二氧化氮（NO2）的年均浓度,采用条件Logistic回归模型评价大气污染物对自评健康及卫生服务需求的影响。结果： NO2和SO2浓度对高血压、心脏病以及脑卒中患者卫生服务需求的影响存在拐点,具体表现为：随着NO2浓度的升高,其对高血压患者住院需求的影响趋势起初为正向,当浓度到达35.1 μg/m3时转为负向;随着SO2浓度的升高,其对心脏病和脑卒中患者自评健康的影响趋势起初为负向,当浓度到达63.8 μg/m3时,趋势转为正向。此外,本研究未观察到大气PM10与卫生服务需求之间的联系。结论： 大气污染可能会对高血压和心脑血管疾病患者的卫生服务需求产生影响,不同种类和不同浓度下的大气污染物的影响可能不同。     

谈医院人力资本投资的风险及防范

人力资本投资在医院经营中占有重要地位,但目前尚未引起医院管理者的普遍高度重视。通过人力资本理论及其与医院联系,人力资本投资风险内涵的阐述,对医院人力资本投资风险防范谈几点粗浅认识。