长沙市社区老年人慢性病患病情况、就医意向及影响因素分析

目的 了解长沙市社区老年人的慢性病患病情况、就医意向及影响因素,为推广社区首诊制提供依据。方法 采用多阶段分层抽样法从长沙市所辖的五个行政区抽取65岁以上老年人6 000名作为调查对象,对其就医意向及相关因素进行调查。结果 长沙市社区老年人慢性病患病率为86.34%。其中,高血压、冠心病、骨关节病、糖尿病是本地区老年人较为常见的慢性病。调查对象中有4 322人(75.3%)患病时首选二级及以上医院就诊,1 021人(17.79%)选择到社区卫生服务中心就诊,397人(6.91%)选择私人诊所或自我医疗。不同行政区域、年龄、文化程度、收入水平、同住人员的老年人,首诊医疗机构选择间差异有统计学意义(P＜0.05)。结论 长沙市老年人社区首诊的就医观念尚未普及。提高社区卫生服务机构水平、转变就医观念、为老年人提供个体化的卫生服务是推行社区首诊、双向转诊的有效途径。     

2014 - 2015年河南省居民急性胃肠炎流行病学负担研究

目的 掌握河南省居民急性胃肠炎的流行病学负担,为制定合理、有效的卫生政策提供科学依据。方法 选择周口市、郑州市、濮阳市作为监测点,2014年4月 - 2015年3月开展为期12个月的社区人群入户调查,询问调查对象过去4周的急性肠胃炎发病情况。结果 获得有效调查问卷共5 433份,河南省急性胃肠炎加权月患病率为1.23%,年发病率为0.13次/人年;就诊率为70.64%;住院率、病原检测率为零;85.33%的患者服用抗生素;66.74%的患者自诉曾食用过受污染食物。结论 河南省居民急性胃肠炎发病率低于全国平均水平,在就医过程中存在病原检测率过低和抗生素不规范使用的问题;为获取高质量的食源性疾病监测数据,应进一步建立健全食源性疾病监测体系。     

Viruses in nondisinfected drinking water from municipal wells and community incidence of acute gastrointestinal illness

Background: Groundwater supplies for drinking water are frequently contaminated with low levels of human enteric virus genomes, yet evidence for waterborne disease transmission is lacking.Objectives: We related quantitative polymerase chain reaction (qPCR)-measured enteric viruses in the tap water of 14 Wisconsin communities supplied by nondisinfected groundwater to acute gastrointestinal illness (AGI) incidence.Methods: AGI incidence was estimated from health diaries completed weekly by households within each study community during four 12-week periods. Water samples were collected monthly from five to eight households per community. Viruses were measured by qPCR, and infectivity assessed by cell culture. AGI incidence was related to virus measures using Poisson regression with random effects.Results: Communities and time periods with the highest virus measures had correspondingly high AGI incidence. This association was particularly strong for norovirus genogroup I (NoV-GI) and between adult AGI and enteroviruses when echovirus serotypes predominated. At mean concentrations of 1 and 0.8 genomic copies/L of NoV-GI and enteroviruses, respectively, the AGI incidence rate ratios (i.e., relative risk) increased by 30%. Adenoviruses were common, but tap-water concentrations were low and not positively associated with AGI. The estimated fraction of AGI attributable to tap-water-borne viruses was between 6% and 22%, depending on the virus exposure-AGI incidence model selected, and could have been as high as 63% among children < 5 years of age during the period when NoV-GI was abundant in drinking water.Conclusions: The majority of groundwater-source public water systems in the United States produce water without disinfection, and our findings suggest that populations served by such systems may be exposed to waterborne viruses and consequent health risks.     

Burden of acute gastrointestinal illness in Denmark 2009: a population-based telephone survey

A cross-sectional telephone survey was conducted in Denmark throughout 2009 to determine the incidence of acute gastrointestinal illness (AGI). Using the Danish population register, a random population sample stratified by gender and age groups was selected and mobile or landline phone numbers found. Representative numbers of interviews were performed by gender, age group and month. A recently proposed international case definition of AGI, including cases with diarrhoea and/or vomiting in a 4-week recall period, was used. A total of 1853 individuals were included and 206 (11·1%) fulfilled the case definition; 78% reported diarrhoea. This corresponds to an overall standardized incidence rate of 1·4 (95% CI 1·2-1·6) episodes of AGI per person-year. The incidence rate was generally higher in the younger age groups; only being 2·3, 1·9 and 0·80 per person-year in the 0-9, 10-39 and ≥40 years age groups, respectively. The incidence rate estimates were considerably higher when calculated from shorter recall periods.     

江苏省2012年急性胃肠炎负担调查情况分析

目的了解江苏居民急性胃肠炎(AGI)负担情况及危险因素。方法 2012年,在江苏10个监测点每月采取整群随机的抽样方式,开展回顾性的横断面调查,并采用多因素非条件logistic回归评估潜在的危险因素。结果共调查12 003名居民,AGI月患病率3.5%,相当于0.50次/人年;秋季最高(4.5%),冬季最低(3.1%);<5岁儿童的患病率最高(10.8%),25~44岁最低(2.9%);38.3%的患者就诊,药物治疗病例中78.4%报告使用抗生素,32.9%使用止泻药。多因素回归分析显示,年龄、季节、监测点和旅游是AGI的影响因素。结论江苏省AGI负担重,使用抗生素、止泻药比例较高。     

An approach for developing a national estimate of waterborne disease due to drinking water and a national estimate model application

In this paper, the US Environmental Protection Agency (EPA) presents an approach and a national estimate of drinking water related endemic acute gastrointestinal illness (AGI) that uses information from epidemiologic studies. There have been a limited number of epidemiologic studies that have measured waterborne disease occurrence in the United States. For this analysis, we assume that certain unknown incidence of AGI in each public drinking water system is due to drinking water and that a statistical distribution of the different incidence rates for the population served by each system can be estimated to inform a mean national estimate of AGI illness due to drinking water. Data from public water systems suggest that the incidence rate of AGI due to drinking water may vary by several orders of magnitude. In addition, data from epidemiologic studies show AGI incidence due to drinking water ranging from essentially none (or less than the study detection level) to a rate of 0.26 cases per person-year. Considering these two perspectives collectively, and associated uncertainties, EPA has developed an analytical approach and model for generating a national estimate of annual AGI illness due to drinking water. EPA developed a national estimate of waterborne disease to address, in part, the 1996 Safe Drinking Water Act Amendments. The national estimate uses best available science, but also recognizes gaps in the data to support some of the model assumptions and uncertainties in the estimate. Based on the model presented, EPA estimates a mean incidence of AGI attributable to drinking water of 0.06 cases per year (with a 95% credible interval of 0.02-0.12). The mean estimate represents approximately 8.5% of cases of AGI illness due to all causes among the population served by community water systems. The estimated incidence translates to 16.4 million cases/year among the same population. The estimate illustrates the potential usefulness and challenges of the approach, and provides a focus for discussions of data needs and future study designs. Areas of major uncertainty that currently limit the usefulness of the approach are discussed in the context of the estimate analysis.     

2016 - 2017年成都市学生及家庭成员急性胃肠炎疾病负担情况调查

目的 了解成都市学生及家庭成员急性胃肠炎的患病情况和流行趋势,为建立和完善食源性疾病预测预警体系提供科学依据。方法 以学校为切入点,采用多阶段分层抽样方法抽取调查对象,于2016 - 2017年分4个季节对成都市17万余名学生及家庭成员,以自填问卷的形式了解调查对象4周内急性胃肠炎的发病情况、就诊情况等。结果 成都市学生及家庭成员急性胃肠炎月患病率为4.46%,年患病率为0.53次/人年。学龄期儿童青少年（7.61%）患病率高于学龄前期（5.17%）,老年期（3.34%）高于成年期（2.88%）,郊区（4.94%）高于城区（4.02%）,夏季（6.52%）高于其他季节,差异均具有统计学意义（P＜0.05）;发病人群中,有53.31%的人接受治疗;在急性胃肠炎的治疗中,家庭成员（13.06%）抗生素使用频率高于学生（10.92%）,差异具有统计学意义（P＜0.05）。结论 成都市学生及家庭成员急性胃肠炎负担较重,建议开展进一步研究来准确评估成都市急性胃肠炎的负担及其食源性比例。     

Use of a health information telephone line, Info-santé CLSC, for the surveillance of waterborne gastroenteritis

The increasing frequency of waterborne outbreaks demonstrates that classic indicators used for the surveillance of the microbiological quality of drinking water have several gaps and that routine public health surveillance seems insufficient to allow for the rapid detection of these outbreaks. The main objective of this study was to evaluate the possibility of using a regional health information telephone line, 'Info-Santé CLSC' (Info-Health Local Community Health Centre), for the surveillance of waterborne gastroenteritis. This study measured the incidence rate of calls for acute gastrointestinal illness (AGI) placed to the Info-Santé CLSC line, investigated the relationship between the frequency of calls for AGI placed to the Info-Santé CLSC line and the turbidity of the treated water in the Quebec City drinking water plant and evaluated the relevance and the conditions of use of the Info-Santé CLSC system for the surveillance of waterborne enteric illness. A relationship between the turbidity and the calls for AGI placed to Info-Santé CLSC line was observed. Significant time lags (11, 15 and 17 days prior to the outcome) were identified in the final model derived from a Poisson model using generalized additive models (GAM) as a time series analysis. Some recommendations to improve the system were formulated even though the system already seems to be useful for the surveillance of waterborne enteric diseases.     

Drinking Water Quality and the Geospatial Distribution of Notified Gastro-Intestinal Infections

Introduction

Even brief episodes of fecal contamination of drinking water can lead directly to illness in the consumers. In water-borne outbreaks, the connection between poor microbial water quality and disease can be quickly identified. The impact of non-compliant drinking water samples due to E. coli taken for regular monitoring on the incidence of notified acute gastrointestinal infections has not yet been studied.

Methods

The objective of this study was to analyse the geographical distribution of notified acute gastrointestinal infections (AGI) in Slovenia in 2010, with hotspot identification. The second aim of the study was to correlate the fecal contamination of water supply system on the settlement level with the distribution of notified AGI cases. Spatial analysis using geo-information technology and other methods were used.

Results

Hot spots with the highest proportion of notified AGI cases were mainly identified in areas with small supply zones. The risk for getting AGI was drinking water contaminated with E. coli from supply zones with 50–1000 users: RR was 1.25 and significantly greater than one (p-value less than 0.001).

Conclusion

This study showed the correlation between the frequency of notified AGI cases and non-compliant results in drinking water monitoring.     

江苏省食源性非伤寒沙门菌疾病负担

目的了解江苏省食源性非伤寒沙门菌的感染负担。方法对江苏省食源性疾病哨点医院2010年7月-2011年6月主动监测和社区人群调查结果,综合急性胃肠炎发病率及各项乘数,获得食源性非伤寒沙门菌的发病率。结果全省累计采集2 328例食源性疑似病例粪便或者肛拭标本,检出非伤寒沙门菌阳性菌株22株;全省调查10 959人,急性胃肠炎的月患病率为4.7%,年发病率为0.63次/人年;推算出江苏省沙门菌的食源性感染发病率为560/10万。结论非伤寒沙门菌食源性感染是江苏省重要的疾病负担之一,应加强以实验室为基础的主动监测系统。     

The rate of acute gastrointestinal illness in developed countries

This paper reviews estimates of the incidence and prevalence of acute gastrointestinal illness (AGI) from 33 studies. These studies include prospective cohort studies, retrospective cross-sectional population-based surveys, and intervention trials from the United States and six other developed countries published since 1953. The incidence and prevalence estimates for AGI reported in these studies range from 0.1 to 3.5 episodes per person-year. However, comparisons of these rates are problematic owing to significant variation in study design, sampling methodology, and case definitions and should be made with caution. In the United States, the Centers for Disease Control and Prevention's (CDC) Foodborne Diseases Active Surveillance Network (FoodNet) estimates a rate of 0.65 episodes of AGI per person-year. This estimate includes diarrhea and/or vomiting of infectious or non-infectious origin, with a measure of severity (impairment of daily activities or diarrhea duration greater than 1 day), and has been adjusted for combined respiratory-gastrointestinal illnesses. However, it excludes episodes of diarrhea or vomiting due to any long-lasting or chronic illness or condition. Limitations in study design result in an unknown degree of uncertainty around this point estimate.     

A review of household drinking water intervention trials and an approach to the estimation of endemic waterborne gastroenteritis in the United States

The incidence of acute gastrointestinal illness (AGI) attributable to public drinking water systems in the United States cannot be directly measured but must be estimated based on epidemiologic studies and other information. The randomized trial is one study design used to evaluate risks attributable to drinking water. In this paper, we review all published randomized trials of drinking water interventions in industrialized countries conducted among general immunocompetent populations. We then present an approach to estimating the incidence (number of cases) of AGI attributable annually to drinking water. To develop a national estimate, we integrate trial results with the estimated incidence of AGI using necessary assumptions about the estimated number of residents consuming different sources of drinking water and the relative quality of the water sources under different scenarios. Using this approach we estimate there to be 4.26-11.69 million cases of AGI annually attributable to public drinking water systems in the United States. We believe this preliminary estimate should be updated as new data become available.     

Incidence of self-reported acute gastrointestinal infections in the community in Poland: a population-based study

A retrospective cross-sectional survey of self-reported acute gastrointestinal infection (AGI) incidence in the community was performed in Poland, from December 2008 to November 2009. The aim of the study was to estimate the magnitude and distribution of self-reported AGI, in order to calibrate the routine AGI surveillance system in Poland. The study population were randomly selected residents of all Polish regions, having a fixed telephone line. An equal number of telephone interviews were collected each month, requesting the interviewee to identify gastrointestinal symptoms that had occurred in the previous 4 weeks. The international AGI case definition was used. In total 3583 complete interviews were obtained. The compliance ratio was 26%. Of 3583 respondents, 240 (6.7%) individuals fulfilled the AGI case definition. The annualized incidence of acute gastroenteritis was 0.9/person-year (95% confidence interval 0.8-1.0). Comparison of the obtained annual AGI estimate (33.3 million infections) with the number of cases reported to national surveillance during the corresponding period (73 512), yielded an underreporting factor of 453 cases occurring in the community for each reported case. Of the 240 AGI cases, 30.4% consulted a general practitioner, and 4.6% were admitted to hospital. Samples for microbiological confirmation were collected from four (1.6%) cases. This first population-based study in eastern Europe has confirmed that AGI places a high burden on Polish society, which is underestimated by national surveillance data. Efforts are necessary to improve AGI reporting and diagnostic practices in order to increase the effectiveness of the Polish surveillance system in detecting threats related to new AGI pathogens, new routes of transmission or the potential for international spread.     

南京市主要细菌性病原体食源性疾病负担研究

目的 研究南京市主要细菌性病原体致食源性疾病负担,提出食源性疾病监测策略。方法 根据南京市11个区17家食源性疾病哨点医院主动监测和食源性疾病负担调查结果,结合各主要细菌性病原体的食源性比例等各项乘数,获得人群中各主要细菌性病原体的发病率及疾病负担。结果 2015年全市共采集1 208份食源性疑似病例生物标本,检出非伤寒沙门氏菌31株、副溶血性弧菌20株、致泻大肠埃希氏菌15株,检出率分别为2.57%、1.66%、2.56%;全市疾病负担调查3 600人,急性胃肠炎的月患病率为3.9%,年发病率为0.55次/人年;推算出南京市非伤寒沙门氏菌食源性感染发病率为1 292/10万,0~4岁年龄组发病率最高(3 481/10万);副溶血性弧菌食源性感染发病率为619/10万,15~24岁年龄组发病率最高(2 076/10万),致泻性大肠埃希氏菌的食源性感染发病率为1 653/10万,5~14岁年龄组发病率最高(5 263/10万)。结论 南京市非伤寒沙门氏菌、副溶血性弧菌、致泻性大肠埃希氏菌感染负担较重,儿童非伤寒沙门氏菌和致泻性大肠埃希氏菌、青壮年副溶血性弧菌的感染负担尤为突出,针对不同人群加强相应病原体的监测,同时应进一步完善相关监测及研究,为制定相应的风险控制措施提供科学依据。     

Stressors and Social Support Perceptions Predict Illness Attitudes and Care-Seeking Intentions: Re-Examining the Sick Role

Parsons' (1951) sick role concept has had a profound impact on the study of sickness as a social phenomenon. The sick role might be better conceived as a set of illness attitudes and care-seeking intentions rather than a set of social norms. This investigation purports (a) to explore the relationships among illness attitudes, (b) to examine the ability of illness attitudes to predict medical care-seeking intentions, and (c) to investigate differences in the sick role as a function of stressors and social support perceptions. Participants (N = 148) completed a survey questionnaire assessing daily hassles, life events, perceived social support, dependence, self-criticism, and the sick role. Results of a factor analysis on the sick role measures revealed four attitudinal (Release, Consideration, Burden, and Deviance) and two behavioral (Denial and Consult) factors. The attitudinal factors were moderately intercorrelated, with some ability to predict care-seeking intentions. Regression analyses revealed that stressors and support perceptions did exhibit some ability to predict the sick role. Results are discussed in terms of their implications for health communication research.     

Association between Rainfall and Pediatric Emergency Department Visits for Acute Gastrointestinal Illness

Background

Microbial water contamination after periods of heavy rainfall is well described, but its link to acute gastrointestinal illness (AGI) in children is not well known.

Objectives

We hypothesize an association between rainfall and pediatric emergency department (ED) visits for AGI that may represent an unrecognized, endemic burden of pediatric disease in a major U.S. metropolitan area served by municipal drinking water systems.

Methods

We conducted a retrospective time series analysis of visits to the Children’s Hospital of Wisconsin ED in Wauwatosa, Wisconsin. Daily visit totals of discharge International Classification of Diseases, 9th Revision codes of gastroenteritis or diarrhea were collected along with daily rainfall totals during the study period from 2002 to 2007. We used an autoregressive moving average model, adjusting for confounding variables such as sewage release events and season, to look for an association between daily visits and rainfall after a lag of 1–7 days.

Results

A total of 17,357 AGI visits were identified (mean daily total, 7.9; range, 0–56). Any rainfall 4 days prior was significantly associated with an 11% increase in AGI visits. Expected seasonal effects were also seen, with increased AGI visits in winter months.

Conclusions

We observed a significant association between rainfall and pediatric ED visits for AGI, suggesting a waterborne component of disease transmission in this population. The observed increase in ED visits for AGI occurred in the absence of any disease outbreaks reported to public health officials in our region, suggesting that rainfall-associated illness may be underestimated. Further study is warranted to better address this association.     

Stressors and social support perceptions predict illness attitudes and care-seeking intentions: re-examining the sick role

Parsons' (1951) sick role concept has had a profound impact on the study of sickness as a social phenomenon. The sick role might be better conceived as a set of illness attitudes and care-seeking intentions rather than a set of social norms. This investigation purports (a) to explore the relationships among illness attitudes, (b) to examine the ability of illness attitudes to predict medical care-seeking intentions, and (c) to investigate differences in the sick role as a function of stressors and social support perceptions. Participants (N = 148) completed a survey questionnaire assessing daily hassles, life events, perceived social support, dependence, self-criticism, and the sick role. Results of a factor analysis on the sick role measures revealed four attitudinal (Release, Consideration, Burden, and Deviance) and two behavioral (Denial and Consult) factors. The attitudinal factors were moderately intercorrelated, with some ability to predict care-seeking intentions. Regression analyses revealed that stressors and support perceptions did exhibit some ability to predict the sick role. Results are discussed in terms of their implications for health communication research.     

东莞市结核病患者就诊延迟及影响因素分析

目的 分析东莞市结核病患者的就诊延迟特征及影响因素,为结核病防治提供科学依据.方法 收集2018年东莞市3 865例结核病患者病案信息.采用秩和检验和多重线性回归分析就诊天数的影响因素,采用x2检验和logistic回归分析就诊延迟率的影响因素.结果 结核病患者就诊天数的中位数为28 d,就诊延迟率为69.5％.多重线...     

甲型H1N1流感大流行期间广州市居民流感样疾病发病情况及就诊行为电话调查

目的快速评估2009年10月1日至12月31日广州市居民流感样病例与普通感冒病例的发病、就诊的情况。方法采用计算机辅助电话调查系统（CATI）及统一调查表,对广州市居民在2009年10月1日至12月31日期间流感样疾病的发病、诊疗情况进行调查,用描述性流行病学方法对数据进行分析。结果该次调查共计拨出电话6 325个,拨通有效电话1 030个,成功调查505户居民（共调查1 197人）,成功应答率为49.03%。流感样病例、普通感冒病例的罹患率分别为6.02%（72/1 197）和8.77%（105/1 197）,高发人群均为低年龄组,尤其是10岁以下人群（流感样病例、普通感冒病例的罹患率分别为20.99%和9.88%）;流感样病例男女性罹患率分别是6.19%（37/598）和5.84%（35/599）;11月份流感样病例罹患率（2.92%）高于10、12月（分别为1.84%、1.25%）（P〈0.05）。采用直接标化法估计2009年第4季度广州市居民流感样病例发病率为7.37%（733 194/9 942 022）。流感样病例和普通感冒病例选择到省、市级医院就诊的比例最高,分别为41.67%和46.67%。结论 2009年第4季度广州市居民流感样疾病罹患率高于往年同期水平,低年龄组尤其是10岁以下人群是流感样疾病的高发人群,应加强对这部分人群呼吸道传染病的预防。     

Abortion incidence and services in the United States in 2000

CONTEXT: Nearly half of unintended pregnancies and more than one-fifth of all pregnancies in the United States end in abortion. No nationally representative statistics on abortion incidence or on the universe of abortion providers have been available since 1996.
METHODS: In 2001-2002, The Alan Guttmacher Institute (AGI) conducted its 13th survey of all known U.S. abortion providers, collecting information for 1999, 2000 and the first half of 2001. Trends were calculated by comparing the survey results with data from previous AGI surveys.
RESULTS: From 1996 to 2000, the number of abortions fell by 3% to 1.31 million, and the abortion rate declined 5% to 21.3 per 1,000 women 15–44. (In comparison, the rate declined 12% between 1992 and 1996.) The abortion ratio in 2000 was 24.5 per 100 pregnancies ending in abortion or live birth, 5% lower than in 1996. The number of abortion providers decreased by 11% to 1,819 (46% were clinics, 33% hospitals and 21% physicians' offices); clinics provided 93% of all abortions in 2000. In that year, 34% of women aged 15-44 lived in the 87% of counties with no provider, and 86 of the nation's 276 metropolitan areas had no provider. About 600 providers performed an estimated 37,000 early medical abortions during the first six months of 2001; these procedures represented approximately 6% of all abortions during that period. Abortions performed by dilation and extraction were estimated to account for 0.17% of all abortions in 2000.
CONCLUSIONS: Abortion incidence and the number of abortion providers continued to decline during the late 1990s but at a slower rate than earlier in the decade. Medical abortion began to play a small but significant role in abortion provision.