三峡库区兴山县疾病监测点1997-2006年传染病疫情分析

目的监测库区法定传染病发病情况。方法按照三峡工程坝区及库区疾病监测方案,收集兴山县疾病监测点1997-2006年法定传染病报告资料进行分析,并进行居民传染病漏报率调查。结果10年间共发生乙类传染病9种1025例,传染病平均报告发病率为351.58/10万,报告发病率最高为1997年（761.25/10万）,最低为2002年（167.79/10万）,痢疾、肺结核、病毒性肝炎3种传染病占报告传染病总数的88.98%。传染病漏报率平均为36.96%,校正发病率为638.86/10万。消化道传染病发病逐年下降,虫媒传染病发病处于基本消灭状态,丙类传染病时有流行。结论漏报情况仍较高,应进一步加强疫情报告管理,提高疫情报告质量。     

2009 - 2018年云南省边境地区法定传染病流行病学特征分析

目的 分析云南省25个边境县市法定传染病流行病学特征,为控制该省边境地区疫情提供科学依据。方法 采用描述性流行病学分析方法对云南省25个边境县市2009 - 2018年法定传染病流行病学特征进行分析。结果 2009 - 2018年25个边境县市共报告法定传染病34种318 186例,死亡5 187例,年均发病率468.70/10万,年均死亡率7.64/10万,病死率1.63%;发病率呈明显上升趋势（χ2趋势 = 6 742.081,P＜0.001）。发病率居前5位病种:手足口病（128.39 /10万）、肺结核（74.32 /10万）、肝炎（71.12 /10万）、其它感染性腹泻病（29.12 /10万）和流行性腮腺炎（25.29 /10万）;发病率居前5位县市:瑞丽市（1 012.65/10万）、盈江县（809.66/10万）、景洪市（727.59/10万）、勐海县（703.43/10万）、芒市（682.04/10万）。发病年龄高峰为1～3岁 （占20.25%）;农民（占39.57%）及散居儿童（占31.63%）发病最多。结论 云南省25个边境县市法定传染病流行现况不容忽视,应建立健全云南省边境地区与邻国长效的联防联控机制,尤其注意加强重点地区（瑞丽市、盈江县、景洪市、勐海县、芒市）和重点人群（农民及散居儿童）的传染病综合防控工作。     

沧州市1962～2010年法定传染病发病与死亡回顾性分析

目的了解沧州市法定传染病长期的发病、死亡趋势,探讨疾病规律,总结防治经验。方法回顾性分析沧州市1962～2010年的法定传染病报告数据,总结其发病和死亡情况并描述变化趋势。结果 (1)沧州市总体上近50年的传染病报告发病率和死亡率呈下降趋势,20世纪60年代的发病报告最高(平均报告发病率为3502.2/10万),20世纪90年代的发病报告最低(平均报告发病率为102.36/10万);(2)最高和最低的报告死亡高峰分别发生在20世纪60年代和20世纪90年代,最高和最低的死亡率发生在1967年(28.65/10万)和1993年(0例)。结论沧州市近50年来的传染病防制工作取得了一定的成效,表现在传染病报告发病率、死亡率出现了降低的趋势。传染病疾病谱和死亡谱的变化反映了所采取的措施是有效的,但一些古老传染病的发生反映了某些工作上的薄弱,而近年呈上升趋势的传染病也提示了传染病防控的长期性和复杂性。应加强和提高研究和控制力度,有效地控制传染病。     

西安市碑林区2002-2006年法定传染病构成分析

目的了解西安市碑林区法定传染病构成，为防治工作提供科学依据。方法对碑林区疾病预防控制中心2002—2006年法定传染病年报表，采用Excel 2003进行数据处理和分析。结果2002-2006年4类法定传染发病构成比中，肠道传染病未见显著变化（细菌性痢疾占首位）。呼吸道传染病明显升高（肺结核占首位）。血源及性传播疾病明显降低（乙型肝炎占首位）。自然疫源及虫媒传染病有一定下降（流行性出血热占首位）。结论肠道传染病发病平稳，呼吸道传染病上升趋势明显，血源及性传播疾病明显下降，自然疫源及虫媒传染病发病趋势有一定下降。碑林区传染病还未稳定控制，应继续加大防制力度。     

Non-malignant occupational respiratory diseases in Germany in comparison with those of other countries

Objective: To present recent data on the occurrence of non-malignant occupational airway diseases in Germany and to compare mainly affected occupations of obstructive airway diseases caused by allergens and irritants with available surveillance data from other countries. Methods: Sources of German data were statistics for the year 2003 of the Ministry of Labour and Social Affairs and of the federation of statutory accident insurance institutions for the industrial sector. Results: Confirmed cases of non-malignant occupational respiratory diseases in Germany are mainly benign asbestos-associated diseases (occupational disease no. 4103: 1,975 cases), silicosis/coal workers pneumoconiosis (occupational disease no. 4101: 1,158 cases), obstructive airway diseases due to allergens (occupational disease no. 4301: 935 cases), chronic obstructive bronchitis and/or emphysema in hard coal miners (occupational disease no. 4111: 414 cases), obstructive airway diseases due to irritants and toxic agents (occupational disease no. 4302: 181 cases), diseases caused by ionising radiation (171 cases), diseases due to isocyanates (occupational disease no. 1315: 55 cases), and 22 cases of other rare occupational lung and airway diseases. Miners, bakers, chemical workers, hairdressers and health care workers are mostly affected. Bakers were also frequently affected by occupational asthma in Finland, France, Sweden, the United Kingdom, the Piedmont region in Italy, South Africa, and New Zealand. Further, high frequencies of occupational asthma were reported for health care workers in France, Italy, New Jersey, Michigan, and South Africa. Conclusion: Despite completely different legal definitions and regulations, comparably high numbers of occupational obstructive diseases in western countries require better primary and secondary prevention in industries with high incidence, especially in bakeries, the health care sector, farming, and mining. Furthermore, there is a urgent need for harmonization of recognition and compensation systems for occupational diseases as well as of respective preventive strategies within the European Union.     

2009年青海省法定报告传染病疫情网络直报质量分析

[目的]对2009年青海省法定报告传染病疫情网络直报质量现状进行评价,为今后进一步提高网络直报工作质量提供科学依据。[方法]查阅"国家疾病监测信息报告管理系统"中的2009年青海省法定报告传染病报告卡的质量统计模块数据,根据《传染病疫情网络直报系统质量评价指标及统计规则》进行质量综合评价与分析。[结果]2009年青海省医疗机构平均及时报告率为90.46%,县区级疾病预防控制中心平均及时审核率为96.74%,重卡率为0.26%,县(区)零缺报率为13.77%。[结论2009年青海省法定报告传染病疫情网络直报质量总体情况不是很理想,医疗卫生机构的报告及时性和县区级疾病预防控制中心的审核、查重及时性需要进一步提高。     

Effects of changes in copayment for obstetric emergency room visits on the utilization of obstetric emergency rooms

In view of the growing proportion of “non-urgent” admissions to obstetric emergency rooms (OERs) and recent changes in copayment policies for OER visits in Israel, we assessed factors contributing to OER overcrowding. The changes investigated were (a) exemption from copayment for women with birth contractions, (b) allowing phone referrals to the OER and (c) exemption from copayment during primary care clinic closing hours.We analyzed data of a large tertiary hospital with 37 deliveries per day. Counts of women discharged to home from the OER were an indicator of “non-urgent” visits.The annual number of non-urgent visits increased at a higher rate (3.4%) than the natural increase in deliveries (2.1%). Exemption from copayment for visits during non-working hours of primary care clinics was associated with increases in OER admissions (IRR = 1.22) and in non-urgent OER visits (IRR = 1.54). Younger and first-time mothers with medically unjustified complaints were more likely to be discharged to home.We showed that the changes in the policy for OER copayment meant to attract new clients to the HMO had an independent impact on OER utilization, and hence, added to the workload of medical personnel. The change in HMO policy regulating OER availability requires rigorous assessment of possible health system implications.     

Health of children looked after by the local authorities

Objectives. To assess the healthcare needs of looked-after children in East Surrey. Methods. Epidemiological, comparative and corporate approaches were used to study the healthcare needs of looked-after children. Information was obtained from published and unpublished sources, case note review, cross-referencing with records from specialist services, and interviews with stakeholders. Results. Of the 136 children whose case notes were reviewed, only 64% had undergone statutory medical examinations. Several physical health problems were identified, emotional and behavioural problems were present in 34% of children, 25% of school-aged children had a statement of special educational need, and 36% had ever used child and adolescent mental health services. Immunization coverage was lower than that of children who were not in care. Several unmet needs and gaps in service provision were identified. Conclusions. Children in care have a higher degree of physical and mental health needs than their not-in-care counterparts. The local service for children in care needs to be improved to meet these health needs and lead to better health and health-related outcomes for the children.     

Preliminary analysis of short term financial implications of a prevention bonus program: First results from the German statutory health insurance

Summary Objectives: With the implementation of the Health Care Modernization Act in 2004 sickness funds in Germany were given the opportunity to award bonuses to their insured for healthpromoting behavior. The aim of this study was to investigate the financial implications of a prevention bonus program from a sickness fund perspective. Method: The investigation was designed as a controlled cohort study (matched pair study) comprising 70,429 members in each group. Matching criteria were sex, postal code, insurance status, and cost categories for health care utilization. Insured opted into the program on a voluntary basis. The program consisted of interventions featuring primary prevention, modest exercise and immunization. Differences in cost trends between the two groups were examined using the paired t-test. Results: A reduction in mean costs of 241.11 € per active member for the year 2005 (90 % CI = 348.70, 133.52; p-value < 0.001) could be achieved in the intervention group compared to the control group. When costs for the implementation of the program and the bonus payments were taken into account, there was a saving of 97.14 € per active member for the year 2005. Conclusions: Preliminary results of a prevention bonus program in the German Statutory Health Insurance suggest a decrease in mean health care spending per enrollee. These effects may increase with time as long term effects of prevention become effective. However, further research is needed to understand how much of these short term cost reductions can be attributed to the program itself rather than to possible confounders or volunteer bias and how the short term savings may be accrued. Submitted: 06 March 2007; Revised: 18 July 2007, 04 December 2007; Accepted: 12 January 2008     

法定节假日对流感样病例就诊比例的影响

目的 对2014-2018监测年度中国大陆流感样病例（ILI）报告数占门/急诊就诊总数比例在"春节"和"国庆节"假日期间出现波动的原因进行分析。方法 统计分析"中国流感监测信息系统"中2014-2018监测年度期间"春节"和"国庆节"假日周及前后周南北方省份哨点医院报告的ILI监测数据。结果 南、北方省份假日周与前后一周ILI报告数差异无统计学意义,假日周门诊就诊总数显著低于假日前后一周,但急诊就诊数出现了升高现象,差异均有统计学意义。结论 出现的ILI%假日高峰中,绝大多数是由于各哨点医院受假日门诊停诊影响,导致监测诊室普通内科患者就诊数大幅减少。     

鹤壁市1957～2011年法定传染病病谱变化分析

目的 通过分析鹤壁市1957～2011年法定传染病病谱变化及各种传染病发病情况变化,探讨传染病防控措施,为更好控制该市传染病疫情提供依据.方法 用描述流行病学方法对鹤壁市54年法定传染病疫情资料进行统计分析.结果 鹤壁市54年共报告法定传染病30种398 335例,年均发病率930.03/10万,年发病率最高为14001.71/10万(1970年),年发病率最低为143.13/10万(1997年),年均死亡率2.06/10万,年死亡率最高达80.03/10万(1959年),年死亡率最低为0(多年).传染病发病率和死亡率均呈大幅度下降趋势,年代不同传染病种类及发病比例不同.结论 年代不同,传染病种类不同,防病、控病重点不同,要针对传染病疫情采取针对性的防控措施,所有传染病都要常防常控,以防疫情反复.     

“Science and proven experience”: How should the epistemology of medicine inform the regulation of healthcare?

The Swedish medico-legal concept of “science and proven experience” is both legally important and ambiguous. The conceptual uncertainty associated with it can hamper effective assessment of medical evidence in legal proceedings and encourage medical professionals to distrust legal regulation. We examine normative criteria a functioning medico-legal notion should presumably meet, e.g. clarity, acceptability and consistency with existing laws. We also survey healthcare professionals to see how they understand science and proven experience and thus determine the extent to which their understanding meets the normative criteria. The survey suggests that medical professionals feel more certain about “science and proven experience” in the medical context than they do in a legal context. They still have substantial trust in the legal use of the notion, but they do not believe that legal professionals should be allowed to determine the meaning of “science and proven experience” in the legal context. With these results in mind, we argue that the best way to meet the normative criteria and resolve conceptual uncertainty is to specify sub-questions that clarify the notion. We recommend an analytical-deliberative approach that will close the gap between the medical and legal professions’ perceptions of how law and medicine relate.     

No alternative? The regulation and professionalization of complementary and alternative medicine in the United Kingdom

In conjunction with its growing popularity, complementary and alternative medicine (CAM) in the United Kingdom has witnessed increasing professionalization, partly prompted by the landmark Parliamentary Inquiry that reported in November 2000. Professionalization has become a significant strategy for practitioner associations and a key focus for the government, media, and patient groups. It is being driven by concern over the interests of patients and consumers, and in relation to the possible integration of certain forms of CAM into publicly funded healthcare. It is, moreover, being reconfigured in explicitly national terms. This paper draws on research into practitioner associations representing nine CAM modalities in the UK-aromatherapy, Chinese herbal medicine, chiropractic, crystal healing, feng shui, 'lay' homeopathy, medical homeopathy, osteopathy, and Radionics-, examining the recent wave of professionalization in relation to Foucault's concern with 'techniques of the self.' It highlights the contrasting experience of an association of Chinese herbalists seeking statutory self-regulation (SSR) and an association of chiropractors that was instrumental in securing SSR for chiropractic.     

Utilization of administrative data to assess the association of an adolescent health check-up with human papillomavirus vaccine uptake in Germany

Background

In Germany, 3-dose human papillomavirus (HPV) vaccination is recommended for 12–17 year-old females. Countrywide monitoring of HPV vaccination coverage (VC) does not exist, but small-scale surveys suggested suboptimal uptake. There is currently no concerted implementation strategy in place, and approaches for improved vaccine delivery are needed. Our objectives were to analyze health insurance claims data to estimate HPV VC in the target population and to assess the association of the routine adolescent health check-up ‘J1’ (offered to 12–14 year-olds) with HPV vaccine uptake.

Methods

We sampled a subset of 12–16 year-old females from claims data in 15 of the 16 German federal states. Sampling was based on documented physician contacts flanking the follow-up period 2008–2012. We reconstructed age- and region-stratified histories of individual-level HPV vaccination series and J1 utilization and calculated country-level estimates.

Results

The study sample represented 54% (n = 1.04 million) of the total target population. VC estimates for starting (and completing) HPV vaccination series ranged from 6.1% (1.2%) among 12-year-olds to 47.6% (36.2%) among 16-year-olds. J1 utilization was 50% at maximum. In J1-attendees, 42.0% had received ≥1 vaccine doses, translating into a significant association of J1 utilization and vaccine uptake with a 6.9-fold higher likelihood in 12-year-olds and 1.4-fold higher likelihood in 16-year-olds of receiving HPV vaccination.

Conclusion

HPV VC in Germany is low. Adolescent check-up J1 is associated with increased and accelerated HPV vaccine uptake securing immunization before sexual debut and should be used as a tool to improve VC in the target population. However, J1 utilization is only moderate and more than half of attendees had not received HPV vaccination, which represents a substantial proportion of missed opportunities. This indicates that J1 needs both further promotion through legislative structures already in place for other health check-ups and more awareness as an opportunity to offer HPV vaccinations.     

Vaccination rates and adherence in premature infants before and after pneumococcal conjugate vaccine schedule change for term infants – A claims database analysis in Germany

BackgroundIn 2015, the German Standing Committee on Vaccination (STIKO) changed the pneumococcal conjugate vaccination (PCV) schedule for mature infants from a 3+1 scheme (2, 3, 4, and 11–14 months of age) to a 2+1 scheme (2, 4, and 11–14 months of age). For premature infants, the 3+1 scheme remained. The aim of this study was to assess vaccination rates, completeness, and timeliness for PCV in premature infants before and after the modified recommendation.MethodsA retrospective claims data analysis using the “Institut für angewandte Gesundheitsforschung Berlin” Research Database was conducted. Premature infants born in 2013 and 2016 with an individual follow-up of 24 months were included. Hexavalent combination (HEXA) vaccination with a consistent 3+1 recommendation for mature and premature infants was analyzed as reference vaccination.ResultsAfter 24 months, the PCV rate for at least one dose remained stable in premature newborns of 2016 compared to 2013, while the HEXA vaccination rate increased slightly. However, a significant decrease of a completed PCV schedule (4 doses) in premature infants was noted, whereas the completeness of HEXA vaccination did not change. The timeliness of PCV in premature newborns increased for the first and the booster PCV, while the timeliness of HEXA immunization did not change from 2013 to 2016.ConclusionAlthough STIKO still recommends a 3+1 PCV schedule for premature infants in Germany, premature infants were vaccinated according to the changed recommendations for mature born infants. A substantial share of premature infants remained unvaccinated, and their vaccinations were often delayed.     

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.