上海县家庭卫生服务调查研究

1981年中美合作在上海县率先开展了卫生服务研究,采用家庭健康询问调查方法研究人群健康状状及卫生服务利用状况。为了进行纵向和横向比较研究,1991年在上海县又进行了本次家庭卫生服务调查研究。 本次调查采用整群分层随机抽样方法,对上海县3个乡9个村1546户家庭共5505人进行了调查。调查内容主要有个人基本情况、健康状况、卫生服务利用情况、医疗费用、个人行为生活方式等。结果表明:两周患病率为48‰,三月慢性病患病率为116.1‰,与1981年及1985年调查结果相比较,两周患病率较低,而慢性病患病率则相似。两周患病主要疾病为呼吸、消化循环系统疾病。15岁以上男性吸烟率为73.5％,饮酒率为39.4％,较1981年调查有明显的上升,建议开展广泛而有效的健康教育,以降低人群的吸烟率。     

A review of the nature and activity of a general surgical service in Ireland

The steady increase in hospital costs has led to demands for closer scrutiny of activity levels, workloads and outcomes. This study sought to examine these parameters in a typical district general surgical unit in this country. In the five year period 1985-89,11,227 inpatient and 3,354 outpatient procedures were performed; 83% of the inpatient procedures were elective and 17% were emergency surgical operations. All inpatient procedures were categorized: minor (41%), intermediate (42%) and major (17%). A prospective one year review in 1990/1991 confirmed the accuracy of the retrospective data. During that year 2,335 inpatient operations and 765 outpatient operations were performed, of which 80.5% of the inpatient operations were elective and 19.5% were emergency procedures. Of these 16.6% were major, 34.4% intermediate and 49% were minor operations. 60% of the operations were performed by consultants. The in-hospital surgical mortality for the 1 year prospective review was 1.35% and the perioperative mortality was 0.64%. The overall operation morbidity rate was 9% and the procedure-related morbidity was 4.7%. The wound infection rate was 2%. Of the common operations performed throughout the six year study period appendicectomies and external hernia operations accounted for 20% of the caseload; 14% were urological, 7% were breast and 6% were biliary operations. The average waiting time for elective admissions was less than 4 weeks. The average length of hospital stay and the bed occupancy rates did not change.     

云南省纳西族居民烟草暴露相关慢性阻塞性肺疾病的经济负担研究

背景　慢性阻塞性肺疾病（COPD）现已成为一个重要的公共卫生问题,其患病率较高,治疗费用高昂,因COPD带来的疾病经济负担较重。目的　对云南省纳西族居民归因于吸烟和被动吸烟的COPD经济负担进行分析。方法　于2018年7-8月,运用多阶段分层随机抽样的方法,在云南省丽江市玉龙纳西族自治县抽取年龄≥35岁的纳西族居民进行问卷调查及肺功能检查。测算人均直接疾病经济负担、人均间接疾病经济负担、COPD患者的总经济负担、归因于吸烟/被动吸烟的经济负担。结果　共发放问卷2 600份,回收有效问卷2 531份,有效回收率为97.35%。云南省纳西族居民COPD的患病率为17.66%,吸烟率为40.58%,被动吸烟率为38.29%;其中男性吸烟率高于女性（P<0.001）;女性被动吸烟率高于男性（P<0.001）。吸烟者〔OR=1.903,95%CI（1.507,2.404）〕和被动吸烟者〔OR=2.195,95%CI（1.718,2.805）〕患COPD的可能性高于非吸烟者和非被动吸烟者。云南省纳西族COPD患者的人均直接疾病经济负担、间接疾病经济负担和疾病经济负担分别为2 827.82元、105.00元和2 932.82元,总疾病经济负担为6 407万元;其中归因于吸烟、被动吸烟的经济负担分别为1 718万元、2 011万元;男性归因于被动吸烟的经济负担低于吸烟,而女性则相反。结论　吸烟和被动吸烟给当地带来了沉重的疾病经济负担。加大控烟力度、降低吸烟率和被动吸烟率,有助于减轻COPD的经济负担。     

Hospital costs of older people in New South Wales in the last year of life

OBJECTIVE: To estimate hospital inpatient costs by age, time to death and cause of death among older people in the last year of life. DESIGN AND SETTING: Cross-sectional analytical study of deaths and hospitalisations in New South Wales from linked population databases. PARTICIPANTS: 70,384 people aged 65 years and over who died in 2002 and 2003. MAIN OUTCOME MEASURES: Hospital costs in the year before death. RESULTS: Care of people aged 65 years and over in their last year of life accounted for 8.9% of all hospital inpatient costs. Hospital costs fell with age, with people aged 95 years or over incurring less than half the average costs per person of those who died aged 65-74 years ($7028 versus $17,927). Average inpatient costs increased greatly in the 6 months before death, from $646 per person in the sixth month to $5545 in the last month before death. Cardiovascular diseases (43.1% of deaths) were associated with an average of $11,069 in inpatient costs, while cancer (25.0% of deaths) accounted for $16,853. The highest average costs in the last year of life were for people who died of genitourinary system diseases ($18,948), and the highest average costs in the last month of life were for people who died of injuries ($8913). CONCLUSION: Population ageing is likely to result in a shift of the economic burden of end-of-life care from the hospital sector to the long-term care sector, with consequences for the supply, organisation and funding of both sectors.     

河南省居民吸烟现状调查

目的:了解河南省居民的吸烟状况,为开展针对性的控烟工作提供依据。方法:采用多阶段分层整群抽样的方法,调查河南省15～69岁居民2056人的吸烟情况。结果:河南省居民的吸烟率为21.11%;男性吸烟率为44.49%(420/944),女性为1.26%(14/1112),男性高于女性(χ2=573.034,P<0.001);现在吸烟率为20.09%(413/2056)。不同年龄、职业和收入水平居民的吸烟率差异有统计学意义(χ2=24.672,69.101和54.166,P<0.001)。吸烟者中有25.35%的人尝试过戒烟,戒烟成功率仅为4.84%,而且仅有13.32%的人打算在1a内戒烟。现在吸烟者开始吸烟时的年龄平均为21.92岁(95%CI为21.25～22.58岁),超过83.82%的现在吸烟者开始吸烟时的年龄不到25周岁。男性开始吸烟年龄早于女性(Z=2.219,P=0.027),烟龄长于女性(Z=2.219,P=0.027),但吸烟量差异无统计学意义(Z=1.746,P=0.081)。79.18%的调查对象知晓吸烟危害健康;现在吸烟者、戒烟者和从不吸烟者知晓率差异无统计学意义(χ2=2.208,P=0.332)。结论:河南省居民吸烟率仍然较高,控烟工作仍面临巨大的挑战。     

杭州市萧山区人群腹泻病发病及就诊现况分析

目的了解杭州市萧山区人群腹泻病发生、就诊和疾病负担现况,为腹泻病预防控制提供基础信息。方法采用横断面调查方法 ,整群抽取3个镇部分人群,一年内分4次入户回顾性调查居民2周、15～30 d和31～90 d内腹泻病发病、就诊和医疗费用情况。统计学处理采用EpiData 3.0软件,率的差异性检验用χ2检验,P〈0.05为差异有统计学意义。结果居民2周内腹泻病发病率为1.58%,依此推算年发病率为41.19%。腹泻病就诊率28.62%。未就诊主要原因为症状轻（83.66%）。未就诊采取的主要方式为药店自行购药（36.88%）和服用家庭自备药（35.64%）。就诊者大多选择乡镇卫生院/社区卫生服务中心（76.54%）。医疗费用平均每人次35.07元,其中门诊就诊费用平均每人次102.66元,1～5岁年龄组平均每人次医疗费用最高（147.61元）。结论萧山区人群腹泻病年发病率较高,就诊率较低,使用自购药和自备药现象普遍,存在肠道传染病未能及时发现和滥用抗生素的隐患,需进一步加强防治工作和用药指导。     

成都市医务人员吸烟状况及控烟干预研究

目的 了解成都市医务人员的吸烟状况及其控烟态度和行为,并对其进行干预及其效果评价。方法 采用问卷形式对成都市3家医院的932名医务人员的吸烟危害知识、控烟态度和行为进行调查,并对一家医院进行干预,同时对干预结果进行评价。结果 男性吸烟率为49．7％,女性为0．2％,男性吸烟者主要集中在外科医生和医技人员中;知识方面,对吸烟与肺癌、缺血性心脏病的关系掌握较好,但对被动吸烟与儿童中耳炎和猝死综合症关系回答正确的仅41．5％和48．2％;86．2％的不吸烟者中反对“被动吸烟无害”,但吸烟者中仅为70．4％,两者的差异有统计学意义;态度方面,对于以经济手段来处罚违反吸烟规定者,不吸烟者和吸烟者赞成的比例分别是87．5％和68．1％,差异有统计学意义（P＜0．001）;行为方面,不吸烟者询问病人吸烟状况的比例高于吸烟者,同时不吸烟者鼓励家人或朋友戒烟的比例明显高于吸烟者,二者差异有统计学意义。通过综合干预,医务人员的吸烟率差异虽无统计学意义,但有好转趋势;控烟态度明显好于干预前,差异有统计学意义（P＜0．05）。结论 目前医务人员的吸烟率较高,控烟意识淡漠,吸烟者和不吸烟者在控烟态度和行为方面存在差异。在医院环境中采取综合干预的方法可以改变医务人员的吸烟行为,提高其控烟意识。     

Impact of worksite health promotion on health care costs and utilization. Evaluation of Johnson & Johnson's Live for Life program

This study explores the relationship between exposure to a comprehensive worksite health promotion program and health care costs and utilization. The experience of two groups of Johnson & Johnson employees (N = 5192 and N = 3259) exposed to Live for Life, a comprehensive program of health screens, life-style improvement programs, and worksite changes to support healthier life-styles, was compared with that of a control group (N = 2955) over a five-year period. To account for baseline differences, analyses of covariance produced adjusted means for inpatient hospital costs, admissions, hospital days, outpatient costs, and other health costs. Mean annual inpatient cost increases were $43 and $42 for two Live for Life groups vs $76 for the non-Live for Life group. Live for Life groups also had lower rates of increase in hospital days and admissions. No significant differences were found for outpatient or other health care costs.     

Intentional iron overdose: an institutional review.

OBJECTIVE: To document the frequency of admissions and the outcome of patients with a diagnosis of intentional iron overdose to a large urban hospital. DESIGN: Retrospective review of hospital records. SETTING: Health Sciences Centre, Winnipeg, an 1100-bed primary and tertiary care centre serving a regional population of about 1.2 million. PATIENTS: All patients with a discharge diagnosis of iron overdose who were admitted from Jan. 1, 1979, to July 1, 1991. Of these 113 cases 66 (58%) represented an intentional iron overdose on the basis of information derived from the patient, family or friends. MAIN OUTCOME MEASURES: Frequency of admissions, length of hospital stay and survival rate. RESULTS: Most (53 [80%]) of the 66 patients were females. The mean age was 19.8 (standard deviation [SD] 6.1) years (range 9 to 48 years). One third of the cases were associated with excess alcohol intake. The frequency of hospital admissions increased during the study period (1.4 cases per year in the first 5 years and 9.8 cases per year in the last 5; 5.3 cases per year overall). The mean length of hospital stay was 6.8 (SD 12.1) days, and the mortality rate was 10%. CONCLUSIONS: Hospital admissions because of intentional iron overdose are becoming more frequent in this centre and are associated with appreciable morbidity and mortality rates. Prospective studies are required to delineate clearly the signs, symptoms and abnormal laboratory findings associated with this problem.     

吸烟、饮酒与高血压患病率的关系

本文以辽宁省１９９１年高血压抽样调查中有关吸烟、饮酒和患病的资料为基础，采用标化率比较、趋势卡方检验以及相关分析的方法，对吸烟、饮酒与高血压患病率的关系做了分析。结果显示吸烟、饮酒者高血压患病率均高于无该两种嗜好者。进一步比较分年龄组患病率发现４５岁以下这种差别更为明显。吸烟、饮酒量与高血压患病率间有明确的趋势相关关系（但吸烟量与确诊高血压趋势相关不显著）。按时量效应计算的吸烟、饮酒指数与血压值之间存在统计学相关关系。根据分析结果，作者认为戒烟和不大量饮酒对预防高血压和心脑血管疾病将会产生明显效果。     

某三甲医院门急诊诊次 住院人数 手术例数的回归分析

目的：研究门急诊诊次、住院人数与手术量的相关关系,为医院管理和提高工作效率提供参考。方法对某院病案统计科病案信息管理系统2006年-2013年门诊工作量统计报表、住院工作综合报表原始数据进行相关分析。结果门急诊诊次、住院人数与手术例数均高度相关。对住院人数与门急诊诊次作线性回归分析,得回归方程：Y=3440.623＋0.040X;以手术例数为因变量,门急诊诊次和住院人数为自变量进行回归分析,只有住院人数进入回归方程,回归方程为：Y=1000.173＋0.183X。结论某院门急诊人次与住院人数高度相关,住院人数与手术例数关系密切,要优化门诊服务流程,不断拓展医疗市场,增加门急诊诊次,提高住院人数,促进手术例数增加。     

Australian patterns of tobacco smoking in 1986

A total of 9440 Australian men and women of over 15 years of age was interviewed at home in 1986 to determine the prevalence and consumption levels of tobacco products. Current smokers were defined as those who smoked any combination of cigarettes, cigars or pipes regularly. The percentage of current smokers among men was 32.9% and among women was 28.5%, and the peak prevalence of smoking was in the age-group 20-24 years for both men (40.5%) and women (40.8%). Among men, 27.7% were past smokers, and among women, 16.5% were past smokers. The proportion of past smokers among those who had ever smoked was higher in men (0.46) than among women (0.37), but in the younger age groups there was no relative excess among men. Male smokers consumed more cigarettes per day than did female smokers and men were exposed to a higher daily average amount of cigarette tar. Sociodemographic variables that were associated with smoking in both men and women included age and educational and occupational level. Asian-born persons had a significantly lower prevalence of smoking than did persons who were born in Australia.     

Trends in cigarette smoking in the United States. Projections to the year 2000

Data from National Health Interview Surveys from 1974 through 1985 are used to project cigarette smoking prevalence to the year 2000. Smoking prevalence in the United States has declined at a linear rate since 1974. If this trend continues, in the year 2000, 22% of the adult population (40 million Americans) will be smokers. By the year 2000, the major inequalities in prevalence will occur among educational categories. At least 30% of those who have not proceeded beyond a high school education will be smokers, whereas less than 10% of college graduates will smoke. Among the other sociodemographic subgroups, smoking prevalence is expected to decrease by the year 2000 to 20% among men, to 23% among women, to 25% among blacks, and to 21% among whites. Between 1974 and 1985, approximately 1.3 million persons per year became former smokers, indicating considerable success in public health efforts to encourage people to stop smoking. However, in the early 1980s, approximately 1 million new young persons per year were recruited to the ranks of regular smokers. This is equivalent to about 3000 new smokers each day. Public health efforts need to focus more on preventing young people from starting to smoke, and such prevention efforts should particularly target less educated socioeconomic groups.     

克罗恩病患者疾病经济负担现状与相关因素

目的: 研究克罗恩病患者的疾病经济负担及其相关因素,为降低个人负担、完善医保报销政策提供意见参考。方法: 采用横断面调查的研究方法,根据卫生服务研究基本原理和原则自行制作问卷,对上海市志愿者服务基金会平台所服务的克罗恩病患者进行调查。搜集患者基本特征、接受治疗的方案、过去一年发生的治疗费用等信息,运用描述性统计分析克罗恩病患者过去一年治疗疾病的住院、门诊费用构成,在此基础上进一步构建对数-线性模型,分析克罗恩病患者经济负担的相关因素。结果: 研究发放820份问卷,回收799份问卷,其中有效问卷797份。男性528例(66.25%),女性269例(33.75%),患者平均年龄(34.02±11.49)岁,年龄集中在18~39岁(510例,63.99%),平均患病年限(5.58±5.13)年。有10.7%的患者并未接受持续治疗,持续治疗的患者平均每年治疗费用54 246元,其中个人支付30 279元(55.8%),统筹支付23 966元(44.2%),个人经济负担接近2020年全国居民人均可支配收入32 189元(94.1%),超过2016年我国2型糖尿病患者每年治疗费用8 245元。门诊与住院分布上,住院每年平均费用31 092元,其中个人自付费用14 673元(48.5%),统筹支付费用16 418元(51.5%);门诊每年平均费用23 154元,个人自付15 606元(65.1%),统筹支付费用7 548元(34.9%),门诊自付费用高于住院自付费用。对数-线性模型回归结果表明,每年治疗总费用与患病年限(β=0.03,P<0.01)、患并发症(β=-0.68,P<0.01)、接受手术治疗(β=0.52,P<0.01)、使用免疫抑制剂(β=0.51,P<0.01)、年门诊就诊次数(β=0.02,P<0.05)、年住院次数(β=0.08,P<0.01)有关。结论: 克罗恩病患者每年疾病经济负担较重,且随着患病年限的增长而明显升高,超过了糖尿病等慢性疾病。患者个人经济负担接近全国居民人均可支配收入,医疗保障部门应该制定相关政策,降低患者经济负担,针对患者门诊个人经济负担超过住院个人经济负担的特点,将克罗恩病纳入门诊特殊病种是未来可以考虑的措施。     

Does breathing other people's tobacco smoke cause lung cancer?

The available epidemiological studies of lung cancer and exposure to other people's tobacco smoke, in which exposure was assessed by whether or not a person classified as a non-smoker lived with a smoker, were identified and the results combined. There were 10 case-control studies and three prospective studies. Overall, there was a highly significant 35% increase in the risk of lung cancer among non-smokers living with smokers compared with non-smokers living with non-smokers (relative risk 1.35, 95% confidence interval 1.19 to 1.54). Part of this increase was almost certainly caused by the misclassification of some smokers as non-smokers. As smokers, who are more likely to get lung cancer than non-smokers, tend to live with smokers this misclassification probably exaggerated the estimated increase in risk. Adjustment for this error reduced the estimate to 30% (relative risk 1.30), but as people who live with non-smokers may still be exposed to other people's smoke this estimate was revised again to allow for the fact that a truly unexposed reference group was not used. The increase in risk among non-smokers living with smokers compared with a completely unexposed group was thus estimated as 53% (relative risk of 1.53). This analysis, and the fact that non-smokers breathe environmental tobacco smoke, which contains carcinogens, into their lungs and that the generally accepted view is that there is no safe threshold for the effect of carcinogens, leads to the conclusion that breathing other people's tobacco smoke is a cause of lung cancer. About a third of the cases of lung cancer in non-smokers who live with smokers, and about a quarter of the cases in non-smokers in general, may be attributed to such exposure.     

Trends in hospitalization associated with traumatic brain injury.

CONTEXT: Traumatic brain injury (TBI) is associated with more than 50000 deaths in the United States each year, and recent observations suggest a substantial decline in TBI-related hospitalizations and deaths. OBJECTIVE: To analyze long-term trends in TBI-related hospitalization in the United States. DESIGN, SETTING, AND PARTICIPANTS: Analysis of existing data from 1980 through 1995 from the National Hospital Discharge Survey, an annual survey representing the US general population. The number of participating hospitals ranged from 400 to 494. MAIN OUTCOME MEASURES: Annual rates of TBI-related hospitalization, stratified by age, sex, severity of injury, and outcome. RESULTS: The annual number of TBI cases identified from the sample during the study period ranged from 1611 to 3129. Overall rates of hospitalization for TBI declined an estimated 51%, from 199 to 98 per 100000 per year. When analyzed by severity of injury, mild TBIs declined most during this period, from 130 to 51 hospitalizations per 100000 per year (61% decline; P<.001 compared with intermediate and severe TBI). The decline was greatest among those aged 5-14 years (-66%) and least among those aged 65 years or older (-9%). The ratio of male to female rates showed little variation during the study period (ratio, 1.8; 95% confidence interval [CI], 1.6-2.0), as did the in-hospital mortality rate (mean, 5.3 per 100000; 95% CI, 3.6-7.1). CONCLUSIONS: Changes in hospital practices may be a major factor in the declining rates of TBI-related hospital admissions. These practices increasingly appear to exclude persons with less severe TBI from hospital admission and shift their care to outpatient settings.     

The cost of asthma in New South Wales

OBJECTIVE: To determine the economic cost of asthma to the New South Wales community. DESIGN: Direct costs (both health-care and non-health-care) plus indirect costs (loss of productivity) were estimated from various sources to assess retrospectively the dollar costs of asthma. Intangible costs (such as quality of life) were not included. SETTING: Estimates of costs were made at all levels of medical care of asthma patients, including inpatient and outpatient hospitalisations, emergency department visits, and visits to general practitioners and specialist physicians, plus costs of pharmaceuticals, nebulisers and home peak-flow monitoring devices. The cost of time lost by the patient attending for medical visits and loss of productivity due to absence from employment as a result of asthma were also included. RESULTS: The total cost of asthma in New South Wales was $209 million in 1989. This was made up of $142 million in direct health-care costs, $19 million in direct non-health-care costs and $48 million in indirect costs. CONCLUSION: Although we believe that our estimate is an underestimate of the true dollar cost of this disease to the community, it represents $769 per asthmatic person per year, assuming a current prevalence rate for asthma in New South Wales of 6%. The cost effectiveness of any new treatment of asthma should be estimated to ensure that the economic cost to the community does not rise unnecessarily.     

Distribution of variable vs fixed costs of hospital care

CONTEXT: Most strategies proposed to control the rising cost of health care are aimed at reducing medical resource consumption rates. These approaches may be limited in effectiveness because of the relatively low variable cost of medical care. Variable costs (for medication and supplies) are saved if a facility does not provide a service while fixed costs (for salaried labor, buildings, and equipment) are not saved over the short term when a health care facility reduces service. OBJECTIVE: To determine the relative variable and fixed costs of inpatient and outpatient care for a large urban public teaching hospital. DESIGN: Cost analysis. SETTING: A large urban public teaching hospital. MAIN OUTCOME MEASURES: All expenditures for the institution during 1993 and for each service were categorized as either variable or fixed. Fixed costs included capital expenditures, employee salaries and benefits, building maintenance, and utilities. Variable costs included health care worker supplies, patient care supplies, diagnostic and therapeutic supplies, and medications. RESULTS: In 1993, the hospital had nearly 114000 emergency department visits, 40000 hospital admissions, 240000 inpatient days, and more than 500000 outpatient clinic visits. The total budget for 1993 was $429.2 million, of which $360.3 million (84%) was fixed and $68.8 million (16%) was variable. Overall, 31.5% of total costs were for support expenses such as utilities, employee benefits, and housekeeping salaries, and 52.4% included direct costs of salary for service center personnel who provide services to individual patients. CONCLUSIONS: The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.     

Surgery in the elderly: is age a risk factor?

This prospective, observational one-year study analyzed 623 patients who were 60 years and older, out of a cohort of 2375 patients who were admitted consecutively to the general surgery wards of the University Hospital of the West Indies (UHWI). Even though only 9.7% of the Jamaican population are 60 years and older, this age group accounted for 26.2% of total admissions. Comparison of elderly and non-elderly patients showed no differences in gender, but less elderly patients were emergency admissions (52% vs 64%, p < 0.001), more underwent surgery (68% vs 60%, p < 0.001), their mean hospital stay was longer (11.5 vs 8.0 days, p < 0.001) and their mortality rate was higher (8.8% vs 1.9%, p < 0.001). Emergency admissions (52%) exceeded elective admissions in the elderly. Forty-four (80%) of the 55 deaths in the elderly group were admitted as emergencies compared to elective admissions (p < 0.001). There were 11 deaths among the 296 elective admissions (3.7%) but 44 deaths among the 327 emergency admissions (13.5%), a significant difference in mortality rates (p < 0.001). Overall, the death rate for males was higher. Cancer was the commonest admission diagnosis (21%) and that amongst mortalities. Steps to improve the opportunities for earlier admission and optimization of care of elderly surgical patients would not only benefit them but would be an important step towards a more efficient use of already scarce resources.