Vaccination in the control of influenza

Although killed influenza vaccine given by injection is protective, able to reduce sickness absence in industry and to control influenza in the armed forces, it has not so far been possible to demonstrate more than a small effect on the disease in otherwise healthy adults in industry and offices in the United Kingdom. The reasons are probably the poor rate of acceptance of vaccine, the relatively low incidence of clinical influenza in most years, and the incomplete protection given by the vaccine. Until major epidemics can be accurately forecast it is suggested that influenza vaccination may most usefully be used on a selective basis, namely for protecting those with illness predisposing to a severe effect from influenza; persons in institutions such as schools and homes for the elderly; key workers in the general population; and persons over the age of 65 years among whom considerable mortality occurs in winters when influenza is prevalent.     

386名健康中、老年人血液流变性调查

本文报告了386名健康中老年人血液流变性的调查结果,发现各年龄组不同性别间的血液流变性各指标的差异,除ηP外均有非常显著意义(P<0.001),ESR,ESR→K男、女组均呈增龄性加快。不论高切速率或低切速率全血比粘度均与LgHCT呈高度线性相关(r分别为0.994,0.992)。本研究对健康人群进行了较严格的筛检,注意了测试技术及数据质量的控制,各指标间存在一定的内部准确性,使研完结果能较客观地反映中老年人血液流变性的变化。     

SOCIAL EPIDEMIOLOGY OF AGING IN THE UNITED STATES

Unprecedented changes in the structure of the population have led to a "graying" of America. Increase in life expectancy and de- clining birth rate have resulted in a larger pro- portion of Americans who are elderly. At the beginning of this century, less than 10% 0f the population were aged 55 0r older-about 7.1 million people; in 1982, more than one-fifth of the population were over the age of 55-an estimated 48.9 million persons. In the year 2050, one in three persons is expected to be over the age of 55. During the past two decades, the 65-plus population grew twice as fast as the rest of the population, and those over 85 years of age comprised the fastest growing segment of the U.S. population. In 1960, those over the age of 85 comprised one-half of i% of the population; just 20 years later, this proportion was doubled and is expected to double again t0 1.9% in the year 2000. Given current projec- tions, the 85-plus age group will comprise more than 5% 0f the population in the year 2050. There are currently more than 2.2 million peo- ple in the U.S. over the age of 85 and this age group is expected to increase t0 16 million in 2050 (Figs l,2).     

潍坊市区人群麻疹抗体水平及麻疹疫苗强化免疫血清学效果监测

为了解潍坊市麻疹疫苗(MV)强化免疫的效果和人群麻疹抗体水平,在2个区随机抽取767名0-39岁健康人,应用酶联免疫吸附试验检测麻疹IgG抗体。结果:767人中抗体阳性595人,阳性率77.57%,几何平均滴度(GMT)1:783。以1-12岁儿童抗体阳性率高(85.71%-98.44%),GMT则从6岁开始下降至中低等水平,抗体阳性率有随年龄增长而下降的趋势。观察MV初种8-12月龄儿童94人,免疫成功率为96.81%;MV复种5-7岁儿童93人,免疫成功率61.29%;免疫后抗体GMT分别比免疫前提高28.4倍和3.1倍。不论是初种或复种,免疫前抗体处于中低等水平者其免疫成功率显著高于免疫前高抗体水平者。     

Patterns of blood pressure in Milwaukee

Blood pressure measurements were obtained among 92,074 persons in Milwaukee between 1974 and 1976 by the Milwaukee Blood Pressure Program. Systolic hypertension was more prevalent in young white men than blacks below 25 years of age, was more common in middle-aged blacks than whites, and was equally prevalent among all persons past 65 years. Diastolic hypertension was more prevalent in blacks than whites of all ages. Whereas the prevalence of systolic hypertension in the population increased with age and was present in a majority or near majority of persons past 65 years, the prevalence of diastolic hypertension rose until the sixth decade, after which it declined. Hypertension was primarily of a diastolic variety in young blacks, whereas systolic hypertension was a prominent feature in young whites.     

Immunization status of thirty patients with sickle cell disease five years post hepatitis B vaccination. A comparison with normal controls

In order for hepatitis B immunization programmes to be cost effective and clinically beneficial, vaccinated persons should maintain an immunity threshold titre of antibodies to hepatitis B surface antigen greater than 10 IU/l. Those who fall below this level should be boosted in order to be covered against the risk for which the vaccine was administered. Persons with sickle cell disease are included in the group for whom hepatitis B immunization is routinely prescribed. Antibody to hepatitis B surface antigen was measured in paired sera of thirty patients with sickle cell disease compared with a control group of healthy medical staff, five years post vaccination. There was no significant difference between patients with sickle cell disease and normal controls in the levels of antibody maintained or numbers that required booster vaccination. Recommendations for the maintenance of protection via revaccination should be the same for persons with sickle cell disease as for healthy persons.     

Diabetes mellitus. I: Routine plain abdominal radiography.

The plain abdominal radiographs of 43 consecutive diabetic patients were studied. Disordered bowel motility which was unrelated to the severity of the diabetes mellitus occurred in 76.7% while artheriosclerosis occurred in 65%. Only 7% (3 patients) had pancreatic calcification; of these, one was a complication of urinary schistosomiasis (Schistosoma haematobium). All the patients with pancreatic calcification were above 45 years of age and had had diabetes mellitus for more than 7 years. This study shows that pancreatic calcification is uncommon among Nigerian diabetics, so plain abdominal radiography should be limited to patients who are above 45 years and who have had the illness for more than 7 years.     

Continuing screening mammography in women aged 70 to 79 years: impact on life expectancy and cost-effectiveness

CONTEXT: Mammography is recommended and is cost-effective for women aged 50 to 69 years, but the value of continuing screening mammography after age 69 years is not known. In particular, older women with low bone mineral density (BMD) have a lower risk of breast cancer and may benefit less from continued screening. OBJECTIVE: To compare life expectancy and cost-effectiveness of screening mammography in elderly women based on 3 screening strategies. DESIGN: Decision analysis and cost-effectiveness analysis using a Markov model. PATIENTS: General population of women aged 65 years or older. INTERVENTIONS: The analysis compared 3 strategies: (1) Undergoing biennial mammography from age 65 to 69 years; (2) undergoing biennial mammography from age 65 to 69 years, measurement of distal radial BMD at age 65 years, discontinuing screening at age 69 years in women in the lowest BMD quartile for age, and continuing biennial mammography to age 79 years in those in the top 3 quartiles of distal radius BMD; and (3) undergoing biennial mammography from age 65 to 79 years. MAIN OUTCOME MEASURES: Deaths due to breast cancer averted, life expectancy, and incremental cost-effectiveness ratios. RESULTS: Compared with discontinuing mammography screening at age 69 years, measuring BMD at age 65 years in 10000 women and continuing mammography to age 79 years only in women with BMD in the top 3 quartiles would prevent 9.4 deaths and add, on average, 2.1 days to life expectancy at an incremental cost of $66773 per year of life saved. Continuing mammography to age 79 years in all 10000 elderly women would prevent 1.4 additional breast cancer deaths and add only 7.2 hours to life expectancy at an incremental cost of $117689 per year of life saved compared with only continuing mammography to age 79 years in women with BMD in the top 3 quartiles. CONCLUSIONS: This analysis suggests that continuing mammography screening after age 69 years results in a small gain in life expectancy and is moderately cost-effective in those with high BMD and more costly in those with low BMD. Women's preferences for a small gain in life expectancy and the potential harms of screening mammography should play an important role when elderly women are deciding about screening.     

余杭地区1360例健康人群骨密度和骨质疏松症调查分析

目的对余杭地区健康人群的骨密度进行测量并对健康人群的骨质疏松发病率进行调查分析。方法收集余杭地区的健康人1360例作为研究对象,将其按照年龄进行分组。如果研究对象的峰值骨密度下降的数值超过2．5SD则可以诊断为骨质疏松症。结果30～35岁年龄段的女性、年龄在35岁左右的男性骨密度出现峰值;年龄大于55岁的女性具有非常显著的下降值,并且与男性的骨质疏松发病率比较,女性明显具有更高的发病率。结论女性55岁以前,男性65岁以前,应该加强学习骨质疏松方面的相关知识,此年龄段后,为了降低骨质疏松症的发生率要给予相应的治疗措施。     

Falls in the elderly--clinician's approach

Fall is an involuntary event producing a change in posture resulting in the individual adopting an unplanned supine position. Globally more than one-third of persons 65 years of age or older fall each year and in half of such cases the falls are recurrent. Several predisposing factors for such falls have been recognised like age related changes in posture control, reduced visual acuity, anxiety, drugs, environmental hazards and underlying neurological diseases. It is the interplay of predisposing and precipitating factors that really matter and not exactly a single cause. Evidence based interventions have been suggested from recent clinical trials and certain preventive guidelines are present to reduce the rate of falling, provided a periodic targeted approach is followed.     

The age threshold for isoniazid chemoprophylaxis. A decision analysis for low-risk tuberculin reactors

Isoniazid chemoprophylaxis recommendations include its use in persons who have positive tuberculin reactions, but neither recent conversion nor other activation risk factors, only if they are under age 35 years. Above this threshold, the isoniazid hepatitis risk is said to outweigh the benefit of preventing activation. Because this policy is controversial, we performed a decision analysis contrasting those who take with those who decline isoniazid therapy according to three outcome measures: life expectancy, likelihood of illness (isoniazid hepatitis and active tuberculosis), and likelihood of fatal illness. We found no threshold between ages 10 and 80 years by the measures of life expectancy and likelihood of fatal illness; isoniazid benefits outweigh risks for all, though the margin is small for the elderly. A threshold exists only in the likelihood of illness: isoniazid risks outweigh benefits for those aged 50 to 65 years. Only extreme variations of assumptions affect these findings. Chemoprophylaxis recommendations should include low-risk tuberculin reactors over age 35 years.     

成人发热出疹性疾病的临床研究

目的 探讨成人发热出疹性疾病的临床特点。方法 回顾性分析我院近5年来420例成人发热出疹性疾病的临床特点、并发症和预后。结果 成人发热出疹性疾病大多数均有典型的临床表现;并发症主要以肝脏、肺脏为主;预后良好。麻疹IgM抗体阳性率为65%,风疹IgM抗体阳性率为15%,麻疹IgM抗体、风疹IgM抗体均为阴性者占20%。结论 血清学诊断是鉴别成人发热出疹性疾病的重要手段,为控制麻疹的发病率,除坚持疫苗接种、对特定人群（成人）强化免疫及对流动人口进行应急接种或加强新疫苗的研制外,还应继续推行风疹疫苗的接种。     

SES discrepancies and Delaware cancer death rates

Cancer can be monitored fairly effectively by using cancer registry data for site, stage, age, sex, and race. Adding to this the patient's years of education, now only found on death certificates, should not be difficult since it is an easily measured major SES factor. Most comorbidities should also be easy to obtain since hospitals usually code them. Capturing all treatment and response data remains a challenge as more and more cancer diagnosis and management is done in outpatient settings. Current efforts to establish electronic medical records in compliance with the Health Insurance Portability and Accountability Act (HIPAA) may be a blessing if adequate software can be standardized and used similar to that already present in the VA hospital in Delaware. Such information would aid efforts to reduce Delaware's high cancer incidence and mortality rates. A proposed state cancer plan should stimulate improved integration of the state's health resources to focus on the quality of individual health care and to use cost-effective measures to improve the public's health. A plan should (1) stimulate a public awareness to reduce risk factors for all major chronic diseases with a special focus on cancer deaths; (2) use medical office settings to provide simple screens to improve the early detection of a number of chronic diseases depending on such risks as age and sex (such studies might include weight, height, blood pressure, sugar, cholesterol, PSAs, exams of skin, oral cavities, breasts, abdomen, rectum, and vagina with pap smears, all of which can be accomplished in a cost-effective fashion); and (3) offer equitable access to a state's health care system for information, screening, and treatment. Current evidence shows that it is less expensive to manage patients with early cancers than those with advanced cases, which often occur because of ignorance and lack of access to health services, and by socioeconomic, educational, and cultural barriers. Implementing the recommendations in the Governor's Advisory Council's report should go a long way toward reducing both Delaware's cancer incidence and death rates. An increase in taxes on tobacco (one of the Council's recommendations) could provide resources to explore relationships between the environment, occupation, and cancer, and provide early access to competent cancer care for those at risk because of limited education, income, and health insurance.     

An estimate of diabetes prevalence from a national population sample: a male excess

We report the prevalence of diabetes in a population sample of 10,083 persons who were aged 25 to 64 years in eight city centres. One hundred and sixty-nine persons were known to have diabetes and 48 persons were newly-discovered to have diabetes on the basis of fasting hyperglycaemia (plasma glucose level, equal to or greater than 7.8 mmol/L). Type-1 diabetes was identified by clinical criteria and accounted for 19% of cases of known diabetes, but this proportion ranged from 67% of persons with known diabetes in the age-group of 25-29 years, to between 9% and 15% in the age-groups of persons who were 50 years of age and over. For both known and newly-discovered cases, persons with type-2 diabetes showed a significant male preponderance, which suggests that an environmental factor is operating preferentially on male subjects to cause this form of diabetes. The results of the present study, when taken with those of other recent prevalence studies, enable an approximate estimate of numbers of persons with diabetes in Australia. Approximately 250,000 persons have diagnosed diabetes, of whom 40,000 persons have type-1 diabetes, including 7000 persons who are less than 25 years of age. The number of persons with undiagnosed diabetes who could be identified on the basis of fasting hyperglycaemia is estimated to be 75,000; an additional 150,000 persons would be diagnosed to have diabetes if they were to undergo glucose tolerance tests. This study gave prevalence rates for known diabetes in Australia in 1984 of 1.6% at all ages and 2.4% for adults who were 21 years of age and older; additionally, the estimated prevalence rates for undiagnosed diabetes were 1.4% for all ages and 2.2% for adults.     

福建省城乡人群恒牙龋病流行病学抽样调查报告

目的：了解福建省居民口腔健康状况及流行趋势,为今后进行口腔健康教育、开展口腔保健项目提供依据。方法：采用多阶段、分层、整群随机抽样的方法对福州市、泉州市、南平市的5,12,15,18,35－44及65－74岁年龄组的城乡人群12792人（男女各半）进行口腔检查。结果：随着年龄的增大,龋均、患龋率、充填率呈上升趋势（P＜0．01）。35－44岁、65－74岁年龄组龋均、患龋率城市高于农村（P＜0．01）,其他年龄组城乡之间差别无显著性（P＞0．05）。各年龄组充填率城市均高于农村（P＜0．01）。福建省城乡居民的恒牙患龋率、龋均高于全国平均水平。结论：应从小进行口腔健康教育,增强口腔健康意识,加大实施口腔预防保健措施的力度。     

Cost-effectiveness of antihyperlipemic therapy in the prevention of coronary heart disease. The case of cholestyramine

Using cholestyramine as a model, we considered the cost-effectiveness of antihyperlipemic therapy in the primary prevention of coronary heart disease among men between 35 and 74 years of age with elevated levels of total plasma cholesterol. Our findings indicate that the cost-effectiveness of treatment varies substantially, ranging from about $36,000 to over $1 million per year of life saved. Cost-effectiveness was highest for younger patients, for those with additional coronary risk factors (eg, smoking or hypertension), and for those whose course of therapy is of less-than-lifelong duration. Conversely, it is lowest for older patients, for those with no additional coronary risk factors, and for those who are treated for a lifetime. Our results suggest that pharmacologic therapy may not be cost-effective for all patients with elevated cholesterol levels, especially those over 65 years of age. For many younger patients, however--those with additional coronary risk factors and more severe elevations in cholesterol levels--the cost-effectiveness of therapy may be comparable with other accepted medical practices.     

13146例狂犬病暴露人群流行病学特征分析

目的了解钦南区狂犬病暴露人群的流行病学特征,为制定狂犬病控制策略提供科学依据。方法对2006—2008年在狂犬病预防接种门诊接受诊治的被犬、猫等动物咬（抓）伤暴露人群进行调查分析。结果三年共报告狂犬病暴露者13146人,年平均暴露率113．82／万;男性占62．06％,女性占37．94％;20～49岁青壮年占65．32％;在各年龄组中,上肢和下肢被犬伤人数均位居前两位,0～岁组中头面部被犬伤率25．37％,明显高于其他组;单月7、8月份犬伤者多于其它月;职业以农民为主（77．85％）;暴露动物以犬为主（92．08％）;被犬主动袭击致伤者以Ⅲ度伤为主（86．07％）;暴露后处理伤口者占97．13％,其中规范者占82．87％,不规范者占17．13％,未处理者占2．87％;全程接种狂犬疫苗者占90．63％,在Ⅲ度犬伤者中用抗狂犬免疫球蛋白和血清仅占8．39％。结论钦南区对狂犬病防治工作采取了有效措施,但危险因素仍然较高。只有在政府相关部门、犬主和市民的共同努力下,狂犬病疫情才会得到有效控制。     

青年与老年冠心病患者行冠状动脉旁路移植术疗效及危险因素分析

目的探讨青年与老年冠心病（coronary heart disease,CHD）患者行冠状动脉旁路移植术（coronary artery bypass grafting,CABG）手术疗效及发病危险因素。方法选择我院2009年5月-2012年5月所有单纯行CABG患者（≤45岁51例;≥65岁386例）与同期行心脏手术的非冠心病患者（≤45岁68例,≥65岁247例）。比较CHD组与非CHD组的术前因素、CHD组两个年龄段术中及术后指标、并发症及死亡率等,并进行危险因素相关分析。结果青年CHD组在呼吸机辅助时间、ICU时间及住院时间等方面明显小于老年CHD组（P〈0.05）,在男性、阳性家族史、吸烟、超重、低-高密度脂蛋白（HDL）等方面明显高于老年CHD组（P〈0.05）。结论青年CHD组手术疗效好于老年组,老年CHD组手术近期效果令人满意;青年CHD危险因素以男性、阳性家族史、吸烟、超重、低-HDL为主,应针对可控因素进行健康教育及治疗。     

深圳市正常体质量指数成人骨密度和峰值骨密度的调查

目的:调查深圳市正常体质量指数人群骨密度和峰值骨密度(PBD),以期为深圳地区骨质疏松症防治工作提供理论依据.方法:近5 a体检的健康成年677名,年龄20以上,男女性均以5岁一个年龄段分为14组;双能X光骨密度仪测量骨密度.结果:男性各部位PBD值出现在25～岁,女性各腰椎PBD值出现在35～岁,髋部PBD值出现在40～岁.在80～岁年龄段,男性腰椎骨密度出现高于其PBD的另一个峰值,女性骨密度自45～岁年龄段后随年龄逐年下降.结论:女性PBD形成晚于男性而接近绝经期;其骨密度自45岁年龄段迅速减低,而男性则发生在65岁年龄段;骨质疏松的预防应从青少年时期提高PBD开始.