上饶市精神疾病流行病学调查

目的　了解上饶市精神疾病流行病学情况。方法　采用初级单位含量比例分层、整群、随机的抽样方法 ,以ICD 10、CCMD 3为诊断标准 ,以《复合性国际诊断检查》(CIDI)为筛查和诊断工具 ,以社会功能缺陷筛选量表 (SDSS)、成人智残评定量表、儿童韦氏智力量表 (C WISC)、克来顿修定行为量表(CRBRS)、日常生活能力量表 (ADL)、Hachinski缺血指数量表 (HIS)及我国残疾定义和分级标准为评定工具。结果　各类精神疾病时点患病率为 2 5 2 5‰ ,终生患病率为 31 6 6‰ ,排前三位的为精神分裂症、酒依赖、心境障碍。残疾率为 13 19‰。结论　精神分裂症仍然是防治和研究的重点疾病 ,酒依赖、心境障碍的患病率升高     

Prospective analysis of risk factors and distribution of venous thromboembolism in the population-based Malmö Thrombophilia Study (MATS)

Background

Despite venous thromboembolism (VTE) being a major cause of morbidity and mortality, there is still limited information on its prevalence and incidence in the general population.

Objective

To evaluate risk factors, distribution and epidemiology of VTE in the Malmö area with 280 000 inhabitants.

Methods

Patients diagnosed with VTE at Malmö University Hospital in 1998–2006 were invited to a prospective population-based study. Blood sampling and a questionnaire study could be performed in 70% of patients. Remaining 30% were excluded due to language problems, dementia, other severe disease, or unwillingness to participate.

Results

During 1998–2006 1140 VTE patients (559 men [49%, age 62 ± 16 years] and 581 women [51%, age 61 ± 20 years]) were included. Deep venous thrombosis (DVT) occurred in 882 (77%), pulmonary embolism (PE) in 330 (29%), and both DVT and PE in 72 (6%). The most common acquired risk factors among VTE patients were hormone therapy (24% of female DVT patients and 19% of female PE patients), immobilisation (17% of DVT patients and 18% of PE patients), previous surgery (13% of DVT patients and 19% of PE patients), and concomitant malignant disease (12% of DVT patients and 11% of PE patients). A positive family history for VTE was obtained from 25% of DVT patients and 22% of PE patients.Yearly incidences of VTE, DVT and PE in Malmö were 66, 51, and 19/100.000, respectively.

Conclusion

Hormone therapy, immobilisation, previous surgery and concomitant malignancy were the most common acquired risk factors among VTE patients in this population-based study. The VTE-incidence was lower than in earlier epidemiological studies.     

西藏自治区精神障碍流行病学调查I:重型精神障碍

目的调查西藏精神障碍患病率,为政府制订西藏卫生工作规划提供科学依据。方法参考两次全国精神障碍流行病学调查的方法,使用美国精神障碍诊断与统计手册轴I障碍用临床定式检查执行手册/研究版(SCID-I)作为定式检查工具,并以美国精神障碍诊断与统计手册-第四版(DSM-IV)为诊断标准,对西藏具有代表性的4个地市进行精神障碍流行病学抽样调查。结果在西藏≥15岁人口中实际调查5375人,心境障碍、精神分裂症、器质性精神障碍和急性短暂精神病性障碍的时点患病率分别为0.48%,0.34%,0.17%和0.037%;终生患病率分别为0.56%,0.37%,0.17%和0.037%。结论西藏4类重型精神障碍总的终生患病率为1.14%,如何妥善解决全自治区1%人口中重型精神障碍患者的诊治问题,在政府制订卫生工作规划时有必要特别加以关注。     

Multiple sclerosis in Europe

At a symposium held in conjunction with the 13th World Congress of Neurology, epidemiological data were presented from 23 European countries. In addition to the confirmation of the well-known north-south gradient, new details emerged on the high-prevalence areas of the British Isles and Scandinavia and on high-prevalence areas in some of the eastern and Mediterranean countries requiring more intensive exploration and confirmation. It became evident that higher prevalences existed in some places in Southern Europe previously thought to be regions of very low frequency. Limitations in the evaluation and comparison of data presented were obvious in view of differences in concepts, techniques and the intensity of surveys carried out. There was general agreement that this first collaborative attempt to map the frequency of multiple sclerosis in Europe should be followed up by standardized procedures and more cooperation in epidemiological surveys.     

The PRIAMO study: background, methods and recruitment

PRIAMO (PaRkinson And non Motor symptOms) is an epidemiology study aimed to assess the prevalence and incidence of non-motor symptoms (NMS) in patients with parkinsonism. PRIAMO consists of two phases: (1) a transversal assessment of the prevalence of NMS and (2) a longitudinal observation with two follow-up visits at 12 and 24 months to establish the incidence of NMS. A secondary aim of PRIAMO is to study the relationship between NMS and quality of life. Patients with parkinsonism have been evaluated in 59 Neurology Centres widely distributed throughout Italy. PRIAMO has analysed a total of 1307 patients (out of 1325 initially enrolled). We expect that PRIAMO will substantially help to quantify the burden of NMS in patients with parkinsonism.     

Epidemiology of myotonic dystrophy type 1 (Steinert disease) in Belgrade (Serbia)

The aim of this study was to estimate the incidence and prevalence of myotonic dystrophy type 1 (DM1) in Belgrade during the period 1983–2002.

The patients who had DM1 were ascertained through hospital records from all neurological departments in Belgrade during 1983–2002. The molecular genetic analysis was performed in all patents included in the study.

We identified 101 DM1 patients (52 males and 49 females). The average annual incidence rate of DM1 in Belgrade for the period observed was 2.0/1,000,000 (95% confidence interval (CI), 0.3–8.3), 2.1/1,000,000 (95% CI, 0.3–8.3) for males and 2.0/1,000,000 (95% CI, 0.3–8.3) for females. The highest age-specific DM1 incidence was registered in the age group 20–49: 3.4/1,000,000 (95% CI, 0.5–7.6), 4.0/1,000,000 (95% CI, 1.1–10.2) in males and 2.5/1,000,000 (95% CI, 0.5–7.6) in females. In the population of Belgrade, a cumulative probability of acquiring DM1 was 1 per 8621 for men and 1 per 9259 for women (1 per 8940 of the population for both sexes). The prevalence of DM1 in Belgrade on 31 December 2002 was 5.3/100,000 (95% CI, 4.2–6.6).     

Prevalence and Incidence of Epilepsy in Ulanga, a Rural Tanzanian District: A Community-Based Study

Summary: A random cluster sample survey of approximately 18,000 people in 11 villages was performed in Ulanga, a Tanzanian district with a population of approximately 139,000 people. Well-instructed fourth-year medical students and neurologic and psychiatry nurses identified persons with epilepsy using a screening questionnaire and sent them to a neurologist for detailed evaluation. Identified were 207 subjects (88 male, 119 female) with epilepsy; of these, 185 (89.4%) (80 male, 105 female) had active epilepsy. The prevalence of active epilepsy was 10.2 in 1,000. Prevalence among villages varied, ranging from 5.1 to 37.1 in 1,000 (age-adjusted 5.8-37.0). In a 10-year period (1979–1988) 122 subjects living in the 11 villages developed epilepsy, with an annual incidence of 73.3 in 100,000. Generalized tonic-clonic seizures (GTCS) accounted for 58% and partial seizures accounted for 31.9%, whereas in 10.1% seizures were unclassifiable. Of the partial seizures, secondarily generalized seizures were the most common. Possible etiologic or associated factors were identifiable in only 25.3% of cases. Febrile convulsions were associated in 13.4 of cases. Other associated factors included unspecified encephalitis (4.7%), cerebral malaria (1.9%), birth injury (1.4%), and other (3%). In 38% of the cases, there was a positive family history of epilepsy.     

A systematic review of the epidemiology of epilepsy in Arab countries

In this report the epidemiologic aspects of epilepsy in Arab countries are systematically reviewed. MEDLINE and Embase were searched, and six papers were identified: one incidence report from Qatar and five prevalence reports (two from Sudan, and one from each of Libya, Tunisia, and Saudi Arabia). An incidence of 174 per 100,000 persons in 2001 was reported in a hospital-based study from Qatar. Prevalence ranged between 0.9/1,000 in Sudan and 6.5/1,000 in Saudi Arabia, with a median of 2.3/1,000. An approximate 724,500 people with epilepsy live in the Arab world. All the studies report higher prevalence in males, which was statistically significant in the Saudi study. The prevalence is approximately 2-fold higher in children and young adults, compared to the rates in middle age. Two studies showed a high prevalence in individuals older than 60 years of age. Primary generalized seizures are reported in 28–97% of cases, partial seizures in 3–43.8%, and unclassified seizures in 18–51%. Idiopathic epilepsy represents 73.5–82.6% of cases. Early childhood brain damage such as in cerebral palsy and mental retardation represented a major cause of symptomatic epilepsy, whereas infection was the main cause in Sudan. The epidemiologic data from Arab states are lacking, especially from populous countries like Egypt, Algeria, and Syria. Well-designed studies are needed to accurately determine the burden of epilepsy in the Arab world.     

Prevalence and incidence of multiple sclerosis in the city of Monreale, Italy

The prevalence and incidence of multiple sclerosis (MS) in the city of Monreale, southern Italy were ascertained 10 years after a preliminary study in the same area. The study was undertaken in a population of 26,256 people. The patients were classified according to Poser’s criteria. The prevalence of MS on 31 December 1991 was 72.4 per 100,000 population. The incidence of MS for the period 1981–1991 was 3.3/100,000 per year. The mean period between onset and diagnosis of MS was 4.9 years for those patients found during this survey and 9.2 years for those in the first study. This study shows an increase of MS prevalence in Monreale city and a high incidence. The findings parallel the reduction of the lag time between onset and diagnosis. Received: 25 March 1997 Received in revised form: 30 June 1997 Accepted: 10 July 1997     

Dehospitalization of psychiatric care in The Netherlands

ABSTRACT What are the major changes in the Dutch mental health system? In this article some main lines of the de jure mental health policy are compared with de facto developments in the period 1970–1982, utilizing data from a national inpatient case register.     

Deinstitutionalization of psychiatric patients in central Europe

The central European countries Germany, Switzerland, Austria, and Luxemburg are confronted with a variety of individual problems concerning health care. After an analysis of problems which are shared by all the countries, these individual aspects are analyzed. In Germany there has been a rapid structural change of psychiatric care in the last 30 years. Although there was a broad movement to deinstitutionalize patients with chronic psychiatric disorders who need long-term care, there are still too many psychiatric beds in large psychiatric hospitals and still missing psychiatric departments in general hospitals in some areas. In Austria the process of deinstitutionalization has been delayed but a general survey of the health care system by the government led to an acceleration of this process in recent years. Due to historical reasons, the mental health care system in Switzerland is not easily comparable with the ones in the other two countries. Deinstitutionalization mainly means reduction of beds in the existing psychiatric hospitals rather than a structural change with a conversion to psychiatric departments in general hospitals. Luxemborg is a good example of the fact that economical factors are not the only aspects influencing development in psychiatric care. Psychiatric care is not community based, centralized, separated from medical care, and the supply system concerning complementary outpatients institutions is underrepresented. Thus, in all the countries the process of deinstitutionalization has still not come to a satisfying level. This is not only due to the economically difficult situation in the recent past. A change can only be expected when the opinions about modern principles of psychiatric care receive more weight in general society and with their political representatives.     

A systematic review and meta-analysis on the epidemiology of Duchenne and Becker muscular dystrophy

The muscular dystrophies are a broad group of hereditary muscle diseases with variable severity. Population-based prevalence estimates have been reported but pooled estimates are not available. We performed a systematic review of worldwide population-based studies reporting muscular dystrophies prevalence and/or incidence using MEDLINE and EMBASE databases. The search strategy included key terms related to muscular dystrophies, incidence, prevalence and epidemiology. Two reviewers independently reviewed all abstracts, full text articles and abstracted data using standardized forms. Pooling of prevalence estimates was performed using random effect models. 1104 abstracts and 167 full text articles were reviewed. Thirty-one studies met all eligibility criteria and were included in the final analysis. The studies differed widely in their approaches to case ascertainment, resulting in significant methodological heterogeneity and varied data quality. The pooled prevalence of DMD and BMD was 4.78 (95% CI 1.94–11.81) and 1.53 (95% CI 0.26–8.94) per 100,000 males respectively. The incidence of DMD ranged from 10.71 to 27.78 per 100,000. This is the first meta-analysis of worldwide prevalence estimates for muscular dystrophies. There is a need for more epidemiological studies addressing global estimates on incidence and prevalence of muscular dystrophies, utilizing standardized diagnostic criteria as well as multiple sources of case ascertainment.     

宁夏同心县回族癫痫流行病学调查

目的调查宁夏回族人群癫痫患病率、发病率及治疗缺口,为回族人群癫痫的防治提供依据。方法通过随机、整群抽样,选取宁夏同心县豫海镇和石狮镇,分别作为城镇及农村代表地区进行调查;采用统一的癫痫流行病学调查表进行入户调查,对初步筛查的癫痫患者经由神经科医师再次确诊。结果实际调查11917例,确诊癫痫患者60例,癫痫患病率为5.03‰。其中城镇患病率为6.61‰,农村为3.37‰,城市和农村地区癫痫患病率存在显著性差异;回族男性与女性癫痫患病率无显著差异;回族儿童(≤14岁)癫痫患病率为8.43‰,高于其他年龄组;70%的患者癫痫的首次发作在儿童时期;癫痫患者的年龄在3月~51岁之间,其中儿童占40%(24/60),城镇癫痫患者的平均年龄为16.38±11.78岁,农村癫痫患者的平均年龄为30.05±14.63岁;在活动性癫痫患者中,正规接受抗癫痫治疗的患者为25.9%(15/58),治疗缺口为74.1%;在所有发作类型中,全面强直阵挛发作者46例,占75.0%;回族癫痫发病率为75.5/100000例。结论宁夏回族人群癫痫患病率城镇高于农村,儿童高于其他年龄组;回族癫痫发病率高于全国平均水平;回族癫痫患者治疗缺口大,需要对该地区进行政策支持并加强宣传,提高患者的就诊率,控制癫痫发作。     

Epilepsy is ubiquitous,but more devastating in the poorer regions of the world… or is it?

The incidence and prevalence of active epilepsy are greatest in Africa compared to all other continents, even those with equivalent poor settings. This is a reflection of the high levels of structural and metabolic causes and may reflect an increased risk in parts of the continent. The full burden of epilepsy, which includes the social and medical morbidity of the disorder and where people with epilepsy are heavily stigmatized and frequently untreated, cannot be fully assessed even using the disability adjusted life‐years, since the assigned disability weights are not specific to these regions. The burden is further exacerbated by social, geographic, and economic barriers to care and the inability of African health systems to manage people with epilepsy effectively because of lack of trained personnel, limited facilities, and poor access to effective or sustained supplies of antiepileptic drugs, or even therapy at all. The situation is compounded by a probable underestimation of the prevalence and incidence of people with epilepsy related to the major stigma associated with the condition in Africa, and the limited training available to most health care workers who are the primary point of assessing most people with epilepsy. Finding innovative ways to address the huge barriers faced by people with epilepsy in Africa needs to be a major goal for the millennium. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here .     

The epidemiology of dementia: GMS-AGECAT studies of prevalence and incidence,including studies in progress

Summary The paper reviews the main studies using the AGECAT computerised diagnostic system for the diagnosis of dementia in community studies of prevalence and incidence. It is suggested that variations in reported rates may be due to the use of unstandardised methods, and the paper reviews the oldest established standardised interview: the Geriatric Mental State. The AGECAT system is outlined, and the studies of its diagnostic validity indicated. Arguments are presented against the inclusion of cognitive tests in such instruments, and for the critical evaluation of the concepts of mild dementia. The use of AGECAT in the US/UK Diagnostic Project, and in the Liverpool study of Continuing Health in the Community is described. In addition, preliminary information is given on the Liverpool ALPHA study, the MRC UK multi-centre study, studies organised by the Pan American Health Organisation (Argentina, Chile, Cuba), the Eurodem concerted action (based in Rotterdam) and the WHO multi-site studies. Individual studies in Spain and Portugal are also discussed.     

Prevalence and incidence of Multiple Sclerosis in Campobasso (Molise region chieftown,southern Italy)

Objective

Multiple Sclerosis in southern Italy was not epidemiologically studied until 2006 in Salerno (Campania region), with data based on the registry of district MS centers established since 1996 by Italian Ministry of Health. This paper reports data about Molise region by the same metodology as Campanian study.

Patients and methods

The registry of MS center was searched for the city of Campobasso, chief town of Molise region. Population screened: 51,633 units. ISTAT 2005 data were used for comparison and age standardization. Prevalence day: September 30, 2009; incidence was calculated by cumulative rates 1996–2000 and 2001–2005.

Results

47 patients were collected, 17 males, 30 females, age 44.10 (9–74, SD 14.38); female/male ratio = 1.76/1; age onset 34.61 (4–61, SD 12.40); mean disease duration 9.48 years (0–24; SD 4.28). Males prevalence: 68.62/100,000; females: 111.68/100,000. Total prevalence: 91.02/100,000; standardized: 90.91/100,000. Incidence rates: 1996–2000: 10.84/100,000; 2001–2005: 4.26/100,000.

Conclusions

Prevalence is coherent with previous Campanian data, and with last epidemiologic papers on middle Italy, confirming also the validity of MS district centers registries. A possible underestimation of data, for some patients could still migrate to northern centers, could contribute to the differences in incidence. Nevertheless, prevalence data confirm southern Italy as high risk area for MS, and stands against a latitude gradient in this country.