城乡高血压老年人生理及心理健康水平

目的 对比云南省昆明市城市和农村地区老年人高血压患病现状及其影响因素,为有针对性地制定城乡两地老年人高血压的防控措施提供参考依据。 方法 于2016年7月 — 2017年10月采用多阶段分层随机抽样方法在昆明市官渡区和宜良县抽取3 225名 ≥ 60岁城乡老年人进行问卷调查和体格检查。 结果 昆明市3 225名≥ 60岁城乡老年人中,城市老年人1 624人,农村老年人1 601人;城市和农村老年人高血压患病率分别为40.9 %和43.5 %,标化患病率分别为41.3 %和43.2 %,昆明市城乡老年人高血压患病率差异无统计学意义（P > 0.05）;多因素非条件logistic回归分析结果显示,饮酒和超重/肥胖是昆明市城市老年人高血压患病的危险因素;年龄 ≥ 75岁、缺乏体力活动、超重/肥胖和中心性肥胖是昆明市农村老年人高血压患病的危险因素,吸烟是昆明市农村老年人高血压患病的保护因素。 结论 昆明市城市和农村老年人高血压患病率差异不大,但影响因素存在着明显的城乡差异,应根据城乡老年人高血压的不同影响因素,制定有针对性的高血压预防控制措施。     

Comparative academic performance of medical students in rural and urban clinical settings

OBJECTIVE: To determine whether the academic performance of medical students learning in rural settings differs from those learning in urban settings. DESIGN: Comparison of results of assessment for 2 full cohorts and 1 part cohort of medical students learning in rural and urban settings in 2002 (209 students), 2003 (226 students) and 2004 (220 students), including results for each specialist rotation in the 3rd year and end-of-year examinations in the 2nd and 4th years. SETTING: University of Queensland School of Medicine, Brisbane. Students spent the whole 3rd year (of a 4-year graduate entry programme) conducting 5 specialist 8-week rotations in either the rural clinical division (rural students) or in Brisbane (urban students), all following the same curriculum and taking the same examinations. RESULTS: For the 2002 cohort there were no statistically significant differences in academic performance between rural and urban students. For the 2003 cohort the only significant difference was a higher score for rural students in the end of the 4th-year clinical skills examination (65.7 versus 62.3%, P = 0.025). For the 2004 cohort, rural students scored higher in the 3rd-year mental health rotation (79.3 versus 76.2%, P = 0.038) and lower in the medicine rotation (65.5 versus 68.6%, P = 0.037). CONCLUSION: Academic performance among students studying in rural and urban settings is comparable.     

Seasonal variation in the association between household food insecurity and child undernutrition in Bangladesh: Mediating role of child dietary diversity

Household food insecurity (HFI) and child dietary diversity (CDD) are variable across seasons. We examined seasonal variation in HFI and child undernutrition association and tested how CDD mediates this association. We analyzed data for 26,353 children aged 6–59 months drawn from nationally representative cross-sectional Food Security and Nutrition Surveillance Project data collected during 2012–2014 in Bangladesh across three seasons annually: Post-Aman harvest (January–April); Monsoon (May–August); and Post-Aus harvest (September–December). Multivariable logistic regression analysis adjusted for individual, maternal, household and geographical characteristics reveals that children of food-insecure households were more likely than food-secure households to be stunted (adjusted odds ratio, AOR: 1.12; 95% confidence interval, CI: 1.02–1.23; p < 0.05), wasted (AOR: 1.21; 95% CI: 1.05–1.39; p < 0.01) and underweight (AOR: 1.16; 95% CI: 1.04–1.3; p < 0.01). CDD mediated 6.1% of the total effect of HFI on underweight. These findings varied across seasons. HFI was associated with greater odds of underweight during Monsoon (AOR: 1.32; 95% CI: 1.08–1.62; p < 0.01) and Post-Aus (AOR: 1.21; 95% CI: 1.06–1.37; p < 0.01) while wasting during Post-Aus (AOR: 1.65; 95% CI: 1.35–2.01; p < 0.001). CDD largely mediated the total effect of HFI on underweight during the Post-Aman in 2012–2014 (23.2%). CDD largely mediated the total effect of HFI on wasting (39.7%) during Post-Aman season in 2014 and on underweight (13.7%) during the same season in 2012. These findings demonstrate that HFI is seasonally associated with child undernutrition and mediated by CDD as well in Bangladesh and seasonality and diversity should be considered while designing appropriate population-level food-based interventions to resolve child undernutrition.     

Consumption of animal source foods,especially fish,is associated with better nutritional status among women of reproductive age in rural Bangladesh

In rural Bangladesh, intake of nutrient-rich foods, such as animal source foods (ASFs), is generally suboptimal. Diets low in nutrients and lacking in diversity put women of reproductive age (WRA) at risk of malnutrition as well as adverse birth outcomes. The objective of this study was to assess the relationship between maternal dietary diversity, consumption of specific food groups and markers of nutritional status, including underweight [body mass index (BMI) < 18.5 kg/m²], overweight (BMI ≥ 23 kg/m²) and anaemia (haemoglobin < 120 g/dl) among WRA in Bangladesh. This analysis used data from the third round of a longitudinal observational study, collected from February through May of 2017. Dietary data were collected with a questionnaire, and Women's Dietary Diversity Score (WDDS) was calculated. Associations between WDDS, food group consumption and markers of nutritional status were assessed with separate adjusted logistic regression models. Among WRA, the prevalence of underweight, overweight and anaemia was 13.38%, 40.94% and 39.99%, respectively. Women who consumed dark green leafy vegetables (DGLV) or eggs were less likely to be anaemic or underweight, respectively, and women who consumed ASFs, particularly fish, were less likely to be underweight compared with women who did not consume these foods. WDDS did not show any consistent relationship with WRA outcomes. Interventions that focus on promoting optimal nutritional status among WRA in Bangladesh should emphasise increasing consumption of specific nutrient-rich foods, including ASFs, DGLV and eggs, rather than solely focusing on improving diet diversity in general.     

基于ARIMA-GRNN组合模型预测医保补偿住院费用

目的 探讨ARIMA-GRNN组合模型在城乡居民基本医疗保险的医保补偿住院费用预测中的应用,比较它与ARIMA模型预测的效果。方法 收集2016年1月至2020年12月河南某市城乡居民基本医疗保险的住院补偿费用,使用Matlab R2016a建立ARIMA-GRNN组合模型,使用R 4.0.3建立ARIMA模型,用2020年5月至12月的数据对两模型的预测效果做评价。结果 ARIMA(0,1,1)(1,0,0)12模型相对最优,其拟合部分的MAE、MAPE、RMSE分别为3998.4、10.9%、5642.9,预测部分的MAE、MAPE、RMSE分别为6521.9、16.5%、6675.8。ARIMA-GRNN模型最优光滑因子为0.166,其拟合部分的MAE、MAPE、RMSE分别为4044.5、11.1%、5622.0,预测部分的MAE、MAPE、RMSE分别为5831.8、14.8%、6013.7。结论 ARIMA-GRNN组合模型预测效果比单纯ARIMA模型好,可短期预测医保补偿住院费用。     

Smokeless tobacco consumption and stillbirth: Population‐based case–control study in rural Bangladesh

Introduction and Aims. To investigate the association between smokeless tobacco consumption (STC) during pregnancy and risk of stillbirth. Design and Methods. We conducted a population‐based case–control study of 253 cases and 759 randomly selected control women in Madaripur, Bangladesh. We conducted a survey of two rural local government areas, including 8082 women, and identified cases based on self‐report of a stillbirth outcome of each participant's first pregnancy. All were asked about STC during their first pregnancy and a range of risk markers and known confounders. Demographic and maternal variables associated either with stillbirth or STC were included in logistic regression models. Results. Of the 241 cases and 757 controls with complete exposure data, 32 cases (13.2%) and 18 controls (2.4%) reported STC during pregnancy [odds ratio 6.28; 95% confidence interval (CI) 3.45, 11.4]. After adjustment for education, household income, age at first pregnancy, vaccination during pregnancy, complications, exposure to arsenic in drinking water, place of delivery and antenatal care, excess risk was attenuated but remained significant [adjusted odds ratio (aOR) 2.87; 95% CI 1.36, 6.08]. There was a dose–effect association, with women who used smokeless tobacco >5 times daily during their first pregnancy at greater risk of having a stillbirth (aOR 5.89; 95% CI 1.70, 20.3) than less frequent users (aOR 1.67; 95% CI 0.65, 4.29). Estimates were robust to extreme assumptions about missing exposure data. Discussion and Conclusions. STC during pregnancy was associated with an increased risk of stillbirth. This finding adds to the urgency of need for smokeless tobacco control strategies to be implemented in South Asia. [Hossain MS, Kypri K, Rahman B,Milton AH. Smokeless tobacco consumption and stillbirth: Population‐based case–control study in rural Bangladesh.     

Impact of national introduction of ten-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in Bangladesh: Case-control and time-trend studies

BackgroundBangladesh introduced the ten-valent pneumococcal conjugate vaccine (PCV10) into its national immunization program in March 2015 creating an opportunity to assess the real-world impact of PCV on invasive pneumococcal disease (IPD).MethodsBetween January 2014 and June 2018, children aged 3–35 months in three rural sub-districts of Sylhet district of Bangladesh were visited every two months to collect morbidity and care-seeking data. Children attending sub-district hospitals with pneumonia, meningitis, or sepsis were assessed for IPD after obtaining informed consent. Blood and cerebrospinal fluid were collected from enrolled children to isolate pneumococcus using culture and molecular test. Children who were age-eligible to receive the PCV and had pneumococcus isolated were enrolled as cases. Four age and sex-matched clinic and community controls were selected for each case within one to two weeks of case identification. Data on immunization status and confounders were collected. PCV coverage was estimated using vaccine coverage surveys. Case-control and incidence trend analyses were conducted to assess the impact of PCV on IPD.ResultsThe community cohort yielded 217,605 child years of observations and 154,773 sick child-visits to study hospitals. Pneumococcus was isolated from 44 children who were age-eligible to receive PCV; these children were enrolled as cases. The cases were matched with 166 community- and 150 clinic-controls. The matched case-control analyses using community-controls showed 83% effectiveness (95% CI: 1.57–97.1%) and clinic controls showed 90% effectiveness (95% CI: −26.0% to 99.1%) of PCV in preventing IPD. Incidence trend analysis estimated vaccine effectiveness at 80.1% (95% CI: 38.4, 93.6).ConclusionPCV in this pediatric population in Bangladesh was highly effective in preventing IPD.     

云南城乡居民营养素摄入状况及膳食结构分析

目的 分析云南城乡居民营养素摄入状况及膳食结构,为制定营养改善策略提供依据。方法 分析2010-2012年云南省6个"中国居民营养与健康状况监测"监测点1024户共1989人的膳食调查数据。结果 居民每标准人日能量和蛋白质摄入量分别为9425.6 kJ和67.9 g,达推荐摄入量(RNI)的93.8%和90.5%,食物能量和蛋白质供给基本充足;维生素A、B1、B2、C及钙摄入不足,分别为381.2μg视黄醇当量、1.0、0.7、79.0和270.7 mg,仅及适宜摄入量(AI)的47.7%、71.4%、50.0%、79.0%和33.8%;居民每标准人日谷薯类、肉类及油脂类食物消费分别为505.5 g、116.3 g、40.3 g,已超过膳食指南推荐量,而蔬菜、水果、豆类、蛋类、水产品及乳类消费量偏低,仅为241.6、44.6、17.8、14.7、10.0和12.3 g;大城市、中小城市、普通农村和贫困农村脂肪供能比分别为36.0%、28.0%、25.0%和21.0%,城市居民已面临脂肪摄入过剩风险;9类食物多样化评分(DDS)分别为大城市6.4分、中小城市5.7分、普通农村5.4分、贫困农村5.0分,居民膳食多样化程度存在明显的城乡差异;结论云南城乡居民存在微量营养素摄入不足和膳食结构失衡的问题,应进一步加强营养宣教和干预工作。     

Cost and sustainability of a successful package of interventions to improve vaccination coverage for children in urban slums of Bangladesh

Objective

To estimate the incremental economic costs and explore satisfaction with a highly effective intervention for improving immunization coverage among slum populations in Dhaka, Bangladesh. A package of interventions based on extended clinic hours, vaccinator training, active surveillance, and community participation was piloted in two slum areas of Dhaka, and resulted in an increase in valid fully immunized children (FIC) from 43% pre-intervention to 99% post-intervention.

Methods

Cost data and stakeholder perspectives were collected January–February 2010 via document review and 10 key stakeholders interviews to estimate the financial and opportunity costs of the intervention, including uncompensated time, training and supervision costs.

Results

The total economic cost of the 1-year intervention was $18,300, comprised of external management and supervision (73%), training (11%), coordination costs (1%), uncompensated staff time and clinic costs (2%), and communications, supplies and other costs (13%). An estimated 874 additional children were correctly and fully immunized due to the intervention, at an average cost of $20.95 per valid FIC. Key stakeholders ranked extended clinic hours and vaccinator training as the most important components of the intervention. External supervision was viewed as the most important factor for the intervention's success but also the costliest. All stakeholders would like to reinstate the intervention because it was effective, but additional funding would be needed to make the intervention sustainable.

Conclusion

Targeting slum populations with an intensive immunization intervention was highly effective but would nearly triple the amount spent on immunization per FIC in slum areas. Those committed to increasing vaccination coverage for hard-to-reach children need to be prepared for substantially higher costs to achieve results.     

‘The clock keeps ticking’ – the role of a community-based intervention in reducing delays in seeking emergency obstetric care in rural Bangladesh: a quasi-experimental study

Objective

To explore the role of a community-based intervention in reducing delays in accessing emergency obstetric care (EmOC) in rural Bangladesh, and the factors associated with delayed decision making, reaching the health facility and receiving treatment.

Study design

Quasi-experimental study.

Methods

Multistage random sampling was used to select 540 villages, from which 1200 women who reported obstetric complications in March–April 2010 were interviewed.

Results

The median time taken to make the decision to access health care was significantly lower in the intervention areas compared with the control areas (80 vs 90 min). In addition, the median time taken to reach the health facility was significantly lower in the intervention areas compared with the control areas (110 vs 135 min). However, no difference was found in the median time taken to receive treatment. Multiple linear regressions demonstrated that the community intervention significantly reduced decision making and time taken to reach the health facility when accessing EmOC in rural Bangladesh. However, for women experiencing haemorrhage, the delays were longer in the intervention areas. Protective factors against delayed decision making included access to television, previous medical exposure, knowledge, life-threatening complications during childbirth and use of a primary health facility. Financial constraints and traditional perceptions were associated with delayed decision making. Complications during labour, use of a motorized vehicle and use of a primary health facility were associated with faster access to EmOC, and poverty, distance, transportation difficulties and decision made by male guardian were associated with slower access to EmOC.

Conclusions

The intervention appeared to reduce the time taken to make the decision to access health care and the time taken to reach the health facility when accessing EmOC. This study provides support for a focus on emergency preparedness for timely referral from the community.