Estimating and Characterizing COVID-19 Deaths,Puerto Rico,March–July 2020

ObjectivesUsing the Council of State and Territorial Epidemiologists (CSTE) classification guidelines, we characterized coronavirus disease 2019 (COVID-19)–associated confirmed and probable deaths in Puerto Rico during March–July 2020. We also estimated the total number of possible deaths due to COVID-19 in Puerto Rico during the same period.MethodsWe described data on COVID-19–associated mortality, in which the lower bound was the sum of confirmed and probable COVID-19 deaths and the upper bound was excess mortality, estimated as the difference between observed deaths and average expected deaths. We obtained data from the Puerto Rico Department of Health COVID-19 Mortality Surveillance System, the Centers for Disease Control and Prevention’s National Electronic Disease Surveillance System Base System, and the National Center for Health Statistics.ResultsDuring March–July 2020, 225 COVID-19–associated deaths were identified in Puerto Rico (119 confirmed deaths and 106 probable deaths). The median age of decedents was 73 (interquartile range, 59-83); 60 (26.7%) deaths occurred in the Metropolitana region, and 140 (62.2%) deaths occurred among men. Of the 225 decedents, 180 (83.6%) had been hospitalized and 93 (41.3%) had required mechanical ventilation. Influenza and pneumonia (48.0%), sepsis (28.9%), and respiratory failure (27.1%) were the most common conditions contributing to COVID-19 deaths based on death certificates. Based on excess mortality calculations, as many as 638 COVID-19–associated deaths could have occurred during the study period, up to 413 more COVID-19–associated deaths than originally reported.ConclusionsIncluding probable deaths per the CSTE guidelines and monitoring all-cause excess mortality can lead to a better estimation of COVID-19–associated deaths and serve as a model to enhance mortality surveillance in other US jurisdictions.     

2004-2018年中国老年居民慢性非传染性疾病死亡水平与变化趋势

目的分析2004-2018年中国≥65岁老年居民慢性非传染性疾病(慢性病)死亡水平及变化趋势,预测2019-2023年慢性病年龄标化死亡率。方法利用2004-2018年中国死因监测数据集中老年居民死亡数据,分析不同性别、城乡、地区的慢性病粗死亡率、年龄标化死亡率、构成比及变化趋势。采用2010年第六次全国人口普查的人口构成计算年龄标化死亡率;采用加权最小二乘法拟合Joinpoint回归模型,计算全时间段内平均年度变化百分比(AAPC)及95%可信区间;采用对数线性模型预测年龄标化死亡率。结果2004-2018年我国老年居民慢性病年龄标化死亡率从4697.05/10万降至3555.35/10万,平均每年下降2.0%(95%CI:-2.7%~-1.3%)。不同性别、城乡、地区间年龄标化死亡率呈下降趋势。东部地区(AAPC=-2.1%,95%CI:-2.8%~-1.3%)、中部地区(AAPC=-2.8%,95%CI:-3.4%~-2.1%)下降速度均快于西部地区(AAPC=-0.8%,95%CI:-1.8%~0.2%)。慢性病死亡构成比从89.82%上升至91.41%,平均每年上升0.1%(95%CI:0.1%~0.2%)。预计至2023年,男性年龄标化死亡率(3906.23/10万)仍高于女性(2708.43/10万);农村年龄标化死亡率(3283.20/10万)与城市(3250.01/10万)相接近;西部地区(3782.48/10万)与东部地区(3037.01/10万)、中部地区(3249.24/10万)的年龄标化死亡率的差距将进一步拉大。结论2004-2018年我国老年居民慢性病年龄标化死亡率呈下降趋势,死亡构成比呈上升趋势,建议以老年人群中男性居民和西部地区居民作为今后慢病防控关注的重点人群。     

Efficacy of m-Health for the detection of adverse events following immunization – The stimulated telephone assisted rapid safety surveillance (STARSS) randomised control trial

IntroductionPassive surveillance is recommended globally for the detection of adverse events following immunisation (AEFI) but this has significant challenges. Use of Mobile health for vaccine safety surveillance enables a consumer-centred approach to reporting. The Stimulated Telephone Assisted Rapid Safety Surveillance (STARSS) a randomised control trial (RCT) sought to evaluate the efficacy and acceptability of SMS for AEFI surveillance.MethodsMulti-centre RCT, participants were adult vaccinees or parents of children receiving any vaccine at a trial site. At enrolment randomisation occurred to one of two SMS groups or a control group. Prompts on days 2, 7 and 14 post-immunisation, were sent to the SMS group, to ascertain if a medical event following immunisation (MEFI) had occurred. No SMS’s were sent to the control participants. Those in the SMS who notified an MEFI were pre-randomised to complete a computer assisted telephone interview or a web based report to determine if an AEFI had occurred whilst an AEFI in the controls was determined by a search for passive reports. The primary outcome was the AEFI detection rate in the SMS group compared to controls.ResultsWe enrolled 6,338 participants, who were equally distributed across groups and who received 11,675 vaccines. The SMS group (4,225) received 12,675 surveillance prompts with 9.8% being non-compliant and not responding. In those that responded 90% indicated that no MEFI had been experienced and 184 had a verified AEFI. 6 control subjects had a reported AEFI. The AEFI detection rate was 13 fold greater in the SMS group when compared with controls (4.3 vs 0.3%).ConclusionWe have demonstrated that the STARSS methodology improves AEFI detection. Our findings should inform the wider use of SMS-based surveillance which is particularly relevant since establishing robust and novel pharmacovigilance systems is critical to monitoring novel vaccines which includes potential COVID vaccines.     

2015—2019年四川省流感哨点监测结果分析

目的 描述四川省2015—2019年流感病毒流行特征,为疫情防控提供依据。方法 对流感监测系统上报的流感样病例数据开展回顾性流行病学分析。结果 2015—2019年间,四川省共监测流感样病例标本131 477份,其中阳性标本23 844份,流感阳性率为18.14%。2015—2019年四川省优势流感亚型主要为甲型H1N1,季节性H3N2和B(Victoria)系流感。流感阳性率随月份、季节而改变,四川省流感阳性率高峰主要出现在冬季,其次为秋季。甲型流感主要在秋冬季流行,乙型流感主要在冬春季流行。流感病毒阳性检出率在5～14岁组年龄段最高。结论 四川省流感有明显的冬季流行高峰,各型别呈交替流行。秋冬季应加强流感防控工作;甲型和乙型流感好发于5～14岁群体,应继续加强对儿童学生流感的防控。     

2019年内蒙古包头市细菌耐药监测

目的 监测2019年包头市11所三级医院所有临床分离菌株的构成及对常用抗菌药物的耐药情况,为临床科室选择抗菌药物提供可靠依据。方法 对上述医院的临床分离菌采用纸片扩散法（KB法）或全自动药敏仪法进行药敏试验,按CLSI 2018年版 M - 100标准判读药敏结果,采用WHONET 2019软件进行数据分析。结果 2019年共收集上述医院非重复临床分离菌8 430株,其中革兰阳性菌2 278株,占比27.0%,革兰阴性菌6 152株,占比73.0%。葡萄球菌属中耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）和耐甲氧西林金黄色葡萄球菌 (MRSA）检出率分别为65.5%和12.8%,未检出利奈唑胺、万古霉素和替考拉宁耐药菌株。粪肠球菌（EFA）对多数抗菌药物的耐药率均低于屎肠球菌（EFM）,EFA中检出2株利奈唑胺耐药菌株,EFM中检出1株替考拉宁耐药菌株、2株万古霉素耐药菌株。产超广谱β- 内酰胺酶（ESBLs）大肠埃希菌（ECO）和ESBLs（+）克雷伯菌属菌株的检出率分别为46.0%和16.8%。耐碳青霉烯大肠埃希菌（CREC）和耐碳青霉烯肺炎克雷伯菌（CRKP） 的检出率分别为0.5%和1.1%,CREC对左旋氧氟沙星的耐药率为100%,远高于CRKP的29.4%。结论 本地区ECO对喹诺酮类抗菌药物耐药率较高,应继续做好耐药监测工作,加强抗菌药物的合理使用,预防耐药菌的产生与传播。     

基于创新的四维密码方法分析共调控与蛋白互作关系

【摘要】目的 基于创新的四维密码子的方法挖掘共调控且互作的基因对，研究共调控与蛋白互作之间的关联趋势。方法 我们提出了创新的基于四维密码子的关联分析方法，并把此方法应用于与结肠癌相关的2000个疾病基因。结果 发现共调控的互作蛋白对比随机情况下显著；随着共调控强度的增强，蛋白间互作趋势越来越明显。结论 基于创新的四维密码子的关联分析方法，能够研究共调控与蛋白互作的关联趋势。     

Drug use in pregnancy: an overview of epidemiological (drug utilization) studies

Summary The need for further information on drug utilization patterns during pregnancy in different countries was assessed by reviewing literature obtained by hand and computer searches for the years 1960–1988.The 13 identified studies showed that pregnant women used an average of 4.7 drugs. The most commonly ingested medications were vitamins and iron preparations (almost all women), analgesics, antiemetics and antacids.However, the important variables taken into account differently in each study, such as date of surveillance, country, size of population, personal habits, and physiopathological and demographic characteristics, may it impossible to construct a comprehensive, detailed, up-to-date picture of drug utilization during pregnancy.The evaluation confirmed the need for systematic permanent surveillance of drug utilization in pregnancy, so as to avoid the use of data based on widely differing contexts, times and methods, in a field where knowledge is often derived from scanty information.This study was supported in part by the National Research Council (CNR, Rome, Italy), Convenzione Farmacologia Clinica     

发展家庭医学之必然趋势

发展全科医学的必要性已逐渐为社会所共识,从家庭的特性和时代的要求两个方面阐述了发展家庭医学的必然趋势。     

北海市医疗卫生机构消毒质量动态分析

本文对广西北海市医疗卫生机构1995～1999年消毒监测资料进行了系统的统计分析。结果表明:①5年间北海市医疗卫生机构的消毒总合格率为81.05％;②市直医疗卫生机构的消毒合格率明显高于个体诊所等其它类别医疗机构的。本文还就如何加强对医疗卫生机构的消毒监测管理工作提出了合理性的建议。