Study on the determinants regarding malaria epidemics in Anhui province during 2004-2006 / 中华流行病学杂志

Objective To analyze the determinants of malaria in Anhui province during the year of 2004-2006.Methods A GIS-based database of malaria at the township scale of Anhui province was established,using remote sensing and spatial analysis technologies.Methods on statistical analysis,principal component analysis combined with logistic regression analysis were synthetically used to analyze the association between malaria and environmental factors.Results Malaria epidemics in Anhui province during 2004-2006 mainly occurred in the northern districts of Huai River,and the epidemics had become more serious yearly.The determinants of malaria at the township scale mainly included factors as temperature,rainfall,normalized difference vegetable index and elevation.If the lowest temperature in a year,which appeared the fourth principal component of the temperature index series,increased by one unit,the probability of incidence of malaria would decrease by 33%.If the total annual rainfall,which was the first principal component of the rainfall index series,increased by one unit,the probability would decrease by 27%.If the elevation increased by 10 meters,the probability would decrease by 2%.However,the relationship between Normalized Difference Vegetable Index (NDVI) and the probability of incidence of malaria was different.If the NDVI had a one unit increase,the probability would increase 3.28 times.Conclusion The northern districts of Huai River during 2004-2006 appeared to be a new spatio-temporal cluster when reemergence of malaria epidemics had occurred in Auhui province since 2000.Terrain and physiognomy,nature and circumstances factors,such as temperature and rainfall had affected the incidence rates of malaria.Our research data from Auhui province would provide some important references to the discovery of main reasons on the reemergence of malaria epidemics since 2000,especially in the central geographic areas of China.

Cause-excluded health adjusted life expectancy: a new indicator in measuring the burden of diseases / 中华预防医学杂志

Based on the integration of concept and methods of cause-eliminated life expectancy (CELE), health-adjusted life expectancy (HALE) and disability-adjusted life year (DALY), a new index named cause-excluded health adjusted life expectancy (CEHALE) was developed in this study to evaluate the health impact(both fetal and non-fetal) of single disease. In order to include the impact of both premature death and health problems among those who are alive, the concept of suppositional death was introduced to calculate CEHALE. Cause-excluded health adjusted life expectancy developed in this study, should be not only easy to understand in concept, but also has theoretical support and be not affected by age structure, and be more suitable to use in comparison among different diseases and different population. Moreover, the new index is easy to calculate. So, CEHALE should be an ideal index to evaluate the impact of disease to population health.

Identification and generalization of classes of public health laboratory detection activities / 中国医疗器械杂志

<p><b>OBJECTIVE</b>To identify and generalize classes of public health laboratory detection activities and to discuss the method of identification and generalization of classes of Public Health Conceptual Information Model.</p><p><b>METHODS</b>At first, materials should be collected from consulting literatures and experts, referring to the existing system. Then, identification and generalization of classes are got for business process analysis, writing description documents, summing up important conceptions and activities, By use-case analysis, use-case diagram and tabulation of important conception and activities and reference to PHCDM, a structural diagram of classes is constructed.</p><p><b>RESULTS</b>A structure diagram of classes of public health laboratory detection activity is given.</p><p><b>CONCLUSIONS</b>This is a feasible method in identification and generalization of classes of public health laboratory detection activities.</p>

Study on classification and coding for public health information / 中华预防医学杂志

<p><b>OBJECTIVE</b>To improve data unified descriptions, identification, query and management in public health service by means of establishing public health information classification framework and coding system.</p><p><b>METHODS</b>Data sets created from all fields in public health, scientific research, health management were classified into four layers of frameworks primary class, sub-class, main class and subject areas by means of integration of vertical with horizontal classifications. All these classes were further abstracted, merged and coded by individual characteristics in public health systems.</p><p><b>RESULTS</b>(1) 4 subject areas in diseases control and prevention, public health service, public health management and sanitation surveillance were established including a total of 18 main classes, 49 sub-classes and 205 primary classes. (2) 7 digits and 4 segments (area code, code, disease classification code) were designed including a total of 30 digits multi-classification codes. The purpose of data effectively classifying and coding by application of 50 basic data sets in 9 areas fo public health has been realized.</p><p><b>CONCLUSION</b>We believe that this method is of efficiency in data classification and code for public health information communication.</p>

The conceptual framework for decision making data elements in public health / 中华预防医学杂志

<p><b>OBJECTIVE</b>To develop a conceptual framework for decision-making data elements (indicator) in public health through determining its dimensions, sub-dimensions and their interrelationships.</p><p><b>METHODS</b>On the basis of literatures review, conceptual analysis and health determinant models, a conceptual framework was set up. This framework construction followed five principles: evidence-based, applicable, public health relevant, systemic and extensible. While, with the principles of conceptualization, objective-orientation, independence, and number-restriction, the domain and subdomains were also developed.</p><p><b>RESULTS</b>A conceptual framework consisting of five domains and 20 sub-domains was developed. The 5 domains were health status, non-medical health determinants, public health system performance, the resources of public health system, and characteristics of community and assurance system. The health outcome included three subdomains of health status, functional status, and death; Non-medicine health determinants domain consisted of health behavior, working and living conditions, personal resources and environmental factors; performance domain was made up of effectiveness, accessibility, efficiency, responsibility and safety; resources domain had institution resources, human resources, financial resources, equipment resources and information resources; The characteristics of community and assurance system domain was the last domain which comprises characteristics of community, public health related policy and assurance system. The complicated relationship between these domains was also described.</p><p><b>CONCLUSION</b>As the abstraction of public health system, this conceptual framework comprehensively depicts the components of public health system and complicated process of public health system. This framework conforms to the medical care quality model which is made up of structure, process, intermediate results and outcomes.</p>

Standardizing basic data set in public health information system / 中华预防医学杂志

<p><b>OBJECTIVES</b>To study methodologies and relevant data-element specifications for basic dataset development in China public health information system construction</p><p><b>METHODS</b>The goals and scopes were determined through data-viewing analysis, while the function model was developed through information viewing analysis. The components and the structure of the data sets were also identified to distill data elements.</p><p><b>RESULTS</b>50 basic datasets were developed and 1513 data elements were determined in 8 main domains and one public domain in China's public health information system. The 8 domains included Expanded Immunization Program (including 7 Basic Datasets and 326 data elements), Occupational Health and Poisoning (5 Basic Datasets and 158 data elements developed), Laboratory Management (9 Basic Datasets and 118 data elements included), Public Health Emergencies (including 3 Basic Datasets and 47 data elements), Infectious Disease Surveillance (4 Basic Datasets and 177 data elements developed), Non-Chronic Disease Surveillance (3 Basic Datasets and 64 data elements developed), Maternal and Child Health (totally 8 Basic Datasets and 368 data elements developed) and Environment Health (including 4 Basic Datasets and 72 data elements). One common domain consisted of 7 basic datasets and 183 data elements.</p><p><b>CONCLUSION</b>Standardizing basic datasets in public health information systems is an essential foundation in facilitating information system planning and the effective utilization of resources.</p>

Contribution of diabetes to the burden of diseases / 中华预防医学杂志

<p><b>OBJECTIVE</b>To overview the contribution of diabetes in the burden of diseases.</p><p><b>METHODS</b>Based on the data published by MOH, prevalence rate, mortality rate, cause eliminated life year were used to calculate the health burden of disease. Meanwhile, direct economic burden of diseases was presented.</p><p><b>RESULTS</b>According the calculation, about 23 million of people suffered from diabetes and 90,000 died from diabetes. The cause eliminated life year attributed to diabetes is different between urban and rural, 0.21 years for urban and 0.08 years for rural. Moreover, the direct economic burden reached 1.071 billion RMB, about 1.88% of national health expenditure at the same period.</p><p><b>CONCLUSION</b>The burden of diabetes, based on calculation of both health and economic burden, and will give a heavy pressure to the government and society.</p>

Epidemiologic characteristics of dyslipidemia in people aged 18 years and over in China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To study the difference in prevalence of dyslipidemia, hypercholesterolemia, hypertriglyceridemia and low blood high-density lipoprotein cholesterol (HDL-C) between the residents of urban and rural areas of varied regions in China.</p><p><b>METHODS</b>Fasting plasma levels of total cholesterol, triglyceride and HDL-C were determined with the enzyme methods for 49,252 subjects aged 18 and over during August to December, 2002.</p><p><b>RESULTS</b>Prevalence of dyslipidemia in Chinese adults aged 18 and over was 18.6%, with 17.0%, 22.9% and 23.4% in the groups of 18-44, 45-59 and over 60 years old, respectively, 22.2% and 15.9% in males and females, respectively, and 21.0% and 17.7% in urban and rural areas, respectively. Prevalence of hypercholesterolemia, hypertriglyceridemia and low blood HDL-C in those aged 18 and over was 2.9%, 11.9% and 7.4%, respectively.</p><p><b>CONCLUSIONS</b>Dyslipidemia has become one of important risk factors threatening health of Chinese people, with hypertriglyceridemia and low blood HDL-C as two major types in those aged 18 and over. Prevalence of dyslipidemia was nearly the same in the middle-aged and in the elderly people, and not significantly different in those living in urban areas from those in rural areas. It is very important to pay more attention to earlier comprehensive prevention and control of dyslipidemia.</p>

Study on the cost of expanded programme on immunization in areas with different economic levels / 中华流行病学杂志

<p><b>OBJECTIVE</b>The expanded programme on immunization (EPI) is an important part of the social commonwealth projects providing health care service by the government, which benefits communities. Government has the responsibility for EPI's financing which should be covered by the national budget. It is essential that the cost of EPI service be scientifically estimated to provide propriety information for policy makers.</p><p><b>METHODS</b>This study, using the cost accounting theory of health economics, to calculate EPI service cost at different levels. 3 provinces, 3 prefectures, 9 counties, 18 towns and 12 villages were selected from three provinces Guizhou, Heilongjiang and Zhejiang from the western, central and eastern regions of the country.</p><p><b>RESULTS</b>The average costs for one EPI-targeted child in Guizhou, Heilongjiang and Zhejiang, were 15.68 Yuan, 29.00 Yuan and 31.09 Yuan, and the costs for one dose were 10.99 Yuan, 18.64 Yuan and 16.51 Yuan, respectively. The costs for complete immunization program for one child were 131.88 Yuan, 242.32 Yuan and 280.67 Yuan, respectively. The main factors affecting the cost would include the average personnel cost (salary and benefit cost) by different economic levels of areas, the number of EPI items developed, and the number of total doses for one child.</p><p><b>CONCLUSION</b>(1) Obvious differences were found between different areas. (2) The proportion of the cost was not reasonably set because of the shortage of input. (3) Guideline for different areas to compensate the working item cost according to the number of the items should be formulated.</p>

SARS epidemic trends in Beijing since late April 2003 / 中国医学科学院学报

Since May 8th, Beijing's severe acute respiratory syndrome (SARS) epidemic is on a continuous decline. Indicating and verifying measures taken since the end of April to be effective. Three stages of SARS have been distinguished in Beijing since late April, they are described in this article as rapid growth stage beginning late April until early May, decline and stable stage throughout the first week of May, and rapid decline stage since May 9th until present. These three stages depict the effectiveness of interventive measures against SARS in Beijing since late April. Information transparency towards the public is an import part among all measures taken, enhancing public awareness and understanding of the current situation and government action as well as introduce public action. Public awareness is an important factor, forming active support for government interventions.

Interaction and its solution in individual matching case-control study / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To indicate the deficiency of the classical method for analyzing data on individual matching case-control study in consideration of the interaction between the study factor (exposure) and the matching factor, and to find out a proper method for handling this deficiency.</p><p><b>METHOD</b>First, experimental data with 50 pairs of cases and controls were used for strata analysis according to the values of a matching factor to illustrate the possible interaction between a risk factor (exposure) and the matching factor. Second, a detailed procedure was proposed for analyzing such data.</p><p><b>RESULTS</b>Interaction between the study factor and matching factor was demonstrated by using strata analysis and unconditional logistic regression analysis. Therefore the results from the classical analysis for such data might be incorrect.</p><p><b>CONCLUSION</b>Data from individual matching case-control study design should be dealt with strata analysis or multivariate analysis to explore and evaluate the possible interaction between the study factor and matching factor. The conclusion would be valid only after such analysis is conducted.</p>

Methodology for the assessment of burden of smear-positive pulmonary TB and its infectivity / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The study investigated the burden of smear-positive pulmonary TB and its infectivity using DALY (disability-adjusted life year) as an indicator.</p><p><b>METHODS</b>An assumed cohort of 2,000 cases was set up based on the age-specific incidence of 794 newly registered smear-positive cases in Beijing in 1994. Prognostic trees and model diagrams of infectivity under natural history and DOTS(directly observed treatment, short-course) strategy were established according to the epidemiological evidence.</p><p><b>RESULTS</b>The results showed that 29.6% of DALYs would be neglected if the burden caused by the infectivity was not considered.</p><p><b>CONCLUSION</b>DOTS strategy may reduce 97.3% of the number of potential cases infected, 92.9% of DALYs related to TB-patients themselves, and 99.9% of DALYs caused by TB's infectivity as well.</p>

Tuberculosis control priorities defined by using cost-effectiveness and burden of disease / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To define TB control priorities using cost-effectiveness and burden of disease.</p><p><b>METHODS</b>An assumed cohort of 2,000 cases was set up based on age-specific incidence of 794 newly registered smear-positive cases in Beijing in 1994. Prognostic trees and model diagrams of infectivity with natural history and DOTS intervention were constructed based on the epidemiological parameters.</p><p><b>RESULTS</b>DOTS reduced 89.19% of YLL, 78.90% of YLD, and 99.98% of infectivity BOD. One DALY could be saved with 45.70 Yuan by DOTS with 3% discount. Sensitivity analysis showed that discount had effect on CER. Weight of age was insensitive to CER. The higher the DOTS cured rate, the more the cost-effectiveness.</p><p><b>CONCLUSIONS</b>DOTS is a good cost-effectiveness TB control strategy. Cost-effectiveness and burden of disease can be used to define TB control priorities.</p>