ABSTRACT
Objective All news reports (NR) that were related to public health emergency (PHE) were collected from the Southern Metropolis Daily (SMD) to explore the characteristics of epidemiology in the fields.Methods Based on the theory of communication that including both case and text analysis,qualitative analysis on all the NR regarding PHE published in SMD from the years of 2008 to 2012,was carried out and input to database using the EpiData.Numbers of articles as indicators were compared to show the yearly change of different types of events.Various features of the NR including coverage,source of information,location of the incident,style and size of news,with or without editorials etc.were statistically analyzed by SPSS version 18.0.Results Among all the 998 reports related to PHE,higher proportion was found in the events of Infectious diseases (35.3％)and food safety (34.1％) respectively.Events on vaccines and drugs used for disease prevention and control (8.9％),environmental pollution caused incidents (8.0％) appeared to be less frequent.Events related to occupational disease,poisoning,bioterrorism and biochemical events were rare.Looking at the monthly distribution of reports,we noticed that the peaks occurred in 2008 and in 2009,which were caused by the Melamine-contamination events and the 2009 H1N1 pandemic.Between 2010 and 2012,figures of monthly reports were smooth,including some critical events from the interests of the media.Most events took place in Guangdong province (34.3％) and other provinces (50.9％),with some were from Hong Kong,Macao and Taiwan regions (9.5％).However,international events (5.2％) were less seen.Extensive coverage accounted for 17.6％ of all of reports,and 11.5％ allotted the editorials or other forms of in-depth reports.Most of the source of reports on infectious diseases and food safety were from the official release,however.The main sources of occupational diseases and poisoning,vaccines and drug incidents,environmental pollution related incidents were reported by active journalists through interview.Reports on hand,foot and mouth disease,influenza,milk safety,AIDS and lead pollution showed continued concern in the past five years by SMD.Conclusion NR on public health emergencies by SM had encompassed all 10 categories-related events formulated by the Ministry of Health.Sustained and in-depth coverage were more commonly seen.Fieldepidemiologists should learn interdisciplinary sciences on the theory and methodology of communication.They also need to interact with media people during the whole processes of public health emergency preparedness and responses.
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Objective Both epidemiologic characteristics and transmission mode of a varicella outbreak among schoolchildren in Shenzhen city were studied and related control measures were discussed.Methods Case definition was established.Case-finding and face-to-face investigation were conducted,followed by analysis on distributions of time,place and persons of the outbreak.Association between possible modes of transmission and the outbreak was explored.Retrospective cohort study was carried out.Results The overall attack rate of this outbreak was 4.4％ (122 of 2742).The attack rate among primary schoolchildren (8.3％,118/1419) was higher than that in the middle-school children (0.3％,4/1323).There were no statistically significant differences on the attack rates between male and female students.A total of 22 classes from the 9 grades were affected by this outbreak and the aggregation of varicella cases was found in classes.The highest attack rates was found in the students of fifth grade (23.7％),followed by from the third grade (13.4％).The main transmission mode appeared to be close personal contact.The outbreak,with four peaks of incidence,lasted 72 days.Data from the investigation suggested that the primary case was introduced into the school during military training involved by the students.Activities related to physical examination for all the schoolchildren seemed to have contributed to the spread of this disease among classes.Delayed isolation of cases appeared to be the major factor causing the spread of disease among classes.Intensive off-school activities or free community bus for children did not seem to be associated with the spreading of the disease.52.5％ (64/122) of the cases had received one-dose of varicella vaccine,with the median of onset after the vaccination as 7 years.The results demonstrated that one single-dose vaccine or long vaccination period were factors related to the insufficient immunity that causing the outbreak of disease.Conclusion Varicella outbreak has been one of the most grievous public health problems in schools,posting challenges on the implementation of isolation measures,in particular.Once the chain of transmission is in place,it is difficult to make the universal measures effective within a short period.
ABSTRACT
Objective To estimate the intangible cost and associated factors on patients with hepatitis B-related diseases, so as to explore the differences of the three elicitation techniques on the health economics-related information by trained investigators, using a structured questionnaire. WTP was employed to estimate the intangible cost while an open-ended question format, together with iterative bidding game and payment card were respectively used to elicit WTP for the hypothetical cure of hepatitis B-related diseases. A Multiple linear stepwise regression model was determined to identify those factors potentially affecting the intangible cost. Results A total of 564 subjects from 641 patients with hepatitis B-related diseases were identified for the inclusion of this study. The average annual intangible cost of patient with hepatitis B-related diseases was 54 320.4 Yuan (Ren Minbi).The intangible cost accounted for 53.0% of the total cost, which was much more than the proportions of the direct and indirect costs (38.5% and 8.5%, respectively). Among annual personal and the household income of the patient, proportions of intangible cost were 262.6% and 67.6% respectively,suggesting that the patients were under huge spiritual and psychological pressure. Response rate of the approach, combined open-ended questions with iterative bidding game, was the highest (76.6%) among the three elicitation formats. Considered the characteristics of data being gathered, the approach seemed to be more reasonable. Further studies were needed to examine the results yielded from other WTP elicitation formats. We also noticed that the progression of disease was associated with the increase of direct and indirect costs, but not with the intangible cost. Data from the multiple linear stepwise regression analysis indicated that the types of hospital and commercial medical insurance were significantly different in explaining the variation of the intangible cost. Conclusion Measures should be taken to reduce the intangible cost of hepatitis B-related diseases. The approach regarding the combination of open-ended questions with iterative bidding game should be recommended when carrying our further WTP studies of this kind.
ABSTRACT
Objective To investigate the direct, indirect and intangible costs due to hepatitis B-related diseases and to explore main factors associated with the costs in Shenzhen. Methods Cluster sampling for cases collected consecutively during the study period was administrated. Subjects were selected fiom eligible hepatitis B-related patients. By pre-trained professional investigators,health economics-related information was collected, using a structured questionnaire. Hospitalization expenses were obtained through hospital records after the patients were discharged from hospital.Total economic burden of hepatitis B-related patients would involve direct, indirect and intangible costs. Direct costs were further divided into direct medical costs and direct nonmedical costs. Human Capital Approach was employed to measure the indirect costs both on patients and the caregivers in 1-year time span. Willing to pay method was used to estimate the intangible costs. Multiple linear stepwise regression models were conducted to determine the factors linked to the economic burden.Results On average, the total annual cost of per patient with hepatitis B-related diseases was 81 590.23 RMB Yuan. Among which, direct, indirect and intangible costs were 30 914.79 Yuan (account for 37.9% ), 15 258.01 Yuan (18.7% ), 35 417.43 Yuan (43.4%), respectively. The total annual costs per patient for hepatocellular carcinoma, severe hepatitis B, decompensated cirrhosis,compensated cirrhosis, chronic hepatitis B and acute hepatitis B were 194 858.40 Yuan, 144 549.20 Yuan, 120 333.60 Yuan, 79 528.81 Yuan, 66 282.46 Yuan and 39 286.81 Yuan, respectively. The ratio of direct to indirect costs based on the base-case estimation foot add to 2.0∶1, increased from hepato-eellular carcinoma (0.7∶1)to compensated cirrhosis (3.5∶ 1 ), followed by acute hepatitis B (3.3∶1 ), severe hepatitis B (2.8∶1 ), decompensate cirrhosis (2.3:1)and chronic hepatitis B(2.2∶1 ).Direct medical costs were more than direct nonmedical. Ratio between the sum total was 16∶1. The proportions of total annual cost per patient with hepatitis B-related diseases accounted for annual patient income were 285.3%, and 75.4% for annual household income. Furthermore, proportions of direct costs accounted for annual patient income and annual household income were 108.1% and 28.6%. The total annual indirect cost per person was 8123.38 Yuan for patients of all hepatitis B-related diseases, while 7134.63 Yuan for caregivers. Corresponding work-loss days were 55.74 days for patients and 19.83 days for caregivers. Based on multiple linear stepwise regression analysis, age of patients was a common influencing factor to all kinds of costs. Other factors were as follows:complicated with other diseases, antiviral medication, monthly household income and selfmedications. Conclusion The economic burden of hepatitis B-related diseases was substantial for patients and their families. All costs tended to increase with the severity of disease. The direct costs were larger than the indirect costs. And the direct medical costs were more than the direct ones.Indirect costs based on patients were larger than the ones of caregivers.