2000～2002年湖南省出生缺陷动态分析

目的 动态分析湖南省出生缺陷的消长情况，弄清出生缺陷的发生和疾病种类的变化，为开展出生缺陷的预防和干预提供依据。方法 根据卫生部制定的《中国妇幼卫生监测方案》，采用以医院为基础的监测，对资料进行统计和分析。结果 三年共监测围生儿数94531例，出生缺陷儿980例，2000、2001、2002年出生缺陷发生率分别为98．31／万、91．77／万、120．23／万，出生缺陷发生率城市高于农村，主要出生缺陷为：总唇裂、多指(趾)、外耳畸形、脑积水、神经管缺陷、肢体短缩。结论 在我省神经管缺陷、脑积水、肢体短缩畸形、泌尿生殖道畸形呈上升趋势，孕早期增补叶酸和加强产前诊断，可以预防和减少出生缺陷的发生。     

北京市东城区围生儿出生缺陷监测研究

目的 了解北京市东城区围生儿出生缺陷发生的现况，为预防出生缺陷、提高出生人口素质提供科学依据。方法 以医院为基础，按北京市出生缺陷监测方法，对2001年至2003年在北京市东城区孕28周至产后7天新生儿进行出生缺陷及其相关因素监测。结果 ①3年监测28249例围生儿，出生缺陷平均发生率为15．89‰，2003年呈显著下降趋势；②城市人口平均出生缺陷发生率为17．09‰；③春季出生缺陷发生率均显著高于其它3个季节；④先天性心脏病、指趾四肢畸形始终处于第一、二位，神经管畸形已降至第五位；⑤出生缺陷产前诊断率为22．88％～28．85％，但不同出生缺陷病种的产前诊断率不同。结论 出生缺陷是当前围生儿死亡的首因，以先天性心脏病、指趾四肢畸形发生率最高，提高产前诊断水平，及早发现严重畸形儿并终止妊娠是降低围生儿死亡的有效途径。     

宝鸡市11年出生缺陷监测分析

目的了解宝鸡市出生缺陷发生率、顺位及流行病学特征，为制定干预措施提供可靠数据。方法按照国家出生缺陷监测方案，随机整群抽取8家医院，连续监测1996～2006年孕满28周～产后7天的围产儿。结果宝鸡市出生缺陷率从1996年的190．48／万下降到2006年的162．34／77。11年来，出生缺陷的主要顺位是神经管畸形、肢体畸形、面耳畸形和心血管畸形等。结论宝鸡市不同地区出生缺陷发生率有所不同，经干预后逐渐下降，且漏报率也随监测工作的进展逐渐降低。     

陕西省出生缺陷患病情況分析

目的 了解陕西省出生缺陷患病水平,为进一步探讨出生缺陷影响因素提供科学依据.方法 应用分层随机整群抽样方法,抽取陕西省9市12个区县共124个乡镇,对终止妊娠日期发生在2007年10月-2009年7月且孕满28周的13 273名妇女(其怀孕及生产均在调查点的常住人口)进行入户调查.结果 陕西省出生缺陷患病率为141.6/万;出生缺陷患病率前5位依次为皮肤系统畸形(43.7/万)、先天性心脏病(30.9/万)、中枢神经系统和神经管畸形(17.3/万)、单纯唇裂(3.8/万)、四肢畸形(3.8/万)、副耳畸形(3.8/万)、腹股沟疝(3.0/万)、脑瘫(3.0/万)、上眼睑下垂(3.0/万).结论 陕西省出生缺陷患病率高于中国妇幼卫生监测中心公布的2004年全国平均水平,与2000年比较出生缺陷顺位情况变化较大,其中皮肤系统畸形为首位,中枢神经系统和神经管畸形位居第3位.     

2000-2004年通州市围产儿出生缺陷监测资料分析

目的：对通州市出生缺陷监测资料进行分析，了解出生缺陷发生、分布及其影响因素，为制定和采取预防措施提供决策依据。方法：2000年1月1日-2004年12月31日，对通州市2所监测医院住院分娩孕满28周至出生后7天的围产儿、出生缺陷发生率、临床类型及死亡率进行监测。结果：在7328例围产儿中，共检出60例出生缺陷儿，出生缺陷发生率为8．19‰，出生缺陷儿死亡率为46．67％。出生缺陷中以唇腭裂居首。其次为神经管畸形。农村围产儿畸形率明显高于城市。结论：出生缺陷工作的重点在农村，应加强优生知识宣传，提高群众自身的保健意识，降低出生缺陷发生率，提高人口素质。     

2007—2011年东台市围产儿出生缺陷监测结果分析

目的分析东台市2007—2011年出生缺陷监测资料,为进一步降低出生缺陷发生率,探讨切实可行的干预措施提供依据。方法按照全国出生缺陷监测方案要求,对东台市2007—2011年29家监测医院住院分娩的围产儿进行监测。结果监测34 498例围产儿中,出生缺陷儿148例,出生缺陷发生率为4.29‰。5年出生缺陷率差异无统计学意义(P>0.05)。前5位出生缺陷依次为:肢体畸形、唇腭裂、泌尿生生殖道畸形、外耳畸形、神经管畸形。各年龄组产妇的围产儿出生缺陷发生率差异无统计学意义(P>0.05)。结论加强孕前孕早期保健知识宣传教育,开展产前筛查、产前诊断和新生儿疾病筛查工作,是预防和减少出生缺陷的关键措施。     

1998～2001年衡阳市出生缺陷监测分析

目的 探讨提高出生缺陷监测水平，降低出生缺陷发生率的有效措施。方法 对1998年1月～2001年12月间衡阳市23家出生缺陷监测医院的住院分娩中孕满28周，产后7d的围产儿进行监测分析。结果 围产儿中的出生缺陷发生率为57．0ll／万，围产儿死亡率为12．27‰，出生缺陷发生顺位以唇裂并腭裂为主，占13．55％，出生缺陷按系统分类肢体畸形居首，占26．37％。出生缺陷的发生率与出生年份、城乡分布、季节性、产母居住地、母亲年龄及婴儿性别等无关。出生缺陷儿的死亡率为417．58‰，是同期围产儿死亡的32．83倍，是非出生缺陷死亡率的40．15倍，死亡数占同期围产儿死亡数的18．72％。结论 我市出生缺陷监测的发生率较全国及全省有水平低。出生缺陷是导致围产儿死亡的重要因素。主要出生缺陷病种及出生缺陷系统分类是唇裂并腭裂和肢体畸形。加强监测队伍的建设，提高诊断技术水平，减少漏报。     

北京市东城区围生儿出生缺陷监测研究

目的了解北京市东城区围生儿出生缺陷发生的现况,为预防出生缺陷、提高出生人口素质提供科学依据。方法以医院为基础,按北京市出生缺陷监测方法,对2001年至2003年在北京市东城区孕28周至产后7天新生儿进行出生缺陷及其相关因素监测。结果①3年监测28249例围生儿,出生缺陷平均发生率为15.89‰,2003年呈显著下降趋势;②城市人口平均出生缺陷发生率为17.09‰;③春季出生缺陷发生率均显著高于其它3个季节;④先天性心脏病、指趾四肢畸形始终处于第一、二位,神经管畸形已降至第五位;⑤出生缺陷产前诊断率为22.88%～28.85%,但不同出生缺陷病种的产前诊断率不同。结论出生缺陷是当前围生儿死亡的首因,以先天性心脏病、指趾四肢畸形发生率最高,提高产前诊断水平,及早发现严重畸形儿并终止妊娠是降低围生儿死亡的有效途径。     

2004～2008年新疆兵团出生缺陷监测数据分析

目的:分析新疆兵团5年的出生缺陷发生率、主要畸形发生顺位及构成比,掌握兵团出生缺陷发生情况及其动态变化,探讨降低出生缺陷发生率的干预措施。方法:对2004～2008年新疆兵团出生缺陷监测医疗单位的监测资料进行统计分析。结果:监测围产儿62 330例,出生缺陷儿228例,出生缺陷发生率为3.66‰。在228例出生缺陷儿中,单发畸形211例,多发畸形17例;出生缺陷前5位畸形依次为:唇腭裂、先天性心脏病、神经管畸形、多指(趾)、先天性脑积水。结论:要加强对围孕期妇女的优生优育知识宣传教育和指导,为孕妇提供舒适、安全的生活环境,减少有毒有害环境污染,孕前、孕期远离有毒有害作业;积极开展优生技术和方法,开展产前筛查和产前诊断技术;针对出生缺陷发生及构成情况,尽快建立先天性心脏病等常见畸形的产前诊断中心,对医院产科相关人员进行出生缺陷知识和技能的培训,提高其对畸形的识别能力和诊断水平。     

湖南省1996～1999年出生缺陷监测结果分析

目的 为了解我省出生缺陷发生情况,提高出生人口素质。方法 在全省37家医院进行连续四年的出生缺陷监测。结果 四年全省出生缺陷总发生率为9．86％,出生缺陷主要集中在头颈部畸形、运动系统畸形、,中枢神经系统畸形和循环系统畸形,出生缺陷儿存活占66．46％,出生缺陷儿的诊断依据主要是临床诊断占70．36％。结论 我省出生缺陷发生率较高,应加强三级预防,减少出生缺陷的发生。     

宁波市江北区2010-2015年基于孕产人群队列的子代生后2年内出生缺陷发病率研究

目的 分析在母体孕产期和出生后不同时间段对出生缺陷发病率和诊断报告案例构成,探索更合适的出生缺陷监测时段。方法 利用宁波市江北区2009年10月11日-2015年9月30日全部23 054例妊娠人口,收集孕13周至子代生后2年内报告的出生缺陷个案,描述分析出生缺陷发病率、疾病谱、疾病诊断时间构成。结果 基于孕产队列的人群监测中发现,2010-2015年期间,宁波市江北区共发现1 040例出生缺陷。每100名孕妇中,从孕13周至子代生后2年的时间内,子代出生缺陷累计发病率为4.51%;发病率呈逐年上升趋势。出生缺陷在死胎中发病率高。先天性心脏病在出生缺陷顺位中稳居首位。该人群在孕13周~生后7天监测到的发病率为2.70%,监测期延长至生后42天时的发病率3.61%,延长至1年时发病率4.42%,延长至2年时发病率4.51%,从孕13周~生后2年能发现的出生缺陷率是孕13周~生后7天的1.7倍,约97.88%的出生缺陷是在生后1年内被发现。结论 延长出生缺陷监测时限,使数据更接近真实值,建议扩大监测期至2年。     

A Method for Detecting Runs of Good and Bad Clinical Outcomes on Variable Life-Adjusted Display (VLAD) Charts

In recent years there has been a growing need for effective monitoring of clinical outcomes. Two techniques for continuous monitoring that have emerged almost simultaneously are the Variable Life-Adjusted Display (VLAD) and risk-adjusted cumulative sum charts (CUSUM). The VLAD provides clinicians and management with an easily understandable overview of outcome history and is now in routine use in several hospitals. Although it can indicate runs of good and bad outcomes, unlike the CUSUM, it does not provide a quantitative means for assessing whether they merit investigation. This paper introduces a scheme for applying control limits from CUSUM charts onto the VLAD, thus enhancing its role as an effective monitoring tool.     

Monitoring vaccine safety using case series cumulative sum charts

We adapt the self-controlled case series method for routine surveillance of vaccine safety using cumulative sum (CUSUM) charts. The CUSUM surveillance method we propose is applicable for detecting associations that arise in a short pre-determined risk period following vaccination. The performance of the case series CUSUM is investigated through simulations. We illustrate the method using retrospective analyses of influenza vaccine and Bell's palsy, and MMR vaccine and febrile convulsions.     

Methods for monitoring influenza surveillance data

BACKGROUND: A variety of Serfling-type statistical algorithms requiring long series of historical data, exclusively from temperate climate zones, have been proposed for automated monitoring of influenza sentinel surveillance data. We evaluated three alternative statistical approaches where alert thresholds are based on recent data in both temperate and subtropical regions. METHODS: We compared time series, regression, and cumulative sum (CUSUM) models on empirical data from Hong Kong and the US using a composite index (range = 0-1) consisting of the key outcomes of sensitivity, specificity, and time to detection (lag). The index was calculated based on alarms generated within the first 2 or 4 weeks of the peak season. RESULTS: We found that the time series model was optimal in the Hong Kong setting, while both the time series and CUSUM models worked equally well on US data. For alarms generated within the first 2 weeks (4 weeks) of the peak season in Hong Kong, the maximum values of the index were: time series 0.77 (0.86); regression 0.75 (0.82); CUSUM 0.56 (0.75). In the US data the maximum values of the index were: time series 0.81 (0.95); regression 0.81 (0.91); CUSUM 0.90 (0.94). CONCLUSIONS: Automated influenza surveillance methods based on short-term data, including time series and CUSUM models, can generate sensitive, specific, and timely alerts, and can offer a useful alternative to Serfling-like methods that rely on long-term, historically based thresholds.     

Comparing syndromic surveillance detection methods: EARS' versus a CUSUM-based methodology

This paper compares the performance of three detection methods, entitled C1, C2, and C3, that are implemented in the early aberration reporting system (EARS) and other syndromic surveillance systems versus the CUSUM applied to model-based prediction errors. The cumulative sum (CUSUM) performed significantly better than the EARS' methods across all of the scenarios we evaluated. These scenarios consisted of various combinations of large and small background disease incidence rates, seasonal cycles from large to small (as well as no cycle), daily effects, and various types and levels of random daily variation. This leads us to recommend replacing the C1, C2, and C3 methods in existing syndromic surveillance systems with an appropriately implemented CUSUM method.     

2004~2007年武汉市围产儿出生缺陷监测结果分析

目的:进一步了解掌握武汉地区围产儿出生缺陷的发生率和种类,探索出生缺陷影响因素和制定降低出生缺陷发生的干预措施。方法:对武汉地区2004~2007年部分开展助产的医疗机构分娩的围产儿出生缺陷监测资料进行分析。结果:武汉市2004~2007年围产儿出生缺陷发生率为8.1‰,4年间出生缺陷发生率有上升趋势,前5位出生缺陷类型依次为多指、唇腭裂、外耳畸形、唇裂及先天性心脏病;孕母年龄大于35岁,出生缺陷发生率明显增高;男婴出生缺陷发生率明显高于女婴;双胎出生缺陷发生率明显高于单胎;产前诊断率为27.1%;出生缺陷发生与孕早期异常情况、遗传有一定的相关性。结论:做好出生缺陷监测工作,加强出生缺陷的综合预防工作,减少出生缺陷儿的发生。     

CUSUM analyses of time-interval data for online radiation monitoring

Three statistical control chart methods were investigated to determine the one with the highest detection probability and the best average run length (ARL). The three control charts include the Shewhart control chart of count data, cumulative sum (CUSUM) analysis of count data (Poisson CUSUM), and CUSUM analysis of time-interval (time difference between two consecutive radiation pulses) data (time-interval CUSUM). The time-interval CUSUM (CUSUMti) control chart was compared with the Poisson CUSUM (CUSUMcnt) and the Shewhart control charts with experimental and simulated data. The experimental data were acquired with a DGF-4C (XIA, Inc.) system in list mode. Simulated data were obtained by using Monte Carlo techniques to obtain a random sampling of a Poisson process. All statistical algorithms were developed using R (R Development Core Team). Detection probabilities and ARLs for the three methods were compared. The time-interval CUSUM control chart resulted in a similar detection probability as that of the Poisson CUSUM control chart but had the shortest ARL at relatively higher radiation levels; e.g., about 40% shorter than the Poisson CUSUM at 10.0 counts per second (cps) (five times above the background count rate). Both CUSUM control charts resulted in a higher detection probability than that of the Shewhart control chart; e.g., 100% greater than the Shewhart control method at 4.0 cps (two times above the background count rate). In addition, when time-interval information was used, the CUSUM control chart coupled with a modified runs rule (mrCUSUMti) showed the ability to further reduce the time needed to respond to changes in radiation levels and keep the false positive rate at a required level.     

A simple signaling rule for variable life‐adjusted display derived from an equivalent risk‐adjusted CUSUM chart

The variable life‐adjusted display (VLAD) is the first risk‐adjusted graphical procedure proposed in the literature for monitoring the performance of a surgeon. It displays the cumulative sum of expected minus observed deaths. It has since become highly popular because the statistic plotted is easy to understand. But it is also easy to misinterpret a surgeon's performance by utilizing the VLAD, potentially leading to grave consequences. The problem of misinterpretation is essentially caused by the variance of the VLAD's statistic that increases with sample size. In order for the VLAD to be truly useful, a simple signaling rule is desperately needed. Various forms of signaling rules have been developed, but they are usually quite complicated. Without signaling rules, making inferences using the VLAD alone is difficult if not misleading. In this paper, we establish an equivalence between a VLAD with V‐mask and a risk‐adjusted cumulative sum (RA‐CUSUM) chart based on the difference between the estimated probability of death and surgical outcome. Average run length analysis based on simulation shows that this particular RA‐CUSUM chart has similar performance as compared to the established RA‐CUSUM chart based on the log‐likelihood ratio statistic obtained by testing the odds ratio of death. We provide a simple design procedure for determining the V‐mask parameters based on a resampling approach. Resampling from a real data set ensures that these parameters can be estimated appropriately. Finally, we illustrate the monitoring of a real surgeon's performance using VLAD with V‐mask.     

Use of the local Knox statistic for the prospective monitoring of disease occurrences in space and time

The detection of clusters of events occurring close together both temporally and spatially is important in finding outbreaks of disease within a geographic region. The Knox statistic is often used in epidemiology to test for space-time clustering retrospectively. For quicker detection of epidemics, prospective methods should be used in which observed events in space and time are assessed as they are recorded. The cumulative sum (CUSUM) surveillance method for monitoring the local Knox statistic tests for space-time clustering each time there is an incoming observation. We consider the design of this control chart by determining the in-control average run length (ARL) performance of the CUSUM chart for different space and time closeness thresholds as well as for different control limit values. We also explain the effect of population density and region shape on the in-control ARL and discuss other distributional issues that should be considered when implementing this method.     

三峡库区0～14岁儿童出生缺陷调查与分析

目的:了解三峡库区7个区县0～14岁儿童的出生缺陷现状。方法:按ICD-10所列病种设计调查表,采用分层整群随机抽样现场对0～14岁儿童出生缺陷开展调查,包括出生缺陷的种类、发生率、城乡儿童出生缺陷发生比例、不同部位发生情况等,收集出生缺陷/遗传病信息数据。结果:获得有效调查问卷7 977份,出生缺陷种类24种患儿158例,出生缺陷发生率19.81‰。前4位为:唇裂73例,发生率9.152‰;肢体畸形17例,发生率2.137‰;脑积水14例,发生率1.755‰;心脏畸形12例(男童5例,女童7例),发生率1.504‰。其中男童95例,出生缺陷发生率22.37‰;女童63例,出生缺陷发生率16.89‰,男童明显高于女童(χ2=204.44,P<0.005)。城市儿童2 198例(27.55%)中出生缺陷42例,农村儿童5 779例(72.45%)中出生缺陷116例;城市儿童出生缺陷发生率19.11‰,农村为20.07‰,两者比较无统计学差异(χ2=0.076,P=0.782)。发生部位第一位是面部缺陷86例(54.43%),第二位为神经缺陷20例(12.66%),第三位为四肢缺陷17例(10.76%),第四位为心脏缺陷12例(7.59%),第五位为泌尿生殖缺陷6例(3.80%),其他缺陷17例(10.76%)。结论:对出生缺陷扩大监测地区、监测时间、监测病种,加强孕前优生指导和检查,做好出生缺陷预防干预,降低出生缺陷发生率。