石家庄市2006—2007年流感疫情暴发分析

对石家庄市2006-2007年19起流感疫情暴发的监测资料进行分析,探讨全市流感活动状况.     

痴呆危险因素人群归因分值的城乡差异

目的 使用人群归因分值(population attributable fractions,PAF)探讨痴呆危险因素所造成痴呆患者的比例,为今后痴呆的早期预防和干预提供建议.方法 采用随机整群抽样的方法选取3 361名≥65岁的老年人进行调查,使用x2检验分析危险因素的城乡差异.在主成分分析探索危险因素之间重叠效应的基...     

脑出血归因危险度分析

根据脑出血危险因素的病例对照研究资料，初步估计并分析了脑出血的归因危险度和人群归因危险度。结果表明高血压、短暂脑缺血发作（ＴＩＡ）和打鼾的归因危险度分别为９１．４％、９３．８％和５２．７％。以上３种因素的人群归因危险度分别为６８．６％、１８．５％和１９．５％，提示在一般人群中控制高血压、ＴＩＡ和打鼾对预防脑出血具有重要的卫生学意义。     

病例对照研究资料人群归因危险度估计的改进法

在病例对照研究中由暴露因素为等级变量出发推导出估计人群归因危险度的改进公式, 并以医学实例介绍了这一公式的使用方法。文中对改进公式与Whittem ore及Walter等提出的归因危险度估计法作了必要的讨论     

构建个体化预测医务人员职业暴露风险的列线图模型

目的探究医护人员职业暴露的影响因素,构建个体化预测职业暴露风险的列线图模型。方法调查2016年7月—2017年7月医院医护人员职业暴露发生情况,使用二分类Logistic回归方法探索医务人员职业暴露风险的危险因素,应用R软件构建预测职业暴露风险的列线图模型。结果 962名医务人员中发生职业暴露有142例,职业暴露发生率为14. 76%; Logistic回归分析发现:夜班间隔时间、日均工作时间、防护用品满意度及职业防护培训是医护人员发生职业暴露的独立危险因素(P <0. 05),根据多因素分析结果绘制出职业暴露风险列线图。结论不参加单位职业防护培训、夜班间隔时间≤5 d是医护人员发生职业暴露的高危因素;基于以上危险因素建立个体化预测医务人员职业暴露风险的列线图模型,对医疗机构制定有针对性的职业暴露防控方案具有指导意义。     

脑出血与脑梗塞人群归因危险度的分析及比较

采用配比病例对照研究方法,对经颅脑CT确诊的162例脑出血病人和158例脑梗塞病人分别配以同等数量的对照作1:1配比分析,探讨中老年人脑出血和脑梗塞发病的危险因素.多因素条件logistic回归分析结果表明,脑出血的主要危险因素为高血压、短暂脑缺血发作(TIA)、父母脑卒中病史及打鼾,相应的调整人群归因危险度(PARs)分别为0.7004、0.1862、0.1357、0.2020;4个因素综合的人群归因危险度(PAR)为0.8318.脑梗塞的主要危险因素为高血压、TIA、习惯性饮酒和打鼾,相应的PARs分别为0.7473、0.1229、0.2403、0.4959;四因素综合的PAR为0.9137,经常参加体育锻炼对脑梗塞具有保护作用(OR为0.30).     

应用Meta分析有效估计人群归因危险度百分比的探讨

人群归因危险度百分比 (populationattributableriskproportion ,PARP)是总体人群中某种疾病归因于某种因素的暴露所引起的发病 (死亡 )占全部发病 (死亡 )的百分比 ,反映该因素所引起的发病 (死亡 )占全部发病 (死亡 )的比重。通过PARP可了解各危险因素对人群中某疾病的发病所产生的影响 ,亦即消除某危险因素后 ,所产生的对预防该疾病的效果将占有多大比重。它能够为卫生政策的制订提供依据 ,有着重要的公共卫生的实际意义。目前常用的估计PARP的方法有两种 :一种是利用全国人群抽样调查获得的人群总暴露率来估计 ;另一种是利用某地区…     

基于列线图的中国西部MSM人群暴露前预防用药依从性预测研究

目的 本研究旨在建立男男性行为者(men who have sex with men,MSM)艾滋病暴露前预防用药(pre-exposure prophylaxis,PrEP)依从性的列线图预测模型,为基层防控人员提供可直观判断服药依从性的测量工具,以提醒服药依从性差者,从而降低其HIV新发感染.方法 采用非概率抽样法...     

Selecting participants that raise a clinical trial's population attributable fraction can increase the treatment effect within the trial and reduce the required sample size

Background

Detection of modest but worthwhile treatment effects in randomized controlled trials (RCTs) demands trials of large sample size. Approaches to decreasing required size of RCTs while maintaining power are needed.

Objective

The epidemiological concept of population attributable fraction (AF_p) was applied to the population selected for an RCT to assess its role in determining the size of treatment effect and the required sample size. The additional effect of efficacy of treatment specifically among participants at risk for attributable target events (relative risk reduction_{at risk} [RRR_{at risk}]) was also examined.

Results

A model is described which accounts for size of treatment effect in an RCT based on AF_p and RRR_{at risk}: RRR_trial = (AF_p) (RRR_at risk). The increase in RRR_trial resulting from raising AF_p exceeds that possible under the traditional high risk/high response approach to trial design and allows a reduction in required trial sample size. AF_p can be estimated from studies of causation that determine both risk and attributable risk (AR) associated with specific risk factors.

Conclusion

Larger treatment effects within RCTs are enabled by choosing a target outcome having a specific cause and selecting participants at specific risk for that outcome. Using information about phenotypic and genetic predictors of AR may increase our capacity to select trial populations having high AF_p.     

The extrapolation of attributable risk to new populations

I develop a method for extrapolation of attributable risk estimated from one population, to other populations with a different rate of risk factor exposure and/or rate of outcome. The method uses the relationship between attributable risk and the product moment correlation.     

1990至2019年中国及全球归因于高温暴露的疾病负担分析

目的 分析1990至2019年中国及全球归因于高温暴露的疾病负担,研究相关人群疾病负担现状。方法 于2021年10月,通过2019年全球疾病负担（GBD 2019）研究数据,提取并分析1990年与2019年不同年龄及性别中国及全球人群归因于高温暴露的人群归因分值（PAF）、死亡数、死亡率、伤残调整寿命年（DALY）以及DALY率等指标,计算变化率,通过世界标准人口的年龄结构对死亡率进行标化,并分析中国居民高温暴露造成疾病负担的原因。结果 2019年中国及全球人群PAF较1990年分别下降43.98%、12.41%,死亡数分别上升29.55%、49.40%,粗死亡率分别上升7.81%、3.30%,DALY分别下降48.12%、14.41 %,DALY率分别下降56.82%、40.82%;≥70岁年龄组人群的死亡率高于其他年龄群组;男性归因于高温暴露的PAF、标化死亡率、DALY等疾病负担指标均高于女性。2019年中国人群因高温暴露的影响DALY的主要原因是缺血性心脏病（8.44万人年）,影响死亡的主要原因也是缺血性心脏病（0.49万例）。结论 中国及全球归因于高温暴露的疾病负担仍然较为严重,应对男性、老年群体及职业暴露人群制定针对性干预措施,建立完善的监测体系,降低高温暴露造成的疾病负担。     

抚顺市职业暴露与肺癌关系的病例对照研究

本文着重评价职业暴露与肺癌的关系。研究结果表明,病例组与对照组的职业暴露史有显著差异,有职业暴露史者患肺癌的相对危险性为 OR_(MH)=3.84,95％CI 为1.58～9.30(调整吸烟后的 OR值)。且随职业暴露年限的延长患肺癌的危险性增大,存在剂量反应关系。据人群回归危险度估计,抚顺市大约有16.47％的肺癌是由职业暴露所致。吸烟与职业暴露存在正交互作用,符合相加模型     

Mortality attributable to smoking in Vietnamese men in 2008

Objective

Smoking prevalence among Vietnamese men is among the highest in the world. Our aim was to provide estimates of tobacco attributable mortality to support tobacco control policies.

Method

We used the Peto–Lopez method using lung cancer mortality to derive a Smoking Impact Ratio (SIR) as a marker of cumulative exposure to smoking. SIRs were applied to relative risks from the Cancer Prevention Study, Phase II. Prevalence-based and hybrid methods, using the SIR for cancers and chronic obstructive pulmonary disease and smoking prevalence for all other outcomes, were used in sensitivity analyses.

Results

When lung cancer was used to measure cumulative smoking exposure, 28% (95% uncertainty interval 24–31%) of all adult male deaths (> 35 years) in Vietnam in 2008 were attributable to smoking. Lower estimates resulted from prevalence-based methods [24% (95% uncertainty interval 21–26%)] with the hybrid method yielding intermediate estimates [26% (95% uncertainty interval 23–28%)].

Conclusion

Despite uncertainty in these estimates of attributable mortality, tobacco smoking is already a major risk factor for death in Vietnamese men. Given the high current prevalence of smoking, this has important implications not only for preventing the uptake of tobacco but also for immediate action to adopt and enforce stronger tobacco control measures.