BackgroundPsychological distress is prevalent among health care professionals and can lead to poor-quality patient care. Internet-based acceptance and commitment therapy (iACT) is a promising intervention for improving mental health due to its low cost and easy access. However, there is limited evidence of its effectiveness in reducing health care professionals’ psychological distress. ObjectiveThis study aims to examine the effects of iACT on psychological distress (stress, anxiety, and depression) among health care professionals in China. MethodsFrom October 2022 to February 2023, a total of 108 health care professionals were recruited via WeChat and randomized into a 6-week iACT intervention program with therapist support (n=54) or waitlist control group (n=54). The intervention included 21 self-guided sessions combining teaching videos, mindfulness practices, and journal writing, followed by 7 live conferences to share experiences and discuss questions, all conducted via WeChat. Primary outcomes (stress, anxiety, and depression) and secondary outcomes (burnout and psychological flexibility) were collected using the Sojump platform, the most popular web-based survey platform in China. Generalized estimating equations were used to compare the outcomes between groups and assess the effects of group, time, and group-by-time interaction. Subgroup and sensitive analyses were performed to test the robustness of our findings across various groups. ResultsAmong the 108 health care professionals, 68 (63%) completed the follow-up assessment at week 10, including 35 (64.8%) in the iACT group and 33 (61.1%) in the waitlist control group. Of the 54 participants in the iACT group, all attended at least 2 sessions, and 25 attended all 28 sessions. On average, participants attended 20 (71%) sessions. The iACT group showed significant improvement in the Depression Anxiety and Stress Scales-21 total score (d=0.82, 95% CI 0.39-1.26), and the effects were sustained for 4 weeks after the intervention (d=1.08, 95% CI 0.57-1.59). Compared to the control group, the iACT group showed significantly lower scores in burnout at week 6 (d=1.42, 95% CI 0.95-1.89) and week 10 (d=1.52, 95% CI 0.98-2.06). The iACT group showed significantly higher psychological flexibility at week 6 (d=1.23, 95% CI 0.77-1.69) and week 10 (d=1.15, 95% CI 0.64-1.66). ConclusionsThe iACT effectively decreased health care professionals’ psychological distress and burnout and improved their psychological flexibility. Our findings provide implications and guidance for the development and broad implementation of iACT in health care settings to improve the mental health of health care professionals. Trial RegistrationChinese Clinical Trial Register ChiCTR2400093584; https://tinyurl.com/38werwsk

目的 了解长沙市居民心理健康素养现况,为心理健康促进相关政策的制定提供科学依据.方法 于2021年5-10月采取分层多阶段抽样的方法,抽取长沙市18岁及以上常住居民6 426人进行问卷调查,问卷包括一般人口学资料调查表、国民心理健康素养问卷、2条目患者健康问卷抑郁量表(PHQ-2)和9条目患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑筛查量表(GAD-7)和失眠严重程度调查问卷(ISI).使用SPSS 20.0统计软件进行x2检验和多因素logistic回归分析.结果 共6 286人完成问卷调查,长沙市居民心理健康素养达标人数为470名(7.48％).多因素logistic回归分析结果显示,家庭月收入为 3 000～5 999 元(OR=0.607,95％CI:0.395～0.933)、6 000～9 999 元(OR=0.460,95％CI:0.300～0.705)、1万元及以上(OR=0.362,95％CI:0.237～0.553),职业为商业或服务或后勤保障人员(OR=0.518,95％CI:0.360～0.747)的居民心理健康素养水平高;患慢性病(OR=1.394,95％CI:1.089～1.784)、有抑郁症状(OR=2.111,95％CI:1.220～3.652)和有失眠症状(OR=1.741,95％CI:1.051～2.886)的居民心理健康素养水平低,均有统计学意义(P＜0.05,P＜0.01).结论 长沙市居民心理健康素养水平较低,应重点关注低收入和患慢性病人群的心理健康素养水平,在制定相关政策时应考虑心理健康素养的干预,控制居民心理健康问题的发生.

[Purpose] To analyze the cancer incidence and mortality in Changsha City in 2018 and trends from 2014 to 2018. [Methods]The data of new cancer cases and deaths were collected from Changsha cancer registration areas. The data were stratified by areas and gender, and the incidence and mortality were calculated. The population composition of China in 2000 and Segi’s population structure were used to calculate age-standardized rate（ASR）. Joinpoint 4.9 software was used to analyze the incidence and mortality trends of cancer. The annual percentage change（APC）of the rate was estimated by log-linear regression model, and t test was used for statistical test,with test level α=0.05. [Results] The crude cancer incidence in Changsha cancer registration areas in 2018 was 277.46/105, which was higher in male（304.94/105） than that in female（249.69/105）,and higher in urban areas（294.42/105） than that in rural areas（251.63/105）. The age-standardized incidence rate by Chinese standard population in 2000（ASIRC） and by Segi’s world standard population（ASIRW） were 192.10/105and 188.88/105, respectively. The cumulative incidence rate（0～74years old） was 22.53%. The top five cancers in male were lung cancer, colorectal and anal cancer, liver cancer, esophageal cancer, oral and pharyngeal cancer; while the top five cancers in female were breast cancer, lung cancer, and colorectal and anal cancer, cervical cancer and thyroid cancer. The crude cancer mortality in Changsha cancer registration areas in 2018 was 169.48/105,which was higher in male（222.02/105） than that in female（116.40/105）, and higher in urban areas（176.01/105） than that in rural areas（159.54/105）. The age-standardized mortality rate by Chinese standard population in 2000（ASMRC） and by Segi’s world standard population（ASMRW） were107.54/105and 107.40/105, respectively. The cumulative incidence rate（0～74 years） was 12.77%.The top five cancer deaths in male were lung cancer, liver cancer, colorectal and anal cancer,esophageal cancer and gastric cancer; while the top five cancer deaths in female were lung cancer, colorectal and anal cancer, liver cancer, breast cancer and cervical cancer. The trend of incidence was increasing from 2014 to 2018, with the APC of ASIRC 7.37%（95% CI: 2.62% ～12.33%）. The APC was lower in male（5.97%, 95%CI: 2.62%～12.33%） than that in female（9.03%,95%CI: 4.28%～14.01%）, and lower in urban areas（6.55%, 95%CI: 0.26%～13.23%） than that in rural areas（9.61%, 95%CI: 8.07%～11.18%）. The trend of mortality from 2014 to 2018 was relatively stable, while it was increasing in rural areas with the APC of ASMRC 7.21%（95% CI:0.32%～14.57%）. [Conclusion] The incidence and mortality of cancer in Changsha City were high in 2018, especially in male and in urban areas. The burden of cancer was increasing from 2014 to2018, especially in rural areas. Lung cancer, breast cancer, colorectal and anal cancer, liver cancer, cervical cancer, esophageal cancer and stomach cancer were the most common cancers,and oral cavity and pharynx cancer were the characteristic cancer in Changsha City. The comprehensive measures should be taken to strengthen cancer prevention and treatment.

目的 了解具有糖尿病危险因素人群糖尿病前期和糖尿病患病情况.通过筛查将确诊为的糖尿病患者纳入社区慢性病重点人群管理.方法 2017-11/2018-05期间,在长沙市174个街道(乡镇)对符合糖尿病高危人群的居民随机筛查.统计分析采用SPSS 22.0软件,比较采用卡方检验,P＜0.05为差异有统计学意义.结果 本次共筛查高危人群42705例,其中血糖正常者28839(67.5％)例、糖尿病前期结局检出8458(19.8％)例、糖尿病结局检出5408(12.7％)例;高危因素聚集者糖尿病前期和糖尿病检出率增高.不同性别危险因素:女性有巨大儿生产史或妊娠糖尿病史的妇女,多囊卵巢综合征(PCOS)患者;BMI≥24 kg/m2;中心型肥胖;静坐生活方式;一级亲属中有2型糖尿病家族史;高血压或正在接受降压治疗;血脂异常均有统计学意义(P＜0.05).不同年龄组危险因素:有巨大儿生产史或妊娠糖尿病史的妇女,多囊卵巢综合征(PCOS)患者;有糖调节受损史;BMI≥24 kg/m2;中心型肥胖;静坐生活方式;一级亲属中有2型糖尿病家族史;高血压或正在接受降压治疗;血脂异常;动脉粥样硬化性心脑血管疾病患者;长期接受抗精神病药物和/或抗抑郁药物治疗均有统计学意义(P＜0.05).不同危险因素糖尿病前期和糖尿病筛查:年龄≥40岁;有糖调节受损史;BMI≥24 kg/m2;中心型肥胖;静坐生活方式;一级亲属中有2型糖尿病家族史;高血压或正在接受降压治疗;有一过性类固醇糖尿病病史者均有统计学意义(P＜ 0.05).Logistic回归分析:年龄≥40岁;有糖调节受损史;BMI≥24 kg/m2;中心型肥胖;静坐生活方式;一级亲属中有2型糖尿病家族史;高血压或正在接受降压治疗;有一过性类固醇糖尿病病史者均是引起糖尿病前期结局和糖尿病结局的共同影响因素.结论 糖尿病前期结局人群在筛查中占比较高,都是成为糖尿病患者潜在人群.糖尿病筛查有助于早期发现糖尿病,有利于减少糖尿病的并发症.

目的 分析湖南省≥30岁社区居民高血压、糖尿病、高血脂共病的影响因素,为高血压、糖尿病、高血脂防治提供依据.方法 采用多阶段随机抽样方法,选取湖南省6个地区≥30岁常住居民为调查对象;采用自行设计的问卷收集基本信息,测量身高、体重和血压,实验室检测空腹血糖、三酰甘油等生化指标,采用无序多分类Logistic回归模型分析高血压、糖尿病、高血脂共病的影响因素.结果 发放调查问卷5 258份,回收有效问卷4 012份,回收有效率为76.30％.患高血压、糖尿病、高血脂其中1种慢性病1 573例,患病率为39.21％;患2种慢性病727例,患病率为18.12％;息3种慢性病164例,患病率为4.09％.无序多分类Logistic回归分析结果显示,与未患高血压、糖尿病、高血脂相比,男性(OR=1.352, 95％CI:1.100～1.663)、≥50岁(OR: 1.822～3.741, 95％CI:1.398～ 5.150)、超重(OR=2.001, 95％CI:1.690～2.368)、肥胖(OR=3.179,95％CI: 2.330～ 4.336)、吸烟(OR=1.480,95％CI:1.029 ～ 2.131)是社区居民患高血压、糖尿病、高血脂其中1种慢性病的影响因素;男性(OR=1.648,95％CI: 1.272 ～ 2.136)、≥40岁(OR: 3.199～ 11.591,95％CI:2.092～18.955)、体重过低(OR=0.385, 95％CI=0.219～0.676)、超重(OR=2.682,95％CI: 2.177～ 3.305)、肥胖(OR=4.881, 95％CI: 3.424～6.959)、吸烟(OR=1.695,95％CI:1.103～2.605)、饮酒(OR=1.341, 95％CI: 1.060～1.696)是社区居民患其中2种慢性病的影响因素;男性(OR=1.367,95％CI: 1.109～1.685)、≥40岁(OR: 4.684～61.976,95％CI: 1.068～269.680)、体重过低(OR=0.095,95％CI: 0.013～0.702)、超重(OR=3.572,95％CI: 2.443 ～ 5.222)、肥胖(OR=11.239,95％CI: 6.745～18.726)、吸烟(OR=1.711,95％CI:1.281～ 2.285)、饮酒(OR=2.078,95％CI:1.234～3.500)是社区居民患3种慢性病的影响因素.结论 性别、年龄、BMI、吸烟、饮酒是湖南省≥30岁社区居民高血压、糖尿病、高血脂共病的影响因素.

OBJECTIVES:To assess the accuracy and influential factors for hypertension prevalence based on questionnaire interview by on-site measurement.METHODS:Data were from the baseline surveys for chronic diseases among residents ages ≥18 years old in 4 districts/counties of Changsha between 2013 and 2014. All surveys adopted multi-stage random sampling to select samples. The Bootstrap resampling method was used to randomly select 1 000 repeated samples with replacement to obtain robust estimate of subgroup prevalence rates. Hypertension prevalence was calculated by using the data from both questionnaire interview and on-site measurement. Using the results of on-site measurement as the golden standard, the accuracy of questionnaire interview and 95% uncertainty interval were estimated. Multivariate logistic regression was used to investigate the influential factors for the underestimated hypotension prevalence based on questionnaire interview.RESULTS:The hypertension prevalence from on-site measurement among the residents in the 4 districts/counties of Changsha was significantly higher than that from questionnaire interview (prevalence ratio: 1.26-2.31). Taking the results of on-site measurement as the golden standard, the sensitivity of questionnaire interview on hypotension prevalence range from 41.76% to 74.83% among the 4 districts/counties, and the specificity fell between 98.51% and 99.46%. The underestimation in questionnaire interview was more likely to occur in the youngest age group (18-34 years old), males, and residents were at lower levels of education in all 4 districts/counties.CONCLUSIONS:Compared with the on-site measurement, questionnaire interview significantly under-estimate the hypertension prevalence, suggesting that the on-site measurement method should be firstly considered in epidemiological surveys for hypertension prevalence. If only the questionnaire method can be used to collect data due to conditions, it is necessary to make corresponding corrections to the questionnaire results with reference to relevant research evidence.

目的 了解长沙市2型糖尿病(T2DM)患者流感疫苗接种意愿及影响因素,为开展T2DM患者流感疫苗接种工作提供依据.方法 采用系统抽样方法 ,选取长沙市9个县(市、区)174家社区卫生服务中心(乡镇卫生院)中慢性病健康管理信息系统的T2DM患者为调查对象,通过问卷收集患者的基本情况、流感疫苗知晓情况及接种意愿,采用多因素Logistic回归模型分析T2DM患者流感疫苗接种意愿的影响因素.结果 共发放问卷8 700份,回收有效问卷8 258份,回收有效率为94.92％.T2DM患者知晓流感疫苗4 903例,占59.37％.愿意接种流感疫苗4 120例,占49.89％.多因素Logistic回归分析结果 显示,男性(OR=1.105,95％C7:1.006～1.214),家庭人均月收入≥1 000元(1 000～＜3 000元,OR= 1.273,95％CI:1.133～1.431;3 000～＜5000元,OR= 1.424,95％CI:1.245～1.629;≥5 000元,OR= 1.537,95％CI:1.277～1.851),知晓T2DM患者容易并发流感、肺炎(OR=1.476,95％CI:1.308～1.665),知晓流感加重T2DM患者病情甚至导致死亡(OR=1.229,95％CI:1.078～1.401),知晓流感疫苗(OR=1.863,95％CI:1.680～2.065),知晓流感疫苗可预防T2DM急性并发症(0R=1.413,95％CI:1.197～1.668),以及知晓T2DM患者接种流感疫苗降低门诊、住院和死亡风险(OR=1.441,95％CI:1.234～1.682)的T2DM患者更愿意接种流感疫苗.结论 长沙市T2DM患者流感疫苗接种意愿较低;性别、家庭人均月收入及流感疫苗知晓情况是T2DM患者流感疫苗接种意愿的影响因素.

目的 了解长沙市居民恶性肿瘤死亡的流行特征,为制定恶性肿瘤防治策略提供依据.方法 收集2014-2016年恶性肿瘤死亡监测资料,采用描述性统计学方法进行分析,计算死亡数,构成比,粗死亡率和标化死亡率.结果 2014-2016年该市恶性肿瘤死亡率为121.12/10万,标化死亡率为111.93/10万;男性死亡率为158.66/10万,标化死亡率为141.87/10万;女性死亡率为83.11/10万,标化死亡率为79.31/10万.男性死亡率高于女性,差异有统计学意义(P<0.01).0～44岁年龄组恶性肿瘤死亡率处于较低水平,45岁后随年龄增长死亡率呈急速上升.该市恶性肿瘤死因顺位为肺癌(45.73/10万)、肝癌(15.68/10万)、结直肠癌(11.07/10万)、胃癌(5.29/10万)、食管癌(5.27/10万).结论 该市重点防治的肿瘤主要是肺癌、肝癌、结直肠癌、胃癌、食管癌,应针对主要恶性肿瘤和重点人群开展综合防控措施.

目的 评价2014-2016年长沙市恶性肿瘤的死亡情况和其所致寿命损失特征,为政府制定调控防治策略提供依据.方法 2014-2016年长沙市居民死亡数据来源于中国疾病预防控制信息系统人口死亡信息登记管理系统.采用SPSS 21.0计算粗死亡率、标化死亡率、潜在减寿年数(PYLL)、标化潜在减寿年数(SPYLL)、标化潜在减寿率(SPYLLR)和平均减寿年数(AYLL),率的比较采用u检验.结果 2014-2016年长沙市恶性肿瘤死亡人数为24 803例,死亡率为121.12/10万,标化死亡率为111.93/10万;男性死亡率(158.66/10万)高于女性(83.11/10万),差异有统计学意义(P＜0.01).恶性肿瘤PYLL为190 827.5人年,SPYLL为183 887.70人年,SPYLLR为9.61‰,AYLL为12.86年.肺癌、肝癌、结直肠癌、白血病和乳腺癌是减寿的主要恶性肿瘤,占所有恶性肿瘤PYLL的63.52％.结论 肺癌、肝癌、结直肠癌、白血病和乳腺癌是严重危害长沙市居民健康最主要的恶性肿瘤,应重点针对上述恶性肿瘤开展综合防治措施.

目的 了解长沙市儿童青少年血压偏高现状及其影响因素.方法 数据来源于"全国学生常见病及健康危险因素监测"调查,共12所学校2927名学生.采用χ2分析进行血压偏高患病率的单因素分析,采用二元Logistic回归进行多因素分析.结果 长沙市男性儿童青少年血压偏高患病率27.48％,女性为28.37％.多因素分析结果显示,初中(OR=1.57,95％CI:1.20～2.05)、高中/职高(OR=1.45,95％CI:1.04～2.01)、超重(OR=1.66,95％CI:1.24～2.23)、肥胖(OR=2.69,95％CI:1.87～3.87)是男性儿童青少年血压偏高的危险因素.超重(OR=1.56,95％CI:1.10～2.22)、肥胖(OR=1.64,95％CI:1.02～2.65)、郊区(OR=1.45,95％CI:1.15～1.84)是女性儿童青少年血压偏高的危险因素.结论 长沙市儿童青少年血压偏高患病率高,呈广泛流行趋势,应加强儿童青少年高血压防治,特别是初高中、超重、肥胖的儿童青少年.

目的 了解心脑血管疾病的流行特征,为制定防控策略提供科学依据.方法 从“重点慢性病监测信息系统”导出心脑血管事件数据并进行描述性统计分析.结果 2016年长沙市心脑血管事件报告发病率为318.09/10万,标化发病率326.40/10万,其中脑卒中报告发病率237.99/10万,标化发病率244.12/10万,发病以脑梗死为主,冠心病报告发病率80.09/10万,标化发病率82.27/10万,发病以急性心肌梗死为主.心脑血管事件报告死亡率132.43/10万,标化死亡率136.21/10万,脑卒中报告死亡率为80.14/10万,标化死亡率为82.34/10万,死亡以脑出血为主,冠心病报告死亡率52.29/10万,标化死亡率53.78/10万,死亡以急性心肌梗死为主.心脑血管事件报告发病率与报告死亡率均随年龄的上升而增加(x2发病=64 537.26,P=0.000;x2死亡=32646.53,P=0.000),且男性均高于女性(x2发病=194.66,P=0.000;x2死亡=178.54,P=0.000),发病与死亡主要发生在60岁及以上人群.心脑血管事件复发率为38.03％.结论 2016年长沙市心脑血管事件报告发病率、复发率和报告死亡率呈“三高”趋势,报告发病率和报告死亡率随年龄的上升而逐渐增加,防控形势严峻,发病与死亡以脑卒中为主,60岁及以上人群是主要的防控对象.

目的 分析长沙市成年人运动锻炼身体活动现状及影响因素,为制定慢性病防制策略和措施提供依据.方法 采用多阶段分层随机抽样法对长沙市≥18岁常住居民开展问卷调查.结果 长沙市成人经常锻炼率为28.17％,女性高于男性,城市高于农村,年龄越大,经常锻炼率越高,差异均有统计学意义(P＜0.01).参加锻炼的人群中,每日锻炼活动量达标率为32.10％,其中男性(30.78％)与女性(32.95％)间差异无统计学意义(x2=3.639,P=0.056),城市(32.86％)高于农村(30.17％) (x2=4.78,P＜0.05);每周运动锻炼时间达标率为47.19％,女性(54.46％)高于男性(50.27％) (x2=11.81,P＜0.01),农村(68.68％)高于城市(46.52％) (x2=282.21,P＜0.01),随着年龄的增长,每天活动量达标率(x2趋势=187.37,P＜0.01)和每周运动时间达标率(x2趋势=210.79,P＜0.01)均增加.结论 长沙市成年人运动锻炼率、活动量及锻炼时间达标率均较低,相关部门应结合“健康长沙”建设出台包括加强健康宣教在内的针对性措施,提高居民锻炼意识.

目的 了解长沙市儿童青少年慢性病现状.方法 数据来源于"全国学生常见病及健康危险因素监测",共调查13所学校3163名学生.采用χ2分析对不同组间率进行比较.结果 长沙市儿童青少年自报慢病患病率3.79％,男性自报慢病患病率(1.42％)低于女性(5.32％),男女性间自报慢病患病率差异有统计学意义(χ2=19.27,P=0.000).大学生自报慢病患病率最高(13.98％),其次为初中生(3.92％),小学生的最低(1.62％),不同年级间的自报慢病患病率差异有统计学意义(χ2=80.68,P=0.000).从病种上看,贫血自报患病率最高(3.13％),其次是过敏性哮喘(0.38％),糖尿病和高血压患病率最低(均为0.03％).通过现场检测,长沙市儿童青少年血压正常高值检出率为14.48％,高血压检出率为19.89％,严重高血压检出率为11.29％,超重率为14.83％,肥胖率为8.76％.结论 长沙市儿童青少年自报慢性病患病水平不高,年级以大学生为主,病种以贫血为主,高血压、超重和肥胖呈广泛流行趋势,应将慢性病防治窗口下移至儿童青少年,以减少成人期慢性病负担.

Objective To study the prevalence,awareness,treatment,and control rates of hypertension and their risk factors among adults in Changsha city,and to identify high-risk subjects,and then to provide evidence for prevention and control strategies of hypertension.Methods The study was based on the baseline survey of main chronic diseases in 2013-2014 in Changsha.The epidemiological survey was performed on permanent residents aged 18 years and older by multi-stage cluster sampling method.Binary Logistic regression analysis was used for multivariate analysis.Results The prevalence,awareness,treatment and control rates of hypertension were 32.79％,63.71％,56.80％ and 22.47％,respectively.The standardized prevalence,awareness,treatment and control rates of hypertension were 22.53％,47.61％,39.13％ and 15.27％,respectively.The prevalence rate of hyper tension was higher in rural areas than in urban areas (35.41％ vs 29.84％),while the awareness(55.20％ vs 75.10％),treatment(49.25％ vs 66.92％) and control rates(14.14％ vs 33.62％) were all lower in rural areas than in urban areas.Age,rural residents,blood glucose,central obesity,overweight and obesity were risk factors for prevalence of hypertension.Rural residents,blood glucose and drinking were risk factors for lower control rate of hypertension.Conclusion The prevalence of hypertension was high,while the awareness,treatment and control rates were low among residents in Changsha,and the trend was even more obvious in rural residents.

Objective To examine incidence and influencing factors of injury among adult residents in Changsha city.Methods Data on injuries among 6 397 community residents aged ≥ 18 years were extracted from the dataset of a questionnaire survey on chronic diseases conducted in Furong and Kaifu district of Changsha municipality between 2013 and 2014.The subjects were selected by multistage random sampling.Two-level Poisson regression was used to explore influencing factors of injury incidents and incidence rate ratio (IRR) was used to measure the impact of the factors.Resuits Of all the respondents averagely aged 52.0 ± 16.5 years,58.2％ were females and 24.8％ were retired.The overall injury incidence rate among the respondents was 3.6％ (95％ confidence interval [95％ CI]:3.2％-4.1％) and person-time incidence rate of injury was 4.5 ％ (95 ％ CI:4.0％-5.0％).The first three leading causes of injuries were falls,road traffic accidents and other injuries,with the incidence rates of 2.6％,0.7 ％,and 0.7％,respectively.For all the respondents with injuries,the average hospitalization duration was 19.1 days and the disability rate was 2.1％.For the road traffic accidents reported by the respondents,main victims were pedestrian (36.2％) and driver or passenger of electric passenger cars (31.9％).Stable marriage and being employed were protective factors for injury incident;while no significant impact of residential region,gender,age,and educational level on injury incidents was observed.Conclusion The first three leading causes of injuries were falls,road traffic injury and other injuries and marriage and employment status were main impact factors for injury incidents among adult community residents in Changsha city between 2013 and 2014.

BACKGROUND:Influenza A (H1N1) outbreaks have become common at schools in China since 2009. However, the effects of common countermeasures for school influenza outbreak have not been quantified so far, including isolation, vaccination, antivirus and school closure. We conducted a mathematically modeling study to address this unsolved issue.METHODS:We collected data of all small-scale school outbreaks caused by influenza A that occurred in Changsha city between January 2009 and December 2013. Two outbreaks (one was in 2009 and the other one was in 2013) were used for simulating the effects of single and combined use of common measures, including isolation (Iso), therapeutics (T), prophylactics (P), vaccinating 70% of susceptible individuals prior to the outbreak (VP70), vaccinating 70% of susceptible individuals every day during the outbreak (VD70) and school closure of one week (S1w). A susceptible-exposed-infectious/asymptomatic-recovered (SEIR) model was developed to implement the simulations based on the natural history of influenza A.RESULTS:When no control measures are taken, the influenza is expected to spread quickly at school for the selected outbreak in 2013; the outbreak would last 56 days, and the total attack rate (TAR) would reach up to 46.32% (95% CI: 46.12-46.52). Of all single control measures, VP70 is most effective to control the epidemic (TAR = 8.68%), followed by VP50, VD70, VD50 and Iso. The use of VP70 with any other measure can reduce TAR to 3.37-14.04% and showed better effects than any other combination of two kinds of measures. The best two-measure combination is 'S1w+VP70' (TAR = 3.37%, DO = 41 days). All combinations of three kinds of measures were not satisfactory when Vp70 and VD70 were excluded. The most effective three-intervention combination was 'Iso+S1w+VP70' (with TAR = 3.23%). When VP70 or VD70 is included, the combinations of four or five kinds of interventions are very effective, reducing TAR to lower than 5%. But the TAR of combination of 'T+P+Iso+S1w' is 23.20%. Similar simulation results were observed for the selected outbreak in 2009.CONCLUSION:Vaccinating no less than 70% of individuals prior to the outbreak and isolation are recommended as single measures to control H1N1outbreak at school. The combination of VP70+S1w can achieve very good control for school outbreak.

Objective To understand the diabetes treatment and control and influencing factors among adults in Changsha city and to provide the basis for preventing and controlling diabetes.Methods The multistage random sampling method was used to select 19 580 residents (＞18 years old) as the subjects.The investigation was performed with the questionnaires,physical examinations and fasting blood glucose tests.The data were compared with x2 test,and the influencing factors of preventing and controlling diabetes were analyzed with the unconditional multivariate logistic regression method.The used software was SPSS 21.0.Results The treatment rate of adult diabetes in Changsha was 55.43％,the urban treatment rate (58.21％) of diabetes was significantly higher than the rural treatment rate (52.28％) (P＜0.01);the treatment rate of diabetes increased with age;the treatment rate of diabetes patients with hypertension was 60.51％ which was significantly higher than that (47.85％) of diabetes patients without hypertension (P＜0.01);the treatment rate of diabetes patients with awareness was higher (86.80％);the treatment rate of diabetes patients increased with frequent exercise (P＜0.01).The control rate of adult diabetes in Changsha city was 34.87％,and increased with age,education level and exercise frequency.The blood glucose control rates in urban diabetes patients,diabetes patients with hypertension,diabetes patients with awareness and diabetes patients with treatment were 39.50％,36.61％,53.97％ and 51.56％,respectively,which were significantly higher than rural diabetes control rate (29.61％),diabetes control rate (28.48％) of patients without hypertension,diabetes control rate (1.12％) of patients without awareness and diabetes control rate (14.12％) of patients without treatment (P＜0.01).The results of multivariate logistic regression analysis indicated that urban area (OR=2.23,95％CI:1.47-3.37),age (OR=1.88,95％CI:1.44-2.46),awareness (OR=4 281.91,95％CI:592.50-30 944.95) were the influencing factors of diabetes treatment;the education level (OR=1.19,95％CI:1.00-1.40),the illness awareness (OR=427.26,95％CI:129.63-1 408.22) and medication therapy (OR=0.48,95％CI:0.32-0.70) were influencing factors of the diabetes control.Conclusion The diabetes treatment and control rates in Changsha are lower.The importance of publicity and education for diabetes treatment and blood glucose control on health should be strengthened.

目的 分析长沙市甲型H1N1流感重症病例流行特征及其危险因素.方法 收集2009年5月1日～2010年10月31日长沙市辖区报告的甲型H1N1流感重症病例资料,采用1:2频数匹配的病例对照研究方法,以非条件Logistic回归方法分析重症病例的危险因素.结果 2009年5月1日～2010年10月31日长沙市共报告甲型H1N1流感重症病例215例,其中193例痊愈,22例死亡,病死率为0.33％.重症病例危险因素的方差分析结果显示,年龄、性别、职业、发病至首次就诊时间间隔、地区、接触者有无症状和BMI的差异均有统计学意义.多因素logistic回归分析结果显示,年龄、地区、发病至就诊时间间隔是甲型H1N1流感由轻症转为重症的危险因素.相对于6～59岁组人群,＜5岁组和60～岁组人群发生重症的风险为2.016倍.相对于城市,农村发生重症的风险为0.193倍.发病2d以上就诊的人群相对发病2d以内就诊的人群,发生重症的风险为3.751倍.结论 对于年龄＜5岁组或60～岁组、学生群体及城市居民,在出现甲型H1N1流感症状时应及早就医,防止发展为重症病例.

Objective To analyze the diabetes prevalence and it's risk factors among adults in Changsha city and provide the scientific evidence for diabetes prevention and control. Methods The stratified multi-stage cluster sampling method was used to collect data of residents(≥18 years old)from 5 counties or districts as the subjects during 2013 to 2014. The survey included structured questionnaire, physical examination and blood tests. Risk factors of diabetes were analyzed by Chi-square test and multivariate logistic regression analysis. Results A total of 19 812 subjects were investigated. The effective response subjects were 19 580; 1 970 subjects had diabetes and the crude prevalence of diabetes was 10.06%. The prevalence rates of male and female was 8.95%(746/8 335) and 10.88%(1 224/11 245) respectively, with statistically significant difference(χ2=19.80, P<0.01). The prevalence rates of urban and suburb were 11.34%(1 048/9 238)and 8.92%(922/10 342)respectively,which has statistical significance (χ2=31.82,P<0.01).The prevalence of diabetes between 1.10%and 18.03%among all age groups, which has statistical significance among different age groups(χ2=797.67, P<0.01), and increased with the increase of age(χ2trend=731.99, P<0.01). The prevalence of diabetes of those whose educational background was Junior high school, senior high school, college, bachelor or above was 10.88%(1 529/14 050), 9.06%(290/3 201), 6.94%(97/1 398), 5.84%(52/891) respectively, The difference of diabetes prevalence also showed statistical significance among population with different educational background(χ2=46.62,P<0.01). The prevalence rates of people with hypertension and without hypertension were 18.33%(1 180/6 437)and 6.02%(790/13 132) respectively, which has statistical significance(χ2=723.68, P<0.01). The results of multi variant logistic regression analysis indicated that high blood pressure(OR=2.24), obesity(OR=2.12), overweight(OR=1.48), living in urban area(OR=1.54) and high age(OR=1.36)were independent risk factors of diabetes. Conclusion The diabetes prevalence in Changsha was high. The comprehensive prevention measures according to risk factors of diabetes should be taken, especially should focus on the people 40 years of age or older, with high blood pressure, being overweight or obese and living in urban area.

目的了解长沙市居民对糖尿病患病的知晓情况并探讨其影响因素。方法采用多阶段整群随机抽样方法,在长沙市5个区县对18岁以上常住居民进行流行病学调查。结果长沙市18岁及以上居民糖尿病患病率为10.06%,糖尿病患病知晓率为63.86%;单因素和多因素Logistic回归分析显示年龄、地区、文化程度、高血压、饮酒、锻炼、食盐量、食油量是影响糖尿病患病知晓率的主要因素;年龄越大（P＜0.001）,文化程度越高（P=0.011）,患病知晓率越高;城区患病知晓率（69.27%）高于农村（57.70%）（X~2=28.469,P＜0.001）;同时患糖尿病和高血压的人群糖尿病患病知晓率（68.14%）高于仅患糖尿病的人群（57.47%）（X~2=23.330,P＜0.001）、不饮酒（P＜0.001）、开展锻炼（P＜0.001）的患病人群中具有更高的患病知晓率。结论长沙市成人糖尿病患病率较高,而糖尿病患病知晓率较低,应大力开展健康教育与促进、加强血糖筛查,提高患病知晓率,预防和延缓并发症发生。