BACKGROUND:The incongruity between the regional supply and demand of healthcare services is a persistent challenge both globally and in China. Patient mobility plays a pivotal role in addressing this issue. This study aims to delineate the cross-provincial inpatient mobility network (CIMN) in China and identify the underlying factors influencing this CIMN. METHODS:We established China's CIMN by applying a spatial transfer matrix, utilizing the flow information from 5,994,624 cross-provincial inpatients in 2019, and identified the primary demand and supply provinces for healthcare services. Subsequently, we employed GeoDetector to analyze the impact of 10 influencing factors-including medical resources, medical quality, and medical expenses-on the spatial patterns of CIMN. FINDINGS:Beijing, Shanghai, Zhejiang, and Jiangsu provinces are the preferred medical destinations for cross-provincial inpatients, while Anhui, Henan, Hebei, and Jiangsu provinces are the main sources for cross-provincial inpatients. Patient flow between provinces decreases with distance. The spatial distribution of medical resources, medical quality, and medical expenses account for 87%, 73%, and 56% of the formation of CIMN, respectively. Additionally, interactions between these factors enhance explanatory power, suggesting that considering their interactions can more effectively optimize medical resources and services. CONCLUSIONS:The analysis of CIMN reveals the supply and demand patterns of healthcare services, providing insights into the inequality characteristics of healthcare access. Furthermore, understanding the driving factors and their interactions offers essential evidence for optimizing healthcare services.

为应对不断增长的慢病人群，各种形式的慢病管理模式不断涌现。本文通过系统的研究，从管理理念、系统结构和操作方法等方面梳理了目前国内区域慢病人群的健康管理模式，分析其利弊，面向紧密型医共体的慢病人群，提出了基于医联网的慢性病整合型全面健康管理模式。医联网能够连接并整合所有与医疗健康相关的人、物和信息资源，是慢性病全面健康管理的强有力支撑。紧密型医共体是医联网环境下慢性病健康管理的最佳应用场景，适应当前国家积极推动紧密型县域医共体的政策。基于医联网的慢性病整合型全面健康管理模式作为紧密型医共体内慢性病健康管理的资源整合新模型，以数字化技术为支撑，对于控制区域慢病人群的增长，探索新的健康管理模式有积极的意义。

The community-based chronic disease containment in China is still in its infancy, and there is a lack of a complete system for practical implementation with tertiary and secondary or primary hospitals collaboratively involved. We systematically summarized the development of chronic disease management in China, then analyzed the essentials of three major foreign chronic disease management models (chronic care model, innovative care for chronic conditions framework, and chronic disease self-management program) and chronic disease management experiences of Finland, the U.S., Australia, Japan with a focus on management ideas, systematic structures, and operable approaches. With these foreign models and experiences as a reference, we developed a general practice plus compact regional medical consortium-based chronic disease management model used in Lishui Town with complexity science and analysis for resource integration, against the backdrop of promoting the development of the compact county medical consortium and contracted family doctor services. We expect that our study could provide new ideas for the research on chronic disease containment in China's primary care.

Taking the foodborne diseases outbreaks in Beijing-Tianjin-Hebei region in 2016 as an example,the spatial distribution pattern was explored to provide scientific basis for accurate early warning of foodborne diseases outbreaks.In the multi-scale background,spatial visualization,kernel density estimation and regional analysis were used to analyze the foodborne disease outbreaks.The results of early warning analysis showed that there were outbreaks of foodborne diseases in Beijing,Tianjin and Hebei from March to December,with the largest number of cases in August.The hot spots of foodborne diseases were mainly located in Tianjin,Qinhuangdao and other neighboring Bohai area.The incidence of foodborne diseases in Beijing-Tianjin-Hebei region is seasonal,the summer is high.The spatial distribution is significant,and the coastal area is a low incidence area.The kernel density estimation method can accurately depict the spatial distribution characteristics of foodborne disease events and is favorable for hot warning.

在全世界范围,细菌性痢疾是一个得到广泛关注的健康问题,具有显著的时空异质性,但大多数研究只是在某一区域单独实施了时间或空间层面的分析,其在不同地区的时空关联尚不清楚.考虑到山东省社会经济发展不平衡,东、中、西部差异明显,因此本研究首先利用贝叶斯时空层次模型(BSTHM)呈现山东省细菌性痢疾的时空异质性,其次利用地理探测器法(GeoDetector)分别从不同的区域(东、中、西部)来研究气象要素对此疾病的影响,且针对热点地区,量化社会经济要素及其两两的交互作用对其的解释力.结果表明,时间上,发病高峰出现在夏季.空间上,高风险地区主要分布在山东省东部和北部区县,且气象因子在不同地区对该病的影响也存在显著差异.山东省东部沿海地区最重要的两个主导因子是风速和日照时数,其解释力分别为0.28和0.22.山东省西部内陆地区前两个主导因子为平均温度和降水量,其解释力分别为0.47和0.32.山东省中部地区前两个主导因子为平均温度和风速,其解释力分别为0.66和0.48.本研究通过对山东省各个地区细菌性痢疾发病情况的时空异质性以及影响因素的分析发现,湿热的环境有利于细菌性痢疾的传播.另外,在热点地区,起主导作用的社会经济因子是第三产业比重,表明社会经济状况对细菌性痢疾的发病具有一定的影响作用,为本地区细菌性痢疾的控制和预防政策的制定提供理论依据,针对不同地区需要更具体的方案来预防、控制和分配医疗资源,以提高其疾病应对能力,减少该疾病造成的潜在损失.

The environmental Kuznets curve (EKC) is often used to analyze the relationship between environmental pollution health indicators and economic development level in different regions. In developed countries, the blood lead levels (BLLs) of children have been declining fitting the EKC since the 1970s. However, such figures in China have remained at relatively high levels, without any obvious decline, since 2010. We explored spatial variations and graded countermeasures using reported data on BLLs including the lead poisoning rates (LPRs) of children. We found that there were prefectures where either the mean BLLs of the children had reached 100.00 μg/L or the LPRs of more than 40% of the children had reached 100 μg/L. When we reduced the average BLLs to 50 μg/L or lowered the proportion of children with a lead poisoning rate (LPR) above 100 μg/L to 10.00%, the EKC trend decreased, and the linear slope after 2010 became -0.202. If the areas where children's BLLs exceeded 50.00 μg/L or the proportion of children with an LPR above 100 μg/L was more than 10.00% will be controlled, the linear slope of the EKC decrease trend after 2010 will became -0.989, and the national average of children's BLLs would decline by 22.17%. The study concluded that children's BLLs in different regions of China are situated at different EKC stages, and urgent prevention and control strategies must be put in place for undeveloped areas.

针对食品安全社会共治存在的问题,本文构建了大数据融合背景下的食品安全社会共治体系模型,并以猪肉健康链中的安全监管为例进行应用分析,为相关政策实施提供参考.

Children's exposure to lead is a global health problem, especially in low- and middle-income countries. However, research on the relationship between children's blood lead levels (BLLs) and the development of the lead industry is still limited. This study examined whether children's BLLs were associated with the development of lead industry in different regions. Using survey data on the BLLs of children living in 250 prefectures in China with corresponding data on their economic factors and lead industries, we explored the regional variation of children's BLLs using statistical methods. The results show that the level of economic development in leaded areas was associated with inequity in children's BLLs and met the environmental Kuznets hypothesis. In areas without lead industries, there was little correlation between the level of economic development and the BLLs of children and thus the environmental Kuznets hypothesis was not supported. Lead mines, lead smelting and chemical companies are major sources of blood lead in children living in leaded areas. This study demonstrated the success of control policies for lead-acid battery manufacturers in promoting the prevention and control of childhood lead poisoning in China. China should consciously support the improvement of children's BLLs in undeveloped areas with lead industries through national financing and policies to avoid the continuous effects of the regional inequality problem of high children's BLLs.

目的:本文旨在分析我国小麦主要种植省份的重金属污染状况,以监控小麦重金属污染水平和预防食品安全隐患问题.方法:采用了绘制箱线图的方法研究了1171份小麦中重金属元素镉(Cr)、铅(Pb)、铬(Cd)、汞(Hg)和砷(As)的含量以及各省份中的分布差异.结果:小麦中镉污染分布平均水平为0.02 mg/kg,铅集中分布在0～0.16 mg/kg,总铬分布集中在0～0.3 mg/kg,总汞分布相对集中,平均水平小于0.01 mg/kg,总砷分布普遍集中在0.01～0.06 mg/kg,5种重金属元素均值含量均低于国家限定值.《食品安全国家标准食品中污染物限量》(GB 2762—2017)规定限量为镉(0.1 mg/kg)、铅(0.2 mg/kg)、总铬(1.0 mg/kg)、总汞(0.02 mg/kg)及总砷(0.5 mg/kg).安徽省、甘肃省和江苏省小麦总铬含量较高;湖北省、山西省和陕西省除汞外,其他元素含量较高;河北省、河南省、黑龙江省、内蒙古自治区、山东省、四川省以及新疆维吾尔自治区5种元素含量均较低.结论:小麦种植区域重金属污染程度较轻,受试省份的5种重金属均值含量具有显著性的差异.

This study performed statistical analysis and risk assessment of five heavy metals (As, Cd, Cr, Hg, Pb) in crayfish samples collected from six provinces in the middle and lower reaches of Yangtze River during 2015–2017. The Spearman correlation test and the results of hierarchical cluster analysis (HCA) indicated that As, Pb, and Cd in crayfish were significantly correlated, and the results of HCA showed that Jiangxi, Jiangsu, and Zhejiang were clustered into one group; Hubei, Hunan, and Anhui were clustered into another group; and provinces in the same group had spatial similarities in heavy metals. The pollution index (PI) values of five heavy metals in all provinces were below 1, implying that crayfish samples in this area were not highly contaminated. The target hazard quotient (THQ) values of five heavy metals were mainly below 1 except Hg in Anhui (2.9709), which was far beyond 1, indicating that the health risk posed by Hg exposure should not be ignored in Anhui.

This study analyzed five heavy elements (HEs), including cadmium (Cd), chromium (Cr), mercury (Hg), lead (Pb), and arsenic (As), in fresh vegetables (i.e., legume, rhizome and potato, gourd, bulb, solanaceous fruit, leafy, and brassica; total: 7214) collected from 31 provinces in China from 2016 to the first half of 2017. By analyzing the concentration level of the five HEs in seven regions (the Northeast, North China, East China, South China, Central China, the Northwest, and the Southwest), except for As, average HEs concentrations were higher in the Southwest than that in the other six regions. According to the maximum permissible limit (MPL), the highest rate of HEs concentration above the MPL was found in the Southwest (11.038%). Analysis of variance (ANOVA) showed varying degrees of variability between regions and categories. By using principal component analysis (PCA), it was found that two principal components account for 73.79% of the total variance in the data. Together with hierarchical cluster analysis (HCA), concluded that Tibet was significantly different from the other 30 provinces. By calculating estimated daily intake (EDI) and the target hazard quotient (THQ), the EDI of Cr in the Southwest was the highest, with results of 1.2119 μg/kg/day for children and 0.8073 μg/kg/day for adults. North China had the highest total target hazard quotient (TTHQ) for HEs in vegetables ingested by children, with a result of 0.933.

背景 随着我国老年流动人口数量的不断增加,该群体面临的健康和就诊问题成为建设健康中国的重要内容和关注热点.目的 了解我国老年流动人口的常见病症患病情况、就诊情况及影响因素.方法 使用2017年全国流动人口动态监测调查数据,以6478名60岁及以上的老年流动人口为研究对象,收集老年流动人口个人及家庭特征、流动特征、公共服务利用情况、个人健康状况4个方面变量.采用二元Logistic回归模型分析老年流动人口常见病症患病及就医行为选择的影响因素.结果 6478个有效样本中,健康自评结果显示,"健康"和"基本健康"的老年流动人口5264人(81.2％),而实际患有高血压和/或糖尿病的比例为35.0％(2270/6478).4112人(63.5％)表示在1年之内出现过常见病症的症状,其中,仅有1624人(39.5％)去医院就诊.Logistic回归分析结果显示,受教育程度、同住家庭成员数、流动范围、流入地区、参加健康教育情况、参加医疗保险情况、自评健康情况及慢性病患病情况是老年流动人口是否患有常见病症的影响因素(P<0.05);年龄、受教育程度、户口性质、流入地区、参加健康教育情况及自评健康情况是老年流动人口常见病症就诊情况的影响因素(P<0.05).结论 老年流动人口对自身健康的评价偏高,而就医主动性整体较差.老年流动人口常见病症的患病率和就诊情况受多维度因素影响.建议重点加强老年流动人口的健康教育力度,优化异地就医政策,关注老年流动人口医疗服务需求与利用情况,有效改善老年流动人口健康水平.

基于2017年全国综合调查(简称CSS)数据,选取性别、年龄、受教育程度、婚姻状况、就业状况、收入水平以及本地认同等7个指标,比较分析中国城镇居民食品安全满意程度.通过描述性统计发现,总体上,无论男性还是女性,均认为食品安全的比例低于食品不安全的比例,女性在食品安全评价上更为敏感,认为不安全的比例要高于男性;30～39岁年龄段的城镇居民认为食品不安全的比例最高;居民对于食品安全的评价偏向不安全,收入越高,食品安全评价为不安全的比例越高;认为自己是本地人的居民认为食品安全比例相对更高.进一步通过Logistic回归分析发现,不同性别、年龄、受教育程度、婚姻状况、年收入水平及本地认同的城镇居民对于食品安全程度评价不同,存在显著性差异,其他指标没有统计学意义.最后,针对当前中国城镇居民的食品安全认知水平和满意度现状提出了食品安全风险交流对策.

详细阐述食品安全风险监测信息平台系统设计,包括业务框架、应用系统、标准规范体系、数据采集和交换方式、基于大数据的食源性疾病预警等方面,指出该平台建设有助于提高国家、省两级平台数据采集交换能力,推进各地食品安全信息化建设,完善国家食品安全风险监测管理工作流程.

While one has yet to be built in China, a rice supply flow network would provide essential information for stabilizing and optimizing food distribution and ensuring food security. Moreover, it is unclear how socioeconomic and natural environmental factors affect the rice supply flow. In this study, 35,768 random samples from the rice sales market were collected to build the rice flow network of China. The rice supply patterns at a regional and provincial level were revealed by the rice flow network. At the regional level, Northeast, Central, and East China are the main rice source areas, supplying almost all of China. At the provincial level, economically developed megacities, such as Beijing and Shanghai, and provinces with low temperatures like Tibet and Qinghai, rely heavily on imported rice. Determinant analysis shows that the rice supply patterns are mainly attributable to the cultivated area, primary industry employees, the permanent population, and tertiary industry proportion. These factors explain 75%, 59%, 48%, and 31%, respectively, of the rice supply spatial patterns. Furthermore, the interactions of cultivated area and temperature, cultivated area and primary industry proportion, and cultivated area and precipitation can explain 94%, 91%, and 89%, respectively, of the rice supply patterns. These findings reveal China's rice supply patterns and their determinants in recent years, providing essential information for optimizing the layout of rice production and ensuring food security in the future scenarios of climate change and socioeconomic development.

The blood lead levels (BLLs) of children in China remain notably high in many areas. We aimed to summarise the relevant regional characteristics, identifying problematic areas and the causes of lead pollution. We searched the databases of PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data, systematically reviewing 219 articles published from January 2010 to September 2020. In doing so, we assessed the BLLs noted in 220 prefectures across China. Data were organised using Geographic Information Systems (GIS) mapping. Out of a total of 629,627 children sampled, we found that the average blood lead level (BLL) of children included in our study is 50.61 ± 13.63 μg/L, which slightly exceeds the 50.00 μg/L US standard. Within the sample, 8.75% had BLLs higher than 100.00 μg/L. Children living in Liaoning, Hebei, Shanxi, Jiangxi, Anhui, Fujian, Guizhou, Yunnan, and Guangxi had notably high BLLs, at more than 60.00 μg/L. A total of 112 municipalities had an average children's BLL above 50.00 μg/L. Furthermore, Chenzhou, Linfen, Yuncheng, and Hechi had the highest children's BLLs, with average values above 100.00 μg/L. The leading contributors to lead pollution are lead mining, lead recovery and the smelting industry. Nonetheless, the lead-acid battery industry needs more attention. Although data suggest that BLLs are decreasing in China, many areas still have high BLLs that need to be monitored. Moreover, national standards must improve to decrease acceptable BLL thresholds for children.

Previous studies indicate that the incidence of bacillary dysentery is closely related to meteorological factors. However, the impact of temperature and the spatial heterogeneity of the disease in regions of unbalanced socioeconomic development remains unclear. Therefore, this research collected data for 29,639 daily bacillary dysentery cases in children under 5 years of age, as well as the meteorological variables from China’s Beijing–Tianjin–Hebei region, to analyze the spatial pattern of bacillary dysentery and reveal its nonlinear association with temperature. The SatScan method was employed first, to detect the spatial heterogeneity of the disease risk, and then the distributed lag nonlinear model (DLNM) was used to analyze the relationships between the daily minimum, mean, and maximum temperatures and bacillary dysentery in the stratified heterogeneous regions. The results indicated that bacillary dysentery incidence presented statistically significant spatial heterogeneity. The area of highest risk was found to be Beijing and its neighboring regions, which have high population densities. There was also a positive association between bacillary dysentery and temperature. Hotter temperatures were accompanied by higher relative risks. In the most likely spatial cluster region, the excess risk (ER) values for a 1°C rise in minimum, mean, and maximum temperatures above the median were 4.65%, 11.30%, and 19.21%, respectively. The effect of temperature on bacillary dysentery peaked at a lag of 3 to 4 days. The findings of this study will aid risk assessments and early warning systems for bacillary dysentery.

Hand, foot, and mouth disease (HFMD), predominantly occurs among infants and children. Previous studies have shown that suitable, stable temperatures favor HFMD virus reproduction; however, temperature fluctuations also affect virus transmission, and there are, so far, no studies concerning the association between such fluctuations and the incidence of HFMD. The objective of this study was to map the spatial-temporal distribution of HFMD incidence and quantify the long-term effects of temperature fluctuations on HFMD incidence in children. HFMD cases in children under five, from January 2009 to December 2013, in Beijing, Tianjin, and Hebei provinces of China, were used in this study. The GeoDetector and Bayesian space-time hierarchy models were employed to explore the spatial-temporal association between temperature fluctuations and HFMD incidence. The results indicate that HFMD incidence had significant spatial stratified heterogeneity (GeoDetector q-statistic = 0.83, p < 0.05), and that areas with higher risk mainly appeared in metropolises and their adjacent regions. HFMD transmission was negatively associated with temperature fluctuations. A 1 °C increase in the standard deviation of maximum and minimum temperatures was associated with decreases of 8.22% and 11.87% in the risk of HFMD incidence, respectively. The study suggests that large temperature fluctuations affect virus growth or multiplication, thereby inhibiting the activity of the virus and potentially even leading to its extinction, and consequently affecting the spatial-temporal distribution of HFMD. The findings can serve as a reference for the practical control of this disease and offer help in the rational allocation of medical resources.

为了提高智能医疗图像处理水平,减少人工分析病理图像,节约医院成本,提出一种基于血管连通性的视网膜血管分割技术,该技术采用连接敏感注意力U-Net(connection sensitive attention U-Net,CSAU)的网络模型,设计新型神经网络结构的注意门,结合提出的连接敏感损失,应用视网膜血管分割,从而实现对异常、分叉和微血管的血管分割.最后,通过在DRIVE、STARE和HRF数据集上进行测试,实验结果表明,基于血管连通性的视网膜血管分割技术可以通过对连通性和拓扑性进行建模保留细血管的连通性.

针对卫健委多监测系统间食品分类编码不规范、层级不统一,数据难以有效关联、深度挖掘等问题,以现有全国食品污染物填报系统、食源性疾病暴发监测系统和全国食品微生物风险监测数据汇总信息平台中的食品分类和编码相关数据为研究对象,比较各系统食品大类构成、设计目标、分类层次及依据、编码位数及规则,结合我国饮食结构特征,构建基于食品分类+属性的多元组合理论方法及编码规则,建立基于通用标准体系的食品映射标注系统网络平台并形成数据映射融合机制.基本完成了卫健委三大监测系统中食品分类和编码的映射工作,实现了数据融合.建立的通用标准体系具备兼容性强、可进化、可扩展特点,可以实现现有食品安全数据的跨库查询、统计,为进一步实现跨系统、跨部门、全链条食品安全业务数据融合提供了解决方案.