Ischaemic stroke (IS) has a heavy disease burden. Although epidemiological research has suggested that heatwaves are associated with cardiovascular disease, there is a lack of empirical evidence for a correlation between heatwaves and IS. The China Meteorological Administration defines a heatwave as a wave lasting ≥ 3 days, with a maximum temperature of ≥ 35℃. We collected data on daily meteorological conditions, air pollution, and IS admissions in Hunan Province from 2018 to 2019. A generalized additive model and distributed lag nonlinear model were used to determine the associations between heatwaves and IS admissions. We analysed 329,876 admitted patients with IS in Hunan Province from 2018 to 2019. The main effect of heatwaves was that they significantly increased the risk of hospitalization for IS. The single-day lag maximum risk occurred at a daily average temperature of 30.88℃ (RR = 1.05, 95% CI: 1.04–1.06) and at a daily maximum temperature of 35.82℃ (RR = 1.05, 95% CI: 1.03–1.06). The use of the 5th and subsequent days of a heatwave as a reference showed that the 1st–2nd days (RR = 1.07, 95% CI: 1.02–1.12) and the 3rd–4th days (RR = 1.06, 95% CI: 1.03–1.10) of the heatwave increased the risk of hospitalization for IS. Compared with the third and subsequent heatwaves, the first (RR = 1.27, 95% CI: 1.19–1.35) and second (RR = 1.24, 95% CI: 1.16–1.32) heatwaves had greater impacts on the risk of hospitalization for IS. The risk of IS hospitalization was also exacerbated by high relative humidity (RR = 1.25, 95% CI: 1.16–1.35) and a low diurnal temperature range (RR = 1.08, 95% CI: 1.02–1.14) during the heatwave period. In our study, the main effects of heatwaves increased the risk of IS hospitalization. The effects varied according to the day of the heatwave, the timing of the heatwave, the DTR during the heatwave, and the humidity during the heatwave. This evidence has significant implications for the strategic planning of public health interventions to mitigate adverse health outcomes associated with heatwaves.

OBJECTIVES: This study investigated the seasonal impact of diurnal temperature range (DTR) on hospitalization rates for intracerebral hemorrhage (ICH) in middle-aged and elderly adults.METHODS: We collected data on the DTR and hospitalization records of ≥45-year-old patients with ICH in 2019 in Hunan Province, central China. Time-series analyses were performed using a distributed lag non-linear model.RESULTS: Overall, 54,690 hospitalizations for ICH were recorded. DTR showed a non-linear relationship with ICH hospitalization in both middle-aged and elderly populations (45-59 and ≥60 years, respectively). During spring, a low DTR coupled with persistently low temperatures increased ICH risk in both age groups, while a high DTR was associated with an increased risk in the middle-aged group only (relative risk [RR], 1.24; 95% confidence interval [CI], 1.21 to 1.27). In the summer, a low DTR combined with persistently high temperatures was linked to a higher risk exclusively in the middle-aged group. A high DTR in the autumn was correlated with increased risk in both age groups. In winter, either a low DTR with a continuously low temperature or a high DTR elevated the risk solely in the elderly population (RR, 1.37; 95% CI, 1.00 to 1.69). In the elderly group, the impact of DTR on hospitalization risk manifested within a 5-day period.CONCLUSIONS: The impact of DTR on ICH hospitalization risk differed significantly across seasons and between age groups. Elderly individuals demonstrated greater sensitivity to the impact of DTR. Weather forecasting services should emphasize DTR values, and interventions targeting sensitive populations are needed.

Objective:To study the effect of diurnal temperature range on the number of elderly inpatients with ischemic stroke in Hunan Province.Method:Demographic and disease data, meteorological data, air quality data, population, economic and health resource data of elderly inpatients with ischemic stroke were collected in 122 districts/counties of Hunan Province from January to December 2019. The relationships between the diurnal temperature range and the number of elderly inpatients with ischemic stroke were analyzed by using the distributed lag non-linear model, including the cumulative lag effect of the diurnal temperature range in different seasons, extremely high diurnal temperature range and extremely low diurnal temperature range.Results:In 2019, 152 875 person-times were admitted to the hospital for ischemic stroke in the elderly in Hunan Province. There was a non-linear relationship between the diurnal temperature range and the number of elderly patients with ischemic stroke, with different lag periods. In spring and winter, with the decrease in diurnal temperature range, the risk of admission of elderly patients with ischemic stroke increased ( Ptrend<0.001, Ptrend=0.002);in summer, with the increase in diurnal temperature range, the risk of admission of elderly patients with ischemic stroke increased ( Ptrend=0.024);in autumn, the change in the diurnal temperature range would not cause a change in admission risk ( Ptrend=0.089). Except that the lag effect of the extremely low diurnal temperature range in autumn was not obvious, the lag effect occurred in other seasons under extremely low and extremely high diurnal temperature ranges. Conclusion:The high diurnal temperature range in summer and the low diurnal temperature range in spring and winter will increase the risk of admission of elderly patients with ischemic stroke, and the risk of admission of elderly patients with ischemic stroke will lag under the extremely low and extremely high diurnal temperature ranges in the above three seasons.

Objective Little is known about spatial variability of hospitalisation rate (HR) of patients with rheumatoid arthritis (RA) worldwide, especially in China. Methods A cross-sectional study was conducted among patients with RA admitted to hospitals in Hunan Province. Global Moran’s I and local indicators of spatial association were used to explore the geospatial pattern of the HR of patients with RA. Generalised estimating equation analysis and geographically weighted regression were used to identify the potential influencing factors of the HR of patients with RA. Results There were a total of 11 599 admissions, and the average HR was 1.57 per 10 000 population in Hunan. We detected different cluster patterns of the HR among patients with RA by local indicators of spatial association. Age, ethnicity, average temperature, average temperature range, average rainfall, regions, gross domestic product per capita, and doctors and hospitals per 10 000 people were risk factors for the HR. However, only average temperature, gross domestic product per capita and hospitals per 10 000 people showed different regression coefficients on the HR in different counties. The increase in hospitals increased the probability of HR from east to west in Hunan with a positive coefficient, while temperature decreases increased the risk of HR from south to north negatively. Similarly, the growth of gross domestic product per capita decreased the probability of HR from southwest to northeast. Conclusion A non-random spatial distribution of the HR of patients with RA was demonstrated in Hunan, and average temperature, gross domestic product per capita and hospitals per 10 000 people showed different regression coefficients on the HR in different counties. Our study indicated that spatial and geostatistics may be useful approaches for further study among patients with RA.

OBJECTIVESStroke readmission increases financial burden on the family and the consumption of medical resources, and 30-day readmission rate is an important indicator for quality evaluation on health services. The influential factors for readmission mainly include patient-related factors, hospital factors, and society-related factors, with regional differences. This study aims to explore the spatial distribution and its main relevant factors for 30-day readmission of stroke patients in Hunan Province, and to provide the useful information for the improvement of regional prevention and control of stroke readmission.METHODSStroke patients in Hunan Province who were hospitalized in 2018 and readmitted within 30 days were included in the study. The vector map of the county boundary in Hunan Province was used as the basic map since county was the spatial analysis unit. SPSS 26.0 and ArcGIS 10.8 were used for statistical analysis that contains descriptive analysis of the general situation and the distribution map of readmission rate within 30 days of stroke patients. Spatial autocorrelation analysis and spatial regression analysis were further used to find the spatial clusters of the 30-day readmission rate of stroke and the local relationship between the readmission rate and main influential factors.RESULTSIn 2018, a total of 172 800 stroke patients were hospitalized in Hunan Province, of which 6 953 patients were re-hospitalized within 30 days after discharging due to stroke. The 30-day readmission rate was 4.09% in Hunan Province. The clusters of stroke readmission rates were mainly concentrated in the northeast and western regions in Hunan Province. The geographically weighted regression revealed that proportion of patients with complications, number of hospitals per 10 000 population and number of primary medical and health care institution per 10 000 population were the main relevant factors for stroke readmission, and there were differences both in the direction and degree of the effect on readmission in different regions.CONCLUSIONSThe 30-day readmission rate for stroke patients in Hunan province and its main influential factors had spatial heterogeneity. The key prevention and control areas were mainly concentrated in the northeast and western regions. It is recommended that the prevention and treatment of stroke complications and the construction of medical institutions need to be strengthened to improve the quality of medical services, particularly in the western region. The importance to the treatment of stroke complications should be attached in the northern region, and the primary health care should be reinforced in the northeast region. All counties should take prevention and control measures according to local conditions, so as to effectively control the readmission rate of stroke within 30 days.

Objective:To analyze the current status of referral of stroke inpatients and explore the characteristics of the referral network in Changsha, for the reference to improve and promote the hierarchical medical system of stroke.Methods:Data of the inpatient medical record of stroke patients and the annual reports of medical institutions in Changsha in 2018 were collected from the health statistics network direct reporting system of Health Commission of Hunan province, for analysis of the referrals of inpatients in different medical institutions. Social network analysis was adopted to analyze the density, centrality and K-core of the referral network of stroke inpatients.Results:A total of 82 medical institutions for stroke inpatients were included with 2 859 referrals of patients. Most of the referrals were made between tertiary hospitals(1 515), especially within hospitals of a stroke alliance(1 123). The density of referral network was 0.613.Tertiary hospitals were in the center of the network, the entry points of secondary hospitals were in the center of the network and primary medical institutions were located at peripheral positions. Most of the tertiary hospitals in the 15-core(14, 72.68%), 12 of them were the units of Hunan Stroke Alliance.Conclusions:Tertiary hospitals played an important role in the region, secondary hospitals were able to receive patients referred by tertiary hospitals, but few patients were transferred to primary care institutions; The primary medical institutions failed to play due roles in the referral network. The establishment of stroke alliances could promote the cooperation of hospitals in the alliance, but the division of labor and cooperation among different levels of medical institutions in the region needed to be further optimized.

目的 通过对湖南省恶性肿瘤住院患者死亡情况进行统计分析,为相关部门恶性肿瘤的防治提供决策依据.方法 以国际疾病分类ICD-10编码为标准进行分类,对2017年1月1日-2017年12年31日湖南省医疗系统住院病案首页数据库资料进行回顾性统计分析.结果 恶性肿瘤住院死亡患者男女性别比为2:1;60岁以上年龄组死亡率最高,占67.60％;职业为农民最多,占41.44％;付款方式以城镇职工基本医疗保险支付为主,占56.11％;来源地以长沙最多,占37.65％;死因顺位前十位为:肺癌、肝癌、胃癌、食管癌、胰腺癌,直肠癌、胆囊癌、乳腺癌、结肠癌、前列腺癌,合计占53.06％.恶性肿瘤住院死亡患者病死率在不同性别、年龄、职业、付款方式、来源地间的差异具有统计学意义(P<0.01).结论 2017年湖南省恶性肿瘤住院死亡患者以男性、中老年患者、农民居多;死因顺位以肺癌和消化系统肿瘤为主.应针对该省恶性肿瘤住院死亡患者的流行特征,采取行之有效的防治措施,达到早诊早治,达到降低恶性肿瘤病死率的目的.

在抗击新型冠状病毒肺炎(简称新冠肺炎)疫情的斗争中,湖南省率先启动重大突发公共卫生事件一级响应,采取一系列前所未有的防控和救治举措,确诊病例的总体治愈率在全国名列前茅.但此次新冠肺炎的暴发也暴露出了湖南省公共卫生人才数量不足、结构不合理、人员经费投入不足、人员考核和激励机制不够完善等突出问题.本文从以下四个方面提出建设意见:深化公共卫生与预防医学人才培养改革,为公共卫生事业提供人才支撑;完善公共卫生人才准入原则与使用办法;加大公共卫生的政府投入,提高人员待遇保障;完善公共卫生人员考核评价和激励机制,增强人员工作效率和发展高质量公共卫生服务等.

目的 了解某省病案首页填写缺陷情况,分析原因,提出改进措施,为下一步顺利开展DRGs工作打下基础.方法 从某省卫生统计直报系统数据库中抽取52家三级医院2017年病案首页数据,从缺项、误填、填写规范、逻辑错误和质量评分方面对住院病案首页进行分类统计分析.结果 抽取的三级医院2 331 180份病案首页中,项目填报完整率为96.03％,缺陷率为3.97％,其中患者住院过程信息缺陷率最高,为7.42％,其中入院科别缺陷严重,缺陷率达50.64％,且三级非甲非乙等医院缺陷率要高于三级甲等和三级乙等医院.某省病案首页数据平均分为91.75分,优秀率为16.37％,合格率为95.15％.结论 某省三级医院病案首页缺陷的主要原因在于医务人员重视度不够和质控监管不到位,病案首页质量有待提高,需要提高医务人员对病案信息重要性的认识,并利用信息化手段进行病案首页质量控制.

Objective The paper aims to analyze the Human resource allocation and its fairness for Hunan medical treatment and public health between 2008 and 2013 and provide basis for optimization of human resource allocation of medical treatment and public health for health administrative department.Method Based on the Gini coefficient and Theil index, the fairness of human resource allocation for Hunan medical treatment and public health can be measured from population, geography and economy distribution.Result The total amount of human resource for Hunan medical treatment and public health is continuously increasing from 2008 to 2013, but it is still unable to reach the national average level. Gini coefifcient is less than 0.3. Furthermore, Gini coefifcient distributed in accordance with population distribution is greater than the Gini coefficient distributed in accordance with economy distribution and lower than the Gini coefficient distributed in accordance with geographical distribution. Theil index distributed in accordance with geographical distribution is greater than the Theil index distributed in accordance with population and economy distribution. The Gini coefifcient and Theil index for registered nurse are greater than the one for certiifed doctor and health workers. After adjustment, the amounts of certiifed doctors have impacts on Gini coefifcient and Theil index.Conclusion The allocation level of main medical treatment and public health resource is relatively lower, but its fairness is pretty well. Distribution in accordance with population and economy is obviously better than distribution in accordance with geography. The allocation fairness for nurses is worse than certiifed doctors and medical technician. The difference between public health human resource qualities will inlfuence the fairness of public health human resource allocation. Therefore, it is suggested that the government should strengthen the efforts to distribution of medical treatment and public health resource, take count of equity simultaneously, shorten regional difference, lay emphasis on optimization of nurse human resource allocation to improve Human medical service quality.

流动人口与常住人口相比,因其居无定所、劳无定职、行无定踪而成为社会管理的难点人群,有些甚至是盲点人群,人口和计划生育管理也概莫能外.流动人口管理难,似乎已成为难以解题的计划生育管理"哥德巴赫猜想".笔者基于近年在开发、应用和监控全国流动人口计划生育信息交换平台的经验,试图通过设计流动人口信息流管理的模式,为全国实现流动人口计划生育以现居住地管理为主和"一盘棋"管理的目标提供优化信息交换平台模式的解决方案.

<正>本文基于三年来开发、应用和监控全国流动人口计划生育信息交换平台的经验,试图通过设计流动人口信息流管理的模式,为全国实现流动人口计划生育以现居住地管理为主和”一盘棋”管理的宏伟目标提供优于现行信息交换平台模式的解决方案。一、流动人口信息流管理概念的引入背景流动人口信息流管理是指各级政府和相关部门对人口流动过程中各类有价值信息进行收集、分析、应用、储存的工作过