目的 探讨甘肃省手足口病的时空分布特征和发病风险区域,评估防控措施实施效果.方法 收集2018年甘肃省87个县每周手足口病数据,分析手足口病的时间风险特征指数,采用空间聚类分析方法对时间风险特征指数的发病风险区进行可视化探测和分析.结果 2018年甘肃省手足口病共报告病例13571例,报告发病率为51.73/10万,全年有两个发病高峰.手足口病的时间风险特征指数(频率指数为0.430,持续时间指数为4.657,强度指数为11.106)存在空间聚集性,3个时间风险特征指数在定西市安定区和兰州市七里河区均呈现高值聚集状态,是手足口病发病的热点区域.结论 甘肃省手足口病发病存在时空聚集性,安定区和七里河区是手足口病的发病高风险区域,不同发病风险区防控措施效果不同.

目的 描述并探讨甘肃省新型冠状病毒肺炎(COVID-19)疫情的时间风险特征.方法 收集截至2020年2月16日甘肃省各县(区)报告的COVID-19的发病数、相应县(区)人口数等数据,运用空间统计学的方法计算各县(区)的时间风险指数频率指数(α)、持续时间频率(β)和强度指数(y).结果 全局自相关分析发现,α的Moran's I系数为0.115,提示未来COV1D-19发病频率增加概率较小.y的Moran's I系数为0.070,说明COVID-19确诊病例不会集中出现,疫情的发病强度较低.甘肃省COVID-19疫情的α、β存在全局空间自相关性(P＜0.05),y不存在全局空间自相关性(P＞0.05).α局部空间自相关分析发现区域(主要分布于兰州市城关区、七里河区、安宁区、红古区、皋兰县和榆中县)内存在高-高聚集性(P＜0.05).β局部空间自相关分析发现区域(主要分布于兰州市城关区、七里河区、西固区、安宁区、皋兰县和榆中县)内存在高-高聚集性(P＜0.05).结论 结果提示兰州市大部分县(区)呈现高风险聚集性,但发病强度较低;全省在疫情期间采取的各项防控措施及时、有效.

目的 探索气象因素对甘肃省流行性感冒(流感)流行强度的影响,为流感防控关口前移提供科学依据.方法 本研究选择2010-2016甘肃省白银、天水、酒泉3个地区监测点的病原学监测数据及气象资料,通过交互相关分析确定各气象因素对流感发病效应的滞后时间,运用分类回归树模型遴选出对流感流行强度影响最大的气象因素.结果 气象因素相关性研究显示,温度、湿度与流感流行强度呈负相关.天水市最高温度的3周移动平均低于19.11℃时流感流行强度升高1.89倍;酒泉市平均温度的3周移动平均低于8.03℃时流行强度升高2.01倍;白银市平均温度的3周移动平均低于8.68℃且相对湿度的14周移动平均低于61.04％时流行强度升高2.24倍.结论 甘肃省流感的流行受气象因素影响,寒冷干燥的气象条件有利于流感在人群中传播.

Objective To analyze the epidemic dynamics and distribution characteristics of influenza in Gansu province, so as to provide scientific basis for formulating prevention and control strategy. Methods Etiological surveillance data of influenza in Gansu province from 2010 to 2016 were collected through the Chinese Influenza Surveillance Information System. The difference in the positive rates of viral nucleic acid and type constitution of influenza in different years, seasons, populations and regions were compared by Chi-square test. The geographic distribution maps were drawn by ArcGIS 10.2. Results A total of 54 795 samples of influenza-like illness were collected in Gansu province from 2010 to 2016, the positive detection rate of influenza virus nucleic acid was 14.77% (8 091/ 54 795). The main types of influenza virus were A(H1N1)pdm09, A(H3N2) and B, accounting for 98.89% (8 001/ 8 091) of all positive specimens. The statistical difference of positve rates existed among each surveillance year (x2=289.68, P<0.01), and the highest was in 2015-2016 (19.00%, 2 529/13 309). The influenza epidemic intensity showed a typical annual single-peak distribution in December to the next January. For positive detection rate of influenza virus and pathogen type composition, there were statistically significant differences among age groups (the Chi-square values were 589.06 and 173.53, respectively, and both P values were less than 0.01). The positive rate was the highest in the 5~14 years old group (21.36%, 2 765/12 942), and influenza B virus was predominant in this group (51.02%, 1 401/2 746). Both influenza positive rate and pathogen type composition had statistically significant differences in different regions (the Chi-square values were 430.82 and 233.47, respectively, and both P values were less than 0.01). The positive rate was the highest in Dingxi city (20.25%, 559/2 761). Conclusions Annual influenza vaccination campaigns should start in October to provide effective protection during the epidemic period. School was the key sites of influenza epidemic prevention and control. Influenza vaccination for 5~14 years old group would be helpful to the prevention and control of influenza.

目的 了解2009-2015年甘肃省各级医疗机构公共卫生资源配置及服务能力现状.方法 回顾性调查甘肃省5家省级,7家市(州)级,14家县级医院及27家乡(镇)卫生院公共卫生科建设、人员和硬件配置、组织管理、公共卫生服务能力等情况,访谈公共卫生科责任人.结果 48家医疗机构设置了公共卫生科,5家虽未单独建立,但隶属于护理部、中医科或预防接种室,办公总面积3 257 m2,配备专用电脑158台,工作人员436人次,年龄中位数32.90岁,专职人员279人次,大专及以上学历76.61％,预防医学专业9.17％,省、市(州)级人员学历和预防专业(公共卫生)均高于县级及乡(镇)卫生院(x2=17.421,P=0.000;x2=24.497,P=0.000),非在岗人员63.16％调至其他科室.100.00％医疗机构开展医院感染预防控制、传染病诊疗管理、预防接种和慢病管理工作,14.81％和22.22％开展职业病管理和放射安全防护.结论 甘肃省医疗机构公共卫生科建设、硬件配备和日常运营状况良好,专业人员素质有待加强,公共卫生服务范围有待明确和规范,服务能力有待提高.

目的 评价甘肃省6年间各级医疗机构法定传染病报告水平,为进一步提高传染病报告质量提供科学依据.方法 采用分层随机抽样的方法,抽取甘肃省7个市、州57家医疗机构作为调查对象,开展传染病报告和登记质量的调查分析.结果 甘肃省6年来法定传染病报告率平均为94.31％,及时报告率为95.92％,门诊日志完整率为92.57％,出入院登记完整率为93.95％,不同级别医疗机构及时报告率6年来整体呈现上升趋势.省级医疗机构的传染病报告和登记质量低.结论 甘肃省不同级别医疗机构传染病报告质量有所上升,要进一步完善和规范HIS系统传染病报告管理功能,重点加强省级医疗机构传染病报告管理工作,全面提升甘肃省传染病报告质量的水平.

Objective To analyze the performance efficiency of temporal model in China Infectious Diseases Automated-Alert and Response System(CIDARS) in Gansu province from 2008 to 2013 and to evaluate the sensitivity and practicability of CIDARS.Methods Data on infectious disease automated alert signals form CIDARS in Gansu province from January 2008 through December 2013 were collected and analyzed with descriptive methods and the effect of alert threshold adjustment in temporal model in CIDARS was assessed for different areas and diseases.Results Totally 39 940 early-warning signals were issued by CIDARS;the ratio between the number of reported infectious disease cases and the number of early-warning signals was 9.01:1;the suspected incident signals accounted for 1.57％ of all the early warning signals;the positive rate of early-warning signals was 0.64％.The majority of the warning signals were the incidents of dysentery,other infectious diarrhea,and mumps,accounting for 63.17％ of all the warning signals.The earlywarning signals involved 86 counties or districts of 14 prefectures in the province and the median response time for the signals was 0.84 hour.After the adjustment of early-warning threshold in December 2010,the sensitivity of CIDARS dropped from 70.59％ to 39.62％ and the positive rate dropped from 0.88％ to 0.34％.The positive rate declined for the early-warning signals of influenza,mumps,rubella,hand foot and mouth disease,other infectious diarrhea,dysentery,hepatitis A,and acute hemorrhagic conjunctivitis;whereas the positive rate increased for the signals for the incidents in Lanzhou and Jiayuguan municipality.The median response time shortened for all the early-warning signals.Conclusion The performance of CIDARS in Gansu province was stable between 2008 and 2013,but the adjustment of early-warning threshold in CIDARS showed no good results,suggesting that the threshold still needs to be optimized for the improve ment of sensitivity and specificity of CIDARS.

2017年1月9日至19日,我随扶贫成效省际交叉考核甘肃组赴内蒙古自治区,对其扶贫开发工作成效进行了实地考核.通过入户走访及与考核组同志共同分析探讨,我了解到内蒙古自治区解决脱贫攻坚工作难题的一系列正确解法.

We used molecular-biology methods to identify the pathogens that caused an outbreak of viral encephalitis in Guazhou (Gansu province, China)during June-August 2015.We also undertook molecular characterizations of these pathogens. A total of 132samples(14cerebrospinal fluid(CSF)samples;25throat swabs;66serum samples;27fecal samples)were collected from 74 patients during the outbreak of viral encephalitis. For CSF and serum samples, enzyme-linked immunosorbent assay immunoglobulin-M tests were undertaken to detect Japanese encephalitis viruses, enteroviruses, herpes simplex viruses, mumps viruses, and adenoviruses. Real-time polymerase chain reaction was done to detect enteroviruses(including coxsackievirus A16 and enterovirus 71) and the RNA of human adenoviruses. Then, viral isolation was carried out using HEp-2 and RD cells, and the entire VP1 region of positive viral isolates was amplified and sequenced. Finally, molecular characterizations of these pathogens were completed. Seventy two samples were identified as enteroviruses from 132 samples. Among them,71 were identified as echovirus(ECHO)30using enterovirus molecular typing. Japanese encephalitis viruses,herpes simplex viruses, mumps viruses, and adenoviruses were not detected.ECHO30 was isolated from 46 samples out of 29 patients.Similarities in nucleic acids among these ECHO30 isolates were 99.2%-100.0%.ECHO30 from Gansu province and other ECHO30 strains isolated in China since 2011 belonged to a same evolutionary branch.ECHO30 was the pathogen that caused the outbreak of viral encephalitis in Guazhou in 2015.ECHO30 from and Gansu province and ECHO30 isolated in China since 2011 belonged to the same evolutionary branch.

目的 运用空间统计学的方法描述并分析2013年甘肃省肺结核发病的空间分布模式,为肺结核的防控提供理论依据.方法 利用"全国传染病疫情信息网络直报系统"导出甘肃省2013年各区(县)肺结核发病数据、相应区(县)人口数等数据,运用空间统计软件分析甘肃省肺结核发病的空间相关性、空间聚集性特征.结果 甘肃省2013年肺结核报告发病率存在空间自相关性(Moran's I=0.314,Z(I)=4.673,P＜0.001);局部空间自相关分析发现区域内存在高-高(或热点区域,主要分布于金昌市以西的河西地区)、低-低(或冷点区域,分布于兰州市部分地区、定西市安定区、平凉市与庆阳市相连地区)等关联模式的县(区)(P＜0.05);不规则空间扫描结果显示肺结核发病最大可能聚集区为河西地区(LLR=364.83,RR=1.888,P=0.001),且与局部空间自相关高-高关联模式区域相似.结论 甘肃省2013年肺结核报告发病率呈非随机分布,河西及陇南部分地区为甘肃省肺结核发病聚集区域,是肺结核的重点防控地区.

目的 运用空间统计学的方法描述并探讨2013年甘肃省猩红热发病的空间分布特征.方法 利用"全国传染病疫情信息网络直报系统"导出2013年甘肃省各区(县)猩红热发病数据、相应区(县)人口数等数据,运用空间统计软件分析甘肃省猩红热发病的空间相关性、空间聚集性特征.结果 2013年甘肃省猩红热报告发病率存在空间自相关性(Z(I) =5.222,P=0.001);局部空间自相关分析发现区域内存在高-高关联模式的县(区)为安宁区(P =0.050)、肃北县(P =0.030)、安西县(P=0.010)和敦煌市(P =0.010)、低-低等关联模式的县(区)为武山县(P=0.040)、通渭县(P=0.010)、陇西县(P =0.020)、渭源县(P=0.030)、岷县(P=0.040)、武都区(P=0.040)、西峰区(P =0.020)、庆城县(P=0.010)和宁县(P=0.050);规则空间扫描结果显示猩红热发病最大可能聚集区为酒泉市的部分县区(RR=12.17 ,P =0.001).结论 2013年甘肃省猩红热报告发病率呈非随机分布,酒泉市、嘉峪关市、金昌市、兰州市、白银市和临夏州为甘肃省猩红热发病聚集区域,是猩红热的重点防控地区.

目的 探讨甘肃省4种主要自然疫源性疾病空间分布特征,掌握高发重点区域,为疫情防控提供理论依据.方法 利用Flexible空间扫描统计量对甘肃省2009-2013年4种自然疫源性疾病进行空间扫描分析,通过地理信息系统呈现空间聚集区域.结果 空间扫描结果显示,甘肃省4种自然疫源性疾病具有明显的空间聚集区域.其中,肾综合征出血热、布鲁氏菌病(布病)和炭疽主要集中在甘肃省东南部的湿润区,呈现出东南多西北少的特点,并且布病和炭疽高发区主要在农牧区.疟疾主要集中在甘肃省西部地区.结论 Flexible空间扫描软件与地理信息系统相结合可有效对甘肃省4种自然疫源性疾病的空间聚集性作出早期预警.

Objective To understand the spatial distribution of bacillary dysentery cases in Gansu in 2013 and its spatial autocorrelation and clustering areas.Methods The incidence data of bacillary dysentery in 87 counties in Gansu in 2013 were collected from National Disease Reporting Information System to analyze the spatial autocorrelation by using Geoda 1.60 and conduct spatial scan statistics by using Sa TScan 9.1.1.0.The results were visualized by using Arc GIS 10.0 software.Results In 2013,8191 bacillary dysentery cases were reported,the incidence was31.81 /100 000.The bacillary dysentery distribution showed a spatial autocorrelation in all the study areas(Moran's I =0.4555,Z = 6.51,P = 0.001).By local spatial autocorrelation analysis,the highly autocorrelation of bacillary dysentery cases was observed in Qingyang in eastern Gansu and 9 countries in southern Gansu,thehot spotareas,and the lowautocorrelation of bacillary dysentery cases was observed in 11 counties in west-central Gansu,the cold spotareas.The spatial scan detected the major clustering areas in 5 counties near Lanzhou(LLR = 137.10,RR = 2.38) and in 9counties in Qingyang(LLR = 428.60,RR = 2.40).Conclusion The bacillary dysentery cases were not distributed randomly in Gansu in 2013,the spatial autocorrelation and obvious clustering were observed.

目的 了解轮状病毒在5岁以下门诊和住院腹泻儿童中的流行特征,探索建立轮状病毒腹泻经济负担的评价方法,为轮状病毒疫苗的使用和成本效益评价提供背景资料.方法 收集甘肃省2012年8月-2013年7月2个轮状病毒哨点医院门诊和住院的5岁以下腹泻就诊儿童的个案信息和粪便标本,进行轮状病毒腹泻流行特征分析,对所有标本统一使用酶联免疫吸附试验方法检测轮状病毒,资料采用SPSS 17.0进行数据分析.结果 共调查5岁以下腹泻就诊儿童734例,轮状病毒阳性率为41.69％,其中门诊病例的轮状病毒阳性率为30.99％,住院病例的轮状病毒阳性率为46.07％,门诊和住院轮状病毒腹泻儿童的发病年龄主要集中在2岁以下,分别占门诊和住院腹泻儿童的92.42％和97.92％,其中6月龄组的婴幼儿比例最高,分别占门诊和住院腹泻儿童的54.55％和55.42％,粪便性状主要以水样便为主,占85.80％,其次为稀便,占81.27％.5岁以下轮状病毒腹泻儿童人次均门诊直接医疗费用375.42元,人次均住院直接医疗费用2 053.91元,人次均门诊直接非医疗费用47.92元,人次均住院直接非医疗费用180.13元.人次均门诊间接费用270.45元,人次均住院间接费用721.20元.结论 2岁以下婴幼儿是轮状病毒腹泻的高发人群,针对轮状病毒腹泻对儿童健康造成的危害和经济负担,需采取措施控制轮状病毒腹泻的发病水平.

目的 了解甘肃省社区人群腹泻病的流行特征、就诊情况和经济负担,为有效控制腹泻病提供参考依据.方法 采用分层多阶段随机整群抽样方法进行入户问卷调查.结果 甘肃省社区人群腹泻发病率为1.7％,平均1.28次/人/年;男性发病率为1.94％,女性发病率为1.47％;5岁以下儿童发病率最高,为4.67％;14项职业中家庭主妇发病率最高,为2.23％;7项文化程度中学龄前儿童发病率最高,为3.89％.腹泻病例腹泻天数以2～3天最多,占51.23％;腹泻伴发热的病例较少,仅占10.18％;发生腹泻的原因主要是食物源型,占61.11％;61.19％的人发生腹泻后选择服药,选择口服补液的仅占0.70％;43.71％的腹泻病例不去医疗机构就诊,在就诊的腹泻病例中有74.86％的人选择基层医疗机构.两周腹泻病例人(次)均门诊经济负担和住院经济负担分别为347元和2 434.07元.结论 甘肃省腹泻病发病率较高,其中5岁以下儿童腹泻病发病率最高,造成的经济负担也重,针对这一情况采取相应卫生干预措施,才能有效降低发病率,减轻疾病负担.

目的了解甘肃省2010-2011年各级医疗卫生部门法定传染病报告及管理工作的现状,为传染病疫情分析和防制提供科学的指导依据。方法按分层随机抽样方法,抽取甘肃省7个市州32家医疗机构和20家疾病预防控制中心作为调查单位,包括省级单位2家,市级15家,县级23家,乡镇级12家,进行门诊日志、传染病报告卡的填写和网络直报质量的调查。结果甘肃省的传染病报告率为95.21%,及时率90.88%,报卡完整率61.01%,准确率73.27%,一致率为69.81%,按以上指标综合评价,报告质量由高到低依次为乡镇级、市级、县级和省级。疾控机构传染病监测管理中专业技术培训、常规监测管理工作和网络直报设备市、县级评分均较高,本级专项配套经费评分较低。结论甘肃省传染病报告质量有所上升,但仍需进一步提高传染病报告的及时性、完整性、准确性和信息一致性。

人轮状病毒(human rotavirus,HRV)是导致人类病毒性腹泻最常见的病原,自1973年澳大利亚Bishop在电镜下发现HRV以来,已成为世界范围内婴幼儿重型腹泻的主要病原之一,几乎每位儿童在5岁之前均感染过HRV,严重影响儿童的健康,甚至危及生命,给全球造成了巨大的经济和社会负担.目前尚无特效药物治疗,口服HRV疫苗在一定程度上可预防和控制HRV的发病,降低死亡率[1].为了解国内外HRV腹泻的流行趋势、疾病负担的最新研究进展,笔者就国内外公开发表的相关文献进行了检索和综述。

WHO估计全球每年有453 000例5岁以下儿童因感染轮状病毒(RV)腹泻而死亡,大部分发生在发展中国家[1];亚洲5岁以下儿童腹泻中RV检出率高达55.0％,我国住院腹泻患儿RV检出率为46.0％,门诊为29.0％[2];RV可通过受污染的手和物品以及呼吸道进行传播[3].为此本研究于2007-2008年对甘肃省5岁以下儿童RV腹泻患病的危险因素开展1∶2配对病例对照研究. 关键词：轮状病毒;危险因素;病例对照研究

OBJECTIVE To understand community residents prevention knowledge and attitude on Hand-foot-mouth Disease(HFMD),and provide reference for health education.METHODS By using self-designed questionnaire and the method of typical sampling and encountering sampling,117 community residents were anonymously surveyed.RESULTS Most of the respondents(84.62%)knew HFMD,those respondents who never heard HFMD were mainly middle-aged and elderly people.29.3% of the respondents could describe the HFMD route of transmission correctly and completely.Precision rate of those residents who have children below five was higher then those who have no children(P0.01).Residents prevention knowledge about HFMD were mainly from television and newspaper.Only 20.20% of the respondents could answer the question about prevention of HFMD.As to the prevention of HFMD,they think highly of keep good hygiene of children(83.84%) and dietetic hygiene(66.67%).Only 33.33% of them paid attention to the prevention of personal hygiene of keepers which was easily ignored especially by residents who have no children.As to the health seeking behaviors,only 1/5 of the respondents would rationally choose hospital according to children's state of illness.CONCLUSION Children below 5 years old,a population with high prevalence of HFMD,are unable to discern their own diseases.Thus,their parents play an important part in the key link of HFMD prevention,and they are also the key person to identify serious symptom early.However,their knowledge about HFMD is still insufficient.Therefore,it is vital importance to spread core information about HFMD to parents.

<正>TOPSIS法是Technique for order preference by similarity to ideal solution的简称,指逼近理想的排序方法,是系统工程中多目标决策分析方法,它将原始数据经归一化处理后从中找出有限方案中的最优方案和最劣方案,然后通过计算评价对象与最优、最劣方案之间的距离,求出相对接近程度作为综合评价的依据。用此方法对医院的医疗质量进行评价已有报道。我国现行的传染病信息报告质量评价是综合评