目的 采用德尔菲法构建深圳市龙华区区级医疗机构突发公共卫生事件应急能力评价指标体系,为评估公共卫生应急能力和完善应急体系的建设提供参考依据.方法 在文献检索、专家访谈的基础上,制定专家函询问卷,选择16名专家进行两轮的德尔菲问卷调查,确定评价指标体系.结果 两轮咨询的积极系数分别100.00%和93.75%,协调系数分别为0.229和0.340.专家权威系数为0.850,第2轮各项指标的变异系数(CV)均＜0.25,最终构建的指标体系包括7个一级指标、14个二级指标、44个三级指标.结论 本研究构建的评价指标体系专家积极性高,权威性与协调性均较好,可用于突发公共卫生事件应急能力评估,为完善公共卫生应急体系的建设提供参考依据.

Background: Benefits of green spaces on stress reduction have been shown in previous studies. Most existing studies to date have focused on the general population. However, there is a lack of understanding of physio-logical mechanisms underlying the beneficial effects of green space among special populations, such as pregnant women.Objectives: To examine physiological and affective responses to green space on stress recovery among pregnant women, using simulated green space exposure through virtual reality (VR). Methods: We recruited 63 pregnant women between 8 and 14 weeks' gestational age for a laboratory experiment. Participants were randomly assigned to view one of three, 5-min, VR videos of an urban scene with different green space levels (i.e., non-green, moderate, and high) after a laboratory stressor, the Trier Social Stress Test. Physiological stress responses were measured via changes in blood pressure, heart rate, skin conductance level, salivary alpha-amylase, and salivary cortisol. Affective response was measured using the Positive and Negative Affect Scale.Results: We found that visual exposure to a green space environment in VR was associated with both physio-logical and affective stress reduction among pregnant women, including lower systolic blood pressure [-4.6 mmHg, 95% confidence interval (CI):-8.8,-0.4], reduced salivary alpha-amylase concentration (-1.2 ng/ml, 95% CI:-2.2,-0.2), improved overall positive affect (score: 6.6, 95% CI: 0.3, 13.0) and decreased negative affect of anxiety (score:-2.6, 95% CI:-5.19,-0.04) compared to non-green space environment. Exposure to high green space environment in park-like setting had the strongest impacts on stress recovery.Conclusion: This study demonstrated that virtual green space exposure could effectively ease stress and improve mental health and well-being during pregnancy. Even a short immersion in VR-based green space environment may bring health benefits, which has significant implications for pregnant women when access to an actual nature may not be possible.

目的 了解婴幼儿湿疹的发病现状,从多角度探索其发病因素.方法 以中国孕产妇队列研究-子代项目中的681名婴幼儿为研究对象,在孕期收集父母亲的一般人口学信息、孕期膳食摄入及婴幼儿出生信息,随访调查其家居环境和婴幼儿湿疹状况,应用多因素非条件logistic回归分析模型分析婴幼儿湿疹发病的影响因素.结果 研究对象婴幼儿湿疹的发生率为23.79％.logistic回归分析模型分析结果显示,相比初产妇,经产妇(OR=0.601,95％CI:0.398～0.908)所分娩的孩子患湿疹风险会降低47.6％.母亲有过敏史(OR=2.191,95％CI:1.393～3.447)和父亲有过敏史(OR=2.008,95％CI:1.244～3.239)的孩子更容易患湿疹.相比于母乳喂养,人工喂养(OR=4.165,95％CI:1.450～11.963)和混合喂养(OR=8.151,95％CI:5.165～12.866)增加婴幼儿患湿疹的风险.孕期禽肉摄入频率越高的孕妇,产后孩子患湿疹的风险增高(OR=1.145,95％CI:1.011～1.297).家庭地板、窗台、墙壁有褪色、变黑或霉变(OR=2.051,95％CI:1.094～3.843)会使婴幼儿湿疹的发病风险增高.结论 产次、喂养方式、父母过敏史、孕期禽肉摄入频率及居家环境对于婴幼儿湿疹发病有影响,应加强开展针对性宣传指导,有效预防婴幼儿湿疹发生.

Background: Limited evidence to show the longitudinal associations between maternal dietary patterns and antenatal depression (AD) from cohort studies across the entire gestation period. Methods: Data came from the Chinese Pregnant Women Cohort Study. The qualitative food frequency questionnaire (Q-FFQ) and Edinburgh Postnatal Depression Scale (EPDS) were used to collect diet and depression data. Dietary patterns were derived by using factor analysis. Generalized estimating equation models were used to analyze the association between diet and AD. Results: A total of 4139 participants finishing 3-wave of follow-up were finally included. Four constant diets were identified, namely plant-based, animal-protein, vitamin-rich and oily-fatty patterns. The prevalence of depression was 23.89%, 21.12% and 22.42% for the first, second and third trimesters. There were reverse associations of plant-based pattern (OR:0.85, 95%CI:0.75-0.97), animal-protein pattern (OR:0.85, 95%CI:0.74-0.99) and vitamin-rich pattern (OR:0.58, 95%CI:0.50-0.67) with AD, while a positive association between oily-fatty pattern and AD (OR:1.47, 95%CI:1.29-1.68). Except for the plant-based pattern, other patterns had linear trend relationships with AD (P-trend < 0.05). Moreover, a 1-SD increase in vitamin-rich pattern scores was associated with a 20% lower AD risk (OR:0.80, 95%CI:0.76-0.84), while a 1-SD increase in oily-fatty pattern scores was associated with a 19% higher risk (OR:1.19, 95%CI:1.13-1.24). Interactions between dietary patterns and lifestyle habits were observed. Limitations: The self-reported Q-FFQ and EPDS may cause recall bias. Conclusions: There are longitudinal associations between maternal dietary patterns and antenatal depression. Our findings are expected to provide evidence for a dietary therapy strategy to improve or prevent depression during pregnancy.

目的 了解孕早期妇女抑郁和睡眠质量的现状及其影响因素,分析抑郁症状与睡眠质量及其各维度的关系.方法 以中国孕产妇队列研究·协和项目中5210名孕早期妇女为研究对象,该项目选择了15个省/自治区/直辖市的24家医院作为调研现场,根据研究方案,项目于2017年7月25日—2018年7月24日,招募处于孕早期妇女.纳入研究对象后,采用自行设计问卷,收集孕妇年龄、民族、文化程度、职业、家庭年收入、身高、孕前体重、吸烟史、饮酒史等基本信息,采用爱丁堡产后抑郁量表(EPDS)和匹兹堡睡眠质量指数量表(PSQI)评定孕早期妇女的抑郁状况及睡眠质量.结果 5210名孕早期妇女抑郁检出率为25.9％,睡眠障碍的检出率为34.0％.Pearson法分析显示,EPDS评分与PQSI评分(r=0.397,P<0.001)、主观睡眠质量(r=0.349,P<0.001)、睡眠障碍(r=0.339,P<0.001)呈正相关.多因素非条件Logistic回归分析显示,与BMI正常的孕妇相比,孕前BMI偏低是睡眠质量的危险因素(OR=1.26,95％CI:1.06～1.51),吸烟是孕妇发生睡眠障碍的危险因素(OR=1.50,95％CI:1.06～2.14),抑郁的孕妇发生睡眠障碍的风险是非抑郁孕妇的3.46倍(OR=3.46,95％CI:3.04～3.94).结论 孕早期妇女睡眠质量与抑郁呈正相关,应采取综合性干预措施改善孕早期妇女的抑郁情绪和睡眠质量,并加强相关方面的保健工作.

Purpose A multicentre prospective cohort study, known as the Chinese Pregnant Women Cohort Study (CPWCS), was established in 2017 to collect exposure data during pregnancy (except environmental exposure) and analyse the relationship between lifestyle during pregnancy and obstetric outcomes. Data about mothers and their children’s life and health as well as children’s laboratory testing will be collected during the offspring follow-up of CPWCS, which will enable us to further investigate the longitudinal relationship between exposure in different periods (during pregnancy and childhood) and children’s development.Participants 9193 pregnant women in 24 hospitals in China who were in their first trimester (5–13 weeks gestational age) from 25 July 2017 to 26 November 2018 were included in CPWCS by convenience sampling. Five hospitals in China which participated in CPWCS with good cooperation will be selected as the sample source for the Chinese Pregnant Women Cohort Study (Offspring Follow-up) (CPWCS-OF).Findings to date Some factors affecting pregnancy outcomes and health problems during pregnancy have been discovered through data analysis. The details are discussed in the ‘Findings to date’ section.Future plans Infants and children and their mothers who meet the criteria will be enrolled in the study and will be followed up every 2 years. The longitudinal relationship between exposure (questionnaire data, physical examination and biospecimens, medical records, and objective environmental data collected through geographical information system and remote sensing technology) in different periods (during pregnancy and childhood) and children’s health (such as sleeping problem, oral health, bowel health and allergy-related health problems) will be analysed.Trail registration number CPWCS was registered with ClinicalTrials.gov on 18 January 2018: NCT03403543. CPWCS-OF was registered with ClinicalTrials.gov on 24 June 2020: NCT04444791.

目的 回顾分析母婴健康队列研究的应用趋势,展望未来发展方向.方法 检索中国发表的中文及英文(简称"中英文")母婴队列研究文献,对发表时间、科研单位、研究目标与随访调查等情况进行统计分析.结果 自1991年以来,母婴健康队列研究的文献数量明显增加,中英文核心期刊群均已形成.中英文文献发表数量的年平均增长率分别为12.2％和23.2％,54.4％的中文文献与79.3％的英文文献为近5年发表.56.9％的中文文献发表在核心期刊,54.3％的英文文献发表在影响因子＞3分的期刊.国内外期刊发表的文献均以病因研究为主,多为大样本研究,回归分析模型运用普遍.结论 队列研究在我国母婴健康领域的应用逐渐增加,但研究者仍需加强对队列研究的认识,控制失访率、改善随访效果,运用Cox回归分析模型等统计分析方法 ,更加科学地运用队列研究解决实际问题.

本文就我国COVID-19疫情防控过程中,暴露出的公共卫生体系建设的诸多问题,进行分析研究.认真学习两会精神,结合我国国情,从公共卫生体系的法制建设、机构体制完善、人才培养、服务体系、信息化体系以及卫生应急体系建设等方面提出具体的改革建议,为进一步健全重大疫情应急响应机制进行初步探索.

目的 了解中国胎儿脐带缠绕现状及其与环境暴露因素的相关性,为预防和干预脐带缠绕提供科学的指导.方法 以中国孕产妇队列研究?协和项目的孕妇为研究对象,在孕早期收集孕妇的一般人口学信息和环境暴露信息,随访获取脐带缠绕相关结局,应用多因素非条件Logistic回归分析模型分析胎儿脐带缠绕的影响因素.结果 胎儿脐带缠绕的发生率为9.00％.Logistic回归分析模型分析结果 显示:调整混杂因素后,与孕期没有暴露于被动吸烟或噪声的孕妇相比,暴露于被动吸烟(OR= 1.199,95％CI:1.010～1.423,P = 0.038)或噪声(OR= 1.242,95％CI:1.002～1.541,P= 0.048)的孕妇发生脐带缠绕的风险较高.结论 孕妇孕期被动吸烟和接触噪声对胎儿脐带缠绕有影响,应加强孕期教育,减少孕妇孕期被动吸烟和噪声环境暴露.

目的 探究孕期妇女体力活动(physical activity,PA)、久坐行为与胎膜早破(prema-ture rupture of membranes,PROM)发生风险的相关性及剂量反应关系.方法 采用国际体力活动短问卷收集中国孕产妇队列研究?协和项目中孕妇的体力活动状况和静坐时间(sedentary time,ST),并随访收集研究对象PROM的诊断情况,采用Logistic回归分析模型和限制性立方样条模型进行数据分析,计算OR及95％CI值.结果 共纳入研究对象6 848例.孕妇PROM的发生率为13.79％.在中/低强度PA方面,与低频组相比,高频组PROM的发生风险更高(中强度OR= 1.50,95％CI:1.01～2.23;低强度OR=1.19,95％CI:1.04～1.73);高强度PA 频次每增加1 d/week,PROM 发生风险增加13％(OR=1.13,95％CI:1.03～1.24);ST 每增加1 h/d,PROM 发生风险增加2％(OR=1.02,95％CI:1.01～1.04).剂量反应关系显示,高强度PA超过2 d/周,中强度超过5 d/周或低强度超过5 d/周均可增加PROM的发生风险(OR及95％CI均＞1).结论 孕期高频体力活动和久坐行为是胎膜早破发生的危险因素,应鼓励孕妇进行适宜和中低强度体力活动的同时,减少静坐时间,以降低胎膜早破的发生风险.

Data standard plays an important role in the process of data collection, Integration and sharing in clinical cohort studies, and more attention have been paid to it. This paper summarizes the 5 international proven data standard model, analyze their characteristics and development status, and match their data modules with the general data set of the clinical cohorts to evaluate the international data standard models' applicability and provide reference for the development and improvement of the data standard model for clinical cohort studies in China.

目的 探讨中国妊娠期妇女营养素补充剂的使用情况和妊娠合并贫血的关系.方法 采用自行设计的妊娠期营养素补充剂使用情况调查问卷,对"中国孕产妇队列研究?协和"项目中的孕妇进行调查,随访收集研究对象营养素补充剂的使用情况和妊娠合并贫血的诊断情况,采用Logistic线性回归分析模型对数据进行关联性分析.结果 共纳入研究对象3 321例.妊娠合并贫血的发生率为14.0％.Logistic线性回归分析模型结果 显示,与全妊娠期使用叶酸的孕妇相比,未坚持全妊娠期使用叶酸的孕妇,更容易发生贫血(OR= 1.362,95％CI:1.096-1.691,P =0.005).结论 未坚持全妊娠期使用叶酸是妊娠合并贫血的危险因素,应鼓励孕妇在全妊娠期持续地使用叶酸以降低贫血的发生风险.

Under the limitation of cross-sectional studies, more researchers are turning their attention to maternal and child cohort studies. However, some problems do exist in the traditional maternal and child cohort studies, if data is only gathered from the hospitals. The limitation would include the contents of research and the high rate of loss to follow-up. With the integration of different medical traits and the progress in big data, the development of maternal and child related cohorts, with characteristics of dynamic follow-up and data sharing, through combining the information and health service systems of different institutions, seem in urgent need. This paper aims to provide some basic achievements in conducting maternal and child cohorts that can serve the related health problems through full-life cycle, and provide new references on conducting cohort studies, aiming at special population or diseases.