Discrete time modelling of disease incidence time series by using Markov chain Monte Carlo methods

Summary.  A stochastic discrete time version of the susceptible–infected–recovered model for infectious diseases is developed. Disease is transmitted within and between communities when infected and susceptible individuals interact. Markov chain Monte Carlo methods are used to make inference about these unobserved populations and the unknown parameters of interest. The algorithm is designed specifically for modelling time series of reported measles cases although it can be adapted for other infectious diseases with permanent immunity. The application to observed measles incidence series motivates extensions to incorporate age structure as well as spatial epidemic coupling between communities.     

上海市空气污染造成人群健康经济损失的研究

文章通过对上海市空气污染季节性状况的描述 ,分析了各种污染物的污染程度和变化趋势 ,并利用对上海某市级医院的实地调查数据 ,对空气污染物与医院呼吸系统疾病患者日门诊量之间的相关关系进行研讨 ,建立了多元分析模型 ,探讨了患者健康经济损失的计量方法 ,并对由空气污染造成呼吸系统疾病患者健康经济损失进行了估算。研究表明 ,在其他条件不变的情况下 ,NOX 日指数每增长 10 % ,被调查医院呼吸系统疾病患者的日门诊人次增加 7 7人次 ,而这些疾病患者由于患病产生的年度健康经济损失为 2 11万元。据此作保守的推断估计 ,上海市一年内因NOX 超标而发生的呼吸系统疾病门诊行为造成的健康经济损失可以达到 4 2亿元。同样 ,SO2 和TSP造成门诊患者的健康经济损失分别为 1 5亿元和 0 86亿元     

Analysis of Regional Scale Risk of Whirling Disease in Populations of Colorado and Rio Grande Cutthroat Trout Using a Bayesian Belief Network Model

Introduction and spread of the parasite Myxobolus cerebralis, the causative agent of whirling disease, has contributed to the collapse of wild trout populations throughout the intermountain west. Of concern is the risk the disease may have on conservation and recovery of native cutthroat trout. We employed a Bayesian belief network to assess probability of whirling disease in Colorado River and Rio Grande cutthroat trout (Oncorhynchus clarkii pleuriticus and Oncorhynchus clarkii virginalis, respectively) within their current ranges in the southwest United States. Available habitat (as defined by gradient and elevation) for intermediate oligochaete worm host, Tubifex tubifex, exerted the greatest influence on the likelihood of infection, yet prevalence of stream barriers also affected the risk outcome. Management areas that had the highest likelihood of infected Colorado River cutthroat trout were in the eastern portion of their range, although the probability of infection was highest for populations in the southern, San Juan subbasin. Rio Grande cutthroat trout had a relatively low likelihood of infection, with populations in the southernmost Pecos management area predicted to be at greatest risk. The Bayesian risk assessment model predicted the likelihood of whirling disease infection from its principal transmission vector, fish movement, and suggested that barriers may be effective in reducing risk of exposure to native trout populations. Data gaps, especially with regard to location of spawning, highlighted the importance in developing monitoring plans that support future risk assessments and adaptive management for subspecies of cutthroat trout.     

论WTO《SPS协定》“适用地区”条款及我国的对策

WTO《实施卫生与植物卫生措施协定》(Agreement on the Application of Sanitary and Phytosani-tary Measures,简称SPS协定)第六条"适应地区条件"将地区划分为"疫病非疫区"和"低度流行区",由于该条在解释上留有一定的弹性并且国际社会缺乏统一的规范文件,致使适用时出现了许多问题。该条规定的价值取向是既要保护本国或地区内的人员或动植物免受其他地区病虫害之威胁,又要促进成员方国际贸易的发展。要同时实现这两种目标,建立病虫害非疫区并赋予成员方根据其适当保护水平之需要确定合适的贸易地区之权利不失为一种可行的办法。我国应以SPS委员会的各项相关制度为根据,加强与相关国际组织的联系,积极研究我国主要农产品进出口成员之卫生和植物卫生状况和适当保护水平,在此基础上完善对病虫害非疫区或低度流行区承认的法律制度,促进我国对外贸易的发展。     

Diabetes education program for people with type 2 diabetes: An international perspective

BackgroundIn the Palestinian community, lifestyle changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases especially diabetes mellitus. Diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range. Therefore, patient education is critical in controlling blood glucose levels within the normal range.ObjectiveThis study aimed at measuring the effect of diabetes educational intervention program for patients suffering from type 2 diabetes attending the Diabetes Clinic in Tulkarim Directorate of Health.MethodsA short duration observational study involving pre- and post-test educational intervention program was carried out on a relatively small number of type 2 diabetes patients at the Diabetes Clinic in Tulkarim Directorate of Health. In total, 215 patients attended a group-based 4 h educational intervention session about diabetes. The program included explaining diabetes mellitus-symptoms, risk factors, types, treatment and complications and main aspects of self-care of the disease (foot care, eye care, and blood glucose monitoring), main aspects of dietary management, weight reduction, blood pressure, smoking cessation, periodic investigations, home monitoring and importance of physical activity. Knowledge evaluation questionnaire were evaluated pre- and post-study. Anthropometric measurements such as body weight (WT), body mass index (BMI) and laboratory tests such as fasting blood glucose (FBG), hemoglobin A1C (HbA1c), cholesterol (Chol), and triglycerides (TG) were measured both at the beginning and at the end of the study. Significance of the results was assessed by paired t-test at 95% confidence interval.ResultsThe participant’s mean age was 51.07 that ranged between 31 and 70 years. For a total of 215 participants, 41.4% were males and 58.6% were females. The mean weight before educational intervention was 80.81 ± 14.95 kg (82.6 kg for males and 79.5 kg for females) that decreased to 78.9 ± 14.33 kg (81.1 kg for males and 77.3 kg for females) after educational intervention program. The BMI also decreased significantly after educational intervention. The mean fasting blood sugar was 188.65 ± 71.45 mg/dL before educational intervention that decreased to 177.7 ± 66.11 mg/dL after the educational intervention (p = 0.049). The mean glycosylated hemoglobin was 8.57 ± 1.21 before educational intervention that decreased to 7.95 ± 1.42 after educational intervention. The mean value of cholesterol before educational intervention was 183.27 ± 37.74 mg/dL that decreased to 169.57 ± 34.23 mg/dL after educational intervention. The mean triglycerides value decreased after educational intervention from 209.85 ± 171.04 mg/dL to 183.28 ± 152.4 mg/dL (p = 0.025). The mean score of knowledge questionnaire before educational intervention was 60.6 ± 20.65 that increased to 78.1 ± 13.4 after conducting educational intervention.ConclusionsDiabetes education was found to be effective on BMI, FBG, HbA1c, Chol, TG, and knowledge.RecommendationsDiabetes education is a cornerstone in the management and care of diabetes and should be an integral part of health planning involving patient’s family, diabetes care team, community, and decision makers in the education process.     

Statement of Withdrawal: Statistical analysis of an endemic disease from a capture–recapture experiment

There are a number of statistical techniques for analysing epidemic outbreaks. However, many diseases are endemic within populations and the analysis of such diseases are complicated by changing population demography. Motivated by the spread of cowpox among rodent populations, a combined mathematical model for population and disease dynamics is introduced. An MCMC algorithm is then constructed to make statistical inference for the model based on data being obtained from a capture–recapture experiment. The statistical analysis is used to identify the key elements in the spread of the cowpox virus.     

Risk Assessment for Hospital-Acquired Diseases: A Risk-Theory Approach

We introduce a new approach to hospital-acquired disease risk assessment from public health databases. In a spirit similar to actuarial risk theory, we define an adjustment coefficient that can quantify the risk associated with a hospital department, allowing comparisons of similar departments. The adjustment coefficient characterizes the tail of the distribution of the total patient length of stay in a department before the first disease event occurs. We show that this coefficient is the solution of a Lundberg-like equation, and we provide a nonparametric estimation procedure for this measure, based on a Cramér-Lundberg approximation for the tail of the distribution. Using simulations, we provide evidence of the robustness of the approximation to various individual risk models. In addition, we illustrate the relevance of this approach by evaluating the risk associated with a standard patient safety indicator in 20 hospitals of southeastern France.     

ASSOCIATIONS BETWEEN AIR POLLUTION AND HOSPITAL VISITS FOR CARDIOVASCULAR DISEASES IN THE ELDERLY IN SYDNEY USING BAYESIAN STATISTICAL METHODS

Using generalized linear models (GLMs), Jalaludin  et al. (2006;  J. Exposure Analysis and Epidemiology   16 , 225–237) studied the association between the daily number of visits to emergency departments for cardiovascular disease by the elderly (65+) and five measures of ambient air pollution. Bayesian methods provide an alternative approach to classical time series modelling and are starting to be more widely used. This paper considers Bayesian methods using the dataset used by Jalaludin  et al.  (2006) , and compares the results from Bayesian methods with those obtained by Jalaludin  et al.  (2006) using GLM methods.     

Men,Gender, and Health: Toward an Interdisciplinary Approach

Abstract

The anatomy and physiology of the ears, nose, and sinuses are reviewed. Diseases and injuries typically associated with water sports are discussed, with emphasis on pathophysiology, treatment, and preventative measures.

“Screening for Chlamydial Infections in Women Attending Family Planning Clinics: Evaluation of Presumptive Indicators for Therapy,” JULIUS SCHACHTER, EILEEN STONER, and JEANNE MONCADA. Chlamydia trachomatis was recovered from the cervices of 9.8 percent (268/2,729) of women attending seven family planning clinics. The infection rate varied from 5.5 percent to 22.5 percent in different clinics. Chlamydial infection could be associated with younger age, nulliparity, being black and use of oral contraceptives. Most (70 percent) of the chlamydial infections were inapparent and presumptive indicators for antichlamydial therapy that are useful for symptomatic women will not make a major impact on this reservoir. It is concluded that chlamydial cultures are needed to deal with the high prevalence of these infections. (Western Journal of Medicine 1983 Mar;138:375–379.)     

Incorporating human sexuality content into a positive youth development framework: Implications for community prevention

As approaches to positive youth development (PYD) gain momentum, the issue of sexuality – a critical component of human development – is being subsumed by ideological debates. In the current political climate, sexuality education is often relegated to biological and/or values-based approaches, neglecting essential relational and collective aspects of sexuality. Through the explication of sexuality as an important component of youth's social ecology, this paper provides a conceptual link between the goals of the Sexuality Information and Education Council of the United States' (SIECUS) Guidelines for comprehensive sexuality education and those of PYD. We argue that sexuality, as a normative part of human development, culture, identity, and relationships, be approached from an asset-based perspective, rather than a deficit-based perspective. We propose a framework that illustrates how aspects of sexuality are embedded within PYD contexts, and demonstrates how a sexuality education program rooted in SIECUS guidelines can further PYD goals across community contexts.