Educational differences in health risks and illness over the life course: A test of cumulative disadvantage theory

This study tests the cumulative disadvantage hypothesis by examining the age-varying relationships between education, health risks, and disease onset and survival duration. Results based on 20 years of longitudinal data suggest that education is related to both the individual and accumulated number of behavioral, social, and economic health-risks, which in turn, are related to increasing educational differences in rates of disease incidence and survival. For hypertension, behavioral risks fully account for education’s negative effect on disease onset whereas educational differences in survival are best explained by the accumulation of social and economic risks. For heart attack, a combination of behavioral, social, and economic risks mediate the association between education and incidence, but neither the individual nor accumulated health-risks could account for education’s positive effect on surviving after a heart attack. Similar findings for diabetes and stroke are also discussed.     

SARS疫情的状态评估和预测建模研究

从定义SARS疫情发展状态的标志参数出发,给出对疫情发展过程进行阶段划分的基本方法。按照这些标志参数在各个阶段的取值,可以分析SARS疫情从爆发到衰减过程中的关键因素,讨论新增病例数量和留院治疗人数进入收敛状态的基本条件,并给出预报有关地区达到WHO解除疫情警报的时间的方法。论文以香港和北京的数据为例,验证了所研究模型的合理性和有效性。同时,对北京解除WHO旅游警告的时间进行推测。     

Environmental Surveillance System Characteristics and Impacts on Confidence About No Undetected Serotype 1 Wild Poliovirus Circulation

Surveillance for poliovirus during the polio endgame remains uncertain. Building on prior modeling of the potential for undetected poliovirus transmission for conditions like those in Pakistan and Afghanistan, we use a hypothetical model to explore several key characteristics of the poliovirus environmental surveillance (ES) system (e.g., number and quality of sites, catchment sizes, and sampling frequency) and characterize their impacts on the time required to reach high (i.e., 95%) confidence about no circulation (CNC95%) following the last detected case of serotype 1 wild poliovirus. The nature and quality of the existing and future acute flaccid paralysis (AFP) surveillance and ES system significantly impact the estimated CNC95% for places like Pakistan and Afghanistan. The analysis illustrates the tradeoffs between number of sites, sampling frequency, and catchments sizes, and suggests diminishing returns of increasing these three factors beyond a point that depends on site quality and the location of sites. Limitations in data quality and the hypothetical nature of the model reduce the ability to assess the extent to which actual ES systems offer benefits that exceed their costs. Thus, although poliovirus ES may help to reduce the time required to reach high confidence about the absence of undetected circulation, the effect strongly depends on the ability to establish effective ES sites in high‐risk areas. The costs and benefits of ES require further analysis.     

《水产动物疾病学》课程教学改革的探索与实践

分析了《水产动物疾病学》课程教学存在的问题,通过对教学手段、教学内容和教学方法的探索与实践,提出了增强课堂趣味性、改进教学方法的课堂教学改革措施,以及实践教学改革的措施:(1)多媒体教学与传统教学相结合;(2)注重搜集和制备疾病标本;(3)增补细节菌性疾病的课程实习;(4)积极开辟第二课堂。     

浅议难诊治疾病的医疗损害赔偿

医疗损害赔偿是特殊的民事损害赔偿，由疑难病症引发的医疗损害赔偿更为特殊。医疗损害赔偿应该实行严格的过错责任原则，同时引入医疗责任险作为补充。难诊治疾病有别于普通疾病，其治疗过程与损害结果之间存在的因果关系不是必然，且难以界定。因此，对于在难诊治疾病治疗过程中，造成的医疗损害赔偿同样应该严格按照过错责任原则，且在赔偿范围和指标上略低于普通的医疗损害赔偿。同时，为了缓解患方的风险，尤其应在难诊治疾病的治疗中引入医疗责任险。     

Geoadditive models

Summary. A study into geographical variability of reproductive health outcomes (e.g. birth weight) in Upper Cape Cod, Massachusetts, USA, benefits from geostatistical mapping or kriging . However, also observed are some continuous covariates (e.g. maternal age) that exhibit pronounced non-linear relationships with the response variable. To account for such effects properly we merge kriging with additive models to obtain what we call geoadditive models . The merging becomes effortless by expressing both as linear mixed models. The resulting mixed model representation for the geoadditive model allows for fitting and diagnosis using standard methodology and software.     

A large-scale initiative to disseminate an evidence-based drug abuse prevention program in Italy: Lessons learned for practitioners and researchers

Across developed countries, experimentation with alcohol, tobacco, and other drugs often begins in the early adolescent years. Several evidence-based programs have been developed to prevent adolescent substance use. Many of the most rigorously tested and empirically supported prevention programs were initially developed and tested in the United States. Increasingly, these interventions are being adopted for use in Europe and throughout the world. This paper reports on a large-scale comprehensive initiative designed to select, adapt, implement, and sustain an evidence-based drug abuse prevention program in Italy. As part of a large-scale regionally funded collaboration in the Lombardy region of Italy, we report on processes through which a team of stakeholders selected, translated and culturally adapted, planned, implemented and evaluated the Life Skills Training (LST) school-based drug abuse prevention program, an evidence-based intervention developed in the United States. We discuss several challenges and lessons learned and implications for prevention practitioners and researchers attempting to undertake similar international dissemination projects. We review several published conceptual models designed to promote the replication and widespread dissemination of effective programs, and discuss their strengths and limitations in the context of planning and implementing a complex, large-scale real-world dissemination effort.     

Evaluation of Response Scenarios to Potential Polio Outbreaks Using Mathematical Models

Appropriate response to polio outbreaks represents an important prerequisite for achieving and maintaining global polio eradication. We use an existing dynamic disease transmission model to evaluate the impact of different aspects of immunization campaigns in response to polio outbreaks occurring in previously polio-free areas. This analysis yields several important insights about response strategies. We find that delay in response represents a crucial risk factor for occurrence of large outbreaks and we characterize the tradeoffs associated with delaying the initial response to achieve better population coverage. We also demonstrate that controlling most potential outbreaks will likely require at least three immunization rounds, although the impact of the optimal interval between rounds varies. Finally, long after oral poliovirus vaccine cessation the choice of target age groups during a response represents an important consideration.     

Bayesian multivariate Poisson mixtures with an unknown number of components

In this paper we present Bayesian analysis of finite mixtures of multivariate Poisson distributions with an unknown number of components. The multivariate Poisson distribution can be regarded as the discrete counterpart of the multivariate normal distribution, which is suitable for modelling multivariate count data. Mixtures of multivariate Poisson distributions allow for overdispersion and for negative correlations between variables. To perform Bayesian analysis of these models we adopt a reversible jump Markov chain Monte Carlo (MCMC) algorithm with birth and death moves for updating the number of components. We present results obtained from applying our modelling approach to simulated and real data. Furthermore, we apply our approach to a problem in multivariate disease mapping, namely joint modelling of diseases with correlated counts.     

Disease clusters: should they be investigated, and, if so, when and how?

Individual cluster reports are subject to several difficulties in interpretation. Although they rarely lead to new aetiological insights, a public health response to delineate the size and extent of any excess risk may be warranted. Further investigation, where merited, should usually include an examination of data for different areas and/or different time periods. A statistical evaluation of disease clusters is often secondary to a detailed appreciation of issues such as the availability and quality of data, confounding and bias in the selection of areas for study.