Epidemiological trend of hepatitis B, liver cirrhosis and liver cancer during 1990 - 2007 in Shandong province, China [山东省乙型肝炎、肝硬化及肝癌流行趋势分析]

Objective To analyze the epidemiological trend of hepatitis B, liver cirrhosis and liver cancer during 1990 to 2007 in Shandong province, and to evaluate the effectiveness of hepatitis B prevention and control measures, so as to provide evidence for policy-making. Methods Based on the routine incidence data of hepatitis B, mortality data of hepatitis B, liver cirrhosis, liver cancer and demographic data, the incidence rate, mortality rate and age-specific mortality rate were calculated and analyzed with simple linear regression model. Results A total of 437094 cases of hepatitis B were reported during 1990 - 2007 with an average yearly morbidity of 27.32 per 100 000 persons and a decreased trend for the 0-9 years old children. At the same time, the adjusted mortality rate for hepatitis B and liver cirrhosis showed a decreased trend and the combined mortality rate decreased from 17.55 /100 000 in 1990 to 4.01 /100 000 in 2007. The mortality of liver cancer was stable during this time (P = 0. 9998). Conclusion Immunization of hepatitis B vaccine may have lowered the incidence of hepatitis B in the target population and the overall mortality rates of liver cirrhosis and liver cancer. Abstract in Chinese 目的 了解山东省1990～2007年乙肝、肝硬化和肝癌的流行状况及变化趋势,初步评价乙肝预防控制措施的效果,为今后防治决策制定提供参考. 方法 根据报告的乙肝发病资料和乙肝、肝硬化、肝癌死亡资料以及历年人口资料,利用发病率、死亡率、年龄别死亡率等指标对上述3种疾病进行流行趋势的分析,并建立简单线性回归模型进行统计分析. 结果 1990～2007年山东省共报告乙肝病例437 094例,年均总发病率为27.32/10万,并呈上升趋势,而0～9岁年龄组的发病率呈显著下降趋势.乙肝和肝硬化调整死亡率下降趋势明显,两者合并死亡率由1990年的17.55/10万下降到2007年的4.01/10万.肝癌调整死亡率基本稳定(P=0.999 8). 结论 做好乙肝疫苗的免疫接种不仅可降低目标人群乙肝的发病,并将最终降低与此相关的肝硬化和肝癌的死亡率.

Epidemiological Trend of Hepatitis B in Shandong Province of China, 1990 - 2007 []

Objective To analyze the epidemiological trend of hepatitis B from 1990 to 2007 in Shandong province, and to find the high risk population so as to explore the further control strategy. Methods Based on the routine reporting incidence data of hepatitis B and demographic data of Shandong province, the incidence rates and sex - specific, age - specific incidence rates of hepatitis B were calculated and statistically analyzed in the simple linear regression model. Results The total number of hepatitis B was 437 094, the annual average morbidity was 27132 per 100 000 population during 1990 to 2007. The incidence of men (38142 per 100 000) was higher than that for women (15183 per 100 000) 1The annual incidence rate of hepatitis B indicated an increasing trend for the whole population, while a decreased trend for the 0～9 year - old children p resented in the past 18 years. It showed that the average age of onset moved to the older. Conclusion Young adult men are the high-risk groups for the onset of hepatitis B. For the prevention of hepatitis B, the immunization of hepatitis B vaccine should be enhanced for other groups, especially for the high - risk population on the basis of imp roving the immunization coverage rate for newborns.

Estimation of the burden of malignant neoplasms by DALYs in Shandong Province [应用伤残调整寿命年测量山东省恶性肿瘤疾病负担的研究]

Objective: To evaluate the burden of malignant neoplasms in Shandong Province in order to provide scientific evidence for policy-making. Methods: The main data for this study were from Shandong third cause of death sampling survey in 2006 and Shandong 2007 cancer prevalence survey. YLLs, YLDs, DALYs and disability weights of each type of cancers were calculated according to the global burdens of disease （GBD） methodology. The direct method was used to estimate YLDs. The uncertainty analysis was conducted following the methodology in GBD study. Results: The total cancers burden in Shandong population was 1 383 thousands DALYs. Lung cancer, liver cancer, stomach cancer and esophagus cancer were the top four cancers with the highest health burden. The burden of the four major cancers together accounted for 71.45% of the total burden of all cancers. 95% of the total burden of malignant tumors was caused by premature death, and only 5.26% of the total cancer burden was due to disability. The uncertainty of total burden estimate was around±11%， the uncertainty of YLDs was bigger than that of YLLs. Conclusion: The health burden due to cancers in Shandong population is heavier than that of the national average level. Liver cancer, lung cancer and stomach cancer should be the major cancers for disease control and prevention in Shandong.

Disaster resilience in tertiary hospitals : a cross-sectional survey in Shandong Province, China

Background: Hospital disaster resilience can be defined as a hospital’s ability to resist, absorb, and respond to the shock of disasters while maintaining critical functions, and then to recover to its original state or adapt to a new one. This study aims to explore the status of resilience among tertiary hospitals in Shandong Province, China. Methods: A stratified random sample (n = 50) was derived from tertiary A, tertiary B, and tertiary C hospitals in Shandong Province, and was surveyed by questionnaire. Data on hospital characteristics and 8 key domains of hospital resilience were collected and analysed. Variables were binary, and analysed using descriptive statistics such as frequencies. Results: A response rate of 82% (n = 41) was attained. Factor analysis identified four key factors from eight domains which appear to reflect the overall level of disaster resilience. These were hospital safety, disaster management mechanisms, disaster resources and disaster medical care capability. The survey demonstrated that in regard to hospital safety, 93% had syndromic surveillance systems for infectious diseases and 68% had evaluated their safety standards. In regard to disaster management mechanisms, all had general plans, while only 20% had specific plans for individual hazards. 49% had a public communication protocol and 43.9% attended the local coordination meetings. In regard to disaster resources, 75.6% and 87.5% stockpiled emergency drugs and materials respectively, while less than a third (30%) had a signed Memorandum of Understanding with other hospitals to share these resources. Finally in regard to medical care, 66% could dispatch an on-site medical rescue team, but only 5% had a ‘portable hospital’ function and 36.6% and 12% of the hospitals could surge their beds and staff capacity respectively. The average beds surge capacity within 1 day was 13%. Conclusions: This study validated the broad utility of a framework for understanding and measuring the level of hospital resilience. The survey demonstrated considerable variability in disaster resilience arrangements of tertiary hospitals in Shandong province, and the difference between tertiary A hospitals and tertiary B hospitals was also identified in essential areas.

Developing an evaluation framework for hospital disaster resilience : tertiary hospitals of Shandong Province, China

This thesis provided a definition and conceptual framework for hospital disaster resilience; it used a mixed-method, including an empirical study in tertiary hospitals of Shandong Province in China, to devise an assessment instrument for measuring hospital resilience. The instrument is the first of its type and will allow hospitals to measure their resilience levels. The concept of disaster resilience has gained prominence in the light of the increased impact of various disasters. The notion of resilience encompasses the qualities that enable the organisation or community to resist, respond to, and recover from the impact of disasters. Hospital resilience is essential as it provides 'lifeline' services which minimize disaster impact. This thesis has provided a framework and instrument to evaluate the level of hospital resilience. Such an instrument could be used to better understand hospital resilience, and also as a decision-support tool for its promoting strategies and policies.

Incidence and fatality of serious suicide attempts in a predominantly rural population in Shandong, China : a public health surveillance study

Objectives To estimate the incidence of serious suicide attempts (SSAs, defined as suicide attempts resulting in either death or hospitalisation) and to examine factors associated with fatality among these attempters. Design A surveillance study of incidence and mortality. Linked data from two public health surveillance systems were analysed. Setting Three selected counties in Shandong, China. Participants All residents in the three selected counties. Outcome measures Incidence rate ( per 100 000 person-years) and case fatality rate (%). Methods Records of suicide deaths and hospitalisations that occurred among residents in selected counties during 2009–2011 (5 623 323 person-years) were extracted from electronic databases of the Disease Surveillance Points (DSP) system and the Injury Surveillance System (ISS) and were linked by name, sex, residence and time of suicide attempt. A multiple logistic regression model was developed to examine the factors associated with a higher or lower fatality rate. Results The incidence of SSAs was estimated to be 46 (95% CI 44 to 48) per 100 000 person-years, which was 1.5 times higher in rural versus urban areas, slightly higher among females, and increased with age. Among all SSAs, 51% were hospitalised and survived, 9% were hospitalised but later died and 40% died with no hospitalisation. Most suicide deaths (81%) were not hospitalised and most hospitalised SSAs (85%) survived. The fatality rate was 49% overall, but was significantly higher among attempters living in rural areas, who were male, older, with lower education or with a farming occupation. With regard to the method of suicide, fatality was lowest for non-pesticide poisons (7%) and highest for hanging (97%). Conclusions The incidence of serious suicide attempts is substantially higher in rural areas than in urban areas of China. The risk of death is influenced by the attempter’s sex, age, education level, occupation, method used and season of year.

Assessment of the underreporting rate of death cause data in Shandong province using capture-mark-recapture method [应用捕获再捕获方法评估山东省死因登记漏报率水平]

To evaluate the underreporting rate of death -cause data in Shandong province during 2012 to 2013 by capture -mark -recapture method and to provide the base for health strategy. Methods All counties were divided into 5 stratifications according the death rates of 2012, and 14 counties were selected, then 3 towns or streets were selected in each country, 10 villages or neighborhood committees were selected in each town （street）. The death data collected from security bureau and civil affairs bureau were compared with the reporting death data from the National Cause of Death Surveillance, and the underreporting rate was calculated. Results In present study, 6 929 death cases were collected, it was found that 1 556 cases were underreported. The death cases estimated by CMR method were 6 227 cases （95%CI: 7 593-7 651）, and the average underreporting rate was 23.15%. There were significantly differences between different stratifications （P<0.01）. The underreporting rate in 0-4 years old group was 56.93%, the male underreporting rate was 22.31% and the female underreporting rate was 24.09%. There was no significant difference between male and female groups （P>0.05）. Conclusion There is an obvious underreport in the cause of death surveillance of Shandong province, and the underreporting rates are different among the 5 stratifications. The underreporting rate is higher in 0-4 years old group, and the investigation of the death cause surveillance for young residents is not perfect in some countries. The investigation quality of the death cause surveillance should be improved, increasing the integrity of the report data and adjusting the mortalities in different stratifications for obtaining a accurate mortality in Shandong province.

Human papillomavirus infection and vaccination: Awareness and knowledge of HPV and acceptability of HPV vaccine among mothers of teenage daughters in Weihai, Shandong, China

In preparation for the introduction of human papillomavirus (HPV) vaccine, we investigated awareness and knowledge of HPV/HPV vaccine and potential acceptability to HPV vaccine among mothers with a teenage daughter in Weihai, Shandong, China. A cross-sectional survey was conducted in 2013 with a sample of 1850 mothers who had a daughter (aged 9–17 years) attending primary, junior and senior high schools. In the final sample (N = 1578, response rate 85.30%), awareness of HPV was reported by 305 (19.32%) mothers. Awareness varied significantly by daughter’s age (P<0.01), mother’s education level (P<0.01), mother’s occupation (P<0.01), household income (P<0.01) and residence type (P<0.01). Knowledge about HPV/HPV vaccine was poor with a mean total score of 3.56 (SD = 2.40) out of a possible score of 13. Mothers with a higher education level reported higher levels of knowledge (P = 0.02). Slightly more than one-fourth (26.49%) of mothers expressed their potential acceptability of HPV vaccine for their daughters. Acceptability increased along with increased daughters’ age (P<0.01), household income (P<0.01) and knowledge level (P<0.01). House wives and unemployed mothers had the highest acceptability (P<0.01). The most common reasons for not accepting HPV vaccination were “My daughter is too young to have risk of cervical cancer (30.95%)”, “The vaccine has not been widely used, and the decision will be made after it is widely used (24.91%)”, “Worry about the safety of the vaccine (22.85%)”. Awareness and knowledge of HPV/HPV vaccines are poor and HPV vaccine acceptability is low among these Chinese mothers. These results may help inform appropriate health education programs in this population.

山东山旺中新世古气候的定量研究

本论文研究的创新之处是在高分辨率的地层层序上选定3米X3米的工作剖面，逐层采集标本，定量研究山旺中新世古气候的变化过程。主要有以下新的认识和结论： 植物化石的数量和种类在地层层序上的变化很大。第5层、第6层、第7层、第13层、第15层和第16层的标本丰富，可以进行CLAMP分析。 第5层、第6层和第7层的泥岩中保存有丰富的植物化石，运用荧光显微分析技术可以清晰地观察到泥岩中植物的气孔和表皮细胞形态。 山旺地区中新世年均温（MAT）在9.5℃和11.3℃之间。较热月份平均温度（WMMT）在19.9 ℃和22.4 ℃之间。生长季月数（GSL）为5.9－－6.9个月。生长季节平均降水量（MGSP）为860－－1770 mm。生长季月平均降水量（MMGSP）为152－－253mm，生长季三个连续最湿的月份降水量（3－WET）为530－－920mm，三个连续最旱的月份的降水量（3－DRY）为286－－687mm。相对湿度（Rel. Hum）在73％以上，高达80％。特殊湿度（q-Specific Humidity）在5.9－－6.7之间，热熵值（H－Enthalpy）为298.5－－304.5。 气候参数在地层层序上存在变化。CLAMP分析的结论与最近亲缘种分析（NLR）的结论相似。CLAMP分析的年均温比现在山旺的年均温12.5℃低，比同层的线性分析结果低3℃。与海底有孔虫氧同位素的研究结论一致。山东山旺中新世古气候的研究可以作为中中新世全球气候变化研究的一个标尺。

山东山旺中新世植物重要类群演化生物学与古气候定量重建的研究

　　早在20世纪三十年代，前人发现山旺中新世具有丰富的植物化石，枝叶、果实、花保存完好。1940年我国植物学家胡先骗与美国加州大学钱耐发表研究专著《中国山东山旺中新世植物群》，报道了30科61属84种植物，为最早系统地进行山旺植物研究的奠基之作，至今仍然具有很高的科学价值和国际影响。1946年布朗发表论文涉及山旺部分属种修订工作。1951年斯行健发表文章：评胡先骗与钱耐著“山东中新统植物群”， 对部分属种鉴定提出异议。1978年植物所与南古所老一辈科学家又作了大量补充与修订，完成合著《中国新生代植物》，该书对山旺植物群进行了系统整理，总计43科87属125种植物，奠定了 山旺植物群的基本面貌。此后，山旺植物群陆续有新的类群添加。目前所知山旺植物群主要以温带落叶植物为主混生了部分亚热带常绿和落叶阔叶植物。该植物群不仅种类繁多，数量丰富，而且保存完整，是我国新生代植物群中研究程度最好的代表。 尽管山旺研究已经取得如此丰富的成果，但是在Hu&Chaney (1940)研究山旺植物群之后的长达60年里( 1940-1999)，关于山旺叶、果实与花的研究仅局限于外部的形态描述，缺乏对其进行细胞形态结构和角质层等结构植物学的实验分析研究，从而大大制约了对该植物群性质的理解和类群演化生物学的深入的研究。 近年来我们通过与国际国内同行的广泛合作，运用国际古植物学研究的新技术、新方法，如叶结构分析、角质层分析、细胞形态结构分析等，在光学显微镜与电子显微镜不同层次的观察上，将植物体外部形态学与内部细胞结构研究相结合，开展对山旺植物群的类群研究，取得了重要进展。我们首次成功提取了山旺植物“阿斯羌属”(As tronium)的角质层，并观察到气孔器结构，为该类群的正确修订提供了确凿的生物学证据，建立了化石新属钱耐属(Wang andManchester，2000)。山旺中新世地层中过去报道存在大量的“阿斯羌”花化石，为五个萼片宿存的辐射对称的花，果实球形，一枚，项生。这种生殖结构也普遍见于欧洲大陆的中新世地层和北美大陆美国的始新世地层中。欧洲人Heer在1859年提出它属于分布于东亚的旋花科的飞蛾藤属(Porana)植物; Weyland在1937年认为它应当是热带龙脑香科非洲马达加斯加岛屿特有分布的Mono tes属植物;美国人MacGinitie在1953年认为它属于分布于南美的漆树科的阿斯羌属(Astronium)植物，其确切系统位置众说纷纭。在中国新生代植物一书中，采用了美国人MacGinitie在1953年的观点，称之为阿斯羌花。斯行健先生认为是旋花科的飞蛾藤属植物。 我们调查了密苏里北京植物园标本馆馆藏的南美和非洲标本，以及哈佛大学标本馆的馆藏东亚标本，对上述科属现存植物的花结构进行了全面的详细研究。发现5个萼片宿存的辐射对称的花见于多个不同的科属类群，是一种趋同演化性状，而萼片脉纹与表皮细胞气孔器排列、果实形态与数目等特征在上述不同类群中极易区分。因而逐一排除了属于上述现存类群的可能性。我们研究的山旺与北美的化石标本显示的果实个体发育过程与现存植物苦木科苦木属(Picrasma)的果实发育相似，果实发育早期为5枚分离，后期3-4枚退化，仅1-2枚，通常为1枚球形果实留存，花瓣脱落，萼片宿存。但是，它们二者在果实形态与萼片表皮结构上，仍存在很大差异。现在认为它属于一个绝灭的植物类群，化石的系统位置尚无法放入现存的科属系统，可能接近于苦木科。因此，建立了一个化石新属钱耐属(Chaneya)。目前，该属包含二个种，一个分布于北美始新世地层，另一个分布于东亚中新世地层，欧洲的材料由于缺乏深入研究，尚无法确定归属。钱耐属在北半球第三纪地层中呈东亚北美间断分布。钱耐属的研究，不仅为探讨东亚与北美植物区系的联系和植物类群的分化历史提供了重要的证据(Wang and Manchester，2000)，更为深入探讨山旺化石植物重要类群的结构与演化生物学研究提供了成功的范例。 山旺的榉属(Zelkova)是山旺植物群的一个常见分子。榉属是欧亚大陆分布的植物，现存6种，在欧亚大陆第三纪地层中发现了大量的榉属化石，包括果实与叶连生的枝条。在北美大陆虽然有榉属化石报道，但是由于缺乏果实，仅靠叶的特征难以令人信服，榉属是否存在于北美仍有争议( Manchester，1989;Manchester，个人通讯)。近年基于我们在山旺组发现和采集到大量的榉属离散叶片以及联生有果实和叶的生殖枝条的深入研究，获得了化石叶结构、表皮细胞、表皮毛、气孔器、核果的大量结构生物学信息。通过与奥地利维也纳大学的 Ferguson教授合作，建立了欧亚现存榉属6个种的生物学形态与结构信息参照系，古今对比结果清楚表明山旺榉的叶缘齿式结构及表皮特征组合最接近我国南部分布的Z. schneideriana，而不是Hu and Chaney (1940)建议的广布于东亚的Z serrata，也明显不同于欧亚大陆共有、分布于西亚伊朗和东欧高加索地区的Z. carpinifolia。常见于欧洲第三纪的翁格榉(Z. ungeri)在形态学更接近Z.carpinifolia。因此，山旺榉明显不同于翁格榉，有其独立的种级特征，应建立东亚中新世榉属的一新种一山旺榉(Z shanwangensis sp. nov.)。榉属在欧亚大陆上的种级分化可能至少在中中新世即已出现。 我们1995年报道了山旺中新世地层发现中国特有植物杜仲化石，并利用先进的电子显微镜设备，找到了确凿无疑的原位化石杜仲特殊胶丝结构直接证据。《美国植物学报》1997年发表文章评论这是目前我国唯一可靠的、保存有精美的胶丝细胞结构的杜仲化石。近年我们迸一步采用古今结合的方法，运用自创的“特有种气候分析法”，对中国重要特有植物杜仲开展了多学科综合研究，利用现存杜仲种子春季萌发需要特定温度的生理学研究结果，结合自然分布区的温度分布，定量恢复了山旺中新世古春季温度数值;该项研究工作的论文列入著名国际SCI刊物《美国植物学报》2003年1月第一期首篇文章。美国植物学报评审人评价：这是应用现代植物实验数据解决地质时期古气候学问题的一个极好例子，是经典之说“现代是（认知）过去的钥匙”的例证，更是当前古植物学研究的一个范例。该文作出的重要贡献体现在如下几个方面：1、提供了现代植物生理生态的实验数据;2、提供了古植物学研究需要的解剖学证据（胶丝）;3、更正了古生物地理方面的一个假说（杜仲何时在中国出现）; 4、提出了一个解答古气候学问题的新方法。 最后一点实际上也是最重要的一点。” 油杉属的研究显示该属现代有三个种，生活在东亚中国，越南和老挝。它曾经在北半球广泛分布，以球果、种鳞、具翅的种子、木材等形式保存在新生代第三纪地层中，如已经有报道的北美大陆美国俄勒冈渐新世和中新世，欧洲中部中新世，亚洲日本中新世和上新世，俄罗斯远东渐新世到中新世地层。本次山旺中中新世与美国俄勒冈渐新世Rujada flora发现的油杉，接近现存油杉属的属型种油杉。北美中新世和亚洲日本中新世和上新世报道了接近于现存种铁坚油杉的化石。这些证据反映了东亚与北美第三纪植物区系的联系远比今天密切，油杉在北美中新世末期后、在欧洲早更新世之后和在东亚日本上新世结束，在上述地区消失。油杉今天仅孑遗分布于东亚中国秦岭以南、雅砻江以东，长江以南及台湾、海南岛和越南、老挝等亚热带至热带北缘的低山、丘陵山区。山旺油杉的球果化石具有现存油杉和铁坚油杉复合种的特征，可能代表了兼具中国两种油杉共同特征的一个早期类型，由此也表明油杉和铁坚油杉的物种分化在中国有可能是1500万年以来发生的新近事件。同时，油杉球果（松科）的首次发现，解决了山东山旺中中新世化石产地有无裸子植物这个长达半个世纪的争论(Hu andChaney，1940：斯行健，1951)，进一步确证了山旺中中新世气候为亚热带山地气候类型。

OCCURRENCE AND DISTRIBUTION OF SILICA-SCALED CHRYSOPHYTES IN ZHEJIANG, JIANGSU, HUBEI, YUNNAN AND SHANDONG PROVINCES, CHINA

Fifty-one phytoplankton samples were collected from different ecological environments in five provinces located in the central, eastern and southwestern parts of China. 41 taxa of silica-scaled chrysophytes, 8 of them belonging to the Chrysophyceae and 33 to the Synurophyceae, have been identified by means of electron microscopy. Among them, Mallomonas parvula, M. calceolus, M. cyathellata (?), M. costata, M. crassisquama, and Synura echinulata are new to China. The silica-scaled chrysophyte flora and its geographical distribution in this region are analysed and discussed.