流行性感冒季节性的基本原因和模型理论

流行性感冒（流感）在世界范围内每年造成（300～500）万例严重疾病和（25～50）万例死亡。流感可造成严重的公共卫生和经济问题。流感流行和爆发都是以流感季节为特征。因为与甲型流感病毒相关疾病的发病率和死亡率水平较高,因此本研究从病毒学、流行病学、生物学和数学等方面重点讨论甲型流感季节性的基本原因和模型理论。     

Death,demography and the denominator: Age-adjusted Influenza-18 mortality in Ireland

Using the Irish experience of the 1918–1919 Spanish flu pandemic (“Influenza-18”), we demonstrate how pandemic mortality statistics can be sensitive to the demographic composition of a country. We build a new spatially disaggregated population database for Ireland’s 32 counties for 1911–1920 with vital statistics on births, ageing, migration and deaths. Our principal contribution is to show why, and how, age-at-death data should be used to construct the age-standardised statistics necessary to make meaningful comparisons of mortality rates across time and space. We conclude that studies of the economic consequences of pandemics must better control for demographic factors if they are to yield useful policy-relevant insights. For example, while Northern Ireland had a higher crude death rate during the first wave of the Covid-19 pandemic, it also has an older population; age-adjusted mortality paints a very different picture.     

Ascorbic acid role in containment of the world avian flu pandemic

In this Comment, the ultimate intent is to increase survival of the anticipated global flu pandemic. The apparent failure of "medicine" to provide a completely understood and logically based biochemical prevention and treatment for all influenzas (and many other viral diseases) may be an unavoidable result of the evolving complexity of the H5N1 virus. However, clinical experience cited in all accounts, including the 2003 to 2006 period, suggest that: (i) ascorbic acid is not being administered to humans infected or at risk for influenza, and (ii) ascorbic acid is (mistakenly) believed to be a vitamin ("vitamin C"). Proper use of ascorbic acid as described here could provide effective containment for the flu pandemic.     

Opposing the veil in the name of liberalism: popular attitudes to liberalism and Muslim veiling in the Netherlands

Is popular antagonism towards Muslim veils in Europe rooted in an exclusionary ‘enlightenment liberalism’? By examining different conceptions of liberalism and readings of veiling in a Dutch survey from 2014, we present the first study that investigates this question empirically. We thus bring together two hitherto largely unconnected literatures. The first is the work on immigration and ethnicity, which has shown the centrality of enlightenment liberalism in anti-Muslim media and policy discourses. The second is the literature on anti-Muslim attitudes in public opinion, which explains support for veil bans as the result of perceiving veils as threatening the respondent's own, supposedly liberal, values – but has failed to distinguish between different conceptions of liberalism and thus reached inconclusive results. This, we show, can be remedied by distinguishing between ‘enlightenment liberals’, who hold negative attitudes, and ‘reformation liberals’, who hold positive attitudes towards Muslim veils.     

Vacunación antigripal en personas mayores

Seasonal flu is a very serious public health problem in the elderly due to its morbidity and mortality and financial and social costs arising from this. The aim of this review is to describe the magnitude and importance of seasonal flu in this population group, and its prevention by means of vaccination. For this reason, an updated account of the composition of the vaccine, its dosage and administration route, vaccine safety and the evaluation of the immunogenicity and effectiveness of vaccination. There is variation between different countries and official organisations on the age at which flu vaccination must be established in the elderly. New flu vaccination strategies need to be introduced, to further improve flu vaccination cover in Spain.     

Flu vaccination in the elderly

Seasonal flu is a very serious public health problem in the elderly due to its morbidity and mortality and financial and social costs arising from this. The aim of this review is to describe the magnitude and importance of seasonal flu in this population group, and its prevention by means of vaccination. For this reason, an updated account of the composition of the vaccine, its dosage and administration route, vaccine safety and the evaluation of the immunogenicity and effectiveness of vaccination. There is variation between different countries and official organisations on the age at which flu vaccination must be established in the elderly. New flu vaccination strategies need to be introduced, to further improve flu vaccination cover in Spain.     

Effectiveness of the public health policy for breast cancer screening in Finland: population based cohort study.

OBJECTIVE: To evaluate the effectiveness of screening for breast cancer as a public health policy. DESIGN: Follow up in 1987-92 of Finnish women invited to join the screening programme in 1987-9 and of the control women (balanced by age and matched by municipality of residence), who were not invited to the service screening. SETTING: Finland. SUBJECTS: Of the Finnish women born in 1927-39, 89893 women invited for screening and 68862 controls were followed; 1584 breast cancers were diagnosed. MAIN OUTCOME MEASURES: Rate ratio of deaths from breast cancer among the women invited for screening to deaths among those not invited. RESULTS: There were 385 deaths from breast cancer, of which 127 were among the 1584 incident cases in 1987-92. The rate ratio of death was 0.76 (95% confidence interval 0.53 to 1.09). The effect was larger and significant (0.56; 0.33 to 0.95) among women aged under 56 years at entry. 20 cancers were prevented (one death prevented per 10000 screens). CONCLUSIONS: A breast screening programme can achieve a similar effect on mortality as achieved by the trials for breast cancer screening. However, it may be difficult to justify a screening programme as a public health policy on the basis of the mortality reduction only. Whether to run a screening programme as a public health policy also depends on its effects on the quality of life of the target population and what the resources would be used for if screening was not done. Given all the different dimensions in the effect, mammography based breast screening is probably justifiable as a public health policy.     

Socioeconomic development and mortality levels in less developed countries

Abstract

Some demographers have argued that post‐World War II mortality declines in the less‐developed countries (LDC's) are not associated with economic and social development because of the diffusion of health and medical techniques from the developed to the underdeveloped countries. This paper examines the current relationship between socioeconomic development and mortality levels in 124 countries, 94 of which are LDC's. The argument is tested with a path model consisting of five multidimensional and three unidimensional indicators. Results indicate that for the LDC's, there is a very strong set of direct and indirect relationships between indicators of socioeconomic development and mortality. Between 62 and 80 per cent of the variances in the crude death rate, infant mortality, and life expectancy are explained in the LDC model. The empirical test of the model demonstrates that lower mortality levels in the LDC's are dependent on socioeconomic factors and health services; continued improvement of socioeconomic levels in the LDC's will result in further mortality declines. For comparative purposes, the same model also is tested for more developed countries. Results for the model with more developed countries (MDC's) show that entirely different measures are necessary for MDC mortality models; the concept of “mortality” for LDC's and MDC's is orthogonal and requires different empirical indicators.     

Differential sex mortality in a rural nineteenth-century population: Escazu, Costa Rica.

Cross-cultural studies of sex-specific mortality indicate that, whereas males experience their greatest mortality in industrialized societies, females experience their greatest mortality in populations with low life expectancy. The higher mortality of females in low-life-expectancy communities has been interpreted as a reflection of nutritional and health-care discrimination against females. Cross-cultural demographic studies also indicate that males have a higher frequency of violent and accidental deaths, possibly because of more frequent risky behaviors. This study focuses on Escazu, a rural nineteenth-century population from Costa Rica with low life expectancy. I investigate whether Escazu males had higher violent and accidental deaths and whether females had higher diarrhea-related deaths, an indication of nutritional discrimination. An analysis of mortality by cause of death indicates that males and females did not experience significantly different diarrhea-related death rates, although males did experience greater violent mortality. This study illustrates that more anthropological community-specific studies of mortality are needed to elucidate variation of death rates within large national or international regions.     

Estimation of cancer mortality rates: a Bayesian analysis of small frequencies

A Bayesian method is presented for estimating mortality rates of specific diseases when the frequency of deaths over a specified time period is assumed to have a Poisson distribution with mean proportional to the population size. The estimators use information from related populations, each having its own rate which is assumed distributed according to a common prior distribution about which some information is available. The study was motivated by an epidemiological study on the geographic variation of cancer mortality in the state of Missouri. Data from this study are used to illustrate the method and to compare it to a somewhat simpler empirical Bayes method.     

Effect of changing mortality on the working life of American men and women, 1970–1990

Abstract

The mortality patterns of men and women of working age, in terms of the major causes of death, have changed over the past three decades. This study assesses the extent to which mortality among persons of working age represents an economic loss to society. This economic loss is measured by the per capita loss of productive working life, defined as the number of years, on the average, a person can expect to be an active member of the labor force. Causes of death affecting primarily older Americans (heart disease, cancer, stroke) had a relatively small and declining impact on the working lives of men and women. Major causes of death affecting the young (motor vehicle accidents, homicide, AIDS), although accounting for fewer deaths, were responsible for many more years of lost productivity. Gender and socioeconomic differentials in mortality suggest that different strategies are necessary for future reductions in lost work‐years.     

Bayer revisited

Bayer accuses me of wrongly claiming that he holds a negative thesis about the role that the liberal emphasis on privacy rights has had on AIDS public health policy. In his reply to my review essay, he denies holding such a thesis and, moreover, makes the stronger claim that his position is sympathetic to liberalism, or at least to some versions of it. Although I appreciate Bayer's efforts to clarify his views about liberalism and a "culture of restraint and responsibility", it is clear to me that our differences are related not to a misunderstanding on my part, but to a fundamental disagreement concerning what liberalism as a political philosophy is, and what public policy implications it entails in the case of AIDS....     

Seasoned adaptive antibody immunity for highly pathogenic pandemic influenza in humans

Fundamentally new approaches are required for the development of vaccines to pre-empt and protect against emerging and pandemic influenzas. Current strategies involve post-emergent homotypic vaccines that are modelled upon select circulating 'seasonal' influenzas, but cannot induce cross-strain protection against newly evolved or zoonotically introduced highly pathogenic influenza (HPI). Avian H5N1 and the less-lethal 2009 H1N1 and their reassortants loom as candidates to seed a future HPI pandemic. Therefore, more universal 'seasoned' vaccine approaches are urgently needed for heterotypic protection ahead of time. Pivotal to this is the need to understand mechanisms that can deliver broad strain protection. Heterotypic and heterosubtypic humoral immunities have largely been overlooked for influenza cross-protection, with most 'seasoned' vaccine efforts for humans focussed on heterotypic cellular immunity. However, 5 years ago we began to identify direct and indirect indicators of humoral-herd immunity to protein sites preserved among H1N1, H3N2 and H5N1 influenzas. Since then the evidence for cross-protective antibodies in humans has been accumulating. Now proposed is a rationale to stimulate and enhance pre-existing heterotypic humoral responses that, together with cell-mediated initiatives, will deliver pre-emptive and universal human protection against emerging epidemic and pandemic influenzas.     

Climate change and heat-related mortality in six cities Part 1: model construction and validation

Heat waves are expected to increase in frequency and magnitude with climate change. The first part of a study to produce projections of the effect of future climate change on heat-related mortality is presented. Separate city-specific empirical statistical models that quantify significant relationships between summer daily maximum temperature (T _max) and daily heat-related deaths are constructed from historical data for six cities: Boston, Budapest, Dallas, Lisbon, London, and Sydney. ‘Threshold temperatures’ above which heat-related deaths begin to occur are identified. The results demonstrate significantly lower thresholds in ‘cooler’ cities exhibiting lower mean summer temperatures than in ‘warmer’ cities exhibiting higher mean summer temperatures. Analysis of individual ‘heat waves’ illustrates that a greater proportion of mortality is due to mortality displacement in cities with less sensitive temperature–mortality relationships than in those with more sensitive relationships, and that mortality displacement is no longer a feature more than 12 days after the end of the heat wave. Validation techniques through residual and correlation analyses of modelled and observed values and comparisons with other studies indicate that the observed temperature–mortality relationships are represented well by each of the models. The models can therefore be used with confidence to examine future heat-related deaths under various climate change scenarios for the respective cities (presented in Part 2).     

Statistical tests for recessive lethal-carriers.

This paper presents a statistical method for testing whether a male mouse is a recessive lethal-carrier. The analysis is based on a back-cross experiment in which the male mouse is mated with some of his daughters. The numbers of total implantations and intrauterine deaths in each litter are recorded. It is assumed that, conditional on the number of total implantations, the number of intrauterine deaths follows a binomial distribution. Using computer-simulated experimentation it is shown that the proposed statistical method, which is sensitive to the pattern of intrauterine death rates, is more powerful than a test based only on the total number of implant deaths. The proposed test requires relatively simple calculations and can be used for a wide range of values of total implantations and background implant mortality rates. For computer-simulated experiments, there was no practical difference between the empirical error rate and the nominal error rate.     

Moving from Data on Deaths to Public Health Policy in Agincourt,South Africa: Approaches to Analysing and Understanding Verbal Autopsy Findings

Background

Cause of death data are an essential source for public health planning, but their availability and quality are lacking in many parts of the world. Interviewing family and friends after a death has occurred (a procedure known as verbal autopsy) provides a source of data where deaths otherwise go unregistered; but sound methods for interpreting and analysing the ensuing data are essential. Two main approaches are commonly used: either physicians review individual interview material to arrive at probable cause of death, or probabilistic models process the data into likely cause(s). Here we compare and contrast these approaches as applied to a series of 6,153 deaths which occurred in a rural South African population from 1992 to 2005. We do not attempt to validate either approach in absolute terms.

Methods and Findings

The InterVA probabilistic model was applied to a series of 6,153 deaths which had previously been reviewed by physicians. Physicians used a total of 250 cause-of-death codes, many of which occurred very rarely, while the model used 33. Cause-specific mortality fractions, overall and for population subgroups, were derived from the model''s output, and the physician causes coded into comparable categories. The ten highest-ranking causes accounted for 83% and 88% of all deaths by physician interpretation and probabilistic modelling respectively, and eight of the highest ten causes were common to both approaches. Top-ranking causes of death were classified by population subgroup and period, as done previously for the physician-interpreted material. Uncertainty around the cause(s) of individual deaths was recognised as an important concept that should be reflected in overall analyses. One notably discrepant group involved pulmonary tuberculosis as a cause of death in adults aged over 65, and these cases are discussed in more detail, but the group only accounted for 3.5% of overall deaths.

Conclusions

There were no differences between physician interpretation and probabilistic modelling that might have led to substantially different public health policy conclusions at the population level. Physician interpretation was more nuanced than the model, for example in identifying cancers at particular sites, but did not capture the uncertainty associated with individual cases. Probabilistic modelling was substantially cheaper and faster, and completely internally consistent. Both approaches characterised the rise of HIV-related mortality in this population during the period observed, and reached similar findings on other major causes of mortality. For many purposes probabilistic modelling appears to be the best available means of moving from data on deaths to public health actions. Please see later in the article for the Editors'' Summary     

Disparity and Convergence: Chinese Provincial Government Health Expenditures

The huge regional disparity in government health expenditures (GHE) is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.     

Impact of future cigarette smoking scenarios on mortality of the adult population in the United States, 2000–2050

Abstract

The prevalence of cigarette smoking in the United States has declined over the past few decades. However, some leveling‐off in prevalence rates has been observed in recent years, and the rate for teenagers and young adults has even turned upward. This paper considers four alternative scenarios of future cigarette smoking patterns in the United States for the population 25 and over and measures the impact these different scenarios would have on excess mortality due to smoking and on the sex and age distributions of deaths. Scenarios reflecting higher levels of smoking prevalence produce considerably more deaths than scenarios tied to lower levels. As many as two and one‐half million excess deaths would take place in the decade of the 2020's if a high prevalence, rather than low prevalence, assumption proves correct. Even when a constant prevalence, assumption proves correct. Even when a constant prevalence assumption is compared with a moderately‐declining prevalence assumption, as many as one million excess deaths would be generated during that decade alone. Lowering smoking prevalence rates would also change the population sex ratio by reducing deaths for males more than deaths for females, and by contributing to the aging of the population. The results are interpreted in terms of the overall impact of smoking on mortality and with regard to public and private policy decisions related to cigarette smoking.     

Hot weather warning might help to reduce elderly mortality in Hong Kong

While there was evidence on the relationship between extreme hot weather and the increase in mortality, particularly from ischaemic heart disease (IHD) and cerebrovascular disease (stroke), some researchers suggested that early warning systems might reduce mortality. In this study, the relationship between Very Hot Weather Warning (VHWW) and mortality was examined in the context of Hong Kong, which has a sub-tropical climate. An observational study was conducted on the daily number of deaths due to IHD and stroke in the Hong Kong elderly population (aged 65 or above) during summer (May–September) in 1997–2005. Totals of 4,281 deaths from IHD and 4,764 deaths from stroke occurred on days with maximum temperature reaching/exceeding 30.4°C. Multiple linear regression models were used to study the association between VHWW and the daily mortality rates from IHD and from stroke, respectively. Results showed that absence of VHWW was associated with an increase of about 1.23 (95% CI: 0.32, 2.14) deaths from IHD and 0.97 (95% CI: 0.02, 1.92) deaths from stroke among the elderly per day. Public education is required to inform the elderly to take appropriate preventive measures and to remind the public to pay more care and attention to the elderly on days which are not considered to be stressful to the general public. Warning systems tailored for the elderly could also be considered.     

Debunking American exceptionalism and rescuing liberalism

Culling the Masses seeks to explain the shift in American immigration policy from one based on racial and ethnic selection to a more equitable and colorblind approach. The authors argue that international and foreign policy considerations led to a radical shift in policy after World War II. They succeed in debunking American exceptionalism, but in this critique I argue that more attention should be given to the interaction of international and domestic politics, using a ‘two-level game’ framework. Moreover it is important to highlight the contradictions that are inherent in liberalism as a governing philosophy.