This article discusses the issues of the practice of medical ethics.It expounds the significance of the clinical practice of medical ethics and how to carry out medical ethics in clinical practice from the perspective of medical ethics,ethical decision-making,ethical practice,as well as ethics supervision.

Objective To analyze the level and change trends of cancer mortality in the media focused area,Yingcheng of Hubei Province,to further support the authenticity and reliability of the information from media report.Methods Use the data of the first national retrospective death survey and the third national retrospective sampling death survey to describe cancer mortality and change trends in Yingcheng of Hubei Province.Results Crude cancer mortality in Yingcheng was 148.26/100 000.In the past 30 years,cancer mortality significantly increased by 9.27 times.Among 100 000 people in the county,each year 43 cases of malignant tumor death occurred more than the national average level.A variety of malignant tumors' mortality change in the county is significantly different from those of the country,such as esophageal cancer,stomach cancer did not fall but rise;liver cancer,lung cancer,leukaemia and colorectal cancer increased 5.84 times,5.61 times,5.07 times and 17.91 times more than the national average,respectively.The excess mortality rate of stomach cancer,liver cancer,lung cancer and colorectal cancer were 15.32/100 000,16.78/100 000,8.32/100 000 and 3.98/100 000 respectively.Negative binomial distribution fitting results suggest that death of stomach cancer exists village aggregation.Conclusions The level of historical cancer mortality in Yingcheng was low,but increase quickly,presently it is on the national high-incidence level.It presents the phenomenon that a variety of malignant tumors is generally on high-incidence level and stomach cancer exists village aggregation.

Objective:To analyze the death rate of asthma among Chinese people aged 0-19 years in 2018 and the trend of asthma mortality between 2008 and 2018, in order to guide the research of asthma control management and prevention strategy, and reduce the mortality of childhood asthma in China.Methods:Data from the national disease surveillance points system (DSPs) was adopted.The mortality rates of 0-19-year-old people in different age groups, genders, places of residence and geographical regions from 2008 to 2018 were calculated, and the national death toll of asthma was estimated as well.The annual percentage change (APC) and average annual percentage change (AAPC) were calculated, and the death rate of asthma among Chinese people aged 0-19 years in 2018 and change trend of asthma mortality from 2008 to 2018 were analyzed.Results:In 2018, there was no significant gender diffe-rence in asthma mortality among Chinese people aged 0-19 years among different age groups, places of residence and geographical regions(all P>0.05). From 2008 to 2018, the mortality rate of people aged 0-19 fluctuated from 0.023/100 000 to 0.046/100 000, the highest mortality rate was in 2009 and 2012, and the lowest was in 2018. It was estimated that the total number of deaths among people aged 0-19 years reached the highest in 2009 (148 cases) and the lowest in 2018 (70 cases). It is estimated that the total number of deaths among people aged 0-19 years in China from 2008 to 2018 was 1 158 cases.From 2008 to 2018, the total mortality rate of asthma in Chinese population aged 0-19 years decreased significantly (AAPC=-7.6%, 95% CI: -10.4%--4.7%). There was a significant decrease in male group(AAPC=-7.4%, 95% CI: -12.5%--2.0%), female group(AAPC=-7.5%, 95% CI: -12.7%--2.0%), 1-<5 years old group(AAPC=-11.4%, 95% CI: -17.9%--4.5%), 15-19 years old group(AAPC=-14.4%, 95% CI: -24.8%--2.6%), rural group(AAPC=-9.0%, 95% CI: -13.1%--4.8%) and central areas(AAPC=-13.1%, 95% CI: -24.0%--0.5%), with statistical significance(all P<0.05). Conclusions:The total mortality of asthma in 0-19-year old population decreased significantly from 2008 to 2018.The mortality rate of asthma in 0-19-year old people in China is at the low level around the world.

OBJECTIVETo investigate the burden of infectious disease of the Chinese population in 1990 and 2010 and changing pattern in the past 20 years.

METHODSResults of the Global Burden of Disease Study 2010 (GBD 2010) were used to demonstrate the burden of infectious disease of the Chinese population in 1990 and 2010 and changing pattern from 1990 to 2010 by gender and age groups, including indicators of incidence, mortality, years of life lost due to premature mortality (YLL), years lived with disability (YLD), disability-adjusted life years (DALY), and their age-standardized rates using data of the 2010 National Census as a standard population.

RESULTSIn 1990 incidence, standardized incidence rate, mortality, standardized mortality rate, DALY, standardized DALY rate, YLL, standardized YLL rate, YLD, and standardized YLD rate of infectious disease in China were 3 067 469 200 cases, 242 669.34 cases/100 000, 824 300 cases, 72.27 cases/100 000, 58 937 700 person-years (PYRS), 3 992.85 PYRS/100 000, 46 504 100 PYRS, 2 932.99 PYRS/100 000, 12 433 600 PYRS, and 1 059.86 PYRS/100 000, respectively. All the aboved indicators were declined from 1990 to 2010, in 2010 they were 3 065 985 800 cases, 224 351.66 cases/100 000, 388 600 cases, 30.74 cases/100 000, 19 492 200 PYRS, 1 440.75 PYRS/100 000, 12 045 700 PYRS, 891.87 PYRS/100 000, 7 446 500 PYRS, and 548.89 PYRS/100 000, respectively. When 2010's indicators were compared to those in 1990, the rates of increase of incidence, incidence rate, mortality, mortality rate, DALY, DALY rate, YLL, YLL rate, YLD, and YLD rate were 56.84%, -9.85%, -33.07%, -61.54%, -27.68%, -58.42%, -32.46%, -61.17%, -16.75%, and -52.13% for 50-69 age group; for ≥ 70 age group, 57.90%, -5.86%, 7.41%, -36.12%, -5.00%, -43.51%, -5.14%, -43.59%, -4.52%, and -43.2%.

CONCLUSIONSThe burden of infectious disease of the Chinese population was declined from 1990 to 2010; however, the incidence of infectious disease was increased in ≥ 50 age groups.

Asian Continental Ancestry Group ; China ; Communicable Diseases ; Cost of Illness ; Disabled Persons ; Humans ; Incidence ; Mortality ; Quality-Adjusted Life Years ; Reference Standards

Along with the society and economy development in China, life expectancy of Chinese increased substantially since 1990, chronic and non-communicable disease has became a serious disease effecting on health. In the process of transition of the health mode, it's a complicated challenge how to effectively reduce the burden of and improve the health of Chinese. Based on the results of the burden of disease study of Chinese, referring to the experience of other countries and combining with the practice in our country, we put forward some suggestions to solve the health problems in China, and we hope we can promote the development of the prevention and control of disease, and realize the health dream of Chinese.
China ; Chronic Disease ; Cost of Illness ; Health ; Humans ; Life Expectancy

OBJECTIVETo analyze the features of distribution and variation trends of mortality of ischemic heart disease over the age of 35 years old in China, 2004-2011.

METHODSA total of 493 274 cases were recruited in the study, the mortality data of the ischemic heart diseases were collected from the national disease surveillance point (DSP) system between 2004 and 2011. The change of ischemic heart disease standardized mortality was described, and the annual change percentage of age group mortality and standardized mortality were analyzed using log linear regression method.

RESULTSIn 2004-2011, the standardized mortality of ischemic heart disease over the age of 35 showed an upward trend in each regions of China.In 2004, the ischemic heart disease standardized mortality over the age of 35 was 176.2/100 000 among males and 131.7/100 000 among females in urban areas, and the figures increased to 204.6/100 000 and 147.9/100 000 respectively in 2011.In 2004, the ischemic heart disease standardized mortality over the age of 35 was 164.4/100 000 among males and 122.2/100 000 among females in rural areas, and the figures increased to 236.8/100 000 and 151.5/100 000 respectively in 2011. The ischemic heart disease standardized mortality was lower in rural regions than in urban regions in 2004, but it changed to be higher in rural regions than in urban regions in 2011 both in males and female. The annual growth rate of ischemic heart disease mortality over the age of 35 was separately 5.00% in male and 3.65% in female. The annual growth rate was highest among males in rural areas (7.09%), followed by females in rural areas (5.06%). The growth rate was lowest among females in urban areas (1.69%).It was found that the increasing trends of ischemic heart disease mortality of males both in urban and rural areas, and females in rural areas was statistically significant (P < 0.05).

CONCLUSIONThe mortality of ischemic heart disease has still been showing an uprising trend, especially in the rural areas.

Adult ; Age Factors ; Aged ; China ; Coronary Artery Disease ; Demography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Ischemia ; Rural Population ; Sex Factors ; Urban Population

Multistage sampling is a frequently-used method in random sampling survey in public health.Clustering or independence between observations often exists in the sampling,often called complex sample,generated by multistage sampling.Sampling error may be underestimated and the probability of type Ⅰ error may be increased if the multistage sample design was not taken into considerationin analysis.As variance (error) estimator in complex sample is often complicated,statistical software usually adopt ultimate cluster variance estimate (UCVE) to approximate the estimation,which simply assume that the sample comes from one-stage sampling.However,with increased sampling fraction of primary sampling unit,contribution from subsequent sampling stages is no more trivial,and the ultimate cluster variance estimate may,therefore,lead to invalid variance estimation.This paper summarize a method of variance estimation considering multistage sampling design.The performances are compared with UCVE and the method considering multistage sampling design by simulating random sampling under different sampling schemes using real world data.Simulation showed that as primary sampling unit (PSU) sampling fraction increased,UCVE tended to generate increasingly biased estimation,whereas accurate estimates were obtained by using the method considering multistage sampling design.

Cancer has become one of the most important public health issues than ever.It was reported that the incidence rate of cancer was 235.0/100 000 and the mortality rate was 144.3/100 000.In China,cases of deaths and new eases of cancer accounted for 26.9％ and 21.8％ of the world's total numbers.The seven papers included in this issue had elaborated the cancer morbidity,mortality and attributable years of life lost at national and provincial levels since 1990,as well as explored the risk factors and strategies on prevention and control of cancer.Information on burden of cancers is important in determining the target population on prevention and control of cancer,for the adequate arrangement of health resources and evaluation on the effects of intervention measures.

Objective:To explore the association between low air temperature and influenza incidence in winter in 31 provinces in China.Methods:Influenza incidence and meteorological data were collected from January, 2004 to December, 2016 in 31 provinces in China. Distributed lag nonlinear model was applied to evaluate the association between low air temperature and influenza incidence in early and late winter, after controlling for the long-term trend, as well as the effect of "day of week" .Results:The influenza incidence increased from 4/100 000 in 2004 to 22/100 000 in 2016 in China, showing an overall increasing trend. The incidences of some provinces were lower than 5/100 000, such as Heilongjiang, Liaoning and Jilin, but the incidences of influenza in Gansu, Hebei, Guangdong, Beijing were higher than 30/100 000 in some years. From January to June, the influenza incidence showed a decreasing trend with the increase of air temperature, but the influenza incidence showed a rising trend from July to December with the decrease of air temperature. In early winter, low air temperature had the highest influence on the incidence of influenza in Beijing, the RR was 2.90 (2.57-3.28), but in late winter, low air temperature had the highest influence on the incidence of influenza in Tibet, the RR was 3.37 (2.03-5.58). In early winter, low temperature had the highest influence on the incidence of influenza in northeastern China, the RR was 2.04 (1.48-2.79), but in late winter, low air temperature had the highest influence in southern China, the RR was 1.77 (1.61-1.94). There were area specific difference in the influence of low air temperature on the incidence of influenza between early winter and late winter. Conclusions:The correlation between low air temperature in winter and influenza incidence exists. The influenza of early and late winter on influenza incidence varies with different areas. We should take appropriate protective measures according to local conditions.

Objective:To assess the relationship between body mass index (BMI) and death risk of cardiovascular disease (CVD) in rural male population.Methods:22 282 men aged 40 years older in Tanghe county and Fenghuang county from the cohort of the "Prospective Study on Adult Behavior and Health Risk Factors in China" were selected as subjects of this study. Cox regression model was used to calculate the hazard ratios ( HRs) of the death of CVD during the follow-up period with different BMI groups at baseline. Results:The average follow-up period in the two counties was (19.1±8.7) years and 10 828 (48.6%) people died during the follow-up period. 4 504 deaths were attributed to CVD. Among the deaths of CVD, 1 279 cases died of ischemic heart disease (IHD), ischemic stroke (IS) died in 1 201, cases died of died of 1 317 hemorrhagic stroke (HS), other 707 cases. Compared to population with BMI<18 kg/m 2, Cox regression model (adjusting factors of region, age, nationality, education level, occupation, smoking, drinking, blood pressure, blood pressure, etc.) showed that people with BMI between 20-22 kg/m 2 had the lowest risk of CVD death ( HR=0.95, 95 %CI: 0.83-1.09). But the difference was not statistically significant among each BMI group ( P>0.05). The risk of IHD death was the lowest in the population with BMI between 20-22 kg/m 2 ( P<0.05) ( HR=0.64, 95 %CI: 0.52-0.80). There was no statistically significant difference between the risk of IHD death in the population with BMI≥24 kg/m 2 and that in the population with BMI<18 kg/m 2 ( P>0.05). There was no statistically significant difference between the risk of IS death and BMI ( P>0.05). The death risk of HS in the population with BMI between 18-24 kg/m 2 was higher than that in the population with BMI<18 kg/m 2 ( P<0.05). The death risk of the population with BMI between 26-28 kg/m 2 was the highest ( HR=1.88, 95 %CI:1.18-2.99). Conclusions:The mortality risk of CVD and IHD was the lowest in lean or normal weight group, and HS was higher in overweight group. Maintaining a reasonable weight can reduce the risk of death in patients with CVD.