中国军队高原病人群水平影响因素分析及卫勤保障对策研究
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摘要
研究背景
中国拥有世界上面积最大的高原国土，同时拥有数量众多的高原常住人口和移居人口，而高原地区也是边境争端、极端主义、分离主义、恐怖主义异常活跃的地区。为了保卫和建设这片世界上最辽阔的高原国土，每年都有大批人员进入这一地区，同时有更多数量的移居者长期工作、战斗和生活在这一地区。这一人群的主体是来自低海拔地区的青年汉族群体，而且以男性为主，包括军人、工人、商人、地方干部等等，其中军人是构成这一群体的重要组成部分。
进入高原地区后，由于低压缺氧的影响，军人群体中会出现各型高原病。初进高原的军人群体易发生急性高原病，虽然经过一段适应期症状可自行消退，但在进驻初期会严重影响军人的作业能力。对于常驻高原的军队人群而言，即便经过较长的适应期，仍有相当一部分人员因无法很好地适应高原环境而罹患慢性高原病。其初期症状虽然轻微，但迁延难愈，逐渐加重，严重侵蚀高原官兵的健康和军队的战斗力。然而，慢性高原病对军队人群的影响在既往的研究中一直未引起足够的重视。
对高原任务部队而言，急、慢性高原病不仅是一类复杂的医学问题，更是一类复杂的公共卫生和军事后勤问题；不仅会造成官兵个人和家庭的痛苦，也会造成高原部队战斗力的损失和巨大的后勤保障负担。因此，需要采取有效的卫勤保障措施，对急、慢性高原病加以预防和控制，以达到减少发病、缓解症状、降低危害、改善健康、提升战斗力的目的。成功的高原病防治工作必须将人群水平因素纳入考虑。对高原病人群水平影响因素的评估，有助于在宏观层面制定更为有效的卫勤保障对策，以防控高原病的流行。然而，目前有关此领域的研究尚少。
研究目的
本项研究旨在调查当前高原任务部队急、慢性高原病在不同进驻时间、不同地域、不同人群间分布的有关情况，主要包括急、慢性高原病的各类发病指标及失能指标；探讨军事因素、环境因素、社会因素、卫生因素、行为因素、人口统计特征等各类人群水平影响因素与军队急、慢性高原病的关系；发现与军队急、慢性高原病相关的危险因素与保护因素，定量描述其的作用强度，并建立相应的军队高原病发病模型，估计高原病在军队中的流行趋势；有针对性地提出军队急、慢性高原病的卫勤保障对策建议。同时，通过本研究探索新的研究方向、构建新的研究模式、发现新研究线索，为高原卫生勤务学相关领域的科学研究奠定基础、打开局面。
研究内容
本研究主要由三个部分组成。第一部分为军队急性高原病人群水平健康影响因素研究；第二部分为军队慢性高原病人群水平健康影响因素研究；第三部分为针对军队高原病的卫勤保障对策研究。其中，前两部分为平行研究，第三部分是在前两部分的基础上探讨军队急、慢性高原病的卫勤保障对策。
第一部分的研究分为前后两个阶段。在第一阶段，主要依据现有病例资料和比较容易获得的病例资料进行初步分析。第二阶段，在第一阶段研究的基础上深入高原部队单位收集更为详细的病例资料，提取更为详细的指标，做进一步的研究分析，验证第一阶段的发现并寻找其他潜在的急性高原病人群水平影响因素，完成军队急性高原病人群水平影响因素发病模型的构建。
第二部分的研究分为两项平行研究，一项为军队慢性高原病生态学调查研究——探讨各类群体水平因素与慢性高原病患病率之间的关系。另一项研究为军队慢性高原病疾病负担研究——探讨慢性高原病给高原部队造成的健康损失及其人群水平相关因素。通过研究发现军队慢性高原病的人群水平因素，并量化评估慢性高原病给军人群体造成的疾病负担。
第三部分的研究根据前两部分的发现，分别针对军队急性高原病和慢性高原病提出相应的卫勤保障对策。其中，针对军队急性高原病的卫勤保障对策重点关注高原任务部队进驻高原军事行动前的卫勤准备工作和进驻过程中的卫勤保障工作；针对军队慢性高原病的卫勤保障对策重点关注常驻高原部队慢性高原病防治和官兵健康促进过程中的卫勤保障工作。
研究方法
第一部分研究采用回顾性研究的方法，在搜集近年来部队进驻高原军事行动病历资料的基础上，提取相关指标，通过统计分析得出各类进驻条件下部队急性高原病的发病率，找出有意义的影响因素，并构建发病模型。第二部分研究采用横断面调查的方法，随机抽取部分有代表性的高原部队单位，进行慢性高原病的现场调查；对抽样单位进行慢性高原病诊断、症状问卷调查、卫生学调查以及单位基本情况调查。第三部分则采用推理归纳、逻辑演绎的方法探讨高原病的卫勤保障对策。
在具体研究中，本课题采用现场调查、问卷调查的方法，了解、掌握目标人群的相关情况，获取指标数据；采用病例-对照研究的方法，分析急性高原病人群水平影响因素；采用氰化高铁血红蛋测定法诊断军人慢性高原病；采用生态学调查法查找、分析高原部队单位慢性高原病人群水平影响因素；采用德尔菲—人数权衡法制订军队慢性高原病症状权重；采用伤残调整寿命年的测算方法测算军队慢性高原病的疾病负担；采用相关分析对急、慢性高原病的人群水平影响因素进行初步筛选；采用回归分析验证急、慢性高原病相关的人群水平影响因素，并建立疾病的数学模型。
主要结果
经过对军队急性高原病人群水平影响因素的分析，进驻高原地区军事行动中急性高原病的人群水平影响因素主要包括：民族（藏族vs.汉族，OR为0.03-0.08）、兵源地（东部省区vs.西北省区，OR为1.32-1.39）、进驻季节（寒季vs.暖季，OR为1.25-1.28）、进驻方式（紧急陆路vs.常规陆路，OR为2.08-2.11；常规空运vs.常规陆路，OR为2.00-2.20；紧急空运vs.常规陆路，OR为2.40-3.34）、药物预防措施（采用vs.未采用，OR为0.75-0.76）等。在制定高原军事行动计划的过程中，低海拔出发地（600-800米vs.1300-1500米，OR为1.32-1.44）以及高海拔目的地（4100-4300米vs.2900-3100米，OR为3.94-4.12；3600-3700米vs.2900-3100米，OR为2.71-2.74）等风险因素也必须给予高度的重视。研究中建立的急性高原病多元回归模型具有一定的预测价值（接受者特征曲线下面积为0.703），可为部队进驻高原前卫勤保障计划提供参考。
经调查各类高原部队单位慢性高原病患病率为1.25—36.58%（14.65±8.15%）。一系列的社区水平影响因素，如部队单位药品投入（OR=0.897，P=0.022）、集中供氧系统的使用（可用vs.不可用，OR=0.827，P=0.020）、军兵种差别（工程兵vs.后勤兵，OR=1.240, P=0.029）以及驻地城市化水平（城市vs.乡村，OR=1.228，P=0.019）都会对部队单位慢性高原病的患病率造成影响。研究还显示，军队慢性高原病的疾病负担较重，且不同人群间具有较大差异。在不同军人群体间，个体损失的伤残调整寿命年为0.13至0.33，每千人损失的伤残调整寿命年为3.60至52.78。具有较高的驻地海拔、较大的年龄、较长的高原服役时间、吸烟习惯以及从事工程专业的军队人群，更容易发生慢性高原病，且慢性高原病的疾病负担也更为严重。
在制定进驻高原军事行动卫勤保障计划时，卫勤部门可以将各项人群水平影响因素的风险水平作为参考，并利用发病风险预测模型输出部队人群急性高原病风险预测值，从而为科学拟定进驻高原地区军事行动计划提供定量依据。对于常驻高原部队，卫勤保障工作应着力于加大药品补给、供氧系统建设方面的投入；对承担工程任务的军人群体应加强针对性卫生防护与保健支持；在广大高原官兵中推行吸烟控制与健康防护教育；根据驻地海拔、驻守时间、从事专业建立科学合理的轮换机制和补偿机制。
政策建议
军队急、慢性高原病的卫勤保障工作具有不完全相同的特点和需求，需要有针对性地实施卫勤保障。
针对军队急性高原病的卫勤保障工作应重点针对大部队进驻高原军事任务；目标在于提高军人群体进驻高原初期的作业能力，促其快速适应高原环境；关键在于做好急性高原病的发病预测，根据预测正确拟定卫勤保障计划。
针对军队慢性高原病的卫勤保障工作应重点针对长期驻守高原的军人群体；减缓、减轻高原环境对官兵的不良影响，促进人群健康，保持部队在高原地区的战斗力；关键在于减轻军人群体慢性高原病的疾病负担，形成长效的卫勤保障机制。
急、慢性高原病的根本病因都是高海拔带来的低压缺氧，其在军队人群中的发生、发展会受到医疗条件和行为方式的影响。急性高原病主要和高原军事任务本身的一些特征（方式、季节）有关，慢性高原病则与驻守时间、生活条件、职业类型有更密切的关系。实施针对军队高原病的卫勤保障，需要把握各类高原病人群水平影响因素，从而科学分配卫生资源，合理制定保障计划，有效采取干预措施。
Backgrounds
China has the world largest highland territory and a large number of native andimmigrant highlanders. The highland territory also is the flash point of border conflicts,race extremism, separatism, and terrorism. To defense and develop the world largesthighland territory, a great many of people are working and living in the area, and there alsoare a great many of new comers enter the area every year. The population that entering thehighland is mainly make up of young male Chinese Han population. The populationincludes soldiers, workers, merchants, and civil servants, among which soldiers take up alarge part of them.
After military population entering highland area, many servicemen will developaltitude disease due to the effectiveness of hypobaric hypoxia. During the early period ofnewly entering high altitude, military population will affect by acute altitude disease.Although the symptoms would subside after a period of acclimation, the symptoms cansignificantly reduce operation capability of the servicemen in the early time of entering.Even if living in highland for a long period, many of the servicemen who were deployed forlong-term highland service cannot fully get acclimation and develop chronic altitudedisease. The early symptoms of the chronic altitude disease are not serious. However, it istreatment-resistance and would deteriorate gradually as time goes on, which disintegratehealth of the highland servicemen and decay combat effectiveness of the highland troops.Unfortunately, there are not enough awareness been paid for the harmful effectiveness ofchronic altitude disease in the highland servicemen population.
Altitude diseases are not only a series of complicated medical problems, but also aseries of complicated public health and military logistics’ problems for highland troops. Thediseases not only cause suffering and misery for oneself and his family, but also cause losing of the troops’ combat effectiveness and heavy logistics burden of the army. Hence, itis imperative for the authorities to take effective health service measures to prevent andcontrol both acute and chronic altitude disease. The purposes should be decreasingincidence, alleviating symptoms, reducing harm, improving health status, enhancingcombat effectiveness. To accomplish these purposes of control and heal altitude diseases,population level health related determents should be taken into account. Evaluation ofpopulation level determents of altitude diseases is helpful for countermeasure making foreffective controlling of the diseases in highland troops on the view of macroscopic.However, there is little work on this study field presently.
Study purposes
The purposes of this study, firstly, are to investigate the contemporary distributionstatus of acute and chronic altitude disease among different time, different area, anddifferent military populations, including disease indicators and disability indicators.Secondly, to discuss the relationship between altitude diseases and population leveldeterments that include military factor, environmental factor, social factor, hygiene factor,behavior factor, and demographic characteristic factor. Thirdly, to find out and quantify therisk and protect factors of altitude diseases and build up disease model for describing theepidemic tendency of the diseases. Fourthly, to bring forward suggestions of the highlandtroops’ health service for altitude diseases according to the factors. Moreover, through thisstudy, to discover new research direction, build up new research mode, find out new studyclues, and lay the groundwork and pave the way for future studies of military highlandhealth service.
Study contents
This study is composed by three parts. The first part is the study of population levelhealth determents of acute altitude disease in highland troops. The second part is the studyof population level health determents of chronic altitude disease in highland troops. Thethird part is countermeasure study of health service for altitude diseases. The first two partsare parallel study, while the third part gives out the countermeasures that based on thefindings of the first two parts.
The first part of this study includes two stages. The first stage is preliminary analysesby using the medical records that already possessed or easy to obtain. The second stage is further analyses based on the first stage by using the advanced medical records thatcollected from highland units. Aims of the second stage are to verify the findings of the firststage, to find out other potential population level determents of acute altitude disease, andto build up acute altitude disease model of highland troops.
The second part of this study is composed by two parallel study sections. One of thesections is epidemiological ecological study of chronic altitude disease among permanenthighland units, which is to discuss the relationship between prevalence of chronic altitudedisease and population level determents of highland military unit. The other section is studyon the highland troops’ burden of chronic altitude disease, which is to discuss the highlandtroops’ health lost caused by chronic altitude disease and its related population level factors.
The third part of this study is to discuss the highland troops’ health servicecountermeasures for acute and chronic altitude disease separately. The health servicecountermeasures for acute altitude disease are focus on the health service preparationsbefore highland entering operation and health supports during the highland enteringoperation. The health service countermeasures for chronic altitude disease are focus on thehealth service for prevention and heal the disease and servicemen health improvement inpermanent highland units.
Study methodology
The first part of this study based on retrospective strategy. We collected highlandtroops’ recent year medical records during highland entering operations and extracted studyfactors. By statistic analyses we obtained the incidence rates, significant determents, andbuilt up disease model. The second part of this study based on across sectional strategy. Werandomly selected a sample of representative highland military units for chronic altitudedisease field investigation. During the investigation we carried out chronic altitude diseasediagnosis, symptom questionnaire, hygienic survey, and unit base information inquiry in thesample units. The third part of this study discussed health service countermeasures bymethodology of reasonable induction and logical deduction.
In specific study, we used field investigation and questionnaire to obtain the status oftarget population; used case-control research to analyze the population level determents ofacute altitude disease; used cyanmethemoglobin technique to diagnose chronic altitudedisease; used epidemiological ecological investigation to find and analyze population level determents of chronic altitude disease; used Delphi processed person-treat-off strategy todeduce the disease weights of chronic altitude disease; used disability adjusted life year tocalculate the disease burden of highland troops; used correlation analysis to preliminarilyselect the population level determents of altitude disease, used regression analysis toconclude the population level determents of altitude diseases and to build up mathematicaldisease model.
Main findings
By the population level determents’ analyses of highland troops, the acute altitudedisease determents were obtained, including: race (Tibetan vs. Han, OR=0.03-0.08), bornprovince (east vs. northwest, OR=1.32-1.39), season (cold vs. warm, OR=1.25-1.28),deployment type (emergency by land vs. normal by land, OR=2.08-2.11; normal by air vs.normal by land, OR=2.00-2.20; emergency by air vs. normal by land, OR=2.40-3.34),prophylaxis (prophylaxis vs. none, OR=0.75-0.76). When draw up highland enteringoperation plan, lower start point (600-800m vs.1300-1500m, OR=1.32-1.44) and higherdestination (4100-4300m vs.2900-3100m, OR=3.94-4.12;3600-3700m vs.2900-3100m, OR=2.71-2.74) also should be seriously take into account. Prediction value of themultiple regression model built in the study is acceptable (the area under receivercharacteristic curve is0.703), which could be used as reference for health service planmaking before troops entering highland.
According to this investigation, the prevalence rate of chronic altitude disease amongthe highland troops is from1.25to36.58%(14.65±8.15%). Series community level factorswere verified as significant determents of chronic altitude disease, including pharmacyinvestment (OR=0.897，P=0.022), oxygen generation system (available vs. unavailable,OR=0.827, P=0.020), occupation (construction vs. logistics, OR=1.240, P=0.029), andsocial development level (urban vs. rural, OR=1.228, P=0.019). The study also indicatedthat the disease burden caused by chronic altitude disease is serious among highland troops,although it changes dramatically in different servicemen population. In differentservicemen population, the individual disability adjusted life years lost was form0.13to0.33, while the disability adjusted life years lost by one thousand people was form3.60to52.78. The population who lived in a higher area, got older, serviced for longer years inhighland, had smoking behavior, and engaged in construction occupation, are more likely to develop chronic altitude disease and also more likely to get heavier disease burden.
When making health service plan before troops entering highland, the health serviceauthority should take the population level determents of acute altitude disease into account,and use the risk predicting model to export risk value of the disease, so that it could providequantitive reference for scientific military planning before operation of entering highland.For highland permanent military units, the health service should focus on increasing theinvestment of pharmacy and oxygen generation system, giving more attention to the healthcare and health protection of the population of construction occupation, enhancingservicemen’s awareness of giving up smoking and self protection, and establishingscientific and reasonable rotation and compensation mechanism according to one’s livingaltitude, highland service year, and occupation.
Policy recommendation
The characteristics of health service are different between acute and chronic altitudedisease, thereby they should be carried out focus on their factors.
The health service for acute altitude disease should focus on entering highlandoperation. Its purpose should be to enhance the operation capability and promote highlandacclimation during early time of entering. Its key point should be to advance prediction ofacute altitude disease and correctly make health service plan based on the prediction.
The health service for chronic altitude disease should focus on the long-term highlandservice military population. Its purpose should be to reduce and alleviate harmful effectscaused by chronic altitude disease, promote the population health, maintain the highlandtroops’ combat effectiveness. Its key point should be to reduce the disease burden ofhighland troops caused by chronic altitude disease and establish long-term health servicemechanism.
Fundamental reason of both acute and chronic altitude disease is hypobaric hypoxiacaused by high altitude, while the occurring developing of the diseases are significantlyaffected by medical facilitate and health behavior. Acute altitude disease mainly relatedwith some characteristics of highland military operation, e.g. deployment type and season;while chronic altitude disease mainly related with highland service year, living condition,occupation. In the implementation of highland troops’ health service for altitude disease,the population level determents of altitude disease should be taken into account, so that medical resources could be distributed scientifically, support plan could be made reasonably,and health intervention could be executed effectively.
中国拥有世界上面积最大的高原国土，同时拥有数量众多的高原常住人口和移居人口，而高原地区也是边境争端、极端主义、分离主义、恐怖主义异常活跃的地区。为了保卫和建设这片世界上最辽阔的高原国土，每年都有大批人员进入这一地区，同时有更多数量的移居者长期工作、战斗和生活在这一地区。这一人群的主体是来自低海拔地区的青年汉族群体，而且以男性为主，包括军人、工人、商人、地方干部等等，其中军人是构成这一群体的重要组成部分。
进入高原地区后，由于低压缺氧的影响，军人群体中会出现各型高原病。初进高原的军人群体易发生急性高原病，虽然经过一段适应期症状可自行消退，但在进驻初期会严重影响军人的作业能力。对于常驻高原的军队人群而言，即便经过较长的适应期，仍有相当一部分人员因无法很好地适应高原环境而罹患慢性高原病。其初期症状虽然轻微，但迁延难愈，逐渐加重，严重侵蚀高原官兵的健康和军队的战斗力。然而，慢性高原病对军队人群的影响在既往的研究中一直未引起足够的重视。
对高原任务部队而言，急、慢性高原病不仅是一类复杂的医学问题，更是一类复杂的公共卫生和军事后勤问题；不仅会造成官兵个人和家庭的痛苦，也会造成高原部队战斗力的损失和巨大的后勤保障负担。因此，需要采取有效的卫勤保障措施，对急、慢性高原病加以预防和控制，以达到减少发病、缓解症状、降低危害、改善健康、提升战斗力的目的。成功的高原病防治工作必须将人群水平因素纳入考虑。对高原病人群水平影响因素的评估，有助于在宏观层面制定更为有效的卫勤保障对策，以防控高原病的流行。然而，目前有关此领域的研究尚少。
研究目的
本项研究旨在调查当前高原任务部队急、慢性高原病在不同进驻时间、不同地域、不同人群间分布的有关情况，主要包括急、慢性高原病的各类发病指标及失能指标；探讨军事因素、环境因素、社会因素、卫生因素、行为因素、人口统计特征等各类人群水平影响因素与军队急、慢性高原病的关系；发现与军队急、慢性高原病相关的危险因素与保护因素，定量描述其的作用强度，并建立相应的军队高原病发病模型，估计高原病在军队中的流行趋势；有针对性地提出军队急、慢性高原病的卫勤保障对策建议。同时，通过本研究探索新的研究方向、构建新的研究模式、发现新研究线索，为高原卫生勤务学相关领域的科学研究奠定基础、打开局面。
研究内容
本研究主要由三个部分组成。第一部分为军队急性高原病人群水平健康影响因素研究；第二部分为军队慢性高原病人群水平健康影响因素研究；第三部分为针对军队高原病的卫勤保障对策研究。其中，前两部分为平行研究，第三部分是在前两部分的基础上探讨军队急、慢性高原病的卫勤保障对策。
第一部分的研究分为前后两个阶段。在第一阶段，主要依据现有病例资料和比较容易获得的病例资料进行初步分析。第二阶段，在第一阶段研究的基础上深入高原部队单位收集更为详细的病例资料，提取更为详细的指标，做进一步的研究分析，验证第一阶段的发现并寻找其他潜在的急性高原病人群水平影响因素，完成军队急性高原病人群水平影响因素发病模型的构建。
第二部分的研究分为两项平行研究，一项为军队慢性高原病生态学调查研究——探讨各类群体水平因素与慢性高原病患病率之间的关系。另一项研究为军队慢性高原病疾病负担研究——探讨慢性高原病给高原部队造成的健康损失及其人群水平相关因素。通过研究发现军队慢性高原病的人群水平因素，并量化评估慢性高原病给军人群体造成的疾病负担。
第三部分的研究根据前两部分的发现，分别针对军队急性高原病和慢性高原病提出相应的卫勤保障对策。其中，针对军队急性高原病的卫勤保障对策重点关注高原任务部队进驻高原军事行动前的卫勤准备工作和进驻过程中的卫勤保障工作；针对军队慢性高原病的卫勤保障对策重点关注常驻高原部队慢性高原病防治和官兵健康促进过程中的卫勤保障工作。
研究方法
第一部分研究采用回顾性研究的方法，在搜集近年来部队进驻高原军事行动病历资料的基础上，提取相关指标，通过统计分析得出各类进驻条件下部队急性高原病的发病率，找出有意义的影响因素，并构建发病模型。第二部分研究采用横断面调查的方法，随机抽取部分有代表性的高原部队单位，进行慢性高原病的现场调查；对抽样单位进行慢性高原病诊断、症状问卷调查、卫生学调查以及单位基本情况调查。第三部分则采用推理归纳、逻辑演绎的方法探讨高原病的卫勤保障对策。
在具体研究中，本课题采用现场调查、问卷调查的方法，了解、掌握目标人群的相关情况，获取指标数据；采用病例-对照研究的方法，分析急性高原病人群水平影响因素；采用氰化高铁血红蛋测定法诊断军人慢性高原病；采用生态学调查法查找、分析高原部队单位慢性高原病人群水平影响因素；采用德尔菲—人数权衡法制订军队慢性高原病症状权重；采用伤残调整寿命年的测算方法测算军队慢性高原病的疾病负担；采用相关分析对急、慢性高原病的人群水平影响因素进行初步筛选；采用回归分析验证急、慢性高原病相关的人群水平影响因素，并建立疾病的数学模型。
主要结果
经过对军队急性高原病人群水平影响因素的分析，进驻高原地区军事行动中急性高原病的人群水平影响因素主要包括：民族（藏族vs.汉族，OR为0.03-0.08）、兵源地（东部省区vs.西北省区，OR为1.32-1.39）、进驻季节（寒季vs.暖季，OR为1.25-1.28）、进驻方式（紧急陆路vs.常规陆路，OR为2.08-2.11；常规空运vs.常规陆路，OR为2.00-2.20；紧急空运vs.常规陆路，OR为2.40-3.34）、药物预防措施（采用vs.未采用，OR为0.75-0.76）等。在制定高原军事行动计划的过程中，低海拔出发地（600-800米vs.1300-1500米，OR为1.32-1.44）以及高海拔目的地（4100-4300米vs.2900-3100米，OR为3.94-4.12；3600-3700米vs.2900-3100米，OR为2.71-2.74）等风险因素也必须给予高度的重视。研究中建立的急性高原病多元回归模型具有一定的预测价值（接受者特征曲线下面积为0.703），可为部队进驻高原前卫勤保障计划提供参考。
经调查各类高原部队单位慢性高原病患病率为1.25—36.58%（14.65±8.15%）。一系列的社区水平影响因素，如部队单位药品投入（OR=0.897，P=0.022）、集中供氧系统的使用（可用vs.不可用，OR=0.827，P=0.020）、军兵种差别（工程兵vs.后勤兵，OR=1.240, P=0.029）以及驻地城市化水平（城市vs.乡村，OR=1.228，P=0.019）都会对部队单位慢性高原病的患病率造成影响。研究还显示，军队慢性高原病的疾病负担较重，且不同人群间具有较大差异。在不同军人群体间，个体损失的伤残调整寿命年为0.13至0.33，每千人损失的伤残调整寿命年为3.60至52.78。具有较高的驻地海拔、较大的年龄、较长的高原服役时间、吸烟习惯以及从事工程专业的军队人群，更容易发生慢性高原病，且慢性高原病的疾病负担也更为严重。
在制定进驻高原军事行动卫勤保障计划时，卫勤部门可以将各项人群水平影响因素的风险水平作为参考，并利用发病风险预测模型输出部队人群急性高原病风险预测值，从而为科学拟定进驻高原地区军事行动计划提供定量依据。对于常驻高原部队，卫勤保障工作应着力于加大药品补给、供氧系统建设方面的投入；对承担工程任务的军人群体应加强针对性卫生防护与保健支持；在广大高原官兵中推行吸烟控制与健康防护教育；根据驻地海拔、驻守时间、从事专业建立科学合理的轮换机制和补偿机制。
政策建议
军队急、慢性高原病的卫勤保障工作具有不完全相同的特点和需求，需要有针对性地实施卫勤保障。
针对军队急性高原病的卫勤保障工作应重点针对大部队进驻高原军事任务；目标在于提高军人群体进驻高原初期的作业能力，促其快速适应高原环境；关键在于做好急性高原病的发病预测，根据预测正确拟定卫勤保障计划。
针对军队慢性高原病的卫勤保障工作应重点针对长期驻守高原的军人群体；减缓、减轻高原环境对官兵的不良影响，促进人群健康，保持部队在高原地区的战斗力；关键在于减轻军人群体慢性高原病的疾病负担，形成长效的卫勤保障机制。
急、慢性高原病的根本病因都是高海拔带来的低压缺氧，其在军队人群中的发生、发展会受到医疗条件和行为方式的影响。急性高原病主要和高原军事任务本身的一些特征（方式、季节）有关，慢性高原病则与驻守时间、生活条件、职业类型有更密切的关系。实施针对军队高原病的卫勤保障，需要把握各类高原病人群水平影响因素，从而科学分配卫生资源，合理制定保障计划，有效采取干预措施。
Backgrounds
China has the world largest highland territory and a large number of native andimmigrant highlanders. The highland territory also is the flash point of border conflicts,race extremism, separatism, and terrorism. To defense and develop the world largesthighland territory, a great many of people are working and living in the area, and there alsoare a great many of new comers enter the area every year. The population that entering thehighland is mainly make up of young male Chinese Han population. The populationincludes soldiers, workers, merchants, and civil servants, among which soldiers take up alarge part of them.
After military population entering highland area, many servicemen will developaltitude disease due to the effectiveness of hypobaric hypoxia. During the early period ofnewly entering high altitude, military population will affect by acute altitude disease.Although the symptoms would subside after a period of acclimation, the symptoms cansignificantly reduce operation capability of the servicemen in the early time of entering.Even if living in highland for a long period, many of the servicemen who were deployed forlong-term highland service cannot fully get acclimation and develop chronic altitudedisease. The early symptoms of the chronic altitude disease are not serious. However, it istreatment-resistance and would deteriorate gradually as time goes on, which disintegratehealth of the highland servicemen and decay combat effectiveness of the highland troops.Unfortunately, there are not enough awareness been paid for the harmful effectiveness ofchronic altitude disease in the highland servicemen population.
Altitude diseases are not only a series of complicated medical problems, but also aseries of complicated public health and military logistics’ problems for highland troops. Thediseases not only cause suffering and misery for oneself and his family, but also cause losing of the troops’ combat effectiveness and heavy logistics burden of the army. Hence, itis imperative for the authorities to take effective health service measures to prevent andcontrol both acute and chronic altitude disease. The purposes should be decreasingincidence, alleviating symptoms, reducing harm, improving health status, enhancingcombat effectiveness. To accomplish these purposes of control and heal altitude diseases,population level health related determents should be taken into account. Evaluation ofpopulation level determents of altitude diseases is helpful for countermeasure making foreffective controlling of the diseases in highland troops on the view of macroscopic.However, there is little work on this study field presently.
Study purposes
The purposes of this study, firstly, are to investigate the contemporary distributionstatus of acute and chronic altitude disease among different time, different area, anddifferent military populations, including disease indicators and disability indicators.Secondly, to discuss the relationship between altitude diseases and population leveldeterments that include military factor, environmental factor, social factor, hygiene factor,behavior factor, and demographic characteristic factor. Thirdly, to find out and quantify therisk and protect factors of altitude diseases and build up disease model for describing theepidemic tendency of the diseases. Fourthly, to bring forward suggestions of the highlandtroops’ health service for altitude diseases according to the factors. Moreover, through thisstudy, to discover new research direction, build up new research mode, find out new studyclues, and lay the groundwork and pave the way for future studies of military highlandhealth service.
Study contents
This study is composed by three parts. The first part is the study of population levelhealth determents of acute altitude disease in highland troops. The second part is the studyof population level health determents of chronic altitude disease in highland troops. Thethird part is countermeasure study of health service for altitude diseases. The first two partsare parallel study, while the third part gives out the countermeasures that based on thefindings of the first two parts.
The first part of this study includes two stages. The first stage is preliminary analysesby using the medical records that already possessed or easy to obtain. The second stage is further analyses based on the first stage by using the advanced medical records thatcollected from highland units. Aims of the second stage are to verify the findings of the firststage, to find out other potential population level determents of acute altitude disease, andto build up acute altitude disease model of highland troops.
The second part of this study is composed by two parallel study sections. One of thesections is epidemiological ecological study of chronic altitude disease among permanenthighland units, which is to discuss the relationship between prevalence of chronic altitudedisease and population level determents of highland military unit. The other section is studyon the highland troops’ burden of chronic altitude disease, which is to discuss the highlandtroops’ health lost caused by chronic altitude disease and its related population level factors.
The third part of this study is to discuss the highland troops’ health servicecountermeasures for acute and chronic altitude disease separately. The health servicecountermeasures for acute altitude disease are focus on the health service preparationsbefore highland entering operation and health supports during the highland enteringoperation. The health service countermeasures for chronic altitude disease are focus on thehealth service for prevention and heal the disease and servicemen health improvement inpermanent highland units.
Study methodology
The first part of this study based on retrospective strategy. We collected highlandtroops’ recent year medical records during highland entering operations and extracted studyfactors. By statistic analyses we obtained the incidence rates, significant determents, andbuilt up disease model. The second part of this study based on across sectional strategy. Werandomly selected a sample of representative highland military units for chronic altitudedisease field investigation. During the investigation we carried out chronic altitude diseasediagnosis, symptom questionnaire, hygienic survey, and unit base information inquiry in thesample units. The third part of this study discussed health service countermeasures bymethodology of reasonable induction and logical deduction.
In specific study, we used field investigation and questionnaire to obtain the status oftarget population; used case-control research to analyze the population level determents ofacute altitude disease; used cyanmethemoglobin technique to diagnose chronic altitudedisease; used epidemiological ecological investigation to find and analyze population level determents of chronic altitude disease; used Delphi processed person-treat-off strategy todeduce the disease weights of chronic altitude disease; used disability adjusted life year tocalculate the disease burden of highland troops; used correlation analysis to preliminarilyselect the population level determents of altitude disease, used regression analysis toconclude the population level determents of altitude diseases and to build up mathematicaldisease model.
Main findings
By the population level determents’ analyses of highland troops, the acute altitudedisease determents were obtained, including: race (Tibetan vs. Han, OR=0.03-0.08), bornprovince (east vs. northwest, OR=1.32-1.39), season (cold vs. warm, OR=1.25-1.28),deployment type (emergency by land vs. normal by land, OR=2.08-2.11; normal by air vs.normal by land, OR=2.00-2.20; emergency by air vs. normal by land, OR=2.40-3.34),prophylaxis (prophylaxis vs. none, OR=0.75-0.76). When draw up highland enteringoperation plan, lower start point (600-800m vs.1300-1500m, OR=1.32-1.44) and higherdestination (4100-4300m vs.2900-3100m, OR=3.94-4.12;3600-3700m vs.2900-3100m, OR=2.71-2.74) also should be seriously take into account. Prediction value of themultiple regression model built in the study is acceptable (the area under receivercharacteristic curve is0.703), which could be used as reference for health service planmaking before troops entering highland.
According to this investigation, the prevalence rate of chronic altitude disease amongthe highland troops is from1.25to36.58%(14.65±8.15%). Series community level factorswere verified as significant determents of chronic altitude disease, including pharmacyinvestment (OR=0.897，P=0.022), oxygen generation system (available vs. unavailable,OR=0.827, P=0.020), occupation (construction vs. logistics, OR=1.240, P=0.029), andsocial development level (urban vs. rural, OR=1.228, P=0.019). The study also indicatedthat the disease burden caused by chronic altitude disease is serious among highland troops,although it changes dramatically in different servicemen population. In differentservicemen population, the individual disability adjusted life years lost was form0.13to0.33, while the disability adjusted life years lost by one thousand people was form3.60to52.78. The population who lived in a higher area, got older, serviced for longer years inhighland, had smoking behavior, and engaged in construction occupation, are more likely to develop chronic altitude disease and also more likely to get heavier disease burden.
When making health service plan before troops entering highland, the health serviceauthority should take the population level determents of acute altitude disease into account,and use the risk predicting model to export risk value of the disease, so that it could providequantitive reference for scientific military planning before operation of entering highland.For highland permanent military units, the health service should focus on increasing theinvestment of pharmacy and oxygen generation system, giving more attention to the healthcare and health protection of the population of construction occupation, enhancingservicemen’s awareness of giving up smoking and self protection, and establishingscientific and reasonable rotation and compensation mechanism according to one’s livingaltitude, highland service year, and occupation.
Policy recommendation
The characteristics of health service are different between acute and chronic altitudedisease, thereby they should be carried out focus on their factors.
The health service for acute altitude disease should focus on entering highlandoperation. Its purpose should be to enhance the operation capability and promote highlandacclimation during early time of entering. Its key point should be to advance prediction ofacute altitude disease and correctly make health service plan based on the prediction.
The health service for chronic altitude disease should focus on the long-term highlandservice military population. Its purpose should be to reduce and alleviate harmful effectscaused by chronic altitude disease, promote the population health, maintain the highlandtroops’ combat effectiveness. Its key point should be to reduce the disease burden ofhighland troops caused by chronic altitude disease and establish long-term health servicemechanism.
Fundamental reason of both acute and chronic altitude disease is hypobaric hypoxiacaused by high altitude, while the occurring developing of the diseases are significantlyaffected by medical facilitate and health behavior. Acute altitude disease mainly relatedwith some characteristics of highland military operation, e.g. deployment type and season;while chronic altitude disease mainly related with highland service year, living condition,occupation. In the implementation of highland troops’ health service for altitude disease,the population level determents of altitude disease should be taken into account, so that medical resources could be distributed scientifically, support plan could be made reasonably,and health intervention could be executed effectively.
引文
[1]高钰琪.高原军事医学[M].重庆:重庆出版社,2005.
[2]李素芝.高原病学[M].拉萨:西藏人民出版社,2001.
[3]陶发胜,曹金军,方立,等.基层部队急救训练存在的问题及对策[J].西南国防医药,2011,11:1255-1256.
[4]陶发胜,何新建,高钰琪,等.刍议高原战时医疗后送机动力量能力建设[J].西南国防医药,2011,3:323-325.
[5]陶发胜,何新建,高钰琪,等.卫生勤务概念的重新审视[J].西南国防医药,2011,6:666-667.
[6]陶发胜,何新建,高钰琪,等.勤务概念释义[J].西南国防医药,2011,8:906-907.
[7]李立明,叶冬青等.流行病学[M].北京:人民卫生出版社,2005.
[8] H. H. Huang, et al., Alternations of heart rate variability at lower altitude in thepredication of trekkers with acute mountain sickness at high altitude, Clin J SportMed, vol.20, pp.58-63, Jan2010.
[9] B. Basnyat and D. R. Murdoch, High-altitude illness, Lancet, vol.361, pp.1967-74,2003.
[10] Houghton Mifflin Harcourt, The American Heritage Medical Dictionary. Boston:Houghton Mifflin Company,2007.
[11] A. Arregui, et al., Migraine, polycythemia and chronic mountain sickness,Cephalalgia, vol.14, pp.339-41, Oct1994.
[12] W. C. Cockerham, Medical Sociology. Beijing: Pearson Education Asia Limitedand Peiking University Press,2005.
[13] C. Moll, et al., Gross Domestic Product (GDP) and productivity ofschizophrenia trials: an ecological study, BMC Psychiatry, vol.3, p.18, Dec52003.
[14] R. S. Heyderman, et al., The incidence and mortality for meningococcal diseaseassociated with area deprivation: an ecological study of hospital episode statistics,Arch Dis Child, vol.89, pp.1064-8, Nov2004.
[15] S. S. da Cunha, et al., Ecological study of socio-economic indicators andprevalence of asthma in schoolchildren in urban Brazil, BMC Public Health, vol.7,p.205,2007.
[16] L. R. Kerr-Pontes, et al., Inequality and leprosy in Northeast Brazil: anecological study, Int J Epidemiol, vol.33, pp.262-9, Apr2004.
[17] K. E. Pickett, et al., Wider income gaps, wider waistbands? An ecological studyof obesity and income inequality, J Epidemiol Community Health, vol.59, pp.670-4, Aug2005.
[18] P. R. Ward, et al., How equitable are GP practice prescribing rates for statins?:an ecological study in four primary care trusts in North West England,International journal for equity in health, vol.6, p.2,2007.
[19] R. Maheswaran, et al., Impact of NHS walk-in centres on primary care accesstimes: ecological study, BMJ (Clinical research ed), vol.334, p.838,2007.
[20] M. Jones, et al., Influence of practices' ethnicity and deprivation on access toangiography: an ecological study, Br J Gen Pract, vol.54, pp.423-8, Jun2004.
[21] E. Perea-Milla, et al., Estimation of the real population and its impact on theutilisation of healthcare services in Mediterranean resort regions: an ecologicalstudy, BMC Health Serv Res, vol.7, p.13,2007.
[22] G. Damiani, et al., An ecological study on the relationship between supply ofbeds in long-term care institutions in Italy and potential care needs for the elderly,Bmc Health Services Research, vol.9, Sep242009.
[23] W. B. Grant, Ecological study of dietary and smoking links to lymphoma, AlternMed Rev, vol.5, pp.563-72, Dec2000.
[24] C. Emslie and R. Mitchell, Are there gender differences in the geography ofalcohol-related mortality in Scotland? An ecological study, BMC Public Health,vol.9, Feb162009.
[25] J. Didkowska, et al., Lung cancer mortality at ages35-54in the European Union:ecological study of evolving tobacco epidemics, British Medical Journal, vol.331,pp.189-191, Jul232005.
[26] K. Guldbrandsson and S. Bremberg, Two approaches to school healthpromotion--a focus on health-related behaviours and general competencies. Anecological study of25Swedish municipalities, Health Promot Int, vol.21, pp.37-44, Mar2006.
[27] D. Stanistreet, et al., Women's empowerment and violent death among womenand men in Europe: an ecological study, J Epidemiol Community Health, vol.4, pp.257-265,2007.
[28] A. Seidler, et al., Cancer risk among residents of Rhineland-Palatinatewinegrowing communities, Journal of Occupational Medicine and Toxicology, vol.3, p.12,2008.
[29] C. J. Williams, et al., Geographic correlation between deprivation and risk ofmeningococcal disease: an ecological study, BMC Public Health, vol.4, Jul262004.
[30] Z. E. S. Guildea, et al., Differences in risk of mortality under1year of agebetween rural and urban areas: an ecological study, Public Health, vol.119, pp.442-447, May2005.
[31]珍曲,向远根.西藏藏族急性高原病发病调查[J],高原卫生资料,1994,24:7-8.
[32]张军峰,马宽军.急性高原病流行病学调查[J].中华实用医学,2003,3:100.
[33]童世君.进驻高海拔区人群急性高原脑水肿流行病学调查评论[J].医学信息:下旬刊,2009,270:270.
[34]张雪峰,叶平安,陈晓峰.高原施工人群急性重型高原病患病率调查[J].高原医学杂志,2005,15:7-9.
[35]郑然,周世伟.构建急性高原病易感者预测模型的方法学研究[J].中国临床康复,2005,9:160-162.
[36]游海燕.急性高原病多指标神经网络BP模型诊断分析[J].中国卫生统计,2008,25:484-486.
[37]刘运胜,易东,李维民.青年军人急性高原病医学地理差异聚类分析[J].西南国防医药,2005,15:145-147.
[38]王岩飞,次旦群佩,孙红娟.体重指数与急性高原病发病的相关分析[J].中华急诊医学杂志,2006,15:85-86.
[39]曹祯吾,贺彪.高原红细胞增多症的流行病学研究[J].西藏科技,1995,1:25-32.
[40]张富生,王文明,郭伟.高原病临床流行病学调查报告[J].中国工业医学杂志,1998,11:50.
[41]黄跃,姜泗元,彭东.高原环境下高原病再发的流行病学研究[J].西南国防医药,2004,14:599-601.
[42]黄跃,李素芝,郭灵常.高原环境下急性高原病预后与慢性高原病关系的随访研究[J].高原医学杂志,2002,12:1-3.
[43]黄跃,王学凯,郭灵常,等.高原环境下慢性高原病预后与其相互转型关系的临床流行病学研究[J].西南国防医药,2003,13:6-8.
[44]张西洲,崔建华,王宏运.驻喀喇昆仑山和西藏阿里高原部队慢性高原病流行病学调查[J].临床军医杂志,2006,34:609-611.
[45] F. C. Breslin, et al., An ecological study of regional variation in work injuriesamong young workers, BMC Public Health, vol.7, p.91,2007.
[46] K. L. Quarrie, et al., Effect of nationwide injury prevention programme onserious spinal injuries in New Zealand rugby union: ecological study, BMJ, vol.334, p.1150, Jun22007.
[47] F. Rivas-Ruiz, et al., Geographic variability of fatal road traffic injuries in Spainduring the period2002-2004: an ecological study, BMC Public Health, vol.7, p.266,2007.
[48] B. Honigman, et al., Acute mountain sickness in a general tourist population atmoderate altitudes, Annals of internal medicine, vol.118, pp.587-92,1993.
[49] B. Basnyat, et al., Disoriented and ataxic pilgrims: an epidemiological study ofacute mountain sickness and high-altitude cerebral edema at a sacred lake at4300m in the Nepal Himalayas, Wilderness&environmental medicine, vol.11, pp.89-93,2000.
[50] S.-H. Wang, et al., Epidemiology of acute mountain sickness on Jade Mountain,Taiwan: an annual prospective observational study, High altitude medicine&biology, vol.11, pp.43-9,2010.
[51] K. Okumiya, et al., Comprehensive geriatric assessment of elderly highlandersin Qinghai, China II: the association of polycythemia with lifestyle-relateddiseases among the three ethnicities, Geriatr Gerontol Int, vol.9, pp.342-51, Dec2009.
[52] M. Schneider, et al., Acute mountain sickness: influence of susceptibility,preexposure, and ascent rate, Med Sci Sports Exerc, vol.34, pp.1886-91, Dec2002.
[53] D. R. Wagner, et al., Variables contributing to acute mountain sickness on thesummit of Mt Whitney, Wilderness Environ Med, vol.17, pp.221-8, Winter2006.
[54] R. D. Vann, et al., Statistical models of acute mountain sickness, High Alt MedBiol, vol.6, pp.32-42, Spring2005.
[55]刘莉,邢玉梅.氰化高铁血红蛋白测定方法的质量控制[J].山西医药杂志,2005,34(2):169.
[56] A. Guijarro Morales, et al., Acute mountain sickness, An Med Interna, vol.7, pp.375-8, Jul1990.
[57] R. Karniol, Fighting on the Roof of the World, Jane's Defence Weekly, vol.30, p.30,1998.
[58] F. J. Bia, Current prevention and management of acute mountain sickness, Yale JBiol Med, vol.65, pp.337-41, Jul-Aug1992.
[59] D. L. Gilbert, The first documented description of mountain sickness: theAndean or Pariacaca story, Respir Physiol, vol.52, pp.327-47, Jun1983.
[60] T. Y. Wu, et al., Reduced incidence and severity of acute mountain sickness inQinghai-Tibet railroad construction workers after repeated7-month exposuresdespite5-month low altitude periods, High Alt Med Biol, vol.10, pp.221-32, Fall2009.
[61] L. P. Queiroz and A. M. Rapoport, High-altitude headache, Curr Pain HeadacheRep, vol.11, pp.293-6, Aug2007.
[62] T. Wu, et al., Ataxia: an early indicator in high altitude cerebral edema, High AltMed Biol, vol.7, pp.275-80, Winter2006.
[63] C. Pesce, et al., Determinants of acute mountain sickness and success on MountAconcagua (6962m), High Alt Med Biol, vol.6, pp.158-66, Summer2005.
[64] S. Jafarian, et al., Respiratory rate within the first hour of ascent predictssubsequent acute mountain sickness severity, Arch Iran Med, vol.11, pp.152-6,Mar2008.
[65] M. Burtscher, et al., Prediction of susceptibility to acute mountain sickness bySaO2values during short-term exposure to hypoxia, High Alt Med Biol, vol.5, pp.335-40, Fall2004.
[66] P. J. Fagenholz, et al., Optic nerve sheath diameter correlates with the presenceand severity of acute mountain sickness: evidence for increased intracranialpressure, J Appl Physiol, vol.106, pp.1207-11, Apr2009.
[67] O'Connor, et al., Changes in oxygen saturation and optic nerve sheath diameterhelp predict acute mountain sickness in individuals at high altitude (vol51, pg477,2008), Annals of Emergency Medicine, vol.52, pp.34-34, Jul2008.
[68] H. M. Karinen, et al., Prediction of acute mountain sickness by monitoringarterial oxygen saturation during ascent, High Alt Med Biol, vol.11, pp.325-32,Winter2010.
[69] G. H. Kamimori, et al., Catecholamine levels in hypoxia-lnduced acutemountain sickness, Aviat Space Environ Med, vol.80, pp.376-80, Apr2009.
[70] F. Zhou, et al., Association of hsp70-2and hsp-hom gene polymorphisms withrisk of acute high-altitude illness in a Chinese population, Cell Stress Chaperones,vol.10, pp.349-56, Winter2005.
[71] J. L. Rupert and M. S. Koehle, Evidence for a genetic basis for altitude-relatedillness, High Alt Med Biol, vol.7, pp.150-67, Summer2006.
[72] M. A. Pasha and J. H. Newman, High-altitude disorders: pulmonaryhypertension: pulmonary vascular disease: the global perspective, Chest, vol.137,pp.13S-19S, Jun2010.
[73] J. B. West, English translation of Nomenclature, classification, and diagnosticcriteria of high altitude disease in China, High Alt Med Biol, vol.11, pp.169-72,Summer2010.
[74] G. Savourey, et al., Evaluation of the Lake Louise acute mountain sicknessscoring system in a hypobaric chamber, Aviation, space, and environmentalmedicine, vol.66, pp.963-7,1995.
[75] C. Banwell, et al., Body mass index and health-related behaviours in a nationalcohort of87,134Thai open university students, Journal of epidemiology andcommunity health, vol.63, pp.366-72,2009.
[76] F. M. Biro, et al., Body mass index and waist-to-height changes during teenyears in girls are influenced by childhood body mass index, The Journal ofadolescent health: official publication of the Society for Adolescent Medicine, vol.46, pp.245-50,2010.
[77] B. Morkedal, et al., Mortality from ischaemic heart disease: age-specific effectsof blood pressure stratified by body-mass index: the HUNT cohort study inNorway, Journal of epidemiology and community health, vol.65, pp.814-9,2011.
[78] D. W. Hosmer and S. Lemshow, Applied logistic regression. New York: Wiley-Interscience,2000.
[79] C. G. Blood, et al., Implications for modeling casualty sustainment duringpeacekeeping operations, Military medicine, vol.167, pp.868-72,2002.
[80] S. Jafarian, et al., Respiratory rate within the first hour of ascent predictssubsequent acute mountain sickness severity, Archives of Iranian medicine, vol.11,pp.152-6,2008.
[81] V. Ziaee, et al., Acute mountain sickness in Iranian trekkers around MountDamavand (5671m) in Iran, Wilderness&environmental medicine, vol.14, pp.214-9,2003.
[82] S. Gaillard, et al., Awareness, prevalence, medication use, and risk factors ofacute mountain sickness in tourists trekking around the Annapurnas in Nepal: a12-year follow-up, High Alt Med Biol, vol.5, pp.410-9, Winter2004.
[83] T. Wu, et al., Tibetans at extreme altitude, Wilderness&environmentalmedicine, vol.16, pp.47-54,2005.
[84] T. Y. Wu, et al., Reduced incidence and severity of acute mountain sickness inQinghai-Tibet railroad construction workers after repeated7-month exposuresdespite5-month low altitude periods, High altitude medicine&biology, vol.10,pp.221-32,2009.
[85] P. H. Hackett and R. C. Roach, High-altitude illness, The New England journalof medicine, vol.345, pp.107-14,2001.
[86] M. D. Harris, et al., High-altitude medicine, American family physician, vol.57,pp.1907-14,1924-6,1998.
[87] P. Bartsch and B. Saltin, General introduction to altitude adaptation andmountain sickness, Scand J Med Sci Sports, vol.18Suppl1, pp.1-10, Aug2008.
[88] Y. Zhang, et al., Climate change and the transmission of vector-borne diseases: areview, Asia-Pacific journal of public health/Asia-Pacific Academic Consortiumfor Public Health, vol.20, pp.64-76,2008.
[89] G. W. Rodway, et al., High-altitude-related disorders--Part I: Pathophysiology,differential diagnosis, and treatment, Heart Lung, vol.32, pp.353-9, Nov-Dec2003.
[90] N. P. Mason, et al., Cough frequency and cough receptor sensitivity to citric acidchallenge during a simulated ascent to extreme altitude, Eur Respir J, vol.13, pp.508-13, Mar1999.
[91] L. Dumont, et al., Efficacy and harm of pharmacological prevention of acutemountain sickness: quantitative systematic review, BMJ, vol.321, pp.267-72, Jul292000.
[92] R. C. Roach, et al., Exercise exacerbates acute mountain sickness at simulatedhigh altitude, J Appl Physiol, vol.88, pp.581-5, Feb2000.
[93] P. H. Hackett, et al., The incidence, importance, and prophylaxis of acutemountain sickness, Lancet, vol.2, pp.1149-55, Nov271976.
[94] D. R. Murdoch, Altitude Illness Among Tourists Flying to3740MetersElevation in the Nepal Himalayas, J Travel Med, vol.2, pp.255-256, Dec11995.
[95] WHO. BMI classification. Available:http://apps.who.int/bmi/index.jsp?introPage=intro_3.html
[96] T. S. Simonson, et al., Genetic evidence for high-altitude adaptation in Tibet,Science, vol.329, pp.72-5, Jul22010.
[97] J. H. Cui, et al.,[Effects of Rholida on the free radical metabolism and serumcreatine kinase after exercise at plateau], Hang tian yi xue yu yi xue gong cheng=Space medicine&medical engineering, vol.14, pp.448-51,2001.
[98] X. Zhang, et al., The effect of Rholida and Acetazolamide on Sleep Deprivationand Metabolism of Oxygen Free Radicals After Exhausitive Exercise of HighlandServicemen, Journal of Preventive Medicine of Chinese People's Liberation Army,vol.19, pp.266-268,2001.
[99] K. Hirata, et al., Obesity as risk factor for acute mountain sickness, Lancet, vol.2,pp.1040-1, Oct281989.
[100] G. Ri-Li, et al., Obesity: associations with acute mountain sickness, Annals ofinternal medicine, vol.139, pp.253-7, Aug192003.
[101] F. A. Moraga, et al., Acute mountain sickness in children and their parents afterrapid ascent to3500m (Putre, Chile), Wilderness Environ Med, vol.19, pp.287-92,Winter2008.
[102] F. A. Moraga, et al., Acute mountain sickness in tourists with children at LakeChungara (4400m) in northern Chile, Wilderness&environmental medicine, vol.13, pp.31-5,2002.
[103] X. Zhang, et al., Role of six different medicines in the symptomatic scores ofbenign form of acute mountain sickness, Medical Journal of National DefendingForces In Northwest China, vol.24, pp.341-343,2003.
[104] R. C. Roach, et al., How well do older persons tolerate moderate altitude?, West JMed, vol.162, pp.32-6, Jan1995.
[105] B. Honigman, et al., Acute mountain sickness in a general tourist population atmoderate altitudes, Ann Intern Med, vol.118, pp.587-92, Apr151993.
[106] Y. Gao, High Altitude Military Medicine,1ed. Chongqing: Chongqing Press,2005.
[107] S. Li, High Altitude Disease. Lhasa: Tibetan People's Press,2001.
[108] C. C. Monge, et al., Pathophysiology and epidemiology of chronic mountainsickness, Int J Sports Med, vol.13Suppl1, pp. S79-81, Oct1992.
[109] F. Leon-Velarde, et al., The role of menopause in the development of chronicmountain sickness, Am J Physiol, vol.272, pp. R90-4, Jan1997.
[110] S. Sun, et al., Breathing and brain blood flow during sleep in patients with chronicmountain sickness, J Appl Physiol, vol.81, pp.611-8, Aug1996.
[111] J. Zhuang, et al., Hypoxic ventilatory responsiveness in Tibetan compared with Hanresidents of3,658m, J Appl Physiol, vol.74, pp.303-11, Jan1993.
[112] L. S. Curran, et al., Ventilation and hypoxic ventilatory responsiveness inChinese-Tibetan residents at3,658m, J Appl Physiol, vol.83, pp.2098-104, Dec1997.
[113] F. C. Breslin, et al., An ecological study of regional variation in work injuriesamong young workers, BMC Public Health, vol.7, pp.-, May232007.
[114] M. M. Zaman, et al., Non-biochemical risk factors for cardiovascular disease ingeneral clinic-based rural population of Bangladesh, J Epidemiol, vol.14, pp.63-8,Mar2004.
[115] N. Wang, et al., Perceived health as related to income, socio-economic status,lifestyle, and social support factors in a middle-aged Japanese, J Epidemiol, vol.15,pp.155-62, Sep2005.
[116] J. Iralu, et al., Risk factors for HIV disease progression in a rural southwestAmerican Indian population, Public Health Rep, vol.125Suppl4, pp.43-50,Jul-Aug2010.
[117] S. London, Community characteristics help shape women's decisions on whether togive birth in a health facility, Int Fam Plan Perspect, vol.32, pp.52-3, Mar2006.
[118]叶为民,亦应南,周天舒.食用鱼露与福建省胃癌死亡率关系的流行病学研究[J].中国公共卫生,1997,13:188-190.
[119]顾惠心,杨志刚,金秀媛.流感流行生态学的流行病学研究[J].中华流行病学杂志,1996,17:77-79.
[120]赵玉婉.环境有机氯污染与结肠癌及乳腺癌发病率的关系[D].浙江:浙江大学,2003.
[121]钱序.广东外来未婚女工生殖健康行为的生态学因素及干预探索研究[D].上海:复旦大学,2008.
[122] L. Cai, et al., Fish sauce and gastric cancer:an ecological study in FujianProvince,China, World J Gastroenterol, vol.6, pp.671-675, Oct2000.
[123] X. Ren, et al., Type2diabetes mellitus associated with increased risk for colorectalcancer: evidence from an international ecological study and population-based riskanalysis in China, Public Health, vol.123, pp.540-4, Aug2009.
[124]张新民,俞顺章,沈杰.略论时序回归分析方法在流行病学生态学研究中的应用[J].中国公共卫生,1993,9:481-484.
[125] T. Y. Wu, Chronic mountain sickness on the Qinghai-Tibetan plateau, Chin Med J(Engl), vol.118, pp.161-8, Jan202005.
[126] E. Vargas and H. Spielvogel, Chronic mountain sickness, optimal hemoglobin, andheart disease, High Alt Med Biol, vol.7, pp.138-49, Summer2006.
[127] P. Jin and F. Chen, Medical Statistic Method,3ed. Shanghai: Fudan UniversityPress,2009.
[128] F. Leon-Velarde, et al., Consensus statement on chronic and subacute high altitudediseases, High Alt Med Biol, vol.6, pp.147-57, Summer2005.
[129] R. Hong, et al., Relationship between household wealth inequality and chronicchildhood under-nutrition in Bangladesh, International journal for equity in health,vol.5, p.15,2006.
[130] F. G. De Maio, et al., An average/deprivation/inequality (ADI) analysis of chronicdisease outcomes and risk factors in Argentina, Population health metrics, vol.7, p.8,2009.
[131] R. Plata, et al., Angiotensin-converting-enzyme inhibition therapy in altitudepolycythaemia: a prospective randomised trial, Lancet, vol.359, pp.663-6,2002.
[132] J. L. Rupert, et al., Selective pressure has not acted against hypercoagulabilityalleles in high-altitude amerindians, Annals of Human Genetics, vol.67, pp.426-432, Sep2003.
[133] M. Rivera-Ch, et al., Treatment of chronic mountain sickness: critical reappraisal ofan old problem, Respir Physiol Neurobiol, vol.158, pp.251-65, Sep302007.
[134] M. Rivera-Ch, et al., Effect of acetazolamide on ventilatory response in subjectswith chronic mountain sickness, Respir Physiol Neurobiol, vol.162, pp.184-9, Aug312008.
[135] H. Y. Kam, et al., Role of the spleen in the exaggerated polycythemic response tohypoxia in chronic mountain sickness in rats, J Appl Physiol, vol.87, pp.1901-8,Nov1999.
[136] J. T. Reeves and F. Leon-Velarde, Chronic mountain sickness: recent studies of therelationship between hemoglobin concentration and oxygen transport, High AltMed Biol, vol.5, pp.147-55, Summer2004.
[137] T. Y. Wu, et al., Who should not go high: chronic disease and work at altitudeduring construction of the Qinghai-Tibet railroad, High Alt Med Biol, vol.8, pp.88-107, Summer2007.
[138] E. W. Askew, Work at high altitude and oxidative stress: antioxidant nutrients,Toxicology, vol.180, pp.107-19, Nov152002.
[139] S. X. Pei, et al., Chronic mountain sickness in Tibet, Q J Med, vol.71, pp.555-74,Jun1989.
[140] J. Bjork and U. Stromberg, Effects of systematic exposure assessment errors inpartially ecologic case-control studies, International journal of epidemiology, vol.31, pp.154-60,2002.
[141] J. Wakefield, A critique of statistical aspects of ecological studies in spatialepidemiology, Environmental and Ecological Statistics, vol.11, pp.31-54, Mar2004.
[142] A. Kroeger, Anthropological and socio-medical health care research in developingcountries, Soc Sci Med, vol.17, pp.147-61,1983.
[143] P. Y. Katung, Socio-economic factors responsible for poor utilisation of the primaryhealth care services in a rural community in Nigeria, Niger J Med, vol.10, pp.28-9,Jan-Mar2001.
[144] F. Leon-Velarde, et al., Chronic mountain sickness and chronic lower respiratorytract disorders, Chest, vol.106, pp.151-5, Jul1994.
[145] T. Y. Wu, The Qinghai-Tibetan plateau: how high do Tibetans live?, High Alt MedBiol, vol.2, pp.489-99, Winter2001.
[146] I. S. Anand and T. Y. Wu, Syndromes of subacute mountain sickness, High Alt MedBiol, vol.5, pp.156-70, Summer2004.
[147] C. J. Murray and A. K. Acharya, Understanding DALYs (disability-adjusted lifeyears), Journal of health economics, vol.16, pp.703-30,1997.
[148] C. J. Murray, et al., The global burden of disease in1990: summary results,sensitivity analysis and future directions, Bull World Health Organ, vol.72, pp.495-509,1994.
[149] C. J. Murray, Quantifying the burden of disease: the technical basis fordisability-adjusted life years, Bull World Health Organ, vol.72, pp.429-45,1994.
[150] C. D. Mathers, et al., The burden of disease and injury in Australia, Bull WorldHealth Organ, vol.79, pp.1076-84,2001.
[151]孙建东,郭晓雷,李维卡,等.应用伤残调整寿命年测量山东省居民疾病负担[J].中国卫生经济,26(8):61-63.
[152] N. S. Murthy, et al., Disability adjusted life years for cancer patients in India, AsianPac J Cancer Prev, vol.11, pp.633-40,2010.
[153] K. Krishnamoorthy, et al., Burden of chikungunya in India: estimates of disabilityadjusted life years (DALY) lost in2006epidemic, J Vector Borne Dis, vol.46, pp.26-35, Mar2009.
[154] WHO.(2004, Global burden of disease2004update: disability weights for diseasesand conditions. Available:http://www.who.int/healthinfo/global_burden_disease/GBD2004_DisabilityWeights.pdf
[155] J. A. Haagsma, et al., Alternative approaches to derive disability weights in injuries:do they make a difference?, Qual Life Res, vol.18, pp.657-65, Jun2009.
[156] M. E. A. Stouthard, et al., Disability weights for diseases: a modified protocol andresults for a western european region, European Journal of Public Health, vol.10,pp.24-30,2000.
[157] C. N. McIntosh, et al., Eliciting Canadian population preferences for health statesusing the Classification and Measurement System of Functional Health (CLAMES),Chronic diseases in Canada, vol.28, pp.29-41,2007.
[158] C. Gorber and Sarah, A new classification and measurement system of functionalhealth, September2003.
[159] K.-S. Hong and J. L. Saver, Quantifying the value of stroke disability outcomes:WHO global burden of disease project disability weights for each level of themodified Rankin Scale, Stroke; a journal of cerebral circulation, vol.40, pp.3828-33,2009.
[160] National burden of disease studies: a practical guide (Edition2.0ed.). Available:www.who.int/healthinfo/nationalburdenofdiseasemanual.pdf
[161] J. M. Melse, et al., A national burden of disease calculation: Dutch disability-adjusted life-years. Dutch Burden of Disease Group, Am J Public Health, vol.90,pp.1241-7, Aug2000.
[162] P. H. van Baal, et al., Disability weights for comorbidity and their influence onhealth-adjusted life expectancy, Popul Health Metr, vol.4, p.1,2006.
[163] D. Ding, et al., Assessing the disease burden due to epilepsy by disability adjustedlife year in rural China, Epilepsia, vol.47, pp.2032-7,2006.
[164] H. Vlajinac, et al., Burden of cancer in Serbia, Croat Med J, vol.47, pp.134-41,Feb2006.
[165] WHO. ICD2007, Chapter XIX, Injury, poisoning and certain other consequences ofexternal causes (S00-T98). Available:http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gt66.htm+T702
[166] WHO. WHO disease and injury regional estimates for2004. Available:http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html
[167] J. P. Richalet, et al., Acetazolamide for Monge's disease: efficiency and tolerance of6-month treatment, Am J Respir Crit Care Med, vol.177, pp.1370-6, Jun152008.
[168] Z. W. Chao, et al., High Altitude Polycythemia,1ed. Beijing: Military MedicalScience Press,1996.
[169] F. Sime, et al., Age as a cause of chronic mountain sickness (Monge's disease), Int JBiometeorol, vol.19, pp.93-8, Jun1975.
[170] K. Otsuka, et al., Effect of aging on blood pressure in Leh, Ladakh, a high-altitude(3524m) community, by comparison with a Japanese town, Biomed Pharmacother,vol.59Suppl1, pp. S54-7, Oct2005.
[171] K. Otsuka, et al., Chronoecological health watch of arterial stiffness andneuro-cardio-pulmonary function in elderly community at high altitude (3524m),compared with Japanese town, Biomed Pharmacother, vol.59Suppl1, pp. S58-67,Oct2005.
[172] L. Bernardi, et al., Ventilation, autonomic function, sleep and erythropoietin.Chronic mountain sickness of Andean natives, Adv Exp Med Biol, vol.543, pp.161-75,2003.
[173] E. C. Fletcher, Invited review: Physiological consequences of intermittent hypoxia:systemic blood pressure, J Appl Physiol, vol.90, pp.1600-5, Apr2001.
[174] D. Penaloza and J. Arias-Stella, The heart and pulmonary circulation at highaltitudes: healthy highlanders and chronic mountain sickness, Circulation, vol.115,pp.1132-46, Mar62007.
[175] J. A. Calbet, Chronic hypoxia increases blood pressure and noradrenaline spilloverin healthy humans, J Physiol, vol.551, pp.379-86, Aug152003.
[176] P. Siques, et al., Blood pressure responses in young adults first exposed to highaltitude for12months at3550m, High Alt Med Biol, vol.10, pp.329-35, Winter2009.
[177] V. Ziaee, et al., Acute mountain sickness in Iranian trekkers around MountDamavand (5671m) in Iran, Wilderness Environ Med, vol.14, pp.214-9, Winter2003.
[178] S. Anand and K. Hanson, Disability-adjusted life years: a critical review, Journal ofhealth economics, vol.16, pp.685-702, Dec1997.
[179] S. Robinson, Test-retest reliability of health state valuation techniques: the timetrade off and person trade off, Health Econ, Nov32010.
[180] C. G. Blood and E. D. Gauker, The relationship between battle intensity and diseaserates among Marine Corps infantry units, Military medicine, vol.158, pp.340-4,1993.
[1]李立明,叶冬青等.流行病学[M].北京:人民卫生出版社,2005.
[2] Oliver WC Morgan, Clare Griffiths，Azeem Majeed. Association between mortalityfrom suicide in England and antidepressant prescribing: an ecological study. BMCPublic Health2004,4:63.
[3] BenedictWWheeler, David Gunnell, ChrisMetcalfe, et al. The population impact onincidence of suicide and non-fatal self harm of regulatory action against the use ofselective serotonin reuptake inhibitors in under18s in the United Kingdom: ecologicalstudy. BMJ.2008,8,336(7643):542-5.
[4] David M. Studdert, Lyle C. Gurrin, Uma Jatkar, Jane Pirkis. Relationship betweenVehicle Emissions Laws and Incidence of Suicide by Motor Vehicle Exhaust Gas inAustralia,2001-06: An Ecological Analysis. PLoS Med.2010,7(1):e1000210.
[5] Morven Leese, Stuart Thomas, Louisa Snow. An ecological study of factors associatedwith rates of self-inf licted death in prisons in England and Wales. International Journalof Law and Psychiatry2006,29:355-360.
[6] F Curtis Breslin, Peter Smith, James R Dunn. An ecological study of regional variationin work injuries among young workers. BMC Public Health2007,7:91.
[7] Kenneth L Quarrie, Simon M Gianotti, Will G Hopkins, Patria A Hume. Effect ofnationwide injury prevention programme on serious spinal injuries in New Zealandrugby union: ecological study. BMJ,2007,2,334(7604):1150.
[8] Francisco Rivas-Ruiz, Emilio Perea-Milla, Alberto Jimenez-Puente. Geographicvariability of fatal road traffic injuries in Spain during the period2002–2004: anecological study. BMC Public Health2007,7:266.
[9] M. D. Tobin, J. Milligan, R. Shukla, et al. South Asian ethnicity and risk of childhoodaccidents: an ecological study at enumeration district level in Leicester. Journal ofPublic Health Medicine,24(4):313-318.
[10]Otto Visser, Joop H van Wijnen, Flora E van Leeuwen. Incidence of cancer in the areaaround Amsterdam Airport Schiphol in1988–2003: a population-based ecological study.BMC Public Health2005,5:127.
[11]Sharif B. Mohr, Cedric F. Garland, Edward D. Gorham, et al. Is ultraviolet Birradiance inversely associated with incidence rates of endometrial cancer: anecological study of107countries. Preventive Medicine2007,45:327-331.
[12]Ravi Maheswaran, Robert P. Haining, Paul Brindley. Outdoor air pollution, mortality,and hospital admissions from coronary heart disease in Sheffield, UK: a small-arealevel ecological study.
[13]Zhiyong Hu, and K Ranga Rao. Particulate air pollution and chronic ischemic heartdisease in the eastern United States: a county level ecological study using satelliteaerosol data. Environmental Health2009,8:26.
[14]Robin M Turner1, David J Muscatello, Wei Zheng, et al. An outbreak of cardiovascularsyndromes requiring urgent medical treatment and its association with environmentalfactors: an ecological study. Environmental Health2007,6:37.
[15]Christof Wolf, Urban air pollution and health: an ecological study of chronicrhinosinusitis in Cologne, Germany. Health&Place2002,8:129-139.
[16]Kazushi Okamoto. Life expectancy at the age of65years and environmental factors:An ecological study in Japan. Archives of Gerontology and Geriatrics2006,43:85-91.
[17]Raymond F. Palmera, Steven Blanchardb, Zachary Stein, et al. Environmental mercuryrelease, special education rates, and autism disorder: an ecological study of Texas.Health&Place,2006,12:203-209.
[18]P.C. Kanojia. Ecological study on mosquito vectors of Japanese encephalitis virus inBellary district, Karnataka. Indian J Med Res,2007,126:152-157.
[19]P. S. Craig, P. Giraudoux, D. Shi, et al. An epidemiological and ecological study ofhuman alveolar echinococcosis transmission in south Gansu, China. Acta Tropica,2000,77:167-177.
[20]Ward P. Myers, Janice L. Westenhouse,, Jennifer Flood, Lee W. Riley. An EcologicalStudy of Tuberculosis Transmission in California. American Journal of Public Health,2006, l96(4):685-690.
[21]D Che, B Decludt, C Campese, J C Desenclos. Sporadic cases of community acquiredlegionnaires’ disease: an ecological study to identify new sources of contamination. JEpidemiol Community Health2003;57:466-469.
[22]Peng Bi, A. Scott Cameron, Ying Zhang, Kevin A. Parton. Weather and notifiedCampylobacter infections in temperate and sub-tropical regions of Australia: Anecological study. Journal of Infection,2008,57:317-323.
[23]MasakazuWashio, Asae Oura, Mitsuru Mori. Ecological studies on influenza infectionand the effect of vaccination: Their advantages and limitations. Vaccine,2008,26:6470–6472.
[24]Florian M. Marx, Rifat A. Atun, Wieslaw Jakubowiak. Reform of tuberculosis controland DOTS within Russian public health systems: an ecological study. European Journalof Public Health,2006,17(1):98-103.
[25]A Nkondjock, O Receveur. Fish-seafood consumption, obesity, and risk of type2diabetes: an ecological study. Diabetes Metab,2003,29,635-642.
[26]Michael Stoneham, Michael Goldacre, Valerie Seagroatt, Leicester Gill. Olive oil, dietand colorectal cancer: an ecological study and a hypothesis. J Epidemiol CommunityHealth2000;54:756-760.
[27]Chisato Nagata. Ecological study of the association between soy product intake andmortality from cancer and heart disease in Japan. International Journal of Epidemiology,2000,29:832-836.
[28]Simon M Collin, Richard M Martin, Chris Metcalfe, et al. Prostate-cancer mortality inthe USA and UK in1975-2004: an ecological study. Lancet Oncol2008,9:445-52.
[29]D.J. Etherington, D.F.H. Pheby and F.I. Bray. An Ecological Study of Cancer Incidenceand Radon Levels in South West England. European journal of Cancer,1996,32(7):1189-1197.
[30]Elizabeth Lamont, Lauren Dias. Secular Changes in NSAID Use and InvasiveColorectal Cancer Incidence: An Ecological Study. Cancer J.2008;14(4):276–277.
[31]珍曲,向远根.西藏藏族急性高原病发病调查[J].高原卫生资料,1994,(24):7-8.
[32]张军峰，马宽军等.急性高原病流行病学调查[J].中华实用医学,2003,5(3):100.
[33]童世君.进驻高海拔区人群急性高原脑水肿流行病学调查评论[J].医学信息:下旬刊,2009(9):270.
[34]张雪峰,叶平安,陈晓峰.高原施工人群急性重型高原病患病率调查[J].高原医学杂志,2005,15(3):7-9.
[35]郑然,周世伟.构建急性高原病易感者预测模型的方法学研究[J].中国临床康复,2005,9(7):160-162.
[36]游海燕.急性高原病多指标神经网络BP模型诊断分析[J].中国卫生统计,2008,25(5):484-486.
[37]刘运胜,易东,李维民.青年军人急性高原病医学地理差异聚类分析[J].西南国防医药2005,15(2):145-147.
[38]王岩飞,次旦群佩,孙红娟等.体重指数与急性高原病发病的相关分析[J].中华急诊医学杂志,2006,15(1):85-86.
[39]曹祯吾,贺彪.高原红细胞增多症的流行病学研究[J].西藏科技,1995,(1):25-32.
[40]张富生,王文明,郭伟,康海虎.高原病临床流行病学调查报告[J].中国工业医学杂志,1998,11(1):50.
[41]黄跃,姜泗元,彭东等.高原环境下高原病再发的流行病学研究[J].西南国防医药,2004,14(6):599-601.
[42]黄跃,李素芝,郭灵常等.高原环境下急性高原病预后与慢性高原病关系的随访研究[J].高原医学杂志,2002,12(2):1-3.
[43]黄跃,王学凯,郭灵常等.高原环境下慢性高原病预后与其相互转型关系的临床流行病学研究[J].西南国防医药,2003,13(1):6-8.
[44]张西洲,崔建华,王宏运等.驻喀喇昆仑山和西藏阿里高原部队慢性高原病流行病学调查[J].临床军医杂志,2006,34(5):609-611.
[45]Benjamin Honigman, Mary Kay Theis, Jane Koziol-McLain, et al. Moore. AcuteMountain Sickness in a General Tourist Population at Moderate Altitudes. Annals ofInternal Medicine,118(8):587-592.
[46]Basnyat B, Subedi D, Sleggs J, et al. Disoriented and ataxic pilgrims: anepidemiological study of acute mountain sickness and high-altitude cerebral edema at asacred lake at4300m in the Nepal Himalayas. Wilderness Environ Med.2000,11(2):89-93.
[47]Wang SH, Chen YC, Kao WF, et al. Epidemiology of acute mountain sickness on JadeMountain, Taiwan: an annual prospective observational study. High Alt Med Biol.2010,11(1):43-9.
[48]Okumiya K, Sakamoto R, Kimura Y, et al. Comprehensive geriatric assessment ofelderly highlanders in Qinghai, China II: the association of polycythemia withlifestyle-related diseases among the three ethnicities. Geriatr Gerontol Int.2009,9(4):342-51.
[49]Schneider M, Bernasch D, Weymann J, et al. Acute mountain sickness: influence ofsusceptibility, preexposure, and ascent rate. Med Sci Sports Exerc.2002,34(12):1886-91.
[50]Wagner DR, Fargo JD, Parker D, et al. Variables contributing to acute mountainsickness on the summit of Mt Whitney. Wilderness Environ Med.2006,17(4):221-8.
[51]Vann RD, Pollock NW, Pieper CF, et al. Statistical models of acute mountain sickness.High Alt Med Biol.2005,6(1):32-42.
[52]Mairer K, Wille M, Bucher T, Burtscher M. Prevalence of acute mountain sickness inthe Eastern Alps. High Alt Med Biol.2009,10(3):239-45.
[53]M Stevenson, R McClure. Use of Ecological Study Designs for Injury Prevention. InjPrev,2005,11:2-4.
[2]李素芝.高原病学[M].拉萨:西藏人民出版社,2001.
[3]陶发胜,曹金军,方立,等.基层部队急救训练存在的问题及对策[J].西南国防医药,2011,11:1255-1256.
[4]陶发胜,何新建,高钰琪,等.刍议高原战时医疗后送机动力量能力建设[J].西南国防医药,2011,3:323-325.
[5]陶发胜,何新建,高钰琪,等.卫生勤务概念的重新审视[J].西南国防医药,2011,6:666-667.
[6]陶发胜,何新建,高钰琪,等.勤务概念释义[J].西南国防医药,2011,8:906-907.
[7]李立明,叶冬青等.流行病学[M].北京:人民卫生出版社,2005.
[8] H. H. Huang, et al., Alternations of heart rate variability at lower altitude in thepredication of trekkers with acute mountain sickness at high altitude, Clin J SportMed, vol.20, pp.58-63, Jan2010.
[9] B. Basnyat and D. R. Murdoch, High-altitude illness, Lancet, vol.361, pp.1967-74,2003.
[10] Houghton Mifflin Harcourt, The American Heritage Medical Dictionary. Boston:Houghton Mifflin Company,2007.
[11] A. Arregui, et al., Migraine, polycythemia and chronic mountain sickness,Cephalalgia, vol.14, pp.339-41, Oct1994.
[12] W. C. Cockerham, Medical Sociology. Beijing: Pearson Education Asia Limitedand Peiking University Press,2005.
[13] C. Moll, et al., Gross Domestic Product (GDP) and productivity ofschizophrenia trials: an ecological study, BMC Psychiatry, vol.3, p.18, Dec52003.
[14] R. S. Heyderman, et al., The incidence and mortality for meningococcal diseaseassociated with area deprivation: an ecological study of hospital episode statistics,Arch Dis Child, vol.89, pp.1064-8, Nov2004.
[15] S. S. da Cunha, et al., Ecological study of socio-economic indicators andprevalence of asthma in schoolchildren in urban Brazil, BMC Public Health, vol.7,p.205,2007.
[16] L. R. Kerr-Pontes, et al., Inequality and leprosy in Northeast Brazil: anecological study, Int J Epidemiol, vol.33, pp.262-9, Apr2004.
[17] K. E. Pickett, et al., Wider income gaps, wider waistbands? An ecological studyof obesity and income inequality, J Epidemiol Community Health, vol.59, pp.670-4, Aug2005.
[18] P. R. Ward, et al., How equitable are GP practice prescribing rates for statins?:an ecological study in four primary care trusts in North West England,International journal for equity in health, vol.6, p.2,2007.
[19] R. Maheswaran, et al., Impact of NHS walk-in centres on primary care accesstimes: ecological study, BMJ (Clinical research ed), vol.334, p.838,2007.
[20] M. Jones, et al., Influence of practices' ethnicity and deprivation on access toangiography: an ecological study, Br J Gen Pract, vol.54, pp.423-8, Jun2004.
[21] E. Perea-Milla, et al., Estimation of the real population and its impact on theutilisation of healthcare services in Mediterranean resort regions: an ecologicalstudy, BMC Health Serv Res, vol.7, p.13,2007.
[22] G. Damiani, et al., An ecological study on the relationship between supply ofbeds in long-term care institutions in Italy and potential care needs for the elderly,Bmc Health Services Research, vol.9, Sep242009.
[23] W. B. Grant, Ecological study of dietary and smoking links to lymphoma, AlternMed Rev, vol.5, pp.563-72, Dec2000.
[24] C. Emslie and R. Mitchell, Are there gender differences in the geography ofalcohol-related mortality in Scotland? An ecological study, BMC Public Health,vol.9, Feb162009.
[25] J. Didkowska, et al., Lung cancer mortality at ages35-54in the European Union:ecological study of evolving tobacco epidemics, British Medical Journal, vol.331,pp.189-191, Jul232005.
[26] K. Guldbrandsson and S. Bremberg, Two approaches to school healthpromotion--a focus on health-related behaviours and general competencies. Anecological study of25Swedish municipalities, Health Promot Int, vol.21, pp.37-44, Mar2006.
[27] D. Stanistreet, et al., Women's empowerment and violent death among womenand men in Europe: an ecological study, J Epidemiol Community Health, vol.4, pp.257-265,2007.
[28] A. Seidler, et al., Cancer risk among residents of Rhineland-Palatinatewinegrowing communities, Journal of Occupational Medicine and Toxicology, vol.3, p.12,2008.
[29] C. J. Williams, et al., Geographic correlation between deprivation and risk ofmeningococcal disease: an ecological study, BMC Public Health, vol.4, Jul262004.
[30] Z. E. S. Guildea, et al., Differences in risk of mortality under1year of agebetween rural and urban areas: an ecological study, Public Health, vol.119, pp.442-447, May2005.
[31]珍曲,向远根.西藏藏族急性高原病发病调查[J],高原卫生资料,1994,24:7-8.
[32]张军峰,马宽军.急性高原病流行病学调查[J].中华实用医学,2003,3:100.
[33]童世君.进驻高海拔区人群急性高原脑水肿流行病学调查评论[J].医学信息:下旬刊,2009,270:270.
[34]张雪峰,叶平安,陈晓峰.高原施工人群急性重型高原病患病率调查[J].高原医学杂志,2005,15:7-9.
[35]郑然,周世伟.构建急性高原病易感者预测模型的方法学研究[J].中国临床康复,2005,9:160-162.
[36]游海燕.急性高原病多指标神经网络BP模型诊断分析[J].中国卫生统计,2008,25:484-486.
[37]刘运胜,易东,李维民.青年军人急性高原病医学地理差异聚类分析[J].西南国防医药,2005,15:145-147.
[38]王岩飞,次旦群佩,孙红娟.体重指数与急性高原病发病的相关分析[J].中华急诊医学杂志,2006,15:85-86.
[39]曹祯吾,贺彪.高原红细胞增多症的流行病学研究[J].西藏科技,1995,1:25-32.
[40]张富生,王文明,郭伟.高原病临床流行病学调查报告[J].中国工业医学杂志,1998,11:50.
[41]黄跃,姜泗元,彭东.高原环境下高原病再发的流行病学研究[J].西南国防医药,2004,14:599-601.
[42]黄跃,李素芝,郭灵常.高原环境下急性高原病预后与慢性高原病关系的随访研究[J].高原医学杂志,2002,12:1-3.
[43]黄跃,王学凯,郭灵常,等.高原环境下慢性高原病预后与其相互转型关系的临床流行病学研究[J].西南国防医药,2003,13:6-8.
[44]张西洲,崔建华,王宏运.驻喀喇昆仑山和西藏阿里高原部队慢性高原病流行病学调查[J].临床军医杂志,2006,34:609-611.
[45] F. C. Breslin, et al., An ecological study of regional variation in work injuriesamong young workers, BMC Public Health, vol.7, p.91,2007.
[46] K. L. Quarrie, et al., Effect of nationwide injury prevention programme onserious spinal injuries in New Zealand rugby union: ecological study, BMJ, vol.334, p.1150, Jun22007.
[47] F. Rivas-Ruiz, et al., Geographic variability of fatal road traffic injuries in Spainduring the period2002-2004: an ecological study, BMC Public Health, vol.7, p.266,2007.
[48] B. Honigman, et al., Acute mountain sickness in a general tourist population atmoderate altitudes, Annals of internal medicine, vol.118, pp.587-92,1993.
[49] B. Basnyat, et al., Disoriented and ataxic pilgrims: an epidemiological study ofacute mountain sickness and high-altitude cerebral edema at a sacred lake at4300m in the Nepal Himalayas, Wilderness&environmental medicine, vol.11, pp.89-93,2000.
[50] S.-H. Wang, et al., Epidemiology of acute mountain sickness on Jade Mountain,Taiwan: an annual prospective observational study, High altitude medicine&biology, vol.11, pp.43-9,2010.
[51] K. Okumiya, et al., Comprehensive geriatric assessment of elderly highlandersin Qinghai, China II: the association of polycythemia with lifestyle-relateddiseases among the three ethnicities, Geriatr Gerontol Int, vol.9, pp.342-51, Dec2009.
[52] M. Schneider, et al., Acute mountain sickness: influence of susceptibility,preexposure, and ascent rate, Med Sci Sports Exerc, vol.34, pp.1886-91, Dec2002.
[53] D. R. Wagner, et al., Variables contributing to acute mountain sickness on thesummit of Mt Whitney, Wilderness Environ Med, vol.17, pp.221-8, Winter2006.
[54] R. D. Vann, et al., Statistical models of acute mountain sickness, High Alt MedBiol, vol.6, pp.32-42, Spring2005.
[55]刘莉,邢玉梅.氰化高铁血红蛋白测定方法的质量控制[J].山西医药杂志,2005,34(2):169.
[56] A. Guijarro Morales, et al., Acute mountain sickness, An Med Interna, vol.7, pp.375-8, Jul1990.
[57] R. Karniol, Fighting on the Roof of the World, Jane's Defence Weekly, vol.30, p.30,1998.
[58] F. J. Bia, Current prevention and management of acute mountain sickness, Yale JBiol Med, vol.65, pp.337-41, Jul-Aug1992.
[59] D. L. Gilbert, The first documented description of mountain sickness: theAndean or Pariacaca story, Respir Physiol, vol.52, pp.327-47, Jun1983.
[60] T. Y. Wu, et al., Reduced incidence and severity of acute mountain sickness inQinghai-Tibet railroad construction workers after repeated7-month exposuresdespite5-month low altitude periods, High Alt Med Biol, vol.10, pp.221-32, Fall2009.
[61] L. P. Queiroz and A. M. Rapoport, High-altitude headache, Curr Pain HeadacheRep, vol.11, pp.293-6, Aug2007.
[62] T. Wu, et al., Ataxia: an early indicator in high altitude cerebral edema, High AltMed Biol, vol.7, pp.275-80, Winter2006.
[63] C. Pesce, et al., Determinants of acute mountain sickness and success on MountAconcagua (6962m), High Alt Med Biol, vol.6, pp.158-66, Summer2005.
[64] S. Jafarian, et al., Respiratory rate within the first hour of ascent predictssubsequent acute mountain sickness severity, Arch Iran Med, vol.11, pp.152-6,Mar2008.
[65] M. Burtscher, et al., Prediction of susceptibility to acute mountain sickness bySaO2values during short-term exposure to hypoxia, High Alt Med Biol, vol.5, pp.335-40, Fall2004.
[66] P. J. Fagenholz, et al., Optic nerve sheath diameter correlates with the presenceand severity of acute mountain sickness: evidence for increased intracranialpressure, J Appl Physiol, vol.106, pp.1207-11, Apr2009.
[67] O'Connor, et al., Changes in oxygen saturation and optic nerve sheath diameterhelp predict acute mountain sickness in individuals at high altitude (vol51, pg477,2008), Annals of Emergency Medicine, vol.52, pp.34-34, Jul2008.
[68] H. M. Karinen, et al., Prediction of acute mountain sickness by monitoringarterial oxygen saturation during ascent, High Alt Med Biol, vol.11, pp.325-32,Winter2010.
[69] G. H. Kamimori, et al., Catecholamine levels in hypoxia-lnduced acutemountain sickness, Aviat Space Environ Med, vol.80, pp.376-80, Apr2009.
[70] F. Zhou, et al., Association of hsp70-2and hsp-hom gene polymorphisms withrisk of acute high-altitude illness in a Chinese population, Cell Stress Chaperones,vol.10, pp.349-56, Winter2005.
[71] J. L. Rupert and M. S. Koehle, Evidence for a genetic basis for altitude-relatedillness, High Alt Med Biol, vol.7, pp.150-67, Summer2006.
[72] M. A. Pasha and J. H. Newman, High-altitude disorders: pulmonaryhypertension: pulmonary vascular disease: the global perspective, Chest, vol.137,pp.13S-19S, Jun2010.
[73] J. B. West, English translation of Nomenclature, classification, and diagnosticcriteria of high altitude disease in China, High Alt Med Biol, vol.11, pp.169-72,Summer2010.
[74] G. Savourey, et al., Evaluation of the Lake Louise acute mountain sicknessscoring system in a hypobaric chamber, Aviation, space, and environmentalmedicine, vol.66, pp.963-7,1995.
[75] C. Banwell, et al., Body mass index and health-related behaviours in a nationalcohort of87,134Thai open university students, Journal of epidemiology andcommunity health, vol.63, pp.366-72,2009.
[76] F. M. Biro, et al., Body mass index and waist-to-height changes during teenyears in girls are influenced by childhood body mass index, The Journal ofadolescent health: official publication of the Society for Adolescent Medicine, vol.46, pp.245-50,2010.
[77] B. Morkedal, et al., Mortality from ischaemic heart disease: age-specific effectsof blood pressure stratified by body-mass index: the HUNT cohort study inNorway, Journal of epidemiology and community health, vol.65, pp.814-9,2011.
[78] D. W. Hosmer and S. Lemshow, Applied logistic regression. New York: Wiley-Interscience,2000.
[79] C. G. Blood, et al., Implications for modeling casualty sustainment duringpeacekeeping operations, Military medicine, vol.167, pp.868-72,2002.
[80] S. Jafarian, et al., Respiratory rate within the first hour of ascent predictssubsequent acute mountain sickness severity, Archives of Iranian medicine, vol.11,pp.152-6,2008.
[81] V. Ziaee, et al., Acute mountain sickness in Iranian trekkers around MountDamavand (5671m) in Iran, Wilderness&environmental medicine, vol.14, pp.214-9,2003.
[82] S. Gaillard, et al., Awareness, prevalence, medication use, and risk factors ofacute mountain sickness in tourists trekking around the Annapurnas in Nepal: a12-year follow-up, High Alt Med Biol, vol.5, pp.410-9, Winter2004.
[83] T. Wu, et al., Tibetans at extreme altitude, Wilderness&environmentalmedicine, vol.16, pp.47-54,2005.
[84] T. Y. Wu, et al., Reduced incidence and severity of acute mountain sickness inQinghai-Tibet railroad construction workers after repeated7-month exposuresdespite5-month low altitude periods, High altitude medicine&biology, vol.10,pp.221-32,2009.
[85] P. H. Hackett and R. C. Roach, High-altitude illness, The New England journalof medicine, vol.345, pp.107-14,2001.
[86] M. D. Harris, et al., High-altitude medicine, American family physician, vol.57,pp.1907-14,1924-6,1998.
[87] P. Bartsch and B. Saltin, General introduction to altitude adaptation andmountain sickness, Scand J Med Sci Sports, vol.18Suppl1, pp.1-10, Aug2008.
[88] Y. Zhang, et al., Climate change and the transmission of vector-borne diseases: areview, Asia-Pacific journal of public health/Asia-Pacific Academic Consortiumfor Public Health, vol.20, pp.64-76,2008.
[89] G. W. Rodway, et al., High-altitude-related disorders--Part I: Pathophysiology,differential diagnosis, and treatment, Heart Lung, vol.32, pp.353-9, Nov-Dec2003.
[90] N. P. Mason, et al., Cough frequency and cough receptor sensitivity to citric acidchallenge during a simulated ascent to extreme altitude, Eur Respir J, vol.13, pp.508-13, Mar1999.
[91] L. Dumont, et al., Efficacy and harm of pharmacological prevention of acutemountain sickness: quantitative systematic review, BMJ, vol.321, pp.267-72, Jul292000.
[92] R. C. Roach, et al., Exercise exacerbates acute mountain sickness at simulatedhigh altitude, J Appl Physiol, vol.88, pp.581-5, Feb2000.
[93] P. H. Hackett, et al., The incidence, importance, and prophylaxis of acutemountain sickness, Lancet, vol.2, pp.1149-55, Nov271976.
[94] D. R. Murdoch, Altitude Illness Among Tourists Flying to3740MetersElevation in the Nepal Himalayas, J Travel Med, vol.2, pp.255-256, Dec11995.
[95] WHO. BMI classification. Available:http://apps.who.int/bmi/index.jsp?introPage=intro_3.html
[96] T. S. Simonson, et al., Genetic evidence for high-altitude adaptation in Tibet,Science, vol.329, pp.72-5, Jul22010.
[97] J. H. Cui, et al.,[Effects of Rholida on the free radical metabolism and serumcreatine kinase after exercise at plateau], Hang tian yi xue yu yi xue gong cheng=Space medicine&medical engineering, vol.14, pp.448-51,2001.
[98] X. Zhang, et al., The effect of Rholida and Acetazolamide on Sleep Deprivationand Metabolism of Oxygen Free Radicals After Exhausitive Exercise of HighlandServicemen, Journal of Preventive Medicine of Chinese People's Liberation Army,vol.19, pp.266-268,2001.
[99] K. Hirata, et al., Obesity as risk factor for acute mountain sickness, Lancet, vol.2,pp.1040-1, Oct281989.
[100] G. Ri-Li, et al., Obesity: associations with acute mountain sickness, Annals ofinternal medicine, vol.139, pp.253-7, Aug192003.
[101] F. A. Moraga, et al., Acute mountain sickness in children and their parents afterrapid ascent to3500m (Putre, Chile), Wilderness Environ Med, vol.19, pp.287-92,Winter2008.
[102] F. A. Moraga, et al., Acute mountain sickness in tourists with children at LakeChungara (4400m) in northern Chile, Wilderness&environmental medicine, vol.13, pp.31-5,2002.
[103] X. Zhang, et al., Role of six different medicines in the symptomatic scores ofbenign form of acute mountain sickness, Medical Journal of National DefendingForces In Northwest China, vol.24, pp.341-343,2003.
[104] R. C. Roach, et al., How well do older persons tolerate moderate altitude?, West JMed, vol.162, pp.32-6, Jan1995.
[105] B. Honigman, et al., Acute mountain sickness in a general tourist population atmoderate altitudes, Ann Intern Med, vol.118, pp.587-92, Apr151993.
[106] Y. Gao, High Altitude Military Medicine,1ed. Chongqing: Chongqing Press,2005.
[107] S. Li, High Altitude Disease. Lhasa: Tibetan People's Press,2001.
[108] C. C. Monge, et al., Pathophysiology and epidemiology of chronic mountainsickness, Int J Sports Med, vol.13Suppl1, pp. S79-81, Oct1992.
[109] F. Leon-Velarde, et al., The role of menopause in the development of chronicmountain sickness, Am J Physiol, vol.272, pp. R90-4, Jan1997.
[110] S. Sun, et al., Breathing and brain blood flow during sleep in patients with chronicmountain sickness, J Appl Physiol, vol.81, pp.611-8, Aug1996.
[111] J. Zhuang, et al., Hypoxic ventilatory responsiveness in Tibetan compared with Hanresidents of3,658m, J Appl Physiol, vol.74, pp.303-11, Jan1993.
[112] L. S. Curran, et al., Ventilation and hypoxic ventilatory responsiveness inChinese-Tibetan residents at3,658m, J Appl Physiol, vol.83, pp.2098-104, Dec1997.
[113] F. C. Breslin, et al., An ecological study of regional variation in work injuriesamong young workers, BMC Public Health, vol.7, pp.-, May232007.
[114] M. M. Zaman, et al., Non-biochemical risk factors for cardiovascular disease ingeneral clinic-based rural population of Bangladesh, J Epidemiol, vol.14, pp.63-8,Mar2004.
[115] N. Wang, et al., Perceived health as related to income, socio-economic status,lifestyle, and social support factors in a middle-aged Japanese, J Epidemiol, vol.15,pp.155-62, Sep2005.
[116] J. Iralu, et al., Risk factors for HIV disease progression in a rural southwestAmerican Indian population, Public Health Rep, vol.125Suppl4, pp.43-50,Jul-Aug2010.
[117] S. London, Community characteristics help shape women's decisions on whether togive birth in a health facility, Int Fam Plan Perspect, vol.32, pp.52-3, Mar2006.
[118]叶为民,亦应南,周天舒.食用鱼露与福建省胃癌死亡率关系的流行病学研究[J].中国公共卫生,1997,13:188-190.
[119]顾惠心,杨志刚,金秀媛.流感流行生态学的流行病学研究[J].中华流行病学杂志,1996,17:77-79.
[120]赵玉婉.环境有机氯污染与结肠癌及乳腺癌发病率的关系[D].浙江:浙江大学,2003.
[121]钱序.广东外来未婚女工生殖健康行为的生态学因素及干预探索研究[D].上海:复旦大学,2008.
[122] L. Cai, et al., Fish sauce and gastric cancer:an ecological study in FujianProvince,China, World J Gastroenterol, vol.6, pp.671-675, Oct2000.
[123] X. Ren, et al., Type2diabetes mellitus associated with increased risk for colorectalcancer: evidence from an international ecological study and population-based riskanalysis in China, Public Health, vol.123, pp.540-4, Aug2009.
[124]张新民,俞顺章,沈杰.略论时序回归分析方法在流行病学生态学研究中的应用[J].中国公共卫生,1993,9:481-484.
[125] T. Y. Wu, Chronic mountain sickness on the Qinghai-Tibetan plateau, Chin Med J(Engl), vol.118, pp.161-8, Jan202005.
[126] E. Vargas and H. Spielvogel, Chronic mountain sickness, optimal hemoglobin, andheart disease, High Alt Med Biol, vol.7, pp.138-49, Summer2006.
[127] P. Jin and F. Chen, Medical Statistic Method,3ed. Shanghai: Fudan UniversityPress,2009.
[128] F. Leon-Velarde, et al., Consensus statement on chronic and subacute high altitudediseases, High Alt Med Biol, vol.6, pp.147-57, Summer2005.
[129] R. Hong, et al., Relationship between household wealth inequality and chronicchildhood under-nutrition in Bangladesh, International journal for equity in health,vol.5, p.15,2006.
[130] F. G. De Maio, et al., An average/deprivation/inequality (ADI) analysis of chronicdisease outcomes and risk factors in Argentina, Population health metrics, vol.7, p.8,2009.
[131] R. Plata, et al., Angiotensin-converting-enzyme inhibition therapy in altitudepolycythaemia: a prospective randomised trial, Lancet, vol.359, pp.663-6,2002.
[132] J. L. Rupert, et al., Selective pressure has not acted against hypercoagulabilityalleles in high-altitude amerindians, Annals of Human Genetics, vol.67, pp.426-432, Sep2003.
[133] M. Rivera-Ch, et al., Treatment of chronic mountain sickness: critical reappraisal ofan old problem, Respir Physiol Neurobiol, vol.158, pp.251-65, Sep302007.
[134] M. Rivera-Ch, et al., Effect of acetazolamide on ventilatory response in subjectswith chronic mountain sickness, Respir Physiol Neurobiol, vol.162, pp.184-9, Aug312008.
[135] H. Y. Kam, et al., Role of the spleen in the exaggerated polycythemic response tohypoxia in chronic mountain sickness in rats, J Appl Physiol, vol.87, pp.1901-8,Nov1999.
[136] J. T. Reeves and F. Leon-Velarde, Chronic mountain sickness: recent studies of therelationship between hemoglobin concentration and oxygen transport, High AltMed Biol, vol.5, pp.147-55, Summer2004.
[137] T. Y. Wu, et al., Who should not go high: chronic disease and work at altitudeduring construction of the Qinghai-Tibet railroad, High Alt Med Biol, vol.8, pp.88-107, Summer2007.
[138] E. W. Askew, Work at high altitude and oxidative stress: antioxidant nutrients,Toxicology, vol.180, pp.107-19, Nov152002.
[139] S. X. Pei, et al., Chronic mountain sickness in Tibet, Q J Med, vol.71, pp.555-74,Jun1989.
[140] J. Bjork and U. Stromberg, Effects of systematic exposure assessment errors inpartially ecologic case-control studies, International journal of epidemiology, vol.31, pp.154-60,2002.
[141] J. Wakefield, A critique of statistical aspects of ecological studies in spatialepidemiology, Environmental and Ecological Statistics, vol.11, pp.31-54, Mar2004.
[142] A. Kroeger, Anthropological and socio-medical health care research in developingcountries, Soc Sci Med, vol.17, pp.147-61,1983.
[143] P. Y. Katung, Socio-economic factors responsible for poor utilisation of the primaryhealth care services in a rural community in Nigeria, Niger J Med, vol.10, pp.28-9,Jan-Mar2001.
[144] F. Leon-Velarde, et al., Chronic mountain sickness and chronic lower respiratorytract disorders, Chest, vol.106, pp.151-5, Jul1994.
[145] T. Y. Wu, The Qinghai-Tibetan plateau: how high do Tibetans live?, High Alt MedBiol, vol.2, pp.489-99, Winter2001.
[146] I. S. Anand and T. Y. Wu, Syndromes of subacute mountain sickness, High Alt MedBiol, vol.5, pp.156-70, Summer2004.
[147] C. J. Murray and A. K. Acharya, Understanding DALYs (disability-adjusted lifeyears), Journal of health economics, vol.16, pp.703-30,1997.
[148] C. J. Murray, et al., The global burden of disease in1990: summary results,sensitivity analysis and future directions, Bull World Health Organ, vol.72, pp.495-509,1994.
[149] C. J. Murray, Quantifying the burden of disease: the technical basis fordisability-adjusted life years, Bull World Health Organ, vol.72, pp.429-45,1994.
[150] C. D. Mathers, et al., The burden of disease and injury in Australia, Bull WorldHealth Organ, vol.79, pp.1076-84,2001.
[151]孙建东,郭晓雷,李维卡,等.应用伤残调整寿命年测量山东省居民疾病负担[J].中国卫生经济,26(8):61-63.
[152] N. S. Murthy, et al., Disability adjusted life years for cancer patients in India, AsianPac J Cancer Prev, vol.11, pp.633-40,2010.
[153] K. Krishnamoorthy, et al., Burden of chikungunya in India: estimates of disabilityadjusted life years (DALY) lost in2006epidemic, J Vector Borne Dis, vol.46, pp.26-35, Mar2009.
[154] WHO.(2004, Global burden of disease2004update: disability weights for diseasesand conditions. Available:http://www.who.int/healthinfo/global_burden_disease/GBD2004_DisabilityWeights.pdf
[155] J. A. Haagsma, et al., Alternative approaches to derive disability weights in injuries:do they make a difference?, Qual Life Res, vol.18, pp.657-65, Jun2009.
[156] M. E. A. Stouthard, et al., Disability weights for diseases: a modified protocol andresults for a western european region, European Journal of Public Health, vol.10,pp.24-30,2000.
[157] C. N. McIntosh, et al., Eliciting Canadian population preferences for health statesusing the Classification and Measurement System of Functional Health (CLAMES),Chronic diseases in Canada, vol.28, pp.29-41,2007.
[158] C. Gorber and Sarah, A new classification and measurement system of functionalhealth, September2003.
[159] K.-S. Hong and J. L. Saver, Quantifying the value of stroke disability outcomes:WHO global burden of disease project disability weights for each level of themodified Rankin Scale, Stroke; a journal of cerebral circulation, vol.40, pp.3828-33,2009.
[160] National burden of disease studies: a practical guide (Edition2.0ed.). Available:www.who.int/healthinfo/nationalburdenofdiseasemanual.pdf
[161] J. M. Melse, et al., A national burden of disease calculation: Dutch disability-adjusted life-years. Dutch Burden of Disease Group, Am J Public Health, vol.90,pp.1241-7, Aug2000.
[162] P. H. van Baal, et al., Disability weights for comorbidity and their influence onhealth-adjusted life expectancy, Popul Health Metr, vol.4, p.1,2006.
[163] D. Ding, et al., Assessing the disease burden due to epilepsy by disability adjustedlife year in rural China, Epilepsia, vol.47, pp.2032-7,2006.
[164] H. Vlajinac, et al., Burden of cancer in Serbia, Croat Med J, vol.47, pp.134-41,Feb2006.
[165] WHO. ICD2007, Chapter XIX, Injury, poisoning and certain other consequences ofexternal causes (S00-T98). Available:http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gt66.htm+T702
[166] WHO. WHO disease and injury regional estimates for2004. Available:http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html
[167] J. P. Richalet, et al., Acetazolamide for Monge's disease: efficiency and tolerance of6-month treatment, Am J Respir Crit Care Med, vol.177, pp.1370-6, Jun152008.
[168] Z. W. Chao, et al., High Altitude Polycythemia,1ed. Beijing: Military MedicalScience Press,1996.
[169] F. Sime, et al., Age as a cause of chronic mountain sickness (Monge's disease), Int JBiometeorol, vol.19, pp.93-8, Jun1975.
[170] K. Otsuka, et al., Effect of aging on blood pressure in Leh, Ladakh, a high-altitude(3524m) community, by comparison with a Japanese town, Biomed Pharmacother,vol.59Suppl1, pp. S54-7, Oct2005.
[171] K. Otsuka, et al., Chronoecological health watch of arterial stiffness andneuro-cardio-pulmonary function in elderly community at high altitude (3524m),compared with Japanese town, Biomed Pharmacother, vol.59Suppl1, pp. S58-67,Oct2005.
[172] L. Bernardi, et al., Ventilation, autonomic function, sleep and erythropoietin.Chronic mountain sickness of Andean natives, Adv Exp Med Biol, vol.543, pp.161-75,2003.
[173] E. C. Fletcher, Invited review: Physiological consequences of intermittent hypoxia:systemic blood pressure, J Appl Physiol, vol.90, pp.1600-5, Apr2001.
[174] D. Penaloza and J. Arias-Stella, The heart and pulmonary circulation at highaltitudes: healthy highlanders and chronic mountain sickness, Circulation, vol.115,pp.1132-46, Mar62007.
[175] J. A. Calbet, Chronic hypoxia increases blood pressure and noradrenaline spilloverin healthy humans, J Physiol, vol.551, pp.379-86, Aug152003.
[176] P. Siques, et al., Blood pressure responses in young adults first exposed to highaltitude for12months at3550m, High Alt Med Biol, vol.10, pp.329-35, Winter2009.
[177] V. Ziaee, et al., Acute mountain sickness in Iranian trekkers around MountDamavand (5671m) in Iran, Wilderness Environ Med, vol.14, pp.214-9, Winter2003.
[178] S. Anand and K. Hanson, Disability-adjusted life years: a critical review, Journal ofhealth economics, vol.16, pp.685-702, Dec1997.
[179] S. Robinson, Test-retest reliability of health state valuation techniques: the timetrade off and person trade off, Health Econ, Nov32010.
[180] C. G. Blood and E. D. Gauker, The relationship between battle intensity and diseaserates among Marine Corps infantry units, Military medicine, vol.158, pp.340-4,1993.
[1]李立明,叶冬青等.流行病学[M].北京:人民卫生出版社,2005.
[2] Oliver WC Morgan, Clare Griffiths，Azeem Majeed. Association between mortalityfrom suicide in England and antidepressant prescribing: an ecological study. BMCPublic Health2004,4:63.
[3] BenedictWWheeler, David Gunnell, ChrisMetcalfe, et al. The population impact onincidence of suicide and non-fatal self harm of regulatory action against the use ofselective serotonin reuptake inhibitors in under18s in the United Kingdom: ecologicalstudy. BMJ.2008,8,336(7643):542-5.
[4] David M. Studdert, Lyle C. Gurrin, Uma Jatkar, Jane Pirkis. Relationship betweenVehicle Emissions Laws and Incidence of Suicide by Motor Vehicle Exhaust Gas inAustralia,2001-06: An Ecological Analysis. PLoS Med.2010,7(1):e1000210.
[5] Morven Leese, Stuart Thomas, Louisa Snow. An ecological study of factors associatedwith rates of self-inf licted death in prisons in England and Wales. International Journalof Law and Psychiatry2006,29:355-360.
[6] F Curtis Breslin, Peter Smith, James R Dunn. An ecological study of regional variationin work injuries among young workers. BMC Public Health2007,7:91.
[7] Kenneth L Quarrie, Simon M Gianotti, Will G Hopkins, Patria A Hume. Effect ofnationwide injury prevention programme on serious spinal injuries in New Zealandrugby union: ecological study. BMJ,2007,2,334(7604):1150.
[8] Francisco Rivas-Ruiz, Emilio Perea-Milla, Alberto Jimenez-Puente. Geographicvariability of fatal road traffic injuries in Spain during the period2002–2004: anecological study. BMC Public Health2007,7:266.
[9] M. D. Tobin, J. Milligan, R. Shukla, et al. South Asian ethnicity and risk of childhoodaccidents: an ecological study at enumeration district level in Leicester. Journal ofPublic Health Medicine,24(4):313-318.
[10]Otto Visser, Joop H van Wijnen, Flora E van Leeuwen. Incidence of cancer in the areaaround Amsterdam Airport Schiphol in1988–2003: a population-based ecological study.BMC Public Health2005,5:127.
[11]Sharif B. Mohr, Cedric F. Garland, Edward D. Gorham, et al. Is ultraviolet Birradiance inversely associated with incidence rates of endometrial cancer: anecological study of107countries. Preventive Medicine2007,45:327-331.
[12]Ravi Maheswaran, Robert P. Haining, Paul Brindley. Outdoor air pollution, mortality,and hospital admissions from coronary heart disease in Sheffield, UK: a small-arealevel ecological study.
[13]Zhiyong Hu, and K Ranga Rao. Particulate air pollution and chronic ischemic heartdisease in the eastern United States: a county level ecological study using satelliteaerosol data. Environmental Health2009,8:26.
[14]Robin M Turner1, David J Muscatello, Wei Zheng, et al. An outbreak of cardiovascularsyndromes requiring urgent medical treatment and its association with environmentalfactors: an ecological study. Environmental Health2007,6:37.
[15]Christof Wolf, Urban air pollution and health: an ecological study of chronicrhinosinusitis in Cologne, Germany. Health&Place2002,8:129-139.
[16]Kazushi Okamoto. Life expectancy at the age of65years and environmental factors:An ecological study in Japan. Archives of Gerontology and Geriatrics2006,43:85-91.
[17]Raymond F. Palmera, Steven Blanchardb, Zachary Stein, et al. Environmental mercuryrelease, special education rates, and autism disorder: an ecological study of Texas.Health&Place,2006,12:203-209.
[18]P.C. Kanojia. Ecological study on mosquito vectors of Japanese encephalitis virus inBellary district, Karnataka. Indian J Med Res,2007,126:152-157.
[19]P. S. Craig, P. Giraudoux, D. Shi, et al. An epidemiological and ecological study ofhuman alveolar echinococcosis transmission in south Gansu, China. Acta Tropica,2000,77:167-177.
[20]Ward P. Myers, Janice L. Westenhouse,, Jennifer Flood, Lee W. Riley. An EcologicalStudy of Tuberculosis Transmission in California. American Journal of Public Health,2006, l96(4):685-690.
[21]D Che, B Decludt, C Campese, J C Desenclos. Sporadic cases of community acquiredlegionnaires’ disease: an ecological study to identify new sources of contamination. JEpidemiol Community Health2003;57:466-469.
[22]Peng Bi, A. Scott Cameron, Ying Zhang, Kevin A. Parton. Weather and notifiedCampylobacter infections in temperate and sub-tropical regions of Australia: Anecological study. Journal of Infection,2008,57:317-323.
[23]MasakazuWashio, Asae Oura, Mitsuru Mori. Ecological studies on influenza infectionand the effect of vaccination: Their advantages and limitations. Vaccine,2008,26:6470–6472.
[24]Florian M. Marx, Rifat A. Atun, Wieslaw Jakubowiak. Reform of tuberculosis controland DOTS within Russian public health systems: an ecological study. European Journalof Public Health,2006,17(1):98-103.
[25]A Nkondjock, O Receveur. Fish-seafood consumption, obesity, and risk of type2diabetes: an ecological study. Diabetes Metab,2003,29,635-642.
[26]Michael Stoneham, Michael Goldacre, Valerie Seagroatt, Leicester Gill. Olive oil, dietand colorectal cancer: an ecological study and a hypothesis. J Epidemiol CommunityHealth2000;54:756-760.
[27]Chisato Nagata. Ecological study of the association between soy product intake andmortality from cancer and heart disease in Japan. International Journal of Epidemiology,2000,29:832-836.
[28]Simon M Collin, Richard M Martin, Chris Metcalfe, et al. Prostate-cancer mortality inthe USA and UK in1975-2004: an ecological study. Lancet Oncol2008,9:445-52.
[29]D.J. Etherington, D.F.H. Pheby and F.I. Bray. An Ecological Study of Cancer Incidenceand Radon Levels in South West England. European journal of Cancer,1996,32(7):1189-1197.
[30]Elizabeth Lamont, Lauren Dias. Secular Changes in NSAID Use and InvasiveColorectal Cancer Incidence: An Ecological Study. Cancer J.2008;14(4):276–277.
[31]珍曲,向远根.西藏藏族急性高原病发病调查[J].高原卫生资料,1994,(24):7-8.
[32]张军峰，马宽军等.急性高原病流行病学调查[J].中华实用医学,2003,5(3):100.
[33]童世君.进驻高海拔区人群急性高原脑水肿流行病学调查评论[J].医学信息:下旬刊,2009(9):270.
[34]张雪峰,叶平安,陈晓峰.高原施工人群急性重型高原病患病率调查[J].高原医学杂志,2005,15(3):7-9.
[35]郑然,周世伟.构建急性高原病易感者预测模型的方法学研究[J].中国临床康复,2005,9(7):160-162.
[36]游海燕.急性高原病多指标神经网络BP模型诊断分析[J].中国卫生统计,2008,25(5):484-486.
[37]刘运胜,易东,李维民.青年军人急性高原病医学地理差异聚类分析[J].西南国防医药2005,15(2):145-147.
[38]王岩飞,次旦群佩,孙红娟等.体重指数与急性高原病发病的相关分析[J].中华急诊医学杂志,2006,15(1):85-86.
[39]曹祯吾,贺彪.高原红细胞增多症的流行病学研究[J].西藏科技,1995,(1):25-32.
[40]张富生,王文明,郭伟,康海虎.高原病临床流行病学调查报告[J].中国工业医学杂志,1998,11(1):50.
[41]黄跃,姜泗元,彭东等.高原环境下高原病再发的流行病学研究[J].西南国防医药,2004,14(6):599-601.
[42]黄跃,李素芝,郭灵常等.高原环境下急性高原病预后与慢性高原病关系的随访研究[J].高原医学杂志,2002,12(2):1-3.
[43]黄跃,王学凯,郭灵常等.高原环境下慢性高原病预后与其相互转型关系的临床流行病学研究[J].西南国防医药,2003,13(1):6-8.
[44]张西洲,崔建华,王宏运等.驻喀喇昆仑山和西藏阿里高原部队慢性高原病流行病学调查[J].临床军医杂志,2006,34(5):609-611.
[45]Benjamin Honigman, Mary Kay Theis, Jane Koziol-McLain, et al. Moore. AcuteMountain Sickness in a General Tourist Population at Moderate Altitudes. Annals ofInternal Medicine,118(8):587-592.
[46]Basnyat B, Subedi D, Sleggs J, et al. Disoriented and ataxic pilgrims: anepidemiological study of acute mountain sickness and high-altitude cerebral edema at asacred lake at4300m in the Nepal Himalayas. Wilderness Environ Med.2000,11(2):89-93.
[47]Wang SH, Chen YC, Kao WF, et al. Epidemiology of acute mountain sickness on JadeMountain, Taiwan: an annual prospective observational study. High Alt Med Biol.2010,11(1):43-9.
[48]Okumiya K, Sakamoto R, Kimura Y, et al. Comprehensive geriatric assessment ofelderly highlanders in Qinghai, China II: the association of polycythemia withlifestyle-related diseases among the three ethnicities. Geriatr Gerontol Int.2009,9(4):342-51.
[49]Schneider M, Bernasch D, Weymann J, et al. Acute mountain sickness: influence ofsusceptibility, preexposure, and ascent rate. Med Sci Sports Exerc.2002,34(12):1886-91.
[50]Wagner DR, Fargo JD, Parker D, et al. Variables contributing to acute mountainsickness on the summit of Mt Whitney. Wilderness Environ Med.2006,17(4):221-8.
[51]Vann RD, Pollock NW, Pieper CF, et al. Statistical models of acute mountain sickness.High Alt Med Biol.2005,6(1):32-42.
[52]Mairer K, Wille M, Bucher T, Burtscher M. Prevalence of acute mountain sickness inthe Eastern Alps. High Alt Med Biol.2009,10(3):239-45.
[53]M Stevenson, R McClure. Use of Ecological Study Designs for Injury Prevention. InjPrev,2005,11:2-4.
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