Objective: To investigate the association between long-term fasting blood glucose (FPG) variability and all-cause mortality in patients with type 2 diabetes. Methods: A total of 7 174 type 2 diabetic patients included in National Basic Public Health Service Program in Changshu of Jiangsu Province were recruited as participants. Long-term glucose variability was assessed using standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variability independent of the mean (VIM) across FPG measurements at the more than three visits. Death information were mainly obtained from the death registry system in Jiangsu. Then Cox proportional hazards regression models were used to estimate the associations of four variability indicators and all-cause mortality's hazard ratios (HRs) and their 95%CIs. Results: Among 55 058.50 person-years of the follow-up, the mean follow-up time was 7.67 years, and 898 deaths occurred during the follow-up period. After adjustment, compared with T1 group, the Cox regression model showed that HRs of T3 group in SD, CV, ARV and VIM were 1.24 (95%CI: 1.03-1.49), 1.20 (95%CI: 1.01-1.43), 1.28 (95%CI: 1.07-1.55) and 1.20 (95%CI:1.01-1.41), respectively. HRs of per 1 SD higher SD, CV, ARV and VIM were 1.13 (95%CI: 1.06-1.21), 1.08 (95%CI: 1.01-1.15), 1.05 (95%CI: 1.00-1.12) and 1.09 (95%CI: 1.02-1.16) for all-cause mortality, respectively. In the stratified analysis, age, gender, hypoglycemic agent and insulin uses had no effect on the above associations (all P for interaction >0.05). Conclusion: Long-term FPG glycemic variability was positively associated with the risk of all-cause mortality in type 2 diabetes patients.
目的 了解2016-2020 年山西省耐药结核病的流行情况,为制定山西省耐药结核病防控政策提供科学依据.方法 利用"中国疾病预防控制信息系统"的子系统"结核病管理信息系统"中,收集2016-2020 年登记的病原学阳性肺结核患者的耐药筛查情况、耐药检出情况及综合确诊结果等相关数据,对山西省耐药结核病流行情况进行描述性分析.结果 2016-2020 年山西省共登记病原学阳性肺结核患者16 214 例,结核分枝杆菌培养阳性菌株8075 株,总耐药率为11.49％(928/8075),耐多药率为8.54％(690/8 075),单耐药率为1.93％(156/8075),多耐药率为0.80％(65/8075),广泛耐药率为0.21％(17/8 075).总耐药率(趋势x2=276.329,P＜0.001)、耐多药率(趋势x2=297.186,P＜0.001)、广泛耐药率(趋势x2=6.300,P＜0.05)均呈下降趋势.复治患者的总耐药率[23.89％(308/1289)]和耐多药率[18.23％(235/1289)]均明显高于初治患者[总耐药率为9.14％(620/6 786),耐多药率为6.70％(455/6786)],差异均有统计学意义(x2=231.95,P＜0.001;x2=1 84.155,P＜0.001).近5 年耐药患者发现数逐年上升,且以初治患者、中青年和农民等为主要发病群体,耐药菌株耐药谱逐渐复杂化,单耐药(MR)菌株以利福平(R)耐药菌为主,耐多药(MDR)菌株以异烟肼+利福平(H+R)、异烟肼十利福平十链霉素(H+R+S)为主,初治患者中共出现异烟肼十利福平+链霉素+乙胺丁醇+氧氟沙星(H+R+S+E+OF)联合耐药株16株.结论 山西省耐药结核病防控形势依然严峻,应强化中青年、农民等重点人群结核病的防控意识,规范临床用药,加强肺结核患者健康管理,避免或减少耐药结核病的发生.
Objective To explore the protective effect and mechanism of lactoferrin（Lf） on a radiation-induced intestinal injury. Methods Mice were randomly divided into the control group, 10 Gy group, and Lf+10 Gy group. On 7 d before irradiation, the Lf+10 Gy group was given 250 mg/kg Lf by gavage daily. Mice in the 10 Gy group and Lf+10 Gy group received 10 Gy abdominal irradiation. The mice were sacrificed 3.5 d after irradiation, and the samples were collected to determine the related indexes. Results Irradiation-induced intestinal injury. Lf intervention restored weight loss, hepatic oxidative stress, and pathological intestinal damage in mice. Lf significantly increased the number of Lgr5 and Ki67 positive cells, reflecting the proliferation and regeneration ability of small intestinal cells. Irradiation-induced ferroptosis in small intestinal tissue. Via the iron metabolism pathway, Lf intervention significantly downregulated the expression of intestinal divalent metal transporter（DMT1） and Fe 2+ content; via the GSH/GPX4-lipid peroxidation pathway, Lf intervention significantly upregulated the intestinal solute carrier family 7 members（SLC7A11） and glutathione peroxidase 4（GPX4） protein expression, downregulated acyl-CoA synthase long chain 4（ACSL4） protein expression, and reduced malondialdehyde（MDA） levels. Conclusions Lf ameliorated radiation-induced intestinal injury, possibly due to the regulation of ferroptosis through iron metabolism and the GSH/GPX4-lipid peroxidation pathway.
目的 分析舒适护理联合家庭参与式护理对支气管炎患儿康复效果的影响.方法 选取2021年10月至2022年10月在我院接受治疗的支气管炎患儿70例作为研究对象,将其依照随机数表法进行分组,参照组35例接受舒适护理,观察组35例接受舒适护理联合家庭参与式护理,研究时间为7 d,对两组治疗有效率、各项症状消退时间、患儿的护理依从性以及患儿家长对护理的满意度进行对比.结果 (1)观察组治疗有效率高于参照组(P＜0.05);(2)观察组退热时间、肺啰音消失时间、憋喘症状消失时间、咳嗽症状消失时间均比参照组短(P＜0.05);(3)观察组护理依从性比参照组高(P＜0.05);(4)观察组患儿家长对护理的满意度比参照组高(P＜0.05).结论 对支气管炎患儿实施舒适护理联合家庭参与式护理可显著提升患儿的护理依从性,进而有利于患儿临床症状快速缓解,提高临床疗效.患儿家长对此护理模式的满意度更高,具有较高应用价值.
目的 探究临床护理路径(CNP)模式在肝胆管残余结石患者围术期中的应用效果.方法 选取2018年1月至2021年4月就诊于我院的85例肝胆管残余结石患者,随机分为CNP组(n=43)和常规组(n=42).两组均行胆道镜取石术,常规组接受常规护理干预,CNP组在此基础上联合CNP模式干预.比较两组干预前后疼痛程度、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、肝胆管残余结石健康宣教知识掌握度(注意事项、并发症预防方法、肝胆管残余结石知识、饮食知识)、并发症率及护理满意度.结果 干预后CNP组SAS、SDS评分较常规组低(P＜0.05);术后24 h、48 h CNP组疼痛程度较常规组轻(P＜0.05);干预后CNP组注意事项、并发症预防方法、肝胆管残余结石知识及饮食知识评分均较常规组高(P＜0.05);CNP组并发症率2.33％(1/43)较常规组19.05％(8/42)低(P＜0.05);CNP组护理满意度97.67％(42/43)较常规组78.57％(33/42)高(P＜0.05).结论 CNP模式应用于肝胆管残余结石患者围术期可有效改善其心理状态,减轻疼痛感,提升肝胆管残余结石健康宣教知识掌握度,减少并发症发生,提升护理满意度.
Objective In the elderly,sarcopenia is a common disease and efficient identification of sarcopenia is very important to keep health.Methods Based on the longitudinal physical examination data,a total of 2 544 subjects in a hospital from Shanghai during 2013-2019 were included.Considering the difference across annual indices,various machine learning models were constructed to predict the risk of sarcopenia in the elderly,and the decision curve analysis was applied to provide reference for clinical decision makers.Results The prediction models results showed that the prediction accuracy based on the Light Gradient Boosting Machine(LightGBM)model was relatively high(AUC=0.913 4).Decision curve analysis indicated that the net profit of the LightGBM model became larger when threshold probability(threshold for judging sarcopenia)ranged from 0.01 to 0.42 and from 0.84 to 0.92.And the net profit of the Random Forest model was larger when threshold probability ranged from 0.42 to 0.50 and from 0.60 to 0.67,while in the case of logistic regression model,the range was located in 0.50-0.60 and 0.67-0.84.Conclusions The prediction model established based on longitudinal physical examination data and machine learning methods can effectively predict the future risk of sarcopenia in the elderly,and is of great value for the early diagnosis and intervention of sarcopenia.
2023年10月28-29日,由中华预防医学会流行病学分会主办,中华流行病学杂志编辑委员会和中华疾病控制杂志编辑委员会协办,安徽理工大学公共卫生学院和北京大学公众健康与重大疫情防控战略研究中心共同承办的"2023年全国流行病学学术会议"在安徽省合肥市召开.本次大会的主题是"系统流行病学引领发展之路".
目的 探究对糖尿病合并神经外科颅脑损伤患者实施个性化护理对其血糖水平的影响及护理效果.方法 选取我院神经外科2020年1月至2022年12月收治的糖尿病合并颅脑损伤患者80例,以随机信封法进行分组研究,接受常规神经外科护理干预的患者为参照组(n=40),接受个性化护理干预的患者为观察组(n=40),对两组血糖指标、生活自理能力、智力状况以及对护理的满意度进行比较.结果 干预前两组各项血糖指标对比差异无统计学意义(P＞0.05),干预后观察组患者各项血糖指标水平较参照组更低(P＜0.05);干预前两组生活自理能力及智力状况评分对比差异无统计学意义(P＞0.05),干预后观察组两项量表评分均较参照组高(P＜0.05);观察组的护理满意度比参照组高(P＜0.05).结论 对神经外科收治的糖尿病合并颅脑损伤患者实施个性化护理可有效改善患者的血糖水平,并有利于促进患者自理能力以及智力恢复,患者的满意度高,值得推广.
Objective The purpose of this study is to understand the factors influencing suicidal ideation among medical students and to explore the predictive effect of machine learning(ML)algorithms.Methods A random stratified whole-group sampling of medical students in Shandong Province was conducted from November 2021 to March 2022 to conduct the questionnaire survey.The Chi-square test,Fisher's exact probability method,and Logistic regression were used to explore the factors influencing suicidal ideation among medical students.The prediction models were constructed based on a machine learning algorithm in the training set.The predictive ability of the model was evaluated in the test set based on accuracy,sensitivity,and so on.Results The suicidal ideation rate in medical students was 12.80％.The results showed that living in rural areas(OR=1.523,95％CI:1.023-2.271,P=0.039),and depression symptoms(OR=3.874,95％CI:2.676-5.621,P＜0.001)were risk factors for suicidal ideation.Having not been in love in the past two years(OR=0.601,95％CI:0.427-0.841,P=0.003)and so on were protective factors for suicidal ideation.The prediction accuracy and sensitivity of the four models were higher than 0.90,the Kappa values were higher than 0.80,and the positive and negative predictive values were higher than 0.90.Conclusions All four prediction models perform well,among which the suicide ideation prediction model based on support vector machine(SVM)has more advantages.The SVM model can effectively predict the risk of suicidal ideation,which is more helpful for early identification and intervention of high-risk groups.
目的 分析疼痛护理质量指标在提高急诊过程中骨科病房疼痛护理质量中的作用.方法 随机选取2021年2月至2023年2月就诊于我院骨科急诊的80例患者作为研究对象,分为对照组与观察组,每组40例.对照组行常规护理,观察组应用疼痛护理质量指标进行护理干预.对比两组护理满意度和疼痛情况.结果 对照组VAS评分高于观察组(P＜0.05);对照组护理质量评分低于观察组(P＜0.05);对照组SDS及SAS评分高于观察组(P＜0.05);对照组生活质量评分低于观察组(P＜0.05).结论 针对骨科急诊患者,疼痛护理质量指标有着良好效果,能够加快患者康复速度并提高生活能力,同时也提高了骨科的服务质量及家属的满意度,值得广泛应用.
目的 探讨基于多学科的整体护理联合积极心理学干预在癫痫患者PET-MRI检查中的应用.方法 将我院78例行PET-MRI检查的癫痫患者随机分为对照组(n=39)和观察组(n=39),对照组给予常规干预,观察组在常规干预基础上实施基于多学科的整体护理联合积极心理学干预,比较两组干预前后的焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、医学应对方式问卷(MCMQ)评分、候诊时间和检查时间、图像合格率、检查依从性.结果 干预前两组SAS、SDS、MCMQ各量表评分差异无统计学意义(P＞0.05);干预后观察组SAS、SDS、MC-MQ评分优于对照组(P＜0.05);观察组候诊时间、检查时间短于对照组(P＜0.05),检查依从度和图像合格率高于对照组(P＜0.05);观察组不良情况发生率低于对照组(P＜0.05).结论 基于多学科的整体护理联合积极心理学干预有助于缓解行PET-MRI检查的癫痫患者的焦虑抑郁情绪,帮助其建立积极应对方式,提高检查成功率.
Objective A two-sample Mendelian randomization method was used to investigate the causal relationship between long-chain non-coding RNAs(lncRNAs)and the risk of lung adenocarcinoma.Methods The genome-wide association study data of lung adenocarcinoma and the cis-eQTL data set of eQTL Gene Alliance were used.The single nucleotide polymorphisms(SNPs)closely related to lung adenocarcinoma was used as a tool variable.Five two-sample Mendelian randomization models,including the inverse variance weighting method,MR-Egger regression model,weighted median analysis method,simple mode method and weighted mode method,were applied to evaluate the causal effect between lncRNAs and the risk of lung adenocarcinoma.Moreover,the heterogeneity test,gene pleiotropy test and sensitivity analysis were carried out to evaluate the reliability and stability of the results.Results PVT1,LINC00824,Z94721.1 exhibited significant association with lung adenocarcinoma(all P＜0.05).The OR was 0.79(95％CI:0.71-0.89)for PVT1 and 0.59(95％CI:0.42-0.83)for LINC00824,indicating that both PVT1 and LINC00824 reduced the risk of lung cancer.The OR was 1.09(95％CI:1.03-1.16)for Z94721.1,showing that Z94721.1 increased the risk of lung cancer.All passed the heterogeneity test,gene pleiotropy test and sensitivity analysis.Conclusions The three lncRNAs,PVT1,LINC00824 and Z94721.1,have stable causal association with lung adenocarcinoma,providing an important theoretical basis for the study of the pathogenesis of lung adenocarcinoma.
目的 研究脑梗死患者抗血小板治疗前后血小板计数(PLT)、血小板平均体积(MPV)及血小板分布宽度(PDW)参数与短期预后的关系.方法 选取2021年1月至2022年12月通许第一医院神经内科一病区、二病区、三病区及脑血管科抗血小板治疗的90例脑梗死患者作为研究对象,3个月后随访,采用改良Rankin量表(mRS)评估预后情况,根据mRS评分情况将患者分为预后良好组(MPS≤2分)和预后不良组(MPS＞2分).比较两组基线资料,抗血小板治疗前后PLT、MPV、PDW等血小板参数变化,并进行多因素Logistic回归分析,采用ROC曲线分析血小板参数与脑梗死患者短期预后的关系.结果 随访结果显示,预后良好组74例,预后不良组16例,两组基线资料中的年龄、性别、吸烟史、饮酒史、基础疾病类型比较,差异无统计学意义(P＞0.05);预后不良组治疗后MPV、PDW水平及治疗前后MPV/PLT水平高于预后良好组,差异有统计学意义(P＜0.05);多因素Logis-tics 回归分析显示,治疗后的MPV水平升高(OR=1.969,95％CI:1.355～2.863)和MPV/PLT水平升高(OR=2.638 × 107,95％C/:5.867 × 103～1.187 × 1011)是脑梗死预后不良的危险因素;ROC曲线分析显示,MPV的ROC曲线下面积为 0.812(95％CI:0.716～0.887),敏感性75.00％,特异性77.03％;MPV/PLT 的 ROC 曲线下面积为 0.908(95％CI:0.828～0.959),敏感性75.00％,特异性93.24％.结论 抗血小板治疗后MPV和MPV/PLT水平升高是脑梗死预后不良的危险因素,并且具有判断脑梗死患者短期预后的价值.
目的 分析快速康复外科(fast track surgery,FTS)理念在膀胱癌(bladder cancer,BC)患者根治性全膀胱切除术围术期护理中的应用效果.方法 回顾性收集我院147例BC患者,均接受根治性全膀胱切除术治疗,将2017年1月至2018年10月在围术期接受常规护理干预的73例作为对照组,将2020年10月至2021年10月在围术期接受FTS理念干预的74例作为观察组,比较两组围术期情况、不同时间点(术前1d及术后1 h、1 d)疼痛程度、并发症指标.结果 观察组术后首次下床活动时间、术后首次排气时间以及住院时间均短于对照组(P＜0.05);两组视觉模拟疼痛评分(visual analogue scale,VAS)比较,差异具有统计学意义(P＜0.05);观察组和对照组不同时间点的VAS评分比较,差异具有统计学意义(P＜0.05);两组VAS评分在时间和组间存在交互作用(P＜0.05);两组术后并发症率比较,观察组为31.08％(23/74),对照组为41.10％(30/73),组间比较差异无统计学意义(P＞0.05).结论 FTS理念护理应用于BC患者根治性全膀胱切除术围术期,能减轻疼痛程度,缩短术后首次下床活动、术后首次排气时间,促进术后恢复.
Objective To analyze the temporal and spatial clustering and spatial correlation of pertussis in Anhui Province from 2016 to 2021 by using geographic information system(GIS),and to provide reference for prevention and control.Methods The reported cases of pertussis in Anhui Province from 2016 to 2021 were collected from the Chinese Disease Control and Prevention Information System,and a database was established by GIS to analyze spatial autocorrelation and spatiotemporal clustering.Results From 2016 to 2021,a total of 923 cases of pertussis were reported in Anhui Province,with an average annual reported incidence of 0.25/100 000;the peak incidence was from May to August every year;Spatial autocorrelation analysis showed that the incidence of pertussis in Anhui Province in 2016,2018,2019 and 2021 showed significant spatial clustering.In 2016 and 2018-2021,a total of 28"High-High"aggregation areas were scanned;It was mainly concentrated in some counties and districts of Lu'an,Wuhu,Xuancheng,Huangshan,Chuzhou,Bengbu,Hefei and Huainan;A total of 13 significant aggregation areas were scanned for the incidence of pertussis in Anhui Province from 2016 to 2021,and the Class Ⅰ aggregation areas were mainly located in some counties and districts of Lu'an,Bengbu,Chuzhou,Wuhu,Ma'anshan,and Hefei.The gathering time was mainly from June to September,and the gathering continued until December in 2018 and 2021.Conclusions From 2016 to 2021,the incidence of pertussis in Anhui Province is mainly gathered in summer.The agglomeration area is mainly concentrated in the inter-provincial border counties and districts,and the provincial capital with convenient transportation and around large cities.The monitoring and prevention work in key areas should be strengthened.
With the intensification of population aging,diseases in adolescents and elderly people have gradually attracted attention.In these two special age groups,drug treatment needs are very different,so drug research for adolescents and elderly people is particularly important.Sertraline hydrochloride tablet is a multi-indication drug with good efficacy in many diseases,such as anti-depression,anti-anxiety and so on.As a widely used drug,its efficacy has been proven in several fields.With the deepening of clinical research,its application in adolescents and elderly people has been paid more and more attention.In the treatment of diseases in these two age groups,how to rationally use Sertraline hydrochloride tablets and how to avoid potential risks are the focus of this paper.This article will discuss the application of sertraline hydrochloride tablets in these two special age groups,in order to provide more references for clinicians on the application of this drug in different age groups.
Objective To explore the priority of physical activity promotion measures in China and provide a theoretical basis for developing strategies and plans on physical activity promotion.Methods Key personnel from district-level Centers for Disease Control and Prevention(CDCs)in 488 national demonstration areas for comprehensive control and prevention of chronic diseases were asked to rate the feasibly and importance of 47 physical activity promotion measures under 13 dimensional indicators.The Importance-Performance Analysis(IPA)model was used to divide the dimensional indicators of physical activity promotion into quadrants,and the standardized factor loading coefficients of the second-order Confirmatory Factor Analysis were used to determine the priority of the dimensional indicators in the same quadrant,and the priority of the measures in each dimension.Results In the highest priority quadrant,the priority order of the dimensional indicators was capacity building,workplace intervention,school intervention,communications and community events,sports sector intervention,and improved facilities/spaces accessibility.In the quadrant for prioritized improvement,the only indicator was environment improvement.In the quadrant for the least prioritized improvement,the priority order was interventions in other settings and population,leadership and partnership,healthcare intervention,enhanced building design,financing and fiscal support,and monitoring and evaluation.Conclusions Combining confirmatory factor analysis,IPA model can work well in constructing the decision model for physical activitypromoting.
目的 对某中学学生常见病进行监测,对监测结果进行分析并提出相应的预防策略.方法 选取2022年3月至12月在某中学就读的中学生2 280人作为本次研究对象,组织学生进行体格检测,主要包括身高、体质量、视力情况、牙齿健康情况、肥胖及营养不良情况,并根据检查结果提出具有针对性的预防策略.结果 (1)2 280名中学生中检出视力不良者1 557名,占比达68.29％;检出龋齿者1 551名,占比达68.03％;检出肥胖者271名,占比达11.89％;检出营养不良者203名,占比达8.90％.按性别比较,女生视力不良占比、龋齿占比均高于男生,肥胖及营养不良占比均低于男生(P＜0.05);按照年级比较,各年级学生视力不良率(七年级47.84％、八年级75.79％、九年级88.98％)对比差异有统计学意义(P＜0.05);各年级学生肥胖率(七年级14.29％、八年级11.84、九年级8.43％)对比差异有统计学意义(P＜0.05);各年级学生营养不良率(七年级10.96％、八年级7.89％、九年级7.13％)对比差异有统计学意义(P＜0.05);各年级学生龋齿率(七年级66.11％、八年级69.74％、九年级69.69％)对比差异无统计学意义(P＞0.05).结论 视力不良、龋齿和肥胖是某中学学生最为多发的疾病,需要重视对学生的正面引导以提高学生主动防病的意识.
Objective To understand the real-world epidemiological characteristics of hepatitis B virus(HBV)infection under different hepatitis B vaccine(HepB)immunization strategies in Fujian Province.Methods HBV infection data were obtained from the Nationally Notifiable Disease Reporting System.The study population was divided into three birth cohort groups based on the national HepB immunization strategy in effect when they were born.Epidemiological characteristics of HepB incidence in different cohorts were analyzed and evaluated.Results In the 2002-2020 birth cohort group,the overall annual incidence of hepatitis B was 145.80/100,000;the acute hepatitis B(AHB)annual incidence was 35.72/100 000 and the chronic hepatitis B(CHB)annual incidence was 110.08/100 000.Before 1992,the AHB incidence was 46.44/100 000.The annual incidence of CHB increased in all three groups,with the 1992-2001 group having a statistically significant increase(R2=0.68).The incidence rates in coastal areas were relatively high.Conclusions The incidence of hepatitis B is low among young people born under the free Hep B policy from 2002-2020 in Fujian Province.Following up and managing CHB patients to prevent or delay the development of cirrhosis and liver cancer is essential work to achieve the goal of eliminating hepatitis B as a public health problem by 2030.
目的 为提高妇幼保健工作质量提供理论指导.方法 以2011年至2019年《中国卫生和计划生育统计年鉴》中妇幼保健相关指标为原始资料,运用描述性统计分析方法对数据进行分析,再用TOPSIS法和RSR法对内蒙古自治区妇幼保健相关指标进行分析,并对2010年至2018年妇幼保健服务质量进行评价.结果 2010年至2018年内蒙古自治区妇幼保健服务水平逐年上升,妇幼保健指标总体发展趋向良好.女性常见病检查率保持平稳态势,婚前检查率明显提升;孕产妇死亡率保持连续下降趋势,由33.25/10万下降至12.75/10万,建卡率及住院分娩率连续九年保持高水平态势;新生儿死亡率、婴儿死亡率及5岁以下儿童中重度营养不良比重均呈现下降趋势,分别由10.2‰、12.3‰和0.98％下降至2.8‰、3.8‰和0.6％,7岁以下儿童保健管理率呈上升趋势;2010年的Ci值(相对接近距离)为0.113 7,2018年的Ci值0.900 1,显示内蒙古自治区2010至2018年妇幼保健工作质量有所提升.结论 2010至2018年内蒙古自治区妇幼保健服务质量明显提升,新阶段自治区在保持上升趋势的同时,有针对性地加强薄弱环节,提升综合服务质量.
