Chinese Journal of Prevention and Control of Chronic Diseases

Standards of basic dataset of chronic and noncommunicable diseases behavior risk factors surveillance in adults(T/CPMA 033-2023)was published and officially implemented by Chinese Preventive Medicine Association on October 20th,2023.The standard specifies the metadata attributes and data element attributes of the adult chronic and noncommunicable disease behavioral risk factors.It is suitable for the collection of data related to the monitoring,investigation,intervention and evaluation of chronic disease behavior risk factors conducted by health administrative departments,disease prevention and control institutions,primary-level medical and health care institutions,health examination and management institutions and scientific research institutes.The article interprets the key points of the standard,and provides guidance for medical and health institutions and professionals to deeply understand and promote the application of the standard.

Objective To explore the scientific cooperation,disciplinary interaction,hot topics and development trends in the field of metabolic surgery for overweigl t and obese patients with type 2 diabetes mellitus(T2DM)at home and abroad,and provide the scientific basis for relevant researchers to quickly understand the field.Methods The four databases of CNKI,WanFang,VIP and Web of Science(WoS)were searched for metabolic surgery and related research content on overweight or obese patients with T2DM since the establishment of the database until 31 December 2022;and CiteSpace 6.1.R6 software was used to conduct the comprehensive visualization analysis of the selected literature,including domestic and foreign publications,countries or regions,institutions,authors and key ords.Results A total of 170 Chinese literature and 1 885 English literature were included,and the overall number of English literature published showed an increasing trend(R2=0.872 7).The country with the highest number of articles published was the Unitcd States(492),followed by China(388).In centrality analysis of countries and institutions,the countries such as the United States(centrality=0.37),France(centrality=0.18),the United Kingdom(centrality=0.14),Brazil(centrality=0.14),and China(centrality=0.03),as well as institutions such as the Cleveland Medical Center(centrality=0.15),the Italian National Research Council(centrality=0.15),and Minsein General Hospital(centrality=0.12)played a key role in the cooperation.The results of author distribution showed that Lee WJ,Schauer,Liang H and Zheng CZ had published more papers.Domestic research focused on sleeve gastrectomy(SG)and gastric bypass(GB),while foreign research focused on SG,GB and Roux-en-y gastric bypass(RYGB).The research frontiers in China mainly focused on the clinical effects and SG,while foreign research focused on SG and single anastomosis gastric bypass(OAGB).Conclusion The relative research on metabolic surgery for overweight and obese T2DM patients showed an increasing trend in general.Scholars and institutions at home and abroad should strengthen exchanges and cooperation to promote further development in the field.

目的 了解急性冠脉综合征(ACS)患者血运重建术后双联抗血小板用药依从性对其临床结局及经济负担的影响,为提高ACS患者用药依从性,降低其疾病负担提供证据支撑.方法 基于2015-2019年天津市城镇职工基本医疗保险随机抽样数据库,通过疾病诊断与药品处方信息识别2016-2018年进行过血运重建术且使用过双联抗血小板药物的ACS患者4986例为研究对象.对研究对象进行随访,随访时间为1年,随访结局为随访期内首次发生的主要不良心血管事件(MACE)、急性心肌梗死、缺血性卒中、全因死亡、经皮冠状动脉介入术(PCI)、冠状动脉旁路移植术(CABG)以及任意出血和严重出血.根据ACS事件出院后1年内的双联抗血小板用药依从性,将患者分为依从组和非依从组.使用Stata 13.0进行t检验、x2检验、Kaplan-Meier生存分析、Log-rank检验、Cox回归分析、logistic回归、负二项回归和广义线性回归分析.结果 该研究4 986例患者的平均依从用药天数占比(PDC)为0.57±0.28.依从组1 314人(26.4％),非依从组3 672人(73.6％).多因素Cox回归分析结果显示,与非依从组相比,依从组患者的MACE发生风险降低34％(HR=0.66),PCI发生风险降低55％(HR=0.45),均有统计学意义(P＜0.05);两组患者的任意出血事件发生风险差异无统计学意义(P＞0.05).依从组患者的MACE发生率低于非依从组,生存曲线差异有统计学意义(P＜0.05).在医疗资源使用方面,依从用药会增加人均门诊就诊次数(调整后差值=8.4次,P＜0.01),但显著降低了住院患者的比例(调整后差值=-7.1％,P＜0.01)、人均住院次数(调整后差值=-0.1次,P＜0.01)和人均住院天数(调整后差值=-2.0d,P＜0.01).在直接医疗费用方面,依从用药会增加人均门诊费用2 952元(P＜0.01),但人均住院费用降低4 079元(P＜0.01).总体而言,依从组患者的人均总费用与非依从组患者的差异无统计学意义(P＞0.05).结论 天津市ACS患者血运重建术后的双联抗血小板用药依从性较差.依从使用双联抗血小板药物可降低ACS患者血运重建术后MACE和PCI事件发生风险,对其他单个心脑血管终点的影响较小,总体上并未增加ACS患者的总医疗费用.

Objective To investigate the effects of atmospheric fine particulate matter(PM2.5)and ozone(O3-8 h)on the risk of admission to hospital for acute myocardial infarction(AMI)in Tianjin,and provide the evidence for the prevention of AMI.Methods The subjects were 2 530 inpatients diagnosed with AMI in the cardiology Department of Tianjin First Central Hospital from January 1,2018 to December 31,2021,and their basic information was recorded from the medical record system.The date of air pollutants and meteorological factors in the same period were provided by Tianjin Meteorological Bureau.Spearman correlation test and t-test were used to analyze the data,the time-stratified case-crossing study was used to analyze the effects of PM2.5 and O3-8h on hospitalization risk of AMI residents.The used software was SPSS 25.0.Results The daily average concentrations of PM2.5 and O3-8h in 6 districts of Tianjin from 2018 to 2021 were(50.42±39.08)and(98.86±57.30)μg/m3.After adjusting the meteorological factors,in the single pollutant model,the admission risk of AMI patients was the highest when the PM2.5 and O3-8 h increased by 10 μg/m3,and the lag time was 4 days(lag4),OR values were 1.026(95％CI:1.003-1.049)and 1.022(95％CI:1.002-1.043),respectively(P＜0.05).In the single-pollutant model,the seasonal,gender and age stratified analysis showed that PM2.5 increased the risk of AMI admission in lag0,lag1,lag2,lag4 and lag7,and the OR value of lag1 was the highest,which was 1.039(95％CI:1.016-1.062)in the cold season;PM2.5 increased the risk of AMI admission in ≥ 65 years old group only in lag4(OR=1.032,95％CI:1.001-1.063),P＜0.05;O3-8h exposure increased AMI admission risk in lag4 during the cold season(OR=1.077,95％CI:1.025-1.131),P＜0.05.In two-pollutant model and the multi-pollution model,there was no significant effect of PM2.5 concentration on AMI admission risk(P＞0.05);O3-8 h concentration increased by 10 µg/m3,the risk of admission of AMI patients increased in both the double pollutant model(O3-8h+PM10,O3-8h+CO,O3-8h+SO2,O3-8h+NO2,O3-8h+PM2.5)and multi-pollution(O3-8h+PM10+CO+SO2+NO2+PM2.5)model,and the OR value was the highest in the multi-pollutant model(OR=1.025,95％CI:1.005-1.046),P＜0.05.Conclusion In Tianjin,short-term exposure to PM2.5 and O3-8h both increased the risk of AMI admission,and active measures should be taken to control air pollution.At the same time,the protection of residents(≥ 65 years old)should be strengthened,and it should pay attention to the difference of admission risk between PM2.5 and O3-8h during cold and warm seasons.

Objective To understand the serum cholesterol levels and their changes among residents(18-59 years old)in rural areas of Shanxi Province,and provide the reference basis for further development of cholesterol prevention and control strategies.Methods The data were from the Shanxi Family Cohort Study on Nutrition and Chronic Diseases,the rural residents(18-59 years old)in the investigations who performed in 2002,2015,and 2019 served as the subjects for the across section study,The three investigations were performed with the questionnaires,physical examinations and laboratory tests.The t test,analysis of variance,Bonferroni two-by-two comparison,and x2 test were used to analyze the data.The used software was SAS 9.4.Results The number of subjects in 2002,2015 and 2019 investigations were 1 321,1 748 and.1 291 cases,respectively;and the mean age of the subjects was(41.5±10.4),(45.7±10.1)and(47.8±9.2)years old,respectively.The ratios of male to female in 2002,2015 and 2019 investigations were 1∶1.18,1∶1.14 and 1∶1.21,respectively.Serum cholesterol(TC)and low density lipoprotein cholesterol(LDL-C)levels in 2015 and 2019 were significantly higher than those in 2002;the serum TC and LDL-C levels of females in 2002 were significantly lower than those of males,but the serum TC and LDL-C levels of females in 2019 were significantly higher than those of males(P＜0.05).Serum high density lipoprotein cholesterol(HDL-C)level were lower in 2015 and 2019 than that in 2002.Three investigations showed that TC and LDL-C levels in 50-59 years old group were significantly higher than those in 18-29 years old group(P＜0.05);TC and LDL-C levels in overweight and obese group were significantly higher than those in normal weight group(except for TC level in 2019),TC and LDL-C levels in central obese group were significantly higher than those in normal waistline group;HDL-C level in females was significantly higher than that in males;HDL-C level in non-smokers was significantly higher than that in smokers;HDL-C level in overweight and obese group was significantly lower than that in normal weight group;HDL-C level in central obese group was significantly lower than that in normal waistline group(P＜0.05).The results of gender comparison among all age groups showed that TC levels of 30-39 years old group in females in three investigations were significantly lower than those in males;in 2015 and 2019 investigations,TC and LDL-C levels of 50-59 years old group in females were significantly higher than those in males;in three investigations,HDL-C levels of 40-49 years old and 50-59 years old groups in females were significantly higher than those in males(P＜0.05).Conclusion Serum TC and LDL-C levels of Shanxi rural residents in 2015 and 2019 increased significantly,as compared with 2002,but HDL-C level decreased significantly.In the prevention and treatment of dyslipidemia,it should pay attention to serum cholesterol level in rural areas.

Objective To understand the incidence and influencing factors of injury-related behaviors of middle school students in Hebei District of Tianjin,and provide the scientific support for the development of injury intervention measures for middle school students.Methods The two-stage sampling method was used to select 1 601 students from two public middle schools and one vocational high school in Hebei district of Tianjin as the subjects.The x2 test and multivariate logistic regression method were use to analyze the influencing factors of injury-related behaviors.The used software was SPSS 19.0.Results In 1 601 students,there were 424 students with injury-relative behaviors,the incidence was 26.5％;the incidence of unintentional injury behaviors was 17.1％;the incidence of intentional injury behaviors was 13.7％.The order of five injury-relative behaviors was walking violation(16.7％),family bullying(8.8％),fighting behavior(5.4％),school bullying(1.6％),and swimming in unsafe sites(0.7％).The most frequent combination of injury-related behaviors was walking violation+family bullying(7.1％).The multivariate logistic regression method showed that male students(OR=1.60,95％CI:1.20-2.12),vocational high school(OR=1.69,95％CI:1.18-2.41),previous drinking(OR=2.26,95％CI:1.66-3.09)easy had walking violation,and residential school(OR=0.38,95％CI:0.22-0.64)did not easy have walking violation;internet addiction(OR=3.64,95％CI:1.13-11.77)and higher risk of depression(OR=7.28,95％CI:2.76-19.20)easy had the school bullying;boys(OR=2.35,95％CI:1.44-3.83),junior high school students(OR=3.66,95％CI:2.06-6.50),previous drinking(OR=3.53,95％CI:2.14-5.82)and depression risk(OR=1.99,95％CI:1.12-3.55)easy had the fighting behaviour;the junior high school students(OR=2.78,95％CI:1.80-4.30),internet addicts(OR=3.25,95％CI:1.56-6.75),previous drinking(OR=1.58,95％CI:1.03-2.43),depression risk(risk of depression OR=2.91,95％CI:1.85-4.59,higher risk of depression OR=6.32,95％CI:3.70-10.79)easy had the family bullying.Conclusion Injury-related behaviors are common among middle school students in Hebei district of Tianjin.The students with male,non-resident students,junior high school and high vocational school stage,internet addiction,previous drinking and high score of depression should be important intervention subjects.

目的 分析2015-2020年西藏自治区常住居民4类慢性病的早死概率及其变化趋势,探讨实现《"健康中国2030"规划纲要》早死概率下降目标的可能性.方法 数据来源于中国疾病预防控制中心"人口死亡信息登记管理系统"中2015-2020年西藏自治区国家级监测点常住居民死亡数据资料.用Excel 2010、SPSS 20.0软件计算粗死亡率、标化死亡率、构成比、早死概率等指标.用 Joinpoint 4.9.1.0软件计算平均年度变化百分比(AAPC)进行趋势分析.结果 2015年和2020年西藏自治区常住居民慢性病的粗死亡率分别为216.43/10万、268.97/10万,标化死亡率分别为364.27/10万、388.14/10万,变化趋势均无统计学意义(AAPC分别为3.57％、0.86％,P＞0.05),4类慢性病占总死亡的构成比由67.55％上升至76.60％,变化趋势有统计学意义(AAPC=3.11％,P＜0.05).2015年和2020年4类慢性病的早死概率分别为21.89％、17.09％,变化趋势无统计学意义(AAPC=-1.46％,P＞0.05).2015-2020年男性4类慢性病早死概率高于同期女性.根据年平均增长速度预测,到2030年,除糖尿病外,4类慢性病合计及心脑血管疾病、癌症、慢性呼吸系统疾病基本可以实现"健康中国2030"目标.结论 2015-2020年西藏自治区常住居民4类慢性病早死概率波动下降,继续努力开展慢性病危险因素干预工作,基本可以实现"健康中国2030"目标.

目的 分析睡眠效率与蒙特利尔记忆指数(MIS)得分的关系及其性别差异,为预防中老年人认知功能下降提供参考.方法 于2022年3-8月对福泉市第一人民医院健康体检中心符合纳入标准的699名体检人员进行面对面调查.应用R 4.2.2软件对数据进行Mann-Whitney U检验和Kruskal-Wallis H秩和检验,利用有向无环图得出睡眠效率与MIS关联中所需调整的最小控制变量集,使用分位数回归模型分析睡眠效率与记忆指数的关联性.结果 睡眠效率＞85％者MIS得分中位数为11分(P25～P75:9～13分),高于睡眠效率≤85％者(中位数为10分,P25～P75:8～13分),差异有统计学意义(Z=-2.897,P＜0.01).分位数回归模型分析结果显示,在总人群中,相较于睡眠效率高组(＞85％),睡眠效率低(≤85％)在MIS得分P20-40分位的回归系数小于零(P＜0.05);在男性中,睡眠效率低(≤85％)在MIS得分P60分位点及以下的回归系数小于零(P＜0.05),回归系数绝对值由MIS得分P10分位的1.87变化至P60分位的0.71;在女性中,睡眠效率在MIS得分各分位点的影响效应均无统计学意义(P＞0.05).结论 睡眠效率低对低分位MIS得分的中老年人影响较大,在男性中老年人可能是受影响的主要人群.

Objective To analyze the disease burden of stroke in Nanshan district of Shenzhen city from 2016 to 2021,and provide the evidence for further improving the comprehensive prevention and control system of stroke.Methods The data of stroke morbidity and mortality in Nanshan district from 2016 to 2021 were obtained from.Chronic Disease Prevention and Control Management System of Shenzhen,and the data were collated and analyzed with Excel 2019 software and R software V 4.2.0.Years lived with disability(YLDs),years of life lost(YLLs),and disability adjusted life years(DALYs)were used to analyze the disease burden of stroke in Nanshan district,and average annual percent change(AAPC)was used to analyze the trend of disease burden of stroke.Results A total of 19 813 incident cases(12 716 males and 7 097 females)of stroke were reported in permanent residents of Nanshan district from 2016 to 2021;825 patients died of stroke,including 480 males and 345 females.From 2016 to 2021,the standardized YLD rate,standardized YLL rate,and standardized DALY rate of stroke in males were higher than those in females;the standardized YLD rate and standardized DALY rate of ischemic stroke were higher than those of hemorrhagic stroke,but the standardized YLL rate of ischemic stroke was lower than that of hemorrhagic stroke.From 2016 to 2021,the YLD rate of stroke in Nanshan district increased from 4.66‰ to 4.84‰,AAPC was 1.78％;and the DALY rate decreased from 6.90 ‰ to 5.95‰,AAPC was-2.16％;but the overall trends of YLD rate and DALY rate were not statistically significant(P＞0.05).However,the YLL rate and YLL/DALY of stroke showed the decreasing trend from 2016 to 2021(AAPC values were-13.32％and-11.40％,respectively,P＜0.05).Conclusion The YLL rate of stroke in Nanshan district showed the decreasing trend from 2016 to 2021,but the DALY rate of stroke did not change significantly.Therefore,improving the health literacy of male residents and reducing the incidence of ischemic stroke and the mortality of hemorrhagic stroke are the focus of further comprehensive prevention and control of stroke.

目的 探讨全身炎症反应综合征评分(SIRS)、序贯器官衰竭评分(SOFA)和血液参数对重症慢性阻塞性肺疾病(COPD)患者重症监护病房(ICU)住院时间延长的风险预测价值,为COPD患者ICU住院时间管理提供依据.方法 数据来源于重症监护医学数据库(MIMIC-Ⅲ).选取其中2001-2012年,年龄≥18岁、首次进入ICU、ICU入院时间＞1 d的COPD患者为研究对象,收集研究对象的人口统计学资料、SIRS评分、SOFA评分和血液参数.采用SPSS 26.0软件进行Mann-Whitney U检验、x2检验,绘制受试者工作特征曲线,进行单因素和多因素logistic回归分析.基于多因素logistic回归分析结果,采用R 4.2.1绘制列线图,构建重症COPD患者ICU住院时间延长的风险预测模型.使用校准图、Hosmer-Lemeshow检验、一致性指数(C指数)评价列线图模型的预测效果.采用临床决策曲线、临床影响曲线评价模型的临床效应.结果 共纳入重症COPD患者1 698例,363例患者ICU住院时间延长.白蛋白(OR=0.374,95％CI:0.271～0.445)与COPD 患者 ICU 住院时间延长低风险相关;年龄(OR=1.509,95％CI:1.264～1.989)、SIRS 评分(OR=1.157,95％CI:1.007～1.329)、SOFA评分(OR=1.151,95％CI:1.104～1.201)与COPD患者ICU住院时间延长高风险相关.校准图中校准曲线与理想曲线的贴合度较高,列线图模型的C指数为0.713,Hosmer-Lemeshow检验P=0.143,表明列线图模型具备良好的区分度和一致性.临床决策曲线和临床影响曲线显示,列线图具有良好的临床应用价值.结论 列线图能准确预测重症COPD患者ICU住院时间延长的风险,可为管理重症COPD患者ICU住院时间延长发生风险提供依据.

目的 探讨银行职业人群血尿酸(SUA)水平与轻度非酒精性脂肪肝(NAFLD)的相关性,为银行职业人群NAFLD的监测和防治提供参考依据.方法 于2021年3-12月,选取南京某银行在职职工1 046人进行问卷调查、体格检查、实验室检测及肝脏B超检查.根据诊断标准,将研究对象分为轻度NAFLD组(256人)和对照组(790人),根据SUA四分位数水平将研究对象分为Q1～Q4组4组.采用SPSS 23.0和R 4.0.4软件进行t检验、秩和检验、x2检验和方差分析,采用多因素logistic回归模型、限制性立方样条及敏感性分析探讨SUA与NAFLD的相关性.结果 纳入研究对象1 046 人,其中男性551人,女性495人.轻度NAFLD的患病率为24.47％,其中男性(39.02％)高于女性(8.28％),差异有统计学意义(x2=133.275,P＜0.01).随着SUA水平的上升,研究对象轻度NAFLD的患病率呈上升趋势,有统计学意义(x2=117.531,Ptrend＜0.01).限制性立方样条分析结果显示,SUA水平与轻度NAFLD患病有显著的非线性剂量-效应关系(整体关联性检验:P-overall＜0.001;非线性检验:P-non-liner=0.031).多因素logistic回归分析结果显示,调整了混杂因素后,与Q1组相比,Q3组(OR=2.256,95％CI:1.107～4.595)和Q4组(OR=2.552,95％CI:1.214～5.367)轻度 NAFLD 的患病风险较高(P＜0.05).敏感性分析结果显示,调整了混杂因素后,与Q1组相比,正常体重人群Q4组(OR=20.306,95％CI:2.304～178.989)和剔除糖尿病人群Q4组(OR=2.837,95％CI:1.317～6.111)轻度NAFLD的患病风险更高(P＜0.05).结论 南京市某银行职业人群轻度NAFLD患病率较高,高SUA水平与该银行职业人群轻度NAFLD发生高风险相关.

目的 了解创建国家卫生区(简称创卫)对天津市室内公共场所控烟状况的影响,为指导健康相关政策的实施提供科学依据.方法 以天津市创建"2018-2020周期国家卫生城市(区)"的9个区为干预组,以未创建的3个区为对照组,采用多阶段抽样方法抽取上述辖区内的室内公共场所为研究对象,最终于2017年12月(创卫前)抽取697个样本,2020年12月(创卫后)抽取650个样本.创卫前后均采用现场观察法开展调查,获取场所内吸烟现象及禁烟标志张贴等 指标.采用SPSS 24.0进行x2检验,应用采用倍差法结合logistic回归模型进行干预效果评估.结果 干预前创卫区与非创卫区的室内公共场所在吸烟现象和张贴禁烟标志方面的比例差异均无统计学意义(P＞0.05).倍差法分析结果显示,创卫后创卫区室内公共场所发生吸烟现象的风险降低(OR=0.549,95％CI:0.315～0.956),同时创卫区室内公共场所禁烟标志张贴的概率增加(OR=2.572,95％CI:1.462～4.527),均有统计学意义(P＜0.01);销售卷烟的场所内发生吸烟现象的风险高于不销售烟草场所(OR=3.022,95％CI:1.462～4.527),张贴禁烟标志的概率低于不销售烟草场所(OR=0.642,95％CI:0.500～0.841).结论 天津市施行的"创卫+控烟"工作模式可有效改善室内公共场所控烟状况,应确保控烟在创卫工作中的重要地位,进而推动控烟工作取得长期实效.

Objective To understand the relationship between school neighborhood food environment(SNFE)and the prevalence of overweight and obesity among children and adolescents in China,and provide the scientific basis for construction of supportive SNFE to prevent and control the childhood overweight and obesity.Methods Based on China Nutrition and Health Surveillance(2015-2017),multi-stage and stratified random sampling method was used to select 1 309 primary and secondary schools in 264 cities(districts or counties)of 31 provinces in China as the subjects.Data of SNFEs was obtained based on geographic information system(GIS)technology.Kruskal-Wallis rank-sum test and the pairwise comparison of Dwass-Steel-Crithlow-Fligner method were used to analyze the data.The structured ordered logit regression model was used to analyze the relationship between SNFE and the prevalence of overweight and obesity among children and adolescents.The used software was SAS 9.4.Results The number of supermarkets,wet markets and foreign restaurants within 800 meters,1 200 meters and 1 500 meters around schools,fast food restaurants and Chinese restaurants within 1 500 meters in areas with high prevalence of overweight and obesity was significantly higher than that in areas with middle or low prevalence of overweight and obesity among children and adolescents in China(P＜0.05).The result of ordered logit regression model showed that in no consideration of other factors except for SNFE,the number of supermarkets within 1 500 meters around schools was positively correlated with the prevalence of overweight and obesity among children and adolescents(Z=2.34,P＜0.05).Conclusion There are significant differences in SNFEs between different prevalence levels of overweight and obesity among children and adolescents.The number of supermarkets within 1 500 meters around schools was significant correlated with prevalence of overweight and obesity among children and adolescents

Objective To evaluate the effects of the"technology comprehensive demonstration of chronic disease intervention model"on blood pressure management in southwest China,and provide the basis for popularizing the comprehensive demonstration intervention model in future.Methods Total 107 067 managed subjects in four chronic disease science and technology demonstration bases(Sichuan-Tibet,Chongqing,Yunnan,Guizhou)in southwest China from December 2018 to March 2019 were selected as subjects.Relying on the chronic disease appropriate technology population application management platform and chronic disease management information platform,the investigation was performed with the health education of blood pressure management,life-style management or medication therapy of hypertension and regular follow-up comprehensive management.The rate of blood pressure management,therapy or control rates of hypertension were evaluated.The x2 test and Cochran-Armitage trend test were used to anlyze the data.The used software was SAS 9.4.Results The morbidity rates of hypertension at baseline,middle and end stages were 57.5％,56.8％and 56.9％,respectively.The follow-up rates of blood pressure management in the middle and end stages(99.9％,99.9％)were signifi cantly higher than that(80.5％)in the baseline,and the rate of blood pressure management showed an upward trend(Z=176.9,P＜0.01).The medication treatment rates were 77.9％and 79.0％at the middle and end stage follow-up,respectively;which increased by 6.3％and 7.8％as compared with the baseline,respectively.The treatment rate of hypertension showed an increasing trend(Z=23.8,P＜0.01).The control rates of hypertension were 43.3％and 46.7％at the middle and end stage follow-up,which increased by 24.1％and 33.8％,respectively,as compared with the baseline.The hypertension control rate showed an increasing trend(Z=41.6,P＜0.01).Conclusion The"science and technology comprehensive demonstration of chronic disease intervention model"constructed in this project had a remarkable effect on blood pressure management,and had certain demonstration effects on the prevention or early diagnosis and treatment of major chronic diseases in southwest China.

objective To construct the evaluation index system for prevention and control effect in chronic disease comprehensive prevention and control demonstration area(referred to as"demonstration zone"),and provide the basis for evaluating the prevention and control effect of chronic diseases in the demonstration zone.Methods Delphi method was used to conduct 3 rounds of expert consultation to determine the evaluation index system for prevention and control effect in demonstration zone.The weight of each index was calculated by the method of analytic hierarchy process(AHP)and proportional distribution.Expert positive coefficient was indicated with recovery rate of questionnaires,the expert authority coefficient(Cr)was used to express the expert authority,the coefficient of variation(CV)and Kendall coordination coefficient(W)were used to determine the harmony of expert consultation.The used software was SPSS 26.0 or yaahp 10.1.Results The recovery rates of questionnaires in the first,second and third rounds were 100.00％,88.24％and 88.24％,respectively;the expert positivity was higher.The expert authority in the first,second and third rounds was 0.78-0.95,0.75-0.93 and 0.75-0.93,respectively;the expert authority was higher.The Delphi method was used to determine the evaluation index system of chronic disease comprehensive prevention and control demonstration zone,including 3 the first-level indexes(prevalence of chronic diseases and risk factors,implementation and effectiveness of intervention measures,safeguard measures),6 the second-level indexes(prevalence of chronic diseases,prevalence of chronic disease risk factors,implementation of intervention measures,chronic disease control effect,policy,funding and personnel protection,data quality control)and 42 the third-level indexes.Conclusion The construction of the indicator system in demonstration area is relatively comprehensive,scientific and reasonable,which has certain practical guiding significance for improving the prevention and control levels of chronic diseases;in future,it should pay attention to the dynamic adjustment for indicator system according to the specific situation;and reflect the prevention and control effects of chronic diseases in demonstration zone.

Objective To understand the distribution characteristics,clustering patterns and influencing factors of 7 behavioral risk factors of chronic diseases in Hainan Province,and provide the relative basis for the prevention and control of chronic disease.Methods The data of adult chronic disease and nutrition surveillance of Hainan Province in 2018 were used,and 3 690 residents were included;the distribution characteristics and clustering patterns of 7 behavioral risk factors(recent smoking,second-hand smoking,high frequency drinking,insufficient intake of vegetable and fruit,insufficient physical action,insufficient sleeping and overweight/obesity)for chronic disease among adult residents were analyzed.The x2 test and rate weighted approach were used to analyze the data.The ordered logistic regression was used to analyze the effects of social demographic characteristics on the number of behavioral risk factors for chronic diseases.The used software was SPSS 26.0.Results In Hainan Province,the residents(≥ 18 years old)had 1.97 behavioral risk factors for chronic diseases on average,and the top three risk factors were second-hand smoke exposure rate(46.28％),insufficient fruit and vegetable intake rate(43.65％),and overweight/obesity rate(37.81％).The top three clustering patterns were second-hand smoke exposure(11.25％),second-hand smoke exposure+overweight/obesity(9.43％)and second-hand smoke exposure+insufficient fruit and vegetable intake(9.38％).The results of ordered logistic regression analysis showed that male(OR=1.993,95％CI:1.754-2.264),agricultural production personnel(OR=1.366,95％CI:1.169-1.596),urban residents(OR=1.271,95％CI:1.113～1.451)had more number of behavioral risk factors for chronic diseases.Conclusion The morbidity rates of the behavioral risk factors for chronic diseases of adult residents in Hainan Province are higher.The comprehensive intervention of behavioral risk factors for chronic diseases should be taken for the important residents.

目的 探讨罕见病患者焦虑症状和自我污名化与非稳态负荷(allostatic load,AL)的关联强度并建立风险预测模型,为罕见病群体AL和精神心理问题预防保健提供科学依据.方法 于2022年1-4月,采用同伴推动抽样方法(RDS)招募蔻德罕见病关爱中心378例罕见病患者为研究对象.应用一般情况调查表、心理疾病内化污名量表(ISMI)、广泛性焦虑障碍量表(GAD-7)、童年不良经历国际版问卷(ACE-IQ)和AL临床诊断量表对罕见病患者进行调查.采用SPSS 22.0软件进行x2检验,采用多因素logistic回归分析罕见病群体焦虑症状和自我污名化与AL水平的关联,并构建logistic回归风险预测模型,用Hosmer-Lemeshow检验评估模型拟合度,采用受试者工作特征(ROC)曲线下面积(AUC)评估预测模型效能.结果 罕见病患者高AL水平的检出率为43.4％(164/378),焦虑症状和自我污名化的检出率分别为72.5％(274/378)和85.7％(324/378).多因素logistic回归分析结果显示,焦虑症状(OR=3.619,95％CI:2.020～6.483)和自我污名化(OR=5.932,95％CI:2.212～15.905)与罕见病患者高AL水平呈正相关.构建的风险预测模型Hosmer-Lemeshow检验拟合度良好(x2=1.626,P=0.463),模型对罕见病患者AL水平的预测效能良好,AUC为0.685(95％CI:0.629～0.735).结论 罕见病患者焦虑症状和自我污名化与高AL水平存在显著关联,logistic回归模型对罕见病患者AL水平具有良好的预测效果,可针对焦虑症状和自我污名化等危险因素制定精准干预方案,以降低罕见病患者AL水平.

目的 探讨北京农村老年人群握力值与认知障碍患病风险的关联,为老年认知障碍的早期识别提供依据.方法 数据来自北京城乡老年人群健康综合研究的横断面数据,该研究于2014年采用随机整群抽样方法选取密云县农村地区2 397名60岁及以上人群为研究对象,使用JAMAR握力计和中文版简易智力状态筛查表(CMMSE)分别测量握力和评估认知功能.采用SPSS 25.0和R4.0.5软件进行方差分析和x2检验,使用限制性立方样条拟合握力与认知障碍的剂量反应关系,应用多因素非条件logistic回归分析握力与认知障碍风险的关联强度.结果 2 397名研究对象年龄为(69.5±6.8)岁,平均握力值为(24.55±10.55)kg,老年人群认知障碍总体患病率为31.8％.在调整人口学特征、生活方式和健康状况等之后,握力值每升高1 kg,认知障碍患病风险下降4％(OR=0.96,95％CI:0.95～0.97);与Q1组老年人群相比,Q2,Q3,Q4组认知障碍的患病风险较低,OR 值分别为 0.46(95％CI:0.37～0.60),0.57(95％CI:0.44～0.74)及 0.38(95％CI:0.28～0.53),剂量反应关系显示二者间存在反"J"形的负相关关系,且握力值＜22 kg后,认知障碍患病风险明显上升.结论 老年人较高握力与低认知障碍患病风险存在关联,握力测量有助于评估认知功能状况,明确认知功能障碍.

目的 了解江苏省2006-2021年儿童伤害发生的流行特征,为儿童伤害的预防与控制提供科学依据.方法 收集2006-2021年因伤害首次在哨点医院就诊的0～14岁儿童病例信息,使用SPSS 25.0软件进行x2检验,组间两两比较采用Post hoc testing检验,根据调整后的标化残差(AR)判断各组的差异,使用Excel 2021运用圆形分布法分析时间分布特征.结果 共收集0～14岁儿童伤害病例130 317例,男女性别比为1.63∶1.儿童伤害发生时间具有季节性特征,且不同伤害原因发生时间分布不同,均有统计学意义(P＜0.05).儿童伤害病例居于前5位的伤害发生原因依次为跌倒或坠落伤(34.9％)、动物伤(30.6％)、钝器伤(10.1％)、道路交通伤(9.7％)和刀或锐器伤(7.5％).2006-2021年跌倒或坠落伤、钝器伤和道路交通伤的构成比呈下降趋势(x2趋势值分别为2 630.59、551.64、4 477.66,P＜0.01),动物伤和刀或锐器伤的构成比呈上升趋势(x2趋势值分别为11 034.17、383.14,P＜0.01).儿童伤害发生时活动前3位依次是休闲活动(70.7％)、驾乘交通工具(7.9％)和体育活动(6.2％).2006-2021年休闲活动构成比呈上升趋势(x2趋势=1 819.80,P＜0.01),驾乘交通工具和体育活动的构成比呈下降趋势(x2趋势值分别为3 182.72,300.77,P＜0.01).2006-2021年在家中发生伤害的占比稳居首位,且呈上升趋势(x2趋势=4 028.1,P＜0.01).伤害意图以非故意伤害(意外事故)为主(97.7％).伤害临床特征中,伤害性质以锐器伤或咬伤或开放伤为主(41.5％),伤害部位主要为上肢(36.7％),伤害严重程度以轻度为主(88.8％),伤害病例结局以处理后离院(93.2％)为主,上述主要伤害临床特征在2006-2021年间的构成均呈上升趋势(x2趋势值分别为6 454.56、2 225.46、1 758.23、5 673.24,P＜0.01).结论 2006-2021年江苏省0～14岁儿童伤害病例的伤害事件的基本情况和临床特征呈现不同程度的变化,其中伤害原因为动物伤、休闲活动时发生伤害、伤害发生在家中、伤害性质为锐器伤或咬伤或开放伤及处理后离院的构成比近年来呈上升趋势,伤害发生具有季节性特征.