Background:Given the rising incidence of hepatocellular carcinoma (HCC) globally, especially in China, information about independent risk factors for survival and disease prognosis of the illness is scarce. In the field of HCC research, there is an urgent need for a scientific basis to enhance the accuracy of clinical diagnosis, optimize the course of therapy, and accurately predict the prognosis. Against this backdrop, the objective of this work was to develop a scientific, efficient, and methodical nomogram to forecast the survival prognosis of HCC. Methods:A real-world study collected clinical data from January 1, 2011, to December 31, 2019, for individuals with HCC. Overall survival (OS) was determined using Kaplan-Meier analysis. Independent risk variables were identified using Cox proportional hazards regression. A nomogram predicting 1-, 3-, and 5-year OS was created. The reliability of the predictions of the model was assessed using receiver operating characteristic (ROC), calibration, and decision curve analysis (DCA). Results:Data from 1,128 HCC cases showed 1-, 3-, and 5-year OS rates were 86.3%, 65.3%, and 43.1%, respectively. Univariate Cox regression identified 13 variables influencing HCC survival including age, HCC screening status, hepatitis C virus (HCV) status, nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) status, liver cirrhosis, elevated alpha-fetoprotein (AFP), Child-Pugh grade, tumor size, tumor number, treatment method, tumor thrombus, and extrahepatic metastasis (P<0.05). Multivariate analysis confirmed HCC screening status, tumor size, ALD, Child-Pugh classification, and therapy method as independent prognostic factors (P<0.05). The nomogram achieved an area under the ROC curve (AUC) of 0.868. Calibration curves of the 1-, 3-, and 5-year survival times and the DCA curve confirmed its predictive accuracy. Conclusions:Patients without HCC screening, tumor size >5 cm, ALD, Child-Pugh grade C, and conservative treatment had a poor survival prognosis. A nomogram based on these risk variables provides a reliable tool for predicting the survival chances of patients with HCC.

ObjectiveTo construct a standardized，scientific and systematic quality evaluation index system of hospital⁃community linkage continuous nursing for patients with inflammatory bowel disease.MethodsBased on the three⁃dimensional quality structure model，the first draft of the index system was developed through literature analysis and semi⁃structured interview.The quality evaluation index system of hospital⁃community linkage continuous nursing for patients with inflammatory bowel disease and the weights of indicators at each level were determined by expert letter inquiry and analytic hierarchy process.ResultsA total of two rounds of expert correspondence were conducted.The effective recovery rates were 100% and 95%，the expert opinion submission rates were 68.2% and 28.6%，the expert authority coefficients were 0.926 and 0.931，and the Kendall's coefficients were 0.226 and 0.239，respectively（all P<0.01）.The final evaluation index system consists of 3 first⁃level indicators（structure， process and outcome），13 second⁃level indicators and 67 third⁃level indicators.ConclusionThe constructed quality evaluation index system of hospital⁃community linkage continuous nursing for patients with inflammatory bowel disease is authoritative and scientific，and it can provide reference for the evaluation of continuous nursing quality for IBD patients.

Objective: To understand the passive smoking exposure status in adults aged ≥40 years in China. Methods: Local residents aged ≥40 years were enrolled as study subjects from 125 areas of chronic obstructive pulmonary disease (COPD) surveillance during 2014-2015 and 2019-2020 in 31 provinces of China. A total of 74 559 adults aged ≥40 years were selected through multi-stage stratified cluster sampling for a face to face questionnaire survey and the data from 64 142 study subjects were used for the analysis. The passive smoking exposure rate, the proportions of the adults reporting passive smoking exposure at four types of places and the proportion of the adults living with daily smokers were described by using complicated sampling weighting method, the related factors were analyzed and the results were compared with the data of COPD surveillance during 2014-2015. Results: The passive smoking exposure rate in the adults aged ≥40 years was 46.4% (95%CI: 44.1%-48.8%) in China during 2019-2020, and the rate was higher in women (47.2%, 95%CI:44.8%-49.7%) than in men (44.8%, 95%CI:42.0%-47.6%) and lower in the older people. The office workers had the highest passive smoking exposure rate. The proportions of those reporting passive smoking exposure at homes, workplaces, restaurants, and public transports were 24.3% (95%CI:22.2%-26.4%)、23.3% (95%CI:21.1%-25.5%)、6.6% (95%CI:5.3%-7.9%) and 2.2% (95%CI:1.6%-2.7%). The higher education level the adults had, the less passive smoking exposure at home they reported. The proportions of those living with daily smokers before 14 years old and since 14 years old were 56.4% and 59.2%. Compared with the data during 2014-2015, the overall passive smoking exposure rate in the adults aged ≥40 years during 2019-2020 showed an increase, and the difference was not significant (P=0.356); The passive smoking exposure rate at homes declined, but the exposure rate at workplaces increased, with the biggest increase found in those being engaged in farming, forestry, husbandry, fishery and water conservancy. Multivariate analysis indicated that the factors influencing the passive smoking exposure and the exposure proportions at different places included gender, age, occupation, and education level. Conclusions: The passive smoking exposure rate in China is still high, especially in those being engaged in farming, forestry, husbandry, fishery and water conservancy. It is necessary to strengthen supervision of the enforcement of current smoking bans in public places and promote the legislation of ban smoking in public places. More attention should be paid to smoking ban and protection against passive smoking exposure in women, people with lower education level and people being engaged in in farming, forestry, husbandry, fishery and water conservancy.

Objective: To understand the current status of occupational exposure to dust or harmful gases and occupational protection in people aged ≥40 years in China, and provide data support for the prevention and control of occupational dust or harmful gas exposure. Methods: The data were obtained from the surveillance for chronic obstructive pulmonary disease (COPD) in adults aged ≥40 years selected by multi-stage stratified cluster sampling from 125 surveillance points in 31 provinces (autonomous regions and municipalities) during 2014-2015 and 2019-2020, and relevant information about occupational dust or harmful gas exposure and protection measures were collected through face-to-face interviews. Occupational dust or harmful gas exposure rate and occupational protection rate were estimated by using weighting complex sampling methods, and then the results were compared. Results: From 2014 to 2015 and from 2019 to 2020, a total of 71 061 and 71 023 individuals aged ≥40 years were surveyed, respectively. The rate of occupational exposure to dust or hazardous gas was 33.8% (95%CI: 29.9%-37.7%) during 2019-2020. The occupational exposure rate was higher in men than in women and in rural residents than in urban residents. With the increase of education level, the rate of occupational exposure to dust or harmful gas showed a downward trend. The protection rate against occupational dust or hazardous gas exposure was 47.9% (95%CI: 43.2%-52.6%) during 2019-2020. Compared with 2014-2015, the rate of occupational exposure to dust or hazardous gas decreased by 10.7 percentage points in different gender, area and occupational groups and the occupational protection rate increased by 21.9 percentage points during 2019-2020. The decrease in occupational exposure rate was higher in western China than in eastern and central China, and the increase in occupational protection rate was higher in western China than in eastern and central China. Conclusions: The rate of occupational exposure to dust or harmful gas decreased and the rate of occupational protection against dust or harmful gas exposure increased in China during 2019-2020. However, about one-third of the population still suffer from the occupational exposure, and less than half of them take protection measures. It is necessary to pay more attention to the key populations, such as workers with lower cultural level and rural migrant workers, in occupational health practice.

Background The association between years of non-diabetes status after diagnosis of impaired glucose tolerance (IGT) and the risk of long-term death and cardiovascular outcomes needed to be clarified. Methods and findings In this post hoc analysis, we included 540 individuals with IGT who participated in the original Da Qing Diabetes Prevention Study (DQDPS). In the DQDPS, all participants were diagnosed with IGT by a 75 g oral glucose tolerance test and randomized to intervention or control groups with a 6-year lifestyle intervention trial. After the completion of the trial, death, cardiovascular events, and microvascular complications were monitored over a 30-year follow-up. In this post hoc analysis, the Cox analysis assessed the extended risk of these outcomes in individuals who either remained non-diabetes status or progressed to diabetes at the end of 2, 4, and 6 years after diagnosis of IGT. In all participants, the difference in the cumulative incidence rate of the outcomes between the diabetes and non-diabetes group gradually increased over 30 years. Compared with the diabetes group, a significantly lower risk of all-cause death (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.57 to 0.97, p = 0.026), cardiovascular events (HR: 0.63; 95% CI: 0.49 to 0.82, p < 0.001), and microvascular complications (HR: 0.62; 95% CI: 0.45 to 0.86, p = 0.004) first emerged in individuals who remained non-diabetes at the 4 years visit, whereas the significant risk reduction in cardiovascular death was first observed at the end of 6 years (HR: 0.56; 95% CI: 0.39 to 0.81, p = 0.002) after adjustment for age, sex, smoking status, BMI, systolic blood pressure, blood glucose, total cholesterol, intervention, and medications (including insulin plus oral hypoglycaemics, antihypertensives, and lipid-lowering agents). The results in the original intervention group alone were similar to the whole group. The main limitations of our study are the limited number of participants and the sole ethnicity of the Chinese population. Conclusions In this study, we observed that maintaining several years of non-diabetes status after IGT diagnosis was associated with a significant reduction in long-term risk of death and vascular complications, and for most of these outcomes, maintaining at least 4 years of non-diabetes status may be needed to achieve a significant risk reduction.

RationaleWith the accelerating process of population aging, the comorbidity of chronic disease (CCD) has become a major public health problem that threatens the health of older adults.ObjectiveThis study aimed to assess whether CCD is associated with basic activities of daily living (BADL) and explore the factors influencing BADL in older adults.MethodA cross-sectional community health survey with stratified random sampling among older residents (≥60 years old) was conducted in 2022. A questionnaire was used to collect information on BADL, chronic diseases, and other relevant aspects. Propensity score matching (PSM) was used to match the older adults with and without CCD. Univariate and multivariate logistic regression analyses were used to explore the factors influencing BADL. PSM was used to match participants with single-chronic disease (SCD) and CCD.ResultsAmong the 47,720 participants, those with CCD showed a higher prevalence of BADL disability (13.07%) than those with no CCD (6.33%) and SCD (7.39%). After adjusting for potential confounders with PSM, 6,513 pairs of cases with and without CCD were matched. The univariate analysis found that the older adults with CCD had a significantly higher prevalence of BADL disability (13.07%, 851 of 6,513) than those without CCD (9.83%, 640 of 6,513, P < 0.05). The multivariate logistic regression analysis revealed that CCD was a risk factor for BADL in older adults [OR = 1.496, 95% CI: 1.393–1.750, P < 0.001]. In addition, age, educational level, alcohol intake, social interaction, annual physical examination, retirement benefits, depression, weekly amount of exercise, and years of exercise were related to BADL disability (P < 0.05). PSM matching was performed on participants with CCD and SCD and showed that the older adults with CCD had a significantly higher prevalence of BADL disability (13.07%, 851 of 6,513) than those with SCD (11.39%, 742 of 6,513, P < 0.05).ConclusionThe older adults with CCD are at a higher risk of BADL disability than their counterparts with no CCD or SCD. Therefore, we advocate paying attention to and taking measures to improve the health and quality of life of these individuals.

Objective:To understand the impact of diet on glycemic control in community-managed patients with type 2 diabetes mellitus (T2DM) and provide evidence for implementing prevention strategies and measures for diabetes patients.Methods:Eight communities were randomly selected from Changshu and Wuhan in 2015, and T2DM patients managed in the community were selected to conduct questionnaire surveys, physical measurements, and blood glucose testing. Factor analysis was used to obtain dietary patterns. A binary logistic regression model was used to analyze the factors affecting glycemic control.Results:Finally, 1 818 T2DM patients were included, and the control rate of FPG was 57.59% (95% CI: 55.30%-59.86%), and the control rate of 2 h postprandial blood glucose (2 h PBG) was 24.90% (95% CI: 22.93%- 26.91%). Five dietary patterns were obtained by factor analysis: animal food pattern, fruit-aquatic products-potato patterns, vegetable-grain pattern, egg-milk-bean pattern, and oil-salt patterns. No-conditional multivariate logistic regression analysis showed that after adjusting for confounding factors, the reduced probability of FPG control was related to animal food pattern ( OR=0.71, 95% CI: 0.52-0.98) and fruit-aquatic products-potato patterns ( OR=0.71, 95% CI: 0.51-0.97). The decrease in the 2 h PBG control probability was related to fruit-aquatic products-potato patterns ( OR=0.60, 95% CI: 0.40-0.90). The increased probability of FPG and 2 h postprandial glucose control were both related to vegetable-grain pattern ( OR=1.41, 95% CI: 1.03-1.94; OR=1.68, 95% CI: 1.13-2.51) and egg-milk-bean pattern ( OR=1.75, 95% CI: 1.25-2.46; OR=1.56, 95% CI: 1.00-2.42). Compared with the Q4 group of egg-milk-bean pattern, the FPG control rate of the combination of "fruit-aquatic products-potato pattern ( Q4 group), vegetable-grain pattern ( Q2 group), egg-milk-bean pattern ( Q3 group)" was higher ( OR=6.79, 95% CI: 1.15-40.23, P=0.035). Compared with the Q4 group of vegetable-grain pattern, the combination of "fruit-aquatic products-potato pattern ( Q4 group), vegetable-grain pattern ( Q3 group), egg-milk-bean pattern ( Q2 group), oil-salt pattern ( Q2 group)" had higher control rate of 2 h PBG ( OR=12.78, 95% CI: 1.26-130.05, P=0.031). Conclusions:A proper combination of dietary patterns and dietary patterns are more conducive to the control of FPG and 2 h PBG in T2DM patients managed in the communities of Wuhan and Changshu. Patient nutrition education should be strengthened, and the food-matching ability of patients should be improved.

Objective To understand the impaired self-care ability after stroke and its influencing factors among urban and rural elderly people in Henan province,and provide a reference for taking corresponding intervention measures.Methods From July to December 2022,a multi-stage random sampling method was used to select 3 193 elderly people aged≥65 years old who had lived in the local area for≥2.5 years after stroke in 15 districts(counties)of five major regions of eastern Henan,western Henan,southern Henan,northern Henan,and central Henan for a questionnaire survey,and the impaired self-care ability after stroke and its influencing factors of urban and rural elderly people in the region were analyzed.Results Among the 3 067 elderly people after stroke in Henan province finally included in the analysis,554 had impaired self-care ability,with an impairment rate of 18.06％after stroke;the impairment rates of self-care ability after stroke among urban and rural elderly people in Henan province were 10.96％and 20.00％,respectively,and the impairment rate of self-care ability after stroke among urban elderly people was lower than that among rural elderly people(x2=28.513,P＜0.001);the results of multivariate unconditional logistic regression analysis showed that smoking,kidney disease,heart disease,eye disease,and liver disease were risk factors for impaired self-care ability after stroke among urban elderly people in Henan province,while exercise habits were a protective factor for impaired self-care ability after stroke among urban elderly people in Henan province.Smoking,hearing impairment,kidney disease,heart disease,eye disease,and liver disease were risk factors for impaired self-care ability after stroke among rural elderly people in Henan province,while improved toilet environment,exercise habits,and healthy eating habits were protective factors for impaired self-care ability after stroke among rural elderly people in Henan province.Conclusion The impairment rate of self-care ability after stroke among rural elderly people in Henan province was higher than that among urban elderly people,and smoking status,presence or absence of exercise habits,kidney disease,heart disease,eye disease,and liver disease were common influencing factors for impaired self-care ability after stroke among urban and rural elderly people in the region.

Objective: To understand the prevalence of exposure to household cooking oil fumes in women ≥40 years old. Methods: The data were from Chronic Obstructive Pulmonary Disease (COPD) Surveillance in China during 2019-2020, which selected permanent residents ≥40 years old from 125 counties (districts) in 31 provinces (autonomous regions and municipalities) across the country by multi-stage stratified cluster random sampling method. The relevant demographic information and cooking oil fumes were collected by face-to-face interview. Our study served 37 164 women with complete cooking practice information as the subject. After complex sample weighting, we analyzed the prevalence of cooking oil fumes exposure in women from cooking time, kitchen characteristics, and Self-reported cooking oil fumes exposure. Results: In 2019, 83.9% (95%CI: 82.1%-85.7%) and 4.5% (95%CI: 3.8%-5.2%) of Chinese women ≥40 years old cooked daily and often, respectively. The average daily cooking duration is 1.8 hours/day, 31.1% of women who cooked daily more than 2.0 hours, and the average cumulative cooking years of cooking women were 32.8 years. 79.3% of cooking women used ventilation devices, and 3.2% cooked in the living room. 8.9% and 7.2% of cooking women in south China and northwest China cooked in the living room, significantly higher than in other regions (P=0.036). The self-reported exposure rate to cooking oil fumes was 81.0% (95%CI: 79.3%-82.7%). Rural, older, lower education level and women engaged in agriculture had a higher proportion of cooking daily, average daily cooking duration, cumulative cooking years, the proportion of cooking in the living room, and rate of self-reported cooking oil fumes exposure, but a lower proportion of using ventilation devices during cooking (P<0.001). Conclusions: The exposure to household cooking oil fumes was serious in Chinese women, and some women still did not take any ventilation measures when cooking. More attention should be paid to the exposure to home cooking oil fumes and its health hazards in women, especially those with lower socioeconomic status.

Objective: To understand the prevalence of smoking and its change in adults aged ≥40 years in China and provide evidence for the development of chronic obstructive pulmonary disease (COPD) prevention and control strategies. Methods: The data of this study were obtained from COPD surveillance in China during 2014-2015 and during 2019-2020. The surveillance covered 31 provinces (autonomous regions and municipalities). A multi-stage stratified cluster random sampling were used to select residents aged ≥40 years, and face-to-face interviews were conducted to collect the information about their tobacco use. After complex sampling weighting of the samples, the current smoking rate, average age to start smoking and average daily cigarette consumption of people with different characteristics during 2019-2020 were estimated, and the changes in the current smoking rate and average daily cigarette consumption were analyzed from 2014-2015 to 2019-2020. Results: During 2019-2020, the current smoking rate in adults aged ≥40 years was 27.2%, and the rate was much higher in men (52.1%) than in women (2.5%).The average age of the smokers to start smoking was 20.0 years old, and men usually started smoking at younger age (19.6 years) compared with women (27.9 years). The average daily cigarette consumption of daily smokers was 18.0 sticks, and the consumption of men (18.3 cigarettes) was higher than that of women (11.1 cigarettes). Compared with the surveillance results during 2014-2015, the current smoking rate had decreased by 2.8 percentage points in the general population, 4.1 percentage points in males, 1.6 percentage points in females, and the urban and rural areas fell by 3.1 percentage points and 2.5 percentage points, respectively. The average daily cigarette consumption decreased by 0.6 sticks. Conclusions: In recent years, the current smoking rate and average daily cigarette consumption in adults aged ≥40 years decreased in China, but smoking is still common in more than quarter of this population and more than half of men aged ≥40 years. It is necessary to take targeted tobacco control measures based on population and regional characteristics to further reduce the smoking level of the population.

Background Current studies in most Western countries have largely focused on body mass index (BMI) as an important risk factor for impaired glucose tolerance (IGT) and impaired fasting glucose (IFG), which have different pathophysiological bases. In people with obesity, the prevalence of IGT is higher and the prevalence of IFG is lower. The prevalence of IGT in the Asian population is higher than that in the white population, and the obesity rate in China is still increasing. However, few cohort studies explore the relationship between BMI and the incidence of IGT and IFG in China. We aimed to explore the relationship between BMI and the risk of IGT and IFG in Chinese adults and analyze the differences between them. Methods The baseline data were obtained from the 2010 China Chronic Disease and Risk Factor Surveillance, of which 20 surveillance sites were followed up from 2016 to 2017. Finally, in this study, a total of 5,578 studies were grouped into BMI categories of underweight (BMI < 18.5 kg/m 2 ), normal weight (18.5–23.9 kg/m 2 ), overweight (24.0–27.9 kg/m 2 ), and obesity (≥ 28.0 kg/m 2 ). We used the unconditional logistic regression model to analyze the relationship between BMI and the risk of IGT and IFG. Results During an average follow-up of 6.4 years, 562 developed IGT and 257 developed IFG. After age, gender, urban and rural areas, physical activity, family history of diabetes, hypertension, abdominal obesity, dyslipidemia, and other factors were adjusted, overweight increased the risk of IGT by 35% [odds ratio ( OR ) 1.35, 95% confidence interval ( CI ) 1.08–1.70], and obesity increased the risk of IGT by 77% ( OR 1.77, 95% CI 1.27–1.47). After the factors consistent with the above were adjusted, only obesity increased the risk of IFG by 122% ( OR 2.22, 95% CI 1.39–3.54). Conclusions In China, obesity is an important risk factor for IGT and IFG, and the risk of IGT increases during the overweight stage.

The aim of this study was to explore the associations of moderate-to-vigorous-intensity physical activity (MVPA) time and sedentary (SED) time with a history of cardiovascular disease (CVD) and multifactorial (i.e., blood pressure (BP), body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), and glycated hemoglobin A1c (HbA1c)) control status among type 2 diabetes mellitus (T2DM) patients in China. A cross-sectional analysis of 9152 people with type 2 diabetes from the Multifactorial Intervention on Type 2 Diabetes (MIDiab) study was performed. Patients were grouped according to their self-reported MVPA time (low, < 150 min·week−1; moderate, 150 to < 450 min·week−1; high, ≥ 450 min·week−1) and SED time (low, < 4 h·d–1; moderate, 4 to < 8 h·d–1; high, ≥ 8 h·d–1). Participants who self-reported a history of CVD were identified as having a CVD risk. Odds ratios (ORs) and 95% confidence intervals (CIs) of CVD risk and multifactorial control status associated with MVPA time and SED time were estimated using mixed-effect logistic regression models, adjusting for China's geographical region characteristics. The participants had a mean ± standard deviation (SD) age of (60.87 ± 8.44) years, 44.5% were women, and 25.1% had CVD. After adjustment for potential confounding factors, an inverse association between high MVPA time and CVD risk that was independent of SED time was found, whereas this association was not observed in the moderate-MVPA group. A higher MVPA time was more likely to have a positive effect on the control of BMI. Compared with the reference group (i.e., those with MVPA time ≥ 450 min·week−1 and SED time < 4 h·d–1), CVD risk was higher in the low-MVPA group: The OR associated with an SED time < 4 h·d–1 was 1.270 (95% CI, 1.040–1.553) and that associated with an SED time ≥ 8 h·d–1 was 1.499 (95% CI, 1.149–1.955). We found that a high MVPA time (i.e., ≥ 450 min·week−1) was associated with lower odds of CVD risk regardless of SED time among patients with T2DM.

Background In China, few studies have examined the relationship between the combination of body mass index and waist circumference and the risk of stroke. Moreover, the relationship may also be different in different genders. Thus, we investigated the association between the combination of body mass index and waist circumference and the risk of stroke in Chinese. Methods This prospective cohort study included 36 632 participants aged 18 to 90 years. Participants were recruited from 60 surveillance sites (25 urban sites and 35 rural sites) across China in 2010 China Chronic Disease Risk Factor Surveillance, and followed up in 2016-2017. Incident cases of stroke were identified through questionnaires (including the basis of clinical diagnosis, imaging tests, time of diagnosis, diagnosis unit) and Cardiovascular Event Report System. Risk factors for stroke were collected at baseline using questionnaire, physical measurements and laboratory tests. Cox proportional hazards regression models were used to generate adjusted hazard ratios and 95%CI. All analyses were duplicated by gender stratification. Results During 6.42 ± 0.50 years of follow-up, 1 333 (597 males, 736 females) stroke events were observed among the 27 112 participants who did not have cardiovascular diseases at baseline. Compared with the general population who have normal weight or underweight with normal WC, those who have normal weight or underweight with abdominal obesity (adjusted hazard ratios 1.45, 95%CI 1.07-1.97 in males; 0.98, 95%CI 0.78-1.24 in females), overweight with abdominal obesity (1.41, 95%CI 1.14-1.75 in males; 1.33, 95%CI 1.10-1.61 in females), obesity with abdominal obesity (1.46, 95%CI 1.11-1.91 in males; 1.46, 95%CI 1.17-1.81 in females). Overweight with normal WC was found to be not statistically significant for both males and females (all P >0.05). Subgroup analysis found a multiplicative interaction between age and anthropometric group in females ( P for interaction <0.05). Sensitivity analysis results did not change. In the subjects with CVD risk factors, we found a similar relationship as in the general population . Conclusions Combined assessment of body mass index and waist circumference identifies obesity patterns associated with stroke risk.

糖尿病已成为当今全球重大公共卫生问题,其中2 型糖尿病(type 2 diabetes mellitus,T2DM)约占全部糖尿病的90％[1].T2DM的危害在于其并发症危及患者的健康和生命,其中心脑血管疾病(cardiovascular disease,CVD)、糖尿病肾病、糖尿病眼病等血管并发症是患者致死、致残的主要原因[2].T2DM患者血管并发症的发生和发展与发病年龄、病程及疾病史等不可干预因素和高血糖、高血压、脂质代谢异常及肥胖等可干预因素相关[3-4].对可干预因素进行规范管理是预防、延缓血管并发症的关键.本文对国内外T2DM血管并发症多种危险因素控制研究进展进行综述,旨在为T2DM血管并发症预防与控制提供科学依据.

目的 探讨糖尿病足分级健康教育对糖尿病患者足部护理行为的效果及其影响因素,为实施针对糖尿病足护理的策略和措施提供依据.方法 2015年8-9月,在江苏省常熟市和武汉市江岸区分别随机抽取3个社区为干预社区,1个社区为对照社区.在各社区卫生服务机构随机抽取符合纳入标准的2型糖尿病患者为研究对象,根据糖尿病足危险程度将研究对象分为低危、中危、高危3级.干预社区实施分级健康教育(分级健康教育组,897例),对照社区实施基础健康教育(基础健康教育组,256例),干预期为3年.两组患者均进行糖尿病足护理行为的基线调查和终末调查.采用SAS9.4软件进行Wilcoxon秩和检验、x2 检验,并以综合得分是否增加为因变量,采用非条件logistic回归模型分析影响因素.结果 分级健康教育组干预后足部护理行为得分[(5.95±1.29)分]显著高于干预前[(5.82±1.46)分],差异有统计学意义(P＜0.05);基础健康教育组干预后足部护理行为得分[(5.44±1.41)分]与干预前[(5.32±1.44)分]比较,差异无统计学意义(P＞0.05).分级健康教育组中高危患者得分增值[(0.30±1.69)分]显著高于基础健康教育组[(-0.07±1.50)分],分级健康教育组低危患者得分增值[(-0.17±1.71)分]显著低于基础健康教育组[(0.25±1.93)分],差异均有统计学意义(P＜0.05).单项行为得分显示,分级健康教育组每天洗脚后擦干水分、不穿有弹性袜腰或紧口袜子、剪趾甲从不伤及皮肤、过去1年去医院做足部检查行为得分增值显著高于基础健康教育组,差异均有统计学意义(P＜0.05).多因素分析显示,分级健康教育组(OR=1.71,95％CI:1.17～2.50)、65～74 岁患者(OR=1.69,95％CI:1.23～2.34)、学习过糖尿病知识(OR=2.29,95％CI:1.66～3.16)者足部护理行为得分增加的概率更大,城乡居民医保患者(OR=0.68,95％CI:0.49～0.94)、基线足部护理行为得分较高(OR=0.31,95％CI:0.27～0.36)者足部护理行为得分增加的概率更小.结论 糖尿病足分级健康教育可改善糖尿病患者的足部护理行为,对糖尿病足高危患者的效果更显著,后续应加强对糖尿病足低危、无症状患者的健康教育.

Aims: To examine the long-term influence of metabolic syndrome (MetS) on death and vascular complications. Methods: Altogether, 1419 individuals with different levels of glycemia and MetS were recruited for this study. The participants were followed up for 30 years to assess outcomes. Results: Compared with the non_MetS, individuals with impaired glucose tolerance (IGT) plus MetS had a higher incidence (per 1000 person-years) of all-cause death (20.98 vs 11.70, hazard ratio [HR] = 1.84), macrovascular events (29.25 vs 15.94, HR = 1.36), and microvascular complications (10.66 vs 3.57, HR = 1.96). The incidence of these outcomes was even higher in participants with type 2 diabetes mellitus (T2DM) plus MetS. The T2DM without MetS shared a comparable risk profile of the outcomes with the T2DM plus MetS group (HRs were 3.45 vs 3.15, 2.21 vs 2.65, and 6.91 vs 7.41, respectively). Conclusions: The degree of hyperglycemia in MetS is associated with the severity of death and both micro- and macrovascular complications. T2DM was associated with a comparable risk for all outcomes as T2DM plus MetS. The findings highlight the need of early prevention of diabetes in individuals with IGT plus MetS, while the justification to redefine a subgroup of patients with T2DM as having MetS remains to be clarified.

Objective:To explore the incidence and influencing factors of prediabetes in adults in China.Methods:Ten provinces (cities) were selected from the surveillance survey of chronic diseases and their risk factors in China in 2010; two monitoring sites were selected from each province (city) as follow-up spots, and a follow-up survey was conducted from 2016 to 2017. An unconditional logistic regression model was used to analyze the influencing factors of prediabetes.Results:A total of 5 578 participants were included in this study. During the follow-up period, 612 patients (268 males and 344 females) developed impaired glucose tolerone (IGT), with a total follow-up of 37 364.82 person-years, and the incidence of IGT was 16.4/1 000 person-years. Impaired fasting glucose (IFG) occurred in 290 patients (128 males and 162 females) with a total follow-up of 39 731.31 person-years, and the incidence of IFG was 7.3/1 000 person-years. The multivariate unconditional logistic regression model included age, urban and rural areas, family history of diabetes, BMI, central obesity, dyslipidemia, hypertension, and physical activity, and the results showed that age (≥50 years old: OR=1.60, 95% CI: 1.32-1.95), urban residents ( OR=1.41, 95% CI: 1.16-1.71), obesity ( OR=1.56, 95% CI: 1.12-2.19), dyslipidemia ( OR=1.52, 95% CI: 1.25-1.83), hypertension ( OR=1.32, 95% CI: 1.07-1.61) and physical inactivity ( OR=1.25, 95% CI: 1.04-1.50) increase the risk of IGT. Age (≥50 years old: OR=1.31, 95% CI: 1.01-1.70), family history of diabetes ( OR=1.71, 95% CI: 1.13-2.60), overweight ( OR=1.41, 95% CI: 1.04-1.92), obesity ( OR=2.09, 95% CI: 1.38-3.17) and hypertension ( OR=1.53, 95% CI: 1.18-2.00) increase the risk of IFG. Conclusions:The incidence of IGT is higher than the IFG. People aged 50 and above, overweight and obese people, hypertension patients, dyslipidemia patients, people with insufficient physical activity, and family history of diabetes are prone to prediabetic events.

目的 构建基本公共卫生服务项目2型糖尿病患者健康管理数据质量评价指标体系,为促进2型糖尿病患者健康管理服务提供科学适宜工具.方法 通过文献回顾国内外电子健康档案的数据质量评价维度及指标,结合2型糖尿病患者健康管理的工作需要和数据特点,构建具有针对性的数据质量评价指标体系;并利用2012年1月-2017年12月湖南湘潭某区和四川成都某区2型糖尿病患者健康管理项目数据对该指标体系进行应用可行性评价.结果 构建的基本公共卫生服务项目2型糖尿病患者健康管理数据质量评价指标体系包含数据的合理性、完整性和一致性3个维度共7个指标,通过实际应用发现该指标体系具有良好的应用可行性;2012年1月-2017年12月湖南湘潭某区和四川成都某区的2型糖尿病患者健康管理数据质量总体上较好,且近年来改善明显,但两地区数据仍存在数据格式不一致、重复录人和数据匹配率低等现实问题.结论 本研究构建的基本公共卫生服务项目2型糖尿病患者健康管理数据质量评价指标体系在实际应用中具有良好的适宜性和可操作性,建议将数据质量评价纳入常规工作中以发现患者管理过程中存在的问题.

目的 了解分级健康教育对社区2型糖尿病患者糖尿病足病防控知识改善的效果及影响因素,为社区实施分级健康教育提供科学依据.方法 于2015年8-9月,在江苏省常熟市和武汉市江岸区分别随机抽取3个社区为干预社区,1个社区为对照社区,在各社区卫生服务机构随机抽取符合纳入标准的2型糖尿病患者为研究对象.分级健康教育组(n=897)实施分级健康教育,基础健康教育组(n=256)实施基础健康教育,干预期为3年.干预前后两组患者均进行糖尿病足病防控知识问卷调查.采用SAS 9.4统计软件进行t检验、秩和检验、符号秩检验、x2检验、配对x2检验和非条件logistic回归.结果 分级健康教育组和基础健康教育组干预前糖尿病足病防控知识标准化综合得分中位数分别为20.00分(P25～P75:0.00～53.33 分)和 13.33 分(P25～75:0.00～40.00 分),干预后中位数分别为 77.78 分(P25～P75:55.56～88.89 分)和44.44分(P25～P75:16.67～72.22分),均较干预前有明显提升,分级健康教育组得分增值[中位数为40.00分(P25～P75:11.11～63.33分)]高于基础健康教育组[21.11分(P25～P75:0.00～43.33分)],差异均有统计学意义(P＜0.05).多因素logistic回归分析结果显示,与基础健康教育组相比,分级健康教育组DF防控知识综合得分增加的概率更高(OR=1.857,95％CI:1.019～3.384);与城乡居民基本医疗保险患者相比,城镇职工基本医疗保险患者DF防控知识综合得分增加的概率更高(OR=2.138,95％CI:1.192～3.834);学习过 DF 知识(OR=3.744,95％CI:2.198～6.376)、基线血糖控制达标(OR=1.795,95％CI:1.125～2.865)的患者DF防控知识综合得分增加的概率更高,基线知识综合得分高的患者DF防控知识综合得分增加的概率较低(OR=0.950,95％CI:0.941～0.958),均有统计学意义(P＜0.05,P＜O.O1).结论 健康教育可改善糖尿病患者糖尿病足病防控知识水平,分级健康教育较常规基础教育效果更加显著,值得在社区中进行推广.

目的 了解中国成人BMI和腹型肥胖与急性心肌梗死(acute myocardial infarction,AMI)的发病关系.方法 从2010年中国慢性病及危险因素监测中抽取11个省(市),再从中选择60个监测点作为随访点,并于2016-2017年进行随访调查,共随访到27 604人,数据清理后共26 794名调查对象纳入分析.采用Cox比例风险回归模型分析BMI和腹型肥胖与AMI发病的关系.结果 26 794名调查对象,平均随访6.0年,随访期间共观察到256例AMI事件.在调整相关混杂因素后,与腰围(waist circumference,WC)正常、BMI＜24 kg/m2组相比,腹型肥胖、BMI＜24 kg/m2组AMI的发病风险增加85％(HR=1.85,95％CI:1.14～3.01),腹型肥胖、BMI≥24 kg/m2组AMI 的发病风险增加 56％(HR=1.56,95％CI:1.11～2.18),而 WC 正常、BMI≥24 kg/m2组与AMI的发病风险无相关(HR=0.85,95％CI:0.49～1.47).结论 无论BMI值为多少,腹型肥胖都是AMI发病的重要危险因素.