As the ageing process in China further accelerates and the average life expectancy increases, chronic disease prevalence and multimorbidity rates are constantly rising, especially among elderly individuals. However, few previous studies have explored the impacts of chronic diseases and multimorbidity on health-related quality of life (HRQoL). This study aimed to investigate this association among community-dwelling elderly individuals in China. A cross-sectional study was conducted in communities in three cities (Suzhou, Qingdao, and Guangzhou). The basic characteristics, chronic diseases and HRQoL of participants were collected, and HRQoL was measured by the EuroQol 5-Dimensions 3-Level version (EQ-5D-3L). Logistic regression, Tobit regression and generalized linear models were used to assess the impacts of chronic diseases and multimorbidity on HRQoL. Approximately 83.2 percent of the 1,218 respondents had chronic conditions, with 30 percent having multimorbidity. After controlling for sociodemographic and health behaviour factors, patients with stroke were more likely to report problems in all five dimensions of the EQ-5D and had a lower EQ-5D utility index (UI) (b = -0.342) than patients with other chronic conditions. Patients with chronic pulmonary obstruction had a lower EuroQol Visual Analog Scale (EQ-VAS) (b = -11.169) than patients with other chronic conditions. Furthermore, patients with multimorbidity had worse HRQoL (P < 0.001). Both chronic condition probability and multimorbidity rates were high among Chinese community-dwelling elderly individuals. Different disease types had varying degrees of impact on HRQoL, and patients with multimorbidity had worse HRQoL. This study proposes that the government enhance the quality of life of community-dwelling elderly individuals with multimorbidity by establishing long-term care insurance and expanding comprehensive community-based home health care services.

目的:构建社区居家智慧化医养结合服务模式评价指标体系,为社区居家智慧化养老服务模式的评价和改进提供参考.方法:采用文献分析法、专题小组讨论、Delphi法等,基于"结构-过程-结果"理论初步构建社区居家智慧化医养结合模式服务评价指标体系,通过层次分析法确定指标权重.结果:两轮专家咨询的问卷有效回收率分别是100％和97.2％.专家权威系数分别是0.871和0.877.第一轮专家咨询中一、二、三级指标的专家协调系数分别为0.138、0.122、0.132,第二轮专家咨询中一、二、三级指标的专家协调系数分别为0.302、0.130、0.214,且差异有统计学意义(P<0.05).最终确定的评价指标体系包括3个一级指标(服务结构、服务过程、服务结果),21个二级指标,127个三级指标.结论:本研究初步确立的社区居家智慧化医养结合服务模式评价指标体系具有一定科学性和可靠性,可为相关研究提供一定参考.

目的 了解东部地区社区居家医养结合服务老年人生命质量状况,并探讨其影响因素,为我国政府制定促进健康老龄化政策提供理论依据.方法 采用多阶段分层抽样的方法,对苏州、广州两地接受社区居家医养结合服务的老年人进行问卷调查.使用欧洲5维健康量表(EQ-5D量表)计算其健康效用值,单因素分析使用秩和检验,多因素分析使用Tobit回归模型.结果 社区居家医养结合服务老年人健康效用值中位数为0.699.在5个维度中,存在困难比例依次为日常活动能力(56.8％)、行动能力(55.0％)、自我照顾能力(50.8％)、疼痛/不适(42.0％)、焦虑/抑郁(24.7％).Tobit回归模型结果显示:城镇职工基本医疗保险、月收入1 001～5 000元、未患有慢性病、每日睡眠时间6～8h是东部地区社区居家医养结合服务老年人健康相关生命质量的保护因素.结论 东部地区社区居家医养结合服务老年人生命质量较差,需采取针对性措施改善社区居家医养结合服务老年人生命质量.

目的:了解我国老年人认知功能障碍现状及其影响因素,为改善老年人认知功能现状、制定干预措施提供参考.方法:采用2018年中国健康与老年人追踪数据,筛选3523名60岁及以上老年人作为研究对象,使用简易智能状态检查表对老年人认知功能进行评判.运用卡方检验和二分类logistic回归模型分析老年人认知功能障碍的影响因素.结果:老年人认知功能障碍检出1110人,检出率31.5％.回归分析显示年龄≥70岁、农村、单身、睡眠时间>9小时、无社会参与活动、存在抑郁症状是老年人认知障碍的危险因素;教育水平为小学是老年人认知障碍的保护因素.结论:老年人认知功能障碍患病率较高,年龄、居家地址、婚姻状况、睡眠时长、社会参与状况和抑郁状况是老年人认知功能障碍产生的影响因素.

ObjectiveTo explore the relationship between ambient PM2.5 level and outpatient visits of children with respiratory diseases in a megacity, Zhengzhou, in central China.MethodsWe collected daily outpatient visit data, air pollutant data, and meteorological data at the monitoring points of Zhengzhou from the time period 2018 to 2020 and used Spearman's rank correlation to analyze the correlation between children's respiratory outpatient visits and air pollutants and meteorological factors. Generalized additive models were used to analyze the association between PM2.5 exposures and children's respiratory outpatient visits. A stratified analysis was further carried out for the seasons.ResultsFrom 2018 to 2020, the total number of outpatients with children's respiratory diseases was 79,1107, and the annual average concentrations of PM2.5, PM10, SO2, NO2, CO, and O3-8h in Zhengzhou were respectively 59.48 μg/m3, 111.12 μg/m3, 11.10 μg/m3, 47.77 μg/m3, 0.90 mg/m3 and 108.81 μg/m3. The single-pollutant model showed that the risk of outpatient visits for children with respiratory disease increased by 0.341% (95%CI: 0.274–0.407%), 0.532% (95%CI: 0.455–0.609%) and 0.233% (95%CI: 0.177–0.289%) for every 10 μg/m3 increase in PM2.5 with a 3-day lag, 1-day lag, and 1-day lag respectively for the whole year, heating period, and non-heating period. The multi-pollutant model showed that the risk of PM2.5 on children's respiratory disease visits was robust. The excess risk of PM2.5 on children's respiratory disease visits increased by 0.220% (95%CI: 0.147–0.294%) when SO2 was adjusted. However, the PM2.5 effects were stronger during the heating period than during the non-heating period.ConclusionThe short-term exposure to PM2.5 was significantly associated with outpatient visits for children's respiratory diseases. It is therefore necessary to strengthen the control of air pollution so as to protect children's health.

目的 探讨我国中老年人认知功能在慢性病与抑郁症状间中介作用.方法 采用中国健康与养老追踪调查2018年第四次全国追访数据,以5 208名45岁及以上中老年人为研究对象,采用SPSS 25.0进行相关性分析.结果 中老年人抑郁症状的检出率为32.7％.模型中,慢性病对中老年人抑郁症状具有统计学意义的正向预测作用(β=0.295,t=36.079,P＜0.001).认知功能在慢性病与抑郁症状之间存在的中介效应量占40.68％.结论 中老年人的慢性病、认知功能与抑郁症状相关,慢性病可以直接或通过认知功能障碍的中介作用间接影响抑郁症状.

目的:探索河南省农村老年人养老方式的选择意愿及影响因素.方法:采用多阶段整群分层随机抽样法于2019年3～8月共抽取4074例河南省60岁及以上农村老年人,进行问卷调查获取数据;运用x2检验和多元Logistic回归分析养老意愿分布的差异及影响因素;以Andersen模型为理论框架,探究倾向特征、使能资源和需求因素对农村老年人养老方式选择意愿的影响.结果:84.19％的农村老年人选择家庭养老,选择社区养老和机构养老的分别为10.14％和5.67％;多元Logistic回归分析显示,婚姻状况、学历、居住情况、残疾、患慢性病种类及老年人能力状况是影响农村老年人养老意愿选择的因素(P＜0.05);从影响因素回归模型中发现倾向特征和使能资源对因变量的影响较大.结论:河南省农村目前的养老以家庭养老为主,倾向特征、使能资源和需求因素不同程度地影响老年人选择养老方式,建议相关部门关注农村老年人生活条件和提高其健康状况,大力发展农村多元养老服务方式.

Objective To investigate whether there is a curvilinear relationship between burnout and work engagement among staff in Chinese community services for the elderly. Methods A stratified whole-group random sampling method was used to survey 244 staff members from eight communities in two cities. Data were collected using the Maslach Burnout Inventory scale (MBI) and the Utrecht Work Engagement Scale- 9 (UWES- 9). The curve estimation method explored the functional model of burnout and work engagement scales. Results Two hundred forty-four staff members completed the survey. Burnout, depersonalization (DP), and personal accomplishment (PA) were found to be related to work engagement in a cubic function ( R 2 = 0.166, P < 0.05), ( R 2 = 0.061, P < 0.05), and ( R 2 = 0.2230, P < 0.05), respectively. There was no statistically significant relationship between emotional exhaustion (EE) and work engagement ( P > 0.05). “Personal Accomplishment” is related to work engagement in a U-shaped curve. Conclusions There was a cubic function relationship between burnout and work engagement, where “personal accomplishment” was related to work engagement in a U-shaped curve. Therefore, the government and related service organizations should understand the impact of different levels of burnout on work engagement and take targeted measures to alleviate burnout and improve work engagement by targeting emotions and stroke.

目的:分析简化版批判性思维量表在医学生中运用的信度和效度.方法:采用分层抽样方法抽取某高校不同院系、不同年级的医学生共608名填写问卷,获得有效问卷598份.采用Cronbach's α系数评价量表的信度;598人分为两组,分别用于探索性因子分析和验证性因子分析以检验量表效度;从598人中随机抽取100人,15 d后进行重测,检验重测信度.采用Spearman相关分析量表的聚合效度,以原模型和其他模型的拟合指标评价该量表的区分效度.结果:简化版批判性思维量表整体Cronbach's α系数为0.865,重测信度为0.813;探索性因子分析提取出6个公因子,累积方差贡献率为72.019％,验证性因子分析显示,该量表的拟合指数较好(CMIN/DF=2.889、RMSEA=0.080、GFI=0.914、TLI=0.906、CFI=0.909、PGFI=0.659);聚合效度结果显示,6个维度间的相关系数多数小于0.5,各维度与总分之间相关系数多数大于0.5(P＜0.05);区分效度结果显示,其他15个模型与原模型相比,各拟合指标均变差(P＜0.01).结论:简化版批判性思维量表在医学生中具有较好的信度和效度,可为研究医学生批判性思维能力现状提供更为便捷的工具.

目的:探讨慢性病对河南省老年人日常生活能力和精神状态的影响.方法:采用多阶段随机整群抽样方法抽取河南省18个省辖市60岁及以上人群,收集基本信息,使用《老年人能力评估量表》评估日常生活能力和精神状态,采用Logistic回归分析慢性病患病数量及种类对老年人日常生活能力和精神状态的影响.结果:5570名老年人中,慢性病患病率51.33％,高血压、冠心病患病率位居前两位(34.49％和12.41％).Logistic回归分析表明,调整性别、年龄、城乡性质、婚姻状况等混杂因素后,慢性病患病数量较多(≥3种)的老年人日常生活能力和精神状态受损风险更高[OR(95％CI)分别为2.333(1.740～3.128)、1.616(1.257～2.078)];患高血压(OR=1.520,95％CI:1.303～1.772)、糖尿病(OR=1.452,95％CI:1.171～1.798)、脑卒中(OR=1.505,95％CI:1.095～2.069)、慢性阻塞性疾病(OR=1.649,95％CI:1.712～2.320)的老年人日常生活能力受损风险高,而患高血压(OR=1.303,95％CI:1.153～1.472)、糖尿病(OR=1.248,95％CI:1.044～1.492)、脑卒中(OR=1.467,95％CI:1.129～1.906)的老年人精神状态受损风险高.结论:河南省老年人慢性病的患病数量和种类影响其日常生活活动能力和精神状态,应重点加强高血压、糖尿病和脑卒中等慢性病的风险管理,以减少老年人日常生活活动能力和精神状态损害的风险.

目的 了解河南省老年人跌倒发生情况,并探讨老年人能力状况与跌倒之间的关系.方法 采用分阶段抽样的方法,对河南省60岁及以上的老年人进行问卷调查.采用二元logistic回归模型分析日常生活能力、精神状态能力、感知觉与沟通能力、社会参与能力对老年人跌倒的影响.结果 共调查5570例老年人,其中496例老年人发生了跌倒,发生率为8.9％.Logistic回归分析表明,全人群中日常生活能力受损(OR=3.060,95％CI=2.418～ 3.872)、感知觉与沟通能力受损(OR=1.449,95％CI=1.128 ～ 1.861)、社会参与能力受损(OR=1.438,95％CI=1.100～1.880)是河南省老年人跌倒的危险因素.根据性别进行分层后无论对于男性(OR=3.542,95％CI=2.445～5.130)还是女性(OR=2.826,95％CI=2.075～3.848),跌倒都受日常生活能力受损的影响.除此之外,感知觉与沟通能力受损(OR=1.543,95％CI=1.118～2.130)和社会参与能力受损(OR=1.480,95％CI=1.045～2.096)也是女性老年人跌倒的危险因素.结论 能力状况受损是老年人跌倒的危险因素,其中男性跌倒主要受日常生活能力的影响,女性跌倒受日常生活能力、感知觉与沟通能力、社会参与能力的影响.

目的 调查河南省老年人社会参与和脑卒中患病率的流行现状,探讨社会参与和脑卒中患病风险的关联.方法 采用多阶段分层整群随机抽样的方法选取河南省18个省辖市60岁及以上的老年人为研究对象,采用logistic回归分析社会参与得分与脑卒中患病风险的关联,并使用限制性立方样条模型拟合社会参与得分与脑卒中患病风险的剂量-反应关系.结果 共纳入5 570名研究对象,社会参与平均得分为(1.55±2.94),其中社会参与水平失能占19.5％,完全自理占80.5％;脑卒中患病率为5％.调整多种混杂因素后,社会参与水平得分与脑卒中患病风险有关联(P＜0.05),相比社会参与正常的人群,社会参与受限的人群脑卒中比值比升高366％(OR = 4.657,95％CI:2.398～9.044),社会参与得分每升高1分,脑卒中的比值比升高9％(OR = 1.083,95％CI:1.047～1.120),限制性立方样条模型显示社会参与得分与脑卒中易感性存在剂量-反应关系.结论 社会参与水平受限与脑卒中患病风险有关,社会参与得分与患脑卒中存在剂量-反应关系.

[背景]大气污染物PM2.5暴露与循环系统疾病死亡人数存在密切关联,但不同城市之间PM2.5对循环系统疾病死亡人次的影响存在差异.[目的]重点探讨郑州市大气PM2.5浓度与居民循环系统疾病日均死亡人数的相关性.[方法]收集2019年郑州市大气污染物、气象资料以及居民循环系统疾病死亡数据.采用Spearman相关分析三者之间的相关性.采用基于Poisson分布的广义线性模型,控制长期趋势、星期几效应和气象等影响因素后,研究郑州市大气PM2.5浓度与循环系统疾病日均死亡人数的关系及滞后效应,同时对年龄和季节进行分层分析.[结果]2019年郑州市居民因循环系统疾病死亡共19429人,日均死亡(55.32±13.35)人.郑州市2019年PM2.5年均浓度为(65.81±41.10)μg·m-3.Spearman相关分析表明,循环系统疾病日均死亡人数与PM2.5、PM10、SO2、NO2、CO和气压均呈正相关,与O3-8h、日均温度和相对湿度呈负相关(P<0.05).单污染物模型中,PM2.5与循环系统疾病总人群、<65岁和≥65岁人群死亡的关联分别在lag2、1ag4和lag3时最高,PM2.5每升高10μg·m-3,其风险分别增加0.472％(95％CI:0.098％～0.847％)、0.700％(95％CI:0.059％～1.345％)、0.516％(95％CI:0.097％～0.937％),PM2.5浓度与循环系统疾病人群死亡的暴露-反应关系曲线均呈近似线性的缓慢上升状态.在供热期和非供热期,PM2.5浓度每升高10μg·m-3,对总人群循环系统疾病日死亡风险分别增加0.665％(95％CI:0.084％～1.249％)和1.919％(95％CI:0.355％～3.506％)(P<0.05);在非供热期,PM2.5浓度每升高10μg·m-3,≥65岁人群循环系统疾病每日死亡风险增加2.734％(95％CI:0.975％～4.524％)(P<0.05).双污染物模型中,在供热期,纳入SO2时,PM2.5浓度升高对总人群和≥65岁人群循环系统疾病每日死亡风险的影响具有统计学意义(P<0.05);纳入O3-8h时,对总人群的影响仍然具有统计学意义(P<0.05).在非供热期,分别纳入SO2、CO、PM10、NO2和O3-8h后,PM2.5浓度升高对总人群和≥65岁人群循环系统疾病每日死亡风险的影响仍然具有统计学意义(P<0.05).[结论]郑州市大气污染物PM2.5浓度的升高与居民循环系统疾病死亡风险升高存在正相关联,尤其需要关注老年人群.