Impact of sepsis and non-communicable diseases on prognostic models to predict the outcome of hospitalized chronic liver disease patients

AIM To evaluate the impact of sepsis and non-communicable diseases(NCDs) on the outcome of decompensated chronic liver disease(CLD) patients.METHODSIn this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed.Patients older than 18 years with decompensation of CLD(i.e., jaundice, ascites,encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital stay(> 5 d), and early readmission(within 7 d).RESULTS A total of 399 patients were enrolled. The mean age was 54.3 ± 11.7 years and64.6%(n = 258) were male. Six-week mortality was 13%(n = 52). Prolonged hospital stay and readmission were present in 18%(n = 72) and 7%(n = 28) of patients, respectively. NCDs were found in 47.4%(n = 189) of patients. Acute kidney injury, sepsis, and non-ST elevation myocardial infarction were found in41%(n = 165), 17.5%(n = 70), and 1.75%(n = 7) of patients, respectively. Upon multivariate analysis, acute kidney injury, non-ST elevation myocardial infarction, sepsis, and coagulopathy were found to be statistically significant predictors of mortality. While chronic kidney disease(CKD), low albumin, and high Model for End-Stage Liver Disease(MELD)-Na score were found to be statistically significant predictors of morbidity. Addition of sepsis in conventionalMELD score predicted mortality even better than MELD-Na(area under receiver operating characteristic: 0.735 vs 0.686; P < 0.001). Among NCDs, CKD was found to increase morbidity independently.CONCLUSION Addition of sepsis improved the predictability of MELD score as a prognostic marker for mortality in patients with CLD. Presence of CKD increases the morbidity of patients with CLD.

Associated Risk Factors of Non-Communicable Disease in Three Sites across Ivory Coast: An Urban (Cocody), Peri-Urban (Abobo) and Rural (Yocoboué) Area

Introduction: The prevalence of Non-communicable diseases (NCDs) has increased so it’s becoming a global public health problem. This problem is also threatening in Sub-Sahara Africa (SSA) country including Ivory Coast. Ivory Coast is a country of 22.6 million people experiencing rapid economic development and social change. All development is typically associated with an increase in non-communicable disease (NCD) risk factors. Our study aimed to determine the prevalence and associated factors of the major risk factors of NCDs among the population of Cocody, Abobo and Yocoboué in the Ivory Coast. Methods: A descriptive and analytical cross-sectional study was conducted and involved 1146 adults of 19 to 60 years from general population in Cocody (urban), Abob (peri-urban) and Yocoboué (rural). The WHO STEPS risk factor survey has been changed a bit and was administered. it contains anthropometric and biochemical measures. Results: The prevalence of NCD risk factors was markedly different across the three sites particularly between urban (Cocody) and rural (Yocoboué) areas. The overall prevalence estimates of the risk factors were 15.2% for current smoking, 57.71% for harmful use of alcohol, 58.84% for low physical activity, 24.71% for sedentariness (sitting at least 7 h), 69.45% for skipping breakfast, 61% for having late dinner and 36% for snacking. Concerning biological risk factor we noticed 40.95% for Overweight/obesity, 52.96% for abdominal obesity, 14.61% for raised blood pressure, 23.37% for raised blood sugar and 18.51 low HDL-C. Being female has an important associated with an increased risk for having abdominal obesity (OR: 25.7) and being overweight or obese (OR: 11.3), suffering from hypertension increased with age, 30 - 39 years (OR 8.45), 40 - 49 years (OR 13.4) and 50 years and above (OR 24.6). Conclusion: Adult residents in the two (Urban and peri-urban) of three different areas are developing high-risk NCDs, particularly Cocody’s population. At the end, we observed among participants that the female gender, living in urban areas and clustering are the most concerned by non-communicable disease risk factors. To reach the goal, preventive and therapeutic interventions are needed among the targeted population.

Opportunity and challenge of big data in improving chronic non-communicable diseases： by health system engineering approaches

Chronic non-communicable diseases （NCDs） is a sick- state in the complex system of human body. Healthsystems engineering approach can be used to recover health state by many different ways of system adjustments, including physical exercises, nutrition and psychological intervention, and drug therapies. To evaluate and assess the effects of these adjustments, many parameters of the system states have to be monitored （such as molecular high- throughput technologies, physiological, image, etc.）, and estimated at the different levels （such as molecular, cellular, tissue, organ, and system levels） and on the different dimensions （such as metabolic, immune, neural, etc.） for human system. Huge data have been produced during the whole process, and health systems engineering approach will model health and sick state in the human system by detecting and analyzing these multi-dimension and multi- level big-data in order to find personal suitable adjustment method.

医院-社区-家庭一体化护理管理方案的构建与实施

[目的]构建医院-社区-家庭一体化护理管理方案,并探讨其实施的有效性。[方法]将糖尿病、脑梗死、冠心病病人各100例形成3个研究组,每组随机分成对照组和干预组各50例,干预组实施医院-社区-家庭一体化护理管理,对照组实施常规护理,比较3组出院时和出院6个月后的结局指标。[结果]出院后6个月,糖尿病病人干预组自我护理能力高于对照组(P<0.05);脑梗死病人干预组健康行为得分高于对照组(P<0.05);冠心病病人干预组吸烟、不合理饮食、缺乏运动、高血压、血脂异常、肥胖的例数少于对照组(P<0.05)。[结论]医院-社区-家庭一体化护理管理方案在糖尿病、脑梗死、冠心病病人应用效果满意,改善了病人的自我护理能力和健康行为,减少了不良生活方式。

Selected Trace Elements in Domestic Water Boreholes and Their Implications on Human Health, in Huruma Estate, Eldoret Municipality, Uasin-Gishu County, Kenya

Trace elements constitute less than 1% of the rocks in the crust (Stumm and Morgan, 1991). In the human body, they constitute less than 100 mg/kg (0.01%). These elements are released to the environment naturally by weathering and volcanic activities (Flint and skinner, 1997). It has been observed that trace elements are greatly absorbed and retained in the body when in liquid diet. This phenomenon also influences the risk to human health, especially of infants and children whose immature digestive system further promote absorption of toxic heavy metals. The study was based on the analysis of domestic borehole water supplies in Huruma estate of Eldoret Municipality for selected trace elements and their implications on human health. The boreholes were systematically selected for sampling points and trace elements, Cr, Cu and Se analyzed using AAS. Statistical analysis for mean, standard deviation and confidence interval limits was done using SPSS. The statistical t-test was used to test for significance differences at (p = 0.05). The graphs were drawn using the Microsoft Excel package. The resulting data obtained from analysis were compared with WHO data for drinking water. In the study, the mean values of the following parameters were as follows: Chromium 17.9 μg/L, Copper 563 μg/L and Selenium 22.7 μg/L. There was a significant difference at 5% level of significance (p = 0.000) in all the parameter values among the sampling points in Huruma estate. The above mean values were far below the WHO recommended limits for drinking water. It was concluded that the borehole water from Huruma was fit for drinking and therefore could not cause cancer and cardiovascular diseases. However, borehole water should be used if other water sources (tap water etc.) were not available. All the industries near Huruma estate should carefully analyze and regularly monitor their liquid waste effluents to ensure that no harmful discharges get into the soil.

Obesity and High Blood Pressure among Professional Long-Distance Drivers in Yaoundé, Cameroon: Cross-Sectional Study

Background: Drivers play a very important role in the transportation of people, goods and services in Cameroon. The data on obesity and hypertension amongst these professionals is insufficient. The study aimed to determine the prevalence and risk factors of obesity and high blood pressure (HBP) among professional bus drivers in Yaoundé. Methods: This was an analytic cross-sectional study among long-distance bus drivers stationed in Yaoundé between march and April 2018. The data collected focused on driving history, eating habits, driver’s lifestyle, and anthropometric measurements. The analysis was completed using SPSS 21 software;STATA 13;SPAD 5.5 and Excel. Results: Of the 309 drivers, 27.18% and 17.80% were obese and hypertensive, respectively. The risk of developing HBP and obesity was higher among drivers with ≥20 years of driving experience. The risk of obesity was 3.99 (95% CI = 1.65 - 9.64);14.57 (95% CI = 3.65 - 58.16) and 15.23 (95% CI = 3.30 - 70.40) times higher in drivers with 10 - 14, 15 - 19 and 20 years of experience respectively. The risk of HBP was 3.64 (95% CI = 1.22 - 10.85);5.08 (95% CI = 1.18 - 21.92) and 9.42 (95% CI = 1.87 - 47.44) times higher in drivers with 10 - 14;15 - 19 years and 20 years of service, respectively. The more involved the drivers were in sporting activities, the less likely they are to be obese (RR = 0.46;95% CI = 0.24 - 0.88);the risk of HBP was 1.96 (95% CI = 1.05 - 3.67) times higher among drivers who were unable to make trips of at least 10 minutes. And the risk of HBP was less when drivers did not snack while traveling (RR = 0.43;95% CI = 0.21 - 0.90) than when they did. When a driver ate at least 3 meals a day, the risk of being obese was 5.75 (95% CI = 3.15 - 10.48) times higher. The risk of HBP was 4.04 (95% CI = 2.20 - 7.41) times higher in obese drivers than in those with a normal body mass index. Conclusion: Obesity and HBP are common conditions amongst the population of bus drivers. They are particularly exposed due to their socio-professional characteristics, their eating habits, and their lifestyle. These observations call for nutritional and sports education campaigns among bus drivers.

南通地区2008-2011年居民慢性病知识和行为/技能调查分析

目的:了解南通地区2008-2011年居民慢性病知识知晓率和行为/技能形成率,为制定针对性的干预措施提供依据。方法:采用多阶段整群抽样的方法,抽取15-69岁常住居民进行慢性病知识和行为/技能的问卷调查。结果:(1)共调查4 652例,男2 020例,女2 632例。2008-2011年4年间居民慢性病知识知晓率分别为45.88%、44.72%、57.83%和60.93%;行为/技能形成率分别为33.46%、26.18%、44.46%和44.95%。(2)居民的行为/技能形成率均低于知识知晓率。城市居民知识知晓率分别为54.14%、65.60%、57.60%和54.22%,乡村居民慢病知识知晓率分别为53.73%、65.30%、51.81%和53.76%。城市居民行为/技能形成率分别为41.10%、51.80%、44.80%和41.06%;乡村居民行为/技能形成率分别为46.52%、56.34%、47.43%和46.47%。城乡居民知识知晓率和行为形成率比较差异均无统计学意义(P>0.05)。(3)男女性知识知晓率比较差异无统计学意义(P>0.05)。不同年龄组人群中以25-34岁人群行为/技能形成率最高。2011年乡村居民的行为/技能形成率48.51%,城市居民44.86%,两者比较差异有统计学意义(P<0.05)。(4)2008-2011年不同文化程度居民慢性病知识知晓率差异有统计学意义(P<0.05)。2008-2011年各年度不同文化程度居民慢性病行为/技能形成率差异均有统计学意义(P<0.05)。结论:在慢性病健康教育和健康促进中,应采取适应不同人群的对策,侧重信念的提高、行为的改善,从而有效地预防慢性病的发生。

上海市奉贤区慢性病高风险人群饮酒情况及影响因素分析

目的了解上海市奉贤区慢性病高风险人群的饮酒情况及影响因素,为开展慢性病高风险人群的饮酒干预及健康管理提供理论依据。方法以“2018年奉贤区慢性病及其危险因素监测”项目中符合慢性病高风险人群标准的3682人作为研究对象进行问卷调查。结果奉贤区慢性病高风险人群的现在饮酒率和过量饮酒率分别为28.30%和26.10%;男性的现在饮酒率和过量饮酒率分别为53.33%和31.74%,高于女性的10.50%和5.15%。现在饮酒者的日均酒精摄入量为5.98g;男性和女性日均酒精摄入量分别为10.26g和0.85g,差异有统计学意义(P<0.01)。饮用率最高的3种酒分别为黄酒(58.73%)、啤酒(37.81%)和葡萄酒(26.58%);男性中以黄酒的饮用率最高(65.69%),女性中以葡萄酒的饮用率最高(33.68%)。多因素logistic回归分析结果显示:女性、≥65岁人群的现在饮酒风险较低;男性、高年龄组人群的过量饮酒风险较高。结论奉贤区慢性病高风险人群的饮酒率较高,应针对不同人群的饮酒特点开展有针对性的健康干预措施,减少与饮酒相关的慢性病发病风险。

浅述国内外慢病风险评估工具研究进展

随着我国经济的发展和生活水平的提高,慢性非传染性疾病(简称慢病)的发病率逐步上升,成为重大公共健康问题。本文综述了国内外慢病风险评估工具的研究进展,重点分析了心血管疾病(CVD)、糖尿病和脑卒中的风险评估工具,并探讨了生物标记物在CVD风险评估中的应用,以及人工智能技术在风险评估中的潜力与挑战。研究表明,多种风险评估工具能有效预测个体的慢病发病风险,但同时也存在数据依赖性、透明度和可解释性问题、技术局限性与误判风险等挑战。未来研究应注重工具的个性化和精准化,加强跨学科合作和技术创新,提高公众对慢病风险评估工具的认知和使用率。

2016~2020年毕节市国家级死因监测地区慢性非传染性疾病死因分析

目的:分析2016~2020年毕节市国家级死因监测地区慢性非传染性疾病死亡特征,为制定该地区慢性非传染性疾病预防控制措施提供科学依据。方法:采用粗死亡率、标准化死亡率、潜在减寿年数(potential years of life lost, PYLL)、平均减寿年数(average years of life lost, AYLL)等指标对2016~2020年毕节市国家级死因监测地区慢性非传染性疾病死亡资料进行分析。结果:2016~2020年毕节市居民慢性非传染性疾病粗死亡率为436.7/10万,年龄标化死亡率为493.16/10万,呈逐年上升趋势,男性死亡率显著高于女性;慢性非传染性疾病死亡率随着年龄的增长呈上升趋势,从65~岁年龄组开始明显升高;循环系统疾疾病占比最高(50.17%),死亡率为219.12/10万,其次是肿瘤和呼吸系统疾病;慢性非传染性疾病造成的寿命损失年PYLL为356073人年,AYLL为5.78人年,PYLL率为25.24‰。结论:2016~2020年毕节市居民慢性非传染性疾病死亡率呈上升趋势,已成为我市居民的主要死因,严重影响居民的健康和生命,应作为今后疾病防控工作的重点。

中国居民膳食的变迁

为探讨建国 5 0年来我国膳食的变化趋势及其意义 ,分析了来自中国健康与营养调查 (1989～ 1997年 )、全国营养调查 (1982、1992年 )、统计局家庭膳食消费资料和卫生部死亡统计年报。结果表明 ,1985年经济转轨前我国谷类的摄入量一直在上升 ,以后开始下降 ;蔬菜的摄入量也呈下降趋势 ,1995年后趋于稳定 ;1979年前动物性食品的摄入量增加缓慢 ,以后增加速度加快。摄入的总能量开始下降 ,能量的来源构成发生了很大变化 ,至 1997年时 ,来自脂肪的能量已占总能量的 2 7 3% ,城市占 32 8% ,平均三分之一的居民 (城市5 8 4% )来自脂肪的能量已超过 30 %。这些变化导致了超重和肥胖的患病率、营养相关性慢性病的死亡率和城市居民的总死亡率上升。中国的膳食变迁已进入一个新的历史时期 ,传统膳食正在向高脂肪、高能量密度、低膳食纤维改变。

慢性病患者的生命质量评价

目的分析慢性病对患者生命质量的影响。方法采用患者自填的方式,对住院的505例慢性病患者应用英国发展版SF-36量表进行生命质量的测定。结果与四川省一般人群的生命质量参考值相比,各种慢性病患者的绝大多数领域得分均有明显下降(P<0.05),特别是PR、GH和RE3个领域。控制性别和年龄的协方差分析显示,不同慢性病患者的生命质量除PR外,余各领域间差异均有统计学意义(P<0.01)。结论慢性病患者的生命质量都有显著下降,在慢性病患者的治疗中应注意有针对性地采取不同的措施;有必要编制一套中国不同地区和人群的常模,以便对不同人群的生命质量进行对比研究。

中国慢性非传染性疾病经济负担研究

目的了解中国慢性非传染性疾病经济负担及其变化趋势。方法依据1993年、2003年国家卫生服务调查和卫生部常规死因登记报告系统等数据,利用二步模型法和人力资源法分别测算疾病直接经济负担、间接经济负担和总经济负担,并进行分类统计。结果1993年中国慢性非传染性疾病经济负担为1963.44亿元,占全部疾病总经济负担的58.84/,占GDP的5.67/;2003年中国慢性非传染性疾病经济负担达到8580.54亿元,占全部疾病总经济负担的71.45/,占GDP的7.31/。居慢性非传染性疾病总经济负担前5位的疾病是恶性肿瘤、脑血管疾病、高血压、其他类型心脏病、冠心病,其总经济负担合计为3393.53亿元,占慢性非传染性疾病总经济负担的39.55/;占全部疾病总经济负担合计的28.25/。人口老龄化导致明显“疾病堆积”现象。结论慢性非传染性疾病经济负担巨大且以高于GDP增长的速度增长,成为我国主要的疾病经济负担;恶性肿瘤、脑血管疾病、高血压、其他类型心脏病、冠心病是导致慢性非传染性疾病经济负担的主要原因;要从宏观经济和社会发展上警惕“疾病堆积”和“人口红利”,减少对将来社会带来的双重影响。

天津市社区居民慢性病患病情况流行病学调查

目的对天津市内六区社区居民的慢性病患病情况进行调查,为合理配置卫生资源,有效开展社区卫生服务提供客观参考依据。方法采用多阶段随机整群抽样方法,利用自制问卷对社区居民进行入户调查。结果社区居民的超重率和肥胖率为35.83%和11.43%,慢性病患病率高达43.93%,男性低于女性;慢性病疾病谱中排在前5位的分别是高血压、糖尿病、冠心病、颈椎疾病和腰椎疾病。15岁及以上人群高血压男性检出率为23.46%,女性为21.93%,平均22.66%,男性高于女性。成年男性糖尿病患病率为8.89%,女性为9.10%,平均为9.00%。结论天津市区社区居民慢性病患病率处于较高水平且有增高趋势,慢性病预防控制工作任重道远、防控策略和措施亟待加强。

建立新型国家预防医学体系战略研究

改革开放以来,伴随我国经济发展、劳动生活方式的改变,影响我国人民健康的主要疾病谱以及危险因素发生了巨大变化,现有的临床医学和预防医学教育体系已不再适应疾病预防控制、保障人民健康的实际需求。未来的卫生方针和政策、公共卫生和预防医学工作能否及时调整以应对这些变化和需求,是摆在我国卫生决策者面前的重大挑战。探讨建立适应实际需求的新型国家预防医学体系,并制定相应的卫生战略、战术和相关政策,从而实现有效利用有限的卫生资源,获取最大的健康保障效果。

全国慢性病社区综合防治示范点基本情况调查

目的了解2004年全国慢性病社区综合防治示范点机构、人员、经费和保障机制、开展主要工作等基本情况,明确今后的工作方向。方法采用自填问卷的方式对32个全国慢性病社区综合防治示范点进行调查。结果31个示范点慢性病防治人员共计1 480人,92.8%为初级、中级和无职称人员;医护人员数量少,兼职和聘任人员超过1/3,52%的示范点每万人医护人员数不足2人;各点人员培训不均衡,53.9%的培训集中在2个示范点,其他29个示范点的培训量少,省级培训明显偏少;8个(25%)示范点能综合开展人群健康教育、高危人群的多种危险因素干预和多种病种的患者管理工作;示范点政府拨款普遍不足,近50%的示范点政府投入比例低于30%。结论示范点机构、人员初具规模,防治模式初显雏形,但各示范点人力资源不足,培训量少且不均衡,经费不足,综合防治工作发展不平衡。建议明确职责任务,建立考评制度,加强人员培训,提高综合防治能力,落实慢性病防治工作内容,加强政府投入。

四大类主要慢性病流行现状与应对策略

目的阐述4大类主要慢性病(心脑血管疾病、癌症、慢性呼吸系统疾病以及糖尿病)国内外流行现状,探索适合我国国情的应对策略。方法检索中外数据库,对4大慢性病的国内外流行病学数据与相关应对策略进行综述探讨。结果 2012全球总死亡人数5 600万,慢性病死亡人数占到了全球总死亡人数的68%,4大类慢性病占总死亡人数的55.7%,我国慢性病死亡人数占总死亡人数的86.6%,其中心脑血管疾病、癌症和慢性呼吸系统疾病是主要3大死因,占总死亡的79.4%,远高于全球水平。结论慢性病已成为威胁人类健康的头号杀手。对慢性病危险因素的综合干预是防治重点。应重视对老年慢性病人群的照料,实现医养结合,老有所医、老有所养。

社区慢性非传染性疾病综合防治中应用健康管理和疾病管理技术的效果

目的:评价健康管理和疾病管理技术在社区慢性病综合防治中的效果,探索基层慢性病综合干预可持续发展的工作机制和管理模式。方法:采用整群抽样的方法抽取社区内35岁以上常住居民定期随访,采取群体干预和个体干预,进行改善行为和控制危险因素的研究。结果:干预后,目标人群的舒张压(t=0.540,P=0.025)、高血压患者血压控制率(χ2=16.819,P<0.001)、高危人群比例(χ2=46.891,P<0.001)、新发高血压检出率(χ2=20.390,P<0.001)、吸烟率(χ2=3.904,P=0.048)、超重且中心性肥胖人群比例(χ2=3.873,P=0.049)、慢性病患者知晓率(χ2=50.798,P<0.001)、服药率(χ2=9.466,P=0.002)、控制率(χ2=7.893,P=0.005)、高危人群和慢性病患者的血脂异常比例明显下降(χ2=9.998,P=0.002);高危人群和慢性病患者的身体活动充分水平比例明显上升(χ2=7.326,P=0.007)。结论:健康管理和疾病管理技术在以社区卫生服务机构为运转平台的慢性病综合防治中切实可行并初显成效。

中山市慢性非传染性疾病相关危险因素调查分析

目的通过对慢性病相关危险因素的调查分析,探索中山市慢性病发病主要危险因素,为有针对性开展社区干预和防控措施提供依据。方法采用整群随机抽样的调查方法,并应用多因素分析的基本方法筛查危险因素。结果中山市社区人群高血压、慢性阻塞性肺病(COPD)、恶性肿瘤、冠心病、脑卒中、糖尿病的患病率分别为18.51%、6.65%、0.89%、2.79%、0.78%、2.07%;中山市社区慢性病主要危险因素为年龄、吸烟、超重和家族史。结论慢性病的防控与人们的生活方式和行为习惯关系密切,积极引导社区群众戒除不良的生活方式,调整饮食结构,可以有效降低慢性病的发病水平。

疾病预防控制对人群期望寿命提升贡献的测算结果

目的 :定量明确疾病预防控制工作对期望寿命提升的贡献,并对2011—2020年的贡献趋势作出预测。方法 :收集华东某省1950—2010年分年龄组的人口、发病和死亡数据资料,依据课题组形成的疾病预防控制对人群期望寿命提升贡献的测算思路、步骤进行测算。结果 :1950—2010年,华东某省期望寿命提升26.59岁,疾病预防控制的贡献高达77.92%,其中传染病防控贡献3.57%、意外伤害防控贡献5.87%、孕产妇保健贡献3.61%、慢性病防控贡献为-1.73%。2011—2020年自然趋势下,传染病防控和孕产妇保健对期望寿命的提升仍然保持"正贡献",但已相对较小,慢性病和意外伤害对期望寿命提升的"负贡献"加剧。结论 :疾病预防控制工作对人群期望寿命的提升贡献巨大,有力证明了"预防为主"卫生工作方针的重要性。