Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morb...Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.展开更多
Objective： To investigate the prevalence and possible risk factors of Barrett＇s esophagus （BE） in patients with gastroesophageal reflux disease （GERD） in Northwest China. Methods： Patients older than 18 years w...Objective： To investigate the prevalence and possible risk factors of Barrett＇s esophagus （BE） in patients with gastroesophageal reflux disease （GERD） in Northwest China. Methods： Patients older than 18 years who underwent regular health check-up or had upper gastrointestinal symptoms in the endoscopy centers of four major teaching hospitals located in four different provinces of Northwest China from September 2008 to February 2009 were included in the study. A face-to-face reflux diagnostic questionnaire including risk factors were taken and scale scores （So） were accumulated. Diagnostic criterion of GERD was Sc≥12 points. None of these subjects received anti-acid medication prior to their endoscopy done. Barrett＇s esophagus was diagnosed when specialized intestinal metaplasia was detected histologically. Results： A total of 528 patients met the criteria of GERD, among which 32 patients （20 male and 12 female） were diagnosed with BE. BE was present in 6.06% with a mean age of 51.2±11.6 years, which was significantly older than patients with GERD without BE （46.6±13.3 years） （P〈0.05）. There weresignificant differences between BE and GERD patients regarding gender, age, hiatus hernia, smoking and alcohol consumption （P〈0.05）, while no significant difference regarding symptoms of GERD. There was significant difference between short segment Barrett＇s esophagus and long segment （65.6% vs 34.4%, P〈0.05）. Conclusion： The prevalence of BE was 6.06% in patients with GERD in northwest China and was dominated by SSBE. The potential risk factors of Barrett＇s esophagus were older age, male, esophageal hiatal hernia, smoking and alcohol consumption.展开更多
Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. Th...Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. The role of other occupational factors remains a controversial subject. The objective of this study is to evaluate the possible impact of occupational factors on the risk of developing CRC. Materials and Methods： This is a retrospective case-control study. The cases and the control group were enlisted in the general surgical ward of Farhat Hached Teaching Hospital of Sousse （Tunisia） during the period extending from 2004 to 2008, and they were age and gender-matched. The data were analyzed using SPSS 11.0 software with a signification threshold fixed at 5%. A univariate analysis was carried out as well as a multiple binary logistical regression. Results： During the period of the study, 40 cases of colorectal cancers have been colligated including 28 men and 12 women with a sex ratio of 0.43. The average age of the cases was 61.55 ± 13.3 years and 60.40 ± 12.84 years for the control group, with a non significant difference （P = 0.69）. The univariate analysis has objectivized significant associations between colorectal cancer and the housing conditions, the neoplastic and digestive family history, the occupational activity sector, exposure to pesticides, and lack of periodic medical supervision. After logistical regression, the occurrence risk of CRC was significantly associated with： alcohol and smoking （ORa = 3.43; Pa = 0.05）, meat consumption （ORa = 3.34; Pa = 0.03）, exposure to pesticides （ORa = 20.44; Pa = 0.012） and lack of periodic medical supervision （OR = 7.45; P = 0.004）. Conclusion： The occupational risk factors might play a role in the etiopathogenesis of colorectal cancers. With regard to our study, pesticides seem to be most implicated and necessitate suitable preventive measures. Nevertheless, it seems useful to multiply the studies to a much larger scale in order to further explore such relationship and to further reinforce the prevention of such serious disease.展开更多
Diabetes is involved in the development of several cancers. However, whether type 2 diabetes mellitus （T2DM） as well as other potential risk factors are related to gastric cancer （GC） remains unclear. In this stud...Diabetes is involved in the development of several cancers. However, whether type 2 diabetes mellitus （T2DM） as well as other potential risk factors are related to gastric cancer （GC） remains unclear. In this study, 1320 patients with gastric cancer （gastric cancer group） and 1252 thyroid nodule patients （control group）, who were admitted in our hospital from Jan 2010 to Dec 2012, were analyzed in a case-control study. Logistic regression analysis was applied to evaluate the risk of diabetes condition, gender, age, body-mass index （BMI） level and other factors for GC. There were 416 patients with DM in the gastric cancer group （31.5%） and 120 patients with DM in the control group （9.6%）. The differences between the two groups were significant （P = 0.000）. Compared with the control group, the logistic regression analyses suggested that male patients had a higher risk of GC. Moreover, older individuals （especially over 65 years） were more susceptible to GC, and as for T2DM, it was found to be associated with GC, that is, the incidence in the gastric cancer group was significantly higher than in the control group. The OR values of age, T2DM, gender and BMI were 16.951, 15.130, 2.658 and 0.224, respectively. In conclusion, age, gender and T2DM are the risk factors of gastric cancer. Furthermore, male patient over 65 years with T2DM is susceptible to GC, and T2DM is the risk factor only second to age, and there might be synergistic effects among these factors.展开更多
文摘Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.
基金Supported by Key Clinical Program of the Ministry of Health of the People's Republic of China(No.[2007]353)
文摘Objective： To investigate the prevalence and possible risk factors of Barrett＇s esophagus （BE） in patients with gastroesophageal reflux disease （GERD） in Northwest China. Methods： Patients older than 18 years who underwent regular health check-up or had upper gastrointestinal symptoms in the endoscopy centers of four major teaching hospitals located in four different provinces of Northwest China from September 2008 to February 2009 were included in the study. A face-to-face reflux diagnostic questionnaire including risk factors were taken and scale scores （So） were accumulated. Diagnostic criterion of GERD was Sc≥12 points. None of these subjects received anti-acid medication prior to their endoscopy done. Barrett＇s esophagus was diagnosed when specialized intestinal metaplasia was detected histologically. Results： A total of 528 patients met the criteria of GERD, among which 32 patients （20 male and 12 female） were diagnosed with BE. BE was present in 6.06% with a mean age of 51.2±11.6 years, which was significantly older than patients with GERD without BE （46.6±13.3 years） （P〈0.05）. There weresignificant differences between BE and GERD patients regarding gender, age, hiatus hernia, smoking and alcohol consumption （P〈0.05）, while no significant difference regarding symptoms of GERD. There was significant difference between short segment Barrett＇s esophagus and long segment （65.6% vs 34.4%, P〈0.05）. Conclusion： The prevalence of BE was 6.06% in patients with GERD in northwest China and was dominated by SSBE. The potential risk factors of Barrett＇s esophagus were older age, male, esophageal hiatal hernia, smoking and alcohol consumption.
文摘Colorectal cancers （CRC） account for frequent and serious cancers which result from the interaction between individual genetic factors and environmental factors, and in particular widely studied nutritional ones. The role of other occupational factors remains a controversial subject. The objective of this study is to evaluate the possible impact of occupational factors on the risk of developing CRC. Materials and Methods： This is a retrospective case-control study. The cases and the control group were enlisted in the general surgical ward of Farhat Hached Teaching Hospital of Sousse （Tunisia） during the period extending from 2004 to 2008, and they were age and gender-matched. The data were analyzed using SPSS 11.0 software with a signification threshold fixed at 5%. A univariate analysis was carried out as well as a multiple binary logistical regression. Results： During the period of the study, 40 cases of colorectal cancers have been colligated including 28 men and 12 women with a sex ratio of 0.43. The average age of the cases was 61.55 ± 13.3 years and 60.40 ± 12.84 years for the control group, with a non significant difference （P = 0.69）. The univariate analysis has objectivized significant associations between colorectal cancer and the housing conditions, the neoplastic and digestive family history, the occupational activity sector, exposure to pesticides, and lack of periodic medical supervision. After logistical regression, the occurrence risk of CRC was significantly associated with： alcohol and smoking （ORa = 3.43; Pa = 0.05）, meat consumption （ORa = 3.34; Pa = 0.03）, exposure to pesticides （ORa = 20.44; Pa = 0.012） and lack of periodic medical supervision （OR = 7.45; P = 0.004）. Conclusion： The occupational risk factors might play a role in the etiopathogenesis of colorectal cancers. With regard to our study, pesticides seem to be most implicated and necessitate suitable preventive measures. Nevertheless, it seems useful to multiply the studies to a much larger scale in order to further explore such relationship and to further reinforce the prevention of such serious disease.
基金Zhejiang Provincial Science Program (Grant No.Y2110004)Cultivation of High-level Innovation Health Talents (Grant No.2010-190-4)
文摘Diabetes is involved in the development of several cancers. However, whether type 2 diabetes mellitus （T2DM） as well as other potential risk factors are related to gastric cancer （GC） remains unclear. In this study, 1320 patients with gastric cancer （gastric cancer group） and 1252 thyroid nodule patients （control group）, who were admitted in our hospital from Jan 2010 to Dec 2012, were analyzed in a case-control study. Logistic regression analysis was applied to evaluate the risk of diabetes condition, gender, age, body-mass index （BMI） level and other factors for GC. There were 416 patients with DM in the gastric cancer group （31.5%） and 120 patients with DM in the control group （9.6%）. The differences between the two groups were significant （P = 0.000）. Compared with the control group, the logistic regression analyses suggested that male patients had a higher risk of GC. Moreover, older individuals （especially over 65 years） were more susceptible to GC, and as for T2DM, it was found to be associated with GC, that is, the incidence in the gastric cancer group was significantly higher than in the control group. The OR values of age, T2DM, gender and BMI were 16.951, 15.130, 2.658 and 0.224, respectively. In conclusion, age, gender and T2DM are the risk factors of gastric cancer. Furthermore, male patient over 65 years with T2DM is susceptible to GC, and T2DM is the risk factor only second to age, and there might be synergistic effects among these factors.
