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。

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。

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.

慢性非传染性疾病病因研究内容与方法的发展趋势

慢性非传染性疾病(简称慢性病)具有起病隐匿、病程长、病情迁延不愈的特点,并且呈现动态发展过程,其病因具有多效性、稳健性和重塑性特性,因而使人体的健康状态和疾病过程呈现一种相互交织的网络形态。因此,需要打破还原论的静态思维,在研究策略上向系统生物学的复杂性思维转变。充分发挥多组学技术优势,以整合理念为核心,关注研究对象在基因组—暴露组—表型组多层次的相互作用,揭示疾病在全生命周期中不同阶段、不同组学层次间呈现的动态性、多效性、适应性的网络关联。将研究的视角从“单一疾病”转变为“多病”医学,以“疾病为导向”转变为“以人为导向”,从多维度、多层次、多时点的病因网络出发,探明在慢性病发生发展过程中发挥关键作用的分子标志物集群已成为慢性病病因学研究的前沿热点。

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。

临床老年慢性非传染性疾病患者5年代谢指标变化趋势的关联研究

目的:探究老年慢性非传染性疾病患者5年代谢指标变化趋势以及代谢指标之间的相关性。方法:2016年1月至12月基线纳入上海交通大学医学院附属瑞金医院老年病科收治的159例慢性非传染性疾病患者,年龄(66.2±7.4)岁。连续随访至2020年12月,每年采集临床资料与生化指标。运用Spearman相关性分析检测基线各代谢指标间的相关性及各代谢指标5年变化间的相关性。结果:Spearman相关分析显示,基线横断面分析中,受试者收缩压与2 h血糖(r=0.371)、空腹胰岛素(r=0.287)、C反应蛋白(r=0.379)、血尿酸(r=0.268)水平呈正相关(均P<0.05),与高密度脂蛋白(r=-0.308)和载脂蛋白A(r=-0.311)呈负相关(均P<0.05);另外收缩压水平的变化与C反应蛋白水平的变化呈正相关(r=0.305,P<0.05),与高密度脂蛋白水平的变化呈负相关(r=-0.269,P<0.05);糖代谢指标中的空腹胰岛素及2 h胰岛素与低密度脂蛋白(r分别为0.349、0.287)、空腹胰岛素及2 h胰岛素与载脂蛋白B(r分别为0.290、0.259)、2 h血糖及空腹胰岛素与血尿酸(r分别为0.287、0.327)水平的变化呈正相关(均P<0.05);高密度脂蛋白和载脂蛋白A水平的变化与C反应蛋白(r分别为-0.295、-0.377)、血尿酸(r分别为-0.263、-0.262)水平的变化呈负相关(P<0.05),低密度脂蛋白和载脂蛋白B水平的变化与血尿酸(r分别为0.258、0.257)水平的变化呈正相关(P<0.05)。结论:老年慢性非传染性疾病患者的血压、血糖、血脂和炎症指标变化间具有相关性,呈现协同变化趋势。

2015-2020年北京市通州区重点慢性病早死概率预期目标分析

目的 分析2015-2020年北京市通州区户籍人口四类慢性病早死概率变化趋势,为慢性病防治提供科学依据。方法 利用全国死因登记报告信息系统中北京市通州区的死亡登记资料,计算四类慢性病早死概率及年度变化百分比,分析其变化趋势。结果 2015-2020年北京市通州区户籍人口慢性病死亡构成比从86.05%下降至84.89%,差异有统计学意义(t=-2.548,P=0.063),标化死亡率从423.36/10万下降至381.05/10万(t=-4.006,P=0.016);心脑血管疾病和恶性肿瘤早死概率呈下降趋势,差异有统计学意义(t=-7.099、-4.810, P=0.002、 0.009),慢性呼吸系统疾病和糖尿病早死概率有所下降,但差异无统计学意义(t=-2.576、-2.070,P=0.062、0.107)。历年男性慢性病标化死亡率显著高于女性,同时四类慢性病早死概率均高于女性。2020年与2015年相比,男性四类慢性病合计、心脑血管疾病、恶性肿瘤、慢性呼吸系统疾病和糖尿病早死概率的年均下降速度分别为4.31%、 3.64%、4.95%、11.79%和3.80%;女性四类慢性病合计、心脑血管疾病、慢性呼吸系统疾病、糖尿病和恶性肿瘤早死概率的年均下降速度分别为7.54%、11.98%、4.74%、0.54%和10.21%。男性糖尿病早死概率虽然呈下降趋势,年均下降速度为3.80%,但差异无统计学意义(t=-0.943,P=0.399);女性慢性呼吸系统疾病早死概率则无明显下降趋势。结论 北京市通州区四类慢性病早死概率呈下降趋势,根据四类慢性病早死概率变化趋势推算,2030年四类慢性病预期早死概率能够达到“健康中国2030”规划纲要求下降30%的目标,仍需加强女性重点人群和重点疾病的防治。

常用的慢性非传染性疾病患者健康评估工具简介

本文通过系统查阅国内外相关文献,对常用的慢性非传染性疾病(简称“慢病”)患者的健康评估工具进行了综述,对相关内容进行梳理与展示。目前,常用于慢病患者的评估工具主要包括单项健康评估工具及老年人健康综合评估工具,本文简介常用的评估工具及其使用场景,利用这些健康评估工具,可对患者精神心理、社会功能、生活能力等进行评估,以实现对慢病患者更为精准的照护。相关工作的开展可提高医护人员对健康评估工具的认知,为临床工作中正确评估慢病患者健康水平和实施健康管理提供参考依据。

互联网医院全程管理对慢性非传染性疾病患者服药依从性及生活质量影响的Meta分析

目的评价互联网医院全程管理对慢性非传染性疾病(简称慢性病)患者服药依从性及生活质量的影响。方法计算机检索PubMed、Embase、Web of Science、The Cochrane Library、中国知网、中国生物医学文献数据库、万方数据库、维普数据库及手动检索数据库中关于互联网医院全程管理对慢性病患者管理效果的随机对照试验,检索时限为建库起至2022年3月。由2名经过循证护理培训的研究者独立筛选文献、质量评价、提取资料,采用RevMan5.3软件进行Meta分析。结果共纳入13篇文献(涉及5239例患者),纳入文献的方法学质量较高,但异质性较大。Meta分析结果显示,实验组(在传统慢性病管理的基础上采用互联网医院全程管理)服药依从性优于对照组(采用传统慢性病管理模式)[OR=3.02,95%CI(1.98,4.60),Z=5.15,P<0.01],生活质量得分高于对照组[SMD=0.90,95%CI(0.32,1.48),Z=3.04,P<0.01],差异均具有统计学意义;对患者服药依从性进行敏感性分析显示,各研究间无异质性(I²=6%,P<0.01),合并效应值OR=4.15(Z=5.61,P<0.01)。结论目前证据表明,互联网医院全程管理可提高慢性病患者服药依从性、改善其生活质量,建议今后开展更多高质量、多中心的随机对照研究,为未来互联网医院全程管理模式的推广使用提供更有力的循证依据。

社区慢性病医护一体化健康教育模式的研究进展

综述了医护一体化健康教育模式的概念及步骤、在社区中为慢性病病人实施医护一体化健康教育模式的应用方式、应用效果以及社区慢性病医护一体化健康教育的拓展研究,为我国进一步开展社区慢性病医护一体化健康教育模式提供思路。

2022年上海奉贤区钱桥社区老年人健康体检结果分析

目的:了解上海市奉贤区钱桥社区60岁以上老年人的总体健康状况,为进一步开展社区健康管理工作提供理论依据。方法:通过收集本社区2022年度60岁及以上老年人健康体检信息,对5913名居民的体检数据进行分析。结果:社区老年人主要以慢性非传染性疾病患病为主,血压升高、贫血、超重肥胖、高血糖、血脂异常、高尿酸血症等指标的检出率分别为73.70%、48.77%、25.45%、22.85%、13.21%、12.80%。除高血糖、超重肥胖外,男性和女性的其余指标差异均有统计学意义(均P<0.05);各年龄组的指标异常检出率差异均有统计学意义(均P<0.05)。患有2种及以上疾病的人群占比65.03%,女性居民的疾病共病患病率(70.63%)高于男性(58.07%);随着年龄的增加,疾病共病患病率逐渐增加;差别均有统计学意义(均P<0.05)。结论:社区老年人的血压升高、贫血、超重肥胖、高血糖的检出率较高,提示社区慢性非传染病防控形势不容乐观,应加强对老年人慢性病的随访管理和干预,提高老年人自我健康管理能力,推进健康老龄化行动。

老年慢性疾病病人社会参与的研究进展

介绍老年慢性非传染性疾病病人社会参与概述、影响因素及其对疾病影响,为提高老年慢性病病人社会参与水平提供参考依据。

慢性非传染性疾病病人创伤后成长的研究进展

对慢性非传染性疾病病人创伤后成长的影响因素以及干预措施进行综述,旨在为学者今后开展该领域的研究提供理论依据,以指导慢性病病人实现积极心理调适,提高慢性病病人创伤后成长水平。

2020年上海松江区永丰街道户籍居民死因监测结果分析

目的:了解上海松江区永丰街道户籍居民的死亡率和主要死亡原因,为辖区开展疾病预防控制工作、制定预防保健措施提供科学依据。方法:按照国际疾病分类法(ICD-10)编码对上海松江区永丰街道户籍居民2020年死亡资料进行分类整理和分析。结果:2020年上海松江区永丰街道户籍居民死亡率为681.71/10万,主要死因为恶性肿瘤、循环系统疾病、呼吸系统疾病,占总死亡的78.85%。结论:慢性非传染性疾病为上海松江区永丰街道户籍居民的主要死因,应针对居民死因疾病谱对目标人群制订有效的控制策略和措施。