Health evaluation method for degrading systems subject to dependent competing risks

This paper proposes a health evaluation method for degrading systems subject to competing risks of dependent soft and hard failures. To characterize the time-varying degradation rate, the degradation process is determined by a non-stationary Gamma process and the soft failure is encountered when it exceeds a predefined critical level. For the hard failure, a Cox’s proportional hazard model is applied to describe the hazard rate of the time to system failure. The dependent relationship is modeled by incorporating the degradation process as a time-varying covariate into the Cox’s proportional hazard model. To facilitate the health characteristics evaluation, a discretization technique is applied both to the degradation process and the monitoring time.All health characteristics can be obtained in the explicit form using the transition probability matrix, which is computationally attractive for practical applications. Finally, a numerical analysis is carried out to show the effectiveness and the performance of the proposed health evaluation method.

VOR and CVOR Index for Health Evaluation of Typical Steppe in Inner Mongolia

[Objective] The aim of this study was to evaluate the effect of livestock exclusion on the health of grassland ecosystem accurately and quantitatively. [Method] One open grazing site and five seasonal exclusion sites, which had the same vegetation composition （taking Leymus chinensis and Stipa krylovii as main species） and soil type, were chosen as research objects for the VOR and CVOR evaluation of the effect of open grazing and livestock exclusion on the health of typical steppes, and for building the calculation model for VOR and CVOR indices to evaluate the health of typical steppes with different exclusion periods. [ Result] The VOR and CVOR composite indices both could accurately evaluate the health of typical steppes, and the evaluation results from the both indices were quite consistent. Although the condition （C）, vigor（V）, organization （O） and resilience（ R ） indices changed differently in different exclusion periods, the VOR and CVOR composite indices increased gradually with the peri- od of exclusion prolonged, and the health condition of typical steppe changed from ＂alert＂ level （in the open grazing and earlier exclusion period） to ＂healthy＂ level （after 13 to 20 years＇exclusion）. [ Conclusion] The application of exclusion was beneficial to the recovery of degraded grassland ecosystem.

Health economic evaluation on population-based Helicobacter pylori eradication and endoscopic screening for gastric cancer prevention

Gastric cancer is a global public health burden, nearly one million new cases are diagnosed per year worldwide, of which 44% of cases occur in China. The prognosis of gastric cancer varies remarkably by the stage of cancer, and most of the patients in China are diagnosed at advanced stages, resulting in poor prognoses. Effective strategies to reduce the burden of gastric cancer include primary prevention through testing and treatment of Helicobacter pylori(H. pylori) and secondary prevention by screening and early detection. Although many countries have issued management guidelines and consensus reports concerning these strategies, the limited availability of healthcare resources often precludes their widespread implementation. Therefore, assessing the costs, benefits, and harms of population-based intervention measures through health economic evaluation is necessary for informed health policy decisions. Accordingly, we synthesize management approaches from different countries on H. pylori eradication and endoscopic screening, and also summarize recent advancements in health economic evaluations on population-based preventive strategies. The goal of the review is to provide empirical evidence supporting optimal resource allocation, maximizing benefits for the population, and ultimately reducing the burden of gastric cancer.

An Evaluation on Smoking-induced Health Costs in China (1988-1989)

A study on smoking-attributable health economic costs in China was conducted from 1988-1992, in which three major categories of chronic diseases, diseases of cancer, diseases of circulatory system, and diseases of respiratory system were included. A prevalence-based method which estimated the cumulative effect of cigarette smoking during the past 20-30years was used. The results show that in 1989, the total smoking-attributable economic costs to health sectors in China were about 27.1 billion of Chinese Yuan, including about 7 billion Yuan in direct medical costs and 20 billion Yuan in indirect costs, which include indirect morbidity costs and indirect mortality costs. The relatively low direct costs reflected the low medical costs at hospitals in China at that time. And the high proportion of indirect costs relative to the total costs shows the high potential years of life lost due to clgarette smoking. The results also show the heavier health burden in urban areas than in rural areas, reflecting the worse situation in urban China at nowadays. But if considering that almost 80% of the Chinese are rural farmers with the higher smoking prevalence and relatively shorter history of manufactured cigarette smoking than their urban counterparts,the very frightful situation due to cigarette smoking would be for China in the next century

Prospective evaluation of health status, quality of life and clinical outcomes following implantable defibrillator generator exchange

BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Serial assessments of health status were performed by administering the 36-Item Short Form Survey(SF-36).RESULTS Mean age was 67.5±14.3 years,left ventricle ejection fraction(LVEF)was 36.5%±15.0%and over 40%of the cohort had improved LVEF to>35%at the time of GE.SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being(P<0.001 for each comparison).Physical health scores were significantly worse among those with medical comorbidities including diabetes,chronic obstructive pulmonary disease and atrial fibrillation.Mean follow-up was 1.6±0.5 years after GE.Overall SF-36 scores remained stable across all domains during follow-up.Survival at 3 years post-GE was estimated at 80%.Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin.Four patients experienced appropriate ICD shocks after GE,three of whom had LVEF which remains impaired LVEF(i.e.,<35%)at the time of GE.CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being,which is associated with the presence of medical comorbidities.In terms of clinical outcomes,the incidence of appropriate shocks after GE among those with improvement in LVEF is very low,and most deaths post-procedure appear to be non-arrhythmic in origin.These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.

Longitudinal Care Evaluation in Child Healthcare

Objective: To evaluate the essential attribute of Primary Health Care, longitudinal care, care directed at children from birth to two years old. Methods: This is a descriptive and exploratory study of evaluative character and quantitative approach, conducted with parents/caregivers of 186 children, younger than two years old, patients of primary health care services in the city of Santa Cruz/RN, Brazil. For data collection, the instrument Primary Care Assessment Tools (PCA Tools) was used, and the results of the questions dealing with longitudinal attribute were evaluated. The data were stored and processed in Statistical Package for Social Sciences (SPSS). The study was approved by the Research Ethics Committee of the Health Sciences School of Trairí, under number 348896. Results: The mean age of children in months was 8.21;84.4% (n = 157) were assisted by the same doctor/nurse every time;in 81.7% (n = 152) of cases the doctor/nurse know the full medical history of the child;73.7% (n = 137) answered that the professional know their child more as a person than just as someone with a health problem;48.9% (n = 91) stated that the doctor/nurse do not know their family very well;86.6% (n = 161) reported finding the doctor/nurse understands what is saying or questioning;96.2 (n = 179) of respondents said the doctor/nurse answers the questions so that they understand;96.2% (n = 179) of the interviewed said they feel comfortable telling the concerns or problems of their child to the doctor/nurse;66.7% (n = 124) claimed that they would not change the service/doctor/nurse to another health service. Conclusion: It is concluded that the attribute was well rated by the mothers of children seen in primary health care services and that they can establish good communication and relationship with the health professionals who treat their children.

Concept and evaluation of bay health:the role of numerical model in the Yueqing Bay,China

To better evaluate the three-dimensional bay health and predict the dynamic bay health conditions, a concept of numerical bay health was introduced and a method of numerical bay health evaluation（NBHE） was developed.To support the NBHE method, a numerical bay health index（NBHI） system was constructed, which assess the natural and socio-economic effects on the entire bay. Five index groups are combined to formulate the NBHI,including geometry, hydrodynamics and sediment dynamics, bio-ecology, water quality and socio-economy.Each group has different number of indices selected and weighted using AHP method according to their importance. Data were mainly synthesized from a variety of numerical models together with monitoring programs, which provide superior to other approaches in discriminating data integrity and predicting data in future. The NBHE method using NBHI system was applied in the Yueqing Bay during spring tide in April 2007.According to the NBHE results, Sta. A, at the surface level of the estuarine mouth, has a healthy geometry condition, sub-healthy hydrodynamic and sediment dynamic condition, and unhealthy water quality and bioecology conditions. The integrated healthy score at Sta. A indicates its sub-healthy condition.

Assessment of the Accessibility of Users in Primary Health Care

Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will propose improvement in the offered assistance. Methods: This is a quantitative and evaluative study made in the municipality of Santa Cruz, State of Rio Grande do Norte, Brazil, with a sample of 180 people. The study was approved by the Ethics and Research Committee of the Federal University of Rio Grande do Norte under Opinion number 152/2012. Results: It was found that the adult population classified the quality of care from regular to good, showing an association with the waiting time, time spent from the unit to one’s house and the reception. Conclusions: It could be concluded that this study contributes to the development of strategies able to provide a full and equitable care to the adult population in the primary health care network, since this is the gateway to other levels of care, because it aims to promote adult health and prevent diseases.

Assessment of Comprehensive Health Care of the Elderly in Primary Health Care

Objective: To assess comprehensive care in the elderly population, as well as the quality of care in Primary Health Care. Methods: This is an exploratory descriptive study with a quantitative approach, conducted from July to December 2012, in the city of Santa Cruz, Rio Grande do Norte, Brazil. A sample of 130 subjects chosen by drawn was calculated, and data collection was performed at their homes. Results: There were interviewed 130 people, 92 (70.8%) women and 38 men (29.2%), with a minimum age of 60 and maximum of 96 years, with a mean of 72.8, median of 72.0 and a standard deviation of 8.3. Regarding the quality of care ratings of the PHC team, 48.5% (n = 63) of respondents stated this to be good, while 32.3% (n = 42) rated this as fair. Conclusions: In this perspective, one of the most appreciated meanings that were given to comprehensive care by health care professionals refers to holistic knowledge of each patient, resulting in the non-fragmentation of care. Thus, it is noticed that comprehensiveness has some weaknesses that need to be corrected, which shows the need for education and training of professionals assigned to primary health care services.

Importance-performance analysis: Revisiting a tool for the evaluation of clinical services

The importance-performance analysis method (IPA) is used in market research in order to measure the level of customer satisfaction. The aim of this study was to evaluate and highlight the use of IPA as a management tool to measure quality of dental services. We suggest that this method can be easily implemented in a dental educational setting, as a performance outcome measure that includes patient input. The study was conducted in a dental service through a valid questionnaire, SERVQUAL. This instrument explores levels of service quality perceived by patients. It was conducted in four companies in Brazil in 2011 (derived from different industry segments;two from textiles, one from hospital care and the other from the manufacturing industry) in two States (S?o Paulo and Minas Gerais). These companies were covered by the same dental managed care organization which contracted with independent dentists to provide care. The study was divided into two stages: the first, in which beneficiaries answered the questionnaire prior to receiving dental treatment, and the second when the same beneficiaries answered after completing their dental treatment. Data obtained from SERVQUAL generated graphs that were used to characterize the IPA matrix using several dimensions of care. The Assurance Dimension had the highest average in both expectation and perception. The Reliability dimension showed the value of the most negative GAP among the dimensions, and the best value occurred in the Responsiveness dimension. The IPA tool may be effective in Dental Medicine since it highlights the key points to be improved in the delivery of dental services in a clinical setting.

The Role of Health Inequality in the Maternal Health Services Provided by Public Institutions in Mexico

This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We consider the most important service providers corresponding to the main health institutions in Mexico (IMSS, ISSSTE, SESAS, IMSS-Oportunidades). Therefore, a cross-sectional prospective study was conducted to analyze eight intervention packages (Prenatal Care, Syphilis, Influenza, Obstetric Urgent Care, HIV in pregnancy, delivery care, neonatal care and accessibility) offered by the Maternal and Perinatal Health (MPH) program. A quantitative analysis demonstrates low to marginal performance of the MPH program in three regions (South, Mexico City-State of Mexico and the Northwest) and marginal in two other regions (Central and Northeast). Furthermore, four of the intervention packages presented the lowest performance in the South (Prenatal Care, Syphilis, Influenza and Obstetric Urgent Care), as did the average of the total of the MPH packages. The performance of HIV in Pregnancy package was marginal in the Southern and Mexico City-State of Mexico regions and Neonatal Care was low in the Northwest. The assessment of the MPH intervention packages allows us to identify their strengths and weaknesses. This information allows us to identify similarities and differences among the geographical regions in order to describe and analyze the strengths, weaknesses, opportunities and threats in the current system and hence to improve the decision making regarding the Maternal and Perinatal Health Programs in Mexico. The results suggest that a homogenization has taken place in terms of the low quality of the services.

Economic Evaluation of Gastroscopy for Detecting Gastric Cancer in Chinese Natural Population

Objective To evaluate the economy of detecting gastric cancer by electronic gastroscope in Chinese natural population of different ages and genders.Methods A Markov model was constructed for the population,including both men and women of different ages.The model cycle was one year and the simulation time was 60 years.The cost-effectiveness of electronic gastroscopy in detecting gastric cancer of general population in China was analyzed from the perspective of the whole society,and the stability of the results was verified by sensitivity analysis.Results and Conclusion For the general population,the incremental cost-effectiveness ratio(ICER)of gastric cancer screening from the age of 50 is 50143 yuan/QALY(quality-adjusted life-year),which is less than two times of per capita gross domestic product(GDP)compared with the screening from the age of 55.For men who start gastric cancer screening at the age of 50,the ICER is 38525 yuan/QALY,which is less than two times of per capita GDP,and it is economical.For women who start the screening from the age of 55,the ICER is 47814 yuan/QALY,which is less than two times of per capita GDP,so it is economical.The results of sensitivity analysis are consistent with the conclusions of basic analysis,and the results of basic analysis are stable.For the general population,it is more economical to start gastric cancer screening from the age of 50,while for men and women,it is more economical to start gastric cancer screening from the age of 50 and 55,respectively.

Long-term feeding of sand rice(Agriophyllum squarrosum seed)can improve the antioxidant capacity of mice

Unhealthy eating habits with sugar-rich and high-fat foods can bring nutritional imbalance and other chronic diseases. At present, there is an increasing demand in regulating human sub-health through functional foods. Agriophyllum squarrosum(L.) Moq., a pioneer plant native to sand dunes with ecological restoration function, is a traditional food plant of sand regions and Mongolian folk medicine. Numerous studies have confirmed that A. squarrosum seed, also called sand rice, has high nutritional value. However, the long-term health effects of eating sand rice remain unclear. To better explore and evaluate its long-term effects, hereby, ICR mice were fed with sand rice flour at different ratios(control, 60% and 95%) for 100 days. Results show that the growth and blood glucose level curve of these experimental mice were lower and more stable than that of the control. In addition, mice fed pure sand rice ingredient(95%) gained more stable body weight and blood glucose after 28 days, which revealed that sand rice is a food with comprehensive nutritional value and rarely negatively impacts the body growth performance. Our data also demonstrates that, the content of triglyceride(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C) and high-density lipoprotein cholesterol(HDL-C) provided the lowest level in the blood of mice with a diet of pure sand rice ingredient, 0.48, 4.14, 0.91, 3.03 mmol/L, respectively. Also, T-SOD and GSH-PX activity provided a high level in mice with pure sand rice gradient, which significantly increased by 36%(T-SOD)and 19%(GSH-PX) compared to the control. These results suggest that long term intake of the pure sand rice ingredients is more helpful for stabilizing blood lipid and improve antioxidant capacity and beneficial to people suffering from chronic disease. This study supplies the first animal evidence to support the claim that sand rice is a promising functional food with comprehensive nutrition in the future. We are confident that, with increasing demands of daily sand rice usage, planting A. squarrosum in the vast desert regions will further increase the local economy and ecological restoration when coping with global warming.

Predictors of irreversible intestinal resection in patients with acute mesenteric venous thrombosis

BACKGROUND Acute mesenteric venous thrombosis(AMVT)can cause a poor prognosis.Prompt transcatheter thrombolysis(TT)can achieve early mesenteric revascularization.However,irreversible intestinal ischemia still occurs and the mechanism is still unclear.AIM To evaluate the clinical outcomes of and to identify predictive factors for irreversible intestinal ischemia requiring surgical resection in AMVT patients treated by TT.METHODS The records of consecutive patients with AMVT treated by TT from January 2010 to October 2017 were retrospectively analyzed.We compared patients who required resection of irreversible intestinal ischemia to patients who did not require.RESULTS Among 58 patients,prompt TT was carried out 28.5 h after admission.A total of 42(72.4%)patients underwent arteriovenous combined thrombolysis,and 16(27.6%)underwent arterial thrombolysis alone.The overall 30-d mortality rate was 8.6%.Irreversible intestinal ischemia was indicated in 32(55.2%)patients,who had a higher 30-d mortality and a longer in-hospital stay than patients without resection.The significant independent predictors of irreversible intestinal ischemia were Acute Physiology and Chronic Health Evaluation(APACHE)II score(odds ratio=2.368,95% confidence interval:1.047-5.357,P=0.038)and leukocytosis(odds ratio=2.058,95% confidence interval:1.085-3.903,P=0.027).Using the receiver operating characteristic curve,the cutoff values of the APACHE II score and leukocytosis for predicting the onset of irreversible intestinal ischemia were calculated to be 8.5 and 12×10^9/L,respectively.CONCLUSION Prompt TT could achieve a favorable outcome in AMVT patients.High APACHE II score and leukocytosis can significantly predict the occurrence of irreversible intestinal ischemia.Therefore,close monitoring of these factors may help with the early identification of patients with irreversible intestinal ischemia,in whom ultimately surgical resection is required,before the initiation of TT.

Multi-scale evaluation of river health in Liao River Basin,China

Previous studies on river health evaluation mainly focused on characterizations at a river-corridor scale and ignored the complex interactions between the river ecosystem and other components of the river basin.Based on the consideration of the interactions among rivers,associated river basin and habitats,an assessment framework with multi-scale indicators was developed.An index system divided among these three scales to characterize the health of river ecosystems in China’s Liao River Basin was established.Set pair analysis was applied to integrate the multi-scale indicators and determine the health classes.The evaluation results indicated that the rivers in the western and eastern zones of the Liao River were classified as sick,and rivers in the main stream of the Liao and Huntai rivers were classified as unhealthy.An excessive level of disturbances,such as large pollution loads and dense construction of water conservation projects within the river basin,were the main causes of the river health deterioration.

Multicentered prospective investigator initiated study to evaluate the clinical outcomes with extracorporeal cytokine adsorption device (CytoSorb®) in patients with sepsis and septic shock

BACKGROUND Sepsis is a severe clinical syndrome related to the host response to infection.The severity of infections is due to an activation cascade that will lead to an auto amplifying cytokine production:The cytokine storm.Hemoadsorption by CytoSorb®therapy is a new technology that helps to address the cytokine storm and to regain control over various inflammatory conditions.AIM To evaluate prospectively CytoSorb®therapy used as an adjunctive therapy along with standard of care in septic patients admitted to intensive care unit(ICU).METHODS This was a prospective,real time,investigator initiated,observational multicenter study conducted in patients admitted to the ICU with sepsis and septic shock.The improvement of mean arterial pressure and reduction of vasopressor needs were evaluated as primary outcome.The change in laboratory parameters,sepsis scores[acute physiology and chronic health evaluation(APACHE II)and sequential organ failure assessment(SOFA)]and vital parameters were considered as secondary outcome.The outcomes were also evaluated in the survivor and nonsurvivor group.Descriptive statistics were used;a P value<0.05 was considered RESULTS Overall,45 patients aged≥18 and≤80 years were included;the majority were men(n=31;69.0%),with mean age 47.16±14.11 years.Post CytoSorb®therapy,26 patients survived and 3 patients were lost to follow-up.In the survivor group,the percentage dose reduction in vasopressor was norepinephrine(51.4%),epinephrine(69.4%)and vasopressin(13.9%).A reduction in interleukin-6 levels(52.3%)was observed in the survivor group.Platelet count improved to 30.1%(P=0.2938),and total lung capacity count significantly reduced by 33%(P<0.0001).Serum creatinine and serum lactate were reduced by 33.3%(P=0.0190)and 39.4%(P=0.0120),respectively.The mean APACHE II score was 25.46±2.91 and SOFA scores was 12.90±4.02 before initiation of CytoSorb®therapy,and they were reduced significantly post therapy(APACHE II 20.1±2.47;P<0.0001 and SOFA 9.04±3.00;P=0.0003)in the survivor group.The predicted mortality in our patient population before CytoSorb®therapy was 56.5%,and it was reduced to 48.8%(actual mortality)after CytoSorb®therapy.We reported 75%survival rate in patients given treatment in<24 h of ICU admission and 68%survival rates in patients given treatment within 24-48 h of ICU admission.In the survivor group,the average number of days spent in the ICU was 4.44±1.66 d;while in the nonsurvivor group,the average number of days spent in ICU was 8.5±15.9 d.CytoSorb®therapy was safe and well tolerated with no adverse events reported.CONCLUSION CytoSorb®might be an effective adjuvant therapy in stabilizing sepsis and septic shock patients.However,it is advisable to start the therapy at an early stage(preferably within 24 h after onset of septic shock).

Physical activity in primary and secondary prevention of cardiovascular disease:Overview updated

Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.

Outcome of treatment seeking rural gamblers attending a nurse-led cognitive-behaviour therapy service:A pilot study

Objectives:Little is known about the differences between urban and rural gamblers in Australia,in terms of comorbidity and treatment outcome.Health disparities exist between urban and rural areas in terms of accessibility,availability,and acceptability of treatment programs for problem gamblers.However,evidence supporting cognitivebehaviour therapy as the main treatment for problem gamblers is strong.This pilot study aimed to assess the outcome of a Cognitive-Behavioural Therapy(CBT)treatment program offered to urban and rural treatment-seeking gamblers.Methods:People who presented for treatment at a nurse-led Cognitive-Behavioural Therapy(CBT)gambling treatment service were invited to take part in this study.A standardised clinical assessment and treatment service was provided to all participants.A series of validated questionnaires were given to all participants at(a)assessment,(b)discharge,(c)at a one-month,and(d)at a 3-month follow-up visit.Results:Differences emerged between urban and rural treatment-seeking gamblers.While overall treatment outcomes were much the same at three months after treatment,rural gamblers appeared to respond more rapidly and to have sustained improvements over time.Conclusion:This study suggests that rural problem gamblers experience different levels of co-morbid anxiety and depression from their urban counterparts,but once in treatment appear to respond quicker.ACBT approach was found to be effective in treating rural gamblers and outcomes were maintained.Ensuring better availability and access to such treatment in rural areas is important.Nurses are in a position as the majority health professional in rural areas to provide such help.

BRCA1/2基因检测在乳腺癌防治中的卫生经济学评价系统综述

目的评估BRCA基因检测策略在乳腺癌防治中的全球最新成本效果证据,了解不同条件下哪种策略具有性价比,并比较现有的相关卫生经济学评价研究中方法学的异同,为我国BRCA基因检测策略的规划开展和后续原始研究的设计实施提供依据。方法系统检索了2015年3月1日—2020年8月8日国内外已发表的相关文献,总结归纳相关证据,解析纳入研究的建模方法,尤其关注模型结构、模型有效性和不确定性分析,并进行质量评价。结果共纳入17篇文献,涵盖3类BRCA基因检测策略:①面向普通人群(全人群策略);②符合临床或家族历史标准的高危人群(常规策略);③面向乳腺癌或卵巢癌患者(即基于癌症患者的策略)。研究整体质量评价得分较高,以马尔科夫队列模型居多。结论全人群策略和基于癌症患者并结合级联筛查的策略在英国和美国目标人群中更具成本效果优势,但尚未见两者直接比较研究。其他国家人群的相关研究偏少,但普遍表明常规策略或基于癌症患者的策略仍优于不开展任何BRCA检测。后续研究需重点关注对预防性手术的获益和风险、检测技术准确度以及密切影像学监测接受度的充分模拟,并加强模型验证。

Comparison of Charlson＇s weighted index of comorbidities with the chronic health score for the prediction of mortality in septic patients

Background Comorbidity is one of the most important determinants ot short-term and long-term outcomes in septic patients. Charlson＇s weighted index of comorbidities （WIC） and the chronic health score （CHS）, which is a component of the acute physiology and chronic health evaluation （APACHE） II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit （ICU） patients with sepsis. Methods A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of- sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score （APS）, sequential organ failure assessment （SOFA） and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WlC and CHS. The area under the receiver operating characteristic curve （AUC） was used to predict hospital mortality over classes of risk. Results Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WlC, CHS, APACHE II, and SOFA scores than the non-surviving patients （P 〈0.05）. Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WlC, CHS and APS scores （P 〈0.05）. The AUC for the hospital mortality were 0.564 （95% confidence interval （CO 0.496-0.631） of CHS, 0.663 （95% CI 0.599-0.727） of WIC, 0.770 （95% CI 0.718-0.822） of APACHE II, 0.856 （95% Cl 0.815-0.897） of the CHS combined with other administrative data, and 0.857 （95% CI 0.817-0.897） of the WlC combined with other administrative data. The diagnostic value of WIC was better than that of CHS （P=0.0015）. Conclusions The WlC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WlC might be an even better predictor of the mortality of septic patients with comorbidities than CHS. Chin Med J 2014;127 （14）： 2623-2627