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.

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。

Satisfaction about Patient-centeredness and Healthcare System among Patients with Chronic Multimorbidity

The aim of the present study was to measure the prevalence of multimorbidity in Bangladesh,India and China,and to assess the relationship between multimorbidity and patient＇s opinion regarding their involvement in healthcare decision-making and overall satisfaction of healthcare system.Cross-sectional data on 18 696 men and women aged 18 and above were collected from the World Health Survey of World Health Organization（WHO）.Outcome variables were subjective rating of（1） healthcare system＇s ability to involve patients in decision-making,and（2） satisfaction with the way healthcare system runs in the country.Self-reported chronic conditions were used to measure the prevalence of multimorbidity.Out of 9 chronic conditions,back pain,arthritis,and chronic cough appeared to be the most prevalent ones among majority of the participants.About one-third of the participants in China（30.7%） and two-thirds in Bangladesh（66.1%） and India（66.6%） reported having at least one chronic illness.Prevalence of multimorbidity was highest in India（34.3%） followed by Bangladesh（28.8%） and China（14.3%）.In Bangladesh,India and China,respectively 70.5%,41.7%,61.3% women and 54.5%,42.8% and 58.8 % men expressed dissatisfaction regarding the way healthcare system runs in their country.In Bangladesh and India,men who were living with multimorbidity were more likely to rate the patient-centeredness as ＂bad＂ than those who had no disease illness.This study suggests that the prevalence of multimorbidity was remarkably high especially in Bangladesh and India.Higher likelihood of dissatisfaction about healthcare system among multimorbid patients might be indicative of inadequacy in the provision of care in qualitative and quantitative terms.Key words

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。

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。

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。

我国慢性病可避免住院费用变化趋势分析

目的:核算分析我国慢性病可避免住院费用变化趋势,为提高我国医疗资源利用效率提供政策依据。方法:以卫生费用核算体系(SHA2011)为基础,按照可避免住院疾病范围,核算分析2016—2020年我国慢性病可避免住院费用总量和结构的变化趋势。结果:从机构流向看,我国慢性病可避免住院费用主要发生在各级医院,县级医院占比不断提高;从人群分布看,可避免住院费用主要发生在慢性阻塞性肺病、心绞痛、糖尿病,心力衰竭、心绞痛、支气管扩张的可避免住院费用仍处于上涨趋势;从年龄分布看,超七成可避免住院费用发生在60岁及以上人群,其中60~74岁人群可避免住院费用增速最快。结论:我国慢性病可避免住院费用仍处于高位,但增速有所放缓;应加强对重点人群和疾病的健康管理,从患者、服务提供及支付方式等多方发力,减少可避免住院的发生;同时构建可避免住院监测指标体系,促进监测和评价指标体系的应用。

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。

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。

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.

重庆市与贵州省基本公共卫生服务NCD健康管理影响因素调查研究

目的分析重庆市与贵州省慢性非传染性疾病(NCD)健康管理情况及其影响因素。方法采用分层随机抽样,从重庆市和贵州省抽取16个有代表性的基层医疗卫生机构作为研究地点,通过定性和定量研究相结合的方法收集资料。结果共调查760例NCD患者,NCD健康管理项目的知晓率、利用率、满意度均超过84.2%,随访和分类干预的知晓率、利用率、满意度最低。<60岁患者的高血压体检知晓率低于60~<70岁患者(OR=4.28,95%CI:1.43~12.81)和≥70岁患者(OR=3.16,95%CI:1.12~8.91);<60岁患者的糖尿病筛查利用率低于≥70岁患者(OR=2.70,95%CI:1.08~6.76),体检知晓率低于60~<70岁患者(OR=4.24,95%CI:1.01~17.75);重庆市患者的高血压体检知晓率高于贵州省(OR=0.15,95%CI:0.04~0.54),利用情况好于贵州省(OR=0.13,95%CI:0.05~0.34)。访谈结果发现,部分社区未开展分类干预项目,农村患者的满意度高于城市。结论重庆市和贵州省NCD管理服务总体情况较好,但随访和分类干预项目服务质量有待进一步提高。

上海静安区静安寺街道社区卫生诊断分析

目的 :分析社区需优先解决的卫生健康问题,为制定有针对性的社区卫生工作规划提供依据。方法 :收集2020年1月-2022年12月上海静安区静安寺街道社区现况资料和居民健康资料,分析社区卫生健康问题。结果 :静安寺街道的人口老龄化率达到35.2%,在全区14个街镇中处于高位,且高于全市23.4%的比例(P <0.05)。循环系统、肿瘤、呼吸系统以及内分泌、营养和代谢四大类疾病是静安寺街道社区居民前四位的死因疾病。静安寺街道医疗卫生资源丰富,社区卫生服务中心每千人口全科医生数达到0.95,高于本市卫生健康发展“十四五”规划中提到的2025年达到0.45左右的目标(P <0.05)。静安寺商圈楼宇林立,数量庞大的白领人群的医疗卫生需求,成为社区主要关注的健康问题之一。结论 :静安寺街道社区结构呈现多元化,既是一个人口深度老龄化社区,又是楼宇林立、白领人群众多的城市核心商圈。面对不同的人群,不同的卫生健康需求,要充分发挥街道内丰富的医疗资源优势,大力提升“全专结合”医疗服务和“医防融合”健康管理服务能力,推动分级诊疗制度建设运行,推进家庭医生签约老年人、慢性病患者、白领等重点人群服务高质量发展,推行社区卫生服务向机关事业单位、产业园区、商务楼宇等功能社区延伸。

Knowledge, Attitudes, Practices, and Perceptions for Salt/Sodium Reduction in the Gastronomic Sector of Costa Rica

Excess sodium intake is associated with high blood pressure and cardiovascular diseases. This study examined food services in Costa Rica as a major source of sodium. The research included six cafeterias, six fast food establishments, 13 restaurants, and 15 diners using non-probabilistic convenience sampling. Interviews were conducted with workers to assess knowledge, attitudes, and practices regarding salt reduction. The findings were analyzed to determine effective intervention strategies. Participants showed regular knowledge about salt/sodium. While they recognized the link with high blood pressure, understanding of other health problems was limited. Positive attitudes were observed toward healthy cooking and reducing sodium in pre-prepared food, especially in restaurants. Over 70% expressed a desire to reduce salt in food services, with more than 80% indicating a need for staff training, particularly in cafeterias lacking knowledge of low-salt preparations. High-sodium ingredients were prevalent, with saltshakers and sauces readily available. However, some individuals were reluctant to reduce salt/sodium intake, citing concerns about taste, food variety, and customer complaints. Obstacles to reducing salt/sodium levels included limited accessibility and the cost of low-sodium ingredients. The data collection tools and methodologies used in this study can serve as a foundation for future investigations and strategies to reduce salt consumption in food services. The study recommends government support for transforming the gastronomic sector and implementing regulations and knowledge enhancement. Collaboration with the productive sector is crucial for creating healthy environments. This research presents valuable evidence regarding the utilization of salt and sodium in the gastronomic sector, thereby assisting in the decision-making process for public health initiatives and the prevention of non-communicable chronic diseases. It highlights the significance of tackling sodium reduction in food services to encourage the adoption of healthy culinary practices and enhance the overall health of the population.

“互联网+”视角下可穿戴设备助力基层慢性病管理

强化对慢性病患者的管理是我国未来慢性病防治规划中的重要课题。面临人口基数大、患病人数多、管理人员不足等困境,随着可穿戴设备的兴起,以“互联网+可穿戴设备”为代表的新型慢性病管理模式或可化解困难,助力基层医疗机构更好、更高效地服务慢性病患者。本文基于国内外相关研究,对可穿戴设备在慢性病人群中的应用现状及挑战进行了回顾,以期为可穿戴设备在基层慢性病管理中推广使用提供参考。

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。