Risk factors, preventive interventions, overlapping symptoms, and clinical measures of delirium in elderly patients

Delirium is an acute reversible neuropsychiatric syndrome caused by multiple factors.It is associated with many adverse clinical outcomes including cognitive impairment,functional decline,prolonged hospitalization,and increased nursing service.The prevalence of delirium was high in department of cardiology,geriatric,and intensive care unit of hospital.With the increase in the aged population,further increases in delirium seem likely.However,it remains poorly recognized in the clinical practice.This article comprehensively discusses the latest research perspectives on the epidemiological data,risk factors,preventive interventions,overlapping symptoms,and clinical measures of delirium,including specific measures to manage delirium in clinical real-world situations.This article helps readers improve their knowledge and understanding of delirium and helps clinicians quickly identify and implement timely therapeutic measures to address various delirium subtypes that occur in the clinical settings to ensure patients are treated as aggressively as possible.

Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model

Background: Musculoskeletal injuries(MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training,operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available.Methods: A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed(using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made.Results: In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/nonmodifiable, as well as extrinsic/intrinsic risk factors.Conclusions: This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.

Report on Cardiovascular Health and Diseases in China 2021:An Updated Summary

In 2019,cardiovascular disease(CVD)accounted for 46.74%and 44.26%of all deaths in rural and urban areas,respectively.Two out of every five deaths were due to CVD.It is estimated that about 330 million patients suffer from CVD in China.The number of patients suffering from stroke,coronary heart disease,heart failure,pulmonary heart disease,atrial fibrillation,rheumatic heart disease,congenital heart disease,lower extremity artery disease and hypertension are 13.00 million,11.39 million,8.90 million,5.00 million,4.87 million,2.50 million,2.00 million,45.30 million,and 245.00 million,respectively.Given that China is challenged by the dual pressures of population aging and steady rise in the prevalence of metabolic risk factors,the burden caused by CVD will continue to increase,which has set new requirements for CVD prevention and treatment and the allocation of medical resources in China.It is important to reduce the prevalence through primary prevention,increase the allocation of medical resources for CVD emergency and critical care,and provide rehabilitation services and secondary prevention to reduce the risk of recurrence,re-hospitalization and disability in CVD survivors.The number of people suffering from hypertension,dyslipidemia and diabetes in China has reached hundreds of millions.Since blood pressure,blood lipids,and blood glucose levels rise mostly insidiously,vascular disease or even serious events such as myocardial infarction and stroke often already occured at the time of detection in this population.Hence,more strategies and tasks should be taken to prevent risk factors such as hypertension,dyslipidemia,diabetes,obesity,and smoking,and more efforts should be made in the assessment of cardiovascular health status and the prevention,treatment,and research of early pathological changes.

Report on Cardiovascular Health and Diseases in China 2022:an Updated Summary

In the past 30 years,the accessibility and quality index of medical care have made remarkable progress in China,ranking the first among middle-income countries.Many cardiovascular technologies are at or near the world's leading level,and significant progress has been achieved in China solving the problem of“treatment difficulty”of cardiovascular diseases(CVD).However,due to the prevalence of unhealthy lifestyles among Chinese residents,a huge population with CVD risk factors,accelerated population aging,and other reasons,the incidence and mortality rate of CVD are still increasing,and the turning point of the decline in disease burden has not appeared yet in China.In terms of proportions of disease mortality among urban and rural residents,CVD still ranks the first.In 2020,CVD accounted for 48.00%and 45.86%of the causes of death in rural and urban areas,respectively;two out of every five deaths were due to CVD.It is estimated that the number of current CVD patients in China is around 330 million,including 13 million stroke,11.39 million coronary heart disease,8.9 million heart failure,5 million pulmonary heart disease,4.87 million atrial fibrillation,2.5 million rheumatic heart disease,2 million congenital heart disease,45.3 million peripheral artery disease,and 245 million hypertension cases.China has entered a new stage of transformation from high-speed development to high-quality development,and the prevention and control of CVD in China should also shift from previous emphasis on scale growth to strategies focusing more on strategic and key technological development in order to curb the trend of increasing incidence and mortality rates of CVD.

Lifestyle intervention by group-based rehabilitation versus individual counseling in type 2 diabetes: 1-year follow-up of the Copenhagen type 2 diabetes rehabilitation project

Background: Today most guidelines on the management of type 2 diabetes incorporate lifestyle intervention including patient education, physical activity and dietary modification. However, the content and organization of lifestyle intervention programs are still debatable. Aims: To compare the longer term effectiveness of a group-based rehabilitation program with an individual counseling program at improving glycemic control, cardiovascular risk factors and quality of life among type 2 diabetes patients. Methods: We randomized 143 type 2 diabetes patients to either a 6-month group-based rehabilitation program, including patient education, supervised exercise, and diet intervention, or a 6-month individual counseling program. Follow-up time was 12 months after baseline. Outcome measures were glycated hemoglobin (HbA1c), cardiovascular risk factors, quality-of-life and self-rated health. Results: In the rehabilitation group, HbA1c decreased 0.2%-point (95% confidence interval [CI] = -0.4, -0.03), systolic blood pressure decreased 6 mmHg (95% CI = -9.3, -2.5), diastolic blood pressure decreased 4 mmHg (95% CI = -6.3, -2.4), weight decreased 2.2 kg (95% CI = -3.2, -1.3), and waist circumference decreased 2.0 cm (95% CI = -2.9, -1.1). In the individual group, HbA1c decreased 0.4% (95% CI = -0.6, -0.1), systolic blood pressure decreased 3 mmHg (95% CI = -6.3, -0.7), diastolic blood pressure decreased 3 mmHg (95% CI = -4.7, -0.7), weight decreased 1.6 kg (95% CI = -2.6, -.7]), and waist circumference decreased 1.6 cm (95% CI = -2.5, -0.6). Vitality, fatigue distress, physical functioning and cardiovascular distress improved over time (P < 0.05) in the two groups combined. Repeated measurement analysis did not result in significant differences between the groups of any outcome. Conclusions: This study demonstrates that group-based rehabilitation in a primary healthcare center is a comparable alternative to individual counseling in an outpatient clinic. However, the resource use of the rehabilitation program was twice as much as the individual program.

某妇幼专科医院儿童血液病医院血流感染相关危险因素及病原菌分析

目的对儿童血液病医院血流感染相关危险因素及病原菌分布情况进行分析,为临床风险识别及早期干预提供理论依据,进一步减少儿童血液病患儿医院血流感染的发生。方法采取病历调阅结合院感实时监控系统的方式,调查2018年1月至2022年12月期间该院收治血液病住院患儿共5259例。结果医院血流感染95例,感染率1.81%;血管导管相关血流感染5例(5.26%)。革兰氏阳性菌48株(50.53%),主要为草绿色链球菌及表皮葡萄球菌;革兰氏阴性菌45株(47.37%),主要为大肠埃希菌及肺炎克雷伯菌;真菌2株(2.10%),均为白色假丝酵母菌。革兰氏阴性菌占比呈现逐渐增加的趋势。95株病原菌中,多重耐药菌40株(42.11%)。恶性血液病、骨髓抑制、输血、中心静脉置管及住院时间>7 d是儿童血液病患儿发生医院血流感染的危险因素。结论应对儿童血液病患儿医院血流感染危险因素、病原菌类型及耐药情况进行实时监控、早期识别及风险评估;根据风险评估结果,采取合适及有效的感染防控措施,预防医院血流感染发生。

保理合同的法律适用及完善路径——以现代商法思维运用为视角

在界定现代商法思维基础上,对保理合同的金融商事属性作了辨识分析,并结合《民法典》保理合同的制度创新及实施问题,提出中国特色民商合一体例下应尊重保理业特殊规范性,运用现代商法思维予以解释论和立法论路径的进阶完善:针对保理合同适用主体、票据债权可否为保理标的、“将有债权”认定标准、保理融资利息/服务费等提出了商法解释论路径的解决之道;针对无保理商资质要求的合同效力认定问题,提出通过典外立法(特别商事单行条例)对保理商的金融主体属性、业务监管予以立法跟进,促其有良法可依,以更好防控风险、合规运作、稳定交易预期。

高速公路隧道运营安全风险评估与防控探究

为探究高速公路隧道运营安全风险因素和防控策略,通过分析高速公路隧道运营事故特性,从隧道土建结构、车辆、道路状况、人、管理水平等5方面解析隧道运营安全影响因素及作用机理,提出行之有效的防控策略。对提高隧道运营的安全性、降低事故发生率和减轻事故严重性具有重要意义。

体外膜肺氧合支持治疗患者医院感染危险因素及防控的研究进展

体外膜肺氧合(ECMO)支持治疗患者是医院感染的高风险人群。本文综述了ECMO支持治疗患者医院感染的危险因素与防控措施,并从患者相关因素、治疗相关因素及环境与设备因素阐明该人群医院感染的危险因素;防控措施涵盖合理置管、拔管操作,清洁消毒,建立专业团队,加强感染监测,监测药物浓度,导管材料的选择。本文旨在为医务人员提供前沿指导,加强对该领域的专业认知,以实现在ECMO支持治疗中最大限度地降低感染风险,提升患者的生存质量。

一线医务工作者的心理应激反应、影响因素及干预策略的研究进展:以新冠感染疫情为例

通过检索国内外新型冠状病毒感染疫情防控一线医务工作者心理健康相关文献,系统总结并分析一线医务工作者的心理应激反应、影响因素及干预策略。疫情防控一线医务工作者呈现出急慢性心理应激反应,包括失眠、疲劳等躯体症状,以及抑郁、焦虑、创伤后应激等心理症状。个体、工作和社会3个层面的风险和保护因素影响心理应激反应。线上和线下心理干预有助于缓解一线医务工作者压力。目前研究多聚焦于疫情暴发期,关于疫情长期影响的追踪研究较为匮乏;干预研究更多报道方案的开发和执行,而较少涉及干预效果的循证检验,未来可考虑结合数字化技术开发干预方案并检验干预效果。

青少年和年轻人结直肠癌特点及诊疗的研究进展

结直肠癌是较为常见的消化系统恶性肿瘤。近年来,随着人们生活方式、饮食结构的改变及环境污染的加剧,青少年和年轻人(AYAs)结直肠癌的发生率明显升高。AYAs是指15~39岁人群,与老年癌症患者相比,AYAs癌症患者具有更高的长期和晚期风险,预后更差,结直肠癌也成为导致AYAs死亡的重要原因。本研究以结直肠癌为切入点,分析AYAs结直肠癌的发病危险因素、临床特点,探讨AYAs结直肠癌的诊疗方法,以期为临床拟订防控措施提供依据。

凉山彝族自治州林火时空变化规律及火险区划研究

【目的】建立四川省凉山彝族自治州(简称凉山州)林火预测模型,为该地区林火防控和管理决策提供参考。【方法】基于凉山州2001-2015年MCD14DL的火灾数据集,采用核密度评估和空间自相关分析揭示火灾时空变化规律;选取多年平均气温、多年平均降水量、高程、坡度、坡向、植被类型、归一化植被指数、土地利用类型、人口密度、距最近道路距离等10个林火驱动因子,采用随机森林(RF)算法探究各林火驱动因子的影响程度并构建林火预测模型,利用受试者工作特征(ROC)曲线对模型精度进行评价,并完成对凉山州的火险区划。【结果】凉山州林火年际变化波动较大,月季变化显示林火集中发生在12月到次年5月,占全年火灾的96.86%;林火在空间上呈极显著集聚分布,中高和高核密度区域主要集中在德昌县、盐源县、会理县、西昌市、会东县和木里县,二者总面积占比为7.84%。RF模型结果表明,多年平均气温、多年平均降水量、人口密度、高程、归一化植被指数和坡度是林火发生的重要驱动因子,其中气象因子贡献最大;预测模型的ROC曲线下面积(AUC)值为0.873,约登指数为0.495,模型预测精度达到78.70%。依据RF模型,凉山州低风险火险区面积占比为72.61%,中、高风险火险区面积高达27.39%。【结论】凉山州中、高风险火险区域主要集中在南部和中部,少部分位于东北部,其中会理县、德昌县、宁南县、会东县、盐源县和西昌市是高风险林火频发区域,应重点关注这些区域,强化火灾防控措施与管控能力。

风险因素防控干预对宫颈癌患者围手术期负性情绪的影响

目的探讨风险因素防控干预对宫颈癌患者围手术期负性情绪的影响。方法依据围手术期干预方式的不同将85例宫颈癌患者分为对照组(n=43)和观察组(n=42),对照组患者给予常规干预,观察组患者给予风险因素防控干预。比较两组患者的负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、满意度、依从性、生活质量[癌症患者生命质量测定量表-宫颈癌模块(QLICP-CE)]和并发症发生情况。结果干预后,两组患者SAS、SDS评分均低于本组干预前,观察组患者SAS、SDS评分均低于对照组,差异均有统计学意义(P﹤0.05)。干预后,两组患者满意度、依从性评分均高于本组干预前,观察组患者满意度、依从性评分均高于对照组,差异均有统计学意义(P﹤0.05)。干预后,两组患者QLICP-CE量表各维度评分均高于本组干预前,观察组患者QLICP-CE量表各维度评分均高于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的并发症总发生率为11.90%,低于对照组患者的30.23%,差异有统计学意义(P﹤0.05)。结论风险因素防控干预可有效缓解宫颈癌患者围手术期焦虑、抑郁情绪,提高治疗满意度和依从性,改善生活质量并减少并发症的发生。

感染性腹泻患儿发病的相关影响因素及防治措施分析

目的探究感染性腹泻患儿发病的相关因素,为临床制定防治策略提供一定的依据。方法将吉安市青原区人民医院2020年3月至2023年3月收治的感染性腹泻患儿60例作为观察组,另将同期于吉安市青原区人民医院体检的健康儿童65例作为对照组。收集2组研究对象年龄、性别等资料,以logistic回归分析模型探究感染性腹泻发病的相关影响因素。结果2组研究对象性别、年龄、户籍、居住地、父母文化程度、儿童便后洗手、父母便后洗手占比比较,差异均无统计学意义(P>0.05)。观察组患儿饭前未洗手、有吮指行为、餐具未消毒、剩饭未及时处理、手指甲卫生差、最近1周有接触过腹泻患者占比均高于对照组,差异均有统计学意义(χ^(2)=23.706、25.893、37.987、52.377、13.556、15.342,P<0.05);logistic回归分析显示:儿童饭前未洗手[比值比(OR)=6.833,95%可信区间(95%CI)(3.044~15.340)]、儿童有吮指行为[OR=7.142,95%CI(3.247~15.709)]、餐具未消毒[OR=12.146,95%CI(5.199~28.375)]、剩饭未及时处理[OR=22.000,95%CI(8.731~55.437)]、手指甲卫生差[OR=3.941,95%CI(1.872~8.297)]、最近1周有接触过腹泻患者[OR=4.400,95%CI(2.058~9.405)]是感染性腹泻患儿发病的有关危险因素(P<0.05)。结论儿童家长应针对上述危险因素采取有效的防治措施,从多方面注意儿童手部卫生及饮食卫生,避免接触腹泻患者,可减少感染性腹泻发生。

孕产妇下肢深静脉血栓的危险因素分析及防控措施

目的探讨孕产妇发生下肢深静脉血栓的危险因素分析及护理防控措施。方法采集2019年10月-2023年2月于我院进行产检并分娩的88例孕产妇的临床资料分成两组进行回顾性分析。比较两组孕产妇凝血功能指标,采用单因素分析两组孕产妇临床资料,对其中差异有统计学意义的变量采用多因素Logistic回归分析。结果下肢深静脉血栓组孕产妇剖宫产分娩、产后出血量≥1000 mL、产褥期卧床时间≥72 h、有血栓史、有妊娠期高血压、有妊娠期糖尿病的占比均显著高于非下肢深静脉血栓组孕产妇(P<0.05)。多因素Logistic回归分析结果显示,剖宫产分娩、产后出血量≥1000 mL、产褥期卧床时间≥72h、有妊娠期高血压、有妊娠期糖尿病均为孕产妇发生下肢深静脉血栓的危险因素(P<0.05)。结论剖宫产分娩、产后出血量≥1000 mL、产褥期卧床时间≥72 h、有妊娠期高血压、有妊娠期糖尿病均为孕产妇发生下肢深静脉血栓的危险因素,可针对上述因素制定相关临床措施,预防孕产妇发生下肢深静脉血栓。

Trend analysis of noncommunicable diseases and their risk factors in Afghanistan

Background:Afghanistan is suffering from 40-year chronic conflicts,displacement,and demolition of its infrastructure.Afghanistan mortality survey 2010 shows nearly 46%of all deaths in the country were attributed to noncommunicable diseases(NCDs).In this study,we aimed to understand the differences in mortality and premature death due to NCDs by sex and the trend for the next 8 years.Methods:We applied trend analysis using the secondary data from the Institute for Health Metrics and Evaluation,Global Burden of Diseases 2019.The information on NCD mortality,NCD deaths attributed to its risk factors,NCD percent of total years lived with disability(YLDs)attribution to each risk factor extracted from this database from 2008 to 2019.We investigated the trend from 2008 to 2019 for the mentioned factors and then forecast their trends until 2030.Results:Our study shows that Afghanistan has had an increasing death number due to NCDs from 2008 to 2019(50%for both sexes)and this will reach nearly 54%by 2030.Currently,half of NCDs deaths are premature in Afghanistan.The mortality rate and prevalence of risk factors are higher among women.More than 70%of YLDs will be due to NCDs in Afghanistan till 2030.Five risk factors including high systolic blood pressure(28.3%),high body mass index(23.4%),high blood glucose(20.6%),high low-density lipoprotein cholesterol(16.3%),and smoking(12.3%)will have the highest contribution to NCDs death in 2030,respectively.Conclusions:In general,our study indicates that without any specific intervention to address NCDs in Afghanistan,not only the Sustainable Development Goal target for NCDs will not be met,but an increase in almost all risk factors prevalence,as well as NCD mortality,will be seen in Afghanistan.

呼吸机相关肺炎目标性监测研究进展

呼吸机相关肺炎(Ventilator-associated pneumonia,VAP)是指机械通气48 h后至拔管后48 h内出现的肺炎,是医院获得性肺炎的重要类型。目前,VAP发病率较高,是医院感染防控的重点及难点,因此探索VAP目标性监测研究显得尤为重要。本文结合近年来国内外对VAP的研究文献,围绕VAP相关定义、发病机制、流行病学、病原菌及其耐药性、生物膜、危险因素、防控措施等方面进行综述。文献复习结果表明,VAP的主要发病机制是呼吸道及机体防御系统受损、机械通气时病原菌侵入及定植。引起VAP的病原菌通常以混合细菌感染为主,主要是革兰阴性菌。我国各级医院的VAP在病原菌分布及其耐药性情况差异较大。VAP的危险因素主要有:病原微生物定植、有创机械通气时间、高龄、急性生理与慢性健康Ⅱ评分(APACHEⅡ)高、血清白蛋白低、预防性使用抗菌药物、留置胃管、糖皮质激素的使用、使用抑酸剂、侵入性操作、使用镇静药物、床头未抬高30°~45°。VAP预防控制措施主要分为核心预防措施、一般预防措施、不常规或不推荐预防措施3类。这些结果表明,VAP的精准防控可针对不同的危险因素提出相对应的预防与控制措施,从而降低VAP发病率及病死率。

医药协同管理模式对经皮冠状动脉介入治疗术后危险因素控制的影响

目的探讨医药协同管理模式对经皮冠状动脉介入治疗(PCI)术后危险因素控制的影响。方法选取安徽省阜阳市颍上县人民医院2020年1月至2021年11月接受PCI的患者180例,按随机数字表法分为观察组(医药协同管理模式)和对照组(仅医师管理),各90例。患者每月门诊随访1次,随访6个月。结果出院时两组患者各临床指标均无显著差异(P>0.05);随访6个月时,观察组低密度脂蛋白胆固醇达标率(75.56%比48.89%,P<0.001)、非高密度脂蛋白胆固醇达标率(64.44%比45.56%,P=0.011)、心率达标率(22.22%比6.67%,P=0.003)、β受体拮抗剂使用率(75.56%比53.33%,P=0.002)、血管紧张素转化酶抑制剂(或血管紧张素Ⅱ受体拮抗剂)使用率(77.78%比53.33%,P=0.001)及Morisky量表评分[(7.74±0.46)分比(7.11±0.77)分,P<0.001]均显著高于对照组。两组患者药品不良事件发生率无显著差异(2.22%比0,P>0.05)。结论医药协同管理可改善PCI术后患者的危险因素控制,提高患者的用药依从性。

家庭化产房发生医院感染的相关危险因素

目的探讨家庭化产房发生医院感染的相关危险因素及防治措施。方法回顾性选取2020年1月至2023年5月入住郑州人民医院家庭化产房的孕妇6100例,根据是否发生医院感染分为感染组(85例)和非感染组(6015例),比较两组临床资料,通过单因素及多因素logistic回归方程分析医院感染的影响因素。结果感染率为1.39%(85/6100),其中呼吸系统感染42例,生殖道感染20例,手术切口感染16例,泌尿系统感染7例。感染组体重指数≥28 kg·m^(-2)、瘢痕子宫、胎膜早破、妊娠糖尿病、妊娠高血压、白蛋白<35 g·L^(-1)、侵入性检查次数≥3次患者占比高于非感染组,白蛋白≥35 g·L^(-1)、产房定期通风患者占比低于对照组(P<0.05)。体重指数≥28 kg·m^(-2)、胎膜早破、侵入性检查次数≥3次是医院感染的高危因素,白蛋白≥35 g·L^(-1)是医院感染的保护因素(P<0.05)。模型预测感染的曲线下面积(AUC)为0.762,模型预测效能良好。结论家庭化产房产妇发生医院感染主要与体重指数、胎膜早破、侵入性检查次数、白蛋白等有关,logistic预测模型可为临床预测医院感染发生风险提供可靠参考,建议临床提前采取相应干预措施,减少医院感染发生,进而保证产妇和新生儿安全。

前列腺电切术后寒战的危险因素分析及防治策略研究

目的:分析前列腺电切术(TURP)术后寒战发生的危险因素,探讨具体防治措施。方法:回顾性分析2021年1月—2022年6月融通集团信阳154医院收治的125例TURP手术患者临床资料,归纳TURP术后寒战发生的危险因素,制定具体防治策略。结果:年龄<45岁、合并心血管病、术前焦虑自评量表(SAS)评分≥50分、抑郁自评量表(SDS)评分≥52分、社会再适应评定量表(SRRS)评分≥150分、术前视觉模拟量表(VAS)评分≥3分、术中中心体温≤36.0℃、手术时间≥1 h、术中出血量≥60 mL、冲洗后钠离子(Na+)≤135 mmol/L、钾离子(K+)≤3.5 mmol/L、术中平均动脉压(MAP)≤70 mmHg为导致TURP术后寒战发生的危险因素(OR=5.325、5.229、6.325、6.321、5.336、5.161、5.339、5.772、6.033、6.255,P<0.05)。结论:年龄较小且合并心血管病的TURP患者可因术前不良心理、疼痛及术中体温偏低、手术时间过长、出血量过大及电解质、体征紊乱等相关因素而发生术后寒战,术前心理干预、疼痛管理,术中保温措施、体征监测为防治术后寒战的重要举措。