上海市徐汇区胃癌高危患者定期胃镜检查依从性分析

目的 对上海市徐汇区胃癌高危患者进行定期胃镜检查依从性评价及高危人群对肿瘤防治的知识、态度和行为（KAP）调查。方法对206名胃癌高危患者定期胃镜检查依从性及KAP问卷调查。结果206名患者中完全依从者54人，不完全依从69人，不依从83人；胃癌高危人群的依从件分布，性别上具有统计学意义，女性的依从性好于男性；文化程度分布无统计学意义；就业状况、家庭收入状况具有统计学意义。结论本区胃癌高危患者定期胃镜检查依从性及肿瘤防治知识的知晓率均不高，需要在今后的工作中加强。     

基于Andersen模型探讨卒中二级预防药物依从性的影响因素

目的 分析卒中二级预防措施中药物治疗依从性的影响因素。 方法 基于Andersen卫生服务利用模型构建卒中二级预防药物依从性影响因素的理论框架,通过二分类logistic回归模型对卒中二级预防药物依从性的影响因素进行分析。 结果 617名卒中患者被纳入本次研究中,患者平均年龄（67±8.16）岁,男性占比50.1%,药物依从比为67.9%。多因素logistic回归模型结果显示,女性、参与城镇职工医疗保险、年均收入2万元以上与二级预防药物依从有关,年龄在70岁以上、有心脏病史和血脂异常病史、MRS评分25分与二级预防药物不依从有关。 结论 卒中二级预防药物依从性偏低,高龄、心脏病史、血脂异常史和较高MRS评分与药物不依从有关,应加强对具有上述影响因素的卒中患者提供预防性干预。     

安徽地区肝癌高危人群肝癌筛查依从性及其影响因素研究

目的探讨安徽地区肝癌高危人群肝癌筛查的依从性,并对相关影响因素进行分析,为制定相关管理策略提供参考依据。方法选取2020年11月至2022年5月于宿州市某医院参加体检且根据防癌评估结果评估为肝癌高风险成年居民为研究对象,进行腹部超声检查以及甲胎蛋白(α-fetoprotein,AFP)检测,采用自制调查问卷对肝癌高危人群进行问卷调查,对肝癌高危人群筛查情况进行分析,并通过单、多因素分析方法分析肝癌高危人群筛查依从性的影响因素。结果802例肝癌高危者中,有386例接受了随后的肝癌筛查,参与率为48.13%。多因素Logistic回归分析显示,年龄<60岁(OR=4.424)、汉族(OR=2.765)、饮酒(OR=5.551)、慢性肝炎(OR=4.250)、脂肪肝(OR=5.140)、胆结石病史(OR=2.757)、肝癌家族史(OR=5.590)是肝癌高危人群肝癌筛查依从性的独立影响因素。结论安徽地区肝癌高危人群肝癌筛查参与依从性不高,针对相关影响因素给予针对性的干预措施,对于提升筛查依从性具有重要价值。     

西安地区肝癌高危人群筛查依从性调查及影响因素研究

目的 调查西安地区≥40岁肝癌高危人群筛查依从性,并探讨其相关影响因素。方法 采用方便抽样方法抽取西安市≥40岁且在当地居住时间≥3年的居民参与肝癌高危人群评估,并对评估结果为肝癌高危的居民进行血液甲胎蛋白检测和腹部超声检查,采用描述性分析和多因素分析方法对筛查结果、筛查依从情况及其影响因素进行分析。结果 本研究对西安地区36 187名常住居民进行肝癌高危人群筛查,其中6 514例居民评估为肝癌高危,肝癌高危率为18.00%。其中男性高危者比例高于女性,99.08%为汉族,96.65%为已婚,年龄≥60岁人群的肝癌风险更高,多为初中及以上文化程度,88.12%的BMI值为18.5~27.9 kg/m²,58.40%有吸烟史,43.71%有饮酒习惯,44.00%有家族肿瘤史,71.17%伴有慢性丙型肝炎,97.19%伴有慢性乙型肝炎。6 514例肝癌高危人群中有3 192例参加肝癌筛查,肝癌筛查依从性为49.00%。多因素Logistic回归分析结果显示年龄（OR=0.444）、BMI（OR=0.694、0.820）、吸烟（OR=1.177）、饮酒（OR=1.178）、伴有慢性乙型肝炎（OR=1.266）、有家族肿瘤史（OR=1.579）、职业（OR=4.204）、锻炼次数（OR=0.774）、家庭人均月收入（OR=1.790）、定期参加检查（OR=2.542）是筛查依从性的影响因素。结论 西安地区肝癌高危人群筛查依从性整体偏低,影响筛查依从性的重要因素较多,可通过加强健康教育,增强医护患三方沟通来进一步完善筛查机制,提高筛查效率。     

贵阳市农村地区重性精神分裂症患者服药依从性现状及其影响因素分析

目的了解贵阳市农村地区重性精神分裂症患者服药依从性现状,探索影响患者服药依从性的相关因素,为提高患者服药依从性提供科学依据。方法在贵阳市农村地区采用多级阶段随机抽样方法,抽取425例被列入到重性精神疾病治疗管理系统中的重性精神分裂症患者,对其开展问卷调查,内容包括服药依从性及相关因素,分析患者服药依从性现状及其影响因素。结果贵阳市农村地区重性精神分裂症患者服药依从率为35.8%。单因素分析显示,依从服药的患者与不依从服药的患者年龄、病程、文化程度、居住方式、月药费和家属是否认为服药没用等因素存在统计学关联(P0.05);非条件Logistic回归结果显示,年龄、病程、文化程度、患者月药费、家属认为服药没用等因素与服药依从性有统计学关联(P0.05)。结论贵阳市农村地区重性精神分裂症患者服药依从率偏低,贫困、年龄大、病程长是其高危人群,应采取精准识别和帮扶的方式,对患者及其家属进行健康宣教,从而不断提高重性精神分裂症患者的服药依从率。     

肝癌筛查在我国人群中的可及性：一项探索性分析

目的系统量化肝癌筛查及监测服务在我国人群中的可及性, 尤其是可获得性维度的系列指标。方法参照国际权威机构对癌症筛查可获得性评价涉及的具体内容和指标, 包括当地相关政策方案、覆盖率、筛查参与率和依从率及影响因素、治疗率、接受度、公平性等, 通过系统综述方法, 结合核心文献/论著、官网、方案报告等渠道, 对我国人群肝癌筛查及监测相关指标进行系统整合评估。结果文献检索最终纳入34篇期刊论文, 多为地方性肝癌筛查参与率和监测依从率报道, 更多信息来自其他渠道。分析结果提示, 中央财政支持的3项癌症筛查服务项目, 均在特定地区和年龄段有针对一般风险人群的肝癌筛查方案推荐及实践评价, 针对筛查发现的不同高危人群有明确监测方案推荐。肝癌初筛的年度覆盖率在全国35～74岁人群中约为0.09%。因项目模式不同, 整体筛查参与率(参加复筛人数÷初筛阳性人数×100%)在37.5%～62.3%之间;监测依从率(参加监测人数÷复筛阳性需监测人数×100%)在纳入6项研究的M(Q1, Q3)为26.9%(23.5%, 41.0%);系统综述仅纳入2篇影响因素报道。全国大样本分析提示, 城市肝癌高危人群对甲胎蛋白...     

骨质疏松性椎体压缩性骨折二级预防依从性现状及其影响因素的统计分析

目的了解骨质疏松性椎体压缩性骨折患者的二级预防依从性现状,并对其影响因素进行统计分析。方法对2016年3月-2019年3月我院骨科收治的200例骨质疏松性椎体压缩性骨折患者采用一般疾病相关资料调查表、MMAS-8服药依从性量表及非药物依从行为调查问卷进行数据统计分析。结果服药依从性得分为(5.49±2.68)分,依从性较差;非药物依从性得分为(4.28±1.13)分,依从性尚可。经单因素、多元回归分析发现:受教育程度高、距上次住院时间短、住院次数多、与子女及配偶居住、合并其他疾病、骨水泥填充术后是骨质疏松性椎体压缩性骨折患者服药依从性的正向影响因素(P0.05);退休、工作时间短、收入高、受教育程度高、骨水泥填充术后与子女或配偶合居是非药物依从行为的正向影响因素(P0.05)。结论骨质疏松性椎体压缩性骨折患者二级预防的依从性整体较差,医护人员需根据主要影响因素及患者的基本情况对患者进行针对性的调整指导,从而更好地提高患者二级预防的依从性。     

海门市肝癌早诊早治的主要经验与成效分析

目的通过海门市肝癌早诊早治项目的筛查和随访复查,总结经验与成效。方法根据《中国癌症预防与控制规划纲要》和《中国癌症筛查及早诊早治技术方案》,筛查高危地区人群的乙肝表面抗原(HBsAg),建立HBsAg(+)队列人群,每年2次进行甲胎蛋白(AFP)联合B型超声检查,可疑患者再经医院进一步确认是否为肝癌。结果 2010—2012年2 123例乙肝病毒感染者建立HBsAg阳性队列,2010—2018年共随访21 093人次,发现肝癌71人,检出率0.34%。其中早期肝癌41人,早诊率57.75%;治疗68人,治疗率95.77%。肝癌早诊早治项目队列人群的肝癌早诊率(57.75%)明显高于2015年日常系统报告组(4.45%),差异有统计学意义(χ2=114.51,P0.01)。结论对HBsAg(+)队列人群进行定期随访复查,是早期发现肝癌,提高治疗效果的有效措施。     

慢性乙型肝炎病毒感染者肝癌筛查依从情况及结果分析

目的 探讨慢性乙型肝炎病毒感染者肝癌筛查依从情况。方法 以2022年1月至2023年3月在北京某医院治疗的病程满1年的慢性乙肝患者为研究对象定期进行肝癌筛查情况及相关因素调查,采用描述性分析方法对肝癌筛查依从性进行分析,并采用单、多因素分析方法对肝癌筛查依从影响因素进行分析。结果 本研究共调查病程满1年的慢性乙肝感染者224例,男172例,女52例,平均年龄（49.80±7.84）岁,定期进行肝癌筛查患者占31.25%(70/224),男性29.65%(51/172),女性36.53%(19/52)。多因素logistic回归分析结果显示年龄45～60、>60岁（OR=2.284、1.706）、长期接受健康宣传教育（OR=3.284）、有肝癌家族史（OR=2.552）、持续服用抗病毒药物（OR=1.517）、乙肝病毒基因阳性（OR=1.430）的患者其肝癌筛查依从可能性更高。结论 慢性乙型肝炎病毒感染者肝癌筛查依从性总体较差,可针对不同特征的慢性乙肝感染者开展健康宣教及定期回访的措施,对依从性差的感染者开展持续管理工作,以提高该人群的肝癌筛查的长期依从性。     

社区脑卒中二级预防的现状调查

目的调查社区脑卒中患者二级预防的用药现状,分析影响患者用药依从性的影响因素,为改善脑卒中二级预防提供理论依据。方法选取2015年3月—2018年3月洪都社区确诊为脑卒中患者。患者出院后予以电话随访或上门随访,并督促、指导患者治疗,对其出院后的治疗情况进行记录。调查患者出院后二级预防依从性情况,并采用Logistic回归模型分析其影响因素。结果患者出院后3、6和12个月能规律使用二级预防的依从良好率分别为82. 08%、60. 53%和40. 24%。调查分析结果显示,患者医保报销比例高、文化程度高、家庭条件好、有国家慢性病管理以及对脑卒中较为了解等是二级预防治疗依从性的促进因素,再次发生脑卒中患者有16. 01%,且血压控制情况、糖尿病控制、总胆固醇水平及房颤等均是导致脑卒中发生的独立危险因素(P <0. 05)。结论脑卒中患者的二级预防用药依从性普遍较差,需加强对医生、患者及家属二级预防的宣教,提高患者用药依从性,改善疾病结局。二级预防不仅仅在药物治疗方面,更应该重视患者及家属的健康教育,使他们认识到脑卒中的危害及预防措施,以达到二级预防的目的。     

乙肝患者口服核苷类药物依从性调查及干预策略

目的：了解慢性乙肝患者口服抗病毒药物依从性,对其进行有效干预,提高治疗效果。方法：对160例应用核苷类药物的慢性乙肝患者依从性现状进行调查,将服药依从性好者93例作为观察组,依从性差者67例作为对照组,比较两组患者年龄、自我评估病情、药物费用、肝病认知程度、担心不良反应、医疗费用支付方式、文化程度等方面的差异。结果：服药依从性良好者年龄、自感病情稳定、费用高、肝病认知程度较好、担心不良反应和初中以上文化程度分别是（46.8±5.4）岁、34.41%、47.31%、95.70%、22.58%、86.02%,服药依从性差者则是（51.4±4.7）岁、91.04%、79.10%、22.39%、70.15%、26.87%。结论：慢性乙肝患者口服核苷类药物依从性受多种因素影响,临床医生应依据患者情况设定个体化诊疗方案。     

Beliefs, social normative influences, and compliance with antihypertensive medication

We explored the relationship between beliefs and social normative influences and self-reported hypertension medication compliance using questionnaire items based on the belief intention model of Ajzen and Fishbein. Persons for whom antihypertensive medication had been prescribed were asked to agree or disagree with statements about taking their medicine. Respondents were a subset of participants in a 1980 survey of risk factors for heart disease in two Pennsylvania counties. Highly significant differences between compliant and noncompliant individuals were observed for all items except one referring to cost. A stepwise multiple logistic regression analysis was performed with age, sex, and the belief and social normative items as independent variables, and reported compliance as the dependent variable. Three variables, age, "taking my blood pressure medicine as the doctor told me would not be necessary when my blood pressure is normal," and "your family wants you to take your blood pressure medicine as the doctor told you," entering into the equation in that order, significantly improved discrimination between compliant and noncompliant persons. The questionnaire's success may have resulted from moving beyond assessing participant's knowledge or beliefs about hypertension in the abstract to ascertaining the direct relevance of these beliefs to their taking their medicine.     

原发性高血压患者防治依从性及血压控制达标调查

目的探讨原发性高血压患者防治依从性及血压控制达标情况,为控制原发性高血压的发展提供参考。方法选取2019年5月至2021年12月在庐江县中医院就诊的原发性高血压患者696例为研究对象,对患者进行问卷调查及体格调查,进一步分析不同人群特征、不同防治依从行为对血压控制达标的影响。结果696例原发性高血压患者中血压控制达标率为16.24%(113/696)。禁烟、限制饮酒、减少钠盐摄入、控制体重、适量运动、遵医嘱服药的依从性分别为24.86%、28.45%、64.51%、58.05%、66.38%、83.05%。多因素Logistic回归分析显示,年龄55~69岁(OR=1.567)、文化程度为高中/中专及以上(OR=2.849)、病程≤10年(OR=1.431)、禁烟依从性好(OR=1.852)、限制饮酒依从性好(OR=2.083)、减少钠盐摄入依从性好(OR=3.511)、控制体重依从性好(OR=1.145)、适量运动依从性好(OR=1.670)、遵医嘱服药依从性好(OR=1.399)的高血压患者血压控制达标的可能性较高。结论原发性高血压患者血压控制达标情况有待进一步提高,且与人群特征、防治依从项目密切相关,应针对重点人群、危险因素开展高血压综合防治,提高患者的防治依从性,促进血压控制达标。     

Alpha-particle-induced cancer in humans

Updated information is given on alpha-particle-induced cancer in persons internally exposed to 222Rn progeny, Thorotrast, long-lived 226Ra and 228Ra, and short-lived 224Ra. The lung cancer risk to persons breathing 222Rn progeny in the indoor air of offices, schools, and homes is of increasing concern. About half of the recent deaths among the German Thorotrast patients have been from liver cancer. Animal studies indicate that the liver cancer risk from Thorotrast is mainly from its radioactivity and that the risk coefficient for the Thorotrast patients can be used provisionally for other alpha emitters in the human liver. Six skeletal cancers have occurred in persons with average skeletal doses between 0.85 and 11.8 Gy from 226Ra and 228Ra. In the low-dose German 224Ra patients, two skeletal sarcomas have occurred at about 0.7 Gy compared to about six cases predicted by results from 224Ra patients at higher doses. The minimal appearance time for radiation-induced bone sarcomas in humans is about 4 y. Following brief irradiation, the vast majority of induced bone sarcomas are expressed by about 30 y. Recent evidence against the "practical threshold" hypothesis is given. With the downward revision of neutron doses to the atomic-bomb survivors, the follow-up of persons exposed to alpha particles may be the best opportunity to evaluate directly the effects of high LET radiation on humans.     

自贡市结核病患者依从性现状及影响因素调查

目的 通过对结核病患者的依从性进行调查,分析其影响因素,提出更具针对性的提高结核患者依从性的干预措施建议.方法 由调查人员逐题对四川省自贡市4区2县结核病归口治疗点2010年收治接受国家免费检查和治疗3个月以上全部144名患者进行询问,并填写调查表.结果 单因素分析的结果显示影响调查对象的治疗依从性的因素有是否复治、是否认为症状消失后就可以停止服药(P＜0.05);影响调查对象的用药依从性的因素有文化程度,完成全程治疗的信念,对主治医生服务是否满意,对治疗时间满意程度,对单次治疗费用满意程度和对治疗效果的满意程度(P＜0.05).多因素分析结果显示初次治疗患者的依从性较好(OR=0.290,P＜0.05),认为症状消失就可以停止服药的患者治疗依从性较差(OR =3.035);文化程度较高的患者用药依从性差(OR=0.275)和不明白医生意思的患者依从性差(OR =0.116).结论 结核病防治中需注意通过多种途径增强患者的治疗信心,加强对复治患者健康教育.必须尽快开展DOTS,并有必要通过社区动员、家庭健康教育和对医生的培训等途径加强结核病治疗的社会支持.     

The CAUSE Model: A Research-Supported Aid for Physicians Communicating With Patients About Cancer Risk

"Talk to your doctor" may be one of the most common pieces of advice given to help patients manage cancer risk. In fact, though, the support given to physicians for talking with patients about cancer prevention is not extensive. To address this need, we propose a decision aid for physicians. The CAUSE model draws on existing research, identifying common sources of tension or confusion in physician-patient interaction. Specifically, the model assists physicians in anticipating common barriers to effective communication and overcoming them to establish credibility, create awareness and understanding, gain agreement about solutions, and help patients enact solutions for the prevention of cancer.     

Organizing multicenter trials: lessons from the cooperative oncology groups

The execution of cancer clinical therapy trials has evolved over the past 45 years and is centered in the Clinical Oncology Group mechanism. The organization, statistical and administrative support, protocol development, and quality control systems have been worked out well and can be described in detail through the Eastern Cooperative Oncology Group. Prevention trials, on the other hand, are larger and fewer and take longer to complete. They involve people who are healthy or not as motivated to take pills or change lifestyle habits as those who are ill. The problems of compliance, toxicity, and costs become major issues. The practice of medicine is organized to take care of sick people and not healthy volunteers. We describe potential roles for Clinical Oncology Groups. These include preliminary tests of prevention agents for safety and toxicity much like Phase 1 trials with cytotoxic agents. A second important possible involvement would be to provide patients at high risk for developing second cancers, treatment- or non-treatment-induced, for prevention trials. A third set of individuals that can be recruited through current group resources are relatives of cancer patients who themselves might be highly motivated to participate in prevention trials. While the Clinical Oncology Groups may not have primary roles in prevention trials, they do represent a resource that has trial discipline and willingness and could facilitate the research efforts in chemoprevention.     

The CAUSE model: a research-supported aid for physicians communicating with patients about cancer risk

"Talk to your doctor" may be one of the most common pieces of advice given to help patients manage cancer risk. In fact, though, the support given to physicians for talking with patients about cancer prevention is not extensive. To address this need, we propose a decision aid for physicians. The CAUSE model draws on existing research, identifying common sources of tension or confusion in physician patient interaction. Specifically, the model assists physicians in anticipating common barriers to effective communication and overcoming them to establish credibility, create awareness and understanding, gain agreement about solutions, and help patients enact solutions for the prevention of cancer.