1990年和2019年中国分省精神障碍伤残负担分析

目的分析1990年和2019年中国人群精神障碍患病及伤残负担变化情况, 为降低精神障碍健康危害提供参考。方法利用2019年全球疾病负担(Global Burden of Disease Study 2019, GBD2019)中国研究结果, 分析2019年中国人群不同年龄、不同性别、不同省份精神障碍患病及伤残负担, 比较1990年与2019年中国精神障碍的患病和伤残损失寿命年(years of life lived with disability, YLDs)指标变化情况。结果 2019年中国精神障碍50～69岁年龄组患病率最高(13.2%, 患病人数为4 853.0万), 0～14岁年龄组患病率最低(7.3%, 患病人数为1 645.6万);女性总体YLDs数量高于男性(1 091.0万人年/938.2万人年);2019年抑郁障碍、焦虑症、精神分裂症的标化患病率分别为2.7%、3.2%、0.3%, 患病人数分别为5 005.6万、4 784.2万、549.9万;与1990年比较, 抑郁障碍和焦虑症的标化患病率下降幅度分别为9.1%和9.8%, 精神分裂症的标化患病率上升幅度为3.1%...     

二十一世纪中国精神医学的思考——由《全球疾病负担研究》引发的联想

1993年,世界卫生组织、世界银行和美国哈佛大学,联合开展了一项名为《全球疾病负担研究》(Global Burden of Diseases,GBD)的研究。该研究发展了“伤残调整生命年”(Disability Adjusted Life Year, DALY)的概念,以疾病/外伤造成的DALY减少为单位(DALYs),评估社会整体的疾病负担。 传统的疾病流行状况及其严重度的研究,多数以发病率/患病率、或者病死率/死亡率为参数,用以评估疾病负担时有一定弊端。容易造成对高发病率(如上呼吸道感染)或高死亡率的疾病负担过高估     

中国卒中报告2019（中文版）（1）

中国卒中防治正面临巨大挑战。2018年，中国脑血管病的死亡率为149.49/10万，造成了157 万人死亡。脑血管病是我国居民的第三位死亡原因，位列恶性肿瘤和心脏病之后。2013年，卒中年龄 标化患病率和发病率分别为1114.8/10万和246.8/10万人年。根据2017年全球疾病负担研究，1990- 2017年卒中造成的过早死亡损失寿命年（year of life lost，YLL）增加了14.6％，卒中由造成YLL的第三 位原因跃升为第一位；卒中造成的全年龄组伤残调整生命年（disability-adjusted life year，DALY）的 绝对数和百分率也呈持续增长趋势，2017年卒中是造成全年龄组DALY的首位原因。脑血管病的主要 危险因素包括行为危险因素（如吸烟和酗酒）和既往疾病（如高血压、糖尿病、血脂异常和心房颤 动）。卒中存活者中最普遍的危险因素是高血压（63.0％～84.2％）和吸烟（31.7％～47.6％），心房 颤动的比例相对最低（2.7％～7.4％）。这些主要的危险因素在人群中流行水平也较高，并呈持续 增长的趋势。根据最新的国家流行病学调查数据，我国15岁及以上人群的现在吸烟率为26.6％（现 在吸烟人数为3.08亿）。18岁及以上人群的高血压年龄标化患病率为25.2％；高胆固醇血症的标 化患病率为5.8％；糖尿病标化患病率为10.9％。40岁及以上人群心房颤动的标化患病率为2.31％。 医院质量监测系统（Hospital Quality Monitoring System，HQMS）数据显示，2018年我国1853家三级 医院共计收治3 010 204例卒中住院患者，其中2 466 785例（81.9%）为缺血性卒中（ischemic stroke， IS），447 609例（14.9%）为脑出血（intracerebral hemorrhage，ICH），95 810例（3.2%）为蛛网膜下腔 出血（subarachnoid hemorrhage，SAH）。入院患者的平均年龄为66岁，近60%为男性。在IS、ICH和SAH 中，分别有1555例（0.1%）、2774例（0.6%）和1347例（1.4%）为儿童卒中（年龄<18岁）。超过三分之 一（1 063 892例，35.3%）患者的医保类型为城镇居民基本医疗保险，其次是城镇职工基本医疗保 险（699 513例，23.2%）和新型农村合作医疗保险（489 361例，16.3%）。卒中患者的主要危险因素为 高血压（IS：67.4%，ICH：77.2%，SAH：49.1%），主要并发症是肺炎或肺部感染（IS：10.1%，ICH：31.4%， SAH：25.2%）。卒中住院患者的死亡/非医嘱离院率为8.3%，从IS患者的5.8%到ICH患者的19.5%。住 院时间的中位数（四分位数间距）为10.0（7.0～14.0）d，从IS患者的10.0（7.0～13.0）d到SAH患者的 14.0（8.0～22.0）d。中国卒中中心联盟的数据显示，指南推荐的IS、ICH和SAH患者关键绩效指标执行 的综合评分分别为0.77±0.21、0.72±0.28和0.59±0.32。     

中国卒中报告2019（中文版）（1）

中国卒中防治正面临巨大挑战。2018年，中国脑血管病的死亡率为149.49/10万，造成了157
万人死亡。脑血管病是我国居民的第三位死亡原因，位列恶性肿瘤和心脏病之后。2013年，卒中年龄
标化患病率和发病率分别为1114.8/10万和246.8/10万人年。根据2017年全球疾病负担研究，1990-
2017年卒中造成的过早死亡损失寿命年（year of life lost，YLL）增加了14.6％，卒中由造成YLL的第三
位原因跃升为第一位；卒中造成的全年龄组伤残调整生命年（disability-adjusted life year，DALY）的
绝对数和百分率也呈持续增长趋势，2017年卒中是造成全年龄组DALY的首位原因。脑血管病的主要
危险因素包括行为危险因素（如吸烟和酗酒）和既往疾病（如高血压、糖尿病、血脂异常和心房颤
动）。卒中存活者中最普遍的危险因素是高血压（63.0％～84.2％）和吸烟（31.7％～47.6％），心房
颤动的比例相对最低（2.7％～7.4％）。这些主要的危险因素在人群中流行水平也较高，并呈持续
增长的趋势。根据最新的国家流行病学调查数据，我国15岁及以上人群的现在吸烟率为26.6％（现
在吸烟人数为3.08亿）。18岁及以上人群的高血压年龄标化患病率为25.2％；高胆固醇血症的标
化患病率为5.8％；糖尿病标化患病率为10.9％。40岁及以上人群心房颤动的标化患病率为2.31％。
医院质量监测系统（Hospital Quality Monitoring System，HQMS）数据显示，2018年我国1853家三级
医院共计收治3 010 204例卒中住院患者，其中2 466 785例（81.9%）为缺血性卒中（ischemic stroke，
IS），447 609例（14.9%）为脑出血（intracerebral hemorrhage，ICH），95 810例（3.2%）为蛛网膜下腔
出血（subarachnoid hemorrhage，SAH）。入院患者的平均年龄为66岁，近60%为男性。在IS、ICH和SAH
中，分别有1555例（0.1%）、2774例（0.6%）和1347例（1.4%）为儿童卒中（年龄<18岁）。超过三分之
一（1 063 892例，35.3%）患者的医保类型为城镇居民基本医疗保险，其次是城镇职工基本医疗保
险（699 513例，23.2%）和新型农村合作医疗保险（489 361例，16.3%）。卒中患者的主要危险因素为
高血压（IS：67.4%，ICH：77.2%，SAH：49.1%），主要并发症是肺炎或肺部感染（IS：10.1%，ICH：31.4%，
SAH：25.2%）。卒中住院患者的死亡/非医嘱离院率为8.3%，从IS患者的5.8%到ICH患者的19.5%。住
院时间的中位数（四分位数间距）为10.0（7.0～14.0）d，从IS患者的10.0（7.0～13.0）d到SAH患者的
14.0（8.0～22.0）d。中国卒中中心联盟的数据显示，指南推荐的IS、ICH和SAH患者关键绩效指标执行
的综合评分分别为0.77±0.21、0.72±0.28和0.59±0.32。     

成都市精神卫生服务资源五年发展分析

目的 对比分析2012年及2017年成都市精神卫生资源,了解成都市精神卫生医疗机构建设发展的现状和问题,为制定下一步精神卫生体系、人力和服务发展规划提供参考。 方法 于2018年1月-3月,采用成都市精神卫生资源调查表对2017年成都市行政区域内精神卫生医疗机构的床位、人力资源、业务开展情况等进行调查。 结果 2017年成都市实有开设精神科并开展业务的医疗机构共60家,编制床位数4 503张,床位密度3.14张/万人,分别较2012年增长了43.73%、17.60%;实有床位数9 647张,床位密度为6.65张/万人,分别较2012年增长了82.09%、47.12%。2017年成都市精神卫生医疗机构有精神科医生677人（4.71人/每10万人）、精神科护士1 511人（10.53人/每10万人）,分别较2012年增长了2.17%、5.94%。2017年成都市精神科共接收门诊患者792 874人次,住院患者43 981人次,分别较2012年增长了76.09%、78.08%。平均每名精神科医生年负担门诊患者1 171人次、住院患者65人次,分别较2012年增长了40.75%、41.30%。 结论 与2012年相比,2017年成都市的精神卫生医疗机构数量急增;精神科开放床位数量已可以满足中等需求,精神科医疗服务量明显增加,但精神科医护人员并无明显增长。     

上海市浦东新区精神疾病患者期望寿命回顾性分析

目的了解上海市浦东新区精神疾病患者的期望寿命,以探讨精神疾病对期望寿命的影响。方法将浦东新区1999—2008年精神疾病患者与该区普通人群进行比对,采用标准化死亡率,期望寿命等指标进行分析。结果 1999—2008年浦东新区精神疾病患者累计死亡率为13.26‰,标化死亡率为12.57‰,15岁后的各年龄组的标化死亡率均高于普通人群;性别对精神疾病患者的标化死亡率的无影响;10岁组精神疾病患者期望寿命为63.0岁,低于浦东新区普通人群的期望寿命（72.1岁）。结论人群罹患精神疾病后期望寿命较普通人群低。     

上海市青浦区居民脑卒中死亡特征和早病死概率分析

目的分析上海市青浦区居民脑卒中死亡特征和早病死概率情况,为制定脑卒中有效预防控制措施提供依据。方法对2017年上海市青浦区心脑血管急性事件登记报告的339例脑卒中死亡病例进行统计分析。结果 2017年上海市青浦区户籍居民脑卒中死亡率为70. 53/10万,标化死亡率为20. 01/10万;男性死亡率为75. 29/10万,标化死亡率22. 16/10万;女性死亡率为65. 92/10万,标化死亡率17. 84/10万。30～69岁年龄组男性早死亡率和早病死概率(25. 91/10万和0. 94%)均高于女性(8. 34/10万和0. 34%),差异有统计学意义(P 0. 05)。死亡率随年龄的增长而呈上升趋势,死亡病例主要集中在60岁及以上年龄组,占全部死亡病例的93. 80%。脑卒中死亡前3位的疾病类型为脑梗死(非腔隙性) I63例(47. 49%)、脑卒中不分型I64例(25. 96%)、脑内出血I61例(24. 78%)。结论脑卒中是影响农村社区人群健康的重要公共卫生问题。随着人口老龄化形势严峻,应重视男性和老年人脑卒中高危人群的筛查和干预工作,从而降低脑卒中对居民健康和生活的影响。     

1975至2014年上海市静安区户籍人口脑血管病死亡的流行趋势分析

目的 了解1975至2014年上海市静安区户籍人口脑血管病死亡的流行趋势,为制定预防控制策略和 措施提供科学依据。 方法 利用静安区1975至2014年居民死因监测资料,计算脑血管病粗死亡率,标化死亡率,40年间死 亡率变化趋势及平均死亡年龄的变化趋势。 结果 1975至2014年上海市静安区户籍人口脑血管病死亡的平均粗死亡率及标化死亡率分别为 165.60/10万和120.54/10万,男女性的死亡率差异无统计学意义;40年间脑血管病粗死亡率呈上升趋 势（χ 2 趋势=10.58,P <0.001）,标化死亡率呈逐年下降的线性趋势,用SAS系统中的AUTOREG（自回归） 过程进行时间序列线性趋势拟合,回归模型有意义（t =32.13,P <0.001）;脑血管病平均死亡年龄呈 逐年上升的线性趋势,采用时间序列线性趋势拟合,回归模型有意义（t =260.46,P <0.001）。 结论 本文的研究结果提示上海市脑血管病的患病率将持续升高,而脑血管病的存活年龄逐年上升。     

辽宁省城乡居民脑卒中疾病负担分析

目的探讨辽宁省城乡居民脑卒中疾病负担的水平及其分布特征、方法根据辽宁省2003年城乡居民脑卒中患病率和死亡率资料,采用全球疾病负担(GBD)分析方法计算脑卒中的伤残调整寿命年(DALY)。结果2003年辽宁省每千人因脑卒中损失17．2个健康生命年,脑卒中引起的DALY损失农村高于城市(18．8∶14．1),男性高于女性(20．2∶14．1)。结论辽宁省脑卒中每千人DALY是GBD2000对中国估计的1．6倍,农村和男性是脑卒中防治的重点。     

2018年上海市静安区心脑血管急性事件流行病学特征分析

目的 通过分析2018年上海市静安区心脑血管急性事件的流行病学特征，为心脑血管疾病防控提 供参考。 方法 收集静安区2018年心脑血管急性事件监测系统中户籍居民发病资料，分析静安区心脑血管急 性事件的流行病学特征。 结果 2018年，静安区心血管急性事件报告发病率为72.45/10万，标化发病率为40.89/10万。脑血管急 性事件报告发病率为753.03/10万，标化发病率为353.68/10万。其中，卒中报告发病率为420.31/10万，标 化发病率为208.36/10万；腔隙性脑梗死报告发病率为251.48/10万，标化发病率为107.05/10万；TIA报告 发病率为81.25/10万，标化发病率为38.28/10万。心血管急性事件男性标化发病率高于女性（66.18/10万 vs 16.07/10万，P＜0.001）；脑血管急性事件男性标化发病率高于女性（410.09/10万 vs 299.03/10万， P＜0.001），其中，卒中男性标化发病率高于女性（266.27/10万 vs 151.35/10万，P＜0.001），腔隙性脑 梗死（P =0.733）、TI A（P =0.906）标化发病率男、女性差异没有统计学意义。不同年龄段的心脑血管 事件发病率差异具有统计学意义（均P＜0.001）。心脑血管事件发病报告例数最高的是11月，报告例数 最低的是9月。 结论 静安区心脑血管疾病流行形势严峻，应综合控制多重危险因素，采取有效措施加强防控工作。     

头痛严重程度对偏头痛患者生活质量的影响

目的 探讨头痛严重程度对偏头痛患者生活质量的影响.方法 根据头痛严重程度将84例偏头痛患者分为轻、中、重度3组,采用生活质量综合评定问卷-74(GQOLI-74)对患者进行测试.结果 轻、中、重度3组偏头痛患者在躯体不适感、进食功能、工作与学习、婚姻与家庭方面评分的平均值差异均有统计学意义(均P＜0.05),其余牛活质...     

Supervision of mental health care in the Netherlands

Summary In the Netherlands the Inspectorate of Mental Health has to supervise the quality of mental health care that is given to its citizens. A shortage of inspectors hampers effective accomplishment of this task, and government budget cuts have increased this problem. Another obstacle is the absence of standarized methods of supervision and clear norms for medical practice. This paper describes the efforts of the Inspectorate to develop a new technique of supervision to solve this problem, the so-called frames of reference.     

Effects of Family Interventions on Burden of Relatives of Psychiatric Patients in The Netherlands: A Pilot Study

In this study, the effects of psychoeducational family support groups in the Netherlands on relatives' burden were investigated, using a quasi-experimental design. The experimental group consisted of 119 participants of 19 family support groups, the control group of 45 relatives of once-only informational meetings. Subjects from both groups filled in a questionnaire before the group started and one year later. While controlling for confounding variables in multiple regression analyses, significant effects of family support groups were found on elements of burnout and burden.     

Quality of life of patients with epilepsy living in Kingston, Jamaica

Quality of life in epilepsy has not been documented in the English-speaking Caribbean. The aim of this study was to explore the quality of life of persons with epilepsy (PWE) living in Jamaica and determine the impact of socioeconomic factors by examining two socially distinct groups in semiprivate (Epilepsy Centre of Jamaica) and public (Kingston Public Hospital) outpatient clinics. One hundred nine consecutive patients were interviewed. Quality of life was assessed using the Quality of Life in Epilepsy-31 inventory (QOLIE-31). Both groups were matched for gender, epilepsy syndrome, epilepsy duration, and number of antiepileptic drugs. Predictors of quality of life included number of antiepileptic drugs (P=0.039), epilepsy duration (P<0.05), and functional status (P<0.001). Neither seizure frequency nor socioeconomic status predicted QOLIE-31 scores. Mean QOLIE-31 total score (61.57 vs 49.2, P<0.001) and QOLIE-31 subscale scores (with the exception of the Seizure Worry score [53.8 vs 48.2, P=0.08]) were significantly higher than the corresponding t scores. The QOLIE-31 can reliably be used in Jamaica. Our findings suggest Jamaicans living with epilepsy perceive themselves as having a better than expected quality of life.     

Development of the Quality of Life in Epilepsy Inventory

Summary: We developed an instrument to measure health-related quality of life (HRQOL) in epilepsy. A 99-item inventory was constructed from the RAND 36-Item Health Survey (generic core), with 9 additional generic items, 48 epilepsy-targeted items, and 6 other items concerning attitudes toward epilepsy and self-esteem. We administered the 99-item inventory to 304 adults with epilepsy at 25 epilepsy centers. Patients and patient-designated proxies completed the inventory and were retested 1–91 days later. A multitrait scaling analysis of these data led to retention of 86 items distributed in 17 multiitem scales (Cronbach's alpha ranged from 0.78 to 0.92). Factor analysis of the 17 multiitem scales yielded four underlying dimensions of health: an epilepsy-targeted dimension, a cognitive factor, mental health, and physical health. Construct validity was supported by significant patient-proxy correlations for all scales and correlations between neuropsychologic tests and self-reported emotional and cognitive function (all p values < 0.05). There were significant negative correlations between the four factor scores derived from the HRQOL scales and neurotoxicity, systemic toxicity, and health care utilization (except for the correlation between mental health factor and health care utilization; all p values < 0.05). Patients who were seizure-free in the preceding year reported better HRQOL for the overall score, three of the four factor scores, and 8 of the 17 scale scores than did patients with a high frequency of seizures. Relative validity analysis showed that the epilepsy-targeted factor and three of its four component scales were more sensitive to categorization of patients by severity of seizure frequency and type than scales tapping physical health, mental health, or cognitive function. These cross-sectional data support the reliability and validity of this measure of HRQOL in epilepsy. The addition of an epilepsy-targeted supplement to the generic core improved the sensitivity to severity of epilepsy. The 86 items included in the field testing were supplemented by three additional items to form the Quality of Life in Epilepsy (QOLIE-89) inventory.     

Central distribution of subdiaphragmatic vagal branches in the rat

In the rat, the subdiaphragmatic vagus nerves (SDX) have five major branches--the right gastric, the left gastric, the coeliac, the accessory coeliac, and the hepatic. Although these branches innervate more than the organs after which they are named, some mediate specific behavioral functions. In addition to the SDX trunk, the central stump of each of these branches was incubated in horseradish peroxidase (HRP) for 6 hours in anesthetized rats. After processing the vagal ganglia, pons, medulla, and upper cervical spinal cord of each preparation, the sections were examined for both retrogradely and anterogradely transported HRP reaction product. When only one nerve had been incubated, retrogradely labeled neurons were confined primarily to the ipsilateral ganglion, medulla, and spinal cord. Within the brain, a few labeled neurons occurred within the nucleus ambiguus (NA) and the reticular formation caudal to the NA, but the vast majority appeared in the dorsal motor nucleus of the vagus (DMX). The axons of most labeled neurons in the NA distributed in the gastric branches; those from cells caudal to the NA, probably distributed in the coeliac branch. Most labeled DMX cells also distributed with the gastric branches. Those on the lateral tip of the right DMX, however, had axons in the coeliac branch; those on the left DMX tip, in the accessory coeliac. After incubation of the SDX trunk, anterograde HRP reaction product occurred in the caudomedial nucleus of the solitary tract (NST) just rostral and subjacent to the area postrema (AP). Unlike the retrograde label, anterograde reaction product was bilateral, but always weaker contralaterally. Within the SDX distribution, the afferent axons from the gastric branches exhibited one pattern of termination; those from the coeliac, accessory coeliac, and hepatic branches, another. The gastric branch distributions began dorsolaterally in the SDX termination zone and continued caudally beneath the AP. Immediately subjacent to the AP, gastric branch terminals were never dense and the entire distribution faded at the level of the obex. The coeliac and accessory coeliac distributions began dorsomedially within the SDX termination zone and intensified caudally in a thin band immediately subjacent to the AP. The densest label was associated with the caudal half of the AP, but the distribution thinned rapidly caudal to the obex. The hepatic distribution was similar to that of the coeliac branches but never achieved similar density. Physiological and behavioral data correlate with the anatomical picture in that the efferent functions appear to be more densely localized than the afferent functions.     

Epidemiology of Different Types of Epilepsy in School Age Children of Modena, Italy

An epidemiologic study of epilepsy in school age children has been carried out in Modena, Italy, during the period 1968 to 1973. The prevalence of epileptics aged 5 to 14 years varied between 3.98% and 4.91%. The accession rate varied between 60 and 98 cases /100,000. The primary generalized epilepsies represent 30.8%, the epilepsies with rolandic spike foci 23.9%, the other types of partial epilepsy 42.1%, and the Lennox-Gastaut syndrome 3.2%. Of the 178 epileptics diagnosed during school age, 159 have been followed for at least 4 years, with recovery in 55% of the cases and tendency to improve in 24%.     

Alterations in the contents of consciousness in partial epileptic seizures

Epilepsy research suffers from a deficiency of systematic studies concerning the phenomenology of the contents of consciousness during seizures, partially because of the lack of suitable research methods. The Phenomenology of Consciousness Inventory (PCI), a standardized, valid, and reliable questionnaire, was used here to study which dimensions of the contents of consciousness are distorted during partial epileptic seizures compared with baseline. Further, the similarity of the altered pattern of subjective experiences across recurring seizures was also explored. Our results indicate that patients with epilepsy report alterations on most dimensions of the contents of consciousness in conjunction with seizures, but individual seizure experiences remain similar from one seizure to another. The PCI was found suitable for the assessment of subjective experiences during epileptic seizures and could be a valuable tool in providing new information about phenomenal consciousness in epilepsy in both the research and clinical settings.