广西玉林地区健康体检人群高尿酸血症的流行病学研究

目的 研究玉林地区体检人群高尿酸血症检出率及相关危险因素.方法 分析2018年1-12月在该院体检中心进行健康体检者的体检资料,统计高尿酸血症检出率,分析其影响因素.结果 高尿酸血症总检出率为37.8％,其中男性人群的检出率高于女性人群,差异有统计学意义(43.2％vs.24.2％,χ2=171.76,P<0.01).男性>30～40岁年龄段检出率最高,为48.4％;女性>60岁年龄段检出率最高,为33.9％.Lo-gistic回归分析显示,性别(OR=1.49,P<0.01)、高三酰甘油水平(OR=1.15,P<0.01)、脂肪肝(OR=1.29,P<0.01)、体质量指数(OR=1.10,P<0.01)、高低密度脂蛋白胆固醇水平(OR=1.17,P<0.01)是高尿酸血症发生的独立危险因素.结论 玉林地区体检人群高尿酸血症的检出率较高,男性检出率高于女性且检出率高峰出现的年龄段不同,存在高血脂、脂肪肝、超重或肥胖等危险因素的人群或许更容易发生高尿血酸血症.     

659例飞行员体重指数与脂肪肝、血脂及谷丙转氨酶的关系分析

目的对现役飞行员的体重指数（BMI）进行分析,并分析其与脂肪肝、血脂、谷丙转氨酶（ALT）的关系,为防治军事飞行员的超重和肥胖提供依据,进一步提高飞行员的健康水平。方法研究对象为2009-03—2010—06来我院健康疗养的男性飞行员659例,测身高、体质量,计算BMI;进行肝脏B超检查;测清晨空腹血清总胆固醇（TC）、三酰甘油（TG）、ALT,进行统计学分析。结果659例飞行员超重占514％、肥胖占8．0％;各年龄组超重肥胖检出率除≥50岁组外,其余各年龄组的超重率及肥胖率随年龄递增;超重与肥胖组脂肪肝、高胆固醇血症、高TG血症、ALT异常检出率明显高于体质量正常组;肥胖组高脂血症检出率明显高于体质量正常组;肥胖组脂肪肝、高TG血症、高脂血症的检出率明显高于超重组。结论飞行员超重率或肥胖率较高,应加强健康教育,改善生活方式,选择合适的膳食和运动方式,以控制体质量,预防疾病。     

银行系统职工代谢综合征及其主要成分异常患病情况调查

目的了解银行系统职工代谢综合征及其主要成分异常的患病情况。方法对2007年某银行系统1 628名20～50岁在职职工进行血压、血脂、血糖、身高、体质量检测,并对结果进行统计学分析。结果本组人群代谢综合征检出率6.94%,其中高血压、高血脂、高血糖、超重/肥胖检出率分别为12.65%、20.15%、1.97%、12.53%,并随年龄增加有上升趋势。高血压、高血脂、高血糖检出率,男性高于女性（P〈0.05）;干部超重/肥胖、高血脂检出率高于工人（P〈0.05）。结论高血压、高血脂、超重/肥胖在银行系统职工中常见,有必要定期进行体检,对有异常结果者给予生活方式教育及早期治疗,以减少代谢综合征的发病率。     

西藏地区干部脂肪肝检出情况分析

目的了解西藏干部患脂肪肝的情况,探讨西藏地区脂肪肝的患病因素与相关疾病的关系。方法对门诊696名干部的体检资料进行分析。结果脂肪肝检出率与民族(χ2=12.401)、性别(χ2=10.420)、年龄(χ2=30.526)之间有关(P<0.05)。脂肪肝组、非脂肪肝组在血压、血尿酸升高、超重和肥胖、谷丙转氨酶升高、血糖升高、血清总胆固醇升高、血清甘油三酯升高和高密度脂蛋白胆固醇降低等方面,两组比较差异均有统计学意义(P<0.05)。不同海拔(即:海拔>3800米和3650米两组)脂肪肝检出率比较差异无统计学意义。结论西藏地区脂肪肝患病率藏族明显高于汉族,男性明显高于女性。脂肪肝的检出与高血压、高尿酸血症、超重肥胖、血脂异常、血糖升高等有明显的伴随关系,它们都是影响西藏干部健康的主要疾病。     

16708例长沙居民健康体检结果分析

目的对长沙居民健康体检结果进行分析。方法选取2014年6月~2015年6月在湘雅健康管理中心进行健康体检的16708例长沙居民的资料进行回顾性统计分析。结果 16708例体检人群前5位疾病分别是:超重、高血脂、脂肪肝、窦性心律过缓(简称窦缓)、肥胖,其发病率分别是29.36%、25.80%、13.80%、11.44%、7.16%;超重、高血脂、脂肪肝的男性发病率高于女性有差异(P0.05),肥胖男性发病率高于女性有显著差异(P0.01)。超重、高血脂、脂肪肝、窦缓、肥胖发病均集中于20~59岁年龄段,59岁以后发病率明显低于总体发病率。结论超重、高血脂、脂肪肝等发病率在青中年男性群体中发病率高,需加强青中年男性的卫生宣教。     

电网公司人群健康状况分析报告

目的了解电网公司人群的健康状况,分析影响电网公司人群健康的不利因素,制定相应的健康促进措施,促进员工健康,以利于企业发展。方法由我院健康管理中心制定统一体检套餐,包括临床检查、实验室检查、特殊检查,组织员工进行健康体检,并对体检结果进行健康评估,统计学处理。结果①常见疾病检出率排在前10位的是口腔疾病、高脂血症、超重及肥胖、骨量减少、女性乳腺疾病、脂肪肝、高血压、心电图异常、颈椎病、血糖升高。②不同性别常见疾病检出率只有心电图异常男女患病率差异无统计学意义（〉0.05）,颈椎病患病率女性高于男性,其他疾病患病率均为男性高于女性,差异有统计学意义（〈0.01）。③不同年龄组常见疾病检出情况：随年龄增加发病率有增高趋势的疾病为骨量减少、脂肪肝、高血压、心电图异常;乳腺疾病30～49岁年龄组患病率明显高于其他年龄组,差异有统计学意义（〈0.01）;颈椎病、血糖升高40～59岁年龄组患病率明显高于其他年龄组;超重及肥胖、高脂血症30岁后检出率增高明显;口腔疾病各年龄组检出率差异无统计学意义（〉0.05）。④秦皇岛市区及各县常见疾病检出情况：除口腔疾病市区与各县区发病率无明显区别外,骨量减少、高脂血症、高血压、心电图异常、颈椎病市区发病率均高于其他县区,差异有统计学意义（〈0.01）;超重及肥胖、脂肪肝、血糖升高以青龙县发病率为高,女性乳腺疾病以抚宁县、卢龙县发病率为高。结论各种慢性病的检出率与性别、年龄和所在地区存在显著差异性。     

4303名铁路客运职工健康体检结果分析及健康干预对策

目的:分析北京铁路客运职工健康体检人群的体检结果,对慢性病危害因素进行综合分析,做到早发现、早预防、早诊断、早治疗。提高对慢性病危险因素的认识,改变生活方式和健康行为,提高生活质量。方法:2016年2~3月客运系统4303名职工集中进行健康体检,将体检结果按照各年龄段主要异常结果检出率、主要异常结果男女检出率分别进行分析比较。根据体检结果,做出相应的健康指导和干预措施。结果:体检结果显示,常见慢性病检出率分布于各个年龄段,其中男性职工异常指标检出率较高的疾病是:超重肥胖75.28%,脂肪肝60.56%,脂代谢异常57.95%,血压增高44.25%,骨质疏松和骨量减少27.46%,糖代谢异常25.95%,甲状腺形态异常25.75%,心电图异常23.00%。女性职工异常指标检出率较高的疾病是:乳腺增生32.46%,超重肥胖30.79%,心电图异常24.46%,甲状腺形态异常23.88%,骨量减少和骨质疏松23.31%,脂肪肝21.58%,脂代谢异常21.01%,子宫肌瘤11.02%,血压增高8.99%。各年龄段慢性病检出率随年龄增长而逐步增高,各种慢性病检出率男性高于女性(P0.05)。结论:客运系统职工的健康状况不容乐观,慢性病检出率较高,患各种慢性病的风险较高,主要原因是男性承担的工作压力和社会压力较大,再加上吸烟、饮酒、运动量小等不良生活方式的影响。所以加强职工健康宣传、健康维护、健康管理,建立良好的生活方式和健康行为,改善健康状况,提高生活质量,积极开展健康指导尤为重要。     

某IT公司职工体检健康现状及影响因素

目的探究某公司职工体检健康现状,并针对性开展健康干预措施,研究其干预效果。方法选择2014~2018年期间某IT公司在北京大学深圳医院的体检健康状况,分析其主要健康问题及危险因素,并针对体检发现率最高的疾病类型进行干预,分析其效果。结果除2014、2015年度体检率比较差异无统计学意义(P>0.05)外,其余各年度间比较差异均有统计学意义(均P<0.05)。男性员工在2014~2018年度体检率依次为86.52%、87.09%、96.26%、84.96%及92.94%。女性则为84.55%、81.52%、93.66%、53.70%及86.81%,男性、女性员工分别在各年度体检率差异有统计学意义(P<0.05)。在各年度中男女性别体检率比较,除2017年度差异有统计学意义(P<0.05)外,其余各年度差异均无统计学意义(P>0.05)。男性主要健康问题为高血脂或血脂异常、脂肪肝、超重。女性为乳腺小叶增生(彩超女性)、乳腺小叶增生、巴氏Ⅱ级。在两性健康问题在各年度检出率差异均有统计学意义(P<0.05)。男性高血脂或血脂异常、超重检出率显著下降,脂肪肝比例显著增加;女性乳腺小叶增生(彩超女性)、巴氏Ⅱ级检出率显著下降,乳腺小叶增生显著增加。男性主要健康问题的高危因素为腹型肥胖、超重、静坐时间较长、锻炼时间较短、饮酒,女性则为多次流产、家族史、负性情绪状态、不良避孕方式及初潮年龄较早。结论该IT公司职业人群健康体检参与度较高,男性主要健康问题是高血脂或血脂异常、脂肪肝、超重,女性主要健康问题是乳腺小叶增生、巴氏Ⅱ级。对于行为生活方式中的高危因素,则应积极培养健康生活方式,对于家族史等非生活方式因素,则应积极做好筛查,争取早发现、早治疗。     

医务人员脂肪肝257例临床分析

目的探索脂肪肝的发生与年龄、性别、血脂等因素的关系。方法收集2006年我院参加健康体检的离退休及在职职工共1400人的体检资料，根据B超诊断脂肪肝257例，按年龄、性别、血脂进行分类统计分析。结果脂肪肝总患病率18．36％。男性患病率明显高于女性（P〈0．01）。男性发病率随着年龄的增长而升高，60～69岁达到高峰；女性30岁以前患病率很低，30-49岁开始增长，但明显低于男性（P〈0．01）；50-59岁大幅上升，60～69岁有所下降，70岁以后再次升高，呈双峰性，但与男性相比，均无明显差异（P〉0．05）。脂肪肝组甘油三脂增高率高于非脂肪肝组，两者相比，有高度显著性差异（P〈0．01）；胆固醇增高率脂肪肝组高于非脂肪肝组，两者相比，有高度显著性差异（P〈0．01）。结论脂肪肝的发生不仅与血脂升高关系非常密切，与不同性别的不同年龄段也密切有关。     

992例健康体检者血浆同型半胱氨酸水平的调查与分析

目的了解乌海市健康人群同型半胱氨酸水平。方法对该地区992例健康体检者的血浆同型半胱氨酸(Hcy)水平及血脂水平进行检测。血脂试剂由浙江伊利康公司提供(三酰甘油、总胆固醇采用酶法,高密度脂蛋白胆固醇、低密度脂蛋白胆固醇采用直接法);Hcy由美康公司提供(Hcy采用循环酶法)。结果通过检测发现健康人群高Hcy检出率较高,为28%,其中男性达34.7%,女性为20.3%,并且女性年龄越大,血浆Hcy水平越高。而男性的Hcy总体水平高于女性;其中男性在30~50岁较其他年龄段高,而女性在60岁以上较其他年龄段高。总胆固醇、低密度脂蛋白胆固醇是随着年龄增高而增高。三酰甘油、高密度脂蛋白胆固醇年龄段不同,增高也不同。结论健康人群血浆Hcy水平存在年龄、性别差异,高Hcy血症的检出率较高。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.