连云港市老年人代谢综合征的现状调查

目的调查连云港市60岁以上老年人群代谢综合征的患病状况。方法对2015年1~12月到该院体检的60岁以上老年人群进行血压、身高、体质量、体质量指数、空腹血糖、三酰甘油、高密度脂蛋白胆固醇等指标按中华医学会糖尿病分会(中华医学会糖尿病分会)2004年制订的诊断标准进行统计分析。结果代谢综合征患病率27.42%,其中男性患病率25.20%,女性29.89%,高血压患病率56.35%,高血糖患病率32.71%,高血脂患病率36.58%,肥胖患病率50.05%;代谢异常情况检出率从高到低依次为高血压、肥胖、高血脂和高血糖,高收缩压、高三酰甘油、肥胖不同年龄间代谢异常检出率比较,差异有统计学意义(P0.05);高舒张压、高血糖不同年龄间代谢异常检出率比较,差异无统计学意义(P0.05),随着体质量指数的增高,代谢综合征、高血糖、高血压、高三酰甘油、低高密度脂蛋白胆固醇都呈明显增高趋势(P0.05)。结论代谢综合征患病率及各项单独指标的患病率比例相当高;女性代谢综合征的患病率明显高于男性(P0.05)。加强对社区老年人特别是女性的健康教育是社区医务工作者的首要任务。     

2010年北京某三甲医院医务人员健康查体结果调查

目的了解医务人员的健康状况,制定相应的保健预防策略。方法对某三甲医院工作人员进行常规健康体检,并对结果进行汇总分析。结果 1 723人参加体检,年龄35~88岁,随着年龄的增加,疾病检出率明显增加(P=0.000),主要疾病谱的患病率为高酯血症53.1%,超重肥胖50.1%,脂肪肝25.4%,高血压31.2%,血糖升高17.8%,尿酸升高7.5%,前列腺肥大16.6%,乳腺增生57.5%,子宫肌瘤22.8%。具有中级以上技术职称人员高血压患病率明显高于低职称人员,而低职称人员超重肥胖、脂肪肝、高脂血症、高血糖患病率更高。结论医务人员患病率高,健康状况令人担忧,针对危险因素进行干预和预防尤为重要。     

40岁以上医务人员高尿酸血症相关因素分析及策略

目的探讨洛阳市某医院40岁以上医务人员高尿酸血症(HUA)的患病率及相关因素,为医务人员重视和控制高尿酸血症提供依据。方法对洛阳市某医院40岁以上医务人员的体检情况,采用整群随机抽样方法进行研究,对体检人群高尿酸血症及相关因素进行分析。结果 745例医务人员体检,检出高尿酸血症158例,占21.20%,男性检出率显著高于女性(P=0.0017);高尿酸血症见于各年龄组,患病率随年龄增长;高尿酸血症组中伴肥胖、高血压、高血脂、高血糖者的百分率高于血尿酸正常组(P均0.05)。结论洛阳某医院医务人员高尿酸血症患病率较高,在医务人员中应加强控制体质量,改变不良生活习惯,对高血压、高血脂、高血糖进行预防和干预,以降低高尿酸血症的发生率,从而降低痛风及其相关并发症,同时减少心血管危险因素。     

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。     

2008～2009年度肥城矿区4628名在职职工健康状况调查

目的通过对矿区4628名在职职工的健康查体资料进行统计分析,进一步了解矿区30～60岁职工血脂异常、高血糖、高血压及代谢综合征(MS)的患病情况。方法以2008～2009年度矿区4628名在职职工为调查对象,对其进行询问、测量身高、体质量和血压,并采集空腹静脉血检测血糖、血脂系列,采用中华医学会糖尿病分会(CDS)诊断标准确定MS患者。结果体检者中血脂紊乱的患病率为35.6%(1648例),高血糖发病率为6.0%(279例),高血压患病率为19.6%(907例),超体质量(OW)/肥胖(OB)者检出率30.7%(1423例),MS患病率为12.7%(587例),其中男性患病率高于女性(14.6%、10.2%),不同性别组MS患病率均随年龄的增长而上升。结论 30～60岁矿区在职职工三高(高血压、高血脂、高血糖)患病率和MS患病率随年龄增长呈上升趋势。     

浙江省瑞安市体检职工代谢综合征调查分析

目的从2008年职工体检人群中了解浙江省瑞安市代谢综合征(MS)及其体征成分肥胖、高血压、高血脂、高血糖患病情况,分析相关高危因素。方法对2351例职工体检人群的MS流行情况进行调查并分析。结果MS患病率为11.0%,男性及女性患病率分别为13.6%和7.6%;男性30岁以上和女性40岁以上患病率高,为高危人群;与MS相关的非条件logistic多元逐步回归分析显示,男性和女性组中高血压的IOR/I值分别为66.869和109.13,提示高血压为MS的高危因素。结论瑞安市2008年职工体检人群MS发病率男性高于女性。MS及其组成成分的高危人群为30岁以上男性、40岁以上女性及高血压人群。相关医疗及护理人员应重视本病预防、治疗和健康宣教工作,对高危人群应定期体检,早期诊断和干预,以期降低临床不良预后。     

2950例老年人代谢综合征患病调查

[目的]调查老年人代谢综合征（MS）患病情况,为早期预防、控制提供参考.[方法]对武汉地区2 950例老年人健康体检资料进行MS患病情况分析.[结果]MS总患病率29.4%,男27.3%,女32.9%,各年龄组女性MS患病率显著高于男性;知识分子、在岗老年人MS患病率显著高于非知识分子及离退休老年人（P〈0.01）;80岁前MS及代谢异常组分如高血糖、高血脂、高血压等患病率随年龄增加而增高;具有1种以上代谢异常者达89.9%,无论男女均超过40%患有高血压;老年人MS以超重/肥胖＋血脂异常＋高血压为最主要表现形式,占50.7%.[结论]MS是老年人严重的健康问题,早发现、早预防对控制MS有重要意义.     

代谢综合征302例发病情况分析

目的了解城市中老年人代谢综合征(MS)的患病情况。方法2004年6月集中对安徽部分省直机关公务员、离退休人群、正高职称的知识分子进行健康体检,并与2002年的体检结果进行了对比分析。结果成人代谢综合征(MS)的患病率明显增高,新增病例年轻化,中老年前期组高血压患病率达18.7%;60岁以后高血压的患病率达44.0%,血脂紊乱患病率达32.5%;糖尿病患病率达11.3%;男、女超重或肥胖达47.0%;高血脂患病率与年龄增加无明显关系。结论代谢综合征人群中很常见,它是增加冠心病患病率的重要因素,因此,干预MS的各个环节,采取有力措施防治,是今后医疗工作的重点之一。     

老年代谢综合征及合并疾病分析

【目的】探讨老年体检人群代谢综合征（Ms）的患病率,各年龄段MS的分布及合并心脑血管代谢疾病状况。【方法】进行体检的1665例老年人,按60～69岁;70～79岁;≥80岁年龄段分为三组,分析各组冠心病、肥胖、高血压、高血糖、血脂异常等及患病情况。【结果】MS在老年人群中的患病率为24．5％,MS患者中,高血压患病率73．7％,高血糖患病率49．8％,血脂异常的患病率达43．6％,肥胖症为35％。MS患者患冠心痛、高尿酸血症、脂肪肝、脑卒中等疾病的患病率显著高于非MS受检者。【结论】MS的高患病率预示心脑血管代谢疾病患病率的增加。     

粤西某高校教职工2010年体检结果分析

目的了解粤西某高校教职工患心脑血管疾病的患病率及其危险因素,为心脑血管疾病的防治提供防控策略依据。方法对2010年粤西某高校30岁以上教职工1260人进行健康体检,对体检结果进行分析。结果超重和肥胖、高血压、高血脂、高血糖检出率分别为24．76％,14．21％,26．67％,7．69％。并随年龄增加而增高,超重和肥胖、高血压、高血脂检出率男性高于女性,差异有统计学意义（x^2分别为27．31,37．03,29．18;P〈0．01）;不同年龄教职工超重和肥胖、高血压、高血脂结果差异有统计学意义（X^2分别为17．19,22．13,26．31,19．29;P〈0．01）;教研人员、干部高血压、高血脂检出率均高于工人,差异有统计学意义（x。分别为2．61,4．07,4．23,2．05;P〈0．05）。结论超重和肥胖、高血压、高血脂、高血糖在高校教职工中常见,有必要定期进行体检,加强早期干预,对防治心血管疾病具有重要意义。     

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.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.