4种慢性病共病模式及运动与全因死亡的相关性研究

目的 了解人群慢性病共病罹患现状、不同共病模式的全因死亡风险及运动对共病相关死亡风险和寿命损失的影响。方法 研究纳入我国台湾地区美兆健康管理中心437 408名体检者,采用分类决策树对高血压、糖尿病、慢性肾功能不全（CKD）和慢性阻塞性肺疾病（COPD）4种疾病进行组合,使用Cox比例风险回归模型计算共病模式的危险比（HR）及其95%CI,采用蒋式寿命表法计算人群预期寿命。结果 人群中共病检出率为8.7%,二元、三元、四元共病组合中检出率最高的分别为“高血压+CKD”（3.6%）、“高血压+糖尿病+CKD”（1.1%）、“高血压+糖尿病+CKD+COPD”（0.1%）;与健康人群相比,全因死亡风险最高的组合分别为“糖尿病+CKD”（HR=3.80,95%CI：3.45~4.18）、“糖尿病+COPD+CKD”（HR=4.34,95%CI：3.43~5.49）、“高血压+糖尿病+CKD+COPD”（HR=4.75,95%CI：4.15~5.43）。与不运动人群相比,进行低强度运动和中高强度运动均降低了由共病升高的死亡风险。单一疾病和共病带来4.6、13.4年的人群寿命损失,运动可分别挽回2.3、4.6年的寿命损失年,低强度和中高强度运动分别挽回1.5、3.7年由慢性病造成的寿命损失。结论 基于“糖尿病+CKD”的共病模式死亡风险最高。运动能降低共病患者的死亡风险。运动强度越大,降低效果越显著。     

Sleep disturbances and risk of falls in an old Chinese population-Rugao Longevity and Ageing Study

BackgroundTo explore the relationship between sleep disturbances and falls in an elderly Chinese population.MethodsData from 1726 individuals aged 70–87 years from the Rugao Longevity and Ageing Study were used. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep variables. Outcomes were falls ≥1 time per year and falls ≥2 times per year.ResultsA total of 22.7% of the participants experienced ≥1 fall, and 9.8% experienced ≥2 falls per year. Poor sleep quality was associated with ≥1 fall (OR 1.08, 95% CI 1.05–1.12; OR 1.27, 95% CI 1.14–1.41) and ≥2 falls (OR 1.08, 95% CI 1.03–1.14; OR 1.28, 95% CI 1.10–1.48), with an increase per PSQI score and SD PSQI score, respectively. In addition, sleep quality, sleep latency, sleep efficiency, and sleep disturbance subcomponents were associated with an increased risk of ≥1 fall with ORs of 1.44 (95% CI, 1.21–1.72), 1.23 (95%CI,1.09–1.40), 1.12 (95%CI, 1.01–1.23) and 1.70 (95% CI,1.35–2.14), respectively, and were associated with an increased risk of ≥2 falls with ORs 1.54 (95%CI, 1.22–1.96), 1.21(95%CI, 1.02–1.44), 1.17 (95% CI 1.02–1.33), and 1.78 (95%CI, 1.31–2.44), respectively. Further, participants slept ≤5 h per night had an increased risk of ≥1 fall (OR 2.34; 95%CI, 1.59–3.46) and ≥2 falls (OR 2.19; 95%CI, 1.30–3.69).ConclusionsPoor sleep quality and several subcomponent sleep symptoms were consistently associated with increased risk of falls ≥1 time and ≥2 times in Chinese elderly. The identification of sleep disturbances may help identify high-risk Chinese elders who may benefit from fall prevention education.     

The impact of air pollution on physical disability in a middle-aged and older Chinese population using regression discontinuity design

Emerging evidence has shown the association between ambient air pollution exposure and comorbid chronic diseases, which can subsequently impair physical function. However, less is known about the causal and contextual effect of air pollution on physical disability. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study employs a geographical regression discontinuity design based on the Huai River Policy to estimate the impact of ambient air pollution on physical disability in activities of daily living (ADL) in China. We find that a 10 μg/m³ increase in particulate matter [particulate matter smaller than 10 μm (PM₁₀)] leads to a 5.4% increase in the incidence of physical disability among middle-aged and older adults. This result is robust to using alternative measurement of key variables, different bandwidths and polynomial functions, and adjustment for a set of sociodemographic covariates. Stroke might be one of the potential pathological pathways linking air pollution and physical disability, with a 10 μg/m³ increase in PM₁₀ leading to a 4.7% increase in the incidence of stroke. In heterogeneity analyses, we find that older adults, males, urban residents, and people with lower socioeconomic status are more vulnerable to air pollution. These results contribute to the limited evidence on the causal and contextual effect of air pollution on physical health, and further provide policy implications for air quality control and health protection for vulnerable populations.     

Event-free survival in Desmoid-Type fibromatosis (DTF): A pre-post comparison of upfront surgery versus wait-and-see approach

BackgroundDesmoid-Type Fibromatosis (DTF) is a rare mesenchymal neoplasm with a locally invasive pattern and high risk of local recurrence after surgery. Historically, the standard treatment for DTF was surgical resection. However, considering the difficulty of achieving surgical eradication, the possible unnecessary morbidity and the unpredictability of the natural history, a wait-and-see approach has been proposed for asymptomatic DTF.MethodsWe analyzed 87 consecutive patients with histologically-proven sporadic primary DTF, first recurrence or residual disease managed at our institution between 2000 and 2018. Patients and tumor-related variables were reviewed and analyzed. Two different treatment strategies were adopted according to different time periods: in the “early period” (2000–2010) patients underwent surgical treatment irrespective of the clinical presentation, whereas in the “late period” (2012–2018) asymptomatic patients used to undergo a wait-and-see strategy. The event-free survival (EFS) was compared trough a pre-post comparison.ResultsIn the early period, surgery was performed in 51 (94.4%) patients and watchful waiting in 3 (5.6%). In the late period, the watchful waiting group accounted for 24 (72.7%) patients and the surgical group for 9 (27.3%). No statistically independent prognostic factors were found. EFS did not show statistically significant differences between early and late period groups.ConclusionWait-and-see policy has shown to be equivalent to upfront surgery in terms of EFS; therefore, a conservative approach is recommended in asymptomatic patients diagnosed with DTF that can be followed through watchful waiting.