求和自回归滑动平均模型结合圆分布法分析脑卒中死亡率动态规律

通过1999年1月至2006年12月天津市脑卒中逐月死亡率数据,应用圆分布法探讨脑卒中死亡率的季节分布,动态变化规律,建立监测与预测的时间序列模型.通过模型辨识、参数估计及其检验、白噪声检验、模型的拟合度分析等过程,建立求和自回归滑动平均模型(ARIMA)的季节乘积模型(P,d,q)(P,D,Q)s.脑卒中死亡率以年为周期,一年中1月为高发月份.建立ARIMA(0,1,0)×(0,1,1)12:模型:(1-B)(1-B12)lnx1=0.001+(1-0.537B12)εt.结论:ARIMA乘积模型结合圆分布法是对脑卒中死亡率进行时间序列分析的重要方法;应用该方法可对脑卒中流行趋势及死亡率进行预测,为卫生资源合理分配、公共卫生政策计划制定和防治结果考核提供科学依据.     

Association of Hypoalbuminemia on the First Postoperative Day and Complications Following Esophagectomy

Objective Changes in serum albumin may reflect systemic immunoinflammation and hypermetabolism in response to insults such as trauma and sepsis. Esophagectomy is associated with a major metabolic stress, and the aim of this study was to determine if the absolute albumin level on the first postoperative day was of value in predicting in-hospital complications. Methods A retrospective study of 200 patients undergoing esophagectomy for malignant disease at St. James Hospital between 1999 and 2005 was performed. Patients who had pre and postoperative (days 1, 3, and 7) serum albumin levels measured were included in the study. Patients were subdivided into three postoperative albumin categories <20 g/l, 20–25 g/l, >25 g/l. Logistic regression analysis was performed to calculate the odds of morbidity and mortality according to the day 1 albumin level. Results Patients with an albumin of less than 20 g/l on the first postoperative day were twice as likely to develop postoperative complications than those with an albumin of greater than 20 g/l (54 vs 28% respectively, p < 0.011). Correspondingly, these patients also had a significantly higher rate of Adult Respiratory Distress Syndrome (22 vs 5%, p < 0.001), respiratory failure (27 vs 8%, p < 0.01) and in-hospital mortality (27 vs 6% (p < 0.001). On multivariate logistic regression analysis, day 1 albumin level was independently related to postoperative complications (odds ratios, 0.89: 95%; confidence intervals, 0.83–0.96; p < 0.005). In addition, albumin <20 g/l on the first postoperative day was associated with the need for further surgery and a return to ICU. Conclusion Serum albumin concentration on the first postoperative day is a better predictor of surgical outcome than many other preoperative risk factors. It is a low cost test that may be used as a prognostic tool to detect the risk of adverse surgical outcomes.     

Factors associated with mortality and functional disability after hip fracture: an inception cohort study

Hip fracture results in excess mortality and functional disability. This study sought to identify predictors of mortality and limited functional ability 1 year after hip fracture. We conducted a 1-year follow-up of a prospective population-based inception cohort of 218 hip fracture patients who had been consecutively admitted and discharged from hospital during the previous year. Mortality was observed to be independently associated with poor mental status (relative risk [RR]=6.96; 95% confidence interval [95% CI], 1.73–28.00), prefracture limited functional ability (RR=4.35; 95% CI, 1.32–14.36), institutionalized disposition at discharge (RR=2.92; 95% CI, 1.02–8.38), and male gender (RR=2.44; 95% CI, 1.01–5.93). Independent predictors of limited functional ability were prefracture functional disability (RR=34.14; 95% CI, 3.13–372.33), poor mental status (RR=9.71; 95% CI, 1.57–59.82), age >80 years (RR=4.03; 95% CI, 1.48–11.00), and female gender (RR=3.57; 95% CI, 0.08–0.98). On discharge, special attention and care should thus be given to all patients displaying any of the above predictive factors.     

Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: A 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study

The aim of this study was to evaluate whether a prevalent vertebral deformity predicts mortality and fractures in both men and women. In the city of Malmö, 598 individuals (298 men, 300 women; age 50–80 years) were selected from the city's population and were included in the Swedish part of the European Vertebral Osteoporosis Study (EVOS). At baseline the participants answered a questionnaire and lateral spine radiographs were performed. The prevalence of subjects with vertebral deformity was assessed using a morphometric method. The mortality during a 10-year follow-up period was determined through the register of the National Swedish Board of Health and Welfare. Eighty-five men and 43 women died during the study period. The subsequent fracture incidence during the follow-up period was ascertained by postal questionnaires, telephone interviews and by a survey of the archives of the Department of Radiology in the city hospital. Thirty-seven men and 69 women sustained a fracture during the study period. Data are presented as hazard ratios (HR) with 95% confidence interval (95% CI) within brackets. Prevalent vertebral deformity, defined as a reduction by more than 3 standard deviations (SD) in vertebral height ratio, predicted mortality during the forthcoming decade in both men [age-adjusted HR 2.4 (95% CI 1.6–3.9)] and women [age-adjusted HR 2.3 (95% CI 1.3–4.3)]. In men there was an increased mortality due to cardiovascular and pulmonary diseases and in women due to cancer. Prevalent vertebral deformity predicted an increased risk of any fracture during the forthcoming decade in both men [age-adjusted HR 2.7 (95% CI 1.4–5.3)] and women [age-adjusted HR 1.8 (95% CI 1.1–2.9)]. Prevalent vertebral deformity predicted an increased risk of any subsequent fragility fracture in women [age-adjusted HR 2.0 (95% CI 1.1–3.5)]; however, in men the increased risk was nonsignificant [age-adjusted HR 1.9 (95% CI 0.7–5.1)]. In summary, a prevalent vertebral deformity can predict both increased mortality and increased fracture incidence during the following decade in both men and women. We conclude that prevalent vertebral deformity could be used as a risk factor in both genders for mortality and future fracture.     

Prostate cancer: Prevalence and treatment in African men

Epidemiological data from the United States of America (USA) indicate that the incidence and mortality of prostate cancer is higher among Black African-American men (AAM) than among White (Caucasian) American men (CAM). Earlier studies suggesting that prostate cancer is relatively rare among indigenous Black men in Africa are probably flawed by underreporting because recent studies indicate that the incidence rates among Black men are similar to those of White men living in Africa. The higher incidence of prostate cancer among AAM has been ascribed to racial differences in genetic susceptibility, dietary factors, or androgen metabolism. However, it may also be due to registration artefacts because in Africa the reported incidence rates of prostate cancer in different countries correlate directly with the per capita gross national product, suggesting improved access to medical facilities is responsible for higher reported incidence rates.

The greater prostate cancer mortality among AAM may result from higher tumour grade and stage and higher serum PSA at presentation, but it has also been suggested that prostate cancer is biologically more aggressive in AAM than in CAM. However, recent studies indicate that tumour grade and stage and serum PSA at presentation are similar in the races, with no difference in survival after multivariate analysis controlling for pretreatment cancer severity. This suggests that the higher prostate cancer mortality among AAM results from socio-economic factors and limited access to healthcare. Black men living inside as well as outside of Africa still tend to present with locally advanced or metastatic prostate cancer due to lack of early detection programmes.     

老年人急性心肌梗塞的临床特点

目的：研究60岁以上老年人急性心肌梗塞的临床特点。方法：对86例老年人急性心肌梗塞资料进行临床分析,并与同期255例小于60岁的急性心肌梗塞病人进行对比。结果：老年急性心肌梗塞患者女性的比例较60岁以下者明显增多(P＜0.01),老年无痛性心肌梗塞比例(30.5%)明显增多(P＜0.05),并发症心力衰竭(P＜0.01)、心律失常(P＜ 0.05),死亡率(P＜0.01)也明显增多。结论：老年人无痛性急性心肌梗塞多见,并发症发生率、死亡率高,应予重视。     

What really matters in the social network–mortality association? A multivariate examination among older Jewish-Israelis

The aim of the inquiry was to examine the social network–mortality association within a wider multivariate context that accounts for the effects of background framing forces and psychobiological pathways. The inquiry was based upon the Berkman et al. (2000) conceptual model of the determinants of health. Its main purpose was to identify the salient network correlates of 7-year all cause mortality among Jewish men and women, aged 70 and over, in Israel (n = 1,811). The investigation utilized baseline data from a national household survey of older adults from 1997 that was linked to records from the National Death Registry, updated through 2004. At the time of the study, 38% of the sample had died. Multivariate Cox hazard regressions identified two main network-related components as predictors of survival: contact with friends, a social network interaction variable, and attendance at a synagogue, a social engagement variable. Friendship ties are seen to uniquely reduce mortality risk because they are based on choice in nature, and reflect a sense of personal control. Synagogue attendance is seen to promote survival mainly through its function as a source of communal attachment and, perhaps, as a reflection of spirituality as well. Other possibly network-related correlates of mortality were also noted in the current analysis—the receipt of instrumental support and the state of childlessness. The study on which this article is based was made possible by grants from the Israel Ministry of Science and Technology to the Israel Gerontological Data Center.     

不稳定型骨盆骨折的疗效探讨

目的 探讨不稳定型骨盆骨折(Tile B和Tilec型)的治疗和疗效。方法 比较78例骨盆骨折患者使用和非使用骨盆外固定支架手术疗效。结果 在38例骨盆骨折患者未使用骨盆外固定支架治疗中，失血性休克的纠正率为76％，死亡率10．6％，平均ISS评分11．6。而在使用骨盆外固定支架治疗的40例患者中，失血性休克的纠正率为90％，死亡率为2．5％，平均ISS评分9．87结论 骨盆外固定支架治疗不稳定型骨盆骨折合并失血性休克，手术简单，疗效可靠，大大降低了患者的死亡率。