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2011年12月慢性阻塞性肺疾病全球倡议(GOLD)正式颁布了《慢性阻塞性肺疾病诊断、处理和预防全球策略(2011年修订版)》(简称COPD全球策略修订版)。COPD全球策略修订版对慢性阻塞性疾病(COPD)的定义以及COPD急性发作(AECOPD)的定义进行了修订,提出了COPD综合评估的新概念以及COPD稳定期治疗的新方案。COPD全球策略修订版中第一次阐述了COPD合并症的处理。文章简明扼要地介绍了COPD全球策略修订版的更新内容,并且结合国内临床实践对COPD全球策略修订版进行了评析以规范国内COPD的诊断和治疗。     

社区脑卒中高危人群服用脑安胶囊强化干预效果评价

目的评价在社区脑卒中高危人群中应用中药脑安胶囊进行脑卒中一级预防的干预效果。方法采用多中心、随机对照研究,筛选出脑血管血流动力学分值<75分的脑卒中高危人群4069例作为干预对象。根据知情同意原则,以村或居委会为单位随机分为强化干预组2000例和一般干预组2069例。2组干预观察2年,随访脑卒中发病情况。评价指标为干预结束时,2组脑卒中累积发病率。结果干预结束时,2组共新发生脑卒中52例,强化干预组新发生脑卒中18例,脑卒中累积发病率为900人/10万人。一般干预组新发生脑卒中34例,发病率为1643人/10万人。与一般干预组比较,强化干预组脑卒中累积发病率明显降低,差异有统计学意义(X~2=4.957,P=0.026)。采用多因素Cox回归分析,在调整了年龄、性别及其他几种主要危险因素后,服用脑安胶囊可降低脑卒中发病风险(HR=3.798,P=0.001)。结论在社区脑卒中高危人群中应用脑安胶囊进行脑卒中一级预防是安全有效的,可以降低脑卒中发病率。     

急性肺栓塞二次溶栓治疗的疗效及安全性评价

目的 评价急性肺栓塞二次溶栓治疗的疗效及安全性.方法 回顾分析2002年7月～2010年10月在我院住院的12例需溶栓的急性肺栓塞病人,予重组组织型纤溶酶原激活剂(rt-PA)50 mg静脉输注,24小时后复查CT肺动脉造影(CTPA)、心脏超声,血栓部分溶解且心脏超声示右心室室壁运动功能异常,再次予重组组织型纤溶酶原激活剂40mg静脉输注行二次溶栓治疗.结果 有效率100％.1例病人出现生殖道出血,无颅脑出血等危及生命的不良反应.结论 急性肺栓塞首次予重组组织型纤溶酶原激活剂50 mg静脉溶栓,血栓部分溶解且心脏超声示右心室室壁运动功能异常者二次溶栓疗效确切,安全性好.     

滨州市2001～2010年肺结核发病情况及DOTS策略实施的效果

目的了解滨州市《规划》实施情况,评价DOTS策略的执行效果。方法通过对2001年～2010年登记管理的病人,以病人登记本、月报、季报和年报为来源,进行患病登记率、流行特征、DOTS策略执行情况进行分析。结果 2001年～2010年登记患病率为35.65/10万,新涂阳登记率24.39/10万;治愈率为92.07%;避免63 164人感染结核菌,避免5 667人发病。结论滨州市积极推行现代结核病控制策略,结核病人的发现率和治愈率显著提高。     

Medication compliance in ischaemic stroke patients

Aim: This study aimed to assess the degree of patient compliance with medications prescribed at hospital discharge following ischaemic stroke, and concordance between self‐reported medication use and general practitioner (GP) records. Methods: The Auckland City Hospital Stroke database was used to identify consecutive patients with ischaemic stroke over a three‐month period. Participants were contacted and invited to participate in a telephone questionnaire that asked about current medications. GPs were also asked to list the medications their patients were taking. Results: Fifty‐one patients were approached to participate of whom 48 consented to be interviewed at 6 weeks and 47 at 6 months. At 6 weeks, 36 of 38 (95%) were compliant with aspirin, 12 of 13 (92%) dipyridamole, 8 of 9 (88%) warfarin, 36 of 41 (88%) statins, 33 of 38 (87%) antihypertensive medications, and 7 of 7 (100%) diabetes medications. At 6 months, 97% were compliant with aspirin, 100% dipyridamole, 100% warfarin, 94% statins, 91% antihypertensive medications, and 100% diabetes medications. Natural or herbal remedy use was reported by 10 of 48 (21%) at 6 weeks and 11 of 47 (23%) at 6 months. Blister packs were used by 8 of 48 (17%) at 6 weeks and 5 of 47 (11%) at 6 months. Conclusion: Adherence to secondary stroke prevention medication was between 87% and 100% at 6 weeks with similar findings at 6 months after discharge. We speculate that these high compliance rates may be due to one‐on‐one stroke nurse counselling and the use of stroke information packs, which include information about the importance of adherence to secondary prevention medication.     

Influenza-associated bacterial pathogens in patients with 2009 influenza A (H1N1) infection: impact of community-associated methicillin-resistant Staphylococcus aureus in Queensland, Australia

Background: Secondary bacterial pneumonia due to community onset methicillin‐resistant Staphylococcus aureus (MRSA) has become a highly publicised cause of influenza‐associated death. There is a risk that case reports of fatal outcomes with post‐influenza MRSA pneumonia may unduly influence antibiotic prescribing. Aims: The aim of this study was to demonstrate the incidence of community‐onset MRSA pneumonia in 2009 H1N1 influenza patients. Methods: The microbiology records of patients positive for influenza A (H1N1) in 2009 were reviewed for positive blood or respiratory tract cultures and urinary pneumococcal antigen results within a Queensland database. Patients with such positive results within 48 h of hospital admission and a positive H1N1 influenza result in the prior 6 weeks were included. Results: In 2009, 4491 laboratory‐confirmed pandemic influenza A (H1N1) infections were detected. Fifty patients (1.1% of the H1N1 cohort) who were hospitalised with H1N1 and who had a bacterial respiratory tract pathogen were identified. Streptococcus pneumoniae (16 patients; 32%), Staphylococcus aureus (13 patients; 26%) and Haemophilus influenzae (9 patients; 18%) were the most commonly cultured organisms. Of the cohort of 4491 patients, MRSA was detected in only two patients, both of whom were admitted to intensive care units and survived after prolonged admissions. Conclusions: Influenza‐associated community‐onset MRSA pneumonia was infrequently identified in the 2009 H1N1 season in Queensland, despite community‐onset MRSA skin and soft tissue infections being very common. Although post‐influenza MRSA pneumonia is of great concern, its influence on empiric‐prescribing guidelines should take into account its incidence relative to other secondary bacterial pathogens.     

Complex obstacle negotiation exercise can prevent falls in community‐dwelling elderly Japanese aged 75 years and older

Objectives: The aim of the present study was to evaluate whether a complex course obstacle negotiation exercise (CC), a 24‐week exercise program, can reduce falls and fractures in older adults, as compared with a simple course obstacle negotiation exercise (SC). Methods: This trial was carried out on older adults, aged 75 years and above in Japan. In total, 157 participants were randomized into the CC group (n = 78) and the SC group (n = 79). Participants were enrolled in the exercise class using the CC program or the SC program for 24 weeks. The outcome measure was the number of falls and fracture rates in CC and SC groups for 12 months after the completion of the 24‐week exercise class. Results: Two participants (2.8%) in the CC group and 19 (26.0%) in the SC group experienced falls during 12 months. During the 12‐month follow‐up period after the intervention, the incidence rate ratio (IRR) of falls in the SC group against the CC group was 9.37 (95% CI = 2.26–38.77). One participant (1.4%) in the CC group and eight (10.9%) in the SC group had experienced fractures during 12 months after the exercise class. The IRR of fractures in the SC group compared with the CC group was 7.89 (95% CI = 1.01–61.49). Conclusions: The results of the present trial show that the participants who received individualized obstacle avoidance training under complex tasks combined with a traditional intervention had a lower incidence rate of falls and fractures during the 12 months after the intervention. Geriatr Gerontol Int 2012; 12: 461–467.     

EPODE approach for childhood obesity prevention: methods, progress and international development

Childhood obesity is a complex issue and needs multi-stakeholder involvement at all levels to foster healthier lifestyles in a sustainable way. 'Ensemble Prévenons l'Obésité Des Enfants' (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to prevent childhood obesity. This paper describes EPODE methodology and its objective of preventing childhood obesity. At a central level, a coordination team, using social marketing and organizational techniques, trains and coaches a local project manager nominated in each EPODE community by the local authorities. The local project manager is also provided with tools to mobilize local stakeholders through a local steering committee and local networks. The added value of the methodology is to mobilize stakeholders at all levels across the public and the private sectors. Its critical components include political commitment, sustainable resources, support services and a strong scientific input--drawing on the evidence-base--together with evaluation of the programme. Since 2004, EPODE methodology has been implemented in more than 500 communities in six countries. Community-based interventions are integral to childhood obesity prevention. EPODE provides a valuable model to address this challenge.