1990—2019年中国人群早发性结直肠癌疾病负担及变化趋势分析

目的 分析1990—2019年我国早发结直肠癌（early-onset colorectal cancer,EOCRC）疾病负担及时间变化趋势。方法 利用全球疾病负担2019（Global Burden of Disease 2019,GBD 2019）数据库获取我国14～49岁人群1990—2019年间结直肠癌发病、死亡及伤残调整寿命年（disability-adjusted life years,DALYs）的数量和率,以及危险因素所致EOCRC相关DALYs百分比。计算年龄标化发病率（age-standardized incidence rate,ASIR）及死亡率（age-standardized mortality rate,ASMR）,并用Joinpoint软件对我国EOCRC的ASIR及ASMR行时间变化趋势分析。结果 2019年我国EOCRC新发病例及死亡人数为87383及26274,相比1990年分别增加264.53%及76.92%。我国EOCRC的ASIR及ASMR为10.31/10万及3.07/10万,较1990年分别增加140.32%及14.13%。时间变化趋势分析显示,我国EOCRC的ASIR及ASMR均呈显著上升趋势,其平均年变化百分比（average annual percentage change,AAPC）分别为3.0（95%CI为2.8～3.3）及0.3（95%CI为0.1～0.6）。我国EOCRC相关DALYs为1304828,占我国总体结直肠癌相关DALYs的20.40%及全球EOCRC相关DALYs的30.63%。归因分析提示我国42.85%的EOCRC相关DALYs可归因于饮食、行为及代谢因素。结论 我国EOCRC发病率及死亡率均明显升高,其导致的疾病负担十分严峻。     

2017—2019年北京某高校教职工健康体检结果分析

目的 掌握中国人民大学教职工的健康状况及变化趋势,为改善教职工的生命质量、提出合理的健康教育和促进策略提供数据支持。方法 将2017—2019年参加体检的中国人民大学的教职工(含离退休人员)纳入研究,对获得的体检资料进行分析,采用χ2趋势检验分析异常指标在2017—2019的变化趋势。结果 2017—2019年有效体检的教职工人数分别为6 082,6 088和6 507人,各年的平均年龄在44～45岁左右,其中女性多于男性。全体职工在2017—2019年3年间高血压检出率分别为16.29%、15.85%、20.01%;高血糖检出率分别为12.20%、17.34%、29.29%;尿酸偏高检出率分别为16.36%、20.28%、20.81%;心电图异常的检出率分别为14.24%、17.58%、19.43%,检出率均逐年递增;而血脂异常检出率分别为44.33%、32.29%、32.1%;血清谷丙转氨酶偏高的检出率分别为9.48%、7.62%、7.82%,检出率呈现降低趋势(P<0.05)。2017—2019年,在各个年龄组中高血糖检出率最低为2017年<35岁组(0.81%),最高为2019年≥60岁组(48.55%);尿酸偏高的检出率最低为2017年<35岁组(15.04%),最高为2018年≥60岁组(24.4%),均明显上升,血脂异常和谷丙转氨酶偏高的检出率在各个年龄组呈下降趋势(P<0.05),血脂异常检出率最低为2019年<35岁组(15.96%),最高为2017年50～59岁组(50.79%);谷丙转氨酶偏高检出率最低为2018年≥60岁组(7.62%),最高为2019年35～49组(12.08%)。校正了年份、年龄和性别后,高血压、高血糖、血脂异常、尿酸偏高、谷丙转氨酶偏高和心电图异常的检出率均随着BMI的升高而递增(P<0.05),各项指标在肥胖组的检出率分别为30.83%、33.7%、58.51%、45.67%、27.97%和21.0%。结论 2017—2019年本校教职工的健康状况不容乐观,高血压、高血糖、尿酸偏高和心电图异常的检出率均呈现上升的趋势,血脂异常的检出率呈现逐年下降,35岁以下教职工心电图异常检出率升高明显。     

Diagnostic Testing in Long-Term Care and Resident Emergency Department Visits: A Retrospective Cohort Study

ObjectivesTo investigate the association between rapid access to radiographs, blood tests, urine cultures, and intravenous (IV) therapy in a long-term care (LTC) home with resident transfers to the emergency department (ED).DesignRetrospective cohort study.Setting and Participants21,811 residents living in 162 LTC homes in Ontario, Canada.MethodsWe administered a survey to LTC homes to collect wait times for radiographs, basic blood tests, urine culture, and IV therapy. Rapid availability was defined as typically receiving test results within 1 or 2 days, or same-day IV therapy. We linked the survey results to administrative data and defined a cohort of residents living in survey-respondent homes between January and May 2017. We followed residents in the linked administrative databases for 6 months, until discharge, or death. Two physicians identified diagnostic codes for ED visits that were potentially preventable with rapid availability of each of the 4 resources. Multilevel logistic regression models estimated associations between potentially preventable ED visits and rapid diagnostic tests and intravenous access while controlling for demographic characteristics, illness severity, LTC home size, chain status, and physician availability.ResultsRapid blood tests, radiographs, urine culture, and IV therapy were available in 55%, 47%, 34%, and 45% of LTC homes, respectively. LTC homes that were part of multihome chains were less likely to have rapid access to the 4 resources. Of the 4736 residents (27%) who visited an ED during follow-up, individuals from homes with rapid access to radiographs (odds ratio 0.79, 95% confidence interval 0.66-0.97), urine culture (0.88, 0.72-1.08), blood tests (0.83, 0.69-1.00), and IV therapy (0.93, 0.70-1.23) tended to have fewer potentially preventable ED visits.Conclusions and ImplicationsRapid access to diagnostic testing and IV therapy in LTC reduced ED visits. Improving access to these resources may prevent ED visits and allow residents to stay home.     

COVID-19 and the Need for Adult Day Services

COVID-19 has shone a harsh light on the inequities of health care in the United States, particularly in how we care for older people. We summarize some of the effects of lockdown orders on clients, family caregivers, and staff of adult day service programs throughout the United States, which may serve as a counterpoint to scientific evidence suggesting a lack of efficacy of these programs. Given the ramifications of state lockdown orders for users and staff of the long-term services and support system, we provide recommendations to better support community-based programs and those they serve. Specifically, (1) adult day programs should be classified as essential, (2) a focus on the value of adult day and similar programs is needed, and (3) an exploration of new ways to finance home and community-based services is warranted. Such advances in policy and science would help to integrate adult day services more effectively into the broader health care landscape.     

2011—2017年中国心肌梗死治疗质量的趋势与变异

目的分析2011—2017年急性ST段抬高型心肌梗死(STEMI)治疗质量评价指标使用率变化趋势;计算急性心肌梗死治疗质量综合得分,获得综合质量变化趋势及变异,为改善STEMI治疗质量提供依据。方法选择STEMI治疗指南Ⅰ类推荐的STEMI治疗质量评价指标12项,提取单病种监测系统中STEMI患者的数据;计算STEMI评价指标使用率;利用分母权重法获得治疗质量综合得分及变异,并进行趋势性检验。结果与2011年相比,12项治疗质量指标中,到医院90 min内实施经皮冠状动脉介入治疗使用率增幅最大,到达医院后即刻使用β受体阻滞剂使用率下降最大,趋势性检验有统计学意义;2011年至2017年间,医院综合得分中位数随时间变化不明显,四分位数间距随时间有增大趋势。结论我国STEMI的多数治疗质量指标使用率显著改善;医院综合治疗得分趋势稳定,但医院间变异扩大。     

A Profile of Black and Latino Older Adults Receiving Care in Nursing Homes: 2011–2017

ObjectiveTo identify if disparate trends in the access and use of nursing home (NH) services among Black and Latino older adults compared with White older adults persist. Access was operationalized as the NHs that served Black, Latino, and White residents. Use was operationalized as the utilization of NH services by Black, Latino, and White residents.DesignThis was an observational study analyzing facility-level data from LTCfocus for 2011 to 2017.Setting and ParticipantsAll NH residents present in US NHs participating in the Centers for Medicare and Medicaid Services program on the first Thursday in April in the years 2011 to 2017. NHs with fewer than 4500 bed-days per year are excluded in the LCTfocus dataset. Black, Latino, and White were the racial/ethnic groups of interest.MethodsWe calculated the mean percentage of each racial/ethnic group in NHs (Black, Latino, White) annually along with the number of NHs that provided care for these groups. We conducted a simple trend analysis using ordinary least squares to estimate the change in NH access and use by racial/ethnic group over time.ResultsOur NH sample ranged from 15,564 in 2011 to 14,956 in 2017. Latino residents' use of NHs increased by 20.47% and Black residents increased by 11.42%, whereas there was a 1.36% decrease in White residents’ use of NHs. In this 7-year span, there was a 4.44% and 6.41% decline in the number of NHs that serve any Black and Latino older adults, respectively, compared with a 2.26% decline in NHs that serve only White older adults (access).Conclusions and ImplicationsOur findings reveal a continued disproportionate rise in Black and Latino older adults’ use of NHs while the number of NHs that serve this population have declined. This work can inform federal and state policies to ensure access to long-term care services and supports in the community for all older adults and prevent inappropriate NH closures.     

The Utilization and National Variation of Plain X-Ray Services by Australian Residents of Long-Term Care Facilities

ObjectivesTo (1) estimate incidence, trends, and determinants of government-subsidized diagnostic radiography (ie, plain x-ray) services utilization by Australian long-term care facility (LTCF) residents between 2009 and 2016; (2) examine national variation in services used.DesignA repeated cross-sectional study.Setting and ParticipantsAustralian LTCF residents who were ≥65 years old.MethodsMedicare Benefits Schedule subsidized plain x-rays employed for diagnosing fall-related injuries, pneumonia, heart failure, and acute abdomen or bowel obstruction were identified. Yearly sex- and age-standardized utilization rates were calculated. Poisson and negative binomial regression models were employed. Facility-level variation was examined graphically. Overall and examination site–specific analyses were conducted.ResultsA total of 521,497 LTCF episodes for 453,996 individuals living in 3018 LTCFs were examined. The median age was 84 years (interquartile range 79-88), 65% (n = 339,116) were women, and 53.9% (n = 281,297) had dementia. In addition, 34.5% (n = 179,811) of episodes had at least one x-ray service. Overall, there was a 12% increase in utilization between 2009 and 2016 (from 535/1000 in 2009 to 602/1000 person-years in 2016, incidence rate ratio=1.02, 95% confidence interval 1.02-1.02). Factors associated with x-ray use included being 80-89 years old, being a man, not having dementia, having multiple health conditions (4-6 or ≥7 compared to 0-3), being at a smaller facility (0-24 bed compared to 50-74), facility located in the Australian state of New South Wales, or in major cities (compared to regional areas). National variation in x-ray service use, with largest differences observed by state, was detected.Conclusions and ImplicationsPlain x-ray service utilization by LTCF residents increased 12% between 2009 and 2016. Sex, age, dementia status, having multiple health conditions as well as facility size, and location were associated with plain x-ray use in LTCFs and use varied geographically. Differences in x-ray service utilization by residents highlight lack of consistent access and potential over- or underutilization.     

海南省“营养改善计划”某试点地区中小学生贫血状况及影响因素分析

目的 分析海南省“农村义务教育学生营养改善计划”（简称“计划”）某试点地区中小学生贫血的变化趋势及影响因素。方法 2014—2017年采用分层整群随机抽样法,在实施“计划”的重点监测县抽取中小学生进行血红蛋白等生化指标检测及问卷调查。多组均值间比较采用方差分析,率的比较采用χ²检验,贫血影响因素分析采用二分类Logistic回归。结果 2014—2017年共抽取学生2 590人,各年血红蛋白平均水平分别为（138.1±12.0）、（136.4±13.4）、（138.1±12.4）、（138.1±15.4）g/L,差异无统计学意义（P>0.05）。4年来各年贫血率分别为5.4%、5.4%、4.5%、6.7%,变化趋势无统计学意义（P>0.05）;其中2015年初中生贫血率高于小学生（P<0.05）,其余年度小学、初中生间,男、女生间贫血率差异均无统计学意义（均P>0.05）。Logistic回归分析结果显示,少数民族学生（OR=6.947）和维生素A亚临床缺乏/缺乏学生（OR=2.030）发生贫血的风险更高。结论 该地区中小学生贫血状况改善不明显,少数民族和维生素A亚临床缺乏/缺乏学生是需改善贫血的重点人群。     

顽固性心律失常患儿远期预后分析

目的 :了解小儿顽固性心律失常患儿远期预后。方法 :对 5 2例顽固性心律失常患儿进行长达 6年的随访观察。结果 :除 1例死于 °房室传导阻滞外 ,71.2 %病例 6年内可自行缓解。结论 :顽固性心律失常患儿绝大部分预后良好