医院单病种医疗费用的研究近况

随着社会的发展和进步,有效的控制医疗费用增长,利用现有的医疗资源,解决好人民群众＂看病难、看病贵＂的问题,日益成为社会各界普遍关注的热点,同时也是困扰医疗卫生事业发展的难点。科学的对单病种医疗费用进行分析,有利于形成降低病人费用与促进医院健康发展有机统一的运行模式。     

Impact of Physical Activities on Frailty in Community-Dwelling Older Women

Aims: The aim of the study was to determine whether increased physical activities (PA) affect frailty for old women, 75 years and older (OO), compared to 60–74 years old (YO). Methods: This cross-sectional study measured 19 frailty indicators (muscle strength and endurance, balance, gait characteristics, and function), using 46 community-dwelling women. PA were divided into three levels by caloric expenditure per week (<2,000 kcal/week, 2,000–3,999 kcal/week, >4,000 kcal/week). Results: As PA level increased, a gap (=difference) between OO and YO narrowed for step length and function, but for quadriceps strength and endurance, a gap widened. Conclusions: Frailty progresses with aging but older women who engage in a high level of physical activity (>4,000 kcal/week) can increase mobility and functional capacity, but not for muscle strength and endurance. Starting regular resistance training activities early in the aging process is critical to improve or maintain muscle quality to offset age-related frailty.     

Comparison of the effect of multiple short-duration with single long-duration exercise sessions on glucose homeostasis in type 2 diabetes mellitus

Aims/hypothesis We evaluated and compared the effects on glycaemic control of two different exercise protocols in elderly men with type 2 diabetes mellitus. Methods Eighteen patients with type 2 diabetes mellitus carried out home-based bicycle training for 5 weeks. Patients were randomly assigned to one of two training programmes at 60% of maximal oxygen uptake: three 10 min sessions per day (3 × 10) or one 30 min session per day (1 × 30). Plasma insulin, C-peptide and glucose concentrations were measured during a 3 h oral glucose tolerance test (OGTT). Insulin sensitivity index (ISI_composite), pre-hepatic insulin secretion rates (ISR) and change in insulin secretion per unit change in glucose concentrations (B_total) were calculated. Results Cardiorespiratory fitness increased in response to training in both groups. In group 3 × 10 (n = 9) fasting plasma glucose (p = 0.01), 120 min glucose OGTT (p = 0.04) and plasma glucose concentration areas under the curve at 120 min (p < 0.04) and 180 min (p = 0.07) decreased. These parameters remained unchanged in group 1 × 30 (n = 9). No significant changes were found in ISI_composite, ISR and B_total in either of the exercise groups. In a matched time-control group (n = 10), glycaemic control did not change. Conclusions/interpretation Moderate to high-intensity training performed at 3 × 10 min/day is preferable to 1 × 30 min/day with regard to effects on glycaemic control. This is in spite of the fact that cardiorespiratory fitness increased similarly in both exercise groups. A possible explanation is that the energy expenditure associated with multiple short daily sessions may be greater than that in a single daily session.     

Glucagon-like peptide-1(9-36)amide metabolite inhibits weight gain and attenuates diabetes and hepatic steatosis in diet-induced obese mice

Aims: The metabolic syndrome, a disease arising from the world‐wide epidemic of obesity, is manifested as severe insulin resistance, hyperlipidaemia, hepatic steatosis and diabetes. Previously we reported that GLP‐1(9‐36)amide, derived from the gluco‐incretin hormone, glucagon‐like peptide‐1 (GLP‐1), suppresses gluconeogenesis in isolated hepatocytes. The aims of this study were to determine the effects of GLP‐1(9‐36)amide in diet‐induced obese mice that model the development of the metabolic syndrome. Methods: Mice rendered obese by feeding a very high fat diet were administered GLP‐1(9‐36)amide via subcutaneous osmopumps for 8 weeks. Body weight, energy intake, plasma insulin and glucose levels (insulin‐resistance), and hepatic steatosis were assessed. Results: Eight‐week infusions of GLP‐1(9‐36)amide inhibited weight gain, increased energy intake, prevented the development of fasting hyperinsulinaemia and hyperglycaemia, and curtailed the accumulation of liver triglycerides. The peptide had no effects in mice fed a normal chow diet. Notably, energy intake in the obese mice receiving GLP‐1(9‐36)amide was 20% greater than obese mice receiving vehicle control. Conclusions: GLP‐1(9‐36)amide exerts insulin‐like actions in the presence of insulin resistance and prevents the development of metabolic syndrome. Curtailment of weight gain in the face of increased caloric intake suggests that GLP‐1(9‐36)amide increases energy expenditure. These findings suggest the possibility of the use of GLP‐1(9‐36)amide, or a peptide mimetic derived there from, for the treatment of obesity, insulin resistance and the metabolic syndrome.     

Pharmacotherapy of obesity

The growing recognition of the health risks of obesity coupled with the difficulties in treating it successfully by lifestyle modification predicates a need for effective drug treatment. The history of drug treatment in the second half of the 20th century is, however, one of disappointment and concern over drug toxicity. However, the advances in our understanding of the mechanism of weight control, together with improved ways of evaluating anti-obesity drugs, has resulted in two effective compounds, sibutramine and orlistat, becoming available for clinical use. Sibutramine has actions on both energy intake and expenditure and had been shown to enhance weight loss and weight maintenance achieved by diet, in simple obesity as well as when accompanied by complications of diabetes or hypertension. About 50-80% of patients can achieve a >5% loss, significantly more than if patients receive the same lifestyle intervention with placebo. Orlistat, which acts peripherally to block the absorption of dietary fat, has had similar results in clinical trials; a recent study (XENDOS) has just reported results which show that the enhanced, albeit modest, weight loss achieved with orlistat delays the development of diabetes over a 4-year period. A number of other compounds are expected to complete or enter clinical trials over the next decade. There is considerable optimism that we will soon have the pharmacological tools needed to make the treatment of obesity feasible.     

Resting energy expenditure in patients with alcoholic chronic pancreatitis

The aim of this study was to assess resting energy expenditure in patients with chronic pancreatitis; 33 patients with alcohol-related chronic pancreatitis (group 1: 13 normal weight, group 2: 20 underweight) and 11 undernourished patients without identifiable disease (group 3) were studied. Body composition was determined by bioelectric impedance analysis and energy expenditure by indirect calorimetry. The percentage of body weight occupied by fat-free mass was similar among the three groups (76.4±1.5%, 78.6±1.3% and 76.8±2.1% for groups 1, 2, and 3, respectively). The measured resting energy expenditure (REE) was higher than the predicted EE (Harris and Benedict formula and Cunningham's equation) for the underweight patients with chronic pancreatitis (group 2) (P<0.05), but not for the two other groups. According to Cunningham's equation, 65% of the group 2 patients were hypermetabolic (REE>110% of predicted EE) versus 23.1% and 20% in groups 1 and 3. When adjusted for fat free mass, REE was significantly (P<0.01) higher in group 2 (35.0±0.9 kcal/kg/24 hr) than in the other two groups (30.1±0.7 kcal/kg/24 hr and 30.8±1.4 kcal/kg/24 hr in groups 1 and 3, respectively). During chronic pancreatitis, weight loss is accompanied by hypermetabolism, which should be taken into consideration during nutritional support.     

Validation of a 7-day physical activity diary against doubly-labelled water

Background: The assessment of physical activity intensity and duration is essential for understanding group activity patterns.

Methods: The present study evaluated the validity of measurement of total energy expenditure (TEE) and physical activity level (PAL) using a categorized physical activity diary. In 29 young healthy men, aged 18–27 years, with body mass index range 21–43 kg m^?2, TEE using doubly-labelled water (DLW), resting metabolic rate (RMR) by indirect calorimetry, physical activity level (PAL defined as TEE/RMR) and activity pattern, timing and level from 7-day physical activity diaries were determined.

Results: TEE by DLW and estimated by activity diary were correlated (r?=?0.61, p?=?0.005). The mean underestimation of TEE by the activity diary compared with the DLW method was 2.50?±?0.72 MJ day^?1. Sedentary (lying, sitting and standing) time averaged 18 h day^?1 and was negatively correlated with PAL (r?=??0.44, p?=?0.018) whilst time spent in light intensity activity (5 h day^?1) was positively correlated (r?=?0.51, p?=?0.005).

Conclusions: It is concluded that the categorized physical activity diary measured TEE with limited accuracy but presents an inexpensive, convenient method of discriminating individual and group physical activity patterns.     

Congruent validity and inter-day reliability of two breath by breath metabolic carts to measure resting metabolic rate in young adults

Background & aims

Achieving high inter-day reliability is a key factor to analyze the magnitude of change in RMR, for instance after an intervention. The aims of this study were: i) to determine the congruent validity of RMR and respiratory quotient (RQ) with two breath by breath commercially available metabolic carts [CCM Express (CCM) and Ultima CardiO2 (MGU)]; and ii) to analyze the inter-day reliability of RMR and RQ measurements.

北京市社区卫生服务实施效果及建议

收支两条线管理是我国针对社区卫生服务机构实行的一项新财务管理制度,北京市是较早推行收支两条线管理的试点城市之一.通过对北京市社区卫生服务工作现状、财政资金投入以及社区卫生服务绩效结果进行分析,了解北京市收支两条线管理政策的实施效果及其影响,并对北京市社区卫生服务机构的发展提供政策性建议,以期完善以社区卫生服务为基础的新型城市医疗卫生服务体系.