An examination of sex and racial/ethnic differences in the metabolic syndrome among adults: A confirmatory factor analysis and a resulting continuous severity score

Objective

The metabolic syndrome (MetS) is typically diagnosed based on abnormalities in specific clustered clinical measures that are associated with increased risk for coronary heart disease (CHD) and Type 2 diabetes mellitus (T2DM). However, current MetS criteria result in racial/ethnic discrepancies. Our goals were to use confirmatory factor analysis (CFA) to delineate differential contributions to MetS by sub-group, and if contributions were discovered, develop sex and racial/ethnic-specific equations to calculate MetS severity.

Research Design and Methods

Using data on adults from the National Health and Nutrition Examination Survey 1999–2010, we performed a CFA of a single MetS factor that allowed differential loadings across groups, resulting in a sex and race/ethnicity-specific continuous MetS severity score.

Results

Loadings to the single MetS factor differed by sub-group for each MetS component (p < 0.001), with lower factor loadings among non-Hispanic-blacks for triglycerides and among Hispanics for waist circumference. Systolic blood pressure exhibited low factor loadings among all groups. MetS severity scores were correlated with biomarkers of future disease (high-sensitivity C-reactive-protein, uric acid, insulin resistance). Non-Hispanic-black-males with diabetics had a low prevalence of MetS but high MetS severity scores that were not significantly different from other racial/ethnic groups.

Conclusions

This analysis among adults uniquely demonstrated differences between sexes and racial/ethnic groups regarding contributions of traditional MetS components to an assumed single factor. The resulting equations provide a clinically-accessible and interpretable continuous measure of MetS for potential use in identifying adults at higher risk for MetS-related diseases and following changes within individuals over time. These equations hold potential to be a powerful new outcome for use in MetS-focused research and interventions.     

Effectiveness of combined therapy with angiotensin-converting enzyme inhibitors and statins in reducing mortality in diabetic patients with critical limb ischemia: An observational study

Aims

To investigate the effect of combined treatment with angiotensin-converting enzyme inhibitors (ACE) and statins on mortality in diabetic patients with critical limb ischemia (CLI).

Methods

Prospective observational study of 553 consecutive diabetic patients admitted because of CLI followed for a mean of 2.2 years. All patients underwent peripheral revascularization and antithrombotic therapy was prescribed or continued and therapy with statin and ACE was recorded. Mortality from any cause was assessed and Kaplan–Meier analyses were performed to compare the relationship between survival and recorded variables.

Results

One hundred thirty-nine patients did not have therapy with statin or an ACE, 78 had therapy with statin without ACE, 164 had therapy with ACE without statin and 172 patients had therapy with both statin and ACE. One hundred thirty-six patients died, 45/139 with neither statin nor ACE, 40/164 with ACE only, 26/78 with statin only, and 25/172 with both statin and ACE. Multivariate analysis confirmed the independent role of age, history of stroke, renal insufficiency and dialysis. Combined treatment with ACE and statin appeared to have a protective role.

Conclusions

In patients with diabetes and CLI mortality after two years is high. Life expectancy was better in patients receiving combined therapy with ACE and statin but not with therapy with only a statin or an ACE.     

黄芩处方的调查和分析

目的通过处方统计探讨黄芩在医疗机构门诊处方中的使用情况、用药思维和配伍规律。方法调查北京地区医疗机构门诊处方7682张,对其中含有黄芩的处方进行统计分析。结果黄芩处方占门诊处方的15．13％,其中黄芩剂量在6-15g范围的处方占88．83％,黄芩平均剂量为9．82g,黄芩处方主要用于治疗肺系、肝胆系、脾胃系、和妇科四类病证,这四类病证的处方占88．33％,临床常配伍柴胡、黄连、金银花、鱼腥草、半夏、桑白皮、白术等药物。结论黄芩临床使用广泛,配伍药物具有多样性和规律性。     

总额预付下定点医院加强医保管理实践探索

定点医院不仅是参保人员获取基本医疗服务和实现基本医疗消费的主体,又是直接控制医疗费用的载体,还是具体与参保人员接触、沟通、落实医保政策的场所。定点医院成为基本医疗保险管理体系中极为重要的组成部分,总额预付下如何加强医保管理与政策落实是否到位,直接关系到控制医保费用的关键所在。     

结直肠癌根治术后肠梗阻的相关影响因素探讨

目的：探讨结直肠癌根治术后肠梗阻的相关影响因素。方法选择2003年6月～2013年6月河南省封丘县中医院普外科收治的行结直肠癌根治术患者678例。采用自制量表调查患者一般情况,包括性别、年龄、既往手术史、术前合并症、手术类型、手术方式、手术时间、术后镇痛剂应用及肿瘤TNM分期、分级情况。采用Logistic回归分析进行多因素检验。结果结直肠癌根治术患者678例,其中发生肠梗阻41例,肠梗阻发生率为6.05%（41/678）。TNM分期为N2期、既往史有结直肠肿瘤切除、术前合并肠梗阻、行左半结肠切除术和右半结肠切除术是直结肠癌根治术后发生肠梗阻的独立危险因素（P＜0.05）。结论在临床工作中应注意危险因素的预防,减轻患者痛苦,改善预后。     

酒石酸长春瑞滨的细菌内毒素检查方法验证

目的：参考 USP、EP,探讨并建立酒石酸长春瑞滨的细菌内毒素标准与检查方法（凝胶法）。方法按《中国药典》（2010年版）二部附录Ⅺ E 细菌内毒素检查方法进行。结果经验证,酒石酸长春瑞滨的细菌内毒素限值确定为 L ＜2.0IU/mg（以长春瑞滨计）,通过稀释法可消除干扰,无干扰浓度为0.035mg/mL（以长春瑞滨计）。结论可按此标准采用本法对本品进行细菌内毒素检查。     

Geographic disparity: the dilemma of lower socioeconomic status,multiple listing,and death on the liver transplant waiting list

Due to the current regionally based allocation system, some patients list for and are transplanted away from home in regions with shorter waits and higher transplant rates. Of 147 included patients, 120 died waiting and 27 received transplants at outside centers during the study (32.5 months). Those transplanted elsewhere had higher median incomes than patients dying on the waitlist ($84 946 vs. $55 250, p = 0.0001). Those with median incomes <$60 244 were more likely to die than those with incomes >$60 244 (94% vs. 70%, RR: 1.35, 95% CI: 1.14–1.59). Patients with Medicaid were more likely to die waiting than those with other insurance (100% vs. 77%, RR: 1.30, 95% CI: 1.18–1.44). Our analysis demonstrates that those who died waiting were more likely to have lower incomes and Medicaid compared with those transplanted elsewhere. Even when we controlled for Medicaid status, patients who died waiting had lower incomes compared with those transplanted elsewhere. Increased organ sharing over geographically broader regions, as recommended by the Institute of Medicine in 1999, may reduce incentives for patients to travel to receive a liver and reduce inequities. Current efforts to address this disparity continue to fall short of the Institute of Medicine recommendations, United States Department of Health and Human Services regulations and the Final Rule.