大气污染对健康影响的疾病负担研究进展

大气污染对健康的影响已受到越来越多的关注,如何定量描述大气污染所造成的健康影响成为环境与健康领域的研究热点和难点,近年来已有学者采用疾病负担指标评价大气污染对健康的影响:全球疾病负担(GBD)2010研究中,归因于颗粒物污染造成的伤残调整寿命年(DALY)约为7 600万,归因于O3造成的DALY约为245万;欧洲国家每百万人因O3污染损失约30~140 DALY;2004—2008年期间,北京市PM10、PM2.5、NO2和SO2日均浓度每增加1个四分位间距,死亡寿命损失年(YLL)分别为15.8,15.8,15.1和16.2。采用疾病负担评价大气污染危害可为政府制定环境政策和健康干预措施提供更直接的依据。该文综述了大气主要污染物对健康影响疾病负担的研究进展。     

Medical status of elderly patients consulting two oral and maxillofacial surgery departments in Germany

An increasing number of elderly patients requires dental care. The data concerning the medical risk profile of seniors consulting dentists are scarce. In this context, the comorbidity-polypharmacy-score (CPS) could be an effective clinical tool to quickly assess the medical status of elderly patients. The medical data from 648 patients (60 years and older) of two cohorts (Fulda group [Fg] and Marburg group [Mg]) from two maxillofacial surgical units were recorded using a standardised questionnaire and compared concerning the number of the regular medications and the CPS. No medication was needed in 57 patients and 311 took 1 to 4 medications per day. Polypharmacy (5 or more medications per day) could be observed in 280 patients. The average medication was 4.28 in the Fg and 4.57 in the Mg groups (p = 0.249). Antihypertensives and antithrombotics were the most common medications. The CPS was subdivided into three groups (minor, moderate, severe). In total, 332 patients belonged to the minor group and 80 to the severe group. The average CPS was 7.49 in the Fg and 7.99 in the Mg groups (not significant). CPS was strongly correlated with age (p < 0.001) but not with sex. The prevalence of elderly patients with polypharmacy presenting for dental care is increasing. Scores like CPS may be a useful adjunct for quantifying the burden of disease in the context of dental treatment.     

Comparison of three different methods to estimate the burden of disease of burn injuries in Western Australia in 2011-2018

BackgroundPriority setting and resource allocation in health care, surveillance and interventions is based increasingly on burden of disease. Several methods exist to calculate the non-fatal burden of disease of burns expressed in years lived with disability (YLDs). The aim of this study was to assess the burden of disease due to burns in Western Australia 2011–2018 and compare YLD outcomes between three existing methods.MethodsData from the Burns Service of Western Australia was used. Three existing methods to assess YLDs were compared: the Global Burden of Disease (GBD) method, a method dedicated to assess injury YLDs (Injury-VIBES), and a method dedicated to assess burns YLDs (INTEGRIS-burns).ResultsIncidence data from 2,866 burn patients were used. Non-fatal burden of disease estimates differed substantially between the different methods. Estimates for 2011–2018 ranged between 610 and 1,085 YLDs per 100.000 based on the Injury-VIBES method; between 209 and 324 YLDs based on the INTEGRIS-burns method; and between 89 and 120 YLDs based on the GBD method. YLDs per case were three to nine times higher when the Injury-VIBES method was applied compared to the other methods. Also trends in time differed widely through application of the different methods. There was a strong increase in YLDs over the years when the Injury-VIBES method was applied, a slight increase when the INTEGRIS-burns method was applied and a stable pattern when the GBD method was applied.ConclusionThis study showed that the choice for a specific method heavily influences the non-fatal burden of disease expressed in YLDs, both in terms of annual estimates as well as in trends over time. By addressing the methodological limitations evident in previously published calculations of the non-fatal burden of disease, the INTEGRIS-burns seems to present a method to provide the most robust estimates to date, as it is the only method adapted to the nature of burn injuries and their recovery.     

序贯疗法根治幽门螺杆菌感染的疗效观察

目的 观察序贯疗法对幽门螺杆菌(Helicobacter pylori,Hp)感染的治疗和根治效果.方法 选择无锡市第四人民医院经胃镜检查确诊为慢性胃炎、消化性溃疡且Hp感染阳性患者92例,随机分为序贯疗法组(治疗组)和标准三联疗法组(对照组)2组.治疗组45例,给药方案:前5d,埃索美拉唑20 mg+阿莫西林1000mg,日2次；后5d,埃索美拉唑20 mg+克拉霉素500 mg+替硝唑500 mg,日2次；对照组47例,采用标准三联疗法:埃索美拉唑20 mg+克拉霉素500 mg+阿莫西林1 000mg,日2次,疗程7d.所有患者停药4周后复查,观察2组患者治疗的总有效率；采用13C-尿素呼气试验判断Hp感染根治效果,观察Hp根除率.结果 2组患者治疗的总有效率,治疗组为95.56％,对照组为91.48％,两组差异无统计学意义(x2=0.528,P＞ 0.05).Hp根除率治疗组为93.33％,对照组为78.72％,差异有统计学意义(x2=4.040,P＜ 0.05).不良反应治疗组出现7例,发生率为15.56％,对照组8例,发生率为17.02％,差异无统计学意义(x2=0.008,P＞0.05).治疗组平均每例患者治疗费用为165.90元/人,对照组为171.78元/人,费用基本相同.结论 序贯疗法治疗Hp感染疗效明显,是一种有效、安全、经济的Hp感染根除疗法.     

深圳市艾滋病疾病负担分析

目的 利用残疾调整生命年(DALY)指标分析深圳市201 1年艾滋病(AIDS)的疾病负担,确定AIDS防治工作重点,为合理分配卫生资源提供科学依据.方法 计算2011年深圳市AIDS疾病DALY,并进行各年龄组、性别的比较.结果 2011年深圳市AIDS疾病DALY为7458.42人年,其中,YLL为5234.42人年,占70.18％,YLD为2224.00人年,占29.82％.负担强度为0.71人年/千人,YLL/YLD为2.35∶1.DALY主要集中在20～44岁年龄组,男性高于女性.结论 对艾滋病高危人群进行健康教育,降低发病率和病死率,提高患者生活质量,可以降低疾病的间接经济负担.     

辽宁省城乡居民脑卒中疾病负担分析

目的探讨辽宁省城乡居民脑卒中疾病负担的水平及其分布特征、方法根据辽宁省2003年城乡居民脑卒中患病率和死亡率资料,采用全球疾病负担(GBD)分析方法计算脑卒中的伤残调整寿命年(DALY)。结果2003年辽宁省每千人因脑卒中损失17．2个健康生命年,脑卒中引起的DALY损失农村高于城市(18．8∶14．1),男性高于女性(20．2∶14．1)。结论辽宁省脑卒中每千人DALY是GBD2000对中国估计的1．6倍,农村和男性是脑卒中防治的重点。     

抑郁症患者家庭功能和家庭成员生活质量的调查

目的了解抑郁症患者的家庭功能和家庭成员的生活质量。方法采用家庭关怀度指数问卷（APGAR）和健康状况问卷（SF-36），对96例符合DSM-Ⅳ标准的抑郁症患者的家庭功能和家庭成员的生活质量进行评定，并与一般家庭作对照，从家庭的角度评价抑郁症的疾病负担。结果抑郁症患者患病后家庭功能存在障碍的家庭均显著多于对照组，差异具有统计学意义（62．5％比17．3％；χ^2=68．125，P〈Q05），患病后比患病前家庭功能出现障碍的比例显著升高，差异具有统计学意义（62．5％比24．0％；χ^2=118．387，P〈0.01）。经配对检验，患病后APGAR总分及各因子分均比患病前显著降低（t分别为10．874，7．330，11．649，8．240，11．797，10．162；P〈0.01）。家庭成员生活质量评定，在SF-36的8个因子中，生理职能（t=6.024，P〈0.01）、一般健康（t=12．254，P〈0．01）、社会功能（t=11．225，P〈0．01）、情感职能（t=10．328，P〈0．01）和精神健康（t=14．625，P〈0．01）因子评分显著低于对照组，生理机能（t=1．856，P〉0.05）、躯体疼痛（t=1．114，P〉0.05）、精力（t=0．032，P〉0.05）三个因子评分差异无统计学意义。结论抑郁症对家庭功能和家庭成员生活质量的影响是严重和多层次的，需进行相应干预。     

伤寒、副伤寒疾病负担研究现状

国内外关于伤寒、副伤寒的疾病负担研究,大多从疾病流行病学负担方面进行评价,仅有少量有关伤寒疫苗的研究从成本效果方面进行深入的分析,认为在伤寒中高流行地区开展普遍的疫苗接种有较好的成本效果,在这些地区把伤寒疫苗纳入免疫规划具有重要意义.本文通过对国内外研究现状进行综合描述,以期为我国伤寒、副伤寒疾病的负担评价提供参考.     

应用伤残调整生命年评价疾病负担的方法学探究

疾病负担是确定卫生资源配置优先权的基础，疾病负担的评价与分析正在逐渐成为疾病预防控制和卫生行政决策部门的常规工作，而选择适合的疾病负担研究方法才能保证疾病负担测算的科学性。该研究拟系统评价伤残权重、年龄变量、贴现率等伤残调整生命年（DALY）重要参数的本土化合理性，并探索在现有疾病监测系统基础上建立我国完善的常规疾病负担测算体系。