广东省家庭医生式服务试点地区居民健康行为及影响因素分析

目的了解广东省家庭医生式服务试点地区居民健康行为及影响因素,为开展健康教育提供依据。方法2015年7—10月抽样选取1010名家庭医生式服务试点地区居民进行问卷调查,以吸烟、饮酒、早餐、吃水果、锻炼及睡眠等6项行为为调查内容,同时选用P-CAT量表测量基层医疗服务质量。结果 6项行为方式共赋值12分,被调查者平均得分(8.72?0.65)分,得分从高到低依次为吃早餐、限酒、不吸烟、体育锻炼、吃水果和睡眠。多重线性回归分析结果显示:女性、已婚或慢性病患者的健康行为优于各对应组;收入对健康行为有正面影响;基层医疗服务可及性、服务提供综合性对健康行为有正向影响。结论试点地区居民整体健康行为较好。健康教育和健康促进应聚焦于合理膳食、锻炼及睡眠等健康行为;男性、单身或离异及低收入群体是重点关注的对象;提高基层医疗服务可及性和服务提供综合性有利于促进居民的健康行为。     

上海市长宁区中学生智能终端成瘾现况及其相关因素研究

目的 了解长宁区中学生智能终端的成瘾现况及其相关因素,为指导中学生科学、合理地使用智能终端提供依据。方法 2017年5月采用分层整群抽样的方法在长宁区中学抽取949名学生,通过问卷调查的方式收集学生智能终端的成瘾现况,参考Young网络成瘾评价方法进行成瘾是否的判定,分别通过K10 量表和ULS-8量表收集学生的心理健康状况及孤独感,探讨学生智能终端成瘾的相关因素。结果 中学生智能终端成瘾检出率为14.33%(136/949)。单因素分析显示年级段、学习成绩、使用安排方式、使用目的均与成瘾检出率有关(χ²分别为43.046、8.711、21.652、13.970,P<0.05),成瘾组学生K10量表及USL-8量表总分均高于非成瘾组(Z值分别为-7.998、-7.297)。多因素分析显示年级高中(OR=1.822,95%CI:1.167~2.585)、使用目的为娱乐(OR=1.572,95%CI:1.060~2.330)、K10量表总分>14分(OR=2.788,95%CI:1.786~4.352)、USL-8量表总分>14分(OR=2.013,95%CI:1.320~3.071)是智能终端成瘾的危险因素(P<0.05)。结论 长宁区中学生智能终端成瘾检出率较高,其与年级段及使用目的有关,智能终端成瘾还与心理健康及孤独程度有关,应引起关注。     

Evaluation of the Ability of Diet-Tracking Mobile Applications to Estimate Energy and Nutrient Intake in Japan

We evaluated the energy and nutrient intake estimates of popular Japanese diet-tracking mobile applications (apps). We identified five diet-tracking apps in the iTunes store during August 2020. A researcher entered the dietary data from a one-day paper-based dietary record (DR) previously obtained from apparently healthy free-living adults (15 males and 15 females; 22–65 years) into each app. The energy and nutrient intakes estimated by the apps were compared with those calculated using the Standard Tables of Food Composition in Japan based on the paper-based DR (reference method). The number of dietary variables available ranged from one (energy in Mogutan) to 17 (FiNC). Compared to the DR-based estimates, the median energy intake was significantly overestimated by MyFitnessPal, Asken, Calomiru, and Mogutan. Moreover, the intakes of many nutrients were overestimated by Asken and Calomiru and underestimated by MyFitnessPal. For energy intake, the Spearman correlation coefficient between the DR and the apps was lowest for Mogutan (0.76) and highest for FiNC (0.96). The median correlation coefficient for nutrient intakes was lower in MyFitnessPal (0.50) than in the other three apps (0.80 in Asken, 0.87 in FiNC, and 0.88 in Calomiru). These results suggest that intake calculations differ among apps. Further evaluation is needed in free-living settings, where users input their own food intake.     

ROCCIPI技术框架下智慧医院建设的问题识别及分析

建设智慧医院旨在以患者为中心,通过智慧化途径向患者提供便捷化、个性化的医疗卫生服务,改善患者就医体验。文章采用ROCCIPI技术框架,就规则、机会、能力、交流、利益、过程和意识七个方面对我国医院智慧化建设进行深入分析,为现代化医院建设提供一定参考。     

基于EHR对骨质疏松分级诊疗管理模式的探索与实践

目的探讨EHR对骨质疏松分级诊疗管理模式的临床效果。方法以上海市某社区慢性病管理团队为例,依托瑞金-卢湾医联体"全-专门诊"进行分级诊疗,介绍该区域医联体内专科与全科医生团队如何开展区域医联体特色的家庭医生"1+1+1"签约服务,建立个人EHR,通过调阅区、市两级EHR查阅患者区域内就诊信息,对签约骨质疏松患者进行管理,分析管理效果。结果研究对象疼痛症状、身体机能、社会适应能力和精神心理功能较一年前得分均有下降(P0.05);骨代谢指标β-CTX、PICP、PTH和BGP明显下降(P0.05),维生素D升高(P0.001);L1～3、股骨颈、wards三角、大粗隆和total髋的骨密度有提高(P0.05)。结论 EHR对骨质疏松分级诊疗、实施区域医联体特色的签约服务和建立个人EHR等方案可改善骨质疏松患者生活质量,值得推广。     

基于穿戴式智慧衣的心电远程实时监护系统设计

目的:针对目前心电监护系统在穿戴式、实时性和数据分析上存在的不足之处,设计一种基于穿戴式智慧衣的心电远程实时监护系统。方法:该系统包括穿戴式智慧衣、Android智能手机App和私有云服务器3个部分。通过穿戴式智慧衣实时采集老年人心电信号。Android智能手机App通过无线蓝牙技术接收心电数据,实时传输心电数据到私有云服务器。私有云服务器接收智能手机传输的心电数据,采用基于机器学习的心电分类算法对心电数据进行房颤检测。云端服务器的云端心电图实时监护平台实时显示心电图和心电分析结果,辅助社区监护人员监护老年人心电。结果:心电分类算法的房颤检测效果较好,该系统的心电数据采集和数据远程传输可靠,监护功能运行正常。结论:该系统可以在社区中对老年人进行心电远程实时监护和房颤检测。     

Predicting traffic volumes and estimating the effects of shocks in massive transportation systems

Public transportation systems are an essential component of major cities. The widespread use of smart cards for automated fare collection in these systems offers a unique opportunity to understand passenger behavior at a massive scale. In this study, we use network-wide data obtained from smart cards in the London transport system to predict future traffic volumes, and to estimate the effects of disruptions due to unplanned closures of stations or lines. Disruptions, or shocks, force passengers to make different decisions concerning which stations to enter or exit. We describe how these changes in passenger behavior lead to possible overcrowding and model how stations will be affected by given disruptions. This information can then be used to mitigate the effects of these shocks because transport authorities may prepare in advance alternative solutions such as additional buses near the most affected stations. We describe statistical methods that leverage the large amount of smart-card data collected under the natural state of the system, where no shocks take place, as variables that are indicative of behavior under disruptions. We find that features extracted from the natural regime data can be successfully exploited to describe different disruption regimes, and that our framework can be used as a general tool for any similar complex transportation system.Well-designed transportation systems are a key element in the economic welfare of major cities. Design and planning of these systems requires a quantitative understanding of traffic patterns and relies on the ability to predict the effects of disruptions to such patterns, both planned and unplanned (1).There is a long history of analytic and modeling approaches to the study of traffic patterns (2), for example using simulated scenarios in simple transportation systems (3), and analysis of real traffic data in complex systems, either focusing on a small samples (4) or using more aggregate data (5, 6). Here we take this approach to the next level by making use of smart-card data and incident logs to (i) predict traffic patterns and (ii) estimate the effect of unplanned disruptions on these patterns. We analyzed 70 d of smart-card transactions from the London transportation network, composed of ∼10 million unique IDs and 6 million transactions per day on average, resulting in one of the largest statistical analyses of transportation systems to date.A related literature deals with various aspects of dynamics in complex networks and complex systems in general (7–9), using a variety of data sources, from emails (10) to the circulation of bank notes (11) to online experiments on Amazon Turk (12). More recently, a number of analyses have leveraged mobile phone data as proxies for mobility (4, 13–15).However, smart-card technology allows us to obtain large samples of passenger location and movements without requiring noisy and potentially unreliable proxies such as mobile Global Positioning System traces (16), while also leveraging a more structured environment that imposes hard constraints on patterns of urban mobility (17). In particular, these constraints of the system allow us to identify a global model of passenger behavior under local line and station closures.     

'Smart' delivery systems for biomolecular therapeutics

OBJECTIVE: There is a strong need for drug delivery systems that can deliver biological signals from biomaterials and tissue engineering scaffolds, and a particular need for new delivery systems that can efficiently deliver biomolecules to intracellular targets. Viruses and pathogens have evolved potent molecular machinery that sense the lowered pH gradient of the endosomal compartment and become activated to destabilize the endosomal membrane, thereby enhancing protein or DNA transport to the cytoplasmic compartment. A key feature of many of these biological delivery systems is that they are reversible, so that the delivery systems are not directly toxic. These delivery systems have the ability to change their structural and functional properties and thus display remarkable 'smart' material properties. The objective of this presentation is to review the initial development of smart polymeric carriers that mimic these biological delivery systems and combine similar pH-sensitive, membrane-destabilizing activity for the delivery of therapeutic biomolecules. DESIGN: We have developed new 'smart' polymeric carriers to more effectively deliver and broaden the available types of biomolecular therapeutics. The polymers are hydrophilic and stealth-like at physiological pH, but become membrane-destabilizing after uptake into the endosomal compartment where they enhance the release of therapeutic cargo into the cytoplasm. They can be designed to provide a range of pH profiles and membrane-destabilizing activities, allowing their molecular properties to be matched to specific drugs and loading ranges. A versatile set of linker chemistries is available to provide degradable conjugation sites for proteins, nucleic acids, and/or targeting moieties. RESULTS: The physical properties of several pH-responsive polymers were examined. The activity and pH profile can be manipulated by controlling the length of hydrophobic alkyl segments. The delivery of poly(propyl acrylic acid) (PPAA)-containing lipoplexes significantly enhanced wound healing through the interconnected effects of altered extracellular matrix organization and greater vascularization. PPAA has also been shown to enhance cytoplasmic delivery of a model protein therapeutic. Polymeric carriers displaying pH-sensitive, membrane-destabilizing activity were also examined. The pH profile is controlled by the choice of the alkylacrylic acid monomer and by the ratio of the carboxylate-containing alkylacrylic acid monomer to alkylacrylate monomer. The membrane destabilizing activity is controlled by the lengths of the alkyl segment on the alkylacrylic acid monomer and the alkylacrylate monomer, as well as by their ratio in the final polymer chains. CONCLUSION: The molecular mechanisms that proteins use to sense and destabilize provide interesting paradigms for the development of new polymeric delivery systems that mimic biological strategies for promoting the intracellular delivery of biomolecular drugs. The key feature of these polymers is their ability to directly enhance the intracellular delivery of proteins and DNA, by destabilizing biological membranes in response to vesicular compartment pH changes. The ability to deliver a wide variety of protein and nucleic acid drugs to intracellular compartments from tissue engineering and regenerative scaffolds could greatly enhance control of important processes such as inflammation, angiogenesis, and biomineralization.