农村老年人老化期望现状及影响因素研究

目的 了解农村老年人的老化期望现状，分析其影响因素，为针对干预提供参考。 方法 采用一般资料调查表、UCLA孤独感量表简化版、老化期望量表、简版自我感知老化量表对199名农村老年人进行问卷调查。 结果 老化期望总分为32.72±9.18，孤独感得分为15.11±3.82，自我感知老化得分为52.75±2.76；多元线性回归分析显示，性别、婚姻状况、患慢性病种数、独居、孤独感、自我感知老化及经济来源是农村老年人老化期望的影响因素（调整R2=0.612，均P＜0.05）。 结论 农村老年人的老化期望水平较低，女性、孤独、无配偶、患慢性病较多、老化态度消极及低收入人群是关注的重点。     

Adherence to and persistence with antidiabetic medications and associations with clinical and economic outcomes in people with type 2 diabetes mellitus: A systematic literature review

We designed a systematic literature review to identify available evidence on adherence to and persistence with antidiabetic medication in people with type 2 diabetes (T2D). Electronic screening and congress searches identified real-world noninterventional studies (published between 2010 and October 2020) reporting estimates of adherence to and persistence with antidiabetic medication in adults with T2D, and associations with glycaemic control, microvascular and/or macrovascular complications, hospitalizations and healthcare costs. Ninety-two relevant studies were identified, the majority of which were retrospective and reported US data. The proportions of patients considered adherent (median [range] 51.2% [9.4%-84.3%]) or persistent (median [range] 47.7% [16.9%-94.0%]) varied widely across studies. Multiple studies reported an association between greater adherence/persistence and greater reductions in glycated haemoglobin levels. Better adherence/persistence was associated with fewer microvascular and/or macrovascular outcomes, although there was little consistency across studies in terms of which outcomes were improved. More adherent and more persistent patients were typically less likely to be hospitalized or to have emergency department visits/admissions and spent fewer days in hospital annually than less adherent/persistent patients. Greater adherence and persistence were generally associated with lower hospitalization costs, higher pharmacy costs and lower or budget-neutral total healthcare costs compared with lower adherence/persistence. In conclusion, better adherence and persistence in people with T2D is associated with lower rates of microvascular and/or macrovascular outcomes and inpatient hospitalization, and lower or budget-neutral total healthcare expenditure. Education and treatment strategies to address suboptimal adherence and persistence are needed to improve clinical and economic outcomes.     

Niven and Scott (2003): Sixteen years of hindsight

This paper revisits a 2003 publication in Nursing Philosophy: The need for accurate perception and informed judgement in determining the appropriate use of the nursing resource: hearing the patient's voice. The author suggests that the basic ideas and focus of this 16‐year‐old paper are still topical and relevant in considerations of nursing care. However, it is also suggested that greater attention to the importance of the nurse–patient relationship in considerations of resource allocation, and potential rationing of nursing care, would have strengthened the original paper.     

Relationship between rosacea and dietary factors: A multicenter retrospective case–control survey

Although patients with rosacea often consult dermatologists for dietary factors that might be related to their skin disorders, few studies have been conducted to research the relationship between rosacea and dietary factors. The purpose of this study was to evaluate the potential relationship between rosacea and diet among the large Chinese population with rosacea, which would provide dietary guidelines for patients with rosacea. A multicenter case–control study was conducted. The feeding frequency 2 years before the occurrence of rosacea was collected by standardized questionnaires. Multiple logistic regression analysis was used to calculate risks related to the diet. One thousand three hundred and forty‐seven patients with rosacea and 1290 controls were enrolled in our study. We found that high‐frequency intake of fatty food and tea presented a positive correlation with rosacea, while high‐frequency dairy product intake showed significant negative correlation with rosacea. Sweet food, coffee and spicy food appeared to be independent of any subset of rosacea in our study. However, high‐frequency dairy product intake showed a borderline beneficial effect on rosacea severity. We further analyzed the correlation between diet and the subtype of rosacea. We found that high‐frequency fatty intake was associated with erythematotelangiectatic rosacea (ETR) and phymatous rosacea, while high‐frequency tea intake was only associated with ETR. In addition, high‐frequency dairy product intake showed negative correlations with ETR and papulopustular rosacea. Rosacea is associated with some dietary factors, and our study is valuable in establishing dietary guidelines to prevent and improve rosacea.     

The clinical and cost impact of switching to fingolimod versus other first line injectable disease-modifying therapies in patients with relapsing multiple sclerosis

Background: There is limited evidence on the effectiveness and healthcare costs of switching to fingolimod versus another first line injectable therapy (FLIT) in patients with relapsing multiple sclerosis (RMS) who have already been treated with FLIT.

Objective: The objectives of the study were to assess the annualized relapse rate (ARR), socio-demographic and clinical characteristics, persistence and adherence rates, healthcare resource utilization and cost among patients with RMS who either switch to fingolimod or another FLIT in routine clinical practice.

Methods: A multicenter, observational, retrospective chart review was conducted across eight clinics in Canada between 1 May 2011 and 30 June 2013. The data was collected from two cohorts: patients who switched to fingolimod and patients who switched to FLIT from a previous FLIT.

Results and conclusions: A total of 124 patients were included in the study: 82 and 42 switched to fingolimod and FLIT, respectively. There were no significant differences in the patient characteristics at the date of switch except for number of previous disease-modifying therapies (DMTs) which was higher in the fingolimod cohort (fingolimod: 1.52; FLIT: 1.10, p?<?.001). The ARR during the first year of switching was numerically higher in the FLIT cohort compared to the fingolimod cohort (FLIT: 0.9 [95% CI 0.3–1.6]; fingolimod: 0.3 [95% CI 0.1–0.5]). The negative binomial model adjusted for the number of previous DMTs confirmed a statistically significant difference in ARR between the fingolimod and FLIT cohorts at 12?months of follow-up (p?=?.012). In the fingolimod cohort, 20.7% of patients experienced at least one relapse compared to 38.1% in the FLIT cohort. In both groups, a high proportion of patients (>90%) showed good treatment adherence (≥80% of prescribed doses).     

深圳市龙华区居民代谢性综合征流行状况及相关因素分析

目的 了解深圳市龙华区代谢综合征发病情况及相关因素。方法 采取横断面研究，经过多阶段随机抽样，最终确定1 015名调查对象。调查内容包括问卷调查、身体测量和实验室检测。结果 龙华区代谢综合征的患病率为15.57%， 11种组分组合中，有4个组分组合的比例为28.49%，有5个组分组合的比例为5.06%。膳食调查中，水果分别在代谢综合征和非代谢综合征被调查者中的摄入有统计学差异（Z = - 2.47, P = 0.0135）。logistic回归分析结果显示在控制了年龄、性别、婚姻和户籍所在地后，不吸烟者与吸烟≥20支/天者相比，患代谢综合征的可能性可降低58%。性别分别与年龄和BMI的交互效应结果显示，女性在55～65岁，或女性肥胖，患代谢综合征的可能性分别是男性的40.56倍和32.82倍。结论 龙华区代谢性综合征患病情况不容乐观，因代谢性综合征诱导的心血管疾病风险较大，应针对其风险因素采取措施，以控制代谢性综合征的发生，并控制其进行性发展。     

北京市2017-2018年卫生资源公平性分析

基于对北京市居民对基本社会医疗保险制度的调查及《北京市统计年鉴》的数据,运用卫生资源分布图、集中指数和卡瓦尼指数等方法从资源总体配置公平性、卫生筹资公平性、卫生资源分布公平性3个方面分析北京市2017年、2018年卫生资源配置的情况。2017年、2018年的集中指数、基尼系数、卡瓦尼指数分别为-0.148、0.244、-0.392及-0.065、0.220、-0.285。并针对性提出统筹城乡基本医保,重视卫生资源的合理配置,保障低收入人群诊疗权益,满足不同人群对医保的需求,增加制度的灵活性,使医保向更公平的方向发展等可操作性政策建议。     

鞍山市学生常见病调查及相关因素分析

目的 调查鞍山市学生常见病情况,并对其相关因素进行分析。方法 2018年9～11月选择鞍山市1个城区和1个县(铁东区和千山区),共监测13所学校,其中城区8所学校,县5所学校,其中包含小学到大学,调查学生常见病发生情况,分析不同年级、性别、地区学生常见病差异性。结果 鞍山市学生视力不良检出率最高,占53.77%,其次为恒牙龋齿,占21.11%;随着年级的增长视力不良检出率呈现出升高趋势(P0.05);与城区相比,县级学校视力不良、恒牙龋齿检出率明显偏高,且女性高于男性,差异有统计学意义(P0.05);随着年级增长,营养不良检出率逐渐降低(P0.05)。结论 鞍山市学生健康状况不容乐观,其中视力不良、龋齿以及营养不良等成为影响学生健康的主要卫生问题,应给予高度重视。     

岗位价值评估在A医院人力资源管理过程的应用

探讨岗位价值评估方法在医院人力资源的管理过程中的应用和意义。采用国际岗位价值评估系统(IPE)对A医院现有140个岗位进行岗位价值评估,并利用岗位评分对人力资源管理问题进行剖析。A医院岗位评估分数的总趋势和总分布结果显示,岗位评估分值曲线现呈较平滑的递减趋势,这表明A医院职能处室内部各类岗位的岗位价值不存在明显差异。从各个职能处室内部来看,内部岗位评价结果分布比较均匀,说明部门内部分工相对合理。岗位价值评价有助于增强医院薪酬分配的公平性,提高薪酬的激励性,也有利于优化医院管理制度,推动医院可持续发展。     

江苏省13家医院新生儿严重高胆红素血症现状调查

目的 了解江苏省新生儿严重高胆红素血症的发生情况及诊治、随访等管理情况，为新生儿严重高胆红素血症的预防及规范化管理提供依据。方法 以2018年1~12月江苏省13家医院收治的严重高胆红素血症新生儿为研究对象，回顾性分析患儿的临床资料及随访资料。结果 江苏省13家医院2018年严重高胆红素血症新生儿病例共上报740例，占新生儿科收治病例总数的2.70%（740/27 386），其中重度高胆红素血症620例（83.8%），极重度高胆红素血症106例（14.3%），危险性高胆红血症14例（1.9%）；诊断为急性胆红素脑病共4例（0.5%）。484例（65.4%）新生儿于分娩机构出院后因严重高胆红素血症返回医院住院治疗，中位入院日龄为7 d，其中214例（44.2%）再入院前进行过门诊黄疸随访，第1次门诊中位随访日龄为6 d。住院期间行头颅MRI检查211例（28.5%），其中85例（40.3%）提示双侧基底节、苍白球T1WI信号偏高；行脑干听觉诱发电位检查238例（32.2%），其中14例（5.9%）仅一侧通过，7例（2.9%）双侧均未通过。急性胆红素脑病或危险性高胆红素血症患儿（共17例）进行了随访，除1例失访外，均无异常神经系统症状。结论 新生儿严重高胆红素血症在新生儿科住院病人中的占比较高；新生儿从分娩机构出院后黄疸监测及管理需要加强；对并发了严重高胆红素血症的患儿，住院期间相关检查需更完善，出院后均需全面系统地随访。