农村居民与城市居民急性心肌梗死的临床特点及危险因素分析

目的探讨农村和城市居民急性心肌梗死(AMI)危险因素的差异。方法回顾性分析农村、城市AMI患者的临床特点、发病年龄、既往史、吸烟、高血压、糖尿病和高血脂等危险因素,并进行对比研究。结果农村和城市患者年龄无明显差别;城市居民AMI危险因素依次为高血压、低密度脂蛋白升高、高血压加脑梗死、高血脂、糖尿病和高密度脂蛋白降低;农村居民AMI危险因素依次为高血压、高血压加脑梗死、胆固醇升高和高密度脂蛋白降低;城市早期就诊率高于农村。结论农村和城市居民AMI发病平均年龄、临床特点相似,危险因素略有差别。     

Mortality and Revascularization Following Admission for Acute Myocardial Infarction: Implication for Rural Veterans

Introduction: Annually, over 3,000 rural veterans are admitted to Veterans Health Administration (VA) hospitals for acute myocardial infarction (AMI), yet no studies of AMI have utilized the VA rural definition. Methods: This retrospective cohort study identified 15,870 patients admitted for AMI to all VA hospitals. Rural residence was identified by either Rural-Urban Commuting Area (RUCA) codes or the VA Urban/Rural/Highly Rural (URH) system. Endpoints of mortality and coronary revascularization were adjusted using administrative laboratory and clinical variables. Results: URH codes identified 184 (1%) veterans as highly rural, 6,046 (39%) as rural, and 9,378 (60%) as urban; RUCA codes identified 1,350 (9%) veterans from an isolated town, 3,505 (22%) from a small or large town, and 10,345 (65%) from urban areas. Adjusted mortality analyses demonstrated similar risk of mortality for rural veterans using either URH or RUCA systems. Hazards of revascularization using the URH classification demonstrated no difference for rural (HR, 0.96; 95% CI, 0.94-1.00) and highly rural veterans (HR, 1.13; 0.96-1.31) relative to urban veterans. In contrast, rural (relative to urban) veterans designated by the RUCA system had lower rates of revascularization; this was true for veterans from small or large towns (HR, 0.89; 0.83-0.95) as well as veterans from isolated towns (HR, 0.86; 0.78-0.93). Conclusion: Rural veterans admitted for AMI care have a similar risk of 30-day mortality but the adjusted hazard for receipt of revascularization for rural veterans was dependent upon the rural classification system utilized. These findings suggest potentially lower rates of revascularization for rural veterans.     

Acute Myocardial Infarction Mortality Before and After State-wide Smoking Bans

Rapid declines in hospital admissions for acute myocardial infarction (AMI) following smoke-free ordinances have been reported in smaller communities. The AMI mortality rate among persons age 45 + years (deaths per 100,000 persons, age-standardized to the 2000 US population) in the 3 years before adoption of the smoke-free ordinance (the expected rate) was compared with the rate observed in the first full year after the ban (the target year) in six US states. Target-year declines were also compared to those in states without smoking bans. Target-year declines in AMI mortality in California (2.0%), Utah (7.7%) and Delaware (8.1%) were not significantly different from the expected declines (P = 0.16, 0.43 and 0.89, respectively). In South Dakota AMI mortality increased 8.9% in the target year (P = 0.007). Both a 9% decline in Florida and a 12% decline in New York in the 2004 target year exceeded the expected declines (P = 0.04 and P < 0.0002, respectively) but were not significantly different (P = 0.55 and 0.08, respectively) from the 9.8% decline that year in the 44 states without bans. Smoke-free ordinances provide a healthy indoor environment, but their implementation in six states had little or no immediate measurable effect on AMI mortality.     

急性心肌梗死患者血清中Hcy、HDL-C和apoA-I的水平及其相互关系

目的 观察急性心肌梗死患者血清中的同型半胱氨酸、载脂蛋白A1、高密度脂蛋白胆固醇的水平及三者之间的关系.方法 收集2010年6-8月份急性心梗住院患者60例为观察组,同期健康成人51例为对照组.入选对象在入院后就对其抽血进行同型半胱氨酸、载脂蛋白A1、高密度脂蛋白水平的测定,并进行统计分析.结果 观察组同型半胱氨酸、载脂蛋白A1、高密度脂蛋白的水平和正常对照组比较差异有统计学意义,观察组的血清同型半胱氨酸较对照组明显升高(P<0.01),而高密度脂蛋白和载脂蛋白A1较对照组明显降低(P<0.01),且同型半胱氨酸和高密度脂蛋白胆固醇之间呈负相关关系(r=-0.824,P<0.01).结论 同型半胱氨酸在动脉粥样硬化的形成中具有重要作用,其与高密度脂蛋白的负相关关系可能是其参与动脉粥样硬化的形成机制之一.     

急性心肌梗死合并心力衰竭患者和肽素分析

目的分析急性心肌梗死合并心力衰竭患者和肽素的变化。方法2017年8月30日—2019年8月30日,本院共收治57例急性心肌梗死合并心力衰竭患者,回顾分析57例患者全部资料并将其定为研究对象,并纳入观察组,同期选择我院57例健康体检人员作为对照组,对两组患者入院、入院后3 h、6 h、12 h、24 h以及72 h的和肽素水平进行检测,评价分析和肽素水平的变化意义。结果观察组入院、入院后3 h、6 h、12 h、24 h以及72 h的和肽素水平高于对照组,P<0.05,随着入院时间延长,和肽素水平逐渐降低。结论与健康人员相比较,急性心肌梗死合并心力衰竭患者的和肽素水平会显著升高,可作为急性心肌梗死合并心力衰竭早期诊断生物学标志物,及时监测有利于作出正确的诊疗方案。     

Chiropractic Use by Urban and Rural Residents With Insurance Coverage

ABSTRACT:  Purpose: To describe the use of chiropractic care by urban and rural residents in Washington state with musculoskeletal diagnoses, all of whom have insurance coverage for this care. The analyses investigate whether restricting the analyses to insured individuals attenuates previously reported differences in the prevalence of chiropractic use between urban and rural residents as well as whether differences in provider availability or patient cost-sharing explain the difference in utilization. Methods: Claims data from 237,500 claimants in 2 large insurance companies in Washington state for calendar year 2002 were analyzed, using adjusted clinical group risk adjustment for differences in disease burden and rural urban commuting area codes for rurality definition. Findings: The proportion of claimants using chiropractors was higher in rural than urban residents (44% vs 32%, P < .001). Lack of conventional providers in rural areas did not completely explain this difference, nor did differences in patient cost-sharing or demographics. Among those who used chiropractors, those in urban areas had more chiropractic visits than users of chiropractic in rural areas. Conclusions: Among insured adults, use of chiropractic care was higher in rural than in urban areas. Reasons suggested for this difference in previous reports were not borne out in this data set.     

Access to Revascularization Among Patients with Acute Myocardial Infarction in New York City—Impact of Hospital Resources

Timely revascularization can improve survival in patients with acute myocardial infarction. Identification of factors associated with increased use of revascularization in appropriate patients could improve outcomes. Using New York City hospital discharge records for 1988-1992 and 1998-2002, we determined revascularization rates for patients hospitalized with MI by neighborhood. Odds ratios for revascularization were estimated using a spatial model adjusting for neighborhood sociodemographic characteristics, while accounting for similarities in the rate of revascularization among geographically adjacent neighborhoods. Only 16 out of 112 New York City hospitals performed coronary revascularization. They were located in 14 of 41 neighborhoods. In general, patients living in neighborhoods with higher percentages of patients admitted to hospitals capable of revascularization service were more likely to be revascularized than those in neighborhoods with low percentages of patients admitted to hospitals with revascularization resources. This was true regardless of neighborhood availability of revascularization, after accounting for neighborhood socioeconomic characteristics and patients' clinical status. Revascularization rates in New York City increased from 1988-1992 to 1998-2002 in every neighborhood and as a whole from 103 to 326 per 1,000 hospitalized AMI patients. This increase was not explained by the addition of new revascularization services. Thus, in New York City, where only certain hospitals can perform revascularization, efficient delivery of patients to hospitals with these resources appears to increase the likelihood of revascularization performance among AMI patients without increasing the number of new hospitals capable of revascularization.     

Association of Race and Poverty With Mortality Among Nursing Home Residents on Maintenance Dialysis

ObjectivesThe association of race, ethnicity, and socioeconomic factors with survival rates of nursing home (NH) residents with treated end-stage renal disease (ESRD) is unclear. We examined whether race/ethnicity, ZIP code–level, and individual-level indicators of poverty relate to mortality of NH residents on dialysis.DesignRetrospective cohort study.Participants/SettingUsing the United States Renal Data System database, we identified 56,194 nursing home residents initiated on maintenance dialysis from January 1, 2007 through December 31, 2013, followed until May 31, 2014.MeasurementsWe evaluated baseline characteristics of the NH cohort on dialysis, including race and ethnicity. We assessed the Medicare-Medicaid dual eligibility status as an indicator of individual-level poverty and ZIP code–level median household income (MHI) data. We conducted Cox regression analyses with all-cause mortality as the outcome variable, adjusted for clinical and sociodemographic factors including end-of-life preferences.ResultsAdjusted Cox analysis showed a significantly lower risk of death among black vs nonblack NH residents [adjusted hazard ratio (AHR) 0.91, 95% confidence interval (CI) 0.89, 0.94]. Dual-eligibility status was significantly associated with lower risk of death compared to those with Medicare alone (AHR 0.80, 95% CI 0.78, 0.82). Compared to those in higher MHI quintile levels, NH ESRD patients in the lowest quintile were significantly associated with higher risk of death (AHR 1.09, 95% CI 1.06, 1.13).Conclusions/ImplicationsBlack and Hispanic NH residents on dialysis had an apparent survival advantage. This “survival paradox” occurs despite well-documented racial/ethnic disparities in ESRD and NH care and warrants further exploration that could generate new insights into means of improving survival of all NH residents on dialysis. Area-level indicator of poverty was independently associated with mortality, whereas dual-eligibility status for Medicare and Medicaid was associated with lower risk of death, which could be partly explained by improved access to care.     

急性心肌梗死行急诊经皮冠状动脉介入术的护理体会

目的探讨急性心肌梗死急诊行PCI术的护理体会。方法采用经皮冠状动脉介入术（PCI术）,让急性心肌梗死的血液运输功能重建。结果 15例患者急性心肌梗死后行急诊PCI术均成功重建血液运输功能。结论 PCI术的治疗效果不仅与主治医生的专业技术经验相关,更离不开护理人员周到的护理     

Excess Mortality Among Assisted Living Residents With Dementia During the COVID-19 Pandemic

ObjectiveTo evaluate whether assisted living (AL) residents with Alzheimer’s disease and related dementias (ADRD) experienced a greater rate of excess all-cause mortality during the first several months of the COVID-19 pandemic compared to residents without ADRD, and to compare excess all-cause mortality rates in memory care vs general AL among residents with ADRD.DesignRetrospective cohort study.Setting and ParticipantsTwo cohorts of AL residents enrolled in Medicare Fee-For-Service who resided in 9-digit ZIP codes corresponding to US AL communities of ≥25 beds during calendar year 2019 or 2020.MethodBy linking Medicare claims and Vital Statistics data, we examined the weekly excess all-cause mortality rate, comparing the rate from March 12, 2020, to December 31, 2020, to the rate from January 1, 2019, to March 11, 2020. We adjusted for demographics, chronic conditions, AL community size, and county fixed effects.ResultsOf the 286,350 residents in 2019 and the 273,601 in 2020 identified in these cohorts, approximately 31% had a diagnosis of ADRD. Among all AL residents, the excess weekly mortality rate in 2020 was 49.1 per 100,000 overall during the pandemic. Compared to residents without ADRD, residents with ADRD experienced 33.4 more excess deaths per 100,000 during the pandemic. Among residents with ADRD, those who resided in memory care communities did not experience a statistically significant different mortality rate than residents who lived in general AL.Conclusions and ImplicationsAL residents with ADRD were more vulnerable to mortality during COVID-19 than residents without ADRD, a finding similar to those reported in other settings such as nursing homes. Additionally, the study provides important new information that residents with ADRD in memory care communities may not have been at differential risk of COVID-19 mortality when compared to residents with ADRD in general AL, despite prior research suggesting they have more advanced dementia.     

Attitudes Toward Telehealth Use Among Rural Residents: A Danish Survey

ABSTRACT:  Context: Rural communities tend to be underserved by medical services. Low access to medical services affects quality of life and may also affect settlement decisions. The use of telehealth has often been mentioned as an alternative way to provide health care services in remote, underserved areas. One prerequisite for successful delivery of health care by means of telehealth is the existence of positive attitudes toward telehealth solutions among the potential end beneficiaries. Purpose: The purpose of this study was to examine the attitudes toward telehealth use among residents in a Danish rural area. Method: A representative sample from the island of Ærø (n = 1,000) was selected and attitudes toward 2 telehealth applications were examined by structured telephone interviews regarding: (1) video consultation between patient and specialist, and (2) transfer of work tasks from local hospital to a hospital outside Denmark. Findings: As many as 58% did not like the idea of having a consultation with a specialist carried out by video consultation, whereas 26% did not like the idea of having their X-rays assessed by a hospital outside Denmark. The reluctance regarding both telehealth solutions was higher among older people and people with no education beyond primary school. Conclusions: As the rural population in Denmark, as well as in other countries, tends to be older and less educated than the national average, the introduction of telehealth services faces special challenges in rural areas.     

2004～2005年东营市农村居民自杀死亡情况调查

[目的]了解农村居民自杀死亡率,探讨其死亡原因,为制订干预措施提供科学依据。[方法]对东营市利津县、河口区2004~2005年农村居民自杀死亡情况进行回顾性调查,按1∶1配比进行病例对照研究,探讨自杀危险因素。选择对照的匹配条件是性别相同、年龄相差1~2岁。[结果]利津县、河口区2004~2005年农村居民自杀死亡178例,年均死亡率为21.13/10万,其中男女性分别为21.95/10万、20.31/10万(P>0.05),40~79岁男女性分别为42.55/10万、28.99/10万(P<0.05);随着年龄增长死亡率逐渐升高(P<0.01)。多因素条件Logistic回归分析结果,受教育程度低、有精神疾病、1年内遭遇负性生活事件、既往自杀未遂史者自杀死亡的危险高(OR分别为5.05、24.92、64.17、40.33)。自杀方式为口服农药的占76.97%、自缢占14.04%、其他方式占8.99%;58.99%存在慢性或严重躯体性疾病。[结论]该地区农村居民自杀死亡率较高,中老年男性高于女性,文化程度低、精神和躯体疾患、负性生活事件和既往自杀未遂者自杀死亡的危险高。     

State Variation in Antipsychotic Use Among Assisted Living Residents With Dementia

ObjectivesMore than two-thirds of assisted living (AL) residents have dementia or cognitive impairment and antipsychotics are commonly prescribed for behavioral disturbances. As AL communities are regulated by state-level policies, which vary significantly regarding the care for people with dementia, we examined how antipsychotic prescribing varied across states among AL residents with dementia.DesignThis was an observational study using 20% sample of national Medicare data in 2017.Setting and ParticipantsThe study cohort included Medicare beneficiaries with dementia aged 65 years or older who resided in larger (≥25-bed) ALs in 2017.MethodsThe study outcome was the percentage of eligible AL person-months in which antipsychotics were prescribed for each state. We used a random intercept linear regression model to shrink estimates toward the overall mean use of antipsychotics addressing unstable estimates due to small sample sizes in some states.ResultsA total of 20,867 AL residents with dementia were included in the analysis, contributing to 194,718 person-months of observation. On average, AL residents with dementia were prescribed antipsychotics during 12.6% of their person-months. This rate varied significantly by state, with a low of 7.8% (95% CI 5.9%-10.3%) for Hawaii to a high of 20.5% (95% CI 16.4%-25.3%) for Wyoming.Conclusions and implicationsWe observed significant state variation in the prescribing of antipsychotics among AL residents with dementia using national data. These variations may reflect differences in state regulations regarding the care for AL residents with dementia and suggest the need for further investigation to ensure high quality of care.     

Stress and Coping Among Missouri Rural and Urban Children

A cross-sectional survey using a convenience sample of 157 Missouri rural and urban children (ages 8-13 years) yielded no significant differences in perceptions of stressors or use of coping strategies for dealing with those stressors between rural and urban children. The Feel Bad Scale and the Schoolagers' Coping Strategies Inventory measured the children's perceptions of stressors and use of coping strategies. Rural children experienced stressor levels equivalent to urban children, yet they were underserved in mental and physical health needs. The children studied reported self-care through coping strategies for management of their stressors. Longitudinal research is needed to identify the impact of stress and interventions on the health and behavior of children in rural settings.     

即墨市居民恶性肿瘤死亡情况分析

目的通过分析即墨市居民肿瘤死亡状况,为辖区制定肿瘤预防控制策略和措施提供科学依据。方法采用DeathReg2005、Excel2010软件包、SPSS17．0等工具,对即墨市2011年死亡监测资料进行统计分析,以2010年人口普查数据进行人口标化。结果2011年即墨市恶性肿瘤死亡2328例,占总死亡人数的28．87％。恶性肿瘤标化死亡率为161．81／10万（男209．81／10万、女111．50／10万）,男性死亡率高于女性（P〈0．05）。35～64岁截缩标化死亡率为200．10／10万,O～74岁累积死亡率为13．98％。恶性肿瘤中位死亡年龄为68．26岁。恶性肿瘤总潜在减寿年数（PYLL）为16957．50人年,占全死因减寿年数的34．94％,为首位减寿死因。标化减寿年数（SPYLL）12701．85人年,平均减寿年数（AYLL）为13．66年,标化减寿率（SPYLLR）为12．e6go。死亡率较高的前5位的恶性肿瘤为肺癌、肝癌、胃癌、食管癌、结直肠肛门癌。结论恶性肿瘤严重危害即墨市居民的健康,是当前公共卫生工作的重点。     

Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals

CONTEXT: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. PURPOSE: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. METHODS: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality. FINDINGS: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]). CONCLUSIONS: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI.