运动饮食平衡促健康服务模式在社区慢病综合干预中的相关研究与探讨

目的：研究非药物干预治疗“运动，饮食，平衡”促健康服务模式对糖尿病，高血压，肥胖等慢性病的影响及药物开支情况。方法：用量化非药物治疗的系统管理方法，对社区44例糖尿病，56例高血压和16例肥胖症患进行干预，观察患病儒控制及费用情况，结果：进行非药物干预治疗4个月，患血糖得到良好地控制，血压下降，血脂及体重改善，各组与干预前自身对比有显性差异，P＜0．001。糖尿病，高血压药费支出人均分别下降67元／月及62元／月及62元／月。结论：糖尿病，高血压及肥胖病慢性病非药物治疗的量化管理方法，效果显，通过综合干预，可以提高糖尿病，高血压及肥胖病的控制率，降低国家及患药费开支，为社区慢病防治探索出一条经济有效的新途径。     

糖尿病教育在糖尿病防治中的作用

目的 探讨糖尿病教育在糖尿病防治中的作用。方法 选择口服降糖药物治疗的２型糖尿病患者６０例参加糖尿病教育学习班，３个月后评价教育效果。结果 糖尿病患者的糖尿病知识积分明显高于受教育前，血糖，血脂，体重指数下降，降糖药物用量减少。结论 糖尿病教育使患者提高对糖尿病的认识，有利于防治糖尿病的发生，发展并能直接减轻患者的医药费用。     

糖尿病社区综合防治效果评价

[目的 ]　通过社区糖尿病综合防治 ,使糖尿病病人病情稳定 ,并发症减少 ,病人生活质量提高 ,医药费用降低。以此观察社区卫生服务在糖尿病综合防治中的实际效果。　 [方法 ]　对糖尿病人进行防治糖尿病健康教育 ,并饮食和运动的量化干预 ,建立科学的生活方式 ,纠正不良的生活习惯 ,控制可能导致糖尿病并发症发生的危险因素 ,配合必要的药物治疗。　 [结果 ]　综合管理 3个月 ,83例病人综合防治前后自身对照糖尿病防治知识及自我保健能力方面平均提高 89.16% (P <0 .0 1) ,纠正不良生活方式和不良生活习惯 79.3 2 % (P <0 .0 1) ,糖尿病自测率提高 71.0 8% (P <0 .0 1) ,体重平均下降 1.80kg(P <0 .0 1) ,腰围平均下降 1.77cm(P <0 .0 1) ,臀围平均下降 1.0 4cm(P <0 .0 1) ,体重指数 (BMI)平均下降 0 .68(P <0 .0 1) ,收缩压平均下降 11.19mmHg(P <0 .0 1) ,舒张压平均下降 5 .61mmHg(P <0 .0 1) ,空腹血糖平均下降 3 .3 3mmol/L(P <0 .0 1) ,餐后 2h血糖平均下降 3 .5 4mmol /L(P <0 .0 1) ,患者医药费用平均每人减少 97.0 5元。　 [结论 ]　社区卫生服务综合防治糖尿病 ,能提高疗效 ,提高患者的生活质量和降低医药费用     

社区2型糖尿病肾病并发率及其相关因素分析

目的了解社区糖尿病患者中肾病并发率及其相关因素，为社区糖尿病防治提供依据。方法以社区确诊的372例2型糖尿病患者为对象，调查一般情况，测量体重、身高、腰围以及尿微量蛋白、血压、血脂、血糖，并进行统计学分析。结果本组糖尿病患者中肾病并发率为49．2％。空腹血糖〉8．0mmol／L。、餐后2h血糖〉12mmol／L、糖化血红蛋白〉7％、收缩压〉140mmHg、体重指数〉24．9kg／m^2、腰围大于正常者，肾病并发率较高。结论糖尿病患者肾病并发率较高，要引起临床医生重视，在控制患者血糖的强础上，同时控制高血压，降低体重，控制腰围，可以减少肾脏并发症的发生。     

建立糖尿病管理中心 对社区糖尿病患者实施综合干预的效果分析

目的探讨对容桂社区糖尿病患者及其高危人群进行综合干预的防治效果。方法建立糖尿病管理中心,采用多种形式对所在辖区糖尿病病人实施综合干预,干预前后对病人进行认知水平、保健能力掌握程度和遵医率进行比较,同时测量病人干预前后的空腹血糖、餐后2h血糖等生化指标,结果经过护理干预后,社区糖尿病患者对糖尿病及其并发症知识的认识,肥胖、高血压、高血脂与糖尿病的关系及健康生活方式的重要性;患者对糖尿病防治知识、不良生活方式纠正率、血糖自测率：遵医率（患者按时检查、饮食控制、药物疗法、运动疗法以及护理干预后空腹血糖及餐后2h血糖等指标优于干预前,差异有统计学意义．P〈0．01）。结论通过建立糖尿病管理中心对社区糖尿病病人实施综合干预,对糖尿病患者及高危人群的干预．控制了糖尿病的易患因素．降低了糖尿病及其并发症的发病率,提高了糖尿病的早期检出率,对糖尿病的早期发现、早期治疗、有效控制、减少并发症的发生起到了积极的作用,减轻了患者的医疗负担,提高了健康水平,达到自我照顾、自我实现．提高社区糖尿病病人生命质量的目的。     

糖尿病社区适宜技术应用效果评价

目的了解糖尿病社区适宜技术的综合防治效果，为糖尿病的社区综合防治提供理论依据。方法对深圳市宝安区公明街道登记在册的87例糖尿病患者进行为期1年的系统管理和行为干预，随访观察治疗结局并与项目实施前的基线资料进行对比分析。结果项目的实施可以提高医务人员（P=0．00）和患者（P=0．03）对糖尿病相关知识的了解。有效控制血糖（P=0．00），降低医疗费用（P=0．00）。结论糖尿病社区适宜技术的开发与应用对提高糖尿病的综合防治效果，降低医疗费用有着重大的实践意义。     

2型糖尿病患者的社区综合干预效果分析

目的探讨社区综合干预防治2型糖尿病的效果。方法对本中心就诊的62例2型糖尿病患者进行综合干预措施。结果干预后糖尿病患者对糖尿病相关知识的知晓率显著提高，空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HBA1c）、体质指数（BMI）均较干预前显著降低。结论通过社区综合干预能较好控制2型糖尿病的发展，减少并发症，提高生活质量。     

蜂胶软胶囊辅助综合干预对糖尿病高危人群生命质量的影响

目的评价不含其他药物成份的蜂胶软胶囊辅助综合干预对糖尿病（DM）高危人群生命质量的影响，为DM的综合防治提供参考。方法利用随机区组方法，将DM高危人群100人随机分为实验组与对照组每天口服蜂胶软胶囊50mg／kg体重，同时给予综合干预措施，对照组给予相应的综合干预措施，但不服用蜂胶软胶囊。研究实验前、后各组体重指数（BMI）、血压（Bp）、空腹血糖（FBG）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）等生物检测指标及SF-36量表评分的组内差别和组间差别，比较实验后两组间DM罹患率差别。结果经过10个月的实验研究，实验后体重指数（BMI）、血压（Bp）、空腹血糖（FBG）、总胆固醇（TC）、甘油三酯（TG）等生物检测指标及SF-36量表评分两组间差别均具有统计学意义，但两组间DM罹患率差别无统计学意义。结论蜂胶软胶囊辅助综合干预能提高DM高危人群的生命质量。     

上海市松江区社区糖尿病高危人群分级干预效果

目的分析上海市松江区社区糖尿病高危人群分级干预效果,以期创建一个新型社区糖尿病高危人群管理模式。方法以社区随机对照试验设计,通过比较两组干预前后各指标的变化了解干预效果。结果干预24个月之后,干预组对象总体糖尿病知识知晓率平均上升14．73％,体重指数减少1．1kg/m^2,体重下降2．31kg,危险计分减少5．7分;对照组对象总体糖尿病知识知晓率平均上升0．52％,体重指数上升0．23kg／m^2,体重增加0．28kg,危险计分增加2．61分;干预组空腹血糖增加较对照组少0．22mmol／L,干预组口服葡萄糖耐药试验（OGTT）减少较对照组多0．15mmol／L。结论分级干预这一新型社区糖尿病高危人群管理模式能帮助高危人群提高糖尿病知识知晓率,减轻体重,降低危险因素计分,但未发现降低血糖值方面的改善。     

农村社区糖尿病患者四年综合干预效果评价

目的观察对糖尿病患者进行综合干预的效果，为在农村社区中实施有效的干预措施提供依据。方法抽取常州市武进区4个农村社区，对其中2个社区的糖尿病患者（173例）进行综合干预，2个社区作对照（142例）。进行为期4年的社区综合干预。对干预组给予药物治疗、健康教育、饮食、运动以及生活行为指导；对照组仅给予药物治疗。结果干预后干预组患者对空腹血糖正常值范围、糖尿病的主要危险因素、科学饮食与治疗方法的知晓率分别为90．8％、74．6％、89．6％与59．5％，认知水平明显高于对照组（均P〈0．05），在饮食控制与规律运动方面的行为改变率分别为68．8％、58．4％，也高于对照组（均P〈0．05）。而干预后干预组患者的收缩压、舒张压、空腹血糖以及总胆固醇的平均水平分别为（130．6±10．4）mmHg（1mmHg=0．133kPa）、（78．4±7．5）mmHg、（6．2±3．1）mmol／L、（4．5±0．9）mmol／L，均低于对照组（均P〈0．05）。结论综合干预措施对农村社区的糖尿病患者有明显的干预效果。     

企业职工高尿酸血症与血压、血脂、血糖的相关性研究

目的探讨企业职工高尿酸血症（HUA）与血压、血脂、血糖的相关性,为企业进行健康管理提供依据。方法以中国石油长庆油田公司各下属企业为抽样单位,整群随机抽取2个单位,每个单位中所有的HUA者作为HUA组,共720人;同时在尿酸水平正常者中随机选取620人为正常组。通过Logistic回归分析HUA与年龄、性别、血压、血脂、血糖的关系。结果HUA合并高血压、高血脂、空腹m糖受损任意一项、两项、三项的比例均远高于正常组（OR值分别为：4．036,2．562,4．174）。多因素Logistic回归发现：男性、收缩压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇是HUA的危险因素（OR值分别为7．736,2．309,1．721,2．761,1．411）;高密度脂蛋白胆固醇为HUA的保护因素（OR值为0．211）。结论HUA存在性别差异,且与血压、血脂密切相关。企业对职工的健康管理应充分考虑多危险因素的综合作用,全面的进行健康教育及干预。     

癌缺氧病因及预防和治疗

目的 探讨癌及安阳林州市食管癌高发原因及癌病因预防和治疗措施.方法 对林州市食管癌等疾病现场进行调查,在进行10余年统计分析基础上,综合分析了全国156篇文献成果.结果 提出癌缺氧病因学说,使用制氧机、按摩器、饮用纯净水治疗恶性肿瘤,取得良好效果,改水能够大幅降低林州市居民食管癌发病率、死亡率.结论 癌可能是由于机体长...     

Recruitment and retention challenges and successes

Objective: Addressing health disparities requires well designed, culturally adapted research. However, recruiting/retaining minority participants has often been challenging. We present strategies used to successfully recruit and retain rural Hispanic women during a breastfeeding education intervention.

Design: This study involved a two-group repeated measures quasi-experimental design with assessments at seven intervals between enrollment and 6 months postpartum. Participants (Hispanic women?≥?15 years old) were recruited through a regional hospital.

Results: We successfully met our recruitment goals, most women contacted were enrolled (46 of 58), and 100% completed the study.

Discussion: Research staff with ties within the community helped establish trust. Using bilingual study materials, simple language, and an interpreter addressed language/literacy concerns. Phone assessments facilitated participation as transportation was an issue. Accommodating requests to deliver or mail study materials and providing incentives were important. Extra effort was needed to maintain contact when phone service was disrupted or participants moved. Keys to success were persistence, flexibility, and alleviating barriers to participation.     

初产妇与经产妇焦虑抑郁状态分析及干预

目的：分析初产妇、经产妇心理状态特点,以便采取更有效的干预措施。方法筛选2014年6月至2015年1月在咸阳市旬邑县妇幼保健院产科门诊产前检查的健康初产和经产妇各60名,孕周为28~40周。入组时用焦虑自评量表( SAS)、抑郁自评量表(SDS)对两组孕妇进行心理评定,并给1次支持性心理干预(40~60分钟),1周后再次用SAS、SDS对两组孕妇进行评定分析。结果经产妇干预前SAS(50.73±3.45)、SDS(49.13±3.86)评分明显高于初产妇SAS(42.45±2.08)、SDS(41.77±2.21),差异均有统计学意义(t值分别为-15.921、-12.817,均P<0.01);干预后两组SAS、SDS评分均比干预前明显降低,差异均有统计学意义(t值分别为14.999、15.413;15.724、15.832,均P<0.01);干预后经产妇 SAS(38.61±5.02)、SDS(39.10±3.03)评分明显高于初产妇SAS(34.88±3.31)、SDS(32.01±4.27),差异均有统计学意义(t值分别为-4.805、-10.489,均P<0.01)。结论初产妇和经产妇均伴有焦虑、抑郁情绪,干预前后经产妇抑郁、焦虑情绪均较初产妇明显,支持性心理干预能有效改善孕妇的不良情绪。     

Continuity and change in neighborhood disadvantage and adolescent depression and anxiety

We used data from the Fragile Families and Child Wellbeing Study which includes a sample of adolescents of age 15 at the most recent wave (between 2014 and 2017) from mainly low-income urban families in the United States, to examine the association between neighborhood poverty entries and exits and adolescent depression and anxiety. In addition, we examined whether these associations differed by gender. Adolescents who consistently lived in disadvantaged neighborhoods had the highest level of depression and anxiety. Those who entered poor neighborhoods were more depressed than those who never lived in poor neighborhoods. Those who exited poor neighborhoods showed no significant difference in depression and anxiety compared to those never lived in poor neighborhoods. Furthermore, these associations applied to adolescent girls only and were not statistically significant for boys. The results suggest that neighborhood poverty has cumulative negative impacts on adolescent mental health and disproportionally affects adolescent girls. Reducing neighborhood poverty would substantially improve the health of adolescents, especially girls, which would reduce health disparities.     

Enabling positive change: Progress and setbacks in HIV and sexual and reproductive health and rights

At a point in history when the future of sexual and reproductive health including HIV looks particularly uncertain, it is helpful to recognise that many of the challenges currently faced are neither new nor insurmountable. Reflecting on past achievements and lessons learned helps us to have confidence that positive change is feasible. This paper reflects on some of the changes observed in countries like India and Mozambique and identifies a range of factors which need to coalesce to enable these developments, along with specific contextual factors. It is the combination of these influences rather than any one of them alone that brought about the change in the three instances described – fostering a positive political response to HIV in its early years in India; bringing about policy reform on abortion in Mozambique; and increasing contraceptive prevalence and age at marriage in some districts in Bihar, India. Change is always fragile and susceptible to setbacks, but change-seekers can learn in the process and gain renewed hope that progress can and often does take place if they persevere.     

儿童青少年超重肥胖评价方法及SPSS和SAS实现

超重肥胖已成为世界各国儿童青少年面临的重大公共卫生问题之一。现行的儿童青少年超重肥胖筛查标准不统一,逐条评价或自行编写程序容易出错且效率较低。本研究以中国学龄儿童青少年超重与肥胖筛查标准为例,详细介绍了国际和中国共四种评价儿童青少年超重肥胖的方法和步骤,结合具体案例详细介绍其应用方法,同时编制SPSS和SAS程序包和解...     

Car ownership and the association between fruit and vegetable availability and diet

Objective

Nearly all research on the food environment and diet has not accounted for car ownership — a potential key modifying factor. This study examined the modifying effect of car ownership on the relationship between neighborhood fruit and vegetable availability and intake.

Methods

Data on respondents' (n = 760) fruit and vegetable intake, car ownership, and demographics came from the 2008 New Orleans Behavioral Risk Factor Surveillance System. Shelf space data on fresh, frozen, and canned fruits and vegetables were collected in 2008 from a random sample of New Orleans stores (n = 114). Availability measures were constructed by summing the amount of fruit and vegetable shelf space in all stores within defined distances from respondent households. Regression analyses controlled for demographics and were run separately for respondents with and without a car.

Results

Fruit and vegetable availability was positively associated with intake among non-car owners. An additional 100 m of shelf space within 2 km of a residence was predictive of a half-serving/day increase in fruit and vegetable intake. Availability was not associated with intake among car owners.

Conclusions

Future research and interventions to increase neighborhood healthy food options should consider car ownership rates in their target areas as an important modifying factor.