Geriatric screening and preventive care

Preventive health care decisions and recommendations become more complex as the population ages. The leading causes of death (i.e., heart disease, malignant neoplasms, cerebrovascular disease, and chronic lower respiratory disease) among older adults mirror the actual causes of death (i.e., tobacco use, poor diet, and physical inactivity) among persons of all ages. Many aspects of mortality in older adults are modifiable through behavior change. Patients 65 years and older should be counseled on smoking cessation, diets rich in healthy fats, aerobic exercise, and strength training. Other types of preventive care include aspirin therapy; lipid management; and administration of tetanus and diphtheria, pneumococcal, and influenza vaccines. Although cancer is the second leading cause of death in patients 65 years and older, a survival benefit from cancer screening is not seen unless the patient's life expectancy exceeds five years. Therefore, it is best to review life expectancy, functionality, and comorbidities with older patients when making cancer screening recommendations. Other recommended screenings include abdominal aortic aneurysm for men 65 to 75 years of age, breast cancer for women 40 years and older with a life expectancy greater than five years, and colorectal cancer for men and women 50 years and older with a life expectancy greater than five years.     

肝移植受体直接照顾者生活质量调查分析

目的探讨肝移植受体直接照顾者的生活质量及影响因素。方法对肝移植受体直接照顾者46例进行一般情况和SF-36量表调查,采用Spearm an相关分析和多元回归分析影响因素。结果(1)与正常人群相比,在小于40岁的照顾者中,男性情感职能得分高于正常人群(P<0.05),其余纬度无统计学意义;女性情感职能得分高于正常人群(P<0.05),生理职能与精神状态得分低于正常人群(P<0.05),其余纬度无统计学意义;在大于40岁的照顾者中,男性生理职能、情感职能、社会功能、精神状态及健康总评价得分均低于正常人群(P<0.05);女性生理职能、情感职能、社会功能、精神状态及活力的分值均低于正常人群(P<0.01),其余纬度无统计学意义。(2)影响照顾者生活质量的因素:年龄、文化程度、经济状况、受体有无并发症、受体术后时间、医疗费用支付方式。结论肝移植受体直接照顾者当中,大年龄组较正常人群生活质量明显下降,而小年龄组较正常人群虽有所下降,但却能采取积极的应对方式,改善不良情绪对生活质量的影响;通过分析,发现影响这些照顾者生活质量的因素是多方面的;提示在临床工作当中,关注这部分特殊人群,有必要采取有效的干预措施,提高其生活质量。     

Absence of age and gender effects on the pharmacokinetics of a single 500-milligram oral dose of levofloxacin in healthy subjects.

The influence of age and gender on the pharmacokinetics of levofloxacin in healthy subjects receiving a single oral 500-mg dose of levofloxacin was investigated in this parallel design study. Six young males (aged 18 to 40 years), six elderly males (aged > or = 65 years), six young females (aged 18 to 40 years), and six elderly females (aged > or = 65 years) were enrolled and completed the study. The study reveals that the bioavailability (rate and extent) of levofloxacin was not affected by either age or gender. In both age (young and elderly) and gender (male and female) groups of subjects, peak concentrations in plasma were reached at approximately 1.5 h after dosing; renal clearance of levofloxacin accounted for approximately 77% of total body clearance, and approximately 76% of the administered dose was recovered unchanged in urine over the 36 h of collection. The apparent differences in the calculated pharmacokinetic parameters for levofloxacin between the age groups (young versus elderly) and between the gender groups (males versus females) could be explained by differences in renal function among the subjects. A single dose of 500 mg of levofloxacin administered orally to both young and old, male and female healthy subjects was found to be safe and well tolerated. As the differences in levofloxacin kinetics between the young and the elderly or the males and the females are limited and are mainly related to the renal function of the subjects, dose adjustment based on age or gender alone is not necessary.     

Soluble transferrin receptor (sTfR): biological variations and reference limits.

The aim of this study was to establish soluble serum transferrin receptor (sTfR) reference limits. sTfR was measured in 885 healthy subjects from 3 to 91 years old (433 men, 409 women), without hematological abnormalities, using an immunonephelometric assay. The sTfR median concentrations in our population decreased gradually from the group aged 3-10 years to the group aged 21-40 years, then there were no changes in the older groups except for the females >60 years of age. The interindividual variability ranged from 12.6% to 30.3% among different age groups, and the analytical variability was 5%. Biological factors and other factors associated with sTfR concentration variation were examined and accounted for 35% of the sTfR variability in men aged 20 years or less, and 18% in those older than 20 years. Also, they accounted for 45% of the variability in women aged 20 years or less and 14% in those older than 20 years. The main factors statistically associated with sTfR concentration in males were ferritin, orosomucoid, hemoglobin, and tobacco in all age groups and only mean corpuscular volume (MCV) in males less than 20 years old. In the females the main factors were age, orosomucoid, and hemoglobin in all age groups, MCV and tobacco in females less than 20 years old, and ferritin and physical activity in females more than 20 years old. These factors were used to define the exclusion and partition criteria for obtaining the reference samples. Medians for reference values were: 1.60 mg/l in the 3-10-year old group (males and females); 1.42 mg/l in males between 11 and 20 years of age, and 1.33 mg/l in females of the same age. In the other age groups, the median of the reference values was 1.16 mg/l, except in females over 60 years old, for whom it was 1.26 mg/l.     

糖化血红蛋白和空腹血糖的关系在不同年龄和性别间的差异

目的分析不同年龄和性别人群糖化血红蛋白(HbA1c)和空腹血糖(GLU)之间的差异及其关系,探讨其在糖尿病防治中的意义。方法随机选取体检人群样本300例,其中35～55岁男性100例,55岁以上男性40例;35～55岁女性110例,55岁以上女性50例。静脉抽血分别检测糖化血红蛋白和空腹血糖,采用t检验评估各组差异,并对二者进行直线回归分析。结果 55岁以上人群,不论男女,其HbA1c和GLU与全部样本的差异存在统计学意义(P<0.01)。35～55岁男性HbA1c与GLU的相关性(r=0.743)低于其他3组,与55岁以上男性组(r=0.961)和55岁以上女性组(r=0.896)差异有统计学意义(P<0.01),与35～55岁女性组(r=0.908)差异无统计学意义(P>0.05)。结论 HbA1c可作为糖尿病病情监测和评估指标,对不同年龄人群应结合多因素综合判断疾病的发生发展趋势,尤其要做好对中青年人群的糖尿病预防工作。     

Age and gender differences in the control of vertical ground reaction force by the hip,knee and ankle joints

[Purpose] This study examined the relationships between joint moment and the control of the vertical ground reaction force during walking in the elderly and young male and female individuals. [Subjects and Methods] Forty elderly people, 65 years old or older (20 males and 20 females), and 40 young people, 20 to 29 years old (20 males and 20 females), participated in this study. Joint moment and vertical ground reaction force during walking were obtained using a 3D motion analysis system and force plates. Stepwise linear regression analysis determined the joint moments that predict the amplitude of the vertical ground reaction force. [Results] Knee extension moment was related to the vertical ground reaction force in the young males and females. On the other hand, in the elderly females, hip, ankle, and knee joint moments were related to the first peak and second peak forces, and the minimum value of vertical ground reaction force, respectively. [Conclusion] Our results suggest that the young males and females make use of the knee joint moment to control of the vertical ground reaction force. There were differences between the elderly and the young females with regard to the joints used for the control of the vertical ground reaction force.Key words: Elderly people, Vertical ground reaction force, Lower extremity joint moment     

呼和浩特地区不同年龄段HBV感染者血清抗体检测结果比较分析

目的 了解呼和浩特地区不同类型乙型肝炎病毒(HBV)血清抗体阳性模式者的年龄分布.方法 HBV既往或现症感染者4 662例,男性2 192例、女性2 470例,采用酶联免疫吸附法检测HBV血清抗体.结果 HBsAb阳性者男性主要分布在40～＜50岁人群(17.34%),女性以20～＜30岁人群为主(19.13%).HBsAb、HBcAb-IgG阳性者在男、女性均以40～＜50岁人群为主,分别占21.07%和21.94%.HBsAb、HBeAb、HBc-IgG阳性者在男性以30～＜40岁人群为主(22.11%),在女性以50～＜60岁人群为主(23.23%).HBc-IgG阳性者在男、女性均以40～＜50岁人群为主,分别占21.52%和22.65%.结论 呼和浩特地区HBV血清抗体阳性者以20～＜60岁人群为主.     

Mortality and Life Expectancy in Dutch Residential Centres for Individuals with Intellectual Disability, 1991–1995

Background Several studies showed that the individuals with intellectual disability have a shorter life expectancy than their intellectually average peers. To gain insight in the present life expectancy of people with intellectual disability, a study with recent data was performed. Methods We used data of the National Case Register (LRZ) with data of almost all residents of residential centres in the Netherlands for the period 1991–1995 (N = 29 290). Approximately 40% of all people with intellectual disability in the Netherlands reside in such centres. Results Results showed that 5‐year‐old people with intellectual disability in Dutch residential centres have a life expectancy of 41 years. The life expectancy of their peers with Down's syndrome in the centres is 46. At the age of 30 years, the respective figures are 36 and 26 years. No statistically significant differences in mortality were found between women and men and between levels of intellectual disability. Conclusions Due to prolonged longevity, the client population in residential centres will continue to age and thus the numbers of older individuals will increase. This ageing process has implications for the care for elderly individuals, because they need other care than before due to physical, psychological and social changes and spiritual challenges.     

Predicted impact of attaining smoking reduction goals on mortality

The impact of reducing smoking initiation, increasing smoking cessation, and combination approaches on life expectancy, deaths averted, and life-years gained in a birth cohort of 50,000 persons and in the state population (3.6 million) were analyzed. A 60% reduction in initiation of smoking in adolescents would increase life expectancy by 0.42 years. Over the next 100 years, there would be an additional 18,000 years of life for a birth cohort and an additional 675,000 years of life for the state's population. The reduction in mortality, however, would not begin before 35 years, and only 25% of the benefit would occur in the next 70 years. An increase in smoking cessation would have a smaller impact that would occur sooner. Maximum reduction in mortality could be achieved by reducing initiation and increasing cessation at all ages, but a reduction in mortality would not occur for several decades.     

不同形式上肢运动的能量消耗

背景:测量体力活动能量消耗的方法有很多,但测量上肢活动能量消耗方面的研究较少.目的:以间接热量测定法测量几种常见的上肢运动形式能量消耗,分析上肢运动能量消耗的特征以及年龄、性别等因素的影响.设计、时间及地点:对比观察,实验于2009-01/03在江苏省体育科学研究所完成.对象:无代谢性疾病的健康成年人108名,男47名,女61名,其中20-39岁65名,40-59岁43名.方法:受试者以坐姿做摆臂(60次/min)、屈肘(40次/min)、肩水平屈伸(60次/min)、直臂侧上举(30次/min)4种动作,每个动作间隔休息3 min.主要观察指标:采用德国CORTEX系列MetaMax 3B心肺功能测试仪受试者静息及不同运动形式下耗氧量值.结果:静息耗氧量男性高于女性(P<0.05),20～39岁高于40-59岁(P<0.05).摆臂的耗氧量最高男性(550.9±90.6)mL/min,女性(425.8±75.7)mL/min;屈肘最低男性(440.4±82.7)mL/min,女性(367.0±60.1)mL/min.4种运动形式的净耗氧量都低于250 mL/min(1代谢当量).结论:①4种常见上肢活动形式的耗氧量增加较少,一般不会超过1代谢当量.②年龄和体质量对静息状态能量消耗影响较大,性别的影响较小.⑨年轻人群的上肢运动效率更高,在运动中的能量更加节省.     

Trends in disability-free life expectancy

Purpose: To assess trends in Disability-Free Life Expectancy, in life expectancy with disabilities according to levels of severity and in Disability-Adjusted Life Expectancy in the Netherlands between 1989 and 2000.

Method: The disability-free life expectancy, a composite population health status measure, was calculated with data on long-term disability. Weights reflecting the impact of disability on personal functioning were assigned to different levels of severity of disability, in order to calculate a Disability-Adjusted Life Expectancy and to define cut-off points, in order to distinguish between levels of severity.

Results: At an aggregated level, for both males and females at the ages of 16 and of 65 years, an increase in years with disabilities and a decline in disability-free life expectancy were observed. These trends were mainly caused by a rise in the number of years with mild disabilities, with the number of years with moderate and severe disabilities decreasing. The combined changes have resulted in an increase in the Disability-Adjusted Life Expectancy.

Conclusion: Trends in disability-free life expectancy and in years with disabilities provide support for a scenario of dynamic equilibrium. The number of years with moderate and severe disabilities has reduced, resulting in an increase in the number of years with minor disabilities. Further research should focus on the underlying causes of the increase of years with minor disabilities.     

2014年云南省大理州居民死因监测分析

目的 利用我国死因登记报告系统年度报告数据分析2014年云南省大理州居民死亡水平和主要死亡原因,为卫生防控政策的制定提供参考依据。方法 以死亡率、构成比和期望寿命描述居民死亡水平;以潜在减寿年数（PYLL）描述疾病生命损失。结果 2014年大理州共报告死亡个案20989例,居民死亡率为585.83/10万（标化死亡率601.08/10万）,男性死亡率（685.49/10万）高于女性（521.25/10万）（2=383.56,P0.001）;三大类疾病死亡构成依次为慢性非传染性疾病（82.11%）、损伤和中毒（11.36%）、感染性、母婴及营养缺乏性疾病（6.53%）;前5位死因依次为循环系统疾病、呼吸系统疾病、肿瘤、损伤和中毒、消化系统疾病,占总死亡的89.00%;全人群PYLL前5位依次为损伤和中毒、循环系统疾病、肿瘤、呼吸系统疾病和消化系统疾病;男性前5位PYLL与全人群一致;女性顺位第1位为循环系统疾病、第2位为肿瘤、第3位为损伤和中毒;全人群期望寿命77.08岁,其中男性74.46岁,女性79.94岁。去除循环系统疾病、呼吸系统疾病、肿瘤、损伤和中毒的影响,居民期望寿命分别将增加6.24、3.08、1.68和1.56岁。结论 大理州居民主要死因以慢性非传染性疾病为主,损伤和中毒是青壮年减少寿命的主要原因,各年龄组主要死因有差异,应针对不同年龄组人群开展健康教育和行为干预。     

Population characteristics of traffic accident-related deaths in Japan and Ireland, 1950-2000

To compare epidemiological characteristics of traffic accidents in Japan andIreland, we analyzed mortality and thenegative effect on life expectancy between 1950 and 2000 and generated amultivariate model. The characteristics were similar in the two countries: Thetime trends showed an increase in mortality followed by a decrease. The mortality rates wereabout 13 and 5/100,000 for males and females, respectively, in 2000. Correlationcoefficients for sex were over 0.9. Age distribution obeyed the naturallogarithm regularity. The negative effect on life expectancy was about 0.34 yearfor males, and 0.13 year for females. The economic level was positively associatedwith mortality, whereas “number of vehicles owned” was associated negatively.In conclusion, we can take advantage of the broad consistencies in these twocountries when we draw up an intervention strategy. Any preventive strategyshould be directed to the young, particularly males.     

Healthy life expectancy for selected race and gender subgroups: the case of Tennessee

OBJECTIVE: To analyze healthy life expectancy (HLE) for major racial and gender subgroups, based on the diverse population of Tennessee and compared with the United States. MATERIALS AND METHODS: We use life table methodology and the HLE calculation model of the National Center for Health Statistics (NCHS), using two databases for 2001: NCHS National Vital Statistics Reports life tables and CDC Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS: For Tennessee, although average total life expectancy (TLE) is 73.6 years at birth, only 61.1 years of "good" health are expected. Substantial racial and gender differences are found in both TLEs and HLEs with black males having the lowest and white females the highest. Although females have longer TLE, they spend more years in an unhealthy state than males. CONCLUSIONS: The findings raise new challenges for researchers and health policy makers for accomplishing the dual goals of longer life expectancy and elimination of health disparities among population subgroups.     

北京市新增维持性血液透析患者的人口统计学及病因构成的变迁

目的 分析北京市新增维持性血液透析（MHD）患者的人口统计学与病因构成及其变迁,为治疗策略的调整和制定提供依据.方法 回顾性分析北京市血液净化质量控制和改进中心数据登记系统2007～2012年间新增MHD患者的人口统计学及原发病资料,按照年份、性别、年龄等因素进行分层分析.结果 6年间新增MHD患者共14945例,患者中男性8397例,女性6548例,男：女1.3：1;其中登记年龄的13571例患者进入透析时的平均年龄为56.2＆#177;17.1岁,男性患者进入MHD平均年龄为54.4岁,女性为58.5岁.总体上,MHD患者的前5位原发病依次是是糖尿病、慢性肾小球肾炎（CGN）、高血压、间质性肾炎及多囊肾.糖尿病超过CGN,在男性患者这种转变发生于2009年,女性患者发生于2010年.新增MHD患者平均年龄缓慢增长,40岁以上中老年患者占新增MHD的主体（81.8％）.原发病构成比与年龄有关,对于＜50岁的患者,CGN占33.9％,为进入MHD的首位原因;50岁以上患者则为糖尿病,占31.6％.结论 新增MHD患者年龄呈缓慢增长趋势,40岁以上中老年患者为新进入MHD的主体.MHD患者存在性别差异,男性发病率高,进入MHD早.＜50岁患者进入MHD的首位病因是CGN; 50岁以上则为糖尿病;总体上糖尿病已经取代CGN成为北京市新增MHD患者的首位病因.     

Inequalities regarding death in the past

Was mortality differentiated socio-economically in past centuries, as it is nowadays? The issue has been hotly debated. Certain demographers admitted that, periods of famine excepted, the death risk was evenly distributed among the ancient populations, regardless of wealth, instruction or social status. On the other hand, the research project currently carried out at the French National Institute of Demographic Studies is evidencing wide mortality social differentials in the 19th century. In Paris, male life expectancy at the age of 40 reached 29.7 years for the nobility and bourgeoisie, but decreased to 25.6 years among merchants and 23.7 years among workers and day-labourers. Generally speaking, regional differentials were less pronounced than socioeconomic differentials. Mortality decline was found among the elites: life expectancy at 40 of the Knights of the Holy Spirit, for instance, increased to 30.8 years in the 18th century, from 27.8 years in the 16th century. The same life expectancy today (at 40 years of age) reaches 35.7 years among French professionals. The main problem with this kind of research is how to identify and collect relevant information. The researchers make use here of marriage registers from the past century. These registers recorded not only particulars of the married couple but also those of their parents (occupation, age, and date of death, if any). This information allows the calculation of mortality rates (and life expectancy) of ancient birth cohorts in various occupational groups. The primary condition is that the registers have been well kept and soundly stored until now. This is the case in certain city halls: the 4th arrondissement of Paris (1860-1863), Ivry-sur-Seine (1817-1823)... etc...     

经颅多普勒超声检测脑动脉狭窄的临床研究

目的调查体检人群中脑动脉狭窄的发生率及分布规律,为其他影像检查及颈内动脉血管内膜剥脱手术(CEA)和支架置入血管成形术(CAS)提供依据。方法以参加常规体检的3 953人为研究对象,采用经颅多普勒超声(TCD)检测颅内外动脉情况。结果 3 953位体检者中,男性2 687人(67.97%),女性1 266人(32.03%)。检出动脉狭窄111人次(2.81%),134例次(3.39%)。其中男性77人(69.37%),女性34人(30.63%),男性及女性发生动脉狭窄的比率与男性及女性体检人数占总人数的比率相当(P>0.05)。发生狭窄者平均年龄(61.93±13.43)岁,男性发生狭窄平均年龄为63.21岁,女性发生狭窄平均年龄60.53岁,男性与女性发生动脉狭窄年龄无显著差异(P>0.05)。134例次动脉狭窄患者中颅内血管狭窄85例(占狭窄血管的63.43%),颅外血管49例(占狭窄血管的36.57%)。55岁以下组1 315人,脑动脉狭窄26人,占1.98%;>55岁组2 638人,发生脑动脉狭窄49人,占1.86%,≤55岁年龄组与>55岁年龄组发生脑动脉狭窄的比率差异无显著性(P>0.05)。结论 TCD可检出无症状脑动脉狭窄,因无创、简便、准确、快速、经济、可实时评价等特点适宜于普查,可作为中老年人群体检的常规项目。     

2015年甘肃省兰州市居民死因及期望寿命分析

目的 调查兰州市2015年疾病监测点居民死因情况,为制定慢性疾病的综合防控策略及措施提供科学依据。方法 收集2015年兰州市居民死因监测资料,分析监测点居民主要死亡原因及期望寿命。结果 2015年兰州市居民期望寿命为79.43岁,男性77.68岁,女性81.36岁;报告粗死亡率为480.48/10万,标化死亡率为381.99/10万,男性死亡率高于女性;死因前5位疾病依次为循环系统疾病、肿瘤、呼吸系统疾病、损伤和中毒及内分泌、营养和代谢疾病;循环系统疾病以心脏病和脑血管病为主,恶性肿瘤死因前3位依次为肺癌、胃癌和肝癌,呼吸系统疾病以慢性阻塞性肺病和慢性支气管炎为主;分别去除顺位前5类疾病死因后,不同人群期望寿命增加0.43～7.01岁,循环系统疾病对期望寿命影响最大。结论 目前,危害兰州市居民健康的主要死因是慢性非传染病,应对其加强开展常见慢性病的健康教育,防治结合,提高居民的整体健康水平。     

The lifetime risks and costs of nursing home use among the elderly

In this paper, we estimate the risk of an individual of entering a nursing home throughout the aging process. We then estimate the expected lifetime costs of nursing home use both for an individual and for society as a whole. The model is based on double-decrement life-table analysis. Data are taken from a 1977 survey of 4,400 Medicare beneficiaries. At age 65, the upper bound for the lifetime risk of entering a nursing home is 43.1%. The risk of entering a nursing home increases with age until around age 80. At about age 85, the risk begins to decline significantly. At almost all ages, the lifetime risk of entry for females is twice that of males. The expected lifetime costs of nursing home care across all ages are between $10,500 and $13,600. These costs are distributed very unequally. Only 13% of the elderly account for 90% of all nursing home expenditures. Given current life expectancy, the expected annual cost per person over age 65 is between $532 and $760. In the year 2000, the expected annual average costs of nursing home care per elderly person will range from $450 to $650. The decline in the average annual cost per person reflects shifts in the age structure and increased life expectancy. These figures need not represent an unmanageable burden on society's resources. Figures presented here help establish the feasibility and desirability of long-term care risk-sharing arrangements among the elderly, like long-term care insurance, life care communities, and other models.     

2017年新疆疏附县户籍居民心脑血管疾病死亡情况及对期望寿命的影响

目的分析新疆疏附县户籍居民心脑血管疾病（CVD）的死亡水平及对预期寿命的影响,为制定CVD的防控措施提供科学基础数据。方法通过多部门获取2017年疏附县户籍居民死亡名单,采用多阶段抽样的方法确定调查对象,利用死因推断量表对死者家属或知情人进行入户调查,计算CVD死亡率、死因顺位和去CVD死因预期寿命。结果2017年疏附县户籍居民CVD粗死亡率为195.00/10万,标化死亡率为253.30/10万。 其中,男性CVD死亡率为219.43/10万（标化死亡率290.28/10万）,女性为169.70/10万（标化死亡率226.31/10万）。 CVD死亡率随年龄的增长呈明显的上升趋势,尤其在65岁以后迅速升高。 CVD死亡率有2个高峰,分别为4－5月和11－12月。 心血管疾病以其他冠心病（37.93%）、急性心肌梗死（32.76%）死亡为主,脑血管疾病以脑出血（47.97%）和脑血管病后遗症（25.20%）死亡为主。 去CVD死因后,2017年疏附县户籍居民的期望寿命可由71.40岁增加到77.98岁,平均增加6.58岁,其中男性增加5.84岁,女性增加8.06岁。结论CVD是导致疏附县户籍居民最主要的死亡原因,针对高危人群开展预防控制措施对提高人口预期寿命具有重要的公共卫生意义。