常州市武进区健康人群高尿酸血症患病率及相关因素分析

目的：分析常州市武进区健康人群高尿酸血症患病率及相关危险因素。方法对2013年的3538名健康人群体检资料进行分析。结果人群血尿酸水平为（326.69±90.30）μmol／L,男性（356.76±81.90）μmol／L,女性（253.97±64.68）μmol／L,差异有统计学意义（t＝36.004,P ＜0.001）;高尿酸血症患病率为16.26％。男性20.54％,女性5.89％,差异有统计学意义（χ2＝114.26,P ＜0.001）。多因素 logistic 回归分析显示：年龄（OR ＝1．02,95％CI ：1．01～1．03）、男性（OR ＝1.40,95％CI ：1.01～1.95）、超重（OR ＝2.59,95％CI ：2.09～3.20）和肥胖（OR ＝3.82,95％CI ：2.89～5.05）、高血压（OR ＝1.45,95％CI ：1.12～1.87）、总胆固醇（OR＝1.17,95％CI ：1.05～1.32）、甘油三脂（OR ＝1.19,95％CI ：1.12～1.27）、血肌酐（OR＝1.04,95％CI ：1.03～1.05）、尿素氮（OR＝1.18,95％CI ：1.10～1.28）、谷丙转氨酶（OR＝1.01,95％CI ：1.01～1.02）均为高尿酸血症的危险因素。结论男性、年龄、超重和肥胖、高血压、血酯异常、肝功能异常等均与高尿酸血症相关,应加强综合干预。     

中山市成年人不良健康行为现况分析

摘要:目的　对中山市成年人不良健康行为（包括吸烟、饮酒和体力活动不足等）特征进行分析,为慢性病防控健康促进活动提供策略。方法　采用多阶段整群随机抽样方法,对中山市400名18岁以上居民进行健康相关行为（吸烟、饮酒、日常强度活动、交通性活动）的问卷调查。对调查对象的不良健康行为进行描述分析。结果　（1）调查人群的吸烟率为25.3%,饮酒率40.3%。男性吸烟（χ2＝109.470,P＝＜0.001）和饮酒（χ2＝64.623,P＝＜0.001）的比例均高于女性,34.1%的男性每天吸烟,女性仅为0.5%;79.5%的女性不喝酒,而男性为40.5%;（2）男性的高强度活动的比率高于女性（χ2＝109.470,P＝＜0.001）,而女性具有中强度活动（χ2＝14.933,P＝＜0.001）和交通性活动（χ2＝6.991,P＝＜0.05）的比例高于男性。结论　中山市成年居民不良健康行为率较高,在落实健康促进策略的过程中,应开展有针对性的干预。     

自我管理健康教育模式对老年高血压患者行为与血压的影响

目的 观察自我管理健康教育模式对老年高血压患者行为与血压的干预效果,提高社区老年高血压的治疗效果.方法 选择206例老年高血压患者,按患者意愿分为观察组和对照组,每组103例.对照组给予常规高血压三级管理模式干预,观察组接受自我管理健康教育模式干预.两组均干预12个月,干预前后评估患者高血压知识掌握情况、生活方式和行为改善情况、自我管理效能指标变化值.结果 观察组干预后各项高血压知识掌握情况较干预前明显改善,差异有统计学意义（P＜0.01）.对照组干预前后各项高血压知识掌握情况比较差异无统计学意义（P＞0.05）.观察组干预后各项高血压知识掌握情况明显优于对照组,差异有统计学意义（P＜0.01）.观察组干预后收缩压、舒张压、服药依从性评分、体育锻炼评分、医患交流评分、自我效能评分变化值均优于对照组[（-4.43±1.53）mm Hg（1mm Hg=0.133 kPa）比（0.33±0.95） mm Hg、（-2.65±1.85）mm Hg比（-0.42±0.83）mm Hg、（1.18±0.32）分比（0.07±0.11）分、（0.51±0.12）分比（-0.05±0.07）分、（0.53±0.21）分比（-0.05±0.04）分、（2.04±0.08）分比（1.22±0.06）分],差异有统计学意义（P＜0.01）.观察组干预后各项生活方式和行为较干预前明显改善,差异有统计学意义（P＜0.01）.对照组干预前后各项生活方式和行为改善不明显,差异无统计学意义（P＞0.05）.观察组干预后各项生活方式和行为改善情况明显优于对照组,差异有统计学意义（P＜0.01）.结论 自我管理健康教育模式能够有助于老年高血压患者不良行为习惯的改善,提高高血压知识与自我管理水平,提高血压达标控制率,是传统的高血压三级管理模式的有益补充.     

健康管理降低老年高血压患者心血管事件风险的研究

目的研究健康管理对老年高血压患者心血管事件风险的影响。方法患有高血压病的老年人182例,随机分为对照组（n=61）、药物治疗组（n=61）和健康管理组（n=60）,于入组当时和研究结束后分别测量血压、baPWV（肱一踝脉搏波速度）、血脂、血糖等指标,并进行健康问卷。对照组在就诊时按照指南原则用药并按需给予健康指导;药物治疗组由专人监督用药,并定期随诊调整药物治疗方案;健康管理组由专人制定全面的健康管理计划,并监督实施。随访中记录心血管事件的发生情况和其他健康事件。结果三组基线数据无统计学差异。平均随访时间（21．3±7．2）个月。健康管理组的收缩压（t=3．915,P=0．000）、脉压（t=3．966,P=0．000）、baPWV（t=3．093,P=0．002）改善优于对照组,收缩压的改善优于药物治疗组（t=2．008,P=0．046）。健康管理组的患者累积生存率为96．7％,高于对照组的83．6％（χ2=5．921,P=0．015）,与药物治疗组的93．3％近似（χ2=2．821,P=0．091）。单变量Cox比例风险模型收缩压下降、舒张压减小、脉压缩小、baPWV减小是保护因素,具有统计学意义;经年龄、性别等因素校正后收缩压变化量的（RR=0．75,P〈0．05）。结论健康管理可以减少老年高血压患者心血管事件的发生,效果优于单纯药物治疗。     

某地中学生健康素养现状调查

摘要:目的　了解某地中学生的健康素养状况,为进一步开展中学生健康素养研究提供科学依据。方法　采用多阶段分层抽样的方法从某县随机抽取一所初中和高中,根据年级分层,在各层中随机选取学生共483人,采用统一制作的问卷进行现场调查,并用χ2检验对数据进行分析。结果　中学生健康素养具备率为25.96%;基本健康知识和理念知晓率为68.51%,初中生和高中生之间差异有统计学意义（χ2＝14.36,P＜0.001）;健康生活方式与行为形成率为45.32%;基本健康技能掌握率为25.96%,初中生和高中生间差异有统计学意义（χ2＝12.19,P＜0.001）。结论　中学生健康素养亟待改善,应加强学校健康教育工作,努力提升中学生健康素养水平。     

健康教育对晚癌患者生活质量及生存期研究

摘要:目的　探索健康教育对晚癌患者生活质量（Quality Of Life,QOL）及生存期的影响。方法　回顾性调查2013年8月-2014年2月期间接受华西宁养院家居服务的112例晚期癌症患者,对给予健康教育及躯体症状控制者纳入研究组（56例）,对仅给予躯体症状控制者作为对照组（56例）。分析两组患者基线资料可比性,比较两组患者QOL及生存期的差异。结果　两组间基线资料比较均无统计学差异（P＞0.05）;干预前两组患者间QOL评分比较无统计学差异（t＝0.110,P＝0.913）及QOL评分等级比较无统计学意义（Z＝0.180,P＝0.857）;干预后研究组QOL评分显著高于对照组（t＝5.093,P＜0.001）,研究组干预后较干预前QOL显著升高（t＝5.093,P＜0.001）;干预后研究组较对照组QOL评分等级明显改善（Z＝4.418,P＜0.001）。两组生存曲线整体比较具有统计学意义（χ2＝5.993,P＝0.014）。结论　健康教育能提高晚癌患者的生活质量及延长其生存期。     

老年高血压患者健康管理的效果分析

目的通过对老年高血压患者的健康管理,提高高血压患者的血压控制达标率,减少心脑血管事件的发生率及死亡率。方法对高血压患者进行信息化管理,建立健康档案,找准危险因素,进行危险分层,制定个体化的健康计划,实施针对性地健康教育、合理膳食、适量运动、戒烟限酒、心理调适与循证药物治疗等规范化管理,并跟踪随访。结果（1）本人群的高血压患病率为68．15％,其中65．07％为单纯收缩期高血压;（2）通过3年健康管理,观察组高血压患者血压控制达标率提高了10．65％（P〈0．01）,对照组血压达标率差异无统计学意义（P〉0．05）;（3）高血压患者治疗率达到96．68％;经合理调整用药,尼群地平、血管紧张素转换酶抑制剂（ACEI）或血管紧张素Ⅱ受体拮抗剂（ARB）和利尿剂的服用率分别提高了31．25％、32．61％和104．39％（P〈0．01）,硝苯地平服用率下降了66.35％,传统复方制剂服用率下降了36．17％（P〈0．01）;（4）心脑血管事件发生率下降了54．40％．死亡率下降了32．16％。结论通过健康管理,能有效控制老年高血压患者的血压水平,提高血压控制达标率。改善生活质量,降低心脑血管事件的发生率与死亡率。     

西部地区宁夏城乡老年人健康自我评价的对比研究

摘要:目的　了解西部宁夏地区老年人健康自评状况,分析影响老年人健康自评因素的城乡差异。方法　宁夏地区60岁及以上的城市和农村老年人各1 501名作为研究对象,内容包括社会人口学资料、健康自评、社会交往意愿、养老意愿、社会服务满意度等。结果　宁夏地区城乡老年人健康自评结果比较差异无统计学意义。年龄、外出频次是城乡老年人的共同影响因素,高龄、外出频次≤2次的老年人健康自评较差。另外,城市老年人健康自评还与社区服务满意度相关（χ2＝3.160,P＜0.001）,对社区服务满意的老年人要比不满意的健康自评好;农村老年人健康自评还与养老意愿相关（χ2＝9.658,P＜0.001）;有居家养老意愿的老年人比机构养老意愿的健康自评好。结论　西部宁夏地区老年人健康自评整体情况没有明显城乡差异,健康自评影响因素有一定不同。护理人员应根据实际情况为老年人提供不同的卫生服务,才能有效地提高老年人群的健康水平。     

社区健康管理提高老年高血压患者生活质量的调查

目的探讨社区健康管理提高老年高血压患者生活质量。方法收集、建立102例老年高血压患者健康档案,制定健康管理方案,实施健康管理3年。采用自身对照的方法,对102例患者健康管理前后保健知识掌握、保健意识、心理状态、血压达标、住院次数及医药费用、高血压并发症（心、脑、肾等损害）6个方面进行问卷调查,通过χ^2检验进行分析总结。结果开展社区健康管理后,老年高血压患者的生活质量明显高于社区健康管理前,6项评价指标明显改善,差异有统计学意义（P〈0.001）。结论实施老年高血压患者社区健康管理有利于提高老年高血压患者的生活质量。     

湖北省普通高校大学生健康素养调查分析

目的了解高校大学生的健康素养现状,为今后更好地开展健康教育工作提供指导依据。方法采用中国公民健康素养调查组设计的2008中国公民健康素养调查问卷,以湖北省普通高校在校1 665名大学生为调查对象,对有效问卷进行数据统计和综合分析。结果高校类别对健康素养水平的影响,不同高校之间在健康素养基本知识、健康生活方式和行为,以及健康素养基本技能水平的差异有统计学意义（χ2=19.91,P〈0.001）;社会性别对健康素养水平的影响,健康素养基本知识水平在不同性别之间的差异有统计学意义（χ2=87.71,P〈0.001）;健康生活方式和行为,以及健康素养基本技能及健康理论之间的差异有统计学意义（χ2=87.71,P〈0.001）;不同户口类型对健康素养水平的影响,在健康素养3方面的差异无统计学意义（χ2=0.01605,P=0.9999）。结论大学生健康素养水平不高,影响健康素养水平的因素很多,如性别、不同类别院校、不同户口类型等,在大学生中开展健康素养教育势在必行,对于提高中华民族整体健康水平具有十分重要意义。     

Self-rated cardiovascular risk and 15-year cardiovascular mortality

PURPOSE Many individuals perceive their cardiovascular disease (CVD) risk to be lower than established clinical tools would estimate, yet little is known about the long-term consequences of holding such optimistic beliefs. We evaluated whether lower self-ratings of CVD risk are associated with lower rates of CVD death after addressing potential confounding by an extensive set of social and biologic CVD risk factors.METHODS We conducted a 15-year mortality surveillance study of adults aged 35 to 75 years from southeastern New England (n = 2,816) who had no history of myocardial infarction. Baseline evaluation in 1990–1992 included household interview, anthropomorphic measures, and laboratory analyses. Outcomes were obtained using the National Death Index records through December 2005.RESULTS Rating oneself to be at lower-than-average risk for one’s age and sex was associated with lower rates of CVD mortality among men (hazard ratio [HR]=0.3; 95% confidence interval [CI], 0.2–0.7) but not among women (HR = 0.9; 95% CI, 0.5–1.7). None of the following weakened the findings among men: adjustment for baseline Framingham Risk Score, propensity score adjustment for both social and biologic factors, and censoring the first 2 years of surveillance.CONCLUSIONS Lower self-ratings of CVD risk are independently associated with lower rates of CVD death among men.     

Contraception and cardiovascular disorders

Prescribing contraceptives for women with underlying medical conditions requires careful attention from practitioners. This article reviews current knowledge on the metabolic effects and cardiovascular risks associated with use of combined oral contraceptives (OCs). OCs exert effects on lipids, high- and low-density lipid cholesterol, serum triglycerides, hemostasis, insulin resistance and hyperinsulinemia, and hypertension, all of which may have implications for ischemic heart disease, cerebrovascular accidents, and venous thromboembolism. Also discussed are alternative contraceptive methods for women with contraindications to OC use. Preconception counseling is especially important to provide women with information on the likely impact of their disease on pregnancy outcome and of pregnancy on their disease.     

Women and cardiovascular disease

More women die of cardiovascular disease than men; in women, cardiovascular mortality is 1.5 times greater than cancer mortality. The pathophysiology of cardiovascular disease has female-specific aspects such as fragile coronary arteries and microvascular ischaemia. Women with acute coronary syndromes are more likely to present with atypical symptoms such as dyspnoea, nausea or fatigue. With regard to diagnostic tests in women, exercise ECG can be difficult to interpret and a normal coronary angiogram does not exclude coronary heart disease. Myocardial perfusion scintigraphy may be considered for high-risk women who are clinically suspected of having coronary heart disease and have a normal or inconclusive exercise ECG and angiogram. Women are less likely to be treated according to guidelines than men, and their prognosis after a myocardial infarction or a coronary intervention is worse. Female-specific aspects such as gestational hypertension and diabetes allow for early detection and treatment of women at risk for cardiovascular disease.     

Multiculturalism and cardiovascular diseases

Immigration has increased drastically to the point of becoming an ordinary structure of our society. Once in Italy, the immigrant's health is compromised rapidly due to a series of conditions and illnesses that exist in our country: lack of work, inadequate salary, inappropriate residence, lacking family support, climate changes, nutritional differences. Cardiovascular illnesses represent 7.6% of the diseases of the immigrants, and cause 36.6% of deaths. The risk factors that affect the genesis of cardiovascular diseases include: subjective factors (age, ethnic group), environmental, nutritional and pathological (arterial hypertension, AIDS, tuberculosis, alcohol). The challenge for our time is to design a new solidarity model to promote cultural and social integration in order to meet the multiethnical and multiracial needs of western society. This model should permit reconsideration of doctor-patient relationship in order to build a real intercultural society.     

Vitamins and cardiovascular disease

CVD is a major cause of mortality and morbidity in the Western world. In recent years its importance has expanded internationally and it is believed that by 2020 it will be the biggest cause of mortality in the world, emphasising the importance to prevent or minimise this increase. A beneficial role for vitamins in CVD has long been explored but the data are still inconsistent. While being supported by observational studies, randomised controlled trials have not yet supported a role for vitamins in primary or secondary prevention of CVD and have in some cases even indicated increased mortality in those with pre-existing late-stage atherosclerosis. The superiority of combination therapy over single supplementation has been suggested but this has not been confirmed in trials. Studies have indicated that beta-carotene mediates pro-oxidant effects and it has been suggested that its negative effects may diminish the beneficial effects mediated by the other vitamins in the supplementation cocktail. The trials that used a combination of vitamins that include beta-carotene have been disappointing. However, vitamin E and vitamin C have in combination shown long-term anti-atherogenic effects but their combined effect on clinical endpoints has been inconsistent. Studies also suggest that vitamins would be beneficial to individuals who are antioxidant-deficient or exposed to increased levels of oxidative stress, for example, smokers, diabetics and elderly patients, emphasising the importance of subgroup targeting. Through defining the right population group and the optimal vitamin combination we could potentially find a future role for vitamins in CVD.