广西壮族自治区柳州市2013-2014年HIV/AIDS抗病毒治疗后BMI变化及相关因素分析

目的 了解广西壮族自治区柳州市艾滋病病毒感染者/艾滋病患者（HIV/AIDS）抗病毒治疗后BMI变化的动态趋势及相关因素。方法 选择2013年1月1日至2014年12月31日柳州市开始抗病毒治疗、年龄≥ 15岁、治疗基线、第（6±2）个月和（12±2）个月BMI值均有体重记录的HIV/AIDS作为研究对象,收集研究对象体重、身高数据计算BMI。采用PASW Statistics 18.0.0软件进行统计学分析,采用一般线性模型重复测量方差分析方法,进行BMI随时间变化趋势分析和多因素分析。结果 2 871例研究对象治疗基线、第（6±2）个月和（12±2）个月BMI值分别为（20.65±3.32）、（20.87±3.22）和（21.18±3.20）,3个时段的BMI值差异有统计学意义（F=18.86,P<0.001）。治疗后BMI随时间推移而提升（F=37.25,P<0.001）,相关因素主要为年龄、性别、婚姻状态、基线CD₄⁺T淋巴细胞计数和WHO临床分期。结论 柳州市HIV/AIDS抗病毒治疗前BMI诊断营养不良所占的比例较高,接受抗病毒治疗后BMI的变化受多种因素影响,针对不同患者采用不同的治疗措施,有利于患者身体营养状况的恢复。     

叶酸与p16蛋白在宫颈癌变中的作用及其相互效应

目的 探讨叶酸与p16蛋白在宫颈癌变中的作用及其相互效应。方法 选取经病理学确诊的80例正常宫颈（NC）妇女、55例低度宫颈上皮内瘤样变（CINⅠ）患者、55例高度宫颈上皮内瘤样变（CINⅡ/Ⅲ）患者、64例宫颈鳞状细胞癌（SCC）患者为研究对象。分别采用微生物法和Western-blot方法检测其血清叶酸水平和p16蛋白的表达量。同时采用体外细胞实验研究方法,对HPV阴性的宫颈癌细胞C33A和HPV16阳性的宫颈癌细胞Caski进行不同浓度叶酸干预,检测两种宫颈癌细胞的增殖和凋亡情况,以及p16蛋白的表达。结果 NC组、CINⅠ组、CINⅡ/Ⅲ组和SCC组血清叶酸含量分别为（5.96±3.93） ng/ml、（5.08±3.43） ng/ml、（3.92±2.59） ng/ml、（3.18±2.71） ng/ml,p16蛋白表达水平分别为0.80±0.32、1.33±0.52、1.91±0.77、2.09±0.72;随着宫颈病变的进展,血清叶酸含量逐渐降低（趋势检验 χ²=32.71,P<0.001）,p16蛋白表达量逐渐升高（趋势检验 χ²=56.06,P<0.001）。在CINⅠ、CINⅡ/Ⅲ、SCC组中血清叶酸缺乏与p16蛋白高表达均存在正相加交互作用。体外实验结果显示,随着叶酸浓度的增加,宫颈癌细胞的增殖抑制率（C33A：r=0.928,P=0.003;Caski：r=0.962,P=0.001）和凋亡率（C33A：r=0.984,P<0.001;Caski：r=0.986,P<0.001）均上升,p16蛋白表达量逐渐降低（C33A：r=-0.817,P=0.025;Caski：r=-0.871,P=0.011）,且p16蛋白表达量与宫颈癌细胞的增殖抑制率（C33A：r=-0.935,P=0.002;Caski：r=-0.963,P=0.001）和凋亡率（C33A：r=-0.844,P=0.017;Caski：r=-0.898,P=0.006）均呈负相关关系。结论 血清叶酸缺乏与p16蛋白高表达均可增加宫颈癌和癌前病变的发病风险,两者在宫颈癌和癌前病变中存在正相加交互作用。补充叶酸可逆转p16蛋白的异常表达,有效抑制宫颈癌细胞的增殖,促进凋亡。     

手足口病重症病例临床分期与结局分析

目的 了解手足口病重症病例临床分期与结局的特征及关联性,为建立临床重症病例评估方法提供依据。方法 根据地理位置、经济状况和疫情高发水平选择河南、山东、浙江、四川和云南省,随机抽取法定传染病报告中手足口病重症病例,收集病例人口学、临床资料和实验室检测结果等,按统一标准进行临床分期,分析各期病例构成、临床结局及其关联性。结果 共调查手足口病重症病例657例。实验室诊断病例357例,其中肠道病毒71型阳性病例326例,占91.3%（326/357）。临床分期：2期（神经系统受累期）病例542例、3期（心肺功能衰竭前期）病例99例、4期（心肺功能衰竭期）病例16例,分别占重症病例数的82.5%（95%CI：79.4%~85.3%）、15.1%（95%CI：12.4%~18.0%）、2.4%（95%CI：1.4%~3.9%）。11例有后遗症,占重症病例数的1.7%（95%CI：0.9%~3.0%）;8例死亡,病死率为1.2%（95%CI：0.6%~2.3%）。临床2、3和4期在各年龄组、5个省份、后遗症病例数、死亡例数的构成比差异均有统计学意义（分别为 χ²=22.632,P=0.012;χ²=41.481,P=0.000;χ²=12.960,P=0.001;χ²=16.850,P=0.001）。结论 手足口病重症病例临床分期与后遗症、死亡结局有关联性。临床分期可用于手足口病重症病例严重程度的评价。     

基于群组轨迹模型的含糖饮料摄入模式与儿童牙周健康关联的队列研究

目的 探讨童年期含糖饮料摄入模式对牙周健康的前瞻性影响。方法 以安徽省蚌埠市儿童4年随访队列为基础,应用群组轨迹模型（GBTM）建立童年期含糖饮料摄入轨迹发展模型,分别采用线性多元回归和logistic多元回归分析含糖饮料摄入模式不同分组与菌斑指数和牙龈炎发生的关联。结果 共有997名儿童纳入分析,其中男童418名,女童579名,第三次随访年龄为（11.00±0.70）岁。GBTM识别出4种含糖饮料摄入模式：持续较低组（80.70%）、渐降组（12.40%）、先升后降组（2.20%）和渐增组（4.70%）。相比于持续较低组,含糖饮料摄入渐增组菌斑指数较高（1.73±0.80 vs.1.08±0.70）（t=4.00,P<0.001）、牙龈炎检出率（12.80% vs.3.00%）较高（χ²=12.40,P<0.001）。控制相关混杂因素发现,相比于持续较低组,渐增组和先升后降组菌斑指数分别增加0.58（95% CI：0.27～0.89）和0.38（95% CI：0.03～0.73）。渐增组牙龈炎风险显著增加（OR=4.42,95% CI：1.65～12.20,P=0.003）。结论 童年期至青春期过渡阶段含糖饮料摄入较高儿童牙周疾病风险显著增加。     

中国2014年7~14岁学生血红蛋白水平及贫血状况分析

目的 了解我国7~14岁学生血红蛋白水平及贫血流行状况。方法 基于2014年全国学生体质与健康调研数据库,抽取检测了血红蛋白的7、9、12和14岁共71 130名学生作为研究对象,采用2011年WHO贫血诊断标准,了解研究对象血红蛋白水平和贫血患病率,分析我国7~14岁学生贫血流行现状。结果 2014年我国7、9、12和14岁学生血红蛋白水平分别为（129.25±11.37）g/L、（131.04±11.08）g/L、（135.02±12.12）g/L和（138.47±13.97）g/L,贫血检出率分别为9.0%、6.5%、8.6%和7.7%,其中男生为（135.49±13.33）g/L,女生为（131.38±11.67）g/L。总体贫血患病率为7.9%,其中女生（9.7%）显著高于男生（6.2%）（P<0.01）;乡村学生（8.8%）显著高于城市（7.1%）（P<0.001）。消瘦、正常、超重和肥胖学生的血红蛋白水平分别为（133.19±12.56）g/L、（133.28±12.76）g/L、（134.24±12.73）g/L和（133.79±12.16）g/L;贫血率分别为8.8%、8.3%、6.7%和5.9%,四组间差异有统计学意义（P<0.001）。结论 我国7~14岁学生贫血检出率仍较高,且在不同性别、城乡、年龄以及营养状况人群中存在差异。     

新疆维吾尔自治区2017-2019年布鲁氏菌病患者医疗费用分析

目的 分析新疆维吾尔自治区（新疆）布鲁氏菌病（布病）患者的医疗费用及影响因素。方法 收集2017年1月1日至2019年12月31日期间首要诊断为布病患者的人口学信息、就诊信息和费用信息。通过非参数检验分析不同性别、年龄组、临床分期、并发症对患者医疗资源利用及医疗费用的影响。使用中位数描述布病患者的门诊和住院费用。结果 共13 532例纳入分析,其中门诊8 113例,住院5 419例,男性占67.8%（9 176/13 532）,年龄（42.7±15.4）岁,以18~44岁（46.6%,6 304/13 532）和45~59岁（34.2%,4 622/13 532）年龄组为主。住院患者年龄（43.3±15.7）岁,高于门诊患者年龄（42.3±15.1）岁（Z=-3.85,P < 0.001）。住院患者就诊时,全身症状以发热（36.9%,1 997/5 419）和乏力（36.6%,1 983/5 419）常见,局部症状以关节/肌肉疼痛（68.9%,3 735/5 419）常见;急性期患者占79.1%（4 289/5 419）,慢性期患者占20.9%（1 130/5 419）;患者有并发症占46.5%（2 519/5 419）,主要为骨骼系统并发症。门诊患者人均门诊次数（1.6±1.4）次。住院患者次均住院天数为（11.3±4.2）d,慢性期和有并发症患者住院天数较长（P < 0.05）。住院患者同年也有门诊记录占89.3%（4 840/5 419）,人均门诊次数（3.6±2.6）次。门诊患者医疗费用以化验费和药物费为主（75.1%）,住院患者以药物费、化验费和其他费用为主（74.4%）。2017-2019年门诊患者医疗费用M（Q₁,Q₃）分别为61（52,497）、61（51,346）和58（46,318）元,住院患者医疗费用M（Q₁,Q₃）分别为8 214（6 355,10 721）、9 095（7 018,12 155）和9 492（7 530,12 351）元。患者年龄、临床分期、并发症和关节/肌肉疼痛症状为住院患者医疗费用的影响因素（P < 0.001）。结论 2017-2019年新疆布病住院患者经济负担较重,特别是高年龄组、慢性期、合并骨骼和神经系统并发症的患者。提高患者早期就诊和规范治疗意识,减少慢性化和并发症发生,可降低布病诊治所导致的经济负担。     

衰弱指数模型在老年人综合评估中的初步应用

目的 探讨基于老年人综合评估的衰弱指数模型(FI-CGA)在中国老年人群中的适用性,及其评估老年人的衰弱状况。方法 对118例参加体检的老年人进行综合评估,并计算衰弱指数;同时采用临床衰弱量表(CFS)-09的9级分级法进行衰弱测评,比较两种衰弱评估方法的相关性。结果 118例老年人FI-CGA均值为0.19±0.07,平均CFS分级为3.11±1.46;5例老年女性FI-CGA均值为0.20±0.02、CFS分级均值为3.40±0.55;113例老年男性FI-CGA均值为0.19±0.07、CFS分级均值为3.10±1.48,女性高于男性,但差异均无统计学意义(t=0.270、0.452,P=0.788、0.652)。随着年龄增加老年人FI-CGA值和CFS衰弱分级均增加(F=10.437、5.651,P=0.000、0.001);且FI-CGA值与CFS衰弱分级水平呈正相关(r=0.615,P=0.000)。结论 FI-CGA可为中国老年患者准确定量评估病情,应在老年医学临床中推广应用。     

浙江省台州市1998-2022年HIV/AIDS死因分析

目的 了解台州市1998-2022年HIV/AIDS的死亡情况和死因。方法 资料来源于中国疾病预防控制信息系统的艾滋病综合防治信息系统和台州市慢性病信息管理系统,以1998-2022年现住址为台州市的5 126例HIV/AIDS为研究对象,用SAS 9.4软件进行秩和检验、χ²检验及趋势分析。结果 1998-2022年HIV/AIDS死亡796例,病死率为15.53%（796/5 126）,病例在确证后1年内死亡占52.26%（416/796）。年初尚存活病例在年内死亡的构成比呈下降趋势（趋势χ²=5.60,P<0.001）。在死因构成上,艾滋病140例（17.59%）、恶性肿瘤237例（29.77%）、心血管病99例（12.44%）、伤害58例（7.29%）、其他160例（20.10%）和不详102例（12.81%）。恶性肿瘤、心血管病和其他死因的死亡病例构成比随时间变化均呈上升趋势（趋势χ²=1.92,P=0.028;趋势χ²=2.81,P=0.003;趋势χ²=2.07,P=0.020）。在HIV/AIDS不同死因中,确证年龄、职业、婚姻状况、民族、文化程度和感染途径的差异有统计学意义（均P<0.05）。死因为心血管病者死亡年龄最大,死因为艾滋病的死亡距确证间隔时间最短且首次检测CD4⁺T淋巴细胞计数最低,死因不详者的确证至抗病毒治疗的时间间隔最长（均P<0.05）。结论 1998-2022年台州市HIV/AIDS的非艾滋病相关死亡的构成比较高,随时间变化呈上升趋势,要进一步加强HIV/AIDS慢性非传染性疾病的早期筛查、干预和治疗。     

神经外科肿瘤患者术后感染对住院日和住院费用的影响

目的 研究神经外科肿瘤患者术后感染对住院日和住院费用的影响。方法 以2015年7月1日至2017年6月30日神经外科肿瘤术后患者为研究对象,在院发生术后感染患者为病例组,未发生感染者为对照组,按住院时间（±3月）、年龄（±5岁）及手术部位进行1∶1配对,比较两组平均住院日和各项医疗费用。结果 神经外科肿瘤患者术后感染率为5.66%,以手术部位感染（54.72%）和下呼吸道感染（31.32%）为主;病例组平均住院日为20.5 d,较对照组延长8.5 d（Z=-10.618,P<0.001）;病例组平均费用为91 573.42元,较对照组增加30 518.17元（Z=-9.988,P<0.001）;其中手术部位感染和下呼吸道感染患者平均费用分别为84 888.50元和110 442.64元,较对照组分别增加23 627.49元（Z=-6.627,P<0.001）和43 631.36元（Z=-4.954,P<0.001）。结论 术后感染将延长患者住院日并增加住院费用,影响医院的社会效益和经济效益,应引起各级医院的高度重视。     

广东省慢性病患者生存质量及健康调整期望寿命分析

目的 分析广东省慢性病患者生存质量及健康调整期望寿命。方法 基于广东省第五次全国卫生服务调查数据,通过欧洲五维度三水平健康量表对人群生存质量进行评价。运用多重线性回归和等级logistic回归评价慢性病对人群生存质量的影响,并用期望寿命和健康调整期望寿命指标评价慢性病对人群健康的综合影响。结果 共纳入68 550名居民数据进行分析,等级logistic回归显示在校正了社会人口学特征后,慢性病对生存质量各个维度的影响均有统计学意义,其中对疼痛/不舒服维度的影响最大[OR=4.48（95% CI：4.20~4.77）],其余依次为焦虑/抑郁[OR=3.95（95% CI：3.62~4.31）]、日常活动[OR=3.69（95% CI：3.37~4.04）]、行动[OR=3.63（95% CI：3.34~3.94）]和自我照顾[OR=3.30（95% CI：2.98~3.66）]。慢性病患者期望寿命比非慢性病人群平均少12.7年,健康调整寿命平均减少14.6年（男性减少17.8年,女性减少9.7年）。人群去慢性病健康调整期望寿命收益为3.8年（男性为5.1年,女性为2.0年）。结论 慢性病会影响患者生存质量的各维度,从而减少患者的健康调整期望寿命,给人群和社会带来沉重的健康负担。从卫生政策和卫生资源优化配置的角度看,需为慢性病患者尤其是为老年患者提供更全面可及的医疗照护,照护需不仅关注生理健康也要注重心理健康。     

Using the EQ-5D-5L to investigate quality-of-life impacts of disease-modifying therapy policies for people with multiple sclerosis (MS) in New Zealand

Background

Health state utilities (HSU) are a health-related quality-of-life (HRQoL) input for cost-utility analyses used for resource allocation decisions, including medication reimbursement. New Zealand (NZ) guidelines recommend the EQ-5D instruments; however, the EQ-5D-5L may not sufficiently capture psychosocial health. We evaluated HRQoL among people with multiple sclerosis (MS) in NZ using the EQ-5D-5L and assessed the instrument’s discriminatory sensitivity for a NZ MS cohort.

Methods

Participants were recruited from the NZ MS Prevalence Study. Participants self-completed a 45-min online survey that included the EQ-5D-5L/EQ-VAS. Disability severity was classified using the Expanded Disability Status Scale (EDSS) to categorise participant disability as mild (EDSS: 0–3.5), moderate (EDSS: 4.0–6.0) and severe (EDSS: 6.5–9.5). Anxiety/depression were also measured using the Hospital Anxiety and Depression Score (HADS). In the absence of an EQ-5D-5L NZ tariff, HSUs were derived using an Australian tariff. We evaluated associations between HSUs and participant characteristics with linear regression models.

Results

254 participants entered the study. Mean age was 55.2 years, 79.5% were female. Mean (SD) EQ-5D-5L HSU was 0.58 (0.33). Mean (SD) HSUs for disability categories were: mild 0.80 ± 0.17, moderate 0.57 ± 0.21 and severe 0.14 ± 0.32. Twelve percent reported HSU = 1.0 (i.e., no problems in any domain). Participants who had never used a disease-modifying therapy reported a lower mean HSU. Multivariable modelling found that the HADS anxiety score was not associated with EQ-5D-5L.

Conclusions

HRQoL for people with MS in NZ was lower than comparable countries, including Australia. We suggest a comparison with other generic tools that may have improved sensitivity to mental health.

     

Health-Related Quality of Life Among Pregnant Women With Pre-pregnancy Smoking and Smoking Cessation During Pregnancy in China: National Cross-sectional Study

BackgroundPrevious studies have hardly explored the influence of pre-pregnancy smoking and smoking cessation during pregnancy on the health-related quality of life (HRQoL) of pregnant women, which is a topic that need to be addressed. In addition, pregnant women in China constitute a big population in the largest developing country of the world and cannot be neglected.ObjectiveThis study aims to evaluate the HRQoL of pregnant women in China with different smoking statuses and further estimate the association between pre-pregnancy smoking, smoking cessation, and the HRQoL.MethodsA nationwide cross-sectional study was conducted to determine the association between different smoking statuses (smoking currently, quit smoking, never smoking) and the HRQoL in pregnant women across mainland China. A web-based questionnaire was delivered through the Banmi Online Maternity School platform, including questions about demographics, smoking status, and the HRQoL. EuroQoL Group’s 5-dimension 5-level (EQ-5D-5L) scale with EuroQoL Group’s visual analog scale (EQ-VAS) was used for measuring the HRQoL. Ethical approval was granted by the institutional review board of the First Affiliated Hospital of Sun Yat-sen University (ICE-2017-296).ResultsFrom August to September 2019, a total of 16,483 participants from 31 provinces were included, of which 93 (0.56%) were smokers, 731 (4.43%) were ex-smokers, and 15,659 (95%) were nonsmokers. Nonsmokers had the highest EQ-VAS score (mean 84.49, SD 14.84), smokers had the lowest EQ-VAS score (mean 77.38, SD 21.99), and the EQ-VAS score for ex-smokers was in between (mean 81.04, SD 17.68). A significant difference in EQ-VAS scores was detected between nonsmokers and ex-smokers (P<.001), which indicated that pre-pregnancy smoking does have a negative impact on the HRQoL (EQ-VAS) of pregnant women. Compared with nonsmokers, ex-smokers suffered from more anxiety/depression problems (P=.001, odds ratio [OR] 1.29, 95% CI 1.12-1.50). Among ex-smokers, the increased cigarette consumption was associated with a lower EQ-5D index (P=.007) and EQ-VAS score (P=.01) of pregnant women. Compared to smokers, no significant difference was found in the ex-smokers’ EQ-5D index and EQ-VAS score (P=.33).ConclusionsSmoking history is associated with a lower HRQoL in pregnant Chinese women. Pre-pregnancy smoking is related to a lower HRQoL (EQ-VAS) and a higher incidence of depression/anxiety problems. Smoking cessation during pregnancy does not significantly improve the HRQoL of pregnant Chinese women. Among ex-smokers, the more cigarettes they smoke, the lower HRQoL they have during pregnancy. We suggest that the Chinese government should strengthen the education on quitting smoking and avoiding second-hand smoke for women who have pregnancy plans and their family members.     

Assessment of health-related quality of life among hypertensive patients: a cross-sectional study from Palestine

Aim

The ability to identify indicators of poor health-related quality of life (HRQoL) is crucial for both improving clinical care and determining targets of intervention for the prevention and treatment of disease. The main objectives of this study were to assess the HRQoL profile of the hypertensive population from Palestine, and to determine the socio-demographic and clinical characteristics associated with poor HRQoL.

Subject and methods

A cross sectional study was conducted, adopting the EuroQoL-5 Dimensions scale (EQ-5D-5 L) for the assessment of HRQoL. Hypertensive patients attending outpatients’ clinics at Al-Makhfyah primary health care clinic and from Alwatani Hospital, Nablus, Palestine were approached for study.

Results

Four hundred and ten hypertensive patients were enrolled in the study. Of these, 213 patients (52 %) were female. The average age of the study population was 58.38?±?10.65 years. HRQoL was good, with a mean EQ-5D-5 L index value and EQ visual analogue scale (EQ-VAS) score of 0.80?±?0.16 and 74.1?±?15.6 respectively. There was a significant positive correlation (r?=?0.56; p?<?0.001) between the EQ-5D-5 L index values and the reported EQ-VAS scores. A significant difference in EQ-5D-5 L index values was found among participants when grouped according to age, occupation, marital status, income, educational level, duration of disease, total number of chronic diseases, and total number of medications (Kruskal–Wallis test; p-value?<?0.05), as well as gender and therapy type (Mann–Whitney test, p-value?<?0.05).

Conclusions

This study highlighted that specific socio-demographic and disease-related characteristics of hypertensive patients as well as treatment factors were strongly associated with HRQoL. The study findings could be helpful in clinical practice, mainly in the early treatment of hypertensive patients, at a point where improving HRQoL is still possible.     

Health-related quality of life in Chinese patients with chronic prostatitis/chronic pelvic pain syndrome

Objective  

To examine the health-related quality of life (HRQoL) and factors associated with HRQoL in Chinese patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) using two generic preference-based HRQoL instruments, EQ-5D (plus EQ-VAS) and SF-6D, with the results compared with general population.     

Health-related quality of life among pulmonary tuberculosis patients in Pakistan

Purpose

Health-related quality of life (HRQoL) of pulmonary TB patients has not been assessed in Pakistan. We assessed self-reported HRQoL of pulmonary TB patients in Karachi, Pakistan utilizing the EQ-5D and EQ-VAS prior to, during, and after completion of TB treatment.

Methods

We enrolled 226 pulmonary TB patients in a longitudinal cohort study. Health-utility scores were estimated by the EQ-5D five dimensions and the EQ-Visual Analogue Scale (VAS) at baseline (month 0) and each monthly follow-up visit until treatment completion at month 6. Repeated-measures ANOVA was used to investigate effect of time into treatment on EQ-5D and EQ-VAS scores.

Results

EQ-5D health utility and EQ-VAS scores increase with treatment progression. For the enrolled TB patients, the mean EQ-5D utility scores more than doubled from 0.43 to 0.88, p?<?.001, effect size η²?=?0.40 from treatment initiation to treatment completion.

Conclusion

Perceived HRQoL of TB patients improves with treatment progression. This can inform targeted treatment plans as well as TB policy and funding for high-burden countries.

     

Quality of Life and Health Status in Middle-aged Presumed Healthy Slovenian Family Practice Attendees

BackgroundThere is a gap in our knowledge of health-related quality of life (HRQoL) in a population presumed healthy, so this study aimed to assess the associations between HRQoL, demographics and clinical variables.MethodsThe participants were attendees, presumed healthy, at 40 pre-selected model family medicine practices (MFMPs), aged between 30 and 65 years and recruited during a preventive check-up in 2019. Each MFMP pragmatically invited 30 attendees to voluntarily participate. The EQ-5D questionnaire was administered as a measure of HRQoL; the independent variables were demographic characteristics, smoking, alcohol consumption, stress perception, physical activity, signs of depression, cardiovascular risk, body mass index, blood pressure values, and blood sugar and lipidogram laboratory test values. Ordinal logistic regression was used to calculate associations between self-assessed quality of life, demographics, and clinical variables, with P<0.05 set as statistically significant.ResultsOf 986 participants, 640 (64.9%) were women and 346 (35.1%) men, aged 42.7±8.6 years. The average values for the EQ-5D-3L were 0.91±0.15. In the multivariate model, a positive association between adequate physical activity (p=0.003), and a negative association between higher age (p<0.001), female gender (p=0.009), signs of depression (p<0.001), stress (p=0.013), and EQ-5D score were identified.ConclusionGiven that physical activity was shown to be positively associated with HRQoL, it is of the utmost importance for family physicians to motivate their middle-aged patients, especially women and those with signs of depression and excessive stress, to adopt a more rigorously physically active lifestyle.     

湖南省安化县2013-2016年手足口病住院负担估计

目的 估计2013年10月至2016年9月湖南省安化县各血清型及分年龄组的手足口病住院负担。方法 收集6家病毒学监测医院的儿童手足口病住院记录及23家乡镇卫生院的手足口病新农合报销记录,估计安化县分年龄组的手足口病住院负担。结合病毒学监测结果,估计各血清型肠道病毒（EV）相关的手足口病住院负担。结果 共纳入手足口病住院病例3 541例,其中实验室确诊病例数为3 146例。仅有1例为手足口病重症,其余均无并发症。临床诊断和实验室确诊手足口病平均住院率分别为723/10万（95% CI：699/10万~747/10万）和642/10万（95% CI：620/10万~665/10万）。柯萨奇病毒（Cox）A组16型（Cox A16）（208/10万）和6型（Cox A6）（202/10万）相关的手足口病住院率高于EV71（130/10万）、Cox A10（38/10万）和其他EV（64/10万）,差异有统计学意义（P<0.001）。手足口病住院率在1岁组最高（3 845/10万）,之后随年龄增长住院率逐渐降低。与EV71和Cox A16相比,Cox A6相关的手足口病住院率表现出低年龄特点（P<0.001）。结论 湖南省安化县轻症手足口病住院负担严重,尤其在低年龄组儿童中,且主要由EV71、Cox A16、Cox A6和Cox A10导致。     

Factors associated with low health-related quality of life among younger and older Thai patients with non-valvular atrial fibrillation

Purpose

The aim of this study was to investigate the factors associated with low health-related quality of life (HRQoL) compared between younger and older Thai patients with non-valvular atrial fibrillation (NVAF).

Methods

This is a cross-sectional analysis of baseline data from a prospective NVAF registry from 24 hospitals located across Thailand. Patient demographic, clinical, lifestyle, and medication data were collected at baseline. EuroQOL/EQ-5D-3L was used to assess HRQoL. Health utility was calculated for the entire study population, and low HRQoL was defined as the lowest quartile. Multivariate logistic regression was used to identify factors that significantly predict low HRQoL among younger and older (≥?65 years) patients with NVAF.

Results

Among the 3218 participants that were enrolled, 61.0% were aged older than 65 years. Mean HRQoL was lower in older than in younger patients (0.72?±?0.26 vs. 0.84?±?0.20; p?<?0.001). Factors associated with low HRQoL among younger NVAF patients were the treatment-related factors bleeding history (p?=?0.006) and taking warfarin (p?=?0.001). Among older patients, the NVAF-related complications ischemic stroke or TIA, heart failure (HF), and dementia (all p?<?0.001) were all significantly associated with low HRQoL. Dementia is the factor that most adversely influences low HRQoL among older NVAF. Interestingly, symptomatic NVAF was found to be a protective factor for low HRQoL (p?<?0.001).

Conclusions

Bleeding history and taking warfarin among younger patients, and ischemic stroke/TIA, HF, and dementia among older patients are significant predictors of low HRQoL. These factors should be taken into consideration when selecting treatment options for patients with NVAF.

     

A Bayesian Approach for Incorporating the EQ-5D Visual Analog Scale When Estimating the Health-Related Quality of Life

ObjectivesThe EuroQoL 3-level version of EQ-5D and 5-level version of EQ-5D questionnaires are often used to quantify health states. They include ordinal responses across 5 health dimensions (EQ-5D index) and an EQ-visual analog scale (EQ-VAS) overall health rating. We investigated the value of incorporating the EQ-VAS to update health utility estimates using a Bayesian framework.MethodsWe created a joint bivariate normal EQ-VAS and EQ-5D index utility model and compared this to a univariate normal EQ-5D index utility model. We tested these models for 1026 Sri Lankan patients with chronic kidney disease and 94 Australian patients with wounds. We validated our approach by simulating EQ-VAS and EQ-5D index responses and applying our Bayesian model and then comparing the modeled estimates to our observed data.ResultsThe combined model showed a reduction in estimate uncertainty for all respondents. Compared with the EQ-5D index-only model, the mean utility for Sri Lankan respondents dropped from 0.556 (0.534-0.579) to 0.540 (0.521-0.559) in men and increased from 0.489 (0.461-0.518) to 0.528 (0.506-0.550) in women, with reduced credible interval width by 13% and 23%, respectively. The mean utility in Australian respondents moved from 0.715 (0.633-0.800) to 0.716 (0.652-0.782) in men, and 0.652 (0.581-0.723) to 0.652 (0.593-0.711) in women, with reduced credible interval width by 23% and 17%, respectively. The credible interval width for simulated data also narrowed, ranging from 8.3 to 8.5%.ConclusionsIncluding the EQ-VAS through Bayesian methods can add value by reducing requisite sample sizes and decision uncertainty using small amounts of additional data that is often collected but rarely used.     

Comparing EQ-5D-3L and EQ-5D-5L performance in common cancers: suggestions for instrument choosing

Purpose

To compare the performance of three-level EuroQol five-dimensions (EQ-5D-3L) and five-level EuroQol five-dimensions (EQ-5D-5L) among common cancer patients in urban China.

Methods

A hospital-based cross-sectional survey was conducted in three provinces from 2016 to 2018 in urban China. Patients with breast cancer, colorectal cancer, or lung cancer were recruited to complete the EQ-5D-3L and EQ-5D-5L questionnaires. Response distribution, discriminatory power (indicator: Shannon index [H′] and Shannon evenness index [J′]), ceiling effect (the proportion of full health state), convergent validity, and health-related quality of life (HRQoL) were compared between the two instruments.

Results

A total of 1802 cancer patients (breast cancer: 601, colorectal cancer: 601, lung cancer: 600) were included, with the mean age of 55.6 years. The average inconsistency rate was 4.4%. Compared with EQ-5D-3L (average: H′?=?1.100, J′?=?0.696), an improved discriminatory power was observed in EQ-5D-5L (H′?=?1.473, J′?=?0.932), especially contributing to anxiety/depression dimensions. The ceiling effect was diminished in EQ-5D-5L (26.5%) in comparison with EQ-5D-3L (34.5%) (p?<?0.001), mainly reflected in the pain/discomfort and anxiety/depression dimensions. The overall utility score was 0.790 (95% CI 0.778–0.801) for EQ-5D-3L and 0.803 (0.790–0.816) for EQ-5D-5L (p?<?0.001). A similar pattern was also observed in the detailed cancer-specific analysis.

Conclusions

With greater discriminatory power, convergent validity and lower ceiling, EQ-5D-5L may be preferable to EQ-5D-3L for the assessment of HRQoL among cancer patients. However, higher utility scores derived form EQ-5D-5L may also lead to lower QALY gains than those of 3L potentially in cost-utility studies and underestimation in the burden of disease.