低收入人群中高费用病例经济负担的调查分析

上海市贫困居民中，灾难性支出家庭占26.7%，高费用病例家庭占5.7%，高费用家庭的疾病经济负担极为严重，社会对他们的救助也远不能满足其需要，高费用病例所患的疾病主要为癌症，尿毒症，脑血管意外（中风）和糖尿病，对这些高费用病例进行救助需要2.3亿-7.5亿元。     

Interstitial lung disease in mixed connective tissue disease

INTRODUCTION: The authors analyzed the incidence of interstitial lung disease in mixed connective tissue disease. They were seeking an answer to the following problems: the nature of the pathological course of mixed connective tissue disease complicated by and the therapy to be used in interstitial lung disease. PATIENTS AND METHODS: 179 patients were followed up during a period of 15.9 +/- 6.1 years. Interstitial lung disease was diagnosed using high resolution computed tomography. The diagnosis of interstitial lung disease was not obvious in 5 patients thus open lung biopsy was performed, which confirmed common interstitial pneumonitis. The patients were followed-up, and the data of computed tomography and respiratory function tests were detected 6 months, and then 4 years after the acute lung disease complicated by mixed connective tissue disease. RESULTS: Out of the 179 mixed connective tissue disease patients 96 (53.6%) had interstitial lung disease. The onset of interstitial lung disease was the most frequent in the 2-4 years of the disease. Four years after the first appearance of interstitial lung disease severe fibrosis was diagnosed in 24 patients (25%). A honey comb formation in the lung developed only in one patient. For the treatment of interstitial lung disease, corticosteroid treatment had to be combined with cyclophosphamide in 51 cases. In 4 patients (24%), pulmonary arterial hypertension evolved 2-4 years following interstitial lung disease. The high pulmonary arterial pressure decreased using pulsed corticosteroid treatment, cyclophosphamide, prostacyclin analogue, anticoagulants therapy and the 4 patients stay alive. The pulmonary arterial hypertension was caused by obliterative vasculopathy. CONCLUSION: Pulmonary involvement is found in more than half of the patients with mixed connective tissue disease. Early diagnosis of interstitial lung disease is possible by computed tomography. Interstitial lung disease can be treated by the combination of corticosteroids and cyclophosphamide. The authors were the first to detect the coexistence of interstitial lung disease and pulmonary arterial hypertension in mixed connective tissue disease. Subsequent respiratory alterations in these patient necessitate regular patient follow up.     

疾病中的性

当人的生命受到威胁的时候,他所有的精力都会用在关注自己的生命方面,当他们度过了对病情的焦虑担心后,接下来的就是对疾病现实的认同。随着病情的控制,生命中正常的需求被逐渐唤醒,性就成为必须面对的问题。很久以采,在性的问题上存在着很多很多的误区,这些无形的观念像一条看不见的绳索,束缚着人们。性带给人的快乐就如     

Glutathione in disease

Altered glutathione metabolism in association with increased oxidative stress has been implicated in the pathogenesis of many diseases. However, whether strategies aimed at restoring glutathione concentration and homeostasis are effective in ameliorating or modifying the natural history of these states is unknown. In this review we discuss the pathogenic role for altered glutathione metabolism in such diseases as protein energy malnutrition, seizures, Alzheimer's disease, Parkinson's disease, sickle cell anaemia, chronic diseases associated with ageing and the infected state. In addition, we discuss the efficacy of glutathione precursors in restoring glutathione homeostasis both in vitro and in vivo.     

超声心动图检测在川崎病患儿冠状动脉病变评估中的应用价值

目的 探讨超声心动图检测在川崎病患儿冠状动脉病变评估中的应用价值.方法 将2017年10月-2019年1月期间我院收治的100例川崎病患儿作为研究对象,所有患儿均经冠状动脉造影与超声心动图检查并分析其检测结果.结果 以冠状动脉造影诊断结果作为“金标准”,超声心动图诊断的准确度为87％(87/100)、灵敏度为96.55...     

农村慢性病病人家庭的疾病经济风险分析

当前，慢性病正在成为危害农村居民健康和生命的主要卫生问题，慢性病的疾病经济负担也成为农村居民因病致贫的主要诱因之一。因此，新型农村合作医疗制度对慢性病门诊费用的补偿方式与程度，对减轻农村居民经济负担具有重要影响，也是影响新型农村合作医疗可持续发展的重要因素。山东大学卫生管理与政策研究中心尹爱田等在对山东、甘肃两省抽样调查基础上，分析了农村慢性病病人家庭的疾病经济风险，探讨了慢性病门诊费用纳入新型农村合作医疗大病统筹基金管理的必要性。同时，通过对慢性病病种的筛选、人均筹资增加额的测算，论证了慢性病门诊费用纳入新型农村合作医疗大病统筹基金管理的可行性。最后，提出了慢性病纳入后的管理模式和策略。现将他们的研究成果一起奉上。供大家讨论和参考。[编者按]     

胃食管反流病在慢性阻塞性肺疾急性加重中的作用

目的 探讨胃食管反流病(GERD)对慢性阻塞性肺疾病(COPD)急性加重的影响.方法 纳入本研究患者均确诊为COPD,均完成反流性疾病诊断问卷(RDQ),依据RDQ结果 分为GERD组(38例)和非GERD组(36例),比较两组患者的临床资料及每年COPD急性加重次数等.结果 与非GERD组比较,GERD组每年COPD急性加重次数增多[(2.68±0.77)次,年比(1.38±0.49)次,年,t=8.74,P＜0.05],气流阻塞程度差异无统计学意义[FEV1/预计值(39.82±10.95)%比(37.11±12.24)%,t=1.00,P＞0.05].多元线性回归模型显示,RDQ分数是COPD急性加重次数一种可能的预测因子(R2a=0.39,t=6.98,P＜0.05).结论 GERD可能与COPD急性加重次数有关.     

Response shift and disease activity in inflammatory bowel disease

Purpose

Response shift (RS) may mask true change in health-related quality of life in longitudinal studies. People with chronic conditions may experience RS as they adapt to their disease, but it is unknown whether fluctuations in disease activity will influence the presence of RS. The study purpose was to test for RS in individuals with inflammatory bowel disease (IBD), a condition characterized by periods of symptom flares and remission.

Methods

Data were from the Manitoba IBD Cohort Study (N = 388). Multi-group confirmatory factor analysis (MG-CFA) and a RS detection method based on structural equation modeling were used to test for reconceptualization, reprioritization, and recalibration RS in participants with consistent active, consistent inactive, and inconsistent disease activity over a 6-month period on the SF-36.

Results

The MG-CFA revealed that a weak invariance model with equal factor loadings across groups was the best fit to the baseline SF-36 data. Reconceptualization, uniform recalibration, and non-uniform recalibration RS was detected in the consistent active group, but effect sizes were small. For the consistent inactive group, recalibration RS was observed and effect sizes were small to moderate. For the inconsistent disease activity group, small-to-moderate recalibration RS effects were observed. There was no evidence of reprioritization.

Conclusions

Individuals with a chronic disease may exhibit RS even if they are not actively experiencing symptoms on a consistent basis. Heterogeneity in the type and magnitude of RS effects may be observed in chronic disease patients who experience changes in disease symptoms.

     

中国老年人群慢性病患病状况和疾病负担研究

目的 掌握我国老年人群主要慢性病患病情况和疾病负担,为制定慢性病防控政策和合理配置卫生资源提供科学依据。方法 采用具有全国和省级代表性的中国慢性病及其危险因素监测数据,分析我国≥ 60岁居民慢性病患病情况。利用全球疾病负担研究中国数据,分析我国老年人群慢性病疾病负担。结果 我国≥ 60岁居民高血压、糖尿病、高胆固醇血症患病率分别为58.3%、19.4%和10.5%,75.8%的居民患≥ 1种慢性病,女性均高于男性,城市高于农村;随着年龄的增加慢性病患病率增加。≥ 70岁居民伤残调整寿命年构成中,心脑血管疾病（39.11%）、癌症（15.40%）、COPD（10.48%）占前3位。结论 老年人群主要慢性病患病率高,3/4的人患≥ 1种慢性病,慢性病疾病负担不断加重。     

健康教育对冠心病患者发病的预防作用

目的:探讨健康教育对冠心病患者发病的预防作用.方法:选取医院收治的76例冠心病患者作为此次研究对象,随机分为A组和B组,A组患者给予常规护理,B组患者给予健康教育,对健康教育对冠心病患者带来的影响进行分析.结果:B组患者服药规律、监测血压、饮食、复查及戒烟酒情况明显优于A组患者,差异具有统计学意义(P<0.05).结论:健康教育有效地降低了患者并发症的发生概率,保证了患者的治疗效果,值得临床推广和使用.     

The role of disease burden measures in future estimates of endemic waterborne disease

The 1996 Safe Drinking Water Act amendments require the US Environmental Protection Agency and the Centers for Disease Control and Prevention to develop a national estimate of the occurrence of waterborne infectious disease that is attributable to public drinking water systems in the United States. Much of the information for developing the national estimate will be derived from epidemiologic data, and the primary outcome of this effort will be an estimate of the number of cases of gastrointestinal illness. While quantifying the number of these cases provides some measure of waterborne disease impact, the usefulness of this measure may be limited because the full spectrum of societal impact also involves consideration of the additional effects of these diseases such as hospitalization costs and lost productivity. If decision-makers wish to compare the impact of waterborne infectious diseases to the impact of some other public health concern (e.g. to aid in resource allocation decisions), then a comparison of case numbers may prove inadequate. Case numbers alone do not provide sufficient information about the severity of different illnesses. Society may value the avoidance of a few cases of severely debilitating illness more than it values the avoidance of many cases of mild illness. In order to compare disparate public health concerns, "burden of disease" measures that incorporate indicators of disease severity, costs, or societal values may prove essential for some types of decisions. We describe epidemiologic measures of severity, quality adjusted life years (QALYs), disability adjusted life years (DALYs), willingness-to-pay, and cost-of-illness methods commonly used for burden of disease estimates, and discuss how some of these summary measures of burden might be used for waterborne disease estimates.     

Lyme disease and post-treatment Lyme disease syndrome: the neglected disease in our own backyard

Objectives

A survey was developed to assess experience and opinions about Lyme disease and post-treatment Lyme disease syndrome (PTLDS) among faculties in public health. No previous surveys of public health faculties have been found in the literature.

Study design

This is a cross sectional study of public health school faculty members designed to measure knowledge and experience with Lyme disease and PTLDS using an internet survey instrument.

Methods

Participants were recruited using all the publicly available e-mail addresses of faculty members in all the 50 accredited Schools of Public Health in the United States.

Results

A 15% response rate was seen for the survey. 50% of respondents were from Lyme endemic states. Less than 5% of faculty members consider themselves expert in Lyme or PTLDS. Many faculty members had known someone with Lyme disease or PTLDS, but few had been diagnosed themselves. Most believe that PTLDS can be severe and chronic, is not easy to treat, and does not resolve on its own, but were uncertain about its aetiology. Most respondents also felt that the incidence of Lyme disease will increase and that more education is needed.

Conclusions

The need for further understanding and communication presents an opportunity for public health research and education in Lyme disease and the sequelae of PTLDS.