中国肥胖和2型糖尿病外科治疗指南(2014)

<正>据中华医学会糖尿病学分会2008年中国糖尿病和代谢疾病研究(China national diabetes and metabolic disorders study)报告,我国20岁以上人群糖尿病(diabetes mellitus,DM)总体患病率为9.7%,其中男性10.6%,女性8.8%。由此推算我国DM患病总人数达9240万,位居世界第一。DM前期的患病率高达15.5%,估算人数约为1.5亿。而且DM患病率有进一步增加的趋势,2010年数据显示DM患病率已达11.6%。在所有类     

江西省慢性丝虫病现状调查

目的了解江西省慢性丝虫病的患病情况,估算慢性丝虫病患病人数。方法采用分层整群抽样的方法抽取所调查乡（镇）,在抽取的每个乡（镇）中,随机抽取3个村调查慢性丝虫病患病情况。结果75个流行县共调查249个流行乡（镇）,708个流行村,703489人,查出慢性丝虫病患者674例。患者以象皮肿为主,占92.88%;年龄以〉60岁居多,占89.91%;病程以≥20年者为主,占93.62%。全省慢性丝虫病患病率为0.10%。全省慢性丝虫病患者推算数为24103人。结论江西省遗留慢性丝虫病患者人数众多,关怀照料工作任务繁重。     

心脏再同步治疗慢性心力衰竭的建议（2009年修订版）

背景 心力衰竭的流行病学及治疗现状 慢性心力衰竭是心内科治疗学上的难题,是使患者丧失工作能力,具有较高患病率和死亡率的严重疾患。流行病学资料显示：美国大约有500万人罹患心力衰竭,每年新增病例55万;全球心力衰竭患病人数高达2250万,每年新增病例数约200万。我国2003年一项心力衰竭流行病学调查资料显示,在35～74岁人群中,心力衰竭患病率为0．9％。按此比率推算,     

广州市石牌社区55岁以上人群肥胖和代谢综合征患病状况的10年变迁

目的了解广州市"城中村"石牌社区55岁以上人群肥胖和代谢综合征患病情况及其影响因素,以及近10年来的变化。 方法采用横断面的调查方法,对2013年广州石牌社区55岁以上人群（975人）进行代谢异常患病情况（肥胖和代谢综合征）的调查,并与2002年该人群（639人）的调查结果进行比较。 结果该人群2002年肥胖的患病率为14.7%,标化率为12.2%,2013年为15.3%,标化率为13.1%。2002年该人群MS患病率为32.2%,标化率为30.6%。2013年该人群MS的患病率为32.1%,标化率为31.1%,其中女性MS患病率34.1%,高于男性（27.5%）。女性MS患病率随年龄增加而升高（P<0.05）。采用多因素非条件logistic回归分析发现性别、腰围、收缩压、FBG、TG和低HDL-C是MS独立相关因素。 结论广州市石牌社区55岁以上人群肥胖和代谢综合征的患病状况严峻,与10年前对比其肥胖和代谢综合征患病率无明显变化。     

高血压管理的关键问题

<正>目前,根据《中国心血管病报告2012》资料,我国心血管患病人数为2.9亿,每10s就有1人死于心血管病[1]。按以往年龄>15岁人群高血压患病率平均年增长3%推算,2012年我国高血压患病率为24%,估算全国高血压患者为2.66亿,每5个成年人中至少有1人患高血压。高血压是脑卒中和冠心病发病的主要危险因素。我国有超过半数的心脑     

京棉一厂高血压与脑卒中相关性的十年随访

脑卒中是使中老年人住院和长期致残的重要原因。众所周知它与高血压关系密切,约80％以上脑卒中患者入院时有高血压。1979年全国高血压普查资料表明成人高血压患病率为7.7％,北京市高血压患病率为9.53％,而脑卒中已成为我国第一位死因。纺织系统的高血压发病情况和脑卒中的相关性尚未见报导。现将京棉一厂1984年5月高血压普查情况及其后十年的随访结果报导如下。     

心脏再同步化治疗进展

慢性心力衰竭(CHF)是心脏病学亟待解决的难题.慢性心力衰竭的患病率及病死率逐年增加,美国每年有55万人新发生慢性心力衰竭,慢性心力衰竭患者约有500万.全世界每年新发生慢性心力衰竭的患者约200万,总患者人数达2240万.2003年我国一项流行病学调查显示,35～74岁人群心力衰竭的患病率为0.9％.现在中国已经进入老龄化社会,从我国人口基数和医疗现状推算,慢性心力衰竭患者人数至少在400万人以上.     

我国糖尿病教育的问题与思考

中华医学会糖尿病学分会(CDS)全国糖尿病流行病学调查(2007-2008)显示,在我国20岁以上人群中,男性和女性的糖尿病患病率分别达10.6%和8.8%,总体糖尿病患病率为9.7%,推算出全国糖尿病总患病人数约为9200万人,由此,我国已一跃而成为全球糖尿病第一大国!     

杭州市社区居民脑卒中患病情况及知信行调查

目的探讨杭州市社区居民中老年人群脑卒中防治知信行现状及危险因素。方法采用分层整群随机抽样方法抽取2 718名40岁以上中老年社区居民,进行问卷调查和体格检查。结果杭州社区居民中老年人脑卒中患病率为9.27%,年龄标化患病率为10.31%;多因素logistic回归显示,年龄大、患有高血压、得分糖尿病、有房颤史、中心性肥胖是杭州市中老年人群脑卒中患病的危险因素;杭州社区居民脑卒中防治相关知识总平均分(16.71±1.85)分、总得分率41.76%,脑卒中防治信念总平均分(42.05±1.61)分、总得分率58.40%,杭州社区居民脑卒中防治相关行为总平均分(34.21±1.43)分、总得分率45.61%;对调查对象脑卒中知识、信念、行为得分进行相关分析显示均有统计学意义(均P<0.05)。结论杭州市社区居民中老年人群脑卒中患病率较高,高龄、高血压、糖尿病、房颤病史及中心性肥胖是中老年人群患脑卒中的危险因素;且社区居民脑卒中防治知识普遍缺乏,防治态度总体趋向积极,防治健康行为依从性较低。     

256排螺旋CT应用于老年脑血管病的诊断价值

脑血管病是中老年人的常见病、多发病，已成为危害人群健康的主要疾病之一。我国每年新发脑卒中约200万人，上海地区〉／60岁发病人数占总发病人数的88．79％，各型脑卒中以缺血性为主（70％～90％）。虽然缺血性脑卒中多数并非致命，但是致残率很高，幸存者中约3／4遗留不同程度的残疾。     

HIV prevalence in 72 000 urban and rural male army recruits,Ethiopia

BACKGROUND: The recent estimate of around 2 million HIV-infected people in Ethiopia derives from data that are sparse, especially in the rural areas where the majority (> 85%) of the population lives. We assessed HIV prevalence in almost 72 000 army recruits who resided in urban and rural areas prior to recruitment. METHODS: Rapid HIV tests, HIVSPOT and Determine, were conducted on blood samples drawn at enrolment from almost 10 000 urban recruits, in 1999, and 62 000 rural recruits, in 2000. Socio-demographic data from recruits were available. RESULTS: In urban recruits, overall HIV prevalence was 7.2%, ranging from 4.3 to 10.5% depending on region. In rural recruits, overall HIV prevalence was 3.8%, but the majority were farmers (57%) and students (18%) with an HIV prevalence of 2.7% and 2.6%, respectively. (Higher) level of education in rural recruits was associated with HIV infection. Rural recruits of the Muslim religion were less likely to be HIV infected than recruits of the Orthodox Christian religion (odds ratio: 0.7; 95% confidence interval, 0.65-0.84). Urban and rural residents of Amhara region were at higher risk of HIV infection. CONCLUSION: Prevalence in both rural and urban army recruits is below previous estimates. Geographic distribution of HIV is uneven. The impact of religion, education, and region on HIV prevalence suggests avenues for targeting HIV prevention efforts in Ethiopia.     

Morbidity and physical functioning in old age: differences according to living area

OBJECTIVES: To describe differences in morbidity and functional status according to living area. DESIGN: Community‐based survey. SETTING: A community‐based prospective cohort, the Kungsholmen‐Nordanstig Project. PARTICIPANTS: Adults aged 75 and older living in an urban area of central Stockholm (n=1,222) and in the rural community of Nordanstig in northern Sweden (n=919). MEASUREMENTS: Physicians clinically examined all participants using the same standardized protocols in both living areas; trained nurses directly assessed disability. RESULTS: Cardiovascular disease was the most common disorder in both living areas (39.9% in the urban area and 45.2% in the rural area). There were great area differences in the prevalence of stroke (7.4% and 14.0%), diabetes mellitus 6.3% and 16.1%), and Parkinson's disease (1.0% and 3.7%). It was more common to have two or more diseases than no diseases in the rural area than in the urban area (odds ratio=1.9, 95% confidence interval=1.4–2.4). Significant living area differences (urban vs rural) in population attributable risk (PAR) was found for disability due to stroke (5.6 vs 32.2), diabetes mellitus (1.2 vs 6.1), fractures (1.4 vs 10.7), and hearing impairment (8.7 vs 22.0). CONCLUSION: Differences were found in disability, morbidity, and disease patterns according to living area. The rural elderly population was more disabled and had more diseases than the urban elderly population, despite being slightly younger than the urban cohort. There were significant area differences in the PAR of how specific chronic conditions influenced the risk of disability.     

Giant cell arteritis is more prevalent in urban than in rural populations: results of an epidemiological study of primary systemic vasculitides in Germany

OBJECTIVE: To investigate the period prevalences of primary systemic vasculitides (PSV) in urban and rural populations in northern and southern Germany in 1994. METHODS: Questionnaires were sent to all hospital departments, all physicians, health insurance providers and pension funds, reference laboratories for autoimmune diseases, and death registries in two catchment areas in northern and southern Germany (combined population 875 983) to identify patients with PSV between 1 January and 31 December 1994. Each catchment area encompassed both an urban and a rural area. Each case was re-evaluated by the authors by applying the definitions of the 1992 Chapel Hill Consensus Conference on the Nomenclature of Systemic Vasculitis. RESULTS: A total of 180 PSV patients were identified. The overall prevalence of PSV was 216 cases per 1 000 000 inhabitants (95% confidence interval (CI) 173-259) in northern Germany vs 195 (95% CI 153-236) in southern Germany. The prevalence of PSV was two-fold higher in women than in men, and five-fold higher in people aged > or =50 yr than in people aged <50 yr. The most frequent type of PSV was giant cell arteritis (GCA), with 87 cases per 1 000 000 in northern and 94 in southern Germany, followed by Wegener's granulomatosis, with 58 and 42 cases respectively. In the population aged > or =50 yr the prevalence of GCA was 240 per 1 000 000 in northern and 300 in southern Germany. In both northern and southern Germany the prevalence of GCA in this older population was significantly higher in urban than in rural populations (355 per 1 000 000 vs 115 in northern Germany (P<0.01) and 395 vs 220 (P<0.05) in southern Germany). The relative risk for the older urban population having GCA was 2.25-fold higher (95% CI 1.4-3.6) than in the rural population, and for the female population it was 4.7-fold higher in the urban than in the rural areas (95% CI 2.4-9.3). CONCLUSION: In both northern and southern Germany, GCA was significantly more prevalent in urban than in rural populations, especially among people aged > or =50 yr and in women. It remains unclear whether this disparity was due to underdiagnosis of GCA in the rural regions associated with differences in the German health-care system in cities vs rural areas. Further studies must examine the role of (chronic) exposure to the environmental factors characteristic of cities.     

Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China

BACKGROUND: Over the past two decades, China has enjoyed impressive economic development, and her citizens have experienced many remarked changes in their lifestyle. These changes are often associated with an increase in obesity and chronic disease. METHODS: In this meta-analysis, based on nationally representative data, we studied the current prevalence of obesity and the trends in obesity, mortality and morbidity in China. RESULTS: Between 1992 and 2002, the prevalence of overweight and obesity increased in all gender and age groups and in all geographic areas. Using the World Health Organization body mass index cut points, the combined prevalence of overweight and obesity increased from 14.6 to 21.8%. The Chinese obesity standard shows an increase from 20.0 to 29.9%. The annual increase rate was highest in men aged 18-44 years and women aged 45-59 years (approximately 1.6 and 1.0% points, respectively). In general, male subjects, urban residents, and high-income groups had a greater increase. With the increase in overweight and obesity, obesity-, and diet-related chronic diseases (e.g., hypertension, cardiovascular disease (CVD), and type 2 diabetes) also increased over the past decade and became a more important preventable cause of death. Hypertension increased from 14.4% in 1991 to 18.8% in 2002 in adults; in older adults aged 35-74 years, it increased from 19.7 to 28.6%. Between 1993 and 2003, the prevalence of CVD increased from 31.4 to 50.0%; diabetes increased from 1.9 to 5.6%. During 1990-2003, although total mortality rate (per 100 000) decreased, overall the mortality rate and contribution (as percentages) to total death of obesity-related chronic disease increased, in particular, in rural areas. Mortality rate (per 100 000) of CVD increased from 128 to 145 and its contribution to total death, 27 to 32%, in rural areas; the figures decreased slightly in urban areas. The mortality rate of 'nutrition, endocrinology and metabolism-related disease' (NEMD) increased in both rural and urban areas between 1990 and 2000, 8.0 to 10.6 and 4.9 to 5.3, respectively. The current prevalence of hypertension, dyslipidaemia, metabolic syndrome, and diabetes among Chinese adults is approximately 20, 20, 15, and 3%, respectively. CONCLUSION: The prevalence of overweight and obesity and obesity-related chronic diseases have increased in China in the past decade. Our findings provide useful information for the projection of future trends and the formulation of national strategies and programmes that can address the challenges of the growing obesity and chronic disease epidemic.     

The prevalence of functional disability in activities of daily living and instrumental activities of daily living among elderly Beijing Chinese

In order to assess the prevalence of the functional disability defined by activity of daily living (ADL) and instrumental activity of daily living (IADL) and associated factors in elderly Chinese, a population-based cross-sectional study was performed in urban, plain rural and mountain rural regions of Beijing. Of the 3440 subjects, 1707 are males and 1733 are females, with mean age of 71.4+/-7.7 years. Demographic, socio-economic and health aspects were obtained by trained interviewers. The results showed functional disability prevalence was 6.5% on ADL and 7.9% on IADL. Among the three representative areas in Beijing, the plain rural had the highest disability rate, increasing with the progression of age. Bathing and doing heavy housework were the two most difficult functional tasks. The functional disabilities were associated with gender and marital status. Our data suggest that plain rural elderly are most likely to generate functional disability, and bathing and doing heavy housework are two promising predictors to monitor the development of functional disability in the elderly.     

社区卫生服务机构就诊的缺血性脑卒中患者抑郁患病率及影响因素

目的 调查社区卒中患者卒中后抑郁(PSD)的患病率及其相关影响因素. 方法在北京市城区选择五家二级医院所属社区卫生服务中心,登记2003年1月至2006年12就诊的缺血性脑卒中患者.采用抑郁自评量表(SDS)评价脑卒中患者PSD患病情况,同时还收集了脑卒中起病情况、脑卒中危险因素等资料. 结果共登记1089例脑卒中患者,其中1074例符合入选标准并有完整资料,平均年龄(65.0±8.9)岁,脑卒中病程中位数为13.0个月.PSD总患病率为49.9%(536/1074),其中轻、中、重度PSD分别占52.2%、36.0%和11.8%.不同脑卒中病程的PSD患病率差别不大,脑卒中后6个月内、7～18个月、18个月以上的PSD患病率分别是51.3%、47.1%和53.2%.PSD患病与文化程度、日常生活依赖、认知功能情况、脑卒中发作次数、文化程度独立相关. 结论在社区卫生服务机构就诊的缺血性脑卒中患者中有较高的PSD患病率,但是以轻中度为主,积极采取有效的早期干预,可以有效控制PSD的发生和发展,促进患者神经功能的康复,改善预后,提高生活质量.

Abstract：

Objective To estimate the prevalence and related risk factors of post-stroke depression (PSD) in ischemic stroke survivors from community-based medical centers in urban areas of Beijing.Methods Five community-based medical centers in urban areas of Beijing were selected.Patients with first-ever or recurrent ischemic stroke were evaluated from January 2003 to December 2006. The prevalence of PSD was evaluated by Self-Rating Depression Scale (SDS), and the information on the onset of stroke, vascular risk factors and living style was also collected.Results Totally 1089 stroke patients were registered, 1074 cases among which had complete information and met inclusion criteria. The mean age of the patients was (65.0 ± 8.9) years with a median stroke course of 13.0 months. The overall prevalence of PSD was 49.9% (536/1074), and the proportions of mild, moderate and major PSD were 52.2%, 36.0% and 11.8%, respectively. There were no significant differences in prevalence of PSD among different stages of stroke and the prevalence of PSD was 51.3% within 6 months after stroke onset, 47. 1% during 6-18 months and 53.2% after 18months. Low education, activities of Daily Living (ADL) dependence, cognition impairment and recurrence of stroke were independent risk factors for PSD.Conclusions The prevalence of PSD among ischemic stroke patients is higher in community-based medical centers, but most of PSD patients are mild or moderate. More effective early intervention should be adopted to decrease PSD,promote the recovery of neural function and improve their quality of life.     

北京地区急性卒中事件病死率17年变化趋势

目的分析1984—2000年北京地区35～74岁人群急性卒中事件病死率变化趋势、分布特点及可能的影响因素。方法在WHO—MONICA方案的北京地区心血管病监测人群中,用统一标准化的方法登记北京地区急性卒中事件13556例,其中死亡病例3905例,死亡事件定义为发生卒中事件后28d内。结果（1）卒中总病死率为28．8％,其中缺血卒中的病死率为12．3％,脑内出血型卒中的病死率为63.2％,蛛网膜下腔出血型卒中的病死率为34．8％;（2）卒中病死率的变化趋势：男性平均每年下降1．51％（P〈0．01）,女性平均每年下降1．83％（P〈0．01）;出血型卒中病死率年平均下降1．48％,缺血型卒中病死率年平均下降0．51％;（3）男女两性卒中病死率之比为1：1．13（P〈0．01）,农村人群的病死率（38．7％）高于城市人群（26．3％）（P〈0．01）,卒中复发者的病死率（36．1％）高于卒中首发者（25．2％）（P〈0．01）。结论17年间北京地区35～74岁人群卒中病死率呈下降趋势,其中主要表现为出血型卒中病死率的下降。加强农村地区的医疗保健水平,积极开展卒中二级预防,是进一步降低卒中病死率的重要措施。     

北京地区25～64岁人群15年血清总胆固醇水平的变化趋势

目的分析北京地区25～64岁人群1984-1999年15年中,血清总胆固醇（TC）水平的变化趋势以及在不同亚组人群中的变化特点。方法1984-1999年间在北京地区MONICA心血管病监测人群中,对25～64岁人群分别进行了5次心血管病危险因素的横断面调查。5次样本的选择均按男女两性、10岁1个年龄组进行分层随机抽取。结果（1）15年间,25～64岁组人群平均血清TC水平增加1．058mmol／L（25．1％）,其中,25～34岁组增加的幅度最大,为0．998mmol／L（25．9％）;城市人群的平均TC水平高于农村人群,而15年间平均TC水平的增加幅度农村人群（32．8％）高于城市人群（26．3％）。（2）高TC血症患病率从1984年的6．1％增加到1999年的29．9％,15年间增加了23．8％,男性25～34岁组的患病率最低,但15年间的增加幅度最高,1999年为1984年的16．4倍。结论15年来北京地区人群平均TC水平及高TC血症患病率均呈持续增加趋势,农村人群及男性25～34岁年龄组的增加幅度尤为显著。     

Frailty and survival of older Chinese adults in urban and rural areas: results from the Beijing Longitudinal Study of Aging

Differences in frailty between rural and urban older adults have been demonstrated in developed countries. It is not understood how the apparently greater differences in living conditions between different types of regions in China may affect health and outcomes of older Chinese adults. Here, a frailty index (FI) based on the accumulation of health deficits was used to investigate health and survival differences in older Chinese men and women. We studied rural (n = 1121) and urban (n = 2136) older adults (55-97 years old) in the Beijing Longitudinal Study of Aging (BLSA), of whom 48.9% (rural) and 35.4% (urban) died over 8 years of follow-up. The FI was generated from 35 self-reported health deficits. The mean FI increased exponentially with age (r² = 0.87) and was higher in women than in men. The death rate increased significantly with increases in the FI, but women showed a lower death rate than did men. The mean FI in urban older adults (0.12 ± 0.10) was lower than that in their rural counterparts (0.14 ± 0.12, p < 0.001). Urban dwellers showed better survival compared with their counterparts in the rural areas. Adjusted by age, sex, and education level, the hazard ratio for death for each increment of the FI was 1.28 for urban people and 1.27 for rural people. Chinese urban dwellers showed better health and survival than rural dwelling older adults. The FI readily summarized health and mortality differences among different geographic regions, reflecting the impact of the environment, socioeconomics, and medical services on deficit accumulation and on survival.     

Prevalence and socio-demographic characteristics of disability in older adults in China: Findings from China Comprehensive Geriatric Assessment Study

ObjectiveDisability affects older adults’ quality of life. This study aimed to examine the socio-demographic characteristics of disability in older adults in China.MethodData was obtained from the China Comprehensive Geriatric Assessment Study (CCGAS). The sample comprised 6864 people aged 60 years and above from seven provinces in China. A door-to-door survey was conducted by formally trained interviewers using a unified questionnaire. Disability was assessed with physical health assessment comprising activities of daily living (ADL), and independent activities of daily living (IADL). For the purpose of this study, we analyzed only disability and some socio-demographic dimensions. The rates were standardized based on China’s Sixth National Census population distribution.ResultsThe disability rate in older adults was 7.0%. The disability rate was significantly higher in women than men, significantly higher in rural areas than urban areas, and higher in northern China than southern China. Urban disability rates ranged from 5.7% to 1.2%. The differences were statistically significant, with Beijing having the highest and Shanghai the lowest disability rates. Disability increased with age.ConclusionIn China, the disability rate in older adults is 7.0%, and increases with age. The disability rate is significantly higher in women, rural area, and northern China. This is the first study to report the epidemiology of disability in older adults in China in recent years and indicates the need for further epidemiological data on disability in China to facilitate long-term care and care policy formulation.