MNA和SGA在评价炎症性肠病病人营养状况中的应用

目的:探讨炎症性肠病(IBD)病人营养评估的合理方法. 方法:选择微型营养评定法(MNA)联合营养状况主观综合评估(SGA)对IBD病人进行营养状态评估,同时检测血红蛋白(Hb)、总淋巴细胞计数(TLC)、血清前清蛋白(PA)、清蛋白(ALB)以及钠、钾和钙等指标. 结果:Pearson相关分析显示,MNA值与Hb、ALB、和Na+呈显著相关性.Kendall's tau-b相关方法分析证明,MNA与SGA两种营养评估方法具有很好的相关性(r=0.772,P=0.000). 结论:MNA联合SGA对IBD病人进行营养状况评估方法科学和准确.     

不同营养评价方法在肝病病人中的比较及适宜肝病营养评价的方法

目的:应用不同营养筛查/评估方法对肝病病人进行营养状况调查,筛选出新的适合肝病病人的营养评价方法. 方法:选择慢性肝病住院病人525例,其中慢性肝炎149例,肝硬化360例,肝衰竭16例.应用主观全面评定法(SGA)、营养风险筛查NRS 2002、微型营养评价精法(MNA-SF)和传统营养指标的测定和比较,通过多因素分析筛选出适合慢性肝病病人的营养评价指标. 结果:应用SGA法、MNA-SF法和上臂肌围(MAMC)、肱三头肌皮皱厚度(TSF)、血清清蛋白(ALB)、前清蛋白(PA)、淋巴细胞总数(LCT)指标评估营养状态时,不同疾病分组营养状况差异存在统计学意义(P＜0.05).TSF、MAMC、ALB和活动能力是影响慢性肝病病人发生感染、胸腹水、器官功能衰竭和进入ICU的危险因素,并以此建立肝病病人营养评价方法(NALD). 结论:应用NALD,更适合评价肝病病人的营养状况.     

总体主观评价法和微型营养评价精法在老年肿瘤患者、营养评估中的比较

目的研究总体主观评价法（PG—SGA）和微型营养评价精法（MNA—SF）在老年肿瘤患者营养评估方面的差异,为临床营养评价提供科学依据。方法108例老年肿瘤患者分别应用MNA—SF和PG—SGA进行营养评估,将2种评估方法的结果进行比较。结果MNA—SF法评价42例营养正常的患者中,PG—SGA评分为A级12例,B级30例,没有评为C级者;MNA—SF法评价66例营养不良的患者中,PG—SGA评分为A级2例,B级60例,C级4例,PG—SGA对老年肿瘤营养不良的检出率（87．0％）高于MNA—SF（61．1％）;2种方法的评估结果间差异有统计学意义（P〈0．05）。结论PG-SGA更适合用于老年肿瘤患者进行营养评估,并可为临床治疗提供指导性意见。     

利用简易营养评价法调查住院老年人的营养状况

目的 利用简易营养评价法(MNA)评价住院老年人的营养状况，了解MNA与传统营养指标的相关性。方法 利用MNA量表对144名住院老年人进行调查，同时收集人体测量指标、生化指标和其他资料。结果 住院老年人营养不良的患病率为36．1％，潜在营养不良为46．5％，营养正常占17．4％；年龄、牙齿状况和疾病状态是影响老年人营养的重要因素；MNA与多数传统营养指标之间有良好相关性。结论 住院老年人营养不良的患病率高，MNA是一种可靠、快捷、简便的老年人营养状况评价方法。     

微型营养评定法评价胃肠道肿瘤病人营养状况的应用

目的:应用微型营养评定(MNA)法调查和分析胃肠道肿瘤病人的营养状态,并比较与其他营养评价方法的相关性. 方法:应用MNA法问卷调查、人体测量和实验室检查,对496例胃肠道肿瘤拟手术病人,入院24 h内进行营养评价,研究营养不良的发生率,并比较MNA法与人体测量和实验室检查的相关性. 结果:①MNA法:胃肠道肿瘤病人中营养不良者84例(16.94%),营养不良危险者211例(42.54%),营养良好者201例(40.52%).②人体测量:体质指数(BMI)、肱三头肌皮皱厚度(TSF)、上臂围(AC)和上臂肌围(AMC)等指标,病人的营养不良发生率分别为13.5%、21.9%、15.1%和15.5%.③实验室检查:ALB、PA和总淋巴细胞计数,病人的营养不良发生率分别为14.9%、25.4%和30.8%.④MNA法与BMI、ALB、AC、TSF、AMC、TLC的相关系数在0.18～0.53(P<0.05),有良好的相关性. 结论: ①应用MNA法评价胃肠道肿瘤病人中营养不良和营养不良高危状态的发生率高.②MNA是一种简单、易行、无创性、适合于外科胃肠道肿瘤病人的营养评价方法.     

应用微型营养评价精法评价老年住院病人的营养状况

目的:应用微型营养评价精法(MNA-SF)评价老年住院病人的营养状况,并比较不同营养状况病人间传统营养评价指标的差异。方法:随机抽取753例老年住院病人,采用MNA-SF对其进行营养状况评价,同时测定传统营养指标进行分析。再根据病人牙齿状况进行分组,并对各组营养指标进行比较。结果:老年住院病人营养不良和营养不良风险发生率分别为19.39%和39.71%,营养正常率仅为40.90%。三组病人的体重指数(BMI)、上臂围(AMC)、小腿围(CC)、握力和体力活动水平(ADL)差异均有显著性统计学意义(P0.05);其中营养正常组营养不良风险组营养不良组。义齿组与牙齿正常组病人BMI、CC、AMC、握力、ADL和MNA评分明显高于缺齿组病人(P0.05)。结论:老年住院病人营养不良和营养不良风险的发生率较高,牙齿状况也将对病人营养状态产生影响。     

脑卒中住院康复治疗患者营养状态评估方法的比较

目的分析比较营养风险筛查2002(NRS2002)、主观全面评估法(SGA)、微型营养评定法(MNA)在脑卒中住院康复治疗患者营养评估中的作用。方法以BMI、近三个月体重变化、白蛋白水平作为判断营养状态的标准诊断方法,分别采用SGA、MNA、NRS2002法对106例脑卒中患者进行营养状况评估,比较其与标准诊断方法的一致性及灵敏度、特异度。结果SGA与标准诊断方法有较好的一致性(Kappa值在0.410);在灵敏度、特异度比较中,发现SGA的特异度较高(94.4%),而MNA、NRS2002的灵敏度较高(92.3%)。结论SGA在判断营养正常时与标准诊断一致性良好,但判断营养不良时NRS2002及MNA灵敏度更高。     

主观评价方法(SGA)在肿瘤病人营养状况评价中的应用

将主观全面评价方法(SGA)应用于肿瘤病人的营养状况评价,并与传统的评价方法进行比较,发现其与传统评价方法有较高的符合率(>80%);SGA评价结果与传统评价方法中多项评价指标显著相关(P<0,01).肿瘤病人大多存在不同程度的营养问题,SGA以其无创性、易掌握、简便易行的优点,在肿瘤病人动态营养状况评价中具有特别的意义.但在应用过程中可能会受一些因素的干扰,在SGA与传统评价方法结果不符时,应以传统方法为准.     

主观综合性营养评价法在住院病人营养状况及预后评价中的作用

主观综合性营养评价法(SGA)虽在临床应用广泛,但对其用途及评价结果的临床意义,各家报道差异甚大.有些研究将其视为筛选营养风险的工具;有些将其视为预测病人预后的工具,甚至将其视为评价其他营养评价方法或指标的参照值.不同营养状况评价指标所反映出的营养状况改变的侧重点不同.故临床应针对不同病人采用不同的评价方法或指标,以客观和有所侧重地评价病人的营养状况,为实施营养干预提供依据.     

简易营养评估法量表在中国老年肺癌手术患者中的应用及与术后并发症相关性分析

目的 通过在中国老年肺癌手术患者人群中应用修订后的简易营养评估法(MNA)量表及简易营养评估精法(MNA-SF)量表,了解中国老年肺癌手术患者的营养状况以及评价营养状况与术后并发症之间的关系.方法 利用修订后的MNA量表及MNA-SF量表对150例2010年6月至2011年6月新人院的老年肺癌准备手术的患者进行术前营养评估,同时收集患者基本资料、患病情况、人体测量指标、生化指标、术后并发症等相关资料.结果 根据MNA修订界值后的评分标准,所调查150例(男98例,女52例)老年肺癌手术患者营养不良的发生率为10.7％(16/150),潜在营养不良发生率为32.0％(48/150),营养正常率为57.3％( 86/150);MNA得分(23.7±3.8)分,MNA得分与体质指数(BMI)、上臂肌围(MAC)和腓肠肌围(CC)呈正相关(P＜0.01);MNA-SF得分(11.5±2.4)分,MNA-SF得分与BMI、三头肌皮褶厚度(TSF)、MAC、CC和MNA得分呈正相关(P＜ 0.01或＜0.05);术后并发症的发生率依次为:呼吸系统37.4％(55/147),心血管系统31.3％(46/147),胸腔0.7％(1/147);术后并发症不同发病数目之间及发病类型之间的营养状况比较差异无统计学意义(P=0.590、0.601).结论 修订界值后的MNA量表适合于中国老年肺癌手术患者的营养状况评估,评估结果表明老年肺癌手术患者的营养不良发生率较高,其MNA量表评估结果与术后并发症之间相关性有待进一步证实.     

临床营养评价方法SGA的应用与比较

<正> 主观的全面评价(Subjective Global Assessment SGA)又称全面的临床评价(Global Clinical Assessment GCA)是最近加拿大营养学家研究与发展的一种临床营养评价方法。这与Blackburn根据身体组成来评价营养状况的评价方法(Body Composition Assessment BCA)是临床营养学中最主要的两种评价方法。SGA的最大优点是:不论是医生、护士还是营养     

行为决策的评估理论构建研究

本研究构建了行为决策的评估理论,揭示人类行为发生、发展和改变的规律,为开展健康相关行为干预提供科学依据。本理论认为,所有的人类行为都是个体为了生存和发展,在对内、外部刺激进行评估后所做出的主动反应。个体以基因遗传、自我图式、群体规范和直觉为参照系,对内、外部刺激的重要性、安全性威胁和获益性,以及个体所拥有的行为资源进行感觉性评估和社会性评估,用以做出生理性反应和社会性行为决策,并通过感受器、中枢神经和效应器,形成“刺激-评估-行为决策-行为”循环。开展行为干预时,应通过与个体进行讨论和分析,帮助其发现和确认刺激的重要性、安全性、获益性及其拥有的行为资源。     

The effectiveness of human impact assessment in the Finnish Healthy Cities Network

OBJECTIVES: To develop a framework for analysing the effectiveness of prospective assessment and to apply the framework to human impact assessments (HuIA) carried out in the Finnish Healthy Cities Network. METHODS: The framework was formed by synthesizing and developing the themes that emerged from the published literature on effectiveness. The research material consists of interviews with people who participated in the assessment process in the municipalities (19 interviews). The research material also included assessment documents, proceedings of working meetings, municipal policy documents, background material and project reports produced in the municipalities studied. The research datasets were examined by content analysis. RESULTS: HuIA increased the decision-makers' awareness of effects and functioned as a tool for empowerment. The latter was apparent, for instance, in the social welfare and healthcare sector, finding a role for itself in decisively co-ordinating interdisciplinary work and actively seeking to alleviate identified negative effects. The assessment process also opened up the planning process, committed various actors to the decision, helped select the right alternative and promoted social learning. CONCLUSIONS: From the viewpoint of preparation and decision-making, the effectiveness of a HuIA increases when assessment becomes a recurring process and an integral part of an organization's activities. Integration of an assessment into permanent structures or activities, such as drawing up programmes or preparing strategies, helps the results of the assessment to be seen more clearly. From the viewpoint of decision-making, it is also important to strengthen the decision-makers' expertise in prospective assessment. When the effectiveness of HuIA is looked at in a new way (i.e. from the viewpoint of goal achievement, decision-making or learning), a more comprehensive interpretation can be given.     

Predictors of short-term clinical response to acute asthma care in adults.

OBJECTIVE: We assessed the effects of potential patient risk factors on short-term clinical response to acute asthma care among adults who often require emergency department (ED) visits and hospitalizations to manage their asthma. DESIGN AND SETTING: Prospective cohort study that included adult patients treated for acute asthma, which was conducted in a US public hospital ED between March 1997 and August 1999, with a 2- to 3-week follow-up. STUDY PARTICIPANTS: Three hundred and nine patients completed the study. MAIN MEASURES: We identified patient risk factors that predicted lower peak expiratory flow rate (PEFR) change over 2-3 weeks following acute asthma care. Potential risk factors were ozone exposure, indoor allergy and exposure, smoking, upper respiratory infection in the last month, lower asthma knowledge, and medication non-adherence. RESULTS: Univariate analyses indicated that lower asthma knowledge significantly and positively correlated with lower PEFR change (r = 0.15, P = 0.01). Multivariate analysis that controlled for patient case-mix indicated that indoor allergy and exposure [b = 32.76, 95% confidence interval (CI) = 3.98-61.53, P = 0.03] significantly predicted lower PEFR change. There was no change in the multivariate analysis when the absence of treatment with corticosteroids during the 2-3 weeks before follow-up was added as a potential patient risk factor. CONCLUSION: The study suggests that interventions are needed to target the patient risk factors, indoor allergen exposure, and poor asthma knowledge, to promote short-term clinical response to acute asthma care in adults, especially among economically disadvantaged inner-city residents.     

生物监测在化学危害物风险评估中的应用

风险评估,是目前国际上推崇的评估暴露于环境化学危害物导致不良人体健康效应概率的科学方法,已在世界各国广泛使用。然而,在大部分的风险评估中,因缺乏人群暴露和剂量的数据而增加了评估的不确定性。生物监测能提高风险评估的准确性和真实性,直接提供人体内暴露和早期效应的信息。目前,许多国际组织和发达国家已建立生物监测项目,并鼓励将生物监测数据应用于风险评估之中。本文将阐述生物监测的定义和发展,详细描述化学危害物风险评估和暴露评估中生物监测的作用,举例说明风险评估中生物监测数据的解释,以及整合生物监测的局限性。总之,随着各类数据的积累,生物监测有能力使化学危害物风险评估更完善。     

Assessment of the Nutritional Status of Four Selected Rural Communities in KwaZulu-Natal,South Africa

Under- and over-nutrition co-exist as the double burden of malnutrition that poses a public health concern in countries of the developing regions, including South Africa (SA). Vulnerable groups such as pregnant women and children under five years are the most affected by malnutrition, especially in rural areas. Major contributing factors of malnutrition include food and nutrition insecurity, poverty, and unhealthy lifestyles. The current study aimed to assess the nutritional status, using selected anthropometric indices and dietary intake methods (repeated 24 h recall and food frequency), of four rural communities in KwaZulu-Natal (SA). Purposive sampling generated a sample of 50 households each in three rural areas: Swayimane, Tugela Ferry, and Umbumbulu and 21 households at Fountain Hill Estate. The Estimated Average Requirement cut-point method was used to assess the prevalence of inadequate nutrient intake. Stunting (30.8%; n = 12) and overweight (15.4%; n = 6) were prevalent in children under five years, whilst obesity was highly prevalent among adult females (39.1%; n = 81), especially those aged 16–35 years. There was a high intake of carbohydrates and a low intake of fibre and micronutrients, including vitamin A, thus, confirming the need for a food-based approach to address malnutrition and micronutrient deficiencies, particularly vitamin A deficiency.     

Comparison of different methods for spatial analysis of cancer data in Utah

BACKGROUND: The standardized incidence ratio (SIR) and SaTScan software are used by the Environmental Epidemiology Program (EEP), Utah Department of Health, to investigate health concerns and exposures in Utah (USA). Recently, the EEP acquired the Rapid Inquiry Facility (RIF). The RIF enables access of additional dimensions of data, identifies potentially exposed populations, and computes disease rates and relative risk statistics for that potentially exposed population. OBJECTIVE: In this article we present a comparison of the SIR, SaTScan, and RIF methodologies in an investigation of cancer rates in residents living over contaminated groundwater plumes near Hill Air Force Base (HAFB) in Utah. METHODS: For this study, we used cancer data from the Utah Cancer Registry for cancers of the lung, kidney, and non-Hodgkin lymphoma. We used SIR and the RIF to investigate the cancer rate in a defined population within the study area during six consecutive 5-year time intervals (1975-2004). We used SaTScan and the RIF to explore the study area for clusters. RESULTS: The RIF risk analysis and SIR are mathematically identical. SIR is set up and computed by programming SAS; the RIF risk analysis, on the other hand, is set up through four menu-driven steps. The RIF disease-mapping feature enhanced the interpretation of SaTScan results. We found kidney and lung cancer to be statistically elevated for the potentially exposed population for one and two periods, respectively. SaTScan found two clusters, one outside the potentially exposed population and one that included a portion of that population. CONCLUSION: The RIF is an easy-to-use and useful tool that extends the ability of the investigator to conduct analysis of disease rates and interpret the findings.