江苏盛泽农村老年高血压患病现况及危险因素调查

目的调查江苏盛泽农村地区老年高血压患病率、治疗率、知晓率、控制率及相关危险因素。方法采用整群抽样的方法,随机抽取当地19个村≥60岁的全部居民进行现况调查,并根据性别、年龄分层从中随机抽取3181名居民进行配对病例对照研究,调查方法包括问卷调查、体格检查及血生化检查。结果该地区≥60岁人群高血压患病率达64.9%,高血压知晓率、治疗率及接受治疗患者血压控制率分别为73.5%、65.3%、53.4%。随着年龄的增长,高血压患病率逐渐升高(χ2=27.25,P0.01)。多因素Logistic回归分析显示吸烟(OR=1.197)、饮酒(OR=1.181)、超重与肥胖(OR=1.252),腹型肥胖(OR=1.651)、血糖异常(OR=1.461)、高尿酸血症(OR=1.826)、高三酰甘油血症(OR=1.371)、高胆固醇血症(OR=1.227)是高血压发病的独立危险因素(P均0.05)。结论江苏盛泽农村老年高血压患病率较高,治疗率、知晓率及控制率有待进一步提高,应通过健康宣教和规律体检进一步加强上述危险因素的防治。     

昆明市2020年常住18岁及以上居民高血压患病、知晓、治疗和控制情况分析

目的 了解昆明市2020年成人居民高血压的患病、知晓、治疗和控制现状,为高血压防治提供科学依据。方法 利用云南省2020年在昆明市开展的成人居民主要慢性病及其危险因素调查数据,采用多阶段整群随机抽样方法,抽取昆明市4个县区18岁及以上常住居民为样本,分析昆明市不同特征居民高血压的患病率、知晓率、治疗率、控制率、知晓治疗率和治疗控制率。结果共收集6 308份有效问卷,其中高血压患者2 358人,高血压患病率为37.4%,标化患病率为26.7%;高血压知晓率、治疗率、控制率、知晓治疗率和治疗控制率分别为55.8%、50.3%、63.5%、90.1%和71.2%。男性、老年、大专以下学历、超重和肥胖、中心性肥胖人群的患病率较高,男性、中青年、大专以下学历、吸烟、饮酒、非肥胖人群的患病知晓率较低,吸烟和饮酒人群的知晓治疗率较低,中青年、大专以下学历、吸烟、饮酒、肥胖人群的治疗控制率较低。结论 昆明市成人居民的高血压患病率偏高,知晓率、治疗率和控制率不高,不同人群各率差异较大,需采取针对性措施开展干预工作。     

南充市23598名45岁及以上居民血脂调查及分析

目的调查南充市顺庆区城区内45岁及以上人群血脂异常分布情况及相关影响因素,为血脂异常的防治决策提供科学依据。方法整群抽取南充市顺庆区8个社区27 000名45岁及以上居民,通过问卷调查、医学体检和膳食调查3部分进行血脂水平和影响因素调查。对结果进行χ~2或t检验以及多因素Logistic回归分析。结果血脂异常检出率为45.7%,知晓率为7.2%,治疗率为2.3%,控制率为0.5%;女性血脂异常率为55.72%,男性为44.28%,二者间差异有统计学意义(P0.05)。单因素分析显示:在男性中,年龄、文化程度、吸烟史、高血压家族史、糖尿病家族史、血脂异常家族史、高血压病、糖尿病、锻炼、油炸面食食用、身高、体重、BMI、腰围、臀围、水果是血脂异常的主要影响因素;在女性中,仅年龄、吸烟史、血脂异常家族史、高血压病、糖尿病、薯类食用、体重、BMI、腰围、臀围是血脂异常的主要影响因素。多元Logistic回归分析结果显示:在男性中,吸烟、血脂异常家族史、高血压、糖尿病、锻炼、油炸食品食用、体重、BMI、腰围是危险因素,年龄和文化程度是保护因素;在女性中,血脂异常家族史、高血压、糖尿病、薯类食用、体重、BMI、腰围是危险因素。结论南充市顺庆区城区内45岁及以上人群血脂异常情况不容乐观。迫切需要我们建立包括血脂异常在内的慢病管理综合服务模式,提高患者自我管理的知识和技能,减少或延缓心脑血管事件的发生。     

北京市居民脑卒中危险因素及认知情况分析

目的调查北京社区人群脑卒中相关危险因素和认知情况,为加强北京市社区居民的健康干预提供依据。方法于2007年6月至8月,采用整群抽样方法,对北京10 054名社区居民进行问卷调查、体格检查及空腹血浆血糖、血脂检测。结果 10 054名被调查者脑卒中患病率为4.78%,其中男性6.08%,女性4.02%,并伴有随年龄增高趋势。多因素Logistic回归显示年龄、性别、吸烟、饮酒、体重指数、工作强度、血脂、高血压、ABI是脑卒中患病的危险因素。超重、肥胖伴有高血压、高血脂、踝肱指数(ABI)异常者患脑卒中的危险性是同龄健康者的4.541倍(95%CI 2.187～9.432)。高血压患者知晓率仅50.8%,血脂异常患者知晓率仅13.0%。结论北京市居民脑卒中患病率高,脑卒中相关危险因素患病率高、知晓率低。应加强对社区居民进行健康教育和健康促进。     

梅州客家人群高血压患病的社区调查和危险因素分析

目的:探讨梅州客家人群社区高血压的患病现况及患病危险因素。方法:2012年10月至2014年10月,采用多阶段随机抽样调查方法,抽取梅州客家20岁以上的常住社区居民4 500人进行关于高血压患病现况、知晓、治疗和控制情况,以及危险因素等的问卷调查,并测量血压和进行常规体检。结果:调查有效人数为4 481人,高血压患者有1 327例(29.61%)。不同性别间高血压患病率无显著差异(P0.05),随年龄增长,高血压患病率显著上升(P0.01)。高血压知晓率、治疗率和控制率分别为46.80%、79.87%、47.58%。社区居民对肥胖是高血压影响因素的知晓率(74.85%)显著高于其他影响因素。非条件Logistic回归分析显示,年龄、偏咸饮食、高脂血症、糖尿病、肥胖和高血压家族史是高血压的独立危险因素(OR=2.308~2.907,P均0.01)。结论:对于梅州客家人群高血压患者需要加大健康教育宣传力度,倡导健康生活方式,加强对高血压危险因素的控制,以降低患病率。     

新疆乌鲁木齐市米东区回族高血压流行现状及其相关因素

目的:了解乌鲁木齐市米东区回族人群高血压的流行病学特征和相关危险因素。方法:采用整群随机抽样调查的方法对米东区回、汉人群进行高血压的流行病学调查。由经培训的医师对调查对象进行血压测量和资料收集。结果:米东区回族人群高血压的患病率为31.95%,显著高于汉族的患病率(26.91%),P0.05;回族高血压患者的知晓率为64.44%,治疗率为57.78%,控制率为10.37%;年龄的增长(OR 7.986,P0.001)、摄盐量(≥6g/d,OR 4.604,P0.001)、超重或肥胖(OR 2.762,P0.001)以及亲属高血压史(OR 1.920,P0.05)为回族高血压患病的危险因素。结论:乌鲁木齐市米东区回族高血压的患病率较高,高血压的知晓率、治疗率、控制率较2002年全国水平上升,年龄、摄盐量、超重或肥胖以及亲属高血压史是高血压的危险因素。     

四川省部分城乡居民高血压患病情况及影响因素分析

目的了解四川省城市和农村年龄≥15岁常住居民高血压流行情况及其影响因素,为下一步开展城乡高血压防控工作提供依据。方法 2015年11-12月,采用分层多阶段随机抽样的方法,分别在成都市成华区和达州市大竹县抽取4040人进行问卷调查和体格检查。结果调查资料完整3868人,其中城市居民1769人,农村居民2099人。城乡居民高血压患病率及其95%CI为23.32%(21.99%～24.65%),标化患病率为20.59%;农村居民高血压患病率高于城市居民(26.06%比20.07%,P0.01)。城乡居民高血压患病率在75岁呈上升趋势,≥75岁下降,患高血压高峰年龄段为65～75岁。四川省城乡高血压总知晓率、治疗率和控制率分别为55.65%、48.67%、15.52%。城市居民高血压知晓率51.83%(95%CI 49.50%～54.16%),治疗率48.45%(95%CI 46.12%～50.78%),控制率20.56%(95%CI 18.68%～22.44%);农村居民高血压知晓率58.14%(95%CI 56.03%～60.25%),治疗率48.81%(95%CI 46.27%～50.55%),控制率12.25%(95%CI 10.85%～13.65%)。城乡居民高血压知晓率、治疗率差异无统计学意义,城市居民高血压控制率高于农村居民(P0.01)。Logistic回归分析结果显示,城乡居民高血压患病的共同危险因素为年龄、体质量指数(BMI)和心血管病家族史;城市居民高血压患病的危险因素还包括吸烟和腹型肥胖。结论四川省城乡高血压患病率为23.32%;总知晓率、治疗率和控制率分别为55.65%、48.67%、15.52%,城乡居民高血压患病的主要危险因素为年龄、BMI和心血管病家族史。     

延安市60岁以上人群脑卒中危险因素调查分析

目的了解延安市年龄≥60岁居民脑卒中及危险因素。方法采用整群抽样的方法抽取延安市年龄≥60岁的居民27 153例进行脑卒中筛查,包括问卷调查、体格检查及实验室检查。结果本地区年龄≥60岁人群脑卒中发病率为4.4%;高危人群占16.1%;男性吸烟及低危人群检出率高于女性,高危人群、中危人群、运动缺乏、血脂异常、高血压、心房颤动/心脏瓣膜病、糖尿病、超重/肥胖、脑卒中家族史、既往短暂性脑缺血发作检出率低于女性(P0.01)。脑卒中人群年龄、吸烟、高脂血症、高血压、心房颤动/心脏瓣膜病、糖尿病、超重/肥胖、脑卒中家族史比例明显高于非脑卒中者[(71.23±7.76)岁vs (69.44±8.04)岁,26.9%vs 21.8%,24.6%vs 10.1%,63.8%vs 24.7%,12.8%vs 4.9%,12.7%vs 4.3%,16.5%vs 9.3%,8.8%vs 3.2%,P=0.000];高血压、脑卒中家族史、糖尿病为年龄≥60岁人群脑卒中的主要独立危险因素(B=1.427,B=0.712,B=0.640,P=0.000)。结论延安市年龄≥60岁人群脑卒中发病率较高,高血压、糖尿病和脑卒中家族史是本地区脑卒中最重要的危险因素。     

北京社区血脂异常者患病知晓率影响因素分析

目的研究影响北京社区血脂异常患者患病知晓率的因素。方法2007年6月至8月北京大学人民医院对北京大兴、朝阳、海淀及西城4个城区、51个居委会10054名居民中筛选出的3373例血脂异常患者资料进行分析。通过问卷了解患者社会经济学情况及血脂异常患病知晓情况;根据体格检查及晨起空腹血浆化验结果,评价人群高血压、肥胖及糖尿病等心血管病危险因素患病情况。结果(1)随年龄增长,血脂异常患者患病知晓率逐渐升高(P0.01)。(2)学历、婚姻状况、医保类型及家庭人均收入等社会经济学因素对患者知晓率存在影响。自费患者与享受农村合作医疗、城镇职工医保以及公费医疗患者,血脂异常知晓率分别为15.4%、14.4%、46.4%及54.4%。享受农村合作医疗的患者,其血脂异常知晓率并不高于自费患者人群(P=0.608)。(3)合并存在其他心血管病危险因素的亚组人群中,超重或肥胖的患者其知晓率并不高于正常体重血脂异常人群(29.3%、31.6%对27.6%,P=0.167);吸烟者的患病知晓率仅为19.2%,低于不吸烟或已戒烟患者群体(19.2%对34.4%、32.3%,P0.01)。结论中青年及合并心血管病危险因素的血脂异常患者其知晓率仍不理想,应加大对上述人群的降脂干预力度。     

天津市滨海新区心血管病高危人群慢性病患病现况及相关危险因素分析

目的 分析心血管病高危人群的慢性病患病及知晓、治疗和控制现况并分析相关影响因素。方法 2019年2～10月采用整群随机抽样的方法在天津市滨海新区21个街道(镇)中随机抽取4个街道(镇),对其中的6 305位常住居民进行问卷调查、体格检查，根据疾病史、血压和血脂水平及心血管病风险评估结果筛选出心血管病高危对象纳入研究。对心血管病高危人群的高血压、糖尿病、血脂异常的患病、知晓、治疗和控制现况分别分析，多因素logistic回归分析探索相关影响因素。结果 共筛选出心血管病高危对象1 494例。在心血管病高危人群中，高血压患病率、知晓率、治疗率、控制率分别为72.49%、87.53%、81.44%、39.70%;糖尿病患病率、知晓率、治疗率和控制率分别为35.48%、86.98%、80.19%、32.64%;血脂异常的患病率、知晓率、治疗率和控制率分别为59.84%、57.61%、45.30%、14.09%。高血压、糖尿病、血脂异常的患病率、知晓率及治疗率均随着年龄的增长而升高(均为P<0.05)。多因素logistic回归分析结果显示，年龄≥50岁、超重/肥胖是高血压、糖尿病患病主要危...     

Glucose and insulin concentration in amniotic fluid and in maternal blood in early and in late pregnancy

Glucose concentration in the amniotic fluid decreases towards the end of gestation, whereas the insulin concentration increases. The ratio between fetal (amniotic fluid) glucose to maternal glucose is reduced by about 50% at the end of pregnancy, whereas the ratio of C peptide is increased four times. The higher glucose concentration in amniotic fluid in early pregnancy could be explained by a lower fetal metabolic rate in the early stage of development and a low insulin activity of the fetus.     

Osteoporosis in celiac disease and in endocrine and reproductive disorders

As the increase in lifespan brings to light diseases that were previously not clinically detectable, osteoporosis has become an issue of worldwide significance. The disease is marked by a loss of bone mass; the bones become less dense, fragile and more prone to fracturing. Because it is regulated by endocrine and environmental factors, osteoporosis presents a multifactorial etiopathogenesis, with the genetic component accounting for 70% of an individual variation in bone mass density （BMD）, the principal determinant, with age, of fracture risk. Pathological conditions such as celiac disease （CD） exacerbate the process of bone loss, so that the occurrence of osteoporosis in celiac subjects is of particular note： indeed, the screening of osteoporosis patients for this disease is advisable, since it may be the only sign of undiagnosed CD. An increase in interleukin IL-1β, of the IL-1 system, in the relatives of celiac patients confirms the genetic predisposition to osteoporosis and its presence is evidence of an association between the two conditions. The direct effect on the bones of CD is secondary to poor absorption of calcium and vitamin D. In women osteoporosis is indirectly associated with early menopause and amenorrhea, and it may follow prolonged breast-feeding and frequent pregnancies, while in men it is associated with hypogonadism and GH deficit. These endocrine and non-endocrine factors exert their effects on bones by modulating the RANK/RANK-L/OPG system. An appropriate lifestyle from adolescence onwards, together with early diagnosis of and treatment for CD and primaryand secondary endocrine pathologies are important for the prevention of damage to the bones.     

Anti-malarial efficacy of pyronaridine and artesunate in combination in vitro and in vivo

Pyronaridine is a Mannich base anti-malarial with demonstrated efficacy against drug resistant Plasmodium falciparum, P. vivax, P. ovale and P. malariae. However, resistance to pyronaridine can develop quickly when it is used alone but can be considerably delayed when it is administered with artesunate in rodent malaria models. The aim of this study was to evaluate the efficacy of pyronaridine in combination with artesunate against P. falciparum in vitro and in rodent malaria models in vivo to support its clinical application. Pyronaridine showed consistently high levels of in vitro activity against a panel of six P. falciparum drug-sensitive and resistant strains (Geometric Mean IC50=2.24 nM, 95% CI=1.20-3.27). In vitro interactions between pyronaridine and artesunate showed a slight antagonistic trend, but in vivo compared to pyronaridine and artesunate administered alone, the 3:1 ratio of the combination, reduced the ED90 of artesunate by approximately 15.6-fold in a pyronaridine-resistant P. berghei line and by approximately 200-fold in an artesunate-resistant line of P. berghei. Complete cure rates were achieved with doses of the combination above or equal to 8 mg/kg per day against P. chabaudi AS. These results indicate that the combination had an enhanced effect over monotherapy and lower daily doses of artesunate could be used to obtain a curative effect. The data suggest that the combination of pyronaridine and artesunate should have potential in areas of multi-drug resistant malaria.     

Differentiation pathways in carcinogenesis and in chemo- and radioresistance

Cancer stem cells (CSCs) share many features with embryonic stem cells (ESCs) such as the ability for self-renewal and differentiation. Signaling pathways that are involved in these processes are also involved in chemo- and radioresistance (e.g. Wnt, Notch and Hedgehog pathways). This review is focused on the influence of three important differentiation pathways on carcinogenesis and on chemo- and radioresistance in ESCs and CSCs.     

Telemedicine and Advances in Urban and Rural Healthcare Delivery in Africa

Telecardiology holds great promise for Africa, from tele-echocardiography and tele-ECG s, to home monitoring and text messaging for medication adherence monitoring. The burden of disease is great and there is an extreme shortage of health professionals. Telemedicine can provide access to scarce specialist care, improve the quality of care in rural areas and reduce the need for rural patients to travel to seek medical attention. International cross border service can alleviate the shortage of doctors. But telecardiology, and telemedicine uptake in general, has been poor in Africa. Legal and ethical issues around local and cross border telemedicine have not been resolved. The literature was reviewed and obstacles to telemedicine in Africa and current telemedicine activities in Africa, are described. There are few sustained telemedicine services in Africa with the exception of tele-education. There is an expectation that mobile phones will facilitate a range of telemedicine activities in Africa. Africa needs telemedicine.