浙江省主要恶性肿瘤失能权重评定

目的评定浙江省恶性肿瘤疾病的失能权重。方法以全球疾病负担研究中疾病失能权重7级分类标准及22个指示症状为依据，采用德尔菲法，选择10名肿瘤临床专家和18名公共卫生专家，通过自制的专家咨询表评定浙江省恶性肿瘤疾病失能权重的最小值和最大值。结果专家咨询表回收率100％，13种恶性肿瘤的疾病失能权重最小值的均数为0．19～0．36，最大值的均数为0．70～0．90。结论13种恶性肿瘤疾病失能权重的评定结果与世界银行全球疾病负担（GBD）研究及荷兰的数据有一定差异。     

浙江省主要神经精神及相关疾病失能权重的评定

目的：评定浙江省神经精神及相关疾病的失能权重。方法：以全球疾病负担研究中疾病失能权重7级分类标准及22个指标症状为依据,采用德尔菲法,选择10名肿瘤临床专家和18名公共卫生专家,通过自制的专家咨询表评定浙江省神经精神及相关疾病的失能权重的最小值和最大值。结果：专家咨询表回收率100%,8种神经精神及相关疾病失能权重最小值的均数为0．102～0．618,最大值的均数为0．311～0．932。结论：对8种神经精神及相关疾病失能权重的评定结果与荷兰等国的研究数据有一定的差异。     

浙江省主要传染病失能权重的评定

目的评定浙江省主要传染病的失能权重。方法以全球疾病负担研究中疾病失能权重7级分类标准及22个指标症状为依据，采用德尔菲法，选择10名传染病临床专家和18名公共卫生专家，通过自制的专家咨询表评定浙江省主要传染病的疾病失能权重的最小值和最大值。结果专家咨询表回收率100％，6种主要传染病的疾病失能权重最小值的均数为0．048～0．295，最大值的均数为0．300～0．950。结论对6种主要传染病的疾病失能权重的评定结果与澳大利亚疾病负担研究结果有一定的差异。     

长期照护失能等级评估量表的指标权重分析

目的:确立长期照护保险中关于失能等级评估量表的指标体系权重。方法:在德尔菲法构建的失能等级评估量表指标体系基础上,应用层次分析法对该量表的各指标进行重要性评价并测算其权重。结果:失能等级评估量表4项一级指标的权重分别为感知觉0.2408、日常生活能力0.5899、认知能力0.1204、情绪行为0.0489;并同时测算出22项二级指标的权重。结论:指标权重的确定进一步完善了失能等级评估体系,为长期照护保险制度的发展提供借鉴与参考。     

北京市失能老年人失能等级对非正式照护成本的影响研究

目的：以北京市失能老年人为研究对象,分析失能老年人失能等级对非正式照护成本的影响。方法：使用中国老年健康影响因素跟踪调查（Chinese Longitudinal Healthy Longevity Survey,CLHLS） 2005年、2008年、2011年、2014年、2018年5期调查数据,探究失能老年人失能等级对非正式照护的支出和时间的影响。结果：失能等级对非正式照护成本具有显著影响,老年人失能等级越高,其接受的非正式照护的支出和时间越多;子女和其他亲属与失能老年人的配偶在非正式照护时间的提供上具有一定的替代性;相较于与家人居住的老年人,独居老年人接受的非正式照护的时间明显降低。结论：建议加强对子女等非正式照护者的照护技能培训,提升非正式照护质量,同时积极探索多种形式的照护方式,例如推进正式照护以满足不同失能老年人的照护需求。     

杭州市和富阳县6种病失能寿命损失年（YLD）估算的探索

目的：探索失能寿命损失年（YLD）及权重的估算方法。方法：采用不同标准对6种疾病的失能权重进行了评估,并估算其失能寿命损失年（YLD）。结果：肺癌和精神分裂症评估得到的权重与世界银行的权重差异明显,肺结核和脑卒中判差别不明显,车祸和白内障的权重与世办银行的权重之间无可比性,结论：此次调查结果,无法判断在国内使用六级失能等级标准和七级失能等级标准的明显不同,为中国开展相应类型的研究提供了有价值的信息。     

三种ADL量表在我国中老年人失能评定中的应用比较——基于CHARLS 2018的数据分析

目的 比较KATZ指数量表、PSMS量表、IADL量表三种失能评定标准对中老年人失能状况评定结果的差异.方法 选择2018年中国健康与养老追踪调查数据中12515名中老年人,分别使用KATZ指数量表、PSMS量表、IADL量表进行失能状况评估,并采用Kappa检验分析三种ADL量表的一致性.结果 KATZ指数量表、PS...     

疾病负担研究--失能调整寿命年指标的应用

目前,全球受到传染病和非传染病的双重威胁,为了对不同疾病的危害进行综合的评价,以达到公平、合理、有效地分配有限卫生资源,确定优先发展的卫生领域及优先解决的卫生问题,世界卫生组织及各国政府正致力于疾病负担的研究。该文主要对疾病负担研究中失能调整寿命年(DALY)的引入、构成和国内外研究现状进行综述,虽然DALY较全面地综合了疾病、伤残、死亡对人的影响,但一个真正的疾病负担应包括患者周围支持环境的负担情况,它的一些参数仍存在技术缺陷,还需要对DALY进一步完善。     

衰老还是疾病——老年性痴呆的误区

您也许认为在日常生活中的健忘或变得唠叨不停是衰老的表现。然而,有时候不断加重的记忆减退却是痴呆的早期信号。衰老并不引起记忆障碍,因此当记忆丧失影响到日常生活的时候,应该及时寻求医生的帮助。除认知功能下降外,痴呆的其他常见症状包括日常生活     

用失能调整寿命年指标测量呈多分支发展的疾病

在衡量慢性疾病后期效应的疾病负担时，首先要弄清楚疾病的发展过程。通常慢性疾病的发展过程呈多分支性，比如感染乙型肝炎病毒后有可能发展成急性肝炎、慢性携带者或隐性感染者，而不同的分支又有各自的发展模式。目前，国际上有许多研究者采用失能调整寿命年（DALYS）指标衡量疾病负担，这一指标的设计只是针对单一疾病，为能综合衡量多分支疾病的疾病负担，必须使疾病发展的各分支疾病负担具有可加性，为此有必要对DALYs指标的计算公式进行适当的改进。一、方法1．DALYs公式：1994年，世界银行和哈佛大学联合推出DALYs来衡量疾病…     

A 6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects

OBJECTIVE: Weight loss is a common occurrence in Alzheimer's disease (AD). This study was undertaken to investigate the relationship between weight loss and behavioral symptoms in institutionalized AD subjects. DESIGN: Observational study. SETTING: Two facilities that included assisted living and nursing care. PARTICIPANTS: Residents with probable or possible AD (n = 32). MEASUREMENTS: Weight was measured monthly. At baseline, month 3, and month 6, a knowledgeable staff member provided information that included the Neuropsychiatric Inventory: Nursing Home Version (NPI-NH, ie, a measure of behavioral symptoms) and a questionnaire regarding eating habits, food intake, and appetite. Two-day calorie counts were done and accelerometers were worn to monitor physical activity. RESULTS: At baseline, the mean body mass index (BMI) was 24.0 (standard deviation, 3.5) with 12 subjects exhibiting a BMI <22. BMI was negatively associated with the baseline NPI-NH total score (Spearman Correlation Coefficient -0.52, P <0.01), which indicates that subjects with low BMIs were more likely to have higher frequency and severity of behavioral problems. Individual behavior scores for agitation/aggression (-0.40, P <0.05), depression (-0.31, P = 0.08), irritability/lability (-0.47, P <0.01), aberrant motor behavior (ie, pacing, -0.42, P <0.05), nighttime behavior (-0.37, P = 0.05), and appetite/eating (-0.48, P <0.01) at baseline were negatively correlated with baseline BMI. Behaviors not correlated with BMI were delusions, hallucinations, elation, apathy, and disinhibition. Although this was a small sample followed for a relatively short time period, change in specific NPI-NH scores from baseline to month 6 were correlated with the change in weight over the 6-month period. Both agitation/aggression (-0.37, P = 0.05) and disinhibition (-0.45, P <0.05) showed negative correlation with weight change, which indicates an association between changes in these behaviors and weight loss. There were no significant differences between those who lost weight (n = 13) and those who did not (n = 19) on baseline variables, which included age, comorbidity, functional status, and NPI-NH. However, those who lost weight had a significantly higher BMI at baseline than those who gained weight. CONCLUSIONS: These preliminary results suggest that behavioral disturbances play a role in low body weight and weight loss in AD subjects.     

阿尔茨海默病与家族史病例对照研究

目的：探讨家族史和阿尔茨海默病（AD）的关系。方法：采用以人群为基础的病例对照研究设计，病例组为127例临床诊断为AD的病例，并以1；2配对，以年龄、性别、受教育 程度为匹配条件的254名非痴可者作为对照，通过单因素分析和条件logistc回归分析，估计AD与家族史之间的联系强度。结果：一级亲属有痴呆病史或重性精神病史者，患AD危险性显著高于对照人群（OR值分别为6．25和8．33，P＜0．01）。调整混杂因子的影响后，一级亲属的痴呆家族史和AD的发生仍有显著联系（调整后OR＝2．07，P＝0．018）。结论：AD可能存在家族史聚集性。     

帕金森病的营养支持

疾病自身的原因与抗帕金森病(PD)药物的副作用共同导致了PD的营养问题。PD的营养问题应采取预防为主,治疗为辅的策略进行处理。同时,PD患者的饮食应遵循个体化原则,立足于补充总热量,合理搭配膳食。     

Parkinson's disease without expected neuropathologic abnormality

A case is reported of an initially 78-year-old man whose presentation and course, closely followed over 10 years by an academic neurologist, were consistent with classic idiopathic Parkinson's disease (PD), including unilateral onset, obvious cogwheeling, and a very good prolonged response to levodopa/carbidopa (LD/CD). Yet at autopsy, there was no neuronal loss in the substantia nigra nor were there any Lewy bodies or immunochemical evidence of alpha synuclein in the multiple brain structures studied. This case does not support the hypothesis that the use of LD/CD is toxic to the substantia nigra in people. This patient had been on traditional doses of LD/CD for approximately 10 years, yet the number of cells in the substantia nigra was well within the normal range at autopsy. These findings are not unique, but point out the need to explain the occurrence of typical PD symptoms and course in the absence of any PD-related neuropathologic changes.     

Differentiating between lewy body dementia and Alzheimer's disease: a retrospective brain bank study

Recent research has shown that while Lewy body dementia. (LBD) may be the second most common form of dementia, it is difficult to confirm the disease before autopsy. Patients with LBD share many clinical signs and symptoms with patients diagnosed with Alzheimer's disease (AD), making it difficult to differentiate between the two diseases in patients who are still living. Still, our purpose in this study was to determine any clinical features which may differentiate between autopsy-confirmed cases of AD and cases of LBD. We compared 13 patients with autopsy-confirmed AD with 12 patients who had autopsy-confirmed LBD. Phone calls were made to family members of the deceased to help clarify and add any other information not documented in the patient's files. Significant differences were found in three areas, and trends approaching statistical significance were found in two other areas. Visual hallucinations were more prominent in the patients with LBD than in the patients with AD (10/12 LBD vs. 4/13 AD, P < 0.05). A nonspecific tremor was also found more often in the LB patients than in the Alzheimer's patients (8/12 LBD vs. 3/13 AD, P < 0.05). Finally, the LB patients were more prone to wandering, especially earlier in the disease course than were the patients with AD (10/12 LBD vs. 6/13 AD, P < 0.5). There was also a trend within the LB patients for higher use of anxiolytics (9/12 LBD vs. 6/13 AD, P = 0.14) as well as antidepressants (7/12 LBD vs. 4/13 AD, P = 0.16). Our data confirmed our hypothesis that LBD from a clinical perspective is indeed similar to AD. However, the higher incidence of visual hallucinations, tremor and wandering as well as the trend toward the use of anxiolytics and antidepressants among LB patients was noted. This gives hope that a clinical differentiation between these two diseases and more specific treatments may be possible in the future.     

Integration of chronic disease and disability and health state programs in Montana

This paper describes the strategies used in one state, Montana, to improve the health of individuals at risk for or living with chronic conditions associated with disability. These strategies demonstrate capacity to intervene at individual and environmental levels, and reveal opportunities for public health professionals to collaborate with independent living and long term care partners. In this paper we attempt to outline some of the challenges inherent in these collaborations and suggest strategies to overcome them.     

阿尔茨海默病与维生素B12及同型半胱氨酸的相关性

目的研究阿尔茨海默病(AD)与血清维生素B12、叶酸及血浆同型半胱氨酸水平之间的关系。方法采用简易精神状态量表(MMSE)对30例AD患者和30例同龄健康人进行评分,并用放射免疫分析法测定血清维生素B12及叶酸水平;用荧光偏振免疫法测定血浆同型半胱氨酸。结果AD组维生素B12水平为(217.3±134.2)pmol/L明显低于对照组(313.6±184.7)pmol/L,两者差异有极显著性(P<0.001)。AD组血浆同型半胱氨酸为(18.9±6.8)μmol/L高于对照组(9.4±4.1)μmol/L,差异有极显著性(P<0.001)。AD组叶酸水平为(29.2±12.7)nmol/L低于对照组(37.2±21.2)nmol/L,但差异无显著性(P>0.05)。AD患者血清维生素B12水平与MMSE得分呈正相关(r=0.87,P<0.01)。结论AD患者血浆维生素B12水平与智能障碍及其程度有关。     

Systematic Assessment of Decision Models in Parkinson''s Disease

OBJECTIVE: To give an insight into the structural and methodological approaches used in published decision-analytic models evaluating interventions in Parkinson's disease (PD) and to derive recommendations for future comprehensive PD decision models. METHODS: A systematic literature review was performed to identify studies that evaluated PD interventions using mathematical decision models. Using a standardized assessment form, information on the study design, methodological framework, and data sources was extracted from each publication and systematically reported. Strengths and limitations were assessed. RESULTS: We identified eight studies that used mathematical models to evaluate different pharmaceutical (n=7) and surgical (n=1) treatment options in PD. All models included economic evaluations. Modeling approaches comprised mathematical equations, decision trees, and Markov models with a time horizon ranging from 5 years to lifetime. All based progression on the evolution of clinical surrogate endpoints. Treatment effects were either modeled via reduction of symptomatic progression and/or initial symptomatic improvement or via reduction of adverse effect rates. No model is currently available that encompasses both the underlying biologic disease progression and the spectrum of all relevant complications and also links them to patient preferences and economic outcomes. CONCLUSIONS: Models have been successfully applied to evaluate PD treatments. However, currently available models have substantial limitations. We recommend that a comprehensive, generic, and flexible decision model for PD that can be applied to different treatment strategies should consider a large spectrum of clinically relevant outcomes and complications of the disease during a sufficiently long time horizon, include PD-specific mortality, systematically evaluate uncertainty including heterogeneity effects, and should be validated by independent data or other models. Approaches to model treatment effects included reduction of symptomatic progression, initial symptomatic improvement, or reduction of adverse effects. We believe that structural bias could be avoided if underlying disease progression and treatment effects on symptoms are modeled separately.     

北京市丰台区阿尔茨海默病患病现状分析

目的 了解北京市丰台区阿尔茨海默病（AD）患病现状,分析其影响因素,为制定健康管理政策提供科学依据。方法 采用方便抽样方法抽取北京市丰台区≥60岁常住居民进行AD患病及相关因素调查,采用简易智能精神状态检查量表（MMSE）对调查对象进行初筛,阳性者由精神科医师按诊断标准确诊。采用描述流行病学方法进行分析,并采用单、多因素分析方法对AD患病影响因素进行分析。结果 本研究调查丰台区≥60岁人群5 901人,年龄60~92岁,以70~79岁为主,占39.3%,男女性别比为0.96∶1。检出AD 者319 例,患病率为 5.41%。二分类Logistic回归分析结果显示,年龄增大（OR=2.284）、未婚/丧偶/离异（OR=2.487）、内向性格（OR=2.298）、过量饮酒（OR=12.820）、社会支持水平低（OR=1.514）、血脂异常（OR=2.512）均为老年AD的危险因素;有兴趣爱好（OR=0.299）、经常参加体育锻炼（OR=0.045）均为老年AD的保护因素。结论 北京市丰台区老年人AD患病率较高,且随着年龄增大患病率升高,危险因素较多,应引起相关部门重视。