北京市城区居民慢性病患病现状及危险因素分析

目的通过对慢性病患病现状及趋势分析 ,探讨预防对策。方法将北京城区居民 30 0 0 0 0人作为研究对象 ,通过随机抽样对 15 0 0 0人入户调查慢性病患病情况及行为危险因素等。结果 1样本人群慢性病患病率为 35 .90 % (标化率为 2 4.78% ) ,其中男性患病率为 33.6 1% ,女性为 37.92 % ,女性患病率高于男性 (P<0 .0 0 1)。 2危险因素调查显示 :人群总吸烟率为 31.6 1% ,酗酒率 11.46 % ,超重为 31.45 % ,不运动率 33.90 %。 3多因素回归分析显示 :年龄、性别、吸烟、饮酒、超重和受教育的年限等是慢性病的主要影响因素。结论北京城区居民慢性病患病率与危险因素均处于较高水平且有继续增加的趋势。慢性病预防控制策略和措施亟待加强     

整个生命过程的饮食营养和慢性病预防

世界卫生组织和联合国粮农组织联合专家咨询组《关于膳食营养与慢性病预防的报告》于2003年4月正式发表。本文介绍该报告中整个生命过程的膳食营养与慢性病的关系及预防的主要内容。     

慢性病危险因子筛检的流行病学评价

目的：探讨慢性病危险因子筛检的各项流行病学评价指标之间的关系。方法：导出慢性病危险因子筛检流行病学评价的多数数学表达式,讨论筛检参数（危险因了灵敏度、特异度、阳性预测值）、人群危险因子频率、人群患病率及危险因子致病的相对危险度之间的数学联系。结果：危险因子的灵敏度、特异度和阳性预测值是评价一项筛检试验流行病学意义的重要指标,而人群危险因子频率、其致病的相对作用大小以及人群慢性病患病率则是影响上述指     

职业司机慢性疾病发病危险因素的调查

目的探讨职业司机慢性疾病发病率的危险因素,做好健康监护,减少交通事故。方法采用余善法推荐的NIOSH职业紧张测量工具对调查对象进行测试,每一因素都按照Likert s 5点法和7点法赋分予以数量化,按照量表赋分方法计算各因素得分。随机抽查504名职业司机慢性疾病患病情况及其危险因素,将有、无慢性疾病者进行分组对照分析。结果504名职业司机中有377名曾患有慢性疾病,患病率为74.80%。其中患病率较高的有慢性胃炎,消化性溃疡最多(占26.16%),其他依次为痔疮、慢性泌尿系统疾病、高血压、慢性关节炎、椎间盘突出等。结论影响职业司机慢性疾病患病率的危险因素主要有司机的文化程度、经济状况、生活方式、医疗保障、慢性疾病家族史、从事司机作业工龄等;其次,倒班方式、发生过交通事故、司机平时危险感、紧张感以及对职业态度等也是慢性疾病发病率的危险因素。     

Chronic Diseases and Related Risk Factors among Low-Income Mothers

The aim is to describe the burden of chronic disease and related risk factors among low-income women of reproductive age. We analyzed population-based data from the 2005–2006 Pregnancy Risk Assessment Monitoring System (PRAMS) for 14,990 women with a live birth in 7 states. We examined the prevalence of selected chronic diseases and related risk factors (preexisting diabetes, gestational diabetes, chronic hypertension, pregnancy-induced hypertension, obesity, smoking or binge drinking prior to pregnancy, smoking or excessive weight gain during pregnancy, and postpartum depressive symptoms) by Federal Poverty Level (FPL) (≤100% FPL; 101–250% FPL; >250% FPL). Approximately one-third of women were low-income (≤100% FPL), one-third were near-low-income (101–250% FPL), and one-third were higher-income (>250% FPL). Compared to higher-income women, low-income women were significantly more likely to smoke before or during pregnancy (34.2% vs. 14.4%, and 24.8% vs. 5.4%, respectively), be obese (22.2% vs. 16.0%), experience postpartum depressive symptoms (23.3% vs. 7.9%), have 3 or more chronic diseases and/or related risk factors (28.1% vs. 14.4%) and be uninsured before pregnancy (48.9% vs. 4.8%). Low-income women of reproductive age experienced a higher prevalence of selected chronic diseases and related risk factors. Enhancing services for these women in publicly-funded family planning clinics may help reduce disparities in pregnancy and long-term health outcomes in the poor.     

Systematic Review of Nutrition Supplements in Chronic Kidney Diseases: A GRADE Approach

Chronic kidney disease (CKD) is cumulative worldwide and an increasing public health issue. Aside from the widely known protein restriction and medical therapy, less evident is the renal protection of nutrition supplements in CKD patients. This systematic review (SR), using a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach, aims to summarize and quantify evidence about the prevention effects of vitamin D and analogues, omega-3 polyunsaturated fatty acid (omega-3 PUFA), dietary fiber, coenzyme Q10 (CoQ10), and biotics on CKD progression. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to examine SRs and/or meta-analysis of clinical controlled trials identified from PubMed, Embase, and the Cochrane Library. Finally, seventeen SRs were included in the qualitative analysis. The beneficial effects of these nutrition supplements in CKD patients mostly seem to be at low to very low evidence on proteinuria, kidney function, and inflammations and did not appear to improve CKD prognosis. The recommendation of nutrition supplements in CKD patients needs to discuss with physicians and consider the benefits over the adverse effects. Longer follow-up of larger randomized trials is necessary to clarify the benefits of nutrition supplements in CKD patients.     

The Global Meningococcal Initiative: recommendations for reducing the global burden of meningococcal disease

The Global Meningococcal Initiative (GMI) is composed of an international group of scientists, clinicians and public health officials with expertise in meningococcal immunology, epidemiology and prevention. The primary goal of the GMI is the promotion of the global prevention of invasive meningococcal disease through education and research. The GMI members reviewed global meningococcal disease epidemiology, immunization strategies, and research needs. Over the past decade, substantial advances in meningococcal vaccine development have occurred and much has been learned about prevention from countries that have incorporated meningococcal vaccines into their immunization programs. The burden of meningococcal disease is unknown for many parts of the world because of inadequate surveillance, which severely hampers evidence-based immunization policy. As the field of meningococcal vaccine development advances, global surveillance for meningococcal disease needs to be strengthened in many regions of the world. For countries with meningococcal vaccination policies, research on vaccine effectiveness and impact, including indirect effects, is crucial for informing policy decisions. Each country needs to tailor meningococcal vaccination policy according to individual country needs and knowledge of disease burden. Innovative approaches are needed to introduce and sustain meningococcal vaccination programs in resource-poor settings with a high incidence of meningococcal disease.     

The Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases: monitoring progress in funded states

To help address the challenges posed by the obesity epidemic in the United States, the U.S. Congress authorized the Centers for Disease Control and Prevention to establish the Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases. In this article, we summarize the progress of the first 20 states funded by this program. The data presented are based on the information provided by the states in their semiannual progress monitoring reports on program activities from January through June 2004. The states have made progress in developing capacity and infrastructure for their programs, including leveraging financial resources and developing strong partnerships. In addition, they are planning and initiating environmental changes through legislation, and, although less frequently, through policies and other changes such as expanding physical activity opportunities. Collectively, the states are making progress in planning and implementing activities to prevent and control obesity and other chronic diseases.     

Nutrition agenda setting, policy formulation and implementation: lessons from the Mainstreaming Nutrition Initiative

Undernutrition is the single largest contributor to the global burden of disease and can be addressed through a number of highly efficacious interventions. Undernutrition generally has not received commensurate attention in policy agendas at global and national levels, however, and implementing these efficacious interventions at a national scale has proven difficult. This paper reports on the findings from studies in Bangladesh, Bolivia, Guatemala, Peru and Vietnam which sought to identify the challenges in the policy process and ways to overcome them, notably with respect to commitment, agenda setting, policy formulation and implementation. Data were collected through participant observation, documents and interviews. Data collection, analysis and synthesis were guided by published conceptual frameworks for understanding malnutrition, commitment, agenda setting and implementation capacities. The experiences in these countries provide several insights for future efforts: (a) high-level political attention to nutrition can be generated in a number of ways, but the generation of political commitment and system commitment requires sustained efforts from policy entrepreneurs and champions; (b) mid-level actors from ministries and external partners had great difficulty translating political windows of opportunity for nutrition into concrete operational plans, due to capacity constraints, differing professional views of undernutrition and disagreements over interventions, ownership, roles and responsibilities; and (c) the pace and quality of implementation was severely constrained in most cases by weaknesses in human and organizational capacities from national to frontline levels. These findings deepen our understanding of the factors that can influence commitment, agenda setting, policy formulation and implementation. They also confirm and extend upon the growing recognition that the heavy investment to identify efficacious nutrition interventions is unlikely to reduce the burden of undernutrition unless or until these systemic capacity constraints are addressed, with an emphasis initially on strategic and management capacities.     

The Nutrition Transition: New Trends in the Global Diet

Analyses of economic and food availability data for 1962–1994 reveal a major shift in the structure of the global diet marked by an uncoupling of the classic relationship between incomes and fat intakes. Global availability of cheap vegetable oils and fats has resulted in greatly increased fat consumption among low-income nations. Consequently, the nutrition transition now occurs at lower levels of the gross national product than previously, and is accelerated further by high urbanization rates. Data from Asian nations, where diet structure is rapidly changing, suggest that diets higher in fats and sweeteners are also more diverse and more varied. Given that preferences for palatable diets are a universal human trait, fat consumption may be governed not by physiological mechanisms but by the amount of fat available in the food supply. Whereas economic development has led to improved food security and better health, adverse health effects of the nutrition transition include growing rates of childhood obesity. The implications of these trends are explored.     

Building Global Nutrition Policies in Health Care: Insights for Tackling Malnutrition from the Academy of Nutrition and Dietetics 2019 Global Nutrition Research and Policy Forum

Around the world, the burden of malnutrition remains high despite significant efforts to thwart both undernutrition and overnutrition. The links between food security, dietary choices, and health outcomes pose a dilemma: What can nutrition policymakers and health care professionals do to harness the benefits of nutrition to improve health outcomes for young and old? The Academy of Nutrition and Dietetics gathered a group of health care policymakers, physicians, and credentialed nutrition and dietetics practitioners from around the world for a Policy and Nutrition Forum that took place on August 31, 2019 in Krakow, Poland. Participants from countries in Asia, Europe, North America, and Latin America presented on nutrition and policy from their perspective and took part in discussions about the effects of nutrition policies on health and health care. To extend the conversation about food and nutrition and to build a healthier future for people worldwide, this report highlights information from the Forum.     

慢性病与危险因素的疾病负担分析——残疾调整生命年及其意义

目前研究疾病对人群健康状况的影响都局限在某些发病率、死亡率、患病率、残疾率、潜在寿命损失年等指标，这些指标只能反映疾病对健康影响的某个方面，不能反映疾病对人群健康总的影响。20世纪80年代后期和90年代提出了一个新的指标——残疾调整生命年或健康生命损失年（Disability Adjusted Life Year，DALY）解决了这个问题。DALY是对人群健康总的测量指标，它考虑了早死对寿命的影响，也考虑了疾病持续时间和残疾对健康寿命损失的影响。但国内在实际工作和研究中应用DALY的还很少。经过众多专家多年研究，WHO在其2002年世界卫生报告中首次应用DALY全面系统地分析了2000年全球疾病负担和主要危险因素，这是一次里程碑式的报告。     

慢性病自我管理

慢性病已成为我国多数地区的主要健康问题。随着我国人口老龄化的加剧 ,慢性病患病的绝对数和相对数都将日益显著增加 〔1〕。由于传统的医疗保健系统和医疗保健服务在解决通常都是由于病人的行为和环境的因素作用所致的慢性病问题时 ,作用有限、且费用昂贵 ;又由于慢性病人的预防性干预和卫生保健活动通常都必须长期在社区和家里执行 〔2〕。因此 ,病人及其家庭将不可避免地成为预防和管理慢性病的主要责任承担者——成为慢性病的自我管理者。由于他们大都缺乏进行自我管理所需的技能 ,所以 ,通过健康教育项目提高慢性病患者及其家庭的自我…