踝臂指数与心血管疾病

踝臂指数是指踝部动脉收缩压和肱动脉收缩压的比值。已经证实踝臂指数是诊断外周动脉疾病,评估其预后的简单有效的方法,同时其异常也反映了冠状动脉病变程度,是心、脑血管事件和死亡风险强有力的预测因子,应作为心血管疾病危险人群风险评估的重要组成部分。现就踝臂指数及其在心血管领域的主要研究进展做一综述。     

Years of good life is a well-being indicator designed to serve research on sustainability

Sustainable development (SD) as popularized by the Brundtland Commission and politically enshrined in the Sustainable Development Goals has been the explicit focus of sustainability science. While there is broad agreement that the trend of human well-being (W) over time should serve as a sustainability criterion, the literature so far has mostly addressed this in terms of its determinants rather than focusing on W itself. There is broad agreement that an indicator for W should have multiple constituents, clearly going beyond gross domestic product. Here, we propose a tailor-made indicator to serve precisely this purpose following a set of specified desiderata, including its applicability to flexibly defined subnational populations by gender, place of residence, ethnicity, and other relevant characteristics. The indicator, years of good life (YoGL), reflects the evident fact that in order to be able to enjoy any quality of life, one has to be alive and thus is primarily based on life expectancy. However, since mere survival is not considered good enough, life years are counted conditional on meeting minimum standards in two dimensions: the objective dimension of capable longevity (consisting of being out of absolute poverty and enjoying minimal levels of physical and cognitive health) and the subjective dimension of overall life satisfaction. We illustrate the calculation of this indicator for countries and subpopulations at different stages of development and with different degrees of data availability.

Sustainability science refers to the most comprehensive scholarly effort to understand the interactions between natural and social systems in order to assess whether certain developmental pathways can be considered sustainable. This should also include the possible negative effects of environmental changes, such as climate change and biodiversity loss, on future human well-being. In this paper, we propose a tailor-made indicator to assess long-term human well-being as the ultimate end of sustainable development. This indicator, called “years of good life” (YoGL), is designed in such a way that it can be both empirically measured—which is the focus of this paper—and modeled in its long-term future trends—which will be the focus of future work.When assessing changes over time in the well-being of certain human populations (or subpopulations, as defined, e.g., by gender, ethnicity, urban/rural place of residence, or other social groupings), one can focus on the determinants or the constituents of well-being. In sustainability science, thus far, empirical and theoretical research has placed more emphasis on studying the determinants, including environmental services (1), whereas specifying its constituents has received less systematic attention, often leaving us with nothing but the unspecific notion of “utility.” The focus on determinants has led to the concept of “inclusive wealth” (IW) which can be used to assess whether a society is on a sustainable development trajectory in terms of the productive base necessary to maintain a high standard of living in the future (2). However, empirically measuring the values and relative effects of the different capitals determining human well-being remains extremely challenging and “no current attempt to date can be said to be fully inclusive” (3).The idea behind YoGL, on the other hand, is to study sustainability by focusing explicitly on the constituents of well-being and its change over time. In doing so, YoGL avoids several of the pitfalls by which the IW approach is plagued (3, 4). For example, rather than making contestable quantitative assessments of the relative contributions of the different determinants of well-being, the demographic approach underlying YoGL provides numerical values of human well-being directly, expressed as the average number of years of good life a person can expect to live as part of a given subpopulation under the conditions of a specified point in time. Based on the assumed universal nature of its unit of measurement—YoGL lived today in one specific population has the same meaning as YoGL lived in the future or in another population—the indicator has a time-independent meaning. This also avoids the pitfalls of specifying a rate at which to discount future well-being, which have become apparent at least since the debates around the Stern report (5). YoGL allows us to directly compare human well-being across different subpopulations and generations. Moreover, while all estimates of the different determinants of future human well-being are highly sensitive to population growth, as a measure referring to per-person well-being the derivation of YoGL is not directly affected by assumptions about the future trajectory of population size. Finally, as stressed by Dasgupta (6), the nature of determinants can change over time and across places depending on different commodities and technological regimes, whereas the constituents of well-being—as used in YoGL—are arguably shared across space and time.In the following, we will first present the proposed design of the indicator. We will then provide a step-by-step user’s guide for empirically deriving YoGL based on the most appropriate available data source, before offering examples of how it can be calculated based on auxiliary information on populations for which the necessary data are not yet fully available. We will close with a discussion and brief outlook as to what is still needed to use this indicator for the assessment of sustainability.     

应用Delphi法构建“健康食堂”评价指标体系

[目的]探讨建立健康食堂评价指标体系,为开展健康食堂评定工作提供科学依据。[方法]选择32名专家进行两轮Delphi专家咨询,根据指标重要性赋值得分,确定健康食堂的评价指标及其权重。[结果]32名咨询专家的平均工龄为（18．41±8．03）年,两轮的应答率均为100％,权威系数分别为0．85±0．06、0．88±0．06,Kendall协调系数分别为0．708（χ^2=675．773,P〈0．01）、0．853（χ^2=818．902,P〈0．01）,经卡方检验均具有统计学意义;确定了健康食堂评价一级指标6项、二级指标25项,以及各项指标的权重,其中一级指标健全的组织管理、健康的环境、健康的膳食、健康的膳食服务和指导、健康的膳食安全保障、科学的效果评估的平均权重分别为1．55、1．56、2．05、1．91、1．08、1．86。[结论]Delphi专家咨询法是构建健康食堂评价指标体系的有效方法。     

基层医疗机构基本药物制度实施效果评价研究综述

回顾了国内外基本药物制度实施及评价方面的研究,简述了基本药物制度的产生与发展,对目前国内外基本药物制度实施的现状、相关评估方法和指标体系进行综述,分析了国内基本药物制度实施及评价中存在的问题并提出改进的思路。     

C-reactive protein for simple prediction of mortality in patients with acute non-variceal upper gastrointestinal bleeding: A retrospective analysis

In upper gastrointestinal bleeding (UGIB), scoring systems using multiple variables were developed to predict patient outcomes. We evaluated serum C-reactive protein (CRP) for simple prediction of patient mortality after acute non-variceal UGIB.The associated factors for 30-day mortality was investigated by regression analysis in patients with acute non-variceal UGIB (N = 1232). The area under the receiver operating characteristics (AUROC) curve was analyzed with serum CRP in these patients and a prospective cohort (N = 435). The discriminant validity of serum CRP was compared to other prognostic scoring systems by means of AUROC curve analysis.Serum CRP was significantly higher in the expired than survived patients (median, 4.53 vs 0.49; P < .001). The odds ratio of serum CRP was 4.18 (2.10–9.27) in multivariate analysis. The odds ratio of high serum CRP was higher than Rockall score (4.15 vs 1.29), AIMS65 (3.55 vs 1.71) and Glasgow-Blatchford score (4.32 vs 1.08) in multivariate analyses. The AUROC of serum CRP at bleeding was 0.78 for 30-day mortality (P < .001). In the validation set, serum CRP was also significantly higher in the expired than survived patients, of which AUROC was 0.73 (P < .001). In predicting 30-day mortality, the AUROC with serum CRP was not inferior to that of other scoring systems.Serum CRP at bleeding can be simply used to identify the patients with high mortality after acute non-variceal UGIB.     

Overbite depth indicator and anteroposterior dysplasia indicator cephalometric norms for African Americans

Objectives:To examine normal Overbite Depth Indicator (ODI) and Anteroposterior Dysplasia Indicator (APDI) values in African Americans and to compare them with mean values from white patients. Secondary aims were to compare mean ODI and APDI values among different age, gender, and combined age-gender groups in African American patients.Materials and Methods:Lateral cephalometric radiographs of 160 African American patients (97 boys and 63 girls; age, 7 to 14 years) with normal occlusion and no history of orthodontic treatment were collected from the Bolton-Brush Growth Center. Cephalometric images were hand traced, and ODI and APDI values were assessed. Two-sample t tests were used to compare mean ODI and APDI values between African American and white patients; and between male and female African American patients. One-way analysis of variance, followed by the Tukey test, was used to compare mean ODI and APDI values among different African American age and combined age-gender groups.Results:Mean ODI and APDI values were significantly lower (P < .0001) in African American than white patients with normal occlusion and no history of orthodontic treatment. Mean ODI and APDI values increased with age in African American patients, and there were no significant gender differences.Conclusions:The mean ODI and APDI values in 7- to 14-year-old African Americans with normal occlusion and no history of orthodontic treatment were 70.9° and 78.1°, respectively, and were significantly lower than the mean values for white patients in the same age range.     

不同年龄、性别新疆锡伯族、哈萨克族成人血清生化指标比较

目的 探讨新疆锡伯族和哈萨克族人群血清生化指标随年龄及性别的变化规律及其差异,为相关疾病的预防提供依据。 方法 随机选择新疆维吾尔自治区某医院正常体检的新疆锡伯族和哈萨克族健康成人511人,其中新疆锡伯族252人,哈萨克族259人。使用美国Beckman生产的CX-7自动生化分析仪对血清生化指标进行检测,采用方差分析、t 检验、相关性分析和 χ2 检验进行统计学分析。结果 新疆锡伯族和哈萨克族血清生化指标男性和女性谷丙转氨酶（GPT）、直接胆红素（DBil）、肌酐（Cre）、尿素(Ure)、尿酸(UA)、血糖(Glu)、总胆红素（TBil）、胱抑素C(Cys-C)均随年龄增长而增加,同性别各年龄组间差异均有统计学意义（Ｐ<0.05）,同年龄段男性高于女性（Ｐ<0.05）;高密度脂蛋白（HDL）随年龄增长逐渐降低,低密度脂蛋白（LDL）、甘油三酯(TG)、总胆固醇(TC)随年龄增长逐渐增高,同性别各年龄段之间差异有统计学意义（Ｐ<0.05）;TG、TC 和 LDL 在50岁以前各年龄组女性低于男性,HDL 女性高于男性（Ｐ<0.05）,50岁以后无差异（Ｐ>0.05）。同性别同年龄段新疆锡伯族和哈萨克族的Glu、TG、TC、LDL和 HDL 差异有统计学意义（Ｐ<0.05）。结论 不同年龄、不同性别新疆锡伯族和哈萨克族血清生化指标有差异;新疆锡伯族Glu、血脂水平与哈萨克族存在差异。     

城市无障碍设施(盲道)应用状况的调查及分析

文题释义： 无障碍设施：以提高残障人士的社会生活质量,确保有需求的人能够安全地、方便地使用为目的的各种设施。 盲道：在人行道上或其他场所铺设的一种固定形态的地面砖,视障者可产生盲杖触觉及脚感,引导视障者前行和辨别方向的通道。 背景：国内城市无障碍设施不完善,但是视障者对无障碍设施的需求较为急迫。 目的：通过调研石家庄城市无障碍设施(以盲道为例)的应用状况,以了解民众对于城市无障碍设施的认知、存在问题,并提出针对性改善建议。 方法：以问卷调查方式,在河北省石家庄市随机抽选118名普通市民和51名环卫工人,进行盲道认知情况调查,同时对60名视障者进行盲道使用情况调查。 结果与结论：多数市民、环卫工人和视障者对盲道有一定了解,但民众对盲道的知晓率依然较低,仍有7%的普通市民和18%的环卫工人对盲道完全不了解;视障者出行率极低,仅38%的视障者可经常出行;50%以上市民和视障者认为盲道没有起到实际作用,仅19%的市民对盲道的监管、维护、保养工作较满意率,56%的视障者认为盲道没有实际作用,42%的视障者表示其出行范围多以家为中在1 km以内。提示民众知晓率低、盲道利用率低,建议从加强宣传与培训、对视障者行康复训练、加强建设与维护三方面着手,才能更好地保障残疾人生存权益,促进其回归社会,提高其生活质量。 ORCID: 0000-0002-3784-3867(苟波) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

多项血液指标对慢性阻塞性肺疾病长期死亡率的预测价值

目的探讨C反应蛋白(CRP)、中性粒细胞、嗜酸性粒细胞、中性粒细胞/淋巴细胞比值(NRL)、胆碱脂酶、白蛋白(Alb)和维生素D与慢性阻塞性肺疾病(COPD)患者长期死亡率的相关性。方法选取2015年1月-2017年1月广东省罗定市人民医院COPD患者120例,并对其开展为期24个月的随访,统计患者长期死亡率。根据结果将研究对象分为长期死亡组(17例)和存活组(89例)。比较2个组CRP、中性粒细胞、嗜酸性粒细胞、NRL、胆碱脂酶、Alb和25-羟基维生素D[25(OH)D](维生素D)水平。采用Logistic分析评价COPD患者各血液指标与长期死亡率的相关性。采用受试者工作特征(ROC)曲线分析各血液指标对COPD患者长期死亡率的预测价值。结果长期死亡组CRP、中性粒细胞、嗜酸性粒细胞水平及NRL均显著高于存活组(P<0.05),胆碱酯酶、25(OH)D、Alb水平显著低于存活组(P<0.05)。CRP、中性粒细胞、嗜酸性粒细胞、NRL、胆碱脂酶、25(OH)D和Alb均可作为预测COPD患者长期死亡率的独立危险因素,比值比分别为1.23、0.99、1.45、2.75、1.30、1.08、0.59(P<0.05)。CRP、中性粒细胞、嗜酸性粒细胞、NRL、胆碱脂酶、25(OH)D和Alb的敏感性与特异性比较差异均无统计学意义(P>0.05),NRL的曲线下面积(AUC)显著大于其他血液指标(P<0.05)。结论 CRP、中性粒细胞、嗜酸性粒细胞、NRL、胆碱脂酶、Alb和25(OH)D对COPD患者长期死亡率预测均有积极意义,其中NRL的预测价值较为显著。