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61.
Yanhui Dong Peijin Hu Yi Song Bin Dong Zhiyong Zou Zhenghe Wang Rongbin Xu Dongmei Luo Disi Gao Bo Wen Yinghua Ma Jun Ma Xiaobo Tian Xiaona Huang George C Patton 《Lancet》2018
Background
The level and pace of mortality, and causes of death in children and adolescents might vary across regions within China. We aimed to analyse the national and subnational mortality trends, and the principal causes of deaths among Chinese children and adolescents aged 1–19 years from 1953 to 2016.Methods
Data were drawn from the Global Burden of Disease study, Chinese Population Census, and China Health Statistics Yearbooks. National mortalities from 1953 to 2016 and subnational mortalities from 1981 to 2010 were calculated on the basis of data from the Chinese Population Census and China Health Statistics Yearbooks. The causes of deaths were taken from the Global Burden of Disease data for 1990 to 2016.Findings
Mortality of Chinese children and adolescents aged 1–19 years declined steadily from 1953 to 2016, and there was a marked decline in mortality rates in children aged 1– 4 years during this period. Large subnational disparities in mortality (from all causes) existed across the 31 provinces, with higher mortality in western regions (eg, Xinjiang, Guizhou, and Yunnan). and lower mortality in eastern regions (eg, Beijing, Tianjin, and Hebei), but this gap narrowed with time from 1981 to 2010 (the period for which regional data were available). Injuries caused the highest number of deaths in children and adolescents (aged 1–19 years) each year from 1990 to 2016. Until 2016, the three factors that caused the highest numbers of deaths were road injuries (8·22 per 100?000 people), drowning (8·07 per 100?000 people), and congenital birth defects (3·22 per 100?000 people), but in 1990, they were drowning (31·21 per 100?000 people), lower respiratory infection (18·00 per 100?000 people), and road injuries (15·91 per 100 000 people). Drowning caused the most mortality in boys and in children aged 1–14 years, and road injury caused the most mortality in girls and in adolescents aged 15–19 years in 2016.Interpretation
Remarkable improvements in the mortality rates of Chinese children and adolescents were observed from 1953 to 2016. There was also a reduction in the large subnational differences in mortality rates for this group in China, nevertheless disparities were still present in 2010. Our findings emphasise the need to strengthen measures to reduce the occurrence and severity of injuries, to establish subnational health systems across the nation, and to further reduce the subnational disparity in mortality rates across the provinces of China.Funding
The study was supported by the National Natural Science Foundation to JM (81673192). 相似文献62.
Shu Chen Wenhui Mao Weixi Jiang Zhan Wang Lei Guo Xiyu Ding Guanshen Dou Shanquan Chen Di Dong John S Ji Qian Long Shenglan Tang 《Lancet》2018
Background
Despite relative affluence, Jiangsu, China, faces challenges brought by disease burdens, regional disparities, ageing, and migrant workforce, in achieving the health-related Sustainable Development Goals (SDGs) and Healthy Jiangsu 2030 goals. Therefore, we aimed to assess the current situation, gaps, and projection of Jiangsu attaining these goals.Methods
We did a systematic analysis using a combination of quantitative and qualitative methods. We collected quantitative data from national and provincial health-related government agencies and the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016). We did semi-structured interviews with key stakeholders at provincial and sub-provincial levels. We also included other policy documents and grey literatures. On the basis of the model developed by the SDG Collaborators of GBD 2016, we did projections to assess the attainment of the quantitative health targets in Jiangsu. We also explored the gender disparities. Our study protocol was reviewed and approved by the Institutional Review Board of Duke University.Findings
At baseline in 2015, Jiangsu performed well in indicators related to child under-nutrition and maternal and child health, meeting targets of the SDGs early. By 2030, Jiangsu is expected to meet targets in mental health, environmental health, and universal health coverage. However, our projections indicate that Jiangsu will not achieve the targets in exclusive breastfeeding, child overweight, infectious diseases, and non-communicable diseases, according to current trajectories. 7–28 day exclusive breastfeeding rate is expected to increase to 25·6%, a huge gap compared with the 6-month 50% target. Child overweight rate (1–4 years) was projected to increase by 2·6% compared with the zero increase target. The incidence of HIV/AIDS were projected to decrease to 0·9 per 100 000 population and tuberculosis to 15·3 per 100 000 population in 2030, suggesting that ending these epidemics would be highly improbable. New cases of hepatitis B virus and hepatitis C virus infections were projected to decrease by 45·3%, which is far from the 90% target. Large gender disparity was seen in non-communicable diseases, such as premature mortality and smoking rates.Interpretation
The provincial Government of Jiangsu needs to take immediate and concerted actions to meet the SDGs and the Healthy Jiangsu 2030 goals.63.
Background
A longer time in consultation with doctors in ambulatory care has been associated with better quality of care. Patient experience is of great concern to policy makers and is linked with health-care quality. However, the relationship between consultation length and patient experience remains unclear. We aimed to investigate the effect of consultation length on patient experience, based on analysis of a cross-sectional nationwide patient survey data in China.Methods
We obtained patient survey data from a strati?ed nationwide survey sample that covered 136 tertiary hospitals in China. Patient-estimated consultation length and associated patient experience data were collected by questionnaire after each patient attended a face-to-face consultation with a doctor. The consultation experience was rated on a 5-point scale. We applied a two-piecewise linear regression model to examine the saturation effect of the consultation length on patient experience (consultation score), using a smoothing function, while age, sex, education, and profession were adjusted in the model, then estimated the turning point that gave the maximum model likelihood by using trial and error.Findings
Between Dec 18, 2017, and Dec 30, 2017, 27?721 patients, aged 15–85 years, were eligible and selected for inclusion. The median patient-reported duration of face-to-face ambulatory care consultation was 10 min (IQR 5–12), and the mean score of the consultation experience rated by the patient was 4·25 (SD 0·83; 95% CI 4·24–4·26) on the 5-point scale. After adjusting for potential confounders including age, sex, education, and profession, there was a non-linear relationship between consultation length and measure of patient experience after smooth curve fitting. A turning point at 8 min was identified in the modelling process. Below this point, there was a higher probability of rating a consultation score above average with longer consultation length (odds ratio [OR] 1·28, 95% CI 1·26–1·30, p<0·001). After this point, the OR changed to 1·03 (95% CI 1·02–1·04, p<0·001). There was a significant difference in patient experience measure before and after this consultation length turning point (p<0·001).Interpretation
Consultation length was associated with a measure of patient experience in a non-linear pattern. Longer consultations might not be required to achieve better patient experience, but an adequate consultation should not be shorter than 8 min. Future research about the appropriateness of consultation length for varies ambulatory care institutions would be of benefit.Funding
National Natural Science Foundation of China (71532014), National Health Commission of China 相似文献64.
Background
The public hospital reform in China was launched in April 2009. Whether patients are satisfied with medical services or not is an important index to measure the effectiveness of the public hospital reform. We aimed to explore whether patients experience improved medical service under the public hospital reform.Methods
Patient-reported experience measures (PREMs) were used to evaluate medical service performance. We designed a questionnaire to collect patient-reported experiences, using a scoring method based on a scale of one to ten, with one being very poor and ten being excellent. A total of nine urban public hospitals from four provinces (Fujian, Jiangsu, Anhui, and Shanxi) were selected for a field survey in August 2016. We chose two cities as sample sites in each province; one city that had undergone reform and one that had not. In addition, we chose Maanshan city from Anhui province (which underwent public hospital reform well from 2009) as our ‘typical’ sample city. In each city, the biggest general hospital was selected to participate in the study. We ran face-to-face interviews with 2633 patients (we planned to collect data from 200 outpatients and 100 inpatients in each hospital for a sample size 15 times the number of independent variables (20) from nine hospitals. Data were collected from outpatient and emergency patients who had just completed their treatment, inpatients who were being prepared for discharge, or patients who remained in hospital for more than one week. The age of participants was from 0 to 93 (surveys for children under the age of 15 were completed by their parents or guardians), 1199 (45·5%) were male, 1434 (54·5%) were female. We explored factors that might influence performance rating using single-factor analysis of variance and correlation analysis (for example, type of medical insurance, disease diagnosis, disease type, disease severity, and the public hospital reforming policy).Findings
A total of 2633 participants (a minimum of 268 participants from each hospital) were interviewed, including 1703 outpatients (64·68%) and 930 inpatients (35·32%). Overall, the evaluation of medical services was positive. Question relating to the relationship between doctors and patients had the highest score (7·986), whereas the lowest score was given for question relating to medical service quality and effectiveness (4·917). Question relating to medical costs had a lower score (6·882). The total performance scores differed significantly by patient type, age, sex, marital status, educational level, occupation, type of medical insurance, disease diagnosis, disease type, and disease severity.Interpretation
The patient–doctor relationship seems to have improved greatly since the initiation of the public hospital reform, but patients' experience of service quality and efficiency, and medical costs remain unsatisfactory. PREMs could reflect improvements to medical services as a result of the urban public hospital reform, and the public hospital reforming policy might improve the service efficiency and medical costs.Funding
The project is funded by the National Science Foundation of China (number 71473129). 相似文献65.
Background
People with prehypertension are highly likely to develop hypertension and other cardiovascular diseases. Lifestyle modifications may prevent hypertension in patients with prehypertension, but evidence remains scarce in developing countries. This study aimed to investigate whether a community-based intervention could prevent hypertension through lifestyle modifications in people with prehypertension in the rural areas of China.Methods
A community-based quasi-experiment design was applied. Eighteen villages from six townships in Sheyang county, a rural area in eastern China, were randomly sampled. Of these local residents, patients with prehypertension—a systolic blood pressure (SBP) of 120–139 mm Hg or a diastolic blood pressure (DBP) of 80–89 mm Hg—and who were 30–60 years old were screened. Participants from three of the townships (n=206) were randomly assigned to the intervention group, and those from the other three townships (n=250) were assigned to the control group. At the outset, intervention group participants received individual consultations from a community health management team to assess their self-management ability, determine their lifestyle, set goals for a healthier lifestyle, and design individualised action plans. A guideline booklet was provided to intervention group participants, which contained detailed explanations of hypertension, prehypertension, healthy lifestyles and their impacts, and methods to lose weight, cease smoking, and deal with mental pressure. Intervention group participants also received quarterly follow-ups to assess the implementation of action plans, identify difficulties in changing unhealthy lifestyles, and find feasible solutions. In both intervention and control groups, usual care was provided to participants according to national guidelines, and the available resources were the same across the townships. Evaluations were conducted at baseline, and at the end of months 6, 12, 18, and 30. Between-group analyses were performed using repeated measures ANOVA. Written informed consent was obtained from the participants.Findings
At 30 months, 18 participants in the intervention group (n=188) showed progression to hypertension, whereas 47 in the control group (n=234) developed hypertension. This difference between intervention and control groups was statistically significant (9·6 vs 20·1%, p=0·007). Significant changes in DBP (–2·7 vs 0·7 mmHg, p<0·0001), weight (–0·79 vs ?0·66 kg, p=0·029), and daily walking steps (11?500 vs 8000 steps, p<0·0001) were observed between intervention and control groups. No differential effects were found for SBP, drinking, and smoking, with both groups showing substantial improvements.Interpretation
This intervention could prevent hypertension among patients with prehypertension by improving health-related behaviours. This study might be one of the first community-based experiments implemented among people with prehypertension in the rural areas of China. Further investigations are required to assess the sustainability of this intervention.Funding
This study was funded by the Postgraduates Innovation Project of Jiangsu Province (KYZZ15_0267). 相似文献66.
David Vivas Inmaculada Roldán Raquel Ferrandis Francisco Marín Vanessa Roldán Antonio Tello-Montoliu Juan Miguel Ruiz-Nodar Juan José Gómez-Doblas Alfonso Martín Juan Vicente Llau María José Ramos-Gallo Rafael Muñoz Juan Ignacio Arcelus Francisco Leyva Fernando Alberca Raquel Oliva Ana María Gómez Carmen Montero Andrés Íñiguez 《Revista espa?ola de cardiología》2018,71(7):553-564
During the last few years, the number of patients receiving anticoagulant and antiplatelet therapy has increased worldwide. Since this is a chronic treatment, patients receiving it can be expected to need some kind of surgery or intervention during their lifetime that may require treatment discontinuation. The decision to withdraw antithrombotic therapy depends on the patient's thrombotic risk versus hemorrhagic risk. Assessment of both factors will show the precise management of anticoagulant and antiplatelet therapy in these scenarios. The aim of this consensus document, coordinated by the Cardiovascular Thrombosis Working Group of the Spanish Society of Cardiology, and endorsed by most of the Spanish scientific societies of clinical specialities that may play a role in the patient-health care process during the perioperative or periprocedural period, is to recommend some simple and practical guidelines with a view to homogenizing daily clinical practice.Full English text available from: www.revespcardiol.org/en 相似文献
67.
Relationships between plasma sex hormones and different parameters of obesity (weight, ideal body weight [IBW], overweight, fat mass, and body surface) were investigated in 70 healthy nonobese and obese males, 20–40 yr of age and with a body weight of 85%–245% of IBW. Plasma sex hormones remained unaffected by weight up to approximately 160% of the IBW. Only in the massively obese subjects was plasma testosterone decreased to 40% of controls (from 6.2 to 2.5 ng/ml), whereas free testosterone remained almost constant. On the other hand, plasma estrone and estradiol exhibited significant increases in obese subjects, ranging from 31.5 ± 5.3 to 52.3 ± 5.8 pg/ml for estrone, and 25.4 ± 5.4 increasing to 44.7 ± 5.0 pg/ml for estradiol. Similarly, free estradiol was shown to significantly increase with obesity in men from 505 ± 118 to 991 ± 123 fg/ml (p < 0.001). The ratios of testosterone/androstenedione, as well as of estradiol/estrone, were not affected by obesity, suggesting that reduction of the 17-oxo-group of the steroids is not influenced by the amount of fat tissue. A significant (p < 0.001) correlation was found between IBW and estrone (r = 0.80) and estradiol (r = 0.75), as well as the ratios of estrone/androstenedione (r = 0.62) and estradiol/testosterone (r = 0.86). This is consistent in its evidence indicating that fat tissue may be able to aromatize androgens. In the obese subjects, there were significant correlations between plasma sex hormones (testosterone, estrone, estradiol, and free estradiol) and the parameters of obesity used. Among these, correlations were best with IBW, overweight, and fat mass (r = 0.74–0.89; p < 0.001); body weight and body surface were less favorable. 相似文献
68.
M.D. P.E. Puddu M.D. R. Jouve M.D. J. Torresani M.D. R. Sambuc M.D. A. Jouve 《Journal of electrocardiology》1980,13(4):337-340
Electrical systole duration has been studied in two groups of 23 patients (39 M and 7 F) admitted in the coronary care units of two different hospitals for documented acute myocardial infarction (AMI). The mean QT interval duration corrected for heart rate (QTc) was obtained from three measurements of non consecutive complexes in five different leads and compared to the ideal electrical systole duration of a normal population with the same cardiac cycle length. During the evolution of AMI, QT interval increased in both groups of patients (11.5% and 14.8% respectively) and was prolonged (17.6% and 21.5% respectively) at the 48th hour.Prolongation of electrical systole can be best measured using the ratio: QTc (according to Bazett)/normal QT (according to Ashman). 相似文献
69.
70.
Sleep disturbance in pain clinic patients 总被引：3，自引：0，他引：3
One hundred out-patients, referred to a multidisciplinary pain clinic for the management of chronic pain, were questioned regarding their sleeping habits and were grouped according to whether they reported 'good,' 'fair' or 'poor' sleep. All patients were administered questionnaires to measure illness behaviour, depression and anxiety. Information was also obtained regarding the site, intensity and quality of pain as well as amount of general activity. 'Good' and 'poor' sleepers were found to differ on most measures, particularly depression, pain intensity, activity levels and hypochondriasis. These findings suggest that reported sleep disturbance may provide an index of impairment and act as an indicator of psychological disturbance in chronic pain patients. 相似文献