上海市空气污染造成人群健康经济损失的研究

文章通过对上海市空气污染季节性状况的描述 ,分析了各种污染物的污染程度和变化趋势 ,并利用对上海某市级医院的实地调查数据 ,对空气污染物与医院呼吸系统疾病患者日门诊量之间的相关关系进行研讨 ,建立了多元分析模型 ,探讨了患者健康经济损失的计量方法 ,并对由空气污染造成呼吸系统疾病患者健康经济损失进行了估算。研究表明 ,在其他条件不变的情况下 ,NOX 日指数每增长 10 % ,被调查医院呼吸系统疾病患者的日门诊人次增加 7 7人次 ,而这些疾病患者由于患病产生的年度健康经济损失为 2 11万元。据此作保守的推断估计 ,上海市一年内因NOX 超标而发生的呼吸系统疾病门诊行为造成的健康经济损失可以达到 4 2亿元。同样 ,SO2 和TSP造成门诊患者的健康经济损失分别为 1 5亿元和 0 86亿元     

Finite mixture models with concomitant information: assessing diagnostic criteria for diabetes

The World Health Organization (WHO) diagnostic criteria for diabetes mellitus were determined in part by evidence that in some populations the plasma glucose level 2 h after an oral glucose load is a mixture of two distinct distributions. We present a finite mixture model that allows the two component densities to be generalized linear models and the mixture probability to be a logistic regression model. The model allows us to estimate the prevalence of diabetes and sensitivity and specificity of the diagnostic criteria as a function of covariates and to estimate them in the absence of an external standard. Sensitivity is the probability that a test indicates disease conditionally on disease being present. Specificity is the probability that a test indicates no disease conditionally on no disease being present. We obtained maximum likelihood estimates via the EM algorithm and derived the standard errors from the information matrix and by the bootstrap. In the application to data from the diabetes in Egypt project a two-component mixture model fits well and the two components are interpreted as normal and diabetes. The means and variances are similar to results found in other populations. The minimum misclassification cutpoints decrease with age, are lower in urban areas and are higher in rural areas than the 200 mg dl^-1 cutpoint recommended by the WHO. These differences are modest and our results generally support the WHO criterion. Our methods allow the direct inclusion of concomitant data whereas past analyses were based on partitioning the data.     

Examining Outpatient Health Care Utilization Among Adults with Severe or Profound Intellectual Disabilities Living in an Urban Setting

Abstract

The present study examined the health status and outpatient health care utilization among 52 adults with severe or profound intellectual disabilities (IDs) living with their families or in group homes in New York City. Bivariate and regression analyses among demographic variables, medical conditions, health care utilization, and type of living situation were conducted. Findings indicate that demographic factors andhealth statuses were similar regardless of living situation, except for ageand the presence of Down Syndrome, that is, younger people and people with Down Syndrome were more likely to live with family than in group homes. The results indicated that regardless of where they lived, individuals had high rates (70%) of overweight/obesity. The mean number of internal medicine, specialty medicine, nursing, and total clinic visits were significantly higher for those living in group homes compared to those living with their families. The findings and their implications are discussed with respect to social work policy and practice.     

多渠道医疗门诊挂号的时间策略研究

现阶段多种门诊挂号方式并存时,根据患者特性制定不同的等待时间策略尤为重要。本文考虑门诊挂号的三种渠道：直接排队挂号渠道、电话预约挂号渠道与O2O预约挂号渠道。在价格外生前提下,综合考虑患者的渠道偏好程度、时间敏感性与提前支付敏感性,基于效用理论构建患者的渠道选择模型。根据该模型推导得出不同市场条件下医院的需求,医院再据此制定患者的等待时间策略以达到利润最大化的目的。研究发现：当医院仅开通单一挂号渠道时,若患者的时间敏感度越大、渠道偏好程度越小,等待时间均越小;开通某两种挂号渠道时,还需考虑患者对两种渠道的偏好比例,偏好某种渠道的患者比例增加,选择该渠道的患者等待时间增加,选择另一渠道的患者等待时间减小;同时开通三种渠道时,最偏好某渠道的患者比例越大,选择该渠道的患者的等待时间也越大;在所有情况下,患者对提前支付的敏感度均不影响最优等待时间的制定。     

The impact of testosterone replacement therapy on glycemic control,vascular function,and components of the metabolic syndrome in obese hypogonadal men with type 2 diabetes

Objective: This study set out to assess effects of testosterone replacement therapy (TRT) on parameters of metabolic syndrome and vascular function in obese hypogonadal males with type 2 diabetes mellitus (DM2).

Study design: Fifty-five obese hypogonadal diabetic males on oral hypoglycemic treatment were enrolled into this one-year, double-blind, randomized, placebo-controlled clinical study. Group T (n?=?28) was treated with testosterone undecanoate (1000?mg i.m. every 10?weeks) while group P (n?=?27) received placebo.

Methods: Anthropometrical and vascular measurements – flow-mediated dilatation (FMD) and intima media thickness (IMT) – biochemical and hormonal blood sample analyses were performed at the start of the study and after one year. Derived parameters (BMI, HOMA-IR, calculated free testosterone (cFT) and bioavailable testosterone (BT)) were calculated.

Results: TRT resulted in reduction of HOMA-IR by 4.64?±?4.25 (p?p?p?=?.005).

Conclusion: TRT normalized serum testosterone levels, improved glycemic control and endothelial function while exerting no ill effects on the study population.     

Diabetes education program for people with type 2 diabetes: An international perspective

BackgroundIn the Palestinian community, lifestyle changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases especially diabetes mellitus. Diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range. Therefore, patient education is critical in controlling blood glucose levels within the normal range.ObjectiveThis study aimed at measuring the effect of diabetes educational intervention program for patients suffering from type 2 diabetes attending the Diabetes Clinic in Tulkarim Directorate of Health.MethodsA short duration observational study involving pre- and post-test educational intervention program was carried out on a relatively small number of type 2 diabetes patients at the Diabetes Clinic in Tulkarim Directorate of Health. In total, 215 patients attended a group-based 4 h educational intervention session about diabetes. The program included explaining diabetes mellitus-symptoms, risk factors, types, treatment and complications and main aspects of self-care of the disease (foot care, eye care, and blood glucose monitoring), main aspects of dietary management, weight reduction, blood pressure, smoking cessation, periodic investigations, home monitoring and importance of physical activity. Knowledge evaluation questionnaire were evaluated pre- and post-study. Anthropometric measurements such as body weight (WT), body mass index (BMI) and laboratory tests such as fasting blood glucose (FBG), hemoglobin A1C (HbA1c), cholesterol (Chol), and triglycerides (TG) were measured both at the beginning and at the end of the study. Significance of the results was assessed by paired t-test at 95% confidence interval.ResultsThe participant’s mean age was 51.07 that ranged between 31 and 70 years. For a total of 215 participants, 41.4% were males and 58.6% were females. The mean weight before educational intervention was 80.81 ± 14.95 kg (82.6 kg for males and 79.5 kg for females) that decreased to 78.9 ± 14.33 kg (81.1 kg for males and 77.3 kg for females) after educational intervention program. The BMI also decreased significantly after educational intervention. The mean fasting blood sugar was 188.65 ± 71.45 mg/dL before educational intervention that decreased to 177.7 ± 66.11 mg/dL after the educational intervention (p = 0.049). The mean glycosylated hemoglobin was 8.57 ± 1.21 before educational intervention that decreased to 7.95 ± 1.42 after educational intervention. The mean value of cholesterol before educational intervention was 183.27 ± 37.74 mg/dL that decreased to 169.57 ± 34.23 mg/dL after educational intervention. The mean triglycerides value decreased after educational intervention from 209.85 ± 171.04 mg/dL to 183.28 ± 152.4 mg/dL (p = 0.025). The mean score of knowledge questionnaire before educational intervention was 60.6 ± 20.65 that increased to 78.1 ± 13.4 after conducting educational intervention.ConclusionsDiabetes education was found to be effective on BMI, FBG, HbA1c, Chol, TG, and knowledge.RecommendationsDiabetes education is a cornerstone in the management and care of diabetes and should be an integral part of health planning involving patient’s family, diabetes care team, community, and decision makers in the education process.     

Chronic Musculoskeletal Pain:

Two diseases, osteoporosis and osteoarthritis, are responsible for a majority of the chronic musculoskeletal pain that older women experience. Osteoporosis is the metabolic bone disease most common in older women and is responsible for fractures, kyphosis, and chronic pain. Osteoarthritis, the most commonly diagnosed musculoskeletal problem in older women, causes degeneration of the weight-bearing joints in the body, resulting in limited function and chronic pain. In this paper, these and other common disorders are briefly described and typical coping strategies used by older women in pain are reviewed. In addition, potential multidisciplinary treatment regimens are discussed.     

Estrogen receptor alpha single nucleotide polymorphism as predictor of diabetes type 2 risk in hypogonadal men

Abstract

Estradiol (E2) is, apart from its role as a reproductive hormone, also important for cardiac function and bone maturation in both genders. It has also been shown to play a role in insulin production, energy expenditure and in inducing lipolysis. The aim of the study was to investigate if low circulating testosterone or E2 levels in combination with variants in the estrogen receptor alpha (ESR1) and estrogen receptor beta (ESR2) genes were of importance for the risk of type-2 diabetes. The single nucleotide polymorphisms rs2207396 and rs1256049, in ESR1 and ESR2, respectively, were analysed by allele specific PCR in 172 elderly men from the population-based Tromsø study. The results were adjusted for age. In individuals with low total (≤11?nmol/L) or free testosterone (≤0.18?nmol/L) being carriers of the variant A-allele in ESR1 was associated with 7.3 and 15.9 times, respectively, increased odds ratio of being diagnosed with diabetes mellitus type 2 (p?=?0.025 and p?=?0.018, respectively). Lower concentrations of E2 did not seem to increase the risk of being diagnosed with diabetes. In conclusion, in hypogonadal men, the rs2207396 variant in ESR1 predicts the risk of type 2 diabetes.     

Epidemiological aspects of diabetes in the aging male

Type 2 diabetes mellitus is a common chronic disease of older men, affecting an estimated 40% of American men over age 60¹. This paper reviews epidemiological aspects of diabetes mellitus in the aging male, with emphasis on the impact of diabetes in older American men. The first part of the report provides an overview of diabetes in relation to health-care costs, key demographic factors and population dynamics. The second part uses data examples from the Health, Aging and Body Composition Study to illustrate several areas of interest to researchers who study diabetes in older men.     

Regular physical exercise in patients with type II diabetes mellitus

It is widely accepted that regular physical exercise helps diabetic patients control blood glucose, reduce cardiovascular risk factors, and prevent other related complications. In spite of the undoubted benefits of regular physical exercise, diabetic patients with chronic complications should be aware of potential hazards of practicing exercise. To avoid some harmful consequences of acute exercise, it is necessary to adopt a vigilant attitude with these risk patients and to carefully adjust type and intensity of exercise to the individual situation. This article intends to summarize and analyze the current literature concerning the preventive and therapeutic effects of regular exercise in diabetic patients, pointing out its physiological influence on blood glucose regulation, and to analyze the potential risks of acute physical exercise and the precautions given to patients with a variety of complications.