·高被引論文摘要·

·高被引論文摘要·

被引頻次：213

中國心血管病報(bào)告2013概要

陳偉偉，高潤霖，劉力生，等

隨著社會(huì)經(jīng)濟(jì)的發(fā)展，居民生活方式的變化，人口老齡化進(jìn)程的加快等，心血管病危險(xiǎn)因素水平持續(xù)增加，心血管病負(fù)擔(dān)日漸加重，已成為重大的公共衛(wèi)生問題。中國城鄉(xiāng)居民心血管病患病率呈上升趨勢(shì)，死亡率居高不下，全國每年約有 350 萬人死于心血管病。心血管病是中國居民的首位死亡原因。加強(qiáng)心血管病防治刻不容緩。

心血管??；危險(xiǎn)因素；患病率；死亡率

來源出版物：中國循環(huán)雜志, 2014, 29(7): 487-491

被引頻次：241

我國14省市中老年人肥胖超重流行現(xiàn)狀及其與高血壓患病率的關(guān)系

陳捷，趙秀麗，武峰，等

摘要：目的：了解我國目前中老年人群肥胖超重的流行特征及其與常見慢性病的關(guān)系，為肥胖的社區(qū)防治提供科學(xué)依據(jù)。方法：利用我國14省市房顫流行病學(xué)調(diào)查資料，選擇14個(gè)自然人群進(jìn)行整群抽樣調(diào)查，根據(jù)中國肥胖問題工作組推薦的中國成人超重肥胖診斷標(biāo)準(zhǔn)，對(duì)肥胖、超重患病情況進(jìn)行統(tǒng)計(jì)分析。結(jié)果：14省市超重總患病率為38.93%，標(biāo)準(zhǔn)化率為37.17%；肥胖總患病率為13.94%，標(biāo)準(zhǔn)化率為12.63%。女性肥胖患病率顯著高于男性，而男性超重患病率顯著高于女性（均 P＜0.001）；超重肥胖的患病率隨年齡增加呈現(xiàn)一定規(guī)律性；高血壓患病率隨人群體重指數(shù)（BMI）增加而顯著增加。結(jié)論：我國超重和肥胖患病形勢(shì)嚴(yán)峻，加強(qiáng)人群防治刻不容緩，控制體重對(duì)高血壓等慢性病的防治具有重要意義。關(guān)鍵詞：肥胖癥；流行病學(xué)；高血壓

來源出版物：中華醫(yī)學(xué)雜志, 2005, 85(40): 2830-2834

被引頻次：113

慢性病及亞健康狀態(tài)對(duì)我國人民健康的影響及其防治原則

王隴德

摘要：當(dāng)前慢性病及亞健康狀態(tài)已影響到我國大部分群眾的身體健康。如何改變這種狀況，以努力實(shí)現(xiàn)十六大提出的全民族“健康素質(zhì)明顯提高”的目標(biāo)，作者嘗試提出一些觀點(diǎn)，希望有助于全民保健工作的開展。作者主要從慢性病和亞健康狀態(tài)對(duì)人類身體健康的危害以及如何保持人類身體健康等方面進(jìn)行一些探討。

來源出版物：中華醫(yī)學(xué)雜志, 2003, 83(12): 1031-1034

被引頻次：100

慢性病患者自我管理研究進(jìn)展

張麗麗，董建群

摘要：病人主動(dòng)參與慢性病管理的最終目的是提高病人的自我效能（self-efficacy）并開展有效的自我管理。慢性病自我管理的實(shí)質(zhì)為通過“醫(yī)患合作，患者互助，自我管理”來提高患者對(duì)疾病的認(rèn)識(shí)水平，改善患者心理狀態(tài)，改變患者不良健康行為，促進(jìn)患者功能恢復(fù)，減少醫(yī)療費(fèi)用支出。該文從心理學(xué)、生態(tài)學(xué)、倫理學(xué)、衛(wèi)生經(jīng)濟(jì)學(xué)等領(lǐng)域?qū)颊咦晕夜芾碓诓煌嵌?、不同層次的研究進(jìn)行探索，深入了解患者自我管理的科學(xué)性和有效性，同時(shí)就目前研究中存在的問題進(jìn)行探討。

關(guān)鍵詞：慢性??；自我管理；社區(qū)；健康教育；效果評(píng)價(jià)來源出版物：中國慢性病預(yù)防與控制, 2010, 18(2):

207-211

被引頻次：94

北京市2005年18歲及以上居民主要慢性病的流行特征和防治水平調(diào)查

張普洪，焦淑芳，周瀅，等

摘要：目的：了解北京市主要慢性病的流行特征和防治水平。方法：于2005年9—10月份采用多階段等比例分層整群抽樣的方法調(diào)查北京市18歲以上16658名常住居民，調(diào)查方法包括問卷調(diào)查、體格測(cè)量和實(shí)驗(yàn)室檢查。結(jié)果：患病率、知曉率、服藥率和控制率，高血壓分別為29.1%、49.3%、42.3%和10.6%，糖尿病分別為8.8%、56.7%、50.0%和15.0%，血脂異常分別為33.2%、31.1%、13.0%和4.3%；代謝綜合征患病率為22.9%；急性心肌梗死和腦 卒 中的患 病 率分別為8.1‰和 18.4‰。除 糖 尿 病外，高血壓、血脂異常、代謝綜合征、急性心肌梗死和腦卒中的患病率都是郊區(qū)縣人群高于城區(qū)。18～50歲人群上述慢性病的患病率男性顯著高于女性，50歲后女性的患病水平逐漸趕上甚至超過男性。結(jié)論：北京市18歲以上常住居民中主要慢性病患病率高于既往調(diào)查資料，郊區(qū)人群患病水平已超過市區(qū)人群。應(yīng)根據(jù)新的流行特點(diǎn)，調(diào)整和加強(qiáng)北京市慢性病防治的工作重點(diǎn)。

關(guān)鍵詞：高血壓；糖尿病；血脂異常；急性心肌梗死；腦卒中

來源出版物：中華流行病學(xué)雜志, 2007, (7): 625-630

被引頻次：79

慢性病的主要危險(xiǎn)因素流行水平及其預(yù)防策略的發(fā)展

孫曉東，呂筠，李立明

摘要：慢性病的流行已經(jīng)引起全世界的廣泛重視，WHO明確提出慢性病的3個(gè)主要危險(xiǎn)因素：吸煙、缺乏體力活動(dòng)和不健康飲食，并針對(duì)這些危險(xiǎn)因素提出了全球性干預(yù)策略。我國在慢性病的防治方面也做了很多努力，但依然存在很多問題，如慢性病防治的政策支持環(huán)境尚未形成，慢性病防治工作缺乏法律保障等。根據(jù)國際性的慢性病防治策略和經(jīng)驗(yàn)在中國開展健康促進(jìn)策略，建立支持性的政策環(huán)境,開展綜合性社區(qū)干預(yù)項(xiàng)目應(yīng)該成為我國進(jìn)一步開展慢性病防治工作的重點(diǎn)。

關(guān)鍵詞：慢性??；危險(xiǎn)因素；流行病學(xué)研究；疾病控制策略

來源出版物：中國慢性病預(yù)防與控制, 2008, 16(5): 538-540

被引頻次：78

慢性病現(xiàn)狀流行趨勢(shì)國際比較及應(yīng)對(duì)策略

李鵬，楊文秀

摘要：目的：了解目前世界慢性病的現(xiàn)狀及其在可預(yù)測(cè)的未來的發(fā)展趨勢(shì)，為決策者提供可行的慢性病防治政策建議。方法：根據(jù)世界銀行給出的國家分類，從高收入國家、中高收入國家、中低收入國家、低收入國家中各隨機(jī)抽取2個(gè)國家進(jìn)行數(shù)據(jù)統(tǒng)計(jì)，還將所有地區(qū)和各收入層次國家總計(jì)進(jìn)行了數(shù)據(jù)統(tǒng)計(jì)與分析。對(duì)國家間的慢性病主要疾病譜作橫向比較。結(jié)果：全球范圍內(nèi)慢性病死亡人數(shù)占所有死亡人數(shù)的60%以上；慢性病死亡主要發(fā)生在低收入和中低收入國家，占慢性病死亡人數(shù)的70%以上；其中心血管系統(tǒng)疾病、癌癥、慢性呼吸道疾病、糖尿病、孕期和圍產(chǎn)期疾病及營養(yǎng)不良等疾病是導(dǎo)致死亡的5類主要慢性病。結(jié)論：慢性病對(duì)發(fā)展中國家的威脅與日俱增，發(fā)展中國家也需要加大對(duì)慢性病的防治力度。采取相關(guān)行動(dòng)去減慢和遏制慢性病的上升趨勢(shì)已成為全球公共衛(wèi)生的當(dāng)務(wù)之急。

關(guān)鍵詞：慢性??；流行病學(xué)；國際性；衛(wèi)生政策

來源出版物：天津醫(yī)藥, 2009, 47(4): 254-257

被引頻次：60

北京市成年人主要慢性病流行特征分析

董忠，李剛，謝瑾，等

摘要：目的：分析北京市成年人常見慢性病的流行特征。方法：自行設(shè)計(jì)的調(diào)查問卷。于2008年10—11月，采用多階段分層隨機(jī)整群抽樣方法對(duì)北京市18～79歲的22206名常住居民進(jìn)行問卷調(diào)查、體格測(cè)量和實(shí)驗(yàn)室檢查。結(jié)果：調(diào)查人群高血壓、糖尿病、超重、肥胖、中心性肥胖 和 血 脂 異常的患病率分別為 30.3%、6.1%、36.2%、19.1%、51.5%和34.2%；其中男性分別為38.8%、8.2%、42.5%、22.5%、62.8%和42.9%，女性分別為27.9%、5.7%、34.7%、18.4%、47.9%和30.4%，男性各慢性病患病率均高于女性；郊區(qū)高血壓和肥胖的患病率分別為34.8%和23.0%，已高于城區(qū)的31.6%和18.7%；＜50歲男性各種慢性病的患病率均高于女性，50～60歲糖尿病、肥胖、中心性肥胖和血脂異常的患病率則女性高于男性；男性的發(fā)病高峰在青壯年期，女性在絕經(jīng)期。結(jié)論：肥胖和血脂異常已成為北京市成年人重要健康問題；郊區(qū)的慢性病患病水平已接近或超過城區(qū)。

關(guān)鍵詞：高血壓；糖尿??；肥胖；血脂異常；流行特征

來源出版物：中國公共衛(wèi)生, 2004, 13(1): 357-358

被引頻次：59

北京市2005年成年人慢性病相關(guān)生活方式和行為習(xí)慣研究

張普洪，焦淑芳，周瀅，等

摘要：目的：探索北京市成年人中慢性病相關(guān)生活方式和行為習(xí)慣的分布特征。方法于 2005 年 9—11 月份采用多階段等比例分層整群抽樣的方法調(diào)查北京市18歲以上16658 名常住居民，凋查內(nèi)容包括問卷調(diào)查、體格測(cè)量和實(shí)驗(yàn)室檢查。結(jié)果北京市成年人有 33.2%超重，16.4%肥胖，腹型肥胖率為 45.6%?，F(xiàn)在吸煙率為 26.2%，經(jīng)常吸煙率為 21.4%，男女性現(xiàn)在吸煙率分別為 57.7%和4.6%。男性中 64.3%每月至少飲一次酒，16.1%幾乎每

天飲酒，16.5%為過量飲酒，18.5%為單次大量飲酒。北京市成年人 46.0%缺乏體育鍛煉（每周鍛煉時(shí)間不超過2 h）。膳食中最突出的問題是鈉鹽和食用油攝入過多、豆奶制品攝入不足、不吃早餐、常吃咸菜腌菜和油炸食品、經(jīng)常吃零食和蔬菜水果攝入不足等問題。絕大多數(shù)慢性病危險(xiǎn)因素的流行水平都是郊縣高于城區(qū)，青壯年高于其他年齡段。結(jié)論：北京市成年人中慢性病相關(guān)危險(xiǎn)因素高度流行，郊縣和青壯年是今后干預(yù)的重點(diǎn)。

關(guān)鍵詞：慢性??；危險(xiǎn)因素；肥胖；吸煙；體力活動(dòng)

來源出版物：中華流行病學(xué)雜志, 2007, (12): 1162-1166

被引頻次：56

天津社區(qū)居民慢性病患病現(xiàn)狀及影響因素分析

王媛，于維莉，蘆文麗，等

摘要：目的：了解天津市社區(qū)居民慢性病患病現(xiàn)狀及其相關(guān)影響因素，為社區(qū)居民慢性病預(yù)防與控制提供科學(xué)依據(jù)。方法：采用分層隨機(jī)抽樣方法對(duì)在天津市抽取的2335名≥18歲社區(qū)居民進(jìn)行問卷調(diào)查。結(jié)果：天津市社區(qū)居民慢性病患病率為33.96%，其中男性和女性居民的患病 率 分別為 33.89%和34.03%， 差 異無統(tǒng) 計(jì) 學(xué)意義（P＞0.05）；慢性病患病率隨年齡的增長(zhǎng)呈上升趨勢(shì)（χ2=535.946，P=0.000）；居于慢性病患病前10位的疾病依次為高血壓、糖尿病、冠心病、腦梗塞、頸椎病、腰間盤突出、骨關(guān)節(jié)炎、腦血栓、腦出血和膽石癥，患病率依次為21.60%、7.64%、5.76%、67%、87%、72%、64%、60%、0.44%和0.40%；多因素非條件 Logistic 回歸分析結(jié)果表明，年齡≥30歲、吸煙、超重、肥胖和有慢性病家族史是天津市社區(qū)居民慢性病患病的危險(xiǎn)因素。結(jié)論：天津市社區(qū)居民慢性病患病率隨年齡增長(zhǎng)呈上升趨勢(shì)；吸煙、超重、肥胖和有慢性病家族史的居民是慢性病防治的重點(diǎn)人群。

關(guān)鍵詞：慢性病；高血壓；吸煙；體重指數(shù)

來源出版物：中國公共衛(wèi)生, 2012, 28(3): 296-298

被引頻次：9620

來源出版物：Hypertension, 2003, 42(6): 1206-1252

被引頻次：2875

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary

Rabe, Klaus F.; Hurd, Suzanne; Anzueto, Antonio; et al.

Abstract: Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

Keywords: COPD; guidelines; human; chronic disease

來源出版物：American Journal of Respiratory and Critical Care Medicine, 2007, 176(6): 532-555

被引頻次：2632

The hormone resistin links obesity to diabetes

Steppan, CM; Bailey, ST; Bhat, S; et al.

Abstract: Diabetes mellitus is a chronic disease that leads to complications including heart disease, stroke, kidney failure, blindness and nerve damage. Type 2 diabetes,characterized by target-tissue resistance to insulin, is epidemic in industrialized societies and is strongly associated with obesity; however, the mechanism by which increased adiposity causes insulin resistance is unclear. Here we show that adipocytes secrete a unique signalling molecule, which we have named resistin (for resistance to insulin). Circulating resistin levels are decreased by the anti-diabetic drug rosiglitazone, and increased in diet-induced and genetic forms of obesity. Administration of anti-resistin antibody improves blood sugar and insulin action in mice with diet-induced obesity. Moreover, treatment of normal mice with recombinant resistin impairs glucose tolerance and insulin action. Insulin-stimulated glucose uptake by adipocytes is enhanced by neutralization of resistin and is reduced by resistin treatment. Resistin is thus a hormone that potentially links obesity to diabetes.

來源出版物：Nature, 2001, 409(6818): 307-312

被引頻次：2364

Prevalence of chronic kidney disease in the United States 12.0%-14.1%) in 1999-2004 with a prevalence ratio of 1.3 (95% CI, 1.2-1.4). The prevalence estimates of CKD stages in 1988-1994 and 1999-2004, respectively, were 1.7% (95% CI, 1.3%-2.2%) and 1.8% (95% CI, 1.4%-2.3%) for stage 1; 2.7% (95% CI, 2.2%3.2%) and 3.2% (95% CI, 2.6%-3.9%) for stage 2; 5.4% (95% CI, 4.9%-6.0%) and 7.7% (95% CI, 7.0%-8.4%) for stage 3; and 0.21% (95% CI, 0.15%-0.27%) and 0.35% (0.25%-0.45%) for stage 4. A higher prevalence of diagnosed diabetes and hypertension and higher body mass index explained the entire increase in prevalence of albuminuria but only part of the increase in the prevalence of decreased GFR. Estimation of GFR from serum creatinine has limited precision and a change in mean serum creatinine accounted for some of the increased prevalence of CKD. Conclusions: The prevalence of CKD in the United States in 1999-2004 is higher than it was in 1988-1994. This increase is partly explained by the increasing prevalence of diabetes and hypertension and raises concerns about future increased incidence of kidney failure and other complications of CKD.

Coresh, Josef; Selvin, Elizabeth; Stevens, Lesley A; et al.

來 源 出 版 物 ： Jama-Journal of the American Medical Association, 2007, 298(17): 2038-2047

Abstract: Context: The prevalence and incidence of kidney failure treated by dialysis and transplantation in the United States have increased from 1988 to 2004. Whether there have been changes in the prevalence of earlier stages of chronic kidney disease (CKD) during this period is uncertain. Objective: To update the estimated prevalence of CKD in the United States. Design, Setting, and Participants: Cross-sectional analysis of the most recent National Health and Nutrition Examination Surveys (NHANES 1988-1994 and NHANES 1999-2004), a nationally representative sample of noninstitutionalized adults aged 20 years or older in 1988-1994 (n=15488) and 1999-2004 (n=13233). Main Outcome Measures: Chronic kidney disease prevalence was determined based on persistent albuminuria and decreased estimated glomerular filtration rate (GFR). Persistence of microalbuminuria (＞ 30 mg/g) was estimated from repeat visit data in NHANES 1988-1994. The GFR was estimated using the abbreviated Modification of Diet in Renal Disease Study equation reexpressed to standard serum creatinine. Results: The prevalence of both albuminuria and decreased GFR increased from 1988-1994 to 1999-2004. The prevalence of CKD stages 1 to 4 increased from 10.0% (95% confidence interval [CI], 9.2%-10.9%) in 1988-1994 to 13.1% (95% CI,

被引頻次：2353

National kidney foundation practice guidelines for chronic kidney disease: Evaluation, classification, and stratification

Levey, AS; Coresh, J; Balk, E; et al.

Abstract: Chronic kidney disease is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of chronic kidney disease include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Current evidence suggests that some of these adverse outcomes can be prevented or delayed by early detection and treatment. Unfortunately, chronic kidney disease is underdiagnosed and undertreated, in part as a result of lack of agreement on a definition and classification of its stages of progression. Recent clinical practice guidelines by the National Kidney Foundation 1) define chronic kidney disease and classify its stages, regardless of underlying cause, 2) evaluate laboratory measurements for the clinical assessment of kidney disease, 3) associate the level of kidney function with complications of chronic kidney disease, and 4) stratify the risk for loss of kidney function and development ofcardiovascular disease. The guidelines were developed by using an approach based on the procedure outlined by the Agency for Healthcare Research and Quality. This paper presents the definition and five-stage classification system of chronic kidney disease and summarizes the major recommendations on early detection in adults. Recommendations include identifying persons at increased risk (those with diabetes, those with hypertension, those with a family history of chronic kidney disease, those older than 60 years of age, or those with U.S. racial or ethnic minority status), detecting kidney damage by measuring the albumin-creatinine ratio in untimed (“spot”) urine specimens, and estimating the glomerular filtration rate from serum creatinine measurements by using prediction equations. Because of the high prevalence of early stages of chronic kidney disease in the general population (approximately 11% of adults), this information is particularly important for general internists and specialists.來源出版物：Annals of Internal Medicine, 2003, 139(2): 137-147

被引頻次：1578

Clinical epidemiology of cardiovascular disease in chronic renal disease

Foley, RN; Parfrey, PS; Sarnak, MJ

Abstract: Cardiovascular disease (CVD) is the most common cause of death in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). The clinical epidemiology of CVD in CKD is challenging due to a prior lack of standardized defi nitions of CKD, inconsistent measures of renal function, and possible alternative effects of ‘traditional’ CVD risk factors in patients with CKD. These challenges add to the complexity of the role of renal impairment as the cause or the consequence of cardiovascular disease. The goal of this review is to summarize the current evidence on: (1) the incidence and prevalence of CVD in chronic renal insuffi ciency and in ESRD, (2) risk factors for CVD in CKD, (3) the outcomes of patients with renal failure with CVD, and (4) CKD as a risk factor for CVD. The epidemiological associations implicating the huge burden of CVD throughout all stages of CKD highlight the need to better understand and implement adequate screening, and diagnostic and treatment strategies.

來源出版物：American Journal of Kidney Diseases, 1998, 32(5):112-119被引頻次：1554

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease gold executive summary

Vestbo, Jorgen; Hurd, Suzanne S; Agusti, Alvar G; et al.

Abstract: Chronic obstructive pulmonary disease (COPD) is a global health problem, and since 2001, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published its strategy document for the diagnosis and management of COPD. This executive summary presents the main contents of the second 5-year revision of the GOLD document that has implemented some of the vast knowledge about COPD accumulated over the last years. Today, GOLD recommends that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation. The document highlights that the assessment of the patient with COPD should always include assessment of (1) symptoms, (2) severity of airflow limitation, (3) history of exacerbations, and (4) comorbidities. The first three points can be used to evaluate level of symptoms and risk of future exacerbations, and this is done in a way that splits patients with COPD into four categories-A, B, C, and D. Nonpharmacologic and pharmacologic management of COPD match this assessment in an evidence-based attempt to relieve symptoms and reduce risk of exacerbations. Identification and treatment of comorbidities must have high priority, and a separate section in the document addresses management of comorbidities as well as COPD in the presence of comorbidities. The revised document also contains a new section on exacerbations of COPD. The GOLD initiative will continue to bring COPD to the attention of all relevant shareholders and will hopefully.

Keywords: COPD; clinical assessment; COPD management; exacerbations; comorbidities

來源出版物：American Journal of Respiratory and Critical Care Medicine, 2013, 187(4): 347-365

被引頻次：1220

Patient self-management of chronic disease in primary care

Bodenheimer, T; Lorig, K; Holman, H; et al.

Abstract: Patients with chronic conditions make day-to-day, decisions about-self-manage-their illnesses. This reality introduces a new chronic disease paradigm: the patient-professional partnership, involving collaborativecare and self-management education. Self-management education complements traditional patient education in supporting patients to live the best possible quality of life with their chronic condition. Whereas traditional patient education offers information and technical skills, self-management education teaches problem-solving skills. A central concept in self-management is self-efficacyconfidence to carry out a behavior necessary to reach a desired goal. Self-efficacy is enhanced when patients succeed in solving patient-identified problems. Evidence from controlled clinical trials suggests that (1) programs teaching self-management skills are more effective than information-only patient education in improving clinical outcomes; (2) in some circumstances, self-management education improves outcomes and can reduce costs for arthritis and probably for adult asthma patients; and (3) in initial studies, a self-management education program bringing together patients with a variety of chronic conditions may improve outcomes and reduce costs. Self-management education for chronic illness may soon become an integral part of high-quality primary care.

來源出版物：JAMA-Journal of the American Medical Association, 2002, 287(19): 2469-2475

被引頻次：1129

Depression, chronic diseases, and decrements in health: results from the World Health Surveys

Moussavi, Saba; Chatterji, Somnath; Verdes, Emese

Abstract: Background Depression is an important public-health problem, and one of the leading causes of disease burden worldwide. Depression is often comorbid with other chronic diseases and can worsen their associated health outcomes. Few studies have explored the effect of depression, alone or as comorbidity, on overall health status. Methods The WHO World Health Survey (WHS) studied adults aged 18 years and older to obtain data for health, health-related outcomes, and their determinants. Prevalence of depression in respondents based on ICD-10 criteria was estimated. Prevalence values for four chronic physical diseases-angina, arthritis, asthma, and diabeteswere also estimated using algorithms derived via a Diagnostic Item Probability Study. Mean health scores were constructed using factor analysis and compared across different disease states and demographic variables. The relation of these disease states to mean health scores was determined through regression modelling. Findings Observations were available for 245404 participants from 60 countries in all regions of the world. Overall, 1-year prevalence for ICD-10 depressive episode alone was 3.2% (95% CI 3.0-3.5); for angina 4.5% (4.3-4.8); for arthritis 4.1% (3.8-4.3); for asthma 3.3% (2.9-3.6); and for diabetes 2.0% (1.8-2.2). An average of between 9.3% and 23.0% of participants with one or more chronic physical disease had comorbid depression. This result was significantly higher than the likelihood of having depression in the absence of a chronic physical disease (P＜0.0001). After adjustment for socioeconomic factors and health conditions, depression had the largest effect on worsening mean health scores compared with the other chronic conditions. Consistently across countries and different demographic characteristics, respondents with depression comorbid with one or more chronic diseases had the worst health scores of all the disease states. Interpretation Depression produces the greatest decrement in health compared with the chronic diseases angina, arthritis, asthma, and diabetes. The comorbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression. These results indicate the urgency of addressing depression as a public-health priority to reduce disease burden and disability, and to improve the overall health of populations.

來源出版物：Lancet 2007, 370: 851-858

The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: The JNC 7 report

Chobanian, AV; Bakris, GL; Black, HR; et al.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure provides a new guideline for hypertension prevention and management. The following are the key messages: (1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (＜140/90 mm Hg or ＜130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a patent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician’s judgment remains paramount.來源出版物：JAMA-Journal of the American Medical Association, 2003, 289(19): 2560-2572被引頻次：6434Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressureChobanian, AV; Bakris, GL; Black, HRAbstract: The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like itspredecessors, the purpose is to provide an evidence- based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals ( systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP ( ＜ 140/90 mm Hg, or ＜ 130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician’s judgment remains paramount.

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