·推薦論文摘要·

·推薦論文摘要·

城市社區(qū)常見慢性病綜合防治模式探索

劉盈，張開金，湯仕忠，等

本文探討了運用疾病管理策略開展城市社區(qū)慢性病綜合防治。通過構(gòu)建慢性病管理指導(dǎo)網(wǎng)絡(luò)，組建可持續(xù)發(fā)展的慢性病管理隊伍并進行系統(tǒng)培訓(xùn)，集成社區(qū)慢性病防治干預(yù)技術(shù)及醫(yī)療衛(wèi)生保健技術(shù)；通過建立城市社區(qū)慢性病信息系統(tǒng)、實行分級診療和雙向轉(zhuǎn)診、建立科學(xué)的評價體系等社區(qū)慢性病支持性環(huán)境建設(shè)，以實現(xiàn)社區(qū)慢性病綜合防治的可持續(xù)發(fā)展。

社區(qū)；慢性??；健康管理；雙向轉(zhuǎn)診

來源出版物：中國全科醫(yī)學(xué), 2013, 16(1A): 76-78

居民高血壓、糖尿病及知信行社區(qū)干預(yù)效果評價

張磊，史中鋒，遲阿魯，等

摘要：目的：探討社區(qū)干預(yù) 11 年對城區(qū)居民高血壓和糖尿病患病率及知信行（KAP）影響，為進一步完善慢性病社區(qū)干預(yù)模式提供理論依據(jù)。方法：采用多階段抽樣方法于 1999 年 1 月對慢性病綜合防治示范點山東省濟南市槐蔭區(qū)≥15歲常住居民作進行基線調(diào)查，通過控鹽、控?zé)?、平衡膳食和推動全民健身等措施進行了 11年的慢性病綜合社區(qū)干預(yù)，于 2010 年 5 月再次以相同方法進行慢性病及相關(guān) KAP調(diào)查，對 2次調(diào)查居民慢性病患病率及相關(guān) KAP 得分進行比較。結(jié)果：1999 和2010 年分別獲得有效問卷 1998、2042 份；1999 年調(diào)查槐蔭區(qū)≥15 歲常住居民高血壓患病率為 16.3%，糖尿病患病率為 3.1%，2010 年高血壓患病率為 25.6%，糖尿病患病率為 7.3%，均有升高（P＜0.05）；1999 年居民慢性病 KAP 平均得分（27.94±6.95）分，2010 年慢性病 KAP平均得分（30.62±7.98）分，2010 年較 1999 年提高了 2.68分（t=11.397, P＜0.001）。結(jié)論：≥15 歲居民高血壓和糖尿病患病率均有所增長，慢性病相關(guān) KAP得分提高。

關(guān)鍵詞：慢性?。簧鐓^(qū)干預(yù)；知識、態(tài)度和行為（KAP）；高血壓；糖尿病

來源出版物：中國公共衛(wèi)生, 2013. 29(4): 608-611

中國慢性病防控策略和體系建設(shè)探索

王隴德

摘要：慢性非傳染性疾病已成為當(dāng)前人類的重大威脅。國際研究表明，2008年全球5700萬人死亡，其中的63%（3600萬人）死于慢性非傳染性疾病；80%的非傳染性疾病所致死亡（2900萬人）發(fā)生在低收入和中等收入國家。WHO 預(yù)測，如果按目前的情況繼續(xù)發(fā)展，到2030年每年死于慢性非傳染性疾病的人數(shù)將增加至5500萬人。在中國，伴隨著工業(yè)化、城鎮(zhèn)化、老齡化進程的加快和國民生活方式的快速變遷，居民慢性病患病率、死亡率呈持續(xù)快速增長趨勢。因此，慢性非傳染性疾病流行的應(yīng)對，是中國當(dāng)前必須盡快考慮的重大問題。本文在總結(jié)中國重大慢性病流行狀況、分析中國慢性病防控中存在的主要問題和關(guān)鍵影響因素以及總結(jié)前期項目探索經(jīng)驗的基礎(chǔ)上，對中國慢性病防控應(yīng)制定和采取的策略及防控體系建設(shè)工作要點提出了建議：如相關(guān)政府部門都應(yīng)制定相應(yīng)政策；建立結(jié)構(gòu)合理、系統(tǒng)內(nèi)任務(wù)分工明確，協(xié)調(diào)、高效的工作體系；從制度、工作規(guī)范與要求上推行“整合醫(yī)學(xué)”的發(fā)展，從而提高中國慢性病防控工作效能與效益等。

關(guān)鍵詞：慢性病防控；策略與體系建設(shè)

來源出版物：中國工程科學(xué), 2014, 16(10): 22-30

成年人體質(zhì)指數(shù)、腰圍與高血壓、糖尿病和血脂異常的關(guān)系

蘇健，向全永，呂淑榮，等

摘要：目的：探討成人體質(zhì)指數(shù)（body mass index, BMI）、腰圍（waist circumference，WC）與高血壓、糖尿病和血脂異常的關(guān)系。方法：采用方差分析、偏相關(guān)和非條件 Logistic 回歸模型研究 BMI、WC 與血壓、血糖、血脂、高血壓、糖尿病和血脂異常的關(guān)系。結(jié)果：調(diào)查人群新檢出高血壓、糖尿病和血脂異?；疾÷蕿?35.3%、4.3%和 28.4%。不同 BMI、WC 組間血壓、血糖和血脂差異有統(tǒng)計學(xué)意義（均有 P＜0.05）。BMI、WC 與收縮壓、舒張壓、空腹血糖、總膽固醇、甘油三酯和低密度脂蛋白膽固醇正相關(guān)，與高密度脂蛋白膽固醇負(fù)相關(guān)（均有 P＜0.05）。隨著 BMI和 WC 增加，高血壓、糖尿病和血脂異?；疾★L(fēng)險上升（均有 P＜0.05），且 BMI、WC每增加 1 個標(biāo)準(zhǔn)差,高血壓患病風(fēng)險分別增加 57%和58%，糖尿病增加 53%和 64%，血脂異常增加 61%和67%。結(jié)論：BMI、WC 與高血壓、糖尿病和血脂異常密切相關(guān)，且WC對患病風(fēng)險影響更大。

關(guān)鍵詞：高血壓；糖尿病；血脂異常

來源出版物：中華疾病控制雜志, 2015, 19(7): 969-700

關(guān)鍵詞：心血管疾?。晃ｋU因素；患病率；死亡率

來源出版物：中國循環(huán)雜志, 2016, 31(6): 521-528

我國慢性病管理現(xiàn)狀、問題及發(fā)展建議

中國居民慢性病防治素養(yǎng)水平及其影響因素

聶雪瓊，李英華，陶茂萱，等

摘要：目的：了解我國居民慢性病防治素養(yǎng)水平及其影響因素，為制定衛(wèi)生政策和健康教育干預(yù)措施提供依據(jù)。方法：采用分層多階段與人口規(guī)模成比例抽樣（PPS抽樣）方法，對全國31個省（區(qū)、市）336個監(jiān)測點非集體居住的15～69歲常住人口進行調(diào)查，以問卷調(diào)查方式對調(diào)查對象慢性病防治素養(yǎng)水平進行測評。結(jié)果：2012年健康素養(yǎng)監(jiān)測共調(diào)查全國15～69歲常住人口102985人，收回有效問卷98448份，有效率為95.59%。其中，城市人口占44.32%，農(nóng)村人口占55.68%；男性占51.72%，女性占48.28%。2012年我國居民慢性病防治素養(yǎng)水平的點估計值為9.07%，其95%可信區(qū)間為8.82%～9.34%，城市居民為13.23%,高于農(nóng)村居民的6.75%；東部地區(qū)居民為10.74%，高于中部地區(qū)居民的8.69%，高于西部地區(qū)居 民 的 7.08% ； 男 性 為 8.85% ， 女 性 為 9.20%。 多 因 素Logistic回歸分析結(jié)果顯示：農(nóng)村居民慢性病防治素養(yǎng)水平低于城市居民，OR值為0.698（95%CI：0.567～0.859），文化程度越高，慢性病防治素養(yǎng)水平越高，以不識字/少識字者為參照，小學(xué)、初中、高中/職高/中專、大專/本科及以上文化程度者具備慢性病防治素養(yǎng)的OR分別為1.717（95%CI：1.324～2.228）、2.554（95%CI：1.935～3.371）、4.507（95%CI：3.383～6.005）、8.224（95%CI：6.097～11.095）。結(jié)論：我國居民慢性病防治素養(yǎng)水平較低，其中農(nóng)村居民、文化程度較低者是健康教育的重點人群。

關(guān)鍵詞：慢性病防治素養(yǎng)；監(jiān)測；居民；影響因素

來源出版物：中國健康教育, 2015, 31(2): 108-111

呂蘭婷，鄧思蘭

摘要：慢性非傳染性疾病對我國居民健康造成較大威脅，慢性病管理工作是我國衛(wèi)生工作的重點。本文通過文獻和相關(guān)政策研究，從宏觀—政策，中觀—組織機構(gòu)間的協(xié)調(diào)，微觀—患者和人群三個層面對我國慢性病管理工作進程進行梳理歸納，并立足我國慢性病管理實際提出我國慢性病管理仍存在的一些問題。建議未來的慢性病管理工作應(yīng)注重提煉慢性病管理理論模型；結(jié)合醫(yī)改分級診療工作的推行，構(gòu)建整合式慢性病管理服務(wù)網(wǎng)絡(luò)；加快提升慢性病管理“終端”能力建設(shè)。

關(guān)鍵詞：慢性病管理；衛(wèi)生服務(wù)；現(xiàn)狀

來源出版物：中國衛(wèi)生政策研究, 2015, 35(11): 1-7

慢性病管理研究進展

王榮英，賀振銀，趙穩(wěn)穩(wěn)，等

摘要：隨著經(jīng)濟、社會的快速發(fā)展，慢性病患病率、病死率逐年升高。本文參閱了國內(nèi)外有關(guān)慢性病管理的最新研究文獻，對慢性病管理的概念、意義、對象及國內(nèi)外慢性病管理研究進展進行了綜述，同時對我國未來慢性病管理模式進行了展望，提出：以社區(qū)為依托，綜合性三級甲等醫(yī)院全科醫(yī)療科聯(lián)合各專科及基層醫(yī)院對慢性病進行持續(xù)、綜合性的管理，有利于提高社區(qū)全科醫(yī)生規(guī)范化管理慢性病的水平，有利于提高慢性病的知曉率和控制率。

關(guān)鍵詞：慢性病； 疾病管理； 全科醫(yī)生； 綜述

來源出版物：中國全科醫(yī)學(xué), 2016, 19(17): 1989-1993

《中國心血管病報告 2015》概要

陳偉偉，高潤霖，劉力生，等

摘要：我國心血管病危險因素流行趨勢明顯，導(dǎo)致了心血管病的發(fā)病人數(shù)增加?？傮w上看，我國心血管病患病率及死亡率仍處于上升階段。心血管病占居民疾病死亡構(gòu)成的 40%以上，為我國居民的首位死因。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，防治心血管病刻不容緩。

“慢性病管理”專家主題研討

曾學(xué)軍，王芳，沙悅，等

摘要：本文組織多位全科醫(yī)學(xué)專家對慢性病管理展開主題研討，曾學(xué)軍教授認(rèn)為全科醫(yī)生應(yīng)做真正的“健康守門人”，促進以慢性病患者為中心的分級診療；王芳主任探討分級診療制度下慢性病防治一體化模式；沙悅提出慢性病管理是從疾病管理到人的健康管理；沈薔分析信息化支撐下的慢性病管理；于國泳分析中西醫(yī)結(jié)合的慢性病管理；李廣順提出慢性病管理對社區(qū)衛(wèi)生服務(wù)中心的挑戰(zhàn)和對策；趙春山提示提高全民健康意識，健康教育先行；崔殿柱分析如何加強慢性病防治，發(fā)展社區(qū)衛(wèi)生服務(wù)；趙輝探討如何依靠慢性病管理來助力分級診療；王海龍分析社區(qū)衛(wèi)生服務(wù)中心慢性病防治專科建設(shè)思考。旨在促進社區(qū)衛(wèi)生服務(wù)機構(gòu)有效地開展慢性病管理，探索適應(yīng)新醫(yī)改的慢性病管理工作模式，提升社區(qū)衛(wèi)生服務(wù)機構(gòu)慢性病管理效果。

關(guān)鍵詞：慢性??；病例管理；社區(qū)衛(wèi)生服務(wù)；分級診療；家庭醫(yī)生簽約

來源出版物：中國全科醫(yī)學(xué), 2016, 19(29): 3517-3523

錯位：當(dāng)代人類慢性病發(fā)病率飆升的病理生理學(xué)基礎(chǔ)——基于人類進化過程中飲食-體力活動-基因的交互作用

喬玉成

摘要：有證據(jù)表明，當(dāng)代人類慢性病的高發(fā)與基因和環(huán)境的交互作用有關(guān)，但關(guān)于兩者的關(guān)系機制尚未完全明晰?；谌祟愡M化過程中飲食-體力活動-基因間的交互作用以及表觀遺傳學(xué)的研究證據(jù)，從“匹配”的視角梳理和探討了當(dāng)代人類慢性病發(fā)病率飆升的原因與機制。人類生物進化與文化進化的不同步，基因型與飲食、體力活動、物質(zhì)能量代謝方面的不匹配、不適應(yīng)、不兼容等造成的基因與環(huán)境之間的錯位，是導(dǎo)致當(dāng)代人類慢性病高發(fā)的原因。過度飲食和體力活動不足通過影響基因的表觀遺傳修飾，進而影響到相關(guān)基因的表達，是導(dǎo)致慢性病高發(fā)的機制。在此基礎(chǔ)上,提出了限制熱量攝入，增加體力活動消耗，促使生活方式與基因型相匹配的慢性病防治策略。

關(guān)鍵詞：慢性病；基因；飲食；體力活動； 交互作用；節(jié)儉基因；表觀遺傳學(xué)

來源出版物：體育科學(xué), 2017, 37(1): 28-44

來源出版物：Kidney International, 2014, 85(3): 529-535

Chronic obstructive pulmonary disease in heart failure: Accurate diagnosis and treatment

Gueder, Guelmisal; Brenner, Susanne; Stoerk, Stefan; et al.

Abstract: Coincidence of COPD and heart failure (HF) is challenging as both diseases interact on multiple levels with each other, and thus impact significantly on diagnosis, disease severity classification, and choice of medical therapy. The current overview aims to educate caregivers involved in the daily management of patients with HF and (possibly) concurrent COPD in how to deal with clinically relevant issues such as interpreting spirometry, the potential role of extensive pulmonary function testing, and finally, the potential beneficial, but also detrimental effects of medication used for HF and COPD on either disease.

Keywords: Heart failure; COPD misdiagnosis; Severity classification

來源出版物： European Journal of Heart Failure, 2014, 16(12): 1273-1282

Recent clinical trials for the etiological treatment of chronic chagas disease: Advances, challenges and perspectives

Urbina, Julio A

Abstract: Chagas disease, a chronic systemic parasitosis caused by the Kinetoplastid protozoon Trypanosoma cruzi, is the first cause of cardiac morbidity and mortality in poor rural and suburban areas of Latin America and the largestparasitic disease burden in the continent, now spreading worldwide due to international migrations. A recent change in the scientific paradigm on the pathogenesis of chronic Chagas disease has led to a consensus that all T. cruziseropositive patients should receive etiological treatment. This important scientific advance has spurred the rigorous evaluation of the safety and efficacy of currently available drugs (benznidazole and nifurtimox) as well as novel anti-T. cruzi drug candidates in chronic patients, who were previously excluded from such treatment. The first results indicate that benznidazole is effective in inducing a marked and sustained reduction in the circulating parasites’ level in the majority of these patients, but adverse effects can lead to treatment discontinuation in 10-20% of cases. Ergosterol biosynthesis inhibitors, such as posaconazole and ravuconazole, are better tolerated but their efficacy at the doses and treatment duration used in the initial studies was significantly lower; such results are probably related to suboptimal exposure and/or treatment duration. Combination therapies are a promising perspective but the lack of validated biomarkers of response to etiological treatment and eventual parasitological cures in chronic patients remains a serious challenge.

Keywords: Adverse side effects; antiparasitic; benznidazole; efficacy; posaconazole; randomized trial; ravuconazole; Trypanosoma cruzi

來源出版物：Journal of Eukaryotic Microbiology, 2015, 62(1): 149-156

Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: The CSPPT randomized clinical trial

Y Huo; J Li; X Qin; et al.

Abstract: Uncertainty remains about the efficacy of folic acid therapy for the primary prevention of stroke because of limited and inconsistent data. To test the primary hypothesis that therapy with enalapril and folic acid is more effective in reducing first stroke than enalapril alone among Chinese adults with hypertension. The China Stroke Primary Prevention Trial, a randomized, double-blind clinical trial conducted from May 19, 2008, to August 24, 2013, in 32 communities in Jiangsu and Anhui provinces in China. A total of 20702 adults with hypertension without history of stroke or myocardial infarction (MI) participated in the study. Eligible participants, stratified by MTHFRC677T genotypes (CC, CT, and TT), were randomly assigned to receive double-blind daily treatment with a single-pill combination containing enalapril, 10 mg, and folic acid, 0.8 mg (n = 10348) or a tablet containing enalapril, 10 mg, alone (n = 10354). The primary outcome was first stroke. Secondary outcomes included first is chemic stroke; first hemorrhagic stroke; MI; a composite of cardiovascular events consisting of cardiovascular death, MI, and stroke; and all-cause death. During a median treatment duration of 4.5 years, compared with the enalapril alone group, the enalapril-folic acid group had a significant risk reduction in first stroke (2.7% of participants in the enalapril-folic acid group vs 3.4% in the enalapril alone group; hazard ratio [HR], 0.79; 95% CI,.68-0.93), first ischemic stroke (2.2% with enalapril-folic acid vs 2.8% with enalapril alone; HR, 0.76; 95% CI, 0.64-0.91), and composite cardiovascular events consisting of cardiovascular death, MI, and stroke (3.1% with enalapril-folic acid vs 3.9% with enalapril alone; HR, 0.80; 95% CI, 0.69-0.92). The risks of hemorrhagic stroke (HR, 0.93; 95% CI, 0.65-1.34), MI (HR, 1.04; 95% CI, 0.60-1.82), and all-cause deaths (HR, 0.94; 95% CI, 0.81-1.10) did not differ significantly between the 2 treatment groups. There were no significant differences between the 2 treatment groups in the frequencies of adverse events. Among adults with hypertension in China without a history of stroke or MI, the combined use of enalapril and folic acid, compared with enalapril alone, significantly reduced the risk of first stroke. These findings are consistent with benefits from folate use among adults with hypertension and low baseline folate levels.

來源出版物：JAMA, 2015, 313(13):1325-35

Early chronic obstructive pulmonary disease: Definition, assessment, and prevention

Rennard, Stephen I; Drummond, M. Bradley

Abstract: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. COPD, however, is a heterogeneous collection of diseases with differing causes, pathogenic mechanisms, and physiological effects. Therefore a comprehensive approach to COPD prevention will need to address the complexity of COPD. Advances in the understanding of the natural history of COPD and the development of strategies toassess COPD in its early stages make prevention a reasonable, if ambitious, goal.

來源出版物：Lancet, 2015, 385(9979): 1778-1788

Antioxidant phytochemicals for the prevention and treatment of chronic diseases

Zhang, Yujie; Gan, Renyou; Li, Sha; et al.

Abstract: Overproduction of oxidants (reactive oxygen species and reactive nitrogen species) in the human body is responsible for the pathogenesis of some diseases. The scavenging of these oxidants is thought to be an effective measure to depress the level of oxidative stress of organisms. It has been reported that intake of vegetables and fruits is inversely associated with the risk of many chronic diseases, and antioxidant phytochemicals in vegetables and fruits are considered to be responsible for these health benefits. Antioxidant phytochemicals can be found in many foods and medicinal plants, and play an important role in the prevention and treatment of chronic diseases caused by oxidative stress. They often possess strong antioxidant and free radical scavenging abilities, as well as anti-inflammatory action, which are also the basis of other bioactivities and health benefits, such as anticancer, anti-aging, and protective action for cardiovascular diseases, diabetes mellitus, obesity and neurodegenerative diseases. This review summarizes recent progress on the health benefits of antioxidant phytochemicals, and discusses their potential mechanisms in the prevention and treatment of chronic diseases.

Keywords: antioxidant phytochemicals; health benefits; mechanism; cardiovascular disease; cancer

來源出版物： Molecules, 2015, 20(12): 21138-21156 interventions will prevent, mitigate, and treat obesity and its related diseases. Challenges with the implementation of this model include provider training, the need to provide incentives for health systems to move beyond clinical care to link with community systems, and addressing the multiple elements necessary for integration within clinical care and with social systems. The Affordable Care Act, with its emphasis on prevention and new systems for care delivery, provides support for innovative strategies such as those proposed here.

來源出版物：Health Affairs, 2015, 34(9): 1456-1463

An integrated framework for the prevention and treatment of obesity and its related chronic diseases

Dietz, William H.; Solomon, Loel S; Pronk, Nico; et al.

Abstract: Improved patient experience, population health, and reduced cost of care for patients with obesity and other chronic diseases will not be achieved by clinical interventions alone. We offer here a new iteration of the Chronic Care Model that integrates clinical and community systems to address chronic diseases. Obesity contributes substantially to cardiovascular disease, type 2 diabetes mellitus, and cancer. Dietary and physical activity

Oxidative stress in chronic vascular disease: From prediction to prevention

Santilli, Francesca; D’Ardes, Damiano; Davi, Giovanni; et al.

Abstract: This review article is intended to describe the strong relationship between oxidative stress and vascular disease. Reactive oxygen species (ROS) play an important role in the pathogenesis of vascular disease: oxidative stress is intimately linked to atherosclerosis, through oxidation of LDL and endothelial dysfunction, to diabetes, mainly through advanced glycation end-products (AGEs)/ receptor for AGE (RAGE) axis impairment, protein kinase C (PKC), aldose reductase (AR) and NADPH oxidase (NOX) dysfunction, and to hypertension, through reninangiotensin system (RAS) dysfunction. Several oxidative stress biomarkers have been proposed to detect oxidative stress levels and to improve our current understanding of the mechanisms underlying vascular disease. These biomarkers include ROS-generating and quenching molecules, and ROS-modified compounds, such as F-2-isoprostanes. An efficient therapeutic approach to vascular diseases cannot exclude evaluation and treatment of oxidative stress. In fact, oxidative stress represents an important target of several drugs and nutraceuticals, including antidiabetic agents, statins, renin-angiotensin system blockers, polyphenols and other antioxidants. A better understanding of the relations between atherosclerosis, diabetes, hypertension and ROS and the discovery of new oxidative stress targets will translate into consistent benefits for effective vascular disease treatment and prevention.

Keywords: Oxidative stress; Isoprostanes; Biomarkers; Hypertension; Diabetes; Antioxidants

來源出版物：Vascular Pharmacology, 2015, 74: 23-37

Canakinumab for the treatment of chronic obstructive pulmonary disease

Liu, Na; Zhuang, Shougang

Abstract: Histone deacetylases (HDACs) induce deacetylation of both histone and non-histone proteins and play a critical role in the modulation of physiological and pathological gene expression. Pharmacological inhibition of HDAC has been reported to attenuate progression of renal fibrogenesis in obstructed kidney and reduce cyst formation in polycystic kidney disease. HDAC inhibitors (HDACis) are also able to ameliorate renal lesions in diabetes nephropathy, lupus nephritis, aristolochic acid nephropathy, and transplant nephropathy. The beneficial effects of HDACis are associated with their anti-fibrosis, anti-inflammation, and immunosuppressant effects. In this review, we summarize recent advances on the treatment of various chronic kidney diseases with HDACis in pre-clinical models.

Keywords: histone deacetylases; chronic kidney diseases; renal fibrosis; renal fibroblasts

來源出版物：Frontiers in Physiology, 2015, (6): 121

Cardiac effects of current treatments of chronic obstructive pulmonary disease

Lahousse, Lies; Verhamme, Katia M; Stricker, Bruno H; et al.

Abstract: We review the cardiac safety of the drugs available at present for the maintenance treatment of chronic obstructive pulmonary disease (COPD) in stable disease, focusing on inhaled long-acting muscarinic antagonists (LAMA) and long-acting beta 2 agonists (LABA), used either as a monotherapy or as a fixed-dose combination. We report the difficulties of, and pitfalls in, the investigation of the safety of drug treatments in COPD, which is hampered by the so-called COPD trial paradox: on the one hand, COPD is defined as a systemic disease and is frequently associated with comorbidities (especially cardiovascular comorbidities), which have an important effect on the prognosis of individual patients; on the other hand, patients with COPD and cardiovascular or other coexisting illnesses are often excluded from participation in randomised controlled clinical trials. In these trials, inhaled long-acting bronchodilators, both LAMA or LABA, or both, seem to be safe when used in the appropriate dose in adherent patients with COPD without uncontrolled cardiovascular disease or other notable comorbidities. However, the cardiac safety of LAMA and LABA is less evident when used inappropriately (eg, overdosing) or in patients with COPD and substantial cardiovascular disease, prolonged QTc interval, or polypharmacy. Potential warnings about rare cardiac events caused by COPD treatment from meta-analyses and observational studies need to be confirmed in high quality large randomised controlled trials. Finally, we briefly cover the cardiac safety issues of chronic oral drug treatments for COPD, encompassing theophylline, phosphodiesterase inhibitors, and macrolides.

來源出版物：Lancet Respiratory Medicine, 2016, 4(2): 149-164

Chronic low-dose melatonin treatment maintains nigrostriatal integrity in an intrastriatal rotenone model of Parkinson’s disease

Carriere, Candace H; Kang, Na Hyea; Niles, Lennard P

Abstract: Quantitative risk assessment and risk management processes are critically examined in the context of their applicability to the statistically infrequent and sometimes unforeseen events that trigger major disasters. While of value when applied at regional or larger scales by governments and insurance companies, these processes do not provide a rational basis for reducing the impacts of major disasters at the local (community) level because in any given locality disaster events occur too infrequently for their future occurrence in a realistic timeframe to be accurately predicted by statistics. Given that regional and national strategies for disaster reduction cannot be effective without effective local disaster reduction measures, this is a significant problem. Instead, we suggest that communities, local government officials, civil society organisations and scientists could usefully form teams to co-develop local hazard event and effects scenarios, around which the teams can then develop realistic long-term plans for building local resilience. These plans may also be of value in reducing the impacts of other disasters, and are likely to have the additional benefits of improving science development, relevance and uptake, and of enhancing communication between scientists and the public.

Keywords: disaster risk quantification; risk management; community resilience; event and effects scenarios; coproduction of knowledge

來 源 出 版 物 ： International Journal of Disaster Risk Reduction, 2015, 13: 242-247

Cardiac effects of current treatments of chronic obstructive pulmonary disease

Lahousse, Lies; Verhamme, Katia M; Stricker, Bruno H; et al.

Abstract: We review the cardiac safety of the drugs available at present for the maintenance treatment of chronic obstructive pulmonary disease (COPD) in stable disease, focusing on inhaled long-acting muscarinic antagonists (LAMA) and long-acting beta 2 agonists (LABA), used either as a monotherapy or as a fixed-dose combination. We report the difficulties of, and pitfalls in, the investigation of the safety of drug treatments in COPD, which is hampered by the so-called COPD trial paradox: on the one hand, COPD is defined as a systemic disease and is frequently associated with comorbidities (especially cardiovascular comorbidities), which have an important effect on the prognosis of individual patients; on the other hand, patients with COPD and cardiovascular or other coexisting illnesses are often excluded from participation in randomised controlled clinical trials. In these trials, inhaled long-acting bronchodilators, both LAMA or LABA, or both, seem to be safe when used in the appropriate dose in adherent patients with COPD without uncontrolled cardiovascular disease or other notable comorbidities. However, the cardiac safety of LAMA and LABA is less evident when used inappropriately (eg, overdosing) or in patients with COPD and substantial cardiovascular disease, prolonged QTc interval, or polypharmacy. Potential warnings about rare cardiac events caused by COPD treatment from meta-analyses and observational studies need to be confirmed in high quality large randomised controlled trials. Finally, we briefly cover the cardiac safety issues of chronic oral drug treatments for COPD, encompassing theophylline, phosphodiesterase inhibitors, and macrolides.

來源出版物：Lancet Respiratory Medicine, 2016, 4(2): 149-164 on 3367 hypertensive participants in the Chronic Renal Insufficiency Cohort (CRIC) to determine prevalence, associations, and clinical outcomes of ATRH in nondialysis chronic kidney disease patients. ATRH was defined as blood pressure 140/90 mm Hg on 3 antihypertensives, or use of 4 antihypertensives with blood pressure at goal at baseline visit. Prevalence of ATRH was 40.4%. Older age, male sex, black race, diabetes mellitus, and higher body mass index were independently associated with higher odds of having ATRH. Participants with ATRH had a higher risk of clinical events than participants without ATRHcomposite of myocardial infarction, stroke, peripheral arterial disease, congestive heart failure (CHF), and all-cause mortality (hazard ratio [95% confidence interval], 1.38 [1.22-1.56]); renal events (1.28 [1.11-1.46]); CHF (1.66 [1.38-2.00]); and all-cause mortality (1.24 [1.06-1.45]). The subset of participants with ATRH and blood pressure at goal on 4 medications also had higher risk for composite of myocardial infarction, stroke, peripheral arterial disease, CHF, and all-cause mortality (hazard ratio [95% confidence interval], (1.30 [1.12-1.51]) and CHF (1.59 [1.28-1.99]) than those without ATRH. ATRH was associated with significantly higher risk for CHF and renal events only among those with estimated glomerular filtration rate 30 mL/min per 1.73 m2. Our findings show that ATRH is common and associated with high risk of adverse outcomes in a cohort of patients with chronic kidney disease. This underscores the need for early identification and management of patients with ATRH and chronic kidney disease.

Keywords: antihypertensive agents; hypertension; hypertension resistant to conventional therapy; myocardial infarction; renal insufficiency; chronic

來源出版物：Hypertension, 2016, 67(2): 387-396

Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease report from the chronic renal insufficiency cohort study

Thomas, George; Xie, Dawei; Chen, Hsiangyu; et al.

Abstract: The association between apparent treatment resistant hypertension (ATRH) and clinical outcomes is not well studied in chronic kidney disease. We analyzed data

Chronic disease prevention tobacco avoidance, physical activity, and nutrition for a healthy start

Qamar, Arman; Bhatt, Deepak L

Abstract: The efficacy of adjusted-dose warfarin for prevention of stroke in atrial fibrillation patients with stage 3 chronic kidney disease (CKD) is unknown.Patients with stage 3 CKD participating in the Stroke Prevention in Atrial Fibrillation 3 trials were assessed to determine the effect of warfarin anticoagulation on stroke and major hemorrhage, and whether CKD status independently contributed to stroke risk. High-risk participants (n = 1044)in the randomized trial were assigned to adjusted-dose warfarin (target international normalized ratio 2 to 3) versus aspirin (325 mg) plus fixed, low-dose warfarin (subsequently shown to be equivalent to aspirin alone). Low-risk participants (n = 892) all received 325 mg aspirin daily. The primary outcome was ischemic stroke (96%) or systemic embolism (4%). Among the 1936 participants in the two trials, 42% (n = 805) had stage 3 CKD at entry. Considering the 1314 patients not assigned to adjusted-dose warfarin, the primary event rate was double among those with stage 3 CKD (hazard ratio 2.0, 95% CI 1.2, 3.3) versus those with a higher estimated GFR (eGFR). Among the 516 participants with stage 3 CKD included in the randomized trial, ischemic stroke/systemic embolism was reduced 76% (95% CI 42, 90; P＜0.001) by adjusted-dose warfarin compared with aspirin/low-dose warfarin; there was no difference in major hemorrhage (5 patients versus 6 patients, respectively).Among atrial fibrillation patients participating in the Stroke Prevention in Atrial Fibrillation III trials, stage 3 CKD was associated with higher rates of ischemic stroke/systemic embolism. Adjusted-dose warfarin markedly reduced ischemic stroke/systemic embolism in high-risk atrial fibrillation patients with stage 3 CKD.

來源出版物：Circulation, 2016, 133(15):1512-1515

Burden and prevention of adverse cardiac events in patients with concomitant chronic heart failure and coronary artery disease: A literature review

Lavoie, Louis; Khoury, Hanane; Welner, Sharon; et al.

Abstract: Background: Chronic heart failure (HF) or coronary artery disease (CAD) confers risk for thromboembolism and secondary adverse cardiac events (ACEs) (e. g., mortality, myocardial infarction, and stroke). When HF and CAD occur concomitantly, ACE risk is reported to be elevated. We investigated ACEs, their epidemiology, and the resulting burden among patients with concomitant HF and CAD through a structured review of recent literature. Antithrombotic treatment for ACE prevention was assessed. Methods: Pertinent databases (PubMed, other) were searched for relevant articles published from January 2004 to March 2015. Data collected included ACE incidence, healthcare resource use, costs, change in quality of life attributed to ACEs, and treatment practice for prevention of ACEs in patients with concomitant HF and CAD. Results: Mortality rates for patients with both HF and CAD ranged from 4.9%-12.3% at 30 days to 13.7%-86% for periods between 9.9 months and 10 years. Incidence of ACEs among HF patients with CAD is, respectively, at least 82% and 15% higher than for patients without HF or without CAD, except for stroke investigated in two studies. All-cause and HF-related hospitalization is the main driver of the economic burden in patients with HF, the majority of whom had CAD origin. Despite high prevalence of ischemic complications, there is limited evidence to support the use of warfarin-type antithrombotics among HF patients. Conclusion: This study confirms that patients with concomitant HF and CAD are at elevated risk for ACEs and suggests the need for effective new antithrombotic treatments to further decrease ischemic complication rates in this population.

Keywords: adverse cardiac events; antithrombotics; coronary artery disease; heart failure

來源出版物：Cardiovascular Therapeutics, 2016, 34(3): 152-160

Cause-specific mortality for 240 causes in China during 1990-2013: A systematic subnational analysis for the Global Burden of Disease Study 2013

Zhou M; Wang H; Zhu J; et al.

Abstract: Background: China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China. Methods: Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013. Findings: All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4.0 years in Hebei province to 14.2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0-14, 15-49, and 50-74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990. Interpretation: Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems.

來源出版物：Lancet, 2016, 387(10015): 251-272

Fresh fruit consumption and major cardiovascular disease in China

H Du; L Li; D Bennett

Abstract: In Western populations, a higher level of fruit consumption has been associated with a lower risk of cardiovascular disease, but little is known about such associations in China, where the consumption level is low and rates of stroke are high. Between 2004 and 2008, we recruited 512891 adults, 30 to 79 years of age, from 10 diverse localities in China. During 3.2 million personyears of follow-up, 5173 deaths from cardiovascular disease, 2551 incident major coronary events (fatal or nonfatal), 14579 ischemic strokes, and 3523 intracerebral hemorrhages were recorded among the 451,665 participants who did not have a history of cardiovascular disease or antihypertensive treatments at baseline. Cox regression yielded adjusted hazard ratios relating fresh fruit consumption to disease rates. Overall, 18.0% of participants reported consuming fresh fruit daily. As compared with participants who never or rarely consumed fresh fruit (the “nonconsumption” category), those who ate fresh fruit daily had lower systolic blood pressure (by 4.0 mm Hg) and blood glucose levels (by 0.5 mmol per liter [9.0 mg per deciliter]) (P＜0.001 for trend for both comparisons). The adjusted hazard ratios for daily consumption versus nonconsumption were 0.60 (95% confidence interval [CI], 0.54 to 0.67) for cardiovascular death, and 0.66 (95% CI, 0.58 to 0.75), 0.75 (95% CI, 0.72 to 0.79), and 0.64 (95% CI, 0.56 to 0.74), respectively, for incident major coronary events, ischemic stroke, and hemorrhagic stroke. There was a strong log-linear dose-response relationship between the incidence of each outcome and the amount of fresh fruit consumed. These associations were similar across the 10 study regions and in subgroups of participants defined by baseline characteristics. Among Chinese adults, a higher level of fruit consumption was associated with lower blood pressure and blood glucose levels and, largely independent of these and other dietary and nondietary factors, with significantly lower risks of major cardiovascular diseases.

來源出版物：New England Journal of Medicine, 2016, 374(14): 1332

責(zé)任編輯：衛(wèi)夏雯

Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA

Wieland, M.; Pittore, M; Parolai, S; et al.

With non-communicable conditions accounting for nearly two-thirds of deaths worldwide, the emergence of chronic diseases as the predominant challenge to global health is undisputed. In the USA, chronic diseases are the main causes of poor health, disability, and death, and account for most of health-care expenditures. The chronic disease burden in the USA largely results from a short list of risk factors-including tobacco use, poor diet and physical inactivity (both strongly associated with obesity), excessive alcohol consumption, uncontrolled high blood pressure, and hyperlipidaemia-that can be effectively addressed for individuals and populations. Increases in the burden of chronic diseases are attributable to incidence and prevalence of leading chronic conditions and risk factors (which occur individually and in combination), and population demographics, including ageing and health disparities. To effectively and equitably address the chronic disease burden, public health and health-care systems need to deploy integrated approaches that bundle strategies and interventions, address many risk factors and conditions simultaneously, create population-wide changes, help the population subgroups most affected, and rely on implementation by many sectors, including public-private partnerships and involvement from all stakeholders. To help to meet the chronic disease burden, the US Centers for Disease Control and Prevention (CDC) uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programmes; (2) environmental approaches that promote health and support healthy behaviours; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. Establishment of community conditions to support healthy behaviours and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health-care system. Collectively, these four strategies will prevent the occurrence of chronic diseases, foster early detection and slow disease progression in people with chronic conditions, reduce complications, support an improved quality of life, and reduce demand on the health-care system. Of crucial importance, with strengthened collaboration between the public health and health-care sectors, the health-care system better uses prevention and early detection services, and population health is improved and sustained by solidifying collaborations between communities and health-care providers. This collaborative approach will improve health equity by building communities that promote health rather than disease, have more accessibleand direct care, and focus the health-care system on improving population health.來源出版物：Lancet, 2014, 384(9937): 45-52Towards a paradigm shift in the treatment of chronic chagas diseaseViotti, R; Alarcon de Noya, B; Araujo-Jorge, T; et al.Abstract: Treatment for Chagas disease with currently available medications is recommended universally only for acute cases (all ages) and for children up to 14 years old. The World Health Organization, however, also recommends specific antiparasite treatment for all chronic-phase Trypanosoma cruzi-infected individuals, even though in current medical practice this remains controversial, and most physicians only prescribe palliative treatment for adult Chagas patients with dilated cardiomyopathy. The present opinion, prepared by members of the NHEPACHA network (Nuevas Herramientas parael Diagnóstico y la Evaluación del Paciente con Enfermedad de Chagas/New Tools for the Diagnosis and Evaluation of Chagas Disease Patients), reviews the paradigm shift based on clinical and immunological evidence and argues in favor of antiparasitic treatment for all chronic patients. We review the tools needed to monitor therapeutic efficacy and the potential criteria for evaluation of treatment efficacy beyond parasitological cure. Etiological treatment should now be mandatory for all adult chronic Chagas disease patients.來源出版物：Antimicrobial Agents and Chemotherapy, 2014, 58(2): 635-639Bicarbonate therapy for prevention of chronic kidney disease progressionLoniewski, Igor; Wesson, Donald E; et al.Abstract: Kidney injury in chronic kidney disease (CKD) is likely multifactorial, but recent data support that a component is mediated by mechanisms used by the kidney to increase acidification in response to an acid challenge to systemic acid-base status. If so, systemic alkalization might attenuate this acid-induced component of kidney injury. An acid challenge to systemic acid-base status increases nephron acidification through increased production of endothelin, aldosterone, and angiotensin II, each of which can contribute to kidney inflammation and fibrosis that characterizes CKD. Systemic alkalization that ameliorates an acid challenge might attenuate the contributions of angiotensin II, endothelin, and aldosterone to kidney injury. Some small clinical studies support the efficacy of alkalization in attenuating kidney injury and slowing glomerular filtration rate decline in CKD. This review focuses on the potential that orally administered NaHCO3prevents CKD progression and additionally addresses its mechanism of action, side effects, possible complications, dosage, interaction, galenic form description, and contraindications. Current National Kidney Foundation guidelines recommend oral alkali, including NaHCO－3, in CKD patients with serum HCO－3＜22mmol/L. Although oral alkali can be provided by other medications and by base-inducing dietary constituents, oral NaHCO3will be the focus of this review because of its relative safety and apparent efficacy, and its comparatively low cost.

alkali therapy; bicarbonate; chronic kidney disease