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期刊信息/Journal information
中华健康管理学杂志
中华医学会杂志社
中华健康管理学杂志

中华医学会杂志社

白书忠

双月刊

1674-0815

zhjkgl@cma.org.cn

010-85158816

100710

北京市东城区东四西大街42号

中华健康管理学杂志/Journal Chinese Journal of Health ManagementCSCDCSTPCD北大核心
查看更多>>2007年10月创刊，中国科协主管，中华医学会主办。本刊是我国健康管理学领域唯一的一本学术期刊。2009年6月进入中国科技论文统计源期刊（中国科技核心期刊）。主要栏目：述评、专家论坛、标准与规范、论著、短篇论著、综述、学术争鸣、健康体检、健康评估与控制、慢性疾病管理、社区卫生、中医健康管理、继续教育园地、国内学术动态、国外健康管理动态、新技术研发与应用、经验与信息交流、健康管理服务导航、健康管理师、模式探讨、健康科普理论与实践、心理健康管理、个案报道、讲座、功能医学、妇幼健康管理、健康视点等。
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    成人代谢综合征防控健康教育专家共识

    刘绍辉莫龙宋国营
    81-92页
    查看更多>>摘要：代谢综合征是腹型肥胖、血糖异常、血脂异常和高血压等聚集发病，严重影响机体健康的临床综合征，是心脑血管疾病、糖尿病、痛风等多种疾病的共同病因。随着人口老龄化和超重肥胖的日趋严重，代谢综合征的发病率在全球范围内呈逐年上升趋势，已成为全球范围内危害人类健康的重要公共卫生问题。对于代谢综合征的防控，主要是生活方式改变及药物治疗，其中，以健康教育为基础的治疗性生活方式改善，为其根本和首要防控措施。然而从公共卫生管理实际现状来看，我国代谢综合征防控健康教育存在方法针对性不强、内容欠全面及教育效果不佳等问题，亟待规范代谢综合征预防与控制相关健康教育的方法、内容和流程。本共识采纳大规模循证证据，结合我国实际情况和文化特点，对成人代谢综合征防控健康教育的目标、理论模式、方法、媒介、流程、内容及效果评价等方面组织国内相关领域专家进行多轮讨论达成共识，以指导医护人员规范开展成人代谢综合征防控健康教育，提高我国代谢综合征防治水平和人群健康素养，从而降低代谢综合征及其并发症的发生率。

    代谢综合征预防与控制健康教育自我管理能力共识

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    基层中医药健康管理服务质量影响因素模型构建及政策建议

    王文婷任建萍周冯晨刘克宁...
    93-98页
    查看更多>>摘要：目的 构建基层中医药健康管理服务质量影响因素模型，并提出相应的政策建议。 方法 本研究为横断面研究，采用典型抽样和随机抽样相结合的方法，于2022年8—10月抽取浙江省15个社区39名基层中医药健康管理服务知情人，针对服务开展项目、实施效果和影响因素进行访谈，基于扎根理论研究方法对访谈记录进行三级编码，根据编码后结果构建基层中医药健康管理服务质量影响因素模型，并提出相应的政策建议。 结果 对39份原始访谈资料进行开放式编码，共获得516个参考点，形成了与主题相关的53个初始概念，并归纳为17个一级范畴。通过主轴编码进一步归纳，提取出“政策环境”“健康素养”“社区定位”“能力建设”“健康偏好”“利益冲突”6个主范畴，通过选择式编码分析6个主范畴之间的逻辑关联，以服务质量影响因素的故事线为基础构建了影响因素模型。该模型的故事线为：首先，政策环境是服务质量的外部保障；其次，作为服务需求侧，居民的健康素养、健康偏好是服务质量的调节因素；最后，社区作为服务供给侧，服务能力是关键影响因素，社区职能和目标定位是内驱因素，内/外部利益冲突则对服务质量起到反向制约作用。 结论 现阶段对基层中医药外部政策环境保障力度有限，服务需求侧重视不足，服务供给侧功能也存在缺位，应进一步完善外部政策环境，深化中医药服务领域的供需对接，持续推进基层中医药服务能力建设，平衡中医药相关部门利益，进而提升服务质量。 Objective To construct the impact factor model of primary traditional Chinese medicine (TCM) health management service quality, and put forward corresponding policy suggestions. Methods In this cross-sectional study, the typical sampling and random sampling method were used to select 39 insiders of primary TCM health management service from 15 communities in Zhejiang Province from August to October in 2022. Interviews on service projects, implementation effects and impact factors were conducted, the three-level coding of interview record was carried out using the grounded theory research method, a model of impact factor for health management service quality of basic TCM was constructed, and the corresponding policy recommendations were put forward. Results Based on the open coding of 39 original interview data, a total of 516 reference points were obtained, and 53 initial concepts related to the topic were formed and summarized into 17 first-level categories. Through the summary of main axis coding, 6 main categories of “policy environment”，“health literacy”，“community orientation”，“capacity building”，“health preference” and “conflict of interest” were extracted. The logical correlation between the six main categories were analyzed with selective coding, an impact factor model was constructed in accordance with the story line of factors affecting service quality. The story line of this model was as follows: first, the policy environment was the external guarantee of community TCM service quality second, as the demand-side of the services, the health literacy and requirement of residents was the regulatory factor for service quality in addition, the community played the role of the supply-side of the services, the service ability construction was the key factor, and the community functions and target orientation was the internal driving factor, meanwhile, the internal/external conflicts of interest had a negative constraint on the service quality. Conclusions The guarantee intensity of external policy environment is limited, the service demand side pays insufficient attention, and the service supply side functions are absent at the present stage. It is necessary to improve the external policy environment, deepen the connection between supply and demand sides in the field of TCM health service, promote the capacity building of TCM service at the grass-roots level, balance the interests of relevant departments of TCM service, in order to improve the quality of TCM health management service at the grass-roots level.

    中医药基层卫生服务健康管理质量影响因素

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    基于数据包络分析法的医养结合型养老机构中护理人力资源效率评价指标体系的构建及评价

    何明欣李艳艳杨雅楼朱宏锐...
    99-106页
    查看更多>>摘要：目的 基于数据包络分析法（DEA）构建医养结合型养老机构护理人力资源效率评价指标体系并进行评价。 方法 本研究属于横断面调查研究。运用文献研究及调查法初步建立护理人力资源效率评价指标体系库，采用德尔菲法对17名专家（护理管理、养老机构管理、医养结合型养老机构管理、卫生经济学管理、公共卫生等领域的专家）展开两轮函询。通过专家积极性、专家权威程度、专家意见集中程度与协调程度等因素判断指标体系的可靠性，结合专家意见对指标进行调整、修改及完善，以确立最终的指标体系。并于2022年8—12月在该指标体系基础上运用DEA模型对海口市12家医养结合型养老机构进行效率评价。 结果 构建的评价指标体系分为3级68项，包括一级指标9项，二级指标19项，三级指标40项。两轮专家函询积极系数为100%和94.1%，权威系数为0.88与0.92，肯德尔和谐系数为0.471和0.348，变异系数均值为0.16和0.12（P<0.001）。DEA评价的12家医养结合型养老机构结果显示，综合效率（OE）、技术效率（TE）和规模效率（SE）值均为1.000的DEA有效机构有5家；非DEA有效机构有7家，其中包括SE值<1.000但TE值=1.000的4家，SE值及TE值均<1.000的3家。 结论 构建的评价指标体系其函询专家的参与积极性高，权威系数和协调度好，对指标体系认可性高，内容涵盖全面、层次分明、可获取强、具有较强的专科特性。DEA模型评价的结果能客观有效地反映医养结合型养老机构护理人力资源效率发挥情况，实用性较强。 Objective To construct an evaluation indicator system for the efficiency of nursing human resources in integrated medical and elderly care institutions using Data Envelopment Analysis (DEA) and subsequently evaluate its effectiveness. Methods This cross-sectional survey utilized literature review and investigative methods to initially establish a library of evaluation indicators for nursing human resource efficiency. The Delphi method was employed in two rounds of consultations with 17 experts from various fields, including nursing management, elderly care institution management, integrated medical and elderly care institution management, health economics management, and public health. The reliability of the indicator system was assessed based on factors such as expert enthusiasm, authority, concentration of opinions, and coordination. Adjustments, modifications, and improvements were made to the indicators based on expert opinions to establish the final indicator system. From August to December 2022, the DEA model was applied to evaluate the efficiency of 12 integrated medical and elderly care institutions in Haikou city based on this indicator system. Results The constructed evaluation indicator system comprised 68 items divided into three levels: 9 primary indicators, 19 secondary indicators, and 40 tertiary indicators. The positive coefficients of the two rounds of expert consultations were 100% and 94.1%, with authority coefficients of 0.88 and 0.92, Kendall harmony coefficients of 0.471 and 0.348, and mean coefficients of variation of 0.16 and 0.12 (P<0.001). DEA evaluation results for the 12 integrated medical and elderly care institutions showed that 5 were DEA effective institutions with comprehensive efficiency (OE), technical efficiency (TE), and scale efficiency (SE) values all equal to 1.000, while 7 were non-DEA effective institutions, including 4 with SE <1.000 but TE=1.000 and 3 with both SE and TE<1.000. Conclusions The constructed evaluation indicator system demonstrates high enthusiasm, authority coefficients, and coordination in expert consultations, indicating high acceptability and comprehensive content with distinct levels and strong specialty characteristics. The DEA model′s evaluation results objectively and effectively reflect the efficiency of nursing human resources in integrated medical and elderly care institutions, demonstrating practical utility.

    护理卫生资源效率评价养老机构医养结合数据包络分析

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    浙江省15~69岁居民不同慢性病患病状况下的健康素养水平及其影响因素分析

    胡秀静姚丁铭徐越陈赫妮...
    107-113页
    查看更多>>摘要：目的 分析浙江省15~69岁居民不同慢性病患病状况下的健康素养水平及其影响因素。 方法 本研究为横断面研究，采用分层多阶段整群随机抽样方法，于2022年6—11月在浙江省30个监测点抽取19 200名15~69岁常住居民，使用《全国居民健康素养监测调查问卷》展开入户问卷调查。调查内容包括社会人口学特征、健康相关因素及健康素养水平等。共发放问卷19 200份，收回问卷19 051份，其中有效问卷18 857份（98.98%）。采用χ2检验比较居民不同慢性病患病状况下的健康素养水平，采用logistic回归分析其影响因素。 结果 2022年浙江省15~69岁居民健康素养具备率为38.36%，其中多重慢性病患者的健康素养具备率显著低于单一慢性病患者及未患慢性病者（14.70%比25.37%、42.21%）（χ2=483.05，P<0.001）。患有多重慢性病与健康素养不足呈正相关（OR=1.26，95%CI：1.01~1.58），多重慢性病患者在基本知识和理念（OR=1.29，95%CI：1.03~1.63）、健康生活方式与行为（OR=1.24，95%CI：1.01~1.53）、基本技能（OR=1.37，95%CI：1.11~1.69）以及健康信息（OR=1.27，95%CI：1.08~1.50）维度素养不足的概率均显著高于未患慢性病者（OR=1.00）。 结论 慢性病种数是影响居民健康素养水平的关键因素，多重慢性病患者常伴有更高的健康素养不足风险。 Objective To investigate the level of health literacy and its influencing factors among residents aged 15-69 years with different chronic disease in Zhejiang Province. Methods In this cross-sectional study, a stratified multistage whole cluster random sampling method was used to select 19 200 permanent residents aged 15-69 years from 30 monitoring sites in Zhejiang Province from June to November 2022, and a household questionnaire survey was carried out with the National Health Literacy Monitoring Questionnaire for the Population. The content of the survey included socio-demographic characteristics, health-related factors and health literacy level. A total of 19 200 questionnaires were distributed and 19 051 were collected, of which 18 857 (98.98%) were valid. The χ2 test was used to compare the health literacy levels of residents with different chronic diseases, and logistic regression was used to analyze the influencing factors of the health literacy levels. Results The health literacy level of residents aged 15-69 in Zhejiang Province in 2022 was 38.36%. Among them, the health literacy level of patients with multiple chronic diseases was much lower than those with single chronic disease and those without chronic disease (14.70% vs 25.37%, 42.21%) (χ2=483.05, P<0.001). It was positively associated between having multiple chronic diseases and insufficient health literacy (OR=1.26, 95%CI: 1.01-1.58) compared with those without chronic disease (OR=1.00), patients with multiple chronic diseases were significantly more likely to have inadequate health literacy in basic knowledge and concepts (OR=1.29, 95%CI: 1.03-1.63), health behaviors (OR=1.24, 95%CI: 1.01-1.53), basic skills (OR=1.37, 95%CI: 1.11-1.69), and health information literacy (OR=1.27, 95%CI: 1.08-1.50). Conclusions The number of chronic diseases is a key factor that affects the residents′ health literacy level, and people with multiple chronic diseases are often associated with a higher risk of inadequate health literacy.

    健康素养慢性病横断面研究

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    个体和区域层面社会经济学特征对中老年人抑郁症状的影响——基于中国健康与养老追踪调查数据的分析

    张旭王子元周书铎宋国营...
    114-119页
    查看更多>>摘要：目的 基于中国健康与养老追踪调查数据分析个体和区域层面社会经济学特征对中老年人抑郁症状的影响。 方法 本研究采用队列研究设计，基于运用中国健康与养老追踪调查的数据，筛选基线调查中无抑郁的研究对象，追踪观察随访7年过程中入选对象出现抑郁症状的情况，采用描述性统计分析、多因素logistic分析、交叉分析等方法，分析性别、个人年收入、受教育程度、城乡和地区等因素对中老年人抑郁症状的影响。 结果 7年追踪随访结果显示，研究对象抑郁症状的检出率是42.24%；女性出现抑郁症状的风险显著高于男性（OR=1.782）；中学（包括中专）、小学及以下出现抑郁症状的风险显著高于大专及以上者（OR=1.476、2.134）；年收入≤10 000元者出现抑郁症状的风险显著高于年收入>10 000元者（OR=1.251）；同时，农村地区出现抑郁症状风险显著高于城市（OR=1.389）；中部和西部地区出现抑郁症状的风险显著高于东部地区（OR=1.342、1.730）。联合作用结果显示，与高收入高学历男性相比，低收入低学历女性、高收入低学历女性、低收入中等学历女性、高收入中等学历女性出现抑郁症状的风险比值排在前4位（OR=5.050、3.662、3.047、2.641）；与东部城市男性相比，西部农村女性、中部农村女性、西部城市女性、东部农村女性出现抑郁症状的风险比值排在前4位（OR=4.286、3.216、2.642、2.158）。 结论 个体和区域层面社会经济学因素对中老年人抑郁症状的患病风险有显著影响，应加强对低社会经济地位中老年人的精神健康管理。 Objective To analyze the impact of individual and regional level socioeconomic characteristics on the mental health of middle-aged and older adults based on data from the China Health and Retirement Longitudinal Study. Methods This study was a cohort study. Using the data from the China Health and Retirement Longitudinal Study, subjects without depression were screened in the baseline survey, the depression status of the selected subjects was tracked and observed for seven years. Descriptive statistical analysis, multivariate logistic analysis, joint analysis were used to analyze the influence of factors such as gender, personal annual income, education level, urban and rural areas, and eastern, central, and western regions on the risk of depression among middle-aged and elderly people. Results The 7-year follow-up results showed that the prevalence of depression symptoms in the study subjects was 42.24% compared with men, women′s risk of developing depression symptoms was significantly increased (OR=1.782) compared with junior college education and above, middle school (including technical secondary school), primary and lower education levels had a significantly increased risk of developing depression symptoms (OR=1.476, 2.134) compared with annual income of more than 10 000 yuan, subjects with an annual income of 10 000 yuan or below had significantly increased risk of developing depression symptoms (OR=1.251). At the same time, compared with the urban area, the risk of developing depression symptoms was significantly increased in the rural areas (OR=1.389). Compared with the eastern area, the risk of developing depression symptoms was significantly higher in the central and western areas (OR=1.342, 1.730). The joint analysis results showed that compared with high-income and high-education men, low-income low-education women, high-income low-education women, low-income middle-education women, and high-income middle-education women were at the top four odd ratios for developing depression symptoms (OR=5.050, 3.662, 3.047, 2.641) compared with men in eastern cities, rural women in the west, rural women in the middle, women in the western cities, and rural women in the east ranked the first four odd ratios for developing depression symptoms (OR=4.286, 3.216, 2.642, 2.158). Conclusion Socioeconomic factors at the individual and regional levels have a significant impact on the risk of developing depressive symptoms in middle-aged and older adults, and mental health management of middle-aged and older adults with low socioeconomic status should be strengthened.

    抑郁中老年人社会经济因素健康管理

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    正常体重人群中基于定量CT技术测量内脏脂肪面积与脂肪肝的相关性

    乔琦周阳孙永兵戚昕...
    120-126页
    查看更多>>摘要：目的 分析正常体重人群中基于定量CT（QCT）技术测量内脏脂肪面积与脂肪肝的相关性。 方法 本研究为横断面研究。选取2021年1至12月于河南省人民医院健康管理学科行胸部CT联合QCT检查的1 305名体检者为研究对象，QCT测量腰2锥体中心层面体质成分，包括皮下脂肪面积（SFA）、内脏脂肪面积（VFA）及肝脏脂肪含量（LFC），收集血脂、血糖等代谢指标。采用t检验、χ2检验分析LFC和脂肪肝检出率与年龄、性别相关性。根据VFA<100 cm2、100 cm2≤VFA<150 cm2、VFA≥150 cm2将体检者分为3组，采用单因素方差分析和χ2检验进行组间比较。以多元线性回归分析VFA及代谢指标与LFC的相关性。 结果 1 305例体检者中男634例，女671例。正常体重指数（BMI）人群脂肪肝检出率65.67%，男性和女性检出率分别为72.71%、59.02%（χ²=27.12，P<0.001），LFC及脂肪肝检出率随年龄增加而增长（均P<0.05）。随着VFA增高，年龄、BMI、SFA、LFC、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇、空腹血糖（FBG）、丙氨酸转氨酶（ALT）、血尿酸及脂肪肝患病率递增（均P<0.05），低密度脂蛋白胆固醇递减（P<0.001）。多元线性回归分析显示，校正年龄因素后，无论男、女性，LFC与VFA、BMI、ALT均呈独立正相关（男性β=0.206、0.145、0.174，女性β=0.194、0.150、0.184；均P<0.05）；FBG与男性独立正相关（β=0.134，P<0.001）；与女性独立相关的指标有TC、TG、血尿酸（β=-0.121、0.145、0.141，均P<0.05）。 结论 在BMI正常健康体检人群中，基于QCT技术测量VFA与脂肪肝关系密切。 Objective To analyze the association between visceral fat area (VFA) and fatty liver based on quantitative CT (QCT) in people receiving health examination with normal body mass index (BMI). Methods A cross-sectional study. A total of 1 305 physical examiners who underwent chest CT and QCT examination in the Department of Health Management of Henan Provincial People′s Hospital from January to December 2021 were retrospectively selected as subjects. The physical components at the central level of the lumbar two cone were measured with QCT, including subcutaneous fat area (SFA), VFA and liver fat content (LFC). And the metabolic indexes, such as blood lipids and blood glucose, were collected. The t-test and χ2 test were used to analyze the correlation between the detection rate of fatty live and LFCr and age and gender. According to level of VFA (<100 cm2, 100-150 cm2 and≥150 cm2), the subjects were divided into three groups, and one-way ANOVA and χ2 test were used in comparison between groups. Multiple linear regression was used to analyze the correlation between VFA and metabolic indexes and LFC. Results Of the 1 305 subjects, there were 634 males and 671 females. The detection rate of fatty liver in normal BMI population was 65.67%, and it was 72.71% and 59.02% respectively in men and women (χ2=27.12, P<0.001), and the detection rate of fatty liver and LFC increased with age (bothP<0.05). With the increase of VFA, the age, BMI, SFA, LFC, total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), alanine aminotransferase (ALT), blood uric acid and prevalence of fatty liver increased (allP<0.05), and the low-density lipoprotein cholesterol (HDL-C) decreased (P<0.001). Multiple linear regression analysis showed that after adjustment for age factors, regardless of male or female, LFC was independently positively related with VFA, BMI, and ALT (maleβ=0.206, 0.145, 0.174, female β=0.194, 0.150, 0.184 all P<0.05). FBG was positively correlated with male independently (β=0.134 P<0.001). The indicators related to female independently were TC, TG, and blood uric acid (β=-0.121, 0.145, 0.141, all P<0.05) Conclusion In the population receiving health examination with normal BMI, the VFA measured by QCT technique is closely related to fatty liver.

    体重指数肥胖脂肪肝血生化指标相关性分析定量CT

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    肥胖人群减重术前的定量CT体质成分与代谢综合征组分的关系

    洪薇郝小军陶超殷鹏展...
    127-134页
    查看更多>>摘要：目的 探讨肥胖人群减重术前定量CT（QCT）体质成分与代谢综合征（MS）组分的关系。 方法 本研究为横断面研究，回顾性选取2021年1月至2023年3月在皖南医学院第一附属医院行减重手术的97例肥胖患者，记录其体重指数（BMI）、生化指标以及基于QCT测量的体质成分。按照不同性别、肥胖程度、MS组分数进行分组，比较各组之间体质成分的差异，同时分析各体质成分与代谢指标的相关性，采用受试者工作特征（ROC）曲线分析各体质成分对不同MS组分肥胖人群的诊断效能。 结果 肥胖患者中女性75例（77.3%）。男性肥胖人群较女性有更高的腹部总脂肪面积［（693.23±148.90）比（574.99±114.89）cm2，t=-3.958，P<0.001］、腹内脂肪面积（289.65±57.67比195.60±57.37 cm2，t=-6.753，P<0.001）、胰头脂肪含量［27.45%（21.65%，45.48%）比21.60%（17.6%，26.9%），Z=-2.675，P=0.007］及骨骼肌指数［73.36（68.74，81.26）比61.52（55.74，66.41）cm2/m2，Z=-5.246，P<0.001］。随肥胖程度的增加，腹部脂肪以皮下脂肪增加为主。随MS组分的增加（MS2组、MS3组、MS4组、MS5组），患者腹内脂肪面积、腹内脂肪/皮下脂肪、肝脏脂肪含量、胰头脂肪含量以及骨骼肌指数均随之升高。在诊断合并2项MS组分中，腹内脂肪面积的曲线下面积［AUC（95%CI）=0.706（0.577~0.834）］最大；在诊断合并3项、4项及5项MS组分中，肝脏脂肪含量的曲线下面积［AUC（95%CI）：0.712（0.605~0.818）；0.652（0.537~0.766）；0.706（0.576~0.836）］最大。 结论 合并不同MS组分数数目的肥胖患者QCT体质成分存在差异，且各体质成分与MS组分间存在相关性，其中腹内脂肪面积及肝脏脂肪含量对评估肥胖患者合并不同MS组分具有重要价值。 Objective To investigate the association between quantified CT (QCT)-measured body composition and metabolic syndrome (MS) components in obese populations before bariatric surgery. Methods A cross-sectional study. A retrospective analysis was conducted on a cohort of 97 obese patients scheduled for weight-loss surgery at the First Affiliated Hospital of Wannan Medical College from January 2021 to March 2023. The patients′ body mass index (BMI), biochemical parameters and body composition measurements obtained by QCT were recorded. The patients were stratified into groups based on gender, obesity severity and the number of MS components. Differences in body composition among the groups were compared. Additionally, the correlations between each body composition parameter and metabolic indicators were analyzed. The diagnostic efficacy of each body composition parameter for identifying obese individuals with different MS components was assessed using receiver operating characteristic (ROC) curve analysis. Results There were 75 females (77.3%). Male obese patients had higher total abdominal fat area [(693.23±148.90) vs (574.99±114.89) cm2, t=-3.958,P<0.001], visceral fat area [(289.65±57.67) vs (195.60±57.37) cm2, t=-6.753, P<0.001], fat content of pancreatic head [27.45%(21.65%, 45.48%) vs 21.60%(17.6%, 26.9%),Z=-2.675,P=0.007], and skeletal muscle index [73.36(68.74, 81.26) vs 61.52(55.74, 66.41) cm2/m2, Z=-5.246,P<0.001]. With the increase of obesity, abdominal fat mainly increases in subcutaneous fat. With the increase of MS components (MS2 group, MS3 group, MS4 group, MS5 group), the abdominal fat area, abdominal fat/subcutaneous fat, liver fat content, pancreatic head fat content, and skeletal muscle index of patients all increased accordingly. In diagnosing the presence of two components of MS, area under the curve of visceral fat area was the largest (AUC=0.706, 95%CI=0.577-0.834). For diagnosing the presence of three, four and five components of MS, area under curve of liver fat content were all the largest (MS3=0.712, 95%CI=0.605-0.818 MS4=0.652, 95%CI=0.537-0.766 MS5=0.706, 95%CI=0.576-0.836). Conclusion There are differences in QCT body composition among obese patients with different MS components, and there is a correlation between each body composition and MS component. Among them, intra-abdominal fat area and liver fat content are of great value in evaluating obese patients with different MS components.

    肥胖症代谢综合征体质成分X线计算机体层摄影

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    天津市≥18岁非吸烟人群二手烟暴露及影响因素分析

    范莉莉郑文龙辛鹏李静...
    135-140页
    查看更多>>摘要：目的 分析天津市≥18岁非吸烟人群二手烟暴露情况及其影响因素。 方法 本研究为横断面研究。以2018年天津市成人慢性病与营养监测调查中7个监测点≥18岁非现在吸烟人群为研究对象，以天津市2018年人口数据为标准人口对样本数据进行加权后，对一般人口学特征、二手烟暴露水平、对烟草危害的认知、二手烟暴露的影响因素进行分析。率的组间比较采用Pearson χ2检验，影响因素分析采用非条件logistic回归分析。 结果 经加权后，天津市≥18岁非现在吸烟人群二手烟暴露率为51.5%；非现在吸烟居民中，对吸烟导致肺癌、二手烟导致成人肺癌的知晓率最高，分别为83.3%和80.0%。对吸烟导致卒中和二手烟导致成人心脏疾病的知晓率最低，分别为61.4%和66.4%。非二手烟暴露者对吸烟会导致卒中的知晓率高于二手烟暴露者（62.7%比60.3%，P<0.05），非二手烟暴露者与二手烟暴露者对吸烟导致心脏病发作、肺癌，二手烟导致成人心脏疾病、成人肺癌、儿童肺部疾病的知晓率差异均无统计学意义（均P>0.05）。非现在吸烟居民同时知晓吸烟导致3种疾病（卒中、心脏病发作、肺癌）的比例为57.9%，同时知晓二手烟导致3种疾病（成人心脏病、肺癌、儿童肺部疾病）的比例为64.9%。男性受教育程度为本科及以上是二手烟暴露的保护因素，国家机关、党群组织企事业单位负责人、办事人员和有关人员是二手烟暴露的危险因素。女性中，年龄≥60岁、高受教育程度是二手烟暴露的保护因素。 结论 天津市≥18岁非吸烟人群二手烟暴露水平较高，对烟草暴露可导致心血管疾病的知晓率较低。应加强对相关知识的宣传普及。 Objective To analyze the passive smoking exposure and its influencing factors in non-smokers aged≥18 in Tianjin. Methods This was a cross-sectional study. Based on the 2018 Tianjin Adults Noncommunicable Disease and Nutrition Surveillance, non-smokers aged≥18 years old at 7 surveillance sites were selected as the research objects, taking 2018 population data of Tianjin as the standard population, the sample data were weighted to analyze the general demographic characteristics, the level of passive smoking exposure, the cognition of tobacco harm, and the influencing factors of passive smoking exposure. Pearson χ2 test was used to compare the rate between groups, and the influencing factors were analyzed by unconditional logistic regression. Results After weighted, the passive smoking exposure rate was 51.5%, among non-current smokers, the awareness rates of smoking related lung cancer and passive smoking related adult lung cancer were 83.3% and 80.0%, respectively. The awareness rates of smoking related stroke and passive smoking related heart disease in adults were 61.4% and 66.4%, respectively. The awareness rate that smoking related stroke was higher in the non-passive smoking exposed group than in the secondhand smoke exposed group (62.7%vs 60.3%, P<0.05). There was no statistical difference in the awareness rate of smoking related heart attacks and lung cancer as well as passive smoking related adult heart disease, adult lung cancer, and lung disease in children between the passive smoking exposed group and the non-passive smoking exposed group (allP>0.05). The awareness rate of smoking related three diseases (stroke, heart attack and lung cancer) was 57.9% and the awareness rate of passive smoking related three diseases (heart disease in adults, lung cancer and lung disease in children) was 64.9% in non-current smokers. Among men, undergraduate or above was a protective factor for second-hand smoke exposure. Heads, clerical and related personnel of state organs, party and mass organizations, enterprises and public institutions were risk factors for secondhand smoke exposure. Among women, age ≥60 years and high education were protective factors for secondhand smoke exposure. Conclusions Non smokers aged 18 and above in Tianjin have a higher level of passive smoking exposure, and the awareness rate of tobacco exposure related cardiovascular diseases is low. In future, the health education of relevant knowledge should be strengthened.

    烟草,非吸烟二手烟知晓率影响因素

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    基于海因里希法则的健康管理中心管理模式思考

    周瑜赵辉袁庆
    141-143页
    查看更多>>摘要：健康管理（体检）中心是承担人群健康检查的核心机构，然而随着医疗活动地增多和人们依法维权意识地增强，在健康管理日常工作中，将不可避免地出现纠纷或投诉，因此建立高效的医疗纠纷防范管理制度至关重要。海因里希法则是一种安全管理办法，该法则认为一切事故都是可以提前预防的。本研究以海因里希法则为基础，对医疗投诉实例进行详细的分析和反推，找到引发纠纷的关键点，并针对关键因素查缺补漏，完善体检流程，旨在从源头遏制医疗纠纷的发生，从而构建健康管理中心防范医疗投诉的新模式。

    海因里希法则多米诺骨牌理论医疗投诉医疗管理质量控制

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    神经性厌食合并肝损害肠外营养治疗1例

    王海生李昕付佳佳刘丽波...
    144-145页
    查看更多>>摘要：神经性厌食是一类由心理因素引起的以怕胖、进食行为紊乱、体重明显下降、体象障碍等为主要特征的慢性难治性精神障碍，患者因长期进食不足常导致重度营养不良，甚至合并肝功能损害，这类患者通过个性化的营养治疗可逐步改善营养状况和肝功能。本案例为1例重度营养不良合并肝功能损害的神经性厌食症患者制订了个性化的营养治疗方案，充分评估了再喂养综合征的风险后，通过肠外营养过渡到口服营养补充+膳食营养治疗方法，逐渐改善了患者的营养状况，病情稳定后好转出院。

    神经性厌食肠外营养营养不良

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