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环境与职业医学 2013年第12期30卷 962-962页

作者： Tamara Schikowski Emmanuel Schaffner Flurina Meier Harish C.Phuleria Andrea Vierktter Christian Schindler Susi Kriemler Elisabeth Zemp Ursula Krmer pierre-olivier bridevaux Thierry Rochat Joel Schwartz Nino Künzli Nicole Probst-Hensch

[背景]假设随着年龄的增长,空气污染和肥胖通过致炎特性加速肺功能减退。[目的]先前公布的以人口为基础的SAPALDIA队列研究中,空气质量改善与肺部健康之间是否存在关联。本文探讨肥胖是否会改变这一关联。[方法]使用校正的混合模型分析... 详细信息

[背景]假设随着年龄的增长,空气污染和肥胖通过致炎特性加速肺功能减退。[目的]先前公布的以人口为基础的SAPALDIA队列研究中,空气质量改善与肺部健康之间是否存在关联。本文探讨肥胖是否会改变这一关联。[方法]使用校正的混合模型分析,评估在10年的随访期间,平均身体质量指数(BMI)和空气动力学直径≤10μm的颗粒物变化(PM10;ΔPM10)与肺功能减退之间的关联。[结果]共获得4664人的肺功能数据和完整信息。与低或正常平均BMI者相比,高平均BMI者年龄相关的肺功能减退,其FVC(用力肺活量)指标下降得更快,而FEV1/FVC(1秒用力呼气量/FVC)和FEF25-75(在25%～75%肺活量时的用力呼气流量)下降的速度较慢。在低和正常BMI者中,空气质量改善与随着时间推移的FEV1/FVC、FEF25-75、FEF25-75/FVC下降减缓相关,但在超重或肥胖者中无相关性。这种减缓作用在ΔFEF25-75/FVC上最为明显:在低或正常体质量者中,PM10每下降10μg/m3,ΔFEF25-75/FVC下降分别为30%和22%。[结论]上述研究结果指出并列考虑空气污染暴露和肥胖对健康的影响的重要性。今后需要进一步研究所观察到的相互作用的机制。

关键词：肺功能减退空气污染质量改善队列研究肥胖者身体质量指数用力肺活量用力呼气流量

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Team Effectiveness in Patient Health Management: An Overview of Reviews

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International Journal of Clinical Medicine 2012年第7期3卷 614-627页

作者： Amédé Gogovor Bernard Burnand Sara Ahmed Terrence Montague Isabelle Peytremann-bridevaux CareNet Corporation Montreal Canada Faculty of Medicine McGill University Montreal Canada Faculty of Medicine McGill University Montreal Canada Lausanne University Hospital Lausanne Switzerland Lausanne University Hospital Lausanne Switzerland

Background: The desire to improve the quality of health care for an aging population with multiple chronic diseases is fostering a rapid growth in interprofessional team care, supported by health professionals, governments, businesses and public institutions. However, the weight of evidence measuring the impact of team care on patient and health system outcomes has not, heretofore, been clear. To address this deficiency, we evaluated published evidence for the clinical effectiveness of team care within a chronic disease management context in a systematic overview. Methods: A search strategy was built for Medline using medical subject headings and other relevant keywords. After testing for performance, the search strategy was adapted to other databases (Cinhal, Cochrane, Embase, PsychInfo) using their specific descriptors. The searches were limited to reviews published between 1996 and 2011, in English and French languages. The results were analyzed by the number of studies favouring team intervention, based on the direction of effect and statistical significance for all reported outcomes. Results: Sixteen systematic and 7 narrative reviews were included. Diseases most frequently targeted were depression, followed by heart failure, diabetes and mental disorders. Effectiveness outcome measures most commonly used were clinical endpoints, resource utilization (e.g., emergency room visits, hospital admissions), costs, quality of life and medication adherence. Briefly, while improved clinical and resource utilization endpoints were commonly reported as positive outcomes, mixed directional results were often found among costs, medication adherence, mortality and patient satisfaction outcomes. Conclusions: We conclude that, although suggestive of some specific benefits, the overall weight of evidence for team care efficacy remains equivocal. Further studies that examine the causal interactions between multidisciplinary team care and clinical and economic outcomes of disease

关键词： Team Care Effectiveness Chronic Disease Management Chronic Care Model Overview of Reviews

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