背景跌倒是老年人的常见和严重的问题之一,跌倒效能是跌倒的重要影响因素,提高老年人跌倒效能的运动方式多样但各种运动干预效果的优劣尚无定论。目的分析比较不同运动方式对老年人跌倒效能的影响,旨在为患者选择最佳运动方式提供参考...背景跌倒是老年人的常见和严重的问题之一,跌倒效能是跌倒的重要影响因素,提高老年人跌倒效能的运动方式多样但各种运动干预效果的优劣尚无定论。目的分析比较不同运动方式对老年人跌倒效能的影响,旨在为患者选择最佳运动方式提供参考。方法计算机检索中国知网、万方数据知识服务平台、维普网、SinoMed、PubMed、CINAHL、Web of Science、Embase、Cochrane Library、FMRS等数据库中关于运动提高老年人跌倒效能的相关文献,检索时限为建库至2025-08-15。结局指标为国际版跌倒效能量表(FES-I)、Berg平衡量表(BBS)、计时起立-行走测试(TUGT)。采用Cochrane偏倚评估工具进行文献质量评价,采用Stata 18.0软件进行网状Meta分析,采用累积概率排名曲线下面积(SUCRA)对不同方案的效果进行排名。结果共纳入35项研究,包括2627例研究对象、13种运动方式。在跌倒效能方面,奥塔戈(MD=8.94,95%CI=3.51~14.38)、太极拳(MD=9.24,95%CI=4.96~13.51)、方步运动(MD=8.60,95%CI=2.56~14.64)、普拉提(MD=6.86,95%CI=1.19~12.53)的效果优于常规护理组(P<0.05),太极拳成为最佳干预措施的可能性最大(SUCRA=81.2)。在平衡功能方面,奥塔戈(MD=3.87,95%CI=2.71~5.02)、太极拳(MD=3.87,95%CI=1.71~6.03)、抗阻+平衡训练(MD=3.26,95%CI=0.53~6.00)的效果优于常规护理组(P<0.05),奥塔戈成为最佳干预措施的可能性最大(SUCRA=68.1)。在移动能力方面,奥塔戈(MD=3.90,95%CI=2.77~5.04)、太极拳(MD=4.44,95%CI=3.50~5.39)、八段锦(MD=2.25,95%CI=1.47~3.02)、八卦掌(MD=2.35,95%CI=1.26~3.43)、步态平衡操(MD=3.60,95%CI=2.15~5.05)的效果优于常规护理组(P<0.05),太极拳成为最佳干预措施的可能性最大(SUCRA=95.0)。结论太极拳、奥塔戈运动在改善老年人跌倒效能、平衡功能、移动能力方面效果较好。临床医护人员应结合老年人健康状况及需求,合理选择运动方式,以提高老年人跌倒效能,有效预防跌倒,促进患者健康。未来仍需进一步开展更多高质量的研究以验证此结论。展开更多
Global environmental changes including climate warming,extreme weather events,ambient air pollution,freshwater contamination,and landscape transformation are reshaping the epidemiology of infectious diseases with unpr...Global environmental changes including climate warming,extreme weather events,ambient air pollution,freshwater contamination,and landscape transformation are reshaping the epidemiology of infectious diseases with unprecedented complexity,particularly in the post-COVID-19 era.This review synthesizes evidence from the past decade(2015-2024)to systematically elucidate how key environmental drivers modulate pathogen emergence,transmission dynamics,and clinical outcomes,with a focus on underlying mechanistic pathways.Specifically,we highlight:(1)the temperature-and precipitation-dependent transmission of vector-borne diseases(e.g.,malaria,dengue)via expanded vector habitats and accelerated pathogen incubation;(2)the exacerbation of respiratory infections(including COVID-19)by particulate matter(PM2.5)and nitrogen dioxide(NO2)through impaired mucosal immunity and enhanced inflammatory responses;(3)the persistence of diarrheal diseases in low-and middle-income countries(LMICs)linked to water insecurity and climate-induced infrastructure failure;and(4)zoonotic spillover risks amplified by urbanization and deforestation-driven human-wildlife interface disruption.Integrating the One Health socioecological framework,we further summarize methodological advances from high-resolution genomic surveillance to climate-informed machine learning models that have improved causal inference and predictive accuracy.Our synthesis confirms that environmental factors are not merely contextual but central,modifiable determinants of infectious disease risk,with disproportionate impacts on vulnerable populations.To mitigate future threats,we emphasize the urgency of interdisciplinary collaboration,integrated environmental-health monitoring platforms,and climate-resilient public health policies tailored to post-pandemic challenges.This review provides a timely roadmap for translating environmental epidemiology insights into actionable strategies to strengthen global health resilience.展开更多
文摘背景跌倒是老年人的常见和严重的问题之一,跌倒效能是跌倒的重要影响因素,提高老年人跌倒效能的运动方式多样但各种运动干预效果的优劣尚无定论。目的分析比较不同运动方式对老年人跌倒效能的影响,旨在为患者选择最佳运动方式提供参考。方法计算机检索中国知网、万方数据知识服务平台、维普网、SinoMed、PubMed、CINAHL、Web of Science、Embase、Cochrane Library、FMRS等数据库中关于运动提高老年人跌倒效能的相关文献,检索时限为建库至2025-08-15。结局指标为国际版跌倒效能量表(FES-I)、Berg平衡量表(BBS)、计时起立-行走测试(TUGT)。采用Cochrane偏倚评估工具进行文献质量评价,采用Stata 18.0软件进行网状Meta分析,采用累积概率排名曲线下面积(SUCRA)对不同方案的效果进行排名。结果共纳入35项研究,包括2627例研究对象、13种运动方式。在跌倒效能方面,奥塔戈(MD=8.94,95%CI=3.51~14.38)、太极拳(MD=9.24,95%CI=4.96~13.51)、方步运动(MD=8.60,95%CI=2.56~14.64)、普拉提(MD=6.86,95%CI=1.19~12.53)的效果优于常规护理组(P<0.05),太极拳成为最佳干预措施的可能性最大(SUCRA=81.2)。在平衡功能方面,奥塔戈(MD=3.87,95%CI=2.71~5.02)、太极拳(MD=3.87,95%CI=1.71~6.03)、抗阻+平衡训练(MD=3.26,95%CI=0.53~6.00)的效果优于常规护理组(P<0.05),奥塔戈成为最佳干预措施的可能性最大(SUCRA=68.1)。在移动能力方面,奥塔戈(MD=3.90,95%CI=2.77~5.04)、太极拳(MD=4.44,95%CI=3.50~5.39)、八段锦(MD=2.25,95%CI=1.47~3.02)、八卦掌(MD=2.35,95%CI=1.26~3.43)、步态平衡操(MD=3.60,95%CI=2.15~5.05)的效果优于常规护理组(P<0.05),太极拳成为最佳干预措施的可能性最大(SUCRA=95.0)。结论太极拳、奥塔戈运动在改善老年人跌倒效能、平衡功能、移动能力方面效果较好。临床医护人员应结合老年人健康状况及需求,合理选择运动方式,以提高老年人跌倒效能,有效预防跌倒,促进患者健康。未来仍需进一步开展更多高质量的研究以验证此结论。
基金the Natural Science Basic Research Program of Shaanxi Province,China[2023-JC-QN-0858]the Free Exploration Program of the Second Affiliated Hospital,School of Medicine,Xi’an Jiaotong University[2020YJ(ZYTS)605]the National Natural Science Foundation of China[81900620].
文摘Global environmental changes including climate warming,extreme weather events,ambient air pollution,freshwater contamination,and landscape transformation are reshaping the epidemiology of infectious diseases with unprecedented complexity,particularly in the post-COVID-19 era.This review synthesizes evidence from the past decade(2015-2024)to systematically elucidate how key environmental drivers modulate pathogen emergence,transmission dynamics,and clinical outcomes,with a focus on underlying mechanistic pathways.Specifically,we highlight:(1)the temperature-and precipitation-dependent transmission of vector-borne diseases(e.g.,malaria,dengue)via expanded vector habitats and accelerated pathogen incubation;(2)the exacerbation of respiratory infections(including COVID-19)by particulate matter(PM2.5)and nitrogen dioxide(NO2)through impaired mucosal immunity and enhanced inflammatory responses;(3)the persistence of diarrheal diseases in low-and middle-income countries(LMICs)linked to water insecurity and climate-induced infrastructure failure;and(4)zoonotic spillover risks amplified by urbanization and deforestation-driven human-wildlife interface disruption.Integrating the One Health socioecological framework,we further summarize methodological advances from high-resolution genomic surveillance to climate-informed machine learning models that have improved causal inference and predictive accuracy.Our synthesis confirms that environmental factors are not merely contextual but central,modifiable determinants of infectious disease risk,with disproportionate impacts on vulnerable populations.To mitigate future threats,we emphasize the urgency of interdisciplinary collaboration,integrated environmental-health monitoring platforms,and climate-resilient public health policies tailored to post-pandemic challenges.This review provides a timely roadmap for translating environmental epidemiology insights into actionable strategies to strengthen global health resilience.
