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Profiling vaccine attitudes and subsequent uptake in 1·1 million people in England:a nationwide cohort study
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作者 Matthew Whitaker 《四川生理科学杂志》 2026年第1期216-216,共1页
Background:Despite highly effective vaccines against SARS-CoV-2,COVID-19 vaccine hesitancy persisted in some populations in England during the pandemic,with rates and motivations for hesitancy varying by demographic g... Background:Despite highly effective vaccines against SARS-CoV-2,COVID-19 vaccine hesitancy persisted in some populations in England during the pandemic,with rates and motivations for hesitancy varying by demographic group.Addressing the drivers of vaccine hesitancy through targeted interventions in hesitant groups is a public health priority for better and more rapid control of disease spread.We aimed to characterise the determinants and subtypes of vaccine hesitancy and identify more persistent forms of hesitancy via analysis of vaccine uptake in a large cross-sectional cohort with linked National Health Service(NHS)data. 展开更多
关键词 vaccine hesitancy demographic group targeted interventions vaccine uptake vaccine attitudes SARS CoV public health priority nationwide cohort study
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基于GROUP STUDY的《资产评估》多元教学法研究 被引量:1
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作者 康翻莲 《财会学习》 2021年第22期165-167,共3页
近年来,很多高校在传统资产评估课程的教学中引入了案例,但大多案例是事先组织和规划好的,使得资产评估的案例教学变成了单纯的计算和解答,忽略了对学生实践能力的培养。本文在分析传统教学方法不足的基础上,提出了基于GROUP STUDY的《... 近年来,很多高校在传统资产评估课程的教学中引入了案例,但大多案例是事先组织和规划好的,使得资产评估的案例教学变成了单纯的计算和解答,忽略了对学生实践能力的培养。本文在分析传统教学方法不足的基础上,提出了基于GROUP STUDY的《资产评估》多元教学法,详细分析了基于GROUP STUDY的《资产评估》多元教学法的构成。得出采用该方法后,学生的缺课率明显降低、课堂热情和参与度明显提高、成绩的区分度明显改善、综合能力大大提高等结论。该研究为应用性专业课程的教学提供了新的思路。 展开更多
关键词 group study教学法 多元教学法 翻转课堂 案例分享
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Group Investigation in a College English Program at a Chinese University:A Case Study
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作者 刘浩 《海外英语》 2015年第6期85-89,共5页
This study investigated the application and the effect of Group Investigation(GI) in the College English Program in a Chinese University. A qualitative case study method was used to understand the GI system used by Ch... This study investigated the application and the effect of Group Investigation(GI) in the College English Program in a Chinese University. A qualitative case study method was used to understand the GI system used by Chinese instructors as well as the achievements acquired and challenges met by the participants. Three instructors and fifteen second-year-undergraduates taking a course titled Sources of European Culture participated. Interviews, observations, and documents were used to collect the data. Data analysis showed Chinese instructors applied a GI technique similar to that discussed by Johnson and Johnson(1999); however, GI in the Chinese context demanded more effort from the teacher for designing tasks and provided help in modeling uses of English and in preparing visual, especially Power Point, presentations. Although participants used their mother tongue at some stages, their autonomy over English learning was activated, and horizons in the course content were broadened. 展开更多
关键词 COOPERATIVE learning group investigation COLLEGE English PROGRAM critical THINKING teaching methods case study
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STUDY GROUP在中国
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作者 谭永基 《数学建模及其应用》 2012年第1期44-47,共4页
<正>一、什么是STUDY GROUP STUDY GROUP是牛津大学的A.B.Tayler博士和当时他的学生J.Ockendon等人在1968年创立的,它的原名是Oxford Study Group with Industry。这种活动历时一周,是由数学工作者和工业界人士参加的旨在解决实... <正>一、什么是STUDY GROUP STUDY GROUP是牛津大学的A.B.Tayler博士和当时他的学生J.Ockendon等人在1968年创立的,它的原名是Oxford Study Group with Industry。这种活动历时一周,是由数学工作者和工业界人士参加的旨在解决实际问题的研讨会。在研讨会的第一天,由工业界代表陈述要解决的问题和目的要求,通常会有5~6个问题。后续2~3天按问题分组讨论,试图建立问题的数学模型和求解方法来解决问题。 展开更多
关键词 数学建模教学 院士 工业界 study group 李大潜 全国大学生数学建模竞赛 应用数学 国家自然科学基金 数学模型 试验模型 数学家 数学界 中华人民共和国
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Association of ABO blood groups with the severity of coronary artery disease: a cross-sectional study 被引量:3
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作者 Xu-Lin HONG Ya LI +4 位作者 Guo-Sheng FU Heng WU Yao WANG Chun-Xia GU Wen-Bin ZHANG 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2019年第9期701-705,共5页
Objective To investigate whether ABO blood groups is associated with the severity of coronary artery disease(CAD). Methods Between January 2015 and December 2017, 1425 first diagnosed CAD patients confirmed by selecti... Objective To investigate whether ABO blood groups is associated with the severity of coronary artery disease(CAD). Methods Between January 2015 and December 2017, 1425 first diagnosed CAD patients confirmed by selective coronary angiography were recruited into this cross-sectional study, and their baseline characteristics, ABO blood groups, Gensini score were collected. Multiple linear regression analysis was performed to test the association between the severity of CAD and ABO blood groups. Results The Gensini score was significantly higher in the blood group A than in the non-A groups(41.2 ± 32 vs. 38 ± 27;P = 0.026). After adjusting for age, male, smoking, family history of CAD, hypertension, diabetes mellitus and hypercholesterolemia, multivariate linear regression indicated that blood group A was associated with the severity of CAD(β= 3.298, 95% CI: 0.91–6.505, P = 0.044). In diabetes group, A blood type was also associated with increased Gensini score(P = 0.02) after adjusting for age, male, family history of CAD, hypercholesterolemia, smoking and hypertension. Conclusion In this cross-sectional study, the data indicated that blood group A was an independent risk factor of severity of CAD in Chinese population and Chinese patients with type 2 diabetes. 展开更多
关键词 ABO blood groups CORONARY ARTERY disease CROSS-SECTIONAL study
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Large Cohort Data Based Group or Community Disease Prevention Design Strategy: Strong Heart Study
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作者 Wenyu Wang Elisa T. Lee +3 位作者 Barbara V. Howard Richard Devereux Ying Zhang Julie A. Stoner 《World Journal of Cardiovascular Diseases》 2018年第3期196-207,共12页
Background and Objective: A multitude of large cohort studies have data on incidence rates and predictors of various chronic diseases. However, approaches for utilization of these costly collected data and translation... Background and Objective: A multitude of large cohort studies have data on incidence rates and predictors of various chronic diseases. However, approaches for utilization of these costly collected data and translation of these?valuable results to inform and guide clinical disease prevention practice are?not well developed. In this paper we proposed a novel conceptual group/community disease prevention design strategy based on large cohort study data. Methods and Results: The data from participants (n = 3516;2056 women) aged 45 to 74 years and the diabetes risk prediction model from Strong Heart Study were used. The Strong Heart Study is a population-based cohort study of cardiovascular disease and its risk factors in American Indians. A conceptual group/community disease prevention design strategy based on large cohort data was initiated. The application of the proposed strategy for group diabetes prevention was illustrated. Discussion: The strategy may provide reasonable solutions to the prevention design issues. These issues include complex associations of a disease with its combined and correlated risk factors, individual differences, choosing intervention risk factors and setting their appropriate, attainable, gradual and adaptive goal levels for different subgroups, and assessing effectiveness of the prevention program. Conclusions: The strategy and methods shown in the illustration example can be analogously adopted and applied for other diseases preventions. The proposed strategy for a target group/community in a population provides a way to translate and apply epidemiological study results to clinical disease prevention practice. 展开更多
关键词 group/Community Disease PREVENTION PREVENTION Design PREVENTION Strategy TRANSLATE study to Clinical Practice
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Autonomous Unbiased Study Group Formation Algorithm for Rapid Knowledge Propagation
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作者 Monday Eze Charles Okunbor +7 位作者 Solomon Esomu Nneka Richard-Nnabu Kayode Oladapo Oghenetega Avwokuruaye Abisola Olayiwola Akpovi Ominike Godwin Odulaja Oluwatobi Akinmerese 《Computer Systems Science & Engineering》 SCIE EI 2022年第7期15-31,共17页
Knowledge propagation is a necessity,both in academics and in the industry.The focus of this work is on how to achieve rapid knowledge propaga-tion using collaborative study groups.The practice of knowledge sharing in... Knowledge propagation is a necessity,both in academics and in the industry.The focus of this work is on how to achieve rapid knowledge propaga-tion using collaborative study groups.The practice of knowledge sharing in study groupsfinds relevance in conferences,workshops,and class rooms.Unfortu-nately,there appears to be only few researches on empirical best practices and techniques on study groups formation,especially for achieving rapid knowledge propagation.This work bridges this gap by presenting a workflow driven compu-tational algorithm for autonomous and unbiased formation of study groups.The system workflow consists of a chronology of stages,each made of distinct steps.Two of the most important steps,subsumed within the algorithmic stage,are the algorithms that resolve the decisional problem of number of study groups to be formed,as well as the most effective permutation of the study group participants to form collaborative pairs.This work contributes a number of new algorithmic concepts,such as autonomous and unbiased matching,exhaustive multiplication technique,twisted round-robin transversal,equilibrium summation,among others.The concept of autonomous and unbiased matching is centered on the constitution of study groups and pairs purely based on the participants’performances in an examination,rather than through any external process.As part of practical demon-stration of this work,study group formation as well as unbiased pairing were fully demonstrated for a collaborative learning size of forty(40)participants,and partially for study groups of 50,60 and 80 participants.The quantitative proof of this work was done through the technique called equilibrium summation,as well as the calculation of inter-study group Pearson Correlation Coefficients,which resulted in values higher than 0.9 in all cases.Real life experimentation was carried out while teaching Object-Oriented Programming to forty(40)under-graduates between February and May 2021.Empirical result showed that the per-formance of the learners was improved appreciably.This work will therefore be of immense benefit to the industry,academics and research community involved in collaborative learning. 展开更多
关键词 Knowledge propagation collaborative study group unbiased matching twisted round robin exhaustive multiplication
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Study on fishery biology features of spawning group of Pseudopleuronectes yokamae(Gunther) in the Sheath Bay
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作者 Chen Dagang, Liu Chang’anOcean University of Qingdao, Qingdao, ChinaDong GuangjunFusion Aquatic Bureau of Shandong, Shandong, China 《Acta Oceanologica Sinica》 SCIE CAS CSCD 1991年第3期471-476,共6页
Pseudopleuronectes yokamae (Günther) is one of the most important economic fish species in the genus living specially in the northwest Pacific, and is distributed in the southern area of the far east sea of Russi... Pseudopleuronectes yokamae (Günther) is one of the most important economic fish species in the genus living specially in the northwest Pacific, and is distributed in the southern area of the far east sea of Russia, Japan, Korea, the Huanghai Sea, the Bohai Sea and the northern area of the East China Sea. Usually they live in nearshore waters of these areas as geographic subpopulations. P. yokamae in the Sheath Bay belongs to a local group of the Huanghai-Bohai Sea subpopulation and is distributed in the mouth and adjacent waters of the bay all the year round, and the catch of its spawning group has 展开更多
关键词 study on fishery biology features of spawning group of Pseudopleuronectes yokamae Gunther in the Sheath Bay BAY
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Studies on the Total Synthesis of Hainanolide(Ⅳ)-Revising the Stereochemistry of C_(2α)-H and Introducing the Two Hydroxy Groups at C_(3β),C_(4α) Positions
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作者 Wen Qian YANG Xiao Ming YU +1 位作者 Shi Zhi CHEN Liang HUANG(Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing, 100050) 《Chinese Chemical Letters》 SCIE CAS CSCD 1997年第12期0-0,共2页
Tricyclic compound 6 was synthesized form compound 1 through sis steps, thus preblem of the stereochemistry of C2α-H being solved. The stereochemistry for introducing hydroxy groups at C3β and C4α positions in com... Tricyclic compound 6 was synthesized form compound 1 through sis steps, thus preblem of the stereochemistry of C2α-H being solved. The stereochemistry for introducing hydroxy groups at C3β and C4α positions in compound 1 was also described. 展开更多
关键词 Studies on the Total Synthesis of Hainanolide POSITIONS Revising the Stereochemistry of C H and Introducing the Two Hydroxy groups at C
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Study on non-invasively detecting of prenatal fetal ABO and Rh(D)blood groups by flow cytometry (FCM)
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《中国输血杂志》 CAS CSCD 2001年第S1期384-,共1页
关键词 ABO study on non-invasively detecting of prenatal fetal ABO and Rh D)blood groups by flow cytometry FCM flow
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The Roadmap for Lenovo to Go Global——A Case study of Lenovo Group Strategies
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作者 Cheung Kong GSB Case Study Centre 《China Economist》 2007年第6期132-140,共9页
I.Lenovo: refocus on PC operation On December 8th, 2004, Lenovo consummated a deal with IBM whereby Lenovo was to acquire IBM’s desktop and laptop PC unit and its R&D and procurement operations worldwide for the... I.Lenovo: refocus on PC operation On December 8th, 2004, Lenovo consummated a deal with IBM whereby Lenovo was to acquire IBM’s desktop and laptop PC unit and its R&D and procurement operations worldwide for the sum of US$1.25 billion. On May 1st 2005, Lenovo completed its acquisition of IBM’s PC Unit. "Using an analogy, our enterprise is well likened to a tortoise but our foreign competitor is more like a rabbit. Instead of racing against the rabbit heads-on, we would rather ride on its back and let it carry us forward," said former Lenovo Chairman Liu Chuanzhi. 展开更多
关键词 CASE In The Roadmap for Lenovo to Go Global A Case study of Lenovo group Strategies IBM IT
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ZTE Joins Global IT Leaders on Cloud Computing Standards Study Group
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作者 ZTE Corporation 《ZTE Communications》 2012年第1期F0003-F0003,共1页
ZTE Corporation announced on 1 March that it will join global information technology leaders in a cloud computing standards study group.
关键词 ZTE Joins Global IT Leaders on Cloud Computing Standards study group IT
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An Investigation of Samoan Student Experiences in Two Homework Study Groups in Melbourne
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作者 Vaoiva Ponton 《Sociology Study》 2017年第7期349-363,共15页
This research examines Samoan student experiences in two Homework Study Groups (HSGs) in Melbourne using a researcher-practitioner approach. It highlights that school teachers need to acknowledge students' preferre... This research examines Samoan student experiences in two Homework Study Groups (HSGs) in Melbourne using a researcher-practitioner approach. It highlights that school teachers need to acknowledge students' preferred learning methods, especially those of minority backgrounds like the Samoan participants in this investigation. A detailed exploration of the experiences of students in two HSGs finds that while students and their families place a high priority on learning, their cultural practices are not compatible with standard Western learning approaches. The HSGs provided a social space in which students could ask the teacher questions without fear of appearing foolish, in which they could apply themselves to study. It provided a physical study space away from the demands some Samoan families place on their young people, and it provided a cultural space in which the students could learn according to fa'aSamoa (traditional values and beliefs). This research makes a contribution to an understanding of the motivations of Melbourne-based Samoan students to learn, of what concerns them, and of impediments to their educational success. It also offers insight into the benefits that set up a specific space for students offers, when its specific intent is influencing the merging of Samoan and Western ideas to further learning. 展开更多
关键词 Samoan student learning experiences homework study groups Pacific community engagement
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A Study on the Chess Culture of Ethnic Minority Groups in Gansu Province
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作者 Ying’an Wang Xiaoming Ma 《Open Journal of Applied Sciences》 2023年第12期2360-2370,共11页
As a region inhabited by large populations of ethnic minority groups,Gansu province boasts rich ethnic cultural resources which reflect traditional culture and intangible cultural heritage that had taken shape thousan... As a region inhabited by large populations of ethnic minority groups,Gansu province boasts rich ethnic cultural resources which reflect traditional culture and intangible cultural heritage that had taken shape thousands of years ago.Among these are various ethnic folk chess games.They are time-honored with many types such as the“Fang”chess of the Hui ethnic group,the“Jiu”chess of the Tibetans,the“King and Ministers”chess,the Mongolian chess,the Mongolian military chess,etc.These games embody distinctive ethnic and regional characteristics,as well as the cultural elements of a particular ethnic minority group.It is of great significance,therefore,to study the ethnic chess by collecting,documenting and comparing different types of related chess.The paper explores ways to standardize,protect and promote them scientifically in joint efforts,and draws a conclusion that examining their significance in the present era and the ethnic characteristics is the key to understanding the profound culture behind the chess. 展开更多
关键词 Ethnic Minority groups in Gansu Province Chess Culture A study
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如何举办一次成功的Study Group——以2012工业与应用数学国际研讨会为例
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作者 陆立强 《数学建模及其应用》 2012年第3期29-31,共3页
作为数学工作者和产业界专业人士共同探讨实际问题的数学建模及其解决方案的一种国际合作形式,诞生40多年的Study Group with Industry(工业与应用数学国际研讨会)活动遍及世界各大洲,为数学工作者参与高技术领域的创新、产业部门发现... 作为数学工作者和产业界专业人士共同探讨实际问题的数学建模及其解决方案的一种国际合作形式,诞生40多年的Study Group with Industry(工业与应用数学国际研讨会)活动遍及世界各大洲,为数学工作者参与高技术领域的创新、产业部门发现和培养高素质人才提供了有效的平台。在中国科学院院士李大潜、英国皇家学会会员(Fellow)J.Ockendon的大力推动下,这项活动在中国的影响力正在逐步扩大[1]。 展开更多
关键词 应用数学 研讨会 study group 数学建模 会议网站 混合动力公交车
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Perception of healthcare professionals on patient safety culture and associated factors:a qualitative study using MAXQDA software
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作者 Aileen J.Abraham Pushpanjali Krishnappa Frank Federico 《Frontiers of Nursing》 2025年第1期123-132,共10页
Objective:Patient safety culture is a concern in every healthcare organization,therefore,the healthcare leadership is encountering issues related to patient safety across the globe.In India,there is limited research a... Objective:Patient safety culture is a concern in every healthcare organization,therefore,the healthcare leadership is encountering issues related to patient safety across the globe.In India,there is limited research and information about patient safety culture among healthcare stakeholders and there is relatively little qualitative research available that captures the factors of patient safety culture.Hence,this study aims to explore the perception of healthcare professionals on patient safety culture.Methods:An exploratory qualitative study design was adopted in a tertiary care hospital.Structured focus group discussion(FGD)(n=4)among healthcare professionals and two in-depth interview focus groups were audio-recorded and transcribed.Two coders reviewed transcripts using the editing approach and organized codes into themes.The data were analyzed through MAXQDA 2022(VERBI Software GmbH,Berlin,Germany),qualitative data analysis software,and descriptive analysis technique.The main codes and themes were generated using inductive and deductive method and smart coding was done.Results:Overall,there were 190 unique mentions of codes related to patient safety culture from 4 FGDs.They were categorized into 6 major themes and subcodes were derived via smart coding using the MAXQDA software.“Resources and constraints”was the most prominent code,followed by management support,manpower shortage,burnout,and lack of personnel commitment.Conclusions:The study highlights significant gaps in patient safety culture within the healthcare setting,with resource constraints,management support,and manpower shortages emerging as critical challenges.Burnout and lack of personnel commitment further exacerbate these issues,underscoring the need for targeted interventions. 展开更多
关键词 focus group discussion healthcare stakeholders patient safety culture qualitative study healthcare leadership
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COSSH-ACLFⅡ评分联合LSR评估HBV相关慢加急性肝衰竭患者预后临床价值研究
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作者 马凤锦 陈玉升 +3 位作者 周明凯 韩冰莎 赵亮 郑凯娟 《实用肝脏病杂志》 2026年第1期73-76,共4页
目的分析应用中国重症乙型肝炎研究学组-慢加急性肝衰竭Ⅱ(COSSH-ACLFⅡ)评分联合肝脾体积比值(LSR)评估乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者预后的临床价值。方法2022年2月~2025年2月我院收治的HBV-ACLF患者93例,均接受常规内科... 目的分析应用中国重症乙型肝炎研究学组-慢加急性肝衰竭Ⅱ(COSSH-ACLFⅡ)评分联合肝脾体积比值(LSR)评估乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者预后的临床价值。方法2022年2月~2025年2月我院收治的HBV-ACLF患者93例,均接受常规内科综合治疗,观察到90 d,记录生存情况。收集基线资料,行上腹部CT检查并计算LSR,采用多因素Logistic回归分析影响HBV-ACLF患者预后的相关因素,应用受试者工作特征曲线(ROC)并计算曲线下面积(AUC)分析COSSH-ACLFⅡ评分联合LSR评估HBV-ACLF患者预后的效能。结果本组HBV-ACLF患者90 d死亡45例(48.4%),生存48例(51.6%);死亡组COSSH-ACLFⅡ评分为为(8.2±0.7)分,显著高于生存组【(6.8±0.9)分,P<0.05】,而LSR为(1.5±0.9),现在低于生存组【(3.0±1.2),P<0.05】;死亡组年龄、血清总胆红素、凝血酶原时间国际标准化比值和终末期肝病模型评分均显著大于或高于生存组(P<0.05);多因素Logistic回归分析显示,COSSH-ACLFⅡ评分(OR=3.200,95%CI:1.458~7.021)是影响HBV-ACLF患者预后的独立危险因素,而LSR(OR=0.119,95%CI:0.027~0.520)是保护因素(P<0.05);ROC曲线分析显示,COSSH-ACLFⅡ评分联合LSR评估预后的AUC为0.940,其敏感度为86.7%,特异度为77.1%(P<0.05)。结论应用COSSH-ACLFⅡ评分联合LSR预测HBV-ACLF患者预后有一定的临床价值,值得深入研究。 展开更多
关键词 慢加急性肝衰竭 中国重症乙型肝炎研究学组-慢加急性肝衰竭Ⅱ评分 肝脾体积比值 预后
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老年人身体活动变化轨迹与衰弱的关联研究
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作者 郑华涛 王世强 +4 位作者 李丹 杨鄂 罗丹 赖雨 马仁涛 《中国全科医学》 北大核心 2026年第3期316-324,共9页
背景随着我国人口老龄化加剧,老年人的衰弱问题日益突出,对其预防和干预研究显得尤为重要。目前,大部分研究缺乏身体活动变化轨迹与衰弱动态关系的探讨。目的探究老年人身体活动变化轨迹与衰弱的关联,为老年人衰弱的预防和干预提供科学... 背景随着我国人口老龄化加剧,老年人的衰弱问题日益突出,对其预防和干预研究显得尤为重要。目前,大部分研究缺乏身体活动变化轨迹与衰弱动态关系的探讨。目的探究老年人身体活动变化轨迹与衰弱的关联,为老年人衰弱的预防和干预提供科学依据。方法本研究基于2011—2020年中国健康与养老追踪调查(CHARLS)5期数据,采用组轨迹模型(GBTM)识别调查对象随访期间身体活动随时间变化的潜在分组和轨迹特征。通过多因素Logistic回归模型分析不同身体活动轨迹类型与衰弱的关联及亚组分析。结果共纳入1889名老年人,其中男1014名(53.7%)、女875名(46.3%),平均年龄(68.76±6.31)岁,衰弱者318名(16.8%)。身体活动轨迹分为持续低组262名(13.87%)、先低后上升组993名(52.57%)、先高后下降组122名(6.46%)和持续高组512名(27.10%);4组老年人衰弱状况比较,差异有统计学意义(χ^(2)=20.867,P<0.001)。调整了年龄、性别等混杂因素后,多因素Logistic回归分析结果显示,与持续低组相比,先低后上升组(OR=0.581,95%CI=0.414~0.815,P=0.002)和持续高组(OR=0.546,95%CI=0.373~0.799,P=0.002)的老年人衰弱发生风险显著降低。亚组分析结果显示,与持续低组相比,先低后上升组可降低年龄≥65岁(OR=0.502,95%CI=0.345~0.730)、男性(OR=0.539,95%CI=0.326~0.891)、居住地为城镇(OR=0.441,95%CI=0.211~0.922)、无伴侣(OR=0.312,95%CI=0.160~0.606)老年人的衰弱风险(P<0.05),持续高组可降低年龄≥65岁(OR=0.425,95%CI=0.274~0.658)、女性(OR=0.539,95%CI=0.328~0.886)、居住地为城镇(OR=0.280,95%CI=0.101~0.780)、无伴侣(OR=0.347,95%CI=0.164~0.737)老年人的衰弱风险(P<0.05)。结论不同身体活动轨迹组别与衰弱发生风险有关,身体活动轨迹先低后上升组和持续高组可显著降低老年人衰弱发生风险。 展开更多
关键词 衰弱 老年人 身体活动 纵向研究 组基轨迹模型
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正常高值血压人群血压轨迹对心血管疾病发病风险的影响:基于开滦队列研究
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作者 鹿妍秋 吴云涛 +7 位作者 刘少鹏 林海颖 邓惠友 武英 黄喆 杨鹏 吴寿岭 李云 《中国全科医学》 北大核心 2026年第3期299-310,共12页
背景心血管疾病(CVD)是全球过早死亡和医疗费用上涨的主要原因。据估计,中国约有3.3亿人受到CVD的影响,给国家带来了巨大的医疗和财政负担。中国18岁以上未被诊断过高血压的成年人中,有50.9%的人处于正常高值血压,正常高值血压与CVD发... 背景心血管疾病(CVD)是全球过早死亡和医疗费用上涨的主要原因。据估计,中国约有3.3亿人受到CVD的影响,给国家带来了巨大的医疗和财政负担。中国18岁以上未被诊断过高血压的成年人中,有50.9%的人处于正常高值血压,正常高值血压与CVD发病风险增加有关,有效控制正常高值血压可预防10%以上的CVD病例。目的本研究采用群组轨迹模型(GBTM)探索正常高值血压人群的血压轨迹变化模式,探究正常高值血压人群血压轨迹对CVD发病风险的影响,为制订正常高值血压人群血压管理和CVD预防策略提供科学依据。方法选取参加开滦研究2006—2012年度健康体检且首次参加体检时为正常高值血压者为研究对象,通过问卷调查、人体测量学指标检查及实验室生化检测收集基线资料。对患者进行随访,随访结局事件为首次发生CVD事件[心肌梗死(MI)和脑卒中],随访终止时间为2022-12-31。采用GBTM拟合研究对象的收缩压(SBP)和舒张压(DBP)的轨迹模型。采用Kaplan-Meier生存曲线分析不同轨迹组CVD累积发病率,Log-rank检验比较组间差异。采用多因素Cox比例风险回归模型或不受比例风险假设约束的加权多因素Cox比例风险回归模型分析不同血压轨迹组发生CVD事件的风险。采用Cox比例风险回归模型分析性别、年龄与血压轨迹之间存在的潜在相乘交互作用并进行分层分析。进行敏感性分析验证结果的稳健性。结果最终纳入21745名研究对象,平均年龄(54.0±11.4)岁,男17556名(80.74%),女4289名(19.26%)。GBTM结果显示,SBP确定了4条不同的轨迹,每条轨迹均根据其SBP范围和随体检时间变化的模式(即稳定、下降和上升)进行标记,7088名研究对象的SBP稳定在115 mmHg(1 mmHg=0.133 kPa)左右,称为“正常高值血压下降组”,11662名研究对象的SBP稳定在130 mmHg左右,称为“正常高值血压稳定组”,1710名研究对象在轨迹期从129 mmHg逐渐增长到160 mmHg左右,称为“正常高值血压上升组”,1285名研究对象的SBP增长到158 mmHg左右后再下降到140 mmHg以下,称为“正常高值血压上升-下降组”。DBP确定了4条不同的轨迹,每条轨迹都根据其DBP范围和随体检时间变化的模式(即稳定、下降和上升)进行标记,4856名研究对象的DBP稳定在75 mmHg左右,称为“正常高值血压下降组”,13668名研究对象的DBP稳定在83 mmHg左右,称为“正常高值血压稳定组”,1640名研究对象在轨迹期DBP从82 mmHg逐渐增长到100 mmHg左右,称为“正常高值血压上升组”,1581名研究对象的SBP增长到98 mmHg左右后再下降到90 mmHg以下,称为“正常高值血压上升-下降组”。不同SBP轨迹组中研究对象年龄、性别、BMI、受教育程度、吸烟、饮酒、体育锻炼、SBP、DBP、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC)、空腹血糖(FBG)、超敏C反应蛋白、估算肾小球滤过率(eGFR)、单纯收缩期高血压(ISH)、单纯舒张期高血压(IDH)、高血压、糖尿病、服用降压药、服用降糖药比例比较,差异有统计学意义(P<0.05)。不同DBP轨迹组中研究对象年龄、性别、BMI、受教育程度、吸烟、饮酒、喜盐、SBP、DBP、高密度脂蛋白胆固醇(HDL-C)、LDL-C、TG、TC、FBG、超敏C反应蛋白、eGFR、ISH、IDH、高血压、糖尿病、服用降压药比例比较,差异有统计学意义(P<0.05)。患者平均随访时间(9.43±1.94)年,共计发生CVD1429例(259例MI,1170例脑卒中,两者同时发生20例)。SBP轨迹分组正常高值血压下降组、正常高值血压稳定组、正常高值血压上升组和正常高值血压上升-下降组新发CVD病例分别为274例、794例、191例和170例;DBP轨迹分组正常高值血压下降组、正常高值血压稳定组、正常高值血压上升组和正常高值血压上升-下降组CVD新发病例分别为227例、881例、163例和158例。绘制研究对象CVD累积发病率生存曲线,Log-rank检验结果显示不同SBP轨迹组、DBP轨迹组CVD累积发病率比较,差异有统计学意义(χ^(2)=275.39、90.69,P<0.001)。采用Cox比例风险回归模型计算不同SBP轨迹组发生CVD的HR(95%CI),以正常高值血压下降组作为参照组,正常高值血压稳定组、正常高值血压上升组和正常高值血压上升-下降组发生CVD的HR(95%CI)分别为1.41(1.22~1.62)、1.92(1.58~2.33)和2.24(1.84~2.74),发生脑卒中的HR(95%CI)分别为1.46(1.25~1.71)、2.04(1.65~2.53)和2.37(1.90~2.96),发生MI的HR(95%CI)分别为1.25(0.92~1.72)、1.42(0.90~2.23)和1.81(1.14~2.86)。使用不受比例风险假设约束的加权多因素Cox比例风险回归模型计算发生CVD的aHR(95%CI),以正常高值血压下降组作为参照组,正常高值血压稳定组、正常高值血压上升组和正常高值血压上升-下降组发生CVD的aHR(95%CI)分别为1.43(1.12~1.82)、2.59(1.62~4.13)和2.11(1.40~3.17),发生脑卒中的aHR(95%CI)分别为1.45(1.11~1.71)、2.95(1.75~4.97)和2.34(1.48~3.71),发生MI的aHR(95%CI)分别为1.34(0.76~2.34)、1.17(0.62~2.19)和1.32(0.69~2.55)。分层分析结果提示只有SBP轨迹与性别和年龄的相乘交互作用有统计学意义(P交互<0.05),DBP轨迹与性别和年龄的相乘交互作用无统计学意义(P交互>0.05)。男性人群中,以SBP轨迹正常高值血压下降组作为参照组,正常高值血压稳定组、正常高值血压上升组和正常高值血压上升-下降组发生CVD发生HR(95%CI)分别为1.42(1.20~1.67)、1.93(1.53~2.42)和2.30(1.82~2.90);女性人群中,以SBP轨迹正常高值血压下降组作为参照组,正常高值血压稳定组、正常高值血压上升组和正常高值血压上升-下降组发生CVD发生HR(95%CI)分别为1.80(1.14~2.85)、2.91(1.62~5.21)和2.79(1.43~5.43)。年龄<60岁的正常高值血压人群中,以SBP轨迹正常高值血压下降组作为参照组,发生CVD的HR(95%CI)分别为1.48(1.22~1.78)、2.00(1.46~2.71)和3.01(2.24~4.06),年龄≥60岁的正常高值血压人群中,以SBP轨迹正常高值血压下降组作为参照组,发生CVD的HR(95%CI)分别为1.35(1.01~1.79)、1.94(1.40~2.69)和1.91(1.35~2.69)。结论在正常高值血压人群中具有CVD发病风险更高的不同血压轨迹类型。在SBP血压轨迹中,高水平且波动大的轨迹模式发生CVD的风险最高,在DBP轨迹中上升趋势且基线DBP高的轨迹模式发生CVD的风险最高。正常高值血压人群即使血压稳定在120~139/80~89 mmHg范围内且没有较大的变化波动,但依然存在发生CVD的风险。 展开更多
关键词 心血管疾病 正常高值血压 血压轨迹 开滦队列研究 群组化轨迹模型 COX比例风险回归模型
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