重视限盐在高血压防治中的作用

心脑血管疾病已超越恶性肿瘤成为人类的头号"杀手".发生心脑血管疾病的风险与血压水平正相关,高血压患者发生心脑血管意外的可能性远高于血压正常者.高血压的发病原因非常复杂,可能是多种因素综合作用的结果.摄盐过多可能是现代社会高血压发病率较高的重要因素.本文试图从人类进化角度揭示长期高盐饮食导致高血压的历史根源,进一步阐明限盐在高血压防治中的重要性.     

正确认识高血压患者应用阿司匹林的出血问题

高血压作为一种全球性的心脑血管疾病,会导致多器官损害,其患者发生心肌梗死、心绞痛、脑卒中等血栓栓塞性事件的几率远远高于血压正常者,因此防止心脑血管事件的发生是高血压治疗中的一个重要目标。多项大型临床研究证明,阿司匹林可以有效预防高血压患者心脑血管事件发生,同时也增加了出血的危险。本文将探讨如何正确认识高血压患者应用阿司匹林的出血问题,并如何将出血的危险降低到最小。     

重视对病前状态的临床研究

用矛盾转化理论探讨病前状态的发生发展规律及治疗策略。常见的病前状态包括亚健康、血压升高及糖尿病前期等状态。亚健康是人体介于健康与疾病之间的过渡环节,采用非药物干预及中医辨证论治可以使亚健康状态向健康状态转化。血压升高是血压正常和高血压的过渡状态,对于血压正常人群、血压升高及高血压的病人分别实施平衡进盐、低盐及限盐干预措施,使血压升高及高血压的发展方向逆转。糖尿病前期是处于糖代谢正常和糖尿病的中间状态,根据糖调节受损不同状态分别采取自由平衡、保持平衡和控制平衡策略,促进血糖调节异常向血糖正常转化。     

公务员正常高值血压的流行现状及危险因素分析

对吉林省516名公务员的血压及心血管疾病危险因素进行描述性分析,用二分类Logistic回归法筛选危险因素.公务员正常高值血压现患率为34.9%.正常高值血压人群体重指数、腰围、空腹血糖、总胆固醇、低密度脂蛋白胆固醇、甘油三酯、血清肌酐、血尿酸、心-踝血管指数水平以及代谢综合征患病率均高于正常血压组低于高血压组,高密度脂蛋白胆固醇水平低于正常血压组高于高血压组.男性、血脂紊乱会显著增加正常高值血压的患病风险.应加强正常高值血压人群的监测及干预,降低心脑血管疾病发病风险.     

常见老年病与口腔疾病关系的辩证思考及处置

老年口腔疾病患者常合并心脑血管等全身系统性疾病,且其发生、发展及治疗也与全身疾病密切相关,例如:牙周病是冠心病发病的危险因素;糖尿病又可加重牙周病;牙周局部治疗有利于全身血糖的控制;牙病治疗时易引起高血压患者血压暂时升高,应及时进行风险防范。本文通过揭示二者的辩证关系,全面分析全身病史,综合评估治疗风险,制定整体治疗方案,并施以个性化人文关怀,为老年口腔疾病科学的临床诊疗决策,提供合理思路。     

焦虑抑郁与高血压的研究进展

焦虑抑郁不仅是高血压的促发因素,也是影响高血压发生及预后的不良因素之一.抗焦虑抑郁治疗不仅可以有效消除高血压患者焦虑抑郁的情绪,还可以减少降压药的用药剂量,增强降压药的疗效,而且明显改善高血压患者的预后,降低心脑血管事件的发生率.现就有关焦虑抑郁和高血压的研究进展做一综述.     

山东省社区医疗机构高血压控制效果和影响因素研究

为了解山东省社区医疗机构对辖区内高血压患者的血压控制效果及其影响因素,并为社区高血压患者健康管理工作提供指导,采用多阶段分层抽样方法,在全省抽取了1 605名患者进行调查.对调查结果进行统计分析,结果显示城乡差异,患者对疾病的认知,对血压控制不满意的患者规范调整用药或进行转诊是血压控制率的影响因素.     

高血压治疗的血管保护策略

高血压治疗的血管保护策略第二军医大学长海医院心内科博士生（上海２００４３３）章建梁导师章同华秦永文一、高血压治疗的发展和血管保护的提出高血压是严重影响人类健康的疾病，对它的研究已经有一百多年的历史了。１８９６年Ｒｉｖａ－Ｒｏｃｉ始将袖带式间接测量血压...     

用辩证的眼光看待高血压

1　局部与整体高血压的发病是由于多种原因引起的 ,就目前所知 ,高血压是一种多基因疾病 ,这是由于它由多种基因可能存在的变异或者是多态性引起的。血压主要由神经系统、循环内分泌系统血管收缩 /舒张激素、心血管系统的结构、体液容量、肾功能及其他因素控制。它们与血压之间相互制约、相互影响 ,形成了更为复杂的调控系统 ,是一种很大范围内的新的整体 ;每个因素 ,如阻力的变化、心脏功能的变化及血容量的变化等 ,都只是这个整体中的一个局部。而在每一个这种局部之中又自成一个整体 ,因而包含了新的局部。如阻力因素中的血管张力 ,血管…     

个体危机干预中的伦理学问题

由于诸多因素,使得一些高血压患者对治疗产生抵抗,或表现为难治性,其中有疾病因素、对治疗的依从性、其他药物的干扰和生活方式等。研究已经证明,有效地控制血压,使之达标,可以有效地降低重要靶器官受损的危险性。而规范、系统地控制血压、加强对抵抗性高血压的管理是保护靶器官的重要途径,同时需要进一步的研究证据的支持。     

从JNC高血压指南的演变史看盐与高血压的关系

高血压是当今世界上最大的流行病,是脑卒中、心脏病及肾脏病最主要的危险因素。通过回顾比较不同时期的JNC高血压指南,了解对盐与高血压关系认识的发展过程,体会限盐对高血压防治的重要性及发展前景。     

Food and water intake as functions of resource consumption costs in a closed economy.

In two experiments, rats living in a closed economy were offered continuous, concurrent access to four resources: food, water, a nest, and a running wheel. Costs of consuming food and water were imposed with bar-press requirements, and the price of either one or both resources was raised. As the consumption cost increased, less was consumed in each bout of resource use. Bout frequency increased, but not sufficiently to compensate for the fall in bout size, and total intake fell. Food and water tended to be complementary resources, in that as intake of one fell with its price, intake of the other also decreased. This interaction was accounted for by the defense of the ratio of body water to lean body mass. As amount consumed decreased, increases in feed efficiency (weight gain per unit of food ingested) and the use of stored calories compensated for the reduced energy intake. There was evidence of competition between feeding and drinking at the higher costs: When both commodities were expensive, the decline in the intake of each one was greater than when only one commodity was expensive. Although the time spent nesting, running, and in unmonitored activity was adjusted when feeding or drinking took more of the rat's day, there was no particular activity that was sacrificed.     

Separate neural sites for d-amphetamine suppression of mouse killing and feeding behavior in rats

The present study was conducted to investigate several possible neural sites for d-amphetamine's effect on mouse killing and feeding behaviors. d-Amphetamine (10, 20, and 30 μg) injected into each lateral ventricle, suppressed mouse kiling, food, and water intake in a dose-dependent manner. Bilateral adminstration of d-amphetamine (20 μg) into the central amygdaloid nucleus abolished mouse killing behavior but did not affect feeding and drinking. By contrast, bilateral amphetamine injections into the substantia nigra, or into the ventral region of the caudate nucleus, did not suppress mouse killing behavior, but significantly decreased food and water intake. The lateral hypothalamus was sensitive to d-amphetamine injections, which suppressed mouse killing and food intake as well as water intake. d-Amphetamine injections into the nucleus accumbens produced inconsistent effects on mouse killing and feeding. Our observations suggest a differentiation of the neural sites that mediate feeding from those underlying mouse killing behavior.     

Biased perception of overeating in bulimia nervosa and compulsive binge eaters

This study investigated the relationship between caloric intake and perceived overeating in subjects with and without a history of problematic binge eating. Eighty subjects (20 in four groups: bulimia nervosa, compulsive binge eaters, obese, and normal controls) self-monitored eating for 2 weeks. The regression slopes for self-reported overeating as a function of caloric intake were contrasted across the four groups. At higher caloric levels, bulimics and binge eaters reported overeating at a significantly higher rate compared to obese and normal control groups. These data were interpreted as a type of cognitive bias whereby subjects with a history of binge eating distorted their perception of overeating at progressively higher caloric levels. It was proposed that excessive concern about eating and dieting may cause such cognitive biases. A parallel was drawn with body image distortion, which appears to be associated with overconcem with body size and shape.     

Perceived control,depressive symptomatology,and professional burnout: A review of the evidence

This article examines the extent to which self-reported emotional eating is a predictor of unhealthy snack consumption or, alternatively, an expression of beliefs about the relation between emotions and eating derived from concerns about eating behaviour. Three studies were conducted. Study 1 (N = 151) and Study 2 (N = 184) investigated the predictive validity of emotional eating compared to habit strength in snack consumption, employing 7-day snack diaries. Both studies demonstrated that snack consumption was not predicted by emotional eating but depended on the habit of unhealthy snacking and on restraint eating. As emotional eating was not a significant predictor of snack intake, Study 3 addressed the alternative hypothesis of emotional eating being an expression of concerns about eating behaviour. Results from this cross-sectional survey (N = 134) showed that emotional eating was significantly associated with several concerns. Together, these studies show that snack intake is better predicted by habit strength and restraint eating than by emotional eating. Additionally, the results suggest that in normal-weight women the concept of emotional eating may not capture the tendency to eat under emotional conditions, but rather reflects beliefs about the relation between emotions and eating.     

Sensitization and habituation of motivated behavior in overweight and non-overweight children

The rate of habituation to food is inversely related to energy intake, and overweight children may habituate slower to food and consume more energy. This study compared patterns of sensitization, as defined by an initial increase in operant or motivated responding for food, and habituation, defined by gradual reduction in responding, for macaroni and cheese and pizza in overweight and non-overweight 8- to 12-year-old children. Non-overweight children habituated faster to both foods than overweight children (p = .03). All children recovered motivated responding for a new food (chocolate). Overweight children consumed more energy than non-overweight children (p = .0004). Children who showed a sensitization in responding consumed more food (p = .001), and sensitization moderated the effect of overweight on habituation, with slower habituation for overweight children who sensitized (p < .001). This study replicates previous data on overweight/non-overweight differences in habituation of food and energy intake, and provides new information that individual differences in sensitization and habituation of motivated responding to obtain food may be associated with a sustained motivation to eat, resulting in greater energy intake.     

吸烟:促进还是损害前瞻记忆?

以往研究对吸烟或尼古丁摄入影响前瞻记忆的特点和机制进行了探讨,发现吸烟或尼古丁摄入对前瞻记忆的影响具有双重机制:尼古丁能短暂刺激神经递质释放,并通过促进策略加工提高即时的前瞻记忆表现;但长期来看,吸烟会损伤心脑血管和神经元,降低认知和执行功能的水平,从而持久损害前瞻记忆。将来的研究应在区分前瞻记忆任务类型、尼古丁摄入方式等的基础上,进一步明确吸烟或尼古丁摄入影响前瞻记忆的机制。     

Models,monitoring, and the mind: Comments on Wansink and Chandon's “Slim by Design”

Wansink and Chandon have examined the “mindlessness” that is often evident in everyday food intake. In this commentary, we focus on four issues raised by Wansink and Chandon's paper: (1) the distinction between food choice and food intake; (2) their model of food intake (and how it compares and contrasts with our own model of food intake); (3) the role of monitoring in the control of food intake; and (4) the meaning of “mindless” eating. In each case we find value in Wansink and Chandon's proposals but also an opportunity for further analysis and refinement.     

A meta-analysis of children’s self-reports of dietary intake

Objective: Although research studies increasingly use children as primary reporters in dietary assessments, it is unclear how well children’s self-reported intake correlates with independently validated reports of their intake; this meta-analysis assesses that correlation.

Design: Moderators of the correlation between self-reported and independently validated intake were predicted a priori: type of dietary intake assessment (24 h recall, food diary and food frequency questionnaires), validation measures, parental assistance and age. Online databases were searched for articles published from 1990 to 2014 that compared children’s self-reports of dietary intake to validated observations of food intake in children age 4–16.

Main outcome measures: Summary effect size Pearson r between children’s self-reported dietary intake and independently validated dietary intake were calculated.

Results: In k = 32 samples from 23 studies, a statistically significant correlation (r = .48, Z = 7.26, p < .001) was found between children’s self-reported dietary intake and independently validated reports of dietary intake. Validation method (Q = 17.49, df = 2, p < .001) and parental assistance (Z = 2.03, p = .042) were significant moderators of this correlation. Self-report methodology (Q = 3.95, df = 2, p = .139) and age (Q = .02, p = .879) were not significant moderators of the distribution of effect sizes.

Conclusion: Together, these results provide baseline information about children’s recall in dietary intake assessments conducted with children as primary reporters.     

Nonregulation of food intake in restrained,emotional, and external eaters

In the present study, regulation of ice cream intake after a preload was examined in 20 high and 20 low scorers (median split) on subscales of the Restraint Scale (RS) (Herman, Polivy, Pliner, Threshold, & Munic, 1978) and the Dutch Eating Behavior Questionnaire (DEBQ) (van Strien, 1986). For each subscale it was hypothesized that low scorers would regulate their ice cream intake. High scorers on disinhibitive scales (i.e., the RS and the DEBQ-emotional and -external subscales) were expected to counterregulate after a preload. In contrast, high scorers on the inhibitive DEBQ-restraint scale were expected to regulate their ice cream intake. A robust effect was found: high scorers never regulated ice cream intake after a preload on either the disinhibitive or the inhibitive scales, while low scorers always did. For the RS a significant interaction effect was found [F(1,39)=4.97, p=.03]. None of the other subscales showed interaction effects. The t tests showed that low scorers on all subscales ate significantly less after a preload than without one, while high scorers on all subscales did not differ in intake after a preload or without one. This nonregulation appears to be characteristic of people preoccupied with caloric intake, regardless of the content of the preoccupation.