2013年 · 第07卷第01期

Advocating the concept of healthy weight, starting with the prevention of overweight, in this issue, we launched the key number of weight management for the benefit of readers.

In the 21st century, the development of health management in China is faced with a rare opportunity, which has made great progress in terms of the number of institutions, service objects and service contents^[1]。 But we also face challenges! Among many problems and challenges, the lagging of discipline construction has become the bottleneck restricting the development of health management. Health management needs to vigorously strengthen the discipline construction, transition from the extension development mode dominated by scale effect to the connotation development mode dominated by discipline construction, and actively lead the sustainable development of health management institutions and industries.

In recent years, with the rapid and sustainable development of China's economic construction, people's living standard and quality of life have been improved correspondingly, and the dietary calorie intake level has increased obviously. At the same time, due to the progress of industrialization and the change of modern lifestyle, physical activity has been significantly reduced. These factors contribute to the development of obesity. Obesity is a chronic metabolic disease in which energy intake exceeds energy expenditure, resulting in excessive accumulation and/or abnormal distribution of fat in the body, weight gain, and reaching harmful degree^[1]。 According to a survey in 2002, the number of overweight and obese adults in China has reached 270 million^[2]In China, the chronic diseases caused by obesity and it are increasing year by year, and the total cost of its treatment is as high as 10 billion RMB/year, causing a heavy burden on individuals and society^[3,4]。 Paying attention to obesity has become a major event related to the national economy and people's livelihood.

Cervical cancer is the most common gynecological malignancy, and 80% of cervical cancer cases worldwide occur in developing countries^[1]。 In the past 20 years, the morbidity and mortality rates remain high in some rural areas of the central and western regions, and tend to be younger^[2]It is an urgent problem to establish a screening program for early diagnosis and treatment of cervical cancer suitable for economically underdeveloped areas. The World Health Organization recommends the use of acetic acid macroscopic observation for cervical cancer screening in underdeveloped areas^[3]。 This study aimed to apply visual inspection with acetic acid (VIA) and iodine staining visual inspection with Lugol's iodine (VILI) The function of screening cervical cancer was comprehensively evaluated, and the practical value of VIA/VILI as a screening method for cervical cancer in economically underdeveloped areas was discussed.

With the continuous aging of China's population^[1]The epidemic of chronic diseases has aroused widespread concern in the society, and a large number of studies rely on health management centers to carry out health interventions for different groups, which have played a good effect on their prevention and treatment^[2,3,4,5]。 However, the health status of different groups and the prevalence characteristics of chronic disease risk factors are different, and the health management model cannot be uniform^[2]Especially, there are few research reports on the faculty and staff of military academies. The teachers and staff of military colleges have distinct occupational characteristics, stable personnel composition and strict management. This study selects this group as the main body. By comparing with some civil servants in the same area, it deeply analyzes the detection rate of common chronic diseases and abnormal findings in different age stages, and the epidemic characteristics of chronic disease risk factors, aiming at providing scientific basis for this group to make effective health management scheme, so as to improve the compliance and effectiveness of health management.

Insomnia is a kind of sleep disorder syndrome, which is caused by difficulty in falling asleep or sleep maintenance disorders, resulting in insufficient sleep time or poor sleep quality, which cannot meet individual physiological needs, and obviously affects patients' daytime activities^[1]。 It is not only one of the most common clinical complaints, but also a common co-symptom and triggering factor of mental disorders, cardiovascular and cerebrovascular diseases and other diseases. Insomnia reduces the quality of life of individuals and impairs their social functions, increases the incidence of social traffic accidents, and consumes a lot of medical resources^[2]。 According to statistics, the direct and indirect economic losses caused by insomnia in a certain province in the United States are as high as $660 million every year^[3]。 In recent years, scholars at home and abroad have carried out a large number of epidemiological studies on insomnia, which can provide a basis for preventing and controlling insomnia and formulating corresponding prevention and control strategies. This article summarizes the epidemiological research progress of insomnia at home and abroad in recent years as follows.

In recent years, Chinese people's health awareness has been increasing, and the incidence of chronic infectious diseases has decreased year by year. In contrast to developed countries, the incidence of chronic non-infectious diseases (hereinafter referred to as chronic diseases) such as cardiovascular and cerebrovascular diseases (hereinafter referred to as chronic diseases) has increased in China^[1]。 The mortality rate of chronic diseases accounts for 80% of the total mortality rate in China, and chronic diseases account for 70% of the total burden of diseases^[2]。 According to the latest data published by WTO, cardiovascular diseases have become the leading cause of death in the world, and cardiovascular diseases are prone to sudden death^[3]。 Regular physical examinations can detect potential diseases early, so the demand for health examinations is increasing. The survey showed that the abnormal rate of ECG of healthy people was as high as 27.8%. Electrocardiogram is used to screen for various arrhythmias, cardiac hypertrophy, myocardial infarction, myocardial ischemia, electrolyte disorder, heart failure, and daily ECG monitoring of healthy people, etc.^[4]。 Electrocardiogram plays a preventive role in early screening, early diagnosis and early treatment in clinic. Electrocardiogram has a wide range of adaptations (across hospitals, health service centres and clinics at all levels). However, it is extremely difficult to train a high-level electrocardiogram diagnostician, because they need not only to master the medical theory knowledge of cardiovascular, but also need to have more practical experience in electrocardiogram diagnosis. Hospitals and institutions are actively exploring how to reduce the labor cost of ECG and improve the pass rate of ECG examination. The development of the Internet of Things allows us to build a medical cloud service system^[5]And electrocardiogram is the easiest scheme to implement.

As early as 1987, Rowe and Kahn proposed the concept of healthy aging, which includes: reduced risk of disease or disability, improved mental and physical function, and positive commitment to old life^[1]。 In 1999, the World Health Organization (WHO) further introduced the slogan of "active ageing" and in 2002, the Madrid Declaration clearly defined "active ageing" as the process of maximizing opportunities for health, participation and security at old age in order to improve the quality of life. It can be summarized as the principles of "independence, participation, dignity, care and self-fulfillment"^[2]。 Therefore, the existing disease is an important parameter in the evaluation criteria of the health condition of the elderly, but the functional state and social adaptability are more important indicators.

Many malignant tumors have the characteristics of occult onset, and often have no obvious symptoms in the early stage. If early clinical diagnosis can be obtained through health examination, a better prognosis can be obtained. Our hospital has been engaged in health examination for more than 20 years. Years of work practice tells us that health examination is one of the effective ways to detect malignant tumors early. The experience is as follows:

Health information collection is the initial link of physical examination, and it is also the prerequisite for drawing correct conclusions. As an important tool to collect individual health information and disease risk factors information and evaluate, questionnaire has been paid more and more attention. How to design and analyze the questionnaire well and play its basic role in health information collection has become one of the hot issues in health management academic circles. In recent years, we have carried out some work in the standardized design, data processing and comprehensive analysis of health questionnaires, and achieved preliminary results. Now we will introduce our experience and thinking as follows:

A study investigated the relationship between intake and variety of fruits and vegetables and type 2 diabetes. In this cohort study, 3704 subjects (653 with diabetes onset at follow-up) were studied, and all subjects completed food diary records for 7 days. Multivariate weighted regression analysis assessed hazard ratios and 95% confidence intervals. The results showed that in the tertile group of fruit and vegetable intake, the group with the highest intake could reduce the risk of type 2 diabetes by 21% compared with the group with the lowest intake (hazard ratio 0.79, 95%CI:0.62～1.00)。 Separate analysis of fruits and vegetables showed that vegetable intake was inversely associated with the incidence of type 2 diabetes (hazard ratio 0.76, 95%CI:0.62-1.00), but fruit intake was not associated with the incidence of type 2 diabetes. The variety diversity of fruit and vegetable intake was negatively correlated with the occurrence of type 2 diabetes (hazard ratio 0.77, 0.61, 95%CI:0.61～0.98、0.48～0.78)。 This study confirmed that the intake of a wide variety of fruits and vegetables can prevent the development of type 2 diabetes (Nat Med, 2012, 18: 589-594).

A recent study showed that taking antidepressants early in pregnancy can lead to abnormal pregnancies such as miscarriage and perinatal death. The researchers surveyed women aged 15 to 45 in primary care in the UK between 1990 and 2009. Among 331,414 surveyors, there were 512,574 pregnancies. Compared with those without a history of depression or anxiety, those who took antidepressants during pregnancy had the highest risk of abnormal pregnancy. Those diagnosed with depression or anxiety before pregnancy but who did not receive treatment had the middle risk. There is insufficient evidence to suggest that tricyclic drugs have a higher risk than other drugs, so avoiding or reducing the use of antidepressants early in pregnancy may reduce abnormal pregnancy to some extent (PLoS One, 2012, 7: e43462. Epub).