Risk Factors

危险因素
  • 文章类型: Journal Article
    特发性突发性感觉神经性听力损失(ISSHL)是一种突然发作,原因不明的感觉神经性听力损失.抑郁症是一种常见的精神障碍和残疾的主要原因。这里,我们使用双样本孟德尔随机化方法,使用来自ISSHL全基因组关联研究的汇总统计数据(1491例,196,592名对照)和抑郁症(23,424例,192,220个对照)在欧洲人口中。本研究使用逆方差加权研究了与抑郁症相关的单核苷酸多态性与ISSHL之间的双向关系。额外的敏感性分析,如孟德尔随机化-Egger(MR-Egger),加权中位数估计,和遗漏分析,进行评估结果的可靠性。在随机效应IVW方法中,对ISSHL的遗传易感性与抑郁症之间存在显着因果关系(OR=1.037,95%CI=1.004-1.072,P=0.030)。相比之下,遗传性抑郁不是ISSHL的危险因素(OR=1.134,95%CI=0.871~1.475,P=0.350)。通过不同的MR方法验证和敏感性分析,所有上述结果是一致的。我们收集的证据表明ISSHL与抑郁症之间存在因果关系。前者的存在诱发或进一步加剧后者,而当后者是影响因素时,就不存在类似的情况。
    Idiopathic Sudden Sensorineural Hearing Loss (ISSHL) is a sudden onset, unexplained sensorineural hearing loss. Depression is a common mental disorder and a leading cause of disability. Here, We used a two-sample Mendelian randomization approach using pooled statistics from genome-wide association studies of ISSHL (1491 cases, 196,592 controls) and depression (23,424 cases, 192,220 controls) in European populations. This study investigated the bidirectional relationship between single nucleotide polymorphisms associated with depression and ISSHL using inverse variance weighting.Additional sensitivity analyses, such as Mendelian randomization-Egger (MR-Egger), weighted median estimates, and leave-one-out analysis, were performed to assess the reliability of the findings. Significant causal association between genetic susceptibility to ISSHL and depression in a random-effects IVW approach (OR = 1.037, 95% CI = 1.004-1.072, P = 0.030). In contrast, genetic depression was not risk factors for ISSHL (OR = 1.134, 95% CI = 0.871-1.475, P = 0.350). After validation by different MR methods and the sensitivity analysis, all of the above results are consistent. The evidence we have gathered suggests a causal relationship between ISSHL and depression. The presence of the former induces or further exacerbates the latter, whereas a similar situation does not exist when the latter is an influencing factor.
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  • 文章类型: Journal Article
    引言下颌第三磨牙可以无症状或引起一些病变,如远端龋齿和牙源性囊肿和肿瘤。这项研究调查了下颌第二磨牙邻近近中角或水平部分萌出的下颌第三磨牙的远端龋齿的患病率及其与腐烂的关系,缺失和填充牙齿(DMFT)风险组,年龄,侧面(左右)和性别。方法该研究包括预约了近角或水平定位并部分萌出下颌第三磨牙手术的患者。手术前,DMFT得分,年龄,记录性别和侧面。提取后,对第二磨牙的远端龋齿进行了临床检查。远端龋的患病率和DMFT风险组之间的相关性,年龄,性别和侧面进行了确定。结果本研究共对514例患者进行,共639颗牙齿。中危或高危人群中的男性和患者明显容易发生第二磨牙远端龋齿。关于年龄组,没有统计学上的显著关系,侧面和位置。结论性别和DMFT风险组会影响邻近近中角或水平部分萌出的第三磨牙的第二磨牙远端龋的患病率。在中度或高危人群中的男性和患者中应考虑预防性提取。
    Introduction Impacted mandibular third molars can be asymptomatic or cause some pathologies, such as distal caries and odontogenic cysts and tumours. This study investigates the prevalence of distal caries of the mandibular second molar adjacent to the mesioangular or horizontally partially erupted mandibular third molar and its relationship regarding decayed, missing and filled teeth (DMFT) risk group, age, side (left-right) and sex.Methods The study included patients who had an appointment for mesioangular or horizontally positioned and partially erupted mandibular third molar surgery. Before the surgery, the DMFT score, age, sex and side were recorded. After extraction, the second molar was clinically examined for distal caries. The prevalence of distal caries and the correlation between the DMFT risk group, age, sex and side were determined.Results The study was conducted on 514 patients and involved 639 teeth. Men and patients in the moderate- or high-risk group are significantly prone to developing distal caries of the second molar. No statistically significant relationship exists regarding age group, side and position.Conclusion Sex and DMFT risk groups affect the prevalence of distal caries in second molars adjacent to the mesioangular or horizontally partially erupted third molars. The prophylactic extraction should be considered in men and patients in the moderate- or high-risk group.
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  • 文章类型: Journal Article
    鲍曼不动杆菌(AB)已成为易感和重症患者的主要病原体。尚不清楚由于AB菌血症引起的早期死亡率(EM)是由于感染患者的临床特征较差还是病原体的毒力所致。在这项研究中,我们旨在研究AB毒力对菌血症引起的EM的影响。这项回顾性研究包括138例AB菌血症患者(年龄≥18岁),他们在2015年至2019年期间入住韩国三级护理教学医院。EM定义为菌血症发作后7天内发生的死亡。将从患者血液培养物中获得的AB临床分离株分别注射到15只Galleriamelonella幼虫中,将其孵育5天。根据死亡幼虫的数量,将临床分离株分为高毒力和低毒力组。合并患者的临床数据,并进行多变量Cox回归分析,以确定EM的危险因素。总的来说,48/138(34.8%)患者在菌血症发作后7天内死亡。Pitt菌血症评分是唯一与EM相关的危险因素。总之,AB毒力对AB菌血症患者EM无独立影响。
    Acinetobacter baumannii (AB) has emerged as a major pathogen in vulnerable and severely ill patients. It remains unclear whether early mortality (EM) due to AB bacteremia is because of worse clinical characteristics of the infected patients or the virulence of the pathogen. In this study, we aimed to investigate the effect of AB virulence on EM due to bacteremia. This retrospective study included 138 patients with AB bacteremia (age: ≥ 18 years) who were admitted to a tertiary care teaching hospital in South Korea between 2015 and 2019. EM was defined as death occurring within 7 days of bacteremia onset. The AB clinical isolates obtained from the patients\' blood cultures were injected into 15 Galleria mellonella larvae each, which were incubated for 5 days. Clinical isolates were classified into high- and low-virulence groups based on the number of dead larvae. Patients\' clinical data were combined and subjected to multivariate Cox regression analyses to identify the risk factors for EM. In total, 48/138 (34.8%) patients died within 7 days of bacteremia onset. The Pitt bacteremia score was the only risk factor associated with EM. In conclusion, AB virulence had no independent effect on EM in patients with AB bacteremia.
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  • 文章类型: Journal Article
    本研究旨在开发和验证针对韩国2型糖尿病(T2DM)人群的机器学习(ML)模型,为预测心血管疾病(CVD)的发展提供更好的方法。这些患者的主要慢性并发症。我们使用了两个队列的数据,即发现(一家医院;n=12,809)和验证(两家医院;n=2019)队列,在2008年至2022年之间招募。感兴趣的结果是3年时是否存在CVD。我们在发现队列中选择了各种基于ML的模型,并进行了超参数调整,并在验证队列中进行了接收器工作特征曲线下面积(AUROC)分析。在发现队列中,1238例(10.2%)患者观察到CVD。随机森林(RF)模型表现出最佳的整体性能,发现数据集中的AUROC为0.830(95%置信区间[CI]0.818-0.842),验证数据集中的AUROC为0.722(95%CI0.660-0.783)。肌酐和糖化血红蛋白水平是RF模型中最有影响的因素。这项研究介绍了一种开创性的基于ML的模型,用于预测韩国T2DM患者的CVD,优于现有的预测工具,为早期个性化预防医学提供了开创性的方法。
    This study aimed to develop and validate a machine learning (ML) model tailored to the Korean population with type 2 diabetes mellitus (T2DM) to provide a superior method for predicting the development of cardiovascular disease (CVD), a major chronic complication in these patients. We used data from two cohorts, namely the discovery (one hospital; n = 12,809) and validation (two hospitals; n = 2019) cohorts, recruited between 2008 and 2022. The outcome of interest was the presence or absence of CVD at 3 years. We selected various ML-based models with hyperparameter tuning in the discovery cohort and performed area under the receiver operating characteristic curve (AUROC) analysis in the validation cohort. CVD was observed in 1238 (10.2%) patients in the discovery cohort. The random forest (RF) model exhibited the best overall performance among the models, with an AUROC of 0.830 (95% confidence interval [CI] 0.818-0.842) in the discovery dataset and 0.722 (95% CI 0.660-0.783) in the validation dataset. Creatinine and glycated hemoglobin levels were the most influential factors in the RF model. This study introduces a pioneering ML-based model for predicting CVD in Korean patients with T2DM, outperforming existing prediction tools and providing a groundbreaking approach for early personalized preventive medicine.
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  • 文章类型: Journal Article
    虽然目前有超过40个复制基因具有晚期阿尔茨海默病(LOAD)的映射风险等位基因,载脂蛋白E基因座E4单倍型仍然是风险的最大驱动因素,神经病理学证实的E44携带者的比值比超过30(95%置信区间16.59-58.75)。我们试图解决APOEE4单倍型是否通过表达网络在全球范围内修饰表达以增加LOAD风险。我们使用人脑组数据构建表达网络,使用可扩展的混合数据类型贝叶斯网络(BN)建模将APOEE4携带者与非携带者进行比较。我们发现VGF具有最大的解释权重。VGF的高表达是一种保护性信号,甚至在APOEE4等位基因的背景下。负载风险信号,考虑到APOE背景,包括高水平的SPECC1L,HLA-DRA和RANBP3L。我们的发现提名了几个新的成绩单,采取组合方法构建网络,包括已知的LOAD风险位点。
    While there are currently over 40 replicated genes with mapped risk alleles for Late Onset Alzheimer\'s disease (LOAD), the Apolipoprotein E locus E4 haplotype is still the biggest driver of risk, with odds ratios for neuropathologically confirmed E44 carriers exceeding 30 (95% confidence interval 16.59-58.75). We sought to address whether the APOE E4 haplotype modifies expression globally through networks of expression to increase LOAD risk. We have used the Human Brainome data to build expression networks comparing APOE E4 carriers to non-carriers using scalable mixed-datatypes Bayesian network (BN) modeling. We have found that VGF had the greatest explanatory weight. High expression of VGF is a protective signal, even on the background of APOE E4 alleles. LOAD risk signals, considering an APOE background, include high levels of SPECC1L, HLA-DRA and RANBP3L. Our findings nominate several new transcripts, taking a combined approach to network building including known LOAD risk loci.
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  • 文章类型: Journal Article
    目的:重度狼疮性肾炎(LN)后停止或继续维持免疫抑制治疗(MIST)需要测量复发风险,但缺乏可靠的临床和生物学标志物。WIN-IgE研究评估血清抗dsDNAIgE自身抗体作为预测严重LN复发的生物标志物的价值。
    方法:WIN-IgE是WIN-Lupus研究的辅助研究(NCT01284725),一项前瞻性对照临床试验,该试验评估了有活动性病变的III级或IV±V级LN在2-3年后停用MIST的情况。WIN-IgE包括在随机分组时收集的所有患者,用于继续或停止MIST。在这些血清中,抗dsDNA抗体,IgE和IgG,通过ELISA定量,并在24个月随访期间发生LN复发的患者和未发生LN复发的患者之间进行比较。
    结果:纳入52例患者,MIST延续组25人,MIST停药组27人,12经历了活检证实的LN复发。在随后的LN复发的患者中,初始抗dsDNAIgE抗体水平较高。抗dsDNAIgG与复发无关。在抗dsDNAIgE水平高于和低于阈值1.9任意单位的患者中,无LN复发的生存率较低(p=0.019),特别是在随机停止MIST的患者亚组(p=0.002).在所有患者中,抗dsDNAIgE高于1.9任意单位对严重LN复发的阳性预测值为0.8.
    结论:这些结果表明血液抗dsDNAIgE是LN复发的非侵入性预测标志物。
    OBJECTIVE: Discontinuation or continuation of maintenance immunosuppressive therapy (MIST) after a severe lupus nephritis (LN) requires measuring the risk of relapse but reliable clinical and biological markers are lacking. The WIN-IgE study assesses the value of serum anti-dsDNA IgE autoantibodies as a biomarker for the prediction of relapse in severe LN.
    METHODS: WIN-IgE is an ancillary study of the WIN-Lupus study (NCT01284725), a prospective controlled clinical trial which evaluated the discontinuation of MIST after 2-3 years in class III or IV±V LN with active lesions. WIN-IgE included all patients with available serum collected at randomisation for continuation or discontinuation of MIST. In these sera, anti-dsDNA antibodies, IgE and IgG, were quantified by ELISA and compared between patients who experienced LN relapse and those who did not during the 24 months of follow-up.
    RESULTS: 52 patients were included, 25 in the MIST continuation group and 27 in the MIST discontinuation group, 12 experienced a biopsy-proven relapse of LN. Initial anti-dsDNA IgE antibodies levels were higher in patients with subsequent LN relapse. Anti-dsDNA IgG was not associated with relapse. Survival without LN relapse was lower in patients with anti-dsDNA IgE levels above vs below a threshold of 1.9 arbitrary units (p=0.019), particularly in the subgroup of patients randomised to discontinue MIST (p=0.002). In all patients, anti-dsDNA IgE above 1.9 arbitrary units had a positive predictive value of 0.8 for severe LN relapse.
    CONCLUSIONS: These results suggest blood anti-dsDNA IgE as a non-invasive predictive marker of LN relapse.
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  • 文章类型: Journal Article
    背景:炎症之间关系的性质,轴性脊柱关节炎(axSpA)的心血管危险因素(CV)和动脉粥样硬化在很大程度上还不清楚,在这方面的性别差异还有待评估.
    方法:研究包括来自西班牙多中心AtheSpAin队列的611名男性和302名女性,以评估axSpA中的CV疾病。在疾病诊断和登记时都收集了CV疾病危险因素的数据,和疾病活动的数据,仅在招募时进行功能指数和颈动脉超声检查。
    结果:中位病程为9年后,诊断为疾病的男女患者急性期反应物(APRs)升高,更常见的是高血压和肥胖。男性血脂异常和女性糖尿病也是如此。在入学时,CV危险因素与APR以及活动和功能指数独立相关,有各种性别差异。C反应蛋白(CRP)值与男性HDL-胆固醇呈负相关(β系数:-1.2(95%CI:-0.3至-0.07)mg/dL,p=0.001),而红细胞沉降率值与女性甘油三酯呈正相关(β系数:0.6(95%CI:0.04至1)mg/dL,p=0.035)。此外,只有女性显示胰岛素抵抗参数与APR或疾病活动性之间的独立关系。根据冠状动脉风险评估系统评估2,具有高-非常高CV风险的男性和女性,在诊断该疾病时CRP水平高于3mg/L,其颈动脉斑块的频率明显高于CRP水平正常的患者。诊断。
    结论:在axSpA中,炎症与动脉粥样硬化和CV疾病相关。在这种关系中观察到性别驱动的效应。
    BACKGROUND: The nature of the relationship between inflammation, cardiovascular (CV) risk factors and atherosclerosis in axial spondyloarthritis (axSpA) remains largely unknown and sex differences in this regard are yet to be assessed.
    METHODS: Study including 611 men and 302 women from the Spanish multicentre AtheSpAin cohort to assess CV disease in axSpA. Data on CV disease risk factors were collected both at disease diagnosis and at enrolment, and data on disease activity, functional indices and carotid ultrasonography only at enrolment.
    RESULTS: After a median disease duration of 9 years, patients of both sexes who at disease diagnosis had elevated acute phase reactants (APRs), more frequently had hypertension and obesity. The same occurred with dyslipidaemia in men and with diabetes mellitus in women. At enrolment, CV risk factors were independently associated with APR and with activity and functional indices, with various sex differences. C reactive protein (CRP) values were inversely associated with HDL-cholesterol in men (β coefficient: -1.2 (95% CI: -0.3 to -0.07) mg/dL, p=0.001), while erythrocyte sedimentation rate values were positively associated with triglycerides in women (β coefficient: 0.6 (95% CI: 0.04 to 1) mg/dL, p=0.035). Furthermore, only women showed an independent relationship between insulin resistance parameters and APR or disease activity. Both men and women with high-very high CV risk according to the Systematic Assessment of Coronary Risk Evaluation 2 and CRP levels higher than 3 mg/L at diagnosis of the disease presented carotid plaques significantly more frequently than those with normal CRP levels at disease diagnosis.
    CONCLUSIONS: Inflammation is associated with atherosclerosis and CV disease in axSpA. A gender-driven effect is observed in this relationship.
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  • 文章类型: Journal Article
    背景:确定生活在孟加拉国Madrasahs(伊斯兰宗教教育机构)的儿童中sc疮的患病率和相关因素是研究的目的。
    方法:这项横断面研究是在2023年5月至10月的8个选定的Madrasahs中对3至18岁的男女儿童进行的。根据国际控制of病联盟制定的标准,对儿童进行了of疮筛查。
    结果:发现居住在Madrasahs的儿童中sc疮的总体患病率几乎为34%(轻度73.5%,中度24.9%和重度1.6%)。男性sc疮患病率高于女性(39.4%vs28.4%)。男性(aOR2.09,95%CI1.27至3.47,p=0.004)和年龄(aOR0.95,95%CI0.91至0.99,p=0.017)是儿童sc疮的两个重要预测因素。此外,生活在有更多寄宿生的伊斯兰教徒(aOR1.37,95%CI1.06至1.69,p=0.025),共用床上用品,与其他儿童一起的衣服或厕所(aOR1.46,95%CI1.03至2.09,p=0.036)和亲密随行人员的瘙痒史(aOR4.19,95%CI3.07至5.73,p<0.001)与更高的机会相关。sc感染。
    结论:生活在孟加拉国伊斯兰寄宿学校的儿童中,几乎有三分之一患有sc疮,男性和年幼儿童的患病率更高。住宿人数较多的寄宿生,在密切接触者中共享私人员工和瘙痒会增加这些儿童患sc疮的风险。
    BACKGROUND: To determine the prevalence and associated factors of scabies among the children living in the Madrasahs (Islamic religious educational institution) of Bangladesh was the objective of the study.
    METHODS: This cross-sectional study was conducted in eight selected Madrasahs from May to October 2023 among male and female children aged between 3 and 18 years. Children were screened for scabies according to criteria developed by the International Alliance for the Control of Scabies.
    RESULTS: It was found that overall prevalence of scabies among the children living in Madrasahs was almost 34% (mild 73.5%, moderate 24.9% and severe 1.6%). Prevalence of scabies among male was higher than female (39.4% vs 28.4%). Male gender (aOR 2.09, 95% CI 1.27 to 3.47, p=0.004) and age (aOR 0.95, 95% CI 0.91 to 0.99, p=0.017) were two significant predictors of scabies among children. Besides, living in Madrasahs having more boarders (aOR 1.37, 95% CI 1.06 to 1.69, p=0.025), shared bedding, clothes or toilet stuffs with other children (aOR 1.46, 95% CI 1.03 to 2.09, p=0.036) and history of pruritus in the close entourage (aOR 4.19, 95% CI 3.07 to 5.73, p<0.001) were associated with a higher chance of being infected by scabies.
    CONCLUSIONS: Almost one-third of the children living in the Islamic boarding schools in Bangladesh are suffering from scabies, more prevalence in male and younger children. Accommodation of higher number of boarders, sharing personal staffs and pruritus in close contacts increase the risk of scabies in these children.
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  • 文章类型: Journal Article
    背景:尽管饮酒是癌症的既定危险因素,关于减少或停止饮酒对癌症发病率的影响的证据很少.我们的主要研究目的是评估酒精康复和禁欲对酒精依赖者癌症发病率的影响。
    方法:我们进行了一项全国性医院回顾性队列研究,纳入了居住在法国大陆并于2018-21年出院的所有成年人。多变量Cox比例风险模型用于评估在医院康复治疗或戒酒史与无康复或戒酒史的酒精依赖对因性别而发生的酒精相关癌症风险的影响。控制潜在的混杂风险因素。
    结果:2018-21年,10260056名男性和13739369名女性从法国医院出院。在645720(6·3%)男性和219323(1·6%)女性中发现了酒精依赖。酒精依赖与男女酒精相关的癌症部位密切相关(肝细胞癌和口腔,咽部,喉,食道,和结肠直肠癌),除了乳腺癌.与没有康复或禁欲的酒精依赖相比,康复治疗或禁欲的风险显着降低(调整后的风险比:男性为0·58,99·89%CI0·56-0·60,女性为0·62,0·57-0·66)。男女中每个酒精相关癌症部位的相对风险降低均显着,并得到所有亚组和敏感性分析的支持。
    结论:我们的研究结果支持酒精康复和禁欲在降低酒精相关癌症风险方面的明显益处。由于只有五分之一的酒精依赖患者有康复治疗或禁欲史,在降低癌症发病率方面存在巨大的未开发潜力。
    背景:欧盟的EU4Health计划。
    BACKGROUND: Even though alcohol consumption is an established risk factor for cancer, evidence regarding the effect of a reduction or cessation of alcohol consumption on cancer incidence is scarce. Our main study aim was to assess the effect of alcohol rehabilitation and abstinence on cancer incidence in people with alcohol dependence.
    METHODS: We conducted a nationwide hospital retrospective cohort study which included all adults residing in mainland France and discharged in 2018-21. Multivariable Cox proportional hazards models were used to estimate the effect of rehabilitation treatment at hospital or a history of abstinence versus alcohol dependence without rehabilitation or abstinence on the risk for incident alcohol-associated cancers by sex, controlled for potential confounding risk factors.
    RESULTS: 10 260 056 men and 13 739 369 women were discharged from French hospitals in 2018-21. Alcohol dependence was identified in 645 720 (6·3%) men and 219 323 (1·6%) women. Alcohol dependence was strongly related to alcohol-associated cancer sites in both sexes (hepatocellular carcinoma and oral, pharyngeal, laryngeal, oesophageal, and colorectal cancers), except for breast cancer. Rehabilitation treatment or abstinence was associated with significantly lower risks compared with alcohol dependence without rehabilitation or abstinence (adjusted hazard ratios: 0·58, 99·89% CI 0·56-0·60 in men and 0·62, 0·57-0·66 in women). Relative risk reductions were significant for each alcohol-associated cancer site in both sexes and supported by all subgroup and sensitivity analyses.
    CONCLUSIONS: Our study results support the clear benefits of alcohol rehabilitation and abstinence in reducing the risk for alcohol-associated cancers. As only two in five patients with alcohol dependence were recorded with a history of rehabilitation treatment or abstinence, a large untapped potential exists for reducing cancer incidence.
    BACKGROUND: European Union\'s EU4Health programme.
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  • 文章类型: Journal Article
    背景:一些队列研究报告了痴呆患病率和发病率随着时间的推移而下降,尽管这些发现在所有研究中并不一致.我们使用已发表的基于人群的队列研究回顾了痴呆患病率和发病率随时间变化的证据,这些研究使用了与每个波一致的方法,旨在使用人群归因分数(PAF)量化风险因素随时间的相关变化。
    方法:我们搜索了关于痴呆患病率或发病率随时间变化的队列研究的系统评价。我们搜索了PubMed从数据库开始到2023年1月12日的出版物,使用搜索词“系统评价”和“痴呆症”和(“患病率”或“发病率”),没有语言限制。我们在2024年3月28日重复了这一搜索。从合格的系统审查中,我们检索了有关在同一地理位置测量痴呆患病率或发病率的队列研究的参考文献和经过同行评审的出版物,至少在两个时间点,并报告了痴呆的年龄标准化患病率或发病率。此外,数据必须来自基于人群的样本,评估参与者的认知状态,并使用经过验证的标准诊断痴呆.我们从每篇论文中提取了关于痴呆症危险因素的汇总数据,当发表的论文中没有这些数据时,联系作者,并在所有可用时间点计算每个风险因素的PAF。在可能的情况下,我们将痴呆患病率或发病率的变化与危险因素患病率的变化联系起来.
    结果:我们在最初的搜索中确定了1925条记录,其中确定了五项合格的系统评价。在这些系统审查中,我们确定了71篇潜在合格的初级论文,其中27个被包括在我们的分析中。27篇主要论文中有13篇(48%)报告了痴呆症患病率的变化,十个(37%)报告了痴呆症发病率的变化,4例(15%)报告了痴呆的发病率和患病率的变化.欧洲(n=5)和美国(n=5)的痴呆症发病率随时间变化的研究报告一致地报告了痴呆症的发病率下降。来自日本的一项研究报告了痴呆患病率和发病率的增加,尼日利亚的一项研究报告了稳定的发病率。总的来说,在整个研究中,受教育程度较低或吸烟的PAF,或者两者兼而有之,随着时间的推移,通常会下降,而肥胖的PAF,高血压,糖尿病普遍增加。在Framingham研究中,受教育和吸烟较少的PAF减少与痴呆症发病率下降有关(Framingham,MA,美国,1997-2013),唯一有足够数据允许分析的研究。
    结论:我们的研究结果表明,通过国家层面的政策改变,义务教育和降低吸烟率等生活方式干预措施可能与观察到的减少有关。因此未来的减少,在痴呆症的发病率中。低收入和中等收入国家需要更多的研究,痴呆症负担最高的地方,并继续增加。
    背景:国家健康与护理研究所三所学校痴呆症研究计划。
    BACKGROUND: Some cohort studies have reported a decline in dementia prevalence and incidence over time, although these findings have not been consistent across studies. We reviewed evidence on changes in dementia prevalence and incidence over time using published population-based cohort studies that had used consistent methods with each wave and aimed to quantify associated changes in risk factors over time using population attributable fractions (PAFs).
    METHODS: We searched for systematic reviews of cohort studies examining changes in dementia prevalence or incidence over time. We searched PubMed for publications from database inception up to Jan 12, 2023, using the search terms \"systematic review\" AND \"dementia\" AND (\"prevalence\" OR \"incidence\"), with no language restrictions. We repeated this search on March 28, 2024. From eligible systematic reviews, we searched the references and selected peer-reviewed publications about cohort studies where dementia prevalence or incidence was measured in the same geographical location, at a minimum of two timepoints, and that reported age-standardised prevalence or incidence of dementia. Additionally, data had to be from population-based samples, in which participants\' cognitive status was assessed and where validated criteria were used to diagnose dementia. We extracted summary-level data from each paper about dementia risk factors, contacting authors when such data were not available in the published paper, and calculated PAFs for each risk factor at all available timepoints. Where possible, we linked changes in dementia prevalence or incidence with changes in the prevalence of risk factors.
    RESULTS: We identified 1925 records in our initial search, of which five eligible systematic reviews were identified. Within these systematic reviews, we identified 71 potentially eligible primary papers, of which 27 were included in our analysis. 13 (48%) of 27 primary papers reported change in prevalence of dementia, ten (37%) reported change in incidence of dementia, and four (15%) reported change in both incidence and prevalence of dementia. Studies reporting change in dementia incidence over time in Europe (n=5) and the USA (n=5) consistently reported a declining incidence in dementia. One study from Japan reported an increase in dementia prevalence and incidence and a stable incidence was reported in one study from Nigeria. Overall, across studies, the PAFs for less education or smoking, or both, generally declined over time, whereas PAFs for obesity, hypertension, and diabetes generally increased. The decrease in PAFs for less education and smoking was associated with a decline in the incidence of dementia in the Framingham study (Framingham, MA, USA, 1997-2013), the only study with sufficient data to allow analysis.
    CONCLUSIONS: Our findings suggest that lifestyle interventions such as compulsory education and reducing rates of smoking through country-level policy changes could be associated with an observed reduction, and therefore future reduction, in the incidence of dementia. More studies are needed in low-income and middle-income countries, where the burden of dementia is highest, and continues to increase.
    BACKGROUND: National Institute for Health and Care Research Three Schools\' Dementia Research Programme.
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