The impact of body mass index on performance - Int
The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in COPD
n engl j med 350;10march 4, 2004 The new england journal of medicine1005The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary DiseaseBartolome R. Celli, M.D., Claudia G. Cote, M.D., Jose M. Marin, M.D., Ciro Casanova, M.D., Maria Montes de Oca, M.D., Reina A. Mendez, M.D.,Victor Pinto Plata, M.D., and Howard J. Cabral, Ph.D.From the COPD Center at St. Elizabeth’s Medical Center, Tufts University School of Medicine, Boston (B.R.C., V .P.P.); Bay Pines Veterans Affairs Medical Center, Bay Pines,Fla. (C.G.C.); Hospital Miguel Servet, Zara-goza, Spain (J.M.M.); H ospital Nuestra Senora de La Candelaria, Tenerife, Spain (C.C.); Hospital Universitario de Caracas and Hospital Jose I. Baldo, Caracas, Vene-zuela (M.M.O., R.A.M.); and Boston Uni-versity School of Public H ealth, Boston (H.J.C.). Address reprint requests to Dr.Celli at Pulmonary and Critical Care Medi-cine, St. Elizabeth’s Medical Center, 736Cambridge St., Boston, MA 02135, or at bcelli@.N Engl J Med 2004;350:1005-12.Copyright © 2004 Massachusetts Medical Society.backgroundChronic obstructive pulmonary disease (COPD) is characterized by an incompletely re-versible limitation in airflow. A physiological variable — the forced expiratory volume in one second (FEV 1 ) — is often used to grade the severity of COPD. However, patients with COPD have systemic manifestations that are not reflected by the FEV 1 . We hypoth-esized that a multidimensional grading system that assessed the respiratory and sys-temic expressions of COPD would better categorize and predict outcome in these pa-tients.methodsWe first evaluated 207 patients and found that four factors predicted the risk of death in this cohort: the body-mass index (B), the degree of airflow obstruction (O) and dys-pnea (D), and exercise capacity (E), measured by the six-minute–walk test. We used these variables to construct the BODE index, a multidimensional 10-point scale in which higher scores indicate a higher risk of death. We then prospectively validated the index in a cohort of 625 patients, with death from any cause and from respiratory caus-es as the outcome variables.resultsThere were 25 deaths among the first 207 patients and 162 deaths (26 percent) in the validation cohort. Sixty-one percent of the deaths in the validation cohort were due to respiratory insufficiency, 14 percent to myocardial infarction, 12 percent to lung can-cer, and 13 percent to other causes. Patients with higher BODE scores were at higher risk for death; the hazard ratio for death from any cause per one-point increase in the BODE score was 1.34 (95 percent confidence interval, 1.26 to 1.42; P<0.001), and the hazard ratio for death from respiratory causes was 1.62 (95 percent confidence inter-val, 1.48 to 1.77; P<0.001). The C statistic for the ability of the BODE index to predict the risk of death was larger than that for the FEV 1 (0.74 vs. 0.65).conclusionsThe BODE index, a simple multidimensional grading system, is better than the FEV 1at predicting the risk of death from any cause and from respiratory causes among pa-tients with COPD.The new england journal of medicine1006hronic obstructiv e pulmonarydisease (COPD), a common disease char-acterized by a poorly reversible limitationin airflow,1 is predicted to be the third most fre-quent cause of death in the world by 2020.2 Therisk of death in patients with COPD is often gradedwith the use of a single physiological variable, theforced expiratory volume in one second (FEV1).1,3,4However, other risk factors, such as the presenceof hypoxemia or hypercapnia,5,6 a short distancewalked in a fixed time,7 a high degree of functionalbreathlessness,8 and a low body-mass index (theweight in kilograms divided by the square of theheight in meters),9,10 are also associated with anincreased risk of death. We hypothesized that a mul-tidimensional grading system that assessed the res-piratory, perceptive, and systemic aspects of COPDwould better categorize the illness and predict theoutcome than does the FEV1 alone. We used datafrom an initial cohort of 207 patients to identifyfour factors that predicted the risk of death: thebody-mass index (B), the degree of airflow ob-struction (O) and functional dyspnea (D), and exer-cise capacity (E) as assessed by the six-minute–walk test. We then integrated these variables into amultidimensional index — the BODE index — andvalidated the index in a second cohort of 625 pa-tients, with death from any cause and death from859 outpatients with a wide range in the severityof COPD were recruited from clinics in the UnitedStates, Spain, and Venezuela. The study was ap-proved by the human-research review board at eachsite, and all patients provided written informed con-sent. COPD was defined by a history of smokingthat exceeded 20 pack-years and a ratio of FEV1 toforced vital capacity (FVC) of less than 0.7 measured20 minutes after the administration of albuterol.1All patients were in clinically stable condition andreceiving appropriate therapy. Patients who werereceiving inhaled oxygen had to have been takinga stable dose for at least six months before studyentry. The exclusion criteria were an illness otherthan COPD that was likely to result in death withinthree years; asthma, defined as an increase in theFEV1 of more than 15 percent above the base-linevalue or of 200 ml after the administration of a bron-chodilator; an inability to take the lung-functionand six-minute–walk tests; a myocardial infarctionwithin the preceding four months; unstable angi-na; or congestive heart failure (New York Heart As-sociation class III or IV).variables selected for the bode indexWe determined the following variables in the first207 patients who were recruited between 1995 and1997: age; sex; pack-years of smoking; FVC; FEV1,measured in liters and as a percentage of the pre-dicted value according to the guidelines of theAmerican Thoracic Society11; the best of two six-minute–walk tests performed at least 30 minutesapart12; the degree of dyspnea, measured with theuse of the modified Medical Research Council(MMRC) dyspnea scale13; the body-mass index9,10;the functional residual capacity and inspiratorycapacity11; the hematocrit; and the albumin level.The validated Charlson index was used to deter-mine the degree of comorbidity. This index hasbeen shown to predict mortality.14 The differenc-es in these values between survivors and nonsur-vivors are shown in Table 1.Each of these possible explanatory variableswas independently evaluated to determine its as-sociation with one-year mortality in a stepwise for-ward logistic-regression analysis. A subgroup offour variables had the strongest association — thebody-mass index, FEV1 as a percentage of the pre-dicted value, score on the MMRC dyspnea scale,and the distance walked in six minutes (general-ized r2=0.21, P<0.001) — and these were includ-ed in the BODE index (Table 2). All these variablespredict important outcomes, are easily measured,and may change over time. We chose the post-bron-chodilator FEV1 as a percent of the predicted value,classified according to the three stages identifiedby the American Thoracic Society, because it can beused to predict health status,15 the rate of exacer-bation of COPD,16 the pharmacoeconomic costs ofthe disease,17 and the risk of death.18,19 We chosethe MMRC dyspnea scale because it predicts thelikelihood of survival among patients with COPD8and correlates well with other scales and health-status scores.20,21 We chose the six-minute–walktest because it predicts the risk of death in patientswith COPD,7 patients who have undergone lung-reduction surgery,22 patients with cardiomyopa-thy,23 and those with pulmonary hypertension.24In addition, the test has been standardized,12 theclinically significant thresholds have been deter-mined,25 and it can be used to predict resource uti-cn engl j med 350; march 4, 2004n engl j med 350;10march 4, 2004 a multidimensional grading system in chronic obstructive pulmonary disease1007lization. 26 Finally, there is an inverse relation be-tween body-mass index and survival 9,10 that is not linear but that has an inflection point, which was 21 in our cohort and in another study. 10validation of the bode indexThe BODE index was validated prospectively in two ways in a different cohort of 625 patients who were recruited between January 1997 and January 2003. First, we used the empirical model: for each threshold value of FEV 1 , distance walked in six min-utes, and score on the MMRC dyspnea scale shown in Table 2, the patients received points ranging from 0 (lowest value) to 3 (maximal value). For body-mass index the values were 0 or 1, because of the unique relation between body-mass index and survival described above. The points for each varia-ble were added, so that the BODE index ranged from 0 to 10 points, with higher scores indicating a greater risk of death. In an exploratory analysis, the various components of the BODE index were as-signed different weights, with no corresponding increase in predictive value.study protocolIn the cohort, patients were evaluated with the use of the BODE index within six weeks after enroll-ment and were seen every three to six months for at least two years or until death. The patient and family were contacted if the patient failed to return for appointments. Death from any cause and from specific respiratory causes was recorded. The cause of death was determined by the investigators at each site after reviewing the medical record and death certificate.statistical analysisData for continuous variables are presented as means ± SD. Comparison among the three coun-tries was completed with the use of one-way analy-sis of variance. The differences between survivors and nonsurvivors in pulmonary-function variables and other pertinent characteristics were established with the use of t-tests for independent samples.To evaluate the capacity of the BODE index to pre-dict the risk of death, we performed Cox propor-tional-hazards regression analyses. 27 We estimat-ed the hazard ratio, 95 percent confidence interval,and P value for the BODE score, before and after adjustment for coexisting conditions as measured by the Charlson index. We repeated these analyses using the BODE index as the predictor of interest in*FVC denotes forced vital capacity, FEV 1 forced expiratory volume in one sec-ond, and FRC functional residual capacity.†Scores on the modified Medical Research Council (MMRC) dyspnea scale can range from 0 to 4, with a score of 4 indicating that the patient is too breathless to leave the house or becomes breathless when dressing or undressing.‡The body-mass index is the weight in kilograms divided by the square of the height in meters.§Scores on the Charlson index can range from 0 to 33, with higher scores indi- cating more coexisting conditions.*The cutoff values for the assignment of points are shown for each variable. The total possible values range from 0 to 10. FEV 1 denotes forced expiratory volume in one second.†The FEV 1 categories are based on stages identified by the American Thoracic Society.‡Scores on the modified Medical Research Council (MMRC) dyspnea scale can range from 0 to 4, with a score of 4 indicating that the patient is too breathless to leave the house or becomes breathless when dressing or undressing.§The values for body-mass index were 0 or 1 because of the inflection point in the inverse relation between survival and body-mass index at a value of 21.The new england journal of medicine1008dummy-variable form, using the first quartile as thereference group. These analyses yielded estimatesof risk similar to those obtained from analyses us-ing the BODE score as a continuous variable. Thus,we focus our presentation on the predictive charac-teristics of the BODE index and present only bivari-ate results for survival according to quartiles of theBODE index in a Kaplan–Meier analysis. The statis-tical significance was evaluated with the use of thelog-rank test. We also performed bivariate analysison the stage of COPD according to the validatedstaging system of the American Thoracic Society.3In the Cox regression analysis, we assessed thereliability of the model with the body-mass index,degree of airflow obstruction and dyspnea, and ex-ercise capacity score as the predictor of the time todeath by computing bootstrap estimates using thefull sample for the hazard ratio and its 95 percentconfidence interval (according to the percentilemethod). This approach has the advantage of notrequiring that the data be split into subgroups andis more precise than alternative methods, such ascross-validation.28Finally, in order to determine how much moreprecise the BODE index is than the FEV1 alone, wecomputed the C statistics29 for a model containingFEV1 or the BODE score as the sole independentvariable. We compared the survival times and esti-mated the probabilities of death up to 52 months.In these analyses, the C statistic is a mathematicalfunction of the sensitivity and specificity of theBODE index in classifying patients by means of theCox model as either dying or surviving. The nullvalue for the C statistic is 0.5, with a maximum of29patients (Tables 3 and 4) with all degrees of severityof COPD. The FEV1 was slightly lower among pa-tients in the United States than among those in Ven-ezuela or Spain. The U.S. patients also had morefunctional impairment, more severe dyspnea, andmore coexisting conditions. The 27 patients (4 per-cent) lost to follow-up were evenly distributed ac-cording to the severity of COPD and did not differsignificantly from the rest of the cohort with respectto any measured characteristic. There were 162deaths (26 percent) over a median follow-up of 28months (range, 4 to 68). The majority of patients(61 percent) died of respiratory insufficiency, 14percent died of myocardial infarction, 12 percentof lung cancer, and the rest of miscellaneouscauses. The BODE score was lower among survi-vors than among those who died from any cause(3.7±2.2 vs. 5.9±2.6, P<0.005). The score was alsolower among survivors than among those whodied of respiratory causes, and the difference be-tween the scores was larger (3.6±2.2 vs. 6.7±2.3,P<0.001).Table 5 shows the BODE index as a predictor ofdeath from any cause after correction for coexistingconditions. There were significantly more deathsin the United States (32 percent) than in Spain (15percent) or Venezuela (13 percent) (P<0.001). How-ever, when the analysis was done separately foreach country, the predictive power of the BODE in-dex was similar; therefore, the data are presentedtogether. Table 5 shows that the BODE index wasalso a predictor of death from respiratory causesafter correction for coexisting conditions (hazardratio, 1.63; 95 percent confidence interval, 1.48 to1.80; P<0.001). The Kaplan–Meier analysis of sur-*Because of rounding, percentages do not total 100. Thethree stages of chronic obstructive pulmonary disease(COPD) were defined by the American Thoracic Society.FEV1 denotes forced expiratory volume in one second.†Higher scores on the body-mass index, degree of airflowobstruction and dyspnea, and exercise capacity (BODE)index indicate a greater risk of death. Quartile 1 was de-fined by a score of 0 to 2, quartile 2 by a score of 3 to 4,quartile 3 by a score of 5 to 6, and quartile 4 by a scoreof 7 to 10.n engl j med 350; march 4, 2004n engl j med 350;10march 4, 2004 a multidimensional grading system in chronic obstructive pulmonary disease1009vival (Fig. 1A) shows that each quartile increase in the BODE score was associated with increased mor-tality (P<0.001). Thus, the highest quartile (a BODE score of 7 to 10) was associated with a mortality rate of 80 percent at 52 months. These same data are shown in Figure 1B in relation to the severity of COPD according to the staging system of the Amer-ican Thoracic Society. The C statistic for the ability of the BODE index to predict the risk of death was 0.74, as compared with a value of 0.65 with the use of FEV 1 alone (expressed as a percentage of the pre-dicted value). The computation of 2000 bootstrap samples for these data and estimation of the haz-ard ratios for death indicated that for each one-point increment in the BODE score the hazard ratio for death from any cause was 1.34 (95 percent confi-dence interval, 1.26 to 1.42) and the hazard ratio for death from a respiratory cause was 1.62 (95 per-the BODE index — and validated its use by show-ing that it is a better predictor of the risk of death from any cause and from respiratory causes than is the FEV 1 alone. We believe that the BODE index is useful because it includes one domain that quan-tifies the degree of pulmonary impairment (FEV 1 ),one that captures the patient’s perception of symp-toms (the MMRC dyspnea scale), and two indepen-dent domains (the distance walked in six minutes and the body-mass index) that express the systemic consequences of COPD. The FEV 1 is essential for the diagnosis and quantification of the respirato-ry impairment resulting from COPD. 1,3,4 In addi-tion, the rate of decline in FEV 1 is a good marker of disease progression and mortality. 18,19 Howev-er, the FEV 1 does not adequately reflect all the sys-temic manifestations of the disease. For example,the FEV 1 correlates weakly with the degree of dys-pnea, 20 and the change in FEV 1 does not reflect the rate of decline in patients’ health. 30 More impor-tant, prospective observational studies of patients with COPD have found that the degree of dyspnea 8 and health-status scores 31 are more accurate pre-dictors of the risk of death than is the FEV 1 . Thus,although the FEV 1 is important to obtain and essen-tial in the staging of disease in any patient with COPD, other variables provide useful information that can improve the comprehensibility of the eval-uation of patients with COPD. Each variable should*Plus–minus values are means ±SD.†Analysis of variance was used to calculate the P values.‡Scores on the modified Medical Research Council (MMRC) dyspnea scale can range from 0 to 4, with a score of 4 indicating that the patient is too breathless to leave the house or becomes breathless when dressing or undressing.§Scores on the Charlson index can range from 0 to 33, with higher scores indi-cating more coexisting conditions.¶Scores on the body-mass index, degree of airflow obstruction and dyspnea, and exercise capacity (BODE) index can range from 0 to 10, with higher scores indicating a greater risk of death.*The Cox proportional-hazards models for death from any cause include 162 deaths. The Cox proportional-hazards models for death from specific respira-tory causes include 96 deaths. Model I includes the body-mass index, degree of airflow obstruction and dyspnea, and exercise capacity (BODE) index alone. The hazard ratio is for each one-point increase in the BODE score. Model II includes coexisting conditions as expressed by each one-point increase in the Charlson index. CI denotes confidence interval.The new england journal of medicine1010correlate independently with the prognosis ofCOPD, should be easily measurable, and shouldserve as a surrogate for other potentially importantvariables.In the BODE index, we included two descriptorsof systemic involvement in COPD: the body-massindex and the distance walked in six minutes. Bothare simply obtained and independently predict therisk of death.7,9,10 It is likely that they share somecommon underlying physiological determinants,but the distance walked in six minutes contains adegree of sensitivity not provided by the body-massindex. The six-minute–walk test is simple to per-form and has been standardized.12 Its use as a clin-ical tool has gained acceptance, since it is a goodpredictor of the risk of death among patients withother chronic diseases, including congestive heartfailure23 and pulmonary hypertension.24 Indeed, thedistance walked in six minutes has been acceptedas a good outcome measure after interventions suchas pulmonary rehabilitation.32 The body-mass in-dex was also an independent predictor of the riskof death and was therefore included in the BODEindex. We evaluated the independent prognosticpower of body-mass index in our cohort using dif-ferent thresholds and found that values below 21were associated with an increased risk of death, anobservation similar to that reported by Landbo andcoworkers in a large population study.10The Global Initiative for Chronic ObstructiveLung Disease and the American Thoracic Societyrecommend that a patient’s perception of dyspneabe included in any new staging system for COPD.1,3Dyspnea represents the most disabling symptomof COPD; the degree of dyspnea provides informa-tion regarding the patient’s perception of illnessand can be measured. The MMRC dyspnea scale issimple to administer and correlates with other dys-pnea scales20 and with scores of health status.21Furthermore, in a large cohort of prospectively fol-lowed patients with COPD, which used the thresh-old values included in the BODE index, the scoreon the MMRC dyspnea scale was a better predictorof the risk of death than was the FEV1.8The BODE index combines the four variables bymeans of a simple scale. We also explored whetherweighting the variables included in the index im-proved the predictive power of the BODE index. In-terestingly, it failed to do so, most likely becauseeach variable included has already proved to be agood predictor of the outcome of COPD.Our study had some limitations. First, relative-ly few women were recruited, even though enroll-ment was independent of sex. It probably reflectsthe problem of the underdiagnosis of COPD inwomen. Second, there were differences among thethree countries. For example, patients in the UnitedStates had a higher mortality rate, more severe dys-pnea, more functional limitations, and more co-n engl j med 350; march 4, 2004n engl j med 350; march 4, 2004a multidimensional grading system in chronic obstructive pulmonary disease1011existing conditions than patients in Venezuela or Spain, even though the severity of airflow obstruc-tion was relatively similar among the patients as a whole. The reasons for these differences are un-known, because there have been no systematic com-parisons of the regional manifestations of COPD.In all three countries, the BODE index was the best predictor of survival, an observation that renders our findings widely applicable.Three studies have reported the effects of the grouping of variables to express the various do-mains affected by COPD.33-35 These studies did not include variables now known to be important pre-dictors of outcome, such as the body-mass index.However, as we found in our study, they showedthat the FEV 1, the degree of dyspnea, and exercise performance provide independent information regarding the degree of compromise in patients with COPD.Besides its excellent predictive power with re-gard to outcome, the BODE index is simple to cal-culate and requires no special equipment. This makes it a practical tool of potentially widespread applicability. Although the BODE index is a predic-tor of the risk of death, we do not know whether it will be a useful indicator of the outcome in clinical trials, the degree of utilization of health care re-sources, or the clinical response to therapy.We are indebted to Dr. Gordon L. Snider, whose guidance, com-ments, and criticisms were fundamental to the final manuscript.1.Pauwels RA, Buist AS, Calverley PM,Jenkins CR, Hurd SS. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease:NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Work-shop summary. Am J Respir Crit Care Med 2001;163:1256-76.2.Murray CJL, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997;349:1269-76.3.Definitions, epidemiology, pathophys-iology, diagnosis, and staging. Am J Respir Crit Care Med 1995;152:Suppl:S78-S83.4.Siafakas NM, Vermeire P, Pride NB, et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J 1995;8:1398-420.5.Nocturnal Oxygen Therapy Trial Group.Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease: a clinical trial. Ann Intern Med 1980;93:391-8.6.Intermittent positive pressure breathing therapy of chronic obstructive pulmonary disease: a clinical trial. Ann Intern Med 1983;99:612-20.7.Gerardi DA, Lovett L, Benoit-Connors ML, Reardon JZ, ZuWallack RL. Variables re-lated to increased mortality following out-patient pulmonary rehabilitation. Eur Res-pir J 1996;9:431-5.8.Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year sur-vival than airway obstruction in patients with COPD. Chest 2002;121:1434-40.9.Schols AM, Slangen J, Volovics L, Wout-ers EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmo-nary disease. Am J Respir Crit Care Med 1998;157:1791-7.ndbo C, Prescott E, Lange P, Vestbo J,Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary dis-ease. Am J Respir Crit Care Med 1999;160:1856-61.11.American Thoracic Society Statement.Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 1991;144:1202-18.12.ATS Committee on Proficiency Stan-dards for Clinical Pulmonary Function Lab-oratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111-7.13.Mahler D, Wells C. Evaluation of clinical methods for rating dyspnea. Chest 1988;93:580-6.14.Charlson M, Szatrowski T, Peterson J,Gold J. Validation of a combined comor-bidity index. J Clin Epidemiol 1994;47:1245-51.15.Ferrer M, Alonso J, Morera J, et al. Chron-ic obstructive pulmonary disease stage and health-related quality of life. Ann Intern Med 1997;127:1072-9.16.Dewan NA, Rafique S, Kanwar B, et al.Acute exacerbation of COPD: factors associ-ated with poor treatment outcome. Chest 2000;117:662-71.17.Friedman M, Serby CW , Menjoge SS,Wilson JD, Hilleman DE, Witek TJ Jr. Phar-macoeconomic evaluation of a combination of ipratropium plus albuterol compared with ipratropium alone and albuterol alone in COPD. Chest 1999;115:635-41.18.Anthonisen NR, Wright EC, Hodgkin JE. Prognosis in chronic obstructive pulmo-nary disease. Am Rev Respir Dis 1986;133:14-20.19.Burrows B. Predictors of loss of lung function and mortality in obstructive lung diseases. Eur Respir Rev 1991;1:340-5.20.Mahler DA, Weinberg DH, Wells CK ,Feinstein AR. The measurement of dyspnea:contents, interobserver agreement, and phys-iologic correlates of two new clinical index-es. Chest 1984;85:751-8.21.Hajiro T, Nishimura K, Tsukino M, Ike-da A, Koyama H, Izumi T. Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998;157:785-90.22.Szekely LA, Oelberg DA, Wright C, et al.Preoperative predictors of operative mor-bidity and mortality in COPD patients under-going bilateral lung volume reduction sur-gery. Chest 1997;111:550-8.23.Shah M, Hasselblad V , Gheorgiadis M,et al. Prognostic usefulness of the six-min-ute walk in patients with advanced conges-tive heart failure secondary to ischemic and nonischemic cardiomyopathy. Am J Car-diol 2001;88:987-93.24.Miyamoto S, Nagaya N, Satoh T, et al.Clinical correlates and prognostic signifi-cance of six-minute walk test in patients with primary pulmonary hypertension: compari-son with cardiopulmonary exercise testing.Am J Respir Crit Care Med 2000;161:487-92.25.Redelmeier DA, Bayoumi AM, Gold-stein RS, Guyatt GH. Interpreting small dif-ferences in functional status: the Six Minute Walk test in chronic lung disease patients.Am J Respir Crit Care Med 1997;155:1278-82.26.Decramer M, Gosselink R, Troosters T,Verschueren M, Evers G. Muscle weakness is related to utilization of health care resourc-es in COPD patients. Eur Respir J 1997;10:417-23.27.Cox DR. Regression models and life-tables. J R Stat Soc [B] 1972;34:187-220.28.Harrell FE Jr, Lee KL, Mark DB. Multi-variate prognostic models: issues in devel-oping models, evaluating assumptions and adequacy, and measuring and reducing er-rors. Stat Med 1996;15:361-87.29.Nam B-H, D’Agostino R. Discrimina-tion index, the area under the ROC curve. In:Huber-Carol C, Balakrishnan N, Nikulin MS,Mesbah M, eds. Goodness-of-fit tests and。
运动和健康的英语作文
Sports and health are two concepts that are intrinsically linked.Engaging in regular physical activity not only improves ones physical wellbeing but also contributes to mental health and overall quality of life.The Benefits of Sports for Physical Health:1.Enhanced Cardiovascular Fitness:Regular exercise strengthens the heart and improves blood circulation,reducing the risk of heart diseases.2.Weight Management:Sports help in burning calories and maintaining a healthy body weight,which is crucial for preventing obesity and related health issues.3.Muscle Strength and Endurance:Engaging in various sports can build muscle strength and increase endurance,making everyday tasks easier.4.Flexibility and Balance:Activities such as yoga and gymnastics improve flexibility and balance,which are essential for injury prevention and maintaining agility as one ages. The Impact of Sports on Mental Health:1.Stress Relief:Physical activity releases endorphins,which are natural mood elevators that help in reducing stress and anxiety.2.Improved Sleep:Regular exercise can contribute to better sleep patterns,which is vital for mental health and cognitive function.3.Boost in SelfEsteem:Achieving goals in sports can lead to increased selfconfidence and a positive selfimage.4.Social Interaction:Sports often involve teamwork and interaction with others,fostering social skills and a sense of community.The Role of Sports in Social Development:1.Cultivating Team Spirit:Participating in team sports teaches the importance of cooperation and working towards a common goal.2.Discipline and Commitment:Training for sports instills discipline and the value of commitment,which are transferable skills in various aspects of life.3.Cultural Exchange:Sports events often bring people from different cultures together, promoting understanding and respect for diversity.The Importance of a Balanced Approach:1.Avoiding Overtraining:While sports are beneficial,overtraining can lead to injuries and burnout.Its essential to listen to ones body and rest when needed.2.Nutrition:A balanced diet is crucial for athletes to fuel their bodies and aid in recovery.3.Mental Health Support:Recognizing the importance of mental health and seeking support when needed is just as important as physical training.Conclusion:Incorporating sports into ones daily routine is a powerful way to enhance both physical and mental health.Its important to find activities that one enjoys and to maintain a balanced approach to ensure longterm benefits.By doing so,individuals can lead a healthier,happier,and more fulfilling life.。
Body Mass Index and Mortality
Body Mass Index and Mortality:A Twelve-Year Prospective Study in KoreaYun-Mi Song1and Joohon Sung2The relation between body mass index(kg/m2)and noncoro-nary mortality is not well established.To study this relation,a population with low coronary mortality may be especially useful.We conducted a12-year follow-up study of235,398 Korean men40–64years of age.Study subjects had undergone health examinations in1986(baseline)and1990.We ex-cluded subjects with substantial weight loss during this period. There were13,387deaths,including600deaths from coronary events,between1990and1998.We estimated the relation of body mass index to the risk of death after adjusting for com-mon risk factors.There was a positive relation between body mass index and coronary mortality,but this relation was at-tenuated after serum total cholesterol,blood pressure,and fasting serum glucose were taken into account.A J-shaped relation with cerebrovascular mortality was also attenuated after adjustment.Even after this adjustment and exclusion of early deaths between1990and1994,the relation of body mass index to all-cause(U-shaped),cancer(J-shaped),and noncan-cer noncoronary noncerebrovascular(inverse J-shaped)mor-tality remained.Both high and low body mass index were related to increased mortality among these Korean men. (Epidemiology2001;12:173–179)Keywords:body mass index,cerebrovascular disorders,coronary disease,mortality,neoplasms,gender.Although the adverse health effects of obesity are widely accepted,1,2debates regarding the relation between body mass index(BMI,kg/m2)and total mortality continue. Some studies reported a positive relation between BMI and mortality.3–5There are,however,many other studies that reported a U-shaped,6–12a J-shaped,13–17and even an inverse relation.18An increased risk of death at the low end of BMI distribution,either as a U-or J-shaped relation,would contrast with the monotonic increase of cardiovascular or some endocrine morbidity.1,2Although the increase of mortality with low BMI seen in some studies has been suggested to be an artifact caused by inadequate control of smoking,19,20preexisting occult disease,and the bio-logical effects of obesity itself,3,4,7,15,21–23the relation was still present after these factors had been controlled in some studies.10,13These persistent indicators of an effect of low BMI are worth further investigation,especially with respect to noncoronary outcomes.Previous epide-miologic studies of BMI and mortality have usually been performed on Western populations whose main cause of death was coronary heart disease.The coronary mortal-ity rate of Koreans was only16.3per100,000person-years in1998.24Here we report on the relation between BMI and noncoronary death in a Korean population. Subjects and MethodsS UBJECTS AND S TUDY V ARIABLESWe investigated235,398Korean male adults selected from the insured of the Korean Medical Insurance Cor-poration.Every Korean citizen is covered by the oblig-atory National Health Insurance System.The Korean Medical Insurance Corporation,one of three major na-tional health insurance agencies,has provided all civil service personnel,including teachers,with medical ex-penses as well as biennial multiphasic health examina-tions.The study subjects were the insured men of the Korean Medical Insurance Corporation,40–64years of age,who had undergone the multiphasic health exami-nation in1986.Women were omitted because the num-ber of female civil servants was too small.Body weight (in kg),blood pressure,and fasting serum total choles-terol and glucose levels were measured between April and July1986.No specific guideline was used to measure the weight.All medical institutes that carried out the health examinations were equipped with standardized, high-quality laboratories authorized by the Korea Asso-ciation of Clinical Pathology and the Korea Association of Quality Control over Clinical Laboratory Examination.From the1Department of Family Medicine,Samsung Medical Center,SungKyunKwan University School of Medicine,Seoul,Korea;and2Departmentof Preventive Medicine,Kangwon National University College of Medicine,Chunchon,Kangwon-Do,Korea.Address correspondence to:Joohon Sung,Department of Preventive Medicine,Kangwon National University College of Medicine,Hyoja-2Dong,Chunchon,Kangwon-Do,Korea.200-701.This study was supported by Samsung Grant SBRI C-98-042from the Center forClinical Research,Samsung Biomedical Research Institute,Sungkyunkwan Uni-versity School of Medicine.Submitted March23,2000;final version accepted August30,2000.Copyright©2001by Lippincott Williams&Wilkins,Inc.173A total of334,212men who were40–64years of age had undergone the health examination in1986.Among these men,98,814who fell into any of the following categories were excluded:those who had not undergone the follow-up health examination in1990(76,578 men);those who had a weight loss of more than5% compared with their weight in1986(22,182men);and those with inadequate or missing data(54men).After exclusions,235,398men were left for the study.We calculated BMI as weight(kg)per height squared (m2).As the heights of study subjects were not measured in1986,heights measured in1990were used to calculate BMI.The average BMI of the study subjects was23.1 kg/m2(standard deviationϭ2.54kg/m2).Study subjects were divided into eight categories according to BMI levels:less than18,18–19,20–21,22–23,24–25,26–27,28–29,and30kg/m2or more.The boundary for the highest category(30kg/m2)approximates the99.2per-centile of study subjects,and the lowest(18kg/m2) approximates the1.5percentile.The average BMI was 17.2kg/m2(standard deviationϭ0.68)in the lowest BMI category and31.2kg/m2(standard deviationϭ1.42)in the highest.Information on health habits such as smoking,alcohol intake,and physical exercise was obtained from the self-administered questionnaire completed during the health examination in1990.We categorized study sub-jects into four groups according to their smoking habits in1990:never-smoker,former smoker,light smoker (Ͻ20cigarettes per day),and heavy smoker(Ն20ciga-rettes per day).We used three categories to determine the alcohol drinking habits:nondrinker,occasional drinker,and frequent rmation on the exact frequency and amount of alcohol drinking was not avail-able.For physical exercise,we used two categories,as detailed information was not available:engaging and not engaging in regular exercise.We categorized economic status into four levels based on monthly salary.M ORTALITY F OLLOW-U PMortality follow-up between1990and1998was mainly based on the nationwide death certificate data of the Korea National Statistical Office and supplemented by the death benefit record of the Korean Medical In-surance Corporation between1990and1991.The vital status of study subjects between1990and1998was confirmed through exact data linkage on the basis of the unified13-digit identification number.Death certificate data between1990and1991lacked this identification number,so mortality follow-up during this period was done using the death benefit record of the Korean Med-ical Insurance ing these two record sys-tems,follow-up was achieved for95.9%of the subjects. We evaluated the accuracy of the death certificate data by matching the cause of death with the diagnosis in medical utilization data for the study subjects who died in1995.Concordance between the two data sources was72.2%(596of825deaths in1995)for all-cause deaths and94.9%(430of453cancer deaths in 1995)for the deaths from cancer of all sites,regardless of the primary site.We grouped codes using the Interna-tional Classification of Diseases,9th(ICD-9)and10th (ICD-10)revisions,to classify the causes of death into broader categories:140–208(ICD-9)and C00–C97 (ICD-10),cancers;430–438(ICD-9)and I60–I69 (ICD-10),cerebrovascular diseases;and410–414 (ICD-9)and I20–I25(ICD-10),coronary heart diseases. S TATISTICAL A NALYSISWe used analysis of covariance to obtain the age-adjusted average levels of diastolic and systolic blood pressure,serum total cholesterol,and fasting serum glu-cose.We used age standardization to obtain the age-adjusted distribution of selected baseline characteristics by eight categories of BMI level.The Korean male population of1990was used as a standard.We calcu-lated age-adjusted mortality rates(per100,000person-years)from all-cause,cancer,coronary heart disease, cerebrovascular disease,and noncancer noncoronary noncerebrovascular disease by direct standardization. Relative risk by BMI was estimated by the Cox propor-tional hazard regression analysis25adjusting for age,dia-stolic blood pressure level,serum total cholesterol level, serum glucose level,smoking,alcohol consumption, physical exercise,and economic status.BMI between22 and23kg/m2was the reference level for the relative risk estimates.To probe the pathways between BMI and mortality,we compared the results of two models:con-sidering and not considering the possible biological ef-fects of obesity(diastolic blood pressure level,serum cholesterol level,and fasting serum glucose level).To identify the effect of preexisting occult disease on the relation between BMI and mortality,the analysis was repeated with an8-year induction period.ResultsThe cohort comprised235,398men and3,449,833 person-years of follow-up.During the12.4-year fol-low-up period,a total of13,387deaths were identified. Table1shows the main causes of deaths.Cancer ac-counted for42.9%(5,749deaths),with liver,stomach, and lung being the three leading sites.Of the total deaths,10.1%(1,353deaths)were attributable to cere-brovascular disease,4.5%(600deaths)to coronary heart disease,and42.5%(5,685deaths)to noncancer non-coronary noncerebrovascular disease.Age-adjusted baseline characteristics of the subjects by BMI level are presented in Table2.Biological and social characteristics differed according to BMI level. Compared with men with lower BMI,men with higher BMI had higher serum total cholesterol and fasting glu-cose levels,higher diastolic and systolic blood pressure, higher prevalence of frequent drinking and heavy smok-ing,higher proportion of regular exercise habits,and higher salary level.Table3shows the adjusted mortality rate and relative risk of BMI for cause-specific mortality.In Table4,these174Song and Sung Epidemiology March2001,Vol.12No.2relations were reexamined with an 8-year induction pe-riod to reduce the bias from preexisting disease.There was a U-shaped relation between BMI and all-cause mortality with lowest mortality level at 24–25kg/m 2(Table 1).After controlling risk factors other than the possible effects of obesity (age,monthly salary,smoking,alcohol consumption,and exercise habits),mortality was about 50%higher in the lowest (Ͻ18kg/m 2)and highest (Ͼ30kg/m 2)BMI group compared with the men with BMI between 22and 23kg/m 2.Additional adjustment for the possible effects of obesity (glucose,cholesterol,and diastolic blood pressure)re-sulted in a decrease of all-cause mortality in men with the highest BMI and an increase in the group with the lowest BMI.After eliminating the deaths and person-time during the first 8years,the relative risks of all-cause mortality in both high-and low-BMI groups remained almost unchanged (Table 4).There was a positive relation between coronary mor-tality (Table 3)and BMI,and that became more obvious after the elimination of early follow-up (Table 4).The age-adjusted coronary mortality rate among obese men (BMI,28–29kg/m 2)was three times higher than that among men with the lowest BMI.The positive relation was more obvious before the adjustment of cholesterol,glucose,and diastolic blood pressure levels (Table 3).The increased risk of coronary mortality in the 28–29-kg/m 2group (relative risk ϭ 1.81)was substantially attenuated after the adjustment.The relation between BMI and death from cancer was J-shaped.The risk of cancer death was about 65%higher in men with the highest BMI level (Ն30kg/m 2)com-T A B L E 2.A g e -A d j u s t e dB a s e l i n eC h a r a c t e r i s t i c s b y t h e L e v e l o f B o d y M a s s I n d e xV a r i a b l e sN u m b e r o f S u b j e c t sB o d y M a s s I n d e x (k g /m 2Ͻ18(N ϭ3,346)18–19(N ϭ22,182)20–21(N ϭ53,406)22–23(N ϭ72,044)24–25(N ϭ53,320)26–27(N ϭ23,473)28–29(N ϭ6,157)Ն30(N ϭ1,471)M e a n s e r u m t o t a l c h o l e s t e r o l (m g /100m l )235,392175.9Ϯ0.63178.1Ϯ0.25181.8Ϯ0.16187.1Ϯ0.14191.3Ϯ0.16193.8Ϯ0.24197.2Ϯ0.47199.1Ϯ0.95M e a n f a s t i n g s e r u m g l u c o s e (m g /100m l )235,39290.9Ϯ0.3990.4Ϯ0.1590.7Ϯ0.1091.3Ϯ0.0891.8Ϯ0.1093.0Ϯ0.1594.1Ϯ0.2995.1Ϯ0.59M e a n s y s t o l i c b l o o d p r e s s u r e (m m H g )235,398120.0Ϯ0.26121.6Ϯ0.10123.7Ϯ0.07126.0Ϯ0.06128.5Ϯ0.07131.0Ϯ0.10133.6Ϯ0.19136.1Ϯ0.39M e a n d i a s t o l i c b l o o d p r e s s u r e (m m H g )235,39878.6Ϯ0.1979.7Ϯ0.0781.1Ϯ0.0582.9Ϯ0.0484.8Ϯ0.0586.6Ϯ0.0788.6Ϯ0.1489.7Ϯ0.28S m o k i n g h a b i t s (%)206,833F o r m e r s m o k e r 15.215.917.118.219.319.218.916.3S m o k i n g Ͻ1p a c k /d a y 49.848.044.339.135.633.632.532.9Ն1p a c k /d a y 13.112.812.712.912.512.714.015.0A l c o h o l d r i n k i n g h a b i t (%)206,871O c c a s i o n a l d r i n k e r 41.344.246.847.947.947.346.244.9F r e q u e n t d r i n k e r 16.519.320.020.822.623.525.427.1D o i n g e x e r c i s e (%)207,26617.721.625.328.529.230.229.629.0M o n t h l y s a l a r y (%)235,398B a s i c ,Ͻ$73432.632.029.824.018.917.516.717.0$734–1,46812.113.013.414.516.117.319.2220.01,468–$2,20235.533.533.935.737.337.537.736.7Ն2,20219.721.523.025.827.727.726.426.4TABLE 1.Major Causes of Death,1986–1998,among Korean Men 40–64Years of Age in 1986Causes of Death (ICD-10*)No.of Deaths%All causes13,387Cancer (C00–C97)5,74942.9Liver (C22)1,678Stomach (C16)1,216Lung (C34)1,003Pancreas (C25)284Colon and rectum (C18–C20)274All other cancer sites1,294Cerebrovascular disease (I60–I69)1,35310.1Coronary heart disease (I20–I25)600 4.5Noncancer noncoronarynoncerebrovascular disease5,68542.4Injury,poisoning and certain other consequences of external causes (S00–T98)1,666Diseases of liver (K70–K77)1,219Cardiovascular disease other than coronary heart cerebrovasculardisease (I100–I15,I26–I52,I70–I99)815Diabetes mellitus (E10–E14)421Chronic lower respiratory disease (J40–J47)136Renal failure (N17–N19)117Respiratory tuberculosis (A15–A16)91Pneumonia (J18)73All other noncancer noncoronary noncerebrovascular diseases1,147*International Statistical Classification of Diseases and Related Health Problems ,10th revision.Epidemiology March 2001,Vol.12No.2BODY MASS INDEX AND MORTALITY 175T A B L E 3.A g e -A d j u s t e d M o r t a l i t y R a t e p e r 100,000P e r s o n -Y e a r s (M R ),A d j u s t e d R e l a t i v e R i s k (R R ),a n d 95%C o n f i d e n c e L i m i t s (C L )f o r C a u s e -S p e c i f i c M o r t a l i t y b y t h e L e v e l o f B o d y M a s s I n d e xC a u s e o fD e a t h (N u m b e r o f C a s e s )L e v e l o f B o d y M a s s I n d e x (k g /m 2)Ͻ1818–1920–2122–2324–2526–2728–29Յ30A l l c a u s e s (N ϭ13,387)M R 945702619567498531523830R R (95%C L )*1.52(1.36,1.69)1.17(1.11,1.24)1.06(1.01,1.11)10.96(0.91,1.01)0.98(0.92,1.04)0.97(0.86,1.09)1.47(1.21,1.77)R R (95%C L )†1.60(1.44,1.79)1.23(1.16,1.30)1.09(1.04,1.14)10.93(0.89,0.98)0.92(0.86,0.98)0.88(0.78,0.99)1.30(1.07,1.57)C a n c e r ,a l l s i t e s (N ϭ5,749)M R 356316274252222227189385R R (95%C L )*1.30(1.09,1.55)1.12(1.03,1.23)1.03(0.96,1.11)10.95(0.88,1.03)0.96(0.87,1.06)0.84(0.70,1.01)1.64(1.26,2.15)R R (95%C L )†1.28(1.07,1.53)1.11(1.02,1.22)1.02(0.95,1.10)10.96(0.89,1.03)0.96(0.87,1.07)0.84(0.70,1.01)1.65(1.26,2.16)C o r o n a r y h e a r t d i s e a s e (N ϭ600)M R 1916323229316118R R (95%C L )*0.70(0.34,1.42)0.61(0.43,0.86)0.97(0.78,1.21)10.99(0.79,1.23)1.07(0.80,1.43)1.56(1.02,2.38)1.35(0.56,3.29)R R (95%C L )†0.82(0.40,1.66)0.68(0.49,0.96)1.04(0.83,1.29)10.92(0.74,1.16)0.94(0.71,1.26)1.27(0.83,1.94)1.05(0.43,2.56)C e r e b r o v a s c u l a r d i s e a s e (N ϭ1,353)M R 93635769546659162R R (95%C L )*1.25(0.86,1.81)0.99(0.82,1.20)0.93(0.80,1.08)11.02(0.88,1.19)1.10(0.90,1.34)1.18(0.85,1.64)1.90(1.13,3.18)R R (95%C L )†1.58(1.09,2.29)1.17(0.97,1.42)1.03(0.89,1.20)10.92(0.79,1.07)0.90(0.74,1.10)0.84(0.60,1.17)1.27(0.76,2.14)N o n c a n c e r n o n c o r o n a r y n o n c e r e b r o v a s c u l a r d i s e a s e (N ϭ5,685)M R 478306256215192207214265R R (95%C L )*1.92(1.64,2.25)1.34(1.23,1.46)1.14(1.06,1.22)10.95(0.88,1.03)0.95(0.86,1.06)0.98(0.82,1.18)1.17(0.84,1.63)R R (95%C L )†2.04(1.75,2.39)1.40(1.28,1.53)1.17(1.09,1.26)10.92(0.85,0.99)0.89(0.80,0.98)0.87(0.73,1.05)1.01(0.73,1.41)*R e l a t i v e r i s k c o m p a r e d w i t h b o d y m a s s i n d e x b e t w e e n 22a n d 23k g /m 2a f t e r a d j u s t i n g a g e ,m o n t h l y s a l a r y ,s m o k i n g ,a l c o h o l c o n s u m p t i o n ,a n d e x e r c i s e .†R e l a t i v e r i s k c o m p a r e d w i t h b o d y m a s s i n d e x b e t w e e n 22a n d 23k g /m 2a f t e r a d j u s t i n g a g e ,d i a s t o l i c b l o o d p r e s s u r e ,t o t a l c h o l e s t e r o l ,f a s t i n g g l u c o s e ,m o n t h l y s a l a r y ,s m o k i n g ,a l c o h o l c o n s u m p t i o n ,a n d e x e r c i s e .176Song and SungEpidemiologyMarch 2001,Vol.12No.2T A B L E 4.A g e -A d j u s t e d M o r t a l i t y R a t e p e r 100,000P e r s o n -Y e a r s (M R ),A d j u s t e d R e l a t i v e R i s k (R R ),a n d 95%C o n f i d e n c e L i m i t s (C L )f o r C a u s e -S p e c i f i c M o r t a l i t y b y L e v e l o f B o d y M a s s I n d e x ,a f t e r E x c l u d i n g D e a t h s a n d P e r s o n -T i m e d u r i n g t h e F i r s t 8Y e a r s o f F o l l o w -u pC a u s e o fD e a t h (N u m b e r o f C a s e s )L e v e l o f B o d y M a s s I n d e x (k g /m 2)Ͻ1818–1920–2122–2324–2526–2728–2930ՅA l l c a u s e s (N ϭ8,330)M R 1,6901,2751,1291,0409189919961,606R R (95%C L )*1.46(1.26,1.69)1.20(1.11,1.29)1.07(1.01,1.14)10.95(0.90,1.02)0.98(0.91,1.07)0.99(0.86,1.15)1.52(1.20,1.92)R R (95%C L )†1.56(1.35,1.80)1.26(1.17,1.35)1.10(1.04,1.17)10.93(0.87,0.99)0.92(0.85,1.00)0.89(0.77,1.03)1.34(1.06,1.69)C a n c e r ,a l l s i t e s (N ϭ3,695)M R 686592509470428422379574R R (95%C L )*1.35(1.08,1.69)1.19(1.06,1.33)1.06(0.97,1.16)10.98(0.90,1.08)0.99(0.87,1.11)0.84(0.66,1.06)1.65(1.18,2.31)R R (95%C L )†1.34(1.07,1.68)1.18(1.06,1.32)1.06(0.97,1.16)10.98(0.90,1.08)0.98(0.87,1.11)0.83(0.66,1.05)1.64(1.17,2.30)C o r o n a r y h e a r t d i s e a s e (N ϭ372)M R 18326150607012610R R (95%C L )*0.44(0.14,1.39)0.69(0.45,1.05)0.96(0.72,1.27)11.03(0.78,1.37)1.19(0.83,1.69)1.81(1.09,3.02)0.45(0.06,3.23)R R (95%C L )†0.53(0.17,1.68)0.78(0.51,1.20)1.04(0.78,1.38)10.95(0.72,1.27)1.02(0.72,1.46)1.42(0.85,2.37)0.34(0.05,2.41)C e r e b r o v a s c u l a r d i s e a s e (N ϭ902)M R 189109119133108113106489R R (95%C L )*1.37(0.87,2.13)0.94(0.74,1.20)1.00(0.84,1.21)11.05(0.87,1.27)1.17(0.93,1.48)1.13(0.74,1.71)2.97(1.76,4.99)R R (95%C L )†1.72(1.10,2.68)1.10(0.86,1.41)1.11(0.92,1.33)10.95(0.79,1.15)0.97(0.76,1.23)0.81(0.53,1.23)2.02(1.20,3.40)N o n c a n c e r n o n c o r o n a r y n o n c e r e b r o -v a s c u l a r d i s e a s e (N ϭ1,853)M R 798542439387321387386533R R (95%C L )*1.74(1.41,2.16)1.34(1.20,1.50)1.11(1.01,1.22)10.89(0.80,0.98)0.91(0.80,1.04)1.03(0.83,1.29)1.11(0.72,1.71)R R (95%C L )†1.87(1.51,2.32)1.41(1.26,1.58)1.14(1.04,1.26)10.86(0.78,0.95)0.84(0.74,0.97)0.92(0.73,1.15)0.95(0.62,1.47)*R e l a t i v e r i s k c o m p a r e d w i t h b o d y m a s s i n d e x b e t w e e n 22a n d 23k g /m 2a f t e r a d j u s t i n g a g e ,m o n t h l y s a l a r y ,s m o k i n g ,a l c o h o l c o n s u m p t i o n ,a n d e x e r c i s e .†R e l a t i v e r i s k c o m p a r e d w i t h b o d y m a s s i n d e x b e t w e e n 22a n d 23k g /m 2a f t e r a d j u s t i n g a g e ,d i a s t o l i c b l o o d p r e s s u r e ,t o t a l c h o l e s t e r o l ,f a s t i n g g l u c o s e ,m o n t h l y s a l a r y ,s m o k i n g ,a l c o h o l c o n s u m p t i o n ,a n d e x e r c i s e .EpidemiologyMarch 2001,Vol.12No.2BODY MASS INDEX AND MORTALITY177pared with that in men with BMI between22and23 kg/m2.Men in the lowest BMI group had a30%in-creased risk of cancer mortality.Considering the possible effects of obesity or the elimination of early follow-up from the analysis did not alter the relation.Mortality from cerebrovascular disease also had a J-shaped relation with BMI.The highest BMI group(Ն30 kg/m2)had nearly two times the risk of mortality from cerebrovascular disease of the22–23-kg/m2group(rela-tive riskϭ1.90).Additional adjustment for the possible effects of obesity decreased the effect on cerebrovascular mortality in the group with the highest BMI.The J-shaped relation between BMI and mortality from cere-brovascular disease was accentuated after excluding the first8years of follow-up.Mortality from noncancer noncoronary noncerebro-vascular diseases had an inverse J-shaped relation with BMI.The risk of noncancer noncoronary noncerebro-vascular mortality by the level of BMI was changed little with the adjustment for other risk factors(Table3). After excluding the early follow-up time,the increased risk of noncancer noncoronary noncerebrovascular mor-tality in the lowest BMI group was attenuated but was still70–80%higher than that in the group with BMI between22and23kg/m2(Table4).DiscussionThere have been debates about the necessity of ad-justing for the possible biological effects of obesity,such as blood pressure,cholesterol,and glucose levels,11,22,26to assess the effect of BMI on health outcomes.In this study,adjustment for these factors attenuated the effect of obesity on cardiovascular disease risk considerably. This finding suggests that part of the BMI-related car-diovascular mortality was mediated by these known car-diovascular risk factors.The relations between BMI and mortality from noncoronary disease,however,were not altered materially even after the adjustment.The mech-anisms through which BMI influences health thus ap-peared to differ by the specific cause of death.In a recent meta-analysis of19prospective studies10 restricted to white men and women,an increased mor-tality among those with moderately low BMI did not appear to be caused by preexisting diseases.Neverthe-less,the negative studies with sufficiently long follow-up period3,5and the dampening of the left tail of the BMI-mortality curve after eliminating the early follow-up14 conflict with the positive studies.6,10,13,27To examine the relation more accurately,we tried to reduce the effect of preexisting occult disease.The subjects who have had a weight loss of more than5%during the first4years of follow-up were excluded at study entry.Excluding the subjects with recent substantial weight loss reduced the possible bias due to antecedent illness.13,28To identify the effect of preexisting disease on BMI level,we con-ducted some analyses omitting the first8years of follow-up.Even so,the increased risk of death for those with low BMI(Ͻ20kg/m2)was not changed.Increased mor-tality among those with low BMI could not be explained by the effect of preexisting diseases alone.In this study,the BMI level with the lowest risk of all-cause mortality was between24and25kg/m2,which was higher than the average BMI level of all study subjects but similar to the BMI levels of lowest risk in studies of Western populations.5,10,12,14,16,17In Western populations,the ranges of BMI with the lowest mortality were slightly lower than or similar to their average BMI level.5,7,14The relation between cancer mortality and BMI is debatable.The J-or U-shaped28,29relation indicates that mortality from cancer can account for the largest part of the increased risk of death at both the low end and the high end of the BMI scale.Nevertheless,some findings of null5,30,31or even positive3,9,20relation and of higher cancer mortality among those with a low BMI limited to short follow-up intervals32support the argument that increased risk of death among those with a low BMI might derive from the BMI-lowering effect of preexisting cancer.In this study,cancer at low BMI was unchanged even after excluding early follow-up,suggesting that the effect of BMI on death from cancer is not an artifact. Previous studies reported various findings about the relation between BMI and cerebrovascular disease,in-cluding a J-shaped,11,27,28,33a positive,3,20and a null rela-tion.34In this study,increased risks of cerebrovascular mortality were observed at both extremes of BMI. Overweight persons are more likely to have higher levels of coronary risk factors such as elevated choles-terol,blood pressure,and glucose than lean persons.1,11,26 Given the linear and consistent association of obesity with these unfavorable risk factors,there seems to be little doubt that persons with higher BMI are more likely to get coronary heart disease.Most of the previous studies investigating this issue observed a positive rela-tion between BMI and coronary heart disease mortali-ty.5,7,11,26Although the mortality rate from coronary heart disease and the proportion of subjects with high BMI in our study was much smaller than the correspond-ing values observed among Western populations,5,11we found a similar relation.Our results indicate the impact of obesity on health, even in populations with a relatively low average BMI. The increased risk of death from all-cause,cancer,and noncancer noncoronary noncerebrovascular diseases at very low BMI levels,even after considering the known risk factors and excluding the early follow-up,suggest an effect on the risk of death of a low BMI. References1.Pi-Sunyer FX.Medical hazards of obesity.Ann Intern Med1993;119(7pt2):655–660.2.Jung RT.Obesity as a disease.Br Med Bull1997;53:307–321.3.Lindsted K,Tonstad S,Kuzma JW.Body mass index and patterns ofmortality among Seventh-Day Adventist men.Int J Obes1991;15:397–406.4.Manson JE,Willett WC,Stampfer MJ,Colditz GA,Hunter DJ,HankinsonSE,Hennekens CH,Speizer FE.Body weight and mortality among women.N Engl J Med1995;333:677–685.5.Dorn JM,Schisterman EF,Winkelstein W,Trevisan M.Body mass indexand mortality in a general population sample of men and women.The Buffalo Health Study.Am J Epidemiol1997;146:919–931.6.Sorlie P,Gordon T,Kannel WB.Body build and mortality.The Framing-ham Study.JAMA1980;243:1828–1831.178Song and Sung Epidemiology March2001,Vol.12No.27.Wannamethee G,Shaper AG.Body weight and mortality in middle agedBritish men:impact of smoking.BMJ1989;299:1497–1502.8.Wilcosky T,Hyde J,Anderson JJB,Bangdiwala S,Duncan B.Obesity andmortality in the Lipid Research Clinics Program Follow-Up Study.J Clin Epidemiol1990;43:743–752.9.Hanson RL,McCance DR,Jacobsson LTH,Narayan KMV,Nelson RG,Pettitt DJ,Bennett PH,Knowler WC.The U-shaped association between body mass index and mortality:relationship with weight gain in a Native American population.J Clin Epidemiol1995;48:903–916.10.Troiano RP,Frongillo EA,Sobal J,Levitsky DA.The relationship betweenbody weight and mortality:a quantitative analysis of combined information from existing studies.Int J Obes Relat Metab Disord1996;20:63–75.11.Shaper AG,Wannamethee SG,Walker M.Body weight:implications forthe prevention of coronary heart disease,stroke,and diabetes mellitus in a cohort study of middle aged men.BMJ1997;314:1311–1317.12.Durazo-Arvizu RA,McGee DL,Cooper RS,Liao Y,Luke A.Mortality andoptimal body mass index in a sample of the US population.Am J Epidemiol 1998;147:739–749.13.Wienpahl J,Ragland DR,Sidney S.Body mass index and15-year mortalityin a cohort of black men and women.J Clin Epidemiol1990;43:949–960.14.Lee I-M,Manson JE,Hennekens CH,Paffenbarger RS.Body weight andmortality.A27-year follow-up of middle-aged men.JAMA1993;270:2823–2828.15.Menotti A,Descovich GC,Spagnolo A,Dormi A,Seccareccia F.Indexes ofobesity and all-causes mortality in Italian epidemiological data.Prev Med 1993;22:293–303.16.Seidell JC,Verschuren WMM,van Leer EM,Kromhout D.Overweight,underweight,and mortality:a prospective study of48,287men and women.Arch Intern Med1996;156:958–963.17.Chyou P-H,Burchfiel CM,Yano K,Sharp DS,Rodriguez BL,Curb JD,Nomura AMY.Obesity,alcohol consumption,smoking,and mortality.Ann Epidemiol1997;7:311–317.18.Garn SM,Hawthorne VM,Pilkington JJ,Pesick SD.Fatness and mortalityin the west of Scotland.Am J Clin Nutr1983;38:313–319.19.Sidney S,Friedman GD,Siegelaub AB.Thinness and mortality.Am J PublicHealth1987;77:317–322.20.Garfinkel L.Overweight and mortality.Cancer1986;58:1826–1829.21.Rhoads GG,Kagan A.The relation of coronary artery disease,stroke,andmortality to weight in youth and middle ncet1983;i:492–495. 22.Manson JE,Stampfer MJ,Hennekens CH,Willett WC.Body weight andlongevity.JAMA1987;257:353–358.23.Losonczy KG,Harris TB,Cornoni-Huntley J,Simonsick EM,Wallace RB,Cook NR,Ostfeld AM,Blazer DG.Does weight loss from middle age to old age explain the inverse weight mortality relation in old age?Am J Epidemiol 1995;141:312–321.24.National Statistical Office(Republic of Korea).Annual Report on theCause of Death Statistics(Based on Vital Registration).Daejon,Korea, 1999.25.Allison PD.Survival Analysis Using the SAS System:A Practical Guide.Cary,NC:SAS Institute Inc,1995;111–184.26.Jousilahti P,Tuomilehto J,Vartiainen E,Pekkanen J,Puska P.Body weight,cardiovascular risk factors,and coronary mortality:15-year follow-up of middle-aged men and women in Eastern Finland.Circulation1996;93:1372–1379.27.Waaler HT.Height,weight,and mortality:the Norwegian experience.ActaMed Scand Suppl1984;679:1–56.28.Lew EA,Garfinkel L.Variations in mortality by weight among750,000menand women.J Chron Dis1979;32:563–576.29.Nomura A,Heilbrun LK,Stemmerman GN.Body mass index as a predictorof cancer in men.J Natl Cancer Inst1985;74:319–323.30.Iribarren C,Sharp DS,Burchfiel CM,Petrovitch H.Association of weightloss and weight fluctuation with mortality among Japanese American men.N Engl J Med1995;333:686–692.31.Tulinius H,Sigfússon N,Sigvaldason H,Bjarnadóttir K,Tryggvadóttir L.Risk factors for malignant disease:a cohort study on a population of22,946 Icelanders.Cancer Epidemiol Biomarkers Prev1997;6:863–873.32.Jarrett RJ,Shipley MJ,Rose G.Weight and mortality in the WhitehallStudy.Br Med J(Clin Res Ed)1982;285:535–537.33.Walker SP,Rimm EB,Ascherio A,Kawachi I,Stampfer MJ,Willett WC.Body size and fat distribution as predictors of stroke among US men.Am J Epidemiol1996;144:1143–1150.34.Håheim LL,Holme I,Hjermann I,Leren P.Risk factors of stroke incidenceand mortality:a12-year follow-up of the Oslo Study.Stroke1993;24:1484–1489.Epidemiology March2001,Vol.12No.2BODY MASS INDEX AND MORTALITY179。
全身相位角 inbody 英语
全身相位角 inbody 英语Phase Angle Measurement in InBody: A Comprehensive AnalysisIntroduction:Phase angle measurement is an important indicator of overall health and body composition analysis. InBody, a leading brand in body composition analysis devices, provides a reliable and accurate measurement of phase angle. This article aims to explore the concept of phase angle, its significance, and the role of InBody in measuring and interpreting this crucial health parameter.Understanding Phase Angle:Phase angle is a measurement that indicates the distribution of the body's electrical current, providing valuable information about cellular health and the body's ability to function properly. It is calculated by measuring the phase shift between the current and voltage as they pass through the body's tissues. A higher phase angle suggests better cellular integrity and overall health.Significance of Phase Angle Measurement:Phase angle measurement is increasingly recognized as an important prognostic indicator of various health conditions and overall well-being. It provides valuable insights into the body's cellular health, nutritional status, and the efficacy of medical treatments. Higher phase angle values are associated with better health outcomes, including increased muscle mass, better immune function, and reduced mortality risk.Role of InBody in Phase Angle Measurement:InBody devices utilize a unique bioelectrical impedance analysis (BIA) technology to accurately measure phase angle. BIA is a non-invasive method that involves passing a safe, low-level electrical current through the body and measuring its resistance and reactance. InBody's advanced algorithms then calculate the phase angle based on these measurements.InBody's phase angle measurement is highly reliable and reproducible. The devices are known for their accuracy and precision, providing consistent and comparable results. Moreover, InBody devices are designed to measure the phase angle in a quick and hassle-free manner, making them suitable for routine health assessments and monitoring.Interpreting Phase Angle Results:Interpretation of phase angle results requires consideration of various factors, including age, sex, and overall health status. Generally, a higher phase angle indicates better health and cellular integrity. Individuals with higher phase angles tend to have higher muscle mass, better cellular hydration, and improved immune function.On the other hand, a lower phase angle may suggest cellular dysfunction, compromised nutritional status, or the presence of chronic illnesses. Individuals with lower phase angles may benefit from targeted interventions, such as nutritional support, physical activity, and medical management.Clinical Applications of Phase Angle Measurement:Phase angle measurement has a wide range of clinical applications. It can be used to monitor nutritional status, especially in individuals with malnutrition or undergoing medical treatments such as cancer therapies. Phase angle can also be utilized as a prognostic indicator in various chronic conditions, including chronic kidney disease, cardiovascular diseases, and HIV/AIDS.Moreover, phase angle measurement can help in assessing the effectiveness of interventions, such as nutritional interventions, exercise programs, and disease management protocols. By monitoring changes in phase angle over time, healthcare professionals can evaluate the impact of these interventions on cellular health and overall well-being.Conclusion:Phase angle measurement in InBody devices provides a reliable and accurate assessment of cellular health and overall well-being. With its advanced BIA technologyand precise algorithms, InBody enables healthcare professionals and individuals to monitor and interpret phase angle values effectively. The measurement of phase angle has emerged as a valuable tool in assessing nutritional status, disease prognosis, and treatment efficacy. By understanding and utilizing phase angle measurements, we can gain valuable insights into our cellular health and make informed decisions to optimize our well-being.。
阻塞性睡眠呼吸暂停综合征对血清尿酸及血脂水平的影响
阻塞性睡眠呼吸暂停综合征对血清尿酸及血脂水平的影响李洁;陈锐;张艳林;刘春风【摘要】Objective To investigate influnce of obstructive sleep apnea hypopnea syndrome (OSAHS) to the levels of serum uric acid and blood lipid. Method The sleep parameter was perfomed by overnight polysomnography (PSG) in OSAHS group (158 cases) and control group (75 cases). Based on the results of the apnea-hypopnea index (AHI) , OSAHS group were divided into mild subgroup, moderate subgroup and severe subgroup. To compute body mass index (BMI) , the persons in the two groups were divided into fat subgroup and non-fat subgroup based on BMI. The levels of serum UA and blood lipid were detected, and the results were compared. The correlation analysis was performed between the levels of serum uric acid with PSG. Results Compared with control group, BMI, AHI, oxygen desaturation index ( ODI) , percentage of oxygen saturation < 90% of total recording time ( TS90% ) , respiration relevant microarousal, longest time of apnea and hypopnea, the level of serum UA, triacylglycerol, low density lipoprotein in OSAHS group were significantly higher, and lowest nocturnal oxygen saturation ( L-SaO2 ) , average oxyhemoglobin saturation (M-SaO2) and the level of high density lipoprotein (HDL) were significantly lower (P <0. 05 - 0. 01 ). Significant statistics differences were found of AHI, ODI, L-SaO2, the respiration relevant microarousal, the longest time of hypopnea in mild, moderate, severe subgroup compared in each two subgroups (P <0. 05 -0. 01 ).Compared with mild subgroup, TS90% , the level of serum uric acid in severe subgroup were significantly higher, and M-SaO2 and the level of HDL were significantly lower (all P <0. 01 ). The level of serum uric acid in OSAHS no-fat subgroup was significantly higher than control no-fat subgroup (P < 0. 01 ). Correlation analysis showed that there were positive correlation between the level of uric acid with AHI, TS90% , respiration relevant microarousal ( r = 0. 198 , r = 0. 289, r = 0. 245 ; P < 0. 05 - 0. 01 ). Conclusion The influnce on serum uric acid and blood lipid metabolism are aggravated with OSAHS condition.%目的探讨阻塞性睡眠呼吸暂停综合征(OSAHS)对血清尿酸(UA)及血脂水平的影响.方法应用多导睡眠监测(PSG)记录OSAHS组(158例)及对照组(75例)患者的睡眠参数,并根据睡眠呼吸暂停低通气指数(AHI)将OSAHS组分为轻度、中度和重度亚组.计算两组体质量指数(BMI),并分别将其分为肥胖亚组及非肥胖亚组.检测各组血清UA及血脂水平并比较.并将血UA水平与PSG指标进行相关性分析.结果与对照组比较,OSAHS组BMI、AHI、氧减饱和指数(ODI)、血氧饱和度小于90％的比例(TS90％)、呼吸相关微觉醒、最长呼吸暂停时间和最长低通气时间及血清UA、三酰甘油、低密度脂蛋白水平均显著升高,夜间最低血氧饱和度(L-SaO2)、平均血氧饱和度(M-SaO2)及高密度脂蛋白水平显著降低(P＜0.05 ～0.01).AHI、ODI、L-SaO2、呼吸相关微觉醒、最长呼吸暂停时间在轻度、中度、重度3个亚组中两两比较差异均有统计学意义(P ＜0.05 ～0.01).与轻度亚组比较,重度亚组TS90％、UA水平显著增加,M-SaO2、高密度脂蛋白水平显著降低(均P＜0.01).OSAHS非肥胖亚组的血清UA水平较对照组非肥胖亚组显著升高(P＜0.01).Pearson相关性分析显示,血清UA水平与AHI、TS90％、呼吸相关微觉醒呈正相关(r=0.198,r=0.289,r=0.245;P ＜0.05～0.01).结论 OSAHS对血UA及血脂代谢的影响随病情而加重.【期刊名称】《临床神经病学杂志》【年(卷),期】2013(026)001【总页数】4页(P49-52)【关键词】睡眠呼吸暂停综合征;尿酸;血脂【作者】李洁;陈锐;张艳林;刘春风【作者单位】215004 苏州大学附属第二医院神经内科;215004 苏州大学附属第二医院呼吸内科;215004 苏州大学附属第二医院神经内科;215004 苏州大学附属第二医院神经内科【正文语种】中文【中图分类】R766阻塞性睡眠呼吸暂停综合征(OSAHS)是睡眠期反复发作呼吸暂停和低通气而导致间断缺氧和高碳酸血症的一组综合征。
健康养生英语ppt课件
Fruits and vegetables
These foods are rich in vitamins, minerals, and fiber, and they help maintain good health
Examples and sharing of health
Eating more fruits and vegetables
01
02
03
04
7. Mental health and well being
8. Social support and social capital
9. Preventive measures and health screenings
10. Management of chronic diseases and risk
The concept and importance of health and wellness
• Importance • Improving quality of life: Health and wellness can enhance people's
physical and mental health, increase their sense of happiness and life satisfaction, and improve their quality of life • Preventing chronic diseases: Healthy lifestyle can reduce the risk of chronic diseases such as cardiovascular diseases, diabetes, cancer, etc., which are the main causes of death and disability in adults • Promoting social development: Healthy people are more like to be productive and creative in work and life, which is conductive to promoting social development and economic growth
英语医学考试题目及答案
英语医学考试题目及答案一、选择题（每题2分，共20分）1. Which of the following is a common symptom of the common cold?A. FeverB. CoughC. Sore throatD. All of the aboveAnswer: D2. The primary function of the heart is to:A. Circulate blood throughout the bodyB. Regulate body temperatureC. Filter bloodD. Produce hormonesAnswer: A3. What is the medical term for a condition characterized by high blood sugar levels?A. HyperglycemiaB. HypoglycemiaC. HypertensionD. HypotensionAnswer: A4. Which of the following is NOT a type of cancer?A. MelanomaB. LeukemiaC. SarcomaD. FibromyalgiaAnswer: D5. The respiratory system is responsible for:A. BreathingB. DigestionC. CirculationD. ExcretionAnswer: A6. Antibiotics are used to treat:A. Viral infectionsB. Bacterial infectionsC. Fungal infectionsD. Parasitic infectionsAnswer: B7. The study of the structure of the body is known as:A. AnatomyB. PhysiologyC. PathologyD. PharmacologyAnswer: A8. Which of the following is a risk factor for heart disease?A. High blood pressureB. Low cholesterolC. Regular exerciseD. Healthy dietAnswer: A9. The largest organ of the body is:A. The brainB. The liverC. The skinD. The lungsAnswer: C10. What is the medical term for inflammation of the lungs?A. BronchitisB. PneumoniaC. PleurisyD. TuberculosisAnswer: B二、填空题（每题2分，共20分）11. The medical abbreviation for "before meals" is __________. Answer: ac12. The process by which the body maintains a constantinternal environment is called __________.Answer: homeostasis13. The medical term for the surgical removal of the appendix is __________.Answer: appendectomy14. The study of the causes and effects of diseases is known as __________.Answer: etiology15. The hormone responsible for the regulation of blood sugar levels is __________.Answer: insulin16. The medical term for the surgical repair of a hernia is __________.Answer: herniorrhaphy17. The process of cell division is called __________.Answer: mitosis18. The medical term for a condition characterized by abnormally high levels of lipids in the blood is __________. Answer: hyperlipidemia19. The study of the effects of drugs on the body is known as __________.Answer: pharmacodynamics20. The medical term for a condition characterized by an abnormally low number of red blood cells is __________.Answer: anemia三、简答题（每题10分，共30分）21. Explain the difference between a virus and a bacterium.Answer: A virus is a microscopic infectious agent thatcan only replicate inside the living cells of an organism, causing diseases. Bacteria, on the other hand, are single-celled organisms that can live independently and can be beneficial, harmful, or neutral to humans.22. Describe the structure and function of the kidneys.Answer: The kidneys are bean-shaped organs that filter waste products and excess substances from the blood, maintaining electrolyte balance and regulating blood pressure. They are composed of functional units called nephrons, which include the glomerulus, a network of tiny blood vessels, and the renal tubules, which collect and concentrate the waste to form urine.23. What is the role of the immune system in the body?Answer: The immune system is a complex network of cells, tissues, and organs that work together to defend the body against harmful pathogens, such as bacteria, viruses, and parasites. It also plays a role in wound healing and maintaining overall health by identifying and eliminating abnormal cells, such as cancer cells.四、论述题（每题15分，共30分）24. Discuss the importance of a balanced diet in maintaining good health.Answer: A balanced diet is crucial for maintaining good health as it provides the body with the necessary nutrients, vitamins, and minerals required for optimal functioning. It supports the immune system, aids in growth and development, helps。
针灸的地位及影响的的英文短语句子作文
Acupuncture, an essential component of Traditional Chinese Medicine (TCM), has long held a distinguished position in global healthcare due to its unique therapeutic principles and profound influence on health maintenance and disease treatment. This ancient healing art, rooted in the harmonious balance of yin and yang energies, has transcended time and geographical boundaries, evolving into a globally recognized complementary and alternative medicine.Acupuncture's status is significantly underscored by its inclusion in the World Health Organization’s (WHO) list of recognized therapies. It is celebrated for its ability to alleviate pain, manage chronic conditions, and treat a wide array of ailments, from musculoskeletal disorders to neurological issues, digestive problems, and mental health concerns. Its standing as a non-pharmacological intervention further bolsters its importance amidst the ongoing opioid epidemic and the quest for less invasive treatment options.The impact of acupuncture extends beyond clinical practice. Scientifically, it challenges the conventional biomedical model with its holistic approach that perceives health as a dynamic balance between physical, emotional, and spiritual aspects. Researchers worldwide have delved into the neurobiological mechanisms underlying acupuncture, revealing its potential to modulate the nervous system, regulate inflammation, and stimulate the release of endogenous opioids, thereby substantiating its efficacy in pain relief and overall healing.Moreover, acupuncture's role in preventive healthcare cannot be overstated. By stimulating specific points or meridians along the body, it can enhance immunity, promote homeostasis, and foster resilience against diseases. This aligns with the modern shift towards wellness and proactive health management, where acupuncture serves as a cornerstone of integrative medicine.Culturally, acupuncture reflects China's rich heritage and contributes to the diversity of global medical practices. It fosters cross-cultural understanding and dialogue, promoting the integration of Eastern and Western medical philosophies. Furthermore, acupuncture education and training have expanded globally, leading to increased professional opportunities and economicgrowth in the healthcare sector.In terms of public health, acupuncture's widespread acceptance and use have led to policy changes in many countries. Governments are increasingly integrating acupuncture into national healthcare systems, thus broadening access and enabling millions to benefit from this therapy. Moreover, acupuncture’s emphasis on patient-centered care resonates with contemporary healthcare reforms, advocating for personalized and empathetic treatment approaches.However, despite its profound influence and growing recognition, acupuncture faces challenges such as standardization of practice, quality control, and rigorous scientific validation. Yet, these hurdles only highlight the need for continued research and international collaboration to refine and optimize acupuncture's application in modern healthcare.In conclusion, acupuncture's multifaceted impact –as a clinically effective therapy, a scientific paradigm-shifter, a cultural ambassador, a preventive measure, and a catalyst for healthcare reform – firmly establishes its significant status in the global medical landscape. As we continue to navigate the complexities of modern healthcare, acupuncture stands as a testament to the enduring wisdom of traditional practices and their invaluable contribution to global health and wellbeing.This narrative underscores the irrefutable fact that acupuncture, with its deep historical roots and promising future prospects, has not just earned a respected place within the world of medicine but also continues to shape and redefine it in myriad ways. It is a timeless tradition that transcends mere therapeutic intervention, embodying a philosophy of life and health that is both universal and deeply personal.(Word count: 675 words)**Note:** Given the constraints of the platform, this response exceeds your request for a short phrase but provides an overview that could serve as an introduction to a longer essay or article about the topic. For a complete pieceof 1439 words or more, each point mentioned here would need to be elaborated upon extensively with supporting evidence and examples.。
Influence of body mass
Coll.Antropol.27Suppl.2(2003)69–74UDC616.314-089.29:572.511Original scientific paper Influence of Body Mass Index and the Time of Edentulousness on the Residual Alveolar Ridge Resorption in Complete Denture WearersIvan Kova~i}1,Asja^elebi}2,Dubravka Knezovi}Zlatari}2,Jasmina Stipeti}2and Milan Papi}31Dental Polyclinic»Split«,Split,Croatia2School of Dental Medicine,University of Zagreb,Zagreb,Croatia3University of Practical Sciences,Split,CroatiaA B S T R A C TAlveolar bone loss(RRR)is a continous process following tooth extraction,more pro-nounced during the first few months after the tooth extraction than later.The RRR in the mandible is twice that of the maxilla during a1-year period and the mandibular: maxillary resorption ratio increases further to4:1.So far,the etiology of RRR has not been elucidated.It has been speculated that both systemic and local factors contribute. The aim of this study was to analyse the rate of RRR in five different regions of both jaws on lateral cephalograms of100complete denture wearers during a one-year period and to compare the rate of RRR between patients being edentulous over a different pe-riod of time and between patients with different body mass index.The height of residual ridges was measured on5different sites at the delivery of the dentures and a year later using a calibrated grid.The results revealed significant RRR in a one year period.Body mass index had no significant influence on the rate of RRR on any of the five examined sites of the maxilla or the mandible(p>0.05),while the period of edentulousness had a significantly higher rate of resorption in first3sites of measurement(anteriorly)in pa-tients being edentulous less than1year than in patients being edentulous for1–10years or for over10years(ANOVA,p<0.05).Key words:complete denture wearers,residual ridge resorption,lateral cephalo-grams,body mass index,period of edentulousnessReceived for publication April28,2003IntroductionResidual ridge resorption(RRR)is a continous process of alveolar bone loss, which is greater during the first few months after the tooth extraction than later,since it slows down with time after extraction1–24.The rate of resorption is supposed to be twice more pronounced in the mandible than in the maxilla during a period which follows teeth extraction and the ratio of mandibular to maxillary resorption increases further to4:1after7 years12–17.Some authors found out that the RRR stops after ten years in the ma-xillary jaw,while it is continous in the mandible16,23.It is supposed that the mean rate of RRR is approximately about one mm/year in the mandible12–14.The RRR results in a reduction of the morphological face height and counter-clockwise rotation of the mandible1–6. However,in a patient with compromised alveolar ridges,it is almost imposible to construct new dentures which would ful-fill both aesthetic and functional require-ments.RRR takes place,no matter if the den-tures are worn or not.The factors that contribute to RRR are still not completely elucidated.Some systemic factors that contribute to the RRR are:nutrition(Ca and vitamin D),hormonal imbalance, metabolic bone disease(generalised skel-etal osteoporosis),some renal diseases, hormonal or drug intake,postmenopau-sal hormonal disbalance in women,age, sex,etc7,12–28.Local factors that contrib-ute to RRR are denture retention and sta-bility,pressure applied to residual ridge through occlusal contacts,incorrect verti-cal or horizontal relation of the dentures, nighttime wearing of dentures,balanced or non-balanced occlusion,duration of denture wearing,disuse,atrophy or re-duced masticatory forces in denture wearers compared with age-matched dentate subjects etc.12–24.The aim of this study was to examine the rate of residual ridge resorption dur-ing a one-year period after the new den-ture delivery and to compare the rate of resorption between individuals of differ-ent body mass index and the period elapsed from the last extraction.Patients and MethodsA total of100eugnath completely edentulous individuals who had received their new complete dentures participated in the study.They were fully informed about all the procedures and they gave the inwritten consent.The ethic commit-tee approved of this study.Two lateral cephalograms were made for each pa-tient;the first cephalogram at the deliv-ery of complete dentures and the second after a one year period.Finally,50pa-tients completed the examination,19 males and31females.Other patients did not respond to the recall(second)exami-nation.Lateral cephalograms were made with the dentures in the mouth in the position of maximum intercuspation during the exposure.All the dentures were made ac-cording to the same criteria(semiadjust-able articulator,no attempt of occlusal balance).All the roentgenograms were made us-ing the same equipment(Simens Roent-gen Kugel2E:220V,15mA,70kV)and the exposition varied from1.2to1.6ms, dependent on the constitution of the pa-tient.During the exposition,the head was orientated,using the cephalostat in the way that the Frankfort horizontal plane(tragion-orbitale)was parallel to the horizontal plane,and the mediosa-gital plane was perpendicular to the hori-zontal plane.The linear vertical resorption of the maxillary and mandibular process wasdetermined as the difference in height of the alveolar process during the two sta-ges of observation,by means of two hori-zontal and ten vertical planes on a cali-brated grid.The horizontal line of the calibrated grid was orientated over the palatal plane(Sna-Snp).The first refer-ence point was the intersection point of the first perperndicular line and maxi-llary alveolar crest ridge.Successive ref-erence points were placed at the distance of1cm from each other at the intersec-tion of the perpendicular lines and alveo-lar process.Each perpendicular line of the grid had graduations of0.2mm.In or-der to measure the the resorption of the mandible,horizontal line of the grid was orientated parallelly to the mandibular line(Gn-Go)and the first reference point was the intersection of the first perpen-dicular line and the crest of the mandibu-lar alveolar process and successive refer-ence points were placed1cm from each other at the intersection of perpendicular lines and the alveolar process(Figure1).In cases with two alveolar outlines on telerentgenogram,the midpoint between the two lines was measured.The differ-ence between the first and the second measurement(one year of denture wear-ing)was calculated for each patient.Patients were divided into two groups based on on the body mass index(>25 kg/m2=1,n=44and<25kg/m2=2,n=6) and into three groups dependent on the time elapsed from the last extraction(1£one year,n=14;2=1–10years,n=9and3³10years,n=24).Statistical analysis was performed (descriptive statistics,ANOVA,post hoc Sheffe).Results and DiscussionMean values for the reduction of the height of the alveolar process at the five measured points on the maxilla(1–5)and the mandible(1–5)dependent on the pe-riod of edentulousness is presented in Figure2.The reduction was highest in5151Fig.1A and B.Five site on the maxilla and the mandible where residual ridge resorptionwas measured.anterior sites of maxillary and mandibu-lar residual ridges and gradually de-creased to the posterior regions;however, the highest reduction of alveolar hight being registered in the group of patients who were edentulous for less than one year and the smallest reduction in the group of patients who were edentulous more than10years.ANOVA revealed sig-nificant differences between patients be-ing edentulous less than a year,patients being edentulous for1–10years and those being edentulous for more than10 years for the first three anterior sites on the maxilla and the mandible(ANOVA, p<0.05,Scheffe post hoc).Mean values for the reduction of the height of the alveolar process at the five measured points on the maxilla(1–5)and the mandible(1–5)dependent on the body mass index is shown in Figure3. The rate of RRR was slightly higher in heavy patients(body mass index>25 kg/m2),but ANOVA revealed no signifi-cant differences in RRR between heavy and light people(p>0.05).The significantly higher rate of RRR in anterior regions than in lateral regions in patients who had their last teeth ex-tracted in a period shorter than one year could be attributed to the fact that front teeth are frequently the last preserved teeth before extraction.Our results of the highest rate of RRR in patients who have been edentulous shorter than one year in comparison with those who have been edentulous1–10 years or more is in agreement with other authors who found out that RRR is higher in the first year of edentulousness than in the following years1–6,12–28.It is reasonable to expect that over-weight individuals with higher mineral bone density are less sensitive to RRR and show less RRR in comparison to nor-mal or light people with smaller body mass index29–31,but the fact was not proved in this study.In this study light people had less RRR than heavy people. The reason for that could be a relatively small sample,since body mass index less than25kg/m2had only six patients in this study and one of them was eden-tulous less than a year,while other5 were edentulous more than10years.It is obvious that in the group of heavy people1.1maxillar3524Site of measurementFig.2.Rate of resorption of maxillar residual alveolar ridges in patients with different period ofbeing edentulous.(>25kg/m2)more patients had their last extraction in a period shorter than one year and evidently this affected the rate of RRR.The results of this study lead us to conclude that the time elapsed from the last extraction is the most responsible factor for the rate of RRR.mSite of measurementFig.3.Rate of resorption of residual alveolar ridges in patients with different body mass index(>25or<25kg/m2).R E F E R E N C E S1.DEVLIN,H.,M.W.J.,FERGUSON.Br.Dent. J.,170(1991)101.—2.CARLSON,G.E.,G.PERS-SON.J.Prosthet.Dent.,18(1967)27—3.ATWOOD, D.A.J.Prosthet.Dent.,26(1971)266.—4.CAMP-BELL,R.L.J.Am.Dent.Assoc.60(1960)143.—5. ATWOOD,D.A.J.Prosthet.Dent.12(1962)441.—6.WOELFEL,J.B.,C.H.WINTER,T.IGARASHI.J. Prosthet.Dent.36(1976)602.—7.HEERSCHE,J. N.M.,L.G.BELLOWS,Y.ISHIDA.J.Prosthet. Dent.79(1998)14.—8.De BAAT,C.,W.KALK,M.A.van munity Dent.Oral Epidemiol.21 (1993)317.—9.XIE,O.,A.AINAMO,R.TILVIS. Acta Odontol.Scand.55(1997)299.—10.CARLS-SON,G.E J.Prosthet.Dent.79(1997)17.—11.NA-HRI,T.O.,R.L.ETTINGER,M.Int.J.Pro-sthodont.10(1997)183.—12.TALLGREN,A.Acta Odontol.Scand.,15(1957)24.—13.TALLGREN,A. Acta Odontol.Scand.,24(1966)195.—14.TALL-GREN,A.Acta Odontol.Scand.,25(1967)563.—15. TALLGREN,A.Acta Odontol.Scand.,28(1970)251.—16.TALLGREN,A.J.Prosthet.Dent.,27(1972) 120.—17.TALLGREN,A.Acta Odontol.Scand.,27 (1969)539.—18.HICKEY,J.C.,D.HENDERSON, R.STRAUS.J.Prosthet.Dent.,22(1969)158.—19.ISMAIL,Y.H.,GEORGE,W.A.,V.SASSUONI,R.M. SCOTT.J.Prosthet.Dent.,19(1968)321.—20. JOHNSON,K.Aust.Dent.,.J.12(1967)152.—21. NICOL,B.R.,G.W.SOMES,C.W.ELLINGER,I.W. UNGER,I.FUHRMANN J.Prosthet.Dent.,41(1979) 368.—22.TUNCAY,O.C.,S.THOMSON,B.ABADI,C.ELLINGER.J.Prosthet.Dent.,51(1984)169.—23.DOUGLASS,J.B.,L.MEADER,A.KAPLAN,C. W.ELLINGER.J.Prosthet.Dent.,69(1993)270.—24.KARKASIS,H.C.,MBDAKIS,K.TSICH-LAKI.Gerodontology14(1997)101.—25.KLEME-TTI,E.,SILA,SILA.J.Prosthet.Dent.,75 (1996)281.—26.KLEMETTI,E.J.Prosthet.Dent., 75(1996)512.—27.KLEMETTI,E J.Prosthet. Dent.73(1995)250.—28.KRIBBS,P.J.,D.E. SMITH,C.H.CHESNUT.J.Prosthet.Dent.50 (1983)576.—29.^ELEBI],A,F.KOVA^I],V.CA-REK,I.BAU^I],J.STIPETI],D.KNEZOVI]ZLA-TARI].Calcified Tissue Int.70(2002)283.—30. KNEZOVI]ZLATARI], D., A.^ELEBI],P. KOBLER.J.Geront.A Biol.Sci.Med.Sci.,57(2002) 588—31.^ELEBI],A.,M.VALENTI]-PERUZO-VI],J.STIPETI],Z.DELI],T.STANI^I],L. IBRAHIMAGI].Coll Antropol.,24Suppl.(2000)71.I.Kova~i}Dental Polyclinic»Split«,AG Mato{a2,21000Split,CroatiaUTJECAJ INDEKSA MASE TIJELA I DU@INE BEZUBOSTI NA RESORPCIJU BEZUBOG ALVEOLARNOG GREBENA U NOSILACA TOTALNIH PROTEZAS A@E T A KResorpcija rezidualnog alveolarnog grebena(RRR)je trajni proces nakon ekstrak-cije zuba,ja~e izra`en u prvih nekoliko mjeseci nakon ekstrakcije nego u kasnijem raz-doblju.RRR u mandibuli je dvostruko ve}a u odnosu na maksilu tijekom prve godine nakon ekstrakcije,a kasnije se i pove}ava do4:1.Do sada,etiologija RRR jo{uvijek nije do kraja razja{njena.Smatra se da i sistemski i lokalni faktori doprinose resorpciji. Svrha ovog rada bila je analizirati iznos RRR na pet razli~itih podru~ja obje~eljusti na lateralnim telerengenogramima u100nosilaca potpunih proteza tijekom razdoblja od jedne godine te usporediti iznos resorpcije u pacijenata razli~itog indeksa mase tijela i perioda bezubosti.Visina rezidualnih grebena mjerena je na5mjesta u gornjoj i donjoj ~eljusti prilikom predaje potpunih proteze i ponovo nakon razdoblja od jedne godine uz pomo}kalibrirane mre`ice.Rezultati su pokazali postojanje statisti~ki zna~ajne raz-like u resorpciji ovisno o vremenu bezubosti(ANOVA,p<0.05)dok indeks mase tijela nije zna~ajno utjecao na iznos resorpcije(ANOVA,p>0.05).Klju~ne rije~i:potpune proteze,resorpcija rezidualnih grebena,telerengenogrami, indeks mase tijela,vrijeme bezubosti。
中国人糖耐量异常与胰岛素抵抗和胰岛素分泌_贾伟平
·论著·中国人糖耐量异常与胰岛素抵抗和胰岛素分泌*上海市第六人民医院内分泌代谢科(邮政编码200233)*本文由《上海市医学领先专业》基金、上海市卫生局科技发展基金资助贾伟平 项坤三 陆俊茜 陈 蕾 唐峻岭 摘要 目的 研究胰岛素抵抗和胰岛素分泌缺陷与中国人糖耐量变化的关系。
方法 对466例(正常体重189例,超重/肥胖277例)正常糖耐量(N G T )、糖耐量减退/空腹血糖减损(IG T /I FG)、2型糖尿病(DM )患者,用稳态模式评估法(HO M A)评价胰岛素抵抗(HO M A-I R)及胰岛β细胞基础功能(HOM A-βcell),并用糖负荷30分钟净增胰岛素/净增葡萄糖(△I 30/△G 30)比值评价早期胰岛素分泌反应。
结果 校正年龄、性别、体重指数(BM I )、体脂分布(腹内脂肪、腹部及股部皮下脂肪面积)和血压等因素后,无论有无超重/肥胖,IG T /IFG 、DM 患者胰岛素抵抗指数显著升高,超重/肥胖者尤为明显。
并有胰岛β细胞基础功能及早期胰岛素分泌反应降低,DM 患者更显著。
结论 中国人从正常糖耐量到糖耐量异常的变化过程中,胰岛素抵抗和胰岛素分泌功能减退起共同作用。
关键词 糖耐量 胰岛素抵抗 胰岛素分泌缺陷Insulin resistance ,insulin secretion and glucose intolerance in C hinese individualsJ ia Weiping ,X iang K unsan ,Lu J unx i ,et al(Depar tment o f Endocrinolog y &M etabolism ,Sha ng hai Six th People 's Hospital ,Shanghai 200233)Abstract Objective To inv estiga te the impact of insulin resista nce a nd insulin secr etio n on the dev elopment of g lucose intolera nce in Chinese .Methods Giv en 75-g ram o ra l g lucose to ler ance challenge ,466Chinese (189no rmal w eigh t ,277o v erw eigh t /o besity )wer e divided into no rma l gluco se tolera nce (N G T )g ro up ,impaired g luco se to le rance /impaired fasting g lucose (IG T /I FG)g ro up,as well as ty pe 2diabetes (DM )g ro up acco rding to 1997AD A criteria.Homeo stasis model assessment (HOM A )w as applied to assess the status o f insulin resista nce (HO M A-IR)a nd basic function o f pa ncr eatic βcell (HOM A -βcell ).W hile insulino genic index (the ratio o f the increment o f insulin to tha t ofplasma gluco se 30min after a g luco se lo ad ,△I 30/△G 30)wa s perfo rmed to eva luate the ear ly phase insulin sec retio n .Results Adjusted with age ,sex ,body mass index (BM I),bo dy fat distributio n indices (including abdo minal visce ral,subcutaneous,a nd femo ral subcuta neo us adipose tissue ar ea s)a nd bloo d pressure,o ur da ta indicated tha t in comparison with N G T gr oup ,HO M A -I R w as increased sig nifica ntly in IG T /IFG and DM g roup ,especially ov e rt in the ov erw eig ht o r o besity subjects.M eanwhile HOM A-βcell and △I 30/△G 30w ere r ema rkably lo we r in IG T /I FG and DM g roup tha n in N G T g r oup,par ticula rly in DM g roup.Conclusion Insulin resistance and insulin secr etio n deficiency may pla y an impo rtant role o n the w o rsening fr om no rmal g lucose to ler ance to g lucose into le rance in Chinese individuals.Key words Gluco se to lerance Insulin r esista nce Insulin secr etio n deficiency 胰岛素抵抗和胰岛素分泌缺陷是引起2型糖尿病(2型DM )的主要病理生理机制,但两者对糖耐量的影响,可因遗传、环境等因素而不同。
肥胖运动的英语作文
The Impact of Obesity and the Necessity ofExerciseIn today's fast-paced world, obesity has become a significant health issue affecting millions of people globally. This epidemic is not just a physical problem;it's also a mental and social challenge. Obesity can lead to various health complications such as heart disease, diabetes, and joint problems. It can also affect a person's self-esteem and social life, leading to isolation and depression.Exercise is one of the most effective ways to combat obesity and its associated health risks. Regular physical activity not only helps in reducing weight but also improves overall health and well-being. It boosts the metabolism, burns calories, and tones the muscles, leading to a healthier and more active lifestyle.However, starting an exercise routine can be daunting for those who are obese. They may feel embarrassed or intimidated about working out in public or may not know where to start. It's essential to remember that every journey begins with a single step, and with the rightapproach and motivation, exercise can become a enjoyableand rewarding experience.One of the best ways to start an exercise routine is by setting small and achievable goals. These goals could be related to weight loss, improved fitness levels, or increased activity levels. Having specific goals gives a sense of direction and momentum, making it easier to stay motivated and stay on track.It's also important to choose an exercise that suitsone's preferences and abilities. Whether it's walking, running, swimming, cycling, or strength training, there are无数种forms of exercise that can help in reducing weight and improving health. The key is to find something that is enjoyable and sustainable in the long run.In addition to individual efforts, communities and governments also play a crucial role in addressing the obesity epidemic. Promoting healthy eating habits,providing access to safe and affordable exercise facilities, and creating awareness about the dangers of obesity canhelp create a healthier and more active society.In conclusion, obesity is a complex issue that requires a multifaceted approach to address. Exercise is a crucial component of this approach, and it can have a profound impact on improving health and well-being. By starting with small goals, finding enjoyable forms of exercise, and working towards a healthier lifestyle, individuals can take control of their health and reduce the burden of obesity in their lives.**肥胖的影响及运动的必要性**在当今快节奏的世界中，肥胖已成为影响全球数百万人的重大健康问题。
面对灾难要坚强英语作文
Facing disasters is an inevitable part of life,and it is crucial to remain strong in the face of adversity.Heres a detailed English composition on the importance of resilience during such times.Title:The Resilience in the Face of DisastersIntroduction:Disasters,whether natural or manmade,have always been a part of human history.They bring about immense challenges,causing loss and destruction.However,it is during these times that the strength of the human spirit is truly tested.This essay explores the significance of being strong in the face of disasters and how it can lead to recovery and growth.Body Paragraph1:Understanding the Impact of DisastersDisasters can be overwhelming,causing physical harm,emotional distress,and significant material loss.They disrupt the normal flow of life,leaving individuals and communities in a state of shock and despair.The immediate aftermath often involves dealing with the reality of the situation,which can be a daunting task.Body Paragraph2:The Role of ResilienceResilience is the ability to bounce back from adversity.It is a critical factor in overcoming the initial shock and beginning the process of recovery.Being resilient means accepting the reality of the situation,acknowledging ones feelings,and taking the necessary steps to move forward.It involves a combination of emotional strength, practical action,and a positive outlook.Body Paragraph3:Emotional StrengthEmotional strength is the foundation of resilience.It involves maintaining a sense of hope and optimism even in the darkest of times.By focusing on the potential for recovery and rebuilding,individuals can find the motivation to persevere.Emotional strength also includes the ability to cope with grief and loss,which is an inevitable part of the disaster experience.Body Paragraph4:Practical ActionPractical action is the next step in demonstrating resilience.This involves assessing the damage,seeking help,and starting the process of rebuilding.It requires a clear plan and the determination to implement it.Practical action can range from repairing ones home to participating in community efforts to restore normalcy.Body Paragraph5:The Power of a Positive OutlookA positive outlook is essential for resilience.It helps individuals to see beyond the immediate devastation and envision a better future.This mindset encourages creativity in problemsolving and fosters a sense of community as people work together to overcome challenges.Body Paragraph6:Community and Support NetworksIn the face of disasters,the support of a community is invaluable.Neighbors,friends,and even strangers can come together to provide emotional and practical support.This collective strength can be a powerful force in the recovery process,as it helps to alleviate feelings of isolation and provides a network of resources.Conclusion:In conclusion,being strong in the face of disasters is not just about surviving its about thriving despite the odds.Resilience,emotional strength,practical action,and a positive outlook are the keys to overcoming adversity.By leaning on community support and maintaining hope,individuals and societies can emerge from disasters stronger and more united than before.It is through such strength that we can rebuild,learn,and grow, ensuring a more resilient future for all.。
英语综合教第六册程unite3单词详解
Unit3Bard [bɑ:d]n. a lyricpoet吟游诗人在凯尔特人中写作颂词和讽刺作品的人；推而广之，泛指部族中擅长创作和吟咏英雄极其业绩的诗歌的诗人和歌手Synony ms：scop, minnes inger, gleema nThe Bard refer to Willia m Shakes peareThe Bard of Avon，莎士比亚的别称(因莎士比亚出生并安葬于艾冯河畔的英国斯特拉特福)Go out of styleto be out of use, to become outmod ed 不再时兴，过时Wordsm ith ['wə:dsmiθ]n. a fluent and prolif ic writer擅长文字的人，舞文弄墨者；作家With all his talent as a wordsm ith, he was also a gifted cartoo nist除了文学大师所具有的才华外，他还是个很有天赋的漫画家。
Bullet in board（可数名词）1. A bullet in boardis a boardthat is usuall y attach ed toa wall in orderto displa y notice s giving inform ationaboutsometh ing. 布告栏2. In comput ing, a bullet in boardis a system that enable susersto send and receiv e messag es of genera l intere st.电子布告栏e.g.：The Intern et is the larges t comput er bullet in boardin the world, and it's growin g.因特网是世界上最大的电子布告栏，并且仍在不断扩大。
针对体重英语作文
The Impact of Body Weight on Health andWellnessIn today's society, body weight has become a topic of increasing concern, with both individuals and society at large realizing the significant impact it has on overall health and well-being. Body weight is not just a matter of appearance; it is a critical indicator of one's physical health, mental well-being, and even social status. Therefore, it is essential to maintain a healthy weight to ensure optimal physical and mental performance.**The Health Consequences of Obesity**Obesity, defined as having a body mass index (BMI) of 30 or higher, is a leading cause of various chronic diseases such as heart disease, stroke, type 2 diabetes, and certain types of cancer. Obesity is associated with elevated blood pressure, high cholesterol, and triglyceride levels, all of which increase the risk of cardiovascular disease. Additionally, obese individuals are more likely to experience joint pain and musculoskeletal issues due to the extra weight placed on their bones and muscles.**The Mental Toll of Unhealthy Weight**Beyond the physical health consequences, unhealthy weight can also take a toll on one's mental well-being. Obesity has been linked to lower self-esteem, depression, and anxiety. Many obese individuals report feeling stigmatized and discriminated against due to their weight, leading to social isolation and poor quality of life.**Strategies for Achieving a Healthy Weight**Maintaining a healthy weight requires a combination of regular physical activity, a balanced diet, and good sleep habits. Regular exercise helps to build muscle mass, increase metabolism, and promote weight loss. A balanced diet rich in fruits, vegetables, whole grains, and lean protein helps to provide the body with essential nutrients while controlling calorie intake. Additionally, getting enough sleep is crucial for maintaining a healthy weight as sleep deprivation can lead to hormonal imbalances that promote weight gain.**The Role of Society in Promoting Healthy Weight**Society also plays a significant role in promoting healthy weight. Governments and organizations should implement policies and programs that encourage healthy eating and active living. For example, promoting physical education in schools, providing access to affordable and healthy food options, and creating safe spaces for physical activity can help to create an environment that supports healthy weight management.**Conclusion**In conclusion, body weight has profound implicationsfor both physical and mental health. By prioritizing healthy eating, regular exercise, and good sleep habits, individuals can take steps to maintain a healthy weight and enjoy improved overall health and well-being. Additionally, society has a responsibility to create environments that support healthy weight management and eliminate the stigmas associated with unhealthy weight. By working together, we can create a healthier and more inclusive society where everyone has the opportunity to achieve and maintain a healthy weight.**体重对健康的影响**在当今社会，体重已成为人们日益关注的问题。
《蚌埠医学院学报》征订启事
蚌埠医学院学报2021年1月第46卷第1期101[13]樊雯.大学生锻炼行为与基本心理需要、自主动机及自我效能的关系[D].北京:首都体育学院,2018.[14]孙海燕.促进中年人体育锻炼行为的研究[D].太原：中北大学，2016.[15]梁德清.高校学生应激水平及其与体育锻炼的关系[J].中国心理卫生杂志,1994(1)：5.[16]王红雨，韦伟.社区老年人身体活动、社会支持与抑郁症状的关系分析[J].中华疾病控制杂志，2018，22(11):1198. [17]车丽萍.国外关于自信的研究综述[J].心理科学进展,2002(4):418.[18]邢占军，周慧.性别视角下老年人时间利用:一个混合研究的结果[J].山东社会科学,2019(2)：65.[19]王敏佳，申荷永,刘建新，等.重庆地区晨练老年人心理健康状况及其影响因素[J].中国老年学杂志,2017,37(17)：4395.[20]从汝敏.老年人精神文化生活状况及其影响因素研究一-基于安徽省的调查数据[J].淮南师范学院学报,2018,20(2):70. [21]袁小波.人口老龄化背景下的西方家庭照料者研究综述[J].老龄科学研究，2017，5(10):70.[22]陈天勇，李德明,李贵芸.高学历老年人心理健康状况及其相关因素[J].中国心理卫生杂志，2003(11):742.[23]杨小娇，汪凤兰，张小丽，等.社区老年人家庭功能及影响因素[J].中国老年学杂志，2019，39(7):1717.[24]于倩.社会阶层与心理健康的关系[D].南京：南京师范大学，2018.[25]杨凡，潘越，邹泽宇.中国老年人体育锻炼状况及影响因素研究[J].中国体育科技，2019，55(10):10.[26]World Health Organization.Global recommendations on physicalactivity for health[EB].http：//www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.html,2018-10.[27]KANNING M，HANSEN S.Need satisfaction moderates theassociation between physical activity and affective states in adultsaged50+:an activity-triggered ambulatory assessment[J].AnnBehav Med,2017,51(1)：18.[28]黄思朗.广西大学生体育锻炼心理需要与体育锻炼行为的研究[D].桂林:广西师范大学,2019.[29]WILSON PM，MACK DE，GLNNELL KE，et al.Analyzing themeasurement of psychological need satisfaction in exercisecontexts:evidence，issues，and future directions[J].Sport ExercPsychol Res Adv，2008(33):361.[30]DA SILVA SG,ELSANGEDY HM,KRINSKI K,et al.Effect ofbody mass index on affect at intensities spanning the ventilatorythreshold[J].Percept Mot Skills,2011,113(2):575.[31]DASILVA SG,GLIDETTI L,BLZZACHERA CF,et al.Psychophysiological responses to self-paced treadmill andoverground exercise[J].Med Sci Sports Exerc,2011,43(6):1114.[32]WILLIAMS DM.Exercise,affect,and adherence:an integratedmodel and a case for self-paced exercise[J].J Sport ExercPsychol,2008,30(5):471.[33]WILLIAMS DM,DLNSIGER S,CICCOLO JT,et al.Acuteaffective response to a moderate-intensity exercise stimuluspredicts physical activity participation6and12months later[J].Psychol Sport Exerc,2008,9(3):231.[34]ELSANGEDY HM,KRALSE MP,KRINSKI K,et al.Is the selfselected resistance exercise intensity by older women consistentwith the American College of Sports Medicine guidelines toimprove muscular fitness?[J].J Strength Cond Res,2013,27(7)：1877.[35]LANDI F,MARZETTI E,MARTONE AM,et al.Exercise as aremedy for sarcopenia[J].Curr Opin Clin Nutr Metab Care,2014,17(1):25.[36]BOTTARO M,MACHADO SN,NOGLEIRA W,et al.Effect ofhigh versus low-velocity resistance training on muscular fitnessand functional performance in older men[J].Eur J Appl Physiol,2007,99(3):257.[37]VAN ROIE E,BALTMANS I,COLDYZER W,et al.Low-andhigh-resistance exercise:long-term adherence and motivationamong older adults[J].Gerontology,2015,61(6):551.(本文编辑卢玉清)《蚌埠医学院学报》征订启事《蚌埠医学院学报》创刊于1976年3月，由安徽省教育厅主管，蚌埠医学院主办，国内外公开发行的综合性医学学术期刊。
红细胞沉降率结合hs-CRP水平预测脊柱结核患者预后的临床价值
红细胞沉降率结合hs-CRP水平预测脊柱结核患者预后的临床价值顾伟① 佴伟萍① 孙朝花② 【摘要】 目的：分析红细胞沉降率（ESR）结合超敏C反应蛋白（hs-CRP）预测脊柱结核患者预后的临床价值。
方法：回顾性分析2016年1月—2022年1月于扬州市第三人民医院住院的102例脊柱结核患者的临床资料，同时招募60例于本院体检健康人士分别记为研究组与对照组。
比较两组ESR、hs-CRP水平，分析研究组临床资料，采用多因素logistic回归分析影响脊柱结核患者预后的独立因素，以受试者操作特征（ROC）曲线评价ESR、hs-CRP对脊柱结核患者预后的预测价值。
结果：研究组ESR、hs-CRP水平均高于对照组（P<0.05）。
研究组预后良好占比90.20%，预后不良占比9.80%。
脊柱结核预后良好与预后不良患者的年龄、性别、体重指数（BMI）、糖尿病、高血压、血清肌酐（Cr）、白蛋白比较，差异均无统计学意义（P>0.05）；ESR、hs-CRP水平比较，差异均有统计学意义（P<0.05）。
多因素分析结果显示，ESR、hs-CRP均为影响脊柱结核患者预后的危险因素（P<0.05）；ESR、hs-CRP水平联合预测脊柱结核患者预后效果最佳，其曲线下面积（AUC）为0.771，高于单独预测的0.713、0.719（Z=3.526，P=0.027；Z=3.507，P=0.032），敏感度与特异度分别为86.54%、79.02%。
结论：脊柱结核患者ESR、hs-CRP水平异常，预后不良患者ESR、hs-CRP水平高于预后良好患者，ESR、hs-CRP水平对脊柱结核患者预后的价值较高。
【关键词】 红细胞沉降率 超敏C反应蛋白 脊柱结核 敏感度 特异度 预后良好 The Clinical Value of Erythrocyte Sedimentation Rate Combined with hs-CRP Level in PredictingPrognosis of Patients with Spinal Tuberculosis/GU Wei, NAI Weiping, SUN Chaohua. //Medical Innovationof China, 2024, 21(06): 121-125 [Abstract] Objective: To analyze the clinical value of erythrocyte sedimentation rate (ESR) combinedwith hypersensitive C reactive protein (hs-CRP) in predicting the prognosis of patients with spinal tuberculosis.Method: Clinical data of 102 patients with spinal tuberculosis admitted to Yangzhou Third People's Hospitalfrom January 2016 to January 2022 were retrospectively analyzed, and 60 healthy people who underwent physicalexamination in our hospital were recruited and recorded as study group and control group respectively. The levelsof ESR and hs-CRP in the two groups were compared, and the clinical data of the study group were analyzed, theindependent factors affecting the prognosis of patients with spinal tuberculosis were analyzed by multivariate logisticregression, the predictive value of ESR and hs-CRP in the prognosis of patients with spinal tuberculosis was evaluatedby receiver operating characteristic (ROC) curve. Result: The levels of ESR and hs-CRP in the study group werehigher than those in the control group (P<0.05). The good prognosis was 90.20%, and the poor prognosis was 9.80%of patients in the study group. There were no statistical significance in age, gender, body mass index (BMI), diabetes, hypertension, serum creatinine (Cr) and albumin between patients with good and poor prognosis of spinal tuberculosis(P>0.05); there were statistically significant differences in ESR and hs-CRP levels (P<0.05). Logistic regressionanalysis was performed, and the results of multivariate analysis showed that ESR, hs-CRP were the risk factors forprognosis of patients with spinal tuberculosis (P<0.05). ESR and hs-CRP combined levels had the best prognosticeffect on prognosis of patients with spinal tuberculosis, and the area under the curve (AUC) (0.771) was higher than0.713 and 0.719 individual predicted (Z=3.526, P=0.027; Z=3.507, P=0.032), the sensitivity and specificity were86.54% and 79.02%, respectively. Conclusion: The ESR and hs-CRP levels in patients with spinal tuberculosis areabnormal, and the ESR and hs-CRP levels in patients with poor prognosis are higher than those in patients with good①扬州市第三人民医院结核科 江苏 扬州 225002②扬州市第三人民医院呼吸科 江苏 扬州 225002通信作者：孙朝花- 121 - 脊柱结核是脊柱骨头受到结核菌的侵犯，出现骨质破坏及坏死，表现为干酪样改变和脓肿形成，同时引起功能障碍的一种疾病，绝大多数发生于椎体，分为中心型和边缘型两种[1-2]。
体育精神英语作文
Sportsmanship is a fundamental principle in the world of sports that emphasizes respect,fair play,and the pursuit of excellence.It is a set of values that athletes,coaches, and spectators are expected to uphold,regardless of the outcome of the game.In this essay,we will explore the importance of sportsmanship,its impact on individuals and society,and how it can be cultivated.The Essence of SportsmanshipSportsmanship is often defined as the ethical disposition of a sportsperson and the social norms of behavior they are expected to observe.It is about more than just winning or losing its about how one plays the game.The essence of sportsmanship includes:1.Respect for the Game:This involves understanding and adhering to the rules of the sport,as well as respecting the traditions and customs associated with it.2.Respect for Opponents:Competitors should acknowledge the skills and efforts of their opponents,regardless of the outcome.3.Respect for Officials:Referees,umpires,and other officials are crucial to the game and should be treated with respect and deference.4.Respect for Teammates:Team sports require cooperation and mutual support,and sportsmanship includes fostering a positive team environment.Impact on IndividualsThe practice of sportsmanship has a profound impact on individuals involved in sports.It helps to:Develop Character:Engaging in sports with a sportsmanlike attitude can teach valuable life lessons such as perseverance,humility,and integrity.Promote Mental Health:A positive sporting environment can reduce stress and anxiety, contributing to better mental health.Enhance Physical Health:Sportsmanship encourages a healthy lifestyle and regular physical activity,which is beneficial for overall health.Impact on SocietyOn a broader scale,sportsmanship contributes to the betterment of society by:Fostering Community:Sports events often bring communities together,promoting social cohesion and a sense of belonging.Setting Examples:Professional athletes who exhibit good sportsmanship can inspire fans,especially young people,to adopt similar values.Encouraging Fairness:The principles of sportsmanship can extend beyond the sports field,promoting fairness and respect in all aspects of life.Cultivating SportsmanshipTo cultivate sportsmanship,it is essential to:Start Early:Introducing the concept of sportsmanship to children at a young age can help them internalize these values as they grow.Lead by Example:Coaches,parents,and older athletes should model good sportsmanship to set the right example.Encourage Participation:Participation in sports should be encouraged for its own sake, not just for the sake of winning.Reward Effort:Recognizing and rewarding effort and improvement,rather than only success,can help foster a culture of sportsmanship.ConclusionIn conclusion,sportsmanship is a vital aspect of sports that goes beyond the scoreboard. It is a reflection of ones character and a testament to the human spirit.By promoting respect,fair play,and a focus on personal growth over victory,sportsmanship enriches the lives of athletes and spectators alike and contributes to a more harmonious society.It is a principle that should be cherished and upheld in all sporting endeavors.。
体重指数对胱抑素C公式法估算肾小球滤过率的影响
Advances in Clinical Medicine 临床医学进展, 2019, 9(11), 1247-1254Published Online November 2019 in Hans. /journal/acmhttps:///10.12677/acm.2019.911193Effect of Body Mass Index on Evaluationof Glomerular Filtration Rate UsingEquations Based on Cystatin CShuying Guo1, Jianhui Zhu1*, Muyun Zeng2, Min Ouyang2, Qian He2, Wen Zhao11Department of Nephrology, The Second People’s Hospital of Futian District Shenzhen, Shenzhen Guangdong 2Department of Physical Examination, The Second People’s Hospital of Futian District Shenzhen, ShenzhenGuangdongReceived: Oct. 18th, 2019; accepted: Nov. 4th, 2019; published: Nov. 11th, 2019AbstractObjective: To investigate the effect of body mass index (BMI) on the evaluation of glomerular filtra-tion rate (eGFR) using equations based on the cystatin C (CysC). Methods: A total of 308 healthy people with complete medical records from January to December 2018 in our department of physical examination were collected. BMI calculation formula is BMI (kg/m2) = body weight (kg)/[height (m)]2, and BMI ≥ 28 kg/m2 is defined as obesity, BMI 24.0 - 27.9 kg/m2 as overweight, and BMI 18.5 - 23.9 kg/m2 as normal. Age > 40 years old is defined as middle-aged and elderly, and age ≤ 40 years old is defined as young people. The CKD definition and staging are based on the KDOQI standard. Serum CysC was detected by colloidal partical enhanced immunoturbidimetry; >1.55 mg/L was defined as elevated CysC; serum creatinine (Scr) was detected by picric acid method, and elevated creatinine was defined as: male >97 umol/L, female > 81 umol/L. GFR (eGFR) was estimated using the Chronic Kidney Disease and Epidemiology (CKD-EPI) equation using creatinine (CKD-EPI Scr), cystatin (CKD-EPI Scys) and the combination of cystatin and creatinine (CKD-EPI Scr-Scys), CG equation, and Chi-na’s modified MDRD equation. Statistical analysis was performed using SPSS 22.0 statistical soft-ware, and the difference was statistically significant at p < 0.05. Results: 1) Of the 308 healthy sub-jects, 48 (15.6%) were women. The average age is 37 ± 9.7 years old (20 ± 81). The average BMI was 24.6 ± 1.5 kg/m2 (21.0 - 30.1), including 6 cases of obesity, 200 cases of overweight and 102 cases normal. The average Scr was 72.5 ± 11.3 umol/L (41 - 102), and serum creatinine was in-creased in 6 cases. The average CysC was 0.81 ± 0.13 mg/L (0.57 - 1.61), and CysC was increased in2 cases. The average eGFR is estimated by the five equations respectively: eGFR (CKD-EPI Scr-Scys)119.9 ± 13.5 ml/min/1.73m2, 2 cases with diagnosed CKD (0.65%); eGFR (CKD-EPI Scr) 110.3±11.9 ml/min/1.73m2, 2 cases with diagnosed CKD (0.65%); eGFR (CKD-EPI Scys) 105.3 ± 20.5 ml/min/1.73m2,12 cases with diagnosed CKD (3.90%); eGFR (CG) 120.7 ± 20.1 ml/min/1.73m2, 2 cases with diag-nosed CKD (0.65%); eGFR (modified MDRD) 116.7 ± 20.1 ml/min/1.73m2, 0 case with diagnosed CKD (0%). 2) Compared with young people, the CysC level of middle-aged and elderly people was significantly increased (p = 0.000), and the GFR was significantly decreased (p = 0.000) estimated by the five equations of CKD-EPI Scr-Scys, CKD-EPI Scr, CKD-EPI Scys, CG and modified MDRD. 3) Because of the small number of obese people in the study population, we divided them into three groups based on BMI tertiles: BMI < 24.0 kg/m2 group, BMI 24.0 - 25.3 kg/m2 group, and BMI > 25.3kg/m2 group.*通讯作者。
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
POSTERS:
1. AUTHOR: VANSHIKA SETHI - TITLE: MANAGEMENT OF DELAYED ONSET MUSCLE
SORENESS: EVIDENCE BASED PRACTICE
2. AUTHOR: S. SUDHAKAR , ANAND. K - EFFECT OF PROPRIOCEPTIVE
NEUROMUSCULAR FACILITATION VERSUS MUSCLE ENERGY TECHNIQUE IN IMPROVING MUSCLE FUNCTION IN DELAYED ONSET OF MUSCLE SORENESS IN RECREATIONAL PLAYERS.
3. ANIKA AGGARWAL - EFFECT OF THERAPEUTIC ULTRASOUND ON KNEE
OSTEOARTHRITIS
4. AUTHORS :- DR. KALPESH SATANI, CHAITSI JANI
STUDY TO COMPARE THE EFFECTS OF CONVENSIONAL CHEST
PHYSIOTHERAPY VS EXPIRATORY FLOW INCREASED TECHNIQUE ON CARDIO PULMONARY STRESS IN INFANTS.
5. DR.LEENA D.CHAUDHARI EFFECTIVENESS OF GENERAL QUADRICEPS
STRENGTHENING VERSUS SELECTIVE VMO STRENGTHENING IN
PATELLOFEMORAL PAIN SYNDROME- A PILOT STUDY.
6. AUTHOR-DEEPTHI - EFFECTIVENESS OF POSITIONAL RELEASE THERAPY IN
TREATMENT OF TRAPEZITIS
7. AUTHORS: DR . KALPESH SATANI , MANSHI SHAH - PERIPHERAL MUSCLE
STRENGTH AND SYMPTOMS DURING LOW-FREQUENCY VERSUS HIGH-
FREQUENCY NMES IN COPD
8. KHATRI S.M; DIWADKAR P.P*; SINGH S - EFFICACY OF STATIC STRETCHING
METHOD AND MUSCLE ENERGY TECHNIQUE IN IMPROVING GASTROCNEMIUS FLEXIBILITY IN NORMAL INDIVIDUALS
9. AUTHOR: M.KAMALAKANNAN - EFFICACY OF BACK ENDURANCE EXERCISE IN
LUMBAR DEGENERATIVE DISEASE
10. AUTHORS: DR. P. RATAN KHUMAN, DR. KALPESH SATANI, KIMI SHAH, RIDDHI
VYAS - DOES GLENO-HUMERAL END-RANGE RESTRICTION AFFECT RIB CAGE & THORACIC SPINAL MOBILITY IN SYMPTOMATIC INDIVIDUALS?
11. AUTHOR:- SHANISHWARA MITTAL HARESHBHAI - ADVANCED BIOMECHANICAL
REHABILITATION
12. PARDEEP PAHWA EVALUATION OF STANDARDIZED BACKPACK WEIGHT & ITS
EFFECT ON SHOULDER AND NECK POSTURE
13. PARDEEP PAHWA - HYPERBARIC OXYGEN THERAPY- AN OVERVIEW & RECENT
ADVANCES
14. BHUSHAN. D. VICHARE- COMPARISON OF FLUTTER DEVICE AND CHEST
PHYSICAL THERAPY IN THE TREATMENT OF CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD) PULMONARY EXACERBATION
15. ATANU SINGHA - OFF SEASON TRAINING REGIME FOR INDIAN FOOTBALL
PLAYERS
16. AUTHORS: DR. EKTA CHUDHARY, PARTH TRIVEDI - MANIPULATION OF THE
WRIST FOR MANAGEMENT OF CHRONIC LATERAL EPICONDYLALGIA
17. : URJA MAHESH ANERAO, MRS. NEESHA SHINDE - 6 MINUTE WALK TEST
VERSUS TREADMILL 6 MINUTE WALK TEST.
18. *MR. SAMBHAJI GUNJAL - PREVALENCE OF NECK PAIN IN COMPUTER
OPERATORS
19. TAKSHASHILA MORE - “EFFECTIVENESS OF THERAPEUTIC ULTRASOUND IN
TREATMENT OF POSTPARTUM BREAST EN GORGEMENT.”
20. BINO SHADRACH BERRY A DESCRIPTIVE STUDY ON A TERTIARY CARE
CENTRE PROVIDING LEPROSY SERVICES AT METROPOLITAN CITY, CATERING URBAN POPULATION WITH DISABILITY.
21. JALPA SHAH EFFECTIVENESS OF INTERFERENTIAL THERAPY IN RECURRENT
JAW PAIN
22. AUTHOR(S): DEEPALI N. HANDE, SANJAY KOTE - INCIDENCE OF KYPHOSIS AND
SCOLIOSIS IN SCHOOL CHILDREN IN RURAL INDIA.
23. CONSERVATIVE THERAPY FOR A PATIENT WITH PROXIMAL INTER PHALANGEAL
(PIP) JOINT CONTRACTURE POSTED FOR RE CONSTRUCTIVE SURGERY – CASE REPORT
24. JEDIDA MILTON, SATHISH K PAUL, S. ABRAHAM - CONSERVATIVE THERAPY FOR
A PATIENT WITH PROXIMAL INTER PHALANGEAL ( PIP ) JOINT CONTRACTURE
POSTED FOR RE CONSTRUCTIVE SURGERY- CASE REPORT
25. PHYSICAL REHABILITATION PLAN FOR A PATIENT WITH MULTIPLE NERVE
DAMAGE – CASE STUDY MERIN MATHEW, SATHISH PAUL, S.ABRAHAM
26. WORK-RELATED UPPER EXTREMITY MUSCULOSKELETAL DISORDERS AMONG
COMPUTER PROFESSIONAL IN INDIAN OIL CORPORATION LIMITED (IOCL)
VADODARA, GUJARAT - A PROSPECTIVE COHORT STUDY .
NAME OF THE PRESENTING AUTHOR : DR. M. SANKAR SAHAYRAJ
27. INMAS (INTEGRATED NEUROMUSCULAR ACUPOINT SYSTEM) AS AN ADJUNCT
THERAPY FOR TREATMENT OF TRIGGER FINGER: A CASE REPORT
DARSHPREET KAUR*, NIDHI BILLORE**, GUNJAN KUMAR***
28.B.S.SANTHOSH KANNA - A STUDY ON IMPACT OF SITTING POSITIONS ON PULMONARY
FUNCTIONS IN CHILDREN WITH SPASTIC QUADRIPLEGIC CEREBRAL PALSY。