健康危险因素评价

健康危险因素评价 健康危险因素的概念是人们在认识疾病病因的过程中逐渐发展起来的，一些急性病、传染病和外伤等的危险因素多为单因单果，有很大的防治价值。但很多慢性病则很难用单一的病因进行解释，如吸烟是肺癌的多病因中的一个，因此一个经流行病学证实的慢性病危险因素就是病因的一个组成单位。由于慢性病病因复杂，因此评价其危险因素可作为研究慢性病病因学的一种方式和慢性病防治的组成内容。 一、开展健康危险因素评价的理论基础 第一次卫生革命的胜利，使危害人类健康的传染病得到了有效控制。慢性非传染性疾病又成为主要死亡原因。而慢性非传染性疾病是多种致病因素长期综合作用的结果，难以用单一的病因加以解释。而且，随着病因学及流行病学研究的进展，人们逐渐认识到许多慢性非传染性疾病的发生、发展与不良行为、生活方式及环境中存在的多种危险因素密切相关。因此要有效防治各种慢性非传染性疾病，必须对与疾病发生、发展有关的各种危险因素进行评价，以便阐明疾病发生的病因，预测疾病发生的概率及严重程度，这是提出健康危险因素评价的依据。 另外，从疾病自然史的观点分析，要有效预防慢性非传染性疾病，也必须进行健康危险因素评价。 慢性非传染性疾病按其发病特点及演变过程可大致分为6个阶段。 1、无危险阶段 这一阶段人们的周围环境和行为生活方式中不存在危险因素，预防措施是通过健康教育使人们认识危险因素的有害影响，保持良好的生产生活环境和健康生活方式，以防止危险因素的发生。 2、出现危险因素 随着年龄增加和环境改变，人们的生产、生活环境中出现了危险因素，但由于作用时间短暂及程度轻微，危险因素并无明显危害，或其危害作用还不易被检出。此时进行环境因素或行为生活方式调查，能够发现危险因素的存在。 3、致病因素出现 随着危险因素数量增加及作用时间延长，危险因素转化为致病因素开始对机体产生危害作用，但由于人们机体防御机制的作用以及致病因素的弱化，尚不足以形成疾病。如果及时采取干预阻断措施，停止危险因素的作用，可阻止疾病的发生。 4、症状出现 疾病已形成可逆的形态功能损害，用生理生化的诊断手段可及时发现。此时预防策略是通过筛检在正常人群中及时发现无症状患者，并予以早期诊断、早期治疗，可及时阻止危险因素的作用，使病程逆转而恢复健康。 5、体征出现 症状与体征可并行或先后出现，此时患者能明显感觉自身异常而主动就医，但即使停止危险因素的继续作用，病程亦不可逆。只能采取治疗措施以改善症状和体征，推迟伤残和减少劳动能力的丧失。 6、劳动力丧失 随着病程发展，症状加剧，患者逐渐丧失生活和劳动能力。此时是疾病进程的最后阶段，只能采取康复治疗，以提高生存质量。 健康危险因素评价是从疾病自然史的第一阶段开始，即在疾病尚未出现时对危险因素及其对健康的影响进行评价，通过健康促进教育使人们保持健康的生活方式，防止危险因素的作用。在危险因素出现的早期，通过测定危险因素的严重程度，分析这些因素对健康可能造成的危害，预测疾病发生的概率，亦能减少危险the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 因素的危害，减少疾病的发生。可见，进行健康危险因素评价是一项最基本的、行之有效的预防慢性非传染性疾病的重要手段和措施。 二、慢性病健康危险因素的特点 了解危险因素影响健康的特点，加深对危险因素的认识，是进行健康危险因素评价的前提，是预防非传染性疾病的基础。 (一)潜伏期长，隐性危害大 危险因素作用于机体往往需要相当长的时间才能显示其危害作用，例如吸烟可提高人群肺癌死亡率10倍以上，但需经过10年或更长时间才起作用，容易被忽视。又如高血压、脑卒中等心脑血管疾病的危险因素之一是不良的膳食结构(高盐高脂肪饮食)，也需要常年累月的作用才能致病。潜伏期长使疾病的危险因素不易确定，给疾病预防工作带来一定困难，但也为其干预赢得了时间与机会。 (二)多因素联合作用增强致病危险性 多种危险因素同时存在可彼此诱发致病作用而明显增加其危害性。如吸烟者同时接触石棉和其他有害金属粉尘，肺癌的发病率比单纯吸烟者增加几倍或十几倍。又如冠心病的发病，有调查显示与高胆固醇血症、高血压、肥胖和吸烟关系最为密切，4个因素同时存在者比只有一、二个因素者发病率要高，而对4个因素同时进行控制者的效果又较好。危险因素的这一特点，提示我们在临床预防工作中，应对各种健康危险因素综合进行干预。 (三)特异性弱 根据慢性病的病因学研究发现，疾病的发生往往与多种危险因素有关，而一种危险因素也可导致发生多种疾病。如吸烟可引起肺癌、口腔癌、食道癌、支气管炎、心脑血管疾病和胃溃疡等全身各系统的各种疾病，而冠心病等心脑血管疾病的发生又与高脂肪、高热量、低纤维素饮食及吸烟、精神紧张、肥胖等多种因素有关。 (四)广泛性存在 慢性病危险因素广泛存在于自然与社会环境中，且早已融入人们的日常生活，已被大多数人所习惯和接受，因此，必须进行深入持久的健康教育和健康促进活动，才能使人们充分认识到各种危险因素的危害，并自觉的加以避免和清除，才能最终达到增进健康的目的。 三、慢性病健康危险因素的分类 健康危险因素种类很多，分类也可以有多种形式，有直接、间接危险因素之分，也有群体和个体危险因素之分等。据生物-心理-社会医学模式加以区分，主要可分为以下几类: 1、环境危险因素 (1)自然环境危险因素 自然环境中影响健康的危险因素有生物性如细菌、病毒、寄生虫等，和物理化学性如噪声、粉尘、电离辐射、农药及汽车尾气等。 (2)社会环境危险因素 包括经济状况、收入水平、居住条件、营养状况、就业条件以及离婚、丧偶、家庭不和睦等家庭因素也是慢性病的发病危险因素。如贫困导致的受教育机会减少，造成其发展能力的剥夺，进一步导致社会地位低下，生存困难和社会隔离的困境，又可因其精神上的压抑，引发躯体上的疾病发生，贫穷和疾病的因果关系形成恶性循环。经济发达生活过于优裕、体力活动太少又可导致营养过剩使肥胖症发病率增高。 2、行为危险因素 主要指不良的个人生活方式或行为所产生的健康危险因素，属“自创性”危险因素，是可以避免的，也易于通过干预加以清除。如吸烟、酗酒、the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 滥用药物、不合理膳食、特殊嗜好、不良性行为和吸毒等，是引起心脏病、恶性肿瘤、脑血管疾病及精神疾病的重要因素，而通过戒烟、减少饮酒、注意合理营养、保持乐观情绪等行为改变及注意控制高血压、降低血胆固醇等措施，可明显降低心脑血管病的发病率及死亡率。 3、生物遗传因素 在人类进入21世纪之际，随着分子生物学的发展，已有部分疾病在分子水平上找到了其发病的遗传学的客观依据，这为疾病的预防提供了有效的生物学基础。 4、医疗卫生保健服务中的危险因素 狭义上来讲，医疗质量低、误诊漏诊、医院交叉感染等都可直接危害人体健康和影响医疗质量;广义上，医疗资源分配不合理、初级卫生保健网络不健全、重治轻防的医疗保健倾向及医疗保健不完善等都可能危害人群健康，需加以重视。 四、健康危险因素评价 根据进行健康危险因素评价的对象和性质，可将其分为个体评价和群体评价两类。通常采用自填调查表或生物医学测定的方法来进行。 (一)个体评价 健康危险因素的个体评价，主要通过比较实际年龄、评价年龄和增长年龄三者之间的差别，以便了解危险因素对寿命可能影响的程度及降低危险因素后寿命可能增长的程度。 评价年龄高于实际年龄，说明被评价者存在的危险因素高于平均水平，即死亡概率可能高于当地同年龄性别组的平均水平。反之则低。增长年龄与评价年龄之差数，说明被评价者接受医生建议后采取降低危险因素的措施，可能延长寿命的年数。根据实际年龄、评价年龄和增长年龄三者之间不同的量值，评价结果可以分为以下四种类型: 1、健康型:被评价者的评价年龄小于实际年龄者，其个体危险因素低于平均水平，预期健康状况良好。如被评价者实际年龄为51岁，其评价年龄为46岁，说明其个体危险因素低于平均水平，即51岁的个体可能处于46岁年龄者的死亡概率，其预期健康状况良好。 2、自创性危险因素型:被评价者评价年龄大于实际年龄(说明危险因素较平均水平高)，并且评价年龄与增长年龄之差值大。如被评价者的实际年龄为41岁，评价年龄为43.5岁，增长年龄为36岁，评价年龄与增长年龄之差值为7.5岁(较大),说明危险因素属自创性，通过自身的行为改变降低和去除危险因素，有可能较大程度的延长预期寿命。 3、难以改变的危险因素型:被评价者的评价年龄大于实际年龄，但评价年龄与增长年龄之差较小。如被评价者实际年零43岁，评价年龄49岁，增长年龄48岁，评价年龄与增长年龄之差值为1岁。其个体的危险因素主要来自生物遗传因素与既往及目前疾病史。通常不易于改变这些因素，因此，降低这类危险因素的可能性小，延长预期寿命的余地不大。 4、一般性危险型:评价年龄接近实际年龄，其危险因素接近于轻微危害程度，降低危险因素的可能性有限，增长年龄和评价年龄接近。 除此之外，尚可对某一特殊危险因素进行分析。例如仅控制超体重的危险因素，用同样的方法计算增长年龄，从评价年龄与增长年龄的差值大小说明超体重的危险因素对个体预期寿命可能影响的程度。 (二)群体评价 the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 群体评价是在个体评价的基础上进行，可进行以下几方面的评价与分析。 1、人群的危险程度:根据个体评价的结果(健康型、自创性危险因素型、难以改变的危险因素型和一般性危险型)，可将人群分为健康组、危险组和一般组三种类型。根据人群中上述三种类型人群所占比重确定哪一种人群危险程度最高，而将其列为健康促进的重点对象。一般而言，某人群处于危险组人群越多，危险水平越高，越应重点加以干预。 2、危险因素属性分析:个体评价后，通过计算属于自创性能够消除的危险因素以及属生物遗传和疾病史等难于消除的危险因素之间的比例，可估计通过健康促进能够提高健康水平可能预期的效果。例如，某市居民中男性危险因素中88%属于能消除的自创性危险因素，可通过改变不良的行为生活方式而降低危险水平，而女性则主要为过去疾病史及家庭遗传史等不易消除的危险因素。因此，对男性居民进行旨在建立健康生活方式的健康教育较女性更为迫切。 3、分析危险因素对健康的影响:分析多种危险因素对预防寿命可能影响的程度，发现其中对人群健康影响最大的危险因素，从而有针对性地制订预防措施。因为有些因素虽然对预期寿命影响不大，但在人群中分布范围较广，对人群总体的危害程度严重，则须加以重视。 总之，健康危险因素评价是进行疾病预防及健康促进工作的一种重要技术和手段，因其简单方便且行之有效，被广泛应用于临床预防服务中，已为人群健康水平的提高做出了巨大的贡献。 (三)个体健康危险因素评价的资料和收集 1.当地性别年龄别的疾病死亡率 这些资料可通过适应登记、疾病检测等途径获得，也可经回顾性调查获得。 2.个人健康危险因素 ?行为生活方式:吸烟、饮酒、体力活动和使用安全带等;?环境因素:经济情况、居住条件、家庭、人际关系、生产环境、紧张程度等;?生物遗传因素:年龄、性别、身高、体重、家族遗传等;?卫生服务利用:是否进行定期体格检查;?疾病史:详细了解个人患病史，及症状、体征、相应检查结果及与疾病、健康有关的各方面情况。 3.计算危险分数 评价危险因素的关键步骤是将危险因素转换成危险分数。危险分数是根据人群流行病学调查资料，经过一定数理统计模型计算得到的。表11-2 以男性40~44岁组冠心病危险因素为例，列举了其危险分数的计算方法。 表11-2 冠心病危险因素转换表(男性40~44岁组) 危险指标 测量值 危险分数 26.6(200) 3.2 收缩压kPa(mmHg) 23.9(180) 2.2 21.3(160) 1.4 18.6(140) 0.8 16.0(120) 0.4 舒张压kPa(mmHg) 14.1(106) 3.7 13.3(100) 2.0 12.5(94) 1.3 the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 11.7(88) 0.8 10.9(82) 0.4 280 1.5 胆固醇(mg/dl) 220 1.0 180 0.5 有 3.0 糖尿病史 已控制 2.5 无 1.0 坐着工作和娱乐 2.5 有些活动的工作 1.0 中度锻炼 0.6 运动情况 较强度锻炼 0.5 坐着工作,有定期锻炼 1.0 其他工作,有定期锻炼 0.5 父母均60岁以前死于冠1.4 心病 父母60岁以前死于冠心1.2 家庭史 病 父或母健在(<60岁) 1.0 父母健在(?60岁) 0.9 ?10支/日 1.5 <10支/日 1.1 吸烟 吸雪茄或烟斗 1.0 戒烟(不足10年) 0.7 不吸或戒烟10年以上 0.5 超重75% 2.5 超重50% 1.5 体重 超重15% 1.0 超重10%以下 0.8 降到平均体重 1.0 (四)健康危险因素的评价步骤 1.收集死亡率资料 收集当地年龄组、性别前10~15位死因、疾病别发病率或死 亡资料。表11-3位某地某41岁男性健康危险因素评价表。表中第(1)、(2) 项是疾病别每10万人口的平均死亡概率，如冠心病为1877，车祸为285等。 the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 表11-3 某地某41岁男性健康危险因素评价表 根 据 医新 组生组危险死危新死亡合建合新存程度亡疾病险存在危降低概率危议危在死降低原诱发指标值分死亡险量(1/10险改险亡危百分因因素(4) 数危险因(%)(1万)(2分变分险比(1(3) (5(7) 素2) ) 数危数(11) (%)(1) ) (9) (6) 险(103) 因) 素 (8) 血压16.0/90. - 0.4 (kPa) .3 4 胆固 醇0.192 - 0.6 (mg/d6 l) 糖尿1.1.0无 - 病史 0 定体力坐着工2.1.93585.期0.1206.43378.冠1.0 47 活动 作 5 1 07 锻1 7 6 心1877 炼 病 家族0.无 - 0.9 史 9 0.吸烟 不吸 - 0.5 5 降 到 超重1.平1.0体重 30% 3 均 体 重 车0.285 饮酒 不饮 - 0.5 祸 5 the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 25000驾车2.公里/1.9 541.5 - 2.5 1.9 541.5 0 0 里程 5 年 安全0.100带使90% 0.8 8 % 用 治 疗抑郁 经常 2.5 1.5 1.5 369.0 264.0 4 抑自264 郁 杀 家族1.1.0无 2.5 660.0 - 史 0 肝0.硬222 饮酒 不饮 0.1 22.2 - 0.1 0.1 22.2 0 0 1 化 血压16.0/90. - 0.4 (kPa) .3 4 胆固 醇0.0.10.1脑192 42.18 - 0.6 42.18 0 0 (mg/d6 9 9 血222 l) 管 病 糖尿1.无 - 1.0 病史 0 0.吸烟 不吸 - 0.8 8 肺0.202 吸烟 不吸 0.2 40.4 - 0.2 0.2 40.4 0 0 癌 2 慢心脏1.无 1.0 性杂音 0 风风湿1.无 0.1 16.7 - 1.0 0.1 16.7 0 0 湿热 0 167 性 心症状0.无 0.1 脏体征 1 病 1.饮酒 不饮 1.0 0 肺111 肺气1.炎 无 1.0 111.0 - 1.0 0.1 111.0 0 0 肿 0 吸烟 不吸 1. 1.0 the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 0 肠息1. 无 - 1.0 肉 0 肛门1.无 1.0 111.0 - 1.0 0.3 33.3 77.7 1 出血 0 1. 肠炎 无 - 1.0 肠0 111 癌 每 年直肠1.检 镜检无 0.3 0 查查 一 次 血压16.6/90. 0.7 39.2 (kPa) .3 4 高 血降 压到56 心超重1.平 体重 1.0 0.4 22.4 16.8 0.2 脏30% 3 均 病 体 重 X线检0. 阴性 - 0.2 查 2 结核1.肺无 0.2 11.2 - 1.0 0.2 11.2 0 0 活动 0 结56 经济核 和社 中等 1.0 会地 位 其1.1987 1987 1.0 1987 0 0 他 0 合7167.3430.3737.5560 52.2 计 45 35 1 注:mg/dl×0.0259=mmol/L 2.收集个人危险因素资料 一般采用调查表的形式(问卷或自填)来收集。表11-3第(3)、(4)项为各种疾病的相应危险因素合资。 3.将危险因素转换成危险因素 个体所具有的危险因素相当于人群平均水平时，危险分数为1.0，即个体发生某病死亡的概率大致与当地平均死亡水平相等。危the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 险分数小于1.0，即个体发生某病死亡的概率小于当地平均死亡水平。危险分数越大，死亡概率越大。如按表11-2中40岁~44岁男性危险因素计算:胆固醇为220mg其危险分数为1.0， 以下类推。 4.计算组合危险分数 同一疾病常常同时受多种危险因素的协同作用。因此计算危险分数时，要考虑危险因素的联合和协同作用，计算组合危险分数。其分2种情况: (1)与死亡危险因素有关的危险因素只有一项时，组合危险分数与该死因危险分数相等; (2)与死亡危险因素有关的危险因素是多项时，组合危险分数的计算:?将危险分数大于1.0的个项分别减去1.0后，剩下的数值作为相加项分别相加，1.0作为相乘项;?小于或等于1.0的各项危险分数值作为相乘项分别相乘;?相加项和相乘项的结果相加即可得到该死亡原因的组合危险分数。如:冠心病的危险因素有7项，其中体力活动的危险分数为2.5，吸烟的危险分数为1.5。其余各项都小于或等于1.0。计算方法:2.5-1.0 = 1.5;1.5-1.0 = 0.5，1.5和0.5就是相加项。危险分数小于或等于1.0的其余各项以及体力活动被减去的1.0都作为相加项。全过程计算为: 相加项之和:1.5+0.5 = 2.0。 相乘项之积:0.6Χ1.0Χ1.0Χ1.0Χ1.0Χ1.0Χ1.0 = 0.6 组合危险分数:2.0+0.6 = 2.6 依据年龄和死亡率之间的函数关系按个体存在的危险因素计算5.计算评价年龄 的预期死亡率水平求出的年龄。方法:将各种死亡原因的存在危险因素求和，得出重的死亡危险值，按表11-4可计算出健康年龄评价。表中左边一行是男性合计的死亡危险值;中间部分的上面一行数值是个体实际娘俩的个位数，主体部分是评价值。如表11-3中第(7)项总存在死亡率41岁男性为7167.45/10万人口。再查评价年龄表，左边一列中无此数值，但其介于6830和7570之间，前者的评价年龄为43岁，后者为44岁，因此得出该男性的评价年龄为43.5岁。 表11-4 健康评价年龄表 男性实际年龄最末一位数 女性男性实际年龄最末一位数 女性存在存在存在存在0 1 2 3 4 0 1 2 3 4 死亡死亡死亡死亡 5 6 7 8 9 5 6 7 8 9 危险 危险 危险 危险 530 5 6 7 8 9 350 4510 38 39 40 41 42 2550 570 6 7 8 9 10 350 5010 39 40 41 42 43 2780 630 7 8 9 10 11 350 5560 40 41 42 43 44 3020 710 8 9 10 11 12 360 6160 41 42 43 44 45 3280 790 9 10 11 12 13 380 6830 42 43 44 45 46 3560 880 10 11 12 13 14 410 7570 43 44 45 46 47 3870 990 11 12 13 14 15 430 8380 44 45 46 47 48 4220 1110 12 13 14 15 16 460 9260 45 46 47 48 49 4600 the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 1230 13 14 15 16 17 490 10190 46 47 48 49 50 5000 1350 14 15 16 17 18 520 11160 47 48 49 50 51 5420 1440 15 16 17 18 19 550 12170 48 49 50 51 52 5860 1500 16 17 18 19 20 570 13230 49 50 51 52 53 6330 1540 17 18 19 20 21 600 14340 50 51 52 53 54 6850 1560 18 19 20 21 22 620 15530 51 52 53 54 55 7440 1570 19 20 21 22 23 640 16830 52 53 54 55 56 8110 1580 20 21 22 23 24 660 18260 53 54 55 56 57 8870 1590 21 22 23 24 25 690 19820 54 55 56 57 58 9730 1590 22 23 24 25 26 720 21490 55 56 57 58 59 10680 1590 23 24 25 26 27 750 23260 56 57 58 59 60 11720 1600 24 25 26 27 28 790 25140 57 58 59 60 61 12860 1620 25 26 27 28 29 840 27120 58 59 60 61 62 14100 1660 26 27 28 29 30 900 29210 59 60 61 62 63 15450 1730 27 28 29 30 31 970 31420 60 61 62 63 64 16930 1830 28 29 30 31 32 1040 33760 61 62 63 64 65 18560 1960 29 30 31 32 33 1130 36220 62 63 64 65 66 20360 2120 30 31 32 33 34 1220 38810 63 64 65 66 67 22340 2310 31 32 33 34 35 1330 41540 64 65 66 67 68 24520 2520 32 33 34 35 36 1460 44410 65 66 67 68 69 26920 2760 33 34 35 36 37 1600 47440 66 67 68 69 70 29560 3030 34 35 36 37 38 1760 50650 67 68 69 70 71 32470 3330 35 36 37 38 39 1930 54070 68 69 70 71 72 35690 3670 36 37 38 39 40 2120 57720 69 70 71 72 73 39250 4060 37 38 39 40 41 2330 61640 70 71 72 73 74 43200 6.计算增长年龄 指通过努力降低危险因素后可能达到的预期寿命。表11-3的第(8)~(11)项都用于计算增长年龄，方法同评价年龄。其中第(8)项可能改变的危险因素，如吸烟、饮酒、体育活动等;不可改变的危险因素如生物遗传、疾病史等。第(9)、(10)项为去除可改变危险因素后，计算出新的危险分数和新组合危险分数。第(11)项为新存在的死亡危险值 = 第(2)×(10)。如上述41岁男性遵医嘱去除可改变的危险因素，重新计算的核计死亡危险为3430.3510/10万人口，查表得增长年龄为36岁。 7.危险因素降低程度 其表示的是如果能够根据医生建议改变现有的危险因素，危险能降低的程度，用存在死亡危险降低死亡危险表示。表11-3第(12)项是危险降低的绝对数，由第(7)-第(11)项求得。第(13)项是危险降低的数量the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding 在总存在死亡危险中所占的百分比，由第(12)项?总存在死亡危险得到。如: 冠心病的危险降低量 = 3585.07-206.47 = 3378.60 危险降低百分比 = 3378.60?7167.45×100% = 47 the Department during a visit to the camp, a few shells of explosions were heard in the distance. Back to Headquarters, Zhu Xi staff was informed by the Department to strengthen alert, watch, place to rest, for night operations. Near 9 o'clock, attack the elves have on the formation of Zhong Jia DUN encirclement. Southeast corner of sudden intense machine gunfire were heard, energize sent a platoon of Shao and attacked the enemy, fighting more hotly, gunfire was tight for a while. Troops were the shock seemed a bit out the chain of command. Offensive Zhong Jia DUN elves, planes covered in the air, river patrol boats, with the, to heavily guard the way to the village of only access--a stone bridge and a path. Under heavy fire against the enemy troops has been disrupted, Zhu Xi himself Despite repeated organizing death squads under the, but terrain unfavorable, enemy fire is too strong, paid a very high casualties and tremendous power again, and finally failed. Second head of mission and Deputy Commander Wang Hesong remnants kill one and five Fan Chunsheng, head of rates of Hades and survive. Qiu Acai Commander Zhu Xi in local farmers risking death save, Ling bin to swim across the river and escaped alone, Yuhang is in court the headquarters report of Jiangsu Zhong Jia DUN bloody situation. Zhu Xi organized forces to break through at the same time, Wen Yongzhi instructed to rate the Department staff retreat. But under the enemy's army arrives, this tiny place where withdrawal? yellow around the rice fields, and everywhere is the devil, mulberry has nowhere to hide in the Woods in the fall. In desperation, temperature a few people from the Department to the local people, and House of a rich family. Officer Xie Chengji, see the living room hangs a plaque, after hiding