Objective To guide the implementation of home enteral nutrition (EN) for outpatients with Crohn's disease, and to observe its effect.Methods In this observational study, 26 patients at active period of Crohn's disease were collected between April 2014 and June 2015 in the clinic of Clinical Nutrition Center of Nanjing General Hospital of Nanjing Military Command.Home EN combined with medication was administered.The nutritional status, Crohn's Disease Activity Index (CDAI), and quality of life before and after EN were compared.Results After home EN therapy, body mass index (BMI) of the patients increased from (17.7 ± 2.1) kg/m2 to (19.8 ± 2.0) kg/m2 (P ＜ 0.001), proportion of lymphocytes from (0.216 ± 0.066) to (0.305 ± 0.106) (P =0.007), albumin level from (40.3 ± 5.9) g/L to (43.7 ± 5.4) g/L (P =0.038), prealbumin from (233.1 ± 71.5) mg/L to (306.0 ± 72.1) mg/L (P =0.009), and transferrin from (2.7 ± 0.6) g/L to (3.1 ±0.7) g/L (P =0.038).In the indicators reflecting the activity of Crohn's disease, CDAI declined from 197.0 ±55.8 to 113.2 ±33.4 (P ＜0.001) after EN, C-reactive protein from 28.50 (18.00-32.80) mg/L to 2.00 (0.58-6.33) mg/L (P ＜0.001), erythrocyte sedimentation rate from (29.6 ± 9.9) mm/h to (9.4 ± 7.6) mm/h (P ＜ 0.001).The patient's disease activity scores and inflammatory reaction indexes all reached the normal levels after EN, show that the patients were in remission stage.In inflammatory bowel disease quality of life score, the score of intestinal symptoms rose from 41.2 ± 13.3 to 57.0 ±9.6 (P ＜ 0.001), the score of systemic symptom from 20.7 ± 5.5 to 28.9 ± 4.2 (P ＜ 0.001), emotional ability from 43.6±16.1 to 61.0 ± 15.9 (P=0.002), and social ability from 20.6 ±4.9 to 28.4 ±5.6 (P＜0.001), all showing statistical significance.Conclusions Standardized home enteral nutrition in patients at active period of Crohn's disease, when implemented under professional guidance of nutritional support team and well followed up, may improve nutritional status, induce remission, and improved quality of life.

Effective doctor-patient communication not only affects the doctor-patient relationship,but also affects the normal medical practice.Johari window is referred to as theself consciousness discovery-feedback model or information exchange process management tool.This article introduces the relationship between self-exposure and experience feedback by doctors and patients.As a skill and theory about communication,Johari widow can help doctors to better understand their patients and to improve their ability of communication.

OBJECTIVETo analyze and compare burden of disease caused by malignant tumor in China, 1990 and 2010.

METHODSThe indicators including prevalence, death, years of life lost (YLL), years lived with disability (YLD), and disability adjusted of life years (DALY) of malignant tumor from the results of Global Burden of Disease (GBD) 2010 were used to calculate the standardized prevalence rate, mortality rate, YLL rate, YLD rate and DALY rate with the 2010 national census data. The research described the prevalence, death, and burden of disease caused by malignant tumor and analyze the trend of these indicators in 1990 and 2010 in China.

RESULTSIn China from 1990 to 2010, the standardized prevalence rate of malignant tumor increased from 529.76/100 000 to 749.57/100 000 (increased by 41.49%); the standardized mortality rate decreased from 196.57/100 000 to 169.88/100 000 (decreased by 13.58%); the standardized DALY rate decreased from 5 206.56/100 000 to 4 150.86/100 000. In 2010, the top five standardized DALY rate of malignant tumor were lung cancer, liver cancer, gastric cancer, esophageal cancer, and colorectal cancer. Their standardized DALY rate were 892.21/100 000, 787.40/100 000, 521.36/100 000, 303.95/100 000, and 269.94/100 000, respectively. In all kind of malignant tumors, the burden of disease of lung cancer had the fastest-growing rate. The standardized mortality rate of lung cancer increased from 34.78/100 000 in 1990 to 41.09/100 000 in 2010; the standardized DALY rate increased from 830.77/100 000 in 1990 to 892.21/100 000 in 2010. The burden of disease of gastric cancer had the fastest-falling rate. The standardized mortality rate of gastric cancer decreased from 39.65/100 000 in 1990 to 23.79/100 000 in 2010; the standardized DALY rate decreased from 968.96/100 000 in 1990 to 521.36/100 000 in 2010.

CONCLUSIONThe burden of disease caused by malignant tumor in China remained at high levels in 2010. The top five burden of disease of malignant tumor were lung cancer, liver cancer, gastric cancer, esophageal cancer, and colorectal cancer. The burden of disease of lung cancer had the fastest-growing rate and gastric cancer had the fastest-falling rate from 1990 to 2010 in China. Prevention and control of malignant tumor was still difficult.

China ; Colorectal Neoplasms ; Cost of Illness ; Esophageal Neoplasms ; Humans ; Liver Neoplasms ; Lung Neoplasms ; Mortality ; Neoplasms ; Prevalence ; Quality-Adjusted Life Years ; Stomach Neoplasms

Objective: To analyze the burden of disease attributable to low fruit intake among Chinese population aged ≥15 years old between 1990 and 2013. Methods: We used data from the 2013 Global Burden of Disease Burden of Disease Study to study the situation in China. The population attributable fraction was calculated to estimate and compare the death and disability-adjusted life years (DALY) attributed to low fruit intake between 1990 and 2013 in China (excluded Taiwan, China). An average world population age structure of the period 2000-2025 was adopted to calculate age-standardized rates. Results: Deaths attributable to low fruit intake accounted for 11.02% of all death in 2013, which were higher than it in 1990 (10.38%). In 2013, the number of deaths attributed to low fruit intake in China increased to 1 046 500 from 793 800 in 1990. From 1990-2013, the age-standardized death rate attributable to low fruit intake decreased from 113.04/100 000 to 79.80/100 000. DALYs caused by low fruit intake increased from 18.346 5 million in 1990 to 21.296 7 million in 2013. Compared with 1990, the age-standardized DALY rate attributed to low fruit intake decreased by 34.67%. In 2013, the top three provinces with the highest burden of disease attributed to low fruits intake were Tibet, Guizhou and Xinjiang provinces, with standardized DALY rate at 2 612.53/100 000, 2 281.85/100 000 and 2 198.22/100 000, respectively. Compared with the results in 1990, the standardized DALY attributed to low fruits intake decreased, especially in Tianjin, where decreased by 63.61%; followed by Aomen, Zhejiang, Shanghai and Beijing, where decreased by 59.74%, 59.53%, 56.64% and 53.88%, respectively. Conclusion Compared with the situation in 1990, the burden of disease attributable to low fruit intake decreased in 2013, but the situation is still serious, especially in Tibet, Guizhou and Xinjiang provinces, where the burden decreased comparatively slowly.

Objective To analyze the death status of disease burden of cardiovascular and circulatory diseases in 1990 and 2010 in China, and to provide the basic information for cardiovascular and circulatory disease prevention and control. Methods Using the results of the Global Burden of Diseases Study 2010(GBD 2010) to describe the cardiovascular and circulatory diseases deaths status and disease burden in China. The measurement index included the mortality, years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY). At the same time, we used the population from 2010 national census as standard population to calculate the age-standardized mortality rate and DALY rate, YLL rate and YLD rates which will describe the mortality status and disease burden of total and different types of cardiovascular disease. We also calculated the change in 1990 and 2010 for all indexes, to describe the change of the burden of disease in the 20 years. Results In 2010, the total deaths of cardiovascular and circulatory diseases reached 3.136 2 million, the mortality rate reached 233.70 per 100 000 people and the age-standardized mortality rate was 256.90 per 100 000 people. The total DALYs, YLLs, and YLDs of cardiovascular and circulatory diseases reached 58.2055, 54.0488, and 4.1568 million person-years, respectively, and the age-standardized DALY rate, YLL rate and YLD rate were 4 639.04, 4 313.13, 325.91 per 100 000. In 1990, the deaths only 2.1675 million and the DALYs, YLLs and YLDs were 45.2679, 42.2922, and 2.9757 million person-years. The age-standardized mortality rate was 300.30 per 100 000 people. And the age-standardized DALY rate, YLL rate and YLD rate were 5 872.58, 5 523.42 and 349.16 per 100 000. Compared with the result in 1990, the total deaths, DALYs, YLLs, and YLDs were increased 44.72%, 28.58%, 27.80%, and 39.68%, respectively, while the age-standardized mortality rate, age-standardized DALY rate, age-standardized YLL rate, and age-standardized YLD rate were decreased 14.45%, 21.01%, 21.91%, and 6.66%, respectively. In 1990 and 2010, cerebrovascular disease caused the most DALYs (24.8768 and 30.1389 million person-years, respectively) compared with other types of cardiovascular and circulatory diseases, and followed by ischemic heart disease (10.1270 and 17.8858 million person-years). And the YLLs of cerebrovascular disease (24.3436 and 29.1726 million person-years) also the highest in different type of cardiovascular and circulatory diseases, ischemic heart disease ( 8.9919 and 16.0839 million person-years) was the second highest. The deaths of cerebrovascular disease and cerebrovascular disease increased from 1 340.6 and 450.3 thousands in 1990 to 1 726.7 and 948.7 thousands in 2010, respectively. The age-standardized mortality rate and DALY rate of cerebrovascular disease were decreased from 187.19 and 3 335.37 per 100 000 people in 1990 to 141.43 and 2 409.09 per 100 000 people. While in the ischemic heart disease, the age-standardized mortality rate, and DALY rate were increased form 62.53 and 1 318.38 per 100 000 people in 1990 to 77.89 and 1 428.31 per 100 000 people. Conclusion Burden of cardiovascular and circulatory disease became more and more serious in China, of which the cerebrovascular disease and ischemic heart disease were most serious.

Objective To analyze the status and trend of injury burden in 1990 and 2010 for Chinese people. Methods We used results of the Global Burden of Diseases Study 2010(GBD 2010) to analyze the status of injury burden in China. The main outcome measurements included years of life lost (YLL), years lived with disability(YLD), and disability-adjusted life years(DALY). Moreover,the China Census in 2010 was used as the reference population to calculate the age-standardized rate with each five-year as an age group. We also calculate the percentage change from 1990 to 2010 and analyze the trend of injury burden in China for the past twenty years. Results In 2010, a total of 796 240 people died of injury. The crude death rate of injury in China was 59.34/100 000 and the standardized death rate was 61.87/100 000;the YLL due to injury was 31.7593 million person years. The YLD due to injury was 9.0447 million person years and the DALY due to injury was 40.8040 million person years. In 2010, the top five causes of death related to injury were road traffic, injury, suicide, falls, drowning and poisoning. The death number for the five causes were 282 576, 172 964, 115 294, 67 402,and 36 997,respectively. The top five causes of DALY related to injury were road traffic injury, falls, suicide, drowning and poisoning and the DALY were 14.9623 million, 7.0583 million, 5.9699 million, 3.6634 million,and 1.6137 million person years. From 1990 to 2010, the burden attributable to road traffic injury increased quickly, the standardized death rate increased from 15.76/100 000 to 21.83/100 000, up 38.54%; the standardized DALY rate increased from 930.12/100 000 to 1142.19/100 000, up 22.80%. From 1990 to 2010, the burden attributable to suicide decreased, the standardized death rate decreased from 22.62/100 000 to 13.62/100 000, down 39.82%, and the standardized DALY rate decreased from 875.09/100 000 to 462.28/100 000, down 47.17%. The disease burden of injury topped at the group aged 20-24, followed by group aged 40-44 and group aged 35-39,the DALY for the three age groups were 4.2211 million,4.1655 million,and 4.0319 million person years, respectively. Conclusion Injury was the main disease for burden among Chinese population, especially among young adults. In recent years, the burden attributable to road traffic injury increased quickly.Targeted prevention and control measures for road traffic injury, falling, suicide and other key injury should be in place to reduce the burden of injury effectively.

Objective To analyze the disease burden of chronic obstructive pulmonary disease (COPD) among people aged over 15 years in 1990 and 2010 in China. Methods The estimation of China data for the Global Burden of Disease Study 2010 (GBD 2010) was used to analyze the mortality and prevalence as well as the years of life lost due to premature mortality(YLL), years lived with disability(YLD) and disability-adjusted life years (DALY) of COPD in China in 1990 and 2010 for Chinese people aged 15 years and above. The death rate and DALY rate of COPD in China in 1990 and 2010 were compared. Results In 2010, 0.934 million people (0.534 million men and 0.400 million women) aged over 15 years died from COPD, decreased 34.5% (24.3% for men and 44.4% for women) compared with that in 1990 (1.425 million with 0.705 million men and 0.720 million women). There were 41.764 million COPD patients in 2010 (22.111 million men and 19.653 million women), increased 42.1%(41.7%for men and 42.6%for women) compared with 1990 (29.382 million patients with 15.599 million men and 13.783 million women). The mortality rate of COPD decreased for 61.5%from 2.352/100 000 in 1990 to 90.5/100 000 in 2010. The prevalence rate of COPD was 4.2%and 3.9%in 1990 and 2010,respectively. The DALY, YLL and YLD due to COPD was 16.598, 12.946, and 3.652 million person years,respectively in 2010. The YLD increased 42.3%compared with 1990 (2.567 million person years). From 1990 to 2010, the age-standardized DALY rate, YLL rate and YLD rate decreased from 4 120.1/100 000 to 1 575.9/100 000, from 3 756.9/100 000 to 1 235.6/100 000 and from 363.2/100 000 to 340.3/100 000,respectively. Conclusion Although there was significant decrease of DALY due to COPD in 2010, compared to 1990, the YLD burden is still increasing.

Objective To analyze the death status of disease burden of cardiovascular and circulatory diseases in 1990 and 2010 in China, and to provide the basic information for cardiovascular and circulatory disease prevention and control. Methods Using the results of the Global Burden of Diseases Study 2010(GBD 2010) to describe the cardiovascular and circulatory diseases deaths status and disease burden in China. The measurement index included the mortality, years of life lost due to premature mortality (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY). At the same time, we used the population from 2010 national census as standard population to calculate the age-standardized mortality rate and DALY rate, YLL rate and YLD rates which will describe the mortality status and disease burden of total and different types of cardiovascular disease. We also calculated the change in 1990 and 2010 for all indexes, to describe the change of the burden of disease in the 20 years. Results In 2010, the total deaths of cardiovascular and circulatory diseases reached 3.136 2 million, the mortality rate reached 233.70 per 100 000 people and the age-standardized mortality rate was 256.90 per 100 000 people. The total DALYs, YLLs, and YLDs of cardiovascular and circulatory diseases reached 58.2055, 54.0488, and 4.1568 million person-years, respectively, and the age-standardized DALY rate, YLL rate and YLD rate were 4 639.04, 4 313.13, 325.91 per 100 000. In 1990, the deaths only 2.1675 million and the DALYs, YLLs and YLDs were 45.2679, 42.2922, and 2.9757 million person-years. The age-standardized mortality rate was 300.30 per 100 000 people. And the age-standardized DALY rate, YLL rate and YLD rate were 5 872.58, 5 523.42 and 349.16 per 100 000. Compared with the result in 1990, the total deaths, DALYs, YLLs, and YLDs were increased 44.72%, 28.58%, 27.80%, and 39.68%, respectively, while the age-standardized mortality rate, age-standardized DALY rate, age-standardized YLL rate, and age-standardized YLD rate were decreased 14.45%, 21.01%, 21.91%, and 6.66%, respectively. In 1990 and 2010, cerebrovascular disease caused the most DALYs (24.8768 and 30.1389 million person-years, respectively) compared with other types of cardiovascular and circulatory diseases, and followed by ischemic heart disease (10.1270 and 17.8858 million person-years). And the YLLs of cerebrovascular disease (24.3436 and 29.1726 million person-years) also the highest in different type of cardiovascular and circulatory diseases, ischemic heart disease ( 8.9919 and 16.0839 million person-years) was the second highest. The deaths of cerebrovascular disease and cerebrovascular disease increased from 1 340.6 and 450.3 thousands in 1990 to 1 726.7 and 948.7 thousands in 2010, respectively. The age-standardized mortality rate and DALY rate of cerebrovascular disease were decreased from 187.19 and 3 335.37 per 100 000 people in 1990 to 141.43 and 2 409.09 per 100 000 people. While in the ischemic heart disease, the age-standardized mortality rate, and DALY rate were increased form 62.53 and 1 318.38 per 100 000 people in 1990 to 77.89 and 1 428.31 per 100 000 people. Conclusion Burden of cardiovascular and circulatory disease became more and more serious in China, of which the cerebrovascular disease and ischemic heart disease were most serious.

Objective To analyze the status and trend of injury burden in 1990 and 2010 for Chinese people. Methods We used results of the Global Burden of Diseases Study 2010(GBD 2010) to analyze the status of injury burden in China. The main outcome measurements included years of life lost (YLL), years lived with disability(YLD), and disability-adjusted life years(DALY). Moreover,the China Census in 2010 was used as the reference population to calculate the age-standardized rate with each five-year as an age group. We also calculate the percentage change from 1990 to 2010 and analyze the trend of injury burden in China for the past twenty years. Results In 2010, a total of 796 240 people died of injury. The crude death rate of injury in China was 59.34/100 000 and the standardized death rate was 61.87/100 000;the YLL due to injury was 31.7593 million person years. The YLD due to injury was 9.0447 million person years and the DALY due to injury was 40.8040 million person years. In 2010, the top five causes of death related to injury were road traffic, injury, suicide, falls, drowning and poisoning. The death number for the five causes were 282 576, 172 964, 115 294, 67 402,and 36 997,respectively. The top five causes of DALY related to injury were road traffic injury, falls, suicide, drowning and poisoning and the DALY were 14.9623 million, 7.0583 million, 5.9699 million, 3.6634 million,and 1.6137 million person years. From 1990 to 2010, the burden attributable to road traffic injury increased quickly, the standardized death rate increased from 15.76/100 000 to 21.83/100 000, up 38.54%; the standardized DALY rate increased from 930.12/100 000 to 1142.19/100 000, up 22.80%. From 1990 to 2010, the burden attributable to suicide decreased, the standardized death rate decreased from 22.62/100 000 to 13.62/100 000, down 39.82%, and the standardized DALY rate decreased from 875.09/100 000 to 462.28/100 000, down 47.17%. The disease burden of injury topped at the group aged 20-24, followed by group aged 40-44 and group aged 35-39,the DALY for the three age groups were 4.2211 million,4.1655 million,and 4.0319 million person years, respectively. Conclusion Injury was the main disease for burden among Chinese population, especially among young adults. In recent years, the burden attributable to road traffic injury increased quickly.Targeted prevention and control measures for road traffic injury, falling, suicide and other key injury should be in place to reduce the burden of injury effectively.

Objective To analyze the disease burden of chronic obstructive pulmonary disease (COPD) among people aged over 15 years in 1990 and 2010 in China. Methods The estimation of China data for the Global Burden of Disease Study 2010 (GBD 2010) was used to analyze the mortality and prevalence as well as the years of life lost due to premature mortality(YLL), years lived with disability(YLD) and disability-adjusted life years (DALY) of COPD in China in 1990 and 2010 for Chinese people aged 15 years and above. The death rate and DALY rate of COPD in China in 1990 and 2010 were compared. Results In 2010, 0.934 million people (0.534 million men and 0.400 million women) aged over 15 years died from COPD, decreased 34.5% (24.3% for men and 44.4% for women) compared with that in 1990 (1.425 million with 0.705 million men and 0.720 million women). There were 41.764 million COPD patients in 2010 (22.111 million men and 19.653 million women), increased 42.1%(41.7%for men and 42.6%for women) compared with 1990 (29.382 million patients with 15.599 million men and 13.783 million women). The mortality rate of COPD decreased for 61.5%from 2.352/100 000 in 1990 to 90.5/100 000 in 2010. The prevalence rate of COPD was 4.2%and 3.9%in 1990 and 2010,respectively. The DALY, YLL and YLD due to COPD was 16.598, 12.946, and 3.652 million person years,respectively in 2010. The YLD increased 42.3%compared with 1990 (2.567 million person years). From 1990 to 2010, the age-standardized DALY rate, YLL rate and YLD rate decreased from 4 120.1/100 000 to 1 575.9/100 000, from 3 756.9/100 000 to 1 235.6/100 000 and from 363.2/100 000 to 340.3/100 000,respectively. Conclusion Although there was significant decrease of DALY due to COPD in 2010, compared to 1990, the YLD burden is still increasing.