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1、THE SILENT EPIDEMIC of COPD:HOW IT HITS FAMILY PRACTICE潜在流行性慢阻肺对家庭医生的困扰,PROF.CHRIS VAN WEELUMC NIJMEGEN,THE NETHERLANDS,伏仇澈锈鞭刽彼淖奎劈蜀仰象攻字邓漾痴儡咕戈盖沁莲猩玫书芽当渤辫松HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,Epidemiology:流行病学 from population to practice从居民到医生,CO
2、PD as the example-study慢阻肺作为研究范例Practice level:individual advice and therapyRole of family physician 家庭医生的作用Organize individual care,population perspective对居民有组织的个体化照顾Data from the Netherlands 荷兰的数据Encouragement to pursue Chinese dataCritical for leadership,实际水平：个体化指导和治疗,对中国人的追踪研究数据,对领导工作的评价,柿统洋锌睁恼皂
3、锣呜仟赛要翻菩赫篡亡近勃修撞去箭植窄饼乙走密扳伎才HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,COPDIn family practice家庭医疗中的慢阻肺,Incidence*发病率 2 3/1,000 Prevalentie*患病率 22/1,000Average family practice:每个家庭医生平均患者55 under treatment 治疗中6-7 new cases yearly 每年新病例*Data Continous Mor
4、bidity Registration,Department of Family Medicine,Nijmegen根据家庭医学部持续登记的患病率,碾博均烽偷昔嗜极莲怪戴夕磋蓝皮禾抽造橇误恒盟谤叔寅网怒钾住仲您糕HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,Trends1996 2050*1996-2050的趋势,*Data Continuous Morbidity Registration,Department of Family Practice,N
5、ijmegen 根据家庭医学部持续登记的患病率,战恤男莫韭记亮北斥沮焕怔驴胸警窘碾匿店嘎赁潜絮缔朱娘秦磊抉敛锁统HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,Only diagnosed cases,Dimca Study:undiagnosed COPD10 Family practices Nijmegen,1992Questionnaires and spirometry1159 adults without known COPD,asthmaHo
6、w to make a difference?,仅“已诊断的病例”,漏诊的慢阻肺,1992年10个家庭医生的材料,问卷调查及肺活量测定,1159例没有已知慢阻肺和哮喘的成年人,如何鉴别？,结棠橇七近兴东内辨仆艾烽砚茫柜省乎哄餐澳搅咐姜汲螺斩吠恋鸣契岩牢HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,(Tirimanna et al Br J Gen Pract 1996;46:277-282),废寻障阎颜穷粱猫做淀灰桶臻完鸯墙履牛戏捡胀揪崇捕喧姜魄嫁瓦赴违
7、停HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,Underdiagnosis*漏诊,Substantial:7%population signs/symptomsIncreased prevalence 1977-1992Diagnostic uncertaintymainly mild disease(Gold stages 1,2)Effectiveness early intervention unclear*Tirimanna et al Br
8、J Gen Pract 1996;46:277-282,实际数：有症状/体征者7%,1977-1992年患病率增加,诊断不肯定,早期干预效果不肯定,主要是轻病例(Gold 1、2期)-,旨晶瓮艰始翌渡渤搜尊孪庭搀猾爱歹屠倦俊美勺禄盼镁牵路诧仆瓶绑凡涡HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,Determinants underdiagnosis漏诊的决定因素,PHYSICIAN 医生方面Knowledge 知识Skills 技能Implication
9、s 暗示expectation:期望值：label/stigma 标记/担心smoking cessation 戒烟,PATIENT 病人方面tolerate symptoms 能忍受dislike medication 不想吃药anxiety stigma 焦虑担心know FP advice:知道医生要劝：smoking cessation 戒烟,恤孝孟容硒辞眷铣赌片默偷攒蒙倡洁炊骨耳趟钠跟雷解杨霹晰俞地仇安七HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van We
10、el,5 years DIMCA:Gold Class&Functional Status DIMCA5年:Gold分级及功能状况,5年后COOP-WONCA量表评分,体能 日常活动,氛白腮哆溉但膀鸦说矢劳移拢紧痰峰藻杉晒虱吃赵晃扔紊厂溯板塑簇呛帧HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,Coop/Wonca ChartsCOOP/WONCA量表,Daily Actvities 日常活动,Physical Fitness 体能,嘶幻另报十潞垂炎哮溪即
11、鸵炉卤镰铰痔抓闷狱掏扑秧彻撼覆矢奶歧曰倔恃HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,溪歼浑撑鳖匡苫宿炒远园蹄中面泌蕊笑淑萌姿稠碉疫押卜府秩擒口涕幻尤HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,5 years DIMCA:Gold Class&Functional Status DIMCA5年:Gold分级及功
12、能状况,体能 日常活动,检饭央圃坛掇择厘考瀑丈嘘楼公袁撵珍霸驭具衬摹缄惠蓬恼诸鹏着须扑少HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,professor Chris van Weel,Effectiveness Early Intervention(DIMCA)早期干预的作用,Early treatment*:早期治疗：Improves quality of life&functioning改善生活质量及功能Reduces exacerbations 减少恶化No effect lungfunction
13、 decline 肺功能减低无作用No effect mild persistent symptoms 轻度持续性症状无作用No case for screening 无供筛查病例 No alternative primary prevention:smoking,open fires cessation 无可替代的一级预防：戒烟和明火,*van den boom et al Prev Med,30,302-308,阿虞芽苯摸份舞嫡动戎恃眺眶交荆氏阅鹅靶休未举篱屹腆霸集盼键胡卒账HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜
14、在流行性慢阻肺对家庭,professor Chris van Weel,Conclusion 结论,COPD important problem practice population 慢阻肺是居民中的重要问题Diagnosis and treatment 诊断和治疗Make a difference 区别对待But smoking cessation Key to success 戒烟是胜利的关键 Family medicine leadership 家庭医学主导address population needs 致力于公众需求priority to what counts 优先解决遇到的问题,巧画颇暗诗全造欣魂枪桥员秸鹤荫量言君淮邓芯恨借瘟翔贫墙吵墨晓词卷HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭HOWITHITSFAMILYPRACTICE潜在流行性慢阻肺对家庭,
