厦门市糖尿病“三师共管”模式的卫生经济学评价

目的 对厦门市糖尿病“三师共管”模式进行卫生经济学评价,了解该模式的效果。方法 2016年7月至8月从厦门市随机抽取5个社区的糖尿病患者,以“三师共管”满1年的糖尿病患者为干预组、同期常规慢病管理患者为对照组,采用自行设计的问卷开展调查;测算项目成本和疾病经济负担,并以糖化血红蛋白(HbA1c)控制率、餐后2 h血糖控制率、双向转诊下转率、社区首诊率、糖尿病知识达标率、自我管理达标率等为效果指标进行增量成本效果分析,以因干预而减轻的疾病经济负担为净效益进行增量成本效益分析。结果 共调查800名糖尿病患者,获得有效问卷798份,有效回收率为99.75%,其中,干预组413人,对照组385人。干预1年后,干预组HbA1c、餐后2 h血糖控制达标率分别为74.8%、79.9%,相较于对照组的41.0%、66.0%均有明显上升(t值分别为86.63、19.14,P均<0.05),双向转诊意愿和社区首诊意愿上升、糖尿病知识和自我管理达标率也显著上升(t值分别为12.59、82.42、12.54、10.40,P均<0.05)。干预组人均疾病经济负担为5 569元/年,比对照组少1412元/年。增量成本效果分析显示,HbA1c控制率增加1%的成本为15.04元/人年,餐后2 h血糖控制率增加1%的成本为36.47元/人年;双向转诊、社区首诊率以及糖尿病知识、自我管理达标率增加1%的成本分别为51.57、16.73、40.00和47.34元/人年。增量成本效益分析显示,增量成本效益比为2.78。结论 与社区常规慢病管理相比,糖尿病“三师共管”模式的1年干预效果良好,并且具有较好的成本效果和成本效益。国家自然科学基金(81573257,71874147

The effect of storage conditions on the viability of welsh onion (Allium fistulosum L.) seed

本研究利用提高北蔥種子含水量及人工加速老化等處理以瞭解影響北蔥種子壽命之因素，處理種子以鋁袋及紙袋包裝，貯藏於室溫及8℃，調查種子發芽及測定種子內部成分含量及生理上之變化。北蔥種子於25℃、RH82%下經一天後，種子含水量提高至14%，以紙袋包裝貯藏於室溫下，種子發芽率顯著減少。含水量5%的種子貯藏於8℃，種子發芽率能達80%以上，二氧化碳產生量顯著較其他處理高，全可溶性糖及澱粉較14%含水量者高出10%，種子內的脂肪酸變化最小，種子內的總過氧化物與MDA含量顯著較高含水量者減少10%以上，SOD及CAT顯著較含水量14%者提高13%及25%。 北蔥種子於室溫下經五個月貯藏後，以鋁袋包裝對照組種子與經2天於40℃、82%RH加速老化處理的種子比較，前者種子發芽率仍維持在78.6%，以紙袋包裝的北蔥種子，在未處理及老化處理的種子含水量增加至15%以上，發芽率皆明顯下降。二氧化碳釋出量、全可溶性糖、澱粉及游離脂肪酸含量亦有下降的情形，於8℃以鋁袋包裝的對照組種子發芽率經貯藏五個月仍維持在87%，在二氧化碳釋出量上為190 μlCO2 /g‧hr顯著最高，種子內的全可溶性糖及澱粉含量顯著較老化者提高7%。種子內的脂肪酸方面，於8℃貯藏以鋁袋包裝的對照組種子脂肪酸含量顯著最低，亞油酸含量維持在30mg/g．FW，與種子活力成正相關。種子內的過氧化物及MDA含量以紙袋包裝貯藏於室溫下的兩種子內顯著較其他處理高，以鋁袋包裝貯藏於兩溫度下及8℃下以紙袋包裝的老化者含量也較未老化者提高20-30%之間，種子內的SOD、CAT及POD活性均會下降，以鋁袋包裝貯藏於8℃下的酵素活性顯著較其他處理高。在種子活力檢測上，於8℃以鋁包裝的未老化種子，經貯藏後其浸潤液的導電度、游離氨基酸、可溶性糖及鉀離子濃度顯著較其他處理降低，老化處理增加種子的浸潤液內容物之滲出。 老化種子浸於100 ppm vit.C四個小時後，以紙袋貯藏三個月，種子發芽率維持在79%，且種子浸潤液的導電度顯著降低76%，種子內的總過氧化物含量顯著降低48%，MDA含量也降低約一倍，種子內的SOD及CAT也顯著提高3倍及6倍，APX由1.4unit/g提升至15unit/g，種子內的抗壞血酸及榖胱苷肽含量皆會顯著提升。飽和脂肪酸、油酸及亞麻酸的含量降低，提高亞油酸的含量達28.8mg/g FW。 由此可知，低溫貯藏可維持北蔥種子的活力，利用100 ppm vit. C處理增加種子抗氧化作用能力，有效促進北蔥種子活力並延長種子貯藏壽命。The objective of this research was to approach the effect of seed moisture content, seed viability and storage environment on welsh onion seed longevity. Welsh onion seeds with 5% or 14% moisture content were stored for five months at 8℃ or at room temperature [25±5℃/15±5℃]. Germination of seeds stored in a paper package at room temperature was significantly lower around 80% than that of seeds stored at 8℃. For seeds with 5% moisture content stored at 8℃, germination was greater than 80% after stored for 5 months, CO2 production was 210μl/ g FW/ hr, and soluble sugar content were 60 mg/g DW. In addition, total peroxide and malondialdehyde (MDA) content were 10% lower, superoxide dismutase (SOD) activity was 13% higher, and catalase (CAT) activity was 25% higher than in seeds stored at 8℃ with 14% moisture content. Accelerated aging seeds packaged in aluminum or paper were stored at 8℃ or room temperature for five months. Germination of control seeds stored in an aluminum package at room temperature or at 8℃ for five months was 78.6% and 87%, respectively. Total soluble sugar and starch content in control seeds packaged in paper and stored at 8℃ were significantly higher than in accelerated seeds. The fatty acid content (especially linoleic acid) in seeds packaged in aluminum and stored at 8℃ was significantly lower than in seeds in other treatments. For accelerated aging seeds stored in paper packages for five months, germination, CO2 production, and total soluble sugar, stach and fatty acid content were significantly lower than in control seeds. Total peroxide and malondialdehyde (MDA) content in seeds stored in paper package at SOD, CAT and peroxidase activity was reduced. In seed vigour tests, conductivity and the amount of free amino acid, total soluble sugars and potassium ions in the soaking solution of control seeds stored in aluminum package at 8℃ were significantly lower than in accelerated aging seeds stored at room temperature. For accelerated aging seeds treated with 100 ppm Vit. C, germination remained at 79%, and conductivity of leaching solution was 312μS/cm. In treated seeds, total peroxide and MDA content in treated seeds were significantly reduced, however, SOD, CAT, and APX activity, as well as ascorbic acid and glutathione content were significantly increased. In treated seeds saturated fatty acid, oleic acid and linolenic acid content significantly decreased, but linoleic acid content significantly increased. The storability of welsh onion could be effectively elongated by treated Vit. C, then stored in aluminum packages at 8℃.目 錄 壹、中文摘要……………………………………………………………………….i 貳、英文摘要………………………………………………………………………ii 參、前言……………………………………………………………………………1 肆、前人研究 一、影響種子貯藏壽命的因素………...……………………………………2 二、過氧化作用對種子壽命之影響…...…………………………………...5 三、種子生理的變化對種子生活力的影響………………………………..8 四、維持種子活力的方法……………………………………………….....11 伍、材料與方法 一、種子的處理…………………………………………………………….13 二、種子發芽及內容物測定……………………………………………….13 三、種子活力之檢測…...............…………………………………………15 四、種子抗氧化作用之分析……………………………………………….16 陸、結果 一、貯藏溫度及不同種子含水量對北蔥種子活力的影響…………….20 二、貯藏溫度及包裝材料對老化之北蔥種子活力及生理特性之影響 ...................................................................................................22 三、利用抗氧化劑處理對北蔥種子活力之影響………………………..26 柒、討論 一、種子含水量、貯藏溫度及包裝材料對種子發芽之影響………….47 二、種子碳水化合物含量及呼吸作用與種子壽命之關係…………….48 三、老化對種子活力影響………………………………………………....49 四、種子過氧化作用與相關生理變化…………………………………...50 捌、參考文獻……………………………………………………………………..5

Effect of Seed Moisture Content on Welsh Onion (Allium fistulosium L.) Storability

為瞭解不同北蔥種子含水量對種子貯藏生理影響及影響種子貯藏性之因素進行本實驗。北蔥種子於25°C、RH82%下經一天後，種子含水量提高至14%，將14%及5%含水量種子以紙袋包裝貯藏於室溫及8°C下。含水量5%的種子貯藏於8°C，種子發芽率達80%以上，於室溫下者，14%含水量種子經五個月貯藏其發芽率為0%。貯於8°C含水量5%種子內全可溶性糖及澱粉較其他處理者高出10%，於室溫下貯藏種子內五種脂肪酸較8°C下者含量增加，總過氧化物與MDA含量顯著減少10%以上，SOD及CAT分別增加13%及25%。The objective of this research was to approach the effect of seed moisture content on welsh onion seed longevity. Welsh onion seeds with 5％ or 14％ moisture content were stored for five months at 8℃ or at room temperature [25±5℃/15±5℃]. Germinationof seeds stored in a paper package at room temperature was significantly lower around 80％ than that of seeds stored at 8℃. For seeds with 5％ moisture content stored at 8℃, germination was greater than 80％ after stored for 5 months, CO2 production was 210 μ1/ g FW/hr , and soluble sugar content were 60 mg/g DW. For three seeds, total peroxide and malondialdehyde (MDA) content were 60 mg/g DW.For three seeds, total peroxide and malondialdehyde (MDA) content were 10％ lower, superoxide dismutase (SOD) activity was 13％ higher, and catalase (CAT) activity was 25％ higher than in seeds stored at 8％ with 14％ moisture content