BACKGROUND & AIMS: :Transforming small independent practices to patient-centered medical homes is widely believed to be a critical step in reforming the US health care system. Our team has conducted research on improving primary care practices for more than fifteen years. We have found four characteristics of small primary care practices that seriously inhibit their ability to make the transformation to this new care model. We found that small practices were extremely physician-centric, lacked meaningful communication among physicians, were dominated by authoritarian leadership behavior, and were underserved by midlevel clinicians who had been cast into unimaginative roles. Our analysis suggests that in addition to payment reform, a shift in the mind-set of primary care physicians is needed. Unless primary care physicians can adopt new mental models and think in new ways about themselves and their practices, it will be very difficult for them and their practices to create innovative care teams, become learning organizations, and act as good citizens within the health care neighborhood.

背景与目标： : 将小型独立实践转变为以患者为中心的医疗之家被广泛认为是改革美国医疗体系的关键一步。我们的团队在改善初级保健实践方面进行了超过15年的研究。我们发现了小型初级保健实践的四个特征，这些特征严重抑制了他们向这种新护理模式转变的能力。我们发现，小型实践以医师为中心，缺乏医师之间的有意义的沟通，以专制领导行为为主导，并且被那些被赋予缺乏想象力的角色的中层临床医生服务不足。我们的分析表明，除了支付改革之外，还需要改变初级保健医生的思维方式。除非初级保健医生能够采用新的心理模式，并以新的方式思考自己和他们的做法，否则他们和他们的做法将很难创建创新的护理团队，成为学习型组织，并在医疗保健社区内充当好公民。

BACKGROUND & AIMS: PURPOSE:The incidence of poor ovarian response in controlled ovarian stimulation (COH) has been reported in 9-24 % of IVF-ET cycles. Growth hormone augments the effect of gonadotropin on granulosa and theca cells, and plays an essential role in ovarian function, including follicular development, estrogen synthesis and oocyte maturation. The aim of this study was to assess IVF-ET cycle outcome after the addition of growth hormone in antagonist protocol in poor responders. MATERIALS AND METHODS:Eighty-two poor responder patients selected for ART enrolled the study and were randomly divided into two groups. Group I (GH/HMG/GnRHant group, n = 40) received growth hormone/gonadotropin/GnRH antagonist protocol and group II (HMG/GnRHant group, n = 42) received gonadotropin/GnRH antagonist protocol. RESULTS:The number of retrieved oocytes was significantly higher in GH/HMG/GnRHant group than HMG/GnRHant group, 6.10 ± 2.90 vs. 4.80 ± 2.40 (p = 0.035) and the number of obtained embryos was also significantly higher in GH/HMG/GnRHant group than HMG/GnRHant group, 3.7 ± 2.89 as compared to 2.7 ± 1.29 (p = 0.018). There were no significant differences between groups regarding implantation, and chemical and clinical pregnancy rates. CONCLUSION:Our study showed that co-treatment with growth hormone in antagonist protocol in patients with a history of poor response in previous IVF-ET cycles did not increase pregnancy rates.

背景与目标：

BACKGROUND & AIMS: :Psychiatrists and psychotherapists in the US (1970s to 1985) and Switzerland (1988-1993) used MDMA legally as a prescription drug, to enhance the effectiveness of psychotherapy. Early reports suggest that it is useful in treating trauma-related disorders. Recently, the first completed pilot study of MDMA-assisted psychotherapy for PTSD yielded encouraging results. Designed to test the safety and efficacy of MDMA-assisted psychotherapy in patients with treatment-resistant PTSD; our randomized, double-blind, active-placebo controlled trial enrolled 12 patients for treatment with either low-dose (25 mg, plus 12.5 mg supplemental dose) or full-dose MDMA (125 mg, plus 62.5 mg supplemental dose). MDMA was administered during three experimental sessions, interspersed with weekly non-drug-based psychotherapy sessions. Outcome measures used were the Clinician-Administered PTSD Scale (CAPS) and the Posttraumatic Diagnostic Scale (PDS). Patients were assessed at baseline, three weeks after the second and third MDMA session (end of treatment), and at the 2-month and 1-year follow-ups. We found that MDMA-assisted psychotherapy can be safely administered in a clinical setting. No drug-related serious adverse events occurred. We did not see statistically significant reductions in CAPS scores (p = 0.066), although there was clinically and statistically significant self-reported (PDS) improvement (p = 0.014). CAPS scores improved further at the 1-year follow-up. In addition, three MDMA sessions were more effective than two (p = 0.016).

背景与目标： : 美国 (20世纪70年代1985年) 和瑞士 (1988-1993) 的精神科医生和心理治疗师合法使用MDMA作为处方药，以提高心理治疗的有效性。早期报告表明，它在治疗创伤相关疾病中很有用。最近，第一个完成的MDMA辅助心理治疗PTSD的初步研究取得了令人鼓舞的结果。旨在测试MDMA辅助心理治疗在治疗耐药的PTSD患者中的安全性和有效性; 我们的随机，双盲，活性安慰剂对照试验招募了12名患者接受低剂量 (25 mg，加12.5 mg补充剂量) 或全剂量MDMA (125 mg，加62.5 mg补充剂量)。MDMA在三个实验课程中进行，并散布在每周的非基于药物的心理治疗课程中。使用的结果指标是临床医生管理的PTSD量表 (CAPS) 和创伤后诊断量表 (PDS)。在基线，第二次和第三次MDMA疗程 (治疗结束) 后三周以及2个月和1年随访时对患者进行评估。我们发现MDMA辅助心理治疗可以在临床环境中安全施用。未发生与药物相关的严重不良事件。尽管有临床和统计学上显着的自我报告 (PDS) 改善 (p = 0.066)，但我们没有看到CAPS评分的统计学显着降低 (p = 0.014)。在1年的随访中，CAPS评分进一步提高。此外，三个MDMA会话比两个更有效 (p = 0.016)。

BACKGROUND & AIMS: :Many studies have shown how a 'paternal effect' can cause repeated assisted reproduction failures. In particular, with increasing experience of intracytoplasmic sperm injection (ICSI), it became evident that spermatozoa from some patients repeatedly fail to form viable embryos, although they can fertilize the oocyte and trigger early preimplantation development. Many authors have shown how this paternal effect can be traced back to anomalies in sperm chromatin organization: the spermatozoa of subfertile men are characterized by numerical abnormalities in spermatozoal chromosome content, Y chromosome microdeletions, alterations in the epigenetic regulation of paternal genome and non-specific DNA strand breaks. In particular, pathologically increased sperm DNA fragmentation is one of the main paternal-derived causes of repeated assisted reproduction failures in the ICSI era. The intention of this review is to describe nuclear sperm DNA damage, with emphasis on its clinical significance and its relationship with male infertility. Assessment of sperm DNA damage appears to be a potential tool for evaluating semen samples prior to their use in assisted reproduction, helping to select spermatozoa with intact DNA or with the least amount of DNA damage for use in assisted conception.

背景与目标： : 许多研究表明，“父系效应” 如何导致反复的辅助生殖失败。特别是，随着卵胞浆内单精子注射 (ICSI) 经验的增加，很明显，尽管某些患者的精子可以使卵母细胞受精并触发早期植入前发育，但它们反复未能形成存活的胚胎。许多作者已经证明了这种父系效应如何可以追溯到精子染色质组织的异常: 不育男性的精子的特征是精子染色体含量，Y染色体微缺失，父系基因组表观遗传调控的改变和非特异性DNA链断裂。特别是，病理上增加的精子DNA片段化是ICSI时代反复辅助生殖失败的主要父亲来源原因之一。这篇综述的目的是描述核精子DNA损伤，重点介绍其临床意义及其与男性不育的关系。精子DNA损伤的评估似乎是在精液样本用于辅助生殖之前评估精液样本的潜在工具，有助于选择DNA完整或DNA损伤最少的精子用于辅助受孕。

BACKGROUND & AIMS: :Radical cystoprostatectomy remains the gold standard treatment for muscle invasive bladder cancer. Use of minimally invasive approaches have gained prominence aided by surgical adjuncts such as harmonic scalpel and laparoscopic bowel staplers, however laparoscopic radical cystoprostatectomy remains extremely technically challenging even for experienced laparoscopic surgeons. Following the successful application of the da Vinci robotic surgical system for radical prostatectomy, attention has now turned to the use of robot assistance for laparoscopic cystoprostatectomy. Several centers have explored the feasibility of robotic cystoprostatectomy although long-term data is lacking. Controversy exists on the oncologic efficacy and safety, need for intracorporeal diversion and standardization of technique. This article details the history, technique, results and current status of robotic cystoprostatectomy and urinary diversion.

背景与目标： : 根治性膀胱前列腺切除术仍然是肌肉浸润性膀胱癌的金标准治疗。在谐波手术刀和腹腔镜肠吻合器等外科辅助手段的帮助下，微创方法的使用已得到重视，但是即使对于经验丰富的腹腔镜外科医生来说，腹腔镜根治性膀胱前列腺切除术在技术上仍然极具挑战性。随着达芬奇机器人手术系统在根治性前列腺切除术中的成功应用，现在的注意力转向使用机器人辅助腹腔镜膀胱前列腺切除术。尽管缺乏长期数据，但一些中心已经探索了机器人膀胱前列腺切除术的可行性。在肿瘤学的疗效和安全性，对体内转移的需求以及技术的标准化方面存在争议。本文详细介绍了机器人膀胱前列腺切除术和尿流改道的历史，技术，结果和现状。

BACKGROUND & AIMS: BACKGROUND:Fine needle aspiration (FNA) cytology has been widely used for pathologic assessment of breast lesions. However, the examination suffers a risk of false-negative results owing to insufficient sample volumes, inaccurate sampling positions, nondefinitive cytologic features, or suboptimal cell preservation. One approach to improve its accuracy is using modern mass spectrometry to detect disease biomarkers, of which the tissue samples are collected through FNA. METHODS:The biological compounds in the FNA tissue samples were extracted and characterized by matrix-assisted laser desorption ionization time-of-flight/mass spectrometry (MALDI-TOF/MS). The results were further analyzed by principal component analysis. Distribution of lipid biomarkers on tissues was explored by imaging mass spectrometry. RESULTS:Lipid profiles of the tissue samples collected by FNA were rapidly obtained through MALDI-TOF/MS analysis. Phosphatidylcholines and triacylglycerols were detected as the predominant compounds in cancerous and normal regions, respectively. The samples were clearly classified by principal component analysis, based on the differences in their lipid profiles. Different lipid patterns were clearly viewed through the molecular imaging of normal and tumorous regions of breast tissue samples. CONCLUSION:The FNA-MALDI-TOF/MS approach can provide complementary information for pathological examinations and improve the accuracy of breast cancer diagnoses. Owing to the ease of operation and automation, it is possible to efficiently screen the lipid biomarkers in a large number of tissue samples by means of MALDI-TOF/MS.

背景与目标：

BACKGROUND & AIMS: :With the increasing participation of women in the physician workforce, it is important to understand the sources of differences between male and female physicians' market labour supply for developing effective human resource policies in the health care sector. Gendered associations between family status and physician labour supply are explored in the Canadian labour market, where physicians are paid according to a common fee schedule and have substantial discretion in setting their hours of work. Canadian 1991, 1996, 2001 and 2006 twenty percent census files with 22,407 physician observations are used for the analysis. Although both male and female physicians have statistically indistinguishable hours of market work when never married and without children, married male physicians have higher market hours, and their hours are unchanged or increased with parenthood. In contrast, female physicians have lower market hours when married, and much lower hours when a parent. Little change over time in these patterns is observed for males, but for females two offsetting trends are observed: the magnitude of the marriage-hours effect declined, whereas that for motherhood increased. Preferences and/or social norms induce substantially different labour market outcomes. In terms of work at home, the presence of children is associated with higher hours for male physicians, but for females the hours increase is at least twice as large. A male physician's spouse is much less likely to be employed, and if employed, has lower market hours in the presence of children. In contrast, a female physician's spouse is more likely to be employed if there are three or more children. Both male and female physicians have lower hours of work when married to another physician. Overall, there is no gender difference in physician market labour supply after controlling for family status and demographics.

背景与目标： : 随着妇女越来越多地参与医师工作，重要的是要了解男女医师市场劳动力供应之间的差异来源，以制定卫生保健部门的有效人力资源政策。在加拿大劳动力市场上探讨了家庭状况与医生劳动力供应之间的性别关联，在加拿大劳动力市场上，医生根据共同的收费表获得报酬，并在确定工作时间方面拥有很大的酌处权。分析使用加拿大1991，1996，2001和2006 20% 具有22,407医师观察结果的人口普查文件。尽管男性和女性医生在从未结婚和没有孩子的情况下在市场工作的时间在统计上没有区别，但已婚男性医生的市场工作时间较高，并且他们的工作时间不变或随着父母的身份而增加。相比之下，女医生结婚时的上市时间较低，而父母则较低。男性观察到这些模式随时间的变化很小，而女性观察到两个抵消趋势: 结婚时间影响的幅度下降，而母亲的影响则增加。偏好和/或社会规范导致了截然不同的劳动力市场结果。就在家工作而言，儿童的存在与男性医生的工作时间增加有关，但女性的工作时间增加至少是后者的两倍。男性医生的配偶受雇的可能性要小得多，如果受雇，在有孩子的情况下，其上市时间会减少。相比之下，如果有三个或三个以上的孩子，女医师的配偶更有可能被雇用。与另一位医生结婚时，男性和女性医生的工作时间都较低。总体而言，在控制了家庭状况和人口统计之后，医生市场劳动力供应没有性别差异。

BACKGROUND & AIMS: INTRODUCTION:Suicide is known as a major health concern worldwide. There is evidence for the role of brain-derived neurotrophic factor (BDNF) in suicide behavior. Therefore, this factor has been proposed as a biomarker for suicide behavior. Clinical studies have measured BDNF concentrations at central and peripheral levels. As a consequence, the aim of this study was to assess BDNF levels in blood plasma and serum to see whether there is a difference in concentrations in patients with suicide behavior when compared to those in controls, using a meta-analysis approach. METHODS:We conducted a systematic review and meta-analysis. The search strategy was performed using three databases: PubMed, EBSCO and ScienceDirect. The meta-analysis included a total of nine case-control studies, six measured the BDNF level in serum and three in plasma in suicide behavior. RESULTS:A decrease in BDNF levels in plasma was observed (d = -0.73, 95% CI -1.42 to -0.03 pg/ml). In the case of serum concentrations, no BDNF differences were encountered between cases and controls (d = 0.09, 95% CI -0.31 to 0.13 ng/ml, p(Q) = .92). CONCLUSIONS:According to the results found in the present meta-analysis, the plasma BDNF level could be suggest as a potential biomarker in suicide behavior. However, since the number of studies included in the analysis is limited, a larger number is necessary to determine conclusively the role of BDNF as a biomarker in suicide behavior.

背景与目标：

BACKGROUND & AIMS: :The progress of the research work of the author and his colleagues on the field of CL-emission generated by pyrogallol oxidation and further application for the direct determination of periodate and indirect or direct determination of other compounds through flow-injection manifold/CL-detection set up is described. The instrumentation used for these studies was a simple flow-injection manifold that provides good reproducibility, coupled to a red sensitive photomultiplier that gives sensitive CL-detection. In addition, recent reports on studies and analytical methods based on CL-emission generated by periodate oxidation by other authors are included.

背景与目标： : 作者及其同事在邻苯三酚氧化产生的CL-排放领域的研究工作进展以及通过流动注射歧管/CL-检测设置直接用于高碘酸盐的直接测定和间接或直接测定其他化合物的进一步应用。用于这些研究的仪器是一个简单的流动注入歧管，可提供良好的再现性，并与可进行灵敏CL检测的红色敏感光电倍增管耦合。此外，还包括有关其他作者基于高碘酸盐氧化产生的CL排放的研究和分析方法的最新报告。

BACKGROUND & AIMS: :We cloned the streptolysin O gene from the Streptococcus pyogenes genome and tested the possibility of using it as an anticancer reagent. Transient transfection of the streptolysin O gene efficiently killed 293T cells after 12 hours of transfection as determined by lactate dehydrogenase release and propidium iodide uptake. No caspase activity was observed and necrosis was prominent during streptolysin O-induced cell death. Biochemical analysis of streptolysin O protein revealed that the deletion of only 5 amino acids from the COOH-terminal region of streptolysin O, which is essential for cholesterol binding activity, abolished its cell-killing activity, whereas the NH2-terminal region was more resilient, i.e., up to 115 amino acids could be deleted without changing its cell-killing activity. We generated a streptolysin O-expressing adenovirus and injected it into human cervical cancer cell-derived tumors grown in a nude mouse model. Twenty-one days postinjection, the average size of tumors in the streptolysin O adenovirus-injected group was 29.3% of that of the control PBS-treated group. Our results show that the genes of pore-forming toxins, like streptolysin O protein, have the potential to establish a novel class of suicide gene therapeutic reagents.

背景与目标： : 我们从化脓性链球菌基因组中克隆了链球菌溶血素O基因，并测试了将其用作抗癌试剂的可能性。如通过乳酸脱氢酶释放和碘化丙啶摄取所确定的，在转染12小时后，链霉溶血素O基因的瞬时转染有效地杀死了293T细胞。在链球菌溶血素O诱导的细胞死亡期间，未观察到caspase活性，并且坏死明显。链球菌溶血素O蛋白的生化分析表明，对于胆固醇结合活性至关重要的链球菌溶血素O的COOH末端区域仅缺失了5个氨基酸，从而消除了其细胞杀伤活性，而NH2-terminal区域则更具弹性，即，可以在不改变其细胞杀伤活性的情况下删除多达115个氨基酸。我们产生了表达链球菌溶血素O的腺病毒，并将其注射到裸鼠模型中生长的人宫颈癌细胞衍生的肿瘤中。注射后21天，链球菌溶血素O腺病毒注射组的平均肿瘤大小为对照组PBS治疗组的29.3%。我们的结果表明，形成孔的毒素的基因 (如链球菌溶血素O蛋白) 具有建立新型自杀基因治疗试剂的潜力。

BACKGROUND & AIMS: :What is the Best Practice for automated inference in Medical Decision Support for personalized medicine? A known system already exists as Dirac's inference system from quantum mechanics (QM) using bra-kets and bras where A and B are states, events, or measurements representing, say, clinical and biomedical rules. Dirac's system should theoretically be the universal best practice for all inference, though QM is notorious as sometimes leading to bizarre conclusions that appear not to be applicable to the macroscopic world of everyday world human experience and medical practice. It is here argued that this apparent difficulty vanishes if QM is assigned one new multiplication function @, which conserves conditionality appropriately, making QM applicable to classical inference including a quantitative form of the predicate calculus. An alternative interpretation with the same consequences is if every i = radical-1 in Dirac's QM is replaced by h, an entity distinct from 1 and i and arguably a hidden root of 1 such that h2 = 1. With that exception, this paper is thus primarily a review of the application of Dirac's system, by application of linear algebra in the complex domain to help manipulate information about associations and ontology in complicated data. Any combined bra-ket can be shown to be composed only of the sum of QM-like bra and ket weights c(), times an exponential function of Fano's mutual information measure I(A; B) about the association between A and B, that is, an association rule from data mining. With the weights and Fano measure re-expressed as expectations on finite data using Riemann's Incomplete (i.e., Generalized) Zeta Functions, actual counts of observations for real world sparse data can be readily utilized. Finally, the paper compares identical character, distinguishability of states events or measurements, correlation, mutual information, and orthogonal character, important issues in data mining and biomedical analytics, as in QM.

BACKGROUND & AIMS: :We report a case of a Colles' fracture on the arteriovenous fistula forearm of a maintenance hemodialysis patient treated with percutaneous pinning with the aid of Chinese finger trap reduction combined with cavity creation using a pediatric uromatic balloon with calcium phosphate cement augmentation. Five months after surgery, the arteriovenous fistula was patent, and the range of motion, grip strength, and radiographic findings were comparable with a non-arteriovenous fistula forearm. Wrist x-rays showed a complete union of the distal radius with progressive absorption of the calcium phosphate cement.

背景与目标： : 我们报告了一例维持性血液透析患者的动静脉瘘前臂上的colles骨折，该患者在中国手指陷阱复位的帮助下经皮钉扎，并使用小儿尿路球囊和磷酸钙骨水泥增强术建立了腔。手术后五个月，动静脉瘘是专利，其运动范围，握力和影像学表现与非动静脉瘘前臂相当。腕部x射线显示桡骨远端完全结合，磷酸钙水泥逐渐吸收。

BACKGROUND & AIMS: :Autopsy rates remain disturbingly low in nursing homes despite the fact that 1 of 5 deaths occurs in this setting. To determine the autopsy rate for nursing homes, we analyzed all deaths occurring in New York State nursing homes from 1980 to 1984. Of 58,985 nursing home deaths, autopsies were performed in only 499 cases (0.8%). In comparison to the general nursing home population, autopsied residents were more likely to be male and never married and less likely to be widowed. Of 110 practicing nursing home physicians surveyed, 19% believed autopsies had little if any value in the nursing home population, whereas 71% saw autopsy as a valuable tool but rarely requested one. Fewer than 1 in 10 physicians routinely discussed autopsies with patients and/or families before death. Perceived obstacles included the emotional lability of patients and families and a lack of financial reimbursement. Concerns over religious objections, funeral delays, and unnecessary mutilation were cited by fewer than one third of respondents. Facilitation of consent, physician education, and cost sharing may all contribute to enhanced rates of autopsies in the future.

背景与目标： : 尽管5例死亡中有1例发生在这种情况下，疗养院的尸检率仍然低得令人不安。为了确定疗养院的尸检率，我们分析了1984年1980年在纽约州疗养院发生的所有死亡。在58,985例疗养院死亡中，只有499例 (0.8% 例) 进行了尸检。与一般疗养院人口相比，经过尸检的居民更有可能是男性且从未结婚，也不太可能丧偶。在接受调查的110名执业疗养院医生中，19% 人认为尸检对疗养院人群几乎没有价值，而71% 人认为尸检是一种有价值的工具，但很少要求尸检。在死亡前，只有不到十分之一的医生与患者和/或家属进行常规尸检。感知到的障碍包括患者和家人的情绪不安和缺乏经济补偿。不到3分之1的受访者提到了对宗教异议，葬礼延误和不必要的肢解的担忧。同意的便利，医师教育和费用分担都可能有助于将来提高尸检率。

BACKGROUND & AIMS: UNLABELLED:Survival and prognostic factors were analyzed in 315 patients with esophageal cancer undergoing thoracoscopic-assisted esophagectomy (TAE). The 5-year survival rate of 57.8% was satisfactory, indicating the oncological feasibility of TAE. Perioperative outcomes affected overall survival in the whole cohort but not in the subgroup treated with 2 endoscopic stages. OBJECTIVE:To estimate the oncological feasibility of thoracoscopic-assisted esophagectomy (TAE) for esophageal cancer and to clarify the prognostic impact of perioperative factors after TAE. BACKGROUND:Favorable perioperative outcomes of TAE versus open surgery have been demonstrated. However, survival data after TAE in a large cohort are limited, and no information on the prognostic influence of perioperative factors after TAE is available. METHODS:Prospectively collected data for 315 patients undergoing TAE for esophageal cancer were analyzed. Survival was compared with the Kaplan-Meier analysis and Cox regression analysis between 2 surgical approaches: thoracoscopic and hand-assisted laparoscopic esophagectomy (THLE) and thoracoscopic and open laparotomic esophagectomy (TOE). Factors affecting overall survival were identified with Cox multivariate regression analysis in the whole cohort and the THLE subgroup. RESULTS:THLE and TOE were performed in 153 and 162 patients, respectively. The overall 5-year survival of the whole cohort was 57.8%, with no difference between the THLE and the TOE group. Multivariate analysis of the 315 patients identified the following prognostic factors: blood loss, blood transfusion, intensive care unit stay, cardiovascular complications, pathological T and N stages, lymphatic invasion, intramural metastasis, and number of metastatic nodes. In the THLE subgroup, cerebral comorbidity, histological subtype, pathological T stage, and number of metastatic nodes were independent prognostic factors. CONCLUSIONS:TAE was oncologically feasible. Perioperative factors affected survival in the whole cohort, but did not in the THLE subgroup. However, the reduced perioperative factor effect in this subgroup would be small because the survival rates of the 2 surgical approaches were equal.

背景与目标：

BACKGROUND & AIMS: :On an average day in the United States, more than 100 Americans die by suicide; half of these suicides involve the use of firearms. In this ecological study, we used linear regression techniques and recently available state-level measures of suicide attempt rates to assess whether, and if so, to what extent, the well-established relationship between household firearm ownership rates and suicide mortality persists after accounting for rates of underlying suicidal behavior. After controlling for state-level suicide attempt rates (2008-2009), higher rates of firearm ownership (assessed in 2004) were strongly associated with higher rates of overall suicide and firearm suicide, but not with nonfirearm suicide (2008-2009). Furthermore, suicide attempt rates were not significantly related to gun ownership levels. These findings suggest that firearm ownership rates, independent of underlying rates of suicidal behavior, largely determine variations in suicide mortality across the 50 states. Our results support the hypothesis that firearms in the home impose suicide risk above and beyond the baseline risk and help explain why, year after year, several thousand more Americans die by suicide in states with higher than average household firearm ownership compared with states with lower than average firearm ownership.

背景与目标： : 在美国，平均每天有100多名美国人死于自杀; 这些自杀中有一半涉及使用枪支。在这项生态学研究中，我们使用线性回归技术和最近可用的州一级自杀未遂率测量方法来评估家庭枪支拥有率与自杀死亡率之间的良好关系，以及在何种程度上，在考虑了潜在自杀行为的发生率后仍然存在。在控制了州一级的自杀企图率 (2008-2009) 之后，较高的枪支拥有率 (评估2004年) 与较高的总体自杀和枪支自杀率密切相关，但与非枪支自杀无关 (2008-2009)。此外，自杀企图率与枪支拥有率没有显着关系。这些发现表明，枪支拥有率与自杀行为的基本发生率无关，在很大程度上决定了50个州自杀死亡率的变化。我们的结果支持这样的假设，即家庭枪支带来的自杀风险高于和超过基线风险，并有助于解释为什么年复一年，与家庭枪支拥有量低于平均水平的州相比，数千名美国人死于自杀。