BACKGROUND & AIMS: BACKGROUND:Epidemiological studies consistently show low rates of alcohol treatment utilization among individuals with an alcohol use disorder (AUD). However, there is not as great consistency in the characteristics that predict alcohol treatment utilization. METHODS:Using data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we examined attributes associated with treatment utilization among individuals with an AUD. We used stepwise backward selection logistic regression analysis to examine demographic and clinical predictors of treatment utilization, in order to identify opportunities to improve the delivery of services to this population. RESULTS:Only 14.6% of individuals who met lifetime criteria for an AUD reported ever having received alcohol treatment (including self-help group participation). A greater proportion of respondents with both alcohol abuse and dependence (27.9%) reported having received treatment, compared with 7.5% of those with alcohol abuse only and 4.8% of those with alcohol dependence only. Older individuals, men, and those who were divorced, had less education or more lifetime comorbid mood, personality, and drug use disorders were also more likely to have received treatment. CONCLUSIONS:The majority of individuals with an AUD never receive formal alcohol treatment, nor do they participate in self-help groups. Although natural recovery from an AUD is well documented, participation in alcohol treatment is associated with improved outcomes. The data presented here should be taken into account when efforts are made to enhance alcohol treatment utilization.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:There are no direct comparisons of blood glucose values in samples collected with barrier serum tubes (SST) and NaF/potassium oxalate (NaF/KOx) plasma tubes. Collection of samples in SST tubes can offer considerable savings and specimen processing advantages for national level surveys. DESIGN AND METHODS:Serum and plasma samples were collected under 'field conditions' from a single draw of 3692 individuals participating in the Canadian Health Measures Survey. The samples were analyzed retrospectively using the VITROS GLU Slide method (glucose oxidase-based). RESULTS:There was a high rate of hemolysis in the NaF/KOx tubes (86.2%) while hemolysis was infrequently observed with the SST tubes (2%). Comparing only blood draws where no hemolysis was observed in both tubes (n=495; paired t-test) showed no effect of tube type on serum/plasma glucose concentrations. This was also observed when data was restricted to cases when only SST samples were not hemolyzed (n=3546; paired t-test). CONCLUSIONS:These data show that both collection tubes can be used under survey collection and processing conditions to measure glucose with our assay system with no difference in reported results.

背景与目标：

BACKGROUND & AIMS: :This study evaluated the prevalence and factors associated with sleep disturbance in a large cohort of HIV-infected patients across China. A cross-sectional study was conducted among HIV-infected patients on antiretroviral therapy at 20 AIDS clinics. The Pittsburgh Sleep Quality Index was self-administered by subjects. Socio-demographic characteristics, medical history and HIV-related clinical data were collected. 4103 patients had complete data for analysis. Sleep disturbances were observed in 43.1% of patients. Associated factors in multivariable analysis included psychological factors: anxiety (odds ratio [OR], 3.13; 95% confidence interval [CI], 2.44-4.00; P < 0.001), depression (OR, 2.09; 95% CI, 1.70-2.57; P < 0.001), and both anxiety and depression (OR, 5.90; 95% CI, 4.86-7.16; P < 0.001); sociodemographic factors: MSM (OR, 1.26; 95% CI, 1.04-1.52; P = 0.018), being single (OR, 1.45; 95%CI 1.21-1.74; P < 0.001), higher education (OR, 1.25; 95% CI, 1.03-1.53; P = 0.025); and clinical factors: suboptimal adherence (OR,1.51; 95% CI,1.23-1.85; P < 0.001), regimen-switching (OR, 1.94; 95% CI, 1.12-3.35; P = 0.018), and antidepressant use (OR, 1.98; 95% CI, 1.47-2.67; P = 0.044). Prevalence of sleep disturbance is high in this large Chinese cohort. Associated factors appear related to psychological and social-demographic factors. Health workers may consider routinely assessing sleep disturbances among HIV-infected patients, especially in the first three months after HIV diagnosis, and referring for mental health services, which may positively impact adherence to treatment.

背景与目标： : 这项研究评估了中国大量HIV感染患者的患病率和与睡眠障碍相关的因素。在20个艾滋病诊所对接受抗逆转录病毒治疗的HIV感染患者进行了横断面研究。匹兹堡睡眠质量指数由受试者自行管理。收集了社会人口统计学特征，病史和与HIV相关的临床数据。4103患者有完整的数据进行分析。在43.1% 患者中观察到睡眠障碍。多变量分析的相关因素包括心理因素: 焦虑 (优势比 [OR]，3.13; 95% 置信区间 [CI]，2.44-4.00; P  <  0.001)，抑郁 (OR，2.09; 95% CI，1.70-2.57; P  <  0.001)，焦虑和抑郁 (OR，5.90; 95% CI，4.86-7.16; P  <  0.001); 社会人口统计学因素: MSM (OR，1.26; 95% CI，1.04-1.52; P   =   0.018)，单身 (OR，1.45; 95% CI 1.21-1.74; P  <  0.001)，高等教育 (OR， 1.25; 95% CI，1.03-1.53; P   =   0.025); 和临床因素: 次优依从性 (OR，1.51; 95% CI，1.23-1.85; P <  0.001)，方案转换 (OR，1.94; 95% CI，1.12-3.35; P   =   0.018) 和抗抑郁药的使用 (或，1.98; 95% CI，1.47-2.67; P   =   0.044)。在这个庞大的中国人群中，睡眠障碍的患病率很高。相关因素似乎与心理和社会人口因素有关。卫生工作者可以考虑定期评估HIV感染患者的睡眠障碍，尤其是在HIV诊断后的前三个月，并推荐精神卫生服务，这可能会对治疗依从性产生积极影响。

BACKGROUND & AIMS: BACKGROUND:Regulatory bodies including the European Medicines Agency register medications (formulation, route of administration) for specific clinical indications. Once registered, prescription is at clinicians' discretion. Off-label use is beyond the registered use. While off-label prescribing may, at times, be appropriate, efficacy and toxicity data are often lacking. AIM:The aim of this study was to document off-label use policies (including disclosure and consent) in Australian palliative care units and current practices by palliative care clinicians. DESIGN:A national, cross-sectional survey was conducted online following an invitation letter. The survey asked clinicians their most frequent off-label medication/indication dyads and unit policies. Dyads were classified into unregistered, off-label and on-label, and for the latter, whether medications were nationally subsidised. SETTING/PARTICIPANTS:All Australian palliative medicine Fellows and advanced trainees. RESULTS:Overall, 105 clinicians responded (53% response rate). The majority did not have policies on off-label medications, and documented consent rarely. In all, 236 medication/indication dyads for 36 medications were noted: 45 dyads (19%) were for two unregistered medications, 118 dyads (50%) were for 26 off-label medications and 73 dyads (31%) were for 12 on-label medications. CONCLUSIONS:Off-label prescribing with its clinical, legal and ethical implications is common yet poorly recognised by clinicians. A distinction needs to be made between where quality evidence exists but registration has not been updated by the pharmaceutical sponsor and the evidence has not been generated. Further research is required to quantify any iatrogenic harm from off-label prescribing in palliative care.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Breast-feeding is associated with maternal health, such as electrolyte metabolism, lipid profile and body component change. The aim of this study was to evaluate the relationship between duration of breast-feeding and obesity in postmenopausal women. METHODS:We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012, a cross-sectional study in a Korean population. A total of 6621 postmenopausal women were analyzed. RESULTS:Body mass index and waist circumference were greater in women who had breast-fed for 6 months or more than in those who had not (BMI: 23.7±0.1 vs 24.5±0.1, P<0.0001; WC: 80.6±0.4 vs 82.8±0.3, P<0.001). This association persisted after adjustment for confounding factors (BMI: odds ratio[OR]1.54, 95% confidence interval[CI] 1.19-2.0; WC: OR1.67, 95% CI 1.29-2.17). The duration of breast-feeding tended to increase with increasing BMI and WC (P for trend, 0.001 for each). The proportions of women with greater BMI and WC increased with increasing duration of breast-feeding (27.3% in ≤6 months vs 41.2% in >18months, P<0.0001). CONCLUSION:The results of this study suggest that prolonged breast-feeding may be associated with greater BMI and WC among postmenopausal women.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:While the incidence of discontinuation events in controlled studies of serotonin reuptake inhibitors ranges between 34.5% and 86%, only a small number of discontinuation reactions are reported to national data bases of spontaneously reported adverse drug reactions. It was hypothesized that the disparity was due to lack of knowledge amongst physicians about the potential for antidepressant discontinuation reactions.

METHOD:Therefore, a questionnaire was mailed to 100 psychiatrists and 100 general practitioners (GPs) in northeast England to assess the knowledge base and to validate this assumption.

RESULTS:Fifty psychiatrists (50%) and 53 GPs (53%) responded to the questionnaire. Of the respondents, 36 (72%) of the psychiatrists and 16 (30%) of the GPs were aware that patients may experience antidepressant discontinuation events; 33 (66%) psychiatrists and 22 (42%) GPs had had experience with patients who had discontinuation symptoms; and 10 (20%) psychiatrists and 9 (17%) GPs said they always caution patients about the possibility of discontinuations events.

CONCLUSION:According to the results of the survey, a sizable minority of physicians denied being confidently aware of the existence of antidepressant withdrawal symptoms. Education about discontinuation reactions, including the hallmark features, symptoms, and course, is needed for both psychiatrists and family practice physicians.

背景与目标： 背景 : 虽然5-羟色胺再摄取抑制剂的对照研究中停药事件的发生率在34.5% 至86% 之间，但只有少量停药反应被报告给自发报告的药物不良反应的国家数据库。假设这种差异是由于医师缺乏抗抑郁药中止反应的潜在知识。
方法 : 因此，向英格兰东北部的100名精神科医生和100名全科医生 (gp) 邮寄了一份问卷，以评估知识库并验证这一假设。结果: 50名精神科医生 (50% 名) 和53名全科医生 (53% 名) 回答了问卷。在受访者中，36 (72%) 名精神科医生和16 (30%) 名全科医生意识到患者可能经历抗抑郁药停药事件; 33 (66%) 名精神科医生和22 (42%) 名全科医生有过停药症状患者的经历; 10名 (20% 名) 精神科医生和9名 (17% 名) 全科医生表示，他们总是提醒患者停药事件的可能性。
结论 : 根据调查结果，相当一部分医生否认自信地意识到抗抑郁药戒断症状的存在。精神科医生和家庭执业医师都需要对停药反应进行教育，包括特征，症状和病程。

BACKGROUND & AIMS: This paper reports on a public authority's decision to "make" or "buy" mental health services. Data come from key informant interviews with California county contract or program managers. The questionnaire measures the extent of contracting and the importance of factors that are hypothesized to affect the relative costs of contracting. The percent of contracting by programs ranges from zero to 100, averaging 41%. Sixty-two percent of rural programs perceive little or no competition for public mental health contracts, and contract significantly less than urban programs. The extent of contracting is related to economic and public organizational factors.

背景与目标： 本文报告了公共机构 “制造” 或 “购买” 精神卫生服务的决定。数据来自对加利福尼亚县合同或计划经理的关键线人采访。问卷测量了合同的程度以及假设会影响合同相对成本的因素的重要性。按项目签订合同的百分比从零到100，平均41%。60 2% 的农村计划对公共精神卫生合同的竞争很少或没有竞争，并且合同明显少于城市计划。缔约的程度与经济和公共组织因素有关。

BACKGROUND & AIMS: BACKGROUND:In recent years, decision makers in Canada and elsewhere have expressed a desire for more explicit, evidence-based approaches to priority setting. To achieve this aim within health care organizations, knowledge of both the organizational context and stakeholder attitudes towards priority setting are required. The current work adds to a limited yet growing body of international literature describing priority setting practices in health organizations. METHODS:A qualitative study was conducted using in-depth, face-to-face interviews with 25 key decision makers of the Provincial Health Services Authority (PHSA) of British Columbia. Major themes and sub-themes were identified through content analysis. RESULTS:Priorities were described by decision makers as being set in an ad hoc manner, with resources generally allocated along historical lines. Participants identified the Strategic Plan and a strong research base as strengths of the organization. The main areas for improvement were a desire to have a more transparent process for priority setting, a need to develop a culture which supports explicit priority setting, and a focus on fairness in decision making. Barriers to an explicit allocation process included the challenge of providing specialized services for disparate patient groups, and a lack of formal training in priority setting amongst decision makers. CONCLUSION:This study identified factors important to understanding organizational context and informed next steps for explicit priority setting for a provincial health authority. While the PHSA is unique in its organizational structure in Canada, lessons about priority setting should be transferable to other contexts.

背景与目标：

BACKGROUND & AIMS: UNLABELLED:Infertility and its treatment can be a very stressful experience. Some countries have legislation governing the provision of counselling for assisted conception treatments. All licensed IVF clinics in the UK are required to offer patients counselling. OBJECTIVES:To determine the proportion of patients who were offered counselling, the proportion of those who then received counselling, how useful they found it, and to establish the main reasons why patients may opt not to receive counselling. METHODS:An internet-based survey of users of an independent infertility website. Two-hundred-and-forty-four patients participated in the survey, of which 62% received treatment in the UK. CONCLUSIONS:Seventy-three per cent of all couples were offered, or obliged, to receive counselling compared to 91% of those patients treated in the UK. Of the patients who took part in the survey, only 30% received counselling; over half of those patients found it either 'very helpful' or 'helpful'. No differences were observed in the perceived usefulness of counselling, comparing those patients who were offered, and chose to receive, counselling versus those who received mandatory counselling. In patients who did not receive counselling, the main reasons cited were: 'felt I can cope on my own' (37%), 'counselling was not offered' (21%), and 'did not think it would be beneficial' (15%).

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Professional organizations have issued guidelines recommending breast cancer screening for women 50 years of age. OBJECTIVE:This study examines the percent of U.S. primary care physicians who report breast cancer screening practices that are not consistent with guidelines, and the characteristics of physicians who reported offering extra test modalities. DESIGN:We analyzed a subset of a 2008 cross-sectional Women's Health Care survey sent to primary care physicians randomly selected from the national American Medical Association (AMA) Physician Masterfile. A subset of physicians received a survey that presented a vignette of a health maintenance visit for an asymptomatic 51-year-old woman who was not at high risk for breast cancer. Responses were weighted to represent physicians nationally. PARTICIPANTS:1,654 U.S. family physicians, general internists, and obstetrician-gynecologists under age 65, who practiced in office or hospital based settings (62.8 % response rate). After exclusions, 553 study physicians remained for analysis. MAIN MEASURE:Physician self-report of breast cancer screening practices that are not consistent with the recommendations of the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), defined as almost always offering mammography. KEY RESULTS:36.0 % (95 % CI: 31.8 %-40.5 %) of physicians reported offering breast cancer screening tests inconsistent with national guidelines, with most offering extra tests (magnetic resonance imaging [MRI] and/or ultrasound) (33.2 %, 95 % CI 29.1 %-37.6 %). In adjusted analysis, risk-averse physicians and those who believed in the clinical effectiveness of MRI were more likely to offer extra breast cancer screening tests. CONCLUSIONS:Physicians often report offering breast cancer screening test modalities beyond those recommended for a 51-year-old woman. Strategies, such as academic detailing regarding appropriate use of technology and provision of clinical decision support for breast cancer screening, could decrease overuse of resources.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Cardiovascular patients are likely to have an impaired health-related quality of life (HRQoL) due to functional and psycho-social limitations. The main objective of this study was to assess the distribution of HRQoL scores in coronary heart disease (CHD) patients across 22 European countries and to identify factors associated with the variation between patients. METHODS:Data from the EUROASPIRE III survey (European Action on Secondary and Primary Prevention by Intervention to Reduce Events), on 8734 patients, were used. Patients with a diagnosis of CHD (coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) or myocardial ischemia) were interviewed and examined at least 6 months after their acute coronary event. Quality of life of each patient was measured using 2 standardized questionnaires: the EuroQoL-5D (EQ-5D) and the 12-item short-form health survey (SF-12v2). RESULTS:HRQoL values differed significantly across countries. Lower HRQoL estimates were found in women, older patients, less educated patients, patients with myocardial infarction or ischemia as recruiting diagnosis, patients with a history of stroke and patients who suffered from a recurring CHD event. In addition, HRQoL was significantly associated with current smoking, central obesity, lack of exercise and inappropriate HbA1c control in patients with diabetes. Furthermore the number of risk factors is inversely associated with HRQoL. CONCLUSION:Overall, a large heterogeneity was observed in HRQoL values between countries and patient groups. There seems to be a significant association between quality of life and patient characteristics with lifestyle risk factors as important determinants of HRQoL.

背景与目标：

BACKGROUND & AIMS: :The World Health Organization European Region has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, resulting in many vulnerable children being exposed each year. Evidence for preventive therapy following MDR-TB exposure is limited and current guidance is conflicting. An internet-based survey was performed to determine clinical practice in this region. Seventy-two clinicians from 25 countries participated. Practices related to screening and decision-making were highly variable. Just over half provided preventive therapy for children exposed to MDR-TB; the only characteristic associated with provision was practice within the European Union (adjusted OR 4.07, 95%CI 1.33-12.5).

背景与目标： : 世界卫生组织欧洲地区是世界上耐多药结核病 (mdr-tb) 发病率最高的地区之一，每年都有许多易受感染的儿童。耐多药结核病暴露后预防性治疗的证据有限，目前的指导意见存在矛盾。进行了基于互联网的调查，以确定该地区的临床实践。来自25个国家的72名临床医生参加了会议。与筛选和决策相关的实践变化很大。刚刚超过一半的人为暴露于耐多药结核病的儿童提供了预防性治疗; 与提供相关的唯一特征是欧盟内部的实践 (调整或4.07，95% CI 1.33-12.5)。

BACKGROUND & AIMS: AIM:To explore nursing students' experiences of patient safety and peer reporting using hypothetical medication administration scenarios. BACKGROUND:Pre-registration nurse training is tasked with the preparation of students able to provide safe, high quality nursing care. How students' contextualise teaching related to patient safety, risk recognition and management in the clinical setting is less clear. METHOD:A total of 321 third year students enrolled in the final semester of an adult branch pre-registration nursing programme in 2011 in a UK university were surveyed. Using free texts, the questionnaire contained hypothetical medication administration scenarios where patient safety could potentially be at risk. Students' qualitative responses were analysed using thematic analysis. FINDINGS:The response rate was 58% (n = 186). Four themes were identified from the scenarios: (1) Protecting patient safety (2) Willingness to compromise; (3) Avoiding responsibility; (4) Consequences from my actions. CONCLUSION:The findings underscore the importance of contextual teaching about risk management, practical techniques for error management and leadership for optimal patient safety in nursing curricula. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers are role models for nursing students in the clinical setting. Nursing management must lead, by example, the patient safety agenda in the clinical setting.

背景与目标：

BACKGROUND & AIMS: :We investigated immunoglobulin G (IgG) subclass antibody responses to Plasmodium falciparum merozoite surface protein 1 (MSP-1) and MSP-2 in 112 malaria-exposed subjects in Brazil. IgG3 polarization was primarily epitope driven, being little affected by cumulative or current exposure to malaria and not affected by a subject's age and Fcgamma receptor IIA genotype.

背景与目标： : 我们调查了巴西112名疟疾暴露受试者对恶性疟原虫裂殖子表面蛋白1 (MSP-1) 和MSP-2的免疫球蛋白G (IgG) 亚类抗体反应。IgG3极化主要是表位驱动的，几乎不受累积或当前暴露于疟疾的影响，并且不受受试者年龄和Fcgamma受体IIA基因型的影响。

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。