• 【津巴布韦哈特克利夫社区对与高血压和2型糖尿病相关的饮食需求的认识。】 复制标题 收藏 收藏
    DOI:10.1186/s12889-019-8030-4 复制DOI
    作者列表:Gonde LL,Chimbari MJ
    BACKGROUND & AIMS: BACKGROUND:Diet is an important modifiable risk factor for non-communicable diseases (NCDs) like hypertension (HTN) and type 2 diabetes mellitus (T2DM). A NCD is a disease that cannot be transmitted from person to person. Dietary risk factors account for 5.8% of all-cause mortality in Sub-Saharan Africa (SSA). There has been an increase in the consumption of 'westernized 'diets in SSA. The westernized diets consumed in low-income countries are usually high in salt content, fatty, processed and fast foods; and hence accelerate the development of HTN and T2DM. Previous studies carried out in Zimbabwe showed low levels of knowledge and awareness of HTN and T2DM; and the dietary needs for patients with those conditions. The aim of this study was to explore the dietary habits and awareness of HTN and T2DM of both males and females in a high-density area (HDA) of Zimbabwe. METHODS:We conducted household-based cross-sectional study in a high density area of Hatcliffe, which has a population of close to 50,000 residents. Face to face interviews were conducted using hand-held mobile devices loaded with KoBo Toolbox. We selected two consenting adults, a male and female, from every fourth household in selected areas of Hatcliffe. RESULTS:In this study all the 492 participants that were interviewed responded. Eighty eight point 6% (88.6%) of the participants in the study did not know if they were hypertensive or not. In addition, 91.7% of the participants had never voluntarily checked for hypertension. Similarly, 97.6% of the participants did not know if they had T2DM or not. Ninety eight percent (98%) of the participants had not voluntarily checked their blood glucose level. CONCLUSIONS:The majority of the participants in the study were not aware if they had HTN or T2DM. The participants in the study perceived that the salt they consume is the right quantity. There is a high consumption of vegetable oil in most meals prepared.
    背景与目标: 背景:饮食是非传染性疾病(NCD)(例如高血压(HTN)和2型糖尿病(T2DM))的重要可修正危险因素。非传染性疾病是一种无法在人与人之间传播的疾病。饮食风险因素占撒哈拉以南非洲地区(SSA)所有原因死亡率的5.8%。 SSA中“西餐”饮食的消费有所增加。在低收入国家消费的西式饮食通常含盐量高,脂肪多,加工食品和快餐食品高;从而加快了HTN和T2DM的发展。以前在津巴布韦进行的研究表明,他们对HTN和T2DM的知识和意识水平较低。以及患有这些疾病的患者的饮食需求。这项研究的目的是探讨津巴布韦高密度地区(HDA)男性和女性的饮食习惯和对HTN和T2DM的认识。
    方法:我们在人口接近50,000的Hatcliffe高密度地区进行了基于家庭的横断面研究。面对面访问是使用装有KoBo Toolbox的手持移动设备进行的。我们从哈特克利夫(Hatcliffe)选定地区的每四个家庭中选出两名同意的成年人,一男一女。
    结果:在这项研究中,所有被采访的492名参与者都做出了回应。该研究的参与者中有88%的6%(88.6%)不知道自己是否患有高血压。此外,有91.7%的参与者从未自愿检查过高血压。同样,有97.6%的参与者不知道他们是否患有T2DM。百分之九十八(98%)的参与者没有自愿检查他们的血糖水平。
    结论:该研究的大多数参与者不知道他们是否患有HTN或T2DM。研究参与者认为他们食用的盐是正确的数量。大多数准备的饭菜中植物油的消耗量很大。
  • 【津巴布韦的森林保护区治理:需要远离长期被当地社区排斥的历史。】 复制标题 收藏 收藏
    DOI:10.1016/j.jenvman.2017.05.006 复制DOI
    作者列表:Mutekwa VT,Gambiza J
    BACKGROUND & AIMS: :In this literature review based paper we explored the concept of exclusion of local communities from accessing resources in forest protected areas (FPAs) in Zimbabwe. We discussed the colonial and post-colonial forms, causes and mechanisms of exclusion and their social, economic and ecological outcomes. We examined the range of powers embodied in and exercised through various mechanisms, processes and social relations and their impact on local communities' access to FPA resources and associated benefits along the historical trajectory of forest governance in Zimbabwe. Results showed that the forms and extent of exclusion changed over time in tandem with the shifting political and economic landscape. During the colonial period, it was total exclusion whereby people were evicted from forest land as well as being denied access to basic resources for their livelihoods. Local communities' access to low value FPA resources improved during the post-colonial period but access to high value resources like commercial timber as well as sharing income benefits derived from FPA commercial activities remained a pipe dream. Regulation, legitimation, force and markets constituted the mixture of the power elements that FPA governing authorities used to exclude local communities. These powers remained intact despite attempts at collaborative governance in the 1990s. However, from the year 2000, local communities expressed their dissatisfaction with the centralised exclusionary governance system by invading the FPAs rendering them ungovernable. There is therefore a need for policy reform within the FPA sector to improve the current dire situation.
    背景与目标: :在这份基于文献综述的论文中,我们探讨了将当地社区排除在津巴布韦森林保护区(FPA)资源之外的概念。我们讨论了殖民和殖民后的形式,排斥的原因和机制及其社会,经济和生态后果。我们研究了各种机制,过程和社会关系所体现和行使的权力范围,以及它们对津巴布韦森林治理的历史轨迹对当地社区获取FPA资源及相关利益的影响。结果表明,排斥的形式和程度随着时间的推移随着政治和经济格局的变化而变化。在殖民时期,完全被排斥在外,使人们被逐出林地,并被剥夺了谋生的基本资源。在后殖民时期,当地社区获得低价值FPA资源的途径有所改善,但是获得高价值资源(如商业木材)以及分享FPA商业活动所带来的收入收益仍然是梦dream以求的事情。规章,合法性,武力和市场构成了联邦警察管理当局用来排斥当地社区的权力要素的混合体。尽管在1990年代尝试进行协作治理,但这些权力仍然完好无损。但是,从2000年开始,当地社区通过入侵FPA使其无法管理而对集中式排他性治理系统表示不满。因此,需要在FPA部门内进行政策改革,以改善当前的严峻形势。
  • 【一种基于运动的干预措施,以提高青少年男学生自愿接受包皮环切术的摄取:来自津巴布韦布拉瓦约的MCUTS 2簇随机试验的结果。】 复制标题 收藏 收藏
    DOI:10.1097/QAI.0000000000001046 复制DOI
    作者列表:Kaufman ZA,DeCelles J,Bhauti K,Hershow RB,Weiss HA,Chaibva C,Moyo N,Mantula F,Hatzold K,Ross DA
    BACKGROUND & AIMS: BACKGROUND:Mathematical models suggest that 570,000 HIV infections could be averted between 2011 and 2025 in Zimbabwe if the country reaches 80% voluntary medical male circumcision (VMMC) coverage among 15- to 49-year-old male subjects. Yet national coverage remains well below this target, and there is a need to evaluate interventions to increase the uptake. METHODS:A cluster-randomized trial was conducted to assess the effectiveness of Make-The-Cut-Plus (MTC+), a single, 60-minute, sport-based intervention to increase VMMC uptake targeting secondary school boys (14-20 years). Twenty-six schools in Bulawayo, Zimbabwe, were randomized to either receive MTC+ at the start (intervention) or end (control) of a 4-month period (March to June 2014). VMMC uptake over these 4 months was measured via probabilistic matching of participants in the trial database (n = 1226 male participants; age, 14-20 years; median age, 16.2 years) and the registers in Bulawayo's 2 free VMMC clinics (n = 5713), using 8 identifying variables. RESULTS:There was strong evidence that the MTC+ intervention increased the odds of VMMC uptake by approximately 2.5 fold (odds ratio = 2.53; 95% confidence interval, 1.21 to 5.30). Restricting to participants who did not report being already circumcised at baseline, MTC+ increased VMMC uptake by 7.6% (12.2% vs 4.6%, odds ratio = 2.65; 95% confidence interval, 1.19 to 5.86). Sensitivity analyses related to the probabilistic matching did not change these findings substantively. The number of participants who would need to be exposed to the demand creation intervention to yield one additional VMMC client was 22.7 (or 13.2 reporting not already being circumcised). This translated to approximately US dollar 49 per additional VMMC client. CONCLUSIONS:The MTC+ intervention was an effective and cost-effective strategy for increasing VMMC uptake among school-going adolescent male subjects in Bulawayo.
    背景与目标: 背景:数学模型表明,如果津巴布韦在15岁至49岁的男性受试者中实现自愿性男性包皮环切术(VMMC)覆盖率达到80%,则该国在2011年至2025年之间可以避免570,000例HIV感染。然而,全国覆盖率仍远低于这一目标,因此有必要评估干预措施以增加吸收。
    方法:进行一项整群随机试验,以评估Make-The-Cut-Plus(MTC)的有效性,这是一项以运动为基础的单项60分钟干预措施,旨在增加针对中学生(14-20岁)的VMMC摄入量。津巴布韦布拉瓦约的26所学校被随机分配在4个月(2014年3月至2014年6月)开始(干预)或结束(控制)期间接受MTC。通过试验数据库中参与者(n = 1226名男性参与者;年龄14-20岁;中位年龄16.2岁)的参与者的概率匹配以及Bulawayo的2家免费VMMC诊所中的寄存器(n = 5713)来测量这4个月内VMMC的摄入量),使用8个识别变量。
    结果:有力的证据表明,MTC干预使VMMC摄取的几率增加了约2.5倍(优势比= 2.53; 95%的置信区间为1.21至5.30)。仅限于那些尚未报告已接受基线割礼的参与者,MTC将VMMC的摄取增加了7.6%(12.2%对4.6%,优势比= 2.65; 95%的置信区间为1.19至5.86)。与概率匹配相关的敏感性分析并没有实质性地改变这些发现。需要进行需求创建干预以产生一名额外的VMMC客户的参与者人数为22.7(或尚未割包皮的13.2报告)。这相当于每个额外的VMMC客户大约49美元。
    结论:MTC干预是增加布拉马约州在校青少年男性受试者VMMC摄入量的有效且具有成本效益的策略。
  • 【在津巴布韦引入紧急环颈切开术模拟培训有助于挽救两个生命。】 复制标题 收藏 收藏
    DOI:10.1017/S0022215116008719 复制DOI
    作者列表:Avnstorp MB,Jensen PV,Dzongodza T,Matinhira N,Chidziva C,Melchiors J,Von Buchwald C
    BACKGROUND & AIMS: BACKGROUND:In developing countries with limited access to ENT services, performing emergency cricothyroidotomy in patients with upper airway obstruction may be a life-saving last resort. An established Danish-Zimbabwean collaboration of otorhinolaryngologists enrolled Zimbabwean doctors into a video-guided simulation training programme on emergency cricothyroidotomy. This paper presents the positive effect of this training, illustrated by two case reports. CASE REPORTS:A 56-year-old female presented with upper airway obstruction due to a rapidly progressing infectious swelling of the head and neck progressing to cardiac arrest. Cardiopulmonary resuscitation was initiated and a secure surgical airway was established via an emergency cricothyroidotomy, saving the patient. A 70-year-old male presented with upper airway obstruction secondary to intubation for an elective procedure. When extubated, the patient exhibited severe stridor followed by respiratory arrest. Re-intubation attempts were unsuccessful and emergency cricothyroidotomy was performed to secure the airway, preserving the life of the patient. CONCLUSION:Emergency cricothyroidotomy training should be considered for all surgeons, anaesthetists and, eventually, emergency and recovery room personnel in developing countries. A video-guided simulation training programme on emergency cricothyroidotomy in Zimbabwe proved its value in this regard.
    背景与目标: 背景:在获得耳鼻喉科服务机会有限的发展中国家,对上呼吸道阻塞的患者进行紧急环颈切开术可能是挽救生命的最后选择。丹麦-津巴布韦的耳鼻喉科医生建立了良好的合作关系,使津巴布韦的医生参加了有关紧急环颈切开术的视频指导模拟培训计划。本文通过两个案例报告展示了这种培训的积极效果。
    病例报告:一名56岁的女性由于快速发展的头颈部传染性肿胀发展为心脏骤停而出现上呼吸道阻塞。开始进行心肺复苏术,并通过紧急环颈切开术建立了安全的手术气道,从而挽救了患者的生命。一名70岁的男性因插管手术而出现继发于插管的上呼吸道阻塞。拔管时,患者表现出严重的喘鸣,随后呼吸停止。重新插管尝试未成功,并进行了紧急环颈切开术以确保气道安全,从而挽救了患者的生命。
    结论:应考虑对发展中国家的所有外科医生,麻醉师,以及最终急诊室和恢复室人员进行紧急环颈切开术培训。在津巴布韦进行紧急环颈切开术的视频指导模拟培训计划证明了其在这方面的价值。
  • 【同伴教育是否超越了提供生殖健康信息的范围?在津巴布韦的布拉瓦约和达尔文山进行队列研究。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2019-034436 复制DOI
    作者列表:Mangombe A,Owiti P,Madzima B,Xaba S,Makoni TM,Takarinda KC,Timire C,Chimwaza A,Senkoro M,Mabaya S,Samuelson J,Ameyan W,Tapera T,Zwangobani N,Tripathy JP,Kumar AMV
    BACKGROUND & AIMS: OBJECTIVE:Peer education is an intervention within the voluntary medical male circumcision (VMMC)-adolescent sexual reproductive health (ASRH) linkages project in Bulawayo and Mount Darwin, Zimbabwe since 2016. Little is known if results extend beyond increasing knowledge. We therefore assessed the extent of and factors affecting referral by peer educators and receipt of HIV testing services (HTS), contraception, management of sexually transmitted infections (STIs) and VMMC services by young people (10-24 years) counselled. DESIGN:A cohort study involving all young people counselled by 95 peer educators during October-December 2018, through secondary analysis of routinely collected data. SETTING:All ASRH and VMMC sites in Mt Darwin and Bulawayo. PARTICIPANTS:All young people counselled by 95 peer educators. OUTCOME MEASURES:Censor date for assessing receipt of services was 31 January 2019. Factors (clients' age, gender, marital and schooling status, counselling type, location, and peer educators' age and gender) affecting non-referral and non-receipt of services (dependent variables) were assessed by log-binomial regression. Adjusted relative risks (aRRs) were calculated. RESULTS:Of the 3370 counselled (66% men), 65% were referred for at least one service. 58% of men were referred for VMMC. Other services had 5%-13% referrals. Non-referral for HTS decreased with clients' age (aRR: ~0.9) but was higher among group-counselled (aRR: 1.16). Counselling by men (aRR: 0.77) and rural location (aRR: 0.61) reduced risks of non-referral for VMMC, while age increased it (aRR ≥1.59). Receipt of services was high (64%-80%) except for STI referrals (39%). Group counselling and rural location (aRR: ~0.52) and male peer educators (aRR: 0.76) reduced the risk of non-receipt of VMMC. Rural location increased the risk of non-receipt of contraception (aRR: 3.18) while marriage reduced it (aRR: 0.20). CONCLUSION:We found varying levels of referral ranging from 5.1% (STIs) to 58.3% (VMMC) but high levels of receipt of services. Type of counselling, peer educators' gender and location affected receipt of services. We recommend qualitative approaches to further understand reasons for non-referrals and non-receipt of services.
    背景与目标: 目的:同伴教育是自2016年以来在津巴布韦布拉瓦约和芒特达尔文市开展的自愿性男性包皮环切术(VMMC)-青少年性生殖健康(ASRH)链接项目中的一项干预措施。除结果之外,人们对结果的了解还很少。因此,我们评估了受同伴教育者推荐和接受HIV检测服务(HTS),避孕,性传播感染管理(STIs)和年轻人(10-24岁)的VMMC服务的影响程度和因素。
    设计:一项队列研究,在2018年10月至12月期间,由95位同伴教育者对所有年轻人进行了咨询,对常规收集的数据进行了二次分析。
    地点:达尔文山和布拉瓦约的所有ASRH和VMMC站点。
    参加者:所有年轻人均受到95位同伴教育者的指导。
    观察指标:评估接受服务的截止日期是2019年1月31日。影响未推荐和不接受推荐的因素(服务对象的年龄,性别,婚姻和就学状况,咨询类型,位置以及同伴教育者的年龄和性别)。服务(因变量)通过对数二项回归进行评估。计算调整后的相对风险(aRRs)。
    结果:在3370名接受咨询的人(66%的男性)中,有65%的人至少接受了一次服务。 58%的男性因VMMC而被转诊。其他服务的推荐率为5%-13%。 HTS的非推荐人随着客户年龄的增长而减少(aRR:〜0.9),但在团体咨询的情况下更高(aRR:1.16)。男性(aRR:0.77)和农村地区(aRR:0.61)的咨询减少了VMMC不推荐的风险,而年龄增加了(AMR≥1.59)。服务的接收率很高(64%-80%),另外还有STI推荐(39%)。团体咨询和在农村地区居住(aRR:〜0.52)和男性同伴教育者(aRR:0.76)减少了未接受VMMC的风险。农村地区增加未接受避孕的风险(aRR:3.18),而婚姻减少的风险(aRR:0.20)。
    结论:我们发现推荐率从5.1%(STIs)到58.3%(VMMC)不等,但服务接收率很高。咨询的类型,同伴教育者的性别和受地点影响的服务获得情况。我们建议您使用定性方法,以进一步了解不推荐和不接受服务的原因。
  • 【津巴布韦农村地区两项基于人口的连续调查得出的证据表明,艾滋病毒预防行为随时间变化(2007年至2009年)。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-3156.2012.02999.x 复制DOI
    作者列表:Langhaug L,Buzdugan R,Copas A,Dirawo J,Benedict C,Mundida O,Manyenya S,Woelk G,Cowan F
    BACKGROUND & AIMS: OBJECTIVE:To assess reported HIV knowledge and attitudes, sexual behaviours and HIV testing in Zimbabwe. METHODS:Representative household surveys of all 18-24 year olds and a proportion of 25-44 year olds were conducted in six purposefully selected rural districts in two provinces in 2007 and 2009. Both surveys used the same methods and questionnaires. We compared differences in reported HIV knowledge, sexual behaviours and HIV testing, controlling for differences in socio-demographics at baseline, using cross-tabulations and multivariate regression analyses. RESULTS:Analysis was restricted to districts included in both baseline (n = 1891) and mid-term (n = 2746) surveys. Comparisons indicate increased reports of HIV knowledge (35%vs. 22% had high knowledge) and more favourable individual attitudes towards HIV. There was an increase in reported HIV testing (men: 41%vs. 31%, women: 55%vs. 36%) and condom use (men: adjusted odds ratio (AOR) = 1.35, women: AOR = 1.22) and a decrease in number of sexual partners (men: 67%vs. 49% reported 1 partner/previous 6 months, women: 77%vs. 68%). CONCLUSIONS:As Zimbabwe continues to document declines in HIV prevalence, this analysis offers insight into recent and continuing positive changes in knowledge, attitudes and behaviours among the rural population.
    背景与目标: 目的:评估津巴布韦报道的艾滋病毒知识和态度,性行为以及艾滋病毒检测。
    方法:在2007年和2009年,在两个省的六个有针对性地选择的农村地区中,对所有18-24岁年龄段和一部分25-44岁年龄段的代表家庭进行了调查。两次调查使用的方法和问卷均相同。我们使用交叉表和多元回归分析比较了报告的艾滋病毒知识,性行为和艾滋病毒检测的差异,控制了基线时社会人口统计学的差异。
    结果:分析仅限于基线(n = 1891)和中期(n = 2746)调查中包括的地区。比较表明,关于艾滋病毒知识的报道有所增加(35%的人对22%的人具有较高的知识),并且个人对艾滋病毒的态度更加有利。报告的艾滋病毒检测率有所增加(男性:41%vs。31%,女性:55%vs.36%)和使用安全套(男性:调整后的优势比(AOR)= 1.35,女性:AOR = 1.22)和性伴侣数量减少(男性:67%vs. 49%,报告有1个伴侣/之前的6个月,女性:77%vs. 68%)。
    结论:随着津巴布韦继续记录艾滋病毒感染率下降的情况,该分析提供了对农村人口知识,态度和行为的近期和持续积极变化的见识。
  • 【男性包皮环切术预防艾滋病:南非和津巴布韦的医疗服务提供者的临床实践和态度。】 复制标题 收藏 收藏
    DOI:10.1097/OLQ.0b013e31824f9eaf 复制DOI
    作者列表:Sheldon WR,Nhemachena T,Blanchard K,Chipato T,Ramjee G,Trussell J,McCulloch CE,Blum M,Harper CC
    BACKGROUND & AIMS: BACKGROUND:This study aimed to document the clinical practices and attitudes of health care providers in South Africa and Zimbabwe on male circumcision for human immunodeficiency virus (HIV) prevention. METHODS:We conducted national surveys of physicians and nurses in both countries in 2008-2009 (N = 1444). Data on male circumcision for HIV prevention were analyzed; outcomes were patient counseling, provision of services, and desire for training. We used multivariable logistic regression to examine associations between these outcomes and clinician, practice, and attitudinal variables. RESULTS:Overall, 57% of clinicians reported counseling male patients on male circumcision, 17% were offering services (49% referrals), and 61% desired training. In the multivariable analyses, provision of services was more common in South Africa (P ≤ 0.001) but desire for training higher in Zimbabwe (P ≤ 0.01). Provision of services was highest among physicians (P ≤ 0.01) and in hospital settings (P ≤ 0.001). However, nurses had greater desire for training (P ≤ 0.05) as did younger clinicians (P ≤ 0.001). Clinicians in rural and clinic settings were just as likely to express training interest. Clinician attitudes that patients would be upset due to cultural beliefs and would increase risky behaviors were associated with less counseling and service provision (P ≤ 0.05). CONCLUSIONS:Many clinicians in South Africa and Zimbabwe showed willingness to integrate new HIV prevention evidence into practice and to become trained to offer the procedure to patients. Results suggest that both countries should consider involving nurses in male circumcision for HIV prevention, including those in rural areas, and should help clinicians to address cultural concerns.
    背景与目标: 背景:本研究旨在记录南非和津巴布韦的医疗服务提供者对男性包皮环切术预防人类免疫缺陷病毒(HIV)的临床实践和态度。
    方法:我们在2008-2009年对这两个国家的医师和护士进行了全国调查(N = 1444)。分析了男性包皮环切术预防艾滋病的数据;结果是患者咨询,服务提供和培训需求。我们使用多元逻辑回归分析了这些结果与临床医生,实践和态度变量之间的关联。
    结果:总体而言,有57%的临床医生报告了对男性包皮环切术进行男性咨询的患者,有17%的患者提供服务(49%的转诊),以及61%的期望培训。在多变量分析中,服务的提供在南非更为普遍(P≤0.001),但在津巴布韦需要更高的培训(P≤0.01)。在医生中(P≤0.01)和在医院环境中(P≤0.001)提供的服务最高。但是,护士对培训的渴望更大(P≤0.05),而年轻的临床医生也是如此(P≤0.001)。农村和诊所环境中的临床医生也很可能表达出培训兴趣。临床医生认为患者会因文化信仰而感到不高兴,并会增加危险行为,这与较少的咨询和服务提供有关(P≤0.05)。
    结论:南非和津巴布韦的许多临床医生都表示愿意将新的艾滋病毒预防证据纳入实践,并愿意接受培训以向患者提供该程序。结果表明,两国都应考虑让护士参加男性包皮环切术以预防艾滋病毒,包括在农村地区,并应帮助临床医生解决文化问题。
  • 【在津巴布韦卖性的年轻女性中使用避孕套:预防级联分析,以识别艾滋病毒预防规划中的差距。】 复制标题 收藏 收藏
    DOI:10.1002/jia2.25512 复制DOI
    作者列表:Chabata ST,Hensen B,Chiyaka T,Mushati P,Busza J,Floyd S,Birdthistle I,Hargreaves JR,Cowan FM
    BACKGROUND & AIMS: INTRODUCTION:Adolescent girls and young women (AGYW), including those who sell sex in sub-Saharan Africa, are especially vulnerable to HIV. Reaching them with effective prevention is a programmatic priority. The HIV prevention cascade can be used to track intervention coverage, and identify gaps and opportunities for programme strengthening. The aim of this study was to characterise gaps in condom use and identify reasons underlying these gaps among young women who sell sex (YWSS) in Zimbabwe using data from enrolment into an impact evaluation of the DREAMS programme. DREAMS provided a package of biomedical, social and economic interventions to AGYW aged 10 to 24 with the aim of reducing HIV incidence. METHODS:In 2017, we recruited YWSS aged 18 to 24 using respondent-driven sampling in six sites across Zimbabwe. We measured knowledge about efficacy of, access to, and effective (consistent) use of condoms with the most recent three sexual partners, separately by whether YWSS self-identified as female sex workers (FSW) or not. Among YWSS without knowledge about efficacy of, not having access to, and not effectively using condoms, we described the potential reasons underlying the gaps in the condom cascade. To identify socio-demographic characteristics associated with effective condom use, we used logistic regression modelling. All analyses were RDS-II weighted and restricted to YWSS testing HIV-negative at enrolment. RESULTS:We enrolled 2431 YWSS. Among 1842 (76%) YWSS testing HIV-negative, 66% (n = 1221) self-identified as FSW. 89% of HIV-negative YWSS demonstrated knowledge about efficacy of condoms, 80% reported access to condoms and 58% reported using condoms consistently with the three most recent sexual partners. Knowledge about efficacy of and effective use of condoms was similar regardless of whether or not YWSS self-identified as FSW, but YWSS self-identifying as FSW reported better access to condoms compared to those who did not (87% vs 68%; age- and site-adjusted (adjOR) = 2.69; 95% CI: 2.01 to 3.60; p < 0.001). Women who reported experiencing sexual violence in the past year and common mental disorder in the past week were less likely to use condoms consistently (43% vs. 60%; adjOR = 0.49; 95% CI: 0.35 to 0.68; p < 0.001) and (51% vs. 61%; adjOR = 0.76; 95% CI: 0.60 to 0.97; p = 0.029), respectively. CONCLUSIONS:Despite high knowledge about efficacy of and access to condoms, there remain large gaps in self-reported consistent condom use among YWSS. Addressing the structural determinants of YWSS' inconsistent condom use, including violence, could reduce this gap. YWSS who do not self-identify as FSW have less access to condoms and may require additional programmatic intervention.
    背景与目标: 简介:包括在撒哈拉以南非洲地区出售性行为的少女和青年妇女(AGYW)特别容易感染艾滋病毒。通过有效的预防措施达到这些目标是一项计划优先事项。艾滋病毒预防级联可用于跟踪干预措施的覆盖范围,并找出差距和加强计划的机会。这项研究的目的是使用从DREAMS计划的效果评估中纳入的数据,来描述津巴布韦使用安全套的空白,并找出导致这些空白的年轻女性(YWSS)造成这些空白的原因。 DREAMS为10至24岁的青年妇女提供了一揽子生物医学,社会和经济干预措施,目的是减少艾滋病毒的发病率。
    方法:2017年,我们在津巴布韦的六个地点进行了由受访者驱动的18至24岁的YWSS。我们通过YWSS是否自我确定为女性性工作者(FSW)来分别评估与最近三个性伴侣的避孕套的功效,使用和有效(一致)使用的知识。在没有了解安全套功效,无法使用和无法有效使用安全套的YWSS中,我们描述了安全套级联中存在差距的潜在原因。为了确定与有效使用避孕套相关的社会人口统计学特征,我们使用了逻辑回归模型。所有分析均按RDS-II加权,并仅限于YWSS在入院时检测HIV阴性。
    结果:我们注册了2431 YWSS。在1842年(76%)的YWSS测试呈阴性的YWSS中,有66%(n = 1221)自我确定为FSW。 89%的HIV阴性YWSS表现出对安全套功效的了解,80%的人报告使用安全套,58%的人报告与最近三个性伴侣保持一致使用安全套。不论YWSS是否自我识别为FSW,关于安全套功效和有效使用的知识都是相似的,但是YWSS自我识别为FSW的情况与不使用安全套的人相比,安全套的使用情况更好(87%vs 68%;年龄-且网站调整后(adjOR)= 2.69; 95%CI:2.01至3.60; p <0.001)。在过去一年中报告经历过性暴力和在过去一周中患有常见精神障碍的妇女较少持续使用避孕套的比例(43%vs. 60%; adjOR = 0.49; 95%CI:0.35至0.68; p <0.001)和分别为(51%vs.61%; adjOR = 0.76; 95%CI:0.60至0.97; p = 0.029)。
    结论:尽管对避孕套的功效和使用有很高的了解,但在YWSS中,自我报告的一致使用避孕套仍存在很大差距。解决YWSS避孕套使用不一致(包括暴力)的结构性决定因素,可以缩小这一差距。没有自我认定为FSW的YWSS使用安全套的机会较少,可能需要其他程序干预。
  • 【人类免疫缺陷病毒感染中的心肌功能障碍:津巴布韦医院157名患者的超声心动图研究。】 复制标题 收藏 收藏
    DOI:10.1136/hrt.76.2.161 复制DOI
    作者列表:Hakim JG,Matenga JA,Siziya S
    BACKGROUND & AIMS: OBJECTIVE:To determine the prevalence and characteristics of myocardial dysfunction and other cardiac manifestations in acutely ill hospital patients infected with human immunodeficiency virus (HIV) in Zimbabwe. DESIGN:A prospective echocardiographic survey of acutely ill HIV seropositive patients. SETTING:General medical ward, Harare Central Hospital, Zimbabwe. PATIENTS:One hundred and fifty seven HIV seropositive patients admitted with various acute medical conditions over a 12 month period, January to December 1994. MAIN OUTCOME MEASURES:Detection of myocardial dysfunction and other cardiac abnormalities by cross sectional echocardiography. RESULTS:Eighty (51%) men and 77 women were studied (mean (SD) age 34.4 (8.5), range 15-60 years for males and 31.6 (9.0), range 16-65 years for females). They were all heterosexual. None was haemophiliac or an intravenous drug user. Echocardiographic abnormalities were found in 79 (50%) patients: 14/151 (9%) had dilated cardiomyopathy, 33/151 (22%) left ventricular dysfunction, 9/151 isolated right ventricular dilatation, and 30/157 (19%) pericardial disease (28 with effusions, three having tamponade). There were two cases of constrictive pericarditis and one of ascending aortic aneurysm. CONCLUSIONS:There is a high prevalence of echocardiographically detected myocardial and pericardial disease in this group of acutely ill HIV infected patients. Left ventricular dysfunction without dilatation was common, but its significance was not ascertained.
    背景与目标: 目的:确定津巴布韦感染人类免疫缺陷病毒(HIV)的急症医院患者的心肌功能障碍和其他心脏表现的患病率和特征。
    设计:对急性病HIV血清反应阳性患者的前瞻性超声心动图调查。
    地点:津巴布韦哈拉雷中央医院普通病房。
    患者:1994年1月至12月的12个月期间,有157名HIV血清反应阳性的患者接受了各种急性医疗条件治疗。
    主要观察指标:横断面超声心动图检测心肌功能障碍和其他心脏异常。
    结果:研究了80名(51%)男性和77名女性(平均(SD)年龄34.4(8.5),男性15-60岁,女性31.6(9.0),女性16-65岁)。他们都是异性恋。没有人是血友病患者或静脉吸毒者。在79名(50%)患者中发现了超声心动图异常:14/151(9%)患有扩张型心肌病,33/151(22%)左心功能不全,9/151单独的右心室扩张和30/157(19%)心包疾病(28例有积液,三例有填塞物)。缩窄性心包炎2例,升主动脉瘤1例。
    结论:在这组急性感染艾滋病毒的患者中,超声心动图检测到的心肌和心包疾病的患病率很高。没有扩张的左心功能不全是常见的,但其意义尚未确定。
  • 【津巴布韦农村地区接受自我报告的性传播感染症状的治疗方式。】 复制标题 收藏 收藏
    DOI:10.1136/sti.2004.012773 复制DOI
    作者列表:Lewis JJ,Garnett GP,Nyamukapa CA,Donnelly CA,Mason PR,Gregson S
    BACKGROUND & AIMS: OBJECTIVES:To determine the extent of self reported symptoms perceived to be related to sexually transmitted infections and the patterns of subsequent treatment seeking behaviour in a predominantly rural population of Zimbabwe. METHODS:A population based survey of 4331 men and 5149 women was conducted in rural Zimbabwe during 1998-2000. Structured confidential interviews collected data on self reported sexually transmitted infection symptoms, treatment seeking behaviour, sociodemographic characteristics, and sexual behaviour. RESULTS:25% of men aged 17-54 years report experiencing genital sores and 25% of men report experiencing urethral discharge; 30% of women aged 15-44 years report experiencing vaginal discharge. The lifetime number of sexual partners, age, and years of sexual activity were all significant predictors of symptoms for both men and women (all p values <0.001). 92% of men and 62% of women had sought treatment for their symptoms in the past year (p value <0.001). Men and women were equally likely to have sought treatment at a local hospital or clinic, but women were much less likely than men to have sought treatment at a different hospital or clinic. Among those who had sought treatment, men sought treatment faster than women and were more likely to report being "very satisfied" with their treatment than women. CONCLUSIONS:The gender differences in treatment seeking are of major concern for control efforts and further work on determining the reasons for these should be a priority. This would inform the likely impact of both increasing availability of local services and further reducing the stigma faced by those wishing to access such services.
    背景与目标: 目的:确定在津巴布韦以农村为主的人群中,与性传播感染有关的自我报告症状的程度以及寻求行为的后续治疗方式。
    方法:1998-2000年在津巴布韦农村地区进行了基于人口的4331名男性和5149名女性的调查。有组织的机密访谈收集了有关自我报告的性传播感染症状,寻求治疗的治疗方法,社会人口统计学特征和性行为的数据。
    结果:年龄在17-54岁之间的男性中有25%的人患有生殖器疮,而有25%的男性中的人患有尿道分泌物。 15-44岁的女性中有30%报告有白带。性伴侣的终生数量,年龄和性活动年限都是男女症状的重要预测指标(所有p值均<0.001)。在过去的一年中,有92%的男性和62%的女性就症状寻求过治疗(p值<0.001)。男性和女性在当地医院或诊所寻求治疗的可能性相同,但是女性在男性在另一家医院或诊所寻求治疗的可能性要小得多。在寻求治疗的人中,男性寻求治疗的速度比女性快,并且比女性更容易报告对治疗“非常满意”。
    结论:寻求治疗中的性别差异是控制工作的主要关注点,确定这些原因的进一步工作应作为优先事项。这将说明增加本地服务的可用性以及进一步减少希望访问此类服务的人所面临的污名化的可能影响。
  • 【津巴布韦艾滋病毒感染儿童的麻痹性脊髓灰质炎与口服口服脊髓灰质炎疫苗相关:病例报告。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:1999-03-27
    来源期刊:BMJ
    DOI:10.1136/bmj.318.7187.841 复制DOI
    作者列表:Chitsike I,van Furth R
    BACKGROUND & AIMS: OBJECTIVE:To describe a complication of oral vaccination with live, attenuated poliomyelitis virus in a child infected with HIV. DESIGN:Case report. SETTING:Teaching hospital in Harare, Zimbabwe. SUBJECTS:A boy of 41/2 years and his mother. MAIN OUTCOME MEASURES:Results of clinical and laboratory investigations. RESULTS:Two weeks after receiving the second dose of oral poliomyelitis vaccine during national immunisation days the child developed paralysis of the right leg. He had a high titre of antibodies against poliovirus type 2, as well as antibodies against HIV-1, a low CD4 count, a ratio of CD4 to CD8 count of 0.47, and hypergammaglobulinaemia. He did not have any antibodies against diphtheria, tetanus, or poliovirus types 1 and 3, although he had been given diphtheria, tetanus, and pertussis and oral polio vaccines during his first year and a booster of the diphtheria, tetanus, and pertussis vaccine at 24 months. He had no clinical symptoms of AIDS, but his mother had AIDS and tuberculosis. CONCLUSION:Paralytic poliomyelitis in this child with HIV infection was caused by poliovirus type 2 after oral poliomyelitis vaccine.
    背景与目标: 目的:描述感染了艾滋病毒的儿童口服减毒活脊髓灰质炎病毒的并发症。
    设计:病例报告。
    地点:津巴布韦哈拉雷的教学医院。
    主题:一个41/2岁的男孩和他的母亲。
    主要观察指标:临床和实验室检查的结果。
    结果:在全国免疫日接受第二剂口服脊髓灰质炎疫苗两周后,该儿童发展为右腿麻痹。他具有高滴度的抗2型脊髓灰质炎病毒抗体,抗HIV-1抗体,较低的CD4计数,CD4与CD8的比率为0.47和高丙种球蛋白血症。他没有任何抗白喉,破伤风或脊髓灰质炎病毒1型和3型的抗体,尽管他在第一年就接种了白喉,破伤风和百日咳疫苗以及口服脊髓灰质炎疫苗,并在当年接种了白喉,破伤风和百日咳疫苗。 24个月。他没有艾滋病的临床症状,但他的母亲患有艾滋病和结核病。
    结论:该儿童HIV感染性麻痹性脊髓灰质炎是由口服脊髓灰质炎疫苗接种后的2型脊髓灰质炎病毒引起的。
  • 【评估针对儿童的以卫生机构为基础和以社区为基础的指数挂钩的艾滋病毒检测策略的有效性和成本效益:津巴布韦的B-GAP研究方案。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2019-029428 复制DOI
    作者列表:Dziva Chikwari C,Simms V,Dringus S,Kranzer K,Bandason T,Vasantharoopan A,Chikodzore R,Sibanda E,Mutseta M,Webb K,Engelsmann B,Ncube G,Mujuru H,Apollo T,Weiss HA,Ferrand R
    BACKGROUND & AIMS: INTRODUCTION:The number of new paediatric infections per year has declined in sub-Saharan Africa due to prevention-of-mother-to-child HIV transmission programmes; many children and adolescents living with HIV remain undiagnosed. In this protocol paper, we describe the methodology for evaluating an index-linked HIV testing approach for children aged 2-18 years in health facility and community settings in Zimbabwe. METHODS AND ANALYSIS:Individuals attending for HIV care at selected primary healthcare clinics (PHCs) will be asked if they have any children aged 2-18 years in their households who have not been tested for HIV. Three options for HIV testing for these children will be offered: testing at the PHC; home-based testing performed by community workers; or an oral mucosal HIV test given to the caregiver to test the children at home. All eligible children will be followed-up to ascertain whether HIV testing occurred. For those who did not test, reasons will be determined, and for those who tested, the HIV test result will be recorded. The primary outcome will be uptake of HIV testing. The secondary outcomes will be preferred HIV testing method, HIV yield, prevalence and proportion of those testing positive linking to care and having an undetectable viral load at 12 months. HIV test results will be stratified by sex and age group, and factors associated with uptake of HIV testing and choice of HIV testing method will be investigated. ETHICS AND DISSEMINATION:Ethical approval for this study was granted by the Medical Research Council of Zimbabwe, the London School of Hygiene and Tropical Medicine and the Institutional Review Board of the Biomedical Research and Training Institute. Study results will be presented at national policy meetings and national and international research conferences. Results will also be published in international peer-reviewed scientific journals and disseminated to study communities at the end of study.
    背景与目标: 简介:由于预防母婴艾滋病毒的传播计划,撒哈拉以南非洲地区每年新增的儿科感染数量有所减少;许多感染艾滋病毒的儿童和青少年仍未得到诊断。在本协议文件中,我们描述了评估津巴布韦医疗机构和社区环境中2-18岁儿童的与索引相关的HIV测试方法的方法。
    方法和分析:将询问在选定的初级保健诊所(PHC)进行HIV护理的个人,如果他们的家庭中有2至18岁的孩子未接受HIV检验。将为这些儿童提供三种HIV检测方法:在PHC进行检测;在PHC中进行检测。由社区工作者进行的基于家庭的测试;或提供给看护人的口腔粘膜HIV测试,以在家中对儿童进行测试。将对所有符合条件的儿童进行随访,以确定是否进行了艾滋病毒检测。对于未进行检测的人,将确定原因,对于那些进行检测的人,将记录HIV检测结果。主要结果将是接受艾滋病毒检测。次要结果将是首选的HIV检测方法,HIV产生率,患病率和检测与护理呈正相关且在12个月内无法检测到病毒载量的人群的比例。 HIV检测结果将按性别和年龄组进行分层,并将调查与HIV检测的采用和HIV检测方法的选择相关的因素。
    道德与传播:这项研究的伦理批准是由津巴布韦医学研究理事会,伦敦卫生与热带医学学院以及生物医学研究与培训学院的机构审查委员会批准的。研究结果将在国家政策会议以及国家和国际研究会议上发表。研究结果还将在国际同行评审的科学期刊上发表,并在研究结束时分发给研究社区。
  • 13 Emergency medical services in Zimbabwe. 复制标题 收藏 收藏

    【津巴布韦的紧急医疗服务。】 复制标题 收藏 收藏
    DOI:10.1016/j.resuscitation.2005.01.008 复制DOI
    作者列表:Thomson N
    BACKGROUND & AIMS: :Emergency medical services in Zimbabwe are of a very variable standard, and exist in many forms: *Reasonably well-developed urban emergency medical services systems mixed with very poorly resourced and under-developed rural services. *Very high patient workloads, with severely ill medical patients and a large proportion of major trauma and multiple-casualty situations (public safety is given a low priority, and public transport is poorly regulated). *Long emergency response times and patient transport distances. *Somewhat under resourced and under developed emergency departments, with large numbers of critically ill acute patients, as well as many non-emergency/chronic patients who have no other access to appropriate health care. This paper provides a description of the development of ambulance services and acute health care in Zimbabwe, and outline the current demands on the system. Particular reference is made to the City of Harare Ambulance Service, which is considered to be the most developed of the local authority services.
    背景与目标: :津巴布韦的急诊医疗服务标准具有很大的可变性,并且以多种形式存在:*合理发展的城市急诊医疗服务系统与资源非常匮乏和欠发达的农村服务相结合。 *患者的工作量非常高,医护人员病重,主要创伤和多重伤亡情况占很大比例(公共安全的优先级低,公共交通管理不善)。 *较长的紧急响应时间和患者运输距离。 *在资源丰富和急诊科之下有一些医疗服务,有大量危重病急症患者,以及许多无法获得适当医疗服务的非急诊/慢性患者。本文介绍了津巴布韦的救护车服务和急救医疗服务的发展,并概述了当前对该系统的需求。特别参考了哈拉雷市救护车服务局,该服务被认为是最先进的地方当局服务机构。
  • 【在津巴布韦不同的小农耕作制度下,肥料管理和土壤类型影响谷物中锌和铁的浓度。】 复制标题 收藏 收藏
    DOI:10.1038/s41598-019-42828-0 复制DOI
    作者列表:Manzeke MG,Mtambanengwe F,Watts MJ,Hamilton EM,Lark RM,Broadley MR,Mapfumo P
    BACKGROUND & AIMS: :Micronutrient deficiencies remain prevalent in food systems of southern Africa, although advances in biofortification through crop breeding and agronomy provide opportunities to address these. We determined baseline soil availability of zinc (Zn) and iron (Fe) and the effects of soil type and farmer management on extractable soil Zn and Fe and subsequent concentration in cereal and legume grains under two contrasting agro-ecologies in Zimbabwe. Soil and crop surveys were conducted in Hwedza and Mutasa Districts of Zimbabwe in 2015-16 on 350 locations over different soil types. Fields with different levels of productivity (designated as "most" and "least" productive fields) were sampled using an inherited hierarchical randomized sampling design. Grain Zn and Fe concentration in maize (Zea mays), sorghum (Sorghum bicolor), finger millet (Eleusine coracana) and cowpea (Vigna unguiculata) were generally insufficient for adequate human nutrition. A Linear Mixed Effects (LME) model revealed that diethylene triamine penta-acetic acid- (DTPA) extractable soil Zn concentration and grain Zn concentration were affected primarily by field productivity level. DTPA-extractable soil Zn concentration was more than two-fold greater on the most productive fields (mean 0.8 mg kg-1) than on the least productive fields, with mean grain Zn concentration of 25.2 mg grain Zn kg-1 which was 13% greater than seen on the least productive fields.  An interaction effect of field productivity level and total soil Zn concentration on DTPA-extractable soil Zn concentration suggests potential contribution of organic matter management to unlocking unavailable forms of soil Zn. DTPA-extractable soil Fe and grain Fe concentration were primarily affected by soil type and crop type, respectively. The LME modelling approach revealed additional soil geochemical covariates affected DTPA-extractable soil Zn and Fe concentration and grain Zn and Fe concentration within Districts. Future studies can therefore be powered to detect their roles at wider spatial scales for sustainable management of crop Zn and Fe nutrition.
    背景与目标: 尽管南部非洲的粮食系统中微量营养素缺乏症仍然很普遍,尽管通过作物育种和农艺学在生物强化方面的进展为解决这些问题提供了机会。我们确定了津巴布韦两种不同的农业生态条件下土壤锌(Zn)和铁(Fe)的基线土壤有效性以及土壤类型和农民管理对可提取土壤锌和铁的影响以及随后谷物和豆类谷物中的浓度。 2015-16年度在津巴布韦的Hwedza和Mutasa区进行了土壤和农作物调查,涉及不同土壤类型的350个地点。使用继承的分层随机抽样设计,对具有不同生产率水平的字段(称为“最高”和“最低”生产性字段)进行采样。玉米(Zea mays),高梁(Sorghum bicolor),小米(Eleusine coracana)和cow豆(Vigna unguiculata)中的锌和铁含量通常不足以提供足够的人体营养。线性混合效应(LME)模型表明,二亚乙基三胺五乙酸(DTPA)可提取的土壤锌浓度和谷物锌浓度主要受田间生产力水平的影响。 DTPA可提取的土壤锌含量在最高产田(平均0.8 mg kg-1)要比最低产田高两倍,平均谷物锌浓度为25.2 mg谷物Zn kg-1,为13%。比生产力最低的领域更大。田间生产力水平和土壤总锌浓度对DTPA可提取的土壤锌浓度的相互作用影响表明,有机物管理对释放土壤锌的潜在形式有潜在的贡献。 DTPA提取的土壤铁和谷物铁的浓度分别主要受土壤类型和作物类型的影响。 LME建模方法揭示了额外的土壤地球化学协变量影响了DTPA可提取的区域内土壤Zn和Fe浓度以及籽粒Zn和Fe浓度。因此,未来的研究有可能在更广阔的空间尺度上探测其作用,从而对作物锌和铁的营养进行可持续管理。
  • 【噻嗪类,血管扩张剂和利血平与甲基多巴加氢氯噻嗪的联合治疗在津巴布韦的高血压。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Stein CM,Neill P,Mwaluko GM,Kusema T
    BACKGROUND & AIMS: :Brinerdin (Sandoz), a combination of a diuretic (clopamide 5 mg), a vasodilator (dihydro-ergocristine 0.5 mg) and reserpine (0.1 mg) (CDR) was compared with methyldopa (MD) plus hydrochlorothiazide (HCT) for antihypertensive effect, adverse reactions, compliance and patient preference in an open cross-over trial. Eighteen patients completed both arms of the trial and 5 patients who completed the CDR arm were withdrawn while on the MD arm because of adverse effects in 4 and poor control in 1. On HCT 50 mg daily the mean baseline systolic blood pressure was 163.9 +/- 16.3 mmHg and the diastolic blood pressure was 105.9 +/- 6.7 mmHg. On CDR these were reduced to systolic blood pressure 140.3 +/- 15.1 mmHg and diastolic blood pressure 87.8 +/- 9.3 mmHg. On MD + HCT the systolic blood pressure was reduced to 138.5 +/- 16.9 mmHg and the diastolic blood pressure to 88.9 +/- 10.3 mmHg. The differences between the two treatment periods in systolic blood pressure (1.8 mmHg; 95% confidence interval (CI) - 4.1 + 7.7 mmHg) and diastolic blood pressure (1.1 mmHg; 95% CI - 4.6 + 2.4 mmHg) were not significant with P values of 0.6 and 0.7 respectively. Compliance was 98.2% for CDR and 94.7% for MD + HCT (P = 0.02). Unusual sleepiness occurred more frequently in the MD arm (P less than 0.01). Thirteen patients chose to continue on CDR, 2 on MD + HCT and 3 had no preference (P = 0.005). CDR is similar in antihypertensive effect to MD + HCT but is better tolerated with fewer withdrawals, fewer adverse effects, better compliance and has more patients electing to continue taking it.
    背景与目标: :将Brinerdin(Sandoz),利尿剂(5克氨酰胺),血管扩张剂(二氢-麦角新碱0.5 mg)和利血平(0.1 mg)(CDR)的组合与甲基多巴(MD)加氢氯噻嗪(HCT)的抗高血压作用进行了比较,开放式交叉试验中的不良反应,依从性和患者偏爱。由于不良反应4例和不良对照1例,有18位完成了试验两臂的患者,有5位完成了CDR臂的患者退出了MD臂,而在HCT上每天50 mg的平均收缩压为163.9 /- 16.3 mmHg,舒张压为105.9 /-6.7 mmHg。在CDR上,这些降低到收缩压140.3±15.1mmHg和舒张压87.8±9.3mmHg。在MD HCT上,收缩压降至138.5±16.9mmHg,舒张压降至88.9±10.3mmHg。 P值为P时,收缩压(1.8 mmHg; 95%置信区间(CI)-4.1 7.7 mmHg)和舒张压(1.1 mmHg; 95%CI-4.6 2.4 mmHg)的两个治疗期之间的差异不显着。分别为0.6和0.7。 CDR的依从性为98.2%,MD HCT的依从性为94.7%(P = 0.02)。 MD组中异常嗜睡的发生率更高(P小于0.01)。 13例患者选择继续CDR,2例在MD HCT上继续接受治疗,3例无偏好(P = 0.005)。 CDR的抗高血压作用与MD HCT相似,但耐受性更好,停药次数更少,不良反应更少,依从性更好,并且更多的患者选择继续服用它。

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