BACKGROUND & AIMS: OBJECTIVE:This study reviewed whether participants who were given a continence education package, which included a Continence Educational Brochure (CEB), and who indicated that they were bothered by incontinence symptoms changed health-seeking behaviors about their incontinence problem because of being given the brochure. METHOD:This study used a descriptive and exploratory design. Participants were given the CEB and asked to read the information. They were also asked to complete a continence questionnaire and mail this back to the research team. Participants who indicated that they were bothered by a continence problem and consented to being interviewed were telephoned 2 to 3 months later. They were asked questions to determine their actions and progress in relation to managing their continence problem and whether the CEB had influenced their behavior. SETTING AND SUBJECT:A total of 631 participants (352 females, 55.8%; 279 males, 44.2%) from 4 rural and regional settings in Victoria, Australia, participated. Of this sample, 111 participants (78 females, 70.3%; 33 males, 29.7%) who reported that they were bothered by a continence problem were interviewed 3 months after being given the CEB. RESULTS:Two thirds of the total sample of participants (n=111) sought help for their continence problem. Approximately 70.3% (n=78) continued to have a continence problem. Of this group, 84.6% were still bothered by the continence problem and 65.4% had taken action to treat their incontinence. Forty-nine participants (44.1%) indicated that they had discussed the issue of bladder or bowel problems with someone directly because of this study or the information contained in the brochure. More than 94% of participants who remembered the CEB indicated that they believed the brochure would be helpful if given to other people. CONCLUSIONS:These findings suggest that the CEB prompted individuals to discuss their continence problem and in fewer cases to seek professional help. Given these findings, distribution of a continence education package is advocated as a continence health promotion strategy.

背景与目标： 目的：本研究回顾了参加者的节制教育包，其中包括节制教育手册（CEB），并指出他们因节制失禁症状而受到困扰，从而改变了他们对失禁问题的健康寻求行为，因为他们获得了手册。
方法：本研究采用描述性和探索性设计。参加者获得了CEB的邀请，并要求阅读信息。还要求他们填写节制问卷并将其邮寄回研究团队。 2至3个月后打电话给表示自己受到节制问题困扰并同意接受采访的参与者。他们被问到问题，以确定他们在处理自控问题方面的行动和进展，以及CEB是否影响了他们的行为。
地点和主题：来自澳大利亚维多利亚州4个农村和地区性地区的631名参与者（352名女性，占55.8％； 279名男性，占44.2％）参加了该项目。在该样本中，有111名参与者报告他们受到节制问题困扰，其中有78名女性，占70.3％； 33名男性，占29.7％，在接受CEB后三个月进行了访谈。
结果：参与者（n = 111）的总样本的三分之二寻求帮助，以解决他们的节制问题。大约70.3％（n = 78）仍然存在尿失禁问题。在这一组中，仍有84.6％的人患有尿失禁问题，还有65.4％的人已经采取了行动来治疗他们的尿失禁。 49名参与者（44.1％）表示，由于该研究或小册子中包含的信息，他们直接与某人讨论了膀胱或肠道问题。记得CEB的参与者中，超过94％的参与者表示，他们认为该手册对其他人有帮助。
结论：这些发现表明，CEB促使个人讨论他们的节制问题，并在较少的情况下寻求专业帮助。鉴于这些发现，提倡分发节制教育一揽子计划作为节制健康促进策略。

BACKGROUND & AIMS: OBJECTIVE:The 24-hour creatinine clearance is the standard clinical technique for measuring kidney function; however, this measurement is cumbersome and inconvenient for patients. We hypothesized that a camera-based technetium-99m mercaptoacetyltriglycine (MAG3) clearance obtained simultaneously with a standard MAG3 scan would correlate well with the 24-hour creatinine clearance and could serve as a simple marker of kidney function. MATERIALS AND METHODS:Data were obtained from a retrospective analysis of 28 patients with varying degrees of kidney dysfunction and 85 subjects evaluated for kidney donation. The MAG3 clearance was calculated using a camera-based technique without blood or urine sampling. The creatinine clearance was measured using the plasma creatinine and a 24-hour urine collection. The MAG3 and creatinine clearances were corrected for body surface area, and clearance values in healthy subjects and patients were compared using the paired Student's t test. The linear association between the MAG3 and creatinine clearances was expressed by Pearson's correlation coefficient. RESULTS:The mean MAG3 clearance in the potential kidney donors was 321 +/- 95 mL/min/1.73 m2 (95% CI, 171-546 mL/min/1.73 m2), significantly higher than the mean creatinine clearance of 152 +/- 51 mL/min/1.73 m2 (79-278 mL/min/1.73 m2, p < 0.001). The mean MAG3 clearance in patients was 153 +/- 70 mL/min/1.73 m2 (32-316 mL/min/1.73 m2) and was also significantly higher than the mean creatinine clearance of 74 +/- 36 mL/min/1.73 m2 (21-138 mL/min/1.73 m2, p < 0.001). The ratio of the mean creatinine clearance to the mean MAG3 clearance was essentially the same for volunteers and patients, 0.47 and 0.48, respectively. The Pearson's correlation between the MAG3 and creatinine clearances was 0.80 (0.72-0.86). CONCLUSION:The camera-based 99mTc-MAG3 clearance correlates well with the 24-hour creatinine clearance and can provide a simple and convenient index of kidney function.

背景与目标： 目的：24小时肌酐清除率是衡量肾脏功能的标准临床技术。然而，这种测量对于患者而言是麻烦且不便的。我们假设与标准MAG3扫描同时获得的基于相机的tech 99m巯基乙酰基三甘氨酸（MAG3）清除率与24小时肌酐清除率相关性很好，并且可以用作肾脏功能的简单标记。
材料与方法：数据来自对28位不同程度的肾功能不全患者的回顾性分析，并对85位受试者的肾脏捐赠进行了评估。 MAG3清除率是使用基于相机的技术计算的，无需进行血液或尿液采样。使用血浆肌酐和24小时尿液收集来测量肌酐清除率。校正了MAG3和肌酐的清除率以进行表面积测定，并使用配对的Student's t检验比较了健康受试者和患者的清除率值。 MAG3和肌酐清除率之间的线性关联由皮尔逊相关系数表示。
结果：潜在肾脏供体的平均MAG3清除率为321 /-95 mL / min / 1.73 m2（95％CI，171-546 mL / min / 1.73 m2），显着高于平均肌酐清除率152 /-51 mL / min / 1.73平方米（79-278 mL / min / 1.73平方米，p <0.001）。患者的平均MAG3清除率为153 /-70 mL / min / 1.73 m2（32-316 mL / min / 1.73 m2），也显着高于平均肌酐清除率74 /-36 mL / min / 1.73 m2（ 21-138 mL / min / 1.73 m2，p <0.001）。志愿者和患者的平均肌酐清除率与平均MAG3清除率之比基本相同，分别为0.47和0.48。 MAG3和肌酐清除率之间的Pearson相关性为0.80（0.72-0.86）。
结论：基于相机的99mTc-MAG3清除率与24小时肌酐清除率相关性良好，可以提供简单便捷的肾脏功能指标。

BACKGROUND & AIMS: OBJECTIVES:Cases of hypophosphataemia (often coincident with renal dysfunction) have been reported in HIV-infected patients taking tenofovir disoproxil fumarate (TDF), but randomized placebo-controlled trials of HIV-infected persons with normal baseline renal function have found a comparable incidence of hypophosphataemia in the TDF and placebo groups. We assessed the incidence of grade 2 and higher hypophosphataemia in the HIV Outpatient Study (HOPS). METHODS:We analysed a prospective cohort of patients who initiated either a TDF-containing highly active antiretroviral therapy (HAART) regimen [TDF-exposed (TDF+) group; n = 165] or a TDF-sparing HAART regimen [TDF-unexposed (TDF-) group; n = 90], and who had normal baseline phosphate and creatinine values. RESULTS:The TDF+ and TDF- groups had comparable median follow-up times (10.9 vs 8.8 months, respectively; P = 0.18) and number of phosphate measurements (median = 3 for both) and were similar on most clinical and demographic factors. During follow up, 12.7% of TDF+vs 6.7% of TDF-patients developed grade 2 hypophosphataemia (2.0-2.4 mg/dL), and 2.4% of TDF+ patients vs 0% of TDF-patients developed grade 3 hypophosphataemia (1.0-1.9 mg/dL); none developed grade 4 hypophosphataemia (<1.0 mg/dL). The incidence of grade 2 or higher hypophosphataemia was 16.7 per 100 person-years among TDF+ patients vs 8.0 per 100 person-years among TDF-patients (P = 0.11). CONCLUSIONS:The incidence of hypophosphataemia was somewhat elevated in HOPS patients who took TDF-containing HAART compared with those who took TDF-sparing HAART during the first 1 to 2 years of observation, but the difference was not statistically significant. Longer follow-up of a larger population is needed to determine if this trend towards an association achieves statistical significance and to evaluate the clinical consequences of hypophosphataemia.

背景与目标： 目的：已经报道了接受替诺福韦二富马酸富马酸酯（TDF）感染HIV的患者发生低血磷的情况（通常与肾功能不全同时发生），但基线肾功能正常的HIV感染者的随机安慰剂对照试验发现TDF和安慰剂组的低磷血症。我们在HIV门诊研究（HOPS）中评估了2级和更高的低血磷的发生率。
方法：我们分析了开始采用含TDF的高活性抗逆转录病毒疗法（HAART）方案[TDF暴露（TDF）组）的患者的前瞻性队列研究。 n = 165]或保留TDF的HAART方案[未暴露TDF（TDF-）的组； n = 90]，并且基线磷酸盐和肌酐值正常。
结果：TDF和TDF-组的中位随访时间（分别为10.9和8.8个月； P = 0.18）和磷酸盐测量次数（两者的中位数= 3）具有可比性，并且在大多数临床和人口统计学因素上相似。在随访期间，TDF的12.7％与TDF的患者的6.7％发生了2级低血磷（2.0-2.4 mg / dL），TDF的2.4％vs TDF的患者中出现了3级的低血磷（1.0-1.9 mg） / dL）;没有一个发生4级低血磷（<1.0 mg / dL）。 TDF患者中2级或更高水平低血磷的发生率为每100人年16.7人，而TDF患者为每100人年8.0人（P = 0.11）。
结论：在观察的头1至2年中，与含TDF的HAART的HOPS患者相比，接受含TDF的HAART的HOPS患者的低磷酸盐血症发生率有所升高，但差异无统计学意义。需要对更大的人群进行更长时间的随访，以确定这种联系趋势是否达到统计学意义并评估低血磷的临床后果。

BACKGROUND & AIMS: BACKGROUND:The literature reports that the learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGBP) is approximately 75-100 cases. This aim of the present study was to evaluate the safety and feasibility of shortening the learning curve for performing LRYGBP by an experienced laparoscopic surgeon. METHODS:This study analyzed retrospectively the first 100 consecutive LRYGBP cases performed by an experienced laparoscopic surgeon between April 2003 and September 2003. The surgeon performed these cases after first assisting in 30 cases, and the first 4 cases were proctored by an experienced laparoscopic bariatric surgeon. Two cases done after previous gastric stapling and Nissen fundoplication were excluded from the study. Outcome variables included operative time, complications, conversion, and mortality. RESULTS:For the first 100 LRYGBP patients, the mean age was 42.6 years (range, 22-62 years) and mean body mass index (BMI) was 47.6 kg/m2 (range, 36-71.8). The complications included 1 case of intestinal leak, 1 case of small bowel obstruction, 6 cases of gastrojejunal stenosis, 8 cases of wound infection, 1 case of wound seroma, and 2 cases of pulmonary embolism, resulting in 1 mortality. One case was converted to an open technique. Over the second 50 cases, there was a significant reduction in mean operative time, to 73 minutes (range, 39-145 minutes) from 113 minutes (range, 54-238 minutes) (P < .0001). However, despite the reduction in complication frequency (no gastrointestinal leak or obstruction, 2 cases of gastrojejunal stenosis, 2 cases of wound infection, no pulmonary embolism/deep venous thrombosis, and no mortality), there was no significant correlation between the mortality, conversion, and complication rates and the surgeon's experience. CONCLUSION:A bariatric surgical practice incorporating LRYGBP can be safely done by an experienced laparoscopic surgeon. With appropriate advanced laparoscopic skills, preparatory steps, proctorship, and adequate volume of cases, the learning curve for performing LRYGBP can be reduced to 50 cases. Further experience is associated with a significant reduction in operative time with acceptable mortality, complication, and conversion rates.

背景与目标： 背景：文献报道腹腔镜Roux-en-Y胃旁路术（LRYGBP）的学习曲线约为75-100例。本研究的目的是评估由经验丰富的腹腔镜外科医生缩短进行LRYGBP学习曲线的安全性和可行性。
方法：本研究回顾性分析了2003年4月至2003年9月由经验丰富的腹腔镜外科医生进行的前100例连续LRYGBP病例。在首次协助30例患者之后，外科医生进行了这些病例，前4例病例由经验丰富的腹腔镜肥胖手术医师指导。该研究排除了先前进行胃吻合术和尼森胃底折叠术后完成的两个病例。结果变量包括手术时间，并发症，转化率和死亡率。
结果：前100名LRYGBP患者的平均年龄为42.6岁（范围22-62岁），平均体重指数（BMI）为47.6 kg / m2（范围36-71.8）。并发症包括肠漏1例，小肠梗阻1例，胃空肠狭窄6例，伤口感染8例，伤口血清肿1例和肺栓塞2例，导致1例死亡。一个案例被转换为开放技术。在后50例中，平均手术时间从113分钟（54-238分钟）减少到73分钟（39-145分钟）（P <.0001）。然而，尽管并发症发生率降低（无胃肠道渗出或阻塞，2例胃肠空肠狭窄，2例伤口感染，无肺栓塞/深静脉血栓形成，无死亡率），但死亡率，转化率之间无显着相关性。 ，并发症发生率和外科医生的经验。
结论：有经验的腹腔镜外科医生可以安全地进行结合了LRYGBP的减肥手术。借助适当的高级腹腔镜检查技巧，准备步骤，指导以及适当的病例数量，可以将进行LRYGBP的学习曲线减少到50例。进一步的经验可以显着减少手术时间，并具有可接受的死亡率，并发症和转化率。

BACKGROUND & AIMS: :Priority setting of health interventions is often ad-hoc and resources are not used to an optimal extent. Underlying problem is that multiple criteria play a role and decisions are complex. Interventions may be chosen to maximize general population health, to reduce health inequalities of disadvantaged or vulnerable groups, ad/or to respond to life-threatening situations, all with respect to practical and budgetary constraints. This is the type of problem that policy makers are typically bad at solving rationally, unaided. They tend to use heuristic or intuitive approaches to simplify complexity, and in the process, important information is ignored. Next, policy makers may select interventions for only political motives. This indicates the need for rational and transparent approaches to priority setting. Over the past decades, a number of approaches have been developed, including evidence-based medicine, burden of disease analyses, cost-effectiveness analyses, and equity analyses. However, these approaches concentrate on single criteria only, whereas in reality, policy makers need to make choices taking into account multiple criteria simultaneously. Moreover, they do not cover all criteria that are relevant to policy makers. Therefore, the development of a multi-criteria approach to priority setting is necessary, and this has indeed recently been identified as one of the most important issues in health system research. In other scientific disciplines, multi-criteria decision analysis is well developed, has gained widespread acceptance and is routinely used. This paper presents the main principles of multi-criteria decision analysis. There are only a very few applications to guide resource allocation decisions in health. We call for a shift away from present priority setting tools in health--that tend to focus on single criteria--towards transparent and systematic approaches that take into account all relevant criteria simultaneously.

背景与目标： ：卫生干预措施的优先级设置通常是临时的，资源没有得到最佳利用。潜在的问题是多个标准起着作用，并且决策很复杂。可以选择干预措施，以最大程度地提高总体人口健康，减少弱势或弱势群体的健康不平等，广告/或应对危及生命的情况，所有这些都涉及实际和预算方面的限制。这是决策者通常无助于理性解决的典型问题。他们倾向于使用启发式或直观的方法来简化复杂性，并且在此过程中，重要的信息将被忽略。接下来，政策制定者可能只出于政治动机选择干预措施。这表明需要采取合理和透明的方法来确定优先事项。在过去的几十年中，已经开发出许多方法，包括循证医学，疾病负担分析，成本效益分析和公平性分析。但是，这些方法仅集中于单个标准，而实际上，决策者需要在选择时同时考虑多个标准。此外，它们并未涵盖与决策者相关的所有标准。因此，有必要开发一种确定优先级的多标准方法，并且最近确实将其确定为卫生系统研究中最重要的问题之一。在其他科学学科中，多准则决策分析已经得到了很好的发展，已经得到了广泛的认可并被常规使用。本文介绍了多准则决策分析的主要原理。只有很少的应用程序可以指导健康状况中的资源分配决策。我们呼吁从目前卫生领域的优先重点设定工具（倾向于只关注单一标准）转变为同时考虑所有相关标准的透明，系统的方法。

BACKGROUND & AIMS: :In the last few decades, the importance of selenium in human health has been the subject of numerous studies. It is believed that the physiological effects of selenium occur mainly through the function of selenoproteins, which incorporate selenium in the form of one or more selenocysteine residues. Recent advances in understanding the complex regulation of selenoprotein synthesis and functional characterization of several members of the selenoprotein family have contributed to an improved comprehension of the role(s) of selenium in human health and the great diversity of physiological pathways influenced by this trace element.

背景与目标： ：在过去的几十年中，硒在人类健康中的重要性一直是众多研究的主题。相信硒的生理作用主要通过硒蛋白的功能而发生，硒蛋白以一种或多种硒代半胱氨酸残基的形式掺入硒。在了解硒蛋白合成的复杂调控和硒蛋白家族几个成员的功能表征方面的最新进展有助于人们更好地理解硒在人体健康中的作用以及受该微量元素影响的多种生理途径。

BACKGROUND & AIMS: :Phosphorus MRS was evaluated as a monitor of tumour therapeutic response to the herpes simplex virus thymidine kinase suicide gene therapy paradigm. In vivo 31P spectra were obtained from subcutaneous rat C6 gliomas constitutively expressing the HSVtk gene post treatment with ganciclovir (GCV, 15 mg/kg i.p., twice-daily). Significant regression (p < 0.1) of tumour volume was observed 10 days after beginning GCV administration. However, no changes in tumour pH or energy metabolites from pre-treatment values were observed. High-resolution 31P spectra of tumour extracts revealed a statistically significant reduction in the phosphocholine to phosphoethanolamine ratio six days post-GCV administration. These results indicate that the HSVtk/GCV-induced killing of tumours is not associated with corresponding changes in 31P MRS-observable energy metabolites and pH. The observed reduction in the PE/PC ratio may provide a non-invasive in vivo indicator of therapeutic efficacy.

背景与目标： ：磷MRS被评估为对单纯疱疹病毒胸苷激酶自杀基因治疗范例的肿瘤治疗反应的监测器。从更昔洛韦治疗后组成性表达HSVtk基因的皮下大鼠C6神经胶质瘤获得体内31P光谱（GCV，15 mg / kg i.p.，每天两次）。开始GCV给药10天后，观察到肿瘤体积显着消退（p <0.1）。但是，未观察到肿瘤pH值或能量代谢物相对于治疗前值的变化。肿瘤提取物的高分辨率31P光谱显示，GCV给药后六天，磷酸胆碱与磷酸乙醇胺的比率在统计学上显着降低。这些结果表明，HSVtk / GCV诱导的肿瘤杀伤与31P MRS可观察到的能量代谢产物和pH值的相应变化无关。所观察到的PE / PC比的降低可以提供治疗功效的非侵入性体内指标。

BACKGROUND & AIMS: :The health issues of young adulthood have received relatively little attention compared with those of adolescence, although the critical issues in young adulthood parallel those of adolescence. Young adults often fare worse than adolescents on health indicators, with many measures of negative outcomes--including rates of injury, homicide, and substance use--peaking during the young adult years. The contextual factors shaping health status and access to care in young adulthood differ significantly from the context of adolescence. This article synthesizes national data to present a health profile of young adults, reviewing social indicators that describe the context of young adulthood and presenting measures of health status. We examine mortality, morbidity, risky behaviors, and health care access and utilization, identifying the most significant gender and racial/ethnic disparities. The article also identifies limitations of existing data and offers suggestions for future research and health monitoring in this area. We conclude with a discussion of current efforts to address the health and well-being of young adults and argue for creating a national health agenda for young adults that includes research, programs and policies to address health issues during this period of the lifespan.

背景与目标： ：与青春期相比，青年期的健康问题受到的关注相对较少，尽管青年期的关键问题与青春期的问题平行。在健康指标上，年轻人通常比青少年情况更糟，在年轻人成年时期，有很多负面结果的衡量指标，包括伤害率，杀人率和药物使用率。决定健康状况和成年后获得医疗服务的情境因素与青春期有很大不同。本文综合了国家数据，以介绍年轻人的健康状况，回顾了描述年轻人成年背景的社会指标，并提出了健康状况的衡量指标。我们检查了死亡率，发病率，危险行为以及医疗保健的获取和利用，确定了最重要的性别和种族/族裔差异。本文还指出了现有数据的局限性，并为该领域的未来研究和健康监测提供了建议。最后，我们讨论了当前为解决年轻人的健康和福祉所做的努力，并争辩了制定一项针对年轻人的国家健康议程，其中包括研究，计划和政策，以解决这一时期的健康问题。

BACKGROUND & AIMS: OBJECTIVE:To investigate the effects of local labor market conditions and the availability of employer-sponsored health insurance on exits from the Medicaid program. DATA SOURCE:Data for this project come from a unique administrative database containing a 2 percent sample of all cases on California's Medicaid program in 1987 and a 2 percent sample of all new cases starting each year between 1987 and 1995. STUDY DESIGN:The results are estimated using a discrete duration model where the monthly exit probability is a function of demographic characteristics, local labor market variables, the probability of having employer-sponsored insurance, and fixed year and county effects. PRINCIPAL FINDINGS:Improvements in labor market opportunities (i.e., employment growth, wage growth, and increases in the availability of employer-sponsored health insurance) promote exits off the Medicaid program. A 2.5 percentage point increase in the availability of employer-sponsored insurance leads to a 6 percent increase in the probability that a completed spell lasts no more than 2 years. It would take a 2 percentage point decrease in unemployment rates or a 10 percent increase in average quarterly earnings to yield an equivalent increase in the likelihood of exiting Medicaid within 2 years. These effects are robust to the inclusion of county-level fixed effects and time effects. CONCLUSIONS:Medicaid expenditures and caseloads are sensitive to local economic fluctuations and secular trends in the availability of health insurance. Continued decreases in employer-based health insurance coverage will greatly increase the demand for public insurance coverage and the financial pressures on state governments.

背景与目标： 目的：调查当地劳动力市场状况以及雇主赞助的医疗保险对医疗补助计划退出的影响。
数据来源：该项目的数据来自一个独特的管理数据库，该数据库包含1987年加利福尼亚州医疗补助计划所有病例的2％样本，以及从1987年至1995年每年开始的所有新病例的2％样本。
研究设计：使用离散持续时间模型估算结果，其中每月退出概率是人口统计学特征，当地劳动力市场变量，拥有雇主赞助的保险的概率以及固定的年度和县级影响的函数。
主要发现：劳动力市场机会的增加（即就业增长，工资增长以及雇主赞助的健康保险的增加）促使人们退出了医疗补助计划。雇主赞助的保险的可用性增加2.5个百分点，则完整的持续时间不超过2年的概率将增加6％。失业率降低2个百分点或平均季度收入提高10％，才能在2年内退出医疗补助计划。这些效应对于将县级固定效应和时间效应包括在内是有力的。
结论：医疗补助支出和病案量对当地经济波动和健康保险可及性的长期趋势很敏感。基于雇主的健康保险覆盖率的持续下降将大大增加对公共保险覆盖率的需求以及州政府的财务压力。