• 【儿科护理工作诊断调查:一种评估工具。】 复制标题 收藏 收藏
    DOI:10.1046/j.1365-2834.1997.t01-1-00003.x 复制DOI
    作者列表:Eaton N,Thomas P
    BACKGROUND & AIMS: Two distinct trends can be identified in the context within which nursing care is planned and delivered. One is the continuous pressure to find ways of increasing efficiency and cost-effectiveness. The second is the widespread expectation that public services in general, and health services in particular, should be monitored and evaluated. In these circumstances, nurses and their managers need a range of evaluative tools so that changes in the organization of nursing care can be evaluated. Hackman and Oldham's 'Job Diagnostic Survey' (JDS) approach was tested in a Paediatric Unit in which aspects of primary nursing were being introduced. The paper outlines the JDS approach in the Unit in question and offers an assessment of the value of the JDS as an evaluative tool.

    背景与目标: 在计划和实施护理的背景下,可以确定出两种截然不同的趋势。一种是不断寻求提高效率和成本效益的方法的压力。第二个是普遍的期望,即一般的公共服务,尤其是卫生服务,应该受到监测和评估。在这种情况下,护士及其经理需要一系列评估工具,以便可以评估护理组织的变化。哈克曼和奥德汉姆(Hackman and Oldham)的“工作诊断调查”(JDS)方法在儿科中进行了测试,该科介绍了初级护理的各个方面。本文概述了有关部门中的JDS方法,并评估了JDS作为一种评估工具的价值。

  • 【寄生虫病和乳汁病学调查显示,坦桑尼亚黑手党岛上的泌尿生殖道血吸虫病是外来感染。】 复制标题 收藏 收藏
    DOI:10.1016/j.actatropica.2012.09.006 复制DOI
    作者列表:Stothard JR,Ameri H,Khamis IS,Blair L,Nyandindi US,Kane RA,Johnston DA,Webster BL,Rollinson D
    BACKGROUND & AIMS: :To confirm the local endemicity of Schistosoma haematobium on Mafia Island, Tanzania, conjoint parasitological and malacological surveys were undertaken in July 2006 with parasitological investigations supplemented with case-history questionnaires. A total of 238 children (125 girls and 113 boys, mean age of 13.9 years) across 9 primary schools were examined. The prevalence of micro-haematuria and egg-patent infection was 18.1% (CI95=9.6-33.6) and 4.2% (CI95=1.9-7.6), respectively but a strong female bias was observed for micro-haematuria (5.6F:1M) contrasting with a strong male bias for the presence of eggs (1F:4M). All egg-patent infections were of light-intensity (<10eggs/10ml). No clear associations between infection prevalence and local water-contact, by school, were found and all 10 of the egg-positive children had a travel history to the nearby mainland or Zanzibar. Inspection of community diagnostic registers at Kilindoni Hospital revealed a low proportion (<2%) of egg-patent infection for 20,306 samples tested in the 2000-2005 period. A total of 43 freshwater sites, a third of which were previously sampled in 1999 and 2002, were surveyed and 11 species of freshwater mollusc were found. Four species of Bulinus (B. nasutus, B. forskalii, B. barthi and B. sp.) were encountered across 13 sites with B. nasutus restricted to 3 of these towards the north of the island. No collected snail was observed to shed schistosome cercariae. Further characterisation of B. nasutus and S. haematobium included infection challenge on two occasions, with miracidia obtained from egg-patent children from Mafia and Unguja islands as well as DNA barcoding of snails and schistosomes. B. nasutus was shown refractory to infection. With the substantial travel to and from Mafia, the refractory nature of local snails and evidence from DNA barcoding in schistosomes and snails, we conclude that urogenital schistosomiasis is an imported infection.
    背景与目标: :为了确认坦桑尼亚黑手党岛上血吸虫血吸虫病的地方流行性,2006年7月进行了寄生虫学和乳汁病学联合调查,并进行了寄生虫学调查,并附有病例历史调查表。对9所小学的238名儿童(125名女孩和113名男孩,平均年龄13.9岁)进行了检查。微血尿和鸡蛋专利感染的患病率分别为18.1%(CI95 = 9.6-33.6)和4.2%(CI95 = 1.9-7.6),但是微血尿症的女性偏见性很强(5.6F:1M)与此相反,男性对卵的存在有强烈的偏见(1F:4M)。所有卵专利性感染均为轻度感染(<10eggs / 10ml)。在学校,没有发现感染发生率与当地水接触之间的明确关联,所有10名鸡蛋阳性的儿童都有去往附近大陆或桑给巴尔的旅行史。在Kilindoni医院检查社区诊断记录后发现,在2000年至2005年期间测试的20,306个样本中,鸡蛋专利感染的比例很低(<2%)。总共对43个淡水站点进行了调查,其中有1/3是先前在1999年和2002年采样的,对它们进行了调查,发现了11种淡水软体动物。在13个地点遇到了4种Bulinus(B。nasutus,B。forskalii,B。barthi和B. sp。),其中B. nasutus仅限于该岛北部的其中3个。没有观察到收集的蜗牛流下血吸虫尾。纳豆双歧杆菌和嗜血链球菌的进一步表征包括两次感染挑战,从黑手党和翁古雅岛的卵子专利儿童获得的水acid症,以及蜗牛和血吸虫的DNA条形码。纳豆芽孢杆菌显示对感染难治。随着往返于黑手党的大量旅行,当地蜗牛的难治性以及血吸虫和蜗牛中DNA条形码的证据,我们得出结论,泌尿生殖道血吸虫病是一种外来感染。
  • 【美国医院的抗菌药物使用:2015年和2011年新兴感染计划患病率调查结果的比较。】 复制标题 收藏 收藏
    DOI:10.1093/cid/ciaa373 复制DOI
    作者列表:
    BACKGROUND & AIMS: BACKGROUND:In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. METHODS:The Centers for Disease Control and Prevention's Emerging Infections Program sites in 10 states each recruited ≤25 general and women's and children's hospitals. Hospitals selected a survey date from May-September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. RESULTS:Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6-50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). CONCLUSIONS:Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.
    背景与目标: 背景:在2011年美国医院针对医疗保健相关感染和抗菌药物使用的患病率调查中,有50%的患者在调查日期或前一天接受了抗菌药物治疗。此后,更多的医院建立了抗菌素管理计划。我们在2015年重复了这项调查,以确定抗菌药物的使用率并描述自2011年以来的变化。
    方法:美国疾病控制和预防中心的新发感染项目站点分别招募了≤25家普通医院和妇女儿童医院。医院从2015年5月至9月选择了一个调查日期。在调查日期对随机患者样本的病历进行了审查,以收集有关在调查日期或前一天施用的抗菌药物的数据。比较了使用抗菌药物的患者百分比;多变量对数二项式回归模型用于评估与抗菌药物使用相关的因素。
    结果:在199家医院的12至299名患者中,有6084名患者(49.5%; 95%CI,48.6-50.4%)接受了抗菌药物治疗。在两项调查的148家医院中,尽管2015年新生儿重症监护患者使用抗菌药物的比例较低,但总体抗菌药物使用率在2011年和2015年相似(22.8%vs 32.0%[2011]; P = .006)。 2015年氟喹诺酮类药物的使用率较低(10.1%的患者对11.9%的患者[2011]; P <0.001)。第三或第四代头孢菌素的使用率较高(12.2%比10.7%[2011]; P = .002),碳青霉烯的使用率也较高(3.7%比2.7%[2011]; P <0.001)。
    结论:2011年和2015年医院总体抗菌药物使用率无差异。但是,在选定的患者或抗菌药物组中观察到的差异可能会提供管理影响的证据。
  • 【龋齿诊断:世卫组织和ICDAS II标准在流行病学调查中达成一致。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Iranzo-Cortés JE,Montiel-Company JM,Almerich-Silla JM
    BACKGROUND & AIMS: OBJECTIVE:The aim of this study was to ascertain the equivalence between WHO caries diagnosis criteria and the ICDAS II caries classification scale for comparisons in epidemiological studies. MATERIALS AND METHODS:Two intraoral examinations, one using the ICDAS II caries codes and the other the WHO caries assessment method, were performed in a random sample of 101 children (29 aged 5-6 years, 32 aged 12 and 40 aged 15). Both examinations were performed not more than one month apart by two calibrated examiners (one for ICDAS II criteria, Kappa=0.86, and the other for WHO criteria, Kappa=0.91). The DMFT/dft, DMFS/dfs and caries prevalence (DMFT or dfs>0) indices were obtained in accordance with WHO assessment criteria and by applying 5 cut-off points on the ICDAS II scale. The differences between means were analysed with the Wilcoxon test and those between proportions with the McNemar test. Agreement was determined by the intraclass correlation index and the Kappa statistic. RESULTS:The least differences between the WHO and ICDAS 11 criteria were found at cut-off point 3 (ICDAS 11 codes 3 to 6). The greatest agreement was found at the same cut-off point. CONCLUSION:While the equivalence between both methods used in epidemiological studies does not appear to be clear, possible errors could be reduced by locating this equivalence at cut-off point 3 and not at cut-off point 4.
    背景与目标: 目的:本研究旨在确定WHO龋齿诊断标准与ICDAS II龋齿分类量表之间的等效性,以便在流行病学研究中进行比较。
    材料与方法:随机抽取101名儿童(29名5-6岁的儿童,32名12岁的儿童和40名15岁的儿童)进行两次口内检查,一项使用ICDAS II龋齿法,另一项使用WHO龋齿评估法。两次检查相隔不超过一个月,由两名经过校准的检查员进行(一个为ICDAS II标准,Kappa = 0.86,另一个为WHO标准,Kappa = 0.91)。 DMFT / dft,DMFS / dfs和龋齿患病率(DMFT或dfs> 0)指数是根据WHO评估标准并在ICDAS II量表上应用5个临界点得出的。使用Wilcoxon检验分析均值之间的差异,使用McNemar检验分析比例间的差异。一致性由组内相关指数和Kappa统计量确定。
    结果:WHO和ICDAS 11标准之间的最小差异是在临界点3(ICDAS 11代码3至6)发现的。在相同的临界点发现了最大的共识。
    结论:虽然流行病学研究中使用的两种方法之间的等效性尚不清楚,但可以通过将等效性定位在截止点3而非截止点4来减少可能的错误。
  • 【饮食行为中的性别差异及其与心血管危险因素的关系评估:对七个中低收入国家的全国代表性调查的横断面研究。】 复制标题 收藏 收藏
    DOI:10.1186/s12937-019-0517-4 复制DOI
    作者列表:McKenzie BL,Santos JA,Geldsetzer P,Davies J,Manne-Goehler J,Gurung MS,Sturua L,Gathecha G,Aryal KK,Tsabedze L,Andall-Brereton G,Bärnighausen T,Atun R,Vollmer S,Woodward M,Jaacks LM,Webster J
    BACKGROUND & AIMS: BACKGROUND:Cardiovascular diseases (CVD) are the leading causes of death for men and women in low-and-middle income countries (LMIC). The nutrition transition to diets high in salt, fat and sugar and low in fruit and vegetables, in parallel with increasing prevalence of diet-related CVD risk factors in LMICs, identifies the need for urgent action to reverse this trend. To aid identification of the most effective interventions it is crucial to understand whether there are sex differences in dietary behaviours related to CVD risk. METHODS:From a dataset of 46 nationally representative surveys, we included data from seven countries that had recorded the same dietary behaviour measurements in adults; Bhutan, Eswatini, Georgia, Guyana, Kenya, Nepal and St Vincent and the Grenadines (2013-2017). Three dietary behaviours were investigated: positive salt use behaviour (SUB), meeting fruit and vegetable (F&V) recommendations and use of vegetable oil rather than animal fats in cooking. Generalized linear models were used to investigate the association between dietary behaviours and waist circumference (WC) and undiagnosed and diagnosed hypertension and diabetes. Interaction terms between sex and dietary behaviour were added to test for sex differences. RESULTS:Twenty-four thousand three hundred thirty-two participants were included. More females than males reported positive SUB (31.3 vs. 27.2% p-value < 0.001), yet less met F&V recommendations (13.2 vs. 14.8%, p-value< 0.05). The prevalence of reporting all three dietary behaviours in a positive manner was 2.7%, varying by country, but not sex. Poor SUB was associated with a higher prevalence of undiagnosed hypertension for females (13.1% vs. 9.9%, p-value = 0.04), and a higher prevalence of undiagnosed diabetes for males (2.4% vs. 1.5%, p-value = 0.02). Meeting F&V recommendations was associated with a higher prevalence of high WC (24.4% vs 22.6%, p-value = 0.01), but was not associated with undiagnosed or diagnosed hypertension or diabetes. CONCLUSION:Interventions to increase F&V intake and positive SUBs in the included countries are urgently needed. Dietary behaviours were not notably different between sexes. However, our findings were limited by the small proportion of the population reporting positive dietary behaviours, and further research is required to understand whether associations with CVD risk factors and interactions by sex would change as the prevalence of positive behaviours increases.
    背景与目标: 背景:心血管疾病(CVD)是中低收入国家(LMIC)男女死亡的主要原因。营养向低盐,高脂肪和高糖,低水果和蔬菜的饮食过渡,同时在低收入和中低收入国家中饮食相关的CVD危险因素的患病率上升,这表明需要采取紧急措施来扭转这一趋势。为了帮助确定最有效的干预措施,至关重要的是要了解与CVD风险相关的饮食行为是否存在性别差异。
    方法:从46个国家代表性调查的数据集中,我们纳入了七个国家的数据,这些国家记录了成年人的饮食行为测量值;不丹,埃斯瓦蒂尼,格鲁吉亚,圭亚那,肯尼亚,尼泊尔和圣文森特和格林纳丁斯(2013-2017)。调查了三种饮食行为:积极的食盐使用行为(SUB),符合水果和蔬菜(F&V)的建议以及在烹饪中使用植物油而非动物脂肪。使用广义线性模型研究饮食行为和腰围(WC)与未诊断和诊断的高血压和糖尿病之间的关联。性别与饮食行为之间的相互作用被添加到性别差异测试中。
    结果:24,323位参与者被纳入研究。 SUB阳性的女性多于男性(31.3 vs. 27.2%p值<0.001),但满足F&V建议的人数较少(13.2 vs. 14.8%,p值<0.05)。以积极的方式报告这三种饮食行为的患病率为2.7%,因国家/地区而异,但没有性别差异。 SUB差与女性未确诊高血压的患病率较高(13.1%vs. 9.9%,p值= 0.04)以及男性未诊断糖尿病的患病率较高(2.4%vs. 1.5%,p值= 0.02)有关)。达到F&V建议与高WC患病率较高相关(24.4%比22.6%,p值= 0.01),但与未被诊断或诊断的高血压或糖尿病无关。
    结论:迫切需要采取干预措施以增加所涉国家的F&V摄入量和阳性SUB。饮食行为在两性之间没有显着差异。但是,我们的研究结果受到少数饮食活动呈阳性的人群的限制,因此,需要进行进一步的研究以了解与CVD危险因素和性别相互作用的关联是否会随着积极行为的普及而改变。
  • 【印度国家公共资助的健康保险计划Pradhan Mantri Jan Arogaya Yojana(PMJAY)在改善医院护理的可及性和财务保护方面的绩效:查蒂斯加尔邦家庭调查的结果。】 复制标题 收藏 收藏
    DOI:10.1186/s12889-020-09107-4 复制DOI
    作者列表:Garg S,Bebarta KK,Tripathi N
    BACKGROUND & AIMS: BACKGROUND:A national Publicly Funded Health Insurance (PFHI) scheme called Pradhan Mantri Jan Arogaya Yojana (PMJAY) was launched by government of India in 2018. PMJAY seeks to cover 500 million persons with an annual cover of around 7000 USD per household. PMJAY claims to be the largest government funded health scheme globally and has attracted an international debate as a policy for Universal Health Coverage. India's decade-long experience of the earlier national and state-specific PFHI schemes had shown poor effectiveness in financial protection. Most states in India have completed a year of implementation of PMJAY but no evaluations are available of this important scheme. METHODS:The study was designed to find out the effect of enrolment under PMJAY in improving utilisation of hospital services and financial protection in Chhattisgarh which has been a leading state in implementing PFHI in terms of enrolment and claims. The study analyses three repeated cross-sections. Two of the cross-sections are from National Sample Survey (NSS) health rounds - year 2004 when there was no PFHI and 2014 when the older PFHI scheme was in operation. Primary data was collected in 2019-end to cover the first year of PMJAY implementation and it formed the third cross-section. Multivariate analysis was carried out. In addition, Propensity Score Matching and Instrumental Variable method were applied to address the selection problem in insurance. RESULTS:Enrollment under PMJAY or other PFHI schemes did not increase utilisation of hospital-care in Chhattisgarh. Out of Pocket Expenditure (OOPE) and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PMJAY or other PFHI schemes. The size of OOPE was significantly greater for utilisation in private sector, irrespective of enrollment under PMJAY. CONCLUSION:PMJAY provided substantially larger vertical cover than earlier PFHI schemes in India but it has not been able to improve access or financial protection so far in the state. Though PMJAY is a relatively new scheme, the persistent failure of PFHI schemes over a decade raises doubts about suitability of publicly funded purchasing from private providers in the Indian context. Further research is recommended on such policies in LMIC contexts.
    背景与目标: 背景:印度政府于2018年启动了一项名为Pradhan Mantri Jan Arogaya Yojana(PMJAY)的国家公共医疗保险计划。PMJAY旨在覆盖5亿人,每户每年约7000美元。 PMJAY声称是全球最大的政府资助的医疗计划,并作为全民医疗保险的政策引起了国际关注。印度在较早的针对特定国家和州的PFHI计划的十年经验表明,在金融保护方面效果不佳。印度大多数州已经完成了PMJAY的实施一年,但没有对该重要计划进行评估。
    方法:本研究旨在查明在贾蒂斯加尔邦PMJAY项下登记对改善医院服务的利用和财务保护的影响,该市在实施PFHI方面在登记和索赔方面一直处于领先地位。该研究分析了三个重复的横截面。其中两个横截面来自国家抽样调查(NSS)健康调查-2004年没有PFHI,而2014年则是较旧的PFHI计划正在实施。在2019年底收集了主要数据,以涵盖实施PMJAY的第一年,并形成了第三部分。进行多变量分析。此外,运用倾向得分匹配和工具变量法解决了保险业的选择问题。
    结果:在恰蒂斯加尔邦,根据PMJAY或其他PFHI计划进行的入学并未增加医院护理的利用率。在PMJAY或其他PFHI计划下,自费支出(OOPE)和灾难性健康支出的发生率并未随入学率而降低。不论PMJAY是否注册,OOPE的规模都显着更大,可用于私营部门。
    结论:PMJAY提供的纵向覆盖比印度早期的PFHI方案大得多,但到目前为止,该州仍无法改善访问权限或财务保护。尽管PMJAY计划是一个相对较新的计划,但PFHI计划在过去十年中持续失败,这引发了人们对在印度背景下从私人提供商处购买公共资助的采购是否合适的怀疑。建议在LMIC背景下对此类政策进行进一步研究。
  • 【一项针对新加坡普通人群糖尿病的全国性知识,态度和实践(KAP)调查的研究方案。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2020-037125 复制DOI
    作者列表:AshaRani PV,Abdin E,Kumarasan R,Siva Kumar FD,Shafie S,Jeyagurunathan A,Chua BY,Vaingankar JA,Fang SC,Lee ES,Van Dam R,Chong SA,Subramaniam M
    BACKGROUND & AIMS: INTRODUCTION:This study aims to establish the Knowledge, Attitudes and Practices (KAP) of the general population (people with and without diabetes) towards diabetes. The study will examine (a) recognition and understanding of causes, prevention and treatment strategies of diabetes; (b) identify the knowledge gaps and behavioural patterns that may hamper diabetes prevention and control; (c) stigma towards and stigma perceived by people with diabetes and (d) awareness of anti-diabetes campaigns. METHODS AND ANALYSIS:The study is a nationwide, cross-sectional study of Singapore's general population aged 18 years and above (n=3000), comprising Chinese, Malay, Indian and other ethnic groups, who can understand English, Chinese, Malay or Tamil language. The sample was derived using a disproportionate stratified sampling using age and ethnicity. The proportion of respondents in each ethnic group (Chinese, Malay and Indian) was set to approximately 30%, while the proportion of respondents in each age group was set around 20% in order to ensure a sufficient sample size. The respondents will be administered questionnaires on diabetes KAP, stigma towards diabetes, lifestyle, diet and awareness of local anti-diabetes campaigns. The analysis will include descriptive statistics and multiple logistic and linear regression analyses to determine the socio-demographic correlates of correct recognition of diabetes, help-seeking preferences, as well as overall knowledge and attitudes among those with and without diabetes. We will consider a p value ≤0.05 as significant. ETHICS AND DISSEMINATION:This study protocol has been reviewed by the Institutional Research Review Committee and the National Healthcare Group Domain Specific Review Board (NHG DSRB Ref 2018/00430). The results of the study will be shared with policymakers and other stakeholders. There will be a local mass media briefing to disseminate the findings online, in print and on television and radio. The results will be published in peer-reviewed journals and presented in scientific meetings.
    背景与目标: 简介:本研究旨在建立普通人群(患有和不患有糖尿病的人)对糖尿病的知识,态度和实践(KAP)。这项研究将检查(a)对糖尿病的病因,预防和治疗策略的认识和理解; (b)找出可能妨碍糖尿病预防和控制的知识差距和行为方式; (c)对糖尿病患者的污名和耻辱感;以及(d)对抗糖尿病运动的认识。
    方法和分析:该研究是一项全国性的横断面研究,涉及新加坡华裔,马来人,印度人和其他种族的18岁及以上(n = 3000)的普通人群,他们能够理解英语,中文,马来语或泰米尔语语。该样本是根据年龄和种族使用不成比例的分层抽样得出的。为了确保足够的样本量,每个族裔(中国,马来人和印度裔)的受访者比例设定为大约30%,而每个年龄组的受访者比例设定为20%左右。将对受访者进行有关糖尿病KAP,对糖尿病的污名,生活方式,饮食和对当地抗糖尿病运动意识的问卷调查。该分析将包括描述性统计数据以及多元逻辑和线性回归分析,以确定正确识别糖尿病,寻求帮助的偏好以及在患有或不患有糖尿病的人群中的总体知识和态度的社会人口统计学相关性。我们认为p值≤0.05是有意义的。
    道德与传播:本研究方案已由机构研究审查委员会和国家医疗保健集团领域特定审查委员会(NHG DSRB Ref 2018/00430)进行了审查。研究结果将与决策者和其他利益相关者共享。将在当地进行大众媒体简报,以在线,印刷形式以及在电视和广播上传播调查结果。研究结果将发表在同行评审的期刊上,并在科学会议上发表。
  • 【改良的IOTN:用于口腔健康调查的正畸治疗需求指数。】 复制标题 收藏 收藏
    DOI:10.1034/j.1600-0528.2001.290308.x 复制DOI
    作者列表:Burden DJ,Pine CM,Burnside G
    BACKGROUND & AIMS: :This paper reports the results of a study of the reliability of a modified version of the Index of Orthodontic Treatment Need (IOTN) for use in oral health surveys. Twelve non-specialist dental examiners were trained in the use of the Modified IOTN using a standardised teaching protocol lasting approximately 1.5 hours. Following a school-based calibration exercise it was found that nearly all the examiners achieved either good or excellent agreement (mean Kappa=0.74). The average sensitivity and specificity scores were 0.90 and 0.84, respectively. The Modified IOTN appears to overcome the training and reliability problems that often accompany the use of orthodontic indices by non-specialists in oral health surveys.
    背景与目标: :本文报告了口腔健康调查中使用的正畸治疗需求指数(IOTN)修改版本的可靠性研究结果。十二名非专业的牙科检查员接受了使用改良的IOTN的培训,使用了持续约1.5小时的标准化教学方案。在进行了基于学校的校准练习后,发现几乎所有考官都达成了良好或出色的协议(平均Kappa = 0.74)。平均敏感性和特异性得分分别为0.90和0.84。改进的IOTN似乎克服了非专业人员在口腔健康调查中经常伴随使用正畸指数的培训和可靠性问题。
  • 【改进的Kato浓密涂片技术在现场调查期间检测肠结节病的潜在实用性。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Tungtrongchitr A,Chiworaporn C,Praewanich R,Radomyos P,Boitano JJ
    BACKGROUND & AIMS: :A total of 479 stool specimens were collected from rural communities of Ubon Ratchathani Province, Thailand and examined by two techniques: the modified Kato thick smear and the direct smear. The prevalence of Opisthorchis viverrini (14.8%), hookworm (10.2%), Sarcocystis spp (4.6%), Taenia spp (2.9%), Strongyloides stercoralis (2.1%), Giardia lamblia (1.2%), Echinostoma spp (0.6%), Ascaris lumbricoides (0.4%), Entamoeba histolytica (0.2%), Chilomastix mesnili (0.2%) and Endolimax nana (0.2%) were determined. The morphology of the Sarcocystis spp sporocysts examined by both procedures looked similar and was found to be easily recognizable. Among these specimens, 22 cases (4.6%) were positive for Sarcocystis infection detected by the modified Kato technique, whereas only one case (0.2%) was detected by both techniques. These differences were found to be statistically significant (p < 0.05), indicating that the modified Kato technique was decidedly more sensitive than the direct smear procedure in identifying Sarcocystis infection. An epidemiological survey was conducted in Khon Kaen Province involving 1124 stool samples using the modified Kato technique. The greatest frequency was Opisthorchis viverrini at 32.0% while the second highest was Sarcocystis spp at 8.0%. The prevalences of hookworm, Echinostoma spp, Taenia spp, Trichuris trichiura and Enterobius vermicularis were 2.7, 2.1, 1.0, 0.2 and 0.2%, respectively. Other than opisthorchiasis, northeastern Thailand may be an endemic area for sarcocystosis. This is the first report of the applicability and potential usefulness of the Kato thick smear technique for the diagnosis of Sarcocystis infection in a field survey.
    背景与目标: :从泰国乌汶府农村地区收集了479份粪便标本,并通过两种技术进行了检查:改良的加藤厚涂片和直接涂片。维氏梭菌(14.8%),钩虫(10.2%),肉孢子虫(4.6%),Ta虫(2.9%),硬核纲(2.1%),贾第鞭毛虫(1.2%),棘皮虫(0.6%)的患病率分别测定了A虫(0.4%),溶血性变形虫(0.2%),中型Chilomastix(0.2%)和Endolimax nana(0.2%)。通过两种方法检查的Sarcocystis spp孢子囊的形态看起来相似,并且很容易辨认。在这些标本中,改良的加藤技术检测出22例(4.6%)阳性的肉囊肿感染,而两种技术仅检测到1例(0.2%)。发现这些差异具有统计学显着性(p <0.05),表明改良的Kato技术在确定肉囊肿感染方面肯定比直接涂片检查更加灵敏。使用改进的加藤技术在孔敬府进行了一项流行病学调查,涉及1124份粪便样本。频率最高的是维氏梭菌,为32.0%,第二高的是肉囊藻,为8.0%。钩虫,E棘皮虫,Ta虫、,虫和毛肠Enter虫的患病率分别为2.7%,2.1%,1.0%,0.2%和0.2%。除阿片气管扩张症外,泰国东北部可能是结节病的流行地区。这是在野外调查中,加藤厚涂片技术在诊断肉囊肿感染中的适用性和潜在实用性的首次报道。
  • 【心血管危险因素-使用反复的横断面调查来评估邻国社会经济不平等的时间趋势。】 复制标题 收藏 收藏
    DOI:10.1136/bmjopen-2016-013442 复制DOI
    作者列表:Hughes J,Kabir Z,Kee F,Bennett K
    BACKGROUND & AIMS: OBJECTIVES:This study compares trends in socioeconomic inequalities related to key cardiovascular risk factors in neighbouring countries Northern Ireland (NI) and the Republic of Ireland (RoI). DESIGN:Repeated cross-sectional studies. SETTING:Population based. PARTICIPANTS:3500-4000 in national surveys in NI and 5000-9000 in RoI, aged 20-69 years. MEASURES:Educational attainment was used as a socioeconomic indicator by which the magnitude and direction of trends in inequalities for smoking, diabetes, obesity and physical inactivity in NI and RoI were examined between 1997/1998 and 2007/2011. Gender-specific relative and absolute inequalities were calculated using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII) for both countries. RESULTS:In both countries, the prevalence of diabetes and obesity increased whereas levels of smoking and physical inactivity decreased over time. In NI relative inequalities increased for obesity (RII 1.1 in males and 2.1 in females in 2010/2011) and smoking (RII 4.5 in males and 4.2 in females in 2010/2011) for both genders and absolute inequalities increased for all risk factors in men and increased for diabetes and obesity in women. In RoI greater inequality was observed in women, particularly for smoking (RII 2.8 in 2007) and obesity (RII 8.2 in 2002) and in men for diabetes (RII 3.2 in 2002). CONCLUSIONS:Interventions to reduce inequalities in risk factors, particularly smoking, obesity and diabetes are encouraged across both countries.
    背景与目标: 目的:本研究比较了邻国北爱尔兰(NI)和爱尔兰共和国(RoI)与主要心血管危险因素相关的社会经济不平等趋势。
    设计:重复的横截面研究。
    地点:基于人口。
    参加者:年龄在20-69岁之间的国家调查中的3500-4000,在ROI中的国家调查的5000-9000。
    指标:教育程度被用作社会经济指标,通过该指标对1997/1998至2007/2011年间NI和RoI中的吸烟,糖尿病,肥胖和身体不活动的不平等趋势的大小和方向进行了研究。使用这两个国家的不平等相对指数(RII)和不平等斜率指数(SII)计算了特定于性别的相对和绝对不平等。
    结果:在这两个国家中,糖尿病和肥胖症的患病率随着时间的流逝而增加,而吸烟和缺乏身体活动的水平则下降。在NI中,男女的肥胖症相对不平等现象有所增加(2010/2011年,男性为RII 1.1,女性为2.1),吸烟(男性和女性的RII为4.5,2010 / 2011年女性为4.2,男性所有危险因素的绝对不平等现象均增加了)妇女的糖尿病和肥胖症增加。在投资回报率中,女性尤其是吸烟者(2007年为RII 2.8)和肥胖症(2002年为RII 8.2)和男性因糖尿病(2002年为RII 3.2)观察到更大的不平等。
    结论:两国都鼓励采取干预措施以减少危险因素特别是吸烟,肥胖和糖尿病等方面的不平等。
  • 【对医学期刊上发表的邮件调查的答复率。】 复制标题 收藏 收藏
    DOI:10.1016/s0895-4356(97)00126-1 复制DOI
    作者列表:Asch DA,Jedrziewski MK,Christakis NA
    BACKGROUND & AIMS: OBJECTIVE:The purpose of this study was to characterize response rates for mail surveys published in medical journals; to determine how the response rate among subjects who are typical targets of mail surveys varies; and to evaluate the contribution of several techniques used by investigators to enhance response rates.

    METHODS:One hundred seventy-eight manuscripts published in 1991, representing 321 distinct mail surveys, were abstracted to determine response rates and survey techniques. In a follow-up mail survey, 113 authors of these manuscripts provided supplementary information.

    RESULTS:The mean response rate among mail surveys published in medical journals is approximately 60%. However, response rates vary according to subject studied and techniques used. Published surveys of physicians have a mean response rate of only 54%, and those of non-physicians have a mean response rate of 68%. In addition, multivariable models suggest that written reminders provided with a copy of the instrument and telephone reminders are each associated with response rates about 13% higher than surveys that do not use these techniques. Other techniques, such as anonymity and financial incentives, are not associated with higher response rates.

    CONCLUSIONS:Although several mail survey techniques are associated with higher response rates, response rates to published mail surveys tend to be moderate. However, a survey's response rate is at best an indirect indication of the extent of non-respondent bias. Investigators, journal editors, and readers should devote more attention to assessments of bias, and less to specific response rate thresholds.

    背景与目标: 目标:这项研究的目的是描述医学期刊上发表的邮件调查的回复率;确定作为邮件调查的典型目标的主题的响应率如何变化;

    方法:摘录了1991年出版的178份手稿,代表了321个不同的邮件调查,确定答复率和调查技术。在后续邮件调查中,这些手稿的113位作者提供了补充信息。

    结果:医学期刊上发表的邮件调查的平均答复率约为60%。但是,响应率会根据所研究的主题和所使用的技术而有所不同。公开发表的医师调查的平均应答率仅为54%,非医师的平均应答率为68%。此外,多变量模型表明,随文书副本和电话提醒一起提供的书面提醒,与未使用这些技术的调查相比,其答复率分别高出约13%。其他技术(例如匿名性和经济诱因)与更高的响应率无关。

    结论:尽管几种邮件调查技术与更高的响应率相关,但对已发布邮件的响应率调查往往比较温和。但是,调查的回应率充其量只能间接表明无回应者的偏见程度。研究人员,期刊编辑和读者应更多地关注偏倚的评估,而不是特定的响应率阈值。

  • 【1995年至2005年和2009年德国普通人群自我报告的头痛发生率:每年一次的全国性基于人口的横断面调查的结果。】 复制标题 收藏 收藏
    DOI:10.1186/1129-2377-14-11 复制DOI
    作者列表:Straube A,Aicher B,Förderreuther S,Eggert T,Köppel J,Möller S,Schneider R,Haag G
    BACKGROUND & AIMS: BACKGROUND:Although primary headache is the most frequent neurological disorder and there is some evidence that the prevalence rates have increased in recent years, no long-term data on the annual prevalence of headache are available for Germany. The objective of the study was therefore to obtain long-term data on the period prevalence of headache in the general population in Germany by means of population-based cross-sectional annual surveys (1995-2005 and 2009). METHODS:These surveys were conducted as face-to-face paper-and-pencil interviews from 1995 through 2004, and from 2005 onwards as computer-aided personal interviews. The reported headaches were self-diagnosed by the interviewees. Per year, approximately 640 trained interviewers interviewed between 10,898 and 12,538 German-speaking individuals aged 14 and older and living in private households in the whole of Germany (response rate: 67.4% and 73.1%, gross samples: 16,026 to 18,176 subjects). A total of more than 146,000 face-to-face interviews were analyzed. RESULTS:The one-year headache prevalence remained stable over the entry period, with 58.9% (95%CI 57.7-60.1) to 62.5% (95%CI 61.3-63.7) (p=0.07). Women showed consistently higher prevalence rates than men (females: 67.3 (95%CI 65.7-68.9) to 70.7% (95%CI 69.1-72.3), males: 48.4% (95%CI 46.5-50.3) to 54.3% (95%CI 52.4-56.2)), and both sexes showed a bell-shaped age dependence with peaks in the 30-39 age group. A stable slightly higher prevalence was observed in urban versus rural areas (p<0.0001), and there was also a significant trend towards higher prevalence rates in groups with a monthly household income larger than 3,500 € (p=0.03). CONCLUSION:The overall headache prevalence remained stable in Germany in the last 15 years.
    背景与目标: 背景:尽管原发性头痛是最常见的神经系统疾病,并且有一些证据表明近年来的患病率有所增加,但是德国尚无关于每年头痛患病率的长期数据。因此,本研究的目的是通过基于人口的横断面年度调查(1995-2005年和2009年),获得有关德国普通人群头痛期间患病率的长期数据。
    方法:这些调查从1995年至2004年以面对面的纸笔访谈方式进行,从2005年开始以计算机辅助的个人访谈方式进行。所报告的头痛是由受访者自我诊断的。每年,大约有640名受过训练的访调员采访了全德国10,898至12,538名14岁及以上,居住在私人家庭中的德语人士(答复率:67.4%和73.1%,总样本:16,026至18,176名受试者)。总共对超过146,000个面对面访谈进行了分析。
    结果:一年期头痛患病率在入院期间保持稳定,从58.9%(95%CI 57.7-60.1)增至62.5%(95%CI 61.3-63.7)(p = 0.07)。女性的患病率一直高于男性(女性:67.3(95%CI 65.7-68.9)至70.7%(95%CI 69.1-72.3),男性:48.4%(95%CI 46.5-50.3)至54.3%(95% CI 52.4-56.2)),并且两性都显示出钟形的年龄依赖性,并且在30-39岁年龄组中达到峰值。观察到城市地区和农村地区的患病率略有稳定(p <0.0001),并且家庭月收入大于3500欧元的人群中患病率也有显着趋势(p = 0.03)。
    结论:在过去的15年中,德国的总体头痛患病率保持稳定。
  • 【人脐带基质干细胞的生物学:原位和体外调查。】 复制标题 收藏 收藏
    DOI:10.1634/stemcells.2006-0286 复制DOI
    作者列表:Karahuseyinoglu S,Cinar O,Kilic E,Kara F,Akay GG,Demiralp DO,Tukun A,Uckan D,Can A
    BACKGROUND & AIMS: :Cells in the umbilical cord stroma have gained attention in recent years; however, differentiation to certain lineages in humans has been demonstrated in few studies. Unlike bone marrow MSCs, human umbilical cord stroma cells (HUCSCs) are far from being well characterized. This study attempts to describe proliferation, structural, and differentiation properties of these cells to account for their exceptional nature in many aspects. Cellular dynamics, cellular structure, and the degree of transformations during expansion and differentiation into mesenchymal and neuronal lineages were examined in vitro over a 10-month period. Comparisons with human bone marrow MSCs regarding differentiation were performed. HUCSCs in culture revealed two distinct cell populations, type 1 and type 2 cells, that possessed differential vimentin and cytokeratin filaments. Corresponding cells were encountered in cord sections displaying region-specific localization. alpha-Smooth muscle actin and desmin filaments, which were evident in cord sections, diminished through passages. No difference was noted regarding type 1 and type 2 cells in differentiation to chondrogenic, adipogenic, and osteogenic lineages, whereas a preferential differentiation was noted in neuronal lineage. Relative success was achieved by production of chondrocytic spheres and osteogenic monolayers, whereas adipocytes were immature compared with bone marrow MSCs. The presence of neuronal markers suggests that they transform into a certain state of maturity under neurogenic induction. Conclusively, HUCSCs retain their original phenotype in culture without spontaneous differentiation, have a limited lifespan, and bear multipotent stem cell characteristics. Given these characteristics, they may be generally considered progenitor cells if manipulated under appropriate conditions and deserve further study to be potentially used in cell-based therapies.
    背景与目标: 近年来,脐带基质中的细胞得到了关注。但是,很少有研究证明可以分化为人类的某些血统。与骨髓间充质干细胞不同,人脐带基质细胞(HUCSC)远未得到很好的鉴定。这项研究试图描述这些细胞的增殖,结构和分化特性,以解释它们在许多方面的特殊性质。在10个月的时间内,在体外检查了细胞动力学,细胞结构以及在扩增和分化为间充质和神经元谱系过程中的转化程度。与人类骨髓MSC进行了分化比较。培养中的HUCSC揭示了两个不同的细胞群,即1型和2型细胞,它们具有差异的波形蛋白和细胞角蛋白丝。在显示区域特定定位的脐带部分遇到了相应的细胞。 α-平滑肌肌动蛋白和结蛋白细丝(在脐带部分可见)通过通道减少。关于向软骨形成,脂肪形成和成骨谱系的分化,没有注意到关于1型和2型细胞的差异,而在神经元谱系中则注意到了优先的分化。相对成功是通过生产软骨球和成骨单层细胞实现的,而与骨髓MSC相比,脂肪细胞还不成熟。神经元标记物的存在表明它们在神经源性诱导下转化为某种成熟状态。结论是,HUCSC在培养中保留了其原始表型,没有自发分化,寿命有限,并具有多能干细胞特性。鉴于这些特征,如果在适当的条件下进行操作,它们通常被认为是祖细胞,值得进一步研究以潜在地用于基于细胞的疗法中。
  • 【摄影比较:定性的室外热感知调查的一种方法。】 复制标题 收藏 收藏
    DOI:10.1007/s00484-018-1575-6 复制DOI
    作者列表:Cortesão J,Brandão Alves F,Raaphorst K
    BACKGROUND & AIMS: :This article addresses the use of photographic comparison as a complementary visual appraisal method in an outdoor thermal perception survey. This survey was carried out during a Ph.D. research exploring how materials and vegetation influence thermal comfort in outdoor public spaces. Objective and subjective thermal perception parameters were combined and quantitative and qualitative research methods were used. The quantitative methods included microclimatic measurements, whilst the qualitative methods comprised observations and spatially localised interviews based on a questionnaire and the photographic comparison. This article explores how such visual research method allowed triangulating findings of this field survey. Three non-edited photographs of outdoor public spaces, under similar summer meteorological conditions but with contrasting spatial features, were shown to respondents to the questionnaire. The photographs depicted undisclosed locations for preventing biased emotional appreciations. Respondents were asked to select the potentially most comfortable and uncomfortable environments depicted. The choice of photographs matched the previous answers on the thermal sensation and evaluation judgement scales. Hence, we discuss the way the visual interpretations by respondents allowed the triangulation of in situ thermal perception data. The extent to which thermal comfort can be interpreted from thermal environments depicted in photographs containing clear visual signs is further discussed. The article concludes on how such a visual appraisal method can be valuable for enriching future qualitative outdoor thermal perception surveys with subjective interpretation of visual data.
    背景与目标: :本文介绍了摄影比较在室外热感知调查中作为辅助视觉评估方法的用途。这项调查是在博士学位期间进行的。研究探索材料和植被如何影响室外公共场所的热舒适性。结合客观和主观热感知参数,并使用定量和定性研究方法。定量方法包括微气候测量,而定性方法则包括观察和基于问卷和照片比较的空间局部访谈。本文探讨了这种视觉研究方法如何对本次实地调查的结果进行三角剖分。向问卷的受访者展示了三张未经编辑的户外公共空间照片,它们在相似的夏季气象条件下但具有鲜明的空间特征。这些照片描绘了未公开的位置,以防止偏爱的情感欣赏。要求受访者选择所描绘的可能最舒适和最不舒适的环境。照片的选择与以前在热感和评估判断量表上的答案相符。因此,我们讨论了受访者的视觉解释允许对现场热感数据进行三角测量的方式。进一步讨论了可以从包含清晰视觉符号的照片中描述的热环境中解释热舒适度的程度。本文总结了这样的视觉评估方法如何通过对视觉数据的主观解释来丰富未来的定性户外热感知调查的价值。
  • 【加纳运动引起的支气管痉挛和特应性:相隔十年的两次调查。】 复制标题 收藏 收藏
    DOI:10.1371/journal.pmed.0040070 复制DOI
    作者列表:Addo-Yobo EO,Woodcock A,Allotey A,Baffoe-Bonnie B,Strachan D,Custovic A
    BACKGROUND & AIMS: BACKGROUND:Asthma and allergic diseases have increased in the developed countries. It is important to determine whether the same trends are occurring in the developing countries in Africa. We aimed to determine the time trend in the prevalence of exercise-induced bronchospasm (EIB) and atopic sensitisation over a ten-year period in Ghanaian schoolchildren. METHODS AND FINDINGS:Two surveys conducted using the same methodology ten years apart (1993 and 2003) among schoolchildren aged 9-16 years attending urban rich (UR), urban poor (UP), and rural (R) schools. Exercise provocation consisted of free running for six minutes. Children were skin tested to mite, cat, and dog allergen. 1,095 children were exercised in 1993 and 1,848 in 2003; 916 were skin tested in 1993 and 1,861 in 2003. The prevalence of EIB increased from 3.1% (95% CI 2.2%-4.3%) to 5.2% (4.3%-6.3%); absolute percentage increase 2.1% (95% CI 0.6%-3.5%, p < 0.01); among UR, UP, and R children EIB had approximately doubled from 4.2%, 1.4%, and 2.2% to 8.3%, 3.0% and 3.9% respectively. The prevalence of sensitisation had also doubled from 10.6%, 4.7%, and 4.4% to 20.2%, 10.3%, and 9.9% (UR, UP, and R respectively). Mite sensitisation remained unchanged (5.6% versus 6.4%), but sensitisation to cat and dog increased considerably from 0.7% and 0.3% to 4.6% and 3.1%, respectively. In the multiple logistic regression analysis, sensitisation (odds ratio [OR] 1.77, 95% CI 1.12-2.81), age (OR 0.88, 95% CI 0.79-0.98), school (the risk being was significantly lower in UP and R schools: OR 0.40, 95% CI 0.23-0.68 and OR 0.54, 95% CI 0.34-0.86, respectively) and year of the study (OR 1.73, 95% CI 1.13-2.66) remained significant and independent associates of EIB. CONCLUSIONS:The prevalence of both EIB and sensitisation has approximately doubled over the ten-year period amongst 9- to 16-year-old Ghanaian children irrespective of location, with both EIB and atopy being more common among the UR than the UP and R children.
    背景与目标: 背景:发达国家的哮喘和过敏性疾病有所增加。重要的是要确定非洲的发展中国家是否正在出现同样的趋势。我们旨在确定加纳学童在十年期间运动诱发的支气管痉挛(EIB)和特应性致敏的流行趋势。
    方法和研究结果:两次调查使用相同的方法,分别对十年级(1993年和2003年)就读于城市富人(UR),城市穷人(UP)和农村(R)学校的9-16岁的学童进行了调查。运动挑衅包括自由奔跑六分钟。对孩子的皮肤进行了螨,猫和狗过敏原测试。 1993年有1,095名儿童运动,2003年有1,848名儿童运动; 1993年对916例皮肤进行了测试,2003年进行了1,861例。EIB的患病率从3.1%(95%CI 2.2%-4.3%)增加到5.2%(4.3%-6.3%);绝对百分比提高2.1%(95%CI 0.6%-3.5%,p <0.01);在UR,UP和R儿童中,EIB分别从4.2%,1.4%和2.2%翻了一番,分别达到8.3%,3.0%和3.9%。致敏率也从10.6%,4.7%和4.4%翻了一番,达到20.2%,10.3%和9.9%(分别为UR,UP和R)。螨的敏感性保持不变(5.6%比6.4%),但是对猫和狗的敏感性从0.7%和0.3%分别显着增加到4.6%和3.1%。在多元logistic回归分析中,敏化度(比值[OR] 1.77,95%CI 1.12-2.81),年龄(OR 0.88,95%CI 0.79-0.98),学校(在UP和R学校中的风险明显较低) :OR 0.40,95%CI 0.23-0.68和OR 0.54,95%CI 0.34-0.86)和研究年份(OR 1.73,95%CI 1.13-2.66)仍然很重要,并且是EIB的独立关联者。
    结论:在9年至16岁的加纳儿童中,无论位置如何,在10年期间,EIB和致敏的患病率均增加了一倍左右,UR和UUP患儿比UP和R患儿更常见EIB和特应性过敏。

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