BACKGROUND & AIMS: BACKGROUND:It can be difficult to engage consumers in health decision making. This is particularly so in the area of palliative care, where consumers are very unwell and are unlikely to become involved in long-term programmes that promote consumer input. This paper explores the possibility of using 'Consumer Impact Statements' to facilitate the inclusion of the viewpoint of people at the end of life in the process of policy and decision making, particularly in the area of subsidy of pharmaceuticals used in palliative care. SEARCH STRATEGY:A broad search was conducted to find information about the use of impact statements in any health field. The health literature and grey literature were searched to explore the use of Consumer Impact Statements to date. RESULTS:No papers were found describing the use of Consumer Impact Statements in the palliative care setting. Health impact assessment is used in the areas of environmental health and community health. Impact statements are less commonly used in other areas of health, especially policy development, and no formal description of a Consumer Impact Statement was found. DISCUSSION:There is considerable scope for developing the use of Consumer Impact Statements to promote the consumer viewpoint in health decision making, because it will allow people who are otherwise unlikely to contribute to the public debate to have their views heard by decision makers. CONCLUSION:The use of Consumer Impact Statements is particularly suited to palliative care, given that consumers are often otherwise unable to contribute to the public debate.

背景与目标：

BACKGROUND & AIMS: :America is in the grips of a diabetes epidemic. Underserved communities disproportionately bear the burden of diabetes and associated harms. Diabetes self-management education and training (DSME/T) may help address the epidemic. By empowering patients to manage their diabetes, DSME/T improves health outcomes and reduces medical expenditures. However, participation in DSME/T remains low. Insurance coverage offers 1 approach for increasing participation in DSME/T. The impact of DSME/T insurance coverage on advancing diabetes-related health equity depends on which types of insurers must cover DSME/T and the characteristics of such coverage. We conducted a legal survey of DSME/T coverage requirements for private insurers, Medicaid programs, and Medicare, finding that substantial differences exist. Although 43 states require that private insurers cover DSME/T, only 30 states require such coverage for most or all Medicaid beneficiaries. Public health professionals and decision makers may find this analysis helpful in understanding and evaluating patterns and gaps in DSME/T coverage.

背景与目标： : 美国正处于糖尿病流行的控制之中。服务不足的社区不成比例地承担着糖尿病和相关危害的负担。糖尿病自我管理教育和培训 (DSME/T) 可能有助于解决这一流行病。通过赋予患者管理糖尿病的能力，DSME/T改善了健康结果并减少了医疗支出。然而，对DSME/T的参与仍然很低。保险范围为增加对DSME/T的参与提供了一种方法。DSME/T保险承保范围对推进糖尿病相关健康公平的影响取决于哪些类型的保险公司必须承保DSME/T以及这种承保范围的特点。我们对私人保险公司、医疗补助计划和医疗保险的DSME/T保险要求进行了法律调查，发现存在实质性差异。尽管有43个州要求私人保险公司承保DSME/T，但只有30个州要求大多数或所有医疗补助受益人承保此类保险。公共卫生专业人员和决策者可能会发现此分析有助于理解和评估DSME/T覆盖范围的模式和差距。

BACKGROUND & AIMS: :Periodontal researchers frequently use case-control studies, but information on participation rates and the reasons for participation are often missing in the publications, thus hindering the assessment of the validity of those studies. A nested case-control study based on a well-defined population was used to (i) describe the patterns of participation; (ii) show how some associations can be biased; and (iii) illustrate how inverse probability weights can be applied to reduce bias. Differential subject participation was quantified using the ratio between participation for each level and the overall participation. Possible biased associations were illustrated using the odds ratios found for eligible and participant subjects. Finally, we used the estimated probability that an individual participates in the case-control study conditional on that individual's covariate pattern, as observed in the screening study to attempt bias reduction. Considerable differential participation was observed for selected factors, including age, annual tuitions and fees, parental income, and parental education. The strategy used for adjustment of bias resulted in some degree of bias reduction. These findings challenge the inferential validity of many studies on periodontitis. The design and conduct of these studies should aim to improve subject participation and must consider and minimize this potential source of bias.

背景与目标： : 牙周研究人员经常使用病例对照研究，但是出版物中经常缺少有关参与率和参与原因的信息，因此阻碍了对这些研究有效性的评估。基于明确定义的人群的嵌套病例对照研究用于 (i) 描述参与模式; (ii) 显示某些关联如何产生偏差; (iii) 说明如何应用反向概率权重来减少偏差。使用每个级别的参与与总体参与之间的比率来量化受试者的不同参与。使用合格受试者和参与者受试者的比值比说明了可能的偏倚关联。最后，我们使用了在筛选研究中观察到的以个体的协变量模式为条件的个体参与病例对照研究的估计概率，以尝试减少偏倚。对于选定的因素，包括年龄，年度学费和费用，父母收入和父母教育，观察到相当大的参与程度。用于调整偏差的策略导致一定程度的偏差减少。这些发现挑战了许多牙周炎研究的推论有效性。这些研究的设计和实施应旨在提高受试者的参与度，并且必须考虑并最大程度地减少这种潜在的偏见来源。

BACKGROUND & AIMS: IMPORTANCE:The value of direct-to-consumer advertising (DTCA) of prescription drugs is widely debated, as is the effect of DTCA on prescription sales and health care utilization. OBJECTIVE:We examined the association between DTCA intensity for statin medications and prescription sales and cholesterol-related health care utilization. DESIGN, SETTING, AND PARTICIPANTS:We conducted an ecological study for 75 designated market areas from 2005 to 2009 in the United States using linked data regarding televised DTCA volume, non-DTCA marketing and promotion, retail, mail order and long-term care prescription drug sales, prescription drug and ambulatory care health care utilization, and contextual factors such as health care density and socioeconomic status. Main outcomes and measures were volume of sales, number of dispensed prescriptions, and high cholesterol-related outpatient visits. Analyses were conducted in 2016. RESULTS:The intensity of rosuvastatin and atorvastatin ad exposures per household varied substantially across designated market areas. After adjustment for socioeconomic, demographic, and clinical characteristics, each 100-unit increase in advertisement viewership was associated with a 2.22% [95% confidence interval (CI), 0.30%-4.19%] increase in statin sales. Similar patterns were observed between DTCA and statin dispensing among the commercially insured. DTCA was associated with increases in high cholesterol-related outpatient visits among adults 18-45 years of age (3.15% increase in visits per 100-unit increase in viewership, 95% CI, 0.98%-5.37%) but not among those 46-65 years of age (0.51%, 95% CI, -1.49% to 2.55%). CONCLUSION:DTCA for statins is associated with increases in statin utilization and hyperlipidemia-related outpatient visits, especially for young adults.

背景与目标：

BACKGROUND & AIMS: :Hearing or visual impairments may negatively affect child's development and participation. Yet the literature about participation of children with hearing or visual impairments is insufficient. The present study aimed to compare participation patterns of children with visual impairments to those of children with hearing impairments and to typical peers and to examine the correlations between participation and socio-demographic parameters in each group. Participants were 70 children between the ages of 6-11: 25 with hearing impairments, 20 with visual impairments and 25 typical peers. All children filled the Children's Assessment of Participation and Enjoyment (CAPE). This self-report refers to participation in daily out of school activities. Children with hearing or visual impairments showed significant limited participation compared to typical peers, expressed in lower number of activities, lower participation intensity; more activities performed at home and with someone else. The limited participation was more emphasized among children with visual impairments. Socio-demographic variables (age, mother's education and socio-economic level) correlated with participation dimensions in both study groups. In conclusion, children with hearing or visual impairments may have restricted participation in out of school activities. Socio-demographic parameters may play a role in encouraging child's participation. Participation among these populations should be further studied in order to assist service providers to create intervention programs together with the child, for enhancing his/her inclusion in the community.

背景与目标： : 听力或视力障碍可能会对儿童的发育和参与产生负面影响。然而，有关听力或视力障碍儿童参与的文献还不够。本研究旨在比较视力障碍儿童与听力障碍儿童和典型同龄人的参与模式，并研究每组参与与社会人口统计学参数之间的相关性。参与者为70名6-11岁的儿童: 25名听力障碍，20名视力障碍和25名典型同龄人。所有儿童都填写了儿童对参与和享受的评估 (CAPE)。此自我报告是指参加日常校外活动。与典型的同龄人相比，有听力或视力障碍的儿童的参与程度显着有限，表现为活动次数少，参与强度低; 在家里和与他人一起进行的活动更多。在视力障碍儿童中，有限的参与更为强调。两个研究组的社会人口统计学变量 (年龄，母亲的教育程度和社会经济水平) 与参与维度相关。总之，听力或视力障碍的儿童可能会限制参加校外活动。社会人口参数可能在鼓励儿童参与方面发挥作用。应进一步研究这些人群的参与，以协助服务提供者与儿童一起制定干预计划，以增强其在社区中的融入能力。

BACKGROUND & AIMS: :This paper outlines a program for promoting mental health in the population by "giving away our skills" as mental health professionals. This kind of program can be started on a shoestring by a community mental health center, family service agency, or adult education program. It consists of teaching parent-child communication courses, with selected parents then becoming instructors to build a network of nonprofessional personpower. The paper explores strategies of setting up programs. It explores the shifting role of the professional toward a colleague relationship with nonprofessionals. Finally, it presents research on the program's effectiveness with parents and the impact on the lives and self-images of the nonprofessional instructors themselves.

背景与目标： : 本文概述了通过 “放弃我们的技能” 作为精神卫生专业人员来促进人口精神卫生的计划。这种计划可以由社区精神卫生中心，家庭服务机构或成人教育计划开始。它包括教授亲子交流课程，然后由选定的父母成为讲师，以建立非专业的人格力量网络。本文探讨了项目设置的策略。它探讨了专业人员在与非专业人员建立同事关系方面的角色转变。最后，它介绍了该计划对父母的有效性以及对非专业教师本身的生活和自我形象的影响的研究。

BACKGROUND & AIMS: BACKGROUND:There is an increased interest in the analysis of large, national palliative care data sets including patient reported outcomes (PROs). No study has investigated if it was best to include or exclude data from services with low response rates in order to obtain the patient reported outcomes most representative of the national palliative care population. Thus, the aim of this study was to investigate whether services with low response rates should be excluded from analyses to prevent effects of possible selection bias. METHODS:Data from the Danish Palliative Care Database from 24,589 specialized palliative care admittances of cancer patients was included. Patients reported ten aspects of quality of life using the EORTC QLQ-C15-PAL-questionnaire. Multiple linear regression was performed to test if response rate was associated with the ten aspects of quality of life. RESULTS:The score of six quality of life aspects were significantly associated with response rate. However, in only two cases patients from specialized palliative care services with lower response rates (< 20.0%, 20.0-29.9%, 30.0-39.9%, 40.0-49.9% or 50.0-59.9) were feeling better than patients from services with high response rates (≥60%) and in both cases it was less than 2 points on a 0-100 scale. CONCLUSIONS:The study hypothesis, that patients from specialized palliative care services with lower response rates were reporting better quality of life than those from specialized palliative care services with high response rates, was not supported. This suggests that there is no reason to exclude data from specialized palliative care services with low response rates.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Upper limb (UL) impairment affects up to 77% of stroke survivors impacting on their ability to carry out everyday activities. However, despite an increase in research exploring these devices for UL rehabilitation, little is known of their effectiveness. OBJECTIVE:This review aimed to assess the effectiveness of UL wearable technology for improving activity and participation in adult stroke survivors. METHODS:Randomized controlled trials (RCTs) and randomized comparable trials of UL wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability, and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs and the Downs and Black Instrument for the quality of non RCTs. RESULTS:In the review, we included 11 studies with collectively 354 participants at baseline and 323 participants at final follow-up including control groups and participants poststroke. Participants' stroke type and severity varied. Only 1 study found significant between-group differences for systems functioning and activity (P≤.02). The 11 included studies in this review had small sample sizes ranging from 5 to 99 participants at an average (mean) age of 57 years. CONCLUSIONS:This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes and the appropriateness of the methodology for complex interventions. However, technology has the potential to measure outcomes, provide feedback, and engage users outside of clinical sessions. This could provide a platform for motivating stroke survivors to carry out more rehabilitation in the absence of a therapist, which could maximize recovery. TRIAL REGISTRATION:PROSPERO CRD42017057715; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=57715.

背景与目标：

BACKGROUND & AIMS: :The study focuses on integrated malaria control in 23 communities on the Pacific Coast of Colombia, with several elements of an ecosystem approach to human health, including malaria-related sociopolitical, ecological, and economic factors. The program fostered community participation. The program presented here had 2 components: implementation and research. The first was conducted in 23 communities, 21 of which lacked adequate health services in terms of education, community participation, prompt diagnosis and complete treatment, and vector control. Research focused on specific vector control measures and the current national health services decentralization process. The project: 1) created a malaria prevention culture in the community; 2) avoided deaths from malaria (no fatal cases in the 3-year period, compared to 5-8 deaths a year previously); 3) avoided cases of cerebral malaria (no cases, as compared to 90-110 per year previously); 4) reduced malaria incidence by 45.36%; 5) decreased length of sick leave from 7.52 to 3.7 days; 6) established a permanent network of microscope technicians and 2-way radio communications; 7) integrated work by local, regional, and outside institutions; 8) demonstrated efficacy of insecticide-impregnated bednets to reduce malaria transmission.

背景与目标： : 这项研究的重点是哥伦比亚太平洋沿岸23个社区的综合疟疾控制，其中包括生态系统方法对人类健康的若干要素，包括与疟疾有关的社会政治，生态和经济因素。该计划促进了社区参与。这里介绍的程序有两个组成部分: 实施和研究。第一次在23个社区进行，其中21个社区在教育、社区参与、及时诊断和全面治疗以及病媒控制方面缺乏适当的保健服务。研究的重点是特定的病媒控制措施和当前的国家卫生服务权力下放过程。该项目: 1) 在社区中建立了预防疟疾的文化; 2) 避免了疟疾死亡 (3年内没有致命病例，而前一年有5-8例死亡); 3) 避免了脑型疟疾病例 (没有病例，与以前的每年90-110相比); 4) 将疟疾发病率降低45.36%; 5) 将病假时间从7.52天减少到3.7天; 6) 建立了一个由显微镜技术人员和双向无线电通信组成的永久网络; 7) 由地方、区域、和外部机构; 8) 证明了杀虫剂浸渍蚊帐减少疟疾传播的功效。

BACKGROUND & AIMS: :A follicular spike in cyclic AMP (cAMP) and its subsequent degradation to AMP promotes oocyte maturation and ovulation. In vitro matured (IVM) oocytes do not receive the cAMP increase that occurs in vivo, and artificial elevation of cAMP in IVM cumulus-oocyte complexes improves oocyte developmental potential. This study examined whether mouse oocytes can use the cAMP degradation product AMP to generate ATP via the adenosine salvage pathway, and examined whether pharmacological elevation of cAMP in IVM cumulus-oocyte complexes alters ATP levels. Oocytes cultured with isotopic 13C5-AMP dose-dependently produced 13C5-ATP, however total cellular ATP remained constant. Pharmacological elevation of cAMP using forskolin and IBMX prior to IVM decreased oocyte ATP and ATP:ADP ratio, and promoted activity of the energy regulator AMPK. Conversely, cumulus cells exhibited higher ATP and no change in AMPK. Culture of oocytes without their cumulus cells or inhibition of their gap-junctional communication yielded lower oocyte 13C5-ATP, indicating that cumulus cells facilitate ATP production via the adenosine salvage pathway. In conclusion, this study demonstrates that mouse oocytes can generate ATP from AMP via the adenosine salvage pathway, and cAMP elevation alters adenine nucleotide metabolism and may provide AMP for energy production via the adenosine salvage pathway during the energetically demanding process of meiotic maturation.

背景与目标： : 环状AMP (cAMP) 中的卵泡尖峰及其随后降解为AMP促进卵母细胞成熟和排卵。体外成熟 (IVM) 卵母细胞不接受体内发生的cAMP增加，而IVM卵丘-卵母细胞复合物中cAMP的人工升高可提高卵母细胞的发育潜力。这项研究检查了小鼠卵母细胞是否可以使用cAMP降解产物AMP通过腺苷挽救途径产生ATP，并检查了IVM卵丘-卵母细胞复合物中cAMP的药理学升高是否会改变ATP水平。用同位素13C5-AMP培养的卵母细胞剂量依赖性产生13C5-ATP，但是总细胞ATP保持恒定。在IVM之前使用forskolin和IBMX对cAMP进行药理提升会降低卵母细胞的ATP和ATP:ADP比率，并促进能量调节剂AMPK的活性。相反，卵丘细胞表现出更高的ATP，而AMPK没有变化。没有卵丘细胞或抑制其间隙连接通讯的卵母细胞培养产生较低的卵母细胞13C5-ATP，表明卵丘细胞通过腺苷挽救途径促进ATP的产生。总之，这项研究表明，小鼠卵母细胞可以通过腺苷挽救途径从AMP产生ATP，而cAMP升高会改变腺嘌呤核苷酸的代谢，并可能在减数分裂成熟的能量需求过程中通过腺苷挽救途径为能量产生提供AMP。

BACKGROUND & AIMS: BACKGROUND:It is widely agreed that children's services should use participation-focused practice, but that implementation is challenging. This paper describes a method for using audit and feedback, an evidence-based knowledge translation strategy, to support implementation of participation-focused practice in front-line services, to identify barriers to implementation, and to enable international benchmarking of implementation and barriers. METHOD:Best-practice guidelines for using audit and feedback were followed. For audit, participation-focused practice was specified as clinicians' three observable behaviours: (a) targets participation outcomes; (b) involves child/parent in setting participation outcomes; and (c) measures progress towards participation outcomes. For barrier identification, the Theoretical Domains Framework Questionnaire (TDFQ) of known implementation barriers was used. A cycle of audit and barrier identification was piloted in three services (n = 25 clinicians) in a large U.K. healthcare trust. From each clinician, up to five randomly sampled case note sets were audited (total n = 122), and the clinicians were invited to complete the TDFQ. For feedback, data on the behaviours and barriers were shared visually and verbally with managers and clinicians to inform action planning. RESULTS:A Method for using Audit and feedback for Participation implementation (MAPi) was developed. The MAPi audit template captured clinicians' practices: Clinicians targeted participation in 37/122 (30.3%) of the sampled cases; involved child/parent in 16/122 (13.1%); and measured progress in 24/122 (19.7%). Barriers identified from the TDFQ and fed back to managers and clinicians included clinicians' skills in participation-focused behaviours (median = 3.00-5.00, interquartile range [IQR] = 2.25-6.00), social processes (median = 4.00, IQR = 3.00-5.00), and behavioural regulation (median = 4.00-5.00, IQR = 3.00-6.00). CONCLUSIONS:MAPi provides a practical, off-the-shelf method for front-line services to investigate and support their implementation of participation-focused practice. Furthermore, as a shared, consistent template, MAPi provides a method for generating cumulative and comparable, across-services evidence about levels and trends of implementation and about enduring barriers to implementation, to inform future implementation strategies.

背景与目标：

BACKGROUND & AIMS: :Macrophages have a critical function in the recognition and engulfment of dead cells. In some settings, macrophages also actively signal programmed cell death. Here we show that during developmentally scheduled vascular regression, resident macrophages are an obligatory participant in a signaling switch that favors death over survival. This switch occurs when the signaling ligand angiopoietin 2 has the dual effect of suppressing survival signaling in vascular endothelial cells (VECs) and stimulating Wnt ligand production by macrophages. In response to the Wnt ligand, VECs enter the cell cycle and in the absence of survival signals, die from G1 phase of the cell cycle. We propose that this mechanism represents an adaptation to ensure that the macrophage and its disposal capability are on hand when cell death occurs.

背景与目标： : 巨噬细胞在识别和吞噬死亡细胞方面具有关键功能。在某些情况下，巨噬细胞还主动发出程序性细胞死亡的信号。在这里，我们显示，在发育预定的血管消退期间，常驻巨噬细胞是信号转换的强制性参与者，该信号转换有利于死亡而不是生存。当信号配体血管生成素2具有抑制血管内皮细胞 (VECs) 中的存活信号和刺激巨噬细胞产生Wnt配体的双重作用时，就会发生这种切换。响应Wnt配体，VECs进入细胞周期，在没有存活信号的情况下，从细胞周期的G1期死亡。我们建议这种机制代表一种适应，以确保在发生细胞死亡时，巨噬细胞及其处置能力就在眼前。

BACKGROUND & AIMS: :SUMMARY The changes in family burden and participation in care of relatives to both voluntarily and compulsorily admitted patients were investigated as part of a longitudinal study of the quality of the mental health services in a Swedish county performed between 1986 and 1997. The relationship between the relative's mental health and family burden, participation in care and need of own support was also investigated. The results showed similar and high levels of burden and a non-sufficient participation in care in both periods investigated despite the ongoing changes in the delivery of psychiatric services and a change in the compulsory legislation in Sweden during the period. More relatives experienced an own need of care and support from the psychiatric services in the 1997 investigation. Relatives who experienced mental health problems of their own more often experienced other forms of burden, experienced less participation in the patient's treatment and also more often had own needs of care and support. It is concluded that interventions in families where relatives experience mental health problems will be useful, since a well-functioning network around the mentally ill person has shown to reduce relapse.

背景与目标： : 总结在1986年和1997年进行的瑞典县精神卫生服务质量纵向研究中，对自愿和强制入院患者的家庭负担和亲属护理的变化进行了调查。还调查了亲属的精神卫生与家庭负担，参与护理和需要自己的支持之间的关系。结果显示，尽管在此期间，瑞典在提供精神病服务方面的持续变化以及强制性立法的变化，但在调查的两个时期中，负担水平相似且水平很高，并且对护理的参与不足。在1997调查中，更多的亲戚经历了精神科服务机构对自己的护理和支持的需求。经历过自己的精神卫生问题的亲戚更经常经历其他形式的负担，对患者治疗的参与较少，也更经常有自己的护理和支持需求。结论是，对亲属遇到精神卫生问题的家庭进行干预将是有用的，因为围绕精神病患者的良好运作的网络已显示出可以减少复发。

BACKGROUND & AIMS: :Racial minority groups are often underrepresented in biobehavioral research. Mistrust stemming from historic abuses of minority research participants is one explanation for this problem. Although mistrust and other variables affect dispositions toward research, brief, quantitative measures of these factors have not been available to researchers in assessing potential recruitment barriers. The present paper is a description and psychometric examination of the Barriers to Research Participation Questionnaire (BRPQ), a new survey designed to assess five factors that affect research participation (religious beliefs, mistrust, health-related fears/beliefs, role overload/ time demands, and perceived personal and community benefits). Good model-fit for the proposed five-factor structure and good test-retest reliability were observed among African American undergraduate men and women at an urban, primarily African American university. The BRPQ appears to be a reliable and valid tool for researchers to use in identifying barriers to recruiting African American participants.

背景与目标： : 种族少数群体在生物行为研究中的代表性通常不足。少数族裔研究参与者的历史虐待引起的不信任是对这个问题的一种解释。尽管不信任和其他变量会影响对研究的态度，但研究人员在评估潜在的招聘障碍时，还没有对这些因素进行简短的定量测量。本文是对研究参与障碍问卷 (BRPQ) 的描述和心理测验，这是一项新的调查，旨在评估影响研究参与的五个因素 (宗教信仰，不信任，与健康相关的恐惧/信念，角色超负荷/时间需求，以及感知的个人和社区利益)。在城市大学 (主要是非裔美国大学) 的非裔美国人本科生中，观察到建议的五因素结构的良好模型拟合性和良好的重测信度。BRPQ似乎是研究人员用来识别招募非裔美国人参与者的障碍的可靠且有效的工具。

BACKGROUND & AIMS: OBJECTIVE:To compare the characteristics and survival of participants and nonparticipants in a community-based study of myocardial infarction (MI). PARTICIPANTS AND METHODS:Residents of Olmsted County, MN, who presented with elevated cardiac troponin T levels from September 1, 2002, through December 31, 2005, were prospectively enrolled and classified with standardized criteria for MI. With specific Institutional Review Board approval, the medical records of patients with MI who did not provide consent but who had given general research authorization were reviewed, as was done for their consenting peers. RESULTS:During the study period, 2277 individuals with elevated cardiac troponin T levels were approached, of whom 1863 (82 percent) consented to participate. Among the 414 nonparticipants, 375 (91 percent) had general research authorization. Of the 558 with general research authorization who met the criteria for incident (ie, first-ever) MI, 67 (12 percent) refused to participate. These participants tended to be older (mean plus or minus SD age, 71 plus or minus 14 vs 67 plus or minus 15 years; P equals .04), were more likely to be of races other than white (9 percent vs 2 percent; P equals .01), and had more comorbidities, including peripheral vascular disease (P equals .02), chronic pulmonary disease (P equals .06), heart failure (P equals .07), and impaired creatinine clearance (P equals .02). No significant differences were detected in cardiovascular risk factors or MI characteristics. During a median follow-up of 517 days, nonparticipants experienced increased mortality rates compared with participants (hazard ratio, 1.97; 95 percent confidence interval, 1.21 to 3.20), which was largely attributable to their older age and excess comorbidities (adjusted hazard ratio, 1.43; 95 percent confidence interval, 0.86 to 2.35). CONCLUSION:In this community-based study of MI, nonparticipants experienced worse survival rates than participants largely because of differences in demographic and clinical characteristics. These differences should be kept in mind when interpreting study results, particularly if participation is low.

背景与目标：