• 【在11个国家/地区咨询后,影响妇女选择联合激素避孕方法的因素: CHOICE研究的子分析结果。】 复制标题 收藏 收藏
    DOI:10.3109/13625187.2013.819077 复制DOI
    作者列表:Bitzer J,Cupanik V,Fait T,Gemzell-Danielsson K,Grob P,Oddens BJ,Pawelczyk L,Unzeitig V
    BACKGROUND & AIMS: OBJECTIVES:To investigate which characteristics of women and healthcare professionals (HCPs) were associated with changing to another combined hormonal contraceptive (CHC) method after contraceptive counselling. METHODS:CHOICE was a cross-sectional survey in which 18,787 women were counselled about combined hormonal contraceptives, during which their contraceptive methods preferred both prior to and after counselling were recorded. In this subanalysis, characteristics associated with changing the method after counselling were determined using logistic regression models. RESULTS:The probability of intending to change from the pill to another method was associated with being older; university-educated; being in a steady relationship; a prior unintended pregnancy; a younger HCP or one who recommended methods other than the pill. Changing to the patch was associated with a female HCP or a HCP who recommended the patch or an injectable. Changing to the ring was associated with being over 21 years; university-educated; being in a relationship; previous hormonal method use; and counselling by a female HCP, a HCP < 60 years old, or a HCP who recommended the ring or an implant. The country of residence influenced these changes in a complex pattern. CONCLUSIONS:Women's choice of CHC methods after contraceptive counselling are influenced by their age, educational background, relationship status, prior unplanned pregnancies and country of residence, as well as age, gender and preferences of their HCP.
    背景与目标:
  • 【女用避孕套: 有效性和便利性,而不是美国城市青少年所重视的 “女性控制”。】 复制标题 收藏 收藏
    DOI:10.1521/aeap.2008.20.2.160 复制DOI
    作者列表:Latka MH,Kapadia F,Fortin P
    BACKGROUND & AIMS: :Abstract Data on adolescents' views regarding the female condom are limited. We conducted seven single-gender focus groups with 47 New York City boys and girls aged 15-20 years (72% African American; 43% ever on public assistance; 72% sexually active; 25% had either been pregnant or fathered a pregnancy). Conceptual mapping was performed by participants to reveal the characteristics of protective methods deemed important to them. During analysis we specifically evaluated how the female condom was mapped. Girls consistently organized methods by, and thus were concerned about, contraceptive effectiveness, side effects, and availability (over the counter vs. provider controlled). Participants tended to classify the female condom with the male condom rather than as "female controlled." Maps varied among boys but contraceptive effectiveness was an important theme. Boys, but not girls, consistently and variously articulated an awareness of sexual pleasure when discussing this topic. Emphasizing the female condom's contraceptive effectiveness, lack of side effects, and availability may be important when counseling adolescents.
    背景与目标: : 关于青少年对女用避孕套的看法的抽象数据有限。我们与47名年龄在15-20岁之间的纽约市男孩和女孩进行了七个单性别焦点小组 (72% 非裔美国人; 43% 获得公共援助; 72% 性活跃; 25% 已经怀孕或怀孕)。参与者进行了概念映射,以揭示对他们重要的保护方法的特征。在分析过程中,我们专门评估了女性避孕套的绘制方式。女孩通过避孕效果,副作用和可用性 (在柜台上与提供者控制下) 始终如一地组织方法,因此担心。参与者倾向于将女用避孕套与男用避孕套分类,而不是 “女性控制”。男孩之间的地图各不相同,但避孕效果是一个重要主题。在讨论这个话题时,男孩而不是女孩始终如一地表达了对性快感的认识。在咨询青少年时,强调女用避孕套的避孕效果,缺乏副作用和可用性可能很重要。
  • 【对小组实践与单手实践的有效性进行系统评价。】 复制标题 收藏 收藏
    DOI:10.1016/j.healthpol.2013.07.008 复制DOI
    作者列表:Damiani G,Silvestrini G,Federico B,Cosentino M,Marvulli M,Tirabassi F,Ricciardi W
    BACKGROUND & AIMS: BACKGROUND:Since the 1970s, many countries have employed the use of the General practitioner group practice, but there is contrasting evidence about its effectiveness. A systematic review was performed to assess whether group practice has a more positive impact compared with the single-handed practice on different aspects of health care. METHODS:A systematic review was conducted by querying electronic databases and reviewing articles published between 1990 and 2012. A quality assessment was performed. The effect of group practice was evaluated by collecting all items analysed by the articles into four main categories: (1) studies of quality (measured in terms of clinical processes) and productivity (measured in terms of throughput), named "Clinical process measures and throughput"; (2) studies exploring physician's opinion--"Doctor's perspective"; (3) studies looking into the use of innovation, information and communication technology (ICT) and quality assurance--"Innovation, ICT and quality assurance"; (4) studies focused on patient's opinion--"Patient's perspective". The results were synthesized according to three levels of scientific evidence. RESULTS:A total of 26 studies were selected. The most studied category was Clinical process measures and throughput (58%). A positive impact of group medicine on "Clinical process measures and throughput", "Doctor's perspective", "Innovation, ICT and quality assurance" was found. There was contrasting evidence considering the "Patient's perspective". CONCLUSIONS:Group practice might be a successful organizational requirement to improve the quality of clinical practice in Primary Health Care. Further comparative studies are needed to investigate the impact of organizational and professional determinants such as physician's economic incentives, mode of payment, size of the groups and multispecialty on the effectiveness of medical primary care.
    背景与目标:
  • 【全科医生对建议戒烟服务的有效性和意图的信念: 定性和定量研究。】 复制标题 收藏 收藏
    DOI:10.1186/1471-2296-8-39 复制DOI
    作者列表:Vogt F,Hall S,Marteau TM
    BACKGROUND & AIMS: BACKGROUND:General practitioners' (GPs) negative beliefs about smoking cessation services may act as barriers to them recommending such services to smokers motivated to stop smoking. METHODS:In Study 1, 25 GPs from 16 practices across London were interviewed in this qualitative study. Framework analysis was used to identify key themes in GPs' beliefs about smoking cessation services. In Study 2, a convenience sample of 367 GPs completed an internet-based survey. Path-analysis was used to examine relationships between beliefs identified in Study 1 and intentions to recommend smoking cessation services. RESULTS:In Study 1, GPs felt that smoking cessation assistance was best provided by others. GPs favoured local services (i.e. practice nurses offering stop smoking support) over central services (i.e. offered through the Primary Care Trust), mainly because these were seen as more personalised and accessible for patients. These beliefs appeared to influence GPs' beliefs about the effectiveness of services. In Study 2, GPs' beliefs had a large effect on their intentions to recommend both central services, (f2 = .79) and local services, (f2 = 1.04). GPs' beliefs about effectiveness and cost-effectiveness were key predictors their intentions to recommend central services and local services. Beliefs about the level of personalisation offered and smokers' likelihood of attending services had indirect effects on intentions to recommend services operating via beliefs about effectiveness. CONCLUSION:GPs vary in their perceptions of the effectiveness of smoking cessation services and their intentions to recommend these services vary in line with these beliefs. Interventions aimed at increasing the likelihood with which GPs recommend these services may therefore be more effective if they addressed these beliefs.
    背景与目标:
  • 【计算机断层结肠成像筛查大肠癌,结肠外癌和主动脉瘤: 具有成本效益分析的模型模拟。】 复制标题 收藏 收藏
    DOI:10.1001/archinte.168.7.696 复制DOI
    作者列表:Hassan C,Pickhardt PJ,Laghi A,Kim DH,Zullo A,Iafrate F,Di Giulio L,Morini S
    BACKGROUND & AIMS: BACKGROUND:In addition to detecting colorectal neoplasia, abdominal computed tomography (CT) with colonography technique (CTC) can also detect unsuspected extracolonic cancers and abdominal aortic aneurysms (AAA).The efficacy and cost-effectiveness of this combined abdominal CT screening strategy are unknown. METHODS:A computerized Markov model was constructed to simulate the occurrence of colorectal neoplasia, extracolonic malignant neoplasm, and AAA in a hypothetical cohort of 100,000 subjects from the United States who were 50 years of age. Simulated screening with CTC, using a 6-mm polyp size threshold for reporting, was compared with a competing model of optical colonoscopy (OC), both without and with abdominal ultrasonography for AAA detection (OC-US strategy). RESULTS:In the simulated population, CTC was the dominant screening strategy, gaining an additional 1458 and 462 life-years compared with the OC and OC-US strategies and being less costly, with a savings of $266 and $449 per person, respectively. The additional gains for CTC were largely due to a decrease in AAA-related deaths, whereas the modeled benefit from extracolonic cancer downstaging was a relatively minor factor. At sensitivity analysis, OC-US became more cost-effective only when the CTC sensitivity for large polyps dropped to 61% or when broad variations of costs were simulated, such as an increase in CTC cost from $814 to $1300 or a decrease in OC cost from $1100 to $500. With the OC-US approach, suboptimal compliance had a strong negative influence on efficacy and cost-effectiveness. The estimated mortality from CT-induced cancer was less than estimated colonoscopy-related mortality (8 vs 22 deaths), both of which were minor compared with the positive benefit from screening. CONCLUSION:When detection of extracolonic findings such as AAA and extracolonic cancer are considered in addition to colorectal neoplasia in our model simulation, CT colonography is a dominant screening strategy (ie, more clinically effective and more cost-effective) over both colonoscopy and colonoscopy with 1-time ultrasonography.
    背景与目标:
  • 【创新和有效性: 改变新西兰中学的学校护士范围。】 复制标题 收藏 收藏
    DOI:10.1111/j.1753-6405.2008.00197.x 复制DOI
    作者列表:Kool B,Thomas D,Moore D,Anderson A,Bennetts P,Earp K,Dawson D,Treadwell N
    BACKGROUND & AIMS: OBJECTIVE:To describe the changing role of school nurses in eight New Zealand (NZ) secondary schools from low socio-economic areas with high Pacific Island and Māori rolls. METHODS:An evaluation of a pilot addressing under-achievement in low-decile schools in Auckland, NZ (2002-05). Annual semi-structured school nurse interviews and analysis of routinely collected school health service data were undertaken. RESULTS:Two patterns of school nurse operation were identified: an embracing pattern, where nurses embraced the concept of providing school-based health services; and a Band-Aid pattern, where only the basics for student health care were provided by school nurses. CONCLUSIONS AND IMPLICATIONS:School nurses with an embracing pattern of practice provided more effective school-based health services. School health services are better served by nurses with structured postgraduate education that fosters the development of a nurse-practitioner role. Co-ordination of school nurses either at a regional or national level is required.
    背景与目标:
  • 【经皮神经电刺激和干扰电流在原发性痛经中的有效性。】 复制标题 收藏 收藏
    DOI:10.1111/j.1526-4637.2007.00308.x 复制DOI
    作者列表:Tugay N,Akbayrak T,Demirtürk F,Karakaya IC,Kocaacar O,Tugay U,Karakaya MG,Demirtürk F
    BACKGROUND & AIMS: OBJECTIVE:To compare the effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea. DESIGN:A prospective, randomized, and controlled study. SETTING:Hacettepe University School of Physical Therapy and Rehabilitation. PATIENTS:Thirty-four volunteer subjects with primary dysmenorrhea (mean age: 21.35 +/- 1.70 years) were included. Statistical analyses were performed in 32 subjects who completed all measures. INTERVENTIONS:Fifteen subjects received interferential current application for 20 minutes and 17 subjects received transcutaneous electrical nerve stimulation for 20 minutes when they were experiencing dysmenorrhea. OUTCOME MEASURES:Physical characteristics, years since menarche, length of menstrual cycle (days), and duration of menstruation (days) were recorded. Visual analog scale ( VAS) intensities of menstrual pain, referred lower limb pain, and low back pain were recorded before treatment, and immediately, 8 hours, and 24 hours after treatment. RESULTS:Intensities of the evaluated parameters decreased beginning from just after the applications in both groups (P<0.05). Intensity of referring low back pain in first three measurement times was different between the groups (P<0.05), but this difference is thought to be due to the baseline values of the groups. So, it can be said that no superiority existed between the methods (P>0.05). CONCLUSION:Both transcutaneous electrical nerve stimulation and interferential current appear to be effective in primary dysmenorrhea. As they are free from the potentially adverse effects of analgesics, and no adverse effects are reported in the literature nor observed in this study, a clinical trial of their effectiveness in comparison with untreated and placebo-treated control groups is warranted.
    背景与目标:
  • 【用抗感染剂治疗的中心静脉导管在预防血流感染方面的临床有效性和成本效益: 系统评价和经济评价。】 复制标题 收藏 收藏
    DOI:10.3310/hta12120 复制DOI
    作者列表:Hockenhull JC,Dwan K,Boland A,Smith G,Bagust A,Dündar Y,Gamble C,McLeod C,Walley T,Dickson R
    BACKGROUND & AIMS: OBJECTIVES:To assess the clinical effectiveness and cost-effectiveness of central venous catheters (CVCs) treated with anti-infective agents in preventing catheter-related bloodstream infection (CRBSI). DATA SOURCES:Major electronic databases were searched from 1985 to August 2005. REVIEW METHODS:The systematic clinical and economic reviews were conducted according to accepted procedures. Only full economic evaluations (synthesis of costs and benefits) comparing the use of anti-infective central venous catheters (AI-CVCs) with untreated CVCs or other treated catheters were selected for inclusion in the economic review. RESULTS:A total of 32 trials met the clinical inclusion criteria. Seven different types of AI-CVC were identified, with the most frequently tested being chlorhexidine and silver sulfadiazine (CHSS) (externally treated), CHSS (externally and internally treated) and minocycline rifampicin (internally and externally treated). In general, the trials were of a poor quality in terms of reported methodology, microbiological relevance and control of confounding variables. The pooled result suggests a statistically significant advantage for AI-CVCs in comparison to standard catheters in reducing CRBSI [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.34 to 0.60, 24 studies, I-squared = 0%, fixed effects]. Analysis by subgroups of catheters demonstrates that antibiotic-treated catheters and catheters treated internally and externally decrease CRBSI rates significantly (OR 0.26, 95% CI 0.15 to 0.46, six studies, I-squared = 0%, fixed effects, and OR 0.43, 95% CI 0.26 to 0.70, nine studies, I-squared = 0%, fixed effects, respectively). Catheters treated only externally demonstrate a wider CI and non-significant effect (OR 0.67, 95% CI 0.43 to 1.06, nine studies, I-squared = 0%, fixed effects). A treatment effect was also found for trials with an average duration of between 5 and 12 days, and for the one study with a mean duration of over 20 days. There was a statistically significant treatment effect for both femoral and jugular insertion sites and for those studies reporting a mix of insertion sites. The treatment effect was not observed in trials using exclusively subclavian insertion sites. Of the four trials that compared treated catheters, one reported a benefit of antibiotic-treated catheters over catheters treated externally with CHSS. All three sensitivity analyses testing for study design differences reported a statistically significant treatment effect. The review was limited owing to the quality of the trials included, marked differences in the definitions and methods of diagnosis of CRBSI, and inconsistent reporting of risk factors and patient population factors. Furthermore, two-thirds of trials were commercially funded. The economic performance (cost-effectiveness and potential cost-savings) of using AI-CVCs to reduce the number of CRBSIs in patients requiring a CVC was also reviewed. Results show that the use of AI-CVCs instead of standard CVCs can lead to a reduction in CRBSIs and decreased medical costs. To complement the reviews, a basic decision-analytic model was constructed to explore a range of possible scenarios for the NHS in England and Wales. Results show that for every patient who receives an AI-CVC there is an estimated cost-saving of 138.20 pounds. The multivariate sensitivity analyses estimate potentially large cost-savings, depending on the size of the population, under a wide range of cost and clinical assumptions. However, those considering the purchase of AI-CVCs should ensure that their patient populations and the important characteristics of local clinical practice are indeed similar to those described in this economic evaluation. CONCLUSIONS:Overall, AI-CVCs are clinically effective and relatively inexpensive and therefore their integration into clinical practice can be justified. However, the use of these anti-infective catheters without the appropriate use of other practical care initiatives will have only a limited success on the prevention of CRBSIs. Comparative trials are required to determine which, if any, of the treated catheters is the most effective. Pragmatic research related to the effectiveness of bundles of care that may reduce rates of CRBSI is also warranted.
    背景与目标:
  • 【包裹长度对Nissen和Toupet胃底折叠术有效性的影响: 一项前瞻性随机研究。】 复制标题 收藏 收藏
    DOI:10.1007/s00464-008-9852-9 复制DOI
    作者列表:Mickevicius A,Endzinas Z,Kiudelis M,Jonaitis L,Kupcinskas L,Maleckas A,Pundzius J
    BACKGROUND & AIMS: BACKGROUND:Incontinence or hypercontinence of the fundic wrap depends primarily on the length of the valve or the type of procedure. Much less attention has been paid to the fundic wrap length. This study aimed to compare the effectiveness of two different wrap lengths among the patients undergoing partial or total fundoplication. METHODS:For this study, 153 patients were randomized to either Nissen (1.5- or 3-cm wrap) or Toupet (1.5- or 3-cm wrap) laparoscopic fundoplication. The groups were compared according to intensity of dysphagia, esophageal manometry data, ambulatory 24-h pH monitoring data, postoperative esophagitis rate, and overall treatment failure rate. RESULTS:In all the groups, the tone of the lower esophageal sphincter was significantly increased and the DeMeester score significantly decreased, reaching normal levels. At 6 months after surgery, the Toupet 1.5-cm group had significantly more cases of esophagitis than the 3-cm wrap group (24.2% vs 3.3%; p<0.05). At 12 months after surgery, only one patient in the Nissen 3-cm group had moderate to severe dysphagia. In all cases, failures were associated with persistent erosive esophagitis. At the 12-month follow-up assessment, treatment failures were significantly more common in Toupet 1.5-cm group than in the Toupet 3-cm group (17.5% vs 2.7%; p<0.05). However, such differences were not observed in the Nissen groups (7.8% for 1.5 cm and 15.6% for 3 cm; p>0.05). CONCLUSIONS:Evaluation of the treatment results suggests that the wrap length is important in partial Toupet fundoplication to avoid treatment failures. The 3-cm wrap is superior to the 1.5-cm wrap in cases of partial posterior Toupet fundoplication. The influence of wrap length on treatment failure remains unconfirmed for the Nissen procedure.
    背景与目标:
  • 【羧苄青霉素-氨基糖苷和头孢菌素-氨基糖苷组合在体外对肠球菌的有效性。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Klastersky J,Daneau D
    BACKGROUND & AIMS: :Combination of carbenicillin and cephalothin with various aminoglycosides (gentamicin, sisomicin, tobramycin, kanamycin and amikacin) were studied in vitro using 20 strains of enterococci isolated from clinical material. The addition of the aminoglycosides to carbenicillin increased the rate of bactericidal action of carbenicillin on most strains. Little benefit was obtained by adding the aminoglycosides to cephalothin and antagonistic action has been observed on some strains.
    背景与目标: : 使用从临床材料中分离的20株肠球菌,体外研究了羧苄青霉素和头孢菌素与各种氨基糖苷类 (庆大霉素,西索米星,妥布霉素,卡那霉素和丁胺卡那霉素) 的组合。在羧苄青霉素中添加氨基糖苷类可提高羧苄青霉素对大多数菌株的杀菌作用速率。通过将氨基糖苷类添加到头孢菌素中几乎没有益处,并且在某些菌株上观察到拮抗作用。
  • 【MRSA的人口统计学筛查可能会损害关节置换单元上环围的有效性。】 复制标题 收藏 收藏
    DOI:10.1016/j.jhin.2012.07.020 复制DOI
    作者列表:Schmidt HM,Izon C,Maley MW
    BACKGROUND & AIMS: :Ring fencing of joint replacement (JR) units has been reported to reduce infections and is recommended by health authorities in Australia and the UK. It has not been determined whether a demographic risk assessment is adequate to prevent the admission of patients colonized with meticillin-resistant Staphylococcus aureus (MRSA) to ring-fenced units. As such, 250 admissions to the JR unit of a suburban Sydney hospital were screened, and MRSA colonization was identified in 2.8% of patients complying with the demographic risk assessment. Demographic risk assessment is not an adequate substitute for physical MRSA screening, and undermines the effectiveness of ring-fencing procedures.
    背景与目标: : 据报道,关节置换 (JR) 单位的围栏可减少感染,并由澳大利亚和英国的卫生当局推荐。尚未确定人口统计学风险评估是否足以防止感染耐甲氧西林金黄色葡萄球菌 (MRSA) 的患者进入环围单位。因此,对悉尼郊区医院的JR病房的250入院进行了筛查,并在符合人口统计学风险评估的2.8% 患者中确定了MRSA定植。人口统计学风险评估不能完全替代物理MRSA筛查,并且会破坏围栏程序的有效性。
  • 【ustekinumab和抗肿瘤坏死因子治疗在银屑病和慢性乙型或丙型肝炎患者中的安全性和有效性: 临床环境中的一项回顾性,多中心研究。】 复制标题 收藏 收藏
    DOI:10.1111/bjd.12045 复制DOI
    作者列表:Navarro R,Vilarrasa E,Herranz P,Puig L,Bordas X,Carrascosa JM,Taberner R,Ferrán M,García-Bustinduy M,Romero-Maté A,Pedragosa R,García-Diez A,Daudén E
    BACKGROUND & AIMS: BACKGROUND:Both the safety and efficacy of biologic therapy may be affected in the presence of highly prevalent chronic viral hepatitis. OBJECTIVE:To evaluate the safety and effectiveness of ustekinumab and antitumour necrosis factor therapy in patients with psoriasis and concomitant chronic viral hepatitis. METHODS:This was a retrospective, multicentre study. Twenty-five patients with psoriasis and concurrent hepatitis C virus (HCV) (20 patients) or hepatitis B virus (HBV) (five patients) infection who had received at least one biologic agent (etanercept, 21 treatments; adalimumab, four; ustekinumab, four; infliximab, two) were included. Clinical, imaging and laboratory data were recorded. RESULTS:In the case of HCV infection, the majority of the patients did not exhibit increases in their viral load or serum liver tests. Aspartate aminotransferase, alanine aminotransferase and gamma glutamyl transpeptidase were doubled from the baseline measurement in only one patient treated with etanercept. Two other cases exhibited viral load increases during the follow-up period. In total, 18 of the 26 treatments achieved a 75% improvement in their Psoriasis Area and Severity Index (PASI 75) score during the follow-up period. Two patients treated with etanercept were diagnosed with hepatocellular carcinoma. In the case of HBV infection, all of the patients were being treated with antiviral therapy, and none presented significant variations in viral load or serum liver enzymes. All patients achieved a PASI 75 during follow-up. CONCLUSIONS:Biologic therapy was effective and safe for the majority of our patients with HCV and HBV infection, although there may be a risk of reactivation or aggravation. We describe the first cases to receive ustekinumab. The use of biologics should be limited to those cases in which the risk-benefit ratio is justified.
    背景与目标:
  • 【探索2型糖尿病Maghrebian队列中胰岛素类似物的安全性和有效性: a-chieve研究的结果。】 复制标题 收藏 收藏
    DOI:10.1016/S0168-8227(13)70014-7 复制DOI
    作者列表:Belhadj M,Dahaoui A,Jamoussi H,Farouqi A
    BACKGROUND & AIMS: AIM:To evaluate the safety and effectiveness of insulin analogues in patients with type 2 diabetes (T2D) from Morocco, Algeria and Tunisia that formed the Maghrebian cohort of the 24-week, non-interventional A₁chieve study. METHODS:Patients starting biphasic insulin aspart, insulin detemir and insulin aspart, alone or in combination, were included. The primary outcome was the incidence of serious adverse drug reactions (SADRs), including major hypoglycaemic events. Secondary outcomes included hypoglycaemia, glycated haemoglobin A₁c (HbA₁c), fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), systolic blood pressure (SBP), body weight and lipids. Quality of life (QoL) was evaluated using the EQ-5D questionnaire. RESULTS:Overall, 3720 patients with a mean age of 58.6 years, body mass index of 27.7 kg/m(2) and diabetes duration of 11.5 years were enrolled. Pre-study, insulin-experienced patients had a mean ± SD dose of 0.54 ± 0.27 U/kg. In the entire cohort, the mean dose was 0.42 ± 0.27 U/kg at baseline, titrated to 0.55 ± 0.30 U/kg by Week 24. Twenty-six SADRs were reported during the study. There was a significant decrease in the proportion of patients reporting overall hypoglycaemia from baseline to Week 24 (18.3% to 13.8%, p < 0.0001). The mean HbA₁c improved significantly from 9.5 ± 1.8% to 7.9 ± 1.4% (p < 0.001). The mean FPG, PPPG, SBP, total cholesterol and QoL also improved significantly (all p < 0.001), while the mean body weight increased by 0.9 ± 3.9 kg (p < 0.001). CONCLUSION:Insulin analogue therapy was well-tolerated and was associated with improved glycaemic control.
    背景与目标:
  • 【[皮质激素脉冲在SARS-CoV-2感染诱导的细胞因子风暴综合征患者中的有效性]。】 复制标题 收藏 收藏
    DOI:10.1016/j.medcli.2020.04.018 复制DOI
    作者列表:Callejas Rubio JL,Luna Del Castillo JD,de la Hera Fernández J,Guirao Arrabal E,Colmenero Ruiz M,Ortego Centeno N
    BACKGROUND & AIMS: INTRODUCTION:Cytokine storm syndrome (CSS) is a serious complication of COVID-19 patients. Treatment is tocilizumab. The use of glucocorticoids (GC) is controversial. In other very similar CSS, such as macrophage activation syndrome (MAS) and hemophagocytic syndrome (HFS), the main treatment are corticosteroids. Our objective is to evaluate the efficacy of GC in the CSS by COVID-19. PATIENTS:We included 92 patients with CSS associated to COVID-19 who received GC, GC, and tocilizumab and only tocilizumab. We determine CSS markers. We evaluated mortality, intubation, and a combined variable. RESULTS:In all cases the percentages of events were lower in the group of patients with GC was administered. The hazard ratio of the final variables with GC versus the group in which only tocilizumab was administered was lower as CGs were considered, with statistical significance for survival. DISCUSSION:The early use of GC pulses could control SLC, with a lower requirement to use tocilizumab and a decrease in events such as intubation and death.
    背景与目标:
  • 【自愿协会中喀麦隆妇女使用避孕药具的社交网络协会。】 复制标题 收藏 收藏
    DOI:10.1016/s0277-9536(96)00385-1 复制DOI
    作者列表:Valente TW,Watkins SC,Jato MN,van der Straten A,Tsitsol LP
    BACKGROUND & AIMS: :This paper examines the association between social networks and contraceptive use. Using data from a survey of women belonging to voluntary associations in Yaoundé, Cameroon, we find that the behavior and characteristics of the members of a respondent's personal networks are associated with her contraceptive use, over and above a set of her own individual characteristics that are usually found to be important. Respondents who report that their network partners approve of contraception, use it, and encourage the respondent to use are more likely to use contraception themselves; the association with encouragement is particularly strong. Moreover, there is a strong association between the specific methods of contraception used by a respondent and those used by her network partners, suggesting that members of personal networks exchange and evaluate specific methods. Because most of the respondent's network partners were interviewed, we are able to compare the respondent's perceptions of contraceptive use by her network partners with the network partner's actual use. We find that it is perceptions of use that matter, even if those perception are incorrect.
    背景与目标: : 本文研究了社交网络与避孕药具使用之间的关联。使用来自喀麦隆雅温得自愿协会的妇女的调查数据,我们发现受访者个人网络成员的行为和特征与她的避孕药具使用有关,超出了她自己的一系列个人特征,通常被发现很重要。报告自己的网络伴侣赞成避孕,使用避孕并鼓励受访者使用避孕的受访者更有可能自己使用避孕措施; 与鼓励的联系特别强烈。此外,受访者使用的特定避孕方法与她的网络合作伙伴使用的避孕方法之间存在很强的联系,这表明个人网络成员交换和评估特定方法。由于大多数受访者的网络合作伙伴都接受了采访,因此我们能够将受访者对其网络合作伙伴使用避孕药具的看法与网络合作伙伴的实际使用情况进行比较。我们发现,重要的是对使用的感知,即使这些感知是不正确的。

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