• 【将集中开发的药物经济学评估用于当地配方决策。】 复制标题 收藏 收藏
    DOI:10.2146/ajhp060027 复制DOI
    作者列表:Tordoff JM,Murphy JE,Norris PT,Reith DM
    BACKGROUND & AIMS: PURPOSE:The distribution, content, timeliness, use, and influence of pharmacoeconomic assessments (PEAs) of drugs in New Zealand public hospitals were examined. METHODS:In April 2005, a questionnaire-based, cross-sectional survey was sent to chief pharmacists at all 29 New Zealand hospitals employing a pharmacist. The questionnaire asked pharmacists about the use and influence of PEAs in their hospitals' formulary decision-making process. Answers were given using a scale of 1 to 6, with 1 being the most positive response. RESULTS:Of the 29 surveys mailed, 24 (83%) were completed. Data on 12 PEAs were analyzed. Assessments were seen and summaries read in most hospitals (median, 77% and 65%, respectively). Full documents were read in fewer hospitals (35%). In general, the PEAs were considered moderately easy to understand, provided a concise summary, and contained adequate detail of the methodology. Of the 24 respondent hospitals, 21 had assessment processes for new medicines; hence, a total of 252 hospital evaluations of Pharmaceutical Management Agency (PHARMAC)-assessed drugs were possible. A total of 132 possible evaluations (52%) were undertaken. More evaluations (106 [42%]) took place before PHARMAC's PEAs were distributed and fewer (26 [10%]) after distribution. Where used, the PEAs appeared to have a modest effect on hospital decisions. CONCLUSION:The provision of 12 PEAS by PHARMAC to hospitals in New Zealand had only a modest influence on their formulary decision-making process, mostly due to the lack of timeliness of the PEAs. The timely delivery of centrally developed PEAs may be essential to generating a greater effect on the formulary decisions at a wider level.
    背景与目标: 目的:检查了新西兰公立医院药物的药物经济评估(PEA)的分布,内容,及时性,使用和影响。
    方法:2005年4月,基于问卷调查的横断面调查被发送给新西兰所有29家雇用药剂师的医院的首席药剂师。该问卷向药剂师询问了PEA在其医院处方制定决策过程中的使用和影响。答案以1到6的等级给出,其中1是最积极的回答。
    结果:在邮寄的29份调查中,有24份(83%)已完成。分析了12个PEA的数据。大多数医院都进行了评估并阅读了摘要(中位数分别为77%和65%)。较少的医院(35%)读取了完整的文档。一般而言,PEA被认为具有中等程度的易懂性,提供了简洁的摘要,并包含了该方法的足够详细信息。在24家受访医院中,有21家拥有新药评估程序;因此,总共可以对252个由美国药物管理局(PHARMAC)评估的药物进行医院评估。总共进行了132次可能的评估(52%)。在分发PHARMAC的PEA之前进行了更多的评估(106 [42%]),而在分发之后进行的评估较少(26 [10%])。在使用PEA的情况下,似乎对医院的决策影响不大。
    结论:PHARMAC向新西兰的医院提供了12个PEAS,对他们的处方制定决策过程影响不大,这主要是由于PEAs缺乏及时性。及时提供集中开发的PEA对于在更大范围内对配方决策产生更大影响可能是必不可少的。
  • 【对发展中国家蛋白质充足性的评估:质量至关重要。】 复制标题 收藏 收藏
    DOI:10.1017/S0007114512002577 复制DOI
    作者列表:Ghosh S,Suri D,Uauy R
    BACKGROUND & AIMS: :Dietary protein and amino acid requirement recommendations for normal "healthy" children and adults have varied considerably with 2007 FAO/WHO protein requirement estimates for children lower, but dietary essential AA requirements for adults more than doubled. Requirement estimates as presented do not account for common living conditions, which are prevalent in developing countries such as energy deficit, infection burden and added functional demands for protein and AAs. This study examined the effect of adjusting total dietary protein for quality and digestibility (PDCAAS) and of correcting current protein and AA requirements for the effect of infection and a mild energy deficit to estimate utilizable protein (total protein corrected for biological value and digestibility) and the risk/prevalence of protein inadequacy. The relationship between utilizable protein/prevalence of protein inadequacy and stunting across regions and countries was examined. Data sources (n = 116 countries) included FAO FBS (food supply), UNICEF (stunting prevalence), UNDP (GDP) and UNSTATS (IMR) and USDA nutrient tables. Statistical analyses included Pearson correlations, paired-sample/non-parametric t-tests and linear regression. Statistically significant differences were observed in risk/prevalence estimates of protein inadequacy using total protein and the current protein requirements versus utilizable protein and the adjusted protein requirements for all regions (p < 0·05). Total protein, utilizable protein, GDP per capita and total energy were each highly correlated with the prevalence of stunting. Energy, protein and utilizable protein availability were independently and negatively associated with stunting (p < 0·001), explaining 41 %, 34 % and 40 % of variation respectively. Controlling for energy, total protein was not a statistically significant factor but utilizable protein remained significant explaining~45 % of the variance (p = 0·017). Dietary utilizable protein provides a better index of population impact of risk/prevalence of protein inadequacy than crude protein intake. We conclude that the increased demand for protein due to infections and mild to moderate energy deficits, should be appropriately considered in assessing needs of populations where those conditions still prevail.
    背景与目标: :对于正常的“健康”儿童和成年人,饮食中蛋白质和氨基酸的需求建议相差很大,因为2007年FAO / WHO对儿童的蛋白质需求量估计值有所降低,但成年人的饮食中必需氨基酸的需求量增加了一倍以上。提出的需求估算并未考虑到发展中国家普遍存在的生活条件,例如能量不足,感染负担以及对蛋白质和氨基酸的额外功能需求。这项研究检查了调整饮食中总蛋白质的质量和消化率(PDCAAS)的效果,以及针对感染和轻度能量不足的影响校正当前蛋白质和AA需求以估算可利用蛋白质的影响(校正了总蛋白质的生物学价值和消化率),以及蛋白质不足的风险/患病率。研究了可利用的蛋白质/蛋白质不足的患病率与跨地区和国家发育迟缓之间的关系。数据来源(n = 116个国家)包括粮农组织FBS(食品供应),UNICEF(致病率),UNDP(GDP)和UNSTATS(IMR)和USDA营养表。统计分析包括Pearson相关性,成对样本/非参数t检验和线性回归。在所有区域中,使用总蛋白和当前蛋白需求量与可利用蛋白和调整后的蛋白需求量相比,蛋白不足的风险/患病率估计值中存在统计学上的显着差异(p <0·05)。总蛋白,可利用蛋白,人均GDP和总能量均与发育迟缓的发生率高度相关。能量,蛋白质和可利用的蛋白质利用率与发育迟缓独立相关并且呈负相关(p <0·001),分别解释了41%,34%和40%的变异。控制能量时,总蛋白质不是统计学上显着的因素,但是可利用的蛋白质仍然是重要的,解释了〜45%的方差(p = 0·017)。与粗蛋白摄入量相比,膳食可利用蛋白对蛋白质不足风险/流行的总体影响指数提供了更好的指标。我们得出的结论是,在评估那些情况仍然普遍存在的人群的需求时,应适当考虑由于感染和轻度至中度的能量不足导致的蛋白质需求增加。
  • 【在拉丁美洲国家之间,血清学检测作为幽门螺杆菌相关的癌前病变和胃癌的生物标志物的用途各不相同。】 复制标题 收藏 收藏
    DOI:10.1007/s10552-012-0106-8 复制DOI
    作者列表:Flores-Luna L,Camorlinga-Ponce M,Hernandez-Suarez G,Kasamatsu E,Martínez ME,Murillo R,Lazcano E,Torres J
    BACKGROUND & AIMS: PURPOSE:Currently, studies on serologic diagnosis of Helicobacter pylori-associated gastric cancer (GC) in Latin America are scarce. The aim of the present study was to evaluate the association between H. pylori serology tests in patients with early precancerous lesions or GC, when compared with non-atrophic gastritis in Colombia, Paraguay, and Mexico, three countries in Latin America with a high prevalence of H. pylori infection but contrasting rates of GC mortality. METHODS:Gastric biopsies and blood samples were obtained from patients attending the gastroenterology or oncology services of hospitals in the three participating countries. IgG antibodies against H. pylori whole-cell antigens and CagA were tested in 1,117 sera using an enzyme-linked immunoabsorbent assay. RESULTS:Positive and significant associations were shown for H. pylori seropositivity and preneoplastic lesions in Mexico (OR 2.0; 95 % CI 1.1-3.4) but not in Colombia (OR 1.2; 95 % CI 0.6-2.1) or Paraguay (OR 1.5; 95 % CI 0.6-3.2); no significant associations were shown for GC in any country. CagA seropositivity was associated with preneoplasic lesions in all three countries (ORs = 2.1, 3.0, and 3.1 for Mexico, Colombia, and Paraguay, respectively), and with GC only in Colombia (OR 4.3; 95 % CI 2.1-9.2). CONCLUSIONS:In countries of Latin America, the IgG CagA test might be a useful biomarker for patients with gastric preneoplastic lesions and for those at risk of developing gastric cancer.
    背景与目标: 目的:目前,拉丁美洲缺乏关于幽门螺杆菌相关性胃癌(GC)的血清学诊断的研究。本研究的目的是,与哥伦比亚,巴拉圭和墨西哥这三个高流行率国家中的非萎缩性胃炎相比,评估具有早期癌前病变或GC的幽门螺杆菌血清学检测之间的相关性幽门螺杆菌感染的发生率,但GC死亡率却相反。
    方法:从三个参与国医院的胃肠病学或肿瘤学服务的患者那里获取胃活检和血液样本。使用酶联免疫吸附试验在1117份血清中测试了针对幽门螺杆菌全细胞抗原和CagA的IgG抗体。
    结果:在墨西哥(OR 2.0; 95%CI 1.1-3.4)或哥伦比亚(OR 1.2; 95%CI 0.6-2.1)或巴拉圭(OR 1.5;墨西哥; OR);幽门螺杆菌血清阳性和肿瘤前病变的阳性和显着相关性。 95%CI 0.6-3.2);在任何国家/地区,GC均未显示任何重要关联。在所有三个国家中,CagA血清阳性与肿瘤前病变有关(墨西哥,哥伦比亚和巴拉圭的OR分别为2.1、3.0和3.1),仅在哥伦比亚与GC相关(OR 4.3; 95%CI 2.1-9.2)。
    结论:在拉丁美洲国家,IgG CagA检测对于胃癌前病变和有患胃癌风险的患者可能是有用的生物标志物。
  • 【不良健康状况对进入和维持有酬就业的影响:欧洲国家的证据。】 复制标题 收藏 收藏
    DOI:10.1136/jech.2006.047456 复制DOI
    作者列表:Schuring M,Burdorf L,Kunst A,Mackenbach J
    BACKGROUND & AIMS: OBJECTIVES:To examine the effects of ill health on selection into paid employment in European countries. METHODS:Five annual waves (1994-8) of the European Community Household Panel were used to select two populations: (1) 4446 subjects unemployed for at least 2 years, of which 1590 (36%) subjects found employment in the next year, and (2) 57 436 subjects employed for at least 2 years, of which 6191 (11%) subjects left the workforce in the next year because of unemployment, (early) retirement or having to take care of household. The influence of a perceived poor health and a chronic health problem on employment transitions was studied using logistic regression analysis. RESULTS:An interaction between health and sex was observed, with women in poor health (odds ratio (OR) 0.4), men in poor health (OR 0.6) and women (OR 0.6) having less chance to enter paid employment than men in good health. Subjects with a poor health and low/intermediate education had the highest risks of unemployment or (early) retirement. Taking care of the household was only influenced by health among unmarried women. In most European countries, a poor health or a chronic health problem predicted staying or becoming unemployed and the effects of health were stronger with a lower national unemployment level. CONCLUSION:In most European countries, socioeconomic inequalities in ill health were an important determinant for entering and maintaining paid employment. In public health measures for health equity, it is of paramount importance to include people with poor health in the labour market.
    背景与目标: 目的:研究健康状况对欧洲国家选择有偿就业的影响。
    方法:欧洲共同体家庭小组的五次年度调查(1994-8年)用于选择两个人口:(1)4446名失业至少两年的受试者,其中1590(36%)受试者在下一年找到工作, (2)57 436名受雇至少2年的对象,其中6191(11%)个受雇者由于失业,(提前)退休或不得不照顾家庭而在第二年离开工作岗位。使用逻辑回归分析研究了感知不到的健康状况和慢性健康问题对就业转变的影响。
    结果:观察到健康与性别之间的相互作用,健康状况较差的女性(优势比(OR)0.4),健康状况较差的男性(OR 0.6)和女性(OR 0.6)的机会少于有良好状况的男性健康。健康状况差,教育水平低/中级的受试者失业或(早退休)的风险最高。照顾家庭仅受未婚妇女健康的影响。在大多数欧洲国家中,健康状况不佳或慢性健康问题预计会留下或变得失业,而且国民失业水平较低时,健康的影响更大。
    结论:在大多数欧洲国家,健康状况不佳的社会经济不平等是进入和维持有酬就业的重要决定因素。在实现健康公平的公共卫生措施中,将健康状况不佳的人纳入劳动力市场至关重要。
  • 【在11个国家提供咨询服务后,影响妇女选择激素结合避孕方法的因素:《选择》研究的亚分析结果。】 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: 目的:调查在避孕咨询后,女性和医护人员(HCP)的哪些特征与改用另一种联合激素避孕(CHC)方法有关。
    方法:选择是一项横断面调查,其中向18,787名妇女提供了有关联合激素避孕药的咨询,在此期间,记录了她们在咨询之前和之后首选的避孕方法。在此子分析中,使用逻辑回归模型确定与咨询后更改方法有关的特征。
    结果:打算从药丸换成另一种方法的可能性与年纪大有关。受过大学教育;保持稳定的关系;先前的意外怀孕;较年轻的HCP或建议使用除药丸以外的方法的人。更换贴剂与女性HCP或推荐贴剂或注射剂的HCP有关。更换戒指的年龄超过21岁。受过大学教育;处于恋爱关系中;以前使用过的荷尔蒙方法;并由女性HCP,小于60岁的HCP或推荐环或植入物的HCP进行咨询。居住国以复杂的方式影响了这些变化。
    结论:避孕咨询后,妇女选择慢性丙型肝炎的方法受到其年龄,教育背景,人际关系,先前计划外的怀孕和居住国家,年龄,性别和他们的HCP偏好的影响。
  • 【世卫组织欧洲区域各国间儿童耐多药结核病接触者的管理:对当前做法的调查。】 复制标题 收藏 收藏
    DOI:10.5588/ijtld.16.0949 复制DOI
    作者列表:Turkova A,Tebruegge M,Brinkmann F,Tsolia M,Mouchet F,Kampmann B,Seddon JA
    BACKGROUND & AIMS: :The World Health Organization European Region has one of the highest rates of multidrug-resistant tuberculosis (MDR-TB) in the world, resulting in many vulnerable children being exposed each year. Evidence for preventive therapy following MDR-TB exposure is limited and current guidance is conflicting. An internet-based survey was performed to determine clinical practice in this region. Seventy-two clinicians from 25 countries participated. Practices related to screening and decision-making were highly variable. Just over half provided preventive therapy for children exposed to MDR-TB; the only characteristic associated with provision was practice within the European Union (adjusted OR 4.07, 95%CI 1.33-12.5).
    背景与目标: :世界卫生组织欧洲区域是世界上耐多药结核病(MDR-TB)发病率最高的国家之一,每年导致许多弱势儿童被暴露。耐多药结核病暴露后进行预防性治疗的证据有限,目前的指导意见相互矛盾。进行了基于互联网的调查,以确定该地区的临床实践。来自25个国家的72名临床医生参加了会议。与筛查和决策有关的做法变化很大。刚刚超过一半的人为患有耐多药结核病的儿童提供了预防性治疗;与规定相关的唯一特征是欧盟内部的惯例(调整后的OR 4.07,95%CI 1.33-12.5)。
  • 【向其他国家学习:卫生政策的随时待命工具。】 复制标题 收藏 收藏
    DOI:10.1258/jhsrp.2007.007146 复制DOI
    作者列表:Nolte E,Ettelt S,Thomson S,Mays N
    BACKGROUND & AIMS: :Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere.
    背景与目标: :卫生部认识到其他国家/地区强大的卫生系统信息可以为英国国家卫生服务局提供宝贵的经验,因此在2005年委托一个学术团队提供“国际医疗比较的待命服务”。这种新颖的方法来指导政策并回顾前两年的经验。它说明了卫生系统比较分析中有据可查的挑战。一个重要的问题是了解卫生系统的背景情况,以便解释现象并得出适当的政策结论。其他挑战包括学术兴趣和严格性之间的潜在紧张关系,以及需要及时分析以告知卫生部迅速变化的政策议程的挑战。所涉主题的多样性和性质以及快速的周转时间,意味着该基金必须认真权衡严格性和及时性,以确保报告的价值和相关性。强大的研究基础与国家专家的国际网络相联系,促进了以相对较低的成本提供高质量的分析。但是,只有为其他基础研究提供了范围,这样的安排才能维持下去。目前尚无关于英格兰对卫生保健政策制定影响的正式评估。这些知识对于开发其他地方的类似资源至关重要。
  • 【13价肺炎球菌结合疫苗在婴儿和儿童中的安全性:9个国家/地区的13项临床试验的荟萃分析。】 复制标题 收藏 收藏
    DOI:10.1016/j.vaccine.2013.08.025 复制DOI
    作者列表:Thompson A,Gurtman A,Patterson S,Juergens C,Laudat F,Emini EA,Gruber WC,Scott DA
    BACKGROUND & AIMS: BACKGROUND:Meta-analyses enable summarization and interpretation of data across clinical trials. When applied to safety data they allow for detection of rare events. Recently, a 13-valent pneumococcal conjugate vaccine (PCV13) was approved in multiple countries worldwide for routine immunization of infants and young children. This meta-analysis was conducted to identify potentially clinically important rare safety events associated with PCV13. OBJECTIVE:To summarize the safety of PCV13 compared with 7-valent pneumococcal conjugate vaccine (PCV7) administered to infants and toddlers. METHODS:A meta-analysis was performed of integrated safety data from 13 infant studies (PCV13 n=4729 and PCV7 n=2760) conducted in 9 North American, European, and Asian countries. Local reactions at the vaccine injection site and systemic events were collected for 4-7 days after each dose into electronic diaries. Adverse events (AEs) were collected after each vaccination. RESULTS:Overall, rates of local reactions after any dose of the infant series were similar between PCV13 and PCV7 groups: tenderness (46.7% vs 44.8%, respectively); swelling (28.5% vs 26.9%); and redness (36.4% vs 33.9%). After the toddler dose, tenderness was significantly higher among PCV7 subjects than PCV13 subjects (54.4% vs 48.8%; P=0.005). Frequencies of fever (≥38°C) were similar in both groups and mostly mild (≤39°C); incidence of moderate fever (>39°C to ≤40°C) with PCV13 was ≤2.8% after any infant dose and 5.0% after the toddler dose, compared with ≤2.6% and 7.3%, respectively, with PCV7. Fever >40°C was uncommon in both groups. Frequencies of decreased appetite, irritability, and sleep disturbances were similar in both groups. AEs were the types of conditions and symptoms expected in infants and children, and clinically significant differences between vaccine groups were not observed. CONCLUSION:PCV13 has a favorable safety profile similar to that of PCV7, a vaccine for which there is >10 years clinical experience.
    背景与目标: 背景:元分析可以汇总和解释整个临床试验中的数据。当应用于安全数据时,它们允许检测罕见事件。最近,一种13价肺炎球菌结合疫苗(PCV13)已在全球多个国家/地区批准用于婴儿和幼儿的常规免疫。进行这项荟萃分析,以鉴定与PCV13相关的潜在的临床上重要的罕见安全事件。
    目的:总结与婴幼儿使用的7价肺炎球菌结合疫苗(PCV7)相比,PCV13的安全性。
    方法:对9个北美,欧洲和亚洲国家进行的13项婴儿研究(PCV13 n = 4729和PCV7 n = 2760)的综合安全性数据进行了荟萃分析。每次注射疫苗后4-7天,将疫苗注射部位的局部反应和全身性事件收集到电子日记中。每次疫苗接种后收集不良事件(AE)。
    结果:总的来说,在PCV13和PCV7组中,任何剂量的婴儿系列后的局部反应率相似:压痛(分别为46.7%和44.8%);肿胀(28.5%对26.9%);和发红(36.4%比33.9%)。幼儿服药后,PCV7受试者的压痛明显高于PCV13受试者(54.4%比48.8%; P = 0.005)。两组的发烧频率(≥38°C)相似,且多数为轻度(≤39°C)。在任何婴儿剂量下,PCV13发生中度发烧(> 39°C到≤40°C)的发生率≤2.8%,在幼儿剂量后为5.0%,而PCV7分别为≤2.6%和7.3%。两组中发烧> 40°C的情况很少见。两组食欲减退,烦躁不安和睡眠障碍的频率相似。不良事件是婴儿和儿童中预期的疾病和症状类型,未观察到疫苗组之间的临床显着差异。
    结论:PCV13具有与PCV7类似的良好安全性,后者具有10年以上的临床经验。
  • 【在北非国家中,质粒测定的共利斯汀抗性:系统综述。】 复制标题 收藏 收藏
    DOI:10.1089/mdr.2019.0471 复制DOI
    作者列表:Touati A,Mairi A
    BACKGROUND & AIMS: :We have conducted a systematic review to update available information on plasmid-mediated colistin resistance (mobilized colistin resistance [mcr]) genes in North African countries. We have searched the articles of PubMed, Scopus, and Web of Science databases reporting plasmid-mediated colistin resistance bacteria isolated in North African countries. After searching and selection, 30 studies that included 208 mcr-positive isolates were included. Different mcr-positive strains frequencies were recorded and ranged from 2% in clinical isolates to 12.3% in environmental samples. Escherichia coli was the predominant species recorded and these microorganisms showed high resistance to ciprofloxacin and cotrimoxazole. IncHI2 plasmids are probably the key vectors responsible for the dissemination of mcr genes in these countries. This review highlighted that the mcr-positive isolates are circulating in different ecological niches with different frequencies. Therefore, actions should be implemented to prevent the dissemination of the mcr genes within and outside of these countries, such as microbiological and molecular surveillance programs and restriction use of colistin in farming.
    背景与目标: :我们进行了系统的综述,以更新北非国家中质粒介导的大肠菌素抗性(动员大肠菌素抗性[mcr])基因的可用信息。我们搜索了PubMed,Scopus和Web of Science数据库的文章,这些文章报告了在北非国家分离的质粒介导的大肠菌素抗性细菌。经过搜索和选择,纳入了包括208个mcr阳性分离株的30个研究。记录了不同的mcr阳性菌株频率,范围从临床分离株的2%到环境样品的12.3%。大肠杆菌是记录的主要物种,这些微生物显示出对环丙沙星和卡曲美唑的高抗性。 IncHI2质粒可能是在这些国家/地区传播mcr基因的关键载体。这篇综述强调了mcr阳性分离株在不同生态位中以不同的频率传播。因此,应采取行动防止在这些国家内外传播mcr基因,例如微生物和分子监测计划以及限制大肠菌群的使用。
  • 【卫生信息交换的状况:六个国家的比较。】 复制标题 收藏 收藏
    DOI:10.7189/jogh.09.020427 复制DOI
    作者列表:Payne TH,Lovis C,Gutteridge C,Pagliari C,Natarajan S,Yong C,Zhao LP
    BACKGROUND & AIMS: Background:Health information exchange (HIE) is frequently cited as an important objective of health information technology investment because of its potential to improve quality, reduce cost, and increase patient satisfaction. In this paper we examine the status and practices of HIE in six countries, drawn from a range of higher and lower income regions. Methods:For each of the countries represented - China, England, India, Scotland, Switzerland, and the United States - we describe the state of current practice of HIE with reference to two scenarios: transfer of care and referral. For each country we discuss national objectives, barriers and plans for further advancing clinical information exchange. Results:The countries vary widely in levels of adoption of EHRs, availability of health information in electronic form suitable for HIE, and in the information technology infrastructure to be used for transmission. Common themes emerged, however, including an expectation that information will be exchanged rather than gathered anew, the need for incentives to promote information exchange, and concerns about data security and patient confidentiality. Conclusions:Although the ability to transfer health information to where it is most needed is nearly always mentioned as an advantage of HIE adoption, there are wide differences in the degree to which this has been achieved to support the scenarios used in this study. Nevertheless, these differences indicate varying stages of progress along a comparable pathway, with similar barriers being identified in the countries described. In some cases, these have been partially surmounted while elsewhere work is needed. We reflect on contextual factors influencing the status and direction of HIE efforts in different global regions and their implications for progress.
    背景与目标: 背景:健康信息交换(HIE)经常被认为是健康信息技术投资的重要目标,因为它具有提高质量,降低成本和提高患者满意度的潜力。在本文中,我们从六个高收入和低收入地区中考察了六个国家中HIE的现状和实践。
    方法:对于代表的每个国家(中国,英国,印度,苏格兰,瑞士和美国),我们参考两种情况描述了HIE的当前实践状况:护理转移和转诊。对于每个国家,我们都讨论了进一步推进临床信息交换的国家目标,障碍和计划。
    结果:各国在采用电子病历的水平,适用于HIE的电子形式的健康信息的可获得性以及用于传输的信息技术基础设施方面差异很大。然而,出现了共同的主题,包括期望交换信息而不是重新收集信息,对促进信息交换的激励措施的需求以及对数据安全性和患者机密性的担忧。
    结论:尽管几乎总是提到将健康信息传输到最需要的地方的能力,这是采用HIE的优势,但在支持本研究中所用方案的程度上却存在很大差异。然而,这些差异表明,在可比的道路上,进展阶段各不相同,在上述国家中也发现了类似的障碍。在某些情况下,这些已被部分覆盖,而其他地方则需要进行工作。我们思考影响全球不同地区HIE努力的状态和方向的背景因素及其对进展的影响。
  • 【低,中,高收入国家的抑郁症状与心血管疾病和死亡率的关系。】 复制标题 收藏 收藏
    DOI:10.1001/jamapsychiatry.2020.1351 复制DOI
    作者列表:
    BACKGROUND & AIMS: Importance:Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live. Objective:To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. Design, Setting, and Participants:This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019. Exposures:Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. Main Outcomes and Measures:Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. Results:Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR, 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). The associations between having 4 or more depressive symptoms and the combined outcome were similar in 7 different geographical regions and in countries at all economic levels but were stronger in urban (HR, 1.23; 95% CI, 1.13-1.34) compared with rural (HR, 1.10; 95% CI, 1.02-1.19) communities (P for interaction = .001) and in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001). Conclusions and Relevance:In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas. Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.
    背景与目标: 重要性:抑郁症与高收入国家的心血管疾病(CVD)和癌症的发生和过早死亡有关,但尚不清楚在低收入和中等收入国家以及大多数人所在的城市地区是否如此抑郁症现在生活。
    目的:确定经济发展水平不同的国家和城乡地区的抑郁症状与心血管疾病和全因死亡率之间的关系。
    设计,背景和参与者:这项基于人群的多中心队列研究于2005年1月至2019年6月进行(中位随访时间为9.3年),纳入了来自五大洲21个经济不同国家的370个城市社区和314个农村社区。年龄在35至70岁之间的符合条件的参与者入选。分析于2018年2月开始,至2019年9月结束。
    暴露:来自简短综合国际诊断面试的四个或更多个自我报告的抑郁症状。
    主要结果和措施:事件性CVD,全因死亡率,以及对事件性CVD或全因死亡率的综合测量。
    结果:145862名参与者中,有61235名(58%)为男性,平均(SD)年龄为50.05(9.7)岁。在这些患者中,有15983名(11%)在基线时报告了4种或更多种抑郁症状。抑郁与突发性CVD(危险比[HR]为1.14; 95%CI为1.05-1.24),全因死亡率(HR为1.17; 95%CI为1.11-1.25),CVD /死亡率综合结果(HR)相关。在多变量模型中,分别为1.18; 95%CI,1.11-1.24),心肌梗塞(HR,1.23; 95%CI,1.10-1.37)和非心血管死亡(HR,1.21; 95%CI,1.13-1.31)。合并症状的风险随症状数量的增加而逐渐增加,在有7种症状的人群中最高(HR,1.24; 95%CI,1.12-1.37),最低的有1种症状(HR,1.05; 95%CI,0.92 -1.19) ; P表示趋势<.001)。在7个不同的地理区域和所有经济水平的国家中,具有4种或更多种抑郁症状与综合结果之间的关联相似,但与农村地区(HR)相比,城市地区(HR,1.23; 95%CI,1.13-1.34)更强,1.10; 95%CI,1.02-1.19)社区(互动率P = 0.001)和男性(HR,1.27; 95%CI,1.13-1.38),而女性(HR,1.14; 95%CI,1.06- 1.23;交互作用的P <<。001)。
    结论与相关性:在这项大型的,基于人群的队列研究中,患有抑郁症状的成年人在经济上多样化的环境中,特别是在城市地区,患心血管疾病的风险增加和死亡率增加。作为减少全球非传染性疾病负担的全面战略的一部分,应优先提高对这些身体健康风险的了解和认识。
  • 【用藜麦(Chenopodium quinoa Willd。)面粉制备的新开发的婴儿辅食(6-24个月大)的理化,流变,分子,热和感官评估。】 复制标题 收藏 收藏
    DOI:10.1016/j.foodchem.2020.126208 复制DOI
    作者列表:Ayseli MT,Yilmaz MT,Cebi N,Sagdic O,Ozmen D,Capanoglu E
    BACKGROUND & AIMS: :The aim of the current work was to evaluate the physicochemical, rheological, molecular, thermal and sensory properties of complementary food (CF) formulations prepared with quinoa (Chenopodium quinoa Willd.) flour (QF). It was observed that QF addition significantly affected the physicochemical and rheological properties of CF formulations, resulting in higher protein and crude fiber, but lower total sugar contents and increased storage (G') and loss (G″) modulus values. The glass transition temperature decreased due to QF addition. The FTIR spectra revealed the presence of aromatic amino acids derived from QF. GC, GC-MS and GC-O analyses revealed the presence of 50 aroma and 23 aroma-active compounds, among which aldehydes, alcohols and ketones were the most prevalent group of compounds. The formulation with 8% QF received the highest sensory scores. QF could be used to improve the physicochemical, rheological, thermal and sensory properties of CF products.
    背景与目标: :当前工作的目的是评估用藜麦(藜麦藜麦(Chenopodium quinoa Willd。))面粉(QF)制备的辅食(CF)制剂的理化,流变,分子,热和感官特性。观察到QF的添加显着影响CF制剂的物理化学和流变性质,导致更高的蛋白质和粗纤维,但是更低的总糖含量以及增加的储能(G')和损失(G'')模量值。由于添加了QF,玻璃化转变温度降低了。 FTIR光谱显示存在源自QF的芳香族氨基酸。 GC,GC-MS和GC-O分析显示存在50种香气和23种香气活性化合物,其中醛,醇和酮是最常见的化合物。 QF为8%的配方获得最高的感官评分。 QF可用于改善CF产品的理化,流变,热和感官性能。
  • 【中低收入国家建立和维持放射治疗服务的障碍和促进者的经验:定性研究。】 复制标题 收藏 收藏
    DOI:10.1111/ajco.13310 复制DOI
    作者列表:Donkor A,Luckett T,Aranda S,Vanderpuye V,Phillips J
    BACKGROUND & AIMS: AIMS:The factors contributing to the establishment of high-quality radiotherapy services in low- and middle-income countries (LMICs) are poorly understood. The aim was to identify and describe barriers and facilitators to establishing and sustaining high-quality and accessible radiotherapy services in LMICs based on the experience of successful and unsuccessful attempts. METHODS:An exploratory-descriptive qualitative study using semistructured telephone interviews was undertaken. Purposive and snowball sampling techniques were used to recruit participants. The World Health Organization Innovative Care for Chronic Conditions Framework informed the interview guide. A constant comparative data analysis approach was adopted. FINDINGS:Seventeen participants were interviewed. Ten were working permanently in nine LMICs and seven were permanently employed in four high-income countries. Three themes were developed: committing to a vision of improving cancer care; making it happen and sustaining a safe service; and leveraging off radiotherapy to strengthen integrated cancer care. Identified barriers included lack of political leadership continuity, lack of a coordinated advocacy effort, non-Member State of the IAEA, lack of reliable epidemiological data, lack of a comprehensive budget and lack of local expertise. Facilitators identified included strong political support, vision champion, availability of a regulator, costed cancer control plan, diversified sources of funding, responsible project manager, adoption of evidence-based practice, strategic partnerships, motivation to provide patient-centered care, and availability of supportive technology. CONCLUSIONS:Assessing the level of readiness to establish and sustain a radiotherapy service is highly recommended. Future research is recommended to develop a readiness assessment tool for radiotherapy services implementation at LMICs.
    背景与目标: 目的:对在中低收入国家(LMIC)建立高质量放射治疗服务的因素知之甚少。目的是根据成功和失败尝试的经验,确定和描述在中低收入国家建立和维持高质量和可及的放射治疗服务的障碍和促进者。
    方法:采用半结构化电话访谈进行了探索性描述性定性研究。目的性和滚雪球采样技术被用来招募参与者。世界卫生组织慢性病创新护理框架为采访指南提供了信息。采用了恒定的比较数据分析方法。
    结果:对十七名参与者进行了采访。十个在九个中低收入国家中长期工作,七个在四个高收入国家中永久性工作。制定了三个主题:致力于改善癌症护理的愿景;使其实现并维持安全的服务;并利用放射疗法加强综合癌症治疗。所查明的障碍包括缺乏政治领导连续性,缺乏协调的宣传工作,原子能机构非成员国,缺乏可靠的流行病学数据,缺乏全面的预算以及缺乏当地专门知识。确定的促进者包括强大的政治支持,愿景支持者,可利用的监管者,成本高昂的癌症控制计划,多元化的资金来源,负责任的项目经理,采用循证实践,战略合作伙伴关系,提供以患者为中心的护理动机以及可利用的医疗服务。支持技术。
    结论:强烈建议评估建立和维持放射治疗服务的准备程度。建议进行进一步的研究,以开发用于中低收入国家的放射治疗服务准备情况评估工具。
  • 【痴呆症对发展中国家的经济影响:对中国上海阿尔茨海默氏型痴呆症的评估。】 复制标题 收藏 收藏
    DOI:10.3233/jad-2008-15109 复制DOI
    作者列表:Wang G,Cheng Q,Zhang S,Bai L,Zeng J,Cui PJ,Zhang T,Sun ZK,Ren RJ,Deng YL,Xu W,Wang Y,Chen SD
    BACKGROUND & AIMS: :The main objective of this study was to assess the economic cost of Alzheimer's disease (AD) in Shanghai, China, as a pilot study for future evaluations. Sixty-seven patients with AD were interviewed, and the information of the AD-related cost and resources used was collected from October 2005 to September 2006. By retrospective analysis, annual costs were calculated and expressed in Chinese renminbi (RMB). Direct cost per patient per year averaged approximately 8,432 RMB (1,058 USD), indirect cost per patient per year was 10,568 RMB (1,326 USD), and annual costs were 19,001 RMB (2,384 USD) per patient per year in this investigation. Total cost was significantly associated with the degree of severity including cognitive function (MMSE) and activity of daily living (ADL). With the increase in the number of persons at risk for developing AD, the economic burden of AD patients in China is significantly heavy.
    背景与目标: :这项研究的主要目的是评估中国上海阿尔茨海默氏病(AD)的经济成本,作为未来评估的试点研究。采访了67例AD患者,从2005年10月至2006年9月收集了与AD相关的费用和资源信息。通过回顾性分析,计算了年度费用并以人民币(RMB)表示。在此研究中,每位患者每年的直接费用平均约为8,432元(1,058美元),每位患者每年的间接费用为10,568元(1,326美元),每位患者每年的年费用为19,001元(2,384美元)。总成本与严重程度显着相关,包括认知功能(MMSE)和日常生活活动(ADL)。随着罹患AD的风险人数增加,中国AD患者的经济负担显着增加。
  • 【埃塞俄比亚处理慢性病的主要医疗方法:其他国家的例子。】 复制标题 收藏 收藏
    DOI:10.7861/clinmedicine.7-3-228 复制DOI
    作者列表:Mamo Y,Seid E,Adams S,Gardiner A,Parry E
    BACKGROUND & AIMS: :Chronic non-communicable diseases such as epilepsy, diabetes, cardiac disease and hypertension represent a growing but neglected burden in developing countries. Rural sufferers, distant from health facilities, bear this most acutely. In response, a community care programme has been developed at Jimma University Hospital and its allied health centres in rural southwest Ethiopia. This involves general duty nurses at rural health centres being trained to provide care for chronic disease patients, with regular supervision from the hospital physicians. The programme allows treatment to be provided away from the main hospital so that those who cannot afford to travel can access care near their homes. Improved access increases the request for care, and helps to address the large unmet need for chronic disease treatment. This is a good model in which rural healthcare delivery through a team can bring widespread benefit. In this article chronic disease care is discussed with a particular focus on diabetes and epilepsy. The model can be replicated in more or less developed countries and may also be relevant for HIV care.
    背景与目标: :癫痫,糖尿病,心脏病和高血压等慢性非传染性疾病在发展中国家造成的负担正在增加,但被忽视。离卫生设施较远的农村患者承受得最为严重。作为回应,吉马大学医院及其在埃塞俄比亚西南部农村地区的专职医疗中心制定了一项社区护理计划。这需要在医院医生的定期监督下,对农村保健中心的普通值班护士进行培训,以为慢性病患者提供护理。该计划允许在总医院以外的地方提供治疗,以便那些无力旅行的人可以在家附近获得医疗服务。改善的出入途径增加了对护理的需求,并有助于解决对慢性病治疗的大量未满足需求。这是一个很好的模式,通过团队提供农村医疗保健可以带来广泛的利益。在本文中,我们将重点讨论糖尿病和癫痫病的慢性病护理。该模型可以在或多或少的发达国家中复制,也可能与HIV护理有关。

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