BACKGROUND & AIMS: BACKGROUND:In recent years, decision makers in Canada and elsewhere have expressed a desire for more explicit, evidence-based approaches to priority setting. To achieve this aim within health care organizations, knowledge of both the organizational context and stakeholder attitudes towards priority setting are required. The current work adds to a limited yet growing body of international literature describing priority setting practices in health organizations. METHODS:A qualitative study was conducted using in-depth, face-to-face interviews with 25 key decision makers of the Provincial Health Services Authority (PHSA) of British Columbia. Major themes and sub-themes were identified through content analysis. RESULTS:Priorities were described by decision makers as being set in an ad hoc manner, with resources generally allocated along historical lines. Participants identified the Strategic Plan and a strong research base as strengths of the organization. The main areas for improvement were a desire to have a more transparent process for priority setting, a need to develop a culture which supports explicit priority setting, and a focus on fairness in decision making. Barriers to an explicit allocation process included the challenge of providing specialized services for disparate patient groups, and a lack of formal training in priority setting amongst decision makers. CONCLUSION:This study identified factors important to understanding organizational context and informed next steps for explicit priority setting for a provincial health authority. While the PHSA is unique in its organizational structure in Canada, lessons about priority setting should be transferable to other contexts.

背景与目标： 背景：近年来，加拿大和其他地区的决策者表达了对更明确，基于证据的优先级确定方法的渴望。为了在医疗保健组织内实现这一目标，需要了解组织环境和利益相关者对确定优先重点的态度。当前的工作增加了描述卫生组织中确定优先重点实践的国际文献的数量，但数量却在不断增长。
方法：定性研究是通过对不列颠哥伦比亚省医疗服务管理局（PHSA）的25名主要决策者进行的深入面对面访谈进行的。通过内容分析确定了主要主题和子主题。
结果：决策者将优先级描述为临时设置，资源通常按历史路线分配。参与者确定了战略计划和强大的研究基础是该组织的优势。需要改进的主要领域是希望有一个更加透明的优先级确定过程，需要发展一种支持明确的优先级确定的文化，并注重决策的公平性。明确分配流程的障碍包括为不同的患者群体提供专业服务的挑战，以及决策者之间缺乏优先级确定方面的正规培训。
结论：本研究确定了对理解组织背景非常重要的因素，并为下一步确定省级卫生当局的优先重点提供了依据。虽然PHSA在加拿大的组织结构中是独一无二的，但是有关优先级设置的课程应该可以转移到其他环境中。

BACKGROUND & AIMS: UNLABELLED:Infertility and its treatment can be a very stressful experience. Some countries have legislation governing the provision of counselling for assisted conception treatments. All licensed IVF clinics in the UK are required to offer patients counselling. OBJECTIVES:To determine the proportion of patients who were offered counselling, the proportion of those who then received counselling, how useful they found it, and to establish the main reasons why patients may opt not to receive counselling. METHODS:An internet-based survey of users of an independent infertility website. Two-hundred-and-forty-four patients participated in the survey, of which 62% received treatment in the UK. CONCLUSIONS:Seventy-three per cent of all couples were offered, or obliged, to receive counselling compared to 91% of those patients treated in the UK. Of the patients who took part in the survey, only 30% received counselling; over half of those patients found it either 'very helpful' or 'helpful'. No differences were observed in the perceived usefulness of counselling, comparing those patients who were offered, and chose to receive, counselling versus those who received mandatory counselling. In patients who did not receive counselling, the main reasons cited were: 'felt I can cope on my own' (37%), 'counselling was not offered' (21%), and 'did not think it would be beneficial' (15%).

背景与目标： 不育症：不孕及其治疗可能是一个非常压力的经历。一些国家制定了立法，规定为受孕治疗提供咨询。英国所有获得许可的IVF诊所都必须向患者提供咨询。
目的：确定接受咨询的患者比例，接受咨询的患者比例，发现该咨询的有用性，并确定患者可能选择不接受咨询的主要原因。
方法：基于互联网的独立不育网站用户调查。 244名患者参加了调查，其中62％在英国接受了治疗。
结论：有百分之三十三的新婚夫妇有义务提供咨询服务，而在英国，这一比例为91％。参与调查的患者中，只有30％接受了咨询；只有30％的患者接受了咨询。这些患者中有超过一半的人发现它“非常有帮助”或“有帮助”。比较提供的和选择接受咨询的患者与接受强制咨询的患者之间，在咨询的有用性方面没有观察到差异。在没有接受咨询的患者中，被引用的主要原因是：“感到自己可以自己应付”（37％），“没有提供咨询服务”（21％）和“不认为这会是有益的”（ 15％）。

BACKGROUND & AIMS: BACKGROUND:Professional organizations have issued guidelines recommending breast cancer screening for women 50 years of age. OBJECTIVE:This study examines the percent of U.S. primary care physicians who report breast cancer screening practices that are not consistent with guidelines, and the characteristics of physicians who reported offering extra test modalities. DESIGN:We analyzed a subset of a 2008 cross-sectional Women's Health Care survey sent to primary care physicians randomly selected from the national American Medical Association (AMA) Physician Masterfile. A subset of physicians received a survey that presented a vignette of a health maintenance visit for an asymptomatic 51-year-old woman who was not at high risk for breast cancer. Responses were weighted to represent physicians nationally. PARTICIPANTS:1,654 U.S. family physicians, general internists, and obstetrician-gynecologists under age 65, who practiced in office or hospital based settings (62.8 % response rate). After exclusions, 553 study physicians remained for analysis. MAIN MEASURE:Physician self-report of breast cancer screening practices that are not consistent with the recommendations of the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), defined as almost always offering mammography. KEY RESULTS:36.0 % (95 % CI: 31.8 %-40.5 %) of physicians reported offering breast cancer screening tests inconsistent with national guidelines, with most offering extra tests (magnetic resonance imaging [MRI] and/or ultrasound) (33.2 %, 95 % CI 29.1 %-37.6 %). In adjusted analysis, risk-averse physicians and those who believed in the clinical effectiveness of MRI were more likely to offer extra breast cancer screening tests. CONCLUSIONS:Physicians often report offering breast cancer screening test modalities beyond those recommended for a 51-year-old woman. Strategies, such as academic detailing regarding appropriate use of technology and provision of clinical decision support for breast cancer screening, could decrease overuse of resources.

背景与目标： 背景：专业组织已发布指南，建议对50岁以下的女性进行乳腺癌筛查。
目的：本研究调查了报告乳腺癌筛查实践与指南不一致的美国基层医疗医生的百分比，以及报告提供额外测试方式的医生的特征。
设计：我们分析了2008年横断面的妇女健康护理调查的一部分，该调查发送给从美国国家医学会（AMA）医师主档案中随机选择的初级保健医生。一部分医生接受了一项调查，该调查显示了对没有患乳腺癌高风险的无症状51岁女性进行健康维持就诊的情况。回答权重代表全国范围内的医师。
参与者：1,654位65岁以下的美国家庭医生，普通内科医师和妇产科医师，他们在办公室或医院工作（应答率为62.8％）。排除后，有553名研究医师留待分析。
主要测量：医师对乳腺癌筛查实践的自我报告与美国预防服务工作队（USPSTF），美国妇产科学院（ACOG）和美国癌症协会（ACS）的建议不一致，被定义为几乎总是提供乳房X光检查。
关键结果：36.0％（95％CI：31.8％-40.5％）的医生报告说提供的乳腺癌筛查检查与国家指南不一致，大多数提供额外的检查（磁共振成像[MRI]和/或超声检查）（33.2％， 95％CI 29.1％-37.6％）。在调整后的分析中，规避风险的医生和那些相信MRI的临床有效性的医生更有可能提供额外的乳腺癌筛查测试。
结论：医师通常报告提供了超出推荐给51岁女性的乳腺癌筛查检查方法。策略，例如关于适当使用技术的学术细节以及为乳腺癌筛查提供临床决策支持，可以减少资源的过度使用。

BACKGROUND & AIMS: BACKGROUND:Cardiovascular patients are likely to have an impaired health-related quality of life (HRQoL) due to functional and psycho-social limitations. The main objective of this study was to assess the distribution of HRQoL scores in coronary heart disease (CHD) patients across 22 European countries and to identify factors associated with the variation between patients. METHODS:Data from the EUROASPIRE III survey (European Action on Secondary and Primary Prevention by Intervention to Reduce Events), on 8734 patients, were used. Patients with a diagnosis of CHD (coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), acute myocardial infarction (AMI) or myocardial ischemia) were interviewed and examined at least 6 months after their acute coronary event. Quality of life of each patient was measured using 2 standardized questionnaires: the EuroQoL-5D (EQ-5D) and the 12-item short-form health survey (SF-12v2). RESULTS:HRQoL values differed significantly across countries. Lower HRQoL estimates were found in women, older patients, less educated patients, patients with myocardial infarction or ischemia as recruiting diagnosis, patients with a history of stroke and patients who suffered from a recurring CHD event. In addition, HRQoL was significantly associated with current smoking, central obesity, lack of exercise and inappropriate HbA1c control in patients with diabetes. Furthermore the number of risk factors is inversely associated with HRQoL. CONCLUSION:Overall, a large heterogeneity was observed in HRQoL values between countries and patient groups. There seems to be a significant association between quality of life and patient characteristics with lifestyle risk factors as important determinants of HRQoL.

背景与目标： 背景：由于功能和心理社会方面的限制，心血管疾病患者的健康相关生活质量（HRQoL）可能受损。这项研究的主要目的是评估HRQoL分数在22个欧洲国家中的冠心病（CHD）患者中的分布，并确定与患者之间差异相关的因素。
方法：使用EUROASPIRE III调查（欧洲通过干预减少事件的二级和一级预防行动）对8734例患者的数据。诊断为冠心病（冠状动脉搭桥术（CABG），经皮冠状动脉介入治疗（PCI），急性心肌梗塞（AMI）或心肌缺血）的患者在其急性冠状动脉事件发生后至少6个月进行了访谈和检查。每个患者的生活质量使用2份标准问卷进行测量：EuroQoL-5D（EQ-5D）和12个项目的简短健康调查（SF-12v2）。
结果：HRQoL值在不同国家之间存在显着差异。在女性，年龄较大的患者，受教育程度较低的患者，患有心肌梗塞或局部缺血的患者（作为招募诊断），有中风病史的患者以及患有复发性冠心病事件的患者中发现较低的HRQoL估计值。此外，HRQoL与糖尿病患者当前的吸烟，中心性肥胖，缺乏运动和不适当的HbA1c控制密切相关。此外，危险因素的数量与HRQoL成反比。
结论：总体而言，国家和患者群体之间的HRQoL值存在很大的异质性。生活质量和患者特征与作为HRQoL的重要决定因素的生活方式危险因素之间似乎存在显着联系。

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）。

BACKGROUND & AIMS: AIM:To explore nursing students' experiences of patient safety and peer reporting using hypothetical medication administration scenarios. BACKGROUND:Pre-registration nurse training is tasked with the preparation of students able to provide safe, high quality nursing care. How students' contextualise teaching related to patient safety, risk recognition and management in the clinical setting is less clear. METHOD:A total of 321 third year students enrolled in the final semester of an adult branch pre-registration nursing programme in 2011 in a UK university were surveyed. Using free texts, the questionnaire contained hypothetical medication administration scenarios where patient safety could potentially be at risk. Students' qualitative responses were analysed using thematic analysis. FINDINGS:The response rate was 58% (n = 186). Four themes were identified from the scenarios: (1) Protecting patient safety (2) Willingness to compromise; (3) Avoiding responsibility; (4) Consequences from my actions. CONCLUSION:The findings underscore the importance of contextual teaching about risk management, practical techniques for error management and leadership for optimal patient safety in nursing curricula. IMPLICATIONS FOR NURSING MANAGEMENT:Nurse managers are role models for nursing students in the clinical setting. Nursing management must lead, by example, the patient safety agenda in the clinical setting.

背景与目标： 目的：使用假设的药物管理方案，探索护理专业学生对患者安全和同行报告的经验。
背景：预注册护士培训的任务是准备能够提供安全，高质量护理的学生。在临床环境中，学生的情境化教学与患者安全性，风险识别和管理之间的关系还不清楚。
方法：对英国大学2011年成人分行预注册护理课程最后一个学期的321名第三年级学生进行了调查。调查问卷使用自由文本，包含假设的药物管理方案，可能会危及患者的安全。使用主题分析法对学生的定性反应进行了分析。
结果：回应率为58％（n = 186）。从方案中确定了四个主题：（1）保护患者安全（2）愿意妥协； （3）回避责任； （4）我行动的后果。
结论：研究结果强调了有关风险管理的上下文教学的重要性，错误管理的实用技术以及护理课程中的最佳患者安全领导能力。
护理管理的含义：护理经理是临床环境中护理专业学生的榜样。例如，护理管理必须领导临床环境中的患者安全议程。

BACKGROUND & AIMS: :We investigated immunoglobulin G (IgG) subclass antibody responses to Plasmodium falciparum merozoite surface protein 1 (MSP-1) and MSP-2 in 112 malaria-exposed subjects in Brazil. IgG3 polarization was primarily epitope driven, being little affected by cumulative or current exposure to malaria and not affected by a subject's age and Fcgamma receptor IIA genotype.

背景与目标： ：我们在巴西112名疟疾暴露者中调查了对恶性疟原虫裂殖子表面蛋白1（MSP-1）和MSP-2的免疫球蛋白G（IgG）亚类抗体反应。 IgG3极化主要是由表位驱动的，几乎不受累积或当前暴露于疟疾的影响，并且不受受试者的年龄和Fcgamma受体IIA基因型的影响。

BACKGROUND & AIMS: :Autopsy rates remain disturbingly low in nursing homes despite the fact that 1 of 5 deaths occurs in this setting. To determine the autopsy rate for nursing homes, we analyzed all deaths occurring in New York State nursing homes from 1980 to 1984. Of 58,985 nursing home deaths, autopsies were performed in only 499 cases (0.8%). In comparison to the general nursing home population, autopsied residents were more likely to be male and never married and less likely to be widowed. Of 110 practicing nursing home physicians surveyed, 19% believed autopsies had little if any value in the nursing home population, whereas 71% saw autopsy as a valuable tool but rarely requested one. Fewer than 1 in 10 physicians routinely discussed autopsies with patients and/or families before death. Perceived obstacles included the emotional lability of patients and families and a lack of financial reimbursement. Concerns over religious objections, funeral delays, and unnecessary mutilation were cited by fewer than one third of respondents. Facilitation of consent, physician education, and cost sharing may all contribute to enhanced rates of autopsies in the future.

背景与目标： ：尽管在这种情况下5例死亡中有1例死亡，但养老院的尸检率仍然非常低。为了确定疗养院的尸检率，我们分析了1980年至1984年在纽约州疗养院发生的所有死亡。在58985所疗养院死亡中，仅进行了499例尸检（0.8％）。与普通疗养院人口相比，有尸检的居民更可能是男性，从未结婚，丧偶的可能性也较小。在接受调查的110名执业疗养院医师中，有19％的人认为尸检对疗养院人口几乎没有价值，而71％的人认为尸检是一种有价值的工具，但很少有人要求。不到10名医生中有不到1名在死亡前常规与患者和/或家属讨论尸检。可以理解的障碍包括患者和家庭的情感不稳定以及缺乏经济补偿。不到三分之一的受访者对宗教异议，葬礼延误和不必要的残害表示了担忧。同意的便利，医生的教育以及费用的分担，都可能在将来提高尸检率。

BACKGROUND & AIMS: BACKGROUND & OBJECTIVE:Estimation of maternal mortality has been difficult because of large sample size requirement. A study using snowball technique for identification of households where maternal death has taken place and its related causes was conducted. We present here the feasibility of carrying out the snowball technique for capturing maternal deaths as against house-to-house survey and to obtain the estimates of maternal mortality ratio (MMR) in some selected States of India. METHODS:Five states representing high MMR (Uttar Pradesh), medium MMR (Maharashtra, Karnataka, Uttranchal) and low MMR (Delhi) were selected. A total of 8 PHCs and 3 (UFS) were covered. Study used both house-to-house survey and snowball technique to enumerate the maternal deaths in the selected PHCs in rural area and urban frame survey (UFS) in urban area. RESULTS:In all, 94 maternal deaths were captured through snowball technique as against 83 through house-to-house survey. The estimate of MMR for the five States combined was 356 per 100,000 live births, as compared to assumed 400 per 100,000 live births for the country as a whole. The relative standard error of the estimate of MMR was about 10 per cent. INTERPRETATION & CONCLUSION:Snowball technique captured more maternal deaths than those in house-to-house survey particularly in rural areas. The estimates also indicated the feasibility of replicating the proposed methodology for estimation of MMR as a time and cost-effective methodology.

背景与目标： 背景与目的：由于样本量大，难以估计产妇死亡率。进行了一项使用雪球技术来识别已发生产妇死亡及其相关原因的家庭的研究。我们在这里介绍了进行雪球技术来捕获孕产妇死亡的可行性，而不是逐户进行调查，并获得了印度某些选定州的孕产妇死亡率比（MMR）的估计值。
方法：选择代表高MMR（北方邦），中等MMR（马哈拉施特拉邦，卡纳塔克邦，北方邦）和低MMR（德里）的五个州。总共涵盖了8个PHC和3个（UFS）。该研究使用逐户调查和滚雪球技术来枚举农村部分重点城市的孕产妇死亡人数，以及城市地区的城市框架调查（UFS）。
结果：通过滚雪球技术共捕获了94名孕产妇死亡，而通过逐户调查获得了83名孕产妇死亡。五个国家的MMR估算合计为每100,000例活产356例，而整个国家的假设为每100,000例活产400例。 MMR估计值的相对标准误差约为10％。
解释与结论：雪球技术捕获的孕产妇死亡人数比逐户调查的死亡人数高，尤其是在农村地区。估算还表明，将拟议的MMR估算方法复制为一种既省时又具有成本效益的方法是可行的。

BACKGROUND & AIMS: BACKGROUND:Hypoglycemia is a frequent phenomenon in people being treated for diabetes mellitus, which can acutely disrupt driving performance. For the benefit of personal and public traffic safety, we decided to identify successful diabetes-related (SDR) behaviors to support safe driving for people with diabetes, from the perspective of experiential experts with diabetes mellitus. Experiential experts are people who can manage their own illness and conditions by developing expertise relevant to maintaining health and countering illness, and who are able to use this expertise to the benefit of peers. OBJECTIVE:The aim of our study was to objectify and systematize experiential expertise in terms of SDR behaviors, based on reports by experiential experts, to support safe driving for people with type 1 and type 2 diabetes mellitus. The emphasis was on preventing hypoglycemia as a short-term complication during driving. METHODS:We performed a mixed-methods study involving (i) semi-structured in-depth interviews with 33 experiential experts with diabetes mellitus from the Dutch Diabetes Association (DVN; Diabetesvereniging Nederland), in order to identify SDR behaviors regarding safe driving, and (ii) a validation study by means of a survey among a panel of 98 experiential experts (peers) from the DVN, to determine the extent to which they agreed with the communicability, importance, and feasibility of these behaviors for drivers with diabetes mellitus. RESULTS:We identified a comprehensive set of 11 SDR behaviors, differentiated into seven general and four specific behaviors, to support safe driving. The general behaviors concern the following topics: (i) acquiring knowledge and information; (ii) acquiring and using self-measuring of blood glucose (SMBG) equipment; (iii) knowing one's physical response pattern; (iv) obtaining knowledge about the medication used; (v) preventing long-term eye complications; (vi) influencing factors that can affect blood glucose; and (vii) renewal procedure for driving license. The four specific behaviors refer to the following topics: (i) measures to be taken before driving; (ii) responding effectively to hypoglycemia while driving; (iii) informing and instructing passengers; and (iv) preventing hypoglycemia in drivers with type 2 diabetes mellitus not using SMBG equipment. Key factors for safe driving proved to be the ability of drivers to anticipate and respond effectively to hypoglycemia while driving and to inform and instruct fellow passengers. Participants of the validation survey agreed to a considerable degree with the communicability, importance, and feasibility of these behaviors to support safe driving for people with diabetes mellitus. CONCLUSIONS:This study resulted in the identification and description of SDR behaviors to support safe driving. It proved possible to operationalize experiential expertise in terms of such behaviors. The next step is to have these behaviors validated by professional care providers in the field of diabetes, followed by translation into recommendations in self-management programs.

背景与目标： 背景：低血糖症在接受糖尿病治疗的人们中很常见，会严重破坏驾驶性能。为了个人和公共交通安全，我们决定从经验丰富的糖尿病专家的角度确定成功的糖尿病相关（SDR）行为，以支持糖尿病人安全驾驶。经验丰富的专家可以通过发展与维护健康和对抗疾病有关的专业知识来管理自己的疾病和状况，并能够利用这些专业知识来为同行带来好处。
目的：我们的研究目的是根据经验专家的报告，对SDR行为进行客观化和系统化的专门知识，以支持1型和2型糖尿病患者的安全驾驶。重点是预防驾驶过程中的短期并发症即低血糖症。
方法：我们进行了一项混合方法研究，涉及（i）对来自荷兰糖尿病协会（DVN; Diabetesvereniging Nederland）的33位糖尿病专家进行的半结构化深度访谈，以确定与安全驾驶有关的SDR行为，以及（ii）通过对来自DVN的98位经验丰富的专家（同行）进行的调查来进行验证研究，以确定他们在多大程度上同意这些行为对于糖尿病驾驶员的可传播性，重要性和可行性。
结果：我们确定了11种SDR行为的综合集合，分为7种一般行为和4种特定行为，以支持安全驾驶。一般行为涉及以下主题：（i）获取知识和信息； （ii）获取和使用自我测量的血糖仪（SMBG）； （iii）了解一个人的身体反应方式； （iv）获得有关所用药物的知识； （v）预防眼部长期并发症； （vi）可能影响血糖的影响因素； （vii）驾驶执照的续签程序。四种具体行为涉及以下主题：（i）驾驶前应采取的措施； （ii）驾驶时有效应对低血糖； （iii）通知和指示乘客； （iv）预防不使用SMBG设备的2型糖尿病驾驶员的低血糖症。事实证明，安全驾驶的关键因素是驾驶员在驾驶时能够预见和有效应对低血糖以及告知和指导同伴的能力。验证调查的参与者在相当程度上同意这些行为的可传播性，重要性和可行性，以支持糖尿病人的安全驾驶。
结论：本研究确定并描述了支持安全驾驶的SDR行为。事实证明，可以根据这种行为来操作经验专业知识。下一步是使这些行为得到糖尿病领域专业护理人员的验证，然后转化为自我管理计划中的建议。

BACKGROUND & AIMS: BACKGROUND:Informed consent in family planning includes knowledge of mechanism of action. Some methods of family planning occasionally work after fertilization. Knowing about postfertilization effects may be important to some women before choosing a certain family planning method. The objective of this survey is to explore women's attitudes towards postfertilization effects of family planning methods, and beliefs and characteristics possibly associated with those attitudes. METHODS:Cross-sectional survey in a sample of 755 potentially fertile women, aged 18-49, from Primary Care Health Centres in Pamplona, Spain. Participants were given a 30-item, self-administered, anonymous questionnaire about family planning methods and medical and surgical abortion. Logistic regression was used to identify variables associated with women's attitudes towards postfertilization effects. RESULTS:The response rate was 80%. The majority of women were married, held an academic degree and had no children. Forty percent of women would not consider using a method that may work after fertilization but before implantation and 57% would not consider using one that may work after implantation. While 35.3% of the sample would stop using a method if they learned that it sometimes works after fertilization, this percentage increased to 56.3% when referring to a method that sometimes works after implantation. Women who believe that human life begins at fertilization and those who consider it is important to distinguish between natural and induced embryo loss were less likely to consider the use of a method with postfertilization effects. CONCLUSION:Information about potential postfertilization effects of family planning methods may influence women's acceptance and choice of a particular family planning method. Additional studies in other populations are necessary to evaluate whether these beliefs are important to those populations.

背景与目标： 背景：计划生育中的知情同意包括对作用机制的了解。受精后，某些计划生育方法有时会起作用。在选择某种计划生育方法之前，了解受精后的影响对某些女性可能很重要。这项调查的目的是探讨妇女对计划生育方法受精后效果的态度，以及可能与这些态度相关的信念和特征。
方法：对来自西班牙潘普洛纳的初级保健健康中心的755名年龄在18-49岁之间的潜在可育妇女进行了横断面调查。与会人员获得了关于计划生育方法以及药物和手术流产的30项自我管理的匿名问卷。 Logistic回归用于确定与女性对受精后效果的态度有关的变量。
结果：有效率80％。大多数妇女已婚，拥有学历，并且没有孩子。 40％的女性不会考虑使用在受精后但在植入前可能起作用的方法，而57％的女性不会考虑使用在植入后可能会起作用的方法。如果35.3％的样本如果得知受精后有时仍会使用某种方法，则停止使用该方法，但当提及植入后有时仍可使用的方法时，该百分比增加至56.3％。认为人类生命始于受精的妇女，以及认为重要的是区分自然损失和诱发的胚胎损失的妇女，不太可能考虑使用具有受精后作用的方法。
结论：有关计划生育方法潜在的受精后效果的信息可能会影响女性对某种计划生育方法的接受和选择。有必要在其他人群中进行其他研究，以评估这些信念是否对这些人群重要。

BACKGROUND & AIMS: BACKGROUND:Oppositional defiant disorder (ODD) is a leading cause of referral for youth mental health services; yet, many uncertainties exist about ODD given it is rarely examined as a distinct psychiatric disorder. We examined the lifetime prevalence, onset, persistence, and correlates of ODD. METHODS:Lifetime prevalence of ODD and 18 other DSM-IV disorders was assessed in a nationally representative sample of adult respondents (n = 3,199) in the National Comorbidity Survey Replication. Retrospective age-of-onset reports were used to test temporal priorities with comorbid disorders. RESULTS:Lifetime prevalence of ODD is estimated to be 10.2% (males = 11.2%; females = 9.2%). Of those with lifetime ODD, 92.4% meet criteria for at least one other lifetime DSM-IV disorder, including: mood (45.8%), anxiety (62.3%), impulse-control (68.2%), and substance use (47.2%) disorders. ODD is temporally primary in the vast majority of cases for most comorbid disorders. Both active and remitted ODD significantly predict subsequent onset of secondary disorders even after controlling for comorbid conduct disorder (CD). Early onset (before age 8) and comorbidity predict slow speed of recovery of ODD. CONCLUSIONS:ODD is a common child- and adolescent-onset disorder associated with substantial risk of secondary mood, anxiety, impulse-control, and substance use disorders. These results support the study of ODD as a distinct disorder. Prospective and experimental studies are needed to further delineate the temporal and causal relations between ODD and related disorders.

背景与目标： 背景：抗逆性疾病（ODD）是转介青年心理健康服务的主要原因。然而，由于ODD很少被视为一种独特的精神病，因此存在许多不确定性。我们检查了ODD的终生患病率，发病率，持续性和相关性。
方法：在全国合并症调查复制中，在全国代表性的成年受访者（n = 3,199）中评估了ODD和其他18种DSM-IV疾病的终生患病率。回顾性发病年龄报告用于测试合并症的时间优先级。
结果：ODD的终生患病率估计为10.2％（男性= 11.2％；女性= 9.2％）。一生中有ODD的患者中，有92.4％符合至少一种其他一生中DSM-IV疾病的标准，包括：情绪（45.8％），焦虑症（62.3％），冲动控制（68.2％）和药物滥用（47.2％）失调。对于大多数合并症，在大多数情况下，ODD在时间上是主要的。即使在控制了共病行为障碍（CD）之后，活动性ODD和缓解性ODD仍可显着预测继发性疾病的继发。早发（8岁之前）和合并症预示着ODD的恢复速度较慢。
结论：ODD是一种常见的儿童和青少年期疾病，伴有继发性情绪，焦虑，冲动控制和药物滥用疾病的重大风险。这些结果支持了ODD作为一种独特疾病的研究。需要进行前瞻性和实验研究，以进一步描述ODD与相关疾病之间的时间和因果关系。

BACKGROUND & AIMS: AIMS OF THE STUDY:The economic implications of co-morbid depression in patients with chronic medical disorders have been studied mainly in high-income countries. However, the applicability of such findings in developing countries cannot be assumed. In the present study we estimate diabetes related costs and explore the link between depression and diabetes related costs in Romania. In this former communist country, the general perception of practitioners and policy-makers is that psychological issues are far less important than medical concerns for patients with diabetes, a perception that may lead to the misallocation of already scarce resources. METHODS:Data related to costs of diabetes care and to co-morbid depression were collected from a sample of 1,171 diabetes patients at the Nutrition and Diabetes Center in Cluj-Napoca, Romania, using the Diabetes Costs Questionnaire (DCQ) and the Patient Health Questionnaire 9 (PHQ9). The gathered data were subjected to a bivariate analysis of the depression-cost relationship, as well as a regression analysis in order to isolate the effect of depression on diabetes related costs from the effect of covariates. RESULTS:Direct and indirect diabetes related costs equally contributed to the total costs. The repartition of the cost burden between the public system and private agents is nearly equal as well. The bivariate analysis of the depression-cost relationship reveals statistically significant larger diabetes related costs for patients with major depression than for patients with minor depression, and the latter have larger diabetes related costs than patients free of depression symptoms. When the pure effect of depression on diabetes related costs was isolated by means of regression techniques, the provisional diagnosis of major depression was found to significantly increase diabetes related costs. DISCUSSION:The equal distribution of diabetes related costs between direct and indirect measures, as well as the cost burden equally split between the public system and private agents can be explained by the costs of medication and the costs associated with time lost by the non-compensated caregivers. Consistent with Romanian cultural traditions, most of the patients rely on their relatives in an informal diabetes caregiving market for assistance. Alongside depression, the multivariate analysis revealed that factors such as Hungarian ethnicity, income, and number of years since diagnosis also significantly contribute to diabetes related costs. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:Findings that depression increases diabetes related costs bear potential implications for health policies and health care provision (i.e., the effect of depression on costs can be minimized by adequate recognition and treatment). As such, screening and treatment of co-occurring depression in diabetes patients should become part of the diabetes treatment protocol, not only in Romania but in other Central and Eastern European countries as well.

背景与目标： 研究的目的：主要在高收入国家中研究了慢性病患者的合并抑郁症的经济意义。但是，不能假定这种发现在发展中国家的适用性。在本研究中，我们估计了与糖尿病相关的费用，并探讨了罗马尼亚的抑郁症与与糖尿病相关的费用之间的联系。在这个前共产主义国家，从业者和决策者的普遍看法是，对于糖尿病患者，心理问题远不如医学问题重要，这种看法可能会导致本已稀缺的资源分配不当。
方法：使用糖尿病费用调查表（DCQ）和患者健康调查表，从罗马尼亚克卢日-纳波卡营养与糖尿病中心的1,171名糖尿病患者的样本中收集了与糖尿病护理费用和合并症相关的数据。 9（PHQ9）。对收集到的数据进行抑郁-成本关系的双变量分析，以及回归分析，以便将抑郁对糖尿病相关费用的影响与协变量的影响分开。
结果：与糖尿病相关的直接和间接费用平均占总费用。公共系统和私人代理之间的成本负担分配也几乎相等。对抑郁症-成本关系的二元分析显示，与轻度抑郁症患者相比，重度抑郁症患者与糖尿病相关的费用具有统计学上的显着性，而轻度抑郁症患者的糖尿病相关性费用则高于无抑郁症症状的患者。当通过回归技术分离出抑郁症对糖尿病相关费用的单纯影响时，发现重大抑郁症的临时诊断会显着增加糖尿病相关费用。
讨论：直接和间接措施之间与糖尿病相关的费用的均等分配，以及公共系统和私人机构之间平均分配的费用负担，可以用药物费用以及与未补偿的时间损失相关的费用来解释照顾者。与罗马尼亚的文化传统一致，大多数患者在非正式的糖尿病护理市场上依靠其亲属寻求帮助。除抑郁外，多变量分析还显示，匈牙利种族，收入和自诊断以来的年限等因素也显着增加了与糖尿病相关的费用。
卫生保健规定和使用的含义：发现抑郁症增加了与糖尿病相关的成本，对健康政策和医疗保健提供了潜在的影响（即，通过充分的认可和治疗，可以将抑郁症对成本的影响降至最低）。因此，不仅在罗马尼亚而且在其他中欧和东欧国家，对糖尿病患者同时发生的抑郁症的筛查和治疗也应成为糖尿病治疗方案的一部分。

BACKGROUND & AIMS: INTRODUCTION AND AIMS:As the popularity of electronic cigarettes (e-cigarettes) increases, it is becoming important to find out more about the characteristics of e-cigarette users, why and how they use the product and whether e-cigarettes are used exclusively or in combination with conventional cigarettes. The objective of this study was to investigate patterns and effects of e-cigarette use and user beliefs about e-cigarette safety and benefits. DESIGN AND METHODS:E-cigarette users in Poland were recruited online and asked to participate in a web-based survey. The participants provided information on their smoking history, patterns of e-cigarette use, beliefs and attitudes regarding the product and information on concurrent use of conventional cigarettes. RESULTS:The survey was completed by 179 e-cigarette users. Almost all participants used e-cigarettes daily. E-cigarettes were primarily used to quit smoking or to reduce the harm associated with smoking (both 41%), and were successful in helping the surveyed users to achieve these goals with 66% not smoking conventional cigarettes at all and 25% smoking under five cigarettes a day. Most participants (82%) did not think that e-cigarettes were completely safe, but thought that they were less dangerous than conventional cigarettes. Sixty percent believed that e-cigarettes were addictive, but less so than conventional cigarettes. DISCUSSION AND CONCLUSIONS:The participants primarily used e-cigarettes as a stop-smoking aid or as an alternative to conventional cigarettes, and the majority reported that they successfully stopped smoking. More data on e-cigarette safety and its efficacy in harm-reduction and smoking cessation are needed.

背景与目标： 简介和目的：随着电子烟（电子烟）的普及，了解电子烟用户的特征，为什么以及如何使用该产品以及是否仅使用电子烟还是变得越来越重要。结合常规香烟。这项研究的目的是调查电子烟使用的方式和效果以及用户对电子烟安全性和益处的信念。
设计与方法：波兰的电子烟用户是在线招募的，并被要求参加基于网络的调查。参与者提供了有关其吸烟史，电子烟使用方式，对该产品的信念和态度的信息以及有关常规香烟同时使用的信息。
结果：这项调查是由179名电子烟用户完成的。几乎所有参与者每天都使用电子烟。电子烟主要用于戒烟或减少与吸烟有关的危害（均为41％），并成功帮助被调查者实现了这些目标，其中66％的人根本不抽烟，而25％的五岁以下烟民不吸烟。每天抽烟。大多数参与者（82％）并不认为电子烟是完全安全的，但认为它们比传统香烟的危险性要小。 60％的人认为电子烟会上瘾，但不如传统香烟那么容易上瘾。
讨论与结论：参与者主要使用电子烟作为辅助吸烟或替代传统香烟，并且大多数人报告他们成功戒烟。需要更多关于电子烟安全性及其在减少伤害和戒烟中的功效的数据。

BACKGROUND & AIMS: OBJECTIVE:To investigate the characteristics of epidemiological distribution of the ossification of the ligamentum flavum (OLF) in the thoracic spine including the incidence, segmental distribution, and shape. METHODS:Chest spiral computed tomography scans of 993 cases (male 506, female 487, mean age 60 years, range 5-102 years) who presented due to chest symptoms were analyzed with axial slices combined with sagittal slices. The conditions of OLF in the thoracic spine, including segments, thickness, location, and dural sac compression, were recorded. Prevalence was standardized according to the "Age Structure of Population in Beijing 2008". RESULTS:Among the population investigated, the standardized prevalence rate was 63.9 %. The standardized prevalence rate for males (68.5 %) was higher than that for females (59.0 %). The highest prevalence rate of OLF was in the 50-59 years age group (79.2 %); however, high density originated it can be found in individuals aged 10-19 years. The comparison of different thoracic segments showed that T10-11 (44.0 %) and T11-12 (41.6 %) had the highest prevalence rates. CONCLUSION:The prevalence of ossification of the ligamentum flavum was highest in the 50-59 years group, but also occurred in early years. OLF occurs more frequently in the lower than in the upper and middle thoracic regions and its prevalence increases with aging.

背景与目标： 目的：探讨胸椎黄韧带骨化症的流行病学分布特征，包括发病率，节段分布和形态。
方法：采用轴向切面结合矢状切面分析了993例因胸部症状而出现的胸部螺旋CT扫描（男506例，女487例，平均年龄60岁，范围5-102岁）。记录胸椎OLF的状况，包括节段，厚度，位置和硬膜囊压缩。流行率根据“北京2008年人口年龄结构”进行了标准化。
结果：在所调查的人群中，标准化患病率为63.9％。男性的标准化患病率（68.5％）高于女性的标准化患病率（59.0％）。 OLF的最高患病率是在50-59岁年龄段（79.2％）；然而，高密度起源于10-19岁的人群。比较不同的胸段，发现T10-11（44.0％）和T11-12（41.6％）的患病率最高。
结论：黄韧带骨化的发生率在50-59岁组中最高，但也发生在早期。 OLF在下部胸部的发生率高于上部和中部胸腔区域，并且其发生率随着年龄的增长而增加。