• 【非洲农村地区对破伤风和白喉的免疫。】 复制标题 收藏 收藏
    DOI:10.4269/ajtmh.1997.56.576 复制DOI
    作者列表:Kurtzhals JA,Kjeldsen K,Hey AS,Okong'o-Odera EA,Heron I
    BACKGROUND & AIMS: :To assess the effect of the Expanded Program on Immunization (EPI) in rural Africa, blood samples were collected in two Kenyan sublocations. Serum antibodies against tetanus toxoid were measured in 155 individuals 1-70 years of age. Titers greater than the protective level of 0.01 IU/ml were found in 47% of the population. Protection was significantly higher in children born after the launching of the EPI (68%) and in women who had been at childbearing age since then (69%). Significantly lower protection was demonstrated in other age and sex-groups. The level of protection in children was equal in the two populations, whereas protection in fertile women was significantly lower in the population living a long distance from a health center. Diphtheria anti-toxin was measured in the samples from one sublocation, and 70 of 84 individuals (83%) had antibody levels greater than the protective level. No age or sex difference could be found, and there was no correlation between response levels to diphtheria and tetanus. This implicates natural infections as an important source of diphtheria antibodies. Our findings demonstrate a need for better coverage of the adult population against tetanus. Furthermore, diphtheria transmission still appears to take place, underscoring the importance of diphtheria vaccination of travelers to rural Africa.
    背景与目标: :为了评估非洲农村地区免疫扩展计划(EPI)的效果,在两个肯尼亚子地区采集了血液样本。在1-5个1至70岁的个体中测量了抗破伤风类毒素的血清抗体。在47%的人口中发现的滴度大于0.01 IU / ml的保护水平。 EPI启动后出生的孩子(68%)和此后达到育龄的妇女(69%)的保护水平明显更高。在其他年龄段和性别组中,保护作用明显降低。在这两个人口中,儿童的保护水平是相同的,而在距卫生所很远的人口中,生育妇女的保护水平要低得多。在一个分区中的样品中测量了白喉抗毒素,在84个人中有70个人(83%)的抗体水平高于保护水平。没有发现年龄或性别差异,并且对白喉和破伤风的反应水平之间没有相关性。这暗示自然感染是白喉抗体的重要来源。我们的发现表明,需要更好地覆盖破伤风的成年人群。此外,白喉传播仍在发生,强调了前往非洲农村的旅行者接种白喉疫苗的重要性。
  • 【南非特兰斯凯(Transkei)的故乡的骨科创伤工作量。】 复制标题 收藏 收藏
    DOI:10.1016/j.injury.2006.06.118 复制DOI
    作者列表:Millar TM,McConnachie CC
    BACKGROUND & AIMS: :The Bedford Orthopaedic Centre is situated in Umtata at the heart of the former homeland of the Transkei in the Eastern Cape of South Africa. It acts as an orthopaedic and trauma referral hospital for a mainly rural population approaching 4 million. This article focuses on the workload of the hospital over a 4-month period and like many hospitals in South Africa we highlight the difficulties it faces with the trauma epidemic.
    背景与目标: :贝德福德骨科中心位于Umtata,位于南非东开普省特兰斯凯(Transkei)故土的心脏地带。它作为骨科和创伤转诊医院,主要针对接近400万的农村人口。本文重点介绍医院在4个月内的工作量,并且像南非的许多医院一样,我们着重强调了该医院在创伤性流行病方面所面临的困难。
  • 【审查撒哈拉以南非洲和印度洋非洲猪瘟的动荡周期。】 复制标题 收藏 收藏
    DOI:10.1016/j.virusres.2012.10.005 复制DOI
    作者列表:Jori F,Vial L,Penrith ML,Pérez-Sánchez R,Etter E,Albina E,Michaud V,Roger F
    BACKGROUND & AIMS: :African swine fever (ASF) is a major limiting factor for pig production in most of the countries in Sub-Saharan Africa and the Indian Ocean. In the absence of vaccine, a good understanding of the ecology and epidemiology of the disease is fundamental to implement effective control measures. In selected countries of Southern and East Africa, the association between Ornithodoros moubata ticks and warthogs has been described in detail in the literature. However, for many other countries in the region, information related to the sylvatic cycle is lacking or incomplete. In West African countries, for instance, the role of wild pigs in the epidemiology of ASF has never been demonstrated and the existence and potential impact of a sylvatic cycle involving an association between soft ticks and warthogs is questionable. In other countries, other wild pig species such as the bushpigs (Potamochoerus spp.) can also be asymptomatically infected by the virus but their role in the epidemiology of the disease is unclear and might differ according to geographic regions. In addition, the methods and techniques required to study the role of wild hosts in ASF virus (ASFV) epidemiology and ecology are very specific and differ from the more traditional methods to study domestic pigs or other tick species. The aim of this review is (i) to provide a descriptive list of the methodologies implemented to study the role of wild hosts in African swine fever, (ii) to compile the available knowledge about the sylvatic cycle of ASFV in different regions of Sub-Saharan Africa and the Indian Ocean in addition to the one that has been described for East and Southern Africa, and (iii) to discuss current methodologies and available knowledge in order to identify new orientations for further field and experimental surveys.
    背景与目标: 非洲猪瘟(ASF)是撒哈拉以南非洲和印度洋大多数国家/地区猪生产的主要限制因素。在没有疫苗的情况下,对疾病的生态学和流行病学有充分的了解是实施有效控制措施的基础。在南部非洲和东非的选定国家中,文献中已详细描述了鸟嘴Or和疣猪之间的联系。但是,对于该地区的许多其他国家来说,与sylvatic周期有关的信息仍然缺乏或不完整。例如,在西非国家,从未证明过野猪在ASF流行病学中的作用,而且涉及软壁虱和疣猪之间的森林周期的存在及其潜在影响值得怀疑。在其他国家/地区,其他野猪物种(例如,丛林猪(Potamochoerus spp。))也可能无症状感染该病毒,但尚不清楚它们在该疾病流行病学中的作用,并且可能因地理区域而异。此外,研究野生宿主在ASF病毒(ASFV)流行病学和生态学中的作用所需的方法和技术非常具体,不同于研究家猪或其他壁虱物种的更传统的方法。这项审查的目的是(i)提供描述性方法列表,以实施研究野生宿主在非洲猪瘟中的作用的方法;(ii)汇编有关亚SFV子区不同区域的ASFV sylvatic周期的现有知识。撒哈拉以南非洲和印度洋,以及已经描述的东非和南部非洲的一种,以及(iii)讨论当前的方法和可用知识,以便为进一步的野外调查和实验调查确定新的方向。
  • 【南非的Martin-Gruber联系。解剖学研究。】 复制标题 收藏 收藏
    DOI:10.1016/s0266-7681(97)80396-8 复制DOI
    作者列表:Taams KO
    BACKGROUND & AIMS: One hundred and twelve forearms in 56 preserved cadavers were dissected to assess the incidence of Martin-Gruber connections in a population in South Africa. The connections were found in 13 cadavers (23%) and one was bilateral. There were no significant racial or sexual differences in the incidence. The course of Martin-Gruber connections and their anatomical relationship with the ulnar artery are illustrated.

    背景与目标: 解剖了56个保存完好的尸体中的11个前臂,以评估南非人口中Martin-Gruber连接的发生率。在13具尸体(占23%)中发现了这种联系,其中一种是双边的。发病率没有明显的种族或性别差异。阐明了Martin-Gruber连接的过程以及它们与尺动脉的解剖关系。

  • 【针对非英语母语作者的科学家友好政策:及时且受欢迎。】 复制标题 收藏 收藏
    DOI:10.1590/s0100-879x2007000600001 复制DOI
    作者列表:Vasconcelos SM,Sorenson MM,Leta J
    BACKGROUND & AIMS: :That English is the lingua franca of today's science is an indisputable fact. Publication in English in international journals is a pre-requisite for a research paper to gain visibility in academia. However, English proficiency appears to be taken for granted in the scientific community, though this language can be a hurdle for a number of authors, particularly from non-native English-speaking countries. The influence of English proficiency on the publication output of Brazilian authors has never been assessed. We report our preliminary data on the relationship between the English proficiency of 51,223 researchers registered in the CNPq database and their publication output in international journals. We have found that publication rates are higher for those authors with good command of English, particularly written English. Although our research is still underway and our results are preliminary, they suggest that the correlation between written English proficiency and research productivity should not be underestimated. We also present the comments of some Brazilian scientists with high publication records on the relevance of communication skills to the scientific enterprise.
    背景与目标: :英语是当今科学的通用语,这是不争的事实。在国际期刊上以英语发表是研究论文在学术界获得知名度的前提。但是,英语水平似乎在科学界是理所当然的,尽管这种语言可能会阻碍许多作者,尤其是来自非英语国家的作者。从未评估过英语水平对巴西作者的出版物输出的影响。我们报告了有关CNPq数据库中注册的51,223名研究人员的英语水平与他们在国际期刊上的出版物输出之间的关系的初步数据。我们发现,英语水平特别是书面英语水平较高的那些作者的出版率更高。尽管我们的研究仍在进行中,并且我们的结果只是初步的,但他们认为,英语笔试水平和研究效率之间的相关性不应低估。我们还介绍了一些发表率很高的巴西科学家对交流技巧与科学事业的相关性的评论。
  • 【冈比亚按蚊2La染色体倒置与非洲对恶性疟原虫的易感性有关。】 复制标题 收藏 收藏
    DOI:10.7554/eLife.25813 复制DOI
    作者列表:Riehle MM,Bukhari T,Gneme A,Guelbeogo WM,Coulibaly B,Fofana A,Pain A,Bischoff E,Renaud F,Beavogui AH,Traore SF,Sagnon N,Vernick KD
    BACKGROUND & AIMS: :Chromosome inversions suppress genetic recombination and establish co-adapted gene complexes, or supergenes. The 2La inversion is a widespread polymorphism in the Anopheles gambiae species complex, the major African mosquito vectors of human malaria. Here we show that alleles of the 2La inversion are associated with natural malaria infection levels in wild-captured vectors from West and East Africa. Mosquitoes carrying the more-susceptible allele (2L+a) are also behaviorally less likely to be found inside houses. Vector control tools that target indoor-resting mosquitoes, such as bednets and insecticides, are currently the cornerstone of malaria control in Africa. Populations with high levels of the 2L+a allele may form reservoirs of persistent outdoor malaria transmission requiring novel measures for surveillance and control. The 2La inversion is a major and previously unappreciated component of the natural malaria transmission system in Africa, influencing both malaria susceptibility and vector behavior.
    背景与目标: :染色体倒置抑制基因重组并建立共同适应的基因复合体或超基因。 2La倒位是冈比亚按蚊物种复合体(人类疟疾的主要非洲蚊媒)中广泛的多态性。在这里,我们显示了2La倒位的等位基因与来自西非和东非的野生捕获载体中的自然疟疾感染水平相关。携带易感性等位基因(2L a)的蚊子在行为上也不太可能在房屋内被发现。目前,针对室内休息蚊子的病媒控制工具(例如蚊帐和杀虫剂)是非洲控制疟疾的基石。 2L等位基因水平较高的人群可能会形成持续的室外疟疾传播库,需要采取新的监视和控制措施。 2La倒置是非洲自然疟疾传播系统的主要组成部分,而以前却未被重视,它既影响了疟疾易感性,又影响了媒介的行为。
  • 【让人们对与大规模疫苗接种有关的道德价值观进行解释;魁北克省(加拿大法国)的A(H1N1)疫苗接种运动案例。】 复制标题 收藏 收藏
    DOI:10.1111/hex.12005 复制DOI
    作者列表:Massé R,Désy M
    BACKGROUND & AIMS: BACKGROUND:Pandemic influenza ethics frameworks are based on respect of values and principles such as regard for autonomy, responsibility, transparency, solidarity and social justice. However, very few studies have addressed the way in which the general population views these moral norms. OBJECTIVES:(i) To analyse the receptiveness of the population of French-speaking Quebecers to certain ethical principles promoted by public health authorities during the AH1N1 vaccination campaign. (ii) To add to the limited number of empirical studies that examine the population's perception of ethical values. DESIGN:Eight months after the end of the AH1N1 vaccination campaign in the Province of Quebec (Canada), 100 French-speaking Quebecers were assembled in ten focus groups. Discussions focussed on the level of respect shown by public health authorities for individual autonomy, the limits of appeals for solidarity, the balance between vaccination efficiency and social justice towards non-prioritized subpopulations, vaccination as a demonstration of civic duty and social responsibility. RESULTS:The population acknowledged a high level of individual responsibility towards family members and agreed to vaccination to protect children and ageing parents. However, the concepts of civic duty and solidarity did not elucidate unanimous support, despite the fact that social justice stood out as a dominant value of public morals. CONCLUSION:The ethical principles promoted in influenza pandemic ethics frameworks are subject to reinterpretation by the population. An ethic of public health must consider their understanding of the fundamental values that legitimize mass vaccination.
    背景与目标: 背景:大流行性流感道德框架基于对价值和原则的尊重,例如对自治,责任,透明度,团结和社会正义的尊重。但是,很少有研究讨论普通民众如何看待这些道德规范。
    目标:(i)分析在AH1N1疫苗接种运动中,法语魁北克人对公共卫生当局倡导的某些道德原则的接受程度。 (ii)增加数量有限的实证研究,以检验人们对道德价值观的看法。
    设计:在魁北克省(加拿大)的AH1N1疫苗接种运动结束后八个月,将100个讲法语的魁北克人聚集在十个焦点小组中。讨论的重点是公共卫生当局对个人自治的尊重程度,呼吁声援的局限性,疫苗接种效率和对非优先人群的社会公正之间的平衡,疫苗接种是公民义务和社会责任的体现。
    结果:该人群承认对家庭成员的高度个人责任,并同意接种疫苗以保护儿童和年迈的父母。然而,尽管社会正义是公共道德的主导价值,但公民义务和团结的概念并没有阐明一致的支持。
    结论:流感大流行伦理框架中提倡的伦理原则有待人群重新解释。公共卫生伦理必须考虑他们对使大规模接种合法化的基本价值观的理解。
  • 【在撒哈拉以南非洲,HIV诊断与开始抗逆转录病毒治疗之间的程序丢失:系统评价和荟萃分析。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-3156.2012.03089.x 复制DOI
    作者列表:Mugglin C,Estill J,Wandeler G,Bender N,Egger M,Gsponer T,Keiser O,IeDEA Southern Africa.
    BACKGROUND & AIMS: OBJECTIVES:To assess the proportion of patients lost to programme (died, lost to follow-up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub-Saharan Africa, and determine factors associated with loss to programme. METHODS:Systematic review and meta-analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow-up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random-effects meta-analysis. RESULTS:Twenty-nine studies from sub-Saharan Africa including 148,912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta-analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60-84) had a CD4 cell count measured, 40 (95% CI 26-55) were eligible for ART and 25 (95% CI 13-37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25%vs. 54%, P < 0.0001), but eligible patients were more likely to die (11%vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio-economic status and in recent time periods. CONCLUSIONS:Monitoring and care in the pre-ART time period need improvement, with greater emphasis on patients not yet eligible for ART.
    背景与目标: 目的:评估在撒哈拉以南非洲艾滋病毒诊断与开始抗逆转录病毒治疗(ART)之间因计划而流失(死亡,失去随访,转出)的患者比例,并确定与计划流失相关的因素。
    方法:系统评价和荟萃分析。我们在PubMed和EMBASE数据库中进行了成人研究。结果是开始接受抗逆转录病毒治疗之前死亡的患者百分比,随访损失的百分比,具有CD4细胞计数的百分比,首次CD4计数的分布以及符合条件的开始抗逆转录病毒治疗的患者的百分比。使用随机效应荟萃分析合并数据。
    结果:分析了来自撒哈拉以南非洲地区的29项研究,包括148,912名患者。六项研究涵盖了从艾滋病毒诊断到抗病毒治疗的整个过程。对这些研究的荟萃分析显示,在100例HIV检测呈阳性的患者中,有72例(95%CI 60-84)的CD4细胞计数被测量,40例(95%CI 26-55)符合ART的条件,而25例(95%CI 26-55)符合条件。 95%CI 13-37)开始接受抗逆转录病毒治疗。研究之间存在很大的异质性(P <0.0001)。呈现时CD4细胞的中位数范围为154至274细胞/μl。有资格接受抗逆转录病毒治疗的患者不太可能失去程序(25%vs. 54%,P <0.0001),但与不符合资格的患者相比,有资格死亡的患者更有可能死亡(11%vs. 5%,P <0.0001)。男性,CD4细胞计数低,社会经济地位低的患者以及最近一段时间的程序丢失率更高。
    结论:在ART治疗之前的时期内的监测和护理需要改善,重点更多的是尚未获得ART治疗资格的患者。
  • 【南非在卫生方面的公私互动:扩大规模的机会。】 复制标题 收藏 收藏
    DOI:10.1093/heapol/czt042 复制DOI
    作者列表:Kula N,Fryatt RJ
    BACKGROUND & AIMS: :South Africa has long recognized partnerships between the public and private sectors as a policy objective in health, but experience is still limited and poorly documented. The objectives of this article are to understand the factors that increase the likelihood of success of public-private interactions in South Africa, and identify and discuss opportunities for them to be scaled up. There is a strong legislative framework and a number of guidelines and tools that have been developed by the Treasury for managing partnerships. The review of literature confirmed the need for the state to have effective regulations in order to oversee quality and standards and to provide stewardship and oversight. The public sector requires sufficient capacity not only to manage relationships with the private sector but also to enable innovation and experimentation. Evaluation is an integral part of all interactions not only to learn from successes but also to identify any perverse incentives that may lead to unintended consequences. Four case studies show that the private for-profit sector is already engaged in a number of projects that are closely aligned to current health system reform priorities. Factors that increase the likelihood of interactions being successful include: increasing the government's capacity to manage public-private relationships; choosing public-private interactions that are strategically important to national goals; building a knowledge base on what works, where and why; moving from pilots to large scale initiatives; harnessing the contracting expertise in private providers; and encouraging innovation and learning.
    背景与目标: 南非:长期以来,公立和私营部门之间的伙伴关系已被公认为卫生领域的政策目标,但经验仍然有限,文献记载也很少。本文的目的是了解增加南非公私互动成功的可能性的因素,并确定和讨论扩大其规模的机会。财政部已经建立了强有力的立法框架以及许多准则和工具来管理伙伴关系。对文献的审查证实,国家有必要制定有效的法规,以监督质量和标准,并提供管理和监督。公共部门不仅需要足够的能力来管理与私营部门的关系,而且还需要进行创新和试验。评估是所有互动中不可或缺的一部分,不仅可以从成功中学习,而且可以识别可能导致意想不到的后果的任何不正当动机。四个案例研究表明,私营营利部门已经参与了许多与当前卫生系统改革优先事项紧密相关的项目。增加互动成功的可能性的因素包括:提高政府管理公私关系的能力;选择对国家目标具有战略意义的公私互动;建立关于什么有效,在哪里以及为什么起作用的知识库;从试点转向大规模计划;利用私人提供商的订约专业知识;并鼓励创新和学习。
  • 【法语样本在BNI屏幕的法语翻译中表现出较高的脑功能。】 复制标题 收藏 收藏
    DOI:10.3109/02699052.2013.823665 复制DOI
    作者列表:Prigatano GP,Tonini A,Truelle JL,Montreuil M
    BACKGROUND & AIMS: OBJECTIVE:To obtain normative data using a French translation of the BNI Screen for Higher Cerebral Functions (BNIS) administered to French-speaking individuals. METHODS:Recruitment and administration of the BNIS to a convenience sample of 167 French-speaking individuals between the ages of 15-84 years. RESULTS:Mean BNIS total score for a French sample was within 1 point of what was observed in the original standardization study using 200 English-speaking controls. Age and education correlated significantly with BNIS scores in a manner reported by other studies. CONCLUSION:The French translation of the BNIS appears to be a reliable method of assessing higher cerebral functioning in French-speaking individuals.
    背景与目标: 目的:使用法语国家的BNI高级脑功能屏幕(BNIS)的法语翻译获得规范性数据。
    方法:招募和管理BNIS,以方便样本的167名15至84岁的说法语的人为样本。
    结果:法国样本的平均BNIS总得分与使用200名以英语为母语的对照组进行的原始标准化研究中所观察到的分数之差在1分之内。年龄和受教育程度与BNIS得分显着相关,这是其他研究报告的方式。
    结论:BNIS的法语翻译似乎是评估法语个人较高大脑功能的可靠方法。
  • 【复发性霍奇金病患者大剂量治疗和自体干细胞移植后生存的预后因素:来自法国登记处的280例患者的分析。法国兴业银行(法国)。】 复制标题 收藏 收藏
    DOI:10.1038/sj.bmt.1700838 复制DOI
    作者列表:Brice P,Bouabdallah R,Moreau P,Divine M,André M,Aoudjane M,Fleury J,Anglaret B,Baruchel A,Sensebe L,Colombat P
    BACKGROUND & AIMS: :High-dose therapy with autologous stem cell transplantation (ASCT) has been widely proposed for patients with relapsed Hodgkin's disease (HD). From 1982 to 1993, we selected (from the French registry for bone marrow transplantation) 280 patients, who underwent ASCT for relapsed HD after initial treatment including chemotherapy. Patient characteristics at diagnosis were: sex ratio (M/F): 1.5; median age: 30 years (5-59 years), stage I, II: 43%; III, IV: 57%; 32% had chemotherapy, 68% chemo+ radiotherapy. All patients achieved complete remission after first-line therapy and subsequently relapsed. The median interval between diagnosis and high-dose therapy was 34 months. First relapse occurred in 78% of the patients at a median end-of-treatment to relapse time of 18 months. All patients received salvage chemotherapy before high-dose therapy, and the median time between relapse and high-dose therapy was 5 months. After this regimen, 84% of the patients were considered to have chemosensitive relapse. Conditioning regimens were: BEAM: 60%; CBV/BEAC: 26%. Transplant-related mortality was 6%. With a median follow-up of 3 years after high-dose therapy, overall and progression-free survivals at 4 years were 66 and 60%, respectively. Neither the conditioning regimen nor the stem cell source affected survival. Good prognostic factors for survival were: chemosensitivity of relapse (P < 0.01) and first relapse vs further relapse (P < 0.05). For 214 patients in first relapse, other significant factors for survival were: end-of-treatment to relapse interval < 12 months (P < 0.05) and nodal vs extranodal relapse (P < 0.001). These two prognostic factors were used to validate a prognostic model with three significantly different subgroups: 0 (n = 59), 1 (n = 125), or 2 factors (n = 30) with 4-year survival, respectively, at 93, 59 and 43% (P < 0.001). Salvage therapy can be tailored in patients with relapsing HD: conventional treatment in the good prognosis group (0 factor), high-dose therapy after response to second line regimen (1 factor) and more intensive treatments for the bad prognosis group (2 factors).
    背景与目标: :自体干细胞移植(ASCT)的高剂量治疗已被广泛推荐用于复发性霍奇金病(HD)的患者。从1982年至1993年,我们从法国骨髓移植登记机构中选择了280例接受了包括化疗在内的初始治疗后HD复发的ASCT患者。诊断时的患者特征为:性别比(M / F):1.5;中位年龄:30岁(5-59岁),第一,第二阶段:43%;三,四:57%; 32%接受过化学疗法,68%进行了化学放疗。所有患者在一线治疗后均完全缓解,随后复发。诊断与大剂量治疗之间的中位间隔为34个月。首次复发发生在78%的患者中位,治疗中位至18个月的复发时间。所有患者在大剂量治疗之前均接受了挽救性化疗,复发和大剂量治疗之间的中位时间为5个月。在此方案之后,84%的患者被认为具有化学敏感性复发。调理方案为:BEAM:60%; CBV / BEAC:26%。移植相关死亡率为6%。高剂量治疗后的3年中位随访结果显示,4年总生存率和无进展生存率分别为66%和60%。调理方案和干细胞来源均不影响生存。生存的良好预后因素是:复发的化学敏感性(P <0.01)和首次复发vs进一步复发(P <0.05)。对于214例首次复发的患者,生存的其他重要因素是:治疗结束至复发间隔<12个月(P <0.05)和淋巴结相对于结外复发(P <0.001)。这两个预后因素用于验证具有三个显着不同的亚组的预后模型:分别为93岁,0(n = 59),1(n = 125)或2个因素(n = 30)的4年生存率, 59%和43%(P <0.001)。可以为复发性HD患者量身定制挽救疗法:预后良好的常规治疗(0因子),对二线方案有反应后的大剂量治疗(1因子)和对预后不良的患者进行更深入的治疗(2因子) 。
  • 【法国国家医疗保健系统数据库(SNDS)中基于案例的方法鉴定与上消化道出血相关的药物的经验评估。】 复制标题 收藏 收藏
    DOI:10.1002/pds.5038 复制DOI
    作者列表:Thurin NH,Lassalle R,Schuemie M,Pénichon M,Gagne JJ,Rassen JA,Benichou J,Weill A,Blin P,Moore N,Droz-Perroteau C
    BACKGROUND & AIMS: PURPOSE:Upper gastrointestinal bleeding (UGIB) is a severe and frequent drug-related event. In order to enable efficient drug safety alert generation in the French National Healthcare System database (SNDS), we assessed and calibrated empirically case-based designs to identify drug associated with UGIB risk. METHODS:All cases of UGIB were extracted from SNDS (2009-2014) using two definitions. Positive and negative drug controls were used to compare 196 self-controlled case series (SCCS), case-control (CC) and case-population (CP) design variants. Each variant was evaluated in a 1/10th population sample using area under the receiver operating curve (AUC) and mean square error (MSE). Parameters that had major impacts on results were identified through logistic regression. Optimal designs were replicated in the unsampled population. RESULTS:Using a specific UGIB definition, AUCs ranged from 0.64 to 0.80, 0.44 to 0.61 and 0.50 to 0.67, for SCCS, CC and CP, respectively. MSE ranged from 0.07 to 0.39, 0.83 to 1.33 and 1.96 to 4.6, respectively. Univariate regressions showed that high AUCs were achieved with SCCS with multiple drug adjustment and a 30-day risk window starting at exposure. The top-performing SCCS variant in the unsampled population yielded an AUC = 0.84 and MSE = 0.14, with 10/36 negative controls presenting significant estimates. CONCLUSIONS:SCCS adjusting for multiple drugs and using a 30-day risk window has the potential to generate UGIB-related alerts in the SNDS and hypotheses on its potential population impact. Negative control implementation highlighted that low systematic error was generated but that protopathic bias and confounding by indication remained unaddressed issues.
    背景与目标: 目的:上消化道出血(UGIB)是一种严重且频繁的药物相关事件。为了在法国国家医疗保健系统数据库(SNDS)中实现高效的药物安全警报生成,我们评估并校准了基于经验的基于案例的设计,以识别与UGIB风险相关的药物。
    方法:所有的UGIB病例均使用两个定义从SNDS(2009-2014)中提取。使用阳性和阴性药物对照来比较196个自控病例系列(SCCS),病例对照(CC)和病例人群(CP)设计变体。使用接收器工作曲线(AUC)和均方误差(MSE)下的面积,在人口样本的1/10中评估每个变体。通过逻辑回归确定对结果有重大影响的参数。最佳设计在未抽样人群中重复进行。
    结果:使用特定的UGIB定义,SCCS,CC和CP的AUC分别为0.64至0.80、0.44至0.61和0.50至0.67。 MSE的范围分别为0.07至0.39、0.83至1.33和1.96至4.6。单因素回归表明,SCCS的高AUCs可以通过多种药物调整和从暴露开始的30天风险窗口来实现。未抽样人群中表现最好的SCCS变体的AUC = 0.84,MSE = 0.14,其中10/36个阴性对照的估计值显着。
    结论:针对多种药物进行调整并使用30天风险窗的SCCS可能会在SNDS中产生与UGIB相关的警报,并假设其可能对人群产生影响。负控制措施的实施突显出产生了较低的系统误差,但原发病率偏倚和因指示而造成的混淆仍未解决。
  • 【非英语国家的患者在急性护理中有什么价值?从患者的角度看文化能力:定性研究。】 复制标题 收藏 收藏
    DOI:10.1080/13557850802035236 复制DOI
    作者列表:Garrett PW,Dickson HG,Whelan AK,Roberto-Forero
    BACKGROUND & AIMS: OBJECTIVE:The purpose of this research was to locate cultural competence within the experiential domain of the non-English-speaking patient. DESIGN:Seven language-specific focus groups were held with 59 hospital patients and carers of patients with limited English to better understand their experience and to identify critical factors leading to their constructions of care. Grounded theory analysis within a constructivist perspective was undertaken. RESULTS:While the majority of patients were positive about their hospital experience, the theme of powerlessness appeared central to many patient experiences. Language facilitation was the most common issue. Inattention to specific cultural mores and racism in some instances contributed to negative experiences. Patients primarily valued positive engagement, information and involvement, compassionate, kind and respectful treatment, and the negotiated involvement of their family. CONCLUSION:Because of the specific nature of each patient-provider interaction within its particular social and political environment, culturally competent behaviour in one context may be culturally incompetent in another. We propose a model of cultural empowerment that reflects the phenomenological basis of cultural competence in that cultural competence must be consistently renegotiated with any particular patient in a particular healthcare context. Similarly, ongoing community consultations are needed for health services and organisations to retain cultural competence.
    背景与目标: 目的:本研究的目的是将文化能力定位于非英语患者的体验领域。
    设计:针对59个医院患者和英语水平有限的患者的护理人员举行了七个针对特定语言的焦点小组,以更好地了解他们的经验并确定导致其护理结构的关键因素。在建构主义视角下进行了扎根的理论分析。
    结果:尽管大多数患者对他们的住院经历持肯定态度,但无能为力的主题似乎是许多患者经历的核心。语言便利化是最常见的问题。在某些情况下,对特定文化习俗和种族主义的不重视造成了负面的经历。患者主要重视积极的参与,信息和参与,富有同情心,友善和尊重的治疗以及家人的协商参与。
    结论:由于每种患者与提供者之间在特定的社会和政治环境中互动的特殊性,在一种情况下具有文化能力的行为在另一种情况下可能在文化上不适合。我们提出了一种文化授权模型,该模型可以反映文化能力的现象学基础,因为文化能力必须与特定医疗环境中的任何特定患者重新协商。同样,卫生服务和组织需要进行持续的社区磋商以保持文化才能。
  • 【亚洲和非洲用于农产品的太阳能干燥机的回顾:一种创新的景观方法。】 复制标题 收藏 收藏
    DOI:10.1016/j.jenvman.2020.110730 复制DOI
    作者列表:Udomkun P,Romuli S,Schock S,Mahayothee B,Sartas M,Wossen T,Njukwe E,Vanlauwe B,Müller J
    BACKGROUND & AIMS: :Solar drying is one of the most efficient and cost-effective, renewable, and sustainable technologies to conserve agricultural products in Asian and sub-Saharan African (SSA) countries. This review paper presents the different types of solar dryers that are widely used in Africa and Asia. In addition, the pre-eminent effects of their use on product quality, as well as their economic, environmental, and social impacts, are highlighted. Since financial, external, and structural factors play a key role in the adoption and scaling of solar dryers, this paper also discusses the impact of these factors on the effectiveness of solar drying technologies in selected Asian and SSA countries.
    背景与目标: :太阳能干燥是保护亚洲和撒哈拉以南非洲(SSA)国家农产品的最有效,最具成本效益,可再生和可持续的技术之一。这篇评论文章介绍了非洲和亚洲广泛使用的不同类型的太阳能干燥机。此外,还强调了其使用对产品质量的显着影响及其经济,环境和社会影响。由于财务,外部和结构因素在太阳能干燥机的采用和扩展中起着关键作用,因此本文还讨论了这些因素对某些亚洲国家和SSA国家中太阳能干燥技术有效性的影响。
  • 【受艾滋病毒及其子女影响的青春期母亲:范围广泛的撒哈拉以南非洲证据和经验回顾。】 复制标题 收藏 收藏
    DOI:10.1080/17441692.2020.1775867 复制DOI
    作者列表:Toska E,Laurenzi CA,Roberts KJ,Cluver L,Sherr L
    BACKGROUND & AIMS: :While adolescents have received increasing attention in the global HIV response and international strategies and commitments, adolescent mothers and their children remain largely overlooked in research, funding and, programming for health-related outcomes. We conducted an extensive scoping review of current evidence on the experiences of adolescent mothers affected by HIV and their children in this region. We included published literature and conference abstracts, complemented by consultations with key stakeholders, and a review of documents through grey literature searching. First, we summarise the experiences of adolescent mothers and their children related to HIV and key health and development indicators. The syndemic of early motherhood and HIV in sub-Saharan Africa increases the vulnerability of adolescent mothers and their children. We then highlight lessons from a series of promising programmes focused on supporting adolescent mothers through novel approaches. In sub-Saharan Africa, supporting adolescent mothers living in high HIV-risk communities is critical not only to eliminate HIV/AIDS, but also to attain the Sustainable Development Goals. While research on and programming for adolescent mothers and their children is growing, the complex needs for this vulnerable group remain unmet. We conclude with evidence gaps and programming priorities for adolescent mothers affected by HIV and their children.
    背景与目标: :尽管青少年在全球艾滋病毒应对以及国际战略和承诺中受到越来越多的关注,但在为与健康相关的结果进行研究,资助和规划方面,青少年母亲及其子女仍然被忽视。我们对有关该地区受艾滋病毒感染的青春期母亲及其子女的经历的现有证据进行了范围广泛的回顾。我们收录了出版的文献和会议摘要,并与主要利益相关者进行了磋商,并通过灰色文献搜索对文档进行了审查。首先,我们总结了青春期母亲及其子女与艾滋病毒以及主要健康和发展指标相关的经验。在撒哈拉以南非洲,早孕和艾滋病毒的综合症增加了青春期母亲及其子女的脆弱性。然后,我们重点介绍了一系列有前途的计划的教训,这些计划的重点是通过新颖的方法来支持青春期的母亲。在撒哈拉以南非洲,支持生活在艾滋病毒高发地区的青春期母亲不仅对消除艾滋病毒/艾滋病至关重要,而且对于实现可持续发展目标也至关重要。尽管对青春期的母亲及其子女的研究和计划正在增长,但对这一弱势群体的复杂需求仍未得到满足。我们以受艾滋病毒及其子女影响的青春期母亲的证据差距和方案优先重点作为结论。

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