OBJECTIVES To evaluate the effectiveness of a large-scale,web-based,in-service hypertension management training project among lay health workers(LHWs) at primary care health(PHC) settings in China,and to examine the f...OBJECTIVES To evaluate the effectiveness of a large-scale,web-based,in-service hypertension management training project among lay health workers(LHWs) at primary care health(PHC) settings in China,and to examine the factors contributing to the variations of effectiveness.METHODS We used data from a web-based national hypertension management training project implemented in 2018,it was designed to facilitate LHWs to learn,understand,and apply the relevant knowledge and skills in hypertension management through providing training courses by use of the web-based platform with unified standards.All LHWs were required to participate in the exams before and after training to acquire scores for the use of evaluating their performance of hypertension management knowledge.We first used descriptive analysis to present the variations of effectiveness in hypertension management knowledge among LHWs by important subgroups.Afterwards,we used multilevel logistic regression to examine the individual and regional factors contributing to the variations and quantify the magnitude of how these factors affected training effectiveness.RESULTS There were 1,208,610 LHWs who completed training and were certificated.Nationally,the scores of LHWs increased significantly from 62.87 ± 21.14 out of 100 in the pre-test to 88.30 ± 11.31 in the post-test by 25.43(95% confidence interval[CI]:25.40-25.47).Training contents involved in antihypertensive medication showed the lowest score(54.36) in the pre-test and soared the most after training,up to 84.22 by 54.94%.Individual factors associated with disparities in the knowledge of hypertension management decreased substantially after training,which included sex,age,education,practice type,professional level,and hierarchy of working institutions.Geographical variations were shown at the provincial level,with the majority of them being explained by factors at the regional level.CONCLUSIONS Accessible web-based training modality,government efforts,accompanied with experiences derived from the training,could be generalized to other low-and middle-income countries in facilitating the hypertension management capacity of LHWs.Localization and evaluation is warranted on the way to its further application.展开更多
<strong>Background</strong> Knowledge, attitude, perception, and practice of Covid-19 prevention affect the effectiveness of healthcare workers in the pandemic response. This study assessed gaps in awarene...<strong>Background</strong> Knowledge, attitude, perception, and practice of Covid-19 prevention affect the effectiveness of healthcare workers in the pandemic response. This study assessed gaps in awareness, knowledge, attitude, perception, and practice of Covid-19 prevention among healthcare workers in Rivers State, Nigeria. <strong>Methods</strong> This was a descriptive cross-sectional survey carried out six weeks into Rivers State response that commenced on February 20, 2020, in the 23 Local Government Areas (LGAs). State Disease Surveillance and Notification Officers used multistage sampling to recruit 555 healthcare workers for the survey. A self-designed structured interviewer-administered questionnaire built into the Open Data Kit application for android phones was used for data collection. Descriptive data analysis was done, and outputs presented as frequency and percentages. <strong>Results</strong> There was a total of 372 (67.0%) female respondents. Majority of study participants had tertiary education 453 (81.6%). The mean age of study participants was 40.6 years (Standard Deviation = 7.8 years). Furthermore, 285 (51.4%) were Community Health Workers, and had over ten years practicing experience 393 (70.8%). Most healthcare workers 554 (99.8%) had heard about Covid-19, through radio 539 (97.1%), and television 445 (80.2%) yet 213 (38.4%) respondents did not know that it is caused by a virus. Most respondents 415 (74.8%) had good knowledge about Covid-19. However, only 148 (26.7%) would refer suspected cases to a facility and only 365 (65.8%) respondents demonstrated the correct hand washing technique. <strong>Conclusion</strong> There are some gaps in health worker knowledge, attitude, perception, and practice of Covid-19 prevention. Interventions to bridge these gaps are needed for effective containment of this pandemic.展开更多
Background: In Taiwan, emergency departments are so busy that it is not uncommon for staffs (doctors and nurses) to be deprived of their lunch breaks or breaks to go to the restroom. As a consequence, during their bus...Background: In Taiwan, emergency departments are so busy that it is not uncommon for staffs (doctors and nurses) to be deprived of their lunch breaks or breaks to go to the restroom. As a consequence, during their busy shifts some emergency department healthcare workers choose to limit their water intake and no time to micturate which are both risk factors of urinary tract infection or urolithiasis. Hematuria is a common laboratory finding due to urinary tract infection and urolithiasis. Objective: To assess the prevalence of hematuria among the emergency department healthcare workers, we conducted a retrospective study in a district hospital in Taiwan. Documented data included those of healthcare workers who worked in the emergency department, as well as other departments of the same hospital. Methods: We reviewed the three-year records of general body checkup of hospital staffs who served in the emergency room and other departments of the same hospital between January 1, 2009 and December 31, 2011. Statistical software SPSS statistical analysis of survey data recovery is applied;data and test results by the questionnaire analysis patterns are associated with the urinary system abnormalities to ANOVA analysis to explore the hospital group whether there is a significant sex differences, and the other to analyze and verify the correlation analysis to the Scheffe post-hoc comparison method. Results: A higher prevalence of hematuria was observed among emergency department healthcare workers when compared with their colleagues who work in other departments of the same hospital. Female workers have higher risk of urinary system abnormalities than male workers. Nurses in the urinary system abnormalities are higher than other positions category. Shift work system has a negative effect on the urinary system. Conclusion: In conclusion, hematuria is more prevalent among emergency department healthcare workers than healthcare workers working in the inpatient wards. Hematuria might well be due to urinary tract infection which in turns caused by the overwhelmingly busy nature of the emergency department duty that deprived the emergency department healthcare workers from frequent voiding and sufficient intake of fluid.展开更多
Background:As the elderly population grows,the demand for long-term care services is increasing.Despite significant investments in care quality and workforce training,long-term care workers often face challenges such ...Background:As the elderly population grows,the demand for long-term care services is increasing.Despite significant investments in care quality and workforce training,long-term care workers often face challenges such as work fatigue,heavy workloads,and inadequate support.These issues can impact job satisfaction,mental health,and care quality,leading to staff turnover.This study examines how optimism,social support,and psychological resilience relate to caregiving burden,aiming to understand their effects on caregivers’well-being and performance to enhance the quality of long-term care services.Methods:The participants were 542 long-term care workers.Descriptive statistics,t-tests,one-way ANOVA,and hierarchical regression were used for data analysis.Results:(1)Optimism and social support were significantly and positively correlated with psychological resilience and significantly and negatively associated with caregiving burden.(2)Regarding differences in optimism,social support,psychological resilience,and caregiving burden among long-term care workers,females scored significantly higher than males in“social support;”married workers scored significantly higher than unmarried workers in“optimism,”“social support,”and“psychological resilience”;workers aged 45–65 scored significantly higher than those aged 25–45 in“optimism”;workers aged 25–45 scored significantly higher than those aged 45–65 in“caregiving burden”;social workers scored significantly higher than nursing staff in“optimism.”(3)Psychological resilience partially mediated the relationship between social support and caregiving burden concerning explanatory and predictive power.Conclusions:These findings suggest that optimism,social support,and psychological resilience are essential factors in reducing the caregiving burden among long-term care workers.The study highlights the importance of promoting psychological resilience and providing social support to alleviate the burden of caregiving.展开更多
History of upper respiratory tract infection in the mother or siblings was associated with higher risk of acute lower respiratory tract infection in cases. Most upper respiratory tract infections were caused by viral ...History of upper respiratory tract infection in the mother or siblings was associated with higher risk of acute lower respiratory tract infection in cases. Most upper respiratory tract infections were caused by viral pathogens and likely to occur in many members of the family. The study aimed to determine the existence and pattern of relationship between risk of acute respiratory infection (ARI) among infants and exposure to pre-existing maternal/caregiver acute respiratory tract infection. The study was designed as a community-based Nested case-control study of 1100 infants randomly selected from 12 communities out of 6 Local Government Areas of the 3 senatorial districts of Rivers State. A multistage random sampling technique was used in selecting the subjects up to the community level. Descriptive method was used to represent the characteristics of the subjects and the differences in ARI between exposed and unexposed infants were tested in a bivariate logistics regression at 5% level of significance. Odds ratio (OR) was used to interpret the size effect measures of ARI on exposure to pre-existing maternal/caregiver ARI differences. A total of 275 Cases of ARI and 825 controls were included in the study. Among exposed infants (N = 104), ARI cases were found to be higher n = 80 (76.9%) than in control n = 24 (23.1%). Whereas, among unexposed infants N = 991, ARI cases were found to be lower n = 195 (19.7%) than in control n = 796 (80.3%). For the exposed infants, the odds for ARI were 13.5 times significantly higher compared to those of their unexposed counterparts (OR-Unadjusted = 13.52, (p < 0.0001, 95% CI = 0.047 - 0.121)). The findings will widen the horizon in the etiological consideration of ARI among infants vis-à-vis exposure potential to pre-existing maternal/caregiver ARI via nursing care. Therefore, community-based sensitization programme on barrier nursing care techniques and personal hygiene practices should be on focus.展开更多
This is a review paper that brings to focus, concepts of Community Health Practice that connect Community Health Practitioners’ Roles to National development in view of its composite index improvement measure of soci...This is a review paper that brings to focus, concepts of Community Health Practice that connect Community Health Practitioners’ Roles to National development in view of its composite index improvement measure of social welfare services provision among others for the citizens of a country over time, with particular emphasis on medical care component of such index aimed at reduction in diseases and poverty in the population. The objective of the review work is to determine the extent to which Community Health Practice, particularly by Community Health Practitioners is capable of ensuring National Development in democratic governance or otherwise, in the context of our country, Nigeria. The methodology applied was traditional review of published literatures concerning the subject and findings of operational research of programme implemented by Community Health Practitioners at the Primary Health Care facilities and household level in the communities. This paper emphasizes on Primary Health Care services delivery contribution to National Development, since it is the level where Community Health Practitioners are mainly commissioned to render their services. Home-Based Care Strategy for Integrated Maternal, Newborn and Child Health piloted in three (3) local government areas (Ahoada West, Etche and Oyigbo) in Rivers State, Nigeria, in 2012 and implemented by Community Health Practitioners, aimed at reducing maternal, newborn and child morbidity and mortality by 20% by 2015 in line with the United Nations (UN) Millennium Development Goals 4 and 5, had been shown to achieve an average of 26% improvement in utilization of maternal and newborn health services, an average of 27% overall reduction in maternal malnutrition status, an average of 14% overall improvement in under 5 years malnutrition status among others in 2013 on comparing with baseline indicators. Nigeria also attained 80% coverage in routine immunization in most vaccine preventable diseases except Tetanus Toxiod (TT) 2 (54%) in 2013 to achieve herd immunity of the community to prevent transmission of disease pathogen to cause a disease. Community Health Practitioners are the frontline Primary Health Care Professionals charged with the responsibility of implementation of immunization programmes in Nigeria and therefore contributing significantly to the prevention and control of targeted vaccine preventable diseases in Nigeria Health System. Our findings on factors militating against Community Health Practitioners’ Roles in National Development as elicited in this paper may form basis for empirical studies to determine the level of significance of each of these factors. In conclusion, it is when the Community Health parameters are adequately addressed that we can ensure sustainable National Development and we can say we have succeeded in our various strategic agenda of government at whatever level that makes up the complex whole. This brings to fore, the importance of the roles of Community Health Practitioners in health care delivery to National Development in the context of our country, Nigeria.展开更多
Health-related quality of life (HRQOL) has not been investigated among Iranian industrial workers. The present paper aimed to study the influence of the socio-demographic, health and work-related factors on HRQOL amon...Health-related quality of life (HRQOL) has not been investigated among Iranian industrial workers. The present paper aimed to study the influence of the socio-demographic, health and work-related factors on HRQOL among Iranian industrial workers. In this cross-sectional study, participants were 280 workers of two factories. The Persian version of World Health Organization Quality of Life-Brief (WHOQOL-BREF) was used to assess the HRQOL. A questionnaire was developed to assess the socio-demographic, health and work-related factors. Results showed that the means (SD) of physical health, psychological health, social relationships, and environment domains of HRQOL were 13.2 (2.7), 13.3 (2.6), 14.2 (3.5) and 12.6 (2.5), respectively. A multiple linear regression showed that types of job, exercise activity, working schedule, sleep quality, smoking, and conflict between work and social life were significantly associated with physical health domain;whereas, working schedule, marital status, working demand, sleep quality, BMI, and conflict between work and individual life were significantly associated with psychological health domain. Working schedule, working demand, sleep quality, conflict between work and individual life, and having children over two years were significantly associated with social relationship domain;however, working demand, working schedule, smoking, sleep quality, working hour, job satisfaction, marital status and exercise activity were significantly associated with environment domain. Collectively, work-related factors including unhealthy working conditions, unsafe working environments, long working hours, irregular working schedules, and the lack of occupational training may negatively influence the HRQOL of workers. To improve workers’ HRQOL, intervention programs should focus on improving work environment, working schedule, occupational training and restricting working hours.展开更多
Objective:To give a comprehensive and basic understanding of diabetes and its risk factors in floating people in China.Method:We use"(diabetes or type 2 diabetes or chronic disease)and(floating population or empl...Objective:To give a comprehensive and basic understanding of diabetes and its risk factors in floating people in China.Method:We use"(diabetes or type 2 diabetes or chronic disease)and(floating population or employed floating population)"as the key words to search in the China academic literature database(CNKI),Wan Fang database,PubMed and Web of Science for relevant literature and extract the data about the prevalence of diabetes,relevant risk factors and disease management of the floating population in China.Result:Twenty-one literatures are entered into analysis finally,one is English and the rest are Chinese.According to the national survey,the prevalence rate of diabetes in floating population in China was 5.1%(95%CI,4.9%-5.3%),which is lower than that of the general population(11.6%,95%CI,11.3%–11.8%),and is consistent with the results of the local surveys.The comparison result between the prevalence of floating population and that of local population in each region differs in local surveys.In addition,the prevalence of male floating population is lower than that of the female population.Finally,as the age of the population rises,so does the prevalence of diabetes.As for the risk factors of chronical diseases,the overweight rate in every region is similar but the obesity rate differs in different regions(Ningxia,26.0%;Xiangshan,14.0%),and the obesity rate of the floating population is less than half of that of the general people(4.7%,11.9%).The awareness rate,treatment rate and control rate in the floating patients differ in the regional researches,but they all can’t meet the goals set by the local health departments.Conclusion:Compared with the general population,the prevalence of diabetes in the floating population are lower.However,Considering the growing population number and the poor disease management of the floating patients,the potential threat brought by the diabetes in floating population is imponderable.The government should establish the national surveillance system of diabetes for the floating population,strengthen the construction of the primary medical institutions,and optimize the existing funding system.展开更多
Background:Payment methods are known to influence maternal care delivery in health systems.Ghana suspended a piloted capitation provider payment system after nearly five years of implementation.This study aimed to exa...Background:Payment methods are known to influence maternal care delivery in health systems.Ghana suspended a piloted capitation provider payment system after nearly five years of implementation.This study aimed to examine the effects of Ghana’s capitation policy on maternal health care provision as part of lesson learning and bridging this critical literature gap.Methods:We used secondary data in the District Health Information Management System-2 and an interrupted time series design to assess changes in level and trend in the provision of ANC4_(+)(visits of pregnant women making at least the fourth antenatal care attendance per month),HB36(number of hemoglobin tests conducted for pregnant women who are at the 36th week of gestation)and vaginal delivery in capitated facilities-CHPS(Community-based Health Planning and Services)facilities and hospitals.Results:The results show that the capitation policy withdrawal was associated with a statistically significant trend increase in the provision of ANC4+in hospitals(coefficient 70.99 p<0.001)but no effect in CHPS facilities.Also,the policy withdrawal resulted in contrasting effects in hospitals and CHPS in the trend of provision of Hb36;a statistically significant decline was observed in CHPS(coefficient−7.01,p<0.05)while that of hospitals showed a statistically significant trend increase(coefficient 32.87,p<0.001).Finally,the policy withdrawal did not affect trends of vaginal delivery rates in both CHPS and hospitals.Conclusions:The capitation policy in Ghana appeared to have had a differential effect on the provision of maternal services in both CHPS and hospitals;repressing maternal care provision in hospitals and promoting adherence to anemia testing at term for pregnant women in CHPS facilities.Policy makers and stakeholders should consider the possible detrimental effects on maternal care provision and quality in the design and implementation of per capita primary care systems as they can potentially impact the achievement of SDG 3.展开更多
BACKGROUND The association of single nucleotide polymorphism of KCNQ1 gene rs2237895 with type 2 diabetes mellitus(T2DM)is currently controversial.It is unknown whether this association can be gene realized across dif...BACKGROUND The association of single nucleotide polymorphism of KCNQ1 gene rs2237895 with type 2 diabetes mellitus(T2DM)is currently controversial.It is unknown whether this association can be gene realized across different populations.AIM To determine the association of KCNQ1 rs2237895 with T2DM and provide reliable evidence for genetic susceptibility to T2DM.METHODS We searched PubMed,Embase,Web of Science,Cochrane Library,Medline,about:blank Academic,China National Knowledge Infrastructure,China Biomedical Literature Database,and Wanfang to investigate the association between KCNQ1 gene rs2237895 and the risk of T2DM up to January 12,2022.Review Manager 5.4 was used to analyze the association of the KCNQ1 gene rs2237895 polymorphism with T2DM and to evaluate the publication bias of the selected literature.RESULTS Twelve case–control studies(including 11273 cases and 11654 controls)met our inclusion criteria.In the full population,allelic model[odds ratio(OR):1.19;95%confidence interval(95%CI):1.09–1.29;P<0.0001],recessive model(OR:1.20;95%CI:1.11–1.29;P<0.0001),dominant model(OR:1.27.95%CI:1.14–1.42;P<0.0001),and codominant model(OR:1.36;95%CI:1.15–1.60;P=0.0003)(OR:1.22;95%CI:1.10–1.36;P=0.0002)indicated that the KCNQ1 gene rs2237895 polymorphism was significantly correlated with susceptibility to T2DM.In stratified analysis,this association was confirmed in Asian populations:allelic model(OR:1.25;95%CI:1.13–1.37;P<0.0001),recessive model(OR:1.29;95%CI:1.11–1.49;P=0.0007),dominant model(OR:1.35;95%CI:1.20–1.52;P<0.0001),codominant model(OR:1.49;95%CI:1.22–1.81;P<0.0001)(OR:1.26;95%CI:1.16–1.36;P<0.0001).In non-Asian populations,this association was not significant:Allelic model(OR:1.06,95%CI:0.98–1.14;P=0.12),recessive model(OR:1.04;95%CI:0.75–1.42;P=0.83),dominant model(OR:1.06;95%CI:0.98–1.15;P=0.15),codominant model(OR:1.08;95%CI:0.82–1.42;P=0.60.OR:1.15;95%CI:0.95–1.39;P=0.14).CONCLUSION KCNQ1 gene rs2237895 was significantly associated with susceptibility to T2DM in an Asian population.Carriers of the C allele had a higher risk of T2DM.This association was not significant in non-Asian populations.展开更多
BACKGROUND The risks associated with negative doctor-patient relationships have seriously hindered the healthy development of medical and healthcare and aroused wide-spread concern in society.The number of public comm...BACKGROUND The risks associated with negative doctor-patient relationships have seriously hindered the healthy development of medical and healthcare and aroused wide-spread concern in society.The number of public comments on doctor-patient relationship risk events reflects the degree to which the public pays attention to such events.Thirty incidents of doctor-patient disputes were collected from Weibo and TikTok,and 3655 related comments were extracted.The number of comment sentiment words was extracted,and the comment sentiment value was calculated.The Kruskal-Wallis H test was used to compare differences between each variable group at different levels of incidence.Spearman’s correlation analysis was used to examine associations between variables.Regression analysis was used to explore factors influencing scores of comments on incidents.RESULTS The study results showed that public comments on media reports of doctor-patient disputes at all levels are mainly dominated by“good”and“disgust”emotional states.There was a significant difference in the comment scores and the number of partial emotion words between comments on varying levels of severity of doctor-patient disputes.The comment score was positively correlated with the number of emotion words related to positive,good,and happy)and negatively correlated with the number of emotion words related to negative,anger,disgust,fear,and sadness.CONCLUSION The number of emotion words related to negative,anger,disgust,fear,and sadness directly influences comment scores,and the severity of the incident level indirectly influences comment scores.展开更多
This review summarizes research discoveries within 4 areas of exercise immunology that have received the most attention from investigators :(1) acute and chronic effects of exercise on the immune system,(2) clinical b...This review summarizes research discoveries within 4 areas of exercise immunology that have received the most attention from investigators :(1) acute and chronic effects of exercise on the immune system,(2) clinical benefits of the exercise—immune relationship,(3) nutritional influen?ces on the immune response to exercise, and(4) the effect of exercise on immunosenescence. These scientific discoveries can be organized into distinctive time periods: 1900-1979, which focused on exercise-induced changes in basic immune cell counts and function; 1980-1989, during which seminal papers were published with evidence that heavy exertion was associated with transient immune dysfunction, elevated inflammatory biomarkers,and increased risk of upper respiratory tract infections; 1990-2009, when additional focus areas were added to the field of exercise immunology including the interactive effect of nutrition, effects on the aging immune system, and inflammatory cytokines; and 2010 to the present, when technological advances in mass spectrometry allowed system biology approaches(i.e., metabolomics, proteomics, lipidomics, and microbiome characterization) to be applied to exercise immunology studies. The future of exercise irmmunology will take advantage of these technologies to provide new insights on the interactions between exercise, nutrition, and immune function, with application down to the person?alized level. Additionally, these methodologies will improve mechanistic understanding of how exercise-induced immune perturbations reduce the risk of common chronic diseases.展开更多
AIM:To investigate the possible mechanism of how glucose promotes invasion and metastasis of colon cancer cells.METHODS:CT-26 rat colorectal cancer cells were cultured in different concentrations of glucose environmen...AIM:To investigate the possible mechanism of how glucose promotes invasion and metastasis of colon cancer cells.METHODS:CT-26 rat colorectal cancer cells were cultured in different concentrations of glucose environments(10,20,and 30 mmol/L).Wound healing assay and transwell chamber invasion assay were utilized to test the migration and invasion,respectively.In order to understand the role of signal transducer and activator of transcription 3(STAT3)in the process,STAT3 inhibitors,including Stattic(an STAT3 specific inhibitor)and small interfering RNA targeting STAT3,were used to block STAT3 function to evaluate their impact on CT-26 cell motion.To verify whether STAT3 and matrix metalloproteinase-9(MMP-9)protein expression is associated with glucose-induced cell movement,Western blot was used to compare the differences in the expression of MMP-9 and STAT3 in cells incubated with and without STAT3 inhibitors in high glucose condition.RESULTS:In both wound healing and invasion assays,the migration and invasion of CT-26 cells increased gradually with the increase in glucose concentration.However,the glucose-induced migration and invasion were obviously inhibited by STAT3 inhibitors(P<0.05).Similarly,in Western blot assessment,both MMP-9and STAT3 expression increased under a high glucose environment and the highest expression was achieved when 30 mmol/L glucose was used.However,in cells treated with 30 mmol/L mannitol,either MMP-9 or STAT3expression did not increase(P>0.05).When STAT3inhibitors were added in the 30 m M glucose group,not only STAT3 but also MMP-9 expression decreased significantly(P<0.05).CONCLUSION:Our study provides evidence that glucose can promote both migration and invasion of CT-26 cells,and that the STAT3-induced MMP-9 signal pathway is involved in this process.展开更多
AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In ...AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.展开更多
BACKGROUND Barrett’s esophagus(BE)is a pre-malignant condition associated with the development of esophageal adenocarcinoma.The prevalence of BE in the general populations of Asian countries ranges from 0.06%to 1%.Ho...BACKGROUND Barrett’s esophagus(BE)is a pre-malignant condition associated with the development of esophageal adenocarcinoma.The prevalence of BE in the general populations of Asian countries ranges from 0.06%to 1%.However,with lifestyle changes in Asian countries and adoption of western customs,the prevalence of BE might have increased.AIM To determine the current prevalence of BE in Taiwan,and to investigate risk factors predicting the presence of BE.METHODS This retrospective study was conducted at the Health Evaluation Center of Kaohsiung Veterans General Hospital in Taiwan.Between January 2015 and December 2015,3385 subjects undergoing routine esophagogastroduodenoscopy examinations as part of a health check-up at the Health Evaluation Center were included.Patient characteristics and endoscopic findings were carefully reviewed.Lesions with endoscopic findings consistent with BE awaiting histological evaluation were judged as endoscopically suspected esophageal metaplasia(ESEM).BE was defined based on extension of the columnar epithelium≥1 cm above the gastroesophageal junction and was confirmed based on the presence of specialized intestinal metaplasia(IM)in the metaplastic esophageal epithelium.Clinical factors of subjects with BE and subjects without BE were compared,and the risk factors predicting BE were analyzed.RESULTS A total of 3385 subjects(mean age,51.29±11.42 years;57.1%male)were included in the study,and 89 among them were confirmed to have IM and presence of goblet cells via biopsy examination.The majority of these individuals were classified as short segment BE(n=85).The overall prevalence of BE was 2.6%.Multivariate analysis disclosed that old age[odds ratio(OR)=1.033;95%confidence interval(CI):1.012-1.055;P=0.002],male gender(OR=2.106;95%CI:1.145-3.872;P=0.017),ingestion of tea(OR=1.695;95%CI:1.043-2.754;P=0.033),and presence of hiatal hernia(OR=3.037;95%CI:1.765-5.225;P<0.001)were significant risk factors predicting BE.The independent risk factor for the presence of IM in ESEM lesions was old age alone(OR=1.029;95%CI:1.006-1.053;P=0.014).CONCLUSION Current prevalence of BE among the general population in Taiwan is 2.6%.Old age,male gender,ingestion of tea and hiatal hernia are significant risk factors for BE.展开更多
AIM:To investigate the prevalence of gallstone dis-ease(GSD) and to evaluate the risk of symptomatic GSD among diabetic patients.METHODS:The study was conducted by analyzing the National Health Research Institutes(NHR...AIM:To investigate the prevalence of gallstone dis-ease(GSD) and to evaluate the risk of symptomatic GSD among diabetic patients.METHODS:The study was conducted by analyzing the National Health Research Institutes(NHRI) dataset of ambulatory care patients,inpatient claims,and the updated registry of beneficiaries from 2000 to 2008.A total of 615 532 diabetic patients without a prior history of hospital treatment or ambulatory care visits for symptomatic GSD were identified in the year 2000.Age-and gender-matched control individuals free from both GSD and diabetes from 1997 to 1999 were randomly selected from the NHIR database(n = 614 871).The incidence densities of symptomatic GSD were estimated according to the subjects' diabetic status.The distributions of age,gender,occupation,income,and residential area urbanization were compared between diabetic patients and control subjects using Cox proportion hazards models.Differences between the rates of selected comorbidities were also assessed in the two groups.RESULTS:Overall,60 734 diabetic patients and 48 116 control patients developed symptomatic GSD and underwent operations,resulting in cumulative operation rates of 9.87% and 7.83%,respectively.The age and gender distributions of both groups were similar,with a mean age of 60 years and a predominance of females.The diabetic group had a significantly higher prevalence of all comorbidities of interest.A higher incidence of symptomatic GSD was observed in females than in males in both groups.In the control group,females under the age of 64 had a significantly higher incidence of GSD than the corresponding males,but this difference was reduced with increasing age.The cumulative incidences of operations for symptomatic GSD in the diabetic and control groups were 13.06 and 9.52 cases per 1000 person-years,respectively.Diabetic men exhibited a higher incidence of operations for symptomatic GSD than did their counterparts in the control group(12.35 vs 8.75 cases per 1000 person-years).CONCLUSION:The association of diabetes with increased symptomatic GSD may provide insight to the treatment or management of diabetes in clinical settings.展开更多
AIM: To evaluate the efficacy of vitamin E treatment on liver stiffness in nonalcoholic fatty liver disease(NAFLD).METHODS: Thirty-eight NAFLD patients were administered vitamin E for > 1 year. The doses of vitamin...AIM: To evaluate the efficacy of vitamin E treatment on liver stiffness in nonalcoholic fatty liver disease(NAFLD).METHODS: Thirty-eight NAFLD patients were administered vitamin E for > 1 year. The doses of vitamin E were 150, 300, or 600 mg; three times per day after each meal. Responses were assessed by liver enzyme levels [aspartate aminotransferase(AST), alanine aminotranferease(ALT), and γ-glutamyl transpeptidase(γ-GTP)], noninvasive scoring systems of hepatic fibrosis-4 [FIB-4 index and aspartate aminotransferaseto-platelet index(APRI)], and liver stiffness [velocity of shear wave(Vs)] measured by acoustic radiation force impulse elastography. Vs measurements were performed at baseline and 12 mo after baseline. The patients were genotyped for the patatin-like phospholipase domain containing 3(PNPLA3) polymorphisms and then divided into either the CC/CG or GG group to examine each group's responses to vitamin E treatment. RESULTS: We found marked differences in the platelet count, serum albumin levels, alkaline phosphatase levels, FIB-4 index, APRI, and Vs at baseline depending on the PNPLA3 polymorphism. AST, ALT, and γ-GTP levels(all P < 0.001); FIB-4 index(P = 0.035); APRI(P < 0.001); and Vs(P < 0.001) significantly decreased from baseline to 12 mo in the analysis of all patients. In the subset analyses of PNPLA3 genotypes, AST levels(P = 0.011), ALT levels(P < 0.001), γ-GTP levels(P = 0.005), APRI(P = 0.036), and Vs(P = 0.029) in genotype GG patients significantly improved, and AST and ALT levels(both P < 0.001), γ-GTP levels(P = 0.003), FIB-4 index(P = 0.017), and APRI(P < 0.001) in genotype CC/CG patients. CONCLUSION: One year of vitamin E treatment improved noninvasive fibrosis scores and liver stiffness in NAFLD patients. The responses were similar between different PNPLA3 genotypes.展开更多
Introduction: Hospital infections prolong patient hospitalization, necessitate additional treatment, increase mortality rate, raise hospital expenses, and even reduce the level of health in the society. The purpose of...Introduction: Hospital infections prolong patient hospitalization, necessitate additional treatment, increase mortality rate, raise hospital expenses, and even reduce the level of health in the society. The purpose of this research was to study hospital infections in selected hospitals of Qazvin. Methods and Materials: This was an analytic-cross-sectional study. The research population consisted of 25,628 hospitalized patients in the first eight months of 2012 in three selected hospitals of the Qazvin Province. The algorithm of reporting hospital infections, the National Program of Controlling Hospital Infections, and 223 patient files hospitalized due to hospital-acquired infections were used to collect information. The collected information was analyzed using the SPSS V. 17 software;the descriptive statistics was used to analyze the qualitative variables;and the descriptive statistics together with chi-square and t-test were employed for the quantitative variables. Results: The ICU units had the most cases of hospital infections. Respiratory pneumonia and urinary infections topped the list of hospital infections. The most invasive treatments carried out on patients with hospital infections were surgery, urinary catheter, and venous catheter, respectively. More than 50 percent of patients with hospital infections were hospitalized for 2 to 21 days. Results and Conclusions: Because of the high rate of hospital infections, especially in the ICU ward, authorities must give top priority in their plans to designing suitable educational programs to inform hospital staff and patients of hospital infections and to provide suitable resources for dealing with this problem.展开更多
Patient satisfaction with hospital services is one of the most important indicators of effectiveness and quality of hospital services. Patient satisfaction surveys can provide valuable data for evaluating the current ...Patient satisfaction with hospital services is one of the most important indicators of effectiveness and quality of hospital services. Patient satisfaction surveys can provide valuable data for evaluating the current status, awareness of quality and quantity of process improvement programs and quality improvement to health managers and policy makers. The present study discusses previous studies conducted in this area, and presents recommendations to improve patient satisfaction. The method of this study is review. Selected papers were identified by searching keyword in Persian and English in different databases and after applying the inclusion criteria, 19 studies were extracted and analyzed. 23,793 patients in 12 studies entered into this research were investigated. Generally, satisfaction of the patients in this study was estimated at an average level. Continuous evaluation of patient satisfaction and identification of the factors affecting it requires establishment of comprehensive and accurate data system in this area;that by application of the results of previous studies steps can be taken to improve patient satisfaction. Patients’ satisfaction in Iran, compared with other countries, is desirable. In addition, the overall satisfaction of patients in recent years has increased compared to previous years and the reason can be measures like different ways of improving the quality, customer orientation, and applying the results of research conducted in this area.展开更多
The purpose of this study was to identify the relationships among disposition toward critical thinking, learning styles, and caring behaviors in student nurses enrolled in three 5-year junior nursing colleges in South...The purpose of this study was to identify the relationships among disposition toward critical thinking, learning styles, and caring behaviors in student nurses enrolled in three 5-year junior nursing colleges in Southern Taiwan. Methods: This cross-sectional study used a convenience sample that comprised 777 nursing students from two cities. The data were obtained through the Critical Thinking Disposition Inventory, Chinese Version (CTDI-CV), Index of Learning Styles (ILS), and the Caring Behavior Scale (CBS). The sample ranged in age from 16 to 22 years (M = 18.21). Results: Students scored highest on the inquisitiveness subscale and lowest on the truth-seeking subscale. Additionally, some dimensions of disposition toward critical thinking differed significantly by learning style. There was a positive relationship between overall critical thinking dispositions and caring behaviors (r = 0.23, p < 0.01). Finally, dimensions of caring behavior, with the exception of the maturity dimension, were significantly positively related to most dimensions of the disposition toward critical thinking (p < 0.05). Conclusion: The findings indicate that not only is learning style related to critical thinking disposition but also to caring behaviors. However, the cause of these relationships warrants further study.展开更多
文摘OBJECTIVES To evaluate the effectiveness of a large-scale,web-based,in-service hypertension management training project among lay health workers(LHWs) at primary care health(PHC) settings in China,and to examine the factors contributing to the variations of effectiveness.METHODS We used data from a web-based national hypertension management training project implemented in 2018,it was designed to facilitate LHWs to learn,understand,and apply the relevant knowledge and skills in hypertension management through providing training courses by use of the web-based platform with unified standards.All LHWs were required to participate in the exams before and after training to acquire scores for the use of evaluating their performance of hypertension management knowledge.We first used descriptive analysis to present the variations of effectiveness in hypertension management knowledge among LHWs by important subgroups.Afterwards,we used multilevel logistic regression to examine the individual and regional factors contributing to the variations and quantify the magnitude of how these factors affected training effectiveness.RESULTS There were 1,208,610 LHWs who completed training and were certificated.Nationally,the scores of LHWs increased significantly from 62.87 ± 21.14 out of 100 in the pre-test to 88.30 ± 11.31 in the post-test by 25.43(95% confidence interval[CI]:25.40-25.47).Training contents involved in antihypertensive medication showed the lowest score(54.36) in the pre-test and soared the most after training,up to 84.22 by 54.94%.Individual factors associated with disparities in the knowledge of hypertension management decreased substantially after training,which included sex,age,education,practice type,professional level,and hierarchy of working institutions.Geographical variations were shown at the provincial level,with the majority of them being explained by factors at the regional level.CONCLUSIONS Accessible web-based training modality,government efforts,accompanied with experiences derived from the training,could be generalized to other low-and middle-income countries in facilitating the hypertension management capacity of LHWs.Localization and evaluation is warranted on the way to its further application.
文摘<strong>Background</strong> Knowledge, attitude, perception, and practice of Covid-19 prevention affect the effectiveness of healthcare workers in the pandemic response. This study assessed gaps in awareness, knowledge, attitude, perception, and practice of Covid-19 prevention among healthcare workers in Rivers State, Nigeria. <strong>Methods</strong> This was a descriptive cross-sectional survey carried out six weeks into Rivers State response that commenced on February 20, 2020, in the 23 Local Government Areas (LGAs). State Disease Surveillance and Notification Officers used multistage sampling to recruit 555 healthcare workers for the survey. A self-designed structured interviewer-administered questionnaire built into the Open Data Kit application for android phones was used for data collection. Descriptive data analysis was done, and outputs presented as frequency and percentages. <strong>Results</strong> There was a total of 372 (67.0%) female respondents. Majority of study participants had tertiary education 453 (81.6%). The mean age of study participants was 40.6 years (Standard Deviation = 7.8 years). Furthermore, 285 (51.4%) were Community Health Workers, and had over ten years practicing experience 393 (70.8%). Most healthcare workers 554 (99.8%) had heard about Covid-19, through radio 539 (97.1%), and television 445 (80.2%) yet 213 (38.4%) respondents did not know that it is caused by a virus. Most respondents 415 (74.8%) had good knowledge about Covid-19. However, only 148 (26.7%) would refer suspected cases to a facility and only 365 (65.8%) respondents demonstrated the correct hand washing technique. <strong>Conclusion</strong> There are some gaps in health worker knowledge, attitude, perception, and practice of Covid-19 prevention. Interventions to bridge these gaps are needed for effective containment of this pandemic.
文摘Background: In Taiwan, emergency departments are so busy that it is not uncommon for staffs (doctors and nurses) to be deprived of their lunch breaks or breaks to go to the restroom. As a consequence, during their busy shifts some emergency department healthcare workers choose to limit their water intake and no time to micturate which are both risk factors of urinary tract infection or urolithiasis. Hematuria is a common laboratory finding due to urinary tract infection and urolithiasis. Objective: To assess the prevalence of hematuria among the emergency department healthcare workers, we conducted a retrospective study in a district hospital in Taiwan. Documented data included those of healthcare workers who worked in the emergency department, as well as other departments of the same hospital. Methods: We reviewed the three-year records of general body checkup of hospital staffs who served in the emergency room and other departments of the same hospital between January 1, 2009 and December 31, 2011. Statistical software SPSS statistical analysis of survey data recovery is applied;data and test results by the questionnaire analysis patterns are associated with the urinary system abnormalities to ANOVA analysis to explore the hospital group whether there is a significant sex differences, and the other to analyze and verify the correlation analysis to the Scheffe post-hoc comparison method. Results: A higher prevalence of hematuria was observed among emergency department healthcare workers when compared with their colleagues who work in other departments of the same hospital. Female workers have higher risk of urinary system abnormalities than male workers. Nurses in the urinary system abnormalities are higher than other positions category. Shift work system has a negative effect on the urinary system. Conclusion: In conclusion, hematuria is more prevalent among emergency department healthcare workers than healthcare workers working in the inpatient wards. Hematuria might well be due to urinary tract infection which in turns caused by the overwhelmingly busy nature of the emergency department duty that deprived the emergency department healthcare workers from frequent voiding and sufficient intake of fluid.
文摘Background:As the elderly population grows,the demand for long-term care services is increasing.Despite significant investments in care quality and workforce training,long-term care workers often face challenges such as work fatigue,heavy workloads,and inadequate support.These issues can impact job satisfaction,mental health,and care quality,leading to staff turnover.This study examines how optimism,social support,and psychological resilience relate to caregiving burden,aiming to understand their effects on caregivers’well-being and performance to enhance the quality of long-term care services.Methods:The participants were 542 long-term care workers.Descriptive statistics,t-tests,one-way ANOVA,and hierarchical regression were used for data analysis.Results:(1)Optimism and social support were significantly and positively correlated with psychological resilience and significantly and negatively associated with caregiving burden.(2)Regarding differences in optimism,social support,psychological resilience,and caregiving burden among long-term care workers,females scored significantly higher than males in“social support;”married workers scored significantly higher than unmarried workers in“optimism,”“social support,”and“psychological resilience”;workers aged 45–65 scored significantly higher than those aged 25–45 in“optimism”;workers aged 25–45 scored significantly higher than those aged 45–65 in“caregiving burden”;social workers scored significantly higher than nursing staff in“optimism.”(3)Psychological resilience partially mediated the relationship between social support and caregiving burden concerning explanatory and predictive power.Conclusions:These findings suggest that optimism,social support,and psychological resilience are essential factors in reducing the caregiving burden among long-term care workers.The study highlights the importance of promoting psychological resilience and providing social support to alleviate the burden of caregiving.
文摘History of upper respiratory tract infection in the mother or siblings was associated with higher risk of acute lower respiratory tract infection in cases. Most upper respiratory tract infections were caused by viral pathogens and likely to occur in many members of the family. The study aimed to determine the existence and pattern of relationship between risk of acute respiratory infection (ARI) among infants and exposure to pre-existing maternal/caregiver acute respiratory tract infection. The study was designed as a community-based Nested case-control study of 1100 infants randomly selected from 12 communities out of 6 Local Government Areas of the 3 senatorial districts of Rivers State. A multistage random sampling technique was used in selecting the subjects up to the community level. Descriptive method was used to represent the characteristics of the subjects and the differences in ARI between exposed and unexposed infants were tested in a bivariate logistics regression at 5% level of significance. Odds ratio (OR) was used to interpret the size effect measures of ARI on exposure to pre-existing maternal/caregiver ARI differences. A total of 275 Cases of ARI and 825 controls were included in the study. Among exposed infants (N = 104), ARI cases were found to be higher n = 80 (76.9%) than in control n = 24 (23.1%). Whereas, among unexposed infants N = 991, ARI cases were found to be lower n = 195 (19.7%) than in control n = 796 (80.3%). For the exposed infants, the odds for ARI were 13.5 times significantly higher compared to those of their unexposed counterparts (OR-Unadjusted = 13.52, (p < 0.0001, 95% CI = 0.047 - 0.121)). The findings will widen the horizon in the etiological consideration of ARI among infants vis-à-vis exposure potential to pre-existing maternal/caregiver ARI via nursing care. Therefore, community-based sensitization programme on barrier nursing care techniques and personal hygiene practices should be on focus.
文摘This is a review paper that brings to focus, concepts of Community Health Practice that connect Community Health Practitioners’ Roles to National development in view of its composite index improvement measure of social welfare services provision among others for the citizens of a country over time, with particular emphasis on medical care component of such index aimed at reduction in diseases and poverty in the population. The objective of the review work is to determine the extent to which Community Health Practice, particularly by Community Health Practitioners is capable of ensuring National Development in democratic governance or otherwise, in the context of our country, Nigeria. The methodology applied was traditional review of published literatures concerning the subject and findings of operational research of programme implemented by Community Health Practitioners at the Primary Health Care facilities and household level in the communities. This paper emphasizes on Primary Health Care services delivery contribution to National Development, since it is the level where Community Health Practitioners are mainly commissioned to render their services. Home-Based Care Strategy for Integrated Maternal, Newborn and Child Health piloted in three (3) local government areas (Ahoada West, Etche and Oyigbo) in Rivers State, Nigeria, in 2012 and implemented by Community Health Practitioners, aimed at reducing maternal, newborn and child morbidity and mortality by 20% by 2015 in line with the United Nations (UN) Millennium Development Goals 4 and 5, had been shown to achieve an average of 26% improvement in utilization of maternal and newborn health services, an average of 27% overall reduction in maternal malnutrition status, an average of 14% overall improvement in under 5 years malnutrition status among others in 2013 on comparing with baseline indicators. Nigeria also attained 80% coverage in routine immunization in most vaccine preventable diseases except Tetanus Toxiod (TT) 2 (54%) in 2013 to achieve herd immunity of the community to prevent transmission of disease pathogen to cause a disease. Community Health Practitioners are the frontline Primary Health Care Professionals charged with the responsibility of implementation of immunization programmes in Nigeria and therefore contributing significantly to the prevention and control of targeted vaccine preventable diseases in Nigeria Health System. Our findings on factors militating against Community Health Practitioners’ Roles in National Development as elicited in this paper may form basis for empirical studies to determine the level of significance of each of these factors. In conclusion, it is when the Community Health parameters are adequately addressed that we can ensure sustainable National Development and we can say we have succeeded in our various strategic agenda of government at whatever level that makes up the complex whole. This brings to fore, the importance of the roles of Community Health Practitioners in health care delivery to National Development in the context of our country, Nigeria.
文摘Health-related quality of life (HRQOL) has not been investigated among Iranian industrial workers. The present paper aimed to study the influence of the socio-demographic, health and work-related factors on HRQOL among Iranian industrial workers. In this cross-sectional study, participants were 280 workers of two factories. The Persian version of World Health Organization Quality of Life-Brief (WHOQOL-BREF) was used to assess the HRQOL. A questionnaire was developed to assess the socio-demographic, health and work-related factors. Results showed that the means (SD) of physical health, psychological health, social relationships, and environment domains of HRQOL were 13.2 (2.7), 13.3 (2.6), 14.2 (3.5) and 12.6 (2.5), respectively. A multiple linear regression showed that types of job, exercise activity, working schedule, sleep quality, smoking, and conflict between work and social life were significantly associated with physical health domain;whereas, working schedule, marital status, working demand, sleep quality, BMI, and conflict between work and individual life were significantly associated with psychological health domain. Working schedule, working demand, sleep quality, conflict between work and individual life, and having children over two years were significantly associated with social relationship domain;however, working demand, working schedule, smoking, sleep quality, working hour, job satisfaction, marital status and exercise activity were significantly associated with environment domain. Collectively, work-related factors including unhealthy working conditions, unsafe working environments, long working hours, irregular working schedules, and the lack of occupational training may negatively influence the HRQOL of workers. To improve workers’ HRQOL, intervention programs should focus on improving work environment, working schedule, occupational training and restricting working hours.
文摘Objective:To give a comprehensive and basic understanding of diabetes and its risk factors in floating people in China.Method:We use"(diabetes or type 2 diabetes or chronic disease)and(floating population or employed floating population)"as the key words to search in the China academic literature database(CNKI),Wan Fang database,PubMed and Web of Science for relevant literature and extract the data about the prevalence of diabetes,relevant risk factors and disease management of the floating population in China.Result:Twenty-one literatures are entered into analysis finally,one is English and the rest are Chinese.According to the national survey,the prevalence rate of diabetes in floating population in China was 5.1%(95%CI,4.9%-5.3%),which is lower than that of the general population(11.6%,95%CI,11.3%–11.8%),and is consistent with the results of the local surveys.The comparison result between the prevalence of floating population and that of local population in each region differs in local surveys.In addition,the prevalence of male floating population is lower than that of the female population.Finally,as the age of the population rises,so does the prevalence of diabetes.As for the risk factors of chronical diseases,the overweight rate in every region is similar but the obesity rate differs in different regions(Ningxia,26.0%;Xiangshan,14.0%),and the obesity rate of the floating population is less than half of that of the general people(4.7%,11.9%).The awareness rate,treatment rate and control rate in the floating patients differ in the regional researches,but they all can’t meet the goals set by the local health departments.Conclusion:Compared with the general population,the prevalence of diabetes in the floating population are lower.However,Considering the growing population number and the poor disease management of the floating patients,the potential threat brought by the diabetes in floating population is imponderable.The government should establish the national surveillance system of diabetes for the floating population,strengthen the construction of the primary medical institutions,and optimize the existing funding system.
文摘Background:Payment methods are known to influence maternal care delivery in health systems.Ghana suspended a piloted capitation provider payment system after nearly five years of implementation.This study aimed to examine the effects of Ghana’s capitation policy on maternal health care provision as part of lesson learning and bridging this critical literature gap.Methods:We used secondary data in the District Health Information Management System-2 and an interrupted time series design to assess changes in level and trend in the provision of ANC4_(+)(visits of pregnant women making at least the fourth antenatal care attendance per month),HB36(number of hemoglobin tests conducted for pregnant women who are at the 36th week of gestation)and vaginal delivery in capitated facilities-CHPS(Community-based Health Planning and Services)facilities and hospitals.Results:The results show that the capitation policy withdrawal was associated with a statistically significant trend increase in the provision of ANC4+in hospitals(coefficient 70.99 p<0.001)but no effect in CHPS facilities.Also,the policy withdrawal resulted in contrasting effects in hospitals and CHPS in the trend of provision of Hb36;a statistically significant decline was observed in CHPS(coefficient−7.01,p<0.05)while that of hospitals showed a statistically significant trend increase(coefficient 32.87,p<0.001).Finally,the policy withdrawal did not affect trends of vaginal delivery rates in both CHPS and hospitals.Conclusions:The capitation policy in Ghana appeared to have had a differential effect on the provision of maternal services in both CHPS and hospitals;repressing maternal care provision in hospitals and promoting adherence to anemia testing at term for pregnant women in CHPS facilities.Policy makers and stakeholders should consider the possible detrimental effects on maternal care provision and quality in the design and implementation of per capita primary care systems as they can potentially impact the achievement of SDG 3.
基金Supported by the Natural Science Foundation for the Higher Education Institutions of Anhui Province of China,No.2023AH050561,No.2022AH051143,No.KJ2021A0266,and No.KJ2021A1228School-level offline courses,No.2021xjkc13.
文摘BACKGROUND The association of single nucleotide polymorphism of KCNQ1 gene rs2237895 with type 2 diabetes mellitus(T2DM)is currently controversial.It is unknown whether this association can be gene realized across different populations.AIM To determine the association of KCNQ1 rs2237895 with T2DM and provide reliable evidence for genetic susceptibility to T2DM.METHODS We searched PubMed,Embase,Web of Science,Cochrane Library,Medline,about:blank Academic,China National Knowledge Infrastructure,China Biomedical Literature Database,and Wanfang to investigate the association between KCNQ1 gene rs2237895 and the risk of T2DM up to January 12,2022.Review Manager 5.4 was used to analyze the association of the KCNQ1 gene rs2237895 polymorphism with T2DM and to evaluate the publication bias of the selected literature.RESULTS Twelve case–control studies(including 11273 cases and 11654 controls)met our inclusion criteria.In the full population,allelic model[odds ratio(OR):1.19;95%confidence interval(95%CI):1.09–1.29;P<0.0001],recessive model(OR:1.20;95%CI:1.11–1.29;P<0.0001),dominant model(OR:1.27.95%CI:1.14–1.42;P<0.0001),and codominant model(OR:1.36;95%CI:1.15–1.60;P=0.0003)(OR:1.22;95%CI:1.10–1.36;P=0.0002)indicated that the KCNQ1 gene rs2237895 polymorphism was significantly correlated with susceptibility to T2DM.In stratified analysis,this association was confirmed in Asian populations:allelic model(OR:1.25;95%CI:1.13–1.37;P<0.0001),recessive model(OR:1.29;95%CI:1.11–1.49;P=0.0007),dominant model(OR:1.35;95%CI:1.20–1.52;P<0.0001),codominant model(OR:1.49;95%CI:1.22–1.81;P<0.0001)(OR:1.26;95%CI:1.16–1.36;P<0.0001).In non-Asian populations,this association was not significant:Allelic model(OR:1.06,95%CI:0.98–1.14;P=0.12),recessive model(OR:1.04;95%CI:0.75–1.42;P=0.83),dominant model(OR:1.06;95%CI:0.98–1.15;P=0.15),codominant model(OR:1.08;95%CI:0.82–1.42;P=0.60.OR:1.15;95%CI:0.95–1.39;P=0.14).CONCLUSION KCNQ1 gene rs2237895 was significantly associated with susceptibility to T2DM in an Asian population.Carriers of the C allele had a higher risk of T2DM.This association was not significant in non-Asian populations.
基金Supported by the National Natural Science Foundation of China,No.72374005Natural Science Foundation for the Higher Education Institutions of Anhui Province of China,No.2023AH050561Cultivation Programme for Young and Middle-aged Excellent Teachers in Anhui Province,No.YQZD2023021.
文摘BACKGROUND The risks associated with negative doctor-patient relationships have seriously hindered the healthy development of medical and healthcare and aroused wide-spread concern in society.The number of public comments on doctor-patient relationship risk events reflects the degree to which the public pays attention to such events.Thirty incidents of doctor-patient disputes were collected from Weibo and TikTok,and 3655 related comments were extracted.The number of comment sentiment words was extracted,and the comment sentiment value was calculated.The Kruskal-Wallis H test was used to compare differences between each variable group at different levels of incidence.Spearman’s correlation analysis was used to examine associations between variables.Regression analysis was used to explore factors influencing scores of comments on incidents.RESULTS The study results showed that public comments on media reports of doctor-patient disputes at all levels are mainly dominated by“good”and“disgust”emotional states.There was a significant difference in the comment scores and the number of partial emotion words between comments on varying levels of severity of doctor-patient disputes.The comment score was positively correlated with the number of emotion words related to positive,good,and happy)and negatively correlated with the number of emotion words related to negative,anger,disgust,fear,and sadness.CONCLUSION The number of emotion words related to negative,anger,disgust,fear,and sadness directly influences comment scores,and the severity of the incident level indirectly influences comment scores.
文摘This review summarizes research discoveries within 4 areas of exercise immunology that have received the most attention from investigators :(1) acute and chronic effects of exercise on the immune system,(2) clinical benefits of the exercise—immune relationship,(3) nutritional influen?ces on the immune response to exercise, and(4) the effect of exercise on immunosenescence. These scientific discoveries can be organized into distinctive time periods: 1900-1979, which focused on exercise-induced changes in basic immune cell counts and function; 1980-1989, during which seminal papers were published with evidence that heavy exertion was associated with transient immune dysfunction, elevated inflammatory biomarkers,and increased risk of upper respiratory tract infections; 1990-2009, when additional focus areas were added to the field of exercise immunology including the interactive effect of nutrition, effects on the aging immune system, and inflammatory cytokines; and 2010 to the present, when technological advances in mass spectrometry allowed system biology approaches(i.e., metabolomics, proteomics, lipidomics, and microbiome characterization) to be applied to exercise immunology studies. The future of exercise irmmunology will take advantage of these technologies to provide new insights on the interactions between exercise, nutrition, and immune function, with application down to the person?alized level. Additionally, these methodologies will improve mechanistic understanding of how exercise-induced immune perturbations reduce the risk of common chronic diseases.
基金Supported by Chi-Mei Medical Center Grant,No.CMFHR10252
文摘AIM:To investigate the possible mechanism of how glucose promotes invasion and metastasis of colon cancer cells.METHODS:CT-26 rat colorectal cancer cells were cultured in different concentrations of glucose environments(10,20,and 30 mmol/L).Wound healing assay and transwell chamber invasion assay were utilized to test the migration and invasion,respectively.In order to understand the role of signal transducer and activator of transcription 3(STAT3)in the process,STAT3 inhibitors,including Stattic(an STAT3 specific inhibitor)and small interfering RNA targeting STAT3,were used to block STAT3 function to evaluate their impact on CT-26 cell motion.To verify whether STAT3 and matrix metalloproteinase-9(MMP-9)protein expression is associated with glucose-induced cell movement,Western blot was used to compare the differences in the expression of MMP-9 and STAT3 in cells incubated with and without STAT3 inhibitors in high glucose condition.RESULTS:In both wound healing and invasion assays,the migration and invasion of CT-26 cells increased gradually with the increase in glucose concentration.However,the glucose-induced migration and invasion were obviously inhibited by STAT3 inhibitors(P<0.05).Similarly,in Western blot assessment,both MMP-9and STAT3 expression increased under a high glucose environment and the highest expression was achieved when 30 mmol/L glucose was used.However,in cells treated with 30 mmol/L mannitol,either MMP-9 or STAT3expression did not increase(P>0.05).When STAT3inhibitors were added in the 30 m M glucose group,not only STAT3 but also MMP-9 expression decreased significantly(P<0.05).CONCLUSION:Our study provides evidence that glucose can promote both migration and invasion of CT-26 cells,and that the STAT3-induced MMP-9 signal pathway is involved in this process.
基金Supported by Kaohsiung Municipal Min-Seng Hospital(KMSH 9702)
文摘AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.
基金Supported by the In-Hospital Research Project Funding of Kaohsiung Veterans General Hospital,No.VGHKS107-040
文摘BACKGROUND Barrett’s esophagus(BE)is a pre-malignant condition associated with the development of esophageal adenocarcinoma.The prevalence of BE in the general populations of Asian countries ranges from 0.06%to 1%.However,with lifestyle changes in Asian countries and adoption of western customs,the prevalence of BE might have increased.AIM To determine the current prevalence of BE in Taiwan,and to investigate risk factors predicting the presence of BE.METHODS This retrospective study was conducted at the Health Evaluation Center of Kaohsiung Veterans General Hospital in Taiwan.Between January 2015 and December 2015,3385 subjects undergoing routine esophagogastroduodenoscopy examinations as part of a health check-up at the Health Evaluation Center were included.Patient characteristics and endoscopic findings were carefully reviewed.Lesions with endoscopic findings consistent with BE awaiting histological evaluation were judged as endoscopically suspected esophageal metaplasia(ESEM).BE was defined based on extension of the columnar epithelium≥1 cm above the gastroesophageal junction and was confirmed based on the presence of specialized intestinal metaplasia(IM)in the metaplastic esophageal epithelium.Clinical factors of subjects with BE and subjects without BE were compared,and the risk factors predicting BE were analyzed.RESULTS A total of 3385 subjects(mean age,51.29±11.42 years;57.1%male)were included in the study,and 89 among them were confirmed to have IM and presence of goblet cells via biopsy examination.The majority of these individuals were classified as short segment BE(n=85).The overall prevalence of BE was 2.6%.Multivariate analysis disclosed that old age[odds ratio(OR)=1.033;95%confidence interval(CI):1.012-1.055;P=0.002],male gender(OR=2.106;95%CI:1.145-3.872;P=0.017),ingestion of tea(OR=1.695;95%CI:1.043-2.754;P=0.033),and presence of hiatal hernia(OR=3.037;95%CI:1.765-5.225;P<0.001)were significant risk factors predicting BE.The independent risk factor for the presence of IM in ESEM lesions was old age alone(OR=1.029;95%CI:1.006-1.053;P=0.014).CONCLUSION Current prevalence of BE among the general population in Taiwan is 2.6%.Old age,male gender,ingestion of tea and hiatal hernia are significant risk factors for BE.
基金Supported by The Cheng-Hsin General Hospital and National Yang-Ming University
文摘AIM:To investigate the prevalence of gallstone dis-ease(GSD) and to evaluate the risk of symptomatic GSD among diabetic patients.METHODS:The study was conducted by analyzing the National Health Research Institutes(NHRI) dataset of ambulatory care patients,inpatient claims,and the updated registry of beneficiaries from 2000 to 2008.A total of 615 532 diabetic patients without a prior history of hospital treatment or ambulatory care visits for symptomatic GSD were identified in the year 2000.Age-and gender-matched control individuals free from both GSD and diabetes from 1997 to 1999 were randomly selected from the NHIR database(n = 614 871).The incidence densities of symptomatic GSD were estimated according to the subjects' diabetic status.The distributions of age,gender,occupation,income,and residential area urbanization were compared between diabetic patients and control subjects using Cox proportion hazards models.Differences between the rates of selected comorbidities were also assessed in the two groups.RESULTS:Overall,60 734 diabetic patients and 48 116 control patients developed symptomatic GSD and underwent operations,resulting in cumulative operation rates of 9.87% and 7.83%,respectively.The age and gender distributions of both groups were similar,with a mean age of 60 years and a predominance of females.The diabetic group had a significantly higher prevalence of all comorbidities of interest.A higher incidence of symptomatic GSD was observed in females than in males in both groups.In the control group,females under the age of 64 had a significantly higher incidence of GSD than the corresponding males,but this difference was reduced with increasing age.The cumulative incidences of operations for symptomatic GSD in the diabetic and control groups were 13.06 and 9.52 cases per 1000 person-years,respectively.Diabetic men exhibited a higher incidence of operations for symptomatic GSD than did their counterparts in the control group(12.35 vs 8.75 cases per 1000 person-years).CONCLUSION:The association of diabetes with increased symptomatic GSD may provide insight to the treatment or management of diabetes in clinical settings.
文摘AIM: To evaluate the efficacy of vitamin E treatment on liver stiffness in nonalcoholic fatty liver disease(NAFLD).METHODS: Thirty-eight NAFLD patients were administered vitamin E for > 1 year. The doses of vitamin E were 150, 300, or 600 mg; three times per day after each meal. Responses were assessed by liver enzyme levels [aspartate aminotransferase(AST), alanine aminotranferease(ALT), and γ-glutamyl transpeptidase(γ-GTP)], noninvasive scoring systems of hepatic fibrosis-4 [FIB-4 index and aspartate aminotransferaseto-platelet index(APRI)], and liver stiffness [velocity of shear wave(Vs)] measured by acoustic radiation force impulse elastography. Vs measurements were performed at baseline and 12 mo after baseline. The patients were genotyped for the patatin-like phospholipase domain containing 3(PNPLA3) polymorphisms and then divided into either the CC/CG or GG group to examine each group's responses to vitamin E treatment. RESULTS: We found marked differences in the platelet count, serum albumin levels, alkaline phosphatase levels, FIB-4 index, APRI, and Vs at baseline depending on the PNPLA3 polymorphism. AST, ALT, and γ-GTP levels(all P < 0.001); FIB-4 index(P = 0.035); APRI(P < 0.001); and Vs(P < 0.001) significantly decreased from baseline to 12 mo in the analysis of all patients. In the subset analyses of PNPLA3 genotypes, AST levels(P = 0.011), ALT levels(P < 0.001), γ-GTP levels(P = 0.005), APRI(P = 0.036), and Vs(P = 0.029) in genotype GG patients significantly improved, and AST and ALT levels(both P < 0.001), γ-GTP levels(P = 0.003), FIB-4 index(P = 0.017), and APRI(P < 0.001) in genotype CC/CG patients. CONCLUSION: One year of vitamin E treatment improved noninvasive fibrosis scores and liver stiffness in NAFLD patients. The responses were similar between different PNPLA3 genotypes.
文摘Introduction: Hospital infections prolong patient hospitalization, necessitate additional treatment, increase mortality rate, raise hospital expenses, and even reduce the level of health in the society. The purpose of this research was to study hospital infections in selected hospitals of Qazvin. Methods and Materials: This was an analytic-cross-sectional study. The research population consisted of 25,628 hospitalized patients in the first eight months of 2012 in three selected hospitals of the Qazvin Province. The algorithm of reporting hospital infections, the National Program of Controlling Hospital Infections, and 223 patient files hospitalized due to hospital-acquired infections were used to collect information. The collected information was analyzed using the SPSS V. 17 software;the descriptive statistics was used to analyze the qualitative variables;and the descriptive statistics together with chi-square and t-test were employed for the quantitative variables. Results: The ICU units had the most cases of hospital infections. Respiratory pneumonia and urinary infections topped the list of hospital infections. The most invasive treatments carried out on patients with hospital infections were surgery, urinary catheter, and venous catheter, respectively. More than 50 percent of patients with hospital infections were hospitalized for 2 to 21 days. Results and Conclusions: Because of the high rate of hospital infections, especially in the ICU ward, authorities must give top priority in their plans to designing suitable educational programs to inform hospital staff and patients of hospital infections and to provide suitable resources for dealing with this problem.
文摘Patient satisfaction with hospital services is one of the most important indicators of effectiveness and quality of hospital services. Patient satisfaction surveys can provide valuable data for evaluating the current status, awareness of quality and quantity of process improvement programs and quality improvement to health managers and policy makers. The present study discusses previous studies conducted in this area, and presents recommendations to improve patient satisfaction. The method of this study is review. Selected papers were identified by searching keyword in Persian and English in different databases and after applying the inclusion criteria, 19 studies were extracted and analyzed. 23,793 patients in 12 studies entered into this research were investigated. Generally, satisfaction of the patients in this study was estimated at an average level. Continuous evaluation of patient satisfaction and identification of the factors affecting it requires establishment of comprehensive and accurate data system in this area;that by application of the results of previous studies steps can be taken to improve patient satisfaction. Patients’ satisfaction in Iran, compared with other countries, is desirable. In addition, the overall satisfaction of patients in recent years has increased compared to previous years and the reason can be measures like different ways of improving the quality, customer orientation, and applying the results of research conducted in this area.
文摘The purpose of this study was to identify the relationships among disposition toward critical thinking, learning styles, and caring behaviors in student nurses enrolled in three 5-year junior nursing colleges in Southern Taiwan. Methods: This cross-sectional study used a convenience sample that comprised 777 nursing students from two cities. The data were obtained through the Critical Thinking Disposition Inventory, Chinese Version (CTDI-CV), Index of Learning Styles (ILS), and the Caring Behavior Scale (CBS). The sample ranged in age from 16 to 22 years (M = 18.21). Results: Students scored highest on the inquisitiveness subscale and lowest on the truth-seeking subscale. Additionally, some dimensions of disposition toward critical thinking differed significantly by learning style. There was a positive relationship between overall critical thinking dispositions and caring behaviors (r = 0.23, p < 0.01). Finally, dimensions of caring behavior, with the exception of the maturity dimension, were significantly positively related to most dimensions of the disposition toward critical thinking (p < 0.05). Conclusion: The findings indicate that not only is learning style related to critical thinking disposition but also to caring behaviors. However, the cause of these relationships warrants further study.
