AIM： To investigate the knowledge, attitude and practice （KAP） in prevention and control of liver fluke infection in northeast Thailand. METHODS： A descriptive KAP survey pertaining to liver fluke infection was ca...AIM： To investigate the knowledge, attitude and practice （KAP） in prevention and control of liver fluke infection in northeast Thailand. METHODS： A descriptive KAP survey pertaining to liver fluke infection was carried out in June 2005 to October 2006 using structured questionnaires. Data were collected by questionnaires consisting of general parameters, knowledge, attitude, practice, and a history of participation in the prevention and control of liver fluke infection. RESULTS： A total of 1077 persons who were interviewed and completed the questionnaires were enrolled in the study. The majority were females （69.5%） and many of them were 15-20 years of age （37.26%）. The questionnaires revealed that information resources on liver fluke infection included local public health volunteers （31.37%）, public health officers （18.72%）, televisions （14.38%）, local heads of sub-districts （12.31%）, doctors and nurses （9.18%）, newspaper （5.72）, intemets （5.37%）, and others （12.95%）. Fiftyfive point eleven percent of the population had a good level of liver fluke knowledge concerning the mode of disease transmission and 79.72% of the population had a good level of prevention and control knowledge with regards to defecation and consumption. The attitude and practice in liver fluke prevention and control were also at a good level with a positive awareness, participation, and satisfaction of 72.1% and 60.83% of the persons studied. However, good health behavior was found in 39.26% and 41.42% of the persons studied who had unhygienic defecation and ate raw cyprinoid＇s fish. The result also showed that 41.25% of the persons studied previously joined prevention and control campaigns. CONCLUSION： The persons studied have a high level of liver fluke knowledge and positive attitude. However, improvement is required regarding personal hygiene specifically with hygienic defecation and consumption of undercooked fish.展开更多
Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medlin...Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medline,Embase,the Cochrane Library,and clinicaltrials.gov(www.clinicaltrials.gov)were searched for randomized controlled trials(RCTs).Standard pairwise meta-analysis and network meta-analysis(NMA)were both carried out.The risk of bias(ROB)tool recommended by the Cochrane handbook was used to assess the quality of studies.Subgroup analysis,sensitivity analysis,meta-regression,and quality evaluation based on the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)were also performed.Results A total of 292 trials were included in this study.Compared with placebo,dipeptidyl-peptidase IV inhibitors(DPP-4 Is)increased weight slightly by 0.31 kg[95%confidence interval(CI):0.05,0.58]and had negligible effects on BMI and WC.Compared with placebo,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)lowered weight,BMI,and WC by-1.34 kg(95%CI:-1.60,-1.09),-1.10 kg/m2(95%CI:-1.42,-0.78),and-1.28 cm(95%CI:-1.69,-0.86),respectively.Conclusion GLP-1 RAs were more effective than DPP-4 Is in lowering the three indicators.Overall,the effects of GLP-1 RAs on weight,BMI,and WC were favorable.展开更多
An important problem in management of the case with myasthenia gravis (MG) is the control of exacerbation. There are several possible causes of exacerbation of MG including the use of drug. Here, the authors report a ...An important problem in management of the case with myasthenia gravis (MG) is the control of exacerbation. There are several possible causes of exacerbation of MG including the use of drug. Here, the authors report a case of MG exacerbation and diarrhea associated with erythromycin treatment.展开更多
AIM: To investigate the quality of life following lapa-roscopic Nissen fundoplication by assessing short-term and long-term outcomes. METHODS: From 1992 to 2005, 249 patients under-went laparoscopic Nissen fundoplicat...AIM: To investigate the quality of life following lapa-roscopic Nissen fundoplication by assessing short-term and long-term outcomes. METHODS: From 1992 to 2005, 249 patients under-went laparoscopic Nissen fundoplication. Short-term outcome data including symptom response, side effects of surgery, endoscopy, and patient's perception of over-all success were collected prospectively. Long-term out-comes were investigated retrospectively in patients witha median follow-up of 10 years by assessment of reflux symptoms, side effects of surgery, durability of antire-flux surgery, need for additional treatment, patient's perception of success, and quality of life. Antireflux sur-gery was considered a failure based on the following criteria: moderate to severe heartburn or regurgitation; moderate to severe dysphagia reported in combination with heartburn or regurgitation; regular proton pump inhibitor medication use; endoscopic evidence of erosive esophagitis Savary-Miller grade 1-4; pathological 24-h pH monitoring; or necessity to undergo an additional surgery. The main outcome measures were short-and long-term cure rates and quality of life, with patient sat-isfaction as a secondary outcome measure. RESULTS: Conversion from laparoscopy to open sur-gery was necessary in 2.4% of patients. Mortality was zero and the 30-d morbidity was 7.6% (95%CI: 4.7%-11.7%). The median postoperative hospital stay was 2 d [interquartile range (IQR) 2-3 d]. Two hundred and forty-seven patients were interviewed for short-term analysis following endoscopy. Gastro-esophageal reflux disease was cured in 98.4% (95%CI: 95.9%-99.6%) of patients three months after surgery. New-onset dysphagia was encountered postoperatively in 13 patients (6.7%); 95% reported that the outcome was better after antireflux surgery than with preopera-tive medical treatment. One hundred and thirty-nine patients with a median follow-up of 10.2 years (IQR 7.2-11.6 years) were available for a long-term evalu-ation. Cumulative long-term cure rates were 87.7% (81.0%-92.2%) at 5 years and 72.9% (64.0%-79.9%) at 10 years. Gastrointestinal symptom rating scores and RAND-36 quality of life scores of patients with treatment success were similar to those of the general population but significantly lower in those with failed antireflux surgery. Of the patients available for long-term follow-up, 83% rated their operation a success. CONCLUSION: For the long-term, our results indicate decreasing effectiveness of laparoscopic antirefluxsurgery, although most of the patients seem to have an overall quality of life similar to that of the general population.展开更多
Trichinosis is one of the most common food-borne para-sitic zoonoses in Thailand and many outbreaks are re-ported each year. This paper reviews the history, species, and epidemiology of the disease and food habits of ...Trichinosis is one of the most common food-borne para-sitic zoonoses in Thailand and many outbreaks are re-ported each year. This paper reviews the history, species, and epidemiology of the disease and food habits of the people with an emphasis on the north, northeast, cen-tral and south regions of Thailand. The earliest record of trichinosis in Thailand was in 1962 in the Mae Sariang District, Mae Hong Son Province. Since then, about 130 outbreaks have been reported involving 7392 patients and 97 deaths (1962-2005). The highest number of cas-es, 557, was recorded in 1983. The annual epidemiologi-cal surveillance reports of the Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand, show that trichinosis cases increased from 61 in 1997 to 351 in 1998. In contrast to these figures, the number of reported cases decreased to 16 in 1999 and 128 cases in 2000. There was no record of trichinosis in 2001, but then the figures for 2002, 2003 and 2004 were 289, 126 and 212 respectively. The infected pa-tients were mostly in the 35-44 years age group and the disease occurred more frequently in men than women at a ratio of 1.7-2.0:1. There were 84 reported cases of trichinosis in Chiang Rai, Nan, Chiang Mai, Si Sa ket, Nakhon Phanom, Kalasin, Nakhon Ratchasima, Nakhon Nayok, Nakhon Pathom and Surat Thani, provinces locat-ed in different parts of Thailand in 2005. The outbreaks were more common in the northern areas, especially in rural areas where people ate raw or under-cooked pork and/or wild animals. This indicates the need for health education programs to prevent and control trichinosis as soon as possible in the high-risk areas.展开更多
To understand the infection process, the viral multiplication and entry to the cell is widely studied. The Ebola virus nucleoprotein is the important problem for the pathological process. Focusing on the specific biol...To understand the infection process, the viral multiplication and entry to the cell is widely studied. The Ebola virus nucleoprotein is the important problem for the pathological process. Focusing on the specific biological process, the post translational modification is needed. Here, the authors used the bioinformatics study to find the phosphorylation sites within the Ebola virus nucleoprotein and could identify many new sites.展开更多
The new challenges that the phenomenon of demographic aging imposes on society in general, and health services in particular, can impact active and healthy aging. The project was implemented for two years （2012/2013...The new challenges that the phenomenon of demographic aging imposes on society in general, and health services in particular, can impact active and healthy aging. The project was implemented for two years （2012/2013） and aimed to combat loneliness in the elderly, which constitutes an obstacle to healthy and active aging. Decrease the sense of loneliness of individuals from 65 to 84 years of age, the project was made by using the health planning methodology, starting with a descriptive study （health diagnosis of the independent elderly population） followed by the development, implementation and evaluation of a community intervention project, which included home visits to the elderly, assessment of the level of loneliness in two different times （UCLA scale） and various intergenerational activities of social life （dancing, walking, online courses, games...） using a cross-section of partnerships and community involvement. There was a decrease from 62.8% to 41.9% in the reported overall feeling of loneliness of independent individuals between the ages of 65 and 84 years of age. There was an increase from 50.0% to 86.4% of seniors who now have dreams/life projects. The reduction of social and emotional isolation resulted in the promotion of social networks, which not only encouraged social interaction but also considered the elderly who live alone. The health gains arising from it are evidenced in contributing more proactively and the improvement of the quality of life in the elderly community.展开更多
Aim: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary car...Aim: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary care. Material and methods: A random sample of patients answered a disease-specific and a quality-of-life (MiniAQLQ) questionnaire. Results: The 146 adolescents in paediatric care had more years with asthma, better continuity of annual surveillance, higher use of inhaled steroids and a stated better knowledge of their asthma than the 174 patients in primary care. No difference could be detected in asthma control or quality of life. Of all 320 adolescents, approximately 20%had woken at night due to asthma symptoms during the last week. About 15%hadmade unscheduled, urgent care visits and a third had used short-acting beta-agonist relievers more than twice a week. Quality-of-life scores were high and similar in both settings. Conclusions: Swedish adolescents with asthma are managed and treated somewhat differently in paediatric and primary care but with equal and, for the most part, satisfying results. The difference between the two settings probably reflects both differences in severity of asthma and different treatment traditions. For all adolescents, better ful-filment of goals regarding symptoms and exacerbations would be desirable, whereas a good quality of life including normal physical activity seems to have been achieved.展开更多
Objective:The incidence and mortality of hepatocellular carcinoma(HCC)have been increasing around the world.Current guidelines recommend HCC screening in high-risk population.However,the strength of evidence of ben-ef...Objective:The incidence and mortality of hepatocellular carcinoma(HCC)have been increasing around the world.Current guidelines recommend HCC screening in high-risk population.However,the strength of evidence of ben-efits and harms of HCC screening to support the recommendation was unclear.The objective is to systematically synthesize current evidence on the benefits and harms of HCC screening.Methods:We searched PubMed and nine other databases until August 20,2021.We included cohort studies and RCTs that compared the benefits and harms of screening and non-screening in high-risk population of HCC.Case series studies that reported harms of HCC screening were also included.Pooled risk ratio(RR),according to HCC screening status,was calculated for each benefit outcome(e.g.,HCC mortality,survival rate,proportion of early HCC),using head-to-head meta-analysis.The harmful outcomes(e.g.,proportion of physiological harms provided by non-comparative studies were pooled by prevalence of meta-analysis).Analysis on publication bias and quality of life,subgroup analysis,and sensitivity analysis were also conducted.Results:We included 70 studies,including four random clinical trials(RCTs),63 cohort studies,three case se-ries studies.The meta-analysis of RCTs showed HCC screening was significantly associated with reduced HCC mortality(RR[risk ratio],0.73[95%CI,0.56-0.96];I^(2)=75.1%),prolonged overall survival rates(1-year,RR,1.72[95%CI,1.13-2.61];I^(2)=72.5%;3-year,RR,2.86[95%CI,1.78-4.58];I^(2)=10.1%;and 5-year,RR,2.76[95%CI,1.37-5.54];I^(2)=28.3%),increased proportion of early HCC detection(RR,2.68[95%CI,1.77-4.06];I^(2)=50.4%).Similarly,meta-analysis of cohort studies indicated HCC screening was more effective than non-screening.However,pooled proportion of physiological harms was 16.30%(95%CI:8.92%-23.67%)and most harms were of a mild to moderate severity.Conclusion:The existing evidence suggests HCC screening is more effective than non-screening in high-risk pop-ulation.However,harms of screening should not be ignored.展开更多
Due to globalization, there is a need for nurses with skills and competence in providing safe, competent and culturally appropriate care. The aim of the study was to investigate whether International Study Experiences...Due to globalization, there is a need for nurses with skills and competence in providing safe, competent and culturally appropriate care. The aim of the study was to investigate whether International Study Experiences (ISE) in other countries during basic nursing education had an impact on newly graduated nurses as regards to self-reported competence. Moreover, a second aim was to explore what background factors that facilitated or constituted a hindrance for nursing students to choose to conduct part of their basic nursing education abroad. At 11 Universities/University Colleges (henceforth called Higher Education Institutions [HEIs]) in Sweden, 565 nursing students responded to the Nurse Professional Competence (NPC) Scale. Students with ISE rated their competence significantly higher on three NPC competence areas—“Legislation in nursing and safety planning”, “Leadership and development of nursing” and “Education and supervision of staff/students”. Background factors that significantly seemed to enhance ISE were living alone, not having children or other commitments in relation to family, international focus at the HEI and previous international experience. Lack of financial means was reported to prevent students from choosing ISE. The study implies that several background factors are of importance whether students choose ISE or not. ISE during basic nursing education might result in better self-reported competence in leading and developing nursing care, including education of future nurses, and in providing safe care.展开更多
Objectives Dizziness is a common and challenging clinical presentation in general practice.Failure to determine specific aetiologies can lead to significant morbidity and mortality.We aimed to establish frequency and ...Objectives Dizziness is a common and challenging clinical presentation in general practice.Failure to determine specific aetiologies can lead to significant morbidity and mortality.We aimed to establish frequency and associations of general practitioner(GP)trainees’(registrars’)specific vertigo provisional diagnoses and their non-specific symptomatic problem formulations.Design A cross-sectional analysis of Registrar Clinical Encounters in Training(ReCEnT)cohort study data between 2010 and 2018.ReCEnT is an ongoing,prospective cohort study of registrars in general practice training in Australia.Data collection occurs once every 6 months midtraining term(for three terms)and entails recording details of 60 consecutive clinical consultations on hardcopy case report forms.The outcome factor was whether dizziness-related or vertigo-related presentations resulted in a specific vertigo provisional diagnosis versus a non-specific symptomatic problem formulation.Associations with patient,practice,registrar and consultation independent variables were assessed by univariate and multivariable logistic regression.Setting Australian general practice training programme.The training is regionalised and delivered by regional training providers(RTPs)(2010-2015)and regional training organisations(RTOs)(2016-2018)across Australia(from five states and one territory).Participants All general practice registrars enrolled with participating RTPs or RTOs undertaking GP training terms.Results 2333 registrars(96%response rate)recorded 1734 new problems related to dizziness or vertigo.Of these,546(31.5%)involved a specific vertigo diagnosis and 1188(68.5%)a non-specific symptom diagnosis.Variables associated with a non-specific symptom diagnosis on multivariable analysis were lower socioeconomic status of the practice location(OR 0.94 for each decile of disadvantage,95%CIs 0.90 to 0.98)and longer consultation duration(OR 1.02,95%CIs 1.00 to 1.04).A specific vertigo diagnosis was associated with performing a procedure(OR 0.52,95%CIs 0.27 to 1.00),with some evidence for seeking information from a supervisor being associated with a non-specific symptom diagnosis(OR 1.39,95%CIs 0.92 to 2.09;p=0.12).Conclusions Australian GP registrars see dizzy patients as frequently as established GPs.The frequency and associations of a non-specific diagnosis are consistent with the acknowledged difficulty of making diagnoses in vertigo/dizziness presentations.Continuing emphasis on this area in GP training and encouragement of supervisor involvement in registrars’diagnostic processes is indicated.展开更多
Background Schistosomiasis is highly endemic in sub-Saharan Africa and frequently imported to Europe.Male urogenital manifestations are often neglected.We aimed to ascertain the prevalence of genitourinary clinical si...Background Schistosomiasis is highly endemic in sub-Saharan Africa and frequently imported to Europe.Male urogenital manifestations are often neglected.We aimed to ascertain the prevalence of genitourinary clinical signs and symptoms among long-term African migrants in a non-endemic European country using a serology test.Methods We carried out a prospective,community-based cross-sectional study of adult male migrants from sub-Saharan Africa living in Spain.Schistosoma serology tests and microscopic urine examinations were carried out,and clinical data were obtained from an electronic medical record search and a structured questionnaire.Results We included 388 adult males,mean age 43.5 years[Standard Deviation(SD)=12.0,range:18-76].The median time since migration to the European Union was 17[Interquartile range(IQR):11-21]years.The most frequent country of origin was Senegal(N=179,46.1%).Of the 338,147(37.6%)tested positive for Schistosoma.Parasite eggs were present in the urine of only 1.3%.Nine genitourinary clinical items were significantly associated with positive Schistosoma serology results:pelvic pain(45.2%;OR=1.57,95%CI:1.0-2.4),pain on ejaculation(14.5%;OR=1.85,95%CI:1.0-3.5),dyspareunia(12.4%;OR=2.45,95%CI:1.2-5.2),erectile dysfunction(9.5%;OR=3.10,95%CI:1.3-7.6),self-reported episodes of infertility(32.1%;OR=1.69,95%CI:1.0-2.8),haematuria(55.2%;OR=2.37,95%CI:1.5-3.6),dysuria(52.1%;OR=2.01,95%CI:1.3-3.1),undiagnosed syndromic STIs(5.4%),and orchitis(20.7%;OR=1.81,95%CI:1.0-3.1).Clinical signs tended to cluster.Conclusions Urogenital clinical signs and symptoms are prevalent among male African long-term migrants with a positive Schistosoma serology results.Genital involvement can be frequent even among those with long periods of non-residence in their sub-Saharan African countries of origin.Further research is needed to develop diagnostic tools and validate therapeutic approaches to chronic schistosomiasis.展开更多
Background:The global pandemic coronavirus disease 2019(COVID-19)has become a major public health problem and presents an unprecedented challenge.However,no specific drugs were currently proven.This study aimed to eva...Background:The global pandemic coronavirus disease 2019(COVID-19)has become a major public health problem and presents an unprecedented challenge.However,no specific drugs were currently proven.This study aimed to evaluate the comparative efficacy and safety of pharmacological interventions in patients with COVID-19.Methods:Medline,Embase,the Cochrane Library,and clinicaltrials.gov were searched for randomized controlled trials(RCTs)in patients infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)/SARS-CoV.Random-effects network metaanalysis within the Bayesian framework was performed,followed by the Grading of Recommendations Assessment,Development,and Evaluation system assessing the quality of evidence.The primary outcome of interest includes mortality,cure,viral negative conversion,and overall adverse events(OAEs).Odds ratio(OR)with 95%confidence interval(CI)was calculated as the measure of effect size.Results:Sixty-six RCTs with 19,095 patients were included,involving standard of care(SOC),eight different antiviral agents,six different antibiotics,high and low dose chloroquine(CQ_HD,CQ_LD),traditional Chinese medicine(TCM),corticosteroids(COR),and other treatments.Compared with SOC,a significant reduction of mortality was observed for TCM(OR=0.34,95%CI:0.20–0.56,moderate quality)and COR(OR=0.84,95%CI:0.75–0.96,low quality)with improved cure rate(OR=2.16,95%CI:1.60–2.91,low quality for TCM;OR=1.17,95%CI:1.05–1.30,low quality for COR).However,an increased risk of mortality was found for CQ_HD vs.SOC(OR=3.20,95%CI:1.18–8.73,low quality).TCM was associated with decreased risk of OAE(OR=0.52,95%CI:0.38–0.70,very low quality)but CQ_HD(OR=2.51,95%CI:1.20–5.24)and interferons(IFN)(OR=2.69,95%CI:1.02–7.08)vs.SOC with very low quality were associated with an increased risk.Conclusions:COR and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care.CQ_HD might increase the risk of mortality.CQ,IFN,and other antiviral agents could increase the risk of OAEs.The current evidence is generally uncertain with low-quality and further high-quality trials are needed.展开更多
普遍认为,医患共同决策(shared decision-making,SDM)是优质医疗的核心特征。英国国家健康体系(National Health Services,NHS)章程的第四条规定“在适宜情况下,患者、家属及其照护者应参与并咨询所有有关照护和治疗决策的讨论及制订过...普遍认为,医患共同决策(shared decision-making,SDM)是优质医疗的核心特征。英国国家健康体系(National Health Services,NHS)章程的第四条规定“在适宜情况下,患者、家属及其照护者应参与并咨询所有有关照护和治疗决策的讨论及制订过程。”大多数NHS从业人员和专员承认,在实践中这种参与和咨询并不常见,因此,要求英国国家健康与临床优选研究所(NICE)提供有关促进医患共同决策的指南并将其融入日常实践。展开更多
基金Supported by the Department of Research, College of Medicine and Public Healththe Division of Research Promotion, Ubon Rajathanee University, Thailand
文摘AIM： To investigate the knowledge, attitude and practice （KAP） in prevention and control of liver fluke infection in northeast Thailand. METHODS： A descriptive KAP survey pertaining to liver fluke infection was carried out in June 2005 to October 2006 using structured questionnaires. Data were collected by questionnaires consisting of general parameters, knowledge, attitude, practice, and a history of participation in the prevention and control of liver fluke infection. RESULTS： A total of 1077 persons who were interviewed and completed the questionnaires were enrolled in the study. The majority were females （69.5%） and many of them were 15-20 years of age （37.26%）. The questionnaires revealed that information resources on liver fluke infection included local public health volunteers （31.37%）, public health officers （18.72%）, televisions （14.38%）, local heads of sub-districts （12.31%）, doctors and nurses （9.18%）, newspaper （5.72）, intemets （5.37%）, and others （12.95%）. Fiftyfive point eleven percent of the population had a good level of liver fluke knowledge concerning the mode of disease transmission and 79.72% of the population had a good level of prevention and control knowledge with regards to defecation and consumption. The attitude and practice in liver fluke prevention and control were also at a good level with a positive awareness, participation, and satisfaction of 72.1% and 60.83% of the persons studied. However, good health behavior was found in 39.26% and 41.42% of the persons studied who had unhygienic defecation and ate raw cyprinoid＇s fish. The result also showed that 41.25% of the persons studied previously joined prevention and control campaigns. CONCLUSION： The persons studied have a high level of liver fluke knowledge and positive attitude. However, improvement is required regarding personal hygiene specifically with hygienic defecation and consumption of undercooked fish.
基金supported by the National Natural Science Foundation of China[No.81302508,71673003,81473067,and 91646107].
文摘Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medline,Embase,the Cochrane Library,and clinicaltrials.gov(www.clinicaltrials.gov)were searched for randomized controlled trials(RCTs).Standard pairwise meta-analysis and network meta-analysis(NMA)were both carried out.The risk of bias(ROB)tool recommended by the Cochrane handbook was used to assess the quality of studies.Subgroup analysis,sensitivity analysis,meta-regression,and quality evaluation based on the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)were also performed.Results A total of 292 trials were included in this study.Compared with placebo,dipeptidyl-peptidase IV inhibitors(DPP-4 Is)increased weight slightly by 0.31 kg[95%confidence interval(CI):0.05,0.58]and had negligible effects on BMI and WC.Compared with placebo,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)lowered weight,BMI,and WC by-1.34 kg(95%CI:-1.60,-1.09),-1.10 kg/m2(95%CI:-1.42,-0.78),and-1.28 cm(95%CI:-1.69,-0.86),respectively.Conclusion GLP-1 RAs were more effective than DPP-4 Is in lowering the three indicators.Overall,the effects of GLP-1 RAs on weight,BMI,and WC were favorable.
文摘An important problem in management of the case with myasthenia gravis (MG) is the control of exacerbation. There are several possible causes of exacerbation of MG including the use of drug. Here, the authors report a case of MG exacerbation and diarrhea associated with erythromycin treatment.
基金Supported by EVO-funding of the Central Hospital of Central Finland
文摘AIM: To investigate the quality of life following lapa-roscopic Nissen fundoplication by assessing short-term and long-term outcomes. METHODS: From 1992 to 2005, 249 patients under-went laparoscopic Nissen fundoplication. Short-term outcome data including symptom response, side effects of surgery, endoscopy, and patient's perception of over-all success were collected prospectively. Long-term out-comes were investigated retrospectively in patients witha median follow-up of 10 years by assessment of reflux symptoms, side effects of surgery, durability of antire-flux surgery, need for additional treatment, patient's perception of success, and quality of life. Antireflux sur-gery was considered a failure based on the following criteria: moderate to severe heartburn or regurgitation; moderate to severe dysphagia reported in combination with heartburn or regurgitation; regular proton pump inhibitor medication use; endoscopic evidence of erosive esophagitis Savary-Miller grade 1-4; pathological 24-h pH monitoring; or necessity to undergo an additional surgery. The main outcome measures were short-and long-term cure rates and quality of life, with patient sat-isfaction as a secondary outcome measure. RESULTS: Conversion from laparoscopy to open sur-gery was necessary in 2.4% of patients. Mortality was zero and the 30-d morbidity was 7.6% (95%CI: 4.7%-11.7%). The median postoperative hospital stay was 2 d [interquartile range (IQR) 2-3 d]. Two hundred and forty-seven patients were interviewed for short-term analysis following endoscopy. Gastro-esophageal reflux disease was cured in 98.4% (95%CI: 95.9%-99.6%) of patients three months after surgery. New-onset dysphagia was encountered postoperatively in 13 patients (6.7%); 95% reported that the outcome was better after antireflux surgery than with preopera-tive medical treatment. One hundred and thirty-nine patients with a median follow-up of 10.2 years (IQR 7.2-11.6 years) were available for a long-term evalu-ation. Cumulative long-term cure rates were 87.7% (81.0%-92.2%) at 5 years and 72.9% (64.0%-79.9%) at 10 years. Gastrointestinal symptom rating scores and RAND-36 quality of life scores of patients with treatment success were similar to those of the general population but significantly lower in those with failed antireflux surgery. Of the patients available for long-term follow-up, 83% rated their operation a success. CONCLUSION: For the long-term, our results indicate decreasing effectiveness of laparoscopic antirefluxsurgery, although most of the patients seem to have an overall quality of life similar to that of the general population.
基金Supported by Division of Reseach Promotion, Ubon Rajathanee University, Thailand
文摘Trichinosis is one of the most common food-borne para-sitic zoonoses in Thailand and many outbreaks are re-ported each year. This paper reviews the history, species, and epidemiology of the disease and food habits of the people with an emphasis on the north, northeast, cen-tral and south regions of Thailand. The earliest record of trichinosis in Thailand was in 1962 in the Mae Sariang District, Mae Hong Son Province. Since then, about 130 outbreaks have been reported involving 7392 patients and 97 deaths (1962-2005). The highest number of cas-es, 557, was recorded in 1983. The annual epidemiologi-cal surveillance reports of the Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Thailand, show that trichinosis cases increased from 61 in 1997 to 351 in 1998. In contrast to these figures, the number of reported cases decreased to 16 in 1999 and 128 cases in 2000. There was no record of trichinosis in 2001, but then the figures for 2002, 2003 and 2004 were 289, 126 and 212 respectively. The infected pa-tients were mostly in the 35-44 years age group and the disease occurred more frequently in men than women at a ratio of 1.7-2.0:1. There were 84 reported cases of trichinosis in Chiang Rai, Nan, Chiang Mai, Si Sa ket, Nakhon Phanom, Kalasin, Nakhon Ratchasima, Nakhon Nayok, Nakhon Pathom and Surat Thani, provinces locat-ed in different parts of Thailand in 2005. The outbreaks were more common in the northern areas, especially in rural areas where people ate raw or under-cooked pork and/or wild animals. This indicates the need for health education programs to prevent and control trichinosis as soon as possible in the high-risk areas.
文摘To understand the infection process, the viral multiplication and entry to the cell is widely studied. The Ebola virus nucleoprotein is the important problem for the pathological process. Focusing on the specific biological process, the post translational modification is needed. Here, the authors used the bioinformatics study to find the phosphorylation sites within the Ebola virus nucleoprotein and could identify many new sites.
文摘The new challenges that the phenomenon of demographic aging imposes on society in general, and health services in particular, can impact active and healthy aging. The project was implemented for two years （2012/2013） and aimed to combat loneliness in the elderly, which constitutes an obstacle to healthy and active aging. Decrease the sense of loneliness of individuals from 65 to 84 years of age, the project was made by using the health planning methodology, starting with a descriptive study （health diagnosis of the independent elderly population） followed by the development, implementation and evaluation of a community intervention project, which included home visits to the elderly, assessment of the level of loneliness in two different times （UCLA scale） and various intergenerational activities of social life （dancing, walking, online courses, games...） using a cross-section of partnerships and community involvement. There was a decrease from 62.8% to 41.9% in the reported overall feeling of loneliness of independent individuals between the ages of 65 and 84 years of age. There was an increase from 50.0% to 86.4% of seniors who now have dreams/life projects. The reduction of social and emotional isolation resulted in the promotion of social networks, which not only encouraged social interaction but also considered the elderly who live alone. The health gains arising from it are evidenced in contributing more proactively and the improvement of the quality of life in the elderly community.
文摘Aim: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary care. Material and methods: A random sample of patients answered a disease-specific and a quality-of-life (MiniAQLQ) questionnaire. Results: The 146 adolescents in paediatric care had more years with asthma, better continuity of annual surveillance, higher use of inhaled steroids and a stated better knowledge of their asthma than the 174 patients in primary care. No difference could be detected in asthma control or quality of life. Of all 320 adolescents, approximately 20%had woken at night due to asthma symptoms during the last week. About 15%hadmade unscheduled, urgent care visits and a third had used short-acting beta-agonist relievers more than twice a week. Quality-of-life scores were high and similar in both settings. Conclusions: Swedish adolescents with asthma are managed and treated somewhat differently in paediatric and primary care but with equal and, for the most part, satisfying results. The difference between the two settings probably reflects both differences in severity of asthma and different treatment traditions. For all adolescents, better ful-filment of goals regarding symptoms and exacerbations would be desirable, whereas a good quality of life including normal physical activity seems to have been achieved.
基金supported by the National Natural Science Foundation of China(grant numbers:71673003,72074011).
文摘Objective:The incidence and mortality of hepatocellular carcinoma(HCC)have been increasing around the world.Current guidelines recommend HCC screening in high-risk population.However,the strength of evidence of ben-efits and harms of HCC screening to support the recommendation was unclear.The objective is to systematically synthesize current evidence on the benefits and harms of HCC screening.Methods:We searched PubMed and nine other databases until August 20,2021.We included cohort studies and RCTs that compared the benefits and harms of screening and non-screening in high-risk population of HCC.Case series studies that reported harms of HCC screening were also included.Pooled risk ratio(RR),according to HCC screening status,was calculated for each benefit outcome(e.g.,HCC mortality,survival rate,proportion of early HCC),using head-to-head meta-analysis.The harmful outcomes(e.g.,proportion of physiological harms provided by non-comparative studies were pooled by prevalence of meta-analysis).Analysis on publication bias and quality of life,subgroup analysis,and sensitivity analysis were also conducted.Results:We included 70 studies,including four random clinical trials(RCTs),63 cohort studies,three case se-ries studies.The meta-analysis of RCTs showed HCC screening was significantly associated with reduced HCC mortality(RR[risk ratio],0.73[95%CI,0.56-0.96];I^(2)=75.1%),prolonged overall survival rates(1-year,RR,1.72[95%CI,1.13-2.61];I^(2)=72.5%;3-year,RR,2.86[95%CI,1.78-4.58];I^(2)=10.1%;and 5-year,RR,2.76[95%CI,1.37-5.54];I^(2)=28.3%),increased proportion of early HCC detection(RR,2.68[95%CI,1.77-4.06];I^(2)=50.4%).Similarly,meta-analysis of cohort studies indicated HCC screening was more effective than non-screening.However,pooled proportion of physiological harms was 16.30%(95%CI:8.92%-23.67%)and most harms were of a mild to moderate severity.Conclusion:The existing evidence suggests HCC screening is more effective than non-screening in high-risk pop-ulation.However,harms of screening should not be ignored.
文摘Due to globalization, there is a need for nurses with skills and competence in providing safe, competent and culturally appropriate care. The aim of the study was to investigate whether International Study Experiences (ISE) in other countries during basic nursing education had an impact on newly graduated nurses as regards to self-reported competence. Moreover, a second aim was to explore what background factors that facilitated or constituted a hindrance for nursing students to choose to conduct part of their basic nursing education abroad. At 11 Universities/University Colleges (henceforth called Higher Education Institutions [HEIs]) in Sweden, 565 nursing students responded to the Nurse Professional Competence (NPC) Scale. Students with ISE rated their competence significantly higher on three NPC competence areas—“Legislation in nursing and safety planning”, “Leadership and development of nursing” and “Education and supervision of staff/students”. Background factors that significantly seemed to enhance ISE were living alone, not having children or other commitments in relation to family, international focus at the HEI and previous international experience. Lack of financial means was reported to prevent students from choosing ISE. The study implies that several background factors are of importance whether students choose ISE or not. ISE during basic nursing education might result in better self-reported competence in leading and developing nursing care, including education of future nurses, and in providing safe care.
基金The Registrar Clinical Encounters in Training(ReCEnT)project was funded from 2010 to 2015 by the participating educational organisations:General Practice Training Valley to Coast,the Victorian Metropolitan Alliance,General Practice Training Tasmania,Adelaide to Outback GP Training Program and Tropical Medical Training,all of which were funded by the Australian Department of Health(DoH).From 2016 to 2019,ReCEnT was funded by a DoH commissioned research grant(no award/grant number)and supported by GP Synergy RTO.From 2019,ReCEnT is conducted by GP Synergy in collaboration with Eastern Victoria GP Training and General Practice Training Tasmania.GP Synergy,Eastern Victoria GP Training and General Practice Training Tasmania are funded by the DoH.JL was supported by a GP Synergy Medical Student Scholarship.
文摘Objectives Dizziness is a common and challenging clinical presentation in general practice.Failure to determine specific aetiologies can lead to significant morbidity and mortality.We aimed to establish frequency and associations of general practitioner(GP)trainees’(registrars’)specific vertigo provisional diagnoses and their non-specific symptomatic problem formulations.Design A cross-sectional analysis of Registrar Clinical Encounters in Training(ReCEnT)cohort study data between 2010 and 2018.ReCEnT is an ongoing,prospective cohort study of registrars in general practice training in Australia.Data collection occurs once every 6 months midtraining term(for three terms)and entails recording details of 60 consecutive clinical consultations on hardcopy case report forms.The outcome factor was whether dizziness-related or vertigo-related presentations resulted in a specific vertigo provisional diagnosis versus a non-specific symptomatic problem formulation.Associations with patient,practice,registrar and consultation independent variables were assessed by univariate and multivariable logistic regression.Setting Australian general practice training programme.The training is regionalised and delivered by regional training providers(RTPs)(2010-2015)and regional training organisations(RTOs)(2016-2018)across Australia(from five states and one territory).Participants All general practice registrars enrolled with participating RTPs or RTOs undertaking GP training terms.Results 2333 registrars(96%response rate)recorded 1734 new problems related to dizziness or vertigo.Of these,546(31.5%)involved a specific vertigo diagnosis and 1188(68.5%)a non-specific symptom diagnosis.Variables associated with a non-specific symptom diagnosis on multivariable analysis were lower socioeconomic status of the practice location(OR 0.94 for each decile of disadvantage,95%CIs 0.90 to 0.98)and longer consultation duration(OR 1.02,95%CIs 1.00 to 1.04).A specific vertigo diagnosis was associated with performing a procedure(OR 0.52,95%CIs 0.27 to 1.00),with some evidence for seeking information from a supervisor being associated with a non-specific symptom diagnosis(OR 1.39,95%CIs 0.92 to 2.09;p=0.12).Conclusions Australian GP registrars see dizzy patients as frequently as established GPs.The frequency and associations of a non-specific diagnosis are consistent with the acknowledged difficulty of making diagnoses in vertigo/dizziness presentations.Continuing emphasis on this area in GP training and encouragement of supervisor involvement in registrars’diagnostic processes is indicated.
基金Fight Infections Foundation,Badalona,Spain.Unspecified Grant
文摘Background Schistosomiasis is highly endemic in sub-Saharan Africa and frequently imported to Europe.Male urogenital manifestations are often neglected.We aimed to ascertain the prevalence of genitourinary clinical signs and symptoms among long-term African migrants in a non-endemic European country using a serology test.Methods We carried out a prospective,community-based cross-sectional study of adult male migrants from sub-Saharan Africa living in Spain.Schistosoma serology tests and microscopic urine examinations were carried out,and clinical data were obtained from an electronic medical record search and a structured questionnaire.Results We included 388 adult males,mean age 43.5 years[Standard Deviation(SD)=12.0,range:18-76].The median time since migration to the European Union was 17[Interquartile range(IQR):11-21]years.The most frequent country of origin was Senegal(N=179,46.1%).Of the 338,147(37.6%)tested positive for Schistosoma.Parasite eggs were present in the urine of only 1.3%.Nine genitourinary clinical items were significantly associated with positive Schistosoma serology results:pelvic pain(45.2%;OR=1.57,95%CI:1.0-2.4),pain on ejaculation(14.5%;OR=1.85,95%CI:1.0-3.5),dyspareunia(12.4%;OR=2.45,95%CI:1.2-5.2),erectile dysfunction(9.5%;OR=3.10,95%CI:1.3-7.6),self-reported episodes of infertility(32.1%;OR=1.69,95%CI:1.0-2.8),haematuria(55.2%;OR=2.37,95%CI:1.5-3.6),dysuria(52.1%;OR=2.01,95%CI:1.3-3.1),undiagnosed syndromic STIs(5.4%),and orchitis(20.7%;OR=1.81,95%CI:1.0-3.1).Clinical signs tended to cluster.Conclusions Urogenital clinical signs and symptoms are prevalent among male African long-term migrants with a positive Schistosoma serology results.Genital involvement can be frequent even among those with long periods of non-residence in their sub-Saharan African countries of origin.Further research is needed to develop diagnostic tools and validate therapeutic approaches to chronic schistosomiasis.
基金the National Natural Science Foundation of China(No.72074011)the Special Project for Major Infectious Disease of Peking University Health Program of China(No.BMU2020HKYZX010)the National Key Technology R&D Program of China(No.2020YFC0840800).
文摘Background:The global pandemic coronavirus disease 2019(COVID-19)has become a major public health problem and presents an unprecedented challenge.However,no specific drugs were currently proven.This study aimed to evaluate the comparative efficacy and safety of pharmacological interventions in patients with COVID-19.Methods:Medline,Embase,the Cochrane Library,and clinicaltrials.gov were searched for randomized controlled trials(RCTs)in patients infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)/SARS-CoV.Random-effects network metaanalysis within the Bayesian framework was performed,followed by the Grading of Recommendations Assessment,Development,and Evaluation system assessing the quality of evidence.The primary outcome of interest includes mortality,cure,viral negative conversion,and overall adverse events(OAEs).Odds ratio(OR)with 95%confidence interval(CI)was calculated as the measure of effect size.Results:Sixty-six RCTs with 19,095 patients were included,involving standard of care(SOC),eight different antiviral agents,six different antibiotics,high and low dose chloroquine(CQ_HD,CQ_LD),traditional Chinese medicine(TCM),corticosteroids(COR),and other treatments.Compared with SOC,a significant reduction of mortality was observed for TCM(OR=0.34,95%CI:0.20–0.56,moderate quality)and COR(OR=0.84,95%CI:0.75–0.96,low quality)with improved cure rate(OR=2.16,95%CI:1.60–2.91,low quality for TCM;OR=1.17,95%CI:1.05–1.30,low quality for COR).However,an increased risk of mortality was found for CQ_HD vs.SOC(OR=3.20,95%CI:1.18–8.73,low quality).TCM was associated with decreased risk of OAE(OR=0.52,95%CI:0.38–0.70,very low quality)but CQ_HD(OR=2.51,95%CI:1.20–5.24)and interferons(IFN)(OR=2.69,95%CI:1.02–7.08)vs.SOC with very low quality were associated with an increased risk.Conclusions:COR and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care.CQ_HD might increase the risk of mortality.CQ,IFN,and other antiviral agents could increase the risk of OAEs.The current evidence is generally uncertain with low-quality and further high-quality trials are needed.
文摘普遍认为,医患共同决策(shared decision-making,SDM)是优质医疗的核心特征。英国国家健康体系(National Health Services,NHS)章程的第四条规定“在适宜情况下,患者、家属及其照护者应参与并咨询所有有关照护和治疗决策的讨论及制订过程。”大多数NHS从业人员和专员承认,在实践中这种参与和咨询并不常见,因此,要求英国国家健康与临床优选研究所(NICE)提供有关促进医患共同决策的指南并将其融入日常实践。
