江苏省暗娼性病新发感染及失访人群特征分析

目的了解江苏省暗娼人群艾滋病毒(HIV)和梅毒(TP)新发感染及队列研究中失访人群的特征。方法采用方便抽样建立暗娼队列,3个月后进行随访。在基线和随访时对每个调查对象进行匿名问卷调查,对随访和失访对象的人口学、行为学和实验室指标进行比较。抽取5 ml静脉血和2支宫颈拭子检测性病(STI)、HIV。结果本次共调查1 806名暗娼,3个月后随访到737名,随访率为40.8%,HIV和TP血清阳转率分别为0.0/100人年和6.1/100人年;接受的教育程度高、来源的场所档次高、最近一年在本地未接受过HIV宣传服务及TP感染者更容易失访。结论虽然江苏省暗娼人群处于HIV低流行状态,但是TP新发感染率高,失访暗娼感染STI、HIV的危险性高,应更加关注高档场所暗娼的干预工作。     

Incidence rates of sexually transmitted infection and the characteristic analysis of female sex workers failing in follow-up in cohort study

目的 了解江苏省暗娼人群艾滋病毒(HIV)和梅毒(TP)新发感染及队列研究中失访人群的特征.方法 采用方便抽样建立暗娼队列,3个月后进行随访.在基线和随访时对每个调查对象进行匿名问卷调查,对随访和失访对象的人口学、行为学和实验室指标进行比较.抽取5 ml静脉血和2支宫颈拭子检测性病(STI)、HIV.结果 本次共调查1 806名暗娼,3个月后随访到737名,随访率为40.8%,HIV和TP血清阳转率分别为0.0/100人年和6.1/100人年;接受的教育程度高、来源的场所档次高、最近一年在本地未接受过HIV宣传服务及TP感染者更容易失访.结论 虽然江苏省暗娼人群处于HIV低流行状态,但是TP新发感染率高,失访暗娼感染STI、HIV的危险性高,应更加关注高档场所暗娼的干预工作.     

暗娼人群艾滋病队列研究中失访率及影响因素分析

目的了解暗娼人群艾滋病队列研究中艾滋病病毒(HIV)、梅毒感染现况以及失访率和影响因素,为采取干预措施提供依据。方法通过经过培训的调查员,采用统一的问卷调查,6~12月后进行随访,随访内容同第一次调查。结果共调查108名暗娼人群,6~12个月后随访率75.00%(81人)。最近一次性行为使用安全套率92.59%。最近一个月商业性行为的安全套每次都使用率为41.67%,logistic回归分析显示来源于低档场所是暗娼人群失访的保护因素,其失访率是来源于中档暗娼的0.11倍(P0.05)。首次调查阳性检出率为0.93%,6个月后HIV无新发感染。结论暗娼队列研究随访难度高,暗娼危险行为比例高,是干预的重点人群。     

精神分裂症患者门诊随访的危险因素研究

目的:为了解定期门诊随访和失访精神分裂症患者的危险和保护因素。方法:以出院6月为时间点,173名精神分裂症患者被分成随访组(n=114)和失访组(n=59),比较定期门诊随访和失访精神分裂症患者的人口社会学和临床特征,并筛选失访的危险因素。结果:精神分裂症患者出院6个月失访的危险因素是费用来源(OR=3.374),保护因素是本次住院日(OR=0.891)。结论:随访和失访精神分裂症患者的人口社会学和临床特征差异为进一步研究和干预提供了依据。     

糖化血红蛋白A1c浓度与心血管疾病及全因死亡率增加相关——糖化血红蛋白A1c浓度与冠心病事件、心血管事件、全因死亡率之间的相关性如何？

设计：队列研究（欧洲前瞻性癌症调查研究．诺福克地区组（EPIC—Norfolk）），平均随访时间为6年。     

桂林市娱乐场所暗娼人群队列研究中随访与失访影响因素研究

目的 了解桂林市高危娱乐场所暗娼人群艾滋病队列研究中艾滋病病毒(Human immunodeficiency virus,HIV)、梅毒和丙肝感染现况，随访与失访情况的影响因素，为进一步采取针对性的干预措施提供依据。方法 通过培训调查员，对暗娼人员采用统一问卷调查，并进行HIV、梅毒和丙肝检测，1年后随访，随访内容同第1次调查。结果 2020年共调查暗娼人数400人，1年后有效随访到70人，有效随访率为17.5%。有效随访到暗娼人群出现艾滋病抗体阳转1人，梅毒和丙肝抗体未出现阳转情况。有效随访与失访人群比较，单因素分析显示在文化程度、年龄和民族差异有统计学意义(χ²=41.678、8.975、20.344,P均<0.05),在婚姻状况、户籍和娱乐场所档次差异无统计学意义(χ²=0.028、2.226、0.822,P均>0.05);二元logistic回归分析显示在文化程度和民族差异有统计学意义(χ²=33.538、12.742,P均<0.05)。对暗娼失访人群在失访原因进行分析，单因素分析显示在不同档次...     

肿瘤患者失访原因分析及对策

目的探讨肿瘤患者治疗出院后电话随访中失访原因及对策。方法电话随机随访2008年1月-2010年12月480例恶性肿瘤住院患者,了解出院后的生存及健康情况。结果 480例患者中访到206例,因电话号码有误、关机、停机、未留号码、拒访、留公用电话等原因失访274例。结论将失访结果及时反馈给医教部门并向医院提出合理化建议,做好住院患者的随访宣教工作。在失访患者中通过多种方式查找新的联系方式。随访人员提高自身素质,增强服务意识,使病人充分感受到医院＂三好一满意＂的服务理念,提高随访率。     

幽门螺杆菌感染对胃粘膜病变作用的五年随访观察

目的 评价5年随访根除幽门螺杆菌（Hp)感染对胃粘膜病变的作用。方法 采用前瞻性队列研究方法,病例为上海7家企业单位在我院定点体检进行胃镜检查的病人。入选时间为1993年7月至1994年6月,部分病人有中上腹不适,胃镜及病理检查确诊为慢性胃炎的病人作为入选病例。入选时确定Hp感染状态,阳性病人根据自愿原则或采用根除Hp感染治疗,或采用对症治疗。阴性组仅在有消化不良症状时采用对症治疗。全部对象跟踪随访5年。结果 入选时30例Hp阴性,45例Hp阳性。结束随访时,24例阴性无变化（另3例失访,1例变为阳性,2例可疑）,作为对照组,45例Hp阳性。结束随访时,24例阴性无变化（另3例失访,1例变为阳性,2例可疑）,作为对照组。45例阳性病人中,1例失访,16例经抗Hp感染治疗结束4周后转阴,作为Hp阴性观察组;28例仍为Hp阳性,作为Hp阳性观察组。对照组仅17％－33％的病人炎症有进展,Hp阳性观察组,炎症加重的病人占43％－57％,Hp阴性观察组,50％的病人肠化生加重,但50％－67％的病人无明显变化;Hp阳性观察组肠化生加重的病人增至43％－57％,而Hp阴性观察组无一例加重,75％的病人维持原状。结论 根除Hp感染不仅可减轻病人的炎症程度,同时能阻止肠上皮化生的发展。     

腹腔镜与开腹手术行胃癌根治术效果的临床对照研究

目的探讨应用腹腔镜行胃癌根治术的效果及安全性。方法回顾性分析2009年1月—2010年6月在我院行根治性手术的101例胃癌患者的临床资料,其中腹腔镜手术51例(腹腔镜组),开腹手术50例(开腹组)。观察两组手术切口长度、手术时间、术中失血量、淋巴结清扫个数、术后排便时间、术后住院时间、围术期并发症发生情况。每月随访1次,随访终点为2010-12-31,记录患者失访、复发、转移及死亡情况。结果腹腔镜组与开腹组患者手术切口长度、手术时间、术中失血量、术后排便时间、术后住院时间比较,差异均有统计学意义(P<0.05);两组患者淋巴结清扫个数比较,差异无统计学意义(P>0.05)。开腹组术后无并发症发生,腹腔镜组2例出现并发症,1例为术后残胃功能障碍,1例为腹腔感染。腹腔镜组平均随访时间为(14.3±9.0)个月,失访3例,失访率为6%;开腹组平均随访时间为(15.8±10.3)个月,失访6例,失访率为12%。两组随访时间、失访率比较,差异均无统计学意义(P>0.05)。腹腔镜组复发率为4%(2/48)、转移率为4%(2/48)、病死率为6%(3/48),开腹组分别为4%(2/44)、4%(2/44)、9%(4/44),两组比较差异均无统计学意义(P>0.05)。结论经腹腔镜行胃癌根治术与开腹手术相比具有创伤小、失血量少、术后恢复快等优点,且根治度与开腹手术无明显差别,短时期复发、转移及病死率无明显增加,值得推广。     

糖尿病教育管理对患者延续性护理失访的影响分析

目的 探究在糖尿病患者延续性护理中,采用相应的健康教育管理模式进行护理,观察其对失访率的影响.方法 选取178例糖尿病患者作为研究的案例,根据随机数字表法,将其分为探究组和比较组,各89例,比较组患者给予常规的电话随访方式予以延续性护理,探究组患者在给予电话随访的同时,采用相应的健康教育管理模式进行综合护理,比较2组患者的失访率情况.结果 探究组患者在给予电话随访的同时,采用相应的健康教育管理模式进行综合护理后,其健康大课堂参与率高达59.55%,其失访率只有10.11%;比较组患者给予常规的电话随访方式予以延续性护理后,其健康大课堂参与率达到28.09%,其失访率为33.71%.2组患者在失访率方面,差异有统计学意义(P<0.05).结论 在糖尿病患者延续性护理中,采用相应的健康教育管理模式进行护理,具有良好的效果,能够有效的提升患者健康课堂参与率,极大的降低患者失访率,提高患者随访质量.     

幽门螺杆菌感染胃部病变的随访研究

目的：探讨幽门螺杆菌（Hp)感染在胃癌发生发展中所起的作用。方法：应用队列研究的方法随访样本人群的胃部病变情况的变化及饮食,生活等方面的情况,并调查胃癌的发生情况。结果：943例患者中,Hp阳性率为61．4％,随访期为5－10年,平均5．5年,失访率为18．98％,其中阳性队列中发现胃癌23例（胃癌的发生率为5．7％,23／403）,而阴性组确诊胃癌7例（2．2,7／324）,两组差异有显著性（p=0.017),结论：幽门螺杆菌感染与胃癌的发生关系密切。     

The patient cohort of the German competence network for HIV/AIDS (KompNet):a profile

Objective

In this paper, we describe the main objectives, the study design and the onset of the patient cohort of the German Competence Network for HIV/AIDS (KompNet). Furthermore, we depict sociodemographic and clinical baseline characteristics and an estimation of the coverage and representativity as to the composition of persons living with HIV/AIDS (PLWHA) in Germany.

Methods

The KompNet cohort is an open, retrospective and prospective, multicenter, disease-specific and nationwide cohort study that started gathering data in June 2004. Semi-annually, follow up visits of the patients are documented, covering clinical and sociodemographic data. At enrolment and three years afterwards, an EDTA-sample is taken; a serum-sample is taken at every follow up visit.

Results

As of 14.9.2008, a total of 15,541 patients were enrolled by 44 documenting sites. In September 2007, the cohort size was reduced to 10 outpatient clinics and fifteen private practitioners, covering a total of 9,410 patients. The documentation of these patients comprises 24,117 years of follow up-time since enrolment (mean: 2.6 years), 62,862 person years inclusive data documented retrospectively on course of HIV-infection and combined antiretroviral therapy (cART, mean: 6.7 years). 1,008 patients (10.7%) were lost to follow up and 175 (1.9%) died since enrolment. 84.9% of patients were men. Main risks of transmission were sex between men (MSM: 62.9%), heterosexual contacts (18.4%), intravenous drug use (IVDU: 7.0%) and origin from a high prevalence country (HPL: 5.2%). Mean age was 45 years.

Conclusion

The KompNet cohort covers about a quarter of all patients being under treatment in Germany. The composition of the cohort represents well the most important risks of transmission in Germany. The cohort contains a high proportion of patients being older than 49 years (28.1%). On basis of its comprehensive database and its biomaterials banks, the KompNet cohort serves as an important instrument to monitor and analyse the effects of combined antiretroviral therapy (cART) in Germany, interdigidating basis, clinical and psychosocial research in view to translational research.     

精神病人自杀行为的随访研究

目的：探讨精神病人自杀行为的危险因素。方法：对73例有自杀行为的精神病人的出院后进行5年跟踪随访研究。结果：出院后5年内有61．6％的病人再次出现自杀行为,其中15．1％的病人自杀身亡,再次出现自杀的因素有阳性家庭史,社会支持状态较差异等。结论：有精神病和自杀家族史且有自杀行为者再次发生自杀的机率较大,病人出院后的心理康复治疗和建立良好的社会环境是防止自杀的重要措施。     

Epidemiological composition,clinical and treatment characteristics of the patient cohort of the german competence network for HIV/AIDS

Objective

As its central basis for research, the Competence Network for HIV/AIDS (KompNet) established a nationwide cohort study on HIV-positive patients being in medical care in Germany. In this paper, we describe the epidemiological composition, and clinical as well as treatment characteristics of the KompNet cohort over time.

Methods

The KompNet cohort is an open, retrospective and prospective, multi-center, disease-specific and nationwide cohort study that started gathering data in June 2004. Semiannually, follow up visits of the patients are documented, covering a wide range of clinical and sociodemographic data. At enrolment and three years afterwards, an EDTA-sample is taken; a serum-sample is taken at every follow up.

Results

As of 20.10.2008, a total of 15,541 patients were enrolled by 44 documenting sites. In September 2007, the cohort size was reduced to ten outpatient clinics and fifteen private practitioners, covering a total of 9,410 patients. The documentation of these patients comprised 24,117 years of follow up-time since enrolment (mean: 2.6 years), 62,862 person years inclusive data documented retrospectively on course of HIV-infection and antiretroviral therapy (ART, mean: 6.7 years). Due to the short period of recruitment till now, rates of death (0.3%-0.8%) and losses to follow up (1.1%-5.5%) were low.84.9% of patients were men. Main risk of transmission was sex between men (MSM: 62.9%). Mean age was 45 years. About two third of patients were classified as CDC-stage B or C. Therapy regimens of currently treated patients complied with recent guidelines. Trends of mean CD4 cell count/μl regarding the initial therapy and concerning the population under treatment reflected the developments and the changing standards of antiretroviral therapy over time.

Conclusion

The KompNet cohort covers about a quarter of all patients estimated as being under treatment in Germany. Its composition can be accounted approximately representative for the situation of clinical care and treatment in the scope of HIV/AIDS in Germany. Therefore, it is an important instrument for measuring the course of HIV/AIDS, the reality of use of antiretroviral therapy and its clinical and psychosocial outcomes in Germany.     

单侧旁正中切口下椎弓根螺钉固定合并双侧椎管减压TLIF术的中长期疗效

 目的   回顾性研究单侧旁正中切口下单侧椎弓根螺钉固定合并双侧减压的经椎间孔的椎体间融合术(transforaminal lumbar interbody fusion,TLIF)在治疗双侧椎管狭窄患者中的中长期疗效。方法   收集2007年7月至2010年6月复旦大学附属中山医院收治的73例单节段腰椎管狭窄的患者,所有患者均有双侧椎管狭窄的症状及体征,且均接受单侧旁正中切口下单侧椎弓根螺钉固定及双侧椎管减压。统计并比较患者术前、术后6个月及末次随访的ODI评分、JOA评分、VAS评分、腰椎前凸角(angle of lumbar lordosis,LL)及节段前凸角(angle of segmental lordosis,SL);同时记录手术时间,术中出血量、住院时间、相关并发症及椎体间的融合情况。结果    73例患者中,男性30名、女性43名,平均年龄(57.7±10.1)岁(33～81 岁),平均手术时间(92.0±26.7)min(55～180 min),平均出血量(150.5±130.3)mL(50～300 mL),平均住院天数(12.3±2.7)天(7～20天)。术后随访时间至少5年,平均随访时间(79.4±11.1)个月(60～98个月)。术后6个月和末次随访的ODI评分、JOA评分、VAPS评分较术前明显改善(P<0.05);术后6个月和末次随访的LL及SL较术前明显增加(P<0.05)。所有患者都获得骨性融合,融合率为100%。结论   单侧旁正中切口下单侧椎弓根螺钉固定合并双侧椎管减压TLIF术是对传统TLIF术的改良,能够减轻手术创伤并减少手术费用,是治疗具有双侧症状的椎管狭窄症的理想术式。     

Pupillary evaluation for differential diagnosis of coma

Objectives: To determine the usefulness of bedside evaluation of pupils in determining the aetiology of coma by adopting a probabilistic approach. Patients and methods: One hundred and fifteen consecutive patients presenting with coma were enrolled in this prospective cohort during the 12 month study period in the emergency room of a community teaching hospital. Patients underwent structured clinical examinations and laboratory and imaging tests. Assignment of aetiology of coma was based on strict adherence to predetermined criteria and achieved by consensus of the two physician investigators. One year follow up was obtained in all patients. Results: Aetiology of coma was determined in 98% of the patients. It was metabolic in 69 patients (60%) and structural in 46 patients (40%). Metabolic causes included drug overdose, acute alcohol intoxication, hypoglycaemia, sepsis, and pneumonia. Structural causes included intracerebral haemorrhage, subarachnoid haemorrhage, cerebral infarction, subdural haematoma, and epidural haematoma. Multivariate logistic regression analysis showed light reflex loss (likelihood ratio for positive test result 3.59) and anisocoria (likelihood ratio for positive test result 9.0) as independent predictors of structural origin. Conclusions: In this prospective study of patients presenting to the emergency room of a community based teaching hospital with coma, in about 60% the coma is of metabolic origins and in about 40% of structural origins. Light reflex loss and anisocoria suggest a structural aetiology.     

In-vivo parasitological response to sulfadoxine-pyrimethamine in pregnant women in southern Malawi

Background

Malaria in pregnancy is a significant cause of maternal and infant morbidity and mortality. Malawi adopted intermittent preventive treatment with sulfadoxinepyrimethamine (SP) for the control of malaria in pregnancy in 1993. However there is little information on the in-vivo SP efficacy in pregnant women. This study was conducted to determine: prevalence of malaria and anaemia at the first antenatal visit and rate of parasitological failure to SP in pregnancy.

Methods

A cross-sectional followed by a prospective cohort study was conducted in women attending antenatal care clinic at Montfort Hospital in Lower Shire Valley from June 2004 to February 2005. Women were screened for malaria and anaemia at the first antenatal visit. After taking SP under direct observation, women with malaria parasitaemia were followed up to day 14 to determine parasitological response.

Results

Of 961 women screened, 9% had malaria, 77% had anaemia (HB<11.0g/dl), 24% had moderate anaemia (HB 7.0-8.9g/dl) and 6% had severe anaemia (HB<7.0g/dl). Malaria was significantly more frequent in primigravidae, the second trimester and in the post- rainy season (all p <0.05). Moderate anaemia (Hb < 9.0g/dl) was significantly more common in adolescents and primigravidae (both p <0.05). In the14-day follow up study, loss to follow up was 13%. Of the 74 women who completed the follow up, 89% cleared malaria parasites successfully and 11% had parasitological failure. Parasitological failures were all of the R1 type except for one with R2 failure.

Conclusion

Anaemia prevalence was high at first antenatal visit in this population. Rate of parasitological failure to SP in pregnancy increased from 5% in 1996 to 11% in 2004.     

Cohort Study on the Recurrence Rate of High Altitude Pulmonary Oedema

Keeping in view the importance of High Altitude Pulmonary Oedema (HAPO) as well as the absence of published evidence as regards recurrence rate of this disease, a cohort study was undertaken, based on data available with the Central Diseases Registry. The inception cohort consisted of all cases of HAPO occurring over a one year period, This cohort was followed up for another 12 months, to observe any recurrence. The study revealed that the recurrence rate of HAPO in terms of Incidence density was 1.83 per 1000 person-months of those who had an initial episode (95% confidence limit 0.53 to 3.13 per 1000 person-months). The cumulative incidence was 32.9 per 1000, over an average follow up of 18 months (95% confidence limit 4.55 to 61.25 per 1000). The time gap between the initial episode and recurrence was 115 to 208 days. All recurrent cases had their initial as well as recurrent episode at the first stage of high altitude (9000 to 12000 feet), with the onset being within 48 hours of entry into high altitude. Based on the findings, some recommendations for prevention of recurrence of HAPO have been submitted.Key Words: High Altitude Pulmonary Oedema, Incidence rate, Recurrence rate     

Long term effects of cryosurgery on cutaneous sensation

In a study of the time course and nature of the sensory loss after cryosurgery the forearms of nine normal subjects were treated with liquid nitrogen using freeze times currently employed in clinical practice in Britain. Ability to appreciate touch, pinprick, and cold in the treated areas was tested at regular intervals and biopsy samples taken to investigate the pathogenesis. Appreciation of all three modalities of sensation was initially reduced in all nine subjects for all freeze times, yet complete recovery occurred in the seven patients completing follow up. This recovery, however, took up to one and a half years for the longest freeze, with even a 10 second freeze taking up to 10 months. Patients may be reassured that sensory loss after cryosurgery for up to two periods of 30 seconds will almost certainly recover, though it may take up to 18 months to do so.