两种管理方式对复治涂阳肺结核转归的影响

目的探讨两种管理方式对复治涂阳肺结核患者转归的影响。方法将56例完成9个月治疗的流动人口肺结核患者采用强化期督导方式,并按1∶1病例配对,选取56例当地户籍肺结核患者采用全程督导方式,分析影响转归的相关因素。结果复治涂阳病例总治愈率为74.1%(80/112),全程督导组(当地户籍)治愈率为83.9%(43/56),强化督导组(流动人口)治愈率为64.3%(36/56),全程督导高于强化督导组,差异有统计学意义(χ2=5.63,P<0.05)。全程督导组中不规则服药率7.14%(4/56),强化督导组为25.00%(14/56),差异有统计学意义(χ2=6.62,P<0.05);耐药患者中,全程和强化督导两组的耐药率分别为21.43%(12/56)和28.57%(16/56),差异无统计学意义(P>0.05)。结论复治涂阳肺结核患者转归受多种因素影响,其中不规则服药和耐药为主要因素,可采用全程督导管理方式提高治愈率。     

社区-家庭督导化疗治疗肺结核病疗效观察

目的探讨社区-家庭督导化疗模式治疗肺结核病的临床效果。方法对3年来在果园社区建档管理的肺结核病患者54例进行家庭访视,接受社区督导化疗的46例为督导组,不接受社区督导化疗的8例为对照组,比较两者治疗效果。结果督导组46例均治愈,治愈率100%;对照组6例治愈,2例未愈,治愈率75%,两组治愈率比较差异有统计学意义(P0.05)。结论社区-家庭督导化疗可有效提高肺结核病人治愈率。     

全程间歇短程化疗方案治疗109例肺结核疗效观察

[目的]了解全程间歇短程化疗方案治疗初治涂阳肺结核临床疗效.[方法]临床观察分两组：初治涂阳肺结核空洞组54例,初治涂阳肺结核无空洞组55例.两组年龄、性别和职业构成基本相同：均采用2H3R3Z3E3/4H3R3化疗方案;临床医生指导下家庭督导化疗.[结果]肺结核空洞组治愈率77.78%,肺结核无空洞组治愈率92.72%.两组治愈率差异有统计学意义（P＜0.05）;组内男女肺结核治愈率差异无统计学意义（P＞0.05）;组间男性和女性肺结核治愈率差异有统计学意义（P＜0.05）.[结论]短程化疗方案全程间歇疗法用于初治涂阳肺结核无空洞病例适宜的,初治涂阳肺结核空洞者以2HRZE/4HR为首选短程化疗方案.     

传统督导和电话督导对县及乡镇肺结核患者治疗依从性的影响

目的：对比电话督导和传统督导对县、乡镇肺结核病患者管理效果的影响。方法将2014—2015年在象山县疾病预防控制中心结核门诊就诊的肺结核病患者随机分为电话督导组和传统督导组,共180例患者被纳入调查,其中传统督导组107例,电话督导组73例。随访观察两组患者治疗的依从性和转归情况。结果传统督导组和电话督导组患者就诊延迟率分别为44.86%（48/107）和19.18%（14/73）,差异有统计学意义（χ2=12.675,P<0.01）。电话督导组患者规律服药率（83.56%）、规律复查率（97.26%）﹑规律取药率（94.52%）和治愈率/完成疗程率（97.26%）均高于传统督导组的49.53%、82.24%﹑71.03%和79.44%,差异有统计学意义（χ2=21.638,9.496,15.290和11.926,P均<0.01）。结论电话督导方式对肺结核患者依从性、治疗效果优于传统督导,适于对县、乡镇地区肺结核病患者推广管理。     

农村结核病人全程医疗管理辅以家庭督导的效果分析

[目的]比较初治涂阳结核病人分别在全程医疗管理与辅以家庭督导下短程化疗的效果.[方法]对全程医疗管理的104例和结合家庭督导99例初治涂阳病例均用2HREZ/4H3 R3方案化疗.[结果]全程医疗管理组和辅以家庭督导组间断用药率分别为11.5%和3.0%,两者间差异有显著性(x2=4.19,P＜0.05);治疗2个月痰菌阴转率分别为84.6%和94.9%,两者间差异有显著性(x2=4.77,P＜0.05);满疗程治愈率分别为89.4%和98.0%,两者间差异有显著性(x2=4.85,P＜0.05).[结论]在居住分散、交通不便的农村地区,结合家庭督导的短程化疗优于全程医疗管理下的短程化疗.     

隔代抚养与老年人心理健康相关性的Meta分析

目的 对隔代抚养与老年人心理健康关系进行meta分析。 方法 检索PubMed、Embase、the Cochrane Library、Web of Science、中国知网、万方、维普等中英文数据库,收集关于隔代抚养对老年人心理健康影响的相关文献,检索时限为自建库起至2021年5月。对纳入文献进行质量评价及数据整理。所有数据均采用RevMan 5.4软件进行meta分析。结果 最终纳入20篇文献,总样本量69 974例。Meta分析结果显示:在认知功能（SMD = 0.32, 95%CI:0.28～0.36, P＜0.001）、生活满意度（SMD = 0.06, 95%CI:0.04～0.09, P＜0.001）及自评健康（SMD = 0.08, 95%CI:0.02～0.14, P = 0.010）评估中,隔代抚养组评估结果优于非隔代抚养组,呈正相关且有统计学差异;在抑郁状况（SMD = - 0.04, 95%CI: - 0.09～0.01, P = 0.150）评估中,隔代抚养组评估结果劣于非隔代抚养组,呈负相关且有统计学差异。亚组分析结果显示:与非隔代抚养组相比,国外隔代抚养组（SMD = 0.27, 95%CI:0.15～0.39, P＜0.001）;国内隔代抚养组（SMD = - 0.07, 95%CI: - 0.09～ - 0.05, P＜0.001）老年人抑郁状况差异具有统计学意义。祖父抚养组与祖母抚养组（SMD = - 0.32, 95%CI: - 0.40～ - 0.24, P＜0.001）;城镇抚养组与农村抚养组（SMD = - 0.23, 95%CI: - 0.30～ - 0.17, P＜0.001）抑郁状况差异具有统计学意义。结论 隔代抚养对老年人的认知功能、生活满意度及自评健康有维持和促进作用。国家、性别及地域是隔代抚养老年人抑郁状况的重要影响因素。     

重点初治涂阳肺结核病人规范管理方法探讨

目的　探索适合重点初治涂阳肺结核病人的管理方式。方法　选取初治涂阳肺结核病人 ,对重点初治涂阳病人实行规范管理 ,称规范管理组 ,其余实施全程督导 ,称全程督导组 ,两组均采用初治涂阳肺结核病人短程化疗方案 ( 2HRZE/4H 3R 3 ) ,并采用板式组合药 ,观察两种管理方式下病人的疗效及中断治疗情况。结果　规范管理组和全程督导组 2个月痰菌阴转率分别为 97 8%和 97 4% ,疗程结束治愈率分别为 95 6%和 96 6% ,断药率分别为 0 3 %和 0 19% ,差异均无显著性(P >0 .0 5 )。结论　家庭督导式规范管理可获得与以医生为主体的全程督导同样的效果。     

不同督导模式对涂阳肺结核患者治疗管理效果的研究

目的 比较不同督导模式下新涂阳肺结核患者的治疗管理效果,为探索科学、高效的结核病患者管理模式提供理论依据。方法 将2016年1月 - 2018年6月确诊的新涂阳患者随机分组,纳入常规医务人员督导模式组（对照组）和新型综合督导模式组（实验组）,随访观察至治疗结束,比较不同督导模式下2月痰阴转率、患者服药率、按时查痰率、治愈率、不良反应发生率的差异。结果 与常规督导组相比,新型综合督导模式组2月痰未转阴的风险降低73.7%（OR = 0.263,95%CI:0.094～0.733)）,未按时查痰的风险降低31.1%（OR = 0.689,95%CI:0.478～0.994)）,不规则治疗的风险降低65.7%（OR = 0.343,95%CI:0.156～0.753）,治疗失败的风险降低65.0%（OR = 0.350,95%CI:0.155～0.791）,发生不良反应的风险降低54.9%（OR = 0.451,95%CI:0.219～0.926）。新型综合督导模式中医务人员电话督导模式效果最佳。结论 新型综合督导模式可有效提高患者的治疗依从性及治疗效果,是切实可行的肺结核督导管理方法,其中医务人员电话督导模式效果最优。     

深圳市南山区登记肺结核患者电子服药系统管理下督导服药情况分析

目的了解深圳市南山区抗结核固定剂量复合制剂(FDC)药物服药情况,从而改进对肺结核患者的督导管理。方法从电子服药系统中导出2013年10月1日至2014年9月30日南山区管理的363例肺结核患者的服药数据,用Excel 2007软件建立数据库进行数据整理、分类筛选统计,采用描述性统计方法分析数据。将研究对象按督导方式分为全程督导组及强化期督导组,以督导点不同将研究对象划分为一级督导点组及三级督导点组,以应用电子系统管理时间将患者分为应用前组(n=437)及应用后组(n=363),利用SPSS 13.0软件对构成比或率进行χ2检验。结果首选FDC药物占总管理患者数的82.65%(300/363),其中,首选且全程服用FDC药物占53.99%(196/363),全程督导组中首选全程服用FDC药物的患者比例为48.69%(112/230),强化期督导组中比例为63.16%(84/133),两组间差异有统计学意义(χ2=7.096,P0.05);首选FDC药物中途换药的占28.66%(104/363),换药原因中药物不良反应占换药比例77.88%(81/104);全程服用FDC药物带药患者比例为47.96%(94/196),其中全程督导组带药患者的比例为67.86%(76/112),强化期督导组带药患者的比例为21.43%(18/84),两组间差异有统计学意义(χ2=41.457,P0.05)。2013年10月1日至2014年9月30日,三级督导点组该时段服药总天数占一级与三级督导点组该时段患者总服药天数比例为32.66%(20 523/62 836),一级督导点组患者服药总天数所占比例为67.34%(42 313/62 836),差异有统计学意义(χ2=3 747.59,P0.05);在该时段,三级督导点组累计月管理服药患者数占一级与三级督导点组总累计月管理服药患者数比例为40.15%(931/2 319),一级督导点组累计月管理服药所占比例为59.85%(1 388/2 319),差异有统计学意义(χ2=105.87,P0.05);应用电子服药系统前后患者治愈率或完成治疗率分别为90.10%、91.46%,差异无统计学意义(χ2=0.399,P0.05)。结论电子服药系统不但方便了肺结核患者取药,还有利于医务人员对南山区的督导服药情况进行详尽了解,为进一步加强和改进督导管理工作奠定了基础。     

全程督导与非督导治疗在初治涂阳肺结核患者临床疗效对比观察

目的对比观察我院收治初涂阳性肺结核全程督导化疗（DOTS）与非督导化疗的效果。方法将204例初涂阳性的肺结核患者随机分为全程督导组（102例）和非全程督导组（102例）,均采用2HRZE/4HR方案,非全程督导组是将一个疗程的药物一次性发给患者,而全程督导组每次服药都采用＂送药到手,看服到口,咽下再走＂的全程督导治疗,并对2组患者进行随访观察。结果化学治疗疗程结束后全程督导组痰夜涂片检查痰菌转阴率为91.40%,非全程督导组痰菌转阴率为76.09%;X线胸片检查,全程督导组吸收有效率为93.55%,非全程督导组吸收有效率为68.48%,P〈0.05,2组比较存在显著性差。随访2年全程督导组的复发率为3.7%,非全程督导组为16.9%。结论初治痰夜涂片阳性的肺结核在全程督导下进行化学药物治疗疗效确切,值得临床推广应用。     

Effectiveness of a community-based observation of anti-tuberculosis treatment in Bangalore City,India, 2010-2011

Setting:

The Revised National Tuberculosis Control Programme in an urban setting of Bangalore City, India.

Objectives:

To compare treatment outcomes and smear conversion rates among new smear-positive tuberculosis (TB) patients undergoing treatment administered by community directly observed treatment (DOT) providers with those undergoing treatment administered by institutional DOT providers in Bangalore City in 2010-2011.

Method:

Cohort study of routine data recorded from treatment cards of TB patients undergoing treatment under the public health services from 1 October 2010 to 30 September 2011.

Result:

Treatment records of 1864 new smear-positive TB patients registered during this period were evaluated. Among those evaluated, 604 (32%) had been administered treatment by community DOT providers and the remainder by institutional DOT providers. The treatment success rate in those undergoing community DOT was 93% (n = 564) and that of those undergoing institutional DOT was 75% (n = 951; RR 1.23, 95%CI 1.19-1.28). The sputum smear conversion rate of patients who underwent community DOT was 92% and that of those who underwent institutional DOT was 71% at the end of 2 months.

Conclusion:

We conclude that community DOT for treatment supervision of TB patients is more effective than institutional DOT and that it should be reinforced.     

Acceptability of community and health facility-based directly observed treatment of tuberculosis in Tanzanian urban setting

SETTING: An urban district in Dar es Salaam, Tanzania. OBJECTIVE: To assess the acceptability of community and health facility-based direct observation of treatment (DOT) of tuberculosis (TB) patients in Temeke district. DESIGN: Both quantitative and qualitative study methodologies were used. Eight focus group discussions were carried out with TB patients, treatment supporters, health workers and community members. Quantitative study was also carried out among TB patients and treatment supporters. RESULTS: A total of 268 patients and 103 treatment supporters were enrolled in the study. The majority of the patients (75%) were satisfied with the DOT options they received. Males were more satisfied with community-based DOT (84%) than females (67%) (OR 4.96, 95% CI 1.38-17.86). The majority (81%) were willing to supervise another TB patient. The results of the qualitative study demonstrated that community-based DOT was preferred because it was found to be convenient, reduced costs, saved time of the patients and reduced workload in health services. The main challenge of community-based DOT was to ensure effective supervision and monitoring of patients and treatment supporters in the community. CONCLUSION: The results from the quantitative and qualitative studies indicate that both DOT options were acceptable. The study has also identified key challenges and opportunities for effective implementation of community-based DOT interventions that are relevant, sensitive and acceptable to the population. Community-based DOT is a viable option and can complement and strengthen the existing health facility-based DOT, especially in countries like Tanzania where the health system is overwhelmed with increasing number of TB and HIV/AIDS patients.     

对涂阳肺结核病人实施直接面视下服药影响因素定性研究

目的：评价重庆市医务人员对涂阳肺结核病人实施直接面视下服药管理的执行情况,找出影响其实施的因素,为今后促进重庆地区的结核病人管理工作提供科学的依据.方法：采用定性研究,对有代表性的4个县的63人,包括县级分管领导,县乡村各级医务人员及涂阳结核病人等进行了关键人物访谈和个人深入访谈.结果：多数结核病人吃药时没有医务人员监督.影响这一管理方式实施的因素包括：医生和病人认为没有必要执行DOT;村医督导病人缺乏有效的激励机制,病人担心受到社会歧视而拒绝接受督导等等.结论：重庆市DOT的执行没有达到国家规划指南的要求,在实际的实施过程中面临了很多的困难.应该针对病人的具体情况及当地的社会经济发展状况来制定切实可行的病人管理模式,以促进结核病控制工作的可持续发展.     

膳食模式与精液质量参数相关性的Meta分析

目的：通过Meta分析评价膳食模式与精液质量参数的相关性。方法：遵循流行病学观察性研究Meta分析（MOOSE）指南,计算机检索PubMed、EMBASE、Web of Science和The Cochrane Library数据库,查找关于膳食模式与精液质量相关性的观察性研究,检索时间自建库至2018年6月。由2位研究者分别严格按照纳入与排除标准筛选文献、提取资料并评价文献质量,采用 Stata 12.0 软件进行 Meta 分析。结果：共纳入7篇文献,总样本量1 873例。Meta分析结果显示,健康膳食模式与非健康膳食模式相比,精子浓度（SMD=0.20,95%CI：0.07～0.33,P=0.003）、精子总数（SMD=0.27,95%CI：0.07～0.46,P=0.008）和精子前向运动率（SMD=0.46,95%CI：0.24～0.69,P＜0.001）提高,差异有统计学意义;精液量（SMD=-0.20,95%CI：0.82～0.42,P=0.525）、精子正常形态率（SMD=-0.01,95%CI：-0.14～0.12,P=0.890）和精子总活力（SMD=-0.10,95%CI：-0.55～0.36,P=0.680）差异无统计学意义。结论：健康膳食模式与男性精子浓度、精子总数和精子前向运动率等精液质量参数有正相关关系。     

Impact of the Level of Adherence to Mediterranean Diet on the Parameters of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Observational Studies

High adherence to the Mediterranean diet (MD) has been associated with a lower prevalence of Metabolic Syndrome (MetS). The present study aimed to investigate the impact of MD adherence on parameters of MetS. A systematic literature search was performed in PubMed, Cochrane Central Registry of Clinical Trials (CENTRAL), Scopus, EMBASE, Web of Science and Google Scholar databases. Observational studies that recorded adherence to MD and components/measures of the MetS, such as waist circumference (WC), blood pressure (BP), fasting blood glucose (FBG), high-density lipoprotein (HDL) cholesterol and triglycerides (TG), were included in this study. A total of 58 studies were included in our study. WC and TG were significantly lower in the high adherence MD group (SMD: −0.20, (95%CI: −0.40, −0.01), SMD: −0.27 (95%CI: −0.27, −0.11), respectively), while HDL cholesterol was significantly higher in the same group (SMD: −0.28 (95%CI: 0.07, 0.50). There was no difference in FBG and SBP among the two groups (SMD: −0.21 (95%CI: −0.54, 0.12) & SMD: −0.15 (95%CI: −0.38, 0.07), respectively). MD may have a positive impact on all parameters of MetS. However, further research is needed in this field.     

Selective directly observed therapy: appraisement and perception of likely participants.

Directly observed therapy (DOT) has become a popular strategy in tuberculosis (TB) control. Limited resources to provide DOT makes selection of patients an issue. Studies were done in San Francisco to analyze the socioeconomic and behavioral characteristics of 1992 TB patients--and of those on DOT--and to determine attitudes of indigent San Franciscans toward TB and adherence to TB control measures. The studies show that (1) African American and Latino patients were more likely to be selected for DOT than Asian/Pacific Islanders and whites, regardless of factors associated with adherence behavior, and (2) DOT, delivered in a respectful manner and combined with incentives, was evaluated positively by those with risk factors.     

Creation of a tuberculosis directly observed therapy provider network in New York City: a new model of public health.

A 1990-1991 New York State Department of Health (NYSDOH) assessment of the ongoing tuberculosis (TB) epidemic in New York City (NYC) led to legislative enactment of policy recommendations to help stem the epidemic. The principal strategy entailed mobilization of community resources for TB directly observed therapy (DOT) to supplement the DOT available from the NYC Department of Health (NYCDOH). For implementation, the NYSDOH engaged a coalition of public and private health care providers in a TB DOT Provider Network. Network participants include freestanding facilities, many of which already have preexisting affiliative relationships through which DOT can be extended. The number of individuals receiving DOT in NYC has increased more than 10-fold in two years. Over 1,000 individuals have completed their anti-TB treatment while enrolled in the network.     

Cost-effectiveness analysis of an alternative tuberculosis management strategy for permanent farm dwellers in South Africa amidst health service contraction

AIM: To establish the cost-effectiveness of lay health workers (LHWs) in conjunction with the current, local tuberculosis (TB) control programme, amidst health service contraction. METHOD: A cost-effectiveness analysis, comparing direct time costs of the current TB management strategy among permanent farm dwellers, with an intervention, whereby LHWs are involved in TB control activities on farms. Measure of effectiveness was case finding and cure rates of adult new smear-positive (NSP) TB cases, alongside a randomized control trial (RCT): RESULTS: The observed cost reduction to the Boland Health District was 74% per case detected and cured on the intervention farms relative to the control farms. Intervention farms reached 83% successful treatment completion rate, control farms 65%. Although the successful treatment adherence was significantly different (18% letter). The improved case detection and cure rates were not statistically significant (chi-squared test). Direct LHW costs are borne by farmers. Farmers were motivated to bear costs by reduced job absenteeism and other positive side-effects. Even without outcome improvements costs per case cured were 59% lower on the intervention farms. CONCLUSION: TB control has suffered from budget reductions in South Africa. It is critically important to develop cost-effective strategies to reduce the TB burden. Costs to public budgets can be substantially reduced while maintaining or improving case detection and treatment outcomes, by using farm-based LHWs.     

Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials

BACKGROUND: Intrauterine devices (IUDs) are safe and effective methods of long-term reversible contraception. The design and copper content as well as placement of the copper on IUDs could affect their effectiveness and side effect profile. We compared different copper IUDs for their effectiveness and side effects. STUDY DESIGN: We searched multiple electronic databases with appropriate keywords and names of the IUDs known to be on the market. We searched the reference lists of papers identified and contacted authors when possible. There was no language restriction. Randomized controlled trials comparing different IUDs that reported on clinical outcomes were considered for inclusion. Two reviewers independently extracted data on outcomes and trial characteristics. We combined the trial results in meta-analyses and expressed results as rate difference (RD) using a fixed-effects model with 95% confidence interval (CI). In the presence of significant heterogeneity, a random-effects model was applied. RESULTS: We included 35 trials, resulting in 18 comparisons of 10 different IUDs in approximately 48,000 women. TCu380A was more effective in preventing pregnancy than MLCu375 (RD 1.70%, 95% CI 0.07-2.95% after 4 years of use). TCu380A was also more effective than MLCu250, TCu220 and TCu200. There tended to be fewer pregnancies with TCu380S compared to TCu380A after the first year of use, a difference which was statistically significant in the fourth year (RD -1.62%, 95% CI -3.00% to -0.24%). This occurred despite more expulsions with TCu380S (RD 3.50%, 95% CI 0.36-6.63% at 4 years). MLCu375 was no more effective than TCu220 at 1 year of use, or MLCu250 and NovaT up to 3 years. Compared to TCu380A or TCu380S, none of the IUDs showed any benefits in terms of bleeding or pain or any of the other reasons for early discontinuation. None of the trials that reported events at insertion found one IUD easier to insert than another or caused less pain at insertion. There is no evidence that uterine perforation rates vary by type of device. There are minimal randomized data on IUD use in nulliparous women. CONCLUSIONS: TCu380A and TCu380S appear to be more effective than other IUDs. No IUD showed consistently lower removal rates for bleeding and pain in comparison to other IUDs. There is no evidence that any particular framed copper device is better suited to women who have not had children.