基于移动医疗的妊娠期盆底肌训练对产后尿失禁发生的影响：一项基于随机对照试验设计的探索性研究

背景 孕产妇尿失禁（UI）发病率高，严重影响了女性生活质量。研究表明，盆底肌训练是UI有效的防治手段，本研究前期进行了一项随机对照试验（RCT），结果发现相比于常规宣教，基于移动医疗APP的盆底肌训练并未显现出预防优势，其原因需要进一步深入探讨。 目的 本研究拟对一项基于APP的妊娠期盆底肌训练的干预研究的阴性结果进行探索性分析，旨在探讨产后UI预防效果的影响因素以及获益的亚组人群。 方法 本研究数据来源于前期开展的一项RCT，采用方便抽样法，于2020年6—10月在南方医科大学深圳医院产科门诊招募了126例研究对象，采用随机数字表法分为干预组与对照组，每组各63例。对照组采用常规护理，干预组在此基础上使用"有爱屋"APP进行尿失禁自我管理，干预周期为2个月。产后42 d随访时收集两组产后相关资料，包括产后42 d UI发生情况。以产后是否发生UI为结局指标，将研究对象分为病例组和对照组，采用Logistic回归分析探讨混杂因素及其与干预方式之间的交互作用对产后UI发生的影响。针对Logistic回归分析的结果进行分层分析，探讨是否存在能从APP干预中获益的亚组人群。 结果 病例组和对照组阴道分娩史、入组时存在UI、Broome盆底肌自我效能量表（BPMSES）得分比较，差异均有统计学意义（P<0.05）。Logistic回归分析结果显示，入组时存在UI是产后发生UI的危险因素〔OR=15.897，95%CI（4.724，53.495），P<0.001〕；BPMSES得分与干预方式的交互作用可影响产后UI的发生〔OR=1.034，95%CI（1.017，1.051），P<0.001〕。分层分析结果显示，入组时存在UI症状的孕妇，干预组产后UI发生率低于对照组（χ2=4.18，P=0.041）；入组时不存在UI症状的孕妇，两组产后UI发生率比较，差异无统计学意义（χ2=1.89，P=0.284）。 结论 推荐有UI症状的孕妇使用"有爱屋"APP或许可预防产后UI的发生。而对于妊娠期没有UI症状的人群使用"有爱屋"APP预防产后UI发生的证据尚不充分。另外，不管有无UI症状，盆底肌训练自我效能高的孕妇有望从APP干预中获益。     

National level data analysis of facial lacerations in Korea using the National Health Insurance Service (NHIS) database

No national epidemiological investigations have been conducted recently regarding facial lacerations. The study was performed using the data of 3,634,229 people during the 5-year period from 2014 to 2018 archived by the National Health Information Database (NHID) of the Health Insurance Review and Assessment Service. Preschool and children under 10 years old accounted for about one-third of patients. Facial lacerations were concentrated in the “T-shaped” area, which comprised forehead, nose, lips, and the perioral area. The male to female ratio for all study subjects was 2.16:1. Age and gender are significantly related with each other (P < .001). Mean hospital stays decreased, and numbers of outpatient department visits per patient were highest for hospitals and lowest for health agencies. Over the study period, hospital costs per patient in tertiary and general hospitals increased gradually. Preschool and school-aged children are vulnerable to trauma. Male patients outnumbered female patients by a factor of more than 2. The “T-shaped’” area around forehead is vulnerable to injury. Total cost of medical care benefits per patient in tertiary hospitals was about 7 times on average than in health agencies. Regarding functional, behavioral, and aesthetic outcomes, more attention should be paid to epidemiologic data and hospital costs for facial lacerations.     

Associations of potentially inappropriate medication use with four year survival of an inception cohort of nursing home residents

BackgroundSurvival in older adults has a high variability. The possible association of length of survival with potentially inappropriate medication (PIM) use remains unclear.AimTo examine the four-year survival rate, the prevalence of polypharmacy and PIM use at admission, and the association between the two, in an inception cohort of newly admitted nursing home residentsMethodsData were used from ageing@NH, a prospective observational cohort study in nursing homes. Residents (n = 613) were followed for four years after admission or until death. PIM use was measured at admission, using STOPPFrail. The Kaplan-Meier method was used to estimate survival, using log-rank tests for subgroup analyses. Cox regression analyses was used to explore associations with PIM use and polypharmacy, corrected for covariatesResultsMean age was 84, 65% were females. After one, two, three and four years the survival rates were respectively 79%, 60.5%, 47% and 36%. At admission, 47% had polypharmacy and 40% excessive polypharmacy, 11% did not use any PIMs, and respectively 28%, 29%, and 32% used one, two and three or more PIMs. No difference in survival was found between polypharmacy and no polypharmacy, and PIM use and no PIM use at admission. Neither polypharmacy nor PIM use at admission were associated with mortality.ConclusionResidents survived a relatively short time after NH admission. Polypharmacy and PIM use at admission were relatively high in this cohort, although neither was associated with mortality.     

Increase in Power through Multivariate Analyses

Power to detect genetic and environmental influences increases not only with sample size but also with the number of measurements through longitudinal and/or multivariate designs, if those measurements correlate with each other. Power simulations are presented for uni- through quadrivariate cases, with differing genetic and environmental parameters. Even though subject attrition is a problem for most longitudinal studies, the gain in power available may more than make up for this shortcoming in many situations. In terms of planning studies to examine genetic and environmental influences, power calculations should not only consider sample size but number of measurements on particular phenotypes and their intercorrelations.     

人机工程学工作分析方法在体力劳动负荷评价中的应用

对鞍钢耐火厂、炼钢厂22个工种分别进行体力劳动负荷的人机工程学分析及劳动强度测定。调查表明,两种方法所得结果基本一致,但人机工程学分析方法简便,易于基层单位推广应用。     

广东省SARS流行株M基因序列分析

目的：测定广东省不同流行时期13份SARS病毒(SARS CoV)标本的M基因序列，通过分析该基因序列的变异情况，初步了解广东省SARS病毒在流行过程中是否发生了变异。方法：提取病毒RNA，用M基因特异引物进行RT-PCR，将产物纯化后直接测定核苷酸序列。结果：13份标本M基因核苷酸序列同源性很高，为99．7％～100％，M基因核苷酸序列只在2个位点(80和203位)发生变异，1株80位点的变化引起编码的氨基酸从苯丙氨酸(F)变为半胱氨酸(C)，3株203位变化为无义突变。结论：M基因核苷酸序列变异不大，初期和后期M基因核苷酸序列与流行高峰期的毒株相差1个碱基，但氨基酸序列相同；从香港感染病人分离的1株病毒M基因与广东本地感染分离株存在1个氨基酸的差异。     

10个钨矿职工死因分析

对中南地区10个钨矿1972—1974年入矿(工龄至少1年)的在册职工28453人进行了队列研究。队列成员追访至1989年,死亡2870人,比全国居民死亡率计算的期望值略高(SMR=1.15,95％CI=1.11—1.19);主要是非恶性呼吸道疾病,特别是尘肺(SMR=66.79,95％CI=59.65—73.68)以及与呼吸道疾病相关的肺心病明显超高(SMR=8.19,95％CI=7.42—9.02),比全国居民死亡率高5倍。癌症死亡数在全死因中虽占第一位,但仅鼻咽癌轻度超高(SMR=1.73,95％CI=1.23—2.37),而肺癌死亡率明显偏低(SMR=0.53)。研究结果不支持矽肺与肺癌病因学相关的假说。     

用速率法测定尿NAG活性及其临床应用

本文报道用５５０型全自动生化分析仪，以速率法测定尿ＮＡＧ活性及本室尿ＮＡＧ活性的正常参考范围；并对可能影响尿ＮＡＧ活性的尿ＰＨ，尿素浓度等进行了干扰试验及分析。     

Second births among teenage mothers: program results and statistical methods

This paper uses survival analysis to examine three large-scale, multi-site, randomized, controlled programs that attempted to prevent or delay second births to teenagers. Statistically significant differences in the hypothesized direction were found between the intervention and the control groups in the Elmira and Memphis Home Visitation sites. No statistically significant differences in the hypothesized direction were found in the Teen Parent Welfare Demonstration overall or in any of its three sites or in all New Chance sites combined. Delaying second pregnancies among teenagers requires intensive efforts. Survival analysis is a more accurate and useful way of presenting program results than simple analysis of the proportion of women with a second birth.     

A new nematode, <Emphasis Type="Italic">Pongobius hugoti</Emphasis> gen. et sp. n. from the orangutan <Emphasis Type="Italic">Pongo abelii</Emphasis> (Primates: Hominidae)

Summary Light and scanning electron microscopical examination and molecular analysis of pinworm samples collected from the Sumatran orangutan (Pongo abelii) from Sumatra (Indonesia) revealed the presence of a new taxon, Pongobius hugoti gen. et sp. n. (Oxyuridae: Enterobiinae). The monotypic genus Pongobius is characterised by the presence of a triangular mouth, three rounded teeth and three chisel-like inner teeth in the buccal cavity, an oesophagus with a long pharyngeal part, corpus posteriorly slightly enlarged and continuing as a pyriform bulb, isthmus absent. These features differentiate P. hugoti from all members of the subfamily Enterobiinae. The male has a long caudal appendix (> 50% of total tail length). Molecular analysis of the new taxon is presented for more precise identification.