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《Revue d'épidémiologie et de santé publique》2021,69(6):345-359
ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies. 相似文献
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Introduction: This article, a supplement to the work of the Institute of Medicine's Committee on Oral Health Access, examines dental access disparities, reviews societal strategies for reducing disparities, explores the relationship between state level public health and dental safety net efforts and utilization/oral health outcomes, and describes selected public health and safety net programs with special promise. Methods: Data were obtained from interviews with state dental directors and safety net leaders and a review of the literature. Findings: There is a two-fold difference in utilization rates between low- (<30 percent) and high- (56 percent) income families. The three societal strategies for reducing disparities - Medicaid, dental safety net system, and increasing the supply of dentists - all have significant limitations. The primary factor positively related to oral health is per capita income. Five promising programs for reducing access disparities include a dental home initiative for young children; a virtual dental home for school children and nursing home residents; a women, infants, and children early oral education and prevention intervention program; an enhanced Medicaid reimbursement program for educational institutions in North Carolina; and a school-based dental care system run by Connecticut Federally Qualified Health Centers. Conclusions: There are wide disparities in access to dental care, and current societal strategies to reduce disparities have significant limitations. At the state level, the primary determinant of oral health status is per capita income. Several states have promising programs to reduce disparities but most are still at the demonstration level and have not been adequately evaluated. 相似文献
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Irwin Hirsch 《Contemporary psychoanalysis》2013,49(3):330-345
It is highly likely that most of us who have founded a psychoanalytic institute or have been responsible for administering one have approached this responsibility with something that approximates idealistic hopes and dreams. As with most other significant commitments in life, however, one soon finds that perfection does not exist, and one begins to adjust to aims and goals that fall short of the original ideals. Even within the most successful and well-respected institutions administrators must recognize the necessity for adaptive compromise. 相似文献
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Donnel B. Stern 《Contemporary psychoanalysis》2013,49(3):292-305
How does the ideal psychoanalytic institute deal with the divergence of ideas? We should teach the desirability of both the accretion of ideas and of the revolution against them. The sum of these two paths is curiosity, a demanding ideal. 相似文献
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Naoto Kawabata 《Contemporary psychoanalysis》2013,49(3):406-414
This article describes the foundation of a psychoanalytic institute in Japan and how its creation was based on the experience of training at the William Alanson White Institute. The process of starting a new institute is compared to the stages of growing plants, including planting seeds, sprouting, pruning, and transplanting. Creating an “ideal” institute requires a belief in education, the ability to find joy in relating to colleagues, and a capacity to deal with the evaluation process and with healthy tensions among subgroups. 相似文献
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目的探讨2型糖尿病合并脑梗死患者发生氯吡格雷抵抗的危险因素。方法纳入112例2型糖尿病合并脑梗死患者,根据血小板聚集率将患者分为试验组(氯吡格雷抵抗组,25例)和对照组(氯吡格雷非抵抗组,87例)。2组患者持续口服硫酸氢氯吡格雷75 mg至少7 d,详细记录患者基本资料并进行美国国立卫生研究院卒中量表(NIHSS)评分和Alberta卒中项目早期电子计算机断层扫描(ASPECT)评分,用腺苷二磷酸(ADP)诱导光比浊法测定血小板聚集功能,并分析其相关性。结果试验组和对照组NIHSS评分分别为(3.91±4.95),(2.40±2.09)分,ASPECT评分分别为(11.57±6.05),(13.40±1.29)分,差异均有统计学意义(均P<0.05)。结论脑梗死严重程度及脑梗死面积是2型糖尿病合并脑梗死患者发生氯吡格雷抵抗的风险因素,脑梗死程度越严重、梗死面积越大在使用氯吡格雷进行二级预防时,对氯吡格雷抗血小板疗效的敏感性较低,需及时调整方案。 相似文献
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Darrell R. Boverhof Greg Ladics Bob Luebke Jane Botham Emanuela Corsini Ellen Evans Dori Germolec Michael Holsapple Scott E Loveless Haitian Lu Jan Willem van der Laan Kimber L. White Jr. Yung Yang 《Regulatory toxicology and pharmacology : RTP》2014
As experience is gained with toxicology testing and as new assays and technologies are developed, it is critical for stakeholders to discuss opportunities to advance our overall testing strategies. To facilitate these discussions, a workshop on practices for assessing immunotoxicity for environmental chemicals was held with the goal of sharing perspectives on immunotoxicity testing strategies and experiences, developmental immunotoxicity (DIT), and integrated and alternative approaches to immunotoxicity testing. Experiences across the chemical and pharmaceutical industries suggested that standard toxicity studies, combined with triggered-based testing approaches, represent an effective and efficient approach to evaluate immunotoxic potential. Additionally, discussions on study design, critical windows, and new guideline approaches and experiences identified important factors to consider before initiating DIT evaluations including assay choice and timing and the impact of existing adult data. Participants agreed that integrating endpoints into standard repeat-dose studies should be considered for fulfilling any immunotoxicity testing requirements, while also maximizing information and reducing animal use. Participants also acknowledged that in vitro evaluation of immunosuppression is complex and may require the use of multiple assays that are still being developed. These workshop discussions should contribute to developing an effective but more resource and animal efficient approach for evaluating chemical immunotoxicity. 相似文献
9.
John P Coghlan 《Clinical and experimental pharmacology & physiology》2014,41(6):381-391
The origins of the Howard Florey Laboratories of Experimental Physiology, Department of Physiology, The University of Melbourne, are tied to the ground‐breaking clinical work of Derek A Denton in 1947 and to the investigations of the initial scientific team into the control of salt and water balance in health and disease over the period 1947–1963 were Professor RD Wright, Drs JR Goding, IR McDonald, John P Coghlan, E Marelyn Wintour and John R Blair‐West. An Act of Parliament in 1971 by the Victorian State Government formally established the Institute named after Howard Florey, the Australian Nobel Prize winner who isolated penicillin. The Howard Florey Laboratories/Institute quickly became an international leader in the scientific areas of the physiological control of body fluids and electrolyte balance, especially sodium regulation and the regulation of the secretion of aldosterone, the adrenal salt‐retaining hormone; the micro measurement of hormones, in particular steroids and peptides; instinctive ingestive behaviour; fetal fluid regulation; hybridization histochemistry, and the hormone relaxin. Subsequently, the senior staff included, inter alia, Bruce Scoggins, Richard Weisinger, John McDougall, Brian Oldfield, Michael McKinley, Robin McAllen, Hugh Niall, Geoff Tregear and Felix Beck. During the 1990s, an explosion occurred in neuroscience and, in 1997, the Board made the strategic decision to change the focus of the Institute to brain disorders. From 1997 to 2007, Fred Mendelsohn steered the Florey to become one of Australia's premier brain research institutes and, under the current director (the eminent clinician and neuroscientist Geoffrey Donnan), this reputation has been further enhanced. 相似文献
10.
目的 观察注射用益气复脉治疗急性分水岭脑梗死的临床效果.方法 80例急性分水岭脑梗死患者完全随机分为观察组(40例),对照组(40例).2组均给予抗血小板聚集、调脂、调控血压、改善微循环及保护脑细胞等治疗,观察组在此基础上加用注射用益气复脉,5.2 g/d静脉滴注,共10 d.治疗前后应用美国国立卫生研究院卒中量表(NIHSS)进行神经功能缺损评分.结果 2组患者治疗后NIHSS评分均低于本组治疗前[观察组(8.4±2.5)分比(13.2±2.3)分,对照组(9.6±3.2)分比(13.4±2.7)分],观察组治疗后NIHSS评分明显低于对照组(P<0.05).观察组治疗有效率为85.0%(34/40),明显高于对照组的65.0% (26/40)(P<0.05).2组均无明显不良反应.结论 注射用益气复脉治疗分水岭脑梗死安全、有效. 相似文献