Consultation as a political process

Consultation may be viewed as a political-bargaining process in which actors seek to maximize at minimal cost expertise, organizational position, and organizational reputation. A view of consultation as political process allows for a shift in language in discussions of consultation. Such a language shift suggests shifts in the social meaning of the consultation process. Emphasis was placed on four suggested functions of consultation: definition and legitimation of a situation or of facts as problematic; raising the priority of an issue on the agenda of action in a consultee's agency;legitimation of deviant administrative behavior; and creation and sustenance of interagency linkages. A perspective is proposed that looks at the consequences as well as the intents of the process. This view of consultation can be studied empirically.     

健康素养管理量表(HeLMS)在大肠癌初筛阳性居民中的适用性评估

 目的   对健康素养管理量表(Health Literacy Management Scale,HeLMS)的信度和效度进行评价,探讨其在大肠癌初筛阳性居民中的适用性。方法   采用HeLMS量表对上海市嘉定区2015—2016年1 959名大肠癌初筛阳性的居民进行问卷调查,用因子分析法、Cronbach α系数、相关系数等考察量表的信度和效度。结果    量表的总Cronbach α系数为0.961,量表各维度的Cronbach α系数为0.834~0.929;量表每个条目与其所属维度间的相关系数为0.511~0.936,且均有统计学意义;肠镜检查组的健康素养量表得分为128.99±12.83,显著高于未进行肠镜检查组的126.98±15.66 (P=0.002)。对年龄、性别、初筛阳性特点等进行分层分析,发现年龄>70岁、女性、风险评估及大便隐血均阳性者在肠镜组和非肠镜检查组患者量表得分差异上有统计学意义(P<0.05)。分半信度的Cronbach α系数0.976;因子分析法得到的结果与量表结构大致相符,各维度得分与量表总得分的相关系数为0.517~0.916,均有统计学意义;量表得分的三分位组别(高分、中分和低分)在量表各维度的差异均有统计学意义,提示量表区分效度较好。结论    HeLMS量表在大肠癌初筛阳性居民中具有较好的信度和效度,可用于评价其健康素养水平。     

Outcomes of bariatric surgery in extreme obesity: results from the United Kingdom National Bariatric Surgery Registry for patients with a body mass index >70 kg/m2

BackgroundBariatric and metabolic surgery (BMS) is an established safe, effective, and durable treatment for obesity and its complications. However, there is still a paucity of evidence on surgery outcomes in patients suffering from extreme obesity.ObjectivesThis study aimed to evaluate outcomes of BMS in weight loss and the resolution of co-morbidities in patients with a body mass index (BMI) ≥70kg/m².SettingNational Health Service and private hospitals in the United Kingdom.MethodsThis cohort study analyzed prospectively collected records from the UK National Bariatric Surgery Registry of patients with a BMI ≥70 kg/m² undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or adjustable gastric band (AGB) between January 2009 and June 2014.ResultsThere were 230 patients (64% female) eligible for inclusion in the study: 22 underwent AGB; 102 underwent SG, and 106 underwent RYGB. Preoperative weight and BMI values were comparable (76 ± 7 kg/m² for AGB; 75 ± 5 kg/m² for SG; 74 ± 5 kg/m² for RYGB). The median postoperative follow-up was 13 months for AGB (10–22 mo), 18 for SG (6–28 mo), and 15 for RYGB (6–24 mo). Patients undergoing RYGB and SG exhibited the greatest postoperative total body weight loss (35 ± 13% and 31 ± 15%, respectively; P = .14), which led to postoperative BMIs of 48 ± 10 kg/m² and 51 ± 11 kg/m², respectively (P = .14). All procedures conferred a reduction in the incidence of co-morbidities, including type 2 diabetes, and led to improved functional statuses. The overall complication rate was 7%, with 3 deaths (1%) within 30 days of surgery.ConclusionThis study found that primary BMS in patients with a BMI >70kg/m² has an acceptable safety profile and is associated with good medium-term clinical outcomes. RYGB and SG are associated with better weight loss and great improvements in co-morbidities than AGB. Given the noninferiority of SG outcomes and SG’s potential for further conversion to other BMS procedures if required, SG may be the best choice for primary BMS in patients with extreme obesity.     

极端气温对淄博市居民非意外死亡和寿命损失年的影响

目的 探讨极端气温对非意外死亡数和早死所致的寿命损失年(YLL)的影响,以期为疾病预防控制以及卫生决策提供科学参考。方法 收集和整理2015至2019年山东省淄博市逐日非意外死亡资料和气象资料,计算逐日YLL,采用分布滞后非线性模型(DLNM)分析极端低温和极端高温[分别定义为研究期间日均气温分布的第2.5(-4.2℃)和97.5百分位数(29.1℃)]对非意外死亡数和YLL的滞后效应,并识别脆弱人群。结果 研究期间,淄博市共报告了144 310例非意外死亡,YLL为1 886 493年。极端低温对非意外死亡的影响具有一定的滞后性,单日和累积滞后效应分别在暴露第4和21天最大[死亡的相对危险度(RR)分别为1.05(95%CI:1.04～1.07)和1.23(95%CI:1.10～1.39);YLL的变化值分别为56.51(95%CI:37.92～75.11)和259.55(95%CI:116.45～402.65)年];极端高温的影响较为短促,单日和累积滞后效应分别在暴露当天和第7天最大[死亡的RR分别为1.19(95%CI:1.15～1.24)和1.45(95%CI:1.34～1.5...     

Characterization of onion lectin (Allium cepa agglutinin) as an immunomodulatory protein inducing Th1-type immune response in vitro

Onion (Allium cepa), a bulb crop of economic importance, is known to have many health benefits. The major objective of the present study is to address the immunomodulatory properties of onion lectin (A. cepa agglutinin; ACA). ACA was purified from onion extract by d-mannose-agarose chromatography (yield: ~ 1 mg/kg). ACA is non-glycosylated and showed a molecular mass of ~ 12 kDa under reducing/non-reducing SDS-PAGE; glutaraldehyde cross-linking indicated that ACA is a non-covalent tetramer of ~ 12 kDa subunits. Its N-terminal sequence (RNVLLNNEGL; UniProt KB Accn. C0HJM8) showed 70–90% homology to mannose-specific Allium agglutinins. ACA showed specific hemagglutination activity of 8200 units/mg and is stable in the pH range 6–10 and up to 45 ° C. The immunomodulatory activity of ACA was assessed using the macrophage cell line, RAW264.7 and rat peritoneal macrophages; at 0.1 μg/well, it showed a significant increase (6–8-fold vs. control) in the production of nitric oxide at 24 h, and significantly stimulated (2–4-fold vs. control) the production of pro-inflammatory cytokines (TNF-α and IL-12) at 24 h. ACA (0.1 μg/well) enhanced the proliferation of murine thymocytes by ~ 4 fold (vs. control) at 24 h; however, ACA does not proliferate B cell-enriched rat splenocytes. Further, it significantly elevated the expression levels of cytokines (IFN-γ and IL-2) over the control in murine thymocytes. Taken together, purified ACA induces a Th1-type immune response in vitro. Though present in low amounts, ACA may contribute to the immune-boosting potential of the popular spice onion since considerable amounts are consumed on a daily basis universally.     

Skin advanced glycation end products as a screening tool of neuropathy in type 2 diabetes mellitus

Aim of the studyTo examine the diagnostic utility of skin advanced glycation end products (AGEs) as screening tool of neuropathy in type 2 diabetes mellitus (T2DM).Patients and methodsWe included 132 participants (88 men) with a mean age of 64.57 years and median T2DM duration of 14.5 years. Skin AGEs were measured with AGE reader mu connect (Diagnoptics) on the dominant arm and were interpreted as normal vs. elevated. Distal sensorimotor polyneuropathy (DSPN) was diagnosed by the Neuropathy Disability Score. Cardiovascular autonomic neuropathy (CAN), sympathetic and parasympathetic nervous system impairment were diagnosed by cardiovascular autonomic reflex tests.ResultsFor DSPN, AGEs yielded high sensitivity (82.8%) and NPV (80.4 %) with moderate specificity (55.4 %). For CAN, they yielded relatively high sensitivity (75.0 %) and NPV (74.5 %) with low specificity (48.7 %). For sympathetic nervous system impairment, AGEs yielded relatively high sensitivity (75.0 %) and high NPV (84.3 %) with low specificity (43.9 %). For parasympathetic nervous system impairment, they yielded high PPV (81.0 %) with moderately high sensitivity (66.7 %) and moderate specificity (55.9 %).ConclusionsIn a simplified approach, skin AGEs may be used as a screening tool of DSPN and CAN (including sympathetic and parasympathetic nervous system impairment) in T2DM.     

Analysis of osteoporosis treatment patterns with bisphosphonates and outcomes among postmenopausal veterans

PurposeAdherence and persistence with bisphosphonates are frequently poor, and stopping, restarting, or switching bisphosphonates is common. We evaluated bisphosphonate change behaviors (switching, discontinuing, or reinitiating) over time, as well as fractures and costs, among a large, national cohort of postmenopausal veterans.MethodsFemale veterans aged 50 + treated with bisphosphonates during 2003–2011 were identified in Veterans Health Administration (VHA) datasets. Bisphosphonate change behaviors were characterized using pharmacy refill records. Patients' baseline disease severity was characterized based on age, T-score, and prior fracture. Cox Proportional Hazard analysis was used to evaluate characteristics associated with discontinuation and the relationship between change behaviors and fracture outcomes. Generalized estimating equations were used to evaluate the relationship between change behaviors and cost outcomes.ResultsA total of 35,650 patients met eligibility criteria. Over 6800 patients (19.1%) were non-switchers. The remaining patients were in the change cohort; at least half displayed more than one change behavior over time. A strong, significant predictor of discontinuation was ≥ 5 healthcare visits in the prior year (11–23% more likely to discontinue), and discontinuation risk decreased with increasing age. No change behaviors were associated with increased fracture risk. Total costs were significantly higher in patients with change behaviors (4.7–19.7% higher). Change-behavior patients mostly had significantly lower osteoporosis-related costs than non-switchers (22%–118% lower).ConclusionsMost bisphosphonate patients discontinue treatment at some point, which did not significantly increase the risk of fracture in this majority non-high risk population. Bisphosphonate change behaviors were associated with significantly lower osteoporosis costs, but significantly higher total costs.