Is there an ideal age for hypospadias repair? A pilot study

ObjectiveTo assess whether repairing hypospadias before or after 18 months affects psychological adjustment, health-related quality of life (HRQoL) and surgical outcome.Patients and methodsSeventy-seven boys aged 6–17 years were assigned to one of two groups, according to whether they had a hypospadias repair before or after the age of 18 months. The surgical outcome was assessed using the pediatric penile perception score by non-involved urologists. A psychologist interviewed the patients to assess HRQoL and gender-role behavior. The child's psychological adjustment was assessed with a questionnaire for parents.ResultsThe surgical outcome and complication rate were not significantly different between groups. A covariance analysis of HRQoL, gender-role behavior and psychological adjustment as a function of age at the last operation with current age as covariant was performed, but differences did not reach significance.ConclusionThis study does not provide evidence to support recommendations concerning the ideal age for hypospadias repair. In the absence of evidence of a benefit of early surgery, anesthesia-related risk factors must be considered when operating in very early infancy. Large, prospective studies, measuring surgical and psychological outcome with similar instruments to those presented may reveal whether there is a true ideal age for hypospadias surgery.     

Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk,treatment and outcome

BackgroundUpcoming mass screening for colorectal cancer (CRC) makes a review of recent literature on the association with socioeconomic status (SES) relevant, because of marked and contradictory associations with risk, treatment and outcome.MethodsThe Pubmed database using the MeSH terms ‘Neoplasms’ or ‘Colorectal Neoplasms’ and ‘Socioeconomic Factors’ for articles added between 1995 and 1st October 2009 led to 62 articles.ResultsLow SES groups exhibited a higher incidence compared with high SES groups in the US and Canada (range risk ratio (RR) 1.0–1.5), but mostly lower in Europe (RR 0.3–0.9). Treatment, survival and mortality all showed less favourable results for people with a lower socioeconomic status: Patients with a low SES received less often (neo)adjuvant therapy (RR ranging from 0.4 to 0.99), had worse survival rates (hazard ratio (HR) 1.3–1.8) and exhibited generally the highest mortality rates up to 1.6 for colon cancer in Europe and up to 3.1 for rectal cancer.ConclusionsA quite consistent trend was observed favouring individuals with a high SES compared to those with a low SES that still remains in terms of treatment, survival and thus also mortality. We did not find evidence that the low/high SES gradients for treatment chosen and outcome are decreasing. To meet increasing inequalities in mortality from CRC in Europe for people with a low SES and to make mass screening successful, a high participation rate needs to be realised of low SES people in the soon starting screening program.     

The incidence of varicella and herpes zoster in Massachusetts as measured by the Behavioral Risk Factor Surveillance System (BRFSS) during a period of increasing varicella vaccine coverage, 1998–2003

Background  

The authors sought to monitor the impact of widespread varicella vaccination on the epidemiology of varicella and herpes zoster. While varicella incidence would be expected to decrease, mathematical models predict an initial increase in herpes zoster incidence if re-exposure to varicella protects against reactivation of the varicella zoster virus.     

Impacts of Typhoon ‘Koppu’ on Infectious Diarrhea in Guangdong Province,China

This study aims to quantify the impact of typhoon ‘Koppu’ on infectious diarrhea in Guangdong,China in 2009.Rate ratios (RRs) were calculated by comparing person-time of infectious diarrhea cases between typhoon period and reference period.RRs of dysentery and other infectious diarrhea increased to a maximum of 1.12(95％ CI,0.86-1.47),1.10 (95％ CI,1.00-1.20) on the fifth lag day respectively.     

思维导图在卫生统计学教学中的应用

卫生统计学是公共卫生学科的主干课题,其学习难度较大。思维导图作为一种直观、立体化、可视化的辅助学习方法,与卫生统计学教学具有天然的契合性,它不仅有助于提高教师对授课内容的驾驭能力、提高备课效率和质量,而且有助于引导学生梳理统计学知识、改善传统笔记的记录方式、提高学习效率、培养创新性思维等作用。因此,将思维导图引入卫生统计学教学实践中去,可以为卫生统计学教学改革提供新的教学思想和思考问题的方法,最终提高卫生统计学的教学效果。     

空间经验贝叶斯平滑法在肺癌死亡空间分析中的应用

目的：探讨空间经验贝叶斯平滑法在肺癌死亡空间分析中的应用。方法：利用2010年研究区死亡监测资料,采用空间经验贝叶斯平滑法和地理信息技术分析肺癌死亡的空间分布特征。结果：平滑后肺癌死亡的插值格网图显示,死亡率向局部均值靠拢,高低值区域分布集中,聚集趋势明显。结论：空间经验贝叶斯平滑对肺癌死亡率的估计更加稳定,可为小人群死亡率的空间特征分析提供一种有效的研究方法。     

卫生信息标准对疾病预防控制信息化工作的启示

随着疾病预防控制信息化的发展,标准化和规范化问题日益显现。本文回顾了卫生信息标准工作进展情况,并阐述了卫生信息标准工作对疾病预防控制信息化工作的启示。同时,基于原卫生部在"十二五"期间提出的"35212"卫生信息发展规划,结合电子病历和区域卫生信息平台建设,提出一些有针对性的工作建议。     

Conceptualising access in the direct-acting antiviral era: An integrated framework to inform research and practice in HCV care for people who inject drugs

As direct-acting antiviral (DAA) therapy costs fall and eligibility criteria are relaxed, people who inject drugs (PWID) will increasingly become eligible for HCV treatment. Yet eligibility does not necessarily equate to access. Amidst efforts to expand treatment uptake in this population, we seek to synthesise and clarify the conceptual underpinnings of access to health care for PWID, with a view to informing research and practice.Integrating dominant frameworks of health service utilisation, care seeking processes, and ecological perspectives on health promotion, we present a comprehensive theoretical framework to understand, investigate and intervene upon barriers and facilitators to HCV care for PWID. Built upon the concept of Candidacy, the framework describes access to care as a continually negotiated product of the alignment between individuals, health professionals, and health systems. Individuals must identify themselves as candidates for services and then work to stake this claim; health professionals serve as gatekeepers, adjudicating asserted candidacies within the context of localised operating conditions; and repeated interactions build experiential knowledge and patient-practitioner relationships, influencing identification and assertion of candidacy over time. These processes occur within a complex social ecology of interdependent individual, service, system, and policy factors, on which other established theories provide guidance.There is a pressing need for a deliberate and nuanced theory of health care access to complement efforts to document the HCV ‘cascade of care’ among PWID. We offer this framework as an organising device for observational research, intervention, and implementation science to expand access to HCV care in this vulnerable population. Using practical examples from the HCV literature, we demonstrate its utility for specifying research questions and intervention targets across multiple levels of influence; describing and testing plausible effect mechanisms; and identifying potential threats to validity or barriers to research translation.     

营养强化辅助食品补充物对甘肃贫困农村婴幼儿体格生长的影响

目的探讨补充含有蛋白质、微量营养素的辅助食品对婴幼儿身长和体重的影响。方法从甘肃省5个贫困县选取1478名4~12个月的婴幼儿分成2组,所有儿童均在保持其家庭习惯辅助食品添加的前提下,每天再补充1包不同配方的营养补充物,其中配方1组补充了蛋白质和微量营养素,配方2组补充了与配方1组同等的能量,每隔6个月对全部儿童补充一次大剂量维生素A。补充期间,每3个月进行一次体格测量,两组儿童观察到满24个月为止。结果基线调查时,配方2组LAZ和WAZ要优于配方1组,配方1组儿童的营养不良率均高于配方2组,但差异无显著性(P>0.05)。补充12个月以后,配方1组和配方2组儿童LAZ、WAZ和营养不良率已经没有差别。如果比较同一个儿童随访调查与其基线调查时的LAZ差值、WAZ差值的变化,配方1的作用要优于配方2,效用尺度是0.17。对于基线调查不同营养状况的儿童,配方1组均有正的效用。所有儿童满24个月时,儿童身长和体重Z评分的变化值在配方1组和配方2组之间有显著意义(P<0.05),配方1组婴幼儿身长的变化值要显著大于配方2组(P<0.05),如果只分析基线调查时月龄小于7个月的儿童,配方1组儿童身长Z评分的变化值要显著优于配方2组(P<0.005),儿童平均身长要多增加1.3cm(P<0.005)。结论辅食补充物可以促进婴幼儿的体格发育,家庭水平强化辅食在中国贫困农村是可行的。