Socioeconomic position and cardiovascular risk factors among people with screen-detected Type 2 DM: Six-year follow-up of the ADDITION-Denmark trial

AimsTo examine whether socioeconomic position (SEP) was associated with change in cardiovascular risk factors and meeting treatment targets for cardiovascular risk factors among individuals with screen-detected Type 2 DM at six-year follow-up.MethodsThe study population was 1533 people with Type 2 DM identified from at stepwise diabetes screening programme in general practice during 2001–2006 in the ADDITION-Denmark study. The ADDITION-study was performed as a randomised trial but the two randomisation groups were analysed as one cohort in this study. Cardiovascular risk factors were measured at baseline and repeated at follow-up (mean: 5.9 [1.4] years). Information on SEP, redeemed antihypertensive and lipid-lowering treatment were obtained from Danish registers. Multivariate analyses were performed to estimate change in cardiovascular risk factors and difference in meeting treatment targets.ResultsThe change in HbA_1c, cholesterol, blood pressure and BMI were virtually the same across educational level, income level, occupational status or cohabiting status. Overall, the ability to meet treatment targets for HbA_1c, cholesterol and blood pressure was not modified by SEP-group. A higher proportion of people with lower educational level or lower income level in the intensive care redeemed anti-hypertensive treatment compared to people with higher educational or income levels.ConclusionScreen-detection and early treatment onset did not introduce socioeconomic inequality in metabolic control in people with screen-detected Type 2 DM at six-year follow-up.     

Antibiotic optimisation in ‘the bush’: Local know-how and core-periphery relations

The growing global concern around antimicrobial mis-use and proliferating resistance has resulted in increasing interest in optimising antibiotics, particularly in hospitals. While the agenda to tighten antibiotic use has been critically explored in metropolitan settings, the dynamics of rural and remote settings have remained largely unexplored. Drawing on 30 interviews with doctors, nurses, and pharmacists in a remote Australian hospital, we focus on the pertinence of setting, and its importance for contextualising and potentially achieving antibiotic optimisation. Building on previous work on the dynamics of locale and core-periphery relations, here we consider how antimicrobial practice is deeply embedded in experiences of being on the geographical periphery, and crucially, at the periphery of (established) knowledge.     

Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group

AimTo determine if patients with untreated chronic lymphocytic leukemia (CLL) benefit from vaccination with a 13-valent pneumococcal conjugated vaccine (PCV13), Prevenar13®, compared to a 23-valent pneumococcal polysaccharide vaccine (PPSV23), Pneumovax®, in terms of immune response.BackgroundStreptococcus pneumoniae causes substantial morbidity in patients with CLL, a group known to respond poorly to polysaccharide vaccines. Comparative studies with conjugated vaccines are lacking.Methods128 treatment naïve CLL patients from eight hematology clinics in Sweden were randomized to vaccination with PCV13 (n = 63) or PPSV23 (n = 65) after stratification by IgG level and CLL clinical stage (Rai). Blood samples for evaluation of immune response were obtained at baseline, and at one and six months after vaccination. Analyses for each of the 12 pneumococcal serotypes common for PCV13 and PPSV23 were performed by opsonophagocytic assay (OPA) and enzyme-linked immunosorbent assay (ELISA).ResultsPCV13 elicited a superior immune response than PPSV23 in 10/12 serotypes one month after vaccination and in 5/12 serotypes six months after vaccination, measured as OPA geometric mean titers (GMTs). Geometric mean concentrations of serotype-specific IgG antibodies elicited by PCV13 as measured by ELISA, were higher than those elicited by PPSV23 in half of the common serotypes, both after one and six months. PPSV23 did not trigger a better immune response than PCV13 for any of the serotypes, regardless of analysis method or time point of analysis. Negative predictive factors for vaccination response were hypogammaglobulinemia and long disease duration. Both vaccines were well tolerated.ConclusionsIn patients with previously untreated CLL, the efficacy of PCV13 in terms of immune response is superior to PPSV23 for most serotypes common for the two vaccines. We therefore propose that PCV13 should be included in vaccination programs against Streptococcus pneumoniae for CLL patients and administered as early as possible during the course of the disease.     

The effect of a grief support program on Turkish parents whose babies have died

The purpose of this study was to determine the effect of the Grief Support Program on the bereavement of parents whose babies had died. The sample consisted of 77 couples. The data was collected by the Texas Revised Inventory of Grief and the Coping Strategies Inventory. The intervention group was offered before, immediately after, and a month after death of their baby in accordance with the Grief Support Program guideline. The Grief Support Program did not affect grief intensity in the short term but had a positive effect 1 year later.     

成釉细胞蛋白基因多态性与氟斑牙关系的研究

目的观察成釉细胞蛋白(AMBN)基因多态性在重庆市燃煤型氟中毒人群中的分布，探讨AMBN基因多态性与氟斑牙的关系。方法采用病例对照研究，在重庆市巫山、奉节县2个燃煤型氟中毒病区抽取8~12岁氟斑牙患病儿童100例、成人30例作为病例组;分别抽取非氟斑牙患病8~12岁儿童100例、成人30例作为内对照组，另在渝北区(非病区)抽取50名儿童、30名成人作为外对照组。采集所有研究对象外周静脉血，提取DNA，采用聚合酶链反应一限制性片段长度多态性(PCR-RFLP)方法测定3组人群AMBN基因7号外显子(538_{_} 540de1GGA),10号外显子(657A > G)和13号外显子(986C>T)位点基因型，观察并分析比较组间各基因型分布差异。结果病例及内、外对照组GGA/GGA基因频率分别为61.2%(74/121),78.5%(102/130)和74.3%(52/70 ), GGA/-基因频率分别为24.0% ( 29/121),15.4% ( 20/130)和22.9% (16/70 )，-/--(GGA完全缺失)基因频率分别为14.8%(18/121),6.1%(8/130)和2.8% ( 2/70 )，各组间的差异有统计学意义( x²=14.353, P=0.006 );病例及内、外对照组AA基因频率分别为86.8%(105/121),93.1%(121/130)和91.4% ( 64/70 ), AG基因频率分别为13.2%(16/121),6.9%(9/130)和8.6% ( 6/70 )，各组间差异无统计学意义(x²=2.972,P>0.05);病例及内、外对照组CC基因频率分别为81.0% ( 98/121),90.0% (117/130)和87.1%(61/70);CT基因频率分别为19.0% ( 23/121),10.0% (13/130)和12.9% ( 9/70)，各组间差异无统计学意义(x²=4.319,P>0.05)。与两对照组相比，病例组的GGA/GGA基因型频率降低(x²值分别为8.957,3.405,P值均<0.05 ), GGA完全缺失基因型频率增高(才值分别为5.134,6.833,P值均<0.05。单因素分析显示，携带一基因型的个体发生氟中毒的风险增高(病例组与内、外对照组比较，OR值分别为2.7, 5.9, P值均<0.05 )。与内对照组比较，病例组CT基因型频率增高(x²=4.139,P<0.05)。病区携带CT基因型的个体发生氟中毒的风险增高(OR=2.1,P< 0.05 )。结论AMBN基因7号外显子538_{_}540de1GGA和13号外显子986C>T位点多态性可能是影响氟斑牙发病的易感性因素之一。     

生态位理论对医疗行业可持续发展的适用性

为探讨生态位理论对医疗行业可持续发展的适用性,通过基于文献研究与理论分析的适用性分析法研究,提示生态位理论在医疗行业可持续发展中具有背景适用性和理论适用性,医疗行业可持续发展问题研究可以跳出行业本身,站到生态文明的高度客观审视,可能更容易找到问题根源及解决方案,生态位理论及其视角可以为相关研究提供借鉴。