上海市社区药学服务需求现状

背景 随着患者就诊下沉明显，联合家庭医生团队开展社区药学服务日益重要，但如何发挥家庭医生团队作用以满足患者社区药学服务需求仍有待进一步探索。 目的 了解上海市社区药学服务需求现状，为改进社区药学人员参与家庭医生团队开展服务的方式提供参考建议。 方法 于2020年9—12月，采用多阶段抽样法抽取349例老年慢性病患者和855例家庭医生团队主要成员〔全科医生（n=481）、护士（n=234）、公共卫生医生（n=140）〕进行问卷调查。针对老年慢性病患者的调查问卷主要内容包括基本情况、患病情况、用药情况、社区药学服务需求情况和社区药学服务利用情况。针对家庭医生团队成员的调查问卷主要内容包括基本情况、社区药学服务认知情况和社区药学服务需求情况。 结果 349例老年慢性病患者中，125例（35.8%）同时患有≥3种慢性病，305例（87.4%）每日需多次用药。用药管理类药学服务方面，"用药重整及随访"需求人数最多，为52例（14.9%），"用药随访"利用人数最多，为49例（14.0%）。用药教育类药学服务方面，"慢性病用药特殊性的普及教育"需求人数最多，为247例（70.8%），"宣传健康生活方式"利用人数最多，为33例（9.4%）。家庭医生团队成员中，全科医生、护士、公共卫生医生对药学服务的了解程度方面，分别有440例（91.5%）、202例（86.3%）、112例（80.0%）表示了解；对药师的信任程度方面，分别有302例（62.8%）、183例（78.2%）、103例（73.6%）表示非常信任；"协同医师做好药物使用遴选"服务项目的需求人数分别有359例（74.6%）、112例（47.9%）、81例（57.8%）；"指导护士使用与管理药品"服务项目的需求人数分别有190例（39.5%）、153例（65.4%）、57例（40.7%）。 结论 一方面患者实际迫切需要用药管理类药学服务，另一方面患者的用药教育类药学服务需求远未得到满足。鉴于社区药学人员队伍薄弱及家庭医生团队对社区药学服务认知局限的现状，社区药学人员应通过培训团队成员，提升团队的社区药学服务认知水平及服务能力，借助团队力量及成员特性，更广泛高效地开展社区药学服务。     

横断面研究能否进行因果推断

基于变量调查(或测量)的共时性、统计学关联及幸存者偏倚等原因,横断面研究被认为不能进行因果推断,这是当前的"共识"。本文基于因果思维,借助因果图,首先明确定义真实截面和测量截面,并识别截面概念仅存在于理论的特性。实际横断面研究中,测量变量的共时性并不存在,而是无一例外地表现为非共时性时序,其实质上相当于测量变量间互为独立性假设,或不存在有差别错分偏倚。类似于累积病例对照研究和历史性队列研究,横断面研究均为暴露和结局已存在或发生后进行的测量,这种测量相当于对变量值的历史重建或"考古"。这类研究进行因果推断的共性前提条件之一是,测量变量与其历史变量间必须存在着因果律。测量变量均为真实变量的替代者,测量变量间的时序在因果推断上并不重要。应加强对横断面研究分析性角色的认识。     

基于离散型地理信息的H7N9流感病毒动态时空传播模式

目的 基于离散型的地理信息构建了H7N9病毒时空动态传播模式图，探索H7N9病毒的空间传播路径。方法 选取全球共享禽流感数据倡议组织（GISAID）中中国以人类为宿主的H7N9流感病毒血凝素（HA）和神经酰胺酶（NA）基因序列，利用BioEdit 7.0软件进行多序列比对。在贝叶斯理论框架下，运用BEAST 1.8.2软件构建H7N9时空传播模型，采用symmetric substitution model和贝叶斯随机搜索变量选择（BBSVS）方法，对H7N9的历史传播轨迹进行推断和检验。以Google Earth软件展现H7N9病毒的时空传播动态图。结果 感染人类的H7N9病毒起源于上海或杭州，最早可追溯到2012年10月。并在2013年3、4月份开始传向邻近省份，同年8、9月份传播加剧，3个月内传向10余处地区。结论 基于基因核苷酸序列和空间地理信息，追踪了H7N9病毒历史传播轨迹，为早期流感疫情的防控及病毒的溯源提供线索。     

基于大自然时间轴的测量时序分类法

因果推断中，时序（或方向性）的概念尚未完全明确。本文从因果思维出发，以真实因和真实果的发生时间将大自然时间轴划分为3个时域和2个时点，从而锚定了因果推断只能实现于第3时域。测量时序可分为5种类型：跨第1和3时域纵向时序（实验性时序）、跨第2和3时域纵向时序、同时域纵向时序、同时域逆纵向时序和同时域横向时序（观察性时序）。这种分类法适用于首次或多次测量、及时和延后测量等所有测量策略。除了实验中真实因的测量（或干预措施）在其发生之前（第1时域）或观察和实验中真实因的测量在真实果发生之前（第2时域）的情形外，所有其他测量策略类似于历史重建或"考古"，测量时序的重要性次于测量的准确性。从研究设计应整合偏倚设计的观点来看，本文提出基于大自然时间轴的测量时序五分类法，概念清楚并将有助于判断研究过程中可能出现的偏倚，为正确进行因果推断研究奠定基础。     

TIGIT and PD-1 may serve as potential prognostic biomarkers for gastric cancer

Gastric Cancer (GC) is the fifth leading cause of cancer-related death in the world, and in urgent need of specific therapeutic targets to acquire prominent effectiveness. T-cell immunoglobulin and immunoreceptor tyrosine–based inhibitory motif (ITIM) domain (TIGIT) and programmed cell death protein 1 (PD-1) are identified to be abnormally overexpressed in various types of cancers including GC. This study aimed to investigate whether TIGIT and PD-1 could serve as potential prognostic biomarkers for GC. Firstly, TCGA GC dataset analysis and correlation analysis were utilized to inspect the relationship between expression of TIGIT, PD-1 and CD8 + T cells in GC and adjacent normal tissues. Then, flow cytometry was used to verify the data after collecting the peripheral blood, GC and adjacent normal tissues from 150 GC patients. Lastly, quantitative RT-PCR was performed to detect the expression of CD155, CD113, CD112 and TIGIT in six human GC cell lines and 631 GC patients in KM Plotter Database to conduct prognostic analysis. As results, we found that TIGIT and PD-1 were upregulated in GC tissues with high CD8 + T cells infiltration, while correlation analysis indicated they were in high-positive correlation. In addition, the flow cytometry analysis further showed that the high-expression of TIGIT in tumor microenvironment of GC could suppress the function of infiltrative CD8 + T cells, which leads to the escape of GC cells from immune killing. Furthermore, CD155 and CD112 were found abnormally upregulated in GC tissues and cell lines and the high expression of CD155, CD112 and TIGIT demonstrated poor prognosis results. In conclusion, these results provided potential therapeutic targets and prognostic biomarkers for treatment of GC in clinic.     

Cumulative risk assessment of the exposure to pyrethroids through fruits consumption in China – Based on a 3-year investigation

In the present study, the long-term and short-term cumulative risks of pyrethroids exposured for the Chinese general population and children through fruits consumption were evaluated. A total of 1450 fruit samples and seven pyrethroids were included based on the pesticide residues monitoring programme of China from 2013 to 2015. The exposure was estimated using both deterministic approach and semi-probabilistic model for comparison. The hazard index approach was used to assess cumulative risk. 26% of samples contained pyrethroid residues with concentrations ranged from 0.0050 mg/kg to 1.2 mg/kg, of which 30% simultaneously with 2–4 mixture residues. Results demonstrated that the cumulative health risks were extremely low for both general population and children (1–6 years old) of China in the long term. Acute risk estimations calculated by deterministic method were several or many times overestimated than the results based on semi-probabilistic method. Acute cumulative exposure of children to pyrethroid compounds in 0.76% samples were exceeded 1 in worst case scenario. More detailed assessments with adequate data in the future use probabilistic method is expected to reduce the uncertainties of cumulative dietary exposure.     

Social Determinants of Breastfeeding in the United States

Despite overall improvement in breastfeeding in the past 3 decades in the United States, significant and alarming social disparities persist. Adverse social determinants of health are increasingly recognized as root causes of social disparities in health outcomes, including breastfeeding initiation and continuation. We provide an overview of the evidence and mechanisms by which social determinants of health, including education, employment, food, neighborhood, and housing contribute to ongoing social disparities in breastfeeding in the United States, including current research gaps. We also review the intersection of social determinants of health with income, racism, and theory of planned behavior, a commonly used decision-making framework for breastfeeding promotion. Future interventions to address social determinants of breastfeeding should occur at the policy, community, organization, and individual levels.     

Prenatal exposure to perfluoroalkyl substances,immune-related outcomes,and lung function in children from a Spanish birth cohort study

BackgroundPrenatal exposure to perfluoroalkyl substances (PFASs) has been associated with impaired immune and respiratory health during childhood but the evidence is inconsistent and limited for lung function. We studied the association between prenatal PFASs exposure and immune and respiratory health, including lung function, up to age 7 years in the Spanish INMA birth cohort study.MethodsWe assessed four PFASs in maternal plasma samples collected during the 1st trimester of pregnancy (years: 2003–2008): perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorononanoate (PFNA). Mothers reported the occurrence (yes/no) of lower respiratory tract infections, wheezing, asthma, and eczema in the previous 12 months at 1.5 and 4 years of the child (n = 1188) and at 7 years (n = 1071). At ages 4 (n = 503) and 7 (n = 992) years lung function was assessed using spirometry tests.ResultsThe most abundant PFASs were PFOS and PFOA (geometric means: 5.80 and 2.31 ng/mL, respectively). The relative risk of asthma during childhood per each doubling in PFNA concentration was 0.74 (95 CI%: 0.57, 0.96). The relative risk of eczema during childhood per every doubling in PFOS concentration was 0.86 (95 CI%: 0.75, 0.98). Higher PFOA concentrations were associated with lower forced vital capacity and lower forced expiratory volume in 1 s z-scores at 4 years [β (95 CI %): −0.17 (−0.34, −0.01) and −0.13 (−0.29, 0.03), respectively], but not at 7 years.ConclusionThis longitudinal study suggests that different PFASs may affect the developing immune and respiratory systems differently. Prenatal exposure to PFNA and PFOS may be associated with reduced risk of respiratory and immune outcomes, particularly asthma and eczema whereas exposure to PFOA may be associated with reduced lung function in young children. These mixed results need to be replicated in follow-up studies at later ages.