Bayesian semiparametric joint modeling of longitudinal explanatory variables of mixed types and a binary outcome

Many prospective biomedical studies collect longitudinal clinical and lifestyle data that are both continuous and discrete. In some studies, there is interest in the association between a binary outcome and the values of these longitudinal measurements at a specific time point. A common problem in these studies is inconsistency in timing of measurements and missing follow-ups which can lead to few measurements at the time of interest. Some methods have been developed to address this problem, but are only applicable to continuous measurements. To address this limitation, we propose a new class of joint models for a binary outcome and longitudinal explanatory variables of mixed types. The longitudinal model uses a latent normal random variable construction with regression splines to model time-dependent trends in mean with a Dirichlet Process prior assigned to random effects to relax distribution assumptions. We also standardize timing of the explanatory variables by relating the binary outcome to imputed longitudinal values at a set time point. The proposed model is evaluated through simulation studies and applied to data from a cancer survivor study of participants in the Women's Health Initiative.     

补肾益智方治疗阿尔兹海默病的研究进展

阿尔茨海默病（AD）是最常见的痴呆形式,目前缺少疾病修饰性的治疗药物。中医理论认为肾精亏虚是AD发生发展的内在机制,补肾益精是中医治疗AD的基本原则,贯穿AD治疗的始终。补肾益智方是治疗AD的临床经验方。补肾益智方治疗AD已有大量文献报道,但补肾益智方缺乏临床应用安全性评价,同时其基础研究薄弱,有效成分不明、多靶点作用机制不清。为阐明补肾益智方多成分、多靶点、多途径治疗AD的作用机制,该文综述了补肾益智方治疗AD的研究进展。进一步收集了16个基于高效液相色谱指纹图谱的补肾益智方主要化学成分,并对其成药性与安全性进行评价。利用基于AD重要病理生理学过程的网络药理学与文献综述相结合的方法,深入分析了补肾益智方靶向胆碱能系统、AD神经病理学特征的有效成分及可能机制。该研究为AD对症治疗、疾病修饰性治疗的药物研发提供了一系列有潜力的先导化合物,并为深入拓展补肾益智方的临床应用提供了理论依据。     

肺结核专科护理质量评价指标体系的构建

目的：构建肺结核专科护理质量评价指标体系,为肺结核临床护理质量管理提供参考依据。方法：以Donabedian的“结构–过程–结果 ”三维质量评价模型为理论基础,通过文献检索、德尔菲专家函询法、层次分析法确立肺结核专科护理质量评价指标体系。结果：共有45名专家完成两轮函询,问卷有效回收率均为100%;专家权威系数（Cr）分别为0.822和0.859;两轮函询肯德尔协调系数（Kendall’s W）分别为0.140～0.379和0.107～0.665,P均<0.01。根据条目筛选标准、专家意见及院内外专家小组会议讨论结果,确立终版评价指标体系含一级指标3项,二级指标18项,三级指标73项。结论：肺结核专科护理质量评价指标体系结构合理,构建过程科学、可靠,可为肺结核专科护理质量管理及专业学科发展提供理论参考。     

Effects of Advertising: A Qualitative Analysis of Young Adults’ Engagement with Social Media About Food

Young adults are constantly exposed to energy-dense, nutrient-poor food and beverages, particularly through advertising. Exposure can influence poor food choices and negatively impact health. This study aimed to understand young adults’ attitudes and experiences associated with food-related advertisements, particularly on social media. This qualitative analysis involved n = 166 Australian 18 to 24-year-olds who were involved in a four-week online conversation on different areas relating to health, social media, and eating. Inductive thematic analysis was utilised on two forums on the recall and perceptions of food-related advertisements. Young adults commonly mentioned aspects of the marketing mix (promotion, product, price, and place) in food advertisements. Participants were more readily able to recall energy-dense, nutrient-poor food advertisements compared to healthy food-related advertisements. Digital advertisements were often discussed alongside the use of ad-blockers and algorithms which tailored their social media viewing to what they like. Participants felt constant exposure to unhealthy food advertisements hindered their ability to realise healthy eating behaviours and created feelings of guilt. This current analysis highlights the need to provide an advertising environment that appropriately motivates healthy eating and a food environment that allows healthy food to be the affordable and convenient option.     

Psycho-Behavioural Segmentation in Food and Nutrition: A Systematic Scoping Review of the Literature

Inadequate dietary intakes are a key modifiable risk factor to reduce the risk of developing non-communicable diseases. To encourage healthy eating and behaviour change, innovative public health interventions are required. Social marketing, in particular segmentation, can be used to understand and target specific population groups. However, segmentation often uses demographic factors, ignoring the reasons behind why people behave the way they do. This review aims to explore the food and nutrition related research that has utilised psycho-behavioural segmentation. Six databases from were searched in June 2020. Inclusion criteria were: published 2010 onwards, segmentation by psycho-behavioural variables, outcome related to food or nutrition, and healthy adult population over 18 years. 30 studies were included; most were quantitative (n = 28) and all studies used post-hoc segmentation methods, with the tools used to segment the population varying. None of the segments generated were targeted in future research. Psycho-behavioural factors are key in understanding people’s behaviour. However, when used in post-hoc segmentation, do not allow for effective targeting as there is no prior understanding of behaviours that need to change within each segment. In future, we should move towards hybrid segmentation to assist with the design of interventions that target behaviours such as healthy eating.     

Teacher Evaluation of an Experiential Vegetable Education Program for Australian Primary Schools: Does Face-to-Face Training Add Value above Digital Training?

The teacher-led implementation of healthy eating programs in schools is cost-effective and potentially impactful. Teacher acceptability is important for uptake; however, process evaluations are scarce. This study evaluated the effect of two intensities of teacher training on the evaluation of a vegetable education program for Australian primary schools by teachers. The teachers (n = 65) who implemented the program as part of a cluster RCT (25 schools in two states, New South Wales and South Australia) received either low- (provision with materials and online training) or high (additional face-to-face (F2F) training)-intensity training prior to implementing a 5-week vegetable education program. They evaluated the acceptability of a digital training module and program by indicating the level of agreement with 15 and 18 statements, respectively, using 5-point Likert scales. The average item scores ranged from 3.0 to 4.2. All but one item, including student engagement, alignment to the curriculum and intent for reuse of the program, had a rounded average or median score of 4. The level of training intensity did not impact the teacher acceptability ratings. In conclusion, the teacher acceptability was good, and additional F2F training does not add value above the solely digital training of the teachers.     

A Multidisciplinary,Community-Based Program to Reduce Unplanned Hospital Admissions

ObjectivesTo evaluate the effect of Hospital Admission Risk Program (HARP) on unplanned hospitalization, bed days, and mortality of enrolled individuals and to evaluate the cost-effectiveness of HARP.DesignA retrospective longitudinal analysis of hospital administrative data.InterventionIndividuals at risk of hospitalization were provided with multidisciplinary, community-based care support managed by care coordinators including integrated care planning, education, monitoring, service linkages, and general practitioner liaison over 6-9 months.Setting and ParticipantsIndividuals who were enrolled into 1 of 8 HARP chronic disease management programs between July 1, 2017, and June 30, 2018, at the Royal Melbourne Hospital, Australia.MethodsHospital admissions between 18 months before and 18 months after HARP enrollment were analyzed. Total hospital costs were compared between 18 months before and 12 months after HARP enrollment.ResultsA total of 1553 individuals with a median age of 71 years (interquartile range 60-81), 63.4% males, were admitted to HARP. Both unplanned hospitalizations and bed days were reduced during the HARP intervention compared to within 3 months before enrollment in each of the HARP management programs. After the HARP intervention, cardiac coach, cardiac heart failure, chronic respiratory, diabetes comanagement, and medication management programs had higher hospitalizations and bed days than individuals’ baseline of at least 3 months before HARP enrollment. Individuals in cardiac heart failure and chronic respiratory management programs had a higher mortality rate than other HARP chronic disease management programs. Individuals in cardiac coach, diabetes comanagement, and medication management programs had lower hospital costs during the HARP intervention compared to within 3 months before HARP enrollment.Conclusions and ImplicationsHARP reduced unplanned hospitalization and bed days but did not return individuals’ hospital use to baseline before the intervention. The variations in mortality between HARP chronic disease management programs implies that condition-specific goals between programs is preferable.     

2016—2018年湖南省含乳冷冻饮品生产加工过程肠杆菌科和单核细胞增生李斯特菌监测

目的 了解含乳冷冻饮品生产加工过程中肠杆菌科和单核细胞增生李斯特菌(简称单增李斯特菌)的分布,分析其污染的来源。方法 对湖南省4家含乳冷冻饮品生产企业生产加工过程各个环节的样品进行监测,采用国家标准检测方法对肠杆菌科和单增李斯特菌进行检验,利用脉冲场凝胶电泳(pulse field gel electrophoresis,PFGE)技术对分离的单增李斯特菌进行分子分型。结果 2016—2018年4家企业共监测1 132份样品。2018年66份终产品样品中肠杆菌科定量检测有超标现象(计数结果>100 CFU/g的样品有3份),同时检出2株单增李斯特菌。非食品样品中肠杆菌科检出率最高是工具类样品(48.0%)(χ²=28.440,P＜0.001),单增李斯特菌检出率最高是环境类样品(18.7%)(χ²=41.193,P＜0.001)。分离的102株单增李斯特菌共有11种PFGE带型,其中有6组分离株分别具有同源性。终产品中单增李斯特菌的污染主要来自环境定植菌株。结论 该研究对掌握含乳冷冻饮品生产加工过程肠杆菌科和单增李斯特菌的污染分布及终产品中单增李斯特菌的可能污染源有重要意义,提示企业应加强生产监管,完善生产加工过程中的卫生控制措施,防止潜在风险以保障冷冻饮品终产品的食用安全。     

基于德尔菲法的护理人员医院感染防控能力评价指标体系构建

 目的 构建护理人员医院感染防控能力评价指标体系,为培养及评价护理人员感染防控能力提供客观标准。方法 通过文献查阅和半结构式访谈法拟定护理人员医院感染防控能力评价指标草案,筛选并邀请全国20名感染防控、护理管理、感染性疾病等领域专家采用德尔菲法对草案进行修改,采取层次分析法确定最终指标权重。结果 两轮咨询专家积极系数均为100%,权威系数分别为0.874、0.882;肯德尔和谐系数在0.139~0.545,两轮专家咨询最终确定了包括一级指标3项、二级指标10项、三级指标28项的护理人员医院感染防控能力评价指标体系。结论 研究构建的护理人员医院感染防控能力评价指标体系,可为护理人员医院感染防控能力培训、评价提供依据。     

对促宫颈成熟与引产孕产妇的全程分娩管理模式

目的探讨在全程分娩管理模式下,为孕产妇提供促宫颈成熟与引产服务的可行性。方法选择2018年1月1日至2020年12月31日,在南京大学医学院附属鼓楼医院接受待产、分娩到产后康复(LDRP)一体化全程分娩管理模式(以下简称为LDRP管理)的848例孕产妇为研究对象。根据孕产妇进入产房时是否进入自然产程,将其分为自然临产组(n=441)和引产组(n=407)。采用回顾性分析法,对2组孕产妇的一般临床资料,如分娩年龄、孕次、孕龄、妊娠并发症,以及母儿结局进行比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》的要求,并经过南京大学医学院附属鼓楼医院伦理委员会审核批准(审批文号:201702001)。结果①2组孕产妇分娩年龄、孕次和高龄孕产妇所占比例比较,差异无统计学意义(P>0.05)。2组孕产妇分娩孕龄、经产妇占比、早产率、缩宫素使用率、分娩时长比较,差异有统计学意义(P<0.05)。②引产组孕产妇均使用前列腺素类药物促宫颈成熟或缩宫素进行引产,其中使用地诺前列酮栓、米索前列醇、缩宫素、地诺前列酮栓+米索前列醇分别为26.5%(108/407)、10.3%(42/407)、60.0%(244/407)、3.2%(13/407)。③2组接受LDRP管理孕产妇总剖宫产术分娩率(2.9%vs 7.1%)、会阴侧切率(20.1%vs 28.6%)、新生儿出生体重[3410 g(3180~3650 g)vs 3340 g(3040~3640 g)]、总住院时间[4 d(3~4 d)vs 4 d(4~5 d)]比较,差异均有统计学意义(χ^(2)=7.846、χ^(2)=7.894、Z=-2.730、Z=-5.112,P<0.05)。④2组LDRP管理孕产妇临产后剖宫术分娩产率、产后24 h出血率、产后24 h出血量≥1000 mL、异体红细胞悬液输注率和宫腔水囊压迫率和产后住院天数比较,差异均无统计学意义(P>0.05)。结论为符合纳入、排除标准孕产妇LDRP管理具有一定可行性,孕产妇及其分娩新生儿均可获得良好妊娠结局。