Patterns and risk factors associated with index Lower Extremity Amputations (LEA) among Type 2 Diabetes Mellitus (T2DM) patients in Fiji

AimTo describe patterns of index (first ever) Lower Extremity Amputations (LEA) and to determine factors associated with their occurrence amongst Type 2 Diabetes Mellitus (T2DM) patients in Fiji.MethodsThis cross-sectional study was conducted that adheres to the STROBE check lists for observational research among T2DM patients who experienced index LEA at the Colonial War Memorial Hospital (CWMH) in Fiji between 2011 and 2015. Demographic and clinical variables were extracted from patient folders. Univariate and multivariate logistic regression were used to determine factors associated with Major LEA. A p-value < 0.05 was considered significant.ResultsA total of 649 study participants were studied with the average age of index amputation was 58.4 years (±9.6 years, range 30–91 years). The average duration of T2DM was 9.5 ± 5.7 years. LEAs were more common amongst males (55%) and indigenous Fijians (71.8%). One-third of index LEA (33%) were major amputations. Factors associated with occurrence of Major LEA were poor Random Blood Sugar (RBS) levels (OR = 1.68, 95% CI: 1.01, 2.81), midfoot lesion (OR = 9.38 95% CI: 4.95, 19.52), septicaemia (OR = 2.42, 95% CI: 1.28, 4.57), low haemoglobin level (OR = 0.78 95% CI: 0.72, 0.86), and history of hypertension (OR = 0.58, 95% CI: 0.40, 0. 84).ConclusionsResults indicate that diabetic patients with foot infections present late to tertiary level care. Our findings also show an urgent need to strengthen primary care interventions and surveillance of both diabetes and diabetic LEA.     

湖南省郴州市乡镇卫生院基层医生对国家基本药物制度试点效果满意度分析

目的了解湖南省郴州市乡镇卫生院基层医生对国家基本药物制度试点效果满意度,并分析其影响因素。方法采用分层整群随机抽样的方法,在郴州市随机抽取北湖区、苏仙区和桂阳县的9所乡镇卫生院作为调查现场。调查内容包括基层医生对国家基本药物制度的认知度、可及性、可获得性和试点效果满意度等。计算Cronbach’sα系数分析满意度问卷内部一致性,采用频率或构成比描述二分类资料,利用均数和标准差分析描述满意度值,统计推断方法包括95%可信区间,χ2检验,t检验或者方差分析。采用Logistic回归模型分析满意度的影响因素。所有统计分析应用SPSS16.0统计软件包,检验水准为α=0.05。结果 86.6%的基层医生了解国家基本药物制度,超过90%医生认为基本药物制度实行零差率销售会减少患者的药物经济负担,约60%基层医生对基本药物制度试点效果满意,但有68%的医生不满意科室药品收入,有69%医生认为现有基本药物不能满足临床常见疾病的诊治,多因素分析显示医学学历为影响满意度的主要因素。结论多数基层医生对国家基本药物制度试点效果满意,药品质量可以得到保障,国家基本药物制度能够减少患者的经济负担;大多数医生不满意科室收入和基本药物品种数量;中专医学学历的医生满意度较差。     

Complementary and alternative medicine use in British Columbia--a survey of HIV positive people on antiretroviral therapy

In 2002, the British Columbia (BC) Centre for Excellence in HIV/AIDS collected final detailed data on complementary and alternative medicine (CAM) use in their HIV treatment program. This cross-sectional study of 682 participants examines types and determinants of CAM use in this program, and examines adverse effects associated with CAM use and antiretroviral therapy (ART). Among the 47% ever CAM users in the included population, vitamins/minerals (81%), meditation/yoga (36%), massage (31%), marijuana (30%), dietary supplements (24%), and herbal medicines (19%), were most commonly used. Multivariate analysis indicated CAM users were less likely to have low education (AOR=0.51), more likely to be unemployed (AOR=1.52), more likely to have been on ART longer (AOR=1.19), and more likely to experience objective, action-requiring (OA) side effects (AOR=1.45). CAM use is common. Both patients and health professionals should be aware of potential toxicities and drug interactions related to the use of CAM and HIV/AIDS treatment.     

军队男性老年人脑卒中发病与死亡因素的队列研究

目的了解军队男性老年人群脑卒中发病与死亡相关因素。方法从2005年6月30日至2006年6月30日对1987年建立的西安市22所军队干休所离退休干部队列人群进行了再次调查,统计学方法主要应用多元Cox比例风险模型进行多因素分析,由SPSS13.0软件完成。结果至2005年6月30日脑卒中发病186人,调整发病率为984.43/10万人年,其中新发脑梗死157人,新发脑出血29人;至2006年6月30日脑卒中死亡69人,死亡率为357.02/10万人年,其中脑梗死死亡26人,脑出血死亡43人;队列研究结果显示,年龄、收缩压、舒张压、既往脑动脉硬化和高血压病史与脑卒中发病相关,HR值(95%CI)分别为1.037(1.002～1.072)、1.087(1.012～1.169)、1.186(1.050～1.340)、1.515(1.006～2.281)和1.571(1.052～2.347);脑卒中死亡相关因素为年龄、收缩压、吸烟、高血压家族史、卒中家族史、体质指数、卒中、高脂血症和高血压既往病史,HR值(95%CI)分别为1.072(1.017～1.131)、4.283(1.706～10.753)、2.180(1.019～4.665)、2.069(1.066～4.014)、2.069(1.066～4.014)、0.858(0.779～0.946)、10.034(3.366～29.912)、3.351(1.194～9.406)和2.366(1.247～4.491)。结论西安地区军队男性老年人群脑卒中发病以缺血性为主,脑卒中死亡以出血性为主;发病率和死亡率均低于全国水平;控制血压、总胆固醇、总胆红素和体重水平,戒烟,控酒,预防脑动脉硬化、高脂血症和高血压可以降低该人群脑卒中发病风险。     

Facilitators and barriers to external cephalic version for breech presentation at term among health care providers in the Netherlands: A quantitative analysis

Objectiveguidelines recommend that external cephalic version (ECV) should be offered to all women with a fetus in breech presentation at term. However, only 50–60% of the women receive an ECV attempt. We explored the determinants (barriers and facilitators) affecting the uptake of the guidelines among gynaecologists and midwives in the Netherlands.Designnational online survey.Settingthe Netherlands.Participantsgynaecologists and midwives.Measurementsin the online survey, we identified the determinants that positively or negatively influenced the professionals׳ adherence to three key recommendations in the guidelines: (a) counselling, (b) advising for ECV, (c) arranging an ECV. Determinants were identified in a previously performed qualitative study and were categorised into five underlying constructs; attitude towards ECV, professional obligation, outcome expectations, self-efficacy and preconditions for successful ECV. We performed a multivariate analysis to assess the importance of the different constructs for adherence to the guideline.Findings364 professionals responded to the survey. Adherence varied: 84% counselled, 73% advised, and 82% arranged an ECV for (almost) all their clients. Although 90% of respondents considered ECV to be an effective treatment for preventing caesarean childbirths, only 30% agreed that ‘every client should undergo ECV’. Self-efficacy (perceived skills) was the most important determinant influencing adherence.Key conclusionsself-efficacy appears to be the most significant determinant for counselling, advising and arranging an ECV.Implications for practiceto improve adherence to the guidelines on ECV we must improve self-efficacy.     

基于网格化管理下的流动儿童计划免疫接种率调查及其影响因素分析

目的 了解深圳市某社区0～6岁儿童免疫规划的接种率,分析影响流动儿童免疫接种的主要因素,并结合网格化管理探讨流动儿童计划免疫管理工作的新方案。 方法 利用普查的方法对该社区6周岁以内的儿童进行免疫接种情况调查,并随机抽取部分儿童家长进行问卷调查以探索其影响因素。 结果 儿童卡介苗(BCG)、乙肝全程(HepB3)、脊灰三次(OPV3)、脊灰④(OPV4)、百白破三次(DPT3)、百白破④(DPT4)、麻疹①(MV1)、麻疹②(MV2)、乙脑①(JE1)、乙脑②(JE2)、A群流脑两次(MenA2)、A+C群流脑①(MenA1)、甲肝(HepA)的接种率分别为99.57%、95.57%、94.36%、61.48%、95.69%、86.19%、89.43%、88.89%、96.93%、87.36%、92.70%、72.64%、87.83%。非条件Logistic逐步回归显示,儿童出生具体地点、父亲文化程度、是否知道儿童入园入学要凭接种证开查验证明是影响儿童接种的主要因素。 结论 提高流动儿童计划免疫接种率的关键在于建立有效的计划免疫管理模式,提高家长对儿童计划免疫的认识,加强儿童2周岁后疫苗接种的通知与宣传发动工作。     

What are the determinants of post-traumatic stress disorder: age,gender, ethnicity or other? Evidence from 2008 Wenchuan earthquake

Objective

To estimate the prevalence of post-traumatic stress disorder (PTSD) and assess determinants related to PTSD symptoms among adult earthquake survivors after the 2008 Wenchuan earthquake in China.

Study design

Cross-sectional multicluster sample surveys with data collected from four counties.

Methods

Surveys were conducted separately in four counties in Sichuan Province, with a total of 2004 respondents. Beichuan County and Dujiangyan City were damaged more severely than Yaan County and Langzhong County during the earthquake. In total, 1890 households were represented, with a mean of 2.2 respondents per household. Data were collected using structured interviews, and the Harvard Trauma Questionnaire and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria were used to diagnose PTSD.

Results

The prevalence rates of suspected PTSD were 47.3% (n = 436) in heavily damaged areas and 10.4% (n = 93) in moderately damaged areas. The prevalence rates of PTSD symptoms among elderly, middle aged and young adults were 55.8%, 50.2% and 28.6% (P = 0.001), respectively, in heavily damaged areas. Older age, female gender, unmarried/divorced/widowed, ethnic minority, death of family member, no household income and damaged household were independent risk factors for PTSD symptoms in heavily damaged areas.

Conclusion

Interventions designed to reduce PTSD among populations affected by the 2008 earthquake should focus on people without household incomes, those with damaged households and those who experienced the death of a family member. Effective, sustainable and culturally sensitive psychosocial interventions and mental health services are required, and attention should be directed to survivors who experienced the death of a family member, women and older adults following the devastating natural disaster. Governments should support income-generating activities and improve living conditions. Trained field personnel can assist with PTSD assessments and referrals, and existing rural healthcare services can be used to provide treatment for common psychiatric disorders.     

Determinants influencing self-paid vaccination coverage,in 0–5 years old Polish children

Immunization is an important and cost-effective public health intervention to protect the population from illness. In Poland, in addition to free of charge vaccines, listed in the national program on immunization, self-paid vaccinations for pneumococcal, meningococcal, rotavirus, varicella, influenza infections and combination vaccines are recommended. The study objective was to measure the coverage and influencing determinants of self-paid vaccinations in 0–5-year-old children seen between June 2009 and January 2010 at 3 randomly selected GP practices located in one region in the south-western part of Poland. Parents of the children who were seen consecutively were invited to participate and complete questionnaires on socio-demographic data and other factors related to paid vaccination. The response rate: 93.3%. Among the 308 parents (18–50 years old, median 31 years) who agreed to participate, 77.9% (95%CI: 73.0–82.2%) had their child vaccinated with at least one paid vaccine. Combination vaccines were most commonly chosen (62.3%), followed by a pneumococcal (36.4%), influenza (14.3%), meningococcal (13.3%), and rotavirus (12.7%) vaccine. Most parents admitted that their decision was based on a healthcare worker's initiative informing them about the topic. The multi-variable regression model revealed that parent's factors: age ≥ 25 years, high socio-economic status, having one child, and health system factor, i.e. practice location were each associated with greater odds of child immunization The high cost of a vaccine was associated with more than five times lower chance to immunize a child. Observed high coverage rate regarding self-paid vaccines among young children was influenced mostly by combination vaccines. As the cost of a vaccine was an important barrier for the immunization, the gradual introduction of some of currently self-paid vaccines in a national program would be of value. Future interventions on self-paid vaccination coverage should be more tailored, focusing especially on young parents with low income who have more than one child.