On Supplementing “Foot in the Door” Incentives for eHealth Program Engagement

Financial health incentives, such as paying people to lose weight, are being widely implemented by Western nations and large corporations. A growing number of studies have tested the impact of incentives on health behaviors, though few have evaluated the approach on a population-scale. In this issue of the Journal of Medical Internet Research, Liu et al add to the evidence-base by examining whether a single incentive can motivate enrollment and engagement in a preventive eHealth program in a sample of 142,726 Canadian adults. While the incentives increased enrollment significantly (by a factor of about 28), a very high level of program attrition was noted (90%). The “foot in the door” incentive technique employed was insufficient; enrollees received incentives for signing-up for, but not for engaging with, the eHealth program. To supplement this technique and drive sustained behavior change, several theoretically- and empirically-based strategies are proposed. Specifically, incentives indexed to behavioral achievements over time are highlighted as one approach to boost engagement in this population in the future.     

Measurement of Mercury in Human Hair

Measurements of total and inorganic mercury in human hair were used to trace the history and extent of methyl mercury exposures. Data on the distribution of mercury in hair were converted by a mathematical model into information about the key indices of exposure, including times of onset and termination, peak concentration in hair, and half-time of retention in blood. The model was used for computer simulations of the true distribution of mercury in hair and was validated by analyses of segments of single hairs. Conventional methods of hair sampling and fitting the resulting data to a curve were shown to introduce systematic errors underestimating peak concentrations and overestimating retention times. These errors were minimized by practical modification of the hair sampling procedures and by a new graphic method for deriving the measurements of distribution of the trace element in hair.     

Sexual morbidity following radical hysterectomy for cervical cancer

Radical hysterectomy for early stage cervical cancer has satisfactory results in terms of survival, but may impact negatively on a patient’s quality of life, which may include sexual dysfunctions. Female sexual dysfunctions (FSD) represent a frequent morbidity but often remain unrecognized and undertreated. Although discussions regarding sexuality are found by many medical doctors to be sensitive and embarrassing, psychosexual counseling is an essential component of comprehensive care for gynecological cancer patients and their partners. The goal of this article is to summarize and discuss available relevant data on FSD in women who have undergone radical hysterectomy for an early stage of cervical cancer.     

肝硬化病人首次食管胃底静脉曲张破裂出血现状及其危险因素的调查分析

目的:探讨肝硬化病人首次食管胃底静脉曲张破裂出血(EVB)现状及其危险因素。方法:收集2017年12月—2019年1月收治的307例肝硬化病人为研究对象,经治疗后将未发生首次EVB的229例病人设为对照组,首次出现EVB的78例病人设为观察组。分析两组病人临床基本信息及相关资料,统计静脉曲张破裂出血现状,采取单因素分析及多元Logistic回归模型分析发生出血状况的危险因素。结果:多元Logistic回归分析结果显示,饮酒史(OR=1.912)、门静脉主干内径(OR=2.760)、肝功能Child-Pugh分级(OR=2.375)、失血量(OR=3.682)、食管静脉曲张分级重度率(OR=5.013)、红色征(OR=2.704)为肝硬化病人首次EVB独立危险因素。结论:肝硬化病人发生首次EVB的独立危险因素包括饮酒史、门静脉主干内径、肝功能Child-Pugh分级、失血量、食管静脉曲张分级重度率、红色征。医护人员应加强危险因素监测,帮助病人戒烟酒、忌粗糙饮食,定期复查,加强早期预防及诊断,以改善病人生活质量和生命健康水平。     

The Effectiveness and Safety of Platelet-Rich Plasma for Chronic Wounds: A Systematic Review and Meta-analysis

ObjectiveTo evaluate the effectiveness and adverse events of autologous platelet-rich plasma (PRP) in individuals with lower-extremity diabetic ulcers, lower-extremity venous ulcers, and pressure ulcers.Patients and MethodsWe searched multiple databases from database inception to June 11, 2020, for randomized controlled trials and observational studies that compared PRP to any other wound care without PRP in adults with lower-extremity diabetic ulcers, lower-extremity venous ulcers, and pressure ulcers.ResultsWe included 20 randomized controlled trials and five observational studies. Compared with management without PRP, PRP therapy significantly increased complete wound closure in lower-extremity diabetic ulcers (relative risk, 1.20; 95% CI, 1.09 to 1.32, moderate strength of evidence [SOE]), shortened time to complete wound closure, and reduced wound area and depth (low SOE). No significant changes were found in terms of wound infection, amputation, wound recurrence, or hospitalization. In patients with lower-extremity venous ulcers or pressure ulcers, the SOE was insufficient to estimate an effect on critical outcomes, such as complete wound closure or time to complete wound closure. There was no statistically significant difference in adverse events.ConclusionAutologous PRP may increase complete wound closure, shorten healing time, and reduce wound size in individuals with lower-extremity diabetic ulcers. The evidence is insufficient to estimate an effect on wound healing in individuals with lower-extremity venous ulcers or pressure ulcers.Trial RegistrationPROSPERO Identifier: CRD42020172817     

The Impact of Psychosis on Sexual Functioning: A Systematic Review

BackgroundSexual dysfunction among psychotic patients is highly prevalent. However, most research has focused on antipsychotic side effects on sexual functioning.AimTo provide evidence by means of a systematic review of the literature about the impact of psychosis on sexual functioning among unmedicated patients.MethodsSystematic search of MEDLINE (PubMed), Scopus, and Google Scholar for studies that reported sexual functioning among psychotic patients, who were drug-naïve or drug-free for at least 3 weeks before the study. Studies were published in English language between January 1994 and October 2019. We used the approach recommended by PRISMA, and the selection process was carried out by 2 reviewers.OutcomesThe outcome measures were sexual function and sexual dysfunctions.ResultsA total of 734 articles were obtained, 658 were obtained after duplicates were removed, 612 were excluded after reading the title and abstract, and 46 were included for a complete review of the articles. 5 papers were finally included. A total of 770 cases were included in the systematic review. The prevalence of sexual dysfunction in psychosis varied from 16.8% to 70% and in ultra-high state was 50%. It is noteworthy that those ultra–high-risk (prodromal) patients who develop psychosis had higher rates of sexual impairment. Therefore, we found higher rates of sexual dysfunction among untreated patients, both psychotic and ultra-high risk patients, than healthy controls.Clinical ImplicationsThe assessment of sexual behavior should be a part of routine psychiatric examination not only in psychotic but also in ultra–high-risk patients.Strengths & LimitationsThis is the first systematic review about the impact of psychosis on sexual functioning among unmedicated patients. However, scarce and heterogeneous studies were identified.ConclusionsImpaired sexual functioning is common in the onset of psychosis (or during ultra–high-risk state) and prior to the beginning of treatment. This suggests that psychotic symptoms and sexual dysfunction may have common etiological pathways at the psychosocial and neurobiological levels.Vargas-Cáceres S, Cera N, Nobre P, et al. The Impact of Psychosis on Sexual Functioning: A Systematic Review. J Sex Med 2021;18:457–466.