An Obesity Risk Assessment Tool for Young Children: Validity With BMI and Nutrient Values

Objective

Demonstrate validity and reliability for an obesity risk assessment tool for young children targeting families' modifiable home environments.

Economic evaluations of occupational therapy approaches for people with cognitive and/or functional decline: A systematic review

With the ageing of the world's population comes significant implications for nearly all sectors of society, including health and aged care spending. Health and aged care systems need to respond to the increasing need for services for older people. Occupational therapy is concerned with maintaining a person's functional independence and well‐being from preventative and treatment perspectives. The aim of this systematic review was to identify the costs and outcomes of occupational therapy for people with cognitive and/or functional decline. The searches for this review were conducted on 23 September 2016 and updated on 20 April 2017. Full economic evaluation studies, partial economic evaluations, randomised trials reporting estimates of resource use or costs associated with intervention(s) and comparator(s) and studies with pre‐ and post‐intervention cost comparators were included. Thirteen studies met the inclusion criteria. The type and duration of occupational therapy intervention in the included studies varied, ranging from one‐off assessments through to systematic multicomponent programmes. Results suggested that structured occupational therapy interventions which comprised of multiple consultations and engaged caregivers delivered better functional and economic outcomes.     

Constructing health capital in ecological systems: A qualitative evaluation of community‐based health workshops in the refugee community

Refugee communities face numerous health and mental health concerns both during and after resettlement. Health issues, already deteriorated by chronic poverty, malnutrition and poor living conditions, are exacerbated by acculturative challenges, such as cultural and language barriers, stigma, and lack of resources and information. Since such needs in refugee communities affect both individual and collective capacity, it is important to consider policy environment and socioecological contexts for cultural adjustment and community resources for navigating systems, rather than individual health behaviours and communication skills only. To expand our understanding of health promotion capacity and resources, a broad and context‐dependent concept will be necessary. Adopting a concept of health capital, this study aims to explore the impact of community‐based health workshops, while expanding and redefining the framework in the context of health promotion efforts for the refugee community in resettlement. As part of community‐based participatory research, this qualitative study conducted seven focus group discussions (FGDs) with 22 Bhutanese refugees in 2014. Using a hybrid thematic analysis, themes emerged from the FGD data were organised and categorised into health capitals in ecological systems. The participants reported enhanced confidence and capacity for health promotion at individual, family and community levels. Given the interdependent coping and lifestyles of refugee communities, impacts on the participants’ interactions and relations with family and community were significant, which emphasises the importance of assessment of interventions beyond an individualistic approach. The findings of this study underscore the vital role of varied forms of health capital in promoting health in the refugee community and connecting members to needed health resources and information. Health capital is an old and yet still new concept with a great potential to broaden our understanding of health resources by elaborating the impacts and interactions in individuals, family and community for health promotion.     

探索利用外部专家开展信息系统投资审计的方法

本文通过利用外部信息技术专家对信息系统工程投资审计的案例,探索对公立医院信息系统软件开发项目实施投资价格评估的审计方法,并将审计结果加以利用,建立长效机制,制定针对信息系统开发的合同模板,取得软件开发的知识产权,引进监理服务,强化对软件开发公司的全过程质量管理,形成对信息系统投资审计的新模式。     

依非韦仑在妊娠早期的安全性评价

目的 评价非核苷逆转录酶抑制剂依非韦仑（efavirenz,EFV）在妊娠早期抗逆转录病毒治疗（antiretroviral therapy,ART）中的安全性。方法 以代表性meta分析为依据,介绍EFV用于妊娠早期的文献资料及各国指南修订变化,对比各指南中妊娠期ART方案中EFV的推荐级别,阐述EFV的药动学和妊娠期用法。结果 EFV对HIV-1病毒有显著抑制作用,早期动物实验和少量人类临床数据显示EFV会导致胎儿神经管畸形,被列为妊娠早期禁用药物。随着样本量增加,数据显示妊娠早期使用EFV不增加整体出生缺陷风险,神经管缺陷风险概率不高于一般人群。但由于人类数据较为有限,仅部分指南推荐妊娠早期使用EFV。结论 针对不同个体的妊娠早期ART方案,仍需针对具体问题进行分析评估。     

复方对乙酰氨基酚片溶出度方法研究及溶出行为评价

目的 建立复方对乙酰氨基酚片的溶出度方法并对不同样品进行溶出曲线评价。方法采用HPLC法,使用Sepax Amethyst C18-H(4.6×150mm,5μm)色谱柱,以磷酸盐缓冲液（取0.01mol/L磷酸二氢钾溶液,用磷酸调节pH值至2.6±0.1）-甲醇（70：30）;流速：1.0ml/min;柱温：35℃;检测波长：波长切换,0～12.5min,波长为275nm,12.5～16min,波长为303nm;溶出度试验采用桨法,以900ml盐酸溶液（稀盐酸24ml,加水至1000ml）为溶出介质,转速为50r?min-1。结果 在本文色谱条件下,阿司匹林和水杨酸分别在12.54～501.60μg?ml-1(r=1.0000)和0.99～39.76μg?ml-1(r=0.9999)范围内线性关系良好;低、中、高3种浓度的平均回收率分别为98.9%、96.7%、97.7%,RSD分别为0.46%、0.65%、0.31%;溶出度方法较好地反映了不同厂家复方对乙酰氨基酚片溶出行为的差异。结论 建立的HPLC溶出度测定方法简单方便,具有较好的专属性、精密度和准确度,溶出方法较好地体现了不同厂家样品间的差异。     

利福霉素钠与利福平治疗肺结核安全性评价

目的 比较利福霉素钠和利福平在治疗肺结核中的安全性.方法 792例肺结核患者分为利福霉素钠组(393例)和利福平组(399例),治疗2个月后评价其安全性.结果 利福霉素钠不良反应发生率(12.47％),较利福平(18.29％)低,严重不良反应发生率:利福霉素钠为1.78％,利福平为5.76％,差异有统计学意义;主要表现为肝损伤、过敏反应、肾功能损伤、血细胞减少和消化道不适.结论 利福霉素钠的不良反应发生率和严重程度小于利福平,若患者不能耐受利福平,可考虑利福霉素钠作为替代治疗.     

综合评估及个体化干预在预防老年人跌倒中的应用

目的 探讨老年综合评估及个体化干预在预防老年人跌倒、降低跌倒风险及发生率方面的作用.方法 选择2015年10月至2016年9月在华北理工大学附属医院老年病科住院患者,应用跌倒风险量表筛选出高风险患者共224例,按随机数字表法随机均分为干预组和对照组,其中对照组患者给予常规的入院疾病治疗、健康教育和临床护理,干预组在此基础上同时进行老年综合评估,并对评估后发现的问题实施科学的个体化干预方案.结果 研究前干预组和对照组跌倒风险评分相比差异无统计学意义(P=0.103);研究后干预组跌倒风险评分相比对照组下降更为明显,差异有统计学意义(P=0.000);干预组跌倒发生率明显低于对照组(P=0.030).结论 综合评估及个体化的干预措施能有效降低老年人的跌倒风险,减少老年人跌倒的发生.     

血清胃泌素释放肽前体在小细胞肺癌鉴别诊断及疗效监测中的价值

目的 探讨血清胃泌素释放肽前体(ProGRP)在小细胞肺癌(SCLC)鉴别诊断、疗效监测中的临床意义。 方法 收集2015年12月至2017年7月在安徽省立医院西区诊治的334例患者资料,其中SCLC134例,NSCLC和肺良性疾病(BLD)患者各100例。回顾性分析其化疗前血清ProGRP、神经烯醇化酶(NSE)和癌胚抗原(CEA)的水平及治疗过程中血清ProGRP水平变化,评估血清ProGRP在SCLC诊治中临床意义。 结果 (1)血清ProGRP和NSE在SCLC患者组均显著高于NSCLC组和肺良性疾病(BLD)组,P<0.05。(2)受试者工作特征曲线(ROC)曲线分析cut-off值取185.25时,血清ProGRP对SCLC诊断敏感性74.6%,特异性100%。(3)血清ProGRP水平与SCLC患者临床特征无相关性。(4)化疗前SCLC治疗有效组和无效组血清ProGRP水平差异无统计学意义(1 556 比 1 025 ng·L-1,P＞0.05),治疗有效组血清ProGRP进行性下降,末次化疗后血清ProGRP与治疗前差异有统计学意义 (121.8 ng·L-1,P<0.05)。治疗无效组血清ProGRP水平在化疗2周期后下降,随后上升。末次化疗后血清ProGRP水平与化疗前差异无统计学意义(989.7 ng·L-1,P>0.05)。 结论 血清ProGRP水平对SCLC鉴别诊断具有高度特异性,SCLC患者治疗过程中ProGRP水平与治疗疗效呈负相关,对SCLC鉴别诊断和疗效预测的具有一定临床意义。     

Time-dependent ROC analysis for censored biomarker data due to limit of detection

Receiver operating characteristic (ROC) curve is a well-established analysis method to evaluate biomarker’s discrimination accuracy for binary outcomes. When the endpoint of interest is time to event outcome such as time to cancer recurrence, a biomarker’s time-varying discriminatory performance is often assessed by time-dependent ROC analysis. In practice, biomarkers are often imprecisely measured due to the limitation of assay sensitivity. The values below the limit of detection are not detectable. Ignorance of such data characteristic may lead to inaccurate estimation of marker’s potential discriminatory power. The objective of this article is to extend time-dependent ROC method to censored biomarker data by using parameter estimates from the Cox regression model that accommodates censored biomarker measurements. In the simulation study, the proposed methods are shown to outperform the simple substitution method that has been conventionally adopted for handling censored data. Application data are also given to illustrate our methods.