采用同伴推动抽样法进行男男性接触人群HIV／STD流行病学调查的探索

目的探索同伴推动抽样法（Respondent driven sampling，RDS）在我国男男性接触（MSM）人群调查的可行性。方法使用RDS对北京市MSM进行抽样调查及血清学检测，了解他们艾滋病病毒（HIV）、性病感染状况及行为特点；采用RDSAT软件进行统计分析，NETDRAW和EXCEL作图。结果共征募MSM　325人，其中35岁以下占90．5％，未婚占83．0％（95％CI：76．4～88．9），外地户籍为61．9％（95％CI：54．0～70．1）；HIV感染率为0．4％（95％CI：0．1～0．5），梅毒抗体阳性率为13．7％（95％CI：9．1～19．0），梅毒RPR阳性率6．0％（95％CI：3.8～8．7）；56．2％（95％CI：50．0～65．0）为男性性取向，88．9％首次性行为年龄≤24岁，56．3％（95％CI：49．5～64．0）半年内有≥2个性伴，近6个月无保护插入性肛交为51.8％（95％CI：44．0～59．4），无保护被插入性肛交为44．8％（95％CI：37．2～52．3）。结论RDS简便易行，无需过多凋查员投入前期准备工作，实为开展隐匿人群调查的行之有效的方法之一。北京市MSM人群HIV感染率可能处于低水平．但存在HIV行隐患。     

Potential and Challenges in Collecting Social and Behavioral Data on Adolescent Alcohol Norms: Comparing Respondent-Driven Sampling and Web-Based Respondent-Driven Sampling

Background

Respondent-driven sampling (RDS) is a method successfully used to research hard-to-access populations. Few studies have explored the use of the Internet and social media with RDS, known as Web-based RDS (WebRDS). This study explored the use of combining both “traditional” RDS and WebRDS to examine the influences on adolescent alcohol use.

Objective

This paper reports on the recruitment processes and the challenges and enablers of both RDS and WebRDS. It details comparative recruitment data and provides a summary of the utility of both methods for recruiting adolescents to participate in an online survey investigating youth alcohol norms.

Methods

Process evaluation data collected from research staff throughout the study were used to assess the challenges and solutions of RDS and WebRDS. Pearson chi-square test (Fisher’s exact test if applicable) was used to compare the differences in sociodemographics and drinking behavior between data collected by RDS and WebRDS.

Results

Of the total sample (N=1012), 232 adolescents were recruited by RDS and 780 by WebRDS. A significantly larger proportion of Aboriginal or Torres Strait Islander (P<.001) participants who spoke English as their main language at home (P=.03), and of middle and lower socioeconomic status (P<.001) was found in the RDS sample. The RDS sample was also found to have a higher occurrence of past 7-day drinking (P<.001) and past 7-day risky drinking (P=.004). No significant differences in gender, age, past month alcohol use, and lifetime alcohol use were observed between the RDS and WebRDS samples. This study revealed RDS and WebRDS used similar lengths of chains for recruiting participants; however, WebRDS conducted a faster rate of recruitment at a lower average cost per participant compared to RDS.

Conclusions

Using WebRDS resulted in significant improvements in the recruitment rate and was a more effective and efficient use of resources than the traditional RDS method. However, WebRDS resulted in partially different sample characteristics to traditional RDS. This potential effect should be considered when selecting the most appropriate data collection method.     

深圳市MSM人群的HIV感染状况及相关危险因素

目的了解深圳市男男性行为人群（MSM）艾滋病病毒（HIV）感染状况及其行为特征,分析其影响因素,为制定针对性干预策略提供建议。方法应用同伴推动抽样法招募MSM,采用电脑辅助自填问卷形式进行调查,采血检测HIV和梅毒抗体。使用RDSAT软件进行统计分析。结果调查的492名MSM,HIV阳性率为4．6％[95％可信区间（CI）：2．59％～6．7％],梅毒患病率为16．4％（95％CI：11．9％～21．0％）。平均年龄为（27．2±6．3）岁,初中以上文化占98．4％,该市户籍占8．5％,60％以上通过互联网寻找性伴,最近半年内平均男男性伴数为2．37个,32．2％的调查对象最近6个月男男性行为时未能使用安全套。艾滋病基本知识知晓率仅为61．1％,安全套使用知识知晓情况也较差,仅为55．7％。Logistic回归分析结果显示,在深圳居住小于3个月、已婚、来自HIV高流行地区、有超过一个非商业男性性伴,是MSM感染HIV的危险因素;最近6个月内获得过艾滋病相关服务,是感染HIV的保护因素。结论需进一步加强MSM中HIV监测和干预工作,有效阻断HIV传播和蔓延。     

肺表面活性物质的临床应用进展

肺泡表面活性物质是Ⅱ型肺泡上皮细胞合成的一种磷脂-蛋白复合物,具有降低肺泡表面张力、维持肺泡稳定性、减少肺泡中液体外渗、预防肺水肿、促进气道的清除功能、抑制支气管收缩及增加肺免疫功能、减轻炎症反应、提高肺抗感染能力等多种作用。天然肺泡表面活性物质和合成肺泡表面活性物质制剂经气管注人或雾化吸人,临床治疗原发性肺泡表面活性物质缺乏性疾病及各种继发性肺泡表面活性物质缺乏相关性疾病具有一定疗效。     

Foetal to neonatal transition — what can go wrong?

Failure of the foetus to make a successful transition from the intrauterine environment can be life threatening. Prompt recognition of problems can enable critical, life-saving interventions to take place. Whilst there are numerous adaptations of the newborn at birth, this article focuses on those which are the most common and/or clinically urgent, and describes not only the conventional treatments but also emerging therapies. The article therefore covers maladaptive processes in the normal newborn, not those with genetic or other congenital problems which cause maladaptation due to the underlying disease. Likewise, it is outside the scope of this article to discuss neonatal jaundice, as it is arguably not a maladaptation, and may also not be the ‘design flaw’ that it has previously been considered to be, as bilirubin may have a physiological role as the main antioxidant in the newborn in the first week of postnatal life. I have described five neonatal conditions: transient tachypnoea of the newborn, respiratory distress syndrome, persistent pulmonary hypertension, which can all cause significant hypoxaemia, patent ductus arteriosus which is usually not clinically significant but is common and often causes considerable parental anxiety, and transient hyperinsulinaemia which can cause profound hypoglycaemia.     

Morbidity after surgical treatment of isolated intestinal perforation and necrotizing enterocolitis is similar in preterm infants weighing less than 1500 g

Introduction

Isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC) seem to be separate diseases, though their surgical treatment is similar. We compared the morbidity after surgery for IIP and NEC in preterm infants (birth weight <1500 g).

Patients and Methods

Isolated intestinal perforation was defined as intestinal perforation with associated necrosis less than 5% of bowel length and NEC as necrosis of 5% or more of bowel length ± perforation. Outcome measures included time to full enteral feeds, incidence of total parenteral nutrition-associated cholestasis, and nutritional and neurologic status up to 60 months of age. Data are quoted as median (range).

Main Results

Sixty-one surviving patients treated between 1986 and 2006 were retrospectively reviewed (IIP: n = 32 versus NEC: n = 29). Median % resection of small and large bowel in IIP and NEC was 2% (1%-22%) versus 12% (6%-32%), and 5% (2%-13%) versus 7% (2%-25%), respectively (P < .05 in both). There was no significant difference in gestational age, birth weight, incidence of cerebral hemorrhage, respiratory distress syndrome, or surgical technique (enterostomy or primary anastomosis). Median time to enteral feeds, incidence of total parenteral nutrition-associated cholestasis, length of ventilation, and ultimate nutritional and neurologic outcome did not differ statistically significantly between the groups.

Conclusion

Surgery in NEC resulted in more extensive intestinal resection than in IIP. However, subsequent morbidity was similar in both groups.     

Full-term neonatal intenstive care unit admission in an urban community hospital: the role of respiratory morbidity

Objective.?To investigate the incidence of respiratory morbidity among full-term neonatal intenstive care unit (NICU) admissions and identify risk factors for such admissions.

Methods.?We performed a retrospective cohort study of NICU admissions between 1/06 and 12/08. We included neonates between 37 and 40 weeks with a diagnosis of transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), pneumonia, pneumothorax, and meconium aspiration syndrome. Obstetrical outcomes were compared with a control group of women during the same period whose neonates were not admitted to the NICU.

Results.?Two-hundred two infants admitted to the NICU with respiratory morbidity were compared with 9580 controls. TTN comprised the majority of the respiratory morbidity. Only RDS was associated with cesarean delivery.

Conclusion.?RDS remains a significant morbidity in full-term NICU admission. When compared with controls, admissions to our NICU with any respiratory morbidity were more likely to be delivered by cesarean to a mother with hypertension or diabetes during pregnancy.     

Eosinophil cationic protein in tracheal aspirates of preterm infants with bronchopulmonary dysplasia

Eosinophil cationic protein was elevated during the first week of life in tracheal aspirates from 11 preterm infants in whom bronchopulmonary dysplasia subsequently developed compared with 8 preterm and 8 term infants without bronchopulmonary dysplasia. Eosinophil cationic protein levels increased progressively with continued intubation in the infants with bronchopulmonary dysplasia but remained low in a comparison group of term infants. We suggest that eosinophils participate in the inflammatory process in bronchopulmonary dysplasia and may contribute to lung injury. (J Pediatr 1997;130:944-7)     

眼镜蛇毒对油酸型呼吸窘迫综合征的保护作用

实验组小白鼠先从腹腔注射眼镜蛇毒(200μg/kg),然后从尾静脉注射油酸(0.07ml/kg),对照组先从腹腔注射生理盐水(200μl/kg),再从尾静脉注入同剂量油酸。结果表明,实验组的肺湿重、肺干重、肺系数及肺含水量等指标均比对照组显著下降。增加静脉注射的油酸剂量至0.1ml/k8,重复实验,结果相同。说明适量的眼镜蛇毒可缓解油酸型呼吸窘迫综合征(RDS)。