Development of nocturia in relation to health, age and the menopause

Objectives:To analyse the relationship between nocturia, age, the menopausal transition, parturition and hormone replacement treatment (HRT) in women.Material and methods:A questionnaire study was carried out in 3669 randomly selected women (out of 6000 invited) in the County of Jämtland, Sweden. Questions were asked about health, the occurrence of somatic diseases and symptoms, habits, health care and medication.Results:In univariate analyses age, menopausal state and HRT, but not parturition, were associated with increased nocturia. In a multiple logistic regression analysis, independent correlates for two or more nocturnal micturition episodes versus no more than one episode were: health, poor versus good 2.9 (2.1–3.8); <5 years after the menopause versus before 1.8 (1.3–2.5); 5–9 years after the menopause versus before 2.1 (1.5–3.0); ≥10 years after the menopause versus before 3.1 (2.3–4.2). Age and HRT were deleted by the logistic regression model.Conclusion:The present data indicate that menopausal state, but not age, parturition and HRT are independent correlates of nocturia in 40–64-year-old women.     

Segmentation of Bacteria Image Based on Level Set Method

In biology ferment engineering, accurate statistics of the quantity of bacteria is one of the most important subjects. In this paper, the quantity of bacteria which was observed traditionally manuauy can be detected automatically. Image acquisition and processing system is designed to accomplish image preprocessing, image segmentation and statistics of the quantity of bacteria. Segmentation of bacteria images is successfully realized by means of a region-based level set method and then the quantity of bacteria is computed precisely, which plays an important role in optimizing the growth conditions of bacteria.     

Self-reported comfort in athletic training of gender-specific and non-gender-specific injuries and issues

Context: To assist athletes in maintaining optimal health, athletic trainers must work with athletes of both sexes.Objective: To examine athletic trainers'' comfort levels in providing care for gender-specific and non-gender-specific injuries and issues.Design: We mailed 235 Gender Comfort in Athletic Training Questionnaires to program directors, who were asked to distribute and collect them.Setting: We randomly selected 21 athletic training education program directors and invited them by e-mail to participate in the study. Fourteen program directors representing the 10 National Athletic Trainers'' Association districts agreed to participate.Patients or Other Participants: A total of 192 participants returned completed questionnaires, for a response rate of 82% (103 women, 89 men; 101 senior athletic training students, 91 certified athletic trainers).Main Outcome Measure(s): The questionnaire consisted of 17 injuries and issues common to both female and male athlete scenarios. Three gender-specific items were added to each scenario. Responses were scored on a 5-point scale anchored by 1 (very uncomfortable) and 5 (very comfortable). Participants were asked to indicate the reason for any degree of discomfort. Internal consistency, determined by the Cronbach alpha, was .92 for the female athlete scenario and .93 for the male athlete scenario.Results: We found significant differences between women and men certified athletic trainers for the female and male athlete scenarios. Overall, women were more comfortable caring for female injuries and issues, whereas men were more comfortable caring for male injuries and issues. Certified athletic trainers reported more comfort overall than athletic training students. The most common underlying reason reported for discomfort in caring for female and male injuries and issues was experience level.Conclusions: Athletic training education programs should provide early and more deliberate experiences with injuries and issues of a more intimate nature, including those that are gender specific and non-gender specific. These experiences may increase athletic trainers'' level of comfort in providing care to athletes of the opposite sex.     

Serum digoxin concentrations in a representative digoxin — Consuming adult population

Summary As part of health examination of a representative sample of an adult population (n=8000) serum digoxin concentration was measured in 661 patients on continuous digoxin therapy. The prescribed mean daily dose of digoxin was significantly higher in men (223 µg) than in women (201 µg); the dose significantly decreased with increasing age. The mean serum digoxin concentration was the same in men and women and it differed insignificantly between age groups, although older persons tended to have a higher concentration. The age — adjusted mean steady state digoxin concentration was 1.02 ng/ml in men and 0.98 ng/ml in women; in about 60% the concentration was within the therapeutic range (0.80–2.00 ng/ml). The concentrations were clearly related to daily dose of digoxin. At equal dose levels old persons tended to have higher concentrations than younger persons. The interindividual variation in serum digoxin concentrations was very wide. However, when digoxin measurements in the same subjects were repeated about three months later, a good correlation between the two measurements was found. The interval between the last dose of digoxin and the collection of blood (up to 41 h) had relatively little effect on individual serum digoxin concentrations. Patients on concomitant thiazide or loop diuretic therapy had the same mean serum digoxin concentration as those not-receiving a diuretic. The mean concentration was significantly higher in patients taking a thiazide or loop diuretic combined with triamterene. The difference may have been due to an interaction between triamterene and digoxin.     

Effects of different speeds of induction with sevoflurane on the EEG in Man

The effects of two kinds of induction speed of sevoflurane anesthesia on the EEG pattern were compared in the same individual using medical student volunteers: a first exposure of 4% was given, followed after full recovery, by incremental doses of 1, 2 and 4% successively, each being administered for 10min. The arterial blood level of the anesthetic was measured using gaschromatograph. The changes of EEG pattern during fast induction with 4% were not represented by the abbreviation of those observed during the slow induction with the incremental doses. The administration of 4% induced a sudden appearance of high voltage, rhythmic slow waves of 2–3Hz at 1–3min when the arterial blood anesthetic level increased maximally, which was then followed by a pattern of faster activities of 10–14Hz mixed with 5–8Hz slow waves. In contrast, the administration of incremental doses induced an increase in frequency and amplitude of EEG activities in the light plane, followed by their decreases in deeper planes. The final EEG patterns were identical for both these methods of induction. These findings confirmed our previous hypothesis that not only the arterial blood level of anesthetics but the rate of its increase are important factors determining the EEG pattern of anesthesia.(Avramov MN et al.: Effects of different speeds of induction with sevoflurane on the EEG in man. J Anesth 1: 1–7, 1987)     

Long-term periodontal status of labially erupted canines following orthodontic treatment

Periodontal status was studied at the mesiobuccal, midbuccal and distobuccal aspects of contralateral pairs of canines in 22 postorthodontic patients aged 30 to 51 years with a mean time of 26.4 years (SD, 5.6) out of active treatment. The pretreatment models showed one canine erupting severely to the labial ("ectopic") with a contralateral canine in good arch alignment (control). None of the patients experienced relapse of the "ectopic" canine in a labial direction, and none had missing teeth, malalignment, overhanging restorations or open tooth contacts adjacent to the canines evaluated. Periodontal parameters were examined using a Michigan #0 probe with Williams markings. A nonstandardized light force was used and the measurements were rounded to the nearest millimeter. The results demonstrated statistically significant differences between the canines in probing attachment and bone levels (mean, 0.75; SD, 0.92; P less than 0.01) and width of attached gingiva (mean, 0.50; SD, 1.07; p less than 0.05) at the midbuccal aspects. The reason for these differences could only be speculated upon.     

一例促皮质素静脉外渗至局部皮肤坏死的案例解析与改进

对1例癫痫性痉挛患儿采用促皮质素静脉给药时发生静脉外渗至局部皮肤坏死的案例进行解析。针对事件发生原因,制定并采取措施:静脉穿刺难度事前评估,优化临床监护,加强相关知识培训,以肌肉注射代替静脉滴注等,避免了此类事件的再次发生,提升了临床合理用药水平,确保了患者安全。     

基于双重差分法视角评估按病种分值付费对心血管病种患者的影响

目的 分析按病种分值付费政策对心血管病种患者实施效果并提供相关建议。方法 以广东省某大型三甲综合医院DIP政策实施前后收治的64 970份心血管病种患者为研究样本,通过描述性统计和双重差分法,分析两种不同医保支付方式(广州医保、其他医保)对相关医疗指标的影响。结果 按病种分值付费政策实施后,广州医保患者人均住院费用从49 060.62元下降到46 984.24元(t=-6.924,P＜0.001),自负金额减少2 104.67元(t=-10.654,P＜0.001),住院天数下降0.40天(t=-8.824,P＜0.001),三个指标的差异均具有统计学意义,而其他医保支付方式患者的这三个指标在两个时期的差异无统计学意义。在费用结构中有明显变化幅度的分别是综合医疗服务费(t=53.403,P＜0.001)、诊断费(t=50.198,P＜0.001)、治疗费(t=22.804,P＜0.001)、西药费(t=-12.488,P＜0.001)、血浆和血浆制品费(t=-7.93,P＜0.001)、耗材费(t=-17.901,P＜0.001)以及其他费用(t=-115.076,P＜0.001),差异均具有统计学意义,变化幅度最大的是耗材费,同比减少5.53%。以“风险级别”为分层标准对人均住院费用和住院天数进行双重差分法分层分析,政策效果仅发生在人均住院天数中“中低风险级别”和“没有出现死亡病例”两组病例。结论 按病种分值付费改革有利于增强医院自主管理意识,减轻参保人员个人负担水平,优化费用结构,但仍需加强控制重点费用类别,并未能充分体现医疗服务价值和达到促进分级诊疗目的,需提高支付标准的科学性和精准性。     

1990—2019年中国高血清低密度脂蛋白胆固醇疾病负担趋势分析与预测

目的 描述和分析1990—2019年中国高血清低密度脂蛋白胆固醇（high LDL cholesterol,高LDL - C）疾病负担状况及变化趋势,并预测未来5年的疾病负担,为中国高LDL - C科学防控提供依据。方法 提取2019年全球疾病负担（GBD 2019）中因高LDL - C造成的死亡数、死亡率及DALYs等疾病负担指标,相关指标均采用GBD 2019全球标准人口进行年龄标准化,采用平均年度变化百分比（AAPC）分析率的变化趋势,并应用R 4.1.0对1990—2016年中国因高LDL - C造成的死亡率和DALYs率建立ARIMA模型和NNAR模型,用2017—2019年的数据来评价两模型的拟合效果,最后用拟合效果最好的模型预测2020—2024年中国高LDL - C死亡率和DALYs率。结果 1990—2019年中国高LDL - C造成的死亡率（AAPC = 3.1%,P＜0.05）和DALYs率（AAPC = 2.2%,P＜0.05）整体呈波动上升趋势;标化死亡率和DALYs率增长14.21%和0.56%,男女性别比范围分别为1.33～1.67和1.36～1.76,男性高于女性;年龄别疾病负担≥70岁人群远高于15～49岁和50～69岁群体;ARIMA（0,2,0）和NNAR（1,1）模型预测与实际趋势基本一致,前者预测值与实际值相对误差、均方根误差（RMSE）、平均绝对误差（MAE）以及平均绝对百分误差（MAPE）均较小,预测精度更好。 结论 中国高LDL - C造成的疾病负担呈逐渐上升趋势,在2020—2024年将继续上升。男性、高龄人群疾病负担更加沉重,应采取针对性措施进行干预。