医学生基层就业意向及影响因素分析

目的：了解医学生基层就业意向,分析其影响因素,为解决当前医学生就业难与基层人才短缺的结构性矛盾提供参考与建议.方法：采用自行设计的问卷调查表,对杭州师范大学、浙江医学高等专科学校的482名医学生进行调查,通过卡方检验与二分类Logistic多元回归分析医学生基层就业意向的主要影响因素.结果：44.4％的医学生不愿意去基层就业,仅有8.5％表示非常愿意去基层就业.多因素分析结果显示：女医学生的基层就业意向是男生2.5倍（P ＜0.001）;农村户口医学生的基层就业意向是城市户口医学生的2.1倍（P =0.007）;医学生的基层就业意向与政府政策和学校的基层就业指导的效果呈正相关.结论：制定积极的政策、做好宣传与引导工作、探索合理的用人机制、加强学校就业指导和深化教育教学改革是引导医学毕业生面向基层就业的重要措施.     

Do adult patients with diabetes mellitus living in rural part of Ethiopia and having poor social support have disproportionately poor self-care practice? A systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis is aimed at determining the pooled national percentage of diabetic self-care practice and its determinants among adult diabetic patients in Ethiopian.MethodsDifferent electronic databases including PubMed/Medline and search engines such as Google scholar were used to retrieve published studies. The Joanna Briggs Institute quality appraisal checklists were used to appraise the quality of studies. Data were extracted using excel spreadsheets and analyses were done by STATA 14. Heterogeneity among studies was diagnosed using the I² test. The DerSimonian and Laird random-effects model was employed for substantial heterogeneity (I2 > 50%). The pooled estimate of diabetic self-care and odds ratio was reported based on the 95% CI.ResultsA total of 3861 studies were identified, of which only 19 studies have reached the final qualitative synthesis and quantitative analysis. Well over half of the Ethiopian diabetic patients have good self-care 54.04% (47.07–61.01, I² = 97.3, P < 0.001). Subgroup analysis by region showed that the highest pooled estimate was observed in Southern Nations Nationalities and Peoples 81.96% (71.85–92.04), I² = 89.1, p < 0.002), whereas the lowest was from the Harari region 44.53% (32.16–56.89%) I² = 94%, p < 0.001). Being knowledgeable about diabetes Mellitus 2.69 (1.62, 4.46; I2 = 99%, p < 0.001), having good social support 2.25 (1.49–3.39; I² = 99%, p = 0.00), owning private glucometer 3.04(1.64, 5.65; I² = 97.4, P < 0.001), and being urban residents 3.26 (2.24, 4.74; I² = 96.3%, P < 0.001) promote diabetic victims to apply self-care practice.ConclusionsDespite the life-threatening complications of diabetes Mellitus, the percentage of patients applying self-care has remained low in Ethiopia, depicting the high proportion of diabetic patients are prone to develop long and short-term sequelae of diabetes Mellitus. Therefore, improving the client’s awareness about the disease and counseling clients about the significance of social support are believed to be possible strategies to improve self-care practice and policymakers are strongly recommended to combat complications to attain sustainable development goal 3.4 Aims to reduce premature death.RegistrationThe protocol has been registered under the prospective Register of Systematic Review and Meta-analysis (PROSPERO) and received a unique registration number CRD42020151014.     

Mapping vaccine hesitancy—Country-specific characteristics of a global phenomenon

The term vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite the availability of vaccination services. Different factors influence vaccine hesitancy and these are context-specific, varying across time and place and with different vaccines. Factors such as complacency, convenience and confidence are involved. Acceptance of vaccines may be decreasing and several explanations for this trend have been proposed. The WHO Strategic Advisory Group of Experts (SAGE) on Immunization has recognized the global importance of vaccine hesitancy and recommended an interview study with immunization managers (IMs) to better understand the range of vaccine hesitancy determinants that are encountered in different settings. Interviews with IMs in 13 selected countries were conducted between September and December 2013 and various factors that discourage vaccine acceptance were identified. Vaccine hesitancy was not defined consistently by the IMs and most interpreted the term as meaning vaccine refusal. Although vaccine hesitancy existed in all 13 countries, some IMs considered its impact on immunization programmes to be a minor problem. The causes of vaccine hesitancy varied in the different countries and were context-specific, indicating a need to strengthen the capacity of national programmes to identify the locally relevant causal factors and to develop adapted strategies to address them.     

Determinants of protein–energy malnutrition in community-dwelling older adults: A systematic review of observational studies

Protein–energy malnutrition is associated with numerous poor health outcomes, including high health care costs, mortality rates and poor physical functioning in older adults. This systematic literature review aims to identify and provide an evidence based overview of potential determinants of protein–energy malnutrition in community-dwelling older adults.A systematic search was conducted in PUBMED, EMBASE, CINAHL and COCHRANE from the earliest possible date through January 2013. Observational studies that examined determinants of protein–energy malnutrition were selected and a best evidence synthesis was performed to summarize the results.In total 28 studies were included in this review from which 122 unique potential determinants were derived. Thirty-seven determinants were examined in sufficient number of studies and were included in a best evidence synthesis. The best evidence score comprised design (cross-sectional, longitudinal) and quality of the study (high, moderate) to grade the evidence level. Strong evidence for an association with protein–energy malnutrition was found for poor appetite, and moderate evidence for edentulousness, having no diabetes, hospitalization and poor self-reported health. Strong evidence for no association was found for anxiety, chewing difficulty, few friends, living alone, feeling lonely, death of spouse, high number of diseases, heart failure and coronary failure, stroke (CVA) and the use of anti-inflammatory medications.This review shows that protein–energy malnutrition is a multifactorial problem and that different domains likely play a role in the pathway of developing protein–energy malnutrition. These results provide important knowledge for the development of targeted, multifactorial interventions that aim to prevent the development of protein–energy malnutrition in community-dwelling older adults.     

What factors determine patients’ preference for tumour necrosis factor inhibitors in ankylosing spondylitis?

Tumour necrosis factor inhibitor (TNFi) therapy, either intravenous (IV) or subcutaneous (SQ), demonstrates similar efficacy in ankylosing spondylitis (AS). The objective of this study was to examine factors influencing patient preference of TNFi. Fifty-nine (79.7%) participants were male with mean age 43.9 years and disease duration of 22.0 years. Fifty-nine patients (79.7%) agreed with the statement ‘My doctor gave me a choice and I made a decision based on my personal preference’. Patients commenced first on IV TNFi most commonly cited reduced frequency of injections (96.6%), administration by a trained professional (89.7%) and use of infusion time for leisure activities (86.2%). Patients commenced on SQ TNFi cited flexibility with timing of treatment (80%), shortened administration time (73.3%) and the convenience of home therapy (73.3%). Shared clinical decision-making between clinicians and patients may be desirable for AS patients commencing TNFi therapy.     

婚前避孕措施使用状况及其影响因素分析

本文对上海市7872对新婚夫妇婚前,包括结婚登记前和结婚登记至办婚礼期间(简称举办婚礼前,下同)避孕措施的使用状况作了分析。结果表明,结婚登记前和婚礼前,分别有12.3%和15.4%的夫妇有过性行为,其中分别有35.2%和23.7%的夫妇使用过避孕措施。最常使用的避孕措施为安全期、避孕套和体外排精。避孕失败率分别为33.7%和18.0%。避孕失败的最重要原因是安全期计算失误和体外排精失控。结婚登记前不使用避孕措施的主要原因是缺乏避孕知识和无法获得药具。影响夫妇在结婚登记前和婚礼前使用避孕措施的因素有:妻子的避孕知识分数、与他人谈论避孕的能力、夫妇的晚育意愿,发生性行为距结婚登记或距办婚礼的时间间隔。本文对婚前使用的避孕药具的来源及对避孕知识的了解途径也作了分析。调查表明,加强对未婚青年(包括已领取结婚证但尚未办婚礼的夫妇)避孕知识的宣教和避孕药具的发放是必要的。     

Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study

This prospective 18-month study was designed to assess long-term compliance with a program of exercise aimed to prevent osteoporosis after an educational intervention and to uncover determinants of compliance. A total of 135 postmenopausal women were recruited by flyers or instructed by their physicians to participate in an educational session added to usual medical care. After a baseline visit and dual-energy X-ray absorptiometry, volunteers participated in a 1-day educational session consisting of a lecture and discussion on guidelines for appropriate physical activity and training in a home-based exercise program taught by a physical therapist. Scheduled follow-up visits were 1, 6, and 18 months after the educational session. Compliance with the exercise program was defined as an exercise practice rate 50% or greater than the prescribed training. The 18-month compliance rate was 17.8% (24/135). The main reason for withdrawal from the program was lack of motivation. Two variables predicted compliance: contraindication for hormone replacement therapy (odds ratio [OR] = 0.13; 95% confidence interval [95% CI], 0.04 to 0.46) and general physical function scores from an SF-36 questionnaire (OR=1.26; 95% CI, 1.03 to 1.5). To a lesser extent, osteoporosis risk, defined as a femoral T-score –2.5, predicted compliance (OR=0.34; 95% CI, 0.10 to 1.16). Despite the addition of an educational session to usual medical care to inform participants about the benefits of exercise, only a minority of postmenopausal women adhered to a home-based exercise program after 18 months.     

What determines health? To where should we shift resources? : Attitudes towards the determinants of health among multiple stakeholder groups in Prince Edward Island, Canada

The population health perspective has become significant in academic and policy discourse. The purpose of this paper is to assess its significance among health care practitioners and administrators as well as the general public. Respondents in Prince Edward Island, Canada were asked to rank the broad determinants of health and comment on to where resources should be shifted to improve the health of the population. Important variations are noted between the groups with family physicians and front-line staff being similar in perceptions to the general public on most determinants than other groups. The paper concludes with discussion on the relevance of the findings for population health research and health policy.     

输卵管注药绝育术效果影响因素Cox模型分析

本研究采用多中心随机化临床试验设计,共接纳1705例合格受术对象,其条件为术时年龄25～35岁已有两个或两个以上孩子的健康妇女。试验遵照随机原则将复方苯酚糊剂(PAP)和显影苯酚胶浆(PM)分配给合格受术对象。PAP组接纳871例,PM组接纳834例。施术采用细塑料经宫颈插入输卵管间质部定量注药0.08ml,术后拍摄盆腔X光片测量药物在输卵管内的充盈长度。在5年随访观察期间内发生明确诊断妊娠者为失败,其中PAP组失败41例,PM组失败99例。随访率分别为97.5％和98.1％。该随访资料属生存资料,因此本文应用Cox模型对影响生存期(有效期)的主要因素进行了分析。结果表明,绝育药物种类和术后盆腔X光片显影长度与本术节育效果显著有关。以PM组为参照组,PAP组的RR值为0.3407;以输卵管注药显影长度间质部≤0.5cm为参照组,X光显影输卵管峡部1.5～1.9cm组的RR值为0.3163。说明应用PAP和X光片显影显示峡部达1.5cm以上者的失败风险小。分析结果提示,除选择高效粘堵药物外,熟练掌握施术技巧则是保证本术成功的关键。