Statin use and medically attended acute respiratory illness among influenza vaccine recipients

BackgroundPrevious studies have suggested that statins decrease influenza vaccine effectiveness and increase risk of medically attended acute respiratory illness (MAARI).ObjectivesTo examine the association of incident statin use and MAARI in a cohort of influenza vaccine recipients.MethodsThis retrospective cohort study evaluated influenza vaccine recipients within the Tricare population. The primary outcome compared MAARI incidence during the follow-up period in a propensity score-matched cohort of incident statin users and statin non-users. Secondary analysis included propensity score-adjusted comparisons between incident statin users and statin non-users in the entire cohort and prespecified sub-cohorts with and without comorbidities. The propensity score was derived from 72 variables encompassing demographics, medical history, comorbidities, medication use, and healthcare utilization.ResultsMAARI incidence in statin users was similar to non-users in the propensity score-matched cohort (odds ratio [OR] 0.92; 95% confidence interval [CI] 0.84–1.01). In contrast, statin users with lower comorbidity had lower OR for MAARI compared to non-users (Charlson Score zero cohort: 0.85 [CI 0.74–0.98]; No Diabetes cohort: 0.88 [CI 0.80–0.96]).ConclusionIncident statin use was not associated with increased MAARI incidence and may be associated with lower incidence of MAARI in those with less comorbidity. This study thus offers reassurance regarding the effectiveness of the influenza vaccine in statin users.     

Alcance de la implementación en Cataluña de las estrategias de salud reproductiva (2008-2017)

ObjectiveWe analyse how reproductive health strategies have been incorporated into the everyday activities of the services and the resulting transformation of professional and user practices.MethodCartographic research taking a multi-sited ethnographic approach that seeks to reveal the processes of transformation. Data generation techniques featuring participant observation and situated interviews. Discourse analysis of the text corpus using three analytical axes based on three main lines of action promoted by the strategies.ResultsWe identified transformations in: 1) demedicalisation: an increase in midwives’ know-how and autonomy, changes in episiotomy practice and the facilitation of bonding practices; 2) warmth of care: incorporation of women's needs and expectations and improvements in the comfortableness of birth settings, especially in assistance at physiological birth; and 3) participation: actions that foster shared decision-making and the involvement of the persons accompanying women in labour.ConclusionsAbove all, transformation is visible in the incorporation of new attitudes, sensibilities and practices that have developed around the old structures, especially during physiological childbirth. The more technological areas have been less permeable to change. Risk management in decision-making and addressing diversity are identified as areas where transformation is less evident.     

Evaluating the transparency of pharmaceutical company disclosure of payments to patient organisations in the UK

Patient organisations contribute to many areas of pharmaceutical policy. In developing their organisational capacity, many turn to financial support from pharmaceutical companies, which may create conflicts of interests. However, the transparency of the industry’s self-regulatory approach to the disclosure of payments to patient organisations has evaded scrutiny. Using company reports disclosing payments to UK patient organisations in 2012–2016, we evaluate the transparency of reporting using indicators derived from industry’s European patient organisation Code. We found a large proportion of companies did not have any disclosure reports available despite many having made payments, confirmed by comparing with annual financial accounts of patient organisations registered as charities. Where disclosure reports were available, many payments were not adequately described, resulting in large portions of money being disclosed without clarity as to the payment type and purpose. We found companies were clearer regarding whether payments were financial or benefits-in-kind, but transparency was particularly inadequate as to whether it could be determined if payments were indirect or direct and restricted or unrestricted, and almost no companies mentioned the VAT status of payments. Our findings suggest that the industry’s self-regulatory approach to transparency has not been working efficiently. We suggest ways for standardising and increasing the precision of information by pharmaceutical companies and advocate for the introduction of a centralised, and easily accessible national-level payment database.     

一线全科医生视角下对新技术如何融入社区信息系统并服务家庭医生签约的思考

我国的家庭医生签约服务正在如火如荼地进行着，目前关于家庭医生签约的评价、见解、效果反馈的研究多来自管理专业、经济学专业、公共卫生专业的学者，尚缺乏来自签约主体之一的医务人员的视角。本文将从一线全科医生即家庭医生签约服务执行者的视角，阐述现阶段基层医疗信息系统服务家庭医生签约的现状，并对其中存在的问题和可能的解决办法进行探讨。     

补脾益肾方联合温针灸治疗重症肌无力疗效及对患者免疫功能的影响

目的:探讨补脾益肾方联合温针灸治疗对重症肌无力(MG)疗效及对免疫功能的影响。方法:随机分配84例MG病例为西药组和针药组,每组各42例,西药组给予常规西药治疗,即泼尼松片中剂量冲击,小剂量隔日维持治疗,针药组基于以上用药基础给予补脾益肾方联合温针灸治疗,治疗3个月后,统计两组治疗前后的中医证候积分,评估两组中医证候疗效,对比治疗前后的颈部血管流速、T淋巴细胞亚群水平和血清可溶性白细胞介素6受体水平。结果:治疗后,两组中医证候积分显著降低,针药组的变化幅度大于西药组(P<0.05); 针药组的中医证候总有效率低于西药组(P<0.05); 治疗后,两组颈内动脉(ICA)、颈总动脉(CCA)、颈外动脉(ECA)显著提高(P<0.05),两组T淋巴细胞中CD₃⁺、CD₄⁺亚群所占比和CD₈⁺、CD₄⁺比值显著降低(P<0.05),两组血清slL-6R水平均显著降低(P<0.05),以上指标针药组变化幅度大于西药组(P<0.05)。结论:补脾益肾方联合温针灸治疗能缓解MG患者的中医证候症状,提高疗效,促进其颈部血管循环,纠正患者自身机体免疫功能紊乱。