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Background/purposePertussis incidence markedly decreased due to universal vaccination, but outbreaks had been noted worldwide in recent decade. This study was conducted to know the epidemiology of pertussis and its impact on infants in Taiwan.MethodsEpidemiologic parameters for confirmed pertussis cases were collected from the Taiwan Centers for Disease Control. The incidence of each age group over years was calculated using population data. We also did retrospective reviews of laboratory-confirmed pertussis cases in NTUH to analyze clinical characteristics and disease severity.ResultsA total of 668 confirmed pertussis cases were obtained from the Taiwan CDC open database between 2003 and 2017. There was higher incidence during the period 2009–2015, with a mean incidence of 0.27 cases per 100,000 population, about 2-fold increase compared with mean incidence of 0.12 cases per 100,000 population during the period 2003–2008. Infants accounted for the highest proportion of all cases (49.8%), with mean incidence of 16.1 cases per 100,000 people per year during 2009–2015, and a trend of increase was found from 2003 to 2015. In NTUH, a total of 17 laboratory-confirmed pertussis cases were diagnosed during 2012–2016, and 14 cases were young infants. Among them, 9 infants had been admitted to intensive care unit and 2 infant needed invasive ventilator support.ConclusionThere was a resurgence of pertussis during 2009–2015 and it had significant impact on infants. Young infants with pertussis may be severe and need intensive care, so preventive strategy may be advocated for them.  相似文献   
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目前,有3种吸吮线虫可感染人体导致吸吮线虫病:结膜吸吮线虫(Thelaziacallipaeda)、加利福尼亚吸吮线虫(T. californiensis)和大口吸吮线虫(T. gulosa)。结膜吸吮线虫主要分布在欧洲和亚洲地区,加利福尼亚吸吮线虫和大口吸吮线虫主要分布在北美地区。结膜吸吮线虫病主要流行于经济卫生条件较差的地区且当地有大量的家养或野生动物感染,虫种鉴定主要依赖口及生殖器官的特征,果蝇为其传播媒介,在亚洲是冈田绕眼果蝇(Phorticaokadai),在欧洲传播媒介则为变色伏绕眼果蝇(P. variegate)。我国是世界上结膜吸吮线虫病例数最多的国家,其他亚洲国家如韩国、日本等也有大量病例报道;欧洲地区病例较少,但在多数国家感染该虫的野生及家养动物较普遍。基于cox1基因,在全球范围内共鉴定出21个单倍型,其中单倍型1(Haplotype1)仅在欧洲不同地区不同宿主之间循环,其他20个单倍型分布于东亚国家(中、韩、日),又以我国的结膜吸吮线虫遗传多态性水平最高。遗传差异性分析表明,亚洲结膜吸吮线虫类群与欧洲类群存在长期地理隔离,且这两个类群在更新世中期已经开始分化。  相似文献   
65.
BackgroundLow back pain is a highly prevalent and disabling musculoskeletal disorder. Physical activity is widely used as a prevention strategy for numerous musculoskeletal disorders; however, there is still conflicting evidence as to whether physical activity is a protective or risk factor for low back pain or whether activity levels differ between people with and without low back pain.ObjectiveTo investigate the association between low back pain and different types (occupational and leisure) and intensities (moderate and vigorous) of physical activity.MethodsThis is cross-sectional observational study. We included in this study a total of 1059 individuals recruited from a Spanish twin registry with data available on low back pain. Outcome: Self-reported leisure and occupational physical activity were the explanatory variables. The low back pain outcome used in this study was recurrent low back pain.ResultsOur results indicate that leisure physical activity is associated with a lower prevalence of recurrent low back pain. In contrast, occupational physical activity, such as carrying, lifting heavy weight while inclined, awkward postures (e.g. bending, twisting, squatting, and kneeling) are associated with a higher prevalence of recurrent low back pain. There was no statistically significant association between other occupational physical activities, such as sitting or standing, and low back pain.ConclusionLeisure and occupational physical activity are likely to have an opposed impact on low back pain. While leisure physical activity appears to be protective, occupational physical activity appears to be harmful to low back pain. Future longitudinal studies should assist in formulating guidelines addressing specific types and intensity of physical activity aimed at effectively preventing low back pain.  相似文献   
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Aim

To describe current practices of glucose-lowering treatments in people with diabetes and chronic kidney disease (CKD), the associated glucose control and hypoglycaemic symptoms, with an emphasis on sex differences.

Methods

Among the 3033 patients with CKD stages 3–5 recruited into the French CKD-REIN study, 645 men and 288 women had type 2 diabetes and were treated by glucose-lowering drugs.

Results

Overall, 31% were treated only with insulin, 28% with combinations of insulin and another drug, 42% with non-insulin glucose-lowering drugs. In CKD stage 3, 40% of patients used metformin, 12% at stages 4&5, similar for men and women; in CKD stage 3, 53% used insulin, similar for men and women, but at stages 4&5, 59% of men and 77% of women used insulin. Patients were reasonably well controlled, with a median HbA1c of 7.1% (54 mmol/mol) in men, 7.4% (57 mmol/mol) in women (P = 0.0003). Hypoglycaemic symptoms were reported by 40% of men and 59% of women; they were not associated with the estimated glomerular filtration rate, nor with albuminuria or with HbA1c in multivariable analyses, but they were more frequent in people treated with insulin, particularly with fast-acting and pre-mixed insulins.

Conclusion

Glucose-lowering treatment, HbA1c and hypoglycaemic symptoms were sex dependent. Metformin use was similar in men and women, but unexpectedly low in CKD stage 3; its use could be encouraged rather than resorting to insulin. Hypoglycaemic symptoms were frequent and need to be more closely monitored, with appropriate patient-education, especially in women.  相似文献   
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Background/Objectives

Due to its rarity, epidermoid cyst in intrapancreatic accessory spleen (ECIPAS) is still a diagnostic dilemma during clinical practice. The aim of this review was to summarize the epidemiologic features and management of ECIPAS.

Methods

MEDLINE and EMBASE were searched for English articles reporting on ECIPAS up to April 30th, 2018 following the methodology suggested by the PRISMA guidelines. Categorical variables were reported as frequency and percentage. Continuous variables were reported as median (range).

Results

A total of 56 patients from 47 full articles were included for the final data synthesis. More than half of the ECIPASs (59%) were found incidentally. The female/male ratio was 1.33. ECIPAS is typically a single mono-/multi-lobular cystic lesions in the pancreatic tail with thickened cystic wall or various amount of solid component which had identical density/signal to the spleen on imaging examinations. The cyst is filled with serous or non-serous fluid. Recognition of the surrounding ectopic splenic tissue is the key point to diagnose ECIPAS. However, no preoperative examination was able to make a definite diagnosis. Almost all the patients (96%) received surgical treatment, due to the suspicion of pancreatic malignant or potentially malignant cystic tumor, especially mucinous cystic neoplasm (MCN).

Conclusions

Although seldom encountered, ECIPAS should be considered as a differential diagnosis for pancreatic cystic lesions, especially when solid component was detected. As a benign disease, unnecessary surgery should be avoided. Because it is difficult to make a definite diagnosis preoperatively by one single examination, multiple modalities may be required.  相似文献   
70.
BackgroundInclusion Health aims to address and prevent the health harms of extreme inequity faced by excluded groups, including those affected by homelessness, drug addiction, imprisonment, and sex work. Engagement workshops with these groups have shown discordance between published research and what research they think is important. We aimed to involve these excluded groups and the wider service, policy, charity, and academic community who work with them to co-develop research and advocacy priorities.MethodsUsing a co-production approach, we held a 1-day event in London, UK, that involved inclusive, participatory, and consensus-building activities. We facilitated workshops on preventing exclusion, improving services for excluded groups, and escaping exclusion. We recorded participants’ views as observations, field notes, and ranked-lists of problems and suggested solutions. Professional artists captured frustrations and hopes for the future by drawing a visual representation. We conducted rapid thematic analysis of discussions on the day and triangulated these sources of information to develop research and advocacy priorities.FindingsApproximately 100 people attended, with at least 20 people with experience of exclusion. The other participants represented the National Health Service, various charity organisations, national, regional, and local government representatives, and several academic institutions. Emerging priorities included the following: tackling the upstream causes of exclusion (political determinants, poverty, and traumatic childhoods); addressing public and professional ignorance, indifference, and stigma by creating inclusion-focused public messages; making services more accessible and integrated through infrastructure (eg, national registries of services); putting excluded groups at the heart of health research, service development, and decision making, through the development of training for recruitment and co-design; and creating better routes out of exclusion.InterpretationDespite challenges in finding a common language, co-production effectively developed an Inclusion Health agenda aligned with the perceived needs of excluded groups and those who work with them. Funding agencies and the public health community should deliver this research agenda to improve the health and lives of people affected by exclusion.FundingUniversity College London Grand Challenges.  相似文献   
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