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991.
992.
K. A. Harding M. E. Pushpanathan S. R. Whitworth S. Nanthakumar R. S. Bucks T. C. Skinner 《Diabetic medicine》2019,36(12):1600-1611
993.
Hanna Lee Mary K. Tan Andrew T. Yan Paul Angaran Paul Dorian Claudia Bucci Jean C. Gregoire Alan D. Bell Martin S. Green Peter L. Gross Allan Skanes Charles R. Kerr L. Brent Mitchell Jafna L. Cox Vidal Essebag Brett Heilbron Krishnan Ramanathan Carl Fournier Shaun G. Goodman 《The Canadian journal of cardiology》2019,35(2):160-168
Background
Physicians treating nonvalvular atrial fibrillation (AF) assess stroke and bleeding risks when deciding on anticoagulation. The agreement between empirical and physician-estimated risks is unclear. Furthermore, the association between patient and physician sex and anticoagulation decision-making is uncertain.Methods
We pooled data from 2 national primary care physician chart audit databases of patients with AF (Facilitating Review and Education to Optimize Stroke Prevention in Atrial Fibrillation and Coordinated National Network to Engage Physicians in the Care and Treatment of Patients with Atrial Fibrillation Chart Audit) with a combined 1035 physicians (133 female, 902 male) and 10,927 patients (4567 female and 6360 male).Results
Male physicians underestimated stroke risk in female patients and overestimated risk in male patients. Female physicians estimated stroke risk well in female patients but underestimated the risk in male patients. Risk of bleeding was underestimated in all. Despite differences in risk assessment by physician and patient sex, > 90% of patients received anticoagulation across all subgroups. There was modest agreement between physician estimated and calculated (ie, CHADS2 score) stroke risk: Kappa scores were 0.41 (0.35-0.47) for female physicians and 0.34 (0.32-0.36) for male physicians.Conclusions
Our study is the first to examine the association between patient and physician sex influences and stroke and bleeding risk estimation in AF. Although there were differences in agreement between physician estimated stroke risk and calculated CHADS2 scores, these differences were small and unlikely to affect clinical practice; further, despite any perceived differences in the accuracy of risk assessment by sex, most patients received anticoagulation. 相似文献994.
K.-C. Sung D.-C. Seo S.-J. Lee M.-Y. Lee S.H. Wild C.D. Byrne 《Nutrition, metabolism, and cardiovascular diseases : NMCD》2019,29(5):489-495
Background and aims
It is not known whether non alcoholic fatty liver disease (NAFLD) is a risk factor for diabetes in non obese, non centrally-obese subjects. Our aim was to investigate relationships between fatty liver, insulin resistance and a biomarker score for liver fibrosis with incident diabetes at follow up, in subjects who were neither obese nor centrally-obese.Methods and results
As many as 70,303 subjects with a body mass index (BMI) < 25 kg/m2 and without diabetes were followed up for a maximum of 7.9 years. At baseline, fatty liver was identified by liver ultrasound, insulin resistance (IR) by homeostatic model assessment of insulin resistance (HOMA-IR) ≥2.0, and central obesity by waist circumference (waist circumference ≥90 cm (men) and ≥85 cm (women). The Fibrosis-4 (FIB-4 score) was used to estimate extent of liver fibrosis. Cox proportional hazards models adjusted for confounders were used to estimate hazard ratios (aHRs) for incident diabetes. As many as 852 incident cases of diabetes occurred during follow up (median [IQR] 3.71 [2.03] years). Mean ± SD BMI was 22.8 ± 1.8 and 21.7 ± 2.0 kg/m2 in subjects with and without diabetes at follow up. In subjects without central obesity and with fatty liver, aHRs (95% CI) for incident diabetes at follow up were 2.17 (1.56, 3.03) for men, and 2.86 (1.50,5.46) for women. Similar aHRs for incident diabetes occurred with fatty liver, IR and the highest quartile of FIB-4 combined, in men; and there was a non significant trend toward increased risk in women.Conclusions
In normal weight, non-centrally obese subjects NAFLD is an independent risk factor for incident diabetes. 相似文献995.
996.
In this work, we propose a semiparametric method for estimating the optimal treatment for a given patient based on individual covariate information for that patient when data from a crossover design are available. Here, we assume there are carry-over effects for patients switching from one treatment to another. For the K treatment (K ≥ 2) scenario, we show that nonparametric estimation of carry-over effects can have the undesirable property that comparison of treatment means can only be done using independent outcome measurements from different groups of patients rather than using available joint measurements for each patient. To overcome this barrier, we compare probabilities of outcome variable of each treatment dominating outcome variables for all other treatments conditional on patient-specific scores constructed from patient covariates. We suggest single-index models as appropriate models connecting outcome variables to covariates and our empirical investigations show that frequencies of correct treatment assignments are highly accurate. The proposed method is also rather robust against departures from a single-index model structure. We also conduct a real data analysis to show the applicability of the proposed procedure. 相似文献
997.
Datkhayev Ubaidilla M. Sakipova Zuriadda B. Ustenova Gulbaram O. Zhakipbekov Kairat S. Kozhanova Kaldanay K. Kapsalyamova Elmira N. Datkayeva Gulmira M. Ibadullayeva Galiya S. Sapakbay Malik M. Bekenov Kudaibergen E. Tulemissov Saken K. Blatov Ravil M. 《Pharmaceutical Chemistry Journal》2019,53(6):572-576
Pharmaceutical Chemistry Journal - The purpose of this work was to validate the method of UV absorption spectrophotometry for the determination of thiamazole in transdermal patches during their... 相似文献
998.
A. Desclaux M. S. Malan M. Egrot K. Sow for EBSEN Study Group F. Akindès for EBO-CI Study Group 《Global public health》2019,14(5):709-721
During an Ebola outbreak, the WHO recommends that health professionals consider people as suspect cases (SCs) when they show key signs such as the sudden onset of high fever or specific symptoms after having had contact with a suspect or confirmed Ebola case. SCs should then get care, be isolated and be reported to health authorities until the Ebola virus disease is confirmed through a lab test. This exploratory study aims to understand this identification process in the field based on a qualitative analysis of the diagnosis and therapeutic itineraries of 19 SCs in Cote d’Ivoire and Senegal (2014–2015). Results indicate that the main criteria for SC identification at the field level were fever (understood broadly) and provenance from a highly affected country (applied indiscriminately). WHO criteria were not followed in at least 9 of the 19 cases. Several medical, social and cultural factors favour over-identification of people as SCs, including relativism in defining ‘high fever’, placism, humanitarian or securitarian bias, issues in categorising SC's contact cases, and the context of fear. To avoid undue categorisation and its possible harmful social effects, the WHO definition should be implemented more carefully in various contexts and with greater consideration for ethical issues, while prioritising diagnosis strategies with higher specificity. 相似文献
999.
1000.
Health scholars have long been calling for a new approach to understanding and responding to public health challenges, recognizing the dynamic influence of social and ecological processes and the importance of respecting different ways of knowing. With daunting new challenges to collective health, we sought to ascertain how future generations of public health researchers and practitioners are being prepared with the knowledge, attitudes, and skills needed for the tasks ahead. We found that of the 76 graduate level programs listed by the Public Health Agency of Canada, 65% required at least one quantitative methods course, but only 26% required qualitative methods and only 16% required a course in community engagement. While 25% had at least one required course related to social theory or social determinants of health, only 3% required a course on the ecological determinants. Our examination suggests that the majority of schools of public health may still be frozen in old paradigms wherein interdisciplinary inquiry and the development of skills to work with communities to implement and evaluate interventions to promote and protect collective health are still only peripheral considerations. With the intensification of public distrust in experts in this post-truth era, greater emphasis is needed now more than ever to develop skills in understanding and engaging the public in addressing the underlying issues threatening health. We argue that as the challenges of the Anthropocene are upon us, it is urgent that we rethink the skills we are teaching and prepare ourselves to radically adjust our approach. 相似文献