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1.
PurposeAccording to the social determinants of health framework, income inequality is a potential risk factor for adverse mental health. However, few studies have explored the mechanisms suspected to mediate this relationship. The current study addresses this gap through a mediation analysis to determine if social support and community engagement act as mediators linking neighbourhood income inequality to maternal anxiety and depressive symptoms within a cohort of new mothers living in the City of Calgary, Canada.MethodsData collected at three years postpartum from mothers belonging to the All Our Families (AOF) cohort were used in the current study. Maternal data were collected between 2012 and 2015 and linked to neighbourhood socioeconomic data from the 2006 Canadian Census. Income inequality was measured using Gini coefficients derived from 2006 after-tax census data. Generalized structural equation models were used to quantify the associations between income inequality and mental health symptoms, and to assess the potential direct and indirect mediating effects of maternal social support and community engagement.ResultsIncome inequality was not significantly associated with higher depressive symptoms (β = 0.32, 95%CI = −0.067, 0.70), anxiety symptoms (β = 0.11, 95%CI = −0.39, 0.60), or lower social support. Income inequality was not associated with community engagement. For the depression models, higher social support was significantly associated with lower depressive symptoms (β = −0.13, 95%CI = −0.15, −0.097), while community engagement was not significantly associated with depressive symptoms (β = 0.059, 95%CI = −0.15, 0.27). Similarly, for the anxiety models, lower anxiety symptoms were significantly associated with higher levels of social support (β = −0.17, 95%CI = −0.20, −0.13) but not with higher levels of community engagement (β = 0.14, 95%CI = −0.14, 0.41).ConclusionThe current study did not find clear evidence for social support or community engagement mediating the relationship between neighbourhood income inequality and maternal mental health. Future investigations should employ a broader longitudinal approach to capture changes in income inequality, potential mediators, and mental health symptomatology over time.  相似文献   
2.
The management of patients with metastatic hormone-sensitive prostate cancer (mHSPC) has been significantly modified by the availability of innovative but expensive treatments, increasing the economic burden of prostate cancer. Here, we aimed to systematically identify and review published economic evaluations (EEs) related to the treatment of mHSPC and assess their quality. A systematic search was performed of the PubMed and Cochrane databases. Three reviewers independently selected EEs by defined inclusion and exclusion criteria. They extracted all data from each EE (general information, study population, data about the EE, interventions and comparators, and outcomes). They also assessed the quality of the selected EEs according to Drummond's checklist. Fourteen EEs published between 2016 and 2021 were eligible for the systematic review. The EEs found ADT + docetaxel to be the most cost-effective of all available treatments as a first-line strategy for mHSPC (abiraterone acetate plus prednisone, enzalutamide, and apalutamide). Five EEs showed that a simple price reduction of abiraterone acetate of 50% to 75% could change the results to render this treatment also cost-effective relative to that with docetaxel. Twelve EEs were of high quality, with a Drummond score ≥ 7. Analysis of the 14 EEs identified by our systematic review, amongst which 78.6% met high quality standards, showed that ADT + docetaxel tends to be the most cost-effective alternative for mHSPC. These results were assessed by sensitivity analysis. The data provided by this systematic review help to provide a better understanding of these treatments and the better use of healthcare resources.  相似文献   
3.
目的:探讨健脾益肝方对非酒精性脂肪性肝病(NAFLD)患者脂肪分布及脂代谢的影响。方法:将80例NAFLD患者随机分为对照组和治疗组各40例。两组患者均在多学科联合管理下给予个体化的饮食、运动等生活方式指导,治疗组患者在此基础上加用健脾益肝方,疗程均为3个月。通过生物电阻抗技术测量患者治疗前后脂肪质量及分布,定期监测肝肾功能、血脂指标。比较两组患者肥胖、脂肪分布、血脂指标变化。结果:治疗组患者有效率为97.5%,明显高于对照组的82.5%,差异有统计学意义(P<0.05);治疗组患者BMI、BFP、WHR、TC、TG及LDL-C水平明显低于对照组,差异有统计学意义(均P<0.05);治疗组患者躯干及内脏脂肪沉积改善明显优于对照组,差异有统计学意义(均P<0.05)。结论:生活方式干预联合健脾益肝方治疗NAFLD患者能显著改善患者的肥胖及脂代谢紊乱,并且与躯干和内脏脂肪质量的下降密切相关。  相似文献   
4.
目的:探讨不同分期结直肠癌患者肿瘤组织内CD73表达分布情况及其与患者临床病理参数、预后之间的关系。方法:选取2012年1月至2013年6月于本院就诊并行手术治疗的结直肠癌患者共60例作为研究对象,于术中取其肿瘤组织和癌旁组织样本,使用免疫组化法检测收集的所有样本中CD73分布与表达情况,并分析CD73与结直肠癌患者临床病理参数及预后的关系。结果:TNM分期越高的结直肠癌患者病灶组织CD73阳性率越高(P<0.05),癌旁组织中CD73阳性率明显低于结直肠癌患者(P<0.05);CD73在结直肠癌中的阳性表达率与年龄、组织分化程度无相关(P>0.05);与浸润深度、淋巴结转移和临床分期有重要联系(P<0.05);CD73表达阳性组术后存活时间明显短于阴性组(P<0.05);疾病复发率明显高于阴性组(P<0.05);阳性组5年存活率也明显低于阴性组(P<0.05),提示CD73呈阳性高表达的结直肠癌患者预后往往较差。结论:CD73在结直肠癌患者肿瘤组织中的表达量明显升高,可作为评估患者预后的独立预测因子,临床医师可根据结直肠癌患者病理组织中CD73表达量对其预后进行判断和评估,具有推广价值。  相似文献   
5.
适宜性产区能够保障傣族药的品质,然而有关植物类傣族药适宜生态因子及适宜产区的研究目前较为匮乏。本研究利用中药材产地适宜性分析地理信息系统(GMPGIS)对植物类傣族药进行全国产地生态适宜性分析,首次提出了植物类傣族药主要分布区域的生态因子范围和主要土壤类型,如年均温8. 6~23. 7℃,年均降水量1 212~1 881 mm,年均日照149. 7~157. 4 W·m-2,主要土壤类型为强淋溶土、冲积土、高活性强酸土等。以179个采样点为基础,通过生态相似性分析得到植物类傣族药在全球范围内的最大生态相似度区域,主要包括中国、巴西、美国、缅甸、老挝等国家。在中国主要集中在云南的西部和南部,包括西双版纳傣族自治州、德宏傣族景颇族自治州普洱市、保山市、临沧市具有较大的适宜栽培区域。除此之外,本文通过分析傣族药人才匮乏、傣族药资源日益减少、文化传承具有局限性、科学研究薄弱等问题,并提出了通过傣族医药高素质人才培养、傣族药资源调研和保护工作、推进傣族药资料古籍的搜集整理、加强傣族药基础研究和应用研究等策略促进傣族医药发展。本研究为指导植物类傣族药生产基地合理布局、引种繁育等提供依据,为高品质傣族药的科学规范化生产奠定基础。  相似文献   
6.
目的:研究在鼻咽癌放射治疗中应用发泡胶进行体位固定对剂量分布的影响。方法:随机选取11例应用头颈肩热塑膜联合发泡胶进行体位固定的鼻咽癌患者,在Pinnacle计划系统中将空白CT值设置到发泡胶的CT值以下,以确保发泡胶的CT值被计算在内,作为第一组计划(Plan_F)。同时,复制第一组计划并在定位图像上勾画出发泡胶,设置发泡胶的CT值为0,在不改变射野分布、权重及计划跳数的情况下重新计算剂量分布,作为第二组计划(Plan_N)。比较两组计划的靶区及周围正常组织的剂量分布。结果:对于靶区(GTVnx、GTVnd、GTVrpn、PGTVnx、CTV1、PTV1、CTV2、PTV2)的最小剂量Dmin,最大剂量Dmax,平均剂量Dmean去除发泡胶之后,所测 255组数据中仅有6组数据出现减小(约占2.4%),Dmin、Dmax和Dmean的变化度(%)(X±SD)依次为0.215±0.969、 0.395±0.623和 0.442±0.178,其中除了GTVrpn的Dmin(P=0.727)和Dmax(P=0.142),PGTVnx的Dmin(P=0.623),CTV1 Dmin(P=0.713),CTV2 Dmax(P=0.066),其他评估指标皆显示发泡胶使用组剂量低于去除发泡胶组(P<0.05);而对于周围正常组织(脑干、脊髓、左右晶体、左右视神经和腮腺)的Dmean和Dmax去除发泡胶之后,所测的154组数据中仅有14组数据出现减小(约占9.1%),Dmax和Dmean的变化度(%)(X±SD)依次为0.194±0.192 和0.129±0.128,其中除了左、右晶体的平均剂量Dmean(P值分别为0.123和0.06),其余各项指标同样显示发泡胶使用组剂量低于去除发泡胶组(P<0.05)。结论:发泡胶的使用降低了实际治疗过程中受照部位的剂量,但发泡胶对剂量变化的影响都在目前临床可接受的范围之内。  相似文献   
7.
目的:通过文献探析中医治疗多囊卵巢综合征(PCOS)的证型分布及临床用药规律。方法:检索2003年至2018年1月1日中国期刊全文数据库(CNKI)、万方、维普3个中文数据库中相关中医治疗PCOS的临床研究文献,建立中医治疗PCOS的整体证型及临床用药数据库,并对数据进行处理、分析。结果:①共纳入符合标准的文献252篇,方剂284首;②涉及证型共37种,其中常见证型为肾虚血瘀证、痰湿证、肾虚痰瘀证,共占43.31%;③涉及病位要素以肾为主,其次为肝、脾;涉及病性要素以血瘀、痰、湿为主;④涉及药物193味,按功效共分为16类,补虚药占41.44%,活血化瘀药占16.20%,化痰祛湿药占14.90%;⑤中医治疗PCOS药性以温、平为主,药味以甘为主,辛、苦次之。结论:PCOS病因病机复杂,以肾虚为本,血瘀、痰湿为标,治疗以补肾活血、化湿祛痰为主。  相似文献   
8.

Objective

The objective was to evaluate the pharmacokinetics (PKs) of levonorgestrel (LNG)-containing combined oral contraceptives (COCs) in obese women.

Study design

We pooled and reanalyzed data from 89 women with different body mass index (BMI) categories from four clinical studies. The LNG and ethinyl estradiol (EE) PKs were analyzed utilizing a zero-order absorption (K0), two-compartment PK model to evaluate key PK parameters in relation to a range of weights, BMI and body surface area (BSA).

Results

Increasing of body habitus metrics is correlated with decreasing Cmax (p<.0001) and AUCτ (p<.05) for both LNG and EE, but no correlation was found for Cmin (p≥.17). Increasing weight and BMI were associated with a modest increase (p≤.056) of clearance (CL) and appreciable increases of central volume (V1, p<.05), distribution clearance (CLd, p≤.001) and peripheral volume (V2, p<.0001) for LNG. For EE, increases in CL (p≤.009) were found with greater weight, BMI and BSA. Values of V1, CLd and V2 also increased (p<.0001) in obese subjects. The half-life and steady-state volume were greater among obese women (p<.0001) for both LNG and EE. LNG and EE PK parameters correlated well (p≤.006 for all), indicating that individual subject physiology affected both drugs similarly.

Conclusions

The primary effects of obesity on LNG and EE were a modest increase in CL and a marked increase in distribution parameters. We observed no obesity-related differences in trough LNG and EE concentrations.

Implications

This population PK analysis demonstrated reduced systemic exposure to LNG/EE oral contraceptives in obese subjects (Cmax and AUCτ); these particular differences are unlikely to lower contraceptive effectiveness among obese women who are correctly using LNG-containing contraceptives.  相似文献   
9.
BackgroundTreatment decisions in routine clinical practice are based on reports of clinical trials, which represent highly selected populations. Limited studies reported real-world evidences representing routine clinical practices in patients with renal-cell carcinoma (RCC) in Europe. The aim of this retrospective, noninterventional chart review was to collect data on the treatment landscape for patients with advanced/metastatic RCC in routine clinical practice in a broader patient population in Austria.Patients and MethodsPatients with advanced/metastatic RCC receiving systemic treatment between June 2010 and June 2016 across 12 centers in Austria were included. Parameters were entered into an electronic case report form from the participating sites via the application Hermesoft electronic data capture system. Progression-free survival (PFS) and overall survival (OS) were the 2 primary end points.ResultsThe median PFS and OS were 12 months and 44 months, respectively (first-line PFS was 14 months for pazopanib and 13 months for sunitinib; first-line OS was 44 months for pazopanib and 48 months for sunitinib). Factors influencing the OS were sex, with female patients at a significantly higher risk than male patients (hazard ratio = 1.719), Eastern Cooperative Oncology Group performance status > 0 increased the risk twice (hazard ratio = 2.048), and number of metastases > 3 before the first line doubled the risk compared to metastases (hazard ratio = 2.064).ConclusionOS in this retrospective chart review was considerably longer than the previous reports in real-world patients, underlining the benefit of current RCC treatment options in routine clinical practice.  相似文献   
10.
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