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American Indian and Alaska Native (AIAN) individuals are diverse culturally and geographically but share a high prevalence of chronic illness, largely because of obstacles to high-quality health care. The authors comprehensively examined cancer incidence and mortality among non-Hispanic AIAN individuals, compared with non-Hispanic White individuals for context, using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Overall cancer rates among AIAN individuals were 2% higher than among White individuals for incidence (2014 through 2018, confined to Purchased/Referred Care Delivery Area counties to reduce racial misclassification) but 18% higher for mortality (2015 through 2019). However, disparities varied widely by cancer type and geographic region. For example, breast and prostate cancer mortality rates are 8% and 31% higher, respectively, in AIAN individuals than in White individuals despite lower incidence and the availability of early detection tests for these cancers. The burden among AIAN individuals is highest for infection-related cancers (liver, stomach, and cervix), for kidney cancer, and for colorectal cancer among indigenous Alaskans (91.3 vs. 35.5 cases per 100,000 for White Alaskans), who have the highest rates in the world. Steep increases for early onset colorectal cancer, from 18.8 cases per 100,000 Native Alaskans aged 20–49 years during 1998 through 2002 to 34.8 cases per 100,000 during 2014 through 2018, exacerbated this disparity. Death rates for infection-related cancers (liver, stomach, and cervix), as well as kidney cancer, were approximately two-fold higher among AIAN individuals compared with White individuals. These findings highlight the need for more effective strategies to reduce the prevalence of chronic oncogenic infections and improve access to high-quality cancer screening and treatment for AIAN individuals. Mitigating the disparate burden will require expanded financial support of tribal health care as well as increased collaboration and engagement with this marginalized population.  相似文献   
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背景国内外用于评估癌症患者支持性照护需求的量表较多,但有关此类量表质量的标准化评价研究及不同量表间的横向比较研究较为缺乏,也少有研究者对此类量表的测量特性进行系统的整合与评价。目的评价中文版癌症患者支持性照护需求量表的测量学性能及研究的方法学质量。方法2021年4月检索中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库、中国生物医学文献数据库、PubMed、EmBase、Web of Science、CINAHL Complete数据库,获取有关中文版癌症患者支持性照护需求量表测量学性能评价的研究,检索时限均为建库至2021年3月30日。由两位研究者独立筛选文献、提取资料后,采用健康测量工具遴选标准(COSMIN)系统综述指南,在对量表的测量特性及研究的方法学质量进行评价的基础上,综合评定中文版癌症患者支持性照护需求评估量表各测量特性的证据等级,并形成对于量表的最终推荐意见。采用描述分析法对评价结果进行汇总、分析。结果共纳入15项研究,涉及8个中文版癌症患者支持性照护需求评估量表〔癌症患者支持性照护需求简明问卷中文版(SCNS-SF34)、中文版支持性照护需求筛查工具(SCNS-ST9-C)、癌症患者综合需求评估量表(CNAT)、癌症需求简明问卷(CNQ-SF)、中文版癌症患者未满足需求量表(CaSUN-C)、癌症患者未满足需求简明量表(SF-SUNS)、晚期癌症患者需求评估问卷(ACNQ-41)、晚期癌症患者需求评估表简表(ACNQ-29)〕。就量表的测量特性质量而言,除ACNQ-29的内容效度为"未提及"外,其余7个量表的内容效度均为"不确定";除CaSUN-C、SF-SUNS的结构效度为"充分"外,其余6个量表的结构效度均为"不确定";SCNS-SF34、CNQ-SF、CaSUN-C、SF-SUNS的内部一致性为"充分",ACNQ-41的内部一致性为"不充分",其余3个量表的内部一致性为"不确定";CNAT、CNQ-SF、ACNQ-29的假设检验为"未提及",CaSUN-C、SF-SUNS、ACNQ-41的假设检验为"不确定",SCNS-SF34、SCNS-ST9-C的假设检验为"充分";除ACNQ-41的稳定性为"不充分",SCNS-ST9-C、ACNQ-29的稳定性为"未提及"外,其余5个量表的稳定性均为"充分";仅SCNS-SF34的跨文化效度为"充分",其余7个量表的跨文化效度均为"未提及"。8个量表的推荐等级均为B级。结论SCNS-SF34的测量特性得到了最为全面的评价,其具有较好的信效度,且临床应用可行性高,可暂时被推荐使用,但上述结论仍有待更多高质量证据加以支撑。  相似文献   
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[目的] 探讨《金匮要略·痉湿暍病脉证并治第二》“纳药鼻中”之“药”所指的具体方药。[方法] 从历代注家注疏入手,对不同观点进行源流上的梳理。同时,通过文字学考证,对“药”字在古汉语中的含义展开探讨。[结果] 对于“纳药鼻中”之“药”,历代注家观点大致可归纳为三类,即随文注解、认为“药”为具有某些特性的药物、认为“药”为瓜蒂散或其类方,其中认为“纳瓜蒂于鼻中”的观点流传较广。通过文字学考证,“药”在楚方言中有指代“白芷”之意,“纳药鼻中”即是“纳白芷于鼻中”,白芷治疗鼻病也为历代医家所习用。[结论] “纳瓜蒂于鼻中”与“纳白芷于鼻中”两种观点都具有一定证据支持,但从文献学角度和仲景书体例而言,“纳药鼻中”原意应为“纳白芷于鼻中”。  相似文献   
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[目的] 观察耳穴压豆疗法对老年慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者症状及肺功能的影响。[方法] 选取2018年11月至2020年10月入住浙江大学医学院附属第一医院老年医学科,符合纳入标准的AECOPD患者60例,使用随机数字表法分成观察组30例和对照组30例。对照组采用常规治疗,观察组采用常规治疗和耳穴压豆(王不留行籽)疗法。分别于治疗前和治疗1、2、3个月评价肺功能,干预后临床症状和COPD评估测试问卷(COPD assessment test,CAT)评分。[结果] 耳穴压豆治疗3个月后,观察组第1秒用力呼气量占预计值(forced expiratory volume in first second accounted for the predicted value,FEV1%)和第1秒用力呼气量/用力肺活量(forced expiratory volume in first second/forced vital capacity,FEV1/FVC%)高于对照组,差异具有统计学意义(P<0.05)。耳穴压豆治疗3个月后,观察组总有效率(81.8%)高于对照组(64.3%),但两组比较差异无统计学意义(P>0.05)。耳穴治疗干预3个月后,观察组CAT评分低于对照组,差异有统计学意义(P<0.05)。[结论] 耳穴压豆可显著改善AECOPD患者肺功能,且耳穴压豆疗法操作简便,易于掌握,具有临床推广价值。  相似文献   
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BackgroundPolypharmacy is commonly related to poor drug adherence, decreased quality of life and inappropriate prescribing in eldery. Furthermore, this condition also leads to a higher utilization of health services resources, due to the increased risk of adverse drug events, length of stays in hospitals and readmissions rates after discharge.ObjectiveThis Systematic Review aimed to synthesize the current evidence that evaluates pharmaceutical services on polymedicated patients, from an economic perspective.MethodsSystematic searches were conducted in MEDLINE, SCOPUS and Cochrane Library databases to identify studies that were published until January 2021. Experimental and observational studies were included in this review, using strict inclusion/exclusion criteria and were assessed for quality using the following tools: RoB and ROBINS-I. Two independent reviewers selected the articles and extracted the data.Results3,662 articles were retrieved from the databases. After the screening, 18 studies were included: 9 experimental and 9 observational studies. The studies reported that the integration of the pharmacist as a member of the healthcare team provides an optimized use of pharmacotherapy to polymedicated patients and contributes to health promotion, providing reduction of spending on medication, reduction of expenses related to emergency care and hospitalizations and other medical expenses. The ECRs made cost-effectiveness or cost-benefit analysis, and most of the Non Randomized studies had statistically significant cost savings even considering the expenses of pharmaceutical assistance. Experimental studies reported a cost reduction varying between US$ 193 to US$ 4,966 per patient per year. Furthermore, observational studies estimated a cost reduction of varying from US$ 3 to US$ 2,505 per patient per year. The cost savings are related to decrease in emergency visits and hospitalizations, through pharmacist intervention (medication review and pharmacotherapy follow-up).ConclusionsConsidering the set of studies included, pharmaceutical care services directed to polymedicated patients may cooperate to save financial resources. Most of the interventions showed positive economic trends and also contributed to improving clinical parameters and quality of life. However, due to the majority of the studies having exploratory or qualitative methodology, it is essential to carry out more robust studies, based on full economic evaluation.  相似文献   
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