Residential greenness and risks of depression: Longitudinal associations with different greenness indicators and spatial scales in a Finnish population cohort

We carried out a longitudinal study on the associations between residential greenness and depression risk in urban areas in Finland. Residential greenness indicators were estimated within various buffer sizes around individuals' home locations (selected n = 14424) using time-series of normalized differential vegetation index (NDVI) and CORINE land cover data (CLC). We estimated individuals’ cumulative exposure to residential greenness over a 5-years and 14-years follow-up. We used doctor-diagnosed depression and Beck Depression Inventory for depression assessment. Our multi-logistic model showed an inverse association between residential greenness and depression, implying lowered depression risk for individuals with higher residential greenness. The association was particularly evident when using NDVI-based residential greenness (within a buffer of 100 m radius) and doctor-diagnosis depression data, adjusted with individual-level covariates. The odds ratio was 0.56 (95% CI 0.33 to 0.96) for the 5-years follow-up, and 0.54 (95% CI 0.30 to 0.98) for the 14-years follow-up. The associations between CLC-based total residential green space and depression varied across the different buffer sizes. In general, all the associations depended on the type of depression assessment, quality of greenness indicators, and the spatial scale of analysis. The associations also varied across the socio-demographic groups and neighborhood socioeconomic disadvantage level.     

营养教育在腹主动脉瘤患者根治术后的临床应用

目的 探讨营养教育在腹主动脉瘤患者根治术中的应用价值。 方法 选取2017年10月至2019年10月青岛市市立 医院收治的行根治术的腹主动脉瘤患者96例，采用随机数字表法分为对照组（48例，行常规护理）和观察组（48例，行常规护理 联合营养教育），比较两组康复效果、营养指标和生活质量，另参照焦虑自评量表（SAS）和抑郁自评量表（SDS）判定患者心理状 态。 结果 观察组首次排气时间、下床活动时间和住院时间短于对照组，心理状态评分低于对照组，依从性和生活质量综合评 定问卷评分高于对照组，差异有统计学意义（P<0.05）；观察组患者体重为(68.16±6.32) kg，体质指数为（23.02±0.54）kg/m2，血清 白蛋白水平为（37.2±2.4）g/L,血清转铁蛋白水平为（2.45±0.36）g/L，血清前白蛋白水平为（267.27±25.12）mg/L，总铁结合力为 （56.17±6.24）μmol/L，高于对照组的（64.32±5.44）kg、（21.72±0.78）kg/m2 、（32.1±1.8）g/L、（2.16±0.32）g/L、（215.12±22.26）mg/L和 （50.34±5.21）μmol/L，差异有统计学意义（P<0.05）。 结论 在腹主动脉瘤患者根治术中联合营养教育可促进患者术后康复，对 患者负面情绪有缓解作用，可提高患者依从性，改善营养不良状态，促进生活质量的提升。     

What is the impact of zinc deficiency for pancreatectomies in patients with pancreatic ductal adenocarcinoma?

Backgroundand purpose: Zinc is an essential element for human health and plays an important role in metabolic, immunological and other biological processes. The present study was conducted to investigate the association between zinc deficiency (ZD) and the perioperative clinical course in patients with pancreatic ductal adenocarcinoma (PDAC).MethodsOf 216 patients with PDAC who underwent elective pancreatectomy between 2013 and 2017 at our institution, 206 patients with sufficient clinical data were retrospectively reviewed. The perioperative variables were compared and the risk factors associated with infectious complications were identified.ResultsZD was preoperatively present in 36 (17.5%) of 206 patients with PDAC. In the patients of the ZD group, a higher proportion of males, higher preoperative modified Glasgow prognostic scores, a higher neutrophil-to-lymphocyte ratio, and a higher occurrence of postoperative infectious complications after pancreatectomy were observed, compared to the non-ZD group. By a univariate analysis, three risk factors were significantly associated with infectious complications after pancreatectomy: ZD (vs non-ZD: p = 0.002), serum albumin <3.5 g/dl (vs ≥ 3.5 g/dl: p = 0.005), and the procedure of pancreaticoduodenectomy (vs others: p = 0.013). By multivariate logistic regression analysis, the occurrence of infectious complications was significantly associated with ZD (OR 3.430, 95%CI 1.570 to 7.490, p = 0.002) and the procedure of pancreaticoduodenectomy (OR 2.030, 95%CI 1.090 to 3.770, p = 0.025).ConclusionsThe current study newly demonstrated that ZD could serve as a preoperative predictor of infectious complications after pancreatectomies in the patients with PDAC.     

Exploring attributions of causality for child undernutrition: Qualitative analysis in Lusaka,Zambia

Child undernutrition is responsible for 45% of all under-five deaths in low- and middle-income countries (LMICs) and numerous morbidities. Although progress has been made, high levels of child undernutrition persist in Zambia. Existing studies have explored primary caretakers' (PCs) explanatory models of child undernutrition in LMICs, without comparison with those of health care providers (HCPs). This paper examines and compares the perceived causes of child undernutrition among PCs and HCPs in Zambia. We conducted a qualitative study, using semistructured one-to-one and group interviews, with 38 PCs and 10 HCPs to explore their perceptions of child undernutrition and its perceived causes in Lusaka district, Zambia. Interview data were analysed with thematic analysis. Our findings indicate that PCs and HCPs in Lusaka district have divergent explanatory models of child undernutrition and perceive parental agency differently. In divergently framing how they conceptualise undernutrition and who is able to prevent it, these models underpin different attributions of causality and different opportunities for intervention. PCs highlighted factors such as child food preferences, child health, and household finances. Contrarily, HCPs stressed factors such as ‘improper feeding’, only highlighting factors such as wider economic conditions when these impacted specifically on health care services. One factor, identified by both groups, was ‘inadequate mothering’. To accelerate the reduction of child undernutrition, interventions must address divergences between PCs and HCPs' explanatory models. Additionally, attention needs to be paid to how wider socio-economic and cultural contexts not only impact childhood undernutrition but shape attributions of causality.     

The Importance of Quality Perioperative Patient Education

Surgical patients, both inpatient and outpatient, need perioperative education in order to know how to prepare for surgery and what they can expect in the days following their surgical procedure. Quality perioperative patient education not only improves postoperative patient outcomes, but contributes as well to high patient satisfaction scores, which are currently tied to Centers for Medicare and Medicaid Services (CMS) reimbursements. This paper will demonstrate the importance of patient education and describe some perioperative Internet-based resources.     

Prognostic impact of preoperative prognostic nutritional index in resected advanced gastric cancer: A multicenter propensity score analysis

BackgroundAdvanced gastric cancer (AGC) causes debilitating malnutrition and leads to deterioration of the immune response. However, the concept of the prognostic nutritional index (PNI) is controversial when applied to patients with AGC. The aim of the present study was to evaluate the effect of the PNI after gastrectomy in patients with AGC.Materials and methodsA multicenter retrospective study was conducted using propensity score matching (PSM) in gastric adenocarcinoma patients who underwent resection via laparoscopic or open surgery between 2014 and 2017. To overcome selection bias, we performed 1:1 matching using 5 covariates.ResultsThe resection margins (P < 0.001) and LNM (P = 0.004) were significantly different between the two groups. In univariate analysis, poor tumor differentiation (P = 0.038) (R1+R2, P = 0.004), vascular and neural invasion (P < 0.001), and a PNI<50 (P < 0.001) were associated with poor recurrence-free survival (RFS). In multivariate analysis, a PNI<50 (hazard ratio (HR), 12.993; P < 0.001) was a risk factor for RFS. Univariate analysis for overall survival (OS) revealed that a PNI<50 (P < 0.001) (R1+R2,P = 0.006) and vascular and neural invasion (P < 0.001) were risk factors. In subsequent multivariate analysis, a PNI<50 (HR, 24.501; P < 0.001) was a significant risk factor for OS. Clinical assessments performed during a 12.34 (±5.050) month follow-up revealed that OS (P < 0.001) and RFS (P < 0.001) were worse in patients with a low PNI (<50) than in matched patients with a high PNI.ConclusionA low PNI is a strong predictor of unfavorable RFS and OS in patients with AGC.     

老年食管癌患者预后营养指数与老年营养风险指数的相关分析

目的:对中老年食管癌患者的预后营养指数和老年营养风险指数进行相关分析。方法:回顾性分析43例中老年食管癌患者的相关营养指标并进行相应的统计学检验。结果:PNI＜45营养不良组有9人，占20.93%；GNRI<98风险值组17人，占39.53%。营养良好组与营养不良组的PNI值在体重指数、白蛋白、前白蛋白、红细胞、血红蛋白、淋巴细胞值上均具有统计学差异，GNRI正常组、低风险组、中高风险组在体重指数、白蛋白、前白蛋白、血红蛋白、PNI值上均具有统计学差异。PNI与GNRI存在线性依存关系。结论:PNI、GNRI均为监测营养状况的良好指标且存在依存关系，可作为筛查营养风险的基本指标。     

儿童慢性腹泻高营养风险情况及对预后的影响

目的 探讨儿童慢性腹泻高营养风险情况及对预后的影响。方法 选择2019年1～12月在我院诊断治疗的慢性腹泻患儿100例为研究对象,进行营养风险筛查,分析高营养风险患儿与非高营养风险患儿临床特征以及预后情况,分析性别、年龄、病因对慢性腹泻患儿高营养风险的影响。结果 (1)100例患儿24例患儿STAMP评分≥4分,为高营养风险组,占24.0%。(2)7～14岁患儿高营养风险发生率显著高于其他年龄段患儿(P0.05);炎症性肠病患儿高营养风险发生率显著其他病因的患儿(P0.05)。(3)炎症性肠病是慢性腹泻患儿发生高营养风险的独立危险因素(P0.05)。(4)高营养风险组白蛋白、前白蛋白水平显著低于非高营养风险组,差异有统计学意义(P0.05)。两组Hb水平比较差异无统计学意义(P0.05)。(5)非高营养风险组痊愈率显著高于高营养风险组,医院感染率显著低于高营养风险组,住院时间显著短于高营养风险组,差异均有统计学意义(P0.05)。结论 儿童慢性腹泻高营养风险发生率相对较高,病因会影响患儿高营养风险的发生,而高营养风险影响患儿的预后,延长住院时间。     

疗前预后营养指数对老年食管鳞癌放疗预后预测价值

目的 评价预后营养指数(PNI)在老年食管鳞癌放疗中的作用。方法 回顾性分析接受根治性放疗的初治老年(>65岁)食管鳞癌患者共108 例。计算出每位患者PNI值,通过建立受试者工作特征曲线(ROC曲线)确定治疗前 PNI最佳cutoff值,并按该值分为低PNI组和高PNI组。Kaplan-Meier法计算总生存率,并Logrank检验和单因素预后分析,Cox模型多因素预后分析。结果 ROC曲线显示PNI最佳cutoff值为50.1(高PNI组52例,低PNI组56例)。两组在年龄、性别、治疗方式均相近,在TNM分期不同(P=0.022)。高PNI组有效率明显优于低PNI组(96%︰73%,P=0.001)。高PNI组1、2、3年总生存率分别为94%、69%、62%,低PNI组分别为70%、32%、27%(P<0.001)。单因素分析显示PNⅠ、T分期、N分期、TNM分期均与总生存密切相关(均P<0.01)。多因素分析结果显示N分期(RR=1.94,95%CI为1.29~2.94,P=0.002)和PNI (RR=0.83,95%CI为0.77~0.90,P<0.001)为影响总生存因素。结论 疗前PNI与患者放疗疗效及预后均有很好相关性,可作为预测老年食管鳞癌放疗获益的重要指标。