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《Vaccine》2022,40(52):7604-7612
Background and ObjectiveVaccine uptake during pregnancy remains low. Our objectives were to describe 1) development and adaptation of a clinician communication training intervention for maternal immunizations and 2) obstetrics and gynecology (ob-gyn) clinician and staff perspectives on the intervention and fit for the prenatal care context.MethodsDesign of the Motivational Interviewing for Maternal Immunizations (MI4MI) intervention was based on similar communication training interventions for pediatric settings and included presumptive initiation of vaccine recommendations (“You’re due for two vaccines today”) combined with motivational interviewing (MI) for hesitant patients. Interviews and focus group discussions were conducted with ob-gyn clinicians and staff in five Colorado clinics including settings with obstetric physicians, certified nurse midwives (CNMs), and clinician-trainees. Participants were asked about adapting training to the ob-gyn setting and their implementation experiences. Feedback was incorporated through iterative changes to training components.ResultsInterview and focus group discussion results from participants before (n = 3), during (n = 11) and after (n = 25) implementation guided intervention development and adaptation. Three virtual, asynchronous training components were created: a video and two interactive modules. This virtual format was favored due to challenges attending group meetings; however, participants noted opportunities to practice skills through role-play were lacking. Training modules were adapted to include common challenging vaccine conversations and live-action videos. Participants liked interactive training components and use of adult learning strategies. Some participants initially resisted the presumptive approach but later found it useful after applying it in their practices. Overall, participants reported that MI4MI training fit well with the prenatal context and recommended more inclusion of non-clinician staff.ConclusionsMI4MI training was viewed as relevant and useful for ob-gyn clinicians and staff. Suggestions included making training more interactive, and including more complex scenarios and non-clinician staff. 相似文献
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以“七麦数据”网站收录的中医移动医疗App作为研究对象,采用网络调查法和文献分析法,根据“七麦数据”对移动医疗App的分类,结合中医移动医疗App的信息服务内容和特点,将筛选出的中医移动医疗App划分为医疗健康类、中医养生类、知识传播类、全面综合类,并根据“七麦数据”网站中对各类中医移动医疗App的打分及累计下载量筛选出最具代表性的12款中医移动医疗App,从全面性、人性化、安全性、实用性4个一级指标和40个二级指标对其信息服务现状进行评价,指出当前中医移动医疗App信息服务存在的问题并提出建议。 相似文献
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《Health & place》2022
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
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《Vaccine》2022,40(52):7515-7519
The recent wave of COVID-19 cases has led to the potential need for booster doses. We surveyed 6,294 people and found that 87.6% reported willingness to take a booster dose, with vaccine efficacy rate being the most common reason cited to accept booster dose. Differences in acceptance rates were noted among those working in non-health related sectors, different ethnic groups as well as those who had taken viral vector vaccines. 相似文献
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背景 致密性骨炎(OCI)和其他疾病有时难以鉴别,探讨血清骨转换生化标志物可为OCI的鉴别诊断提供依据。 目的 探索女性OCI患者的血清骨转换生化标志物的水平变化及临床意义。 方法 回顾性选取2013年6月至2022年2月在北京积水潭医院门诊及住院诊断为OCI的61例女性患者作为观察组,年龄15~50岁,平均(33.8±6.6)岁,病程2周~15年。选择同期61例女性体检健康者作为对照组,年龄15~48岁,平均(35.6±7.6)岁。比较两组一般临床资料和血清骨转换生化标志物水平,并对血清骨转换生化标志物与病情相关指标进行相关性分析。 结果 观察组血清白蛋白(45.4±2.9)g/L低于对照组(46.5±2.8)g/L(t=2.190,P<0.05)。血清骨转换生化标志物比较结果显示,观察组血清1型胶原羧基末端肽β特殊序列(β-CTX)〔0.28(0.23,0.37)μg/L〕、N-端骨钙素(OC)〔13.1(11.2,16.2)μg/L〕、25-羟维生素D3〔25-(OH)VD3〕〔(14.1±5.1)μg/L〕低于对照组〔0.36(0.29,0.48)μg/L,15.6(13.7,17.3)μg/L,(17.5±6.6)μg/L〕(Z=-2.983、-3.255,t=3.081,P<0.05)。长病程亚组OC水平〔14.6(12.4,18.5)μg/L〕高于短病程亚组〔11.7(10.2,14.0)μg/L〕(Z=-2.407,P<0.05)。多孕亚组β-CTX〔0.25(0.22,0.32)μg/L〕、OC水平〔12.2(10.3,15.0)μg/L〕低于非多孕亚组〔0.33(0.26,0.44)μg/L、13.4(12.0,18.8)μg/L〕(Z=-2.486、-1.897,P<0.05)。相关性分析显示,观察组血清1型前胶原氨基端延长肽(tP1NP)与妊娠次数、生产次数均呈负相关(rs=-0.276、-0.298,P<0.05),OC与体质指数(BMI)、视觉模拟评分法(VAS)评分、妊娠次数均呈负相关(rs=-0.284、-0.374、-0.360,P<0.05),25-(OH)VD3水平与BMI呈正相关(rs=0.275,P<0.05)。 结论 女性OCI患者血清OC、β-CTX水平明显降低,可为鉴别其他疾病提供依据;血清OC水平可以反映OCI患者的严重程度,同时OC水平与患者妊娠次数相关;tP1NP与妊娠次数、生产次数相关。 相似文献
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《Orthopaedics and Trauma》2022,36(6):304-310
Congenital vertical talus (CVT) is a rare foot deformity that presents with a rigid flat foot at birth. CVT can present as an isolated abnormality in the newborn, however in at least 50% of cases in association with other conditions. Full neuro-axial imaging is essential to detect any associated neurologic problems. Radiographs of the foot, including forced plantar and dorsiflexion laterals, are diagnostic. Gold standard modern treatment uses the Dobbs method of serial manipulation and casting with minimally-invasive stabilization of the talonavicular joint and Achilles tendon tenotomy. 相似文献
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《American journal of surgery》2023,225(1):198-205
BackgroundLiver resection is commonly performed for hepatic tumors, however preoperative risk stratification remains challenging. We evaluated the performance of contemporary prediction models for short-term mortality after liver resection in patients with and without cirrhosis.MethodsThis retrospective cohort study examined National Surgical Quality Improvement Program data. We included patients who underwent liver resections from 2014 to 2019. VOCAL-Penn, MELD, MELD-Na, ALBI, and Mayo risk scores were evaluated in terms of model discrimination and calibration for 30-day post-operative mortality.ResultsA total 15,198 patients underwent liver resection, of whom 249 (1.6%) experienced 30-day post-operative mortality. The VOCAL-Penn score had the highest discrimination (area under the ROC curve [AUC] 0.74) compared to all other models. The VOCAL-Penn score similarly outperformed other models in patients with (AUC 0.70) and without (AUC 0.74) cirrhosis.ConclusionThe VOCAL-Penn score demonstrated superior predictive performance for 30-day post-operative mortality after liver resection as compared to existing clinical standards. 相似文献
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