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1.
BackgroundRecreational cannabis has been legalized in 11 states and Washington DC in the US. However, little is known about individual preferences for legal cannabis products. This study estimated the impacts of tetrahydrocannabinol (THC), cannabidiol (CBD), warning messages, and price on preferences for cannabis flowers.MethodsA cross-sectional online survey with discrete choice experiments was implemented in October 2017. A sample of 2400 adults aged 21 years or older were recruited from 6 US states with recreational cannabis legalization, consisting of 1200 past-year nonusers and 1200 past-year users. Each respondent was randomly assigned to 12 discrete choice scenarios, each asking them to choose from an opt-out option and 3 cannabis flower products with varying levels in THC, CBD, warning messages, and price. The impacts of product attributes on individual choices were analyzed with nested logit regressions.ResultsBoth cannabis nonusers and users preferred higher CBD and lower price. Users also preferred higher THC. The results on warning messages were mixed: graphic warning on drugged driving and text warning message had positive impacts on nonusers’ and users’ preferences for cannabis flowers, respectively, whereas FDA disapproval disclaimer had negative impacts on nonusers’ preferences. Heterogeneities in preferences were revealed among nonusers by former use status and among users by reason of use. Particularly, medical cannabis users were not as responsive to THC as recreational cannabis users or dual users were. Regarding relative importance of the attributes, all respondents but medical cannabis users perceived price as the most important attribute (relative importance 51–64%), whereas medical cannabis users perceived CBD as the most important attribute (relative importance 47%).ConclusionThe findings indicated that product characteristics may have influences on US adults’ choices of legal cannabis flower products and may deserve consideration for cannabis regulatory framework.  相似文献   
2.
ObjectiveTo carry out a cost-utility analysis of the application of the Oncotype genomic test to inform the decision to use or not to use chemotherapy in the Basque Country (Spain).MethodThe cost-utility study was carried out using a discrete event simulation model representing the natural history of breast cancer. The decision of treatment with chemotherapy based on Oncotype was compared with the standard of treatment based on clinical-pathological criteria. The model included clinical data from Basque hospitals and the literature and was processed by deterministic and probabilistic analysis to calculate the incremental cost-effectiveness ratio (ICER), the cost-effectiveness plane, the acceptability curve and the expected value of perfect information. The study adopted both a health and societal perspective.ResultsFrom a health perspective, the deterministic analysis estimated an ICER for Oncotype of 17,453 euros/quality-adjusted life year (QALY), discount included, and 9,613 euros/QALY without the discount. Eighty five percent (85%) of the simulations were below the efficiency threshold for Spain. The parametric variability associated with the Oncotype results was the main uncertainty factor in the decision.ConclusionsOncotype is a cost-effective intervention from a health system perspective since each QALY gained costs less than 25,000 euros. From a societal perspective, it is dominant since it provides greater health and is accompanied by cost savings.  相似文献   
3.
目的 基于离散型的地理信息构建了H7N9病毒时空动态传播模式图,探索H7N9病毒的空间传播路径。方法 选取全球共享禽流感数据倡议组织(GISAID)中中国以人类为宿主的H7N9流感病毒血凝素(HA)和神经酰胺酶(NA)基因序列,利用BioEdit 7.0软件进行多序列比对。在贝叶斯理论框架下,运用BEAST 1.8.2软件构建H7N9时空传播模型,采用symmetric substitution model和贝叶斯随机搜索变量选择(BBSVS)方法,对H7N9的历史传播轨迹进行推断和检验。以Google Earth软件展现H7N9病毒的时空传播动态图。结果 感染人类的H7N9病毒起源于上海或杭州,最早可追溯到2012年10月。并在2013年3、4月份开始传向邻近省份,同年8、9月份传播加剧,3个月内传向10余处地区。结论 基于基因核苷酸序列和空间地理信息,追踪了H7N9病毒历史传播轨迹,为早期流感疫情的防控及病毒的溯源提供线索。  相似文献   
4.
ObjectivesTo investigate: (1) whether women self-report an ability to choose their preferred termination of pregnancy (TOP) procedure, (2) what factors influence this choice, and (3) what effect this choice has on emotional responses and satisfaction with care.Study designA mixed-method prospective comparative study in which women requesting a TOP between five and eighteen weeks gestation for social reasons (as opposed to medical indications), were invited to complete a semi-structured pre-TOP interview and questionnaire, and a post-TOP questionnaire four weeks after the procedure.Main outcome measuresQuantitative data was collected using the Patient Health Questionnaire, Generalised Anxiety Disorder Scale, Positive and Negative Affect Scale, Impact of Event Scale – Revised, and Client Satisfaction Questionnaire.ResultsPre-TOP emotion-based factors did not differ between groups. Most women felt that they were able to choose their preferred method of TOP. Their decisions were based on factors categorised as procedure-related, lifestyle or social circumstance-related, emotional, or other factors. When no choice was perceived, common reasons reported were that: (1) gestation was too far along for there to be another option, or (2) an appointment was not available within the required timeframe. When women felt that the method of TOP performed was not their choice they found the procedure more stressful. All women reported high satisfaction with care.ConclusionA better understanding of the patient experience can inform service development, enabling staff to ensure that the services provided meet women’s needs. The perception that one is able to choose their preferred TOP procedure is important for reducing procedure-related stress and ensuring high satisfaction with care.  相似文献   
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6.
To which extent is it possible to conduct a professional care defined by the care-receiver him-herself? Taking the exemple of the “Housing First program” in France, which refers to the north-american recovery model of care, this article intends to analyse the difficulties this form of care meets. Based on empirical cases, described through ethnographic observations, focus groups and interviews conducted with the members of the Housing-First Team, this article enlights two main limits to the development of a “recovery care”: the various degrees to which the model is known, understood and endorsed by the teams and their partners and some “borderline-situations” which question the ability of the teams to maintain a recovery-based care (risk to lose ones home or see ones health badly affected). This example is the occasion to explore a problem characteristic to the care relation: who may legitimely define the “best care” for someone in each case?  相似文献   
7.
IntroductionPost-stroke individuals usually present a delay in choice reaction time (CRT), and it would be important to verify the efficacy in the reduction of CRT after intervention protocols.ObjectiveThe main question of this review is ‘What are the characteristics of the CRT test and the interventions that decrease the CRT?’Study designSystematic review.MethodsThe search was performed in March 2019 using the electronic databases, PubMed, Science Direct, Scopus, Web of Science, Lilacs, Cinahal, Cochrane, Ovid, Scielo, PEDro, and Embase. There was no restriction regarding publication dates, and studies written in English that were conducted on poststroke patients and presented CRT results were included.ResultsSix studies were included in this systematic review, and the majority showed varied objectives, methodologies, and groups, regarding the number and characteristics of the sample, varying from complex to simple tasks for the CRT evaluation.ConclusionThis review suggests the investigation of the CRT in stroke patients with functional tasks using auditory and/or visual stimulus. About the CRT training in stroke patients, this review also suggests bilateral training, including functional tasks, and the use of structural practice blocks, but more studies are needed to better demonstrate the effects of interventions on the CRT.Registration numberPROSPERO (protocol no. CRD42017073995).  相似文献   
8.
AimsThe aims of this project were to investigate changes in nursing students’ attitudes and perceptions of older adults after implementing individualized Music and Memory© playlists. In addition, the inquiry sought to compare pre and post survey responses for changes in rankings of caring for the older adult as a career choice. The qualitative inquiry sought to explore students’ perceptions of their experience through narrative journaling for a better understanding of the experience.DesignThis study used an explanatory sequential mixed design.MethodsA pre post-intervention approach was used for quantitative data collection along with a ranking item for career choices. Journal narratives completed within one week following the experience were explored for qualitative themes to better understand students’ experiences. Attitudes and perceptions of students (N = 44) were measured by two tools before and after implementation of Music and Memory© Interventions during a 7-week clinical experience. Student journals were analyzed for themes.ResultsIn the two-tailed paired t-test, nursing students’ attitudes and perceptions of caring for older adults were analyzed for differences. Significance improvement was found in students’ reported interaction scores and other constructs (p ≤ .01). Mean ranking of caring for the older adult improved from 7.6 to 7.0 in the post intervention analysis. Student journals reported the activity as worthwhile and time consuming.ConclusionsAs the baby boomer generation ages the need for residential long-term care is projected to increase significantly. Recruiting and retaining nurses to care for this vulnerable population is challenging. Music and Memory© Interventions have the potential to change student attitudes and perceptions of the older adult that could improve caring for the older adult as a career choice.  相似文献   
9.
BackgroundAntimicrobial resistance (AMR) is one of the greatest threats in 21st century medicine. AMR has been characterized as a social dilemma. A familiar version describes the situation in which a collective resource (in this case, antibiotic efficacy) is exhausted due to over-exploitation. The dilemma arises because individuals are motivated to maximize individual payoffs, although the collective outcome is worse if all act in this way.ObjectivesWe aim to outline the implications for antimicrobial stewardship of characterizing antibiotic overuse as a social dilemma.SourcesWe conducted a narrative review of the literature on interventions to promote the conservation of resources in social dilemmas.ContentThe social dilemma of antibiotic over-use is complicated by the lack of visibility and imminence of AMR, a loose coupling between individual actions and the outcome of AMR, and the agency relationships inherent in the prescriber role. We identify seven strategies for shifting prescriber behaviour and promoting a focus on the collectively desirable outcome of conservation of antibiotic efficacy: (1) establish clearly defined boundaries and access rights; (2) raise the visibility and imminence of the problem; (3) enable collective choice arrangements; (4) conduct behaviour-based monitoring; (5) use social and reputational incentives and sanctions; (6) address misalignment of goals and incentives; and (7) provide conflict resolution mechanisms.ImplicationsWe conclude that this theoretic analysis of antibiotic stewardship could make the problem of optimizing antibiotic prescribing more tractable, providing a theory base for intervention development.  相似文献   
10.
介绍王绵之教授诊治女子月经不调的治则和经验。王老认为女子的月经来潮主要涉及肾、肝、脾三脏,提出治则"辨证立法,治标先治本",强调治疗月经不调主要从肝、肾、脾论治,用药应侧重疏肝理气,补脾肾;同时,王老认为女子月经是以阴血为物质基础,阴血运行异常是月经不调发生的直接原因,因此提出治则"辨证审因,治标不忘本",从血虚、血瘀、血寒、血热四个方面对患者的血分异常进行严格的辨证审因,进而对症用药。此外,王老对于药物配伍也颇有研究,重在养血而不留瘀,活血而不伤正,心思奇巧,用药精准。该文详尽阐述了王老治疗月经不调的治则与经验,为之后学者研究月经不调提供了研究思路。  相似文献   
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