The burden of herpes zoster disease in Norway

BackgroundNo national vaccination program against herpes zoster (HZ) is currently in place in Norway. We aimed to quantify the burden of medically attended HZ to assess the need for a vaccination program.MethodsWe linked data from several health registries to identify medically attended HZ cases during 2008–2014 and HZ-associated deaths during1996–2012 in the entire population of Norway. We calculated HZ incidences for primary and hospital care by age, sex, type of health encounter, vaccination status, and co-morbidities among hospital patients. We also estimated HZ-associated mortality and case-fatality.ResultsThe study included 82,064 HZ patients, of whom none were reported as vaccinated against HZ. The crude annual incidence of HZ was 227.1 cases per 100,000 in primary healthcare and 24.8 cases per 100,000 in hospitals. Incidence rates were higher in adults aged ≥50 years (461 per 100,000 in primary care and 57 per 100,000 in hospitals), and women than in men both in primary healthcare (267 vs 188 per 100,000), and hospitals (28 vs 22 per 100,000). Among hospital patients, 47% had complicated zoster and 25% had comorbidities, according to the Charlson comorbidity index. The duration of hospital stay (median 4 days) increased with the severity of comorbidities. The estimated mortality rate was 0.18 per 100,000; and in-hospital case-fatality rate was 1.04%.ConclusionsMedically attended HZ poses a substantial burden in the Norwegian healthcare sector. The majority of the zoster cases occurred among adults aged ≥50 years – the group eligible for zoster vaccination – and increased use of zoster vaccination may be warranted, especially among persons with co-morbidities.     

Symptoms During or Shortly After Isolated Carpal Tunnel Release and Problems Within 24?hours After Surgery

This study used the National Survey of Ambulatory Surgery (NSAS) database to measure the incidence of and risk factors for symptoms in the ambulatory surgery center and problems within 24 h after isolated carpal tunnel release (CTR). The NSAS contained records on 400,000 adult patients with carpal tunnel syndrome who were treated with CTR in 2006, based on ICD-9 codes. The type of anesthesia used and factors associated with symptoms and problems were sought in bivariate and multivariable statistical analyses. The mean duration of the procedure was 16 ± 8.8 min. Only 5 % were performed under local anesthesia without sedation, 45 % with IV sedation, 28 % regional anesthesia, and 19 % general anesthesia. Symptoms in the ambulatory surgery center or a problem within 24 h after discharge were recorded in 10 % of patients, all of them minor and transient, including difficulties with pain and its treatment. The strongest risk factors were male sex, age of 45 years and older, and participation of an anesthesiologist. Local anesthesia and regional anesthesia were associated with more perioperative symptoms and postoperative problems. Most CTR are performed with some sedation in the United States. CTR is a safe procedure: one in 10 patients will experience a minor issue in the perioperative or immediate postoperative period.     

Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries

BackgroundAmong older men, comparable cross-cultural investigations of sexual problems and associated distress that also include a multitude of relevant explanatory variables of these sexual problem and related distress are rare in the research literature.AimsTo investigate prevalence rates of sexual problems and associated distress among older men across 4 European countries (Norway, Denmark, Belgium, and Portugal) and assess for associated mental and physical health–related factors.MethodsMultinational cross-sectional questionnaire study using self-report measures.OutcomesPrevalence rates of sexual problems and associated distress levels.ResultsWe found a high prevalence of sexual problems persisting for months or longer across countries, but noted that many affected men experienced minimal or no distress related to these problems. We also found marked cross-cultural differences in reported distress about sexual problems, with southern European men (ie Portugal) reporting significantly more distress related to the majority of sexual problems investigated compared with northern European men (ie Denmark and Norway). Finally, we identified several relational, physical, and mental health problems associated with the reported number of sexual problems and the distress related to these problems.Clinical ImplicationsWe suggest that healthcare professionals also target distress when considering sexual problems among older men and contextualize these considerations within a multifactorial approach to general health in which (other) mental and physical health factors relevant to these patients’ sexual health and function are also jointly considered.Strengths & LimitationsStrengths of this study include the large sample size, inclusion of participants from 4 European countries, assessment of distress associated with sexual problems, and similar research design and method of data collection across the 4 included countries. Limitations of the study include the cross-sectional design, which precludes causal conclusions; the low response rate in the Portuguese sample; the lack of homosexual participants; and the lack of comprehensive assessments of dyadic factors that may be of relevance to sexual problems and associated distress.ConclusionThis study identified a high prevalence of sexual problems persisting for 3 months or longer among older men across 4 European countries, but also found that many of the men with sexual problems experienced minimal or no distress related to these problems.G.M. Hald, C. Graham, A. ?tulhofer, et al. Prevalence of Sexual Problems and Associated Distress in Aging Men Across 4 European Countries. J Sex Med 2019;16:1212–1225.     

浅析持续改进120院前急救工作

医疗急救水平是衡量城市现代化程度、社会发展的重要标志之一，本文通过分析目前红河州120在院前急救中的存在问题，提出了应对措施，为进一步提高本地区120院前急救工作效率，提供了一定的依据。     

达克罗宁胶浆在手术患者留置导尿中的应用观察

目的探讨采用盐酸达克罗宁胶浆作为润滑剂留置导尿管的效果。方法将846例全麻手术患者随机分为观察组和对照组,每组423例。观察组在放置留置尿管时采用了盐酸达克罗宁胶浆作为润滑剂放置尿管,对照组采用医用硅油作为润滑剂放置尿管。观察两组全麻手术患者术后复苏过程中因留置导尿管致尿道疼痛等不适的效果比较。结果观察组与对照组在复苏过程中的合作程度及术后尿道疼痛两方面比较,差异均有统计学意义(P0.05)。结论采用盐酸达克罗宁胶浆作为润滑剂放置尿管对减轻全麻手术患者术后复苏过程中的合作程度及术后尿道疼痛不适感效果明显。     

垫江县基层卫生工作存在的问题及建议

医改,政府在围绕解决人民群众看病难、看病贵等方面做了大量的工作。但一些如绩效工资分配不合理、医保报账定额限制、医技人员缺乏、医疗机构城乡布点不均、临床医疗与公共卫生信息不能共享等问题,在基层越发突出,一定程度更加重了群众“看病难”和基层医疗机构的发展。提出绩效工资分配政策,适度向基层医疗机构倾斜,稳定基层队伍;提高基层医疗机构医保报账分配额度和病人报销比例,引导病人分级诊疗、科学就医;加强医技人才培训和引进,不断提高基层医疗卫生机构的服务能力;加大财政投入力度,进一步完善基层医疗服务条件等建议。