The Impact of Postoperative Complications on Short- and Long-Term Health-Related Quality of Life After Total Mesorectal Excision for Rectal Cancer

BackgroundSurvival for rectal cancer patients has improved over the past decades. In parallel, long-term health-related quality of life (HRQoL) is gaining interest. This study focuses on the effect of complications following rectal cancer surgery on HRQoL and survival.MethodsThe TME-trial (1996-1999) randomized patients with operable rectal cancer between surgery with preoperative short-course radiotherapy and surgery. Questionnaires including the Rotterdam Symptom Checklist were sent at 6 time points within the first 24 months and after 14 years the EORTC QLQ-C30 and EORTC QLQ-CR29 questionnaires. Differences in HRQoL and survival between patients with and without complications were analyzed.ResultsA total of 1207 patients were included, of which 482 (39.9%) patients experienced complications, surgical complications occurred in 177 (14.6%) patients, non-surgical complications in 197 (16.3%) and 108 patients (8.9%) had a combination of both types of complications. Three months after surgery, patients with a combination of surgical- and non-surgical complications, especially patients with anastomotic leakage, had the worst HRQoL. Twelve months postoperative HRQoL returned to a similar level as before surgery, regardless of complications. In patients who survived 14 years, no significant differences in HRQoL were seen between patients with and without complications. However, patients with complications did have lower overall survival.ConclusionThis study shows that survival and short-term HRQoL are negatively affected by complications. Twelve months after surgery HRQoL had returned to the preoperative level regardless, of complications. Also, in patients that survived 14 years, there was no effect of complications on HRQoL detected.     

不同地区和年龄组人群接受结核病防治健康教育途径的分析

目的 通过调查全国各省居民接受结核病防治核心信息的健康教育途径,为结核病防治健康教育工作提供科学依据。方法 采用多阶段分层整群随机抽样的方法,在全国31个省(自治区、直辖市;不包括我国港澳台地区)按照调查点和调查对象的选取原则共抽取181个调查点和≥15岁的33357名调查对象,其中城镇和农村调查点分别为84个和97个,调查对象为18156名(54.43%)和15201名(45.57%)。为了解不同人群对于健康教育途径和宣传材料选择的偏好,将调查对象按照地区、城乡和年龄组分成12个组,分别为东部城镇15~60岁组(5311名)、东部城镇>60岁组(1618名)、东部乡村15~60岁组(3561名)、东部乡村>60岁组(1106名);中部城镇15~60岁组(6055名)、中部城镇>60岁组(1560名)、中部乡村15~60岁组(4476名)、中部乡村>60岁组(974名);西部城镇15~60岁组(2791名)、西部城镇>60岁组(732名)、西部乡村15~60岁组(3789名)、西部乡村>60岁组(1218名)。使用专家设计的结核病防治核心信息知晓率调查问卷对所有调查对象进行面对面询问式调查。本研究收集调查对象的社会人口学分类一般情况和接受健康教育的途径数据资料,有效问卷为33191份,有效率为99.50%;其中21296名(64.16%)表示接受过健康教育。结果 既往接受过健康教育的12个群组21296名调查对象选择媒介前三位者依次为电视(17.46%,11087/63510)、广播(14.54%,9237/63510)、传单/折页/宣传画(13.60%,8635/63510),其中选择电视和广播者均以中部城镇>60岁组为最高(分别为23.07%,314/1361;19.62%,267/1361),而选择传单/折页/宣传画者以中部乡村>60岁组为最高(14.97%,299/1998);选择网站/微博/微信者以东部城镇15~60岁组为最高(5.89%,577/9792)、西部乡村>60岁组为最低(0.30%,5/1639)。33191名调查对象希望了解结核病防治信息的途径前3位者分别为广播/电视/电影/网络/音像材料(26.76%,15517/57978)、医生宣传(18.21%,10559/57978)和张贴画/宣传栏/板报/展板/墙体标语(16.06%,9311/57978)。对宣传材料的选择依次为图画为主(25.76%,9549/37074)、文字为主(24.57%,9110/37074)。对网络的接受率以东部城镇>60岁组为最高(9.16%,163/1779),中部、西部乡村均较低[分别为2.60%(27/1037)和2.71%(25/923)]。最喜欢的网络咨询或查询方式依次为“使用医学专业人员在线咨询”(27.89%,9653/34608)、“到医学专业的网站查看”(21.86%,7563/34608)、“用百度或谷歌搜索”(15.74%,5448/34608)等方式。大众比较喜欢的网络传播知识的形式以文字+图片(29.14%,11268/38672)、文字+视频(26.20%,10131/38672)为主。结论 应针对不同地区、不同年龄组人群的特点,采取不同的健康教育途径和方法,将结核病防治核心信息有效地传达到特定的目标人群,特别是知晓率相对较低的老年人群和西部农村人口。     

How common is repeat surgery and multi-level treatment in Degenerative Cervical Myelopathy? Findings from a patient perspective survey

Degenerative Cervical Myelopathy (DCM) is a common condition which causes significant disability and reduces health-related quality of life. The only evidence-based treatment and current management guidance is surgery to decompress the spinal cord and stop further damage in moderate to severe cases. However, this guidance is mainly informed by studies that only include first time surgery and/or single level disease, but DCM can reoccur after primary surgery and affect multiple levels of the spine. It is unclear whether patients in these subgroups; repeat surgery and multi-level DCM, differ significantly in their baseline and disease characteristics from those with single-level, single-operation disease. To investigate this, we conducted an online survey of people with DCM looking at key demographic, disease (e.g. mJOA) and treatment characteristics. We received a total of 778 respondents, of which 159 (20%) had undergone surgery for DCM. Around 75% of these respondents had a single operation and 65% at a single level. We found no statistically significant difference in key participant and disease characteristics between respondents with single-level or single-operation and those with multi-level DCM or multiple operations. These data support generalisability of research to these subgroups but also warrants further investigations as these subgroups are underrepresented in current research.     

全面两孩政策下已育育龄妇女生育意愿的影响因素及其对策研究

目的：在全面两孩政策下，通过抽样调查上海市户籍已育育龄妇女二孩生育意愿，并分析其影响因素，为生育政策的实施及相关配套的完善提供参考。方法：采用目的抽样的方法，对上海市2个区4个街道的920名夫妻一方为上海市户籍家庭中15~49岁已育一孩妇女进行问卷调查，采用卡方检验、多因素Logistic回归模型进行二孩生育意愿影响因素分析。结果：回收有效问卷904份，其中有二孩生育意愿者20.7%，无意愿者57.7%，不确定者21.6%。回归分析结果显示，育龄妇女年龄、家庭年收入、夫妇类型、生育偏好和区域差异是妇女二孩生育意愿的重要影响因素。结论：全面两孩政策的实施对已生育一孩妇女的二孩生育意愿影响有限，意愿生育子女数明显低于政策允许生育子女数，除生育政策外，还有很多因素制约着人们的二孩生育意愿。全面两孩政策之后，延长产假、哺乳假和提供经济支持是最受期待的育儿支持政策。     

1213所医疗机构助产技术应用现状的调查研究

目的 了解国内医疗机构助产技术的应用现状,为助产教育、培训及政策的制订提供依据。方法 2017年12月—2018年11月,采用自行设计的“中国助产技术开展情况调查表”,对全国22个省份的1 213所医疗机构进行调查。 结果 共调查672所（55.4%）三级医院、541所（44.6%）二级医院。三级医疗机构使用的助产技术中,自由体位、心理保健、全面支持、非药物镇痛、导乐陪伴分娩等助产技术的应用率高于二级医疗机构,差异具有统计学意义（均P<0.05）;二级医疗机构使用的助产技术中,剃除阴毛、经肛门评估宫口、强迫体位分娩、常规人工破膜、增加腹压等助产技术的应用率高于三级医疗机构,差异具有统计学意义（均P<0.05）。按医疗机构类型分,综合医院使用的助产技术中,自由体位分娩、导乐陪伴分娩和助产士门诊的应用率低于专科医院和妇幼保健院,差异具有统计学意义（均P<0.05）;剃除阴毛、第二产程用手扩张阴道、强迫体位分娩等助产技术的应用率高于专科医院和妇幼保健院,差异具有统计学意义（均P<0.05）。 结论 国内医疗机构中明显有益的助产适宜技术应用情况较好,但不同级别医院的助产技术应用不均衡,建议制订适合国内的助产适宜技术实施标准和规范,提高助产服务质量,更好地保障母婴安全。     

A survey of blood transfusion errors in Aichi Prefecture in Japan: Identifying major lapses threatening the safety of transfusion recipients

BackgroundDespite recent progress in blood systems, transfusion errors can occur at any time from the moment of collection through to the transfusion of blood and blood products. This study investigated the actual statuses of blood transfusion errors at institutions of all sizes in Aichi prefecture.Materials and methodsWe investigated 104 institutions that perform 98 % of the blood transfusions in Aichi prefecture, and investigated the errors (incidents/accidents) that occurred at these facilities over 6 months (April to September, 2017). Incident/accident data were collected from responses to questionnaires sent to each institution; these were classified according to the categories and risk levels.ResultsNinety-seven of the 104 institutions (93.3 %) responded to the questionnaire; a total of 688 incidents/accidents were reported. Most (682 cases; 99.2 %), were classified as risk level 2; however, 6 were level 3 and over, which included problems with autologous transfusion and inventory control. Approximately one-half of the incidents/accidents (394 cases; 57.3 %), were related to verification and the actual administration of blood products at the bedside; more than half of these incidents/accidents occurred at large-volume institutions. Meanwhile, a high frequency of incidents/accidents related to transfusion examination and labeling of blood products was observed at small- or medium-sized institutions. The reasons for most of these errors were simple mistakes and carelessness by the medical staff.ConclusionsOur results emphasize the importance of education, operational training, and compliance instruction for all members of the medical staff despite advances in electronic devices meant to streamline transfusion procedures.     

中国中西部8县母亲孕期贫血与儿童发育迟缓的关联性研究

目的 了解中国中西部8县的母亲孕期贫血状况,并探讨其与儿童发育迟缓的关联性,为相关干预措施提供依据。方法 2016年10月-2017年1月采用横断面研究和按容量比例概率抽样法,调查了中国中西部地区8个县的1 100名1~59月龄儿童母亲孕期贫血状况,使用年龄与发育进程问卷(ASQ)评价儿童发育状况。运用多因素Logistic回归分析,计算调整混杂因素后的比值比(OR)和95%置信区间(95%CI)。结果 被调查地区儿童母亲孕期贫血患病比例为38.1%。控制了儿童性别、月龄、孩次、分娩方式、出生胎龄、出生体重、营养不良、儿童贫血、家庭年人均纯收入及母亲文化程度等因素后,孕期贫血是儿童沟通能区(OR=2.02,95%CI:1.09~3.75,P=0.025)和ASQ总评分(OR=1.63,95%CI:1.12~2.38,P=0.011)的可疑发育迟缓的危险因素。结论 被调查地区儿童母亲孕期贫血与儿童可疑发育迟缓的发生存在关联。     

Adaptación y validacion al español de un cuestionario específico de calidad de vida en pacientes con traqueostomía (TQOL)

Background and objectiveA long-term tracheostomy can have significant negative effects on quality of life because it causes physical, functional, sensory, psychological, social, economic, and work impairments to the life of the individual. The objective of this study was to validate in Spanish a quality-of-life questionnaire for these patients.Materials and methodsA psychometric validation study of a questionnaire in 45 patients over 18 years of age, with tracheostomy for six months, who understand Spanish and have a good understanding of the questions of the SF-36 questionnaire and a specific quality of life questionnaire for the patient with tracheostomy (TQOL-versión española). This questionnaire is a modification and cultural adaptation into Spanish of the original English instrument named Tracheostomy Specific Quality of Life Questionnaire (TQOL). The 2 questionnaires (TQOL-versión española) and the SF-36 were completed 6 months after the tracheostomy and between 30 and 50 days after the first administration. The reliability, repeatability, and construct validity of the TQOL-versión española were evaluated. The construct validity was assessed by the correlation between the results of the TQOL-versión española and the dimensions of the SF-36 questionnaire.ResultsThe reliability of the TQOL-versión española measured by Cronbach's alpha coefficient was .814, with variation between items from .783 to .817 in the sample at 6 months and from .794 in the validation sample, with variation between items from .758 to .813. There was intraclass correlation for the total score of the scale using the concordance analysis of Bland-Altman and agreement for the individual questions with the McNemar symmetry test. There was also a good correlation between the scales of the TQOL-versión española and the dimensions of the S-F36.ConclusionsThe TQOL-versión española showed good reliability, repeatability, and construct validity, therefore it is a useful tool to assess the impact on individual patients with a tracheostomy in place for more than 6 months, and to establish strategies at the healthcare and social levels to improve the quality of daily life.     

中国中西部8县1~59月龄儿童精细动作可疑发育迟缓状况及与早产的关系

目的 了解中国中西部8县1~59月龄儿童精细动作可疑发育迟缓状况并探讨其与早产的关系。方法 采用横断面研究和按容量比例概率抽样法,调查中国中西部地区8个县的1 927名1~59月龄儿童及其主要看护人,使用年龄与发育进程问卷(ASQ)评价其精细动作可疑发育迟缓状况。运用多因素Logistic回归分析,计算调整混杂因素后的比值比(OR)和95%置信区间(CI)。结果 被调查地区儿童精细动作可疑发育迟缓率为9.8%(95%CI:8.4%~11.1%)。控制了儿童性别、月龄、民族、主要看护人文化程度等因素后,早产、家庭人均纯收入低于国家贫困线、孩次≥3是儿童精细动作可疑发育迟缓的危险因素,OR值分别为2.69(95%CI:1.37~5.29)、1.87(95%CI:1.24~2.83)、1.74(95%CI:1.05~2.90)。结论 被调查地区儿童精细动作可疑发育迟缓状况需要关注,早产是其危险因素。     

中国北京和日本横滨两地青少年正畸治疗认知程度的调查分析

通过调查中国北京地区和日本横滨地区青少年对错(牙合)畸形的认知情况,探讨不同地区青少年对正畸治疗的理解和认识差异.方法对中国北京地区5500名青少年和日本横滨地区4646名青少年进行关于错(牙合)畸形认知情况的问卷调查,并进行χ<'2>检验.结果北京地区回收问卷3964份(72.1%),横滨地区回收问卷3291份(70.8%).北京地区已行正畸治疗的青少年为753例(19.0%),横滨地区为467例(14.2%),差异有统计学意义(P<0.001).79.2%已行正畸治疗的横滨青少年认为做正畸治疗好,比北京(66.0%)高.不同年龄段横滨青少年对正畸治疗需较长时间的了解程度均高于同年龄段北京青少年.与北京青少年(494名,65.7%)相比,更高比例的横滨青少年(370名,78.6%)认为(牙合)畸形会对面部健康带来不利影响.结论横滨地区行正畸治疗的青少年比例比北京地区小,但更多的横滨青少年认为做正畸治疗好,高于北京青少年.横滨青少年对正畸治疗的认知程度高于北京,且横滨青少年更注重错牙(牙合)畸形对面部健康的影响.