谷氨酰胺对腹部手术后病人肠黏膜通透性影响的系统评价

目的:系统评价谷氨酰胺(Gln)对腹部手术后病人肠黏膜通透性的影响. 方法:通过计算机检索中国学术期刊全文数据库(CNKI)、中国生物医学文献数据库(CBMdisc)、万方数据库和Pub Med数据库等的文献资料,评价纳入随机对照研究,应用Rev Man 5.2软件进行Meta分析. 结果:经筛选共纳入9篇病例对照研究,累计421例受试者.结果显示,Gln可以降低腹部手术后病人肠黏膜乳果糖/甘露醇的比值[WMD=-0.05,95％ CI(-0.09,-0.01)(P=0.01)],降低腹部手术后病人二胺氧化酶浓度[WMD=-1.60,95％ CI(-1.89,-1.31)(P＜0.01)],并有降低术后病人循环D-乳酸的趋势,但无显著性差异[WMD=-8.14,95％ CI(-18.12,-1.84)(P=0.11)]. 结论:Gln能有效地降低外科腹部手术病人术后肠黏膜通透性,降低二胺氧化酶浓度,目前证据不能充分肯定Gln对循环D-乳酸有影响.     

Healthy urban environments for children and young people: A systematic review of intervention studies

This systematic review collates, and presents as a narrative synthesis, evidence from interventions which included changes to the urban environment and reported at least one health behaviour or outcome for children and young people. Following a comprehensive search of six databases, 33 primary studies relating to 27 urban environment interventions were included. The majority of interventions related to active travel. Others included park and playground renovations, road traffic safety, and multi-component community-based initiatives. Public health evidence for effectiveness of such interventions is often weak because study designs tend to be opportunistic, non-randomised, use subjective outcome measures, and do not incorporate follow-up of study participants. However, there is some evidence of potential health benefits to children and young people from urban environment interventions relating to road safety and active travel, with evidence of promise for a multi-component obesity prevention initiative. Future research requires more robust study designs incorporating objective outcome measures.     

Mechanistic insights into the effects of Astaxanthin on lipid profile and glucose homeostasis parameters: A systematic review of animal and clinical trial studies

Background and aimsThe antioxidant Astaxanthin (ASTX) may have potential to improve cardiometabolic risk factors. This study aimed to systematically review the impact of ASTX supplementation on lipid profile and glycemic indices in animal and clinical trial studies.MethodElectronic databases, including PubMed, Scopus, Web of Science, and Google Scholar were searched from inception up to June 2021. All clinical trials and animal studies published in English that investigated the effects of ASTX on lipid profile and glycemic parameters were considered in the study.ResultsA total of 3258 studies were retrieved from the search strategy from which 20 animal and five human studies were included in this systematic review. Twenty animal studies evaluated the effect of ASTX on lipid profile, of which 17 studies reported significant beneficial impact on one or more lipids. In addition, of 20 animal studies assessing the effect of ASTX on glucose homeostasis parameters, only 11 detected significant improvements. Five clinical trials evaluated the effect of ASTX on lipid profile; from these, three reported significant beneficial effect on at least one lipid. Moreover, of five human studies in which glucose homeostasis parameters were measured, only two observed significant improvement.ConclusionEvidence supports positive effects of ASTX on lipid profile. Nevertheless, the results on glycemic parameters are controversial and more studies are needed to draw a definite conclusion. ASTX could have great potential for reducing the risk of CVD and prevent T2DM and obesity-associated metabolic disturbances.     

Potential value of patient record review to assess and improve patient safety in general practice: A systematic review

Background: There is limited research, and guidance, on how to address safety in general practice proactively.

Objectives: This review aimed to synthesize the literature describing the use of patient record review (PRR) to measure and improve patient safety in primary care. The PRR methodologies utilized and the resulting outcomes were examined.

Methods: Searches were conducted using Medline, Embase, CINAHL and PsycINFO in February 2017. Reference lists of included studies and existing review papers were also screened. English language, peer-reviewed studies that utilized PRR to identify patient safety incidents (PSIs) occurring in general practice were included. Two researchers independently extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs.

Results: A total of 3265 studies were screened, with 15 included. Trigger tools were the most frequent method used for the PRRs (n?=?6). The mean number of safety incidents per 100 records was 12.6. Within studies, a mean of 30.6% of incidents were associated with severe harm (range 8.6–50%), and a mean of 55.6% of incidents was considered preventable (range 32.7–93.5%). The most commonly identified types of PSIs related to medication and prescribing, diagnosis, communication and treatment. Three studies reported on improvement actions taken after the PRRs.

Conclusion: This review suggests that PRR may be a promising means of proactively identifying patient safety incidents and informing improvements.     

健康与经济发展关系：国外研究综述

本文总结了健康因素与经济增长关系的研究进展，研究二者关系的主要方法有三种：一是假定技术进步是外生性的，二是假设理论模型中健康对经济增长是内生性的，三是假设差的健康状况是一种直接成本，进而研究流行病学疾病模式的转变与经济发展之间的相关性。在总结了目前该领域已有的研究后，建议将理论和经验研究应用于实践，提出了今后研究的方向，并希望健康与经济增长方面的研究能够为我国经济的长期健康发展起到借鉴作用。     

大气PM_(2.5)长期暴露对健康影响的队列研究进展

大气PM_(2.5)污染是危害人类健康的重要因素,已经成为全球热点问题。长期暴露于大气PM_(2.5)污染与疾病的发生和死亡密切相关,特别是心血管疾病和呼吸系统疾病,但不同研究的结论并不一致。基于人群的队列研究是评价大气污染慢性效应的重要方法。该文从暴露估计方法、健康效应评估两方面综述了大气PM_(2.5)长期暴露对健康影响的队列研究进展,指出了现有研究存在的问题,并提出了今后开展此类研究的建议。     

Early exposure to soy isoflavones and effects on reproductive health: a review of human and animal studies

Soy isoflavones are phytoestrogens with potential hormonal activity due to their similar chemical structure to 17-β-estradiol. The increasing availability of soy isoflavones throughout the food supply and through use of supplements has prompted extensive research on biological benefits to humans in chronic disease prevention and health maintenance. While much of this research has focused on adult populations, infants fed soy protein based infant formulas are exposed to substantial levels of soy isoflavones, even when compared to adult populations that consume a higher quantity of soy-based foods. Infant exposure, through soy formula, primarily occurs from birth to one year of life, a stage of development that is particularly sensitive to dietary and environmental compounds. This has led investigators to study the potential hormonal effects of soy isoflavones on later reproductive health outcomes. Such studies have included minimal human data with the large majority of studies using animal models. This review discusses key aspects of the current human and animal studies and identifies critical areas to be investigated as there is no clear consensus in this research field.     

Damaging effects of a high-fat diet to the brain and cognition: A review of proposed mechanisms

The prevalence of obesity is growing and now includes at least one-third of the adult population in the United States. As obesity and dementia rates reach epidemic proportions, an even greater interest in the effects of nutrition on the brain have become evident. This review discusses various mechanisms by which a high fat diet and/or obesity can alter the brain and cognition. It is well known that a poor diet and obesity can lead to certain disorders such as type II diabetes, metabolic syndrome, and heart disease. However, long-term effects of obesity on the brain need to be further examined. The contribution of insulin resistance and oxidative stress is briefly reviewed from studies in the current literature. The role of inflammation and vascular alterations are described in more detail due to our laboratory's experience in evaluating these specific factors. It is very likely that each of these factors plays a role in diet-induced and/or obesity-induced cognitive decline.     

A rapid review of key strategies to improve the cognitive and social development of children in Scotland

Objectives

Inequalities in health and educational outcomes in Scotland show a strong and persistent socioeconomic status gradient. Our aims were to provide policy-makers with a synthesis of international research evidence that assesses the effectiveness of early childhood interventions aimed at equitably promoting cognitive and social development and suggest potential areas for action in Scotland.

Methods

A rapid review was conducted of review level studies of early childhood interventions with outcome measures relating to child cognitive-language or social-emotional development, subsequent academic and life achievement. Websites were searched and interviews were conducted to identify relevant interventions, policies and programmes delivered in Scotland.

Results

: Early childhood intervention programmes can reduce disadvantage due to social and environmental factors. Scottish health policy demonstrates a clear commitment to early childhood development but much work remains in terms of detail of policy implementation, identification of high risk children and families, and early childhood monitoring systems.

Conclusions

Programmes should provide a universal seamless continuum of care and support from pregnancy through to school entry with the intensity of support graded according to need. The current information systems in Scotland would be inadequate for monitoring the effects of early childhood interventions especially in relation to cognitive-language and social-emotional development.     

Interventions utilising contact with people with disabilities to improve children's attitudes towards disability: A systematic review and meta-analysis

Background

Children with disabilities are often the target of prejudice from their peers. The effects of prejudice include harmful health consequences. The Contact Hypothesis has previously shown to promote positive attitudes towards a range of social groups.

Health professionals’ adherence to stroke clinical guidelines: A review of the literature

Background

The process of implementation of clinical guidelines i.e. getting guidelines into practice has been extensively reviewed and meta-reviewed from a generic perspective. However, in relation to stroke care, there has been no review of these studies to date, although implementing stroke clinical guidelines is a topic of great interest within the stroke literature. This review aims to identify stroke studies that have addressed adherence to generic and specific stroke care clinical guidelines.

Method

A computer search was conducted using PubMed, CINAHL, PsychINFO, Web of Science and the Cochrane Systematic Reviews databases. Search terms included those relevant to the implementation of stroke clinical guidelines. We assessed all studies retrieved against specific inclusion criteria and collated only those studies that emphasized adherence to stroke clinical guidelines.

Results

Eighty-eight articles were selected for further review from 153 articles retrieved. Of those, 27 were studies on adherence to stroke clinical guidelines and were included in this review – 16 were categorized as generic stroke guidelines and 11 were on specific aspects of stroke care. Each category was further divided into studies that assessed adherence to stroke guidelines only and those that intervened to improve adherence. Adherence was generally greater for studies that included an intervention. Specific stroke care guidelines were poorly adhered to compared to generic stroke guidelines but these studies were better at identifying organizational and team barriers to implementation. Most studies conducted audits of patient medical records and a limited number assessed health professionals’ views or used a behavioural framework to assess adherence.

Discussion

Adherence to stroke guidelines varied in the studies reviewed. Given the evidence that implementation of clinical guidelines in stroke care leads to better quality of care and improved health outcomes for patients, there is a need to increase adherence behaviours of health professionals towards recommended guidelines, in particular for long term stroke care.