The Consumption of Food-Based Iodine in the Immediate Pre-Pregnancy Period in Madrid Is Insufficient. San Carlos and Pregnancy Cohort Study

A pre-gestational thyroid reserve of iodine is crucial to guarantee the increased demand for thyroid hormone production of early pregnancy. An iodine intake ≥150 µg/day is currently recommended. The objective of this study was to assess average pre-gestational food-based iodine consumption in pregnant women at their first prenatal visit (<12 gestational weeks), and its association with adverse materno-fetal events (history of miscarriages, early fetal losses, Gestational Diabetes, prematurity, caesarean sections, and new-borns large/small for gestational age). Between 2015–2017, 2523 normoglycemic women out of 3026 eligible had data in the modified Diabetes Nutrition and Complication Trial (DNCT) questionnaire permitting assessment of pre-gestational food-based iodine consumption, and were included in this study. Daily food-based iodine intake was 123 ± 48 µg, with 1922 (76.1%) not reaching 150 µg/day. Attaining this amount was associated with consuming 8 weekly servings of vegetables (3.84; 3.16–4.65), 1 of shellfish (8.72; 6.96–10.93) and/or 2 daily dairy products (6.43; 5.27–7.86). Women who reached a pre-gestational intake ≥150 µg had lower rates of hypothyroxinemia (104 (17.3%)/384 (21.4%); p = 0.026), a lower miscarriage rate, and a decrease in the composite of materno-fetal adverse events (0.81; 0.67–0.98). Reaching the recommended iodine pre-pregnancy intake with foods could benefit the progression of pregnancy.     

两性霉素B在恶性血液病合并侵袭性真菌病患者中的临床应用

目的 分析中国人民解放军总医院恶性血液病合并侵袭性真菌病(IFD)住院患者两性霉素B的临床用药情况,为指导临床合理用药提供依据。方法 选择中国人民解放军总医院2021年1—12月血液病科和造血干细胞移植病房罹患恶性血液病合并IFD并使用两性霉素B治疗的住院患者为研究对象,分析其人口学特征、影像学检查、真菌实验室检查、两性霉素B药品的用法用量等资料。结果 共纳入131例患者,其中临床诊断26例(19.85%),拟诊52例(39.69%),未确定53例(40.46%)。28.57%(34/119)患者(1,3)-β-D葡聚糖试验阳性,13.45%(16/119)半乳甘露聚糖试验阳性,44.64%(50/112)患者真菌培养阳性。共培养64株真菌,以念珠菌属居多(55株)。两性霉素B用法用量情况：111例(84.73%)患者使用两性霉素B脱氧胆酸盐(d-AmB),61例(46.56%)患者以静脉滴注途径给药,13例(9.92%)患者使用0.9%氯化钠注射液作为溶媒,55例(41.98%)患者使用地塞米松磷酸钠作为治疗前用药。109例(83.21%)患者采用抗真菌联合用药方案,以d-AmB联合...     

An implementation intentions intervention, the use of a planning strategy, and physical activity after myocardial infarction

The paper investigates the relations between involvement in an implementation intention intervention programme, frequency of the use of a self-regulatory physical activity planning strategy, and moderate physical activity among patients who had suffered myocardial infarction (MI). It examines whether effects of the implementation intention intervention on behavior change was mediated by change in the use of a planning strategy. A total of 114 patients from central and northern Poland took part in the study after their first uncomplicated MI. Data were collected individually at approximately 1 week after MI (Time 1), 2 weeks after short-term rehabilitation (about 8 weeks after MI: Time 2), and 8 months after MI (Time 3). After data collection at Time 2, patients were randomly assigned to the control group or the intervention group. Patients who participated in the implementation intention intervention maintained the same number of sessions of moderate physical activity at 8 months after MI (Time 3) as at 2 weeks after rehabilitation (Time 2). By contrast, patients from the control group performed significantly fewer sessions of moderate physical activity at Time 3, compared to Time 2. The intervention resulted in the more frequent use of a planning strategy at 8 months after MI. Change in the frequency of the use of a planning strategy completely mediated effects of the intervention on change in physical activity. Only patients who participated in the implementation intention intervention and increased their use of a planning strategy adhered to the recommended three or more sessions of moderate physical activity per week.     

住院患者抗菌药物临床应用干预前后对比分析

目的分析医院住院患者1个月的抗菌药物应用,评价用药合理性,调查其干预效果,为抗菌药物临床合理应用以及管理提供参考依据。方法 2011年5月全院出院患者3 446例作为对照组,2012年5月全院出院患者3 787例作为干预组,比较两组抗菌药物使用率以及使用强度,采用SPSS13.0分析。结果活动前抗菌药物使用金额占药品总金额的27.3%,抗菌药物使用率为77.7%,抗菌药物累计使用DDDs 28 384.9,使用强度74.1,特殊使用抗菌药物构成比14.8%,限制使用抗菌药物构成比39.3%;活动后抗菌药物使用金额占10.7%;抗菌药物使用率为47.6%;抗菌药物累计使用DDDs 21 477.1,使用强度52.9,特殊使用抗菌药物构成比6.7%,限制使用抗菌药物构成比15.2%。结论经过抗菌药物专项整治活动,医院抗菌药物临床应用渐趋合理,抗菌药物使用率、使用量明显下降,使用强度也有明显下降;特殊使用与限制使用抗菌药物的比重有大幅度下降,但仍有不合理使用抗菌药物现象,使用强度达不到卫生部要求(AUD<40DDD)。     

Changes in condom use among a cohort of prostitutes]

OBJECTIVE: To describe changes in condom use among prostitutes enrolled in a prospective cohort study in Alicante (Spain), and to identify those factors associated with changes in this behaviour.Methods: Data from this study come from a prospective cohort study of women working at prostitution enrolled in a center for AIDS preventive at Alicante from 1986 to 1996. The proportion of condom use by prostitutes with their clients was recorded during the first visit and the last one, and changes in condom use were estimated as the difference between them. Two logistic regression analyses were done to identify those factors associated with positive or negative changes in condom use. RESULTS: A statistically significant increase in the prevalence of condom use was observed between the first, 69,2%, and the last visit, 83,9% (p < 0,001). Prostitutes working private increased the condom use more than five time than those working in clubs or at the street. The higher the follow-up time the higher the prevalence of condom user, OR > 6 years = 7,6 (95% CI: 2,2-26,0). No variable was associated with a negative change in condom use. CONCLUSION: This study shows an overall increase of condom use in a cohort of prostitutes after 10 years of follow-up. Relapse in risk behavior has been infrequent. In the future, preventive strategies to increase the use of condoms among prostitutes should be adapted to the new forms of sexual commerce.     

Functional gain and length of hospital stay at a medium-stay geriatric care unit at the Central Red Cross Hospital in Madrid, Spain

BACKGROUND: The medium-stay or convalescent care geriatric units were defined by the Spanish National Health Institute in 1996 as being the level of geriatric hospital care aimed at recovering those functions, activities or sequelae having undergone changes as a result of different prior processes. This study is aimed at evaluating the characteristics of patients related to functional gain and stay in medium-stay geriatric units. METHODS: A study was made of all those patients admitted throughout the May 2000-December 2001 period. The weekly and overall functional gain was evaluated using the Barthel Index (BI), the hospital stay and the effectiveness (BI at discharge-BI at admission/during stay) having been evaluated. An improvement in the weekly gain of BI>5 points was set at the effectiveness threshold. RESULTS: A total of 459 patients averaging age 80.56 (+/-7.45) admitted for functional recovery from sequelae of ictus (48.4%), orthopedic disorders (26.3%) and immobility due to other ailments (23.5%) were evaluated. The total functional gain was 29.71 (+/-16.75) Barthel Index points, entailing an average stay of 24.93 (+/-12.94) days and a 1.44 (+/-1.02) effectiveness. The weekly functional gain was above the threshold set during the first three weeks, independently of the age and disorder for which admitted. In the multivariate regression analysis, the age, admission due to ictus, functional impairment prior to admission, cognitive impairment at admission, comorbility and delay in admission were related to a lesser functional gain. Admission due to ictus and a better functional condition prior to admission and better cognitive condition at admission were related to a longer stay. CONCLUSIONS: Hospital stays in medium-stay geriatric units is adequate, at least during the first three weeks. A comparison of the results among units should be adjusted by age, the disorder for which admitted, comorbility and functional and cognitive condition of the patients.     

Changes in basal and postmethionine load concentrations of total homocysteine and cystathionine after B vitamin intervention

BACKGROUND: Vitamin B-6 is necessary for the metabolism of homocysteine and is often used in combination with folic acid and vitamin B-12 in clinical trials that investigate whether the lowering of plasma total homocysteine (tHcy) can prevent vascular disease. OBJECTIVE: We compared the effects of vitamin B-6 with the effects of folic acid and vitamin B-12, as used in the Western Norway B-vitamin Intervention Trial (WENBIT), on basal and postmethionine load (PML) tHcy and cystathionine concentrations. DESIGN: Ninety patients with suspected coronary artery disease were randomly assigned to 1 of 4 groups to receive daily oral treatment with 1) 0.8 mg folic acid, 0.4 mg vitamin B-12, and 40 mg vitamin B-6 (group A); 2) 0.8 mg folic acid and 0.4 mg vitamin B-12 (group B); 3) 40 mg vitamin B-6 (group C); or 4) placebo (group D). For the first 2 wk, groups A and B received additional folic acid (5 mg/d). A methionine-loading test was performed at baseline and after 3 mo. RESULTS: Treatment with folic acid and vitamin B-12 caused a rapid and significant lowering of basal (31%) and PML tHcy concentrations (22%), with no effect on cystathionine. Vitamin B-6 did not change basal tHcy and had a significant but limited effect on PML tHcy concentrations. However, vitamin B-6 treatment markedly lowered basal and PML cystathionine by 31% and 42%, respectively. CONCLUSION: The folic acid and vitamin B-12 combination applied in WENBIT provides rapid, substantial, and long-term tHcy-lowering effects, whereas the effect of vitamin B-6 on tHcy was relatively small and confined to PML tHcy. However, vitamin B-6 treatment caused a marked reduction in plasma cystathionine. Cystathionine could be a useful marker for assessment of the vitamin B-6 effect and should, together with tHcy, be related to clinical outcome in ongoing trials.     

Trainees assessment of vocational training in psychiatry: a pilot study at the Maudsley Hospital

The adequacy of postgraduate trainees is assessed rather more frequently than that of the teaching process. A survey was therefore undertaken of the views of sixty-two junior psychiatrists regarding the clinical units they had worked on during their 3-year rotational training programme at the Maudsley Hospital. The quality of the training experience was felt to be related to work load (not too light), to the number of trainees attached to each consultant, and to the attention given by the consultant to instruction on practical management. The factors felt to need most attention were feedback from consultants on the trainee's performance, and the standards of academic instruction and of interdisciplinary teamwork.     

“院优秀青年人才”培养计划的实施成效和体会

中青年人才是学科发展和人才培养的基础,是人才活力的重要因素。结合上海交通大学医学院附属第九人民医院的实际情况,围绕2004-2006年设立的“院优秀青年人才”培养计划的指导思想、立项原则、具体措施以及初步成效等四方面,总结和探讨该院中青年人才培养工作中的前期经验。提示中青年人才培养要充分发挥“领军人才”作用,注重个体化的设计,集中资源重点培养。     

Hospital use of chlorine disinfectants in a hepatitis B endemic area--a prevalence survey in twenty hospitals

A survey was conducted to assess the uses of chlorine disinfectants in twenty hospitals in Hong Kong. In the 149 areas visited, the charge nurses were interviewed on the use of chlorine disinfectants. A high proportion of uses (44%) were not at the recommended dilution and only 88 (57%) of the 154 samples were within +/- 10% of the manufacturers quoted chlorine content. Samples with inadequate chlorine were found among all six types of chlorine disinfectants, although sodium dichloroisocyanurate tablets conformed to the quoted strength on 88% occasions. Higher usage frequency and better dilution practices were noted for hospitals with a disinfectant policy.