东阳市流动人口新生儿破伤风疫情及其影响因素分析

目的　探索东阳市流动人口新生儿破伤风 (NNT)疫情的影响因素及防制措施。方法　采用描述流行病学方法 ,对东阳市 1999～ 2 0 0 3年NNT专报系统的监测资料和个案调查材料进行统计分析。结果　不安全接生、卫生知识缺乏、免疫预防意识差、对流动人口的生育管理不善是导致NNT发病的主要因素。结论　不安全接生 ,是NNT发病的主要因素。加强对流动人口的生育管理 ,加强对孕妇卫生知识的宣教 ,普及住院接生、消毒接生及新生儿脐带的无菌护理 ,动员和落实NNT高危险育龄期妇女接种破伤风类毒素 (TT) ,是目前预防和消除NNT的主要措施。     

华北石油育龄妇女麻疹IgG抗体水平监测报告

在边远贫困、交通不便地区 ,由于住院分娩和新法接生普及率低 ,新生儿破伤风仍然是部分地区的新生儿死亡的主要原因。为进一步降低新生儿破伤风对儿童健康的危害 ,安顺地区按卫生部 1 995年下发的《全国消除新生儿破伤风行动计划》 ,于 1 999年对新生儿破伤风 (ＮＮＴ)进行监测 ,结果报告如下。资料来源于 1 999年安顺地区计划免疫新生儿破伤风专报系统。1 999年安顺地区新生儿破伤风累计报告 6 7例 ,调查 6 7例 ,确诊 6 4例 ,排除 3例 ,发病率为 2 6 2 1 0万 ,死亡率为 0 77 1 0万 ,病死率为 2 9 6 9%。 1 999年与 1 998年相比 ,发病率…     

宁波市新生儿破伤风流行病学调查分析

新生儿破伤风 (Ｎｅｏｎａｔａｌｔｅａｎｕｓ,ＮＮＴ)是 1 995年我国从丙类传染病调整为乙类传染病 ,1 996年我市法定传染病报告系统开始按月报告ＮＮＴ病例。根据全国《新生儿破伤风监测方案》 ,为消除新生儿破伤风 ,于 1 999年 1月我市开始对新生儿破伤风进行监测报告。为了摸清我市该病流行现状和探讨影响该病流行因素 ,以便制订有效防制措施 ,现将我市 1 999年新生儿破伤风流行病学调查及监测情况分析如下。资料来自 1 999年全市新生儿破伤风监测系统报告卡和新生儿破伤风病家调查的材料。1 发病数、病死率 :1 999年我市新生儿破伤风…     

1999-2008年浙江省东阳市农民工新生儿破伤风流行特征及其危险因素调查

目的了解1999-2008年浙江省东阳市农民工新生儿破伤风(neonatal tetanus,NT)流行病学特征及其危险因素。方法采用描述流行病学方法,对1999-2008年NT专报系统的监测资料和个案调查材料进行统计分析。结果东阳市1999-2008年共报告NT 124例,全年各月均有病例发生,5-10月高发,主要发病为5～9日龄。患儿男性多于女性,男女性别比为2.18∶1。病例主要集中在乡镇企业发达、流动人口聚集的吴宁、江北、白云街道和横店镇等地。患儿以在家中分娩,由未经培训的丈夫及接生婆助产为主,患儿母亲未接受破伤风疫苗(tetanus,vaccine,TV)接种者占90.32%,结论农民工非住院分娩,不清洁接生是发生NT的主要危险因素,卫生知识缺乏,免疫预防意识差是NT发病的另一个重要因素。     

绍兴市1999～2004年新生儿破伤风病例流行病学分析

目的了解绍兴市新生儿破伤风(NT)的流行病学特征,为控制和消除该病提供科学依据。方法用描述流行病学方法,对绍兴市1999～2004年NT专报系统的监测资料和个案调查材料进行统计分析。结果NT发病率波动在0.15‰～0.65‰之间,总体呈上升趋势,其中2004年有2个县(区)发病率≥1‰。NT病死率波动在11.11%～37.50%之间。病例主要集中在经济相对发达的越城区和绍兴县,发病无明显季节性。78例确诊病例中流动人口占89.74%,男性多于女性,男女性别比为2.12∶1,发病日龄集中在5～8d。在家分娩的占83.33%,接生员均未受过培训,所有母亲均无明确的破伤风类毒素(TT)接种史。结论旧法接生和产前未注射破伤风类毒素及人口流动是NT发病的主要因素。提高孕妇自我保健意识,推广住院分娩,对高危人群接种TT,加强新法接生培训,是消除NT的基本措施。     

2001-2011年浙江省宁波市新生儿破伤风流行病学特征分析

目的 了解2001-2011年浙江省宁波市新生儿破伤风(neonatal tetanus,NT)的流行病学特征以及影响因素,探讨消除NT的策略和措施。 方法 对2001-2011年NT监测资料进行描述性流行病学统计分析。 结果 宁波市2001-2011年共报告NT确诊病例287例,死亡77例,年平均发病率为0.35活产儿,年平均死亡率0.09活产儿,呈现出缓慢下降的趋势。病例主要发病年龄为3~9日龄,男性多于女性,男女性别比为1.66:1,主要集中在工业发达、流动人口密集的地区,外省流动人口最多(95.12%)。患儿以在家分娩,由未经过培训的人员(接生婆、家人以及邻居)为主,患儿母亲中,未接受产前检查占71.43%,未接种破伤风疫苗占86.76%。 结论 加强对流动人口,尤其是育龄期妇女以及儿童的管理,普及住院分娩、新法接生和开展高危地区、高危人群中育龄期妇女破伤风类毒素接种是宁波市消除NT的有效措施。     

安定与冬眠合剂治疗新生儿破伤风疗效比较

新生儿破伤风是由于不洁接生，导致经脐部感染破伤风杆菌而引起的急性严重传染病，病死率极高。随着医疗卫生条件的不断改善和围产期母婴保健措施的强化落实，其发病率已明显下降。但在一些经济和医疗卫生条件落后地区以及贫困的城市流动人口中仍有一定的散发病例发生。新生儿破伤风的治疗原则主要是控制痉挛、防治感染以及营养支持治疗，其中有效的解痉治疗是治疗成败的关键。作者收集我院自1995～2004年住院治疗的新生儿破伤风患者38例，观察对比安定和冬眠合剂治疗新生儿破伤风的疗效差异，现报告如下。     

委内瑞拉1970～1991年新生儿破伤风

一般情况自1970年开始委内瑞拉已规定每周报告新生儿破伤风(NNT)。在此以前,仅有死亡率的资料可利用。虽然在70年代病例死亡率低于其它国家,但 NNT 仍是死亡的重要原因。根据 Halubrohr 的报告,由于监测系统是很敏感的,所以报告的病例中包括假阳     

安定联合东莨菪碱治疗新生儿破伤风的临床观察及护理

新生儿破伤风是由于旧法接生,脐部感染破伤风杆菌所致的急性感染性疾病,其病死率较高。科学接生法普及后,本病的发病率迅速下降,但边远地区的农村仍时有发生。我科近年来在原有治疗的基础上,应用安定联合东莨菪碱治疗新生儿破伤风,同时注意临床护理,疗效满意,现报告如下。1资料     

新生儿破伤风病因分析及预防护理对策的探讨

新生儿破伤风系由破伤风杆菌侵入脐部引起中枢神经系统严重中毒的疾病。本文对我院自1993年～1996年住院的新生儿破伤风患者住院情况进行了分析,对发病人数增加的原因及预防护理进行了探讨,现总结报告如下。 1 临床资料 1.1 一般资料:新生儿破伤风患耆32例,其中男25例,女7例,男女比例为3.6∶1,自然分娩于家中旧法接生30例,自然分娩于卫生院接生2例,其中急产8例。发病天数<7天5例,～10天15例,～14天8例,>14天4例,其中发病时间最晚为25天。早产儿3例,足月儿29例。各年住院人数及转     

Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action

Tricyclic antidepressants and carbamazepine have become the mainstay in the treatment of neuropathic pain. Within the last decade, controlled trials have shown that numerous other drugs relieve such pain. We identified all placebo-controlled trials and calculated numbers needed to treat (NNT) to obtain one patient with more than 50% pain relief in order to compare the efficacy with the current treatments, and to search for relations between mechanism of pain and drug action. In diabetic neuropathy, NNT was 1.4 in a study with optimal doses of the tricyclic antidepressant imipramine as compared to 2.4 in other studies on tricyclics. The NNT was 6.7 for selective serotonin reuptake inhibitors, 3.3 for carbamazepine, 10.0 for mexiletine, 3.7 for gabapentin, 1.9 for dextromethorphan, 3.4 for tramadol and levodopa and 5.9 for capsaicin. In postherpetic neuralgia, the NNT was 2.3 for tricyclics, 3.2 for gabapentin, 2.5 for oxycodone and 5.3 for capsaicin, whereas dextromethorphan was inactive. In peripheral nerve injury, NNT was 2.5 for tricyclics and 3.5 for capsaicin. In central pain, NNT was 2.5 for tricyclics and 3. 4 for carbamazepine, whereas selective serotonin reuptake inhibitors, mexiletine and dextromethorphan were inactive. There were no clear relations between mechanism of action of the drugs and the effect in distinct pain conditions or for single drug classes and different pain conditions. It is concluded that tricyclic antidepressants in optimal doses appear to be the most efficient treatment of neuropathic pain, but some of the other treatments may be important due to their better tolerability. Relations between drug and pain mechanisms may be elucidated by studies focusing on specific neuropathic pain phenomena such as pain paroxysms and touch-evoked pain.     

A note on the number needed to treat.

The concept of the average number of patients needed to treat to prevent a single bad outcome is becoming increasingly popular among clinicians. Defined as the inverse of the absolute risk reduction (delta), its sample estimate is denoted as NNT. Here we discuss the mathematical and statistical properties of NNT and show that simple calculations, like taking sums of different NNTs, can give nonsensical results. The implication for a meta-analysis expressed in NNTs is that we can best calculate the combined NNT by taking the inverse of the combined estimate for delta. Simulations illustrate the better performance of the combined NNT estimate on the delta-scale (NNT(P)) in comparison with the combined estimate of NNT on the NNT-scale (NNT(O)), even in cases where it is reasonable to take sums. The calculations are illustrated using data from anti-epileptic trials.     

Diabetes prevention: is there more to it than lifestyle changes?

Over the past years, there has been an explosive increase in the prevalence of type 2 diabetes (T2DM) and this is expected to continue, entailing associated morbidity and mortality. An increasing number of studies explore the different ways T2DM could be prevented. On-going lifestyle modifications need to be addressed. High-risk patients should be given counselling on weight loss, possibly using a low glycaemic index diet, with a target of around 7-10% over 6-12 months, as well as instruction for increasing physical activity to around 150 min of physical exercise weekly (NNT = 4-8). Moderate alcohol consumption and coffee consumption may also be of benefit (NNT = 89 and 66, respectively). Metformin (NNT = 14), acarbose (NNT = 11) and troglitazone (NNT = 6) have been shown to prevent/delay T2DM and angiotensin-converting enzyme (ACE) inhibitors and statins appear to have an adjunctive role (NNT = 42 and 112, respectively). Trials with orlistat and bariatric surgery have also prevented T2DM (NNT = 36 and 6, respectively), and forthcoming treatment with GLP1 mimetics appears promising. Diabetes prevention studies should help create well-defined strategies for screening and treating high-risk populations in the real world, as prevention is our only chance to alleviate the ever growing burden of diabetes mellitus in the world.     

Medical doctors' perception of the "number needed to treat" (NNT). A survey of doctors' recommendations for two therapies with different NNT

OBJECTIVE: While the number needed to treat (NNT) is in widespread use, empirical evidence that doctors or patients interpret the NNT adequately is sparse. The aim of our study was to explore the influence of the NNT on medical doctors' recommendation for or against a life-long preventive drug therapy. DESIGN: Cross-sectional study with randomisation to different scenarios. SETTING: Postal questionnaire presenting a clinical scenario about a hypothetical drug as a strategy towards preventing premature death among healthy people with a known risk factor. Benefit after 5 years of treatment was presented in terms of NNT, which was set at 50 for half of the respondents and 200 for the other half. SUBJECTS: Representative sample (n = 1616) of Norwegian medical doctors. MAIN OUTCOME MEASURES: Proportion of doctors that would prescribe the drug. Reasons for recommending against the therapy. RESULTS: With NNT set at 50, 71.6% (99% CI 66.8-76.4) of the doctors would prescribe the drug, while the proportion was 52.3% (99% CI 47.5-57.1) with an NNT of 200 (chi = 50.7, p < 0.001). Multivariate logistic regression analysis indicated that the effect of NNT on the likelihood for recommending the therapy was age-dependent; young doctors ( < 36 of age) were more sensitive to the difference in NNTs than older doctors. Thirty-six percent (n = 464) of the doctors would not prescribe the drug, and 77.4% (99% CI 68.5-86.2) of those agreed with an argument stating that only one out of NNT patients would benefit from the treatment. CONCLUSION: Medical doctors appear to be sensitive to the magnitude of the NNT in their clinical recommendations. However, many doctors believe that only one out of NNT patients benefits from therapy. Clinical recommendations based on this assumption may be misleading.     

Medical doctors' perception of the "number needed to treat" (NNT)

The "number needed to treat" is assumed to be readily understood, but empirical evidence to support this assumption is sparse. 72% of medical doctors recommended a preventive drug therapy when NNT was 50 compared to 52% when NNT was 200. 77% of doctors recommending against a preventive drug therapy thought that only one out of NNT patients benefits from therapy. Since this assumption may be misleading, we suggest that the NNT should be used with caution in clinical practice. Objective &#114 - &#114 While the number needed to treat (NNT) is in widespread use, empirical evidence that doctors or patients interpret the NNT adequately is sparse. The aim of our study was to explore the influence of the NNT on medical doctors' recommendation for or against a life-long preventive drug therapy. Design &#114 - &#114 Cross-sectional study with randomisation to different scenarios. Setting &#114 - &#114 Postal questionnaire presenting a clinical scenario about a hypothetical drug as a strategy towards preventing premature death among healthy people with a known risk factor. Benefit after 5 years of treatment was presented in terms of NNT, which was set at 50 for half of the respondents and 200 for the other half. Subjects &#114 - &#114 Representative sample (n=1616) of Norwegian medical doctors. Main outcome measures &#114 - &#114 Proportion of doctors that would prescribe the drug. Reasons for recommending against the therapy. Results &#114 - &#114 With NNT set at 50, 71.6% (99% CI 66.8-76.4) of the doctors would prescribe the drug, while the proportion was 52.3% (99% CI 47.5-57.1) with an NNT of 200 ( &#104 2 =50.7, p<0.001). Multivariate logistic regression analysis indicated that the effect of NNT on the likelihood for recommending the therapy was age-dependent; young doctors (<36 of age) were more sensitive to the difference in NNTs than older doctors. Thirty-six percent (n=464) of the doctors would not prescribe the drug, and 77.4% (99% CI 68.5-86.2) of those agreed with an argument stating that only one out of NNT patients would benefit from the treatment. Conclusion &#114 - &#114 Medical doctors appear to be sensitive to the magnitude of the NNT in their clinical recommendations. However, many doctors believe that only one out of NNT patients benefits from therapy. Clinical recommendations based on this assumption may be misleading.     

Calculating confidence intervals for the number needed to treat

The number needed to treat (NNT) has gained much attention in the past years as a useful way of reporting the results of randomized controlled trials with a binary outcome. Defined as the reciprocal of the absolute risk reduction (ARR), NNT is the estimated average number of patients needed to be treated to prevent an adverse outcome in one additional patient. As with other estimated effect measures, it is important to document the uncertainty of the estimation by means of an appropriate confidence interval. Confidence intervals for NNT can be obtained by inverting and exchanging the confidence limits for the ARR provided that the NNT scale ranging from 1 through infinity to -1 is taken into account. Unfortunately, the only method used in practice to calculate confidence intervals for ARR seems to be the simple Wald method, which yields too short confidence intervals in many cases. In this paper it is shown that the application of the Wilson score method improves the calculation and presentation of confidence intervals for the number needed to treat. Control Clin Trials 2001;22:102-110     

Prevalence of hip fracture risk factors in women aged 70 years and over

We estimated the prevalence of common risk factors for hip fracture and the numbers needed to treat (NNT) to prevent a hip fracture in various high-risk population groups, using a postal risk factor survey of women aged 70 years and above from General Practices in Grampian and Yorkshire. Recorded risk factors included prior fracture of any type; low body weight; smoking; and family history of fracture. The prevalence rates of hip fracture risk factors were 34%, 7% and 11% for previous fracture, maternal hip fracture and smoking, respectively for the Grampian practices (low body weight being defined as falling in the lowest quartile) and 34%, 7% and 7% for a single practice in the York area. Applying previously published estimates of risk, NNT analysis produced a value of about 300 for women with no risk factors, whilst for women with three risk factors it was between 32 and 71, depending on which risk factors were present and assuming intervention reduced fracture rates by 30% or 50%. Groups of women at high risk of hip fracture can easily be identified in primary care and offered treatment, with realistic prospects of hip fracture prevention.     

Differentiating the efficacy of 5-HT(1B/1D) agonists

OBJECTIVE: To examine, for a set of published clinical trials of serotonin (5-HT(1B/1D)) agonists as acute treatments for migraine, whether transformation of efficacy data into therapeutic gain (TG) or number needed to treat (NNT) is useful. BACKGROUND: Pivotal clinical trials of 5-HT(1B/1D) agonists in migraine use a primary end point of change in pain score from 3 or 2 to 1 or 0. Placebo response rates among such studies are variable. Meta-analytic comparisons of 5-HT(1B/1D) agonists often employ TG and NNT as efficacy measures. METHODS: Data from US product labeling or published sources were converted into TG (TG = active response rate [%] - placebo response rate [%]) and NNT (NNT = 1/TG). Pivotal clinical trial data were compared before and after transformation. RESULTS: Therapeutic gain ranged from 17.5% to 51%. The transformation of TG into NNT yielded no clinically significant difference in efficacy estimate for the range of 17.5% to 47% (N = 29 clinical trials). However, NNT and TG had a nonlinear relationship for some secondary end points. When the relationship between the standard primary and secondary end points was compared, the correlation of TG with clinical disability (Pearson coefficient R = 0.93) was stronger than for NNT. Placebo response rates correlated more strongly with NNT (R = 0.66) than active response rates (R = 0.42; N = 29 clinical trials), although both TG and NNT were sensitive to placebo response rate. CONCLUSIONS: Transforming efficacy rates into TG or NNT adds no new information to placebo-controlled trials. The variables, TG and NNT, should not be used to compare members of this class of drugs. Migraine therapies can only be compared using well-designed head-to-head studies and not by meta-analysis. Broader measures of efficacy should be used to describe and compare 5-HT(1B/1D) efficacy.     

The effect of high nursing surveillance on hospital cost

PURPOSE: The purpose of this study was to determine the cost of one nursing treatment, surveillance, for older, hospitalized adults at risk for falling. DESIGN: An observational study using information from data repositories at one Midwestern tertiary hospital. The inclusion criteria included patients age>60 years, admitted to the hospital between July 1, 1998 and June 31, 2002, at risk for falls or received the nursing treatment of fall prevention. METHODS: Data came from clinical and administrative data repositories that included Nursing Interventions Classification (NIC). The nursing treatment of interest was surveillance and total hospital cost associated with surveillance was the dependent variable. Propensity-score analysis and generalized estimating equations (GEE) were used as methods to analyze the data. Independent variables related to patient characteristics, clinical conditions, nurse staffing, medical treatments, pharmaceutical treatments, and other nursing treatments were controlled for statistically. FINDINGS: The total median cost per hospitalization was $9,274 for this sample. The median cost was different (p=0.050) for patients who received high versus low surveillance. High surveillance delivery cost $191 more per hospitalization than did low surveillance delivery. CONCLUSION: Propensity scores were applied to determine the cost of surveillance among hospitalized adults at risk for falls in this observational study. The findings show the effect of high surveillance delivery on total hospital cost compared to low surveillance delivery and provides an example of a useful method of determining cost of nursing care rather than including it in the room rate. More studies are needed to determine the effects of nursing treatments on cost and other patient outcomes in order for nurses to provide cost-effective care. Propensity scores were a useful method for determining the effect of nursing surveillance on hospital cost in this observational study. CLINICAL RELEVANCE: The results of this study along with possible clinical benefits would indicate that frequent nursing surveillance is important and might support the need for additional nursing staff to deliver frequent surveillance.