无排卵障碍的年轻女性供精人工授精周期结局分析

目的 探讨不同方案对年轻、排卵正常女性供精人工授精(artificial insemination with donor sperm,AID)妊娠结局的影响.方法 回顾性分析2013年1月至2016年12月在华中科技大学同济医学院附属同济医院生殖中心就诊女方年龄≤35岁、排卵正常、因男方因素行AID治疗的2188个周期...     

Estimating the global public health implications of electricity and coal consumption

Background: The growing health risks associated with greenhouse gas emissions highlight the need for new energy policies that emphasize efficiency and low-carbon energy intensity.Objectives: We assessed the relationships among electricity use, coal consumption, and health outcomes.Methods: Using time-series data sets from 41 countries with varying development trajectories between 1965 and 2005, we developed an autoregressive model of life expectancy (LE) and infant mortality (IM) based on electricity consumption, coal consumption, and previous year’s LE or IM. Prediction of health impacts from the Greenhouse Gas and Air Pollution Interactions and Synergies (GAINS) integrated air pollution emissions health impact model for coal-fired power plants was compared with the time-series model results.Results: The time-series model predicted that increased electricity consumption was associated with reduced IM for countries that started with relatively high IM (> 100/1,000 live births) and low LE (< 57 years) in 1965, whereas LE was not significantly associated with electricity consumption regardless of IM and LE in 1965. Increasing coal consumption was associated with increased IM and reduced LE after accounting for electricity consumption. These results are consistent with results based on the GAINS model and previously published estimates of disease burdens attributable to energy-related environmental factors, including indoor and outdoor air pollution and water and sanitation.Conclusions: Increased electricity consumption in countries with IM < 100/1,000 live births does not lead to greater health benefits, whereas coal consumption has significant detrimental health impacts.     

Masculinity, social context and HIV testing: an ethnographic study of men in Busia district, rural eastern Uganda

Background

Significant variation exists in published Aboriginal mortality and life expectancy (LE) estimates due to differing and evolving methodologies required to correct for inadequate recording of Aboriginality in death data, under-counting of Aboriginal people in population censuses, and unexplained growth in the Aboriginal population attributed to changes in the propensity of individuals to identify as Aboriginal at population censuses. The objective of this paper is to analyse variation in reported Australian Aboriginal mortality in terms of LE and infant mortality rates (IMR), compared with all Australians.

Methods

Published data for Aboriginal LE and IMR were obtained and analysed for data quality and method of estimation. Trends in reported LE and IMR estimates were assessed and compared with those in the entire Australian population.

Results

LE estimates derived from different methodologies vary by as much as 7.2 years for the same comparison period. Indirect methods for estimating Aboriginal LE have produced LE estimates sensitive to small changes in underlying assumptions, some of which are subject to circular reasoning. Most indirect methods appear to under-estimate Aboriginal LE. Estimated LE gaps between Aboriginal people and the overall Australian population have varied between 11 and 20 years. Latest mortality estimates, based on linking census and death data, are likely to over-estimate Aboriginal LE. Temporal LE changes by each methodology indicate that Aboriginal LE has improved at rates similar to the Australian population overall. Consequently the gap in LE between Aboriginal people and the total Australian population appears to be unchanged since the early 1980s, and at the end of the first decade of the 21st century remains at least 11–12 years. In contrast, focussing on the 1990–2010 period Aboriginal IMR declined steeply over 2001–08, from more than 12 to around 8 deaths per 1,000 live births, the same level as Australia overall in 1993–95. The IMR gap between Aboriginal people and the total Australian population, while still unacceptable, has declined considerably, from over 8 before 2000 to around 4 per 1,000 live births by 2008.

Conclusions

Regardless of estimation method used, mortality and LE gaps between Aboriginal and non-Aboriginal people are substantial, but remain difficult to estimate accurately.     

Putting sex on the table: sex,sexuality and masculinity among HIV-positive men in Nairobi,Kenya

Psychosocial support groups offer an important space for people living with HIV to pursue greater wellbeing as they learn how to accept and live with their HIV status. They are critical for the cultivation of responsible and adherent patients. Occasionally, support groups provide spaces where members are encouraged to discuss sexual struggles related to being HIV-positive, including sexual performance issues, sexual relationships, fertility desires and communicating with sexual partners. This paper examines an HIV-positive men's sex therapy support group at Kenyatta National Hospital in Nairobi, Kenya, where HIV-positive men access information about HIV and treatment, while getting tips on restoring sexual functioning and improving sexual gratification from medical experts, peer counsellors and fellow group members. In the group setting, members worked to rediscover and reconstruct masculinity under the guidance of a range of experts, while focusing on regaining or improving sexual prowess.     

The influence of protein nutrition in early life on growth and development of the pig. 1. Effects on growth performance and body composition

The effects of feeding either a high-protein (HP) diet or a low-protein (LP) diet between 1.8 and 15 kg live weight (LW) and a low-energy (LE) or a high-energy (HE) intake but at the same protein intake subsequent to 15 kg LW on the performance and body composition of pigs growing to 75 kg LW were investigated. During the LW period 1.8-15 kg, pigs given the LP diet exhibited poorer growth performance (P less than 0.01) and at 15 kg contained more fat (P less than 0.01) in their empty bodies than pigs given the HP diet. On the LE treatment subsequent to 15 kg LW, pigs previously given the LP diet deposited protein at a faster rate and exhibited more rapid and efficient growth to 60 kg LW than those given the HP diet before 15 kg. However, on the HE treatment, pigs previously given the LP diet deposited protein at a slower rate and exhibited poorer growth performance (P less than 0.05) between 15 and 45 kg LW but grew at a faster rate between 45 and 60 kg LW than pigs previously given the HP diet. On the LE treatment subsequent to 15 kg LW the differences in body composition between the two protein groups were no longer significant at 45 kg. However, on the HE treatment, pigs previously given the LP diet remained fatter (P less than 0.05) to 60 kg LW than those previously given the HP diet. The results suggested that restricting protein intake between 1.8 and 15 kg LW reduced, temporarily, the upper limit of protein retention and growth performance during subsequent development. This finding is discussed in relation to the effects of protein nutrition in early life on the hyperplasic development of muscle tissue.     

Antiretroviral therapy and reproductive life projects: Mitigating the stigma of AIDS in Nigeria

As millions of people infected with HIV in Africa are increasingly able to live longer and healthier lives because of access to antiretroviral therapy, concerns have emerged that people might eschew protective practices after their health improves. Extending beyond the notion of sexual “disinhibition,” researchers have begun to analyze the sexual behavior of people in treatment through the perspective of their marital and childbearing aspirations. This article explores the reproductive life projects of HIV-positive men and women in southeastern Nigeria, showing how actions that contradict medical advice are understandable in the context of patients’ socially normative desires for marriage and children. Based on in-depth interviews and observations (June–December 2004; June–July 2006; June–July 2007) of people enrolled in the region’s oldest treatment program, we argue that broadly held social expectations with regard to reproduction are experienced even more acutely by HIV-positive people. This is because in Nigeria the stigma associated with AIDS is closely tied to widespread perceptions of social and moral crisis, such that AIDS itself is seen as both a cause and a symptom of anxiety-producing forms of social change. Specifically, in an era of rapid societal transformation, Nigerians see sexual promiscuity and the alienation of young people from traditional obligations to kin and community as indicative of threatened social reproduction. For people who are HIV-positive, marrying and having children offer not only the opportunity to lead normal lives, but also a means to mitigate the stigma associated with the disease. Four ethnographic case studies are provided to exemplify how and why social and personal life projects can trump or complicate medical and public health priorities. These examples suggest that treatment programs must openly address and proactively support the life projects of people on antiretroviral therapy if the full benefits of expanded access to treatment are to be realized.     

来曲唑应用于多囊卵巢综合征促排卵治疗的研究进展

来曲唑(letrozole,LE)是第三代芳香化酶抑制剂(aromatase inhibitors,AIs),为人工合成的三苯三喹类衍生物。2001年国外首次将LE正式应用于临床促排卵治疗。多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄期妇女常见的生殖内分泌和代谢紊乱疾病,无排卵是其主要特征,为不孕不育的直接原因之一。临床上促排卵治疗药物首选氯米芬(clomiphene citrate,CC),但CC因一些不良反应而具有局限性。研究发现,在PCOS妇女不孕治疗中,LE可以促进子宫内膜生长,对宫颈黏液无不利影响,为胚胎种植提供良好条件;且LE在排卵率与出生率方面优于CC,在流产率、多胎妊娠率及对胎儿安全性方面LE和CC相似。因此,在PCOS妇女不孕治疗中,LE或可取代CC成为一线的促排卵药物。     

“Why Aren't You Breastfeeding?”: How Mothers Living With HIV Talk About Infant Feeding in a “Breast Is Best” World

Infant feeding raises unique concerns for mothers living with HIV in Canada, where they are recommended to avoid breastfeeding yet live in a social context of “breast is best.” In narrative interviews with HIV-positive mothers from Ontario, Canada, a range of feelings regarding not breastfeeding was expressed, balancing feelings of loss and self-blame with the view of responsibility and “good mothering” under the current Canadian guidelines. Acknowledging responsibility to put their child's health first, participants revealed that their choices were influenced by variations in social and cultural norms, messaging, and guidelines regarding breastfeeding across geographical contexts. This qualitative study raises key questions about the impact of breastfeeding messaging and guidelines for HIV-positive women in Canada.     

"Throwing the dice": pregnancy decision-making among HIV-positive women in four U.S. cities

CONTEXT: Although AIDS-related deaths among U.S. women have decreased, the number of HIV-positive women, especially of reproductive age, has increased. A better understanding of the interaction between HIV and family planning is needed, especially as antiretroviral medications allow HIV-positive women to live longer, healthier lives. METHODS: Qualitative methods were used to examine pregnancy decision-making among 56 HIV-positive women in four U.S. cities. Biomedical, individual and sociocultural themes were analyzed in groups of women, categorized by their pregnancy experiences and intentions. RESULTS: Regardless of women's pregnancy experiences or intentions, reproductive decision-making themes included the perceived risk of vertical transmission, which was often overestimated; beliefs about vertical transmission risk reduction strategies; desire for motherhood; stigma; religious values; attitudes of partners and health care providers; and the impact of the mother's health and longevity on the child. Most women who did not want children after their diagnosis cited vertical transmission risk as the reason, and most of these women already had children. Those who became pregnant or desired children after their diagnosis seemed more confident in the efficacy of risk reduction strategies and often did not already have children. CONCLUSIONS: Future studies may help clarify the relationship between factors that influence pregnancy decision-making among HIV-positive women. HIV-positive and at-risk women of childbearing age may benefit from counseling interventions sensitive to factors that influence infected women's pregnancy decisions.     

Correlation between national income, HIV/AIDS and political status and mortalities in African countries

OBJECTIVES: To investigate associations between mortalities in African countries and problems that emerged in Africa in the 1990s (reduction of national income, HIV/AIDS and political instability) by adjusting for the influences of development, sanitation and education. METHODS: We compiled country-level indicators of mortalities, national net income (the reduction of national income by the debt), infection rate of HIV/AIDS, political instability, demography, education, sanitation and infrastructure, from 1990 to 2000 of all African countries (n=53). To extract major factors from indicators of the latter four categories, we carried out principal component analysis. We used multiple regression analysis to examine the associations between mortality indicators and national net income per capita, infection rate of HIV/AIDS, and political instability by adjusting the influence of other possible mortality determinants. RESULTS: Mean of infant mortality per 1000 live births (IMR); maternal mortality per 100,000 live birth (MMR); adult female mortality per 1000 population (AMRF); adult male mortality per 1000 population (AMRM); and life expectancy at birth (LE) in 2000 were 83, 733, 381, 435, and 51, respectively. Three factors were identified as major influences on development: education, sanitation and infrastructure. National net income per capita showed independent negative associations with MMR and AMRF, and a positive association with LE. Infection rate of HIV/AIDS was independently positively associated with AMRM and AMRF, and negatively associated with LE in 2000. Political instability score was independently positively associated with MMR. CONCLUSIONS: National net income per capita, HIV/AIDS and political status were predictors of mortality indicators in African countries. This study provided evidence for supporting health policies that take economic and political stability into account.     

HIV阳性患者合并多发骨坏死1例

HIV阳性患者发生骨坏死的概率逐年增加,骨坏死早期症状不明显,预后较差,须早期行手术治疗。HIV阳性患者发生骨坏死的因素主要包括传统因素和HIV相关因素。本文结合1例HIV阳性患者合并多发骨坏死的诊疗情况并回顾相关文献,探讨其病因及相关治疗。     

卵泡发育不良女性氯米芬与来曲唑诱导排卵的助孕结局比较

目的:探讨卵泡发育不良女性氯米芬(CC)与来曲唑(LE)诱导排卵后供精人工授精(AID)周期的助孕结局.方法:回顾性分析我院生殖医学科2012年1月—2019年8月卵泡发育不良女性CC、LE诱导排卵后AID周期的临床资料,包括小卵泡排卵女性的320个周期、卵泡发育停滞或闭锁女性的286个周期;分别按诱导排卵方案分为CC...     

Disclosure of HIV Diagnosis to HIV-Infected Children in South Africa: Focus Groups for Intervention Development

Worldwide about 2.5 million children younger than 15 years of age are living with HIV, and more than 2.3 million of them live in sub-Saharan Africa. Antiretroviral therapy has reduced mortality among HIV-infected children, and as they survive into adolescence, disclosing to them their diagnosis has emerged as a difficult issue, with many adolescents unaware of their diagnosis. There is a need to build an empirical foundation for strategies to appropriately inform infected children of their diagnosis, particularly in South Africa, which has the largest number of HIV-positive people in the world. As a step toward developing such strategies, we conducted a study in Eastern Cape Province, South Africa to identify beliefs about disclosing HIV diagnosis to HIV-infected children among caregivers, health-care providers, and HIV-positive children who knew their diagnosis. We implemented 7 focus groups with 80 participants: 51 caregivers in 4 groups, 24 health-care providers in 2 groups, and 5 HIV-positive children in 1 group. We found that although the participants believed that children from age 5 years should begin to learn about their illness, with full disclosure by age 12, they suggested that many caregivers fail to fully inform their children. The participants said that the primary caregiver was the best person to disclose. The main reasons cited for failing to disclose were (a) lack of knowledge about HIV and its treatment, (b) the concern that the children might react negatively, and (c) the fear that the children might inappropriately disclose to others, which would occasion gossip, stigmatization, and discrimination towards them and the family. We discuss the implications for developing interventions to help caregivers appropriately disclose HIV status to HIV-infected children and, more generally, communicate effectively with the children to improve their health outcomes.     

Growing Older With HIV/AIDS: New Public Health Challenges

At present, the health care infrastructure is ill-equipped to handle the unique treatment and care needs of HIV-positive older adults.The long-term effects of antiretroviral use are still being discovered and have been associated with a number of comorbidities. Stigma presents challenges for those in need of services and health care, and can significantly affect mental health and treatment adherence.The training of elder service providers and health care providers in meeting the needs of HIV-positive older adults, including gay and transgender people, is needed as the population ages. HIV-related and antigay stigma should be challenged by social marketing campaigns. Continued research and key policy changes could greatly improve health outcomes for HIV-positive elderly persons by increasing access to treatment and support.THE ADVENT OF ANTIRETROVIral medications (ARVs) has enabled HIV-positive people to live increasingly longer lives. Those in the developed world who begin highly active antiretroviral treatment (HAART) at an initial CD4 count above 200 can expect to live well into their 70s.1Worldwide the leading cause of death among people living with HIV/AIDS is tuberculosis.2 In the United States tuberculosis is very rare. Less than one third of deaths among people with HIV/AIDS in the United States are now attributed to diseases traditionally associated with HIV infection, such as Kaposi’s sarcoma.3 Liver disease and cardiovascular disease, both associated with long-term use of ARVs, are leading causes of mortality among older people living with HIV.Longer life expectancy is already evident; by 2015 more than half of the HIV-positive population in the United States will be aged 50 years and older.4 Most older adults living with HIV/AIDS were infected in youth or middle age; only 1 in 9 new HIV infections in the United States occurs among people aged 50 years and older.5Aging with HIV/AIDS presents biomedical complexities only now beginning to reveal themselves. Higher rates of comorbidities are among the more severe biomedical issues facing older adults with HIV/AIDS.6 Widespread cognitive impairment among people on treatment of a long time could be caused by “chronic HIV-driven inflammation in an aging brain.”7^(p1) Answers to critical research questions regarding how HIV medications interact with medications to treat other conditions are still in the nascent stages. In this article, we examine what we know about growing older with HIV/AIDS, identify gaps in knowledge, and provide recommendations to enable public health professionals to better treat and care for the burgeoning population of HIV-positive older adults, and reduce infections among older adults.     

Self-disclosure of HIV status: perception of malaysian HIV-positive subjects towards attitude of dental personnel in providing oral care

The objective of this study was to assess the perceptions of Malaysian HIV-positive subjects towards the attitude of dental personnel in providing oral care to them. The study design was cross-sectional with the sampling frame comprising of 27 Government Drug Rehabilitation Centres throughout Malaysia. A convenience sample was then taken from 20 centres with the highest enrolment of HIV-positive subjects. A self-administered questionnaire was used to elicit information on the perception of HIV-positive subjects towards the attitude of dental personnel in providing oral care to the patient with HIV-positive. The study sample consisted of 509 HIV-positive individuals with a mean age of 31.3+/-12.9 years old. Of these, only 15.1% attended a dental clinic after confirmation of HIV-positive status. The study demonstrated that 67.5% of the HIV-positive subjects disclosed their status voluntarily to the dentists and majority of the dentists (76.9%) did not show any negative reaction on knowing their HIV positive status. There was also no difference in the attitude of auxiliary staff toward the above disclosure. In conclusion, the study showed that oral health care personnel are more receptive to the HIV-positive subjects receiving dental care and treatment.     

HIV is underestimated

Results of a New York City survey show that residents view AIDS as the leading health problem, but they underestimate the spread of the epidemic in their neighborhoods. Survey results showed half of the respondents thought about 100 individuals with HIV lived in their community; in fact, 3,200 HIV-positive people, on average, live within the immediate area of the city's 41 major hospitals. According to Ravinia Hayes-Cozier of Harlem Directors Group, this survey emphasizes the need to continue educating the community about the disease.     

2008 - 2014年四川省凉山州某高流行县预防艾滋病母婴传播效果分析

目的 评价四川省凉山州某高流行县预防艾滋病母婴传播工作的开展情况及母婴阻断效果,为今后的工作开展提供科学依据。 方法 通过预防艾滋病母婴传播网络直报信息系统,收集2008 - 2014年孕产妇HIV检测、感染情况,阳性孕产妇及所生儿童相关信息,并用SPSS20.0软件进行统计分析。 结果 2008 - 2014年全县孕产妇HIV抗体总检测率为61.76％,共发现686例阳性孕产妇,孕产妇HIV感染率为4.35%。分娩的阳性孕产妇中抗病毒药物用药率为66.96%。分娩活产婴儿599例,新生儿抗病毒用药率为62.94%。对HIV阳性孕产妇所生儿童进行随访,人工喂养率为88.78%,母婴传播率为14.15%。 结论 7年间,研究地区母婴传播干预措施落实情况有所提高,但仍存在薄弱环节,需加强孕产妇早期咨询检测工作,落实孕产妇及所生儿童的随访管理,以确切评价预防工作效果。     

云南省2010—2013年HIV阳性结核病患者抗结核疗效影响因素

目的分析云南省人类免疫缺陷病毒（HIV）阳性结核病（TB）患者抗结核疗效的影响因素。方法利用TB/HIV双重感染防治监控评价体系,分析云南省2010—2013年登记TB患者HIV抗体检测结果,比较HIV阳性TB患者和HIV阴性TB患者的特征及抗结核治疗效果。数据采用单因素χ²检验,筛选有影响变量进入多因素logistic回归模型,分析影响HIV阳性TB患者治疗成功的因素。结果共登记报告HIV检测阳性TB患者1 526例,HIV阴性TB患者51 838例。与HIV阴性患者比较,HIV阳性TB患者痰涂片阴性比例较高（67.96% vs 56.00%,χ²=327.54,P<0.001）,复治比例较高（22.87% vs 3.69%,χ²=1 342.6,P<0.001）、治疗成功率较低（88.07% vs 95.81%,χ²=210.08,P<0.001）、非结核死亡率较高（5.77% vs 0.61%,χ²=524.73,P<0.001）;诊断肺结核时CD4<200 个/μL 和治疗分类为复治是影响HIV阳性患者抗结核疗效的危险因素。结论及早发现HIV阳性TB患者,结合其CD4水平及时提供抗结核治疗,加强患者随访管理。     

Cotrimoxazole prophylaxis reduces mortality in human immunodeficiency virus-positive tuberculosis patients in Karonga District, Malawi

OBJECTIVE: To estimate the impact of cotrimoxazole prophylaxis on the survival of human immunodeficiency virus (HIV)-positive tuberculosis (TB) patients. METHODS: A cohort study with a historical comparison group was conducted. End-of-treatment outcomes and 18-month survival were compared between TB patients registered in 1999 and patients registered in 2000 in Karonga District, Malawi. Case ascertainment, treatment and outpatient follow-up were identical in the two years except that in 2000 cotrimoxazole prophylaxis was offered to HIV-positive patients in addition to routine care. The prophylaxis was provided from the time a patient was identified as HIV-positive until 12 months after registration. Analyses were carried out on an intention-to-treat basis for all TB patients, and also separately by HIV status, TB type and certainty of diagnosis. FINDINGS: 355 and 362 TB patients were registered in 1999 and 2000, respectively; 70% were HIV-positive. The overall case fatality rate fell from 37% to 29%, i.e. for every 12.5 TB patients treated, one death was averted. Case fatality rates were unchanged between the two years in HIV-negative patients, but fell in HIV-positive patients from 43% to 24%. The improved survival became apparent after the first 2 months and was maintained beyond the end of treatment. The improvement was most marked in patients with smear-positive TB and others with confirmed TB diagnoses. CONCLUSION: Survival of HIV-positive TB patients improved dramatically with the addition of cotrimoxazole prophylaxis to the treatment regimen. The improvement can be attributed to cotrimoxazole because other factors were unchanged and the survival of HIV-negative patients was not improved. Cotrimoxazole prophylaxis should therefore be added to the routine care of HIV-positive TB patients.