共查询到20条相似文献，搜索用时 15 毫秒
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Anna L. Chien Ji Qi Radhika Grandhi Tamia Harris-Tryon Noori Kim Min Soo Jang Omolara Olowoyeye Diane Kuhn Sherry Leung Barbara M. Rainer Flora Poon Sabrina Sisto Alessi César Jean Suh Nancy Cheng Ginette A. Okoye Sewon Kang 《Journal of the National Medical Association》2018,110(6):534-539
Background
Increased photoprotection by natural melanin allows for African-Americans to be less impacted by photoaging than Caucasians. However, less is known about chronological aging in this population.Objective
To create a photonumeric scale for African-Americans to evaluate chronological skin aging and to explore contributing elements to intrinsic aging.Methods
Standardized photographs of the upper inner arm were taken from 75 African-American participants. Five participants were chosen as standards to create a 9-point photonumeric scale (0 = none, 8 = most severe). The scale was utilized by three blinded dermatologists to independently rate participants' photographs.Results
The interrater agreements were 0.768 (95% CI: 0.671–0.834) for trial 1 and 0.725 (0.608–0.794) for trial 2. The intrarater agreements were 0.757 (0.596–0.875), 0.850 (0.771–0.903), and 0.790 (0.686–0.855) for the three raters. Averaged chronological aging scores were correlated with participants' survey responses, which revealed age as a significant predictor (r = 0.72, p < 0.001).Limitation
Our study was limited by the sample size, although the number of study participants was similar on a investigation in Caucasians.Conclusion
This study created the first reliable photonumeric scale for chronologic skin aging in African-Americans and found increased age and greater BMI as contributors to intrinsic skin aging phenotype in this population. 相似文献3.
Roya Nikjou Rafat Kazemzadeh Firoozeh Asadzadeh Razzag Fathi Farideh Mostafazadeh 《Journal of the National Medical Association》2018,110(3):265-269
Objectives
The menopause is a natural biological process that is happened by a permanent regal stop due to the loss of performance. The aim of this research is to evaluate the effect of lavender aromatherapy on the menopause symptoms.Study design
This double-blind cross over clinical trial carried out on 100 menopause women (between 45 and 155 years old) referring to health centers in Ardabil in 2013-14. The samples blocked randomly, placed in two experimental (Lavender) and control (diluted milk) groups. Lavender aroma is smelled two times daily for 20 min during 12 weeks by research subjects. Data were collected by Green questionnaire and the analysis of data carried out in SPSS v.16 by paired t-test.Main outcome measures
The level of the symptoms has been decreased significantly after using lavender.Results
Comparing the level of the symptoms before and after using lavender in experimental group suggested that the rate of the menopause symptoms has been decreased significantly (P = 0.000). The comparison of the mean of the menopause symptoms after intervention between two groups suggested that the menopause symptoms in the experimental group had a significant decrease comparing the control group (P = 0.000).Conclusion
Using the lavender aromatherapy decreases menopause symptoms. According to the undesirable effect of the menopause symptoms on the quality of life of the menopausal women, these interventions may be instructed by midwives in the treatment and care centers as a health activity. 相似文献4.
Sadhana Sharma Asgar Ali Roshan Takhelmayum Mala Mahto Rathish Nair 《Journal of the National Medical Association》2017,109(2):93-97
Purpose
Currently, the curriculum of medical education is compartmentalized which makes achieving the expected outcome, a real challenge. Co-teaching, an existing concept in education, however, may be used in medical education for integrating the applied component while basic concepts are being taught. The hypothesis, “can co-teaching be an alternate for an integrated curriculum?” was explored in this study. Therefore, the present study was designed to compare the outcomes of co-teaching with the existing teaching methodology owing to the absence of integrated curriculum.Methods
Co-teaching and conventional modules of topics Diabetes mellitus (DM) and Alcohol and liver disease (AL), were prepared and validated. 100 under graduate medical students were randomly assigned to groups A and B. Group A was taught DM by Conventional teaching (CT) and AL by Integrated Co-teaching (ICT) and Group B was taught DM by ICT and AL by CT. A knowledge assessment tool of 20 multiple choice items was administered to assess the pre, post and retention knowledge scores. Change between knowledge scores was analyzed using inferential statistics.Results
Both conventional and co-teaching were significantly effective in increasing the knowledge scores (p = 0.0001) with no significant difference in learning outcomes (p = 0.59) between the two. However, co-teaching showed better knowledge retention compared to conventional teaching (p = 0.008).Conclusions
Co-teaching could be considered as a substitute for integrated curriculum as it enabled comparatively better retention of knowledge as revealed by the findings. 相似文献5.
Mina Tadrous Wayne Khuu Gerald Lebovic Matthew B. Stanbrook Diana Martins J. Michael Paterson Muhammad M. Mamdani David N. Juurlink Tara Gomes 《Annals of allergy, asthma & immunology》2018,120(1):59-65.e2
Background
Omalizumab is indicated for the treatment of moderate to severe asthma. There is limited observational evidence on the costs and effectiveness of omalizumab.Objective
To examine the costs and effectiveness of omalizumab for treatment of severe asthma relative to nonusers.Methods
We conducted a within-person repeated-measures matched cohort study in Ontario, Canada from April 1, 2012 to March 31, 2014. Continuous users of omalizumab were matched with up to 4 nonusers according to age, sex, recent specialist visits, oral corticosteroid use, asthma severity, and Charlson comorbidity score. The primary outcome was direct health care costs. Secondary outcomes were asthma-related hospitalizations or emergency department visits and oral corticosteroid use. The association between omalizumab use and each outcome was assessed using mixed-effects models adjusting for confounders.Results
Ninety-five omalizumab users and 352 nonusers were matched. Among users, there was a significant increase in health care costs of $1,796 per person owing to the cost of the medication at treatment initiation (P < .0001). Costs did not change significantly among nonusers ($85 increase in average monthly costs per person; P = .59). We found no significant changes in the rates of asthma-related hospitalizations or emergency department visits among omalizumab users (P = .44) or nonusers (P = .99) between pre- and postintervention periods.Conclusion
The use of omalizumab was associated with increased costs but no evidence of lower rates of clinically important outcomes. These results suggest omalizumab had limited effectiveness in our study population. Future studies should further explore subsets of patients most likely to benefit from omalizumab therapy. 相似文献6.
Charlotte Baker Jill Powell Dominic Le Melissa S. Creary Lori-Ann Daley Mary Anne McDonald Charmaine DM. Royal 《Journal of the National Medical Association》2018,110(6):564-573
Objective
To describe the perspectives and experiences of athletic trainers, coaches, and student-athletes approximately three years post-implementation of the NCAA sickle cell trait (SCT) screening policy.Participants
Two-hundred and eight student-athletes, 32 athletic trainers, and 43 coaches from 10 NCAA Division I (DI) institutions in North Carolina from January to June 2014.Methods
Two online surveys were used to assess knowledge, perspectives, and experiences.Results
Athletic staff were more supportive than student-athletes of the need for the policy. Noted challenges included variation in implementation and follow-up for SCT-positive athletes, financial costs to institutions and athletes, and timing of the screening.Conclusions
More education about SCT is needed for student-athletes and athletic staff in order to help make the implementation more successful. All parties need to be in agreement regarding the importance of knowing which student-athletes have SCT and how that information will be utilized. 相似文献7.
Naeimeh Tayebi Zahra Yazdanpanahi Shahrzad Yektatalab Saeedeh Pourahmad Marzieh Akbarzadeh 《Journal of the National Medical Association》2018,110(5):440-447
Objective
The present research aimed to study the relationship between body mass index and menstrual disorders at different ages of menarche and sex hormones.Methods
In this cross-sectional study, 2000 girls aged between 9 and 18 in all levels were selected through cluster sampling in Shiraz. Data were collected using demographic characteristics, menstrual disorders, body mass index and hormones' measure questionnaires. To analyze the data, we used SPSS 16 and Chi-square test.Results
A total of 1024 (51.2%) out of 2000 subjects had normal BMI and the smallest group belonged to 26 subjects (1.3%) with BMI ≤ 30. There is a significant relationship between body mass index, menstrual cycle length (p = 0.006), spotting (p = 0.005), passing clots (p = 0.001) and menstrual bleeding (p = 0.04), and this relationship is insignificant between body mass index and duration of bleeding (p = 0.95), amenorrhea (p = 0.03), dysmenorrhea (p = 0.26) and menstrual regularity (p = 0.95). Investigating the relationship between body mass index and some of sex hormones shows that there is no significant relationship among BMI and TSH (p = 0.94), FSH (p = 0.21), LH (p = 0.21), Prolactin (p = 0.97), Testosterone (p = 0.66), and DHEAS (p = 0.94).Conclusions
A significant relationship among BMI and menstrual cycle length, spotting, passing clots and menstrual bleeding, and was insignificant with sex hormones. 相似文献8.
Chin-Shiang Tsai Yuan-Pin Hung Jen-Chieh Lee Nan-Yao Lee Po-Lin Chen Ling-Shan Syue Ming-Chi Li Chia-Wen Li Wen-Chien Ko 《Journal of microbiology, immunology, and infection》2018,51(2):243-250
Background
Clostridium difficile infection (CDI) is well-known as the major cause of infectious diarrhea in hospitalized patients. Community-onset CDI (CO-CDI) is an emerging threat. However, clinical information of CO-CDI in Taiwan remains scarce.Methods
A retrospective study was conducted at a medical center in southern Taiwan. Symptomatic patients between 2007 and 2015 with C. difficile toxin or tcdB detected in stool were identified as CDI, and were classified as CO-CDI [including community-associated CDI (CA-CDI) and community-onset health care facility-associated CDI (CO-HCFA-CDI)] and health care facility-onset CDI (HCFO-CDI).Results
Of 427 patients, 15 (3.5%) were CA-CDI, 49 (11.5%) CO-HCFA-CDI, and 363 (85.0%) HCFO-CDI. Despite major involvement of the elderly (mean age: 66.1 years vs. 69.9 years, p = 0.46), no significant differences were noted between CA-CDI and CO-HCFA-CDI groups, except that solid organ cancer was more common in the CO-HCFA-CDI group. The CO-CDI group more often presented with abdominal pain but had shorter hospital stays and less exposure of proton-pump inhibitors or broad-spectrum antibiotics than the HCFO-CDI group did. The mortality rate related to CDI was 4.7% (3 patients) in the CO-CDI group. Despite a lower in-hospital mortality rate in the CO-CDI group (10.9% vs. 22.0%; p = 0.04), the recurrence rate was similar (10.9% vs. 7.2%; p = 0.3).Conclusions
CO-CDI is not common but associated with substantial morbidity and mortality. Physicians should put CDI into consideration among patients who present community-onset fever, diarrhea, or abdominal pain alone or in combination. 相似文献9.
Laurens Holmes Isabel Morgan Brianne Earnest Alexandra LaHurd Arie Nettles Kirk Dabney 《Journal of the National Medical Association》2018,110(6):583-590
Purpose
Variability in pediatric morbidity and mortality tends to be influenced by several factors including though not limited to social determinants of health, namely health inequity as an exposure function of health disparities. We aimed to assess the cumulative incidence of pediatric mortality, racial/ethnic disparities, and the predisposing factors for the disparities.Method
The current study retrospectively examined the Nemours/Alfred I. duPont Hospital for Children medical records of 16,121 patients diagnosed with any pediatric condition during 2009 and 2010.Results
In-hospital pediatric mortality cumulative incidence was relatively low (80 deaths, 0.49%) when compared with similar settings in the U.S. (national average range, 0.8e1.1%) during the same period. Compared with whites/Caucasians, mortality was higher among blacks/African Americans, prevalence odds ratio (POR), 1.06, 95% CI, 0.77e1.45, and higher for some other race, POR, 1.48, 95% CI, 1.06e2.10. After controlling for potential confounders (severity of illness, insurance status, and length of stay), racial differences in pediatric mortality did not persist between whites and some other race, adjusted POR, 1.08, 99% CI, 0.75e1.57.Conclusions
In-hospital pediatric mortality cumulative incidence was relatively low in our region, and racial disparities exist but did not persist after controlling for confounders. These findings are suggestive of the importance of social determinants of health namely quality care, adequate medical insurance, and early detection, diagnosis in pediatric morbidity and epigenomic alterations, as well as the need to go beyond the “close medical model” to improve pediatric morbidity and survival by addressing health inequity as a function of health disparities. 相似文献10.
Melishia Bansa Darryl Brown Daniela DeFrino Nicholas Mahoney Alexandria Saulsberry Monika Marko-Holguin Joshua Fogel Tracy R.G. Gladstone Benjamin W. Van Voorhees 《Journal of the National Medical Association》2018,110(2):130-142
Background
This study explored the implementation of Chicago Urban Resiliency Building (CURB), a randomized clinical trial designed as an Internet-based primary care depression prevention intervention for urban African American and Latino adolescents.Methods
We utilized a mixed methods analysis to explore four aims. First, we estimated the percent of at-risk adolescents that were successfully screened. Second, we examined clinic site factors and performance. Third, primary care providers (n = 10) and clinic staff (n = 18) were surveyed to assess their knowledge and attitudes about the intervention. Fourth, clinic staff (nursing and medical assistant) interviews were analyzed using thematic analysis to gather perspectives of the implementation process.Results
We found that the estimated percent of at-risk adolescents who were successfully screened in each clinic varied widely between clinics with a mean of 14.48%. Daily clinic communication was suggestive of greater successful screening. Feasibility of screening was high for both primary care providers and clinic staff. Clinic staff exit interviews indicated the presence of community barriers that inhibited successful implementation of the intervention.Conclusion
This study shares the challenges and successes for depression screening and implementing Internet-based mental health interventions for urban racial/ethnic minority adolescents in primary care settings. 相似文献11.
Leila Katoozian Nahid Tahan Maryam Zoghi Babak Bakhshayesh 《Journal of the National Medical Association》2018,110(6):547-552
Background
Spasticity is one of the most important causes of disability after stroke. In spite of high incidence of spasticity, little is known about the relationship between the occurrence and the development of spasticity. This study aimed to determine risk-factors of post stroke spasticity.Methods
This was an observational study of 149 persons with first ever stroke. The following parameters were assessed: Stroke severity, Spasticity, Disability and Joint contracture.Results
Prevalence of spasticity was between 17–25% during the first 3 months after stroke. The onset of spasticity was 13.79% and 4.16% at 1 and 3 months after stroke respectively. The prevalence of spasticity in the upper extremity was significantly more than lower extremity at 1 month. Spasticity was significantly more severe in the upper extremity than lower extremity. In patients with hemorrhagic stroke Odds ratios of spasticity was 2.5 times more than persons with ischemic stroke (P = 0.0210. The Odds ratios of severe spasticity at 1 and 3 months were 1.66 and 1.75 times more than the first week (P = 0.024, P = 0.042 respectively).Conclusions
Post stroke spasticity is more common in persons with hemorrhagic stroke, severe paresis and lower functional abilities. The most incidence of spasticity happens in the first month after stroke. 相似文献12.
Bahiah Ismail Mohd Nazri Shafei Azian Harun Saedah Ali Mahamarowi Omar Zakuan Zainy Deris 《Journal of microbiology, immunology, and infection》2018,51(6):763-769
Background
With increasing prevalence and spread of multidrug resistant Gram-negative infections, parenteral polymyxins resurged in clinical practice. The primary aim of the study was to determine the predictors of treatment failure and in-hospital mortality among critically ill patients treated with polymyxin B.Methods
Demographic data, underlying diseases, procedures and details on polymyxin B therapy were retrospectively analyzed in a cohort of 84 patients who received intravenous polymyxin B in an intensive care unit from 2010 to 2014.Results
Polymyxin B was used to treat bacteremia (46.4% of cases) and pneumonia (53.6%). Majority of the pathogens isolated were Acinetobacter spp. (96.4%). The mortality rate was 48.8%, of which 82.9% was attributed to polymyxin B treatment failure. The independent predictors of treatment failure were low doses of polymyxin B (p = 0.002), shorter duration of therapy (p = 0.009), not combining with cefoperazone/sulbactam (p = 0.030), female gender (p = 0.004), administered for treatment of bacteremia (p = 0.023) and renal impairment (p = 0.021). Low polymyxin B doses (p = 0.007), not combining with cefoperazone/sulbactam (p = 0.024), female gender (p = 0.048) and renal impairment (p = 0.022) were also significant predictors for in-hospital mortality.Conclusions
To the best of our knowledge, this is the first report on the association of inadequate dose of polymyxin B (<15,000 units/kg/day) with poor outcome in critically ill patients. Besides that, further clinical studies are warranted to evaluate the use of cefoperazone/sulbactam as second antibiotic in the combination therapy. 相似文献13.
Ching-Hsun Wang Feng-Yee Chang Tsu-Yi Chao Woei-Yau Kao Ching-Liang Ho Yeu-Chin Chen Ming-Shen Dai Ping-Ying Chang Yi-Ying Wu Jung-Chung Lin 《Journal of microbiology, immunology, and infection》2018,51(1):123-131
Background
The aim of this study was to compare the risk factors and clinical outcomes of bacteremia in allogeneic and autologous hematopoietic stem cell transplant (allo-HSCT and auto-HSCT) recipients with levofloxacin prophylaxis during the early period after transplantation.Methods
Characteristics of bacteremia within 45 days after transplantation between allo-HSCT and auto-HSCT recipients who received levofloxacin prophylaxis between January 2005 and December 2014 were retrospectively reviewed.Results
Of 105 HSCT recipients included in this study, 55 (52.4%) received an allo-HSCT and 50 (47.6%) received an auto-HSCT. Twenty-five patients (23.8%) with HSCT developed 28 episodes of bacteremia. Of these 25 bacteremia patients, 15 received an allo-HSCT, while 10 received an auto-HSCT. The occurrence of Grade 3–4 graft-versus-host disease and longer engraftment duration were associated with bacteremia in allo- and auto-HSCT recipients (p = 0.001 and p = 0.002, respectively). Auto-HSCT recipients with bacteremia had a longer hospital stay after transplantation, while allo-HSCT recipients with bacteremia had an increased 45-day mortality rate as compared with those without bacteremia (p = 0.014 and p = 0.013, respectively). All 14 Gram-negative blood isolates in this study were resistant to fluoroquinolone.Conclusion
Levofloxacin prophylaxis in HSCT recipients is associated with the emergence of fluoroquinolone-resistant Gram-negative bacteria. The risk factors and clinical outcomes of bacteremia differ between allo- and auto-HSCT recipients, and these differences should be taken into account when designing strategies to prevent bacteremia. 相似文献14.
Joshua R. Hirsch George Waits Yabing Li Elsayed Z. Soliman 《Journal of the National Medical Association》2018,110(2):169-175
Background
Heart age is an estimate of the age of a person's cardiovascular system given their cardiovascular disease (CVD) risk factors. The difference between a person's chronological age and heart age (excess heart age) represents their added CVD risk.Objective
To examine racial differences in excess heart age and whether race impacts the association between excess heart age and CVD mortality.Methods
This analysis included 5110 participants (2449 non-Hispanic white, 1287 non-Hispanic black, and 1374 Mexican-American) from the NHANES III who were free of CVD. Heart age was calculated using the sex-specific non-laboratory-based Framingham risk prediction functions. Multivariable Cox proportional-hazards regression models were used to evaluate the relationship (overall and by race) between excess heart age and CVD mortality.Results
Mean excess heart age was greatest in non-Hispanic blacks (13.0 years), followed by Mexican-Americans (10.5 years), and non-Hispanic whites (8.5 years); p < 0.001 for pairwise differences. Over a mean follow-up of 13.0 years, 394 CVD deaths occurred. Each 10 years of excess heart age was associated with 65% increased risk of CVD mortality (HR, 95% CI: 1.65, 1.53–1.78). This association was stronger in non-Hispanic whites (1.83, 1.63–2.02) compared to non-Hispanic blacks (1.50, 1.29–1.72) and Mexican American (1.60, 1.33–1.87), interaction p = 0.065.Conclusions
Compared to non-Hispanic whites, non-Hispanic blacks and Mexican Americans have more excess heart age, but the risk of CVD death for the same level of excess heart age appears more pronounced in non-Hispanic whites. Further investigation is needed to show the usefulness of these findings in directing future efforts and resource allocation for reduction of health disparities between ethnic groups. 相似文献15.
Peng-Hao Chang Tsui-Ping Liu Po-Yen Huang Shu-Yu Lin Jung-Fu Lin Chun-Fu Yeh Shih-Cheng Chang Ting-Shu Wu Jang-Jih Lu 《Journal of microbiology, immunology, and infection》2018,51(6):847-855
Background/purpose
We reported an outbreak of Staphylococcus haemolyticus (SH) infection in a group of young patients (mean age 21.6) simultaneously hospitalized due to a mass-burn incident. This study analyzed the clinical features of these patients and the microbiological characteristics of the outbreak.Methods
All 50 patients hospitalized for burns were enrolled, and their clinical differences were analyzed based on culture results. A drug sensitivity test and pulsed-field gel electrophoresis (PFGE) were conducted to analyze the microbiological difference between SH isolates from the mass-burn casualty patients (the study group) and SH isolates from other patients hospitalized during the same period (the control group) with the intention of identifying the strain of SH outbreak.Results
Patients with isolated SH (N = 36) had a significantly higher disease severity (higher revised Baux score, APACHE II score, and concurrent bacteremia rate), and a significantly poorer clinical outcome (longer ICU and hospital stay, and longer MV usage). Significant differences in the phenotype (antibiotics drug sensitivity test) and genotype (PFGE typing) were observed between the study and control groups. The dominant PFGE type C identified among the study group was related to poorer outcomes in a subgroup analysis.Conclusion
A dominant PFGE type of SH infection was found in these mass-burn casualty patients. Pathogenesis or virulence factors may have contributed to our results. Further study of isolated SH should be conducted. 相似文献16.
Mohammad Reza Akbari Ali Ahmadi Shiva Mirkalantari Jafar Salimian 《Journal of the National Medical Association》2018,110(1):84-87
Background
Regarding to the importance of cholera in Iran and the potential advantages of egg yolk antibody (IgY) for immunotherapy, the aim of this study was to produce IgY antibody against V. cholerae Lipopolysaccharide (LPS) and determine its potential for V. cholerae treatment.Methods
LPS was prepared, and the Anti-V. cholerae LPS IgY was purified from egg yolk and serially diluted in phosphate-buffered saline (PBS), mixed with V. cholerae and then gavaged into several groups of suckling mice.Results
The yield of Anti-LPS IgY extraction was 40 mg/Egg yolk. The results demonstrated that up to approximately 75 ng of IgY can detect specifically V. cholerae. The lowest protective dose of anti-V. cholerae LPS IgY was 2.5 μg.Conclusions
The produced anti-Vibrio LPS specific IgY showed a good reactivity with its specific antigen and it may use as a complimentary oral immunotherapy for cholera disease. 相似文献17.
Hong-Yi Lee Yu-Chia Hsieh Ching-Chuan Liu Yi-Chuan Huang Kuang-Yi Chang Hsin Chi Luan-Yin Chang Yhu-Chering Huang Li-Min Huang 《Journal of microbiology, immunology, and infection》2018,51(2):199-206
Background
In Taiwan, the age group with the greatest incidence of invasive pneumococcal disease is 2–5 years of age, which is different from other countries. This study was conducted to identify risk factors and different 13-valent pneumococcal conjugate vaccine (PCV13) schedules associated with vaccine-type invasive pneumococcal pneumonia (IPP) despite prior vaccination.Methods
A case–control study was conducted prospectively between August 2012 and December 2015 at five participating medical centers. The study enrolled children <15 years of age who were admitted to one of the five medical centers for CAP. Blood samples and acute-phase serum specimens were collected and Streptococcus pneumoniae was identified by using a real-time polymerase-chain-reaction (RT-PCR) assay targeting the lytA gene.Results
A total of 25 children diagnosed with vaccine-type IPP and 124 controls were enrolled. Vaccine-type IPP occurred in 6 (28.6%), 14 (24.1%), and 5 (7.1%) children receiving vaccines on a not-age-appropriate schedule (n = 21), primary infant schedule (n = 58), and toddler catch-up schedule (n = 70) (P = 0.008), respectively. Of 25 children, the mean age at disease onset was 36 ± 11 months; serotype 19A was responsible for 84% (21/25).Conclusion
After adjustment for confounding factors, the risk of vaccine-type IPP was significantly higher among children receiving vaccines on a not-age-appropriate schedule, or on a primary infant schedule, compared with children receiving vaccines on a toddler catch-up schedule. Duration of vaccine immunity should be investigated to direct strategies for maintaining individual and population immunity against pneumococcal disease. 相似文献18.
Brock H. Medsker Bronwyn K. Brew Erick Forno Henrik Olsson Cecilia Lundholm Yueh-Ying Han Edna Acosta-Pérez Glorisa J. Canino Catarina Almqvist Juan C. Celedón 《Annals of allergy, asthma & immunology》2017,118(1):55-60.e1
Background
Little is known about the joint effects of maternal asthma and maternal depression on childhood asthma.Objective
To examine whether maternal depression and maternal asthma lead to greater risk of childhood asthma than maternal asthma alone.Methods
Cross-sectional studies of children (6–14 years old) in San Juan, Puerto Rico (n = 655) and Sweden (n = 6,887) were conducted. In Puerto Rico, maternal depressive symptoms were defined using the Center for Epidemiologic Studies Depression Scale (CES-D) questionnaire. In Sweden, maternal physician-diagnosed depression was derived from national registries, and maternal depressive symptoms were defined using an abbreviated CES-D questionnaire. Childhood asthma was defined as physician-diagnosed asthma plus current wheeze (in Puerto Rico) or plus medication use (in Sweden). Logistic regression was used for multivariable analysis.Results
Compared with Puerto Rican children whose mothers had neither asthma nor depressive symptoms, those whose mothers had asthma but no depressive symptoms had 3.2 times increased odds of asthma (95% confidence interval [CI] = 2.1–4.8) and those whose mothers had asthma and depressive symptoms had 6.5 times increased odds of asthma (95% CI = 3.3–13.0). Similar results were obtained for maternal depression and maternal asthma in the Swedish cohort (odds ratio for maternal asthma without maternal depression = 2.8, 95% CI = 2.1–3.7; odds ratio for maternal asthma and maternal depression = 4.0, 95% CI = 1.7–9.6). Although the estimated effect of maternal asthma on childhood asthma was increased when maternal depressive symptoms (Puerto Rico) or maternal depression (Sweden) was present, there were no statistically significant additive interactions.Conclusion
Maternal depression can further increase the risk of asthma in children whose mothers have a history of asthma. 相似文献19.
Gabriel S. Tajeu Jewell Halanych Lucia Juarez Jeff Stone Irena Stepanikova Alexander Green Andrea L. Cherrington 《Journal of the National Medical Association》2018,110(5):464-472
Background
Racial bias is associated with suboptimal healthcare treatment for minorities. Research focuses on bias among physicians rather than non-physician healthcare staff (e.g., receptionists). Patients spend considerable amounts of time with non-physician staff. Therefore, we investigate differences in implicit and explicit racial bias by healthcare staff race and occupation using the Implicit Association Test and Modern Racism Scale, respectively.Methods
Staff (n = 107) were recruited using the Alabama based Primary Care Research Coalition. Occupation was categorized into “medical doctors/registered nurses” (MD/RN) and “non-MD/RN” (e.g., receptionists).Results
Implicit bias scores were higher among whites compared with blacks (0.62, ?0.04, respectively; p < 0.01). Among whites, non-MD/RNs demonstrated more pro-white implicit bias compared with MD/RNs (0.67, 0.44, respectively; p < 0.01). Whites had higher explicit bias scores than blacks (17.7, 12.3, respectively; p < 0.01).Conclusion
Non-MD/RNs should not be overlooked for cultural competency training, and efforts are needed to reduce racial bias among healthcare workers identified as having higher levels of bias. 相似文献20.
Eva N. Woodward Jennifer L. Walsh Theresa E. Senn Michael P. Carey 《Journal of the National Medical Association》2018,110(4):371-377