Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental,controlled, multi-centre study

Background  

Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain).     

改变对骨质疏松的看法

根据最近 11个独立研究群体的汇总分析和 2 0 0 0例以上骨折病例的回顾性分析可以断定 :骨密度“不能确定某个个体会不会发生骨折1”。既然这样 ,为什么我们还要测量它呢 ?据英国骨质疏松协会提供的数据 ,用于测量骨密度的双能量Ｘ线吸收仪已超过 130台。以双能量Ｘ线吸收仪作为检索词 ,在Ｍｅｄｌｉｎｅ检索出的文献从1988年的 2 6条上升到 1997年的 4 6 4条。按照ＷＨＯ定义 ,一旦绝经前妇女的骨密度低于平均值 1个标准差 (ＳＤ) ,即为骨质稀疏 ,这一“骨折阈值”的概念引导人们进行预防性治疗。但我们应该根据这些数字来处理骨质疏松吗 ?…     

Randomized clinical study comparing Compeed® cold sore patch to acyclovir cream 5% in the treatment of herpes simplex labialis

Background Hydrocolloid technology has been proven effective in treating dermal wounds. A previous study showed that a newly developed thin hydrocolloid patch [Compeed® cold sore patch (CSP)] provided multiple wound‐healing benefits across all stages of a herpes simplex labialis (HSL) outbreak. Methods An assessment of CSP efficacy and safety was conducted in an international, multicentre, assessor‐blinded study, which enrolled 728 subjects with a history of recurrent HSL. Of these, 351 experienced an HSL outbreak and were randomized to use CSP (n = 179) or acyclovir cream 5% (n = 172) at the onset of symptoms until the lesion healed, for a maximum of 10 days. The primary end point was the subject's global assessment of therapy (SGAT; 0–10 scale; 0 = no response, 10 = excellent response). Multiple secondary end points included clinician‐assessed healing time and subject assessment of lesion protection, noticeability and social embarrassment. Results CSP and acyclovir were highly effective (mean SGAT = 7.89 and 8.00, respectively), with no significant difference observed (P = 0.65). The difference in healing times between products was not significant (median, 7.57 days with CSP vs. 7.03 days with acyclovir, P = 0.37). Both treatments were well tolerated. Conclusion CSP using hydrocolloid technology provides an efficacious and safe alternative to topical antivirals in treating HSL as a wound while affording additional immediate benefits of wound protection, discretion and relief of social embarrassment.     

Characterization of alpha(s)-immunoreactive ADP-ribosylated proteins in postmortem human brain.

ADP-ribosylation of the stimulatory G protein alpha subunit, alpha(s), has been demonstrated in a number of different mammalian tissues. However, little is known about the occurrence and role of this process in modifying alpha(s) levels/function in human brain. In the present study, endogenous and cholera toxin (CTX)-catalyzed [32P]ADP-ribosylated products were characterized in postmortem human temporal cortex by (1) immunoprecipitation with alpha(s) antisera (RM/1), (2) comparisons of immunoblots and autoradiograms of the [32P]ADP-ribosylated products, and (3) limited protease digestion. Of the three major endogenous [32P]ADP-ribosylated products (48, 45, and 39 kDa) in postmortem brain, the 48-kDa and 45-kDa bands were clearly identified as alpha(s-L) (long isoform) and alpha(s-S) (short isoform), respectively. RM/1 immunoprecipitated the 39-kDa [32P]ADP-ribosylated protein, and overlays of immunoblots and autoradiograms showed that this product corresponded to an alpha(s)-like-immunoreactive protein. Furthermore, limited protease digestion of the 39-kDa endogenous [32P]ADP-ribosylated band generated peptide fragments similar to both endogenous and CTX-catalyzed [32P]ADP-ribosylated alpha(s-S). Two major CTX-catalyzed [32P]ADP-ribosylated products were also identified as alpha(s-L) (52 kDa) and alpha(s-S) (45 kDa). These findings clearly demonstrate that alpha(s) is a substrate for endogenous and CTX-catalyzed [32P]ADP-ribosylation in postmortem human brain. Furthermore, a lower molecular weight alpha(s)-like immunoreactive protein is also expressed in human brain and is a substrate for endogenous but not CTX-catalyzed [32P]ADP-ribosylation.     

Occupational predictors of pregnancy outcomes in Irish working women in the Lifeways cohort

Objective  The objective of this study was to explore the association between occupational factors and pregnancy outcomes in a prospective cohort of Irish pregnant women.
Design  This study has a prospective design.
Population  The Lifeways cohort included 1124 pregnant women, 676 of whom delivered a single baby and were working at their first prenatal care visit when they filled in a self-administered questionnaire.
Methods  Occupational factors were measured using this questionnaire and included eight factors describing job and working conditions. Data including pregnancy outcomes were also obtained from clinical hospital records. Logistic regression analysis was used to adjust for well-known risk factors.
Main outcome measures  Birthweight (≤3000 g and ≤2500 g), preterm delivery (<37 gestation weeks) and small-for-gestational-age.
Results  Significant associations were found between physical work demands and low birthweight (≤2500 g) and working with between a temporary contract and preterm delivery. Trends were also observed between working 40 hours or more a week and shift work, and birthweight of 3000 g or less. The study of a cumulative index showed that being exposed to at least two of these occupational factors significantly predicted birthweight of ≤3000 g (OR = 2.44, 95% CI: 1.17–5.08) and of ≤2500 g (OR = 4.65, 95% CI: 1.08–20.07) and preterm delivery (OR = 5.18, 95% CI: 1.00–27.01).
Conclusions  Our findings suggest that occupational factors may predict birthweight through their predictive effects on preterm delivery. This is one of the few prospective studies on pregnancy outcomes that include working conditions. As they may be modifiable, occupational factors deserve more attention in relation to birth outcomes.     

Variables affecting weight gain in renal transplant recipients

Previous studies of renal transplant recipients have suggested that weight gain after transplantation is relatively common, especially among certain populations. We conducted a retrospective review of 977 renal transplant recipients at the University of Alabama at Birmingham to identify patterns of weight change (as mean percentage of body weight at transplantation) attributed to race, sex, income, age at transplantation, pretransplantation time on dialysis, incidence of diabetes, rejection episode(s), and/or obesity (body mass index >/= 30 kg/m(2)) at transplantation. Patients were evaluated at 3, 6, 9, and 12 months posttransplantation and at 2 and 3 years, when available. Univariate analysis at 1 year showed that blacks achieved a greater weight change than whites (P = 0.0004), women had greater gains than men (P = 0.0001), and low-income patients had greater mean gains versus medium- (P = 0.0001) and high-income patients (P = 0.0001). Advancing age and weight gain were inversely correlated (P = 0.0002). Having one or more rejection episode indicated less weight gain than having no rejection episode (P = 0.0220). Incidence of diabetes or time on dialysis was not a significant predictor of weight gain. Black race, female sex, low income, younger age, and no incidence of rejection episodes were significantly associated with weight gain at 1 year in the multivariate analysis.     

Sonographic estimation of fetal weight in maerosomic fetuses: diabetic versus non-diabetic pregnancies

The objective of this study is to compare the accuracy of sonographic estimation of fetal weight of macrosomic babies in diabetic vs non-diabetic pregnancies. All babies weighing 4,000 g or more at birth, and who had ultrasound scans performed within one week of delivery were included in this retrospective study Pregnancies with diabetes mellitus were compared to those without diabetes mellitus. The mean simple error (actual birthweight--estimated fetal weight); mean standardised absolute error (absolute value of simple error (g)/actual birthweight (kg)); and the percentage of estimated birthweight falling within 15% of the actual birthweight between the two groups were compared. There were 9,516 deliveries during the study period. Of this total 1,211 (12.7%) babies weighed 4,000 g or more. A total of 56 non-diabetic pregnancies and 19 diabetic pregnancies were compared. The average sonographic estimation of fetal weight in diabetic pregnancies was 8% less than the actual birthweight, compared to 0.2% in the non-diabetic group (p < 0.01). The estimated fetal weight was within 15% of the birthweight in 74% of the diabetic pregnancies, compared to 93% of the non-diabetic pregnancies (p < 0.05). In the diabetic group, 26.3 % of the birthweights were underestimated by more than 15 %, compared to 5.4% in the non-diabetic group (p < 0.05). In conclusion, the prediction accuracy of fetal weight estimation using standard formulae in macrosomic fetuses is significantly worse in diabetic pregnancies compared to non-diabetic pregnancies. When sonographic fetal weight estimation is used to influence the mode of delivery for diabetic women, a more conservative cut-off needs to be considered.     

干细胞移植在帕金森病治疗中的应用与进展

目的:综述干细胞移植治疗帕金森病的机制与进展。资料来源:应用计算机检索Medline 2000-01/2006-12与干细胞移植治疗帕金森病相关的文章,检索词为“stem cell,Parkinson disease,transplantation”,限定文献语种为“English”;万方数据库2004/2007期间与有关文章,检索词为“干细胞,帕金森病,移植”,并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。选择所述内容与干细胞移植治疗帕金森病的机制及应用进展相关的文章,无论观察对象是实验动物还是患者全部纳入,重复的研究以近3年且发表在较权威杂志者优先。资料提炼:共收集到500余篇相关文献,52篇符合纳入标准,选用其中31篇作为本文参考文献。资料综合:干细胞能向特定神经细胞定向分化,并在动物模型身上取得明显的治疗效果,为干细胞移植治疗帕金森病带来了新的希望。另外,联合TH、胶质细胞源性神经营养因子基因治疗帕金森病,由于胶质细胞源性神经营养因子的神经营养作用和TH具有分泌多巴胺能神经递质的功能,既能提高脑内多巴胺水平,又能使多巴胺能神经元长期存活、阻止多巴胺能神经元变性,重建宿主神经通路。因此,把干细胞作为基因载体、进行干细胞移植联合多基因治疗,为帕金森病的治疗提供了新的思路。结论:目前大部分的干细胞治疗帕金森病的研究结论是基于动物实验的结果,它们能否在人类身上得到类似或更好的的结果,目前尚未可知,其分子机制、致瘤性及免疫排斥等问题还需进一步研究。