住院患者药物不良反应的发生率：前瞻性研究的汇总 …

目的－对住院患者严重和致命药物不良反应（ａｄｖｅｒｓｅｄｒｕｇｒｅａｃｔｉｏｎｓ，ＡＤＲ）的发生率进行评价。资料来源－检索１９６６－１９９６年４种电子资料库。研究的选择－在１５３项研究中，选择了３９项来自美国各医院的前瞻性研究。资料的提取－对２位研究者各自提取物的采用随机－效果模式进行分析。为了取得患者ＡＤＲｓ的总发生率，我们将住院期间ＡＤＲｓ的发生率与ＡＤＲｓ所致住院的发生经合并计算，我们除外了     

捐献全血对献血者的不良反应:对1000名献血者捐献全血3个星期后的采访研究

以前曾对献血过程中和献血后献血者的献血的负面影响做过研究。血管迷走神经反应,尤其是伴有昏厥的反应,一直是献血安全研究的主要关注所在,但献血者手臂受伤、创伤以及非血管迷走神经的系统反应也已见报道,但都没有主动地向献血者征求意见,其结果是有限的和不全面的。本研究对1,000名献血者在献血3周后进行了采访,以确定发生了哪些全身反应和手臂伤害。     

Factors associated with successful establishment of breastfeeding in very preterm infants

Aim: To describe feeding practices at hospital discharge in relation to characteristics of the very preterm infants (VPI) and their mothers. Methods: Design. Prospective hospital‐based registration of very preterm infants born with a gestational age ≤32 weeks in Denmark during 2004–2008. Subjects. Healthy mothers and VPI without diseases causing eating disabilities at discharge. Results: A total of 478 VPI were registered. At discharge, 60% were exclusively breastfed, 35% were exclusively bottlefed, and 5% were both breast‐ and bottle‐fed. Mothers of high social class (p = 0.000) and ‘not smoking’ (p = 0.003) were significantly more often breastfeeding their preterm infant(s) at discharge. Single births infants tended more often to be breastfed (p = 0.09). Infant age at discharge and duration of hospitalization did not influence breastfeeding at discharge. Increase in weight z‐score from birth to discharge was largest in the bottlefeeding‐group compared with the breastfeeding‐group (p = 0.000) probably as a result of feeding practice the last week(s) of hospitalization. Conclusion: Breastfeeding can successfully be established in very preterm infants. Mothers of low social classes, smokers, multiple birth and very preterm infants with low weight for age may need extra attention in breastfeeding establishing policies.     

＂Anti-HBc alone＂ in human immunodeficiency virus-positive and immuno-suppressed lymphoma patients

Hepatitis B virus （HBV） infection is endemic in various parts of the world. A proportion of patients have resolved prior exposure to HBV, as evidenced by the clearance of circulating hepatitis B surface antigen and the appearance of antibody to hepatitis B core antigen （anti-HBc）, which could produce protective antibody to hepatitis B surface antigen （anti-HBs）. With time, anti-HBs in some patients may become negative. Such patients are described as having occult HBV infection or ＂anti-HBc alone＂. In the context of immunodeficient patients, such as HIV patients or lymphoma patients undergoing immunosuppressive immunotherapy, the lack of protective anti-HBs may increase the risk of hepatitis B reactivation. Serum HBV DNA testing may be necessary in ＂anti-HBc alone＂ patients, to detect patients at a high risk of developing HBV infection allowing appropriate prophylactic management.     

The individual and combined influence of HIV and hepatitis C virus on dyslipidaemia in a high-risk Hispanic population

Objectives

To assess the effects of chronic hepatitis C (HCV) and HIV infection on dyslipidaemia in a Hispanic population at high risk of insulin resistance.

Methods

We compared serum lipids and C‐reactive protein (CRP) in 257 Hispanic adults including 47 HIV‐ mono‐infected, 43 HCV‐mono‐infected and 59 HIV/HCV‐co‐infected individuals as well as 108 healthy controls. We also assessed the effect of HCV on lipid alterations associated with antiretroviral therapy (ART), and the impact of HCV and HIV on the associations among insulin resistance, triglycerides and cholesterol.

Results

HCV infection was associated with lower total and low‐density lipoprotein (LDL) cholesterol, but not high‐density lipoprotein (HDL) cholesterol or triglycerides compared with healthy controls. HIV infection was associated with higher triglycerides and lower HDL, but not total or LDL cholesterol. HCV mitigated the elevation of triglycerides associated with ART. In healthy Hispanic adults, insulin resistance was significantly correlated with higher triglycerides, CRP and lower HDL. HIV infection nullified the association of insulin resistance with triglycerides and HDL, and the association of triglycerides with LDL. HCV infection nullified the association of insulin resistance with triglycerides, HDL and CRP.

Conclusions

HCV co‐infection alters the profile of HIV‐associated dyslipidaemia. The clinical significance of these findings for cardiovascular complications in HIV merits further study.     

Parent weight change as a predictor of child weight change in family-based behavioral obesity treatment

BACKGROUND: Family-based behavioral weight control treatment involves the parent in the modification of child and parent eating and activity change. OBJECTIVE: To assess if parent standardized body mass index (z-BMI) change predicts child z-BMI change. DESIGN: Secondary data analysis based on parent and child z-BMI changes from 3 family-based, randomized, controlled weight control studies. Hierarchical regression models tested whether parent z-BMI change increased prediction of child z-BMI change through treatment and 24-month follow-up beyond other factors that influence child weight change, such as child age, sex, socioeconomic status, and baseline child and parent z-BMI. Differences in child z-BMI change as a function of quartiles of parental z-BMI change were tested using an analysis of covariance. SETTING: Pediatric obesity research clinic. PARTICIPANTS: Obese 8- to 12-year-old children and their parents from 142 families who participated in family-based weight control programs. MAIN OUTCOME MEASURES: Child and parent z-BMI changes over time. RESULTS: Parent z-BMI change significantly predicted child z-BMI change for the 0- to 6-month (P<.001) and 0- to 24-month (P <.009) time points. In hierarchical regression models, parent z-BMI change was a significant incremental predictor of child z-BMI change at 6 and 24 months, with the additional r(2) ranging from 11.6% at 6 months (P <.001) to 3.8% at 24 months (P =.02). Parents in the highest quartile of z-BMI change had children with significantly greater z-BMI change than that of children with parents in the other quartiles (P =.01). CONCLUSION: Parent z-BMI change is an independent predictor of obese child z-BMI change in family-based behavioral treatment, and youth benefit the most from parents who lose the most weight in family-based behavioral treatments.