An increasing number of preschool children are becoming overweight. Although many risk factors have been identified for school-age children, less is known about this young age group. Ecological models have been developed to illustrate how individual characteristics, family characteristics, community-level factors, and policies may influence weight gain. We used this model to review factors that influence overweight in children, aged six months to five years, which are amenable to policy intervention in resource-rich countries. We found strong evidence for a direct association between childhood overweight and maternal prepregnancy body size, maternal smoking during pregnancy, and children's television/media use; strong evidence for an inverse relationship between breastfeeding and overweight, and moderate evidence for children's physical activity. There was limited research on community-level factors, policies and interventions. Future policies and interventions should be subject to evaluation and aim to support parents and young children to develop health-related behaviours that may prevent early childhood overweight. 相似文献
The risk of germline transmission of vector sequences in humans is a major safety concern, because the enrollment of subjects of reproductive age in early-phase clinical trials of gene transfer continues to increase. In a study of adult men with hemophilia B, adeno-associated virus serotype 2 (AAV2) delivered to the liver via the hepatic artery resulted in unexpected transient vector dissemination to the semen. Here we report that intravenous AAV2 injection in rabbits proved a useful model to assess biologic parameters of vector dissemination to the semen. Detectable vector sequences in semen disappeared in a dose-dependent and time-dependent fashion. AAV infectious particles were present only as long as day 4 after injection and were undetectable thereafter. The kinetics of vector clearance was faster in the semen fractions enriched for motile sperm than in the total semen. In addition, increased frequency of semen sampling accelerated the clearance of vector sequences from semen. Long-term follow-up, spanning hundreds of spermatogenesis cycles, showed that there was no recurrence of detectable vector sequences in semen, thus reducing the probability of inadvertent transduction of early spermatogonia not committed to differentiation at the time of vector injection. We conclude that AAV2 presents minimal germline transmission risk for humans. 相似文献
OBJECTIVE: We examined the pattern of organ system dysfunction, the evolution of this pattern over time, and the relationship of these features to mortality in patients who had sepsis syndrome. DESIGN: Prospective, multicenter, observational study. SETTING: Intensive care units in tertiary referral teaching hospitals. PATIENTS: A total of 287 patients who had sepsis syndrome were prospectively identified in intensive care units. MATERIALS AND MEASUREMENTS: Cardiovascular, pulmonary, neurologic, coagulation, renal, and hepatic dysfunction were assessed at onset and on day 3 of sepsis syndrome. Organ dysfunction was classified as normal, mild, moderate, severe, and extreme dysfunction. We calculated the occurrence rate and associated 30-day mortality rate of organ dysfunction at the onset of sepsis syndrome. We then measured the change in organ dysfunction from onset to day 3 of sepsis syndrome and determined, for individual organ systems, the associated 30-day mortality rate. RESULTS: At the onset of sepsis syndrome, clinically significant pulmonary dysfunction was the most common organ failure, but was not related to 30-day mortality. Clinically significant cardiovascular, neurologic, coagulation, renal, and hepatic dysfunction were less common at the onset of sepsis syndrome but were significantly associated with the 30-day mortality rate. Worsening neurologic, coagulation, and renal dysfunction from onset to day 3 of sepsis syndrome were associated with significantly higher 30-day mortality than with improvement or no change in organ dysfunction. CONCLUSIONS: Increased mortality rate in sepsis syndrome is associated with a pattern characterized by failure of nonpulmonary organ systems and, in particular, worsening neurologic, coagulation, and renal dysfunction over the first 3 days. Although initial pulmonary dysfunction is common in patients with sepsis syndrome, it is not associated with an increased mortality rate. 相似文献
The role of arthrodesis in the surgical management of lumbar spondylolisthesis remains controversial. We hypothesized that practice patterns and outcomes for this patient population may vary widely.
Purpose
This study aimed to characterize geographic variation in surgical practices and outcomes for patients with lumbar spondylolisthesis.
Study Design/Setting
A retrospective analysis on a national longitudinal database between 2007 and 2014 was carried out.
Methods
We calculated arthrodesis rates, inpatient and long-term costs, and key quality indicators (eg, reoperation rates). Using linear and logistic regression models, we then calculated expected quality indicator values, adjusting for patient-level demographic factors, and compared these values with the observed values, to assess quality variation apart from differences in patient populations.
Results
We identified a cohort of 67,077 patients (60.7% female, mean age of 59.8 years (standard deviation, 12.0) with lumbar spondylolisthesis who received either laminectomy or laminectomy with arthrodesis. The majority of patients received arthrodesis (91.8%). Actual rates of arthrodesis varied from 97.5% in South Dakota to 81.5% in Oregon. Geography remained a significant predictor of arthrodesis even after adjusting for demographic factors (p<.001). Marked geographic variation was also observed in initial costs ($32,485 in Alabama to $78,433 in Colorado), 2-year postoperative costs ($15,612 in Arkansas to $34,096 in New Jersey), length of hospital stay (2.6 days in Arkansas to 4.5 in Washington, D.C.), 30-day complication rates (9.5% in South Dakota to 22.4% in Maryland), 30-day readmission rates (2.5% in South Dakota to 13.6% in Connecticut), and reoperation rates (1.8% in Maine to 12.7% in Alabama).
Conclusions
There is marked geographic variation in the rates of arthrodesis in treatment of spondylolisthesis within the United States. This variation remains pronounced after accounting for patient-level demographic differences. Costs of surgery and quality outcomes also vary widely. Further study is necessary to understand the drivers of this variation. 相似文献
This randomised, double-blind study conducted at nine sites in the UK and the Netherlands compared the safety and antidepressant efficacy of venlafaxine and dothiepin. Ninety-two geriatric patients (aged 64-87 years) with major depression were randomly assigned to receive either venlafaxine or dothiepin for up to 43 days. The dose of venlafaxine or dothiepin was titrated up to a maximum of 150 mg per day for the first 15 days, and thereafter could range from 50 to 150 mg per day. Adjusted mean scores on the MADRS and the HAM-D decreased significantly (p 0.05) from baseline to the end of the study in both groups. A response to therapy was observed in 60% of patients in the venlafaxine group and 53% of patients in the dothiepin group on the MADRS, and in 60% of patients in both groups on the HAM-D. Suicidal ideation scores on the MADRS were significantly (p=0.042) lower in the venlafaxine group at week 6. Treatment-emergent study events were the primary reason for withdrawal in only 7% of venlafaxine-treated patients and 8% of dothiepin-treated patients. The results confirm the efficacy and tolerability of venlafaxine for treating major depression in the elderly. 相似文献
Background and aim: Cognitive impairments following brain injury, including difficulty with problem solving, can pose significant barriers to successful community reintegration. Problem-solving strategy training is well-supported in the cognitive rehabilitation literature. However, limitations in insurance reimbursement have resulted in fewer services to train such skills to mastery and to support generalization of those skills into everyday environments. The purpose of this project was to develop and evaluate an integrated, web-based programme, ProSolv, which uses a small number of coaching sessions to support problem solving in everyday life following brain injury.
Method: We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study.
Results: Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions.
Conclusions: Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury.
Implications for Rehabilitation
People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts.
Research supports problem solving skills training following brain injury.
Assistive technology for cognition (smartphones, selected apps) offers a means of
supporting problem solving for this population.
This project demonstrated the feasibility of a web-based programme to address this need.