Engagement: an indicator of difference in the perceptions of antenatal care for pregnant women from diverse socioeconomic backgrounds

Background Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds. Objectives To determine whether pregnant women’s perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006). Design A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009. Setting/Participants Cases were primigravida women from ‘least deprived’ (n = 9) and ‘most deprived’ (n = 12) geographical areas within one local authority in Scotland. Analysis Data were analysed using case study replication analysis. Results There was little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups. Perception of care differed in relation to the level of ‘engagement’ (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the ‘least deprived’ cases and almost none of the ‘most deprived’ cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making. Conclusion In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non‐engagement.     

Relationship of Vitamin D Deficiency to Clinical Outcomes in Critically Ill Patients

Background: Despite the numerous disease conditions associated with vitamin D deficiency in the general population, the relationship of this deficiency to outcome in critically ill patients remains unclear. The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes. Methods: The authors conducted an analysis of samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital. They measured serum 25‐hydroxyvitamin D at admission and up to 10 days following admission and followed patients prospectively for 28‐day outcomes. Results: Of analyzable patients, 50 (26%) were deficient (≤30 nmol/L) and 109 (56%) were insufficient (>30 and ≤60 nmol/L). Baseline 25(OH)D levels decreased significantly in all patients after 3 days in the ICU and remained significantly lower through 10 days (P < .001). 25(OH)D status was not significantly associated with 28‐day all‐cause mortality (hazard ratio [HR], 0.89; 95% confidence interval, [CI] 0.37–2.24). Higher levels of 25(OH)D were associated with a shorter time‐to‐alive ICU discharge (HR, 2.11; 95% CI, 1.27–3.51). 25(OH)D‐deficient patients showed a nonstatistically significant trend toward a higher infection rate (odds ratio [OR], 3.20; 95% CI, 0.784–13.07; P = .11) compared with patients with sufficient levels of 25(OH)D. Conclusions: This study demonstrates significant decreases in vitamin D status over the duration of the patient's ICU stay. Low levels of vitamin D are associated with longer time to ICU discharge alive and a trend toward increased risk of ICU‐acquired infection.     

Risk perception of women during high risk pregnancy: A systematic review

Risk perception in women with high risk pregnancies can affect their attitude to medical care and therefore influence the wellbeing of mother and baby. This article reviews quantitative measures of risk perception in women with high risk pregnancies. A systematic search of eight electronic databases was conducted. Additional articles were obtained through searching references of identified articles. Seven studies were identified that reported quantitative measures of risk perception in relation to high risk pregnancy. The main findings were that women with high risk pregnancies perceive themselves and the pregnancies to be at risk. However, mean risk scores consistently fall below the midpoint on risk perception measures suggesting women do not perceive this risk as extreme. Women with high risk pregnancies consistently rated their risk as being greater than that of women with low risk pregnancies. Results were inconsistent for the association between women's risk perception and that of healthcare professionals. Women with higher socio-economic status were more likely to be concerned about risk, although lower socio-economic status is associated with increased risk in pregnancy. There was a consistent association between high risk pregnancy and higher levels of anxiety. This review indicates that women at high risk during pregnancy do not perceive this risk to be extreme and that there is poor agreement between women's and healthcare professionals’ perceptions of risk. This is likely to have implications for medical care and pregnancy outcomes.     

Global cost of correcting vision impairment from uncorrected refractive error

Objective

To estimate the global cost of establishing and operating the educational and refractive care facilities required to provide care to all individuals who currently have vision impairment resulting from uncorrected refractive error (URE).

Methods

The global cost of correcting URE was estimated using data on the population, the prevalence of URE and the number of existing refractive care practitioners in individual countries, the cost of establishing and operating educational programmes for practitioners and the cost of establishing and operating refractive care facilities. The assumptions made ensured that costs were not underestimated and an upper limit to the costs was derived using the most expensive extreme for each assumption.

Findings

There were an estimated 158 million cases of distance vision impairment and 544 million cases of near vision impairment caused by URE worldwide in 2007. Approximately 47 000 additional full-time functional clinical refractionists and 18 000 ophthalmic dispensers would be required to provide refractive care services for these individuals. The global cost of educating the additional personnel and of establishing, maintaining and operating the refractive care facilities needed was estimated to be around 20 000 million United States dollars (US$) and the upper-limit cost was US$ 28 000 million. The estimated loss in global gross domestic product due to distance vision impairment caused by URE was US$ 202 000 million annually.

Conclusion

The cost of establishing and operating the educational and refractive care facilities required to deal with vision impairment resulting from URE was a small proportion of the global loss in productivity associated with that vision impairment.     

Kr-81m ventilation imaging: clinical utility in suspected pulmonary embolism

The results of Kr-81m/Tc-99m ventilation-perfusion (VP) lung scintigraphy were correlated with the results of pulmonary angiography for 74 patients suspected of having pulmonary embolism (PE). Among patients having a diagnostic scan, the sensitivity and specificity of scintigraphy were 91% and 94%, respectively. Also, 157 consecutive cases of Kr-81m/Tc-99m VP lung scintigraphy were reviewed, and the frequency of an indeterminate scan was found to be 22%. A similar frequency was found for VP scintigraphy with xenon-133. Of eight patients who had indeterminate scans due to the presence of a single VP mismatch, four were demonstrated to have PE by angiography. Kr-81m is an excellent agent for VP scanning in cases of suspected PE, offering accuracy in diagnosis as well as favorable physical properties.     

温经止痛凝胶膏剂的促渗剂优选

目的:优选温经止痛凝胶膏剂中促渗剂的种类及用量。方法:采用改良Franz扩散池,以离体小鼠腹部皮肤为屏障,采用HPLC检测不同促渗剂种类、比例及用量对温经止痛凝胶膏剂中藁本内酯累积透皮量、透皮吸收速率、增渗倍数等参数的影响,流动相甲醇-水(80∶20),检测波长328 nm。结果:氮酮和丙二醇联用的促渗效果明显优于其他几种促渗剂,确定氮酮与丙二醇的用量比(2∶1),总用量4%。藁本内酯24 h的累计透皮量84.16μg·cm-2,透皮速率常数3.28μg·cm-2·h-1,增渗倍数3.33。结论:氮酮和丙二醇组合的透皮促渗效果显著,可作为温经止痛凝胶膏剂的促渗剂。     

荜茇总生物碱对6-羟基多巴胺致帕金森病大鼠多巴胺能神经元损伤的保护作用研究

目的:探讨荜茇总生物碱(PLA)对6-羟基多巴胺(6-OHDA)致帕金森病(PD)大鼠多巴胺能神经元损伤的保护作用及其可能的机制。方法:采用脑立体定位单侧纹状体注射6-OHDA建立大鼠PD模型,将PD大鼠随机分为PLA组(PLA50 mg·kg-1·d-1),美多巴组(美多巴50 mg·kg-1·d-1)及模型组,每组15只,每日灌胃给药1次,连续6周。另随机选取15只大鼠在纹状体仅注射生理盐水作为假手术组。采用阿朴吗啡(APO)诱导的大鼠旋转及转棒实验进行行为学观察,酪氨酸羟化酶(TH)免疫组化检测大鼠黑质中TH阳性细胞数及纹状体中TH阳性纤维密度,用分光光度法检测大鼠黑质及纹状体内超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、还原型谷胱甘肽(GSH)、过氧化氢酶(CAT)、丙二醛(MDA)、一氧化氮(NO)及一氧化氮合酶(NOS)的含量。结果:帕金森病大鼠在APO诱导后出现明显的旋转行为,且在转棒上的滞留时间缩短,黑质区TH阳性细胞数及纹状体TH阳性纤维密度明显减少,组织内SOD,GSH-Px,CAT的活力降低,NOS的活力升高,MDA,NO含量升高,GSH含量降低,总抗氧化能力明显降低。PLA能明显改善PD大鼠的行为学异常,增加黑质区TH阳性细胞数及纹状体TH阳性纤维密度,提高组织内SOD,GSH-Px,CAT的活力,降低NOS的活力,降低MDA和NO含量,提高GSH含量,总抗氧化能力明显提高。结论:荜茇总生物碱对6-OHDA致PD模型大鼠的黑质细胞具有保护作用,其机制可能与抗氧化活性有关。     

新疆芍药化学成分的研究

目的 :研究新疆芍药的化学成分。方法 :用柱色谱分离 ,利用化合物的理化性质及波谱方法鉴定。结果 :分离并鉴定了芍药苷 (paeoniflorinⅠ )、白芍苷 (albiflorinⅡ )、芍药新苷 (lactiflorinⅢ )、胡萝卜苷 (daucosterolⅣ )和蔗糖 (sucroseⅤ )等 5个成分。结论 :这些化合物均为首次从该植物中分离得到。另芍药新苷化学结构曾 2次被修正 ,本研究分析后确认了其中的 1个结论。     

HPLC测定蝉蜕止咳颗粒中黄芩苷和汉黄芩素含量

目的:建立高效液相色谱法测定蝉蜕止咳颗粒(蝉蜕、黄芩等)中黄芩苷和汉黄芩素含量的方法.方法:ODS(C18)色谱柱.乙腈-0.6%磷酸(45:55)为流动相;流速:1mL·min-1;柱温:40℃;检测波长275nm.结果:本法可测定蝉蜕止咳颗粒中黄芩苷和汉黄芩素含量.其分别在0.104μg～0.52μg和0.03μg～0.15μg范围内与峰面积成线性关系.平均回收率分别为100.69%和98.8%;RSD分别为1.75%和1.01%.结论:该方法简便、准确,可作为蝉蜕止咳颗粒的含量测定方法.