放置宫内节育器10年随访观察

采用B超对某大学121例放置宫内节育器的妇女进行10年定期随访观察，发现：（1）宫内孕5例，宫外孕1例；带器妊娠率4．96％（1．09％～8．83％）；（2）合并子宫肌瘤4例，宫内膜异位2例，卵巢囊肿3例，畸胎瘤1例；合并症发病率8．26％（3．36％～13．17％）。由此说明，B超在IUD术后随访中的重要意义。     

Cardiovascular diseases,aging, and the gender gap in human longevity

This study probes the biological meaning of the gender gap in longevity and its possible ramifications for the expression of cardiovascular diseases in human beings. It addresses the potential role of estrogen and the X chromosome in the longer life span of women than men in modern societies. In addition, it links features of the reproductive and post-reproductive periods with cardiovascular diseases and longevity in women.     

脊髓损伤患者肠道菌群属水平的特征及意义

目的 探讨脊髓损伤患者肠道菌群属水平变化特征及其在临床康复中的意义。方法 2018年1月至12月,纳入脊髓损伤患者23例(患者组)和健康受试者21例(对照组),采集粪便样本,应用16S rDNA高通量测序检测肠道菌群,并采用物种组成分析及随机森林机器学习等生物信息学方法分析两组间属水平的菌群分布及差异。结果 患者组丰度升高的重要标志性菌属分别是：瘤胃菌科的UBA1819、Ruminiclostridium 9、Ruminococcaceae NK4A214 group、Ruminococcus 2、Ruminococcaceae UCG-005、Ruminiclostridium 5、Flavonifractor;理研菌科的Alistipes、dgA-11 gut group、Rikenellaceae RC9 gut group;毛螺菌科的[Eubacterium] oxidoreducens group;消化链球菌科的Intestinibacter;肠杆菌科的Escherichia-Shigella (志贺菌属);以及Tannerellaceae的Parabacteroides (|U| > 1.962, P< 0.05)。患者组丰度降低的是梭杆菌科Fusobacterium菌属(|U| = -2.284, P< 0.05)。结论 脊髓损伤患者肠道菌群与健康对照组存在差异。脊髓损伤患者与抑郁相关的瘤胃菌科、与中枢神经系统疾病关系密切的瘤胃球菌,以及肠道内致病菌消化链球菌属、志贺菌属等的相对丰度增加;对肠道有益的产丁酸盐菌和抗炎性菌属的相对丰度降低。这些菌群变化可能有一定的临床意义。     

State policy change and organizational response: Expansion of nurse practitioner scope of practice regulations in New York State

BackgroundIn January of 2015, New York (NY) implemented a new policy, Nurse Practitioners Modernization Act, which removed the required written practice agreement between physicians and experienced nurse practitioners (NPs).PurposeWe examined NP work environment in NY before (2012) and after (2018) the implementation of the new policy.MethodsCross-sectional survey data on work environments were collected from NPs in NY in 2012 and 2018. Work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire. In 2012, 278 and in 2018, 348 NPs completed the tool. Regression analyses were used to examine the relationship between the study year and work environment.FindingsControlling for individual and organizational characteristics, NPs reported significantly better work environments in 2018. Positive changes were observed both for experienced and less experienced NPs.DiscussionRemoving state-level policy restrictions on NPs may promote a better work environment within health care organizations.     

卫生决策中对系统评价的十大认识误区

随着循证实践的蓬勃开展,系统评价证据越来越被视为决策的可靠依据,特别是在时间紧急,任务重要,且干扰因素多的情况下,其优势更为凸显。但在非医学领域中,对循证实践及系统评价作用的认知还存在一定局限性,许多认识误区阻碍了系统评价方法在卫生决策领域的推广与使用。本文以健康干预实践证据为例,探讨系统评价在卫生决策领域的作用,力图澄清这些认识误区,推动系统评价的发展。     

Precautionary savings and shock-coping behaviors: Effects of promoting mobile bank savings on transactional sex in Kenya

For the vulnerable, even small shocks can have significant short- and long-term impacts. Beneficial shock-coping mechanisms are not widely available in sub-Saharan Africa. We test whether an individual precautionary savings intervention can reduce a shock-coping behavior common in sub-Saharan Africa that has negative spillovers: transactional sex. Among a set of vulnerable women, we randomly assigned an intervention that promoted savings in a mobile banking account labeled for goals and emergency expenses. We find that a majority of individuals adopt the mobile account and the intervention led to reductions in transactional sex as a shock-coping response, and a decrease in symptoms of sexually transmitted infections. Changes are sustained in the medium-term among sex workers, but not among other vulnerable women.     

Resolving the milk addiction paradox

The milk addiction paradox refers to an empirical finding in which consumption of non-addictive commodities such as milk appears to be consistent with the theory of rational addiction. This paradoxical result seems more likely when consumption is persistent and with aggregate data. Using both simulated and real data, we show that the milk addiction paradox disappears when estimating the data using an AR(1) linear specification that describes the saddle-path solution of the rational addiction model, instead of the canonical AR(2) model. The AR(1) specification is able to correctly discriminate between rational addiction and simple persistence in the data, to test for the main features of rational addiction, and to produce unbiased estimates of the short and long-run elasticity of demand. These results hold both with individual and aggregated data, and they imply that the AR(1) model is a better empirical alternative for testing rational addiction than the canonical AR(2) model.     

How do machine learning algorithms perform in predicting hospital choices? evidence from changing environments

Researchers have found that machine learning methods are typically better at prediction than econometric models when the choice environment is stable. We study hospital demand models, and evaluate the relative performance of machine learning algorithms when the choice environment changes substantially due to natural disasters that closed previously available hospitals. While machine learning algorithms outperform traditional econometric models in prediction, the gain they provide shrinks when patients’ choice sets are more profoundly affected. We show that traditional econometric methods provide important additional information when there are major changes in the choice environment.