2011-2016年合肥市手足口病多次感染状况及流行病学特征分析

目的 探讨合肥市手足口病（hand,foot and mouth disease,HFMD）多次感染状况及其流行特征,为其防控提供科学依据。方法 整理"传染病报告信息管理系统"中现住址为合肥市的HFMD个案,筛选出多次感染的病例,采用描述性流行病学方法进行分析。结果 2011-2016年合肥市HFMD再感染发病率为10.73/10万,多次感染发生率为5.12%。83.36%的再次感染发生在上一次感染后两年内。单次感染和多次感染首次发病年龄中位数分别为2.30岁和1.94岁,差异有统计学意义（Z=-28.84,P<0.001）。0~岁组儿童多次感染发生率（8.15%）最高,<6岁儿童随着年龄的增长多次感染发生率逐渐下降（χ_趋势2=609.28,P<0.001）。男童更容易发生多次感染,再感染病例幼托儿童构成比高。HFMD发病率高的地区再感染发病率也高。结论 合肥市HFMD多次感染疫情比较严重,需重点关注首次发病年龄小于3岁的男童、幼托儿童等人群及发病率高的地区,采取有针对性的防控措施。     

安徽省某地区农村独居老年人主观幸福感及影响因素研究

目的 了解安徽省某地区农村独居老年人主观幸福感（subjective well-being,SWB）现状及影响因素,为提升老年人SWB提供理论依据。方法 整群抽取安徽省某地区的679名农村独居老人,采用纽芬兰纪念大学主观幸福感量表和社会支持评定量表及自编一般情况调查表进行调查。结果 679名农村独居老年人的SWB平均得分为（32.05±10.87）分,总体上处于中等水平。多重线性回归分析显示,独居老年SWB受到月收入、慢性病、体育锻炼和社会支持的影响。月收入为500～1 500元（β=3.243,95%CI:0.824～5.663）、月收入>1 500元为（β=2.940,95%CI:2.010～7.890）、体育锻炼（β=2.254,95%CI:0.610～3.898）、主观支持（β=1.314,95%CI:1.029～1.600）和支持利用度（β=0.486,95%CI:0.082～0.890）与SWB正相关,慢性病（β=-3.586,95%CI:-5.852～-1.321）和客观支持（β=-0.387,95%CI:-0.734～-0.039）与SWB负相关。结论 农村独居老年人SWB受到多种因素影响,应采取针对以上影响因素的措施来提升SWB。     

Trends in Risk of Pregnancy Loss Among US Women, 1990–2011

Background

Pregnancy loss can have physical and psychological consequences for women and their families. Though a previous study described an increase in the risk of self‐reported pregnancy loss from 1970 to 2000, more recent examinations from population‐based data of US women are lacking.

Methods

We used data from the 1995, 2002, 2006–2010, 2011–2015 National Survey of Family Growth on self‐reported pregnancy loss (miscarriage, stillbirth, ectopic pregnancy) among US women (15–44 years) who reported at least one pregnancy conceived during 1990–2011 that did not result in induced termination (n = 20 012 women; n = 42 526 pregnancies). Trends in the risk of self‐reported pregnancy loss and early pregnancy loss (<12 weeks) were estimated, separately, by year of pregnancy conception (limited to 1990–2011 to ensure a sufficient sample of pregnancies for each year and maternal age group) using log‐Binomial and Poisson models, adjusted for maternal‐ and pregnancy‐related factors.

Results

Among all self‐reported pregnancies, excluding induced terminations, the risk of pregnancy loss was 19.7% and early pregnancy loss was 13.5% during 1990–2011. Risk of pregnancy loss increased by a relative 2% (rate ratio [RR] 1.02, 95% confidence interval [CI] 1.01, 1.02) per year in unadjusted models and 1% per year (RR 1.01, 95% CI 1.00, 1.02) during 1990–2011, after adjustment for maternal characteristics and pregnancy‐related factors. In general, trends were similar for early pregnancy loss.

Conclusion

From 1990 to 2011, risk of self‐reported pregnancy loss increased among US women. Further work is needed to better understand the drivers of this increase in reported pregnancy loss in the US.     

Integration of Smartphones into clinical pharmacy practice: An evaluation of the impact on pharmacists׳ efficiency

BackgroundPersonal smartphones are used frequently by healthcare practitioners in hospitals to assist in the provision of care. Island Health is one of the first health authorities in Canada to endorse the iPhone^®smartphone as a potentially valuable tool for clinical practice.ObjectiveTo measure smartphones effect on pharmacists׳ efficiency, to assess pharmacist acceptance of corporate smartphones, and to investigate how these devices are being utilized.MethodsThis multi-center time-trial, survey, and observational prospective study enrolled 90 pharmacists across eight hospitals on Vancouver Island. Participants performed a time-trial of 22 situational drug information questions before and after receiving an iPhone^®. They also completed demographic and satisfaction surveys. A subset of 14 of the 90 pharmacists participated in a pre- and post- iPhone^® implementation eight hour direct observation study. Lastly, communication data from the phone service provider was collected and analyzed.ResultsSmartphone use was associated with a faster median response time of approximately six minutes for all situational time-trial questions combined (48 min:15 s pre-iPhone^® vs. 42 min:18 s post-iPhone^®) (p=0.039). Smartphone use did not significantly influence time spent walking to obtain a resource, time spent using computers, or time spent answering of clinical questions during observation. Almost half of pharmacists reported that using the smartphone increased their confidence and competence to resolve drug therapy problems.ConclusionsPharmacists readily accepted smartphones into their practice and felt positively about using them. Smartphones did not improve direct observation measures of workflow, but they did improve pharmacists׳ efficiency in the answering of hypothetical drug information questions (p=0.039). This study indicates that if smartphones are incorporated into pharmacy practice in a structured, organized manner with supports and training in place, smartphone uptake will occur and pharmacists will adapt and incorporate this technology into their daily routine with no predicted deterioration in the quality of their work. The impact of improved efficiency on patient care resulting from an increased reliance on technology and time spent on devices needs to be further assessed.     

Balloon pulmonary angioplasty vs. pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis

Heart Failure Reviews - Although balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) are effective in chronic thromboembolic pulmonary hypertension (CTEPH), the comparison of...     

The use of biologics in anal fistulas

The management of anal fistulas is often challenging. Simple fistulotomy is ideal for intersphincteric tracts and low transsphincteric fistulas that incorporate a small amount of the sphincter muscles. More complex fistulas require a sphincter-sparing approach. The general goal of the numerous established procedures for the treatment of anal fistulas is to eliminate the fistula tract with the lowest rate of recurrence while preserving sphincter function. As such, the use of biologic materials in this cohort of fistulas has gained popularity over the years because they are resistant to infection, have limited foreign body reaction, and are repeatable without compromising fecal continence. Short- and long-term results are variable and will be discussed further in this article. There are also novel strategies using biologic materials that warrant consideration and further study.     

Community-acquired group B streptococcal meningitis in adults

IntroductionStreptococcus agalactiae (group B streptococci; GBS) is an uncommon cause of bacterial meningitis in adults.MethodsWe reviewed literature published between 1975 and 2018. Studies were included if they reported age, sex and outcome of patients above 16 years of age with cerebrospinal fluid culture (CSF) positive for GBS.ResultsSixty-seven articles describing 141 patients were included. Median age was 56 years (IQR 41–66); 52% were male. Fifty-three patients (38%) were immunocompromised and CSF leakage was reported in 9 (10%) of 88 immunocompetent patients. Sixty-two patients (44%) had extra-meningeal foci of infection, most commonly endocarditis, which occurred in 14 patients (12%). Twenty-eight patients (23%) were described as previously healthy. Forty-four (31%) of the 141 patients died, after a median duration of 5 days after admission. Death was associated with advanced age and an immunocompromised state.ConclusionGBS meningitis in adults mainly occurs in those with underlying conditions such as immunocompromised state, CSF leakage, and endocarditis. These conditions should be actively sought for in adults with GBS meningitis.     

Acute effect of engineered thermoplastic polyurethane elastomer knockoff running footwear on foot loading and comfort during heel-to-toe running

BackgroundBetter midsole materials and comfort have been incorporated into more expensive shoes and are popular with runners. Consequently, knockoff running shoes are currently widely distributed in the Chinese market and and cost only 30%–50% of the total price of genuine branded products.Research questionUncertainty exists concerning the beneficial effects of advanced shoe material application in decreasing foot loading or impact force during running. Additionally, using comfort as a criterion to identify genuine branded running shoes may exclude brand factor.MethodsFifteen healthy male volunteers were asked to perform two different tests, including running and a comfort evaluation. Each participant was asked to identify which footwear was the Adidas brand shoe based on their perception of comfort.ResultsTime to the first peak of the vertical ground reaction force occurred significantly later when subjects wore the genuine branded shoe compared to knockoff shoe 1 (p = 0.003) and knockoff shoe 2 (p = 0.015) footwea. The genuine branded shoe (p = 0.005) and knockoff shoe 1 (p = 0.029) were significantly more comfortable compared to the knockoff shoe 2. Only four subjects selected the genuine branded shoe, whereas six subjects selected both the genuine branded shoe and knockoff shoe 1.SignificanceKnockoff running footwear significantly increases impact loading compared to the genuine branded product, thereby posing greater risk of running injury.