Objectives: Colorectal cancer (CRC) is suitable for population screening due to its high incidence and the recognizable and treatable prephase, and the present study is part of the larger study; Screening for Swedish Colons (SCREESCO). In Sweden, there is, to our knowledge, no questionnaire assessing shared decision making (SDM) with regard to CRC screening and, therefore, the aim of the study was to translate and culturally adapt the CRC screening module of the National Survey of Medical Decisions (DECISIONS) into a Swedish context.
Material and methods: A qualitative design inspired by guidelines based on methods for cross-cultural adaptation of questionnaires was used. In addition, focus group discussions, individual interviews and think-aloud (TA) sessions were performed.
Results: Of the 54 items included in the original DECISION survey, 32 were excluded, 22 were modified, and three were added as a result of the qualitative study. How the health care organization communicated and CRC screening knowledge was communicated were found to be the most important cultural differences between Sweden and the USA. The final questionnaire consists of 24 items.
Conclusion: The process of translation and cultural adaptation of the CRC screening module of the DECISIONS survey resulted in the removal and modifying of a considerable number of items. The major rationale for the removal and modifying of items can be explained by the different cultural traditions between Sweden and the USA when communicating with the health care system regarding screening participation and how CRC screening information and knowledge is communicated. 相似文献
Objective.?The aim of this randomized trial was to compare the efficacy and safety of vaginal misoprostol and oxytocin for cervical ripening and labor induction in patients with premature rupture of membrane (PROM) at term.Methods.?Ninety-seven women with PROM at term were assigned randomly to receive intravaginal misoprostol or oxytocin. The primary outcome measure was the induction–delivery interval. Secondary outcomes included the number of women who delivered vaginally within 12 hours of the start of the induction in the two groups, the cesarean, hyperstimulation, and failed induction rates, the mode of delivery, and the neonatal outcome.Results.?Forty-eight women were assigned to intravaginal misoprostol and 49 to oxytocin administration. The mean interval from induction to delivery was 10.61 ± 2.45 hours in the misoprostol group and 11.57 ± 1.91 hours in the oxytocin group (p = 0.063). The rates of vaginal delivery were 83.3% and 87.7% and cesarean delivery were 16.7% and 8.2% in the misoprostol and oxytocin groups, respectively. Neonatal outcomes were not significantly different. Of the cases, 8.3% in the misoprostol group and 8.2% in the oxytocin group revealed uterine contraction abnormalities.Conclusion.?Our study demonstrates that, intravaginally, misoprostol results in a similar interval from induction of labor to delivery when compared to oxytocin. 相似文献
Objective: The fetal inflammatory response syndrome (FIRS) is considered the fetal counterpart of the systemic inflammatory response syndrome (SIRS), which can be caused by infection and non-infection-related insults. Although the initial response is mediated by pro-inflammatory signals, the control of this response is achieved by anti-inflammatory mediators which are essential for the successful outcome of the affected individual. Interleukin (IL)-19 is capable of stimulating the production of IL-10, a major anti-inflammatory cytokine, and is a potent inducer of the T-helper 2 (Th2) response. The aim of this study was to determine if there is a change in umbilical cord plasma IL-19 and IL-10 concentrations in preterm neonates with and without acute funisitis, the histologic counterpart of FIRS. Methods: A case-control study was conducted including 80 preterm neonates born after spontaneous labor. Neonates were classified according to the presence (n?=?40) or absence of funisitis (n?=?40), which is the pathologic hallmark of FIRS. Neonates in each group were also matched for gestational age. Umbilical cord plasma IL-19 and IL-10 concentrations were determined by ELISA. Results: 1) The median umbilical cord plasma IL-19 concentration was 2.5-fold higher in neonates with funisitis than in those without funisitis (median 87 pg/mL; range 20.6–412.6 pg/mL vs. median 37 pg/mL; range 0–101.7 pg/mL; p?<?0.001); 2) newborns with funisitis had a significantly higher median umbilical cord plasma IL-10 concentration than those without funisitis (median 4 pg/mL; range 0–33.5 pg/mL vs. median 2 pg/mL; range 0–13.8 pg/mL; p?<?0.001); and 3) the results were similar when we included only patients with funisitis who met the definition of FIRS by umbilical cord plasma IL-6 concentrations ≥ 17.5 pg/mL (p?<?0.001). Conclusion: IL-19 and IL-10 are parts of the immunologic response of FIRS. A subset of fetuses with FIRS had high umbilical cord plasma IL-19 concentrations. In utero exposure to high systemic concentrations of IL-19 may reprogram the immune response. 相似文献
Interleukins (ILs) and matrix metalloproteinases actually target collagen IV in the amniochorion in premature rupture of membranes (PROM), IL-10 acts as a membrane protector. In order to counteract the immunological system involved in the pathogenesis, we have used a combination of proapoptotic bax gene P-53 inhibitor, myristoleate, with antimicrobial peptides, neutrophil defensins, and cytokine IL-10 enhancer.
Methods
A comparative prospective randomized study was conducted from July 2006 to January 2007 in patients (46 cases and 60 controls) attending the Gynecology and Obstetrics Emergency Department, Eden Medical College, Kolkata, complaining of leakage per vagina in their antenatal period between 24 and 36 weeks of gestation. Combination of bax gene inhibitor, antimicrobial peptides, neutrophil defensins, and IL-10 enhancer in scheduled protocol was prescribed and cases followed up as per fixed protocols.
Results
In the 24–30 weeks group, mean prolongation of gestational age was 6.16±3.21 as against 2.66±1.05 (significant), while in 31–36 weeks mean prolongation was 4.69±0.84 as against 4.6±0.632 (significant). In the first group mean birth weight in cases was 1.77±0.66 kg as against 1.2±0.43 kg (significant), while in the second it was 2.18±0.56 kg as against 1.76±0.45 kg (significant). Associated complications were less in cases.
Conclusion
Combination of bax gene inhibitor, antimicrobial peptides, neutrophil defensins, and IL-10 enhancer as per scheduled protocol can be advocated routinely in PROM barring a few situations with excellent fetal and maternal prognosis. 相似文献
The benefit of anterior cruciate ligament (ACL) reconstruction has been questioned based on patient‐reported outcome measures (PROMs). Valid interpretation of such results requires confirmation of the psychometric properties of the PROM. Rasch analysis is the gold standard for validation of PROMs, yet PROMs used for ACL reconstruction have not been validated using Rasch analysis. We used Rasch analysis to investigate the psychometric properties of the Knee Numeric‐Entity Evaluation Score (KNEES‐ACL), a newly developed PROM for patients treated for ACL deficiency. Two‐hundred forty‐two patients pre‐ and post‐ACL reconstruction completed the pilot PROM. Rasch models were used to assess the psychometric properties (e.g., unidimensionality, local response dependency, and differential item functioning). Forty‐one items distributed across seven unidimensional constructs measuring impairment, functional limitations, and psychosocial consequences were confirmed to fit Rasch models. Fourteen items were removed because of statistical lack of fit and inadequate face validity. Local response dependency and differential item functioning were identified and adjusted. The KNEES‐ACL is the first Rasch‐validated condition‐specific PROM constructed for patients with ACL deficiency and patients with ACL reconstruction. Thus, this instrument can be used for within‐ and between‐group comparisons. 相似文献