Low birth weight and psychiatric morbidity; stability and change between adolescence and young adulthood

Background

Being born with low birth weight is a risk factor for psychiatric morbidity.Few longitudinal studies have included diagnostic assessment and followed subjects into adulthood.

Aim

To assess stability and change in psychiatric morbidity between adolescence and young adulthood in low birth weight subjects, and explore whether screening in adolescence can predict subsequent psychopathology in these groups.

Study design

Prospective geographically based follow-up study of two low birth weight groups and a control group born between 1986 and 1988, assessed at 14 (T1) and 20 (T2) years of age.

Subjects

Thirty eight subjects born preterm with very low birth weight (VLBW: ≤ 1500 g), 43 born at term but small for gestational age (SGA: < 10th percentile) and 64 controls with normal birth weight participated.

Outcome measures

Mental health was assessed using diagnostic psychiatric interview at both study points supplemented with the Achenbach System of Empirically Based Assessment and Children's Global Assessment Scale at T1.

Results

There was a trend towards increasing morbidity from T1 among VLBW (p = 0.086) and a significant increase among SGA (p = 0.003) participants. Supplementary assessment at T1 discriminated satisfactory between persons with and without psychiatric disorders at T2 (area under ROC curve: 0.66 to 0.89), but was most effective in the VLBW group.

Conclusion

High psychiatric morbidity continued into young adulthood in the VLBW group and increased significantly in the SGA group. Screening in adolescence can be used to detect individuals at risk especially among those born at very low birth weight.     

基于PBL的渐进式教学法在乳腺病实习教学中的探索

[目的]乳腺科实习教学作为一个切入点,探究PBL教学法在医学临床带教中的本土化应用方法.[方法]在乳腺病实习教学中采用基于PBL的渐进式教学法,包括启始准备,标准案例PBL教学法,动态案例PBL教学法等三个阶段,难度逐渐递增.[结果]基于PBL的渐进式教学方法很受实习同学们的欢迎,学生们普遍认为这样的教学提高了他们的学习能力、临床思维能力和沟通能力.[结论]该教学法更能适应中国医学生实习教学,能取得良好的教学效果.     

基于循证医学理念提升临床教学质量探讨

随着我国高等医学教育的迅速发展,其规模效率的弊端也日益突显,这主要表现在师资队伍的建设滞后、临床教学资源缺乏、临床一线教师抗风险能力较弱等方面。为此,基于循证医学的教育理念,对现有临床教学方法进行探讨,这不仅有利于医学生自主学习能力的培养,而且也有利于他们在今后的执业生涯中能自主收集、分析和使用临床证据,更好的为患者服务。     

慢性心力衰竭的辨证施膳研究

慢性心力衰竭证属本虚标实.心气心阳亏虚为病之本,血瘀水停乃病之标,“虚”“瘀”“水”为其病理关键,治宜标本兼顾.根据虚实主次不同,本病可分为心肺气虚、气阴两虚、气虚血瘀、痰饮阻肺、阳虚水泛、阳气虚脱等证型.心肺气虚型治宜补益心肺,方用补虚正气粥合山楂粥;气阴两虚型治宜益气养阴,方用生脉粥;气虚血瘀型治宜益气活血,方用丹参粥合山楂粥;痰饮阻肺型治宜泻肺化痰,方用葶苈子粥合白术茯苓粥;阳虚水泛型治宜温阳利水,方用参芪附子粥合参桂苈枣汤.在具体病证的药膳调理过程中,务必恪守“辨证施膳”原则,随“机”而变.对于阳气虚脱者,药膳调理无助救治.     

Web-based assessment and brief intervention for alcohol use in women of childbearing potential: a report of the primary findings

Background: There is a need for more effective assessment and primary prevention programs aimed at accurately measuring and reducing alcohol consumption among women before conception in underserved, high‐risk populations. Health information technology may serve this purpose; however, the effectiveness of such tools within this population is not known. Methods: We conducted a small‐scale randomized controlled trial to test the effectiveness of an adapted web‐based alcohol assessment and intervention tool among low‐income, nonpregnant women of reproductive age who were receiving Women Infant and Children (WIC) services in San Diego County and who reported currently drinking at a moderate risk level. A total of 150 risky drinking participants completed a web‐based assessment and were randomly assigned to either receive a personalized feedback intervention or general health information about alcohol consumption and fetal alcohol syndrome. Follow‐up assessments on reported alcohol consumption were conducted via telephone at 1‐ and 2‐months postbaseline. Participants ranged in age from 18 to 44 and were predominately Hispanic/Latina (44%). Results: At baseline, all respondents reported consuming ≥3 standard drinks on ≥1 occasion in the previous month. Outcome data were available for 131 participants. The main outcome measure was reduction in the number of risky drinking occasions, which did not differ significantly between treatment conditions (odds ratio 1.200, 95% CI 0.567 to 2.539, p = 0.634). Over 70% of the participants, however, reported a reduction in risky drinking occasions regardless of treatment condition (control 43/63, 68%; experimental 49/68, 72%). Conclusions: The results of this study demonstrate that web‐based assessment of alcohol consumption among low‐income women of reproductive age, as represented by WIC clients, is feasible and acceptable. The findings also suggest that detailed and interactive assessments of alcohol consumption may be sufficient for the reduction of risky drinking within this population without personalized feedback.     

乙型肝炎病毒cccDNA巢式-实时荧光定量PCR法的建立及应用

目的建立检测HBV共价闭合环状（cccDNA）的巢式-荧光定量PCR法,检测外周血单核细胞（PBMC）及骨髓单核细胞（MMNC）中cccDNA。方法根据HBV cccDNA与松弛结构DNA（rcDNA）结构上的差异,设计2对跨缺口的特异性引物及下游的特异性TaqMan探针。根据Mung Bean Nuclease对rcDNA与cccDNA作用的不同,使cccDNA扩增而使rcDNA降解,分别用外引物及内引物进行PCR反应,再用荧光探针进行实时荧光定量PCR,根据阳性参照物,计算出检测标本定量值。结果成功建立了HBV cccDNA巢式-荧光定量PCR的检测方法,线性范围为5.0×102～3.9×107拷贝/ml。用上述方法检测25例慢性乙型肝炎（CHB）及肝硬化血清HBV DNA阳性患者PBMC中cccDNA,7例MMNC中cccDNA,21例健康献血者PBMC cccDNA,骨髓标本中有3例cccDNA阳性,25例外周血标本中有9例cccDNA阳性。结论巢式-荧光定量PCR法可检测乙型肝炎患者PBMC及MMNC中的HBV cccDNA含量。PBMC及MMNC中可检测到HBV cccDNA。     

Pro-equity immunization and health systems strengthening strategies in select Gavi-supported countries

BackgroundAchieving universal immunization coverage and reaching every child with life-saving vaccines will require the implementation of pro-equity immunization strategies, especially in poorer countries. Gavi-supported countries continue to implement and report strategies that aim to address implementation challenges and improve equity. This paper summarizes the first mapping of these strategies from country reports.MethodsThirteen Gavi-supported countries were purposively selected with emphasis on Gavi’s priority countries. Following a scoping of different documents submitted to Gavi by countries, 47 Gavi Joint Appraisals (JAs) for the period 2016–2019 from the 13 selected countries were included in the mapping. We used a consolidated framework synthesized from 16 different equity and health systems frameworks, which incorporated UNICEF’s coverage and equity assessment approach – an adaptation of the Tanahashi model. Using search terms, the mapping was conducted using a combination of manual search and the MAXQDA qualitative analysis tool. Pro-equity strategies meeting the inclusion criteria were identified and compiled in an Excel database, and then populated on a tableau visualization dashboard.ResultsIn total, 258 pro-equity strategies were implemented by the 13 sampled Gavi-supported countries between 2016 and 2019. The framework determinants of social norms, utilization, and management and coordination accounted for more than three-quarters of all pro-equity strategies implemented in these countries. The median number of strategies reported per country was 17. Afghanistan, Nigeria, and Uganda reported the highest number of strategies that we considered as pro-equity.ConclusionFindings from this mapping can be useful in addressing equity gaps, reaching partially immunized, and ‘zero-dose’ vaccinated children, and valuable resource for countries planning to implement pro-equity strategies, especially as immunization stakeholders reimagine immunization delivery in light of COVID-19, and as Gavi finalizes its fifth organizational strategy. Future efforts should seek to identify pro-equity strategies being implemented across additional countries, and to assess the extent to which these strategies have improved immunization coverage and equity.     

综合提醒系统对脑卒中患者出院6个月知信行和临床结局的效果

目的 探讨健康信念综合提醒系统对脑卒中患者出院后6个月健康知识、信念、行为、卫生服务利用情况及临床结局的效果。方法 2015年2月至2016年3月,方便抽样广州市3家综合医院高血压并发缺血性脑卒中出院患者174例,分为对照组(n = 87)和干预组(n = 87)。对照组予常规健康教育;干预组在此基础上采用“基于健康信念模式的综合提醒系统”进行健康教育和延续护理。出院6个月后,采用脑卒中健康知识问卷(SKQ)、脑卒中患者健康信念简表(SF-HBMS-SP)和脑卒中健康行为量表(HBS-SP)进行调查,并记录临床结局(急诊就诊、再住院、复发和死亡)。结果 对照组75例、干预组76例完成调查。干预组SKQ (U = 903.000)、SF-HBMS-SP (t = -9.099)和HBS-SP (t = -7.786)总分均显著高于对照组(P < 0.001)。干预组门诊复诊率(97.37%)显著高于对照组(76.00%) ( P <0.001);两组急诊就诊数和再住院数无显著性差异(P > 0.05),死亡和复发率无显著性差异( P > 0.05)。 结论 健康信念综合提醒系统能提高脑卒中患者出院后健康知识、信念、行为和门诊复诊率,但尚未对临床结局产生明显效果。     

An accelerated rabies vaccine schedule based on toll-like receptor 3 (TLR3) agonist PIKA adjuvant augments rabies virus specific antibody and T cell response in healthy adult volunteers

BackgroundRabies is a fatal disease where post-exposure prophylaxis (PEP) is crucial in preventing infection. However, deaths even after appropriate PEP, have been reported. The PIKA Rabies vaccine adjuvant is a TLR3 agonist that activates B and T cells leading to a robust immune response.MethodsWe conducted a phase I, open label, randomized study in healthy adults to assess the safety and immunogenicity of the PIKA Rabies vaccine and an accelerated vaccine regimen. Thirty-seven subjects were randomized into 3 groups: control vaccine classic regimen, PIKA vaccine classic regimen and PIKA vaccine accelerated regimen. Subjects were followed up for safety, rabies virus neutralizing antibodies (RVNA) and T cell responses.ResultsBoth the control and PIKA Rabies vaccine were well tolerated. All adverse events (AEs) were mild and self-limiting. Seventy-five percent of subjects in the PIKA accelerated regimen achieved a RVNA titer ⩾0.5 IU/mL on day 7, compared to 53.9% in the PIKA classic regimen (p = 0.411) and 16.7% in control vaccine classic regimen (p = 0.012). The PIKA rabies vaccine elicited multi-specific rabies CD4 mediated T cell response already detectable ex vivo at day 7 after vaccination and that was maintained at day 42.ConclusionThe investigational PIKA rabies vaccine was well tolerated and more immunogenic than the commercially available vaccine in healthy adults.Clinical trial registry: The study was registered with clinicaltrials.gov NCT02657161.