Ischemic stroke in Morocco: Prehospital delay and associated factors

ObjectivesThis study aimed to estimate prehospital delay and to identify the factors associated with the late arrival of patients with ischemic stroke at the Souss Massa Regional Hospital Center in Morocco.Patients and methodsAn observational, prospective, cross-sectional study was conducted from March 2019 to September 2019 in the Souss Massa regional hospital center, which is a public hospital structure. A questionnaire was administered to patients with ischemic stroke and to bystanders (family or others), while clinical and paraclinical data were collected from medical records. Univariate and multivariate logistic regression analyses were used to identify the factors associated with delayed arrival at emergency department.ResultsA total of 197 patients and 197 bystanders who fulfilled the criteria for the study were included. The median time from symptom onset to hospital arrival was 6 hours (IQR, 4–16). Multiple regression analysis showed that illiteracy (OR 38.58; CI_95%: 3.40–437.27), waiting for symptoms to disappear (patient behavior) (OR 11.24; CI_95%: 1.57–80.45), deciding to go directly to the hospital (patient behavior) (OR 0.07; CI_95%: 0.01–0.57), bystander's knowledge that stroke is a disease requiring urgent care within a limited therapeutic window (OR 0.005; CI_95%: 0.00–0.36), and direct admission without reference (OR 0.005; CI_95%: 0.00–0.07), were independently associated with late arrival (> 4.5 hours) of patients with acute ischemic stroke. In addition, illiteracy (OR 24.62; CI_95%: 4.37–138.69), vertigo and disturbance of balance or coordination (OR 0.14; CI_95%: 0.03–0.73), the relative's knowledge that stroke is a disease requiring urgent care and within a limited therapeutic window (OR 0.03; CI_95%: 0.00–0.22), calling for an ambulance (relative's behavior) (OR 0.16; CI_95%: 0.03–0.80), distance between 50 and 100 km (OR 10.16; CI_95%: 1.16–89.33), and direct admission without reference (OR 0.03; CI_95%: 0.00–0.14), were independently associated with late arrival (> 6 hours) of patients with acute ischemic stroke.ConclusionPatient behavior, bystander knowledge and direct admission to the competent hospital for stroke care are modifiable factors potentially useful for reducing onset-to-door time, and thereby increasing the implementation rates of acute stroke therapies.     

Self-report of sexually transmitted infections from 1994 to 2010 by adults living in France

BackgroundSince 1994, French population-based knowledge, attitudes, beliefs and practices surveys have enabled researchers to estimate trends in sexual behavioural indicators.MethodsWe estimated trends and prevalence of self-reported sexually transmitted infections during the previous 5 years among 16,095 sexually active adults aged 18–54 through five cross-sectional telephone surveys between 1994 and 2010. We then studied the factors associated with participants’ most recent sexually transmitted infections other than genital candidiasis.ResultsOverall, 2.5% (95% confidence interval: 2.2%–2.9%) of women reported sexually transmitted infections within the previous 5 years, increases being continuously reported between 1998 and 2010. In contrast, men reported lower prevalence of sexually transmitted infections (1.4%; 95% confidence interval: 1.1%–1.7%), which remained stable over time. General practitioners and gynaecologists managed most sexually transmitted infections. Men notified their stable partners about infection less often than women (66% vs. 84%). Self-reported sexually transmitted infections were associated with younger age, multiple sexual partnerships and fear of sexually transmitted infections in both genders, with exclusively homosexual practices in men, and with a high educational level and recent HIV testing in women.ConclusionSelf-reported sexually transmitted infections clearly reflect risky sexual behaviours. The lower prevalence of self-reported sexually transmitted infections among men than among women may reflect less access to screening activities for sexually transmitted infections in men.     

对农村养老护理保健卫生资源配置问题的思考简

目的：了解与提出深化医改形势下人口老龄化的现状及养老护理保健卫生资源配置的问题，为做好老年人养老护理保健工作提供政策依据。方法：主要用调查法和观察法等描述性研究的方法进行综合描述。结论：提出加强农村养老护理保健机构建设、培养农村养老护理保健机构人才等建议。     

Sleep duration and remaining teeth among older people

BackgroundNo studies have examined the associations between the numbers of teeth and sleep disturbance. Therefore, we examined the associations between the number of teeth and sleep duration in older people, considering the evidence linking fewer teeth and sleep apnoea through changes in jaw position.MethodsFor this study we used information from a sample of 23,444 cohort participants, randomly selected from the Japan Gerontological Evaluation Study 2010 (N = 169,215). The outcome variable was self-reported sleep duration (h/day), and the explanatory variable was self-reported number of teeth (0, 1–9, 10–19, ≥20). We treated age, sex, body mass index, educational attainment, annual equalized household income, depressive symptoms, physical activity, activities of daily living, presence of diabetes, and smoking status as covariates. Multinomial logistic regression was used among the 20,548 eligible participants with all necessary information.ResultsThe mean age was 73.7 (standard deviation = 6.13) years. Most participants (28.1%) reported sleep duration of 7 h, while a small proportion of the participants reported short (≤4 h, 2.7%) or long (≥10 h, 4.7%) sleep duration. The proportion of edentulous participants was 14.7%. Taking the 7-h sleep duration as the reference category, edentulous participants (relative risk ratio (RRR) = 1.43, 95% confidence interval (CI) = 1.07–1.90) or one to nine teeth (RRR = 1.29, 95% CI = 1.02–1.63) had a significantly higher relative risk ratio for short sleep, independent of covariates. Furthermore, they had a higher relative risk ratio for long sleep duration (RRR = 1.75, 95% CI = 1.40–2.19; RRR = 1.48, 95% CI = 1.21–1.81, respectively).ConclusionsCompared to people with 20 or more teeth, older adults with fewer than 10 teeth have higher risks for short and long sleep durations.     

Sample size: how many participants do I need in my research?

The importance of estimating sample sizes is rarely understood by researchers, when planning a study. This paper aims to highlight the centrality of sample size estimations in health research. Examples that help in understanding the basic concepts involved in their calculation are presented. The scenarios covered are based more on the epidemiological reasoning and less on mathematical formulae. Proper calculation of the number of participants in a study diminishes the likelihood of errors, which are often associated with adverse consequences in terms of economic, ethical and health aspects.     

Photoablation of meningiomas and neurinomas by Holmium Yag laser radiation

Abstract

Cranial rat bone was irradiated by 2.1 pm Holmium Yag laser radiation. Quantitative edge rates were calculated. Histologic sections were investigated by light and electron microscopy. Eighteen cases of hard fibrous or calcified spinal and cranial meningiomas and neurinomas were operated upon using pulsed laser beam, in rat cranial bone ablation rate ranged between 0.3-0.5 mm per pulse. Perifocal thermal damage was observed in a zone of20-90 pm around the lesion. In all human cases tumors could be removed totally without additional neurological deficit. In vivo heat development was measured by an i.r.-camera. [Neurol Res 1999; 21: 96–98]     

Impact de la modulation d’intensité dans l’irradiation des aires ganglionnaires du cancer du sein

Irradiation of node areas is still a complex challenge in external radiotherapy for breast cancer. Acceptable target coverage is always balanced by protection of organs at risk and patient morphology. Intensity-modulated radiotherapy increases the quality of dose distribution on the planning target volume, but modifies dramatically the irradiation coverage of critical structures in a different way compared to 3D treatment. In this paper we analyze this new technique in breast treatment with node regions, its expected gain and potential risks.     

ATTITUDES AND VALUES OF PERUVIAN COCA GROWERS*

This study uses semi-structured interviews to examine the attitudes and values of Peruvian coca growers toward coca leaf and cocaine basic paste (CBP) consumption and its distribution. The subjects of the study were 186 coca growers from Peruvian jungle valleys who are involved in illegal commercialization of coca leaf and cocaine paste production. Data collected in 1994 reveal that growers consider coca leaf to be a most profitable product and a unique opportunity to improve their quality of life. Although growers acknowledge that a problem exists among local users, they do not assume any responsibility for CBP consumption and dissemination in rural areas. This leads to the conclusion that awareness of a CBP consumption problem is not enough for growers to stop drug production; they need consistent training in social values, as well as support in legal and economic alternatives. [Translations are provided in the International Abstracts Section of this issue.]     

eHEALS健康素养量表的汉化及适用性探索

目的评价eHEALS汉化量表的信度和效度，并用该量表分析高中生电子健康素养的影响因素。方法将英文版“eHeahhLiteracyScale（eHEALS）”翻译为中文并进行修订；使用eHEALS汉化量表对110名高中生进行调查，利用EpiData3．02软件录入数据，SPSS13．0进行统计分析。结果eHEALS汉化量表的Cronbach’sd系数为0．913，因子分析载荷系数在0．692—0．869之间。eHEALS汉化量表总分平均值为（28．58±7．00）分，高中生电子健康素养水平在不同地域、母亲文化程度、健康态度和自评健康状况间均存在差异（P〈0．05）。结论eHEALS汉化量表具有较好的信效度。高中生在获取、应用网络健康信息与服务方面自我信心较为乐观。