Point-of-care hepatitis C screening with direct access referral to improve linkage to care among halfway house residents: a pilot randomised study

INTRODUCTIONLinkage to care among individuals with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine whether point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group.METHODSAll participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment.RESULTS351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis.CONCLUSIONPoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population.     

Experiences of parents whose children participated in a longitudinal follow‐up study

BackgroundLong‐term follow‐up is necessary to understand the impact of perinatal interventions. Exploring parents'' motives and experiences in consenting to their children taking part in longitudinal studies and understanding what outcomes are important to families may enhance participation and mitigate the loss to follow‐up. As existing evidence is largely based on investigators'' perspectives using Western samples, the present pilot study explored parents'' perspectives in a multicultural New Zealand context.MethodsData were generated using semi‐structured interviews with parents whose children had participated in a longitudinal study after neonatal recruitment. Parents'' experiences of being part of the study were analysed thematically using an inductive approach.ResultsParents (n = 16) were generally happy with the outcomes measured. Additionally, parents were interested in lifelong goals such as the impact of parental diabetes. We identified three themes: (1) Facilitators: Research participation was aided by motives and parent and research characteristics such as wishing to help others and straightforward recruitment; (2) Barriers: A hesitancy to participate was due to technical and clinical research aspects, participation burden and cultural barriers, such as complex wording, time commitment and nonindigenous research and (3) Benefits: Children and parents experienced advantages such as the opportunity for education.ConclusionsParents reported positive experiences and described the unexpected benefit of increasing families'' health knowledge through participation. Improvements for current follow‐up studies were identified. Different ethnicities reported different experiences and perspectives, which warrants ongoing research, particularly with indigenous research participants.Patient or Public ContributionNo active partnership with parents of patients took place.     

老年人急性非结石性胆囊炎坏疽穿孔18例临床分析

目的总结老年人非结石性胆囊炎坏疽、穿孔的特点和诊疗经验,提高诊断率及治愈率。方法对我院2000年1月至2005年12月收治的老年人非结石性胆囊炎坏疽、穿孔18例临床资料进行回顾性分析。结果18例患者均行手术治疗,其中开腹手术15例,应用腹腔镜3例。治愈15例(83.3%),死亡3例(16.7%)。结论老年人由于全身重要脏器机能储备及其代偿能力降低,应激能力减退,常伴有各种疾病,临床表现复杂,病情发展迅速,胆囊坏疽、穿孔的发生率高。手术时机把握最为重要,早期手术是关键。     

老年人急性重症胆管炎40例临床分析

目的：探讨老年急性重症胆管炎的诊断与治疗。方法：收治老年重症胆管炎患者40例,回顾性分析临床资料。结果：治愈35例,死亡5例,其中开腹手术死亡2例,经皮肝胆管引流（PTCD）死亡2例,内镜下鼻胆管引流（ENBD）死亡1例。结论：加强围手术期治疗,运用影像介入、现代内镜等微创手段,结合常规手术进行多层次的治疗,可以减少本病的病死率。     

电视胸腔镜手术治疗老年结核性脓胸120例临床分析

目的探讨电视胸腔镜手术在老年结核性脓胸治疗中的价值。方法选择120例老年结核性脓胸患者行电视胸腔镜手术,仅有纤维膜形成者,行脓胸清创术及纤维膜剥离术;病程稍长,已形成纤维板者,则在胸腔镜辅助小切口下行胸膜纤维板剥脱术,观察手术的一般情况、肺功能及并发症发生率。结果手术时间25～150min,平均55rain;术中出血30～1500mL,平均145mL。92例（76．67％）完成胸腔镜手术,22例（18．33％）辅助小切口手术,6例（5．00％）中转开胸。术后胸腔引流3～25d,平均6d。术后近期并发症发生率为29．17％,治疗后均痊愈,无手术死亡及严重并发症。术后1个月肺功能用力肺活量（FVC）、第一秒用力肺活量（FEV1）、肺总量（TLC）较治疗前均明显改善,差异有统计学意义（P〈0．05）,且随访无复发病例。结论电视胸腔镜手术或辅助小切口治疗老年结核性脓胸,能达到清除病因、闭合脓腔、恢复肺功能的目的,对老年患者心肺功能影响小,是治疗老年结核性脓胸的最优选择。     

54例不同性别健康大学生“寸口”脉象及脉图参数分析

目的：探索健康人群不同性别及左右手＂寸口＂关部脉象及脉图参数的变化特征。方法：根据纳入标准筛选健康大学生共54例,其中男性28例、女性26例。用DDMX-100型单道脉象仪采集受试者左右手关部脉象信息,并进行统计分析。结果：男性以平脉、滑脉为多见,女性以平脉或平弦脉为多见;男性、女性右手脉图参数h3、h3/h1显著低于左手（P〈0.05）,h5、h5/h1显著高于左手（P〈0.05）,提示男女右手动脉血管壁的紧张性和外周阻力均低于左手;男性左右手脉图参数h1、h5均高于女性,t4、w/t均低于女性,提示男性左心室的射血功能强、心输出量大、动脉管壁顺应性好。结论：男女右手动脉血管壁的紧张性与外周阻力均低于左手;男性左心室的射血功能及动脉管壁顺应性均优于女性,研究结果与中医经典脉学理论基本相符。     

海口市某社区老年人群脑卒中相关危险因素分析

目的：探讨海口市某社区老年人群中脑卒中患病的危险因素,为制定防治措施及开展预防工作提供依据。方法：按横断面调查的设计,以整群抽样方法抽取海口市某社区年龄逸60岁的人群,进行脑卒中患病率及常见危险因素的调查,描述脑卒中患病率及危险因素的分布特征。结果：本研究发现,60岁及以上的老年人群中,男性脑卒中患病率高于女性,有吸烟史、饮酒史、BMI指数为超重或者肥胖的的人群中脑卒中的患病率高于其他人群,高血压、糖尿病、脑卒中家族史人群中脑卒中的患病率高于其他人群（P0.05）。结论：老年人群脑卒中发病的危险因素有吸烟、饮酒、超重或肥胖、高血压、糖尿病、脑卒中家族史。     

社区老年人跌倒的危险因素分析

目的 分析影响社区老年人发生跌倒的相关因素.方法 对南宁市某社区1 222名老年人(年龄≥60岁)进行调查,分析其发生跌倒的情况,对可能影响老年人跌倒的相关因素进行单因素及多因素非条件logistic回归分析.结果 1 222名老年人中,在1年内有363例发生1次跌倒(29.8％),男性跌倒的发生率高于女性(P＜0.05).生活自理是社区老年人跌倒的保护因素(P＜0.05),高龄、心功能不全、骨折脱臼、晕厥、痴呆、卒中、帕金森病是社区老年人跌倒的危险因素(P＜0.05).结论 社区老年人跌倒发生率较高,针对相关危险因素予以相应的干预措施非常必要.     

临沧口岸入境人员艾滋病监测情况分析

目的通过对3126名临沧口岸入境人员艾滋病抗体结果分析,深入了解临沧口岸入境人员艾滋病病毒(人类免疫缺陷病毒HIV)感染情况,为口岸艾滋病监测、防控工作提供有力科学依据。方法采用人类免疫缺陷病毒(HIV1/2)抗体诊断试剂盒进行初筛;或者用雅培层析快速法试剂条进行初筛[1];以蛋白印迹法进行确认。结果中国籍人员检出率为0.64%,外国籍人员检出率为2.16%,感染者以20～39岁青壮年为主;感染途径以不洁性行为为主。结论临沧口岸HIV传入的危险性较大,出入境检验检疫机构应积极进行HIV的监测和防治工作。     

社区老年人健康状况及卫生行为调查

目的掌握辖区老年人群慢性病患病状况及行为危险因素,为制定老年人群健康管理措施提供科学依据。方法分阶段随机抽样,抽取1000名辖区老年人,采用入户调查与体检相结合的方式。结果辖区老年人群慢性病患病率为68.2%,女性高于男性,差异有统计学意义（χ2=27.381,P〈0.005）;女性慢性病患病率随着年龄的增长,呈上升趋势,差异有统计学意义（χ2=32.247,P〈0.005）;所调查慢性病前5位依次是：高血压、高血脂、糖尿病、冠心病、脑血管病,除高血脂患病率女性高于男性、冠心病患病率男性高于女性外其他没有性别差异;肥胖超重占33.9%,普遍缺乏锻炼。结论慢性病是辖区老年人的主要健康问题,危险因素主要是缺乏锻炼、肥胖超重。解决老年人的健康问题是社区卫生服务的工作重点。加强锻炼和合理饮食、倡导健康的生活方式是健康教育和健康促进的主要内容。