Identifying emerging reproductive vulnerability: an approach to decompose differences in total fertility

PurposeWe introduce a method to partition the difference in total fertility between two groups.MethodsWe computed the total fertility rate for Francophones and Anglophones of Quebec, Canada, between 1989–1993 and 2004–2008. We partitioned the difference in excess fertility for one group relative to the other into the number of children contributed by maternal age, origin, material deprivation, education, and offspring birth order. We calculated the change in total fertility over time and the factors that contributed.ResultsThe total fertility rate was higher by 0.18 children for Francophones in 1989–1993, but the gap reversed in 2004–2008, with total fertility higher for Anglophones by 0.12 children. Francophones had higher fertility in 1989–1993 due mainly to women who were Canadian born, aged 15–29 years, without secondary diploma, or living in socioeconomic deprivation. The reversal in 2004–2008 was caused by a reduction in fertility for Francophones aged 15–29 years and an increase in the contribution of Anglophones who were foreign born, aged 30–49 years or socioeconomically disadvantaged.ConclusionsThrough decomposition of differences in total fertility, we identified populations with emerging reproductive vulnerability in a large Canadian province. Socioeconomically disadvantaged Anglophones in Quebec have increasing fertility, a potential sign of increasing reproductive risk.     

Impact of personally measured pollutants on cardiac function

Epidemiological studies have shown associations between ambient air pollution and changes in heart rate variability (HRV). However, studies using personal air pollution measurements, especially with exposure averages <24 h, are still rare.Between February and March 2008 HRV data as well as personal exposure to particulate matter <2.5 μm (PM_2.5), and particle number concentrations (PNC) were collected in five volunteers for up to 8.3 h on a 5 min resolution. Information about the participant's whereabouts was also collected. Mixed models were used to analyze concurrent and up to 30 min delayed effects of air pollutants as well as being in traffic on 5 min-averages of heart rate (HR), high and low frequency power (HF and LF), standard deviation of all normal-to-normal intervals (SDNN), and the root mean square of successive interval differences (RMSSD). Results are presented as %-change from the mean per increase in interquartile range of air pollutant.In total, 474 5-min segments were available for analysis. We observed concurrent and delayed reductions in SDNN of about 0.8–1.0% in association with a 5.4 μg/m³ increase in PM_2.5. However, being in traffic by car led to an increase of about 20% 10–14 min and 15–19 min later. An increase in PM_2.5 or PNC was associated with lagged decreases for RMSSD and HF. We detected concurrent reductions in RMSSD (−17.6% [95%-confidence interval: 29.1; −4.3]) when being in traffic by bike/foot. Being in traffic by car was associated with an immediate reduction in LF while more delayed increases in LF were observed when being in traffic by bike/foot. Air pollution and traffic effects on HR were less consistent.These rapid changes in HRV within 30 min might be mediated by the autonomic nervous system in response to direct reflexes from receptors in the lungs.     

醋酸戈舍瑞林缓释植入剂联合腹腔镜手术治疗子宫内膜异位症效果

目的:探讨醋酸戈舍瑞林缓释植入剂联合腹腔镜手术治疗子宫内膜异位症的临床疗效。方法:选择本院就诊的子宫内膜异位症患者80例,随机分为两组各40例,根据r-AFS分期进行腹腔镜手术,在术后1周内观察组醋酸戈舍瑞林缓释植入剂3.6mg皮下注射,每4周1次,连用6个月;对照组口服孕三烯酮2.5mg,每周2次,连用6个月。比较两组临床疗效,术前和术后6个月测定血清血管内皮生长因子(VEGF)、基质金属蛋白酶-9/组织金属蛋白酶抑制物-1(MMP-9/TIMP-1),评定患者视觉模拟评分法(VAS)和健康生活质量调查问卷(SF-36),随访3年术后不良反应和复发情况。结果:治疗有效率对照组(75.0%)低于观察组(92.5%)(P<0.05)。术后6个月时,对照组和观察组血清VEGF(158.41±56.28 ng/L、119.63±47.13ng/L),MMP-9/TIMP-1(1.35±0.25、1.14±0.23),生理健康评分(64.20±12.81分、78.53±13.23分),心理健康评分(69.14±13.26分、80.35±14.59分),VAS评分(1.21±0.46分、0.84±0.39分)比较均有差异(P<0.05);观察组无不良反应发生,术后3年复发率对照组(27.5%)高于观察组(10.0%)(P<0.05)。结论:醋酸戈舍瑞林缓释植入剂联合腹腔镜手术治疗子宫内膜异位症疗效确切,可降低术后血管侵袭指标及复发率,提高生活质量,安全性高。     

Reducing questionnaire length did not improve physician response rate: a randomized trial

ObjectivesTo examine the effect of reducing questionnaire length on the response rate in a physician survey.Study Design and SettingA postal four double-page questionnaire on end-of-life decision making was sent to a random sample of 1,100 general practitioners, 400 elderly care physicians, and 500 medical specialists. Another random sample of 500 medical specialists received a shorter questionnaire of two double pages. After 3 months and one reminder, all nonresponding physicians received an even shorter questionnaire of one double page.ResultsTotal response was 64% (1,456 of 2,269 eligible respondents). Response rate of medical specialists for the four double-page questionnaire was equal to that of the two double-page questionnaire (190 and 191 questionnaires were returned, respectively). The total response rate increased from 53% to 64% after sending a short one double-page questionnaire (1,203–1,456 respondents).ConclusionThe results of our study suggest that reducing the length of a long questionnaire in a physician survey does not necessarily improve response rate. To improve response rate and gather more information, researchers could decide to send a drastically shortened version of the questionnaire to nonresponders.     

结构变动度在住院费用构成变动中的应用

目的 探讨降低医疗费用的对策.方法 运用结构变动度和环比增长速度指标,分析2008年-2013年费用构成变动的情况.结果 费用构成变动比较合理,其他费和检查费是引起费用结构变动上升的主要费用项目,二者累积贡献率高达42.44％,护理费结构变动增幅较慢,仅为4.10％,说明在体现医生技术服务价值的同时,也应适当提高护理人员的技术服务价值,药品费、诊疗费、手术费是引起住院费用结构变动下降的主要费用项目,三者累积贡献率高达45.92％,说明了我院优化了收费结构,强化了管理意识.结论 优化医疗收入结构,有重点的控制主要因素,以较低的成本及合理收费,最大限度的满足患者医疗需求,实现医疗费用的理性回归.     

Low Testosterone and Hyperkinetic Blood Pressure Responses in a Cohort of South African Men: The SABPA Study

Hypertension (HT) and the metabolic syndrome are major problems in Africa. The role of sex hormones in the cardiovascular profile of black Africans in South Africa has not been studied. Our objective was to study the association between the sex hormones and ambulatory blood pressure and the heart rate (HR) in black and white South Africans. The 24-hour ambulatory blood pressure measurements were performed and the blood samples were taken between 07:00 and 09:00 hours. A total of 80 black and 98 white South African teachers between 25 and 65 years of age from similar socioeconomic backgrounds from the Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study were included. As a result, a more vulnerable cardiovascular profile was observed in Africans compared with Caucasians. In the African group, low testosterone (T) explained 19%–36% of the variance in systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR, whereas in the Caucasian group non-sex-hormone-binding globulin (non-SHBG)-bound T explained 27% of the variance in HR. In the African males, inverse associations between blood pressure and T (SBP: P = .08; DBP: P = .02) and non-SHBG-bound T (SBP: P < .001; DBP: P < .01) and HR (P < 0.01) were observed. Ambulatory HR predicted a prediabetic state in Africans. In conclusion, low T levels may predispose or result in impaired cardiovascular function in African men. The possibility exists that a prediabetic state, vagal-impaired HR, and hyperkinetic blood pressure responses may predispose or result in low T levels in African men.     

Echocardiographic Evidence for Increased Cardiac Performance During Early Renal Hypertension in Dogs

Cardiac function early (less than 4 weeks) in the course of experimental renal hypertension was investigated. In 11 male mongrel dogs, one kidney was wrapped in silk to produce two-kidney, one-wrapped hypertension. Two weeks later, the contralateral kidney was removed. Five sham-wrapped and then contralaterally-nephrectomized dogs served as controls. M-mode left ventricular (LV) echocardiograms were recorded twice weekly in all dogs for 4 weeks before and for 2 weeks after wrapping (or sham-wrapping) and for 4 weeks after nephrectomy. In the 11 hypertensive dogs, mean arterial pressure (MAP) rose from 127 mm Hg (mean) to 143 two weeks after wrapping (p<0.05) and to 185 two weeks after nephrectomy (p<0.001). The fractional shortening of the left ventricle (%D) of hypertensive dogs was increased (9% maximum, mean, p<0.01) for 2 weeks after wrapping and for one week after nephrectomy. Two weeks after wrapping, LV end-systolic wall stress calculated from femoral artery peak systolic pressure, end-systolic dimension and wall thickness was unchanged, suggesting that increased myocardial contractility accounted for the findings. In normotensive control dogs, there were no echocardiographic changes during the study.     

Chronobiologically Explored Effects of Telmisartan

Effects of Micardis (Telmisartan), alone or with low-dose aspirin, on blood pressure and other cardiovascular endpoints are examined in 20 patients with MESOR-hypertension in a crossover, double-blind, randomized study consisting of three stages, each lasting 7 days: I-placebo, II-Micardis, and III-Micardis with low-dose aspirin. Treatment was administered each day at a different circadian stage, upon awakening, and 3, 6, 9, 12, 15 and 18 hr after awakening. During each stage, the following variables were measured at 3-hr intervals during waking: systolic and diastolic blood pressure, heart rate, ejection fraction, intrarenal resistive index, acceleration time, and serum creatinine. Each data series was analyzed by single cosinor. Results were summarized by population-mean least squares spectra. At matched treatment times, the MESOR and circadian amplitude of each variable were compared among the three treatments by paired t-tests. A prominent circadian rhythm characterizes all variables. Micardis was associated not only with a lowering of blood pressure, but also with a reduction of the circadian blood pressure amplitude. The ejection fraction was increased, and the resistive index and acceleration time were decreased, the effect being more pronounced when low-dose aspirin was added to Micardis. Any circadian-stage dependent effect of Micardis, with or without low-dose aspirin, will require monitoring over spans longer than a single day for a given treatment administration time.     

Is anterior decompression and fusion superior to laminoplasty for cervical myelopathy due to ossification of posterior longitudinal ligament? A systematic review and meta-analysis

Context: Considerable controversy exists over surgical procedures for ossification of the posterior longitudinal ligament (OPLL).Objective: The purpose of the meta-analysis was to compare the clinical outcome of anterior decompression and fusion (ADF) with laminoplasty (LAMP) in treatment of cervical myelopathy due to OPLL.Methods: PubMed, EMBASE and the Cochrane Register of Controlled Trials database were searched to identify potential clinical studies compared ADF with LAMP for cervical myelopathy owing to OPLL. We also manually searched the reference lists of articles and reviews for possible relevant studies. Thirteen studies with 1120 patients were included in our analysis. Subgroup analyses were performed by the canal occupying ratio of OPLL.Results: Overall, the mean preoperative Japanese Orthopaedic Association (JOA) score was similar between two groups. Compared with LAMP group, ADF group was higher at the mean postoperative JOA scores and mean recovery rate, reoperation rate, and longer at mean operation time. There was not significantly different in mean blood loss and complication rate between two groups. In subgroup analysis, ADF had a higher mean postoperative JOA score and recovery rate than LAMP in cases of OPLL with occupying ratios ≥ 50%, while those difference were not found in cases of OPLL with occupying ratios < 50%.Conclusion: ADF achieves better neurological improvement compared with LAMP in treatment of cervical myelopathy due to OPLL, especially in cases of OPLL with occupying ratios ≥ 50%. Complication rate is similar between two groups, but ADF can increase the risk of reoperation