1990年和2016年北京市心脑血管疾病负担及其变化

目的调查1990年和2016年北京市心脑血管疾病负担及其变化情况。方法利用2016年全球疾病负担研究数据,分析1990年和2016年北京市心脑血管疾病死亡情况和疾病负担。主要指标包括死亡人数、过早死亡损失寿命年(YLL)、伤残损失寿命年(YLD)和伤残调整寿命年(DALY),同时使用2000—2025年世界人口的平均人口作为标准人口,计算标化死亡率、DALY率、YLL率和YLD率。结果2016年,北京市居民心脑血管病标化死亡率为209.24/10万;心脑血管病DALY、YLL和YLD分别为87.56、73.36和14.20万人年,较1990年分别增加了58.05%、44.24%和213.47%;标化DALY率和标化YLL率分别为3552.24/10万和2988.01/10万,较1990年分别下降47.90%和52.43%,标化YLD率为564.23/10万,较1990年增加5.10%。2016年,脑血管疾病和缺血性心脏病的死亡数分别为1.76万例和2.37万例;DALY分别为39.63和39.36万人年,较1990年(DALY分别为33.02和16.27万人年)分别增加20.02%和141.92%。结论北京市心脑血管疾病负担重,其中以脑血管疾病和缺血性心脏病最为显著;脑血管疾病的伤残负担严重,缺血性心脏病的疾病负担成倍增长。     

Caring for women undergoing second-trimester medical termination of pregnancy

Objective

The objective was to explore the experiences and perceptions of nurses/midwives caring for women undergoing second-trimester medical termination of pregnancy (MTOP).

Study design

The study had a qualitative design using semistructured interviews. It took place in three wards at one gynecological clinic in a general hospital in Stockholm. Twenty-one nurses/midwives with experience in second-trimester abortion care were interviewed following a semistructured interview guide. The interviews were recorded, transcribed verbatim and then analyzed using qualitative content analysis to identify common themes.

Results

The analysis revealed two themes: “The professional self,” with six subthemes describing the experiences and perceptions described in terms of professional behavior, and “The personal self,” with four subthemes containing the experiences and perceptions described in terms of personal values.

Conclusions

Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge, empathy and the ability to reflect on ethical attitudes and considerations. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. The feeling of supporting women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second-trimester MTOP. The findings of this study support the need for training, mentoring and support by experienced colleagues to help nurses/midwives feel secure in their professional role in difficult situations and feel confident in their personal life situation.

Implications statement

Taking care of women undergoing second-trimester MTOP is a task that requires professional knowledge and empathy. Difficult situations that arise during the process are easier to handle with increased knowledge and experience. Mentorship from experienced colleagues and structured opportunities for reflection on ethical issues enable the nurses/midwives to develop security in their professional roles and also feel confident in their personal life situation. The feeling of doing something good for women's rights bridges the difficulties nurses/midwives face in caring for women undergoing second-trimester MTOP.     

Does α-synuclein have a dual and opposing effect in preclinical vs. clinical Parkinson's disease?

α-Synuclein gene (SNCA) multiplications cause familial parkinsonism and allele-length polymorphisms within the SNCA dinucleotide repeat REP1 increase the risk for developing Parkinson's disease (PD). Since SNCA multiplications increase SNCA expression, and REP1 genotypes that increase the risk of developing PD show increased SNCA expression in cell-culture systems, animal models, and human blood and brain, PD therapies seek to reduce SNCA expression. We conducted an observational study of 1098 PD cases to test the hypothesis that REP1 genotypes correlated with reduced SNCA expression are associated with better motor and cognitive outcomes. We evaluated the association of REP1 genotypes with survival free of Hoehn and Yahr stages 4 or 5 (motor outcome) and of Modified Telephone Interview for Cognitive Status score ≤27 or Alzheimer's Disease Dementia Screening Interview score ≥2 (cognitive outcome). Median disease duration at baseline was 3.3 years and median lag time from baseline to follow-up was 7.8 years. Paradoxically, REP1 genotypes associated with increased risk of developing PD and increased SNCA expression were associated with better motor (HR = 0.87, p = 0.046, covariate-adjusted age-scale analysis; HR = 0.85, p = 0.020, covariate-adjusted time-scale analysis) and cognitive outcomes (HR = 0.90, p = 0.12, covariate-adjusted age-scale analysis; HR = 0.85, p = 0.023, covariate-adjusted time-scale analysis). Our findings raise the possibility that SNCA has a dual, opposing, and time-dependent role. This may have implications for the development of therapies that target SNCA expression.     

The burden of caesarean section refusal in a developing country setting

Objective  To investigate the prevalence, aetiology and outcomes of caesarean section refusal in pregnant women.
Design  A prospective controlled study.
Setting  University of Nigeria Teaching Hospital and Aghaeze Hospital, Enugu, Nigeria.
Population  A total of 62 Nigerian women who declined elective caesarean section.
Method  Interviewer-administered questionnaires at the time of caesarean section refusal and postdelivery. The delivery outcomes of the subjects were compared with that of a matched control group of women who accepted caesarean section.
Main outcome measures  Prevalence, maternal reasons for caesarean section refusal and the resultant maternal and perinatal mortality.
Results  The prevalence of caesarean section refusal was 11.6% of all caesarean deliveries. Maternal reasons for refusing caesarean section include fear of death, economic reasons, desire to experience vaginal delivery and inadequate counselling. Outcomes were significantly worse among women who refused elective caesarean section than in the controls with a maternal mortality of 15% (versus 2%, P = 0.008) and a perinatal mortality of 34% (versus 5%, P < 0.001).
Conclusion  There is a high prevalence of caesarean section refusal in south-eastern Nigeria. Women declining caesareans have very poor maternal and perinatal outcomes and need extra support.     

160例恶性肿瘤患者疼痛负担及其影响因素研究

目的：探索中医药治疗恶性肿瘤患者的疼痛负担及其影响因素。方法：选取2019年9月至2021年12月中国中医科学院广安门医院等10家中医药三甲医院初次就诊的恶性肿瘤患者临床数据,运用简明疼痛调查量表(BPI)进行疼痛评估,采用多因素回归分析方法探讨疼痛负担的影响因素。结果：160例近期未进行抗肿瘤治疗的恶性肿瘤患者中,62.5%为男性患者,65岁以上的患者为55.6%,75.6%临床分期为Ⅳ期,80.6%患者正在使用阿片类药物;癌症患者在过去24 h疼痛平均程度为4分,疼痛最剧烈程度为6分;在疼痛对功能的干扰方面,总体干扰平均得分为4.94分,活动干扰及情感干扰得分分别为5.11分、4.69分;多因素分析中,正在服用阿片类药物的患者具有更高的疼痛最剧烈程度(β=0.239,95%CI为0.267～1.285,P=0.003)。结论：寻求中医药治疗的恶性肿瘤患者疼痛负担总体处于轻至中度水平,疼痛对患者总体功能、活动、情感干扰产生中度影响;正在服用阿片类药物的患者出现爆发痛时疼痛程度更高。     

Lessons Learned: Recruiting Research Participants from an Underrepresented Patient Population at a Safety Net Hospital

BackgroundRecruiting participants to clinical research studies is challenging, especially when conducted in safety net settings. We sought to compare the efficacy of different recruitment strategies in an NIH-funded study assessing treatment burden in patients with multiple chronic conditions (MCCs).MethodsTargeted mailing, in-person table-based recruitment (“tabling”) in the waiting room, and telephone calling were used to enroll subjects into one of two studies of treatment burden: a survey study to validate a brief measure of treatment burden for quality assessment (study 1) or a qualitative study to develop a treatment burden clinical communication tool (study 2).ResultsOver 50% of subjects in each study were African American or African immigrants. In study 1, the enrollment goal of 200 was reached within 4 months. Tabling enrolled 78.5% of patients, while the remainder (21.5%) were enrolled from phone calls to eligible patients identified through the electronic medical record (EMR). In study 2, 340 eligible patients were identified through the EMR, and 7 (2.1%) were successfully enrolled via mailed invitations and responses. Retention rates (66% in study 1 and 71% in study 2) were reasonable in all groups.ConclusionsStudy recruiting goals in our safety net population were rapidly reached using the tabling method, which had substantively higher enrollment rates than mailings or telephone calls based on EMR reports. Future trials could compare recruitment strategies across settings and clinical populations.     

Association Between Clinical Burden and Blood Eosinophil Counts in Asthma: Findings From a Korean Adult Asthma Cohort

BackgroundSome reports have suggested that the clinical and economic burdens of asthma are associated with blood eosinophil levels. The association between clinical burden and blood eosinophil counts were evaluated in a Korean adult asthma cohort.MethodsClinical information including blood eosinophil counts that were not affected by systemic corticosteroids were extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea database. Clinical burden was defined as 1) asthma control status, 2) medication demand and 3) acute exacerbation (AE) events during 1 consecutive year after enrollment. All patients were divided into atopic and non-atopic asthmatics. The associations between asthma outcomes and the blood eosinophil count were evaluated.ResultsIn total, 302 patients (124 atopic and 178 non-atopic asthmatics) were enrolled. In all asthmatics, the risk of severe AE was higher in patients with blood eosinophil levels < 100 cells/µL than in patients with levels ≥ 100 cells/µL (odds ratio [OR], 5.406; 95% confidence interval [CI], 1.266–23.078; adjusted P = 0.023). Among atopic asthmatics, the risk of moderate AE was higher in patients with blood eosinophil levels ≥ 300 cells/µL than in patients with levels < 300 cells/µL (OR, 3.558; 95% CI, 1.083–11.686; adjusted P = 0.036). Among non-atopic asthmatics, the risk of medication of Global Initiative for Asthma (GINA) steps 4 or 5 was higher in patients with high blood eosinophil levels than in patients with low blood eosinophil levels at cutoffs of 100, 200, 300, 400, and 500 cells/µL.ConclusionThe baseline blood eosinophil count may predict the future clinical burden of asthma.