艾滋病患者抗病毒治疗依从性相关情况分析

目的 探讨艾滋病患者抗病毒治疗依从性相关情况。方法 选取我院2018年6月—2020年6月诊治的118例艾滋病患者作为研究对象。根据患者对治疗的依从性分为依从性好组（n=65）及依从性差组（n=53）。对患者的服药情况、抗病毒治疗依从性单因素及多因素相关情况进行分析。结果 118例患者中有53例患者出现药物漏服现象,主要漏服原因为患者用药后出现不良反应,占比43.40%,另外还有忘记服药、害怕他人知道自己患有艾滋病、在外服药不及时及其他原因。家人支持、工作、服药知识、饮酒、文化水平、年龄各单因素与患者治疗依从性密切相关（P <0.05）。工作、服药知识是患者治疗依从性的重要独立影响因素（P <0.05）。结论 家人支持、工作、服药知识及饮酒是影响艾滋病患者抗病毒治疗依从性的主要影响因素,应根据患者的实际情况给予相应的治疗措施,提高患者治疗依从性。     

Opposition to voluntary and mandated COVID-19 vaccination as a dynamic process: Evidence and policy implications of changing beliefs

COVID-19 vaccination rates slowed in many countries during the second half of 2021, along with the emergence of vocal opposition, particularly to mandated vaccinations. Who are those resisting vaccination? Under what conditions do they change their minds? Our three-wave representative panel survey from Germany allows us to estimate the dynamics of vaccine opposition, providing the following answers. Without mandates, it may be difficult to reach and to sustain the near-universal level of repeated vaccinations apparently required to contain the Delta, Omicron, and likely subsequent variants. But mandates substantially increase opposition to vaccination. We find that few were opposed to voluntary vaccination in all three waves of the survey. They are just 3.3% of our panel, a number that we demonstrate is unlikely to be the result of response error. In contrast, the fraction consistently opposed to enforced vaccinations is 16.5%. Under both policies, those consistently opposed and those switching from opposition to supporting vaccination are sociodemographically virtually indistinguishable from other Germans. Thus, the mechanisms accounting for the dynamics of vaccine attitudes may apply generally across societal groups. What differentiates them from others are their beliefs about vaccination effectiveness, their trust in public institutions, and whether they perceive enforced vaccination as a restriction on their freedom. We find that changing these beliefs is both possible and necessary to increase vaccine willingness, even in the case of mandates. An inference is that well-designed policies of persuasion and enforcement will be complementary, not alternatives.

The challenge of the first half-year of most COVID-19 vaccination campaigns was the supply of vaccines, not demand for them. It then appeared that, once vaccines were widely available, vaccination rates would approach the two-thirds level initially thought to be sufficient to control the pandemic. But the Delta and then Omicron variants along with substantial and persistent reported opposition to vaccination have raised doubts about whether vaccine willingness will be sufficient. In response, by the end of 2021, vaccination mandates were being widely adopted by governments, businesses, and educational institutions, and universal mandates were being considered and implemented (1–8).The appropriate strategies for raising vaccination rates depend on the target rate, on how many are unlikely to be vaccinated willingly in a sufficiently timely manner, on the conditions under which opponents change their minds, and on the effect of the policies themselves on vaccination preferences. Our study sheds light on the behavioral side of this evaluation.     

延伸护理服务对提高脑卒中恢复期功能锻炼依从性的效果

目的:观察延伸护理服务对提高脑卒中恢复期患者功能锻炼依从性的效果。方法:将符合诊断标准的70例患者随机分为观察组和对照组各35例。对照组患者出院后常规电话随访1次;观察组患者出院后每周1次电话随访,每月2次上门健康教育,共随访8周。分别于出院后1周与8周后采用Fugl-Meyer运动功能评分量表及日常生活活动能力Barthel指数量表对患者进行评定。结果:出院8周后观察组患者的Fugl-Meyer运动功能评分及日常生活活动能力Barthel指数评分升高幅度均高于对照组(P<0.01)。结论:延伸护理服务能够提高脑卒中恢复期患者功能锻炼的依从性,使患肢得到最大限度地恢复。     

Expression of parathyroid hormone/parathyroid hormone-related peptide receptor 1 in normal and diseased bladder detrusor muscles: a clinico-pathological study

Background

To investigate the expression of parathyroid hormone (PTH)/PTH-related peptide (PTHrP) receptor 1 (PTH1R) in clinical specimens of normal and diseased bladders. PTHrP is a unique stretch-induced endogenous detrusor relaxant that functions via PTH1R. We hypothesized that suppression of this axis could be involved in the pathogenesis of bladder disease.

Methods

PTH1R expression in clinical samples was examined by immunohistochemistry. Normal kidney tissue from a patient with renal cancer and bladder specimens from patients undergoing ureteral reimplantation for vesicoureteral reflux or partial cystectomy for urachal cyst were examined as normal control organs. These were compared with 13 diseased bladder specimens from patients undergoing bladder augmentation. The augmentation patients ranged from 8 to 31 years old (median 15 years), including 9 males and 4 females. Seven patients had spinal disorders, 3 had posterior urethral valves and 3 non-neurogenic neurogenic bladders (Hinman syndrome).

Results

Renal tubules, detrusor muscle and blood vessels in normal control bladders stained positive for PTH1R. According to preoperative urodynamic studies of augmentation patients, the median percent bladder capacity compared with the age-standard was 43.6% (range 1.5–86.6%), median intravesical pressure at maximal capacity was 30 cmH₂O (range 10–107 cmH₂O), and median compliance was 3.93 ml/cmH₂O (range 0.05–30.3 ml/cmH₂O). Detrusor overactivity was observed in five cases (38.5%). All augmented bladders showed negative stainings in PTH1R expression in the detrusor tissue, but positive staining of blood vessels in majority of the cases.

Conclusions

Downregulation of PTH1R may be involved in the pathogenesis of human end-stage bladder disease requiring augmentation.     

基于行为转变理论的饮食教育对血液透析患者的作用

目的探讨基于行为转变理论的饮食教育对维持性血液透析患者的作用。方法将96例维持性血液透析患者随机分为观察组和对照组各48例。对照组给予门诊血液透析常规的饮食相关健康教育,观察组成立行为转变理论模式健康教育团队,实施以行为改变理论模式为指导的饮食健康教育。结果干预6个月后,观察组饮食依从性得分显著高于对照组(P0.05),血钾、血磷水平显著低于对照组(均P0.05)。结论基于行为转变理论的饮食教育可提高维持性血液透析患者饮食依从性,从而控制血钾、血磷,达到饮食管理的目的。     

Does Spatial Accessibility of Pharmacy Services Predict Compliance with Long-Term Control Medications?

Background: Disadvantaged urban children with asthma are at high risk for undermanagement of their disease and poor compliance with inhaled corticosteroids (ICS). Objective: To determine whether spatial accessibility (SA) of retail pharmacy services is associated with ICS compliance. Methods: Caregivers of 137 urban high-morbidity asthmatic children attended a comprehensive intervention to improve asthma care and outcomes. Subsequent ICS compliance was determined at 1, 3, and 6 months. We modeled 18 measures of SA to 339 pharmacies using logistic regression and adjusting for numerous covariates. Results: No relationships between SA and compliance were found. Conclusions: In this group of disadvantaged urban children with severe asthma, compliance with ICS was not significantly associated with SA of retail pharmacy services.     

Providing Feedback on Adherence Increases Use of Preventive Medication by Asthmatic Children

This study investigates the impact of measuring adherence and providing feedback on medication usage by children with unstable asthma. Adherence was measured using an electronic monitoring device. Subjects were randomized to either being told of their adherence during review consultations or for their adherence to remain undisclosed to their parents and treating physician. Subjects were reviewed monthly for 4 months. Twenty-six children aged between 6 and 14 years were recruited. Adherence was significantly higher in the intervention group (79% versus 58%, p <.01). There were significant improvements in clinical measures of disease control compared with baseline in both groups. The change in forced expiratory volume in 1 s (FEV₁) (% predicted) was greater in those subjects receiving feedback (13.8% versus 9.8%). However, lung function values were lower in the intervention group at baseline and the relative improvement failed to reach statistical significance. Measuring adherence and providing feedback increases the use of preventive medication. A larger study is required to explore implications for disease control.