广东省与河南省HIV感染者调查结果的比较分析

目的　比较分析广东省与河南省两地HIV感染者的感染特点。方法　采用调查表对广东省 81例和河南省 130例HIV感染者进行问卷调查并分析。结果　两地患者在性别、年龄、文化程度、婚姻状况、传播途径分布等方面均存在明显差异。(1)广东省男女感染比率约为 2. 1: 1,男性明显多于女性;河南省男女感染比率约为 0. 9: 1。(2)广东地区感染者中 69%年龄分布在 21-40岁间;河南地区 76%的感染者年龄分布在 31-50岁间。(3)广东省感染者总体文化程度较河南地区高。(4)广东省感染者中近一半(43. 2% )未婚或不在婚,河南省 91. 5%感染者已婚。 ( 5 )在广东以性传播 ( 54. 3% )、静脉吸毒 ( 23.4% )为主,同时存在血液传播。在河南血液传播是最主要的传播途径,性传播途径仅见于夫妻间性传播。(6)广东省感染者CD+4 计数相对较低, 57. 2%低于 200个,病情较重;河南省 70. 6%的感染者CD4+计数高于 200个,病情相对较轻。结论　经过分析,发现两地社会、经济因素对两地HIV感染特点有一定影响。根据感染特点实施干预措施,对进一步预防疾病传播及提高HIV感染者的生存质量有重要意义。     

国家儿童医学中心青年儿科医师培养机制研究

目的 探讨对国家儿童医学中心(以下简称为本中心)青年儿科医师培养机制研究现状.方法 选择2020年本中心430位在职青年儿科医师(年龄≤45岁)为调查对象.采用本研究自行设计的《国家儿童医学中心青年儿科医师培养机制调查问卷》,主要包括①纳入调查对象基本情况;②本中心为纳入调查对象提供科研条件情况;③本中心对纳入调查对象...     

Clinical Characteristics and Risk Factors for Mortality in Critical Coronavirus Disease 2019 Patients 50 Years of Age or Younger During the Delta Wave: Comparison With Patients > 50 Years in Korea

BackgroundNumerous patients around the globe are dying from coronavirus disease 2019 (COVID-19). While age is a known risk factor, risk analysis in the young generation is lacking. The present study aimed to evaluate the clinical features and mortality risk factors in younger patients (≤ 50 years) with a critical case of COVID-19 in comparison with those among older patients (> 50 years) in Korea.MethodsWe analyzed the data of adult patients only in critical condition (requiring high flow nasal cannula oxygen therapy or higher respiratory support) hospitalized with PCR-confirmed COVID-19 at 11 hospitals in Korea from July 1, 2021 to November 30, 2021 when the delta variant was a dominant strain. Patients’ electronic medical records were reviewed to identify clinical characteristics.ResultsDuring the study period, 448 patients were enrolled. One hundred and forty-two were aged 50 years or younger (the younger group), while 306 were above 50 years of age (the older group). The most common pre-existing conditions in the younger group were diabetes mellitus and hypertension, and 69.7% of the patients had a body mass index (BMI) > 25 kg/m². Of 142 younger patients, 31 of 142 patients (21.8%, 19 women) did not have these pre-existing conditions. The overall case fatality rate among severity cases was 21.0%, and it differed according to age: 5.6% (n = 8/142) in the younger group, 28.1% in the older group, and 38% in the ≥ 65 years group. Age (odds ratio [OR], 7.902; 95% confidence interval [CI], 2.754–18.181), mechanical ventilation therapy (OR, 17.233; 95% CI, 8.439–35.192), highest creatinine > 1.5 mg/dL (OR, 17.631; 95% CI, 8.321–37.357), and combined blood stream infection (OR, 7.092; 95% CI, 1.061–18.181) were identified as independent predictors of mortality in total patients. Similar patterns were observed in age-specific analyses, but most results were statistically insignificant in multivariate analysis due to the low number of deaths in the younger group. The full vaccination rate was very low among study population (13.6%), and only three patients were fully vaccinated, with none of the patients who died having been fully vaccinated in the younger group. Seven of eight patients who died had a pre-existing condition or were obese (BMI > 25 kg/m²), and the one remaining patient died from a secondary infection.ConclusionAbout 22% of the patients in the young critical group did not have an underlying disease or obesity, but the rate of obesity (BMI > 25 kg/m²) was high, with a fatality rate of 5.6%. The full vaccination rate was extremely low compared to the general population of the same age group, showing that non-vaccination has a grave impact on the progression of COVID-19 to a critical condition. The findings of this study highlight the need for measures to prevent critical progression of COVID-19, such as vaccinations and targeting young adults especially having risk factors.     

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.     

Reimagining care for young adults living with type 1 diabetes

Young adults living with type 1 diabetes often struggle to achieve what clinicians consider to be optimal levels of metabolic control. Despite the impact that this can have on a young person''s future risk of complications, there are relatively few studies reporting new ways of organizing or delivering care to this cohort. In this article, we explore some of the reasons why young adult diabetes care is challenging, and describe approaches to “re‐imagining” how care might be improved. The work is informed by the ‘Making Care Fit’ collaborative and by a program of research, entitled D1 Now, involving co‐design of a complex person‐centered intervention with young adults.     

中青年人初治耐多药肺结核的胸部CT征象分析

目的 分析中青年人初治耐多药肺结核患者的CT表现,探讨其影像学特点.方法 回顾性分析2013年1月至2014年12月本院经药敏试验证实的28例中青年人耐多药(观察组)及同期84例中青年人非耐药(对照组)肺结核患者的CT影像资料;运用统计学方法检验两组间影像表现差异.结果 两组间具有统计学意义的CT表现:(1)观察组少于对照组:病灶内钙化(x2 =5.60,P＜0.025);(2)观察组多于对照组:肺毁损(x2=11.03,P＜0.005)、胸膜钙化(x2=16.85,P＜0.005)、脓气胸(x2=14.54,P＜0.005)、支气管扩张(x2 =8.82,P＜0.01).两组间无统计学意义的CT表现(P＞0.05):斑片灶(x2=0.39)、结节灶(x2=0.9)、斑条灶(x2=2.68)、播散灶(x2=0.63)、空洞分布(x2=0.018)、多发空洞(x2=0.59)、空洞内液平(x2=0.11)、胸腔积液(x2=1.96)、纵隔肺门淋巴结肿大(x2=2.09)、纵隔肺门淋巴结钙化(x2 =0.72).结论 两组患者病灶内钙化的差异具有统计学意义(P＜0.025);在肺毁损、胸膜钙化、脓气胸、支气管扩张的征象上差异具有显著统计学意义(P＜0.01).在CT诊断肺结核时,除斑片、结节、斑条、播散灶及多发空洞、胸腔积液等结核征象外,如存在肺毁损、胸膜钙化、脓气胸、支气管扩张等征象,要高度怀疑为耐多药肺结核.     

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。     

中青年腰椎间盘突出症家庭康复护理

目的探讨中青年腰椎间盘突出症康复护理的方法及效果。方法急性期绝对卧硬板床做牵引治疗（以骨盆牵引法为主）;慢性期注意劳逸结合及腰部活动幅度,红外线照射以活血消肿;康复期注意腰肌、背阔肌功能锻炼。结果42例病人中急性期绝对卧硬板床结合牵引治疗〉60d者10例,随访6个月治愈率达100％,绝对卧床41-60d有7例,治愈6例（86％）;绝对卧床21～40d有14例,治愈10例（71％）;绝对卧床〈20d有11例,治愈5例（45％）,6例暂时症状消失或疼痛减轻,复发经久不能根治。结论中青年腰椎间盘突出经绝对卧硬板床结合牵引治疗足够的时间,治疗效果较好。     

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。     

年轻急性心梗患者临床特点

目的探讨年轻急性心肌梗死患者的心血管危险因素、临床特点和冠状动脉病变的特点。方法对确诊的43例年轻急性心梗患者和55例老年患者间的主要危险因素、临床特点、冠脉病变特点进行对比统计分析。结果 （1）年轻组患者以男性为主;多超重;吸烟史明显多于老年组;糖尿病、高血压病病史明显低。（2）年轻组高TG、CHOL血症发生率高,并且血TG、CHOL水平明显高于老年组。（3）年轻组以单支病变为主,老年组以多支病变为主。（4）年轻组多无心绞痛病史;老年组多有反复发作的心绞痛病史。结论 （1）吸烟和超重是年轻急性心梗的主要危险因素。（2）高脂血症也是重要危险因素。（3）病变相对简单以单支血管最多,三支病变较少。（4）年轻组多无心绞痛病史。