Integration or specialization? Similarities and differences between Sweden and the United States in gerontology education and training

ABSTRACT

This article examines the similarities and differences in the education and training of gerontologists and others who work with older people in Sweden and the United States. It outlines the aging trends in both countries and assesses the level of training for those who provide care in a variety of fields. Both countries are aging, but the programs for gerontological training are quite different in the two countries, reflecting underlying cultural values. Sweden’s education is generally more oriented toward the integration of some aging education in more disciplinary fields, such as nursing and social work and thus could benefit from more specialized, aging-specific courses. The United States is highly specialized, with multiple programs in various subfields of aging (e.g., geropsychology; aging services administration) and could benefit from integrating more aging knowledge into courses in other disciplines. The authors challenge professionals to consider if there is a basic but global curriculum and/or set of competencies in gerontology that could be agreed upon. As an increasingly global village, the ability to share and learn is more easily achievable. Sweden and the United States have much to learn from each other in terms of appropriately educating and training those who support our older people.     

Indirect comparison of bronchial thermoplasty versus omalizumab for uncontrolled severe asthma

Objective: Bronchial thermoplasty (BT) as an add-on therapy for uncontrolled severe asthma is an alternative to biologic therapies like omalizumab (OM). We conducted an indirect treatment comparison (ITC) to appraise comparative effectiveness of BT and OM. Methods: A systematic literature review identified relevant randomized controlled trials. The ITC followed accepted methodology. Results: The ITC comprised a sham-controlled trial of BT (AIR2) and two placebo-controlled trials of OM (INNOVATE; EXTRA). Comparing the BT post-treatment period to ongoing treatment with OM, showed no significant differences in the rate ratios (RRs) for severe exacerbations (RR of BT versus OM = 0.91 [95% CI: 0.64, 1.30]; p = 0.62) or hospitalizations (RR = 0.57 [95% CI: 0.17, 1.86]; p = 0.53); emergency department visits were significantly reduced by 75% with BT (RR = 0.25 [95% CI: 0.07, 0.91]; p = 0.04); the proportions of patients with clinically meaningful response on the asthma quality-of-life questionnaire were comparable (RR = 1.06 [95% CI: 0.86, 1.34]; p = 0.59). The RR for exacerbations statistically favours OM over the total study period in AIR2 (RR = 1.50 [95% CI: 1.11, 2.02]; p = 0.009) likely reflecting a transient increase in events during the BT peri-treatment period. Conclusions: The ITC should be interpreted cautiously considering the differences between patient populations in the included trials. However, based on the analysis, BT compares well with a potentially more costly pharmacotherapy for asthma. Clinicians evaluating the relative merits of using these treatments should consider the totality of evidence and patient preferences to make an informed decision.     

大学生人格的年级变异性

目的探讨大学生人格变化与所处年级的关系。方法采用卡特尔人格问卷(16PF)对浙江农林大学健康管理专业大一至大三104名学生进行为期一学年前后测评。结果①具有统计学显著性变异的人格因子一年级有:C(t=2.079,P<0.05)、E(t=-3.606,P<0.01)、G(t=-2.456,P<0.05)、L(t=-4.86,P<0.01)、Q3(t=2.447,P<0.05)、Q4(t=-2.893,P<0.01);二年级有:E(t=-3.438,P<0.01)、I(t=3.369,P<0.01)、X3(t=-3.747,P<0.01)、Y2(t=-2.5277,P<0.05);三年级有:E((t=-2.832,P<0.01)、M(t=-3.092,P<0.01)、Q1(t=-2.361,P<0.05)、X4(t=-4.629,P<0.01)、Y2(t=-2.603,P<0.05);②不同年级相比,变异程度大的人格因子主要有C(t=-2.103,P<0.05)、I(t=2.321,P<0.05)、X1(t=2.25,P<0.05)、X3(t=-2.052,P<0.05);Q4(t=2.081,P<0.05)、X4(t=-2.322～-2.143,P<0.05)。结论大学生人格变异具有年级特点,一年级人格因子值提高的有C、Q3;降低的有E、G、L、Q4;二年级提高的有I,降低的有E、X3、Y2;三年级人格因子值降低的有E、M、Q1、X4、Y2。并且,情绪性因子变异程度较大。     

A Shared Responsibility

Children's growing use of the Internet creates both opportunities and risks. Collecting and comparing empirical findings on risks and opportunities experienced across 20 different European countries shows significant differences between them. Using Qualitative Comparative Analysis (QCA), this article investigates which factors contribute towards a high degree of online risk experienced by children across these countries. The research shows that patterns of similarities and differences do not seem to coincide with regional, political, and historical divides across European Union countries. The findings seem to endorse the multilayered approach of multi-stakeholder governance, which stresses the co-responsibility in securing children's online safety. However, one of the most important country conditions explaining high risk appears to be the lack of positive online content provision.     

罗氏e602不同仪器间乙肝标志物检测结果的一致性

目的对罗氏cobas 8000 e602乙肝标志物的试剂在Au1和Au2检测两仪器间检测结果的一致性进行评价。方法参照CLSI EP9A3方案,各取40例样本同时在Au1和Au2间单次检测,对其结果进行一致性分析,计算医学决定水平处的偏移值,以≤1/2室间质评(±10%)作为可接受标准。结果罗氏e602 Au1和Au2间乙肝标志物结果 95%在Bland-Altman一致性界限内,Passing-Bablok回归方程分别为HBsAg:Y=-0.0036+1.0458X,HBsAb:Y=0.6364+1.0043X;HBeAg:Y=-0.0096+1.0063X;HBeAb:Y=-0.0011+1.0203X;HBcAb:Y=-0.0002+0.9160X。医学决定水平的偏移值分别为4.13%、6.57%、-0.33%、1.88%、-8.79%,比对结果可接受。结论罗氏cobas 8000 e602Au1和Au2检测乙肝标志物的比对结果一致,检测结果无差异。     

Comparative efficacy of first-line ceritinib and crizotinib in advanced or metastatic anaplastic lymphoma kinase-positive non-small cell lung cancer: an adjusted indirect comparison with external controls

Objective: In the absence of head-to-head trials, this study indirectly compared progression free survival (PFS) and overall survival (OS) between ceritinib and crizotinib among patients with previously untreated advanced anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC).

Methods: A matching-adjusted indirect comparison method was implemented to adjust for cross-trial differences in patient characteristics between ASCEND-4 and PROFILE 1014 trials. Patient-level data from ASCEND-4 and published summary data from PROFILE 1014 were used. Patients in ASCEND-4 were reweighted to match average baseline characteristics (i.e. age, sex, race, tumor histology, ECOG score, smoking status, extent of disease, and presence of brain metastases) reported for PROFILE 1014 patients using propensity score weighting. PFS and OS were then compared between balanced populations.

Results: ASCEND-4 included more current smokers (8.0% vs 4.4%) and fewer patients under the age of 65 years (78.5% vs 84.0%) compared to PROFILE 1014. After matching, these and all other patient characteristics were balanced between the two trial populations. Compared to crizotinib, ceritinib was associated with a significantly longer PFS (hazard ratio [95% confidence interval] (HR [CI])?=?0.64 [0.47–0.87]; median PFS: 25.2 vs 10.8 months, log-rank p-value?=?0.003). OS did not differ significantly, with a HR of 0.82 [0.54–1.27] for ceritinib compared to crizotinib.

Conclusions: In the adjusted indirect comparison with external controls, the second generation ALK inhibitor, ceritinib, was associated with a significantly prolonged PFS compared to crizotinib as first-line treatment for ALK-positive NSCLC.