‘I believe high blood pressure can kill me:’ using the PEN-3 Cultural Model to understand patients’ perceptions of an intervention to control hypertension in Ghana

Objectives: Currently in Ghana, there is an on-going task-shifting strategy in which nurses are trained in hypertension management. While this study will provide useful information on the viability of this approach, it is not clear how patients in the intervention perceive hypertension, the task-shifting strategy, and its effects on blood pressure management. The objective of this paper is to examine patients’ perceptions of hypertension and hypertension management in the context of an on-going task-shifting intervention to manage blood pressure control in Ghana.

Design: Forty-two patients participating in the Task Shifting Strategy for Hypertension program (23 males, 19 females, and mean age 61. 7 years) completed in-depth, qualitative interviews. Interviews were transcribed, and key words and phrases were extracted and coded using the PEN-3 Cultural Model as a guide through open and axial coding techniques, thus allowing rich exploration of the data.

Results: Emergent themes included patients’ perceptions of hypertension, which encompassed misperceptions of hypertension and blood pressure control. Additional themes included enablers and barriers to hypertension management, and how the intervention nurtured lifestyle change associated with blood pressure control. Primary enabling factors included the supportive nature of TASSH nurses, while notable barriers were financial constraints and difficulty accessing medication. Nurturing factors included the motivational interviewing and patient counseling which instilled confidence in the patients that they could make lasting behavior changes.

Conclusions: This study offers a unique perspective of blood pressure control by examining how patients view an on-going task-shifting initiative for hypertension management. The results of this study shed light on factors that can help and hinder individuals in low-resource settings with long-term blood pressure management.     

金黄色葡萄球菌在皮肤病医院对苯唑西林敏感性降低并无性系蔓延

2000年11月，作者得知从Aarhus大学医院皮肤科患者分离到的金黄色葡萄球菌对苯唑西林出现界线耐药（BORSA）。本文旨在描述其表型和基因型，并评估可能的传播途径以干预和阻止进一步蔓延。菌株由脉冲场凝胶电泳鉴定。几个感染控制方案的缺口显示患者间可直接或间接传播。皮肤屏障缺陷、皮肤病患者金黄色葡萄球菌的高携带率和院内双氯西林的高消耗率可促使传播。改善普通感染控制措施和重新评价院内抗生素政策后，该菌的暴发感染消失。     

对中国药典附子中乌头硷限量检查的商榷

用高效液相色谱法测定生附子。炮制附片中的乌头硷、中乌头硷和次乌头硷含量，以及３种生物硷的水解速度，发现炮制附片中主要含次乌头硷，而药典只限定乌头硷含量，显得不够完善。故在此基础上探讨了药典中增加次乌头硷含量限定内容的可能性。     

The Durability of Laparoscopic Nissen Fundoplication: 11-Year Outcomes

Laparoscopic Nissen fundoplication (LNF) has become the most commonly performed antireflux procedure since its introduction in 1991. There are few studies with greater than 5-year outcomes. Herein we report a series of 312 consecutive patients who underwent primary LNF before 1996. Follow-up of more than 6 years was available in 166 patients, and the mean follow-up was 11 years (median 11.1 years, range 6.1–13.3 years). Prospective data collection included preoperative and current symptom scores (scale 0 = none to 3 = severe), as well as the level of patient satisfaction and use of antireflux medications. Total symptom score for each patient was summed from seven symptoms for a maximum value of 21. Heartburn and regurgitation were the most improved symptoms; however, all symptoms were significantly improved (P < 0.01). The total symptom score at follow-up was 2.6 down from 7.5 at baseline, with a mean difference of −4.9 (range −12 to 3). The percentage of patients stating they would have the procedure again was 93.3%, and 70% were off daily antireflux medications. Outcomes at a mean of 11 years after LNF are excellent, and the majority of patients had their symptoms resolved or significantly improved and are satisfied with their results. Presented at the 47th Annual Meeting of the Society for Surgery of the Alimentary Tract, May 22, 2006, Los Angeles, CA     

葛根素对LPS诱导急性脑损伤小鼠的保护作用

目的:研究葛根素(Pur)对脂多糖(LPS)诱导的小鼠急性感染性脑损伤的保护作用及机制。方法:36只清洁级雄性ICR小鼠随机分为正常对照组(NS)、LPS感染组(LPS)和葛根素组(Pur+LPS)。LPS腹腔注射建立急性脑损伤模型,立即腹腔注射给予葛根素注射液治疗,6和24h后旷场。暗场实验检测各组小鼠的自发活动,WesternBlot检测脑组织白细胞分化抗原14(CD14)和环氧化酶2(C0X-2)蛋白表达量,Nisl染色观察神经元存活情况。结果:与NS组相比,LPS组6和24 h旷场实验自主活动距离和穿格次数显著减少,海马神经元的存活数目显著减少,脑组织CD14和C0X-2蛋白表达量显著升高(P<0.05);与LPS组比较,Pur+LPS组6和24 h时海马神经元的存活率明显提高,且CD14和C0X-2蛋白表达量明显下降(P<0.05)。结论:葛根素注射液对LPS所致小鼠急性感染性脑损伤具有一定保护作用,其作用机制可能与抑制脑组织CD14和C0X-2表达有关。     

Identification of Dish-Based Dietary Patterns for Breakfast,Lunch, and Dinner and Their Diet Quality in Japanese Adults

We identified dish-based dietary patterns for breakfast, lunch, and dinner and assessed the diet quality of each pattern. Dietary data were obtained from 392 Japanese adults aged 20–69 years in 2013, using a 4 d dietary record. K-means cluster analysis was conducted based on the amount of each dish group, separately for breakfasts (n = 1462), lunches (n = 1504), and dinners (n = 1500). The diet quality of each dietary pattern was assessed using the Healthy Eating Index 2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3). The extracted dietary patterns were as follows: ‘bread-based’ and ‘rice-based’ for breakfast; ‘bread’, ‘rice-based’, ‘ramen’, ‘udon/soba’, and ‘sushi/rice bowl dishes’ for lunch; and ‘miscellaneous’, ‘meat dish and beer’, and ‘hot pot dishes’ for dinner. For breakfast, the HEI-2015 and NRF9.3 total scores were higher in the ‘rice-based’ pattern than the ‘bread-based’ pattern. For lunch, the HEI-2015 and NRF9.3 total scores were relatively high in the ‘rice-based’ pattern and low in the ‘ramen’ pattern. For dinner, the HEI-2015 total score was the highest in the ‘meat dish and beer’ pattern, and the NRF9.3 total score was higher in the ‘hot pot dishes’ than the ‘miscellaneous’ pattern. These results suggested that breakfast, lunch, and dinner have distinctive dietary patterns with different diet qualities.     

Analysis of time‐to‐event for observational studies: Guidance to the use of intensity models

This paper provides guidance for researchers with some mathematical background on the conduct of time‐to‐event analysis in observational studies based on intensity (hazard) models. Discussions of basic concepts like time axis, event definition and censoring are given. Hazard models are introduced, with special emphasis on the Cox proportional hazards regression model. We provide check lists that may be useful both when fitting the model and assessing its goodness of fit and when interpreting the results. Special attention is paid to how to avoid problems with immortal time bias by introducing time‐dependent covariates. We discuss prediction based on hazard models and difficulties when attempting to draw proper causal conclusions from such models. Finally, we present a series of examples where the methods and check lists are exemplified. Computational details and implementation using the freely available R software are documented in Supplementary Material. The paper was prepared as part of the STRATOS initiative.     

Care of the elderly in Ghana: An emerging issue

Data are presented on the social and economic conditions influencing the care of the elderly in Ghana. The data consist of research findings, personal observations, and field studies of University of Ghana social work students as well as information from case studies of HelpAge Ghana's Adopt a Granny Program. Changes in the traditional family pattern indicate that the nuclear family, including grandchildren, is taking on a crucial role in the care of the elderly.     

Bending of the Cotrel-Dubousset instrumentation after direct trauma: a case report

STUDY DESIGN: Case report. OBJECTIVES: To describe a fracture through the fusion mass of a spine that had been corrected previously with Cotrel-Dubousset rods. These rods had failed in bending after direct trauma. SUMMARY OF BACKGROUND DATA: Nine years after successful treatment of scoliosis with Cotrel-Dubousset instrumentation, the patient was in a motor vehicle accident and sustained a hyperextension spine injury with complete L1-L2 paraplegia and disruption of the fusion mass. The Cotrel-Dubousset instrumentation rods, which failed in bending, could not be corrected in situ, and the angulated segments had to be resected. The spine then became extremely unstable, and the patient consulted the authors for definitive stabilization. RESULTS: The spine was stabilized by attaching the proximal and distal retained Cotrel-Dubousset instrumentation to supplemental rods in a "domino" fashion. Crosslinks were added to improve the torsional stability. Intraoperatively, the fracture was well reduced, and the fixation was stable. A posterolateral fusion was performed with allogenic bone graft. CONCLUSION: Bent Cotrel-Dubousset instrumentation rods are still very strong and may not correct in situ.- If resection is required, the retained portions of Cotrel-Dubousset instrumentation can serve as attachments to restore stable fixation a "domino"technique.