OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure ...OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure Database, Chongqing VIP Database and WANFANG Data was conducted. The studies that met the inclusion and exclusion criteria were used to extract information according to a predesigned assessment instrument. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine were identified. Of these questionnaires, 7 were generic, 12 were condition-specific and 78 were disease-specific. All instruments were suitable for adults, children, and both men and women. These instruments aimed to evaluate the health-related quality of life, signs and symptoms as well as patient satisfaction and doctor-reported outcome. However, the descriptions were poorly constructed for some of the most basic parameters, such as the domains and items, administrative mode, response options, memory recall periods, burden evaluation, format, copyright, content validity, and other properties. CONCLUSION： The instrument development for health outcomes assessment in Chinese medicine is increasing rapidly; however, there are many limitations in current methodologies and standards, and further studies are needed.展开更多
Purpose:The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.Met...Purpose:The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.Methods:An umbrella review of systematic reviews with meta-analyses of observational studies was conducted.We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values,95%prediction intervals,heterogeneity,small-study effects,and excess significance.We graded the evidence from convincing(Class I)to weak(Class IV).Results:From 504 articles returned in a search of the literature,8 systematic reviews were included in our review,with a total of 11 outcomes.Overall,nine of the 11 of the outcomes reported nominally significant summary results(p<0.05),with 4 associations surviving the application of the more stringent p value(p<106).No outcome presented convincing evidence.Three associations showed Class II evidence(i.e.,highly suggestive):(1)higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population(n=34 studies;sample size=1,855,817;relative risk=0.72,95%confidence interval(95%CI):0.670.78),(2)cardiovascular death risk in mixed populations(n=15 studies;relative risk=0.84,95%CI:0.780.91),and(3)incidence of disability(n=7 studies;relative risk=0.76,95%CI:0.660.87).Conclusion:The present results show that handgrip strength is a useful indicator for general health status and specifically for early all-cause and cardiovascular mortality,as well as disability.To further inform intervention strategies,future research is now required to fully understand mechanisms linking handgrip strength scores to these health outcomes.展开更多
The key health issues for women tend to be primarily associated with the female reproductive system. There are also other gender priorities and consequences associated with ageing, which require effective intervention...The key health issues for women tend to be primarily associated with the female reproductive system. There are also other gender priorities and consequences associated with ageing, which require effective interventions. Acupuncture is used worldwide and its evidence base is increasing on both mechanisms of action and its effectiveness in clinical care. Although acupuncture may be a valuable addition to healthcare for some conditions, it is rarely fully integrated into mainstream Western medicine clinical practice. Inadequate design and poor reporting of clinical trials have been barriers. Additionally systematic reviews and meta-analyses have tended to be equivocal and have reported that there is insufficient evidence for its recommendation. Future research should focus on ensuring good trial design including cost effectiveness and qualitative data and using a more pragmatic stance which reflects acupuncture in clinical practice. Undoubtedly, effective interventions are always needed to ensure the best health outcomes and address preventable deaths, morbidities, and disabilities among women but integration will be compromised unless underpinned by good evidence.展开更多
Background:Red yeast rice(RYR),a natural lipid-lowering agent,is widely used in clinical practice.However,the existing meta-analyses concerning the safety of RYR preparations have yielded inconsistent results,and the ...Background:Red yeast rice(RYR),a natural lipid-lowering agent,is widely used in clinical practice.However,the existing meta-analyses concerning the safety of RYR preparations have yielded inconsistent results,and the credibility of the evidence has not been quantified.Objective:This study was designed to evaluate the existing evidence and offer a comprehensive understanding of the associations between the use of RYR preparations and various adverse health outcomes.Search strategy:Seven literature databases were searched from inception to May 5,2023,using medical subject headings and free-text terms(e.g.,“red yeast rice,”“Xuezhikang,”and“Zhibitai”).Inclusion criteria:Meta-analyses that investigated and quantitatively estimated associations between the use of RYR preparations and adverse health outcomes were included in this study.Data extraction and analysis:Two researchers independently extracted data using a standardized data collection table;any disagreements were resolved by consulting a third researcher.Based on the participant,intervention,comparator and outcome(PICO)framework in each eligible meta-analysis,a series of unique associations between the use of RYR preparations and adverse health outcomes were determined.The associations’effect estimates were re-evaluated using random-effect models.Results:Fifteen meta-analyses,comprising 186(164 unique)randomized controlled trials,were identified.Based on A Mea Surement Tool to Assess Systematic Reviews version 2,3(20%)and 12(80%)of these meta-analyses had low and critically low confidence,respectively.A total of 61 unique associations between the use of RYR preparations and adverse health outcomes were extracted from eligible metaanalyses.Based on the random-effect models,10(16.4%)associations indicated a significant protective effect of RYR preparations against adverse health outcomes,while 5(8.2%)indicated an increased risk of adverse health outcomes related to uric acid,alanine transaminase and aspartate transaminase levels.The other 46(75.4%)associations showed no significant difference between the use of RYR preparations and control treatments.Regarding the credibility of the evidence,21(34.4%),34(55.7%)and 6(9.8%)associations showed moderate,low and very low credibility,respectively.Conclusion:The evidence examined in this study suggests that RYR preparations are safe;however,the credibility of the evidence was not high.Further high-quality evidence is required.展开更多
Hepatitis C virus(HCV)infection is still a major health problem throughout the world.HCV patients living in rural areas are less fortunate than their counterparts residing in populous urbanized regions.The lack of med...Hepatitis C virus(HCV)infection is still a major health problem throughout the world.HCV patients living in rural areas are less fortunate than their counterparts residing in populous urbanized regions.The lack of medical resources and properly trained medical personnel in rural regions make it especially burdensome for HCV patients seeking treatment.Dr.Sanjeev Arora at the University of New Mexico Health Sciences Center took initiative to resolve the issue at hand by developing a model named Project Extension for Community Health Outcomes(ECHO).ECHO connects primary care providers(PCPs),usually family medicine physicians,in local communities with specialists.ECHO providers test the efficacy of treatment given using the ECHO model vs that at academic medical centers.The ECHO model has produced promising results such that the sustained virologic response rates for both types of sites were near-equivalent.Show Me ECHO was adapted from Project ECHO to train PCPs in Missouri and equip them with the tools and skills to properly treat and diagnose HCV in a timely manner.This healthcare model can be implemented for treating other common infections and chronic diseases.Telemedicine is the direction healthcare is headed for the next several decades.It has potential to be applied in developing countries to alleviate agony and despair resulting from limited resources and lack of access to expert medical care.展开更多
Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and heal...Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and health outcomes and to summarize the types of utilization and outcomes which have been reported to be associated with PSL.Methods:We conducted a rapid evidence review.Our search of seven databases,including Medline,Embase,PsycINFO,Cochrane Library,CINAHL,Scopus,and JSTOR,on September 21,2020,identified 757 studies,30 of which were retained.Results:Previous evidence is mostly provided by cross-sectional studies with survey data.In this study,evidence suggests that PSL is significantly associated with some types of healthcare utilization and health outcomes.In terms of healthcare utilization,findings indicate PSL is associated with an increase in the use of some preventive sendees and a decrease in the use of emergency care;while findings are mixed regarding associations of PSL with health provider visits and the use of mammograms and pap smears.As for health outcomes,findings suggest PSL is associated with improved mental and self-rated health,decreased incidence of influenza-like illness,and lower occupational injuries and mortality rates.Conclusion:PSL may be an effective tool in improving some healthcare utilization and health outcomes.Future research could help identify mechanisms through which PSL access works and identify what policy components lead to better outcomes.展开更多
Aim We herein provide an umbrella review of systematic reviews(SR)and meta-analyses(MAs)of studies of the association of oral contraceptives(OCs)with the risks of multiple health outcomes in women and their descendant...Aim We herein provide an umbrella review of systematic reviews(SR)and meta-analyses(MAs)of studies of the association of oral contraceptives(OCs)with the risks of multiple health outcomes in women and their descendants.Methods Two investigators retrieved publications from four electronic databases,including PubMed,Embase,Web of Science,and the Cochrane Database of Systematic Reviews up to March 15,2021.For each association,random/fixed-effects summary effect size and 95%CIs were estimated.Heterogeneity and publication bias were also assessed.The method quality and evidence level for each publication were respectively assessed utilizing the AMSTAR and GRADE checklists.Results A total of 68 articles with 82 unique outcomes were included based on the eligibility criteria.Numerous lines of evidence indicated that OCs had effects on nearly all cardiovascular disease-related outcomes,especially for cerebral venous sinus thrombosis(OR=7.59,95%CI:3.82-15.09).Harmful associations were also found for vulvar vestibulitis(OR=2.31,95%CI:1.03-5.16),preterm birth(OR=1.17,95%CI:1.07-1.27),miscarriage(OR=1.13,95%CI:1.02-1.72),ulcerative colitis(OR=1.22,95%CI:1.06-1.41),Crohn's disease(OR=1.24,95%CI:1.09-1.40),alveolar osteitis(RR=1.86,95%CI:1.66-2.08),dry socket(RR=1.8,95%CI:1.33-2.43),and interstitial cystitis(OR=2.1,95%CI:1.26-3.49).However,oral contraceptives did not increase the risk of cancer except breast and cervical cancer.Maternal exposure to OCs was linked to an increased risk for the development of respiratory atopic disorders such as asthma(OR=1.1,95%CI:1.02-1.19)and rhinitis(OR=1.34,95%CI:1.07-1.68).Conclusion In summary,although their use obviously reduces the risk of pregnancy-and parturition-related morbidity and mortality for women,OCs were frequently related to more harm than benefit in terms of other health outcomes.This was true for both women and their descendants in this umbrella review.More large-scale prospective studies analysing different doses,structures,and durations of treatment with estrogen and progestin are needed to confirm these effects.展开更多
Background: There is growing evidence suggesting that those who suffer traumatic injury display high levels of perceived injustice which impedes their recovery, both physically and mentally. Aim: The aim of this syste...Background: There is growing evidence suggesting that those who suffer traumatic injury display high levels of perceived injustice which impedes their recovery, both physically and mentally. Aim: The aim of this systematic review was to examine the association between perceived injustice and pain-related, mental health and functional outcomes in patients who have suffered a traumatic injury. Methods: In May 2023, a systematic review of the literature was performed on the electronic databases of PubMed, Google Scholar, Embase, and the Cochrane Database of Systemic Reviews. Papers were collected and analysed as per PRISMA guidelines for systematic reviews. The outcomes of interest were pain intensity, pain interference, disability, depression, anxiety, and quality of life. The initial search identified 59 papers. Of these papers, five studies met the inclusion criteria and were subsequently analysed (N = 1172). Each of the papers was published in peer-reviewed journals in the English language. Individuals with pain or pathology prior to the trauma and those who were not hospitalised following the trauma were excluded from the study. Results: Of the papers reviewed, each study indicated significant associations between perceived injustice and pain, disability, depression, anxiety, post-traumatic stress disorder, as well as reduced return to work status. Conclusion: This systematic review investigated the relationship between perceived injustice and pain-related, mental health, and functional outcomes in trauma patients. The results highlight the negative role that perceived injustice has on recovery following traumatic injury. Further, it provokes the need for future research regarding the implementation of therapeutic interventions and the development of predictive models of injustice.展开更多
Objective:To identify the effects of health literacy levels on health outcomes in patients with diabetes in a type V health center in Western Jamaica.Method:A correlational survey design with a random sampling techniq...Objective:To identify the effects of health literacy levels on health outcomes in patients with diabetes in a type V health center in Western Jamaica.Method:A correlational survey design with a random sampling technique was used.An 18-item questionnaire and the Newest Vital Sign tool were administered to 88 consenting adults with diabetes to assess their health literacy levels.Their health outcomes were evaluated with docket review.Data were analyzed using SPSS version 18.Results:The participants were predominantly female(77.3%),aged 51-70 years,married(44%),employed(46%),and diagnosed with diabetes>10 years(42%).Only 13.6%of the study population was adequately health literate.The health literacy scores for gender were not significant(P=0.84).The health literacy scores of the patients with different ages and educational levels were significant(P<0.001).Pearson's correlations revealed no linear relationship between health literacy scores and health outcome(r=0.185,P=0.084).Conclusion:Limited health literacy and high likelihood of limited health literacy are predominant in the study population.Age and educational level are significantly associated with health literacy levels.However,these findings suggest no association between health literacy level and diabetic health outcomes.展开更多
Lifestyle factors play a critical role in promoting healthy aging and extending life expectancy Lifestyle factors(Zhao et al.2023,2022;Ofori-Asenso et al.2019).However,the biological mechanisms through which lifestyle...Lifestyle factors play a critical role in promoting healthy aging and extending life expectancy Lifestyle factors(Zhao et al.2023,2022;Ofori-Asenso et al.2019).However,the biological mechanisms through which lifestyle modifications mitigate adverse health outcomes have not yet been fully elucidated.展开更多
Background:Metallic biomaterials have transformed modern medicine,with copper(Cu),zinc(Zn),and selenium(Se)emerging as critical components in medical applications.The study of the single and synergistic effects of ser...Background:Metallic biomaterials have transformed modern medicine,with copper(Cu),zinc(Zn),and selenium(Se)emerging as critical components in medical applications.The study of the single and synergistic effects of serum metal concentrations on human health can provide valuable insights for future clinical transformation of biodegradable alloys.Methods:We evaluated 2381 NHANES 2011-2016 participants to study individual and combined effects of these metals on health outcomes.Multivariable logistic regression,restricted cubic splines,and piecewise linear regression were used to examine linear,nonlinear,and threshold relationships.Overall metal mixture effects were assessed using weighted quantile sum(WQS)and Bayesian kernel-machine regression(BKMR).Results:Elevated serum Cu levels were significantly associated with an increased risk of osteoarthritis.When Serum Cu≥99.48μg/dL,each 1-unit increase in Ln Cu raised diabetes risk 4.55-fold.For Se≥122.74μg/L,each 1-unit increase in Ln Se led to a 29.96-fold rise in diabetes prevalence,for Se<157.56μg/L it increased heart attack risk 165.19-fold.Furthermore,mixtures of Cu,Se,and Zn were positively associated with diabetes,hy-pertension,and heart attack risks;each unit increase in the mixture corresponded to a 23%rise in diabetes and a 15%rise in hypertension prevalence.Conclusions:Serum Cu levels≥99.48μg/dL are significantly linked to diabetes risk,while serum Se levels≥122.74μg/L are associated with diabetes risk and levels<157.56μg/L with elevated heart attack risk.Serum metal mixtures containing Cu,Se and Zn were significantly and positively associated with risk of diabetes,hy-pertension and heart attack.展开更多
Background:Zinc-based biomaterials,including biodegradable metal,nanoparticles,and coatings used in medical implants release zinc ions that may increase the whole-body and serum zinc concentrations.The impact of serum...Background:Zinc-based biomaterials,including biodegradable metal,nanoparticles,and coatings used in medical implants release zinc ions that may increase the whole-body and serum zinc concentrations.The impact of serum zinc concentrations on major health outcomes can provide insights for device design and clinical transformation of zinc-based biomaterials.Methods:This nationally representative cross-sectional study enrolled participants from the National Health and Nutrition Examination Survey(NHANES,2011-2014)including 3607 participants.Using unadjusted and multivariate-adjusted logistic regression analyses,two-piecewise linear regression model with a smoothing function and threshold level analysis,we evaluated the associations between elevated serum zinc levels and major health outcomes.Results:Elevated serum zinc levels were significantly associated with an increase in total spine and total femur bone mineral density(BMD).Every 10μg/dL increase was associated with a 1.12-fold increase in diabetes mellitus(DM)and 1.23-fold and 1.29-fold increase in cardiovascular diseases(CVD)and coronary heart disease(CHD),in participants with serum zinc levels≥100μg/dL.It had no significant linear or nonlinear associations with risk of fractures,congestive heart failure,heart attack,thyroid disease,arthritis,osteoarthritis,rheumatoid arthritis,dyslipidemia and cancer.Conclusion:Serum zinc levels are significantly associated with increased BMD in the total spine and total femur,and risk of DM,and CVD/CHD among participants with serum zinc levels≥100μg/dL.展开更多
Gut microbiota composition is suggested to associate with coronavirus disease 2019(COVID-19)severity,but the impact of gut microbiota on health outcomes is largely unclear.We recruited 81 individuals from Wuhan,China,...Gut microbiota composition is suggested to associate with coronavirus disease 2019(COVID-19)severity,but the impact of gut microbiota on health outcomes is largely unclear.We recruited 81 individuals from Wuhan,China,including 13 asymptomatic infection cases(Group A),24 COVID-19 convalescents with adverse outcomes(Group C),31 severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)re-positive cases(Group D),and 13 non-COVID-19 healthy controls(Group H).The microbial features of Groups A and D were similar and exhibited higher gut microbial diversity and more abundant short-chain fatty acid(SCFA)-producing species than Group C.Group C was enriched with opportunistic pathogens and virulence factors related to adhesion and toxin production.The abundance of SCFA-producing species was negatively correlated,while Escherichia coli was positively correlated with adverse outcomes.All three groups(A,C,and D)were enriched with the mucusdegrading species Akkermansia muciniphila,but decreased with Bacteroides-encoded carbohydrate-active enzymes.The pathways of vitamin B6 metabolic and folate biosynthesis were decreased,while selenocompound metabolism was increased in the three groups.Specifically,the secondary bile acid(BA)metabolic pathway was enriched in Group A.Antibiotic resistance genes were common among the three groups.Conclusively,the gut microbiota was related to the health outcomes of COVID-19.Dietary supplementations(SCFAs,BA,selenium,folate,vitamin B6)may be beneficial to COVID-19 patients.展开更多
Objectives:Recent research has shown that college students experience high levels of stress from various sources,which contribute to heightened rates of psychological distress and make them particularly vulnerable to ...Objectives:Recent research has shown that college students experience high levels of stress from various sources,which contribute to heightened rates of psychological distress and make them particularly vulnerable to mental health issues.Hence,we conducted a study,aimed to analyze the influence of a mobile-based walking routine on mental health outcomes,such as perceived stress and positive and negative affect.Methods:The participants were divided into two groups:the walking group(N=23)and the control group(N=24).The walking group engaged in an approximately 25-min walking session for at least 3 days per week,which was carefully monitored and facilitated with the help of the Nike Run Club application.The statistical analysis of the quantitative data was carried out with the help of SPSS 25.0.In addition to calculating descriptive statistics,we conducted an independent samples t-test,a repeated-measures ANOVA,and a paired sample t-test to analyze the effectiveness of the intervention.Results:A repeated-measures ANOVA revealed that the walking group exhibited significant reductions in perceived stress(t=2.03,p=0.049,Cohen’s D=0.60)and negative affect(t=2.19,p=0.033,Cohen’s D=0.65)after the intervention,whereas the control group showed no significant changes across time in any of the proposed variables.Conclusion:The results of the study continue to be indicative of the positive effects of regular walking on perceived stress and negative affect,preserving its role as a straightforward and accessible tool for reducing stress and negative affect.展开更多
Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly...Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.展开更多
Background Examining the health outcomes of veterans who have completed the United States Veterans Health Administration’s(VHA’s)Traumatic Brain Injury(TBI)Screening and Evaluation Program may aid in the refinement ...Background Examining the health outcomes of veterans who have completed the United States Veterans Health Administration’s(VHA’s)Traumatic Brain Injury(TBI)Screening and Evaluation Program may aid in the refinement and improvement of clinical care initiatives within the VHA.This study compared self-reported physical functioning,cardiometabolic health conditions,and health care utilization patterns in Million Veteran Program enrollees with TBI Screening and Evaluation Program data(collected between 2007 and 2019),with the goal of enhancing understanding of potentially modifiable health conditions in this population.Methods In this observational cohort study,veterans(n=16,452)were grouped based on the diagnostic outcome of the TBI Screening and Evaluation Program:1)negative TBI screen(Screen^(-));2)positive TBI screen but no confirmed TBI diagnosis[Screen^(+)/Comprehensive TBI Evaluation(CTBIE)^(-)];or 3)positive TBI screen and confirmed TBI diagnosis(Screen^(+)/CTBIE^(+)).Chi-square tests and analysis of covariance were used to explore group differences in physical functioning,cardiometabolic health conditions,and health care utilization patterns,and logistic regressions were used to examine predictors of Screen^(+/-)and CTBIE^(+/-)group status.Results The results showed that veterans in the Screen^(+)/CTBIE^(-)and Screen^(+)/CTBIE^(+)groups generally reported poorer levels of physical functioning(P’s<0.001,np2=0.02 to 0.03),higher rates of cardiometabolic health conditions(P’s<0.001,φ=0.14 to 0.52),and increased health care utilization(P’s<0.001,φ=0.14 to>0.5)compared with the Screen-group;however,health outcomes were generally comparable between the Screen^(+)/CTBIE^(-)and Screen^(+)/CTBIE^(+)groups.Follow-up analyses confirmed that while physical functioning,hypertension,stroke,healthcare utilization,and prescription medication use reliably distinguished between the Screen-and Screen^(+)groups(P’s<0.02,OR’s 0.78 to 3.38),only physical functioning distinguished between the Screen^(+)/CTBIE^(-)and Screen^(+)/CTBIE^(+)groups(P<0.001,OR 0.99).Conclusions The findings suggest that veterans who screen positive for TBI,regardless of whether they are ultimately diagnosed with TBI,are at greater risk for negative health outcomes,signifying that these veterans represent a vulnerable group that may benefit from increased clinical care and prevention efforts.展开更多
The essential consideration is the cornerstone of a solid medical care system that provides outstanding health outcomes at a low cost. Medical therapy has evolved over the previous century from concentrating on random...The essential consideration is the cornerstone of a solid medical care system that provides outstanding health outcomes at a low cost. Medical therapy has evolved over the previous century from concentrating on random etiologies to lifestyle, race, and environmental factors. The aim behind these changes is to serve the public health requirements by delivering frequent and easy services based on the individual, couple, or family. Accurate evaluation of the magnitude by which primary health care contributes to the health care system is essential to the improvement of these contributions and determining next step considerations. The number one factor has been associated with greater access to medical care, better health outcomes, and reduced hospitalization and ER (emergency room) visits. The number one consideration may also help balance the adverse effects of poor financial situations on well-being. Therefore, we need more primary care doctors in the US. Research is also necessary to understand which essential consideration models provide acceptable health results.展开更多
Background Heart failure(HF)is a chronic,impactful condition on individuals and healthcare systems,requiring management that goes beyond inpatient care.This study investigated the impact of cardiovascular specialist n...Background Heart failure(HF)is a chronic,impactful condition on individuals and healthcare systems,requiring management that goes beyond inpatient care.This study investigated the impact of cardiovascular specialist nurses on long-term health outcomes and patient satisfaction in HF outpatient care.Methods In a year-long observational study from July 2021 to July 2022,230 HF patients at our hospital were divided into an experimental group(n=115)receiving care from cardiovascular specialist nurses and a control group(n=115)managed by general nursing staff.The interventions included comprehensive care such as patient education,medication management,lifestyle guidance,symptom monitoring,and psychological support.The major adverse cardiovascular events(MACEs)and rehospitalization rates were applied as the primary endpoints.Results The experimental group demonstrated significantly fewer MACEs and lower rehospitalization rates compared to the control group(P<0.001).Higher patient satisfaction was observed in the experimental group,with 81.7%reporting high satisfaction vs.53.9%in the control group(P<0.001).Differences in incidence of myocardial infarction and death rates between the groups were not statistically significant.Conclusions The involvement of cardiovascular specialist nurses in HF outpatient care significantly enhances clinical outcomes and patient satisfaction.These nurses play a key role in bridging the transition from hospital to home care,improving adherence to treatment regimens,and reducing healthcare system burdens.展开更多
OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China...OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China National Knowledge Infrastructure databases was conducted. The resulting articles that met the defined inclusion and exclusion criteria were used for analysis. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine have been used in fundamental and theoretical research, and 14 of these were also used in 29 clinical trials that were randomized controlled trials, or descriptive or cross-sectional studies. In 2 152 Chinese medicine-based studies that used instruments in their methodology, more than 150 questionnaires were identified. Among the identified questionnaires, 51 were used in more than 10 articles （0.5%）. Most of these instruments were developed in Western countries and few studies （4%） used the instrument as the primary evidence for their conclusions. CONCLUSION： Usage of instruments for health outcome assessment in Chinese medicine is increasing rapidly; however, current limitations include selection rationale, result interpretation and standardization, which must be addressed accordingly.展开更多
Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted i...Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted in Ibadan North Local government,Southwest Nigeria the study examined the influences of maternal perceived self-efficacy(MPSE)and maternal perceived vulnerability(MPV)on child health outcomes(CHO).Methods:The study appraised data from 683 nursing mothers aged 15-45 obtained from 20 major primary healthcare centers in the region undergoing routine health checks for their children.Three regression models were fitted to examine the effects of MPV,MPSE,and confounding variables of maternal preventive actions such as insecticide-treated nets(ITN)usage and child immunization,among other maternal and child sociodemographic attributes on CHO.Results:The study finds that MPV has no correlation with CHO and MPSE but positively correlates with maternal age(r=0.123,P<0.05).However,CHO has a negative correlation with MPSE(r=-0.200,P<0.05)while positively correlated with child age(r=0.134,P<0.05).MPSE has a unique effect on CHO(β=-0.203,P<0.05),maternal preventive action of ITN usage show a positive association with CHO in the study Model 2(β=-0.163,P<0.05),while in Model 3,child's age has a positive association with CHO(β=0.180,P<0.05).The net effect of the study models accounted for approximately 10%of the variance in CHO reported among the children.Conclusion:Overall,MPSE and ITN usage are essential factors for understanding and reducing the potential adverse CHO.Global effort must continue to improve maternal education to support child health and preventive carepractices in SSA.展开更多
基金supported by the National Natural Science Foundation of China (Project Grant No. 81073163)
文摘OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure Database, Chongqing VIP Database and WANFANG Data was conducted. The studies that met the inclusion and exclusion criteria were used to extract information according to a predesigned assessment instrument. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine were identified. Of these questionnaires, 7 were generic, 12 were condition-specific and 78 were disease-specific. All instruments were suitable for adults, children, and both men and women. These instruments aimed to evaluate the health-related quality of life, signs and symptoms as well as patient satisfaction and doctor-reported outcome. However, the descriptions were poorly constructed for some of the most basic parameters, such as the domains and items, administrative mode, response options, memory recall periods, burden evaluation, format, copyright, content validity, and other properties. CONCLUSION： The instrument development for health outcomes assessment in Chinese medicine is increasing rapidly; however, there are many limitations in current methodologies and standards, and further studies are needed.
文摘Purpose:The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.Methods:An umbrella review of systematic reviews with meta-analyses of observational studies was conducted.We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values,95%prediction intervals,heterogeneity,small-study effects,and excess significance.We graded the evidence from convincing(Class I)to weak(Class IV).Results:From 504 articles returned in a search of the literature,8 systematic reviews were included in our review,with a total of 11 outcomes.Overall,nine of the 11 of the outcomes reported nominally significant summary results(p<0.05),with 4 associations surviving the application of the more stringent p value(p<106).No outcome presented convincing evidence.Three associations showed Class II evidence(i.e.,highly suggestive):(1)higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population(n=34 studies;sample size=1,855,817;relative risk=0.72,95%confidence interval(95%CI):0.670.78),(2)cardiovascular death risk in mixed populations(n=15 studies;relative risk=0.84,95%CI:0.780.91),and(3)incidence of disability(n=7 studies;relative risk=0.76,95%CI:0.660.87).Conclusion:The present results show that handgrip strength is a useful indicator for general health status and specifically for early all-cause and cardiovascular mortality,as well as disability.To further inform intervention strategies,future research is now required to fully understand mechanisms linking handgrip strength scores to these health outcomes.
文摘The key health issues for women tend to be primarily associated with the female reproductive system. There are also other gender priorities and consequences associated with ageing, which require effective interventions. Acupuncture is used worldwide and its evidence base is increasing on both mechanisms of action and its effectiveness in clinical care. Although acupuncture may be a valuable addition to healthcare for some conditions, it is rarely fully integrated into mainstream Western medicine clinical practice. Inadequate design and poor reporting of clinical trials have been barriers. Additionally systematic reviews and meta-analyses have tended to be equivocal and have reported that there is insufficient evidence for its recommendation. Future research should focus on ensuring good trial design including cost effectiveness and qualitative data and using a more pragmatic stance which reflects acupuncture in clinical practice. Undoubtedly, effective interventions are always needed to ensure the best health outcomes and address preventable deaths, morbidities, and disabilities among women but integration will be compromised unless underpinned by good evidence.
基金supported by the Natural Science Foundation of Fujian Province(Grant No.2022J05062)the Natural Science Foundation of Xiamen(Grant No.3502Z20227041)+3 种基金the Science and Technology Planning Project of Quanzhou(Grant No.2021N142S)the Scientific Research Funds of Huaqiao University(Grant No.21BS126)the Huaqiao University Young and Middleaged Teachers Science and Technology Innovation Funding Program(Grant No.ZQN-PY319)the Huaqiao University Research and Development Project(Grant No.20221HH273)。
文摘Background:Red yeast rice(RYR),a natural lipid-lowering agent,is widely used in clinical practice.However,the existing meta-analyses concerning the safety of RYR preparations have yielded inconsistent results,and the credibility of the evidence has not been quantified.Objective:This study was designed to evaluate the existing evidence and offer a comprehensive understanding of the associations between the use of RYR preparations and various adverse health outcomes.Search strategy:Seven literature databases were searched from inception to May 5,2023,using medical subject headings and free-text terms(e.g.,“red yeast rice,”“Xuezhikang,”and“Zhibitai”).Inclusion criteria:Meta-analyses that investigated and quantitatively estimated associations between the use of RYR preparations and adverse health outcomes were included in this study.Data extraction and analysis:Two researchers independently extracted data using a standardized data collection table;any disagreements were resolved by consulting a third researcher.Based on the participant,intervention,comparator and outcome(PICO)framework in each eligible meta-analysis,a series of unique associations between the use of RYR preparations and adverse health outcomes were determined.The associations’effect estimates were re-evaluated using random-effect models.Results:Fifteen meta-analyses,comprising 186(164 unique)randomized controlled trials,were identified.Based on A Mea Surement Tool to Assess Systematic Reviews version 2,3(20%)and 12(80%)of these meta-analyses had low and critically low confidence,respectively.A total of 61 unique associations between the use of RYR preparations and adverse health outcomes were extracted from eligible metaanalyses.Based on the random-effect models,10(16.4%)associations indicated a significant protective effect of RYR preparations against adverse health outcomes,while 5(8.2%)indicated an increased risk of adverse health outcomes related to uric acid,alanine transaminase and aspartate transaminase levels.The other 46(75.4%)associations showed no significant difference between the use of RYR preparations and control treatments.Regarding the credibility of the evidence,21(34.4%),34(55.7%)and 6(9.8%)associations showed moderate,low and very low credibility,respectively.Conclusion:The evidence examined in this study suggests that RYR preparations are safe;however,the credibility of the evidence was not high.Further high-quality evidence is required.
文摘Hepatitis C virus(HCV)infection is still a major health problem throughout the world.HCV patients living in rural areas are less fortunate than their counterparts residing in populous urbanized regions.The lack of medical resources and properly trained medical personnel in rural regions make it especially burdensome for HCV patients seeking treatment.Dr.Sanjeev Arora at the University of New Mexico Health Sciences Center took initiative to resolve the issue at hand by developing a model named Project Extension for Community Health Outcomes(ECHO).ECHO connects primary care providers(PCPs),usually family medicine physicians,in local communities with specialists.ECHO providers test the efficacy of treatment given using the ECHO model vs that at academic medical centers.The ECHO model has produced promising results such that the sustained virologic response rates for both types of sites were near-equivalent.Show Me ECHO was adapted from Project ECHO to train PCPs in Missouri and equip them with the tools and skills to properly treat and diagnose HCV in a timely manner.This healthcare model can be implemented for treating other common infections and chronic diseases.Telemedicine is the direction healthcare is headed for the next several decades.It has potential to be applied in developing countries to alleviate agony and despair resulting from limited resources and lack of access to expert medical care.
文摘Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and health outcomes and to summarize the types of utilization and outcomes which have been reported to be associated with PSL.Methods:We conducted a rapid evidence review.Our search of seven databases,including Medline,Embase,PsycINFO,Cochrane Library,CINAHL,Scopus,and JSTOR,on September 21,2020,identified 757 studies,30 of which were retained.Results:Previous evidence is mostly provided by cross-sectional studies with survey data.In this study,evidence suggests that PSL is significantly associated with some types of healthcare utilization and health outcomes.In terms of healthcare utilization,findings indicate PSL is associated with an increase in the use of some preventive sendees and a decrease in the use of emergency care;while findings are mixed regarding associations of PSL with health provider visits and the use of mammograms and pap smears.As for health outcomes,findings suggest PSL is associated with improved mental and self-rated health,decreased incidence of influenza-like illness,and lower occupational injuries and mortality rates.Conclusion:PSL may be an effective tool in improving some healthcare utilization and health outcomes.Future research could help identify mechanisms through which PSL access works and identify what policy components lead to better outcomes.
基金supported by the Henan University Science and Technology Innovation Talents Support Program[Grant 19HASTIT005]the National Key Research and Development Program[Grant 2017YFC1309200]the Medical Science and Technology Key Projects of Henan Province and Zhengzhou[Grant numbers 192102310088 and 19A32000820].
文摘Aim We herein provide an umbrella review of systematic reviews(SR)and meta-analyses(MAs)of studies of the association of oral contraceptives(OCs)with the risks of multiple health outcomes in women and their descendants.Methods Two investigators retrieved publications from four electronic databases,including PubMed,Embase,Web of Science,and the Cochrane Database of Systematic Reviews up to March 15,2021.For each association,random/fixed-effects summary effect size and 95%CIs were estimated.Heterogeneity and publication bias were also assessed.The method quality and evidence level for each publication were respectively assessed utilizing the AMSTAR and GRADE checklists.Results A total of 68 articles with 82 unique outcomes were included based on the eligibility criteria.Numerous lines of evidence indicated that OCs had effects on nearly all cardiovascular disease-related outcomes,especially for cerebral venous sinus thrombosis(OR=7.59,95%CI:3.82-15.09).Harmful associations were also found for vulvar vestibulitis(OR=2.31,95%CI:1.03-5.16),preterm birth(OR=1.17,95%CI:1.07-1.27),miscarriage(OR=1.13,95%CI:1.02-1.72),ulcerative colitis(OR=1.22,95%CI:1.06-1.41),Crohn's disease(OR=1.24,95%CI:1.09-1.40),alveolar osteitis(RR=1.86,95%CI:1.66-2.08),dry socket(RR=1.8,95%CI:1.33-2.43),and interstitial cystitis(OR=2.1,95%CI:1.26-3.49).However,oral contraceptives did not increase the risk of cancer except breast and cervical cancer.Maternal exposure to OCs was linked to an increased risk for the development of respiratory atopic disorders such as asthma(OR=1.1,95%CI:1.02-1.19)and rhinitis(OR=1.34,95%CI:1.07-1.68).Conclusion In summary,although their use obviously reduces the risk of pregnancy-and parturition-related morbidity and mortality for women,OCs were frequently related to more harm than benefit in terms of other health outcomes.This was true for both women and their descendants in this umbrella review.More large-scale prospective studies analysing different doses,structures,and durations of treatment with estrogen and progestin are needed to confirm these effects.
文摘Background: There is growing evidence suggesting that those who suffer traumatic injury display high levels of perceived injustice which impedes their recovery, both physically and mentally. Aim: The aim of this systematic review was to examine the association between perceived injustice and pain-related, mental health and functional outcomes in patients who have suffered a traumatic injury. Methods: In May 2023, a systematic review of the literature was performed on the electronic databases of PubMed, Google Scholar, Embase, and the Cochrane Database of Systemic Reviews. Papers were collected and analysed as per PRISMA guidelines for systematic reviews. The outcomes of interest were pain intensity, pain interference, disability, depression, anxiety, and quality of life. The initial search identified 59 papers. Of these papers, five studies met the inclusion criteria and were subsequently analysed (N = 1172). Each of the papers was published in peer-reviewed journals in the English language. Individuals with pain or pathology prior to the trauma and those who were not hospitalised following the trauma were excluded from the study. Results: Of the papers reviewed, each study indicated significant associations between perceived injustice and pain, disability, depression, anxiety, post-traumatic stress disorder, as well as reduced return to work status. Conclusion: This systematic review investigated the relationship between perceived injustice and pain-related, mental health, and functional outcomes in trauma patients. The results highlight the negative role that perceived injustice has on recovery following traumatic injury. Further, it provokes the need for future research regarding the implementation of therapeutic interventions and the development of predictive models of injustice.
基金This research did not receive any specific grant from funding agencies in the public,commercial,or non-profit sectors
文摘Objective:To identify the effects of health literacy levels on health outcomes in patients with diabetes in a type V health center in Western Jamaica.Method:A correlational survey design with a random sampling technique was used.An 18-item questionnaire and the Newest Vital Sign tool were administered to 88 consenting adults with diabetes to assess their health literacy levels.Their health outcomes were evaluated with docket review.Data were analyzed using SPSS version 18.Results:The participants were predominantly female(77.3%),aged 51-70 years,married(44%),employed(46%),and diagnosed with diabetes>10 years(42%).Only 13.6%of the study population was adequately health literate.The health literacy scores for gender were not significant(P=0.84).The health literacy scores of the patients with different ages and educational levels were significant(P<0.001).Pearson's correlations revealed no linear relationship between health literacy scores and health outcome(r=0.185,P=0.084).Conclusion:Limited health literacy and high likelihood of limited health literacy are predominant in the study population.Age and educational level are significantly associated with health literacy levels.However,these findings suggest no association between health literacy level and diabetic health outcomes.
基金supported by grants from the National Science Foundation of China(32200536,32288101)Shanghai Municipal Science and Technology Major Project(2023SHZDZX02,2017SHZDZX01)+1 种基金the Science and Technology Development Fund of Shanghai Pudong New Area(PKJ2023-Y04)the Key Specialty Construction Project of Pudong Health and Family Planning Commission of Shanghai(PWZxk2022-01).
文摘Lifestyle factors play a critical role in promoting healthy aging and extending life expectancy Lifestyle factors(Zhao et al.2023,2022;Ofori-Asenso et al.2019).However,the biological mechanisms through which lifestyle modifications mitigate adverse health outcomes have not yet been fully elucidated.
基金the National Natural Science Foundation of China(grant nos.32222042,82225031,82172464,82172453,81972086)the National Key Research and Development Program of China(2023YFC2509600)+1 种基金the Program of Shanghai Excellent Aca-demic Leader(grant no.22XD1401900)the Shanghai Shuguang Plan Project,and the Shanghai“Rising Stars of Medical Talent”Youth Development Program:Outstanding Youth Medical Talents.
文摘Background:Metallic biomaterials have transformed modern medicine,with copper(Cu),zinc(Zn),and selenium(Se)emerging as critical components in medical applications.The study of the single and synergistic effects of serum metal concentrations on human health can provide valuable insights for future clinical transformation of biodegradable alloys.Methods:We evaluated 2381 NHANES 2011-2016 participants to study individual and combined effects of these metals on health outcomes.Multivariable logistic regression,restricted cubic splines,and piecewise linear regression were used to examine linear,nonlinear,and threshold relationships.Overall metal mixture effects were assessed using weighted quantile sum(WQS)and Bayesian kernel-machine regression(BKMR).Results:Elevated serum Cu levels were significantly associated with an increased risk of osteoarthritis.When Serum Cu≥99.48μg/dL,each 1-unit increase in Ln Cu raised diabetes risk 4.55-fold.For Se≥122.74μg/L,each 1-unit increase in Ln Se led to a 29.96-fold rise in diabetes prevalence,for Se<157.56μg/L it increased heart attack risk 165.19-fold.Furthermore,mixtures of Cu,Se,and Zn were positively associated with diabetes,hy-pertension,and heart attack risks;each unit increase in the mixture corresponded to a 23%rise in diabetes and a 15%rise in hypertension prevalence.Conclusions:Serum Cu levels≥99.48μg/dL are significantly linked to diabetes risk,while serum Se levels≥122.74μg/L are associated with diabetes risk and levels<157.56μg/L with elevated heart attack risk.Serum metal mixtures containing Cu,Se and Zn were significantly and positively associated with risk of diabetes,hy-pertension and heart attack.
基金supported by National Natural Science Foundation of China[grant numbers 51931001,51631009,51431002,51871004]NSFC/RGC Joint Research Scheme[grant number 51661165014]Shanghai"Rising Stars of Medical Talent"Youth Development Program(Youth Medical Talents-Specialist Program).
文摘Background:Zinc-based biomaterials,including biodegradable metal,nanoparticles,and coatings used in medical implants release zinc ions that may increase the whole-body and serum zinc concentrations.The impact of serum zinc concentrations on major health outcomes can provide insights for device design and clinical transformation of zinc-based biomaterials.Methods:This nationally representative cross-sectional study enrolled participants from the National Health and Nutrition Examination Survey(NHANES,2011-2014)including 3607 participants.Using unadjusted and multivariate-adjusted logistic regression analyses,two-piecewise linear regression model with a smoothing function and threshold level analysis,we evaluated the associations between elevated serum zinc levels and major health outcomes.Results:Elevated serum zinc levels were significantly associated with an increase in total spine and total femur bone mineral density(BMD).Every 10μg/dL increase was associated with a 1.12-fold increase in diabetes mellitus(DM)and 1.23-fold and 1.29-fold increase in cardiovascular diseases(CVD)and coronary heart disease(CHD),in participants with serum zinc levels≥100μg/dL.It had no significant linear or nonlinear associations with risk of fractures,congestive heart failure,heart attack,thyroid disease,arthritis,osteoarthritis,rheumatoid arthritis,dyslipidemia and cancer.Conclusion:Serum zinc levels are significantly associated with increased BMD in the total spine and total femur,and risk of DM,and CVD/CHD among participants with serum zinc levels≥100μg/dL.
基金supported by the National Key Research and Development Program(Grant Nos.2020YFC0861100 and 2020YFC0845000)the Strategic Priority Research Program of the Chinese Academy of Sciences(Grant No.XDB29050100)+1 种基金the Scientific Research Fund of Traditional Chinese Medicine of Hubei Health Commission(Grant No.ZY2021M035)the Youth Innovation Promotion Association of CAS.
文摘Gut microbiota composition is suggested to associate with coronavirus disease 2019(COVID-19)severity,but the impact of gut microbiota on health outcomes is largely unclear.We recruited 81 individuals from Wuhan,China,including 13 asymptomatic infection cases(Group A),24 COVID-19 convalescents with adverse outcomes(Group C),31 severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)re-positive cases(Group D),and 13 non-COVID-19 healthy controls(Group H).The microbial features of Groups A and D were similar and exhibited higher gut microbial diversity and more abundant short-chain fatty acid(SCFA)-producing species than Group C.Group C was enriched with opportunistic pathogens and virulence factors related to adhesion and toxin production.The abundance of SCFA-producing species was negatively correlated,while Escherichia coli was positively correlated with adverse outcomes.All three groups(A,C,and D)were enriched with the mucusdegrading species Akkermansia muciniphila,but decreased with Bacteroides-encoded carbohydrate-active enzymes.The pathways of vitamin B6 metabolic and folate biosynthesis were decreased,while selenocompound metabolism was increased in the three groups.Specifically,the secondary bile acid(BA)metabolic pathway was enriched in Group A.Antibiotic resistance genes were common among the three groups.Conclusively,the gut microbiota was related to the health outcomes of COVID-19.Dietary supplementations(SCFAs,BA,selenium,folate,vitamin B6)may be beneficial to COVID-19 patients.
基金supported by the Bio&Medical Technology Development Program of the National Research Foundation(NRF)&funded by the Korean government(MSIT)(NRF-2021M3A9E4080780)Hankuk University of Foreign Studies(2024).
文摘Objectives:Recent research has shown that college students experience high levels of stress from various sources,which contribute to heightened rates of psychological distress and make them particularly vulnerable to mental health issues.Hence,we conducted a study,aimed to analyze the influence of a mobile-based walking routine on mental health outcomes,such as perceived stress and positive and negative affect.Methods:The participants were divided into two groups:the walking group(N=23)and the control group(N=24).The walking group engaged in an approximately 25-min walking session for at least 3 days per week,which was carefully monitored and facilitated with the help of the Nike Run Club application.The statistical analysis of the quantitative data was carried out with the help of SPSS 25.0.In addition to calculating descriptive statistics,we conducted an independent samples t-test,a repeated-measures ANOVA,and a paired sample t-test to analyze the effectiveness of the intervention.Results:A repeated-measures ANOVA revealed that the walking group exhibited significant reductions in perceived stress(t=2.03,p=0.049,Cohen’s D=0.60)and negative affect(t=2.19,p=0.033,Cohen’s D=0.65)after the intervention,whereas the control group showed no significant changes across time in any of the proposed variables.Conclusion:The results of the study continue to be indicative of the positive effects of regular walking on perceived stress and negative affect,preserving its role as a straightforward and accessible tool for reducing stress and negative affect.
文摘Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.
基金supported by a Career Development Award awarded to Dr. Merritt from the VA Clinical Science Research&Development Service (IK2 CX001952)Dr. Clark received start-up funds from the University of Texas at Austin that further supported this work。
文摘Background Examining the health outcomes of veterans who have completed the United States Veterans Health Administration’s(VHA’s)Traumatic Brain Injury(TBI)Screening and Evaluation Program may aid in the refinement and improvement of clinical care initiatives within the VHA.This study compared self-reported physical functioning,cardiometabolic health conditions,and health care utilization patterns in Million Veteran Program enrollees with TBI Screening and Evaluation Program data(collected between 2007 and 2019),with the goal of enhancing understanding of potentially modifiable health conditions in this population.Methods In this observational cohort study,veterans(n=16,452)were grouped based on the diagnostic outcome of the TBI Screening and Evaluation Program:1)negative TBI screen(Screen^(-));2)positive TBI screen but no confirmed TBI diagnosis[Screen^(+)/Comprehensive TBI Evaluation(CTBIE)^(-)];or 3)positive TBI screen and confirmed TBI diagnosis(Screen^(+)/CTBIE^(+)).Chi-square tests and analysis of covariance were used to explore group differences in physical functioning,cardiometabolic health conditions,and health care utilization patterns,and logistic regressions were used to examine predictors of Screen^(+/-)and CTBIE^(+/-)group status.Results The results showed that veterans in the Screen^(+)/CTBIE^(-)and Screen^(+)/CTBIE^(+)groups generally reported poorer levels of physical functioning(P’s<0.001,np2=0.02 to 0.03),higher rates of cardiometabolic health conditions(P’s<0.001,φ=0.14 to 0.52),and increased health care utilization(P’s<0.001,φ=0.14 to>0.5)compared with the Screen-group;however,health outcomes were generally comparable between the Screen^(+)/CTBIE^(-)and Screen^(+)/CTBIE^(+)groups.Follow-up analyses confirmed that while physical functioning,hypertension,stroke,healthcare utilization,and prescription medication use reliably distinguished between the Screen-and Screen^(+)groups(P’s<0.02,OR’s 0.78 to 3.38),only physical functioning distinguished between the Screen^(+)/CTBIE^(-)and Screen^(+)/CTBIE^(+)groups(P<0.001,OR 0.99).Conclusions The findings suggest that veterans who screen positive for TBI,regardless of whether they are ultimately diagnosed with TBI,are at greater risk for negative health outcomes,signifying that these veterans represent a vulnerable group that may benefit from increased clinical care and prevention efforts.
文摘The essential consideration is the cornerstone of a solid medical care system that provides outstanding health outcomes at a low cost. Medical therapy has evolved over the previous century from concentrating on random etiologies to lifestyle, race, and environmental factors. The aim behind these changes is to serve the public health requirements by delivering frequent and easy services based on the individual, couple, or family. Accurate evaluation of the magnitude by which primary health care contributes to the health care system is essential to the improvement of these contributions and determining next step considerations. The number one factor has been associated with greater access to medical care, better health outcomes, and reduced hospitalization and ER (emergency room) visits. The number one consideration may also help balance the adverse effects of poor financial situations on well-being. Therefore, we need more primary care doctors in the US. Research is also necessary to understand which essential consideration models provide acceptable health results.
文摘Background Heart failure(HF)is a chronic,impactful condition on individuals and healthcare systems,requiring management that goes beyond inpatient care.This study investigated the impact of cardiovascular specialist nurses on long-term health outcomes and patient satisfaction in HF outpatient care.Methods In a year-long observational study from July 2021 to July 2022,230 HF patients at our hospital were divided into an experimental group(n=115)receiving care from cardiovascular specialist nurses and a control group(n=115)managed by general nursing staff.The interventions included comprehensive care such as patient education,medication management,lifestyle guidance,symptom monitoring,and psychological support.The major adverse cardiovascular events(MACEs)and rehospitalization rates were applied as the primary endpoints.Results The experimental group demonstrated significantly fewer MACEs and lower rehospitalization rates compared to the control group(P<0.001).Higher patient satisfaction was observed in the experimental group,with 81.7%reporting high satisfaction vs.53.9%in the control group(P<0.001).Differences in incidence of myocardial infarction and death rates between the groups were not statistically significant.Conclusions The involvement of cardiovascular specialist nurses in HF outpatient care significantly enhances clinical outcomes and patient satisfaction.These nurses play a key role in bridging the transition from hospital to home care,improving adherence to treatment regimens,and reducing healthcare system burdens.
基金supported by the National Natural Science Foundation of China(No.81073163)
文摘OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China National Knowledge Infrastructure databases was conducted. The resulting articles that met the defined inclusion and exclusion criteria were used for analysis. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine have been used in fundamental and theoretical research, and 14 of these were also used in 29 clinical trials that were randomized controlled trials, or descriptive or cross-sectional studies. In 2 152 Chinese medicine-based studies that used instruments in their methodology, more than 150 questionnaires were identified. Among the identified questionnaires, 51 were used in more than 10 articles （0.5%）. Most of these instruments were developed in Western countries and few studies （4%） used the instrument as the primary evidence for their conclusions. CONCLUSION： Usage of instruments for health outcome assessment in Chinese medicine is increasing rapidly; however, current limitations include selection rationale, result interpretation and standardization, which must be addressed accordingly.
基金funded as part of Chinese Government Scholarship(CSC 2016GXYX07).
文摘Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted in Ibadan North Local government,Southwest Nigeria the study examined the influences of maternal perceived self-efficacy(MPSE)and maternal perceived vulnerability(MPV)on child health outcomes(CHO).Methods:The study appraised data from 683 nursing mothers aged 15-45 obtained from 20 major primary healthcare centers in the region undergoing routine health checks for their children.Three regression models were fitted to examine the effects of MPV,MPSE,and confounding variables of maternal preventive actions such as insecticide-treated nets(ITN)usage and child immunization,among other maternal and child sociodemographic attributes on CHO.Results:The study finds that MPV has no correlation with CHO and MPSE but positively correlates with maternal age(r=0.123,P<0.05).However,CHO has a negative correlation with MPSE(r=-0.200,P<0.05)while positively correlated with child age(r=0.134,P<0.05).MPSE has a unique effect on CHO(β=-0.203,P<0.05),maternal preventive action of ITN usage show a positive association with CHO in the study Model 2(β=-0.163,P<0.05),while in Model 3,child's age has a positive association with CHO(β=0.180,P<0.05).The net effect of the study models accounted for approximately 10%of the variance in CHO reported among the children.Conclusion:Overall,MPSE and ITN usage are essential factors for understanding and reducing the potential adverse CHO.Global effort must continue to improve maternal education to support child health and preventive carepractices in SSA.
