BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive c...BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive care unit(ICU)admission and compared it with the Acute Physiology and Chronic Health Evaluation(APACHE)II score.There are no studies comparing its accuracy with APACHE III score.AIM To describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.METHODS We conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney.We included all adult patients(age>16 years)admitted to ICU with COVID-19 infection over a 5-month period(July 1,2021 to November 30,2021).We collected the data on demographics,clinical characteristics,interventions and outcomes for all patients.We calculated the 4C Mortality Score for each patient using eight variables as described previously.We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve(AUROC).We determined the optimal cut-off value for each of these scores using the‘nearest’method and its 95%confidence interval by bootstrapping.RESULTS A total of 140 patients(62%males,mean age 56±17 years,mean APACHE II score 13±57)were included in the study.Nineteen(13.6%)of 140 patients died in the hospital.Compared to survivors,the non-survivors were older,males,had more comorbidities,higher rate of mechanical ventilation and vasopressor use.The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75,0.80.0.75 and 0.79 respectively.The optimal cut-off value for these four scores was 9,10,14 and 56 respectively.The cut-point for all the scores had higher sensitivity than specificity.CONCLUSION The 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission.The predictive accuracy was similar to that for APACHE III score.The 4C score at ICU admission needs to be validated in future studies.展开更多
This paper proposes a health evaluation method for degrading systems subject to competing risks of dependent soft and hard failures. To characterize the time-varying degradation rate, the degradation process is determ...This paper proposes a health evaluation method for degrading systems subject to competing risks of dependent soft and hard failures. To characterize the time-varying degradation rate, the degradation process is determined by a non-stationary Gamma process and the soft failure is encountered when it exceeds a predefined critical level. For the hard failure, a Cox’s proportional hazard model is applied to describe the hazard rate of the time to system failure. The dependent relationship is modeled by incorporating the degradation process as a time-varying covariate into the Cox’s proportional hazard model. To facilitate the health characteristics evaluation, a discretization technique is applied both to the degradation process and the monitoring time.All health characteristics can be obtained in the explicit form using the transition probability matrix, which is computationally attractive for practical applications. Finally, a numerical analysis is carried out to show the effectiveness and the performance of the proposed health evaluation method.展开更多
[Objective] The aim of this study was to evaluate the effect of livestock exclusion on the health of grassland ecosystem accurately and quantitatively. [Method] One open grazing site and five seasonal exclusion sites,...[Objective] The aim of this study was to evaluate the effect of livestock exclusion on the health of grassland ecosystem accurately and quantitatively. [Method] One open grazing site and five seasonal exclusion sites, which had the same vegetation composition （taking Leymus chinensis and Stipa krylovii as main species） and soil type, were chosen as research objects for the VOR and CVOR evaluation of the effect of open grazing and livestock exclusion on the health of typical steppes, and for building the calculation model for VOR and CVOR indices to evaluate the health of typical steppes with different exclusion periods. [ Result] The VOR and CVOR composite indices both could accurately evaluate the health of typical steppes, and the evaluation results from the both indices were quite consistent. Although the condition （C）, vigor（V）, organization （O） and resilience（ R ） indices changed differently in different exclusion periods, the VOR and CVOR composite indices increased gradually with the peri- od of exclusion prolonged, and the health condition of typical steppe changed from ＂alert＂ level （in the open grazing and earlier exclusion period） to ＂healthy＂ level （after 13 to 20 years＇exclusion）. [ Conclusion] The application of exclusion was beneficial to the recovery of degraded grassland ecosystem.展开更多
Background The One Health approach recognizes the interconnectedness of human,animal,and environmental health to address global health threats.While the global One Health Index(GOHI)has been applied nationally,its ada...Background The One Health approach recognizes the interconnectedness of human,animal,and environmental health to address global health threats.While the global One Health Index(GOHI)has been applied nationally,its adaptation to sub-national contexts remains unexplored.This study aimed to adapt GOHI to construct localized indi‑cators for Fukuoka,Japan,and assess One Health implementation across municipalities.Methods The research followed a three-phase approach:(1)Indicator Selection,where 34 indicators were selected from GOHI and Fukuoka One Health Promotion Action Plan through expert consultation;(2)Data Collection and Score Standardization using robust scaling methods;and(3)Weight Determination using Fuzzy Analytic Hier‑archy Process.Fukuoka One Health Index(FOHI)scores were computed and analyzed using descriptive statistics and Latent Class Analysis(LCA).Results The mean FOHI score was 52.27(range:41.01-63.71),with the lowest average score in Core Drivers Index(47.11)compared to Internal Drivers Index(59.17)and External Drivers(50.43).Municipalities performed strong‑est in zoonotic disease management(72.33)but weakest in One Health governance(6.36).Miyama City achieved the highest overall score,demonstrating strong governance and integrated implementations.LCA identifed two municipal classes diferentiated by External Drivers Index scores with clear geographic clustering.Conclusions This study demonstrated the feasibility of adapting GOHI to municipal settings and revealed signifcant variation in One Health implementation across Fukuoka’s municipalities.Performance gaps were identifed,particu‑larly in One Health governance despite strong health infrastructure.The methodology ofers a blueprint for similar adaptations globally,potentially accelerating the operationalization of One Health principles in local governance contexts.展开更多
BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To...BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To provide fair organ distribution,predictive mortality scores have been developed.AIM To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of mortality.METHODS Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.RESULTS The transplant recipients were mainly male,with a mean age of 58.1 years.Donors were mostly male,with a mean age of 41.6 years.The median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 days.For APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD 24.2.The 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<0.008.At 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and survivors.As for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.展开更多
BACKGROUND Cytokines and inflammatory mediators are the key factors that are involved in the pathology of sepsis.Extracorporeal cytokine hemoadsorption devices offer an innovative clinical support system to alleviate ...BACKGROUND Cytokines and inflammatory mediators are the key factors that are involved in the pathology of sepsis.Extracorporeal cytokine hemoadsorption devices offer an innovative clinical support system to alleviate the effects of the cytokine storm associated with sepsis.AIM To retrospectively evaluate the efficacy of CytoSorb^(R)therapy as an adjunct to standard care in intensive care unit(ICU)patients with septic shock.METHODS A retrospective study was designed.Data were obtained for the patients who were treated with the CytoSorb^(R)adsorber for the past 5 years.The effects of therapy were assessed by changes in vasopressor requirements,specifically,norepinephrine and epinephrine.In addition,cytokine levels,such as interleukin(IL)-6 and inflammatory biomarkers including C-reactive protein(CRP),procalcitonin,as well as substances such as serum lactate and lactate dehydrogenase were also evaluated.In addition,mean arterial pressure(MAP)and ventilator requirements were also recorded.The survival outcomes were analyzed based on the length of patients'stay in the ICU,and the severity of illness was assessed using Acute Physiology and Chronic Health Evaluation(APACHE II)and Sepsisassociated Organ Failure Assessment(SOFA)scores recorded at baseline and post-therapy.RESULTS Following CytoSorb^(R)therapy,the requirement for vasopressor drugs,particularly norepinephrine,was reduced by 40%and a statistically significant improvement in MAP by 7.8%.Additionally,significant reductions were observed in IL-6 and serum lactate levels by 83%and 52%respectively.Around 56%had a delta lactate score of>1.5,while 23%patients had a score ranging from 1 to<1.5,and 16%patients had a score between 0.5 and<1 and merely 5%patients had a score of≤0.5.Besides,serum levels of creatinine,procalcitonin and CRP were significantly reduced by 17.2%,41.5%and 53.8%respectively.There was a significant reduction in scores,including APACHE II[to 23(18-29)from 27(23-33)],and SOFA[to 12(10-14)from 13(11-15)].Mechanical ventilation was required by 96%patients,with a median duration of 12 days,and the median length of hospital stay in overall patients was 26 days,while the median ICU stay was 18 days.CONCLUSION CytoSorb^(R)therapy seems to be a promising adjunctive approach in the management of septic shock.展开更多
Gastric cancer is a global public health burden, nearly one million new cases are diagnosed per year worldwide, of which 44% of cases occur in China. The prognosis of gastric cancer varies remarkably by the stage of c...Gastric cancer is a global public health burden, nearly one million new cases are diagnosed per year worldwide, of which 44% of cases occur in China. The prognosis of gastric cancer varies remarkably by the stage of cancer, and most of the patients in China are diagnosed at advanced stages, resulting in poor prognoses. Effective strategies to reduce the burden of gastric cancer include primary prevention through testing and treatment of Helicobacter pylori(H. pylori) and secondary prevention by screening and early detection. Although many countries have issued management guidelines and consensus reports concerning these strategies, the limited availability of healthcare resources often precludes their widespread implementation. Therefore, assessing the costs, benefits, and harms of population-based intervention measures through health economic evaluation is necessary for informed health policy decisions. Accordingly, we synthesize management approaches from different countries on H. pylori eradication and endoscopic screening, and also summarize recent advancements in health economic evaluations on population-based preventive strategies. The goal of the review is to provide empirical evidence supporting optimal resource allocation, maximizing benefits for the population, and ultimately reducing the burden of gastric cancer.展开更多
A study on smoking-attributable health economic costs in China was conducted from 1988-1992, in which three major categories of chronic diseases, diseases of cancer, diseases of circulatory system, and diseases of res...A study on smoking-attributable health economic costs in China was conducted from 1988-1992, in which three major categories of chronic diseases, diseases of cancer, diseases of circulatory system, and diseases of respiratory system were included. A prevalence-based method which estimated the cumulative effect of cigarette smoking during the past 20-30years was used. The results show that in 1989, the total smoking-attributable economic costs to health sectors in China were about 27.1 billion of Chinese Yuan, including about 7 billion Yuan in direct medical costs and 20 billion Yuan in indirect costs, which include indirect morbidity costs and indirect mortality costs. The relatively low direct costs reflected the low medical costs at hospitals in China at that time. And the high proportion of indirect costs relative to the total costs shows the high potential years of life lost due to clgarette smoking. The results also show the heavier health burden in urban areas than in rural areas, reflecting the worse situation in urban China at nowadays. But if considering that almost 80% of the Chinese are rural farmers with the higher smoking prevalence and relatively shorter history of manufactured cigarette smoking than their urban counterparts,the very frightful situation due to cigarette smoking would be for China in the next century展开更多
BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Se...BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Serial assessments of health status were performed by administering the 36-Item Short Form Survey(SF-36).RESULTS Mean age was 67.5±14.3 years,left ventricle ejection fraction(LVEF)was 36.5%±15.0%and over 40%of the cohort had improved LVEF to>35%at the time of GE.SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being(P<0.001 for each comparison).Physical health scores were significantly worse among those with medical comorbidities including diabetes,chronic obstructive pulmonary disease and atrial fibrillation.Mean follow-up was 1.6±0.5 years after GE.Overall SF-36 scores remained stable across all domains during follow-up.Survival at 3 years post-GE was estimated at 80%.Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin.Four patients experienced appropriate ICD shocks after GE,three of whom had LVEF which remains impaired LVEF(i.e.,<35%)at the time of GE.CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being,which is associated with the presence of medical comorbidities.In terms of clinical outcomes,the incidence of appropriate shocks after GE among those with improvement in LVEF is very low,and most deaths post-procedure appear to be non-arrhythmic in origin.These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.展开更多
Objective: To evaluate the essential attribute of Primary Health Care, longitudinal care, care directed at children from birth to two years old. Methods: This is a descriptive and exploratory study of evaluative chara...Objective: To evaluate the essential attribute of Primary Health Care, longitudinal care, care directed at children from birth to two years old. Methods: This is a descriptive and exploratory study of evaluative character and quantitative approach, conducted with parents/caregivers of 186 children, younger than two years old, patients of primary health care services in the city of Santa Cruz/RN, Brazil. For data collection, the instrument Primary Care Assessment Tools (PCA Tools) was used, and the results of the questions dealing with longitudinal attribute were evaluated. The data were stored and processed in Statistical Package for Social Sciences (SPSS). The study was approved by the Research Ethics Committee of the Health Sciences School of Trairí, under number 348896. Results: The mean age of children in months was 8.21;84.4% (n = 157) were assisted by the same doctor/nurse every time;in 81.7% (n = 152) of cases the doctor/nurse know the full medical history of the child;73.7% (n = 137) answered that the professional know their child more as a person than just as someone with a health problem;48.9% (n = 91) stated that the doctor/nurse do not know their family very well;86.6% (n = 161) reported finding the doctor/nurse understands what is saying or questioning;96.2 (n = 179) of respondents said the doctor/nurse answers the questions so that they understand;96.2% (n = 179) of the interviewed said they feel comfortable telling the concerns or problems of their child to the doctor/nurse;66.7% (n = 124) claimed that they would not change the service/doctor/nurse to another health service. Conclusion: It is concluded that the attribute was well rated by the mothers of children seen in primary health care services and that they can establish good communication and relationship with the health professionals who treat their children.展开更多
To better evaluate the three-dimensional bay health and predict the dynamic bay health conditions, a concept of numerical bay health was introduced and a method of numerical bay health evaluation（NBHE） was developed...To better evaluate the three-dimensional bay health and predict the dynamic bay health conditions, a concept of numerical bay health was introduced and a method of numerical bay health evaluation（NBHE） was developed.To support the NBHE method, a numerical bay health index（NBHI） system was constructed, which assess the natural and socio-economic effects on the entire bay. Five index groups are combined to formulate the NBHI,including geometry, hydrodynamics and sediment dynamics, bio-ecology, water quality and socio-economy.Each group has different number of indices selected and weighted using AHP method according to their importance. Data were mainly synthesized from a variety of numerical models together with monitoring programs, which provide superior to other approaches in discriminating data integrity and predicting data in future. The NBHE method using NBHI system was applied in the Yueqing Bay during spring tide in April 2007.According to the NBHE results, Sta. A, at the surface level of the estuarine mouth, has a healthy geometry condition, sub-healthy hydrodynamic and sediment dynamic condition, and unhealthy water quality and bioecology conditions. The integrated healthy score at Sta. A indicates its sub-healthy condition.展开更多
Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will prop...Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will propose improvement in the offered assistance. Methods: This is a quantitative and evaluative study made in the municipality of Santa Cruz, State of Rio Grande do Norte, Brazil, with a sample of 180 people. The study was approved by the Ethics and Research Committee of the Federal University of Rio Grande do Norte under Opinion number 152/2012. Results: It was found that the adult population classified the quality of care from regular to good, showing an association with the waiting time, time spent from the unit to one’s house and the reception. Conclusions: It could be concluded that this study contributes to the development of strategies able to provide a full and equitable care to the adult population in the primary health care network, since this is the gateway to other levels of care, because it aims to promote adult health and prevent diseases.展开更多
To grasp the characteristics of Pb, Cd, Cu and Zn in mulberry garden soil in Longchuan County, Yunnan Province, the single-factor pollution index method and multi-factor pollution index method were used to analyze the...To grasp the characteristics of Pb, Cd, Cu and Zn in mulberry garden soil in Longchuan County, Yunnan Province, the single-factor pollution index method and multi-factor pollution index method were used to analyze the environmental quality of mulberry garden soil. The results showed that the Zn content in mulberry soils did not exceed normal water based on the soil pollution risk control standards for agricultural land, but the Cd content was high. The single factor pollution index of Pb and Cu did not exceed 2, and the exceedance rate of points was 16% and 24% respectively, while the single factor pollution index of Cd exceeded 3. The pollution of heavy metal Cd existed in the soil of mulberry garden. The average Pi values of soil heavy metals were ranked as Cd > Cu > Zn > Pb. Heavy metal combined pollution index of 6.58, pollution level of heavy pollution. Principal component analysis (PCA) of the four heavy metals showed that the two elements, Pb and Cu, were strongly correlated in their spatial distribution. Longchuan County mulberry soil heavy metal environmental quality evaluation, for the safe use of soil to provide a scientific reference basis.展开更多
Objective: To assess comprehensive care in the elderly population, as well as the quality of care in Primary Health Care. Methods: This is an exploratory descriptive study with a quantitative approach, conducted from ...Objective: To assess comprehensive care in the elderly population, as well as the quality of care in Primary Health Care. Methods: This is an exploratory descriptive study with a quantitative approach, conducted from July to December 2012, in the city of Santa Cruz, Rio Grande do Norte, Brazil. A sample of 130 subjects chosen by drawn was calculated, and data collection was performed at their homes. Results: There were interviewed 130 people, 92 (70.8%) women and 38 men (29.2%), with a minimum age of 60 and maximum of 96 years, with a mean of 72.8, median of 72.0 and a standard deviation of 8.3. Regarding the quality of care ratings of the PHC team, 48.5% (n = 63) of respondents stated this to be good, while 32.3% (n = 42) rated this as fair. Conclusions: In this perspective, one of the most appreciated meanings that were given to comprehensive care by health care professionals refers to holistic knowledge of each patient, resulting in the non-fragmentation of care. Thus, it is noticed that comprehensiveness has some weaknesses that need to be corrected, which shows the need for education and training of professionals assigned to primary health care services.展开更多
The importance-performance analysis method (IPA) is used in market research in order to measure the level of customer satisfaction. The aim of this study was to evaluate and highlight the use of IPA as a management to...The importance-performance analysis method (IPA) is used in market research in order to measure the level of customer satisfaction. The aim of this study was to evaluate and highlight the use of IPA as a management tool to measure quality of dental services. We suggest that this method can be easily implemented in a dental educational setting, as a performance outcome measure that includes patient input. The study was conducted in a dental service through a valid questionnaire, SERVQUAL. This instrument explores levels of service quality perceived by patients. It was conducted in four companies in Brazil in 2011 (derived from different industry segments;two from textiles, one from hospital care and the other from the manufacturing industry) in two States (S?o Paulo and Minas Gerais). These companies were covered by the same dental managed care organization which contracted with independent dentists to provide care. The study was divided into two stages: the first, in which beneficiaries answered the questionnaire prior to receiving dental treatment, and the second when the same beneficiaries answered after completing their dental treatment. Data obtained from SERVQUAL generated graphs that were used to characterize the IPA matrix using several dimensions of care. The Assurance Dimension had the highest average in both expectation and perception. The Reliability dimension showed the value of the most negative GAP among the dimensions, and the best value occurred in the Responsiveness dimension. The IPA tool may be effective in Dental Medicine since it highlights the key points to be improved in the delivery of dental services in a clinical setting.展开更多
This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We co...This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We consider the most important service providers corresponding to the main health institutions in Mexico (IMSS, ISSSTE, SESAS, IMSS-Oportunidades). Therefore, a cross-sectional prospective study was conducted to analyze eight intervention packages (Prenatal Care, Syphilis, Influenza, Obstetric Urgent Care, HIV in pregnancy, delivery care, neonatal care and accessibility) offered by the Maternal and Perinatal Health (MPH) program. A quantitative analysis demonstrates low to marginal performance of the MPH program in three regions (South, Mexico City-State of Mexico and the Northwest) and marginal in two other regions (Central and Northeast). Furthermore, four of the intervention packages presented the lowest performance in the South (Prenatal Care, Syphilis, Influenza and Obstetric Urgent Care), as did the average of the total of the MPH packages. The performance of HIV in Pregnancy package was marginal in the Southern and Mexico City-State of Mexico regions and Neonatal Care was low in the Northwest. The assessment of the MPH intervention packages allows us to identify their strengths and weaknesses. This information allows us to identify similarities and differences among the geographical regions in order to describe and analyze the strengths, weaknesses, opportunities and threats in the current system and hence to improve the decision making regarding the Maternal and Perinatal Health Programs in Mexico. The results suggest that a homogenization has taken place in terms of the low quality of the services.展开更多
Objective To evaluate the economy of detecting gastric cancer by electronic gastroscope in Chinese natural population of different ages and genders.Methods A Markov model was constructed for the population,including b...Objective To evaluate the economy of detecting gastric cancer by electronic gastroscope in Chinese natural population of different ages and genders.Methods A Markov model was constructed for the population,including both men and women of different ages.The model cycle was one year and the simulation time was 60 years.The cost-effectiveness of electronic gastroscopy in detecting gastric cancer of general population in China was analyzed from the perspective of the whole society,and the stability of the results was verified by sensitivity analysis.Results and Conclusion For the general population,the incremental cost-effectiveness ratio(ICER)of gastric cancer screening from the age of 50 is 50143 yuan/QALY(quality-adjusted life-year),which is less than two times of per capita gross domestic product(GDP)compared with the screening from the age of 55.For men who start gastric cancer screening at the age of 50,the ICER is 38525 yuan/QALY,which is less than two times of per capita GDP,and it is economical.For women who start the screening from the age of 55,the ICER is 47814 yuan/QALY,which is less than two times of per capita GDP,so it is economical.The results of sensitivity analysis are consistent with the conclusions of basic analysis,and the results of basic analysis are stable.For the general population,it is more economical to start gastric cancer screening from the age of 50,while for men and women,it is more economical to start gastric cancer screening from the age of 50 and 55,respectively.展开更多
Body mass index(BMI),with its simple formula of weight divided by height squared,has become a cornerstone tool in global public health for assessing obesity and health risks.However,as populations aging and the demand...Body mass index(BMI),with its simple formula of weight divided by height squared,has become a cornerstone tool in global public health for assessing obesity and health risks.However,as populations aging and the demand for precise health evaluation grows,the limitations of this single metric have become increasingly apparent—it fails to distinguish between muscle and adipose tissue and cannot capture the complex relationship between inflammatory status and body composition.A recent study published in Biomedical and Environmental Sciences(BES)by Zhang et al.[1],which explores the association of white blood cell(WBC)count,platelet(PLT)count,and platelet-to-white blood cell ratio(PWR)with muscle mass among Chinese communitydwelling older adults,provides critical evidence for rethinking the role of BMI.Additionally,several studies published in BES,spanning from childhood nutrition to adult metabolism,further illuminate the complexity of health assessment[2−5].Building on these findings and integrating evidence from multiple Chinese population studies,this commentary revisits the historical context,utility,inherent limitations,and future directions of this classic indicator.展开更多
This letter provides a critical appraisal of the comprehensive meta-analysis by Hou et al,which synthesizes the incidence and risk factors for postoperative delirium(POD)in organ transplant recipients.Their work estab...This letter provides a critical appraisal of the comprehensive meta-analysis by Hou et al,which synthesizes the incidence and risk factors for postoperative delirium(POD)in organ transplant recipients.Their work establishes a pooled POD incidence of 20%,with significant variability across organ types(lung 34%,liver 22%,kidney 6%),and identifies key risk factors including primary graft dysfunction,hepatic encephalopathy,and high model for end-stage liver disease/acute physiology and chronic health evaluation Ⅱ scores.This commentary acknowledges the study's strength in providing a robust,trans-organ synthesis of current evidence.However,it critically discusses the substantial heterogeneity,the counterintuitive non-significance of age as a risk factor,and the unavoidable limitation of unmeasured confounders inherent in meta-analyses,such as preoperative cognitive/psychiatric status and anesthetic protocols.While the findings provide an essential evidence base for risk stratification and prevention,this letter argues that the high heterogeneity underscores the need for organ-specific analysis and calls for large-scale,prospective studies with standardized protocols to translate these findings into reliable clinical prediction tools and targeted interventions.展开更多
BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red bloo...BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.展开更多
文摘BACKGROUND Previous studies have reported the high predictive accuracy of 4C Mortality Score derived at hospital admission in coronavirus disease 2019(COVID-19)patients.Very few studies have assessed it at intensive care unit(ICU)admission and compared it with the Acute Physiology and Chronic Health Evaluation(APACHE)II score.There are no studies comparing its accuracy with APACHE III score.AIM To describe the characteristics and outcomes of patients admitted to ICU with COVID-19 infection and to compare the accuracy of 4C score and APACHE score in predicting mortality in these patients.METHODS We conducted this retrospective cohort study using an electronic database in a tertiary ICU in Sydney.We included all adult patients(age>16 years)admitted to ICU with COVID-19 infection over a 5-month period(July 1,2021 to November 30,2021).We collected the data on demographics,clinical characteristics,interventions and outcomes for all patients.We calculated the 4C Mortality Score for each patient using eight variables as described previously.We compared the predictive accuracy of 4C Mortality Score at hospital and ICU admission and APACHE II and III scores by area under the receiver operating characteristic curve(AUROC).We determined the optimal cut-off value for each of these scores using the‘nearest’method and its 95%confidence interval by bootstrapping.RESULTS A total of 140 patients(62%males,mean age 56±17 years,mean APACHE II score 13±57)were included in the study.Nineteen(13.6%)of 140 patients died in the hospital.Compared to survivors,the non-survivors were older,males,had more comorbidities,higher rate of mechanical ventilation and vasopressor use.The AUROC for the 4C Mortality Score at hospital and ICU admission and APACHE II and II score was 0.75,0.80.0.75 and 0.79 respectively.The optimal cut-off value for these four scores was 9,10,14 and 56 respectively.The cut-point for all the scores had higher sensitivity than specificity.CONCLUSION The 4C score at ICU admission had a higher accuracy in predicting mortality than the 4C score at hospital admission.The predictive accuracy was similar to that for APACHE III score.The 4C score at ICU admission needs to be validated in future studies.
基金supported by the Aeronautical Science Foundation of China(20155553039)the Natural Sciences and Engineering Research Council of Canada(RGPIN 121384-11)
文摘This paper proposes a health evaluation method for degrading systems subject to competing risks of dependent soft and hard failures. To characterize the time-varying degradation rate, the degradation process is determined by a non-stationary Gamma process and the soft failure is encountered when it exceeds a predefined critical level. For the hard failure, a Cox’s proportional hazard model is applied to describe the hazard rate of the time to system failure. The dependent relationship is modeled by incorporating the degradation process as a time-varying covariate into the Cox’s proportional hazard model. To facilitate the health characteristics evaluation, a discretization technique is applied both to the degradation process and the monitoring time.All health characteristics can be obtained in the explicit form using the transition probability matrix, which is computationally attractive for practical applications. Finally, a numerical analysis is carried out to show the effectiveness and the performance of the proposed health evaluation method.
基金supported by National Key Fundamental Research and Development Fund of China (No.2007CB106800)
文摘[Objective] The aim of this study was to evaluate the effect of livestock exclusion on the health of grassland ecosystem accurately and quantitatively. [Method] One open grazing site and five seasonal exclusion sites, which had the same vegetation composition （taking Leymus chinensis and Stipa krylovii as main species） and soil type, were chosen as research objects for the VOR and CVOR evaluation of the effect of open grazing and livestock exclusion on the health of typical steppes, and for building the calculation model for VOR and CVOR indices to evaluate the health of typical steppes with different exclusion periods. [ Result] The VOR and CVOR composite indices both could accurately evaluate the health of typical steppes, and the evaluation results from the both indices were quite consistent. Although the condition （C）, vigor（V）, organization （O） and resilience（ R ） indices changed differently in different exclusion periods, the VOR and CVOR composite indices increased gradually with the peri- od of exclusion prolonged, and the health condition of typical steppe changed from ＂alert＂ level （in the open grazing and earlier exclusion period） to ＂healthy＂ level （after 13 to 20 years＇exclusion）. [ Conclusion] The application of exclusion was beneficial to the recovery of degraded grassland ecosystem.
文摘Background The One Health approach recognizes the interconnectedness of human,animal,and environmental health to address global health threats.While the global One Health Index(GOHI)has been applied nationally,its adaptation to sub-national contexts remains unexplored.This study aimed to adapt GOHI to construct localized indi‑cators for Fukuoka,Japan,and assess One Health implementation across municipalities.Methods The research followed a three-phase approach:(1)Indicator Selection,where 34 indicators were selected from GOHI and Fukuoka One Health Promotion Action Plan through expert consultation;(2)Data Collection and Score Standardization using robust scaling methods;and(3)Weight Determination using Fuzzy Analytic Hier‑archy Process.Fukuoka One Health Index(FOHI)scores were computed and analyzed using descriptive statistics and Latent Class Analysis(LCA).Results The mean FOHI score was 52.27(range:41.01-63.71),with the lowest average score in Core Drivers Index(47.11)compared to Internal Drivers Index(59.17)and External Drivers(50.43).Municipalities performed strong‑est in zoonotic disease management(72.33)but weakest in One Health governance(6.36).Miyama City achieved the highest overall score,demonstrating strong governance and integrated implementations.LCA identifed two municipal classes diferentiated by External Drivers Index scores with clear geographic clustering.Conclusions This study demonstrated the feasibility of adapting GOHI to municipal settings and revealed signifcant variation in One Health implementation across Fukuoka’s municipalities.Performance gaps were identifed,particu‑larly in One Health governance despite strong health infrastructure.The methodology ofers a blueprint for similar adaptations globally,potentially accelerating the operationalization of One Health principles in local governance contexts.
文摘BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life.The number of organs available for transplantation is lower than the demand.To provide fair organ distribution,predictive mortality scores have been developed.AIM To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of mortality.METHODS Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.RESULTS The transplant recipients were mainly male,with a mean age of 58.1 years.Donors were mostly male,with a mean age of 41.6 years.The median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 days.For APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD 24.2.The 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<0.008.At 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and survivors.As for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.
文摘BACKGROUND Cytokines and inflammatory mediators are the key factors that are involved in the pathology of sepsis.Extracorporeal cytokine hemoadsorption devices offer an innovative clinical support system to alleviate the effects of the cytokine storm associated with sepsis.AIM To retrospectively evaluate the efficacy of CytoSorb^(R)therapy as an adjunct to standard care in intensive care unit(ICU)patients with septic shock.METHODS A retrospective study was designed.Data were obtained for the patients who were treated with the CytoSorb^(R)adsorber for the past 5 years.The effects of therapy were assessed by changes in vasopressor requirements,specifically,norepinephrine and epinephrine.In addition,cytokine levels,such as interleukin(IL)-6 and inflammatory biomarkers including C-reactive protein(CRP),procalcitonin,as well as substances such as serum lactate and lactate dehydrogenase were also evaluated.In addition,mean arterial pressure(MAP)and ventilator requirements were also recorded.The survival outcomes were analyzed based on the length of patients'stay in the ICU,and the severity of illness was assessed using Acute Physiology and Chronic Health Evaluation(APACHE II)and Sepsisassociated Organ Failure Assessment(SOFA)scores recorded at baseline and post-therapy.RESULTS Following CytoSorb^(R)therapy,the requirement for vasopressor drugs,particularly norepinephrine,was reduced by 40%and a statistically significant improvement in MAP by 7.8%.Additionally,significant reductions were observed in IL-6 and serum lactate levels by 83%and 52%respectively.Around 56%had a delta lactate score of>1.5,while 23%patients had a score ranging from 1 to<1.5,and 16%patients had a score between 0.5 and<1 and merely 5%patients had a score of≤0.5.Besides,serum levels of creatinine,procalcitonin and CRP were significantly reduced by 17.2%,41.5%and 53.8%respectively.There was a significant reduction in scores,including APACHE II[to 23(18-29)from 27(23-33)],and SOFA[to 12(10-14)from 13(11-15)].Mechanical ventilation was required by 96%patients,with a median duration of 12 days,and the median length of hospital stay in overall patients was 26 days,while the median ICU stay was 18 days.CONCLUSION CytoSorb^(R)therapy seems to be a promising adjunctive approach in the management of septic shock.
基金supported in part by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (No. ZLRK202325)a grant from National Key R&D Program of China (No. 2018YFC 1313105)。
文摘Gastric cancer is a global public health burden, nearly one million new cases are diagnosed per year worldwide, of which 44% of cases occur in China. The prognosis of gastric cancer varies remarkably by the stage of cancer, and most of the patients in China are diagnosed at advanced stages, resulting in poor prognoses. Effective strategies to reduce the burden of gastric cancer include primary prevention through testing and treatment of Helicobacter pylori(H. pylori) and secondary prevention by screening and early detection. Although many countries have issued management guidelines and consensus reports concerning these strategies, the limited availability of healthcare resources often precludes their widespread implementation. Therefore, assessing the costs, benefits, and harms of population-based intervention measures through health economic evaluation is necessary for informed health policy decisions. Accordingly, we synthesize management approaches from different countries on H. pylori eradication and endoscopic screening, and also summarize recent advancements in health economic evaluations on population-based preventive strategies. The goal of the review is to provide empirical evidence supporting optimal resource allocation, maximizing benefits for the population, and ultimately reducing the burden of gastric cancer.
文摘A study on smoking-attributable health economic costs in China was conducted from 1988-1992, in which three major categories of chronic diseases, diseases of cancer, diseases of circulatory system, and diseases of respiratory system were included. A prevalence-based method which estimated the cumulative effect of cigarette smoking during the past 20-30years was used. The results show that in 1989, the total smoking-attributable economic costs to health sectors in China were about 27.1 billion of Chinese Yuan, including about 7 billion Yuan in direct medical costs and 20 billion Yuan in indirect costs, which include indirect morbidity costs and indirect mortality costs. The relatively low direct costs reflected the low medical costs at hospitals in China at that time. And the high proportion of indirect costs relative to the total costs shows the high potential years of life lost due to clgarette smoking. The results also show the heavier health burden in urban areas than in rural areas, reflecting the worse situation in urban China at nowadays. But if considering that almost 80% of the Chinese are rural farmers with the higher smoking prevalence and relatively shorter history of manufactured cigarette smoking than their urban counterparts,the very frightful situation due to cigarette smoking would be for China in the next century
基金supported by a Pilot Translational&Clinical Studies Program grant from the National Center for Advancing Translational Studies of the National Institutes of Health(UL1TR002378)a FAME grant from the Emory University Department of Medicine。
文摘BACKGROUND Little is known about health status and quality of life(QoL)after implantable cardioverter-defibrillator(ICD)generator exchange(GE).METHODS We prospectively followed patients undergoing first-time ICD GE.Serial assessments of health status were performed by administering the 36-Item Short Form Survey(SF-36).RESULTS Mean age was 67.5±14.3 years,left ventricle ejection fraction(LVEF)was 36.5%±15.0%and over 40%of the cohort had improved LVEF to>35%at the time of GE.SF-36 scores were significantly worse in physical/general health domains compared to domains of emotional/social well-being(P<0.001 for each comparison).Physical health scores were significantly worse among those with medical comorbidities including diabetes,chronic obstructive pulmonary disease and atrial fibrillation.Mean follow-up was 1.6±0.5 years after GE.Overall SF-36 scores remained stable across all domains during follow-up.Survival at 3 years post-GE was estimated at 80%.Five patients died during follow-up and most deaths were adjudicated as non-arrhythmic in origin.Four patients experienced appropriate ICD shocks after GE,three of whom had LVEF which remains impaired LVEF(i.e.,<35%)at the time of GE.CONCLUSION Patients undergoing ICD GE have significantly worse physical health compared to emotional/social well-being,which is associated with the presence of medical comorbidities.In terms of clinical outcomes,the incidence of appropriate shocks after GE among those with improvement in LVEF is very low,and most deaths post-procedure appear to be non-arrhythmic in origin.These data represent an attempt to more fully characterize the spectrum of QoL and clinical outcomes after GE.
文摘Objective: To evaluate the essential attribute of Primary Health Care, longitudinal care, care directed at children from birth to two years old. Methods: This is a descriptive and exploratory study of evaluative character and quantitative approach, conducted with parents/caregivers of 186 children, younger than two years old, patients of primary health care services in the city of Santa Cruz/RN, Brazil. For data collection, the instrument Primary Care Assessment Tools (PCA Tools) was used, and the results of the questions dealing with longitudinal attribute were evaluated. The data were stored and processed in Statistical Package for Social Sciences (SPSS). The study was approved by the Research Ethics Committee of the Health Sciences School of Trairí, under number 348896. Results: The mean age of children in months was 8.21;84.4% (n = 157) were assisted by the same doctor/nurse every time;in 81.7% (n = 152) of cases the doctor/nurse know the full medical history of the child;73.7% (n = 137) answered that the professional know their child more as a person than just as someone with a health problem;48.9% (n = 91) stated that the doctor/nurse do not know their family very well;86.6% (n = 161) reported finding the doctor/nurse understands what is saying or questioning;96.2 (n = 179) of respondents said the doctor/nurse answers the questions so that they understand;96.2% (n = 179) of the interviewed said they feel comfortable telling the concerns or problems of their child to the doctor/nurse;66.7% (n = 124) claimed that they would not change the service/doctor/nurse to another health service. Conclusion: It is concluded that the attribute was well rated by the mothers of children seen in primary health care services and that they can establish good communication and relationship with the health professionals who treat their children.
基金The Key National Project under contract No.009zx07424-001Doctoral Fund of Ministry of Education of China under contract No.2012101110108+2 种基金MEL Visiting Fellowship Programthe Fundamental Research Funds for the Central UniversitiesZhejiang Provincial Natural Science Foundation of China under contract No.LQ16D060002
文摘To better evaluate the three-dimensional bay health and predict the dynamic bay health conditions, a concept of numerical bay health was introduced and a method of numerical bay health evaluation（NBHE） was developed.To support the NBHE method, a numerical bay health index（NBHI） system was constructed, which assess the natural and socio-economic effects on the entire bay. Five index groups are combined to formulate the NBHI,including geometry, hydrodynamics and sediment dynamics, bio-ecology, water quality and socio-economy.Each group has different number of indices selected and weighted using AHP method according to their importance. Data were mainly synthesized from a variety of numerical models together with monitoring programs, which provide superior to other approaches in discriminating data integrity and predicting data in future. The NBHE method using NBHI system was applied in the Yueqing Bay during spring tide in April 2007.According to the NBHE results, Sta. A, at the surface level of the estuarine mouth, has a healthy geometry condition, sub-healthy hydrodynamic and sediment dynamic condition, and unhealthy water quality and bioecology conditions. The integrated healthy score at Sta. A indicates its sub-healthy condition.
文摘Objectives: The goal of this project was to evaluate the quality of the accessibility of the adult population to services in Primary Health Care, with a view to contribute to the development of measures that will propose improvement in the offered assistance. Methods: This is a quantitative and evaluative study made in the municipality of Santa Cruz, State of Rio Grande do Norte, Brazil, with a sample of 180 people. The study was approved by the Ethics and Research Committee of the Federal University of Rio Grande do Norte under Opinion number 152/2012. Results: It was found that the adult population classified the quality of care from regular to good, showing an association with the waiting time, time spent from the unit to one’s house and the reception. Conclusions: It could be concluded that this study contributes to the development of strategies able to provide a full and equitable care to the adult population in the primary health care network, since this is the gateway to other levels of care, because it aims to promote adult health and prevent diseases.
文摘To grasp the characteristics of Pb, Cd, Cu and Zn in mulberry garden soil in Longchuan County, Yunnan Province, the single-factor pollution index method and multi-factor pollution index method were used to analyze the environmental quality of mulberry garden soil. The results showed that the Zn content in mulberry soils did not exceed normal water based on the soil pollution risk control standards for agricultural land, but the Cd content was high. The single factor pollution index of Pb and Cu did not exceed 2, and the exceedance rate of points was 16% and 24% respectively, while the single factor pollution index of Cd exceeded 3. The pollution of heavy metal Cd existed in the soil of mulberry garden. The average Pi values of soil heavy metals were ranked as Cd > Cu > Zn > Pb. Heavy metal combined pollution index of 6.58, pollution level of heavy pollution. Principal component analysis (PCA) of the four heavy metals showed that the two elements, Pb and Cu, were strongly correlated in their spatial distribution. Longchuan County mulberry soil heavy metal environmental quality evaluation, for the safe use of soil to provide a scientific reference basis.
文摘Objective: To assess comprehensive care in the elderly population, as well as the quality of care in Primary Health Care. Methods: This is an exploratory descriptive study with a quantitative approach, conducted from July to December 2012, in the city of Santa Cruz, Rio Grande do Norte, Brazil. A sample of 130 subjects chosen by drawn was calculated, and data collection was performed at their homes. Results: There were interviewed 130 people, 92 (70.8%) women and 38 men (29.2%), with a minimum age of 60 and maximum of 96 years, with a mean of 72.8, median of 72.0 and a standard deviation of 8.3. Regarding the quality of care ratings of the PHC team, 48.5% (n = 63) of respondents stated this to be good, while 32.3% (n = 42) rated this as fair. Conclusions: In this perspective, one of the most appreciated meanings that were given to comprehensive care by health care professionals refers to holistic knowledge of each patient, resulting in the non-fragmentation of care. Thus, it is noticed that comprehensiveness has some weaknesses that need to be corrected, which shows the need for education and training of professionals assigned to primary health care services.
文摘The importance-performance analysis method (IPA) is used in market research in order to measure the level of customer satisfaction. The aim of this study was to evaluate and highlight the use of IPA as a management tool to measure quality of dental services. We suggest that this method can be easily implemented in a dental educational setting, as a performance outcome measure that includes patient input. The study was conducted in a dental service through a valid questionnaire, SERVQUAL. This instrument explores levels of service quality perceived by patients. It was conducted in four companies in Brazil in 2011 (derived from different industry segments;two from textiles, one from hospital care and the other from the manufacturing industry) in two States (S?o Paulo and Minas Gerais). These companies were covered by the same dental managed care organization which contracted with independent dentists to provide care. The study was divided into two stages: the first, in which beneficiaries answered the questionnaire prior to receiving dental treatment, and the second when the same beneficiaries answered after completing their dental treatment. Data obtained from SERVQUAL generated graphs that were used to characterize the IPA matrix using several dimensions of care. The Assurance Dimension had the highest average in both expectation and perception. The Reliability dimension showed the value of the most negative GAP among the dimensions, and the best value occurred in the Responsiveness dimension. The IPA tool may be effective in Dental Medicine since it highlights the key points to be improved in the delivery of dental services in a clinical setting.
文摘This work aims to determine the role of inequality in the provision of maternal health services among five regions in Mexico (northwest, northeast, central, the Mexico City-State of Mexico region and the south). We consider the most important service providers corresponding to the main health institutions in Mexico (IMSS, ISSSTE, SESAS, IMSS-Oportunidades). Therefore, a cross-sectional prospective study was conducted to analyze eight intervention packages (Prenatal Care, Syphilis, Influenza, Obstetric Urgent Care, HIV in pregnancy, delivery care, neonatal care and accessibility) offered by the Maternal and Perinatal Health (MPH) program. A quantitative analysis demonstrates low to marginal performance of the MPH program in three regions (South, Mexico City-State of Mexico and the Northwest) and marginal in two other regions (Central and Northeast). Furthermore, four of the intervention packages presented the lowest performance in the South (Prenatal Care, Syphilis, Influenza and Obstetric Urgent Care), as did the average of the total of the MPH packages. The performance of HIV in Pregnancy package was marginal in the Southern and Mexico City-State of Mexico regions and Neonatal Care was low in the Northwest. The assessment of the MPH intervention packages allows us to identify their strengths and weaknesses. This information allows us to identify similarities and differences among the geographical regions in order to describe and analyze the strengths, weaknesses, opportunities and threats in the current system and hence to improve the decision making regarding the Maternal and Perinatal Health Programs in Mexico. The results suggest that a homogenization has taken place in terms of the low quality of the services.
文摘Objective To evaluate the economy of detecting gastric cancer by electronic gastroscope in Chinese natural population of different ages and genders.Methods A Markov model was constructed for the population,including both men and women of different ages.The model cycle was one year and the simulation time was 60 years.The cost-effectiveness of electronic gastroscopy in detecting gastric cancer of general population in China was analyzed from the perspective of the whole society,and the stability of the results was verified by sensitivity analysis.Results and Conclusion For the general population,the incremental cost-effectiveness ratio(ICER)of gastric cancer screening from the age of 50 is 50143 yuan/QALY(quality-adjusted life-year),which is less than two times of per capita gross domestic product(GDP)compared with the screening from the age of 55.For men who start gastric cancer screening at the age of 50,the ICER is 38525 yuan/QALY,which is less than two times of per capita GDP,and it is economical.For women who start the screening from the age of 55,the ICER is 47814 yuan/QALY,which is less than two times of per capita GDP,so it is economical.The results of sensitivity analysis are consistent with the conclusions of basic analysis,and the results of basic analysis are stable.For the general population,it is more economical to start gastric cancer screening from the age of 50,while for men and women,it is more economical to start gastric cancer screening from the age of 50 and 55,respectively.
文摘Body mass index(BMI),with its simple formula of weight divided by height squared,has become a cornerstone tool in global public health for assessing obesity and health risks.However,as populations aging and the demand for precise health evaluation grows,the limitations of this single metric have become increasingly apparent—it fails to distinguish between muscle and adipose tissue and cannot capture the complex relationship between inflammatory status and body composition.A recent study published in Biomedical and Environmental Sciences(BES)by Zhang et al.[1],which explores the association of white blood cell(WBC)count,platelet(PLT)count,and platelet-to-white blood cell ratio(PWR)with muscle mass among Chinese communitydwelling older adults,provides critical evidence for rethinking the role of BMI.Additionally,several studies published in BES,spanning from childhood nutrition to adult metabolism,further illuminate the complexity of health assessment[2−5].Building on these findings and integrating evidence from multiple Chinese population studies,this commentary revisits the historical context,utility,inherent limitations,and future directions of this classic indicator.
基金Supported by National Research Foundation of Korea,No.RS-2023-00237287.
文摘This letter provides a critical appraisal of the comprehensive meta-analysis by Hou et al,which synthesizes the incidence and risk factors for postoperative delirium(POD)in organ transplant recipients.Their work establishes a pooled POD incidence of 20%,with significant variability across organ types(lung 34%,liver 22%,kidney 6%),and identifies key risk factors including primary graft dysfunction,hepatic encephalopathy,and high model for end-stage liver disease/acute physiology and chronic health evaluation Ⅱ scores.This commentary acknowledges the study's strength in providing a robust,trans-organ synthesis of current evidence.However,it critically discusses the substantial heterogeneity,the counterintuitive non-significance of age as a risk factor,and the unavoidable limitation of unmeasured confounders inherent in meta-analyses,such as preoperative cognitive/psychiatric status and anesthetic protocols.While the findings provide an essential evidence base for risk stratification and prevention,this letter argues that the high heterogeneity underscores the need for organ-specific analysis and calls for large-scale,prospective studies with standardized protocols to translate these findings into reliable clinical prediction tools and targeted interventions.
基金Supported by Health and Birth Control Committee of Liaoning Province,China
文摘BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.
