BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical...BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical implications of high body mass index(BMI)on survival outcomes in ALF.AIM To explore the impact of overweight and obesity on the clinical outcomes of patients with ALF.METHODS A retrospective observational cohort study was conducted involving patients with ALF admitted to the Johns Hopkins Health System between January 1,2000 and May 1,2020.We performed Cox proportional hazards regression to identify outcomes,including the need for liver transplantation(LT)or all-cause mortality.RESULTS A total of 196 patients were included,the median age was 43.5 years,63.3%were female,and 59.7%were of Caucasian ethnicity.Acetaminophen-induced ALF was the most common etiology(45%).The mean BMI was significantly greater among patients who underwent LT or died(29.64 kg/m^(2)vs 26.59 kg/m^(2),P=0.008)than among survivors.Patients with overweight and obesity had a higher risk of all-cause mortality or need for LT by 2.22-fold(95%CI:1.30-3.78)and 2.04-fold(95%CI:1.29-3.39),respectively.Elevated BMI was associated with renal failure and higher grades of hepatic encephalopathy.Derangements in serologic markers,including alanine transaminase,lactate,and ammonia,were associated with a mortality risk or need for LT.CONCLUSION In this large,retrospective study,with a diverse cohort of United States patients,Overweight and obese were independently associated with an increased risk of all-cause mortality or need for LT.This work highlights the importance of closely monitoring ALF patients who are overweight or obese for adverse complications and measures to improve outcomes in this vulnerable patient population.展开更多
BACKGROUND Current antiviral treatment for chronic hepatitis B can suppress viral replication and reduce the risk of cirrhosis and liver cancer.It requires lifelong daily medication,and long-term adherence is often ci...BACKGROUND Current antiviral treatment for chronic hepatitis B can suppress viral replication and reduce the risk of cirrhosis and liver cancer.It requires lifelong daily medication,and long-term adherence is often cited as a concern when initiating treatment.Hepatitis B treatment adherence in the context of the patient’s medical and life experiences remains underexplored.AIM To evaluate factors associated with adherence to hepatitis B oral antiviral treatment.METHODS A global online survey was administered anonymously to adults(aged 18 years or older)living with chronic hepatitis B.A subsample of 614 individuals who reported being on hepatitis B treatment was included in the analysis.Indices for treatment affordability,healthcare service acceptability,and individual physical,psychological,and emotional functioning were constructed(Cronbach’s alpha=0.71-0.83).Data analysis was conducted using Stata/BE 17.0.RESULTS Overall,81%of respondents reported high adherence to hepatitis B treatment.Lower adherence was observed among individuals who identified as African or African American(P=0.008).Among participants with low adherence,60%cited affordability as a challenge(P=0.068),53%identified healthcare service acceptability as a challenge(P=0.04),79%described physical functioning as a challenge(P=0.002),and 40.5%reported difficulties with psychological functioning(P=0.55).CONCLUSION Findings demonstrate high treatment adherence,although access to and acceptability of healthcare services,as well as an individual’s physical functioning challenges,appear to be related to low adherence.展开更多
Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with prim...Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with primary health services.This study aimed to evaluate the performance of the urban medical group using the triangular value chain framework.Methods:The evaluation was conducted using the Donabedian model,focusing on three key dimensions:safety and quality,accessibility,and affordability.Longitudinal data were collected from 2016 to 2022 through government annual reports,the medical insurance bureau,and hospital information systems.Preprogram and postprogram outcome measurements were compared to assess differences and trends,providing a clear picture of the program's effectiveness.Results:Accessibility improved significantly,with the number of hospital beds per 1000 residents increasing from 2.62 in 2017 to 3.76 in 2022.The availability of general practitioners(GPs)also rose markedly,from 0 per 10,000 residents in 2017 to 6.27 in 2022.Regarding safety and quality,the proportion of complex medical procedures conducted within the New District expanded substantially,from 7.35%in 2017 to 38.11%in 2021.Additionally,there was an enhancement in the standardized management rate of chronic diseases.Affordability assessments showed that the proportion of medical income derived from the medical insurance fund increased by nearly 22.81 percentage points between 2012 and 2021.By 2021,75.02%of medical patients were covered by medical insurance,representing an increase of approximately 44 percentage points from 31.19%in 2012.Conclusions:The implementation of the urban medical group in Dapeng New District has led to substantial improvements in healthcare accessibility,safety and quality,and affordability.Future initiatives will focus on advancing the“Dapeng Mode”to generate exemplary healthcare outcomes and minimize disparities in basic health services and health status between urban and rural populations.The reform agenda includes piloting payment reforms and innovative payment models within the Dapeng group,complemented by a health assessment and performance incentive system aimed at encouraging healthcare institutions to prioritize health management.展开更多
The rapid evolution of digital health technologies has sparked transformative changes across the healthcare landscape.These advancements were at the heart of discussions during the recent academic conference co-organi...The rapid evolution of digital health technologies has sparked transformative changes across the healthcare landscape.These advancements were at the heart of discussions during the recent academic conference co-organized by The First Affiliated Hospital,Sun Yat-sen University(FAH-SYSU)and University of California at Berkeley,the Pacific-Rim Conference on Healthcare Innovation(PRC-HI 2024),convening under the theme“The Future of Medicine:Integrating Robotics,AI and Healthcare.”This article distills the key developments and their implications for the future of healthcare,focusing on innovations in robotic surgery,health data science,and AI for medicine.展开更多
Ambient air pollution is increasingly being recognized as a risk factor for heart failure;however,its effects on cardiac biomarkers remain unclear.This scoping review assessed the existing evidence on the association ...Ambient air pollution is increasingly being recognized as a risk factor for heart failure;however,its effects on cardiac biomarkers remain unclear.This scoping review assessed the existing evidence on the association between air pollution and cardiac biomarkers in heart failure,described the key concepts,synthesized data,and identified research gaps.Following the PRISMA-ScR guidelines,PubMed,Embase,Web of Science,and CNKI databases were searched for studies on air pollution,heart failure,and biomarkers.A total of 765 records were screened,and 81 full texts were assessed for eligibility,resulting in 15 studies.The results showed that the exposure to particulate matter was associated with elevated N-terminal pro-B-type natriuretic peptide and troponin levels.Several studies have linked particulate matter exposure to a higher cardiovascular risk and heart failure biomarkers.Inflammatory and oxidative stress markers were consistently elevated across studies,supporting the biological relevance of these associations.However,few studies have focused specifically on populations with heart failure or clinically relevant biomarkers,and the evidence for gaseous pollutants remains inconclusive.These findings highlight the need to integrate environmental risk assessment into heart failure care and inform policy efforts to reduce the pollutionrelated cardiovascular burden.Further research should address these gaps through improved exposure assessments and the integration of mechanistic evidence.展开更多
Background:A shift from self-reports to wearable sensors for global physical activity(PA)surveillance has been recommended.The conventional use of a generic cut-point to assess moderate-to-vigorous PA(MVPA)is problema...Background:A shift from self-reports to wearable sensors for global physical activity(PA)surveillance has been recommended.The conventional use of a generic cut-point to assess moderate-to-vigorous PA(MVPA)is problematic as these cut-points are often derived from non-representative samples under non-ecological laboratory conditions.This study aimed to develop age-and sex-(age-sex)specific cut-points for MVPA based on population-standardized values as a feasible approach to assess the adherence to PA guidelines and to investigate its associations with all-cause mortality.Methods:A total of 7601 participants(20-85+years)were drawn from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Surveys(NHANES).Minutes per week of MVPA were assessed with a hip-worn accelerometer.Counts per minute(CPM)were used to define an age-sex specific target intensity,representing the intensity each person should be able to reach based on their age and sex.Age-sex specific MVPA cut-points were defined as any activity above 40%of the target intensity.These population-and free-living-based age-sex specific cut-points overcome many of the limitations of the standard generic cut-point approach.For comparison,we also calculated MVPA with a generic cut-point of 1952 CPM.Both approaches were compared for assessing adherence to PA guidelines and association of MVPA with allcause mortality(ascertained through December 2015).Results:Both approaches indicated that 37%of the sample met the 150+min/week guideline.The generic cut-point approach showed a trend to inactivity with age,which was less pronounced using the age-sex specific cut-points.Overall mortality rates were comparable using generic cutpoint(hazard ratio(HR)=0.61,95%confidence interval(95%CI):0.50-0.73)or age-sex specific cut-points(HR=0.57,95%CI:0.50-0.66)for the entire sample.The generic cut-point method revealed an age-and sex-related gap in the benefits of achieving 150+min/week of MVPA,with older adults showing an 18%greater reduction in mortality rates than younger adults,and a larger difference in women than in men.This disparity disappeared when using age-sex specific cut-points.Conclusion:Our findings underscore the value of age-sex specific cut-points for global PA surveillance.MVPA defined with age-sex specific thresholds was associated with all-cause mortality and the dose-response was similar for all ages and sexes.This aligns with the single recommendation of accumulating 150+min/week MVPA for all adults,irrespective of age and sex.This study serves as a proof of concept to develop this methodology for PA surveillance over more advanced open-source acceleration metrics and other national and international cohorts.展开更多
Objectives:Maker education is a dominant force in education reform and is viewed as a revolutionary way to learn.As innovative pedagogy is continuously explored in the field of nursing,the emerging role of maker educa...Objectives:Maker education is a dominant force in education reform and is viewed as a revolutionary way to learn.As innovative pedagogy is continuously explored in the field of nursing,the emerging role of maker education must be examined.This research aims to build a nursing bachelor education program based on maker education and to evaluate the effectiveness of this program.Methods:Forty volunteer junior students majoring in nursing from a college were the subjects for this quasi-experiment.The training program for nursing students based on maker education was developed and implemented as an additional class for a period of 12 weeks.Before and after the experiment,two measures including the"Williams Creative Scale"and"Current Status Questionnaire of Nursing Students'Learning"were adopted for investigation,and corresponding statistical methods were used for analysis.The degree of satisfaction with this training program was investigated after the experiment.Results:The average scores of creativity,learning interest,cooperative learning skill,scientific research ability,and information attainment of the nursing students after the implementation of maker education all improved.The differences in the above points before and after the experiment were all statistically significant(P<0.05).Most of the students expressed satisfaction with this training program(72.5%were very satisfied,15.0%were partially satisfied,and 12.5%were not satisfied).Conclusion:Implementing the training program based on maker education enhanced student creativity,learning interest,cooperative learning skill,scientific research ability,and information attainment.Comprehensive nursing talents were also cultivated.Our data suggested the importance of improving this program,adopting the method,and pursuing research in nursing education.展开更多
Qidong(Jiangsu, China) has been of interest to cancer epidemiologists and biologists because, until recently, it was an endemic area for liver cancer, having amongst the highest incidence rates in the world. The estab...Qidong(Jiangsu, China) has been of interest to cancer epidemiologists and biologists because, until recently, it was an endemic area for liver cancer, having amongst the highest incidence rates in the world. The establishment of the Qidong Cancer Registry together with the Qidong Liver Cancer Institute in 1972 has charted the patterns of liver cancer incidence and mortality in a stable population throughout a period of enormous economic, social, and environmental changes as well as of improvements in health care delivery. Updated incidence trends in Qidong are described. Notably, the China age-standardized incidence rate for liver cancer has dropped by over 50% in the past several decades. Molecular epidemiologic and genomic deep sequencing studies have affirmed that infection with hepatitis B virus as well as dietary exposure to aflatoxins through contamination of dietary staples such as corn, and to microcystins–blue-green algal toxins found in ditch and pond water – were likely important etiologic factors that account for the high incidence of liver cancer in this region. Public health initiatives to facilitate universal vaccination of newborns against HBV and to improve drinking water sources in this rural area, as well as economic and social mandates serendipitously facilitating dietary diversity, have led to precipitous declines in exposures to these etiologic factors, concomitantly driving substantive declines in the liver cancer incidence seen now in Qidong. In this regard, Qidong serves as a template for the global impact that a package of intervention strategies may exert on cancer burden.展开更多
文摘BACKGROUND Acute liver failure(ALF)is a life-threatening multisystemic condition with high short-term mortality.With the growing prevalence of obesity and metabolic syndrome,it is important to investigate the clinical implications of high body mass index(BMI)on survival outcomes in ALF.AIM To explore the impact of overweight and obesity on the clinical outcomes of patients with ALF.METHODS A retrospective observational cohort study was conducted involving patients with ALF admitted to the Johns Hopkins Health System between January 1,2000 and May 1,2020.We performed Cox proportional hazards regression to identify outcomes,including the need for liver transplantation(LT)or all-cause mortality.RESULTS A total of 196 patients were included,the median age was 43.5 years,63.3%were female,and 59.7%were of Caucasian ethnicity.Acetaminophen-induced ALF was the most common etiology(45%).The mean BMI was significantly greater among patients who underwent LT or died(29.64 kg/m^(2)vs 26.59 kg/m^(2),P=0.008)than among survivors.Patients with overweight and obesity had a higher risk of all-cause mortality or need for LT by 2.22-fold(95%CI:1.30-3.78)and 2.04-fold(95%CI:1.29-3.39),respectively.Elevated BMI was associated with renal failure and higher grades of hepatic encephalopathy.Derangements in serologic markers,including alanine transaminase,lactate,and ammonia,were associated with a mortality risk or need for LT.CONCLUSION In this large,retrospective study,with a diverse cohort of United States patients,Overweight and obese were independently associated with an increased risk of all-cause mortality or need for LT.This work highlights the importance of closely monitoring ALF patients who are overweight or obese for adverse complications and measures to improve outcomes in this vulnerable patient population.
文摘BACKGROUND Current antiviral treatment for chronic hepatitis B can suppress viral replication and reduce the risk of cirrhosis and liver cancer.It requires lifelong daily medication,and long-term adherence is often cited as a concern when initiating treatment.Hepatitis B treatment adherence in the context of the patient’s medical and life experiences remains underexplored.AIM To evaluate factors associated with adherence to hepatitis B oral antiviral treatment.METHODS A global online survey was administered anonymously to adults(aged 18 years or older)living with chronic hepatitis B.A subsample of 614 individuals who reported being on hepatitis B treatment was included in the analysis.Indices for treatment affordability,healthcare service acceptability,and individual physical,psychological,and emotional functioning were constructed(Cronbach’s alpha=0.71-0.83).Data analysis was conducted using Stata/BE 17.0.RESULTS Overall,81%of respondents reported high adherence to hepatitis B treatment.Lower adherence was observed among individuals who identified as African or African American(P=0.008).Among participants with low adherence,60%cited affordability as a challenge(P=0.068),53%identified healthcare service acceptability as a challenge(P=0.04),79%described physical functioning as a challenge(P=0.002),and 40.5%reported difficulties with psychological functioning(P=0.55).CONCLUSION Findings demonstrate high treatment adherence,although access to and acceptability of healthcare services,as well as an individual’s physical functioning challenges,appear to be related to low adherence.
文摘Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with primary health services.This study aimed to evaluate the performance of the urban medical group using the triangular value chain framework.Methods:The evaluation was conducted using the Donabedian model,focusing on three key dimensions:safety and quality,accessibility,and affordability.Longitudinal data were collected from 2016 to 2022 through government annual reports,the medical insurance bureau,and hospital information systems.Preprogram and postprogram outcome measurements were compared to assess differences and trends,providing a clear picture of the program's effectiveness.Results:Accessibility improved significantly,with the number of hospital beds per 1000 residents increasing from 2.62 in 2017 to 3.76 in 2022.The availability of general practitioners(GPs)also rose markedly,from 0 per 10,000 residents in 2017 to 6.27 in 2022.Regarding safety and quality,the proportion of complex medical procedures conducted within the New District expanded substantially,from 7.35%in 2017 to 38.11%in 2021.Additionally,there was an enhancement in the standardized management rate of chronic diseases.Affordability assessments showed that the proportion of medical income derived from the medical insurance fund increased by nearly 22.81 percentage points between 2012 and 2021.By 2021,75.02%of medical patients were covered by medical insurance,representing an increase of approximately 44 percentage points from 31.19%in 2012.Conclusions:The implementation of the urban medical group in Dapeng New District has led to substantial improvements in healthcare accessibility,safety and quality,and affordability.Future initiatives will focus on advancing the“Dapeng Mode”to generate exemplary healthcare outcomes and minimize disparities in basic health services and health status between urban and rural populations.The reform agenda includes piloting payment reforms and innovative payment models within the Dapeng group,complemented by a health assessment and performance incentive system aimed at encouraging healthcare institutions to prioritize health management.
文摘The rapid evolution of digital health technologies has sparked transformative changes across the healthcare landscape.These advancements were at the heart of discussions during the recent academic conference co-organized by The First Affiliated Hospital,Sun Yat-sen University(FAH-SYSU)and University of California at Berkeley,the Pacific-Rim Conference on Healthcare Innovation(PRC-HI 2024),convening under the theme“The Future of Medicine:Integrating Robotics,AI and Healthcare.”This article distills the key developments and their implications for the future of healthcare,focusing on innovations in robotic surgery,health data science,and AI for medicine.
文摘Ambient air pollution is increasingly being recognized as a risk factor for heart failure;however,its effects on cardiac biomarkers remain unclear.This scoping review assessed the existing evidence on the association between air pollution and cardiac biomarkers in heart failure,described the key concepts,synthesized data,and identified research gaps.Following the PRISMA-ScR guidelines,PubMed,Embase,Web of Science,and CNKI databases were searched for studies on air pollution,heart failure,and biomarkers.A total of 765 records were screened,and 81 full texts were assessed for eligibility,resulting in 15 studies.The results showed that the exposure to particulate matter was associated with elevated N-terminal pro-B-type natriuretic peptide and troponin levels.Several studies have linked particulate matter exposure to a higher cardiovascular risk and heart failure biomarkers.Inflammatory and oxidative stress markers were consistently elevated across studies,supporting the biological relevance of these associations.However,few studies have focused specifically on populations with heart failure or clinically relevant biomarkers,and the evidence for gaseous pollutants remains inconclusive.These findings highlight the need to integrate environmental risk assessment into heart failure care and inform policy efforts to reduce the pollutionrelated cardiovascular burden.Further research should address these gaps through improved exposure assessments and the integration of mechanistic evidence.
基金supported in part by the intramural research programs at the National Institute on Aging and National Cancer Institute(USA)supported by the Spanish Ministry of Science,Innovation and Universities under Beatriz Galindo's 2022 fellowship program(BG22/00075).
文摘Background:A shift from self-reports to wearable sensors for global physical activity(PA)surveillance has been recommended.The conventional use of a generic cut-point to assess moderate-to-vigorous PA(MVPA)is problematic as these cut-points are often derived from non-representative samples under non-ecological laboratory conditions.This study aimed to develop age-and sex-(age-sex)specific cut-points for MVPA based on population-standardized values as a feasible approach to assess the adherence to PA guidelines and to investigate its associations with all-cause mortality.Methods:A total of 7601 participants(20-85+years)were drawn from the 2003-2004 and 2005-2006 National Health and Nutrition Examination Surveys(NHANES).Minutes per week of MVPA were assessed with a hip-worn accelerometer.Counts per minute(CPM)were used to define an age-sex specific target intensity,representing the intensity each person should be able to reach based on their age and sex.Age-sex specific MVPA cut-points were defined as any activity above 40%of the target intensity.These population-and free-living-based age-sex specific cut-points overcome many of the limitations of the standard generic cut-point approach.For comparison,we also calculated MVPA with a generic cut-point of 1952 CPM.Both approaches were compared for assessing adherence to PA guidelines and association of MVPA with allcause mortality(ascertained through December 2015).Results:Both approaches indicated that 37%of the sample met the 150+min/week guideline.The generic cut-point approach showed a trend to inactivity with age,which was less pronounced using the age-sex specific cut-points.Overall mortality rates were comparable using generic cutpoint(hazard ratio(HR)=0.61,95%confidence interval(95%CI):0.50-0.73)or age-sex specific cut-points(HR=0.57,95%CI:0.50-0.66)for the entire sample.The generic cut-point method revealed an age-and sex-related gap in the benefits of achieving 150+min/week of MVPA,with older adults showing an 18%greater reduction in mortality rates than younger adults,and a larger difference in women than in men.This disparity disappeared when using age-sex specific cut-points.Conclusion:Our findings underscore the value of age-sex specific cut-points for global PA surveillance.MVPA defined with age-sex specific thresholds was associated with all-cause mortality and the dose-response was similar for all ages and sexes.This aligns with the single recommendation of accumulating 150+min/week MVPA for all adults,irrespective of age and sex.This study serves as a proof of concept to develop this methodology for PA surveillance over more advanced open-source acceleration metrics and other national and international cohorts.
基金funded by the National Institutes of Health USA(P30 ES 003819,P01 ES 006052,N01 CN-25437,U01 CA77130,R21 CA98485)the National Science and Technology Mega-Projects of China(No.2008ZX10002-015,No.2012ZX10002-008)
基金This research was supported by the Graduate Education Reform Project of Chengdu University in 2017[Grant number:cdjgy2017011]the Medical Education Research Project of the Medical Education Branch of Chinese Medical Association and the Medical Education Committee of Chinese Higher Education Association in 2016[Grant number:2016B-HL071].
文摘Objectives:Maker education is a dominant force in education reform and is viewed as a revolutionary way to learn.As innovative pedagogy is continuously explored in the field of nursing,the emerging role of maker education must be examined.This research aims to build a nursing bachelor education program based on maker education and to evaluate the effectiveness of this program.Methods:Forty volunteer junior students majoring in nursing from a college were the subjects for this quasi-experiment.The training program for nursing students based on maker education was developed and implemented as an additional class for a period of 12 weeks.Before and after the experiment,two measures including the"Williams Creative Scale"and"Current Status Questionnaire of Nursing Students'Learning"were adopted for investigation,and corresponding statistical methods were used for analysis.The degree of satisfaction with this training program was investigated after the experiment.Results:The average scores of creativity,learning interest,cooperative learning skill,scientific research ability,and information attainment of the nursing students after the implementation of maker education all improved.The differences in the above points before and after the experiment were all statistically significant(P<0.05).Most of the students expressed satisfaction with this training program(72.5%were very satisfied,15.0%were partially satisfied,and 12.5%were not satisfied).Conclusion:Implementing the training program based on maker education enhanced student creativity,learning interest,cooperative learning skill,scientific research ability,and information attainment.Comprehensive nursing talents were also cultivated.Our data suggested the importance of improving this program,adopting the method,and pursuing research in nursing education.
基金supported by grants from the US National Institutes of Health (Grant No. R01 CA196610 and R35 CA197222)Chinese National Key Projects (Grant No. 2008ZX10002-015, 2008ZX10002-017, 2012ZX10002009, 2018ZX10732202-001)
文摘Qidong(Jiangsu, China) has been of interest to cancer epidemiologists and biologists because, until recently, it was an endemic area for liver cancer, having amongst the highest incidence rates in the world. The establishment of the Qidong Cancer Registry together with the Qidong Liver Cancer Institute in 1972 has charted the patterns of liver cancer incidence and mortality in a stable population throughout a period of enormous economic, social, and environmental changes as well as of improvements in health care delivery. Updated incidence trends in Qidong are described. Notably, the China age-standardized incidence rate for liver cancer has dropped by over 50% in the past several decades. Molecular epidemiologic and genomic deep sequencing studies have affirmed that infection with hepatitis B virus as well as dietary exposure to aflatoxins through contamination of dietary staples such as corn, and to microcystins–blue-green algal toxins found in ditch and pond water – were likely important etiologic factors that account for the high incidence of liver cancer in this region. Public health initiatives to facilitate universal vaccination of newborns against HBV and to improve drinking water sources in this rural area, as well as economic and social mandates serendipitously facilitating dietary diversity, have led to precipitous declines in exposures to these etiologic factors, concomitantly driving substantive declines in the liver cancer incidence seen now in Qidong. In this regard, Qidong serves as a template for the global impact that a package of intervention strategies may exert on cancer burden.
