BACKGROUND People living with human immunodeficiency virus(HIV)are aging as a result the benefits of combination antiretroviral therapy.AIM To provide descriptions of eligible existing studies on demographics,methodol...BACKGROUND People living with human immunodeficiency virus(HIV)are aging as a result the benefits of combination antiretroviral therapy.AIM To provide descriptions of eligible existing studies on demographics,methodologies,and outcome measures related to health-related quality of life(HRQoL)in the context of HIV and aging.METHODS The MEDLINE,CINAHL,Scopus,and PsycINFO databases were systematically searched using the terms HIV,age,and HRQoL to find studies published between January 1995 and June 2022.Key variables of the eligible studies were identified and categorized into demographics(e.g.,study sites,study year),methodologies(e.g.,use of conceptual frameworks,measures used),and outcome measures[e.g.,HRQoL,quality of life(QoL)].The PRISMA 2009 checklist was followed.RESULTS A total of 68 published studies involving 53504 participants were included.The majority of the studies(55.88%)were conducted in North America,with relatively few studies conducted in Africa.The median age of participants was 51.0 years(IQR=11.0).Over one-third(32.56%)of all participants were older people living with HIV aged 50 years and older Four studies included only older female participants,and six studies included only men who have sex with men.Outcome mea-sures were assessed as HRQoL(26.47%)or QoL(36.76%).Overall,data from African studies,older women living with HIV,socioeconomic status(e.g.,employment,income,education),sexual behavioral risks,theoretical frameworks used,and follow-up studies were limited.CONCLUSION This narrative review highlights imbalances and gaps in research on HRQoL in the context of HIV and aging,providing direction for future studies in this area.展开更多
Objectives:We systematically reviewed the rational use of medicines using the World Health Organization/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of ...Objectives:We systematically reviewed the rational use of medicines using the World Health Organization/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of the coronavirus disease 2019 pandemic and the National Drug Policy(NDP)2005 on the rational use of medicines.Methods:Searches were conducted in PubMed,Scopus,and Google Scholar databases to identify studies that met our eligibility criteria.Assessment of the quality of studies was conducted using the Joanna Briggs Institute criteria for analytical studies.We reported and compared the median values of WHO/INRUD core drug use indicators with standard thresholds.Data were presented with median,interquartile range(IQR),and percentages.MannWhitney and Kruskal-Wallis tests were conducted to assess for statistical significance(P<0.05)across variables.Results:Thirty-one studies were included in the review,comprising 50,931 patient encounters across 268 health facilities.Within prescribing indicators,average number of medicines per patient encountered[3.4(IQR:3.0to 4.0)],percentage of medicines prescribed by generic[50.4%(IQR:47.4%to 65.0%)],percentage of encounters with antibiotic prescribed[40.2%(IQR:30.5%to 52.7%)],percentage of encounters with injection prescribed[18%(IQR:3.2%to 30.0%)]and the percentage of medicines prescribed from essential medicines list[82.0%(IQR:66.4%to 89.3%)].The median percentage of encounters with antibiotics(P=0.04)and the median percentage of medicines prescribed by generics(P=0.03)increased during and after the COVID-19 pandemic.Prescribing indicators were worse in primary and secondary health facilities,with significant differences in the median percentage of encounters with antibiotics(P=0.007)and injections(P=0.0002)across primary,secondary,and tertiary health facilities.There were improvements across all prescribing indicators after the implementation of NDP 2005.Conclusions:Core drug use indicators in Nigerian health facilities deviated from the WHO/INRUD thresholds,with noticeable improvement after the implementation of NDP 2005.More efforts are needed to improve rational drug use in Nigerian hospitals.展开更多
Background:Cardiorespiratory fitness(CRF)is a powerful predictor of mortality and chronic disease risk,yet global patterns and determinants of CRF remain poorly defined,particularly in females and underrepresented pop...Background:Cardiorespiratory fitness(CRF)is a powerful predictor of mortality and chronic disease risk,yet global patterns and determinants of CRF remain poorly defined,particularly in females and underrepresented populations.We conducted a systematic review and quantitative synthesis of directly measured peak oxygen uptake(VO_(2peak))internationally and examined its association with human development and gender ine quality.Methods:Studies were eligible if VO_(2peak)was assessed via direct gas analysis during maximal exercise testing,and if the countries had scores for the Human Development Index(HDI)and Gender Inequality Index(GII).Studies were identified through MEDLINE/PubMed,Embase,CINAHL,and Web of Science.Risks of bias were assessed by an adaptation of the Newcastle-Ottawa Scale.Multivariable linear regression models examined associations between VO_(2peak),age,sex,exercise modality,HDI,GII,and study year.Results:Data included 95 studies from 24 countries with HDI and GII scores,comprising 119,435 adults(42%females)with VO_(2peak)assessed via direct gas analysis during maximal exercise testing.The risk of bias was low.VO_(2peak)was positively associated with HDI(β=14.1)and negatively associated with GII(β=-3.6).Slightly stronger associations were observed in females than males(HDI:β=18.9 vs.β=13.9,GII:β=-4.6vs.β=-3.6).Young females in middle-HDI countries had higher VO_(2peak)than those in low-HDI countries(31.2mL/kg/min vs.28.5 mL/kg/min),with limited additional gams in high-HDI contexts.VO_(2peak)decreased with higher gender inequality,with the largest disparities observed in young females between high-and low-GII countries(26.3 mL/kg/min vs.32.8 mL/kg/min).Conclusion:Global variation in CRF is tied to national levels of human development and gender equality.These findings support prioritizing structural and policy-level interventions that address social and gender disparities in physical activity access and health promotion.Studies from countries with lower HDI and information on ethnicity and socioeconomic status will bridge crucial gaps in understanding factors involved in global CRF levels.展开更多
Background:Investigators from low-,middle-,and high-income countries representing 6 continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire(GAC-PAQ).The GAC-PAQ is ...Background:Investigators from low-,middle-,and high-income countries representing 6 continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire(GAC-PAQ).The GAC-PAQ is designed to assess physical activity(PA)across all key domains(i.e.,school,chores,work/volunteering,transport,free time,outdoor time).It aimed to address multiple gaps in global PA surveillance(e.g.,omission of important PA domains,insufficient cultural adaptation,underrepresentation of rural areas in questionnaire validation studies).The purpose of this study was to assess the content validity of the GAC-PAQ among PA experts,8-to 17-year-olds,and one of their parents/guardians,and to discuss changes made to the questionnaire based on participants'feedback.Methods:Sixty-two experts in PA measurement and/or surveillance from 24 countries completed an online survey that included both closed-and open-ended questions about the content validity of the GAC-PAQ.The proportion of experts who agreed or strongly agreed with the items was calculated.Child-parent/guardian dyads from 15 countries(n=250;10-40 per country)participated in a structured cognitive interview to assess the clarity of the questions and response options,and they were encouraged to provide suggestions to improve clarity and facilitate completion of the questionnaire.Participating countries are:Aotearoa New Zealand,Brazil,Canada,China,Colombia,Czech Republic,India,Malawi,Mexico,Nepal,Nigeria,Spain,Sweden,Thailand,and the United Arab Emirates.Interviews were conducted in 13 different languages and structured by PA domain.Generic images were included to help participants in answering questions about PA intensity.Results:Expert agreement with the items for each domain exceeded 75%,and their qualitative feedback was used to revise the questionnaire before cognitive interviews.In general,participants found the questionnaire to be comprehensive.Adolescents(12-17 years)found it easier than children(8-11 years)to answer the questions.Several children struggled to answer questions about the duration and intensity of activities and/or concepts related to travel modes,active trips,and organized activities.Many parents/guardians were unsure about the frequency,duration,and intensity of their children's or adolescents'PA at school and/or recommended using more culturally relevant and appropriate images.Some participants misunderstood the concept of activities that“make you stronger”(intended to assess resistance activities)and/or struggled to differentiate between work,volunteering,and chores.Conclusion:Participants'feedback was used to develop a revised,simplified,and culturally adapted GAC-PAQ,which will be pilot-tested in all15 countries in an App that will include country-specific images and narration in local languages.Further research is needed to assess the reliability and validity of the revised GAC-PAQ.展开更多
In 2009,Professor Steven Blair predicted that physical inactivity would be the greatest public health issue of the 21st century.~1 A public health problem is one that affects the health,function,and well-being of a la...In 2009,Professor Steven Blair predicted that physical inactivity would be the greatest public health issue of the 21st century.~1 A public health problem is one that affects the health,function,and well-being of a large number of people.展开更多
1.Introduction Before coronavirus disease 2019 (COVID-19) became a global health emergency in early 2020,there was substantial evidence of physical activity’s (PA’s) multiple benefits with direct relevance to reduci...1.Introduction Before coronavirus disease 2019 (COVID-19) became a global health emergency in early 2020,there was substantial evidence of physical activity’s (PA’s) multiple benefits with direct relevance to reducing the harms of the pandemic:improved immune functioning and reduced inflammation to lessen severity of infections,enhanced efficacy of vaccines.展开更多
A Chinese Compilation of Physical Activities was compiled to estimate the energy costs of physical activities(PAs)using data on adults aged 18–64.Data were obtained from published articles and laboratory measurements...A Chinese Compilation of Physical Activities was compiled to estimate the energy costs of physical activities(PAs)using data on adults aged 18–64.Data were obtained from published articles and laboratory measurements.Databases,including PubMed,Embase,Scopus,Ebsco,Web of Science,Chinese National Knowledge Infrastructure,Wan Fang Data,National Science and Technology Report Service,Public Health Scientific Data were searched to collect data from inception to January 2022,on energy expenditure associated with PA in the healthy Chinese population.Two reviewers independently screened the literature and extracted,classified,and summarized data.Data were measured for 36 PAs using indirect calorimetry.Detailed descriptions of specific activities and metabolic equivalent values were provided by summarizing 241 physical activities in 13 categories.The first edition of the Chinese Compilation of PAs in Healthy Adults Aged 18–64(CCPA)was created.It provides valuable resources for people who regularly engage in physical exercise,researchers,educators,fitness professionals,and health or commercial sectors to quickly obtain various PA MET intensities.In the future,the energy expenditure of various PAs of different ages within the Chinese population can be measured based on the CCPA.展开更多
Aim: The primary aim of the project was to conduct focus groups with pregnant women to examine their perceptions on patient and health care provider (HCP) communication during prenatal visits pertaining to health beha...Aim: The primary aim of the project was to conduct focus groups with pregnant women to examine their perceptions on patient and health care provider (HCP) communication during prenatal visits pertaining to health behavioral change. In particular, to determine what types of communication facilitate or prevent patient engagement and adherence to certain health behaviors related to smoking cessation, engagement in physical activity, healthy eating and healthy weight gain, and stress management. Methods: Participants were recruited from the obstetric and midwifery clinics at the University of Colorado Hospital. Twenty-four pregnant, English-speaking women between the ages of 18 and 46 years old, the majority of which had full health insurance coverage, participated in one of three focus groups that were conducted. The transcripts were coded for themes and patterns. Results identified numerous current practices of HCPs, facilitators and barriers in care, and patient recommendations related to effective patient-provider communication. Results: Overall many women received basic information about most health behaviors (i.e. healthy eating, physical activity, and smoking cessation) with the exception of stress management from their HCPs via their introductory information packet. However, typically there was no follow-up beyond receipt of the packet. As a result, women sought information online from numerous sources. Unfortunately, this information often conflicted with HCP provided information, as did the information provided from multiple HCPs in group care settings. A major facilitator of behavioral change pertained to building trust and rapport as it directly enhanced the perceived quality of patient-provider communication on prenatal health behaviors. Across all behaviors, women voiced the need for available resources that were credible and referenced by their HCPs. Conclusions: These findings provide a better understanding of what facilitates and prevents women from engaging in healthy behaviors during their pregnancy, in addition to improving patient and provider communication.展开更多
Physical activity(PA)is fundamentally linked to public health,^(1)providing benefits including chronic disease prevention and treatment,^(2)mental health,^(3)musculoskeletal health,^(4)and healthy aging,^(5)along with...Physical activity(PA)is fundamentally linked to public health,^(1)providing benefits including chronic disease prevention and treatment,^(2)mental health,^(3)musculoskeletal health,^(4)and healthy aging,^(5)along with socioeconomic advantages.^(6)These benefits highlight the importance of promoting PA for all populations.The recent publication of the Compendium of Physical Activities(Compendium)serves as a valuable resource,^(7)offering an updated and expanded guide for adults(ages 19-59)with tailored energy cost values for diverse populations.展开更多
Purpose:This study aims to examine the level of behavioral health integration in primary care clinics among patients with hypertension and type 2 diabetes in Chiang Mai,Thailand.It also aims to explore the provider pe...Purpose:This study aims to examine the level of behavioral health integration in primary care clinics among patients with hypertension and type 2 diabetes in Chiang Mai,Thailand.It also aims to explore the provider perceived prevalence of behavioral problems and need for an expert behavioral health consultant on the primary care team and the risk and protective factors of the patients’psychological and cardio-metabolic health outcomes.Methodology:Using survey data between 2017 and 2018 regarding the level of integration as measured by a Practice Integration Profile,provider ratings of prevalence and need based on a Provider Survey,and patient lifestyle and behavioral problems with a Health Risk Assessment in six primary health care settings in Chiang Mai,Thailand(n=335).We conducted ordinary least squares regressions to explore the relationship between each of the patient psychological and cardio-metabolic health outcomes and physical,mental health and substance abuse variables while controlling for the demographics.Results:The results showed overall high levels of integration,but significant variability across clinics.Providers rated prevalence of health risk and need for a Behavioral Health Consultant as moderate.Results of the patient health risk assessment were variable,with some problems high severity,others low.Conclusion:The results reflect a need for integrated behavioral health into the health care system in Thailand especially for those who are in the chronic illness condition.Recommendations for future study include an evaluation of the translation quality and validity and reliability of the study measures under the Thai context.This study fills the research gap of lacking research on the level of integrated care in clinics in Thailand.展开更多
AIM To systematically review the literature on epidemiology,disease burden, and treatment outcomes for Crohn's disease(CD) patients with complex perianal fistulas.METHODS PubMed, Embase, and Cochrane were searched...AIM To systematically review the literature on epidemiology,disease burden, and treatment outcomes for Crohn's disease(CD) patients with complex perianal fistulas.METHODS PubMed, Embase, and Cochrane were searched for relevant articles(published 2000-November 2016) and congress abstracts(published 2011-November 2016).RESULTS Of 535 records reviewed, 62 relevant sources were identified(mostly small observational studies). The cumulative incidence of complex perianal fistulas in CD from two referral-centre studies was 12%-14%(follow-up time, 12 years in one study; not reported in the second study). Complex perianal fistulas result in greatly diminished quality of life; up to 59% of patients are at risk of faecal incontinence. Treatments include combinations of medical and surgical interventions and expanded allogeneic adipose-derived stem cells. High proportions of patients experience lack of or inadequate response to treatment(failure and relapse rates,respectively: medical, 12%-73% and 0%-41%; surgical:0%-100% and 11%.20%; combined medical/surgical:0%-80% and 0%-50%; stem cells: 29%-47% and not reported). Few studies(1 of infliximab; 3 of surgical interventions)have been conducted in treatment-refractory patients, a population with high unmet needs. Limited data exist on the clinical value of anti-tumour necrosis factor-α dose escalation in patients with complex perianal fistulas in CD.CONCLUSION Complex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to antitumour necrosis factor-α agents, as evidenced by high failure and relapse rates.展开更多
AIM:To study whether the severity of liver fibrosis estimated by the nonalcoholic fatty liver disease(NAFLD) fibrosis score can predict all-cause mortality,cardiac complications,and/or liver complications of patients ...AIM:To study whether the severity of liver fibrosis estimated by the nonalcoholic fatty liver disease(NAFLD) fibrosis score can predict all-cause mortality,cardiac complications,and/or liver complications of patients with NAFLD over long-term follow-up.METHODS:A cohort of well-characterized patients with NAFLD diagnosed during the period of 1980-2000 was identified through the Rochester Epidemiology Project.The NAFLD fibrosis score(NFS) was used to separate NAFLD patients with and without advanced liver fibrosis.We used the NFS score to classify the probability of fibrosis as <-1.5 for low probability,>-1.5 to < 0.67 for intermediate probability,and > 0.67 for high probability.Primary endpoints included allcause death and cardiovascular-and/or liver-related mortality.From the 479 patients with NAFLD assessed,302 patients(63%) greater than 18 years old were included.All patients were followed,and medical charts were reviewed until August 31,2009 or the date when the first primary endpoint occurred.By using a standardized case record form,we recorded a detailed history and physical examination and the use of statins and metformin during the follow-up period.RESULTS:A total of 302/479(63%) NAFLD patients(mean age:47 ± 13 year) were included with a followup period of 12.0 ± 3.9 year.A low probability of advanced fibrosis(NFS <-1.5 at baseline) was found in 181 patients(60%),while an intermediate or high probability of advanced fibrosis(NSF >-1.5) was found in 121 patients(40%).At the end of the follow-up period,55 patients(18%) developed primary endpoints.A total of 39 patients(13%) died during the follow-up.The leading causes of death were non-hepatic malignancy(n = 13/39;33.3%),coronary heart disease(CHD)(n = 8/39;20.5%),and liver-related mortality(n = 5/39;12.8%).Thirty patients had new-onset CHD,whereas 8 of 30 patients(27%) died from CHD-related causes during the follow-up.In a multivariate analysis,a higher NFS at baseline and the presence of new-onset CHD were significantly predictive of death(OR = 2.6 and 9.2,respectively;P < 0.0001).Our study showed a significant,graded relationship between the NFS,as classified into 3 subgroups(low,intermediate and high probability of liver fibrosis),and the occurrence of primary endpoints.The use of metformin or simvastatin for at least 3 mo during the follow-up was associated with fewer deaths in patients with NAFLD(OR = 0.2 and 0.03,respectively;P < 0.05).Additionally,the rate of annual NFS change in patients with an intermediate or high probability of advanced liver fibrosis was significantly lower than those patients with a low probability of advanced liver fibrosis(0.06 vs 0.09,P = 0.004).The annual NFS change in patients who died was significantly higher than those in patients who survived(0.14 vs 0.07,P = 0.03).At the end of the follow-up,we classified the patients into 3 subgroups according to the progression pattern of liver fibrosis by comparing the NFS at baseline to the NFS at the end of the followup period.Most patients were in the stable-fibrosis(60%) and progressive-fibrosis(37%) groups,whereas only 3% were in the regressive fibrosis.CONCLUSION:A higher NAFLD fibrosis score at baseline and a new onset of CHD were significantly predictive of death in patients with NAFLD.展开更多
BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for...BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment(OLGA)and operative link on gastric intestinal metaplasia assessment(OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients(stages Ⅲ–Ⅳ),and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.AIM To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.METHODS In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I(PGI). Between the years 1989 and1993, men with low PGI values(PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM,by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.RESULTS Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio(HR) 2.70, 95%CI: 1.09–6.69, P = 0.03]. The risk increased through OLGIM stages 0-Ⅳ(0 vs Ⅳ: HR 5.72, 95%CI: 1.03–31.77, P for trend = 0.004), but not through OLGA stages 0–Ⅳ(0 vs Ⅳ: HR 5.77, 95%CI:0.67–49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages Ⅲ–Ⅳ were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three-to four-times higher gastric cancer risk compared to the general male population of the same age.CONCLUSION OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.展开更多
TagedPIn February and March 2022,China will host the Beijing 2022 Olympic and Paralympic Winter Games.The vision for this landmark event promises a“joyful rendezvous upon pure ice and snow uniting the passion of hund...TagedPIn February and March 2022,China will host the Beijing 2022 Olympic and Paralympic Winter Games.The vision for this landmark event promises a“joyful rendezvous upon pure ice and snow uniting the passion of hundreds of millions for winter sports”.1 Themes have been developed to create a positive environmental impact with new development for the northern region of the country and to promote winter sports and improve the health and well-being of the Chinese people.The key messages for the winter games include inspiring youth with the Olympic spirit and encouraging millions to embrace winter sports.Notably,the Chinese government aims to mobilize at least 300 million of its citizens to engage in winter sports as an outcome of hosting the Winter Olympic Games.展开更多
AIM To assess the effects of probiotic Medilac-S^(®)as adjunctive therapy for the induction of remission of ulcerative colitis(UC)in a Chinese population through a systematic review and meta-analysis.METHODS A sy...AIM To assess the effects of probiotic Medilac-S^(®)as adjunctive therapy for the induction of remission of ulcerative colitis(UC)in a Chinese population through a systematic review and meta-analysis.METHODS A systematic literature search was conducted to find randomized,controlled trials in a Chinese population with at least two study arms-a control arm which receives a conventional,oral aminosalicylate drug,and a treatment arm,which administers the same conventional drug in conjunction with the probiotic Medilac-S^(®)per os.Both English and Chinese databases were searched,including Pub Med,EMBASE,Google Scholar,Chinese National Knowledge Infrastructure,Wanfang Data,and VIP Search,and study data was extracted onto standardized abstraction sheets.Meta-analyses were conducted for primary and secondary outcomes of interest using a fixed or random effects model.The primary outcome was the induction of clinical remission and the secondary outcomes included changes in Sutherland index,endoscopic and histological scores,proportion of reported clinical symptoms and adverse events(AEs).For outcomes with sufficient data,the type of conventional drug therapy was also assessed to determine if the effects of combination therapy with Medilac-S^(®)was influenced by drug type.All tests were conducted using a typeⅠerror rate of 0.05 and all confidence intervals(CI)were based on a 95%confidence level.Review protocol was uploaded to PROSPERO(CRD42018085658 upon completion).RESULTS Fifty-three clinical trials with a total of 3984 participants were identified and included in the review.Medilac-S^(®)adjunctive therapy significantly improved induction of clinical remission(RR=1.21;95%CI:1.18-1.24;P<0.0001)with the estimated likelihood of effective treatment,on average,21%higher for those consuming the probiotic.Sutherland index scores showed the control mean was on average 3.10(CI:2.41-3.78;P=0.0428)units greater than the treatment mean,thereby demonstrating significant improvement in participants taking the probiotic.Similarly,a significant difference was seen between the overall reduction of endoscopic and histological scores of control and treatment arm participants,with score decreases in the control groups 0.71(CI:0.3537-1.0742)and 1.1(CI:0.9189-1.2300)units smaller than treatment group score decreases.The proportion of participants reporting clinical symptoms,(abdominal pain,tenesmus,blood and mucous in stool,and diarrhea)was significantly reduced after combination therapy with Medilac-S~(P<0.0001)and estimated to be on average 44%(RR=0.44,CI:0.32-0.59),53%(RR=0.53,CI:0.38-74),40%(RR=0.40,CI:0.28-0.58)and 47%(RR=0.47 CI:0.36-0.42)respectively,of the proportion of individuals reporting the aforementioned symptoms after conventional therapy alone.The risk of AEs was also significantly reduced with adjunctive Medilac-S~therapy.The proportion of individuals in the treatment groups reporting AEs was an estimated 72%of the proportion of individuals in the control groups reporting AEs(RR=0.72,CI:0.55-0.94,P=0.0175).Upon comparing effect means for different drug types in conjunction with Medilac-S^(®),evidence of significant variability(P<0.0001)was observed,and sulfasalazine was found to be the most effective drug in both primary and secondary outcomes.CONCLUSION Evidence suggests Medilac-S~adjunctive therapy should be considered standard care for UC in a Chinese population because it aids in the induction of clinical remission,improves symptoms of the gastrointestinal tract and reduces risk of AEs.展开更多
The conceptual physical education(CPE)innovation began in the mid-20th century as an alternative approach to college-level,activity-only basic instruction classes.In addition to physical activity sessions,CPE courses(...The conceptual physical education(CPE)innovation began in the mid-20th century as an alternative approach to college-level,activity-only basic instruction classes.In addition to physical activity sessions,CPE courses(classes)use text material and classroom sessions to teach kinesiology concepts and principles of health-related fitness and health-enhancing physical activity.CPE courses are now offered in nearly all college programs as either required or electives classes.Two decades later,the high school CPE innovation began,and Kindergarten-8 programs followed.In this commentary,I argue that historian Roberta Park was correct in her assessment that physical education has the potential to be the renaissance field of the 21st century.Scientific contributions of researchers in kinesiology will lead the way,but science-based CPE and companion fitness education programs that align with physical education content standards and fitness education benchmarks will play a significant role.CPE courses have been shown to be effective in promoting knowledge,attitudes,and out-of-school physical activity and have the potential to elevate physical education as we chart the course of our future.展开更多
Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standi...Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standing insulin resistance （1R）, which leads to high androgen and testosterone levels; this ultimately disrupts their menstrual cycles. Some researchers attribute IR to genetic factors, although there have been only minute changes in the human genome in the past 20 000 years. However, even with a stable gene pool, genes can be turned on and offby the environment, food and air quality and toxin exposure.展开更多
The purpose of this review and commentary was to provide an historical and evidence-based account of organic acids and the biochemical and organic chemistry evidence for why cells do not produce metabolites that are a...The purpose of this review and commentary was to provide an historical and evidence-based account of organic acids and the biochemical and organic chemistry evidence for why cells do not produce metabolites that are acids.The scientific study of acids has a long history dating to the 16th and 17th centuries,and the definition of an acid was proposed in 1884 as a molecule that when in an aqueous solution releases a hydrogen ion(H^(+)).There are three common ionizable functional groups for molecules classified as acids:1)the carboxyl group,2)the phos-phoryl group and 3)the amine group.The propensity by which a cation will associate or dissociate with a negatively charged atom is quantified by the equilibrium constant(K_(eq))of the dissociation constant(K_(d))of the ionization(K_(eq)=K_(d)),which for lactic acid(HLa)vs.lactate(La^(-))is expressed as:K_(eq)=K_(d)=[H^(+)][La^(-)]/[HLa]=4677.3514(ionic strength=0.01 Mol⋅L^(-1),T=25℃).The negative log10 of the dissociation pKd reveals the pH at which half of the molecules are ionized,which for HLa=3.67.Thus,knowing the pKd and the pH of the solution at question will reveal the extent of the ionization vs.acidification of molecules that are classified as acids.展开更多
Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was u...Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.展开更多
Purpose:This paper presents an update of the 2011 Wheelchair Compendium of Physical Activities designed for wheelchair users and is referred to as the 2024 Wheelchair Compendium.The Wheelchair Compendium aims to curat...Purpose:This paper presents an update of the 2011 Wheelchair Compendium of Physical Activities designed for wheelchair users and is referred to as the 2024 Wheelchair Compendium.The Wheelchair Compendium aims to curate existing knowledge of the energy expenditure for wheelchair physical activities(PAs).Methods:A systematic review of the published energy expenditure of PA for wheelchair users was completed between 2011 and May 2023.We added these data to the 2011 Wheelchair Compendium data that was compiled previously in a systematic review through 2011.Results:A total of 47 studies were included,and 124 different wheelchair PA reported energy expenditure values ranging from 0.8 metabolic equivalents for wheelchair users(filing papers,light effort)to 11.8 metabolic equivalents for wheelchair users(Nordic sit skiing).Conclusion:In introducing the updated 2024 Wheelchair Compendium,we hope to bridge the resource gap and challenge the prevailing narratives that inadvertently exclude wheelchair users from physical fitness and health PAs.展开更多
文摘BACKGROUND People living with human immunodeficiency virus(HIV)are aging as a result the benefits of combination antiretroviral therapy.AIM To provide descriptions of eligible existing studies on demographics,methodologies,and outcome measures related to health-related quality of life(HRQoL)in the context of HIV and aging.METHODS The MEDLINE,CINAHL,Scopus,and PsycINFO databases were systematically searched using the terms HIV,age,and HRQoL to find studies published between January 1995 and June 2022.Key variables of the eligible studies were identified and categorized into demographics(e.g.,study sites,study year),methodologies(e.g.,use of conceptual frameworks,measures used),and outcome measures[e.g.,HRQoL,quality of life(QoL)].The PRISMA 2009 checklist was followed.RESULTS A total of 68 published studies involving 53504 participants were included.The majority of the studies(55.88%)were conducted in North America,with relatively few studies conducted in Africa.The median age of participants was 51.0 years(IQR=11.0).Over one-third(32.56%)of all participants were older people living with HIV aged 50 years and older Four studies included only older female participants,and six studies included only men who have sex with men.Outcome mea-sures were assessed as HRQoL(26.47%)or QoL(36.76%).Overall,data from African studies,older women living with HIV,socioeconomic status(e.g.,employment,income,education),sexual behavioral risks,theoretical frameworks used,and follow-up studies were limited.CONCLUSION This narrative review highlights imbalances and gaps in research on HRQoL in the context of HIV and aging,providing direction for future studies in this area.
文摘Objectives:We systematically reviewed the rational use of medicines using the World Health Organization/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of the coronavirus disease 2019 pandemic and the National Drug Policy(NDP)2005 on the rational use of medicines.Methods:Searches were conducted in PubMed,Scopus,and Google Scholar databases to identify studies that met our eligibility criteria.Assessment of the quality of studies was conducted using the Joanna Briggs Institute criteria for analytical studies.We reported and compared the median values of WHO/INRUD core drug use indicators with standard thresholds.Data were presented with median,interquartile range(IQR),and percentages.MannWhitney and Kruskal-Wallis tests were conducted to assess for statistical significance(P<0.05)across variables.Results:Thirty-one studies were included in the review,comprising 50,931 patient encounters across 268 health facilities.Within prescribing indicators,average number of medicines per patient encountered[3.4(IQR:3.0to 4.0)],percentage of medicines prescribed by generic[50.4%(IQR:47.4%to 65.0%)],percentage of encounters with antibiotic prescribed[40.2%(IQR:30.5%to 52.7%)],percentage of encounters with injection prescribed[18%(IQR:3.2%to 30.0%)]and the percentage of medicines prescribed from essential medicines list[82.0%(IQR:66.4%to 89.3%)].The median percentage of encounters with antibiotics(P=0.04)and the median percentage of medicines prescribed by generics(P=0.03)increased during and after the COVID-19 pandemic.Prescribing indicators were worse in primary and secondary health facilities,with significant differences in the median percentage of encounters with antibiotics(P=0.007)and injections(P=0.0002)across primary,secondary,and tertiary health facilities.There were improvements across all prescribing indicators after the implementation of NDP 2005.Conclusions:Core drug use indicators in Nigerian health facilities deviated from the WHO/INRUD thresholds,with noticeable improvement after the implementation of NDP 2005.More efforts are needed to improve rational drug use in Nigerian hospitals.
基金NJP holds a Future Leader Award from the Novo Nordisk Foundation and European Foundation for the Study of Diabetes(NNF/EFSD NNF21SA0072747)a grant from the Diabetes Wellness Network Sverige(PG21-6524)+5 种基金supported by the Swedish Research Council(2015-00165)the European Research Council(ERC-2023-Ad G 101142093)a Wallenberg Scholars Award from the Knut and Alice Wallenberg Foundation(KAW 2023.0312)the Swedish Research Council for Sport Science(P2023-0093)The Novo Nordisk Foundation Center for Basic Metabolic Research is an independent research center at the Faculty of Health and Medical Sciences,University of Copenhagen,Denmark partially funded by an unrestricted donation from the Novo Nordisk Foundation(NNF18CC0034900,NNF23SA0084103)supported by a postdoctoral fellowship from the Strategic Research Program in Diabetes at Karolinska Institutet。
文摘Background:Cardiorespiratory fitness(CRF)is a powerful predictor of mortality and chronic disease risk,yet global patterns and determinants of CRF remain poorly defined,particularly in females and underrepresented populations.We conducted a systematic review and quantitative synthesis of directly measured peak oxygen uptake(VO_(2peak))internationally and examined its association with human development and gender ine quality.Methods:Studies were eligible if VO_(2peak)was assessed via direct gas analysis during maximal exercise testing,and if the countries had scores for the Human Development Index(HDI)and Gender Inequality Index(GII).Studies were identified through MEDLINE/PubMed,Embase,CINAHL,and Web of Science.Risks of bias were assessed by an adaptation of the Newcastle-Ottawa Scale.Multivariable linear regression models examined associations between VO_(2peak),age,sex,exercise modality,HDI,GII,and study year.Results:Data included 95 studies from 24 countries with HDI and GII scores,comprising 119,435 adults(42%females)with VO_(2peak)assessed via direct gas analysis during maximal exercise testing.The risk of bias was low.VO_(2peak)was positively associated with HDI(β=14.1)and negatively associated with GII(β=-3.6).Slightly stronger associations were observed in females than males(HDI:β=18.9 vs.β=13.9,GII:β=-4.6vs.β=-3.6).Young females in middle-HDI countries had higher VO_(2peak)than those in low-HDI countries(31.2mL/kg/min vs.28.5 mL/kg/min),with limited additional gams in high-HDI contexts.VO_(2peak)decreased with higher gender inequality,with the largest disparities observed in young females between high-and low-GII countries(26.3 mL/kg/min vs.32.8 mL/kg/min).Conclusion:Global variation in CRF is tied to national levels of human development and gender equality.These findings support prioritizing structural and policy-level interventions that address social and gender disparities in physical activity access and health promotion.Studies from countries with lower HDI and information on ethnicity and socioeconomic status will bridge crucial gaps in understanding factors involved in global CRF levels.
基金supported by a Project Grant(Grant No.PJT183705)an Early Career Investigator Prize(Grant No.ECP 184184)from the Canadian Institutes of Health Research+7 种基金a Prentice Institute Research Affiliate Fund Grant from the Prentice Institute for Global Population and Economy(Grant No.G00004116)a Te Herenga Waka Victoria University of Wellington Division of Science Health Engineering Architecture and Design Innovation Faculty Strategic Research Grant(Grant No.FSRG-SHEADI-10724)The Thailand Physical Activity Knowledge Development Centre(TPAK)/Thai Health Promotion Foundation provided funding for the cognitive interviews and pilot study in Thailand(Grant No.66-P1-0473)The University Pablo de Olavide provided a scholarship for 2 undergraduate students working on the project(codes PPI2207 and PPI2308)In the Czech Republicthe study was supported by Palacky University IGA(Grant No.IGA_FTK_2023_017)supported by the Division of Intramural Research at the National Institute on Minority Health and Health Disparities of the National Institutes of Healthsupported by the Key Project of the National Philosophy and Social Science Foundation of China(23&ZD197)。
文摘Background:Investigators from low-,middle-,and high-income countries representing 6 continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire(GAC-PAQ).The GAC-PAQ is designed to assess physical activity(PA)across all key domains(i.e.,school,chores,work/volunteering,transport,free time,outdoor time).It aimed to address multiple gaps in global PA surveillance(e.g.,omission of important PA domains,insufficient cultural adaptation,underrepresentation of rural areas in questionnaire validation studies).The purpose of this study was to assess the content validity of the GAC-PAQ among PA experts,8-to 17-year-olds,and one of their parents/guardians,and to discuss changes made to the questionnaire based on participants'feedback.Methods:Sixty-two experts in PA measurement and/or surveillance from 24 countries completed an online survey that included both closed-and open-ended questions about the content validity of the GAC-PAQ.The proportion of experts who agreed or strongly agreed with the items was calculated.Child-parent/guardian dyads from 15 countries(n=250;10-40 per country)participated in a structured cognitive interview to assess the clarity of the questions and response options,and they were encouraged to provide suggestions to improve clarity and facilitate completion of the questionnaire.Participating countries are:Aotearoa New Zealand,Brazil,Canada,China,Colombia,Czech Republic,India,Malawi,Mexico,Nepal,Nigeria,Spain,Sweden,Thailand,and the United Arab Emirates.Interviews were conducted in 13 different languages and structured by PA domain.Generic images were included to help participants in answering questions about PA intensity.Results:Expert agreement with the items for each domain exceeded 75%,and their qualitative feedback was used to revise the questionnaire before cognitive interviews.In general,participants found the questionnaire to be comprehensive.Adolescents(12-17 years)found it easier than children(8-11 years)to answer the questions.Several children struggled to answer questions about the duration and intensity of activities and/or concepts related to travel modes,active trips,and organized activities.Many parents/guardians were unsure about the frequency,duration,and intensity of their children's or adolescents'PA at school and/or recommended using more culturally relevant and appropriate images.Some participants misunderstood the concept of activities that“make you stronger”(intended to assess resistance activities)and/or struggled to differentiate between work,volunteering,and chores.Conclusion:Participants'feedback was used to develop a revised,simplified,and culturally adapted GAC-PAQ,which will be pilot-tested in all15 countries in an App that will include country-specific images and narration in local languages.Further research is needed to assess the reliability and validity of the revised GAC-PAQ.
文摘In 2009,Professor Steven Blair predicted that physical inactivity would be the greatest public health issue of the 21st century.~1 A public health problem is one that affects the health,function,and well-being of a large number of people.
文摘1.Introduction Before coronavirus disease 2019 (COVID-19) became a global health emergency in early 2020,there was substantial evidence of physical activity’s (PA’s) multiple benefits with direct relevance to reducing the harms of the pandemic:improved immune functioning and reduced inflammation to lessen severity of infections,enhanced efficacy of vaccines.
基金Funding was provided by the National Key R&D Program of China(2018YFC2000600).
文摘A Chinese Compilation of Physical Activities was compiled to estimate the energy costs of physical activities(PAs)using data on adults aged 18–64.Data were obtained from published articles and laboratory measurements.Databases,including PubMed,Embase,Scopus,Ebsco,Web of Science,Chinese National Knowledge Infrastructure,Wan Fang Data,National Science and Technology Report Service,Public Health Scientific Data were searched to collect data from inception to January 2022,on energy expenditure associated with PA in the healthy Chinese population.Two reviewers independently screened the literature and extracted,classified,and summarized data.Data were measured for 36 PAs using indirect calorimetry.Detailed descriptions of specific activities and metabolic equivalent values were provided by summarizing 241 physical activities in 13 categories.The first edition of the Chinese Compilation of PAs in Healthy Adults Aged 18–64(CCPA)was created.It provides valuable resources for people who regularly engage in physical exercise,researchers,educators,fitness professionals,and health or commercial sectors to quickly obtain various PA MET intensities.In the future,the energy expenditure of various PAs of different ages within the Chinese population can be measured based on the CCPA.
文摘Aim: The primary aim of the project was to conduct focus groups with pregnant women to examine their perceptions on patient and health care provider (HCP) communication during prenatal visits pertaining to health behavioral change. In particular, to determine what types of communication facilitate or prevent patient engagement and adherence to certain health behaviors related to smoking cessation, engagement in physical activity, healthy eating and healthy weight gain, and stress management. Methods: Participants were recruited from the obstetric and midwifery clinics at the University of Colorado Hospital. Twenty-four pregnant, English-speaking women between the ages of 18 and 46 years old, the majority of which had full health insurance coverage, participated in one of three focus groups that were conducted. The transcripts were coded for themes and patterns. Results identified numerous current practices of HCPs, facilitators and barriers in care, and patient recommendations related to effective patient-provider communication. Results: Overall many women received basic information about most health behaviors (i.e. healthy eating, physical activity, and smoking cessation) with the exception of stress management from their HCPs via their introductory information packet. However, typically there was no follow-up beyond receipt of the packet. As a result, women sought information online from numerous sources. Unfortunately, this information often conflicted with HCP provided information, as did the information provided from multiple HCPs in group care settings. A major facilitator of behavioral change pertained to building trust and rapport as it directly enhanced the perceived quality of patient-provider communication on prenatal health behaviors. Across all behaviors, women voiced the need for available resources that were credible and referenced by their HCPs. Conclusions: These findings provide a better understanding of what facilitates and prevents women from engaging in healthy behaviors during their pregnancy, in addition to improving patient and provider communication.
文摘Physical activity(PA)is fundamentally linked to public health,^(1)providing benefits including chronic disease prevention and treatment,^(2)mental health,^(3)musculoskeletal health,^(4)and healthy aging,^(5)along with socioeconomic advantages.^(6)These benefits highlight the importance of promoting PA for all populations.The recent publication of the Compendium of Physical Activities(Compendium)serves as a valuable resource,^(7)offering an updated and expanded guide for adults(ages 19-59)with tailored energy cost values for diverse populations.
基金supported by USAID Global Development Research(GDR)Scholar grant.
文摘Purpose:This study aims to examine the level of behavioral health integration in primary care clinics among patients with hypertension and type 2 diabetes in Chiang Mai,Thailand.It also aims to explore the provider perceived prevalence of behavioral problems and need for an expert behavioral health consultant on the primary care team and the risk and protective factors of the patients’psychological and cardio-metabolic health outcomes.Methodology:Using survey data between 2017 and 2018 regarding the level of integration as measured by a Practice Integration Profile,provider ratings of prevalence and need based on a Provider Survey,and patient lifestyle and behavioral problems with a Health Risk Assessment in six primary health care settings in Chiang Mai,Thailand(n=335).We conducted ordinary least squares regressions to explore the relationship between each of the patient psychological and cardio-metabolic health outcomes and physical,mental health and substance abuse variables while controlling for the demographics.Results:The results showed overall high levels of integration,but significant variability across clinics.Providers rated prevalence of health risk and need for a Behavioral Health Consultant as moderate.Results of the patient health risk assessment were variable,with some problems high severity,others low.Conclusion:The results reflect a need for integrated behavioral health into the health care system in Thailand especially for those who are in the chronic illness condition.Recommendations for future study include an evaluation of the translation quality and validity and reliability of the study measures under the Thai context.This study fills the research gap of lacking research on the level of integrated care in clinics in Thailand.
基金Kate Lothman of RTI Health Solutions provided medical writing services,which were funded by Takeda
文摘AIM To systematically review the literature on epidemiology,disease burden, and treatment outcomes for Crohn's disease(CD) patients with complex perianal fistulas.METHODS PubMed, Embase, and Cochrane were searched for relevant articles(published 2000-November 2016) and congress abstracts(published 2011-November 2016).RESULTS Of 535 records reviewed, 62 relevant sources were identified(mostly small observational studies). The cumulative incidence of complex perianal fistulas in CD from two referral-centre studies was 12%-14%(follow-up time, 12 years in one study; not reported in the second study). Complex perianal fistulas result in greatly diminished quality of life; up to 59% of patients are at risk of faecal incontinence. Treatments include combinations of medical and surgical interventions and expanded allogeneic adipose-derived stem cells. High proportions of patients experience lack of or inadequate response to treatment(failure and relapse rates,respectively: medical, 12%-73% and 0%-41%; surgical:0%-100% and 11%.20%; combined medical/surgical:0%-80% and 0%-50%; stem cells: 29%-47% and not reported). Few studies(1 of infliximab; 3 of surgical interventions)have been conducted in treatment-refractory patients, a population with high unmet needs. Limited data exist on the clinical value of anti-tumour necrosis factor-α dose escalation in patients with complex perianal fistulas in CD.CONCLUSION Complex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to antitumour necrosis factor-α agents, as evidenced by high failure and relapse rates.
文摘AIM:To study whether the severity of liver fibrosis estimated by the nonalcoholic fatty liver disease(NAFLD) fibrosis score can predict all-cause mortality,cardiac complications,and/or liver complications of patients with NAFLD over long-term follow-up.METHODS:A cohort of well-characterized patients with NAFLD diagnosed during the period of 1980-2000 was identified through the Rochester Epidemiology Project.The NAFLD fibrosis score(NFS) was used to separate NAFLD patients with and without advanced liver fibrosis.We used the NFS score to classify the probability of fibrosis as <-1.5 for low probability,>-1.5 to < 0.67 for intermediate probability,and > 0.67 for high probability.Primary endpoints included allcause death and cardiovascular-and/or liver-related mortality.From the 479 patients with NAFLD assessed,302 patients(63%) greater than 18 years old were included.All patients were followed,and medical charts were reviewed until August 31,2009 or the date when the first primary endpoint occurred.By using a standardized case record form,we recorded a detailed history and physical examination and the use of statins and metformin during the follow-up period.RESULTS:A total of 302/479(63%) NAFLD patients(mean age:47 ± 13 year) were included with a followup period of 12.0 ± 3.9 year.A low probability of advanced fibrosis(NFS <-1.5 at baseline) was found in 181 patients(60%),while an intermediate or high probability of advanced fibrosis(NSF >-1.5) was found in 121 patients(40%).At the end of the follow-up period,55 patients(18%) developed primary endpoints.A total of 39 patients(13%) died during the follow-up.The leading causes of death were non-hepatic malignancy(n = 13/39;33.3%),coronary heart disease(CHD)(n = 8/39;20.5%),and liver-related mortality(n = 5/39;12.8%).Thirty patients had new-onset CHD,whereas 8 of 30 patients(27%) died from CHD-related causes during the follow-up.In a multivariate analysis,a higher NFS at baseline and the presence of new-onset CHD were significantly predictive of death(OR = 2.6 and 9.2,respectively;P < 0.0001).Our study showed a significant,graded relationship between the NFS,as classified into 3 subgroups(low,intermediate and high probability of liver fibrosis),and the occurrence of primary endpoints.The use of metformin or simvastatin for at least 3 mo during the follow-up was associated with fewer deaths in patients with NAFLD(OR = 0.2 and 0.03,respectively;P < 0.05).Additionally,the rate of annual NFS change in patients with an intermediate or high probability of advanced liver fibrosis was significantly lower than those patients with a low probability of advanced liver fibrosis(0.06 vs 0.09,P = 0.004).The annual NFS change in patients who died was significantly higher than those in patients who survived(0.14 vs 0.07,P = 0.03).At the end of the follow-up,we classified the patients into 3 subgroups according to the progression pattern of liver fibrosis by comparing the NFS at baseline to the NFS at the end of the followup period.Most patients were in the stable-fibrosis(60%) and progressive-fibrosis(37%) groups,whereas only 3% were in the regressive fibrosis.CONCLUSION:A higher NAFLD fibrosis score at baseline and a new onset of CHD were significantly predictive of death in patients with NAFLD.
文摘BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment(OLGA)and operative link on gastric intestinal metaplasia assessment(OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients(stages Ⅲ–Ⅳ),and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.AIM To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.METHODS In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I(PGI). Between the years 1989 and1993, men with low PGI values(PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM,by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.RESULTS Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio(HR) 2.70, 95%CI: 1.09–6.69, P = 0.03]. The risk increased through OLGIM stages 0-Ⅳ(0 vs Ⅳ: HR 5.72, 95%CI: 1.03–31.77, P for trend = 0.004), but not through OLGA stages 0–Ⅳ(0 vs Ⅳ: HR 5.77, 95%CI:0.67–49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages Ⅲ–Ⅳ were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three-to four-times higher gastric cancer risk compared to the general male population of the same age.CONCLUSION OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.
文摘TagedPIn February and March 2022,China will host the Beijing 2022 Olympic and Paralympic Winter Games.The vision for this landmark event promises a“joyful rendezvous upon pure ice and snow uniting the passion of hundreds of millions for winter sports”.1 Themes have been developed to create a positive environmental impact with new development for the northern region of the country and to promote winter sports and improve the health and well-being of the Chinese people.The key messages for the winter games include inspiring youth with the Olympic spirit and encouraging millions to embrace winter sports.Notably,the Chinese government aims to mobilize at least 300 million of its citizens to engage in winter sports as an outcome of hosting the Winter Olympic Games.
文摘AIM To assess the effects of probiotic Medilac-S^(®)as adjunctive therapy for the induction of remission of ulcerative colitis(UC)in a Chinese population through a systematic review and meta-analysis.METHODS A systematic literature search was conducted to find randomized,controlled trials in a Chinese population with at least two study arms-a control arm which receives a conventional,oral aminosalicylate drug,and a treatment arm,which administers the same conventional drug in conjunction with the probiotic Medilac-S^(®)per os.Both English and Chinese databases were searched,including Pub Med,EMBASE,Google Scholar,Chinese National Knowledge Infrastructure,Wanfang Data,and VIP Search,and study data was extracted onto standardized abstraction sheets.Meta-analyses were conducted for primary and secondary outcomes of interest using a fixed or random effects model.The primary outcome was the induction of clinical remission and the secondary outcomes included changes in Sutherland index,endoscopic and histological scores,proportion of reported clinical symptoms and adverse events(AEs).For outcomes with sufficient data,the type of conventional drug therapy was also assessed to determine if the effects of combination therapy with Medilac-S^(®)was influenced by drug type.All tests were conducted using a typeⅠerror rate of 0.05 and all confidence intervals(CI)were based on a 95%confidence level.Review protocol was uploaded to PROSPERO(CRD42018085658 upon completion).RESULTS Fifty-three clinical trials with a total of 3984 participants were identified and included in the review.Medilac-S^(®)adjunctive therapy significantly improved induction of clinical remission(RR=1.21;95%CI:1.18-1.24;P<0.0001)with the estimated likelihood of effective treatment,on average,21%higher for those consuming the probiotic.Sutherland index scores showed the control mean was on average 3.10(CI:2.41-3.78;P=0.0428)units greater than the treatment mean,thereby demonstrating significant improvement in participants taking the probiotic.Similarly,a significant difference was seen between the overall reduction of endoscopic and histological scores of control and treatment arm participants,with score decreases in the control groups 0.71(CI:0.3537-1.0742)and 1.1(CI:0.9189-1.2300)units smaller than treatment group score decreases.The proportion of participants reporting clinical symptoms,(abdominal pain,tenesmus,blood and mucous in stool,and diarrhea)was significantly reduced after combination therapy with Medilac-S~(P<0.0001)and estimated to be on average 44%(RR=0.44,CI:0.32-0.59),53%(RR=0.53,CI:0.38-74),40%(RR=0.40,CI:0.28-0.58)and 47%(RR=0.47 CI:0.36-0.42)respectively,of the proportion of individuals reporting the aforementioned symptoms after conventional therapy alone.The risk of AEs was also significantly reduced with adjunctive Medilac-S~therapy.The proportion of individuals in the treatment groups reporting AEs was an estimated 72%of the proportion of individuals in the control groups reporting AEs(RR=0.72,CI:0.55-0.94,P=0.0175).Upon comparing effect means for different drug types in conjunction with Medilac-S^(®),evidence of significant variability(P<0.0001)was observed,and sulfasalazine was found to be the most effective drug in both primary and secondary outcomes.CONCLUSION Evidence suggests Medilac-S~adjunctive therapy should be considered standard care for UC in a Chinese population because it aids in the induction of clinical remission,improves symptoms of the gastrointestinal tract and reduces risk of AEs.
文摘The conceptual physical education(CPE)innovation began in the mid-20th century as an alternative approach to college-level,activity-only basic instruction classes.In addition to physical activity sessions,CPE courses(classes)use text material and classroom sessions to teach kinesiology concepts and principles of health-related fitness and health-enhancing physical activity.CPE courses are now offered in nearly all college programs as either required or electives classes.Two decades later,the high school CPE innovation began,and Kindergarten-8 programs followed.In this commentary,I argue that historian Roberta Park was correct in her assessment that physical education has the potential to be the renaissance field of the 21st century.Scientific contributions of researchers in kinesiology will lead the way,but science-based CPE and companion fitness education programs that align with physical education content standards and fitness education benchmarks will play a significant role.CPE courses have been shown to be effective in promoting knowledge,attitudes,and out-of-school physical activity and have the potential to elevate physical education as we chart the course of our future.
文摘Patients with a diagnosis of polycystic ovary syndrome （PCOS） are on the rise. About 4%-12% of women are currently estimated to have this condition. It is hypothesized that PCOS appears in women who have long-standing insulin resistance （1R）, which leads to high androgen and testosterone levels; this ultimately disrupts their menstrual cycles. Some researchers attribute IR to genetic factors, although there have been only minute changes in the human genome in the past 20 000 years. However, even with a stable gene pool, genes can be turned on and offby the environment, food and air quality and toxin exposure.
文摘The purpose of this review and commentary was to provide an historical and evidence-based account of organic acids and the biochemical and organic chemistry evidence for why cells do not produce metabolites that are acids.The scientific study of acids has a long history dating to the 16th and 17th centuries,and the definition of an acid was proposed in 1884 as a molecule that when in an aqueous solution releases a hydrogen ion(H^(+)).There are three common ionizable functional groups for molecules classified as acids:1)the carboxyl group,2)the phos-phoryl group and 3)the amine group.The propensity by which a cation will associate or dissociate with a negatively charged atom is quantified by the equilibrium constant(K_(eq))of the dissociation constant(K_(d))of the ionization(K_(eq)=K_(d)),which for lactic acid(HLa)vs.lactate(La^(-))is expressed as:K_(eq)=K_(d)=[H^(+)][La^(-)]/[HLa]=4677.3514(ionic strength=0.01 Mol⋅L^(-1),T=25℃).The negative log10 of the dissociation pKd reveals the pH at which half of the molecules are ionized,which for HLa=3.67.Thus,knowing the pKd and the pH of the solution at question will reveal the extent of the ionization vs.acidification of molecules that are classified as acids.
文摘Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.
文摘Purpose:This paper presents an update of the 2011 Wheelchair Compendium of Physical Activities designed for wheelchair users and is referred to as the 2024 Wheelchair Compendium.The Wheelchair Compendium aims to curate existing knowledge of the energy expenditure for wheelchair physical activities(PAs).Methods:A systematic review of the published energy expenditure of PA for wheelchair users was completed between 2011 and May 2023.We added these data to the 2011 Wheelchair Compendium data that was compiled previously in a systematic review through 2011.Results:A total of 47 studies were included,and 124 different wheelchair PA reported energy expenditure values ranging from 0.8 metabolic equivalents for wheelchair users(filing papers,light effort)to 11.8 metabolic equivalents for wheelchair users(Nordic sit skiing).Conclusion:In introducing the updated 2024 Wheelchair Compendium,we hope to bridge the resource gap and challenge the prevailing narratives that inadvertently exclude wheelchair users from physical fitness and health PAs.
