In recent years,pediatric health care has embraced the concept of quality improvement to improve patient outcomes.As quality improvement efforts are implemented,network collaboration(where multiple centers and practic...In recent years,pediatric health care has embraced the concept of quality improvement to improve patient outcomes.As quality improvement efforts are implemented,network collaboration(where multiple centers and practices implement standardized programs)is a popular option.In a collaborative network,improvement in the conduct of structural,process and outcome quality measures can lead to improvements in overall health,and benchmarks can be used to assess and compare progress.In this review article,we provided an overview of the quality improvement movement and the role of quality indicators in this movement.We reviewed current quality improvement efforts in pediatric inflammatory bowel disease (IBD),as well as other pediatric chronic illnesses.We discussed the need to standardize the development of quality indicators used in quality improvement networks to assess medical care,and the validation techniques which can be used to ensure that process indicators result in improved outcomes of clinical significance.We aimed to assess current quality improvement efforts in pediatric IBD and other diseases,such as childhood asthma,childhood arthritis,and neonatal health.By doing so,we hope to learn from their successes and failures and to move the field forward for future improvements in the care provided to children with IBD.展开更多
Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department...Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department improves the quality of teaching of procedures, and whether videos are particularly beneficial during periods of emergency department crowding. Methods: In this single-centre, prospective, before and after study standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each emergency department shift in the before (August 2008-March 2009) and after (August 2009-March 2010) phase. Online procedure videos were introduced on emergency department computers in the after phase. The primary outcome measure was EP rating of the quality of teaching provided (5-point Likert scale). The interaction between crowding and videos was also assessed, to determine whether videos provide a specific additional benefit during periods of emergency department crowding. Results: There were 1159 procedures performed by 192 trainees. Median procedures performed per shift was 1.0 (IQR 0 - 2.0). Mean EP rating of teaching provided was significantly higher in the group that viewed videos, at 4.2 versus 3.7 (p 0.001). In the adjusted analysis, EP ratings increased by 0.5 with a video (p 0.001), while the odds of a score of 5.0 were 2.2 times greater if a video was viewed (p = 0.03). The interaction of crowding and procedure videos was not significant (the use of videos increased the average score by 0.24 in times of crowding compared to times of non-crowding, p = 0.19). Conclusions: Use of procedural videos was associated with EP perception of improved quality of teaching provided around procedures. While EPs rated the quality of their teaching as improved overall, the effect of videos on teaching quality was the same in crowded settings as it was in non-crowded setting.展开更多
AIM:To determine the general and transplant-specific risk factors for fractures in kidney transplant recipients.METHODS:We conducted a cohort study of all adults who received a kidney-only transplant(n=2723)in Ontario...AIM:To determine the general and transplant-specific risk factors for fractures in kidney transplant recipients.METHODS:We conducted a cohort study of all adults who received a kidney-only transplant(n=2723)in Ontario,Canada between 2002 and 2009.We used multivariable Cox proportional hazards regression to determine general and transplant-specific risk factors for major fractures(proximal humerus,forearm,hip,and clinical vertebral).The final model was established using the backward elimination strategy,selecting risk factors with a P-value≤0.2 and forcing recipient age and sex into the model.We also assessed risk factors for other fracture locations(excluding major fractures,and fractures involving the skull,hands or feet).RESULTS:There were 132 major fractures in the follow-up(8.1 fractures per 1000 person-years).General risk factors associated with a greater risk of major fracture were older recipient age[adjusted hazard ratio(a HR)per 5-year increase 1.11,95%CI:1.03-1.19]and female sex(a HR=1.81,95%CI:1.28-2.57).Transplant-specific risk factors associated with a greater risk of fracture included older donor age(5-year increase)(a HR=1.09,95%CI:1.02-1.17)and end-stage renal disease(ESRD)caused by diabetes(a HR=1.72,95%CI:1.09-2.72)or cystic kidney disease(a HR=1.73,95%CI:1.08-2.78)(compared to glomerulonephritis as the reference cause).Risk factors across the two fracture locations were not consistent(major fracture locations vs other).Specifically,general risk factors associated with an increased risk of other fractures were diabetes and a fall with hospitalization prior to transplantation,while length of time on dialysis,and renal vascular disease and other causes of ESRD were the transplant-specific risk factors associated with a greater risk of other fractures.CONCLUSION:Both general and transplant-specific risk factors were associated with a higher risk of fractures in kidney transplant recipients.Results can be used for clinical prognostication.展开更多
近年来实效性临床试验受到更多重视,尤其在传统医学临床评价研究领域。为了提高实效性临床试验报告的质量,CONSORT声明组和医疗保健体系中的实效性随机对照临床试验(pragmatic randomized controlled trials in health care systems,PRA...近年来实效性临床试验受到更多重视,尤其在传统医学临床评价研究领域。为了提高实效性临床试验报告的质量,CONSORT声明组和医疗保健体系中的实效性随机对照临床试验(pragmatic randomized controlled trials in health care systems,PRACTIHC)小组对《CONSORT声明》进行了修改,以帮助读者评估试验质量和结果的可靠性。实效性试验报告指南,作为《CONSORT声明》的一个特殊扩展,能在报告、评价和应用实效性试验方面帮助编辑、系统评价者、试验设计者和决策者评估实效性试验报告中的信息,判定其结论是否适用,以及干预措施是否可行、可否被接受。2005年1月和2008年3月,在加拿大多伦多分别举行了为期两天的会议来探讨提高随机对照试验对卫生保健决策贡献的方法,焦点集中于实效性试验。2005年会,后扩展版草案修订清单发送至编写组成员,经过几次修订,编写组起草了一份摘要草案。在2008年讨论并修改了这一草案。这份草案发给CONSORT声明组以供修改并发表。这份声明的扩展版提出了对8个条目的补充。及时向国内读者和临床试验研究人员介绍该指南有重要的现实意义和学术价值。北京中医药大学循证医学中心刘建平教授等在短时间内翻译了该指南。本刊希望通过介绍中文版"提高实效性临床试验报告的质量——《CONSORT声明》的扩展"以提高国内实效性临床试验报告的质量,相信也有助于改进试验设计的方法学质量。展开更多
Valproic acid （VPA） has been a first-choice drug for clinical treatment of epilepsy and manic disorder. For decades, its phar- macological action was believed to act on inhibition of gam- ma-aminobutyric acid （GABA...Valproic acid （VPA） has been a first-choice drug for clinical treatment of epilepsy and manic disorder. For decades, its phar- macological action was believed to act on inhibition of gam- ma-aminobutyric acid （GABA） transaminase, in turn, increas- ing GABA in inhibitory synapses. However, in recent years, VPA has been investigated on other therapeutic actions. Those investigations demonstrate that VPA shows neuroprotective ef- fects by promoting neurogenesis, neuronal differentiation, and neuroregeneration （Foti et al., 2013）.展开更多
OBJECTIVE To investigate the effect of microRNA-32 on cold-induced thermogenesis and brown adipocyte energy metabolism.METHODS To apply the cold-induced thermogenesis model in mice,8-10 week old male C57Bl6 mice were ...OBJECTIVE To investigate the effect of microRNA-32 on cold-induced thermogenesis and brown adipocyte energy metabolism.METHODS To apply the cold-induced thermogenesis model in mice,8-10 week old male C57Bl6 mice were placed within a 6℃fridge for 7d.Control microRNA inhibitor or miR-32 inhibitor(10mg·kg-1)was administered via intraperitoneal injection 16 hbefore the mice were placed in the fridge.Daily core body temperatures were taken using a rectal temperature probe.Mice were euthanized after 7dand brown adipose tissue(BAT),inguinal and epididymal white adipose tissue(WAT),skeletal muscle and liver tissue analysed for changes in morphology and gene expression.RESULTS miR-32 inhibition in vivoinhibits the emergence of beige cells,which function like BAT cells,within WAT.In silico prediction and gene ontology analysis identified Tob1 as a likely target gene of miR-32.miR-32 inhibition led to increased expression of Tob1 whilst mutation of target sequence abolished this effect.Expression of brown adipose markers such as Ucp1,Pgc1α,Pparαand Prdm16 were significantly reduced in inguinal white adipose tissue(P<0.05).There was also a significant decrease in serumfgf21 levels due to the inhibition of Fgf21 expression in BAT(P<0.05).p38/MAPK signalling in brown adipose tissue was also significantly inhibited within brown adipose tissue leading to decreased fgf21 expression and secretion.CONCLUSION Our study shows that miR-32 plays a crucial role in stimulating beige cell emergence by activating p38/MAPK signalling during cold thermogenesis.miR-32 may prove effective as a treatment for obesity by activating cold-induced thermogenesis leading to increased energy metabolism.展开更多
This study examined whether people who self-reported depression sought mental health treatment in the year after being interviewed, and how gender affected utilization. Depression data were obtained from the Canadian ...This study examined whether people who self-reported depression sought mental health treatment in the year after being interviewed, and how gender affected utilization. Depression data were obtained from the Canadian Community Health Survey (2000-01), and linked to medical records in Ontario (n = 24,677). Overall, women had higher rates of mental health service utilization, but there were no gender differences in rates of specialist care. The gender difference in mental health contact was greater for those without depression, as opposed to those with depression. Among those without depression, women were significantly more likely than men to use mental health services;however, rates were similar for women and men with depression. This finding suggests that men may be more likely than women to delay seeing a doctor for minor mental health concerns, but will seek help once a problem reaches a threshold.展开更多
<strong>Background:</strong> To make outpatient visits for adolescents with diabetes successful, it is important for health care professionals to meet the adolescents’ needs and wishes. <strong>Aims...<strong>Background:</strong> To make outpatient visits for adolescents with diabetes successful, it is important for health care professionals to meet the adolescents’ needs and wishes. <strong>Aims:</strong> The aim is to investigate adolescents’ expectations of an outpatient diabetes clinic visit in comparison to what was deemed to be delivered and contrast this outcome in adolescents with self-reported high- and low-diabetes distress respectively. <strong>Methods:</strong> All adolescents in Sweden with type 1 diabetes, aged 15 to 18 years, were identified via The National Pediatric Diabetes Registry (SWEDIABKIDS) and asked to complete an online questionnaire regarding their expectations and the support received during the outpatient diabetes clinic visit. <strong>Results:</strong> 453 adolescents completed the survey. Boys’ expectations of discussion topics were mainly met while girls, especially those with diabetes distress, felt their discussion needs were not met regarding quality-of-life aspects. <strong>Conclusions:</strong> Although adolescents’ expectations are in general met during the diabetes outpatient clinic visit, aspects related to living with diabetes are not being met especially among female adolescents who reported diabetes distress. This study shows a gender difference both regarding expected discussion topics and what was deemed covered. <strong>Practice Implications:</strong> A multi-professional, individual person-centred care approach is needed at the diabetes outpatient clinic. This paper proposes that agenda setting performed by the adolescent, and agreed by the physician, prior to the outpatient clinic visit could facilitate individualized care and better meet the adolescents’ needs in a shared decision-making process.展开更多
Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suici...Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this "gender paradox" in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic,neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses(including conforming to others' or one's own expectations of sex/gender identity) and adapt to pain(through substance use and helpseeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s)(e.g., childhood maltreatment) and/or one's ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth.展开更多
BACKGROUND The rise in prevalence of non-alcoholic fatty liver disease(NAFLD)mirrors the obesity epidemic.NAFLD is insidious but may gradually progress from simple steatosis to steatohepatitis,fibrosis and cirrhosis a...BACKGROUND The rise in prevalence of non-alcoholic fatty liver disease(NAFLD)mirrors the obesity epidemic.NAFLD is insidious but may gradually progress from simple steatosis to steatohepatitis,fibrosis and cirrhosis and/or hepatocellular carcinoma.Intervention strategies to ameliorate developmental programming of NAFLD may be more efficacious during critical windows of developmental plasticity.AIM To review the early developmental factors associated with NAFLD.METHODS Databases MEDLINE via PubMed,and EMBASE and Reference Citation Analysis were searched and relevant publications up to April 30,2021 were assessed.Original research studies that included risk factors associated with early development of NAFLD in human subjects were included.These factors include:Maternal factors,intrauterine and prenatal factors,post-natal factors,genetic and ethnic predisposition,childhood and adolescence environmental factors.Studies were excluded if they were review articles or animal studies,case reports or conference abstracts,or if NAFLD was not clearly defined and assessed radiologically.RESULTS Of 1530 citations identified by electronic search,420 duplicates were removed.Of the 1110 citations screened from title and abstract,80 articles were included in the final analysis.Genetic polymorphisms such as patatin-like phospholipase domain-containing protein 3(PNPLA3)and membrane-bound O-acyltransferase domain-containing protein 7(MBOAT7)were associated with increased risk of NAFLD.Familial factors such as maternal obesogenic environment and parental history of hepatic steatosis was associated with offspring NAFLD.Longer duration of exclusive breastfeeding in infancy was associated with a lower risk of developing NAFLD later in life while metabolic dysfunction and/or obesity in adolescence was associated with increased risk of NAFLD.Studies relating to socioeconomic factors and its association with NAFLD reported confounding results.CONCLUSION Maternal metabolic dysfunction during pregnancy,being exclusively breastfed for a longer time postnatally,diet and physical activity in childhood and adolescence are potential areas of intervention to decrease risk of NAFLD.展开更多
Background: Health- related quality of life(HRQOL) among long- term survivors of coronary artery bypass surgery is an important outcome that has been little studied at the population level. Methods: A postal survey wa...Background: Health- related quality of life(HRQOL) among long- term survivors of coronary artery bypass surgery is an important outcome that has been little studied at the population level. Methods: A postal survey was conducted in 1999 to 2000 in patients 6 to 20 years after coronary artery bypass graft(CABG) surgery in Western Australia. A random stratified sample of 2500 was drawn from 8910 patients who had their first CABG surgery in 1980 to 1993. Health- related quality of life was measured with Short Form 36 and EuroQol visual analogue scale. Results: Response was 82% (n=2061). Health- related quality of life declined with age and was similar for men and women, although scores for women were worse for physical functioning. Compared with Australian population norms, the age- and sex- standardized scores of survivors of CABG were generally worse, mainly in the physical domain. Reported angina at the time of follow- up(33% ), symptoms of heart failure equivalent to New York Heart Association(NYHA) classes II to IV(34% ), and comorbidities such as diabetes and hypertension were associated with poorer HRQOL. For both men and women without angina or heart failure at follow- up,HRQOL was no different from that of the general population. Conclusion: Overall, the quality of life among long- term survivors of CABG is worse than that of the general population, the difference being mainly attributable to recurrent symptoms and comorbidities. Quality of life for those without angina or heart failure at follow- up was equivalent to the population norms, providing an incentive to maximize efforts to abolish angina and ameliorate heart failure symptoms.展开更多
Background -There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting(CABG). This study compares gender differences in cardiac events in a populati...Background -There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting(CABG). This study compares gender differences in cardiac events in a population of hospital survivors up to 11 years after isolated CABG surgery in Ontario, Canada. Methods and Results -A population-based cohort study(n=68 774 patients, 15 043 women) between September 1, 1991, and April 1, 2002, was assembled with linked clinical and administrative databases. Cox modeling and propensity score matching were used to compare death, cardiac readmission(angina, heart failure, myocardial infarction), repeat revascularization(angioplasty or CABG), and stroke readmission between men and women. Women were older(65±17 versus 62±13 years), more likely to present with urgent or emergent status(64%versus 56%), and less likely to receive arterial grafts(70%versus 78%). Women had a higher rate of cardiac readmission in the first year after surgery(hazard ratio[HR] of 1.5, 95%confidence interval[CI] 1.36 to 1.56), and this increased risk persisted after 1 year(HR 1.2, 95%CI 1.14 to 1.31). This was primarily due to readmissions for unstable angina(HR 1.3, 95%CI 1.24 to 1.38) and congestive heart failure(HR 1.1, 95%CI 1.06 to 1.21). Propensity-matched women had similar rates of death(HR 0.9, 95%CI 0.83 to 0.98) and repeat revascularization(HR 1.0, 95%CI 0.91 to 1.06). Conclusions -Women have a more complex clinical preoperative presentation and are more likely to be readmitted with unstable angina and congestive heart failure after CABG but experience survival similar to those seen in men. Gender differences in outcomes may be improved through durable revascularization strategies and close postoperative follow-up care targeted to women.展开更多
Fabrication of trace elements incorporated apatite coating could combine the ions’ pharmaceutical effect into the materials. In this study, strontium, silicon, and fluoride ions have been incorporated into apatite co...Fabrication of trace elements incorporated apatite coating could combine the ions’ pharmaceutical effect into the materials. In this study, strontium, silicon, and fluoride ions have been incorporated into apatite coatings through a biomineralization method, which mimics an in vitro mineralization process. The surface composition is tested with X-ray diffraction and X-ray photoelectron spectroscopy, and the surface morphology is characterized with scanning electron microscopy. Compared with pure hydroxyapatite coating, the strontium, silicon, and fluoride substituted apatite coatings show different morphology as spherical, needle-like, and nano-flake-like, individually. The crystal size of these biomimetic hydroxyapatite coatings decreased after ion substitution. The results of the analysis of surface composition present the ion substitutions are increased with the increasing of ion concentrations in the soaking solution. That means the ion incorporation into the apatite structure based on the biomineralization method could not only vary the ion content in but also change the morphology of the apatite coatings. Herein, the role of ion substitution is considered from the point of view of materials science at the micro structural and surface chemistry levels.展开更多
Aim: To study how immunity to Streptococcus pneumoniae normally develops in healthy children. Methods: Ninety two healthy children at 3 - 5, 7 - 9 and 13 - 15 years of age were recruited. No one of the children had pr...Aim: To study how immunity to Streptococcus pneumoniae normally develops in healthy children. Methods: Ninety two healthy children at 3 - 5, 7 - 9 and 13 - 15 years of age were recruited. No one of the children had previously been given pneumococcal vaccine. Serum was analysed for pooled antigens of the 23 most common pneumococcal polysaccharides with ELISA technique, and results are given in opitical density (OD). A three-level semi-quantitative system was used to assess degree of immunity to Streptococcus pneumoniae . Cut-off levels were OD ≤ 0.7 and OD ≥ 1.3, separating low, intermediate and high degree of immunity. Results: Median values for OD differed significantly between the groups, with OD 0.91, 1.18 and 1.10 respectively (p = 0.004). Levels were lower in the youngest age group, but from age 7-9 years, levels were similar trough out childhood. Twenty six percent of the children in the youngest age-group had a low degree of protection (OD ≤ 0.7) to Streptococcus pneumoniae . Such low levels were uncommon from 7 - 9 years of age, found in only 13% of the children. Conclusion: Protective antibodies to Streptococcus pneumoniae develops mainly during the preschool period. Thereafter, levels are stable throughout childhood up to the age of 15 years.展开更多
文摘In recent years,pediatric health care has embraced the concept of quality improvement to improve patient outcomes.As quality improvement efforts are implemented,network collaboration(where multiple centers and practices implement standardized programs)is a popular option.In a collaborative network,improvement in the conduct of structural,process and outcome quality measures can lead to improvements in overall health,and benchmarks can be used to assess and compare progress.In this review article,we provided an overview of the quality improvement movement and the role of quality indicators in this movement.We reviewed current quality improvement efforts in pediatric inflammatory bowel disease (IBD),as well as other pediatric chronic illnesses.We discussed the need to standardize the development of quality indicators used in quality improvement networks to assess medical care,and the validation techniques which can be used to ensure that process indicators result in improved outcomes of clinical significance.We aimed to assess current quality improvement efforts in pediatric IBD and other diseases,such as childhood asthma,childhood arthritis,and neonatal health.By doing so,we hope to learn from their successes and failures and to move the field forward for future improvements in the care provided to children with IBD.
文摘Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department improves the quality of teaching of procedures, and whether videos are particularly beneficial during periods of emergency department crowding. Methods: In this single-centre, prospective, before and after study standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each emergency department shift in the before (August 2008-March 2009) and after (August 2009-March 2010) phase. Online procedure videos were introduced on emergency department computers in the after phase. The primary outcome measure was EP rating of the quality of teaching provided (5-point Likert scale). The interaction between crowding and videos was also assessed, to determine whether videos provide a specific additional benefit during periods of emergency department crowding. Results: There were 1159 procedures performed by 192 trainees. Median procedures performed per shift was 1.0 (IQR 0 - 2.0). Mean EP rating of teaching provided was significantly higher in the group that viewed videos, at 4.2 versus 3.7 (p 0.001). In the adjusted analysis, EP ratings increased by 0.5 with a video (p 0.001), while the odds of a score of 5.0 were 2.2 times greater if a video was viewed (p = 0.03). The interaction of crowding and procedure videos was not significant (the use of videos increased the average score by 0.24 in times of crowding compared to times of non-crowding, p = 0.19). Conclusions: Use of procedural videos was associated with EP perception of improved quality of teaching provided around procedures. While EPs rated the quality of their teaching as improved overall, the effect of videos on teaching quality was the same in crowded settings as it was in non-crowded setting.
基金supported by the Institute for Clinical Evaluative Sciences(ICES)Western siteICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care(MOHLTC)Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario(AMOSO)+1 种基金the Schulich School of Medicine and Dentistry(SSMD),Western University,and the Lawson Health Research Institute(LHRI)The research was conducted by members of the ICES Kidney,Dialysis and Transplantation team,at the ICES Western facility,who are supported by a grant from the Canadian Institutes of Health Research(CIHR)
文摘AIM:To determine the general and transplant-specific risk factors for fractures in kidney transplant recipients.METHODS:We conducted a cohort study of all adults who received a kidney-only transplant(n=2723)in Ontario,Canada between 2002 and 2009.We used multivariable Cox proportional hazards regression to determine general and transplant-specific risk factors for major fractures(proximal humerus,forearm,hip,and clinical vertebral).The final model was established using the backward elimination strategy,selecting risk factors with a P-value≤0.2 and forcing recipient age and sex into the model.We also assessed risk factors for other fracture locations(excluding major fractures,and fractures involving the skull,hands or feet).RESULTS:There were 132 major fractures in the follow-up(8.1 fractures per 1000 person-years).General risk factors associated with a greater risk of major fracture were older recipient age[adjusted hazard ratio(a HR)per 5-year increase 1.11,95%CI:1.03-1.19]and female sex(a HR=1.81,95%CI:1.28-2.57).Transplant-specific risk factors associated with a greater risk of fracture included older donor age(5-year increase)(a HR=1.09,95%CI:1.02-1.17)and end-stage renal disease(ESRD)caused by diabetes(a HR=1.72,95%CI:1.09-2.72)or cystic kidney disease(a HR=1.73,95%CI:1.08-2.78)(compared to glomerulonephritis as the reference cause).Risk factors across the two fracture locations were not consistent(major fracture locations vs other).Specifically,general risk factors associated with an increased risk of other fractures were diabetes and a fall with hospitalization prior to transplantation,while length of time on dialysis,and renal vascular disease and other causes of ESRD were the transplant-specific risk factors associated with a greater risk of other fractures.CONCLUSION:Both general and transplant-specific risk factors were associated with a higher risk of fractures in kidney transplant recipients.Results can be used for clinical prognostication.
文摘近年来实效性临床试验受到更多重视,尤其在传统医学临床评价研究领域。为了提高实效性临床试验报告的质量,CONSORT声明组和医疗保健体系中的实效性随机对照临床试验(pragmatic randomized controlled trials in health care systems,PRACTIHC)小组对《CONSORT声明》进行了修改,以帮助读者评估试验质量和结果的可靠性。实效性试验报告指南,作为《CONSORT声明》的一个特殊扩展,能在报告、评价和应用实效性试验方面帮助编辑、系统评价者、试验设计者和决策者评估实效性试验报告中的信息,判定其结论是否适用,以及干预措施是否可行、可否被接受。2005年1月和2008年3月,在加拿大多伦多分别举行了为期两天的会议来探讨提高随机对照试验对卫生保健决策贡献的方法,焦点集中于实效性试验。2005年会,后扩展版草案修订清单发送至编写组成员,经过几次修订,编写组起草了一份摘要草案。在2008年讨论并修改了这一草案。这份草案发给CONSORT声明组以供修改并发表。这份声明的扩展版提出了对8个条目的补充。及时向国内读者和临床试验研究人员介绍该指南有重要的现实意义和学术价值。北京中医药大学循证医学中心刘建平教授等在短时间内翻译了该指南。本刊希望通过介绍中文版"提高实效性临床试验报告的质量——《CONSORT声明》的扩展"以提高国内实效性临床试验报告的质量,相信也有助于改进试验设计的方法学质量。
基金supported by the Agency for Science and Technology(A*STAR)intramural funding for the Integrative Neuroscience Programme,Singapore Institute for Clinical Sciences
文摘Valproic acid （VPA） has been a first-choice drug for clinical treatment of epilepsy and manic disorder. For decades, its phar- macological action was believed to act on inhibition of gam- ma-aminobutyric acid （GABA） transaminase, in turn, increas- ing GABA in inhibitory synapses. However, in recent years, VPA has been investigated on other therapeutic actions. Those investigations demonstrate that VPA shows neuroprotective ef- fects by promoting neurogenesis, neuronal differentiation, and neuroregeneration （Foti et al., 2013）.
基金The project supported by Singapore Institute for Clinical Sciences(SICS)A*STAR Singapore and BMRC Young Investigator Grant
文摘OBJECTIVE To investigate the effect of microRNA-32 on cold-induced thermogenesis and brown adipocyte energy metabolism.METHODS To apply the cold-induced thermogenesis model in mice,8-10 week old male C57Bl6 mice were placed within a 6℃fridge for 7d.Control microRNA inhibitor or miR-32 inhibitor(10mg·kg-1)was administered via intraperitoneal injection 16 hbefore the mice were placed in the fridge.Daily core body temperatures were taken using a rectal temperature probe.Mice were euthanized after 7dand brown adipose tissue(BAT),inguinal and epididymal white adipose tissue(WAT),skeletal muscle and liver tissue analysed for changes in morphology and gene expression.RESULTS miR-32 inhibition in vivoinhibits the emergence of beige cells,which function like BAT cells,within WAT.In silico prediction and gene ontology analysis identified Tob1 as a likely target gene of miR-32.miR-32 inhibition led to increased expression of Tob1 whilst mutation of target sequence abolished this effect.Expression of brown adipose markers such as Ucp1,Pgc1α,Pparαand Prdm16 were significantly reduced in inguinal white adipose tissue(P<0.05).There was also a significant decrease in serumfgf21 levels due to the inhibition of Fgf21 expression in BAT(P<0.05).p38/MAPK signalling in brown adipose tissue was also significantly inhibited within brown adipose tissue leading to decreased fgf21 expression and secretion.CONCLUSION Our study shows that miR-32 plays a crucial role in stimulating beige cell emergence by activating p38/MAPK signalling during cold thermogenesis.miR-32 may prove effective as a treatment for obesity by activating cold-induced thermogenesis leading to increased energy metabolism.
文摘This study examined whether people who self-reported depression sought mental health treatment in the year after being interviewed, and how gender affected utilization. Depression data were obtained from the Canadian Community Health Survey (2000-01), and linked to medical records in Ontario (n = 24,677). Overall, women had higher rates of mental health service utilization, but there were no gender differences in rates of specialist care. The gender difference in mental health contact was greater for those without depression, as opposed to those with depression. Among those without depression, women were significantly more likely than men to use mental health services;however, rates were similar for women and men with depression. This finding suggests that men may be more likely than women to delay seeing a doctor for minor mental health concerns, but will seek help once a problem reaches a threshold.
文摘<strong>Background:</strong> To make outpatient visits for adolescents with diabetes successful, it is important for health care professionals to meet the adolescents’ needs and wishes. <strong>Aims:</strong> The aim is to investigate adolescents’ expectations of an outpatient diabetes clinic visit in comparison to what was deemed to be delivered and contrast this outcome in adolescents with self-reported high- and low-diabetes distress respectively. <strong>Methods:</strong> All adolescents in Sweden with type 1 diabetes, aged 15 to 18 years, were identified via The National Pediatric Diabetes Registry (SWEDIABKIDS) and asked to complete an online questionnaire regarding their expectations and the support received during the outpatient diabetes clinic visit. <strong>Results:</strong> 453 adolescents completed the survey. Boys’ expectations of discussion topics were mainly met while girls, especially those with diabetes distress, felt their discussion needs were not met regarding quality-of-life aspects. <strong>Conclusions:</strong> Although adolescents’ expectations are in general met during the diabetes outpatient clinic visit, aspects related to living with diabetes are not being met especially among female adolescents who reported diabetes distress. This study shows a gender difference both regarding expected discussion topics and what was deemed covered. <strong>Practice Implications:</strong> A multi-professional, individual person-centred care approach is needed at the diabetes outpatient clinic. This paper proposes that agenda setting performed by the adolescent, and agreed by the physician, prior to the outpatient clinic visit could facilitate individualized care and better meet the adolescents’ needs in a shared decision-making process.
基金Supported by The Canadian Institutes of Health Research,No.319379
文摘Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this "gender paradox" in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic,neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses(including conforming to others' or one's own expectations of sex/gender identity) and adapt to pain(through substance use and helpseeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s)(e.g., childhood maltreatment) and/or one's ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth.
文摘BACKGROUND The rise in prevalence of non-alcoholic fatty liver disease(NAFLD)mirrors the obesity epidemic.NAFLD is insidious but may gradually progress from simple steatosis to steatohepatitis,fibrosis and cirrhosis and/or hepatocellular carcinoma.Intervention strategies to ameliorate developmental programming of NAFLD may be more efficacious during critical windows of developmental plasticity.AIM To review the early developmental factors associated with NAFLD.METHODS Databases MEDLINE via PubMed,and EMBASE and Reference Citation Analysis were searched and relevant publications up to April 30,2021 were assessed.Original research studies that included risk factors associated with early development of NAFLD in human subjects were included.These factors include:Maternal factors,intrauterine and prenatal factors,post-natal factors,genetic and ethnic predisposition,childhood and adolescence environmental factors.Studies were excluded if they were review articles or animal studies,case reports or conference abstracts,or if NAFLD was not clearly defined and assessed radiologically.RESULTS Of 1530 citations identified by electronic search,420 duplicates were removed.Of the 1110 citations screened from title and abstract,80 articles were included in the final analysis.Genetic polymorphisms such as patatin-like phospholipase domain-containing protein 3(PNPLA3)and membrane-bound O-acyltransferase domain-containing protein 7(MBOAT7)were associated with increased risk of NAFLD.Familial factors such as maternal obesogenic environment and parental history of hepatic steatosis was associated with offspring NAFLD.Longer duration of exclusive breastfeeding in infancy was associated with a lower risk of developing NAFLD later in life while metabolic dysfunction and/or obesity in adolescence was associated with increased risk of NAFLD.Studies relating to socioeconomic factors and its association with NAFLD reported confounding results.CONCLUSION Maternal metabolic dysfunction during pregnancy,being exclusively breastfed for a longer time postnatally,diet and physical activity in childhood and adolescence are potential areas of intervention to decrease risk of NAFLD.
文摘Background: Health- related quality of life(HRQOL) among long- term survivors of coronary artery bypass surgery is an important outcome that has been little studied at the population level. Methods: A postal survey was conducted in 1999 to 2000 in patients 6 to 20 years after coronary artery bypass graft(CABG) surgery in Western Australia. A random stratified sample of 2500 was drawn from 8910 patients who had their first CABG surgery in 1980 to 1993. Health- related quality of life was measured with Short Form 36 and EuroQol visual analogue scale. Results: Response was 82% (n=2061). Health- related quality of life declined with age and was similar for men and women, although scores for women were worse for physical functioning. Compared with Australian population norms, the age- and sex- standardized scores of survivors of CABG were generally worse, mainly in the physical domain. Reported angina at the time of follow- up(33% ), symptoms of heart failure equivalent to New York Heart Association(NYHA) classes II to IV(34% ), and comorbidities such as diabetes and hypertension were associated with poorer HRQOL. For both men and women without angina or heart failure at follow- up,HRQOL was no different from that of the general population. Conclusion: Overall, the quality of life among long- term survivors of CABG is worse than that of the general population, the difference being mainly attributable to recurrent symptoms and comorbidities. Quality of life for those without angina or heart failure at follow- up was equivalent to the population norms, providing an incentive to maximize efforts to abolish angina and ameliorate heart failure symptoms.
文摘Background -There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting(CABG). This study compares gender differences in cardiac events in a population of hospital survivors up to 11 years after isolated CABG surgery in Ontario, Canada. Methods and Results -A population-based cohort study(n=68 774 patients, 15 043 women) between September 1, 1991, and April 1, 2002, was assembled with linked clinical and administrative databases. Cox modeling and propensity score matching were used to compare death, cardiac readmission(angina, heart failure, myocardial infarction), repeat revascularization(angioplasty or CABG), and stroke readmission between men and women. Women were older(65±17 versus 62±13 years), more likely to present with urgent or emergent status(64%versus 56%), and less likely to receive arterial grafts(70%versus 78%). Women had a higher rate of cardiac readmission in the first year after surgery(hazard ratio[HR] of 1.5, 95%confidence interval[CI] 1.36 to 1.56), and this increased risk persisted after 1 year(HR 1.2, 95%CI 1.14 to 1.31). This was primarily due to readmissions for unstable angina(HR 1.3, 95%CI 1.24 to 1.38) and congestive heart failure(HR 1.1, 95%CI 1.06 to 1.21). Propensity-matched women had similar rates of death(HR 0.9, 95%CI 0.83 to 0.98) and repeat revascularization(HR 1.0, 95%CI 0.91 to 1.06). Conclusions -Women have a more complex clinical preoperative presentation and are more likely to be readmitted with unstable angina and congestive heart failure after CABG but experience survival similar to those seen in men. Gender differences in outcomes may be improved through durable revascularization strategies and close postoperative follow-up care targeted to women.
基金This work was supported by BIOMATCELL,VINN Ex-cellence Center of Biomaterials and Cell Therapy.
文摘Fabrication of trace elements incorporated apatite coating could combine the ions’ pharmaceutical effect into the materials. In this study, strontium, silicon, and fluoride ions have been incorporated into apatite coatings through a biomineralization method, which mimics an in vitro mineralization process. The surface composition is tested with X-ray diffraction and X-ray photoelectron spectroscopy, and the surface morphology is characterized with scanning electron microscopy. Compared with pure hydroxyapatite coating, the strontium, silicon, and fluoride substituted apatite coatings show different morphology as spherical, needle-like, and nano-flake-like, individually. The crystal size of these biomimetic hydroxyapatite coatings decreased after ion substitution. The results of the analysis of surface composition present the ion substitutions are increased with the increasing of ion concentrations in the soaking solution. That means the ion incorporation into the apatite structure based on the biomineralization method could not only vary the ion content in but also change the morphology of the apatite coatings. Herein, the role of ion substitution is considered from the point of view of materials science at the micro structural and surface chemistry levels.
基金supported by grants from Stiftelsen Samariten,Sachsska Barnsjukhuset,Sodersjukhuset,Stockholm,Sweden.
文摘Aim: To study how immunity to Streptococcus pneumoniae normally develops in healthy children. Methods: Ninety two healthy children at 3 - 5, 7 - 9 and 13 - 15 years of age were recruited. No one of the children had previously been given pneumococcal vaccine. Serum was analysed for pooled antigens of the 23 most common pneumococcal polysaccharides with ELISA technique, and results are given in opitical density (OD). A three-level semi-quantitative system was used to assess degree of immunity to Streptococcus pneumoniae . Cut-off levels were OD ≤ 0.7 and OD ≥ 1.3, separating low, intermediate and high degree of immunity. Results: Median values for OD differed significantly between the groups, with OD 0.91, 1.18 and 1.10 respectively (p = 0.004). Levels were lower in the youngest age group, but from age 7-9 years, levels were similar trough out childhood. Twenty six percent of the children in the youngest age-group had a low degree of protection (OD ≤ 0.7) to Streptococcus pneumoniae . Such low levels were uncommon from 7 - 9 years of age, found in only 13% of the children. Conclusion: Protective antibodies to Streptococcus pneumoniae develops mainly during the preschool period. Thereafter, levels are stable throughout childhood up to the age of 15 years.
