Objective:To explore the associations between income levels,employment risk,lifestyles,occupational stress,and male fertility.Methods:This cross-sectional study analyzed 294 men seeking fertility treatment at fertilit...Objective:To explore the associations between income levels,employment risk,lifestyles,occupational stress,and male fertility.Methods:This cross-sectional study analyzed 294 men seeking fertility treatment at fertility clinics in Terengganu,Pahang,and Kuala Lumpur from November 2021 to June 2023.Data were collected through structured questionnaires covering income levels,lifestyles,employment risks,occupational stress,and semen quality.Multinomial logistic regression was employed to assess predictors of semen quality,with crude and adjusted odds ratios(OR)reported.Results:The lower-income group exhibited higher odds of having abnormal semen quality compared to normal semen quality.Specifically,these participants were more likely to experience azoospermia[crude OR 6.68,95%confidence interval(CI)1.84-52.63;adjusted OR 6.26,95%CI 1.76-51.38],indicating a link between low income and infertility issues.Lifestyle factors did not show significant associations with semen abnormalities after adjustment.High employment risks had significant associations with oligozoospermia after adjustment(crude OR 5.50,95%CI 2.14-14.11;adjusted OR 5.15,95%CI 1.93-13.71),while high occupational stress was linked to asthenozoospermia(crude OR 2.26,95%CI 1.09-4.68;adjusted OR 2.25,95%CI 1.07-4.69).Conclusions:The findings underscore the influence of socioeconomic and occupational factors on male fertility,showing associations between lower income levels,high-risk occupations,and semen abnormalities.In contrast,lifestyle factors did not show significant associations with semen abnormalities after adjustment.Nevertheless,the current findings should be further confirmed through more extensive studies focusing on abnormal semen and lifestyle factors.展开更多
目的:系统评价急性心肌梗死临床指南和共识的方法学质量和报告质量。方法:计算机系统检索PubMed、EMbase、Web of Science、中国生物医学文献数据库(CBM)、万方数据知识服务平台(WanFang Data)以及中国知网(CNKI)等数据库,并辅助检索国...目的:系统评价急性心肌梗死临床指南和共识的方法学质量和报告质量。方法:计算机系统检索PubMed、EMbase、Web of Science、中国生物医学文献数据库(CBM)、万方数据知识服务平台(WanFang Data)以及中国知网(CNKI)等数据库,并辅助检索国际指南协作网(GIN)、英国国家健康与临床优化研究所(NICE)网站、美国国家指南信息交换中心(NGC)网站和医脉通网站,以获取急性心肌梗死相关的临床指南及共识,检索时段为建库至2025年4月30日。由2名研究人员依据严格的纳入与排除标准对文献进行筛选,并进行资料提取。采用指南研究与评价工具(第2版)(AGREEⅡ)和医疗实践指南报告规范(RIGHT)工具对文献质量进行评估。结果:共纳入急性心肌梗死指南和共识11部。亚组分析结果显示,指南类在AGREEⅡ的2个领域(范围和目的、参与人员)得分高于共识类;基于循证制订的指南和共识在AGREEⅡ的6个领域评分和RIGHT评分均高于基于专家意见或综述等制订的指南和共识;国外指南和共识在AGREEⅡ的6个领域评分和RIGHT评分均高于国内指南和共识。结论:当前已发布的急性心肌梗死临床指南与共识在方法学质量及报告质量方面均表现欠佳。相较于国外,我国相关指南与共识尚存在提升空间。建议相关专业机构及研究者参照AGREEⅡ和RIGHT评价准则,致力于制定并推广高质量的急性心肌梗死诊疗指南与共识。展开更多
Nursing education is undergoing a paradigm shift from skill training to clinical thinking cultivation.The integration of artificial intelligence technology offers technical possibilities for this transformation,but it...Nursing education is undergoing a paradigm shift from skill training to clinical thinking cultivation.The integration of artificial intelligence technology offers technical possibilities for this transformation,but it also brings about a deep tension between the cultivation of humanistic qualities and a standardized training.Based on the analysis of the practical forms of nursing smart education,this paper examines the cognitive gap between the deterministic feedback of virtual simulation systems and the complexity of real clinical scenarios,reveals the potential narrowing effect of data-driven ability profiling on the all-round development of nursing students,and then proposes the design logic of intelligent teaching resources centered on real clinical problems,a hierarchical teaching model with clear human-machine division of labor,and a dynamic assessment mechanism for technology application led by professional nursing teachers,in an attempt to find a balance between technological empowerment and humanistic commitment in smart nursing education.展开更多
AI Agent技术凭借环境感知、自主决策与协同执行能力,为财务共享服务中心的智能化升级提供了新型技术方案。财务共享中心作为集约化财务管理载体,在业务规模扩张与数据量激增的背景下,面临着风险识别滞后与资金结算效率不足等挑战,AI Ag...AI Agent技术凭借环境感知、自主决策与协同执行能力,为财务共享服务中心的智能化升级提供了新型技术方案。财务共享中心作为集约化财务管理载体,在业务规模扩张与数据量激增的背景下,面临着风险识别滞后与资金结算效率不足等挑战,AI Agent通过构建智能识别预警系统、动态评估管控体系、自动化应急处置机制及全程追踪管理框架,实现了交易异常、信用风险、资金异常与合规风险的精准防控。展开更多
Background:The frequency and magnitude of dengue epidemics continue to increase exponentially in Malaysia,with a shift in the age range predominance toward adults and an expansion to rural areas.Despite this,informati...Background:The frequency and magnitude of dengue epidemics continue to increase exponentially in Malaysia,with a shift in the age range predominance toward adults and an expansion to rural areas.Despite this,information pertaining to the extent of transmission of dengue virus(DENV)in the rural community is lacking.This communitybased pilot study was conducted to establish DENV seroprevalence amongst healthy adults in a rural district in Southern Malaysia,and to identify influencing factors.Methods:In this study undertaken between April and May 2015,a total of 277 adult participants were recruited from households across three localities in the Sungai Segamat subdistrict in Segamat district.Sera were tested for immunoglobulin G(IgG)(Panbio®Dengue Indirect IgG ELISA/high-titer capture)and immunoglobulin M(IgM)(Panbio®)antibodies.The plaque reduction neutralization test(PRNT)was conducted on random samples of IgGpositive sera for further confirmation.Medical history and a recall of previous history of dengue were collected through interviews,whereas sociodemographic information was obtained from an existing database.Results:The overall seroprevalence for DENV infection was 86.6%(240/277)(95%CI:83-91%).Serological evidence of recent infection(IgM/high-titer capture IgG)was noted in 11.2%(31/277)of participants,whereas there was evidence of past infection in 75.5%(209/277)of participants(indirect IgG minus recent infections).The PRNT assay showed that the detected antibodies were indeed specific to DENV.The multivariate analysis showed that the older age group was significantly associated with past DENV infections.Seropositivity increased with age;48.5%in the age group of<25 years to more than 85%in age group of>45 years(P<0.001).No associations with occupation,study site,housing type,comorbidity,educational level,and marital status were observed,although the latter two were statistically significant in the univariate analysis.None of the studied factors were significantly associated with recent DENV infections in the multivariate analysis,although there was a pattern suggestive of recent outbreak in two study sites populated predominately by Chinese people.The majority of infections did not give rise to recognizable disease(either asymptomatic or nonspecific symptoms)as only 12.9%of participants(31/240)recalled having dengue in the past.Conclusions:The predominantly rural community under study had a very high previous exposure to dengue.The finding of a high proportion of unreported cases possibly due to subclinical infections underscores the need for enhanced surveillance and control methods.This finding also has implications for measuring disease burden,understanding transmission dynamics,and hypothesizing effects on DENV vaccine efficacy and uptake.展开更多
Background:Dengue is one of the most rapidly spreading vector-borne diseases,which is considered to be a major health concern in tropical and sub-tropical countries.It is strongly believed that the spread and abundanc...Background:Dengue is one of the most rapidly spreading vector-borne diseases,which is considered to be a major health concern in tropical and sub-tropical countries.It is strongly believed that the spread and abundance of vectors are related to climate.Construction of climate-based mathematical model that integrates meteorological factors into disease infection model becomes compelling challenge since the climate is positively associated with both incidence and vector existence.Methods:A host-vector model is constructed to simulate the dynamic of transmission.The infection rate parameter is replaced with the time-dependent coefficient obtained by optimization to approximate the daily dengue data.Further,the optimized infection rate is denoted as a function of climate variables using the Autoregressive Distributed Lag(ARDL)model.Results:The infection parameter can be extended when updated daily climates are known,and it can be useful to forecast dengue incidence.This approach provides proper prediction,even when tested in increasing or decreasing prediction windows.In addition,associations between climate and dengue are presented as a reversed slide-shaped curve for dengue-humidity and a reversed U-shaped curves for dengue-temperature and dengueprecipitation.The range of optimal temperature for infection is 24.3e30.5C.Humidity and precipitation are positively associated with dengue upper the threshold 70%at lag 38 days and below 50 mm at lag 50 days,respectively.Conclusion:Identification of association between climate and dengue is potentially useful to counter the high risk of dengue and strengthen the public health system and reduce the increase of the dengue burden.展开更多
Background:Globally,dengue infections constitute a significant public health burden.In recent decades,Malaysia has become a dengue hyper-endemic country with the co-circulation of the four dengue virus serotypes.The c...Background:Globally,dengue infections constitute a significant public health burden.In recent decades,Malaysia has become a dengue hyper-endemic country with the co-circulation of the four dengue virus serotypes.The cyclical dominance of sub-types contributes to a pattern of major outbreaks.The consequences can be observed in the rising incidence of reported dengue cases and dengue related deaths.Understanding the complex interaction of the dengue virus,its human hosts and the mosquito vectors at the community level may help develop strategies for addressing the problem.Methods:A prospective cohort study will be conducted in Segamat district of Johor State in Peninsular Malaysia.Researchers received approval from the Malaysian Medical Research Ethics Committee and Monash University Human Research Ethics Committee.The study will be conducted at a Malaysian based health and demographic surveillance site over a 1 year period in three different settings(urban,semi-urban and rural).The study will recruit healthy adults(male and female)aged 18 years and over,from three ethnic groups(Malay,Chinese and Indian).The sample size calculated using the Fleiss method with continuity correction is 333.Sero-surveillance of participants will be undertaken to identify asymptomatic,otherwise healthy cases;cases with dengue fever who are managed as out-patients;and cases with dengue fever admitted to a hospital.A genetic analysis of the participants will be undertaken to determine whether there is a relationship between genetic predisposition and disease severity.A detailed medical history,past history of dengue infection,vaccination history against other flaviviruses such as Japanese encephalitis and Yellow fever,and the family history of dengue infection will also be collected.In addition,a mosquito surveillance will be carried out simultaneously in recruitment areas to determine the molecular taxonomy of circulating vectors.Discussion:The research findings will estimate the burden of asymptomatic and symptomatic dengue at the community level.It will also examine the relationship between virus serotypes and host genotypes,and the association of the clinical manifestation of the early phase with the entire course of illness.展开更多
基金supported by Malaysia's Ministry of Higher Education through the Fundamental Research Grant Scheme(FRGS)under the reference code FRGS/1/2020/SS0/UMT/02/3 and vote number 59637.
文摘Objective:To explore the associations between income levels,employment risk,lifestyles,occupational stress,and male fertility.Methods:This cross-sectional study analyzed 294 men seeking fertility treatment at fertility clinics in Terengganu,Pahang,and Kuala Lumpur from November 2021 to June 2023.Data were collected through structured questionnaires covering income levels,lifestyles,employment risks,occupational stress,and semen quality.Multinomial logistic regression was employed to assess predictors of semen quality,with crude and adjusted odds ratios(OR)reported.Results:The lower-income group exhibited higher odds of having abnormal semen quality compared to normal semen quality.Specifically,these participants were more likely to experience azoospermia[crude OR 6.68,95%confidence interval(CI)1.84-52.63;adjusted OR 6.26,95%CI 1.76-51.38],indicating a link between low income and infertility issues.Lifestyle factors did not show significant associations with semen abnormalities after adjustment.High employment risks had significant associations with oligozoospermia after adjustment(crude OR 5.50,95%CI 2.14-14.11;adjusted OR 5.15,95%CI 1.93-13.71),while high occupational stress was linked to asthenozoospermia(crude OR 2.26,95%CI 1.09-4.68;adjusted OR 2.25,95%CI 1.07-4.69).Conclusions:The findings underscore the influence of socioeconomic and occupational factors on male fertility,showing associations between lower income levels,high-risk occupations,and semen abnormalities.In contrast,lifestyle factors did not show significant associations with semen abnormalities after adjustment.Nevertheless,the current findings should be further confirmed through more extensive studies focusing on abnormal semen and lifestyle factors.
文摘目的:系统评价急性心肌梗死临床指南和共识的方法学质量和报告质量。方法:计算机系统检索PubMed、EMbase、Web of Science、中国生物医学文献数据库(CBM)、万方数据知识服务平台(WanFang Data)以及中国知网(CNKI)等数据库,并辅助检索国际指南协作网(GIN)、英国国家健康与临床优化研究所(NICE)网站、美国国家指南信息交换中心(NGC)网站和医脉通网站,以获取急性心肌梗死相关的临床指南及共识,检索时段为建库至2025年4月30日。由2名研究人员依据严格的纳入与排除标准对文献进行筛选,并进行资料提取。采用指南研究与评价工具(第2版)(AGREEⅡ)和医疗实践指南报告规范(RIGHT)工具对文献质量进行评估。结果:共纳入急性心肌梗死指南和共识11部。亚组分析结果显示,指南类在AGREEⅡ的2个领域(范围和目的、参与人员)得分高于共识类;基于循证制订的指南和共识在AGREEⅡ的6个领域评分和RIGHT评分均高于基于专家意见或综述等制订的指南和共识;国外指南和共识在AGREEⅡ的6个领域评分和RIGHT评分均高于国内指南和共识。结论:当前已发布的急性心肌梗死临床指南与共识在方法学质量及报告质量方面均表现欠佳。相较于国外,我国相关指南与共识尚存在提升空间。建议相关专业机构及研究者参照AGREEⅡ和RIGHT评价准则,致力于制定并推广高质量的急性心肌梗死诊疗指南与共识。
基金Funding Project for Ideological and Political Model Courses of“Epidemic Fighting”Courses in Henan Province(Project No.:531,2020)University-level Curriculum Ideological and Political Demonstration Course Support Project of Zhengzhou Sias University(Project No.:34,2024)+2 种基金University-level Key Discipline Support Project of Zhengzhou Sias University(Project No.:1,2022)2025 Key Scientific Research Projects of Henan Universities(Project No.:25B360003)Henan Province Private Brand Professional Support Project(Project No.:527,2019)。
文摘Nursing education is undergoing a paradigm shift from skill training to clinical thinking cultivation.The integration of artificial intelligence technology offers technical possibilities for this transformation,but it also brings about a deep tension between the cultivation of humanistic qualities and a standardized training.Based on the analysis of the practical forms of nursing smart education,this paper examines the cognitive gap between the deterministic feedback of virtual simulation systems and the complexity of real clinical scenarios,reveals the potential narrowing effect of data-driven ability profiling on the all-round development of nursing students,and then proposes the design logic of intelligent teaching resources centered on real clinical problems,a hierarchical teaching model with clear human-machine division of labor,and a dynamic assessment mechanism for technology application led by professional nursing teachers,in an attempt to find a balance between technological empowerment and humanistic commitment in smart nursing education.
基金Ethical approval for the study was obtained from the Medical Research Ethics Committee,Ministry of Health Malaysia(NMRR-14-42-19126)the Monash University Human Research Ethics Committee(CF14/2543–2014001379).
文摘Background:The frequency and magnitude of dengue epidemics continue to increase exponentially in Malaysia,with a shift in the age range predominance toward adults and an expansion to rural areas.Despite this,information pertaining to the extent of transmission of dengue virus(DENV)in the rural community is lacking.This communitybased pilot study was conducted to establish DENV seroprevalence amongst healthy adults in a rural district in Southern Malaysia,and to identify influencing factors.Methods:In this study undertaken between April and May 2015,a total of 277 adult participants were recruited from households across three localities in the Sungai Segamat subdistrict in Segamat district.Sera were tested for immunoglobulin G(IgG)(Panbio®Dengue Indirect IgG ELISA/high-titer capture)and immunoglobulin M(IgM)(Panbio®)antibodies.The plaque reduction neutralization test(PRNT)was conducted on random samples of IgGpositive sera for further confirmation.Medical history and a recall of previous history of dengue were collected through interviews,whereas sociodemographic information was obtained from an existing database.Results:The overall seroprevalence for DENV infection was 86.6%(240/277)(95%CI:83-91%).Serological evidence of recent infection(IgM/high-titer capture IgG)was noted in 11.2%(31/277)of participants,whereas there was evidence of past infection in 75.5%(209/277)of participants(indirect IgG minus recent infections).The PRNT assay showed that the detected antibodies were indeed specific to DENV.The multivariate analysis showed that the older age group was significantly associated with past DENV infections.Seropositivity increased with age;48.5%in the age group of<25 years to more than 85%in age group of>45 years(P<0.001).No associations with occupation,study site,housing type,comorbidity,educational level,and marital status were observed,although the latter two were statistically significant in the univariate analysis.None of the studied factors were significantly associated with recent DENV infections in the multivariate analysis,although there was a pattern suggestive of recent outbreak in two study sites populated predominately by Chinese people.The majority of infections did not give rise to recognizable disease(either asymptomatic or nonspecific symptoms)as only 12.9%of participants(31/240)recalled having dengue in the past.Conclusions:The predominantly rural community under study had a very high previous exposure to dengue.The finding of a high proportion of unreported cases possibly due to subclinical infections underscores the need for enhanced surveillance and control methods.This finding also has implications for measuring disease burden,understanding transmission dynamics,and hypothesizing effects on DENV vaccine efficacy and uptake.
基金This work was partially supported by the Indonesian Ministry of Research and Technology(Ristekdikti)or National Agency for Research and Innovation Grant 2020The second author was supported by the Indonesian Ministry of Education and Culture(Kemendikbud)through BU programThe third author was partially supported by the PMDSU grant no.1511/E4.4/2015.
文摘Background:Dengue is one of the most rapidly spreading vector-borne diseases,which is considered to be a major health concern in tropical and sub-tropical countries.It is strongly believed that the spread and abundance of vectors are related to climate.Construction of climate-based mathematical model that integrates meteorological factors into disease infection model becomes compelling challenge since the climate is positively associated with both incidence and vector existence.Methods:A host-vector model is constructed to simulate the dynamic of transmission.The infection rate parameter is replaced with the time-dependent coefficient obtained by optimization to approximate the daily dengue data.Further,the optimized infection rate is denoted as a function of climate variables using the Autoregressive Distributed Lag(ARDL)model.Results:The infection parameter can be extended when updated daily climates are known,and it can be useful to forecast dengue incidence.This approach provides proper prediction,even when tested in increasing or decreasing prediction windows.In addition,associations between climate and dengue are presented as a reversed slide-shaped curve for dengue-humidity and a reversed U-shaped curves for dengue-temperature and dengueprecipitation.The range of optimal temperature for infection is 24.3e30.5C.Humidity and precipitation are positively associated with dengue upper the threshold 70%at lag 38 days and below 50 mm at lag 50 days,respectively.Conclusion:Identification of association between climate and dengue is potentially useful to counter the high risk of dengue and strengthen the public health system and reduce the increase of the dengue burden.
基金The study is funded primarily by the“Infection and Immunity Cluster”of the“Tropical Medicine and Biology Platform”of Monash University Malaysia(fund code is 5140762)and by SEACO(fund code is 2500047)SEACO is funded by the office of the Vice Provost Research,Monash University Australia+1 种基金the office of the Deputy Dean Research,Faculty of Medicine,Nursing and Health Sciences,Monash University Australiathe Monash Malaysia School of Medicine and Health Sciences and the Monash University Malaysia Campus.
文摘Background:Globally,dengue infections constitute a significant public health burden.In recent decades,Malaysia has become a dengue hyper-endemic country with the co-circulation of the four dengue virus serotypes.The cyclical dominance of sub-types contributes to a pattern of major outbreaks.The consequences can be observed in the rising incidence of reported dengue cases and dengue related deaths.Understanding the complex interaction of the dengue virus,its human hosts and the mosquito vectors at the community level may help develop strategies for addressing the problem.Methods:A prospective cohort study will be conducted in Segamat district of Johor State in Peninsular Malaysia.Researchers received approval from the Malaysian Medical Research Ethics Committee and Monash University Human Research Ethics Committee.The study will be conducted at a Malaysian based health and demographic surveillance site over a 1 year period in three different settings(urban,semi-urban and rural).The study will recruit healthy adults(male and female)aged 18 years and over,from three ethnic groups(Malay,Chinese and Indian).The sample size calculated using the Fleiss method with continuity correction is 333.Sero-surveillance of participants will be undertaken to identify asymptomatic,otherwise healthy cases;cases with dengue fever who are managed as out-patients;and cases with dengue fever admitted to a hospital.A genetic analysis of the participants will be undertaken to determine whether there is a relationship between genetic predisposition and disease severity.A detailed medical history,past history of dengue infection,vaccination history against other flaviviruses such as Japanese encephalitis and Yellow fever,and the family history of dengue infection will also be collected.In addition,a mosquito surveillance will be carried out simultaneously in recruitment areas to determine the molecular taxonomy of circulating vectors.Discussion:The research findings will estimate the burden of asymptomatic and symptomatic dengue at the community level.It will also examine the relationship between virus serotypes and host genotypes,and the association of the clinical manifestation of the early phase with the entire course of illness.
