Common Cold

普通感冒
  • 文章类型: Journal Article
    背景:在撒哈拉以南非洲国家,腹泻和急性呼吸道感染等可预防和可控制的疾病仍然夺去儿童的生命。因此,本研究旨在估算6~11个月儿童在研究基线时发生腹泻(NOD)和流感/普通感冒(NOF)的对数预期天数的变化率.
    方法:本研究使用了具有纵向和多层次结构的次级数据。根据探索性分析的结果,提出了一种多级零膨胀Poisson回归模型,其对数预期NOD和NOF的变化率由二次趋势描述,以通过随机效应有效地分析两种结果,说明观察值与个体之间的相关性.此外,残差图用于评估模型的拟合优度。
    结果:考虑到主题和集群特定的随机效应,结果表明,对数预期NOD的变化率呈二次趋势。最初,低剂量铁微量营养素粉(MNP)使用者与非使用者相比表现出更高的变化率,但是随着时间的推移,这种趋势发生了逆转。同样,使用MNP和纯母乳喂养六个月的儿童的对数预期NOF下降,与他们的同行相比。此外,MNP用户每增加两周,没有流感的几率就会降低,与非MNP用户相比。此外,NOD的增加导致对数预期NOF的增加。区域和纯母乳喂养也与NOD和NOF有显著关系。
    结论:本研究的结果强调了用探索性分析开始分析研究产生的数据的重要性。该研究强调了在前六个月促进EBF并在六个月后为儿童提供额外食物以减轻传染病负担的关键作用。
    BACKGROUND: In sub-Saharan African countries, preventable and manageable diseases such as diarrhea and acute respiratory infections still claim the lives of children. Hence, this study aims to estimate the rate of change in the log expected number of days a child suffers from Diarrhea (NOD) and flu/common cold (NOF) among children aged 6 to 11 months at the baseline of the study.
    METHODS: This study used secondary data which exhibit a longitudinal and multilevel structure. Based on the results of exploratory analysis, a multilevel zero-inflated Poisson regression model with a rate of change in the log expected NOD and NOF described by a quadratic trend was proposed to efficiently analyze both outcomes accounting for correlation between observations and individuals through random effects. Furthermore, residual plots were used to assess the goodness of fit of the model.
    RESULTS: Considering subject and cluster-specific random effects, the results revealed a quadratic trend in the rate of change of the log expected NOD. Initially, low dose iron Micronutrient Powder (MNP) users exhibited a higher rate of change compared to non-users, but this trend reversed over time. Similarly, the log expected NOF decreased for children who used MNP and exclusively breastfed for six months, in comparison to their counterparts. In addition, the odds of not having flu decreased with each two-week increment for MNP users, as compared to non-MNP users. Furthermore, an increase in NOD resulted in an increase in the log expected NOF. Region and exclusive breastfeeding also have a significant relationships with both NOD and NOF.
    CONCLUSIONS: The findings of this study underscore the importance of commencing analysis of data generated from a study with exploratory analysis. The study highlights the critical role of promoting EBF for the first six months and supporting children with additional food after six months to reduce the burden of infectious diseases.
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  • 文章类型: Journal Article
    吡唑并[3,4-d]嘧啶代表一类有效的耐受性良好且高活性的鼻病毒(RV)抑制剂,其充当衣壳结合剂。先导化合物OBR-5-340抑制广谱的RV。旨在提高铅活动,我们评估了OBR-5-340的3-苯环中的结构修饰对其体外抗RV活性的效力和谱的影响。我们的结果证明了位置4的替代对强者的关键作用,广谱抗RV活性。4-甲基(RCB23137)和4-氯(RCB23138)衍生物在效力和抗RV活性谱方面优于OBR-5-340。基于这些发现,这些化合物被选择用于计算结合研究.分子动力学模拟与六个不同的RVOBR-5-340,RCB23137和RCB23138敏感性证明了两个VP1环的动态特征的影响,这些抑制剂对抗病毒效力。
    Pyrazolo[3,4-d]pyrimidines represent one potent class of well tolerated and highly active rhinovirus (RV) inhibitors that act as capsid binders. The lead compound OBR-5-340 inhibits a broad-spectrum of RVs. Aiming to improve lead activity, we evaluated the impact of structural modifications in the 3-phenyl ring of OBR-5-340 on its potency and spectrum of anti-RV activity vitro. Our results demonstrate the crucial role of substitution at position 4 for strong, broad-spectrum anti-RV activity. The 4-methyl (RCB23137) and 4-chloro (RCB23138) derivatives outperformed OBR-5-340 in terms of potency and anti-RV activity spectrum. Based on these findings, the compounds were selected for computational binding studies. Molecular dynamic simulations with six RVs differing in OBR-5-340, RCB23137, and RCB23138 sensitivity proved the impact of dynamic features of two VP1 loops enveloping these inhibitors on antiviral potency.
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  • 文章类型: Journal Article
    本研究旨在探讨普通感冒对住院精神分裂症患者血清氯氮平浓度的影响。
    回顾性研究65例普通感冒患者接受氯氮平治疗。人口统计数据,用药情况,氯氮平浓度,常规血液学和生化实验室检查的参数是从病历系统获得的。通过配对样本t检验比较基线期和冷期之间的血清氯氮平浓度和氯氮平浓度/剂量(C/D)比。使用Pearson相关性分析评估氯氮平的血清浓度和C/D比的变化与白细胞(WBC)和中性粒细胞(NE)计数变化之间的相关性。
    发现血清氯氮平浓度(t=-9.856,P<0.001)和氯氮平C/D比(t=-10.071,P<0.001)在寒冷时期显着升高。此外,与男性患者相比,女性患者的血清氯氮平浓度变化显著升高(t=-2.483,P=0.017).此外,血清氯氮平浓度的变化与白细胞(r=0.303,P=0.014)和NE(r=0.315,P=0.011)计数的变化呈正相关。同样,氯氮平C/D比值的变化与白细胞(r=0.275,P=0.027)和NE(r=0.328,P=0.008)的变化呈正相关。
    精神分裂症患者在普通感冒期间的血清氯氮平浓度升高,这可能与白细胞和NE计数升高有关。
    UNASSIGNED: The present study aims to investigate the effect of common cold on the serum clozapine concentrations in hospitalized patients with schizophrenia.
    UNASSIGNED: A total of 65 schizophrenic patients with common cold receiving clozapine treatment were retrospectively enrolled. The demographic data, medication situation, clozapine concentration, and parameters of routine haematological and biochemical laboratory tests were obtained from the medical record system. The serum clozapine concentration and clozapine concentration/dose (C/D) ratios between the baseline period and cold period were compared by paired-sample t tests. Association between the changes in serum concentration and C/D ratios of clozapine and changes in white blood cell (WBC) and neutrophil (NE) counts was evaluated using Pearson correlation analysis.
    UNASSIGNED: The serum clozapine concentration (t = -9.856, P < 0.001) and clozapine C/D ratios (t = -10.071, P < 0.001) were found to be significantly elevated in the cold period compared to the baseline period. Moreover, the changes in the serum clozapine concentration were found to be significantly elevated in female patients compared to male patients (t = -2.483, P = 0.017). Furthermore, changes in the serum clozapine concentration were positively correlated to the changes in WBC (r = 0.303, P = 0.014) and NE (r = 0.315, P = 0.011) counts. Similarly, changes in clozapine C/D ratios were positively correlated to the changes in WBC (r = 0.275, P = 0.027) and NE (r = 0.328, P = 0.008) counts.
    UNASSIGNED: The serum clozapine concentrations in patients with schizophrenia during the common cold period were increased, which might by related to the elevated WBC and NE counts.
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  • 文章类型: News
    这篇医学新闻文章讨论了免疫系统对不同冠状病毒交叉反应性的新研究以及对泛冠状病毒疫苗的影响。
    This Medical News article discusses new research on immune system cross-reactivity to different coronaviruses and implications for pan-coronavirus vaccines.
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  • 文章类型: Journal Article
    在这项研究中,我们调查了日托中心空气传播流感病毒的浓度和影响因素,例如普通感冒患病率,空气污染物,和气象因素。从高雄的日托中心共收集了209份空气样本,并使用实时定量聚合酶链反应分析了流感病毒。使用实时监测设备测量空气污染物和计量因素。冬季空气传播流感病毒阳性率最高,普通感冒患病率最高,其次是夏季和秋季。CO浓度与空气传播流感病毒呈显著正相关。A日托中心,与自然通风和空调系统,空气中的甲型流感病毒浓度较高,空气传播的真菌,和空气传播的细菌,以及普通感冒的患病率较高,比B日托中心,带有机械通风系统和空气净化器,而CO2,CO的浓度,日托中心A的UFP低于日托中心B的UFP。我们在日托中心成功检测到空气传播的流感病毒,证明流感的气溶胶采样可以提供新的流行病学见解,并为日托中心的流感管理提供信息。
    In this study, we investigated the concentration of airborne influenza virus in daycare centers and influencing factors, such as common cold prevalence, air pollutants, and meteorological factors. A total of 209 air samples were collected from daycare centers in Kaohsiung and the influenza virus was analyzed using real-time quantitative polymerase chain reaction. Air pollutants and metrological factors were measured using real-time monitoring equipment. Winter had the highest positive rates of airborne influenza virus and the highest prevalence of the common cold, followed by summer and autumn. The concentration of CO was significantly positively correlated with airborne influenza virus. Daycare center A, with natural ventilation and air condition systems, had a higher concentration of airborne influenza A virus, airborne fungi, and airborne bacteria, as well as a higher prevalence of the common cold, than daycare center B, with a mechanical ventilation system and air purifiers, while the concentrations of CO2, CO, and UFPs in daycare center A were lower than those in daycare center B. We successfully detected airborne influenza virus in daycare centers, demonstrating that aerosol sampling for influenza can provide novel epidemiological insights and inform the management of influenza in daycare centers.
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  • 文章类型: Journal Article
    COVID-19大流行的出现促使人们对季节性人类冠状病毒的兴趣增加。OC43,229E,NL63和HKU1是引起普通感冒的地方性季节性冠状病毒,通常伴有轻度呼吸道症状。在这项研究中,我们鉴定了在被3种冠状病毒感染后表现出细胞病变效应(CPE)的细胞系,并表征了它们的病毒复制动力学和感染对宿主表面受体表达的影响.我们发现NL63在LLC-MK2细胞中产生CPE,而OC43在MRC-5、HCT-8和WI-38细胞系中产生CPE,而229E在感染后第3天在MRC-5和WI-38中产生CPE。我们观察到,从感染后第3天到第5天,所有病毒的核衣壳和刺突病毒RNA(vRNA)急剧增加;然而,在感染细胞的上清液和细胞裂解物中测量的vRNA拷贝的丰度和比例根据病毒-宿主细胞对的不同而有很大差异。重要的是,我们观察到感染时冠状病毒进入和附着受体的调节。229E和OC43的感染分别导致CD13和GD3的下调。相比之下,NL63和OC43感染导致ACE2表达增加。使用可溶性ACE2或抗ACE2单克隆抗体阻断NL63进入的尝试证明了这些策略极大地减少感染的潜力。总的来说,我们的结果使我们能够更好地了解季节性冠状病毒在允许细胞系中的感染动力学,并揭示了可能对促进人类多种冠状病毒共同感染有影响的进入受体调节.IMPORTANCE季节性人类冠状病毒是与一般轻度上呼吸道感染相关的普通感冒的重要原因,可导致某些人的呼吸道并发症。没有针对这些病毒的疫苗,只有有限的抗病毒治疗方案来治疗最严重的病例。更好地了解这些病毒如何与宿主细胞相互作用对于确定预防感染相关并发症的新策略至关重要。通过分析不同允许细胞系中的病毒复制动力学,我们发现细胞依赖性宿主因素影响病毒基因的表达和病毒颗粒的释放。我们还分析了受感染细胞上的进入受体表达,发现这些可以根据感染的冠状病毒进行上调或下调。我们的发现引起了人们对某些冠状病毒共同感染后感染增强的可能性的担忧,这可能有助于基因重组和新变体和菌株的出现。
    The emergence of the COVID-19 pandemic prompted an increased interest in seasonal human coronaviruses. OC43, 229E, NL63, and HKU1 are endemic seasonal coronaviruses that cause the common cold and are associated with generally mild respiratory symptoms. In this study, we identified cell lines that exhibited cytopathic effects (CPE) upon infection by three of these coronaviruses and characterized their viral replication kinetics and the effect of infection on host surface receptor expression. We found that NL63 produced CPE in LLC-MK2 cells, while OC43 produced CPE in MRC-5, HCT-8, and WI-38 cell lines, while 229E produced CPE in MRC-5 and WI-38 by day 3 post-infection. We observed a sharp increase in nucleocapsid and spike viral RNA (vRNA) from day 3 to day 5 post-infection for all viruses; however, the abundance and the proportion of vRNA copies measured in the supernatants and cell lysates of infected cells varied considerably depending on the virus-host cell pair. Importantly, we observed modulation of coronavirus entry and attachment receptors upon infection. Infection with 229E and OC43 led to a downregulation of CD13 and GD3, respectively. In contrast, infection with NL63 and OC43 leads to an increase in ACE2 expression. Attempts to block entry of NL63 using either soluble ACE2 or anti-ACE2 monoclonal antibodies demonstrated the potential of these strategies to greatly reduce infection. Overall, our results enable a better understanding of seasonal coronaviruses infection kinetics in permissive cell lines and reveal entry receptor modulation that may have implications in facilitating co-infections with multiple coronaviruses in humans.IMPORTANCESeasonal human coronavirus is an important cause of the common cold associated with generally mild upper respiratory tract infections that can result in respiratory complications for some individuals. There are no vaccines available for these viruses, with only limited antiviral therapeutic options to treat the most severe cases. A better understanding of how these viruses interact with host cells is essential to identify new strategies to prevent infection-related complications. By analyzing viral replication kinetics in different permissive cell lines, we find that cell-dependent host factors influence how viral genes are expressed and virus particles released. We also analyzed entry receptor expression on infected cells and found that these can be up- or down-modulated depending on the infecting coronavirus. Our findings raise concerns over the possibility of infection enhancement upon co-infection by some coronaviruses, which may facilitate genetic recombination and the emergence of new variants and strains.
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  • 文章类型: Journal Article
    从事适当的体育锻炼可以显着降低中老年人患各种疾病的风险。研究最佳的身体活动水平(PA)对于增强该人群的健康至关重要。本研究旨在探讨中国中老年人群每周PA水平与患感冒频率的量效关系,确定必要的PA水平,以有效降低感冒风险。
    我们进行了一项横断面研究,使用基于网络的调查针对中国40岁及以上的个人(n=1,683)。调查收集了有关PA和感冒频率的信息。使用Kruskal-Wallis检验和χ2检验分析数据。我们通过有序多变量逻辑回归模型和受限三次样条模型探索了过去一年中每周PA与寒冷频率之间的剂量反应关系。
    (1)快走成为40岁以上人群的首选体育锻炼。研究结果表明,每周适度(比值比(OR)=0.64,P<0.001,95%置信区间(CI)[0.50-0.81])和高水平(OR=0.64,P<0.001,95%CI[0.51-0.79])的PA水平显着降低了感冒的风险。患有1种(OR=1.47,P<0.001,95%CI[1.20-1.80])或多种慢性疾病(OR=1.56,P<0.001,95%CI[1.21-2.00])的个体风险增加。与中国东部地区相比,中部地区(OR=1.64,P<0.001,95%CI[1.33-02.01])和西部地区(OR=1.49,P=0.008,95%CI[1.11-02.00])的人群面临更高的风险。(2)根据约束三次样条模型,在过去一年中经历过一次感冒的成年人每周PA水平为537.29代谢当量-每周分钟(MET-min/wk),OR值为1.对于那些报告两个或两个以上感冒的人,PA水平为537.76MET-min/wk,OR为1.
    (1)快走是中国中老年人最喜欢的运动,感冒的患病率受到慢性病数量和地理位置的影响。(2)常规,适度的运动可以降低患感冒的风险。为了有效降低冷频率,建议中国中老年人至少进行538MET-min/wk的运动。
    UNASSIGNED: Engaging in appropriate physical activity can significantly lower the risk of various diseases among middle-aged and older adults. Investigating optimal levels of physical activity (PA) is crucial for enhancing the health of this demographic. This study aims to explore the dose-response relationship between weekly PA levels and the frequency of colds among Chinese middle-aged and elderly individuals, identifying the necessary PA level to effectively diminish the risk of colds.
    UNASSIGNED: We conducted a cross-sectional study using a web-based survey targeting individuals aged 40 and older (n = 1, 683) in China. The survey collected information on PA and the frequency of colds. Data was analyzed using Kruskal-Wallis test and the χ2 test. We explored the dose-response relationship between weekly PA and cold frequency over the past year through an ordered multivariate logistic regression model and a restricted cubic spline model.
    UNASSIGNED: (1) Brisk walking emerged as the preferred physical exercise for those over 40. The findings suggest that engaging in moderate (odds ratio (OR) = 0.64, P < 0.001, 95% confidence interval (CI) [0.50-0.81]) and high (OR = 0.64, P < 0.001, 95% CI [0.51-0.79]) levels of PA weekly significantly reduces the risk of catching a cold. Individuals with one (OR = 1.47, P < 0.001, 95% CI [1.20-1.80]) or multiple chronic diseases (OR = 1.56, P < 0.001, 95% CI [1.21-2.00]) were at increased risk. Those residing in central (OR = 1.64, P < 0.001, 95% CI [1.33-02.01]) and western China (OR = 1.49, P = 0.008, 95% CI [1.11-02.00]) faced a higher risk compared to their counterparts in eastern China. (2) According to the restricted cubic spline model, adults who experienced one cold in the past year had a weekly PA level of 537.29 metabolic equivalent-minutes per week (MET-min/wk) with an OR value of 1. For those reporting two or more colds, the PA level was 537.76 MET-min/wk with an OR of 1.
    UNASSIGNED: (1) Brisk walking is the most favored exercise among the Chinese middle-aged and elderly, with the prevalence of colds being affected by the number of chronic diseases and the geographic location. (2) Regular, moderate exercise is linked to a lower risk of colds. To effectively reduce cold frequency, it is recommended that middle-aged and elderly Chinese individuals engage in a minimum of 538 MET-min/wk of exercise.
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  • 文章类型: Journal Article
    过敏性鼻炎(AR)是一个全球性的健康挑战,特别影响儿童的生活质量。人类鼻病毒(HRV)感染通常会导致上呼吸道(URT)的普通感冒,也会影响气道过敏的发展。比如哮喘恶化,但它与AR的关系知之甚少。该研究旨在深入了解AR儿童中普遍存在的HRV的特征及其在AR严重程度中的作用。在2022-2023年期间,来自中国西南部的362名症状性AR儿童被纳入,并收集鼻腔灌洗样本进行HRV分子表征和细胞因子测量。在40%的AR儿童中检测到HRV,在秋季进行峰值检测。阳性率与受试者是否接受过敏原特异性免疫疗法(AIT)无关。在检测到的HRV中,42%是物种A,36%是B种,22%是C种,涉及21种A基因型,6个B基因型,和7个C基因型。HRV阳性与症状严重程度(视觉模拟量表[VAS]评分)和局部鼻腔IgE水平升高显著相关,白细胞介素-25(IL-25),未接受抗过敏治疗的AR儿童中的IL-4和CXCL13。所有三种HRV菌株(A1B,A21,B27,B70和C17)已被分离,并且能够在体外感染呼吸道上皮组织。全基因组测序表明,分离的HRV的抗原表位具有一定的变异。我们的工作揭示了AR儿童URT-HRV的病因学特征,并提示HRV感染在儿童AR发病机理中的作用。
    目的:我们的研究显示,过敏性鼻炎(AR)患儿的人鼻病毒(HRV)检出率高,和HRV感染(A,B,或C种)与AR儿童的症状严重程度呈正相关。鼻腔IgE升高,白细胞介素-25(IL-25),IL-4和CXCL13水平提示了潜在的致病机制,通过该机制,HRV感染在AR患者中诱导鼻2型免疫/炎症反应和局部IgE产生。此外,病因分析发现,AR儿童中主要流行的HRV种类是A和B(约80%),这不同于急性呼吸道感染和哮喘恶化,其中物种A和C占优势。数据揭示了AR中HRV感染的不同物种流行特征。最后,我们从AR患儿的鼻腔中分离出所有三种具有不同程度的抗原表位突变和体外感染性的HRV株,强调加强AR患儿呼吸道HRV感染监测和干预的重要性。
    Allergic rhinitis (AR) is a global health challenge that particularly affects the quality of life of children. Human rhinovirus (HRV) infection usually causes common cold in the upper respiratory tract (URT) and can also affect airway allergy development, such as asthma exacerbation, but its relationship with AR is poorly understood. The study aimed to gain insight into the characteristics of HRV that is prevalent in AR children and its role in AR severity. A total of 362 children with symptomatic AR were enrolled from southwestern China during 2022-2023, and nasal lavage samples were collected for HRV molecular characterization and cytokine measurement. HRV was detected in 40% of the AR children, with peak detection in autumn. The positive rate was not correlated with whether the subjects were under allergen-specific immunotherapy (AIT). Among the detected HRVs, 42% were species A, 36% were species B, and 22% were species C, involving 21 A genotypes, 6 B genotypes, and 7 C genotypes. HRV positivity was significantly associated with symptom severity (visual analog scale [VAS] score) and elevated levels of local nasal IgE, interleukin-25 (IL-25), IL-4, and CXCL13 in AR children who did not receive antiallergic treatment. All three species of HRV strains (A1B, A21, B27, B70, and C17) had been isolated and were able to infect respiratory epithelial tissue in vitro. Complete genome sequencing showed that the antigenic epitopes of the isolated HRVs had certain variations. Our work reveals the etiological characteristics of URT-HRV in AR children and suggests a role of HRV infection in the pathogenesis of childhood AR.
    OBJECTIVE: Our study revealed high human rhinovirus (HRV) detection rate in children with allergic rhinitis (AR), and HRV infection (A, B, or C species) is positively associated with the symptom severity in AR children. Elevated nasal IgE, interleukin-25 (IL-25), IL-4, and CXCL13 levels suggest a potential pathogenic mechanism by which HRV infection induces nasal type 2 immune/inflammation responses and local IgE production in AR patients. In addition, etiological analysis found that the main prevalent HRV species in AR children are A and B (~80%), which is different from acute respiratory infection and asthma exacerbation, where species A and C are dominant. The data reveal the distinct species prevalence characteristics of HRV infection in AR. Finally, we isolated all three species of HRV strains from nasal cavity of AR children with varying degrees of antigenic epitope mutations and in vitro infectivity, highlighting the importance of strengthening monitoring and intervention for respiratory HRV infection in AR children.
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  • 文章类型: Historical Article
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  • 文章类型: Journal Article
    背景:一些研究报告说,发展中国家的社区药房,包括印度尼西亚,在处理患者的咳嗽自我药物治疗请求时提供次优建议。这些建议背后的原因,因此,需要调查。
    目的:描述印尼药剂师在处理咳嗽自我药疗病例时的临床决策。
    方法:开发了一个开放式问卷,该问卷由两个咳嗽临床小插曲组成(案例1:由于哮喘恶化引起的咳嗽和案例2:作为普通感冒症状的咳嗽)。对药剂师进行了采访,以提供建议以及他们对这些情况的建议的原因。内容分析用于分析参与者对这两种情况的陈述。然后计算提供适当建议和理由的参与者人数。
    结果:共有245名社区药师参与了这项研究。在咳嗽由于哮喘恶化的情况下,推荐产品是最常见的推荐和陈述的原因(40%),因为该产品被表明有助于缓解症状。25%的参与者提供了适当的建议(直接医疗转诊)和适当的推理(指示警告症状和/或做出症状诊断)。如果咳嗽是普通感冒的症状,推荐帮助缓解症状的产品也是最常见的推荐和陈述原因(53%)。81%的参与者提供了适当的建议(推荐产品)和适当的推理(提供产品来治疗症状和/或表明没有警告症状和/或做出症状诊断)。
    结论:印度尼西亚社区药剂师为咳嗽自我用药请求提供适当建议的能力取决于是否需要分诊。大多数社区药剂师无法区分主要和次要疾病可能会对患者造成严重的健康影响,因此应采取教育干预措施来提高社区药剂师的鉴别诊断技能。
    BACKGROUND: Some studies have reported that community pharmacies in developing countries, including Indonesia, provided sub-optimal advice when handling patient\'s self-medication request for cough. The reasons behind such advice, therefore, need to be investigated.
    OBJECTIVE: To describe Indonesian pharmacists\' clinical decision making when handling self-medication cases for a cough.
    METHODS: An open-ended questionnaire consisting of two cough clinical vignettes (case 1: cough due to asthma worsening and case 2: cough as a symptom of common cold) were developed. Pharmacists were interviewed to provide recommendations and reasons for their recommendations for these scenarios. Content analysis was used to analyse participants\' statements for the two scenarios. The number of participants who provided appropriate recommendations and reasons were then counted.
    RESULTS: A total of 245 community pharmacists participated in the study. In the case of cough due to asthma worsening, recommending a product because the product was indicated to help with the symptoms was the most common recommendation and stated reason (40%). Appropriate recommendation (direct medical referral) with appropriate reasoning (indicating warning symptoms and/or making a symptom diagnosis) was provided by 25% participants. In the case of cough as a symptom of common cold, recommending products to help with the symptoms was also the most common recommendation and stated reason (53%). Appropriate recommendations (recommending product) with appropriate reasoning (providing product to treat the symptoms and/or indicating no warning symptoms and/or making a symptom diagnosis) was provided by 81% participants.
    CONCLUSIONS: The ability of Indonesian community pharmacists to provide appropriate recommendations for cough self-medication requests is dependent on whether triage is required. The inability of most community pharmacists to differentiate between major and minor conditions may lead to serious health implications for patients and therefore educational interventions should be undertaken to improve community pharmacists\' differential diagnostic skills for triage.
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