• 文章类型: Journal Article
    坦桑尼亚的桑给巴尔群岛已成为恶性疟原虫的低传播区。尽管多年来一直被认为是淘汰前的领域,实现淘汰一直很困难,可能是由于来自坦桑尼亚大陆的输入性感染和持续的本地传播。
    为了阐明这些传输源,我们利用分子倒置探针对2016年至2018年在桑给巴尔和沿海大陆Bagamoyo地区收集的282株恶性疟原虫进行了高度多重基因分型,以表征其遗传相关性.
    总的来说,沿海大陆和桑给巴尔群岛的寄生虫种群仍然高度相关。然而,由于在很短的距离内寄生虫相关性的快速衰减,来自桑给巴尔的寄生虫分离物表现出种群微观结构。这个,以及shehias内部高度相关的对,表明正在进行的低级本地传输。我们还确定了整个shehias高度相关的寄生虫,这些寄生虫反映了Unguja主岛上的人类活动,并确定了一系列高度相关的寄生虫,暗示爆发,在彭巴岛的米切韦尼区。无症状感染的寄生虫表现出比有症状感染的寄生虫更高的感染复杂性。但有相似的核心基因组。
    我们的数据支持进口作为遗传多样性的主要来源和对桑给巴尔寄生虫种群的贡献,但它们也显示了局部爆发集群,在这些集群中,有针对性的干预措施对于阻止局部传播至关重要。这些结果突出表明,需要对进口疟疾采取预防措施,并在由于易感宿主和有能力的媒介而仍然接受疟疾复发的地区加强控制措施。
    这项研究由美国国立卫生研究院资助,授予R01AI121558、R01AI137395、R01AI155730、F30AI143172和K24AI134990。瑞典研究委员会也提供了资金,Erling-Persson家庭基金会,和杨基金。RV承认MRC全球传染病分析中心的资助(参考MR/R015600/1),由英国医学研究理事会(MRC)和英国外国共同资助,联邦和发展办公室(FCDO),根据MRC/FCDO协约协议,也是欧盟支持的EDCTP2计划的一部分。RV还承认社区Jameel的资助。
    UNASSIGNED: The Zanzibar archipelago of Tanzania has become a low-transmission area for Plasmodium falciparum. Despite being considered an area of pre-elimination for years, achieving elimination has been difficult, likely due to a combination of imported infections from mainland Tanzania and continued local transmission.
    UNASSIGNED: To shed light on these sources of transmission, we applied highly multiplexed genotyping utilizing molecular inversion probes to characterize the genetic relatedness of 282 P. falciparum isolates collected across Zanzibar and in Bagamoyo district on the coastal mainland from 2016 to 2018.
    UNASSIGNED: Overall, parasite populations on the coastal mainland and Zanzibar archipelago remain highly related. However, parasite isolates from Zanzibar exhibit population microstructure due to the rapid decay of parasite relatedness over very short distances. This, along with highly related pairs within shehias, suggests ongoing low-level local transmission. We also identified highly related parasites across shehias that reflect human mobility on the main island of Unguja and identified a cluster of highly related parasites, suggestive of an outbreak, in the Micheweni district on Pemba island. Parasites in asymptomatic infections demonstrated higher complexity of infection than those in symptomatic infections, but have similar core genomes.
    UNASSIGNED: Our data support importation as a main source of genetic diversity and contribution to the parasite population in Zanzibar, but they also show local outbreak clusters where targeted interventions are essential to block local transmission. These results highlight the need for preventive measures against imported malaria and enhanced control measures in areas that remain receptive to malaria reemergence due to susceptible hosts and competent vectors.
    UNASSIGNED: This research was funded by the National Institutes of Health, grants R01AI121558, R01AI137395, R01AI155730, F30AI143172, and K24AI134990. Funding was also contributed from the Swedish Research Council, Erling-Persson Family Foundation, and the Yang Fund. RV acknowledges funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 program supported by the European Union. RV also acknowledges funding by Community Jameel.
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  • 文章类型: Journal Article
    背景:关于公众对当前公共卫生和社会措施(PHSMs)的偏好以及PHSMs下人们的心理健康的信息不足。
    目的:本研究旨在量化公众对不同PHSM的偏好,并测量中国COVID-19正常化阶段的大流行疲劳水平。
    方法:进行了一项具有离散选择实验和心理测量量表的全国性横断面研究,以评估公众对PHSM的偏好和态度,采用配额抽样法。使用COVID-19大流行疲劳量表(CPFS)筛查受访者的疲劳水平。多项式Logit模型,潜在类模型,采用Mann-Whitney检验进行统计分析。我们还进行了基于性别的亚组分析,年龄,月收入,心理健康状况,和大流行性疲劳状态。
    结果:中国共有689名受访者完成了调查。离散选择实验显示,受访者最重视3个月内感染COVID-19的风险(45.53%),其次是3个月内的收入损失(30.69%)。弱势群体(低收入人群和老年人)对感染风险更加敏感,而年轻的受访者对收入损失更敏感,更喜欢不暂停社交场所和交通工具。移民和患有大流行性疲劳的人对强制性加强疫苗接种和暂停运输的接受程度较低。此外,女性受访者的大流行疲劳水平更高,年轻的受访者,移民,和收入相对较低的受访者(CPFS与年龄的相关性:r=-0.274,P<.001;与月收入的相关性:r=-0.25,P<.001)。流行性疲劳程度较高的受访者也不喜欢强制加强COVID-19疫苗接种,而流行性疲劳程度较低的受访者更喜欢普遍的COVID-19加强疫苗接种。
    结论:大流行性疲劳在中国各地的受访者中广泛流行,在中国,在COVID-19正常化阶段,受访者希望恢复正常的社会生活,同时面临对COVID-19感染的恐惧。在未来的大流行期间,正确实施PHSMs应考虑居民的精神负担和依从性。
    BACKGROUND: Information on the public\'s preferences for current public health and social measures (PHSMs) and people\'s mental health under PHSMs is insufficient.
    OBJECTIVE: This study aimed to quantify the public\'s preferences for varied PHSMs and measure the level of pandemic fatigue in the COVID-19 normalization stage in China.
    METHODS: A nationwide cross-sectional study with a discrete choice experiment and psychometric scales was conducted to assess public preferences for and attitudes toward PHSMs, using the quota sampling method. The COVID-19 Pandemic Fatigue Scale (CPFS) was used to screen fatigue levels among respondents. The multinomial logit model, latent class model, and Mann-Whitney test were used for statistical analysis. We also conducted subgroup analysis based on sex, age, monthly income, mental health status, and pandemic fatigue status.
    RESULTS: A total of 689 respondents across China completed the survey. The discrete choice experiment revealed that respondents attached the greatest importance to the risk of COVID-19 infection within 3 months (45.53%), followed by loss of income within 3 months (30.69%). Vulnerable populations (low-income populations and elderly people) were more sensitive to the risk of infection, while younger respondents were more sensitive to income loss and preferred nonsuspension of social places and transportation. Migrants and those with pandemic fatigue had less acceptance of the mandatory booster vaccination and suspension of transportation. Additionally, a higher pandemic fatigue level was observed in female respondents, younger respondents, migrants, and relatively lower-income respondents (CPFS correlation with age: r=-0.274, P<.001; correlation with monthly income: r=-0.25, P<.001). Mandatory booster COVID-19 vaccination was also not preferred by respondents with a higher level of pandemic fatigue, while universal COVID-19 booster vaccination was preferred by respondents with a lower level of pandemic fatigue.
    CONCLUSIONS: Pandemic fatigue is widely prevalent in respondents across China, and respondents desired the resumption of normal social life while being confronted with the fear of COVID-19 infection in the normalization stage of COVID-19 in China. During future pandemics, the mental burden and adherence of residents should be considered for the proper implementation of PHSMs.
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  • 文章类型: Journal Article
    背景:2型糖尿病高危人群患心血管疾病(CVD)的风险也增加。尽管有单独的试验研究生活方式干预对2型糖尿病高危人群绝对CVD风险的影响,缺乏这些试验的综合综合证据。
    目的:我们将系统地综合有关生活方式干预在降低2型糖尿病高危人群中绝对CVD风险和CVD风险因素方面的作用的证据。
    方法:在报告本方案的细节时,我们坚持PRISMA-P(系统评价和Meta分析方案的首选报告项目)声明。糖尿病预防的随机对照试验研究了生活方式干预至少6个月对2型糖尿病高危人群的绝对CVD风险和CVD风险因素的影响。我们将系统地搜索MEDLINE,Embase,PsycINFO,中部,和Scopus数据库和ClinicalTrials.gov使用医学主题词和文本词的混合。两位作者将独立筛选从搜索中检索到的文章的摘要和标题,随后使用纳入和排除标准进行全文综述,并从符合条件的研究中提取数据.文章筛选和数据提取将在Covidence软件中进行。主要结果将是10年CVD绝对风险的变化,由风险预测模型估计。次要结果是CVD危险因素的变化,包括行为,临床,生物化学,和心理社会危险因素,和2型糖尿病的发病率。
    结果:在2023年7月进行了初步的数据库搜索。在筛选了1935篇通过数据库搜索确定的文章后,42篇文章被认为有资格列入。预计研究结果将于2024年底提交同行评审期刊发表。
    结论:这项研究将提供最新的,关于生活方式干预对2型糖尿病高危个体绝对CVD风险和CVD风险因素影响的系统综合证据。
    背景:PROSPEROCRD42023429869;https://tinyurl.com/59ajy7rw.
    DERR1-10.2196/53517。
    BACKGROUND: Individuals at high risk for type 2 diabetes are also at an increased risk for developing cardiovascular disease (CVD). Although there are separate trials examining the effects of lifestyle interventions on absolute CVD risk among people at high risk for type 2 diabetes, a comprehensive evidence synthesis of these trials is lacking.
    OBJECTIVE: We will systematically synthesize the evidence on the effects of lifestyle interventions in reducing absolute CVD risk and CVD risk factors among people at high risk for type 2 diabetes.
    METHODS: We adhered to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) statement in reporting the details of this protocol. Randomized controlled trials of diabetes prevention that examined the effects of lifestyle interventions for at least 6 months on absolute CVD risk and CVD risk factors among individuals at high risk for type 2 diabetes will be eligible. We will systematically search the MEDLINE, Embase, PsycINFO, CENTRAL, and Scopus databases and ClinicalTrials.gov using a mix of Medical Subject Headings and text words. Two authors will independently screen the abstract and title of the articles retrieved from the search, followed by full-text reviews using the inclusion and exclusion criteria and data extraction from the eligible studies. Article screening and data extraction will be performed in the Covidence software. The primary outcome will be the changes in absolute 10-year CVD risk, as estimated by risk prediction models. The secondary outcomes are the changes in CVD risk factors, including behavioral, clinical, biochemical, and psychosocial risk factors, and incidence of type 2 diabetes.
    RESULTS: An initial database search was conducted in July 2023. After screening 1935 articles identified through the database search, 42 articles were considered eligible for inclusion. It is anticipated that the study findings will be submitted for publication in a peer-reviewed journal by the end of 2024.
    CONCLUSIONS: This study will provide up-to-date, systematically synthesized evidence on the effects of lifestyle interventions on absolute CVD risk and CVD risk factors among individuals at high risk for type 2 diabetes.
    BACKGROUND: PROSPERO CRD42023429869; https://tinyurl.com/59ajy7rw.
    UNASSIGNED: DERR1-10.2196/53517.
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  • 文章类型: Journal Article
    背景:在COVID-19大流行期间,世界各地的政府和公共卫生机构在互联网上遇到了社交媒体介导的信息流行病的困难。现有的公共卫生危机沟通策略需要更新。然而,在COVID-19大流行期间,世界各国政府和公共卫生机构的危机沟通经验尚未得到系统地汇编,需要更新的危机沟通策略。
    目的:本系统综述旨在收集和组织发件人的危机沟通经验(即,政府和公共卫生机构)在COVID-19大流行期间。我们的重点是探索政府和公共卫生机构经历的困难,在COVID-19大流行期间,政府和公共卫生机构在危机传播中的最佳做法,以及在未来公共卫生危机中应该克服的挑战。
    方法:我们计划于2024年5月1日开始文献检索。我们将搜索PubMed,MEDLINE,CINAHL,PsycINFO,心术,通讯摘要,和WebofScience。我们将过滤我们的数据库搜索从2020年及以后的搜索。我们将通过引用SPIDER(示例,兴趣现象,设计,评价,和研究类型)工具来搜索数据库中的摘要。我们打算包括政府和公共卫生机构对危机沟通的定性研究(例如,官员,工作人员,卫生专业人员,和研究人员)对公众。基于数据的定量研究将被排除在外。只有用英语写的论文将被包括在内。有关研究特征的数据,研究目的,参与者特征,方法论,理论框架,危机沟通的对象,并提取关键结果。将使用JoannaBriggs研究所关键评估清单对合格研究的方法学质量进行评估,以进行定性研究。共有两名独立审稿人将共同负责筛选出版物,数据提取,和质量评估。分歧将通过讨论解决,将咨询第三位审稿人,如有必要。调查结果将在表格和概念图中进行总结,并在描述性和叙述性审查中进行综合。
    结果:将以与我们的研究目标和兴趣相对应的方式系统地整合和呈现结果。我们预计此次审查的结果将于2024年底提交发布。
    结论:据我们所知,这将是对政府和公共卫生机构在COVID-19大流行期间向公众传达危机的经验的首次系统回顾。这项审查将有助于将来改进政府和公共卫生机构向公众传达危机的指南。
    背景:PROSPEROCRD42024528975;https://tinyurl.com/4fjmd8te。
    PRR1-10.2196/58040。
    BACKGROUND: Governments and public health agencies worldwide experienced difficulties with social media-mediated infodemics on the internet during the COVID-19 pandemic. Existing public health crisis communication strategies need to be updated. However, crisis communication experiences of governments and public health agencies worldwide during the COVID-19 pandemic have not been systematically compiled, necessitating updated crisis communication strategies.
    OBJECTIVE: This systematic review aims to collect and organize the crisis communication experiences of senders (ie, governments and public health agencies) during the COVID-19 pandemic. Our focus is on exploring the difficulties that governments and public health agencies experienced, best practices in crisis communication by governments and public health agencies during the COVID-19 pandemic in times of infodemic, and challenges that should be overcome in future public health crises.
    METHODS: We plan to begin the literature search on May 1, 2024. We will search PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Communication Abstracts, and Web of Science. We will filter our database searches to search from the year 2020 and beyond. We will use a combination of keywords by referring to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool to search the abstracts in databases. We intend to include qualitative studies on crisis communication by governments and public health agencies (eg, officials, staff, health professionals, and researchers) to the public. Quantitative data-based studies will be excluded. Only papers written in English will be included. Data on study characteristics, study aim, participant characteristics, methodology, theoretical framework, object of crisis communication, and key results will be extracted. The methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. A total of 2 independent reviewers will share responsibility for screening publications, data extraction, and quality assessment. Disagreement will be resolved through discussion, and the third reviewer will be consulted, if necessary. The findings will be summarized in a table and a conceptual diagram and synthesized in a descriptive and narrative review.
    RESULTS: The results will be systematically integrated and presented in a way that corresponds to our research objectives and interests. We expect the results of this review to be submitted for publication by the end of 2024.
    CONCLUSIONS: To our knowledge, this will be the first systematic review of the experiences of governments and public health agencies regarding their crisis communication to the public during the COVID-19 pandemic. This review will contribute to the future improvement of the guidelines for crisis communication by governments and public health agencies to the public.
    BACKGROUND: PROSPERO CRD42024528975; https://tinyurl.com/4fjmd8te.
    UNASSIGNED: PRR1-10.2196/58040.
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  • 文章类型: Journal Article
    在低早发性败血症(EOS)风险的极早产儿(VPIs)中过度使用抗生素与死亡率和发病率增加有关。然而,早期抗生素暴露与支气管肺发育不良(BPD)的相关性仍然不明确.
    评估不同持续时间和类型的早期抗生素暴露与低EOS风险VPI中BPD发生率的关联。
    这项国家多中心队列研究利用了中国新生儿网络(CHNN)的数据,该数据前瞻性地收集了2019年1月1日至2021年12月31日的数据。VPI小于32周胎龄或出生体重小于1500克,EOS风险较低,定义为通过剖腹产出生的人,没有分娩或胎膜破裂,没有绒毛膜羊膜炎的临床证据,包括在内。数据分析于2022年10月至2023年12月进行。
    早期抗生素暴露定义为在生命的第一周内使用抗生素的日历天数。被进一步归类为没有暴露,暴露1到4天,和5到7天的暴露。
    主要结局是月经后36周(PMA)的中度至重度BPD或死亡率的复合。使用2种不同的模型采用Logistic回归评估与BPD或死亡率相关的因素。
    在研究期间纳入CHNN的27176个VPI中(男性14874个[54.7%]和女性12302个[45.3%]),6510(23.9%;男性3373人[51.8%],女性3137人[48.2。%])被归类为EOS的低风险。其中,1324(20.3%)没有抗生素暴露,1134(17.4%)接受了1至4天的抗生素治疗,和4052(62.2%)接受了5至7天的抗生素治疗。在5186名接受抗生素治疗的VPI中,4098(79.0%)接受了广谱抗生素,888人(17.1%)接受了窄谱抗生素,200人(3.9%)接受抗真菌药物或其他抗生素治疗。长期暴露(5-7天)与中度至重度BPD或死亡的可能性增加相关(校正比值比[aOR],1.23;95%CI,1.01-1.50)。广谱抗生素的使用(1-7天)也与中度至重度BPD或死亡的高风险相关(aOR,1.27;95%CI,1.04-1.55)。
    在这项低EOS风险VPI的队列研究中,长期或广谱抗生素暴露与中重度BPD或死亡风险增加相关.这些结果表明,应监测生命早期暴露于长期或广谱抗生素的VPI的不良结局。
    UNASSIGNED: The overutilization of antibiotics in very preterm infants (VPIs) at low risk of early-onset sepsis (EOS) is associated with increased mortality and morbidities. Nevertheless, the association of early antibiotic exposure with bronchopulmonary dysplasia (BPD) remains equivocal.
    UNASSIGNED: To evaluate the association of varying durations and types of early antibiotic exposure with the incidence of BPD in VPIs at low risk of EOS.
    UNASSIGNED: This national multicenter cohort study utilized data from the Chinese Neonatal Network (CHNN) which prospectively collected data from January 1, 2019, to December 31, 2021. VPIs less than 32 weeks\' gestational age or with birth weight less than 1500 g at low risk of EOS, defined as those born via cesarean delivery, without labor or rupture of membranes, and no clinical evidence of chorioamnionitis, were included. Data analysis was conducted from October 2022 to December 2023.
    UNASSIGNED: Early antibiotic exposure was defined as the total number of calendar days antibiotics were administered within the first week of life, which were further categorized as no exposure, 1 to 4 days of exposure, and 5 to 7 days of exposure.
    UNASSIGNED: The primary outcome was the composite of moderate to severe BPD or mortality at 36 weeks\' post menstrual age (PMA). Logistic regression was employed to assess factors associated with BPD or mortality using 2 different models.
    UNASSIGNED: Of the 27 176 VPIs included in the CHNN during the study period (14 874 male [54.7%] and 12 302 female [45.3%]), 6510 (23.9%; 3373 male [51.8%] and 3137 female [48.2.%]) were categorized as low risk for EOS. Among them, 1324 (20.3%) had no antibiotic exposure, 1134 (17.4%) received 1 to 4 days of antibiotics treatment, and 4052 (62.2%) received 5 to 7 days of antibiotics treatment. Of the 5186 VPIs who received antibiotics, 4098 (79.0%) received broad-spectrum antibiotics, 888 (17.1%) received narrow-spectrum antibiotics, and 200 (3.9%) received antifungals or other antibiotics. Prolonged exposure (5-7 days) was associated with increased likelihood of moderate to severe BPD or death (adjusted odds ratio [aOR], 1.23; 95% CI, 1.01-1.50). The use of broad-spectrum antibiotics (1-7 days) was also associated with a higher risk of moderate to severe BPD or death (aOR, 1.27; 95% CI, 1.04-1.55).
    UNASSIGNED: In this cohort study of VPIs at low risk for EOS, exposure to prolonged or broad-spectrum antibiotics was associated with increased risk of developing moderate to severe BPD or mortality. These findings suggest that VPIs exposed to prolonged or broad-spectrum antibiotics early in life should be monitored for adverse outcomes.
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  • 文章类型: Journal Article
    美国是发达国家中孕产妇死亡率最高的国家。疾病控制和预防中心认为几乎所有这些死亡都是可以预防的,尤其是那些归因于精神健康状况的人。美国医疗保健和社会服务系统之间的协调可以帮助进一步描述与围产期自杀死亡率相关的情况和风险。
    检查与围产期自杀相关的背景和个体诱发情况和风险。
    这项横断面观察性研究使用了融合的混合方法设计,以探索导致孕产妇自杀和未确定意图死亡的因素(以下简称,未确定的死亡)在2003年1月1日至2021年12月31日的国家暴力死亡报告系统(NVDRS)数据中确定。分析包括10至50岁的死者,怀孕或产后死亡(统称,围产期组)和人口统计上匹配的女性死者,他们在死亡时未怀孕或最近怀孕(非围生期组)。在2022年12月至2023年12月之间进行了分析。
    死亡时的妊娠状态(围产期或非围产期)。
    主要结果包括死因裁判官中提到的与自杀和未确定死亡有关的促成情况,验尸官,或执法案件叙述。该研究使用匹配分析检查了组间的数量差异,并使用定性内容分析表征了突出自杀情况的关键主题。
    这项研究包括在NVDRS中确定的1150个围产期死者:456(39.6%)在死亡时怀孕,203人(17.7%)在死亡后42天内怀孕,491人(42.7%)在死前43至365天内怀孕,产生694名产后死者。非围产期对照组包括17655名10至50岁的女性死者。围产期死者的平均年龄(SD)为29.1(7.4)岁,非围产期死者的平均年龄为35.8(10.8)岁。与匹配的非围生儿相比,围产期死者在以下确定的促成情况中的几率更高:亲密伴侣问题(IPP)(优势比[OR],1.45[95%CI,1.23-1.72]),最近的论点(或,1.33[95%CI,1.09-1.61]),情绪低落(或,1.39[95%CI,1.19-1.63]),药物滥用或其他滥用(OR,1.21[95%CI,1.03-1.42]),身体健康问题(或,1.37[95%CI,1.09-1.72]),以及家庭成员或朋友的死亡(或,1.47[95%CI,1.06-2.02])。定性分析的结果强调了心理健康的重要性,并确定了128名患有产后抑郁症的死者(12.4%)。
    这项研究提供了有关孕产妇自杀的复杂因素的见解,它强调了进一步研究以了解围产期心理健康的长期后果的机会。这些发现还强调了有针对性的循证干预措施和针对精神卫生的有效政策的必要性,物质使用,和IPP,以防止产妇自杀和改善产妇健康结果。
    UNASSIGNED: The US has the highest maternal mortality rate among developed countries. The Centers for Disease Control and Prevention deems nearly all of these deaths preventable, especially those attributable to mental health conditions. Coordination between US health care and social service systems could help further characterize circumstances and risks associated with perinatal suicide mortality.
    UNASSIGNED: To examine contextual and individual precipitating circumstances and risks associated with perinatal suicide.
    UNASSIGNED: This cross-sectional observational study used a convergent mixed methods design to explore factors contributing to maternal suicides and deaths of undetermined intent (hereinafter, undetermined deaths) identified in National Violent Death Reporting System (NVDRS) data for January 1, 2003, to December 31, 2021. Analyses included decedents who were aged 10 to 50 years and pregnant or post partum at death (collectively, the perinatal group) and demographically matched female decedents who were not pregnant or recently pregnant (nonperinatal group) at death. Analyses were performed between December 2022 and December 2023.
    UNASSIGNED: Pregnancy status at death (perinatal or nonperinatal).
    UNASSIGNED: The main outcomes included contributing circumstances associated with suicides and undetermined deaths cited in coroner, medical examiner, or law enforcement case narratives. The study examined quantitative differences between groups using a matched analysis and characterized key themes of salient suicide circumstances using qualitative content analysis.
    UNASSIGNED: This study included 1150 perinatal decedents identified in the NVDRS: 456 (39.6%) were pregnant at death, 203 (17.7%) were pregnant within 42 days of death, and 491 (42.7%) were pregnant within 43 to 365 days before death, yielding 694 postpartum decedents. The nonperinatal comparison group included 17 655 female decedents aged 10 to 50 years. The mean (SD) age was 29.1 (7.4) years for perinatal decedents and 35.8 (10.8) years for nonperinatal decedents. Compared with matched nonperinatal decedents, perinatal decedents had higher odds of the following identified contributing circumstances: intimate partner problems (IPPs) (odds ratio [OR], 1.45 [95% CI, 1.23-1.72]), recent argument (OR, 1.33 [95% CI, 1.09-1.61]), depressed mood (OR, 1.39 [95% CI, 1.19-1.63]), substance abuse or other abuse (OR, 1.21 [95% CI, 1.03-1.42]), physical health problems (OR, 1.37 [95% CI, 1.09-1.72]), and death of a family member or friend (OR, 1.47 [95% CI, 1.06-2.02]). The findings of the qualitative analysis emphasized the importance of mental health and identified 128 decedents (12.4%) with postpartum depression.
    UNASSIGNED: This study provides insights into complex factors surrounding maternal suicide, and it highlights opportunities for further research to understand long-term consequences of perinatal mental health. These findings also underscore the need for targeted evidence-based interventions and effective policies targeting mental health, substance use, and IPPs to prevent maternal suicide and enhance maternal health outcomes.
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  • 文章类型: Journal Article
    目标:此倾向评分匹配,多中心,进行了横断面研究,以检查各种修复方法对牙科诊所门诊患者的影响肯尼迪I类部分性脑萎缩症(KCIPE)对口腔功能减退,主观虚弱症状,与口腔健康相关的生活质量(QOL)。
    方法:将患者(n=348)分为以下三组进行分析:NT,在四个咬合支撑区提供颌间接触的自然牙列患者;RPD,接受可移动局部义齿的KCIPE患者;和ISFP,接受植入物支持的固定假体的KCIPE患者。记录参与者的基本特征,并进行口腔功能测试。通过问卷调查调查身体和口腔虚弱的主观症状。使用日本简短版本的口腔健康影响概况(OHIP-JP16)评估口腔健康相关的QOL。进行倾向评分匹配以调整可能影响每组口腔功能减退的患者背景因素。
    结果:与ISFP组相比,RPD组口腔卫生不良的发生率明显较高,降低了咬合力,咀嚼功能下降,吞咽功能和口腔功能减退下降;口腔功能减退的比值比为4.67。与ISFP组相比,RPD组有明显更大的身体虚弱和口腔虚弱的主观症状,以及更高的OHIP分数。
    结论:KCIPE的修复治疗影响口腔功能减退,主观虚弱症状,口腔诊所门诊患者与口腔健康相关的生活质量。
    OBJECTIVE: This propensity score matching, multicenter, cross-sectional study was performed to examine the effects of various prosthetic methods for dental clinic outpatients with Kennedy Class I partial edentulism (KCIPE) on oral hypofunction, subjective frailty symptoms, and oral health-related quality of life (QOL).
    METHODS: Patients (n = 348) were classified into the following three groups for analysis: NT, patients with natural dentition providing intermaxillary contact in four occlusal supporting zones; RPD, patients with KCIPE who received removable partial dentures; and ISFP, patients with KCIPE who received implant-supported fixed prostheses. Participants\' basic characteristics were recorded, and oral function tests were conducted. Subjective symptoms of physical and oral frailty were investigated via questionnaire. Oral health-related QOL was assessed using the Japanese short version of the Oral Health Impact Profile (OHIP-JP16). Propensity score matching was performed to adjust for patient background factors that could influence oral hypofunction in each group.
    RESULTS: Compared with the ISFP group, the RPD group had significantly higher rates of poor oral hygiene, reduced occlusal force, decreased masticatory function, and declines in swallowing function and oral hypofunction; the odds ratio for oral hypofunction was 4.67. Compared with the ISFP group, the RPD group had significantly greater subjective symptoms of physical frailty and oral frailty, as well as higher OHIP scores.
    CONCLUSIONS: Prosthetic treatment of KCIPE affected oral hypofunction, subjective frailty symptoms, and oral health-related QOL in dental clinic outpatients.
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  • 文章类型: English Abstract
    BACKGROUND: For a long time, chronic pruritus was considered difficult to treat. Modern therapy options and detailed guidelines have created new opportunities for patients to improve their quality of life. However, due to the complexity of the disease, the need for multimodal treatment remains.
    OBJECTIVE: This article aims to investigate whether dermatological rehabilitation offers additional benefits to those affected and whether it should therefore be part of the treatment concept for chronic pruritus.
    METHODS: After introduction of the pruritus program of a rehabilitation clinic, a prospective study is presented that focuses on the patient-relevant benefits of therapy. It used standardized questionnaires to record pruritus intensity, the presence of depression, anxiety, itch-related limitations, and quality of life in patients with chronic pruritus before and after rehabilitation.
    RESULTS: Of the patients surveyed, 91.7% achieved a patient-relevant benefit through rehabilitation. Pruritus intensity, depression, anxiety, itch-related limitations, and restrictions on quality of life decreased significantly. Almost half of all participating patients had been initially diagnosed more than 10 years ago.
    CONCLUSIONS: Dermatological rehabilitation with a multimodal concept for the treatment of chronic pruritus can help affected patients and should be part of the therapy concept. This should be done as early as possible before the disease progresses over a long period of time and makes treatment more difficult.
    UNASSIGNED: HINTERGRUND: Chronischer Pruritus galt lange Zeit als schwer therapierbar. Durch moderne Therapieoptionen und eine ausführliche Leitlinie wurden für die Patienten neue Möglichkeiten geschaffen, ihre Lebensqualität zu verbessern. Es bleibt allerdings durch die Komplexität der Erkrankung die Notwendigkeit einer multimodalen Behandlung.
    UNASSIGNED: In diesem Beitrag soll untersucht werden, ob eine dermatologische Rehabilitation den Betroffenen einen zusätzlichen Nutzen bietet und somit ein Bestandteil im Therapiekonzept des chronischen Pruritus sein sollte.
    METHODS: Nach einem Einblick in das Pruritus-Programm einer Rehabilitationsklinik folgt die Vorstellung einer prospektiven Studie, die den patientenrelevanten Nutzen der Therapie in den Mittelpunkt rückt. Diese erfasste anhand von standardisierten Fragebögen die Pruritusintensität, das Vorliegen von Depression, Angst, Pruritus-bezogene Einschränkungen und Lebensqualität bei Patienten mit chronischem Pruritus vor und nach der Rehabilitation.
    UNASSIGNED: Es erreichten 91,7 % der befragten Patienten durch die Rehabilitation einen patientenrelevanten Nutzen. Die Scores für die Pruritusintensität, das Vorliegen von Depression, Angst, Pruritus-bezogenen Einschränkungen und Einschränkungen der Lebensqualität sanken signifikant. Fast die Hälfte aller teilnehmenden Patienten hatte zuvor einen mehr als 10 Jahre dauernden Krankheitsverlauf.
    UNASSIGNED: Eine dermatologische Rehabilitation mit einem multimodalen Konzept zur Therapie des chronischen Pruritus kann den betroffenen Patienten helfen und sollte beim Erstellen eines Therapiekonzeptes einen festen Stellenwert haben. Dies soll möglichst frühzeitig geschehen, noch bevor sich die Erkrankung durch einen langen Verlauf aggraviert und dadurch die Therapie erschwert.
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  • 文章类型: Journal Article
    胶质瘤是颅内最常见的原发性肿瘤,死亡率高,预后差。目的探讨NID2基因单核苷酸多态性(SNPs)对胶质瘤发病风险及预后的影响。通过AgenaMassARRAY质谱仪成功对529例神经胶质瘤患者和478例健康对照中的NID2的四个候选SNP进行了基因分型。使用Logistic回归评估不同遗传模型下NID2SNP与神经胶质瘤风险之间的关联。此外,通过Kaplan-Meier(KM)生存曲线和Cox比例风险回归分析,探讨NID2中风险相关SNPs与胶质瘤患者预后的关系.结果显示,rs11846847(OR1.24,p=0.017)和rs1874569(OR1.22,p=0.026)与胶质瘤风险增加显著相关,rs11846847对≤40岁参与者的神经胶质瘤也有增加风险的作用.rs11846847和rs1874569的交互作用模型更适合预测胶质瘤的发病风险。我们还发现rs1874569与神经胶质瘤患者的不良预后之间存在显着关联(HR1.32,p=0.039),尤其是CC基因型与高患者的总生存期(OS)和无进展生存期(PFS)相关。此外,研究表明,在中国汉族人群中,大体全切除或化疗可改善胶质瘤预后。本研究首次为NID2SNPs与神经胶质瘤风险和预后的相关性提供了证据,提示NID2变异可能是神经胶质瘤的潜在因素。
    Glioma is the most common primary intracranial tumor with high mortality and poor prognosis. The purpose of this study was to investigate how single-nucleotide polymorphisms (SNPs) of the NID2 gene affect glioma risk and prognosis. Four candidate SNPs of NID2 in 529 glioma patients and 478 healthy controls were successfully genotyped by Agena MassARRAY mass spectrometer. Logistic regression was utilized to assess the associations between NID2 SNPs and glioma risk under different genetic models. Furthermore, the relationship between risk-related SNPs in NID2 and the prognosis of glioma patients was explored through Kaplan-Meier (KM) survival curve and Cox proportional hazard regression analysis. The results showed that rs11846847 (OR 1.24, p = 0.017) and rs1874569 (OR 1.22, p = 0.026) were significantly associated with an increased risk of glioma, and rs11846847 also had a risk-increasing effect on glioma in participants ≤ 40 years old. The interaction model of rs11846847 and rs1874569 could be more suitable for forecasting glioma risk. We also discovered a significant association between rs1874569 and poor prognosis in glioma patients (HR 1.32, p = 0.039) and especially CC genotype was relevant to shorter overall survival (OS) and progression-free survival (PFS) in patients with high-grade glioma. Additionally, the study demonstrated that gross total resection or chemotherapy improve glioma prognosis in the Chinese Han population. This study is the first to provide evidence for the association of NID2 SNPs with glioma risk and prognosis, suggesting that NID2 variants might be potential factors for glioma.
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  • 文章类型: Journal Article
    毒理学研究者联盟(ToxIC)是作为接受医学毒理学咨询的病例的前瞻性多中心注册表而启动的。现在,超过10万例,核心注册中心继续解决许多医学毒理学研究问题,并作为多个分注册中心的基础,包括北美蛇咬伤登记处和阿片类药物使用障碍子登记处。ToxIC还开发了一系列非注册项目,利用医疗毒理学医师现场主要调查人员通过急诊科招募患者,不管他们是否接受了医学毒理学咨询。这些研究包括FDA-ACMTCOVID-19有毒物质药物警戒项目,该研究确定了与COVID-19治疗相关的药物不良反应,Fentalog研究是对疑似阿片类药物过量病例的毒性监测研究,药物过量毒性监测报告计划,该计划登记疑似兴奋剂或阿片类药物过量病例,以及刚刚启动的纳洛酮药物过量逆转项目的真实世界检查。鉴于ToxIC在多中心研究方面的经验及其发达的基础设施,它处于有利地位,可以为医学毒理学界提供灵活的应对措施,以应对不断发展的毒理学威胁,药物和化学毒物监测,和其他重要的医学毒理学优先事项。
    The Toxicology Investigators Consortium (ToxIC) was launched as a prospective multi-center registry of cases who receive medical toxicology consultations. Now, with over 100,000 cases, the Core Registry continues to address many medical toxicology research questions and has served as the foundation for multiple sub-registries, including the North American Snakebite Registry and the Medications for Opioid Use Disorder sub-registry. ToxIC also has evolved a portfolio of non-registry-based projects utilizing medical toxicology physician site principal investigators who enroll patients through emergency departments, irrespective of whether they received a medical toxicology consultation. These studies include the FDA-ACMT COVID-19 ToxIC Pharmacovigilance Project, which identifies adverse drug reactions related to the treatment of COVID-19, the Fentalog Study a toxico-surveillance study of suspected opioid overdose cases, the Drug Overdose Toxico-Surveillance Reporting Program which enrolls either suspected stimulant or opioid overdose cases, and the just being launched Real-World Examination of Naloxone for Drug Overdose Reversal project. Given ToxIC\'s experience in multi-center studies and its well-developed infrastructure, it is well-positioned to provide a nimble response on the part of the medical toxicology community to addressing evolving toxicological threats, drug and chemical toxicosurveillance, and other important medical toxicology priorities.
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