The Association between Perceived Injustice Following Traumatic Injury and Its Impact on Pain-Related, Mental Health and Functional Health Outcomes: A Systematic Review

Background: There is growing evidence suggesting that those who suffer traumatic injury display high levels of perceived injustice which impedes their recovery, both physically and mentally. Aim: The aim of this systematic review was to examine the association between perceived injustice and pain-related, mental health and functional outcomes in patients who have suffered a traumatic injury. Methods: In May 2023, a systematic review of the literature was performed on the electronic databases of PubMed, Google Scholar, Embase, and the Cochrane Database of Systemic Reviews. Papers were collected and analysed as per PRISMA guidelines for systematic reviews. The outcomes of interest were pain intensity, pain interference, disability, depression, anxiety, and quality of life. The initial search identified 59 papers. Of these papers, five studies met the inclusion criteria and were subsequently analysed (N = 1172). Each of the papers was published in peer-reviewed journals in the English language. Individuals with pain or pathology prior to the trauma and those who were not hospitalised following the trauma were excluded from the study. Results: Of the papers reviewed, each study indicated significant associations between perceived injustice and pain, disability, depression, anxiety, post-traumatic stress disorder, as well as reduced return to work status. Conclusion: This systematic review investigated the relationship between perceived injustice and pain-related, mental health, and functional outcomes in trauma patients. The results highlight the negative role that perceived injustice has on recovery following traumatic injury. Further, it provokes the need for future research regarding the implementation of therapeutic interventions and the development of predictive models of injustice.

Exploring the association of paid sick leave with healthcare utilization and health outcomes in the United States:a rapid evidence review

Objective:Paid sick leave(PSL)laws mandate employers give workers paid time off when they are sick or injured.This current study aims to examine whether access to PSL is associated with healthcare utilization and health outcomes and to summarize the types of utilization and outcomes which have been reported to be associated with PSL.Methods:We conducted a rapid evidence review.Our search of seven databases,including Medline,Embase,PsycINFO,Cochrane Library,CINAHL,Scopus,and JSTOR,on September 21,2020,identified 757 studies,30 of which were retained.Results:Previous evidence is mostly provided by cross-sectional studies with survey data.In this study,evidence suggests that PSL is significantly associated with some types of healthcare utilization and health outcomes.In terms of healthcare utilization,findings indicate PSL is associated with an increase in the use of some preventive sendees and a decrease in the use of emergency care;while findings are mixed regarding associations of PSL with health provider visits and the use of mammograms and pap smears.As for health outcomes,findings suggest PSL is associated with improved mental and self-rated health,decreased incidence of influenza-like illness,and lower occupational injuries and mortality rates.Conclusion:PSL may be an effective tool in improving some healthcare utilization and health outcomes.Future research could help identify mechanisms through which PSL access works and identify what policy components lead to better outcomes.

Literature review and analysis of the development of health outcomes assessment instruments in Chinese medicine

OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure Database, Chongqing VIP Database and WANFANG Data was conducted. The studies that met the inclusion and exclusion criteria were used to extract information according to a predesigned assessment instrument. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine were identified. Of these questionnaires, 7 were generic, 12 were condition-specific and 78 were disease-specific. All instruments were suitable for adults, children, and both men and women. These instruments aimed to evaluate the health-related quality of life, signs and symptoms as well as patient satisfaction and doctor-reported outcome. However, the descriptions were poorly constructed for some of the most basic parameters, such as the domains and items, administrative mode, response options, memory recall periods, burden evaluation, format, copyright, content validity, and other properties. CONCLUSION： The instrument development for health outcomes assessment in Chinese medicine is increasing rapidly; however, there are many limitations in current methodologies and standards, and further studies are needed.

Handgrip strength and health outcomes: Umbrella review of systematic reviews with meta-analyses of observational studies

Purpose:The aim of the present study was to assess both the credibility and strength of evidence arising from systematic reviews with meta-analyses of observational studies on handgrip strength and health outcomes.Methods:An umbrella review of systematic reviews with meta-analyses of observational studies was conducted.We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p values,95%prediction intervals,heterogeneity,small-study effects,and excess significance.We graded the evidence from convincing(Class I)to weak(Class IV).Results:From 504 articles returned in a search of the literature,8 systematic reviews were included in our review,with a total of 11 outcomes.Overall,nine of the 11 of the outcomes reported nominally significant summary results(p<0.05),with 4 associations surviving the application of the more stringent p value(p<106).No outcome presented convincing evidence.Three associations showed Class II evidence(i.e.,highly suggestive):(1)higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population(n=34 studies;sample size=1,855,817;relative risk=0.72,95%confidence interval(95%CI):0.670.78),(2)cardiovascular death risk in mixed populations(n=15 studies;relative risk=0.84,95%CI:0.780.91),and(3)incidence of disability(n=7 studies;relative risk=0.76,95%CI:0.660.87).Conclusion:The present results show that handgrip strength is a useful indicator for general health status and specifically for early all-cause and cardiovascular mortality,as well as disability.To further inform intervention strategies,future research is now required to fully understand mechanisms linking handgrip strength scores to these health outcomes.

Oral Contraceptives and Health Outcomes:an Umbrella Review of Systematic Reviews and Meta-analyses in Women and Offspring

Aim We herein provide an umbrella review of systematic reviews(SR)and meta-analyses(MAs)of studies of the association of oral contraceptives(OCs)with the risks of multiple health outcomes in women and their descendants.Methods Two investigators retrieved publications from four electronic databases,including PubMed,Embase,Web of Science,and the Cochrane Database of Systematic Reviews up to March 15,2021.For each association,random/fixed-effects summary effect size and 95%CIs were estimated.Heterogeneity and publication bias were also assessed.The method quality and evidence level for each publication were respectively assessed utilizing the AMSTAR and GRADE checklists.Results A total of 68 articles with 82 unique outcomes were included based on the eligibility criteria.Numerous lines of evidence indicated that OCs had effects on nearly all cardiovascular disease-related outcomes,especially for cerebral venous sinus thrombosis(OR=7.59,95%CI:3.82-15.09).Harmful associations were also found for vulvar vestibulitis(OR=2.31,95%CI:1.03-5.16),preterm birth(OR=1.17,95%CI:1.07-1.27),miscarriage(OR=1.13,95%CI:1.02-1.72),ulcerative colitis(OR=1.22,95%CI:1.06-1.41),Crohn's disease(OR=1.24,95%CI:1.09-1.40),alveolar osteitis(RR=1.86,95%CI:1.66-2.08),dry socket(RR=1.8,95%CI:1.33-2.43),and interstitial cystitis(OR=2.1,95%CI:1.26-3.49).However,oral contraceptives did not increase the risk of cancer except breast and cervical cancer.Maternal exposure to OCs was linked to an increased risk for the development of respiratory atopic disorders such as asthma(OR=1.1,95%CI:1.02-1.19)and rhinitis(OR=1.34,95%CI:1.07-1.68).Conclusion In summary,although their use obviously reduces the risk of pregnancy-and parturition-related morbidity and mortality for women,OCs were frequently related to more harm than benefit in terms of other health outcomes.This was true for both women and their descendants in this umbrella review.More large-scale prospective studies analysing different doses,structures,and durations of treatment with estrogen and progestin are needed to confirm these effects.

Associations between the use of red yeast rice preparations and adverse health outcomes:An umbrella review of meta-analyses of randomized controlled trials

Background:Red yeast rice(RYR),a natural lipid-lowering agent,is widely used in clinical practice.However,the existing meta-analyses concerning the safety of RYR preparations have yielded inconsistent results,and the credibility of the evidence has not been quantified.Objective:This study was designed to evaluate the existing evidence and offer a comprehensive understanding of the associations between the use of RYR preparations and various adverse health outcomes.Search strategy:Seven literature databases were searched from inception to May 5,2023,using medical subject headings and free-text terms(e.g.,“red yeast rice,”“Xuezhikang,”and“Zhibitai”).Inclusion criteria:Meta-analyses that investigated and quantitatively estimated associations between the use of RYR preparations and adverse health outcomes were included in this study.Data extraction and analysis:Two researchers independently extracted data using a standardized data collection table;any disagreements were resolved by consulting a third researcher.Based on the participant,intervention,comparator and outcome(PICO)framework in each eligible meta-analysis,a series of unique associations between the use of RYR preparations and adverse health outcomes were determined.The associations’effect estimates were re-evaluated using random-effect models.Results:Fifteen meta-analyses,comprising 186(164 unique)randomized controlled trials,were identified.Based on A Mea Surement Tool to Assess Systematic Reviews version 2,3(20%)and 12(80%)of these meta-analyses had low and critically low confidence,respectively.A total of 61 unique associations between the use of RYR preparations and adverse health outcomes were extracted from eligible metaanalyses.Based on the random-effect models,10(16.4%)associations indicated a significant protective effect of RYR preparations against adverse health outcomes,while 5(8.2%)indicated an increased risk of adverse health outcomes related to uric acid,alanine transaminase and aspartate transaminase levels.The other 46(75.4%)associations showed no significant difference between the use of RYR preparations and control treatments.Regarding the credibility of the evidence,21(34.4%),34(55.7%)and 6(9.8%)associations showed moderate,low and very low credibility,respectively.Conclusion:The evidence examined in this study suggests that RYR preparations are safe;however,the credibility of the evidence was not high.Further high-quality evidence is required.

Impact of payment source, referral site, and place of residence on outcomes after allogeneic transplantation in Mexico

BACKGROUND The impact of social determinants of health in allogeneic transplant recipients in low-and middle-income countries is poorly described.This observational study analyzes the impact of place of residence,referring institution,and transplant cost coverage(out-of-pocket vs government-funded vs private insurance)on outcomes after allogeneic hematopoietic stem cell transplantation(alloHSCT)in two of Mexico's largest public and private institutions.AIM To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico.METHODS In this retrospective cohort study,we included adolescents and adults≥16 years who received a matched sibling or haploidentical transplant from 2015-2022.Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico.Three payment groups were compared:Out-of-pocket(OOP),private insurance,and a federal Universal healthcare program“Seguro Popular”.Outcomes were compared between referred and institution-diagnosed patients,and between residents of Nuevo Leon and out-of-state.Primary outcomes included overall survival(OS),categorized by residence,referral,and payment source.Secondary outcomes encompassed early mortality,event-free-survival,graft-versus-host-relapse-free survival,and non-relapse-mortality(NRM).Statistical analyses employed appropriate tests,Kaplan-Meier method,and Cox proportional hazard regression modeling.Statistical software included SPSS and R with tidycmprsk library.RESULTS Our primary outcome was overall survival.We included 287 patients,n=164 who lived out of state(57.1%),and n=129 referred from another institution(44.9%).The most frequent payment source was OOP(n=139,48.4%),followed by private insurance(n=75,26.1%)and universal coverage(n=73,25.4%).No differences in OS,event-free-survival,NRM,or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution,nor patients who lived in-state vs out-of-state.Patients who covered transplant costs through private insurance had the best outcomes with improved OS(median not reached)and 2-year cumulative incidence of NRM of 14%than patients who covered costs OOP(Median OS and 2-year NRM of 32%)or through a universal healthcare program active during the study period(OS and 2-year NRM of 19%)(P=0.024 and P=0.002,respectively).In a multivariate analysis,payment source and disease risk index were the only factors associated with overall survival.CONCLUSION In this Latin-American multicenter study,the site of residence or referral for alloHSCT did not impact outcomes.However,access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.

Serum zinc levels and multiple health outcomes: Implications for zinc-based biomaterials

Background:Zinc-based biomaterials,including biodegradable metal,nanoparticles,and coatings used in medical implants release zinc ions that may increase the whole-body and serum zinc concentrations.The impact of serum zinc concentrations on major health outcomes can provide insights for device design and clinical transformation of zinc-based biomaterials.Methods:This nationally representative cross-sectional study enrolled participants from the National Health and Nutrition Examination Survey(NHANES,2011-2014)including 3607 participants.Using unadjusted and multivariate-adjusted logistic regression analyses,two-piecewise linear regression model with a smoothing function and threshold level analysis,we evaluated the associations between elevated serum zinc levels and major health outcomes.Results:Elevated serum zinc levels were significantly associated with an increase in total spine and total femur bone mineral density(BMD).Every 10μg/dL increase was associated with a 1.12-fold increase in diabetes mellitus(DM)and 1.23-fold and 1.29-fold increase in cardiovascular diseases(CVD)and coronary heart disease(CHD),in participants with serum zinc levels≥100μg/dL.It had no significant linear or nonlinear associations with risk of fractures,congestive heart failure,heart attack,thyroid disease,arthritis,osteoarthritis,rheumatoid arthritis,dyslipidemia and cancer.Conclusion:Serum zinc levels are significantly associated with increased BMD in the total spine and total femur,and risk of DM,and CVD/CHD among participants with serum zinc levels≥100μg/dL.

Distinct gut microbiota and health outcomes in asymptomatic infection,viral nucleic acid test re-positive,and convalescent COVID-19 cases

Gut microbiota composition is suggested to associate with coronavirus disease 2019(COVID-19)severity,but the impact of gut microbiota on health outcomes is largely unclear.We recruited 81 individuals from Wuhan,China,including 13 asymptomatic infection cases(Group A),24 COVID-19 convalescents with adverse outcomes(Group C),31 severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)re-positive cases(Group D),and 13 non-COVID-19 healthy controls(Group H).The microbial features of Groups A and D were similar and exhibited higher gut microbial diversity and more abundant short-chain fatty acid(SCFA)-producing species than Group C.Group C was enriched with opportunistic pathogens and virulence factors related to adhesion and toxin production.The abundance of SCFA-producing species was negatively correlated,while Escherichia coli was positively correlated with adverse outcomes.All three groups(A,C,and D)were enriched with the mucusdegrading species Akkermansia muciniphila,but decreased with Bacteroides-encoded carbohydrate-active enzymes.The pathways of vitamin B6 metabolic and folate biosynthesis were decreased,while selenocompound metabolism was increased in the three groups.Specifically,the secondary bile acid(BA)metabolic pathway was enriched in Group A.Antibiotic resistance genes were common among the three groups.Conclusively,the gut microbiota was related to the health outcomes of COVID-19.Dietary supplementations(SCFAs,BA,selenium,folate,vitamin B6)may be beneficial to COVID-19 patients.

Self-reported physical functioning,cardiometabolic health conditions, and healthcare utilization patterns in Million Veteran Program enrollees with Traumatic Brain Injury Screening and Evaluation Program data

Background Examining the health outcomes of veterans who have completed the United States Veterans Health Administration’s(VHA’s)Traumatic Brain Injury(TBI)Screening and Evaluation Program may aid in the refinement and improvement of clinical care initiatives within the VHA.This study compared self-reported physical functioning,cardiometabolic health conditions,and health care utilization patterns in Million Veteran Program enrollees with TBI Screening and Evaluation Program data(collected between 2007 and 2019),with the goal of enhancing understanding of potentially modifiable health conditions in this population.Methods In this observational cohort study,veterans(n=16,452)were grouped based on the diagnostic outcome of the TBI Screening and Evaluation Program:1)negative TBI screen(Screen^(-));2)positive TBI screen but no confirmed TBI diagnosis[Screen^(+)/Comprehensive TBI Evaluation(CTBIE)^(-)];or 3)positive TBI screen and confirmed TBI diagnosis(Screen^(+)/CTBIE^(+)).Chi-square tests and analysis of covariance were used to explore group differences in physical functioning,cardiometabolic health conditions,and health care utilization patterns,and logistic regressions were used to examine predictors of Screen^(+/-)and CTBIE^(+/-)group status.Results The results showed that veterans in the Screen^(+)/CTBIE^(-)and Screen^(+)/CTBIE^(+)groups generally reported poorer levels of physical functioning(P’s<0.001,np2=0.02 to 0.03),higher rates of cardiometabolic health conditions(P’s<0.001,φ=0.14 to 0.52),and increased health care utilization(P’s<0.001,φ=0.14 to>0.5)compared with the Screen-group;however,health outcomes were generally comparable between the Screen^(+)/CTBIE^(-)and Screen^(+)/CTBIE^(+)groups.Follow-up analyses confirmed that while physical functioning,hypertension,stroke,healthcare utilization,and prescription medication use reliably distinguished between the Screen-and Screen^(+)groups(P’s<0.02,OR’s 0.78 to 3.38),only physical functioning distinguished between the Screen^(+)/CTBIE^(-)and Screen^(+)/CTBIE^(+)groups(P<0.001,OR 0.99).Conclusions The findings suggest that veterans who screen positive for TBI,regardless of whether they are ultimately diagnosed with TBI,are at greater risk for negative health outcomes,signifying that these veterans represent a vulnerable group that may benefit from increased clinical care and prevention efforts.

Maternal perceived self-efficacy, perceived vulnerability and child health outcome in Ibadan, South-West Nigeria

Objective:The problems associated with child health continue to constitute a global concern,and child morbidity and mortality remain problematic in Sub-Sahara Africa(SSA).Utilizing a community-based survey conducted in Ibadan North Local government,Southwest Nigeria the study examined the influences of maternal perceived self-efficacy(MPSE)and maternal perceived vulnerability(MPV)on child health outcomes(CHO).Methods:The study appraised data from 683 nursing mothers aged 15-45 obtained from 20 major primary healthcare centers in the region undergoing routine health checks for their children.Three regression models were fitted to examine the effects of MPV,MPSE,and confounding variables of maternal preventive actions such as insecticide-treated nets(ITN)usage and child immunization,among other maternal and child sociodemographic attributes on CHO.Results:The study finds that MPV has no correlation with CHO and MPSE but positively correlates with maternal age(r=0.123,P<0.05).However,CHO has a negative correlation with MPSE(r=-0.200,P<0.05)while positively correlated with child age(r=0.134,P<0.05).MPSE has a unique effect on CHO(β=-0.203,P<0.05),maternal preventive action of ITN usage show a positive association with CHO in the study Model 2(β=-0.163,P<0.05),while in Model 3,child's age has a positive association with CHO(β=0.180,P<0.05).The net effect of the study models accounted for approximately 10%of the variance in CHO reported among the children.Conclusion:Overall,MPSE and ITN usage are essential factors for understanding and reducing the potential adverse CHO.Global effort must continue to improve maternal education to support child health and preventive carepractices in SSA.

Health Disparities among the Western, Central and Eastern Rural Regions of China after a Decade of Health Promotion and Disease Prevention Programming

Summary： Health disparities between the western, central and eastern regions of rural China, and the impact of national health improvement policies and programming were assessed. A total of 400 counties were randomly sampled. ANOVA and Logistic regression modeling were employed to estimate differ- ences in health outcomes and determinants. Significant differences were found between the western, central and eastern rural regions in community infrastructure and health outcomes. From 2000 to 2010, health indicators in rural China were improved significantly, and the infant mortality rate （IMR）, mater- nal mortality rate （MMR） and under 5 mortality rate （U5MR） had fallen by 62.79%, 71.74% and 61.92%, respectively. Central rural China had the greatest decrease in IMR （65.05%）; whereas, western rural China had the greatest reduction in MMR （72.99%） but smallest reduction in U5MR （57.36%）. Despite these improvements, Logistic regression analysis showed regional differences in key health outcome indicators （odds ratios）： IMR （central： 2.13; western： 5.31）, U5MR （central： 2.25; western： 5.69）, MMR （central： 1.94; western： 3.31）, and prevalence of infectious diseases （central： 1.62; western： 3.58）. The community infrastructure and health outcomes of the western and central rural regions of China have been improved markedly during the first decade of the 21st century. However, health dis- parities still exist across the three regions. National efforts to increase per capita income, community empowerment and mobilization, community infrastructure, capacity of rural health facilities, and health literacy would be effective policy options to attain health equity.

Contributions of Primary Health Care and Next Step Considerations: A Systematic Review

The essential consideration is the cornerstone of a solid medical care system that provides outstanding health outcomes at a low cost. Medical therapy has evolved over the previous century from concentrating on random etiologies to lifestyle, race, and environmental factors. The aim behind these changes is to serve the public health requirements by delivering frequent and easy services based on the individual, couple, or family. Accurate evaluation of the magnitude by which primary health care contributes to the health care system is essential to the improvement of these contributions and determining next step considerations. The number one factor has been associated with greater access to medical care, better health outcomes, and reduced hospitalization and ER (emergency room) visits. The number one consideration may also help balance the adverse effects of poor financial situations on well-being. Therefore, we need more primary care doctors in the US. Research is also necessary to understand which essential consideration models provide acceptable health results.

Literature review and analysis of the application of health outcome assessment instruments in Chinese medicine

OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China National Knowledge Infrastructure databases was conducted. The resulting articles that met the defined inclusion and exclusion criteria were used for analysis. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine have been used in fundamental and theoretical research, and 14 of these were also used in 29 clinical trials that were randomized controlled trials, or descriptive or cross-sectional studies. In 2 152 Chinese medicine-based studies that used instruments in their methodology, more than 150 questionnaires were identified. Among the identified questionnaires, 51 were used in more than 10 articles （0.5%）. Most of these instruments were developed in Western countries and few studies （4%） used the instrument as the primary evidence for their conclusions. CONCLUSION： Usage of instruments for health outcome assessment in Chinese medicine is increasing rapidly; however, current limitations include selection rationale, result interpretation and standardization, which must be addressed accordingly.

Improved survival at the cost of more chronic lung disease?Current management and outcomes in extremely preterm infants born in New South Wales and the Australian Capital Territory:2010-2020

Background Since 2010,most tertiary care hospitals in Australia have changed how they care for extremely premature infants.However,in-hospital and longer-term outcome data have suggested unchanged or even worse health outcomes in later epochs,especially respiratory outcomes.This study examined the trend in outcomes since these changes were introduced,particularly the prevalence of chronic neonatal lung disease(CLD).Methods This is a retrospective cross-sectional analysis of data from the Neonatal Intensive Care Units'(NICUS)database of all perinatal intensive care units in New South Wales and the Australian Capital Territory,including infants born at≥24 and≤28 weeks of gestational age in tertiary perinatal units between January 1,2010,and December 31,2020.Temporal trends and changes in primary outcome were examined by linear and adjusted multivariable logistic regression models.Results This study included 3258 infants.We saw significant changes in antenatal magnesium sulfate(75% increase),delayed cord clamping(66% increase),delivery room intubations(30% decrease),any time(20% decrease),duration on mechanical ventilation(100-hour decrease),and hours on noninvasive ventilation(200-hour increase).Mortality decreased from 17% to 6%.The incidence of CLD increased significantly even when adjusted for confounders(15% increase).Any time and mean hours spent on mechanical ventilation significantly increased the odds of CLD.This study could not find a significant association of any of the protective antenatal treatments on CLD.Conclusions The last decade saw a significant improvement in survival and survival to discharge without major morbidity.There was increased use of magnesium sulfate,delayed cord clamping,and less invasive respiratory management of extremely preterm infants.The avoidance of mechanical ventilation may impact the incidence of CLD.

China's Oral Care System in Transition:Lessons to be Learned from Germany

Aim The objective of this discussion paper is to investigate whether the experience gained through the German paradigm shift in dental care can be of benefit in China＇s deliberations on the introduction of universal dental care for its people. Methodology A comparison of representative oral health outcome data from China and Germany, two countries at different stages in their development, is presented here in order to analyse whether the findings meet expected outcome and confirm the presumption that more developed countries perform better. Results The epidemiological comparison reveals surprising findings concerning the severity of dental diseases and, in particular, missing teeth per person in adults and rates of total edentulousness in seniors. In all of these areas German adults and seniors show significantly inferior outcomes compared with the Chinese population. The mainreason for these striking discrepancies, as it turned out, is the decisive role played by the treatment philosophies and strategies of German dentists. Conelusion and recommendations If dentists take a less interventionist approach, checking as well as treating dental diseases with preventive and strictly tooth-preserving methods, dental treatment results in oral health. Under these condi- tions it can be assumed that modem dentistry is generally good for the teeth. These findings are important for developing countries that are seeking to integrate dental care into their health care system. On the basis of long-term experience from highly industrialized Western countries and especially from Germany we will attempt to put forward proposals for creating an effective and efficient dental care system in China.

Improving outcomes in patients with heart failure:The contribution of cardiovascular specialist nurses

Background Heart failure(HF)is a chronic,impactful condition on individuals and healthcare systems,requiring management that goes beyond inpatient care.This study investigated the impact of cardiovascular specialist nurses on long-term health outcomes and patient satisfaction in HF outpatient care.Methods In a year-long observational study from July 2021 to July 2022,230 HF patients at our hospital were divided into an experimental group(n=115)receiving care from cardiovascular specialist nurses and a control group(n=115)managed by general nursing staff.The interventions included comprehensive care such as patient education,medication management,lifestyle guidance,symptom monitoring,and psychological support.The major adverse cardiovascular events(MACEs)and rehospitalization rates were applied as the primary endpoints.Results The experimental group demonstrated significantly fewer MACEs and lower rehospitalization rates compared to the control group(P<0.001).Higher patient satisfaction was observed in the experimental group,with 81.7%reporting high satisfaction vs.53.9%in the control group(P<0.001).Differences in incidence of myocardial infarction and death rates between the groups were not statistically significant.Conclusions The involvement of cardiovascular specialist nurses in HF outpatient care significantly enhances clinical outcomes and patient satisfaction.These nurses play a key role in bridging the transition from hospital to home care,improving adherence to treatment regimens,and reducing healthcare system burdens.

Long-term outcomes of combined chemotherapy in chronic refractory idiopathic thrombocytopenic purpura

Adult idiopathic thrombocytopenic purpura （ITP） is a .chronic acquired organ-specific autoimmune hemorrhagic disease characterized by the production of auto-antibodies against antigens on the membranes of platelet, resulting in enhanced Fc-mediated destruction of the platelets by macrophages in the reticuloendothelial 1-3 system. Splenectomy remains the best treatment of chronic ITP, but approximately 30% of patients do not respond or relapse after surgery;4-6 these patients are defined as patients with chronic refractory ITE There is no consensus on an appropriate sequence of treatments for patients with chronic refractory ITE79 Management of these patients remains a dilemma. We have treated 31 patients with chronic refractory ITP using low dose combination chemotherapy between 1994 and 2005, and the results are presented as follows.

Clinical outcomes after autologous haematopoietic stem cell transplantation in patients with progressive multiple sclerosis

Background Multiple sclerosis （MS） is a continuously disabling disease and it is unresponsive to high dose steroid and immunomodulation with disease progression. The autologous haematopoietic stem cell transplantation （ASCT） has been introduced in the treatment of refractory forms of multiple sclerosis. In this study, the clinical outcomes followed by ASCT were evaluated for patients with progressive MS. Methods Twenty-two patients with secondary progressive MS were treated with ASCT. Peripheral blood stem cells were obtained by leukapheresis after mobilization with granulocyte colony stimulating factor. Etoposide, melphalan, carmustin and cytosine arabinoside were administered as conditioning regimen. Outcomes were evaluated by the expanded disability status scale and progression free survival. No maintenance treatment was administered during a median follow-up of 39 months （range, 6 to 59 months）. Results No death occurred following the treatment. The overall confirmed progression free survival rate was 77% up to 59 months after transplantation which was significantly higher compared with pre-transplantation （P=0.000）. Thirteen patients （59%） had remarkable improvement in neurological manifestations, four （18%） stabilized their disability status and five （23%） showed clinical recurrence of active symptoms. Conclusions ASCT as a therapy is safe and available. It can improve or stabilize neurological manifestations in most patients with progressive MS following failure of conventional therapy.

Comparing outcomes from the two most recognized acupuncturist workforce surveys

OBJECTIVE： To determine the informational consistency produced by the two most recent independent surveys and draw a conclusion whether the data would be sufficient for the National Center for Health Workforce Analysis and Bureau of Labor and Statistics consideration. METHODS： This paper compares workforce outcomes collected by the two most prominent acupuncture entities that have produced the most useful acupuncturist workforce data （California Acupuncture Board 2015 Occupational Analysis and the National Certification Commission of Acupuncture and Oriental Medicine^2013 Job Analysis） at national and state levels. RESULTS： Findings based upon the most compatible survey questions showed the following： more than 70% of acupuncturists work fewer than 40 hours weekly; approximately 76% work in solo practice or in shared space with other acupuncturists; more than 70% of the national sample have been in practice 15 years or less; and median income is between $40 000 and $50 000. A preponderance of acupuncturists is less than 50 years of age, and fewer than 15% of all respondents have been in practice more than 20 years. CONCLUSION： Basic workforce information is a necessary precursor for conducting workforce projections. It is useful to track the expansion or contraction of any given profession. Tracking influences subsequent planning for the profession based upon reliable and valid information about its growth. The ability of the profession to collect its own workforce data is paramount to workforce projection models. Any future survey should be a shared project that follows guidelines supported by the National Center for Health Workforce Analysis.