Reliability of a computerized system for strabismus screening

AIM:To evaluate the reliability of Photo-Hirschberg screening for global strabismus performed by non-specialized personnel.METHODS:Participants at three sites were enrolled.One person at each site was trained in visual acuity measurement and use of the computerized system.Visual acuity was measured,and strabismus testing was performed using two flash photographs.All data from the three primary observers were sent to an experienced assistant researcher,who was blinded to the primary results,for re-evaluation.The primary and re-evaluation results of the Photo-Hirschberg screenings using weighted kappa for agreement were compared.RESULTS:The study included 181 participants(88 males and 93 females)and the results for primary and re-evaluation screenings were corresponded.Ten participants with contrasting results presented with unclear corneal light reflex.Sensitivity and specificity were 100%[95%confidence interval(CI):29.0%-100%]and 99.4%(95%CI:96.6%-100%),respectively,based on the Agresti test of the primary evaluation,considering the re-evaluated classification as true.CONCLUSION:The computerized system can be used for primary strabismus screening by non-specialized personnel,with 98.8%agreement with specialists.However,it cannot be used as a substitute for professional examination.

Prevalence and features of SARS-CoV-2 infection in prisons in Tuscany

BACKGROUND Prisons can be a reservoir for infectious diseases,including severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),due to the very intimate nature of the living spaces and the large number of people forced to share them.AIM To investigate the SARS-CoV-2 epidemiology in prisons,this study evaluated the infection incidence rate in prisoners who underwent nasopharyngeal swabs.METHODS This is an observational cohort study.Data collection included information on prisoners who underwent nasopharyngeal swab testing for SARS-CoV-2 and the results.Nasopharyngeal swab tests for SARS-CoV-2 were performed between 15 February 2021 and 31 May 2021 for prisoners with symptoms and all new arrivals to the facility.Another section included information on the diagnosis of the disease according to the International Classification of Diseases,Ninth Revision,and Clinical Modification.RESULTS Up until the 31 May 2021,79.2%of the prisoner cohort(n=1744)agreed to a nasopharyngeal swab test(n=1381).Of these,1288 were negative(93.3%)and 85 were positive(6.2%).A significant association[relative risk(RR)]was found only for the risk of SARS-CoV-2 infection among foreigners compared to Italians[RR=2.4,95%confidence interval(CI):1.2-4.8].A positive association with SARS-CoV-2 infection was also found for inmates with at least one nervous system disorder(RR=4,95%CI:1.8-9.1).The SARS-CoV-2 incidence rate among prisoners is significantly lower than in the general population in Tuscany(standardized incidence ratio 0.7,95%CI:0.6-0.9).CONCLUSION In the prisoner cohort,screening and rapid access to health care for the immigrant population were critical to limiting virus transmission and subsequent morbidity and mortality in this vulnerable population.

Are school uniforms associated with gender inequalities in physical activity? A pooled analysis of population-level data from 135 countries/regions

Purpose:It is aimed to assess whether school uniforms are associated with population-level gender inequalities in physical activity,and whether associations differ by school level,country/region income,and assessment method.Methods:An ecological study design was employed.We collected data about global uniform practices using an online survey.We searched for country/region-level estimates of school-aged youth meeting physical activity guidelines from international surveillance studies.Study selection was conducted in duplicate using a systematic process,and a random sample of all data was checked to ensure extraction and pooling processes were accurate.We calculated absolute and relative gender inequalities in physical activity for each country.Linear regression examined associations between country/region-level uniform practices(binary yes/no exposure variable) and country/region-level gender inequalities in physical activity guideline compliance(absolute and relative inequalities).We investigated moderation by school level,stratified analyses by income group,and repeated primary analyses using device-measured data.Results:Pooling data from 135 countries/regions(n=1,089,852),we found no association between population-level uniform practices and gender inequalities in physical activity across all ages(absolute:β=-0.2;95% confidence interval(95%CI):-1.7 to 1.3,p=0.74;relative:β=0.1;95%CI:-0.1 to 0.2,p=0.51).Subgroup analysis suggested a positive association in primary school settings(absolute:β=4.3;95%CI:-0.0 to 8.6,p=0.05).Among high-income countries,absolute inequalities were significantly greater in countries/regions with uniform practices(N=37) compared to those without(N=48)(9.1(SD=3.6) vs.7.8 percentage points(SD=4.3)).Repeating analyses using device-measured data(n=32,130;N=24) did not alter our primary finding.From initial descriptive statistics,we found that in countries/regions where a maj ority of schools(>50%) reportedly use uniforms,there was lower compliance with physical activity guidelines among all genders(median:16.0%,interquartile range:13.2%-19.9%,N=103) compared to generally non-uniform countries/regions(median:19.5%,interquartile range:16.4%-23.5 %,N=32)(z=3.04,p=0.002).(N=countries,regions and studies repre sented;n=sample size or participants included).Conclusion:School uniforms are associated with greater gender inequalities in physical activity in primary school settings and in high-income countries.Our population-level findings warrant testing using individual-level data across contexts.

Coverage and Factors Associated with Acceptance and Satisfaction of Seasonal Malaria Chemoprevention in Six Health Zones in Benin

Introduction: Seasonal malaria chemoprevention (SMC) was adopted in 2019 in two health zones in Benin where malaria transmission is very high. Positive results led to the extension of the intervention to other zones with additional financial support. Annual SMC campaigns from 2021 to 2023 were carried out in all six health zones in the Atacora and Alibori departments. In five years of implementation, various approaches have been developed on the basis of a communication plan facilitating buy-in and acceptance by all stakeholders. The aim of this study was to assess the effective coverage and acceptance of the SMC by their beneficiary populations in 2023. Methods: It was a cross-sectional study with an analytical focus. Data collection took place from November 30 to December 13, 2023. The study population consisted of children under 5 years of age residing in the departments of Atacora and Alibori in northern Benin. A total of 3573 children under 5 years of age were included in the study, and their parents or guardians were interviewed. Results: During the 2023 campaign, 87.7% of targets were reached by SMC administration and 100.00% of children had received at least one dose of SMC by the fourth visit. Effective therapeutic coverage of SMC was 70.55%, with 99.60% in BNK, 69.40% in KGS, 16.20% in MK, 56.10% in 2KP, 92.40% in NBT and 89.60% in TMC. This coverage was statistically related to child and respondent ages (p Conclusion: SMC is a strategy accepted by the population, and the main reasons for non-participation in SMC were dominated by the absence of mothers or babysitters when the agents visited.

Psychiatric comorbidities in epilepsy:population co-occurrence,genetic correlations and causal effects

Background Psychiatric comorbidities are common in patients with epilepsy.Reasons for the co-occurrence of psychiatric conditions and epilepsy remain poorly understood.Aim We aimed to triangulate the relationship between epilepsy and psychiatric conditions to determine the extent and possible origins of these conditions.Methods Using nationwide Swedish health registries,we quantified the lifetime prevalence of psychiatric disorders in patients with epilepsy.We then used summarydata from genome-wide association studies to investigate whether the identified observational associations could be attributed to a shared underlying genetic aetiology using cross-trait linkage disequilibrium score regression.Finally,we assessed the potential bidirectional relationships using two-sample Mendelian randomisation.Results In a cohort of 7628495 individuals,we found that almost half of the 94435 individuals diagnosed with epilepsy were also diagnosed with a psychiatric condition in their lifetime(adjusted lifetime prevalence,44.09%;95%confidence interval(Cl)43.78%to 44.39%).We found evidence for a genetic correlation between epilepsy and some neurodevelopmental and psychiatric conditions.For example,we observed a genetic correlation between epilepsy and attention-deficit/hyperactivity disorder(r,=0.18,95%Cl 0.09 to 0.27,p<0.001)—a correlation that was more pronounced in focal epilepsy(r=0.23,95%CI 0.09 to 0.36,p<0.001).Findings from Mendelian randomisation using common genetic variants did not support bidirectional effects between epilepsy and neurodevelopmental or psychiatric conditions.Conclusions Psychiatric comorbidities are common in patients with epilepsy.Genetic correlations may partially explain some comorbidities;however,there is little evidence of a bidirectional relationship between the genetic liability of epilepsy and psychiatric conditions.These findings highlight the need to understand the role of environmental factors or rare genetic variations in the origins of psychiatric comorbidities in epilepsy.

Acute appendicitis: Epidemiology, treatment and outcomesanalysis of 16544 consecutive cases

AIM To investigate the epidemiology,treatment and outcomes of acute appendicitis(AA) in a large population study.METHODS This is a retrospective cohort study derived from the administrative dataset of the Bergamo district healthcare system(more than 1 million inhabitants) from 1997 to 2013.Data about treatment,surgery,length of stay were collected.Moreover for each patients were registered data about relapse of appendicitis and hospital admission due to intestinal obstruction.RESULTS From 1997 to 2013 in the Bergamo district we collected 16544 cases of AA,with a crude incidence rate of 89/100000 inhabitants per year; mean age was 24.51 ± 16.17,54.7% were male and the mean Charlson's comorbidity index was 0.32 ± 0.92.Mortality was < 0.0001%.Appendectomy was performed in 94.7% of the patients and the mean length of stay was 5.08 ± 2.88 d; the cumulative hospital stay was 5.19 ± 3.36 d and 1.2% of patients had at least one further hospitalization due intestinal occlusion.Laparoscopic appendectomy was performed in 48% of cases.Percent of 5.34 the patients were treated conservatively with a mean length of stay of 3.98 ± 3.96 d; the relapse rate was 23.1% and the cumulative hospital stay during the study period was 5.46 ± 6.05 d.CONCLUSION The treatment of acute appendicitis in Northern Italy is slowly changing,with the large diffusion of laparoscopic approach; conservative treatment of non-complicated appendicitis is still a neglected option,but rich of promising results.

Chikungunya virus,epidemiology,clinics and phylogenesis:A review

Chikungunva virus is a mosquito-transmitted alphavirus that causes chikungunva fever,a febrile illness associated with severe arthralgia and rash.Chikungunva virus is transmitted by culicine mosquitoes:Chikungunya virus replicates in the skin,disseminates to liver,muscle,joints.lymphoid tissue and brain,presumably through the blood.Phylogenetic studies showed that the Indian Ocean and the Indian subcontinent epidemics were caused by two different introductions of distinct strains of East/Central/South African genotype of CHIKV.The paraphyletic grouping of African CHIK viruses supports the historical evidence that the virus was introduced into Asia from Africa.Phylogenetic analysis divided Chikungunva virus isolates into three distinct genotypes based on geographical origins:the first,the West Africa genotype,consisted of isolates from Senegal and Nigeria;the second contained strains from East/Central/South African genotype,while the third contained solely Asian.The most recent common ancestor for the recent epidemic,which ravaged Indian Ocean islands and Indian subcontinent in 2004- 2007.was found to date in 2002.Asian lineage dated about 1952 and exhibits similar spread patterns of the recent Indian Ocean outbreak lineage,with successive epidemics detected along an eastward path.Asian group splitted into two clades:an Indian lineage and a south east lineage.Outbreaks of Chikungunya virus fever in Asia have not been associated necessarily with outbreaks in Africa.Phylogenetic tools can reconstruct geographic spread of Chikungunva virus during the epidemics wave.The good management of patients with acute Chikungunva virus infection is essential for public health in susceptible areas with current Aedes spp activity.

Community-based screening for pre-hypertension among military active duty personnel

Objective: The purpose of this study to determine the prevalence of both pre-hypertension and hypertension and risk factors associated with newly diagnosed Saudi military active duty service personnel.Methods: Community-based screening of 1283 Saudi military active duty service personnel was conducted during the period September-December 2007 at six randomly selected out of a total of 15 military units of Taif region,Western of Saudi Arabia.Screening tools included self-administrated questionnaire,general physical examination,anthropometric measurements and assessment of blood pressure.Results: All participants were Saudi males.Their age ranged from 19-56 years old with mean ± SD of 37.2 ± 7.02.By applying the Joint National Committee on prevention,detection,evaluation,and treatment of high hypertension(JNC-7) criteria,214(17.3%) were considered pre-hypertensive.Multivariate logistic regression analysis showed that obesity as measured by body mass index(OR=2.71 CI: 1.39-5.28),positive family history(OR=1.46 CI:1.03-2.06),ever smoking(OR=1.45 CI:1.05-2.02),and increased waist circumference(OR=1.04 CI:1.02-1.06) were the significant predictors of workplace newly diagnosed hypertension among military active duty personnel.Conclusion: Pre-hypertension is a common hidden problem and it predicts the development of frank hypertension.Findings of the current study support the recommendation of lifestyle modification for pre-hypertension patients.However,further prospective studied are required to determine the role of pharmacotherapy in pre-hypertension.

Risk factors for liver disease among adults of Mexican descent in the United States and Mexico

AIM To compare the prevalence of chronic liver disease(CLD) risk factors in a representative sample of MexicanAmericans born in the United States(US) or Mexico, to a sample of adults in Mexico.METHODS Data for Mexican-Americans in the US were obtained from the 1999-2014 National Health and Nutrition Examination Survey(NHANES), which includes persons of Mexican origin living in the US(n = 4274). The NHANES sample was restricted to Mexican-American participants who were 20 years and older, born in the US or Mexico, not pregnant or breastfeeding, and with medical insurance.The data in Mexico were obtained from the 2004-2013 Health Worker Cohort Study in Cuernavaca, Mexico(n =9485). The following known risk factors for liver disease/cancer were evaluated: elevated aminotransferase levels(elevated alanine aminotransferase was defined as > 40 IU/L for males and females; elevated aspartate aminotransferase was defined as > 40 IU/L for males and females), infection with hepatitis B or hepatitis C,metabolic syndrome, high total cholesterol, diabetes,obesity, abdominal obesity, and heavy alcohol use. The main independent variables for this study classified individuals by country of residence(i.e., Mexico vs the US) and place of birth(i.e., US-born vs Mexico-born).Regression analyses were used to investigate CLD risk factors.RESULTS After adjusting for socio-demographic characteristics,Mexican-American males were more likely to be obese,diabetic, heavy/binge drinkers or have abdominal obesity than males in Mexico. The adjusted multivariate results for females also indicate that Mexican-American females were significantly more likely to be obese, diabetic, be heavy/binge drinkers or have abdominal obesity than Mexican females. The prevalence ratios and prevalence differences mirror the multivariate analysis findings for the aforementioned risk factors, showing a greater risk among US-born as compared to Mexico-born MexicanAmericans. CONCLUSION In this study, Mexican-Americans in the US had more risk factors for CLD than their counterparts in Mexico.These findings can be used to design and implement more effective health promotion policies and programs to address the specific factors that put Mexicans at higher risk of developing CLD in both countries.

Why caution should be applied when interpreting and promoting findings from Mendelian randomisation studies

Introduction In their article entitled‘Investigating genetic causal relationships between blood pressure and anxiety,depressive symptoms,neuroticism and subjective well-being’,Cai and colleagues1 presented the results of a two-sample Mendelian randomisation2(MR)study examining associations between blood pressure traits(systolic,diastolic,hypertension and pulse pressure)and psychological traits(anxiety,depression,neuroticism and subjective well-being).After correction for multiple testing.

Dose-dependent associations of joint aerobic and muscle-strengthening exercise with obesity:A cross-sectional study of 280,605 adults

Background:Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone,a combination of moderate-tovigorous physical activity(MVPA:brisk walking/jogging,cycling)and muscle-strengthening exercise(MSE:push-ups/sit-ups,using weight machines)has more favorable associations with optimal weight status.However,few studies have examined the dose-dependent and joint associations of MVPA and MSE with obesity.Methods:Based on cross-sectional analyses of the European Health Interview Survey Wave 2(2013-2014),we examined prevalence ratios(PRs)of joint and stratified associations between MVPA(4 categories:(ⅰ)0 min/week,(ⅱ)1-149 min/week,(ⅲ)150-299 min/week,and(ⅳ)≥300 min/week)and MSE(3 categories:(ⅰ)0 day/week,(ⅱ)1 day/week,and(ⅲ)>2 days/week)with body mass index-defined obesity(body mass index of>30.0 kg/m2)using Poisson regression with robust error variance.PRs were examined unadjusted and adjusted for sociodemographic and lifestyle characteristics(e.g.,sex,age,education,income,and smoking status).Results:Data were available for 280,456 adults(≥18 years),of which 46,166(15.5%)were obese.The interaction MVPA x MSE guideline adherence was statistically significant for obesity(p≤0.05).The joint MVPA-MSE analysis showed that compared to the reference group(i.e.,no MVPA and no MSE),the PRs followed a dose-dependent pattern,with the lowest observed among those reporting≥150 MVPA min/week and≥1 MSE days/week(PR:0.43;95%confidence interval:0.41-0.46).When stratified across each MVPA strata,the PRs were mostly lower among those engaging in MSE 1 day/week,as compared to those doing MSE≥2 days/week.Conclusion:"There was evidence for a dose-dependent association between joint MVPA-MSE with a reduced prevalence of obesity.Public health strategies for the prevention and management of obesity should recommend both MVPA and MSE.

The Contribution of the Xpert® MTB/RIF Assay to the Surveillance of Drug-Resistant Tuberculosis in the Central African Republic

Introduction: The Central African Republic is one of the 30 high Tuberculosis burden countries in the world, with an incidence of 540 cases per 100,000 population and a mortality of 91 deaths per 100,000 population. Since 2020, following WHO recommendations, the National Reference Laboratory for Tuberculosis has been using the Xpert® MTB/RIF assay as a first-line diagnostic test for the early detection of Drug Resistance Tuberculosis. The goal of this study was to evaluate the contribution of the Xpert® MTB/RIF assay to the surveillance of rifampicin resistance in new and previously treated tuberculosis cases. Materials and Methods: The data relative to the Xpert® MTB/RIF assay carried out on various categories of tuberculosis patients registered at the National Reference Laboratory for Tuberculosis in 2020 were analyzed retrospectively. The categories of tuberculosis patients were new cases, failed treatment cases, relapse cases, lost-to-follow-up cases and multidrug-resistant tuberculosis contact cases. Results: A total of 1404 tuberculosis patients were registered at the NRL-TB in 2020;the mean age was 39.2 years (2 - 90 years) and the male-to-female sex ratio was 1.16:1. Overall, 32.7% (454/1404) proved infected with tuberculosis, of which 22.5% (102/454) cases showed resistance to rifampicin. The primary resistance rate was 9.1% (27/298) and the secondary resistance rate was 46.6% (75/161). Treatment failures and relapsed cases were significantly associated with rifampicin resistance (p 0.005). Conclusion: Large-scale use of Xpert® MTB/RIF, especially in the provinces of the Central African Republic, will help the Ministry of Health to better control Drug Resistance Tuberculosis in the country.

Associations between polymorphisms in leptin and leptin receptor genes and colorectal cancer survival

Objective:Leptin(LEP)is an obesity-associated adipokine associated with tumor cell growth.We examined the relevance of genetic variants of LEP and leptin receptor(LEPR)to colorectal cancer(CRC)survival by using data from the Newfoundland Familial Colorectal Cancer Study.Methods:A total of 532 patients newly diagnosed with CRC between 1997 and 2003 were followed up until April 2010.Data on their demographics and lifestyles were collected via questionnaires.Genotyping of blood samples was performed with the Illumina Human Omni-Quad Bead chip.Multivariable Cox models were used to assess the relationships of 35 tag single-nucleotide polymorphisms(SNPs)in LEP and LEPR with overall survival(OS),disease-free survival(DFS),and CRC-specific survival.Results:At the gene level,LEP was associated with DFS(P=0.017),and LEPR was associated with both DFS(P=0.021)and CRCspecific survival(P=0.013)in patients with CRC.In single-SNP analysis,LEP rs11763517,LEPR rs9436301,and LEPR rs7602 were associated with DFS after adjustment for multiple testing.The LEPR haplotypes G-C-T(rs7534511-rs9436301-rs1887285)and A-A-G(rs7602-rs970467-rs9436748)were associated with prolonged OS among patients with CRC overall(G-C-T:HR,0.63;95%CI,0.43–0.93;A-A-G:HR,0.59;95%CI,0.38–0.91)and those diagnosed with colon cancer(G-C-T:HR,0.54;95%CI,0.34–0.86;A-A-G:HR,0.49;95%CI,0.29–0.83).Similar results were observed for DFS.Moreover,significant interactions were found among LEPR rs7602(A vs.G),LEPR rs1171278(T vs.C),red meat intake,and BMI status:the associations between these variants and prolonged DFS were limited to patients with below-median red meat consumption and body mass index(BMI)<25 kg/m2.Conclusions:Polymorphic variations in the LEP and LEPR genes were associated with survival of patients after CRC diagnosis.The LEP/LEPR-CRC survival association was modified by participants’red meat intake and BMI.

Prevalence of type 2 diabetes mellitus in the pediatric population of a third-level care hospital in Mexico City in 2013 and 2018

BACKGROUND Diabetes mellitus type 2(T2DM)is a state of hyperglycemia due to a defect in the secretion and/or action of insulin,and it represents the most common form of diabetes worldwide.In Mexico,10.3%of the adult population have been diagnosed with T2DM and it is expanding to the pediatric population.AIM To evaluate and compare the prevalence of T2DM in the pediatric population at the Children’s Hospital,“Hospital Infantil de México Federico Gómez(HIMFG)”,at two time periods:2013 vs 2018.METHODS A comparison of two cross-sectional studies was done(2013 and 2018).The study population was comprised of children and adolescents 8-17 years old,from the Diabetes Clinic at the aforementioned institution.A comprehensive interrogation regarding family history and perinatal antecedents was performed.Complete blood work after 12 h of fasting was obtained to determine serum levels of glucose,glycated hemoglobin,lipid profile,C-peptide,and insulin.The data were analysed using the statistical software package SPSS v.23.0.A P value of<0.05 was considered statistically significant.RESULTS A total of 151 patients were included:47 from 2013,and 104 from 2018.There were age differences noted between the two periods with younger patients presenting T2DM in 2013.Also,T2DM predominated in the male sex in 55.36%in 2013 vs 32.7%in 2018.An increased prevalence of T2DM was noted from 2013 to 2018(20.2%vs 33.0%,respectively),which was a statistically significant 12.8%increase(P<0.0001).The illness phenotype was more aggressive in the 2018 group with the presence of a higher proportion of obesity,insulin resistance,and adverse lipid profiles.CONCLUSION The prevalence of T2DM at the HIMFG institution from 2013 to 2018 increased by 12.8%(20.2%vs 33.0%,respectively).The study results demonstrate the need for vigilance in T2DM trends,and to strengthen programs of healthy nutrition and physical activity as well as early detection and risk factors for obesity,data on insulin resistance,and metabolic syndrome,with the aim of preventing the development of T2DM.

China-PAR脑卒中模型在北方农村人群中预测脑卒中发病风险的应用

目的:在中国北方农村人群的前瞻性队列中,独立验证并比较脑卒中5年发病风险预测模型的准确性,对模型在一级预防中的实际应用进行评价。方法:研究对象为2010年6月至8月参加基线调查并随访至2017年1月的6483例基线调查时未患心血管病的40~79岁北京房山农村人群,采用最新发表的中国动脉粥样硬化性心血管疾病风险预测研究(prediction for atherosclerotic cardiovascular disease risk in China,China-PAR)脑卒中模型和美国弗明汉脑卒中风险评分(Framingham stroke risk profile,FSRP)模型,分别计算预测的脑卒中5年发病风险。通过Kaplan-Meier方法调整获得5年实际观察到的新发脑卒中事件的发生率,并计算预测风险与实际发生率的比值,以评价验证队列中是否存在风险的高估或低估。采用区分度C统计量、校准度卡方值,以及校准图评估模型的预测准确性。结果:在本验证队列6483例研究对象平均(5.83±1.14)年的随访时间内,共出现新发脑卒中事件438例。再校准后的China-PAR脑卒中模型和FSRP模型在男性中预测准确性较好,区分度C统计量及其95%可信区间分别为0.709(0.675~0.743)和0.721(0.688~0.754),校准度卡方值分别为5.7(P=0.770)和13.6(P=0.137),但在女性中高估了脑卒中的5年发病风险,再校准后的China-PAR和FSRP模型分别高估了11.6%和30.0%;China-PAR和FSRP模型的区分度接近,C统计量及其95%可信区间在女性中分别为0.713(0.684~0.743)和0.710(0.679~0.740),校准度卡方值分别为12.5(P=0.188)和24.0(P=0.004)。另外,只有China-PAR脑卒中模型的校准图显示其预测风险与实际发生率的一致性较好,特别是在男性人群。结论:China-PAR脑卒中模型对于中国北方农村人群脑卒中5年发病风险的预测优于FSRP模型,特别是在男性中更准确。

Cox回归模型在产后哺乳与避孕相关关系分析中的应用

应用Cox伴随时间变化变量回归模型来准确的评价产后哺乳与避孕的关系。从天津市河西区随机抽取9个街,344名产后12～18个月的哺乳期妇女进行问卷调查。调查结果表明产后启用避孕措施的时间与哺乳类型无关,但已恢复月经的妇女比仍闭经的妇女更可能选用避孕措施。年轻妇女产后性生活恢复和启用避孕措施的时间较早。建议妇女产后恢复性生活之后,无论完全哺乳还是闭经,都应尽早选择一种适宜的避孕方法。

国人慢性HBV携带者HBV复制水平与T细胞亚群变化的关系

目的:研究慢性HBV携带者(HBVc)HBV复制水平与T细胞亚群变化的关系.方法:应用流式细胞仪检测肝功能正常的HBvc 216例和正常人100例外周血T细胞亚群百分比,ELISA法检测血清乙肝标志物(HBsAg,HBsAb,HBeAg,HBeAb,HBcAb,Anti-HBcAb IgM),实时荧光定量PCR法检测血清HBV DNA,对T细胞亚群结果与血清HBV DNA载量和HBeAg表达的关系进行分析.结果:HBV c外周血CD3^+,CD4^+及CD4^+/ CD8^+较正常人显著降低(P<0.01),而CD8^+显著升高(P<0.01).与HBV DNA(-)组比较,HBV DNA(+)组CD3^+,CD4^+及CD4^+/CD8^+分别降低20.4%,17.8%和35.7%,CD8^+升高21.9%(P<0.0 1).与HBeAg(-)组比较,HBeAg(+)组CD3^+,CD4^+及CD4^+/CD8^+分别降低19.5%,14.0%和28.6%,CD8^+升高19.6%(P<0.01).随着病毒载量的升高,CD3^+,CD4^+及CD4^+/CD8^+显著下降,分别与病毒载量呈显著负相关(r=-0.67,-0.54,-0.67,P<0.01);CD8^+显著升高,与病毒载量呈显著正相关(r=0.61,P<0.01).HBV DNA(+)和HBeAg(+)组与HBV DNA单阳性组和阴性组比较,CD3^+,CD4^+及CD4^+/CD8^+显著降低(P<0.05,P<0.01),CD8^+显著升高(P<0.01).有母亲感染史者CD3^+,CD4^+及CD4^+/CD8^+较无母亲感染史者明显降低,CD8^+则显著升高(P<0.01).在有母亲感染史者中,血清HBV DNA(+)82.2%,HBeAg(+) 75.2%,HBV DNA水平>1×10^(10)copies/L者65.1%,均分别显著高于无母亲感染史者的34.5%,OR=8.65,95%CI:[4.45,17.33],28.7%,OR=7.44,95%CI:[3.91,14.56]和10.3%,OR=15.94,95%CI:7.13,39.66].有母亲感染史和无母亲感染史者中,与HBV DNA(-)组比较,HBV DNA(+)组CD3^+,CD4^+及CD4^+/CD8^+均显著降低(P<0.05,P<0.01),CD8^+均显著升高(P<0.01);与HBeAg(-)组比较,HBeAg(+)组CD3^+,CD4^+及CD4^+/CD8^+比均显著降低(P<0.05,P<0.01).结论:肝功能正常的HBVc T细胞免疫功能紊乱与病毒复制水平之间存在显著相关性,HBV活跃复制进一步加重紊乱.

东方遇见西方:增龄性骨骼肌肉疾病的临床实践和策略

健康老龄化是指人在维持良好身体功能、保证生活质量前提下的衰老过程。这个过程能否实现取决于机体固有能力,一方面包括心理、生理能力,另一方面包括机体所处环境以及二者的相互作用。在老龄化进程中,骨骼肌肉健康是维持老年人身体功能的重要条件。全球肌少症、骨质疏松症和骨关节炎等老龄化相关的骨骼肌肉疾病及机体失能所致的负担正在增加,因此随着人口老龄化的加剧,防治这类疾病也尤为重要。以此为契机,中华医学会、中华医学会骨质疏松和骨矿盐疾病分会、欧洲骨质疏松和骨关节炎临床经济学会联合开设论坛,共同探讨增龄性肌肉骨骼疾病的现行临床诊治策略。本次会议邀请了中国和欧洲的专家到场,分享这3种疾病的临床诊治经验;双方通过经验交流、讨论异同以取长补短,从而实现对疾病的更佳防治,维持老年人的自身能力、延缓老龄化带来的身体功能退化。展望未来,希望双方经验及最佳临床实践的交流能推进全球战略,以减轻肌肉骨骼疾病的负担,促进符合个体化需求的健康老龄进程。

Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation

AIM:To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy. METHODS:A prospective,double-blind,randomized, placebo-controlled study was conducted.One hundred and twenty-four patients were allocated to receive 2 doses of sodium phosphate plus 240 mg of tablet simethicone or placebo as bowel preparation.Visibility was blindly assessed for the amount of air bubbles and adequacy of colon preparation.Total colonoscopic time,side effects of the medication,endoscopist and patient satisfaction were also compared. RESULTS:Sodium phosphate plus simethicone,compared to sodium phosphate plus placebo,improved visibility by diminishing air bubbles(100.00%vs 42.37%, P<0.0001)but simethicone failed to demonstrate improvement in adequacy of colon preparation(90.16% vs 81.36%,P=0.17).Endoscopist and patient satisfaction were increased significantly in the simethicone group.However,there was no difference in the total duration of colonoscopy and side effects of the medication. CONCLUSION:The addition of simethicone is of ben-efit for colonoscopic bowel preparation by diminishing air bubbles,which results in enhanced visibility.Endoscopist and patient satisfaction is also increased.

Adiponectin as a protective factor in hepatic steatosis

AIM: Obesityand insulin resistance (IR) are closely related to hepatic steatosis (HS), and adiponectin is a hepatic insulin sensitizer that has important effects in liver function.This study aims at investigating the relationship between serum adiponectin concentration and the presence of HS.METHODS: We carried out a cross-sectional study in a check-up unit of a University Hospital in Mexico City. We enrolled 196 subjects, comprising 98 subjects with HS (27 women, 71 men) and 98 controls (37 women and 61men). Anthropometric, metabolic and biochemical variables were measured in the two groups. Serum adiponectin and leptin concentrations were determined,their association with grade of HS tested, and concentrations,according to quartiles, compared between cases and controls. χ2 analysis for linear trends was used to test for a dose-response relationship and logistic regression analysis was conducted to test for a protective effect of adiponectin.RESULTS: The HS subjects were older and more obese than controls, with a central obesity pattern. In the fourth quartile of adiponectin concentrations, HS was less common and severe. In a multivariate model of the fourth quartile of the adiponectin concentrations, we observed a protective effect (OR = 0.17, 95%CI: 0.04-0.67, P= 0.01).In subjects with more severe HS, we observed higher leptin concentrations, and caloric intakes, total fat and iron consumption were higher than in controls.CONCLUSION: The results of the present study suggest that a high serum concentration of adiponectin is associated with a protective effect against HS.