[Analysis on influencing factors of HBV intrauterine transmission based on integration of decision tree model and logistic regression model].

Objective: To investigate the influencing factors of HBV intrauterine transmission and their interaction effects by integrating logistic regression model and Chi-squared automatic interaction detector (CHAID) decision tree model. Methods: A total of 689 pairs of HBsAg-positive mothers and their neonates in the obstetrics department of the Third People's Hospital of Taiyuan from 2007 to 2013 were enrolled, and the basic information of mothers and their neonates were obtained by questionnaire survey and medical record review, such as the general demographic characteristics, gestational week and delivery mode. HBV DNA and HBV serological markers of the mothers and newborns were detected by fluorescence quantitative PCR and electrochemiluminescence immunoassay respectively. The CHAID decision tree model and unconditional logistic regression analysis were used to explore the factors influencing HBV intrauterine transmission in neonates of HBsAg-positive mothers. Results: Among the 689 neonates, the incidence of HBV intrauterine transmission was 11.47% (79/689). After adjusted for confounding factors, the first and second logistic multivariate analysis showed that cesarean delivery was a protective factor for HBV intrauterine transmission (OR=0.25, 95%CI: 0.14-0.43; OR=0.27, 95%CI: 0.15-0.46); both models indicated that maternal HBeAg positivity and HBV DNA load ≥2×105 IU/ml before delivery were risk factors of HBV intrauterine transmission (OR=3.89, 95%CI: 2.32-6.51; OR=3.48, 95%CI: 2.12-5.71), respectively. The CHAID decision tree model screened three significant factors influencing HBV intrauterine transmission, the most significant one was maternal HBeAg status, followed by delivery mode and maternal HBV DNA load. There were interactions between maternal HBeAg status and delivery modes, as well as delivery mode and maternal HBV DNA load before delivery. The rate of HBV intrauterine transmission in newborns of HBeAg-positive mothers by vaginal delivery increased from 19.08% to 29.37%; among HBeAg-positive mothers with HBV DNA ≥2×105 IU/ml, the rate of HBV intrauterine transmission increased to 33.33% in the newborns by vaginal delivery. Conclusions: Maternal HBeAg positivity,maternal HBV DNA ≥2×105 IU/ml and vaginal delivery could be risk factors for HBV intrauterine transmission in newborns. Interaction effects were found between maternal HBeAg positivity and vaginal delivery, as well as vaginal delivery and high maternal HBV DNA load. Logistic regression model and the CHAID decision tree model can be used in conjunction to identify the high-risk populations and develop preventive strategies accurately.

Cost analyses of home care and nursing home services in the southern Taiwan area.

This study compares the cost of long-term care provided at patient homes with that of long-term care provided in nursing homes in southern Taiwan. Caring for a patient with a high degree of dependence at home is more expensive than caring for a patient in a nursing home facility when family costs and provider costs are considered together. This phenomenon is not demonstrated for patients with medium degrees of dependence. To be cost-effective, home care services should target patients with medium physical disability, and nursing home care should focus on patients with high levels of dependence.

Family caregivers' priorities for home care: a need assessment study.

BACKGROUND: Many studies have demonstrated that patients prioritize some attributes of health care over others. However, little effort has been devoted to measure which service attributes are most important to consumers, regardless of their satisfaction, in the field of home care. Moreover, home care requires family members to participate as caregivers. Thus, evaluating the needs of family caregivers who also provide home care should provide an opportunity to envision an effective home care system. METHODS: This study was designed to measure family caregivers' need for auxiliary home care services by examining their priorities for attributes of home care services. The respondents were asked to select 5 attributes, which were most important for them, from 19 choices of home care services, and then to rank 5 attributes in decreasing order of importance to determine their priorities, coded from 1 (the first priority) to 5 (the last important priority). The degree of satisfaction from a single attribute, whether or not the desired attribute was in fact provided, personal data of family caregivers, and types of patient's insurance were also included in this study. RESULTS: The interviewees were inclined to assign high priority to the ease of contacting home care nurses by telephone (73.6%) and the timeliness of obtaining needed services in an emergency (63.6%); they were less likely to attach high priority to provision of spiritual support (6.3%), respect given by home care nurses (5.4%), and acceptance of suggestions (4.5%). Whether a single attribute was selected as a top five priority was significantly associated with family caregiver's education level, degree of satisfaction with the attribute and whether the desired attribute was actually received. CONCLUSIONS: The interviewees had different priorities for attributes of home care, and they assigned high importance to the attributes less satisfied and received; examples are the timeliness of obtaining needed services in an emergency, and the ease of contacting home care nurses by telephone.

In vitro screening of antimotility effect on human sperm with polyphenolic compounds purified from Chinese herbal medicines.

PIP: 24 kinds of pure compounds extracted from Chinese herbal medicines were studied for their effects on human sperm motility. 7 were found to inhibit sperm motility at the concentration of 2 mg/ml. These 7 substances were further investigated for their sperm motility-inhibitory effect at the concentration of 3.0 mg/ml, 4.5 mg/ml, and 6.75 mg/ml to test the dose-related response. The results showed that 5 of the 7 extracts, namely casuarinin, cinnamtannin B-1, pedunculagin, epicatchin-(4beta-8)-epicatechin-(4beta-8)-catechin, and catechin have a strong inhibitory effect on sperm motility with dose-response relationship. Since the chemical structures of these extracts have already been determined, further studies should aim at exploring the mechanisms of their antimotility effect on human sperm. It would appear that some traditional Chinese herbal medicines have the potential of becoming new and acceptable forms of male oral contraceptives in the future.^ieng