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1.
Environ Sci Pollut Res Int ; 30(22): 61271-61289, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-34773583

RESUMO

Access to financial services is regarded as one of the most pressing issues confronting communities worldwide sequel to the COVID-19 pandemic. In this regard, FinTech applications such as mobile financial service (MFS) play an essential role in building resilience during the pandemic. Hence, the aim of the study is to investigate the role of MFS platforms in economic resilience by empirically evaluating the determinants that influence the intention of Bangladeshi users toward adopting MFS platforms during the COVID-19 pandemic, through an extension of the Unified Theory of Acceptance and Use of Technology (UTAUT). Using the core structures of the UTAUT, the theoretical model was constructed based on the consumption attributes of financial services such as perceived value, as well as additional situational factors from the extended valence framework, including risk and trust. To test the model, data was obtained from 227 potential MFS users in Bangladesh with the aid of a structured questionnaire survey. Subsequently, the Structural Equation Modeling (SEM) approach was used to analyze the data. The findings showed that social influence, perceived trust, and perceived value are strongly related to the intention of users to adopt MFS platforms, whereas, perceived risk, performance expectancy, and effort expectancy were observed to influence users' perceived value of the MFS platforms during the COVID-19 pandemic. Interestingly, the study results indicated that the users' perceived risk did not influence their intention to adopt MFS platforms during the pandemic. Therefore, the suggested adoption of the MFS framework during and after the pandemic could contribute to the existing research on the adoption of information technology (IT) through the expansion of the UTAUT, in which the performance and effort expectancy of users influence their intention to indirectly adopt MFS through perceived value. Finally, the significant policy implications and future research directions are further addressed.


Assuntos
COVID-19 , Pandemias , Humanos , Intenção , Aceitação pelo Paciente de Cuidados de Saúde , Modelos Teóricos , Inquéritos e Questionários
3.
Cancer Commun (Lond) ; 42(12): 1387-1402, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36274263

RESUMO

BACKGROUND: Patients with refractory or relapsed acute myeloid leukemia (AML) have poor survival, necessitating the exploration of optimized therapeutic strategy. Here, we aimed to investigate clinical outcomes and health-related quality of life (HR-QoL) after total therapy, which included allogeneic hematopoietic stem cell transplantation (allo-HSCT), and prophylactic donor lymphocyte infusion (DLI) in the early phase after transplantation, followed by multiple measurable residual disease (MRD) and graft-versus-host disease (GvHD)-guided DLIs. METHODS: Consecutive patients who had refractory or relapsed AML and had received non-T-cell-depleted allo-HSCT at Peking University Institute of Hematology were included in the study. If the patients achieved complete remission at 30 days after transplantation and had no evidence of relapse, severe infection, organ failure, and active GvHD at the time of planned DLI, prophylactic DLI was administered at 30 days after transplantation for human leukocyte antigen (HLA)-matched related HSCT or at 45-60 days after transplantation for haploidentical or unrelated HSCT. Subsequently, multiple DLIs were administered based on MRD results and whether they developed GvHD after transplantation. RESULTS: A total of 105 patients were eligible. Eighty-seven patients received prophylactic DLI (group B), while 18 did not receive prophylactic DLI (group A). Among 105 patients, the cumulative incidence of grade 2-4 acute GvHD and chronic GvHD was 40.6% (95% confidence interval [CI] = 30.6%-50.6%) and 73.3% (95% CI = 67.4%-79.2%), respectively. The cumulative incidence of relapse (CIR), transplant-related mortality (TRM), and leukemia-free survival (LFS) at 5 years after transplantation were 31.5% (95% CI = 21.9%-41.1%), 22.1% (95% CI = 11.3%-32.9%), and 46.4% (95% CI = 36.8%-56.0%), respectively. In group B, the CIR, TRM, and LFS at 5 years after transplantation were 27.6% (95% CI = 17.6%-37.6%), 21.6% (95% CI = 11.2%-32.0%), and 50.8% (95% CI = 40.0%-61.6%), respectively. At the end of follow-up, 48 patients survived, and more than 90% of survivors had satisfactory recoveries of HR-QoL. CONCLUSIONS: Our study indicated that total therapy is not only associated with decreased CIR, comparable TRM, and better long-term LFS, but also with satisfactory HR-QoL for refractory or relapsed AML, compared with those of standard of care therapy reported previously. Therefore, total therapy may be an optimized therapeutic strategy for refractory or relapsed AML.


Assuntos
Doença Enxerto-Hospedeiro , Leucemia Mieloide Aguda , Humanos , Transplante Homólogo , Qualidade de Vida , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/prevenção & controle , Leucemia Mieloide Aguda/terapia , Neoplasia Residual , Recidiva
4.
Int J Clin Pract ; 2022: 3356431, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36263235

RESUMO

Background: Cervical cancer, especially in underdeveloped areas, poses a great threat to human health. In view of this, we stratified the age and social demographic index (SDI) based on the epidemiological development trend and attributable risk of cervical cancer in countries and regions around the world. Methods: According to the data statistics of the global burden of disease database (GBD) in the past 30 years, we adopted the annual percentage change (EAPCs) to evaluate the incidence trend of cervical cancer, that is, incidence rate, mortality, and disability adjusted life expectancy (DALY). Meanwhile, we investigated the potential influence of SDI on cervical cancer's epidemiological trends and relevant risk factors for cervical cancer-related mortality. Results: In terms of incidence rate and mortality, the high SDI areas were significantly lower than those of low SDI areas. The incidence and mortality in women aged 20 to 39 were relatively stable, whereas an upward trend existed in patients aged 40 to 59. The global cervical cancer incidence rate increased from 335642 in 1990 to 565541 in 2019 (an increase of 68.50%, with an average annual growth rate of 2.28%), while the age-standardized incidence rate (ASIR) showed a slight downward trend of 14.91/100000 people (95% uncertainty interval [UI], 13.37-17.55) in 1990 to 13.35/100,000 persons (95% UI, 11.37-15.03) in 2019. The number of annual deaths at a global level increased constantly and there were 184,527 (95% UI, 164,836-218,942) deaths in 1990 and 280,479 (95% UI, 238,864-313,930) deaths in 2019, with an increase of 52.00%(average annual growth rate: 1.73%). The annual age-standardized disability adjusted annual life rate showed a downward trend (decline range: 0.95%, 95% confidence interval [CI], from -1.00% to - 0.89%). In addition, smoking and unsafe sex were the main attributable hazard factors in most GBD regions. Conclusions: In the past three decades, the increase in the global burden of cervical cancer is mainly concentrated in underdeveloped regions (concentrated in low SDI). On the contrary, in countries with high sustainable development index, the burden of cervical cancer tends to be reduced. Alarmingly, ASIR in areas with low SDI is on the rise, which suggests that policy makers should pay attention to the allocation of public health resources and focus on the prevention and treatment of cervical cancer in underdeveloped areas, so as to reduce its incidence rate, mortality, and prognosis.


Assuntos
Carga Global da Doença , Neoplasias do Colo do Útero , Humanos , Feminino , Anos de Vida Ajustados por Qualidade de Vida , Neoplasias do Colo do Útero/epidemiologia , Saúde Global , Fatores de Risco , Incidência
5.
Front Public Health ; 10: 757481, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35372224

RESUMO

Background: Some studies found that family doctor contract services (FDCSs) had positive impact on the self-measurement behaviors of hypertension patients. However, evidence concerning the association between FDCSs and blood pressure measurement awareness among hypertension patients is not clear. Objective: This study aims to explore the relationship between FDCSs and blood pressure measurement awareness among the hypertension patients, and examine whether there is a difference in this relationship among middle-aged and aged adults in rural Shandong, China. Methods: A multi-stage stratified random sampling was adopted in 2018 in Shandong Province to conduct a questionnaire survey among the sample residents, in which 982 hypertension patients were included in the study. Pearson chi-square test and logistic regression model were employed using SPSS 24.0 to explore the association between FDCSs and blood pressure measurement awareness. Results: 76.8% of hypertension patients would measure blood pressure regularly. The blood pressure measurement awareness of the signing group was significantly higher than that of the non-signing group when controlling other variables (P < 0.001, OR = 2.075, 95% CI 1.391-3.095). The interaction of age and contracting status were significantly correlated with blood pressure measurement awareness (P = 0.042, OR = 1.747, 95% CI 1.020-2.992; P = 0.019, OR = 2.060, 95% CI 1.129-3.759). Factors including gender (P = 0.011, OR = 0.499, 95% CI 0.291-0.855), household income (P = 0.031, OR = 1.764, 95% CI 1.052-2.956), smoking status (P = 0.002, OR = 0.439, 95% CI 0.260-0.739), sports habits (P < 0.001, OR = 2.338, 95% CI 1.679-3.257), self-reported health (P = 0.031, OR = 1.608, 95% CI 1.043-2.477), distance to the village clinic (P = 0.006, OR = 1.952, 95% CI 1.208-3.153) and medications (P < 0.001, OR = 3.345, 95% CI 2.282-4.904) were also found to be associated with the blood pressure measurement awareness of hypertension patients. Conclusion: The government should take efforts to strengthen publicity and education of family doctors and pay more attention to uncontracted, middle-aged, female patients and patients with unhealthy life behaviors to improve the blood pressure measurement awareness.


Assuntos
Pressão Sanguínea , Serviços Contratados , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão , Adulto , China , Estudos Transversais , Feminino , Humanos , Hipertensão/diagnóstico , Pessoa de Meia-Idade , Médicos de Família , População Rural
6.
Artigo em Inglês | MEDLINE | ID: mdl-36612401

RESUMO

Historic blocks are valuable architectural and landscape heritage, and it is important to explore the distribution characteristics of tourists to historic blocks and their landscape preferences to realize the scientific construction and conservation of historic blocks and promote their sustainable development. At present, few studies combine the analysis of tourist distribution characteristics with landscape preferences. This study takes the historic block of Three Lanes and Seven Alleys in Fuzhou as an example, combines field research and questionnaires to construct a landscape preference evaluation indicator system for the historic block, measures the distribution characteristics of tourists in the block through the heat value of tourist flow obtained from the Tencent regional heat map, and analyses the influence of landscape preference indicators on the heat value of tourist flow in the block through stepwise multiple linear regression. The research shows that: (1) the spatial and temporal variation in the heat value of tourist flow tends to be consistent throughout the block, from 7 a.m. to 6 p.m., showing a "rising, slightly fluctuating and then stabilizing" state, both on weekdays and on weekends. (2) The factors influencing the heat value of tourist flow in the different spatial samples are various, with commercial atmosphere, plant landscape, accessibility of the road space, architecture, and the surrounding environment having a significant impact on the heat value of tourist flow. Based on the analysis of the landscape preferences of tourists in the historic block, a landscape optimization strategy is proposed to provide a reference for the management and construction of the block.


Assuntos
Big Data , Desenvolvimento Sustentável , Inquéritos e Questionários , China , Temperatura Alta
7.
Int J Equity Health ; 20(1): 191, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34445998

RESUMO

PURPOSE: Few studies explored the relationship between the family doctor contract services (FDCS) and health-related quality of life (HRQOL) among patients with chronic diseases in rural China. This study aims to explore the relationship between the status of signing on FDCS and HRQOL among patients with chronic diseases and examine whether there are differences in the relationship between different socioeconomic status (SES). METHODS: A total of 1,210 respondents were included in this study. HRQOL was measured by EQ-5D-3L. The contracting status was divided into uncontracted and contracted. Tobit regression and Logistic regression were employed to explore the association between contracting status and HRQOL. The interaction terms were included to explore the differences in the association among different SES. RESULTS: Contracting with family doctors was associated with HRQOL (coefficient = 0.042; 95%CI 0.008 to 0.075). The association was different among different socioeconomic levels that the contracting status was only associated with HRQOL in sub-high-income (P < 0.01) and highly educated patients (P < 0.05). Compared with uncontracted patients, contracted patients reported higher ED-5D-3L utility value in the sub-high-income group (coefficient = 0.078; 95%CI 0.017 to 0.140) and high educational attainment (coefficient = 0.266; 95%CI 0.119 to 0.413). CONCLUSIONS: This study found a significant association between FDCS and HRQOL among chronic patients in rural Shandong, China. This relationship varied by income levels and educational attainment. The government should take efforts to formulate a variety of measures to encourage chronic patients to contract with family doctors, with special attention to people with low SES.


Assuntos
Doença Crônica , Serviços Contratados , Médicos de Família , Qualidade de Vida , Idoso , China , Doença Crônica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Classe Social
8.
Work ; 2021 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-34308893

RESUMO

Ahead of Print article withdrawn by publisher.

9.
BMC Public Health ; 21(1): 1282, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193114

RESUMO

BACKGROUND: In China, some previous studies have investigated the signing rate and willingness of residents to sign the family doctor contract services (FDCS). Few studies have explored residents' willingness to renew the FDCS. This study is designed to understand the family characteristics difference towards rural households' willingness of maintaining the FDCS. METHODS: A total of 823 rural households were included in the analysis. A descriptive analysis was conducted to describe the sample characteristics. The binary logistic regression model was used to explore the family characteristics that influence the renewal willingness for FDCS among rural households in Shandong province, China. RESULTS: Our study found that about 95.5% rural households had willingness to maintain the FDCS in Shandong, China. Those households with catastrophic health expenditures (CHE) (OR = 0.328, 95%CI = 0.153-0.703), with highest level of education at graduate or above (OR = 0.303, 95%CI = 0.123-0.747) were less willing to maintain the FDCS. Those whose households have more than half of the labor force (OR = 0.403, 95%CI = 0.173-0.941) and those households living in economically higher condition were less willing to maintain the FDCS. CONCLUSIONS: This study demonstrates a significant association between family characteristics (CHE, highest education in households, proportion of the household labor force) and willingness to maintain FDCS among rural households in Shandong, China. Targeted policies should be made for rural residents of identified at-risk families.


Assuntos
Características da Família , População Rural , China , Serviços Contratados , Estudos Transversais , Humanos
10.
Aesthet Surg J ; 37(10): 1188-1198, 2017 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-29044363

RESUMO

BACKGROUND: With the evolving plastic surgery training paradigm, there is an increasing emphasis on aesthetic surgery education during residency. In an effort to improve aesthetic education and to encourage preparation for independent practice, our institution has supported a resident-run aesthetic clinic for over two decades. OBJECTIVES: To provide insight into the educational benefits of a resident-run cosmetic clinic through longitudinal resident follow up and institutional experiential review. METHODS: A retrospective review was conducted to identify all clinic-based aesthetic operations performed between 2009 and 2016. To capture residents' perspectives on the cosmetic resident clinic, questionnaires were distributed to the cohort. Primary outcome measures included: volume and types of cases performed, impact of clinic experience on training, confidence level performing cosmetic procedures, and satisfaction with chief clinic. Unpaired t tests were calculated to compare case volume/type with level of confidence and degree of preparedness to perform cosmetic procedures independently. RESULTS: Overall, 264 operations performed by 18 graduated chief residents were reviewed. Surveys were distributed to 28 chief residents (71.4% completion rate). Performing twenty or more clinic-based procedures was associated with higher levels of preparedness to perform cosmetic procedures independently (P = 0.037). Residents reported the highest confidence when performing cosmetic breast procedures when compared to face/neck (P = 0.005), body/trunk procedures (P = 0.39), and noninvasive facial procedures (P = 0.85). CONCLUSIONS: The continued growth of aesthetic surgery highlights the need for comprehensive training and preparation for the new generation of plastic surgeons. Performing cosmetic procedures in clinic is a valuable adjunct to the traditional educational curriculum and increases preparedness and confidence for independent practice.


Assuntos
Competência Clínica , Internato e Residência/métodos , Procedimentos de Cirurgia Plástica/educação , Clínica Dirigida por Estudantes/economia , Cirurgiões/educação , Cirurgia Plástica/educação , Adulto , Currículo , Avaliação Educacional , Feminino , Humanos , Internato e Residência/economia , Estudos Longitudinais , Masculino , Procedimentos de Cirurgia Plástica/economia , Estudos Retrospectivos , Clínica Dirigida por Estudantes/estatística & dados numéricos , Cirurgiões/psicologia , Cirurgia Plástica/economia , Inquéritos e Questionários
11.
Surg Endosc ; 31(12): 4923-4933, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28547665

RESUMO

OBJECTIVES: To conduct a meta-analysis to provide accurate evidence regarding the preferred diagnostic method, magnifying endoscopy (ME) or endoscopic ultrasonography (EUS), for assessment of the depth of invasion of the gastrointestinal neoplasms. METHODS: PubMed, EMBASE, Ovid Medline, and the Cochrane Library databases were searched for studies published between January 1946 and October 2016, regarding the use of EUS and ME to assess the invasion depth of gastrointestinal cancers. The quality of diagnostic studies was evaluated using the QUADAS2 instrument. The Meta-DiSc software (version 1.4) was used for meta-analysis of the pooled data regarding the diagnostic accuracy of EUS and ME of the invasion depth of gastrointestinal neoplasms. RESULTS: Our meta-analysis included the data of 754 patients with gastrointestinal cancers contributed by seven prospective studies. All studies were of high quality (QUADAS2). The receiver operating characteristic (ROC) planes were not observed in shoulder and arm forms for either EUS or ME, with Spearman's correlation coefficients of -0.821 and 0.234 for EUS and ME, respectively. The p values of the diagnostic odds ratio for EUS and ME were 0.0038 and 0.0131, respectively. The sensitivity and specificity of EUS for the diagnosis of the depth of invasion of gastrointestinal cancers were 0.75 (95% CI 0.69-0.81) and 0.84 (95% CI 0.79-0.88), respectively. In comparison, the sensitivity and specificity for ME were 0.74 (95% CI 0.67-0.69) and 0.85 (95% CI 0.80-0.89), respectively. The values of area under the summary ROC (SROC) curves for EUS and ME were 0.8499 and 0.8757, respectively, with a non-significant Z value between EUS and MR (0.296 < 1.96). CONCLUSIONS: Both EUS and ME provide a comparable performance for judging the depth of invasion of gastrointestinal neoplasms. However, there is heterogeneity between studies contributed by non-threshold effects.


Assuntos
Adenoma/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Endoscopia Gastrointestinal/métodos , Endossonografia , Neoplasias Gastrointestinais/diagnóstico por imagem , Adenoma/patologia , Carcinoma/patologia , Neoplasias Gastrointestinais/patologia , Humanos , Invasividade Neoplásica , Sensibilidade e Especificidade
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2016: 1536-1539, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28268619

RESUMO

The JFK Coma Recovery Scale-Revised (JFK CRS-R), a behavioral scale, is often used for clinical assessments of patients with disorders of consciousness (DOC), such as patients in a vegetative state. However, there has been a high rate of clinical misdiagnosis with the JFK CRS-R because patients with severe brain injures cannot provide sufficient behavioral responses. It is particularly difficult to evaluate the communication function in DOC patients using the JFK CRS-R because a higher level of behavioral responses is needed for communication assessments than for many other assessments, such as an auditory startle assessment. Brain-computer interfaces (BCIs), which provide control and communication by detecting changes in brain signals, can be used to evaluate patients with DOC without the need of behavioral expressions. In this paper, we proposed an audiovisual BCI system to supplement the JFK CRS-R in assessing the communication ability of patients with DOC. In the graphic user interface of the BCI system, two word buttons ("Yes" and "No" in Chinese) were randomly displayed in the left and right sides and flashed in an alternating manner. When a word button flashed, its corresponding spoken word was broadcast from an ipsilateral headphone. The use of semantically congruent audiovisual stimuli improves the detection performance of the BCI system. Similar to the JFK CRS-R, several situation-orientation questions were presented one by one to patients with DOC. For each question, the patient was required to provide his/her answer by selectively focusing on an audiovisual stimulus (audiovisual "Yes" or "No"). As a case study, we applied our BCI system in a patient with DOC who was clinically diagnosed as being in a minimally conscious state (MCS). According to the JFK CRS-R assessment, this patient was unable to communicate consistently. However, he achieved a high accuracy of 86.5% in our BCI experiment. This result indicates his reliable communication ability and demonstrates the effectiveness of our system.


Assuntos
Transtornos da Consciência , Interfaces Cérebro-Computador , Coma/diagnóstico , Transtornos da Consciência/diagnóstico , Feminino , Humanos , Masculino , Estado Vegetativo Persistente
13.
J Plast Surg Hand Surg ; 49(3): 166-71, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25529100

RESUMO

Previous studies assessing the costs associated with two stage expander/implant (E/I) reconstruction rarely include the cost of complications. The purpose of this study is to analyze the complication costs associated with a single institution experience with immediate E/I reconstruction. All immediate two stage E/I reconstructions at a single institution between March 2005-April 2011 were reviewed. The reconstruction database was retrospectively queried for reconstructive details, complications, and cost. Statistical analyses were performed to determine which complications significantly increased reconstructive cost. 327 E/I reconstructions in 195 patients were analyzed. The major complications analyzed included haematoma requiring evacuation (1.2% of reconstructions), major infection (6.1% of reconstructions), E/I exposure (3.1% of reconstructions), and E/I rupture (2.4% of reconstructions); 2.1% of patients experienced reconstructive failure. The mean reconstructive cost was $22,323 ± 9,072. Costs were increased $12,554 by E/I infection (p < 0.001) and $17,153 by prosthetic exposure (p < 0.001). Pre- or postoperative radiation or chemotherapy did not significantly affect reconstructive costs. Unplanned readmissions or unplanned visits to the operative room significantly increased total reconstructive costs (p < 0.001 and p < 0.001, respectively). In conclusion, prosthetic infection and prosthetic exposure significantly increased costs associated with immediate two-stage E/I reconstruction, as did unplanned readmissions and unplanned visits to the operative room. In the current state of the US healthcare system, it is becoming more important for surgeons to be conscious of the economic burden associated with poor reconstructive outcomes.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/economia , Dispositivos para Expansão de Tecidos/economia , Adulto , Implante Mamário/efeitos adversos , Implante Mamário/economia , Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Implantes de Mama/economia , Feminino , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Estudos Retrospectivos , Dispositivos para Expansão de Tecidos/efeitos adversos
14.
Plast Reconstr Surg ; 133(3): 687-699, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24263390

RESUMO

BACKGROUND: Ventral hernias are a common, challenging, and expensive problem for general and reconstructive surgeons. The authors assessed the impact of epidurals on morbidity following abdominal wall reconstruction for hernia. METHODS: A retrospective review of abdominal wall reconstruction patients operated on between 2007 and 2012 was performed with a specific focus on the use of epidurals. Bivariate and multivariate logistic regression analyses were used to assess independent predictors of morbidity. Subgroup analyses were also performed. RESULTS: The study included 134 consecutive reconstructions performed by a single surgeon over a 5-year period at an academic teaching center. Patient groups were similar in terms of demographics, preoperative characteristics, hernia grade, and intraoperative characteristics. Epidural use was associated with a lower incidence of major surgical complications (19.7 percent versus 36.1 percent; p = 0.04) and medical complications (26.8 percent versus 54.1 percent; p = 0.001). A significant and independent reduction in medical morbidity (OR, 0.09; p ≤ 0.001) and unplanned reoperations (OR, 0.23; p = 0.052), was found with patients receiving epidurals. Furthermore, a notable trend toward reduced major surgical complications (OR, 0.45; p = 0.141) and cost savings (-$22,184; p = 0.01) was found in patients who received epidurals. Subgroup analysis did not demonstrate statistically significant reductions in major surgical morbidity in reconstruction either with (p = 0.13) or without (p = 0.07) concurrent intra abdominal procedures when epidurals were not or were used, respectively. CONCLUSIONS: Epidural use may be associated with reduced morbidity and cost savings in abdominal wall reconstruction. This effect appears to be related to reduced medical morbidity and shortened length of stay in patients undergoing more complex, concurrent intraabdominal hernia procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Parede Abdominal/cirurgia , Analgesia Epidural , Hérnia Ventral/cirurgia , Procedimentos de Cirurgia Plástica , Adulto , Analgesia Epidural/economia , Custos e Análise de Custo , Feminino , Hérnia Ventral/complicações , Hérnia Ventral/economia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/economia , Telas Cirúrgicas
15.
Zhonghua Gan Zang Bing Za Zhi ; 19(12): 884-9, 2011 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-22525498

RESUMO

OBJECTIVE: To establish a detection method for HBV drug-resistant mutations related to lamivudine, adefovir and entecavir by optimization and assessment of reverse hybridization system. METHOD: 26 degenerated probes covering 10 drug-resistant hotspots of 3 drugs were synthesized and immobilized on the same positively charged nylon membrane. PCR products labeled with digoxigenin were hybridized with corresponding probes. To improve the sensitivity and specificity, 4 reaction steps of reverse hybridization were optimized including the number of labeled digoxigenin, the energy intensity of UV cross-linking, hybridization and stringency wash conditions. To prove the feasibility, the specificity, sensitivity and accuracy of this system were assessed respectively. RESULT: Sensitive and specific results are obtained by the optimization of the following 4 reaction steps: the primers labeled with 3 digoxigenin, energy intensity of UV cross-linking for 1500 x 0.1 mJ/cm², hybridization at 42 degrees C and stringency wash with 0.5 x SSC and 0.1% SDS solution at 44 degrees C for 30 min. In the assessment of system, the majority of probes have high specificity. The quantity of PCR product with a concentration of 10 ng/µl or above can be detected by this method. The concordant rate between reverse hybridization and direct sequencing is 93.9% in the clinical sample test. CONCLUSION: Though the specificity of several probes needs to be improved further, it is a simple, rapid and sensitive method which can detect HBV resistant mutations related to lamivudine, adefovir and entecavir simultaneously. Due to the short distance between 180 and 181, likewise 202 and 204, the sequence of the same probe covers two codon positions, and hybridization will be interfered by each other. To avoid such interference, the possible solution is that probes are designed by arranging and combining various forms of two near codons.


Assuntos
Farmacorresistência Viral/genética , Vírus da Hepatite B/genética , Hibridização de Ácido Nucleico/métodos , DNA Viral/genética , Vírus da Hepatite B/efeitos dos fármacos , Humanos , Hibridização Genética , Mutação , Análise de Sequência com Séries de Oligonucleotídeos , Sensibilidade e Especificidade
16.
Zhonghua Liu Xing Bing Xue Za Zhi ; 30(11): 1106-10, 2009 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-20193574

RESUMO

OBJECTIVE: To study the epidemic tendency of emerging influenza A (H1N1) in mainland China, and to explore the different patterns of spread on the disease under the following contexts: (1) To stop the temperature screening program at the border areas of the country; (2) To stop measures of prevention and control on those identified cases and their close contacts; (3) To strengthen programs for the foreign immigrants on 'home quarantine'. METHODS: Under relevant parameters and information on the transmission link from different reference data, the patterns of influenza spread were simulated by Monte Carlo method. RESULTS: The temperature screening on border could inhibit the transmission of influenza A (H1N1) to some extent, so that after 3 months the cumulative number of cases will be reduced by 21.5% (1718 cases) and transmission speed of influenza A (H1N1) in mainland China will be delayed by about 4 days. Furthermore, taking positive measures of prevention and control could efficiently slow down the epidemic, so that after 3 months the cumulative number of cases will be reduced by 93.4% (about 90 thousand cases) and it would be delayed by about 15 days if influenza A (H1N1) spreads to the whole country. In addition, if the immigrants were able to practise quarantine measures consciously by themselves at home the effect of prevention and control against influenza A (H1N1) would be more significant. If 30%, 60% and 90% of immigrants would take quarantine measures home consciously, after 3 months the cumulative number of cases will be reduced by about 15% (about 940 cases), 34% (about 2230 cases) and 64% (about 4180 cases), respectively. Also, influenza A (H1N1) spreads to the whole country will be delayed by about 4 days, 10 days and 25 days, respectively. It is difficult to curb fully the development of the epidemic by taking existing control measures, and influenza A (H1N1) may spread to almost all provinces after about 3 months. CONCLUSION: The effects of existing prevention and control measures were objectively assessed and the results showed the necessity and effectiveness of these measures against the transmission of influenza A (H1N1), in the mainland of China.


Assuntos
Influenza Humana/prevenção & controle , Influenza Humana/transmissão , China/epidemiologia , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Método de Monte Carlo , Quarentena
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