Statistical considerations in a delayed‐start design to demonstrate disease modification effect in neurodegenerative disorders

There has been a paradigm shift in diagnostic conceptualization of Alzheimer's disease (AD) based on the current evidence suggesting that structure and biology changes start to occur before clinical symptoms emerge. Consequently, therapeutic drug development is also shifting to treat early AD patients using biomarkers for enrichment in clinical trials. A similar paradigm shift is occurring for Parkinson disease. In the absence of acceptable biomarkers that could be combined with a clinical endpoint to demonstrate a disease modification (DM) effect in neurodegenerative disorders, a delayed‐start design can be applied to demonstrate a lasting effect on the disease course. The delayed‐start design includes two treatment periods, where in period 1, patients are randomized to receive an active treatment or placebo, and in period 2, placebo patients are switched to the active treatment while patients in the active treatment arm will continue the same treatment. The hypothesis is that patients who start the active treatment later will fail to catch up to the treatment benefit achieved by patients who receive the active treatment in both periods. A usual analytical approach has sought to demonstrate the divergence of slope during period 1 and the parallelism of slopes during period 2 as the DM effect. However, due to heterogeneity in timing and the magnitude of maximal effect among patients, nonlinear response over time could be observed within the two treatment arms in both periods. We propose an approach to evaluate the DM effect with the linearity assumption for treatment differences, but not for each arm separately.     

Communicating about infectious disease threats: Insights from public health information officers

The public health communication challenges that arise in times of infectious disease threats (IDTs) were examined using the Risk Amplification through Media Spread (RAMS) Framework and in-depth phone interviews with 40 national, state, and local public health information officers (PIOs). Interviewees shared their experiences and insights related to how IDTs are communicated to the public, including the different types of traditional and social media used, how they develop and assess IDT messages, and their perceptions regarding the IDT risk amplification process. Theoretical and practical implications for health public relations and public health communication are discussed.     

Self-efficacy and social support for psychological well-being of family caregivers of care recipients with dementia with Lewy bodies,Parkinson’s disease dementia,or Alzheimer’s disease

The study identified factors associated with depressive symptoms in family caregivers of persons with dementia with Lewy bodies, Alzheimer’s disease, or Parkinson’s disease dementia. An Internet-based survey generated 606 response sets. Regression analysis indicated that care recipients’ memory and behavioral problems, caregivers’ self-efficacy, grief, and tangible, emotional, and affectionate support were significantly associated with caregivers’ depressive symptoms. Self-efficacy mediated caregiver burden to improve psychological well-being. Social support mediated the association between caregiver grief and psychological well-being. Social workers can provide psychoeducational interventions to help caregivers to manage emotional distress and improve capacity to manage tasks related to the dementia.     

Effectiveness of intrapartum antibiotic prophylaxis for early-onset group B Streptococcal infection: An integrative review

Background

In some countries, up to 30% of women are exposed to intrapartum antibiotic prophylaxis for prevention of early-onset group B Streptococcal infection. Intrapartum antibiotic prophylaxis aims to reduce the risk of neonatal morbidity and mortality from this infection. The intervention may adversely affect non-pathogenic bacteria which are passed to the newborn during birth and are considered important in optimising health. Since many women are offered intrapartum antibiotic prophylaxis, effectiveness and implications of this intervention need to be established. This review considers clinical trials and observational studies analysing the effectiveness of intrapartum antibiotic prophylaxis.

甘肃民族地区新型农村合作医疗运行研究

农村医疗保障制度是社会保障体系的重要组成部分,对保障广大农民身体健康、促进农村经济和社会发展起重要作用。民族地区农民＂因病致贫、因病返贫＂现象严重,甘肃民族地区新型农村合作医疗存在政府财政投入不足,筹集资金困难,基金使用率低;基金补偿率低,农民参合意愿较差;定点医疗机构偏少,医疗设备缺乏,卫生人员水平低;报销程序繁琐,报销比例低。甘肃民族地区完善新型农村合作医疗制度应进一步加大宣传,提高农民对新型农村合作医疗的认识;大力支持民族地区的经济发展,提高农民参合积极性;改善医疗条件,加大农村医疗队伍的培养和再培训力度;制定便捷的报销政策,鼓励使用中医药和民族医药;结合民族地区实际,采取各种方式拓宽筹资渠道。     

高血压病患者颈动脉粥样硬化与心血管危险因素的相关性研究

目的探讨高血压病患者颈动脉粥样硬化程度、斑块形成与高血压等心血管危险因素之间的相关性。方法检测490例高血压病患者的颈动脉内膜中层厚度、斑块,并与高血压分级、病程、脉压、年龄、性别、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸、C-反应蛋白、空腹血糖等心血管病危险因素进行相关性分析;另选253例同期住院的无高血压患者为对照组,行相关指标检测及统计学分析;并对412例高血压合并颈动脉粥样硬化者采用个体化降压治疗、强化调脂治疗。随访一年,观察治疗前后动脉粥样硬化程度变化情况及心血管事件发生情况。结果颈动脉粥样硬化、斑块形成与高血压分级程度、收缩压、脉压高血压病程呈正相关,与TC、LDL—C、UA、CRP、FBG等心血管危险因素均有关,高血压及颈动脉粥样硬化与冠心病的发病呈正相关,有统计学意义：强化降压调脂及综合性干预治疗后动脉粥样硬化程度明显减轻,临床冠心病发病率、心血管事件发生率、死亡率及再次入院率均明显降低,与治疗前比较差异显著。结论颈动脉粥样硬化及斑块的发生、发展与高血压等心血管危险因素有密切关系,早期强化降压调脂治疗及相关危险因素的综合性干预治疗可延缓动脉粥样硬化的发生发展。     

慢性肺心病患者动脉血气参数与肺性脑病的关系探讨

目的探讨慢性肺心病患者动脉血二氧化碳分压（PCO2）、氧分压（PO2）、酸碱失衡与肺性脑病发生率的关系。方法对我院2005年以来住院的慢性肺心病患者250例进行分析。结果慢性肺心病患者发生肺性脑病并发症与动脉血二氧化碳分压升高、酸中毒、氧分压降低密切相关。结论对慢性肺心病患者动态监测动脉血气有利于早期发现肺性脑病并发症和及时治疗。     

《太平经》的虫病理论初探

《太平经》是东汉道教的一部重要经典,书中隐含着古代医药学的丰富思想。探讨《太平经》中有关虫病的成因及其治疗方法,有助于揭示古代中医药学和早期道教对虫患疾病的认知程度和理论贡献。     

行为护理在冠心病护理中的应用

行为护理体现了护理模式的转变,它关注病人的行为改变,用行为的手段及方法来护理病人。运用行为手段来护理冠心病病人,对冠心病病人进行饮食干预和行为干预,使冠心病病人能够积极配合治疗,养成健康的生活方式和健康行为,有效地控制病情的发展,提高患者的生活质量,行为护理在冠心病护理中能发挥重要作用。     

老年2型糖尿病下肢血管病变的研究

目的探讨老年2型糖尿病患者下肢动静脉血管病变的特点及动静脉病变间是否存在相关性。方法用彩色多普勒超声对24例老年2型糖尿病患者及36例非2型糖尿病老年患者进行双下肢血管检查,同时测定了血压、血脂、CRP。结果老年2型糖尿病组在年龄、性别构成比、BMI、血压、血脂、动脉硬化程度及动脉内径等指标与对照组无明显差异的情况下,动脉收缩期流速峰值明显快于对照组,静脉流速峰值则较对照组慢。结论老年2型糖尿病患者在下肢动脉血管病变尚未引起内径明显改变时,可能存在其他因素引起的血管狭窄;并同时存在下肢静脉血流缓慢。