Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies.In this narrative review,we focus on the various neuro-logical manifestations in patients with ...Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies.In this narrative review,we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease,immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and following.We focused on the anti-gliadin antibodies,antibodies to different isoforms of tissue transglutaminase(TG)(anti-TG2,3,and 6 antibodies),anti-glycine receptor antibodies,anti-glutamine acid decarboxylase antibodies,anti-deamidated gliadin peptides antibodies,etc.Most studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction,presented as different neurological disorders.We also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.展开更多
Objective:To determine the healthcare utilization patterns and estimate the economic burden of animal bites in Golestan province,north part of Iran.Methods:This cross-sectional study was performed based on the data of...Objective:To determine the healthcare utilization patterns and estimate the economic burden of animal bites in Golestan province,north part of Iran.Methods:This cross-sectional study was performed based on the data of 12181 animal-bite patients from Golestan province who were referred to the rabies prophylaxis centers between March 2019 and March 2020.The study was a societal perspective,and all patients were investigated by census method.The micro-costing method with a bottom-up approach as well as the human capital approach were used to estimate the economic burden.Results:In our study,the economic burden caused by animal bites was estimated at$1383639(275354672060 Rials).The largest share of costs was related to direct healthcare costs,direct non-healthcare costs,and indirect costs accouting for 91%,5%,and 4%,respectively.In addition,the average cost of a animal-bite patient was estimated at$113.5(22605260 Rials)(The average cost of a case in type 2 and 3 exposures was$45 and$412.8,respectively).The largest share of direct healthcare costs was related to immunoglobulin,vaccine,and personnel expenses accounting for 61.3%,19.8%,and 11.65%,respectively.Conclusions:Our study shows that animal bites in Golestan province,north of Iran impose a high economic burden on the communities,especially the healthcare system,which indicates the need to review management and control programs of animal bites and rabies based on animal-bite patterns of the area.展开更多
Artificial intelligence(AI)is defined as the digital computer or computer-controlled robot's ability to mimic intelligent conduct and crucial thinking commonly associated with intelligent beings.The application of...Artificial intelligence(AI)is defined as the digital computer or computer-controlled robot's ability to mimic intelligent conduct and crucial thinking commonly associated with intelligent beings.The application of AI technology and machine learning in medicine have allowed medical practitioners to provide patients with better quality of services;and current advancements have led to a dramatic change in the healthcare system.However,many efficient applications are still in their initial stages,which need further evaluations to improve and develop these applications.Clinicians must recognize and acclimate themselves with the developments in AI technology to improve their delivery of healthcare services;but for this to be possible,a significant revision of medical education is needed to provide future leaders with the required competencies.This article reviews the potential and limitations of AI in healthcare,as well as the current medical application trends including healthcare administration,clinical decision assistance,patient health monitoring,healthcare resource allocation,medical research,and public health policy development.Also,future possibilities for further clinical and scientific practice were also summarized.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic affects all aspects of our lives,including children.With the advancement of the pandemic,children under five years old are at increased risk of hospitalization...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic affects all aspects of our lives,including children.With the advancement of the pandemic,children under five years old are at increased risk of hospitalization relative to other age groups.This makes it paramount that we develop tools to address the two critical aspects of preserving children's health–new treatment protocols and new predictive models.For those purposes,we need to understand better the effects of COVID-19 on children,and we need to be able to predict the number of affected children as a proportion of the number of infected children.This is why our research focuses on clinical and epidemiological pictures of children with heart damage post-COVID,as a part of the general picture of post-COVID among this age group.AIM To demonstrate the role of children in the COVID-19 spread in Bulgaria and to test the hypothesis that there are no secondary transmissions in schools and from children to adults.METHODS Our modeling and data show with high probability that in Bulgaria,with our current measures,vaccination strategy and contact structure,the pandemic is driven by the children and their contacts in school.RESULTS This makes it paramount that we develop tools to address the two critical aspects of preserving children's health–new treatment protocols and new predictive models.For those purposes,we need to understand better the effects of COVID-19 on children,and we need to be able to predict the number of affected children as a proportion of the number of infected children.This is why our research focuses on clinical and epidemiological pictures of children with heart damage post-COVID,as a part of the general picture of post-Covid among this age group.CONCLUSION Our modeling rejects that hypothesis,and the epidemiological data supports that.We used epidemiological data to support the validity of our modeling.The first summer wave in 2020 from the listed here school proms endorse the idea of transmissions from students to teachers.展开更多
Dietary imbalance and overeating can lead to an increasingly widespread disease-obesity.Aesthetic considerations aside,obesity is defined as an excess of adipose tissue that can lead to serious health problems and can...Dietary imbalance and overeating can lead to an increasingly widespread disease-obesity.Aesthetic considerations aside,obesity is defined as an excess of adipose tissue that can lead to serious health problems and can predispose to a number of pathological changes and clinical diseases,including diabetes;hypertension;atherosclerosis;coronary artery disease and stroke;obstructive sleep apnea;depression;weight-related arthropathies and endometrial and breast cancer.A body weight 20%above ideal for age,gender and height is a severe health risk.Bariatric surgery is a set of surgical methods to treat morbid obesity when other treatments such as diet,increased physical activity,behavioral changes and drugs have failed.The two most common procedures currently used are sleeve gastrectomy and gastric bypass.This procedure has gained popularity recently and is generally considered safe and effective.Although current data show that perioperative mortality is low and better control of comorbidities and short-term complications is achieved,more randomized trials are needed to evaluate the long-term outcomes of bariatric procedures.This review aims to synthesize and summarize the growing evidence on the long-term effectiveness,outcomes and complications of bariatric surgery.展开更多
BACKGROUND Cholangiocarcinoma(CCA)is an intractable cancer,and its incidence in north eastern Thailand is the highest worldwide.Infection with the liver fluke Opisthorchis viverrini(OV)has been associated with CCA ris...BACKGROUND Cholangiocarcinoma(CCA)is an intractable cancer,and its incidence in north eastern Thailand is the highest worldwide.Infection with the liver fluke Opisthorchis viverrini(OV)has been associated with CCA risk.However,animal experiments have suggested that OV alone does not induce CCA,but its combination with a chemical carcinogen like nitrosamine can cause experimentally induced CCA in hamsters.Therefore,in humans,other environmental and genetic factors may also be involved.AIM To examine relations between risk for CCA and genetic polymorphisms in carcinogenmetabolizing and inflammation-related genes.METHODS This hospital-based case-control study enrolled 95 case-control pairs matched by age(±5 years)and sex.We examined relations between risk for CCA and genetic polymorphisms in carcinogenmetabolizing and inflammation-related genes,serum anti-OV,alcohol consumption,and smoking.Polymorphisms of CYP2E1,IL-6(-174 and-634),IL-10(-819),and NF-κB(-94)and their cooccurrence with polymorphisms in the drug-metabolizing enzyme gene GSTT1 or GSTM1 were also analyzed.RESULTS Although CCA risk was not significantly associated with any single polymorphism,persons with the GSTT1 wild-type and CYP2E1 c1/c2+c2/c2 genotype had an increased risk(OR=3.33,95%CI:1.23-9.00)as compared with persons having the GSTT1 wild-type and CYP2E1 c1/c1 wild genotype.The presence of anti-OV in serum was associated with a 7-to 11-fold increased risk,and smoking level was related to an OR of 1.5-1.8 in multivariable analyses adjusted for each of the seven genetic polymorphisms.CONCLUSION In addition to infection with OV,gene-gene interactions may be considered as one of the risk factors for CCA development.展开更多
BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have diff...BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have different conclusions.AIM To explore the medium-term effect of postoperative HRQoL in such patients.METHODS This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups.HRQoL was assessed during the preoperative period and 3,6,and 12 mo postoperative using a modified version of the 36-Item Short Form(SF-36)Health Survey questionnaire,emphasizing eight specific items.RESULTS This cohort randomly assigned 541 patients to receive LR(n=296)or OR(n=245)surgical procedures.More episodes of postoperative urinary tract infection(P<0.001),wound infection(P<0.001),and pneumonia(P=0.048)were encountered in the OR group.The results demonstrated that the LR group subjectively gained mildly better general health(P=0.045),moderately better physical activity(P=0.006),and significantly better social function recovery(P=0.0001)3 mo postoperatively.Only the aspect of social function recovery was claimed at 6 mo,with a significant advantage in the LR group(P=0.001).No clinical difference was found in HRQoL during the 12 mo.CONCLUSION Our results demonstrated that LR resulted in better outcomes,including intra-operative blood loss,surgery-related complications,course of recovery,and especially some health domains of HRQoL at least within 6 mo postoperatively.Patients should undergo LR if there is no contraindication.展开更多
BACKGROUND In this study,recent trends in the distribution and drug resistance of pathogenic bacteria isolated from patients treated at a burn ward between 2006 and 2019 were investigated.AIM To develop more effective...BACKGROUND In this study,recent trends in the distribution and drug resistance of pathogenic bacteria isolated from patients treated at a burn ward between 2006 and 2019 were investigated.AIM To develop more effective clinical strategies and techniques for the prevention and treatment of bacterial infections in burn patients.METHODS Clinical samples with positive bacteria were collected from patients at the burn ward in Beijing Jishuitan Hospital in China between January 2006 and December 2019.The samples were retrospectively analyzed,the distribution of pathogenic bacteria was determined,and the trends and changes in bacterial drug resistance during different period were assessed.Drug resistance in several main pathogenic bacteria from 2006 to 2011 and from 2012 to 2019 was comparatively summarized and analyzed.RESULTS Samples from 17119 patients were collected and analyzed from 2006 to 2019.Surprisingly,a total of 7960 strains of different pathogenic bacteria were isolated at this hospital.Among these bacteria,87.98%(7003/7960)of the strains were isolated from burn wounds,and only 1.34%(107/7960)were isolated from the blood of patients.In addition,49.70%(3956/7960)were identified as Grampositive bacteria,48.13%(3831/7960)were Gram-negative bacteria,and the remaining 2.17%(173/7960)were classified as fungi or other pathogens.Importantly,Staphylococcus aureus(21.68%),Pseudomonas aeruginosa(14.23%),and Staphylococcus epidermidis (9.61%) were the top three pathogens most frequentlyisolated from patients.CONCLUSION In patients treated at the burn ward in this hospital from 2006 to 2019,Staphylococcus aureus and Pseudomonas aeruginosa were the predominant clinicalpathogens responsible for bacterial infections. The circumstantial detection anddetailed monitoring of the intensity and growth of different pathogenic bacteria inclinical patients as well as tests of drug sensitivity during burn recovery areparticularly important to provide guidelines for the application of antibiotics andother related drugs. Careful collection and correct, standard culture of bacterialspecimens are also crucial to improve the efficiency of bacterial infectiondetection. Effective monitoring and timely clinical treatment in patients may helpreduce the possibility and rate of infection as well as alleviate the effects of drugresistance among patients in burn centers.展开更多
BACKGROUND Purpura nephritis,also called Henoch-Schönlein purpura nephritis,is a systemic disease with small dead vasculitis as the main pathological change.AIM To observe the influence of transitional nursing ac...BACKGROUND Purpura nephritis,also called Henoch-Schönlein purpura nephritis,is a systemic disease with small dead vasculitis as the main pathological change.AIM To observe the influence of transitional nursing activities on the compliance behaviors and disease knowledge of children with purpura nephritis.METHODS A total of 82 children with purpura nephritis were included and divided into a general nursing group(41 children)and transitional nursing group(41 children)using the envelope method.The general nursing group received routine nursing care,while the transitional nursing group received transitional nursing care.The behaviors,knowledge of the disease,and self-management ability of the two groups were evaluated after nursing care was provided.RESULTS The scores of four items(self-care ability,self-responsibility,health knowledge level,and self-concept)in the transitional nursing group were significantly higher than those in the general nursing group.CONCLUSION Transitional nursing can directly improve the disease knowledge level and selfmanagement ability of children with purpura nephritis and effectively reduce complications.展开更多
AIM: To investigate whether the use of statins is associated with colorectal cancer risk. METHODS: We conducted a population-based case-control study in Taiwan. Data were retrospectively collected from the Taiwan Nati...AIM: To investigate whether the use of statins is associated with colorectal cancer risk. METHODS: We conducted a population-based case-control study in Taiwan. Data were retrospectively collected from the Taiwan National Health Insurance Research Database. Cases consisted of all patients who were aged 50 years and older and had a first-time diagnosis of colorectal cancer between the period 2005 and 2008. The controls were matched to cases by age, sex, and index date. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multiple logistic regression. RESULTS: We examined 1156 colorectal cancer cases and 4624 controls. The unadjusted ORs for any statin prescription was 1.10 (95% CI = 0.94-1.30) and the adjusted OR was 1.09 (95% CI = 0.91-1.30). When statin use was categorized by cumulative dose, the adjusted ORs were 0.99 (95% CI = 0.78-1.27) for the group with cumulative statin use below 105 defined daily doses (DDDs); 1.07 (95% CI = 0.78-1.49) for the group with cumulative statin use between 106 and 298.66 DDDs; and 1.30 (95% CI = 0.96-1.75) for the group with cumulative statin use of 298.66 DDDs or more compared with nonusers. CONCLUSION: This study does not provide support for a protective effect of statins against colorectal cancer.展开更多
BACKGROUND Gastrointestinal symptoms are prevalent in patients with cirrhosis.Cirrhotic patients have a known predilection to delayed gastric emptying compared to those without cirrhosis.However,the contributing facto...BACKGROUND Gastrointestinal symptoms are prevalent in patients with cirrhosis.Cirrhotic patients have a known predilection to delayed gastric emptying compared to those without cirrhosis.However,the contributing factors have not been fully elucidated.Retained gastric food on esophagogastroduodenoscopy(EGD)has been used as a surrogate marker for delayed gastric emptying with reasonably high specificity.Therefore,we hypothesize that the frequency of retained gastric food contents at EGD will be higher in a cirrhotic population compared to a control population without liver disease.Additionally,we hypothesize that increased frequency of gastric food contents will be associated with increased severity of cirrhosis.AIM To determine the relative frequency of delayed gastric emptying among cirrhotics as compared to non-cirrhotics and to identify associated factors.METHODSWe performed a retrospective case-control study of cirrhotic subjects whounderwent EGD at an academic medical center between 2000 and 2015. Threehundred sixty-four patients with confirmed cirrhosis, who underwent a total of1044 EGDs for the indication of esophageal variceal screening or surveillance,were identified. During the same period, 519 control patients without liverdisease, who underwent a total of 881 EGDs for the indication of anemia, wereidentified. The presence of retained food on EGD was used as a surrogate fordelayed gastric emptying. The relative frequency of delayed gastric emptyingamong cirrhotics was compared to non-cirrhotics. Characteristics of patients withand without retained food on EGD were compared using univariable andmultivariable logistic regression analysis to identify associated factors.RESULTSOverall, 40 (4.5%) patients had evidence of retained food on EGD. Cirrhotics weremore likely to have retained food on EGD than non-cirrhotics (9.1% vs 1.4%, P <0.001). Characteristics associated with retained food on univariable analysisincluded age less than 60 years (12.6% vs 5.2%, P = 0.015), opioid use (P = 0.004),Child-Pugh class C (24.1% Child-Pugh class C vs 6.4% Child-Pugh class A, P =0.007), and lower platelet count (P = 0.027). On multivariate logistic regressionanalysis, in addition to the presence of cirrhosis (adjusted OR = 5.83;95%CI: 2.32-14.7, P < 0.001), diabetes mellitus (types 1 and 2 combined) (OR = 2.34;95%CI:1.08-5.06, P = 0.031), opioid use (OR = 3.08;95%CI: 1.29-7.34, P = 0.011), andChild-Pugh class C (OR = 4.29;95%CI: 1.43-12.9, P = 0.01) were also associatedwith a higher likelihood of food retention on EGD.CONCLUSIONCirrhotics have a higher frequency of retained food at EGD than non-cirrhotics.Decompensated cirrhosis, defined by Child-Pugh class C, is associated with ahigher likelihood of delayed gastric emptying.展开更多
Objective: Porcine liver extract has been shown to be effective in the clinical treatment of severe hepatitis. The aim of the present study was to study its antifibrotic as well as immune regulatory effect in vitro. M...Objective: Porcine liver extract has been shown to be effective in the clinical treatment of severe hepatitis. The aim of the present study was to study its antifibrotic as well as immune regulatory effect in vitro. Methods: Hepatocytes, hepatic stellate cells (HSCs), hepatoma cell line (HepG2) and human peripheral blood mononuclear cells (PMNCs) were studied with respect to proliferation, extracellular matrix production and apoptotic activities by proliferation assay, radioimmunoassay, gene transfection, reporter gene analysis and flow cytometry, respectively. Results: A strong stimulatory proliferation effect was observed in hepatocytes, and an inhibitory effect was found in HSCs. Hyaluronic acid (HA) production and reporter gene activities driven by various α1(I) procollagen gene promoters in HSC-T6 were significantly decreased after treatment with the extract. Fluo-Anexin V binding apoptotic HepG2 cells were more prominent in the presence of 60 μg/ml extract. More CD4+/CD69+ positive T lymphocytes existed in the presence of the extract. Conclusion: Porcine liver extract is effective for antifibrogenesis via hepatocyteregeneration, HSC and hepatoma cell inhibition in vitro. The elevation of active T lymphocytes is helpful for immune surveillance. Fine mapping of the extract is necessary in order to get definite molecules which are essential in all described functions.展开更多
Diabetic macular edema(DME) is a major sight-threatening cause in diabetic patients. We review the long-term outcome of four approved pharmacotherapy for treating DME, including intravitreal injections of corticostero...Diabetic macular edema(DME) is a major sight-threatening cause in diabetic patients. We review the long-term outcome of four approved pharmacotherapy for treating DME, including intravitreal injections of corticosteroids(dexamethasone implants and fluocinolone acetonide inserts) and anti-vascular endothelial growth factor(VEGF)(ranibizumab and aflibercept). They all show superior ability to improve vision and reduce macular thickness, comparing with sham injections or macular focal/grid laser treatment. Anti-VEGF agents result in low incidence of severe ocular or systemic adverse effects, but glaucoma and cataract should be aware after intravitreal corticosteroids. Prompt treatment with these agents can lead to a better outcome.展开更多
Objective: To investigate the neuroprotective effects of Syzygium aromaticum(S.aromaticum)extract(500 mg/kg) on AlCl_3(300 mg/kg)-induced mouse model of oxidative stress and neurotoxicity.Methods: An ethanolic extract...Objective: To investigate the neuroprotective effects of Syzygium aromaticum(S.aromaticum)extract(500 mg/kg) on AlCl_3(300 mg/kg)-induced mouse model of oxidative stress and neurotoxicity.Methods: An ethanolic extract of S.aromaticum seeds was prepared and the active compounds were identified using nuclear magnetic resonance spectroscopy.BALB/c mice were divided into five groups(negative control, AlCl_3-treated, self-recovery, AlCl_3 + S.aromaticum, S.aromaticum only; n=10) and treated with AlCl_3 and S.aromaticum extract.Expression of oxidative markers [Superoxide dismutase 1(SOD1) and peroxiredoxin 6(Prdx6)] and amyloid precursor protein(APP) in the hippocampus and cortex was evaluated via PCR.Histopathological assessment was performed to investigate the extent of neurodegeneration.Results: It was observed that AlCl_3 exposure increased the expression of APP770 while simultaneously down regulated the expression of APP695.AlCl_3 also induced a significant decrease(P<0.05) and an increase(P<0.05) in the expression level of SOD1 and Prdx6, respectively.A substantial decrease substantial(P<0.05) in the density of Nissl substance was also observed in cortex of the mice treated with AlCl_3.Interestingly, treatment with S.aromaticum extract normalized the alterations in the expression level of SOD1, Prdx6 and APPisoforms and improved the neuronal structural damage.Conclusions: The results showed that S.aromaticum is a promising antioxidant and a neuroprotective agent.展开更多
Objective: This study was conducted to explore what media exactly do when disease is emerging and furthermore, to infer the role and the responsibility that media should play. Method: A content analysis with 0.81 inte...Objective: This study was conducted to explore what media exactly do when disease is emerging and furthermore, to infer the role and the responsibility that media should play. Method: A content analysis with 0.81 inter-rater reliability was adopted to categorize SARS-related events shown on the three major newspapers in 117 days, dated from March 13th (the date before the first probable case of SARS in Taiwan was identified) to July 7th (the date after Taiwan was removed from the list of SARS-affected countries by the bulletin of World Health Organization), 2003. Results: There were totally 8923 SARS events related news found in the observed newspapers during the study period. When the epidemic situation is more serious, the media will also lay out more coverage on reporting the related contents. In the reporting contents, the three most influential newspapers in Taiwan mainly emphasized the impact dimension (34.27%). Only 2.16% of the coverage was on the topic of health communication and prevention education. Overall, the opinions of general public are the primary sources of news (46.57%). Health authority was not the main and typical sources information of the press (9.42%). Conclusion: Media is a double-edged sword in the communicable disease control. We suggest that the health authority should take advantage of media to transmit message rapidly to convey related information to public.展开更多
Human immunodeficiency virus(HIV) is rapidly increasing in both high risk groups and the general population.In this study, silent routes of propagation in teenaged Pakistanis are discussed. In order to promote sexual ...Human immunodeficiency virus(HIV) is rapidly increasing in both high risk groups and the general population.In this study, silent routes of propagation in teenaged Pakistanis are discussed. In order to promote sexual activity in youths, regular clients write contact details of sex workers on the doors of public washrooms. HIV prevalence is much higher among Hijra sex workers.Hijra sex workers have apparently stepped into the profession of begging at public places, where they earn money by both begging and distributing visiting cards offering unsafe sex. In many educational institutes, sex education is lacking or absent; if delivered via teachers,government agencies and nongovernmental organizations this could prevent a future epidemic of sexually transmitted infections in Pakistan.展开更多
Myopic choroidal neovascularization(mCNV) can cause severe visual impairment in highly myopic patients. We review the randomized trials of two approved pharmacotherapy for treating mCNV, including intravitreal injecti...Myopic choroidal neovascularization(mCNV) can cause severe visual impairment in highly myopic patients. We review the randomized trials of two approved pharmacotherapy for treating mCNV, including intravitreal injections of ranibizumab and aflibercept. These two vascular endothelial growth factor(VEGF) antagonists show superior ability to improve vision and reduce macular thickness, comparing with sham injections or verteporfin photodynamic therapy(vPDT). There is no severe ocular or systemic adverse reaction reported in studies associated with ranibizumab and aflibercept for mCNV. Prompt treatment with these agents can lead to a better outcome.展开更多
Purpose:The aim of the study was to investigate the actual benefits of the electronic official document online submission and approval system and the satisfaction of hospital staff in a medical center in southern Taiw...Purpose:The aim of the study was to investigate the actual benefits of the electronic official document online submission and approval system and the satisfaction of hospital staff in a medical center in southern Taiwan,and to find out whether there are any differences between medical institutions and general government personnel.Methods:A cross-sectional study was conducted to investigate satisfactory outcome with questionnaires.The subjects were administrators,healthcare professionals and medical personnel of a medical center in the southern part of Taiwan who had signed electronic documents online.A total of 395 questionnaires were sent out,147 of which were valid,and the rate of collecting data survey was 37%.We analyzed with SPSS version 20.Results:The official document approval system was mainly used by administrative units and contractors,accounting for more than 50%of users.Besides,the frequency of use was at least more than once a week.As for the user’s perception of operating system,most people thought that it is easier to choose the format of official document and to set up the duty agent on leave,but in the part of the signing and approval process setting or modifying,it was considered more difficult,accounting for 38.1%.In terms of perceptual usefulness,the average value was 3.81,which showed that the user agreed that the system has met the needs of daily official documents.When some users of service area encountered problems with their use,the clerical staff were able to provide services immediately and have the professional ability to resolve problems,in order to agree to the majority,accounting for 53.7%.In addition,nearly 60%of users rated the official document system positively,with an average of 3.84 satisfaction,which was higher than the certified value of 3,conforming to the standards for satisfaction with the use of official documents.In addition,the role authorization,perceptual easy-to-use and service area were significant(p<0.05).The perceptual usefulness of Subordinate units was also significant(p=0.016).The frequency of use,perceptual easy-to-use,perceptual usefulness,service area and satisfaction were significantly different(p<0.05).The correlation coefficient between perceptual usefulness and user satisfaction was 0.833,indicating that there was a high correlation.The daily usage frequency of contractors was higher than supervisors.However,supervisors had the highest frequency of use every quarter(p=0.135).There was no significant difference between contractors and supervisors in the frequency of use.Conclusion:It is suggested that education and training on the operation of the electronic official document on-line submission and approval system should be conducted,which can enhance the education and training of supervisors and medical personnel.Continually,invite supervisors and medical personnel to provide advices on the official document system as a reference for future improvements of the system.展开更多
Objective:This study aimed to evaluate the influence of advanced glycation end-product(AGE)accumulation on the prevalence and severity of overactive bladder(OAB)in community-dwelling elderly adults.Methods:We conducte...Objective:This study aimed to evaluate the influence of advanced glycation end-product(AGE)accumulation on the prevalence and severity of overactive bladder(OAB)in community-dwelling elderly adults.Methods:We conducted a cross-sectional study involving 269 Japanese community dwellers aged≥75 years in 2015.AGE accumulation was non-invasively measured via skin autofluorescence(SAF)values using AGE Reader.The primary and secondary outcomes were the presence and severity of OAB evaluated using the Overactive Bladder Symptom Score(OABSS).Individuals with an urgency score of≥2 and sum score of≥3 were considered to have OAB.The associations of SAF with the prevalence and severity of OAB were assessed using logistic and linear regression models,respectively,adjusted for clinically important confounders.Results:The median age of participants was 78 years.Of 269 participants,110(40.9%)were men and 75(27.9%)had OAB.The median SAF was 2.2 arbitrary units(AUs).Increasing median SAF was observed with increasing age.Multivariable analysis revealed that SAF was not associated with either the likelihood of having OAB(odds ratio per AU=0.77,95%confidence interval:0.37-1.62)or the natural log-transformed OABSS(0 per AU=-0.07,95%confidence interval:-0.26-0.12).Conclusions:In this study,AGE accumulation,as assessed by SAF,was not associated with the prevalence and severity of OAB in Japanese community-dwelling elderly people aged≥75 years.展开更多
基金Supported by The European Union-NextGenerationEU,Through The National Recov-ery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008。
文摘Gluten ataxia and other central nervous system disorders could be linked to gluten enteropathy and related autoantibodies.In this narrative review,we focus on the various neuro-logical manifestations in patients with gluten sensitivity/celiac disease,immunological and autoimmune mechanisms of ataxia in connection to gluten sensitivity and the autoantibodies that could be used as a biomarker for diagnosing and following.We focused on the anti-gliadin antibodies,antibodies to different isoforms of tissue transglutaminase(TG)(anti-TG2,3,and 6 antibodies),anti-glycine receptor antibodies,anti-glutamine acid decarboxylase antibodies,anti-deamidated gliadin peptides antibodies,etc.Most studies found a higher prevalence of these antibodies in patients with gluten sensitivity and neurological dysfunction,presented as different neurological disorders.We also discuss the role of a gluten-free diet on the clinical improvement of patients and also on imaging of these disorders.
文摘Objective:To determine the healthcare utilization patterns and estimate the economic burden of animal bites in Golestan province,north part of Iran.Methods:This cross-sectional study was performed based on the data of 12181 animal-bite patients from Golestan province who were referred to the rabies prophylaxis centers between March 2019 and March 2020.The study was a societal perspective,and all patients were investigated by census method.The micro-costing method with a bottom-up approach as well as the human capital approach were used to estimate the economic burden.Results:In our study,the economic burden caused by animal bites was estimated at$1383639(275354672060 Rials).The largest share of costs was related to direct healthcare costs,direct non-healthcare costs,and indirect costs accouting for 91%,5%,and 4%,respectively.In addition,the average cost of a animal-bite patient was estimated at$113.5(22605260 Rials)(The average cost of a case in type 2 and 3 exposures was$45 and$412.8,respectively).The largest share of direct healthcare costs was related to immunoglobulin,vaccine,and personnel expenses accounting for 61.3%,19.8%,and 11.65%,respectively.Conclusions:Our study shows that animal bites in Golestan province,north of Iran impose a high economic burden on the communities,especially the healthcare system,which indicates the need to review management and control programs of animal bites and rabies based on animal-bite patterns of the area.
文摘Artificial intelligence(AI)is defined as the digital computer or computer-controlled robot's ability to mimic intelligent conduct and crucial thinking commonly associated with intelligent beings.The application of AI technology and machine learning in medicine have allowed medical practitioners to provide patients with better quality of services;and current advancements have led to a dramatic change in the healthcare system.However,many efficient applications are still in their initial stages,which need further evaluations to improve and develop these applications.Clinicians must recognize and acclimate themselves with the developments in AI technology to improve their delivery of healthcare services;but for this to be possible,a significant revision of medical education is needed to provide future leaders with the required competencies.This article reviews the potential and limitations of AI in healthcare,as well as the current medical application trends including healthcare administration,clinical decision assistance,patient health monitoring,healthcare resource allocation,medical research,and public health policy development.Also,future possibilities for further clinical and scientific practice were also summarized.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic affects all aspects of our lives,including children.With the advancement of the pandemic,children under five years old are at increased risk of hospitalization relative to other age groups.This makes it paramount that we develop tools to address the two critical aspects of preserving children's health–new treatment protocols and new predictive models.For those purposes,we need to understand better the effects of COVID-19 on children,and we need to be able to predict the number of affected children as a proportion of the number of infected children.This is why our research focuses on clinical and epidemiological pictures of children with heart damage post-COVID,as a part of the general picture of post-COVID among this age group.AIM To demonstrate the role of children in the COVID-19 spread in Bulgaria and to test the hypothesis that there are no secondary transmissions in schools and from children to adults.METHODS Our modeling and data show with high probability that in Bulgaria,with our current measures,vaccination strategy and contact structure,the pandemic is driven by the children and their contacts in school.RESULTS This makes it paramount that we develop tools to address the two critical aspects of preserving children's health–new treatment protocols and new predictive models.For those purposes,we need to understand better the effects of COVID-19 on children,and we need to be able to predict the number of affected children as a proportion of the number of infected children.This is why our research focuses on clinical and epidemiological pictures of children with heart damage post-COVID,as a part of the general picture of post-Covid among this age group.CONCLUSION Our modeling rejects that hypothesis,and the epidemiological data supports that.We used epidemiological data to support the validity of our modeling.The first summer wave in 2020 from the listed here school proms endorse the idea of transmissions from students to teachers.
基金Supported by the European Union-NextGenerationEU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No. BG-RRP-2.004-0008-C01。
文摘Dietary imbalance and overeating can lead to an increasingly widespread disease-obesity.Aesthetic considerations aside,obesity is defined as an excess of adipose tissue that can lead to serious health problems and can predispose to a number of pathological changes and clinical diseases,including diabetes;hypertension;atherosclerosis;coronary artery disease and stroke;obstructive sleep apnea;depression;weight-related arthropathies and endometrial and breast cancer.A body weight 20%above ideal for age,gender and height is a severe health risk.Bariatric surgery is a set of surgical methods to treat morbid obesity when other treatments such as diet,increased physical activity,behavioral changes and drugs have failed.The two most common procedures currently used are sleeve gastrectomy and gastric bypass.This procedure has gained popularity recently and is generally considered safe and effective.Although current data show that perioperative mortality is low and better control of comorbidities and short-term complications is achieved,more randomized trials are needed to evaluate the long-term outcomes of bariatric procedures.This review aims to synthesize and summarize the growing evidence on the long-term effectiveness,outcomes and complications of bariatric surgery.
基金Supported by Japan Society for the Promotion of Science,No.21406011.
文摘BACKGROUND Cholangiocarcinoma(CCA)is an intractable cancer,and its incidence in north eastern Thailand is the highest worldwide.Infection with the liver fluke Opisthorchis viverrini(OV)has been associated with CCA risk.However,animal experiments have suggested that OV alone does not induce CCA,but its combination with a chemical carcinogen like nitrosamine can cause experimentally induced CCA in hamsters.Therefore,in humans,other environmental and genetic factors may also be involved.AIM To examine relations between risk for CCA and genetic polymorphisms in carcinogenmetabolizing and inflammation-related genes.METHODS This hospital-based case-control study enrolled 95 case-control pairs matched by age(±5 years)and sex.We examined relations between risk for CCA and genetic polymorphisms in carcinogenmetabolizing and inflammation-related genes,serum anti-OV,alcohol consumption,and smoking.Polymorphisms of CYP2E1,IL-6(-174 and-634),IL-10(-819),and NF-κB(-94)and their cooccurrence with polymorphisms in the drug-metabolizing enzyme gene GSTT1 or GSTM1 were also analyzed.RESULTS Although CCA risk was not significantly associated with any single polymorphism,persons with the GSTT1 wild-type and CYP2E1 c1/c2+c2/c2 genotype had an increased risk(OR=3.33,95%CI:1.23-9.00)as compared with persons having the GSTT1 wild-type and CYP2E1 c1/c1 wild genotype.The presence of anti-OV in serum was associated with a 7-to 11-fold increased risk,and smoking level was related to an OR of 1.5-1.8 in multivariable analyses adjusted for each of the seven genetic polymorphisms.CONCLUSION In addition to infection with OV,gene-gene interactions may be considered as one of the risk factors for CCA development.
基金Supported by The Research Foundation of E-Da Cancer Hospital and E-Da Hospital,Kaohsiung,Taiwan,No.EDCHI111002 and NCKUEDA11110.
文摘BACKGROUND Previous studies that compared the postoperative health-related quality of life(HRQoL)outcomes after receiving laparoscopic resection(LR)or open resection(OR)in patients with colorectal cancer(CRC)have different conclusions.AIM To explore the medium-term effect of postoperative HRQoL in such patients.METHODS This study randomized 567 patients undergoing non-metastatic CRC surgery managed by one surgeon to the LR or OR groups.HRQoL was assessed during the preoperative period and 3,6,and 12 mo postoperative using a modified version of the 36-Item Short Form(SF-36)Health Survey questionnaire,emphasizing eight specific items.RESULTS This cohort randomly assigned 541 patients to receive LR(n=296)or OR(n=245)surgical procedures.More episodes of postoperative urinary tract infection(P<0.001),wound infection(P<0.001),and pneumonia(P=0.048)were encountered in the OR group.The results demonstrated that the LR group subjectively gained mildly better general health(P=0.045),moderately better physical activity(P=0.006),and significantly better social function recovery(P=0.0001)3 mo postoperatively.Only the aspect of social function recovery was claimed at 6 mo,with a significant advantage in the LR group(P=0.001).No clinical difference was found in HRQoL during the 12 mo.CONCLUSION Our results demonstrated that LR resulted in better outcomes,including intra-operative blood loss,surgery-related complications,course of recovery,and especially some health domains of HRQoL at least within 6 mo postoperatively.Patients should undergo LR if there is no contraindication.
文摘BACKGROUND In this study,recent trends in the distribution and drug resistance of pathogenic bacteria isolated from patients treated at a burn ward between 2006 and 2019 were investigated.AIM To develop more effective clinical strategies and techniques for the prevention and treatment of bacterial infections in burn patients.METHODS Clinical samples with positive bacteria were collected from patients at the burn ward in Beijing Jishuitan Hospital in China between January 2006 and December 2019.The samples were retrospectively analyzed,the distribution of pathogenic bacteria was determined,and the trends and changes in bacterial drug resistance during different period were assessed.Drug resistance in several main pathogenic bacteria from 2006 to 2011 and from 2012 to 2019 was comparatively summarized and analyzed.RESULTS Samples from 17119 patients were collected and analyzed from 2006 to 2019.Surprisingly,a total of 7960 strains of different pathogenic bacteria were isolated at this hospital.Among these bacteria,87.98%(7003/7960)of the strains were isolated from burn wounds,and only 1.34%(107/7960)were isolated from the blood of patients.In addition,49.70%(3956/7960)were identified as Grampositive bacteria,48.13%(3831/7960)were Gram-negative bacteria,and the remaining 2.17%(173/7960)were classified as fungi or other pathogens.Importantly,Staphylococcus aureus(21.68%),Pseudomonas aeruginosa(14.23%),and Staphylococcus epidermidis (9.61%) were the top three pathogens most frequentlyisolated from patients.CONCLUSION In patients treated at the burn ward in this hospital from 2006 to 2019,Staphylococcus aureus and Pseudomonas aeruginosa were the predominant clinicalpathogens responsible for bacterial infections. The circumstantial detection anddetailed monitoring of the intensity and growth of different pathogenic bacteria inclinical patients as well as tests of drug sensitivity during burn recovery areparticularly important to provide guidelines for the application of antibiotics andother related drugs. Careful collection and correct, standard culture of bacterialspecimens are also crucial to improve the efficiency of bacterial infectiondetection. Effective monitoring and timely clinical treatment in patients may helpreduce the possibility and rate of infection as well as alleviate the effects of drugresistance among patients in burn centers.
文摘BACKGROUND Purpura nephritis,also called Henoch-Schönlein purpura nephritis,is a systemic disease with small dead vasculitis as the main pathological change.AIM To observe the influence of transitional nursing activities on the compliance behaviors and disease knowledge of children with purpura nephritis.METHODS A total of 82 children with purpura nephritis were included and divided into a general nursing group(41 children)and transitional nursing group(41 children)using the envelope method.The general nursing group received routine nursing care,while the transitional nursing group received transitional nursing care.The behaviors,knowledge of the disease,and self-management ability of the two groups were evaluated after nursing care was provided.RESULTS The scores of four items(self-care ability,self-responsibility,health knowledge level,and self-concept)in the transitional nursing group were significantly higher than those in the general nursing group.CONCLUSION Transitional nursing can directly improve the disease knowledge level and selfmanagement ability of children with purpura nephritis and effectively reduce complications.
基金Supported by A grant from the National Science Council, Executive Yuan, Taiwan, No. NSC97-2314-B-037-006-MY3
文摘AIM: To investigate whether the use of statins is associated with colorectal cancer risk. METHODS: We conducted a population-based case-control study in Taiwan. Data were retrospectively collected from the Taiwan National Health Insurance Research Database. Cases consisted of all patients who were aged 50 years and older and had a first-time diagnosis of colorectal cancer between the period 2005 and 2008. The controls were matched to cases by age, sex, and index date. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multiple logistic regression. RESULTS: We examined 1156 colorectal cancer cases and 4624 controls. The unadjusted ORs for any statin prescription was 1.10 (95% CI = 0.94-1.30) and the adjusted OR was 1.09 (95% CI = 0.91-1.30). When statin use was categorized by cumulative dose, the adjusted ORs were 0.99 (95% CI = 0.78-1.27) for the group with cumulative statin use below 105 defined daily doses (DDDs); 1.07 (95% CI = 0.78-1.49) for the group with cumulative statin use between 106 and 298.66 DDDs; and 1.30 (95% CI = 0.96-1.75) for the group with cumulative statin use of 298.66 DDDs or more compared with nonusers. CONCLUSION: This study does not provide support for a protective effect of statins against colorectal cancer.
基金Supported by Clinical and Translational Science Center,No.CTSC Grant UL1 TR002384
文摘BACKGROUND Gastrointestinal symptoms are prevalent in patients with cirrhosis.Cirrhotic patients have a known predilection to delayed gastric emptying compared to those without cirrhosis.However,the contributing factors have not been fully elucidated.Retained gastric food on esophagogastroduodenoscopy(EGD)has been used as a surrogate marker for delayed gastric emptying with reasonably high specificity.Therefore,we hypothesize that the frequency of retained gastric food contents at EGD will be higher in a cirrhotic population compared to a control population without liver disease.Additionally,we hypothesize that increased frequency of gastric food contents will be associated with increased severity of cirrhosis.AIM To determine the relative frequency of delayed gastric emptying among cirrhotics as compared to non-cirrhotics and to identify associated factors.METHODSWe performed a retrospective case-control study of cirrhotic subjects whounderwent EGD at an academic medical center between 2000 and 2015. Threehundred sixty-four patients with confirmed cirrhosis, who underwent a total of1044 EGDs for the indication of esophageal variceal screening or surveillance,were identified. During the same period, 519 control patients without liverdisease, who underwent a total of 881 EGDs for the indication of anemia, wereidentified. The presence of retained food on EGD was used as a surrogate fordelayed gastric emptying. The relative frequency of delayed gastric emptyingamong cirrhotics was compared to non-cirrhotics. Characteristics of patients withand without retained food on EGD were compared using univariable andmultivariable logistic regression analysis to identify associated factors.RESULTSOverall, 40 (4.5%) patients had evidence of retained food on EGD. Cirrhotics weremore likely to have retained food on EGD than non-cirrhotics (9.1% vs 1.4%, P <0.001). Characteristics associated with retained food on univariable analysisincluded age less than 60 years (12.6% vs 5.2%, P = 0.015), opioid use (P = 0.004),Child-Pugh class C (24.1% Child-Pugh class C vs 6.4% Child-Pugh class A, P =0.007), and lower platelet count (P = 0.027). On multivariate logistic regressionanalysis, in addition to the presence of cirrhosis (adjusted OR = 5.83;95%CI: 2.32-14.7, P < 0.001), diabetes mellitus (types 1 and 2 combined) (OR = 2.34;95%CI:1.08-5.06, P = 0.031), opioid use (OR = 3.08;95%CI: 1.29-7.34, P = 0.011), andChild-Pugh class C (OR = 4.29;95%CI: 1.43-12.9, P = 0.01) were also associatedwith a higher likelihood of food retention on EGD.CONCLUSIONCirrhotics have a higher frequency of retained food at EGD than non-cirrhotics.Decompensated cirrhosis, defined by Child-Pugh class C, is associated with ahigher likelihood of delayed gastric emptying.
基金Supported by the National Natural Science Foundation of China (30270605)
文摘Objective: Porcine liver extract has been shown to be effective in the clinical treatment of severe hepatitis. The aim of the present study was to study its antifibrotic as well as immune regulatory effect in vitro. Methods: Hepatocytes, hepatic stellate cells (HSCs), hepatoma cell line (HepG2) and human peripheral blood mononuclear cells (PMNCs) were studied with respect to proliferation, extracellular matrix production and apoptotic activities by proliferation assay, radioimmunoassay, gene transfection, reporter gene analysis and flow cytometry, respectively. Results: A strong stimulatory proliferation effect was observed in hepatocytes, and an inhibitory effect was found in HSCs. Hyaluronic acid (HA) production and reporter gene activities driven by various α1(I) procollagen gene promoters in HSC-T6 were significantly decreased after treatment with the extract. Fluo-Anexin V binding apoptotic HepG2 cells were more prominent in the presence of 60 μg/ml extract. More CD4+/CD69+ positive T lymphocytes existed in the presence of the extract. Conclusion: Porcine liver extract is effective for antifibrogenesis via hepatocyteregeneration, HSC and hepatoma cell inhibition in vitro. The elevation of active T lymphocytes is helpful for immune surveillance. Fine mapping of the extract is necessary in order to get definite molecules which are essential in all described functions.
文摘Diabetic macular edema(DME) is a major sight-threatening cause in diabetic patients. We review the long-term outcome of four approved pharmacotherapy for treating DME, including intravitreal injections of corticosteroids(dexamethasone implants and fluocinolone acetonide inserts) and anti-vascular endothelial growth factor(VEGF)(ranibizumab and aflibercept). They all show superior ability to improve vision and reduce macular thickness, comparing with sham injections or macular focal/grid laser treatment. Anti-VEGF agents result in low incidence of severe ocular or systemic adverse effects, but glaucoma and cataract should be aware after intravitreal corticosteroids. Prompt treatment with these agents can lead to a better outcome.
基金supported by research grant by National University of Sciences and Technology (NUST), Islamabad, Pakistan
文摘Objective: To investigate the neuroprotective effects of Syzygium aromaticum(S.aromaticum)extract(500 mg/kg) on AlCl_3(300 mg/kg)-induced mouse model of oxidative stress and neurotoxicity.Methods: An ethanolic extract of S.aromaticum seeds was prepared and the active compounds were identified using nuclear magnetic resonance spectroscopy.BALB/c mice were divided into five groups(negative control, AlCl_3-treated, self-recovery, AlCl_3 + S.aromaticum, S.aromaticum only; n=10) and treated with AlCl_3 and S.aromaticum extract.Expression of oxidative markers [Superoxide dismutase 1(SOD1) and peroxiredoxin 6(Prdx6)] and amyloid precursor protein(APP) in the hippocampus and cortex was evaluated via PCR.Histopathological assessment was performed to investigate the extent of neurodegeneration.Results: It was observed that AlCl_3 exposure increased the expression of APP770 while simultaneously down regulated the expression of APP695.AlCl_3 also induced a significant decrease(P<0.05) and an increase(P<0.05) in the expression level of SOD1 and Prdx6, respectively.A substantial decrease substantial(P<0.05) in the density of Nissl substance was also observed in cortex of the mice treated with AlCl_3.Interestingly, treatment with S.aromaticum extract normalized the alterations in the expression level of SOD1, Prdx6 and APPisoforms and improved the neuronal structural damage.Conclusions: The results showed that S.aromaticum is a promising antioxidant and a neuroprotective agent.
文摘Objective: This study was conducted to explore what media exactly do when disease is emerging and furthermore, to infer the role and the responsibility that media should play. Method: A content analysis with 0.81 inter-rater reliability was adopted to categorize SARS-related events shown on the three major newspapers in 117 days, dated from March 13th (the date before the first probable case of SARS in Taiwan was identified) to July 7th (the date after Taiwan was removed from the list of SARS-affected countries by the bulletin of World Health Organization), 2003. Results: There were totally 8923 SARS events related news found in the observed newspapers during the study period. When the epidemic situation is more serious, the media will also lay out more coverage on reporting the related contents. In the reporting contents, the three most influential newspapers in Taiwan mainly emphasized the impact dimension (34.27%). Only 2.16% of the coverage was on the topic of health communication and prevention education. Overall, the opinions of general public are the primary sources of news (46.57%). Health authority was not the main and typical sources information of the press (9.42%). Conclusion: Media is a double-edged sword in the communicable disease control. We suggest that the health authority should take advantage of media to transmit message rapidly to convey related information to public.
文摘Human immunodeficiency virus(HIV) is rapidly increasing in both high risk groups and the general population.In this study, silent routes of propagation in teenaged Pakistanis are discussed. In order to promote sexual activity in youths, regular clients write contact details of sex workers on the doors of public washrooms. HIV prevalence is much higher among Hijra sex workers.Hijra sex workers have apparently stepped into the profession of begging at public places, where they earn money by both begging and distributing visiting cards offering unsafe sex. In many educational institutes, sex education is lacking or absent; if delivered via teachers,government agencies and nongovernmental organizations this could prevent a future epidemic of sexually transmitted infections in Pakistan.
文摘Myopic choroidal neovascularization(mCNV) can cause severe visual impairment in highly myopic patients. We review the randomized trials of two approved pharmacotherapy for treating mCNV, including intravitreal injections of ranibizumab and aflibercept. These two vascular endothelial growth factor(VEGF) antagonists show superior ability to improve vision and reduce macular thickness, comparing with sham injections or verteporfin photodynamic therapy(vPDT). There is no severe ocular or systemic adverse reaction reported in studies associated with ranibizumab and aflibercept for mCNV. Prompt treatment with these agents can lead to a better outcome.
文摘Purpose:The aim of the study was to investigate the actual benefits of the electronic official document online submission and approval system and the satisfaction of hospital staff in a medical center in southern Taiwan,and to find out whether there are any differences between medical institutions and general government personnel.Methods:A cross-sectional study was conducted to investigate satisfactory outcome with questionnaires.The subjects were administrators,healthcare professionals and medical personnel of a medical center in the southern part of Taiwan who had signed electronic documents online.A total of 395 questionnaires were sent out,147 of which were valid,and the rate of collecting data survey was 37%.We analyzed with SPSS version 20.Results:The official document approval system was mainly used by administrative units and contractors,accounting for more than 50%of users.Besides,the frequency of use was at least more than once a week.As for the user’s perception of operating system,most people thought that it is easier to choose the format of official document and to set up the duty agent on leave,but in the part of the signing and approval process setting or modifying,it was considered more difficult,accounting for 38.1%.In terms of perceptual usefulness,the average value was 3.81,which showed that the user agreed that the system has met the needs of daily official documents.When some users of service area encountered problems with their use,the clerical staff were able to provide services immediately and have the professional ability to resolve problems,in order to agree to the majority,accounting for 53.7%.In addition,nearly 60%of users rated the official document system positively,with an average of 3.84 satisfaction,which was higher than the certified value of 3,conforming to the standards for satisfaction with the use of official documents.In addition,the role authorization,perceptual easy-to-use and service area were significant(p<0.05).The perceptual usefulness of Subordinate units was also significant(p=0.016).The frequency of use,perceptual easy-to-use,perceptual usefulness,service area and satisfaction were significantly different(p<0.05).The correlation coefficient between perceptual usefulness and user satisfaction was 0.833,indicating that there was a high correlation.The daily usage frequency of contractors was higher than supervisors.However,supervisors had the highest frequency of use every quarter(p=0.135).There was no significant difference between contractors and supervisors in the frequency of use.Conclusion:It is suggested that education and training on the operation of the electronic official document on-line submission and approval system should be conducted,which can enhance the education and training of supervisors and medical personnel.Continually,invite supervisors and medical personnel to provide advices on the official document system as a reference for future improvements of the system.
基金supported by a Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research(KAKENHI)[Grant No.JP18K09975].
文摘Objective:This study aimed to evaluate the influence of advanced glycation end-product(AGE)accumulation on the prevalence and severity of overactive bladder(OAB)in community-dwelling elderly adults.Methods:We conducted a cross-sectional study involving 269 Japanese community dwellers aged≥75 years in 2015.AGE accumulation was non-invasively measured via skin autofluorescence(SAF)values using AGE Reader.The primary and secondary outcomes were the presence and severity of OAB evaluated using the Overactive Bladder Symptom Score(OABSS).Individuals with an urgency score of≥2 and sum score of≥3 were considered to have OAB.The associations of SAF with the prevalence and severity of OAB were assessed using logistic and linear regression models,respectively,adjusted for clinically important confounders.Results:The median age of participants was 78 years.Of 269 participants,110(40.9%)were men and 75(27.9%)had OAB.The median SAF was 2.2 arbitrary units(AUs).Increasing median SAF was observed with increasing age.Multivariable analysis revealed that SAF was not associated with either the likelihood of having OAB(odds ratio per AU=0.77,95%confidence interval:0.37-1.62)or the natural log-transformed OABSS(0 per AU=-0.07,95%confidence interval:-0.26-0.12).Conclusions:In this study,AGE accumulation,as assessed by SAF,was not associated with the prevalence and severity of OAB in Japanese community-dwelling elderly people aged≥75 years.
