摘要：Objective To identify patterns of hand, foot and mouth disease （HFMD） incidence in China during declining incidence periods of 2008, 2009, and 2010. Methods Reported HFMD cases over a period of 25 months were extracted from the National Disease Reporting System （NDRS） and analyzed. An interrupted time series （ITS） technique was used to detect changes in HFMD incidence rates in terms of level and slope between declining incidence periods of the three years. Results Over 3.58 million HFMD cases younger than 5 years were reported to the NDRS between May 1, 2008, and May 31, 2011. Males comprised 63.4% of the cases. ITS analyses demonstrated a significant increase in incidence rate level （P〈0.0001） when comparing the current period with the previous period. There were significant changes in declining slopes when comparing 2010 to 2009, and 2010 to 2008 （all P〈O.O05）, but not 2009 to 2008. Conclusion Incremental changes in incidence rate level during the declining incidence periods of 2009 and 2010 can potentially be attributed to a few factors. The more steeply declining slope in 2010 compared with previous years could be ascribed to the implementation of more effective interventions and preventive strategies in 2010. Further investigation is required to examine this possibility.

摘要：关键点政策决策者在设计改善医疗的政策时,需要超越传统的财务激励。卫生专业人员受到一系列因素的激励,既有外在因素,也有内在因素。专注于这些其他激励措施或对激励进行组合可能更为有效。Mylène Lagarde、Luis Huicho和Irene Papanicolas探讨了政策决策者可以采取的不同政策激励医务人员改善医疗质量。

摘要：Objectives:Rural areas are the weakest place for epidemic prevention and control,yet few studies have specifically conducted surveys in rural *** purpose of this study is to assess rural residents’knowledge of the COVID-19 and its prevention in ***:A cross-sectional survey study containing 1,426 samples was conducted in Fuqing,China to assess rural residents’knowledge of the COVID-19 and its *** regression was used to identify potential differences in participants’knowledge of COVID-19 and its prevention and control in different population ***:The mean and median of residents’knowledge of COVID-19 was 5.53 and 6 points,*** mean and median of residents’knowledge related to self-protection against COVID-19 was 10.34 and 11 points,*** adults(AOR45e59=2.26,95%CI 1.20 to 4.27;AOR60-69=3.13,95%CI 1.63 to 5.98;AOR70=4.68,95%CI 2.35 to 9.33)were more deficient in knowledge of *** who were better educated and with a higher average annual household income were less likely to be deficient in the knowledge of COVID-19 and knowledge of self-protection against ***,those who were single,divorced,or widowed(AOR=1.67,95%CI 1.13 to 2.46)were more deficient in the knowledge of self-protection against ***:Our study suggests that when facing a pandemic like COVID-19,the key is to inform the public to understand simple and effective self-protection ***,we call on the govern-ments to give priority to publicity and education on self-prevention measures for the targeted pop-ulations and *** is most evident among the vulnerable groups like those who were unmarried,elderly,and those with low education or low *** suggestions may be of use in other countries as well.

摘要：Background： Smokeless tobacco is widely used by athletes to enhance performance. Nicotine is a central nervous system stimulant and acts on cardiocirculatory and metabolic systems, involving tissue blood flow and circulatory vasoreactivity. The aim of this study was to investigate the effects of the oral smokeless tobacco （Swedish snus （SS）） on the perception of fatigue and time to exhaustion （TTE） during moderate-intensity aerobic exercise. Methods： Fourteen healthy non-tobacco male users were recruited for a double-blind, controlled crossover design （SS vs. snus placebo （SP））. Subjects were tested for 3 sessions： experimental session 1 （Exp 1） consisted of an incremental test to determine the maximal aerobic power out-put （Wmax）, whereas Exp2 and Exp3 consisted of exercising at 65%Wmax until exhaustion in SS or SP conditions. During Exp2 and Exp3, muscle and cerebral oxygenation was assessed by means of near-infrared spectroscopy, and the rating of perceived exertion （RPE） was recorded. Results： Comparing SS with SP tests, significant differences （p 〈 0.05） were found in the values of cerebral （-3%） and muscular tissues oxygenation （-4%） in the first 30 min of exercise. The RPE values were not significantly different between the 2 conditions （SS vs. SP）. No significant difference was found in TTE （SS： 54.25 ± 21.84 min; SP： 50.01 ± 17.03 min）. Conclusion： This study showed that muscular and cerebral oxygenation increased significantly with snus administration during an endurance exercise until exhaustion, but this did not affect fatigue perception and TTE. The results showed that snus could not be considered an ergogenic substance in non-tobacco users.2018 Published by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license. （http：//***/licenses/by-nc-nd/4.0/）.

摘要：Objective:Mental disorders of the elderly population in China deserve *** health is significantly associated with *** study aimed to evaluate the rate of depressive symptoms and to test the relationships between social health and depressive symptoms among a large sample of community-dwelling elderly ***:We conducted a cross-sectional study among community-dwelling adults aged 60 years or above in Zhejiang Province,***-to-face interviews were used to complete a structured questionnaire for all *** used the Social health Scale for the Elderly(SHSE)to evaluate social health status and used the short form of the Geriatric Depression Scale to evaluate depressive *** logistic regression was used to evaluate the asso?ciation between social health status and depressive ***:Of the total of 3757 participants included,1887(50.23%)were female,and the mean±standard deviation(SD)age was(70.0±8.3)*** rate of depressive symptoms was 25.92%.The social health score was higher in non?depressed participants than in depressed participants(raw score 50.7 vs.48.3,P<0.001).Participants with"moderate”or"good”social health had a significantly lower risk of depressive symptoms than those with“poor"social health(odds ratio(OR)=0.55,95%con fide nee interval(Cl):0.46-0.66 for moderate social health;OR=0.45,95%Cl:0.35-0.60 for good social health).The association between social health and depressive symptoms was con sistent across several *** clusi ons:Social health is signify cantly inversely associated with depressive *** SHSE may serve as an efficient screener to identify those elderly adults with social health deficits,but systematic assessment to guide intervention merits further investigation.

摘要：动态治疗方案(Dynamic treatment regimens,DTRs)是一种序贯决策规则,是根据每个患者随时间变化而变化的特征和先前观察到的中间结果而量身定制的临床决策。精神障碍具有慢性和复杂性的特点,精神障碍患者具有异质性特点。这就要求随时间推移,根据个体对治疗反应的不同而分析出最佳的治疗方案,并动态地应用到患者之后的治疗中。多重方案随机序贯试验(Sequential Multiple Assignment Randomized Trial,SMARTs)的设计可以估计DTRs的治疗效应。SMARTs收集到大量的个体化变量和中间结果,在此基础上应用已有的现代统计工具可以优化DTRs。这些统计方法也可为今后的SMARTs研究设计推荐量身定制的变量。本文通过两个精神卫生研究案例介绍了DTRs和SMARTs,讨论了从SMARTs数据估算出最佳DTR的两种不同的计算机自动分析方法,并使用模拟数据演示这两种统计方法的性能。

摘要：目的探讨X线照射能否促进大鼠压迫型脊髓损伤区结构及损伤后功能的恢复。方法70只Sprague-Dawley大鼠均接受胸2节段的脊髓损伤,然后被随机分为2组,照射组在损伤后14d接受X线照射,对照组则不接受任何治疗。所有大鼠分别在脊髓损伤后第3、7、14、21、28、35和42天接受后肢运动、斜板及后肢疼痛反射等3项脊髓功能测定,43d将所有实验大鼠处死后取出脊髓损伤标本,进行组织学检查。结果70只实验鼠中符合设计要求的共62只,其中照射组32只,对照组30只。X线照射组大鼠的后肢运动恢复及斜板测定均明显优于对照组,两者之间的差异有显著性(P<0.01),而疼痛反射两组间差异无显著性。照射组大鼠脊髓损伤部位的水肿及坏死区域明显少于对照组,而神经元数目则明显多于对照组。结论X线照射可通过改善脊髓损伤区结构来促进大鼠脊髓损伤后运动功能的恢复。

摘要：目的比较四药联用(四联)和三药联用(三联)的抗逆转录病毒疗法作为HIV感染者一线治疗的疗效和安全性,并探讨现有的临床试验对临床实践及未来研究的启示。研究设计随机对照试验的系统综述和meta分析。数据来源系统检索了PubMed、EMBASE、CENTRAL、Web of Science及Allied health Literature数据库2001年3月至2016年12月期间发表的研究(其中PubMed和EMBASE的检索更新至2018年6月),以及合格研究和相关综述的参考文献。入选标准比较四联与三联抗逆转录病毒疗法作为HIV感染者一线治疗的作用,并评价了至少一种疗效或安全性结局的随机对照试验。分析方法对检测不到的HIV-1 RNA、CD4 T细胞计数、病毒学失败、新发艾滋病事件、死亡和严重不良反应等结局的资料采用随机效应模型进行meta分析。结果共找到12项合格研究,包括4251例HIV感染者。四联和三联抗逆转录病毒疗法对各个疗效和安全性结局的影响均类似,且没有一个总体效应估计值的点值落在支持四联疗法的一侧。与三联疗法相比,四联疗法组出现不同结局的相对危险度及其95%可信区间如下:检测不到的HIV-1 RNA,0.99(0.93~1.05);病毒学失败,1.00(0.90~1.11);新发艾滋病事件,1.17(0.84~1.63);死亡,1.23(0.74~2.05);严重不良反应,1.09(0.89~1.33)。两组CD4 T细胞计数增加的平均差值为-19.55个细胞/μl(-43.02~3.92)。无论联合抗逆转录病毒疗法的具体方案如何,上述2组比较的结果大体不变,且在所有亚组和敏感性分析中均变化不大。结论在HIV感染者的一线治疗中,四联抗逆转录病毒疗法的效果并不优于三联疗法。这一发现为当前推荐三联疗法作为一线治疗的指南提供了支持。除非对现有证据的系统综述显示确有必要,否则不应该再开展新的临床试验去比较四联与三联疗法。当然,本系统综述并不排除当有新的抗逆转录病毒药物种类出现时包含该类药物的四联疗法比三联疗法更好的可能性。

摘要：目的评价包括选择性环氧化酶2抑制剂(昔布类)在内的非甾体抗炎药(NSAIDs)在膝关节骨关节炎患者中的镇痛作用。试验设计对随机安慰剂对照的临床试验进行系统回顾和汇总分析。文献回顾本项研究共对23项研究中的10845例患者进行了回顾性分析,患者的平均年龄为62.5岁,其中7807例患者接受了适当剂量的NSAIDs治疗,3038例患者接受了安慰剂治疗。患者入选时,经100mm视觉模拟尺(VAS)测定的权重疼痛分数基线的平均值为64.2mm,症状存在的平均时间为8.2年。主要观察指标总体疼痛程度的变化。结果各项临床试验的方法学质量可以接受,但是其中13项试验在随机化之前排除了对NSAIDs治疗没有反应的患者。一项试验报告了长期疗效的数据,结果提示治疗1～4年期间,NSAIDs的疗效与安慰剂相当。汇总所有入选试验的数据显示,在治疗2～13周后疼痛程度的差值为VAS10.1mm(95%可信区间为7.4～12.8),优于安慰剂15.6%。来自不同试验所得到的结果之间差异很大,随机效应模型显示,疼痛改善的效应量为0.32(0.24～0.39)。10项没有排除对NSAIDs治疗没有反应患者的试验中,结果比较一致,疼痛改善的效应量为0.23(0.15～0.31)。结论NSAIDs能够在短期内减轻骨关节炎患者的膝关节疼痛,其疗效略优于安慰剂,但是现在的分析不支持对这种疾病长期应用NSAIDs。由于口服NSAIDs可以导致严重的不良反应,因此只推荐有限制的使用。

摘要：目的:研究包含传统泰式按摩、草药以及物理疗法的康复治疗方案是否能够改善脑卒中患者的日常活动能力、情绪、睡眠质量以及疼痛程度。方法:本研究的设计为前瞻性队列研究,研究周期为3个月。患者来自泰国北部一家有42张床位的康复中心,该中心主要针对脑卒中、头部创伤和脊柱病患者进行康复治疗。结果:本研究共纳入脑卒中患者62人,55%为男性。患者平均年龄59岁,其中63%为已婚,首次卒中时间平均为15个月。在基线水平,巴氏量表平均指数为50.7,情绪、疼痛及睡眠平均指数分别为2.6、3.1、3.2。在进行年龄、性别和首次卒中时间的纵向模型评估1个月后,巴氏量表指数、情绪、疼痛和睡眠指数均显著提高,分别上升了6.1、0.7、0.5、0.5分(均P<0.01);3个月后,各指数分别提高了14.2、0.9、0.5、0.6分(均P<0.01)。结论:该康复治疗方案能明显改善患者的日常生活、情绪、睡眠质量以及疼痛程度。我们还需要进一步比较接受该康复治疗方案和接受常规康复治疗方案的患者来支持这一结论。