Background Adverse childhood experiences (ACEs) have been associated with an increased risk of low back pain (LBP). However, the role of depressive symptoms (DS) in this relationship remains insufficiently explored. This study aims to investigate the mediating effect of DS on the association between ACEs and LBP. Method This retrospective cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS). DS were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Logistic regression analyses evaluated associations between ACEs and both DS and LBP. Mediation analysis further examined the mediating effect of DS on the ACEs-LBP association. Results This study included 8186 participants (3979 males; 4207 females). Logistic regression revealed associations between ACEs and both DS and LBP. Mediation analysis identified DS as a partial mediator in the relationship between LBP and eight ACEs: loneliness, peer bullied, poor self-reported health status, sibling death, parental mental health issues, starvation, and poor childhood neighborhood safety and quality. DS accounted for 18.42 % of the total association between ACE count and LBP. After adjusting for the demographics and DS, marginal analysis confirmed a dose-response relationship, with escalating ACE exposure linked to a higher probability of LBP. Conclusion Our study demonstrates a significant association between ACEs and LBP and DS in middle-aged and older Chinese adults. Critically, DS serves as a mediator in the relationship between ACEs and LBP, underscoring its role as a psychological pathway through which early-life adversity influences LBP.

Medical disputes, which are prevalent in China, are a growing global public health problem. The Chinese government has proposed third-party mediation (TPM) to resolve this issue. However, the characteristics, efficiency, and influencing factors of TPM in resolving medical disputes in public hospitals in China have yet to be determined. We conducted a systematic study using TPM records from medical disputes in Gansu Province in China from 2014 to 2019. A χ2 test was used to compare differences between groups, and binary logistic analysis was performed to determine the factors influencing the choice of TPM for resolving medical disputes. We analyzed 5,948 TPM records of medical disputes in Gansu Province in China. The number of medical disputes and the amount of compensation awarded in public hospitals in the Gansu Province increased annually from 2014 to 2019, with most of the disputes occurring in secondary and tertiary hospitals. Approximately 89.01

Objective: To determine the effectiveness of non-pharmacologic interventions and the additional benefits of their combination in patients with heart failure with reduced ejection fraction (HFrEF). Data Sources: We searched PubMed, Embase, and the Cochrane Clinical Trials Register from the date of database inception to April 22, 2023. Study Selection: Randomized controlled trials involving non-pharmacologic interventions conducted in patients with HFrEF were included. Data Extraction: Data were extracted by 2 independent reviewers based on a pre -tested data extraction form. The quality of evidence was assessed using the Cochrane Risk of Bias tool and the Grading of Recommendations Assessment, Development, and Evaluation method. Data Synthesis: A total of 82 eligible studies (4574 participants) were included. We performed a random -effects model within a Bayesian framework to calculate weighted mean differences (WMDs) and 95% credibility intervals. High or moderate certainty evidence indicated that high -intensity aerobic interval training (HIAIT) was best on improving 6 -minute walk distance (6MWD; 68.55 m [36.41, 100.47]) and left ventricular ejection fraction (6.28% [3.88, 8.77]), while high -intensity aerobic continuous training (HIACT) is best on improving peak oxygen consumption (Peak VO 2 ; 3.48 mL/kg center dot min [2.84, 4.12]), quality of life (QOL; -17.26 [-29.99, -7.80]), resting heart rate (-8.20 bpm [-13.32, -3.05]), and N -terminal pro -B -type natriuretic peptide (-600.96 pg/mL [-902.93, -404.52]). Moderate certainty evidence supported the effectiveness of inspiratory muscle training to improve peak oxygen consumption and functional electrical stimulation to improve QOL. Moderate -intensity aerobic continuous training (MIACT) plus moderate -intensity resistance training (MIRT) had additional benefits in Peak VO 2 , 6MWD, and QOL. This review did not provide a comprehensive evaluation of adverse events. Conclusions: Both HIAIT and HIACT are the most effective single non-pharmacologic interventions for HFrEF. MIACT plus MIRT had additional benefits in improving peak oxygen consumption, 6MWD, and QOL. Archives of Physical Medicine and Rehabilitation 2024;105:963 -74 (c) 2023 by the American Congress of Rehabilitation Medicine.

目的 评估生物质燃料使用与老年人全因死亡的关系.方法 纳入2011-2012年进入中国老年健康影响因素跟踪调查(the Chinese Longitudinal Healthy Longevity Survey,CLHLS)并被随访至2018年的≥65岁的参与者共5 853人.采用加权Cox和稳健型逆概率加权后的Cox回归模型评估生物质燃料使用与老年人全因死亡的关系,并探讨随访期间更换使用燃料对全因死亡的影响.结果 生物质燃料使用与老年人的全因死亡风险增加有关[平均风险比(average hazard ratio,AHR)=1.17,95％CI:1.08～1.28].与一直使用生物质燃料的老年人相比,改用清洁能源的老年人全因死亡风险更低(AHR=0.21,95％CI:0.18～0.24).结论 生物质燃料使用可增加老年人的全因死亡风险,改用清洁能源后能够降低老年人的全因死亡风险.

目的:分析取消药品加成政策实施前后肺结核患者住院费用的变化情况.方法:采用回顾性研究,数据来源于四川省泸州市医疗保障局医疗保险结算系统.获取2015年2月1日至2018年11月20日西南医科大学附属医院、泸州市人民医院2家三甲结核病定点医院肺结核住院患者结算数据,共纳入住院肺结核患者3749例.采用中断时间序列模型(interrupted times series,ITS)分析取消药品加成政策实施前后肺结核患者例均住院总费用、各单项费用的水平及趋势变化情况.结果:3749例肺结核患者平均年龄为(48.23±18.90)岁,单次住院总费用在10000～14999元/例的肺结核患者最多,占患者总数的26.25％(984/3749).取消药品加成政策实施后,单次住院总费用中位数降低了1150.13元,单次西药费中位数降低了643.16元.ITS分析结果显示,取消药品加成政策实施前,例均中药费、例均材料费均呈现上升趋势,平均每月增加5.34％(β1=0.052,t=2.941,P<0.05)、1.92％(β1=0.019,t=3.987,P<0.05).政策实施时,例均麻醉费即刻上升83.31％(β2=0.606,t=3.311,P<0.05),例均材料费即刻上升24.48％(β2=0.219,t=2.477,P<0.05),例均中药费即刻下降99.57％(β2=—0.691,t=—2.187,P<0.05).政策实施后,例均中药费平均每月下降0.60％(β1=0.052,β3=—0.058,t=—2.193,P<0.05);例均材料费平均每月下降4.81％(β1=0.019,β3=—0.066,t=—10.051,P<0.05);例均住院总费用平均每月下降1.31％(β1=0.006,β3=—0.019,t=—4.432,P<0.05);例均西药费平均每月下降1.51％(β1=0.003,β3=—0.018,t=—2.223,P<0.05);例均检查费平均每月下降2.53％(β1=0.009,β3=—0.034,t=—4.552,P<0.05);例均麻醉费平均每月下降4.39％(β1=0.003,β3=—0.046,t=—3.373,P<0.05);例均手术费平均每月下降4.92％(β1=0.009,β3=—0.057,t=—3.057,P<0.05).结论:取消药品加成政策实施后,肺结核患者住院总费用、药品费等呈现下降趋势,说明取消药品加成政策对于降低肺结核患者药品费用、控制住院总费用取得显著成效.

目的 分析2009-2019年泸州市丙型病毒性肝炎(丙肝)的发病及流行状况,并对2020-2022年发病趋势进行预测,为制定针对性防控措施提供依据.方法 采用描述性流行病学方法对中国疾病预防控制信息系统中2009-2019年泸州市丙肝病例报告资料进行分析,并运用灰色系统GM(1,1)模型对2020-2022年年均发病率进行预测.结果 2009-2019年泸州市丙肝报告发病率呈上升趋势,年均报告发病率为9.53/10万,由2009年的3.04/10万上升到2019年的14.92/10万.全年均有发病,季节分布不明显(M=0.015);各区县均有病例报告,江阳区(14.32/10万)、叙永县(13.38/10万)和龙马潭区(11.20/10万)年均报告发病率位居前3位.报告病例男女性别比为1.49∶1,男性年均报告发病率(5.19/10万)高于女性(3.48/10万);发病年龄高峰为＞60岁组、＞40～50岁组和＞30～40岁组,分别占发病总数的28.45％、26.76％和19.80％;职业分布以农民、家务及待业为主,分别占发病总数的53.91％、25.85％.GM(1,1)模型预测2020-2022年泸州市丙肝年均发病率分别为14.12/10万、15.15/10万、16.20/10万.结论 泸州市丙肝报告发病率呈上升趋势,地区差异较大,农民和老年人群是重点人群,应加强重点地区及人群疫情监测,预防和控制丙肝的发生和流行.

目的 分析同居孕产妇产前检查次数及其影响因素.方法 采用西部某县级市中国危重孕产妇定点监测医院《孕产妇个案调查表》中的数据,选取2014年1月1日至2018年11月30日期间在该院产科入院的1568名同居孕产妇,分析其至少1次、至少5次、至少8次产前检查的影响因素.结果 同居孕产妇平均产前检查次数(不包括此次检查)为(4.73±3.26)次,主要集中在20岁及以下(67.79％),0次产前检查有165人(10.52％),40.11％ 的同居孕产妇产前检查次数集中在1～4次.Logis-tic回归分析结果显示,与≥35岁年龄组相比,年龄17～20岁、21～25岁对至少5次产前检查有明显影响,OR(95％CI)分别为3.62(1.15～11.36)、4.10(1.27～13.30);与初次妊娠相比,多次妊娠对至少5次、至少8次产前检查均有明显影响,OR(95％CI)分别为0.61(0.41～0.90)、0.59(0.38～0.92);与无剖宫产史相比,既往剖宫产≥1次对至少1次产前检查有明显影响,OR(95％CI)为4.75(1.07～21.07);本次有合并症或并发症对至少5次产前检查有明显影响,OR(95％CI)为1.53(1.04～2.25).结论 同居孕产妇产前检查次数较低,特别是≤16岁的低龄和>35岁高龄及多次妊娠者更应该受到关注.建议通过增加生殖与妇幼健康教育方面的知识,给予同居孕产妇心理关怀,加强对该群体的管理,促进其进行产前检查.

目的 系统评价5α-还原酶抑制剂(5ARIs)与良性前列腺增生(BPH)患者性功能障碍发生风险之间的关联.方法 计算机检索PubMed、Web of Science、The Cochrane Library、 EMbase、CNKI、WanFang Data、VIP和CBM数据库,搜集关于5ARIs与BPH患者性功能障碍发生相关性的研究,检索时限均为建库至2020年10月.由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析.结果 共纳入15个研究,包括17774例患者.Meta分析结果显示:与安慰剂组相比,5ARIs可增加BPH患者勃起功能障碍[RR=1.52,95％CI (1.36,1.69),P＜0.0001]、性欲减退[RR=1.79,95％CI(1.37,2.32),P＜0.0001]及射精功能障碍的发生风险[RR=2.97,95％CI(1.82,4.83),P＜0.0001].不同5ARIs类型、干预期、研究发表年份和样本量的亚组分析结果均显示5ARIs造成性功能障碍的发生风险高于安慰剂.结论 当前证据表明,5ARIs可增加BPH患者勃起功能障碍、性欲减退和射精功能障碍的发生风险.受纳入研究数量和质量的限制,上述结论尚需开展更多高质量的研究予以验证.

目的 本研究分析2013-2017年兰州市稳定型缺血性心脏病患者住院费用构成情况及其影响因素,为控制此病种住院费用的不合理上涨提供参考.方法 从甘肃省卫生计生统计信息网络直报系统中获取2013-2017年22 044例主要诊断为稳定型缺血性心脏病[疾病编码为I20(不包括I20.0)和I25]的患者信息.对患者基本情况、费用构成采用描述性分析;运用单因素分析各项因素与住院费用的关系;利用多元逐步回归分析筛选出住院费用的主要影响因素.结果 22 044例稳定型缺血性心脏病患者平均年龄(65.35±11.84)岁,年龄中位数为66岁;平均住院费用11 814.19元,中位数6 850元.住院费用构成中前3名分别为综合医疗服务费(36.96％)、药费(25.41％)和诊断类费用(21.90％).单因素分析结果显示,不同医院等级(Z=-110.697,P＜0.001)、性别(Z=-26.297,P＜0.001)、年龄(Z= 253.243,P＜0.001)、职业(Z=1 868.973,P＜0.001)、婚姻(Z=112.097,P＜0.001)、医疗付款方式(Z= 3 882.021,P＜0.001)、入院途径(Z=228.379,P＜0.001)、入院病情(Z= 503.614,P＜0.001)、输血情况(Z=-4.866,P＜0.001)、手术情况(Z =-92.755,P＜0.001)、合并症(Z=-10.514,P＜0.001)均与稳定型缺血性心脏病患者住院费用有关联.多元逐步回归分析显示,医院级别(t = 70.267,P＜0.001)、性别(t=-14.472,P＜0.001)、年龄(t = 4.990,P＜0.001)、国家机关企事业单位人员(t=-2.347,P=0.019)、专业技术人员(t=-2.891,P=0.004)、个体经营者(t=-1.975,P = 0.048)、离退休人员(t=-3.980,P＜0.001)、无业人员(t=-4.093,P＜0.001)、已婚(t=-2.541,P = 0.011)、离婚(t=-2.782,P = 0.005)、其他婚姻状况(t=-2.988,P = 0.003)、城镇职工基本医疗保险(t=-12.989,P＜0.001)、城镇居民基本医疗保险(t=-12.927,P＜0.001)、贫困救助(t= 3.429,P = 0.001)、商业医疗保险(t=-2.014,P = 0.044)、全公费(t =-13.688,P＜0.001)、通过急诊入院(t = 9.080,P＜0.001)、通过门诊入院(t=-3.165,P＜0.001)、临床未确定病情(t=-10.070,P＜0.001)、情况不明(t=-3.487,P＜0.001)、无病情(t =-4.196,P＜0.001)、实际住院天数(t =65.562,P＜0.001)、输血(t = 5.946,P＜0.001)、手术(t = 81.041,P＜0.001)和合并症(t=-3.738,P＜0.001)是稳定型缺血性心脏病患者住院费用影响因素.结论 住院天数、手术和医疗付款方式是稳定型缺血性心脏病患者住院费用的主要影响因素.

目的 分析甘肃省0～6岁儿童先天性心脏病(congenital heart disease,CHD)的非遗传影响因素,为预防儿童CHD提出建议.方法 采用分层等距抽样方法,在甘肃全省抽取并筛查5个区县0～6岁儿童29566例.将从中筛查出的106名CHD患儿作为病例组并随机抽取同年龄、同性别、相同生活环境下的健康儿童318名,作为对照组进行1:3病例对照匹配;应用Cox比例风险模型拟合Logistic回归分析模型分析儿童CHD的影响因素;应用限制性立方样条模型分析儿童出生体重与CHD患病的剂量反应关系.结果 多因素分析结果表明:儿童出生体重、母亲文化程度、食用腌晒食品、药物流产史、孕前服用排卵药物、孕期食用鱼肉、经常体育锻炼与儿童CHD的患病风险均存在相关性(均有P＜0.05).限制性立方样条反应分析结果显示:儿童出生体重与CHD患病的关联强度呈线性剂量-反应关系(总趋势P＜0.001,非线性P=0.246).结论 建议育龄妇女做好孕前检查,合理使用促排卵药物;孕期妇女要做好孕期保健和筛查,多食用鱼虾等海产品,不食用腌晒食品,适当进行体育锻炼,加强妇幼保健知识的学习降低儿童CHD的患病风险.

目的 分析四川省泸州市HIV/AIDS患者生存情况及其影响因素.方法 选取2010-2019年泸州市报告的≥15岁HIV/AIDS患者,采用寿命表法计算生存率,采用Kaplan-Meier法计算中位生存时间和绘制生存曲线,采用Cox比例风险回归模型分析生存时间的影响因素.结果 共纳入研究对象12274例,中位生存时间为87.35(95％ CI:86.22～88.49)个月,确诊后1、3、5、7和9年累积生存率分别为78％、73％、69％、66％和63％;多因素分析结果显示,在发生AIDS相关死亡风险方面,男性是女性的1.491倍;汉族是其他民族的2.118倍;离异或丧偶是已婚的1.545倍;确诊感染时的年龄≥60岁是15～＜20岁的3.392倍;大专及以上是文盲的0.473倍;注射毒品、采(供)血及输血/血液制品是异性性传播的1.513倍;样本来源于医疗机构是检测咨询的1.131倍;首次检测CD4+T淋巴细胞计数为≥501个/μl是≤200个/μl的0.205倍;首次诊断疾病状态为AIDS是HIV感染的1.166倍;未接受抗病毒治疗是接受抗病毒治疗的3.524倍.结论 性别、婚姻状况、诊断时的年龄、文化程度、感染途径、样本来源、首次检测CD4+T淋巴细胞计数、疾病状态及抗病毒治疗是影响HIV/AIDS患者生存时间的因素,早发现、早诊断、早治疗可降低HIV/AIDS患者的死亡风险.

目的 分析2009-2019年泸州市梅毒流行特征和变化趋势,为制定梅毒防控措施提供依据.方法 通过中国疾病预防控制信息系统传染病报告信息管理系统收集2009-2019年泸州市梅毒病例资料,描述性分析不同性别、年龄、职业梅毒病例的流行特征和梅毒分期变化趋势.结果 2009-2019年泸州市共报告梅毒病例12305例,报告发病率为16.28/10万～50.22/10万,年均增长率为11.92％.一期、二期和胎传梅毒报告发病率均呈下降趋势(P＜0.05);三期梅毒报告发病率变化趋势无统计学意义(P＞0.05);隐性梅毒报告发病率呈上升趋势(P＜0.05).女性梅毒年均报告发病率为28.16/10万,高于男性的24.23/10万(P＜0.05).≥60岁组报告病例数最多,2895例占23.53％;职业以农民为主,6705例占54.49％.结论 2009-2019年泸州市梅毒报告发病率呈上升趋势,以隐性梅毒为主,女性、60岁及以上和农民为高危人群.

目的 了解轮班工作和长时间工作与脑卒中风险的关系.方法 计算机检索PubMed、Web of science、Cochrane Li-brary、EMBASE、中国知网(CNKI)、万方数据库、维普数据库(VIP)以及中国生物医学文献数据库(CBM),搜集2020年5月以前关于轮班和长时间工作与脑卒中风险相关性的文献.采用纽卡斯尔-渥太华量表(NOS)对纳入文献进行质量评价,运用Stata 12.0进行分析.结果 共纳入8项队列研究和2项病例-对照研究,累计814 605例研究对象.Meta分析结果显示,轮班工作与脑卒中的发生没有相关性(RR=1.03,95％CI:1.00～1.07,P=0.083);长时间工作与脑卒中的发生没有相关性(RR=1.31,95％CI:0.98～1.76,P=0.070).敏感性分析提示研究结果较为稳健.结论 轮班工作和长时间工作与脑卒中发生并无相关性,还需更多的高质量研究加以验证.

目的 了解甘肃省0～6岁儿童在视力、听力、肢体、智力、孤独症以及多重残疾等6类残疾的患病情况,并分析母亲孕前及孕期健康状况等相关因素与儿童残疾的相关性.方法 从甘肃省0～6岁儿童残疾筛查项目数据库中提取2017年1月1日-2017年12月31日数据并进行整理,采用Logistic回归分析模型对数据进行分析.结果 203名(6.64％0)儿童被确诊为残疾,其中男童128名,现患率为7.2‰,女童75名,现患率为5.86‰.Logistic回归分析模型分析结果 显示与儿童残疾相关的因素有12个,其中最主要的因素有早产自娩、既往分娩缺陷、孕前6个月服用过促进排卵药物、孕期疾病史有慢性呼吸系统疾病、居住地周围有排放环境污染物的化工厂及矿场、食用腌晒食品＞350 g/周、室内经常有人吸烟(均为P＜0.05).结论 肢体残疾、智力残疾和视力残疾为重点预防残疾种类;母亲孕前、孕期的健康状况和生活习惯与儿童残疾的发生有关,提示女性应当注重孕期健康和饮食习惯,预防儿童残疾的发生.

Background: Dementia is a gradual decline in cognitive ability and is becoming more common in our elderly population. Mild cognitive impairment (MCI) is defined as a slight clinical deterioration of memory capacity, below the level of normal aging, but does not constitute a clinical diagnosis of dementia. To date, no interventions have been proven to cure MCI and dementia fully. Purpose: To evaluate the potential effectiveness and safety of acupuncture for mild cognitive impairment (MCI) and dementia and evaluate the methodological quality of systematic reviews (SRs). Methods: We conducted a literature search for SRs with meta-analyses in seven Chinese and international databases through October 1, 2020. The basic characteristics of the included SRs/meta-analyses and the basic information of the original included randomized controlled trials were extracted by three reviewers independently. A meta-analysis of the original randomized controlled trials from the included SRs/meta-analyses was performed using Stata 12.0 software. The Assessing the Methodological Quality of Systematic Reviews 2 was used to assess the methodological quality of the included SRs/meta-analyses, and the Grading of Recommendations, Assessment, Development, and Evaluation was used to rate the quality of evidence. Results: A total of 35 SRs/meta-analyses were included, and the majority showed that acupuncture was more effective than western medicine or conventional therapy for MCI and dementia [odds ratio =1.39; 95% confidence interval (CI): 1.24, 1.56]. There was a statistically significant difference in the Mini-Mental State Examination score (weighted mean difference = 1.23; 95% CI: 0.78, 1.68; p < 0.00001), and there was no significant improvement in the activities of daily living score (weighted mean difference = 1.58; 95% CI: −0.02, 3.18; p = 0.053). The assessment results of Assessing the Methodological Quality of Systematic Reviews 2 showed that the methodological quality of most included SRs/meta-analyses was critically low; the lowest scores were items 2, 7, and 10. For Grading of Recommendations, Assessment, Development, and Evaluation, of the 73 outcomes, 50 (68.5%) outcomes were low or very low quality, and 23 (31.5%) outcomes were moderate quality. Conclusions: Acupuncture can be considered as an alternative for the treatment of MCI and dementia when western medicine or other therapies are contraindicated. More high-quality evidence is needed to determine further the effectiveness of acupuncture.

从20世纪50年代开始,南宋在室女分产研究成为日本法律史学界中争论的热点之一,并引起了欧美、中国等学者的关注和讨论.分歧最大的是"女合得男之半"分产法,对此,学者困惑不解、激烈争论,焦点是这一女性分产制度在历史上是否真实存在,是传统法律制度发展中的常态还是家族伦理法制的例外?这一学术史争论基于日本法律史学界家族法理论预设所做,中国传统社会法律文化的研究是否应该基于事实逻辑而不是预先的理论预设,本文在梳理学者们研究成果的同时,尝试重新阐释中国传统社会中法律理想与现实真实中的"女合得男之半".

[背景]医务人员的轮班工作现象尤为普遍,轮班工作可能会对医务人员的睡眠质量产生影响.[目的]评估医务人员的睡眠状况,探讨轮班工作与医务人员睡眠障碍之间的关系.[方法]采用方便抽样的方式于2019年11月10日一2020年1月19日向兰州市5所三甲医院的医务人员发放调查问卷.采用匹兹堡睡眠质量指数量表对医务人员的睡眠质量进行评估.采用描述性分析对医务人员的基本信息进行描述,比较不同特征组间睡眠障碍情况;采用logistic回归分析来探讨轮班工作与睡眠障碍发生的关系,并分别探讨了不同性别、职业和有无编制的医务人员轮班工作与睡眠障碍的关系.[结果]共纳入了1623名医务人员,其中有1027人患有睡眠障碍,其中女性883人;职业中护士患睡眠障碍的比例(730名,71.08％)更高.患睡眠障碍的医务人员平均年龄为(31.67±6.98)岁,平均轮班年限为(6.85±6.30)年.不同性别、年龄、职业、学历、职称、编制、轮班年限、吸烟、饮酒和运动的医务人员睡眠障碍检出率存在差异(P＜0.05).不同轮班年限的医务人员在量表7个维度中以及总分的得分差异都具有统计学意义(P＜0.05).与不轮班的医务人员相比,轮班＜5年、5～＜10年、10～＜15年和≥15年的医务人员发生睡眠障碍的OR (95％CI)分別是2.38 (1.71～3.32)、2.74 (1.91～3.93)、2.57 (1.61～4.10)、1.87 (1.05～3.30),P＜0.05.轮班年限＜5年和10～＜15年的医生与不轮班的医生患睡眠障碍的风险差异具有统计学意义(P＜0.05);而对护士来说,轮班＜5年、5～＜10年和10～＜15年的护士与不轮班的护士患睡眠障碍的风险差异具有统计学意义(P＜0.05).与不轮班的女性医务人员相比,轮班年限＜5年、5～＜10年和10～＜15年的女性医务人员患睡眠障碍的风险更高(P＜0.05);与不轮班的医务人员相比,而有、无编制的医务人员轮班年限＜5年、5～＜10年和10～＜15年的医务人员患睡眠障碍的风险更高(P＜0.05).[结论]医务人员轮班工作与睡眠障碍的发生存在相关关系,轮班工作是医务人员发生睡眠障碍的一个重要危险因素.

对比美、日、英等发达国家的医院感染管理体系,我国欲构建科学、合理的该体系应从完善组织建设与应急协调机制、加强相应专职人员人才队伍建设、推动建立相应的目标性监测与监测预警机制、重视应急医疗物资的储备等方面入手.

OBJECTIVE:The study aimed to evaluate the effectiveness of health education intervention for the control of blood pressure (BP) in older adults with hypertension.METHODS:Five databases were searched in March 2018 for randomized controlled trials to manage hypertension in older adults by health education. The primary outcomes were changes in systolic and diastolic BP. RevMan5 was used for meta-analysis.RESULTS:Seven articles with 1,105 participants were included. In them, 393 (35.56%) older adults participated in health education interventions in the form of courses, and 226 (20.45%), in health education sessions. The meta-analysis suggested an overall reduction in systolic BP after health education courses (SMD, standardized mean difference = 4.80, 95% CI: 7.01-2.59, p < .05). Similar results were observed after health education sessions (SMD = 11.73, 95% CI: 17.63-5.82, p < .05). The diastolic BP reduction showed no difference after the health education course (p = .09). The random effects meta-analysis suggested an overall reduction in diastolic BP after health education sessions (SMD = 5.39, 95% CI: 7.98-2.79, p < .05).CONCLUSION:Although different health education methods had different effects on hypertension control, overall, educational interventions can potentially lead to improved BP control.

目的 系统性评价剖宫产与后代炎症性肠病之间的关联.方法 通过检索PubMed、Web of science、Cochrane Library、EMbase,以及中国知网、万方、维普、中国生物医学文献数据库,搜集2019年8月以前关于剖宫产与后代炎症性肠病发生风险相关性的病例-对照研究和队列研究.按照严格的纳入和排除标准筛选文献,采用纽卡斯尔-渥太华量表对纳入文献进行质量评价,运用STATA 12.0软件进行分析.结果 共纳入11篇文献,其中包含6篇病例-对照研究,5篇队列研究.Meta分析结果显示剖宫产会增加后代溃疡性结肠炎的发生风险(RR=1.14,95％ CI:1.04～ 1.23);尚未发现剖宫产与后代克罗恩病的发生相关.Begg's检验(P =0.076)和Egger's检验(P =0.115)显示未发现明显发表偏倚.结论 剖宫产可能增加后代溃疡性结肠炎的发生风险.