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Healthcare Worker-Related Factors Contributing to Tuberculosis Treatment Non-Adherence among Patients in Kisumu East Sub-County

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Journal of Tuberculosis Research 2024年第1期12卷 13-33页

作者： Marlyn Ochieng Jackline Nyaberi susan Mambo Charles Wafula Department of Environmental Health and Disease Control School of Public Health Jomo Kenyatta University of Agriculture and Technology (JKUAT) Nairobi Kenya European and Developing Countries Clinical Trials Partnership (EDCTP) Strengthening Capacity for Epidemics Preparedness and Response in Sub-Saharan Africa (SCEPRESSA) Nairobi Kenya Great Lakes University of Kisumu (GLUK) Kisumu Kenya

Background: Treatment non-adherence poses significant risks to health outcomes and impedes the health system’s efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interventions to address TB treatment non-adherence, Kenya still reports high TB treatment non-adherence rates of 35% and consequently poor treatment outcome rates. Health Care Workers (HCWs) play a critical role in linking the population to health services, yet little is known of their influence on patients’ TB treatment non-adherence in Kenya. Objective: To analyze HCW-related factors associated with TB treatment non-adherence among patients in Kisumu East Sub-County. Methods: Health facility-based analytical cross-sectional mixed-method study. A Semi-structured questionnaire on treatment adherence and patients’ perceptions of HCWs during the clinic visit was administered to 102 consenting adult (out of a total census of 107 adults) drug-susceptible TB patients. 12 purposively selected HCWs by rank from 6 health facilities participated in Key Informant Interview sessions. Medication adherence was measured using the Morisky Medication Adherence Scale and then expressed as a dichotomous variable. Quantitative analysis utilized STATA version 15.1 while qualitative deductive thematic analysis was done using NVIVO version 14. Results: TB treatment non-adherence rate of 26% (CI: 18% - 36%) was recorded. Overall, patients who felt supported in dealing with the illness were 8 times more likely to adhere to treatment compared to those who were not (aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p = 0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication [adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001) and patie

关键词： Tuberculosis Treatment Adherence Human Resources for Health

Prevalence of Microvascular Complications and Associated Risk Factors among Diabetes Mellitus Patients Attending Nyeri County Referral Hospital, Kenya: A Cross-Sectional Study

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Open Journal of Epidemiology 2024年第3期14卷 444-458页

作者： Rachael Ireri Gideon Kikuvi susan Mambo Betsy C. Rono Cheriro Jomo Kenyatta University of Agriculture and Technology Juja Kenya Department of Clinical Medicine Kenya Medical Training College Nairobi Kenya

Microvascular complications are one of the major causes of morbidity and mortality worldwide among patients with diabetes mellitus (DM). More than 50% of Nyeri County Referral Hospital (NCRH) admissions result from non-communicable diseases (NCDs) and over 55% of hospital deaths are attributable to NCDs. In Kenya, Nyeri County has the highest prevalence of diabetes mellitus compared to other counties. This study therefore sought to assess the prevalence of microvascular complications and the associated risk factors among patients attending Nyeri County Referral Hospital in Kenya. A hospital-based cross-sectional study was conducted on 314 DM patients on follow-up at NCRH from August 2022 to October 2022. Data were analyzed using STATA version 17. Univariate and multivariate logistic regression analyses are used to determine the risk factors associated with Microvascular complications of DM. Among the 314 participants with DM, 58% were females. The overall prevalence of Microvascular complications (MVCs) is 36.62%. Diabetic peripheral neuropathy was the most frequent complication (27.4%). Inadequate physical exercise was a risk factor for all MVCs. Age, marital status, and level of education were risk factors for neuropathy while smoking and alcohol intake were risk factors for nephropathy. Non-smokers were 98% less likely to have nephropathy (OR = 0.024;95% CI 0.003 - 0.145). The odds of those who exercise once weekly getting retinopathic complications reduced by 83% (OR = 0.18, 95% CI 0.049 - 0.398) compared to those who exercise daily. The findings highlight the implication of lifestyle factors in the development of MVCs among DM patients. Therefore, benefits of microvascular complications prevention should thus be factored into the management of patients with diabetes mellitus.

关键词： Diabetes Mellitus Microvascular Complications Risk Factors Retinopathy Neuropathy Nephropathy

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欧洲销售渠道，你了解多少？

国际品牌观察 2024年第17期 38-41页

作者： susan

欧洲市场的多样性和复杂性决定了中国企业在进入该市场时需要制定精细化、灵活的销售渠道策略。中国品牌在出海欧洲市场时，在销售渠道方面面临的挑战较大，这是一个复杂的过程，涉及多种因素，包括市场准入、消费者行为差异、渠道结构...

欧洲市场的多样性和复杂性决定了中国企业在进入该市场时需要制定精细化、灵活的销售渠道策略。中国品牌在出海欧洲市场时，在销售渠道方面面临的挑战较大，这是一个复杂的过程，涉及多种因素，包括市场准入、消费者行为差异、渠道结构、竞争环境、文化适应等问题。随着全球市场竞争日益激烈，销售渠道策略的重要性愈加突出。相比于直接销售，销售渠道策略依托第三方供应商，包括批发商、分销商、增值经销商（VAR）和托管服务提供商，帮助企业高效地将品牌与产品推广至更广泛的市场。尤其是在多样化的欧洲市场，成功的销售渠道策略能够为企业带来显著的业务增长和市场份额提升。

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数字服务税收属性及中国税制构造进路

学习与实践 2024年第3期 113-124,F0002页

作者：李蕊王苏姗中国政法大学民商经济法学院北京100088 中国政法大学地方财政金融和农村法治研究中心北京100088

对数字服务税收属于直接税抑或间接税的属性判定,不仅关涉数字服务的产业发展及税基分配,也将深刻影响数字经济时代税制改革的方向与进路。部分国家着眼于间接税的制度厘定,采行开征数字服务税之类的单边“临时性”措施,会对数字消费产... 详细信息

对数字服务税收属于直接税抑或间接税的属性判定,不仅关涉数字服务的产业发展及税基分配,也将深刻影响数字经济时代税制改革的方向与进路。部分国家着眼于间接税的制度厘定,采行开征数字服务税之类的单边“临时性”措施,会对数字消费产生抑制效应。基于对数字服务税收的直接税属性的判定,在既有所得税领域的税收协定框架下,联合国及经济合作与发展组织分别进行了税制改革方案设计。着眼于对数字服务征收直接税的路径选择,中国亟需实施双阶税制构造,将扩大预提税征税范围作为过渡措施,并作好重新配置税收管辖权的长期税制改革谋划。

关键词：数字服务税收直接税间接税

Association of age at diagnosis of diabetes with subsequent risk of age-related ocular diseases and vision acuity

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World Journal of Diabetes 2024年第4期15卷 697-711页

作者： Si-Ting Ye Xian-Wen Shang Yu Huang susan Zhu Zhuo-Ting Zhu Xue-Li Zhang Wei Wang Shu-Lin Tang Zong-Yuan Ge Xiao-Hong Yang Ming-Guang He The Second Clinical College Guangzhou University of Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Department of Ultrasound The Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Guangdong Eye Institute Department of OphthalmologyGuangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhou 510080Guangdong ProvinceChina Guangdong Cardiovascular Institute Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhou 510080Guangdong ProvinceChina Austin Hospital University of MelbourneMelbourne 3084VictoriaAustralia State Key Laboratory of Ophthalmology Zhongshan Ophthalmic CenterSun Yat-sen UniversityGuangzhou 510060Guangdong ProvinceChina Monash e-Research Center Faculty of EngineeringAirdoc ResearchNvidia AI Technology Research CenterMonash UniversityMelbourne 3080VictoriaAustralia Department of Ophthalmic Epidemiology Centre for Eye Research AustraliaMelbourne 3002VictoriaAustralia

BACKGROUND The importance of age on the development of ocular conditions has been reported by numerous *** may have different associations with different stages of ocular conditions,and the duration of diabetes may affect the development of diabetic eye *** there is a dose-response relationship between the age at diagnosis of diabetes and the risk of cardiovascular disease and mortality,whether the age at diagnosis of diabetes is associated with incident ocular conditions remains to be *** is unclear which types of diabetes are more predictive of ocular *** To examine associations between the age of diabetes diagnosis and the incidence of cataract,glaucoma,age-related macular degeneration(AMD),and vision *** Our analysis was using the UK *** cohort included 8709 diabetic participants and 17418 controls for ocular condition analysis,and 6689 diabetic participants and 13378 controls for vision *** diseases were identified using inpatient records until January *** acuity was assessed using a *** During a median follow-up of 11.0 years,3874,665,and 616 new cases of cataract,glaucoma,and AMD,respectively,were identified.A stronger association between diabetes and incident ocular conditions was observed where diabetes was diagnosed at a younger *** with type 2 diabetes(T2D)diagnosed at<45 years[HR(95%CI):2.71(1.49-4.93)],45-49 years[2.57(1.17-5.65)],50-54 years[1.85(1.13-3.04)],or 50-59 years of age[1.53(1.00-2.34)]had a higher risk of AMD independent of glycated haemoglobin.T2D diagnosed<45 years[HR(95%CI):2.18(1.71-2.79)],45-49 years[1.54(1.19-2.01)],50-54 years[1.60(1.31-1.96)],or 55-59 years of age[1.21(1.02-1.43)]was associated with an increased cataract risk.T2D diagnosed<45 years of age only was associated with an increased risk of glaucoma[HR(95%CI):1.76(1.00-3.12)].HRs(95%CIs)for AMD,cataract,and glaucoma associated with type 1 diabetes(T1D)were 4.12(1.99-8.53),

关键词： Diabetes Age at diagnosis Cataract Glaucoma Age-related macular disease Vision acuity

Early anticoagulation in patients with stroke and atrial fibrillation is associated with fewer ischaemic lesions at 1 month: the ATTUNE study

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Stroke & Vascular Neurology 2024年第1期9卷 30-37,I0034页

作者： Angelos Sharobeam Longting Lin Christina Lam Carlos Garcia-Esperon Yash Gawarikar Ronak Patel Matthew Lee-Archer Andrew Wong Michael Roizman Amanda Gilligan Andrew Lee Kee Meng Tan susan Day Christopher Levi Stephen M Davis Mark Parsons Bernard Yan Melbourne Brain Centre at Royal Melbourne Hospital ParkvilleVictoriaAustralia University of New South Wales South Western Sydney Clinical School LiverpoolNew South WalesAustralia Department of Neurology John Hunter HospitalNewcastleNew South WalesAustralia Department of Neurology Calvary Public HospitalCanberraAustralian Capital TerritoryAustralia Department of Neurology Northern Hospital EppingEppingVictoriaAustralia Department of Neurology Royal Brisbane and Women's HospitalHerstonQueenslandAustralia The University of Queensland School of Medicine HerstonQueenslandAustralia Neurosciences Clinical Institute Epworth HealthcareRichmondVirginiaAustralia Department of Neurology Austin HealthUniversity of MelbourneHeidelbergVictoriaAustralia Flinders University College of Medicine and Public Health AdelaideSouth AustraliaAustralia Department of Neurology Gold Coast University HospitalSouthportQueenslandAustralia The University of Sydney Northern Clinical School St LeonardsNew South WalesAustralia Department of Neurology and Neurophysiology Liverpool HospitalLiverpoolNew South WalesAustralia

Background The optimal time to commence anticoagulation in patients with atrial fibrillation(AF)after ischaemic stroke or transient ischaemic attack(TIA)is unclear,with guidelines differing in recommendations.A limitation of previous studies is the focus on clinically overt stroke,rather than radiologically obvious diffusion-weighted imaging ischaemic *** aimed to quantify silent ischaemic lesions and haemorrhages on MRI at 1month in patients commenced on early(5mL,regardless of anticoagulation *** Commencing anticoagulation<4days after stroke or TIA is associated with fewer ischaemic lesions at 1month in AF *** is no increased rate of haemorrhage with early *** results suggest that early anticoagulation after mild-to-moderate acute ischaemic stroke associated w

关键词： patients lesions ischaemic

Occupational physical activity, all-cause, cardiovascular disease, and cancer mortality in 349,248 adults: Prospective and longitudinal analyses of the MJ Cohort

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Journal of Sport and Health Science 2024年第4期13卷 579-589页

作者： Emmanuel Stamatakis Matthew N.Ahmadi Tiana-Lee Elphick Bo-Huei Huang susan Paudel Armando Teixeira-Pinto Li-Jung Chen Borja del Pozo Cruz Yun-Ju Lai Andreas Holtermann Po-Wen Ku Sydney School of Health Sciences Faculty of Medicine and HealthCharles Perkins CentreUniversity of SydneySydneyNSW 2006Australia Sydney School of Public Health Faculty of Medicine and HealthUniversity of SydneySydneyNSW 2006Australia Department of Exercise Health Science “National”Taiwan University of SportTaichung 40404China Department of Sports Science and Clinical Biomechanics University of Southern DenmarkOdense 5230Denmark Division of Endocrinology and Metabolism Department of Internal MedicinePuli Branch of Taichung Veterans General HospitalNantou 54552China National Research Centre for the Working Environment Copenhagen 2100Denmark Graduate Institute of Sports and Health Management “National”Chung Hsing UniversityTaichung 40227China

Background:Evidence on the health benefits of occupational physical activity(OPA)is *** examined the associations of baseline OPA and OPA changes with all-cause,cardiovascular disease(CVD),and cancer mortality and survival ***:This study included prospective and longitudinal data from the MJ Cohort,comprising adults over 18 years recruited in 1998-2016,349,248 adults(177,314 women)with baseline OPA,of whom 105,715(52,503 women)had 2 OPA measures at 6.3±4.2 years(mean±SD)*** were baseline OPA,OPA changes,and baseline leisure-time physical ***:Over a mean mortality follow-up of 16.2±5.5 years for men and 16.4±5.4 years for women,11,696 deaths(2033 of CVD and 4631 of cancer causes)in men and 8980 deaths(1475 of CVD and 3689 of cancer causes)in women *** moderately heavy/heavy baseline OPA was beneficially associated with all-cause mortality in men(multivariable-adjusted hazard ratio(HR)=0.93,95%confidence interval(95%CI):0.89-0.98 compared to light OPA)and women(HR=0.86,95%CI:0.79-0.93).Over a mean mortality follow-up of 12.5±4.6 years for men and 12.6±4.6 years for women,OPA decreases in men were detrimentally associated(HR=1.16,95%CI:1.01-1.33)with all-cause mortality,while OPA increases in women were beneficially(HR=0.83,95%CI:0.70-0.97)associated with the same *** or changes in OPA showed no associations with CVD or cancer ***:Higher baseline OPA was beneficially associated with all-cause mortality risk in both men and *** longitudinal OPA analyses partly confirmed the prospective findings,with some discordance between sex groups.

关键词： Cancer Cardiovascular disease Epidemiology Mortality

交叉学科研究的机遇与陷阱——张丹与苏珊·罗伯森的对话

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华东师范大学学报（教育科学版） 2024年第7期42卷 114-126页

作者：张丹 [英]苏珊·罗伯森华东师范大学国际与比较教育研究所上海200062 剑桥大学教育学院英格兰剑桥CB28PQ

新时期国家大力提倡学科交叉,加快“双一流”建设目标,着重打破传统学科间壁垒,探索跨院系、跨学科、跨专业交叉培养拔尖创新人才,加快学科协同交叉融合,这对提出并解决交叉学科难题具有重要意义。然而,真正的多学科、交叉学科及跨学科... 详细信息

新时期国家大力提倡学科交叉,加快“双一流”建设目标,着重打破传统学科间壁垒,探索跨院系、跨学科、跨专业交叉培养拔尖创新人才,加快学科协同交叉融合,这对提出并解决交叉学科难题具有重要意义。然而,真正的多学科、交叉学科及跨学科方法并不可能通过制度性的强制要求而孵化产生,且在现有实践中很难实现真正的交叉学科。那么,交叉学科研究是否必要?如何促进交叉学科发展,存在哪些机遇与挑战,在学科交叉发展中又存在哪些制度性发展陷阱?针对以上问题,华东师范大学国际与比较教育研究所张丹副教授与剑桥大学教育学院苏珊·罗伯森教授,以对话的方式共同探讨交叉学科研究发展的机遇与陷阱。

关键词：交叉学科知识生产学科发展

A comprehensive review of genetic causes of obesity

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World Journal of Pediatrics 2024年第1期20卷 26-39页

作者： Marcio Jose Concepcion-Zavaleta Juan Eduardo Quiroz-Aldave Maria del Carmen Durand-Vasquez Elman Rolando Gamarra-Osorio Juan del Carmen Valencia de la Cruz Claudia Mercedes Barrueto-Callirgos susan Luciana Puelles-Leon Elena de Jesus Alvarado-Leon Frans Leiva-Cabrera Francisca Elena Zavaleta-Gutierrez Luis Alberto Concepcion-Urteaga Jose Paz-Ibarra Universidad Cientifica del Sur Bolivar 2150 AvenuePueblo Libre15084LimaPeru Division of Medicine Hospital de Apoyo ChepénChepenPeru Division of Family Medicine Hospital de Apoyo ChepénChepenPeru Division of Endocrinology Hospital Victor Lazarte EchegarayTrujilloPeru Division of Pediatrics Hospital de Apoyo ChepenChepenPeru Division of Internal Medicine Hospital de Apoyo ChepenChepenPeru Division of Genetics Universidad Nacional de TrujilloTrujilloPeru Division of Neonatology Hospital Belen de TrujilloTrujilloPeru Division of Internal Medicine Universidad Nacional de TrujilloTrujilloPeru Department of Medicine School of MedicineUniversidad Nacional Mayor de San MarcosLimaPeru

Background Obesity is a multifactorial chronic disease with a high,increasing worldwide *** causes account for 7%of the cases in children with extreme *** sources This narrative review was conducted by searching for papers published in the PubMed/MEDLINE,Embase and SciELO databases and included 161 *** search used the following search terms:"obesity","obesity and genetics","leptin","Prader-Willi syndrome",and"melanocortins".The types of studies included were systematic reviews,clinical trials,prospective cohort studies,cross-sectional and prospective studies,narrative reviews,and case *** The leptin-melanocortin pathway is primarily responsible for the regulation of appetite and body ***,several important aspects of the pathophysiology of obesity remain *** causes of obesity can be grouped into syndromic,monogenic,and polygenic causes and should be assessed in children with extreme obesity before the age of 5 years,hyperphagia,or a family history of extreme obesity.A microarray study,an analysis of the melanocortin type 4 receptor gene mutations and leptin levels should be performed for this *** are three therapeutic levels:lifestyle modifications,pharmacological treatment,and bariatric *** Genetic study technologies are in constant development;however,we are still far from having a personalized approach to genetic causes of obesity.A significant proportion of the affected individuals are associated with genetic causes;however,there are still barriers to its approach,as it continues to be underdiagnosed.

关键词： Leptin Melanocortin Obesity Prader-Willi syndrome Precision medicine