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Attitude toward preventive counseling and healthy practices among medical students at a Colombian university

Frontiers of Medicine 2015年第2期9卷 251-259页

作者： Luz Helena Alba Nora Badoui Fabian Gil Department of Preventive and Social Medicine Pontificia Universidad Javeriana Bogota Colombia Department of clinical epidemiology and biostatistics Pontificia Universidad Javeriana Bogota Colombia

Unhealthy behaviors of medical students influence their attitudes toward preventive counseling. The burden of chronic diseases is continually growing in developing countries, emphasizing the need for the increased role of general practitioners in preventive counseling. The objective of this study was to describe the effect of medical training on the risk profiles and attitudes of medical students toward preventive counseling in a Colombian university. Students in their first and fifth years of training were surveyed using the ＂Healthy Doctor = Healthy Patient＂ questionnaire to assess counseling attitudes; personal practices, such as risky drinking, smoking, inadequate nutrition, and non-compliance with physical activity recommendations; and the university environment. The association among these components was estimated, as well as the effect of the university environment. Risky drinking and smoking decreased from first to fifth year （59.3% vs. 37.1%, P = 0.021 and 31.5~ vs. 25.9%, P = 0.51, respectively）, whereas inadequate nutrition and non-compliance with physical activity recommendations increased. Physical activity （PA） was associated with positive counseling attitude （ORs： nutrition 7.6; alcohol 5.2; PA 10.6）. Areas governed by institutional policies that are emphasized in the curriculum positively affected student practices. PA promoted preventive counseling and healthy lifestyles most effectively. Universities should therefore strengthen their preventive medicine curricula and modify social determinants.

关键词： lifestyle medical students preventive medicine counseling universities schools medical

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Budd-Chiari syndrome:A single-center experience

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World Journal of Gastroenterology 2014年第43期20卷 16236-16244页

作者： Tanya M Pavri Alan Herbst Rajender Reddy Kimberly A Forde division of Gastroenterology and Hepatology Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA 19104United States Center for clinical epidemiology and biostatistics Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPA 19104United States

AIM: To investigate challenges, risk factors, prognostic indicators, and treatment outcomes associated with Budd-Chiari syndrome (BCS) at a tertiary care center.

关键词： Budd-Chiari syndrome Transjugular intrahepatic portosystemic shunt Liver transplantation Anticoagulation Hepatic vein thrombosis

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Prevalence and impact of diabetes in patients with COVID-19 in China

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World Journal of Diabetes 2020年第10期11卷 468-480页

作者： Min Du Yu-Xin Lin Wen-Xin Yan Li-Yuan Tao Min Liu Jue Liu Department of epidemiology and biostatistics School of Public HealthPeking UniversityBeijing 100191China Research Center of clinical epidemiology Peking University Third HospitalBeijing 100083China

BACKGROUND Coronavirus disease 2019(COVID-19)is an emerging infectious disease that has spread rapidly around the *** studies have indicated that COVID-19 patients with diabetes are prone to having poor clinical *** To systematically evaluate the prevalence of diabetes among COVID-19 patients in China and its impact on clinical outcomes,including ICU admission,progression to severe cases,or *** We searched studies published in PubMed,Web of Science,and EMBASE from December 1,2019 to March 31,2020 to identify relevant observational study that investigated the prevalence of diabetes among COVID-19 patients or its impact on clinical *** used a random-effects or fixed-effects model to estimate the pooled prevalence of diabetes and risk ratio(RR)and its 95%confidence interval(CI)of diabetes on *** plots were used to evaluate the publication bias and the heterogeneity was evaluated by I2 *** Twenty-three eligible articles including 49564 COVID-19 patients(1573 with and 47991 without diabetes)were finally *** pooled prevalence of diabetes was 10%(95%CI:7%-15%)in COVID-19 *** the subgroup analyses,the pooled prevalence of diabetes was higher in studies with patients aged>50 years(13%;95%CI:11%-16%)than in studies with patients aged≤50 years(7%;95%CI:6%-8%),in severe patients(17%;95%CI:14%-20%)than in non-severe patients(6%;95%CI:5%-8%),and in dead patients(30%;95%CI:13%-46%)than in survivors(8%;95%CI:2%-15%)(P<0.05 for all).Compared with patients without diabetes,the risk of severe cases was higher(RR=2.13,95%CI:1.76-2.56,I2=49%)in COVID-19 patients with *** risk of death was also higher in COVID-19 patients with diabetes(RR=3.16,95%CI:2.64-3.78,I2=34%).However,diabetes was not found to be significantly associated with admission to ICU(RR=1.16,95%CI:0.15-9.11).CONCLUSION Nearly one in ten COVID-19 patients have diabetes in *** is associated with a higher risk of severe illne

关键词： Diabetes COVID-19 Systematic review Meta-analysis

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Zinc deficiency in patients with chronic pancreatitis

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World Journal of Gastroenterology 2019年第5期25卷 600-607页

作者： Miroslav Vujasinovic AleksANDra Hedstr?m Patrick Maisonneuve Roberto Valente Henrik von Horn J-Matthias L?hr Stephan L Haas Department for Digestive Diseases Karolinska University Hospital division of epidemiology and biostatistics IEO European Institute of Oncology IRCCS Department for Digestive Diseases Sapienza University of Rome division of clinical Chemistry Department of Molecular Medicine and Surgery Karolinska Institutet Karolinska University Hospital Department of clinical Science Intervention and Technology (CLINTEC)Karolinska Institute

BACKGROUND Zinc is a key element in numerous proteins and plays an important role in essential cell functions such as defense against free radicals and DNA damage repair. Chronic pancreatitis(CP) is a chronic inflammation with progressive fibrosis of pancreas ultimately resulting in pancreatic exocrine insufficiency(PEI),which is associated with malnutrition. Studies analyzing zinc levels in patients with CP are sparse and lead to conflicting *** To investigate serum zinc levels in patients with CP of various *** Between October 2015 and March 2018, patients with a diagnosis of CP were identified and recruited from the Pancreatic Outpatient Clinic at the Karolinska University Hospital in Stockholm, Sweden. Demographic, clinical and laboratory data were analyzed. Etiology of CP was determined according to the MANNHEIM classification system into the following etiological subcategories:alcohol consumption, nicotine consumption, hereditary factors, efferent pancreatic duct factors and immunological factors. Pancreatic exocrine function was defined as normal(fecal elastase 1 > 200 μg/g), mildly reduced(100-200μg/g) and severely reduced(fecal elastase 1 0.002]. Smoking and number of packyears were additionally associated with low zinc levels. The risk of zinc deficiency in current smokers and smokers with ≥ 20 pack-years was approximately three times higher

关键词： Zinc Pancreas Pancreatic exocrine insufficiency Chronic pancreatitis Malnutrition

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Serum pepsinogen Ⅱ is a better diagnostic marker in gastric cancer

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World Journal of Gastroenterology 2012年第48期18卷 7357-7361页

作者： Xue-Yuan Cao Zhi-Fang Jia Mei-Shan Jin Dong-Hui Cao Fei Kong Jian Suo Jing Jiang Department of Gastrointestinal Surgery Jilin University First Hospital division of clinical epidemiology Jilin University First Hospital division of Pathology Jilin University First Hospital

AIM:To investigate screening makers for gastric cancer,we assessed the association between gastric cancer and serum pepsinogens(PGs).METHODS:The subjects comprised 450 patients with gastric cancer,111 individuals with gastric atrophy,and 961 healthy *** anti-Helicobacter pylori(***) immunoglobulin G(IgG),PGⅠand PG Ⅱ were detected by enzyme-linked immunosorbent *** atrophy and gastric cancer were diagnosed by endoscopy and histopathological *** ratios and 95%CIs were calculated using multivariate logistic ***:Rates of *** infection remained high in Northeastern *** of *** IgG positivity were greater in the gastric cancer and gastric atrophy groups compared to the control group(69.1% and 75.7% vs 49.7%,P < 0.001).Higher levels of PG Ⅱ(15.9 μg/L and 13.9 μg/L vs 11.5 μg/L,P < 0.001) and lower PGⅠ/PG Ⅱ ratio(5.4 and 4.6 vs 8.4,P < 0.001) were found in patients with gastric cancer or gastric atrophy compared to healthy controls,whereas no correlation was found between the plasma PGⅠconcentration and risk of gastric cancer(P = 0.537).In addition,multivariate logistic analysis indicated that *** infection and atrophic gastritis were independent risk factors for gastric *** plasma PGⅠ/PG Ⅱ ratio was associated with higher risks of atrophy and gastric ***,plasma PG Ⅱ?level?significantly?correlated?with?*** gastric ***:Serum PG Ⅱ concentration and PG Ⅰ/PG Ⅱ ratio are potential biomarkers for *** gastric *** Ⅱ is independently associated with risk of gastric cancer.

关键词： Gastric cancer Pepsinogens Helicobacter pylori Gastric atrophy Screening

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Effect of oral mesalamine on inflammatory response in acute uncomplicated diverticulitis

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World Journal of Gastroenterology 2015年第27期21卷 8366-8372页

作者： Luca Nespoli Giulia Lo Bianco Fabio Uggeri Fabrizio Romano Angelo Nespoli Davide Paolo Bernasconi Luca Gianotti Department of Surgery and Translational Medicine University of Milan-Bicocca San Gerardo Hospital Department of Health Sciences Centre of Biostatistics for Clinical Epidemiology University of Milan-Bicocca

AIM: To evaluate the impact of mesalamine administration on inflammatory response in acute uncomplicated ***: We conducted a single centre retrospective cohort study on patients admitted to our surgical department between January 2012 and May 2014 with a computed tomography-confirmed diagnosis of acute uncomplicated diverticulitis. A total of 50 patients were included in the analysis, 20(study group) had received 3.2 g/d of mesalamine starting from the day of admission in addition to the usual standard treatment, 30(control group) had received standard therapy alone. Data was retrieved from a prospective database. Our primary study endpoints were: C reactive protein mean levels over time and their variation from baseline(ΔCRP) over the first three days of treatment. Secondary end points included: mean white blood cell and neutrophile count over time, time before regaining of regular bowel movements(passing of stools), time before reintroduction of food intake, intensity of lower abdominal pain over time, analgesic consumption and length of hospital ***: Patients characteristics and inflammatoryparameters were similar at baseline in the two groups. The evaluation of CRP levels over time showed, in treated patients, a distinct trend towards a faster decrease compared to controls. This difference approached statistical significance on day 2(mean CRP 6.0 +/- 4.2 mg/d L and 10.0 +/- 6.7 mg/d L respectively in study group vs controls, P = 0.055). ΔCRP evaluation evidenced a significantly greater increment of this inflammatory marker in the control group on day 1(P = 0.03). A similar trend towards a faster resolution of inflammation was observed evaluating the total white blood cell count. Neutrophile levels were significantly lower in treated patients on day 2 and on day 3(P < 0.05 for both comparisons). Mesalamine administration was also associated with an earlier reintroduction of food intake(median 1.5 d and 3 d, study group vs controls resp

关键词： Acute diverticulitis Inflammatory boweldisease 5-ASA benign colonic disease

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Glycated Haemoglobin in Diagnosis of Diabetes Mellitus and Pre-diabetes among Middle-aged and Elderly Population:Shanghai Changfeng Study

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Biomedical and Environmental Sciences 2013年第3期26卷 155-162页

作者： MA Hui GAO Xin LIN Huan Dong HU Yu LI Xiao Ming GAO Jian ZHAO Nai Qing Department of Endocrinology and Metabolism Zhongshan HospitalFudan University Department of Geriatrics Clinical Epidemiology CenterZhongshan HospitalFudan University Department of clinical Nutrition Zhongshan HospitalFudan University Department of biostatistics College of Public HealthFudan University

Objective To investigate the optimal glycated haemoglobin （HbAlc） cut off points and evaluate the impact of HbAlc on diabetes and pre-diabetes in middle-aged and elderly population. Methods Subjects were recruited from Shanghai Changfeng Study. A total of 1 973 community-based participants （age_〉45） without known diabetes underwent oral glucose tolerance test （OG3-r） by using a 75-g oral glucose load and HbAlc was measured by using high performance liquid chromatography （HPLC）. Subjects were classified as normal glucose tolerance （NGT）, pre-diabetes（impaired glucose regulation, IGR） and new diagnosed diabetes （NDD） per 1999 WHO criteria. Two tests are compared with receiver operating characteristic curve （ROC）. Results Among 1973 subjects, 271 （13.7%） were diagnosed as NDD and 474 （24.0%） as IGR by using OGTT. HbAlc was 5.7%_＋0.7% in this population. Use of 6.5% as the HbAIC cutoff point has sensitivity of 38.7% and specificity of 98.5%. We recommend 6.0% as a better cutoff value for diagnosis of diabetes in this population （AUC 0.829, 95% CI 0.798-0.860, P〈0.001） with its sensitivity and specificity as 66.1% and 86.8%. For IGR, the results showed low sensitivity （44.9%） and specificity （66.7%） with an AUC of 0.571 for HbAlc when 5.8% was used as the cutoff point. Participants detected with HbAlc_〉6.0% were associated with nearly the same metabolic characteristics, including body mass index （BMI）, blood pressure, lipid profile and urine albumin-creatinine ratio （uACR） compared with diabetic subjects detected by OGTT. Conclusion The optimum HbAlc cutoff point for diabetes in our study population was lower than ADA criteria, and HbAlc may not be used to identify IGR.

关键词： Glycated haemoglobin(HbAlc) Diabetes Pre-diabetes Impaired glucose regulation (IGR)

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Risk of second primary cancers after testicular cancer in East and West Germany： a focus on contralateral testicular cancers

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Asian Journal of Andrology 2014年第2期16卷 285-289,I0010,I0011页

作者： Carsten Rusner Brigitte Streller Christa Stegmaier Pietro Trocchi Oliver Kuss Katherine A McGlynn Britton Traberts Andreas Stang Institute of clinical epidemiology Medical Faculty Martin-Luther-University of Halle-Wittenberg Halle (Saale) Common Cancer Registry of Berlin Berlin Saarland Cancer Registry Saarbrucken Institute of Medical epidemiology Biostatistics and Informatics Medical Faculty Martin-Luther-University of Halle-Wittenberg Halle (Saale) Germany division of Cancer epidemiology and Genetics National Cancer Institute National Institutes of Health Bethesda MD Department of epidemiology Scfloof of Public Heaftfl Boston University Boston MA USA.

Testicular cancer survival rates improved dramatically after cisplatin-based therapy was introduced in the 1970s. However, chemotherapy and radiation therapy are potentially carcinogenic. The purpose of this study was to estimate the risk of developing second primary cancers including the risk associated with primary histologic type （seminoma and non-seminoma） among testicular cancer survivors in Germany. We identified 16 990 and 1401 cases of testicular cancer in population-based cancer registries of East Germany （1961-1989 and 1996-2008） and Saarland （a federal state in West Germany; 1970-2008）, respectively. We estimated the risk of a second primary cancer using standardized incidence ratios （SIRs） with 95% confidence intervals （95% Cls）. To determine trends, we plotted model-based estimated annual SIRs. In East Germany, a total of 301 second primary cancers of any location were observed between 1961 and 1989 （SIR： 1.9; 95% Ch 1.7-2.1）, and 159 cancers （any location） were observed between 1996 and 2008 （SIR： 1.7; 95% Ch 1.4-2.0）. The SIRs for contralateral testicular cancer were increased in the registries with a range from 6.0 in Saarland to 13.9 in East Germany. The SIR for seminoma, in particular, was higher in East Germany compared to the other registries. We observed constant trends in the model-based SIRs for contralateral testicular cancers. The majority of reported SIRs of other cancer sites including histology-specific risks showed low precisions of estimated effects, likely due to small sample sizes. Testicular cancer patients are at increased risk especially for cancers of the contralateral testis and should receive intensive follow-ups.

关键词： cancer registry incidence neoplasms second primary testicular neoplasms

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Use of a clinical pathway in laparoscopic gastrectomy for gastric cancer

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World Journal of Gastroenterology 2015年第48期21卷 13507-13517页

作者： Hee Sung Kim Sun Oak Kim Byung Sik Kim Department of Gastric Surgery Asan Medical CenterUlsan University School of Medicine Department of clinical epidemiology and biostatistics Asan Medical CenterUlsan University School of Medicine

AIM: To evaluate the implementation of a clinical pathway and identify clinical factors affecting the clinical pathway for laparoscopic ***: A standardized clinical pathway for gastric cancer(GC) patients was developed in 2001 by the GC surgery team at the Asan Medical Center. We reviewed the collected data of 4800 consecutive patients treated using the clinical pathway following laparoscopic gastrectomy with lymph node dissection for GC involving intracorporeal and extracorporeal anastomosis. The patients were treated between August 2004 and October 2013 in a single institution. To evaluate the rate of completion and risk factors affecting dropout from the clinical pathway, we used a multivariate logistic regression ***: The overall completion rate of the clinical pathway for laparoscopic gastrectomy was 84.1%(n = 4038). In the comparison between groups of intracorporeal anastomosis and extracorporeal anastomosis patients, the completion rates were 8 3. 8 8 %(n = 1 7 4 0) a n d 8 4. 3 6 %(n = 2 0 7 1), respectively, showing no statistically significant difference. The main reasons for dropping out were postoperative complications(n = 463, 9.7%) and the need for patient observation(n = 299, 6.2%). Among the discharged patients treated using the clinical pathway, the number of patients who were readmitted within 30 d due to postoperative complications was 54(1.1%). In a multivariate analysis, the intraoperative events(OR = 2.558) were the most predictable risk factors for dropping out of the clinical pathway. Additionally, being male(OR = 1.459), advanced age(OR = 1.727), total gastrectomy(OR = 2.444), combined operation(OR = 1.731), and ASA score(OR = 1.889) were significant risk factors affecting the dropout rate from the clinical ***: Laparoscopic gastrectomy appears to be a good indication for the application of a clinical pathway. For successful application, patients with risk factors should be managed carefully.

关键词： clinical pathway Laparoscopic gastrectomy Gastric cancer Extracorporeal anastomosis Intracorporealanastomosis

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Pre-illness changes in dietary habits and diet as a risk factor for inflammatory bowel disease: A case-control study

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World Journal of Gastroenterology 2010年第34期16卷 4297-4304页

作者： Giovanni Maconi Sandro Ardizzone Claudia Cucino Cristina Bezzio Antonio Giampiero Russo Gabriele Bianchi Porro Department of clinical Sciences L. Sacco University Hospital Endoscopy Unit Istituto Clinico Santa Rita 20131 Milan Italy epidemiology and biostatistics Unit San Carlo Borromeo Hospital

AIM: To evaluate whether symptoms of inflammatory bowel disease (IBD), before diagnosis modify dietary habits, and to investigate the pre-illness diet in patients with recent IBD in comparison with an age-matched healthy control group. METHODS: Overall, 83 new cases of IBD (41 ulcerative colitis, 42 Crohn's disease) and 160 healthy controls were studied. Portions per week of 34 foods and beverages before onset of symptoms were recorded using a validated questionnaire. Duration of symptoms before IBD diagnosis, presence of specific symptoms and their impact on subjective changes in usual dietary habits were also recorded. The association between diet and IBD was investigated by multiple logistic regression and dietary patterns were assessed by factor analysis. RESULTS: Changes in dietary habits, due to the presence of symptoms, were reported by 38.6% of patients and were not significantly related to specific symptoms, rather to long duration of symptoms, only in Crohn's disease patients. In IBD patients who did not change dietary habits, moderate and high consumption of margarine (OR = 11.8 and OR = 21.37) was associated with ulcerative colitis, whilst high consumption of red meat (OR = 7.8) and high intake of cheese were associated with Crohn's disease. CONCLUSION: More than one third of IBD patients change dietary habits before diagnosis. Margarine, red meat and cheese increase the risk of ulcerative colitis and Crohn's disease.

关键词： Inflammatory bowel diseases Diet Symptoms Factor analysis

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