THE IMPORTANCE OF CONSECUTIVE SPELLS OF POVERTY: A PATH‐DEPENDENT INDEX OF LONGITUDINAL POVERTY

In this paper we propose a new index of individual poverty in the longitudinal perspective, taking into account the way poverty and non‐poverty spells follow one another along individual life courses. The Poverty Persistence Index (PPI) is based on all the pairwise distances between the waves of poverty. The PPI is normalized and it assigns a higher degree of (longitudinal) poverty to people who experience poverty in consecutive, rather than separated, periods, for whom the distances from the poverty line are larger along time and moreover, when the worst years are consecutive and/or recent. We also propose an aggregate index of persistence in poverty (APPI) in order to measure the distribution of the persistence of poverty in a society, and evaluate at once the diffusion of poverty, its depth, duration, and recentness. The indices are tested in comparison with other measures from the literature both at the individual as well as at the societal level.     

高剂量替考拉宁治疗耐甲氧西林金黄色葡萄球菌肺部感染合并低蛋白血症患者的临床疗效

目的探讨高剂量替考拉宁治疗耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染合并低蛋白血症患者的临床疗效和安全性。方法选取2018年6月至2019年6月台州市立医院收治的61例MRSA肺部感染合并低蛋白血症住院患者作为研究对象,随机分为对照组(31例)与试验组(30例)。对照组给予替考拉宁注射液负荷剂量6 mg/kg,每12小时1次(前3剂),维持剂量6 mg/kg q24 h治疗,试验组给予负荷剂量12 mg/kg,每12小时1次(前3剂),维持剂量12 mg/kg,每24小时1次治疗,比较两组患者替考拉宁血药谷浓度(Cmin)及达标率、临床疗效、疗效指标及药物不良反应发生情况。结果试验组患者替考拉宁血药Cmin水平及达标率、临床治愈率高于对照组(P<0.05);试验组治愈患者体温恢复时间、白细胞计数(WBC)恢复时间、C反应蛋白(CRP)恢复时间、住院时间优于对照组(P<0.05),咳嗽咳痰消失时间与对照组比较,差异无统计学意义(P>0.05);两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论对MRSA肺部感染合并低蛋白血症患者提高替考拉宁给药剂量临床疗效显著,能够提高血药浓度,加速临床症状缓解,且不增加不良反应发生。     

Pacemaker complications and costs: a nationwide economic study

Abstract

Aims: Novel leadless pacemakers (LPMs) may reduce complications and associated costs related to conventional pacemaker systems. This study sought to estimate the incidence and associated costs of traditional pacemaker complications, in those patients who were eligible for LPM implantation.

Methods: A retrospective analysis was conducted on the French National Hospital Database (PMSI), including all patients implanted with a pacemaker in France in 2012, who could have alternatively received an LPM. Complication rates and their associated costs 3 years post-implantation were estimated from the perspective of the French social security system.

Results: From a total of 65,553 patients, 11,770 (18%) met the inclusion criteria. Overall, 618 patients (5.3%) had a record of pacemaker complications during follow-up, of which 89% were related to the lead and pocket. Most common were pocket bleeding, lead- or generator-related mechanical complications, and pneumothorax. Overall, the mean cost of pacemaker complications per patient was €6,674?±?3,867 at 3 years. Specifically, €7,143?±?2,685 for pocket bleeding, €5,123?±?2,676 for pneumothorax, and €6,020?±?3,272 for mechanical complications.

Conclusions: Major complications associated with the lead and pocket of conventional pacemaker systems are still common, and these represent a significant burden to healthcare systems as they generate substantial costs.     

重症监护室中中央静脉导管对血液感染的影响

目的探讨与中央静脉导管相关的血液感染的风险因素,尤其是护工和抗菌浸渍因素的影响,这对有效确立预防措施至关重要。方法在两年期间,有预见性地监测重症监护室中抗菌浸渍、护工以及成年患者中中央静脉导管相关的血液感染的变量因素。结果在210例患者中,中中央静脉导管相关的血液感染的案例被确认的共计32例。只有在中央静脉导管被用于管理全肠外营养的患者中,抗菌浸渍中央静脉导管才降低了与中央静脉导管相关的血液感染风险。而没有接受全肠外营养管理的患者,其受与中央静脉导管相关的血液感染风险增加了。结论抗菌浸渍中央静脉导管在接受全肠外营养管理的患者中,其与中央静脉导管相关的血液感染的风险降低了66%。限制采用倒班护工对在使用中央静脉导管患者进行护理、使用外周静脉置入的中央静脉导管都能降低与中央静脉导管相关的血液感染的风险。     

A Predictive Model of Chronic Time Pressure in the Australian Population: Implications for Leisure Research

Time pressure is a perception of being rushed or pressed for time. In its most extreme form, time pressure has implications for leisure, health and wellbeing. Although previous findings from the Australian Bureau of Statistics (ABS) show that time pressure affects large numbers of Australians (ABS, 1998 Australian Bureau of Statistics. 1998. How Australians use their time, Canberra: Australian Bureau of Statistics. Catalogue No. 4153.0 [Google Scholar]; Bittman, 1998 Bittman, M. 1998. The land of the lost long weekend: Trends in free time among working age Australians. SPRC Discussion Paper, 83 [Google Scholar]), no research has addressed chronic time pressure (ie. always feeling time pressured). This study aims to use selected demographic variables to develop a model to predict chronic time pressure in the Australian population. The implications of chronic time pressure for leisure research are also discussed.     

Technology Spillovers between Sectorsand over Time

Technology spillovers are an important source of economic growth. This article presents a new method to measure technology spillovers at the macroeconomic or sectoral level by means of a so-called technology flow matrix. The main novelty relative to existing technology flow matrices is that the matrix in this article provides insight into the time dimension of the spillover process. The matrix is used to assess whether or not R&D spillovers lead to a more equal distribution of technology investment over sectors.     

喜炎平注射液联合抗菌药物治疗小儿急性上呼吸道感染患儿的疗效

目的探讨喜炎平注射液联合抗菌药物治疗小儿急性上呼吸道感染患儿的疗效。方法选取2019年7月至2020年9月沈阳市儿童医院收治的160例小儿急性上呼吸道感染患儿作为研究对象,随机分为联合组与抗菌药物组,各80例。抗菌药物组仅用抗菌药物治疗,联合组实施喜炎平注射液联合抗菌药物治疗,比较两组的治疗效果。结果治疗后,两组患儿白细胞介素-8、白细胞介素-1、超敏C反应蛋白显著降低,且联合组明显低于抗菌药物组,差异有统计学意义(P<0.05);联合组治疗有效率明显高于抗菌药物组,差异有统计学意义(P<0.05);联合组不良反应发生率明显低于抗菌药物组,差异有统计学意义(P<0.05)。结论针对小儿急性上呼吸道感染患儿实施抗菌药物治疗的同时,配合喜炎平注射液共同治疗,能够有效提升治疗效果。     

认知疗法在骨科慢性疼痛性疾病患者护理中的应用价值

目的：探讨认知疗法在骨科慢性疼痛性疾病患者护理中的应用价值。方法选取广东省揭阳市惠来县人民医院骨科诊断为慢性疼痛性疾病的患者资料200例,将其采用随机数字表法分为两组,各100例,对照组患者给予骨科常规护理,观察组患者在其基础上加以认知疗法护理。比较两组患者治疗后的疼痛程度。结果观察组患者护理后疼痛率明显低于对照组;且观察组 SDS、SAS 评分下降水平也明显优于对照组,差异均有统计学意义（均 P＜0.05）。结论对骨科慢性疼痛性疾病患者的护理中施以认知疗法,能有效缓解患者的疼痛和焦虑。     

Cost-effectiveness of telaprevir in combination with pegylated interferon alpha and ribavirin in previously untreated chronic hepatitis C genotype 1 patients

Background:

Telaprevir (T, TVR) is a direct-acting antiviral (DAA) used for the treatment of genotype 1 chronic hepatitis C virus (HCV) infection. The sustained virological response (SVR) rates, i.e., undetectable HCV RNA levels 24 weeks after the end of treatment, is what differentiate treatments. This analysis evaluated the cost-effectiveness of TVR combined with pegylated interferon (Peg-IFN) alfa-2a plus ribavirin (RBV), with Peg-IFN and RBV (PR) alone or with boceprevir (B, BOC) plus Peg-IFN alfa-2b and RBV, in naïve patients.

Methods:

A Markov cohort model of chronic HCV disease progression reflected the pathway of naïve patients initiating anti-HCV therapy. SVR rates were derived from a mixed-treatment comparison including results from Phase II and III trials of TVR and BOC, and trials comparing both PR regimens. SVR has significant impact on survival, quality-of-life, and costs. Incremental cost per life year (LY) gained and quality-adjusted-life-year (QALY) gained were computed at lifetime, adopting the (National Health Service) NHS perspective. Cost and health outcomes were discounted at 3.5%. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Sub-group analyses were also performed by interleukin (IL)-28B genotype and fibrosis stage.

Results:

Higher costs and improved outcomes were associated with T/PR relative to PR alone, resulting in an ICER of £12,733 per QALY gained. T/PR retained a significant SVR advantage over PR alone and was cost-effective regardless of IL-28B genotype and fibrosis stages. T/PR regimen ‘dominated’ B/PR, generating 0.2 additional QALYs and reducing lifetime cost by £2758. Sensitivity analyses consistently resulted in ICERs less than £30,000/QALY for the T/PR regimen over PR alone.

Limitations:

No head-to-head trial provides direct evidence of better efficacy of T/PR vs B/PR.

Conclusion:

The introduction of TVR-based therapy for genotype 1 HCV patients is cost-effective for naïve patients at the £30,000 willingness-to-pay threshold, regardless of IL-28B genotype or fibrosis stage.