ABSTRACT
The 2030 Immunization Agenda of the World Health Organization （WHO） states that everyone in the world should fully benefit from vaccines to achieve good health and well-being. With the ever-changing disease spectrum and the improvement of residents' health literacy， relying solely on vaccines included in the National Immunization Program （NIP） is insufficient to meet the current requirements for disease prevention and control. Non-NIP vaccines play an important role in meeting people's diverse needs. Vaccine hesitancy is a global issue and an important factor affecting vaccine uptake. By reviewing relevant studies on vaccine hesitancy in recent years， this paper summarized different vaccination situations， current situation of vaccine hesitancy， measuring tools of vaccine hesitancy， and major influencing factors. It aims to provide references for the development of scientific and effective vaccine education strategies， which can increase public knowledge and understanding of vaccines， enhance healthcare professional's willingness and behavior in recommending vaccines， improve public vaccine literacy， and reduce vaccine hesitancy. At the same time， the supervision and guidance of media discourse should be strengthened to enhance the protective role of non-NIP vaccines in immunization barriers.
ABSTRACT
OBJECTIVE:To systematically review the efficacy of folic acid in the prevention of gastrointestinal(GI)tumors in elder,and provide evidence-based reference for the clinical treatment. METHODS:Retrieved from Cochrane Library,PubMed,EM-Base,Web of Science,CMB,CJFD,VIP and Wanfang Database,the randomized controlled trials (RCT) about folic acid (test group)versus placebo(control group)in the prevention of GI tumors in elder(age>50 years old). After quality evaluation and da-ta extract,Meta-analysis was performed buy using Rev Man 5.3 statistics software. RESULTS:A total of 9 RCT were included,in-volving 29 494 patients. Results of Meta-analysis showed there was no significant difference in the incidence of GI tumors between 2 groups[RR=0.91,95%CI(0.74,1.12),P=0.38]. Results of subgroup analysis showed the incidence of GI tumors was not affected by GI tumor stage,age,basic serum folic acid level,type and dose of folic acid and follow-up time during follow-up period. CON-CLUSIONS:Folic acid supplement can not effectively prevent the incidence of GI tumors in elder. The incidence of GI tumors in elder with different ages and baseline of folic acid are not decreased by any dose and duration,without obvious adverse reactions. It indicates that folic acid supplement should be careful and give full conscideration to the patients’general situation. Due to the limit of methodological quality and sample size,it remains to be further verified with more rigorously designed and long-term follow-up of large-scale RCT.
ABSTRACT
Objective To assess the effects of gastric bypass versus medical therapy in patients with obesity and type 2 diabetes. Methods The Cochrane library, Embase, PubMed, Chinese biomedical literature database and Wanfang database up to April 2014 were searched. Randomized controlled trails(RCTs) of frequently-used bariatric surgery for obese patients with type 2 diabetes were included. Study selection, data extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Results Four RCTs involving 157 patients in the gastric bypass groups and 152 patients in the medical therapy group were enrolled. Compared with medical therapy, gastric bypass for type 2 diabetes significantly decreased the levels of HbA1C(mean difference = -1. 85% , 95% CI -2. 15 ~ -1. 56, P< 0. 01), fasting blood glucose( standard mean difference = - 0. 90 mmol/ L, 95% CI-1. 24 ~ -0. 57, P<0. 01), body weight(mean difference=-23. 39 kg, 95% CI -29. 17 ~ -17. 61, P<0. 01), waist circumference(mean difference= -15. 36 cm, 95% CI -17. 51 ~ -13. 22, P<0. 01) and the dose of hypoglycemic medicine; while it increased the number of patients with HbA1C<6% (RR=5. 49, 95% CI 2. 22 ~ 13. 56, P<0. 01), the rate of adverse events(RR=1. 96, 95% CI 1. 42 ~ 2. 70, P<0. 01), and the level of high-density lipoprotein-cholesterol(mean difference=1. 24 mmol/ L, 95% CI 0. 64 ~ 1. 84, P<0. 01). Conclusions Gastric bypass surgery is more effective compared with medical therapy alone for obese patients with type 2 diabetes. Further intensive RCTs of high-quality in multiple centers with long-term follow-up should be carried out to provide more reliable evidences.