Evaluation of Madras Diabetes Research Foundation-Indian Diabetes Risk Score in detecting undiagnosed diabetes in the Indian population: Results from the Indian Council of Medical Research-INdia DIABetes population-based study (INDIAB-15)

Background & objectives: Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India. Methods: Data were acquired from the Indian Council of Medical Research–INdia DIABetes (ICMR–INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS. Results: We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under

Prediction of occupational coal workers′ pneumoconiosis incidence by a multi-layer perceptron neural network model / 中国职业医学

OBJECTIVE: To construct and verify the incidence prediction model of occupational coal workers′ pneumoconiosis(CWP) in coal mine workers exposed to dust(hereinafter referred to as ″dust exposure″) based on a multi-layer perceptron(MLP) neural network, and explore its application value in predicting CWP incidence. METHODS: A total of 17 023 dust exposed workers in a coal mining group in Hebei Province from 1970 to 2017 were selected as the research subjects by a typical sampling method. Among them, 839 patients were confirmed as CWP and 16 185 workers did not suffered from CWP. The MLP neural network model was established with the incidence of CWP as the target output variable, and the type of work, age, beginning year of dust exposure, observation year(i.e. incubation period) and cumulative dust exposure as the input variable. The receiver operating characteristic(ROC) curve was used to evaluate the predictive ability of the built model. The established model was used to predict the high-risk group and key monitoring group population of CWP in dust-exposed workers in the following 10 years. RESULTS: There were 44 synapses in the hidden layer of the established MLP neural network model. The area under ROC curve was 0.91. The accuracy, sensitivity and specificity of the model were 92.7%, 74.8% and 93.6%, respectively. In the validation samples, the accuracy, sensitivity and specificity were 92.1%, 70.5% and 93.2%, respectively. The MLP neural network model was used to predict 1 534 workers with high risk of CWP in the following 10 years, and the individuals were located. The number of workers in need of actively monitored was 7 599. Among them, it is predicted that the incidence of CWP in different types of dust exposed workers in the following 10 years from high to low is tunneling worker, coal miner, mixing worker and auxiliary worker(P<0.01). The earlier the dust exposure began, the higher the risk of CWP(P<0.01). CONCLUSION: The MLP neural network model based on the type of work, age, beginning year of dust exposure, incubation period and cumulative dust exposure has a good performance in predicting the incidence of CWP in coal mine dust exposure workers, and can provide a reference for early preventive management measures to prevent and cure CWP.

Prevalence of Systemic Arterial Hypertension in Quilombola Communities, State of Sergipe, Brazil / Prevalência da Hipertensão Arterial Sistêmica em Comunidades Quilombolas do Estado de Sergipe, Brasil

Abstract Background: The quilombolas are groups formed by black ancestry individuals, living in a context of social vulnerability due to low socioeconomic level, which influences health care and the development of chronic diseases. Objective: To assess the prevalence of systemic arterial hypertension and its association with cardiovascular risk factors in the quilombola population in the State of Sergipe, Brazil. Methods: Study design was cross sectional, involving the administration of a questionnaire to individuals aged ≥ 18 years, in 15 quilombola communities of the State of Sergipe, Brazil. A value of two-sided p < 0.05 was considered statistically significant. Results: sA total of 390 individuals were evaluated, 72.3% of whom were women, with a mean age of 44.7 years. The prevalence of hypertension was 26% (with a confidence interval of 95% [95% CI]: 22-30), with no significant sex-related differences. The age was associated with arterial hypertension (95% CI: 1.03-1.06), systolic (95% CI: 1.04-1.07) and diastolic (IC 95%: 1.01-1.04) arterial hypertension. The level of body mass index was associated with arterial hypertension (95% CI: 1.00-1.11) and diastolic arterial hypertension (95% CI: 1.03-1.17). Economic class was associated with diastolic arterial hypertension (95% CI: 1.22-5.03). Conclusion: The prevalence of arterial hypertension in the quilombola communities was high. Its association with cardiovascular risk factors indicates the need to improve access to healthcare services.

Resumo Fundamento: Os quilombolas são grupos formados por indivíduos com ancestralidade negra, inseridos em um contexto de vulnerabilidade social devido ao baixo nível socioeconômico, influenciando assistência à saúde e desenvolvimento de doenças crônicas. Objetivo: Avaliar a prevalência da hipertensão arterial sistêmica e sua associação a fatores de risco cardiovasculares na população quilombola do Estado de Sergipe, Brasil. Métodos: O desenho do estudo foi do tipo transversal, com a aplicação de questionário em indivíduos ≥ 18 anos, em 15 comunidades quilombolas do estado de Sergipe, Brasil. Adotou-se como critério de significância estatística um valor de p bicaudal < 0,05. Resultados: Foram avaliados 390 indivíduos, sendo 72,3% mulheres, com média de idade de 44,7 anos. A prevalência de hipertensão foi de 26% (intervalo de confiança de 95% [IC 95%]: 22 a 30), sem diferença significativa quanto ao sexo. A idade apresentou associação a hipertensão arterial (IC 95%: 1,03 a 1,06) e a hipertensão arterial sistólica (IC 95%: 1,04 a 1,07) e diastólica (IC 95%: 1,01 a 1,04). O índice de massa corpórea apresentou associação a hipertensão arterial (IC 95%: 1,00 a 1,11) e a hipertensão arterial diastólica (IC 95%: 1,03 a 1,17). A classe econômica esteve associada a hipertensão arterial diastólica (IC 95%: 1,22 a 5,03). Conclusão: A prevalência de hipertensão arterial nas comunidades quilombolas apresentou um número elevado. Sua associação a fatores de risco cardiovasculares aponta a necessidade de melhoria do acesso aos serviços de saúde.

Carotid atherosclerosis and contributing factors in a population at high risk of stroke / 中华健康管理学杂志

Objective To investigate the occurrence of carotid atherosclerosis in a population of permanent residents (age ≥40 years) at high risk of stroke in Xuejiadao Street,Huangdao District,Qingdao City,and to provide a scientific basis for reduction of carotid atherosclerosis in high-risk communities.Methods Using a cluster sampling method,10 007 permanent residents of age ≥40 years were enrolled in the study.Based on data from an early population screening project,1 478 subjects at high risk of carotid atherosclerosis and stroke were included for analysis.These study subjects were divided into a carotid atherosclerosis risk group and a normal group.General data were recorded,and the results of a physical examination and clinical and biochemical tests were used to analyze risk factors.Results Of 1 478 high-risk subjects aged (58.8± 9.7) years,726 had normal arteries.Of these,264 (36.36％) were males and 462 (63.64％)were females.Carotid atherosclerosis was identified in 752 cases aged (61.4± 9.5) years,with a detection rate of 50.88％.Of these,390 were males (51.86％) and 362 were females (48.14％).Univariate analysis showed that age,male sex,history of heart disease,diabetes,or hypertension,smoking,alcohol intake,waist circumference,and elevated homocysteine and low-density lipoprotein cholesterol levels were positively correlated with carotid atherosclerosis in those at high risk of stroke,while physical exercise showed a negative correlation;these results were statistically significant (P＜0.05).Multiple logistic regression analysis [OR (95％CI)] showed that age [1.621 (1.410-1.865)],male sex [0.474 (0.378-0.594)],history of heart disease [1.336 (1.085-1.645)],diabetes [1.312 (1.021-1.685)],or hypertension [1.408 (1.074-1.846)],and increased low-density lipoprotein cholesterol [1.444 (1.191-1.751)] were positively correlated with carotid atherosclerosis in those at high risk of stroke,while physical exercise [0.810 (0.690-0.950)] showed a negative correlation;these results were statistically significant (P＜0.05).Conclusion Targeting elderly men at high risk of stroke for intervention and guidance to manage hypertension,diabetes,and other chronic diseases,as well as comprehensive preventive and control measures,including reasonable physical exercise,can effectively reduce the occurrence of carotid atherosclerosis in communities.

Hemi-Thyroidectomy versus Total Thyroidectomy in Patients with Low-Risk Papillary Thyroid Carcinoma Sized 2 cm or Less

BACKGROUND AND OBJECTIVES: The controversy over the optimal extent of thyroidectomy for papillary thyroid carcinoma (PTC) has persisted over a long time period. Particularly, there is a lack of consensus in low-risk PTC sized >1 cm and ≤2 cm. In this retrospective study, we analyzed the oncologic outcomes between hemi-thyroidectomy and total thyroidectomy in patients with low-risk PTC sized 2 cm or less.MATERIALS AND METHODS: A retrospective chart review of 1107 patients who were diagnosed as unilateral low-risk PTC with maximal tumor size 2 cm or less and initially underwent either hemi-thyroidectomy (n=550) or total thyroidectomy (n=557) was conducted. All patients underwent ipsilateral prophylactic central neck dissection. Patients had no evidence of gross extrathyroidal extension or lymph node metastasis. Clinicopathologic factors and recurrence rate were compared according to the surgical extent and factors correlated to recurrence were analyzed.RESULTS: While the total thyroidectomy group had more aggressive clinicopathologic factors such as minimal extrathyroidal extension, multifocality, and lymph node metastasis, recurrence rate was higher in the hemi-thyroidectomy group (p=0.006). However, when the contralateral lobe recurrence was excluded there was no difference in recurrence between the two groups (p=0.597). In patients with tumor sized >1 cm and ≤2 cm there was no significant difference in recurrence between the two groups (p=0.100).CONCLUSION: Total thyroidectomy may not decrease recurrence in patients with PTC presented with unilateral tumor sized >1 cm and ≤2 cm. Hemi-thyroidectomy could be considered the treatment of choice in these patients when they are presented as a low-risk group.

A study on the circulating genotypes of hepatitis C virus in a tertiary care hospital in Central Kerala

Background: Hepatitis C is an emerging infection in India, which is known to progresses to liver cirrhosis and hepatocellular carcinoma. The persistence of chronic HCV infection is due to the existence of various genotypes and its various subtypes. There are seven different genotypes of HCV. These genotypes vary in their severity to cause infections as well as their response to treatment. Aim: This study aims at identifying the predominant genotypes of HCV in a population of patients presenting in a tertiary care center in Central Kerala. Settings and Design: This study was conducted at a tertiary care hospital and medical college, located in Central Kerala in the Department of Microbiology from January 2014 to June 2015.The sample size was 600 and a high risk group of patients attending the gastroenterology department, deaddiction centre and health care workers were screened. Materials and Methods: Serum samples were subjected to EIA, either rapid card or ELISA. Serum samples that were positive for HCV antibodies were confirmed by PCR. Twenty seven samples were positive for HCV antibodies by ELISA/rapid card, out of which 16 were confirmed by PCR. These 16 samples were subjected to gene sequencing to identify the genotype. Results: The prevalent genotypes isolated in this study was genotype 1, 3 and 4. Genotype 1 and 3 was predominantly seen transmitted by blood transfusions and multiple hemodialysis. The variability in laboratory parameters like SGOT and SGPT and its ratio with each genotype was also evaluated. Conclusion: To conclude, the occurrence of genotype 4 at a similar level to genotype 1 shows diffusion of new genotype in Kerala.

Consumo de medicamentos en profesionales y técnicos/ administrativos de la salud: / Consumo de droga na profissional de saúde, técnicos/ administrativos: / Consumption of medicines in health professionals and technical/ administrative staff:

Resumen: El objetivo del estudio fue establecer la situación de consumo de medicamentos no prescritos en profesionales, técnicos/administrativos de salud y los factores de riesgo asociados. Corresponde a un diseño de corte transversal en 182 profesionales y 578 técnicos/administrativos. Se realizó un análisis descriptivo e inferencial, con nivel de significación 5%. Se cuenta con la aprobación del Comité de Ética y Consentimiento Informado. Se obtuvo como resultado que el 44,9% consume medicamentos no prescritos; al comparar con situación profesional se tiene OR=1,66, IC (1,18-2,32); en consumo de tabaco OR=1,38, IC (1,02-1,87); en consumo de alcohol OR=2,10, IC (1,55-2,86); en hipertensión arterial OR=2,25 IC (1,29-3,91); y cefaleas OR=1,73, IC (1,27-2,37). Un alto porcentaje de automedicación, datos similares a un estudio hecho en farmacéuticos y estudiantes de Ciencias de la Salud (38,5%). Asimismo, hay un alto riesgo en variables asociadas, concordante con estudios internacionales que señalan factores exógenos y factores endógenos asociados. Se concluye que existe alta prevalencia de automedicación y que los factores asociados (consumo de tabaco y alcohol) inciden en esta práctica. Se espera que se fomente la indagación en la salud del personal sanitario, garantizando la seguridad de las actividades y la impecabilidad en el ejercicio técnico profesional.

Resumo: O objetivo do estudo foi demonstrar a utilização de medicamentos não prescritos no, saúde / profissional técnica administrativa e fatores associados. Corresponde a um desenho transversal de 182 profissionais e 578 técnicos/administrativos. análise descritiva e inferencial foi realizada com o nível de significância de 5%. É aprovado pela Comissão de Ética e consentimento informado. 44,9% foi obtido que apresenta o consumo de medicamentos, comparando situação profissional tem OR = 1,66, CI (1,18-2,32), o consumo de tabaco OR = 1,38, CI (1,02-1,87), em álcool OR = 2,10, CI (1,55-2,86), na hipertensão OR = 2,25 IC (1,29-3,91), e OR = 1,73 dores de cabeça, CI (1,27-2,37). Elevada percentagem de auto-medicação, semelhante a um farmacêutico de estudo e estudantes de Ciências da Saúde (38,5%) de dados. Além disso, elevado risco associado, variáveis ​​consistentes com estudos internacionais indicando factores exógenos associados e factores endógenos. Concluiu-se que uma elevada prevalência de auto-medicação e factores associados (consumo de tabaco e álcool), afectar esta prática. O inquérito está prevista para ser promovido a saúde dos trabalhadores de saúde, garantindo a segurança das atividades e impecabilidade em exercício técnico profissional.

Abstract: The objective of the study was to assess the situation of consumption of non-prescribed drugs by health professionals, technical/administrative staff and its associated factors. It corresponds to a cross-sectional design in 182 professionals and 578 technicians/ administratives. A descriptive and inferential analysis was performed, with a significance level of 5%. The Committee on Ethics and Informed Consent has approved this study. It was obtained that 44.9% consumed non-prescribed medication, when comparing with professional situation, OR = 1.66, CI (1.18-2.32); in tobacco consumption OR = 1.38, CI 1.02-1.87); in alcohol consumption OR = 2.10, CI (1.55-2.86); in arterial hypertension OR = 2.25 CI (1.29-3.91), and in headaches OR = 1.73, CI (1.27-2.37). A high percentage of self-medication is shown, data similar to a study performed in pharmacists and students of Health Sciences (38.5%). There is also a high risk in associated variables, consistent with international studies that point out exogenous factors and associated endogenous factors. It is concluded that there is a high prevalence of self-medication and that the associated factors (smoking and alcohol consumption) influence this practice. It is hoped that the investigation into the health status of health professionals will be promoted, thus guaranteeing the safety of their activities and the impeccability in the practice of the profession.

Effect of lifestyle intervention among high risk group of chronic diseases in Shenzhen Futian district / 中华预防医学杂志

Objective@#To evaluate the effect of lifestyle intervention among high risk group of chronic diseases in Shenzhen Futian district.@*Methods@#12 out of 115 communities were randomly selected in Futian district of Shenzhen city from October to November, 2013, and 1 923 cases were screened by multiple ways as high risk groups of chronic diseases. High risk groups of chronic diseases were divided into intervention group (1 338 cases, from five residential communities and three villages within city) and control group (585 cases, from four residential communities). The intervention group received group based health education activities as well as lifestyle intervention. The intervention group was provided with health management which was mainly lifestyle intervention. No intervention was implemented in the control group. All participants were followed up over two years. 1 563 participants (1 002 in intervention group and 561 in control group) were followed up from October to November, 2015. The changes of lifestyle related outcome indicators were analyzed to examine the effect of intervention.@*Results@#In the intervention group, 21.8% (219 persons) in high risk groups of chronic diseases became healthy individuals and 15.2% (152 persons) became patients with chronic diseases. In the control group, 9.6% (54 persons) in high risk groups of chronic diseases became healthy individuals and 20.5% (115 persons) became patients with chronic diseases. The outcome of the intervention group was better than that of the control group and the difference was statistically significant (χ2=-5.67, P<0.001). The proportion of people who knew how to correctly use of oil control pot in the intervention group increased from 61.00% (61/100) to 80.00% (280/350). The proportion of people who took oil control measures in the intervention group increased from 36.43% (365/1 002) to 56.99%(571/1 002). The changes in the intervention group were statistically different (P<0.001), but there was no statistical difference in the control group over the years (P>0.05). The proportion of people who knew how to correctly use of the salt restriction spoon increased from 81.95% (109/133) to 97.99% (342/349). The proportion of people who took salt control measures increased from 45.61% (457/1 002) to 62.67% (628/1 002) in the intervention group. The changes in the intervention group were statistically different (P<0.001). There was no statistical difference in the control group over the years (P>0.05).@*Conclusion@#The proportion of people who adopted healthy lifestyles has increased after 2 years intervention and the lifestyle intervention demonstrated good effect.

Incidence rates of HIV-1 epidemics among 4 high risk groups in Sichuan province during 2011-2015 / 中华流行病学杂志

Objective Data from the HIV/AIDS surveillance sentinel sites was used to identify the recent HIV-1 infections and to estimate the HIV-1 incidence and epidemic trends among intravenous drug users (IDU),MSM,female sex workers and men attending the sexually transmitted disease clinics in Sichuan province.Methods Specimens collected from IDUs,MSM,female sex workers and men attending the sexually transmitted disease clinics sentinel sites were confirmed as HIV-I positive and tested with BED-CEIA.Annual HIV-1 prevalence and incidence rates were calculated and the incidence was adjusted by McNermar method.Results A total number of 194 223 serum specimens were collected and HIV antibody tested,with 5 297 HIV-1 positive.4 640 of the positives underwent BED-CEIA,with 749 identified as recent infections.During 2011-2015,HIV-1 incidence rates of the four types of population appeared as 5.16％ (95％CI:4.65-5.66),0.22％ (95％CI:0.16-0.28),0.57％(95％CI:0.45-0.69),7.53％ (95％CI:6.06-9.01) and 0.44％ (95％CI:0.36-0.53) respectively.Significant differences were seen in the HIV-1 incidence rates.Conclusions The HIV-1 incidence rates of IDUs from other sentinel sites in Sichuan province,female sex workers and men attending the sexually transmitted disease clinics appeared low,showing that the AIDS prevention and control activities worked effectively.However,the HIV-1 incidence of MSM was still at high level and even rising,suggesting that HIV-1 transmission between MSM and IDUs was possible.

Incidence rates of HIV-1 epidemics among 4 high risk groups in Sichuan province during 2011-2015 / 中华流行病学杂志

Objective Data from the HIV/AIDS surveillance sentinel sites was used to identify the recent HIV-1 infections and to estimate the HIV-1 incidence and epidemic trends among intravenous drug users (IDU),MSM,female sex workers and men attending the sexually transmitted disease clinics in Sichuan province.Methods Specimens collected from IDUs,MSM,female sex workers and men attending the sexually transmitted disease clinics sentinel sites were confirmed as HIV-I positive and tested with BED-CEIA.Annual HIV-1 prevalence and incidence rates were calculated and the incidence was adjusted by McNermar method.Results A total number of 194 223 serum specimens were collected and HIV antibody tested,with 5 297 HIV-1 positive.4 640 of the positives underwent BED-CEIA,with 749 identified as recent infections.During 2011-2015,HIV-1 incidence rates of the four types of population appeared as 5.16％ (95％CI:4.65-5.66),0.22％ (95％CI:0.16-0.28),0.57％(95％CI:0.45-0.69),7.53％ (95％CI:6.06-9.01) and 0.44％ (95％CI:0.36-0.53) respectively.Significant differences were seen in the HIV-1 incidence rates.Conclusions The HIV-1 incidence rates of IDUs from other sentinel sites in Sichuan province,female sex workers and men attending the sexually transmitted disease clinics appeared low,showing that the AIDS prevention and control activities worked effectively.However,the HIV-1 incidence of MSM was still at high level and even rising,suggesting that HIV-1 transmission between MSM and IDUs was possible.

Changes of the peripheral blood cells in children with high-risk neuroblastoma after chemotherapy and factors related to severe infection / 上海交通大学学报（医学版）

Objective · To investigate the changes of neutrophils and lymphocytes during chemotherapy courses in children with high-risk neuroblastoma, as well as severe infection rate and its relationship with combination chemotherapy regimens in order to provide guidance to prevent infection in these children. Methods · A total of 45 cases of children with high-risk neuroblastoma, who were hospitalized in Xinhua Hospital from July 2012 to September 2015 were recruited. Reactions after chemotherapy and the results of routine blood tests on every 5 days during the whole chemotherapy circles were recorded. Follow-up visits were carried out to learn the infection occurrence. Results · The counts of neutrophils and lymphocytes dropped to the minimum at the 10th day or so during chemotherapy, then rised near the 15th day. Infections were negatively correlated with the numbers of neutrophils (r =-0.245) and lymphocytes (r=-0.227) at the 10th day. Persistent lymphopenia occured after the forth course of chemotherapy. Rate of grade Ⅳ bone marrow suppression after chemotherapy was 90%, and severe infection rate was 15.5%. There were significant differences in the rates of grade Ⅲ bone marrow suppression (P=0.008), grade Ⅳ bone marrow suppression (P=0.001) and severe infection (P=0.010) among the 3 combination chemotherapy regimens used in high-risk neuroblastoma children. Conclusion · Children with high-risk neuroblastoma had obviously high rates of bone marrow suppression and severe infection after chemotherapy, especially after cyclophosphamide+doxorubicin+vincristine regimens. More attention should be paid to this group of children and preventive measures were worthy of taking into account.

Prevalence Of Hepatitis B And HIV And Their Co-infection In Female Sex Workers In Nagpur Region.

Background and Aim: The Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV), have common modes of transmission. Globally, sexually transmitted infection (STI) rates are the highest among population subgroups such as sex workers. Objective is to - (i) Study of Hepatitis B infections and HIV infection in female sex workers (ii) Co-infection rate of HBV and HIV among this population (iii) Simultaneous comparision of infection HBV and HIV infection in healthy female population(blood donar). Methodology: This study was conducted in the department of microbiology IGGMC Nagpur from October 2014 to August 2015. Their sera were tested for the HBsAg and HIV antibodies. Results: A total 400 samples were tested (200 samples of female sex workers and 200 samples of healthy female blood donors. The seropositivity of HBV in FSWs is 1.5% and of HIV is 2%, none of FSWs were coinfected with both the infections. That of healthy female donors HBV prevalence is 0.5% and HIV is also 0.5% similarly none were coinfected with both the infections. Conclusion: The prevalence of Hepatitis-B virus infection and HIV infection is low among the female sex workers in Nagpur region. Similarly prevalence in healthy female population is also low. Targeted intervention among the risk group is effective measure in decreasing the hepatitis B infection rate.

Observational study for evaluation of clinical outcome of non-descent vaginal hysterectomy.

Introduction: Hysterectomy is the fairly common operative procedures carried out in the gynecological practice. Abdominal hysterectomy has it own limitation in high risk groups and had post operative complications. So the present study was undertaken with objective to find out the efficacy of vaginal hysterectomy in other plan prolapse patients to assess its safety and to determine efficacy of adjunctive procedures by vaginal route. Material and methods: Total 60 patients having indication had vaginal hysterectomy without vaginal prolapse having uterus up to 14 weeks size. Patients having capability of lithotomy position and adequate vaginal access were included in the study. Patients suspected or undiagnosed malignancy of urogenital organs and associated other pelvic pathology or abdominal pathology was excluded. After thorough general and systemic examination after USG patient were posted for vaginal hysterectomy. Preoperative and post operative complications were noted and managed accordingly. Results: In present study 80% of the patients were above the age of 40 years. 76.7% of the vaginal patients were having parity 3 or more. Most patients were having more than one complaint. But most common complaint among them was menstrual irregularities and associated medical problems were noted in 51.7% patients. Previous abdominal or pelvic surgery was not a contraindication for vaginal surgery. Most common indication for vaginal hysterectomy was fibroid Uterus in 41.7% and dysfunctional uterine bleeding 38.3%. In the present series, patients with fibroid size up to 14 weeks were operated vaginally successfully. The amount of blood loss was less than 50 ml in this study. Significant blood loss requiring blood transfusion was not found in this study. There was no bladder or bowel injury the special techniques used was bisection, myomectomy, morcellation and combination. The most commonly used technique was bisection. hysterectomies was 48.6 minutes, period more than that was required when there was presence of concurrent A and P repair. No patient required blood transfusion maximum i.e. 63.3% patient’s blood loss was less than 50 ml. There was no bowel or bladder injury during procedure and immediate post operative pain. Febrile episode and UTI was complained with no long term complications. Average hospital stay was 3 days. Conclusion: Vaginal hysterectomy in patients with up to 14 weeks for non-descent large uterus is safe and practical. It ensures minimal blood loss, early postoperative recovery, early ambulation, reduced duration of hospital stay.

Investigation and Ethical Countermeasures for Blood-borne Occupational Exposure in Medical Workers in General Hospitals / 中国医学伦理学

Objective:To understand general hospital medical staff status quo and characteristics of blood -borne occupational exposure , analysis its ethics factor , to make the prevention countermeasures of blood -borne oc-cupational exposure to provide scientific basis .Methods:From January 2013 to December floor all the medical staff of blood -borne occupational exposure cases were retrospectively analyzed .Results:A total of 101 medical staff blood-borne occupational exposure , which is given priority to with the nurse , accounted for 60 .40%;More con-centrated in under 30 employees, accounted for 70.29%;Occupational exposure personnel distribution in the ma-jority with surgical department (42.57%), followed by the physician (36.63%);Wards (60.40%), the operat-ing room (15.84%) and therapy (11.88%) are the sites of occupational exposure often happen;Sharp injury in the composition of the ratio of 87.12%, in the first place, in which a proportion (23.76%), pull out the needle (18.81%) and blood (15.84%), surgical suture (14.85%) and transfusion injection (13.86%) as the sharp injury of frequent occurrence of occupational exposure;Exposure is given priority to with hepatitis b ( 61 .38%) . Conclusion:Medical staff blood-borne occupational exposure risk is high , the hospital infection control personnel must pay attention to occupational exposure of the whole education , strengthen the administration of the occupation-al exposure of ethics , reduce the risk of occupational exposure and injury .

The Effect of Korean Standardized Suicide Prevention Program on Intervention by Gatekeepers / 신경정신의학

OBJECTIVES: Since 2003 South Korea's suicide rate has remained the highest among Organization for Economic Cooperation and Development countries. Gatekeeper training is a major strategy in the national suicide prevention plan in Korea. In this study, we evaluated the effect of the Korean standardized suicide prevention program on the gatekeeper's intervention, developed by the Korea Association for Suicide Prevention and implemented by the Korea Suicide Prevention Center. METHODS: A telephone survey was conducted in order to assess awareness and intervention for the high risk group. Out of the 35825 people who completed the educational course in 2013, 800 gatekeepers were selected by proportional quota sampling. RESULTS: Of the 800 subjects, 93% answered that people in the high risk group of suicide sent diverse signals implying suicide ; 19.9% of the gatekeepers found actual high risk suicidal people, 95% of whom listened to why they came to think about suicide and 71.5% of listeners gave information about suicide prevention and referred them to mental health professionals. CONCLUSION: The Korean standardized suicide prevention program may be helpful to the gatekeepers in playing an adequate role in intervention, but further study is needed in order to evaluate long-term educational effects.

Outcomes of Gleason Score < or =8 among High Risk Prostate Cancer Treated with 125I Low Dose Rate Brachytherapy Based Multimodal Therapy

PURPOSE: To investigate the role of low dose rate (LDR) brachytherapy-based multimodal therapy in high-risk prostate cancer (PCa) and analyze its optimal indications. MATERIALS AND METHODS: We reviewed the records of 50 high-risk PCa patients [clinical stage > or =T2c, prostate-specific antigen (PSA) >20 ng/mL, or biopsy Gleason score > or =8] who had undergone 125I LDR brachytherapy since April 2007. We excluded those with a follow-up period or =9 and Gleason score or =9 (p or =9 was observed to be significantly associated with BCR (p=0.021). Acute and late grade > or =3 toxicities were observed in 20% (10/50) and 36% (18/50) patients, respectively. CONCLUSION: Our results showed that 125I LDR brachytherapy-based multimodal therapy in high-risk PCa produced encouraging relatively long-term results among the Asian population, especially in patients with Gleason score or =9 was a significant predictor of BCR among high risk PCa patients after brachytherapy.

Suicide rates and trends in São Paulo, Brazil, according to gender, age and demographic aspects: a joinpoint regression analysis / Taxas de suicídio e tendências em São Paulo, Brasil, de acordo com gênero, faixa etária e aspectos demográficos

OBJECTIVE: To evaluate suicide rates and trends in São Paulo by sex, age-strata, and methods. METHODS: Data was collected from State registry from 1996 to 2009. Population was estimated using the National Census. We utilized joinpoint regression analysis to explore temporal trends. We also evaluated marital status, ethnicity, birthplace and methods for suicide. RESULTS: In the period analyzed, 6,002 suicides were accrued with a rate of 4.6 per 100,000 (7.5 in men and 2.0 in women); the male-to-female ratio was around 3.7. Trends for men presented a significant decline of 5.3% per year from 1996 to 2002, and a significant increase of 2.5% from 2002 onwards. Women did not present significant changes. For men, the elderly (> 65 years) had a significant reduction of 2.3% per year, while younger men (25-44 years) presented a significant increase of 8.6% from 2004 onwards. Women did not present significant trend changes according to age. Leading suicide methods were hanging and poisoning for men and women, respectively. Other analyses showed an increased suicide risk ratio for singles and foreigners. CONCLUSIONS: Specific epidemiological trends for suicide in the city of São Paulo that warrant further investigation were identified. High-risk groups - such as immigrants - could benefit from targeted strategies of suicide prevention.

OBJETIVO: Avaliar as taxas de suicídio e as tendências em São Paulo por gênero, faixa etária e métodos. MÉTODOS: Dados de mortalidade foram coletados a partir de bases de dados da Prefeitura de São Paulo de 1996-2009. A população total foi estimada utilizando dados do Censo Nacional. Utilizamos o programa Joinpoint regression analysis para explorar tendências temporais. Também avaliamos estado civil, etnia, local de nascimento e métodos de suicídio. RESULTADOS: No período, ocorreram 6.002 suicídios, uma taxa de 4,6 por 100.000 habitantes (7,5 em homens e 2,0 em mulheres), a relação masculino-feminino foi cerca de 3,7. Tendências de suicídio para os homens apresentaram uma queda significativa de 5,3% por ano entre 1996 e 2002, e um aumento significativo de 2,5% ao ano a partir de 2002. Mulheres não apresentaram alterações significativas na tendência. Para os homens, os idosos (> 65 anos) tiveram uma redução significativa de 2,3% ao ano, enquanto os homens mais novos (25-44 anos) apresentaram um aumento significativo de 8,6% ao ano a partir de 2004. Mulheres não apresentaram alterações significativas na tendência por faixa etária. Principais métodos de suicídio foram enforcamento e envenenamento, para homens e mulheres respectivamente. Outras análises mostraram um aumento do risco relativo ao suicídio para os solteiros e estrangeiros. CONCLUSÕES: Foram identificadas tendências epidemiológicas específicas do suicídio na cidade de São Paulo que merecem uma investigação mais aprofundada. Grupos de alto risco - como os imigrantes - poderiam se beneficiar com estratégias focalizadas na prevenção do suicídio.

Eating behaviors and eating disorders symptomatology in nutrition students / Conductas alimentarias y sintomatología de trastornos del comportamiento alimentario en estudiantes de nutrición

Eating disorders are psychopathological problems that currently are becoming important due to its increased incidence in certain population groups. The objective of this study was to analyze eating behaviors and eating disorders symptomatology in nutrition students from a public university of the east of State of Mexico. A battery of tests was applied to 182 students (157 women and 25 men) with an average age of 20.5 years (SD = 2.72). Results showed 8.8% of participants with eating disorders symptomatology, finding independence with the body mass index; however, with the fat percentage we found significant differences. We found body dissatisfaction in 33.51%, although compensatory behaviors were not a predominant factor in this group, however, findings shows latent risk that is increasing by the socio-cultural influence of the body aesthetic model and affect body dissatisfaction, and changes in eating behavior, despite in his academic training students acquired theoretical knowledge about this psychopathologies.

Los trastornos del comportamiento alimentario son problemas psicopatológicos que en la actualidad están adquiriendo importancia por el incremento de su incidencia en ciertos grupos de población. El objetivo del presente estudio fue analizar las conductas alimentarias y la presencia de sintomatología de trastornos del comportamiento alimentario en los estudiantes de nutrición de una universidad pública del oriente del Estado de México. Se aplicó una batería de pruebas, en 182 alumnos (157 mujeres y 25 hombres) con un promedio de edad de 20.5 años (DE = 2.72). Los resultados mostraron 8.8% de participantes con sintomatología de trastornos del comportamiento alimentario, hallando independencia con la variable índice de masa corporal, no obstante, en el porcentaje de grasa si se observaron diferencias estadísticamente significativas. La insatisfacción corporal, se presentó en 33.51%, aunque las conductas compensatorias no fueron un factor predominante en este grupo, sin embargo, los hallazgos muestran riesgo latente que se acrecenta por la influencia sociocultural del modelo estético corporal e introyecta insatisfacción corporal y cambios en la conducta alimentaria, a pesar de que en su formación académica los estudiantes de nutrición adquieren el conocimiento teórico sobre estas psicopatologías.

Pre-exposure prophylaxis for HIV high-risk groups: An analysis of clinical compliance / 第二军医大学学报

Objective: To investigate the factors influencing the compliance of pre-exposure prophylaxis (PrEP) among high-risk groups of human immunodeficiency virus (HIV). Methods: A total of 352 subjects were selected into the cohort by non-probability sampling, including 153 men who have sex with men (MSM), 36 female sex workers (FSMs), and 163 fixed sex partners(PARs) of HIV carriers. Each subject was randomly given a medication regimen of either once daily or twice a week. The pre-exposure prophylaxis compliance was evaluated by observing the maintenance of the cohort and medication omission every 4 weeks from week 0 to week 28. Cochran-Mantel-Haenszel (CMH) test was employed to conduct univariate analysis and logistic regression was adopted for multiple variable analysis. Results: It was found that 76. 70% (270/352) of the subjects finished the 28-week-observation in this PrEP clinical trial among high-risk groups of HIV. The medication omission rate fluctuated around 35% during the follow-up, with the total compliance score being 82. 12 ± 27. 48 and the median score being 95. 24. Logistic regression suggested that the monthly income, presence of worries or difficulties during the trials, need for medical service, and the way of follow-up were the factors influencing the maintenance of cohort. The marital status, medication method, presence of worries or difficulties during the trial, and presence of adverse effect were the influencing factors of medication omission. The population typ e, number of sex partners, taking of other drugs at the same time, need of medical service during the trial, and way of follow-up were the factors impacting the overall compliance score. Conclusion: The compliance of the present PrEP clinical trials among high-risk groups of HIV is high, and it has multiple influencing factors. Compliance management should be reinforced among MSM and FSW populations with greater motility. The cohort management model of follow-up by fixed specialists should be continued with more frequent follow-up; meanwhile, classified management should be implemented for individuals with different characters, so as to ensure a good compliance during the clinical trials.

How low is low enough? Evaluation of various risk-assessment models for lymph node metastasis in endometrial cancer: a Korean multicenter study / 부인종양

OBJECTIVE: The aim of this study was to identify a standard for the evaluation of future models for prediction of lymph node metastasis in endometrial cancer through estimation of performance of well-known surgicopathological models. METHODS: Using the medical records of 947 patients with endometrial cancer who underwent surgical management with lymphadenectomy, we retrospectively assessed the predictive performances of nodal metastasis of currently available models. RESULTS: We evaluated three models included: 1) a model modified from the Gynecologic Oncology Group (GOG) pilot study; 2) one from the GOG-33 data; and 3) one from Mayo Clinic data. The three models showed similar negative predictive values ranging from 97.1% to 97.4%. Using Bayes' theorem, this can be translated into 2% of negative post-test probability when 10% of prevalence of lymph node metastasis was assumed. In addition, although the negative predictive value was similar among these models, the proportion that was classified as low-risk was significantly different between the studies (56.4%, 44.8%, and 30.5%, respectively; p<0.001). CONCLUSION: The current study suggests that a false negativity of 2% or less should be a goal for determining clinical usefulness of preoperative or intraoperative prediction models for low-risk of nodal metastasis.