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A Survey of Clarithromycin Monotherapy for Patients with MAC Lung Disease in Japan 克拉霉素单药治疗日本MAC肺病患者的调查
Pub Date : 2019-01-01 DOI: 10.35248/2167-1052.19.8.224
T. Iwao
Background The number of patients with nontuberculous mycobacteriosis (NTM) has increased exponentially in recent years. In Japan, approximately 88.8% of patients with NTM suffer from Mycobacterium avium-intracellulare complex (MAC) Lung Disease. Incidence of MAC Lung Disease is increasing owing to a rapid increase in nontuberculous mycobacterial infections. Although basic treatment for MAC Lung Disease is chemotherapy, clarithromycin monotherapy is contraindicated by specialists owing to its high potential to induce drug-resistant bacterial strains in patients with MAC Lung Disease. However, it is unclear how much such treatment cases exist in clinical practical. This is because no long-term investigation has been carried out. Materials and Methods This study investigated treatment with these medications from 2005 to 2017, by studying 1107 patients with MAC Lung Disease based on data in patient insurance claims. Results Results showed that approximately 10.3% (114 cases) were prescribed long-term CAM monotherapy for three months. Conclusion Generally, administration of antibiotics over a long period of time is potentially detrimental to some patients. Better awareness of the types of treatments and their potential negative effects will be beneficial to clinical practitioners. In the immediate future, it seems to be effective to develop an educational system on single agent administration of antimicrobial agents.
近年来,非结核性分枝杆菌病(NTM)的患者数量呈指数增长。在日本,大约88.8%的NTM患者患有鸟分枝杆菌-细胞内复合体(MAC)肺病。由于非结核分枝杆菌感染的迅速增加,MAC肺病的发病率正在增加。虽然MAC肺病的基本治疗是化疗,但克拉霉素单药治疗被专家禁用,因为它很有可能在MAC肺病患者中诱导耐药菌株。然而,目前尚不清楚在临床实践中有多少这样的治疗案例。这是因为没有进行长期调查。材料与方法本研究基于患者保险理赔数据,通过研究1107例MAC肺病患者,从2005年至2017年对这些药物的治疗进行了调查。结果约10.3%(114例)的患者给予3个月的长期CAM单药治疗。结论:一般情况下,长期使用抗生素对某些患者有潜在的危害。更好地了解治疗的类型及其潜在的负面影响将有利于临床从业者。在不久的将来,它似乎是有效的发展一个教育系统的单一药物管理的抗菌药物。
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引用次数: 0
Evaluation of Rational Medicine Use based on WHO Core Drug Use Indicators in Public Hospitals in West Shoa Zone, Oromia, Ethiopia 基于世卫组织核心用药指标的埃塞俄比亚奥罗米亚西肖亚区公立医院合理用药评价
Pub Date : 2019-01-01 DOI: 10.35248/2167-1052.19.8.225
Esayas Tadesse Gebramariam, Mustefa Ahmed
Background: The irrational use of medicines is a worldwide problem increasing morbidity, mortality and costs through increasing adverse medicine reactions and hence patients are not achieving their desired outcomes. In Ethiopia, although there are studies that show the presence of irrational use of medicines in the country, there is limited objective evidence on evaluating medicine use from prescriber, patient and health facility perspectives. Therefore, the objective of this study was to evaluate rational medicine of the improved asphalt were contrasted together with each other as well as with the perspicuous asphalt. Conclusions Methods: Retrospective and prospective cross sectional study were employed to collect data from prescriptions dispensed through main pharmacies and Information for patients respectively. A structured questionnaire was employed to collect information from prescription papers and respondents after obtaining a verbal consent. Data was entered, cleaned, edited and analyzed using SPSS Version 23.0 statistical software package. Results: The average number of medicines prescribed per encounter was 1.74. The% of encounters in which an antibiotic and injection was prescribed was 48.9% and 12.6% respectively. The mean consultation time spent between the prescriber and patient was 5.12 minutes and the mean pharmacy dispensing time was 1.28 minutes. The availability of selected tracer medicines in the health facilities was 79.6%. Conclusion: The study identified that the pattern of prescribing was appreciable and nearly similar with WHO standard reference. However, the patient care factors needs to be improved.
背景:药物的不合理使用是一个世界性的问题,通过增加药物不良反应增加发病率、死亡率和成本,因此患者不能达到预期的结果。在埃塞俄比亚,虽然有研究表明该国存在不合理使用药物的情况,但从处方者、患者和卫生机构的角度评价药物使用情况的客观证据有限。因此,本研究的目的是评价改良沥青的合理性,并将其与普通沥青进行对比。方法:采用回顾性和前瞻性横断面研究,分别收集通过主要药房配药的处方资料和患者资料。在获得口头同意后,采用结构化问卷从处方纸和受访者中收集信息。使用SPSS Version 23.0统计软件包对数据进行录入、整理、编辑和分析。结果:平均每次就诊处方药物数为1.74。处方抗生素和注射的比例分别为48.9%和12.6%。处方者与患者之间的平均咨询时间为5.12分钟,平均药房调剂时间为1.28分钟。卫生设施中选定示踪药物的可得性为79.6%。结论:本研究确定的处方模式较为合理,与WHO标准基本一致。然而,患者护理因素有待改进。
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引用次数: 10
Tigecycline in CR-Kp Associated VAP with High Dose vs. Conventional Dose: Adverse Events are the Key Superiority-determiner 替加环素在CR-Kp相关VAP中的高剂量vs常规剂量:不良事件是关键的优势决定因素
Pub Date : 2019-01-01 DOI: 10.35248/2167-1052.19.8.227
J. Hasan
Background: Multi-drug Resistant (MDR) pathogen Carbapenem-Resistance Klebsiella pneumonia (CR-Kp) associated Ventilator-Associated Pneumonia (VAP) is a serious infectious disease and tigecycline with high or conventional dose, is one of the last resort potential antibiotics for its treatment. Objective: The major objective of this study was to evaluate the key role of adverse events in preferring the better dosing option of tigecycline. Methods: Total 45 middle-aged MDR-CR-Kp associated VAP patients and treated with high (200 mg/day) and conventional dose (100 mg/day) of tigecycline (intravenous) distributed into two groups. Group-wise microbiological eradication rate, secondary infection rate, 30 days mortality rate and dose-related adverse events were analyzed and compared, accordingly. Result: After 5 days, highest microbiological eradication was observed in HD-group (79.17%) than CD-group (47.62%) with low rate of secondary infections (8.33% versus 33.33%). The 30 days mortality rate was relatively higher in HD-group (45.83% versus 38.10%). Severity and frequency of high-dose associated adverse events were higher in HD-group at all parameters than CD-group (elevation of ALT: 33.33%/23.81%; AST: 41.67%/28.57%; bilirubin: 37.50%/19.05%; reduction of blood pH: 45.83%/9.52%, respectively). Conclusion: High dose of tigecycline showed relatively higher therapeutic response in MDR-CR-Kp associated VAP treatment than conventional dose but, with increased rate of adverse events, which questioned its practice.
背景:多药耐药(MDR)病原菌碳青霉烯-耐药克雷伯菌肺炎(CR-Kp)相关呼吸机相关性肺炎(VAP)是一种严重的感染性疾病,大剂量或常规剂量的替加环素是其治疗的最后手段之一。目的:本研究的主要目的是评估不良事件在选择替加环素的最佳给药方案中的关键作用。方法:将45例中年MDR-CR-Kp相关性VAP患者分为高剂量(200 mg/d)和常规剂量(100 mg/d)静脉注射替加环素两组。分析比较各组微生物根除率、继发感染率、30天死亡率和剂量相关不良事件。结果:5 d后,hd组微生物根除率最高(79.17%),而cd组最高(47.62%),继发感染率低(8.33%比33.33%)。hd组30 d死亡率相对较高(45.83% vs 38.10%)。hd组高剂量相关不良事件的严重程度和发生频率均高于cd组(ALT升高:33.33%/23.81%;AST: 41.67% / 28.57%;胆红素:37.50% / 19.05%;降低血pH值:45.83%/9.52%)。结论:大剂量替加环素治疗MDR-CR-Kp相关性VAP的疗效高于常规剂量,但不良事件发生率增加,值得质疑。
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引用次数: 1
Second-line Anti-Tuberculosis Drugs and Risk of Alopecia: A Retrospective Cohort study 二线抗结核药物与脱发风险:一项回顾性队列研究
Pub Date : 2018-11-16 DOI: 10.4172/2167-1052.1000223
Mulugeta Russom, A. Berhe, L. Hagos
Background  Alopecia is not a well-known adverse effect of second-line anti-tuberculosis drugs. It is however, been frequently reported in Eritrea and 83% of the reports of alopecia associated with second-line anti-TB drugs in the global adverse drug reaction database, as of July 25, 2017, were submitted from Eritrea. It is wondering why this much variation is happening and this study is therefore aimed at quantifying the risk, identifying possible risk factors and elucidating the causal association between alopecia and the second-line anti-TB drugs in Eritrea. Methods This was a retrospective cohort study that included all patients with multi-drug resistant tuberculosis (MDR-TB) in Eritrea enrolled to Merhano MDR-TB referral hospital for treatment between June 2011 and December 2016. Results A total of 152 eligible MDR-TB patients on treatment were identified with a median observation time of 23 months. Historical longitudinal data of these patients was screened and found 35 cases of alopecia, possibly associated with MDR-TB treatment, with an incidence rate of about 13 cases per 1000 person-months. Majority of the cases (68.6%) developed alopecia after 18 months of exposure to MDR-TB treatment. Patients exposed to treatment for longer period of time (>23 months) were more likely to develop alopecia compared to those exposed for shorter time (p=0.001). Patients younger than 45 years of age reported higher rates of alopecia compared to the older age groups (adjusted OR=9.4; 95%CI: 2.41-36.86, p=0.001). Females were also more likely to develop alopecia compared to males (adjusted OR=3; 95%CI: 1.24 - 7.34, p=0.015). Conclusion Alopecia associated with MDR-TB treatment is frequent but its delayed time to onset might be a reason to be missed by several similar studies conducted elsewhere. Even though alopecia is not life-threatening and does not cause physical pain, the cosmetic effects of hair loss can be psychologically devastating.
背景:脱发并不是二线抗结核药物的一个众所周知的不良反应。然而,厄立特里亚经常报道,截至2017年7月25日,全球药物不良反应数据库中83%的与二线抗结核药物相关的脱发报告来自厄立特里亚。令人好奇的是,为什么会发生如此大的差异,因此,这项研究旨在量化风险,确定可能的风险因素,并阐明厄立特里亚脱发与二线抗结核药物之间的因果关系。方法回顾性队列研究,纳入2011年6月至2016年12月在厄立特里亚Merhano耐多药结核病转诊医院就诊的所有耐多药结核病患者。结果共有152例符合条件的耐多药结核病患者接受治疗,平均观察时间为23个月。对这些患者的历史纵向资料进行了筛选,发现35例脱发,可能与耐多药结核病治疗有关,发病率约为每1000人月13例。大多数病例(68.6%)在接受耐多药结核病治疗18个月后出现脱发。与接受治疗时间较短的患者相比,接受治疗时间较长(>23个月)的患者更容易发生脱发(p=0.001)。年龄小于45岁的患者报告的脱发率高于年龄较大的患者(调整后OR=9.4;95%CI: 2.41 ~ 36.86, p=0.001)。与男性相比,女性患脱发的可能性也更大(调整后OR=3;95%CI: 1.24 ~ 7.34, p=0.015)。结论与耐多药结核病治疗相关的脱发是常见的,但其发病时间的延迟可能是其他地方进行的一些类似研究错过的一个原因。尽管脱发不会危及生命,也不会造成身体上的疼痛,但脱发对美容的影响可能会在心理上造成毁灭性的打击。
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引用次数: 2
Self-Medication Practice in Community Pharmacies: The Case of Dessie Town, Northeast Ethiopia 社区药房自我药疗实践:以埃塞俄比亚东北部德西镇为例
Pub Date : 2018-01-01 DOI: 10.4172/2167-1052.1000221
A. M. Baye, Oumer Sada
Background: Self-medication is widely practiced for a wide range of illness or symptoms for both over the counter and prescription only drugs. It is the selection and use of medicines by individuals to treat self-illness. Inappropriate self-medication practice results economical wastages, impairment due to the adverse drug reactions, contraindication, prolong suffering and damaging of vital organs due to over dose. Misuse of antibiotics by the public results not only harm to the patients but also leads to the developments of drug resistant bacteria. Objective: This study was conducted to assess self-medication practice in Dessie community pharmacies. Methods: An institutional based cross-sectional study was conducted in Dessie community pharmacies starting from January 1 to 14, 2015. The sample size was 370 and we used systematic random sampling method to select the representative samples from the study population. Our data collection instruments were questionnaires. Data was analyzed by using Microsoft excel 2010. Result: Eleven community pharmacies were included in the study during the period of data collection. The majority of the respondents, 89.5%, were between 13 to 64 years of age. Of these clients, 45.1% of them were females. From the total clients, 42.4% obtained drugs without prescriptions for self-medication. The common illness/symptoms that necessitate self-medication were headache/fever (34.65%). Analgesics were requested by 27.7% of the respondents. One third of the clients obtained advice from health professionals other than pharmacy professionals. Conclusion: and recommendations: There is wide range of self-medication practice for a wide range of illness for over the counter and prescription only drugs at the study sites. Pharmacy professionals should maintain good dispensing practices and proper regulatory. Control mechanisms should be devised to prevent the use of prescription only medications without prescription.
背景:自我药疗被广泛用于治疗各种疾病或症状,包括非处方药和处方药。它是指个人选择和使用药物来治疗自我疾病。不适当的自我药疗做法造成经济浪费、药物不良反应损害、禁忌症、延长痛苦和过量用药损害重要器官。公众滥用抗生素不仅对患者造成伤害,而且会导致耐药菌的滋生。目的:对德西社区药房的自我药疗实践进行评估。方法:对2015年1月1日至14日在德西社区药房进行机构横断面研究。样本量为370例,采用系统随机抽样的方法从研究人群中选取具有代表性的样本。我们的数据收集工具是问卷调查。数据分析采用Microsoft excel 2010。结果:在数据收集期间共纳入11家社区药店。大多数受访者(89.5%)年龄在13至64岁之间。其中女性占45.1%。42.4%的患者在没有处方的情况下自行用药。需要自我药疗的常见疾病/症状为头痛/发热(34.65%)。27.7%的受访者要求使用镇痛药。三分之一的客户从药学专业人员以外的保健专业人员处获得咨询。结论和建议:有广泛的自我药疗实践广泛的疾病的非处方和处方药物在研究地点。药学专业人员应保持良好的配药规范和适当的监管。应设计控制机制,以防止使用未经处方的处方药物。
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引用次数: 7
Challenge of Using Antiplatelet Drugs in Patients with Primary Immune Thrombocytopenia and Recently Implanted Coronary Stents-Splenectomy as a Therapeutic Option 原发性免疫性血小板减少症和近期植入式冠状动脉支架患者使用抗血小板药物的挑战-脾切除术作为治疗选择
Pub Date : 2017-11-28 DOI: 10.4172/2167-1052.1000220
D. Marisavljević, O. Markovic, M. Zdravković, S. Hinic, N. Suvajdžić-Vuković, B. Filipović
Background: Immune thrombocytopenic purpura (ITP) in the patients with implanted coronary stents is related with serious risks of haemorrhage related to dual antiplatelet therapy on the one hand and stent thrombosis if antiplatelet therapy is interrupted on the other hand. Therefore, the main objective in these patients is the correction of thrombocytopenia and continuous use of antiplatelet drugs. Case report: We present the patient with implanted stents after acute myocardial infarction (AMI) and severe ITP who was successfully treated with splenectomy. After the patient experienced AMI, primary percutaneous coronary intervention (PCI) with implantation of stents has been performed. Thrombocytopenia (21 × 109/L) was registered for the first time after PCI intervention when it has been noticed a massive hematoma of whole right arm at the site of radial artery puncture. Immediately after the intervention dual antiplatelet therapy and prednisone has been started. Since corticosteroids and azathioprine treatment proved unsuccessful (platelet count <10 × 109/L), the patient has been prepared for splenectomy with intravenous immunoglobulins. As the platelet count was in stable range (40-50 × 109/L) after splenectomy, antiplatelet therapy has been readministered safely. Conclusion: As there are no definitive guidelines for treatment of patients with ITP and implanted stents, the treatment should be individualized to minimize risk of hemorrhagic as well as thrombotic complications. Our case suggests that splenectomy is an available and safe treatment for these patients. However, decision on splenectomy is a challenge; and before the surgical intervention the risk-benefit assessment should be considered.
背景:冠状动脉支架植入术患者发生免疫性血小板减减性紫癜(ITP),一方面与双重抗血小板治疗相关的严重出血风险有关,另一方面与抗血小板治疗中断后支架内血栓形成风险有关。因此,这些患者的主要目的是纠正血小板减少和持续使用抗血小板药物。病例报告:我们报告一例在急性心肌梗死(AMI)和严重ITP后植入支架的患者成功地接受了脾切除术。在患者经历AMI后,进行了初级经皮冠状动脉介入治疗(PCI)并植入支架。PCI介入后首次登记血小板减少(21 × 109/L),在桡动脉穿刺处发现全右臂大量血肿。干预后立即开始双重抗血小板治疗和强的松。由于皮质类固醇和硫唑嘌呤治疗不成功(血小板计数<10 × 109/L),患者已准备行脾切除术并静脉注射免疫球蛋白。脾切除术后血小板计数稳定(40-50 × 109/L),再次给予抗血小板治疗。结论:对于ITP和植入支架患者的治疗尚无明确的指南,因此治疗应个体化,以尽量减少出血和血栓并发症的风险。我们的病例提示脾切除术是一种有效且安全的治疗方法。然而,脾切除术的决定是一个挑战;在手术干预前应考虑风险-收益评估。
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引用次数: 1
Strengthening the clinical evidence provided by observational studies 加强观察性研究提供的临床证据
Pub Date : 2017-10-24 DOI: 10.4172/2167-1052-C1-001
A. Hartzema
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引用次数: 0
Vitamin D Deficiency and Autism 维生素D缺乏和自闭症
Pub Date : 2017-08-31 DOI: 10.4172/2167-1052.1000218
W. F. Elbossaty
Autism is neurodevelopmental disorders characterized by impaired in social skills, repetitive behaviors, speech and nonverbal communication, in addition to unique strengths and differences. There were different reasons for induced autism which include genetics and environmental factors. Many vitamins may be play important role in induced of autism. The major vitamin is vitamin D. Deficiency of vitamin D influence on the development of autism. The main method in treatment of autism the treatment with vitamin D supplements.
自闭症是一种神经发育障碍,其特征是社交技能受损,重复行为,语言和非语言交流,以及独特的优势和差异。诱发自闭症的原因有很多,包括遗传和环境因素。许多维生素可能在自闭症的诱发中起重要作用。主要的维生素是维生素D。缺乏维生素D对自闭症的发展有影响。治疗自闭症的主要方法是补充维生素D。
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引用次数: 1
Evaluation of Antibiotic Use in Medical Ward of Fitche District Hospital, North Showa Zone, Oromia Region, Ethiopia 埃塞俄比亚奥罗米亚州北昭和区菲切区医院内科病房抗生素使用评价
Pub Date : 2017-08-26 DOI: 10.4172/2167-1052.1000217
Addisu Alemayehu Gube, Rufael Gonfa, T. Tadesse
Background: Antibiotic are among the most prescribed drug in medical ward. Because of the rise in health care cost lack of uniformity in drug prescribing and the emergency of antibiotic resistance monitoring and control of antibiotic use are growing concern and strict antibiotic policies should be warranted. Inappropriate use of antibiotic can increase morbidity, mortality, patient cost and bacterial antibiotic resistance. Objective: To evaluate antibiotic use practice in medical ward of Fitche hospital, North Showa Zone, Oromia region, Ethiopia. Methodology: Institution based cross sectional study was conducted by collecting data retrospectively from 200 patient cards drawn by Simple random sampling using balloting from Medical ward of Fitche hospital from March 10- May 30, 2016. After checking for completeness and consistency, data was entered in SPSS (IBM 20) and descriptive statistics was carried. Result: Out of the total 200 patient cards, 110 (55%) were of male and 90 (45%) were of female. Most antibiotics were prescribed for empirical treatment 163 (81.5%) and least for prophylactic treatment 5 (2.5%). In this study, of the total 340 drugs prescribed in Medical ward, the prevalence of antibiotics use was 220 (64.7%). In this study, 65% received more than one antibiotic. And the most commonly prescribed groups of antibiotic were Cephalosporin 32.5% and the most commonly prescribed antibiotic was ceftriaxone 27.5%. Conclusion: This study revealed that of the total of 340 drugs prescribed for 200 patients in Medical Ward of Fitche District Hospital, 64.7% were antibiotics and the most commonly prescribed groups of antibiotic were Cephalosporin and the most commonly prescribed antibiotic was ceftriaxone. And majority of patients in Medical ward 65% received more than one antibiotic.
背景:抗生素是内科病房最常用的药物之一。由于卫生保健费用的增加,药物处方缺乏统一和抗生素耐药性的紧急情况,抗生素使用的监测和控制日益受到关注,应采取严格的抗生素政策。不当使用抗生素可增加发病率、死亡率、患者费用和细菌抗生素耐药性。目的:了解埃塞俄比亚奥罗米亚地区北昭和区菲切医院内科病房抗生素使用情况。方法:采用基于机构的横断面研究方法,回顾性收集菲切医院内科病房2016年3月10日至5月30日采用简单随机抽样法抽取的200张患者卡片。检验数据的完整性和一致性后,将数据输入SPSS (IBM 20)进行描述性统计。结果:200张患者卡中,男性110张(55%),女性90张(45%)。使用抗生素最多的是经验性治疗163例(81.5%),最少的是预防性治疗5例(2.5%)。在本研究中,内科病房340种处方药物中,抗生素使用率为220种(64.7%)。在这项研究中,65%的人服用了一种以上的抗生素。头孢菌素和头孢曲松分别为32.5%和27.5%。结论:本研究显示,菲切区医院内科病房200例患者共使用340种药物,抗生素占64.7%,最常使用的抗生素组为头孢菌素,最常使用的抗生素组为头孢曲松。大多数内科病房的病人65%接受了一种以上的抗生素。
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引用次数: 12
Knowledge of Sexually Transmitted Disease and Barriers to Seeking Sexual and Reproductive Health Care among Chercher High School Students 彻彻高中学生的性传播疾病知识和寻求性与生殖保健的障碍
Pub Date : 2017-07-28 DOI: 10.4172/2167-1052.1000216
Jabessa Dula, Lemessa Oljira, B. Geda, Tadele Kinati
Insufficient knowledge about Sexually Transmitted Infections and issues around sexual and reproductive health services are among the major barriers to successfully prevent the disease among adolescent populations in the world. The objective of the study was to assess knowledge of adolescents about STIs and identify the barriers to seek sexual and reproductive health service among Chercher high school regular students in west Hararge zone Oromiya region from February-March 2014. Institutional based cross sectional study design was used. A simple random sampling procedure was used to randomly select students across the sections. Data were collected using a pre tested self-administered questionnaire. Odds ratio with 95% CI was employed to test the association between variables and multiple logistic regressions was used to control for the possible confounders. Only (17.5%) of the participants were knowledgeable. Respondents who aged 10-14 were 61% less likely to be knowledgeable (AOR=0.39, 95% CI=0.17-0.91). Students whose fathers were either merchant or NGO employer were about 78% less likely to have knowledge [AOR=0.22, 95% CI 0.10-0.51]. Knowledge about sexually transmitted disease was very low. Therefore strengthening of information, education and communication on the issue was recommended.
对性传播感染以及性健康和生殖健康服务方面的问题认识不足,是在世界青少年中成功预防这一疾病的主要障碍之一。该研究的目的是评估2014年2月至3月奥罗米亚地区西哈勒日地区彻彻高中普通学生对性传播感染的了解情况,并确定寻求性健康和生殖健康服务的障碍。采用基于机构的横断面研究设计。一个简单的随机抽样程序被用来随机选择各个部门的学生。数据收集使用预先测试的自我管理问卷。采用95% CI的优势比来检验变量之间的相关性,并采用多元逻辑回归来控制可能的混杂因素。只有(17.5%)的参与者是有知识的。10-14岁的受访者有61%的可能性不太了解(AOR=0.39, 95% CI=0.17-0.91)。父亲是商人或非政府组织雇主的学生拥有知识的可能性约为78% [AOR=0.22, 95% CI 0.10-0.51]。对性传播疾病的了解非常少。因此,建议加强关于这一问题的信息、教育和交流。
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引用次数: 3
期刊
Advances in Pharmacoepidemiology and Drug Safety
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