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我国城乡居民基本医疗保险参保意愿及其影响因素的meta分析
目的:对我国城乡居民基本医疗保险的参保意愿及其影响因素进行系统评价和meta分析,为进一步优化调控政策提供基准证据。方法:系统检索CNKI、VIP、WanFang Data、Web of Science、PubMed和ScienceDirect数据库中有关我国城乡居民基本医疗保险参保意愿的相关研究。用美国卫生保健质量和研究机构推荐的11条标准评价文献质量,用Stata 16.0进行meta分析。结果:共纳入37项横断面研究,包括63601例调查对象。我国城乡居民基本医疗保险参保意愿率为71.5%[95%CI(65.9%,77.2%)]。2016年后的调查(80.5%)、中西部地区(79.6%)、60岁以上(65.7%)、农村居民(74.1%)参保意愿较高;居民的参保意愿与自评健康状况存在负相关,与医保制度满意程度呈正相关。结论:我国城乡居民基本医疗保险总体参保意愿率较高,但仍有地区、年龄、居民健康状况等因素影响着居民的参保意愿,对此,相关部门需精准识别影响居民参保意愿的因素,为制定可持续发展的医保制度提供支持。
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膳食减糖策略有效性的证据图研究
目的 通过证据图方法系统识别、描述和评价膳食减糖策略的有效性。方法 计算机检索CNKI、WanFang Data、VIP、CBM、PubMed、Embase、Web of Science和Cochrane Library数据库,搜集膳食减糖策略有效性的系统评价/Meta分析,检索时限均从建库至2022年11月10日。采用AMSTAR-2对纳入研究进行方法学质量评估,利用Excel 2019软件设计数据提取表,提取相关关键信息,采用气泡图综合呈现干预类型、系统评价/Meta分析纳入研究数量、结论分类等信息。结果 共纳入11篇系统评价/Meta分析。纳入研究根据不同干预措施特点总结为10项干预类型,其中行为改变策略、健康饮食、糖税、物质替代、糖标签、社区干预的研究结局表现出明显有效性,而社会认知模型、减糖指南、健康素养、知识态度行为模型则少有明确的有益效果,说明在理论基础上的干预类型收效甚微。结论 目前证据图显示行为改变策略、健康饮食、糖税、物质替代、糖标签、社区干预具有有效性,同时也存在健康素养、知识态度行为模型等有效性不明确的减糖策略和干预空白。且基于理论方面的膳食减糖策略的有效性证据相对匮乏,未来仍需高质量的研究进一步探讨。
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Reporting Conflicts of Interest and Funding in Health Care Guidelines: The RIGHT-COI&F Checklist
Background: Conflicts of interest (COIs) of contributors to a guideline project and the funding of that project can influence the development of the guideline. Comprehensive reporting of information on COIs and funding is essential for the transparency and credibility of guidelines. Objective: To develop an extension of the Reporting Items for practice Guidelines in HealThcare (RIGHT) statement for the reporting of COIs and funding in policy documents of guideline organizations and in guidelines: the RIGHT-COI&F checklist. Design: The recommendations of the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network were followed. The process consisted of registration of the project and setting up working groups, generation of the initial list of items, achieving consensus on the items, and formulating and testing the final checklist. Setting: International collaboration. Participants: 44 experts. Measurements: Consensus on checklist items. Results: The checklist contains 27 items: 18 about the COIs of contributors and 9 about the funding of the guideline project. Of the 27 items, 16 are labeled as policy related because they address the reporting of COI and funding policies that apply across an organization's guideline projects. These items should be described ideally in the organization's policy documents, otherwise in the specific guideline. The remaining 11 items are labeled as implementation related and they address the reporting of COIs and funding of the specific guideline. Limitation: The RIGHT-COI&F checklist requires testing in real-life use. Conclusion: The RIGHT-COI&F checklist can be used to guide the reporting of COIs and funding in guideline development and to assess the completeness of reporting in published guidelines and policy documents. Primary Funding Source: The Fundamental Research Funds for the Central Universities of China.
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A Systematic Review and Quality Assessment of Cardiovascular Disease-Specific Health-Related Quality-of-Life Instruments Part I: Instrument Development and Content Validity
Objectives: Health-related quality-of-life (HRQoL) instruments for cardiovascular diseases (CVD) have been commonly used to measure important patient-reported outcomes (PROs) in clinical trials and practices. This study aimed at systematically identifying and assessing the content validity of CVD-specific HRQoL instruments in clinical studies. Methods: The research team searched Cumulative Index to Nursing and Allied Health Literature, Embase, and PubMed from inception to January 20, 2022. The research team included studies that reported the development and content validity for CVD-specific instruments. Two reviewers independently assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methods on evaluating content validity of PROs. Content analysis was used to categorize the items included in the instruments. Results: The research team found 69 studies reporting the content validity of 40 instruments specifically developed for CVD. Fourteen (35.0%) were rated "sufficient" with very low to moderate quality of evidence. For PRO development, all instruments were rated "doubtful" or "inadequate." Twenty-eight (70.0%) instruments cover the core concepts of HRQoL. Conclusions: The quality of development and content validity vary among existing CVD-specific instruments. The evidence on the content validity should be considered when choosing HRQoL instrument in CVD clinical studies and health economic evaluations.
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公共卫生决策证据质量分级方法问题的定性系统评价
目的 系统评价公共卫生决策证据质量分级方法相关研究问题。方法 计算机检索PubMed、Web of Science、CNKI、WanFang Data、CBM和VIP数据库,搜集公共卫生决策证据质量分级方法应用相关研究,检索时限均为建库至2022年12月。根据SPIDER模型构建问题,采用CASP清单对纳入文献进行质量评价,利用主题综合法对公共卫生决策证据质量分级方法的应用问题进行三级诠释分析,建立问题条目池。结果 共纳入14篇文献,涵盖7个国家。GRADE是常用的证据质量分级方法。CASP评价结果显示高质量研究8篇,中等质量研究4篇,低质量研究2篇。主题综合法归纳出7类13个问题条目。结论 现有的公共卫生决策证据质量分级方法存在证据来源多样、复杂干预研究的证据等级被低估等问题。
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应用复杂系统模型进行公共卫生干预措施经济学评价指南的解读
为了响应卫生经济学建模者更多地应用合适的复杂系统模型去解决公共卫生领域的复杂挑战的需求,由40余位复杂系统模型和经济学评价领域的专家组成的国际团队制订、并于近期发布了应用复杂系统模型进行公共卫生干预措施经济学评价的指南。本文对该指南的制订过程和主要内容进行解读,以期为国内研究人员提供参考,最终提高我国公共卫生研究和服务的整体质量和改善国民的健康水平。
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Efficacy and safety of Tanreqing injection for cough caused by acute trachea-bronchitis disease: A systematic review and meta-analysis of randomized controlled trials
Ethnopharmacological relevance: Tanreqing injection (TRQI) is an intravenous herbal preparation derived from 5 types of traditional Chinese medicines including Scutellariae Radix, Lonicerae Japonicae Flos, Forsythiae Fructus, bear bile powder and goral horn, incorporating baicalin, chlorogenic acid, ursodeoxycholic acid, and goose deoxycholic acid and other compounds known for anti-inflammatory properties, is widely used in China to treat cough caused by acute trachea-bronchitis disease (ATB). Aim of the study: To investigate the clinical efficacy and safety of Tanreqing injection (TRQI) with and without Western medicine (WM) for cough caused by acute trachea-bronchitis (ATB). Materials and methods: We systematically searched eight databases, including CENTRAL, Embase, PubMed, Science Direct, Wiley, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and WanFang, from inception to August 2023 for randomized clinical trials (RCTs) on TRQI for cough caused by ATB. The critical outcomes of interest were time to symptom disappearance, including time for cough symptom to disappear and time to improve cough and sputum production. Important outcomes included symptom disappearance rate, adverse events (AEs) and lung function. We carried out random-effects meta-analysis using Review Manager 5.4 and assessed the certainty of evidence utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: A total of 2872 citations were identified by our search, of which 26 eligible RCTs enrolled 2731 participants. Low to moderate certainty evidence showed that when compared with WM, TRQI plus WM treatment was associated with a favorable effect on the time for cough symptom to disappear (MD-2.21 d, 95% CI-2.64 to-1.78), time to improve cough and sputum production (MD-0.68 d, 95% CI-0.83 to-0.53), symptom disappearance rate (RR 1.37, 95% CI 1.20 to 1.55), forced vital capacity, and forced expiratory volume in 1 s (MD 0.38 L, 95% CI 0.26 to 0.50; MD 2.92%, 95% CI 1.29 to 4.56, respectively). In terms of AEs, there was no association between TRQI plus WM and WM (RR 0.55, 95% CI 0.14 to 2.21; low-certainty evidence). Very low certainty evidence showed that TRQI alone was associated with reduced time to improve cough and sputum (MD-0.14 d, 95% CI-0.26 to-0.02) and increased symptom disappearance rate (RR 1.89, 95% CI 1.24 to 2.88; low certainty evidence) compared to WM.
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Comparison of the measurement properties of the EQ-5D-5L and SF-6Dv2 among overweight and obesity populations in China
Objective To evaluate and compare the measurement properties of the EQ-5D-5L and SF-6Dv2 among Chinese overweight and obesity populations.Methods A representative sample of Chinese overweight and obesity populations was recruited stratified by age, gender, body mass index (BMI), and area of residence. Social-demographic characteristics and self-reported EQ-5D-5L and SF-6Dv2 responses were collected through the online survey. The agreement was assessed using intraclass correlation coefficients (ICC). Convergent validity and known-group validity were examined using Spearman's rank correlation and effect sizes, respectively. The test-retest reliability was assessed using among a subgroup of the total sample. Sensitivity was compared using relative efficiency and receiver operating characteristic.Results A total of 1000 respondents (52.0% male, mean age 51.7 years, 67.7% overweight, 32.3% obesity) were included in this study. A higher ceiling effect was observed in EQ-5D-5L than in SF-6Dv2 (30.6% vs. 2.1%). The mean (SD) utility was 0.851 (0.195) for EQ-5D-5L and 0.734 (0.164) for SF-6Dv2, with the ICC of the total sample was 0.639 (p < 0.001). The Spearman's rank correlation (range: 0.186-0.739) indicated an acceptable convergent validity between the dimensions of EQ-5D-5L and SF-6Dv2. The EQ-5D-5L showed basically equivalent discriminative capacities with the SF-6Dv2 (ES: 0.517-1.885 vs. 0.383-2.329). The ICC between the two tests were 0.939 for EQ-5D-5L and 0.972 for SF-6Dv2 among the subgroup (N = 150). The SF-6Dv2 had 3.7-170.1% higher efficiency than the EQ-5D-5L at detecting differences in self-reported health status, while the EQ-5D-5L was found to be 16.4% more efficient at distinguishing between respondents with diabetes and non-diabetes.Conclusions Both the EQ-5D-5L and SF-6Dv2 showed comparable reliability, validity, and sensitivity when used in Chinese overweight and obesity populations. The two measures may not be interchangeable given the systematic difference in utility values between the EQ-5D-5L and SF-6Dv2. More research is needed to compare the responsiveness.
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Non-pharmacological interventions for smoking cessation: analysis of systematic reviews and meta-analyses
Background: Although non-pharmacological smoking cessation measures have been widely used among smokers, current research evidence on the effects of smoking cessation is inconsistent and of mixed quality. Moreover, there is a lack of comprehensive evidence synthesis. This study seeks to systematically identify, describe, and evaluate the available evidence for non-pharmacological interventions in smoking populations through evidence mapping (EM), and to search for best-practice smoking cessation programs. Methods: A comprehensive search for relevant studies published from the establishment of the library to January 8, 2023, was conducted in PubMed, Web of Science, Embase, the Cochrane Library, CNKI, CBM, Wan Fang, and VIP. Two authors independently assessed eligibility and extracted data. The PRISMA statement and AMSTAR 2 tool were used to evaluate the report quality and methodology quality of systematic reviews/meta-analyses (SRs/MAs), respectively. Bubble plots were utilized to display information, such as the study population, intervention type, evidence quality, and original study sample size. Results: A total of 145 SRs/MAs regarding non-pharmacological interventions for smoking cessation were investigated, with 20 types of interventions identified. The most commonly used interventions were cognitive behaviour education (n = 32, 22.07%), professional counselling (n = 20, 13.79%), and non-nicotine electronic cigarettes (e-cigarettes) (n = 13, 8.97%). Among them, counselling and behavioural support can improve smoking cessation rates, but the effect varies depending on the characteristics of the support provided. These findings are consistent with previous SRs/MAs. The general population (n = 108, 74.48%) was the main cohort included in the SRs/MAs. The total score of PRISMA for the quality of the reports ranged from 8 to 27, and 13 studies (8.97%) were rated as high confidence, and nine studies (6.21%) as moderate confidence, in the AMSTAR 2 confidence rating. Conclusions: The abstinence effect of cognitive behaviour education and money incentive intervention has advantages, and non-nicotine e-cigarettes appear to help some smokers transition to less harmful replacement tools. However, the methodological shortcomings of SRs/MAs should be considered. Therefore, to better guide future practice in the field of non-pharmacological smoking cessation, it is essential to improve the methodological quality of SRs and carry out high-quality randomized controlled trials (RCTs).
期刊论文
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卫生技术评估报告现状与质量分析
目的 对卫生技术评估报告进行调查,分析发表特征和报告质量,探索卫生技术评估热点。方法 计算机检索Web of Science和CNKI数据库,搜集数据完整的卫生技术评估报告,检索时限均为建库至2023年1月。采用SPSS 26.0软件对卫生技术评估报告的发表期刊、国家、作者数量、评估类型及评估内容等进行统计分析,利用INAHTA的卫生技术评估报告标准(2007版)进行报告质量评估,并用VOSviewer 1.6.11软件进行关键词聚类分析。结果 共纳入216篇文献,其中158篇由中国作者发表,其报告数量在近四年呈快速增长趋势。卫生技术社会适应性评价的报告率仅有17.13%。中文报告中,25篇为普通的卫生技术评估,35篇为快速卫生技术评估,3篇为迷你卫生技术评估。英文报告中,4篇为快速卫生技术评估,54篇为普通卫生技术评估。INAHTA报告标准的14个条目中,简明摘要、问题描述和结果讨论条目报告率高,分别为98.61%、94.91%和97.69%;人员职责、利益声明和同行评审声明等条目报告率低,分别为31.94%、19.44%和3.24%。英文文献报告质量偏高。结论 近年来,我国卫生技术评估报告量呈上升趋势,评估类型与应用范畴有所发展,但也存在报告不够规范的问题。
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