同黃洪、Siu Ming 及Tat Chor出咗篇新文:
本文旨在以香港為例,探討世界城市(global city)中人均居住面積(living density)對於精神健康的影響。透過全港性抽樣調查,發現在控制個人背景因素、收入、住屋類型及開支後,人均居住面積對於居民的焦慮(anxiety)及壓力(stress)有顯著影響︰相對於居住於較高密度(7平方米或以下)的住戶,居於較低密度(13平方米或以上)的住戶較少機會有出現焦慮(adjusted OR 0.41, 95% CI 0.23–0.72)及壓力(adjusted OR 0.44, 95% CI 0.20–0.97)。本文建議政府應推動房屋政策改善住屋環境,包括加建公共房屋、加強房屋市場管制,以改善居民的精神健康。
This study aims to enrich the comprehension of the effect of living density on anxiety and stress among adults in a global city. Logistic regression analysis results have shown that by controlling the confounding effect of demographic variables, income poverty, housing ownership and housing cost, the living density was significantly associated with anxiety and stress of residents.
同時也有10000部Youtube影片,追蹤數超過2,910的網紅コバにゃんチャンネル,也在其Youtube影片中提到,...
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confounding effect 在 臨床筆記 Facebook 的最佳解答
Manipulating vital signs in septic shock: which one(s) and how?
The interplay between elevated body temperature and the outcome of critically ill patients is complex. While it is widely accepted—albeit with variable strength of the evidence—that control of fever in patients with neurological compromise is advantageous, in most other cohorts it is not clear. On one hand, control of fever reduces metabolic demand and its treatment may be beneficial. On the other hand, fever is an adaptive response to infection and its treatment may be deleterious.
In their previous study, Schortgen and colleagues randomized patients with septic shock to a regimen of either permissive fever or external cooling to a normothermia goal. They observed a significant positive effect not only on their primary outcome of reduced vasopressor use but also on overall mortality associated with temperature control (14-day mortality 19 % with cooling vs. 34 % in controls, p = 0.013). In the present study, they conducted a further secondary analysis in order to investigate the confounding effects of heart rate on mortality. This question was raised in part related to an open label clinical trial that showed a significant reduction in mortality among septic shock patients randomized to heart rate control (<95/min) by means of an esmolol infusion as compared to controls. In their present analysis, they observed that the effect of temperature control on mortality was not mediated by control of heart rate.
Based on these data, one may come to the conclusion that fever should be controlled in patients with septic shock. However, there are some key issues which must be taken into consideration.
While the results of the original study by Schortgen are compelling, treatment of fever in septic patients has been by no means conclusively demonstrated to be beneficial. Observational studies including hundreds of thousands of patients have documented highly variable results [5, 6]. In addition, the overall body of clinical trials to date investigating anti-pyretic therapy in critically ill neurologically intact patients has not shown any overall benefit. Finally, we have observed numerous examples of small studies demonstrating dramatic mortality reductions associated with a number of different interventions in septic shock that could not be replicated in subsequent larger definitive studies.
Another important consideration in evaluating the studies reported by Schortgen et al. is that the confounding effects of beta-blocker use on outcome, whether successful or not in heart rate control, is not clear. Similarly, the study by Morelli et al. did not report on specifics regarding temperature control. While the current study by Schortgen et al. supports that the effect of temperature control on outcome is independent of heart rate, we are left wondering what would have been the effect of temperature had beta-blockade been applied systematically? To adequately address this question, the development of a factorial randomized control trial is required.
Further, in a more general sense, it is key to distinguish whether vital signs such as temperature and heart rates are elevated or decreased as a beneficial compensatory mechanism, implying that they should be left alone, or that vitals represent exhausted or counterproductive values which require manipulation by critical care specialists (Fig. 1). This is highly complex given that the transition of a vital sign from compensating (physiological) to decompensating (or pathological) may depend on many simultaneously acting circumstances, such as the underlying disease, the cross-talk with other affected organs, and physiological reserve of the patient. Furthermore, these may vary both inter- and intra-individually over time. Examples of such transitions into decompensated vitals on which more consensus exists include malignant hyperthermia (i.e., cool the patient), stress cardiomyopathy (i.e., start inotropic drugs) but also hypotension in compensated heart failure in an outpatient situation versus hypotension in cardiac shock. With regard to the example of heart failure, it is obvious that the patient with a blood pressure of 80/50 mmHg with compensated heart failure requires no intervention, whereas progression to decompensated heart failure and subsequent shock in another patient with the same blood pressure requires immediate treatment. So, theoretically, trials that include both the physiologically compensated and decompensated subjects for interventions that modify specific vital signs (e.g., blood pressure) may wrongfully practise “one size fits all”, when in fact selection for such interventions based on specific patient characteristics—even with a remarkably similar underlying condition—is essential.
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confounding effect 在 NEJS - the New England Journal of Stupid Facebook 的最佳貼文
到底什麼是意向分析 (intention to treat; ITT)? 意向分析原則 (ITT principle) 與意向分析 (ITT analysis)? 不一樣嗎?有關意向分析的描述,下列哪些正確呢?
(A) 維持隨機分派後的族群組成
(B) 降低治療組之間的共同影響因子 (confounding)
(C) 提供介入效益一個實際的 (pragmatic) 估計值
(D) 提供的數值通常低於介入真值 (true effect of the intervention)
http://jerryljw.blogspot.tw/…/ebm-what-is-intention-to-trea…
confounding effect 在 コバにゃんチャンネル Youtube 的最讚貼文
confounding effect 在 大象中醫 Youtube 的最讚貼文
confounding effect 在 大象中醫 Youtube 的最佳解答
confounding effect 在 Are random effects confounding variables? - Cross Validated 的推薦與評價
Random effects are confounding variables if the variables they represent cause selection into the exposure and variation in the outcome. ... <看更多>
confounding effect 在 effect modification vs confounding factor EXPLAINED - YouTube 的推薦與評價
... <看更多>