北京城市卒中社区康复及危险因素自我管理效果分析

目的应用以引导式教育为内容的康复治疗和危险因素自我管理措施,评价其对促进卒中患者卒中知识知晓、行为改善及功能恢复的作用。方法在北京市东城区选择两个社区分别作为干预社区与对照社区,结合现代康复理念、引导式教育、危险因素自我管理,先后对干预社区109例患者开展3个月的卒中康复治疗及6个月危险因素自我管理干预。通过卒中患者自身治疗和干预前、后比较以及与对照社区110例患者比较,评价干预效果。结果经3个月康复治疗后,干预社区卒中患者简化的Fugl-Meyer运动功能量表评分从57.0(30.0,81.5)分提高到70.5(40.5,92.0)分(P0.001);Barthel指数评分从90(65,95)分提高到95(75,100)分(P0.001);社会功能活动问卷评分从(11.6±8.3)分降低到(10.1±8.4)分(P=0.001)。经过6个月自我管理,干预社区卒中患者对危险因素(P0.001)、预警知识(P0.001)和康复技能知晓(P0.001)以及血糖控制(P=0.033)和坚持康复治疗情况(P0.001)均显著高于对照社区卒中患者。结论社区卒中康复及危险因素自我管理干预,可以提高卒中相关知识知晓、改善行为习惯和功能恢复。     

乳腺癌改良根治术患者围手术期、化疗期的焦虑抑郁情绪、应对方式和生命质量的观察

目的调查乳腺癌改良根治术患者围手术期、化疗期的焦虑、抑郁情绪及应对方式对其生命质量的影响程度,为医护人员开展心理护理及治疗提供依据。方法采用生命质量评定量表、汉密尔顿焦虑量表、汉密尔顿抑郁量表和医学应对问卷对105例乳腺癌病人进行调查,并分析其相关性以及各因素对乳腺癌改良根治术患者生命质量的影响程度。结果乳腺癌改良根治术围手术期的焦虑、抑郁水平最高;乳腺癌病人术后生命质量水平偏低,而影响患者生命质量的关键因素是其应对方式的不同。结论乳腺癌改良根治术患者围手术期的焦虑、抑郁情绪,严重影响生命质量。需要在手术后加强对病人的心理疏导,鼓励病人采用积极应对方式面对术后生活,可以更好地提高其生命质量。     

影响脑卒中患者恢复期生存质量相关因素分析

目的通过对影响脑卒中患者急性期生存质量相关因素进行前瞻性研究,为提高脑卒中患者卒中后恢复期的生存质量提供帮助。方法选取2010-11—2011-10大庆龙南医院神经内科符合实验录入标准的脑卒中住院患者100例。入院后详细询问病史,填写一般情况调查表,并做相关检查。采用脑卒中影响量表评定脑卒中患者生存质量,汉密尔顿抑郁量表评定抑郁程度,神经功能缺损程度用美国国立卫生研究院卒中量表评分,改良兰金量表评定患者的生活自理能力。结果配合完成调查100例,经单因素分析及多元回归分析,年龄、家庭人均月收入、脑卒中次数及神经功能缺损状况、生活自理能力、是否接受康复治疗及卒中后抑郁对患者发病后3个月生存质量有影响。结论积极治疗脑卒中后抑郁,及早进行康复护理干预,促进神经功能康复,重视脑卒中患者(尤其是老年患者)生存质量,做好脑卒中二级预防工作以减少卒中次数是提高脑卒中患者生存质量的重要保证。     

网络干预对社区精神分裂症患者生活质量的影响及机制

目的 探讨网络干预对社区精神分裂症患者生活质量的影响及其机制.方法 随机抽取的社区精神分裂症患者103例分为网络干预组56例和对照组47例.对干预组进行3个月的网络干预,比较两组患者社会支持、临床症状、药物治疗副作用及生活质量,分析影响患者生活质量的因素.结果 网络干预组主观支持、客观支持、支持的利用度、健康状况问卷(SF-36)分高于对照组,P量表、G量表、副作用量表分低于时照组,均有统计学意义(P＜0.05),患者的客观支持、支持的利用度、G量表分、副作用量表分与患者的生活质量相关.结论 网络干预可以提高患者社会支持和生活质量,减轻临床症状和副作用,客观支持、支持的利用度、G量表分、副作用量表分是网络干预影响患者生活质量的重要因素.     

社区康复措施对脑卒中患者生活质量的影响

目的探讨社区综合康复措施对脑卒中患者生活质量的影响。方法对我院收治的50例新发脑卒中患者实施社区规范化康复管理干预,1a后对患者生活能力和生活质量进行观察及量化评定,并与对照组进行比较。结果 2组患者治疗后评分较治疗前均有提高,观察组治疗前后比较差异有统计学意义(P<0.05),且治疗后观察组评分显著高于对照组,患者生活能力和生活质量均优于对照组(P<0.05)。结论社区综合康复措施能够显著提高脑卒中患者生活质量,降低致残率和复发率,极大减轻了家庭及社会负担。     

社区干预对精神分裂症患者的作用

目的：探索主动性社区干预的康复治疗方法对社区精神分裂症患者的作用。方法：精神分裂症128例,连续1年的主动性访视干预社区治疗康复效果。结果：在维持药物治疗的基础上,主动性访视干预1年后精神分裂症患者的简明精神病评定量表（BPRS）各因子、临床疗效总评量表（CGI）评分下降有显著性,世界卫生组织生活质量简表（WHOQOL-BREF）各因子自我评分和总体生活质量评分均高于1年前。结论：主动性访视干预康复对精神分裂症患者有效。     

社区脑卒中患者处理能力及主要照顾者的照顾能力

背景 脑卒中是造成人类死亡和残疾的主要疾病之一,我国卫生部已把康复作为社区卫生服务六位一体功能之一,实施社区康复、家庭康复已势在必行。 目的 通过对社区脑卒中患者自理能力及主要照顾者照顾能力现状的调查,分析其相关影响因素,为制定系统化、标准化、个性化和家庭化的护理方案,完善我国社区康复培训模式,提高脑卒中患者生活质量提供依据。 设计,时间和单位 于2009年1月～2009年4月对上海某两个社区的研究对象进行描述性研究。 对象 上海某两个社区病程在6个月～2年的脑卒中患者60名。 方法 方便抽样法。描述性研究。应用SPSS11.5软件处理数据。 主要观察指标 对研究对象的一般资料、疾病情况、康复训练情况、自理能力及照顾者照顾能力情况进行调查评定。 结果 63.3%脑卒中患者自理能力水平中等,只有36.7%处于高等;照顾者的照顾水平5.0%处于低等,51.7%处于中等,仅43.3%处于高等;参加过社区康复训练的脑卒中患者人数为28名（46.7%）,从未参加过社区康复训练的人数为32名（53.3%）;患者的自理能力与年龄、病程、文化程度、收入、是否参加过康复训练等具有相关性。 结论 社区脑卒中患者自理能力及主要照顾者照顾能力不容乐观,参加康复训练的普及率不高,需加强康复训练的指导。     

综合干预对重性精神病患者健康状况和生活质量的影响

目的:研究社区综合干预对重性精神病患者的防治康复效果. 方法:于2008年6月至2010年9月对江苏靖江市4个社区筛查发现的502例重性精神病患者采取有针对性的药物干预、心理干预、应急处置等综合性社区干预,并对干预前后患者的健康状况、劳动能力和生活质量进行对比分析.结果:社区干预使康复措施的落实率由干预前的50.4％上升到96.8％;患者的病情改善率由17.9％上升为42.8％;患者的全劳动力和半劳动力由12.7％上升为33.7％;干预后患者的生活质量显著高于干预前的水平(P＜0.01). 结论:社区综合干预可改善和控制重性精神病患者的病情,提高患者的劳动能力、健康状况和生活质量.     

社区护理干预对糖尿病周围神经病变患者的效果观察

目的：探讨社区护理干预对糖尿病周围神经病变患者的预后和康复效果的影响。方法选取2012‐06—2014‐06经二、三级医院治疗回社区自主康复治疗的糖尿病周围神经病变患者64例，随机分成观察组32例和对照组32例，观察组对患者进行康复教育、用药指导、中药熏洗和穴位贴敷等社区护理干预措施，对照组患者完全自主康复治疗，不给予任何社区护理干预，观察并比较实施社区护理前和护理6个月后2组患者的空腹血糖、全血黏度、血脂、神经传导速度和病情复发率。结果观察组实施社区护理干预前，空腹血糖、全血黏度等与对照组比较，差异无统计学意义（P＞0.05），护理干预6个月后上述指标与对照组和同组干预前比较，差异均有统计学意义（P＜0.05）；对照组干预前后相比差异无统计学意义（P＞0.05）。观察组患者6个月随访期内未发生返院治疗和病情恶化，对照组患者返院治疗18例，返院治疗率56.23％，2组比较差异有统计学意义（P＜0.05）。结论在糖尿病周围神经病变患者中实施社区护理干预，能有效保障患者预后，提高患者生存、生活质量。     

家庭心理干预对精神分裂症生活质量的影响

目的探讨家庭心理干预对精神分裂症生活质量的影响。方法将符合CCMD-3诊断标准出院的精神分裂症80例患者随机分为研究组和对照组,采用简明精神病量表、社会功能缺陷筛选量表[1]和WHO生存质量测定简表[2],对两组患者进行18个月的干预评估。结论家庭心理护理干预能帮助患者的社会功能恢复,提高自理能力和生活质量,可作为精神分裂症患者的一种辅助治疗和康复手段。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -