社区高龄独居老人意外伤害知信行状况的调查

目的了解社区高龄独居老人的意外伤害知信行（KAP）状况。方法采用自制的意外伤害KAP调查表对上海市黄浦区老西门社区高龄独居老人进行入户调查,数据采用SPSS13．0进行统计学分析。结果社区高龄独居老人对意外伤害知识的知晓率偏低,获取相关知识的最主要途径为电视或广播;调查对象中有58％认为意外伤害可以预防,60．5％很担心或担心自己发生意外伤害,所担心的意外伤害类型中位于前5位的是：跌落、交通伤害、烧烫伤、触电和动物伤害;在意外伤害行为方面,调查对象中可能导致意外伤害发生行为危险因素较多。结论社区高龄独居老人意外伤害知信行情况不容乐观,相关部门应该着力提高他们意外伤害知识知晓率、纠正错误态度、使其行为向有利于降低意外伤害发生率的方向转变。     

兰州市社区独居老人慢性病及意外伤害发生情况调查

[目的]了解兰州市社区独居老人慢性病及意外伤害发生情况。[方法]采用自制问卷对兰州市324名社区独居老人进行调查。[结果]兰州市社区独居老人慢性病患病率为88. 89%;意外伤害发生率为26. 85%;意外伤害发生时间多为上午,地点多为家中;意外伤害发生后以自行处理为主,跌倒是意外伤害的主要类型;不同文化程度独居老人意外伤害发生情况比较差异有统计学意义(P0. 05)。[结论]兰州市社区独居老人慢性病患病率及意外伤害发生率均较高,社区应采取有效的健康教育措施降低慢性病患病率及意外伤害的发生率,加强跌倒的预防是减少意外伤害发生的关键。     

兰州市社区独居老人和空巢非独居老人慢性病患病率及意外伤害的调查研究

目的:了解兰州市社区独居老人和空巢非独居老人意外伤害的发生现状。方法:结合文献资料制定了兰州市社区独居老人和空巢非独居老人意外伤害的调查问卷,并对符合入选条件的536名研究对象进行问卷调查。结果:兰州市社区独居老人慢性病患病率为88.89%;空巢非独居老人慢性病患病率为83.57%。兰州市社区独居老人意外伤害的发生率为26.85%,空巢非独居老人意外伤害的发生率为18.84%;且两者比较差异有统计学意义。兰州市社区独居老人跌倒率和锐器伤的发生率高于空巢非独居老人;跌倒原因主要是步态不稳;跌倒时间集中在上午;跌倒地点主要是家中。文化程度、慢性疾病种类是兰州市社区独居老人意外伤害的危险因素;慢性疾病种类是兰州市社区空巢非独居老人意外伤害的危险因素。结论:兰州市社区独居老人和空巢非独居老人慢性病患病率和意外伤害发生率都比较高,应采取有效的社区干预措施来降低慢性病和意外伤害的发生率,从而提高兰州市社区独居老人和空巢非独居老人的生活质量。     

社区高龄独居老人意外伤害健康教育的做法与效果

目的探讨对社区高龄独居老人进行意外伤害健康教育的做法和实施效果。方法采用播放多媒体宣传片和发放手册的方式对社区高龄独居老人实施一对一意外伤害健康教育。结果高龄独居老人健康状况偏差,干预后1个月高龄独居老人意外伤害的知信行总体水平提高。结论多媒体播放的健康教育方式可以有效提高社区高龄独居老人的意外伤害知信行水平。     

上海某社区高龄独居老人意外伤害现况的调查与分析

目的了解上海市老西门社区高龄独居老人意外伤害的发生现况及意外伤害防范需求。方法自制问卷对老西门社区所有符合研究入选条件的高龄独居老人进行入户调查。结果意外伤害人数发生率为29％，伤害次数发生率为35．5％；意外伤害以上午（66．2％）、家中（57．75％）多发，跌倒是意外伤害中的主要类型（占78．9％）；意外伤害防范需求大、种类多。结论高龄独居老人意外伤害发生率较高，采取有效的健康教育、加强跌倒干预是预防和减少意外伤害的关键。     

知信行理论干预社区高龄独居老人意外伤害的效果

目的探讨知信行理论干预社区高龄独居老人意外伤害的效果。方法 2008年5月,我们采用便利抽样选取上海老西门社区高龄独居老人74例分为两组,各37例,甲组采用入户评估＋VCD播放＋健康教育手册讲解,乙组采用入户评估＋健康教育手册讲解方法对老人进行意外伤害的健康教育干预,比较两种方法在干预前后以及干预后第1个月独居高龄老人意外伤害的知信行改变状况和意外伤害发生情况。结果干预前,甲乙两组在性别、文化程度、宗教信仰、子女联络、婚姻状况、自觉健康状况、生活开心、生活安全、ADL总分以及意外伤害发生次数方面差异均无统计学意义（P〉0.05）。干预后第1个月,甲组在意外伤害的知识、态度、行为及总得分方面均优于乙组（P〈0.05）。甲组干预后第1个月知识、态度、行为及总得分均高于干预前（P〈0.01）。乙组干预后第1个月较干预前相比知识、态度和总得分有明显提高（P〈0.05）,行为方面比较差异无统计学意义（P〉0.05）。结论在知信行理论指导下的意外伤害健康教育可以明显提高高龄独居老人意外伤害的知识水平,改善其态度,改变错误行为,其中图文声并茂的健康教育手段较单纯的资料教育效果好。     

苏州地区老年人意外伤害现状及影响因素调查

[目的]了解苏州地区老年人常见意外伤害发生情况、原因以及老年人对意外伤害的知识、态度、行为(KAP)状况,使老年人重视意外伤害,为社区健康教育工作提供理论依据。[方法]采用社区高龄独居老人现况及意外伤害调查问卷对292名苏州社区的老年人进行调查,对数据进行分类汇总,用多元回归分析法对老年人意外伤害的影响因素进行分析,总结出苏州地区老年人常见意外伤害发生现状及相关因素。[结果]苏州地区老年人意外伤害的发生率43.1%;文化程度、生活自理能力、子女联络频率与KAP总得分、知识得分、态度得分、行为得分呈正相关。[结论]农村社区老人态度得分低于城市社区,进行有效的健康教育能在一定程度上帮助老年人认识并重视意外伤害,减少伤害的发生率。     

社区老年高血压和糖尿病病人跌倒认知与行为的调查分析

[目的]了解社区老年高血压和糖尿病病人跌倒认知与行为现状,并分析其影响因素,为社区医务人员实施跌倒健康指导提供科学依据。[方法]采用自行修订的跌倒知信行问卷,对社区110例老年高血压和糖尿病病人入户进行半访谈式问卷调查。[结果]社区老年高血压和糖尿病病人对疾病、药物及部分环境等跌倒危险因素的认知率均小于70%;老年病人通过浴室厕所安装扶手、浴室铺设防滑垫、定期健康体检、遵医嘱服药等预防跌倒率分别为0.9%,6.4%,12.7%,12.7%;文化程度是影响老年病人部分跌倒认知与行为因素(P<0.05)。[结论]社区老年高血压和糖尿病病人对跌倒危险因素的认知不足,在疾病、药物方面预防跌倒措施较少,社区医务人员应有针对性地进行跌倒健康教育。     

针对居家养老者防跌倒知信行干预的效果评价

[目的]通过对社区居家养老者防跌倒知信行情况的调查与针对性的干预,降低社区居家养老者的跌倒率。[方法]选择我院卫生服务中心隶属的两个社区居家养老者,从其跌倒高危人群中随机抽取200例作为研究对象,以自身对照的方法进行研究。通过查阅文献、专家讨论确定社区居家养老者防跌倒的认知、态度与行为调查表,结合平衡能力测试表的评估结果,制定个性化干预措施和锻炼计划并进行一对一的健康教育指导和个体化干预,评价居家养老干预前及干预3个月后跌倒发生率及知信行情况。[结果]Ⅱ级、Ⅲ级跌倒风险高危居家养老者经干预后跌倒率明显下降(P值分别为0.043,0.029),干预后居家养老者跌倒预防知识、态度和行为得分分别为(15.34±3.59)分、(26.68±6.61)分、(14.75±3.54)分,干预后得分平均增加5.78分、8.01分、5.97分,干预前后得分差异有统计学意义(P0.01)。[结论]根据社区居家养老者防跌倒知信行情况及平衡能力评估结果,进行针对性的干预,可提高知信行水平,有效降低跌倒发生率。     

社区高龄老人综合支持体系与跌倒风险的相关性

[目的]探讨社区高龄老人跌倒的发生情况及其社会支持体系对跌倒的影响,为老年人跌倒的预防提供基础依据。[方法]选取某市社区75岁以上的老年人,采用老年人跌倒危险评估量表进行问卷调查。[结果]最近1年中跌倒次数1次者824人(23.9%),2次者194人(5.6%),3次及以上者79人(2.3%),跌倒发生率为31.8%;多元线性回归分析显示性别、年龄、婚姻、文化程度、与子女交流、子女看望频率、子女提供帮助、邻里来往、亲戚朋友来往、社区心理咨询、社会活动频率对社区高龄老人跌倒有影响。[结论]社区高龄老人跌倒发生率较高;社区高龄老人的跌倒受家庭、社区、社会支持因素影响。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.