冠心病患者的健康行为及其影响因素

目的 探讨影响冠心病患者健康行为水平的因素.方法 采用健康促进生活力式量表、慢性病自我效能量表、冠心病健康信念问卷和冠心病知识问卷对随机抽取的广州市3家三甲医院的103名冠心病患者进行调查,以105名正常人作为对照,并对结果进行分析.结果 冠心病患者的健康行为总分低于正常对照人群(P＜0.05);不同婚娴状况或不同既往住院次数的冠心病患者在健康行为总分上的差异具有统计学意义(P＜0.05);冠心病患者的自我效能、婚娴状况、冠心病知识知晓率进入了健康行为的回归方程,其联合决定系数为0.291;健康信念中维护健康动机因素分别进入了健康行为中健康责任、营养2个维度的回归方程,其决定系数分别为0.098和0.052.结论 冠心病患者的健康行为水平低于正常对照人群,良好的自我效能、健康信念、冠心病知识知晓率可促进冠心病患者建立健康行为.     

冠心病患者健康信念与健康行为的相关性研究

目的探讨冠心病患者的健康信念与健康行为的关系。方法用方便抽样的方法，调查了广州市3所三甲医院的103名冠心病患者，并以105名正常人作为对照。采用问卷调查法，用健康促进生活方式量表和冠心病健康信念问卷分别调查了研究对象的健康行为和健康信念，并使用SPSS11．0软件包进行统计分析。结果冠心病患者的健康信念总分与健康行为中健康责任和营养两个维度呈正相关（P〈0．05）；健康信念中维护健康动机与健康行为总分及其各维度均呈正相关（P〈0．05）；知觉到严重度与健康行为中运动和锻炼、自我实现两个维度呈负相关（P〈0．05）；知觉到益处与健康行为总分及其自我实现、压力应对和营养三个维度呈正相关（P〈0．05）。结论冠心病患者的健康信念可影响其健康行为，对维护其健康的愿望越强烈，就越有利于其健康行为的建立；越能意识到冠心病的严重性，就越能采取运动和锻炼、自我实现等健康行为；越能意识到采取健康行为所能带来的益处，就越能采取自我实现、正确积极地应对压力及合理的饮食等健康行为。     

社区高血压患者健康行为影响因素的调查研究

目的探讨社区高血压患者健康行为的影响因素，为制定健康行为的干预策略提供依据。方法采用健康促进生活方式量表Ⅱ（HPLPID、自我效能问卷（SES）、社会支持评定量表及自行设计的一般资料问卷，对106例社区高血压患者的健康行为、自我效能、社会支持、知识水平等进行调查。结果47．2％的患者健康行为总体水平较差，52．8％的患者为好，健康行为与自我效能、社会支持、婚姻状况显著相关（P〈0．01）；自我效能对健康行为的预测力最强。结论社区的医护人员应综合各相关因素，尤其重视自我效能对患者健康行为的促进作用，制定并督导实施相关的干预措施。     

健康信念模式在冠心病患者知信改变中的应用

目的：探讨健康信念模式在冠心病患者知信改变中的临床应用效果。方法：方便抽样选取心内科住院冠心病患者100名,实验组、对照组各50名。实验组接受健康信念模式为理论基础的健康教育,对照组接受传统健康教育。入选时和干预6个月后,均采用冠心病知识问卷、健康信念问卷、慢性病自我效能量表进行评定。结果：入院时两组患者的一般情况、知识、健康信念、自我效能的差异均没有统计学意义（P＞0.05）。干预后两组患者的冠心病相关知识、健康信念、自我效能中除控制疾病疼痛信心及控制疾病引起情绪压抑的信心（P＞0.05）外,余差异均具有统计学意义（P＜0.05）。结论：健康信念模式能够帮助冠心病患者掌握冠心病基础知识,树立其健康信念,对良好健康行为建立有促进作用,良好的健康行为对降低冠心病发病率及死亡率具有重要的意义。     

围绝经期妇女预防骨质疏松知信行的影响因素研究

目的调查围绝经期妇女预防骨质疏松的知识、信念及行为的现状,并探讨其影响因素。方法于2016年8月—2017年2月,采用骨质疏松知识问卷、骨质疏松自我效能量表、骨质疏松预防保健行为问卷对复旦大学附属妇产科医院130例围绝经期妇女进行调查。结果围绝经期妇女预防骨质疏松的知识问卷总分为(10. 70±5. 27)分、自我效能量表条目均分为(2. 15±0. 20)分、行为问卷总得分为(44. 35±7. 90)分。单因素分析显示,不同文化程度、职业、家庭年收入及健康状况的围绝经期妇女在预防骨质疏松的知信行方面的差异有统计学意义(P 0. 05)。多元线性回归分析提示,自我效能及健康状况可影响知识得分(P 0. 05);知识、行为和家庭年收入可影响自我效能(P 0. 05);而自我效能可影响行为(P 0. 05)。结论知识、信念、行为三者之间可相互影响、相互促进,只有增加围绝经期妇女预防骨质疏松的知识,提高其自我效能,并促进其预防骨质疏松的行为,才能真正降低骨质疏松的发生率。     

糖尿病足高危患者自我管理行为及自我效能的影响因素分析

目的：调查糖尿病足高危患者自我管理行为及自我效能的影响因素。方法采用便利抽样法,选取2013年6月—2015年1月在上海某三级甲等医院内分泌门诊随访的糖尿病足高危患者92例。采用糖尿病自我管理行为量表、糖尿病自我效能量表和一般资料调查表进行调查。结果92例糖尿病足高危患者自我管理能力总分得分为（30．99±12．336）分,得分率为40．25％。自我效能得分为（93．34±20．603）分,得分率为71．80％。单因素分析显示：家庭月收入、婚姻状况、年龄、性别是自我管理行为的影响因素（P 〈0．05）,吸烟、家庭月收入、婚姻状况、职业是自我效能的影响因素（P〈0.05）。结论糖尿病足高危患者自我管理行为及自我效能不容乐观,护理人员应关注该人群的健康宣教,为减少患者的并发症、致残率,提高患者的生存质量,促进患者自我管理行为的有效实践提供理论依据。     

冠脉内支架置入术后患者健康行为影响因素的调查研究

目的 探讨冠脉内支架置入术后患者健康行为的影响因素,为制定健康行为的干预策略提供依据.方法 采用健康促进生活方式量表Ⅱ、自我效能问卷、社会支持评定量表及自行设计的一般资料问卷和知识问卷,对106例冠脉内支架置入术后患者的健康行为、自我效能、社会支持、知识水平等进行调查.结果 健康行为总分为130.08±21.25,47.2%的患者健康行为总体水平为一般和差,52.8%的患者为优秀和良好;健康行为与自我效能、胸闷发作次数、社会支持、婚姻状况显著相关(P均<0.01);自我效能对健康行为的预测力最强,解释了81.5%的行为变异.结论 医护人员应综合各相关因素,尤其重视自我效能对患者健康行为的促进作用,制定并督导实施相应的干预措施.     

社区护理干预对提高糖尿病患者生活质量的作用

目的探讨社区护理干预对提高社区2型糖尿病患者生活质量的作用。方法采用自我效能量表、自护行为量表和生活质量综合评定问卷，调查214例社区2型糖尿病患者，了解社区2型糖尿病患者自我效能的水平、自护行为的执行情况和生活质量；并采用专家授课、多媒体健康教育、护理技能培训等集体指导方法和个体针对性指导相结合方式，实施社区护理干预半年。结果2型糖尿病患者自我效能感和自护行为能力干预前、后比较差异有统计学意义（P〈0．01）；生活质量的躯体功能、心理功能、社会功能和生活总分干预前后差异有统计学意义（P〈0．05），物质生活状态干预前后无统计学意义（P〉0．05）。结论通过社区护理干预，可以增强2型糖尿病患者的自我效能感、自护行为能力，进而提高其生活质量。     

中青年2型糖尿病患者遵医行为影响因素分析

目的：探讨中青年2型糖尿病患者遵医行为现状，分析影响患者遵医行为的影响因素。方法：采取整群抽样的方法，用社会人口学资料问卷、遵医行为量表、社会支持量表、健康信念量表对300例社区中青年2型糖尿病患者进行调查。结果：患者遵医行为得分（56．8&#177;10．9）分，得分率67．62％；遵医行为与社会支持、健康信念的复相关系数分别为r=0．20、r=0．33（P〈0．01）；不同性别患者在饮食治疗方面差异有统计学意义（P〈0．05）；不同居住情况患者在饮食治疗、运动治疗、总分方面差异有统计学意义（P〈0．05）；年龄与运动分数（r=-0．17，P〈0．01）、定期复查分数（r=-0．13，P〈0．05）呈负相关。结论：患者的性别、年龄、居住状况、主客观支持及其健康信念是糖尿病患者遵医行为的影响因素。     

慢性阻塞性肺疾病病人疾病认知、自我效能和健康行为的相关性

[目的]探讨慢性阻塞性肺疾病(COPD)病人疾病认知、自我效能和健康行为的状况及3者之间的关系。[方法]采用自行设计的疾病认知问卷、自我效能感量表、健康行为量表对203例COPD病人进行调查。[结果]COPD病人的健康行为总分为(111.47±30.61)分,总体得分指标53.6%,其疾病认知不及格率为78.3%;自我效能总体得分指标51.3%。文化程度及婚姻状况影响病人的健康行为,健康行为总分及各维度与疾病认知总分、防治方法和康复训练的认知水平以及自我效能均呈正相关(P<0.05)。[结论]COPD病人的健康行为、疾病认知、自我效能有待提高,医院、社区应针对性地加强对病人健康知识的教育,增强其自我效能,以提高其健康行为。     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.