脑卒中后吞咽障碍与医院获得性肺炎的关系

目的观察脑卒中后吞咽障碍与医院获得性肺炎发生的关系及对预后的影响。方法对356例脑卒中住院患者进行床边误吸试验,由此分为吞咽障碍组(A组)与无吞咽障碍组(B组),观察两组医院获得性肺炎发生与死亡情况。结果A组医院获得性肺炎发生率达23.5%,B组医院获得性肺炎发生率4.6%,两组差异有统计学意义(2χ=25.8,P<0.01),A组死亡率10.4%,B组死亡率4.0%,差异有统计学意义(χ2=5.3,P<0.05)。结论脑卒中后吞咽障碍是医院获得性肺炎的重要危险因素,显著影响预后,应予以高度重视。     

针灸结合吞咽训练治疗脑卒中后吞咽障碍的效果及对患者生活质量的影响

目的探讨针灸结合吞咽训练治疗脑卒中后吞咽障碍的效果及对患者生活质量的影响。方法将2014年8月至2017年8月本院收治的脑卒中后吞咽障碍患者112例随机分为吞咽训练组(n=56)和针灸组(n=56),均给予常规对症治疗。吞咽训练组给予吞咽训练康复治疗,针灸组在吞咽训练组基础上给予针灸治疗,观察两组患者的吞咽功能恢复效果及对生活质量的影响。结果针灸组和吞咽训练组吞咽功能恢复总有效率分别为94.64%和80.36%,组间比较差异具有统计学意义(P0.05);两组患者治疗后洼田试验分级改善情况均明显优于治疗前,VFSS评分均明显高于治疗前,SWAL-QOL评分均显著低于治疗前,同时针灸组改善效果显著优于吞咽训练组,差异均有统计学意义(均P0.05)。结论针灸结合吞咽训练治疗脑卒中的临床疗效显著,可提高患者生活质量,值得推广应用。     

早期康复护理对脑卒中吞咽障碍患者的影响

目的:探讨早期康复护理对脑卒中吞咽障碍患者的影响.方法:选取我院2015年2月至2016年11月收治的40例脑卒中吞咽障碍患者作为研究对象,随机分为对照组和训练组,对照组进行常规护理,训练组在常规护理基础上施行吞咽训练为中心的康复护理,比较两组患者的护理效果.结果:治疗前两组各项指标无差异,训练组治疗6周后患者吞咽功能康复优于对照组(P<0.05).结论:脑卒中导致吞咽障碍患者给予早期康复护理干预可以使患者提高代偿性进食技巧,最终恢复患者的吞咽功能,预防营养障碍及肺炎等并发症的发生.     

脑卒中合并吞咽障碍护理干预效果观察

目的观察并分析系统性护理干预脑卒中合并吞咽障碍应用效果。方法将100例在天津市环湖医院五病区治疗的脑卒中合并吞咽障碍患者随机分为观察组和对照组,用洼田饮水试验进行吞咽功能评定,对照组进行常规护理,观察组在常规护理基础上,增加吞咽功能恢复、康复训练操、穴位按摩、仪器治疗、饮食指导、心理护理等系统性护理干预。结果两组干预后吞咽功能均有改善,观察组患者吞咽功能改善比较,对照组更为明显,差异有统计学意义(P0.05)。结论系统性护理干预能够促进脑卒中患者吞咽功能的恢复,并能减少并发症,对疾病的预后有积极的临床意义。     

吞咽训练对偏瘫肢体功能康复的影响

目的 探讨吞咽训练对偏瘫肢体功能康复的影响.方法 入选脑梗死偏瘫合并吞咽障碍患者84例,根据其是否进行个体化吞咽功能康复训练分为吞咽训练组及对照组,比较两组治疗前后摄食-吞咽功能评估、Barthel指数与Fugl-Meyer运动功能评定量表得分.结果 （1）两组患者摄食-吞咽功能评估、Barthel指数与Fugl-Meyer运动功能评定得分均较治疗前改善,差异有统计学意义（P＜0.05）;（2）治疗后吞咽训练组摄食-吞咽功能、Barthel指数与Fugl-Meyer运动功能评定量表得分高于对照组,差异有统计学意义（P＜0.05）.结论 吞咽功能康复训练有利于脑梗死偏瘫合并吞咽障碍患者运动功能及日常生活活动能力的改善.     

预见性吞咽功能评估及康复护理对脑卒中吞咽障碍患者的康复效果分析

目的探讨预见性吞咽功能评估及康复护理对脑卒中吞咽障碍患者的效果。方法选择脑卒中患者80例,分为两组各40例。康复组患者在入院后即用标准化床边吞咽功能检查法评估筛查,有针对性地对吞咽障碍患者进行预见性饮食指导及吞咽功能训练;对照组患者在病程1周后,选择性进行吞咽训练。结果康复组的吸入性肺炎发生率为15.0%,显著低于对照组的37.5%,差异有统计学意义(P<0.05)。康复组的吞咽能力总有效率明显高于对照组(82.5%vs.57.5%,P<0.05)。结论预见性吞咽功能评估能够准确判断脑卒中患者的吞咽情况,通过有效的吞咽运动和感觉训练可降低患者肺炎发生率,改善吞咽状况。     

喂食指导与吞咽功能训练对脑卒中患者吞咽障碍的影响

目的分析喂食指导和吞咽功能训练对脑卒中患者吞咽障碍的影响。方法选取我院2015年1月至2016年12月收治的70例脑卒中吞咽障碍患者,随机分为观察组(34例)和对照组(36例)。对照组采取针灸、低频治疗等常规护理干预,观察组在对照组基础上进行喂食指导和吞咽功能训练。比较两组患者的护理效果。结果与干预前比较,两组患者干预后2周、4周、8周的饮水试验评分均有所降低,且观察组的饮水试验评分明显低于对照组,差异均有统计学意义(P<0.05)。干预后,观察组的总有效率为85.29%,明显高于对照组的55.56%,差异有统计学意义(P<0.05)。结论脑卒中吞咽障碍患者在常规护理干预基础上进行喂食指导和吞咽功能训练,能够有效改善其临床症状,促进恢复,值得推广应用。     

呼吸功能训练对脑卒中吞咽障碍患者吞咽功能的恢复作用

目的探讨呼吸功能训练对脑卒中吞咽障碍患者的影响。方法选取2016年2月-2017年2月我院收治的吞咽障碍患者90例,根据数字表法随机分为实验组和对照组,各45例,对照组患者给予常规吞咽功能训练,实验组患者在此基础上辅以呼吸功能训练。于治疗前、治疗4周后分别采用Rosenbek误吸程度分级标准、吸人性肺炎诊断标准评估患者误吸程度分级及吸入性肺炎发生率,采用洼田饮水试验、吞咽造影检查(VFSS)评估患者吞咽功能。对比两组治疗效果。结果治疗前后同组Rosenbek误吸程度分级有统计学差异(P0.05),且治疗后两组间差异显著(P0.05)。治疗后实验组吸入性肺炎的发生率(11.1%)明显少于对照组(26.7%)(P0.05)。实验组患者治疗有效率(95.6%)明显高于对照组(75.6%)(P0.05)。两组患者治疗后VFSS评分均较治疗前明显提高(P0.05),且实验组[(8.76±1.16)分]明显高于对照组[(7.26±2.10)分](P0.05)。结论早期呼吸功能训练有助于脑卒中吞咽障碍患者吞咽功能的恢复。     

医护联合式健康教育在预防脑卒中吞咽障碍患者误吸中的效果观察

目的探讨医护联合式健康教育在预防脑卒中吞咽障碍患者误吸中的临床效果。方法选取2017年10月到2018年6月我院收治的脑卒中吞咽障碍患者120例,随机分为两组各60例。对照组给予常规健康教育,观察组接受医护联合式健康教育。比较两组的误吸发生率及疾病认知。结果观察组的误吸发生率为5.00%,显著低于对照组的16.67%(P <0.05)。干预后,观察组的吞咽障碍相关知识评分、安全喂食方法评分、吞咽功能训练评分、误吸后紧急处理评分均显著高于对照组(P <0.05)。结论医护联合式健康教育可有效降低脑卒中吞咽障碍患者的误吸发生率,提高患者的疾病认知。     

神经性吞咽障碍不同浓度钡液吞咽造影检查分析

目的探讨神经性吞咽障碍不同浓度钡液吞咽造影检查的影像学特点。方法入选新发脑卒中合并吞咽障碍患者90例,随机分为100%钡液吞咽造影检查组、45%钡液吞咽造影检查组及对照组,每组30例,前两组分别采用相应浓度钡液调配的食物进行造影检查。结果 100%钡液吞咽造影检查组与45%钡液吞咽造影检查组两组造影结果均能显示患者口腔期及咽期的滞留、返流、误吸、隐匿性误吸及清除情况,差异无统计学意义(P>0.05),三组卒中后肺炎的发生率无明显差异(P>0.05)。结论 45%钡液及100%钡液吞咽造影检查均能安全有效地反映神经性吞咽障碍患者的吞咽功能,指导吞咽障碍的康复治疗。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.