机械振动对绝经后骨质疏松患者骨密度影响

目的观察机械振动对绝经后骨质疏松患者骨密度(BMD)的影响。方法随机选择2014年2月~2015年10月就诊于广州军区广州总医院骨科医院康复理疗科及骨质疏松门诊的绝经后骨质疏松患者60例,分为阿仑膦酸钠组(ALN组)和机械振动组(WBV组),每组30例,两组均给予抗骨质疏松基础治疗,分别于入组时、治疗6个月后测定骨密度。结果WBV组治疗6个月后L1~L4、左股骨颈、左股骨上端、Ward's三角、左股骨大粗隆BMD较治疗前明显增加,其中Ward's三角BMD变化率最大(8.37%),差异有统计学意义(P0.05)。ALN组治疗6个月后L1~L4、左股骨颈、左股骨上端、左股骨大粗隆BMD较治疗前明显增加,其中L1~L4 BMD变化率最大(3.17%),差异有统计学意义(P0.05);而Ward's三角BMD虽有增加,但治疗前后相比,差异不具有统计学意义(P0.05)。治疗6个月后,WBV组左股骨(颈、上端、大粗隆)、Ward's三角的变化率均高于ALN组,而ALN组腰椎BMD变化率要高于WBV组。结论阿仑膦酸钠能明显增加腰椎骨密度;而机械振动对股骨、髋部骨密度提升明显,其中Ward's三角可以作为机械振动治疗指征和疗效判定指标;机械振动尤其适用于绝经后骨质疏松治疗。     

The measurement of current perceived health among Chinese people in Guangzhou and Hong Kong,southern China

General percelved health might be considered as a trait measure of perceived health and has been shown to be a reliable predictor of mortality. Current perceived health might be thought of as a state measure and as such should be more sensitive to short-term changes in health status. This paper describes the development of an instrument, the CPH-42 which measures current perceived health among Chinese people. Over 1000 items associated with ill-health were collected after inter-viewing 90 subjects from out-patient and in-patient settings. To these were added 38 items from section 1 of the Nottingham Health Profile (NHP) and the Chinese Health Questionnaire (CHQ30), measures of functional status and mental health respectively. These items were administered to four groups of subjects and 42 items were extracted using discriminant analysis to create the CPH-42. Results show low levels of conceptual overlap between the CHQ30 and CPH-42, and slightly more overlap between the NHP and CPH-42. Subjects' health care utilization behaviour was linearly related to rated current perceived health. It is concluded that the instrument is both a valid and reliable tool (Guttman's split-half coefficient r=0.85) which measures a distinct area of subjective health and is shown to predict health services utilization behaviour significantly better than general perceived health.     

职业对老年人骨密度的影响

目的：了解长期脑力劳动与体力劳动对人体骨矿含量的影响。方法：采用DPX－L型骨密度仪对194名退休教师和工人进行了髋部骨矿含量和骨密度测定。结果：老年男性工人Word‘s三角区骨矿含量、骨密度明显高于老年教师，而老年女性教师和工人没有差异。结论：骨矿含量的高低是各种因素综合作用的结果，其中所从事的职业、青年时期的劳动强度也是一个主要因素。     

Interlocking oppressions: the effect of a comorbid physical disability on perceived stigma and discrimination among mental health consumers in Canada

People living with mental health problems often face stigma and discrimination; however, there is a lack of research that examines how comorbid conditions affect this perceived stigma. This study sought to determine whether people who have a comorbid physical and psychiatric disability experience more stigma than those with only a psychiatric disability. It also looked at how perceived stigma and discrimination affect physical and mental health. A secondary analysis on data from interviews with 336 former and current clients of the mental health system in a mid-size Canadian city in 2005 was performed. Of these, 203 (60.4%) reported they had a psychiatric disability, 112 (33.0%) reported that they had a physical disability, with 74 reporting both a psychiatric and a physical disability. People with a self-reported psychiatric disability and a self-reported comorbid physical disability faced more overall perceived discrimination/stigma ( P  = 0.04), than those with a psychiatric disability alone. Perceived discrimination/stigma was positively correlated with psychiatric problem severity ( P  = 0.02), and negatively correlated with self-rated general health ( P  < 0.001), physical condition ( P  < 0.001), emotional well-being ( P  < 0.001) and life satisfaction ( P  < 0.001). These results bring to light the aggravating effect of a physical disability on the perceived stigma for those living with a mental illness, and also strengthen the knowledge that stigma and discrimination have a negative impact on health. Healthcare providers should recognise this negative impact and screen for these comorbid conditions. Policy-makers should take measures such as improving access to housing and employment services to help reduce stigma and discrimination against this particularly vulnerable group.     

口服复方避孕药对青春期女性骨密度的影响

目的:观察复方口服避孕药(COCs)妈富隆(去氧孕烯/炔雌醇)对青春期女性骨矿物质密度(BMD)的影响。方法:接纳150例年龄16～18岁女性应用COCs避孕为观察组,用药24个月;接纳150例年龄16～18岁从未应用激素避孕药女性做对照组;应用双能X-线吸收法测量腰椎和股骨颈BMD。结果:观察组用药2年后腰椎和股骨颈BMD从基础值1.010±0.107g/cm3和0.818±0.089g/cm3降低到1.007±0.108g/cm3和0.813±0.090g/cm3,分别降低了0.29%和0.61%;而对照组则从基础值1.008±0.109g/cm3和0.816±0.087g/cm3增高至1.027±0.106g/cm3和0.824±0.089g/cm3,分别增高了1.88%和0.98%;用药2年后,观察组与对照组相比BMD无明显差异(P>0.05)。结论:青春期女性应用COCs避孕2年对BMD无明显影响。     

Tackling the needs of the homeless: a controlled trial of health advocacy

The objective of the present study was to assess the effectiveness of a health advocate's casework with homeless people in a primary care setting in terms of improvements in health‐related quality of life (QoL). The impact of the health advocacy intervention was assessed in a quasi‐experimental, three‐armed controlled trial. Homeless people moving into hostels or other temporary accommodation in the Liverpool 8 area of the UK and patients registering at an inner‐city health centre as temporary residents were allocated in alternating periods to health advocacy (with or without outreach registration) or ‘usual care’ over a total intake period of 3 years. Health‐related QoL outcomes were assessed using three independent self‐report measures: the Life Fulfilment Scale; the Delighted–Terrible Faces Scale; and the Nottingham Health Profile. Out of the 326 homeless people who were given baseline questionnaires at registration, 222 (68%) returned usable questionnaires. Out of these individuals, 171 (77.0%) were traceable at follow‐up, and 117 (68.4%) follow‐up questionnaires were returned. The majority of respondents (n = 117) were women (72%) who were under 30 years of age (74%), white British (91%), and single (63%) or separated (23%), many of whom were living with their children (41%) in either women's refuges (30%) or family hostels (25%). Improvements in health‐related QoL were greatest in people recruited and supported by a health advocate early in their stay in temporary housing, in comparison with those in the control group given ‘usual care’ at the health centre. The model of streamlined care for patients with complex psycho‐social needs is shown to be a worthwhile and effective option for primary healthcare providers.     

Socioeconomic status and health behaviors as predictors of changes in self-rated health among older persons in Israel

There is a considerable body of scientific knowledge about factors associated with self-rated health (SRH), a common measure of health status. However, less is known about the factors associated with changes in SRH over time. In order to fill this gap, the aim of the current study was to examine a combination of socioeconomic, psychosocial, and health behaviour variables in explaining changes in SRH among older adults. The study used data from two time periods in Israel of the Survey of Health, Aging and Retirement in Europe (SHARE) to analyse the predictive contribution of Time 1 socioeconomic, psychosocial and behavioural variables and changes in these variables over time to changes in SHR. The sample included 1,549 older persons interviewed at baseline (years 2009–2010) and four years later (year 2013). Using bivariate and multivariate regression models, the findings show that 26 percent and 23 percent of the participants reported either improvement or a deterioration in their SRH, respectively. Decline in SRH was predicted by a combination of Time 1 socioeconomic (subjective assessment of a household's ability to make ends meet), psychosocial (QoL and in trust in people), and behavioural factors (moderate physical activity) and decline in these factors over time. The findings demonstrate that changes in those variables make an additional significant contribution for explaining changes in SRH. The findings suggest that in addition to identification of low SES, poor psychosocial and behavioural factors as risk factors to poor SRH changes in these factors should be monitored among older populations.     

农村女性股骨骨密度影响因素研究

目的:探讨影响农村女性股骨骨密度的相关因素。方法:采用生活方式情况调查表对349名农村女性进行问卷调查。应用双能X线吸收仪对349名女性研究对象进行股骨扫描,用多元线性回归模型分析女性一般特征及劳动强度、吸烟、饮酒、饮茶、绝经与股骨密度的关系。结果:349名被调查女性的股骨密度为(940.79±202.87)mg/cm2,年龄与股骨骨密度呈负相关,身高、BMI与股骨骨密度呈正相关;在调整相关危险因素后,劳动强度和饮酒可增加股骨骨密度(P=0.045,P=0.006),而吸烟、绝经可降低股骨骨密度(P=0.021,P<0.001)。结论:在农村女性人群中年龄、身高、身高体重指数、劳动强度、饮酒、吸烟和绝经状况与股骨骨密度有显著相关性。     

中老年女性骨密度和骨代谢生化指标关系的研究

目的了解中老年女性骨密度和骨代谢生化指标随年龄变化的特点,分析骨代谢生化指标在骨质疏松症早期诊断中的价值。方法测定162例中老年女性腰椎正位骨密度,同时检测所有受检者空腹血清骨钙素、血清碱性磷酸酶及晨尿吡啶啉,尿吡啶啉用肌酐校正。按年龄段和不同骨密度组对骨代谢生化指标值分别进行统计分析。结果骨质疏松在中老年女性中普遍存在,发病率很高,达51.2%。骨代谢指标按年龄分析,中老年女性骨钙素和尿吡啶啉/肌酐在50~69岁时明显升高。70岁以后又趋于下降。而血清碱性磷酸酶各年龄段无显著性差异。按骨密度分析,中老年女性骨质疏松组和骨量减低组的骨钙素和尿吡啶啉/肌酐均明显高于正常组。而骨质疏松组和骨量减低组的骨钙素和尿吡啶啉/肌酐值无显著性差异。各骨密度组的血清碱性磷酸酶无显著性差异。结论骨质疏松症是1种危害极大的疾病,在中老年女性中患病率很高,因此早期诊断尤为重要。血清骨钙素、尿吡啶啉/肌酐分别是反映骨形成和骨吸收特异性和敏感性较高的指标,有助于原发性骨质疏松症的早期诊断。     

无锡市HIV/AIDS患者生活质量及其影响因素调查

目的：调查无锡市艾滋病病毒感染者和艾滋病患者的生活质量,分析其影响因素,为更好地进行关怀干预提供依据。方法：采用健康状况调查问卷（SF-36）加上艾滋病相关条目作为调查问卷,对208例HIV/AIDS患者进行调查。结果：HIV/AIDS患者SF-36的生理健康和心理健康平均得分为53.2±5.9和50.0±11.8;文化程度、工作状况、CD4＋T细胞计数、机会性感染、抗病毒治疗、社会支持等因素,对HIV/AIDS患者的生活质量有影响。结论：艾滋病问题严重影响HIV/AIDS患者的生活质量,应针对其主要的影响因素,加强关怀与干预工作。