Stress is a general reaction to any burden on the body. If such a process becomes chronic, stress-based diseases develop which are hard to treat. The stress cycle in the hypothalamus-hypophysis-suprarenal glands disturbs the bio-psycho-social circuit, which is in a feedback loop with controlled and uncontrolled stress converting processes. This is coupled with the reactivity of the extracellular matrix (ECM) embedded in this circuit. Two “breaks” are installed in the ECM to keep stress reactions under control: The non neuronal acetylcholin system (NNAChS) and the system of endogenous endocannabinoids. Both systems have a limiting effect on pathological increased sympathetic effects raised by stress. Acupuncture stimulates the parasympathicus and NNAChS while neural therapy augments the endocannabinoid system, resulting in slower sympathetic actions. 相似文献
OBJECTIVE: Although the clinical course of Alzheimer disease (AD) is gradual, it is useful for a number of reasons to distinguish between different levels of severity. The Clinical Dementia Rating (CDR) has demonstrated high validity and reliability for this purpose, but it requires a considerable amount of data to be collected both from the patient and from an informant. In the present study, the authors mapped Mini-Mental State Examination (MMSE) scores onto CDR categories to determine how well the MMSE performs as a surrogate of the CDR as a timesaving method of staging dementia. METHOD: Eight hundred sixty-three probands, including 524 patients with probable AD, 92 patients with questionable dementia, and 247 with memory complaints but no objective cognitive impairment, were included. Cutoff scores were identified on one-half of the sample using a receiver operating characteristic analysis. The cutoff values were then applied to the other half of the sample, and the agreement between MMSE score ranges and CDR stages was determined by calculating Cohen's kappa. RESULTS: The MMSE discriminated well between CDR stages 0.5, 1, 2, and 3 but performed poorly in the separation between CDR stages zero and 0.5. The MMSE ranges were 30 for no, 26-29 for questionable, 21-25 for mild, 11-20 for moderate, and 0-10 for severe dementia. Substantial agreement between the two instruments was obtained for the categories mild (kappa=0.62, p<0.001, N=115), moderate (kappa=0.69, p<0.001, N=114), and severe dementia (kappa=0.76, p<0.001, N=39), whereas the agreement was moderate for no (kappa=0.44, p<0.001, N=120) and only fair for questionable dementia (kappa=0.28, p<0.001, N=42). CONCLUSION: The MMSE can be used as a surrogate measure for the CDR for the staging of dementia in AD. 相似文献
The acute psychological reactions of 101 train drivers to on-the-track accidents were studied by means of clinical interviews and questionnaires (Impact of Event Scale, GHQ-20 and a questionnaire addressing stress symptoms, pre-accident expectancies and worries). More than half of the train drivers reported moderate to high intrusive distress (mean 11.3) within hours to days after the accident but only 1/3 reported symptoms of acute psychophysiological arousal. Intrusive symptoms related to visual impressions were most frequently reported. Avoidance was less prevalent (mean 8.8).
Clinical interviews, relationship between pre-accident worries and severity of the acute responses and positive correlation between GHQ-scores relating to the fortnight preceding the accident and IES-intrusion scores, suggest that premorbid variables may influence the stress response. Involvement in more than two previous accidents invoked a feeling of vulnerability and produced stronger acute responses. Post-accident experiences involving various personal contacts did not correlate with the stress responses in this study and only a few drivers experienced such events in a negative way. Denial of the possibility of being involved in accidents was not associated with increased risk of strong acute responses, indicating that denial does not predict poor outcome in healthy persons exposed to situations where possibility of avoiding the event is outside the control of the person. 相似文献
Background. The growing shortage of cadaver kidneys,
the limited possibilities to expand the living related donor pool and the
good results obtained in our centre with poorly matched cadaver kidneys,
led us in 1991 to begin accepting highly motivated, unrelated, living
kidney donors who had a strong emotional bond with the recipients.
Methods. Between 1 January 1991 and 1 January 1996, 46
potential living kidney donors and their emotionally related recipients
were evaluated. Twenty-three cases were accepted for renal transplantation
after thorough somatic and psychological evaluation. The mean
post-transplant follow-up until 1 April 1996 was of 28±3 months.
Compatible blood groups and a negative cross-match were mandatory, but no
minimal HLA matching was required. Results. There was
a 50% drop-out rate following the initial screening. The main reasons for
not performing transplantation were immunological contraindications in 39%
of the cases, somatic in 30.5%, psychological in 26% and socioeconomic in
4.5%. In the accepted group of recipients, 48% (11/23) received transplants
without chronic dialysis. Donor survival was 91%; two deaths unrelated to
nephrectomy occurred 1 year after donation. The 2-year actuarial recipient
and graft survivals were 100% and 91% respectively, compared to 99%
(recipients) and 93% (grafts) in the non-HLA-identical living related
kidney transplant group, and to 93% (recipients) and 83% (grafts) in the
cadaver kidney transplant group. Recipient rehabilitation was completed
after 4±1 months. Emotionally related donors returned to work
5±2 weeks after nephrectomy, and no donor regretted his
decision, even in the case of failure. Conclusions.
Kidney transplantation from emotionally related living donors represents a
valuable option, allowing more patients with end-stage renal disease to
avoid chronic dialysis. Recipient and graft outcome were superior to
cadaver kidney transplantation. Motivated and emotionally related donors
should be allowed to donate one of their kidneys provided that they are
carefully selected and thoroughly informed. 相似文献
The boundaries and floor of the cubital fossa are described. Its contents and their clinically important relationships are emphasised. The commonest variation of the fossa’s venous anatomy is described, and details of a method of blocking the median nerve in the fossa is given. 相似文献
OBJECTIVE: This study explored the value of preoperative self-reported assessment for depression and anxiety in patients who had undergone heart transplantation (HTx). The initial sample was divided into subgroups of patients with ischemic (ICMP) and dilated cardiomyopathy (DCMP). Patient depression and anxiety scores were measured in both subgroups and their impact on pre- and postoperative mortality investigated. METHOD: An initial sample of 152 patients with either ICMP (N = 57) or DCMP (N = 95) and end-stage heart disease awaiting heart transplantation were assessed in a multidimensional longitudinal study, including psychological and somatic variables. One hundred and three patients received a HTx and were followed up for a mean of 4.4 years. Proportional hazard models were computed to test for the influence of psychosocial and somatic factors on outcome. RESULTS: Preoperative depression and state anxiety scores were significantly higher in the ICMP group. In addition to donor and recipient age, ICMP patients in the preoperative high depression group also showed a significantly higher mortality after HTx. This result remained significant even after controlling for sociodemographic and somatic variables. CONCLUSIONS: Patient self-reported depression, but not anxiety, can contribute to the identification of subgroups of patients with an unfavorable outcome after HTx. It therefore may be helpful to screen for depression, particularly in patients with an ischemic cause of their end-stage heart disease. Specific intervention programs should be further developed and evaluated. 相似文献
Although both diabetes and the efficacy of medical management are international issues, psycho-educational interventions might
be culturally bound. Blood Glucose Awareness Training (BGAT) is a psycho-educational program for patients with type 1 diabetes
mellitus. It is focused on improving recognition and management of extreme blood glucose levels, and is the best documented
American psycho-educational program for this purpose. A randomized controlled clinical trial of BGAT's long-term benefits
in a non-American setting has been lacking. One hundred and eleven adults with type 1 diabetes mellitus from Switzerland and
Germany participated. After a 6 months baseline assessment, subjects were randomly assigned to receive either 2 months of
BGAT (n = 56) or a physician-guided self-help control intervention (n = 55). BGAT improved recognition of low (p = 0.008), high (p = .03), and overall blood glucose (p = 0.001), and reduced frequency of severe hypoglycemia (p = 0.04), without compromising metabolic control. BGAT reduced both the external locus of control (p < 0.02) and fear of hypoglycemia (p < 0.02). BGAT was efficacious in reducing adverse clinical events and achieving clinically desirable goals in a European,
as well as American setting. 相似文献