Occupational therapists’ pain knowledge: a national survey

Purpose: This study surveyed Canadian occupational therapists to identify whether their pain knowledge is current or if the gaps identified in past studies have remained the same. The findings will provide information to guide the development of targeted pain knowledge translation strategies for occupational therapists. Method: A self-report survey, including demographic questions and part of the City of Boston’s Rehabilitation Professionals’ Knowledge and Attitude Survey (COBS), was disseminated electronically to all members of the Canadian Association of Occupational Therapists. Results: A total of 354 therapists, most came from Ontario, Alberta and Nova Scotia and working in the community, acute care and private practice, participated. Over 50% had 10 years or less of experience. Deficit knowledge areas were identified in pediatric pain, chronic versus acute pain, pain assessment and medications. These findings are largely consistent with deficits identified in pre-2000 studies. Conclusions: Pain knowledge gaps persist among Canadian occupational therapists and this can, and should, be addressed within the occupational therapist (OT) curriculum and in professional development initiatives. It is concerning that this study identified similar knowledge gaps as those identified in previous studies of OT students and clinicians. Pain is a growing and complex issue with negative impact on occupational performance across the lifespan. Knowledge dissemination of occupational therapy pain assessment and management approaches should be a priority for the profession.

• Implications for Rehabilitation

• Pain is a prevalent condition in all age groups of occupational therapists’ clients.

• There appear to be gaps in occupational therapists’ evidence-based knowledge of aspects of pain.

• Occupational therapy training programs and occupational therapy associations should provide education with a particular focus on identified pain knowledge gaps.

     

湖北省武汉市居民无偿献血现状及思考

目的通过对湖北省武汉市无偿献血现况及影响因素的调查，为提出品牌营销策略提供基础。方法于2007年6～7月对武汉市部分地区1435名不同人群进行现场问卷调查。结果回收有效问卷1423份。在1423名被调查者中有372名参加过献血，占26．4％。愿意参加献血的1177人中，有539人（45．8％）认为参加无偿献血是帮助患者，是有益社会的高尚行为；而参加过献血的372人中，有180人（48．4％）认为捐献血液救助他人值得去做。结论无偿献血的宣教力度仍应增强，以吸引更多的人参加无偿献血；对再次献血者也应有更多鼓励，以提高他们对献血的忠诚度。     

Evidence for cervical muscle morphometric changes on magnetic resonance images after whiplash: A systematic review and meta-analysis

IntroductionMorphometric changes to cervical musculature in whiplash associated disorder have been reported in several studies with varying results. However, the evidence is not clear because only a limited number of cohorts have been studied and one cohort has been reported in multiple publications. The aim of this study was to assess the evidence for cervical muscle morphometric changes on magnetic resonance (MR) images after whiplash using a systematic review with meta-analysis.Materials and methodsPubMed, MEDLINE and Cochrane Library were searched without language restriction using combinations of the MeSH terms “muscles”, “whiplash injuries”, and “magnetic resonance imaging”. Studies of acute and chronic whiplash were included if they compared whiplash and control cervical spine muscle morphometry measurements from MR images. The search identified 380 studies. After screening, eight studies describing five cohorts (one acute, three chronic, one both acute and chronic) met the inclusion criteria. Participant characteristics and outcome measures were extracted using a standard extraction format. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Muscle cross-sectional area (CSA) and fat infiltrate (MFI) for acute and chronic whiplash cohorts were compared using mean difference and 95% confidence intervals. Meta-analysis models were created when data from more than two eligible cohorts was available, using inverse-variance random-effects models (RevMan5 version 5.3.5).ResultsQuality assessment was uniformly good but only two studies blinded the assessor. Analysis of the acute cohorts revealed no consensus with respect to CSA. MFI was not measured in the acute cohorts. Analysis of the chronic cohorts revealed CSA is probably increased in some muscles after whiplash but there is insufficient evidence to confirm whether MFI is also increased. Because the available data were limited, meta-analyses of only multifidus were performed. In chronic whiplash multifidus CSA was significantly increased at C5 (Z = 3.51, p < 0.01) and C6 (Z = 2.66, p < 0.01); and MFI was significantly increased at C7 only (Z = 2.52, p < 0.01) but the heterogeneity was unacceptably high (I² = 83%).ConclusionsThe strength of the evidence for cervical muscle morphometric changes on MR images after whiplash is inconsistent for CSA and MFI. Future study designs should be standardised with quantification of three-dimensional muscle morphometry.     

188例重症肌无力患者生活质量研究

目的分析重症肌无力(MG)患者的生活质量。方法纳入2013-03-2014-06在唐都医院神经内科就诊的MG患者188例,应用重症肌无力量化评分(QMGs)评估患者病情严重程度,采用36项简明健康状况调查表(SF-36)评估患者生活质量,采用汉密尔顿抑郁量表(HDRS)和汉密尔顿焦虑量表(HARS)评估抑郁和焦虑症状。比较不同教育水平、职业、眼肌型重症肌无力(ocular MG,OMG)症状、胸腺情况等患者间SF-36评分的差异,并对QMG评分、年龄、HARS和HDRS得分与SF-36两项复合得分进行多元线性回归分析。结果高级教育组在躯体疼痛项得分高于初级教育组(P0.05),学生组在生理机能项(P0.05)和生理角色功能项(P0.05)得分均高于脑力劳动组,学生组在生理角色功能项得分亦高于体力劳动组(P0.05);学生组在生理复合得分(PCS)项得分高于按照职业分组的其他3组(均P0.05);OMG组在精神复合得分(MCS)项得分高于全身型重症肌无力(generalized MG,GMG)组(P0.05)。较高的QMGs、HARS得分和高龄可以预测较低的PCS得分,较高的QMGs和HARS得分可预测较低的MCS得分。结论影响MG患者生活质量的因素包括年龄、教育水平、职业、胸腺情况、MG的类型和GMG的类型、疾病的严重程度和心理障碍。较高的QMGs和HARS得分可以预测较低的PCS和MCS得分,年龄大可预测较低的PCS得分。     

妇幼保健机构医护人员对孕产妇产后抑郁症的识别现况调查

目的:对妇幼保健机构的医护人员正确识别孕产妇产后抑郁症的现况进行调查。方法:采用分层典型抽样方法选取河北保定市12家妇幼保健机构(5家妇幼保健院和7家综合性医院妇产科)的医生和护士共267人;采用卫生部《精神卫生工作指标调查问卷》中孕产妇常见心理行为问题病例分析(问卷6)对医护人员进行自填式问卷调查。结果:260名被调查的医护人员完成调查,对孕产妇产后抑郁症正确识别率为85%;其中市级医院医护人员的正确识别率(92.4%)高于区县级医院(89.2%)及省级医院(68.7%)(χ2=19.27,P=0.000);对问题2(识别后该病例目前最需要补充资料)的正确率为65%;问题3(该病例目前最合适处理)的正确率为10.8%;其中市级医院妇产科医护人员的正确率(17.6%)高于区县级(7.8%)及省级医院(6.0%)(χ2=6.91,P0.05)。结论:妇幼保健机构的医护人员对孕产妇产后抑郁症有一定的识别能力,但对于识别后的处理能力尚显不足。     

中国高龄老年人血压水平和高血压患病及其控制情况

目的 探讨我国高龄老年人的血压水平和高血压的患病及控制情况。方法 中国老年健康影响因素跟踪调查（Chinese Longitudinal and Health Longevity Study,CLHLS）2014年横断面数据集,探讨血压水平及分布,并开展高龄老年人的高血压患病和控制情况的调查。结果 共调查4 587名≥ 80岁的高龄老年人,年龄（91.3±7.8）岁,其中,男性1 896名,占总人群的41.3%。2014年我国高龄老年人群SBP为（139.5±22.0）mmHg,DBP水平为（79.6±11.8）mmHg,脉压差平均水平为（60.0±18.7）mmHg。高血压患病率为56.5%（95% CI：55.1%~58.0%）,知晓率为52.2%（95% CI：50.3%~54.1%）,控制率为11.5%（95% CI：10.3%~12.5%）,知晓者控制率为22.2%（95% CI：19.9%~24.4%）。年龄、性别、BMI、居住地、来源地区与高龄老年人的血压水平和控制情况有关。结论 我国≥ 80岁高龄老年人血压水平和高血压流行情况与发达国家、我国成年人不同,与年轻老年人结果相差不大。高血压患病率较高而控制率较低,年龄、性别、BMI、居住地、来源地区与血压水平、高血压患病与控制有关。