行为异常儿童社交能力分析

目的探讨儿童行为问题与社交能力之间的的关孔方法使用Achenbach’s儿童行为量表对1051名儿童进行筛查，检出98名行为异常者，计数统计其社交项目与总体儿童社交项目人数比较之，x2统计分析。结果在活动的技巧水平上，在家庭关系中，在校学习对知识的理解、掌握程度、心情舒畅程度等方面，异常儿不如总体（P＜0．05），但在活动的时间、对外社交及学习成绩方面二者无明显差异（P＞0.05）。结论儿童行为问题与社交能力的关系。并不是单一的正、负相关所能概括的，应该具体问题具体分析，审视其全面。     

Dietary behaviour of an adolescent French male population

The dietary history method was used to determine the total energy and macronutrient intake, the distribution of daily energy from the different meals and the energy contribution of various food groups, in a population of 299 boys, aged between 10 and 15 years. The effects of age, the social status of the father (SPS), the ponderal index, the importance of breakfast or lunch, and the level of energy intake on dietary indicators, were studied. In our population, energy intake increased with increasing age but the energy contribution of macronutrients did not vary. The diet of boys whose fathers were in the upper SPS classes differed from the diet of those boys whose fathers were manual workers: for example they consumed less energy and pastries, but more animal protein (in percentage of energy intake), more dairy products, and more fruit. The ponderal index was negatively related to energy intake but positively related to protein intake, especially from meat and meat products. The energy intake from protein, animal protein and the energy contribution of dairy products, meat and meat products, fish and vegetables was lower among large eaters than among small eaters. The energy contribution of pastries, sugar and sweets was higher among large eaters.
Similarily, the energy intake from morning and evening snacks was also higher among large eaters. It should be noted that boys who had a substantial breakfast took in less energy from all other meals (including snacks and main meals). Such informaton is necessary in order to develop an effective health programme.     

1996-2000年某医院五种恶性肿瘤例均住院费用分析

恶性肿瘤是给群众带来严重健康损害的经济负担的疾病之一,已经列居我国城市 疾病死亡原因的第一位。本研究利用医院为基础的五种恶性肿瘤住院患者的费用数据,分析1996-2000年五种恶性肿瘤患者例均住院费用的变化趋势,比较自费患者和公费患者之间的例均费用差异。根据恶性肿瘤费用水平高、增长幅度快,且公费患者费用明显高于自费患者的情况,提出在医疗保障制度改革的社会环境下,医院必须加强病种费用管理,主动控制医疗费用水平。     

Moving beyond empiric continuous positive airway pressure (CPAP) trials for central sleep apnea: a multi-modality titration study

There is no universally accepted method to determine effective therapy for central sleep apnea (CSA). Continuous positive airway pressure (CPAP) applied acutely most often does not eliminate apneas and hypopneas. We hypothesized that the application of two or more therapeutic modalities after the diagnostic phase of polysomnography, a multi-modality titration study (MMTS), would identify a successful CSA treatment more often than a standard split-night study (SNS) and obviate the need for additional polysomnograms to determine a successful therapy. We retrospectively analyzed polysomnograms of patients diagnosed with CSA at our Sleep Disorders Center. We defined a therapy trial that resulted in an apnea–hypopnea index < 10 with at least one treatment modality as a therapeutic success. One hundred fifteen patients with CSA were studied. Sixty-six patients (57.4%) underwent a SNS, and 49 patients (42.6%) underwent a MMTS. SNS yielded only 8/66 (12.1%) successes on the first night, whereas a MMTS yielded 19/49 (38.8%) successes (p = 0.001, two-tailed Fishers exact). Patients who underwent a SNS eventually had similar rate of success as patients studied with MMTS (60.6 vs 63.3%, NS), but required more testing. Adaptive servo-ventilation was the most successful modality tested, yielding 36/46 (78.3%) successes. Trials of additional modalities following a failed trial of CPAP often produce a successful option that may guide therapy in patients with CSA. This approach may lead to establishing the diagnosis and treatment plans faster, while reducing unnecessary testing.     

Structured treatment and teaching of patients with Type 2 diabetes mellitus and impaired cognitive function--the DICOF trial.

BACKGROUND: Patient education is integral part of any diabetes therapy in Germany, but elderly patients are not able to follow the variety of topics comprising standard treatment and teaching programmes (TTP), primarily due to impaired neuropsychological function. This leads to deficits in diabetes knowledge and hindered ability for diabetes self-management. AIM: To evaluate structured TTP for geriatric patients with impaired cognitive function. PATIENTS AND METHODS: A neuropsychological examination was performed on all patients over 54 years [n=102, age 68.6 +/- 8.7 years, diabetes duration 10.3 (0.03-35.4) years, HbA1c 10.3 +/- 1.7% (HPLC, Diamat, NR 4.5-6.3%), cognitive function 87.7 +/- 12.3 IQ points] who took part in TTP for insulin therapy. Patients with impaired cognitive function participated either in the standard TTP of Berger [n = 35, age 67.6 +/- 8.9 years, diabetes duration 9.9 (0.04-35.4) years, HbA1c 10.3 +/- 2.0%] or in the specialized structured geriatric DICOF-TTP [n=33, age 70.4 +/- 8.2 years, diabetes duration 10.4 (0.03-24.9) years, HbA1c 10.7 +/- 1.8%]. RESULTS: After TTP there were no differences in knowledge and ability for diabetes self-management (standard/DICOF: knowledge 11.0 +/- 2.6 vs. 12.2 +/- 2.7 points, P = 0.11; handling 14.9 +/- 3.3 vs. 15.9 +/- 2.5 points, P = 0.18). However, patients who took part in the DICOF programme showed better scores in satisfaction with the education programme [standard/DICOF 44.7 (31-57) vs. 52.5 (45-59) points, P < 0.001]. Six months later the DICOF participants showed better results regarding diabetes self-management (standard/DICOF: handling 12.5 +/- 4.1 vs. 15.9 +/- 3.1 points, P = 0.001). Both groups showed HbA1c decrease (8.3 +/- 1.4 vs. 8.5 +/- 1.3%, P=0.62) and similar incidence of acute complications. CONCLUSIONS: Elderly patients with impaired cognitive function should take part in specialized structured TTP. This leads to both better satisfaction with the education programme and an improved ability for diabetes self-management.     

Le miroir social des souffrances adolescentes : entre maladie du symbolique et aveu généralisé

The psychological suffering of adolescents is a subject that has drawn an increasing amount of attention on the part of the public authorities, local and associative bodies, and of course psychotherapists themselves. While the psychiatric treatment of adolescent disorders is based upon wide ranging nosographic categories that are specific to this age group, new and clinical forms are appearing on the scene, as if they were, an expression of new suffering. This sudden visibility on the social front regarding problematical adolescent behavior has brought with it a concomitant increase in explanations attempting to put into perspective the diversity of so-called “deviant” behavioral patterns in adolescents in relation to the development of a new malaise in contemporary civilization. The author of this study has examined this phenomenon from an anthropological point of view, and has critically examined the possible link between the modifications in the present-day social environment, and the various types of behaviour that are considered to be indicative of underlying psychic suffering. By puting the social explanations of adolescent suffering into perspective vis a vis the proposed solution, such as this multiplied counselling services, the author shows the emergence of a widespread system involving and promoting a generalized “confession” and disclosure of the intimate, in wich listening to what is been said becomes less important than the underlying constraints on expression that it imposes.     

发展民营医院的思路和建议

论述了发展民营医院的思路,针对目前发展民营医院存在的困难和问题提出了对政策调整的建议。     

Marital status and depression: a study of English national admission statistics

Data are presented from the English national statistics for first admissions with affective disorders during the years 1982-1985. Overall rates per 10(5) of the population aged over 15 years were 36.1 for men and 59.1 for women. The peak incidence for depressive neurosis was middle adulthood, that for affective psychosis much later. The widowed and divorced showed much higher rates than the single and married for all types of disorder. Marriage appeared less protective for women than for men. The age-incidence relationship among the divorced and widowed was exaggerated for depressive neurosis and reversed for psychosis. The results are interpreted in terms of a (possibly biological) releasing effect of age upon affective psychosis that could be overwhelmed by severely adverse social circumstances. The findings support the validity of the distinction between affective psychoses and depressive neurosis.     

论现阶段医疗保险个人帐户存在的必要性

[目的]探讨医疗保险个人账户是否有存在的必要性。[方法]将方案设计的初衷与实际运行相比较分析。[结果]医疗保险个人帐户约束和积累作用发挥得不理想，在一定程度上抑制了老年人和陵性病患者的医疗需要。从我国国民的心理承受力和国民素质及解决人口老龄化时支付危机等方面的考虑，笔者认为在现阶段有其存在的必要。[结论]应采取扩大覆盖对象，调整使用范围，取消退休人员个人账户，加强对供方的管理以及其它配套措施来进一步完善。