胆总管“T”形管引流少见并发症及其防治

本文报道在施行胆总管探查、T形管引流的病例中,遇到的“拔除T形管导致急性弥漫性胆汁性腹膜炎;胆汁引流量过多,食物返流入T形管;蛔虫阻塞T形管;结石阻塞T形管”等五种少见的并发症,并结合病例对其发生原因,紧急处理和预防措施进行探讨。     

孤独症谱系障碍儿童情绪行为问题与其母亲焦虑状况关联分析

目的 比较孤独症谱系障碍(ASD)儿童与典型发育(TD)儿童母亲的焦虑状况,探索ASD儿童情绪行为问题与其母亲焦虑水平间的关系。方法 通过临床诊断招募55名6~12岁智商≥70的ASD儿童及74名TD儿童,采用状态-特质焦虑问卷(STAI)评估入组儿童母亲的焦虑情况,采用长处与困难问卷(SDQ)评估两组儿童情绪行为问题及表现。结果 ASD儿童组母亲状态焦虑得分与特质焦虑得分高于TD组母亲(t=5.272、4.484、P<0.05),ASD儿童SDQ困难总分及多动/注意力缺陷、情绪症状、同伴交往问题及品行问题因子得分高于TD组儿童(t=10.791、7.482、4.295、12.925、3.544),亲社会行为因子分(t=5.084)低于TD组儿童,差异均有统计学意义(P<0.01)。校正混杂因素后,ASD组母亲状态、特质焦虑得分与儿童困难总分 [S-AI: β=0.83 (95%CI: 0.19~1.46); T-AI: β=0.60 (95%CI: 0.05~1.14)]、情绪症状 [S-AI: β=2.28 (95%CI:0.72~3.84); T-AI: β=2.04 (95%CI: 0.74~3.33)]存在正相关关系(P<0.05)。TD组母亲状态焦虑得分与儿童困难总分 [β=0.50 (95%CI: 0.03~0.96)]、品行问题 [β=1.74 (95%CI: 0.19~3.30)]存在正相关关系;特质焦虑得分与品行问题 [β=1.54 (95%CI: 0.09~3.00)]存在正相关关系(P<0.05)。结论 ASD儿童母亲比TD儿童母亲更容易出现焦虑。其中ASD儿童母亲的焦虑水平与儿童情绪问题有关,TD儿童母亲的焦虑水平与儿童品行问题有关。     

照养人教养方式与儿童睡眠问题的相关性分析

目的 探索教养方式与儿童睡眠问题的相关性,为基于教养方式的睡眠干预提供依据。方法 于2019年12月—2020年1月,采用整群方便取样,在北京、上海和成都三市抽取6所公办幼儿园与2所公办小学进行调查,由家长通过在线系统填写儿童睡眠习惯问卷(CSHQ),教养方式类型,以及社会人口学和家庭情况问卷,通过协方差分析和二元Logistic回归分析探索教养方式与儿童睡眠问题的关系。结果 共抽取3 861名儿童,平均年龄(5.57±2.28)岁,男、女童分别为2 007名(52.0%)、1 854名(48.0%)。溺爱型、适中型和严格型教养方式分别占4.6%、86.6%和8.8%。溺爱型教养的儿童CSHQ总分(F=44.77,P<0.001)和各维度分均高于严格型和适中型,睡眠问题更严重。相比适中型,溺爱型教养是儿童总体睡眠问题的危险因素(OR=3.62,95%CI:1.88～6.96),尤其是就寝抵抗(OR＝3.80,95%CI:2.51～5.75)。结论 教养方式与儿童睡眠问题密切相关,而溺爱型教养是儿童睡眠问题的危险因素,未来应加强教养方式的科普宣教和行为干预。     

The Influence of Omega-3 Long-Chain Polyunsaturated Fatty Acid,Docosahexaenoic Acid,on Child Behavioral Functioning: A Review of Randomized Controlled Trials of DHA Supplementation in Pregnancy,the Neonatal Period and Infancy

This is a review of randomized controlled trials using docosahexaenoic acid (DHA) interventions in the first 1000 days of life with assessments of behavioral functioning in childhood. Electronic databases were searched for trials with a DHA intervention (compared with a placebo group that received no or less DHA) at any time to either women or infants during the first 1000 days, with a subsequent assessment of child behavior. There were 25 trials involving 10,320 mother–child pairs, and 71 assessments of behavior in 6867 of the children (66.5% of those originally enrolled). From the 71 assessments administered, there were 401 comparisons between a DHA group and a control group, with most reporting a null effect. There were no findings of a positive effect of DHA, and 23 instances where the DHA group had worse scores compared with the control group. There was limited evidence that DHA supplementation had any effect on behavioral development, although two of the largest trials with behavioral measures detected adverse effects. Future trials, and future follow-ups of existing trials, should make an effort to evaluate the effect of DHA intervention on behavioral functioning.     

‘No‐one has listened to anything I’ve got to say before’: Co‐design with people who are sleeping rough

BackgroundDespite policies and programmes aimed at housing people who are homeless, there are still people who live and sleep rough. This project used the skills and knowledge of people in this situation to identify a strategy to mitigate some of the risks.ObjectiveTo describe the development and conduct of a co‐design project involving people who are homeless.Setting/Group MembersA Working Group of 11 was formed following a careful recruitment process from people who had volunteered after consultation by the project team. The co‐design approach was guided by a set of principles.MethodsEight members of the Working Group were interviewed by an external researcher (RM). The approach was primarily deductive, with the principles adopted by the project team used as a framework for data collection and analysis. The co‐design process was captured by the project leaders (BK, PC) supplemented with documentation review and team discussions.ResultsThe group met weekly for 12 weeks, with 8‐10 members present on average. They reviewed information from the survey, contributed ideas for solutions and ultimately decided to provide information via print, a website and an event. Important factors in on‐going involvement were carefully selecting group members and making participation rewarding for them.Discussion/ConclusionsVulnerable people such as those experiencing homelessness can be excluded from decision‐making processes affecting them, as they can be perceived as hard to reach and unable to make a meaningful contribution. This project demonstrated that a carefully managed project, with sufficient resources and commitment, it was possible to involve people who are homeless and maintain involvement over an extended time period.Public ContributionThe Working Group reviewed survey findings and developed an intervention to minimize the health, social and legal harms of sleeping rough. Several members reviewe this paper.     

健康管理背景下慢性病社会问题

我国社会进程的急速变迁使得居民的疾病模式以及健康行为均发生了较大的转变,各种疾病的危险因素不断增加导致慢性病发病率不断上升,同时也使得慢性病危险度有所增加,目前我国慢性病发病出现了逐渐年轻化趋势,疾病对患者的危害也在不断加剧,不仅影响患者的生理、心理健康,还会导致其生活质量下降,同时还可能加重患者的家庭负担和社会负担,因此开展慢性病相关研究具有十分重要的现实意义和理论意义。该文以健康管理为背景,对慢性病健康管理构建中的社会问题和文化意义进行了梳理,以明确健康管理在社会经济发展以及人生进程中的作用和意义,以加强民众对慢性病防治的了解,提升慢性病管理质量,改善慢性病患者的病情和生活质量,同时也为慢性病防治提供新种学术依据。     

学龄前儿童居家隔离期间睡眠问题及影响因素分析

目的 分析学龄前儿童居家隔离期间的睡眠问题及影响因素,为降低因突发性公共卫生事件而居家隔离和限制活动对儿童健康的影响提供科学依据。方法 2020年3月15-28日对16 094名3~6岁儿童进行在线调查。由家长填写一般资料、标准中文版儿童睡眠习惯问卷(CSHQ)以及长处和困难问卷(SDQ),收集儿童睡眠及情绪/行为相关数据。结果 学龄前儿童睡眠问题的发生率为76.8%(CSHQ总分＞41),与年龄、家长受教育程度及家庭类型等人口社会学因素显著相关(χ²=66.98、36.51、11.01, P＜0.05)。控制人口社会学因素后,情绪/行为问题越严重的儿童,睡眠问题的发生风险越高。结论 疫情期间学龄前儿童睡眠问题普遍存在,与儿童情绪/行为问题相关,应当进行综合干预,从而将因疫情而居家隔离和限制活动对儿童健康的影响降至最低。     

儿童常见发育异常性疾病的情绪行为与社交功能问题

孤独症谱系障碍(ASD)、注意缺陷多动障碍(ADHD)和语言障碍(LD)等神经发育障碍性疾病是儿童常见的发育异常性疾病,常伴心理行为与社交功能问题,早期识别、诊断和早期针对性的干预措施,对改善其预后具有重要意义。本文就儿童常见发育异常性疾病的心理行为与社交功能进行介绍,供相关专业人员参考。     

儿童心理问题的家庭治疗原则与策略

儿童心理问题的常规治疗包括心理治疗和药物治疗,但是两者具有一定的局限性和社会不适性。家庭对儿童的成长具有重大影响,也是儿童出现心理问题的重要源头,所以家庭的介入对于心理问题儿童的治疗非常关键。家庭治疗的主要原则包括培养儿童的独立性、解决儿童与外界之间的冲突以及重视家庭成员间的和谐关系。家庭治疗所采取的策略主要是转变家庭内部态度、重视家庭的整体性、心理治疗和家庭治疗的互相配合以及对医学诊断的重视。在专业医学诊断指导下,通过家庭介入传统的心理治疗,从而更好地改善儿童所面临的心理问题。本文回顾了现有的儿童心理问题的研究成果,强调了家庭对儿童心理问题的影响,总结了儿童心理问题的家庭治疗原则和策略。     

Mirizzi综合征18例外科治疗体会

目的：提高临床上对Mirizzi综合征的认识,避免胆道损伤。方法：对经手术证实的18例Mirizzi综合征的临床资料进行回顾性分析。结果：术前明确诊断者仅3例。行单纯胆囊切除11例,胆囊切除、胆管壁瘘口修补3例,胆囊切除、瘘口修补、T型管引流3例,胆囊切除、肝总管空肠Roux-en-y吻合术1例。随访11例平均时间5年,无胆道狭窄情况。结论：为避免胆道损伤,应结合病史、体检、化验及影像学检查进行全面综合分析,以提高术前确诊率,在手术时要认真对待,根据术中情况选择合理术式。