Relation of Family History of Cancer and Environmental Factors to the Risk of Colorectal Cancer: A Case-control Study

The relation of a family history of cancer and environmentalfactors to colorectal cancer was investigated in a case-controlstudy conducted from 1992 to 1994 at 10 medical institutionsin Japan using a self-administered questionnaire, and 363 casesof colorectal cancer were compared with 363 controls matchedfor sex and age. A family history of colorectal cancer was positivelyassociated with colon cancer (odds ratio (OR)=2.0, 95% confidenceinterval(Cl)1.03–3.87) and rectal cancer (OR=2.1 Cl 0.94–4.48),but a family history of other cancers did not increase the risk.The proportion of patients with a family history of colorectalcancer within first-degree relatives was 12.4% — appreciablyhigher than figures previously reported in Japan. On the otherhand, the incidence of hereditary non-polyposis colorectal cancerwas 1.4%, and lower than previous estimates. Among dietary factors,a western-style diet significantly increased the risk of bothcolon and rectal cancer (OR = 2.3 Cl 1.30–3.88 and OR=2.1Cl 1.26–3.63, respectively). Consumption of rice was protectiveagainst both colon and rectal cancer(OR=0.5 Cl 0.31–0.82and OR = 0.3 Cl 0.18–0.65, respectively). Animal meat,oily food, fish, vegetables and fruit were shown to affect therisk, but no statistically significant correlation was found.Among other factors, constipation increased the risk of coloncancer (OR= 2.0 Cl 1.02–3.76) and consumption of coffeeraised the risk of rectal cancer (OR =1.7 Cl 1.07–2.82).Our findings suggest that a family history of colorectal canceris an important risk factor for this disease, and does not contradictthe hypothesis that the risk of colorectal cancer in Japan maybe influenced by westernization of lifestyle. However, we wereunable to find conclusive evidence that familial clusteringof this disease is strongly affected by environmental factorsor genetic diseases such as hereditary non-polyposis colorectalcancer.     

苏州市儿童医院A组轮状病毒胃肠炎流行病学及其疾病负担监测和评价

目的：为确定是否施行轮状病毒免疫计划提供基础资料。方法：选择苏州市儿童医院为哨点监测医院，应用卫生经济学方法、酶联免疫吸附试验和巢式聚合酶链式反应等进行A组轮状病毒胃肠炎的疾病负担监测和评价。结果：有46.047%的胃肠炎患儿受到A组轮状病毒的感染；5岁以下A组轮状病毒胃肠炎住院患儿所花费的平均医疗费用占家庭平均月收入的69.177%，直接费用和间接费用分别占总费用的85.387%和14.613%；A组轮状病毒流行株以G3型为主，其次为G1型。结论：A组轮状病毒胃肠炎带来的疾病负担比较大，应该考虑如何减少轮状病毒胃肠炎的发生。     

抑郁障碍青少年病前家庭功能的研究

目的了解抑郁障碍青少年发病前的家庭功能特征。方法运用Darlington家庭评估法（DFAS）调查抑郁障碍青少年（61例）发病前的家庭功能，并与正常青少年（57名）家庭对照比较。结果抑郁障碍青少年发病前，59％的家庭中其成员间亲密度有问题、64％的家庭存在家庭权力问题、69％的家庭的情感氛围有问题，与对照组家庭（分别为11％、25％、12％）相比，差异有统计学意义（P〈0．01）。结论抑郁障碍青少年发病前其家庭功能已经长期异常，与青少年抑郁的发生有关。     

家庭情感表达方式对神经症的发生、复发相关性分析

目的 探讨家庭情感表达方式对神经症患者疾病的发生、复发及其相关因素。方法 比较两组家属与患者的关系、性别、文化程度、每周与患者的接触时间、年收入、城乡等，同时又比较两组CFI-CV的各项因子。结果 研究组在情感过分参入总分及其因子过激情感、过分奉献牺牲、过分保护及缺乏客观性均高于正常对照组；高情感表达家庭、家属在急性期对治疗的态度、过度保护、患者年龄等与复发相关。结论 家庭情感表达方式对神经症的迁延和复发均具有重要的影响。     

ICU病员家属的沟通技巧

目的：加强ICU医务人员与病员家属进行有效沟通，减少医疗纠纷，方法：对120例病员家属进行问卷调查，分型，并针对不同类型进行沟通。结果：提高了病员及家属的满意度，减少了医疗纠纷的发生，结论：在ICU病房加强医护人员与病员家属的沟通，对于促进护患，医患合作，减少医疗纠纷的发生，促进病员早日康复，具有重要意义。     

Caring for an elderly person: Presictors of burden in dementia care

In a population-based study, the burden of caring for an elderly relative was investigated. In this article the nature of burden, reported by the relatives of the elderly, is described according to Pearlin's conceptual model. Background factors and context as a well as primary stressors were analysed. The close relatives were interviewed with a structured burden questionnaire. Among the background variables, gender of the caregiver was strongly associated with a heavy burden. Behaviour disturbances also emerged as a predictive factor of burden. Analysis of the primary stressors indicated that in the mild phase of dementia, long duration of the disease and decreased ADL capacity cause greater burden for the caregiver.     

Dynamic process of family burden in dementia caregiving: a new field for psychotherapeutic interventions

Families caring for a patient with dementia are prone to significant physical, psychological and social stress. It is now well established that the caregiver burden does not only negatively affect the caregiver's physical and mental health, but is also associated with an increase in behavioural and psychiatric symptoms of dementia. Burden determinants include the quality of the relationship between the patient and caregiver; patient variables, such as the need to manage the behavioural and psychological symptoms of dementia; and also caregiver variables, such as the satisfaction of caring, demographic characteristics and societal roles. The standardised assessment of interventions for caregivers in dementia care remains a difficult task. In recent years, family interventions that focus on the process of burden itself in relation to the caregiver's subjective experience of personal growth and enrichment have been proposed. This new approach is based on the identification of tasks and challenges faced by family members throughout the different stages of the disease. In this context, brief crisis interventions transform periods of disorganisation experienced by the family into opportunities for change, whereas rehabilitation interventions developed by professional caring networks offer a continuous assessment and advice to the family. This article provides a critical review of the consequences and determinants of caregiver burden in dementia care with special reference to the emerging notion of the caregiver's subjective experience in the context of family processes.     

Utilidad y fiabilidad de la ecografía clínica abdominal en medicina familiar (2): grandes vasos,bazo, nefrourológica y ginecológica

This article is a continuation of the review initiated in the previous issue about the usefulness of point of care ultrasound in Primary Care, completing the scenarios of large abdominal vessels, spleen, nephrourological and gynecological ultrasound.     

Utilidad y fiabilidad de la ecografía clínica abdominal en medicina familiar (1): hígado,vías biliares y páncreas

Ultrasound is a safe and reliable way to increase diagnosis capabilities, as well as an improving and speed up method for taking decisions for healthcare professionals of every medical specialty. Family doctor, who must be ready to address all kind of health problems for his patients, is the key person to incorporate this tool to his daily activity, acquiring the best managing skill, unknown nowadays, being quite large the clinical situations in the day by day practice, in which he can obtain benefit in a reliable and effective way.Due to this practice is explorer dependent, it's needed to assure the best competence of the professional who practice it, and define the benefits and potential risks its use can create, as well as its application scenarios, in order to avoid unnecessary explorations and minimize opportunity costs that this activity can add to a currently saturated agenda. This work pretends to summarize the current state of abdominal point of care ultrasound, and its utility for the family doctor, in those scenarios that can be potentially reliable and effective.