Intensive referral to mutual-help groups: A field trial of adaptations for rural veterans

Objective

A multisite field trial testing whether improved outcomes associated with intensive referral to mutual help groups (MHGs) could be maintained after the intervention was adapted for the circumstances and needs of rural veterans in treatment for substance use disorder (SUD).

Echocardiographic features of progressive systemic sclerosis (PSS). Correlation with hemodynamic and postmortem studies.

Echocardiographic abnormalities were noted in 37 (69 per cent) of 54 patients with progressive systemic sclerosis (PSS). Thirty-one of the 54 patients also underwent right heart catheterization. Eight of the 11 patients who died underwent postmortem examination. Pericardial effusion was noted in 22 subjects (41 per cent), although it was suspected on clinical grounds in only seven. Echocardiography appeared to be an excellent tool for evaluating and quantitating pericardial effusions. The presence of a small pericardial effusion (<50 ml) did not affect prognosis, but the presence of a large effusion (>200 ml) was associated with a poor prognosis. The finding on echocardiogram of right ventricular dilatation, left atrial dilatation, asymmetrical septal hypertrophy, paradoxic motion of the interventricular septum or signs of pulmonary hypertension were seen predominantly or exclusively in patients who had pulmonary artery hypertension at cardiac catheterization. Pericardial effusions and abnormal mitral valve diastolic slope on echocardiogram did not correlate with pulmonary hypertension.The present study confirms clinically the frequent involvement of myocardium and pericardium that has been reported in autopsy series. At the same time, however, it suggests that the usefulness of the echocardiogram in clinical practice may really be limited to evaluating pericardial effusion and cardiomegaly, and to substantiating pulmonary artery hypertension in a safe, noninvasive manner.     

Suicide risk in Iraq and Afghanistan veterans with mental health problems in VA care

Suicide rates among U.S. military personnel and veterans are a public health concern, and those with mental health conditions are at particular risk. We examined demographic, military, temporal, and diagnostic associations with suicidality in veterans. We conducted a population-based, retrospective cohort study of all Iraq and Afghanistan war veterans who screened positive for posttraumatic stress disorder (PTSD) and/or depression, received a suicide risk assessment, and endorsed hopelessness about the present or future after their last deployment and between January 1, 2010 and June 29, 2014 (N = 45,741). We used bivariate and multivariate logistic regression analyses to examine variables associated with having endorsed suicidal thoughts and a plan. Multiple factors were associated with suicidality outcomes, including longer time from last deployment to screening (proxy for time to seeking VA care), an alcohol use disorder diagnosis, further distance from VA (rurality), and being active duty during military service. Hispanic veterans were at decreased risk of having suicidal ideation and a plan, compared to their white counterparts. In high-risk veterans, some of the strongest associations with suicidality were with modifiable risk factors, including time to VA care and alcohol use disorder diagnoses. Promising avenues for suicide prevention efforts can include early engagement/intervention strategies with a focus on amelioration of high-risk drinking.     

健康托管对机关代谢综合征高危人群行为与相关指标的影响

目的 探讨对机关代谢综合征高危人群实施健康托管的效果.方法 对148名符合代谢综合征高危人群诊断标准的机关干部实施一对一健康托管,并提供网络平台实现自我管理,1年后对健康行为及体质量、腰围、血压等指标进行评价.结果 健康托管后机关代谢综合征高危人群的运动行为明显加强,收缩压、三酰甘油、总胆固醇、高密度脂蛋白、低密度脂蛋白、空腹血糖及血尿酸显著改善,差异有统计学意义(均P＜0.01).结论 对机关代谢综合征高危人群实施健康托管,在疾病早期进行综合干预,可使高危人群形成良好的健康行为,降低代谢综合征风险.     

2010年某铁路局45岁以上职工体检结果分析

目的解铁路干部职工健康状况,使健康教育与健康促进工作更有针对性和实效性。方法对2010-07/10进行健康体检的44 829名45～60岁在职职工体检结果进行分析。结果 44 829名职工中各项体检项目均正常者占18.73%,异常检出占81.27%;异常检出率占前5位的依次为血脂增高、脂肪肝、前列腺增生、血糖增高、血尿酸增高,检出率分别为23.71%、21.92%、21.13%、19.86%和19.67%。男性与女性相比脂肪肝、血尿酸增高的检出率差异有统计学意义(P0.05,P0.01);脂肪肝、血糖增高、血压增高、男性前列腺增生检出率随着年龄的增长而增加。结论铁路45岁以上职工体检异常率明显增高,应针对性地开展健康教育工作,通过行为干预来预防和控制慢性非传染性疾病的发生和发展。     

谢立科主任治疗眼眶炎性假瘤经验撷菁

眼眶炎性假瘤是一种常见的眼眶疾病,病因不明,临床表现多样,西医多采用皮质类固醇等抗炎治疗,较易复发,预后较差。谢立科主任在临床中着重以中西医结合治疗,效果较佳,本文就谢师对其病因、分型、表现、鉴别、治疗、愈后护理等方面进行探析。     

军队疗养不同分级高血压病心理健康状况分析

目的分析军队退休干部高血压病及其不同分级者的心理健康状况。方法采用症状自评量表(SCL-90)对来院疗养的194名军队退休干部高血压病患者进行专业心理测评。结果①疗养的军队退休干部高血压病者与住院老干部高血压病者的心理健康差异显著,阳性项目数(t=9.892,P=0.000)及躯体化(t=9.180,P=0.000)、强迫症状(t=7.378,P=0.000)、人际关系敏感(t=7.999,P=0.000)、抑郁(t=10.328,P=0.000)、焦虑(t=11.972,P=0.000)、敌对(t=6.841,P=0.000)、恐怖(t=5.647,P=0.000)、偏执(t=7.842,P=0.000)、精神病性因子(t=7.668,P=0.000)得分均低于住院老干部。②高血压病1、2、3级组间比较SCL-90阳性项目数(F=2.87,P0.05)及强迫症状(F=1.60,P0.05)、人际关系敏感(F=1.24,P0.05)、抑郁(F=0.84,P0.05)、焦虑(F=1.97,P0.05)、敌对(F=2.32,P0.05)、恐怖(F=1.42,P0.05)、精神病性因子(F=2.21,P0.05)差异无统计学意义;而躯体化(F=4.29,P0.05)及偏执(F=3.72,P0.05)差异有统计学意义。结论疗养的军队退休干部高血压病者的心理健康水平较高,高血压分级对其心理健康状况影响不大。     

自然疗养因子对军队高血压疗养患者的影响

目的观察昆明安宁疗养地多种自然疗养因子对军队高血压疗养患者的治疗作用。方法对成都军区昆明疗养院疗养的278例军队高血压疗养患者,根据其不同的高血压分期自愿分成单纯疗养组和自然疗养因子组,检测疗养前后血压,并对疗养前后、不同疗养组及不同高血压分期进行对比。结果经过疗养,两组高血压患者血压均有下降,且差异具有统计学意义（P〈0．05）;自然疗养因子疗养组血压下降程度较单纯疗养组大;Ⅰ期和Ⅱ期高血压患者血压下降程度较Ⅲ期高血压患者大。结论自然疗养因子的疗养方式较单纯疗养降压效果更显著,对Ⅰ期和Ⅱ期高血压具有更好的预防和治疗作用。     

干部门诊老年病人焦虑状况的相关性研究

[目的]了解干部门诊老年病人的焦虑状况及其影响因素。[方法]采用Zung焦虑自评量表，对门诊971例老年病人进行问卷调查，分析不同性别、年龄、文化程度、对医护服务满意度及疾病了解程度对病人焦虑水平的影响。[结果]干部门诊就诊的老年病人的焦虑水平高于常模（P〈0．05），不同性别、年龄、文化程度、对医护服务满意程度及对疾病了解程度明显影响病人焦虑水平。[结论]干部门诊就诊的老年病人焦虑水平高于正常人，女性、年龄偏大、文化程度越高、对服务满意度越差、对疾病的知识了解越少，焦虑症状越重。     

Pharmacokinetic differences between peripheral and central drug administration during cardiopulmonary resuscitation

Advanced resuscitation techniques are dependent on drug therapy to increase survival. Because drugs must reach their site of action instantaneously, the choice of appropriate route of administration may be critical. To study the pharmacokinetics of drug administration by peripheral and central venous routes during resuscitation, nine mongrel dogs were studied. Arterial blood pressure and electrocardiograms were monitored continuously. Cardiac output was evaluated before resuscitation to determine control levels. After thoracotomy and fibrillation of the heart, cardiac massage was started with a frequency of compression maintained at 60/min. Bolus injections of two different radioisotopes were given simultaneously through a peripheral and a central vein. Isotope activity was sampled through a catheter in the right femoral artery at 5 second intervals for 90 seconds and at 30 second intervals for 210 seconds. The major differences between the two routes of administration were that central injection produced a 270% higher peak concentration (p less than 0.001) and significantly shorter lag times to the first appearance of tracer (16 +/- 7 versus 38 +/- 13 seconds, p less than 0.05) and times to peak concentration (13 +/- 5 versus 27 +/- 12 seconds, p less than 0.01). In contrast, there were no significant differences in area under the time-counts curve, mean residence time, total body clearance and steady state volume of distribution. The central compartment volume of distribution was significantly smaller after central than after peripheral injection (26.1 +/- 56 versus 76.3 +/- 16.5 ml, p less than 0.01). The therapeutic implications of these findings must be investigated for individual drugs used during cardiorespiratory resuscitation to determine the most appropriate route and dosage for each agent.