重症患者巨细胞病毒活动性感染与Th1/Th2型细胞因子的研究进展

重症患者巨细胞病毒(CMV)感染率极高,并且CMV感染后多呈潜伏性感染,同时感染CMV的重症患者往往缺乏典型的临床表现。但是当CMV再激活,即CMV活动性感染,此时可严重影响重症患者病情转归,导致多种不良预后的发生。究其机制为,CMV可通过影响辅助性T淋巴细胞1型和2型细胞(Th1/Th2)的功能,即通过调控Th1/Th2产生的细胞因子的数量及比例,来改变机体免疫状态,使CMV难以清除及易于再激活。因此Th1/Th2细胞因子的表达对CMV的再激活、复制和散播有着极其重要的作用及意义。本文就重症患者CMV活动性感染与Th1/Th2型细胞因子相互作用机制的研究进展作一综述。     

Time Trends of Physical Activity Among Brazilian Adolescents Over a 7-Year Period

PurposeTo evaluate time trends in physical activity among adolescents aged 10 to 19 years living in southern Brazil over a 7-year period.MethodsTwo population-based cross-sectional surveys with similar methodologies were carried out in the city of Pelotas, Brazil, in 2005 and 2012. Leisure-time and transport-related physical activity were measured using a validated questionnaire. A cut-off point of 300 minutes per week was used to classify adolescents as active or not. We also analyzed the two domains of physical activity (leisure time and transportation) separately.ResultsThe prevalence of physical inactivity was 69.6% (95% CI 66.5–73.2) in 2005 and 69.9% (95% CI 66.5–72.7) in 2012. The percentage of active adolescents in leisure time also remained stable in the period (26.3% in 2005 [95% CI 23.3–29.2] vs. 28.1% in 2012 [95% CI 24.9–31.4]). Among boys, we observed an increase in the practice of some leisure-time activities—weight lifting (87%) and running (78%)—and a decline in others—volleyball (61%) and basketball (56%). Among girls, the only significant difference was an increase in the practice of weight lifting (271%). The prevalence of active commuting to and from school declined from 69% (95% CI 65.6–72.4) in 2005 to 56.5% (95% CI 52.5–60.2) in 2012.ConclusionsThere was a significant decline in active commuting to school among adolescents. Interventions promoting active commuting modes to school are urgently needed in Brazil.     

Impact of physical therapists’ instructions on function and the perception of post-dry needling soreness in mechanical cervical pain; a randomized clinical trial

BackgroundTo investigate the impact of physical therapists’ instructions on the perception of post dry needling (DN) soreness and function in patients with mechanical neck pain.MethodsSeventy-five patients with neck pain were randomly assigned to three groups: “positive” group (n = 25) received positive verbal input; “negative” group (n = 25) received negative verbal input, and control group (n = 25) did not receive any input about post-needling soreness. All three groups received DN of a trigger point in the upper trapezius muscle. The subjective pain experience, pressure pain threshold (PPT), and neck disability Index (NDI) were assessed before and after DN.ResultsPatients in all groups showed improvement in pain, PPT and NDI. There were no significant differences in pain (P = 0.41) and PPT (P = 0.68) in the positive and negative groups compared with the control group. Significant difference in function was seen with the NDI after DN of patients in the positive and negative groups compared with the control group (P = 0.011, standard error: 1.08–1.5).ConclusionConsidering that the power of our study may be too low to draw more definitive conclusions, DN appears to be an effective technique to improve pain and mechanical hyperalgesia. The experience of post-needling soreness does not appear to influence the outcome of DN on pain, PPT, and NDI. Post-needling soreness does not seem to be a limiting factor in achieving acceptable outcomes, especially when clinicians offer DN within a therapeutic emphasizing a positive patient response. This study questions whether any treatments need to be offered to patients receiving DN.     

The WHO active ageing pillars and its association with survival: Findings from a population-based study in Spain

BackgroundThe World Health Organization’s active ageing model is based on the optimisation of four key “pillars”: health, lifelong learning, participation and security. It provides older people with a policy framework to develop their potential for well-being, which in turn, may facilitate longevity. We sought to assess the effect of active ageing on longer life expectancy by: i) operationalising the WHO active ageing framework, ii) testing the validity of the factors obtained by analysing the relationships between the pillars, and iii) exploring the impact of active ageing on survival through the health pillar.MethodsBased on data from a sample of 801 community-dwelling older adults, we operationalised the active ageing model by taking each pillar as an individual construct using principal component analysis. The interrelationship between components and their association with survival was analysed using multiple regression models.ResultsA three-factor structure was obtained for each pillar, except for lifelong learning with a single component. After adjustment for age, gender and marital status, survival was only significantly associated with the physical component of health (HR = 0.66; 95% CI = 0.47−0.93; p = 0.018). In turn, this component was loaded with representative variables of comorbidity and functionality, cognitive status and lifestyles, and correlated with components of lifelong learning, social activities and institutional support.ConclusionAccording to how the variables clustered into the components and how the components intertwined, results suggest that the variables loading on the biomedical component of the health pillar (e.g. cognitive function, health conditions or pain), may play a part on survival chances.     

Training Clinical Psychology Students in Aging

Many conference reports have urged various strategies to increase the numbers of mental health service providers to the aged. The effectiveness of two strategies-specialized training and the infusion of gerontological content into regular professional curricula-were addressed in a program evaluation. Two groups of clinical psychology doctoral trainees were assessed on knowledge, attitudes, and akills. One group was in a special clinical-aging track; the other had different primary interests but-by virtue of being in the same graduate program-encountered gerontological content. The results support the suggestion that exposure to aging indirectly can contribute to increased knowledge and sophistication.     

中医科主动服务模式构建探讨

本研究从患者主观观念转变、诊疗价格下降和中西医结合诊疗理念的发展3个方面，介绍了在中医科构建主动服务模式的可行性，重点从分配中医科医生的服务科室和建立服务制度两个方面论述了主动服务模式的构建方法，并对主动服务模式未来工作的开展提出了可行的建议。