高龄产妇妊娠分娩结局的临床现状研究

介绍高龄产妇妊娠分娩结局的临床现状研究，探讨其可研究的方向。本文通过横向比较多篇研究高龄产妇妊娠分娩结局的文献进行综述。近年来，高龄产妇数量不断增加，并已成为全球的趋势。高龄产妇不良妊娠分娩结局较多，包括妊娠高血压、妊娠糖尿病、胎盘早剥、围产期死亡、早产、胎儿巨体症和胎儿生长受限等；与产妇高龄无关的妊娠分娩结局有冠心病、子女的长期发病率等；医学界普遍鼓励妇女早育。     

The risk of fractures,acute myocardial infarction,atrial fibrillation and ventricular arrhythmia in geriatric patients exposed to promethazine

ABSTRACT

Objectives: This study aimed to compare the risk of fractures, acute myocardial infarction, atrial fibrillation, and ventricular arrhythmia among Danish citizens aged ≥ 65 which were new users of promethazine or domperidone, triazolam, loratadine, and betahistine. Secondly, the study aimed to perform a risk stratification to identify the most relevant predictors for the study outcomes.

Methods: The study period was 01/01/2015 to 31/12/2016. The data sources were the Danish registers. Each patient was followed for 90 days. A logistic regression model was used to compute the unadjusted and adjusted odds ratios (OR), and a conditional inference tree was used to identify the most relevant predictors for the study outcomes.

Results: Promethazine had a higher risk of hospitalization for atrial fibrillation than loratadine and betahistine (OR 1.58; 95% CI 1.07–2.63 and OR 3.22; 95% CI 1.69–7.14, respectively). For fractures, acute myocardial infarction, and ventricular arrhythmia hospitalizations, no statistically significant differences were found among drugs under investigation. The medical history of cardiac arrhythmia (OR 4.14; 95% CI 2.94–5.78, p < 0.0001) was the most relevant predictor for atrial fibrillation hospitalizations.

Conclusion: This study found an increased risk of atrial fibrillation hospitalization among promethazine users, and the risk was higher among patients with prior cardiac arrhythmia.     

反复粪便培养金黄色葡萄球菌阳性老年患者口服万古霉素效果评价

目的 通过探讨肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者口服万古霉素的效果，为此类患者提供一种潜在的治疗方案。方法 前瞻性分析吉林大学第一医院干部病房2015 年9 月～2018 年12 月收治的186 例肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者。根据是否口服万古霉素治疗分为万古组和对照组。收集两组患者的一般临床资料，比较两组患者试验前后万古霉素血药浓度、血常规、降钙素原（PCT）、C 反应蛋白（CRP），试验期间粪便培养结果、体温、抗生素使用情况。结果 试验治疗期间，万古组便培养转阴率高于对照组，差异有统计学意义（P＜0.05）；万古组发热率（29.75%）低于对照组的34.77%，差异有高度统计学意义（P＜0.01）；万古组抗生素使用率（4.49%）低于对照组的19.23%，差异有高度统计学意义（P＜0.01）。试验前两组白细胞、中性粒细胞计数、中性粒细胞比例、PCT、CRP 比较，差异无统计学意义（P＞0.05）；试验后万古组白细胞、中性粒细胞计数、中性粒细胞比例、CRP 低于对照组，差异有高度统计学意义（P＜0.01）。试验后万古组白细胞、中性粒细胞计数、中性粒细胞比例、CRP 低于试验前，差异有高度统计学意义（P＜0.01）。结论 口服万古霉素可能提高肠道非急性感染期反复粪便培养金黄色葡萄球菌阳性的老年患者粪便转阴率，减少发热及抗生素的应用，降低炎症细胞水平，可能是此类患者一种潜在的临床治疗方案。     

高龄直肠癌患者腹会阴联合切除术后会阴切口并发症发生的相关危险因素

探讨高龄直肠癌患者腹会阴联合切除术(APR)后会阴切口并发症发生的相关危险因素。方法采用回顾性病例对照研究的方法,分析中国医学科学院肿瘤医院结直肠外科2007年1月至2018年9月行APR的72例高龄(≥80岁)直肠癌患者的临床病理资料。采用单因素和多因素分析确定影响高龄直肠癌患者APR后会阴切口并发症发生的危险因素。结果72例患者中,男47例,女25例,年龄为(81.8±1.8)岁。术后会阴切口并发症发生率为23.6%(17/72),其中切口感染5例,切口脂肪液化4例,切口延迟愈合8例。所有患者均顺利出院,无围手术期死亡病例。单因素分析显示,术前血清白蛋白<35 g/L、术中置入氟尿嘧啶缓释剂/洛铂冲洗液、盆底修复、糖尿病和冠心病与高龄患者APR术后会阴切口并发症的发生均有关(均P<0.05)。多因素分析显示,未行盆底修复(OR=0.17,95%CI为0.04~0.82;P=0.027)和糖尿病(OR=4.32,95%CI为1.05~17.81;P=0.043)为高龄直肠癌患者APR后会阴切口发生的独立危险因素。结论行APR的高龄直肠癌患者应尽可能保留盆底腹膜,并予以关闭。围手术期血糖监测也是预防会阴切口并发症发生的有力保障。     

新型冠状病毒肺炎疫情期间肿瘤患者的健康教育管理

2019年12月，新型冠状病毒肺炎疫情在湖北武汉发生，并迅速向全国蔓延。新型冠状病毒肺炎疫情发生后，打破了很多患者原有的治疗计划，患者健康教育也受到了较大影响。在这样的特殊形势下，应提倡减少外出、避免人群聚集，缩短患者在院停留时间，因此如何做好肿瘤患者的健康教育成为了一个紧迫的问题。针对新型冠状病毒肺炎对肿瘤患者的影响，肿瘤患者健康教育的需求及重要性，疫情期间如何针对肿瘤患者采取更加合理的方式做好健康教育等问题，本文进行了简要的阐述。希望能够引发肿瘤健康教育工作者对新型冠状病毒肺炎疫情下如何实施肿瘤患者健康教育的思考，最大程度上降低疫情带来的不良影响，保证肿瘤患者健康教育的科学性、连贯性。     

The curvilinear relationship of early-life adversity and successful aging: the mediating role of mental health

Objectives: The steeling effect suggests that early-life adversity can have a beneficial impact later in life. However, little is known about its underlying mechanisms and long-term outcomes . The study aimed to examine the role of early-life adversity (ELA) on successful aging, and whether this relationship can be explained by mental and physical health.

Method: Socio-demographics, early-life adversity (ELA), individual quality of life (iQoL), and mental and physical health of 270 individuals (M_age = 66.82 years, 71.5% female) were assessed. Polynomial regressions and mediation analyses were conducted.

Results: Significant inverse U-shaped associations were found between ELA and iQoL (β = ?.59, p = .005) and between ELA and mental health (β = ?.64, p = .002), but not between ELA and physical health. Furthermore, mental health significantly mediated the relationship between ELA and iQoL (b = ?.84, BCa CI [?1.66, ?.27]).

Conclusion: Highest level of individual quality of life (i.e. successful aging) was related to a moderate amount of ELA. Additionally, mental health significantly mediated this relationship. These findings suggest that some amount of ELA could be beneficial for successful aging. Resource-focused interventions are needed to improve health and promote successful aging for an underdetected, at-risk subgroup with low early-life adversity.     

Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease

Objective

The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.

L’éducation thérapeutique de patients souffrant de schizophrénie ayant commis ou pouvant commettre un ou des passage(s) à l’acte dangereux

Schizophrenia is a chronic mental pathology with polymorphous symptoms that have an invalidating impact on an emotional, interpersonal, behavioural and social level. In certain cases this pathology can increase the risk of self-harm or harm to others, making it necessary to put protocoles in place for specifically-adapted treatment, put forward notably by care units that deal with dangerous patients. The patient's therapeutic education, orientated towards acquiring knowledge about the illness and skills for dealing with it in day-to-day life, is now a recognised practice, having proven its effectiveness in the treatment of chronic psychiatric patients. There is significant interest in this method for treating dangerous mental patients. In this interview, the psychologist Diane Brulin-Solignac shares her knowledge and experience of this therapeutic practice.     

Quality of life and subjective health status according to handgrip strength in the elderly: a cross-sectional study

Objectives: The purpose of this cross-sectional study was to examine potential associations between handgrip strength and health-related quality of life, or subjective health status, in the elderly.

Method: We performed secondary data analysis on 2377 elderly individuals aged >65 years. Raw data from the Korea National Health and Nutrition Examination Survey VI (2014–2015), were drawn from a representative national sample.

Results: Of those aged ≥65 years or older, 25.4% had low handgrip strength. After adjusting for confounding variables, the odds ratios of elderly individuals with low handgrip strength were 1.30 (95% confidence interval [CI]: 1.00–1.69) for mobility, 2.18 (95% CI: 1.47–3.22) for self-care, 1.70 (95% CI: 1.30–2.23) for usual activities, 1.30 (95% CI: 1.01–1.67) for pain/discomfort, 1.03 (95% CI: 0.74–1.44) for anxiety/depression, 1.44 (95% CI: 1.10–1.87) for the EQ-5D index, and 1.37 (95% CI: 1.08–1.73) for subjective health status.

Conclusion: Health-related quality of life and subjective health status differ according to handgrip strength. Therefore, handgrip strength should be addressed to improve quality of life in elderly individuals. Elderly individuals require exercise education and adequate nutritional intake to increase handgrip strength.