耳石复位与药物联合仰卧位摇头法治疗主观性良性阵发性位置性眩晕临床研究

目的:观察耳石复位与药物联合仰卧位摇头法治疗主观性良性阵发性位置性眩晕(S-BPPV)的效果。方法:选取2012年1月至2016年1月期间符合纳入标准的S-BPPV患者186例,采用随机数字表法将患者分为观察组与对照组各93例,对照组采用耳石复位联合药物治疗,观察组在对照组基础上采用仰卧位摇头法治疗。比较两组患者临床疗效、首次治疗成功率、中转手术治疗率、复发率与不良反应发生率的差异。结果:与对照组比较,观察组治疗总有效率、首次治疗成功率明显增高,中转手术治疗率与复发率明显降低,差异具有统计学意义(P0.05);两组中共18例患者经外科手术治疗后症状彻底消失;随访3个月期间,观察组平均复发次数与对照组比较差异具有统计学意义(P0.05);两组患者头晕、恶心呕吐、心律失常、走路不稳与情感障碍等不良反应发生率比较差异无统计学意义(P0.05)。结论:耳石复位与药物联合仰卧位摇头法治疗S-BPPV效果显著,可降低复发率,且未增加不良反应的发生风险。     

慢性主观性头晕病机探讨与常见证候分析

目的:探讨慢性主观性头晕(CSD)的病机与证候分布。方法:采集125例CSD头晕患者的一般资料、中医四诊信息,对年龄、性别、症状、证候、证素进行统计学描述、分析。结果:CSD患者以青中年为主,男女比例1.0∶1.6。男女平均年龄、年龄分布差异均无统计学意义(P>0.05)。核心症状除头晕沉、头痛、自觉走路不稳或晃动等,尚包含眠差、急躁、心烦等精神症状及易疲乏、健忘、心慌等躯体症状。证候以阴虚证、痰热证、瘀热证常见,三组证候年龄分布、证候性别分布差异具有显著统计学意义(P<0.01)。与阴虚证相比,痰热证、瘀热证皆以≤44岁青年人居多(P<0.05),与瘀热证相比,阴虚证以45~59岁中年人较多(P<0.05),在≥60岁年龄段,三组证候分布差异无统计学意义(P>0.05);阴虚证、瘀热证以女性为主(P<0.05),痰热证以男性为主(P<0.05)。结论:CSD病位在心,为形神共病,神病为主导。邪扰神躁、清窍不利、形神失和为其主要病机,阳躁不宁、火热内扰是其发病基础。常见证候不外虚实之分,实证责之因郁化热、阳动神躁,虚证责之阴虚热扰、阳旺神浮。临证治疗CSD,当分析病因,明晰体质,随证施治,总以恢复脏腑气化,神安形合为根本目标。     

Heterogeneous effects of obesity on mental health: Evidence from Mexico

Obesity can spread more easily if it is not perceived negatively. This issue may be more pronounced among the poor, a conjecture that we test in this paper. We start with general evidence on the concave relationship between income and obesity, both across countries and within Mexico, a country characterized by very unequal development levels and the highest obesity rate in the world. We suggest a general model that explains this stylized fact from a simple necessary condition, namely, the complementarity between nonfood consumption and health concerns. Then, we test the direct effect of overweight on mental health among Mexican women. We find a positive effect of obesity in the low consumption group and a depressing effect among the rich. This result is robust to the inclusion of a range of confounders (childhood conditions, lifestyle variables, food expenditure, and household shocks) and after instrumenting individual fatness by the variation in genetic predisposition. The complementarity between living standards and weight concerns may reflect different norms, different labor market penalties, or simply different returns to healthy time across the social spectrum.     

The Bucket Test Improves Detection of Stroke in Patients With Acute Dizziness

BackgroundIt is challenging to detect posterior circulation strokes in patients presenting to the emergency department (ED) with acute dizziness. The current approach uses a combinatorial head-impulse, nystagmus, and test-of-skew method and is sensitive enough to differentiate central causes from peripheral ones. However, it is difficult to perform and underused. Further, magnetic resonance imaging (MRI) of the brain is not always available and can have low sensitivity for detecting posterior circulation strokes.ObjectivesWe evaluated the feasibility and utility of the bucket test (BT), which measures the difference between patient's subjective perception of the visual vertical and the true vertical, as a screening tool for stroke in patients presenting to the ED with acute dizziness.MethodsIn this work, we prospectively enrolled 81 patients that presented to our academic medical center ED with dizziness as their chief complaint. The BT was performed 3 times for every patient.ResultsSeventy-one patients met the study criteria and were included in the analysis. Ten patients were excluded because of a history of drug-seeking behavior. There were no reported difficulties performing the BT. Six patients (8%) were diagnosed with ischemic stroke on MRI and 1 additional patient was diagnosed with transient ischemic attack and found to have a stroke on subsequent MRI. All 7 patients with dizziness attributed to cerebrovascular etiology had an abnormal BT, resulting in a sensitivity of 100% (95% confidence interval [CI] 59–100%). The specificity of the BT was 38% (95% CI 24–52%). The positive predictive value of the BT for detecting stroke was 18% (95% CI 15–21%).ConclusionsThe BT is an easy, cheap, safe, and quick test that is feasible and sensitive to screen acutely dizzy patients for stroke in the ED.     

You are not in the army now! A field study on the impact of a Preparation for Civilian Life program on young soldiers

Recent years have seen the implementation of educational programs aimed at developing future orientation and better employability skills, mostly for people new to or returning to the job market. In a field study, we investigated the impact of a 5-day program on reintegration to civilian life on young Israeli combat soldiers' time preferences, gratitude, patriotism, and perceptions of their combat experience. Questionnaires administered before and after the program revealed a positive effect on future orientation but a negative effect on gratitude and perceptions of the combat experience. Although the positive effect on future orientation is in line with the program design, the negative effects found should be taken into consideration when planning or improving similar educational programs.     

Exploring the broader health and well-being outcomes of mining communities in low- and middle-income countries: A systematic review

Health and well-being outcomes in communities living in proximity to mining activity may be influenced by a broad spectrum of factors including population growth, economic instability or land degradation. This review aims to synthesise broader outcomes associated with mining activity and in doing so, further explore possible determinants in communities of low- and middle-income countries. Four databases were systematically searched and articles were included if the study targeted adults residing in proximity to mining activity, and measured individual or community-level health or well-being outcomes. Narrative synthesis was conducted. Twelve articles were included. Mining was perceived to influence health behaviours, employment conditions, livelihoods and socio-political factors, which were linked to poorer health outcomes. Family relationships, mental health and community cohesion were negatively associated with mining activity. High-risk health behaviours, population growth and changes in vector ecology from environmental modification were associated with increased infectious disease prevalence. This review presents the broader health and well-being outcomes and their determinants, and strengthens the evidence to improve measurement and management of the public health implications of mining. This will support the mining sector to make sustainable investments, and support governments to maximise community development and minimise negative impacts.     

Feasibility of an Internet-based positive psychological intervention for hemodialysis patients with symptoms of depression

ABSTRACT

Background: Depression is a pervasive psychological issue facing hemodialysis (HD) patients. Novel technology-based treatment strategies that deploy psychology-based interventions have not been the focus for therapy and few published studies exist. The aim of the current trial is to determine the feasibility and acceptability of an Internet-based positive psychological intervention in HD patients with comorbid depressive symptoms. Methods: HD patients (n = 14) with elevated symptoms of depression were enrolled in a single-arm pre-post trial with clinical assessments at baseline and immediately post intervention. Chairside during regularly scheduled HD treatment, patients utilized a web browser to complete online modules promoting skills for increasing positive emotion over a 5-week period using Apple IPads. Targeted skills included noting of daily positive events, gratitude, positive reappraisal, acts of kindness, and mindfulness/meditation. Results: Twelve of 14 patients completed the program for an 85.7% retention rate. Participants felt satisfied with each session and offered consistently positive feedback. On average, participants visited the website 3.5 times per week. Significant improvements were evident for depressive symptoms (15.3 vs. 10.9; p = 0.04), as per the Center for Epidemiological Studies Depression Scale. Conclusions: An innovative Internet-based positive psychological intervention represents a feasible and useful therapeutic option for HD patients with depressive symptoms.     

Ecological analysis of college women’s physical activity and health-related quality of life

ABSTRACT

Despite significant health benefits of regular physical activity, over 60 percent of college women do not meet recommended physical activity guidelines to promote their health and health-related quality of life (HRQoL), a comprehensive construct including physical and psychosocial health functioning. The major purpose of this study was to examine the influences of individual (e.g., self-efficacy, enjoyment), social (e.g., family and friend support), and physical environmental factors (e.g., crime safety) on college women’s physical activity and HRQoL. Participants were 235 (Mean age = 21.0 years) college women from a public research university located in the southwest region of the United States. They completed validated surveys assessing their perceptions of physical activity, HRQoL, and social ecological factors during the spring semester of 2012. The findings of three multiple linear regressions, entering individual factors first, followed by social and physical environmental factors, revealed that self-efficacy and crime safety were significantly related to physical activity. For HRQoL-physical functioning, significant factors were self-efficacy, enjoyment, and crime safety. Enjoyment was the only factor related to HRQoL-psychosocial functioning. These findings indicated that physical activity professionals need to foster safe environments, enhance self-efficacy, and provide enjoyable activities to promote college women’s physical activity and HRQoL.