New insights into diabetic polyneuropathy

Michael Polydefkis, MD; John W. Griffin, MD; Justin McArthur, MBBS, MPH

JAMA. 2003;290:1371-1376.

Patients with complaints of numbness, tingling, and dysesthesias in the toes and feet are frequently referred to neurologists. Often, the only objective evidence for peripheral nerve dysfunction in these patients is limited to small-caliber sensory nerve fibers. On examination these patients may have reduced distal pinprick sensation, and distal leg skin biopsies show loss of small-caliber nerve fibers. Studies focusing on small-caliber nerve fibers have led to a growing impression that neuropathy can be associated with early diabetes or impaired glucose tolerance (IGT). Often, neuropathy can be the presenting symptom of either diabetes or IGT. Furthermore, the oral glucose tolerance test appears to be a more sensitive measure of glucose dysmetabolism in these patients than levels of fasting blood glucose or glycated hemoglobin. Patients with IGT-associated neuropathy may represent an attractive target population for future regenerative studies given that their neuropathy is less severe and presumably more easily reversed than neuropathy occurring in patients with diabetes.

Historically, small-caliber fibers have not been extensively evaluated due to a lack of objective measures. Several measures to evaluate these fibers are emerging, including skin biopsy with visualization of epidermal nerve fibers. The accessibility of epidermal nerve fibers makes them an attractive target for nerve injury models, which have potential for development as novel outcome measures. Such approaches may address some of the challenges of past diabetic polyneuropathy trials.

     

Assuring the quality of health care for older persons. An expert panel's priorities

To select topics for quality assurance activities focusing on older patients, we convened a 14-member panel of physicians and experts in quality assurance. In two rounds of ratings, panelists rated 42 medical conditions (eg, pneumonia) in terms of their effects on patient outcomes, the availability of beneficial interventions, and the health benefits from improving current quality. They rated 27 health services (eg, adult day-care) on similar dimensions. The feasibility of doing quality assurance work on each condition and service also was rated. Using the ratings, the conditions selected for quality assurance work were congestive heart failure, hypertension, pneumonia, breast cancer, adverse effects of drugs, incontinence, and depression. Health care services selected were hospital discharge planning, acute inpatient care for the frail elderly, long-term-care facilities (intermediate-care facilities and skilled nursing facilities), home health care services, and case management.     

失代偿性心力衰竭的新观点

20世纪90年代，人们对心力衰竭的发病机制有了深入的认识，并用于指导心衰的治疗。作者回顾了该学科的进展，指出了临床上存在的缺陷，探讨了钠尿肽对诊断的意义和各种治疗方法。     

深港两地围绝经期妇女健康需求状况调查

目的了解深港两地妇女围绝经期妇女的健康状况及健康需求,有效地指导群体保健,为制定针对性地防治措施提供依据。方法在深圳市罗湖区、香港分别随机整群抽取两个社区,采用统一的调查问卷,对40-60岁围绝经期妇女进行健康状况与需求调查。结果在418例被调查者中,围绝经期综合征发生率为50％以上,精神神经症状、骨质疏松症状发生率较高。深港两地围绝经期妇女对相关知识的需求在生活、饮食指导、妇女病防治等方面差异无统计学意义（P〉0．05）;在锻炼指导与常见病预防需求方面,香港妇女高于深圳妇女,组间差异有统计学意义（P〈0．05）;对相关知识获取途径的选择,愿意参加专业讲堂及网络服务方面,香港地区的比例相对较高,组间差异有统计学意义（P〈0．05）;深港两地围绝经期妇女对设立咨询热线的需求最高。结论围绝经期妇女的健康问题不容忽视,她们的健康需求有其自身的特点,做好围绝经期妇女的保健工作一定要适应其需求,才能更好地为围绝经妇女提供服务,改善其生活质量．     

肺炎衣原体与支气管哮喘发病关系的研究新进展

肺炎衣原体（CP）是1989年正式命名的一种新的呼吸道感染病原体，又称TWAR（1965年台湾分离株TW-183和1983年华盛顿分离株AR-39）。CP的感染是世界普遍性的，主要引起急性呼吸道感染和慢性阻塞性肺疾病的急性发作，还与冠心病、心内膜炎、脑膜炎、结节性红斑的发病有关：近年研究资料表明，CP感染与支气管哮喘的发病有重要的关系。本文就CP感染的现状，以及在哮喘发病中的流行病学意义、CP感染引起哮喘的可能机制综述如下：     

Oral health status and treatment needs of pregnant women in Lagos State

The oral health status and treatment needs of 250 pregnant women attending the antenatal clinic at Randle Health Centre was investigated. A coded questionnaire was administered to the pregnant women followed by their oral examination in the dental clinic. The mean oral hygiene index score increased progressively throughout pregnancy viz 1st trimester 0.72, second trimester 1.06 and third trimester 1.23. Community Periodontal Index of Treatment Needs (CPITN) revealed that 50% required scale and polish and oral hygiene instruction, 13.60% required oral hygiene instruction only and 32.2% did not require any treatment. Decayed Missing and Filled (DMF) recorded was 1.54. 51.72% of the pregnant women required amalgam fillings, 23.27% required extraction due to caries and 16.38% required partial dentures.     

Personal health information management among healthy older adults: Varying needs and approaches

ObjectiveWith age, older adults experience a greater number of chronic diseases and medical visits, and an increased need to manage their health information. Technological advances in consumer health information technologies (HITs) help patients gather, track, and organize their health information within and outside of clinical settings. However, HITs have not focused on the needs of older adults and their caregivers. The goal of the SOARING (Studying Older Adults and Researching their Information Needs and Goals) Project was to understand older adult personal health information management (PHIM) needs and practices to inform the design of HITs that support older adults.Materials and MethodsDrawing on the Work System Model, we took an ecological approach to investigate PHIM needs and practices of older adults in different residential settings. We conducted in-depth interviews and surveys with adults 60 years of age and older.ResultsWe performed on-site in-person interview sessions with 88 generally healthy older adults in various settings including independent housing, retirement communities, assisted living, and homelessness. Our analysis revealed 5 key PHIM activities that older adults engage in: seeking, tracking, organizing, sharing health information, and emergency planning. We identified 3 major themes influencing older adults’ practice of PHIM: (1) older adults are most concerned with maintaining health and preventing illness, (2) older adults frequently involve others in PHIM activities, and (3) older adults’ approach to PHIM is situational and context-dependent.DiscussionOlder adults’ approaches to PHIM are dynamic and sensitive to changes in health, social networks, personal habits, motivations, and goals.ConclusionsPHIM tools that meet the needs of older adults should accommodate the dynamic nature of aging and variations in individual, organizational, and social contexts.     

社区妇女保健工作初探

泥岗社区健康服务中心是由深圳市妇幼保健院主办 ,自1996年 12月成立以来 ,为社区居民提供了全面、连续的健康服务 ,深受群众欢迎。我们在工作中 ,特别是在妇女保健方面 ,结合社区特点摸索出了一些工作方法 ,与大家共同商榷。1　社区概况泥岗村是深圳市罗湖区笋岗街道办事处管辖下的一个自然村 ,全村总面积 1 2ｋｍ2 ,总人口 1336 8人 ,其中常住人口 115 0人 (包括空挂户 ) ,暂住及流动人员 115 38人 ,常住人口中育龄妇女 2 6 2人 ,已婚育龄妇女 2 0 2人。2　入户调查 ,了解社区妇女的需求2 1　社区健康服务中心人员入户对 2 0 0名育龄妇女…     

专婚人流女青年生殖健康知识、生殖健康保健需求调查及影响因素分析

目的了解我市未婚人流女青年生殖健康知识、生殖健康保健的需求,并调查及分析其影响因素。方法随机抽取2009年10月～2011年10月我市不同街区的10家市级医院妇产科或妇幼保健院的未婚妊娠女青年,对其人口学特征及生殖健康知识、生殖健康保健需求进行调查。结果各人口学特征按程度分类对生殖健康知识得分有影响,差异有统计学意义。对影响因素的分析也显示,受教育程度低、收入低、年龄过小都会影响患者对生殖知识的掌握程度。结论未婚女青少年普遍缺乏性知识和生殖健康知识,应该动员全社会的力量为她们提供最大的帮助,加强宣教．改善生殖健康服务质量。     

糖尿病肾病患者肾小球滤过膜结构和功能及代谢指标的再认识

流行病学资料表明,全球糖尿病患者总人数已超过2．4亿。据世界卫生组织（World Health Organization,WHO）调查资料证实,糖尿病患者的年增长率达10％左右。中国是全球糖尿患者数最多的国家之一,日前1项调查表明中国糖尿病患病人数已跃居世界第2位。