精神障碍患者社会功能缺损评定量表的初步编制

目的:初步编制精神障碍患者的社会功能缺损评定量表。方法:通过文献复习、患者及其家属访谈、专家评议等过程,建立精神障碍患者社会功能评定量表的理论构架和条目内容,再进行项目区分度分析,形成正式量表后,对实施精神残疾鉴定的1000余例精神障碍患者及50例正常人与50例躯体残疾人进行测试。结果:①精神障碍组自我照料、家庭生活、理解交流、与人相处、社会参与5个分量表分及总分均高于躯体残疾组和正常人组,差异显著(P<0.01)。②不同病种得分从高至低依次为:器质性精神障碍、精神分裂症、偏执性精神障碍、有精神病性症状的心境障碍、无精神病性症状的心境障碍、人格障碍、神经症性障碍,组间差异显著(P<0.01)。③该量表评定精神障碍患者社会功能缺损等级与专家使用GAF分级的总符合率为87%,两种方法的评定结果的差异无显著性(字2=4.924,P=0.295)。结论:该量表的测试结果比较符合精神疾病对社会功能影响的一般临床规律,能较好地反映精神障碍患者社会功能缺损状况。     

浙江省视力和听力残疾人群生存质量调查

目的:调查浙江省视力残疾和听力残疾人群生存质量,并对其影响因素进行分析,同时探索生存质量与一般健康状况的关系。方法:采用问卷法对767名视力残疾人和听力残疾人进行入户式调查。结果:视力残疾人生存质量得分为(63.71±20.06),听力残疾人生存质量得分为(67.11±20.00);生存质量总分在年龄和残疾类别上具有显著的统计学意义(P0.05);生存质量与一般健康状况得分呈显著负相关(r=-0.658,P0.01);多元素逐步回归分析结果显示,影响残疾人生存质量的因素有年龄、残疾等级和残疾类别。结论:视力残疾人和听力残疾人的生活质量相对较低,且其一般健康状况普遍较差,年龄、残疾等级和残疾类别等对生存质量有一定影响。     

韦氏智力测验在智力残疾评定中的应用

目的了解智力测验在智力残疾评定中的作用,为残疾等级的评定提供客观指标。方法对被试进行韦氏智力量表测定,记录一般资料,由2名主治医师以上医生进行智残等级评定。对智力测验结果和医生评定的智残等级之间进行相关分析和一致性检验。结果由医生评定的智力残疾等级为三级和四级,没有一级和二级。智商值在36～68之间,平均49.23±8.49。对医生评定的智力残疾等级与智力测定等级结果进行一致性检验,加权Kappa系数Kw=0.52,P0.01,说明两种评定结果具有高度一致性。评残的轻重程度与言语智商、操作智商和全量表智商之间呈显著正相关(r分别为0.60、0.50、0.62,P0.01),智商值越高,残疾程度越轻。结论在智力残疾评定中辩证地使用智力测验结果,有助于为残疾等级的评定提供重要的客观指标。     

利用人体节律净化基因库提高人类遗传质量

目前，我国人口素质状况不客乐观。国家统计局1987年第一次全国残疾人抽样调查资料表明：我国现有残疾人5100多万，约占人口总数的4．9%，几乎20个人中就有一个是残疾人。其中，聋哑痴呆、综合残疾和精神病患者2200多万。根据卫生部组织的国家出生缺陷监测调查和全国0～4岁儿童智力低下的抽样调查，全国出生缺陷总发病率为13．07‰，最高省份达20‰，其中，患病率为1．07%。     

联合分析法在测量大学生对残疾人态度中的应用

目的了解影响大学生对残疾人态度的因素及其对不同残疾类型残疾人的偏爱顺序,检验联合分析法作为测量残疾人态度间接方法的有效性。方法通过联合分析法发展出的31张卡片调查沈阳两所大学的92名大学生(男47名,女45名),假设被试作为志愿者服务于社区的情境,按照个人对残疾人喜爱程度对卡片进行排序。结果①观测偏好和估计偏好之间的相关系数Kendall’s tau=0.847,P<0.0001,这表明本研究在模型和数据之间有很好的匹配度;②大学生对残疾人态度的主要影响因素排序在前3名的相对重要值分别是:残疾类型(40.505)、残疾程度(18.416)、年龄(16.439),相对于非残疾相关因素(年龄和教育程度),与残疾相关的因素(残疾类型、残疾程度)更显著地影响大学生对残疾人的偏爱程度(t=3.131,P<0.001);③大学生在不同的因素水平上有不同的偏爱顺序,在残疾类型上的成分效用值排序分别是:癌症(1.657)、视力残疾(0.767)、截瘫(0.591)、学习障碍(-0.248)、精神分裂(-2.767)。结论影响大学生对残疾人态度偏好的主要因素是残疾类型、残疾程度、年龄;在残疾类型上,大学生的偏爱等级是沿着身体残疾向精神残疾连续体的方向;联合分析法是一个高效易行的测量对残疾人态度的方法。     

肢体残疾人精神残疾共患率及其相关因素

目的:描述我国15岁及以上人群中肢体残疾人精神残疾共患率及其分布特征,并探讨肢体残疾人共患精神残疾相关因素,为多重残疾预防提供依据。方法:对第二次全国残疾人抽样调查的数据进行统计分析,描述肢体残疾人精神残疾共患率及其分布特征,分析肢体残疾人共患精神残疾的影响因素及共患精神残疾对精神残疾及肢体残疾分级及功能领域损害影响。结果:肢体残疾人中归因于各类精神障碍的精神残疾共患率为9.4‰。肢体残疾人共患精神残疾人中极重度残疾及严重功能损害者所占比例均高于单一肢体残疾人及单一精神残疾人(P0.05)。肢体残疾人共患精神残疾的危险因素包括女性(OR=1.60,95%CI:1.31～1.96),年龄30～44岁(OR=1.98,95%CI:1.26～3.10)及45～59岁(OR=1.69,95%CI:1.06～2.68),未婚(OR=2.52,95%CI:1.85～3.44),离异或丧偶(OR=1.53,95%CI:1.20～1.95),非农业户籍(OR=1.26,95%CI:1.02～1.54)及肢体残疾等级较高者(I级,OR=2.30,95%CI:1.63～3.26;II级,OR=1.76,95%CI:1.34～2.30;III级,OR=1.43,95%CI:1.14～1.79)。结论:肢体残疾人中精神残疾共患率较高,肢体残疾人共患精神残疾的残疾程度及功能损害更严重。     

精神残疾流行病学研究综述

精神障碍的致残作用不容忽视。世界卫生组织为评估精神障碍患者的社会适应和行为障碍研发了《世界卫生组织残疾评定量表第二版》,并将其扩展至测量任何疾病的功能损失。《中华人民共和国国家标准残疾人残疾分类和分级》结合国情对精神残疾进行了定义和分级。国外对于精神障碍残疾率和致残率报告较少，且残疾判定的标准不统一。国内第二次全国残疾人抽样调查报告了归因于精神障碍的残疾率及人口学分布特征，为我国精神残疾研究提供了科学依据。目前国内外均缺乏精神残疾的人群数据。本文通过检索国内外文献，综述了国内外精神残疾的定义、评定方法、精神残疾率、致残率、人口学分布研究以及各种精神障碍与残疾的关联研究，以期为进一步开展精神残疾研究提供参考。     

中国15岁及以上人群归因于精神病性障碍的精神残疾率分析

目的:描述我国15岁及以上人群中归因于精神病性障碍的精神残疾率及其分布特征,为精神残疾预防和康复提供依据。方法:对第二次全国残疾人抽样调查的数据进行统计分析。以全部调查人群中由于精神病性障碍所致残疾的患者所占比例作为归因残疾率的计算公式。以校正标准误后的Poisson回归模型估计患病率比(PR)为指标分析归因于精神病性障碍的精神残疾各相关因素的影响作用。结果:归因于精神病性障碍的精神残疾率为4.16‰,其中,归因于精神分裂症的精神残疾率为3.75‰。归因于精神病性障碍的精神残疾的程度高于归因于非精神病性障碍的精神残疾。女性(PR=1.50),年龄大(30～49岁组PR=12.78,50～64岁组PR=13.90,65岁及以上组PR=6.56)、未婚者(PR=11.74)和离异或丧偶人群(PR=3.22),居住在西部地区者(PR=1.09)归因于精神病性障碍的精神残疾率较高,非汉族人群(PR=0.74),初中教育程度人群(PR=0.82),非农业人口(PR=0.81)归因于精神病性障碍的精神残疾率较低。结论:归因于精神病性障碍的精神残疾率较高,女性、年龄较大者、婚姻不稳定、西部地区人群、汉族以及农业人口是精神病性障碍所致精神残疾防治的重点人群。     

探讨精神残疾人康复就业的现状及影响因素

因精神残疾患者引发的社会问题日趋严重,精神残疾人康复已经成为保障社会安定亟待解决的问题。临床不仅需要针对疾病进行治疗,恢复患者躯体功能,同时应关注其社会功能康复,帮助患者融入社会,提高精神残疾人就业率。本文就这一问题的现状及原因进行综述。     

中国伴有生理紊乱及躯体因素的行为综合征的残疾现况调查:全国第二次残疾人抽样调查数据分析

目的:描述我国归因于伴有生理紊乱及躯体因素的行为综合征的残疾率及其人群和地区分布,分析其残疾等级及功能损害程度,以利于制定残疾防治和康复的卫生政策.方法:采用描述性流行病学研究方法分析我国第二次残疾人抽样调查的资料,计算归因于伴有生理紊乱及躯体因素的行为综合征的残疾率并进行人群和地区分布的显著性检验.结果:本次调查共调查全国社区居民2 526 145人,伴有生理紊乱及躯体因素的行为综合征残疾率为2.3/10万.残疾率的性别分布为女性是男性的2.46倍(P＜0.01)；无工作者残疾率是有工作者的2.21倍(P＜0.01)；受教育程度高者残疾率低于受教育程度低者(高中及以上、初中、小学及以下的残疾率分别为9.8/10万、29.3/10万、61.0/10万,P＜0.05)；而残疾率的婚姻状态分布差异无统计学意义(P＞0.05).残疾率在各省间差异有统计学意义(P＜0.01),其中广东省最高.伴有生理紊乱及躯体因素的行为综合征的残疾者中四级残疾最多,占68％；伴有生理紊乱及躯体因素的行为综合征残疾者的身体移动能力和生活自理能力受到的损害较轻,理解和交流能力、与人相处能力、生活活动能力和社会参与能力受到的损害较重.结论:伴有生理紊乱及躯体因素的行为综合征残疾率有地区和人群分布的差异,此类残疾的各方面社会功能损害程度不一,应该得到应有的重视.     

民营司法精神病鉴定所2年鉴定实践初探

目的探讨民营司法精神病鉴定所鉴定的特点及发展趋势。方法根据自制调查表,查阅记录每个案例鉴定材料及鉴定实践中碰到的一些问题,并进行统计与分析。结果案件类型中以伤害凶杀最多,与以往报道一致。其次是被伤害、被奸、吸毒贩毒案,与以往报道不同,鉴定诊断排序第二、第三的是脑外伤所致的精神障碍及毒品所致精神障碍,与有关报道不同。结论本组资料基本反映了当前民营鉴定所存在的问题,鉴定的任务,内容的变化和特点。     

Prevalence of disability observed in an Oxfordshire practice

A register was compiled of disabled patients in an Oxfordshire practice; patients were considered to be disabled when an impairment appreciably affected their day-to-day life. The rates of disability rose with age. Three-quarters of the disabled patients had one disability, 21% two and 5% three or more disabilities. The most common source of disability was disorders of the nervous system followed by circulatory and musculoskeletal conditions. More than two-thirds of the disabilities were capable of amelioration and 4% could be completely resolved. Most patients had come to terms with their disability, only 8% finding adjustment difficult.     

Screening for disability in a community: the 'ten questions' screen for children,in Bondo,Kenya

Background

Although the need for early identification and interventions of disabilities is evident, the current state of routine screening practice in Kenya needs intensive training of screeners before more rigorous techniques are introduced.

Objective

To compare the precision and practical utility of the ‘ten questions’ and EARC screens among the 2–9 year olds in a community setting.

Method

In this analytical comparative cross-sectional survey of two disabilities screening methods. multiphase sampling and multistage data collection procedures were employed. Quantitative research utilizing structured interview checklist was used for data collection. It described the prevalence rates of different types of disabilities using both methods. It analyzed the precision and practical utility of the two methods in a community setting.

Results

64 of the 399 children under study were disabled (50.5 % male and 49.5 % female). The ‘ten questions’ picks up only those problems that are of great concern to families. EARC services are a more definite case defining process of measuring the existence and degree of disability in children. It screens the children who are severely disabled leaving out the mildly disabled and medical conditions which, when left untreated, could lead to possible disablement.

Conclusion

Parents need to be sensitized about symptoms requiring the ten questions that can be used to screen out the potentially disabled children and the Education Assessment and Resource Centres (EARC) be used to diagnose the type and degree of the disability and refer the ill children for treatment. The basic needs of disabled children could be met in the community and do not require highly specialized personnel. They need to be localized and accessible.     

Frequency of Alzheimer's disease in a postmortem study of psychiatric patients

The brains from 100 consecutive patients dying in psychiatric departments were subjected to a neuropathological study with a quantitative evaluation of neurofibrillary tangles and senile plaques. Histologically, Alzheimer changes were found in 63.4% of the group with the clinical diagnosis of senile dementia and in 60% of the arteriosclerotic dementia group. In other clinical groups (schizophrenic, manic-depressive, and "other disorders") the percentage of Alzheimer changes was about 30. Thus, Alzheimer changes were not only present in the group of patients with the "correct" psychiatric diagnosis senile dementia, but were also frequent among patients with other psychiatric diseases where no clinical suspicion of Alzheimer's disease had been forecast. Alzheimer's disease may, thus, contribute to or be concealed by other psychiatric diseases and should be considered in all geronto-psychiatric cases.     

Knowledge and attitudes of high school pupils towards peers' attention deficit and learning disabilities

The purpose of this study was to investigate pupils' knowledge and attitudes in the areas of attention deficit and hyperactivity (ADHD) and learning disabilities (LD). One hundred and four high school pupils in Holon (Israel) were interviewed and anonymously completed a questionnaire on these conditions. Pupils' knowledge on the topic of ADHD was low (62%); they showed a better knowledge about LD (75%). They showed a partially tolerant attitude (62.7%) towards pupils suffering from ADHD; on the other hand, they had a somewhat more positive and perceptive attitude (74.1%) towards peers diagnosed as learning disabled. Pupils' attitudes became more perceptive with increasing age. There was no correlation between pupils' knowledge and attitude. Pupils had learned about these two handicapped conditions from various sources; TV (66.3%), newspapers (63.5%) and school (53.8%), while physicians and nurses occupied the 5th and last place. Information about these two disabilities (ADHD and LD) should be added to the curriculum and be taught by qualified specialists, as there is an obvious statistically deficient knowledge in these areas.     

400例独生子女病残儿鉴定分析与二胎儿随访

１９８１年１１月－１９９４年１２月，我院共鉴定独生子女病残儿４００例。除１０例未发现明显异常外，余下的疾病有百余种，大致分了七类，神经系统疾病２００例（５０％），其中智力低下（ＭＲ）１７４例，又占神经系统疾病中的８７％，说明ＭＲ已是当前引致小儿残疾的主要疾患。先天性遗传性疾病２１５例，占了总数的５３．７５％，说明加强优生与孕期保健工作的重要性。作者对可生育二胎者随机随访了５４例，３６例（６６．７％）已生育了二胎，大部小儿生长健康，仅２例异常，１例６个月死于心肌炎，另一例为出生低体重（２２５０ｇ），似乎与第一胎之残疾关系不大。说明病残儿医学鉴定小组的监护对第二胎的出生质量是至关重要的。     

浙江省嘉兴地区2007年～2011年病残儿医学鉴定回顾性分析

目的通过对病残儿医学鉴定情况分析,探讨科学有效的出生缺陷干预措施。方法对嘉兴地区2007-2011年565例申请鉴定的病残儿资料进行审查和分析。结果先天性疾病占76．28％,其中神经及精神类疾病位列首位,遗传性疾病占22．57％。结论要提高出生人口素质,避免出生缺陷患儿,必须普及优生优育知识,大力开展孕前一围孕期保健,积极倡导产前诊断。通过病残儿医学鉴定,对再生育夫妇提供优生指导。     

The Utility of Parents' Behavior Checklist Ratings with Developmentally Disabled Children

The Missouri Children's Behavior Checklist ratings were obtainedon 126 males and 47 females from two separate clinics for theinterdisciplinary evaluation of children with suspected developmentaldisabilities and from 27 male and 32 female normal controls.There were no significant differences on any of the seven behavioraldimensions measured by the checklist for either the males orfemales from the two developmental disabilities clinics. However,the developmentally disabled children were rated significantlydifferent than the normal control children on many of the behavioraldimensions. The findings are discussed in terms of the homogeneityof behavior of the two developmentally disabled groups and theutility of parents' behavior checklist ratings in: describingclinically relevant behavioral dimensions of developmentallydisabled children; identifying behavioral differences betweendevelopmentally disabled children and normal controls; and indifferentiating among developmentally disabled children on thebasis of presenting behavioral problems.     

Problem areas of the rheumatic mother.

The extent to which women with rheumatic diseases are disabled in caring for their children is unknown. Fifty-seven women with rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, or systemic lupus erythematosus, all of whom had children under 6 years of age born during the disease, were interviewed. Patients with different diseases differed in their disabilities, but lifting, carrying, transporting, and bathing the child were difficult for most patients. Attention to these problem areas is necessary in the care of young mothers with rheumatic illness.