行动研究法在糖尿病患者足部健康行为干预中的应用

目的 评价行动研究法在糖尿病患者足部健康行为干预中的效果.方法 将上海市3个社区81例糖尿病患者随机分为对照组(42例)和干预组(39例).对照组给予常规足部健康教育指导;干预组给予以行动研究法为重点的足部健康行为护理干预,即确定、评估问题后按计划、行动、观察、反思、修正计划实施干预,如此螺旋式循环3个阶段后评价两组足病知识、自我效能及自护能力.结果 干预组自我效能、自护能力显著优于对照组(均P＜0.01);对照组发生足溃疡3例,其中1例截趾;干预组无1例发生足溃疡.结论 行动研究法运用于糖尿病患者足部健康干预中能够改善患者的自我效能及自护能力,有效控制和降低糖尿病足的发生与发展.     

不同妊娠期阴道出血对母婴健康影响的研究

目的 探讨不同妊娠期阴道出血对母婴健康的影响程度,以利于提供针对性的护理干预和健康指导。方法 对418例妊娠期有阴道出血的孕妇进行跟踪观察至产后。结果 妊娠晚期阴道出血孕妇中重度贫血发生率为27.66％,难产和产后出血发生率分别为65.96％、19.15％,早产和低出生体重发生率为38.30％、25.53％,与妊娠早、中期比较,差异有显著性意义(均P<0.01)。结论 需加强对妊娠各期阴道出血产妇的护理,积极开展健康教育,使之得到及时的治疗和护理,保证母婴健康。     

Life Course Dietary Patterns and Bone Health in Later Life in a British Birth Cohort Study

Evidence for the contribution of individual foods and nutrients to bone health is weak. Few studies have considered hypothesis‐based dietary patterns and bone health. We investigated whether a protein‐calcium‐potassium–rich (PrCaK‐rich) dietary pattern over the adult life course, was positively associated with bone outcomes at 60 to 64 years of age. Diet diaries were collected at ages 36, 46, 53, and 60 to 64 years in 1263 participants (661 women) from the MRC National Survey of Health and Development. DXA and pQCT measurements were obtained at age 60 to 64 years, including size‐adjusted bone mineral content (SA‐BMC) and volumetric bone mineral density (vBMD). A food‐based dietary pattern best explaining dietary calcium, potassium, and protein intakes (g/1000 kcal) was identified using reduced rank regression. Dietary pattern Z‐scores were calculated for each individual, at each time point. Individual trajectories in dietary pattern Z‐scores were modeled to summarize changes in Z‐scores over the study period. Regression models examined associations between these trajectories and bone outcomes at age 60 to 64 years, adjusting for baseline dietary pattern Z‐score and other confounders. A consistent PrCaK‐rich dietary pattern was identified within the population, over time. Mean ± SD dietary pattern Z‐scores at age 36 years and age 60 to 64 years were –0.32 ± 0.97 and 2.2 ± 1.5 (women) and –0.35 ± 0.98 and 1.7 ± 1.6 (men), respectively. Mean trajectory in dietary pattern Z‐scores ± SD was 0.07 ± 0.02 units/year. Among women, a 0.02‐SD unit/year higher trajectory in dietary pattern Z‐score over time was associated with higher SA‐BMC (spine 1.40% [95% CI, 0.30 to 2.51]; hip 1.35% [95% CI, 0.48 to 2.23]), and vBMD (radius 1.81% [95% CI, 0.13 to 3.50]) at age 60 to 64 years. No statistically significant associations were found in men. During adulthood, an increasing score for a dietary pattern rich in protein, calcium, and potassium was associated with greater SA‐BMC at fracture‐prone sites in women. This study emphasizes the importance of these nutrients, within the context of the whole diet, to bone health. © 2016 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR).     

The Classic: A Plan for a More Effective Federal and State Health Administration

This Classic article is a reprint of the original work by Frederick L. Hoffman, LLD, A Plan for a More Effective Federal and State Health Administration. An accompanying biographical sketch on Frederick L. Hoffman, LLD, is available at DOI  10.1007/s11999-009-1001-9. The Classic Article is ©1919 by the American Public Health Association and is reprinted with permission from Hoffman FL. A plan for a more effective federal and state health administration. Am J Public Health. 1919;9:161–169. The article can also be accessed on the American Journal of Public Health web site at http://www.ajph.org/cgi/reprint/9/3/161-a.     

品质圈活动在口服药样健康教育中的应用

目的 提高护士对神经内科口服药知识水平及对患者口服药健康教育的效果.方法 自行设计护士口服药发放健康教育效果不良原因调查表和患者对护士口服药发放教育需求现状调查表,分别向护士和患者发放;根据调查结果在口服药健康教育中采用品质圈(QC)活动,即成立(QC)叮咛小组、分析原因、设定目标、制定对策及方法等,并完成口服药样的设计应用.结果 护士在QC活动前后口服药知识考核成绩比较,差异有显著性意义(P＜0.01).患者对口服药样资料满意度为90.48%.结论 QC活动应用于口服药健康教育工作中有效、及时,能促进护理质量的提高.     

经皮给药治疗小儿肺炎的疗效观察

为了探讨经皮给药对小儿肺炎的治疗效果,随机273例肺炎患儿分为观察组（160例）和对照组（113例）,对照组给予消炎、止咳、解痉、平喘、祛痰、吸氧等常规治疗和护理;观察组除常规治疗和护理外,加用经皮给药8治疗。结果观察组治愈126例,好转29例,总有效率为96．885,平均住院7．05d;对照组治愈67例,好转35例,总有效率90．265,平均住院8．01d,两组治疗效果,住院天数比较,均P＜0．01,差异有显著性意义,提示经皮给药辅助治疗小儿肺炎可提高治愈率,缩短住院时间。     

Growth From Birth to Adulthood and Bone Phenotype in Early Old Age: A British Birth Cohort Study

There is growing evidence that early growth influences bone mass in later life but most studies are limited to birth weight and/or early infant growth and dual‐energy X‐ray absorptiometry (DXA) measurements. In a British birth cohort study with prospective measures of lifetime height and weight, we investigated the growth trajectory in relation to bone in males (M) and females (F) at 60 to 64 years old. Outcomes were DXA measures of hip and spine areal bone density (aBMD) (n = 1658) and pQCT measures of distal and diaphyseal radius cross‐sectional area (CSA), strength, and volumetric bone density (vBMD) (n = 1350 of the 1658). Regression models examined percentage change in bone parameters with standardized measures of birth weight, height, and weight. A series of conditional growth models were fitted for height and weight gain (using intervals: birth–2, 2–4, 4–7, 7–15, 15–20, 20–36, and 36–64 years) and height gain (using intervals: 2–4, 4–7, 7–15, and 15–36 years). Birth weight was positively related to bone CSA (M: 1.4%; 95% confidence interval [CI], 0.3%–2.5%; F: 1.3%; 95% CI, 0.3%–2.4% per 1 SD increase in birth weight for diaphyseal CSA) and strength (M: 1.8%; 95% CI, 0.3–3.4; F: 2.0%; 95% CI, 0.5–3.5). No positive associations were found with trabecular, total, or cortical vBMD. One SD change in prepubertal and postpubertal height and weight velocities were associated with between 2% and 5% greater bone CSA and strength. Height gain in later years was negatively associated with trabecular vBMD. Weight gain velocity during the adult years was positively associated with up to 4% greater trabecular and total BMD, and 4% greater aBMD at hip and spine. In a cohort born in the early post‐war period, higher birth weight, gaining weight and height faster than others, particularly through the prepubertal and postpubertal periods, was positively related to bone strength, mostly through greater bone CSA, at 60 to 64 years. © 2014 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.