TO HAVE AND HAVE NOT: ADAPTIVE BEREAVEMENT BY TRANSFORMING MENTAL TIES TO THE DECEASED

Over the past decade, there has been a paradigm shift in the field of bereavement: From the traditional view that insists on the necessity of disengagement, toward a position that postulates the need for a continuing connection. The authors propose to move beyond the dichotomy that was created by the two paradigms and conceive of it as a process of transformation that involves both disengagement and connection. Drawing on theoretical frameworks of control and adaptation, the authors suggest that the relationship with the deceased may be transformed to mental representations of this person that carry substitute value.     

ANDROGENETIC ALOPECIA IN MEN: THE SCALE OF THE PROBLEM AND PROSPECTS FOR TREATMENT

While the precise incidence of androgenetic alopecia is unknown, it is universally acknowledged to be the most common hair problem in men. Balding is generally associated with ageing; consequently, the desire to prolong a youthful appearance inevitably leads to demands for effective treatments. Further, changing attitudes in modern society have resulted in people becoming concerned about their appearance and less tolerant about conditions that might be alleviated by medical intervention. The importance of hair loss upon quality of life has been underestimated by the medical profession. Clinicians failing to accept hair loss as an important medical problem ignore the real distress suffered by a significant proportion of those affected. New options for treatment that selectively target the metabolic pathways involved in the balding process are showing promise. The first generation of such drugs, Propecia, is now available in some countries and other molecules are currently under development.     

SOCIETAL BURDEN OF STROKE REHABILITATION: COSTS AND HEALTH OUTCOMES AFTER ADMISSION TO STROKE REHABILITATION

ObjectiveTo estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after start of medical specialist rehabilitation.DesignObservational.PatientsConsecutive patients who received medical specialist rehabilitation in the Stroke Cohort Out-comes of REhabilitation (SCORE) study.MethodsParticipants completed questionnaires on health-related quality of life (EuroQol EQ-5D-3L), absenteeism, out-of-pocket costs and healthcare use at start and end of rehabilitation and 6 and 12 months after start. Clinical characteristics and rehabilitation costs were extracted from the medical and financial records, respectively.ResultsFrom 2014 to 2016 a total of 313 stroke patients completed the study. Mean age was 59 (standard deviation (SD) 12) years, 185 (59%) were male, and 244 (78%) inpatients. Mean costs for inpatient and outpatient rehabilitation were US$70,601 and US$27,473, respectively. For inpatients, utility (an expression of quality of life) increased significantly between baseline and 6 months (EQ-5D-3L 0.66–0.73, p = 0.01; visual analogue scale 0.77–0.82, p < 0.001) and between baseline and 12 months (visual analogue scale 0.77–0.81, p < 0.001).ConclusionOne-year societal costs from after the start of rehabilitation in stroke patients were considerable. Future research should also include costs prior to rehabilitation. For inpatients, health-related quality of life, expressed in terms of utility, improved significantly over time.LAY ABSTRACTThe objective of this study was to estimate societal costs and changes in health-related quality of life in stroke patients, up to one year after the start of rehabilitation. Participants were stroke patients who received inpatient or outpatient rehabilitation. They completed questionnaires on quality of life, absenteeism, out-of-pocket costs and healthcare use at start and end of rehabilitation and 6 and 12 months after the start of rehabilitation. Rehabilitation costs were obtained from the financial records. From 2014 to 2016 a total of 313 patients completed the study. Mean age was 59 years, 185 (59%) were male and 244 (78%) inpatients. Mean costs for inpatient and outpatient rehabilitation were $70,601 and $27,473, respectively. For inpatients, health-related quality of life increased significantly between baseline and 6 months, and between baseline and 12 months. In conclusion, societal costs one year after the start of rehabilitation were considerable and health-related quality of life improved for inpatients.Key words: stroke, rehabilitation, cost analysis, utility, health-related quality of life

The number of people living with stroke in Europe is expected to increase from 1.1 million per year in 2000 to 1.5 million per year in 2025 (1). Stroke survivors may experience severe functional impairments, including impairments in physical functioning (2), cognition (3), and speech/language (4), which, in turn, lead to limitations in activities and participation and to worse quality of life (QoL) (5). Specialist rehabilitation was proven to be effective in improving functional outcomes after stroke (6), such as motor function, balance, walking speed and activities of daily living (7–9). Furthermore, in stroke patients admitted for inpatient rehabilitation, QoL increased significantly between admission and discharge (10).Besides the fact that rehabilitation after stroke is effective, rehabilitation was also found to be the main contributor to the costs of post-stroke care, according to a systematic review published in 2018 including 42 publications (11). Costs of post-stroke care, but not those of acute care, were included. Rehabilitation in different care settings was evaluated, which included primary, secondary and tertiary care, and the costs often applied to part of the patients and were not described in detail. For the delivery of value-based healthcare (VBHC), it is important to consider not only the health effects and patient-reported outcome measures, but to also evaluate the costs of care, since it is important to achieve good patient outcomes per dollar spent (12, 13).The aim of the current study was therefore: (i) to estimate the 1-year societal costs from the start of the rehabilitation in stroke patients treated in a medical specialist rehabilitation facility in The Netherlands; and (ii) to evaluate health changes in terms of utility (an expression of quality of life) over that year.     

急,慢性盆腔炎患者治疗前后血液流变性变化的观察

本研究对急、慢性盆腔炎患者治疗前后血液流变学的变化进行了观 测。结果显示,急性盆腔炎和慢性盆腔炎患者治疗后（临术症状恢复正常）的血液 流变性较治疗前显著改善,除血浆粘度、Ｋ值和血浆纤维蛋白原等指标仍处于异常 状态外,其余指标都处于正常范围。     

OSTEOPOROSIS AND THE EFFECTS OF AGEING ON BONE MASS IN ELDERLY MEN AND WOMEN1

A longitudinal study of the effects of ageing on bone mass,height, and body weight was made in random samples of a definedpopulation of elderly men and women. The observations were madetwice with an interval of 11 years between them. At initialsurvey ages ranged from 55 to 64 years. Bone mass was assessedfrom measurements of the second metacarpal cortex made directlyfrom radiographs. Loss of bone occurred in both sexes but thiswas not a universal phenomenon; some men and women lost littleor no bone over the period of study. In those persons in whombone loss did take place this happened at different rates; andthe women tended to lose more bone than the men.Change in bonemass in the metacarpal was not related to loss of heigh, changein body weight, the occurence of fracture, or the presence ofback pains. A separate population of persons with the clinicalsyndrome of senile osteoporosis was not identified.     

FACTORS ASSOCIATED WITH MET AND UNMET REHABILITATION NEEDS AFTER STROKE: A MULTICENTRE COHORT STUDY IN DENMARK AND NORWAY

ObjectivesTo examine patient-reported needs for care and rehabilitation in a cohort following different subacute pathways of rehabilitation, and to explore factors underpinning met and unmet needs.DesignObservational multicentre cohort study.Patients and methodsA total of 318 Norwegian and 155 Danish patients with first-ever stroke were included. Participants answered questions from the Norwegian Stroke Registry about perceived met, unmet or lack of need for help and training during the first 3 months post stroke. The term “training” in this context was used for all rehabilitative therapy offered by physiotherapists, occupational or speech therapists. The term “help” was used for care and support in daily activities provided by nurses or health assistants.ResultsNeed for training: 15% reported unmet need, 52% reported met need, and 33% reported no need. Need for help: 10% reported unmet need, 58% reported met, and 31% reported no need. Participants from both Norway and Denmark had similar patterns of unmet/met need for help or training. Unmet need for training was associated with lower functioning, (odds ratio (OR) = 0.32, p < 0.05) and more anxiety (OR = 0.36, p < 0.05). Patients reporting unmet needs for help more often lived alone (OR = 0.40, p < 0.05) and were more often depressed (OR = 0.31, p < 0.05).ConclusionSimilar levels of met and unmet needs for training and help at 3 months after stroke were reported despite differences in the organization of the rehabilitation services. Functioning and psychological factors were associated with unmet rehabilitation needs.LAY ABSTRACTThe aim of this study was to examine patient-reported needs for care and rehabilitation among selected patients with stroke in Norway and Denmark. A total of 318 Norwegian and 155 Danish patients with first-ever stroke were included. Participants answered the following 2 questions from the Norwegian Stroke Registry: Have you received enough help after the stroke? Have you received as much training as you wanted after the stroke? The term “training” in this context was used for all rehabilitative therapy offered by physio-, occupational or speech therapists. The term «help» was used for care and support in daily activities provided by nurses or health assistants. Levels of anxiety and depression were investigated. With regard to training needs, 15% of all participants reported unmet needs, 52% reported that their needs had been met, and 33% reported that they had no need for training. Regarding the need for help, 10%, 58% and 31% reported unmet needs, that needs had been met, and that they had no need for care, respectively. Participants in the 2 countries had similar patterns of unmet/met needs for help or training. Unmet need for training was associated with low function and anxiety. Patients reporting an unmet need for help more often lived alone and were more often depressed. There was no difference in met or unmet needs between Norwegian and Danish participants.Different rehabilitative follow-up after stroke did not affect levels of met and unmet rehabilitation needs. Health services should pay special attention to patients at risk, including those who are anxious or depressed, live alone or have functional deficits after stroke.Key words: stroke, rehabilitation, unmet needs, rehabilitation pathways

Stroke is a major cause of death, with an increasing number of patients affected worldwide (1). Stroke survivors often have varying degrees of physical, psychosocial and cognitive disabilities, which may substantially affect their functional ability in daily and working life (2). Treatment offered by specialized stroke units (3), inpatient multidisciplinary rehabilitation teams (4) and community-based rehabilitation services adapted to patients’ home environment (5) are key elements to successful rehabilitation. At all intervention levels, the identification of patients’ individual needs is crucial for the optimization of rehabilitation outcomes. The definition of a need is, however, not unambiguous (6). A pragmatic approach is to adopt the most commonly used definition of healthcare needs and define rehabilitation needs as the needs that can be fulfilled by rehabilitation interventions and services (7). From the patient’s perspective, a need represents the perception of a situation in which help or support is desired. If adequate help is not offered, the provision of services does not fit the needs, gaps occur and needs become unmet (8).A perceived need for therapy, comprehensive care, pscyhological support or information are examples of commonly reported unmet needs post-stroke (9).Unmet rehabilitation needs may persist for years after stroke (10). According to a UK study, they are more often reported by people with disabilities, those belonging to ethnic minorities, and those living in the most deprived areas (10). According to a recent systematic review of 19 studies, mostly cross-sectional in design, 74% of stroke survivors experienced at least one unmet need. The studies revealed heterogeneous levels of unmet needs, ranging between 5% and 40% for care and between 2% and 36% for therapy (9). In most studies, unmet needs were assessed by using different multi-item questionnaires, such as the Longer-term Unmet Need after Stroke (11) and the Greater Manchester Stroke Assessment Tool (12), or by the self-report of long-term needs after stroke (10).In a Swedish registry study evaluating perceived unmet or partly met rehabilitation needs with a single question, 21.5% of patients reported unmet needs one year after stroke. Important underpinning factors were older age, dependency on others, pain and depressive/ affective symptoms (13).Rehabilitation practices are formulated and enacted in a cultural and historical context aligned to the development of healthcare services (14). Specialized stroke rehabilitation is integrated in the public healthcare systems in Nordic countries (15), but, whereas the Norwegian study region mainly emphasizes inpatient rehabilitation, the Danish region has developed an additional and more specialized, community-based rehabilitation programme (16). Although some studies have reported different rehabilitation pathways in the early subacute phase of stroke (17), no previous studies have, to our knowledge, compared unmet needs post stroke in participants with different subacute rehabilitation pathways.The primary aim of this study was to examine patient-reported needs for healthcare and rehabilitation services in a cohort with different rehabilitation pathways recruited from 2 Nordic country-regions. Secondary aims were to assess to what extent these needs were met or unmet 3 months post stroke and to explore factors associated with met and unmet needs.     

GENDER,AIDS, AND BEREAVEMENT: A COMPARISON OF WOMEN AND MEN LIVING WITH HIV

The purpose of this study was to examine the bereavement experience, psychiatric morbidity, and suicidality in bereaved men and women living with HIV. HIV + women (n = 31) who reported a loss in the recent 12 months were case matched to bereaved HIV + men (n = 62) on the basis of lifetime histories of major depression. Study participants were examined for grief reactions, psychiatric morbidity, mood symptomatology, and suicidality using the Texas Revised Inventory of Grief Revised, Structured Clinical Interview for DSM-III–R, the Hamilton Depression and Anxiety Rating, and the Diagnostic Interview Schedule for Suicide. Bereaved HIV + women presented with intensified bereavement responses, a higher prevalence of current generalized anxiety disorder, and elevated thoughts and gestures of suicide and when compared to HIV + men. In conclusion, bereaved women living with HIV may be at increased risk for bereavement complicated with psychiatric morbidity and thoughts of suicide. It is critical that adequate mental health support services be available to this growing risk group of bereaved individuals.     

ASSESSMENT OF SUICIDAL IDEATION IN YOUNG MEN AND WOMEN: THE INCREMENTAL VALIDITY OF THE MMPI-2 CONTENT SCALES

This study of 139 women and 75 men investigated the incremental validity of the MMPI-2 in assessing suicidal ideation by examining the unique contribution of the 15 content scales beyond what is provided by the 13 basic validity and clinical scales. A multivariate analysis of variance resulted in a significant difference on the validity, clinical, and content scales for young men and women. Women scored significantly higher than men on the Hypochondriasis, Depression, Conversion Hysteria, and Masculinity-Femininity scales and lower than men on the Hypomania, Fears, Anger, and Type A scales. The results of the hierarchical regression analyses indicated that for women, hopelessness and reasons for living; the Correction, Paranoia, Conversion Hysteria, Psychopathic Deviate, and Hypomania scales; and the Anger content scale contributed significantly to the prediction of suicidal ideation. For men, hopelessness, the Lie and Hypomania scales, and the Type A content scale contributed significantly to the prediction of suicidal ideation.Thus, it would appear that a different pattern of concerns and difficulties are manifested in young men and women related to suicidal ideation. Limitations of the present study and future directions for research are discussed.     

THE INCIDENCE OF OSTEOPOROSIS IN NORMAL WOMEN: ITS RELATION TO AGE AND MENOPAUSE

The spine, hands and femur were X-rayed in 152 normal womenbetween 19 and 83 years of age. Metacarpal and femoral cortical thickness and vertebral densityall tended to fall with age, particularly after the fifth decade.Vertebral biconcavity, on the other hand, did not develop. When the indices of osteoporosis were related to the menopauseit was observed that the fall in vertebral density occurredabout five years after the menopause, metacarpal cortical thicknessstarted to fall about 10 years after the menopause and femoralcortical thickness about five years later still. The results suggest that the osteoporotic process commencesor accelerates in women soon after the menopause but cannotbe taken to signify that this process is necessarily a normalor physiological one. ² Present address: M.R.C. Mineral Metabolism Research Unit,General Infirmary, Leeds. ³ Present address: Department of Bio-Engineering, Universityof Strathclyde, Glasgow.     

LONG-TERM EMPLOYMENT STATUS AND THE ASSOCIATION WITH FATIGUE IN PATIENTS WITH GRADE II GLIOMAS

ObjectiveTo investigate employment status and return to work in relation to fatigue in patients with World Health Organization (WHO) grade II glioma.DesignExploratory cross-sectional study.SubjectsPatients with grade II glioma, who underwent surgery between 2005 and 2016.MethodsA postal survey was sent in 2019, which included the Short Form-Health and Labour Questionnaire and the Multi-dimensional Fatigue Index. Outcomes of fatigue in subgroups of (not-) return to work were compared using independent t-tests and x² tests. The association between fatigue and return to work was analysed using multivariable logistic regression.ResultsIn total, 73 patients were included in the study (age at diagnosis 41.0 years (standard deviation (SD) 9.2 years), time post-diagnosis 8.0 years (interquartile range (IQR) 6-11 years). At diagnosis, 61 patients were employed and 32 returned to work during follow-up. The return to work group was significantly younger than the not-return to work group (p = 0.007). The proportion of patients who indicated that the consequences of glioma had affected return to work, in terms of demotion or reduced working hours, was 68.7%. The not-return to work group reported significantly more fatigue in all domains than the return to work group (p < 0.05). Mental fatigue (p = 0.023) and physical fatigue (p = 0.065) were independently associated with return to work, adjusted for age, sex and the use of anti-epileptic drugs.ConclusionLong-term fatigue is associated with return to work in patients with grade II glioma. Patients who were able to work in the long term were less fatigued, younger, more often male, and used less anti-epileptic drugs than the patients who did not return to work.LAY ABSTRACTPatients with glioma have adult brain cancer. These patients are relatively young and are of working age when they develop this disease. Treatment options for glioma have improved over recent years, and patients will survive approximately 5-15 years. Almost all patients are of working age. Because of the increased survival time, patients find it important to continue to participate in society, especially in work. This study examined working patterns in patients with glioma several years after the start of their disease. Fifty-two percent of patients were working 8 years after the diagnosis of glioma. Many patients with brain tumours felt tired (fatigued), both mentally and physically. Patients who were able to work in the long term were less fatigued, younger, more often male, and used less anti-epileptic drugs than the patients who did not return to work.Key words: employment, glioma, return to work, fatigue

Engagement in work is very important from a societal perspective and from an individual perspective, in preventing financial stress, social isolation and loss of self-esteem (1–3).In the general cancer population, improvements in diagnosis and treatment have increased the prognosis of patients, and an increasing number of patients return to work (RTW) following treatment or continue to work during therapy (4). A focus on RTW is part of the societal reintegration of cancer survivors (5).Rates of RTW in the overall cancer population range widely, from 30% to 93% (5–7). A metaanalysis reported that cancer survivors overall were 1.37 times more likely to be unemployed than healthy control participants, but patients with a central nervous system cancer were 1.78 times more likely to be unemployed (7).Patients diagnosed with grade II glioma are usually early in their working age and have a favourable midterm prognosis, with a survival time between 5 and 15 years (8, 9). RTW has long been an understudied aspect. Recently, Yoshida et al. (10) and Senft et al. (11) studied rates of RTW for patients with grade II and III glioma. They reported a RTW rate of 54.0% one year after surgery and after a median follow-up of 43.8 months (range 11–82 months) 70.7% of patients were able to resume a working life.Fatigue is a highly prevalent and debilitating symptom in cancer survivors, including patients with glioma (12). Cancer-related fatigue is defined as a “persistent, subjective sense of tiredness related to cancer and cancer treatment that interferes with usual functioning” It is described as a multidimensional phenomenon. In all types of cancer, fatigue is common during treatment and follow-up (13, 14).Fatigue is a negative predictor of RTW in patients who survive cancer (1, 15, 16). Fatigue and treatment-related symptoms are important reasons for not returning to work in diffuse glioma of all grades (11, 17). Since many patients with low-grade glioma have a relatively favourable prognosis, RTW is an important element of survival. The present study therefore investigated employment status and RTW in patients who underwent surgery for a grade II glioma after diagnosis, and the association between fatigue and employment status.     

2010年鲁豫两省316名招飞学生心品检测后蛋白尿分析

招收飞行学员体格检查标准中只有晨尿的检测,但没有突出飞行职业体力消耗对泌尿系统的影响,同时也针对招飞学生入学后时有蛋白尿现象的发生。为此,我们对316例招飞学生体格检查合格后,又进行心品检测后的尿液检测,为招飞学生体格检查标准的补充提供科学依据。     

COGNITIVE AND EMOTIONAL SYMPTOMS IN PATIENTS WITH FIRST-EVER MILD STROKE: THE SYNDROME OF HIDDEN IMPAIRMENTS

ObjectiveTo evaluate the prevalence of cognitive and emotional impairments one year after first-ever mild stroke in younger patients.DesignProspective, observational, cohort study.SubjectsA consecutive sample of 117 previously cognitively healthy patients aged 18–70 years with mild stroke (National Institutes of Health Stroke Scale score ≤ 3) were included in 2 hospitals in Norway during a 2-year period.MethodsAt 12-month follow-up, patients were assessed using validated instruments for essential cognitive domains, fatigue, depression, anxiety, apathy and pathological laughter and crying.ResultsIn total, 78 patients (67%) had difficulty with one or a combination of the cognitive domains psychomotor speed, attention, executive and visuospatial function, and memory. Furthermore, 50 patients (43%) had impairment in either one or a combination of the emotional measures for anxiety, depressive symptoms, fatigue, apathy or emotional lability. A total of 32 patients (28%) had both cognitive and emotional impairments. Only 21 patients (18%) scored within the reference range in all the cognitive and emotional tools.ConclusionHidden impairments are common after first-ever mild stroke in younger patients. Stroke physicians should screen for hidden impairments using appropriate tools.LAY ABSTRACTMany patients with minimal or no apparent neurological deficits after stroke may experience cognitive and emotional symptoms. The quality of life and functioning of these patients may be reduced. Our research group studied 117 previously cognitively healthy patients aged 70 years or younger with mild stroke 12 months after the stroke event. They were assessed for cognitive and emotional impairments using validated tests for cognitive function, fatigue, depression, anxiety, and apathy. Only 21 patients (18%) scored within the normal range in these tests. In conclusion, “hidden impairments” are common among younger stroke patients. It is important for patients, their surroundings and stroke physicians to be aware that such difficulties can occur after even a mild stroke.Key words: mild stroke, younger patients, cognitive impairment, depression, anxiety, apathy, fatigue, hidden impairments

Outcome after stroke has improved remarkably over recent years due to better prevention and improved acute treatments in the stroke units (1) and by reperfusion therapy (2).Still, independently of age and lesion size, cognitive and emotional impairments after stroke are common, with a prevalence of dementia of up to 20% and of mild cognitive impairment (MCI) of 38% in a general stroke sample one year after onset of symptoms (3), and a prevalence of depression and anxiety reaching 30% and 20–25%, respectively (4). However, the number of cognitive and emotional impairments detected after stroke vary due to heterogeneity in the cognitive instruments, used diagnostic criteria and demographic factors, such as educational level, vascular risk factors and comorbidity. Since even first-ever stroke can lead to cognitive deficits in patients who are previously cognitively intact, it has been suggested that future research on post-stroke cognitive deficits should focus on this patient group (5).Persons with minimal neurological deficits after stroke are often discharged shortly after admittance, with the observation that “everything seems to be alright”. However, on return to their everyday lives, they may realize that their quality of life and functioning has changed. These patients may face difficulties affecting their memory, concentration, attention, and commonly experience fatigue (6). Pendlebury et al. (7) showed that, in a sample of patient with minor stroke, 8.2% were diagnosed with dementia one year after stroke, which was significantly higher than for an age-matched general population. Emotional impairments, such as anxiety, depression and apathy, can also occur (6, 8). It has been suggested that younger persons are at particular risk of developing disabling cognitive and emotional impairments after stroke (9).As a consequence, patients with stroke, stroke patients’ organizations, and health professionals have introduced the concept of “hidden impairments” (10). The syndrome of hidden impairments is proposed to include cognitive and emotional impairments that are not revealed through neurological examination or cognitive and emotional screening instruments used in clinical daily routine (10). Hidden impairments may include executive dysfunction, memory impairment, language difficulties, reduced psychomotor speed, fatigue, pathological laughter and crying, anxiety, depression, and apathy. The aim of this prospective, observational, cohort study was to evaluate the prevalence of hidden impairments 12 months after first-ever mild stroke in patients aged 70 years or younger.     

促性腺激素紊乱性闭经妇女体围指数与其血液流变性之间关系的研究

目的：研究促性腺激素紊乱所致闭经妇女的体围指数──腰围与臀 围比值与其血液流变性之间的关系。方法：随机选择符合高促性腺激素闭经诊断的 妇女２４例（１组,以下简称高Ｇｎ组）和低促性腺激素闭经诊断的妇女４４例（Ⅱ组, 以下简称低Ｇｎ组）,根据体围指数（ＷＨＲ）的不同（ＷＨＲ＜０．８,ａ组;ＷＨＲ＜０． ８５,ｂ组;ＷＨＲ＞０．８５ｃ组）,Ⅰ组和Ⅱ组各分为ａ、ｂ、ｃ三小组,同时选择正常妇女 ２５钩（Ⅲ组,以下简称正常组）,该组ＷＨＲ均＜０．８０。血流变测定的指标;全血高 切粘度、全血低切粘度、血浆粘度、血沉、压积、还原粘度、Ｋ值、纤维蛋白原、体外血 栓长度、体外血栓湿重。结果：（１）在 ＷＨＲ小于 ０．８的闭经妇女中,高Ｇｎ组闭经 妇女的年龄和闭经时间与低 Ｇｎ组相比都具有显著性差异,但在 ＷＨＲ大于０．８ 的闭经妇女中,高Ｇｎ组和低Ｇｎ组闭经妇女的年龄与闭经时间之间不存在显著差 异;（２）血液流变学指标检测显示,高Ｇｎ组和低Ｇｎ组闭经妇女的血液流变学指标 与正常组妇女相比,绝大部分指标处于异常,在高 Ｇｎ组闭经妇女中,ＷＨＲ＜０．８０ 和 ＷＨＲ＜０．８５组闭经妇女的低切、还原、Ｋ值和血栓湿重等指标均显著低于 ＷＨＲ＞０．８５组,     

EUROPEAN STROKE PREVENTION STUDY 2: DIPYRIDAMOLE AND ACETYLSALICYLIC ACID IN THE SECONDARY PREVENTION OF STROKE

In 1988, an optimal antiplatelet regimen for secondary stroke prevention remained to be defined. We undertook a randomised, placebo-controlled, double-blind trial to investigate the safety and efficacy of low-dose acetylsalicylic acid (ASA), modified-release dipyridamole, and the two agents in combination. Patients with prior stroke or transient ischaemic attack (TIA) were randomised to treatment with ASA alone (50 mg daily), modified-release dipyridamole alone (400 mg daily), the two agents in a combined formulation, or placebo. Primary endpoints were stroke, death, and stroke or death. TIA and other vascular events were secondary endpoints. Patients were followed on treatment for two years. We concluded that dipyridamole, in a modified-release form, at a dose of 200 mg b.d. and ASA 25 mg b.d., have been shown to be equally effective in the secondary prevention of ischaemic stroke and TIA; that when co-prescribed, the protective effects are additive, the combination being significantly more effective than each agent prescribed singly; and that low-dose ASA does not eliminate the propensity for induced bleeding.     

WOMEN SURVIVORS OF CHILDHOOD ABUSE: THE IMPACT OF TRAUMATIC STRESS ON EDUCATION AND WORK

A disempowering after-effect of childhood abuse that is not well-researched in nursing is the inability of many women abuse survivors to perform successfully in adulthood tasks such as working, managing money, and parenting. This inability often results from lack of family support, cultural impoverishment, limited formal education, and for some, illiteracy. By default, many women survivors engage in criminal, usually dangerous forms of work. A critical/feminist interview study involved 20 urban low income abuse survivors, who were mostly women of color. Participants were recovering cocaine misusers who had suffered multiple forms of childhood maltreatment. This article reports on a secondary analysis of narratives given by survivors, focused on learning and work difficulties. Findings were grouped into five broad domains: (1) school as problematic, (2) lack of adult life skills, (3) problems with academic and health literacy, (4) legitimate and illicit forms of work, and (5) means of help. In vivo quotes support these themes, and policy and practice implications are discussed.