精神分裂症患者随访1年的复发规律及因素探讨

目的:探讨精神分裂症患者的复发因素及1年的复发规律。方法:采用自编调查问卷及阳性与阴性症状量表,对2013年1-12月期间我院出院的90例精神分裂症患者在出院当天进行问卷评估,在出院后的3、6、9、12个月进行随访。结果:1研究结束时,24例患者病情复发住院。1年的复发率为26.67%;2复发与未复发患者一般情况及阳性与阴性症状量表比较,病程(Z=-2.078,P0.05)、住院次数(Z=-4.004,P0.05),出院时阳性与阴性量表一般精神病理分(Z=-2.907,P0.05)差异显著;3二元Logistic回归分析发现,住院次数和一般精神病理分是复发入院的影响因素(P0.05),住院次数是复发的危险因素(OR=0.749,95%CI=0.61~0.90),一般精神病理分是复发入院的保护因素(OR=1.139,95%CI=1.02~1.26)。患者在第3、6、9、12个月的累积复发率分别为5.56%(5/90),12.22%(11/90),21.11%(19/90),26.67%(24/90)。对不同时点的复发率进行曲线拟合,曲线拟合优度为R2=0.995,拟合优度良好,说明患者的复发率呈上升的趋势。结论:1患者既往的住院次数,阳性与阴性量表分中的一般精神病理分是复发入院的影响因素,减少入院次数,可以减少患者的复发;2患者1年内的复发率呈上升趋势,如何对出院患者进行积极有效干预,是今后预防复发的工作重点之一。     

Childbirth and changes of women's social support network and mental health

A questionnaire surveys of women was conducted, 58 persons at one month, 73 at four month, and 42 at one year after childbirth, in order to investigate the relationship between social support and mental health. Main results concerning stress-buffering effects of social support were as follows. At one month after childbirth, marital intimacy showed stress-buffering effect. At four months, beneficial factors were; informational and emotional support and social companionship from family members other than husband or mother, and informational and emotional support from a friend who was the second closest. At one year were; instrumental, informational, and emotional support and social companionship from other person who was not among those already mentioned, and informational and emotional support and social companionship from still another who was the second important. These results suggested that social support network of women underwent successive changes after childbirth. In addition, a model of changing social support network was presented, and it suggested that changing support network so that one could obtain appropriate support was effective on stress buffer.     

Depression and cardiac morbidity 5 years after coronary artery bypass surgery

The purpose of this study was to determine whether depression 1 month after coronary artery bypass surgery would be associated with greater cardiac morbidity in patients 5 years later. The cardiac symptom most affected by depression was the recurrence of angina. Factors associated with a return of angina at 5 years were depression measured preoperatively, at 1 month, at 1 year, and at 5 years. Additional significant factors were male sex and a preoperative history of smoking, percutaneous transluminal coronary angioplasty, or cerebrovascular accident. When these factors were combined in multiple logistic regression analyses, the score on the Center for Epidemiologic Studies Depression Scale at 1 month was the most significant of all factors. The depression score at 1 month after coronary artery bypass surgery is an important indicator of cardiac morbidity up to 5 years later.     

Analysis of the medical records in a pediatric emergency room.

A prospective evaluation of Pediatric Emergency Room records permitted analysis of major errors and of factors contributing to them. All records from July 1973 to June 1975 were reviewed daily by a board certified pediatrician using a previously established protocol. Patients had been seen by pediatric house staff from 4 PM to 8 AM on weekdays and from 8 AM to 8 AM on weekends and 25,907 records were reviewed. Errors were detected in 9.5 percent of these. The most common was an incomplete set of vital signs which accounts for 68 percent of all errors. Failure to arrange for appropriate follow-up care occurred in 16 percent of cases. Other errors ranged from two to four percent and included inadequate use of laboratory, incomplete physical examination, inappropriate diagnosis or therapy. Major omissions in the history were uncommon (1.3 percent). The frequency of errors was significantly greater at the start of each academic year (July to October), and at the start of each month (P<0.001). The errors occurred significantly more often at the first year level than the second year level (P<0.01). This study suggests a means of improving record keeping and house staff education, ie, attending-level supervision should be emphasized at the start of each month and academic year. Daily reviews of errors with the house staff as well as modification of chart design may bring about more complete patient evaluation and detailed recording of findings, diagnosis, and disposition.     

Age-dependent organ and effective dose coefficients for external photons: a comparison of stylized and voxel-based paediatric phantoms

This present study investigates the anatomical realism of conventional stylized models of children by comparing organ dose conversion coefficients for the ORNL paediatric phantom series with those determined in the UF (University of Florida) voxel paediatric phantoms. The latter includes whole-body models of a 9 month male, 4 year female, 8 year female, 11 year male and a 14 year male. Of these phantoms, the 1 year, 5 year and 10 year ORNL phantoms, and 9 month male, 4 year female and 11 year male UF voxel phantoms were selected for side-by-side comparisons under idealized external photon irradiation. Organ absorbed dose per unit air kerma (Gy/Gy) for various radiosensitive organs and tissues were calculated for monoenergetic photons over the energy range of 15 keV to 10 MeV and for six irradiation geometries: anterior-posterior (AP), posterior-anterior (PA), right lateral (RLAT), left lateral (LLAT), rotational (ROT) and isotropic (ISO). Differences in organ dose conversion coefficients for the gonads, bone marrow, colon, lung and stomach, to which prominent tissue weighting factors are assigned, were depicted and analysed. Two major causes of observed differences were suggested: differences in organ shape and position and the differences in tissue shielding by overlying tissue regions within the phantoms. Significant discrepancies caused by anatomical differences between the two types of phantoms are also reported for several organs, and in particular, the thyroid and urinary bladder. The results of this study suggest that the paediatric series of ORNL phantoms also have less realistic internal organ and body anatomy and that dose conversion coefficients from these stylized phantoms should be re-evaluated using paediatric voxel phantoms.     

Monthly distribution of menarche among schoolgirls from a municipality in Southeastern Brazil

We studied the monthly distribution of menarche among schoolgirls from Barrinha, Brazil, a municipality of rural characteristics in the process of transition to urbanization, economically dependent on sugar cane culture and processing. The association between season of the year, month of the year, and birth month and the occurrence of menarche was evaluated. The schoolgirls who provided the date of menarche (month and year) by the recall method and who had menarche up to 36 months before the interview were selected for analysis (460 girls). The correlations between month of occurrence of menarche and month of birth and between menarche and seasons of the year were determined by the chi‐square test and the mean monthly ages at menarche were compared by Student's t‐test, with a significance level of 0.05. There was a correlation between month of birth and month at menarche, with a peak of occurrence of menarche in December not affected by the menstruating patterns of maturation, but no correlation between menarche and seasons of the year. The difference between mean age at menarche in December (spring–summer transition) and in June (autumn–winter transition) was not significant. Mean age at menarche during the month following school vacations was lower. We conclude that situations of stress–relaxation transition, such as end of the school year, beginning of school vacation, and, perhaps most important, the socioeconomic factor—the end of the sugar cane harvest, when rural workers receive their final payments—favor the occurrence of the peak of menarche in December. Am. J. Hum. Biol. 16:17–23, 2004. © 2003 Wiley‐Liss, Inc.     

Breastfeeding duration is a risk factor for atopic eczema

BACKGROUND: The results of numerous studies on the influence of breastfeeding in the prevention of atopic disorders are often contradictory. One of the most important problems is confounding by other lifestyle factors. OBJECTIVE: The aim of the present study was to analyse the effect of any breastfeeding duration on the prevalence of atopic eczema in the first seven years of life taking into account other risk factors. METHODS: In an observational birth cohort study 1314 infants born in 1990 were followed-up for seven years. At 3, 6, 12, 18, 24 months and every year thereafter, parents were interviewed and filled in questionnaires, children were examined and blood was taken for in vitro allergy tests. Generalized Estimation Equations (GEE)-models were used to model risk factors for the prevalence of atopic eczema and for confounder adjustment RESULTS: Breastfeeding was carried out for longer if at least one parent had eczema, the mother was older, did not smoke in pregnancy, and the family had a high social status. The prevalence of atopic eczema in the first seven years increased with each year of age (OR 1.05; 95% CI 1.01-1.09 for each year), with each additional month of breastfeeding (1.03; 1.00-1.06 for each additional month), with a history of parental atopic eczema (2.06; 1.38-3.08), and if other atopic signs and symptoms appeared, especially specific sensitization (1.53; 1.25-1.88), and asthma (1.41; 1.07-1.85). Although breastfeeding should be recommended for all infants, it does not prevent eczema in children with a genetic risk. CONCLUSION: Parental eczema is the major risk factor for eczema. But in this study, each month of breastfeeding also increased the risk.     

Life events and relapse in bipolar affective disorder.

In a 2 year study of life events and relapse in a cohort of 62 patients with bipolar affective disorder, an excess of events was found during the month immediately preceding relapse. Of 52 relapses 19% were preceded by a severe event in the previous month, compared to a background rate of 5% of patients experiencing a severe event each month at other times. The rate of life events prior to relapse was not apparently different between manic and depressive relapse, though the number of depressive episodes was small.     

The reliability and validity of the American Board of Internal Medicine Monthly Evaluation Form.

PURPOSE: To report indicators of reliability and validity of the American Board of Internal Medicine Evaluation Form (ABIM-MEF) at one institution (Wright-Patterson Medical Center). METHOD: Completed ABIM-MEFs from 1990-1999 were reviewed. Reliability measures included Cronbach alpha, interrater reliability, and rating consistency between different types of staff and rotations. Construct validity was investigated by tracking ABIM-MEF scores over time and with factor analysis. Predictive validity was assessed by correlating ABIM-MEF scores with the In-training Examination and ABIM Certifying Examination results RESULTS: The 71 residents averaged 12 ABIM-MEFs per year. The forms had a Cronbach alpha of 0.96 and high interrater reliability (intraclass correlation coefficients > 0.80). Ratings did not differ by type of attending or rotation, except that noninternists rated residents lower on procedural skills. ABIM-MEF questions about judgment, knowledge, and clinical skills showed significant improvement from month to month during each academic year as well as year to year. In contrast, questions on professional attitudes, humanism, and procedural skills sections improved between postgraduate year 1 and postgraduate year 2 only. ABIM-MEF questions collapsed into two domains in factor analysis: judgment-knowledge-skills and attitude-humanism. ABIM-MEF questions from judgment and knowledge sections modestly predicted In-training Examination and ABIM Certifying Examination results. In contrast, professional attitude, humanism, and clinical as well as procedural skill questions had little discriminative ability. CONCLUSIONS: The ABIM-MEF appears to be reliable and valid. Further, factor analysis results support the ABIM's movement to simplify the monthly evaluation form to the new Accreditation Council for Graduate Medical Education core competencies.     

Age at natural menopause in Iran

Objectives: Estimation of mean and median age at menopause among Iranian women using a cumulative distribution by region. Methods: The number of 8194 women aged between 30 and 65+ who enrolled in National Health Survey in the year 2000 in Iran through cluster sampling were studied and according to their age and the onset of their menopause (12 month consecutive menstrual cessation), the pattern of age at natural menopause has been described using a cumulative distribution. Results: The median age of menopause has been calculated to be 49.9, 49.2, and 49.6 years in urban, rural, and total population, respectively. While the mean age at menopause in total population was 50.4 years (S.D.=4.3). As it has been shown, the median age of menopause in rural areas (49.2) is earlier than urban areas (49.9). This difference is statistically significant (95% CI: 1.00066, 1.03363). Conclusion: There are different factors influencing age at natural menopause but there are not certain and homogenous results about those factors in different studies. Therefore, it is obvious that exploring these factors in different regions in Iran merit to be done.     

Cellular immunity in adolescents and adults following acellular pertussis vaccine administration

Cell-mediated immune (CMI) responses to an acellular pertussis vaccine administered to 49 subjects, a subset of participants in the National Institutes of Health-funded adult acellular pertussis vaccine efficacy trial, were evaluated and compared with antibody responses to vaccine antigens. Levels of proliferation of and cytokine secretion from lymphocytes cultured in the presence of pertussis toxin, filamentous hemagglutinin, or pertactin were measured before vaccination and 1 month and 1 year after vaccination. Statistically significant increases in lymphocyte stimulation indices and cytokine secretion were noted at both 1 month and 1 year after vaccination. Brisk pertussis antigen-specific immunoglobulin G responses were also noted at 1 month after vaccination, but these responses had declined by nearly 50% at 1 year after vaccination. These studies clearly demonstrate that both cellular and humoral immune responses occur after the administration of acellular pertussis vaccines to adolescents and adults but that the CMI responses are of greater magnitude and longer duration. CMI responses may be a better correlate of long-term protection.     

Clostridium difficile infection after allogeneic hematopoietic stem cell transplantation: incidence, risk factors, and outcome

Clostridium difficile (C. difficile) infection was observed in 13% of recipients after hematopoietic stem cell transplantation (HSCT), mainly in the first month posttransplantation. Risk factors were cord blood as the source of stem cells, acute graft-versus-host disease (GVHD), and total body irradiation (TBI). No association was found with an increased risk of mortality. The purpose of this study was to evaluate the incidence, risk factors, and outcome of C. difficile infection (CDI) after HSCT. We conducted a single-center, retrospective, cohort study on all patients who received an allogeneic HSCT from January 2004 to December 2007. All patients with diarrhea in the first year after HSCT were tested for the presence of C. difficile in stools. Among the 407 assessable patients, 53 presented at least 1 CDI in the first year post-HSCT. The total incidence rate?was 5.6 cases of CDI per 10,000 patient-days. Fifty percent of cases were diagnosed in the first month after HSCT, and 95% occurred during the first 6 months. Fewer than 5% of patients with CDI had severe diarrhea and severe complications were never observed. TBI in the conditioning regimen, cord blood as the source of stem cells, and acute graft-versus-host disease (aGVHD) were independently associated with CDI. Six patients (11%) had a recurrence of CDI. Four patients required second-line treatment with vancomycin. With a median follow-up of 22 months, the 2-year overall survival rates were similar between patients who presented a CDI and those who did not. CDI was observed in approximately 13% of recipients after HSCT, mainly in the first month posttransplantation and was associated with CB, aGVHD, and TBI. CDI was not associated either with severe complications or with an increased risk of mortality in this large cohort of patients.     

婴幼儿肠套叠与轮状病毒性腹泻分布特征分析

目的 了解苏州市婴幼儿肠套叠的发病状况及肠套叠与轮状病毒性腹泻是否存在关联.方法 采用回顾调查的方法 ,以<2岁的婴幼儿为对象,统计1999-2003年在门诊和住院的肠套叠病例.采用ELISA法对2001年9月至2003年8月2岁以下的腹泻住院患者的粪便标本进行病毒抗原测定.结果 苏州市2岁以下的肠套叠患儿1101例,1999-2003年1岁以下肠套叠的发病率分别为:275.3/10万、338.2/10万、547.0/10万、515.3/10万、425.4/10万,平均年发病率为418.1/10万.肠套叠以4-10个月最常见.共692例(62.85%).平均年龄(9.62±5.65)月.轮状病毒性腹泻是以5~16个月最常见,共252例(76.13%).平均年龄(11.42±5.14)月.两组间发病年龄经比较,z=-15.52,P<0.01.肠套叠的发病高峰季节在4~8月份,共595例(54.04%).而轮状病毒性腹泻的发病的高峰季节在10月至次年1月,共232例(70.09%).两组问发病的季节的分布进行统计学检验,X2=226.06,P<0.001.结论 流行病学的资料显示肠套叠与轮状病毒性腹泻的相关性有待进一步研究.     

Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes

This study examined the prevalence of screened posttraumatic stress disorder (PTSD) and associated diabetes-related outcomes. A sample of American Indian adults with type 2 diabetes (n = 218) participated in interviewer-administered surveys. Using a cutoff of 3 on the Primary Care PTSD screener, 21.8 % of participants screened positive for PTSD. PTSD symptoms were negatively associated with self-rated health status and positively associated with past year hospitalization after controlling for several demographic factors, but not after controlling for depressive symptoms. Past month frequency of hyperglycemia symptoms was not related to PTSD symptoms. When grouped by mental health conditions (neither screened PTSD nor depressive symptoms, screened PTSD only, depressive symptoms only, and both), those with both screened PTSD and depressive symptoms reported the highest proportion of any past month hyperglycemia, past year hospitalization, and low self-rated health status. Screened PTSD, especially in those with comorbid depressive symptoms, is an important consideration in diabetes care.     

Month of birth and childhood atopic diseases in the tropics

Relatiotiship between the month of hirth and prevalence of diagnosed asthma, asthma-like symptoms (wheezing, nocturnal cough, and exerctse wheezing), rhinitis, and eczema was investigated in four cohorts each ol primary schoolchildren and secondary school (high school) adolescents in Singapore by questionnaire survey. Significantly increased prevalence rates of diagnosed asthtna and asthma-like symptoms were observed in certain hirth months of the year for two adolescent cohorts, while significant association between birth month and presence of symptoms of rhinitis was found in a cohort of 6-7-year-olds. However, when demographic factors were taken into consideration by multivariate analysis, only the association between asthtna. asthma-like symptoms, and birth month remained significant in one of the adolescent cohorts. There was, therefore, only a weak association between the month of birth and atopic disease in our schoolchildren. The overall seasonal trends, however, did show two mam seasons (March-May and September-November) associated with higher prevalence of these diseases.     

The effect of age on IgE production in rats.

Inbred BN-rats were immunized at different ages with a standardized amount of ovalbumin and a1(OH)3. The specific IgE antibody response and total serum IgE levels were significantly influenced by age. The IgE antibody response increased to a maximum in 2-month-old rats and decreased progressively at a more advanced age. Total serum IgE levels increased progressively from the age of 1 month to the age of 5 months and decreased again at the age of one year.     

Personality predicts quality of life in pediatric patients with unintentional injuries: a 1-year follow-up study

Objective Few studies have charted the course of health-relatedquality of life (HRQoL) in pediatric injury patients, and nostudies so far have examined the extent to which variationsin HRQoL 1 month and 1 year after injury are influenced by thechild’s personality. Method One hundred and seven pediatricinjury victims (6–14 years old) completed an interviewon HRQoL and were rated on the personality domains of the Five-FactorModel by their mothers 1 month and 1 year after the incident.Results HRQoL was compromised after 1 month, particularly inthe physical domain, but improved significantly after 1 year.Lower HRQoL after 1 month was predicted by female gender, injuryseverity, functional status, and neuroticism. After 1 year,lower HRQoL was predicted by concurrent functional status andneuroticism. Conclusions Even if HRQoL in children with unintentionalinjuries returns to normal levels after 1 year, significantvariations remain, which are in part explained by personality.     

Month of birth is not a risk factor for narcolepsy with cataplexy in the Netherlands

The month of birth has been proposed as a risk factor for narcolepsy, suggesting a harmful influence during early development. Several authors have described an excess of births in March in those developing narcolepsy later. Analysis methods in published studies varied, but no study corrected completely for possible changes in seasonal birth pattern over time in the appropriate population. The present study describes changes in seasonal birth pattern of the entire Dutch population over a 79-year span and compared the monthly birth pattern of Dutch narcoleptics with the population data. Month and year of birth were noted for 307 patients with non-familial narcolepsy with cataplexy, born in the Netherlands between 1923 and 2001. The numbers of live births per month and per year from the entire Dutch population for the same period were used to calculate a virtual data set of expected births per month with exactly the number of cataplexy cases, but with the birth pattern of the Dutch population. Observed and expected numbers per month were compared using the chi-square test. In the 1970s the peak of births shifted from spring to autumn, confirming the need to correct for changing seasonal patterns. There was no significant difference between observed and expected birth numbers per month. An effect of birth month on the occurrence of narcolepsy with cataplexy was not found in a study of 307 cases after adjusting for changing birth patterns in the general population.     

Patient understanding of medical jargon: A survey study of U.S. medical students

Objective

With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school.

Methods

533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school.

Results

Fourth-year students were slightly more pessimistic about patients’ understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p = 0.004). Students both over- and under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences.

Conclusion

Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients’ understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients’ understanding or from desensitization to jargon during medical school.

Practice implications

Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula.     

A long term results of external beam radiation therapy in hemophilic arthropathy of the ankle in children

Bleeding into joint space is critical to develop hemophilic arthropathy. To reduce the frequency of bleeding in the ankle joint of children with hemophilic arthropathy, low dose external beam irradiation was performed for 37 patients. Among them, 35 patients followed-up for longer than 1 yr (median 87 months) were enrolled for analysis. The average number of bleedings per month was 3.6 during one year prior to radiation therapy. After radiation therapy, it was decreased to 2.1 during the first year, after then it was maintained in the range of 1.0 to 1.5 until the tenth year. The bleeding frequency was reduced to 42% at the first year and it was maintained in the range of 58% to 73% from the second to the tenth year. Especially the patients who had 3 or more bleedings per month, and who had MRI score more than 3 showed significant decreases. During the follow-up period, growth disturbances and secondary malignancies were not found. External beam radiotherapy can be considered for the hemophilic patients with surgical or isotope therapies are not amenable.