老年人跌倒发生原因及预防措施

随着我国人口老龄化的加剧,老年住院患者逐年增加,跌倒是造成老年患者意外伤害的主要原因,跌倒除了导致老年人死亡外,还严重威胁着老年人的身心健康、日常活动及独立生活能力,给家庭和社会带来了巨大的负担。有研究表明,〉65岁的老年人,至少有1/3每年发生1次跌倒;65-69岁女性跌倒发生率为30%,〉80岁的女性跌倒发生率为31%。以跌倒的危险因素并进行干预,可以减少跌倒的发生。     

2011-2014年上海市潍坊社区伤害监测病例特征分析

目的:了解上海市浦东新区潍坊社区卫生服务中心门诊监测伤害病例分布特征,为建立完善的伤害监测系统及制定本区伤害预防控制策略提供依据.方法:收集分析2011-2014年潍坊社区卫生服务中心门诊伤害监测报告病例,采用上海市统一报告卡填报.结果:共收集有效病例2 405例,其中男、女性别比为1:1.41,病例年龄主要集中在45岁以上,占总病例的75.72％;伤害发生原因构成居前3位的依次为跌倒/坠落(61.37％)、刀/锐器伤(20.54％)及钝器伤(10.60％);伤害发生地点主要为家里(51.27％)、公共居住场所(18.59％)和工业建筑场所(9.27％);伤害的性质主要是挫伤/擦伤(26.74％)、锐器伤/开放性伤(25.95％)及其他骨折(23.45％).结论:伤害防治的工作重点应该放在儿童、老年人的跌落、跌倒的预防上,同时,开展社区安全干预项目,有利于减少各类安全因素造成的伤害.     

老年人跌倒的院外急救及预防

<正>"跌倒包括以下两类:从一个平面至另一个平面的跌落或同一平面的跌倒,这是我国65岁以上老年人伤害死亡的首要原因。老年人跌倒的死亡率随年龄增加而急剧上升,其救治是社区临床救治的一个重要部分。为有效降低老年人跌倒的发生以及减轻老年人跌倒造成的伤害程度,2011年卫生部印发了《老年人跌倒干预技术指南》。"     

哪些老年人容易跌倒

<正>跌倒是我国65岁以上的老年人中伤害死亡的首要原因。2006年全国疾病监测系统死因监测数据显示,我国65岁以上老年人跌倒死亡率男性为49.56/10万,女性为52.80/10万。多数情况下,老年人跌倒的发生并不是一种意外,而是多种危险因素共同作用的结果。一般将老年人跌倒的危险因素分为:内在危险因素,包括生理、病理、心理及药物因     

老年人跌倒 需要社会和家庭的扶起——老年跌倒是由什么原因引起的？

我国已进入老龄化社会,65岁及以上老年人已达1.5亿。按30％的发生率估算每年将有4000多万老年人至少发生1次跌倒。跌倒是我国伤害死亡的第四位原因,而在65岁以上的老年人中则为首位,严重威胁着老年人的身心健康、日常活动及独立生活能力,也增加了家庭和社会的负担。老年人跌倒的预防和干预,是一项社会系统工程,需要政府、社区管理部门和公共卫生部门制定支持性政策,加强社区物理环境的管理和修缮,给予技术指导;需要家庭子女的密切配合：需要老年人的具体参与等,全面落实所制定的干预措施。     

老年人跌倒的危险因素分析及干预措施

跌倒是指突发、不自主、非故意的体位改变,倒在地面或比初始位置更低的平面上.按照国际疾病分类(ICD-10)对跌倒的分类,包括以下两类;从一个平面至另一个平面的跌落;同一平面的跌倒[1].跌倒是老年人常见的伤害事件,是老年人群伤残、失能和死亡的主要原因,对老年人的健康和生活自理的威胁甚大[2-3].据WHO的相关报道,目前全球老年人跌倒发生率呈上升趋势.有报道,美国老年人每年的跌倒发生率为21.6％～34.0％,日本为20.0％,我国为14.0％～34.0％[4].5.0％～15.0％的跌倒会造成脑部损伤、软组织损伤、骨折和脱臼等伤害[5-6],跌倒已成为美国老年人第6位死因[7],是英国＞75岁老年人受伤后的主要死亡原因[8].为了减少老年人跌倒的发生,现对其相关的危险因素及干预措施综述如下.     

2016学年上海市松江区学生伤害发生风险分析

目的:了解分析上海市松江区学生伤害发生现状,为今后开展学生伤害健康教育提供参考,为进行学生伤害针对性干预提供依据。方法:根据收集到的松江区伤害监测数据进行分析整理。结果:共收集学生伤害个案536例,因伤害而缺课共计2549人天数。结论:节假日、课午间休息、放学后、上课是2016学年松江区学生伤害发生的主要时段。过半数伤害发生在校内。街道公路和家庭是校外发生学生伤害最多的场所。其它活动、消遣活动和体育活动是学生伤害发生时主要的伤者活动。     

多因素评估及干预在预防社区老年人跌倒中的效果评价

目的：评价多因素评估及干预在预防社区老年人跌倒中的效果。方法：2013年1月—12月对本街道老年人进行跌倒危险评估,筛选出高危人群200人,实施多因素评估及针对性干预,主要包括健康教育、用药干预、运动干预、饮食干预、环境干预、日常生活方式干预及心理调适,每月上门指导1次。干预后随访1年,通过比较老年人干预前后的跌倒发生率、跌倒危险因素认知、预防跌倒行为,评价上述干预措施的效果。结果：老年人的跌倒发生率从干预前的38%（76/200）下降至干预后的27.1%（52/192）,差异有统计学意义（P＜0.05）。干预后老人对预防跌倒认知水平提高（P＜0.05）。在预防跌倒行为中,除居家环境改造项目外,其他项目干预前后差异均有统计学意义（P＜0.05）。结论：多因素评估及干预能有效提高社区老年人的跌倒认知水平,促使其采取措施以预防跌倒的发生,降低了社区老年人跌倒发生率,提高了老年人的健康水平和生活质量。     

汕头市某综合性医院0~4岁婴幼儿意外伤害原因分析

目的分析汕头大学医学院第二附属医院意外伤害急诊就诊0⁴岁婴幼儿意外伤害发生的原因及年龄特征,为开展低龄幼儿伤害预防干预提供参考依据。方法调查2008年1月至2012年12月期间汕头大学医学院第二附属医院意外伤害急诊就诊患儿的流行病学特征、意外伤害类型,探讨分析04岁婴幼儿意外伤害发生的原因及年龄特征,为开展低龄幼儿伤害预防干预提供参考依据。方法调查2008年1月至2012年12月期间汕头大学医学院第二附属医院意外伤害急诊就诊患儿的流行病学特征、意外伤害类型,探讨分析0⁴岁年龄段儿童在较小年龄区间的伤害机制的差异。结果在该研究群体中,顺位前5位意外伤害原因依次为跑跳中跌倒或坠落(20.6%)、从活动器材中跌倒或坠落(15.8%)、交通事故(15.5%)、从床或其他家具上跌倒或坠落(14.3%)及烧烫伤(11.7%)。在这5个致伤因素中,男女比例差异无统计学意义。1岁以下的婴儿期的主要意外伤害来自从怀抱者或牵拉者中跌倒或坠落。随着年龄增长,坠落或跌倒主要发生在跑跳中或游戏的活动器材中。结论由于跑跳中跌倒/坠落是04岁年龄段儿童在较小年龄区间的伤害机制的差异。结果在该研究群体中,顺位前5位意外伤害原因依次为跑跳中跌倒或坠落(20.6%)、从活动器材中跌倒或坠落(15.8%)、交通事故(15.5%)、从床或其他家具上跌倒或坠落(14.3%)及烧烫伤(11.7%)。在这5个致伤因素中,男女比例差异无统计学意义。1岁以下的婴儿期的主要意外伤害来自从怀抱者或牵拉者中跌倒或坠落。随着年龄增长,坠落或跌倒主要发生在跑跳中或游戏的活动器材中。结论由于跑跳中跌倒/坠落是0⁴岁婴幼儿首位伤害因素,因此应列为预防重点。     

老年人跌倒需要社会和家庭的扶起

<正>我国已进入老龄化社会,65岁及以上老年人已达1.5亿。按30%的发生率估算每年将有4000多万老年人至少发生1次跌倒。跌倒是我国伤害死亡的第四位原因,而在65岁以上的老年人中则为首位,严重威胁着老年人的身心健康、日常活动及独立生活能力,也增加了家庭和社会的负担。老年人跌倒的预防和干预,是一项社会系统工程,需要政府、社区管理部门和公共卫生部门制定支持性政策,加强社区物理环境的管理和修缮.给予     

Injury registration in a developing country. A study based on patients' records from four hospitals in Dar es Salaam,Tanzania

BACKGROUND: A recent study conducted in some parts of Tanzania has revealed that injuries rank as the third major leading cause of death among the adult population only after tuberculosis and HIV/AIDS. Critical to any injury prevention activities is a reliable surveillance system. Such a system may for instance be based on hospital registration of injuries. OBJECTIVES: The aim of this study was to evaluate available hospital records for the purpose of describing the epidemiology of injuries among inpatients in four hospitals in Dar es Salaam, Tanzania. METHODS: The study utilized patients' medical records for the year 1998. The final sample included 1098 cases from four hospitals. Data handling and analysis was performed using statistical software SPSS for windows version 10.0. Cross tabulations with Chi-square testing for independence, t-test for difference between means (independent groups) and one way analysis of variance was used. RESULTS: The age group 21 to 30 years formed the largest proportion of injury-related admissions. The male to female ratio was 2.3 to 1. The largest categories of injuries were road traffic injuries (43.7%), violence and assaults (23.5%), and falls (13.8%). Burns accounted for 6.5% of the cases. The following variables were routinely recorded in case notes: gender (100%), nature of injury/principal diagnosis (99.6%), body part injured (99.4%), and age (96.4%). CONCLUSIONS: There is a need for improving the way injuries are recorded in hospitals. Hospitals' records could provide a useful tool for monitoring injury preventive activities in developing countries like Tanzania.     

2018—2020年某院门诊药房口服降糖药用药分析

目的　了解和分析上海市松江区中心医院门诊口服降糖药用药趋势,为临床合理用药提供参考。方法　采用世界卫生组织推荐的限定日剂量（DDD）分析法,回顾性分析上海市松江区中心医院2018—2020年门诊药房口服降糖药的销售金额、用药频度（DDDs）、限定日费用（DDC）等情况。结果　2018—2020年上海市松江区中心医院门诊口服降糖药销售金额位居前两位的是α-糖苷酶抑制剂和双胍类,二肽基肽酶（DPP-4）抑制剂销售金额逐年上升;DDDs位居前三的始终是格列美脲、二甲双胍及阿卡波糖;二甲双胍和阿卡波糖DDC下降最为明显。结论　α-糖苷酶抑制剂、双胍类和胰岛素促泌剂仍是上海市松江区中心医院临床一线治疗药物,符合指南推荐,DPP-4抑制剂市场前景较大,钠-葡萄糖协同转运蛋白2（SGLT-2）也将逐渐崭露头角。     

上海市松江区居民慢性肾脏病与高尿酸血症相关性研究

目的探讨上海市松江区居民CKD与高尿酸血症的相关性。方法选取2010年2月-2013年2月上海市松江区居民体检人群中CKD合并高尿酸血症患者244例,并按统计学四分位数方法选出高尿酸组和相对低尿酸组患者,对比两组患者的年龄,BMI,SBP,DBP,CHOL,GLU,GFR。用线性回归方法分析各变量与GFR的相关性。结果两组比较,年龄、CHOL、GLU等差异无统计学意义（P〉0.05）;低尿酸组的BMI,SBP,DBP等显著低于高尿酸组,GFR显著高于高尿酸组,差异有统计学意义（P〈0.05）;GFR与血尿酸、年龄、收缩压（SBP）、BMI呈负相关,差异有统计学意义（P〈0.05）;血尿酸与GFR独立相关。结论高尿酸血症是影响GFR的独立危险因素,建议临床上发现CKD合并高尿酸血症的患者应该及时纠正高尿酸血症从而防止CKD的进展、恶化。     

Evaluating the effects of a brief motivational intervention for injured drinkers in the emergency department

OBJECTIVE: The study aim was to test whether a brief motivational intervention, with or without a booster session, would improve drinking-related outcomes more than standard Emergency Department (ED) treatment. METHOD: The study population consisted of 539 (78% male) injured patients treated in the ED and discharged to the community following their treatment. Injured patients met inclusion criteria if they were assessed as hazardous or harmful drinkers by scoring eight or more on the AUDIT and/or having alcohol in their system at the time of their injury or ED visit. Patients were randomly assigned to either standard care (SC), brief intervention (BI) or brief intervention plus a booster session (BIB). At 1-year follow-up, 447 patients (83% of the sample) were re-interviewed to measure alcohol-related negative consequences, injuries and drinking. RESULTS: Patients receiving BIB, but not B1 patients, reduced alcohol-related negative consequences and alcohol-related injuries more than did those in the SC group. All three groups reduced their days of heavy drinking. Patients with histories of hazardous drinking responded to BIB, whether or not they had consumed alcohol prior to their injury. CONCLUSIONS: Together, these results indicate that the effects of a booster session that is added to a brief intervention in the ED can be helpful to injured patients with a history of hazardous or harmful drinking, irrespective of whether they have consumed alcohol prior to their injury.     

抗菌药物不合理应用案例分析

目的:调查上海市松江区中心医院抗菌药物的应用情况,为规范抗菌药物的使用,控制药占比提供依据.方法:对本院住院病案进行回顾性统计,记录病人的基本情况、疾病诊断、用药前后实验室检查结果、手术和用药情况等,对抗菌药物的使用合理性进行分析和评价.结果:共调查住院病案1 176份,其中857份使用了抗菌药物,517份存在不合理用药情况,抗菌药物使用率为72.87%,抗菌药物不合理使用比例为60.33%.结论:本院住院病人抗菌药物使用率高,存在各种情况的不合理用药,需要制定有力的措施来纠正抗菌药物滥用和不合理应用的现象.     

恶性黑色素瘤伴胸腔积液1例报告

恶性黑色素瘤发病率逐年递增,但以胸腔积液为首发表现至呼吸科就诊相对少见。2021年10月上海市松江区中心医院发现1例,报道如下。     

上海市松江区新型冠状病毒肺炎疫情前后呼吸道病原体抗体IgM检测分析

目的:了解新型冠状病毒肺炎疫情前后松江区呼吸道感染患者的呼吸道病原体抗体免疫球蛋白（Ig）M检测情况。方法:收集2019年3月至2021年2月上海市松江区中心医院所有因呼吸道感染就诊的患者5 769例（其中男性3 335例,女性2 434例,年龄3 d～86岁）的血清样本,采用间接免疫荧光法同时检测呼吸道合胞病毒（re...     

拉萨市道路交通事故对机体损伤的研究

目的研究拉萨市道路交通事故流行病学特征及机体损伤规律,探讨交通事故发生时对创伤急救的区域分配,为进一步完善临床医学的应用实践提供理论依据。方法采集西藏自治区第一人民医院2010年拉萨市道路交通事故伤258例进行流行病学及机体损伤的研究,所得数据用统计学的方法进行分析。结果男女比为4.06：1,平均年龄为39.96岁,众数33岁,P2520岁,P7545岁,20~49岁占总案例数的67.8%。损伤部位排序前三位依次是头颈部、下肢、胸部。骨折部位排序前三位依次是颅骨、下肢、胸壁。结论男性明显多于女性,20~49岁年龄段的案例最多;头颈部损伤最多,以颅脑损伤为主;颅骨骨折最多;损伤部位与骨折部位情况基本一致。     

Bicycle road crashes during the fourteenth and fifteenth years of life

From a sample of 848 teenagers 57 individuals reported a total of 62 bicycle road crashes, 40 (65%) of which involved injury to a cyclist. Thirty (48%) of the crashes occurred when the cyclist lost control of the bicycle (73% of which involved injury) and 17 crashes (27%) involved a moving motor vehicle (41% of which involved injury). The majority of the injuries were not serious and of those with multiple injuries no one had an injury severity score greater than five. The body area most frequently injured was the extremities (74%), with the remainder primarily head injuries. Environmental conditions were not a major contributing factor in these crashes. In only five cases the cyclist was wearing a safety helmet. Recommended measures to prevent, or minimise, bicycle related injuries include the wearing of safety helmets, bicycle maintenance checks, and road safety awareness instruction.     

The safety experience of New Zealand adventure tourism operators

BACKGROUND: This survey examined parameters of the New Zealand adventure tourism industry client injury risk. The research also sought to establish priorities for intervention to reduce adventure tourism risk, and identify client injury control measures currently in place (or absent) in the New Zealand adventure tourism industry, with a view to establishing guidelines for the development of effective adventure tourism safety management systems. This 2003 survey builds upon an exploratory study of New Zealand adventure tourism safety conducted by us during 1999. METHOD: A postal questionnaire was used to survey all identifiable New Zealand adventure tourism operators. The questionnaire asked respondents about their recorded client injury experience, perceptions of client injury risk factors, safety management practices, and barriers to safety. RESULTS: Some 27 adventure tourism activities were represented among the responding sample (n=96). The highest client injury risk was reported in the snow sports, bungee jumping and horse riding sectors, although serious underreporting of minor injuries was evident across the industry. Slips, trips and falls (STF) were the major client injury mechanisms, and a range of risk factors for client injuries were identified. Safety management measures were inconsistently applied across the industry. CONCLUSIONS: The industry should consider the implications of poor injury reporting standards and safety management practices generally. Specifically, the industry should consider risk management that focuses on minor (e.g., STF) as well as catastrophic events.