阿尔兹海默病患者生活质量及其影响因素分析

目的 了解阿尔兹海默病(AD)患者生活质量及其影响因素,为AD的临床治疗工作提供科学依据。方法 采用以医院为基础病例对照研究方法对华中科技大学同济医学院附属梨园医院精神科2013年1月-2014年12月收治的378例≥60岁AD患者及同期在该医院进行健康体检的400名≥60岁健康体检者进行问卷调查,评价其生活质量,并采用多元线性逐步回归模型分析AD患者生活质量相关影响因素。结果 病例组AD患者阿尔兹海默病生活质量量表(QOL-AD)总分为(31.43±4.21)分,低于对照组健康体检者的(44.56±4.18)分,差异有统计学意义(t=39.675,P<0.001);病例组AD患者简易精神状态检查量表(MMSE)和日常生活功能量表(ADL)得分分别为(15.82±7.65)和(51.71±13.28)分,均低于对照组健康体检者的(21.83±6.56)和(65.68±14.18)分(均P<0.05);病例组AD患者神经精神调查量表(NPI)和老年抑郁量表(GDS)得分分别为(31.14±7.27)和(19.24±6.56)分,均高于对照组健康体检者的(21.06±8.58)和(14.53±6.18)分(均P<0.05);相关分析结果显示,MMSE量表得分与QOL-AD量表总分呈正相关(r=0.342,P=0.016),GDS量表得分与QOL-AD量表总分呈负相关(r=-0.584,P<0.001);多元线性逐步回归分析结果显示,年龄越大、照顾者关系越不亲密、与照顾者同住、痴呆程度越重、GDS量表得分越高,AD患者生活质量越差。结论 AD患者生活质量较差,年龄、照顾者、居住情况、痴呆程度和GDS量表得分是AD患者生活质量的主要影响因素。     

多奈哌齐治疗老年人血管性痴呆的临床观察

目的观察多奈哌齐治疗老年人血管性痴呆(VD)的疗效和安全性。方法选择符合DSM-IV血管性痴呆诊断标准的30例轻至中度VD患者,分别于治疗前、治疗后8周和16周,用MMSE和ADL痴呆量表评定患者的认知功能及日常生活能力。结果多奈哌齐治疗8周后与治疗前比较,MMSE评分明显提高,提高率为26.67%,ADL评分明显降低,降低率为25.42%。继续治疗至16周后,病情改善明显,MMSE评分增分(增分率52.27%)及ADL评分的减分(减分率51.75%)较治疗前比较更明显。用药过程中1例出现关节疼,1例出现心动过缓,减量后副作用消失。结论多奈哌齐能有效地改善轻至中度老年性血管性痴呆患者的认知功能、社会活动能力及日常生活能力,与应用时间成正比,安全性能较高,值得临床推广。     

轻度认知障碍及早期痴呆人群的社区干预效果

目的探讨轻度认知障碍(MCI)和早期痴呆病人的社区干预临床效果。方法以某社区611例60岁以上老人为研究对象,筛查MCI和早期痴呆患者并对其进行1年的社区干预。用简易智能状态检查量表(MMSE)、日常生活活动能力量表(ADL)评定认知功能状态。结果48例诊断为MCI,11例诊断为早期痴呆。干预后与干预前比较,MMSE评分明显提高,ADL评分显著降低,具有统计学差异(P0.01)。结论对MCI和早期痴呆病人进行社区筛查和干预可以明显改善患者认知功能,并提高社区对早期痴呆的认识。     

盐酸丁咯地尔治疗血管性痴呆的临床研究

目的观察盐酸丁咯地尔治疗血管性痴呆的临床疗效和对生活质量的影响。方法将64例血管性痴呆患者随机分为丁咯地尔治疗组和对照组各32例,治疗组给予丁咯地尔150 -200 mg,对照组给予胞二磷胆碱750 mg,均每日1次静脉滴注,20 d为1个疗程,两组其他治疗均相同。治疗前后评价简易智能精神状态评估量表(MMSE)、日常生活功能量表(ADL)、长谷川痴呆量表(HDS)、痴呆严重程度临床评定量表(WMS)及血液流变学的变化。结果治疗组用药后 MMSE(22．43±3．03)分、ADL(24．43±8．72)分、HDS(23．41±2．81)分、WMS(70．34±18．45)分较对照组MMSE(20．58±3．81)分、ADL(29．23±14．36)分、HDS(20．34±6．24)分、WMS(60．15± 22．49)分明显改善,差异有统计学意义(P<0．05或P<0．01)。结论盐酸丁咯地尔可明显改善血管性痴呆的智能状态、认知功能及提高生活质量,其可能通过抑制血小板聚集而发挥作用。     

喹硫平联合团体心理治疗对老年痴呆的精神行为、认知等影响

目的 探讨喹硫平联合团体心理治疗对老年痴呆精神行为及认知的影响。方法 选取老年痴呆伴随精神行为症状的患者80例,临床分组分为治疗组和对照组,每组各40例,治疗组采取喹硫平联合团体心理治疗,对照组单用喹硫平治疗,两组均治疗8周,以统计学对两组治疗前后精神状态、认知功能,日常生活能力及用药依从性进行处理分析。结果 采用痴呆病理行为评分表(BEHAVE-AD)评估疗效,予简易智能精神状态检查量表(MMSE)评价认知功能,予日常生活能力(ADL)评定生活能力。治疗前,两组BEHAVE-AD、MMSE、ADL评分及用药依从性无明显差异(P>0.05);治疗后,治疗组BEHAVE-AD、MMSE、ADL评分及用药依从性优于对照组(P<0.05)。结论 喹硫平联合团体心理治疗可以改善老年痴呆的精神行为、认知行为、日常生活能力及用药依从性,对提高老年痴呆生命质量有积极影响。     

社区老年人认知功能及相关因素调查

目的了解社区老年人认知功能及相关影响因素,为促进老年保健提供依据。方法对上海市卢湾区某社区601名60岁及以上老年人,采用简易智能状态量表（mini—mental status examination,MMSE）评定认知功能,采用日常生活能力量表（activities of daily living scale,ADL）调查认知功能相关因素。结果年龄与MMSE评分呈负相关,与ADL评分呈正相关;MMSE评分与ADL评分呈负相关。单因素统计分析结果显示,性别、年龄、文化程度、职业、婚姻状况影响老年人认知功能。多元线性回归分析显示,文化程度、年龄、心脏疾病影响MMSE评分。结论增龄、文化程度低、女性、无业或工人、心脏病可能对老年人认知功能产生不良影响。对其中的可干预因素进行干预,有利于提高老年人的认知功能和生活质量。     

高原地区老年期痴呆类型与日常生活能力的调查分析

目的探讨高原地区生存期老年期痴呆患者日常活动能力(ADL)与痴呆类型、痴呆者年龄、认知功能的相关关系。方法痴呆量表(HDS),Hach insk i缺血指数量表(H IS)及日常生活能力量表(ADL)的Parthol指数记分法对患者进行分类评估,并对数字进行统计分析。结果103例老年痴呆中AD型占50%,VD型占24%,混合型占27%,且VD型各年龄段的人数分布存在显著性差异(P<0.05)。ADL评分良者痴呆类型间存在显著差异(P<0.05),评分差者存在极显著差异(P<0.01)。各型痴呆患者HDS均分AD型与混合型之间存在显著差异(P<0.05);ADL-Parthel指数均分VD型与AD型之间存在显著差异(P<0.05),VD型与混合型之间存在极显著差异(P<0.01)。结论痴呆类型与年龄存在一定关联,神经功能的完整性对ADL的影响较大,认知功能与ADL确有关联,但并非是一种平行关系。痴呆随着病程的进展与老年人的日常活动能力下降呈正相关。     

舒血宁联合脑复康治疗血管性痴呆的疗效及对认知功能障碍的影响

[目的]观察舒血宁联合脑复康治疗血管性痴呆的疗效及对认知功能障碍的影响。[方法]2010年8月～2011年8月,126例血管性痴呆患者随机分为两组,观察组63例给予舒血宁联合脑复康治疗,对照组63例给予胞二磷胆碱注射液治疗,比较观察两组的临床疗效及对认知功能障碍的影响。[结果]观察组治疗的总有效率为81.0%,明显高于对照组的61.9%(P﹤0.05)。与治疗前比较,观察组治疗后MMSE评分明显升高,ADL评分明显下降,而对照组MMSE、ADL评分无明显变化(P﹥0.05)。观察组治疗后MMSE评分明显高于同期对照组,而ADL评分明显低于同期对照组,两组比较差异有统计学意义(P﹤0.05)。[结论]舒血宁联合脑复康治疗血管性痴呆,能够明显提高疗效,改善患者的认知功能障碍,值得临床推广应用。     

丁苯酞软胶囊与尼莫地平对卒中后血管性痴呆患者的疗效

目的探讨丁苯酞软胶囊(NBP)及尼莫地平(NMD)治疗卒中后血管性痴呆(VD)的有效性和安全性。方法选择2013年5月至2015年8月在广州军区广州总医院治疗的VD患者96例,按随机数字法分为NBP组和NMD组,各48例。NBP组口服丁苯酞软胶囊治疗,NMD组口服尼莫地平治疗,治疗周期6个月。治疗前及治疗后3个月和6个月随访,利用认知功能量表(MMSE、MOCA)和日常生活能力量表(ADL)对疗效进行评价,并比较2组不良反应发生情况。结果 2组治疗前,MMSE、MOCA和ADL评分相比差异不具有统计学意义(P0.05);治疗后3个月及6个月,NBP组MMSE、MOCA评分均明显高于NMD组,而ADL评分明显低于NMD组(P0.01);NBP组不良反应发生率为10.4%,明显低于NMD组(22.9%)(P0.05)。结论 NBP与NMD均能明显改善卒中后血管性痴呆患者的认知功能和日常生活能力,但NBP效果更显著,且安全性更高。     

尼麦角林治疗血管性痴呆的临床研究

目的探究尼麦角林在治疗血管性痴呆中的临床效果。方法采用前瞻性、随机对照的多中心临床研究。60例血管性痴呆患者随机分为两组,实验组和对照组,实验组应用尼麦角林合并胞二磷胆碱治疗,共4周;对照组单独应用胞二磷胆碱,共4周。治疗前后分别进行简易精神状态检查量表(MMSE)和日常生活能力量表(ADL)进行评价。结果实验组治疗后MMSE评分明显高于治疗前及对照组(P<0.01)。实验组治疗后ADL评分明显低于治疗前及对照组(P<0.01)。实验组的改善效果明显优于对照组(P<0.01)。结论尼麦角林与胞二磷胆碱合用能改善血管性痴呆患者的认知功能和日常生活能力,安全性良好。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.