服药依从性对妊娠合并甲状腺功能减退症孕妇甲状腺功能指标及妊娠结局的影响

目的探究服药依从性对妊娠合并甲状腺功能减退症(甲减)孕妇甲状腺功能指标及妊娠结局的影响,为临床治疗提供参考依据。方法对2015年2月-2017年6月在温岭市妇幼保健院确诊为妊娠合并甲减的186例患者进行回顾性分析,根据是否规律服用左甲状腺素片(优甲乐),分为规律组(规律补充患者,96例)和不规律组(未规律补充患者,90例)。比较两组患者治疗前和产前的血清促甲状腺激素(TSH)、游离甲状腺素(FT_4)和游离三碘甲状腺原氨酸(FT_3)水平,并对母婴妊娠结局进行统计分析。结果在186例合并甲减的孕妇中,共有90例(48. 39%)孕妇未进行规律服药。两组孕妇的年龄、孕前体质量、确诊孕周、孕次和甲状腺过氧化物酶抗体(TPOAb)阳性率差异无统计学意义(均P>0. 05),规律组孕妇的服药时间和服药次数均显著高于不规律组,差异有统计学意义(均P<0. 05)。治疗前两组患者的血清TSH、FT_4、FT_3水平差异无统计学意义(均P>0. 05),治疗后两组的TSH水平明显降低,FT_4明显升高与治疗前相比差异有统计学意义(均P<0. 05),而规律组治疗后的TSH水平显著低于不规律组、FT_4水平明显高于不规律组,差异有统计学意义(均P<0. 05),FT_3水平与不规律组相比差异无统计学意义(P>0. 05)。规律组患者早产发生率及不良妊娠结局的总发生率明显低于不规律组,差异有统计学意义(均P<0. 05);规律组胎儿不良结局的总发生率明显低于不规律组,差异有统计学意义(P<0. 05);规律组贫血发生率及产妇产后并发症总发生率明显低于不规律组,差异有统计学意义(均P<0. 05)。结论妊娠合并甲减患者服药优甲乐的依从性较低;与依从性高的孕妇相比,依从性较低患者的甲状腺激素水平较低,并具有较高的母婴妊娠不良结局发生率。     

左旋甲状腺素联合右归丸治疗妊娠合并亚临床甲状腺功能减退症患者的疗效及对Hcy、SOD、25-(OH)-D与叶酸水平的影响

目的分析左旋甲状腺素联合右归丸治疗妊娠合并亚临床甲状腺功能减退症(亚临床甲减)患者的疗效及对血清同型半胱氨酸(Hcy)、超氧化物歧化酶(SOD)、25-羟基维生素D[25-(OH)-D]与叶酸水平的影响,旨在改善妊娠结局。方法选择2014年5月-2017年6月于磐安县人民医院就诊的80例妊娠合并亚临床甲减患者为研究对象,随机分为对照组和观察组,每组40例。对照组予以左旋甲状腺素治疗,观察组基于对照组加以右归丸治疗。比较两组促甲状腺激素(TSH)、清游离甲状腺素(FT_4)、血清游离三碘甲腺原氨酸(FT_3)、Hcy、SOD、25-(OH)-D和叶酸水平,观察两组不良妊娠结局发生情况。结果治疗后,观察组TSH、Hcy均低于对照组(均P0.05);观察组SOD、25-(OH)-D、叶酸水平高于对照组(均P0.05)。治疗前后两组FT_4、FT_3比较,差异无统计学意义(P0.05)。观察组不良妊娠结局发生率低于对照组,两组比较,差异有统计学意义(P0.05)。结论妊娠合并亚临床甲减患者应用左旋甲状腺素联合右归丸治疗能够降低血清Hcy水平,促进SOD、25-(OH)-D及叶酸分泌,改善妊娠结局。     

亚临床甲状腺功能减退症对妊娠结局及新生儿甲状腺功能的影响

目的对孕妇妊娠期合并亚临床甲状腺功能减退症(甲减)对妊娠结局以及新生儿甲状腺功能的影响进行探析。方法将2017年2月-2018年2月深圳市宝安区妇幼保健院产科收治的55例亚临床甲减孕妇纳入探究组,选取同期60例正常孕妇纳入对照组,对比分析两组妊娠结局,并掌握两组新生儿甲状腺功能情况。结果探究组剖宫产率29. 09%,对照组为8. 33%,差异有统计学意义(P 0. 05);探究组早产、胎儿窘迫、低体重胎儿等发生率均高于对照组,差异有统计学意义(P 0. 05);通过测定,两组新生儿亚临床甲减发生率、TSH水平差异均有统计学意义(P 0. 05);亚临床甲减用药孕妇的新生儿甲状腺功能减退发生率为8. 33%,低于未用药孕妇的23. 81%(P 0. 05)。结论妊娠期孕妇合并亚临床甲减会对妊娠结局和新生儿甲状腺功能造成影响,产前应密切监测孕妇病情,尽早诊疗,确保母婴安全。     

甲状腺功能异常与稽留流产的相关性分析

目的探讨甲状腺功能异常与稽留流产的相关性,为稽留流产的预防及提高妊娠成功率提供相应依据。方法选取妊娠12周内的稽留流产患者93例作为观察组,并选择同期正常妊娠妇女97例作为对照组,采用化学发光法检测观察组与对照组早晨空腹静脉血中促甲状腺激素(TSH)、血清游离三碘甲状腺原氨酸(FT_3)、血清游离甲状腺素(FT_4)、甲状腺球蛋白抗体(TGAb)和甲状腺过氧化物酶抗体(TPOAb)的水平。结果稽留流产患者的FT_3、FT_4水平低于对照组,而TSH、TPOAb水平高于对照组,差异有统计学意义(均P0. 05),两组患者TGAb水平差异无统计学意义(P0. 05);稽留流产患者甲状腺功能减退(甲减)、亚临床甲状腺功能减退(亚甲减)、TPOAb的阳性率高于对照组,差异有统计学意义(均P0. 05),而甲状腺功能亢进(甲亢)、低甲状腺素(T_4)血症、TGAb的阳性率差异无统计学意义(均P0. 05);观察组和对照组TSH≥2. 5 m U/L且TPOAb (+)检出率比较,差异有统计学意义(P0. 01)。结论推荐对所有孕早期妇女进行TSH、FT_4、TPOAb三联筛查策略,并及时对甲状腺功能异常的孕期妇女进行规范的治疗,可以有效防范稽留流产的发生,以改善妊娠结局。     

咸宁市早中期孕妇甲状腺功能检查结果分析

目的分析咸宁市早中期孕妇的甲状腺功能变化特点。方法选择300名妊娠女性和100名健康女性(对照组)为研究对象,妊娠女性中孕早期140名(早期妊娠组),孕中期160名(中期妊娠组),对所有研究对象均行促甲状腺激素(TSH)、游离三碘甲状原氨酸(FT_3)、游离甲状腺素(FT_4)、总三碘甲状原氨酸(TT_3)、总甲状腺素(TT_4)检测,对比3组的检测结果及甲减、亚临床甲减发生率。结果早期妊娠组的TSH水平明显低于对照组(P<0.05),中期妊娠组的TSH水平明显高于早期妊娠组,但仍显著低于对照组(P<0.05)。早期妊娠组和中期妊娠组的TT_3、TT_4水平均显著高于对照组(P<0.05),且中期妊娠组的TT_3、TT_4水平明显高于早期妊娠组(P<0.05)。早期妊娠组的FT_3、FT_4水平均明显低于对照组(P<0.05),中期妊娠组的FT_3、FT_4水平均有所降低,均显著低于早期妊娠组和对照组(P<0.05)。早期妊娠组与中期妊娠组的甲减发生率比较无明显差异(P>0.05),中期妊娠组的亚临床甲减发生率显著高于早期妊娠组(P<0.05)。结论女性在妊娠早期、中期的甲状腺功能指标均会发生明显变化,临床对妊娠期女性进行甲状腺功咸宁市能动态监测,对于早期发现临床甲减、亚临床甲减,预防其对妊娠结局造成的不良影响具有重大意义。     

妊娠不同时期合并亚临床甲状腺功能减退症患者血清甲状腺激素TPO-Ab水平及临床意义

目的探究妊娠不同时期合并亚临床甲状腺功能减退症患者血清甲状腺激素、甲状腺过氧化物酶抗体(TPO-Ab)水平及临床意义。方法选取丽水市中心医院2019年1月—2021年1月收治的2400例产前检查并分娩的孕产妇作为研究对象,所有孕产妇就诊时均确诊为亚临床甲减,并根据就诊产检时孕周的不同分为孕早期组(孕周1~12周)762例,孕中期组(孕周13~27周)830例,孕晚期组(孕周≥28周)808例。另选取同期健康体检的未妊娠妇女800例为对照组。检测并比较所有受试者检测其血清甲状腺激素[促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))]以及TPO-Ab水平状况。结果妊娠期合并亚临床甲减者TSH平均水平为(5.63±1.45)mIU/L、FT_(3)为(3.98±1.02)pmol/L、TPO-Ab为(35.45±6.45)IU/mL,与对照组相比差异有统计学意义(P<0.05),FT_(4)为(13.93±2.57)pmol/L与对照组差异无统计学意义(P>0.05)。合并亚临床甲减不同妊娠时期的孕妇TSH、FT_(3)、TPO-Ab与对照组相比差异均有统计学意义(P<0.05);且孕早期、孕中期、孕晚期各组比较,TSH、TPO-Ab水平孕早期<孕中期<孕晚期,FT_(3)水平孕早期>孕中期>孕晚期,差异均有统计学意义(P<0.05)。孕早期组TPO-Ab阳性456例,孕中期组TPO-Ab阳性495例,孕晚期组TPO-Ab阳性481例,3组TPO-Ab阳性率比较差异无统计学意义(P>0.05)。TPO-Ab阳性组TSH高于阴性组,FT_(4)、FT_(3)低于阴性组,差异有统计学意义(P<0.05)。妊娠期合并亚临床甲减TPO-Ab阳性组不良母婴结局发生率与TPO-Ab阴性组相比差异有统计学意义(P<0.05)。结论不同妊娠期合并亚临床甲减孕者其血清TSH及TPO-Ab水平显著较高,且亚临床甲减合并TPO-Ab阳性是引发早产、新生儿重度窒息、贫血、妊娠期高血压等不良妊娠结局的主要危险因素。     

妊娠期亚临床甲状腺功能减退症患者血清甲状腺激素水平对妊娠结局的预测价值

目的探讨妊娠期亚临床甲状腺功能减退症(亚甲减)患者血清甲状腺激素水平的变化及其对妊娠结局的影响。方法选取2017年1月-2020年1月在该院分娩的妊娠期亚甲减患者200例为研究组,另选取同期在该院分娩的甲状腺功能正常孕妇200例为对照组。研究组患者根据是否应用左旋甲状腺素钠分为A组(应用)和B组(未应用) 2个亚组。比较各组孕妇血清甲状腺激素水平及不良妊娠结局发生情况。结果 A组、B组孕妇治疗前的TSH水平均明显高于对照组,差异均有统计学意义(均P0. 05)。A组、B组孕妇治疗后的TSH水平均较治疗前明显降低,并且A组孕妇治疗后的TSH水平更低,差异均有统计学意义(均P0. 05)。A组孕妇治疗后的TSH水平与对照组接近,差异无统计学意义(P0. 05)。B组孕妇妊娠期贫血、妊娠期糖尿病、早产发生率均明显高于A组,差异均有统计学意义(均P0. 05); A组孕妇妊娠期贫血、妊娠期糖尿病、早产发生率与对照组接近,差异无统计学意义(P0. 05)。B组孕妇围生儿不良结局总发生率明显高于A组和对照组,差异有统计学意义(P0. 05)。结论妊娠期亚甲减会增加孕妇及围生儿不良结局发生率,合理应用左旋甲状腺素钠进行干预能够有效调节血清甲状腺激素水平,改善母婴结局。     

妊娠期甲状腺功能减退对母婴结局的影响

目的探讨妊娠期甲状腺功能减退(甲减)对母婴妊娠结局的影响。方法对产检的30 698例孕妇进行调查,其中临床甲减患者81例作为甲减组、临床亚甲减患者690例为亚甲减组,同期随机选取420例正常孕妇为对照组;经过治疗后比较3组孕中期、孕晚期的TSH、FT4水平及不良母婴妊娠结局。结果 30 698例孕妇中甲减发生率为2.51%(771/30 698);与亚甲减组、对照组相比,甲减组在孕中期、孕晚期的TSH水平表现为升高,而FT4水平下降,差异有统计学意义(P<0.05);与对照组相比,亚甲减组在孕中期、孕晚期的TSH水平也表现为升高,差异有统计学意义(P<0.05),但FT4水平正常。甲减组、亚甲减组的整体不良母婴妊娠结局发生率高于对照组,而甲减组的不良母婴妊娠结局发生率又高于亚甲减组,差异有统计学意义(P<0.05)。结论孕妇妊娠期有较高的甲减发生率,应早期筛查和治疗妊娠期甲减,控制孕妇甲状腺激素水平,改善母婴妊娠结局。     

妊娠早中期亚临床甲状腺功能减退对后代甲状腺功能及智力发育的影响

目的探讨妊娠早中期亚临床甲减对后代甲状腺功能和智力发育的影响。方法选择2013年1月至2015年1月福建医科大学附属宁德市医院产科收治的妊娠早中期合并亚临床甲减的孕妇55例,其中甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)阳性组35例,TPOAb阴性组20例,单纯TPOAb阳性组30例,健康妊娠者30例为对照组。测定4组孕妇20~30月龄子代的甲状腺功能游离三碘甲状腺原氨酸(free triiodothyronine,FT_3)、游离甲状腺素(free thyroxine,FT_4)、促甲状腺激素(thyroid stimulating hormone,TSH),随访20~30月龄子代的发育商指标,比较4组婴儿有无差异。结果亚临床甲减+TPOAb(+)组、亚临床甲减+TPOAb(-)组、单纯TPOAb(+)组子代TSH水平显著高于对照组,血清FT_3、FT_4水平明显低于对照组(P0.05);亚临床甲减+TPOAb(+)组子代发育商低于其余各组,其中智力显著低于亚临床甲减+TPOAb(-)组和对照组(P0.05),而亚临床甲减+TPOAb(+)组与单纯TPOAb(+)组发育商比较差异无统计学意义(P0.05)。结论妊娠早中期亚临床甲减可能引起子代短期的甲状腺功能异常,亚临床甲减伴TPOAb(+)可能对子代神经系统发育造成影响,妊娠期单纯TPOAb(+)也可能会对子代神经智力与运动发育造成一定影响。建议对妊娠早期母体进行TPOAb的广泛筛查,如出现促甲状腺激素增高,应及时治疗。     

不同剂量左甲状腺素钠对妊娠期亚临床甲状腺功能减退患者疗效及新生儿神经智力发育的影响

目的探讨不同剂量左甲状腺素钠(优甲乐,L-T4)对妊娠期亚临床甲状腺功能减(甲减)患者疗效及新生儿神经智力发育的影响。方法212例妊娠期亚临床甲减患者依据随机数字表法分为A组和B组,A组采用高剂量L-T4替代治疗(75μg/d),B组采用低剂量L-T4替代治疗(25μg/d),比较两组疗效、血清维生素B_(12)、叶酸(FA)、铁蛋白(SF)、同型半胱氨酸(Hcy)水平、新生儿神经智力发育情况及妊娠结局。结果A组治疗总有效率(91.5%)高于B组(77.3%),差异有统计学意义(χ^(2)=8.075,P<0.05);两组治疗前血清维生素B_(12)、FA、SF及Hcy水平差异无统计学意义(P>0.05),治疗后维生素B_(12)、FA及SF升高(P<0.05),Hcy降低(P<0.05),差异有统计学意义(P<0.05);A组智力发育指数和精神运动发育指数评分均高于对照组(P<0.05);A组早产、流产、胎膜早破及羊水过多发生率低于B组(P<0.05),A组新生儿巨大儿、畸形、新生儿呼吸窘迫综合征及死胎显著低于B组(P<0.05)。结论L-T4替代治疗妊娠期亚临床甲减疗效与剂量相关,高剂量L-T4替代治疗能够降低血清Hcy水平,升高B_(12)、FA及SF水平,改善妊娠结局,提高疗效,并促进新生儿智力发育。     

Double-blind studies with mefloquine alone and in combination with sulfadoxine-pyrimethamine in 120 adults and 120 children with falciparum malaria in Vietnam

In 120 adult Vietnamese patients with uncomplicated falciparum malaria the efficacy of, and tolerance to, mefloquine (M) vs the combination of mefloquine + sulfadoxine + pyrimethamine (MSP) was studied in a double-blind, randomized comparative trial with chloroquine. Also, a double-blind dose finding study of MSP was performed in 120 Vietnamese children with uncomplicated falciparum malaria. In the adults the mean parasite clearance time with M was 3.8 d and with MSP 3.6 d. Defervescence occurred in 2.9 and 3.0 d respectively for M and MSP. There was a 36.8% resistance rate in 38 patients treated with chloroquine. 96% of the children were sensitive or showed a delayed RI response. The lowest dose of MSP (10 mg/kg M + 20 mg/kg S + 1.0 mg/kg P, 1 tablet Fansimef) was as effective as 1.5-2x this dose in children weighing 23-30 kg. Side effects were mild, except for vomiting which required alternative therapy in 4 patients.     

Differences in muscular changes in rats with vitamin E and with selenium deficiency

The recti muscles of rats with vitamin E deficiency and with selenium deficiency were examined by electron microscopy and compared. In vitamin E deficiency, the first changes occurred in blood vessels and in the extracellular components. The endothelium contained many vacuoles and less cytoplasmic organelles. The basal lamina of the endothelium appeared thicker. As it progressed, vitamin E deficiency caused abnormal pigment granules, mitochondrial degeneration, decreased numbers and irregular arrangement of muscle fibers, and irregular arrangement of z bands. On the other hand, selenium deficiency caused no abnormal changes in the recti muscles. These results suggest that selenium plays a different role from that of vitamin E which is an antioxidant.     

Factors associated with self-esteem in pre-adolescents and adolescents with cerebral palsy

Predictors of self-esteem were examined in 50 pre-adolescents and adolescents with cerebral palsy. On average, self-esteem was high, although 30% scored below a cut-point for low self-esteem. Self-esteem was bivariately associated with female gender, better physician-assessed functional ability, greater perception of the impact of the disability, and higher perceived parent overprotectiveness. In a multivariate model, only perceived impact of the disability remained significant.     

Implicit and Explicit Associations with Erotic Stimuli in Women with and Without Sexual Problems

Conceptual models of sexual functioning have suggested a major role for implicit cognitive processing in sexual functioning. The present study aimed to investigate implicit and explicit cognition in sexual functioning in women. Gynecological patients with (N = 38) and without self-reported sexual problems (N = 41) were compared. Participants performed two Single-Target Implicit Association Tests (ST-IAT), measuring the implicit association of visual erotic stimuli with attributes representing, respectively, valence and motivation. Participants also rated the erotic pictures that were shown in the ST-IATs on the dimensions of valence, attractiveness, and sexual excitement, to assess their explicit associations with these erotic stimuli. Participants completed the Female Sexual Functioning Index and the Female Sexual Distress Scale for continuous measures of sexual functioning, and the Hospital Anxiety and Depression Scale to assess depressive symptoms. Compared to nonsymptomatic women, women with sexual problems were found to show more negative implicit associations of erotic stimuli with wanting (implicit sexual motivation). Across both groups, stronger implicit associations of erotic stimuli with wanting predicted higher level of sexual functioning. More positive explicit ratings of erotic stimuli predicted lower level of sexual distress across both groups.     

Prevalence and factors associated with feeding difficulty in institutionalized elderly with dementia in Taiwan

Objectives  

The purpose of this study was to establish the prevalence rate of feeding difficulty and to understand the factors associated with it among people with dementia.     

原发性高血压患者防治依从性及血压控制达标调查

目的探讨原发性高血压患者防治依从性及血压控制达标情况,为控制原发性高血压的发展提供参考。方法选取2019年5月至2021年12月在庐江县中医院就诊的原发性高血压患者696例为研究对象,对患者进行问卷调查及体格调查,进一步分析不同人群特征、不同防治依从行为对血压控制达标的影响。结果696例原发性高血压患者中血压控制达标率为16.24%(113/696)。禁烟、限制饮酒、减少钠盐摄入、控制体重、适量运动、遵医嘱服药的依从性分别为24.86%、28.45%、64.51%、58.05%、66.38%、83.05%。多因素Logistic回归分析显示,年龄55~69岁(OR=1.567)、文化程度为高中/中专及以上(OR=2.849)、病程≤10年(OR=1.431)、禁烟依从性好(OR=1.852)、限制饮酒依从性好(OR=2.083)、减少钠盐摄入依从性好(OR=3.511)、控制体重依从性好(OR=1.145)、适量运动依从性好(OR=1.670)、遵医嘱服药依从性好(OR=1.399)的高血压患者血压控制达标的可能性较高。结论原发性高血压患者血压控制达标情况有待进一步提高,且与人群特征、防治依从项目密切相关,应针对重点人群、危险因素开展高血压综合防治,提高患者的防治依从性,促进血压控制达标。     

Understanding and Coping with Diversity in Healthcare

In the healthcare sector, race, ethnicity and religion have become an increasingly important factor in terms of patient care due to an increasingly diverse population. Health agencies at a national and local level produce a number of guides to raise awareness of cultural issues among healthcare professionals and hospitals may implement additional non-medical services, such as the provision of specific types of food and dress to patients or the hiring of chaplains, to accommodate the needs of patients with religious requirements. However, in an attempt to address the spiritual, cultural and religious needs of patients healthcare providers often assume that ethnic minority groups are homogenous blocks of people with similar needs and fail to recognize that a diverse range of views and practices exist within specific groups themselves. This paper describes the example of the Sikh community and the provision of palliative care in hospitals and hospices. Although, the majority of patients classifying themselves as Sikhs have a shared language and history, they can also be divided on a number of lines such as caste affiliation, degree of assimilation in the west, educational level and whether baptized or not, all of which influence their beliefs and practices and hence impact on their needs from a health provider. Given that it is unfeasible for health providers to have knowledge of the multitude of views within specific religious and ethnic communities and accounting for the tight fiscal constraints of healthcare budgets, this paper concludes by raising the question whether healthcare providers should step away from catering for religious and cultural needs that do not directly affect treatment outcomes, and instead put the onus on individual communities to provide resources to meet spiritual, cultural and religious needs of patients.