Parent-Child Interaction in the First Year Of Life

The first year of life traditionally refers to the growth and development of an infant. Recent studies have disclosed the powerful effects exerted by young babies upon their parents. These influences depend upon distinct, measurable personality and temperamental factors present in the infant from birth. Parent/child attachment has been observed, in both normal nurseries and premature intensive-care units, and appears to comprise a series of species-specific behaviors. Inadequate or incomplete bonding has been strongly correlated with subsequent ‘disorders of parenting’, including non-organic ‘failure to thrive’ and the abused child syndrome. The implications of these current discoveries for family physicians are discussed.     

The Acute Surgical Abdomen in the First Year of Life

Management of diabetes mellitus in an infant or child requires careful dietary calculation and thorough instruction of the family. The risk of reactions to insulin is minimized if the dosage is adjusted so that the amount of glucose excreted in the urine is maintained at a constant low level. Regular insulin is used initially. When intake of food becomes predictable, NPH or lente insulin is also given. Details of dietary composition, insulin dosage, and treatment of hypoglycemic reactions are given, and hospital record sheets are reproduced.     

脑卒中患者1个月与1年后生存质量的研究

【目的】进行有关脑卒中患者生存质量的研究。了解脑卒中患者发病1个月与1年后生存质量的变化情况,以明确患者今后康复的目标及康复工作重点。【方法】对我科首次发病的56例急性脑卒中患者,经药物及康复治疗后,在发病1个月与1年后采用健康状况调查表（SF-36）进行问卷调查。【结果】1年后〈50岁患者总体健康较1月时有明显改善（P〈0．05）,而年龄越大改善越不明显（P〉0．05）。在社会功能、活力、精神健康等方面的改善均随着年龄的增长而降低。【结论】在脑卒中发生后,临床上通过积极的治疗来尽可能恢复患者躯体功能和改善其生存质量。1年后康复工作的重点是创造良好社会环境,加强患者自理能力的训练;还应设法降低患者对治疗和生活过高的期望,尽力改善机体功能,调节心理障碍以进一步提高脑卒中患者生存质量。     

Recovery and Quality of Life One Year after Coronary Artery Bypass Grafting

In order to study recovery and quality of life after bypass surgery, both objective and subjective data were collected during structured interviews. A total of 56 patients participated in the study. Data were collected during hospital admission and during two home visits at 6 and 12 months after Coronary Artery Bypass Grafting (CABG). Patients reported improved state of health and quality of life. Most of the changes occurred within the first six months after discharge. However, for most patients life had more or less returned to normal one year after CABG. It was also found that few of the patients changed their risk behaviour after surgery.     

Longitudinal Changes in the Health-Related Quality of Life During the First Year After Traumatic Brain Injury

Lin M-R, Chiu W-T, Chen Y-J, Yu W-Y, Huang S-J, Tsai M-D. Longitudinal changes in the health-related quality of life during the first year after traumatic brain injury.

Objective

To track the health-related quality of life (HRQL) at discharge and at 6 and 12 months after a traumatic brain injury (TBI) and examine factors associated with changes in each HRQL domain.

Design

Longitudinal cohort study.

Setting

Using codes of the International Classification of Diseases, eligible participants who had a newly diagnosed TBI were identified from discharge records of 4 hospitals in northern Taiwan. Information on the HRQL and injury-related characteristics at the initial and 2 follow-up assessments was collected by extracting medical records and conducting telephone interviews.

Participants

Subjects (N=158) participated in the initial assessment, and 147 and 146, respectively, completed the follow-up assessments at 6 and 12 months after injury.

Interventions

Not applicable.

Main Outcome Measure

The brief version of the World Health Organization Quality of Life (WHOQOL-BREF) with 4 domains of physical capacity, psychologic well being, social relationships, and environment.

Results

Scores on all WHOQOL-BREF domains except social relationships greatly improved over the first 6 months and showed continued improvement at 12 months after injury. The domain scores of the WHOQOL-BREF at discharge were significantly associated with the preinjury HRQL level, marital status, alcohol consumption at the time of injury, Glasgow Outcome Scale (GOS) level, cognition, activities of daily living, social support, and depressive status. However, after adjusting for these baseline differences, only the GOS level and depressive status significantly influenced longitudinal changes in the psychologic and social domains over the 12-month period. Changes in the physical and environmental domains were not significantly associated with any characteristics of the study.

Conclusions

During the first year after a TBI, the magnitude of HRQL recovery differed across different HRQL domains. Many factors may have significant associations with the initial domain scores of HRQL after TBI; however, only a few factors can significantly influence longitudinal changes in the HRQL.     

The Preparation of Prothrombin-Free Ox Plasma in the Estimation of Prothrombin

Abstract

Oxalated ox plasma treated with barium sulphate (2 g) per 100 ml) is suitable in the estimation of prothrombin activity by the method described by Owren. The preparation is simple and cheapqr than the original procedure.     

Impact of Menopause on Quality of Life in Community-based Women in China: 1 Year Follow-up

Quality of life (QOL) throughout menopause has become an outcome variable requiring measurement in clinical care. Staff nurses can provide earlier nursing during the menopausal transition (MT) stage. The purpose of this study was to describe the changes of QOL in different stages of the MT according to The Stages of Reproductive Aging Workshop (STRAW) in Chinese women in community settings. Prospective longitudinal study design was used to analyze QOL of 327 community women age 30–65 years old. They were followed up at 1-year. An instrument including the Chinese version of the Menopause-Specific Quality of Life Questionnaire was used to obtain data. A gradual decline in QOL was seen from premenopausal to menopausal transition (MT) and in postmenopausal women. Significant differences were observed in vasomotor, physical and sexual scores at baseline and follow-up (P < 0.05). Significant differences in vasomotor scores were observed between baseline and follow-up for women in the premenopausal and Late MT stages (P < 0.05). There were significant differences in psychosocial and physical scores between baseline and follow-up in the Late MT stage (P < 0.05). Menopause might have a negative impact on QOL independent of age in community-based women in China. There seemed to be a potential model of the relationship of menopause status to change in QOL, but this needs supporting evidence from longer longitudinal studies.     

苏州市1993年疾病负担的初步研究

本文应用疾病负担的新指标──ＤＡＬＹ对我国和苏州市的疾病负担进行了分析。认为我国疾病模式演变特点是感染性疾病下降相对迟缓与非感染性疾病上升迅猛。这个特点在苏州市表现得尤为明显。提示今后这两类疾病的防制均应加强，并提出了应防制的重点疾病及对策方向。     

森田疗法对精神分裂症患者自尊水平和生活满意度的1 年随访

目的观察森田疗法对精神分裂症患者自尊水平、生活满意度和社会功能的效果。方法对140 例精神分裂症患者在住院期间应用森田疗法理论指导,出院后跟踪随访1 年,采用自尊量表(SES)、生活满意度指数B(LSIB)和出院后个人和社会表现量表(PSP)进行评定。结果治疗后,康复期精神分裂症患者SES评分和LSIB评分有显著提高(P=0.000)。出院后117 例(83.57%)病情稳定;20 例(14.29%)出现服药依从性差,病情不稳定,3 例(2.14%)复发再入院。对病情稳定者随访1 年后,SES 评分和LSIB 评分均保持在出院水平;94 例患者社会功能保持在良好水平以上。结论森田疗法对改善康复期精神分裂症患者的自尊水平、主观生活满意度和保持良好的社会功能有积极的临床实践意义。     

Hypophyso-Gonadal Function in Humans during the First Year of Life: I. EVIDENCE FOR TESTICULAR ACTIVITY IN EARLY INFANCY

Total and unbound testosterone and Delta(4)-androstenedione have been determined in 104 cord blood samples. The same sexual steroids and pituitary gonadotropins have been measured in 46 normal male infants aged 27-348 days and 34 normal female infants aged 19-332 days.In cord blood of female neonates mean total and unbound testosterone was 29.6+/-7.5 and 0.89+/-0.4 ng/100 ml, respectively (mean+/-1 SD); Delta(4)-androstenedione was 93+/-38 ng/100 ml. In male neonates mean plasma total and unbound testosterone was 38.9+/-10.8 and 1.12+/-0.4 ng/100 ml; Delta(4)-androstenedione was 85+/-27 ng/100 ml.In female infants testosterone concentrations remained constant during the 1st yr of life with a mean concentration of 7+/-3 ng/100 ml. Mean unbound testosterone and Delta(4)-androstenedione concentrations were 0.05+/-0.03 and 16.7+/-8.3 ng/100 ml, respectively. Mean plasma levels of follicle-stimulating hormone and luteinizing hormone were 8.7+/-3.3 and 12.9+/-7.7 mU/ml.In male infants mean plasma total testosterone concentration increased to 208+/-68 ng/100 ml from birth to 1-3 mo of age, decreasing thereafter to 95+/-53 ng/100 ml at 3-5 mo, 23.2+/-18 ng/100 ml at 5-7 mo, and reached prepubertal levels (6.6+/-4.6 ng/100 ml) at 7-12 mo. Mean unbound testosterone concentration plateaued from birth to 1-3 mo of age (1.3+/-0.2 ng/100 ml) decreasing to prepubertal values very rapidly. Mean Delta(4)-androstenedione concentration, although progressively decreasing during the 1st yr of life to 11.7+/-4.5 ng/100 ml, was higher than in the female at 1-3 mo of life (34+/-11 ng/100 ml). Mean plasma level of follicle-stimulating hormone was 6.7+/-2.9 mU/ml, and that of luteinizing hormone was 19.7+/-13.5 mU/ml, significantly higher than in the female. There was no correlation between gonadotropin and age or testosterone.The present data demonstrate that the testes are active during the first natal period. It is tempting to correlate this phenomenon to a progressive maturation of the hypothalamo-pituitary-gonadal axis. It is possible that the surge in testosterone occurring the first 3 mo could play a role in the future life pattern of the male human being.     

Distinct Patterns of Conjoint Symptom Distress and Functional Impairment in the Last Year of Life Predict Terminally Ill Cancer Patients' Survival

Context/Objectives

Our study addressed important knowledge gaps about trajectories of distinct conjoint symptom-functional states, that is, patterns for different levels of combined symptom distress and functional impairment, over cancer patients' last year and their ability to predict survival.

A Case Series of Dacryoendoscopy in Childhood: A Diagnostic and Therapeutic Alternative for Complex Congenital Nasolacrimal Duct Obstruction Even in the First Year of Life

Introduction

Congenital nasolacrimal duct obstruction (CNLDO) is the most common cause of epiphora in infancy. Spontaneous resolution occurs in the majority of the cases by 1 year of age. Nevertheless, obstruction has a negative impact on the outcome of conservative or surgical therapy, especially in cases of complex CNLDO. When the condition persists beyond several months, early intervention with dacryoendoscopy (DE) around the age of 1 year could yield good results. The objective of the study is to analyze the success rate and effectiveness of early DE for complex CNLDO in the first year of life.

Methods

A retrospective, non-comparative case series is presented. DE was performed under general anesthesia in patients between the age of 1 and 12 months with severe recurrent acute or chronic dacryocystitis. The medical histories, intraoperative and postoperative results after 3 months as well as via parents’ interviews were analyzed to investigate the success rate.

Results

A total of 18 consecutive DE in 16 patients between the age of 1 and 12 months (mean 7.3 ± 3.4 months) were studied. Nine lacrimal ducts were diagnosed with persistent chronic dacryocystitis refractory to probing/syringing. The remaining 9 presented recurrent acute dacryocystitis. Diagnostic DE was performed in 18 cases. A therapeutic DE was conducted in 15 lacrimal ducts (83.3%) with simultaneous correction of the associated stenosiswith the tip of the endoscope. A visual controlled opening of the stenosis was impossible in 3 cases due to a too narrow presaccal anatomy (n = 1), an osseous duct stenosis (n = 1), and a bulging membrane of Hasner into the inferior nasal meatus (n = 1). Postoperative findings were classified into four categories: poor, fair, good and excellent. Good results were documented in 16.7% (n = 3) and excellent results in 77.7% (n = 14). The bony obstruction was treated with dacryocystorhinostomy. A minimum follow-up of 3 months was considered for final clinical analysis. Ten patients’ parents (12 surgeries) were interviewed by telephone (mean follow-up 24.8 months). No recurrence of stenosis and no further postoperative complications were observed.

Conclusion

DE is a diagnostic and therapeutic option for complex CNLDO in patients before the age of 1 year. The outcome of DE in the 3 months follow-up is highly indicative of positive final results in terms of patency of the lacrimal duct.

     

Hospital Delirium and Psychological Distress at 1 Year and Health-Related Quality of Life After Moderate-to-Severe Traumatic Injury Without Intracranial Hemorrhage

ObjectivesTo determine whether delirium during the hospital stay predicted health-related quality of life (HRQOL) at 1 year after injury in trauma intensive care unit (ICU) survivors without intracranial hemorrhage, and to examine the association between depressive and posttraumatic stress disorder (PTSD) symptoms and each of the HRQOL domains at 1-year follow-up.DesignPrognostic cohort with a 1-year follow-up.SettingLevel 1 trauma ICU.ParticipantsAdult patients without intracranial hemorrhage (N=173) admitted to a level 1 trauma ICU.InterventionsNot applicable.Main Outcome MeasuresHRQOL was measured with the Medical Outcomes Study 36-Item Short-Form Health Survey at 1 year after traumatic injury.ResultsAverage delirium duration ± SD was .51±1.1 days. Hierarchical multivariable linear regression analyses did not find a statistical relationship between delirium and HRQOL at 1-year follow-up. However, increased levels of depressive symptoms at 1 year were statistically associated with poorer functioning in all physical and mental health HRQOL domains, whereas PTSD at 1 year was statistically associated with all HRQOL domains except role-physical (P<.05).ConclusionsThere was no statistical association between delirium during the hospital stay and HRQOL at 1 year, which may be due to the short time spent in delirium by our study population. Depressive symptoms demonstrated a stronger relationship with mental and physical HRQOL domains at 1 year than PTSD, indicating their own unique pathway after trauma. Findings lend support for the separate assessment and management of depression and PTSD. Additional research on the duration and subtypes of delirium is needed within the trauma ICU population, as the effects are not widely known.