无负荷试验中变异减速波形的临床意义

目的探讨胎心监护无负荷试验（nonstress test,NST）中变异减速（variable deceleration,VD）发生的影响因素及围生儿结局。方法回顾性分析2160例胎儿监护NST中,141例出现VD患者的胎心心率监护图形,比较不同图形影响因素的发生率和围生儿结局。结果胎心监护NST中,VD的发生率为6.5%（141/2160）。141例出现VD患者中,单纯VD为77例（单纯VD组）,不典型VD为64例（不典型VD组）。单纯VD组中,影响因素发生率为55.84%（43/77）;不典型VD组中,影响因素发生率为95.31%（61/64）,两组比较,差异有显著意义（P〈0.001）。VD患者分娩的141例新生儿中,1min Apgar评分大于7分的为125例,小于7分的为16例。其中,单纯VD组新生儿窒息率为2.59%（2/77）,而不典型VD组新生儿窒息率为21.21%（14/66）,两组比较,差异有显著意义（P〈0.001）。单纯VD组剖宫产率（20.78%）低于不典型VD组（54.69%）,两组比较,差异有显著意义（P〈0.001）。结论胎心监护NST中,VD的发生与多种因素有关,其中脐带异常最常见。胎儿窘迫导致的不典型VD较单纯VD更容易发生。     

Prevention and genetic testing for breast cancer: variations in medical decisions

The discovery linking the genes BRCA1&2 to familial breast cancer played an important role in the clinical practice of geneticists and physicians. The availability of genetic tests for BRCA gene mutations prompted cancer geneticists to give information about genetic risk and to assess many women with a personal or family history of breast or ovarian cancer to inform them of preventive measures. These consist mainly of breast self-examination, mammography screening, chemoprevention and prophylactic surgery (mastectomy, oophorectomy). This paper examines clinical practices related to hereditary breast cancer testing and introduces a number of results from a survey carried out, between 1996 and 1998, in three clinics located in Montreal (Quebec, Canada), Marseilles (France) and Manchester (Great Britain). Results show substantial differences in the way cancer geneticists deal with environmental risk factors, breast and ovarian cancer testing, and chemoprevention and prophylactic surgery. Differences across cities persist in the multivariate analysis, suggesting that attitudes towards preventive measures may be partially explained by cultural factors. Different dimensions of culture are discussed including the social representation of health and risk, the interpretation of scientific evidence and the role of innovation leadership.     

Assessing health diagnosis disclosure decisions in relationships: testing the disclosure decision-making model

Illness affects millions of Americans each year, and the disclosure of health conditions can facilitate access to social support, in addition to other physical and physiological benefits. This article tests the Disclosure Decision-Making Model (DD-MM; Greene, 2009 ) to predict factors that influence the likelihood of disclosing (and past disclosure of) nonvisible physical or mental health-related information. One hundred eighty-seven (n?=?187) people were recruited for a study to report on both disclosing and not disclosing a nonvisible health condition. Measured variables included information assessment, relational quality, anticipated reactions (support, relational consequences), confidence in response, disclosure efficacy, and disclosure (likelihood of disclosure and depth of disclosure). Structural equation modeling results supported many of the proposed hypotheses, with a great deal of similarity across models. Specifically, assessing information predicted efficacy, and to some extent relational outcomes. Closeness was related to response overall and to efficacy in one model. Response predicted outcome overall and likelihood of disclosure in one model. Finally, efficacy predicted likelihood of disclosure and depth of disclosure. The article discusses the implications of the findings for understanding information, relationship assessments, and efficacy in disclosing health diagnoses.     

Individuals' decisions affecting radiation exposure after a nuclear explosion

In the aftermath of a nuclear attack, shelters can offer potentially important protection. How well they fill that role depends on a set of interdependent decisions made by the individuals and organizations that must prepare and use them. We look at three such decisions. For each, we begin with formal analysis of the consequences expected from different possible actions. Those analyses are, then, reviewed in terms of how individuals facing these choices will perceive them, given the information that they are likely to have. The first example suggests that preparing a home shelter according to guidelines from the Department of Homeland Security may not pass a cost-benefit test. The second example explores the use of readily available information about a blast to infer how urgently shelter should be sought. The third example considers when shelters should be left, suggesting that individuals with the best shelters and slowest evacuation speeds should evacuate last, if they have the provisions needed to remain. In each case, helping people to protect themselves requires prior risk analyses and communication development.     

Factors affecting gay and bisexual men's decisions and intentions to seek HIV testing.

OBJECTIVES. This paper describes the relationships of sociodemographic, attitudinal, and behavioral variables to (1) decision to be tested, (2) expressed intention to be tested, and (3) reasons for not being tested for the human immunodeficiency virus (HIV) antibody. METHODS. A sample of 1295 men completed an anonymous questionnaire in gay-identified venues. Factor analysis was used to group reasons for not being tested and logistic and multiple linear regression were used to model the dependent variables. RESULTS. Fifty-three percent of the respondents had been tested, of whom 26% tested positive. Metropolitan residence and anal intercourse most strongly correlated with previous test-seeking. Previous test experience correlated most strongly with intention to be tested. Reasons for not being tested fell into three groups: (1) desire for anonymity, (2) self-perceived health, and (3) no benefit and denial. The odds were lower for gay men than bisexuals and men who did not participate in anal intercourse to express a desire for anonymity. CONCLUSIONS. Public health agencies should be prepared to individualize testing policies and education to deal with specific concerns and fears. Improving access to the test by removing some of the current psychological and physical barriers will enhance its medical and public health value.     

Prophylactic surgery decisions and surveillance practices one year following BRCA1/2 testing

BACKGROUND: Although genetic testing for breast cancer risk is clinically available, its impact on health-related behaviors is unknown. This study examined prophylactic surgery and surveillance behavior during the year following BRCA1/2 gene testing. METHODS: Participants were female members (n = 216) of hereditary breast-ovarian cancer families (84 mutation carriers, 83 noncarriers and 49 test decliners). In this prospective observational study, utilization of prophylactic surgery and surveillance behavior were assessed 1-year following BRCA1/2 testing. RESULTS: Only 3% of the unaffected carriers obtained prophylactic mastectomy during the 1-year follow-up period. Among the remaining females, carriers had significantly higher rates of mammography (68%) than noncarriers (44%); (OR = 7.1; C.I. = 1.36-37.1; P = 0.02). However, the adherence rate in carriers was unchanged from baseline, suggesting that this difference is attributable to a reduction in screening among noncarriers. Women ages 25-39 years were significantly less likely to obtain mammograms than those aged 40 years and older. Cancer-related distress had a positive but nonsignificant (P < 0.07) association with adherence in bivariate but not multivariate analysis. With regard to ovarian risk, only 13% of carriers obtained prophylactic oophorectomy; of the remaining female carriers, only 21% reported a CA125 and 15% reported a transvaginal ultrasound. CONCLUSION: The vast majority of BRCA1/2 carriers may not opt for prophylactic surgery, and many do not adhere to surveillance recommendations. Greater attention to risk communication and medical decision-making is warranted.     

NST时减速波型结合B超在脐带缠绕诊断及预后评价中的作用

目的 :探讨 NST时减速波型结合 B超在脐带缠绕产前诊断及预后评价中的作用。方法 :选择入院时未临产的足月单胎头位妊娠 710例进行超声及胎儿监护检查 ,预测脐带缠绕的发生。并对比分析脐带缠绕病例中 NST时减速波型组与非 NST时减速波型组的围产儿病率及剖宫产率。结果 :足月单胎头位的脐带缠绕发生率为 2 4 .2 % ,初产妇高于经产妇 ,分别为 2 5 .6 7%及 18.8%。 NST时减速波型结合 B超预测脐带缠绕的阳性预测值为 84 .36 % ,阴性预测值为 96 .0 5 % ,敏感度为 87.79% ,特异性为 94 .8% ,准确率为 93.1%。 NST时减速波型组与非减速波型组比较 ,前者重度羊水污染率、胎儿窘迫率及剖宫产率高于后者 ,P<0 .0 5 ,P<0 .0 5 ,P<0 .0 2 5。而新生儿窒息率无明显差别 ,P>0 .0 5。结论 :NST时减速波型结合 B超预测脐带缠绕有较高准确率及预测值 ,可作为临床预测脐带缠绕的方法。对 NST时减速波型者适当放宽手术指征 ,能有效降低新生儿窒息率及死亡率     

NST时减速波型结合B超在脐带缠绕诊断及预后评价中的作用

目的探讨NST时减速波型结合B超在脐带缠绕产前诊断及预后评价中的作用.方法选择入院时未临产的足月单胎头位妊娠710例进行超声及胎儿监护检查,预测脐带缠绕的发生.并对比分析脐带缠绕病例中NST时减速波型组与非NST时减速波型组的围产儿病率及剖宫产率.结果足月单胎头位的脐带缠绕发生率为24.2%,初产妇高于经产妇,分别为25.67%及18.8%.NST时减速波型结合B超预测脐带缠绕的阳性预测值为84.36%,阴性预测值为96.05%,敏感度为87.79%,特异性为94.8%,准确率为93.1%.NST时减速波型组与非减速波型组比较,前者重度羊水污染率、胎儿窘迫率及剖宫产率高于后者,P＜0.05,P＜0.05,P＜0.025.而新生儿窒息率无明显差别,P＞0.05.结论NST时减速波型结合B超预测脐带缠绕有较高准确率及预测值,可作为临床预测脐带缠绕的方法.对NST时减速波型者适当放宽手术指征,能有效降低新生儿窒息率及死亡率.     

创伤与非创伤状态下新生儿对外源性脂肪清除影响的研究

对创伤与非创伤状态下新生儿对脂肪乳剂的清除特征进行了研究。结果显示,新生儿TPN期间脂肪乳剂量为2g·kg~(-1)/d,创伤组及非创伤组血TG水平均始终控制在200mg/dl以下;创伤组TG、TC水平始终低于非创伤组;PL、FFA在两组中均见升高;HDL-c、LDL-c、Apo-A1、Apo-B两组中的变化则各与其TG、TC的变化特征相一致。作者认为,新生儿TPN时两组均能耐受2g·kg~(-1)/d的脂肪乳剂剂量,并且创伤组提高了脂肪清除能力。     

Factors shaping at‐risk individuals’ decisions to undergo genetic testing for cancer in Asia

This study aims to enrich our understanding of factors influencing medically indicated at‐risk individuals’ decisions to take genetic tests (or not) in the context of cancer treatment and prevention. While previous studies have explored this topic in communities in Europe and the United States, we know relatively little about the situation in Asia. In this study, we conducted in‐depth interviews with 24 women who underwent genetic testing for hereditary breast and ovarian cancer syndromes in Singapore. Grounded theory with thematic analysis was applied. Six encouraging and three discouraging factors are identified in the analysis. The six encouraging factors are: desire to create awareness for self and family; perceived benefits for self and family; strong family history of cancer; presence of family support; medical professional recommendation and adequate amount of time to consider undertaking the test. The three discouraging factors are: high costs of tests; perceived lack of ability to cope with test results; and insufficient information about genetic testing. Taken together, the findings in this study add to the current literature by providing empirical evidence regarding the importance of holding family included pre‐test counselling and providing adequate time for patients to decide to undergo genetic testing for hereditary cancer syndromes.     

Patients' choices and perceptions after an invitation to participate in treatment decisions.

Previous search indicates that treatment outcomes may be improved if patients perceive greater control over their treatment, but the practical implications of encouraging patients to take more control have not been investigated. The present study investigated responses of 143 patients in a cardiovascular risk management clinic to an invitation to make a decision about their treatment. Subjects' choices of the target behaviour for their behaviour-change treatment were highly predictable from their state of health, reasons for coming to the clinic, what behaviours they were told they were at risk from, and contacts with health workers. The degree of control that subjects reported they had over the decision varied considerably, being negatively related to blood pressure and positively related to the degree of control that subjects believed they had over their health in general. Issues such as time-demands, the practitioner's job satisfaction, and ethical implications of patient participation are discussed.     

Management of tachyarrhythmias after MI

The prognostic significance of ventricular and supraventricular tachyarrhythmias after infarction varies with type and timing. In some cases intervention may be appropriate, and in others not. Management of peri-infarction and of later arrhythmias is reviewed. To avoid proarrhythmic consequences, pharmacologic treatment should be rigorously guided by carefully defined end points.