某医院老年住院患者慢性病情况调查

目的了解北京友谊医院老年住院患者慢性病患病情况及近10年变化。方法通过统计病案首页数据,对我院2008年1月至2017年12月60 630例老年住院患者的慢性病患病情况进行统计,同时分析近5年老年住院患者慢性病共病情况。结果 2008～2012年患病率排前5位的慢性病分别为高血压(19.60%)、冠状动脉粥样硬化性心脏病(15.90%)、恶性肿瘤(13.20%)、糖尿病(10.40%)和血脂代谢异常(9.80%)。2013～2017年,患病率排前5位的慢性病分别为高血压(40.00%)、恶性肿瘤(25.92%)、糖尿病(19.16%)、冠状动脉粥样硬化性心脏病(17.58%)和白内障(15.70%)。2013～2017年不同年龄的老年患者存在不同程度的共病情况,60～69岁患者慢性病共病数(2.71±1.86)种,70～79岁患者慢性病共病数(4.24±1.54)种,80～89岁患者慢性病共病数(5.93±2.33)种。结论我院老年住院患者恶性肿瘤、高血压、白内障患病率显著增高,慢性病共病种数随年龄增长而增多,老年科医师应综合全面地对老年人所患疾病进行诊治。     

老年人常见慢性病防控情况调查与健康管理分析

目的:探究老年人常见慢性病防控情况调查与健康管理分析.方法:运用典型抽样法在我院辖区年龄在60岁以上老年慢性病患者共100例,分别开展问卷调查.结果:患有高血压的患者为73％,患糖尿病的患者为45％,糖尿病伴高血压的患者有30％.结论:高血压糖尿病是老年患者常见的慢性疾病需要给予健康管理,提高老年慢性病防控效果.     

社区老年慢性病患者心理健康状况

目的了解社区老年慢性病患者心理健康状况及相关因素。方法选取社区60岁慢性病患者572例,进行一般情况调查表、症状自评量表(SCL-90)、抑郁自评量表(SDS)、社会支持评定量表(SSRS)、纽芬兰纪念大学幸福度量表(MUNSH)测试。结果老年慢性病患者抑郁情绪检出率34.27%;SCL-90总均分和各因子分都高于中国常模,SCL-90总分与SSRS,MUNSH均负相关(r=-0.142,P0.01;r=-0.539,P0.01),与SDS呈正相关(r=0.698,P0.01);患病种类越多,病程越长,心理问题越严重。结论社区老年慢性病患者心理健康状况不容乐观,需要社区卫生服务机构提高服务能力,完善社会支持功能,改善老年患者心理健康状况。     

高龄老年住院患者1004例慢性病共病特点分析

目的了解高龄老年住院患者慢性病种类、慢性共病类型及其分布特点。方法统计2013年6月至2016年6月期间于武汉大学中南医院老年病科住院的1004例高龄老年患者的疾病信息,筛选出23种慢性疾病,对慢性病类型及慢性共病特点进行统计分析。计数资料采用卡方检验;计量资料采用t检验或单因素方差分析。结果 23种慢性病中患病率最高的前5位疾病分别为高血压(72.51%)、脑血管病(52.29%)、冠心病(37.25%)、心功能不全(36.25%)及骨关节病(33.96%)。93.73%的高龄老人患有两种或两种以上的慢性疾病,平均慢性共病为(4.67±2.18)种。将慢性病两两组合成疾病对,特定疾病对的实际共同患病率较理论患病率高,如高血压与糖尿病(OR=1.25,95%CI 1.02~1.54;P=0.03)、冠心病与心功能不全(OR=2.14,95%CI 1.69~2.69;P0.01)、心功能不全与心律失常(OR=1.77,95%CI 1.34~2.35;P0.01)。结论高龄老年人群共病患者呈现高患病率、平均共病个数较多的特点。慢性病之间相互联系组合可形成特定的疾病对。     

社区老年人功能性体适能现状及与慢性病共病的相关性分析

目的 调查社区老年人功能性体适能水平,并分析功能性体适能水平与慢性病共病的关系。方法 于2020年3～6月招募社区老年人432例,通过慢性病共病调查表进行共病筛查,采用老年人体适能测试(SFT)方法进行功能性体适能测试。结果 与无共病的老人相比,慢性病共病老年人2 min踏步测试、肱二头肌屈举和30 s座椅站立次数均较少,“起立-步行”计时测试(TUGT)时间更长。随着慢性病数量增多,老年人2 min踏步测试和30 s座椅站立次数呈下降趋势,BMI和TUGT时间呈上升趋势。年龄(OR=1.058, 95%CI:1.021～1.097)、经济来源(OR=0.368, 95%CI:0.219～0.620)、肱二头肌屈举次数(OR=0.881, 95%CI:0.822～0.945)和肥胖(OR=2.361, 95%CI:1.096～5.084)是老年人慢性病共病的影响因素。结论 老年慢性病共病病人心肺耐力、肌肉力量和动态平衡能力均低于无慢性病共病者。年龄、经济来源、肥胖和上肢肌肉力量是老年人慢性病共病的影响因素。     

老年人身体功能与慢性病共病关联的研究

目的 探讨老年人身体功能与慢性病共病的关联。方法 采用中国健康与养老追踪调查数据库(CHARLS)的数据,以2011年基线调查的2452名≥60岁的老年人作为研究对象并追踪到2015年,调查内容包括握力、简易躯体能力(SPPB)、慢性病情况、人口学变量及健康行为变量等。采用SPSS 26.0统计软件进行数据分析。根据数据类型,应用广义估计方程分析身体功能与慢性病共病的关联。结果 老年人慢性病共病患病率呈上升趋势,性别、摔倒、握力和SPPB与老年人慢性病共病患病风险显著相关;女性及发生摔倒的老年人慢性病共病患病风险较高(P＜0.05),握力值低(OR=1.274, 95%CI:1.053～1.542, P=0.013)和SPPB得分低 (OR=1.508, 95%CI:1.119～2.033, P=0.007)的老年人慢性病共病患病风险较高。结论 老年人身体功能与慢性病共病患病风险显著相关,身体功能测量可作为筛查慢性病共病的有效手段,有助于对有较高慢性病共病患病风险的个体进行早期识别和重点防控。     

90岁及以上老年原发性高血压患者共病情况及与常见老年事件的相关性

目的调查90岁及以上老年原发性高血压患者共病情况,并对其与常见老年事件的相关性进行分析。方法采用横断面调查方法,入选2017年1~12月于辽宁省金秋医院(辽宁省老年病医院)住院治疗的年龄≥90岁的老年共病患者419例。根据是否患有高血压分为高血压组和对照组,比较两组一般资料差异。收集患者的共病种类,统计数量并采用Charlson共存病指数(CCI)对共病严重程度进行评价。采用Spearman相关分析计算入院时血压水平与CCI的相关性,应用多元线性回归分析CCI与心房颤动、脆性骨折、肺炎、尿路感染、植入起搏器状态、管饲、导尿、催眠药物使用及通便药物使用等老年事件的相关性。结果入选患者总体CCI评分为(4.0±2.2)分,校正年龄后评分为(8.0±2.2)分,总体共病数为(7.7±2.6)种。高血压组患者289例,占全部患者69.0%,其中男性202例,女性87例。高血压组与对照组比较:CCI评分为(4.6±2.1)分比(2.8±1.9)分,t=8.261,P=0.000;共病数量(8.3±2.5)种比(6.3±2.4)种,t=7.568,P=0.000;收缩压(133.81±13.31)mmHg比(124.91±11.61)mmHg,t=6.922,P=0.000;舒张压(72.24±7.56)mmHg比(69.68±7.25)mmHg,t=3.304,P=0.001。采用Spearman相关分析提示,CCI与血压水平存在相关性(r=0.101,P=0.039)。多元线性回归分析提示,CCI与脆性骨折、肺炎、尿路感染、管饲、催眠药使用及通便药使用独立相关(均为P<0.05)。结论90岁及以上老年原发性高血压患者在共病数量及程度上较无高血压者更明显,CCI与血压水平存在相关性,老年共病伴有更多的脆性骨折、肺炎、尿路感染、管饲、催眠药使用及通便药使用。     

城市老年慢性病患者心理健康状况及其与社会支持相关性

目的分析城市老年慢性病患者的心理健康状况及其与社会支持的关系。方法采取随机抽样方式,应用症状自评量表(SCL-90)和社会支持评定量表(SSRS)对长沙市雨花区仁和医院内科明确诊断患有慢性病的451名老年患者及448名非慢性病老年患者进行心理健康和社会支持问卷调查。结果城市老年慢性病患者的社会支持与非慢性病老年人群相比,获得社会支持少(P0.05),其中病程≥5年患者的社会支持各项分值均高于病程5年患者(P0.05);城市老年慢性病患者的心理健康分值均低于非慢性病老年人群(P0.05),其中病程5年的患者心理健康各项分值均高于病程≥5年的患者(P0.05);城市老年慢性病患者的心理健康与主观支持、支持利用度均呈正相关(P0.05)。结论城市慢性病老年患者的心理健康状况总体偏差,其受到社会支持某些方面的影响。应为其营造良好的生活环境,同时加强慢性病知识的宣传和教育,使其及早了解相关疾病知识,以缓解慢性病带来的心理压力。     

农村老年慢性病患者功能状态及其影响因素

目的探讨分析农村老年慢性病患者功能状态及其影响因素。方法抽取2019年7～9月基于连云港海州区朐阳社区老人慢病健康档案为前期数据,以260名常住居民并接受社区健康服务管理的60岁及以上老人为研究对象,进行现场问卷调查,收集相关数据,分析农村老年慢性病患者的功能状态及其影响因素。结果 260名研究对象中60例为慢性病患者(部分患者存在2种及以上慢性病类型),为慢性病组,余200例为无慢性病组。慢性病组功能独立性评定量表(FIM)评分显著低于无慢性病组(P0.05);慢性病组与无慢性病组性别、受教育程度、婚姻状况、照顾孙辈、参加社交活动、日常锻炼身体频率、摄入蔬菜水果种类占比差异无统计学意义(P0.05);慢性病组年龄(≥75岁)、留守、社会经济地位低、家庭饮食不安全、吸烟、饮酒占比均显著高于无慢性病组(P0.05);经Logistic回归分析显示,年龄(≥75岁)、留守、社会经济地位低、家庭饮食不安全、吸烟、饮酒为老年慢性病发生的相关影响因素(OR1,P0.05)。结论慢性病的发生可影响农村老年人功能状态,农村老年人发生慢性病可能受年龄大、留守、社会经济地位低、家庭饮食不安全、吸烟、饮酒等因素的影响,应对农村老年群体及早评估是否存在上述风险因素,并采取针对性的干预措施减少慢性病的发生。     

杭州小营街道慢性病社区调查分析

目的 探讨老年人教育程度及不良行为认知与慢性病发病率的关系.方法 通过社区诊断收集2009年以来社区卫生服务及各相关部门 的工作报表、统计及汇编资料,以及有关居民访谈调查的资料等,进行整理和分析.结果 辖区老年化(17.45%),60岁及以上老人初中及以下文化程度为61.33%.社区居民中学及以下文化程度的慢性病发率病...     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.