进一步重视老年压力性损伤的综合防治

老年压力性损伤患者因自身合并疾病多且并发症多,治疗起来较普通患者难度大,病死率明显增高,是老年人疾病防治的重中之重。尽管目前已投入了大量的人力、物力来防治压力性损伤,但是整体情况依旧不容乐观。近年来,随着对压力性损伤的认识不断深入,治疗手段也有一定的改进,尤其在老年压力性损伤防治方面已取得一些进展。笔者复习压力性损伤的最新定义与分期,比较详尽地阐述老年压力性损伤综合防治措施,为身患其他各种疾病的老年压力性损伤患者提供临床参考。     

Schizophrenia and affective disorder in black and white patients: a methodologic note

Contrary to many published reports of higher rates of schizophrenia and lower rates of affective disorder among blacks, this analysis of data collected over a ten-year period in a psychiatric clinic that serves a predominantly black population found minimal differences between the two ethnic groups. Methodologic considerations that reduce spurious black-white differences are discussed. The authors urge proper caution in evaluating such reported differences and propose screening measures to identify biased diagnostic procedures.     

Nosocomial HIV infection: epidemiology and prevention--a global perspective

Because, globally, HIV is transmitted mainly by sexual practices and intravenous drug use and because of a long asymptomatic period, healthcare-associated HIV transmission receives little attention even though an estimated 5.4% of global HIV infections result from contaminated injections alone. It is an important personal issue for healthcare workers, especially those who work with unsafe equipment or have insufficient training. They may acquire HIV occupationally or find themselves before courts, facing severe penalties for causing HIV infections. Prevention of blood-borne nosocomial infections such as HIV differs from traditional infection control measures such as hand washing and isolation and requires a multidisciplinary approach. Since there has not been a review of healthcare-associated HIV contrasting circumstances in poor and rich regions of the world, the aim of this article is to review and compare the epidemiology of HIV in healthcare facilities in such settings, followed by a consideration of general approaches to prevention, specific countermeasures, and a synthesis of approaches used in infection control, injury prevention, and occupational safety. These actions concentrated on identifying research on specific modes of healthcare-associated HIV transmission and on methods of prevention. Searches included studies in English and Russian cited in PubMed and citations in Google Scholar in any language. MeSH keywords such as nosocomial, hospital-acquired, iatrogenic, healthcare associated, occupationally acquired infection and HIV were used together with mode of transmission, such as "HIV and hemodialysis". References of relevant articles were also reviewed. The evidence indicates that while occasional incidents of healthcare-related HIV infection in high-income countries continue to be reported, the situation in many low-income countries is alarming, with transmission ranging from frequent to endemic. Viral transmission in health facilities occurs by unexpected and unusual as well as more frequent modes. HIV can be transmitted to patients and to donors of blood products by specific vehicles and vectors during blood transfusion, plasma donation, and artificial insemination, by improperly sterilized sharps, by medical equipment during activities such as dialysis and organ transplantation, and by healthcare workers infected by occupational exposure to hazards such as blood-contaminated sharps. Personal, equipment, and environmental factors predispose to acquisition of nosocomial HIV and all are pertinent for prevention. For infection and injury control, poverty is often an underlying determinant. While sophisticated new tests offer improved HIV detection, increasingly higher marginal costs limit their feasibility in many settings. Modest investment in safer equipment and appropriate integrated training in infection control, injury prevention, and occupational safety should provide greater benefit.     

Predictive Factors for Lateral Ankle Sprains: A Literature Review

OBJECTIVE: To review the prospective studies of ankle-ligament-injury risk factors. DATA SOURCES: We searched MEDLINE from 1978 to 2001 using the terms ankle, ligament, injury, risk factor, and epidemiology. DATA SYNTHESIS: The results included many studies on the treatment and prevention of ankle injuries. There were, however, very few prospective studies focusing on identifying the risk factors that predispose an athlete to ankle-ligament trauma. CONCLUSIONS/RECOMMENDATIONS: There is some agreement among authors with regard to the risk factors for ankle-ligament injury; however, considerable controversy remains. Although female athletes are at significantly greater risk of suffering a serious knee sprain, such as disruption of the anterior cruciate ligament, this does not appear to be the case for ankle-ligament sprains. Therefore, sex does not appear to be a risk factor for suffering an ankle-ligament sprain. Athletes who have suffered a previous sprain have a decreased risk of reinjury if a brace is worn, and the consensus is that generalized joint laxity and anatomical foot type are not risk factors for ankle sprains. However, the literature is divided with regard to whether or not height, weight, limb dominance, ankle-joint laxity, anatomical alignment, muscle strength, muscle-reaction time, and postural sway are risk factors for ankle sprains. Future research is needed on this topic to develop a consensus on all ankle-injury risk factors. This will allow future intervention studies to be designed that will reduce the incidence and severity of this common injury.     

Disparities in the Patterns and Determinants of HIV Risk Behaviors among Adolescents Entering Substance Abuse Treatment Programs

Opinions expressed in this paper are those of the authors and do not represent official positions of the government, the grantees or the individuals above.Background:Black youth are disproportionately affected by the HIV/AIDS epidemic. This study examined disparities in patterns and determinants of sexual risk behaviors among black and white adolescents in substance abuse treatment programs.Methods:We used pooled clinical data collected from 4,565 sexually active 12-17-year-old black (29.7%) and white (70.3%) adolescents entering outpatient and residential substance abuse treatment programs nationally. Multivariate logistic regression analyses were used to examine racial differences in patterns of sexual risk behaviors and the associations of these behaviors with demographic, socioenvironmental and psychosocial risk factors, including substance use and abuse, symptoms of mental disorders and criminal behaviors.Results:Blacks were significantly more likely than whites to have had sex with multiple partners, purchased or traded sex and used substances to enhance their sexual experiences, even after adjusting for demographic, socioenvironmental and psychosocial risk factors. Substance use and abuse, internalizing symptoms and drug-related crimes were significantly associated with engaging in ≥ 2 sexual risk behaviors in both groups. Disparities in determinants of HIV risk were also found. For instance, male gender, single-parent custody and history of criminal justice involvement were associated with having had sex with multiple partners among blacks but not among whites. Demographic, socioenvironmental and psychosocial risk factors accounted for up to 30% of the variance in sexual risk in both groups.Conclusions:Black adolescents with substance use problems are at greater risk for HIV infection than their white peers because of their higher rates of sexual risk behaviors.Differences in co-occurring psychosocial problems did not fully explain racial disparities in sexual risk behaviors. HIV prevention programs for black adolescents in treatment should consider both individual and broader contextual factors that co-occur with sexual risk behaviors.     

Racial differences in vitamin B12 levels in the United States

Studies from Africa have demonstrated that black people have higher vitamin B12 (cobalamin) levels than do white people. The authors compared healthy white people, black people, and Latin-Americans in the United States. Their study is also the largest in which the effect of race and sex on the cobalamin levels has been examined. Analysis of 233 healthy subjects showed that black people had significantly higher (P less than 0.0001) vitamin B12 levels than did white people. Latin-Americans had levels intermediate between those of white and black people, although their levels were significantly different only in comparison with white people (P = 0.0029). Based on the study of 305 healthy subjects, no sex difference in vitamin B12 levels was noted. Conflicting claims have been made on sex difference in the past. The authors conclude that there is a racial but not a sex difference in vitamin B12 levels in the United States. Like African black people, black people and Latin-Americans in this country have significantly higher vitamin B12 levels than do white people. This finding supports the thesis that genetic factors contribute to the racial differences in vitamin B12 levels.     

Accidental traumatic head injury in infants and young children

Abstract This article will discuss accidental head injuries in infants and young children. The first category of injury is the crushing head injury. Static forces applied slowly to the head result in multiple fractures of the skull and contusions and lacerations of the brain resulting from the bone fragments striking the brain. This article will discuss the subject of short falls in young children and the resulting head injuries. Because falls are frequent events in early life, many cases have been collected and many papers written on the subject. Study of these cases is informative about the injuries likely to occur in these falls. Most often, only a minor contact injury such as scalp bruise or laceration results. In a 2 to 3% of falls, a simple linear skull fracture occurs and the majority of these are uneventful in terms of neurological deficit or intracranial bleeding. In about 1% of the fractures, an epidural or subdural hemorrhage occurs. Each of these forms of contact hemorrhages will be discussed and illustrated. While these are relatively rare injuries, it is essential that they can be identified as consistent with an accidental mechanism so that an erroneous diagnosis of inflicted injury is not made.     

Using an online survey to assess knowledge of HIV in general and testing specifically among black and white college students

BACKGROUND: Although there have been studies examining HIV knowledge among college population, current study is the first providing comparable information on HIV knowledge in general and testing specifically via online surveys among black and white college students. METHODS: Blacks (N=222) were recruited from 15 historically black college and universities (HBCUs) and whites (N=335) from a traditionally white institution. RESULTS: The majority of the students were aged 18-24 years. Reliability of the overall knowledge scale showed good internal consistency for both samples (alpha=0.70). Students overall scored higher on items related to HIV/AIDS in general (81.5% correct) and lower on items related to HIV testing (71.6% correct), with no significant difference between groups. However, blacks rated significantly higher on their subjective (or "perceived") HIV general knowledge (item mean 3.55 vs. 3.26) and testing specific knowledge (item mean 3.13 vs. 2.54) (p<0.01). Results showed that blacks were 6.9 times more likely to have been tested for HIV. Subjective HIV testing knowledge (OR=2.9) and nonheterosexual orientation (OR=3.2) were also significant predictors to prior testing behavior. CONCLUSIONS: The knowledge scale assessed via the Internet demonstrated satisfactory reliabilities among diverse college students. Data showed that HBCU black students perceived significant higher knowledge levels, despite results showing similar knowledge scores as white students. Results have implications on HIV prevention among students attending their race/ethnic dominant institutions.     

Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans?

OBJECTIVES: This study examined endorsement of HIV/AIDS conspiracy beliefs and their relations to consistent condom use and condom attitudes among African Americans. METHODS: We conducted a telephone survey with a random sample of 500 African Americans aged 15 to 44 years and living in the contiguous United States. RESULTS: A significant proportion of respondents endorsed HIV/AIDS conspiracy beliefs. Among men, stronger conspiracy beliefs were significantly associated with more negative condom attitudes and inconsistent condom use independent of selected sociode-mographic characteristics, partner variables, sexually transmitted disease history, perceived risk, and psychosocial factors. In secondary follow-up analyses, men's attitudes about condom use partially mediated the effects of HIV/AIDS conspiracy beliefs on condom use behavior. CONCLUSIONS: HIV/AIDS conspiracy beliefs are a barrier to HIV prevention among African Americans and may represent a facet of negative attitudes about condoms among black men. To counter such beliefs, government and public health entities need to work toward obtaining the trust of black communities by addressing current discrimination within the health care system as well as by acknowledging the origin of conspiracy beliefs in the context of historical discrimination.     

Mortality among infants of black as compared with white college-educated parents.

BACKGROUND. In the United States, black infants are twice as likely to die as white infants; this difference reflects both black infants' higher rates of low birth weight and the higher mortality among black infants of normal birth weight. We studied mortality in infants born to college-educated parents in order to investigate this gap while controlling for sociodemographic variables. METHODS. We used the National Linked Birth and Infant Death Files for 1983 through 1985 to calculate infant mortality rates for children born to college-educated parents. The study population consisted of 865, 128 white infants and 42,230 black infants. A separate effect of birth weight was assessed by examining mortality rates before and after the exclusion of infants weighing less than 2500 g at birth (low-birth-weight infants). RESULTS. In this population, the infant mortality rate was 10.2 per 1000 live births for black infants and 5.4 per 1000 live births for white infants; the adjusted odds ratio for death among black infants was 1.82 (95 percent confidence interval, 1.64 to 2.01). The rate of low birth weight was more than twice as high among blacks (7 percent) as among whites (3 percent), although the mortality rate in this group was not higher among blacks than among whites. Black infants were three times as likely as white infants to die of causes attributable to perinatal events, including prematurity. They were no more likely to die of the sudden infant death syndrome. After the exclusion of low-birth-weight infants, the mortality rates for black and white infants were equal. CONCLUSIONS. In contrast to black infants in the general population, black infants born to college-educated parents have higher mortality rates than similar white infants only because of their higher rates of low birth weight. Black and white infants of normal birth weight have equivalent mortality rates.     

Antioxidants of the beverage tea in promotion of human health

Tea that contains many antioxidants is a pleasant and safe drink that is enjoyed by people across the globe. Tea leaves are manufactured as black, green, or oolong. Black tea represents approximately 78% of total consumed tea in the world, whereas green tea accounts for approximately 20% of tea consumed. The concept of "use of tea for promotion of human health and prevention and cure of diseases" has become a subject of intense research in the last decade. Diseases for which tea drinkers appear to have lower risk are simple infections, like bacterial and viral, to chronic debilitating diseases, including cancer, coronary heart disease, stroke, and osteoporosis. Initial work on green tea suggested that it possesses human health-promoting effects. In recent years, the research efforts have been expanded to black tea as well. Research conducted in recent years reveals that both black and green tea have very similar beneficial attributes in lowering the risk of many human diseases, including several types of cancer and heart diseases. For cancer prevention, evidence is so overwhelming that the Chemoprevention Branch of the National Cancer Institute has initiated a plan for developing tea compounds as cancer-chemopreventive agents in human trials. Thus, modern medical research is confirming the ancient wisdom that therapy of many diseases may reside in an inexpensive beverage in a "teapot."     

A model for cardiomyocyte cell death: Insights into mechanisms of oncosis

It is now known that there are at least two basic patterns of cell injury progressing to cell death: cell injury with swelling, known as oncosis, and cell injury with shrinkage, known as apoptosis. Both types of cell death are “programmed” in the sense that the genetic information and many of the enzymes and other factors pre-exist in the cell. Previous investigation has pointed to cardiomyocyte ischemic injury evolving as the oncotic pattern of injury, although apoptosis has also been implicated. This study was designed, using a unique cell model system, to gain insight into the molecular events of anticancer agent-induced cardiomyocyte injury. Cardiomyocytes exposed for 2 h to 1.5 μg/ml sanguinarine consistently displayed the morphology of apoptosis in over 80% of cells, whereas a higher dose of 25 μg/ml at 2 h yielded the pattern of oncosis in over 90% of cells. Microarray analysis revealed altered expression of 2514 probes in sanguinarine-induced oncosis and 1643 probes in apoptosis at a level of significance of p < 0.001. Some of the inductions such as perforin were found to be higher than 11-fold in oncosis. When perforin was blocked by perforin-specific siRNA we found a reduction in oncotic cell death. These results strengthen the notion that oncosis is not representative of nonspecific necrosis, but constitutes a genetically controlled form of “programmed cell death”; and also that oncosis might represent a pathogenetic mechanism of cardiomyocyte injury. This is also the first demonstration of the involvement of perforin in cardiomyocyte oncosis.     

Malaria mimicry with tumor necrosis factor. Contrasts between species of murine malaria and Plasmodium falciparum.

Because Plasmodium berghei ANKA induces cerebral malaria and P. vinckei does not, the former has often been studied as a model for human falciparum malaria. It lacks, however, many of the systemic changes seen in the human disease. Because both of these murine models and the human disease have now been defined in terms of excess tumor necrosis factor (TNF) production, the authors have more closely examined the two murine models in this light to see which provides the better overall model for falciparum malaria. Administering TNF to malaria-infected mice did not cause cerebral symptoms nor breakdown of the blood-brain barrier, which is the hallmark of P. berghei ANKA cerebral malaria and is generally absent in human cerebral malaria. Tumor necrosis factor did, however, induce hypoglycemia and liver injury, pathology that is seen in terminal P. vinckei and falciparum malaria, but is absent in terminal P. berghei ANKA malaria. Plasma TNF and interleukin-6 (IL-6) also were found to be consistently higher in infections caused by P. vinckei than in those caused by P. berghei ANKA. The pathology of P. vinckei malaria is thus consistent with raised systemic levels of TNF and other cytokines, as is falciparum malaria. The authors therefore conclude that P. vinckei malaria, although lacking a cerebral component, is the better model for the human disease.     

Vaccine safety

Rates of reported adverse events are remarkably low. VAERS identifies an adverse event rate approximating 11.4 reports per 100,000 vaccine doses. Approximately 15% of these reports represent SAEs, but less than 2% involve death; in most cases, reviews have shown no causal relation between the events and the vaccine. Across the spectrum of vaccines in use (including those directed against influenza and hepatitis B virus), many claims of adverse events regarding vaccines represent typical reactions to vaccinations. These reactions can be thought of as foreign-body reactions and predominate among the inactivated vaccines. In controlled studies, the adverse event rates that occur with vaccination resemble those that occur with placebo injections. Typical reactions associated with live viral and bacterial vaccines, such as MMR and varicella vaccines, may resemble attenuated forms of the disease for which the vaccine is directed. Other claims against vaccines represent chance-coincidence or misunderstood data; further studies of claims have vindicated the overall safety of the vaccines in most cases. Two documented safety concerns with vaccines, however, have demonstrated that vaccines (like other biologics and pharmacologic) can result in harm (eg, rotavirus and OPV vaccines). The denouement with these vaccines indicates the broad postmarketing data collection and evaluation that extends efforts made with prelicensure study to balance the benefits from vaccination with the risk for harm. Overall, measures including prelicensure study and postlicensure surveillance, such as VAERS, the Vaccine Safety Datalink Project, and the Clinical Immunization Safety Assessment Centers, have resulted in an exceptional safety profile for the vaccines in use.     

低温烫伤的特点与治疗

低温烫伤是一类特殊原因的烧伤,流行病学、损伤机制、临床表现以及预防和治疗均有其独特性。本文针对这几方面进行概括和总结,希望引起大家的重视。     

Model for using hip-hop music for small group HIV/AIDS prevention counseling with African American adolescents and young adults

Currently little attention has been directed, with the exception of peer education efforts, to constructively develop new and innovative ways to promote HIV/AIDS primary prevention among African American (AA) adolescents and young adults. With this in mind, the aim of this conceptual effort is to present a HIV/AIDS preventive counseling protocol developed for use with AA young adults that makes use of hip-hop music, a form of music popularized by young AAs. The author contend that an increased understanding of the relationships that many AA young adults have with hip-hop music may be used by disease prevention personnel to educate these populations about protective factors for HIV. Making use of hip-hop music is one strategy for integrating counseling in prevention and health maintenance. The overall implications of using hip-hop music in health promotion are unlimited. First, this method makes use of cultural relevant materials to address the educational and health needs of the target community. Second, it is grounded in an approach that serves to stimulate cooperative learning based on peer developed content. Moreover, the use of this medium can be applied to other health promotion activities such as violence/harm reduction and substance abuse prevention, upon reviews of songs for appropriate content. The authors contend that such an approach holds heuristic value in dealing with HIV/AIDS prevention among AA young adults. Additional testing of the intervention is warranted in the refinement of this innovative intervention.     

Platelet counts in three racial groups

Documented differences exist in red blood cell (RBC) and granulocyte counts between black and white people. However, little comparative information is available on differences in platelet counts in the two racial groups. Therefore, this study was performed to compare platelet counts in healthy white (94), black (92), and Latin-American (63) persons. Black women had significantly higher platelet counts than did white women (P less than 0.025). Latin-American women were between the other two groups. No differences were noted among men. Black women also had a significantly higher prevalence of iron deficiency and microcytosis of RBCs than did white women. After exclusion of women with either microcytosis or iron deficiency, racial differences in platelet counts were no longer evident. The authors conclude that the differences in the platelet counts between black and white women were secondary to common RBC differences (such as iron deficiency and other causes of microcytic anemia) and were not intrinsic to the platelets. These and other factors that can affect platelet counts should be excluded before determining the reference ranges for proper interpretation of the platelet counts.     

Lesser response to angiotensin-converting-enzyme inhibitor therapy in black as compared with white patients with left ventricular dysfunction

BACKGROUND: Black patients with heart failure have a poorer prognosis than white patients, a difference that has not been adequately explained. Whether racial differences in the response to drug treatment contribute to differences in outcome is unclear. To address this issue, we pooled and analyzed data from the Studies of Left Ventricular Dysfunction (SOLVD) prevention and treatment trials, two large, randomized trials comparing enalapril with placebo in patients with left ventricular dysfunction. METHODS: We used a matched-cohort design in which up to four white patients were matched with each black patient according to trial, treatment assignment, sex, left ventricular ejection fraction, and age. A total of 1196 white patients (580 from the prevention trial and 616 from the treatment trial) were matched with 800 black patients (404 from the prevention trial and 396 from the treatment trial). The average duration of follow-up was 35 months in the prevention trial and 33 months in the treatment trial. RESULTS: The black patients and the matched white patients had similar demographic and clinical characteristics, but the black patients had higher rates of death from any cause (12.2 vs. 9.7 per 100 person-years) and of hospitalization for heart failure (13.2 vs. 7.7 per 100 person-years). Despite similar doses of drug in the two groups, enalapril therapy, as compared with placebo, was associated with a 44 percent reduction (95 percent confidence interval, 27 to 57 percent) in the risk of hospitalization for heart failure among the white patients (P<0.001) but with no significant reduction among black patients (P=0.74). At one year, enalapril therapy was associated with significant reductions from base line in systolic blood pressure (by a mean [+/-SD] of 5.0+/-17.1 mm Hg) and diastolic blood pressure (3.6+/-10.6 mm Hg) among the white patients, but not among the black patients. No significant change in the risk of death was observed in association with enalapril therapy in either group. CONCLUSIONS: Enalapril therapy is associated with a significant reduction in the risk of hospitalization for heart failure among white patients with left ventricular dysfunction, but not among similar black patients. This finding underscores the need for additional research on the efficacy of therapies for heart failure in black patients.     

Racial differences in the outcome of left ventricular dysfunction

BACKGROUND: Population-based studies have found that black patients with congestive heart failure have a higher mortality rate than whites with the same condition. This finding has been attributed to differences in the severity, causes, and management of heart failure, the prevalence of coexisting conditions, and socioeconomic factors. Although these factors probably account for some of the higher mortality due to congestive heart failure among blacks, we hypothesized that racial differences in the natural history of left ventricular dysfunction might also have a role. METHODS: Using data from the Studies of Left Ventricular Dysfunction (SOLVD) prevention and treatment trials, in which all patients received standardized therapy and follow-up, we conducted a retrospective analysis of the outcomes of asymptomatic and symptomatic left ventricular systolic dysfunction among black and white participants. The mean (+/-SD) follow-up was 34.2+/-14.0 months in the prevention trial and 32.3+/-14.8 months in the treatment trial among the black and white participants. RESULTS: The overall mortality rates in the prevention trial were 8.1 per 100 person-years for blacks and 5.1 per 100 person years for whites. In the treatment trial, the rates were 16.7 per 100 person-years and 13.4 per 100 person-years, respectively. After adjustment for age, coexisting conditions, severity and causes of heart failure, and use of medications, blacks had a higher risk of death from all causes in both the SOLVD prevention trial (relative risk, 1.36; 95 percent confidence interval, 1.06 to 1.74; P=0.02) and the treatment trial (relative risk, 1.25; 95 percent confidence interval, 1.04 to 1.50; P=0.02). In both trials blacks were also at higher risk for death due to pump failure and for the combined end point of death from any cause or hospitalization for heart failure, our two predefined indicators of the progression of left ventricular systolic dysfunction. CONCLUSIONS: Blacks with mild-to-moderate left ventricular systolic dysfunction appear to be at higher risk for progression of heart failure and death from any cause than similarly treated whites. These results suggest that there may be racial differences in the outcome of asymptomatic and symptomatic left ventricular systolic dysfunction.     

Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care

Individuals living with HIV often have complicated histories, including negative experiences such as traumatic events, mental illness, and stigma. As the medical community in the United States adapts to managing HIV as a chronic disease, understanding factors such as these negative experiences that may be associated with poorer adherence to treatment regimens, greater HIV risk behavior, and lower patient quality of life becomes critical to HIV care and prevention. In less wealthy nations, these issues are also critical for addressing quality of life as well as medication adherence in the areas where antiretroviral therapies are being made available. This article presents a review of the literature regarding the following psychosocial factors as they relate to HIV/AIDS in the US and globally: traumatic events; mental illness, including depression, anxiety, and posttraumatic stress disorder; lack of trust in the healthcare system and government; and experiences of stigma among individuals with HIV disease. These factors have been found to be prevalent among individuals with HIV/AIDS, regardless of gender or race/ethnicity. Traumatic events, mental illness, distrust, and stigma have also been linked with poorer adherence to medication regimens and HIV risk behavior.