麻风存活者2198例畸残现况分析

目的:分析存活的2 198例患者畸残现况,探讨今后麻风康复工作重点.方法:对调查的6 771例患者中存活的2 198例患者畸残现况,进行统计分析.结果:在2 198例患者中,总畸残率为76.9%,2级畸残率随着年龄增高残疾率也随之升高;少菌型麻风患者(57.3%)高于多菌型麻风患者(39.2%);治愈患者(45.4%)高于现症患者(32.6%);院内(60.7%)高于院外(42.4%).结论:开展健康教育,加强自我护理工作,提供防护用具和防护药品,进行手术矫治和康复功能训练,以降低麻风存活者的畸残率.     

中国24128例麻风新发现患者的畸残分析

目的：了解中国近11年来麻风新发现患者的畸残状况。方法：统计分析1989－1999年全国各县、市24128例麻风现症病例初诊登记个案资料，数据由全国性病麻风病控制中心疫情监测系统提供。结果：1989年全国麻风新发现患者的畸残率为46．49％，1999年为32．7％；Ⅱ级畸残率由1989年的25．55％，到1999年的22．06％；有19个省（市）畸残率超过40％。畸残者中，I、Ⅱ级畸残分别为37．54％和61．04％，另1．42％为仅有脱眉、面竣、塌鼻等其他畸残，Ⅱ级畸残率超过50％的有20个省（市）。年龄在15岁以下的畸残率为24．74％，15－65岁者为39．3％，65岁以上者为53．33％。麻风病期在2年以内发生畸残者为28．95％，超过2年和5年者分别为48．06％和60．95％。有过麻风反应者畸残率为53．76％；少菌型患者的Ⅱ级畸残率（28．53％）明显高于多菌型（22．03％）。结论：中国麻风新发现患者的畸残率较高，近11年虽有下降，但其程度无明显变化。因麻风诊断的延迟、麻风反应及麻风型别的不同，畸残率差异非常明显，不同性别、年龄间差异无显著性。早期发现患者，规则进行抗麻风联合化疗，有效处理及控制麻风反应是预防新发现患者发生畸残的有效方法。     

麻风畸残患者的康复认知与需求

目的 了解麻风畸残患者的康复认知及需求。方法 对7个省的23个麻风防治现场已往接受麻风康复教育的4353例麻风患者以问卷及面谈的方式进行调查。结果 80％的患者认知麻风畸残预防及康复的一般常识，知信自我护理预防畸残，但知行未合一；90％的患者欠缺对麻风的早期表现及治疗、畸残发生的根本原因和足底溃疡主要防护方法的了解。康复教育的需求方式大部分患者选择医护人员演示(86％)、阅读手册示意图(81％)，其次为看录像(70％)、听录音(52％)。结论 麻风康复知行合一势在必行，建议康复教育的时间应提前，内容应系统化，方法应多样化。     

492例麻风畸残者自我护理28个月效果分析

目的分析麻风畸残患者自我护理的效果。方法按全国麻风康复工作领导小组《麻风患者眼手足自我护理随访表》的内容和标准，云南省中英麻风康复试点项目每6个月随访一次并作好记录，观察28个月，选择资料完整的492例进行分析。结果红眼明显好转，愈合率77．42％；手部皲裂和溃疡愈合率分别达68．75％和100％；足部皲裂和溃疡愈合率分别达81.25％和42.11％；视力损害及手、足骨缺失没有增加。结论采用自我护理预防麻风畸残的方法是有效、可行的，可以在基层推广。     

麻风畸残患者术前心态的调查

目的了解麻风畸残患者术前的心态及对术后效果的期望。方法采用中国医学科学院皮肤病研究所麻风病防治研究室的调查表,以问卷和面谈的方法对9省（区）拟接受国家彩票公益金麻风畸残手术矫治项目的937例麻风畸残者进行调查。结果麻风畸残患者不配合手术的原因：收费（79.19%）和不了解国家的免费救治政策（64.78%）、害怕手术（48.88%）、对畸残有掩饰心理（46.43%）和担心术后暴露自己的身份（45.57%）、畸残后绝望意念（43.86%）、不了解手术效果（37.46%）、认为畸残是麻风的必然结果（32.98%）和以年龄不适合为由拒绝手术（30.63%）。90%以上患者期望术后改善身体功能、在家庭中发挥自己的作用、减少帮助量和获得心理稳定,对回归职业的期望值不是很高。结论手术之前医务人员了解和掌握麻风畸残患者的心理状态非常必要。     

麻风病足损害患者穿用防护鞋 120例效果观察

防护鞋具有鞋底硬、鞋垫软、鞋帮高等优点，对麻风患者足损害的保护起重要作用。特别是农村和贫困地区的麻风足损害患者，动员并提供防护鞋是预防足底溃疡的有效方法。莆田市作为中英合作康复试点（１９９５～１９９９年），对１２０例穿用防护鞋患者进行了使用和观察，随访４年。表明穿用防护鞋对麻木足损害的保护起重要作用，不但促进了溃疡的愈合而且能防止畸残的加重。报道如下。１对象与方法我市于１９９５年５月对全市存活１４１１例麻风病人进行畸残调查，调查１１３１例（８０．２％），按WHO畸残分级标准登记，发现畸残３３９例…     

麻风溃疡感染病原菌分布及治疗新进展

溃疡是麻风病的一种并发症,常加重肢体畸残,严重者甚至出现溃疡组织恶变而致人死亡.有效地控制麻风溃疡是控制麻风愈后畸残加重和进行畸残康复的一个重要环节.麻风溃疡慢性难愈创面造成了较高的致残率,80%左右的麻风溃疡伴发感染,主要感染特征是混合感染,异位感染.随着对细菌培养、药敏试验的使用,对溃疡创面发生机制和创面愈合过程的深入了解,以及医用新材料和创面治疗新技术的应用和成熟,复杂性溃疡创面愈合有望成为现实.现将麻风溃疡患者感染病原菌分布、感染特征、发病机制及目前应用的治疗新技术作一综述.     

2013年浙江省温州地区麻风病受累者生存状况调查

目的了解浙江省温州市麻风病受累者的生存状况,为消除麻风病危害,降低麻风疾病负担提供参考依据。方法按照统一的技术标准和方法,由调查人员对温州地区内登记的麻风病受累者进行入户调查,调查内容包括人口学特征、家庭状况、劳动能力、麻风病致残状况、康复需求等生存状况,并填写调查表。结果 62例调查对象中,男性43人,女性19人,最小年龄23岁,最大91岁,平均63.7岁;18人处于独居;57人无劳动能力或仅有轻体力劳动能力;2级畸残率30.6%,畸残时长最短59个月,最长635个月,平均298.78个月,有15人缺少基本的防护措施。结论温州市麻风病受累者的生存状况较差,应为符合条件的麻风病患者提供基本生活和医疗救助,降低患者疾病负担,以消除因麻风病带来的危害。     

加强宣传教育和业务培训工作,努力提高麻风病防治质量

麻风病是一种慢性传染病,在我国已有两千年以上的历史。解放前主要发生在沿海、长江流域和西南诸省。麻风杆菌侵犯皮肤和浅层神经,因无特效药,任其发展,造成晚期鼻塌口斜、手足畸残的可怕形象。封建小说、戏剧更是误解夸张,增加了人们对麻风病的恐惧和歧视心理。新中国成立后,全国建立了近千所麻风院(村),培训了近万名专业人员,贯彻了“积极防治,控制感染”的方针,采用“多菌型住院、少菌型在家”的长期     

麻风畸残患者实施自我护理3年效果

目的：探讨麻风畸残患者自我护理效果。方法：989例麻风残疾患者进行自我护理训练，发放自我护理手册和图解，提供必要的自我护理包，并定期随访3年。结果：患者红眼、眼痛、手皲裂、手溃疡、足皲裂、足溃疡等麻风继发性畸残分别较治疗前下降了78．95％、89．02％、91．86％、90．90％、93．85％和38．67％。且有87．06％的患者形成了自我护理行为。说明自我护理可被患者接受．而且效果肯定。结论：自我护理是预防和治疗麻风继发性畸残的重要手段。专业医务人员对患者的健康教育技巧、患者家属和乡村医生日常督导以及适宜的康复器材供应是治疗的关键．同时应开展小外科和矫形手术治疗以解决患者严重的兔眼和足底溃疡问题。     

自我护理小组模式对老年麻风病康复患者 自我护理能力和心理健康的影响

目的 调查研究老年麻风病康复患者应用自我护理小组模式对自我护理能力与心理健康的影响.方法 本研究对该院康复中心老年麻风病康复患者80例为研究对象,根据随机数字表法分为两组.观察组患者40例实施自我护理小组模式,对照组40例患者采用常规护理模式,对比分析其日常生活质量与抑郁状况.结果 两组患者护理前的抑郁评分相比无差异性,观察组患者经自我护理小组模式干预后的抑郁水平低于对照组患者,且差异相比具有统计学意义(P<0.05).两组患者护理干预前的日常生活能力维度评分无显著差异.护理干预后,两组患者日常生活能力各维度评分均显著升高,且除洗澡、大、小便控制外,观察组患者的BI评分均高于对照组,且差异具有统计学意义(P<0.05).结论 老年麻风病康复患者采用自我护理小组模式,能够有效提高自我护理能力,改善心理健康状况,预防麻风病畸残,提高生活质量.     

麻风病致残者的社区康复

目的探索开展社区麻风康复的方式。方法选择2个麻风残疾者较多的镇开展麻风残疾者社区服务康复站试点工作,以当地县、镇两级政府为主导,在镇卫生院内设立康复服务站,利用镇卫生院的卫生资源优势,实行麻风残疾者自愿原则,由县卫生行政主管部门对提供康复服务的医院和医生进行有偿补贴,定期免费为麻风残疾者提供康复服务。结果康复服务站工作呈惯性运行,服务区域范围扩大,绝大多数患者的暴露性结合膜炎、手足皲裂、足溃疡得到愈合或明显改善;康复服务站形式得到当地社会和麻风残疾者的认同;医院和医生从中得到一定的经济补偿。结论麻风残疾者社区康复应是今后我国麻风康复工作的重心,社区综合性医疗机构有偿开展麻风残疾康复工作是可行的,体现和深化了WHO提出的实现麻风防治工作可持续发展的一体化策略。     

Functional dependence after hip fracture

OBJECTIVES: To identify patients at high risk of functional dependence and examine the progression of disability after a hip fracture. DESIGN: This was a population-based prospective inception cohort study of all patients aged 65+ yr who fractured a hip between July 1996 and August 1997. Demographic, socioeconomic, social support, and health status information was assessed in the hospital and 3 mo postfracture. RESULTS: The analysis included 367 patients. Almost all patients with cognitive impairment were functionally dependent postfracture, with new disabilities frequently occurring in transferring. Among patients of high mental status, increased risk of functional dependence was associated with advanced age, more co-morbidities, hip pain, poor self-rated health, and previous employment in a prestigeous occupation. Bathing disability was most likely in those who functioned independently prefracture; a disability in dressing was most common otherwise. CONCLUSION: Hip pain is amenable to treatment and may improve chances of functional recovery. Patients can be assisted in regaining prefracture function if they are targeted for rehabilitation on the basis of mental status. The focus should be on bathing and dressing among patients of high cognition and transferring among those patients with mental impairment.     

Substantiation of patients' length stay in hospital after acute myocardial infarct

AIM: To study and validate the duration of optimal hospital stay for postmyocardial infarction patients and to specify indications for their discharge. MATERIALS AND METHODS: The trial enrolled 187 patients with large- and small-focal acute myocardial infarction. The patients were divided into two groups by different speed of activization and hospital stay. RESULTS: There were no significant differences between the groups with different duration of hospital stay by working ability and invalidism. Temporary disability in patients who have undergone standard rehabilitation was longer than in patients on the shorter-program rehabilitation. Performance of exercise tests on day 14 distinguished patients with a favourable long-term prognosis who were candidates for shorter rehabilitation program. CONCLUSION: The program of quicker rehabilitation (a two-times decrease in the hospital stay) can be applied to patients with uncomplicated myocardial infarction without damage to their health.     

Rehabilitation outcome of patients with dual disability of hemiplegia and amputation

The records of 30 patients with the dual disability of hemiplegia and amputation were reviewed. Six factors noted to have influenced the success of rehabilitation were: (1) age; (2) sequence of onset of disability, whether amputation or hemiplegia first; (3) localization of dual disability, whether ipsilateral or contralateral; (4) side of hemiplegia; (5) level of amputation; (6) availability of prolonged hospital stay and training. The final functional status was better if: (1) the amputation preceded the CVA; (2) the amputation and hemiplegia were ipsilateral; (3) amputation and hemiplegia were both on the right side. The hospital stay of patients with dual disability ranged from 4 months to 1 year. Those who had disability on contralateral sides and those who had left hemiplegia required a more prolonged hospital stay.     

Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity

OBJECTIVE: To evaluate the criterion validity and responsiveness to change of spine kinematic variables to assess disability in patients with low back pain. DESIGN: Blinded comparison between spine kinematic variables, Oswestry disability questionnaire scores, and work status. SETTING: Multidisciplinary occupational rehabilitation clinic of a university hospital. PATIENTS: Population-based cohort of 111 patients with subacute work-related back pain who were absent from regular work for more than 4 weeks because of back pain. INTERVENTIONS: This study was part of a population-based randomized clinical trial. Patients were randomized to 4 different methods of management: usual care, rehabilitation, ergonomics, or rehabilitation and ergonomics. MAIN OUTCOME MEASURES: Oswestry disability questionnaire, kinematic analysis of the spine during flexion and extension of the trunk, and work status were collected at weeks 4, 12, 24, and 52 after the back accident. RESULTS: Kinematic variables were poorly to moderately related to work status and Oswestry questionnaire scores. Kinematic variables were also unresponsive to change in work status and Oswestry questionnaire scores over time. CONCLUSION: Spine kinematics during flexion and extension of the trunk do not appear to be a valid measure of disability in patients with subacute and chronic back pain.     

Functional assessment of older adults in an emergency department

The fast paced nature of emergency medicine often precludes assessment of patient functioning which may have significant consequences for geriatric patients including falls, functional decline and/or hospital re-admission. A rehabilitation consultation service to a hospital emergency department was implemented based on recommendations in the literature that functional assessments and a multidisciplinary approach be used with older adults. A systematic method of targeting and assessing elderly at-risk patients included a safety checklist and a comprehensive functional assessment tool. An observational study of 80 patients receiving functional assessments from rehabilitation professionals is described. Patients with high levels of disability or who lived alone prior to the emergency visit were more likely to be admitted to hospital. This study supports using multidisciplinary efforts and comprehensive functional assessments in emergency departments to guide decision-making about discharge outcome and planning for the health care needs of elderly patients.     

对住院麻风患者开展足底溃疡咨询服务的近期效果研究

目的探索对麻风住院患者开展足底溃疡咨询服务的近期效果,为在麻风村推广足底溃疡咨询服务提供依据。方法自行设计咨询服务指南,对47例住院麻风患者进行咨询服务。采用麻风足底溃疡相关知识、行为养成问卷及麻风继发性残疾分数,对近期疗效进行测评。结果47例患者的麻风足底溃疡相关知识水平明显提高,知晓须带水上油知识的比例由38．30％上升到76．60％;相关行为有了较大程度改善,限制行走者由44．68％上升至80．85％;继发性残疾分数中皲裂及溃疡分数下降,骨缺失分数无变化。结论咨询服务对改善麻风足底溃疡患者的近期效果较好。     

烧伤患者医院感染情况调查及健康教育

目的　了解烧伤患者医院感染情况及相关因素。方法　对 680例烧伤患者进行回顾性调查分析。结果　 680例患者中 ,医院感染率为 7.94% ,医院感染与年龄、文化程度、经济状况、烧伤严重程度及患者的遵医行为有关 ;创面、肠道、呼吸道为病原菌侵入的主要途径 ,共占 79.63 % ;革兰阴性杆菌仍为感染病原菌的首位 ,占 75 .80 % ;实施健康教育前后的医院感染率比较 ,差异有极显著性 (P <0 .0 1)。结论　积极开展针对性健康教育是预防和控制烧伤患者医院感染的有效举措