痴呆精神行为症状临床研究述评

文章回顾了国内外痴呆精神行为症状临床研究进展,全文分四部分进行介绍。第一部分介绍了痴呆精神行为症状(BPSD)的概念;第二部分介绍了不同类型痴呆患者BPSD的特点;第三部分介绍了BPSD的评定方法;第四部分介绍了Jeyapaul等基于循证医学及英国国家卫生与临床优化研究所(NICE)临床治疗指南,提出不同类型痴呆患者BPSD的治疗指南。     

临床实践指南意义、建立方法和评价

1指南的概念和发展临床实践指南(Clinical Practice Guideline,CPG)指人们针对特定的临床情况,制定出的一套系统的能帮助临床医生和患者做出恰当处理的指导意见。在指南的指导下结合患者的具体病情做出诊断和治疗的决策,有助于循证医学的原则在临床     

《中国失眠障碍诊断和治疗指南》解读

2016年6月,中国睡眠研究会组织编制的《中国失眠障碍诊断和治疗指南》正式出版,旨在为失眠障碍的诊断与治疗提供规范化的临床参考依据。指南采用循证医学标准,基于最新的睡眠障碍国际分类第3版,强调认知行为疗法在治疗中的地位,且增加和丰富对特殊人群的评价和干预。本文拟对指南编制过程和重点内容进行详细解释和补充说明,以为临床医师更好地理解和运用指南提供必要的帮助和指导。     

阿尔茨海默病和额颞叶痴呆徘徊行为的比较

目的 比较阿尔茨海默病和额颞叶痴呆徘徊者步行活动水平及活动节律的差异.方法 利用电子示踪监测系统对阿尔茨海默病(Alzheimer disease,AD)徘徊者27例及额颞叶痴呆(frontotemporal dementia,FTD)徘徊者7例进行连续30 d的24 h活动监测,比较两组日、夜活动水平(步行距离),以及活动节律的日间稳定性和日内变异性.结果 AD组和FTD组的年龄分别为 (73.89 ± 9.12)岁和(63.43 ± 14.93)岁,而发病年龄分别为 (70.16 ± 9.26)岁、(58.17 ± 15.16)岁.AD组的年龄较大而发病年龄较晚(P ＜ 0.05).AD组和FTD组在6:00 ～ 23:59的步行距离分别为(2119.39 ± 2535.59)m、(4842.44 ± 2617.94)m,后者较长(P ＜ 0.05),但两组在0:00 ～ 5:59的活动水平差异无统计学意义(P ＞ 0.05).FTD组活动节律更加稳定[(0.50 ± 0.11) vs (0.29 ± 0.15),P ＜ 0.01],日内活动变异片段数更少[(2.80 ± 0.74) vs (4.07 ± 0.95),P ＜ 0.01].结论 AD 和FTD 两类痴呆的徘徊行为特点不同,提示有必要建立痴呆亚型特异性徘徊行为的非药物干预策略.     

卒中后吞咽困难的识别和管理指南

英国皇家医师协会的苏格兰学院指南协作组制定了一套关于卒中诊断治疗方面的国家指南,共包括四个部分,第一部分:卒中的诊断、急性期治疗和二级预防指南;第二部分:颈动脉狭窄和颈动脉内膜剥脱术指南;第三部分:卒中后吞咽困难的指南;第四部分:卒中康复、并发症的预防和处理以及出院计划指南。其中第三部分的吞咽困难指南已经在1997年发表了第一版,本刊所刊登的为2004年9月刚刚更新的第二版。该指南是目前国际上比较全面、系统的关于卒中后吞咽困难的指南,包括了吞咽困难筛查、评估、治疗等方面的内容。在后面的附件当中,提供了Logemann等所制定的筛查、评估的临床实用表格,以供参考。该指南的内容不适合非卒中的患者以及蛛网膜下腔出血的患者。每条建议后的A、B、C、D为建议级别。     

缺血性卒中二级预防新指南的新思路和新启发

随着研究证据的不断积累,缺血性卒中二级预防指南也在不断更新。美国心脏协会/美国卒中协会2014年脑卒中二级预防指南更加强调普适性和临床相关性,同时更加针对特定的临床情况,如动脉粥样硬化性卒中注重他汀类药物调脂治疗和抗栓治疗;小血管病性卒中强调降压治疗;心源性栓塞,新型口服抗凝药疗效优于华法林;颅内动脉粥样硬化性狭窄,积极的药物治疗优于血管内介入治疗。而降低血浆同型半胱氨酸水平和对无症状性颈动脉狭窄人群进行筛查仍缺乏高级别的证据支持。     

烟草使用和依赖临床指南2008修订版（摘要）

烟草使用和依赖临床指南2008修订版,属于美国公共卫生服务的临床实践指南.它是由烟草使用和依赖专家小组、协会代表、顾问和工作人员等共37人员完成,他们挑选出治疗烟草依赖有效且有充足试验证据的方法.……     

自发性颅内出血诊疗指南的介绍和讨论

自发性颅内出血(ICH)是脑卒中最严重的亚型之一,每年发病近200万人,是全球范围内致残和致死的重要原因之一。虽然很大程度上是由于ICH缺乏特异性的靶向治疗,但也与临床医生对于ICH的干预、手术的目标和成功率知之甚少有关。本文就美国心脏病协会(2007)和中国ICH诊疗指南(2011)做一简介。     

中国重症肌无力诊断和治疗指南(2020版)

2015年《中华神经科杂志》发布了第1版中国重症肌无力诊断和治疗指南.时隔5年,在重症肌无力治疗方面积累了更多循证医学的证据,迫切需要更新指南来指导临床实践.因此,中国免疫学会神经免疫分会基于近5年国内外文献中的最新证据,参考相关国际指南,反复讨论,在对中国重症肌无力诊治指南(2015)更新修订的基础上编写了本指南.新...     

EFNS原发性肌张力障碍诊断和治疗指南

目的 提供2006年版原发性肌张力障碍诊断和治疗指南的更新.背景 原发性肌张力障碍是主要发生于年轻人的临床表现多样的慢性致残性疾病.诊断 原发性肌张力障碍分为单纯肌张力障碍、肌张力障碍叠加综合征和阵发性肌张力障碍综合征.肌张力障碍的评价须使用经过验证的评定量表.遗传学检测应在临床诊断后实施.推荐DYT1检测用于发病年龄...     

How Do Physical Activity and Sedentary Behaviour Affect Motor Competence in Children with Autism Spectrum Disorder Compared to Typically Developing Children: A Pilot Study

Journal of Autism and Developmental Disorders - Older children with Autism Spectrum Disorder (ASD) have high levels of motor impairment, however we are unsure if similar patterns exist in young...     

Combined Effects of Physical Inactivity and Sedentary Behaviour on Psychological Distress Among University-Based Young Adults: a One-Year Prospective Study

Psychiatric Quarterly - Insufficient physical activity (PA) and prolonged sedentary behaviour (SB) may have deleterious psychological health consequences. Using one-year prospective data, this...     

Physical exercise,Sedentary Behaviour,Sleep and Depression Symptoms in Chinese Young Adults During the COVID-19 Pandemic: A Compositional Isotemporal Analysis

Numerous studies links movement activity (e.g., physical activity, sedentary behavior [SB], and sleep) with mentalhealth or illness indicators during the COVID-19 pandemic; however, research has typically examined time-usebehaviors independently, rather than considering daily activity as a 24-hour time-use composition. This cross-sectional study aimed to use compositional isotemporal analysis to estimate the association between reallocation oftime-use behaviors and depression symptoms in young adults in China. Participants (n = 1475; 68.0% of female;20.7 [1.60] years) reported their time spent in moderate to vigorous physical activity (MVPA), light physical activity (LPA), SB, and sleep. Replacing SB with sleep, LPA, and MVPA at 5, 10, or 15 min was significantly associatedwith lower estimated depression symptoms scores. For example, adding MVPA from SB at 15 min was associatedwith lower depression symptoms scores (estimated difference: −0.13 [−0.17, −0.09]). The associations betweenreallocation of time use behaviors with depression symptoms scores were slightly differentiated. Our resultsemphasize the importance of increased MVPA and decreased SB as well as their mutual replacements for loweringthe risks of depression symptoms in young adults during the COVID-19 pandemic. Our results can inform policyto develop effective plans and strategies for mental health promotion.     

mHealth Technologies to Influence Physical Activity and Sedentary Behaviors: Behavior Change Techniques,Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

mHealth programs offer potential for practical and cost-effective delivery of interventions capable of reaching many individuals.

Purpose

To (1) compare the effectiveness of mHealth interventions to promote physical activity (PA) and reduce sedentary behavior (SB) in free-living young people and adults with a comparator exposed to usual care/minimal intervention; (2) determine whether, and to what extent, such interventions affect PA and SB levels and (3) use the taxonomy of behavior change techniques (BCTs) to describe intervention characteristics.

Methods

A systematic review and meta-analysis following PRISMA guidelines was undertaken to identify randomized controlled trials (RCTs) comparing mHealth interventions with usual or minimal care among individuals free from conditions that could limit PA. Total PA, moderate-to-vigorous intensity physical activity (MVPA), walking and SB outcomes were extracted. Intervention content was independently coded following the 93-item taxonomy of BCTs.

Results

Twenty-one RCTs (1701 participants—700 with objectively measured PA) met eligibility criteria. SB decreased more following mHealth interventions than after usual care (standardised mean difference (SMD) ?0.26, 95 % confidence interval (CI) ?0.53 to ?0.00). Summary effects across studies were small to moderate and non-significant for total PA (SMD 0.14, 95 % CI ?0.12 to 0.41); MVPA (SMD 0.37, 95 % CI ?0.03 to 0.77); and walking (SMD 0.14, 95 % CI ?0.01 to 0.29). BCTs were employed more frequently in intervention (mean = 6.9, range 2 to 12) than in comparator conditions (mean = 3.1, range 0 to 10). Of all BCTs, only 31 were employed in intervention conditions.

Conclusions

Current mHealth interventions have small effects on PA/SB. Technological advancements will enable more comprehensive, interactive and responsive intervention delivery. Future mHealth PA studies should ensure that all the active ingredients of the intervention are reported in sufficient detail.

     

体力活动与卒中

卒中作为一种慢性疾病,严重危害着人类健康.现代医学认为,卒中的危险因素与人们的日常生活方式、行为习惯及体力活动情况等诸多因素密切相关.……     

A Review of Physical Activity Measures Used Among US Latinos: Guidelines for Developing Culturally Appropriate Measures

Background  As the US population continues to grow and diversify, there is a need for progressive physical activity measurement and cross-cultural research. Studies suggest that US Latinos are among the most sedentary of ethnic groups compared to others; however, study findings may be biased given that some measures may not be culturally sensitive for assessing behaviors that are not characterized as leisure time physical activity. Purpose  The primary objective of this review was to identify and evaluate measures used to quantify physical activity among US Latinos. Methods  A review of the literature was performed and studies examining levels of physical activity among Spanish and English speaking Latinos were documented. This process involved identifying existing guidelines for the purpose of culturally adapting and/or translating (into Spanish) physical activity measures for the Latino population. These guidelines were used as the minimal criteria for the evaluation of the 13 identified measures of physical activity. Results  Of these 13 measures, four were available in English and nine were available in Spanish. One English measure met the guidelines for being culturally adapted for assessing physical activity among Latinos. There were no Spanish measures that met all the guidelines for physical activity assessment among Spanish-speaking Latinos. Lastly, the identified guidelines for developing culturally appropriate measures were improved to advance physical activity measurement among ethnic and cultural groups. Conclusion  Future research should merit the use of culturally appropriate guidelines to increase the understanding of physical activity patterns in the USA. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.