上海市社区人群干预前后脑卒中发病率的变化

目的：探索在社区人群中降低脑卒中发病率的有效措施。方法：在“八五”“九五”期间，在上海市静安区的两个街道约9万人群中开展社区脑血管病综合性防治研究。结果：经过9年干预，干预社区脑卒中总发病率呈波动性下降，2000年干预社区脑卒中发病率为130．2／10万，与1991年相比下降了25．8％，而监测社区脑卒中总发病率呈波动性上升，2000年监测社区脑卒中发病率为187．4％／10万，与1991年同组相比上升了13．2％，1996－2000年脑卒中平均发病率与同组的1991－1995年相比，干预社区下降了13．0％，而监测社区上升了11．0％，干预社区不同年龄性别人群的发病率变化趋势与程度不一致，其中以75－84岁人群下降最为明显，结论：以开展健康教育和积极控制高血压，糖尿病为主的综合干预措施对降低脑座中的发病率效果明显。     

长沙市居民脑血管病十年综合防治的效果评价

目的 :探讨社区居民脑血管病综合性防治的效果。方法 :1991～ 2 0 0 0年在长沙市开福区 10万自然人群中 ,按整群抽样分为干预区和对照区 ,分别在 35～ 74岁的 812例和 831人亚组人群中调查收缩压、舒张压、体重指数和血脂等变量 ,作为评价干预效果指标 ,10年后抽取与干预前相同条件下的对象 80 4和 82 6人进行复查 ;同时在干预区进行脑血管病的综合防治。结果 :干预后甘油三酯显著下降 (P<0 .0 1) ,平均舒张压、胆固醇、血糖均得到了有效控制 ;2 0 0 0年干预区脑卒中的年发病率 (粗率和标化率 )及年死亡率 (粗率 )显著低于对照区 (P<0 .0 5～ 0 .0 1)。结论 :社区综合性脑卒中防治是降低脑血管病发病和死亡的有效途径     

社区人群高血压管理及其效果分析

目的 探讨社区高血压人群管理及其效果。方法 对干预社区35岁以上人群进行高血压普查，然后对检出的确诊高血压和临界高血压患者进行为期3年的综合干预管理。结果 3年确诊高血压管理率平均为81．5％，血压达160／95mmHg以下的控制率为45．8％；3年临界高血压管理率平均为90．3％，160／95mmHg以下的控制率为75．7％；管理率随被管理对象的年龄增大而升高，但是，控制率以45岁年龄组最高，以后随年龄增高而下降。确诊高血压随访组的平均收缩压(MSBP)3年内下降了13．6mmHg，平均每年下降4．6mmHg；平均舒张压(MDBP)3年内下降了7．2mmHg，平均每年下降2．4mmHg;高血压随访组3年内心脑血管病发病率下降了46．7％，死亡率下降52．2％。结论 社区高血压人群管理是降低心脑血管病的发生和死亡的重要途径，而且是切实有效的。     

长沙市居民脑血管病十年综合性预测研究—危险因素的变化

目的 研究社区综合性预防对人群脑血管病危险因素的影响。方法 1990－2000年在长沙市城区10万自然人群（按整群抽样分为干预区和对照区）中开展社区综合性预防研究，2000年、1997年、1995年和1992年分别于研究人群中抽样检查血压和血脂等脑血管病的危险因素。结果 经过近10年干预后，干预区居民人均甘油三酯降低、高密度脂蛋白升高、另外女性居民还有人均舒张压降低；而对照区居民人均收缩压和舒张压以及血清总胆固醇均增高。结论 脑血管病社区综合防治有效，但存在性别差异。     

门诊宣教在脑卒中高危人群一级预防中的应用

我院自2005年成立神经内科门诊宣教室以来,利用病人候诊时间,在卒中高危人群中开展一级预防的护理干预,取得满意的效果,现将干预措施报告如下. 1 脑卒中的高危人群 1.1 高血压 高血压是脑卒中发病最重要的危险因素.77%的初发脑卒中患者都与高血压有关[1],每减少5 mmHg(1 mmHg=0.133 kPa)的舒张压和每减少10 mmHg的收缩压,脑卒中的风险都会降低30%～40%[2].因此,积极治疗和控制高血压是降低脑卒中的有效措施之一.     

脑卒中3年生存和复发的社区干预效果

目的近20年来,脑卒中是中国人群的主要死亡原因,其发病率随着脑卒中危险因素的增加呈上升趋势。本研究旨在评价初发脑卒中患者3年生存和复发的社区干预效果。方法1991～2000年选择北京2个人口约50 000人的社区分别作为干预和对照社区。采取的综合干预措施包括高危人群管理和社区人群健康教育。对初发脑卒中3年生存和复发的社区干预效果进行评价。结果3年内干预社区736例患者中有41．85%的死亡,而对照社区818例患者中有40．34%的死亡;干预社区223例患者中有26人(11．66%)复发〔RR=0．74,95% CI为(0．61,0．89),P= 0．002〕,对照社区250例患者中有52人(20．80%)复发〔RR=0．61,95% CI为(0．46,0．81),P=0．001〕,2个社区的复发率间差别有显著性意义。对照社区比干预社区脑卒中死亡率下降了26%,尤其是出血性脑卒中下降了39%,同时复发率下降了42%。结论社区干预对预防脑卒中,尤其是出血性脑卒中的复发,改善脑卒中生存是有效的。     

社区高血压的预防与综合防治策略

目的探讨社区高血压的防治措施,控制社区人群的血压水平,降低高血压的发病率,加强对高血压患者的控制和提高高血压的治疗率,降低高血压并发症的发病率,总结有效防治社区高血压的策略。方法对我区2009-2010年全人群范围的健康教育和防治干预高血压人群的干预效果进行回顾性分析。结果城市社区和乡镇社区的高血压人群在干预之后的血压水平均发生了平行下移的现象,其中前者下移情况更为明显,干预社区的高危人群患原发性高血压的几率小于对照社区,高危人群的行为和态度等均有改善,社区综合防治高血压有利于提高社区人群的生活质量,符合经济学的效益原则。结论社区高血压的防治措施干预效果明显,有很大的应用价值,为高血压的综合防治提供了实践依据。     

脑卒中高危人群高血压病新型管理模式探索

目的建立脑卒中高危人群的高血压病新型健康促进模式,并探索该模式对乐山社区脑卒中高危人群高血压病的干预效果。方法建立由神经内科专业人员参与的监控管理、社区直接管理、患者及家庭组成的高血压病长程监控管理体系,并筛查出159例伴高血压病的脑卒中高危人群,给予个性化的健康教育和干预方案。结果该新型高血压病管理模式能有效提高脑卒中预防中的高血压病管理效果,平均收缩压下降23.7 mmHg、舒张压下降11.4 mmHg。经干预后血压控制率从9.4%提高到70.4%。高血压病患者的知晓率、用药率、控制达标率、依从性、控盐、运动等均明显提高。结论该新型健康促进模式是脑卒中预防的有效措施,能降低脑卒中高危人群的血压水平,减少高危人群的脑卒中发病率,应加强社区的脑卒中知识教育。     

长沙市脑血管病社区人群预防研究--死亡率的变化

目的减少社区人群脑血管病的死亡率.方法在干预社区采用强化以脑血管病为主的卫生健康知识宣传,管理高血压病为主的综合性预防措施,监测脑血管病死亡病例,而在对照社区仅监测脑血管病的死亡病例.结果10年内对照社区平均年死亡率为147.8/10万,干预社区为110.8/10万.10年内干预社区脑血管病死亡率较对照社区下降25.0%;在干预社区内2000年脑血管病死亡率较1991年下降40.2%,而在对照社区2000年脑血管病死亡率较1991年下降36.5%.结论为期10年的脑血管病社区人群综合性预防可降低脑血管病的死亡率.     

北京崇文社区脑卒中管理模式与实践

目的探讨和建立有效降低北京崇文社区脑卒中发病、死亡及危险因素水平的长效机制与模式。方法选择有良好人群基础的崇文社区,建立以区卫生局领衔,下属3所医院为技术平台的社区人群脑卒中防治体系。培训社区医务人员和街道干部,创建慢性病与公共卫生相结合的基础队伍。在社区人群中开展危险因素水平的调查与评估,对高危人群进行综合性干预及全人群健康教育与促进。结果对1016例心脑血管病患者治疗依从性分析显示,男性和女性患者症状改善而自行停药者分别占35．5%和30．3%,每日坚持规律服药者分别占62．8%和69．6%;影响药物治疗的9项因素中,忘记服药、医疗费用高、家庭经济原因均＞20．0%,因药物产生不适反应而停药的男性和女性仅为17．8%和11．3%,女性遵守医嘱的依从性高于男性。经常进行体育锻炼的居民由基线调查时的53．9%上升到66．4%。从2004年、2003年脑卒中发病率、死亡率观测社区干预初见效果。结论在我国城市脑卒中高危人群中开展大规模、系统的社区综合性干预,群体健康教育与促进,可有效控制社区人群危险因素水平,对降低脑卒中发病率、死亡率有着重要意义。基层医院保健科医生经过系统慢性病防治培训,可承担起社区脑卒中综合性预防的基本职能,为我国社区公共卫生战略实施提供可操作性模式。     

The neuroendocrinology of stress and the pathophysiology and therapy of depression and anxiety

Clinical and preclinical studies have gathered substantial evidence that stress response alterations play a major role in the development of major depression, panic disorder, and post-traumatic stress disorder. The stress response, the hypothalamic pituitary adrenocortical (HPA) system and its modulation by corticotropin-releasing hormones (CRH),corticosteroids,and their receptors, and the roles of natriuretic peptides and neuroactive steroids are described. We review the role of the HPA system in major depression, panic disorder, and post-traumatic stress disorder and its possible relevance for treatment. Impaired glucocorticoid receptor function in major depression is associated with an excessive release of neurohormones such as CRH, to which a number of signs and symptoms characteristic of depression can be ascribed. In panic disorder, a role of central CRH in panic attacks has been suggested. Atrial natriuretic peptide (ANP) is causally involved in sodium lactate-induced panic attacks. Furthermore, preclinical and clinical data on its anxiolytic activity suggest that nonpeptidergic ANP receptor ligands may be potentially useful in the treatment of anxiety disorders. Post-traumatic stress disorder is characterized by a peripheral hyporesponsive HPA system and elevated CRH concentrations in the CSF. This dissociation is probably related to an increased risk of this disorder. We further review recent data that describe an important role of GABA(A)-receptor modulatory,3 alpha-reduced neuroactive steroids in major depression, anxiety, and its treatment. Antidepressants are effective in both depression and anxiety disorders and have major effects on the HPA system,especially on glucocorticoid and mineralocorticoid receptors. Normalization of HPA system abnormalities is a strong predictor of the clinical course, at least in major depression and panic disorder. Currently,CRH-R1 or glucocorticoid receptor antagonists and ANP receptor agonists are being studied and may provide future treatment options more closely related to the pathophysiology of these disorders.     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.     

沙盘游戏疗法在地中海贫血患儿心理干预中的应用

本文目的是对沙盘游戏疗法在地中海贫血患儿心理干预中的应用进行综述,以期为地中海贫血患儿的心理康复提供参考。地中海贫血是以珠蛋白生成障碍为主要特征的遗传性疾病,由于长期输血治疗,患儿存在较多的心理和行为问题。沙盘游戏疗法作为一种有效、实用的儿童心理治疗方法,对提高地中海贫血患儿的康复效果、改善生存质量有重要的临床意义。     

癫痫共病抑郁的机制及临床诊疗

本文目的是探讨癫痫共病抑郁的可能机制及临床诊疗。癫痫是一种常见的、慢性的、致残性的神经疾病,癫痫患者生活质量下降,存在明显的负性情绪,常伴发各种精神疾病。癫痫与抑郁具有共同的神经生物学基础,可能存在共同的发病机制。本文从癫痫共病抑郁的发病机制、临床诊断及治疗方面予以总结归纳。     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Seclusion and restraint and prediction of violence

The authors studied the use of seclusion and restraint on an inpatient unit in a state psychiatric hospital. Of 69 randomly selected inpatients, 51% experienced seclusion or restraint at least once. More psychotic than nonpsychotic patients required seclusion or restraint. However, neither psychosis/nonpsychosis nor voluntary/involuntary admission status predicted the likelihood of violent threats or actions. Patients experiencing seclusion and restraint showed a nonsignificant trend toward longer mean length of stay in the hospital. The frequency of patient behavior leading to seclusion or restraint appeared to be directly related to the stimulation caused by the presence of many staff members and other patients.     

Comparison of trigeminal and spinal modulation of pain and nociception

Modulation of pain and nociception by noxious counterstimulation, also called "diffuse noxious inhibitory controls" or DNIC-like effect, is often used in studies of pain disorders. It can be elicited in the trigeminal and spinal innervation areas, but no study has previously compared effects in both innervation areas. Therefore, we performed a study comparing DNIC-like effects on the nociceptive flexion reflex (NFR) and the nociceptive blink reflex as well as the respective pain sensations. In 50 healthy volunteers, the blink reflex elicited with a concentric electrode and the NFR were recorded before and after immersion of the contralateral hand in cold water. Responses were recorded as the subjective pain sensation and the reflex size. The cold water immersion of the contralateral hand elicited a reduction of both subjective pain sensation and reflex amplitude following the stimulation of both reflexes. However, there were no strong correlations between the individual reductions of both subjective pain sensation and reflex amplitude for both reflexes, and neither when results of the two reflexes were compared with each other. The dissociation between DNIC-like effects on pain and on nociception, which had been found previously already for the NFR, implies that both effects need to be studied separately.