Impact of patients’ symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction

Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI. Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction （STEMI） admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review. Results The median （25%, 75%） prehospital delay was 140 （75, 300） minutes. Only 264 （33.0%） arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain （71.4%）, radiating arm or shoulder pain （68.7%）, shortness of breath or dyspnea （65.5%）, and loss of consciousness （52.1%）. The most common symptoms experienced were central or left chest pain （82.1%）, sweats （71.8%）, shortness of breath or dyspnea （43.7%）, nausea or vomiting （32.3%）, and radiating pain （29.4%）. A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport （86.5% vs. 52.9%, P 〈0.001） and had longer prehospital delays （medians, 180 vs. 120 minutes, P 〈0.001） compared to those who interpreted their symptoms as cardiac in origin. Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emerqency medical service （EMS）.     

辽宁省农村地区急性心肌梗死患者院前延迟时间影响因素研究

背景　农村地区急性心肌梗死（AMI）患者就医延迟现象不容乐观,目前相关研究略显不足。目的　探讨辽宁省农村地区AMI患者院前延迟时间特点及其影响因素,以期为提出有针对性的改善措施提供理论基础。方法　于2010年8月—2012年2月,采用便利抽样法选取辽宁省15家县级医院收治的AMI患者822例为研究对象。采用问卷调查的形式收集患者信息,调查内容包括性别、年龄、吸烟史、饮酒史、高血压史、高血脂史、糖尿病史、脑卒中史、心绞痛史、心肌梗死史、血管重建史、慢性病自我治疗情况、症状发生时间（发病季节、发病时间段）、出发前往医院时间、到达医院时间、医院的级别、患者转移情况、交通方式、迟疑就医的原因。采用有序Logistic回归模型分析院前延迟时间的影响因素。结果　农村AMI患者院前延迟时间为140（220）min。院前延迟时间的影响因素有糖尿病史〔OR=2.368,95%CI（1.501,3.734）〕、慢性病自我治疗情况〔治疗一种慢性病：OR=0.596,95%CI（0.398,0.894）〕、发病时间段〔6：00~11：59：OR=0.314,95%CI（0.193,0.511）;12：00~17：59：OR=0.458,95%CI（0.276,0.761）〕、出发前往医院时间〔6：00~11：59：OR=3.035,95%CI（1.876,4.908）;12：00~17：59：OR=2.189,95%CI（1.326,3.612）〕、患者转移情况〔间接转移且采取措施：OR=4.015,95%CI（2.176,7.407）;间接转移但未采取措施：OR=3.554,95%CI（1.793,7.044）〕、交通方式〔其他：OR=1.695,95%CI（1.004,2.861）〕、迟疑就医的原因〔路途遥远：OR=0.083,95%CI（0.058,0.119）;贫穷：OR=0.352,95%CI（0.161,0.770）;其他：OR=0.584,95%CI（0.393,0.868）〕（P<0.05）。结论　农村地区AMI患者院前延迟时间较长,可能原因是其对AMI认识不足、就诊意识薄弱以及卫生资源相对匮乏,建议加强农村地区急性疾病的宣传教育并制定措施以改善相对落后的医疗状况。     

急性心肌梗死患者就医行为的现状分析

目的 了解急性心肌梗死患者就医行为及其对就医延误的影响.方法 采用自行设计的问卷调查表,对53例急诊行冠脉介入治疗(PCI)的急性心肌梗死(AMI)患者的就医行为、就诊时间及其对预后的影响进行了调查和分析.结果 (1)AMI患者院前延迟时间中位数为3.20h,≤2.00h者占30.19%,2.00h者占69.81%;就诊延迟时间中位数为4.00h,≤6.00h者占88.68%,6.00h者占11.32%.(2)发病后,症状归因于心脏病者占45.28%,归因于非心脏病者占43.40%,不知道者占11.32%,其院前延迟时间中位数分别为2.10h、3.20h和3.90h(P<0.01),就诊延迟时间中位数分别为3.50h、4.80h和5.90h(P<0.01);立即就诊者占32.08%,等待或自行治疗者占60.38%,向朋友家人家庭医生咨询者占7.54%,其院前延迟时间中位数分别为1.10h、3.50h和3.50h(P<0.01),就诊延迟时间中位数分别为3.00h、4.90h和6.00h(P<0.01);采用救护车转运者占54.72%,采用出租车、自家车等其他方式转运者占45.28%,其院前延迟时间中位数分别为2.20h和3.80h(P<0.01),就诊延迟时间中位数分别为3.70h和5.15 h(P<0.01);首诊于三级医院者占79.25%,首诊于二级医院者占11.32%,首诊于社区医院或诊所者占9.43%,其院前延迟时间中位数分别为2.55h、4.60h和4.00h(P<0.01),就诊延迟时间中位数分别为3.75 h、5.95 h和5.50h(P<0.01);立即选择PCI治疗者占66.04%,向朋友家人家庭医生咨询者占30.19%,等待或观察者占3.77%,其就诊延迟时间中位数分别为3.70h、11.00h和5.15h(P<0.01).(3)院前延迟时间≤2.00h者1年内心血管事件发生率明显低于2.00h者(0,27.03%,P<0.05).就诊延迟时间≤6.00h者1年内心血管事件发生率也明显低于6.00h者(14.89%,50.0%,P<0.05).结论 AMI患者目前仍存在不良就医行为,就医延误依然存在,且对预后产生不利影响,改善患者就医行为不容忽视.     

Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing infarction an subsequent quality care in Beijing

Background Cumulative evidence demonstrates that primary percutaneous coronary intervention(PCI)is a mperfusion strategy for ST-elevation myocardial Infarction(STEMI).This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital(SH group)or a large hospital(LH group).Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group(n=160)was significantly longer than in the LH group(n=406)(225 vs.120 minutes,P<0.001).Multivariate analysis showed that interpreting symptoms to non-cardiac origin(OR,1.996;95%CI: 1.264-3.155),absence of history of myocardial infarction(OR,1.595;95%CI:1.086-3.347),non-health insuranca coverage(OR,1.931;95%Cl:1.079-3.012)and absence of sense of impending doom (OR,4.367;95%CI:1.279-1 4.925) were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times(95% CI: 1.1 82-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients'pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.     

急性心肌梗死院前与院内溶栓治疗的疗效比较

目的探讨院前溶栓治疗急性心肌梗死的必要性及安全性。方法对象为2005年1月-2008年1月的急性心肌梗死患者72例,其中35例由我院急诊科进行院前溶栓治疗,37例进行院内溶栓,并将两者对比分析。结果发病至溶栓治疗时间,院前溶栓组为（108．29±29．05）min,院内溶栓组为（179．38±45．67）min。再通率院前组为71．43％,院内组为45．95％。心脏事件发生率院前组为11．43％,院内组为32．43％。两组相比差异有统计学意义（P〈0．05）。结论对急性心肌梗死患者进行院前溶栓治疗能缩短发病至开始溶栓的时间,提高冠脉再通率。降低心脏事件发生率,是必要可行和安全的。     

急性主动脉夹层患者发病至到达首诊医院时间的调查研究

背景　急性主动脉夹层起病急、进展快,部分患者到达医院前就已经死亡。目前关于患者发病到入院时间的研究较少。目的　探索急性主动脉夹层患者发病至到达首诊医院时间的现状、影响因素,为缩短患者院前时间、及早到达医院提供理论支撑。方法　选取2018年3-11月武汉市某三级甲等医院心脏大血管外科收治的急性主动脉夹层患者,经过预调查采用自行设计的《急性主动脉夹层患者院前时间调查表》收集患者一般资料、疾病相关因素、院前相关因素,采用多元线性回归分析探讨急性主动脉夹层患者院前时间的影响因素。结果　共发放问卷200份,回收有效问卷173份,有效回收率为86.50%。173例患者院前时间为12~20 350 min,平均为〔70.0（36.5,150.0）〕min。 不同文化程度、月收入、居住情况、到达居住地最近医疗机构的时间、既往史（胃病）、吸烟情况、饮酒情况、症状（胸或背部痛、大汗、呼吸困难）、疼痛程度、持续性疼痛情况、以前有无类似症状、对疾病的了解程度、发病时间、发病时正在做什么、旁观者反应、自觉严重程度、入院方式、采取措施（打120,自己或让他人送去医院,呼叫或打电话寻求帮助,归因于其他疾病,尽量休息、放松,忍耐等待症状缓解,吃药）患者院前时间比较,差异有统计学意义（P<0.05）。多元线性回归分析结果显示,文化程度、到达居住地最近医疗机构的时间、持续性疼痛情况、旁观者的反应、自觉严重程度、入院方式为打车、归因于其他疾病为院前时间的影响因素（P<0.05）。结论　患者的文化程度越高、到达居住地最近医疗机构的时间越短、自觉症状越严重,院前时间越短;有持续性疼痛、发病时旁观者反应为采取就医措施、打120入院的患者院前时间较短;发病后归因于其他疾病的患者院前时间较长。需增强公众对急性主动脉夹层的认知和警觉意识,发病后采取积极的就医措施,推荐打120入院。     

In-hospital delay to primary angioplasty for patients with ST- elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China

Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction （STEMI） reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention （PPCI） for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 （interquartile range 105 to 180） minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals （147 minutes vs. 120 minutes, P〈0.001; 55 minutes vs. 45 minutes, P=0.035）. After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.     

急性ST段抬高心肌梗死患者发病-治疗延迟时间分布

目的调查急性ST段抬高心肌梗死(STEMI)患者症状发作至治疗各个环节的时间。方法前瞻性调查412例STEMI患者,按患者发病-治疗顺序分别记录如下时间:患者延迟(PD)、转运延迟(TD)、院前延迟(PHD)、门-CCU时间、CCU-签字同意治疗时间以及门-针(DTN)和门-囊(DTB)时间。结果412例患者发病-治疗各环节中位数时间记录如下:PD 75 min,TD 50min,PHD 170 min,门-CCU时间30 min。252例患者入院12 h内接受了再灌注治疗,溶栓145例,急诊介入治疗107例,CCU-签字同意溶栓和介入治疗时间分别为15 min和46.5 min,DTN和DTB分别为65 min和135 min。DTN在60 min内者占48.3%(70/145)。DTB在90 min和120 min者分别为23.4%(25/107)和43.9%(47/107)。结论患者延迟在院前延迟中起关键性作用,获取知情同意时间过长严重影响患者及时治疗,院内治疗延迟仍然高于标准要求。     

北京市16区患者基层医疗卫生机构就诊情况及影响因素研究

背景　近年来北京市分级诊疗服务体系已初现雏形,其中基层首诊作为分级诊疗的基础,对提高医疗服务体系运行效率十分重要。患者作为医疗服务的需方,研究其就医选择意愿及影响因素对落实基层首诊具有重要意义。目的　了解北京市患者在“生小病”时的就医选择及影响因素,从而为将患者引流至基层提出针对性建议。方法　于2019年5月在北京市16个区的48家区属二、三级医院中采用方便抽样的方式对门诊和住院患者的基层就诊选择意愿及其个人基本信息、健康状况和政策知晓情况进行调查。采用多因素Logistic逐步回归分析患者“生小病”时选择基层医疗卫生机构的影响因素。结果　共有3 732例调查对象纳入本研究,其中1 541例（41.29%）患有慢性病;知晓北京开展家庭医生制度和分级诊疗制度的患者分别为1 509例（40.43%）、1 641例（43.97%）,但签约了家庭医生的患者仅占12.43%（464/3 732）。1 349例（36.15%）调查对象“生小病”时会选择前往基层医疗卫生机构就医。多因素Logistic逐步回归分析结果显示,户籍、年龄、文化程度、社会医疗保险情况、家庭月收入、健康自评情况、慢性病数量、家庭医生制度知晓情况、家庭医生签约情况及分级诊疗制度知晓情况是调查对象就诊机构选择的影响因素（P<0.05）。结论　老年人、北京市户籍人口、有社会医疗保险、文化程度和收入较低、知晓分级诊疗和家庭医生相关政策、签约了家庭医生的患者在“生小病”时更倾向选择基层医疗卫生机构,因此对于非北京户籍、无社会医疗保险患者人群,应努力提高医疗保障,加强健康宣教;同时提高基层医疗技术水平和就诊环境,加大医改政策的宣传力度,并继续扩大家庭医生签约覆盖率,吸引更多患者下沉基层。     

焦虑对急性心肌梗死患者院前延误时间的影响

背景　急性心肌梗死（AMI）患者院前延误时间（PHT）延长是影响救治效果的主要因素。现关于PHT的研究越来越多,但多集中在社会人口学因素、AMI临床症状、发病情景、认知等层面,而缺乏对社会心理因素的系统研究。焦虑是AMI患者常见心理问题,但在中国人群中其是否影响AMI患者PHT尚未见相关报道。目的　探究焦虑对AMI患者PHT的影响,以期为AMI伴焦虑患者院前延误干预策略的制订提供依据。方法　本研究为多中心横断面研究,连续选取2016年4月—2017年2月于上海市4家医院（同济大学附属同济医院、同济大学附属第十人民医院、上海市杨浦区中心医院和解放军第411医院）就诊的AMI住院患者265例为研究对象。收集患者一般资料、AMI发病时症状、决定时间、转运时间、PHT（患者发病至到达医院的时间）,采用广泛性焦虑障碍量表（GAD-7）评估患者焦虑情况。结果　265例患者的PHT为150.0（70.0,501.0）min;焦虑评估结果：无焦虑161例,有焦虑104例（其中轻度焦虑81例,中度焦虑16例,重度焦虑7例）。有焦虑患者抑郁、心脏否认发生率及怕死程度得分高于无焦虑患者（P<0.05）。有焦虑患者濒死感、头晕发生率高于无焦虑患者（P<0.05）。无焦虑与有焦虑患者决定时间、转运时间、PHT比较,差异无统计学意义（P>0.05）。重度焦虑患者决定时间、PHT长于轻度焦虑患者（P<0.05）;不同焦虑程度患者转运时间比较,差异无统计学意义（P>0.05）。结论　AMI伴焦虑患者更易发生抑郁、心脏否认,重度焦虑患者较轻度焦虑患者决定时间、PHT更长,从而更可能错过最佳再灌注治疗时间,影响预后。     

Influence of ambulance use on early reperfusion therapies for acute myocardial infarction

Background Ambulance use expedites the definitive treatment of acute myocardial infarction （AMI）. The aim of this study was to evaluate the effect of ambulance use on the administration of early reperfusion therapies for patients with AMI in Beijing, China. Methods Data were prospectively collected from 498 patients with ST-elevation myocardial infarction （STEMI） who were admitted within 12 hours of symptom onset to 19 hospitals in Beijing between November 1,2005 and December 31, 2006. The baseline characteristics of and the initial management of the ambulance users and the non-ambulance users were compared. Results Only 186 （37.3%） patients used an ambulance as transportation to the hospital. Ambulance users were, on average, older and at relatively higher risk on presentation than the non-ambulance users. After adjustment for patient and hospital characteristics, ambulance use was associated with a greater early reperfusion rate, mainly because of a greater incidence of primary percutaneous coronary intervention. In addition, ambulance users had a significantly shorter median door-to-balloon （120 compared with 145 minutes, P 〈0.001） and symptom onset-to-balloon （223 compared with 300 minutes, P 〈0.001） time than non-ambulance users. Conclusions Ambulances are underused by AMI patients in Beijing. Ambulance use may lead to more frequent and faster receipt of early reperfusion therapies. New public health strategies should be developed to facilitate an increased use of ambulances by AMI patients.     

Effect of ambulance 12-lead ECG recording on times to hospital reperfusion in acute myocardial infarction

OBJECTIVE: To review the evidence that recording a prehospital 12-lead electrocardiogram (ECG) reduces time from hospital arrival to initiation of reperfusion therapy for acute myocardial infarction (AMI). DATA SOURCES: Medline search from 1966 to the present (articles in all languages) and examination of bibliographies. STUDY SELECTION: Published studies of prehospital 12-lead ECG recording that included control groups and reported time intervals from hospital arrival to start of reperfusion therapy. DATA EXTRACTION: Eight articles satisfied selection criteria (two randomised controlled trials, four non-randomised interventional studies and two prospective observational studies). DATA SYNTHESIS: Widely varying study methodologies precluded meta-analysis. All studies had methodological problems, but hospital delays were consistently reduced. Such improvements appear to be small in hospitals where delays are already minimal. CONCLUSIONS: Little evidence is available to support routine prehospital 12-lead ECG recording if the median hospital time to reperfusion is already less than 30 minutes. Improvement of in-hospital treatment times may be a better initial strategy than prehospital 12-lead ECG recording, as this will benefit more patients and allow ambulance services to better allocate their available resources.     

Clinico-epidemiological profile of chronic suppurative otitis media patients attending a tertiary care hospital

The cross-sectional study was conducted to assess the clinico-epidemiological profile, perceptions and clinical profile of the chronic suppurative otitis media (CSOM) patients in a tertiary care hospital. A pretested questionnaire was used containing open questions and the patients were assessed clinically. Most patients (31.2%) were from 0-10 years age group and were males (58.8%). Majority of them (96%) lived in "kuccha" houses/slums, 76.8% practised unhygienic ear pricking, 36.8% poured oil in their ears, 70.8% bathed in ponds/rivers, 52.8% had ear discharge for more than 1 year. Among the respondents, 17.2% knew that CSOM was contagious, 24% thought CSOM ran in family, 20% knew CSOM is preventable. There was low threat perception and long time to seek care. Patients mostly presented with earache, deafness and discharge, most had deafness and safe variety of CSOM. More than half had comorbidities. Most of the previous study findings corroborated with the present study. Here was a substantial delay between the onset and treatment seeking due to lack of awareness and low threat perception. Pain and complications were the triggers for care-seeking. Education about the disease, strengthening the frontline workers and good referral system are suggested.     

早期心理护理干预在急性心肌梗死后抑郁患者中的应用

目的：探讨对急性心肌梗死的患者尽早实施心理护理干预后的应用价值。方法整群选取2015年3月-2016年3月因急性心肌梗死入该院诊治的患者进行统计共有156例,24 h后采用抑郁自评量表,发现有急性心肌梗后抑郁症的患者40例,将其作为该次实验对象按照随机分为传统组与干预组各20例,对传统组患者采用临床常规的护理措施,而对干预组患者在常规护理措施的基础上于心梗后第2天进行心理护理干预,经过护理一周后采用焦虑与抑郁自评量表测定患者的心理状况,并观察患者对护理方式的满意度。结果干预前两组患者的SDS与SAS评分对比均差异无统计学意义(P>0.05),在不同模式的护理后,干预组评分显著优于传统组,且基本恢复标准值,差异有统计学意义(P<0.05);护理后两组患者满意度调查发现,干预患者100%的满意度明显超过传统组的85%,差异有统计学意义(P<0.05)。结论对急性心肌梗死后抑郁的患者早期实行心理护理干预,有效缓解多种精神压力,改善抑郁症状,使其在身心放松的状态下配合治疗从而提高疾病治愈率,在临床工作中具有实际指导的价值。     

Seeking Medical Information Using Mobile Apps and the Internet: Are Family Caregivers Different from the General Public?

Family caregivers play an important role to care cancer patients since they exchange medical information with health care providers. However, relatively little is known about how family caregivers seek medical information using mobile apps and the Internet. We examined factors associated with medical information seeking by using mobile apps and the Internet among family caregivers and the general public using data from the 2014 Health Information National Trends Survey 4 Cycle 1. The study sample consisted of 2425 family caregivers and 1252 non-family caregivers (the general public). Guided by Comprehensive Model of Information Seeking (CMIS), we examined related factors’ impact on two outcome variables for medical information seeking: mobile apps use and Internet use with multivariate logistic regression analyses. We found that online medical information seeking is different between family caregivers and the general public. Overall, the use of the Internet for medical information seeking is more common among family caregivers, while the use of mobile apps is less common among family caregivers compared with the general public. Married family caregivers were less likely to use mobile apps, while family caregivers who would trust cancer information were more likely to use the Internet for medical information seeking as compared to the general public. Medical information seeking behavior among family caregivers can be an important predictor of both their health and the health of their cancer patients. Future research should explore the low usage of mobile health applications among family caregiver population.     

改良溶栓疗法治疗不稳定性心绞痛临床疗效观察

目的观察溶栓疗法治疗不稳定性心绞痛(UAP)的疗效。方法采用随机、双盲方法,59例UAP患者分为观察组(30例)和对照组(29例)进行研究。观察组采用小剂量、延迟溶栓、延长疗程的改良溶栓疗法。结果治疗后观察组较对照组72h心绞痛累计发作次数减少[(0.8±0.9)vs,(1.6±1.9)次,P<0.01],累计心绞痛发作时间减少[(7.4±2.8)vs,(1.76±5.7)min,P<0.01]。ST段偏移总和减少[(0.5±0.2)vs,(1.1±0.3)mv,P<0.01]。30d内心脏事件发生率观察组明显少于对照组(P<0.05)。结论小剂量、延迟溶栓、延长疗程的改良溶栓疗法治疗UAP疗效确切。     

陕西省2015年肺结核患者就诊延迟及其相关因素分析

目的 了解陕西省肺结核患者就诊延迟现况,探索与就诊延迟相关的主要因素.方法 从结核病信息管理系统导出陕西省2015年登记的结核病患者个案资料19 319例.采用描述性统计方法,计算就诊延迟率;采用卡方检验分析不同地域、性别、年龄、民族、职业、治疗分类、患者来源、户籍类型的就诊延迟是否有差异,以P＜0.05为差异有统计学意义;采用logistic回归模型进行多因素分析,以P＜0.05为差异有统计学意义.结果 陕西省肺结核患者就诊延迟率为57.7％(11 152/19 319),就诊延迟中位数为19d.多因素Logistic回归分析结果表明:地域、性别、年龄、治疗分类和患者来源是就诊延迟的影响因素(P＜0.05).女性就诊延迟率是男性患者的1.095倍(OR=1.095,95％CI=1.030～1.164).复治患者就诊延迟率是初治患者的1.221倍(OR=1.221, 95％CI=1.051～1.420).结论 陕西省肺结核患者就诊延迟情况比较严重.应根据就诊延迟的高危人群制定相应措施,积极有效的开展预防干预工作.     

北京市严重精神障碍患者监护人看护管理补贴政策实施效果评价分析

背景　家庭在精神障碍预防、照护、功能康复方面发挥着重要作用,《中华人民共和国精神卫生法》赋予监护人各项权利和义务,但是日常生活中常面临监护人缺位或者监护人照护压力较大的问题。严重精神障碍患者监护人看护管理补贴政策是北京市2016年开始实施的一项政策,旨在帮助患者家庭减轻负担,激励监护人更好履责。目的　了解严重精神障碍患者监护人看护管理补贴政策的实施效果。方法　课题组于2018年11月-2019年1月采用多阶段分层整群抽样方法采用自行设计的问卷调研北京市精神卫生政策的实施情况,本研究数据来自其中关于严重精神障碍患者监护人看护管理补贴政策部分的内容,调查患者/家属对该政策的知晓情况和医务人员对该政策的评价。结果　682例精神障碍患者/家属中,614例（90.0%）患者/家属表示知道该项政策。单因素分析结果显示,不同机构类别、学历、家庭人均月收入、患病年限的患者/家属对监护人看护管理补贴政策的知晓情况比较,差异有统计学意义（P<0.05）;Logistic回归分析结果显示,家庭人均月收入对患者/家属监护人看护管理补贴政策的知晓情况有影响（P<0.05）。631例医务人员中,表示该项政策起到了激励作用的有375例（59.4%）,单因素分析结果显示,不同机构类别、职称的医务人员对监护人看护管理补贴政策能否起到激励作用看法不同,差异有统计学意义（P<0.05）;Logistic回归分析结果显示,机构类别对医务人员对监护人看护管理补贴政策能否起到激励作用的看法有影响（P<0.05）。结论　严重精神障碍患者监护人看护管理补贴政策的实施情况较好,但是目前社区精神卫生工作仍然面临政策落实不到位、缺少社会的理解和关注、服务能力有限的问题,建议进一步推动落实精神卫生社区服务政策、完善精神卫生社区服务模式、提高精神卫生社区服务能力。     

Time delay to thrombolytic therapy--a Sri Lankan perspective.

Reducing the time delay in initiating thrombolytic therapy in acute myocardial infarction is critical in maximising the functional and survival benefit. We analysed 120 consecutive admissions for thrombolytic therapy to the Coronary Care Unit. The total delay was divided into prehospital, in-hospital and Coronary Care Unit stages, and the median delays were found to be 130, 70, and 15 minutes, respectively. The delay was significantly longer in patients who sought prehospital medical advice, and when the diagnosis was not made at the emergency treatment unit. Educating at-risk groups and modifying the admission system may help to minimise these delays, while the establishment of an emergency ambulance service with well-trained crew would also improve the prognosis after acute myocardial infarction in Sri Lanka.     

抑郁症、躁狂症患者时间知觉的研究

目的 通过对抑郁症和躁狂症患者时间知觉的神经心理学研究,探讨情绪影响时间知觉的有关神经生化机制.方法 应用时距复制任务,分别测试28例抑郁症患者、22例躁狂症患者以及26名年龄及教育程度相匹配的正常人.结果 抑郁症和躁狂症患者相对于正常人的时间知觉均有偏离(P<0.001).与正常对照组比较,抑郁症患者组对时间高估(600 ms/延迟1 s:1.6±0.6,P<0.001;600 ms/延迟5 s:1.7±0.6,P<0.001;3 s/延迟1 s:3.9±0.9,P<0.001;3 s/延迟5 s:3.9±0.7,P<0.001;5 s/延迟1 s:5.9±1.3,P<0.001;5s/延迟5s:6.1±1.3,P<0.001),躁狂症患者组对时间低估(600 ms/延迟1 s:0.7±0.2,P<0.01;600 ms/延迟5 s:0.6±0.3,P<0.001;3 s/延迟1 s:1.7±0.5,P<0.001;3 s/延迟5 s:1.8±0.6,P<0.001;5 s/延迟1 s:2.9±0.7,P<0.001;5 s/延迟5 s:3.0±0.8,P<0.001).病例组时距复制的结果与年龄、受教育年限、病程、住院次数及用药剂量无明显相关性(P>0.05),而与病情的严重程度相关,即抑郁症患者的汉密尔顿抑郁量表(HAMD)得分与之正相关(6种时间的,分别为0.44、0.46、0.73、0.61、0.55、0.50,均P<0.05),躁狂症患者的贝克躁狂量表(BRMS)得分与之负相关(6种时间的r分别为-0.57、-0.54、-0.71、-0.69、-0.80、-0.71,均P<0.05).结论 情绪会影响人们的时间知觉,这提示大脑中相关神经递质可能参与了时间信息的加工.