Peri-operative elastase-α-1 proteinase inhibitor in patients with postoperative intervertebral discitis

Summary In a prospective study of 251 patients operated upon for lumbar disc herniation it has been investigated whether the preoperative and early postoperative values of Elastase--1 Proteinase Inhibitor (EPI) — an indicator of inflammatory processes — and C-reactive Protein (CRP) — a well known predictor of some postoperative complications — were correlated to the later development of discitis. Postoperatively discitis developed in 14 patients. A randomly choosen group of 15 complication-free patients out of the total of 251 cases was used as control group.Elevated EPI plasma values, especially in the pre-operative and first postoperative days, turned out to be significantly related to the likelyhood of later discitis development, but no such relation for the CRP plasma values could be established. Thus and early prediction of patients at risk for this complication seems to be possible by pre- and postoperative measurement of EPI. It could be justified —but its usefulness has yet to be proven — to give antibiotics prophylactically and other anti-inflammatory medication in patients with elevated pre- and postoperative EPI values.     

Neurosensory outcome and growth at three years in extremely low birthweight infants: follow-up results from the Swedish national prospective study

A prospective national investigation comprising 633 extremely low birthweight (ELBW) infants born alive in the 2-y period 1990-1992 with a birthweight of ≤1000 g and gestational age of ≥23 completed weeks was conducted regarding neurosensory outcome and growth. Three-hundred and sixty-two (98%) surviving ELBW infants were assessed at a median age of 36 months, using a specially designed protocol. At follow-up, mean height, weight and head circumference in both boys and girls were significantly lower than the reference values. The incidence of cerebral palsy was 7% among all children and 14%, 10% and 3% in children born at 23-24, 25-26 and ≥27 gestational weeks, respectively. At least one obvious handicap was present in 14%, 9% and 3% of these three groups of children, respectively. After adjustment for gestational age, a significantly increased risk of handicap was found in children with intraventricular haemorrhage grade ≥3 and/or periventricular leucomalacia and in children with retinopathy of prematurity stage ≥3. The results show that more than 90% of ELBW children born at ≥25 completed gestational weeks were without neurosensory handicap at 36 months of corrected age. In infants born at 23-24 weeks of gestation, both survival and long-term outcome were less favourable.     

Comparing the Discriminative Validity of Two Generic and One Disease-Specific Health-Related Quality of Life Measures in a Sample of Patients with Dry Eye

OBJECTIVE: The purpose of this study was to compare the discriminative properties of two generic health-related quality of life (QoL) instruments (SF-36 and EQ-5D) and a newly developed disease-specific patient-reported outcomes instrument (Impact of Dry Eye on Everyday Life (IDEEL)) to distinguish between different levels of dry eye severity. METHODS: Assessment of 210 people: 130 with non-Sjogren's Keratoconjunctivitis Sicca (non-SS KCS), 32 with Sj?gren's Syndrome (SS) and 48 controls; comparison of SF-36, EQ-5D, and IDEEL age-adjusted data by dry eye severity levels. Severity was assessed based on diagnosis (non-SS KCS, SS, control), patient-report (none, very mild, mild, moderate, severe, extremely severe) and clinician-report (none, mild, moderate, severe). RESULTS: Discriminative validity results were consistent for all instruments. Significant differences between severity levels were found with most SF-36 scales (P < 0.05), all EQ-5D scales (P < 0.05), and all IDEEL scales (P < 0.0001), except for Treatment Satisfaction. IDEEL scales consistently outperformed the generic QoL measures regardless of the severity criterion used. Most SF-36 scales outperformed the EQ-5D QoL scale, but the EQ-5D visual analog scale outperformed the SF-36 scales, except for General Health Perceptions. CONCLUSIONS: The disease-specific IDEEL scales are better able to discriminate between severity levels than the majority of the generic QoL scales. Preliminary evidence demonstrates that the IDEEL will be sensitive to QoL changes over time, although further testing in controlled longitudinal studies is needed.     

The Relationship Between Quality of Life and Psychiatric Impairment for a Taiwanese Community Post-Earthquake

This purpose of this study was to investigate the relationship between quality of life and psychiatric impairment in a Taiwanese community located near the epicenter of the 1999 earthquake, as assessed four to six months after the natural catastrophe. Trained assistants interviewed the 4223 respondents using the disaster-related psychological screening test (DRPST), an instrument specifically designed and validated by senior psychiatrists for assessment of psychiatric impairment after natural catastrophe. Additionally, the 36-Item Short-Form Health Survey (SF-36) was used to evaluate quality of life. The collected results were analyzed using Windows SPSS 10.0 software. Psychiatric impairment rated moderate to severe was assessed for 1448 (34.3%) of the responding residents. The 4223 respondents were divided into 4 psychiatric-impairment groups based on DPRST score: healthy (n = 952); mild impairment (n = 1823); moderate impairment (n = 1126); and, severe impairment (n = 322). The four groups were compared for a number of salient factors, including gender, age, current marital status and psychiatric-impairment score, to determine impact on quality of life. Respondents assessed as psychiatrically impaired tended to be older, female, divorced/widowed, and less educated, and they were more likely to have experienced major familial financial loss as an immediate consequence of the earthquake. Further, the greater the severity of the psychiatric impairment, the lower the scores for quality of life, for both the physical and mental aspects of this important general indicator.     

Three Year Health Outcomes Among Older Women at Risk of Elder Abuse: Women's Health Australia

BACKGROUND: Older women are at increasing risk of various forms of familial violence, yet detection is poor and very little is known of the long-term health effects of this psychosocial problem. The effectiveness of the 'Vulnerability to Abuse' Screening Scale (VASS) in predicting three year health outcomes was investigated among women enrolled in the Australian Longitudinal Study on Women's Health, now known as Women's Health Australia. METHODS: The sample comprised a cohort of 10,421 women aged 73-78 who completed the 1996 and 1999 postal surveys (attrition rate 19.5%). The Time 2 sample had a small bias towards lower risk for elder abuse at Time 1 and better health on SF-36 and self-rated health. The VASS is a 12-item self-report measure with 4 factors: vulnerability, coercion, dependence and dejection. RESULTS: Overall, physical health (PCS) declined while mental health (MCS) increased over the three year period. Decline in physical health was predicted by only the dejection factor, but not by factors which seem to more directly measure abuse. The predictive validity of the VASS for three year mental health outcomes was given partial support. Three of the four VASS factors (dejection, vulnerability, and coercion) predicted decline in mental health at the univariate level, however, after adjusting for confounders, only one VASS factor (dejection) independently predicted decline in mental health. CONCLUSIONS: While the VASS shows some promise as a marker of health risk in older women, only the dejection factor proved consistently predictive of declining health status. Further research is needed to determine longer term predictive validity of the scale and to gain a clearer picture of how abusive experiences impact on older women's health.     

SF-36用于肺结核的信度、效度及敏感性评价

目的　评价中文版SF - 36量表用于肺结核 (PTB)病人的生命质量测量的信度、效度、敏感性。方法　用自行研制的中文版SF - 36量表对肺结核病人及对照进行测量。采用Cronchbach’sα评价量表的信度 ,因子分析评价量表的效度 ,用配对t检验比较患者组和对照组的评分来评价量表的敏感性。结果　对于病人组和对照组 ,SF - 36量表效度 (因子分析聚合为 2个公因子 )、信度 (Cronchbach’sα >0 7)较好。肺结核病人各项得分均低于对照组 ,说明量表的敏感性较高。结论　中文版SF - 36量表是测量肺结核病人的生命质量的有效量表 ,但量表中个别词句的翻译仍须改动 ,并且有必要进行更大样本的调查 ,建立中国人的生命质量正常值标准 ,以利于生命质量的评价     

The ALS Health Profile Study: quality of life of amyotrophic lateral sclerosis patients and carers in Europe

The measurement of functioning and well-being from the perspective of the patient has in recent years become central to the assessment of health and the evaluation of treatment regimes. The past decade has seen an enormous growth in the application of measures designed to assess quality of life in a vast array of medical specialities. However, the use of such measures in neurology has been relatively limited, and this has certainly been the case in amyotrophic lateral sclerosis (ALS). The European ALS Health Profile Study is a longitudinal survey of patients diagnosed with ALS or other motor neurone diseases in which patients are aksed to complete questionnaires concerning their subjective health status. Data from clinical assessments are also collected. It is intended that the information collected will provide more systematic and detailed evidence of the impact of the disease from the perspective of the patient. This contribution documents results from baseline assessment obtained from data supplied by clinicians, carers and patients themselves. Three outcome measured are assessed in this paper: the SF-36, a generic measure of well being and functioning, the ALS Functinal Rating Scale and the Carer Strain Index. The evidence presented here suggests that these measures provide a meaningful and valid picture of the impact of the disease. The data indicate that ALS has substantial adverse effects both upon the functioning and well being of patients and carers, as well as an association between the emotional health status of patients and carers, and between the physical health status of patients and carers. Received: 4 January 2000 / Received in revised form: 15 March 2000 / Accepted: 3 May 2000     

草分枝杆菌F·U·36治疗反复发作呼吸道感染病儿45例

目的:观察草分枝杆菌F·U·36治疗反复呼吸道感染(RRSI)病儿临床疗效。方法:75例RRSI病儿分为2组,其中反复上呼吸道感染50例,反复下呼吸道感染25例。治疗组45例中男性25例,女性20例,年龄(6±s6)a,1.5~14.1a,给予青霉素及利巴韦林注射液,iv,gtt,bid,7~10d;在以上常规治疗的基础上,给予草分枝杆菌F·U·361.72μg,im,每周1次,1mo为一个疗程。对照组30例,男性17例,女性13例,年龄(6±7)a,1.4~14.5a,只给予常规治疗。观察2组临床疗效,并测定IgA,IgG,IgM,CD3+,CD4+,CD8+,CD4+/CD8+的水平。结果:治疗后治疗组,总有效率91%(41/45);对照组总有效率37%(11/30),2组比较差异有非常显著意义(P<0.01)。治疗组治疗后,IgA,IgG,IgM,CD3+,CD4+,CD8+,CD4+/CD8+值均明显增加(P<0.01)。结论:草分枝杆菌F·U·36用于防治RRSI有明显疗效,能有效地改善免疫学指标,无明显不良反应。     

Application of Injection at Acupoint Zusanli （ST 36） in Hydrotubation

220例行输卵管通液术的患者被分为实验组(n=110)和对照组(n=110),实验组患者在进行输卵管通液术前用维生素K1足三里穴位注射,对照组术前不作其他处理.实验组不良反应例数明显少于对照组,且反应较轻.实验组输卵管通畅89例,占80.9%,对照组输卵管通畅63例,占57.3%.     

健康调查简表及其在妇科疼痛相关疾病中的应用进展②

本文介绍健康调查简表(SF-36)的发展及引进中国后在临床的应用概况，重点介绍其在妇科以慢性盆腔疼痛为主要症状相关疾病，如盆腔炎、子宫内膜异位症等的应用概况。临床如能将SF-36与特定疾病量表结合，将为妇科慢性盆腔疼痛评估提供一个重要而有意义的工具。