老年甲状腺功能亢进症的诊治进展

老年甲状腺功能亢进症（简称甲亢）是常见的内分泌疾病。近年来,老年甲亢患病率有逐年增加趋势。但由于其临床表现不典型,容易被误诊或漏诊。由于老年患者伴随疾病多,老年甲亢的治疗方案应以使用抗甲状腺药物为主,且剂量宜偏小,也可采用放射性治疗,不推荐选择手术治疗。治疗时可同时辅以对症及支持疗法,并要密切监测甲状腺功能的变化。     

阿托伐他汀钙治疗老年脑动脉硬化的临床效果探讨

目的 探讨阿托伐他汀钙治疗老年脑动脉硬化的临床效果。方法 选取于2012年12月至2014年12月期间入住海南医学院附属医院的124例老年脑动脉硬化患者进行分析。随机将其分为试验组和对照组(各62例),对照组采用常规方法进行治疗,试验组在对照组的基础上加用阿托伐他汀钙进行治疗;治疗6个月后,观察两组患者的血脂水平、颅内动脉弹性指标、颈动脉硬化斑块大小及脑血管疾病的发生情况等。结果 两组患者治疗后的血脂水平、颅内动脉弹性指标、颈动脉硬化斑块大小均较治疗前有所改善,差异具有统计学意义（P＜0.05）;治疗后试验组的血脂水平、颅内动脉弹性指标、颈动脉硬化斑块大小明显优于对照组,差异具有统计学意义（P＜0.05）。试验组的总有效率（98.4%）明显高于对照组（80.6%）,差异具有统计学意义（χ2＝5.436,P＜0.05）;试验组的脑血管疾病发生率（3.2%）明显低于对照组（16.1%）,差异具有统计学意义（χ2＝5.324,P＜0.05）。结论 老年脑动脉硬化患者采用阿托伐他汀钙治疗可明显改善患者的症状,对减少脑血管疾病的发生具有重要的临床意义。     

老年肺血栓栓塞症的特点和临床诊治思路

老年人群是肺血栓栓塞症（PTE）的高危人群,有研究显示随着年龄增长,PTE的发病率呈现升高趋势,且老年PTE的病死率、复发率和出血发生率较年轻人明显升高。 因此,老年PTE作为一个重要的国际性医疗保健问题已引起各国普遍关注。在过去的20年间,老年PTE的诊断和治疗取得了很大进步,如新的诊断策略的建立（包括Wells评分和改良的Geneva评分）、年龄调整的D?二聚体界限值对于PTE的排除诊断价值、新型抗凝药物在老年患者中的应用等。本文我们主要针对老年PTE诊断治疗方面的最新进展进行了总结,以期对临床肺血管病医师有所帮助。     

慢性间歇性低压低氧对老年大鼠自发运动行为及黑质多巴胺能神经元的影响

目的:用慢性间歇性低压低氧(CIHH)模型,探讨CIHH对老年大鼠自发运动行为以及黑质多巴胺能神经元的影响。方法:用CIHH模型处理老年大鼠30 d,通过旷场实验检测大鼠自发运动行为的改变,通过实时定量PCR和免疫印迹检测黑质多巴胺能神经元酪氨酸羟化酶(TH)和多巴胺转运体(DAT)表达的变化。结果:老年组大鼠旷场实验中闻嗅行为、探索行为、运动行为和理毛行为与成年组相比均显著下降,CIHH处理后理毛行为没有改变,闻嗅行为、探索行为和运动行为显著改善,但没有达到成年组水平;老年组大鼠黑质多巴胺能神经元TH和DAT的表达与成年组相比均显著下降,老年CIHH组TH和DAT的表达升高,但没有达到成年组水平。结论:CIHH可改善老年大鼠闻嗅行为、探索行为和运动行为,并提高黑质多巴胺能神经元TH和DAT的表达。     

老年人外周血单核细胞表面HLA-DR和T淋巴细胞亚群的改变

目的通过对健康老年人与健康年轻人外周血单核细胞人类白细胞抗原(HLA-DR)和T淋巴细胞亚群表达水平的比较,探讨HLA-DR和T淋巴细胞亚群的表达与衰老的关系。方法采用免疫荧光标记流式细胞技术测定20例健康老年人和20例健康年轻人外周血单核细胞HLA-DR和CD3、CD4、CD8的水平。结果老年组外周血单核细胞HLA-DR的表达稍高于年轻组,但统计学上差异不明显(P>0.05),老年人CD4 T细胞、CD4/CD8低于年轻组,两者之间统计学差异明显(P<0.05或P<0.01)。结论老年组单核细胞HLA-DR的表达稍高于年轻组,但功能降低,CD4 T淋巴细胞和CD4/CD8较年轻组下降,是老年人免疫功能减退的原因之一。     

Factors influencing the adaptation to skilled nursing facilities among older Korean adults

This study was conducted to identify the factors that influence the level of adaptation of older Korean adults to skilled nursing facilities. The subjects were 500 adults aged 65 or older who were living in six different skilled nursing facilities in Seoul and Gyeong‐gi‐do, South Korea. The measures were a demographic form, Health Self‐Rating Scale, Activities of Daily Living Scale, Self‐Efficacy Instrument, Korean Simple Depression Scale, Quality of the Facility Scale and Facility Adaptation Scale. The analyses showed that the prediction model was significant (F = 128.624, P < 0.001). The value of the adjusted R² was 0.435, which corresponds to the explanatory power of 43.5%. The factor that was found to have the greatest influence on the adaptation of older Korean adults to skilled nursing facilities was activities of daily living (β = ?0.564), followed by self‐efficacy (β = 0.321), quality of the facility (β = 0.164), depression (β = 0.133), decision to enter a skilled nursing facility (β = 0.122), perceived health status (β = 0.064) and age (β = ?0.010). This cross‐sectional study provides preliminary evidence that the level of adaptation of older Korean adults to skilled nursing facilities is related to their activities of daily living, self‐efficacy, depression, decision to enter a skilled nursing facility, perceived health status and age, and to the quality of the facility.     

Validation and reliability of a modified sphygmomanometer for the assessment of handgrip strength in Parkinson′s disease

BACKGROUND:

Handgrip strength is currently considered a predictor of overall muscle strength and functional capacity. Therefore, it is important to find reliable and affordable instruments for this analysis, such as the modified sphygmomanometer test (MST).

OBJECTIVES:

To assess the concurrent criterion validity of the MST, to compare the MST with the Jamar dynamometer, and to analyze the reproducibility (i.e. reliability and agreement) of the MST in individuals with Parkinson''s disease (PD).

METHOD:

The authors recruited 50 subjects, 24 with PD (65.5±6.2 years of age) and 26 healthy elderly subjects (63.4±7.2 years of age). The handgrip strength was measured using the Jamar dynamometer and modified sphygmomanometer. The concurrent criterion validity was analyzed using Pearson''s correlation coefficient and a simple linear regression test. The reproducibility of the MST was evaluated with the coefficient of intra-class correlation (ICC_2,1), the standard error of measurement (SEM), the minimal detectable change (MDC), and the Bland-Altman plot. For all of the analyses, α≤0.05 was considered a risk.

RESULTS:

There was a significant correlation of moderate magnitude (r≥0.45) between the MST and the Jamar dynamometer. The MST had excellent reliability (ICC_2,1≥0.7). The SEM and the MDC were adequate; however, the Bland-Altman plot indicated an unsatisfactory interrater agreement.

CONCLUSIONS:

The MST exhibited adequate validity and excellent reliability and is, therefore, suitable for monitoring the handgrip strength in PD. However, if the goal is to compare the measurements between examiners, the authors recommend that the data be interpreted with caution.     

Development and psychometric testing of a semantic differential scale of sexual attitude for the older person

The purpose of this study was to develop and test a semantic differential scale of sexual attitudes for older people in Korea. The scale was based on items derived from a literature review and focus group interviews. A methodological study was used to test the reliability and validity of the instrument. A total of 368 older men and women were recruited to complete the semantic differential scale. Fifteen pairs of adjective ratings were extracted through factor analysis. Total variance explained was 63.40%. To test for construct validity, group comparisons were implemented. The total score of sexual attitudes showed significant differences depending on gender and availability of sexual activity. Cronbach's alpha coefficient for internal consistency was 0.96. The findings of this study demonstrate that the semantic differential scale of sexual attitude is a reliable and valid instrument.     

长沙市养老机构医护人员临终关怀知信行现状及影响因素研究

目的调查养老机构医护人员临终关怀知信行现状及影响因素。方法采用医护人员临终关怀知信行问卷对长沙市8所养老机构206名医护人员进行调查。结果医护人员临终关怀知识(11.37±3.13)分,得分指标为56.85%,处于一般水平;态度总分(3.48±0.27)分,处于高等水平;行为总分(4.10±0.65)分,处于高等水平。性别、宗教信仰、个人月收入、课堂教学与教材对临终关怀知识有影响;年龄、性别、从亲戚朋友处学习及临终关怀知识对临终关怀态度有影响;户籍、个人月收入、专门培训、临终关怀知识及临终关怀态度对临终关怀行为有影响。结论养老机构应加强不同特征医护人员的临终关怀知识学习,拓宽知识获取途径,规范临终关怀教育和再教育,提高收入,引导临终关怀知识学习的热情,进而端正态度、规范行为。     

Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis

Background

In this systematic review, the authors aim to assess the effect of silver diamine fluoride (SDF) in preventing and arresting caries in exposed root surfaces of adults.