抑郁症及其一级亲属脑基础活动的BOLD-fMRI研究

目的 运用功能磁共振成像(fMRI)研究抑郁症(MDD)及其一级亲属静息状态下脑区的低频振幅(ALFF)及低频振幅比率(fALFF)的特点及差异,以了解MDD患者早期的脑功能状态.方法 对10例MDD患者(MDD组)、10例MDD一级亲属(一级亲属组)、10例健康志愿者(对照组)进行3.0T静息状态脑功能磁共振成像 (fMRI),分别计算各组的ALFF、fALFF,进行统计学分析.结果 与一级亲属组相比,MDD组的左侧小脑、左侧楔前叶、左侧内侧前额叶皮质的ALFF、fALFF值均显著性降低(P<0.05);而右侧背侧扣带回皮质、右侧顶上小叶的ALFF值显著减低(P<0.05);与对照组相比,MDD组的左侧小脑、左侧楔前叶、左侧顶上小叶的ALFF、fALFF值均显著性降低(P<0.05),而右侧扣带回皮质、内侧前额叶皮质的ALFF值显著减低(P<0.05);一级亲属组与对照组相比,ALFF值无统计学差异,一级亲属组的左侧顶上小叶的fALFF值显著降低(P<0.05).结论 MDD患者及一级亲属脑区均存在广泛的ALFF、fALFF异常,这些异常的脑区可能与MDD认知网络障碍及情感低落相关.     

Implementation of Screening Colonoscopy amongst First-Degree Relatives of Patients with Colorectal Cancer in Turkey: a Cross-Sectional Questionnaire Based Survey

Objective: To evaluate the implementation of screening colonoscopy amongst first-degree relatives (FDRs)of patients with colorectal cancer (CRC) in Turkey. Materials and Methods: A total of 400 first-degree relatives(mean(SD)age: 42.5(12.7) years, 55.5% were male) of 136 CRC patients were included in this cross-sectionalquestionnaire based survey. Data on demographic characteristics, relationship to patient and family history formalignancy other than the index case were evaluated in the FDRs of patients as were the data on knowledge aboutand characteristics related to the implementation of screening colonoscopy using a standardized questionnaireform. Results: The mean(SD) age at diagnosis of CRC in the index patients was 60.0(14.0) years, while mean(SD)age of first degree relatives was 42.5(12.7) years. Overall 36.3% of relatives were determined to have knowledgeabout colonoscopy. Physicians (66.9%) were the major source of information. Screening colonoscopy wasrecommended to 19.5% (n=78) of patient relatives, while 48.7% (n=38) of individuals participated in colonoscopyprocedures, mostly (57.9%) one year after the index diagnosis. Screening colonoscopy revealed normal findingsin 25 of 38 (65.8%) cases, while precancerous lesions were detected in 26.3% of screened individuals. In 19.0% ofFDRs of patients, there was a detected risk for Lynch syndrome related cancer. Conclusions: In conclusion, ourfindings revealed that less than 20% of FDRs of patients had received a screening colonoscopy recommendation;only 48.7% participated in the procedure with detection of precancerous lesions in 26.3%. Rise of awarenessabout screening colonoscopy amongst patients with CRC and first degree relatives of patients and motivationof physicians for targeted screening would improve the participation rate in screening colonoscopy by FDRs ofpatients with CRC in Turkey.     

Smoking Habits of Relatives of Patients with Cancer: Cancer Diagnosis in the Family is an Important Teachable Moment for Smoking Cessation

Background: In this study we aimed to determine the rate and habitual patterns of smoking, intentions ofcessation, dependence levels and sociodemographic characteristics of relatives of patients with a diagnosis ofcancer. Materials and Methods: This study was designed by the Turkish Oncology Group, Epidemiology andPrevention Subgroup. The relatives of cancer patients were asked to fill a questionnaire and Fagerstrom testof nicotine dependence. Results: The median ages of those with lower and higher Fagerstrom scores were 40years and 42 years, respectively. We found no evidence of variation between the two groups for the remainingsociodemographic variables, including the subject’s medical status, gender, living in the same house with thepatient, their educational status, their family income, closeness to their cancer patients or spending time withthem or getting any help or wanting to get some help. Only 2% of the subjects started smoking after cancer wasdiagnosed in their loved ones and almost 20% of subjects had quit smoking during the previous year. Conclusions:The Fagerstrom score is helpful in determining who would be the most likely to benefit from a cigarette smokingcessation program. Identification of these people with proper screening methods might help us to pinpoint whowould benefit most from these programs.     

Functional capacity after hip arthroplasty: A comparison between evaluation with three standard instruments and a personal interview

The aim of the present study was to compare the information obtained from three standard instruments used in physiotherapy and occupational therapy and with information acquired from an unstructured interview. Ten patients with osteoarthritis of the hip were consecutively picked from the waiting list at an orthopedic clinic. All were examined before and six months after arthroplasty. The study layout is a mixture of quantitative and qualitative evaluation. The three instruments used were SF-36 (self-reported health-related quality of life), FAS (an instrument for evaluation of lower extremity dysfunction), and the COPM (for evaluation of self-experienced activity level). All patients were also interviewed in a free, unstructured interview, and data were analyzed with a phenomenological approach. All methods could describe function and activity status of the patients very well, and they were also responsive to postoperative improvement. Together the three instruments gave such good information that almost no extra information was obtained through the interviews. On the other hand, the interviews served as powerful validation of the three instruments. The information in the three separate instruments is qualitatively different, and one instrument cannot replace another. They cannot be replaced by the interview either, because the instruments provide the therapist with specific and structured information that is important for further treatment planning and follow-up.     

健康教育对精神分裂症患者陪护亲属认知水平的影响

目的 探讨针对性健康教育对精神分裂症患者陪护亲属认知水平的影响,为提高其监护质量提供依据.方法将100名精神分裂症患者陪护亲属随机分为观察组和对照组各50名,观察组开展一对一针对性健康教育和心理护理,对照组予以常规健康教育讲座.观察患者住院全程.于患者出院前1 d采用自拟调查表评定两组陪护亲属的认知状况,统计两组患者自杀、外走、伤人、毁物发生率. 结果患者出院时,观察组陪护亲属对精神分裂症的概念、治疗、转归及预防的认知状况评分均显著高于对照组（P〈0.01）;患者的自杀未遂、外走行为、外走企图、伤人行为、伤人倾向、毁物现象、毁物倾向的发生率均显著低于对照组（P〈0.05或0.01）. 结论 针对性健康教育能显著提高精神分裂症患者陪护亲属的认知能力与监护质量,对预防意外事件的发生具有显著效应,更有利于帮助患者早日回归社会.     

Graves病多发家系成员甲状腺自身免疫状况及碘摄入量对其发病率的影响

目的：确定在Graves病（GD）多发家系成员中,甲状腺自身免疫及甲状腺功能异常的发生情况,并研究碘摄入量对GD发病率的影响。方法：对全部家系成员做甲状腺疾病病史询问,体格检查,甲状腺功能及甲状腺自身抗体测定,并测定空腹尿碘含量。结果：GD患者一级亲属的亚临床甲亢,临床甲状,亚临床甲状的患病率分别为5．2％,1．0％和1．4％,这三种疾病患者的甲状腺自身抗体均为阳性,甲状腺功能正常一级亲属的甲状腺自身抗体阳性率为68．6％,尿碘水平500－599ug/L时,GD的发病率显著增高（P＜0．05）,。结论：在GD多发家系中,GD患者一级亲属发生甲状腺功能异常的原因均为自身免疫甲状腺病,尿碘水平500－599ug/L是GD发病率增高的危险因素。     

Psychological and Screening Profiles of First-Degree Relatives of Prostate Cancer Patients

The purpose of the present study was to systematically compare the psychological and screening profiles of first-degree relatives (FDRs) of prostate cancer patients versus non-FDRs. FDRs (n = 56) and non-FDRs (n = 100), recruited through prostate cancer index cases and newspaper advertisements, completed questionnaires via mail. FDRs reported feeling at greater risk for prostate cancer, estimated that they were at higher average lifetime risk for the disease, agreed more strongly that prostate cancer is inherited, and that less can be done to prevent the development of the disease. Increased age, but not FDR status, was associated with more frequent screening behavior. Taken together, the results indicate that FDRs are characterized by greater perceived vulnerability to prostate cancer and lower expectations about disease prevention. Yet, they are no more likely to be screened than non-FDRs. These findings underscore the importance of developing, and evaluating, evidence-based health communication protocols to promote screening adherence among at-risk patients.     

Life review and life story books for people with mild to moderate dementia: a randomised controlled trial

Objectives: To evaluate the effect of different pathways for developing a life story book (LSB) for people with dementia.

Method: Preliminary randomised control trial; 23 people with dementia in care homes (mean age 86) randomly assigned to receive either 12 individual life review sessions and co-creating a LSB or a personal LSB created by their relatives as a ‘gift’

Results: No difference in quality of life (quality of life–Alzheimer's disease (QOL–AD)) was observed between the two groups, six weeks after having received the LSB (F(1,20) = 0.08, p = 0.77). At this point, QOL–AD had improved for both groups, but there was a significant between-group difference at an intermediate assessment immediately after the life review sessions had been completed, before the LSBs were received (F(1, 20) = 5.11, p = 0.035), in favour of life review. A similar pattern was observed on autobiographical memory (extended autobiographical memory interview), with the life review group improving significantly more than the gift group during the life review sessions, but no difference was observed once all participants had had their LSB for six weeks. After the LSBs were produced – by either pathway – quality of relationship as rated by relatives improved significantly (F(2, 39) = 19.37, p < 0.001) and staff knowledge regarding the resident and attitudes to dementia improved.

Conclusion: The creation of LSBs – either through a life review process or by relatives without involving the person with dementia – has benefits for people with dementia, relatives and staff in care homes. However, undertaking a life review requires training and supervision.