The challenge of spinal cord injury care in the developing world

Great strides have been made in reducing morbidity and mortality following spinal cord injury (SCI), and improving long-term health and community participation; however, this progress has not been uniform across the globe. This review highlights differences in global epidemiology of SCI and the ongoing challenges in meeting the needs of individuals with SCI in the developing world, including post-disaster. Significant disparities persist, with life expectancies of 2 years or less not uncommon for persons living with paraplegia in many developing countries. The international community has an important role in improving access to appropriate care following SCI worldwide.     

地震致脂肪栓塞综合征的早期诊断与治疗

目的:探讨地震致脂肪栓塞综合征(FES)的早期诊断与治疗。方法:回顾性分析从2008年5月12日至5月22日共诊治的15例地震致FES病例的临床诊治资料。结果:15例病人12例治愈,2例遗留后遗症,1例死亡。讨论:对地震致FES早期预防重要,强调早期诊断,早期治疗,发生FES以支持呼吸功能,纠正低氧血症与早期大剂量激素相结合的综合治疗为有效治疗的方法。     

不同年龄地震伤病员心理健康状况调查研究

目的:了解不同年龄地震伤病员的心理状况。方法:采用精神症状自评量表(SCL-90)对不同年龄地震伤病员进行问卷调查。结果:本组地震伤病员与国内常模比较SCL-90各因子分均高于全国常模,差异显著。其中躯体化、偏执的差异具有统计学意义;强迫症状、人际关系敏感、抑郁、焦虑、恐怖及总分、阳性项目数等有显著差异。而青少年SCL-90各因子分得分均高于成人。其中抑郁、焦虑、偏执、阳性项目数的差异具有统计学意义。躯体化、强迫症状、人际关系敏感、恐怖及总分等有显著差异。结论:地震伤病员的心理状况较差,而尤以青少年心理问题更为明显。应针对他们不同的心理特点,进行心理健康教育。提高他们的心理素质及乐观开朗的性格和积极向上的生活态度。     

地震伤员PTSD及其影响因素的研究

目的:调查汶川地震灾后伤员的创伤后应激障碍(Posttraumatic stress disorder,PTSD)相关症状的发生及其影响因素.方法:采用美国<精神障碍诊断与统计手册>第四版(DSM-Ⅳ)中关于PTSD的诊断标准,在地震后40 d对伤员PTSD症状进行评定.结果:地震后40 d PTSD症状的检出率为51.4%,其主要影响因素为性别(OR=2.364)、地震中被掩埋(OR=2.171)、目睹有人在地震中受伤(OR=0.338).结论:此次地震后PTSD症状的检出率相当高,应采取针对性的干预措施.     

汶川地震后重灾区人群重性抑郁障碍流行病学调查

目的 了解中国汶川5·12地震后重灾区居民的重性抑郁障碍患病率、患者的人口学和社会文化特征及患病相关危险因素.方法 采用分层整群抽样方法随机抽取≥15岁人群14 503人,以一般健康问卷12项(GHQ-12)为筛选工具,采用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查版(SCID-Ⅰ/P)为调查诊断工具.结果 重性抑郁障碍现患180例,时点患病率为1.27%,终生患病率为1.36%;女性(OR=1.56,95%CI:1.136～2.143,P＜0.05)、合并躯体疾病(OR=4.02,95%CI:2.75～5.90,P＜0.05)、地震中受伤(OR=3.29,95%CI:1.92～5.65,P＜0.05)、财产损失(其中10万～20万元OR=2.09,95%CI:1.18～3.69,P＜0.05;＞20万元OR=2.54,95%CI:1.38～4.68,P＜0.05)、家人去世或失踪(OR=3.79,95%CI:2.08～6.89,P＜0.05)以及中年人群(OR=2.31,95%CI:1.38～3.86,P＜0.05)为危险因素.有职业为保护性因素(OR=0.60,95%CI:0.43～0.83,P＜0.05).结论 重性抑郁障碍是目前地震灾区较为多发的精神疾病.     

Before and after the 1999 Chi-Chi earthquake: traumatic events and depressive symptoms in an older population

Natural disasters, such as earthquakes, can have deleterious consequences for physical and psychological health. In this study, we investigate variability in resilience to depressive symptoms in the aftermath of a massive earthquake that struck Taiwan in 1999. We analyze data on 1160 older individuals from a national, longitudinal survey with interviews before and after the earthquake. This survey contains extensive information on physical and cognitive function, depressive symptoms, socio-demographic characteristics and earthquake-related exposure and experiences. We estimate regression models to identify risk factors associated with the presence of depressive symptoms after the disaster, controlling for health status and the presence of depressive symptoms beforehand. We pay special attention to how socio-demographic factors moderate the psychological impact of the earthquake. Results indicate that persons of low socioeconomic status (SES), socially isolated individuals, and women reported higher levels of depressive symptoms than their respective counterparts, as did persons who experienced damage to their homes. The psychological effects of damage were strongest among those aged 54-70. The findings suggest that people who experience damage to their home during a disaster are at risk of experiencing depressive symptoms, with the elderly being more resilient than the near-elderly.     

Digital radiography of crush thoracic trauma in the Sichuan earthquake

AIM:To investigate the features of crush thoracic trauma in Sichuan earthquake victims using chest digital radiography(CDR).METHODS:We retrospectively reviewed 772 CDR of 417 females and 355 males who had suffered crush thoracic trauma in the Sichuan earthquake.Patient age ranged from 0.5 to 103 years.CDR was performed between May 12,2008 and June 7,2008.We looked for injury to the thoracic cage,pulmonary parenchyma and the pleura.obtained in 349 patients,the remaining 423 patients underwent only AP CDR.Thoracic cage fractures,pulmonary contusion and pleural injuries were noted in 331(42.9%;95% CI:39.4%-46.4%),67 and 135 patients,respectively.Of the 256 patients with rib fractures,the mean number of fractured ribs per patient was 3.Rib fractures were mostly distributed from the 3rd through to the 8th ribs and the vast majority involved posterior and lateral locations along the rib.Rib fractures had a significant positive association with non-rib thoracic fractures,pulmonary contusion and pleural injuries(P < 0.001).The number of rib fractures and pulmonary contusions were significant factors associated with patient death.CONCLUSION:Earthquake-related crush thoracic trauma has the potential for multiple fractures.The high number of fractured ribs and pulmonary contusions were significant factors which needed appropriate medical treatment.     

165名汶川地震伤员心理健康调查和心理护理效果

目的探讨地震灾区伤员的心理健康状况及心理护理效果。方法采用心理健康自评问卷(PHSQ)对165名来深圳住院治疗的灾区伤员进行问卷调查,并实施心理社会支持、健康教育、放松训练等护理措施。结果深圳的灾区伤员入院时PH-SQ高于8分的59人,需重点心理干预的占35.8%,其中最常见的心理问题是紧张或担忧(91.5%),其次是容易疲劳(76.3%)和感觉不快乐(74.6%),有自杀倾向(17.0%),男女心理问题的严重程度差异无显著性(P0.05)。1个月后PHSQ复测,高于8分的5人,与干预前比较有统计学意义(χ2=56.52,P0.05),PHSQ评分与干预前比较有统计学意义(t=11.46,P0.05)。结论地震灾害给伤员造成的心理健康问题较为突出,加强心理护理对伤员非常必要。     

汶川地震经历者睡眠状况及人格影响因素研究

目的了解地震幸存者睡眠状况及其与人格特征的关系,为今后相关的心理干预工作提供依据。方法使用自编一般情况调查表,阿森斯失眠量表(AIS)以及艾森克个性问卷神经质量表(EPQ-N),调查了250名地震幸存者。结果灾民AIS评分为7.87±6.05,失眠发生率为51%;情绪不稳型灾民AIS评分高于中间型及情绪稳定型灾民(分别为9.7±6.74,7.8±5.64及6.5±5.80);控制年龄、性别及亲人遇难影响因素后,神经质与失眠评分成正相关(r=0.268)。结论灾后地震幸存者失眠症状受其神经质特征的影响。     

某部5·12抗震救灾战士的心理健康状况及应付方式调查

目的:了解参与5·12地震救援战士的心理健康水平及应付方式特点。方法:选取310名参与抗震救灾的战士,应用症状自评量表及应付方式问卷进行评估。结果:参与抗震救灾战士的躯体化及焦虑因子分与中国成人常模存在显著性差异,不成熟应付方式与心理健康各因子存在相关。结论:加强官兵的应对技巧的训练,对提升军队人员参与突发性事件的能力具有重要意义。