跌倒风险管理及相关干预措施在老年人群中的作用价值

目的研究跌倒风险管理及相关干预措施在老年人群中的作用价值。方法回顾性分析从2014年1月至2016年1月该院收治的50例老年患者作为对照组,予以常规娱乐健身活动。另取2016年2月至2018年2月,该院收治的50例老年患者作为管理组,实施常规娱乐健身活动联合跌倒风险管理。分别比较干预前后两组跌倒风险情况以及护理质量、满意度、生活质量情况。结果干预后管理组Tinetti步态和平衡测试以及MFES评分均高于对照组(均P<0.05)。管理组护理质量、护理记录书写、护理知识和技能评分高于对照组(均P<0.05)。管理组满意度高于对照组(P<0.05)。管理组各项生活质量评分均高于对照组(均P<0.05)。结论跌倒风险管理及相关干预措施可显著提高老年人群的防跌倒能力,提高临床护理质量,改善患者的满意度以及生活质量。值得临床推广应用。     

Validity and reliability of the modified John Hopkins Fall Risk Assessment Tool for elderly patients in home health care

This prospective cohort study was conducted to evaluate the validity and reliability of the modified Johns Hopkins Fall Risk Assessment Tool (mJH-FRAT) among elderly patients receiving home health care visits. Out of 107 patients, 33 (30.8%) had one or more falls and seven (6.5%) experienced falls with injury. Receiver Operating Characteristics of the tool in predicting falls showed an Area Under Curve (AUC) of 0.66 (p = 0.011) with sensitivity and specificity of 72.5% and 52.2% at the cutoff score of 14. For predicting falls with injury, the AUC was 0.82 (p = 0.016) with sensitivity and specificity of 100% and 65.9% at the cutoff score of 17. Inter-rater reliability of the tool was 85.7% agreement with Cohen's kappa of 0.714 (p < 0.001). The mJH-FRAT is a simple and easy-to-use multi-factor fall risk assessment tool with promising sensitivity, specificity and inter-rater reliability for prospectively identifying patients at risk of falls with injury among community-dwelling elderly populations.     

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No abstract available for this article.     

上海市长宁区新泾镇肢体残疾人伤害特征及其服务需求研究

目的 探讨肢体残疾人群的伤害特征及服务需求。方法 采用自行编制的《残疾人伤害流行病学调查表》,对上海市长宁区新泾镇持有残疾证的肢体残疾人进行横断面调查。结果 共调查1 204人,有效问卷1 199份,应答率99.58%。调查结果显示,肢体残疾人的伤害发生率为31.61%,不同伤害类型中以跌倒发生率最高（19.43%）,其中80岁及以上肢体残疾人群的发生率最高,达到34.07%。下肢残疾的调查对象较非下肢残疾的人群伤害发生率更高（2=6.342,P=0.012）,且跌倒发生率更高（2=8.839,P=0.003）。发生伤害次数越多的人更需要加装扶手、拐杖安全性评估、检查视力并配镜以及居家安全环境评估等伤害防制服务。结论 肢体残疾人群伤害发生率较高,以跌倒伤为主,且对伤害防制有较大需求。     

Drug Treatment,Postural Control,and Falls: An Observational Cohort Study of 504 Patients With Acute Stroke,the Fall Study of Gothenburg

ObjectiveTo identify whether, and to what extent, treatment with cardiovascular drugs and neurotropic drugs are associated with postural control and falls in patients with acute stroke.DesignObservational cohort study.SettingA stroke unit at a university hospital.ParticipantsA consecutive sample of patients (N=504) with acute stroke.InterventionsNot applicable.Main Outcome MeasuresPostural control was assessed using the modified version of the Postural Assessment Scale for Stroke Patients. Data including baseline characteristics, all drug treatments, and falls were derived from medical records. Univariable and multivariable logistic regression and Cox proportional hazards models were used to analyze the association of drug treatment and baseline characteristics with postural control and with falls.ResultsIn the multivariable logistic regression analysis, factors significantly associated with impaired postural control were treatment with neurotropic drugs (eg, opioids, sedatives, hypnotics, antidepressants) with an odds ratio (OR) of 1.73 (95% confidence interval [CI], 1.01-2.97, P=.046); treatment with opioids (OR 9.23, 95% CI, 1.58-54.00, P=0.014); age (OR 1.09, 95% CI, 1.07-1.12, P<.0001), stroke severity, which had a high National Institutes of Health Stroke Scale-score (OR 1.29, 95% CI, 1.15-1.45, P<.0001), and sedentary life style (OR 4.32, 95% CI, 1.32-14.17, P=.016). No association was found between neurotropic drugs or cardiovascular drugs and falls.ConclusionsTreatment with neurotropic drugs, particularly opioids, in the acute phase after stroke, is associated with impaired postural control. Since impaired postural control is the major cause of falls in patients with acute stroke, these results suggest opioids should be used with caution in these patients.     

住院精神疾病患者跌倒的原因分析及应急处理

目的:分析精神科患者跌倒的发生原因,提出预防和应急处理策略。方法:对精神科87例患者发生的89例次跌倒事件进行回顾性分析。结果:精神科患者发生跌倒的主要风险因素是抗精神病药物不良反应,其次是躯体因素、环境因素等;发生时段主要是晚上及午间。结论:精神病患者发生跌倒较多,必须针对其风险因素进行动态风险评估,落实针对性干预措施,做好应急处理,以降低住院精神病患者跌倒的发生率和死亡率。     

丹参多酚酸盐治疗肾病综合征临床疗效观察

目的:观察丹参多酚酸盐对肾病综合征患者的血流变学、血脂、凝血及抗氧化效果。方法:将67例诊断原发性肾病综合征患者随机分为治疗组和对照组。对照组采用常规治疗,治疗组在常规治疗的基础上,加用丹参多酚酸盐治疗,疗程14天。分别观察治疗前后血脂和凝血纤溶、血液流变学指标变化及丙二醛(Malondialdehyde,MDA)、超氧化物歧化酶(Superoxide Dismutase,SOD)等情况。结果:治疗结束后两组患者各项指标与治疗前比较,差异有统计学意义。结论:丹参多酚酸盐能显著改善肾病综合征患者的高脂及高凝状态,防止血栓,并能改善肾综患者的抗氧化应激能力,提高肾病综合征的疗效。     

Perception of invisible masked objects in early infancy

Recurrent loops in the visual cortex play a critical role in visual perception, which is likely not mediated by purely feed-forward pathways. However, the development of recurrent loops is poorly understood. The role of recurrent processing has been studied using visual backward masking, a perceptual phenomenon in which a visual stimulus is rendered invisible by a following mask, possibly because of the disruption of recurrent processing. Anatomical studies have reported that recurrent pathways are immature in early infancy. This raises the possibility that younger infants process visual information mainly in a feed-forward manner, and thus, they might be able to perceive visual stimuli that adults cannot see because of backward masking. Here, we show that infants under 7 mo of age are immune to visual backward masking and that masked stimuli remain visible to younger infants while older infants cannot perceive them. These results suggest that recurrent processing is immature in infants under 7 mo and that they are able to perceive objects even without recurrent processing. Our findings indicate that the algorithm for visual perception drastically changes in the second half of the first year of life.

The standard view of cortical visual processing is that visual information is hierarchically processed along feed-forward pathways, with more complex representations created serially by relaying information from lower to higher visual areas (1). However, recurrent processing, which is mediated by corticocortical feedback and intra-areal horizontal pathways (2, 3), also contributes to fundamental visual functions (4–6). Although the role of recurrent processing is not yet well understood, many studies have proposed that visual perception is not mediated by a purely feed-forward system but rather by a system incorporating recurrent loops (7–12).Anatomical studies of the infant brain have reported that feedback and horizontal connections develop later than feed-forward connections (13–15). Anatomical data from postmortem brains of human infants have shown that the adult-like laminar termination pattern of forward connections between V1 and V2 emerges by 4 mo of age (14), but the feedback (14) and long-range horizontal (15) connections are immature at that age. These findings imply that until at least around the second half of the first year of life, recurrent processing is immature, and visual information may be processed mainly in a feed-forward manner. However, this possibility has so far not been examined. Although neuroimaging studies of human infants have revealed functional and structural brain development (16, 17), it is difficult to determine whether the observed activities or structures are derived from feed-forward or recurrent pathways using imaging techniques in human infant studies. Thus, in the present study, we examined recurrent processing in early infancy using visual backward masking.Visual backward masking is a perceptual phenomenon in which a stimulus is rendered invisible by a mask presented after the target stimulus. We used object substitution masking (OSM) (18), a type of backward masking which is thought to arise from a disruption of recurrent processing (18–23). In OSM, target perception is impaired when a target is briefly presented with a sparse mask that surrounds the target, and the mask remains on screen after the target disappears, while target perception remains intact when the target and the mask disappear simultaneously. OSM has been proposed to occur because the temporally trailing mask disrupts the recurrent signals related to the target (18). Although some studies have questioned the recurrent explanation (24, 25), evidence from psychophysical studies suggests that OSM can be plausibly explained by the recurrent theory rather than the feed-forward theory (18, 20, 22, 23). Indeed, a neuroimaging study has shown that recurrent activities in the early visual cortex are modulated when target perception is impaired by OSM (19).Although an infant study has suggested that OSM occurs in 6-mo-old infants (26), its mechanism and development remain poorly understood. If visual processing is performed without recurrent processing in early infancy, as suggested by the anatomical studies (14, 15), OSM may not occur in younger infants. In other words, younger infants may be able to perceive a masked stimulus that older infants cannot.