精神分裂症患者家属健康教育需求调查分析

目的：探讨精神分裂症患者家属健康教育的需求程度。方法：采用自行设计问卷对80例精神分裂症患者家属进行调查,分为入院时健康教育、住院期间健康教育及出院时健康教育需求程度调查。结果：95%以上患者家属强烈需要了解患者病情、精神疾病相关知识、复发指征及生活指导,对精神疾病的严重程度认识不足。结论：患者家属有强烈的健康教育需求,需要了解健康教育和心理疏导。     

Staff perceptions of residents across the long-term care landscape

AIMS: This paper reports a study to determine how facility-, resident-, family- and staff-level indicators are empirically associated with staff members' perceptions of residents in nursing homes (NHs), assisted living facilities (ASLs) and family care homes (FCHs). BACKGROUND: While various efforts have described the ramifications of staff-resident interactions in nursing homes (NHs), few studies identify the factors that potentially influence staff members' perceptions of residents in multiple long-term care settings. METHODS: The participants were 41 care staff located in five NHs, five ASLs, and 16 FCHs randomly selected in Kentucky, United States of America. Face-to-face and telephone interviews were conducted with care staff, residents in their care, family members of residents, and administrators of participating facilities. Telephone interviews measured staff perceptions of residents on two domains: cohesion (perceived feelings of closeness between staff and residents) and knowledge of residents' personal lives and care needs. RESULTS: Regression models found that staff who were married, reported more positive attitudes towards family members, and worked in smaller facilities reported greater staff-resident cohesion. In addition, staff who cared for a higher percentage of residents with learning difficulties indicated greater knowledge of residents. CONCLUSION: The findings emphasize the need to consider elements of staff-family relationships when considering staff perceptions of residents. They also imply that clinical interventions designed to enhance social relationships in NHs can be extended across the long-term care landscape to influence the staff-resident-family triad positively.     

2型糖尿病患者的NGT一级亲属代谢综合征组分与HbA1c有关

268例2型糖尿病(DM)患者糖耐量正常(NGT)的一级亲属,根据HbA1C水平分成3组,发现HbA1C较高水平(5.4%~5.8%)的2型DM患者NGT的一级亲属中,代谢综合征(MS)的组成成分有升高现象,提示该组人群可能易患MS。     

2型糖尿病患者一级亲属胰岛素抵抗与体重关系的研究

目的探讨2型糖尿病一级亲属胰岛素抵抗与体重的关系。方法2007年10月至2008年10月就诊于中国医科大学附属盛京医院的沈阳地区2型糖尿病患者,经知情同意后,选择其一级亲属(父母、同胞、子女)25例,根据75gOGTT试验分为正常糖耐量(FNGT)组、糖耐量减低(FIGT)组,另外选取性别、年龄与之相匹配,无糖尿病家族史的正常糖耐量12名为对照(NC)组,以正糖高胰岛素钳夹试验求得葡萄糖输注速率(GIR),比较3组间胰岛素敏感性的差异。结果FIGT组、FNGT组、NC组BMI依次为27.28±0.68、25.99±0.98和24.12±0.71,FIGT组明显高于NC组(P0.01),与FNGT组相比差异无统计学意义(P=0.11);FIGT组和FNGT组葡萄糖输注率分别为5.20±0.38和6.38±0.79,均明显低于NC组(9.83±0.86)(P0.01);葡萄糖输注率与BMI的相关系数为0.477(P0.01);多元逐步回归分析显示,BMI、糖尿病家族史均为影响胰岛素抵抗的显著因素(校正r2分别为0.39和0.21,P0.01)。结论2型糖尿病一级亲属不论血糖是否正常均存在胰岛素抵抗,此抵抗和家族史显著相关,独立于肥胖之外。     

Diabetes and impaired glucose regulation in first-degree relatives of patients with type 2 diabetes in isfahan, iran: prevalence and risk factors

OBJECTIVES: The aim of this study was to estimate the prevalence of diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) in first-degree relatives (FDR) of people with type 2 diabetes mellitus. METHODS: A cross-sectional study of FDR of type 2 diabetes patients was conducted between 2003 and 2005. A total of 2,368 FDR of type 2 diabetes outpatients aged 30-60 years (614 men and 1754 women) from Isfahan Endocrine and Metabolism Research Center (Iran) were examined. All subjects underwent a standard 75 g 2-h oral glucose tolerance test (OGTT). IGT, IFG and type 2 diabetes were diagnosed according to the criteria of the American Diabetes Association (ADA). The mean (SD) age of participants was 43.1 (6.9) years. RESULTS: The prevalence of type 2 diabetes, IGT and IFG were 10.3% (95% CI: 9.1-11.5), 19.5% (17.9-21.1) and 17.3% (15.8-18.8) respectively. The prevalence rates were significantly higher than those reported for a control population of the same age (type 2 diabetes, 6.0% (95% CI: 5.7-6.2) and IGT 9.6 (95% CI: 9.3-9.9)). IGT was more frequent among women (OR: 0.66; 95% CI: 0.51-0.87), whereas diabetes (OR: 1.31; 95% CI: 0.96-1.78) and IFG (OR: 1.41; 95% CI: 1.10-1.80) were higher in men. Multivariate analysis revealed that age and obesity or abdominal obesity were significantly associated with diabetes, IGT and IFG. CONCLUSIONS: FDR of people with type 2 diabetes in Iran are at higher risk of IGT and type 2 diabetes than the population at large. Risk increases with age and obesity. These findings may be useful for the identification of persons at risk of developing type 2 diabetes and strongly support the regular screening of FDR of type 2 diabetes patients.     

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。     

Risk and mechanism of dexamethasone-induced deterioration of glucose tolerance in non-diabetic first-degree relatives of NIDDM patients

Summary We tested the hypothesis that glucose intolerance develops in genetically prone subjects when exogenous insulin resistance is induced by dexamethasone (dex) and investigated whether the steroid-induced glucose intolerance is due to impairment of beta-cell function alone and/or insulin resistance. Oral glucose tolerance (OGTT) and intravenous glucose tolerance tests with minimal model analysis were performed before and following 5 days of dex treatment (4 mg/day) in 20 relatives of non-insulin-dependent diabetic (NIDDM) patients and in 20 matched control subjects (age: 29.6 ± 1.7 vs 29.6 ± 1.6 years, BMI: 25.1 ± 1.0 vs 25.1 ± 0.9 kg/m²). Before dex, glucose tolerance was similar in both groups (2-h plasma glucose concentration (PG): 5.5 ± 0.2 [range: 3.2–7.0] vs 5.5 ± 0.2 [3.7–7.4] mmol/l). Although insulin sensitivity (Si) was significantly lower in the relatives before dex, insulin sensitivity was reduced to a similar level during dex in both the relatives and control subjects (0.30 ± 0.04 vs 0.34 ± 0.04 10^–4 min^–1 per pmol/l, NS). During dex, the variation in the OGTT 2-h PG was greater in the relatives (8.5 ± 0.7 [3.9–17.0] vs 7.5 ± 0.3 [5.7–9.8] mmol/l, F-test p < 0.05) which, by inspection of the data, was caused by seven relatives with a higher PG than the maximal value seen in the control subjects (9.8 mmol/l). These “hyperglycaemic” relatives had diminished first phase insulin secretion (?1) both before and during dex compared with the “normal” relatives and the control subjects (pre-dex ?1: 12.6 ± 3.6 vs 26.4 ± 4.2 and 24.6 ± 3.6 (p < 0.05), post-dex ?1: 22.2 ± 6.6 vs 48.0 ± 7.2 and 46.2 ± 6.6 respectively (p < 0.05) pmol · l^–1· min^–1 per mg/dl). However, Si was similar in “hyperglycaemic” and “normal” relatives before dex (0.65 ± 0.10 vs 0.54 ± 0.10 10−4 · min^–1 per pmol/l) and suppressed similarly during dex (0.30 ± 0.07 vs 0.30 ± 0.06 10−4 · min^–1 per pmol/l). Multiple regression analysis confirmed the unique importance of low pre-dex beta-cell function to subsequent development of high 2-h post-dex OGTT plasma glucose levels (R ² = 0.56). In conclusion, exogenous induced insulin resistance by dex will induce impaired or diabetic glucose tolerance in those genetic relatives of NIDDM patients who have impaired beta-cell function (retrospectively) prior to dex exposure. These subjects are therefore unable to enhance their beta-cell response in order to match the dex-induced insulin resistant state. [Diabetologia (1997) 40: 1439–1448] Received: 20 January 1997 and in final revised form: 17 July 1997