The prevalence of airway problems in children with Down's syndrome

AimAirway disorders are common in children with Down's syndrome. We report the findings on airway endoscopy in a birth cohort of children from a well-defined geographical area, in order to estimate true population prevalence of airway problems in children with Down's syndrome.MethodRetrospective case note review over a 20-year period between 1993 and 2013 for all children in Greater Glasgow born with Down's syndrome, identified through the hearing surveillance programme. All children undergoing airway endoscopy under general anaesthesia for investigation of potential airway symptoms (stridor, hoarseness, recurrent croup and difficulties with intubation/extubation) were studied in detail to identify the number with laryngeal, tracheal or bronchial pathology.ResultsAll 239 children (F:M = 1.15:1) were reviewed. Of these, 39 (16.3%) underwent microlaryngoscopy-bronchoscopy under general anaesthesia for airway symptoms. The main presentations were stridor (9), extubation problems (12) and exacerbations of recurrent croup (7). Thirty-three were found to have at least one airway diagnosis (13.8%) including trachaeobronchomalacia (17), laryngeal cleft (2), laryngomalacia (2), tracheal compression (2), vocal cord paralysis (1), acquired tracheal stenosis (2) and symptomatic subglottic stenosis (14).ConclusionLaryngo-tracheo-bronchial pathology is much more common in children with Down's syndrome than in the general population, particularly subglottic stenosis and tracheal problems.     

紧急剖宫产术后产妇心理健康问题的研究进展

紧急剖宫产术是保障急危重症孕产妇及胎儿生命安全的必要手段。近年来对经历紧急剖宫产术后产妇的心理健康问题引起关注。该文从紧急剖宫产术概述、行紧急剖宫产术后产妇的心理健康问题、相关影响因素及对策4个方面进行综述,旨在帮助临床工作者了解行紧急剖宫产术后产妇的心理健康状况,为制订预防及干预措施提供参考。     

超声住院医师规范化培训中临床专业学员的带教问题与应对策略分析

临床专业规培学员与超声专业规培学员的学历背景、知识构架、学习目的、规培计划均有不同,二者的超声科带教模式及方法应有所区别。本文基于本教研室规培带教经验,分析目前临床专业规培学员超声科带教存在的问题,提出“建立针对临床规培学员超声培训的精品课堂”、“建立针对临床规培学员超声培训的微课-翻转课堂”、“将基于PACS系统的临床典型病例图库应用于临床规培学员教学”、“建立临床典型病例图库/超声仿真病人模拟教学系统”四方面建议,以期完善临床专业规培学员培养模式,为学员提供全面、重点、有针对性的超声知识技能培训,提高规培效率和质量。     

Alcohol-related problems, drug use, and male intimate partner violence severity among US couples

BACKGROUND: Particularly for women, level of intimate partner violence (IPV) severity is associated with risk of injury. Previous research suggests that male drinking problems and drug use are key risk factors. Few studies, however, have examined the associations between male and female alcohol problems and drug use and risk of moderate and severe male IPV in general household population samples. METHODS: A multiethnic sample of 1615 married and cohabiting couples was obtained from the 1995 National Study of Couples, a cross-sectional study on alcohol and IPV. We assessed the contribution of past year male and female alcohol-related problems (i.e., drinking consequences and alcohol-dependence symptoms) and illicit drug use to the risk of moderate and severe male IPV. A series of generalized multinomial logit models, with adjustment for sociodemographic and psychosocial covariates, was constructed to assess these associations. RESULTS: Female and male alcohol-related problems and female drug use, were associated with increased risk of moderate and severe male IPV. Contrary to our expectation, male drug use was not associated with elevated risk for either type of male IPV. Compared with couples residing in low-unemployment neighborhoods, couples residing in high-unemployment neighborhoods were at greater risk for severe, but not moderate, male IPV. CONCLUSIONS: Alcohol-related problems among men and women and drug use among women, appear to be important correlates of male IPV severity among couples in the general population. These findings can aid in IPV screening efforts, the formulation of prevention strategies, and help inform batterer and victim treatment programs.     

Ethnic disparities in clinical severity and services for alcohol problems: results from the National Alcohol Survey

BACKGROUND: This study reports lifetime estimates of the extent of unmet need for alcohol services across the 3 largest ethnic groups in America, and examines factors that may contribute to ethnic differences in service use. Prior studies report mixed findings as to the existence of ethnic disparities in alcohol services, with some suggesting that minorities are over-represented in treatment settings. METHODS: Drawing on the most recent National Alcohol Surveys, we compare rates and factors associated with the lifetime service use for alcohol problems among Whites, Blacks, and Hispanics who meet lifetime criteria for alcohol abuse or dependence. RESULTS: While bivariate analyses revealed few ethnic differences in service use, there were significant differences by ethnicity in multivariate models that included alcohol problem severity and its interactions with ethnicity. At higher levels of problem severity, both Hispanics and Blacks were less likely to have utilized services than comparable Whites. Hispanics, on the whole, reported higher-severity alcohol problems than Whites. Yet, they were less likely to have received specialty treatment and multiple types of alcohol services, and were more likely to cite economic and logistical barriers as reasons for not obtaining care. CONCLUSIONS: Future efforts to study ethnic disparities in alcohol services should utilize analytic approaches that address potential confounding between ethnicity and other factors in service use, such as alcohol problem severity. Our findings suggest that Hispanics and Blacks with higher-severity alcohol problems may utilize services at lower rates than comparable Whites, and that, particularly for Hispanics, this may in part be attributable to financial and logistical barriers to care.     

体外受精与胚胎移植孕妇妊娠早期心理问题及干预策略

体外受精与胚胎移植(以下简称IVF一Er)便得许多因输卵 管阻塞及其他原因用传统方法治疗无法受孕的妇女获得了妊娠 机会〔’，2j。在临床工作中，我们发现IvF一盯孕妇比普通孕妇有 较多的心理和行为问题，但对IVI，一Er孕妇妊娠早期的心理问 题、不良行为方式的调查和干预少有研     

Some current problems in teaching graduate pathology

Pathology is a basic and clinical branch of learning, and should never sever its close relations with the departments of autopsy and surgical pathology of the university hospitals. The teaching of general anatomical pathology by lectures, covering cell pathology, inflammation, and neoplastic growth, can be successful, provided many illustrations are shown and microscopical demonstrations are provided. Special pathology needs some integration with clinical teaching, which should always maintain the independence of the pathologist. The most useful teaching is by clinical-pathological conferences. The department of surgical pathology should provide another basis for teaching in special pathology. One should avoid the creation of separate departments of pathology in gynecology, neurology, dermatology, etc., which may lead to a splitting of special pathology into separate, non-communicating sections. The pathologist must have a vast, albeit sometimes superficial, knowledge of all pathology, and should not be considered as a specialist.     

老年病的特点与预防

老年病是指老年期所罹患的疾病或多发的疾病。老年病的特点可概括为10个"多",即多数老年人患有慢性非传染性疾病(慢性病),多种因素可触发老年病的发生,多数老年病的症状和体征不典型;老年病多数为一体多病,同时伴有多脏器衰竭或多系统功能障碍,有多种老年综合征的表现和多种老年问题的出现;老年病常常存在多重用药和药物副作用的问题,需要多专业医师参与诊治,需要多学科团队参与康复及其护理。如要预防老年病的发生,首先个体要用终身的努力进行自身健康工程的建设,其次要适时进行疾病风险预测,有计划治未病、有信心治已病、有恒心求康复。     

Ecological Associations of Alcohol Outlets With Underage and Young Adult Injuries

Objective: This paper argues that associations between rates of 3 specific problems related to alcohol (i.e., accidents, traffic crashes, and assaults) should be differentially related to densities of alcohol outlets among underage youth and young adults based upon age‐related patterns of alcohol outlet use. Methods: Zip code‐level population models assessed local and distal effects of alcohol outlets upon rates of hospital discharges for these outcomes. Results: Densities of off‐premise alcohol outlets were significantly related to injuries from accidents, assaults, and traffic crashes for both underage youth and young adults. Densities of bars were associated with more assaults and densities of restaurants were associated with more traffic crash injuries for young adults. Conclusions: The distribution of alcohol‐related injuries relative to alcohol outlets reflect patterns of alcohol outlet use.