注意缺陷多动障碍伴孤独症特征患儿行为和家庭环境研究

目的 探讨注意缺陷多动障碍（ADHD）伴孤独症特征（ATs）患儿社交行为和家庭环境特点。方法 收集2019年3月至2021年12月安徽省儿童医院儿童保健科就诊的106例ADHD患儿临床资料,根据社交反应量表（SRS）评分分为ADHD-ATs组（SRS评分≥60分）和对照组（SRS评分<60分）,各53例。比较两组SRS、中文版ADHD评定量表-父母版（SNAP-IV）、家庭环境量表中文版（FES-CV）评估结果。结果 ADHD-ATs组SRS总分、社交知觉、认知、沟通、动机和孤独症行为方式评分高于对照组（P<0.05）。ADHD-ATs组SNAP-IV总分、注意缺陷、对立违抗评分高于对照组（P<0.05）。ADHD-ATs组FES-CV亲密度和独立性评分低于对照组（P<0.05）。结论 ADHD-ATs患儿较一般ADHD患儿存在显著的社交困难,并且注意缺陷和对立违抗症状更突出,家庭环境中的亲密度和独立性较低。     

热环境下海军官兵职业倦怠与社会支持的关系:心理资本的中介效应

[摘要] 目的 了解热环境下海军官兵职业倦怠情况,探究社会支持对职业倦怠的影响,并分析心理资本在两者之间的中介效应。方法采用军人职业倦怠问卷、军人社会支持量表和积极心理资本量表进对海军588名官兵进行调查。结果 热环境下海军官兵的职业倦怠显著高于普通海军官兵,其中成就感低表现得最明显。社会支持、心理资本和职业倦怠存在显著相关,其中客观支持、支持利用度、韧性和希望四个因子能共同解释官兵职业倦怠35.10%的方差变异性;中介效应模型和Bootstrap检验结果显示,心理资本在社会支持和职业倦怠之间起到部分中介效应（X2/df=4.762,GFI=0.937,AGFI=0.904,NFI=0.953,RFI=0.939,IFI=0.962,TLI=0.951,CFI=0.962,RMSEA=0.080）。结论 热环境下海军官兵的心理资本在社会支持和职业倦怠中起部分中介作用。     

Dodging the bundle—Persistent healthcare-associated rhinovirus infection throughout the pandemic

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La télémédecine et les réseaux sociaux dans la gestion des ECMO à l’ère de COVID-19 : l’expérience Tunisienne

IntroductionIn Tunisia, as elsewhere in the world, severe forms of acute respiratory distress syndrome (ARDS) related to SARS-Covid19 have been observed. When the usual means of resuscitation were no longer sufficient, the implementation of the Extracorporeal membrane oxygenation or ECMO was needed.AimThe whole problem of the management of these patients in this pandemic period has been to manage the operation of the ECMO machine, usually reserved for expert and specialized centers in the field.MethodsThe cardio-vascular surgery department of La Rabta teaching hospital of Tunis has tried the experience of management of ECMO implanted in the different reanimations of Tunis, remotely, using telemedicine and social networks. Thus, a Facebook-Messenger discussion group was created and enabled the management of patients under ECMO via video conferencing in real time involving all stakeholders.ResultsA call was made whenever the physician needed it. The video provided an opportunity to discuss with surgeons and perfusionists in real time the complications or problems of these patients. Their clinical status was continuously shared on the focus group. Following the instructions of the expert surgeons and the exchanges made on the group, the reanimator could then intervene on this or that parameter.ConclusionSocial media have invaded everyone's daily lives and health professionals are not exception to this trend. The Covid-19 pandemic has only strengthened this digital alternative with the goal of efficiency and patient interest. While their use in a professional setting offers many advantages, it must nevertheless be done in compliance with the rules of ethics and bring real added value.     

Influence of co-existing social isolation and homebound status on medical care utilization and expenditure among older adults in Japan

ObjectiveTo examine whether co-existing social isolation and homebound status influence medical care utilization and expenditure in older adults.MethodsPostal surveys on social isolation and homebound status were performed on older adults aged ≥65 years residing in a Japanese suburban city. Information on medical care utilization and expenditure was obtained from insurance claims data. These outcomes were examined over a three-year period (December 2008 to November 2011) for all participants (Analysis I, n = 1386) and during the last year of life for mortality cases (Analysis II, n = 107). A two-part model was used to analyze the influence of social isolation and homebound status on medical care utilization (first model: logistic regression model) and its related expenditure (second model: generalized linear model).ResultsAlmost 12 % of participants were both socially isolated and homebound. Analysis I showed that these participants were significantly less likely to use outpatient and home medical care than participants with neither characteristic (odds ratio: 0.536, 95 % confidence interval: 0.303−0.948). However, Analysis II showed that participants with both characteristics had significantly higher daily outpatient and home medical expenditure in the year before death than participants with neither characteristic (risk ratio: 2.155, 95 % confidence interval: 1.338−3.470).DiscussionOlder adults who are both socially isolated and homebound are less likely to regularly utilize medical care, which may eventually lead to serious health problems that require more intensive treatment. Measures are needed to encourage the appropriate use of medical care in these individuals to effectively manage any existing conditions.