聂惠民教授治疗抑郁症的临证经验

抑郁症是一种以显著而持久的心境低落为主要特征的综合征,其发病率逐年增长,已成为"二十一世纪的流行病"。聂惠民教授是国家级名老中医,国家第二、三、四批名老中医学术继承人指导老师,临床上善于运用经方治疗疑难杂病。聂惠民教授的学术继承人对其治疗抑郁症的用药规律进行统计分析,结果提示聂老治疗抑郁症主要从心肝两脏入手,以解郁安神为基本治法,常以经方柴胡加龙骨牡蛎汤与酸枣仁汤合方加减治疗,药物多选用炒酸枣仁、柴胡、黄芩、生龙骨、生牡蛎等。     

美国退伍军人医疗系统的特点与启示

美国退伍军人医疗系统为全美退伍军人提供全面医疗保障,是美国目前最大的医疗服务系统。它通过构建一体化医疗服务网络,实施临床绩效测度以及合理吸纳外部医疗资源的方式,维持系统内的正常医疗运营并保障医疗质量。在医疗费用的控制上,实施差异化的病人自付费比例和按人头付费为基础的总额补偿办法,并对医疗项目实施管控。美国退伍军人医疗系统的制度设计理念和管理方法对我国军队和地方的医疗制度改革都具有借鉴意义。     

Prospective post-traumatic stress disorder symptom trajectories in active duty and separated military personnel

Post-traumatic stress disorder (PTSD) is a serious mental illness that affects current and former military service members at a disproportionately higher rate than the civilian population. Prior studies have shown that PTSD symptoms follow multiple trajectories in civilians and military personnel. The current study examines whether the trajectories of PTSD symptoms of veterans separated from the military are similar to continuously serving military personnel. The Millennium Cohort Study is a population-based study of military service members that commenced in 2001 with follow-up assessments occurring approximately every 3 years thereafter. PTSD symptoms were assessed at each time point using the PTSD Checklist. Latent growth mixture modeling was used to compare PTSD symptom trajectories between personnel who separated (veterans; n = 5292) and personnel who remained in military service (active duty; n = 16,788). Four distinct classes (resilient, delayed-onset, improving, and elevated-recovering) described PTSD symptoms trajectories in both veterans and active duty personnel. Trajectory shapes were qualitatively similar between active duty and veterans. However, within the resilient, improving, and elevated recovering classes, the shapes were statistically different. Although the low-symptom class was the most common in both groups (veterans: 82%; active duty: 87%), veterans were more likely to be classified in the other three classes (in all cases, p < 0.01). The shape of each trajectory was highly similar between the two groups despite differences in military and civilian life.     

细节管理在军队老干部健康体检工作中的应用

目的 探讨细节管理在军队老干部健康体检工作中的应用效果.方法 选取2014年3-8月参加体检的军队老干部160例作为对照组,2015年3-8月参加体检的军队老干部160例作为观察组,对照组体检常规进行通知、分组、检查、收集报告、复查、汇总;观察组在此基础上实行细节管理,如细化不同人员重点检查内容、对体检人员进行健康评估、细化体检流程、检查结果归纳汇总分类、异常结果提示告知、建立家属支持系统、定期复查、建立健康档案、跟踪随访等.结果 观察组参检率、对体检结果的知晓率、体检后复查率、对体检程序和医护人员的满意度高于对照组,差异有统计学意义(P<0.05),2组对服务人员满意度比较差异无统计学意义(P>0.05).结论 细节管理能够增强老干部服务机构医护管理队伍的建设,促进医护健康管理质量,提高军队老干部健康体检的效果.     

Muscle strength and history of heavy manual work among elderly trained women and randomly chosen sample population

Summary The association between a history of heavy work and muscle strength was studied among 51 physically active women aged 66–85 years trained in sports and 41 women aged 70–81 years selected randomly from the population register. Maximal isometric muscle strength of hand grip, arm flexion, leg extension and trunk flexion and extension were measured using specially constructed dynamometers. The capacity of the abdominal muscles was evaluated by means of a sit-up test. The study included an interview dealing with the subjects' histories of heavy manual employment. The mean histories of heavy work for the trained and untrained women were 24 and 36 years, respectively. The trained women showed significantly greater maximal isometric muscle strength and abdominal muscle capacity than the untrained women. Among the trained women there was no correlation between the amount of heavy work and muscle performance. Among the untrained women the amount of heavy work correlated positively with maximal isometric trunk extension strength. The results would suggest that among elderly women, whether physically active or not, a history of heavy work has no systematic association with muscle strength.