慢性病儿童心理行为特征及影响因素探讨

【目的】探讨慢性病儿童的心理行为特点及相关因素。【方法】采用少儿艾森克个性问卷(Eysen-ckPersonalityQuestionnaire,EPQ)和Achenbach儿童行为筛查量表(AchenbachChildBehaviorChecklist,CBCL,),对研究儿童进行测试和比较,并收集患儿个人及父母健康状况等信息,进行多元逐步回归分析。【结果】除12~16岁组男童外,慢性病组中其他年龄组儿童CBCL总分和内向性行为得分均显著高于正常对照组;慢性病6~11岁组中男童在抑郁、交往不良、多动和攻击性因子得分和女童在抑郁、社交退缩、体诉、性问题和攻击性因子得分显著高于正常对照组(P<0.05);12~16岁女童组在焦虑强迫、体诉、抑郁退缩、不成熟和残忍因子得分显著高于对照组。多元线性回归分析后得出:影响慢性病儿童CBCL总分的因素由强到弱为年平均住院天数、父母心理状况、疾病稳定情况、父母亲健康状况以及患儿课外活动和体育活动影响程度。【结论】慢性病儿童有更多的心理行为问题,在治疗躯体疾病的同时,对慢性病息儿及家庭进行社会心理干预非常必要。     

深圳地区2011年流感样病例的病毒病原学调查

目的:了解深圳地区流感样病例的病毒病原学现况,为呼吸道传染病的诊断和预防控制提供病原学依据。方法:采用实时荧光定量PCR法,对269份咽拭子样本同时检测流感病毒、腺病毒、鼻病毒、副流感病毒、呼吸道合胞病毒、冠状病毒和人偏肺病毒共7种15个亚型常见呼吸道病毒。结果:2011年深圳流感样病例的病毒阳性检出率为50.2%(135/269),在检出的呼吸道病毒中鼻病毒检出最多,其次是流感病毒、冠状病毒和腺病毒。夏季和秋季都是鼻病毒占优势,分别为57.6%(19/33)和52.6%(20/38);冬季则以流感病毒为优势,占60.5%(23/38)。儿童中鼻病毒检出率最高,青少年和成人中流感病毒检出率最高。结论:鼻病毒、流感病毒、冠状病毒和腺病毒是深圳地区流感样病例的主要病原体,随着季节、月份的不同和年龄的不同而具有一定的流行规律。     

A predictive score for retinopathy of prematurity in very low birth weight preterm infants

Aims

This study describes the development of a score based on cumulative risk factors for the prediction of severe retinopathy of prematurity (ROP) comparing the performance of the score against the birth weight (BW) and gestational age (GA) in order to predict the onset of ROP.

Methods

A prospective cohort of preterm infants with BW⩽1500 g and/or GA⩽32 weeks was studied. The score was developed based on BW, GA, proportional weight gain from birth to the 6th week of life, use of oxygen in mechanical ventilation, and need for blood transfusions from birth to the 6th week of life. The score was established after linear regression, considering the impact of each variable on the occurrences of any stage and severe ROP. Receiver operating characteristic (ROC) curves were used to determine the best sensitivity and specificity values for the score. All variables were entered into an Excel spreadsheet (Microsoft) for practical use by ophthalmologists during screening sessions.

Results

The sample included 474 patients. The area under the ROC curve for the score was 0.77 and 0.88 to predict any stage and severe ROP, respectively. These values were significantly higher for the score than for BW (0.71) and GA (0.69) when measured separately.

Conclusions

ROPScore is an excellent index of neonatal risk factors for ROP, which is easy to record and more accurate than BW and GA to predict any stage ROP or severe ROP in preterm infants. The scoring system is simple enough to be routinely used by ophthalmologists during screening examination for detection of ROP.     

基于古代文献分析经典名方四逆汤的主治疾病

研究从文献入手,对古代四逆汤主治病证进行分析探讨,以便更好地继承古人学术思想,扩大四逆汤应用范围,为临床医疗服务。从古代方书、医案著作中选取记载有四逆汤(及加味方)主治的条目,进行统计与整理,同时选择少量近代"扶阳派"医家著作进行同样统计与整理,以作参考。方书中四逆汤(及加味方)所治疾病病症表现常见手足厥冷、腹泻、呕吐、腹痛、汗出;医案中四逆汤(及加味方)所治疾病病症表现常见腹泻、呕吐、恶心、腹痛、肢冷、烦躁、汗出。四逆汤适应治疗的疾病(与西医疾病相对应)大致可能有霍乱、心衰、休克、溃疡性结肠炎、急慢性肠炎、冠心病心绞痛、心梗等,该复方值得进一步研究与挖掘。     

Prevalence of serious mental illness among parents in the United States: results from the National Survey of Drug Use and Health, 2008–2014

PurposeThis brief research report presents findings from a US national household survey on the number and percentage of parents with mental illness.MethodsUsing combined annual data from the 2008–2014 National Survey on Drug Use and Health, parents were defined as having children in the household from birth to 18 years. Prediction models developed in an earlier clinical study using a National Survey on Drug Use and Health subsample were used to estimate serious mental illness (SMI).ResultsA total of 2.7 million parents (3.8%) had a SMI in the past year and 12.8 million parents (18.2%) had any mental illness in the past year. Mental illness was more common among mothers than fathers and least common among Asians compared with other races. SMI was less prevalent in parents who were aged 50 years and older compared with younger age groups.ConclusionsThe burden of mental illness in parents is high in the United States, especially among mothers. Physicians who treat parents should routinely screen for mental illness and discuss its implications for parenting.     

(Em)placing recovery: Sites of health and wellness for individuals with serious mental illness in supported housing

This study used photo-elicitation methodology to explore how the move from supervised to supported housing affects recovery and community connections for individuals living with serious mental illness (SMI) in four Canadian cities. Qualitative interviews conducted in 2015 revealed five themes: (1) the characteristics distinguishing home from housing; (2) the importance of amenities offered by supported housing; (3) the connections between accessibility, mobility, and wellbeing; (4) the role of certain places in facilitating aspects of recovery such as offering hope or facilitating social connectedness; and (5) the concrete and metaphorical impact of changing vantage points on identity (re)construction. Utilizing therapeutic landscapes as an analytical framework, and combining insights from the health geography, and mental health (MH) housing and recovery literatures, this study deepens current understanding of how everyday places—conceptualized as therapeutic landscapes—directly and indirectly support MH recovery for individuals with SMI. Implications for research on housing, and on the spatial aspects of recovery processes are discussed.     

Health and illness behavior and patient-practitioner relationships

Health is a product of culture and social structure. The routine organization and constraints of everyday settings shape our health. Socio-economic status is of major importance in determining exposure to disease risk and in shaping health and illness behavior responses. Lay explanations of illness affect illness appraisal, self-treatment, decisions to seek care and changes in daily regimen. Somatization of psychosocial stressors is a common concern in primary care systems throughout the world, and doctors are commonly frustrated by such patients. Somatizing patients are often enmeshed in environments of great psychosocial difficulty or are depressed, and many cultural and social factors affect how depression is expressed. Although depression has devastating disabling effects on patients, it is often neither recognized by doctors nor treated. But doctor-patient relationships are often the context for appropriate management of such problems, and how they are handled affect the future trajectory of illness and disability. Doctors' responses are conditioned by their attitudes, training, interviewing and psychosocial skills, and organizational and financial factors. Patient flow is an important intervening variable affecting the management of psychosocial difficulties and depression.     

Water quality,compliance, and health outcomes among utilities implementing Water Safety Plans in France and Spain

Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, seek to proactively identify potential risks to drinking water supplies and implement preventive barriers that improve safety. To evaluate the outcomes of WSP application in large drinking water systems in France and Spain, we undertook analysis of water quality and compliance indicators between 2003 and 2015, in conjunction with an observational retrospective cohort study of acute gastroenteritis incidence, before and after WSPs were implemented at five locations. Measured water quality indicators included bacteria (E. coli, fecal streptococci, total coliform, heterotrophic plate count), disinfectants (residual free and total chlorine), disinfection by-products (trihalomethanes, bromate), aluminum, pH, turbidity, and total organic carbon, comprising about 240 K manual samples and 1.2 M automated sensor readings. We used multiple, Poisson, or Tobit regression models to evaluate water quality before and after the WSP intervention. The compliance assessment analyzed exceedances of regulated, recommended, or operational water quality thresholds using chi-squared or Fisher’s exact tests. Poisson regression was used to examine acute gastroenteritis incidence rates in WSP-affected drinking water service areas relative to a comparison area. Implementation of a WSP generally resulted in unchanged or improved water quality, while compliance improved at most locations. Evidence for reduced acute gastroenteritis incidence following WSP implementation was found at only one of the three locations examined. Outcomes of WSPs should be expected to vary across large water utilities in developed nations, as the intervention itself is adapted to the needs of each location. The approach may translate to diverse water quality, compliance, and health outcomes.     

《中医护理学基础》教学心得

以教学目标和教材内容来组织理论和实践都很强的应用性学科<中医护理学基础>为例,探讨如何采用更好的教学方法与教学形式来调动学生学习兴趣,从而提高中医护理教学质量.     

情志疗法治疗癔症的现代心理学分析

癔症,又称歇斯底里症,是一类常见的心理疾病,多见于女性。其临床表现复杂多样,但这些症状没有可证实的器质性病变基础,并可因情志等因素而诱发、加重、减轻或消失。一般多由急性精神创伤性刺激引起,亦可由持久的难以解决的人际矛盾或内心痛苦引起。中医学虽无“癔症”病名,但根据其临床症状,可归属于脏躁、诈病、郁病、奔豚、梅核气、笑证等范畴。