中青年血清胆红素轻度增高者胆红素与血糖、血脂及血压的关系

目的观察中青年血清胆红素轻度增高者血糖、血脂及血压水平。方法中青年男女556人,高胆红素组296人,对照组260人。测定两组研究对象血清总胆红素、直接胆红素、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及血压并对数据进行分析。结果男性胆红素高于女性,差异有统计学意义（P〈0．01）。高胆红素组空腹血糖低于对照组,男性二组差异有统计学意义（P〈0．01）,女性二组差异无统计学意义（P〉0．05）。高胆红素组收缩压低于对照组,但差异无统计学意义（P〉0．05）,舒张压高于对照组,且差异有统计学意义（P〈0．05）。高胆红素组男性总胆固醇、甘油三酯高于对照组,高及低密度脂蛋白胆固醇低于对照组,其中高密度脂蛋白胆固醇与对照组差异有统计学意义（P〈0．05）。高胆红素组女性总胆固醇、甘油三酯、高与低密度脂蛋白胆固醇均高于对照组,但差异无统计学意义（P〉0．05）。空腹血糖与男性总胆红素、直及间接胆红素和女性直接胆红素负相关。舒张压与男性总胆红素及直接胆红素和女性总胆红素及间接胆红素正相关;收缩压与男性胆红素不相关,与女性直接胆红素负相关。男性低密度脂蛋白胆固醇、女性总胆固醇、腰围与直接胆红素负相关。男性腰围与总胆红素、间接胆红素正相关。结论胆红素不同形式对空腹血糖均有影响,中青年阶段空腹血糖随着胆红素的增高而降低。胆红素对中青年男女舒张压的维持有一定作用,对收缩压的影响有性别差异,女性胆红素较高者,舒张压较低。中青年男女在高胆红素水平时有较少的心脑血管危险因素。     

贵阳社区老年人对老年痴呆症知晓现况调查及影响因素分析

目的：调查贵阳社区60岁以上老年人对老年痴呆症的知晓情况及影响因素。方法用“PPS”随机抽样方法获取调查对象,采用“问卷调查表”逐一面对面调查,通过秩和检验比较不同因素对老年痴呆症的主观认知、客观认知及对出现老年痴呆症症状后就医的态度等方面构成比的差异。结果主观认知方面：高龄、受教育水平低、有宗教信仰者及少数民族对老年痴呆症的知晓度低,不同性别对老年痴呆症的认知无统计学差异;客观认知方面：不同性别、年龄组、文化程度、有无宗教信仰及不同民族在老年痴呆症的客观认知上均无统计学差异;在就医的态度方面上述因素均无影响;在治疗的依从性方面,少数民族对治疗的依从性差,其他均无统计学差异。结论贵阳社区老年人对老年痴呆症的认知情况较差,需加强老年痴呆症科普知识的宣教,提高社区老年人对老年痴呆症的认识,便于更好地开展防治工作。     

45例老年人十二指肠乳头旁憩室合并胆总管结石的内镜治疗

目的探讨内镜治疗老年人十二指肠乳头旁憩室合并胆总管结石的疗效。方法回顾性分析2006年6月—2011年5月45例老年人十二指肠乳头旁憩室合并胆总管结石的内镜治疗临床资料。对44例老年患者行内镜下十二指肠乳头括约肌切开术(EST)和(或)气囊扩张术,并行网篮取石或机械碎石后网篮取石。结果所有病例插管造影成功均显示胆总管结石,结石直径在0.6～3.0 cm。其中单发结石27例,2枚结石12例,三枚以上6例。网篮直接取石34例,碎石后取石7例,3例胆总管放置塑料支架,1例因乳头太小无法行切开同时结石较大转手术治疗。一次取尽结石35例,放置鼻胆管引流后二次取石6例。3例术中乳头肌切开渗血,给予电凝、局部喷洒去甲肾上腺素或气囊压迫出血停止,1例24 h后乳头切口涌血,给予钛铗止血。2例出现术后轻症胰腺炎,5例出现一过性高淀粉酶血症,给予相应处理痊愈。对其中36例随访6～12个月未见结石复发,3例放置塑料支架患者半年后结石明显变小,再次内镜治疗。结论老年十二指肠乳头旁憩室合并胆总管结石的内镜治疗是相对安全有效,内镜治疗应根据憩室位置和结石大小选择合适的乳头切开长度,结合气囊扩张、碎石等方法,可避免并发症发生。     

龙柏社区高龄老人居家护理服务模式探讨

目的：分析龙柏社区高龄老人居家医疗护理服务模式,为更好开展社区居家医疗护理服务提供参考。方法：收集2014年12月1日—2015年11月30日龙柏社区所有申请居家医疗护理的高龄老人215名,从服务流程、服务内容、服务频次、服务转归进行调查分析。结果：215名老人中,66.1%（142/215）的社区老人护理评估需求为重度,25.1%（54/215）为中度;接受基础护理服务的老人最多,其次为临床护理服务;30.3%重度护理需求的老人和48.1%中度护理需求的老人分别享受了政策规定的每周5次和每周2次的居家医疗护理服务;61.8%的高龄老人继续接受居家医疗护理,8.1%的高龄老人因住院或暂住子女家而暂停服务,30.1%的高龄老人因死亡、费用高、不能满足服务需求、搬家或入住养老机构而终止服务。结论：高龄老人居家医疗护理服务应简化申请和评估流程,扩大服务对象范围,完善保险制度,提高服务人员专业技术水平,以更好的满足高龄老人的居家护理需求。     

白三烯拮抗剂孟鲁斯特钠与舒利迭联合治疗在老年哮喘中的应用效果

目的探讨白三烯拮抗剂孟鲁斯特钠与舒利迭联合治疗在老年哮喘患者中的临床效果。方法选择本院102例支气管哮喘老年患者,随机分为观察组和对照组。两组均给予对照组治疗,对照组给予舒利迭,观察组给予舒利迭和孟鲁司特钠。观察两组患者治疗前后肺功能改变情况。结果观察组治疗后最大中期呼气流速、第1秒用力呼气量和最大呼气流速峰值分别与对照组治疗后比较,差异有统计学意义（P〈0.05）;观察组总有效率为96.1%,对照组总有效率为80.3%。观察组总有效率高于对照组,差异有统计学意义（P〈0.05）。结论孟鲁斯特钠与舒利迭联合治疗能够改善老年哮喘患者肺功能,治疗效果显著。     

Malnutrition in Older Adults—Effect on Falls and Fractures: A Narrative Review

Malnutrition in older adults impacts health status, increased mortality, and morbidity. Malnutrition may increase the development of geriatric syndromes and contribute to a higher prevalence of falls and osteoporotic fractures that lead to loss of independence and an increased rate of institutionalization. The role of malnutrition in the pathogenesis of other geriatric syndromes seems to be well established. However, the data concerning nutritional interventions are confounding. Moreover, long-term undernutrition seems to be one of the factors that strongly influences the efficacy of interventions. This review outlines the current literature on this topic, and aims to guide physicians to make proper decisions to prevent the vicious cycle of falls, fractures, and their negative outcomes in patients with malnutrition.     

循证护理在2型老年糖尿病患者护理中的应用及思考

目的:探讨循证护理在护理中的应用方法。方法:根据循证护理的指导思想及实施原则,指导2型老年糖尿病患者的护理工作并观察其效果。结果:本组病例在观察期间维持了良好的健康状态,未出现严重的合并症,患者具有良好的依从性。结论:循证护理应与整体护理相结合,在我国,循证护理尚需进一步的发展和完善。     

Neuromuscular electrical stimulation in the intensive care unit prevents muscle atrophy in critically ill older patients: A retrospective cohort study

Critically ill patients in the intensive care unit (ICU) develop muscle atrophy and decreased physical function. Though neuromuscular electrical stimulation (NMES) therapy has been shown to be effective in preventing this, but its effect on older patients is unknown.To examine the course of critically ill older patients treated with NMES in the ICU and to define the impact of its use.A retrospective cohort study was conducted using older ICU patients (≥65 years) categorized into a control group (n = 20) and an NMES group (n = 22). For subgroup analysis, each group was further classified into pre-old age (65–74 years) and old age (≥75 years).The control group showed significant decrease in muscle thickness during ICU and hospital stay. The NMES group showed lower reduction in muscle thickness and showed decrease in muscle echo intensity during hospital stay, compared to the control group. NMES inhibited decrease in muscle thickness in the pre-old age group versus the old age group. The decreasing effect of NMES on echo intensity during hospital stay manifested only in the pre-old age group. We did not find much difference in physical functioning between the NMES and control groups.Lower limb muscle atrophy reduces in critically ill older patients (≥65 years) with NMES and is pronounced in patients aged < 75 years. The impact of NMES on the physical functioning of older patients in ICU needs to be further investigated.     

An ethnobotanical study of medicinal plants used by the Nandi people in Kenya

ETHNOPHARMACOLOGICAL RELEVANCE: The study of local knowledge about natural resources is becoming increasingly important in defining strategies and actions for conservation or recuperation of residual forests. AIMS OF THE STUDY: This study therefore sought to collect information from local populations concerning the use of Nandi Forest medicinal plants; verify the sources of medicinal plants used and determine the relative importance of the species surveyed. MATERIALS AND METHODS: Data was obtained using semi-structured forms to record the interviewee's personal information and topics related to the medicinal use of specific plants. A total of 40 medicinal plants used locally for the treatment and/or control of human ailments were collected through interviews conducted with selected traditional doctors and professional healers. RESULTS: This study demonstrated that local people tend to agree with each other in terms of the plants use and that leaf material form the major component of plant parts exploited. The other harvested materials consist of stem bark, the roots and the whole plant, though at a lower intensity for making liquid concoctions from different plants. Majority of the remedies were prepared from a single species. In most cases, the mode of administration was oral. In the forest, some of the plants collected were scarce. This scarcity was attributed to indiscriminate logging, overexploitation, poor harvesting methods and current agricultural trends. CONCLUSION: Conservation procedures and creation of awareness were identified as the main remedies to the current situation.     

Obstetric outcomes in nulliparous women aged 35 and over with singleton pregnancies conceived by in vitro fertilization

Objective To investigate obstetric outcomes in singleton pregnancies conceived by in vitro fertilization (IVF) to nulliparous women older than 35 compared to those of their younger counterparts. Methods Nulliparous women 35 years and older at delivery conceived by IVF (n = 89) were compared with nulliparous women 34 years and younger at delivery conceived by IVF (n = 48). Data included antenatal data, gestational age at delivery, maternal and neonatal complications and mode of delivery. Results The incidence of pregnancy-induced hypertension in the younger group was significantly higher than that in the elderly group (13 vs. 3.4%, P = 0.043). There were no measurable differences in other obstetric outcomes such as placental abnormality, premature delivery or neonatal asphyxia between the two groups. Conclusion The current results suggest that obstetric complications in pregnancies conceived IVF are attributed to mechanisms other than those depend on advanced maternal age.