Identification of quality of life concerns of patients with obstructive sleep apnoea at the time of initiation of continuous positive airway pressure: A discourse analysis

Background: Obstructive sleep apnoea syndrome (OSAS) is a common condition with multiple symptoms dominated by daytime somnolence. Thus many worries and concerns of patients remain hidden. Treatment by nasal continuous positive airway pressure (CPAP) can be imposing for the individual. An analysis of the freely expressed concerns of such patients is required. Objective: To seek an in-depth analysis of how patients live with sleep apnoea by allowing them an open discourse and analysing the text of their statements. Design: A trained psychologist conducted semi-directive interviews with patients attending a pulmonary rehabilitation and convalescent unit around the themes of sleep, health and treatment. An analysis of content and of discourse was carried out by textual analysis and by propositional analysis of discourse (PAD) with the aid of dedicated computer programs (Tropes, Sphinx Lexica). Results: Thirty patients with severe sleep apnoea were interviewed of whom 15 were initiating treatment with CPAP. Patients spoke of abnormal fatigue (22 mentions) and somnolence (21 times). Many have problems with obesity (25 instances), snoring related problems (12). There were 30 mentions of depression with a relationship to alcohol and anti-depressives. Twenty six times the theme of nocturnal waking was raised. There were many instances of problems with CPAP (nasal mask and noise problems raised 21 times). Patients have problems with relationships and sex because of OSAS. Other concerns were loss of memory and fear of dying. Conclusion: In a non-directed conversation OSAS patients express concerns not revealed in the standard medical paradigm and such concerns should be addressed in assessing treatment or evaluating quality of life (QOL).     

Chinese diagnostic interview schedule. II. A validity study on estimation of lifetime prevalence

The validity of DIS-CM (Chinese modified version of Diagnostic Interview Schedule) was examined by analyzing lifetime prevalence of each age group, age at onset, and recency of illness. The magnitude of the discrepancy between the empirical and the estimated data was adopted as the criterion of the degree of deviation. Manic and depressive episodes were found to be seriously underestimated. Schizophrenic, panic, phobic and antisocial personality disorders were probably underestimated. The observed lifetime prevalence figures with DIS-CM are rather conservative for these disorders. The prevalence data of a recent 1-year period are less biased and more reliable. The nature of the disease, recall effect, active or passive psychological resistance, mortality, and uncooperative attitude are considered factors that induce an underestimate of lifetime prevalence.     

护理访视对颌面部局麻手术患者疼痛的影响

目的 研究术前术后护理访视作为手术全期护理的全新内容，是否有助于患者应对手术。方法 颌面部局麻手术患者196例，随机分为2组，实验组由巡回护士进行访视和回访；对照组不进行访视，只做简单的术前解释。术后2～3d对疼痛程度、手术耐受分值和满意率3项进行评估和记录。结果 实验组与对照组比较：疼痛0级、Ⅰ级者多于对照组，而疼痛Ⅱ级、Ⅲ级者不少于对照组。耐受分值0分、1分者明显少于对照组，而耐受分值2分、3分者明显多于对照组。实验组对手术室的工作满意率也大于对照组。结论 术前术后护理访视对减轻颌面部局麻手术患者的手术疼痛，提高手术耐受能力，增加对手术室工作的满意度有明显的积极作用，可使患者以恰当的应激水平去应对手术，增强患者对护士的信赖感，消除或减轻恐惧心理，从而提高手术成功率，并使围手术期护理更趋于人性化、科学化。     

Venous leg ulcer management in clinical practice in the UK: costs and outcomes

The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to managing venous leg ulcers (VLUs) in clinical practice by the UK's National Health Service (NHS) and the associated costs of patient management. This was a retrospective cohort analysis of the records of 505 patients in The Health Improvement Network (THIN) Database. Patients' characteristics, wound‐related health outcomes and health care resource use were quantified, and the total NHS cost of patient management was estimated at 2015/2016 prices. Overall, 53% of all VLUs healed within 12 months, and the mean time to healing was 3·0 months. 13% of patients were never prescribed any recognised compression system, and 78% of their wounds healed. Of the 87% who were prescribed a recognised compression system, 52% of wounds healed. Patients were predominantly managed in the community by nurses with minimal clinical involvement of specialist clinicians. Up to 30% of all the VLUs may have been clinically infected at the time of presentation, and only 22% of patients had an ankle brachial pressure index documented in their records. The mean NHS cost of wound care over 12 months was an estimated £7600 per VLU. However, the cost of managing an unhealed VLU was 4·5 times more than that of managing a healed VLU (£3000 per healed VLU and £13 500 per unhealed VLU). This study provides important insights into a number of aspects of VLU management in clinical practice that have been difficult to ascertain from other studies and provides the best estimate available of NHS resource use and costs with which to inform policy and budgetary decisions.     

The global burden of headache: a documentation of headache prevalence and disability worldwide

This study, which is a part of the initiative 'Lifting The Burden: The Global Campaign to Reduce the Burden of Headache Worldwide', assesses and presents all existing evidence of the world prevalence and burden of headache disorders. Population-based studies applying International Headache Society criteria for migraine and tension-type headache, and also studies on headache in general and 'chronic daily headache', have been included. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.     

Bakas照顾结果量表评估脑卒中主要居家照顾者负荷的适用性研究

目的 探讨Bakas照顾结果量表评估脑卒中居家照顾者负荷的适用性.方法 用Bakas照顾结果量表对上海市区180名脑卒中主要居家照顾者进行问卷调查,从内部一致性、结构效度和效标关联效度对量表进行适用性评估.结果 各条目与Bakas照顾结果量表总分的相关系数0.408-0.725(P＜0.01);量表总的Cronbach's α值为0.877;用因子分析检验量表的结构效度,提取3个公因子累积贡献率达到60.93%,每个条目的因子负荷0.510～0.875;以负荷可视化标尺作为标准,Bakas照顾结果量表的效标关联系数为-0.461(P＜0.01).结论 Bakas照顾结果量表用于评估脑卒中居家照顾者负荷有较好的适用性.     

广东省慢性病患者生存质量及健康调整期望寿命分析

目的 分析广东省慢性病患者生存质量及健康调整期望寿命。方法 基于广东省第五次全国卫生服务调查数据,通过欧洲五维度三水平健康量表对人群生存质量进行评价。运用多重线性回归和等级logistic回归评价慢性病对人群生存质量的影响,并用期望寿命和健康调整期望寿命指标评价慢性病对人群健康的综合影响。结果 共纳入68 550名居民数据进行分析,等级logistic回归显示在校正了社会人口学特征后,慢性病对生存质量各个维度的影响均有统计学意义,其中对疼痛/不舒服维度的影响最大[OR=4.48（95% CI：4.20~4.77）],其余依次为焦虑/抑郁[OR=3.95（95% CI：3.62~4.31）]、日常活动[OR=3.69（95% CI：3.37~4.04）]、行动[OR=3.63（95% CI：3.34~3.94）]和自我照顾[OR=3.30（95% CI：2.98~3.66）]。慢性病患者期望寿命比非慢性病人群平均少12.7年,健康调整寿命平均减少14.6年（男性减少17.8年,女性减少9.7年）。人群去慢性病健康调整期望寿命收益为3.8年（男性为5.1年,女性为2.0年）。结论 慢性病会影响患者生存质量的各维度,从而减少患者的健康调整期望寿命,给人群和社会带来沉重的健康负担。从卫生政策和卫生资源优化配置的角度看,需为慢性病患者尤其是为老年患者提供更全面可及的医疗照护,照护需不仅关注生理健康也要注重心理健康。