唐氏综合征儿童社会适应能力现状及影响因素研究

目的探讨唐氏综合征儿童的社会适应能力现状和影响因素。方法在2004年9月至2006年7月期间,采用家庭环境问卷,图片词汇测试和婴儿-初中学生社会生活能力量表对36例52～167个月的唐氏综合征儿童以及30名年龄20—65个月智龄匹配对照组、40名年龄43—144个月年龄匹配对照组儿童进行测试。两组儿童的性别、家庭一般环境状况匹配。结果在测试过程中,三组儿童的数据均进入结果分析。①唐氏综合征儿童在交往和参加集体活动能力得分与智龄匹配对照组差异无统计学意义,独立生活能力、运动能力、作业、自我管理得分均高于智龄匹配对照组儿童（20．0±4．8）分,（13．3±4．7）分,t=5．72,P=0．000;（7．5±1．4）分,（6．4±1．6）分,t=3．10,P=0．003;（8．2±2．4）分,（6．2±2．0）分,t=3．68,P=0．000;（5．9±2．6）分,（4．6±2．0）分,t=2．28,P=0．026。唐氏综合征儿童的社会生活能力各维度得分均低于年龄匹配对照组儿童,其中独立生活能力为（20．0±4．8）分vs（26．5±4．9）分（t=5．84,P=0．000）;运动能力为（7．5±1．4）分vs（11．4±3．3）分（t=6．76,P=0．ooo）;作业为（8．2±2．4）分vs（14．4±3．9）分（t=8．55,P=0．000）;交往为（8．3±3．6）分vs（18_3±4．8）分（t=10．38,P=0．000）;参加集体活动（9．6±2．3）分vs（17．1±4．2）分（t=9．76,P=0．000）;自我管理为（5．9±2．6）分vs（13．8±4．6）分（t=9．25,P=0．000）。②相关分析显示,图片词汇测试初分与生活能力各维度明显相关。即使在控制年龄因素后,各维度与图片词汇测试初分的相关性仍然有统计学意义。③多元逐步回归分析显示,维度独立生活能力选人家庭结构进入回归方程;维度运动能力有家庭结构和母亲文化水平两个维度进入回归方程;维度作业、交往、参加集体活动和自我管理有家庭结构和新生儿患病史两个维度进入回归方程。结论唐氏综合征儿童的社会生活能力落后于同年龄儿童但优于同智龄儿童认知发展水平,家庭环境因素和新生儿期病史对其有不同影响提示合理的干预方式有助于提高他们的社会适应能力。     

高中生的适应性障碍以及相关对策研究

高中生正处于心理与生理发展与完善的关键时期,在这个过程中最易出现学习、生活以及人际交往方面的不适应,直接导致不同程度的心理问题,甚至发展成适应性障碍。高中学生适应障碍主要表现:学习适应性障碍、生活适应性障碍、人际交往障碍。这些适应性障碍将直接影响高中生的学习、生活甚至身心健康的发展,通过分析高中生适应性障碍成因,提出相关决策变得至关重要。     

通过调整脊柱治疗臀上皮神经综合征的临床观察

目的观察通过调整脊柱的方法来治疗臀上皮神经综合征的疗效。方法将65例臀上皮神经综合征患者按就诊顺序随机分为对照组(32例)和治疗组(33例)。对照组患者给予基本手法治疗,治疗组在对照组基础上再给予调整脊柱法。两组均以10次为1个疗程,共2个疗程,治疗结束后比较两组疗效。结果治疗组治愈率为93.94%,对照组为56.25%,治疗组疗效明显高于对照组,且治疗组起效时间明显快于对照组,不易复发。结论通过调整脊柱治疗臀上皮神经综合征疗效明显、安全可行。     

Short-term and long-term initial stay in hospital of children with insulin-dependent diabetes: adjustment of families after two years

A randomized prospective trial on the effect of the length of initial hospital stay (23 ± 4 days and 9 ± 3 days) in 61 consecutive children with newly diagnosed diabetes was carried out. Since the metabolic outcome was similar in the treatment groups for the first two years, we analyzed the adjustment and subjective well-being of families to the diabetes after a two-year follow-up period. A semi-structured interview by a psychologist who was blinded to the initial treatment length and medical history of the child showed that 74% of the families in the short-term and 58% in the long-term treatment groups had good overall psychosocial ability to function (ns); there were no unusual fears in 37% and 15% of the families (ns), respectively. After short-term treatment, families needed slightly but not significantly less time to be confident about the management of diabetes in the family. These findings show that the short-term initial hospital stay does not unfavorably affect the adjustment of the family to diabetes and should probably be preferred over the long-term initial hospital stay.     

如何控制观察性疗效比较研究中的混杂因素：（二）未知或未测量混杂因素的统计学分析方法

观察性疗效比较研究作为随机对照研究的证据补充,其应用价值越来越受到关注。未测量混杂因素的统计学分析方法是观察性疗效比较研究中的重大挑战,本文对观察性疗效比较研究中未知或未测量的混杂因素控制的统计分析方法进行述评。未测量混杂因素的统计学方法包括工具变量法、本底事件率比校正法和双重差分模型及其衍生方法。工具变量法模型构造巧妙,但满足条件的工具变量在实际研究中并不易得;本底事件率比校正法和双重差分模型均要求研究数据有干预前信息,有些实际研究中往往无法满足。未测量混杂因素对统计学方法提出了新的要求、新的挑战,有待国内外统计学者的进一步完善和研究。     

杏苏散加减治疗小儿急性支气管炎60例临床观察

目的:探讨杏苏散加减治疗小儿急性支气管炎的效果。方法:把我院收治的小儿支气管炎患儿60例平均分成两组,治疗组用杏苏散加减,对照组应用头孢曲松、地塞米松、病毒性静脉滴注,比较疗效。结果:治疗组痊愈率为95%,对照组为60%,差异明显。结论:杏苏散加减治疗小儿急性支气管炎,疗效满意,且无不良反应,较之西药治疗可以有效缩短治疗时间,避免患儿病情加重,减轻患儿痛苦,值得临床工作者推广使用。     

Adjustment and intelligence among children with phenylketonuria in Sweden

In this investigation we present a recent survey of treatment effects among 8 to 19-y-old Swedish children and youths with phenylketonuria (PKU). The results from intelligence tests and a questionnaire comprising four scales, work capacity, social competence, and internalising and externalising problems, were used. Severity of disease, early treatment, and contemporary phenylalanine levels were assessed. The results showed that development of the patients' intelligence was normal. Adjustments were rated by the patients, their parents and their teachers, and the results were compared with those of a healthy reference group. The PKU patients did not differ from the reference group except for externalising problems judged by the children themselves. None of the patients with PKU showed signs of externalising problems in contrast to the reference group, where such behaviour was observed. Patients with severe PKU, however, showed less social competence compared with patients with a milder form of the disease, according to their own and their parents' ratings. Phenylalanine level in blood tests was in accordance with treatment norms, although the teenagers had higher levels of phenylalanine than the younger patients.

Conclusion : Normal intelligence and adjustment is found among patients with PKU when plasma phenylalanine levels are within treatment norms.     

Psychosocial factors and their association with reflux oesophagitis,Barrett’s oesophagus and oesophageal adenocarcinoma

AIM:To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma(OAC),as well as the reflux-mediated precursor pathway.METHODS:An all-Ireland population-based case-control study recruited 230 reflux oesophagitis(RO),224 Barrett’s oesophagus(BO) and 227 OAC patients and 260 controls.Each case/control group completed measures of stress,depression,self-efficacy,self-esteem,repression and social support.A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.RESULTS:Compared to controls,OAC patients were almost half as likely to report high stress levels over their lifetime(P = 0.010,OR 0.51;95%CI:0.29-0.90)and 36% less likely to report having experienced depression(OR 0.64;95%CI:0.42-0.98).RO patients reported significantly higher stress than controls particularly during middle-and senior-years(P for trends < 0.001).RO patients were 37% less likely to report having been highly emotionally repressed(OR 0.63;95%CI:0.41-0.95).All case groups(OAC,RO and BO) were more likely than controls to report having had substantial amounts of social support(OR 2.84;95%CI:1.63-4.97;OR 1.97;95%CI:1.13-3.44 and OR 1.83;95%CI:1.03-3.24,respectively).CONCLUSION:The improved psychological profile of OAC patients may be explained by response shift.The role of psychological factors in the development of OAC requires further investigation.