A Pilot Study of Factors Associated With Falls in Individuals With Incomplete Spinal Cord Injury

Abstract

Background/Objective: To determine factors associated with falls among a sample of ambulatory individuals with incomplete spinal cord injury (SCI).

Study Design: Cross-sectional mail survey.

Methods: A survey instrument of participant characteristics and fall-related variables was developed using relevant items from existing measures and was mailed to 221 individuals with incomplete SCI, who were identified from records of a large specialty hospital in the southeastern United States. Of the 221 prospective participants, 119 completed the questionnaire (54%). Multivariable logistic regression models were used to determine factors that were independently associated with having had a fall in the past year.

Results: After adjusting for covariates, having fallen in the past year was significantly (P < 0.05) associated with greater numbers of medical conditions (odds ratio [OR] = 1.3; 95% confidence interval [Cl] = 1.0-1.7), having arthritis (OR = 3.4, 95% Cl = 1.2-9.6), experiencing dizziness (OR = 5.6, 95% Cl = 1.1-27.7), greater numbers of days with poor physical health (OR = 1.1; 95% Cl = 1.0-1.3), and the restriction of community activities because of fear of falling (OR = 1.5, 95% Cl = 1.1-2.1). The multivariable models also showed that the odds of having fallen were significantly lower among those with better current perceived physical health (OR = 0.5; 95% Cl = 0.3-0.9), those with better perceived health compared to a year ago (OR = 0.4; 95% Cl = 0.2-0.8), individuals who exercised more frequently (OR = 0.2; 95% Cl = 0.1-0.7), and those who used a walker (OR = 0.3; 95% CI = 0.1-0.9).

Conclusions: Results suggest that interventions that address exercise frequency, walker use, and dizziness have promise for reducing falls for individuals with incomplete SCI.     

防治术后恶心呕吐的研究进展

背景 术后恶心呕吐(postoperative nausea and vomiting,PONV)是麻醉手术后最常见的并发症之一,其发生率可高达30％.虽然国际上已公布了防治PONV共识和指南,但尚存在缺陷的PONV预测模型和复杂的防治策略成为临床防治PONV最大的障碍. 目的 探究在临床工作中防治PONV的主要障碍,为临床防治PONV工作提供更有效的途径. 内容 尚存在缺陷的PONV预测模型和复杂的防治策略是临床防治PONV最大的障碍,多模式防治PONV是一种简单、有效的预防PONV发生的方法. 趋向 多模式防治PONV更容易被临床麻醉医生接受和应用,新型的抗PONV药物和传统经典的抗呕吐药物为临床多模式防治提供了更大的选择空间.     

肝移植术后慢性肾功能损伤的危险因素分析

目的 探讨影响肝移植术后慢性肾功能损伤(CRD)的危险因素.方法 回顾性分析2007年1月至2008年1月于中国人民武装警察部队总医院接受肝移植术后生存时间＞3年的101例患者的临床资料,应用MDRD公式计算术前以及术后1、3年的肾小球滤过率(GFR).根据术后GFR是否＜60 ml/min将患者分为CRD组(16例)和对照组(85例).采用x2检验或t检验对可能影响肝移植术后肾功能的16项危险因素(性别、年龄、高血压、糖尿病、肌酐、尿素氮、他克莫司浓度、术前GFR、热缺血时间、冷缺血时间、国际标准化比值、TP、TBil、ALT、AST、ALP)进行单因素分析,将差异有统计学意义的因素进行Logistic多因素回归分析.结果 101例肝移植患者手术前GFR为(103±22) ml/min,其中3例患者术前GFR＜60 ml/min;101例患者肝移植术后l、3年GFR分别为(91 ±22) ml/min和(83 ± 21) ml/min,其中7例患者肝移植术后1年GFR＜ 60 ml/min,16例患者术后3年GFR＜ 60 ml/min.单因素分析结果表明:高血压、糖尿病、肌酐、尿素氮、他克莫司浓度和术前GFR是肝移植术后CRD的危险因素(x2=9.400,21.917,f =51.024,91.620,41.381,99.000,P＜0.05).多因素分析结果表明:高血压、糖尿病和术前GFR是肝移植术后CRD的独立危险因素(OR=65.438,17.903,0.911,P＜0.05).结论 GFR降低和手术前合并高血糖和高血压是肝移植术后CRD的危险因素.     

Barrett食管的危险因素及治疗进展

食管腺癌发病率的增长速度居各种食管恶性肿瘤的第2位,目前认为Barrett食管是食管腺癌的一种癌前病变.Barrett食管的发病率与社会经济状况密切相关,在生活水平较高的发达国家,与Barrett食管相关的食管腺癌发病率迅速增长.Barrett食管的危险因素包括胃食管反流病、白人或西班牙裔种族、男性、年龄、吸烟、肥胖等.Barrett食管的治疗主要包括药物治疗、内镜治疗及外科手术治疗,但对Barrett食管有效的化学预防目前仍需进一步的临床随机试验加以阐明.     

全膝关节置换术围手术期隐性失血的危险因素研究

目的探讨影响人工全膝关节置换术（TKA）术后隐性失血的危险因素及发生机制。方法选取2008年5月至2011年5月136位患者192例TKA,患者平均年龄67．5岁,其中单侧膝关节置换80例,双膝关节同期置换56例,同组医师采用同种术式完成,术后24h补液总量不超过2000ml。利用Gross方程,计算患者的术后总失血量,隐性失血量以及血红蛋白降低情况,记录年龄、性别、术侧、BMI、输血等危险因素,通过SPSS13．0进行统计学分析,比较各组之间隐性失血量有无差别,分析影响TKA围手术期隐性失血的危险因素。结果单侧TKA总失血量1650ml,隐性失血830ml;双膝同期置换者总失血量2864ml,隐性失血1487ml。无论是单侧还是双侧TKA,男性及应用自体血回输患者的围手术期失血量多于对照组（P〈0．01）,双膝同期置换隐性失血量比例较大（X^2=6．836,P〈0．01）,高龄肥胖患者隐性失血量明显多于对照组（单膝）X^2=21．587,P〈0．01,双膝X^2=29．233,P〈0．01）。结论TKA术后失血量较高,其中隐性失血比例占50％以上。男性双膝同期置换的患者,年龄〉70且BMI〉27．0,使用自体血回输均是增加围手术期隐性失血的危险因素。     

广州地区住院患者NRS2002营养风险筛查的多中心研究

目的调查广州4所教学医院住院患者营养不足、营养风险发生率以及营养支持的应用状况,并明确营养风险发生率在性别或年龄间的差异。方法对2008年4月至2011年12月广州4所教学医院消化内科、呼吸内科、神经内科、肾内科、普外科、胸外科等6个专科符合NRS2002评定标准的2550例住院患者进行营养筛查,并调查其营养支持应用情况。结果共获取2142例（84％）的BMI值,营养不足和营养风险的发生率分别为17．8％和41．5％;6个专科中,呼吸内科患者的营养不足和营养风险发生率均最高,分别为28．2％和55．9％;≥70岁的患者营养风险发生率高于〈70岁者（64．2％US32．6％,P=0．000）;总的营养风险发生率没有性别差异。有营养风险者的营养支持率为47．6％,无营养风险者的营养支持率为19．4％。肠外营养占全部营养支持的88．7％。结论NRS2002是进行营养筛查的一个有效工具,可推荐用于新人院患者。广州住院患者中存在较高比例的营养风险或营养不足,≥70岁患者更易发生营养风险;营养治疗存在不恰当的营养干预及肠外营养的过度使用。应在精确评估患者营养状况的基础上制定合理的营养支持方案。     

老年患者泌尿系感染的临床特点和危险因素分析

目的调查分析老年患者泌尿系感染的临床特征和相关危险因素,并制定相应的干预对策。方法选择2010年1月至2012年12月本院泌尿外科收治的87例并发泌尿系感染的老年患者,进行回顾性调查分析。结果87例患者以尿频、尿痛、血尿及排尿困难为主要临床表现,其中≥60岁者发生率为83.91%（73/87）,合并糖尿病、脑血管疾患等基础疾病者为78.16%（68/87）,实施侵袭性操作者占67.81%（59/87）。结论老年患者继发泌尿系感染与高龄、合并基础疾病、侵袭性操作等因素密切相关,应给予高度重视。     

Risk factors for recurrence of diabetic foot ulcers: prospective follow‐up analysis in the Eurodiale subgroup

Few studies have examined factors associated with diabetic foot ulcer (DFU) recurrence. Using data from patients enrolled in the prospective Eurodiale DFU study, we investigated the frequency of and risk factors for DFU recurrence after healing during a 3‐year follow‐up period. At our site, 93 Eurodiale‐enrolled patients had a healed DFU. Among these, 14 were not alive; of the remaining 79 patients we enrolled 73 in this study. On entry to the Eurodiale study, we assessed demographic factors (age, sex and distance from hospital); diabetes‐related factors [duration, and glycated haemoglobin (HbA1c) levels]; comorbidities (obesity, renal failure, smoking and alcohol abuse) and DFU‐related factors [peripheral arterial disease, ulcer infection, C‐reactive protein (CRP) and; foot deformities]. During the 3‐year follow‐up period, a DFU had recurred in 42 patients (57·5%). By stepwise logistic regression of findings at initial DFU presentation, the significant independent predictors for recurrence were plantar ulcer location [odds ratio (OR) 8·62, 95% confidence interval (CI) 2·2–33·2]; presence of osteomyelitis (OR 5·17, 95% CI 1·4–18·7); HbA1c > 7·5% ([DCCT], OR 4·07, 95% CI 1·1–15·6) and CRP > 5 mg/l (OR 4·27, 95% CI 1·2–15·7). In these patients with a healed DFU, the majority had a recurrence of DFU during a 3‐year follow‐up period, despite intensive foot care. The findings at diagnosis of the initial DFU were independent risk factors associated with ulcer recurrence (plantar location, bone infection, poor diabetes control and elevated CRP) and define those at high risk for recurrence, but may be amenable to targeted interventions.     

Root resorption diagnosed with cone beam computed tomography after 6 months of orthodontic treatment with fixed appliance and the relation to risk factors

Objectives:To investigate root resorption after 6 months of active orthodontic treatment and its relation to possible risk factors.Materials and Methods:Ninety-seven patients (10–18 years) with a Class I malocclusion and crowding treated with fixed appliance and premolar extractions were examined with cone beam computed tomography before and after 6 months of active treatment. The exposure covered all teeth from first molar to first molar in both jaws. The Malmgren index was used to evaluate the degree of root resorption. Irregular root contour (score 1) was seen in most teeth already before active treatment, and therefore resorptions were registered only as score 2 (<2 mm, minor resorption) or higher.Results:Minor root resorption was noted in 10% of the patients and severe root resorption, >2 mm (score 3) was found in four patients. Root resorption was more frequently seen in the upper jaw, especially the incisors. There was no statistically significant correlation of root resorption with any of the selected risk factors.Conclusions:After 6 months of treatment, clinically significant resorption was diagnosed in 4% of the patients, ie, in 96% of the patients the radiographic examination did not reveal any significant information. The selected risk factors did not have any impact on the amount of resorption after 6 months of active treatment.