Loneliness and social support of older people living alone in a county of Shanghai,China

China has an ageing population with the number of older people living alone increasing. Living alone may increase the risk of loneliness of older people, especially for those in China where collectivism and filial piety are emphasised. Social support may fill the need for social contacts, thereby alleviating loneliness. However, little is known about loneliness and social support of older people living alone in China. This study investigated loneliness and social support of older people living alone, by conducting a cross‐sectional questionnaire survey with a stratified random cluster sample of 521 community‐dwelling older people living alone in a county of Shanghai. Data were collected from November 2011 to March 2012. The instruments used included the UCLA Loneliness Scale version 3 and the Social Support Rate Scale. The participants reported a moderate level of loneliness. Their overall social support level was low compared with the Chinese norm. Children were the major source of objective and subjective support. Of the participants, 53.9% (n = 281) and 47.6% (n = 248) asked for help and confided when they were in trouble, but 84.1% (n = 438) never or rarely attended social activities. The level of loneliness and social support differed among the participants with different sociodemographic characteristics. There were negative correlations between loneliness and overall social support and its three dimensions. The findings suggest that there is a need to provide more social support to older people living alone to decrease their feelings of loneliness. Potential interventions include encouraging more frequent contacts from children, the development of one‐to‐one ‘befriending’ and group activity programmes together with identification of vulnerable subgroups.     

欠发达地区社区卫生服务发展模式研究

目的 探讨欠发达地区开展社区卫生服务的方法,研究提高医疗公平和效率,方便群众就医,减轻费用负担的具体模式.方法 (1)在濮阳市,采用分层、系统抽样方法抽取了8 231位居民,进行了社区卫生服务需求调查.(2)普查了市城区社区卫生服务试点和市城区的卫生资源情况.(3)提出网络建设的方法和社区健康教育工作重点,并进行了实施.(4)运用层次分析法,建立了社区卫生服务层次分析评价体系(CHS-AHP)社区卫生服务综合评估模型GI=1GiPi,对卫生服务站进行纵向和横向评估.结果 (1)濮阳居民对社区卫生服务需求水平较高:慢性病患病率为75.45‰;患者中就诊构成比为84.39%,未就诊构成比为15.61%.(2)两周患病者实际就诊基层医疗卫生单位的占71.30%.(3)在发展社区卫生服务过程中,建立合适的社区卫生服务网络模式,是发展社区卫生服务的关键措施.网络实施后居民对社区卫生服务的需求情况、满意度有很大提高;高血压患者正规服药、血压控制情况有很大改善;社区居民的卫生知识掌握率、不良行为暴露率有明显变化.(4)社区健康教育在社区卫生服务工作中占据着重要地位.社区卫生服务综合指数从1999-2006年依次是0.4348,0.4702,0.6206,0.7561,0.7971,0.8613,0.8853,0.9005,呈逐年增长趋势;社区健康教育综合指数从1999-2006年依次是0.3735,0.4966,0.6140,0.7158,0.7574,0.8091,0.8270,0.8418,呈逐年增长趋势.社区卫生服务和社区健康教育相关性有统计学意义(r=0.988,P＜0.005).结论 在濮阳市构建了有利于帮助社区居民形成健康的生活方式和促进慢性病管理的网络模式,该模式具有较强的实用性和可操作性.提出并证明了"以社区健康教育为载体,把社区卫生服务引向深入"是开展社区卫生服务的有效途径.建立了完善的社区卫生服务评价体系.     

Design and baseline characteristics of participants in the Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial on the cardiovascular effects of dulaglutide

The aim was to determine the effects of dulaglutide, a synthetic once‐weekly, injectable human glucagon‐like peptide 1 analogue that lowers blood glucose, body weight, appetite and blood pressure, on cardiovascular outcomes. People with type 2 diabetes, aged ≥50 years, with glycated haemoglobin (HbA1c) ≤9.5%, and either a previous cardiovascular event, evidence of cardiovascular disease or ≥2 cardiovascular risk factors were randomly allocated to a weekly subcutaneous injection of either dulaglutide (1.5 mg) or placebo and followed within the ongoing Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial every 3 to 6 months. The primary cardiovascular outcome is the first occurrence of the composite of cardiovascular death or non‐fatal myocardial infarction or non‐fatal stroke. Secondary outcomes include each component of the primary composite cardiovascular outcome, a composite clinical microvascular outcome comprising retinal or renal disease, hospitalization for unstable angina, heart failure requiring hospitalization or an urgent heart failure visit, and all‐cause mortality. Follow‐up will continue until the accrual of 1200 confirmed primary outcomes. Recruitment of 9901 participants (mean age 66 years, 46% women) occurred in 370 sites located in 24 countries over a period of 2 years. The mean duration of diabetes was 10 years, mean baseline HbA1c was 7.3%, and 31% had prior cardiovascular disease. The REWIND trial's international scope, high proportion of women, high proportion of people without prior cardiovascular disease and inclusion of participants whose mean baseline HbA1c was 7.3% suggests that its cardiovascular and safety findings will be directly relevant to the typical middle‐aged patient seen in general practice throughout the world.     

Evaluation of the results of delayed rhinoplasty in cleft lip and palate patients: Functional and aesthetic implications and factors that affect successful nasal repair

Patients born with cleft lip and palate (CLP) present with a variety of nasal deformities. These are either congenital or iatrogenic. Our aim was to establish a correlation between aesthetic and functional nasal impairments in patients with CLP whose nasal reconstruction had been delayed. Fifty-four randomly selected patients with CLP deformities, all of whom had delayed nasal repairs were evaluated objectively, aesthetically in three planes, and functionally for symptoms of nasal obstruction, chronic maxillary sinusitis, and olfactory disturbances. Aesthetically the patients were analysed from 1:1 life-size full face, profile, and submental-vertex photographs, and full skull cephalograms. Nasal patency was assessed by rhinomanometry. The presence of chronic maxillary sinusitis and olfactory disturbances were deduced from the history. The degree of nasal dismorphism correlated with the severity of nasal functional impairments. Delayed nasal repairs in patients with CLP did not produce satisfactory aesthetic or functional results, probably because growth was retarded and midfacial development was disturbed at the time of delayed rhinoplasty and resulted in asymmetry. In CLP the nose should be repaired during the early primary cheilorhinoplasty, as this is essential for the restoration of a normally functioning and aesthetically pleasing nose.     

Influence of distraction rates on the temporomandibular joint position and cartilage morphology in a rabbit model of mandibular lengthening

PURPOSE: Although various aspects of bone formation during distraction osteogenesis have been studied extensively, there are only limited experimental data concerning the influence of mandibular distraction rates on structural alterations in the temporomandibular joint (TMJ). In this study, a rabbit model of unilateral mandibular distraction was used to test the effects of various strain schedules on the position and morphology of the TMJ. MATERIAL AND METHODS: Fifty-two immature white female rabbits were used. The distraction procedure was performed using physiologic (2,000 microstrains, 1 per day) and elevated strain magnitudes (20,000 microstrains, 1 per day), as well as high strain magnitudes (200,000 and 300,000 microstrains, 1 per day). The investigation of the TMJ included clinical, radiologic, and histologic aspects. RESULTS: Clinical and radiologic examinations at the end of the distraction period showed no evidence of joint luxation even at maximal distraction rates. Histologic and ultrastructural analyses revealed a positive correlation between the degree of mechanical loading and the development of degenerative alterations in the cartilage. In samples distracted at hyperphysiologic strain magnitudes, all cartilaginous layers were reduced in the regions of the TMJ that had been exposed to the higher pressure forces. The fibrous layer became nearly completely destroyed. CONCLUSIONS: These experimental data show that distraction schedules with single but hyperphysiologic loads may lead to degenerative or even early arthrotic changes in the condyle. These data support the principle that distraction protocols should be performed without extensive mechanical loading on the TMJ.     

Loneliness and social support of older people in China: a systematic literature review

Loneliness is a serious problem for older people, which can be alleviated by social support. The dramatic population ageing together with social and economic change in China increases the likelihood of loneliness and the availability of different sources of social support of older people. The aim of this review was to identify the prevalence of loneliness and its related factors and sources of social support of older people in China. Electronic literature searches were conducted in September 2011 using Web of Science, PsycINFO, MEDLINE, PubMed, CINAHL, China Academic Journal and VIP Database for Chinese Technical Periodicals. Twenty‐six papers were identified and reviewed. The prevalence of loneliness varied across the studies, reflecting the different measurements and samples. Marital status, gender, age, educational level, economic level, living arrangements, health status and social support were significant factors related to loneliness. The family was the most important source of social support followed by friends. The receipt of family support improved subjective well‐being and mental health, but the effects of support from friends were inconsistent. Chinese older people received relatively little support from neighbours, governmental or other social organisations. Further well‐designed studies are needed to identify additional factors related to loneliness and to understand the support from friends, neighbours, formal organisations and other sources.     

Ideas and ideals in medicine: fruits of reason or props of power?

Editors of medical journals play a central role in the promotion – or suppression – of ideas and ideals in medicine. Recently eminent among these have been the advocacies of the Evidence-based Medicine (EBM) movement and colleagues concerned with evidence and guidelines for health care. With regard to these topics, it still remains for editors of journals either to advance or to retard even the consolidation of the associated core concepts, most notably those of evidence in medicine, scientific medicine, and rational medicine. I present, first, a case study on the conduct of the editors of three medical journals, specifically their assumption of the role of authority on the scholarly fundamentals of evidence in medicine and their responding to propositions on the topic with commentaries well below the intellectual standards that should prevail in the journals of a learned profession. Then, following a brief review of the Flexnerian and EBM ideas and ideals on the practice of medicine, supplemented by observations drawn from medical sociology and the precepts of the philosophy of science, I posit a way of understanding such behaviour by editors of medical journals. They can have a temptation, and apparently some propensity, to play a regressive role in the development of the fundamentals of medicine. This is prone to occur whenever reason constitutes a threat to power, whether solely to the editors' own or to that of the profession at large. A full realization of the dream of reason in medicine requires an immense integrity of its journal editors and of its other intellectual leaders.