非酮症高渗性糖尿病昏迷的水化治疗(附23例报告)

目的 探讨非酮症高渗性糖尿病昏迷的水化疗法。方法 8年来我们对23例非酮症高渗性糖尿病昏迷患者采用了水化治疗方法,在常规内科治疗方法的基础上同时口服或胃管灌注温开水进行消化道补液治疗。结果 采用水化治疗12小时后,血糖、血钠及血浆渗透压即开始下降,24小时后明显下降。除3例死于严重的多系统器官功能衰竭外,其余均治愈。结论 水化治疗方法简单、安全、有效。     

Psychosocial aspects of child and adolescent obesity

In addition to counselling families about regular physical activity and healthy nutrition, clinicians need to identify and help them to address the psychosocial factors that may be contributing to their child’s or adolescent’s obesity. Affected individuals may suffer from depression, low self-esteem, bullying, and weight bias, experiences that can make achieving desired health outcomes more difficult. Clinicians should try to identify these underlying stressors and ensure that appropriate counselling is implemented.     

胃肠透析液的急性毒性和对家兔肾衰模型的实验研究

为了通过动物模型验证胃肠透析液(GJD)对流行性出血热(EHF)的治疗安全度和效果,特进行如下两个方面的试验:1.急性毒性试验:对健康成年家兔和小鼠,采用临床用药量的5倍浓缩胃肠透析液,灌胃给药,连续观察一周,均未见明显毒性反应。2.对家兔急性肾衰模型的影响:用0.1％升汞引起家兔的急性肾衰模型仍用前述5倍浓缩液,按120～160ml/kg灌胃,测定透析前后的Cr和BUN值,经配对t检验并与对照组比较,证实有一定的治疗效果(P<0.01)。上述实验结果表明:胃肠透析疗法对流行性出血热的治疗是安全而有效的。     

Correlates of suicidal ideation among HIV-positive persons

OBJECTIVES: The present investigation sought to determine the extent to which demographic characteristics, illness-related burdens, alcohol and other substance use, and psychosocial factors are independently associated with suicidal ideation in HIV-positive individuals. DESIGN: HIV-positive individuals in four US cities (San Francisco, Los Angeles, Milwaukee, and New York City) were screened between July 2000 and January 2002 for recruitment into a randomized behavioral prevention trial. Utilizing data from this screening visit, rates and correlates of suicidal ideation were examined in a diverse sample of 2909 HIV-positive individuals. METHODS: Using binary logistic regression study sites, demographic characteristics, illness-related burdens, alcohol and substance use, and psychosocial factors were entered as predictors of suicidal ideation. This cross-sectional model thus examined the independent effects of each factor. RESULTS: Approximately one-fifth (19%) of participants reported thoughts of suicide in the past week. We observed that participants who were not heterosexual, rated HIV-related symptoms and medication side effects as more severe, reported regular marijuana use, and described elevated affective symptoms of depression were those who were more likely to report suicidal ideation. Conversely, participants who identified as Hispanic/Latino, individuals in a primary romantic relationship, and those who reported greater self-efficacy for coping were less likely to report suicidal ideation. CONCLUSION: Suicidal ideation among HIV-positive individuals is relatively common and is associated with multiple factors. These independent correlates may assist with identifying HIV-positive individuals who are at increased risk of suicidal ideation so that they may be assessed regularly and referred for psychological treatment when appropriate.     

The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia

BACKGROUND/OBJECTIVE: For persons with spinal cord injury (SCI), severe bodily pain is related to a lower quality of life. However, the effect of pain from a specific body region on quality of life has yet to be determined. The shoulder joint is a common site of pain among persons with SCI. Therefore, our purpose was to identify the relationship of self-reported shoulder pain with quality of life, physical activity, and community activities in persons with paraplegia resulting from SCI. METHODS: Eighty participants with shoulder pain who propel a manual wheelchair (mean age: 44.7 years; mean duration of injury: 20 years; injury level T1-L2) completed the following questionnaires: Wheelchair User's Shoulder Pain Index, Subjective Quality of Life Scale, Physical Activity Scale for Individuals with Physical Disabilities, and Community Activities Checklist. Correlations between shoulder pain scores and quality of life, physical activity, and community activities were determined using Spearman's rho test. RESULTS: Shoulder pain intensity was inversely related to subjective quality of life (r(s) =-0.35; P= 0.002) and physical activity (r(s) = -0.42; P < 0.001). Shoulder pain intensity was not related to involvement in community activities (r(s) = -0.07; P = 0.526). CONCLUSIONS: Persons with SCI who reported lower subjective quality of life and physical activity scores experienced significantly higher levels of shoulder pain. However, shoulder pain intensity did not relate to involvement in general community activities. Attention to and interventions for shoulder pain in persons with SCI may improve their overall quality of life and physical activity.     

Effects of behavioral intervention on substance use among people living with HIV: the Healthy Living Project randomized controlled study

AIM: Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH). DESIGN, SETTING AND PARTICIPANTS: A randomized controlled trial was conducted with 936 PLH who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months. INTERVENTION: A 15-session case management intervention was delivered to PLH in the intervention condition; the control condition received usual care. MEASUREMENTS: An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use. FINDINGS: Reductions in recent substance use were significantly greater for intervention PLH compared to control PLH: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition. CONCLUSIONS: A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among PLH.     

ARI临床症状与诊断肺炎价值的研究

本文通过对541例5岁以下儿童急性呼吸道感染的临床症状及其与诊断肺炎价值的研究,表明呼吸增快与诊断肺炎的敏感性基本相同,但呼吸增快对诊断肺炎的特异性要较罗音为高。而乡村医生经过短期培训又不能很好地使用听诊器诊断肺炎,因此培训乡村医生学会数呼吸次数和观察胸凹陷以诊断肺炎和区别肺炎的轻重,是较简便而可靠的适宜技术,可以在我国农村推广,以降低婴幼儿肺炎的死亡率。