Prevalence of Parkinson's disease in Cantalejo, Spain: a door-to-door survey.

We assessed the prevalence of Parkinson's disease in Cantalejo, Spain. In 1994, we screened 1,579 persons (age > or = 40 years) using a high-sensitivity method. Cases fulfilling established clinical criteria were followed for a minimum of 3 years. Prevalences were compared with those from other door-to-door surveys. We detected 27 individuals with parkinsonism, 20 of whom had Parkinson's disease. The prevalence of Parkinson's disease increased with age and, when age-adjusted to European standards, was 9.01 per 1,000 (age 40 years and over; 10.78 in men and 5.23 in women). Of the 11 men, three were in Hoehn & Yahr grades III-IV, but six of the nine women were more severely affected. Overall, we found 18 newly diagnosed cases of parkinsonism, 13 of which were Parkinson's disease, and the majority of which were in men aged 80 years or older with a mean duration of illness of 5 years. Our prevalence figures are the highest reported, apparently because of the inclusion of several very elderly men. Parkinson's disease in Cantalejo is less severe in men than in women, particularly in those newly diagnosed. Despite the low numbers, the high prevalence and sex-related pattern are unexplained but they probably relate to the high sensitivity of the screening method.     

Survey of recognition and utilization of guidelines for the diagnosis and management of bronchial asthma in Japan

BACKGROUND: In Japan in 1993, the Japanese Society of Allergology (JSA) developed guidelines for diagnosis and management of asthma (JGL), which were based on the concept that asthma is a chronic inflammatory disorder of the airway. METHODS: This survey study was intended to investigate the recognition and utilization of JGL among physicians who had treated asthma. The survey comprised two methods: a quantitative mail survey and a qualitative door-to-door survey conducted by trained interviewers. RESULTS: In the mail survey, a total of 1028 physicians responded; 552 members of the JSA and 476 nonmembers. Ninety-four percent of JSA members were aware of adult asthma management guidelines, while 53% of nonmembers were aware of them. Although approximately half of the physicians, both members and nonmembers, found differences between the asthma management policies in JGL and their previous policies, most of them utilized JGL once they read it. In the qualitative door-to-door survey, 80-90% of physicians evaluated JGL as good after they read it. CONCLUSIONS: JGL was recognized and utilized by most JSA members, but only half of nonmember physicians were aware of JGL, although they utilized JGL after they read it. Further action to implement JGL among nonspecialist physicians is needed to improve management of asthma.     

浅析命门穴之“门户”作用

通过命门穴沟通他经他脏进行相关经络脏腑的疾病治疗,在多经受邪时能起到分利气血,通络祛邪之功。命门穴位于"阳经之海"的督脉上,本身即具有振奋督脉阳气的作用,若配合其相通经脉穴位或介质进行辨证施治,其治简而效验。     

Multi-Response Optimisation of Automotive Door Using Grey Relational Analysis with Entropy Weights

Tail-welded blanks (TWBs) are widely used in automotive bodies to improve the structural performance and reduce weight. The stiffness and modal lightweight design optimisation of TWBs for automotive doors was performed in this study. The finite element model was validated through physical experiments. An L27 (3¹²) Taguchi orthogonal array was used to collect the sample points. The multi-objective optimisation problem was transformed into a single-objective optimisation problem based on the grey relational degree. The optimal combination of structural design parameters was obtained for a tail-welded door using the proposed method, and the weight of the door structure was reduced by 2.83 kg. The proposed optimisation method has fewer iterations and a lower computational cost, enabling the design of lightweight TWBs.     

阶段性健康教育在S3～5双开门手术入路行骶前病变手术患者的应用

目的:探讨阶段性健康教育在S3～5双开门手术入路行骶前病变手术患者护理中的应用效果.方法:将28例骶前病变患者随机分为2组,其中:观察组18例,对照组10例.对照组采用常规健康教育方法,针对患者现有和潜在的健康问题给予健康指导；观察组实施阶段性健康教育处方,在入院时、术前、术后及出院前,针对患者不同时期的不同需要,采取阶段性、目的明确且持续的健康教育方法.结果:观察组患者对健康教育知晓率明显高于对照组(P＜0.01),满意度高于对照组(P＜0.05).结论:阶段性健康教育可强化在S3～5双开门手术入路行骶前病变手术患者的遵医行为,建立良好的护患关系,提高患者对健康教育知晓率和满意度,从而促进患者心理和机体功能的早日康复,减少并发症的发生.     

生活垃圾集装箱在集装化转运系统中的改进技术研究

为延长生活垃圾集装箱及其零配件的使用寿命,以及解决箱门无法正常开闭和在运输途中的垃圾渗沥液渗漏问题,对部分零部件(扇齿轮、水平杆、兼容箱箱门门框密封技术)进行了技术革新,有效缓解了现存的问题.     

Improvement in door-to-balloon times in management of acute ST-segment elevation myocardial infarction STEMI through the initiation of 'Code AMI'

Background: ST‐segment elevation myocardial infarction (STEMI) mandates rapid percutaneous coronary intervention (PCI) for optimal outcomes. The aim of this study was to assess our hospital practice for managing acute STEMI, identify processes associated with time delays, instrument changes to our acute STEMI management protocol and assess their effectiveness for improving our door‐to‐balloon time. Methods: We aimed to achieve this through the establishment of a quality improvement programme involving the cardiology and emergency departments. We analysed consecutive patients presenting with STEMI (April to September 2005 (group A) and the corresponding period in 2006 (group B), and compared patients presenting ‘in hours’ (0700 hours to 1800 hours (Monday to Friday)) versus ‘out of hours’ (all other times including public holidays). Results: In group A, 38 patients presented with a STEMI. Assessing time‐to‐treatment analysis, the median door to balloon time for primary PCI was significantly greater for ‘out of hours’ than ‘in hours’ (120 vs 67 min). The greatest time delay to PCI was from the PCI decision time to catheter laboratory arrival. Local changes were implemented to improve ‘out of hours’ times, including initiation of ‘Code AMI’. There were 59 patients in group B. We found that our changes led to a 29% improvement in ‘out of hours’ door‐to‐balloon time (median time 82 min, P = 0.005) with 69% being managed ≤90 min (P = 0.049) (group B). Conclusion: We have shown that ongoing review through a quality improvement programme improves door‐to‐balloon times, which is integral in the optimal management of patients with acute STEMI treated with primary PCI.     

Effect of verapamil on systolic and diastolic coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy

OBJECTIVE: To assess non-invasively the effect of verapamil treatment on coronary blood flow velocity in asymptomatic and mildly symptomatic patients with hypertrophic cardiomyopathy. DESIGN: High frequency transthoracic Doppler echocardiography was used to compare resting phasic coronary blood flow velocity before and after a one month period of verapamil treatment in 17 patients (14 men and three women) with non-obstructive hypertrophic cardiomyopathy. Eighteen healthy subjects formed an age and sex matched control group. Systolic and diastolic coronary blood flow velocity was measured in the distal portion of left anterior descending coronary artery using high frequency transthoracic Doppler echocardiography. Blood flow velocity before and after verapamil was compared in the patients with cardiomyopathy and with the results in the control group. RESULTS: Compared with the controls, patients with hypertrophic cardiomyopathy had increased diastolic coronary blood flow velocity (41.8 (8.1) v 59.9 (21.9) cm/s, p < 0.01) and a lower mean systolic coronary blood flow velocity (18.7 (10.8) v -11.2 (27.5) cm/s, p < 0. 01) before verapamil treatment. A backward pattern of systolic flow, manifested by negative values of coronary blood flow velocity, was recorded in eight of the patients, while no negative values were found in the controls. After verapamil treatment the retrograde systolic blood flow was restored to an anterograde pattern in only one patient. The mean value of systolic coronary blood flow velocity did not change significantly and remained lower than the systolic forward flow velocity in the controls (-3.6 (31.8) v 18.7 (10.8) cm/s, p < 0.05). However, diastolic coronary blood flow velocity decreased significantly after verapamil (59.9 (21.9) v 50.7 (19.5) cm/s p < 0.05), reaching a level comparable with that in the controls (50.7 (19.5) v 41.8 (8.1) cm/s, p > 0.05). CONCLUSIONS: In contrast to healthy subjects, in non-obstructive hypertrophic cardiomyopathy the systolic pattern of coronary blood flow was heterogeneous (both retrograde and anterograde), and diastolic coronary blood flow velocity was abnormally increased, despite a lack of significant symptoms. Verapamil treatment did not restore the forward pattern of systolic blood flow but decreased diastolic blood flow velocity to a level comparable with that in healthy subjects.