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1.
Stephan Koter Tina U. Cohnert Korbinian B. Hindermayr Jörg Lindenmann Maximilian Brückner Wolfgang K. Oswald Georg Werkgartner Doris Wagner 《Journal of vascular surgery》2019,69(4):1227-1232
Objective
Low psoas muscle area is shown to be an indicator for worse postoperative outcome in patients undergoing vascular surgical. Additionally, it has been associated with longer durations of hospital stay in patients with cancer who undergo surgery and subsequently greater health care costs in Europe and the United States. We sought to evaluate this effect on hospital expenditure for patients undergoing vascular repair in a health care system with universal access.Methods
Skeletal muscle mass was assessed on preoperative abdominal computed tomography scans of patients undergoing open aortic aneurysm repair in a retrospective fashion. The skeletal muscle index (SMI) was used to define low muscle mass. Health care costs were obtained for all patients and the relationship between a low SMI and higher costs was explored using linear regression and cross-sectional analysis.Results
We included 156 patients (81.5% male) with a median age of 72 years undergoing elective surgery for infrarenal abdominal aortic aneurysm in this analysis. The median SMI for patients with low skeletal muscle mass was 53.21 cm2/kg and for patients without, 70.07 cm2/kg. Hospital duration of stay was 2 days longer in patients with low skeletal muscle mass as compared with patients with normal (14 days vs 11 days; P = .001), as was duration of intensive care stay (3 days vs 1 day; P = .01). The median overall hospital costs were €10,460 higher for patients with a low SMI as compared with patients with a normal physical constitution (€53,739 [interquartile range, €45,007-€62,471] vs €43,279 [interquartile range, €39,509-€47,049]; P = .001). After confounder adjustment, a low SMI was associated with a 14.68% cost increase in overall hospital costs, for a cost increase of €6521.Conclusions
Low skeletal muscle mass is independently associated with higher hospital as well as intensive care costs in patients undergoing elective aortic aneurysm repair. Strategies to reduce this risk factor are warranted for these patients. 相似文献2.
3.
Camille Veit 《Annales médico-psychologiques》2019,177(4):347-351
Objectives
This paper introduces some epistemology about mental health developments and how it leads to reconsider the landscape of clinical practices.Materials
From an epistemological point of view, the author reviews several writings about mental hygiene going back to the nineteenth century. It clarifies the common roots between mental hygiene and mental health. Then, the article examines the first World Health Organization's reports, that shed light on psychiatric and political issues in the middle of the twentieth century, which allows to reach out the foundations of mental health as a discursive practice.Results
The review of the developments from “mental hygiene” to “mental health” highlights a general climate of redesign on many points: Mental health as a discursive space is characterized by an expansion of its address field. It is not only addressed to specialists, psychiatrist and psychiatric patients, but also, and above all, to every citizen. Psychic suffering, as far as mental illness, is part of a larger whole including what preserves or deteriorates the proper functioning of an individual, within society. Mental health is at the crossroads of financial, political, citizen's rights and social interests. Contemporary mental health relies on the objectives of prevention and promotion. Clinical practices are organized by some discourses with mental health as a key word. At the turn of 2000s, French psychiatry has been impacted by many shuffles in health policies. However, the roots of these restructuring are not new, as they update an old interest in safeguarding public health, funds and welfare. Psychic suffering and mental illness recently enter the field of “psychic disability”. It brought social benefits such as financial assistance from the state. It may also contribute to the campaigns of awareness-raising and destigmatization among the public opinion. However, financial and subjective effects do not perfectly match. In other words, the benefits listed above should not lead to desert the listening of the users’ experience in its singularity.Conclusions
The developments of mental health point out a reorganization in the psychiatric field and open new clinical challenges. If the spaces of singularity and universal are in a permanent relationship, the political and economic sides cannot answer or evacuate the subjectivity posed by the subject and his suffering. It should lead to focus on a clinical practice driven by a subtle listening, which does not exclude psychopathology and recognizes the importance of alterity. 相似文献4.
Maite Cruz Piqueras Ainhoa Rodríguez García de Cortazar Joaquín Hortal Carmona Javier Padilla Bernáldez 《Gaceta sanitaria / S.E.S.P.A.S》2019,33(1)
Objective
To analyse and understand vaccination hesitancy discourses, particularly those of people who have decided not to vaccinate their sons and daughters.Methods
Qualitative study of five individual interviews and two focus groups with people who chose not to vaccinate their children in the province of Granada (Spain).Results
Mothers and fathers manifest a system of health beliefs different to the biomedical paradigm. From an ethical point of view, they justify their position based on the right to autonomy and responsibility for their decisions. Alleged specific reasons: they doubt administration of several vaccines simultaneously at an early age in a systematic way and without individualising each case; they fear adverse effects and do not understand the variations of the vaccination schedule.Conclusions
These vaccination hesitancy discourses respond to the individual vs collective conflict; parents defend their right to bring up their children without any interference from the state and focus their responsibility on the individual welfare of their sons and daughters, regardless of the consequences that their actions might have on the collective. In their management of risks, they consider those derived from vaccination more relevant than the individual or collective consequences of not doing so. The vaccines generating most doubts are the more controversial ones within the scientific world. Transparency in communication of adverse effects; authorities respect for other health/disease concepts; banishment of the term “anti-vaccines” from the media and scientific vocabulary, and developing spaces for dialogue are bridges to be built. 相似文献5.
《Sleep medicine》2020
Study objectivesTo analyze the association between sleep-related symptoms and sleep length in parents and their children in relation to other risk factors in both generations.MethodThe participants were parents (n = 5,855, age 54.3 ± 6.5 years, 45.2% men) who participated in the community-based Respiratory Health in Northern Europe (RHINE) study and one random member of their adult offspring (n = 5,855, age 30.2 ± 7.7 years, 41.5% men) who participated in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) study. Both generations responded to identical questionnaires on sleep symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), snoring, nocturnal sweating, nocturnal gastroesophageal reflux (nGER), sleep time and excessive daytime sleepiness (EDS). Insomnia was defined as either, or both, DIS and DMS in combination with EDS.ResultsAll sleep variables except nocturnal sweating were more common in offspring whose parents had reported the same symptom. After adjusting for age, gender, BMI, smoking, physical activity, education, center and parents' total number of children, there were independent associations between sleep symptoms in parents and offspring for DIS (adj. OR, 95% CI: 1.52, 1.20–1.93), DMS (1.34, 1.15–1.56), snoring (1.45, 1.15,1.83), nGER (1.65, 1.15–2.37), insomnia (1.39, 1.13–1.73), short sleep time (<6 h/night) (2.51, 1.72–3.68) and EDS (1.48, 1.26,1.72). There were no independent relationships between symptoms in parents and offspring for EMA, nocturnal sweating or long sleep time (>9 h/night).ConclusionThe familiar aggregation of many sleep disturbances was not explained by investigated lifestyle and environmental factors. This supports a heritable factor in sleep problems. 相似文献
6.
疾病是人体对外界事物与环境变化的反应过程，而此过程对机体造成了生理和心理上的重大影响，使机体的正常生理和心理出现失衡状态。要恢复机体的平衡必需要通过相应的措施，特别是针对心理变化的改善对策。良好的心理护理会使疾病的恢复“事半功倍”。 相似文献
7.
目的通过分析初中生心理发展的特点，找出信件咨询常见问题的原因，提出问题解决的对策。方法通过对初中生心理咨询信件的整理分析。结果信件咨询作为学校心理咨询的一种非主流形式，由于其自身的种种缺陷并没有受到过多的重视。介从初中生的来询信件中确实反映了一些问题。结论对初中生进行心理健康教育有十分重要的意义。 相似文献
8.
卫诺 《中华临床医学杂志》2006,7(12):105-107
且的调查和分析门诊设立健康教育室的可能性与必要性，使门诊健康教育工作变得更规范．更系统。更科学、更有效，更经济。方法采用发放问卷的形式，随机对2004年1月-2006年1月在上海市桌三级综合性医院门诊就诊的200例病人进行不记名调查、统计和分析．结果病人在门诊就诊时普遍认为健康教育现状不够理想，而对健康教育需求较迫切，对于开设健康教育室十分受欢迎。结论门诊设立健康教育室可将现有的医院内存在的、分散的、不同形式的健康教育工作纳入一个集中、统一的部门，有利于提高门诊健康教育质量。 相似文献
9.
心理因素对小学生脑力工作能力影响的研究 总被引：4，自引：2，他引：2
采用横断面研究方法，对180名小学三年级学生脑力工作能力与其智力、性格、学习动机等心理因素和学习、睡眠时间等作息因素的关系进行分析研究。验证了学习、睡眠时间是影响学生脑力工作能力重要的外部因素；脑力工作能力与智力和学习成绩呈正相关。学生自身的心理因素中，学习动机对脑力工作能力有重要影响，所以激发和强化学生的学习动机，是保持和提高学生学习工作能力的有效手段；而性格内外向性、情绪稳定性等因素，对脑力工作能力的影响不明显。 相似文献
10.