Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators.

Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls.

Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition).

Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05).

Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.     

家庭因素对医学新生适应能力的影响

目的 :探讨家庭因素对医学新生适应能力的影响。方法 :使用“一般情况问卷”、“大学生适应情况调查表”、“父母养育方式问卷”、“家庭环境量表中文版”对三所医学院校新生 5 5 6人进行调查。通过单因素分析和多元回归分析等方法 ,筛选影响新生适应能力的主要家庭因素。结果 :入学新生四个月后仍有9 7%不能适应大学学习 ,3 6 %不适应大学生活 ,11 9%不适应大学的人际关系。女生差于男生。父母情感温暖、亲密度、成功性、娱乐性与适应得分呈低度正相关 (r =0 16～ 0 2 4) ,而父母严厉惩罚、拒绝否认、过度保护、矛盾性、控制性呈低度负相关 (r =-0 15～ 0 2 4)。多元逐步回归显示 :矛盾性、娱乐性、组织性、控制性、父亲过度保护是影响医学新生适应能力的主要因素 (r =3 8～ 2 1)。结论 :家庭背景对新生的适应能力有显著影响     

园艺疗法对慢性精神分裂症患者糖脂代谢指标及自我效能的影响

目的 探讨园艺疗法在慢性精神分裂症患者中的应用效果。方法 选择本院2018年11月至2019年11月收治的慢性精神分裂症患者50例,按随机数字表法将其分为两组,各25例。两组均接受常规药物治疗,对照组给予常规院内活动干预,在此基础上,观察组实施园艺疗法干预,比较两组社会适应能力[住院精神病人康复疗效判定量表(IPROS)]及一般自我效能感量表(GSES)评分。结果 干预12周后,观察组IPROS评分低于对照组,差异有统计学意义(t=11.367,P＜0.001);干预12周后,观察组GSES评分高于对照组,差异有统计学意义(t=2.729,P=0.009)。结论 对慢性精神分裂症患者应用园艺疗法,可有效提高自我效能,改善社会适应能力。     

医学生社会适应能力状况及其与家庭教养方式关系研究

【摘要】 目的：了解医学生社会适应能力状况并分析其与家庭教养方式的关系。方法：采用横断面调查的方法，在吉林市某医学院校随机抽取医学生作为调查对象，采用《父母教养方式评价量表》和《社会适应能力诊断量表》对医学生的家庭教养方式和社会适应能力状况开展问卷调查。结果：198名医学生中，社会适应能力良好和很强者所占比例仅为8.1%（16人）和2.0%（4人）；城市来源以及独生子女学生社会适应能力高于农村和非独生子女学生（p<0.05）；在父母教养方式上，无论性别，是否是独生子女以及生源地，“情感温暖、理解”均与医学生的社会适应能力呈正相关（p<0.05），而“拒绝、否认”均与医学生的社会适应能力呈负相关（p<0.05）；另外“惩罚、严厉”、“过度保护”等教养方式与社会适应能力也呈一定程度负相关（p<0.05）。结论：医学生社会适应能力较差，家庭教养方式与医学生社会适应能力具有相关性。在家庭教养方式上父母应给予医学生温暖和理解，而非拒绝、否认、惩罚、严厉和过度保护，这样才有助于提升其社会适应能力。     

原生家庭亲密度与适应性对产妇产后抑郁的影响

目的：调查产妇产后3年内产后抑郁（PPD）的现状，并探讨原生家庭亲密度与适应性对产妇PPD的影响。方法：采用便利抽样法于2020年7月至8月利用爱丁堡产后抑郁量表、家庭亲密度与适应性量表对211例产后0～3年的产妇进行线上调查。结果：34.1%的产妇在产后3年内存在PPD。原生家庭的家庭亲密度为松散型、家庭适应性为僵硬型以及家庭类型为极端型的产妇其PPD的得分较高。在控制人口学变量后，多元线性回归分析发现原生家庭亲密度可负向预测产妇PPD程度（β=-0.175，P=0.013），而极端型原生家庭可正向预测PPD程度（β=0.178，P=0.033）。结论：产后3年内产妇PPD的患病率较高，原生家庭亲密度及原生家庭类型是PPD的重要影响因素，临床医护人员可从原生家庭角度开展PPD的预防和干预。     

Reactive but not predictive locomotor adaptability is impaired in young Parkinson's disease patients

BackgroundGait and balance disorders are common in Parkinson's disease (PD) and major contributors to increased falling risk. Predictive and reactive adjustments can improve recovery performance after gait perturbations. However, these mechanisms have not been investigated in young-onset PD.ObjectiveWe aimed to investigate the effect of gait perturbations on dynamic stability control as well as predictive and reactive adaptability to repeated gait perturbations in young PD patients.MethodsFifteen healthy controls and twenty-five young patients (48 ± 5 yrs.) walked on a walkway. By means of a covered exchangeable element, the floor surface condition was altered to induce gait perturbations. The experimental protocol included a baseline on a hard surface, an unexpected trial on a soft surface and an adaptation phase with 5 soft trials to quantify the reactive adaptation. After the first and sixth soft trials, the surface was changed to hard, to examine after-effects and, thus, predictive motor control. Dynamic stability was assessed using the ‘extrapolated center of mass’ concept.ResultsPatients’ unperturbed walking was less stable than controls’ and this persisted in the perturbed trials. Both groups demonstrated after-effects directly after the first perturbation, showing similar predictive responses. However, PD patients did not improve their reactive behavior after repeated perturbations while controls showed clear locomotor adaptation.ConclusionsOur data suggest that more unstable gait patterns and a less effective reactive adaptation to perturbed walking may be a disease-related characteristic in young PD patients. These deficits were related to reduced ability to increase the base of support.     

Cortical activation during gait adaptability in people with Parkinson’s disease

BackgroundPeople with Parkinson’s disease (PD) have difficulties adapting their gait. While underlying neural mechanisms involving the prefrontal cortex (PFC) have been studied across various complex walking tasks, less is known about the premotor cortex (PMC) and supplementary motor area (SMA), key cortical regions for motor planning. This study compared frontal cortical regions activation patterns using functional near-infrared spectroscopy (fNIRS), between people with PD and healthy controls (HC) during gait adaptability tasks.MethodsForty-nine people with PD (mean (SD) age: 69.5 (7.9) years) and 21 HC (69.0 (5.9) years) completed a simple walk and three randomly presented gait adaptability tasks: (i) stepping on targets, (ii) avoiding obstacles and (iii) negotiating both targets and obstacles. Cortical activity in the dorsolateral PFC (DLPFC), SMA and PMC were recorded using fNIRS. Step length, velocity and accuracy and cortical activity were contrasted between the groups and walking conditions.ResultsCompared with the HC, the PD group exhibited greater PMC activation and walked significantly slower and took shorter steps in all conditions. A statistically significant group by condition interaction indicated an increase in DLPFC cortical activation in the HC participants when undertaking the obstacle avoidance task compared with the simple walk but no increase in cortical activation in the PD group when undergoing this more challenging gait task.ConclusionsOur findings suggest people with PD have little or no DLPFC, SMA and PMC capacity beyond what they need for simple walking and in consequence need to slow their gait velocity to meet the demands of target stepping and obstacle avoidance tasks. Such behavioral and neural patterns appear consistent with concepts of compensatory over-activation and capacity limitation.     

Transition of newly graduated nurses in China: An evaluation study

The work adaptation of newly graduated nurses exerts a vital impact on their career developments. It is of great significance to guide newly graduated nurses to get acclimatized to the student-to-nurse transition. This study aimed to investigate the work adaptability disorder from the perspective of the organizational socialization and explore the potential factors of work adaptability disorder of newly graduated nurses. A cross-sectional study was performed. Convenience sampling was adopted to recruit 206 newly graduated nurses at four tertiary hospitals in China. The Work Adaptability Disorder Scale, the Transition Shock of Newly Graduated Nurses Scale, and the Organizational Socialization Questionnaire were utilized to measure the work adaptability disorder. The results showed the level of work adaptability disorder was mediocre among newly graduated nurses in China. The variables of gender, education, only child, family residence, transition shock, and organizational socialization could serve as predictors of work adaptability. Our research showed countermeasure of improving organizational socialization and relieving transition shock should be added to the training program of newly graduated nurses with purpose of promoting their adaptation.     

自我效能在宫颈癌患者家庭亲密度与适应性和益处发现间中介效应

目的了解宫颈癌患者益处发现的水平,并探讨自我效能、家庭亲密度与适应性和益处发现3者之间的关系以及自我效能在家庭亲密度与适应性和益处发现的中介作用。方法选取哈尔滨医科大学附属肿瘤医院2016年1—6月入院病理学诊断为宫颈癌、术后3个月的患者239例作为本次调查对象,应用自编一般人口学调查问卷、益处发现评定量表(BFS)、家庭亲密度与适应性量表中文版(FACESⅡ-CV)和一般自我效能感量表(GSES)对宫颈癌患者进行问卷调查。结果本次问卷调查的宫颈癌患者益处发现总分为(65.82±12.12)分,家庭亲密度与适应性总分为(122.08±17.37)分,自我效能总分为(31.57±5.94)分。家庭亲密度与适应性总分及各维度得分与自我效能总分和益处发现总分均呈正相关(P<0.01)。分层回归显示,自我效能在宫颈癌患者家庭亲密度与适应性和益处发现间起部分中介作用,中介效应为0.182,相对中介效应为43.6%。结论家庭亲密度与适应性既可以对益处发现产生直接作用,又可以通过自我效能间接作用于益处发现。自我效能介导了家庭亲密度与适应性对益处发现的正面效应,对宫颈癌患者的益处发现有保护作用。     

抗逆力和个人组织契合在新护士转型冲击与职场适应度间的链式中介效应分析

目的 了解新护士的职场适应度,探讨转型冲击、抗逆力、个人组织契合与新护士职场适应度的关系,为促进新护士职场适应、稳定护理队伍提供参考。方法 便利抽取山东省5所三级甲等医院的368名新护士为研究对象,采用一般资料调查问卷、医护人员抗逆力量表、护士个人-组织契合评估量表、新护士转型冲击量表和护士职场适应度量表进行调查。结果 新护士职场适应度总分为(65.90±10.71)分,转型冲击总分为(80.34±22.87)分,抗逆力总分为(71.18±12.56)分,个人组织契合总分为(159.64±28.82)分。转型冲击对职场适应度的间接效应成立,总的间接效应为-0.161;抗逆力的部分中介效应占总效应的25.41%;抗逆力和个人组织契合在转型冲击与职场适应度之间的链式中介效应占总效应的12.12%。结论 新护士职场适应度处于中等偏上水平,抗逆力和个人组织契合在新护士转型冲击与职场适应度间发挥链式中介作用。护理管理者应重视并采取相应措施减轻新护士的转型冲击,积极培养其抗逆力,增强其个人与组织契合水平,进而提高其职场适应度。